Staying healthy when travelling – a no-nonsense guide to avoiding Travellers Diarrhoea

Getting sick while travelling can quickly put a dampener on your trip. The good news is that a few simple habits can significantly reduce your risk.
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The most common travel illnesses are often caused by eating or drinking something contaminated with bacteria, viruses or parasites. You can't eliminate the risk completely — and trying to do so can take some of the fun out of travelling — but you can stack the odds in your favour.

A simple rule followed by many is:
Boil it, cook it, peel it — or leave it.

It’s generally good advice, but like many rules, I do sometimes break it! If I’m comfortable with where the food has come from, how it has been stored and how it has been prepared, I’m happy to take the risk. If I always followed the rule to the letter, I’d miss out on far too many delicious things.

Use your common sense. If you’re unsure, stick to the rule.

And remember: hot and freshly prepared is generally your friend; food that has been sitting around is not. That is why you are more likely to see see me eating at busy street food stalls than at a hotel buffets!

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What food is safe for me to eat?

You don't need to be obsessive about what you eat when travelling, but a few simple choices can reduce your chances of getting sick.

Generally good choices:

• Food that has been thoroughly cooked and is served piping hot
• Food cooked to order, particularly where there is a high turnover of customers
• Fruit you can peel yourself, such as bananas, oranges and mangoes
• ​Pasteurised dairy products, such as yoghurt, milk and cheese

Take a little more care with:

• Raw or undercooked meat, fish and shellfish
• Salads and raw vegetables if you're unsure how they have been washed
• Unpasteurised milk and dairy products
• Food that has been sitting at room temperature, particularly in hot weather
• Buffets, where food may have been sitting out for some time
• Ice cream and other dairy products if you're unsure whether they have been properly pasteurised, refrigerated or handled

And remember, how food is prepared and stored is often the most important thing and a freshly cooked dish from a busy local restaurant or street-food stall can be a great choice.

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​What about street food?

I definitely don't think street food automatically belongs on the “avoid” list, as some advice would have you believe. Some of the best — and safest — food you can eat while travelling can come from a busy street stall.
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Look for high turnover, food cooked in front of you and served piping hot. A stall with a queue of local customers, where food is going straight from the grill or wok to your plate, may actually be a better bet than an empty restaurant where food has been sitting around.
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Also, have a quick look at what the food is served on and the cutlery. If they’re reusable, consider how they are being washed and whether the water looks clean.
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As always, use your common sense. If it looks busy, clean and well run, and the food is being freshly cooked, I’m usually very happy to give it a go.

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​Is vegetarian food safer?

It can be, but vegetarian doesn't automatically mean safe. Avoiding meat and seafood removes some risks, particularly from undercooked or poorly refrigerated animal products. But some common causes of travellers' diarrhoea are vegetarian — salads, raw vegetables, unpasteurised dairy and food that has been sitting around at room temperature.
So don't worry about whether a dish contains meat. Think about how it has been prepared and stored (there is a theme here!) Freshly cooked vegetarian food served piping hot is generally a good choice.

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Can I drink the water?

The safest default answer is no, but always check destination-specific advice.
If the tap water isn’t safe to drink, I recommend taking a reusable water bottle with a travel filter. That way, you always have a source of safe drinking water with you.

• Drink commercially bottled water with an intact seal, or properly treated water.
• Use safe water for brushing your teeth.
• Avoid ice unless you know it has been made with safe water (purified or disinfected)
• Tea and coffee made with freshly boiled water are generally safe.
• Be cautious with drinks from fountains or dispensers if you don't know what water they use.

If you are buying bottled water, check that the seal hasn't been tampered with.
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And remember that boiling won't remove chemical contaminants. If the water is known or suspected to be chemically contaminated, use a safe alternative such as commercially bottled water.

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​If I only do one thing to avoid "food poisoning", what should it be?

Wash your hands
This is one of the simplest and most effective things you can do.
Wash your hands thoroughly with soap and water, particularly:

• After using the toilet
• Before eating or preparing food
• After contact with animals
• After caring for someone who is unwell

And don’t forget how you dry them. I favour simple air-drying where possible.

