Dear Doctor: What's the deal with this new bug that made a bunch of people who ate raw vegetables get really sick? So much for trying to eat healthy!

Dear Reader: You're referring to an outbreak of cyclospora, an infection by a one-cell parasite that causes watery (and sometimes explosive) diarrhea. It enters the body when you eat food or drink water that has been contaminated with stool from someone who has been infected with the parasite.

At the time that we're writing this, there have been two distinct outbreaks of cyclospora this summer. In the first, 237 people in Minnesota, Iowa, Wisconsin and Michigan fell ill. According to the Centers for Disease Control and Prevention, that outbreak was traced to Del Monte Fresh Produce vegetable trays, which contained carrot and celery sticks, broccoli and cauliflower florets, plus a dill-flavored dip. Which component (or components) of the trays was contaminated by cyclospora is not yet known. A second outbreak in Texas, which sickened 56 people, has been also been reported. Health officials are working to track down the source of that outbreak and are also investigating whether the two outbreaks are linked in any way.

The infection, known as cyclosporiasis, can last anywhere from a few days to several weeks. In people whose immune systems have been weakened either by disease, such as HIV/AIDS, or through medical treatment, such as chemotherapy, the infection can last for several months. In addition to diarrhea, which can be quite severe, the infected individual can experience loss of appetite, abdominal cramps, gas or bloating, nausea or vomiting, as well as flulike symptoms such as fever, body aches and fatigue. Symptoms begin to arise anywhere from two to 11 days after the parasite has been ingested.

Because diarrhea has many possible causes, diagnosis of cyclosporiasis can be a challenge. Even in cases when a physician suspects that a parasitic infection may be the cause of a patient's symptoms, he or she must specifically request that cyclospora be included in the laboratory testing of stool samples. According to the CDC, repeated tests may be needed. That's because cyclospora is infectious only at a specific moment in its life cycle, when it produces something known as oocysts. Those may be shed intermittently and at such low levels that they can easily be missed.

A mild case of cyclosporiasis will clear up by itself. In these cases, it's sufficient to address the fluid loss that diarrhea causes by adequate hydration. However, when symptoms persist beyond a few days, it's important to seek medical help. Be prepared to tell your physician about any recent travel to tropical regions where cyclospora is common and any potentially contaminated foods you may have eaten.

A combination antibiotic known as trimethoprim-sulfamethoxazole (Bactrim, Septra) is commonly prescribed for more severe infections. Ciprofloxacin or nitazoxanide (Alinia) may be used as alternatives. You can track the latest information regarding these outbreaks at cdc.gov/parasites/cyclosporiasis/outbreaks/2018/a-062018/index.html.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Everyone I know has leg cramps at night. Other than the multitude of "home remedies" and stretching (which is the advice my doctor gave that make mine worse), what can I do? They interfere with my sleep.

Dear Reader: Nighttime leg cramps are very common, especially as we grow older. National surveys found the prevalence of nighttime leg cramps to be 40 percent in people 50 and older. The cramps normally occur in the calf and/or the back of the thigh or in the foot. Although leg cramps usually have no known cause, sometimes they're related to electrolyte abnormalities, pregnancy, diabetes, hypothyroidism, alcoholism and medications. Also, structural abnormalities of the foot, genetic muscular disorders, prolonged sitting and walking, or standing for prolonged periods on hard surfaces can lead to leg cramps.

Your doctor has likely already evaluated whether your leg cramps are related to medication, electrolyte abnormality or neurologic abnormality, so let's move to actions you can take. Stretching the calf can ease leg cramps when they occur and, although you said that stretching didn't help you, daily stretching and compression massage of the calf with a foam roller can indeed help prevent the cramps from occurring. The key is to make the stretching a regular routine.

A 2012 study of 80 people with leg cramps showed a decrease in the severity and frequency of cramps when participants performed daily calf and hamstring stretching immediately before bedtime. You also might want to try riding a stationary bike at night, ensuring that your shoes are well-fitting and have good arch support, avoiding dehydration and reducing your intake of alcohol and caffeine. None of these have been well-studied for their effects on muscle cramps, but they could ease symptoms.

