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The 8 Best Fast Food Breakfasts

You know that breakfast is important, but when you're in a pinch in the morning, sometimes fast food is the quickest option. It's no secret that fast food isn't the healthiest or most nutritious option, but when it's the only option, whether you're traveling or running late for work, it helps to know how to make the best choices. Some menu items are definitely better than others. There are countless grab-n-go restaurants, each offering a different menu from the next, and with a little searching, you can find one option at each location that's lower in fat, sodium and calories than the others. Many fast food breakfasts can provide enough fat to last you all day, enough saturated fat for three days and sodium in levels that will make your blood pressure spike just looking at them. So how do you make the right choice? Do your research before you're in a pickle so that you know what to order for your quickie meal. Nearly every fast food restaurant lists nutrition information on its website, and SparkPeople's nutrition experts have done the research for you, listing the best options (or lesser evils) for each restaurant in our Dining Out Guide. And here, we’ve put together a "best of breakfast" list to guide you through your morning. And with the heftiest breakfasts out there racking up around 1,000 calories, placing a smart order can help keep you continue achieving your goals even when you’re pressed for time. When you’re ordering, look for keywords that will tip you off to selections that are higher in fat and calories. High-fat meats like sausage, bacon and steak are sure to add grams of fat (and saturated fat) to your breakfast. A bit of cheese on an egg can fit into a great calorie level for a meal, but extra cheddar topped on a breakfast sandwich or burrito can send it over the edge. Some restaurants add sauces to their meals that can amp up the calorie level, so stipulate no sauce or sauce on the side, if possible. Any menu choice with a biscuit will usually be higher in the calorie and fat department than English muffins or toast. One thing you won’t find when you’re looking at the drive-thru menu is the presence (or amount) of trans fats in each food. Many restaurants have eliminated trans fats from certain menu items, a smart move because trans fat is now known to be the most unhealthful fat you can consume. It's so bad, that experts are saying we shouldn't eat any, yet some restaurant foods contain up to seven grams of trans fat. This is information you’ll need to seek out before you place your order. Trans fat should be avoided whenever possible. If the nutrition facts on a restaurant website don't list trans fat, be wary. Below, we’ve done a bit of research for you by picking one breakfast item from each of eight popular fast food restaurants. None of these breakfast choices are ideal in terms of nutrition or health promotion, but if you’re going to choose fast food, these items have the fewest grams of fat, trans fat and calories at their respective locations. Note that the sodium levels are still quite high, as they are in most fast food options, so select lower sodium foods throughout the rest of the day to balance out your total sodium intake. Restaurant & Menu Item Calories Total fat Saturated Fat Trans fat Sodium Arby's Egg & Cheese Sourdough 392 12 g 3 g 0 g 1,058 mg Burger King Ham Omelet Sandwich 330 14 g 5 g 0 g 1,130 mg Carl's Jr. Sourdough Breakfast Sandwich 460 21 g 9 g Unknown 1,050 mg Chick-Fil-A Chicken Burrito 410 16 g 7 g 0 g 940 mg Hardee's Frisco Breakfast Sandwich 420 20 g 7 g Unknown 1,340 mg Jack In The Box Breakfast Jack 290 12 g 4.5 g 0 g 760 mg McDonald's Egg McMuffin 300 12 g 5 g 0 g 820 mg Subway Cheese Sandwich 400 17 g 7 g 0 g 940 mg None of these items should be part of your diet on a regular basis, but as the occasional treat or breakfast on-the-run, you can make them fit into an otherwise balanced and healthy diet. For more healthy and quick breakfast ideas that you can grab from your own kitchen, check out these speedy morning meal ideas. And remember that with a little planning, breakfast can be quick, easy, and healthy. This article has been reviewed and approved by Becky Hand, Licensed and Registered Dietitian.Article Source:

Photographer captures loving relationship between grandfather with Alzheimer's and cat

A photographer in Japan has captured the special relationship that has formed between her grandfather, who has Alzheimer's, and a kitten that she rescued.

Akiko DuPont says that her grandfather was diagnosed with Alzheimer's disease in 2009, and his demeanor changed over the subsequent years, according to KTVU. Her grandfather lost interest in life and became grumpy.

>> Read more trending news

Enter Kinako, a four-month-old kitten. DuPont was hesitant to introduce the kitten to her grandfather, who had always been more of a dog person. But she says the minute her grandfather laid eyes on the orange cat, his eyes lit up. 

Kinako is a loyal companion to DuPont's grandfather, following him while he engages in his daily routine and even sleeping in a similar position. DuPont has captured the images on her website.

