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TRAVEL HEALTH |
TRAVELERS' DIARRHEA
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Commercial Grapefruit Seed Extracts have been found to contain synthetic toxins as their main active ingredients. When all else fails the standard treatment regimens consist of 3 days of antibiotic. Currently, all the bacteria that can cause traveler's diarrhea are susceptible to the same antibiotic, so it is not necessary to do cultures to find out what to use. The antibiotics of choice at present are either norfloxacin, or ciprofloxacin, closely related drugs that are known as fluoroquinolones. Commonly prescribed regimens are 500 mg of ciprofloxacin twice a day or 400 mg of norfloxacin twice a day for 3-5 days. These medicines are very inexpensive in Peru. Probiotics can be used to prevent antibiotic associated diarrhea, and to create a temporary intestinal flora until your natural flora is re-established. Saccharomyces boulardii and Lactobacillus rhamnosus GG have been proven to be the most effective for travelers. We use non-refrigerated Florastor for our Saccharomyces B. because it has been well tested but there others less expensive such as Jarro; also the Jarro-Dophilus (travel size pack) is a good choice for Lactobacillus. |
Below are some of the articles (somewhat edited) I have used to present the above info of my personal choices: Travelers' Diarrhea:(1) Center for Disease Control: Travelers' diarrhea (TD) is generally self-limited and lasts 3-4 days even without treatment, but persistent symptoms may occur in a small percentage of travelers.....and post infectious irritable bowel syndrome may occur in up to 3% of persons who contracted travelers' diarrhea. Most cases are benign and resolve in 1-2 days without treatment. The standard treatment regimens consist of 3 days of antibiotic, although when treatment is initiated promptly shorter courses, including single-dose therapy, may reduce the duration of the illness to a few hours. Other nonspecific agents, such as kaolin pectin, activated charcoal, and probiotics, have had a limited role in the treatment of TD. Some antibiotics administered in a once-a-day dose are 90% effective at preventing travelers' diarrhea; however, antibiotics are not recommended as prophylaxis. Routine anti-microbial prophylaxis increases the traveler's risk for adverse reactions and for infections with resistant organisms. Antimotility agents (loperamide, diphenoxylate, and paregoric) primarily reduce diarrhea by slowing transit time in the gut, and, thus, allows more time for absorption. Some persons believe diarrhea is the body's defense mechanism to minimize contact time between gut pathogens and intestinal mucosa. In several studies, antimotility agents have been useful in treating travelers' diarrhea by decreasing the duration of diarrhea. However, these agents should not be used by travelers with fever or bloody diarrhea, because they can increase the severity of disease by delaying clearance of causative organisms. For further information go to: http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=travelers_diarrhea.htm&cssNav=browseoyb |
(2) National Institutes of Health: The median duration of diarrhea is 3 to 4 days. Ten percent of the cases persist longer than 1 week, approximately 2 percent longer than 1 month, and less than 1 percent longer than 3 months. Persistent diarrhea is thus quite uncommon and may differ considerably from acute TD with respect to etiology and risk factors. Travelers may experience more than one attack of TD during a single trip. Rarely is TD life-threatening. In an extensive survey of several hundred thousand Swiss travelers, no deaths could be attributed to TD. A variety of "adsorbents" have been used in the treatment of diarrhea. For example, activated charcoal has been found ineffective in the treatment of diarrhea. Kaolin and pectin have been widely used for diarrhea. The combination appears to give the stools more consistency but has not been shown to decrease cramps and frequency of stools nor to shorten the course of infectious diarrhea. Lactobacillus preparations and yogurt have also been advocated, but no evidence supports these treatments for TD. Most individuals with TD do not develop serious dehydration. Fluid and electrolyte balance can be maintained by potable fruit juices, caffeine-free soft drinks, and salted crackers. The individual with TD should avoid alcohol and caffeine-containing beverages. Dairy products aggravate diarrhea in some people and should be avoided. For further information go to: http://consensus.nih.gov/1985/1985TravelersDiarrhea048html.htm |
