Prevention of gastrointestinal infections in India

cyberhippie · Mar 14th, 2007, 23:05

Yep I understand the word prevention and I've seen many, to coin your phrase "followers" of this regime you so ardently champion, guess what they got sick!!!! Just like everyone else. That's based on 15 years of travel in India.

So the thousands of trials you mention don't seem to pan out in "real life" travel in India. You had a diciple here on IM, guess what she got sick.
Try using the words perhaps or maybe then I'll be satisfied, because all your selling is maybes. No guarantees, no exact science.
Even your explanation here is so full of maybes I can't be bothered to go into them.

Mate none of the above is about to harm anyone for trying it.

As I've said people will make their own choices.
Personally, experience tells me it has little chance of preventing dysentery and the like. The variables you quote above simply reinforce that. It's easy to run with an idea that it's a wonderful preventative but it is subject to all sorts of personal factors. That says to me it's just hit and miss, the success stories you will claim as your own, the bad stories simply down to something in their personal equation that didn't allow the prevention to work. Hmmmm

I see you studiously ignored the fact of how wrong you got it on Malaria in Goa. (in case your wondering nearly 3600 cases admitted to Panjim Hospital alone)
Sorry mate but when you enter the fray with info like that, some are going to take with a large pinch of salt any other info you might offer!
This and my experience with the above regime and it's success rate makes me one of the doubting Thomas's.

This isn't personal I just like to see fair and balanced info about India. I feel your info has fallen short on this. The Malaria stuff was just plain wrong from every angle. So for a doctor you've not shown much responsibility towards given accurate info to prospective travelers to India.
Shame!

Anyway we've stated our cases and it's for others to decide what they want to use!

I wish you well and enjoy India wherever you are!

drzog · Mar 15th, 2007, 17:52

maybe u just hang with people that dont look after their bellies?

i am not sure how one sells health- one provides advice based on individual assessments, like you say 'no exact science', although the indian chemists seem to do rather well for upset bellies..

i am not sure to whom you are suggesting I made sick, have i missed her post suggesting this? i dont recall any one specifically under my care on IM, my advice like yours is in the public domain as is....its a forum not a clinic...it has always been stated that one should have a practitioner personally provide the unequivocal health advice. My 15 years of experience includes many developing world places too, no different from indian places and bugs...empirical and scientific, with it many travellers have been advised and none of them have had any of the severe problems that are so often reported by your experience... my clients and friends always come back very grateful.

you could try these papers for a little light reading, researched in the developing world:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retri eve&dopt=AbstractPlus&list_uid s=16728323&query_hl=1&itool=pu bmed_docsum

Quote:

To evaluate the evidence for the use of probiotics in the prevention of acute diarrhoea, we did a meta-analysis of the available data from 34 masked, randomised, placebo-controlled trials. Only one trial was community based and carried out in a developing country. Most of the remaining 33 studies were carried out in a developed country in a health-care setting. Evaluating the evidence by types of acute diarrhoea suggests that probiotics significantly reduced antibiotic-associated diarrhoea by 52% (95% CI 35-65%), reduced the risk of travellers' diarrhoea by 8% (-6 to 21%), and that of acute diarrhoea of diverse causes by 34% (8-53%). Probiotics reduced the associated risk of acute diarrhoea among children by 57% (35-71%), and by 26% (7-49%) among adults. The protective effect did not vary significantly among the probiotic strains Saccharomyces boulardii, Lactobacillus rhamnosus GG, Lactobacillus acidophilus, Lactobacillus bulgaricus, and other strains used alone or in combinations of two or more strains. Although there is some suggestion that probiotics may be efficacious in preventing acute diarrhoea, there is a lack of data from community-based trials and from developing countries evaluating the effect on acute diarrhoea unrelated to antibiotic usage. The effect on acute diarrhoea is dependent on the age of the host and genera of strain used.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retri eve&dopt=AbstractPlus&list_uid s=15942433&query_hl=1&itool=pu bmed_docsum

Quote:

