Don’t lose your cookies

click to enlarge

Health.com

Ever run though the kitchen when your mom or dad or grandparent was whipping up a batch of cookies, and grab a finger-ful of raw cookie dough from the bowl?  Very sugary, very smooth, maybe a chocolate chip or two – yummy.  Sound like fun?  But, you were always warned that the raw eggs will make you sick. 

Well, beware.  The New York Times Health section recently ran an article looking at disease outbreaks associated with uncooked cookie batter, and came up with an interesting suspicion – maybe the concern is not limited to raw eggs.  Researchers studied packaged cookie dough, which uses pasteurized eggs, and still found that infections were occurring.  The source?  They suspect that flour may be the source, as it was the only raw ingredient that went into the mix. 

Further research will be needed to know if this is true, but the bottom line is that if you buy food that is intended to be cooked or baked before you eat it, then you should avoid eating it raw.  A simple solution, so long as you can keep your fingers out of the mixing bowl.

Stomach upset?  Come in to Student Health Services, our healthcare team can help.

Healthy eating!

Roger Miller, MD (OSU Student Health Services)

Poop transplants!?

www.moviefone.com

Kidney transplants?  Old news. 

Liver transplants?  Yawn. 

Face transplants?  Been there, done that, saw it in People

Poop transplants!?

Hah!  New I’d get you with that one.

That’s right, people.  Doctors are now transplanting “healthy” poop into the colons of patients with an intestinal infection called Clostridium Difficile (“C. Diff”) and it looks like it could actually be a very promising treatment.   Researchers in Oklahoma City performed fecal transplants on 77 patients with C. Diff that didn’t respond to standard treatment with antibiotics and had a 91% success rate in eradicating the infection

Why the heck are we talking about a medical treatment that is so gross?  Is the Student Health Center going to start offering poop transplants?  Well no, but many antibiotics that we commonly use to treat infections are associated with an increased risk of C. Difficile infection – even in young, healthy people – so it’s worth chatting about. 

C. Difficile is actually one of many “good” bacteria that normally live in our intestines, where it helps to prevent infections.  When we take antibiotics to treat other kinds of infections, they kill off some of these “good” bacteria in our gut as well as the ones they’re supposed to be killing.  This allows C. difficile to overgrow and release toxins that damage the cells lining the intestinal wall and cause severe diarrhea. 

The most common symptoms are watery diarrhea that occurs 3-5 times a day and is associated with abdominal cramping.  Symptoms usually start while you’re still on the antibiotic or 5-10 days after you stop.  Rarely, symptoms can develop up to 10 weeks later. 

In severe cases, the diarrhea will be more profuse and have blood or pus in it, and will be associated with dehydration, abdominal pain, fever, nausea and weight loss.  This is a serious condition called pseudomembraneous colitis which requires immediate treatment.

Most of the time, C. Difficile is treated by simply stopping the antibiotic that caused it to happen.  If necessary, a different antibiotic pill will be prescribed for 10-14 days.  If that doesn’t work, stronger antibiotics will be given through an IV along with the pills.  And if that doesn’t work… well, we send you to Oklahoma for a poop transplant.    

Probiotics have been shown to shorten the duration of diarrhea related to antibiotics, but research looking specifically at whether they can prevent or help treat C. difficile infection have been inconclusive so they are not routinely recommended. 

So the moral of the story, kids, is to use antibiotics as sparingly as possible.  Believe us when we tell you that your cold is just a cold or your sore throat isn’t strep.  Sometimes – in fact, most of the time – doing “nothing” is the best way to go.

John A. Vaughn, MD
Student Health Services
The Ohio State University

What are probiotics and what do they do?

candida-guide.com

Q: I keep hearing about probiotics.  What are they?  What do they do? 

A: According to the World Health Organization, probiotics are “live microorganisms which confer a health benefit on the host”.  Our gastrointestinal tract normally contains many different types of bacteria, yeast and viruses, collectively known as our “gut flora.”  The theory behind probiotics is that certain illnesses or medications can knock that flora out of balance – which causes all kinds of other problems – and probiotics help restore it.   

Probiotics exist naturally in such foods as yogurts, cultured milks (buttermilk, kefir) and fermented foods such as fresh sauerkraut, kimchi, tempeh, and miso.  They also can be found in certain nutritional supplements, and are added to many commercial foods including:

  • Yogurt (Activia, DanActiv Dairy Drink, YoPlus, store brands)
  • LiveActive Cottage Cheese
  • Kashi Vive Cereal
  • LiveActive Drink Mix
  • Goodbelly Juices
  • Attune Probiotic Bars

So do they work? 

