Prevention of gastrointestinal infections in India

Haylo

For women thinking of self medicating with antibiotics, remember that many antibiotics interfere with absorbtion of the contraceptive pill.

You might not want to come home with a bit more than an upset stomach!

camelgirl

Brilliant story! 4 months of this uncomfortable problem ....I'll say no more Just glad you finally got "fixed"

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Nick-H

There really is nothing like the appropriate cure for the job

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Just one member of the IndiaMike Mod Team

dzibead

Plus, common sense is FREE!

That's an important distinction. I have read that even as high as Everest Base Camp, where water boils at at even lower temperature than in Leh, it's still sufficient to knock out the bacteria in the water itself. My problem was definitely caused by the contaminated veg, which hadn't been very thoroughly cooked.

drzog

Hi friends, checking in...good to see controversy raging as ever.

Immunology is where its at in medicine at the moment.

Here's an update on probiotic science, or why worming may be bad for you...

Humanity's "old friends" ie. the probiotics strains, helminths (worms) and gut mycobacteria are recognized as harmless by the innate immune system but stimulate alertness of the acquired immune system via increased dendritic cell maturation and regulation of T-cell polarization. ie "old friends" reduced the adverse immune responses to allergic triggers and therefore reduce inflammatory and allergic diseases. The reduced level of old friends in western societies means excess Th2 reactivity and specific Th2 upregulation in part explaining our increased autoimmune (Multiple sclerosis, colitis and Crohns, type 1 diabetes, asthma) disease incidence.

Guarner F, Bourdet-Sicard R, Brandtzaeg P, Gill HS, McGuirk
P, van Eden W, et al. Mechanisms of disease: the hygiene
hypothesis revisited. Nat Clin Pract Gastroenterol Hepatol
2006;3(5):275—84.


Put another way: An increase in your immune systems vigilance at any body mucosal surface (sinuses, throat, lung, gut etc) (to perhaps food borne illness) occurs via the action of low grade (probiotic) signals at the gut wall through gut dendritic immune cells, which in turn regulate T-regulator cells that can suppress specific (auto) immuno regulation. These effects are dose- and organism-dependent as long as the probiotics are ‘recognised’ by the innate immune system as harmless. This direct interaction, of dendritic cells at the mucosal surface of the intact gut, is an essential element in the regulation.

Strain-dependent effects of probiotic lactobacilli on EAE autoimmunity
Vaccine, Volume 26, Issue 17, 16 April 2008, Pages 2056-2057
Catharina B.M. Maassen, Eric Claassen


Mechanisms of activation of the Dendritic Cells critical for the induction of primary immune responses:







And while we are updating you, a note on detoxification for those notable skeptics:


It is widely (although not universally) accepted that organismal aging is the result of two opposing forces: (i) processes that destabilize the organism and increase the probability of death, and (ii) longevity assurance mechanisms that prevent, repair, or contain damage. Processes of the first group are often chemical and physico-chemical in nature, and are either inevitable or only under marginal biological control. In contrast, protective mechanisms are genetically determined and are subject to natural selection. Life span is therefore largely dependent on the investment into protective mechanisms which evolve to optimize reproductive fitness. Recent data indicate that toxicants, both environmental and generated endogenously by metabolism, are major contributors to macromolecular damage and physiological dysregulation that contribute to aging; electrophilic carbonyl compounds derived from lipid peroxidation appear to be particularly important. As a consequence, detoxification mechanisms, including the removal of electrophiles by glutathione transferase-catalyzed conjugation, are major longevity assurance mechanisms. The expression of multiple detoxification enzymes, each with a significant but relatively modest effect on longevity, is coordinately regulated by signaling pathways such as insulin/insulin-like signaling, explaining the large effect of such pathways on life span.

