Travelers’ diarrhea not improved by restricted diet

Travelers suffering from ’Montezuma’s revenge’ may not necessarily have to avoid tasty cuisine

Travelers suffering from “Montezuma’s revenge” may not necessarily have to avoid tasty cuisine. In a comparison of two groups of patients receiving antibiotics to treat travelers’ diarrhea, those who restricted their diet to broth and bland foods did not recover any faster than those who ate anything they wanted, according to an article in the August 1 issue of Clinical Infectious Diseases, now available online.

Travelers’ diarrhea is usually caused by a bacterial infection from eating contaminated food. Traditionally, patients with cases of travelers’ diarrhea have been advised to restrict their diet to clear liquids and simple carbohydrates, like crackers, toast, Jell-O, rice, bananas and baked chicken, and told to steer clear of dairy products and spicy or fatty foods.

However, research on diet in relation to recovery from travelers’ diarrhea was lacking, so University of Texas researchers compared two groups of 105 college students visiting Guadalajara, Mexico. The subjects in each group were receiving antibiotic treatment for diarrhea. One group was told to stick to the bland diet, and the other was given no restriction on what to eat, although both groups were advised to drink plenty of fluids to prevent dehydration. The results showed no real benefit to the diet restriction.

One reason for the two groups’ equally speedy recovery time was probably their general good health, said study co-author Dr. Herbert DuPont, a professor at the University of Texas Houston Health Science Center. “Travelers are a different group than children with cholera or people with viral gastroenteritis,” said Dr. DuPont, because they tend to be “young, healthy people with relatively normal intestinal physiology.”

Despite the similarity in the patients’ recovery time, the bland diet recommendation might still be advisable for some, especially if they did not take antibiotics to treat the diarrhea, according to Dr. Charles Ericsson, lead author of the study and Head of Clinical Infectious Diseases at University of Texas Houston Medical School. “The thought is that simple carbohydrates are easier to absorb during diarrhea and would be less likely to contribute to osmotic load and worsen diarrhea, and such a diet might speed the repair of the gut and avoid persistent symptoms,” Dr. Ericsson said. “The problem is that we do not know yet how to identify who might benefit from such a diet.”

The best way to cure travelers’ diarrhea is to seek antibiotic treatment, said Dr. DuPont, and to keep eating so that the diarrhea bout isn’t prolonged. “The intestinal tract has been injured,” he said. “It needs to grow back and needs to be provided with calories.” Dr. Ericsson agreed. “The contamination in food is like rolling dice. It is more important to accept some risk of diarrhea rather than starve,” he said.

To avoid getting travelers’ diarrhea in the first place, Dr. DuPont recommends food that is dry (bread or toast), is very high in sugar (syrup or honey), is highly acidic (citrus), is able to be peeled (fruit), or is freshly cooked. “Tell the waiter that you’re going to require everything served steaming hot,” said Dr. DuPont.