Hard to say.  It’s like comparing billions of apples and oranges and trying to find an exact match.  We each have our own unique gut flora made up of countless groups of microorganisms; within a given group, there are multiple species of microorganisms; and within a given species there are multiple strains of microorganisms.  Studies have shown that some probiotics may be helpful in the following conditions:

  • Acute gastroenteritis (“stomach flu” or “traveler’s diarrhea”)
  • Diarrhea associated with antibiotics
  • Atopic eczema in infants
  • Lactose intolerance
  • Inflammatory bowel disease
  • Irritable bowel disease
  • Childhood respiratory infections
  • Dental caries (cavities)
  • Clostridium Difficile diarrhea
  • Urinary tract infections in females

But there are some very important things to remember:

  • Like other products marketed as supplements (as opposed to medications), probiotics are not regulated by the FDA, so there’s no way to know if the product in the bottle actually contains what the label says.  ConsumerLab.com is an independent laboratory that analyzes dietary supplements and their report on probiotics showed several common brands did not have the ingredients they claimed.
  • Consuming foods that naturally contain probiotics is a healthier way to get them than taking a supplement.  Eating real food is not only more enjoyable, but you get the benefit of other nutrients as well.
  • No matter how you get your probiotic, they need help to work.  It is important to choose meals and snacks that contain fruits, vegetables, and whole grains.  The healthy non-digestible substances in these foods (call prebiotics) help the bacteria to survive and flourish once they enter your gastrointestinal tract.

To learn more about probiotics, click here or make an appointment to talk with one of our nutritionists

Cheryl Czapla, Med IV
College of Medicine
The Ohio State University

Greg Avellana RD, LD, CDE
Student Health Services
The Ohio State University

The Ulcer Rap

You could spend the next 3 minutes reading about the risk of developing stomach ulcers from taking too much non-steroidal anti-inflammatory medications (NSAID’s), or you could just watch this “music video” made by an actual doctor rapping about ulcers courtesy of The ZBlogg.

 

We use NSAID’s all the time for aches, pains and fevers.  Odds are you’ve taken one within the last year, either alone or as an ingredient in one of those multi-symptom cold and sinus medicines.  The most common NSAID’s are ibuprofen (Motrin, Advil, Nuprin) and Naproxen (Aleve). 

These medicines really work well, but like all medications they have side effects, and one of the most serious – as ZDoggMD so eloquently points out – is ulcers in the stomach lining that can cause you to bleed internally. 

So if you need to use these medications, use as little as possible.  And if you develop fatigue, abdominal pain, black or tar-like stool, or bright red blood in your stool while taking them, make sure you get checked out right away.  In fact, if you need to take them that much, you should probably get checked out anyway.

And don’t worry – we don’t rap at the Student Health Center.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Farting – how much is normal and what can I do about it?

Q: What can I do for THE BLOAT? After I eat, it’s like I’m pregnant and I fart for like three hours!

A: Few benign things elicit such concern in the exam room as THE BLOAT. The stories from patients, genuinely miserable and clutching their bellies, are eerily similar: 

“I eat, drink, and a few hours later I swell up like a balloon.”

“I am a human zeppelin!”

“My boyfriend thinks I’m pregnant!”

“I have to unbutton my pants until I poop.”

“It’s disgusting what comes out of me.”

“It can’t be normal.”

“The covers nearly fly off the bed.”

“I thought I’d explode.”

There are some uncommon and concerning problems that can cause intestinal distress and gas: lactose intolerance, malabsorption syndromes like celiac disease, Crohn’s Disease or ulcerative colitis, and bacterial overgrowth syndrome to name but a few. But these problems almost always have other, non-intestinal symptoms like rash, joint problems, anemia, or debilitating diarrhea.

Usually though, abdominal fullness and gas are our own fault. We just can’t help it. Every bite of food and every sip of liquid delivers a few milliliters of air to our gut, more if we gulp or chug. Certain foods-beer, broccoli, those beans and whole grains we health care providers just love to tell you to eat-create a lot more air in the colon.

Fun Fart Facts:

  • There are actually people studying how much intestinal gas is normal using argon washout and body plethsymography. (And you think working in your lab sucks…) The best they can determine, about 200cc (a little more than half a can of Coke) in the gut at any one time is pretty typical.
  • The amount of air coming out from the rectum (Look out below!) varies between 500 and 1500ccs a day. That’s right, some people put out almost 2 liters of gas a day.
  • Most people emit their gas, okay FART, 10-20 times a day.
  • We often suggest Beano, simethicone (Gas-X) and activated charcoal, but there’s actually little evidence that they help. Pepto-Bismol, believe it or not, doesn’t decrease gas production but it can make it less stinky.
  • You can actually buy odor-reducing underpants. It’s true. Something to keep in mind for next Father’s Day.
  • Girls fart too!  If you don’t believe us, take it from the MythBusters guys

If your gaseous output is causing you or your loved ones excessive distress, try the following:

  • Eat slowly.
  • Avoid sorbitol (Often found in diet food and chewing gum).
  • For that matter, avoid chewing gum altogether. People who chew gum often swallow more air.
  • Avoid carbonated beverages.
  • For a few days, lay off the cruciferous veggies and legumes.
  • Get some exercise. Skeletal muscle contraction in the belly will help move that bloat along.

