Everything You Never Knew You Didn’t Want to Know About Traveler’s Diarrhea
After three months of dread-filled anticipation, it was in Kannur, India, at the ironically named “Hotel Happiness,” that I finally got what was coming to me. The first wave of nausea ripped me awake at about 2:45AM, and within a matter of seconds, I found myself hunkered over a concrete squat toilet, boxers around my ankles, spraying a fine cologne of black, stinging excrement out my backside. I then turned around, fell to my knees (my face only inches above the shit-stained toilet hole), and unleashed a greenish mélange of half-digested samosas and pungent stomach acid, sending a half dozen cockroaches scuttling away in fear. When the torrent eventually puttered to a stop, I wiped my face, crawled back to bed, and whimpered myself to sleep in the fetal position. It would only be two hours before another wave of nausea would catapult me back into that fart-locker of a bathroom and demand I repeat the whole process again at 5AM.
And then again at 6AM.
And then again at 8AM.
And then every two hours or so for the rest of the day.
The whole experience was as traumatic as it was expected, and the only real surprise was that it hadn’t happened sooner. As an international traveler, you run a 30-50% chance of experiencing Traveler’s Diarrhea, with an estimated ten million travelers waging battle against exotic toilet demons annually. If you happen to be a backpacker, traveling on a budget, for any period longer than a month, your chances of getting sick hover somewhere around 100%.
With such a high rate of occurrence, it’s shocking how much misconception and misunderstanding swirls around the topic of Traveler’s Diarrhea (a.k.a. TD, Delhi Belly, Montezuma’s Revenge, the Thai Two-Step, Mummy Tummy, the Gringo Gallop, Enterotoxigenic escherichia coli). Despite what you may have been told, you’ll never get the trots from exposing your fragile, white-boy tummy to foreign or spicy foods. Instead, TD is caused by microbial pathogens, with roughly 80% of all cases caused by a strand of bacteria known as enterotoxigenic escherichia coli, which can only be transmitted by the ingestion of human feces. And despite the horror stories you heard through the grape vine, TD is very rarely fatal, and enjoying mysterious street food shouldn’t be considered culinary Russian-roulette.
The unpleasant truth of the matter is that if you’re backpacking, you will inevitably suffer some gastrointestinal nightmare along the way. And when it happens, it will be in the most inconvenient place, at the most inconvenient (and retrospectively humorous) time. As a standard precaution, I always keep an Imodium tablet accessible in either my Money Belt or pocket. Many a good pair of underwear suffered a grisly demise for this lesson to be learned, so let their deaths not be in vain.
Always expect that you will get sick. Some backpackers think that by avoiding raw produce, undercooked meats, and street food, they diminish their chances of tummy malfunction. I find this cautious notion to be as misguided as it is sad. You might say this notion is ‘diarrhetarded.’ To sacrifice the opportunity to experience new, exotic foods would be to sacrifice one of the reasons we travel in the first place. Some of my most divine travel memories relate directly to street food. I’ll never forget my first falafel in Jerusalem, or haggling for a roasted sheep’s head in Marrakech. As long as the food is hot and there’s a crowd of locals, you shouldn’t think twice about digging in.
If you haven’t guessed, street food accounts for much of my diet on the road, and there have only been three or four times that this love affair has blown up in my face (and in the toilet, and once on the wall by accident). This low incident rate is not because I possess a stomach of steel. Instead, some researchers are finding that avoiding ‘dangerous foods’ has little impact on your likelihood of getting TD, and that there are broader transmission routes of bacterial pathogens in the environment—mainly hand-to-mouth contact. So perhaps it wasn’t that fried dumpling that made you weep acid tears out the backside, but instead the dirty, bacteria-laden hand you picked it up with, which you haven’t washed in over three days, you hippy. It doesn’t take a scientist to outline the importance of good hygiene and a liberal supply of hand sanitizer.
Accept the fact that you will get sick. In most cases, it will be mild, and you can continue your gallivanting with only the occasional sad trip to the bathroom. It’s only those more uncommon, severe cases, involving fever, nausea, vomiting, and malaise, that your plans will grind to a halt, and you’ll face a bed-sentence of one or two days (possibly more). In these situations, a little bit of savvy and preparation can have you back on your feet in no time:
To prepare for your long, solitary vigil on the toilet, you’ll need to stock up on lots of clean water and food; bananas, rice, and toast are ideal; dairy products, caffeine, alcohol, fried foods, and fatty meats are not. The key to a speedy recovery is to drink lots of clear fluids and replenish your electrolytes. Oral rehydration salts are highly recommended—good luck finding them though. If they’re unavailable, which they often seem to be in the third world, an acceptable alternative is Coca-Cola (not Pepsi, not Diet Coke), which contains an anti-anemic ingredient that calms your GI tract. Before drinking, shake the bottle several times to remove any remaining carbonation, which will make you puke faster than Lindsey Lohan at a stag party. The main disadvantage of drinking Coke is that it’s high in sugar (which aggravates the stomach), so limit yourself to only one or two sips an hour.
If your chocolate monsoon proves too much to handle, and you’re punishing the toilet more than four times in an eight hour span, considering calling in the cavalry: Ciprofloxicin. It’s Jesus in a pill; a gastrological atom bomb that slaughters nearly every living microbe unfortunate enough to reside in your intestines. Within a couple hours, you’ll feel significantly better. By the end of the day, you might just be back on the streets. If Cipro doesn’t yield results, if you encounter blood or mucus in your stools, high fever, or abdominal pain, and your symptoms persist for more than 72 hours: that’s bad. You might be dealing with a rare virus or protozoa, such as dysentery, cholera, giardiasis, and cryptosporidiosis, and you should seek medical attention immediately. If you fail to get treatment, diseases like cholera can turn life-threatening, and you risk dying alone in a hotel room, surrounded by bananas and Coke cans, sitting in a puddle of your own anal discharge.
At about 6PM, nearly fifteen hours after my first attack, I ran to the bathroom, gloomily mounted the toilet, and shook my fists to the heavens for the last time. The 250mg of Cipro coursing through my veins were starting to take control, and the next morning I would awake feeling refreshed and restored, while perhaps a little more cautious.
After checking out of my godforsaken hotel, I donned my pack and started walking in the vague direction of the train station. I needed to get out of Kannur.
After twenty minutes of walking, a burst of aromatic smoke arrested my progress, and I found myself standing transfixed before a grungy, roadside dhabba, where an old man sat frying onion bhajia in a cast-iron wok. Sure the man looked a bit crusty, and the swarms of flies were eating the snacks faster than the locals, but oh dear god, that heavenly smell… I reached for my wallet, but stopped myself. Was this chance of foodie bliss worthrisking another 24 hours of gastrointestinal torture? Was I mentally prepared for my rear end to once again explode into a terrifying rectal squirt gun?
Without a doubt in my mind, yes. I tossed the man a few rupees and claimed my greasy prize. If there were any repercussions in store, I simply didn’t care. For five glorious minutes, I sat on the curb happily eating bhajia out of a crumpled scrap of newspaper,watching the grimy whirl of Indian street life pass me by, and savoring every fecal-laden bite.
For more tips and tricks to living like a filthy vagabond, click the Backpackology 101 tab at the top of this page.
To hear my all-time most epic culinary backfire at a tribal market in Burma, check out the travel story The Wrong Pancake.
For an in-depth foodie exposé on the cuisine of India, check out Inhaling India: A Foodie’s Guide to India on a Budget