We all know the rules for traveling in undeveloped countries: Don't drink the water unless it has been boiled or bottled. Don't eat fruit unless it's been peeled. Avoid salads, cold platters, pastries, custards, ice, mayonnaise and uncooked or undercooked fish and meat.
But the trouble with rules is that they violate the vacation spirit. You think to yourself, well, this restaurant looks OK. The tablecloth is clean and the waiter is very friendly. The buffet must be safe.
But it's hard to be sure. So you must decide whether you want to follow each rule strictly--and forgo the custard pie--or risk the welfare of your gastrointestinal tract on the accuracy of your intuitive powers for sizing up restaurants.
Personally, I'd rather forgo an hour or two of gastronomical delight than run the chance of up to 93 hours (the average length of an untreated diarrhea bout) of discomfort.
But restaurants aren't the only sources of such illness. Using bathroom tap water to brush your teeth can cause illness. So can swallowing water while taking a shower. Or drinking even bottled water from an improperly washed glass. Or swimming in polluted water. Or drinking bottled water that is not carbonated. (Carbonation makes it harder for bacteria to survive.)
It is a common problem. In fact, doctors who study travelers' diarrhea say that 25% to 50% of the 20 million people traveling each year from industrialized to developing countries get sick. About one-third of them will be sick enough to stay in bed for a day or two.
And those who regularly take antacids for their stomachs may be more vulnerable to infection since the drug neutralizes the protective acidity of the stomach.
Unfortunately, there is no vaccine to prevent travelers' diarrhea. Although diphenoxylate (Lomotil) and loperamide (Imodium) have been advocated as preventives, no controlled studies indicate that they are effective for that purpose.
Antibiotics probably aren't the answer, either. In fact, most public health doctors recommend against taking them prophylactically. The chief objection is that in response to repeated doses, the body tends to build up resistance to the drug, therefore rendering it useless for treating the bacteria should an infection occur. Since most cases are self-limiting and respond well to treatment, it's wiser to save antibiotics for times when illness does occur.
Sometimes non-prescription drugs such as Pepto-Bismol are recommended as a preventive. Some studies have shown that taking two tablets four times a day will reduce chances of getting the mildest and most common type of diarrhea by about 65%.
Pepto-Bismol as a preventive is not recommended for all people, however. Those who already take aspirin-containing drugs or anticoagulants should avoid it because the principal ingredient in Pepto-Bismol is aspirin, which also acts as a blood thinner. Overdosage could occur. Ask your doctor whether taking Pepto-Bismol is safe for you.
It's a good idea to carry a small bottle of 2% iodine or commercial water purification preparations, available in sporting goods stores, to use in case bottled water is not available. To purify water with iodine, put five drops in one quart of water and let it stand for 30 minutes before drinking. If water is cloudy, use 10 drops. While this will affect the taste, it may be worth the safety. If using a commercial water purification product, follow package instructions.
The prescription drugs that have received the most attention as treatments for diarrhea are sulfamethoxazole and trimethoprim (Bactrim). Side effects of these antibiotics include rash and anemia. A study published last year said that the combination of the two compounds plus loperamide was highly effective. Fifty percent of the subjects were relieved of their symptoms in one hour.
Loperamide, a drug which reduces the motility of the intestines, was effective only when used together with the antibiotics.
While many people believe that taking fluids during an attack will worsen the symptoms, the reverse is true, provided the right fluids are consumed. Dehydration can actually worsen the condition. Among the best rehydrators are fruit juices, chicken broth and rice water made by cooking rice with extra water and one teaspoon of salt per quart of water.
The Atlanta-based Centers for Disease Control recommends drinking eight ounces of canned fruit juice with a dollop of honey and a pinch of salt after each movement, alternating with eight ounces of carbonated or boiled water mixed with a quarter teaspoon of baking soda.
Salted crackers and dry toast also are good. Avoid caffeine, dairy products, fatty foods and alcohol. Should a bout of diarrhea last longer than one week, be accompanied by a fever or blood and/or mucus in the stool, consult a doctor.