All Things Traveller’s Diarrhoea

Montezumas Revenge got you running to the toilet mid sundowner? Delhi belly after one too many street food bhajis? Loose bowels after icey cocktails at your favourite beach location? Welcome to traveller’s diarrhoea.

There are lots of questions when it comes to a runny tummy when away, and I am here to answer them all. And whilst most of the debilitating symptoms can disappear after a few days, there is the risk of developing longer term IBS if you don’t give your gut some love.

Read on for all things traveller’s diarrhoea and how to care for your tummy this summer.

WHAT IS TRAVELLER’S DIARRHOEA?

Diarrhoea is a common problem that affects between 20-60% of travellers, particularly

those visiting low and middle-income countries. If you find yourself having an increase in the frequency of bowel movements to three or more loose stools per day when abroad, then it’s pretty likely you have some for of diarrhoea!

Traveller’s diarrhoea can be caused by a variety of organisms, from certain bacteria to viruses, and usually resolves spontaneously, however if you experience ongoing symptoms, you may require further tests such as a stool test(2).

Along with loose bowel movements and an urgency to go, traveller’s diarrhoea can cause stomach cramps, bloating, mucous in your stool and in severe cases, travellers diarrhoea can cause dehydration and even sepsis. (1)

Backpackers have roughly double the incidence of diarrhoea compared with business

travellers, and cruise ship travel is associated with large outbreaks of viral and bacterial

Gastroenteritis, so be wary if you’re planning on taking the seas by storm this summer. (1)

HOW TO AVOID TRAVELLERS DIARRHOEA?

So, are there REALLY ways we can avoid getting struck down with the dreaded Montezuma’s revenge?

General advice is to avoid eating raw salads, shellfish and uncooked meats but there is no strong evidence that specific dietary measures can help reduce the incidence of diarrhoea (1).

Other tips include peeling fruit and vegetables, boiling water before you drink it, avoiding ice, using a straw to drink from bottles and avoiding buffets where food may have been unrefrigerated for several hours (3).

Research has shown that alcohol hand sanitizer gel may help reduce diarrhoea rates in travellers (4), along with regular hand washing with soap which has been estimated to reduce the risk of diarrhoeal illness by as much as 40% (5,6). So, dust off your lockdown hand sanitizer and don’t travel without it! 

My general tips would be to be savvy with your food choices. Eating in hotel restaurants is often a safe option, avoiding ice in your drinks and saying no to that street food stall that tastes delicious but could leave you with Delhi belly!

HOW TO RECOVER FROM DIARRHOEA

For most cases of travellers’ diarrhoea, oral rehydration is the main course of treatment in

in order to replace vital salts and water that the body has lost. Consuming clear fluids such as plenty of water, soups and sachets of rehydration salts in young children, the elderly and anyone with an increased risk of dehydration. If these are not available, you could always make your own by mixing six teaspoons of sugar/honey and half a teaspoon of salt in a litre of clean water.

If a traveller finds themself in a remote area with limited access to sanitation facilities, antibiotics may help in shortening the duration of the diarrhoea.

Where symptoms persist beyond 14 days following travel (or sooner if there are other

concerning symptoms such as a high temperature), patients may be offered further medical testing (1). 

Once symptoms have died down, investing in gut health support is key to avoid long term symptoms or damage. You can try:

• A multi strain probiotic – this can be taken whilst you travel and when you return!
• Fermented foods – 5 x per week – to offer a natural source of good bacteria to help colonise the gut. Consider kefir, kombucha, live yoghurt or pickled foods
• Plenty of fibre – add in healthy fibres from nuts, seeds and vegetables – but go low and slow to allow your digestive system to adjust 

POST INFECTIOUS IBS

If infectious and non-infectious causes have been excluded, the most likely diagnosis is post-infectious (PI) irritable bowel syndrome (IBS), which occurs in up to 30% of patients (7,8). It is important to note that IBS can develop a long time after the initial diarrhoea or infection.

So, how does food poisoning, the main cause of travellers diarrhoea, result in IBS?  

Food poisoning has the ability to trigger IBS symptoms due to a toxin called Cytolethal Distending Toxin B (CdtB). The most common strains of bacteria associated with food poisoning release this toxin CdtB into the body. Once CdtB enters the body, the immune system will fight back with an antibody, which is anti-CdtB. 

However, CdtB is similar to vinculin, a naturally occurring protein found in the body that is key for gut health. And due to CdtB and vinculin looking so similar, the body can mistake CdtB for vinculin, and starts to produce another antibody, which is anti-vinculin.  This potentially creates an autoimmune response, leading to gut nerve damage and poor functioning of the gastrointestinal tract, which results in a disruption to the gut microbiome. 

This disruption results in post-infectious IBS, which shows as diarrhoea predominant IBS or mixed IBS involving both constipation and diarrhoea. 

HOW TO SUPPORT PI-IBS

PI-IBS still requires further research, but often includes persistent inflammation, changes in intestinal permeability and gut flora. The risk of developing IBS increases 6 times after gastrointestinal infections, and can remain elevated for at least 2-3 years post-infection!

So what can we do?

The Clarissa Lenherr Nutrition clinic can run the IBS SMART test, which checks your levels of anti-CdtB and anti-vinculin to determine whether your IBS is post-infectious IBS. Once this is determined, the correct treatment plan can be formulated by our team, and if necessary, alongside your GP.

Some of the avenues that can be used to support post infectious IBS include:

• Following the low FODMAP diet to identify food triggers
• Probiotic use (9)
• Fibre modification
• Addressing lifestyle factors that may worsen symptoms such as chronic stress
• Working with a professional to rule out leaky gut, SIBO etc

For more information and to work with one of our gut specialist nutritonists, email info@clarissalenherr.com or book a free discovery call here

Our intern Jasmine Bliss assisted with the production of this article, Make sure to check out her instagram for delicious recipes @jasminenutrition.

References:

(1) https://www.bmj.com/content/353/bmj.i1937.full

(2) https://jamanetwork.com/journals/jama/article-abstract/2088858

(3) https://academic.oup.com/jtm/article/16/3/149/1808431

(4) https://pubmed.ncbi.nlm.nih.gov/25065273/

(5) https://pubmed.ncbi.nlm.nih.gov/26346329/

(6) https://pubmed.ncbi.nlm.nih.gov/24889816/

(7) https://pubmed.ncbi.nlm.nih.gov/25871571/

(8) https://onlinelibrary.wiley.com/doi/pdf/10.1111/apt.13199

(9) https://pubmed.ncbi.nlm.nih.gov/19244146/

(10) https://pubmed.ncbi.nlm.nih.gov/22155369/