The shops in the Dominican Republic were filled with beautiful people of all shades, colorful jewelry, hand made knick-knacks and clothing. The smell of herbs, cinnamon and exhaust fumes filled the air as we moved swiftly through the market. Long, thick, slabs of meat hung for sale outside many of the shops just waiting to be purchased and served for dinner. 

That evening, I found myself at a local restaurant and as I stared down at the large piece of meat on my plate I thought back to our trip to the shops. Could this have been a piece of meat that was hanging along the shop fronts? The meat that was baking all day in the hot afternoon sun and was turning brown? The meat that served as a hang out spot for the local neighborhood flies? (ew)

Buuuut since I was famished and had already ordered I ate up with a short prayer behind each bite and hallelu, I didn’t get TD!

While I didn’t get sick at that time, traveler’s diarrhea afflicts 20-50% of people traveling from industrialized countries to high-risk developing ones. People commonly pick up bacteria that cause TD through ingesting food contaminated by feces that contain viruses, parasites or pathogenic bacteria (I know, pretty gross right?!). E. coli being a common culprit. 

High-risk locations include areas of:

• Central America
• South America
• Mexico
• Africa
• The Middle East
• Asia

Who is most at risk?

• People who take acid blockers or antacids because acids in the stomach help to destroy organisms
• People with weakened immune systems
• People with IBD, diabetes or cirrhosis of the liver
• Young adults: no one knows why currently, maybe they are a bit more adventurous in their foods
• People who travel during certain seasons – there are high-risk seasons like the rainy season in some places

I’ll be the first to say that I’m a pretty adventurous eater as my motto is ‘I’ll try anything once’. Honestly, I seem to have been blessed in the steel gut category. But as I’ve become a more savvy traveler, I’ve started taking steps toward purposely preventing TD on my trips.

Here is the breakdown of what I do

Pre-trip prep

Probiotics

Probiotics are suspensions, powders or liquids filled with beneficial gut bacteria. These serve to keep the intestines healthy, guard against harmful bacteria, leaky gut and other gi issues.

While I regularly take probiotics, I started taking Jarrow probiotics about three weeks before leaving for my trip. This is because it has the probiotic yeast Saccharomyces Boulardi (it is found on the skin of lychees) in the formula which is protective against traveler’s diarrhea.

The efficacy of your probiotic varies widely depending upon your destination. This is because bacteria differ in different locations. Ideally, you should start these 2 to 3 weeks before taking off for your trip and continuously throughout your trip.

What to look for

• Preferably, you want a probiotic that also has a pre- and post-biotic
• A probiotic with Saccharomyces Boulardi somewhere in the mix
• Pill form, as this will be a lot easier for transport

Dukoral

This may be a bit extreme for some, myself included but it may be of interest to you if you seem to be at high risk for TD. Dukoral is an oral vaccine used to help prevent TD. 

It is taken by mouth and protects against cholera and E.coli or ETEC (Enterotoxigenic Escherichia coli). In studies, it demonstrated 67% protection against certain strains of E.coli for three months.

If interested speak with your doctor about how to obtain the vaccine.

Signs

Yep, I wish I would have done this because as I discussed in my previous article, the possible water contamination slipped my mind one evening and I foolishly opened my mouth in the shower (I know, insert facepalm emoji here). 

It’s so easy to slip up when brushing your teeth, showering or simply grabbing some ice cubes or a drink of water from the faucet if you’re accustomed to doing so, especially at the beginning of your vacation. 

So, if your hotel doesn’t provide reminders make sure you create signs to post around your hotel room. Alternatively, you can download the signs I made here for free.

What I BRING

Activated Charcoal

Activated charcoal is made with a variety of burned materials like coconut shells, bamboo, wood or coal and is used in emergencies to treat certain types of poisoning. The treatment dates back to ancient Egypt and was used by Native Americans hundreds of years ago, cool right!?

It functions to help prevent the poison from being absorbed from the stomach into the body. Basically, it traps what’s in your digestive tract via adsorption. Because of this, don’t take it with any other medications or vitamins.

If you begin to feel nauseous or suspect you may have eaten something that won’t sit well with you later, it’s a great way to prevent traveler’s diarrhea. A common recommendation is 500-1,000 mg two to three times per day, but you will want to speak with a doctor before taking the medication.