Review
Ageing Research Reviews
Detoxification reactions: Relevance to aging
2008 doi:10.1016/j.arr.2008.04.001
Piotr Zimniak


The human body is exposed to a wide array of xenobiotics in one’s lifetime, from food components to environmental toxins to pharmaceuticals, and has developed complex enzymatic mechanisms to detoxify these substances. These mechanisms exhibit significant individual variability, and are affected by environment, lifestyle, and genetic influences. The scientific literature suggests an association between impaired detoxification and certain diseases, including cancer, Parkinson’s disease, fibromyalgia, and chronic fatigue/immune dysfunction syndrome. Data regarding these hepatic detoxification enzyme systems and the body’s mechanisms of regulating them suggests the ability to efficiently detoxify and remove xenobiotics can affect these and other chronic disease processes. This article reviews the myriad detoxification enzyme systems; their regulatory mechanisms; and the dietary, lifestyle, and genetic factors influencing their activities; as well as laboratory tests available to assess their functioning.

The Detoxification Enzyme Systems
by DeAnn J. Liska, Ph.D.
(Altern Med Rev 1998;3(3):187-198)

free full text


More detail on gut bugs for the nerds:

Human gut microbiota and bifidobacteria: from composition to functionality
Francesca Turroni et al
Antonie Van Leeuwenhoek. 2008 Jun;94(1):35-50. Epub 2008 Mar 13.
PMID: 18338233

The human gut is the home of an estimated
10 trillion bacterial cells,
many of which were previously uncharacterized or unculturable.
Novel culture-independent approaches have revealed that the majority of the human gut microbiota consists of members of the phyla Bacteroidetes and Firmicutes.
Nevertheless the role of bifidobacteria in gut ecology illustrates the importance of Actinomycetes and other Actinobacteria that may be underestimated.

The human gut microbiota represents an
extremely complex microbial community the collective
genome of which, the microbiome, encodes functions
that are believed to have a significant impact on human
physiology. The microbiome is assumed to significantly
enhance the metabolism of amino and glycan acids, the
turnover of xenobiotics (ie detoxification),
methanogenesis and the bio-synthesis of vitamins.

Co-colonisation of the gut
commensals Bifidobacterium longum and Bacteroides
in a murine model system revealed that the presence of bifidobacteria induced an expansion in the diversity of polysaccharides targeted for degradation
by Bacteroides and also induced host genes involved in
innate immunity. In addition, comparative analysis of
individual human gut microbiomes has revealed various
strategies that the microbiota use to adapt to the intestinal
environment while also pointing to the existence of a
distinct infant and adult-type microbiota.

The human gut microbiota possesses many meta-
bolic capabilities, which are lacking in the host and
thus can be considered as indispensable for human
life (Savage 2001). It contributes to host nutrition
through increasing the efficacy of energy harvest
from diet as well as by synthesizing essential
vitamins (Backhed et al. 2005; Guarner and Malage-
lada 2003; Hooper and Gordon 2001). The gut
microbiota also influences a wide range of physio-
logical features of the host by directing intestinal
epithelial cell proliferation and differentiation, pH,
and the development of immune system (Backhed
et al. 2004; Backhed et al. 2005). Another physio-
logical function of the gut microflora is the provision
of a barrier against pathogens. It has been demon-
strated that many species of the gut microbiota
contribute to antibacterial defences by producing
antibacterial peptides such as colicins and microcins
(Lievin-Le Moal and Servin 2006). Moreover, the gut
microflora is capable of modulating the intestinal
epithelium of the host.

In model systems involving human cell lines it has been
noted that an appropriate balance of the microbiota
induces mucin gene expression (Destoumieux-Garzon et al. 2002).
Mucin acts as a barrier and at the same time provides
nutrients, like saccharides, for bacterial growth (see
below) thereby promoting intestinal colonization of the
adhering autochthonous bacteria, which helps reduce
the chances of host invasion by pathogens.

-----

happy travels, wishing i was there

__________________
yours in health

http://drzog.blogspot.com

camelgirl

This seems like important information and I certainly would like to know what it means but I simply cannot understand any of it. Is there a way you can simplify this information for an ordinary, non-scientific person who doesn't even understand the basic terms used here?

