International Travel with IBS
Whenever I tell my patients I'm going on a trip, they often exclaim, “But how do you travel with your IBS?!” So I thought it was high time I wrote this post to share some tips that allow me to enjoy traveling while keeping my IBS under wraps. I love traveling, it’s in my blood, I can’t stay put for more than a few months at a time. When I pack my bags for a trip, I wish I could leave behind my IBS too! But since there is no cure, I have to focus on the things that I can control. So with some advanced planning, I can ease my anxiety, minimize my symptoms, and fully enjoy my trip!
Fortunately, from past experiments, I have found that the combination of a modified low FODMAP diet, fiber supplementation, and managing stress are good ways to keep my IBS under control. And even though I swore I’d never go back to Mexico due to a disastrous IBS related honeymoon, cheap plane tickets and a yearning for warm ocean air lured me into going to Puerto Vallarta recently!
Mexico isn’t the easiest place to travel when onion and garlic are two of your biggest digestive triggers, but because I was traveling to a major tourist destination, most of our wait staff spoke relatively good English, so it wasn’t too hard to ask for what I needed. I also tend to rent a house or condo when traveling so I can prepare at least some of my meals at home, in particular breakfasts, lunches, and snacks. This allows me to keep my digestive triggers threshold low during the day so I can splurge a little more when I go out to eat for dinner.
As I mentioned, preparation is key to successfully traveling with IBS. So before we left, I packed my carry-on suitcase full of snacks, a loaf of gluten free bread, and certain supplements like fiber and protein powder because I knew that it might be difficult to find those items in Mexico. By preparing, I was trying to avoid getting stuck out while starving, as that combination tends to lead to poor food choices. I also brought my "IBS toolkit" which includes lactase and digestive enzymes, Chewable Gas-X (soft gels contain sorbitol), a heating pad, and Immodium so that I could manage a flare if I had one.
Airports are typically a hard place to find low FODMAP meals, so I usually snack my way through the airport. People have often asked me how I get through customs with food items, but to this point I haven’t had any problems with that. I know you aren’t allowed to bring fresh produce into many other countries so I never bring it in. I also label my various powders (fiber, protein powder), and be sure to put them in my checked bag to be on the safe side.
Our first day in Puerto Vallarta, we located a grocery store, but I had some trouble finding any of my usual foods there, especially any gluten free items or even rice milk, and I couldn’t find any real Greek yogurt. But I did find lactose free milk there (which I learned is called “deslactosada”!) so I bought some to use for my morning smoothies. We stocked up on some other basic items while we were there too. And then we stopped by a little produce market where we bought some fresh tortillas, Oaxaca cheese, avocado and tomatoes so I could make quesadillas for lunch the next day!
As a side note, a few days after getting settled in, we met a local “snow bird” from Colorado who told us about a huge grocery store where we might find more specialty items. This was way more helpful than the Google searches I did! The dietitian nerd in me had so much fun wandering around that store to see what products they carried and also to try to figure out what some things were. I was thrilled to find they even had the brand of lactose free kefir that I often drink at home. Sometimes it takes a few days to get the lay of the land and figure out where the best stores are. Once we found that awesome store, I was pretty set up for the week for my breakfasts, some lunches and snacks. It can be easier to travel to a major city if you have special dietary needs since it's more likely that you'll have access to a bigger grocery store than if you are in a smaller, more remote area.
I thought it might be helpful to give you an example of what I ate each day while in Mexico. Some days I consciously pushed my limits. I want to be clear that I'm well past the low FODMAP elimination phase and am therefore aware of what my triggers are, so I wasn’t sticking strictly to low FODMAP portions. I tried to eat mostly low FODMAP during the day so that I could go out to eat for dinner and not have to worry as much. I know I have a fairly low threshold from past experiments. I also knew that if I ate chunks of garlic or onion, I wouldn't feel well, but sometimes I can get away with a little cooked into foods.
To give you an example of what I ate on my trip, here is a sample below. Please also keep in mind I was on vacation, and I wasn’t necessarily eating my healthiest. Though I tried to keep my diet fairly balanced, I fell short on some days. But I was exercising a ton, and honestly my priority was having fun and avoiding flare ups!
