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vitamin and supplement industry is big business in the United States. According to the Journal of nutrition there are around 90,000 different dietary supplement products on U.S. store shelves, making up a $30 billion dollar industry.

These supplements make vague, yet bold health claims, including improving ‘heart health,' ‘promoting muscle growth,' and ‘boost vitality.' Men seeking out these benefits in a pill have grown throughout the years, with around 73% of U.S. men taking a supplement daily.

But do these supplements actually work or do they just make your urine quite expensive?

We asked our nutrition specialist Dr. Thunder Jalili. He works with the University of Utah Department of Nutrition and Integrative Physiology and he has the answers to our supplement questions. Research On Supplements is Unclear at Best

So what supplements does Dr. Jalili take? Vitamin D, fish oil, and a baby aspirin. But he admits that he does so even though the science is not clear that these supplements are actually effective.

According to Dr. Jalili, if you look at the research, a majority of supplements have very little effect on your health and just pass through the body. Considering the cost of most of these pills, they're mostly "making your pee expensive."

When it comes to supplement and vitamin research, there are very few reliable, repeatable, and conclusive studies available. In fact, a lot of the findings between studies can be contradictory.

For example, it's a fallacy to assume getting 10,000 percent of your daily suggested dose of Vitamin C will provide any extra benefit than just getting the recommended amount. There is no clear scientific evidence to correlate a super high dose of vitamin C with a reduction of cold symptoms or prevention of illness.

Luckily a high dose of vitamin C is not likely to cause any physical harm. So there's no immediate need to stop taking it, but it's probably providing little health benefit. It's Best to Get Your Micronutrients from Food

"It's really a crutch to help support a poor diet," says Dr. Jalili in regards to vitamins.

He discourages his patients from relying on supplements to make them healthy. It's important to focus on getting the macronutrients and micronutrients your body needs from a healthy diet. Adopting a healthy diet is the most effective, tasty, and safer method of getting vitamins, minerals, and other micronutrients into your body.

In fact, Dr. Jalili tells people not to take multivitamin. While a daily multivitamin may seem like a great way to help ensure you're getting enough minerals every day, they can not only be ineffective, but potentially dangerous.

Some studies assert that multivitamins provide no benefit in the minerals it provides. Other studies have shown a potential link to the regular consumption of multivitamins and an increase in developing cancer. Interestingly, consuming the same dosage of these minerals from food does not show the same cancer risk. There is No Such Thing as a Magic Pill

Out of the 90,000 supplements available, Dr. Jalili suggests there are two that may be worth taking:

• Fish oil - Early research into fish oil supplements has shown it may help reduce a person's risk of primary cardiovascular events.

• Vitamin D - Low levels of vitamin D can lead to a lack of energy and heart disease. It's common for vitamin D levels to drop in people as they age, do older patients may need to take a supplement.

For both of these supplements, recent research has shown that these pills provide only a minimal benefit. Neither present any serious adverse effects. With the low risk and small potential benefit in mind, Dr. Jalili takes both supplements.

It's important to keep in mind that no supplement will completely fix the health effects of a bad diet. The one good rule is: "Eat healthy foods that are good for you."

"Eating unprocessed, plant based foods is good for you. We can all agree on that," says Dr. Jalili, "It's everything beyond that we have to be open minded and objective about. And be prepared to change our mind if the facts change." Workout Supplements Are Best for Elite Athletes

When it comes to performance enhancing workout supplements, Dr. Jalili admits that there are some potential benefits to taking some of the compounds, but they are really only effective for elite athletes.

For example, creatine can be useful in building muscle. It can provide a small increase in performance when used in part of a systematic strength training routine. But the change is relatively minimal and the supplement itself is quite expensive.

Dr. Jalili suggests asking yourself what your goals are before spending the money on creating. Are you an elite athlete that needs gains for a specific athletic performance? Or are you a regular guy trying to get healthy? Do those small expensive differences a supplement may make really matter to you and your health goals? Is it beyond important for you to be able to lift 10 more pounds within a month?