IM is usually not a place for the posting of articles from scientific journals but we dearly love information that we can actually use to help make decisions pertaining to travel in India. I can't for the life of me figure out what to take from this (since I can't understand any of it. Don't eat worms? Eat more worms? We don't know if eating worms "old friends" --not my old friends BTW -- helps at all).

Thanks. (I worked in the legal field for 30 years and promise not to throw those terms at you -- Res Ipsa Loquitur

drzog

ok, fair point of law....the "old friends" are humanities old friends, that for millennia have lived in relative symbiosis with us in our collective guts. They are associated with traditional plant food based diets and traditional fermented food intakes.

for example: Parasitic worms are among the most common and
widespread infections of humans in the world today.
About 48% of the 5 billion or so people living in the developing
world are infected with at least one species, while
almost 10% are infected with at least two species. Here the rates of autoimmune disease (immune system attacks the bodies own tissues) are much lower than in the 'west'.

Even without parasitic worms, the "probiotic" species ie fermenting bugs used in food cultures, yogurts and capsules are essential regulators of both our immune systems readiness and reactivity. Cultures that consume fermented foods have much lower inflammatory (osteoporosis, heart disease, cancer) and autoimmune diseases too.

To summarise: the articles are really saying is that without adequate lifelong gut probiotic colonisation that we are likely to be at risk for increased unruly immune behaviour, whether it is a deficiency or risk of other bugs attacking us in Delhi or the diseases now known to be associated with lack of immmune balance. ITS NOT THE WHOLE STORY BUT THE IMMUNE SYSTEM IS 1/3 OF THE GREAT REGULATING BODY MECHANISM, THE NEURO-ENDOCRINE-IMMUNE SYSTEM.

as for the detox stuff, its hard to make it non-jargonistic without it sounding fluffy. But:

"Toxicants, both environmental and generated internally by metabolism, are major contributors to damage and physiological imbalance that contribute to aging and inflammation"... just look at the cancer rates and probable life expectancy of those sleeping on the smog choked footpaths of Delhi, compared to the rural dwellers.

Just as mother earth is choking in our wastes and unbalanced complex systems so potentially is individual human physiology.

Helpful?

camelgirl

Thank you for the shorter & clearer version! I do understand this one!

I can only comment, that from the little I've read, while we (of more affluent & urban cultures) seem to be setting ourselves up for inflamatory & auto immune diseases, and extreme allergies in our children, we also are having much longer life spans than the people who live in rural & urban areas in developing countries. I don't think the native flora of their guts is helping that much, particularly the the high infant mortality due to diarrheal diseases. But I honestly can't say much because I don't know very much about it. I do know it's very complicated and there are no easy answers (like eating yogurt)!

We are definitely screwing with our environment (including food) which is coming back to bite us in so many ways.

Just saw a fascinating documentary last night called King Korn. Now corn is a crop that has completely distorted agriculture & the whole food chain in the United States in the past 30 years!

drzog

This is now Off topic of gut health i know

but the longevity issue is interesting, however the most likely reason is we in the 20th century have had access to alot of drugs and vaccines that prevent the serious infectious mortality issues we used to have, leaving us with perhaps what is the cost of such long lives, although i believe we can limit our chronic disease suffering by maximising preventative health. This particularly is the role of healthy high nutrient plant based diets, like the traditional Mediterranean or Indian diet, which may be also better for the planet (cows make alot of methane apparently).

In a recent WHO report it was reported that India has been rapidly developing a diabetes and heart disease epidemic that may overtake the levels found in the developed world, this is likely to associated with mass dietary changes associated with globalisation, genetics, a change in the kind of cooking oil or reduced local grown fresh food, but also some less obvious factors like the immune imbalance issue.