(3) CIWEC Clinic - Travel Medicine Center in Nepal: The organisms themselves and the toxins they produce cause the diarrhea. Diarrhea is not a defense mechanism by the host to try to "wash out" the disease - causing organisms. A basic rule of thumb is that bacteria and viruses that can cause diarrhea have an incubation period of a few hours up to two or three days at the most. Protozoa, such as Giardia and E histolytica, have an incubation period of seven to 14 days. Food poisoning generally occurs within two to eight hours after eating the toxin. Thus, the travel history can help you rule out possible causes of diarrhea without even doing a stool exam. Bacterial diarrheas invariably have an abrupt onset. That means that the patient can generally tell you the exact time of day that they began to feel ill. Often, the illness begins in the middle of the night, or in the early morning. You are rushed from the bed by sudden cramps and the urge to defecate, and the result is a very runny or frankly liquid stool. As soon as you get back to bed, you have to run again. Bacterial diarrhea can be accompanied by nausea, vomiting, and fever, but the diarrhea can occur all by itself. The general concept is the abrupt onset of relatively uncomfortable diarrhea. In contrast, the protozoal diarrheas, mainly Giardia and E histolytica, have a more gradual start of less severe symptoms. With Giardia, you may start the day with a couple of loose bowel motions, only to feel generally okay the rest of the day. That evening you might have one or two more loose stools, but you sleep through the night, only to start the cycle the next day. After a few days, you might be more aware of a generally grumbling feeling in your intestines, increased gas, and a growing sense of fatigue. Many patients with Giardia tolerate their symptoms for two weeks or more before coming to the doctor. The general hallmark is the gradual onset of a less severe diarrhea that is generally the same day after day. If you have the gradual onset of milder diarrhea, you may have a protozoal infection. If your symptoms include a crumbling, gassy feeling, and upper abdominal discomfort, you may have Giardia. Although many travelers fear the term "amoebic dysentery," in fact this form of diarrhea is extremely rare in Nepal. Infection with the amoeba called "E histolytica" occurs in about 1% of the patients who come to CIWEC Clinic with diarrhea. However, almost all of these infections present as a chronic, low-grade diarrhea that alternates every 1-3 days. The patient experiences diarrhea for a day or so, then no diarrhea for a day or so, and then diarrhea again. Gradually they experience weight loss and fatigue, and come to the doctor after being sick for a month or more. Amoebic dysentery is a severe form of amoebic infection that causes severe cramps diarrhea with multiple small bowel movements, often with blood. This form is so rare that we see only about one person per year with this form of amoebic infection. However, local laboratories around the world often over diagnose"amoebic dysentery" (that is, they say it is there when it is not). Almost always, when travelers are told by local doctors or laboratories that they have "amoebic dysentery" they actually have bacterial dysentery, and the lab test was simply wrong. It is simplest to think of traveler's diarrhea as having three treatable syndromes: 1) Bacteria; 2) Giardia; and 3) E histolytica amoeba. The sudden onset of diarrhea that is uncomfortable is likely to be bacterial. The more gradual onset of a prolonged, low-grade diarrhea is likely to be protozoal--either Giardia or E histolytica. Bacterial diarrhea can be safely cured with an antibiotic. Currently, all the bacteria that can cause traveler's diarrhea are susceptible to the same antibiotic, so it is not necessary to do cultures to find out what to use. The antibiotics of choice at present are either norfloxacin, or ciprofloxacin, closely related drugs that are known as fluoroquinolones. Some doctors still prescribe sulfamethoxasole-trimethoprim (Bactrim or Septra), but the degree of bacterial resistance to this drug in many countries these days makes it less than an ideal choice. Many studies have shown that the length of illness can usually be reduced to one or two days with treatment. People with diarrhea can be divided into two categories: those who feel like eating, and those who don't. Those who don't feel like eating should not force themselves, but they must remember to drink fluids. Those who feel like eating should try to do so--why add hunger pangs to your existing level of abdominal discomfort? Try to think of what would sound good to you in your present condition; this will be quite different for different people. Avoid spicy food, alcohol, and coffee. If you eat a certain food, and it makes you feel worse, avoid that food for awhile. Don't abandon your dietary precautions; you can still get sick with a new bug while suffering from your current bug. Often, people who are hungry while having diarrhea will experience sudden cramps and an urge to go to the toilet immediately after they start eating. This phenomenon is due to something called the "gastro-colic reflex" and not to the food itself making the diarrhea