Gut Check
By Selene Yeager
Do you have the guts to dive? It has nothing to do with the quality of your character. We mean, quite literally, how healthy is that digestive system that winds its way from your cheekbones to your sit bones? Whether you're fending off the flames of raging heartburn or desperately trying to throw the brakes on a case of the runs, few things wreck an exotic dive trip more quickly than gastrointestinal woes.
Ironically, few things have the potential for throwing the gastrointestinal system out of whack like an exotic dive trip, says wilderness travel medicine expert, Michael Zimring, M.D., coauthor of Healthy Travel. "The gastrointestinal system is a delicately balanced environment. If you start popping meds for stomach acid, eating strange food, exposing it to foreign flora, and putting it under pressure, well, there could be some trouble-sometimes big trouble."
Starting from the top, here's a look at common GI complaints and how they impact your fitness to dive.
Heartburn
Many divers suffer the occasional bout of mild burning in the chest and throat from gastroesophageal reflux or "heartburn." A brief bout the night before a dive, say after a spicy Mexican buffet, shouldn't be a problem, so long as you're reflux-free by the time you step on the boat.
If you're prone to sudden or severe episodes of reflux, however, you should not dive. "Even if you feel fine walking around, some diving positions might trigger a backward flow of stomach contents into the lungs (aspiration), which can cause a life-threatening situation," says Zimring.
Occasional sufferers can stay heartburn-free by taking some precautionary steps the day before and the day of the dive.
Belly back from the bar. Alcohol relaxes the lower esophageal sphincter, a valve that keeps stomach acid in the stomach where it belongs and away from the esophagus, which, as you might guess, sets the stage for heartburn.
Snuff the smokes. Studies show esophageal acid exposure jumps 50 percent after a cigarette. If you can't quit forever, at least lay off the day of your dive.
Lighten up. Eat a little less than usual the night before a dive, concentrating on light carbs. The morning of your dive, eat a small, plain breakfast (like oatmeal and fruit) at least two hours before diving.
Wear the right size. Squishing your insides into a too-tight wetsuit leaves your stomach contents with nowhere to go but up. Your suit should be snug, not constricting.
Finally, if you manage reflux with medication like Zantac or Pepcid, be especially cautious about what you eat and drink while on vacation, warns Zimring. "Those meds work by reducing stomach acid, which is great, except you need stomach acid to kill the bacteria that cause traveler's diarrhea. The less acid you have, the more prone you may be to those problems."
Diarrhea
The Centers for Disease Control estimates that 20 to 50 percent of international travelers end up with traveler's diarrhea. It goes without saying that if you have a bad case of gastroenteritis-that's a good old-fashioned stomach bug-you should not dive until you're symptom-free.
The most common cause of traveler's diarrhea is the infamous E. coli bacteria, but sensitive stomachs can be thrown off-balance simply by being exposed to the normal flora found in a different place. Avoid skipping to the loo throughout your next trip by following the golden rules of food consumption: Boil it. Cook it. Peel it. Or forget it. "Stay away from all uncooked foods-rare steaks, sushi, salads, fruit cups, ice creams, shelled nuts, all of it!" says Zimring. Eat only those foods that are well-cooked and served hot or that come out of a can. Ditto for beverages. Stick to bottled water or carbonated soft drinks in bottles or cans and skip the ice.
If you're one of those people who gets the runs the minute you unsnap your suitcase in an exotic locale, Zimring recommends taking preventive action. "Ask your doctor for a prescription for an antibiotic like Cipro or Levoquin," he says. "This is only for special circumstances because we don't want to abuse antibiotics."
If despite your best efforts, you get diarrhea anyway, you may still be able to salvage your dive with a little Imodium A-D. It physically slows the digestive tract to control diarrhea. You're OK to dive when you're symptom-free and rehydrated (your urine is clear and copious). Do not take Imodium if you have a lot of painful cramping or blood or mucus in your stool. Those are signs of invasive diarrhea and you want to let those nasty bacteria escape without delay. You should also see a doctor.
Constipation
On the other side of the spectrum from diarrhea is constipation. "For most travelers, constipation is just a pain," says Zimring. "But constipation almost always means trapped gas, and every diver knows that trapped gas spells trouble. If you're diving and have a belly full of gas that has nowhere to go, you're going to have a painful problem."
The best treatment is prevention. Prepare your body for the trip by increasing your water intake for a few days before you leave. Before you leave, start increasing your fluid and fiber intake, focusing on plenty of water and eating whole grains, vegetables, salads, and fresh and dried fruit.
Once you reach your destination, maintain regularity by taking it easy on the rich, low-fiber continental breakfasts, fried foods and alcohol. Stay hydrated and try to get plenty of sleep.
Gas
The average person passes gas 14 times a day (yep, there are scientists who count). Bacteria in your intestines produce the gas (which is composed of nitrogen, carbon dioxide, hydrogen, methane and oxygen) as part of the normal digestive process. So long as it can escape, diving with a little gas shouldn't be more than slightly uncomfortable. Ascending from any depth with an excess of intestinal gas, however, can be extremely uncomfortable as it expands.
Classic gas producers include cruciferous veggies like cauliflower, broccoli and cabbage, as well as onions, beans, and, for some people, dairy products. Avoid these foods on the days you dive. If you're still concerned about the local cuisine, try popping a few Beano tablets, which contain enzymes that help you break down hard-to-digest, gas-producing foods.
Finally, minimize the amount of air you take into your system. Chew slowly. Go easy on carbonated beverages. And skip the sugarless gum. It contains a sugar alcohol called sorbitol, which is a notorious gas producer.