As for supplemental vitamins and minerals, a 1998 study showed some benefit from high doses of B complex vitamins in 14 patients with leg cramps when compared with placebo, but high-dose B vitamins can pose the risk of side effects (nerve dysfunction and nerve pain) when taken over the long term. For that reason, I don't recommend them.

People with lower iron levels may find benefit from iron supplements, but they should consult with their doctor before taking additional iron. Magnesium is reputed to help leg cramps, but studies haven't found this to be the case.

Muscle relaxants such as methocarbamol and carisoprodol can ease nighttime muscle cramps but, because they cause drowsiness, should be used with caution in the elderly. The anti-seizure medication gabapentin can also provide relief from nighttime leg cramps, but it too may cause excessive drowsiness.

When I began my practice, physicians normally recommended quinine for leg cramps, which provided significant relief -- as verified by studies. Doctors, including myself, stopped recommending quinine, however, due to its adverse effects on the bone marrow, which led to low platelet counts, anemia and a severe lowering of the white blood cell count. But tonic water contains a small dose of quinine, so I now recommend a small glass -- less than 6 ounces of tonic water -- before bedtime. This has helped many of my patients.

I hope one of these recommendations eases your nighttime leg cramps. You can't overstate the importance of a good night's sleep.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My 16-year-old daughter is normally very sweet and accommodating. But when she's hungry, she becomes a completely different person. I think she can control her mood when she's hungry; she insists she can't. Who's right?

Dear Reader: Not only is the hunger-related crankiness you're describing a real thing, it's prevalent enough to have recently earned an entry in the Merriam-Webster dictionary. According to the official definition, your daughter is "hangry." As the dictionary puts it, hangry is "a clever portmanteau of hungry and angry, and an adjective that describes being irritable due to hunger." But why?

When it's been too long between meals, there's more going on than just that hollow feeling and a stomach rumble. The real action takes place in the brain, which like the rest of the body, uses glucose to function. In fact, the nerve cells of the brain, known as neurons, are so plentiful and active that they use half of all of the glucose we take in each day. Wait too long between meals, and blood glucose levels drop. When this happens, the brain, which plays a role in virtually every vital function that keeps us alive, lets us know. And not in a polite, "Ahem, I'm a bit peckish, can we maybe eat sometime soon?" kind of way. With that blood sugar drop, the brain sets in motion a cascade of biological processes that basically shout: FOOD! NOW! I MEAN IT!

Specifically, when blood sugar drops to levels the brain finds inadequate, it triggers the release of cortisol and epinephrine. Known as counterregulatory hormones, they act against the effects of insulin and raise levels of blood glucose. Also involved in the complex hunger response is something called neuropeptide Y, which contributes to the physical sensation of emptiness.

In addition, cortisol and epinephrine are so-called stress hormones and are associated with increased levels of aggression. So is neuropeptide Y. So as blood sugar levels drop, the biochemicals released to increase the fuel available to the brain are also paving the way for us to feel stressed and angry. Some researchers theorize that this is no accident. While neuropeptide Y is busy making us feel empty, cortisol and epinephrine are making sure that nothing will come between us and finding that next meal that the brain so desperately needs.

In experiments exploring the hunger-anger nexus, researchers from the University of North Carolina at Chapel Hill found a connection between hunger and negative emotions. Participants looked at images that were either positive, negative or neutral. They were then shown a Chinese pictogram. Those who were hungriest, and who had previously viewed a negative image, were the most likely to feel negatively toward the pictogram. Those who reported lower levels of hunger didn't have the same level of negativity. Still, another experiment bolstered your "you can control your hanger" point of view. When participants were asked to be aware of their emotions, the hungry ones experienced less hanger.

So you and your daughter are both right. Hanger is real, and for some people, it can be controlled.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)