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FRIDAY, Sept. 2, 2022 (HealthDay News) — A total of 97 people across six states have now been made ill by E. coli, in an outbreak possibly tied to contaminated lettuce used in sandwiches sold at Wendy’s restaurants.

“Since the last update on August 25, 2022, 13 more illnesses have been reported to CDC,” the U.S. Centers for Disease Control and Prevention said in an updated statement released Thursday. Two states — Kentucky and New York (with one case each) — have now been added to the list of states reporting cases, which also includes Michigan (58 cases), Ohio (24), Indiana (11) and Pennsylvania (2).

Illnesses from infection with the gastrointestinal bacterium have often been severe.

“Of 81 people with information available, 43 have been hospitalized and 10 developed hemolytic uremic syndrome, a serious condition that can cause kidney failure,” the CDC said, although “no deaths have been reported.”

The exact source of the outbreak has still not been officially confirmed, but the CDC said that in 67 cases where investigators asked what people had eaten in the week prior to becoming ill, 81% reported that they had eaten at Wendy’s.

“Of 54 people with detailed information about what they ate at Wendy’s, 37 [69%] reported eating romaine lettuce served on burgers and sandwiches,” the agency noted.

On Aug. 19, Wendy’s announced that it had removed romaine lettuce from its sandwiches in Michigan, Ohio and Pennsylvania.

“Wendy’s is taking the precautionary measure of removing the romaine lettuce being used in sandwiches from restaurants in that region,” the CDC said at the time. “Investigators are working to confirm whether romaine lettuce is the source of this outbreak, and whether romaine lettuce used in Wendy’s sandwiches was served or sold at other businesses.”

Romaine lettuce sold in grocery stores does not appear to be affected, the CDC said, and people can still eat at Wendy’s and eat the romaine lettuce in the salads it sells. Wendy’s explained in a statement that the lettuce used in its salads is not the same as that used in its sandwiches.

“We are fully cooperating with public health authorities on their ongoing investigation of the regional E. coli outbreak reported in certain midwestern states,” the company said at the time. “While the CDC has not yet confirmed a specific food as the source of that outbreak, we are taking the precaution of discarding and replacing the sandwich lettuce at some restaurants in that region.”

Most people with an E. coli infection “start feeling sick 3 to 4 days after eating or drinking something that contains the bacteria,” the CDC said. “However, illnesses can start anywhere from 1 to 10 days after exposure.” Illnesses typically last from 5 to 7 days.

What to Do:

• Watch for symptoms of severe E. coli, which include diarrhea lasting more than three days or diarrhea accompanied by a fever higher than 102˚F, bloody diarrhea, vomiting and a lack of urination.
• If you suffer from these symptoms, call your doctor immediately.
• Keep track of what and where you ate in the week before you got sick and report it to your local or state health department.

More information

For more on the outbreak, head to the U.S. Centers for Disease Control and Prevention.

You may have heard that you shouldn’t eat soy if you are at risk for breast cancer. But then you see headlines saying that it could protect against the disease. So what’s the truth?

Even for health-savvy people, telling fact from fiction can be tricky.

Knowing the real deal is important, especially now that soy is more common in the American diet. Along with its traditional forms of edamame, tofu, tempeh, and miso, soy is also a popular low-fat source of protein. It’s in soy milk, meat substitutes, cereal, baked goods, energy bars, and more.

Should you avoid these foods or eat more of them? The simplest answer is to think “whole” — as in, as close to nature as possible — so you don’t get too much.

For more clarity, get the truth behind these five common myths.

1. Myth: All soy foods raise your risk for breast cancer.

There’s no need to banish tofu and edamame from your diet.

“For years, soy got a bad rap because of its isoflavones,” says Marleen Meyers, MD, director of the Perlmutter Cancer Center Survivorship Program at NYU Langone Medical Center.

These plant-based chemicals are similar in structure to estrogen. Most breast cancers are sensitive to estrogen (or, as doctors say, “estrogen-receptor-positive” or “ER-positive,”) which means that estrogen fuels their growth.

“So there was a fear that soy could act as estrogen in the body and stimulate cancer cells,” Meyers says. “It was spread on blogs, and people would tell each other to avoid soy.”

But a steady stream of studies showed that a diet high in soy didn’t increase the chances of developing breast cancer and may even reduce that risk.

