We pack suncream, plug adaptors and painkillers for a holiday abroad. Yet the one thing we never prepare for our trip is the one thing most likely to ruin it – our gut.
Nothing derails a relaxing break faster than a stomach upset.
Your risk of picking up travellers’ tummy – normally transmitted via food and drink contaminated with bugs – varies according to where you go: around 40 per cent of visitors to Asia, Africa or Latin America, develop diarrhoea.
Even those going to less exotic locations may experience it.
But taking action, ideally a week or two before you go, can help prevent you being one of those statistics. The key is to boost the variety of microbes living in your gut (the gut microbiome). The more varied that community is, the better it is at keeping invading bugs out.
This is because a diverse microbiome collectively uses up the nutrients that pathogens such as salmonella need to get a foothold – it’s a bit like starving them out. No single microbe can do this alone, it takes the whole community working together. The good news is that your gut responds fast – a 2014 study published in Nature found that changing your diet can lead to a noticeable shift in the mix of gut microbes in just three to four days.
The key to avoiding travellers’ tummy is to boost the variety of microbes living in your gut as the more varied that community is, the better it is at keeping invading bugs out
To encourage more of the ‘good’ microbes to grow, focus on fibre – fill half your plate with veg at meal times and have a handful of nuts and seeds a day. Include fermented foods such as kefir or kimchi. You can also try taking a probiotic (friendly bacteria) starting a few days before your trip and continuing throughout. This one step may cut your risk of getting traveller’s diarrhoea by around 15 per cent, according to a review published in Epidemiology and Health in 2018, with a yeast probiotic called Saccharomyces Boulardii having some of the more consistent results.
Around 17 per cent of people who pick up a stomach bug abroad can go on to develop irritable bowel syndrome, reported the journal JAMA in 2015. That’s because the infection can damage the gut lining and disrupt the community of microbes – and for some people these changes can persist, leaving low-level inflammation in the gut and heightened sensitivity.
Prevention is better than cure, so remember the basics: wash your hands before eating and where you can stick to cooked food or fruit you have peeled yourself. Be more cautious with raw salads, ice and fresh juices as the fruit may have been washed in local tap water (it’s usually the water not the food that’s the problem). In a sit-down restaurant with good hygiene, a fresh salad is generally low risk as the kitchen staff are more likely to use filtered or treated water to wash it in. Save the extra caution for buffets and street stalls where food may have been sitting out in the heat for hours and bacteria can multiply quickly. If in doubt it’s also worth packing oral rehydration sachets just in case you get a nasty bout of diarrhoea that lasts more than a few days. These replace the electrolytes (salts that help keep your muscles, nerves and fluid balance working) that you lose. Get pharmacy sachets which have the right balance of salts rather than standard electrolyte drinks which are often little more than flavoured sugar water.
If you’re stuck, make your own by dissolving six level teaspoons of sugar and half a teaspoon of salt in a litre of clean or bottled water, and either blend in a banana, or eat one alongside it for potassium. It won’t taste great, but it will do the job until you can get to a pharmacy.
Most tummy bugs clear up on their own within a few days. But see a pharmacist or GP if you have a fever, blood in your stool, or symptoms last more than a week.
Be aware that in the early days after you recover you may find certain foods harder to handle. Dairy is a common one, as a gut infection can temporarily damage the lining of the small intestine, reducing its ability to digest lactose, the sugar in milk, though it usually resolves within a few weeks at most. Rich or fatty food can also be harder going.
While we tend to fear stomach bugs on our travels, many people have the opposite problem.
Dr Emily Leeming says that changing your diet can lead to a noticeable shift in the mix of gut microbes in just three to four days
Dr Emily suggests to be extra cautious when it comes to buffets, street stalls and anything that’s been sitting out in the heat
Not only do they become constipated, they feel bloated and sluggish from pretty much the moment they step off the plane until they get home.
That’s partly due to the drop in cabin pressure that occurs when you’re in the air which causes the gas in your gut to expand, leaving you feeling full and bloated although this normally eases soon after you land.
But it’s also because your gut works in close alignment with your body clock – it produces stomach acid and digestive enzymes in rhythm with your usual meal times. So when you eat outside of these times your gut isn’t fully ready to digest what hits it.
One way to minimise this is to switch your watch to the time of the destination as soon as you start travelling and only eat at their mealtimes. This will help your gut align with the new time zone a little faster.
Other factors in travel constipation include the fact that often, even if you’re eating well, fibre intake can quietly drop on holiday. Grilled fish and a simple salad by the seafront sounds like a healthy meal (and in many ways it is), but it doesn’t deliver much fibre which helps keep food moving through your gut.
Eating two kiwi fruits a day can be an easy fix, according to a 2023 study published in the American Journal of Gastroenterology. They’re high in fibre and contain an enzyme called actinidin that helps move things through.
A simpler option might be to travel with psyllium powder. Made from the seeds of the Plantago ovata plant, it works in a similar way to kiwi. Most pharmacies stock it and it is available without a prescription (though check with your doctor if you have a gut condition, as it may not be right for you).
Stir a teaspoon into a full glass of water and drink it once a day after a meal, building up to twice a day if needs be. But make sure you’re drinking plenty of water throughout the day, as psyllium needs fluid to work.
In fact, if you regularly struggle with constipation on holiday, you might want to try taking it about a week before you go, rather than waiting until things slow down.
Best wishes for a gut-happy holiday!