Heart-warming video of military dad meeting baby girl for first time

A military dad finally got to meet his 4-month-old baby girl for the first time after returning from a 6-month deployment overseas.

>> Read more trending news

Sgt. Scott Cartwright met 4-month-old Jacqueline Eloise at John Glenn International Airport in Columbus, Ohio, Monday as his troop returned home from Kuwait.

“It was overwhelming. I still haven’t wrapped my head around it yet,” Cartwright told WSYX.

He and his wife, Elizabeth Cartwright, have a 2-year-old daughter, Nora, whom they adopted when she was 7 months old.

They were surprised when Elizabeth learned she was pregnant just after Nora’s first birthday.

“We didn’t think we were able to have kids of our own,” Elizabeth Cartwright told ABC News.

Scott Cartwright watched Jacqueline’s arrival via Skype and anxiously awaited the day he’d get to meet her.

“Honestly, when I was over there, in my head I was like, ‘How could I possibly love somebody else as much as I love Nora?’ I was worried about this. I was talking to my team about this,” Scott told ABC News

>> Related: Adorable photo of daddy-daughter tea party with Florida deputy goes viral

“But when I got to hold [Jacqueline] for the first time, and her and her mother have the exact same eyes, I was like, ‘Oh, my gosh. I see now.’”

The family plans on catching up on some much-needed time together in the upcoming weeks.


California Lawmakers Consider Mandatory Labels On Salon Products To Protect Workers

Beauty salon workers who paint the nails and treat the hair of millions of Californians are regularly exposed to toxic chemicals — and they may not know it, advocates say.

The advocates are asking California lawmakers to approve legislation requiring cosmetic companies to list the ingredients of beauty products used in professional salons. The bill, which passed the Assembly health committee Tuesday, will next be heard by the environmental safety committee.

Ingredient labels are now required on retail beauty products like makeup or shampoo, but federal law on labeling doesn’t apply to cosmetic products such as hair-straightening treatments or nail polishes used in salons.

In addition to requiring a list of ingredients on the salon product, the Assembly bill would require the label to flag any hazardous chemicals. The manufacturer would also be required to print its website address on the product and list its ingredients on the site.

“Nobody’s minding the store” when it comes to protecting the health of the workers who handle these products every day, said Nourbese Flint, policy director for Los Angeles-based Black Women for Wellness, an advocacy organization that is co-sponsoring the bill.

“Hair stylists in black beauty salons are some of the backbones of the black community in terms of economic entrepreneurship,” said Flint. More transparency about salon product ingredients would help the cosmetologists “make better, healthier choices for their bodies and their clients.”

A cosmetics industry trade group, the Personal Care Products Council, opposes the bill. During the hearing in the Assembly health committee, Tom Myers, general counsel for the group, said the bill is unnecessary because the industry already sends out safety information to salons.

The council also opposes the measure because it would impose “unworkable, state-specific labeling requirements on global brands,” according to a legislative analysis.

Nail care products such as artificial nails and polishes contain chemicals like formaldehyde, which is a probable carcinogen, and toluene, which has been shown to cause birth defects when inhaled by pregnant women.

A 2015 study looking at birth outcomes among California cosmetologists and manicurists found that, overall, these workers had a higher rate of gestational diabetes, and babies born to Vietnamese manicurists were smaller than those born in the general population.

Hair-straightening treatments such as the Brazilian Blowout have been known to contain formaldehyde. The U.S. Department of Labor found that workers using such products in one beauty salon were exposed to as much as five times the accepted limits of exposure to formaldehyde.

Dr. Thu Quach, a researcher at the Cancer Prevention Institute of California, says informing workers of potential risks is especially important given their level of exposure to salon products. Beauty salon workers may absorb chemicals both through their skin and the air they breathe, Quach said. A cosmetologist could apply a chemical-laden treatment to customers 10 times a day, or work in a space where chemicals are recirculating in the air all day, she added.

“Workers are exposed at much higher levels, so why would they not have the same right as consumers to know what they’re being exposed to?” said Quach, who is also a Steering Committee member of the California Health Nail Salon Collaborative, a co-sponsor of the bill.

Supporters hope new labeling requirements on salon products would pressure manufacturers to change the chemical formulations in their products.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Homeless Girl Scouts get their own troop

A group of homeless girls in New York have found the family they’ve been searching for thanks to Girl Scout Troop 6000.

Troop 6000 was started exclusively for homeless girls by a single mother who felt she disappointed her children when she lost her housing.

>> Watch the news report here

“I felt ashamed,” mom Giselle Burgess told the “Today” show. “I felt like I let them down.”

