When a work conference brought me down to Mexico in the midst of Ironman training, I was terrified that accidental water consumption would turn long runs into miserably long bathroom sessions. This is a legitimate fear (it happened to several of my colleagues). But, there are many myths about traveler’s diarrhea. It’s not “unavoidable,” as some would have you believe, nor is traditional treatment with the BRAT diet (banana, rice, applesauce, toast) and Gatorade to rehydrate the way to go. In this article, I give you practical tips based on peer-reviewed scientific research to preventing and treating traveler’s diarrhea. So, you can bon voyage worry-free 🙂
Prevention
- Myth: “Don’t drink the water…” Ok, so this is a partial myth. You should only drink bottled water when traveling in new regions (including using bottled water for brushing your teeth and omitting ice from all beverages). But this generally isn’t because the local drinking water is “dirty” or contaminated with bacteria like E. coli. In fact, the drinking water in a foreign area has a completely different microbiome than what your gut is used to. So, it’s not that the water is packed with toxins, but that the extreme amount of different bacteria in the water are hostile to your personal gut’s native environment. This is especially true if your gut microbiome is weak and lacking in diversity.
- Action Steps:
- Supplement with a wide spectrum probiotic at least one week before traveling to diversify and boost your gut flora. I recommend Prescript-Assist, which has 29 symbiotic strains.
- Additionally, research has shown that the strains Saccharomyces boulardii, Lactobacillus rhamnosus GG, Lactobacillus acidophilus, Lactobacillus bulgaricus are particularly effective against diarrhea.1 You can buy these as individual probiotic supplements (which is less expensive than multi-strain probiotics).
- Action Steps:
- Fact: In some cases, harmful bacteria and parasites are the cause of traveler’s diarrhea. The best supplement I’ve found to combat this is a homeopathic spray called Cellutox TravelPro, which has 12 immuno-stimulating isopathic ingredients to prevent and relieve symptoms from dysentery, cholera, giardia, strep, typhoid, yellow fever, and malaria.
- Recommended Use: The directions say to spray 1-2 times under your tongue 1-3 times a day. I did this every day of my travels after meals and sprayed it directly on my toothbrush when I accidentally washed it with sink water… which I did on reflex a number of times…
- Fact: Pooled analysis of zinc supplementation trials suggest an 18% efficacy of zinc supplementation in preventing acute diarrhea.2
- Note: zinc supplements are most effective if they are taken at least 1 hour before or 2 hours after meals. I recommend Life Extension Enhanced Zinc Lozenges.
Treatment
- Myth: BRAT diet (banana, rice, apples, toast) helps alleviate symptoms.
- Why it’s wrong: recent research has shown that amino acids—particularly arginine, glutamine, and leucine—help intestinal repair after diarrhea symptom outset.3 There is little to no protein in the BRAT diet, nor is there a great amount of micronutrients.
- The BRAT diet does get a few things right:
- Low fat is important because fat—as we know from the popular goal of getting “fat adapted” for endurance sport—is digested slowly. When your GI tract is in distress, you don’t want to give it an even harder job by making it slowly break down fat for fuel.
- Bland foods are more palatable when you don’t have an appetite.
- Apples have pectin, which research shows to improve small intestinal permeability and reduce fluid loss from diarrhea.4
- Both apples and bananas supply trace amounts of electrolytes, which are necessary for rehydration after diarrhea.
- Note: “Electrolytes” refer to nutrients or chemicals that conduct electric signals in water (or other polar solvents, if you want to be geeky about it). They are, as we all know, necessary for a number of bodily functions. There are many kinds of electrolytes, but the most common are sodium, potassium, chloride, calcium, magnesium, and phosphate. Yes, apples and bananas do have trace amounts of electrolytes, but not in the high qualities necessary to make up for what you’ve lost from diarrhea. One medium sized banana has 8% of your DRV for magnesium, 12% DRV potassium, 0% DRV sodium, and 0% calcium. One medium apple has 2% DRV magnesium, 5% DRV potassium, 0% sodium, and 1% DRV calcium. So you need more than just apples and bananas to re-hydrate and re-nourish yourself!
- What to eat instead
- Slow-cooked meat and low-fiber veggies in bone broth
- Bone broth has abundant electrolytes and gelatin, which will help soothe your gut. The meat will add extra protein to facilitate the healing process and the array of vegetables will provide diverse micronutrition. Cooked carrots, in particular, have been found to soothe the digestive tract and control diarrhea.5
- Carob, as either carob chips or buy the powder and add hot water to make a hot chocolate.