It is safe for most adults when used short-term. Some side effects are black stools, constipation, and more seriously blockage. Precautions before taking, speak with your doctor if you have any concerns

• Allergies to things like food dyes
• Drug interactions

Filtered water bottle

I speak about this briefly in my article, THE ULTIMATE PACKING LIST OF THINGS YOU DIDN’T KNOW YOU NEEDED, but this was one of the best things that I could have done. Having a water filtered water bottle was a lifesaver when there was no bottled water around during my busy day of site seeing.

Hydrochloric Acid: Betaine HCL with Pepsin

Many people shy away from HCL because it sounds dangerous to ingest since it’s an acid, but it’s just what is already in our stomachs. The stomach is highly acidic so that it can quickly breakdown foods and kill bacteria, fungi, and other pathogens. Good stomach acidity is also needed to break down and absorb minerals. 

Low stomach acidity can be caused by numerous things including bacterial infections, poor diet, stress, some types of anemias and nutritional deficiencies.

As the first line of defense against stomach bugs, you should take an HCL supplement a little before or with your meals. I started taking them before my trip to help get my digestive system adjusted to the dose and had no problems during my trip. 

Make sure to use one that has pepsin as it is needed to break down the protein and works with HCL. If you don’t it could prove to be dangerous and at the very least a waste of your money. 

HCL supplements should be fine to take short-term, more research needs to be done to determine long-term side effects. 

Iodine

This may sound weird, but I regularly placed a drop of iodine in my water while on vacation.  

Iodine has been shown to kill many pathogens, including yeasts, viruses, parasites, and bacteria. It works as a chemical disinfectant and mechanical water purifier. Since my trip was on the shorter side I was comfortable taking it the majority of my time in Bali, but if you are on a longer trip, it is not advised. 

If you already have a bug, it may not be beneficial, but it works great as a preventative. After placing it in my water, I allowed it to You will want to stand for at least thirty minutes. Note that it will change the flavor and color of your water.

I also placed a couple of drops on my toothbrush when I remembered. 

If you decide to take this route speak with your doctor first as it’s not recommended in babies, pregnant women or anyone suffering from thyroid issues. Some people can be allergic to iodine and it is something that you don’t want to do long-term

Oil of oregano

I also placed a drop or two of oregano oil on my tongue daily and placed a couple of drops in my water. 

Oregano oil comes from the shoots and leaves of the oregano plant and is proven to be highly effective at killing bacteria. Make sure that the brand was at least 60% carvacrol, the major active phenol.

There are three common ways to use diluted oil of oregano

1. Skin: use diluted with another oil like olive oil at a concentration of 1 teaspoon (5ml) of olive oil per drop of oregano oil to affected area
2. Under the tongue: I placed 1-3 drops of the dilution under my tongue and then flushed with water
3. With water: I placed a few drops into my bottled water

Be pre-warned even diluted it is still an oil with a very strong and distinctive taste. A little goes a very long way, so while a drop or two may not seem like much that tiny amount packs a pretty powerful punch!

Side effects can include: rashes, stomach upset and even trouble to breathe if too much is ingested. Speak with a doctor before taking as some people can be allergic (which is where the troubled breathing comes into play). Babies, children, and pregnant or breastfeeding women are advised against taking the oil.

Alcohol

I brought a small bottle of alcohol with me and literally used it to spray things daily. 

Alcohol has been shown to kill several bacteria in 10 seconds or less including Staph aureus, Strep, E. coli, Salmonella and Pseudomonas. Also, it can kill some viruses like HIV, hepatitis B, herpes and influenza.

Wash off your cooking utensils and cutlery, yes, I literally ‘sanitized’ everything before using it. I was taking no chances. I simply sprayed my forks, spoons, and knives down with alcohol and allowed it to dry for the time it took the waiter to bring our food. It was quick and no one noticed that I had done it, or if they did they didn’t question it.

Disinfectant spray

I always travel with a small bottle of disinfectant spray (in fact, I have one in my purse right now, maybe that’s TMI). I made sure to spray things down like door handles, telephones, toilet handles, bedding shower knobs and the remote control. This is just in case I touched anything outside and brought it in or if the cleaning staff may have forgotten a spot.

