You were so careful. You avoided tap water, ice, unpeeled fruits and vegetables, and uncooked foods. Yet, you still came down with "the runs" on your last trip out of the country.
If this is you, you're not alone. Studies show many travelers to Third World countries suffer from diarrhea despite taking the recommended precautions. So what is causing it?
One new school of thought says diarrhea-causing germs are more likely to come from the hands of restaurant workers than from tap water or raw food. In addition, one study showed people who ate reheated food had a higher risk of getting sick. Because most Third World countries don't have the same restaurant hygiene standards as the U.S., this line of thought seems to make sense. Some travel medicine experts believe, though, that the real cause for the continuing problem is many people are not as careful in following the standard precautions as they think they are.
Regardless of which reason is right, you can do something to help prevent diarrhea while traveling. First of all, don't toss out the "Boil it, peel it, cook it — or forget it" traveler's mantra. Water is still contaminated in many countries. You should also avoid food that has been sitting out — your meal should go directly from refrigeration or ice to the stove. You can also ask that your meal is served fully cooked and very, very hot.
Some doctors suggest that you arm yourself with preventive doses of Pepto-Bismol or keep Imodium or other over-the-counter medications used to treat gastrointestinal symptoms in your suitcase. The most effective, but controversial, course of action is to take antibiotics ahead of time to prevent diarrhea or carry some with you to take in the event you get sick. But you may not find too many doctors who will prescribe antibiotics in this way — and with good reason. The antibiotic-resistance problem results from increased and improper use of antibiotics.
So what's a traveler to do? Take all possible precautions to help prevent coming into contact with contaminated food. But keep a stash of over-the-counter medication to treat diarrhea in your suitcase, because no matter how careful you think you are, you may still get sick.
December 2003 Update