While i may suggest the use of antibiotics for amoebic dysentery as a traveller, from my observations India has embraced allopathic drugs for everyday sore throats and coughs. I would frequently be asked to hold mini clinics in my hotels for the hotel owners children or grandparents, who then when told it was not serious would request antibiotics..many of the elders were already on several drugs for inflammatory diseases like diabetes, hypertension and the like..and Ayruvedic practitioners are on the decline i was told because of legal restrictions at least in Kerala.

camelgirl

drzog, I had to add this link because of the amazing coincidence of your recent big post....which I didn't understand (I got it the second time ). Here is the exact same topic from a recent New York Times Magazine which I just happened to read last night. Hope the link works. http://query.nytimes.com/gst/fullpag...20turns&st=nyt

Now I totally understand it & it's actually very exciting!

If not try googling
New York Times Magazine
IDEA LAB; The Worm Turns
By MOISES VELASQUEZ-MANOFF
Published: June 29, 2008

Laya

I'm so glad I stumbled upon this thread. It's almost 3 months to the exact day that I'll be embarking on my first trip to India and I would love to know the best probiotic to take for these next 3 months to bolster my gut's resistance to infection.

Your feedback ASAP would be highly appreciated Dr. Zog or anyone else who knows an effective probiotic I can purchase down under.

novice1000

Can one of the more experienced of u give a concise answer to this please?

-what drugs and doses are good for diarrhea (ive always thought cipro)
-is there anything that can be done in the few weeks running up to a trip to provide some preparation?

Also, a drug to stop nausea/vommiting. I plan to use loperamide for the runs....

Ive always found spasmocanulasehelps my gut but not sure why....

cheers, cheers cheers!!

thanks in advance

obione980

drzog is right about drugs increasing life span these days - but a far bigger effect is due to improved understanding of the mechanisms by which disease spreads; and good and improving drainage and sewers, plus the provision of clean drinking water.

We owe a huge debt to the plumbers of the world!

kristinm

Novice 1000 - hello again! I think I am a very bad example but...We took with us some Stematil which is an anti-vomiting medication available here on prescription.. not sure what the equivalent is in the UK, and Immodium for the runs..the gnereic version.

The one day I had a bad tummy I woke up at 4.00 and started vomiting and 'running'.. I had a bus trip that day (oh joy) otherwise I probably would have just stayed in bed, but I took a stematil and of course threw it straight up! After a couple of hours I managed to keep down 1 of each, and an antibiotic, we had 2 sorts with us, 1 for tummies and one for chests (what the hell I thought - may as well take the lot!), got on the bus, and fortunately dozed all the way to the next place which was about 6 hours or so.... I say fortunately because the bus trip was truly dire!

Once in Jaisalmer I went straight to bed - I simply could not keep my eyes open - and woke the next morning feeling pretty good. 1 day of curd and banana lassies - a light dinner of some rice, curd and a tiny bit of dal... and I was right as rain.

Needless to say I would never medicate myself like that here.. that was the first antibiotic I had taken for years.. but I was determined not to miss anything and I really HATE being sick...and it worked!

So when my son got the vomits it only lasted a few hours as he got the Indian antibiotic over the counter with the probiotic mixed in.. he was only given 2, and after taking one he was fine, he took the other that evening and ate a full meal, despite being told not to!

The thing we had trouble with more than tummies was chest stuff - my husband and son both got quite naggy and draining coughs which we kind of ignored for a bit until they developed a bit of a fever..I gave them antibiotics we had brought with us and it was like magic!

We all coughed for weeks after we got home though - Other people have mentioned this a lot on IM, it seems to be quite a common thing.

novice1000

Thanks!

So, antibiotics - I guess cipro for the tummy and ammoxycillin for the chest? This is just my very sketchy knowledge from third year medicine.

Though the chest, perhaps its the dust....though if the fever is becaue of the same thing it does suggest an infection.

thanks for the anti-nausea drug.

Is curd safe to eat? i have no idea what it is, but it sounds like gone-off milk!!

thanks again