Probiotics for the developing world.Reid G, Anand S, Bingham MO, Mbugua G, Wadstrom T, Fuller R, Anukam K, Katsivo M.
Canadian Research and Development Centre for Probiotics, Lawson Health Research Institute, London, Ontario, Canada. gregor@uwo.ca

Every minute of every day more and more children die of diarrheal diseases and women, and girls become infected by HIV. An estimated 7,000 women become infected each day. While many valiant efforts are being made to address these issues, until now they have proved to be markedly ineffective. The notion that lactic acid bacteria, formulated into food or dietary supplements, could have a role to play in slowing the morbidity and mortality associated with HIV/AIDS and gastroenteritis, is built upon sound clinical findings and scientific investigations, yet no international efforts have been placed in this approach, to date. We hereby summarize the reasons why such efforts should be made, provide an example of one model being set up in sub-Saharan Africa, and challenge the international community to consider the potential benefits of probiotics, especially for communities not reached by governmental and nongovernmental agencies.

there are many more

I think my point on malaria was not that their wasnt any but that travelers usually get dengue, its locals that get malaria...+ there has been heavy spraying in most parts of goa. ...i beleive it was also in the context of the problems associated with antimalarial drugs and DEET...

ok later

Varanasi

Sama · Mar 17th, 2007, 23:27

Quote:

Originally Posted by SitaParityaga

I'd like to ask for some recommendations on brands that don't require refridgeration...and are they as good as the other types?

Sita, I use the Pearls by Enzymatic www.enzy.com/pearls

contains Lacto. acidophilus and Bifidobacterium longum, 1 billion CFU

no refrigeration needed -- $40 for 90 pearls at my local health food store.

Nick-H · Mar 17th, 2007, 23:51

No refrigeration needed.

That's good.

vistet · Mar 18th, 2007, 04:14

Quote:

Originally Posted by Nick-H

There's only one thing that I'm really against, and that's the taking-a-powerful-anti-biotic-ever-day-just-in-case school.

Excuse me repeating myself , but doctors who prescribe this deserves a bbad case of the runs on an Indian night train. With locked toilets. Not primarily out of vindictiveness , more as a learning opportunity , since this is what they are creating.

As for probiotics , they definitely have a place in conventional medicine to counteract the side effects of antibiotics. They are used where I work , and this regimen is equally well documunted as other treatments in the ICU.

Zeppy · Mar 18th, 2007, 04:56

Quote:

Originally Posted by cyberhippie

Someone followed his advice and got sick. Case closed.

If the person you are thinking of is my traveling companion, Cyberhippie, then the case is actually more complex. She took probiotics, but then stopped taking them when she had to take a course of antibiotics for a respiratory infection. (Yes, she was constantly sick with one thing or another!) About a week later, she came down with the fever-vomiting-diarrhea scenario, or acute bacterial gastritis, as the doctor called it. Case reopened--?

drzog · Mar 19th, 2007, 13:17

yes it is often the immune system that is underestimated in its vitality and capacity to respond, over 3/4 of the bodies immune cells reside in and around the gut, and the importance of immunoglobulins (eg from mothers breast milk), gluathione containing foods and the symbiotic bacteria = probiotics, to stimulate this system and maintain our health is increasingly being recognised. Although i dont really care that much, in the interests of karma perhaps CH may consider a public apology for the inaccurate and very public accusations against me....

featherbrain · Mar 26th, 2007, 23:44

Just returned from almost 3 weeks in India and thankfully no tummy problems at all. We decided to opt for vegetarian food only as the thought of being ill on tour was unbearable. We used antiseptic handgel (when we remembered)and used bottled water for teeth and our immersion heater for early morning coffee. Perhaps we were lucky but other people on our tour ate everything they saw and sadly paid the price for it. We drank lassi too, but again we were careful where we ordered it.

