Prevention of gastrointestinal infections in India

drzog

this seems a good place to post on my observations of why people get Delhi belly, the Bombay blues, and the Goan runs etc etc.

Naturopaths consider the bowel and liver as the centre of the vitality for the body for good reason I think, too often it is just a hole we stuff food into and empty wates out of without a second thought- No one ever thinks about fortifying their intestines before travel, a few shots and some imodium will see you right seems to be the general rule, and travel doctors dont help much- charging $$$ for a Hep A/Typhoid vaccination, and some not very nice antimalarials, paracetamol and a trendy first aid kit..(hey I am a Dr so i know what goes down)... the problem with that is one may end up coming home with a hitchiker in ones bowel wall...Giardia , Dientomoeba or Blastocystis are the notorious ones. Then its antibiotics and many weeks of recovery for ones poor intestines.

well my observations on many travellers, esp. the backpackers is that by day 5 they invariably get the cramps and diarrhoea, if not the full vomiting spectacular

So here is a few free hints on entirely preventing or minimising gastrointestinal risk the non-drug way

If you have any pre-exisiting conditions this of course should be factored in.

For the usually healthy:

3 months before travel begin by commencing a quality probiotic (healthy gut bacteria). This may and hopefully will include the strains Lactobacillus acidophillus, casei, plantarum and rhamnosus, Bifidobacterium longum and breve, A good brand has these bugs in the billions of organisms per dose. These may also be taken while travelling providing you get a heat stable variety, most require refridgeration.

6 weeks out get hold of Bitter herbal tablets or the famous but yukko Swedish bitters. These strengthen all parts of the bowel, especially the stomach acid which is your first and best line of defense against the food bugs. The best ones I have found contain the herbs Andrographis paniculata, and Ocimum tenuiflorum (Holy basil), both traditional Ayurvedic herbs long used for dysentery and infections generally. Most herbal shops and chemists stock these now in their cold and flu range. Take a low dose for 6 weeks. This is also your medicine if you get any bugs during travel, from sore throat to diarrhoea. I recommend up to 12g ( often 6-10 tablets) of Andrographis may be safely taken daily when unwell.

If you are really enthusiastic you can get some liquid bitter herbs like Barberry (Berberis vulgaris) (50ml lasts 3 months) and drop 7 drops into ones water bottles upon purchase. Tastes a bit tart but is also effective against the above Amoebas.

The effectiveness of the herbal therapies will of course be related to ones general dietary and lifestyle health.

As keenly observed by Nick-H hand to mouth infection is also a common problem, this is indeed how the flu is mostly spread, not by coughing as most people believe. Anyway I use a soapless hand cleaner with herbal oils, that smells great and a small bottle lasts 3 months.

Since i started this practice I have never had anything worse than the occasional squirt, while all around me were going both ends, and begging for me to give them an intramusclular injection for relief.

There are many other great herbs, that an officinado might take to help ones belly depending on the problems. Herbs/plants after all were the first medicine and are where most drugs come from.

Look after your belly and you will have a great time

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SitaParityaga

Great info, drzog. I learned about probiotics on IM several years ago, and I can attest to their benefits. Wish I could afford to take them all the time....but the "Primal Defense" (put out by Garden of Life) I buy is about US$50 for 90 pills.
This brand needs to be refridgerated...just the same, I took them along with me on my last trip and just hoped they would work.

I see you are from Australia....but just the same I'd like to ask for some recommendations on brands that don't require refridgeration...and are they as good as the other types?

SusieK

Hi,

Wish I had read this thread 3 months ago, just returned from Goa and picked up a tummy bug on my 4th day it was soon out of my system though. I will save this info for my next trip, and give it a try.

Is there anything you can take to avoid insect/mosi bites, we all sprayed with deet every morning/early evening, but still managed to come home looking like a smallpox victim. One of the guests in our hotel suggested garlic tablets for two months before she travelled did the trick, not as an anti malarial (another issue) but it just stops them biting. Any thoughts?

Susie

drzog

re the mossies, even with DEET you need to spray at least every 2-3 hours, with my less toxic suggestions on mossie prevention hourly is recommended. see recent post on DEET:Mosquito nets, do I need to take one to Goa & Kerala.
With DEET lower concentrations of DEET are as effective as higher concentrations but remain active for shorter periods of time, e.g. 30 % à 6.5 hours protection, 15 % à 5 hours protection, 10 % à 3 hours protection and 5 % à 2 hours protection.

Vitamin B1 is also reputed to have some effects in mossie prevention, up to 150mg per day, which is quite a high dose, although probably safe, although a publication from some time ago suggests "Vitamin B1 is not a systemic mosquito repellent in man." i tried it- didnt notice any diffference.

...garlic sure, its one of natures great cure alls, again no good scientific trials, ( one was done on a single dose- how silly) odorless garlic is no good, you need good quality aged garlic extract - about 3grams per day, taken for a week or two before you leave i imagine. garlic is also an excellent antiparasitic and anti-candidal agent for your belly, and will even clean out your arteries.

perhaps the best advice is to wear more clothing! Permethrin impregnated even.

re the probiotics: the brand I take is an Aussie one - Nutrition Care (Practitioner only) heat stable for 30 days called "lactobac"- only has 2 kinds of bugs in it, but better than none. You wont get a heat stable one with all those bugs i mentioned above, thats for before you go. Yogurt does not have enough bugs to get through to the lower bowel where the bugs mainly live, although it is an excellent food.

DrZ

gregornot

Namaste,
How often do you take Barberry? I also use grapefruit extract start 2 weeks before going .
peace, gregor

__________________
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"If the roots remain untouched and firm in the ground,
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If the underlying habit of craving and aversion is not
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~Dhammapada XXIV verse 338

drzog

Barberry: Just add a few drops to your water bottles as you buy them... take it most days. Water looks a little well like yellow something...but hey

Grapefruit extract- you mean seed extract?, is a very potent anti-parasitic.

