BiotiQuest® Gut Health & Probiotics Blog with Martha Carlin

How To Get Ahead of Traveler's Diarrhea With Travel Probiotics

Martha Carlin | Oct 26, 2022 | 9 minutes read

Planning a trip abroad after the pandemic? Don't forget a plan for supporting your gut health too! Travel Probiotics can potentially save you a lot of misery because of uninvited traveler's diarrhea (TD).

One of the biggest gut health tips for everyday life and especially traveling is to keep your belly happy with the right probiotics. A happy gut supports a healthy immune system and can help in keeping your digestive health in top shape to support a healthy barrier against tummy troubles.

Traveling to hotter climates and trying different foods can create challenges to your normal gut flora. The right probiotic supplement may act to support your normal flora to help fend off food poisoning or traveler's diarrhea and let you enjoy the exotic sights, instead of spending time on the porcelain throne.

What is traveler's diarrhea (TD)?

Traveler's Diarrhea is having three or more loose¹ stools in a day with one or more additional symptoms such as nausea, abdominal pain, vomiting, bloating, and black or bloody stools while you're traveling abroad or within 10 days after you’ve returned home.

Traveler's Diarrhea (TD) is one of the most common² travel-related GI responses.

Traveling not only introduces you to new sights and cultures, but it also introduces live cultures of microorganisms to your gut that your internal ecosystem isn’t used to. Harmful bacteria and parasites are responsible for up to 90%¹ of travelers' diarrhea.

Staying healthy while traveling can be challenging, as maintaining preferred habits such as eating organic or remembering to drink only bottled water since open water sources and tap water can be full of contaminants³, can be difficult.

Why do you get traveler's diarrhea?

When bad bacteria such as Escherichia coli (E. Coli), Salmonella, Campylobacter, or Shigella, viruses such as rotavirus or norovirus, and parasites such as Entamoeba histolytica or Giardia lamblia enter your gut through contaminated food or tap water, they can lead¹ to traveler's diarrhea.

What is the most common cause of traveler's diarrhea?

Pathogens¹ such as bacteria, viruses, and protozoan parasitescause up to 85% of traveler's diarrhea incidences. Of the total cases of TD, 90% are caused by bad bacteria whereas viral pathogens and protozoan parasites are responsible for the last 10%.

Escherichia coli (E. coli) is the most common bacterial cause of traveler's diarrhea and is largely contracted from consuming contaminated food and water. Enterotoxigenic E. coli (ETEC), which can be responsible for 30% to 60%⁴ of all cases of TD, works by colonizing the surface of the small intestine and producing enterotoxins⁵.

Enterotoxins are harmful proteins that can cause damage to the intestinal cells. ETEC can produce one or both of heat-labile (LT) and heat-stable (ST) enterotoxins. The presence of enterotoxins causes the intestinal cells to release chloride ions followed by water, sodium, and other electrolytes⁵. Although the colon reabsorbs some of this electrolyte rich fluid, the rest is expelled as watery diarrhea.

Learning about Traveler's Diarrhea and its harmful effects may lead you to consider taking preventative antibiotics. The setback with antibiotics is that they do not distinguish between good and bad bacteria. Antibiotics not only kill the bad bacteria but will also kill the good gut flora that you need to keep pathogens in check. Which in turn can lead to side effects such as antibiotics-associated diarrhea⁶, a common effect of antibiotics therapy.

Precautions to take to keep your gut healthy while traveling abroad

Vacations can be a time to let loose for some people, and that can easily turn into trying out exotic foods, drinking alcohol, and late nights. It’s best to take some tried and tested precautions to safeguard yourself against an unwanted bout of traveler’s diarrhea.

Taking probiotics before, during, and after travel can support your natural immunity and overall gut to deal with the invasion of infectious pathogens like E. coli and avoid unwanted stomach issues.

Some tips to keep your gut healthy while traveling are:

How can travel probiotics help?What are probiotics?

Wash your hands frequently with soap and use an alcohol-based sanitizer when hand washing is unavailable.
Eat freshly cooked meals and freshly peeled fruit and ask where the food comes from.
Don’t eat salads or fruits that cannot be peeled unless you know that they have not been washed in tap water and can confirm their safety. Be especially careful at salad bars and food buffets.
When on the go, eat dry foods and drink bottled water.