The New York Times reports Burgess became homeless last year when her rental home was sold to make room for new condominiums in her area. She makes a decent salary, but not enough to afford an apartment.

>> Read more trending news

Burgess wanted to give her daughters something to look forward to, so she decided to start a Girl Scout troop exclusively for homeless girls.

“Our mission is to instill girls with courage, confidence and character,” Burgess said.

So far, they have about 20 members.

>> Need something to lift your spirits? Read more uplifting news

“We’re all Girl Scout sisters,” a scout named Karina told “Today.” “We’re all a pack. And if you see a girl with 6000 on, it just makes you like, we’ve gone through the same thing or you’re still going through it.”

The girls are excited to be starting something great for other kids like them.

“We’re starting a chain reaction. Hopefully in the next couple years, there will be more Girl Scout troops in shelters,” said Karina, according to a blog post by the Girl Scouts of America.

If you would like to support Troop 6000, you can donate to the Girl Scouts of Greater New York.

12 Confusing Things You Hear in Fitness Classes and What They Actually Mean

If you've ever been to a barre class where the instructor asks you to do something with your hips that feels anatomically impossible, you're not alone. We've all been there, trembling in a plié squat, thinking, "What the tuck are they talking about?" Cueing—a technique used by personal trainers and fitness instructors to help clients achieve a specific movement—can be crazy confusing, and this bewilderment doesn't just happen at the barre. You hear confusing cues in yoga class, during personal-training sessions, group classes, and even in your favorite workout videos. We're going to explain what the 12 most common ones really mean, so the next time someone tells you to knit your ribs in, you don't go running for the nearest set of needles and yarn. 