By Selene Yeager
Do you have the guts to dive? It has nothing to do with the quality of your character. We mean, quite literally, how healthy is that digestive system that winds its way from your cheekbones to your sit bones? Whether you're fending off the flames of raging heartburn or desperately trying to throw the brakes on a case of the runs, few things wreck an exotic dive trip more quickly than gastrointestinal woes.
Ironically, few things have the potential for throwing the gastrointestinal system out of whack like an exotic dive trip, says wilderness travel medicine expert, Michael Zimring, M.D., coauthor of Healthy Travel. "The gastrointestinal system is a delicately balanced environment. If you start popping meds for stomach acid, eating strange food, exposing it to foreign flora, and putting it under pressure, well, there could be some trouble-sometimes big trouble."
Starting from the top, here's a look at common GI complaints and how they impact your fitness to dive.
Heartburn
Many divers suffer the occasional bout of mild burning in the chest and throat from gastroesophageal reflux or "heartburn." A brief bout the night before a dive, say after a spicy Mexican buffet, shouldn't be a problem, so long as you're reflux-free by the time you step on the boat.
If you're prone to sudden or severe episodes of reflux, however, you should not dive. "Even if you feel fine walking around, some diving positions might trigger a backward flow of stomach contents into the lungs (aspiration), which can cause a life-threatening situation," says Zimring.
Occasional sufferers can stay heartburn-free by taking some precautionary steps the day before and the day of the dive.
Belly back from the bar. Alcohol relaxes the lower esophageal sphincter, a valve that keeps stomach acid in the stomach where it belongs and away from the esophagus, which, as you might guess, sets the stage for heartburn.
Snuff the smokes. Studies show esophageal acid exposure jumps 50 percent after a cigarette. If you can't quit forever, at least lay off the day of your dive.
Lighten up. Eat a little less than usual the night before a dive, concentrating on light carbs. The morning of your dive, eat a small, plain breakfast (like oatmeal and fruit) at least two hours before diving.
Wear the right size. Squishing your insides into a too-tight wetsuit leaves your stomach contents with nowhere to go but up. Your suit should be snug, not constricting.
Finally, if you manage reflux with medication like Zantac or Pepcid, be especially cautious about what you eat and drink while on vacation, warns Zimring. "Those meds work by reducing stomach acid, which is great, except you need stomach acid to kill the bacteria that cause traveler's diarrhea. The less acid you have, the more prone you may be to those problems."
Diarrhea
The Centers for Disease Control estimates that 20 to 50 percent of international travelers end up with traveler's diarrhea. It goes without saying that if you have a bad case of gastroenteritis-that's a good old-fashioned stomach bug-you should not dive until you're symptom-free.
The most common cause of traveler's diarrhea is the infamous E. coli bacteria, but sensitive stomachs can be thrown off-balance simply by being exposed to the normal flora found in a different place. Avoid skipping to the loo throughout your next trip by following the golden rules of food consumption: Boil it. Cook it. Peel it. Or forget it. "Stay away from all uncooked foods-rare steaks, sushi, salads, fruit cups, ice creams, shelled nuts, all of it!" says Zimring. Eat only those foods that are well-cooked and served hot or that come out of a can. Ditto for beverages. Stick to bottled water or carbonated soft drinks in bottles or cans and skip the ice.
If you're one of those people who gets the runs the minute you unsnap your suitcase in an exotic locale, Zimring recommends taking preventive action. "Ask your doctor for a prescription for an antibiotic like Cipro or Levoquin," he says. "This is only for special circumstances because we don't want to abuse antibiotics."
If despite your best efforts, you get diarrhea anyway, you may still be able to salvage your dive with a little Imodium A-D. It physically slows the digestive tract to control diarrhea. You're OK to dive when you're symptom-free and rehydrated (your urine is clear and copious). Do not take Imodium if you have a lot of painful cramping or blood or mucus in your stool. Those are signs of invasive diarrhea and you want to let those nasty bacteria escape without delay. You should also see a doctor.
Constipation
On the other side of the spectrum from diarrhea is constipation. "For most travelers, constipation is just a pain," says Zimring. "But constipation almost always means trapped gas, and every diver knows that trapped gas spells trouble. If you're diving and have a belly full of gas that has nowhere to go, you're going to have a painful problem."
The best treatment is prevention. Prepare your body for the trip by increasing your water intake for a few days before you leave. Before you leave, start increasing your fluid and fiber intake, focusing on plenty of water and eating whole grains, vegetables, salads, and fresh and dried fruit.
Once you reach your destination, maintain regularity by taking it easy on the rich, low-fiber continental breakfasts, fried foods and alcohol. Stay hydrated and try to get plenty of sleep.
Gas
The average person passes gas 14 times a day (yep, there are scientists who count). Bacteria in your intestines produce the gas (which is composed of nitrogen, carbon dioxide, hydrogen, methane and oxygen) as part of the normal digestive process. So long as it can escape, diving with a little gas shouldn't be more than slightly uncomfortable. Ascending from any depth with an excess of intestinal gas, however, can be extremely uncomfortable as it expands.
Classic gas producers include cruciferous veggies like cauliflower, broccoli and cabbage, as well as onions, beans, and, for some people, dairy products. Avoid these foods on the days you dive. If you're still concerned about the local cuisine, try popping a few Beano tablets, which contain enzymes that help you break down hard-to-digest, gas-producing foods.
Finally, minimize the amount of air you take into your system. Chew slowly. Go easy on carbonated beverages. And skip the sugarless gum. It contains a sugar alcohol called sorbitol, which is a notorious gas producer.