Avoid eating raw seafood, undercooked meat, and cooked food that's been left at room temperature.
Avoid unpasteurized dairy, cream-filled desserts, ice cubes, tap water, and raw leafy greens in salads when you’re not sure if or how they’ve been washed.
Try new foods only at restaurants that follow good hygiene practices.
Take a probiotic to proactively support your microbiome.

The word probiotic originates from the Latin pro meaning 'for' and the Greek bios meaning 'life'. WHO defines probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host.”

The study of probiotics⁷ has come a long way since Louis Pasteur first identified the microorganisms responsible for the process of fermentation. The human gastrointestinal tract is a complex ecosystem colonized by trillions of microorganisms.

Your gut microbiome is unique to you and, over time, evolves with you. The intestinal microbiome plays an important role in maintaining the mucus protective barrier. The protective barrier acts as the first line of defense in protecting you from an attack from harmful pathogens and food toxins.

The beneficial bacteria present in the mucous layer⁸ facilitate an exchange of nutrients at the intestinal wall, prevent infections by intestinal pathogens, and modulate the normal immune response to pathogens and toxins.

escherichia coli, Lactobacillus ruminis strains

Pictured above, left to right: Escherichia coli, Escherichia coli after adding Lactobacillus ruminis

An imbalance or alteration in the intestinal microbiome can make you susceptible to disease and infections of the GI tract. Introducing specific probiotic strains at appropriate doses, usually equal to or over 10 billion⁹ colony-forming units (CFU) of helpful live cultures of bacterial strains such as Lactobacillus Plantarum¹⁰, Bifidobacterium Longum¹¹, Bifidobacterium Bifido¹², and Lactobacillus reuteri, have shown efficacy in reducing the duration of diarrhea and maintaining a healthy gut.

What happens when you start taking probiotics?

When you take a probiotics supplement, you're introducing a live culture of potentially new bacterial strains to your digestive system. This can sometimes lead to gas, indigestion, bloating or an upset stomach as your GI tract gets used to the new strains and they become a part of your microbiome.

Any potential side effects of introducing new probiotics to your gut will generally ease up in a few days or weeks. If you're considering probiotics for travel, starting them a few weeks before you travel would give you the best results.

Why should you consider probiotics for travel?

Over 45 million¹³ people traveled overseas from the US in 2019, and of these 45 million, traveler's diarrhea affected roughly 10% to 40%¹.

If you want to have the best digestive health while you travel abroad, travel probiotics can prepare your gut for your upcoming trip. Probiotics have leaped from being found in fermented food to being readily available in functional foods such as yogurt (Streptococcus thermophilus), and probiotics supplements can give you the best of these friendly bacteria.

The right probiotic for you may contain one or more selected microbial strains. Taking a probiotic daily before and during your trip can prepare your gut for traveling.

Aside from putting a break on your sightseeing plans, traveler's diarrhea can also lead to long-term health challenges that can become difficult to overcome. According to a meta-analysis published in Gastroenterology¹⁴ in 2017, travel diarrhea can add significantly to the risk of post-inflammatory IBS (PI-IBS). Approximately 1% of affected individuals¹ have diarrhea that persists for longer than a month.

The advantage of taking daily probiotics lies in the development of your gut bacteria to maintain a healthy balance between pathogens and beneficial bacteria that will support your digestive system.

Do probiotics work for travelers' diarrhea?

An imbalance or alteration in the intestinal microbiome can make you susceptible to infections of the GI tract, Inflammatory Bowel Disease (IBD), and Irritable Bowel Syndrome (IBS).

There is an ongoing body of study and research into probiotics and the effects they might have on your gut. A 2018 review and meta-analysis published in Frontiers in Medicine¹⁵ included 228 trials and found evidence of strain-specific effectiveness for probiotics such as Lactobacillus reuteri 55730.

Several studies¹⁶ have investigated the efficacy of probiotics in the prevention and treatment of travelers' diarrhea in adults. Introducing select probiotic strains¹⁶ at doses equal to or more than 10 billion colony-forming units (CFU) such as L. reuteri has been found to reduce the duration of acute diarrhea by a day.

(Figure 2, McFarland et al., 2018)

Although results vary because of differences in the type of probiotic strain being investigated and differences in doses, strains such as B. longum, L. plantarum,B. bifidum^10,12 seem to exhibit significant efficacy¹⁶ in reducing the duration of diarrhea.

Should you take probiotics before traveling?

To support your immune system before you start traveling, consider taking probiotics at least two weeks before beginning your trip so that the probiotics have time to get acquainted with your gut bacteria and establish themselves as part of the team.