If you do choose to take creatine, be sure to increase your hydration. Creatine has the potential to cause issues with kidneys and increase the chance of developing kidney stones if you drink enough water Your Doctor is Not the Best Resource for Nutrition

If you have questions related to anything about your nutrition - supplementation included - your doctor probably isn't the best to contact. Most doctors in the U.S. receive minimal nutritional training in medical school. Your doctor will only have knowledge of nutrition if they are self-motivated and self-educated.

For questions about diet, food, and supplements, it's best to go to a certified nutritionist.

Otherwise, Dr. Jalili suggests a few good online sources about supplements:

• Academy of Nutrition and Dietetics

Remember not to look for hope in a pill. Your diet, sleep and exercise will have more of an impact than any sort of supplementation. 23andMe May Have Used Your DNA to Develop a New Medication

Did your genetic data help develop a new treatment for psoriasis? The direct to consumer genetic testing company 23andMe recently announced that their genetic library had been sold to and used by a South American company to develop a new drug that may help a lot of people suffering from psoriasis.

It's exciting news, but individuals whose genetic information was used were not compensated, and many didn't even realize their DNA would be used like this.

The Who Cares team discusses what implications this new breakthrough means for research, big data, and ultimately patients that choose to have their DNA tested. Housekeeping - Who Cares About Their DNA Giveaway

Last week we posted a video of Troy and Scot doing a pushup challenge in the studio with Dr. Ernie Rimer. The challenge was inspired by recent research that suggests men who can perform 40 pushups have a 96% less chance of suffering from a cardiac event.

Check out the video on our Facebook and take a listen to the episode to learn how to improve your pushup form and how you can work up to 40 pushups.

Second, Troy has been recovering from a significant running injury he had last year. He's been working hard on getting back to normal. After months of rehabilitation and perseverance, he's running long distances again. In fact, Troy recently ran a race with a good enough time he was able to qualify for the Boston Marathon. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, learn how Scot accidentally got dog poop in his nose. Troy has serious questions for the designers of men's urinals. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

Dr. Gellner: Diarrhea in children can be caused by many things, but some Old Wives' Tales out there about diarrhea are just plain not true. We'll separate diarrhea facts from fiction on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Remember that one thing that one person told you that one time about what you should or shouldn't do when raising your kids? Find out if it's true or not. This is Debunking Old Wives' Tales with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Everyone says that diarrhea is part of the stomach "flu." Imagine me doing air quotes. That's a myth. There are many viruses that cause diarrhea, however, influenza normally affects the upper respiratory system, not the digestive system, thus, the flu vaccine will not protect against diarrhea.

When it comes to medications, yes, this is true. Some medications can cause diarrhea, especially antibiotics. They kill both good and bad bacteria in the entire body. Giving your child probiotics will help replace the good bacteria and decrease the diarrhea.

What about sugar? This one's true, as well. Sugars in soda, sports drinks, and even natural sugars found in fruit can cause diarrhea. We see diarrhea in toddlers a lot because they drink a lot of juice, and actually, the diagnosis for that is "toddler's diarrhea" and it resolves when parents cut out juice. Sugar draws fluid into the intestines, making the stools more watery. Some sugar substitutes, like Sorbitol, and caffeine even, have the same effect.

Parents often say that their child has diarrhea because they're teething. That one's a myth. Your baby can be cranky or irritable, but if they have diarrhea or a fever, that's going to be a virus, not teeth.

What about fiber? Okay, this one's tricky. Soluble fiber, like what is found in beans, peas, oatmeal, peeled fruits, and cooked vegetables, causes water to be absorbed in the intestines and the stool gets harder, but insoluble fiber, found in the skins of raw fruits and vegetables, whole grains, and wheat bran, may speed up stools as they pass through the intestines and cause diarrhea.

If your child has diarrhea, the most important thing is to make sure your child is hydrated. That's the biggest risk for kids, and the younger they are, the bigger the risk. And if your child's diarrhea lasts longer than three weeks or has blood in it, then it's time to visit your pediatrician.

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Interviewer: What should you do if you have a case of diarrhea? We're going to find out next on The Scope.

Announcer: This is From the Frontlines, with emergency room physician Dr. Troy Madsen on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health. Let's talk about diarrhea and what should somebody do if they start having diarrhea? Should they be taking some medication? Should they be going to see their doctor? When should they start worrying?