1. Engage Your Core (also: activate your core, draw navel to spine, pull belly button to spine) Let's start with the most basic and common cue: Engage your core. The reason you hear this a million times and across a variety of workouts is because it's the single most important thing you can do to prevent injury and ensure you're actually firing the muscles you want to be working. Engaging your core is not to be confused with flexing or sucking in your stomach. It's bracing the abdominal and lower back muscles to stabilize the spine and allow proper breathing. Try coughing. Feel that stabilizing sensation in your midsection? That's engaging your core.  2. Balance on Sits Bones (also: sit, sitz, or sitting bones) Your sit bones refer to—you guessed it—the bones you sit on, otherwise known as the ischium bones of your pelvis. They curve to create two bony protrusions underneath your seat called ischial tuberosities. These bones can be hard to locate due to the muscles and fat that pad our bums, but you'll feel them when you sit up straight with a neutral spine, shoulders stacked over hips. To locate yours, try rolling into a ball (as shown). You should feel two pressure points connect to the mat. Once there, engage core to balance on those two bones. This is a cue often heard during yoga or Pilates classes. 3. Lengthen Your Spine (also: extend or elongate the spine, find length in your spine)  If you're thinking to yourself: It's not possible to make my spine longer—then you're right; anatomically, you can't. But what you can do is stretch the muscles and soft tissue that surround the spine and contribute to its mobility. Improper posture and daily activities that pull your shoulders forward (such as sitting at a desk all day, hunching over your phone, etc.) can cause tightness and decreased flexibility and range of motion. In Pilates, this cue refers to a spinal extension (shown here) and will stretch and thus elongate the spine.  4. Knit Ribs In (also: close your rib cage, don't let ribs flare, ribs down, zip up your ribs) Knitting your ribs in is another way of reminding you to engage your core muscles to properly support your spine. "Opening" the ribs is a common compensation that happens when someone lacks the strength or range of motion to perform an exercise (like reaching overhead) with proper form and alignment. To close your ribs, activate your abdominal muscles to keep spine neutral and enable normal breathing.  5. Resist the Weight (also: fight against the force) Thought you just had to lift the weights? Turns out, you also need to resist them. This cue is a reminder to prevent gravity from controlling the movement. As you lower a weight (for example, in the downward phase of a biceps curl), don't let the force of the weight and the pull of gravity yank your forearm down uncontrollably. Instead, contract your muscle (in this case, the biceps) to resist those forces and maintain control of the movement. This goes for external resistance like dumbbells and barbells, but also for your own body weight, like lowering your legs during a double leg drop exercise for your lower abs.  6. Spread the Floor (also: spread the mat apart, push the floor away, drive the ground away) This cue prevents you from collapsing into your shoulders and reminds you to activate your legs and butt during a plank (shown here), but it's also a great reminder to prevent your knees from collapsing in during a squat, sumo deadlift, or wide-stance lift. This is an example of external cueing, a technique used to help you focus on an external object in your environment (the floor) or the outcome of the action rather than your own body to help you achieve proper form and movement. 7. Pulse (also: pulse it out, pulse reps) Pulsing during a workout is not humping or twerking—what you do in your free time is your business. A "pulse" is a partial movement (think of it like a mini version of the full exercise), and a training technique used to add additional stress to a muscle group. In the case of a bridge (shown here), it may loosely resemble a pelvic thrust, yes, but what you're really doing here is using a very small, controlled movement to exhaust the glute and hamstring muscles. Pulsing an exercise after you've completed a set of the full movement is a great way to further tax the muscles without adding additional weight or requiring a spotter.  8. Stay Light on Your Toes (also: land lightly, light feet, soft landing, toe-to-heel) This cue is often used during jumping, high-impact, or plyometric exercises. The idea is to recruit your muscles and joints to maintain control of your own body weight as you make contact with the ground. To stay light on your toes, let toes hit ground first (rather than stomping down with your entire foot). Then use the mobility in your ankles to roll through the balls of your feet, to midfeet, to heels as you bend your knees. This allows you to properly distribute your own weight as you land and lets your muscles absorb most of the impact instead of your joints.  9. Burn It Out (also: feel the burn) Similar to pulsing, when told to "burn it out," you're being asked to perform an exercise repeatedly to completely fatigue the muscle or muscle group (such as the triceps, shown here). As muscles start to fatigue and use up all of their stored energy, your body releases lactic acid, which results in a tingling, burning sensation. Of course, if this burning ever feels more like an impending injury than muscle fatigue, you should stop the exercise immediately. Otherwise, light those guns on fire.  10. Draw Shoulder Blades Back (also: pinch shoulder blades together, draw shoulders down) As mentioned above, many of our daily activities cause our shoulders to slump and fall forward. But proper posture and alignment calls for our scapulae, or shoulder blades, to be pulled back rather than forward. This cue is especially important when performing exercises that target your shoulders, back, and lats, since you need to first ensure your shoulder blades are in the correct position before strengthing the muscles that surround them to hold them in the proper place. To practice, pretend there's a sheet of paper between your shoulder blades and that you need to squeeze them together to hold it in place.  11. Square Your Hips (also: hips like headlights, square off, square your shoulders) When you're instructed to square your hips, you're being asked to keep hips in-line and balanced so that they form right angles with an external surface (the floor, wall, an opponent, etc.). The same goes for squaring your shoulders. The reason this cue is used with hips and shoulders is because the pelvis and shoulder girdles require stability for proper form and alignment. You'll use the muscles surrounding each (core and glutes for hips; upper back, shoulder, and arm muscles for shoulders) to lock them in place, ensuring balance. 12. Tuck Hips (also: pelvic tuck, scoop, hollow core, flat back, neutral spine) Tucking is often heard in barre or Pilates classes, but understanding the concept will benefit you with basic posture and most exercises. The purpose is to encourage perfect posture by eliminating an excessive arch in your lower back. To do so, roll or rotate your pelvis under, engage core, and stack shoulders in-line with hips. This is where you'll find a "neutral spine," or "flat back." This position prevents overcompensation and is less stressful on your lower back, which means less risk of injury. 

Special thanks to Rodrick Covington, certified Pilates and fitness instructor and founder of Core Rhythm Fitness, for demonstrating these moves for us. 

9 Healthier Ways to Enjoy Your Favorite Girl Scout Cookies

Girl Scout Cookies—while delicious and supportive of a good cause—are not the healthiest. They're also impossible to eat in moderation. That's a dangerous combo for us, so this year, we're avoiding it altogether by digging into these nine healthier versions of Samoas, Thin Mints, and Tagalongs instead. From pops to peanut butter shakes to no-fuss fudge, these bites (and sips) will make you think outside the cookie box.

