How to avoid traveler's diarrhea

This is the first of a series of blogs about staying healthy while you travel.

The commonest cause of illness in people who travel is diarrhea and except for specific kinds of diarrheal diseases like typhoid and cholera there are no shots to protect you from it. The main reason people get diarrhea when they travel is because they become exposed to bacteria that their system is not used to. It is not because the people in the host country are dirty, when they come here they get diarrhea too.
The good news is that you can pretty much avoid diarrhea altogether if you follow certain precautions.
There are three stages of prevention, first is primary prevention where you avoid exposure to the bacteria altogether. Secondary is what to do if you do get diarrhea and tertiary is antibiotic medication if the diarrhea doesn't stop.

Step one: Take a mega acidophilus capsule once or twice a day, only take it with cold liquids. So you don't kill the live bacteria.
If you are going to a third world county take a tablespoon of peptobismol liquid every evening before dinner. Be aware that peptobismol can turn your tongue black so rinse your mouth after taking it, also know that it will give you black stools which are harmless.
Handling water is very important, only drink bottled water and make sure you don't buy it on the street. If you don't have access to bottled water, drink boiled water. Never put ice in your drinks and avoid salads because the lettuce and tomatoes may have been washed in dirty water. Only eat cooked vegetables and peeled fruits. Also avoid dairy products.
Have a liberal amount of hand sanitizer available at all times.
Sometimes despite your best efforts you still develop diarrhea.

First let's define diarrhea. Diarrhea is either defined by frequency or consistency. If you have six bowel movements a day and that is not your norm you have diarrhea, on the other hand just one bowel movement a day that is running out of you like water is also diarrhea. If you believe you have diarrhea you should move on to step two.

Step two: Take two capsules of Loperamide as soon as you think you have diarrhea and one after each loose stool (this is with the prescription strength). If your diarrhea persists longer than 24 hours immediately move to step three which includes taking a prescription antibiotic. It is very important to avoid dehydration especially in warmer countries so increase your fluid intake. Local sodas (unopened without ice) are good for this.

My goal for my patients when they travel is to make sure they do not need to access medical care for any reason. The level of healthcare services vary greatly in other countries and you certainly don't want a medical mistake to lead to your demise. Be wise and be safe.

Don't forget your sunblock and insect repellant.

Bon voyage