Fending off diarrhea

My method for avoiding intestinal problems when traveling involves a lot of little pink bismuth pills (Pepto-Bismol is one brand name).

Two or three days before going to a country where the purity of the tap water is questionable, I begin taking two pink pills three times a day, and I continue this routine during my trip and for two or three days after returning home.

For visits to Western Europe (or even California or on a cruise), I take one or two pills every morning. For visits to Southern or Eastern Europe, I take two pills in the morning and then two or three more during the day.

To date, I have had much less intestinal distress on this regimen than I frequently encounter at home. And, although I do drink bottled water, I have had absolutely no trouble eating nearly everything, including ice in my drinks and salads. It might not work for everyone, but it works for me.

Pittsburgh, PA

    On the suggestion in the above letter, ITN asked the professional opinions of its two Contributing Editors who are medical doctors.

Dr. Spira wrote, “While it is not a medical opinion, by any means, the opinion given seems reasonable and discusses an Over The Counter medication. I would point out that if a traveler winds up needing cipro or a related antibiotic, there could be reduced absorption of the medication because of the pepto. Also, pepto has salicylate, and people with aspirin allergies should not take it. Further, it can turn the tongue black like a chow dog’s!

Dr. Wagenaar wrote, “Over–the-counter bismuth salicylate (one brand name is Pepto-Bismol) has been used for years to treat diarrhea and to relieve the symptoms of an upset stomach. In past articles, I have mentioned that the drug also significantly aids in preventing and/or alleviating indigestion and diarrhea associated with the use of antibiotics.

Not only can the medication relieve symptoms, it can also be used prophylactically to prevent indigestion resulting from drinking water with a different mineral content. Starting this over-the-counter preparation a few days before traveling has been helpful in a number of people. The maximum allowable dose is 2 tablets 4 x daily.

It is unwise, even when taking this medication, to drink tap water or use tap-water ice in countries where the water supply is contaminated. Neither is it advisable to eat raw produce or improperly prepared, unpasteurized or contaminated foods in those countries. Foods arriving steaming hot at the table are generally all right.

Although it may help people with sensitive stomachs, there is no need to take this medication prophylactically when traveling in Western or Southern Europe, except perhaps in some areas in southern Italy or in places where the locals indicate that the water supply is not good.

Note that an upset stomach which does not respond to bismuth may respond to Imodium or Rolaids.
Bismuth salicylate is not an innocuous remedy. You should not take it if you are sensitive to salicylates. Never use it to treat nausea or vomiting in children or teenagers who have or are recovering from the flu or chickenpox (it may cause Reye’s Syndrome).

Bismuth salicylate may interact with blood thinners such as warfarin and heparin, with oral diabetic medications and with drugs that relieve pain and inflammation. They also may reduce the effectiveness of anti-gout drugs and tetracyclines. The medication may affect the following conditions adversely: dysentery, gout, hemophilia (or other bleeding disorders), kidney disease and stomach ulcer.