If these steps don’t help, or you are experiencing other concerning symptoms, come in and see us.

Victoria Rentel, MD
Student Health Services
The Ohio State University

 

Why is my poop green?

photobucket.com

Q: Why is my poop green?

A: Green poop is usually caused by your diet – as they say, what goes in must come out.  Green vegetables like spinach and broccoli contain large amounts of chlorophyll, a green pigment that can remain in the stool as it passes through your system. Artificial dyes from things like soft drinks and candies can also cause your stool to be weird colors.  Blueberries and Pepto Bismol can turn your stool black.

Another potential cause of green poop is bile. Bile is a greenish/yellowish chemical stored in our gall bladder that helps us to digest fat.  It is usually broken down in the intestines and gives stool it’s normal brown color.  But if stool moves too quickly through the intestines – like when you have diarrhea – it can pass through unchanged and give the stool a greenish color.

There are some infections, such as Salmonella, that can cause green poop but they are usually associated with severe diarrhea and abdominal pain.

Unless you’re having other symptoms we don’t usually worry too much about the color of poop.  The only exception would be black or red, which can be a sign of bleeding in your gastrointestinal tract.  If you ate a big piece of Red Velvet cake the night before, it’s probably OK.  But if you see red or black in the toilet bowl, and/or you are having other symptoms (abdominal pain, fever, weakness, diarrhea, nausea, etc.) be sure to come in and see us.

Adam Brandeberry, Med IV (OSU COM)

John A. Vaughn, MD (OSU SHS)

Gettin’ a little dirty may actually be good for you

photo: nymag.com

Bing Images

Science has done it again. Dirty pigs are healthier pigs. It has been proven. Don’t ask how, because it involved a lot of fetal pigs (which makes my undergraduate pig dissecting PTSD flare up), poop and blood.  But it also involved a lot of wallowing and I am ALL about science that proves that wallowing is good for you.

Sure, the title – Environmentally-acquired bacteria influence microbial diversity and natural innate immune responses at gut surfaces – scintillating as it is, might not immediately strike you as a defense of all that is good about being dirty. But pull up a chair and consider the dirty details.

Gut immunologists took baby pigs and sent them outside, inside or into a kind of antibiotic-laced biologic bubble. The guts of the outdoor, mud-wallowing pigs were full of healthier bacteria than the indoor pig guts. Not only was there more of the good stuff in outdoor beasts, there was also less harmful bacteria in the chute. Most cool and interesting, though, is that the bacterial composition of the piggies’ guts influenced the expression of immunologic genes: pristine, white-glove pork expressed more inflammatory genes and other icky inflammatory stuff.

I know what you’re thinking. Pigs aren’t human, Dr. Rentel. True. Based on this study I’m not going to build a heated pigsty with a giant HDTV for me and my kids in the backyard. There is, however, a growing, stinking, microbial-filled gooey heap of evidence that human interaction with bacteria is good. Why does the prevalence of autoimmune diseases and allergies keep going up? This study gives some very direct, powerful evidence as to how the cascade of autoimmune badness gets started. Okay, yes, in pigs, but pigs are a whole lot like us.

As my favorite infectious disease specialist in the whole wide world (Dr. George Gianakopoulos) used to say, “Nature abhors a vacuum. Kill the good bacteria and welcome in the bad.”  I’m not saying you should order dirt for take-out tonight.  But skipping the whole-body antimicrobial gel bath every day might not be a bad idea. 

Victoria Rentel, MD (Ohio State Student Health Services)

BMC Biology 2009, 7:79

Medical Mythbusters – Does gum really stay in your stomach for 7 years?

photo: wikimedia commons

Q: Is it true that swallowed gum stays in your stomach for 7 years?

A:  This myth is definitely false.  The body is very good at digesting material that it can use and passing the rest out in the stool.  It is true that your body is unable to digest the synthetic portion of chewing gum, but it doesn’t stay in the stomach for an extended period of time because the stomach periodically empties into the small intestine.  The gum then moves through the small intestine into the colon and is eventually passed in the stool. 

There are many substances that the body cannot digest that pass harmlessly through our system – for instance, this is why you will often see the outside fiber shell of corn in your bowel movements.  Tougher things than gum will often pass through harmlessly in a couple of days, as any parent of a toddler who swallowed a penny can tell you. 

Of course, if you swallow something that is too large to fit through the various valves and tubes in your guts, it can cause an intestinal obstruction.  So if you swallow a large amount of gum in a relatively small amount of time it can theoretically clump up into a large mass of indigestible substance (called a bezoar) that can get trapped in your GI system.  This medical emergency is very rare, but believe me – it if does happen, it’ll take a lot less than 7 years for you to figure out something ain’t right.