Samoas 1. No-Bake Samoa Cookie Granola Bars Wake and (don’t) bake with this recipe—mix, microwave, and refrigerate instead. If you swap out the corn syrup for honey or maple syrup, you'll have 12 amazing granola bars to snack on that are healthier than the original cookies. 2. Samoa Kefir Pops Hello, probiotics. By using kefir in place of yogurt, you’ll get extra healthy bacteria, calcium, and protein. Plus, since these pops are made with only five ingredients (kefir, shortbread, toasted coconut, chocolate, and caramel), they're a cinch to make and a delight to eat. 3. Sinless Samoas More like energy bites than actual cookies, this vegan and gluten-free snack is a great way to celebrate Samoas without fear of sugar overload. They're made with dates, almond butter, unsweetened shredded coconut, dark chocolate, sea salt, and vanilla, and pair amazingly well with a banana or latté. Thin Mints 4. Thin Mint Freezer Fudge Frozen Thin Mints are pretty awesome. What’s even more awesome: Thin Mint-flavored freezer fudge. With heart-healthy almonds, real mint, plenty of cacao, and natural sweeteners like maple syrup, this healthy dessert provides as many nutrients as it does delicious flavors. Bonus: Keeping it in the freezer means it will last that much longer. 5. Paleo Thin Mints These Paleo Thin Mints (made with gluten-free flour, grass-fed butter, egg, Himalayan sea salt, and maple syrup) will definitely make you consider going full-on caveman if you haven’t already. Pro tip: Pile dairy-free ice cream between two of the chocolate crisps for an extra treat. 6. Thin Mint Spinach Smoothie Really, there’s nothing thin about this smoothie—the combination of Greek yogurt, spinach, and almond milk actually makes it pretty darn thick. It won’t leave you overly full or bouncing off the walls with a sugar high, and you can make it even creamier by adding a quarter of an avocado or vanilla protein powder. Tagalongs 7. No-Bake Tagalong Cookies This vegan dessert proves you don't need milk and butter to make a delicious sweet treat. What these cookies lack in butter and dairy, they make up for in serious flavor (and health benefits). Plus, they're no-bake—which means you can eat them that much sooner. 8. Chocolate Peanut Butter Banana Shake This shake might not have "Tagalong" in the name, but it has all the elements of the original cookie—and by that we mean chocolate and peanut butter are front and center, of course. Since this shake is sweetened with dates instead of added sweeteners, there's nothing really unhealthy about it. Breakfast, anyone? 9. Clean Eating Tagalong Bars Getting those perfect Tagalong layers can be tricky if you're making individual cookies, so consider Tagalong bars your clean-eating shortcut. The "shortbread" here is made with almond meal, but the choclate and peanut butter layers keep these healthy alternatives tasting like the original cookie.

Originally published January 2015. Updated April 2017.

5-Ingredient Make-Ahead Breakfasts for the Person Who Always Hits Snooze

Mornings can be a struggle. And waking up with enough time to make a healthy breakfast is a level of difficulty that's off the charts. This week's featured foodie, Laura Lea, founder of the blog LL Balanced, is here to save you. With five or fewer main ingredients (spices and oils don't count), these make-ahead breakfasts might even turn you into a morning person. Try one of these dishes so you can spend more time ironing your wrinkled shirt. #adulting 

1. Sweet Potato Breakfast Pudding A new way to eat our favorite versatile veggie and a perfect fit for all creamy-texture fans, this sweet potato pudding calls for just four ingredients. Don't dash off to the store yet. Open your pantry or fridge, because you probably already have these simple ingredients.  If the week is looking busy, make five of these on Sunday and store in mason jars. Breakfast for the week. Done.  2. Easiest Cinnamon Raisin Granola Most store-bought granolas are packed with sugar, and most homemade versions have a long list of ingredients. This recipe eliminates both problems. With just a small amount of maple syrup and only five main ingredients, this can be a cost-effective staple in your house. 3. Apple Cinnamon Slow-Cooker Oatmeal If you crave cozy and warm everything in colder months, this make-ahead breakfast is a dream. It’s silly-easy (just combine and cook), makes your home smell amazing, and is full of healthy fats and fiber. If you want to feed yourself or your family quickly and easily all week, this is for you. 4. Blueberry Coconut Overnight Porridge The cool, muesli-like consistency of overnight oats makes it even easier to wake up on a warm summer morning. Feel free to switch out different berries and add-ins, but blueberry and coconut is a pretty solid pairing, if you ask us.    5. Peanut Butter Breakfast Cookies If there was ever a case for making peanut butter its own food group, it’s this recipe. These cookies just cover so many bases: They're grab and go (a.k.a. they hold together easily), satisfy a sweet and savory tooth, and can morph from breakfast to snack to dessert. If you're feeling adventurous, slice them in half and fill with jam for an extra treat. 6. Pesto, Chicken, and Spinach Frittata Pesto fans, have you ever put this sauce on eggs? It's time. This frittata keeps it simple with three ingredients added to the eggs, but the flavor is good enough for the in-laws to come for breakfast. If they cancel on you, you get to enjoy this all week, warm or cold, and at any time of the day. Pro tip: Using store-bought pesto and frozen spinach makes it even easier.   7. Chocolate Breakfast Bars Portable healthy chocolate? That we can eat for breakfast? Sold. If you’re rushed in the morning (who isn't?), keep a batch of these in the freezer at all times. Place one in the fridge at night, and you can snag it on your way out. You might want to bring a second for a just-in-case moment. Warning: This one falls outside of the five-ingredient range, but it's so simple you won't even notice.  

