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Our India trip: 6 weeks of raw fruit, salads, vegetables & street food!

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Feb 25th, 2016, 06:10 AM
  #1
rje
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Our India trip: 6 weeks of raw fruit, salads, vegetables & street food!

The short version:
A few days ago we we got home after six weeks of traveling extensively through both Southern and Northern India.
The two of us had an wonderful trip. And during that time, we ate whatever we wanted, including many foods commonly on "avoid" lists. And we had virtually no digestive problems. Every morning we both took low-dose generic Xifaxan which we purchased cheaply in India.

First some caveats:
I have no medical background. I'm just reporting on the experience of my wife and myself during 6 weeks in India. Obviously I can't promise anyone else our experience And everyone should consult a good doctor before considering such a regimen and consider seeing a travel/tropical diseases doctor before traveling to a place like India.And just to be clear, I have no relationship whatsoever with any drug company or seller of this drug.

The longer version:
Like many people, I was concerned about our coming down with any of the stomach problems so commonly experienced by travelers to India. Particularly as our long trip time increased the odds we would. And we had some lengthy drives planned through regions where toilets were going to be scarce. Not to mention the potential for time lost and the discomfort. So I was intrigued by what I'd read about Xifaxan as a possible way to avoid these problems.

We see a doctor who is a tropical disease specialist before some of our trips. He's at a well-respected hospital in New York City and has had a number of papers published. So I turned to him for a medical opinion about using Xifaxan as a prophylactic to avoid stomach problems while in India. He knew all about it, but said he wanted to check the latest studies, and he'd get back to me. A few days later he called me back (amazing, a doctor who calls you!) He told me that the latest studies showed we could safely take it for an extended period, and that there is no need to use the commonly prescribed 400mg, as 200mg seems to work as well, which would save us a lot of money.

Which brings up a major issue - price. Xifaxan is insanely expensive in the US, and neither of our health insurance would cover it for the use we planned. And although I'd seen it available inexpensively for sale on overseas websites, I think that buying any drug on the internet would be just asking for trouble.

So I asked our doctor about buying a generic version while in India. I was hesitant about going that route, as I've read mixed reviews of the quality and efficacy of generic drugs from some parts of the world. But he said that if we stuck to well-established Indian pharmaceutical companies, that the quality would be good. He suggested buying 6 tablets here in the US (3 for each of us), so that we'd be covered for our first three days of our trip, and then use a second prescription to get the rest in India. We'd be spending our first 3 days in Kochi, which has good health care, so that seemed like a good plan.

He also advised that even with the Xifaxan we should follow the usual advice of avoiding uncooked fruit and vegetables, etc. But based on all that we had read, we decided to eat what we wanted, within limits.

So the day we arrived, we gave our prescription to a pharmacy in Kochi associated with a well-regarded hospital, and purchased 100 pills. All were individually wrapped in foil strips with an expiration date of late 2017. The one we bought has the not terribly lovely brand name of Rifagut.

As for price, the 6 pills purchased an a CVS pharmacy cost me $105.00. Thats's $17.50 per pill!

The 100 pills purchased in Kochi cost $18.00. That's 18 cents per pill!

If we'd bought the entire prescription in the US, it would have cost us $1800.00! Completely unaffordable.

So we were able to enjoy salads, fresh fruit, raw herbs sprinkled on our food, street food from stalls that looked relatively hygienic and busy, etc.

We're not completely crazy, so we did try to avoid the most dangerous practices. It was obvious that we needed to avoid tap water, and used bottled water to brush our teeth. But I'm sure we accidently ingested some anyway from time to time. For example, in one very good Thali joint in Madurai, I watched with trepidation as the waiter poured tap water on the banana leaf that was to be our plate, and then wiped it across the leaf with his bare hand. He then spooned our food onto the still damp leaf.

