The Healthy Secrets of a Mediterranean Diet: Ikaria, Greece

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Late one summer afternoon I sat perched on a counter stool in the kitchen of Thea Parikos’s guesthouse on the Greek island of Ikaria. The guesthouse sits on a rise, overlooking a cobalt blue stretch of the Aegean Sea. Faintly visible in the distance is the thin hazy line of Turkey’s western coast.

At the top of the hill behind the guesthouse, past prickly scrub, rocky riverbeds, and unlikely vegetable gardens, lies the mountain village of Christos Raches. Here, in small homesteads shadowed by cedar forests, reside some of the world’s longest-lived people—people who live eight years longer than Americans typically do, with half the rate of heart disease and almost no dementia. The people of Ikaria have what the rest of us want: long, healthy lives with vitality until the very end.

I’ve made regular research visits to Ikaria during the past few years and enjoyed many meals at the guesthouse. But this was the first time I’d been invited inside the guesthouse kitchen.

As I looked around the warrenlike space, dimly lit by two small windows, I saw a jumble of warped pans and dented pots hanging from the wall. A snarl of just harvested vegetables and foraged greens blanketed the counter opposite me. Above them, great shrubberies of dried oregano, sage, and thyme descended from the ceiling like chandeliers. On the tanklike industrial stove, a pressure cooker whistled steam while smaller pots bubbled with ingredients like black-eyed peas, parsley, feral chicken, feta goat cheese, eggplant, wild asparagus, and fennel. The aromas from the stove were intoxicating: herbal, meaty, deliciously musky, and—I can think of no other adjective—fecund.

At the center of this holy chaos stood Athina Mazari, a 58-year-old master of Ikarian cuisine. In a controlled frenzy, she moved swiftly from task to task, using only the simplest of culinary tools, chopping, mixing, stirring, tasting, and then correcting ingredients. Almost everything that went into Mazari’s dishes came from the nearby gardens that spilled down the mountainside. It struck me as I watched her that I was witnessing one of the world’s great workshops of longevity.

I’d been nagging Mazari for years to let me watch her do her magic in the kitchen. But she’d always made it clear that she would rather prepare food alone, enjoying the wordless routine of her work. Today, for some reason, she made an exception. After all this time, I guess I’d worn her down. Between cooking tasks, she opened up.

Her journey to the guesthouse kitchen had been a long one. Like most Ikarian children of the 1950s, she was born into a large family and hardship. Neither she nor her eight siblings had received more than an elementary education. While her brothers helped their father in the fields, Mazari and her sisters apprenticed in the kitchen, chopping vegetables and washing dishes. There she began to absorb the island’s traditional cooking wisdom, combining the same few dozen ingredients and preparing them in the same way as her ancestors have done since the sixth century B.C.

“I made my first loaf of bread when I was ten,” she said. It was sourdough bread. “I borrowed the starter dough from a neighbor.” Kneading it with rye flour, salt, and water, she waited for it to rise overnight and then baked it in the wood-fired brick oven behind her house. The bacteria that fermented the bread came from the same starter culture that her neighbor’s great-great-grandmother had used.

One day Mazari’s mother called her into the kitchen. She said the family was no longer able to make ends meet. Mazari would be moving in with a young couple in the village that had just had a baby and needed a nanny. In exchange for room and board, she would cook, clean, and take care of the newborn child. She’d learn the skills she’d need herself when she became a mother one day. Mazari was nine years old.

Over the next decade Mazari would be a nanny for three different families. Each time, as she cooked alongside the woman of the house, she acquired more kitchen skills and picked up more recipes. She learned how to cube and steam vegetables according to size and texture so they all delivered the right crunch; to poke a pork roast to discern how well done it was; to measure ingredients by hand, literally; to roll dried oregano between her palms and scatter it perfectly with an operatic wave; to instantly recognize by smell the freshness of fish.

