Traveler's diarrhea

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Vitamin A [1, 28, 29, 30, 31, 32, 33, 34]:

Please note, this management does NOT treat the condition itself. It may mildly help in preventing some of the symptoms, and even then has insufficient evidence to back up this claim at present. Please note, this acts as a PREVENTATIVE treatment, and not necessarily symptomatic relief.

Recommendation: Strongly in favor (Vitamin A may help to prevent diarrhoea due to its role in the body's immune function)

Grade of Evidence: high quality of evidence

Peppermint Oil [1, 22, 23, 24, 25, 26, 27]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (There is insufficient evidence to support claims that peppermint helps to treat diarrhoea)

Grade of Evidence: very low quality of evidence

Mugwort (Artemisa Vulgaris) [1, 19, 20, 21]:

Please note, this management does NOT treat the condition itself. It has been proposed only as a weak supportive symptomatic support, and even then, has been discounted due life-threatening side effects

Recommendation: No recommendation (There is insufficient evidence to support claims that mugwart helps to treat diarrhoea. More research is needed.)

Grade of Evidence: very low quality of evidence

Kampo [1, 17, 18]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (Initial studies indicate a possible reduction of severity in diarrhoea when using Kampo. However, more studies are needed, and the side effects of the treatment are relatively unknown.)

Grade of Evidence: low quality of evidence

Indian Snakeroot (Rauvolfia, Rawolfia Serpentina) [1, 15, 16]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: No recommendation (There is insufficient evidence to support claims that Indian Snakeroot helps to treat diarrhoea in any way)

Grade of Evidence: very low quality of evidence

Gotu Kola (Centella Asiatica, Hydrocotyle Asiatica)[1, 9, 10, 11, 12, 13, 14]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (There is insufficient evidence to support claims that Gotu Kola helps in the treatment of diarrhoea in any way. More research is needed.)

Grade of Evidence: Low quality of evidence

Goldenseal (Hydrastis Canadensis) [1, 2, 3, 4, 5, 6, 7, 8]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: Weakly against (Animal studies show that Goldenseal may help reduce certain types of diarrhoea. However, more studies on humans is needed. In addition, Goldenseal may produce toxic effects, including depression, constipation, rapid heartbeat, stomach pain, mouth ulcers and vomiting.)

Grade of Evidence: Low quality of evidence

Red Pepper (Capsaicin):

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (There is insufficient evidence to support claims that red peppers help to treat or prevent travellers diarrhoea)

Grade of Evidence: very low quality of evidence

Bromelain (Sulphydryl Proteolytic Enzyme, Ananas Comosus):

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (Available evidence does not support claims that Bromelain helps to treat diarrhoea)

Grade of Evidence: low quality of evidence

Black Walnut (Juglans Nigra):

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present.

Recommendation: no recommendation (Available evidence does not support claims that Black Walnut helps to treat travellers diarrhoea)

Grade of Evidence: low quality of evidence

* www.gradeworkinggroup.org

Summary References

Treatments:

1. Ades T, Alteri R, Gansler T, Yeargin P, "Complete Guide to Complimentary & Alternative Cancer Therapies", American Cancer Society, Atlanta USA, 2009

2. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/goldenseal

3. http://nccam.nih.gov/health/goldenseal/

4. Tierra Michael (1998): The Way of Herbs. New York, Pocket Books

5. Grieve M. (1971): A Modern Herbal. New York, Dover Publications, Inc

6. Mills S. and Bone K. (2000): Principles and Practice of Phytotherapy. Philadelphia, Churchill Livingstone

7. Tice Raymond (1997): Goldenseal and Two of its constituent alkaloids: berberine and hydrastine Research Triangle Park, National Institute of Environmental Health Sciences, in Seiger E: Review of Toxilogical Literature

8. http://www.henriettesherbal.com/eclectic/ellingwood/hydrastis.html

9. Winston, D., Maimes, S., Adaptogens: Herbs For Strength, Stamina, and Stress Relief, 2007, pp. 226-7

10. "A Double-Blind, Placebo-Controlled Study on the Effects of Gotu Kola (Centella asiatica) on Acoustic Startle Response in Healthy Subjects". Journal of Clinical Psychopharmacology. 20(6):680-684, December 2000. Bradwejn, Jacques MD, FRCPC *; Zhou, Yueping MD, PhD ++; Koszycki, Diana PhD *; Shlik, Jakov MD, PhD

11.  B. M. Hausen (1993) "Centella asiatica (Indian pennywort), an effective therapeutic but a weak sensitizer." Contact Dermatitis 29 (4), 175–179 doi:10.1111/j.1600-0536.1993.tb03532.x

12. Cataldo, A., Gasbarro, V., et al., "Effectiveness of the Combination of Alpha Tocopherol, Rutin, Melilotus, and Centella asiatica in The Treatment of Patients With Chronic Venous Insufficiency", Minerva Cardioangiology, 2001, Apr; 49(2):159-63

13. http://en.wikipedia.org/wiki/Gotu_kola#Medicinal_effects

14. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/gotu-kola

15. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/indian-snakeroot

16. http://www.mercksource.com/pp/us/cns/cns_hl_dorlands_split.jsp?pg=/ppdocs/us/common/dorlands/dorland/seven/000092149.htm

17. Shibata, Yoshiharu and Jean Wu. "Kampo Treatment for Climacteric Disorders: A Handbook for Practitioners." Paradigm Publications, 1997

18. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/kampo

19.  Anliker MD, Borelli S, Wüthrich B. Occupational protein contact dermatitis from spices in a butcher: a new presentation of the mugwort-spice syndrome. Contact Dermatitis. 2002;46:72-74.

20. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/mugwort

21. Fetrow CW, Avila JR. Professional's Handbook of Complementary & Alternative Medicines. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.

22. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/HerbsVitaminsandMinerals/peppermint

23. http://www.ncbi.nlm.nih.gov/pubmed/17420159

24. http://www.ncbi.nlm.nih.gov/pubmed/19507027

25. http://www.medicine.ox.ac.uk/bandolier/booth/alternat/AT022.html

26. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-peppermint.html

27. http://nccam.nih.gov/health/peppermintoil/index.htm

28. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-vitamina.html

29. http://www.nlm.nih.gov/medlineplus/vitamina.html

30. http://ods.od.nih.gov/factsheets/vitamina.asp

31. http://www.who.int/nutrition/topics/vad/en/

32. Latham, Michael E. (1997). Human Nutrition in the Developing World (Fao Food and Nutrition Paper). Food & Agriculture Organization of the United. ISBN 92-5-103818-X.

33. Sommer, Alfred (1995). Vitamin a Deficiency and Its Consequences: A Field Guide to Detection and Control. Geneva: World Health Organization. ISBN 92-4-154478-3.

34. http://www.unicef.org/worldfitforchildren/files/A-RES-S27-2E.pdf