not normal · Apr 27th, 2007, 09:49

Just a little summary of my health when in india for 6 weeks, for no reason just your information.
Arrived after having all the probiotics mentioned in the original thread and carrying swedish bitters..
Was using good water filter on tap water, not sure if i needed iodine on top of that though.
Was very careful with appearances of restaurants and washing hands.
Had mild controllable squirtage after 3 days for about 5 days, during which time i ate lots of bananas and curd and rice etc..
Was starting to feel very drained and running out of toilet paper so got the antibiotic noraflaxin, stopped filtering and started buying water and it was a miracle cure!
Healthy bowels but two bad colds in the next 4 weeks..
Somehow got the squirts again, and went back to the bland food diet..
After 4-5 days of this again, and another bad cold, i was feeling drained and annoyed so got some random antibiotics and whacko, solid again!!!
So my uneducated unqualified tip is don't be too scared of antibiotics coz they worked fine for me!

Fionabog · Apr 27th, 2007, 14:10

I'm one of those travellers who get sick EVERY time.
Never been to India, but I' sure I'll manage to get Delhi Belly there!
Got every variation of Bali Belly so far.
I'm careful, but not paranoid, never drink unbottled water, use alcohol based hand cleaner, supply my own straws. ( I suspect EVERY one I've been offered in Indonesia has either been recycled or had lots of dirty hands patting the tops down to make them look prettier.
There's been lots of studies reported about the effectiveness of raspberry concentrate on preventing tummy troubles, reckon I'll take some this time, as it can't hurt.
But, you know what, unless you are unlucky enough to get something awful like Dysentry, Giardia etc, you survive. You get yourself medical help, rehydrate, rehydrate, and you get over it.
I speak from much personal expereience.
I'm sure that I'll get it, but I'll get a doctor, and damned if I'll let it spoil India for me!

Nick-H · Apr 27th, 2007, 19:41

Nicely balanced view, Fiona

kiranlal · Apr 27th, 2007, 22:11

What ever preventives you take it is better to have a deworming in the end of your Indian trip.

OcoeeG · May 9th, 2007, 01:47

My momma always told me that an ounce of prevention is worth a pound of cure. I am leaving for a 2 years teaching stint in India mid- July. You know I am going to give the Pro-Biotics and bitters a try. Why not, right? It is not like I am going to eat any worse or be any less careful than I would have been without. I just think if it helps a little and keeps the minor squirts at bay it is worth it to my overall happiness. Thanks for the info DrZog.

Nick-H · May 9th, 2007, 01:54

OcoeeG, if you are staying in one place you will build up some immunity to the local bugs.

I do not drink my tap water, but I really can't be bothered with all the drops from the washing up, and doing stuff like washing my toothbrush in bottled water.

But it does take time, so take those precautions, and take it easy

And just write off each minor tummy upset to the immune system getting in some practice

drzog · Jun 30th, 2007, 06:48

British Medical Journal

Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial.

Consumption of a probiotic drink containing L casei, L bulgaricus, and S thermophilus can reduce the incidence of antibiotic associated diarrhoea and C difficile associated diarrhoea. This has the potential to decrease morbidity, healthcare costs, and mortality if used routinely in patients aged over 50.

http://www.bmj.com/cgi/content/abstract/bmj.39231.599815.55v1?maxtosho w=&HITS=&hits=&RESULTFORMAT=&a ndorexacttitle=and&fulltext=co gnitive+Nutrition&andorexactfu lltext=and&searchid=1&usestric tdates=yes&resourcetype=HWCIT& ct

J Paediatr Child Health.

Probiotics in paediatric gastrointestinal diseases.

Probiotics have become increasingly popular and are now promoted as having a wide range of benefits. Probiotics are generally very well tolerated and safe but many of the purported uses are not yet well supported with adequate scientific evidence. Two well-established roles for probiotics in children are acute diarrhoeal illness and antibiotic-associated diarrhoea. This review summarises the evidence supporting probiotics for various gastrointestinal disorders with particular reference to their role in the management of acute diarrhoea and antibiotic-associated diarrhoea in children.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetai lView&TermToSearch=17489821&or dinalpos=70&itool=EntrezSystem 2.PEntrez.Pubmed.Pubmed_Result sPanel.Pubmed_RVDocSum

yours in health

Dr Z

Mar 17th, 2007, 23:51	#109
Nick-H Loud-mouthed, Noisy Bird Join Date: Oct 2004 Location: Chennai, India Posts: 25,853	No refrigeration needed. That's good. __________________ . Just one member of the IndiaMike Mod Team