In one study of more than 73,000 Chinese women, researchers found that those who ate at least 13 grams of soy protein a day, roughly one to two servings, were 11% less likely to develop breast cancer than those who got less than 5 grams.

“In Asian cultures, where people eat a lot of soy from a young age, there are lower rates of breast cancer,” Meyers says. And in those societies, people still eat soy in its traditional forms.

Meanwhile, another analysis of eight studies showed that those who got the most soy isoflavones — about the amount in a serving of tofu – were 29% less likely to get the disease compared to those who got the least.

“As part of a healthy diet, whole soy foods are safe,” says Denise Millstine, MD, director of integrative medicine at the Mayo Clinic in Scottsdale, AZ.

2. Myth: All types of soy have the same effect on the body.

Your body may process the natural soy in tofu, miso, and soy milk differently than the kind that’s added to processed foods.

The soy protein isolate found in supplements, protein powders, and meat substitutes is usually stripped of nutrients, such as fiber.

“It’s also a more concentrated form of soy,” Millstine says. “So you’re much more likely to get a high dose if you’re having protein shakes and soy hot dogs than if you’re eating edamame.”

Researchers aren’t certain how large amounts of soy affect breast cancer risk. In one early study, soy supplements were shown to “switch on” genes that encourage cancer growth in women with early-stage breast cancer.

Experts recommend sticking with a moderate amount, or about one to two servings, of whole soy a day. One serving includes:

• Half a cup of cooked edamame
• 1 cup of soy milk
• 1 ounce of soy nuts
• 3 ounces of tofu

3. Myth: Eat soy to protect against breast cancer.

While eating a moderate amount of soy is fine, it’s too soon to suggest eating more to protect your breasts.

“The results are promising, but there’s still not enough information,” Meyers says. Experts now believe that soy isoflavones may actually block estrogen from attaching to breast cancer cells instead of spurring growth like once thought.

Meyers notes that many of the hallmark studies are done in Asian countries, where people grow up eating soy in its traditional forms. “That may influence the way their body processes soy,” she says. “We need to look at if having soy later in life has the same effect.”

More research also needs to be done on how much soy you get at different ages. “Soy may have more of an impact on a postmenopausal woman who’s not producing as much estrogen as a healthy 20-year-old,” Millstine says.

4. Myth: If you have or had breast cancer, avoid all soy foods.

Just as eating a moderate amount of whole soy doesn’t make you more likely to get breast cancer, it also doesn’t seem to raise your risk for recurrence.

“Still, I’d recommend that breast cancer patients avoid soy supplements,” Millstine says.

In one report, researchers analyzed data from diet surveys completed by more than 9,500 American and Chinese women. Those who said they ate the most soy were 25% less likely to have their cancer return compared to those who had the least.

Some experts worried that soy might interfere with breast cancer drugs that lower estrogen levels, such as tamoxifen. But the same study showed that soy also protected against recurrence in patients who took tamoxifen.

The soy foods that the study included were tofu, soy milk, and fresh soybeans. As you might expect, the Chinese women ate far more of it than those in the U.S. The results still held when the researchers considered that fact.

5. Myth: Soy only affects breast cancers that are sensitive to estrogen.

While it’s true that soy isoflavones play a bigger role in estrogen-receptor positive breast cancers, early research links it to a lower risk of other types of breast cancer.

That finding comes from a study of 756 Chinese women who had breast cancer and about 1,000 others who didn’t have the disease. All of the women answered questions about their diets, including how much soy they ate. Those who said they ate more soy were less likely to have any type of breast cancer, compared to those who ate the least.

That finding doesn’t prove that soy prevented breast cancer in any of the women. Other things could be involved.

“More research still needs to be done,” Meyers says. “It could be that people who eat more soy have healthier lifestyles in general.”

Stay tuned to see if that proves to be helpful across the board, whether you eat tofu regularly, pour soy milk on your breakfast cereal, or snack on edamame.

Sept. 2, 2022 – Many patients dealing with debilitating long COVID symptoms that interfere with their day-to-day lives might be tempted to go straight to a specialist – whether it’s a pulmonologist for breathing difficulties or a physiatrist for muscle fatigue – to see if they have long COVID. But medical experts – including many specialists who treat the most complex long COVID cases – recommend starting in a different place: primary care.

“Their primary care physicians are often most knowledgeable about the patients’ complete medical history, and that context is important in the process of diagnosing someone with long COVID,” says Benjamin Abramoff, MD, who leads the long COVID collaborative for the American Academy of Physical Medicine and Rehabilitation.

