PHOTO CREDIT: Above photo by John Rickman Photography, San Jose, California.

• Where Most Advice Goes Wrong
• What You Eat & Drink
• Prevention
• Tap Water
• When You Can't Resist a Fresh Salad
• Food Poisoning
• What If You Can't Avoid Getting Sick?

• What About Antibiotics?
• What If It Doesn't Clear Up?
• Regaining Your Strength
• Motion Sickness
• Other Gastro-Intenstinal Health Issues
• Packing Checklist
• Related Articles

This is Part 4 in a series of 5 articles on travel health issues for road warriors, particularly belly dancers. The other articles in the series cover:

• Part 1, Beginning Preparations
• Part 2, Coping with Jet Lag
• Part 3, How to Avoid Catching a Cold While Traveling
• Part 5, Foot, Muscle, & Joint Health

Before you try any of the ideas I've suggested in this article, please discuss them with your own doctor! If you are pregnant or breast-feeding a baby, you need to consider how your actions might affect your baby's health. If you take prescription drugs for any reason, you'll want to make sure your jet lag remedies don't conflict with the behavior of those drugs. If you have allergies or immune system issues, you'll want to be careful to avoid any actions that could cause you further difficulty. I am not a health care professional, and I don't claim to know how my techniques for travel comfort might apply to your individual health issues.

PHOTO CREDIT: Photo by John Rickman Photography, San Jose, California.

Most advice to travelers on how to avoid diarrhea assume that the primary cause of diarrhea for tourists is drinking unsanitary water. The logic is that drinking water in third world destinations such as Egypt is infected with fecal matter containing E. Coli bacteria, which in turn causes diarrhea.

While it is certainly true that this can be a possible cause of diarrhea and appropriate precautions should be taken, it's not the only thing that can make you sick. I agree with all the advice designed to protect against this problem, but there is more that travelers need to know. For example, eating sugar-free cookies that your roommate brought from home could trigger it if your body is sensitive to sorbitol.

PHOTO CREDIT: Photo by Lina Jang, New York City, New York.

When traveling, it can be fun to sample local foods. It's part of the experience of visiting foreign countries. There are many delicious specialties, and the fresh produce in countries like Egypt and Turkey is often vine-ripened for fullest flavor. However, there are some foods that some people have difficulty digesting, and there are some foods and drinks that contain naturally-occurring laxatives. You might not be aware that your body is sensitive to these items, because perhaps you don't eat or drink them when you're home. But when you travel, you may decide to embrace the local cuisine, and you may unknowingly eat something that would have given you diarrhea at home, too.

Some people mistakenly refer to these problems as food allergies, but a more correct term is food intolerances. Fortunately, diarrhea caused by a food intolerance is generally short-lived, perhaps 24 hours at most.

PHOTO CREDIT: Photo by Pixie Vision Productions, Glendale, California.

• Avoid these beverages.
• Drink only small quantities, no more than one cup every few hours.

Milk, yogurt, cheese, butter

(most likely to affect people whose ancestors came from Africa)

• When eating or drinking dairy products, take a supplement that contains lactase, the enzyme that digests lactose. In the U.S., these are sold under the brand names of Dairy Ease and Lact-Aid.
• Avoid dairy products.

• Avoid these vegetables.
• When eating vegetables that your body cannot digest properly, sprinkle a few drops of an enzyme supplement such as Beano on them.

• Avoid these fruits.
• Eat these fruits in small doses.

• Avoid foods that are high in fructose.
• Eat only small doses of foods that are high in fructose.

• Avoid foods that contain gluten.

• Don't eat foods containing sorbitol, Olestra, or other artificial sweeteners or fats.
• If the effects on your own body are mild, you may be able to eat these foods in small doses without problem. In some people, however, the effects are severe.

• Don't drink these teas.

This article discusses several ways to prevent diarrhea by avoiding food or water which may contain contaminants or be hard to digest. In addition to avoiding risky food and water, there are additional things you can do to help your body prevent diarrhea.