worse. The gastro-colic reflex is a normal nerve connection between the stomach and the large bowel, which sends a signal for the large bowel to start moving when food enters the stomach. Ordinarily this impulse is controllable. In the presence of diarrhea, however, this signal is exaggerated, and the bowel wants to move uncontrollably. This is a harmless condition, as long as you can find the toilet in the restaurant in time! Once you go to the toilet, your stomach usually settles down, and you can finish eating. Some people try to eat yogurt when they have diarrhea. The idea is that yogurt contains bacteria that can help replenish your gut flora, and help push aside the "bad" bacteria that are causing your illness. There is not much evidence that eating yogurt makes any real difference in your rate of recovery, but it is an easily digestible food, and probably doesn't cause harm. For further information go to : http://www.ciwec-clinic.com/diar/index.html |
(4) WebMD Medical News: Reviewed By Brunilda Nazario , MD; August 06, 2004: Healthy adults who come down with travelers' diarrhea -- and get antibiotic treatment -- don't have to fast or eat bland foods. The finding comes from a study of U.S. college students attending summer sessions in Guadalajara , Mexico. Travelers' diarrhea struck 105 of the students, who then were enrolled in a study comparing treatment with two different antibiotic regimens. Half the students were told to eat whatever they liked. The other half were told to consume only clear liquids and bland food (crackers, tortillas, or dry toast) while their diarrhea continued. As their symptoms improved, they were allowed to eat bananas, rice, potatoes, and baked chicken or fish. But just about everything else was off the menu. Both groups were advised to drink plenty of water to replace lost fluids. The result: The bland foods didn't help. Those who ate whatever they liked were all better in 33 hours. Those who dieted got better in 37 hours. The antibiotics of choice at present are either norfloxacin, or ciprofloxacin, closely related drugs that are known as fluoroquinolones. Commonly prescribed regimens are 500 mg of ciprofloxacin twice a day or 400 mg of norfloxacin twice a day for 3-5 days. For further information go to : http://www.webmd.com/content/article/92/101692.htm?z=1728_00000_1000_nb_06 |
(5) Centro Medico Docente Adaptogeno The results of in vitro and in vivo studies largely support the majority of ethnomedical uses of sangre de drago including the treatment of diarrhea, wounds, tumors, stomach ulcers, herpes infection, the itching, pain and swelling of insect bites, and other conditions. Clinical studies of sangre de drago products have reported positive results in the treatment of traveler's and watery diarrhea and the symptoms of insect bites. Because the sap has shown low toxicity and preparations used in clinical studies were well tolerated, further clinical and pharmacologic studies are anticipated. For further information go to: http://www.adaptogeno.com/productos/croton_lechleri_ing.asp |
Grapefruit Seed Extract(6) Terressentials Organic Products Grapefruit seed extract has become an extremely controversial chemical compound recently. Studies conducted in the US and abroad report suspicious and abnormal chemical acclivity in numerous, randomly selected grapefruit seed extracts. Here is one report from the Institute of Pharmacy, Ernst Moritz Arndt University, Greifswald, Germany: Further, the USDA did a grapefruit seed extract study (full text here (pdf)) and declared, “Confirming an earlier study by researchers in Germany we found that some commercial grapefruit seed extracts contain benzethonium chloride, a synthetic anti-microbial agent commonly used in cosmetics and only approved for topical use, at relatively high levels of 8%.” The Swiss Toxicological Information Center of Basel, Switzerland, reports that “Grapefruit seed extracts containing benzethonium chloride in concentrations of 7-11% represent a major health risk if larger amounts of a concentrated solution are ingested (i.e. by mouth). Exposure of the skin or the eye may cause toxic symptoms. The Swiss Toxicological Information Center discourages consumers from administration of these extracts unless it is known which of them are containing benzethonium chloride and what the concentrations are." For further information go to: http://www.terressentials.com/truthaboutgse.html |
(7) Western Regional Research Center, Agricultural Research Service, U.S. Department of Agriculture, Commercial grapefruit seed extracts (GSE) were extracted with chloroform. The solvent was evaporated, and the resulting solid was subsequently analyzed by high-performance liquid chromatography, electrospray ionization mass spectrometry, nuclear magnetic resonance (NMR) spectroscopy, and elemental analysis (by proton-induced X-ray emission [PIXE] analysis). The main constituent was identified as benzethonium chloride, a synthetic anti-microbial agent commonly used in cosmetics and other topical applications. This compound comprised 8.03% (n = 2) of the liquid GSE sample. Higher amounts of benzethonium chloride were found in powder GSE samples For further information go to: http://www.sagescript.com/id57.htm |
