June 23, 2000 -- When traveling to foreign countries, the last souvenir a tourist wants to pick up is diarrhea. But intestinal illness caused by contaminated food and drink is the most common malady afflicting international travelers, particularly in developing countries. Results of a new study show that although travelers' diarrhea is common, changes in the diet can help prevent the illness, and the nausea and bloating that often accompany it.
The popular travelers' creed "Cook it, peel it, or leave it" might not be the best advice, according to researchers from the Centers for Disease Control and Prevention (CDC) in Atlanta.
The study's lead researcher, Barbara Herwaldt, MD, MPH, tells WebMD that the most important message for travelers in general is to "avoid potentially risky foods and beverages." Herwaldt is a medical epidemiologist in the division of parasitic diseases at the CDC.
In this month's issue of the journal Annals of Internal Medicine, Herwaldt's team highlights what happened when diarrhea struck a group of healthy, young Peace Corps volunteers in Guatemala. Researchers found that several factors influenced whether the volunteers developed diarrhea.
Diarrhea was more likely when volunteers:
- Drank water from an unknown source
- Ate foods prepared by a Guatemalan friend
- Ate at a small, working-class restaurant and ate fruit peeled by someone else
- Drank an iced beverage
- Ate ice cream, ice milk, or flavored ices
The CDC suggests that all overseas travelers select food and beverages with care. Any raw food could be contaminated, especially in areas of poor sanitation. And food from street vendors could be suspect.
Foods of particular concern include:
- Uncooked vegetables and fruit
- Unpasteurized milk and milk products
- Raw meat
If you peel fruit yourself, it is generally safe, as well as food that has been cooked and is still hot.
Although most episodes of travelers' diarrhea resolve in a few days, it is best to consult a physician rather than attempt self-medication because of the risk of dehydration. You should seek medical help if diarrhea is severe or bloody or does not resolve within a few days. You should also seek medical help if the diarrhea is accompanied by fever or chills, or if you are unable to keep fluids in.
No effective vaccines are currently available to guard against diarrhea, so precautions need to be taken once you arrive at your destination, Robert Edelman, MD, tells WebMD. The best advice for the general tourist, he says, is: "Drink bottled water and beverages with labels on them." He says carbonated beverages are best because they inhibit the growth of bacteria. Edelman is director of the Travelers Health Clinic at the University of Maryland in Baltimore.
But how does the typical globetrotter compare with Peace Corps volunteers? Not very closely, according to Edelman. "Peace Corps volunteers integrate themselves into the environment as much as possible," he says. "As a result, they eat and drink things that a tourist on a four-star jaunt ... surrounded by a cocoon of preventive, trained guides, would not be exposed to."
Still, "we can take a lesson from this study," Edelman says. If Peace Corps volunteers can get sick, anyone can. "Being informed before traveling about good food and water hygiene" is essential.
Good advice. After all, an ideal trip abroad should send you searching for landmarks and castles, not restrooms.
- It is common for people who travel to foreign countries, especially developing countries, to suffer from diarrhea.
- To protect yourself, avoid raw foods such as salad, uncooked vegetables, and fruit (unless you peel it yourself), unpasteurized milk or milk products, raw meat, and shellfish, and be sure to drink bottled water or other beverages with a label on it.
- If diarrhea is severe or bloody, lasts for several days, or is accompanied by fever or chills, you should seek medical attention.