Most days I started with my morning smoothie, because they sit well with me, I love them and I find it easy to add in the various supplements that I take. I also have the unique challenge of being a young person on Coumadin, a blood thinner, for my mechanical heart valves. This means that in addition to my FODMAP restrictions, I have to avoid certain foods and I also have to eat a consistent amount of greens everyday to keep my blood level stable. So I find that smoothies are a great way to be sure I get in my greens for the day.
Day 1 (Travel Day):
We stayed overnight at an airport hotel. Continental breakfast was included but there was really nothing I could eat there and we were running late in the morning. Since I had brought gluten free bread with me, I toasted a slice of it in their toaster (I don't have celiac so cross contamination isn't a concern for me), and I used one of the Justin’s individual peanut butter packets for my spread. Easy enough to throw it on a paper towel and eat in the car! Once I got to the airport and through security, I was still starving so I found a good old Hudson News and bought a cheddar cheese stick, a Greek Chobani yogurt, (and of course a gossip magazine). I know from previous tests that I do ok with about ½ container of Greek yogurt and Chobani brand is a little lower in lactose than some others. I had brought a Nature’s Valley Peanut Butter Granola bar in my carry-on bag, so I sprinkled a few broken bits on top of the yogurt and made sure to eat only about ½ of the yogurt. Nice light meal, but satisfying.
Lunch that day was just snacks, like ½ Go Macro Peanut Butter bar, dried cheddar cheese bite snacks from Trader Joes, plus a few chocolate almonds.
Dinner in Mexico at a restaurant: Grilled chicken, steamed veggies, a glass of wine, and tortilla chips. I asked for no garlic or onion on the chicken and veggies, they were mostly seasoned with salt and pepper. Sometimes simpler even tastes better.
Breakfast: Morning smoothie
My smoothie was made with lactose free or non dairy milk, rice protein powder, peanut butter, an unripe frozen banana, lactose free kefir or a few spoonfuls of Greek yogurt, cocoa powder, a handful of spinach, and sometimes a little stevia to sweeten. Another favorite is to substitute the chocolate/peanut butter with 1/2 unripe banana, 1/2 an orange (no FODMAPs in oranges), along with those same ingredients.
Lunch: I made myself quesadillas at our AirBnb, with a few slices of mashed avocado on the side. Easy, fast and tasty.
Dinner out: I ordered a simple grilled chicken breast, rice that had steamed carrots and peppers, small side of zucchini, and had a few bites of my husband's ice cream with a lactase pill.
Breakfast: Morning smoothie
Lunch out: Caprese salad made with mozzarella, tomatoes, basil and olive oil, side of french fries
Dinner out: Duck with orange sauce, mashed potatoes, steamed cabbage, and a glass of red wine.
Dessert: We went to a chocolate shop and got some local dark chocolate bars. My favorite was cinnamon chocolate!
Breakfast: Morning smoothie
Lunch: We ate at our Airbnb; peanut butter and jelly on gluten free bread, carrot sticks, grapes, a few pieces of cheese
Dinner: We ate at a restaurant. After a nice conversation with an awesome waiter, they prepared an amazing chicken breast for me that was stuffed with cheese, and had steamed veggies on the side (zucchini, carrots, and asparagus- I skipped asparagus as don’t do well with that). This was maybe the best chicken I’ve had in my life! We also shared a piece of gluten free chocolate cake with ice cream (took only a few bites of ice cream again with lactase pill).
Breakfast: Morning smoothie
Lunch: I decided to push my boundaries a few times because I was feeling pretty well. I had a simple and delicious tomato tortilla soup at a
restaurant. It had no chunks of onions or garlic in it, but I know it must have been prepared with them as all soups tend to be. I also indulged in a margarita in the middle of the day (gasp!). I made a conscious decision to enjoy these things knowing that I may endure some consequences but yay, I had only some bloating and mild stomach pain the next day! To me, that level of symptoms is worth the enjoyment of some new foods.
Dinner: I had another “splurge” meal; a seasoned adobo chicken with salad, tortilla chips and a few bites of guacamole which was made with onions. (Onions will leach into foods except oils, so this is not something I’d recommend trying when on a low FODMAP elimination diet).
Breakfast: I made some eggs with cheese, a piece of gluten free toast spread with peanut butter, and had about 1/2 cup strawberries.
Lunch at a restaurant: Fresh salad with lettuce, strawberries, oranges, blue cheese, and pecans.
