One way to quickly stop your trip through India, is by acquiring traveler’s diarrhea or TD. It’s the most common illness affecting travelers, some 20%-50% of international travelers or 10 million persons, annually. While TD typically occurs within the first week of traveling, it can occur at any time while traveling and even after arriving back home. India is unfortunately one of the higher risk areas for developing TD. High-risk persons include young adults, immunosuppressed persons, persons with inflammatory-bowel disease or diabetes, and persons taking H-2 blockers or antacids. Men and women are affected similarly. The primary source of infection is ingestion of fecally contaminated food or water.

Common Symptoms

• Most TD cases begin abruptly.
• The illness usually results in increased frequency, volume, and weight of stool. Altered stool consistency also is common. Typically, a traveler experiences four to five loose or watery bowel movements each day.
• Other commonly associated symptoms are nausea, vomiting, diarrhea, abdominal cramping, bloating, fever, urgency, and malaise.
• Most cases are benign and resolve in 1-2 days without treatment. TD is rarely life-threatening. The natural history of TD is that 90% of cases resolve within 1 week, and 98% resolve within 1 month.

The List

10. Wash your hands regularly. I always carry a small package of wet naps for daily use. Wash basins are not always available and/or they may not provide soap. Hand sanitizers are OK in a pinch, however the alcohol causes drying in the hands.

9. Bum wipes and TP. The availability of TP in the majority of hotels below 3 stars is sketchy. Most road side stops are still without this Western practice. Choose to get familiar with the Indian way of cleaning up (spigot and hand) or travel with TP. For hygienic matters, moist bum wipes are a terrific item to neutralize bacteria. Follow up with a thorough hand washing.

8. Bring Pepto-Bismol or another bismuth subsalicylate for use either as a daily precautionary tool or after you suspect you may be at risk. My previous travel partner swore by Pepto. She chewed two tablets before each meal, every day claiming that kept her troubles away.

7. Expose your stomach to some friendly bacteria. The easiest, and tastiest, way is adding fresh curd to your meals. Curd is simply the Indian version of plain yogurt. It can be ordered and ingested by itself, or found in raita (sauce) and lassi (beverage). I typically start each day with a sweet lassi, and enjoy curd on the spiciest of foods.

6. Oily and spicy foods can play tricks with some travelers. If you’re not used to this type of food at home, trying these dishes while in India is not a suggested time to expand your palette. Go easy on the spices by making a simple request while ordering. Inquire with your server about which items are made with ghee or overly oily bases.

5. Stay hydrated. India’s climate and terrain varies widely and if you’re on the move frequently, your body needs constant replenishing. Skip the sugary energy drinks and carbonated soda (although safe to drink). Limit your alcohol intake. Just like at home, alcohol dehydrates the body.

4. Unpasteurized dairy products can be at increased risk for TD. Street vendors are notorious for unhygienic conditions so it’s best to steer clear. Exception: Chai tea with boiled milk has never given me problems, even from some of the dirtiest stalls.

3. Raw fruits and veggies are a no no unless you personally peel them. Exception: 5 star hotels cater to a business clientele, and as such you’ll find peeled fruits which are perfectly safe to eat. If shopping in the market, purchase fruits that can be peeled either by hand (oranges, bananas) or the skin can be removed with a clean knife (mangoes, apples). Vegetables should be thoroughly cooked.

2. Avoid eating raw or undercooked meat, poultry or seafood. After my first two trips, and two causes of severe sickness, I ditched the meat altogether. A strict vegetarian diet while in India works best for me. Pick your restaurants wisely for meat. Look for high volume spots where the food is most likely fresh and inventory is turned in short order.

1. Water: Always drink bottled water (mineral or drinking water). Ensure caps are still sealed before purchasing bottled water in the market. Do not allow the servers to open and pour your water at restaurants. Many 5 star hotels will alert you to their filtration systems if they deem them safe enough for digestion. As a general rule of thumb, avoid tap water, well water, streams & rivers and lake water. Keep your mouth closed during showers. Brush teeth only using bottled water. Avoid touching your mouth or tongue with wet hands. And remember, ice cubes are your enemy.

Additional Tips

Tourists should bring Immodium (or equivalent) if you find yourself in a location where facilities are not an option.

At minimum, one course of ciprofloxacin or norfloxacin. A 3-5 day course of Cipro is now commonly prescribed for knocking out the ill-effects of traveler’s diarrhea. Trimethoprim-sulfamethoxazole (Spetra) and doxycycline are no longer recommended because of the high level of resistance to these agents. Doxycycline is a popular prescription for anti-malaria so be sure to ask your medical professional for the correct anti-diarrheal drugs.

Pepto-Bismal or other bismuth subsalicylate can be used, follow directions on package. If symptoms continue, seek a medical professional for possible parasitic infection.

More Information

Center for Disease Control

World Health Organization