Signs of Depression

By Erik Kirschbaum and James Mackenzie

BERLIN/PARIS (Reuters) - For years, anyone needing a nicotine fix in a German pub or French cafe didn't even have to light up -- the air was already so full of smoke that they only had to open their mouth and inhale.

But that all changes on Tuesday when strict new bans take effect in two of Western Europe's final bastions for smokers, Germany and France. There was long and fierce resistance to the prohibitions on tobacco that other countries imposed.

"When I have a beer I want to smoke, and if I can't smoke here anymore, I won't come anymore," said Hans Dorsmann, 60, a Berlin salesman summing up a gloom-filled view that has made countless small pub operators fear for their businesses.

"It's a stupid law that will hit the little people," he said in a Berlin corner pub where the faces of 10 smokers on the 10 barstools were veiled in clouds of smoke. A pub owners' lobby calls the ban unconstitutional and plans a legal challenge.

Even though smoking bans led to increased pub and restaurant business in other countries, the argument seemed to fall on deaf ears in Germany and France, where any infringement of the right to smoke was sometimes viewed as an attack on freedom.

From January 1 smoking will be banned in pubs and restaurants in 11 of Germany's 16 states -- exemptions given only to those with separate closed-off rooms. Most other states will follow during the course of 2008.

In France, smoking in shops, offices and other public places has been banned since February 1, but a special exemption for bars and cafes has been in place until January 1.

OUTRAGE IN FRANCE

Smoke-filled bars loved by moody left bank existentialists and melancholy film noir gangsters may be long gone but the ban will mean a huge readjustment in the way people think of cafes.

Millions of French relish their morning "cafe clope" (coffee and cigarette) taken standing at a bar on the way to work and the thought of having to change has been unsettling for many.

"I don't know, it won't be the same at all," said Alain Filipetti, an electrician, as he nursed an "express" and dragged on a cigarette in a cafe near the Paris stock exchange. "I've always started the day with a coffee and a cigarette."

With some 15 million smokers in France, there has been plenty of outrage at the new law that foresees fines of 68 euros on smokers and up to 750 euros for cafe managers.

"There's no stopping now. Soon they'll ban alcohol and you'll need to bring in your latest blood tests to eat in a restaurant," said Francis Attrazic, vice president of the hospitality industry association UMIH.

Almost a third of Germans smoke. Restaurants and pubs long fought tenaciously against regulations on smoking, in part due to economic reasons but also because of the country's Nazi past.

Lighting up became a cherished post-war mark of freedom and tolerance after a smoking crackdown by Adolf Hitler's Nazi regime in the 1930s and there was long a reluctance among German politicians to force through a ban.

"You need the smoke and stench of it all in here otherwise it wouldn't feel right," said Christian Schultz, 47, sipping a beer in a smoky, smelly pub at the Zoo rail station in Berlin.

"The smoke in the air is a key ingredient to give it the right ambience."

His wife Ute, 44, added: "I don't understand who caused the fuss. Non-smokers knew these places were full of smoke and were free to avoid them. Now where are we going to go?"

The small family-owned pubs were long a safe haven for smokers in Germany, a cherished nicotine-filled refuge that seemed immune to the forces of the anti-smoking crusades.

"A lot of these places are going to go bankrupt," said Oliver Resch, 38, an office worker enjoying a schnaps and beer with his pack of cigarettes. "If I can't smoke here with Hans and Fritz, what's the point of coming in?"

Luca Franchini, 29, a chain-smoking Italian office clerk, said he savored his visits to Germany after smoking was banned in indoor public places in Italy three years ago.

"I really enjoyed coming here to be able smoke freely," Franchini said. "It's too bad it'll be gone here too."

(Editing by Peter Millership)

By C. Vidyashankar, MD

CHANNAI, India (Reuters Health) - Yoga induces a feeling of well-being in healthy people, and can reverse the clinical and biochemical changes associated with metabolic syndrome, according to results of studies from Sweden and India. Metabolic syndrome is a cluster of heart disease risk factors such as high blood pressure, obesity and high blood sugar.

Dr. R.P. Agrawal, of the SP Medical College, Bikaner, India, and colleagues evaluated the beneficial effects of yoga and meditation in 101 adults with features of metabolic syndrome. In the study, 55 adults received three months of regular yoga including standard postures and Raja Yoga, a form of transcendental meditation daily, while the remaining received standard care.

Waist circumference, blood pressure, blood sugar, and triglycerides were significantly lower, and "good" HDL cholesterol levels were higher in the yoga group as compared to controls, Agrawal's team reports in the journal Diabetes Research and Clinical Practice.

In the second study, published online December 19 in BioMed Central Complementary and Alternative Medicine, Dr. Anette Kjellgren from the University of Karlstad, Sweden and colleagues evaluated the beneficial effects of yoga-like breathing exercises on healthy volunteers.

Fifty-five adults were advised to practice "Sudarshan Kriya," which involves cycles of slow normal and rapid breathing exercises. The exercises were practiced for an hour daily, six days a week for six weeks, while 48 controls were advised to relax in an armchair for 15 minutes daily.

At the end of the study period, feelings of anxiety, stress and depression were significantly lower and levels of optimism significantly higher in the yoga group compared to the control group, Kjellgren and colleagues report.

Yoga induces a "relaxation response" associated with reduced nervous system activity and a feeling of well-being probably due to an increase in antioxidants and lower levels of the stress hormone cortisol, they suggest.

Yoga not only helps in prevention of lifestyle diseases, but can also be "a powerful adjunct therapy when these diseases arise," co-investigator Dr. Faahri Saatiglou, from the University of Oslo, told Reuters Health. "We do not emphasize this point enough in our Western health care."