Nick-H

I've tried all that B1, garlic, even homeo stuff to keep off the mossies --- no luck at all

I wonder if there is an Indian make of probiotic? Come to think of it, my dentist prescribed one when he gave me antibiotics, but I can't remember the name. We should find this out, it would probably save a lot of money!

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goangoangone

I've just bought "Becelac PB" made by Dr. Reddy's Laboratories Ltd., Hyderabad.



65.96 Rs for 10

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gregornot

Namaste,
Yes grapefruit seed extract. Seven drop in water once a day.
peace,gregor

Quoting "India Travel Forum | IndiaMike.com" <webmaster@indiamike.com>:

> Dear gregornot,
>
> drzog has just replied to a thread you have subscribed to entitled -
> Prevention of gastrointestinal infections in India - in the Health
> and Well Being forum of India Travel Forum | IndiaMike.com.
>
> This thread is located at:
> Prevention of gastrointestinal infections in India
>
> Here is the message that has just been posted:
> ***************
> Barberry: Just add a few drops to your water bottles as you buy
> them... take it most days. Water looks a little well like yellow
> something...but hey
>
> Grapefruit extract- you mean seed extract?, is a very potent anti-parasitic.

johngradycole

Thanks for an excellent and informative post, Drzog. My girlfriend and I are just off to India next week, and I wish we'd seen your advice earlier - still we'll follow it just as far as we are able at this late date. Do you have any advice about what to do if the worst happens and we are struck down with infections while we are there?

Jason

SANJAY_DEL

Lactobacil sachets contain a probiotic powder to be mixed in water.
Darolac capsules are available.

drzog

Sure thing, the Dr is in!
First take it easy, and take the advice from other posts on fluid-rehydration mixtures and low irritant diets.
If its diarrhoea and squirty, especially with cramps its more likely to be bacterial, and hence you risk it hanging around without prompt treatment, so what i would do then is a single dose of norfloxacin 400mg - will usually do the trick. Normally i take the higher dose of Andrographis for 2 days, and extra probiotics, and it settles very quickly. Norfloxacin is the best enteric (gut) antibiotic for travelling, effective against almost all bugs you are likely to come across. Its easily available at here on prescription, SANJAY_DEL will know if its available in India, im sure it would be. If this doesnt settle the problems then see the local Dr -esp if vomiting or dehydrated.

Mio

There is a relatively new oral vaccine against cholera. As a side-effect, it also prevents from travel diarrhea.

Here is a (German) article about it: http://www.medizin.de/gesundheit/deutsch/2043.htm

I used it during my travel to India in 2005 - never had any problem with diarrhea. So I can recommend it.

The vaccine was a suggestion of a travel physicist of the institute for tropical medicine in wuerzburg, Germany.

drzog

nice thx Mio

heres info in English:complete at: http://www.phac-aspc.gc.ca/publicat/...c-7/index.html

Canada Communicable Disease Report
Volume 31 • ACS-7
1 July 2005
An Advisory Committee Statement (ACS)

Committee to Advise on Tropical Medicine and Travel (CATMAT)*†

Statement on New Oral Cholera
and Travellers' Diarrhea Vaccination

Oral Cholera Vaccines: Recommended Usage: Travellers' Diarrhea

Indications for the oral BS-WC vaccine are limited because of the following: 1) most episodes of travellers' diarrhea are usually mild and self-limited; 2) therapeutic options (oral rehydration, dietary management, antimotility, and antibiotic treatment) are available if prevention fails; 3) < 50% (range 25% to 50%) of travellers' diarrhea cases are caused by enterotoxigenic Escherichia coli (ETEC) bacteria; 4) the protection by the vaccine against ETEC diarrhea is approximately 50%; and 5) vaccinated travellers may gain a false sense of security and possibly avoid being as strict in observing food and water precautions.

In summary, vaccination with the BS-WC vaccine as a prevention strategy for travellers' diarrhea is of limited value and cannot be routinely recommended for the majority of travellers.

BS-WC vaccine may be considered for the following selected high-risk, short-term travellers who are aged > 2 years:

with chronic illnesses for whom there is an increased risk of serious consequences from travellers' diarrhea (e.g., chronic renal failure, congestive heart failure, insulin-dependent diabetes mellitus, inflammatory bowel disease);
with an increased risk of acquiring travellers' diarrhea (e.g,. gastric hypochlorhydria and young children aged > 2 years);
who are immunosuppressed due to HIV infection or other immunodeficiency states;
with a history of repeated severe travellers' diarrhea;
for whom a brief illness cannot be tolerated (i.e., elite athletes or business or political travellers).
Conduct a detailed, individual travel-related risk assessment to determine those travellers who may benefit most from BS-WC vaccination as a prevention strategy for travellers' diarrhea.

The BS-WC vaccine provides short-term protection only (approximately 3 months) against ETEC diarrhea, so for the traveller at ongoing risk who has had the vaccine administered, consider the need for booster doses.

So i guess its useful, but not essential.

DrZ

johngradycole

Thanks Drzog and Sanjay_Del! Really speedy replies there! Just a couple fo quick questions for you, if ou can spare me a little more of your time. Can Lactobacil sachets and darolac capsules be bouight over the countr, or do you need a prescription? Norflaxin sounds very useful: again, I imagine we will need a prescription for that. How does a foreign person go about getting a prescription in India? any advice? Sorry to sound so paranoid: it crossed my mind that the time to ask was probably now, before either of us get the famous squirty diarrhea, at which point it might be a bit late!

Thanks again for all the really helpful information.

Jason