Dinner: We found a Thai restaurant! They made me Pad Thai with tofu and peanut sauce, and I confirmed no garlic or onion was in it. The peanut sauce was too spicy and I know my tummy doesn’t like spicy too well, so I ate very little of that. They gave us a tiny scoop of complimentary coconut ice cream for dessert that I couldn't resist. It was truly tiny, so my guess is the lactose content would have been very small.
My daily snacks were things like: trail mix with allowed nuts, dark chocolate, and raisins (all in low FODMAP quantities), Greek yogurt with berries, tortilla chips, fruits, baby carrots, and low lactose cheeses.
Things were going pretty well up to this point. I was dealing with mild constipation throughout and some resulting bloating, but it was all manageable and I was consistent with my fiber supplement. I pushed my boundaries a few other times and was pleased with the outcome. I find my patients often can eat more too when they are vacationing–maybe the lowered stress, maybe the way foods are grown, maybe a combination of factors. The last night was the most difficult in terms of symptoms, though.
Day 9 (Last night in Puerto Vallarta):
The worst night was my last night out. We decided to go back to the place that made me the best chicken ever earlier in the week. I had a different waiter who definitely understood my “no onion, no garlic” request, which he communicated to the chef. When they brought out my dish though, it had huge chunks of shallots on it! My waiter returned it immediately and had it re-made, which took a very long time. While I waited, because of the mishap, my waiter poured me a second glass of wine to make it up to me. When I got my food back, it definitely tasted like it had onions in it though I couldn’t find any evidence. My suspicion was that they pulled them out of it but that it already leached into the meat. But starvation with extra wine led to me being too polite to send it back for a second time and so I ate it. Then our waiter also gave us free gluten free cake with ice cream after dinner. On top of likely being FODMAPPed, I simply ate and drink too much that night. Late into the evening, I started to feel pretty ill when the big D struck. I also had some stomach pain and nausea, but I actually rebounded fairly quickly. I admit I was rather worried that this would be a repeat of my worst ever IBS flare (that sadly occurred on my honeymoon), especially knowing that we had to travel home the next day. But happily, the episode was short lived and I was feeling better within 24 hours. And though I said I’d never eat again after that incident, I did indeed eat the next day.
Day 10 (Travel Day):
The last day was our travel day home. Before leaving, we had brunch at a cute restaurant across the street. I requested an omelette made with feta cheese, tomatoes and spinach, and had some home fries that were fairly plain.
On the plane later that night, I ordered a cheese plate that had sliced hard cheeses, crackers (I couldn’t eat those because I don’t tolerate gluten) and grapes. We brought some tortilla chips home with us, so I had some of those as well. Later, I had another ½ Go Macro Peanut Butter bar and some bites of the dark chocolate we bought in Mexico.
Though I was kind of bummed that I didn't make it through the whole trip without the "Big D", as my husband reminded me many, if not most, people who visit Mexico end up sick with digestive woes at some point in their travels, which was a good thing to be reminded of.
Here are a few other things to keep in mind when vacationing. Try to stick to your usual meal pattern as much as possible, and if that doesn't include drinking multiple margaritas and eating tons of chips at every meal, you probably don't want to do that! Be mindful about what you're eating, try not to over-indulge too much, savor every bite, and use some common sense. Wash your hands before eating, and in a place like Mexico, use hand sanitizer too because the water quality can be questionable. In regions where you're unsure of water quality, drink only bottled water, including ice (though all restaurants I visited used bottled water for ice, just be sure to confirm that). And use bottled water for brushing your teeth. Though my husband (who has a steel gut), ate at food trucks several times, I personally avoid those unless I see some amazing sanitation practices, because I can't afford the risk of food-borne illness.
I do recommend trying to sort out what your digestive triggers are before you travel though because it is very helpful to have this information ahead of time! When I had my horrible IBS honeymoon experience in Mexico five years ago, it was before I knew my triggers, and it seemed they came about with no rhyme or reason then. With the knowledge I have now, I am sometimes willing to push my boundaries a little and possibly deal with a bit of discomfort in exchange for yummy new tastes, fun, and freedom! I hope this post will help you see that with some preparation, you too can still happily travel with IBS.
Do you have travel tips that work well for you? Please be sure to add in the comments below!