Keep your guts healthy on the trail!
Most trekkers can expect to get some form of intestinal upset at some point in their visit to Nepal. But sensible precautions will keep these common travel annoyances to a minimum. This advice all applies to food-borne bacterial illness and not to water-borne parasites. See our post on hydration and water safety for information about that. Above all, TALK TO YOUR DOCTOR before your trip and be well prepared with information and medications to keep you healthy.
Many stomach “bugs” are not food poisoning but are simply just different strains of the same bacteria (such as E. coli) that we all have normally in our guts. Mild cases of traveler’s diarrhea are often just the body reacting and adjusting to these new strains in a new place. Here is some advice on what has worked for us:
1. Carry Pepto-Bismol tablets. The moment you feel any grumbles or stomach unease, immediately chew 4-6 Pepto tabs. This will coat and calm the stomach, and the bismuth in Pepto has a mild antibiotic effect that can often nip any issues in the bud before they progress. Quite often, this is all is takes to set your stomach at ease right away.
2. If your grumbles progress to traveler’s diarrhea, try to let it run its course. A mild case will usually pass in a day or less. Carry a “kit” of tp, alcohol hand sanitizer, and bags to deposit your used supplies in the trash at the next village. (Never dump used tp by the trail.) Once it all passes, your insides are most likely in shape for the rest of the trip. Many people reach right for the immodium, but we recommend against this if possible. Immodium paralyses the guts, which goes against the body’s need to push the bad stuff out. As long as symptoms are not too bad, it’s better to let things run their course. Save the immodium for plane flights or other times when you really need to stop the symptoms for a certain period of time.
3. If symptoms become more severe, you might need to use stronger medications such as antibiotics. This should be a last resort and should only be considered if you are becoming weak and/or dehydrated, which can interfere with your acclimation to the altitude. Take a rest day if you can and stay hydrated. Antibiotics get overused and there are reports of some antibiotic resistance on the trekking routes, so don’t take a decision to treat with antibiotics lightly. The two most common antibiotic treatments are ciprofloxacin and azithromycin. But again, talk to your doctor before using any prescription medication! The few times we have ever resorted to antibiotics on the trail, our symptoms have rapidly cleared up. If antibiotics don’t work, you could have a non-bacterial parasite. These can be much more serious (though they are much more rare for anyone taking sensible precautions).
Finally, try to relax and don’t be too paranoid! Be sensible but don’t obsess. Thousands of people enjoy their treks, gut challenges and all.