(8) PMID: 11453769 [PubMed - indexed for MEDLINE] "Citricidal® is synthesized from the polyphenolic compounds found in grapefruit seed and pulp. Numerous reactions are involved, including distillation, catalytic conversion, and ammoniation. The active component of Citricidal is a quaternary ammonium chloride(a diphenol hydroxybenzene reacted with ammonium chloride) similar to benzethonium chloride when analyzed in accordance with USP XXII/NF XVII. (Benz. Chloride is a powerful germicidal agent, but is highly toxic to all animal life. See info on toxicity, below) " Even on this pro-Citricidal site, they explain a little about the synthesis of the Triclosan-like preservative, while still claiming it to be natural. For further information go to: http://www.gfex.com/citricidal.htm |
Also see: (9) Denver Naturopathic "Why we don't sell grapefruit seed extract. " July 21, 2005 (10) http://www.gaiaresearch.co.za/grapefruitseedextract.html (11) "Aspects of the anti-microbial efficacy of grapefruit seed extract (GSE) and its relation to preservative substances contained." Pharmazie 1999 Jun;54(6):452-6 |
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There is no published evidence that probiotic supplements are able to replace the body’s natural flora when these have been killed off; indeed bacterial levels in feces disappear within days when supplementation ceases. There is evidence, however, that probiotics do form beneficial temporary colonies which may assist the body in the same functions as the natural flora, while allowing the natural flora time to recover from depletion. The probiotic strains are then progressively replaced by a naturally developed gut flora. Hence, probiotics have been defined as correctives of the ecoorgan. If the conditions which originally caused damage to the natural gut flora persist, the benefits obtained from probiotic supplements will be short lived. An organism related to brewer’s yeast, Saccharomyces boulardii (Sb), is widely used in Europe to prevent antibiotic-induced diarrhea. It is also available as a supplement in the United States . Animal research with Sb shows interference with Clostridium difficile, a common bacterial cause of diarrhea. In double-blind trials, Sb has prevented antibiotic-induced and other forms of infectious diarrhea. An intake of 500 mg four times per day has been used in some of this research. Sb has also helped tourists prevent traveler’s diarrhea, according to double-blind research. In one trial, positive results were obtained at amounts as low as 150–450 mg per day. Even diarrhea caused by Crohn’s disease has partially responded to Sb supplementation in double-blind research. While not every trial shows efficacy, the preponderance of evidence clearly supports the use of Sb in people with diarrhea caused by antibiotics or infection. For further information go to: http://en.wikipedia.org/wiki/Probiotics (13) Gastroenterology Canada Meta-analysis showed that probiotics can reduce the risk that infectious diarrhea will last more than three days. Lactobacillus GG, one of the more promising strains, seemed to have a consistent effect compared with other forms such as acidophilus or reuteri. Patients were assigned to take a PPI, amoxycillin and erythromycin, plus either a lactobacillus supplement or placebo for two weeks. While supplementation did not appear to increase H. pylori eradication rates, it did reduce the side effects of the antibiotics, with patients reporting less gas, less pain and less nausea. "So this was more a case of improving antibiotic compliance, not H.P. elimination," he said. In the case of travelers’ diarrhea, however, three trials involving 103,000 subjects from Finland, Germany and the US found no preventive effect-except for individuals travelling to Turkey . For further information go to: http://www.ctccomm.com/Publishing/gastro/GastroSS0803probiotics.html |
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There is some debate about whether or not yogurt starter bacteria should be considered probiotics. The yogurt starter cultures Lactobacillus bulgaricus and Streptotoccus thermophilus are used to ferment milk and turn it into yogurt. But these cultures are not very resistant to conditions in the stomach and small intestine and generally do not reach the gastrointestinal tract in very high numbers. Therefore, they cannot mediate some probiotic effects. But these starter bacteria have been shown to improve lactose digestion in people lacking lactase and have demonstrated some immune enhancing effects. For these reasons, they are often considered to be ‘probiotic’. Traveling through the human digestive tract can be