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Travel Health

Travelling to new and international destinations is exciting for most of us, particularly if this is your holiday of a lifetime. However, it can be quite stressful if you are one of the unfortunate people who develops “Travellers’ Diarrhoea” (TD).

By being well prepared for your travels, reducing the amount of stress, and taking some sensible precautions to reduce your chances of getting ill whilst travelling, you are assured of enjoying that special getaway to paradise. Although TD is rarely life-threatening, it can be a significant nuisance and place a substantial economic burden on those individuals that are unlucky enough to contract it.

Taking Bimuno® Travelaid 7 days prior to travelling and for the duration of the trip, has been shown to reduce the incidence of TD and the severity and duration of symptoms of TD if you are unfortunate enough to get it.

Causes of Traveller’s Diarrhoea

Travellers’ diarrhoea is one of the commonest, if not the most common illness that is associated with travel and the incidence can be as high as 70%.  This depends on the country that you are travelling to and the season of travel. It primarily occurs with travel to countries that have a medium to high risk of infection and these are generally the developing countries where food hygiene and sanitation may be a challenge. The areas of high risk include most of Asia (apart from Japan, Singapore and Hong Kong), the Middle East, most of Africa, Mexico, Central and South America.1

Some individuals may be more susceptible than others and the reason for this is not always clear. You could be travelling with a group of friends and all end up eating the same thing and yet, only one or some of you may become ill. There are many factors that could play a role, but there are certain people who have a higher risk of becoming ill.  These include people who have underlying diseases of the gut such as IBS and Crohn's disease, children and young adults, individuals with low immunity, people with chronic diseases such as diabetes, and those who are taking treatment for reflux or antacids, as these can lower the stomach's ability to kill off harmful bacteria.

Causes of Traveller's Diarrhoea by Country

ETEC (Enterotoxigenic E. coli) and Enteroaggregative E.coli (EAEC) are the main contributors for TD cases occurring in Latin America, Africa, South Asia and Middle East.

Percentage incidence of travellers’ diarrhoea caused by enterotoxigenic Eschericia coli.

It is possible that travellers’ diarrhoea may stem from the stress of travelling or a change in the diet that we are accustomed to. But almost always an infectious agent is to blame. It is more commonly due to the contamination of food or beverages, although it may not just be from that – touching your mouth or nose with contaminated hands, may be all that it takes to set off an episode of travellers’ diarrhoea.

TD can occur due to infection by a range of intestinal bugs. Bacteria are most commonly the culprits and account for 80 to 90% of cases. Viruses and parasites are responsible for the remainder of infections and the illness caused by parasites usually takes longer to manifest and is often more chronic.

Signs and Symptoms of Travellers’ Diarrhoea

Although Travellers’ Diarrhoea is a defined clinical disorder of the digestive system, the term is often used quite generally for illnesses ranging from an upset tummy to diarrhoea that occur during or after travel to countries and regions of intermediate to high risk. It could mean just an increase in bloating and flatulence, or alternatively, a variety of symptoms. 

  • It may start off with a fever and chills with a general feeling of tiredness
  • Abdominal bloating and flatulence, cramping and pain
  • The increased urgency to pass stool, associated with increased frequency and the amount of stool
  • Sometimes associated with bloody stool
  • It may also be associated with nausea and vomiting.

The symptoms usually start within 6 to 48 hours after infection and most individuals will get better within 3 to 7 days, with no further consequences. A small number of individuals may develop chronic post-infective irritable bowel syndrome (IBS) following a bout of travellers’ diarrhoea.

Prevention

Firstly, it is important to take care of your digestive health and maintain a healthy balance of good bacteria in the gut.  Bimuno®, taken 7 days prior to travel and for the duration of the trip, has been shown to reduce the incidence of TD and the severity and duration of symptoms of TD if you are unfortunate enough to get it.  Bimuno® offers a unique and proven protective action within the gut, this promotes digestive health and general well-being and provides a natural support to the body’s defence systems and the health challenges that we face daily.

Taking antibiotics to prevent TD is generally not recommended because doing so can contribute to the development of antibiotic-resistant bacteria.

When you are travelling it is important to always be mindful of what you are eating and drinking.  We always forget simple things like not drinking or swallowing tap water when brushing teeth or showering, because we are so used to doing this at home.

  • Food
  • Don't consume food from street vendors and be wary of some of the places that a local tour guide may want to take you to.
    • If you are not comfortable eating in some of the shops or restaurants then just politely refuse.
    • More upmarket hotels are usually not a problem.
    • You may think that tour guides have your best interests at heart, but it can come down to what is commercially most beneficial for them.
  • Avoid unpasteurized milk and dairy products such as cheeses and ice cream.
  • Avoid raw or undercooked meat, fish and shellfish.
  • Be careful of eating from buffets unless it is in a reputable hotel and you know that the food has been freshly prepared.
  • Eat foods that are well-cooked and served hot. Be careful of consuming anything that has been made for large numbers of people, especially if you don’t know how long it has been there.
  • Stick to fruits and vegetables that you can peel yourself and have been thoroughly cooked where required.
  • Drink
  • Don't drink local tap water and avoid unsterilized water (from taps, wells or streams). If you need to consume local water, make sure that it has been well boiled.
  • Drink bottled water from a reliable source and make sure that you have sufficient with you when you are travelling around so that you do not need to buy from local street vendors. Sometimes street vendors refill bottles with ordinary tap water and even reseal the bottles!
  • Be aware that alcohol in a drink won't keep you safe from contaminated water or ice cubes, try to avoid locally made ice cubes or mixed fruit juices unless of course you are staying in a reputable hotel.
  • General Hygiene
  • Use bottled water to brush your teeth. If you do decide to use tap water for brushing your teeth then don’t swallow the water.
  • Make sure that any dishes and utensils that you are using for eating are clean and dry before using them, especially if you are having meals in smaller restaurants during your travels.
  • Wash your hands often and always do so before eating and after going to the toilet. If washing isn't possible, use an alcohol-based hand sanitizer to clean your hands before eat.

Finally, make sure that you have all of your medical insurance details and a contact number to call someone if you need medical assistance or treatment.  Although the hotels will often help it is good to have these details readily available to reduce any stress in the rare situation that you may need some help.

References

1Connor BA. Centers for Disease Control Yellow Book. Chapter 2: Travellers’ Diarrhea. 2018.

2Drakoularakou A, et al. A double-blind, placebo-controlled, randomized human study assessing the capacity of a novel galacto-oligosaccharide mixture in reducing travellers’ diarrhoea. Eur J Clin Nutr 2010;64:146–152.

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Bimuno® pastilles can help with the symptoms of travellers' diarrhoea if taken before & during travel.