Dr. Madsen: So diarrhea is obviously not the most pleasant topic. It's something probably all of us have dealt with at some point or another. But it's one of those things where you kind of have to give it time. And we do occasionally have people who come to the ER who have had diarrhea for say 12 hours or so. And they're very concerned. And they don't look particularly dehydrated, they've been able to drink plenty of fluids and stay hydrated. They don't have other medical issues that would make them more likely to get really dehydrated. So those are the kind of situations where you know, you really want to give it some time to see what happens.

Because most cases of diarrhea, assuming it's from some sort of a bug or maybe something you ate, are going to get better within 24 hours. Maybe they'll last two days, maybe up to three days, but even if someone comes to the ER and they said, "I've been having diarrhea for two or three days." And I look at them and it's not like their lips look really dry and their eyes look sunken or they look like they're just really dehydrated. And they're not the kind of person who has lots of medical issues that would make them more likely to get dehydrated. I say, well, not a lot of testing we really need to do here. We don't really need to test for really unusual infections. You're probably going to get better within a day and usually it does.

So if you're someone who has diarrhea I'd say, give it a couple of days. Keep drinking fluids. You can try drinking electrolyte drinks. Those might help and make a difference. You're not losing lots of electrolytes, which can be an issue. But if it's gone on for longer than that.

If you're getting beyond three days and maybe into four or five days and maybe you've been camping recently. Or you've been swimming in mountain streams or lakes or drinking from mountain streams. Or you have a new pet. Or you have a pet turtle you found out while you were traveling and you pulled it out of a stream. These unusual things that would set you up for something more serious like giardia or salmonella. Things where we start to think about unusual infections. Those would be cases to come to the ER or see your doctor and get tested for that.

Interviewer: So generally, up until about two days, if somebody came into the ER you wouldn't run many tests if they looked healthy and they weren't at high risk of something else, you just have them wait and see?

Dr. Madsen: Most likely. I mean the reality of the ER there is the dynamics of the ER where the fact that someone comes in the door they often just get testing done. But it's typically not really necessary.

Interviewer: So if it was a family member you would say just wait it out for another day or so?

Dr. Madsen: I would. If a family member called me and said I've had diarrhea for a day or two I'd say wait it out. I would ask them has it been bloody diarrhea? That raises concern for me. But most of these cases people are just having kind of normal diarrhea. Just frequent bowel movements. Watery, they're not describing blood in their bowel movements. If you're seeing those sorts of things, that's going to change things a bit. But, typical diarrhea. Give it a couple of days.

Interviewer: Would you recommend taking any sort of antidiarrheal?

Dr. Madsen: If we're worried about an infection like salmonella. So those unusual cases where let's say you've had recent foreign travel or you have had recent exposure to mountain streams and you're drinking from mountain streams or swimming in lakes. There we're hesitant to say use something like Imodium. Just because people that have those infections can then become chronic carriers of the disease or it can make things worse. But in the average case of diarrhea where those are not a concern, I think Imodium is perfectly fine. I don't think there's a problem at all. If it can help you get through the day, get through work, whatever you have to do. No issues with that.

Again we're talking here about the average person who doesn't have a lot of medical issues. Times where you would be more concerned about diarrhea. Even after a day or two would be . . . If you do have some medical problems that make you more prone to dehydration. Maybe you take a water pill. Something for heart failure or for kidney issues that takes water off. And then you're losing fluids because of diarrhea. Maybe you then start to feel light headed. Or you're dizzy. These would all be things where I would say where I would say yeah, you need to come to the ER. You may need some IV fluids. We may need to rehydrate you.

Also, very young children. If they are really just not taking fluids well. When they cry, they're not making tears. Their eyes look sunken. You look at their mouth, their lips look dry. Again, reasons to go to the ER even after maybe even 12 to 24 hours of diarrhea.

Interviewer: Sounds like in the common cases it's dehydration you're most worried about?

Dr. Madsen: Exactly, dehydration and then along with that electrolyte abnormalities where you can lose electrolytes with the diarrhea.