Things i Avoid

• Drinking-Water: While we’ve all heard this, some people still don’t do it! It is essential in preventing TD and while you may not be able to pack a ton of bottled water, you will want to pick some up when you reach your destination. Most restaurants now filtered water and you should be pretty safe there, but ask them how and if they process their water before taking that first sip. Keep your room stocked with bottled water, not only for drinking purposes and brushing your teeth but also for things like flushing out eyes in emergency cases. If you happen to have access to a kitchen another great option is boiling your water. This is especially beneficial when traveling with babies when mixing their formula. Piping hot beverages like coffee and tea are usually fine to drink. Frozen water is still water (I know shocker right), freezing doesn’t kill many viruses or bacteria nor does drinking alcohol so be wary of ice and alcoholic drinks made with ice. Also, always make sure your bottled water comes sealed.
• Raw vegetables and fruit: Unless you can peel them, don’t eat them. Things like apples, kiwi, and oranges are fine but no strawberries or grapes. Salad is also on the do not eat list. I lived off of potato chips the first couple of days while in Bali because I was too afraid to get sick. Also, avoid pre-sliced or peeled fruit.
• Unpasteurized milk and dairy products: Unfortunately, this includes ice cream. Although I did have great gelato while in Bali (a couple of times) and ice cream in Cuba, so it’s best to use your judgment and decide if you’re willing to risk it all for that little taste of heaven. I think as long as it’s from a reputable restaurant you will be okay. 
• Undercooked meats: Only eat meat and fish that has been recently and thoroughly cooked and get everything pretty well done. Restaurant food is usually safe, but food from street vendors is said to be at higher risk for contamination. This goes without saying but washing your hands with soap and water before eating helps to cut down tremendously on getting bacteria and other germs in your mouth.
• Food trucks: Again, this is a judgment call because I’ve eaten from them and remained A-OK. However, it is not recommended by the Center for Disease Control and Prevention to eat from street vendors
• Room temperature foods: Ideally, you want your food to be hot and freshly cooked.

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Treatment

So, what happens if you come down with Traveler’s Diarrhea? Well, after the tears stop flowing as you’re shut away in your darkroom you can try some of the following

Most cases occur about two weeks after arriving at your destination and if you’ve ever been sick while in paradise then you know it can turn into hell real quick.  It usually lasts about 7 days but can last much longer for about 20% of cases.  And unfortunately, some people can experience more than one episode in a single trip if not careful, getting it one time does not make you immune to reinfection.

Some common treatments are:

Pepto-Bismol or bismuth subsalicylate:

One trial found that taking Pepto-Bismol reduced the rate of TD from 40% to 14% which is a 65% rate of protection.  This was actually noted for people that took the medication prior to getting sick and the protection was only shown if it was taken regularly for the duration of the trip. 

Pepto-Bismol is also great for easing any GI upset or discomfort by protecting your stomach and the lower part of your food pipe from stomach acid. It is also a mild antacid, which helps reduce excess stomach acid.

It is contraindicated in children and pregnant women and you don’t want to take this for more than three weeks.

Lomotil or Imodium:

Both are antidiarrheals and can be found in most stores, but I would stock up before I went on vacation just in case it’s sold out or not available.

They both come with their fair share of side effects so speak with your doctor before taking them.  I would also caution taking it just for diarrhea.  Diarrhea and vomiting are our bodies’ main ways of flushing unwanted bacteria, parasites, and other germs out of our systems and optimally you want to make sure everything gets out of you ASAP!

Pedialyte or Gatorade:  Used to replenish lost electrolytes and help prevent dehydration.

Antibiotics:

Public health experts actually do not recommend this as there is a concern about the development of antibiotic-resistant bacteria.  But some people do get a dose to bring with them from their doctor, this is usually a fluoroquinolone that can come with their own set of negative side effects which could also serve to ruin your vacation.

When to see a doctor

Travelers diarrhea usually goes away on its own, but if you have a fever (above 102 degrees Fahrenheit) and/or bloody stools then these clinical symptoms are usually associated with ore severe infections.  If your symptoms last longer than a couple of days or you notice blood in your stool get to a doctor as soon as possible.

Happy travels & Happy life-making

Court

Where are you going next?

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References:

• GI Society: badgut.org
• Mayoclinic.org
• Cdc.gov
• World Health Organization
• NIH.gov

Any information given should be discussed with your doctor before taking anything

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