dangerous for bacteria. High acid levels in the stomach and high bile concentrations in the small intestine can lead to the injury and death of many members of the probiotic population. Although some bacteria are more resistant than others to this stress, consumption of probiotics with food, including milk, yogurt and other dairy products, buffers stomach acid and increases the chance that the bacteria will survive into the intestine. A paper published in 2002 reviewed seven studies (881 total patients) on the impact of probiotics (Lactobacillus rhamnosus GG or Saccharomyces boulardii) on antibiotic-associated diarrhea (Cremonini, et al. 2002. Aliment. Pharmacol. Ther. 16:1461-1467). The paper concluded that evidence suggests that probiotic can be used to prevent antibiotic associated diarrhea, but that no strong effect on the ability of probiotics to treat diarrhea exists. For further information go to: http://www.usprobiotics.org/ |
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Florastor has been demonstrated to be safe and effective in over 50 years of extensive international use. Multiple double blind studies (the best type of clinical studies) have shown that Florastor® (Saccharomyces boulardii lyo) helps with d iarrhea you get while taking antibiotics, called Antibiotic-Associated Diarrhea. The active ingredient in Florastor®, Saccharomyces boulardii lyo, acts as temporary flora to protect your intestinal tract and keep your intestines functioning well. Florastor® is all-natural and works with your body to re-establish the micro-flora, thereby maintaining a digestive balance. Florastor® by Biocodex has been successfully researched and tested in over 90 countries worldwide for over 56 years. The S. boulardii lyo strain has over a 56-year record of safety for all ages including infants. All the clinical studies on Saccharomyces boulardii have been conducted using the Saccharomyces boulardii lyo strain found in Florastor®. Fourteen years of studies have been done in the US. These studies have been published in leading journals such as JAMA, Gastroenterology, and American Journal of Gastroenterology. Florastor® is non-pathogenic yeast. It is not an acidophilus or Saccharomyces cerevisiae. The Saccharomyces boulardii strain is protected through a patented lyophilization and fermentation process. Development temperature is at 30 degrees Celsius so Florastor® remains intact as it enters the digestive tract. There is no loss of activity due to heat or cold. The patented lyophilization process for Saccharomyces boulardii lyo provides five billion live cells per 250 mg capsule with a shelf life of three years and does not need to be refrigerated. Studies have shown Florastor® to be resistant to all commonly used antibiotics (except anti-fungals). When taking antibiotics, Florastor® can be used in conjunction with your standard antibiotic protocols. For further information go to: http://www.florastor.com/article.asp?id=1139 |
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Saccharomyces boulardii has been shown to prevent antibiotic-associated diarrhea and also to prevent diarrhea in critically ill tube-fed patients. The mechanism of this antidiarrheal effect is not well understood. S. boulardii has been found to secrete a protease which digests two protein exotoxins, toxin A and toxin B, which appear to mediate diarrhea and colitis caused by Clostridium difficile. The protective effects of S. boulardii on C. difficile-induced inflammatory diarrhea may, in part, be due to proteolytic digestion of toxin A and toxin B by a secreted protease. The effectiveness of probiotics is related to their ability to survive in the acidic stomach environment and the alkaline conditions in the duodenum, as well as their ability to adhere to the intestinal mucosa of the colon and to colonize the colon. Some probiotics, such as Lactobacillus GG and Lactobacillus plantarum 299v, are better able to colonize the colon than others. After passage through the stomach and the small intestine, those probiotics that do survive become established transiently in the colon. Among the probiotics, only S. boulardii, E. faecium and Lactobacillus sp. have been useful in preventing antibiotic-related diarrhea. In one double-blind study, 180 hospitalized patients on antibiotic therapy were randomized to receive placebo or S. boulardii supplementation. Incidence of diarrhea was significantly lower among those receiving the probiotic, compared with controls (9% and 22%, respectively). These results have been confirmed in other controlled studies. The most common adverse reactions with use of probiotics are gastrointestinal and include flatulence and constipation. Probiotics are generally well tolerated. For further information go to: http://www.pdrhealth.com/drug_info/nmdrugprofiles/nutsupdrugs/pro_0034.shtml |
There you have some of it.....GOOD LUCK. See also Common Colds |
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