Interviewer: All right, so watch out for those things. Think about, have I done anything strange or unusual recently that might be the cause of this that could be a little bit more insidious. Otherwise just wait it out.

Dr. Madsen: Exactly, give it some time. It'll run its course. You'll probably get better within a day or two.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: May 30, 2018
originally published: September 6, 2016

Interviewer: Using Imodium to treat opioid withdrawals: a bad idea. We'll find out more about this disturbing trend next on The Scope.

Announcer: This is "From the Frontlines" with emergency room physician Doctor Troy Madsen on The Scope. On The Scope.

Interviewer: Doctor Troy Madsen is an emergency room physician at University of Utah Health Care and he said he'd seen a couple instances where people are using Imodium, which is an anti-diarrhea medication, as a way of trying to treat their withdrawal symptoms from opioids. I find this hard to believe. What's going on?

Dr. Madsen: Yeah. So this is really interesting. So as you may know, there's an opioid epidemic in our country and the Centers for Disease Control has acknowledged this and said we have so many people who are using opioids now. So prescription opioids, things like Percocet, Norco, Oxycodone are using that for to get high. Essentially what they may consider it legal high because they're getting a prescription or it's a prescription medication they're buying from someone.

So then, these individuals may then be saying to themselves, "I really can't be doing this. I need to get off this medication." So they're finding things on the Internet that discuss using Imodium or loperamide is the generic name and using that to sort of detox, taking that as a bridge to give yourself some of the same effects as the opioids give you while allowing your body to adapt and adjust and then gradually get off the medication.

Interviewer: So, first of all, bad idea trying to self-treat an addiction like that?

Dr. Madsen: Absolutely, not a great idea. But the reason they're doing this is because it's probably been out there for years and then I think it's just gained steam with some people posting things on the Internet about this. But Imodium or loperamide is actually an opioid. It doesn't give you the same high as things like Oxycodone, but it has kind of the same effects, acts on some of the same receptors in the body.

That's why it help with diarrhea because if you've ever heard of someone who says, "Hey, taking all these Percocets and I can't have a bowel movement. It constipates me." Well, that's kind of how this stuff works for diarrhea. Same kind of idea. It slows down the bowels but also then acts on somebody's same receptors in the body that opioids act on that people are using for highs.

Interviewer: Yeah. So self-treating bad but, above and beyond that, Imodium causes other problems that you see then?

Dr. Madsen: It does. And the big thing we're seeing is some of these people are just taking such incredibly high doses that it's been putting their heart into these arrhythmias, these abnormal heart rhythms that are life-threatening. And that's where we see it in the ER. I've seen cases of people coming in who are in just these crazy heart rhythms, these life-threatening heart rhythms and it's because they're taking large doses of Imodium and then that is triggering this heart rhythm.

And really, it's the kind of heart rhythm where you've got to shock their heart to get them out of it, get them on medication, do something for it or their hearts just not going to keep working and they're going to die from this.

Interviewer: That doesn't sound much better.

Dr. Madsen: It doesn't. It's not a great thing to do.

Interviewer: It doesn't sound like a great solution to the original problem.

Dr. Madsen: Yeah, there's not. There are much better solutions to opioid addiction and to getting off that. It's a sort of thing where you've come into the ER, we will often get people into in-patient detox programs. We can also prescribe medications that can help with this. So I would not recommend taking Imodium or loperamide. Again, that's the generic name for it. I would not recommend taking that to treat an opioid addiction because of the threat of these abnormal heart rhythms.

And this really comes up because there was actually just a study published or report in one of the big emergency medicine journals talking about increasing cases of this and increasing calls to poison centers for people who are taking more and more of these medications to try and treat opioid addictions and then are having very bad effects from this.

Announcer: thescoperadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at thescoperadio.com.

Dr. Gellner: Like all food allergies, milk allergy can be difficult to manage in a child. How can you help your child when milk is a common ingredient in so many foods? I'm Dr. Cindy Gellner with some tips for this tricky food allergy on today's Scope.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on the Scope.

