(NEW YORK) — Wendy’s is removing the romaine lettuce it uses in some of its sandwiches as the Centers for Disease Control and Prevention investigates an E. coli outbreak that has sickened dozens of people.

While a specific food has not been confirmed as the source of the outbreak, the CDC reported that multiple people reported getting sick after eating sandwiches with romaine lettuce from Wendy’s restaurants in Michigan, Ohio and Pennsylvania.

“Based on this information, Wendy’s is taking the precautionary measure of removing the romaine lettuce being used in sandwiches from restaurants in that region,” the CDC said in a statement Friday.

While there are hundreds of varieties of E. coli, most people infected with Shiga toxin-producing E. coli can experience severe stomach cramps, diarrhea (often bloody), and vomiting, according to the CDC.

Symptoms usually present within four days after consuming the bacteria and most will recover without treatment within five to seven days. In severe cases, some people can develop a type of kidney failure and require hospitalization.

The CDC advised people to contact their health care provider immediately if they have any severe E. coli symptoms. Officials also instructed anyone experiencing symptoms to assist public health officials by recording what they ate in the week before they got sick and reporting their illness to a local or state health department.

Wendy’s confirmed it uses a different type of romaine lettuce for salads and has not yet pulled those menu items.

“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,” the CDC continued, adding that the restaurant chain “is fully cooperating with the investigation.”

In a statement on its website Friday, Wendy’s confirmed that it was “fully cooperating with public health authorities on their ongoing investigation of the regional E. coli outbreak reported in certain midwestern states,” adding that it was “taking the precaution of discarding and replacing the sandwich lettuce at some restaurants in that region.”

“The lettuce that we use in our salads is different, and is not affected by this action. As a company, we are committed to upholding our high standards of food safety and quality,” the statement read.

Dr. Darin Detwiler, a professor of food policy and corporate social responsibility at Northeastern University, told “Good Morning America” that “lettuce has a long history of being a ‘culprit food’ with E.coli.”

“Foodborne pathogens do not discriminate. Even the mightiest and the most well-meaning and food safety-focused brands are susceptible to the challenges and failures that are found every year in food safety,” Detwiler explained. “Nobody cooks a salad. Lettuce of any kind is not cooked, thus it has no ‘Kill Step’ to eliminate any harm from pathogens.”

Detwiler, who lost his own 16-month-old son Riley to E. coli in 1993 after a multi-state outbreak “resulting from consumption of hamburgers” according to the CDC, has a doctorate in law and policy and a master’s in education, and has also served on the Department of Agriculture’s National Advisory Board. He currently chairs the National Environmental Health Association’s Food Safety Program.

The food policy expert and author explained that “much of lettuce is still in transition in terms of regulatory compliance with the [Food and Drug Administration’s] Food Safety Modernization Act’s produce safety rule,” which former President Barack Obama signed into law in 2011 and aims to prevent foodborne illness rather than respond to it.

“Many illnesses and those infamous recalls — think Thanksgiving 2017, 2018, 2019 — have been tied to lettuce production’s seasonal transition from Yuma, Arizona to the California central coast region,” he said. “Importers of romaine lettuce and/or salad mixes containing romaine lettuce from the U.S. must declare that the product does not originate from counties of Santa Cruz, Santa Clara, San Benito and Monterey in the Salinas Valley, California, U.S., or prove — through testing results — that the romaine lettuce does not contain detectable levels of E. coli O157:H7.”

He also noted that “Wendy’s leadership has seen outbreaks like this before” and “provided a presence at food safety industry events.”

At the time of publication the CDC said it had not advised any businesses, including Wendy’s, to stop selling or serving food.

Additionally, the CDC said there was “no evidence to indicate that romaine lettuce sold in grocery stores, served in other restaurants, or in people’s homes is linked to this outbreak.”

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(NEW YORK) — Low-calorie sugar alternatives, which had previously been thought to be relatively harmless, may actually have a negative effect on human gut health, according to a new study.

All four substances tested in the study – saccharin, sucralose, aspartame and stevia – were found to change the gut microbiome, the collection of microbes in the gut that help protect humans against disease and enable us to digest food.

“It’s about more than just the number of calories in these ingredients,” ABC News Chief Medical Correspondent Dr. Jennifer Ashton said Monday on “Good Morning America,” describing the study’s findings.

The study, published this month in the medical journal Cell, included 120 healthy adults, who were given the different low-calorie sugar alternatives at levels lower than the acceptable daily intake. The participants who participated in the study did not eat low-calorie sugar alternatives as a part of their diet prior to the study.

Study participants logged all of their food and physical activity using a smartphone app, and researchers took microbiome samples from the gut and mouth.