• Acidophilus. Approximately 2 weeks before your trip, start taking acidophilus capsules with each meal. Take some acidophilus on your trip with you, and continue taking it while there. (Be sure to buy the kind that doesn't need to be refrigerated. It can usually be found in health food stores.) Acidophilus is a probiotic, which means it encourages the growth in your gut of beneficial flora which aid in food digestion and battle harmful bacteria.
• Lemon Juice. Drink lemon juice frequently. In Egypt, it is possible to purchase delicious lemon juice. Lemon juice helps protect your body against amoeba parasites due to its acid content.
• Vinegar. If you can't resist salad, use a dressing that contains vinegar. Vinegar is a natural antiseptic that can help kill any bacteria that may be on the salad, and its acid also kills amoeba parasites.
• Dried Cranberries. These make a delicious snack, and some studies have suggested they may help your body fight bacteria, particularly when combined with oregano. For example, they are frequently recommended to prevent urinary tract infection because they prevent bacteria from adhering to the inner wall of the bladder.
• Disinfecting Hands. Use antibacterial towelettes or gel to cleanse hands before eating rather than relying solely on tap water. (I don't do this myself, but a number of health care professionals recommend it.)
• Sleep. A strong immune system is better able to resist germs of all kinds. Sleep is a powerful tool for making your immune system strong and healthy. See Part 2 in this series, Beating Jet Lag, for advice on how to avoid insomnia.

PHOTO CREDIT: Photo by Kaylyn Hoskins, Solon, Iowa.

Most doctors think of E. Coli bacteria as the cause of most diarrhea in tourists. For this reason, they advise travelers to avoid tap water. In addition to drinking bottled water instead of tap water, the advice includes avoiding:

• Raw unpeeled fruit or vegetables which may have been washed in tap water
• Brushing teeth with tap water
• Ice cubes (which, of course, are made from tap water)
• Cut up fruit salad
• Bottled water if the seal has been broken (some unethical places refill bottles with tap water)
• Avoid water splashing into your mouth and being swallowed when taking a shower or swimming.

In most major metropolitan areas, tap water is probably treated with chlorine to kill bacteria. In more remote areas of third-world countries, that may not be the case. But even if chlorine kills the bacteria, it might not kill the protozoans such as amoebas in the water, and those too can cause diarrhea.

If the tap water has been boiled, for example to prepare hot tea or coffee, it is usually safe.

PHOTO CREDIT: Photo by John Rickman Photography, San Jose, California.

Ironically, the lasagna, casserole, quiche, or other hot food may pose a greater risk of diarrhea than vegetables washed in tap water. This is because food poisoning is a common cause of diarrhea in developing countries.

• Restaurants in such countries often are not inspected very often for sanitation, and in some countries inspectors may accept bribes to omit offenses from their reports.
• Any foods that sit around after being thoroughly cooked, then are rewarmed may pose a risk. They may be left sitting on the counter instead of being refrigerated, and the rewarming might not be sufficient to kill the bacteria that gathered while sitting out.
• Food workers might not wash their hands sufficiently after using the toilet, allowing E. Coli to contaminate the food they handle.

Doctors usually advise people to avoid street vendors and "adventurous eating" as a safeguard against food poisoning. But even upscale restaurants in fancy hotels may exercise poor sanitation practices.

• Try to eat at places that look popular. A large number of customers means that food will be served promptly after being cooked, without sitting out too long to grow germs.
• Try to choose foods that are cooked to order, such as kebabs, shwarma, and other sandwiches.
• Avoid casseroles.
• When eating at a buffet, select food from trays that have been freshly brought from the kitchen, which are still hot.
• Avoid milk or other dairy products that have not been pasteurized.
• Avoid raw or rare red meat or fish.

PHOTO CREDIT: Photo by Kaylyn Hoskins, Solon, Iowa.

Sometimes, despite your best efforts, you get diarrhea anyway. Most diarrhea caused by bacteria (either tap water or food poisoning) clears away on its own within 3-5 days. Diarrhea caused by food intolerance may pass within 24 hours.

It's usually a good idea to allow the body to cleanse itself by allowing the diarrhea to run its course, but many tourists understandably don't want to have their sightseeing or dance activities interrupted by health problems.