She knew where the island’s 80 or so varieties of wild greens—horta—grew, in which months to pick them, and how to bake them into savory pies. She learned how to dry surplus vegetables on the roof, hanging them in mesh bags for storage. Then, as summer turned to winter, her meals changed from fresh vegetables and fish to pork-seasoned stews, root vegetables, and winter cabbage soup. Her culinary repertoire grew to more than a hundred recipes—all in her head, all assembled and prepared by feel and driven by epicurean instinct.

In her 20s, Mazari grew into a great beauty. She recalled how men would stop and stare as she walked by, and one of those men caught her eye. Soon they were married, and in a few years she had two children of her own to cook for. And although her children were now all grown up, she was still cooking for others.

As Mazari’s story unfolded and her dishes neared completion, I sat on my stool in awe. She had talked nonstop, but it hadn’t interfered with her effortless orchestration of tasks. I wondered if the treadmill of preparing fabulous meals three times daily for almost a half century, only to have them end in a pile of dirty dishes to wash, had taken the enjoyment out of her cooking.

Mazari suddenly stopped what she was doing and fixed me with a long look. “When I was in my late 30s, we were short of money, and I worked for a while as chambermaid in a small hotel near my village,” she said. “One day the chef didn’t show up and the hotel owner, a woman named Maria, asked if I could step in. Twenty-six American artists had shown up for dinner and she wanted to know if I could cook. She let me set the menu, and I prepared pies made from wild greens, stuffed grapevine leaves with rice, Greek salad with tzatziki dressing. When I put all the food out on plates, I realized it didn’t look like restaurant food I’d seen in pictures. When Maria came into the kitchen to serve the food, I said to her, ‘I’m sorry these don’t look nice, but they taste nice.’ I was very nervous.”

It was now late afternoon in the guesthouse kitchen. The soft sun suffused the room in a medieval light. Mazari leaned against the opposing counter and rubbed her coarse, damp hands, as she remembered that moment long ago.

“Maria suddenly shouted for me from the dining room,” she said. “I thought she was mad at me—that I had embarrassed her, and that I needed to do the dishes over. Instead, when I walked out of the kitchen, all of the foreigners stood up and gave me a standing ovation. My eyes welled up with tears. I tried to hold them back but I couldn’t. It was the first time in my life I cried with joy.”

THE BEST MEDITERRANEAN DIET

Almost every mother and grandmother on the island possesses a culinary pedigree like Mazari’s, I’ve found. Like other Blue Zones, Ikaria is remote, and people have stuck to their traditions, which have enabled them to avoid the influence of modern Western eating habits. Their tradition of preparing the right foods, in the right way, I believe, has a lot to do with the island’s longevity.

Our research backs this up. During one of our team’s visits to Ikaria, we worked with Trichopoulou, the authority on the Mediterranean diet, to administer surveys of local eating habits. As data from the surveys started coming in, Trichopoulou noted that the island’s traditional diet, like that found in much of the Mediterranean, included lots of vegetables and olive oil, smaller amounts of dairy and meat products, and moderate amounts of alcohol. What set it apart from other places in the region was its emphasis on potatoes, goat’s milk, honey, legumes (especially garbanzo beans, black-eyed peas, and lentils), wild greens, some fruit, and relatively small amounts of fish.

Every one of these foods has been linked to increased longevity. Low dairy consumption has been associated with reduced heart disease. Olive oil—especially unheated—is believed to lower bad cholesterol and increase good cholesterol. Goat’s milk contains serotonin-boosting tryptophan. Some wild greens contain ten times as many antioxidants as red wine. And wine—in moderation—has been shown to be beneficial if consumed as part of a Mediterranean diet, because it helps the body absorb more of the flavonoids, the artery-scrubbing antioxidants, from the food eaten with it.