Laura Lea Goldberg is a certified health-supportive and holistic chef based in Nashville, Tennessee. She began studying the concept of holistic health and cooking fresh, produce-focused meals when the negative effects of a corporate career began to affect her health. She marveled at the profound improvement of her physical and emotional state, particularly her ability to cope with stress and anxiety, that a fresh, vegetable-based diet produced. Determined to share this simple but forgotten connection, she graduated from the Natural Gourmet Institute in New York City and created her website, Her first cookbook, The Laura Lea Balanced Cookbook, debuts May 2017.

San Francisco Seeks To Ban Sale Of Menthol Cigarettes, Flavored Tobacco Products

San Francisco has unveiled a tough anti-tobacco proposal that would ban the retail sale of menthol cigarettes and other flavored tobacco or tobacco-related products that are often the first choice of minority group members and teenagers who smoke.

Supervisor Malia Cohen, sponsor of the proposed ordinance, joined Tuesday with public health experts and community advocates to announce the measure, which she said goes beyond more narrow laws on flavored tobacco in cities such as Chicago, Berkeley and New York.

“The legislation I’ve authored is a full restriction on the sale of all flavored tobacco products, and that does include menthol. There are no exemptions,” Cohen said. This includes cigarettes, cigars, smokeless tobacco and e-cigarettes.

[caption id="attachment_232536" align="alignright" width="270"] San Francisco Supervisor Malia Cohen sponsored the ordinance that would ban the retail sale of menthol cigarettes and other flavored tobacco products. (Courtesy of Malia Cohen)[/caption]

The proposed ordinance is designed to address two major groups, youth and minorities, who have been targeted in successful, well-financed advertising campaigns that promote menthol cigarettes and flavored non-cigarette tobacco products. The products often attract African-Americans, Asian-Americans and Latinos, as well as teenagers.

San Francisco Mayor Ed Lee endorsed the proposal. “We know from research and studies that tobacco-related diseases continue to be the No. 1 cause of preventable deaths, especially among low-income and minority communities,” he said.

A similar measure is being considered in Oakland.

Cohen, who represents the predominantly African-American Bayview-Hunters Point district of San Francisco, said the ordinance grew out of her personal experience with family members who smoked menthol cigarettes and died of cancer, and her desire to spare San Franciscans a similar fate. “This is an evidence-based tobacco prevention strategy that will save lives and cut costs for taxpayers who are collectively shouldering the health care costs of tobacco-related illnesses,” she said.

Nearly 9 in 10 African-Americans who smoke prefer menthol cigarettes, according to the federal Centers for Disease Control and Prevention. Menthol is believed to make the harmful chemicals contained in cigarettes more easily absorbed by the body, and some research shows that menthol cigarettes are more addictive than regular ones, according to the CDC.

“African-Americans don’t have a genetic disposition that makes them smoke menthol cigarettes,” said Dr. Valerie Yerger, an associate professor of health policy at the University of California-San Francisco. “It’s the result of a very conscious advertising campaign by the tobacco industry.” Menthol cigarettes are also preferred by a majority of Latinos and Asian-Americans who smoke, according to Randy Uang, director of tobacco prevention and control services at Breathe California, a Golden Gate Public Health Partnership.

Public health experts say restricting menthol and other flavored tobacco would improve health outcomes not only for the minority populations but also for teens. “Because flavors play such a key role in youth starting to smoke, restricting access to these products means that fewer youth will start smoking,” said Uang.

Flavors are popular with inexperienced smokers, he said, because they mask the taste of tobacco and decrease the irritating effects of nicotine.

E-cigarettes are now the tobacco-related product most commonly used by young people in the U.S., according to the CDC. It found that more than 8 in 10 youths ages 12-17 who vape said they use flavored e-cigarettes that taste like mint, candy or other sweets.

The San Francisco ordinance, if approved, would fill a gap in federal legislation that authorized the U.S. Food and Drug Administration to regulate tobacco. In 2009, the FDA banned “characterizing flavors,” such as candy, fruit and chocolate, in cigarettes. But, faced with tobacco industry lobbying, it stopped short of prohibiting menthol in cigarettes or flavorings in other tobacco-related products such as e-cigarettes, little cigars and smokeless tobacco.