Dr. Gellner: A milk allergy is not the same as lactose intolerance. Lactose intolerance only affects the digestive tract and it cause symptoms such as bloating, gas, and diarrhea. A milk allergy is a reaction by your child's immune system to the protein in milk. Our immune systems normally respond to bacteria or viruses that attack the body, but sometimes the body's immune system mistakenly believes that a harmless substance such as the proteins found in milk are harmful.

In order to protect the body, the immune system goes on attack with antibodies against that food. And the next time you eat that food, your immune system releases huge amounts of histamine to protect the body against the evil food proteins. That is what causes the symptoms that make us so miserable.

Casein is the main protein found in milk. It is found in the solid part of milk called curd when the milk goes sour. Whey, which is the liquid that remains once the curd is removed, contains the rest of the proteins. Your child can be allergic to the proteins in the curd, the whey, or both.

In very young children, cow's milk is the leading cause for allergic reactions. Milk is one of the eight foods that are responsible for food allergies in children. The other foods include eggs, soy, peanuts, tree nuts, wheat, fish, and shellfish. The good news is that most kids outgrow milk allergy by two or three years of age.

If you think your child is allergic to milk, dairy products, or any other food, it is important to get a diagnosis from your pediatrician or an allergist. Usually the history of the reaction is all we need to determine the allergy. But there are blood tests to confirm for some of these foods.

Milk allergies are typically discovered very early in formula and breast-fed babies. If a mother drinks cow's milk, the milk protein also comes out in her breast milk. The symptoms seen in milk allergy depend on whether or not the child has a slow or rapid reaction to milk.

The slower reaction is more common and the symptoms develop over time. Symptoms that occur slowly over several hours or sometimes days include diarrhea, often with streaks of blood, wheezing, rashes like eczema flares, and failure to grow very well. Symptoms that occur rapidly within seconds to hours may include severe wheezing, vomiting and hives.

If a mom is nursing, the pediatrician will most likely recommend avoiding milk products to the mom and taking calcium and vitamin D supplements instead. If your baby is formula fed, sometimes pediatricians will recommend a soy-based formula. These formulas contain soybean proteins, vitamins and minerals. The switch to soy formula helps for about half of the baby's allergic to milk. For those babies who still have reactions to milk proteins, pediatricians recommend hypoallergenic formulas. There are two types.

Hydrolyzed formulas contains proteins that have been broken down so they are easily digested and less likely to cause a reaction. These include Nutramigen, Alimentum and Pregestimil. Elemental formulas have proteins in their simplest form and are used when hydrolyzed formulas continue to cause symptoms. These include Neocate and EleCare.

The only treatment for a child with a milk allergy is to completely avoid milk and foods that contain milk products. Many processed food and restaurant foods contains milk or processed milk products. And you will need to change the way you shop and prepare foods.

The first step is to learn how to read labels and become familiar with ingredients that contains milk or dairy products. Always ask about ingredients if you are not sure. Foods and ingredients that contain milk include milk from other animals such as a goat, as well as yogurt, cheese, cottage cheese, cream, anything with casein or whey, butter and sadly chocolate. And also be careful of any ingredients that begin with "lac" such as lactose, lactate, lactalbumin, and lactic acid, and also fat replacers such as Simplese.

Reading labels to avoid allergens has become a lot easier. Foods that contain common allergens must be listed in plain language on the ingredient list. There are still some things to watch out for when reading food labels. Watch out for the words "may contain". Milk may not be an ingredient but the food may be made in a factory which also produces foods made with milk. If you see the words "may contain," there may be very little of the allergen or there may be a large amount.

A common question from parents is how to avoid cross contamination. Avoid battered or fried foods. The oil is often used for many different items, some of which may contain milk. Separate cooking utensils, cutting boards, and dishes used to prepare dairy products from those used to prepare food for your child.

Your child can still have a healthy diet as well as continue to enjoy some kid favorites. The main nutrients found in milk are protein, calcium, vitamin D and riboflavin. It is important to either take supplements or eat foods that are high in these elements. There's a lot of protein in milk, poultry, pork, fish, beans, nuts, and seeds. Ask your pediatrician about calcium and vitamin D supplements. Good sources of riboflavin are meat and eggs, whole grain or enriched cereals, and dark green leafy vegetables. Many foods such as bread and orange juice are now supplemented with calcium and vitamin D.