Even coffee, the habit your grandmother once warned you about, has been linked to lower rates of diabetes, heart disease, and, for some, Parkinson’s disease. Local sourdough bread contains Lactobacillus sanfranciscensis, a health-boosting type of bacteria that, when eaten with other food, may actually reduce the meal’s glycemic index. (A food’s glycemic index reflects how fast it breaks down to sugar in the bloodstream. Meals with a lower glycemic index will take longer to digest and are less likely to cause a spike in blood sugar levels.) Potatoes have heart-healthy potassium, vitamin B6, and fiber. And, as Trichopoulou observed during our research trip, islanders inevitably consume fewer chemicals because they eat greens from their own gardens or nearby fields. Considering all this, she told me, compared to the standard American diet, the Ikarian diet may add up to four years to the life expectancy of islanders.

We gained more insight into traditional island foods from Ioannna Chinou, a leading authority on the bioactive properties of herbs and other natural foods. She pointed out that different Greek teas may offer specific beneficial effects: wild mint as a way to prevent gingivitis and ulcers, rosemary to treat gout, artemisia to improve blood circulation. When I brought her samples of Ikarian herbal teas to test in her lab, Chinou found that they all had antioxidant properties. In addition, the teas appeared to function as mild diuretics, helping to flush waste products from the body and slightly lower blood pressure.

Five years after I began looking into the healthy habits of Ikarians, a Greek researcher named Christina Chrysohoou published the first academic paper on the Ikarian diet. By day Chrysohoou sees patients as a cardiologist at the University of Athens School of Medicine. By night she somehow finds the energy to follow her wide-ranging intellectual interests.

Chrysohoou was the first academic to recognize the scientific potential of Ikaria as a study site to examine how psychology, depression, obesity, and even radiation might influence longevity. In 2009 she and Demosthenes B. Panagiotakos of Harokopio University organized The Ikaria Study that surveyed 1,420 Ikarians, testing 673 of them over age 65. Amazingly, 79 of them were over age 90. Their research teams fanned out across the island, collecting more than 300 pieces of information on each subject, mostly on diet but also detailed medical histories, including information about sleep, depression, and even sex habits. Four years later, the team returned to Ikaria to check up on their oldest subjects.

The team confirmed that Ikarians have followed an extreme and unique version of the Mediterranean diet, which favors vegetables, whole grains, fruits, fish, olive oil, goat’s milk and cheese, and wine. The researchers observed that fresh vegetables are always in season on Ikaria: potatoes and onions in the fall, cabbage in the winter, and lettuce in the spring. Summer brings peppers, green beans, tomatoes, zucchini, eggplants, apricots, and peaches: These foods the islanders eat fresh or sun-dried and preserved with oregano for winter. Wild greens such as dandelion, chicory, and wild fennel abound, providing a rich source of vitamins A, C, and K, folate, potassium, magnesium, calcium, fiber, and iron. While fat accounts for more than 50 percent of their daily calories, more than half the fat energy comes from olive oil, associated with positive health factors in a number of studies.

Islanders eat relatively more legumes (especially garbanzos, lentils, and black-eyed peas), potatoes, coffee, herbal teas, and wild greens than do people in other Mediterranean cultures. Perhaps due to the island’s famously rough seas, Ikarians traditionally have eaten fish only sporadically, as fishermen have been able to get out. While coastal dwellers enjoy swordfish, sardines, anchovies, and small local fish varieties six to eight times per month, mountain dwellers eat fish only once or twice a month, and often partially preserved fish such as salted cod or sardines. Interestingly, we found more healthy islanders age 90-plus in the mountains than on the coast, so fish doesn’t seem to be contributing to longevity. Ikarians typically consume meat only once or twice a week, poultry twice a week, and sweets perhaps twice a week, not counting the local honey they use to sweeten their tea.

Typical Daily Diet of Ikarians Age 80-Plus (Percentage of daily intake in grams)

Older Ikarians eat a diet rich in greens and other vegetables, beans, and fruit, which together account for 64 percent of their daily food intake—dairy products and beverages excluded. Fat accounts for more than 50 percent of their daily calories, but more than half the fat energy comes from olive oil, associated with positive health factors in a number of studies.

