Mediterranean Diet in crisis

photo: Donna P Feldman

photo: Donna P Feldman

The Mediterranean Diet is a great topic for the end of National Nutrition Month.  There’s nothing but good news about this way of eating.  The research linking a traditional Mediterranean food plan to numerous health benefits just keeps rolling in.  The benefits were first recognized by Dr. Ancel Keys in the 1950’s, who noted that supposedly well-fed Americans had worse rates of heart disease than people living in the Mediterranean region.  Residents of Crete, one of the Greek islands, had the lowest disease rates of the populations Keys studied.  Traditional foods were local and simple, and included olive oil, fish, nuts and greens, with little red meat or dairy products (and most dairy from sheep’s milk).  Strictly speaking, when we talk about the healthy Mediterranean Diet, we’re talking about that unprocessed traditional diet of Crete.

But ironically, while people in the US and other developed countries are choosing more Mediterranean-type foods, people living on Crete in the birthplace of the Mediterranean Diet are being lured away from their traditional healthful foods by processed convenience foods.  Last year, Crete-based dietitian Christina Makratzaki was interviewed by American Public Media’s Marketplace radio about the current state of the traditional Cretan diet.  She described a cuisine in transition, from those healthy and simple traditional foods to the processed convenience foods typical of the US diet.  One of the health consequences of this change: one of the highest childhood obesity rates in the world.  Needless to say, Makratzaki and other Greek health experts find this trend alarming.

How bad is the diet situation on Crete, and in Greece in general?  I contacted Christina Makratzaki recently, and she very graciously made time in her busy schedule to respond to questions about traditional Mediterranean foods, and the changes she’s seeing on Crete.

Radio Nutrition: What are key local foods in the traditional Cretan diet?

Makratzaki:  Now, when I am referring to the Cretan Diet, I am describing the diet [from] the decades of 50s and 60s, where the research of Allbaugh and Keys took place.  The most known foods are olive oil and olives. Allbaugh and Keys were surprised by the amounts of olive oil the Cretans were using in their meals.  From my perspective, another important type of food is the wild green leafy vegetables.  In general, Cretans were eating lots of vegetables, but I believe that the wild green leafy vegetables –or horta — were the key.  Cichorium spinosum (chicory), askrolimbrous (a root vegetable with edible leaves), amaranthous viridis (vlita) and purslane have been found to contain omega–3 fatty acids and antioxidants.

Cretans were also eating lots of fruits, legumes, nuts and different kinds of rusks.   Rusks are made from different kinds of unrefined cereals, such as rye.  They last longer than bread, and so were the preferred snack for long trips and for working in the fields instead of fresh bread.

Other key foods in the Cretan diet are wine and herbs such as oregano and thyme. Lots of antioxidants have been found in them but they are also considered key ingredients of the special flavour of the Cretan meals.

Finally, the small consumption of meat, especially red meat, the small to modest consumption of dairy products and the modest amounts of fish complete the beneficial profile of the Cretan diet.

Radio Nutrition: Are most of these foods still part of the daily diet on Crete?

Makratzaki: Cretans have been changing their diet for many years, especially in urban areas.  In villages, it is mostly the quantity, rather than the quality, that has been changed.  Apart from that, nowadays farmers are using machines for agricultural work instead of their hands, and they travel by car to their fields instead of walking.  So their activity has changed as well.

Some urban Cretans have completely changed their diet in a way that is not at all like the traditional one.  They may eat meat almost every day.  Dairy products are consumed in larger amounts in contrast to that in the 1950s-60s.   Some people hate legumes or eat just one or two types.  There are also people who may eat no salad, or just one during the day.  Many of them forget fruit, or are bored to peel them, so they prefer to eat chocolates and biscuits for snack.  The last few years, people have started to eat rusks and whole wheat bread instead of white bread.

Radio Nutrition: The Marketplace segment noted that many processed foods are now consumed, such as hamburgers and pizza. What traditional foods do you feel have been crowded out of the diet as a result of these processed foods? What are the nutritional changes of these different choices?

Makratzaki: The foods that I feel have been crowded out are vegetables, fruits, nuts and legumes.  School children prefer to eat toasts, chocolates and croissants instead of fruits and nuts.

Some of the preferred processed foods are souvlaki, pizza, sandwiches, hamburgers. Depending on how they are prepared, they can be full of calories, trans and saturated fats, and of course salt.  People are eating more saturated and trans fat, simple sugars, and salt in contrast to the past.  Over the past few years in Greece, some of the big fast food chains, have become more sensitive on healthy diet and are trying to include healthier choices together with the less nutritious ones. For example, you can find:

  • Mediterranean sandwiches
  • Salads with rusks, feta, olive oil and tomato
  • Fresh juices

Radio Nutrition: In the US we think of the Mediterranean Diet as a good choice for adults, to help reduce risk factors for diseases. Have adult diseases increased as well in Greece, as people turn to more processed foods?

Makratzaki:  According to the European Nutrition and Health report in 2004 (Annals of Nutrition and Metabolism, vol 48, suppl 2) you will see that the Greeks have:

  • Increased by 10% the consumption of fat and decreased by 10% the consumption of carbohydrates (1960-2001)
  • Have one of the highest levels of obesity and overweight both in men and women according to the results we gave in 2002.

A study published in 2010 and done on Crete where Keys did his research, found increased risk factors for cardiovascular disease.  Other recent data show an increase in the incidences of diabetes and cancer.

Radio Nutrition: What would be a typical day of food choices for a traditional Cretan diet?