There are several brands of soy and rice milks that are enriched with calcium. They can be used for drinking and to pour on cereal. If milk is part of a recipe just to provide liquid, you can substitute water. Soy and rice milk, as well as fruit juice works well when substitutes baking. Oils, milk-free margarines, and soy butter can take the place of butter.

You can also visit foodallergy.org where there are many other helpful tips. Prepare your child's lunch at home. Talk with teachers about your child's needs. Ask the teachers to keep an eye out and explain the situation to other children if needed. Have the teacher call you if there is a special event or party planned so that you could bring a few modified treats that your child enjoys and can share with other kids. Make a card that lists foods and ingredients that should be avoided and give one to the teacher.

Living with food allergies is possible. I'm proof of that. By making others aware of your child's food allergy, you will keep your child safe. If your child is old enough, even as young as three or four, make sure they are aware of their food allergy. This will empower them to be in charge of their own health.

Announcer: TheScopeRadio.com is University of Utah Health Science's Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com

Announcer: Access to our experts with in depth information about the biggest health issues facing you today. The specialists with Scot is on The Scope.

Scot: Dr. Miller, you told me that one of the questions you get around this time of the year is people wanting to get an antibiotic because they are going to be doing some traveling and they are afraid that they are going to go to some country and then get a bug that's going to cause diarrhea. Is that something that you can even do?

Dr. Miller: I get that question quite frequently. People will come in and they'll say, "I'm going on a trip and I just want to make sure that when I go to this new country, I might get diarrhea. Should I start an antibiotic to prevent getting diarrhea?"

Scot: They want to do something to prevent it?

Dr. Miller: They do, and the reality is taking antibiotics can cause far worse side effects than you might even ever get from traveler's diarrhea.

Scot: I think that's hard for people to understand because it's like . . .

Dr. Miller: Well, we've got into the notion that antibiotics, there's no downside to taking them, that there's no side effects from antibiotics. That's just simply not true. The issue is using an antibiotic when you need it, not as a prophylaxis or preventative, especially when you're going traveling.

Scot: Some of those downsides from what I understand is it can mess up your gut flora and fauna in some instances.

Dr. Miller: Yeah, one of most common things we're dealing with now is C. difficile colitis, which is an awful antibiotic induced diarrhea that is very, very difficult to treat.

Scot: Wouldn't that be ironic? They want to take it to prevent diarrhea . . .

Dr. Miller: Sometimes when they take antibiotics, they actually come back with the C. difficile colitis and it's not traveler's diarrhea. They've self-induced the problem and so after diagnostics, you figure out, "Oh, my gosh. This was induced by the antibiotic that they took to prevent traveler's diarrhea," not a good situation.

Scot:Taking it before, not a good idea. What about having it with you, when you do travel, if you do get something?

Dr. Miller: Right, so that's another issue entirely. It depends on where you're going. If you're going to a third world country and you're going to be out of major urban areas and in the rural areas, probably having antibiotics prescribed by a physician that you can keep with you and understand that when you develop symptoms consistent with traveler's diarrhea, you begin to take those antibiotics. That does make sense. However, people will also request antibiotics when going to other first world countries. That's probably not necessary, unless you're in certain situations where water is unclean, but most major cities of Europe and Asia have clean water supplies and it's not an issue. Also tourists are also in the habit of buying bottled water now.

Scot: I'd heard that . . . I went to Cancun one time and I was under the impression that I should not drink the tap water there, to drink bottled water there. How would I know if where I'm going is some place that's safe or not?

Dr. Miller: That's a really good question. One of the things people can do is get on to the CDC website for travelers and look up the information about particular countries. In addition, we have a travelers clinic here at the University of Utah that can advise people on what are the correct situations under which you might want to begin taking antibiotics if you develop certain symptoms, and also in which countries you'd want to be concerned about the safety of the water supply.

Scot: It sounds like bottom line, taking antibiotics as a precautionary measure - bad idea, could actually cause worse problems, anything that it prevents.

