Health Day

People with diverticular disease, a common digestive disorder, are typically told to avoid eating popcorn, nuts, seeds and corn so they don’t get painful attacks.

But, a new study calls into question that conventional wisdom. The study of more than 47,000 men found that eating those foods did not seem to increase the risk of diverticulosis or diverticular complications.

“We found, contrary to current recommendations, that actually, consumption of these foods did not increase the risk of diverticulitis or diverticular bleeding and didn’t appear to increase the risk of developing diverticulosis or its complications,” said study lead author Dr. Lisa Strate, an assistant professor of medicine at the University of Washington School of Medicine, in Seattle.

The findings are published in the Aug. 27 issue of the Journal of the American Medical Association.

Diverticular disease affects the colon, the part of the large intestine that discards waste. Diverticulosis occurs when pouches — called diverticula — form in the colon. Stool or bacteria can lodge in the pouches. Diverticulitis occurs when the pouches get inflamed; symptoms can include bleeding, infection or a blockage of the digestive system.

One third of U.S. adults have diverticulosis by age 60, although most do not experience serious problems. By age 85, two-thirds of people have come down with the condition, according to the U.S. National Institutes of Health.

The exact cause isn’t known, although many experts blame a low-fiber diet. Muscle strain during defecation may cause the pouches to form.

The advice to avoid nuts, seeds, popcorn and corn comes from the belief that these foods may be more likely to become lodged within the pouches. But there’s been no proof demonstrating such a link.

And Strate’s study failed to find a link, either. Evaluating data from the long-running Health Professionals Follow-up Study, a cohort of men followed from 1986 to 2004, she and her colleagues looked at medical records every two years and dietary information for every four years. The men ranged in age from 40 to 75.

At the study start, all were free of diverticulosis or complications. Eighteen years later, 801 had experienced diverticulitis, and 383 had diverticular bleeding.

When the study authors compared men with the highest intake of foods such as nuts with those with the lowest, they found that those who ate the most nuts were actually 20 percent less likely to get diverticulitis than those who ate the least. And those men who ate the most popcorn were 28 percent less likely to get diverticulitis than those eating the least.

No association was found for corn.

Strate thinks the longstanding dietary recommendations should be reconsidered, but she cautioned that hers was just one study. She believes the findings would probably apply to women, too.

Dr. Anthony Starpoli, an attending gastroenterologist at Lenox Hill Hospital in New York City, who is familiar with the new findings, said that even though the study numbers were large, the results may not apply to everyone. “There are probably going to be a subset of people where perhaps a more restrictive diet does benefit them,” he said.

Starpoli said that, while the recommendation to avoid nuts, popcorn and seeds isn’t based on scientific studies, there are people who do experience distress when they eat those foods.

“If you are a patient with known diverticular disease, and you have had the experience of eating seeds, nuts and popcorn and developed diverticular pain as assessed by your doctor, you should probably not have those foods.”

U.S. health officials declared Thursday that the nationwide salmonella outbreak has ended and that the consumer advisory against eating raw jalapeno and serrano peppers grown in Mexico has been lifted.

“Based on the available information and reports, it appears that this outbreak is over,” Dr. Robert Tauxe, deputy director of the U.S. Centers for Disease Control and Prevention’s division of foodborne, bacterial and mycotic diseases, said during a teleconference.

The CDC’s announcement was based on the falling number of new cases since early July, Tauxe said. “By early August, the number of cases was down to the number of cases we would expect to see anyway in the absence of a major outbreak. There are some cases of this infection that occur every year,” he added.

The last cluster of infections associated with restaurants occurred in early July, Tauxe said. “This is also an important indication that this particular outbreak is over,” he said.

The outbreak, the largest outbreak of food-borne illness in the United States in the past decade, sickened 1,442 people, hospitalized 286, and was implicated in two deaths between April and August. It was originally thought to be caused by tomatoes grown in Florida or Mexico. Eventually, the outbreak was traced to two farms in Mexico that grew jalapeno and serrano peppers, according to a report in the Aug. 29 issue of the CDC’s Morbidity and Mortality Weekly Report.

