Traveler's Diarrhea

A graphic image, I know! But when you’re talking about:

Montezuma’s Revenge
Delhi Belly
The Runs
The Trots
The Squirts
The Aztec two-step … 

It all makes sense.

“Travelers’ diarrhea (TD) is the most predictable travel-related illness. Attack rates range from 30% to 70% of travelers, depending on the destination and season of travel” (CDC 2013). TD is usually defined as 3 or more loose stools in 24 hours (Ashkenazi et al. 2016), sometimes with nausea/vomiting, cramps or fever. Bacterial and viral pathogens usually set in between 6 and 72 hours and protozoal pathogens rarely show up in the first few days, with a typical incubation period of 1-2 weeks (though there are exceptions to this) (CDC 2013).

Untreated, the bacterial diarrhea can last 3-7 days. Viral diarrhea 2-3 days. Protozoal diarrhea can stick around for weeks or months (Connor 2016)

Merson (et al. 1976) studied 73 physicians and 48 family members attending a medical conference in Mexico City in 1974, collecting fecal and blood samples before, during and after their trip. They found 49% developed traveler’s diarrhea, setting in about 6 days after arrival and lasting about 5 days.
(There are a few things that jump out from this study that may skew the results. Did they all stay and eat in the same locations? Those who did not get sick, did they alter their behavior in any way from their traveling companions who did get sick? Of the 49% who got sick, how many were related to one another? These and other questions were not addressed in this study.)

Mainstream advice on avoiding traveler's diarrhea

“Boil it, cook it, peel it or forget it” is one option. I once knew a man who traveled internationally frequently and he swore that if you added gin to your water, that would protect you from the dreaded traveler’s diarrhea. If these suggestions don’t work and something nasty manages to slip in to your system despite your best efforts, it’s very important to replenish the electrolytes (Ashkenazi et al. 2016). Ali (2019) found that in children with acute diarrhea, adding probiotics to the Oral Rehydration Solution (ORS) considerably reduced stool frequency.

In addition to ORS, the standard care for traveler’s diarrhea is antibiotics, sometimes prophylactically and sometimes after the fact, as well as anti-diarrheal medication. Antibiotics can certainly have side effects but, more importantly, “antibiotics used by travelers might result in significant changes in the host microbiome as well as the acquisition of multidrug-resistant bacteria” (Riddle and Connor 2019). For example, post-infectious irritable bowel syndrome may occur in 3-17% of patients following traveler’s diarrhea (Steffen et al. 2015).

A popular anti-diarrheal is Loperamide, AKA Imodium. Drugs.com tells us it is a nonprescription opioid that primarily affects opiate receptors in the intestines to treat diarrhea, which commonly results in constipation, nausea, flatulence, dry mouth, abdominal cramp and vomiting. Loperamide is also known to result in cardiac arrest (Wu and Juurlink 2017) though it is considered “relatively safe at therapeutic doses.” 

How do we avoid this awful predicament?

The worldwide lockdown of the last almost two years certainly is one answer, but staying home 24/7 is not a good option, in my opinion. There’s a whole big world out there with people and places to see!

If you have read any of my articles before, you already know my answer to this problem… Homeopathy!

Fortuoso (et al. 2019) used a homeopathic product (referred to only as Dia 100 in the study, a trademarked remedy with no further information provided), on newborn lambs. The E.coli counts were significantly lower in the stools of the lambs treated with homeopathy and those lambs were able to make “better use of their nutrients, contributing to their immune responses.” (Fortuoso (et al. 2018) completed a similar study with calves. Camerlink (et al. 2010) found similar results in piglets using Coli 30K.)

Jacobs (et al. 1994) found a statistically significant shortening of duration and number of stools per day of diarrhea in children using individualized homeopathy as compared to placebo.

Whether gut issues now exist because one suffered from TD or if gut issues exist following antibiotic use, Uchiyama-Tanaka (2018) found the use of homeopathic bowel nosodes to be effective in 69.6% of patients in a small study of dysbiotic* Japanese patients. ​

Homeopathic Arsenicum album 200c, taken at the beginning of any diarrhea is very effective (Banerji and Banerji 2013, p. 66).

The Banerjis also recommend a couple of cell salts to help with the dehydration that will most likely accompany TD or food poisoning or other causations of prolonged diarrhea: Natrum muriaticum 6x and Kali phos 6x, taken together, every three hours.

Why Arsenicum album?

In addition to the studies referenced above, homeopathic Arsenicum album is noted for its anxiety, restlessness, exhaustion and burning pains. Sudden weakness, sudden intense effects, and “even stupor is interrupted by fits of restlessness with anxious moaning” (Murphy n.d.).

As for Arsenicum album’s connection to food poisoning, it is known to help ill effects from bad food and “injurious effects of fruits, especially more watery ones” (Murphy).

On the mental and emotional plane, Arsenicum album is noted when there is a fear of death and disease and “fixed ideas, hallucinations of smell and sight”  — when you can’t stand the sight or smell of food. Have you ever suffered food poisoning and you can’t get the image or the smell of what you ate out of your mind?

Arsenicum album has been studied, homeopathically speaking, since the days of Samuel Hahnemann, the founder of homeopathy. “He despairs and weeps, and imagines no one can help him, that he must die; he is cold and chilly, and afterwards generally weak” (Hughes et al. 2011, referencing Hahnemann’s findings). When you are in a hotel room, a hotel bathroom in particular, and experiencing these dreaded symptoms, homeopathic Arsenicum album might just be your new best friend.