Tobacco-control advocates, such as Yerger, have been pushing the FDA to ban menthol and other flavorings for years. “This ordinance didn’t happen overnight,” she said. “It’s been a very long process and part of that has been gathering evidence about the role of menthol in hooking kids at a very early age and the tobacco industry knowing that it has the ability to do that by manipulating the levels of menthol in their products.”

Cohen noted the tobacco lobby is strong in Sacramento and she’s expecting pushback from the industry. “I would imagine they will be fighting this legislation every step of the way,” she said.

If enacted, the tobacco ordinance would become effective Jan. 1. Enforcement would be the job of the Department of Public Health, which also would be responsible for educating retailers about the new restrictions.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Stalking the ‘Unknown Enemy’: Doctors Turn Scope On Rare Diseases

WHITTIER, Calif. — Lynn Whittaker stood in the hallway of her home looking at the framed photos on the wall. In one, her son, Andrew, is playing high school water polo. In another, he’s holding a trombone.

The images show no hint of his life today: the seizures that leave him temporarily paralyzed, the weakness that makes him fall over, his labored speech, his scrambled thoughts.

Andrew, 28, can no longer feed himself or walk on his own. The past nine years have been a blur of doctor appointments, hospital visits and medical tests that have failed to produce answers.

“You name it, he doesn’t have it,” his mother said.

Andrew has never had a clear diagnosis. He and his family are in a torturous state of suspense, hanging their hopes on every new exam and evaluation.

Recently, they have sought help from the Undiagnosed Diseases Network, a federally funded coalition of universities, clinicians, hospitals and researchers dedicated to solving the nation’s toughest medical mysteries. The doctors and scientists in the network harness advances in genetic science to identify rare, sometimes unknown, illnesses.

At UCLA, one of the network’s sites, Andrew’s medical team would later map his genetic makeup, then bring him in for a week of exams and consultations with specialists.

Writing A New Disease Encyclopedia

[caption id="attachment_721139" align="alignright" width="370"] Andrew uses the towel rack in his bathroom to perform his daily exercise. (Heidi de Marco/KHN)[/caption]

The Undiagnosed Diseases Network was founded in 2015 with a $43 million grant from the National Institutes of Health (NIH). Building on work already being done at NIH, the initiative expanded to include universities across the country: Duke, Columbia and Stanford are among the other sites. The goals are to provide answers for patients with mysterious diseases and to learn more about the disorders.

A proposal last month by President Donald Trump to cut the NIH budget by $5.8 billion could put the program in jeopardy.

Even with the best technology and the finest brains at work, progress is slow. Since its launch, the network has received nearly 1,400 applications on behalf of patients. It has accepted 545 for review so far. Just 74 of the cases have been diagnosed, including 11 at UCLA. Andrew Whittaker’s case is among many in progress.

It’s like battling “an unknown enemy,” said Euan Ashley, one of the principal investigators of the network’s Stanford University site. “That is a particular form of torment that other patients don’t have.”

A diagnosis can end families’ painful odyssey while helping physicians and scientists better understand rare diseases and human physiology, said Rachel Ramoni, former executive director of the network, which is based at Harvard University.

Researchers throughout the network use advanced medical technology. For example, to study patients’ gene expression and disease progression, they can make models using nearly transparent zebrafish, whose genetic structure is similar to that of humans. And scientists can conduct whole genome sequencing, which allows the medical team to read a patient’s DNA and identify changes that can reveal what may be causing a disease.

[caption id="attachment_721129" align="alignright" width="370"] Lynn and Dave Whittaker describe the progression of Andrew’s disease to Dr. Stanley Nelson at UCLA in January. (Heidi de Marco/KHN)[/caption]

“We have powerful techniques to look at every gene that is being expressed as well as every gene that is inherited,” said Stanley Nelson, one of UCLA’s principal investigators and the lead doctor on Andrew’s case. “This is an example of true precision medicine.”

Nelson said the network can examine all known genes — not just the ones believed to have mutations that cause diseases. Doing that can lead to the discovery of new illnesses.

“Part of what we have to do is keep building that library, that encyclopedia of what gene and what gene mutations cause what symptoms,” Nelson said. “It’s just incomplete at this moment.”

Already the work is helping patients and their families come to terms with their illnesses. In one case, at Stanford, a toddler was diagnosed with two rare diseases, including a connective tissue disorder called Marfan Syndrome, after doctors conducted a form of sequencing that looks for changes in coded genetic segments known as exons.

Sometimes answers come from something decidedly lower-tech: collaboration among clinicians and researchers who share experiences, data and expertise.

“A lot of times your ability to be diagnosed depends on who is in the room,” Ramoni said. “And what we are doing with the network is we are expanding exponentially the number of people in the room.”