The common over-the-counter remedies of bismuth salicylate (Pepto-Bismol) and loperamide (Imodium) may both be effective, especially against diarrhea that was caused by caffeine, sorbitol, and other foods or drinks that have a laxative effect. If you prefer herbal remedies to drugstore remedies, consider an herbal tea made with the leaves and fruit of raspberries or ginger root.

These should not be taken, however, if you suspect the cause of your diarrhea may be food poisoning because blocking your system will cause the germs to linger in your body longer and make you even sicker. If there is blood in the diarrhea, you should not take Imodium.

If the diarrhea has a foul, fishy smell, it may be caused by amoebas instead of bacteria. This can be a risk in Egypt. Try drinking a glass of either lemon juice or vinegar. The acid in these liquids kills amoebas.

PHOTO CREDIT: Photo by Pixie Spindel Productions, Glendale, California.

Some doctors recommend using an antibiotic in case of diarrhea. Discuss this article with your doctor before you leave home. Here are some possible disadvantages of using antibiotics:

• Be aware that a common side effect of antibiotics is diarrhea!
• One major problem with antibiotics is that they kill the beneficial flora in your gut as well as the germs that are making you sick. Those beneficial flora assist in the digestion of food and help the body fight harmful bacteria found in food.
• As noted earlier in this article, undigested foods are one significant cause of diarrhea. If the antibiotic kills the beneficial flora, it prevents some foods from being fully digested and it eliminates one of your body's defenses against new incoming germs.
• Some antibiotics such as Doxycycline make your body sensitive to sunlight, meaning you sunburn more easily. This could be a problem if you are planning to do outdoor sightseeing or go on a camel ride.
• Many of the bacteria that cause diarrhea have become resistant to antibiotics, so taking the antibiotic might do nothing for you. Most doctors who recommend antibiotics choose Cipro. It is one of the few antibiotics that is still effective against the common causes of diarrhea in travelers, and it doesn't have the problem with sun sensitivity that Doxycycline has.
• Some food poisoning is caused by viruses instead of by bacteria. Antibiotics will do nothing to help cure your diarrhea if it is caused by the Norwalk virus (the one that has overwhelmed several cruise ships).
• Some diarrhea is caused by amoeba parasites in the tap water. Antibiotics will not help if this is the cause.

PHOTO CREDIT: Photo by Reel Sound and Light Productions, Los Gatos, California.

Diarrhea interferes with absorption of nutrients and depletes the body of electrolytes. Electrolytes are substances that allow your cells to carry electrical impulses to each other. When your body has been depleted of them, your muscles feel so drained that just going to the bathroom is exhausting.

Diarrhea also leads to dehydration. This can make you feel headachy, dizzy, unable to think clearly, drained of energy, and weak in the muscles.

Specific foods and drinks can help restore your electrolyte balance and rehydrate your body, bringing back your strength and energy.

At this time, drinking plenty of fluid (without caffeine or alcohol) and eating a specific diet known as the BRATT diet can help replenish the body. The BRATT diet includes:

• Bananas
• Rice (white)
• Applesauce
• Toast
• Herbal tea (mint tea or ginger tea is particularly soothing)

Be cautious, though, because apples could make diarrhea worse for someone an intense level of sorbitol intolerance, toast could provoke diarrhea in someone with celiac disease, and some herbal teas contain herbs such as senna that can provoke further diarrhea.

PHOTO CREDIT: Photo by Shira.

If you frequently suffer from motion sickness, you may want to take along your favorite preventions.

• People often forget that motion sickness can attack when you are sitting on a tour bus for sightseeing or enjoying a cruise, and it's more likely to hit you when you're tired than when you're fully rested.
• If you take a dance workshop in a topic such as veil that involves spinning, that provides another environment where motion sickness is likely to strike.

You can pre-empt this issue by researching motion sickness before leaving home. Some people find that deep breathing, looking at the horizon, or opening a window and breathing fresh air, can ease the discomfort. Take the time to educate yourself on non-drug remedies that may be helpful. Avoid drinking alcohol before boarding the tour bus or cruise boat.

I like to use ginger to prevent motion sickness - I usually choose it in candied form from the spice aisle of a grocery store. Some people prefer to drink it in a tea, eat fresh sliced ginger root from the produce aisle, drink ginger ale, or use pills of powdered ginger. Medical studies have shown that it helps about 60% of the population avoid nausea. Therefore, there's no guarantee it will work for you, but it's worth a try.