Arsenicum album, don’t leave home without it.**


Julia Coyte, CHom
Classically Practical homeopath


#wellnessawaits



* Dysbiosis is an unhealthy change in the normal bacterial ecology of a part of body, e.g., of the intestines or oral cavity (Venes and Clarence Wilbur Taber 2013).

** There’s a well-known credit card company that begins with A and has the same number of syllables in their name. Their ad campaign back in the 1970s was “… don’t leave home without it.”

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Reference list
Ali, R., 2019. The Use of Probiotic with ORS and ORS Only in Children with Acute Diarrhea. Journal of the College of Physicians and Surgeons Pakistan [online], 29 (12), 1179–1182. 

Anon., 2012. Loperamide [online]. PubMed. 

Ashkenazi, S., Schwartz, E., and O’Ryan, M., 2016. Travelers’ Diarrhea in Children: What Have We Learnt? The Pediatric Infectious Disease Journal [online], 35 (6), 698–700. 

Banerji, P. and Banerji, P., 2013. The Banerji protocols : a new method of treatment with homeopathic medicines. India: Pratip Banerji.

Camerlink, I., Ellinger, L., Bakker, E. J., and Lantinga, E. A., 2010. Homeopathy as replacement to antibiotics in the case of Escherichia coli diarrhoea in neonatal piglets. Homeopathy [online], 99 (1), 57–62. 

CDC, ed., 2013. Travelers’ Diarrhea | Travelers’ Health | CDC [online]. Cdc.gov. 

Connor, B. A., 2016. Travelers’ Diarrhea - Chapter 2 - 2020 Yellow Book | Travelers’ Health | CDC [online]. Cdc.gov. 

Drugs.com, ed., 2021. Imodium Side Effects: Common, Severe, Long Term [online]. Drugs.com. 

Fortuoso, B. F., Gebert, R. R., Griss, L. G., Glombovisky, P., Cazarotto, C. J., Rampazzo, L., Stefani, L. M., Ferreira, E. B., and da Silva, A. S., 2019. Reduction of stool bacterial counts and prevention of diarrhea using an oral homeopathic product in newborn lambs. Microbial Pathogenesis [online], 127, 347–351.

Fortuoso, B. F., Volpato, A., Rampazzo, L., Glombowsky, P., Griss, L. G., Galli, G. M., Stefani, L. M., Baldissera, M. D., Ferreira, E. B., Machado, G., and da Silva, A. S., 2018. Homeopathic treatment as an alternative prophylactic to minimize bacterial infection and prevent neonatal diarrhea in calves. Microbial Pathogenesis [online], 114, 95–98. 

Hahnemann, S., 2015. Chronic diseases, their particular nature & their homoeopathic cure. Referenced through Radar Opus 2.2.16. New Delhi: B. Jain.

Hughes, R., Timothy Field Allen, and Al, E., 2011. The encyclopedia of pure materia medica : a record of the positive effects of drugs upon the healthy human organism. Accessed via Radar Opus 2.2.16. New Delhi: B. Jain.

Jacobs, J., Jiménez, L. M., Gloyd, S. S., Gale, J. L., and Crothers, D., 1994. Treatment of acute childhood diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua. Pediatrics [online], 93 (5), 719–725. 

Merson, M. H., Morris, G. K., Sack, D. A., Wells, J. G., Feeley, J. C., Sack, R. B., Creech, W. B., Kapikian, A. Z., and Gangarosa, E. J., 1976. Travelers’ Diarrhea in Mexico. New England Journal of Medicine [online], 294 (24), 1299–1305.

Murphy, R., n.d. Homeopathic Remedy Guide. accessed through Radar Opus 2.2.16.

Rafferty, A. and Kayne, S., 1994. The use of Arsenicum album 30c to complement conventional treatment of neonatal diarrhoea (“scours”) in calves. British Homeopathic Journal [online], 83 (04), 202–204.

Riddle, M. S. and Connor, B. A., 2019. Perspectives: Antibiotics in Travelers’ Diarrhea - Balancing the Risks & Benefits - Chapter 2 - 2020 Yellow Book | Travelers’ Health | CDC [online]. wwwnc.cdc.gov.

Riddle, M. S., Connor, B. A., Beeching, N. J., DuPont, H. L., Hamer, D. H., Kozarsky, P., Libman, M., Steffen, R., Taylor, D., Tribble, D. R., Vila, J., Zanger, P., and Ericsson, C. D., 2017. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. Journal of Travel Medicine [online], 24 (suppl_1), S63–S80. 

Steffen, R., Hill, D. R., and DuPont, H. L., 2015. Traveler’s Diarrhea. JAMA [online], 313 (1), 71. 

Uchiyama-Tanaka, Y., 2018. Case Study of Homeopathic Bowel Nosode Remedies for Dysbiotic Japanese Patients. Journal of Alternative and Complementary Medicine (New York, N.Y.) [online], 24 (2), 187–192. 

Venes, D. and Clarence Wilbur Taber, 2013. Taber’s cyclopedic medical dictionary. [22nd ed., ISBN: 9780803629776]. Philadelphia, Pa.: F.A. Davis.

Wu, P. E. and Juurlink, D. N., 2017. Clinical Review: Loperamide Toxicity. Annals of Emergency Medicine [online], 70 (2), 245–252. 
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