Apr 27th, 2007, 09:49	#114
not normal Member Join Date: Jan 2007 Location: australia Posts: 46	my ills Just a little summary of my health when in india for 6 weeks, for no reason just your information. Arrived after having all the probiotics mentioned in the original thread and carrying swedish bitters.. Was using good water filter on tap water, not sure if i needed iodine on top of that though. Was very careful with appearances of restaurants and washing hands. Had mild controllable squirtage after 3 days for about 5 days, during which time i ate lots of bananas and curd and rice etc.. Was starting to feel very drained and running out of toilet paper so got the antibiotic noraflaxin, stopped filtering and started buying water and it was a miracle cure! Healthy bowels but two bad colds in the next 4 weeks.. Somehow got the squirts again, and went back to the bland food diet.. After 4-5 days of this again, and another bad cold, i was feeling drained and annoyed so got some random antibiotics and whacko, solid again!!! So my uneducated unqualified tip is don't be too scared of antibiotics coz they worked fine for me!

Apr 27th, 2007, 22:11	#117
kiranlal The only one of its kind Join Date: Sep 2004 Location: Trivandrum,Kerala,India,Malaysia,Singapore Posts: 521	What ever preventives you take it is better to have a deworming in the end of your Indian trip. __________________ A big world and small people

Jun 30th, 2007, 06:48	#120
drzog Based On A True Story Join Date: Nov 2004 Location: Melbourne, Australia Posts: 97	probiotic update British Medical Journal Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial. Consumption of a probiotic drink containing L casei, L bulgaricus, and S thermophilus can reduce the incidence of antibiotic associated diarrhoea and C difficile associated diarrhoea. This has the potential to decrease morbidity, healthcare costs, and mortality if used routinely in patients aged over 50. http://www.bmj.com/cgi/content/abstract/bmj.39231.599815.55v1?maxtosho w=&HITS=&hits=&RESULTFORMAT=&a ndorexacttitle=and&fulltext=co gnitive+Nutrition&andorexactfu lltext=and&searchid=1&usestric tdates=yes&resourcetype=HWCIT& ct J Paediatr Child Health. Probiotics in paediatric gastrointestinal diseases. Probiotics have become increasingly popular and are now promoted as having a wide range of benefits. Probiotics are generally very well tolerated and safe but many of the purported uses are not yet well supported with adequate scientific evidence. Two well-established roles for probiotics in children are acute diarrhoeal illness and antibiotic-associated diarrhoea. This review summarises the evidence supporting probiotics for various gastrointestinal disorders with particular reference to their role in the management of acute diarrhoea and antibiotic-associated diarrhoea in children. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetai lView&TermToSearch=17489821&or dinalpos=70&itool=EntrezSystem 2.PEntrez.Pubmed.Pubmed_Result sPanel.Pubmed_RVDocSum yours in health Dr Z

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Mar 14th, 2007, 23:05	#106
cyberhippie Account Closed by User's Request Join Date: Jul 2002 Location: the Netherlands Posts: 6,013	Yep I understand the word prevention and I've seen many, to coin your phrase "followers" of this regime you so ardently champion, guess what they got sick!!!! Just like everyone else. That's based on 15 years of travel in India. So the thousands of trials you mention don't seem to pan out in "real life" travel in India. You had a diciple here on IM, guess what she got sick. Try using the words perhaps or maybe then I'll be satisfied, because all your selling is maybes. No guarantees, no exact science. Even your explanation here is so full of maybes I can't be bothered to go into them. Mate none of the above is about to harm anyone for trying it. As I've said people will make their own choices. Personally, experience tells me it has little chance of preventing dysentery and the like. The variables you quote above simply reinforce that. It's easy to run with an idea that it's a wonderful preventative but it is subject to all sorts of personal factors. That says to me it's just hit and miss, the success stories you will claim as your own, the bad stories simply down to something in their personal equation that didn't allow the prevention to work. Hmmmm I see you studiously ignored the fact of how wrong you got it on Malaria in Goa. (in case your wondering nearly 3600 cases admitted to Panjim Hospital alone) Sorry mate but when you enter the fray with info like that, some are going to take with a large pinch of salt any other info you might offer! This and my experience with the above regime and it's success rate makes me one of the doubting Thomas's. This isn't personal I just like to see fair and balanced info about India. I feel your info has fallen short on this. The Malaria stuff was just plain wrong from every angle. So for a doctor you've not shown much responsibility towards given accurate info to prospective travelers to India. Shame! Anyway we've stated our cases and it's for others to decide what they want to use! I wish you well and enjoy India wherever you are!