SOURCES: Diabetes Research and Clinical Practice, December 2007, BMC Complementary and Alternative Medicine, online December 19, 2007.

By Megan Rauscher

NEW YORK (Reuters Health) - Results of a brain autopsy study indicate that most older adults have significant brain pathology (disease), regardless of the presence or absence of outward signs of dementia.

As part of the long-term Rush Memory and Aging Project, researchers evaluated the spectrum of abnormalities found in the brains of 141 older adults, with and without clinically evident dementia.

At the time of death, only 20 persons (14.2 percent) were free of brain disease, Dr. Julie A. Schneider, from Rush University Medical Center, Chicago, and colleagues found.

Most older persons with dementia (i.e., memory and other cognitive impairments) had more than one type of pathology in their brain causing the impairment, Schneider told Reuters Health.

"This most commonly was Alzheimer's disease pathology and cerebral infarcts (strokes), followed by Alzheimer's disease and Lewy body disease, a disease related to Parkinson's disease," she said.

Older persons without dementia also frequently had brain disease, most commonly Alzheimer's-like disease, but also multiple other abnormalities, Schneider noted. Having more than one disease in the brain significantly increased the likelihood that symptoms of dementia will be present.

"Older persons can often handle one pathology in their brain, but the burden of more than one pathology may tip them over the threshold of clinical dementia," Schneider said.

Therefore, prevention of not only Alzheimer's disease but these other pathologies, particularly stroke and those things that may increase the risk of stroke, like high blood pressure, high cholesterol, cigarette smoking, obesity, "are likely to significantly decrease the prevalence of dementia," Schneider added.

The findings are published in the journal Neurology.

Based on this study, write two neurologists in an accompanying editorial, "we may wish to maximize medical management of vascular risk factors in the growing elderly population, regardless of whether cognition is still normal or there are signs of overt dementia."

SOURCE: Neurology, December 11, 2007.

By Anne Harding

NEW YORK (Reuters Health) - Eating a high-fat, high-carb fast food meal produces damaging cellular changes that are greater and longer-lasting in obese people than in normal-weight people, a new study shows.

Dr. Paresh Dandona and colleagues from Kaleida Health in Buffalo, New York looked at inflammation and oxidative stress, which occurs when levels of normal byproducts of metabolism known as free radicals exceed the body's ability to neutralize them.

In previous research they found that obese individuals have higher levels of oxidative stress and inflammation than normal-weight individuals. They also demonstrated that eating a high-fat, high-carb meal increased oxidative stress and inflammation in normal-weight people.

To test whether these increases might be greater in obese people, Dandona and his team had 10 normal-weight and 8 obese people eat a 1,800-calorie meal consisting of a large hamburger, a large serving of fries, a large cola, and a slice of apple pie.

Both groups showed increases in oxidative stress two hours after eating the meal. By three hours, oxidative stress had returned to baseline levels in the normal-weight individuals, but it continued to climb in the obese individuals. The same pattern was seen for inflammation.

"If obese people who already have oxidative and inflammatory stress take the same meal, they get far greater and more prolonged levels of oxidative and inflammatory stress," Dandona told Reuters Health. "Since oxidative and inflammatory stress predispose you to atherosclerosis (hardening of the arteries), heart attack and stroke, this risk is far greater in obese people."

In another study, Dandona and his colleagues demonstrated that a high-fruit, high-fiber meal with the same calorie content as the fast food meal tested in the current study produced no increase in oxidative or inflammatory stress.

The findings provide yet more evidence that people should avoid high-fat, high carb fast food meals and consume as much fruit and vegetables as possible, Dandona said.

SOURCE: The Journal of Clinical Endocrinology & Metabolism, November

By Anne Harding

NEW YORK (Reuters Health) - Fish oil capsules and fatty fish do an equally good job of enriching the blood and other body tissues with healthy omega-3 fatty acids, new findings suggest.

But the findings can't be interpreted to mean that capsules and fish are equally good for the heart, Dr. William S. Harris, who was involved in the research, told Reuters Health. "There are things that can change the blood lipids but don't do anything for the heart and vice versa," said Harris, who is with the University of South Dakota in Sioux Falls.

Omega-3 fatty acid consumption is recommended by the American Heart Association and several other groups to reduce the risk of cardiovascular disease and consumption of fatty fish and fish oil capsules have been assumed to have similar effects, Harris and his colleagues note in the American Journal of Clinical Nutrition.

But there has been little research on whether the body processes fatty acids from fish oil capsules and fish in the same way.

To investigate, Harris and his team had 11 women eat two servings of tuna or salmon each week, while an additional 12 women took in the same amount of omega-3s, an estimated 485 milligrams daily, in capsule form.

After 16 weeks, the amount of omega-3 fatty acids in the red blood cells of women in both groups had risen by 40 percent to 50 percent, while omega-3s in the plasma (the cell-free, liquid portion of the blood) had risen by 60 percent to 80 percent.

"We went into the project assuming that fish would be better, based on some previous literature from other people," Harris noted in an interview. Based on the current findings, he added, "it doesn't make any difference whether you get your omega 3 fatty acids from a concentrate in a capsule or in fish -- they have the same effect on enriching the tissues with omega 3."

Nevertheless, Harris said, he would encourage people to eat fish rather than relying on fish oil capsules. "Fish of course brings with it proteins and minerals and other factors that are good for our health that the capsules don't bring, but we weren't able to measure any of those things," he said.

SOURCE: American Journal of Clinical Nutrition, December 2007.