Friday, August 7, 2015

Can You Protect Your Tummy From Traveler's Diarrhea?

It goes by many names: Delhi belly. Montezuma's revenge. The Aztec two-step.But doctors use one not-so-glamorous term: traveler's diarrhea.
If you're visiting a place this summer with less than ideal sewage disposal — maybe a resort in Mexico or a village in Rajasthan — chances are your GI tract will give you trouble at least once ... maybe twice ... maybe continuously.
There are just about as many misconceptions and myths about traveler's diarrhea as there are names for it. So we're here to try and set the record straight — or a least discuss what's known and not known.
We dove into the literature and talked to two pioneers in the field to figure out what causes Montezuma to take revenge, what precautions might work and what to do when your tummy starts to rumble.
1. I'm sick because the food has "different" bacteria in it that my GI tract isn't accustomed to. FALSE.
Hop on a red-eye flight from New York to New Delhi, and in 24 hours you'll literally have "Delhi belly." About half the bacteria species in your gut will switch from those typically found in New Yorkers to those found in New Delhi residents, says Dr. Bradley Connor, who directs The New York Center for Travel And Tropical Medicine.
"But that's not what makes you sick," Connor says. Those bacteria are the "good guys." They're the bacteria that help you digest food and tune your immune system.
Problems arise when you accidentally pick up a "bad guy" — a pathogenic bacteria, Connor says. These bacteria would make you sick anywhere in the world, even here in the U.S. They're just more common in developing countries because they're found in raw sewage.
2. If I keep eating the local cuisine for a month or so, I'll build up immunity to the bacteria. FALSE.
Shlim has spent 30 years studying travelers' illnesses in Nepal. He found that long-term trekkers and expats will eventually build up immunity to diarrhea-causing bacteria. But it takes years, not weeks or months.
3. Washing my hands will keep me from getting sick. FALSE.
Sure, a quick wash with antibacterial soap will knock out bad E. coli. But that's unlikely to cut your risk of getting sick, Shlim says.
"You can never really be against hand-washing," he says. "But the fact is that it usually takes a high quantity of bacteria, sometimes in the millions, to overcome your stomach acid. So just the random bacteria you get on your hands, I think is unlikely to make you sick."
4. If I avoid certain types of foods, I won't get sick. MAYBE.
The major source of all traveler's diarrhea is contaminated food and water at restaurants, Shlim says. Avoiding the bad water is easy — just buy bottled water, boil it or treat ityourself. But the food part is trickier.
Many travelers swear by the old saying "boil it, cook it, peel it or forget it."
But scientific studies don't really back it up. One meta-analyses of seven studies didn't find a connection between getting bacterial diarrhea and eating raw vegetables or unpeeled fruits. But it did find a link between illness and foods that sat around at room temperature for a while.
5. If I get sick, I should take an antibiotic. MAYBE.
Ten years ago, standard advice from travel clinics was clear-cut: Take a pack of Cipro on your trip and pop a pill at the first rumbles in your belly. Back in 2006, I was given that exact advice from a clinic in Berkeley.
Now the advice is a bit more nuanced. Travel doctors don't recommend taking antibiotics for mild or moderate cases of diarrhea — and definitely not as a preventive measure.
"Your body will naturally fight off bacterial diarrhea in three to seven days," Shlim says.
But if you're running to the bathroom several times a day — or have bloody stools — then Shlim recommends a quick dose of antibiotics. "You'll feel much better in six to 24 hours." npr for the full responses....

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