Mar 19th, 2007, 13:17	#112
drzog Based On A True Story Join Date: Nov 2004 Location: Melbourne, Australia Posts: 97	yes it is often the immune system that is underestimated in its vitality and capacity to respond, over 3/4 of the bodies immune cells reside in and around the gut, and the importance of immunoglobulins (eg from mothers breast milk), gluathione containing foods and the symbiotic bacteria = probiotics, to stimulate this system and maintain our health is increasingly being recognised. Although i dont really care that much, in the interests of karma perhaps CH may consider a public apology for the inaccurate and very public accusations against me....

Mar 26th, 2007, 23:44	#113
featherbrain Member Join Date: Jul 2006 Location: UK Posts: 38	Just returned from almost 3 weeks in India and thankfully no tummy problems at all. We decided to opt for vegetarian food only as the thought of being ill on tour was unbearable. We used antiseptic handgel (when we remembered)and used bottled water for teeth and our immersion heater for early morning coffee. Perhaps we were lucky but other people on our tour ate everything they saw and sadly paid the price for it. We drank lassi too, but again we were careful where we ordered it.

Apr 27th, 2007, 14:10	#115
Fionabog Member Join Date: Jan 2007 Location: Renmark, South Australia Posts: 47	I'm one of those travellers who get sick EVERY time. Never been to India, but I' sure I'll manage to get Delhi Belly there! Got every variation of Bali Belly so far. I'm careful, but not paranoid, never drink unbottled water, use alcohol based hand cleaner, supply my own straws. ( I suspect EVERY one I've been offered in Indonesia has either been recycled or had lots of dirty hands patting the tops down to make them look prettier. There's been lots of studies reported about the effectiveness of raspberry concentrate on preventing tummy troubles, reckon I'll take some this time, as it can't hurt. But, you know what, unless you are unlucky enough to get something awful like Dysentry, Giardia etc, you survive. You get yourself medical help, rehydrate, rehydrate, and you get over it. I speak from much personal expereience. I'm sure that I'll get it, but I'll get a doctor, and damned if I'll let it spoil India for me!

Apr 27th, 2007, 19:41	#116
Nick-H Loud-mouthed, Noisy Bird Join Date: Oct 2004 Location: Chennai, India Posts: 25,853	Nicely balanced view, Fiona

May 9th, 2007, 01:47	#118
OcoeeG Member Join Date: Apr 2007 Location: Uttarkhand Posts: 49	My momma always told me that an ounce of prevention is worth a pound of cure. I am leaving for a 2 years teaching stint in India mid- July. You know I am going to give the Pro-Biotics and bitters a try. Why not, right? It is not like I am going to eat any worse or be any less careful than I would have been without. I just think if it helps a little and keeps the minor squirts at bay it is worth it to my overall happiness. Thanks for the info DrZog.

May 9th, 2007, 01:54	#119
Nick-H Loud-mouthed, Noisy Bird Join Date: Oct 2004 Location: Chennai, India Posts: 25,853	OcoeeG, if you are staying in one place you will build up some immunity to the local bugs. I do not drink my tap water, but I really can't be bothered with all the drops from the washing up, and doing stuff like washing my toothbrush in bottled water. But it does take time, so take those precautions, and take it easy And just write off each minor tummy upset to the immune system getting in some practice

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