“Basically what they did is they looked at all of these sugar substitutes, things like aspartame, saccharin, sucralose, stevia,” said Ashton, who was not involved in the study. “Then they did some blood tests, they look at indicators of gut microbiome, and what they found was that saccharine and sucralose in particular increased the blood glucose, or ‘blood sugar’ level, [and] stevia increased our insulin level.”

She continued, “So bottom line here, these are not harmless or so-called ‘inert substances.’ And, again, it’s about more than whether or not they have calories like regular sugar.”

The researchers noted that previous research has shown that sugar consumption is strongly associated with weight gain, and replacing sugar in the diet with low-calorie sugar alternatives is one of the most common strategies people use to combat obesity and hyperglycemia, citing a study that showed 25.1% of kids and 41.4% of adults in the United States consumed low-calorie sugar alternatives from 2009 to 2021.

The prior study noted that more women than men consumed them as well.

The prevalence of obesity in adults in the United States was 41.9% in 2017-2020, and has increased 11.4% from 1999-2000, according to the Centers for Disease Control and Prevention. In kids and teens, the prevalence of obesity is 19.7% in 2017-2020.

Obesity prevalence can be higher depending on the location, with the Midwest and South having the highest rates of obesity, according to CDC data.

People who are overweight or obese are at an increased risk for many serious health conditions, including cancer, heart disease, stroke, high blood pressure, gall bladder disease, osteoarthritis, mental illness and other health problems.

For people whose diet is currently high in sugar substitutes, Ashton said she recommends minimizing their use, while acknowledging it can take time to do so.

“Right now we need more research to conclusively know what the impact it has on our health is, but the results of this study suggest that there is an impact on our metabolic health, and our overall health, and our gut — all important,” she said. “So, I think my recommendation would be minimize their use, don’t rely on them as a harmless, completely free-for-all when it comes to what we are putting in our foods, and take some time to re-train your taste buds.”

She continued, “That does take time but it is possible, and you can wean yourself away from that sweet tooth.”

Dr. Alexandria C. Wellman, a resident in the combined Anatomical and Clinical Pathology program at the University of California, Los Angeles, is a part of the ABC News Medical Unit.

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(NEW YORK) — Monkeypox has now been detected in all 50 states, health officials revealed.

Wyoming became the final state to report a case of the disease on Monday.

The Wyoming Department of Health announced the case in an adult male in Laramie County, which includes the capital of Cheyenne.

Public health representatives are currently working with the positive individual, to see if additional residents are at higher risk of contracting monkeypox, because of potential direct contact.

“Because monkeypox spreads through close, intimate contact we do not believe the risk for the virus is now a higher concern for the local community or for most people in Wyoming,” Wyoming Health Department state health officer and state epidemiologist Dr. Alexia Harrist said in a statement. said. “Monkeypox does not spread easily like familiar viruses such as influenza or COVID-19.”

Since the first case was announced in a Massachusetts patient in mid-May, more than 14,100 infections have been reported across the country as of Monday, CDC data shows.

New York currently has the most infections with more than 2,700, followed by California, Florida, Texas and Georgia, respectively, CDC data shows.

Over the last month, the daily number of reported cases has increased exponentially from 97 per day one month ago to more than 1,300 per day as of Aug. 10, according to the federal health agency.

Most of the cases in this outbreak have occurred during intimate skin-to-skin contact among men who have sex with men, a group that includes people who identify as gay, bisexual, transgender and nonbinary.

However, the CDC has stressed there is no evidence monkeypox is a sexually transmitted disease and that anyone can be infected through close prolonged contact.

At least five pediatric cases have been reported and at least one case has been reported among a pregnant woman.

While it is also possible to be infected with monkeypox by touching the clothes, sheets or towels of an infected patient or from prolonged face-to-face contact through respiratory droplets, the CDC says most documented transmission has not occurred from either of these two methods.

Two weeks ago, the U.S. Department of Health and Human Services declared the outbreak to be a public health emergency, which officials stated will help with the distribution of treatments and vaccines.

Public health officials urge anyone exposed to monkeypox or thinks that they have been exposed to receive the Jynneos vaccine, which is approved by the U.S. Food and Drug Administration for both smallpox and monkeypox.

As of Aug. 9, more than 620,000 vaccine doses have been shopped and an additional 1.1 million are available to order, according to the HHS.

The CDC says the best way to lower one’s risk of infection is to limit skin-to-skin contact with people whose monkeypox status is unknown, wipe down “high-touch surfaces” their skin may touch and for people to avoid touching their skin or eyes with their hands after coming into contact with a shared surface.

ABC News’ Arielle Mitropoulos and Sony Salzman contributed to this report.

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