Dr. Miller: No question about that. Yeah, absolutely. There are some things that people can do also to cut back on the risk of developing antibiotic or excuse me traveler's diarrhea, which is caused by certain strands of bacteria. Those would be making sure that the food you eat is cooked, not eating raw vegetables in areas where the water supply in question. If you're in rural areas and have the ability to purify water, you can bring now very simple water purification kits and you can use those, they're very effective. I've been camping in the back country for years and years and years and never have had a problem when I use water purification tools.

Scot: You can take those with the iodine tablets if you really need to use any of that kind of stuff?

Dr. Miller: Iodine tablets, if used correctly, you can take purification filters. They're now very small and pack easily in a backpack or a suitcase. Again, it's important to know where you're going and also to be aware of the situations you're going to be in where you're eating and the environment that you're in. That is probably more important than anything.

Scot: That knowledge of knowing what's going on.

Dr. Miller: Right. So keeping the antibiotics as a backup if you need them. That's the best.

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Man: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Scot: Go to the dentist and get diarrhea? It doesn't make a lot of sense, but it happened to my Mom. She went to the dentist, they needed to do a procedure, they gave her some antibiotics and then a couple of days later she started having terrible diarrhea that persisted for a long time. She went to her doctor; they gave her a couple of different medications. Nothing quite seemed to work, except for this really expensive last resort. Dr. Tom Miller, what did she have?

Dr. Tom Miller: Scot sounds like she had Clostridium difficile colitis or diarrhea. And this is caused, it's commonly known as C. diff.

Scot: Yeah, that sounds familiar.

Dr. Tom Miller: We just call it C. diff. It's an increasing cause of prolonged and difficult to treat diarrhea and it's caused or triggered by certain antibiotics that are used to treat common infections, like strep throat or urinary or bladder infections or skin infections.
And what happens is when you take common antibiotics, they not only tackle the infections they are intended to treat but they also kill some of this normal protective bacteria and it's not a bacteria that we normally see in what we call colon carpet bacteria, but once it sets up shop it starts to produce a toxin in certain people, especially those people who receive antibiotics, and that toxin causes diarrhea and left untreated it can be life threatening.

Scot: So, if I get antibiotics, is that something that I need to worry about or only if I'm a carrier of it currently?

Dr. Tom Miller: If you are a carrier, you are at higher risk to get it if you take antibiotics.

Scot: Is C. diff contagious? My Mom said that her physician said it was highly contagious.

Dr. Tom Miller: The problem with C. diff is that it continues to exist on surfaces as spores and so it's hard to kill and so that's why healthcare centers or health centers and hospitals have higher rates of C. diff because it's hard to kill so we have to be very careful about hand washing and hygiene and sterile cleaning of the rooms and all of the pieces of furniture in a place where a person who has this type of diarrhea.

Scot: So what can be done? Like I said, my Mom I think it was for a two week supply of pills spent $1,200.

Dr. Tom Miller: Well, the other part of this is it is hard to treat and it requires prolonged treatment and sometimes repeated courses and treatment of different antibiotics which can be very expensive. So, this is a problem that we're facing nationally and again there are some take home tips for people.
Don't request antibiotics indiscriminately, don't use prolonged courses of antibiotics unless it's clinically indicated and directed by your physician and make sure you let your physician or dentist or healthcare provider know if you've had Clostridium C. diff in the past because they need to take precautions that you don't develop it again or watch for it.
And seek attention if you develop diarrhea lasting several days after completing the course of antibiotics. There's a test that can show if you have C. difficile toxin and this will direct your provider to treat you for it.

Scot: So, if I was concerned and my provider said you should be on some antibiotics and I was really concerned could I ask for this test?

Dr. Tom Miller: Right, I think the key thing is to describe the symptoms and what's going on to the physician and work with them to decide what the best course of action is. Many times people that take antibiotics will have diarrhea that lasts just a few days and then goes away, just simply due to the antibiotic.

Scot: How do I know that it's not in my stomach and if I take the antibiotics that I have been told to take that I'm not going to come down it?

Dr. Tom Miller: Again you don't really know. I guess my point is if you need those antibiotics for say strep throat or a bladder infection, then you need them. It's up to the physician to choose wisely to select an antibiotic that has a lower incidence of causing C. difficile colitis or diarrhea.

Man: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.