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Don't let the 'runs' ruin your holiday

How to treat travellers' diarrhoea

Travelling to distant, exotic places, where the general standards of hygiene leave a lot to be desired is an invitation to gastrointestinal disorders, more commonly the dreaded traveller’s diarrhoea.

It is usually caused by ingesting food or beverages contaminated with bacteria. Although not as common, viruses and parasites may also be responsible. In most cases, the condition clears up on its own in three to four days.

A number of precautions should be taken when traveling abroad, in particular in underdeveloped countries of the tropical regions. These should start with the need to avoid drinking anything but bottled water, and to keep away from cheap, unhygienic street food stalls.

Unfortunately, the sources of these holiday-spoilers don’t stop there. Restaurants, even in plush hotels or resorts, may not wash thoroughly the ingredients that are brought to the table. For salads in particular, untreated tap water may have been used (if at all…) and should be at the top of any list of foods to avoid. Fruits should always be peeled. Remember that a large number of people may have touched them, from the farmer, to the retailer, before they were handled by the hotel or restaurant staff. Add to that the possibility that they did it with unwashed, dirty hands, especially after visits to the toilet, and you have a recipe for fecal contamination, and to become a victim of traveler’s diarrhoea.

Sometimes, the problem is not the cleanliness of the food but its freshness and method of storage. Sea-food goes off quickly in warm weather, and may not have been properly refrigerated, especially when power cuts render the equipment useless. Avoid it unless you are absolutely sure about its quality. All food should be thoroughly cooked and served hot. Self-service, buffet-style restaurants often display food for long periods of time, perhaps uncovered and exposed to flies and other insects. Try to arrive early, when you can see the food being delivered directly from the kitchen.

Now, water: many are aware that you should not drink tap water in foreign countries, not even to brush your teeth; but what about the ice in your drinks? Are you sure it is not simply frozen tap water cubes? If you add to this the possibility that the wine may have been watered-down (especially in all-inclusive resorts to keep the guests reasonably sober…), you must give the Chef his due and blame your “runs” on a ‘few too many’! Ask the hotel manager about the water that is used, and how it is treated before it freezes in the ice-machine. Otherwise, avoid ice, in particular, outside the better hotels.

In the bedroom, keep large bottles of water that you recognize as being safe, by its brand, and if you run out and have a kettle boil tap water, but force it to keep boiling for at least one minute. Beware, of bottled water bought from street vendors (small shops included) as sometimes they contain nothing more than plain tap water! This even happens in European restaurants, where the waiter brings to the table a bottle that he pretends to open in front of you, but that it is fact a refilled bottle with tap water (it’s happened to me)!

One last caveat: upset stomachs don’t always happen due to food and drink. Brushing your teeth; using swimming pools that contain pathogens, irrespective of how often it is cleaned and disinfected; unusual foreign diet based on oily and spicy cuisine; flying across excessive time-zones that your body clock has not adjusted to (a melatonin supplement may help); strenuous exercise interferes with the digestion by drawing blood from the intestines to supply the muscles; and many other reasons including general health condition and medicines being taken.

Anyway, if you fall prey of the bugs, there a few things you can do to rescue what is left of your holiday. Ask your doctor or pharmacist what medicines could be useful to take with you, just in case. Imodium (loperamide) gives some relief by slowing down the frequency of bowel movements. Saccharomyces boulardii is a natural yeast, which rather than blocking the intestines, like Imodium, flushes out the troublesome bacteria to stop the diarrhoea, naturally. In the UK it is marketed by OptiBac. It claims also to maintain a healthy balance of the intestinal flora (those beneficial microbes that help break down the remnants of undigested food, produce some essential vitamins, and fight off invading bad microorganisms).

Diarrhoea dehydrates the body and it is essential that plenty of safe liquids are drunk to make up for the losses. A home preparation recommended by the World Health Organization consists of a mixture of 3 table spoon of salt, 1 of baking powder, juice of 1 orange, and 1 litre of water. If you are in a region of coconuts, it is thought that the juice (the water, not the milk) helps settle the tummy.

While recovering, follow the well-known BRAT diet (bananas, rice, apple sauce, and toast), and keep off alcohol, caffeine drinks and dairy products.

Finally, note that although traveller’s diarrhoea does not usually bring long-term complications, a doctor should be consulted if children or older people are involved, and if anything abnormal is noticed like blood in the feces.

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