Fun Fact: Hot-air hand dryers are generally considered less hygienic than paper towels because they can pull bacteria from the surrounding bathroom air into their intake and blow them onto freshly washed hands!
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When soap and water aren't available, use a hand sanitiser containing at least 60% alcohol and rub your hands together until dry.

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What about a vaccine — is there something I can take to prevent it?

You may have heard of Dukoral, an oral vaccine that protects against cholera and also provides some protection against travellers’ diarrhoea caused by enterotoxigenic E. coli (ETEC) — one of the bacteria that can cause it.

For cholera, Dukoral is quite effective, providing around 80–85% protection in the first few months after vaccination. However, it doesn't protect against all the different bugs that cause travellers’ diarrhoea.
When it comes to travellers’ diarrhoea as a whole, the benefit is much less impressive. Studies in travellers haven't shown a significant reduction in the overall risk of getting diarrhoea.
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So, although Dukoral may be worth considering for certain higher-risk destinations or travellers, it's not something most people need simply to prevent travellers’ diarrhoea. Good hand hygiene, safe water and sensible food choices remain your best everyday protection.

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​What about probiotics and kefir, do they help?

You may have heard that taking probiotics before travelling can prevent travellers' diarrhoea.
There is some evidence that particular probiotic strains may reduce the risk, particularly Saccharomyces boulardii, but the evidence is inconsistent and current travel-health authorities do not routinely recommend probiotics for prevention.

I drink kefir and take a probiotic supplement as part of my usual daily routine, but I don’t specifically take them when I travel — there’s already enough to remember! If you already enjoy live yoghurt, kefir or take a probiotic supplement, there’s no need to stop. There is some evidence that certain probiotics may help reduce the risk of travellers’ diarrhoea, but the evidence isn’t strong enough to rely on them for protection.

If you decide to try a probiotic, look for a specific, well-studied strain rather than assuming that all probiotics work in the same way.

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I always get an "upset stomach" when I travel.

Don't be alarmed if your bowel habits change when you travel. Both softer stools and constipation are common, and neither necessarily means you're unwell.

A change in diet, meal times, routine, activity levels, hydration and even the simple fact of being somewhere different can affect your digestion. You may go more often, less often, or find that your stools are softer or harder than usual.
A short-term change in bowel habit when travelling, on its own, is usually nothing to worry about.
Constipation is particularly common when travelling because of long journeys, dehydration, changes in diet and being less active than usual. Drinking plenty of water, eating some fibre and keeping moving can help.

On the other hand, travellers' diarrhoea is more than simply having a softer-than-usual bowel movement. It generally involves frequent, loose or watery stools and may be accompanied by abdominal cramps, nausea, vomiting or fever.
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The key is to notice what is normal for you and look at the whole picture. Not every change in your bowel habit means you've picked up an infection.

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What should I do if I do get diarrhoea?

Don't panic. Travellers' diarrhoea is common, particularly when travelling to places where sanitation and food-handling standards differ from those at home.

The priority is staying hydrated. Oral rehydration solution can replace the water and salts lost through diarrhoea and vomiting, so it's worth carrying some in your travel medical kit.

Antibiotics aren't routinely needed for simple, traveller's diarrhoea — and some antibiotics will actually cause diarrhoea themselves! Most episodes are self-limiting and settle within a few days, normally within 2–3 days.

It’s generally best not to routinely take medicines that stop or slow diarrhoea unless you really need to control the symptoms — for example, if you have a long journey or flight that day. They can be useful when you need short-term relief, but should be avoided if you have a fever or blood in your stool.
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Seek medical advice if you develop blood in your stool, high fever, severe or persistent symptoms, significant dehydration, or if you are particularly vulnerable to complications.

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The bottom line
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​You can't guarantee that you won't get sick while travelling, but you can develop a few simple habits that can make it less likely:

• Wash your hands — especially before eating.
• Drink safe water and use it for brushing your teeth.
• Choose freshly cooked food served hot.
• Peel your own fruit where possible.
• Be cautious with food that has been sitting around, particularly in hot weather.
• Stay well hydrated, especially if you do become unwell.

That's it.
Simple, sensible precautions to reduce your risk without taking the fun out of eating,
​exploring and enjoying your trip.

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