Whether you’re eating functional foods or taking a supplement, probiotics will need time and prebiotic support to affect your intestinal tract. Continuing your probiotic journey throughout your traveling and after your return will help you maintain the supportive effects of probiotics as TD symptoms can show up as late as two weeks after¹ contracting the pathogen.

Should you take probiotics if you have traveler’s diarrhea?

Probiotics such as Lactobacillus rhamnosus GG, Lactobacillus acidophilus, and Saccharomyces boulardii have shown efficacy in the prevention of TD and suppression¹ of pathogenic microbes.

Lactic acid bacteria such as Leuconostic mesenteroides and Pediococcus acidilactici¹⁷ produce bacteriocins–heat-stable proteins that have an antimicrobial effect¹⁸. Bacteriocins help in inhibiting the growth of pathogens and degrade toxins.

According to this meta-analysis of 63 studies¹⁹, probiotics helped decrease the duration of diarrhea by a day.

Which are the best probiotic strains for travel constipation?

Travelers not only have to brave the risk of traveler diarrhea, but they also have to be prepared for traveler's constipation.

Constipation affects²⁰over 15% to 20% of adults worldwide and is predominant in females. Often when you experience constipation while traveling, it’s due to changes in your activity levels, water, diet, and sleeping patterns.

The general advice for traveler’s constipation will point you towards adding more fiber to your diet or drinking more water. It’s good advice but sometimes you might need just a bit more support to get you going.

(Figure 1, Tabbers et al., 2011)

A review²⁰ of 559 articles suggests that a lower number of Bifidobacterium and Lactobacillus species can result in constipation. Taking probiotics supplements rich²¹ in Lactobacillus and Bifidobacterium species can be a helpful way to increase stool frequency.

Which are the best probiotic strains for male and female constipation?

Changing levels of progesterone and estrogen might be contributing factors that make females twice as likely²² to experience constipation as males.

A 2020 meta-analysis of 15 controlled trials²³ published in Clinical Nutrition, found that multi-species probiotics strains that include Bifidobacterium, Lactobacillus, and Streptococcus strains are more effective in increasing stool frequency and easing the symptoms of constipation than single-strain probiotics in both males and females.

Here at BiotiQuest, we’ve developed a proprietary BiofluxTM Model, the first of its kind that analyzes how different bacterial strains work together and the by-products they produce. Carefully selected multi-species probiotics²⁴ such as Lactobacillus plantarum and Bifidobacterium bifido in Ideal Immunity and Sugar Shift can cohesively work towards supporting a healthy immune system.

What are the best probiotics for traveler's constipation?

According to a 2017 review published in Advances in Nutrition⁹, adults with constipation show a significant lack of bifidobacteria and lactobacilli in their stool samples. These are the species most commonly found in fermented foods around the world and have a long history of supporting a healthy gut and regular bowel movements.

Our Sugar Shift probiotics formula consists of probiotic strains such as bifidobacterium bifidum, Bacillus subtilis (VDE111®), Bifidobacterium longum, Lactobacillus plantarum, Lactobacillus reuteri, Pediococcus acidilactici (TBC0068™) and many more. Each of these strains supports a healthy gut lining and improves bowel irregularity²⁵.

Bacteria are competitive and they produce bacteriocins to inhibit the growth of bad bacteria. Ideal Immunity is rich in strains like Lactobacillus ruminis²⁶and Lactobacillus plantarum²⁷that have exhibited an inhibitory effect on pathogens such as Listeria monocytogenes and Salmonella typhi.

Consuming a mix of selective probiotic trains that have been designed to work together each day may help in increasing gut motility, decrease gut transit time²⁸ by roughly 12 hours and improve other constipation-related symptoms.

Best probiotics for traveling abroad

The best probiotics for traveling abroad should give your immune system just the boost it needs to fight off food-borne tummy issues as well as suppress the growth of pathogenic microbes, and maintain gut motility to protect you from travel constipation.

Probiotics can support your health by producing bacteriocins that kill pathogens and by-products such as short-chain fatty acids like butyrate that support your colonic enterocytes, aka a healthy gut lining. Probiotics compete with bad bacteria to stick to the gut ²⁹lining and enhance the gut barrier function. Our Ideal Immunity formula was designed to help keep your gut microbiome balanced and ready to combat foreign pathogens.

What to look for in the best probiotic supplement for international travel?

If you travel frequently, then you may have considered using prophylactic or preventative antibiotics to deal with potential traveler's diarrhea. But according to CDC³⁰, prophylactic antibiotics can alter your intestinal microbiome in a way that can be difficult to come back from.