We both did have a couple of incidents of extremely mild stomach discomfort, but never anything more, and these only lasted a few minutes. And this was the only problem during 6 weeks of enjoying great Indian food! So after such great results, we've decided we'll be using it again on an upcoming trip to SE Asia.
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Feb 25th, 2016, 08:09 AM
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Thanks for this report. We, too, just returned from India - four weeks for us - and did not have Xifaxan with us. Our doctor (not a travel specialist) would not prescribe anything other than Cipro for us to bring along - even though we tried to explain to him the reduced efficacy of that antibiotic in India. I opted not to fill the Rx, but (fortunately) my husband did.

We took a shelf-stable probiotic every morning, and I took Pepto Bismol tablets once daily as a precaution. Avoided meats, and tried to be careful of where we ate. Really avoided any contact with tap water.

Carried small containers of alcohol-based hand sanitizer in our pockets at all times, and pretty much became obsessive about using it.

We were fine, until near the end of the trip we took a riverboat cruise on the Hooghly - in a "luxury" boat - for eight nights. The food was high end, but buffet, and many of the passengers came down with severe intestinal illness, including muscle aches and fever. My husband did not get sick at all - I didn't ever feel really bad, but had uncontrollable diarrhea for two days, so started the Cipro, which, thank god, worked within 36 hours.

Next time we're going to head to a travel specialist and see about a better plan. I feel like we may have dodged a bullet this time around ...
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Feb 25th, 2016, 03:26 PM
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Thanks for your report on using Xifaxan and how you fared with it. Were you just plain lucky, or was it the Xifaxan? You'll never know for sure.

We just returned from six weeks in Laos and Cambodia, and we were not careful other than with drinking water. We had fruit, salads, smoothies, fresh herbs, a few refreshments from some tribal villages etc. My husband and I each ended up taking a round of antibiotics (not Cipro) once during the trip due to experiencing diarrhea problems (no other symptoms than that though).

We have also taken two six week trips to India and one six week trip combining India and Nepal. Over these four trips it seems that our typical pattern is that we each get a bout of diarrhea that necessitates an antibiotic once during the six week trip. On these other trips, we weren't exceptionally careful other than with water.

Perhaps on longer trips like these individuals' systems start to adapt to the local intestinal flora. A caution for you though with your plans to follow the same regime when you visit SEA. Prior to our recent trip to SEA, the physician at our travel clinic warned us about even over the counter drugs we might get in SEA, saying that there was a distinct possibility they might be coming form China.
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Feb 25th, 2016, 05:44 PM
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Welcome back, rje! Looking forward to reading about your trip and seeing your photos!
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Feb 25th, 2016, 07:42 PM
  #5
rje
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scdreamer,
I'm glad it wasn't as bad for you as the other passengers. I keep hearing about problems on boats, although most of them are on larger cruise ships. My older sister just came back from a high-end cruise where they were quarantined to their rooms by the captain after a mini-epidemic broke out later. Floating petri dishes, as one article described them.

I will tell you that we met people on this trip to India who were having terrible traveler's diarrhea in spite of taking probiotics, so they didn't work for them.

julies,
You're absolutely right that I'll never know for sure if was the Xifaxan or just good luck. I do know that it diminishes traveler's stomach problems in others. And we too experienced some problems in Laos, and also in Indonesia and Vietnam, as well as on the last trip to Southern India, so this was our first symptom-free trip. So it seems likely to me that it helped us in India.

And thanks for the heads up about SEA. I hadn't done any research yet about that, so I'll be looking into that.

One interesting thing I read about the question of acclimation. The question was posed to a doctor as to how long should an expat live in a country before they could safely start drinking the tap water. The answer for a number of third world regions was "Never". Because, they wrote, not even the local people should be drinking the water, if it has too high a concentration of harmful bacteria and impurities.

progol,
thanks for the welcome, and the friendly hint that I need to actually write about the trip!
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Feb 27th, 2016, 01:21 AM
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India is famous for its itinerary and food. People here in India, are foodie. But as per health guidelines you should avoid unhealthy food - wherever you are.
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