Other people prefer acupressure wristbands or pills such as Dramamine. The acupressure wristbands never helped me and therefore I'm skeptical about them, but you're free to make your own decisions. I'm wary of the drugs used in Dramamine, but I know some people like to use it.

PHOTO CREDIT: Photo by Pixie Vision Productions, Glendale, California.

Constipation

If constipation is sometimes an issue for you, take along whatever remedies you normally use.

• As noted above under "What You Eat & Drink", some foods and drinks such as coffee, black tea, apples, peaches, prunes, and pears are natural mild laxatives which can be used to loosen up a fussy gut.
• Foods rich in fiber such as fruits and vegetables or whole-grain breads can help move things along. (Remember to avoid raw vegetables which may have been washed in contaminated tap water unless you first either peel them or wash in bottled water.)
• Avoid starchy foods such as mashed potatoes, rice, or white bread.
• Drink plenty of liquid - the fiber you eat to help get things moving tends to absorb large amounts of liquid, and you need to drink enough ensure your body has the moisture to lubricate your insides.
• Belly dance moves which require a large amount of movement from the abdominal muscles may help encourage the digestive process. In particular, some belly dance students find that stomach rolls are useful for this. If you haven't yet learned how to do these, see the article elsewhere on my web site How Do I Get Belly Rolls to Work? Even if you don't master rolls before you leave for your trip, doing the exercises I suggested to develop those muscles may provide the same benefit.

If you used a product such as Imodium or Pepto-Bismol to treat diarrhea, then you may become constipated because of the action of these drugs. Follow the above tips, and the problem should go away on its own without drugging yourself with laxatives.

PHOTO CREDIT: Photo by Pixie Vision Productions, Glendale, California.

Toilet Tissue

In Egypt and many other Muslim countries, the local people don't use toilet paper. Instead, they use the faucet built into every toilet to cleanse themselves, using their left hand. Of course, places that receive a large number of tourists are likely to provide toilet paper, especially 5-star hotels and major tourist attractions.

However, smaller places, such as the costume shops, carpet factories, or alabaster showrooms where you stop to shop, might not offer toilet tissue. Sometimes places that normally provide it run out. So I recommend taking along your own toilet tissue. In a typical 2-week trip to Egypt, I typically encounter about 3-4 situations in which I need to the tissue I brought along. This admittedly isn't very many times, but I'm grateful to have it every time I need it.

Special packages of it are sold for travel use that don't have the cardboard roll in the middle. These are compact and don't take much room in the luggage.

PHOTO CREDIT: Photo by "K", Santa Clara, California.

Preventive Items

I recommend taking these on the airplane in the carry-on luggage and using them during the flight. Continue using while away from home.

• Acidophilus (the kind that doesn't need to be refrigerated)
• Dried cranberries
• Antibacterial towelettes or gel

• Pepto-Bismol
• Imodium
• Raspberry tea
• Ginger
• Antibiotic

• Dried banana chips
• Powdered Gatorade
• Saltine crackers
• Pretzels

• Ginger
• Dramamine
• Accupressure wristbands 

• Antacid (such as Tums)
• Acid prevention (such as Zantac)
• Prescription medications

• Canned prune juice
• Fiber-rich snack items (trail mix, etc.)
• Dried fruits, especially those containing sorbitol (prune, apple,pear, peach)
• Your favorite brand of laxative

• Travel-sized pack of toilet paper

• Health Secrets of a Belly Dancing Road Warrior
  • Part 1, Beginning Preparations
  • Part 2: Beating Jet Lag
  • Part 3, How to Avoid Catching a Cold While Traveling
  • Part 5, Foot, Muscle, & Joint Health
• Avoiding Injury in Belly Dance
• The Healing Effects of Oriental Dance
  • Part 1, Healing the Body
  • Part 2, Emotional Healing

• When You Can't Dance After Accident, Illness, or Surgery
• The Art of Breathing. By Jodi Blubaugh.
• The Mysterious Zar: What Is It? What Can It Do For You? By Arabella.
• Fit And Healthy. By Despina.
• Belly Dance And Weight Loss