How to choose the best travel probiotics for frequent travelers?

Traveling can be full of stress and changes, so ideally you want a probiotic that travels well and does not need to be refrigerated.

Antibiotics do not differentiate between good and harmful bacteria and, as a result, reduce the population of healthy bacteria and pathogens. If you do need to take antibiotics for any reason during or after your travel, our Antibiotic Antidote formula helps create the right environment to support your gut and enable friendly bacteria to flourish again as your body rebuilds its ecosystem.

Probiotics for travel can keep your gut balanced, support a healthy immune system, and prepare your microbiome before traveling abroad to protect against future tummy issues.

Taking a daily probiotic before travel, during the length of your vacation and after you've returned home can support a healthy mucous lining to deal with the invasion of different strains of bacteria, viruses, yeasts, and protozoan parasites that you may encounter during your time away.

How to choose the best probiotics for international travel?

Before you decide on a travel probiotic to take care of your digestive health, let's answer some common questions about probiotics.

At what temperature should you keep your probiotics?

Dry powdered probiotics can stay stable for up to 24 months at ambient or room temperature. Shelf-stable probiotics that are packaged to withstand heat and moisture offer a stress-free, easy way to take your travel probiotics with you.

Do probiotics need to be refrigerated?

Here at BiotiQuest, our probiotics are designed to be shelf-stable at room temperature. Refrigeration will increase the life of the product but is not required to maintain CFU counts. If you are traveling to a very humid area, make sure to retain the small desiccant pack included with your products as this little packet is designed to absorb moisture and keep your probiotics stable.

How many colony-forming units (CFU) should a probiotic supplement have at the end of its shelf life?

Quality probiotics can have a range of Colony Forming Units (CFU)³¹ per dose. However, the CFU count isn’t a good indicator of the quality or effectiveness of the probiotic supplement. Rather, it is the specific strains and their bacteriocin production against pathogens that are important to look for.

Which probiotics are best when traveling to India or Mexico?

Hot and humid climates can be hotbeds for food-borne illnesses³² because bacteria thrive in such environments. If you're traveling to India or Mexico in the summer, before or during monsoon, be sure to take probiotics that at least have the Lactobacillus and Bifidobacterium strains, as both have shown strong efficacy in the prevention of traveler's diarrhea.

How to travel with probiotic supplements that need refrigeration?

Different probiotic strains have different storage requirements. Some probiotics that survive being freeze-dried and packaged to be shelf-stable can be a convenient option while you're traveling but if you’re set on probiotics that need refrigeration, you could carry them in an insulated carrier box lined with ice packs to maintain their temperature.

Needing to keep probiotics refrigerated while traveling can add undue stress to an otherwise great vacation. Always trying to make sure that your probiotics are at the right temperature can be hectic and there are plenty of quality options that do not require refrigeration.

Will you give probiotics for travel a try?

Probiotics can be the best kind of traveling partner!

Multi-strain probiotics such as Ideal Immunity, Antibiotic Antidote, and Sugar Shift have been designed to support your gut health and a healthy immune system.

Probiotics have shown that they not only produce beneficial short-chain fatty acids such as butyrate³³ but they also produce bacteriocins that inhibit the growth of or even kill bad bacteria.

Let travel probiotics help prop up your immune system against the dual threats of traveler's diarrhea and constipation so that you remember your trip abroad for its happy experiences.

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With gratitude,

Martha Carlin, is a “Citizen Scientist”, systems thinker, wife of Parkinson’s warrior, John Carlin, and founder of The BioCollective , a microbiome company expanding the reach of science and BiotiQuest, the first of it’s kind probiotic line. Since John’s diagnosis in 2002, Martha began learning the science of agriculture, nutrition, environment, infectious disease, Parkinson’s pathology and much more. In 2014, when the first research was published showing a connection between the gut bacteria and the two phenotypes of Parkinson’s, Martha quit her former career as a business turnaround expert and founded The BioCollective to accelerate the discovery of the impact of gut health on all human disease. Martha was a speaker at the White House 2016 Microbiome Initiative launch, challenging the scientific community to “think in a broader context”. Her systems thinking background and experience has led to collaborations across the scientific spectrum from neuroscience to engineering to infectious disease. She is a respected out of the box problem solver in the microbiome field and brings a unique perspective to helping others understand the connections from the soil to the food to our guts and our brains.

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