Primary care providers have been on the front lines of diagnosing long COVID since the early months of the pandemic, when it became clear that a large number of patients had lingering symptoms many weeks after their original COVID-19 infections cleared up.

One early guide for diagnosing long COVID in primary care, published in The BMJ in August 2020, estimated that 1 in 10 patients had a long illness after COVID infections. That estimate now looks low. A July 2022 report from the CDC found 1 in 5 people infected by the virus currently have long COVID symptoms.

Diagnosing long COVID has been a challenge because there’s no simple way to screen for the condition, and no single set of symptoms that definitively lead to the right diagnosis. Primary care providers, who often do detective work to sort out what conditions might explain patients’ health complaints, are well positioned to cast a wide net in exploring possible reasons for the complex mix of symptoms that is par for the course with long COVID.

Symptoms of long COVID Include fatigue, a cough that won’t go away, shortness of breath, lack of smell or taste, a hard time focusing, insomnia, sexual dysfunction, chest pain, and dizziness, among others, says Kristin Englund, MD, director of the Cleveland Clinic reCOVer Clinic, which treats long COVID patients.

Given how complex this is, there are many good reasons to seek a diagnosis in primary care, experts say.

Easier access to care is one big reason. Primary care providers tend to be closer to the patient’s home, and many set aside time to see sick patients quickly. Specialty clinics dedicated to long COVID care tend to be concentrated at academic medical centers in major cities and may have long waits for new patients. The sooner patients are seen, the sooner they may start getting care for symptoms that are interfering with their daily lives.

A primary care doctor who knows the patient well may be able to better distinguish symptoms unique to the COVID infection from old health problems that are resurfacing.

“Working with a primary care provider can avoid unwarranted and expensive diagnostic testing initially,” says Kathleen Bell, MD, a neuro-rehabilitation specialist at the University of Texas Southwestern O’Donnell Brain Institute who helped establish their COVID Recover program. “Patients should always start exploring questions of health care with their primary care physicians.”

Even if many experts agree that primary care is the best place to go for a long COVID diagnosis, they also agree that the process is imperfect and that not all of these doctors are up to the task. There aren’t yet evidence-based guidelines for diagnosing long COVID. And sometimes this diagnosis can get overlooked in primary care, especially when symptoms closely resemble those of other chronic health problems that have become more common during the pandemic – like depression, burnout, and chronic fatigue.

When patients show up with too many unexplained symptoms, primary care providers may also opt to refer patients to local specialists who can explore each issue separately, says Alba Miranda Azola, MD, co-director of the Post-Acute COVID-19 Team at Johns Hopkins University School of Medicine.

“What ends up happening in reality sometimes is patients see their primary care provider, they come in, they have 15 minutes, and they are ranting about all of these symptoms that are multisystemic,” she says. “The primary care provider doesn’t have time to deal with all of these symptoms – it’s gastroenterology and cardiology and neurology – and they refer to all of these different specialists.”

While referrals often help get patients diagnosed properly, it doesn’t always work because not all of these specialists are experienced with diagnosing long COVID, Azola says. “They see the cardiologist who says all of the tests are fine and I can’t help you, then it’s the same with all the different specialists.”

Patients who suspect long COVID, but don’t get this diagnosis despite persistent symptoms, may want to go to a specialized long COVID clinic for a second opinion, says Monica Verduzco-Gutierrez, MD, chair of rehabilitation medicine and director of the COVID-19 Recovery Clinic at the University of Texas Health Science Center at San Antonio.

“If the primary care provider has limited knowledge on the topic or limited options for treatments, or in the case where patients may become more chronic and have multiple conditions and symptoms to manage, this is where a multi-disciplinary long COVID clinic would be an excellent option,” she says.

Long COVID can be diagnosed when patients have persistent symptoms at 4 four weeks after infections start, according to the CDC. Many specialized long COVID clinics focus on more severe, complex cases and won’t see patients unless their symptoms don’t clear up for at least 3 months.

This makes sense, since many long COVID patients can be effectively diagnosed and treated in primary care, says, Tochi Iroku-Malize, MD, founding chair and professor of family medicine for the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. And primary care remains the best place for patients to go whenever they have concerning, unexplained symptoms – whether it’s long COVID or not.

“As the health care community continues to learn more about long COVID, it’s important to start with a health care professional you know and trust – your primary care physician,” she says.