So the next time you’re at a fancy restaurant with a cloth napkin and nowhere to put your gum, you can swallow it with confidence.  Despite what the “old wive’s tale” says, it’ll be out of your system in a day or two.

Adam Brandeberry, Med IV (Ohio State College of Medicine)

John A. Vaughn, MD (Ohio State Student Health Services)

How do I know if I have appendicitis?

photo: about.com

Q: What is appendicitis? How do I know if I have it?

A: Appendicitis is a condition in which the appendix, a small finger-like tube that is attached to the colon, becomes infected. It is a relatively common disease that affects one in fifteen people. It is mostly seen in people aged 10-30.  We don’t really know what the appendix does, but we do know that people without an appendix lead perfectly normal lives and are not affected by its absence.

Appendicitis can manifest in many ways, but classically presents as pain around the belly button which increases and eventually shifts to the right lower side.  The pain can also be accompanied by fever, nausea, vomiting, or loss of appetite.  People with appendicitis classically have sharp abdominal pain that increases with movement or jarring. Another classic sign is “rebound tenderness”, which is sharp pain that occurs when compression is released quickly from the tender area. In other words, you tell your doctor where it hurts and she presses hard, releases, and winces when you scream.

Appendicitis can be caused by a blockage that allows bacteria to grow in the tubular structure.  It can also occur after a gastrointestinal infection, which causes the appendix to become inflamed. Sometimes appendicitis occurs spontaneously and a cause is never identified.

Sometimes, if left too long, the appendix swells up like a balloon and explodes, spilling the infectious goo into the entire abdominal cavity (bacterial peritonitis).  Sometimes an abdominal abscess forms.  In any event, the treatment for appendicitis is surgery: Get it out. Antibiotics are necessary for peritonitis or an abscess.

Fortunately, almost everybody recovers uneventfully from the surgery within a few weeks with a small scar and a good story. Because of the serious complications of appendicitis, it is important for anyone experiencing severe pain for more than a few hours, especially with a fever, nausea, and/or vomiting to be seen by a physician.

Adam Brandeberry, Med IV (Ohio State College of Medicine)

Victoria Rentel, MD (Ohio State Student Health Services)

Help! I can’t stop farting!

Q: Help! I farted in class and someone heard me!  What can I do to get rid of my gas??

A: Believe it or not, the normal frequency of passing gas is 14-23 times per day!  There are two major sources of intestinal gas: swallowed air and gas produced by bacteria in the colon.  Most people who have problems with gas don’t actually have excess gas in their intestines, but rather an increased sensitivity to normal amounts of gas. 

If you’re farting more often than 24 times a day (that’s not a challenge, guys) or you’re having difficulty keeping it from happening at inopportune times, you should take a look at what you’re eating and how fast you’re eating it. 

Air swallowing is the major source of gas in the stomach.  It’s normal to swallow some air while eating, but drinking carbonated beverages, drinking through a straw, chewing gum and eating too quickly can cause you to swallow an excessive amount of air.  Most swallowed air is released through burping, but what doesn’t come up must go down.

Certain high-fiber and carbohydrate containing foods such as cabbage, Brussels sprouts, asparagus, beans, broccoli, and some whole grains may not break down well in your digestive tract.  When they come into contact with the bacteria in your colon they ferment and produce lots of gas, as artfully demonstrated in the following classic scene from Blazing Saddles

(C’mon – there had to be a fart joke in here somewhere and this is the Mona Lisa of fart jokes!  Question the taste and maturity level of the clip all you want, but I’ll bet you a bottle of Bean-O you laughed…) 

If you’re having uncomfortable amounts of gas and bloating, you can do some things to help.  In addition to avoiding the above mentioned foods and activities, you should:

  • Increase your non-carbonated fluid intake, particularly water
  • Minimize alcohol consumption
  • Eat slowly and chew your food thoroughly
  • Do not smoke or use other tobacco products
  • Keep calm – tension can cause you to swallow air
  • Exercise regularly
  • Avoid dairy products if you are lactose intolerant

Some over-the-counter medications may also help:

  • Simethicone containing products (Maalox Anti-Gas, Mylanta Gas, Gas-X, Phazyme) cause gas bubbles to break up, which may decrease discomfort
  • Bean-O is an enzyme supplement that helps break down carbohydrates and may help if your gas is caused by foods such as beans and broccoli
  • A lactase supplement (LactAid) will help gas caused by lactose intolerance

Of course, excessive intestinal gas may also be a sign of a more serious problem.  If the above steps don’t help, be sure to come and see us at the Student Health Center.

Angela Walker, Med IV (Ohio State College of Medicine)

John A. Vaughn, MD (Ohio State Student Health Services)