The U.S. Food and Drug Administration lifted the warning on eating raw jalapeno and serrano peppers from Mexico on Thursday because the outbreak appeared over.

Dr. David Acheson, the FDA’s associate commissioner for foods, said at the teleconference that none of the peppers associated with the outbreak are in circulation and that the agency has completed its field investigation.

The preliminary results of the investigation showed that jalapeno peppers were a major source of contamination and that serrano peppers were also a source, Tauxe said. “In addition, tomatoes were possibly a source, particularly early in the outbreak,” he said.

Since the outbreak began, the FDA has increased its surveillance and sampling of produce from Mexico, Acheson said.

“As a result of that initiative, the FDA has identified shipments of produce from Mexico which tested positive for strains of salmonella, other than the salmonella saintpaul strain,” Acheson said. “In cases where contamination was discovered on imported produce, the FDA has refused the entry and has imposed appropriate import controls on a shipper-specific basis to prevent the entry of contaminated product into the U.S. market.”

To help prevent and control future outbreaks, the FDA is asking Congress to give it the authority to require “industry-to-institute” mandatory preventative controls of high-risk foods, Acheson said. “These foods include certain types of fresh produce that have been repeatedly associated with adverse health events,” he said.

The agency is also calling upon the food industry to develop better tracking systems to identify more efficiently the distribution of produce, Acheson said.

Salmonella is a bacteria that can cause bloody diarrhea in humans. Some 40,000 cases of salmonellosis are reported in the United States each year, although the CDC estimates that because milder cases aren’t diagnosed or reported, the actual number of infections may be 30 or more times greater. Approximately 600 people die each year after being infected.

However, the strain of salmonella saintpaul involved in this summer’s outbreak had been previously considered rare. In 2007, according to the CDC, there were only six people infected in the country during April through June.

Working out on a treadmill improves brain function and fitness for people who have survived a stroke and gone through the usual rehabilitation program, a new study found.

“You address two problems these patients have,” said study researcher Dr. Andreas Luft, a professor of clinical neurology and neurorehabilitation at the University of Zurich in Switzerland. “One is that they don’t know how to walk. Not walking, they become deconditioned and lose cardiovascular fitness. With the treadmill type of training, you improve walking and also increase fitness.”

Luft worked with physicians at Johns Hopkins University, the University of Maryland and the Baltimore Veterans Affairs Medical Center on the study. It compared the brain and physical function of 37 people who had had strokes and worked on a treadmill three times a week, with 34 people who were given traditional stretching exercises.

After six months, peak walking velocity increased by 51 percent in the treadmill group and just 11 percent in the stretching group. Cardiovascular fitness increased by 18 percent with the treadmill routine, but decreased by 3 percent in the group limited to stretching.

And magnetic resonance imaging showed an increase of blood flow carrying more oxygen to the brainstem and cerebellum for those who worked on the treadmill.

“The most important clinical aspect of the study is that it is saying recovery can occur long after a stroke and can occur even after all the routine therapies have been tried,” said Dr. Daniel Hanley, professor of neurology at Johns Hopkins. “Scientifically, the most important point appears to be that rewiring of the brain may be involved in this process, not just body conditioning.”

The average age of study participants was 63, and the average time they began the treadmill program was 50 months after the stroke, Hanley noted.

“The average stroke patient now has about eight physical therapy sessions over six to 12 weeks,” Hanley said.

The study, published in the Aug. 29 issue of the journal Stroke, shows that treadmill work “should be part of standard treatment for every stroke survivor who has a walking habit,” Luft said.

That may not be an easily achievable goal, Luft acknowledged. “Most physical therapy departments have treadmills, but they don’t use them to the extent that we used them in the study,” he said.

And stroke survivors can’t just climb on a treadmill and start walking, Luft said. “Because this is exhausting, it should always be done under supervision,” he said. “There is always the risk of running into heart problems and falling. We used special treadmills with handrails and also monitored the heart rate to achieve the level of exertion we needed.”

Nevertheless, Hanley said, “the study defies current practice.”