Makratzaki: I will describe a typical diet in Crete from the 50s – 60s, but you should know that in the past everything depended on the circumstances.  For example: There were farmers who would start their day with a good meal, such as the ones that you eat for lunch.  On the contrary, if you talk with my father who grew up in the 2nd World War, with 7 siblings and no father, he would tell you, that he would take a slice of bread, made by my grandmother, he would “dive” it in olive oil, add some salt and he would leave for school.

Traditional Choices for Breakfast

  • 1 glass of milk with starch or rice and honey
  • 2-3 peaces from special little pies, called “kaltsounia”, which contain spinach or different wild green leafy vegetables, and some cheese. They can also be made with just cheese and be served with honey
  • A rusk from starch or rye, combined with olive oil or olives, tomato, and some cretan cheese such as “graviera” or “ mizithra” or “anthotiro”
  • Sfouggato with wild green leafy vegetables: You can think it like an omelette with vegetables. It can be combined with some whole wheat bread

Options for Snacks:

  • Fruits
  • Nuts
  • Spinach pies
  • Rusk with graviera
  • Rusk with olive oil

Options for Lunch:

  • A plate of cooked meal, with mostly legumes or cooked vegetables with potatoes.  If there was meat, maybe 90-100 gr (3-4 oz) and the rest of the plate would be covered by other foods such as potatoes, starch combined with sour milk (in greek is called hondros), green beans, eggplants etc
  • Seasonal salad (lots of wild green leafy vegetables)
  • Lots of olive oil
  • Bread or rusk
  • Maybe small amounts of a local cheese

Options for Dinner:

  • Dako: rusk, tomato, olive oil, mizithra
  • A tea of Malotira (it is a herb) with some spinach pies
  • A tea of malotira with some rusk of bread, cretan cheese and some honey
  • Lunch foods in smaller amounts
  • Salad
  • Rice pudding

Radio Nutrition: Are sweets a big part of daily food intake on Crete?

Makratzaki:  The Cretans typically ate healthy sweets, based on honey or petimezi (grape syrup), flour, sesame, walnuts, almonds, cheese and fruits. There were also special sweets depending on the big festivals and celebrations

Examples of some cretan sweets are the following

  • Dried fruits
  • Sweets from fruits (they don’t contain fat, just sugar)
  • Cheese pies with honey or petimezi
  • Bisquits especially in Great celebration such as Christmas or Easter. Many of them made with olive oil
  • Pies or cakes  with honey and nuts

Radio Nutrition: One serious problem here is constant eating and drinking, especially giant sugar-sweetened drinks.  On Crete, someone might just have a small Turkish coffee; here people order a giant sugar-sweetened latte with whipped cream. Have these super-sized soft drinks and coffee drinks shown up on Crete?

Makratzaki: Of course these kinds of sweets have arrived in Crete.  These are one of the reasons that children have forgotten the traditional diet.  People also prefer to drink French coffee, instant coffee, espresso, latte instead of the traditional Greek coffee.

Radio Nutrition: The Marketplace story noted that processed foods were attractive to Cretans because they’re convenient, and people are too busy to cook.  Do you think the current financial crisit, or lack of time or skills for cooking are significant factors in the changing diet?

Makratzaki: I can definitely say that the financial crisis has affected the diet, especially of the people who live in town.  The reason I am saying that, is because the people in villages have the opportunity to cultivate their vegetables and breed animals such as goats, chickens and rabbits.  In town, this is difficult.  Still though, many of the people in the urban areas have land in villages (which is not that far). So if they cultivate plants, they will have their own fruits and vegetables.  Likewise, most of the Cretans have some olive trees, so they can produce some amounts of olive oil at least for their family.  The real problem is in big towns such as Athens and Thessaloniki, where almost all the people buy their foods.

As far as it concerns the lack of time, women now work a lot. Some of them don’t have time to cook, but I know that when a woman wants her children to be fed well, she always finds a way for proper, cooked food.  I have seen that.  In the past you would find more women not knowing how to cook. Today, because of the crisis, is not easy to eat everyday at restaurants and taverns. The Cretan food, especially when it concerns legumes and seasonal vegetables, can be cheaper than eating meat and expensive fish. Don’t forget that sardine is called the fish of the poor, and it’s one of the healthiest fishes.

Radio Nutrition: Finally, are Greek people, or people on Crete, concerned about the changing food choices?  Do people feel they  should return to more traditional food choices?

Makratzaki:  There are an increasing number of people who are concerned about their diet and especially about their children’s food. You will find this trend mostly among educated people.   I was amazed when I met children who know about tahini and carobs.

Last year 14 dietitians, including myself, under the supervision of the municipality of Chania, organized seminars at some primary schools of the town.  We had the opportunity to talk to the children about the Cretan diet.  What I saw is that there were children who knew about carobs, unprocessed cereals and other special products such as avocado, tahini and nuts.  Those children were from more educated families.

We must not forget that most of our grandparents lived in the Second World War and the difficult years after it.  This is the reason why they are feeding their grandchildren without thinking that they may become obese.  They serve them whatever you can imagine: chocolates, biscuits, cakes, crisps etc. If they see a lean child, they get worried.

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Even if you aren’t inclined to seek out traditional Greek foods like vlita, gravieri or kaltsounia, you can choose foods that fit the pattern:

  • lots of vegetables, whole grains and fresh fruits, olive oil and nuts
  • little red meat
  • small portions of dairy products and sweets

For more information on Mediterranean cuisine:

Oldways Mediterranean Foods Alliance


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