Health Secrets of a Belly Dancing Road Warrior:
Part 4, Stomach & Intestinal Health

By Shira

The first question people seem to ask when asking my advice on travel to Egypt is, "How can I avoid getting diarrhea while there?" Although I certainly can't offer any guarantees on how to keep your intestines healthy while traveling, I can offer some insights into things you can do to avoid some of the most common problems. 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 any remedies you try won't conflict with your drugs. If your health is delicate due to age, chemotherapy, immune disease illness, or any other issue, discuss this article with your primary care physician and gain that person's feedback on which measures are best for you. I am not a health care professional, and I don't claim to know how my techniques for travel comfort might apply to your own health issues.

Where Most Advice Goes Wrong

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.

What You Eat & Drink

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. Here are some common food intolerances that can cause diarrhea. It would be rare for one person to possess all of these conditions, but it's possible you may have one that you are not aware of. You may want to experiment with these foods at home before leaving on your trip, so that you'll know which foods your body is sensitive to versus which foods your body can digest effectively: Before you leave home, pay attention to how your body responds to these foods. Make note of which ones appear to cause diarrhea for you. Keep that in mind when making decisions on what food to eat while traveling. Food Or Drink How It Causes Diarrhea How to Avoid Problems  Coffee, tea, soda Caffeine is a natural laxative. A small amount may merely make your stools soft, while a larger amount may cause diarrhea. 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) Some people, particularly those with ethnic African ancestors, do not possess the enzyme needed to digest a substance called lactose which is found in milk. The undigested lactose leads to diarrhea. 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. Beans, asparagus, cauliflower, broccoli, beets, cabbage, corn, cucumbers, leeks, lettuce, onions, bell peppers, chickpeas (what hummus is made from), lentils, peanuts, soybeans Some people lack the necessary enzymes to digest certain vegetables. The undigested portions of the vegetables lead to diarrhea. 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. Pears, apples, peaches, prunes Certain fruits contain a substance called sorbitol which is used in manufacturing some laxatives. The amount in pears, apples, and peaches is small, but in prunes is large. Avoid these fruits. Eat these fruits in small doses. Onions, oranges, artichokes, pears, corn, wheat, some soft drinks and processed foods containing high-fructose corn syrup Certain foods are rich in a sugar called fructose. Some bodies have difficulty digesting it. Avoid foods that are high in fructose. Eat only small doses of foods that are high in fructose. Bread, cookies, cake, rolls, adhesives on envelopes & postage stamps, vitamins, barley soup, pasta A genetic illness called celiac disease prevents the small intestine from digesting foods containing gluten. The undigested food leads to diarrhea. Avoid foods that contain gluten. Diet foods, chewing gum, candies, beverages Products advertising as sugar-free or low-fat may contain sweeteners or fat substitutes that "have a laxative effect". 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. Herbal tea containing senna, rhubarb root, buckthorn, or aloe Certain herbs are known to have a laxative effect. Don't drink these teas. Beyond these intolerances, if your body isn't used to eating a certain food, that food could cause your body to have a diarrhea episode in rebellion. For example, if you normally eat a diet low in red meat, then eat red meat while traveling, your body may protest because it's not in the habit of secreting the necessary enzymes to digest it fully. This could be true of almost anything you eat while traveling but wouldn't eat at home.

Prevention

Tap Water

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.

When You Can't Resist a Fresh Salad

Doctors advise people to avoid fresh salads when traveling because the vegetables are washed in tap water, which might carry bacteria. But sometimes those vine-ripened fresh local vegetables look too good to resist. What to do? It's your choice of whether to take the risk. I sometimes do, and I don't get sick. My secret is that I sprinkle vinegar-based dressing on the salad before eating it. Vinegar is a natural antiseptic, which kills germs before they enter your body. Local food garnishes may also help kill germs. For example, scientists have discovered that the herb cilantro kills the bacteria that cause salmonella food poisoning. Oregano is another herb that kills some kinds of germs.

Food Poisoning

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. Food poisoning may arise as quickly as 30 minutes after you eat the offending food, or it may take longer to develop. If your symptoms include vomiting or muscle aches as well as diarrhea, there is a strong chance the problem is indeed food poisoning. Food poisoning often arises abruptly and subsides just as abruptly. An attack may be as short as 45 minutes or as long as all night. If this describes your situation, remember to avoid taking products like Imodium to try to make it stop - instead, let it run its course and follow my advice below on Regaining Your Strength.

What If You Can't Avoid It?

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. When visiting a foreign country, you will see drug names that do not appear in your pharmacy at home. That's because different countries have different policies regarding which drugs to ban as being ineffective or dangerous. In Egypt, local people may recommend a drug called Intetrix, but beware - it is banned in the United States because it has been linked to causing liver problems. Intetrix is a drug that battles amoeba parasites, but drinking vinegar or lemon juice is much safer for your body.

What About Antibiotics?

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.

What If It Doesn't Clear Up?

Regaining Your Strength

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. If you particularly want to focus on restoring your electrolyte balance, these tips should help: If I could pack only one item to help me regain my strength, it would be dried banana chips. These are the single most effective thing I've found. I won't travel internationally without them. Some people take powdered Gatorade or other supplements along in their luggage to use in replenishing the electrolytes after an attack. If your local grocery store doesn't sell powdered Gatorade in travel-size packets, you can find some on the web site www.minimus.biz. I've seen some people try using other brands of powdered drinks, but they don't all work because they don't all contain electrolytes. Read the label. If it doesn't state that it contains sodium, potassium, chloride, calcium, magnesium, bicarbonate, phosphate, or sulfate, then it won't help replenish your strength. Saltine crackers are rich in sodium, and are soothing to a distressed gut. As the condition starts to clear and you start to feel better, avoid fatty foods such as cheese, fried foods, or red meat for a day or two. Fat is harder to digest than other foods, and can prolong the diarrhea if you resume eating it too soon.

Motion Sickness

Other Gastro-Intestinal Health Issues

Your Packing Checklist for Gut Health

To help you plan ahead for your trip and pack, here is a checklist summarizing the items I described in this article. Here are some ideas - use the ones that are compatible with your own approach to health care, and ignore the rest. As always, discuss any pills or syrups you may be considering with your health care professional before using them. 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 To Make the Diarrhea Stop Pepto-Bismol Imodium Raspberry tea Ginger Antibiotic To Restore Strength To the Body After Diarrhea Attack Dried banana chips Powdered Gatorade Saltine crackers Pretzels Motion Sickness Ginger Dramamine Accupressure wristbands  Heartburn  Antacid (such as Tums) Acid prevention (such as Zantac) Prescription medications Constipation  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 Other  Travel-sized pack of toilet paper