- WHAT?! A chocolate alternative for diarrhea? Yes, indeed. Research shows that the high tannin and polyphenol count of carob helps alleviate diarrhea more quickly in comparison to control groups.6
- What about the carbs?
- Now is NOT the time to be striving for ketosis, or low-carb fat-adaptation. Experimenting with these diets to maximize physical and mental performance when you’re healthy is fine, but when your body is majorly distressed, as in a case of diarrhea, you need to focus on immediate damage control. Butter coffee and fibrous veggies smothered in ghee are only going to impair the recovery process, because your body is working too hard to digest and won’t have resources to heal.
- With that said, white rice is ok! It’s an especially good option if flavorful food, like stew, just isn’t palatable. Cook the rice in bone broth to add more nutrition and sprinkle with salt (one of the electrolytes).
- If you can get your hands on high-quality, long-fermented sourdough and you have never shown symptoms of GI-distress from sourdough in the past, grab a slice of that! A little bread dipped into bone broth can also be a plain, yet satisfying meal.
- Unsweetened applesauce is another good option because of its high pectin content. Applesauce is also better than a whole apple, because the cellulose in the apple’s skin is more difficult to break down.
- Pomegranate seeds are also a great snacking choice, as they are high in tannins, flavonoids, and alkaloids, which are active against diarrhea.7
- Slow-cooked meat and low-fiber veggies in bone broth
- And sip on these…
- Coconut water has more potassium and magnesium than either apples or bananas and these are in balance with sodium levels. Sipping on this will help replenish electrolytes.
- Dissolve 1tsp of psyllium husk powder in one cup of water or one of the teas below. The high mucilage content alleviates diarrhea by absorbing water and adding bulk to stool.8
- Note: psyllium is also great to supplement with while traveling in order to stay regular.
- The following teas are all endorsed by Commission E, the body of scientists that advises the German government about herbs. These herbs are high in tannins (which slow reabsorption of toxic materials in the gut and restrict secretion) and/or mucilage.
- Agrimony
- Try using 2-3tsp to make a tea.
- Blackberry and raspberry leaf
- Use 2tsp to make tea.
- Fenugreek
- Start with 1tsp and don’t use more than 2tsp, or you might cause abdominal distress.
- Oak bark
- Use 1-2tsp to make tea.
- Agrimony
References
1. Sazawal, S., Hiremath, G., Dhingra, U., Malik, P., Deb, S., & Black, R. E. (2006). Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials. The Lancet Infectious Diseases, 6(6), 374–382. https://doi.org/10.1016/S1473-3099(06)70495-9
2. ZA Bhutta, SM Bird, RE Black, et al. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials Am J Clin Nutr, 72 (2000), pp. 1516-1522
3. Marc Rhoads, J., & Wu, G. (2009). Glutamine, arginine, and leucine signaling in the intestine. Amino Acids, 37(1), 111–122. https://doi.org/10.1007/s00726-008-0225-4
4. Rabbani, G. H., Teka, T., Saha, S. K., Zaman, B., Majid, N., Khatun, M., … Fuchs, G. J. (2004). Green Banana and Pectin Improve Small Intestinal Permeability and Reduce Fluid Loss in Bangladeshi Children with Persistent Diarrhea. Digestive Diseases and Sciences, 49(3), 475–484. https://doi.org/10.1023/B:DDAS.0000020507.25910.cf
5. Duke, James A. (1997). The Green Pharmacy. Emmaus, Pennsylvania: Rodale Press.
6. Loeb, H., Vandenplas, Y., Würsch, P., & Guesry, P. (1989). Tannin-Rich Carob Pod for the Treatment of Acute-Onset Diarrhea. Journal of Pediatric Gastroenterology and Nutrition, 8(4). Retrieved from http://journals.lww.com/jpgn/Fulltext/1989/05000/Tannin_Rich_Carob_Pod_for_the_Treatment_of.10.aspx
7. Qnais, E. Y., Elokda, A. S., Abu Ghalyun, Y. Y., & Abdulla, F. A. (2007). Antidiarrheal Activity of the Aqueous Extract of Punica granatum. (Pomegranate) Peels. Pharmaceutical Biology, 45(9), 715–720. https://doi.org/10.1080/13880200701575304
8. Mehmood, M. H., Aziz, N., Ghayur, M. N., & Gilani, A.-H. (2011). Pharmacological Basis for the Medicinal Use of Psyllium Husk (Ispaghula) in Constipation and Diarrhea. Digestive Diseases and Sciences, 56(5), 1460–1471. https://doi.org/10.1007/s10620-010-1466-0