Doctors at one institution might think their patient is a unique case, only to learn that colleagues elsewhere have a patient with a similar illness. But even when diseases are diagnosed or gene mutations are discovered, treatments may still not be available.

A Life-Changing Mystery

Andrew Whittaker’s odyssey began one afternoon at age 19, when he started trembling and couldn’t speak. Doctors suspected he was suffering from anxiety and prescribed medication to control it. But Andrew said he continued to have “episodes,” during which everything just went blank.

“It’s like there’s not enough blood going to your brain,” he said. “You can’t think.”

Andrew also started losing his balance and falling off his bicycle. The family visited several hospitals. Doctors discovered that the receptors in his brain were malfunctioning and that he lacked sufficient dopamine, a chemical compound in the body responsible for transmitting signals between nerve cells. As a result, Andrew has some symptoms similar to those of Parkinson’s disease. Doctors also confirmed he was having seizures.

Still, Andrew’s symptoms didn’t add up to any known disease.

One afternoon last fall at precisely noon, as Andrew sat propped up on the living room couch, Lynn’s phone alarm sounded, signaling it was time for his medication. Lynn pried open Andrew’s hand, which was clenched into a fist, and dropped in the pills.

To keep Andrew from falling, the family has lowered his bed and removed carpet from the house. They also bought him a wheelchair. Their precautions don’t always work. One morning, Lynn was in the kitchen when she heard a crash. “I ran in there and he’s laid flat on his back,” she said.

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Andrew is close to his mom. But he also gets frustrated. He can’t shower or dress without her help. He’s had to give up the things he loved to do: printing T-shirts. Skateboarding. Shooting short films. He’s lost friends and can’t imagine dating anymore.

“Girlfriends? Forget about it,” he said, his face twitching as he talks. “They want a guy who can do stuff for them, not the other way around.”

Running The Medical Gauntlet

On a Monday morning in late January, Andrew and his parents were in an exam room at UCLA. Lynn teased her son, saying she was going to put him in a freezer until doctors figured out what was wrong.

“Then we’ll pull you back out again,” she said, smiling.

“I’ll never get pulled out,” Andrew responded.

“Yes, you will,” she said. “You will.”

[gallery size="full" ids="721130,721131,721134"]

Nelson, Andrew’s main doctor, walked into the room. He told Andrew he’d read through the medical records. “We’re going to try to figure you out.”

The work Nelson does is personal. His teenage son, Dylan, has Duchenne muscular dystrophy, a genetic disorder that causes muscle degeneration and weakness. Nelson knows his son’s disease will eventually take his life, but he said having a diagnosis makes all the difference.

“My heart very much goes out to the families that don’t even get an adequate diagnosis,” he said.

Nelson suspects that Andrew’s disease is genetic as well.

He asked the Whittakers to describe their son’s journey, then he conducted a short physical exam, asking Andrew to push against his hand and touch his own nose. Andrew trembled and his shoulders tensed, but he did it.

The rest of the week, Andrew underwent several other diagnostic tests, including a muscle biopsy, an EEG, MRI and a lumbar puncture. He remained upbeat, though running the medical gauntlet clearly wore him out. He also met with UCLA specialists in brain degeneration and muscle and nerve disorders.

[caption id="attachment_721127" align="alignright" width="1170"] Andrew gets an MRI at the UCLA MRI Research Center in January. (Heidi de Marco/KHN)[/caption]

At week’s end, Nelson sat down with the family to explain what he’d found. He had reviewed Andrew’s genome and compared it with that of both parents. Andrew had one copy of a defective gene that leads to Parkinson’s but the genome sequencing didn’t show a second copy, without which it could not be Parkinson’s.

He explained that Andrew’s illness was clearly progressive and that his brain was shrinking, making it harder for him to process language and information. Nelson said he still didn’t have a diagnosis — he believed it was a brand-new disease.

Nelson planned to continue poring over the test results, conducting additional exams and communicating with others in the network. He also is analyzing Andrew’s muscle tissue, skin and blood to see whether any mutated gene is expressed abnormally.

Even in the absence of a clear diagnosis, Nelson said, rare diseases like Andrew’s help educate scientists and may help other patients. “These are the people we as a society will owe a great debt of gratitude,” he said. “They are effectively donating their lives to this process.”

Lynn Whittaker was disappointed. “We are still left with just hope that they will come up with something,” she lamented. “What else do we have?”

Andrew said his relatives have asked if he’s scared the doctors will find something. “I’m more scared if they don’t,” he replied.

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

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