Prevention of Traveler’s Diarrhea



Travel is great. Traveler’s diarrhea is not! So whilst it might be fun to shop at markets and experience different food tastes, do remember the old “boil it, cook it, peel it or forget it” rule.

Traveler’s diarrhea (TD) is a common health complaint among travelers. Rates of TD can range from 5% to 50%, depending on the destination1. TD is acquired by ingestion of fecally contaminated food, water or other liquids. High-risk foods include raw or undercooked meats and seafood, unpeeled raw fruits and vegetables. Tap water, ice, non-pasteurized milk and other dairy products also can be of high risk. The riskiest sources of contaminated food are street vendors, farmers markets and small restaurants1.



The incubation period (time from exposure to the contaminated food or liquid to the beginning of symptoms) usually is 2–3 days. The major symptom is diarrhea (4–6 loose, watery or bloody bowel movements/d). The duration of TD usually is 2–6 days, if untreated. Other common symptoms are abdominal cramps and nausea. Vomiting and fever are less common1.

The best strategy to prevent TD is education and avoiding contaminated foods and liquids. As easy as this sound, most tourists do not follow these guidelines. Their focus usually is on their vacation and not food safety. Tourists often engage in riskier behaviors at exotic destinations than at home.

One of the reasons tourists become susceptible to illness is travel can disrupt the body’s normal defense mechanisms against infections. Stress, jet lag, unfamiliar foods and water and disrupted body rhythms can disturb the normally protective bacteria in the intestines. These protective bacteria usually fight off disease-causing bacteria and viruses by ‘‘colonization resistance.’’ Colonization resistance is a barrier effect that prevents attachment and colonization by harmful microorganisms. Probiotics are a promising therapeutic strategy for diseases that involve a disruption of normal microflora as they act by inhibiting pathogen attachment, enhancing the immune response and assisting in re-establishing normal microflora1.



Lallemand Health Solutions (LHS), a Canadian company with 80 years of expertise in probiotic research and development is introducing a Probiotic 2.0 formula, a combination of yeast and probiotics aimed at managing intestinal disorders.

The Probiotic 2.0 formula combines the well-known Saccharomyces boulardii yeast, extensively documented for its efficacy in diarrhoea prevention4, with three specific probiotic bacteria strains – Lactobacillus rhamnosus  Rosell-11 (R0011), Lactobacillus helveticus Rosell-52 (R0052), and Bifidobacterium longum Rosell-175 (R0175). Either alone or in combination, these three probiotic bacteria have been well documented for their effectiveness in protecting the gut and restoring a balanced microflora3. While exhibiting different modes of action in the gut, probiotic yeast and bacteria are complementary and allow for dual protection of the gut surface against pathogens. The “dual defence” capabilities of the probiotic combination have been demonstrated in an animal model of traveller’s diarrhoea (enterotoxigenic E. coli infection in rats). After two weeks of probiotic administration, the probiotic combination appeared to offer better protection against E. coli infection than the probiotic yeast or bacteria mixture separately, leading to reduced weight loss, stabilized body temperature, and reduced diarrhoea severity and duration2.



This probiotic combination has been successfully marketed in many countries (US, UK, Canada, France, Australia, to name a few) under different trade names, and several post-marketing clinical trials have been published.

A first trial, conducted by Grandy et al. in Bolivia in children hospitalized for acute rotavirus diarrhea, showed that the combination formula reduced the duration of diarrhea and therefore the time of rotavirus excretion, reducing at the same time the risk of transmission to other children5.

This probiotic combination is now being marketed by Vitamode Sdn Bhd and it is available in selected pharmacies nationwide.  It is recommended for reinforcing or restoring the intestinal barrier and for fighting intestinal infections, in particular traveller’s diarrhoea.





  1. McFarland LV. Meta-analysis of probiotics for the prevention of traveler’s diarrhea. Travel Medicine and Infectious Diseases, 2007 March; 5 (2): 97-105.
  2. Bisson et al., 2009. Preventive effects of different probiotic formulations on travelers’ diarrhea model in wistar rats. Dig Dis Sci. Apr;55(4):911-9.
  3. Foster, L.M., Tompkins,T.A. and Dahl, W.J. A comprehensive post-market review of studies on a probiotic product containing Lactobacillus helveticus R0052 and Lactobacillus rhamnosus R0011. Beneficial Microbes, December 2011; 2(4): 319-334
  4. Kelesidis T. Pothoulakis C. Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of gastrointestinal disorders. Ther Adv Gastroenterol, 2012; 5(2) 111–125
  5. Grandy G, Medina M, Soria R, Terán CG, Araya M. Probiotics in the treatment of acute rotavirus diarrhoea. A randomized, double-blind, controlled trial using two different probiotic preparations in Bolivian children. BMC Infect Dis. 2010 Aug 25;10:253.