Chrysohoou identified several nonfood habits that she believes also contribute to the longevity of islanders. For instance, Ikarians tend to eat slowly and with families or friends. They also take regular naps. In fact, a 2008 paper by the University of Athens Medical School and the Harvard School of Public Health reported findings after following a group of Greeks over several decades. The researchers found that regular napping—at least five days weekly—decreased a person’s risk of heart disease by 37 percent.

Ikarians tend to have other ways they unwind, Chrysohoou has found. She showed me a preliminary study suggesting that roughly 80 percent of Ikarian males between the ages of 65 and 85 were still having sex. “This means less stress, and that means healthier eating,” she speculated. “When you eat a meal in a hurry or with pent-up worry, stress hormones like cortisol interfere with the digestive process. Your body doesn’t absorb nutrients and antioxidants as well; the calories you consume are more likely to end up as fat on your waistline than energy for your cells.”

TOP LONGEVITY FOODS FROM IKARIA

Ikarian cooks, like their counterparts in places such as France, Spain, or Italy, lean heavily on dishes that include vegetables, whole grains, fruits, olive oil, and occasionally a little fish.

  • OLIVE OIL: In Greece the finest extra-virgin olive oil—extracted without any treatment other than washing the fruit, pressing, decanting, and filtration—tends to be cloudy, slightly thick, and a deep golden green. A fondness for the best olive oil may protect Ikarians from heart disease. A recent study in Spain found that a healthy low-fat Mediterranean diet that includes at least four tablespoons of olive oil a day—a typical amount for these Greek islanders—reduces the risk of heart disease by 30 percent. In Ikaria, we found that people consuming at least 100 grams (about four tablespoons, or a quarter cup) of good olive oil a day had 50 percent lower mortality.
  • WILD GREENS: More than 150 varieties of wild greens, such as purslane, dandelion, and arugula, grow all over the island. These rich, dark, wild mountain greens are a great source of minerals like iron, magnesium, potassium, and calcium, as well as carotenoids—the colorful pigments the body converts to Vitamin A. Eating a cup of greens daily seemed to be one of the keys to a longer life in Ikaria. In North America we have plenty of edible wild greens—dandelion, purslane, lamb’s-quarter—and cultivated greens such as collard, mustard greens, beet greens, and kale have nearly the same plenitude of nutrients.
  • POTATOES: Unique among Mediterranean peoples, Ikarians eat potatoes almost daily. Despite high carbs, potatoes offer significant health benefits. Recent studies have suggested that, as long as they’re not fried or loaded up with sour cream and butter, potatoes can help reduce blood pressure, prevent inflammation, and fight diabetes.
  • FETA CHEESE: Bioactive Ikarian feta cheese is made by fermenting goat’s milk with rennin, which the Ikarians get from goats’ stomachs. The result is a protein-rich probiotic high in gut-friendly bacteria with powerful anti-inflammatory and anticancer properties. Famously added to Greek salads, feta is also used by the Ikarians to round out several vegetable stews and other dishes.
  • BLACK-EYED PEAS: Called peas but actually beans, these Ikarian favorites are rich in protein and fiber. They have also been found to contain some of the strongest anticancer, anti-diabetes, and heart-protective substances in nature.
  • CHICKPEAS: Included in many stews and soups, chickpeas are also eaten like a snack on Ikaria, dried and salted like peanuts. They are higher in fat than other beans, but nearly all of their fat is unsaturated, which makes them a healthy choice that avoids the sugar rush that higher-carbohydrate snacks might cause.
  • LEMONS: Ikarians put lemon juice on everything. They eat the whole fruit, skin and all. The high acidity of lemon peels may have a beneficial impact on blood glucose, helping to control or prevent diabetes. Ikarians squeeze lemon on salads, fish, soups, and beans and into drinking water, lowering the glycemic load of the entire meal.
  • MEDITERRANEAN HERBS: Drinking herbal tea is an island ritual. Garden and wild herbs make fragrant, seasonal, and healthful drinks. From rosemary they get a heady rush of rosmarinic acid, carnosic acid, and carnosol—substances that have been shown to protect against certain cancers in animal studies. Marjoram offers ursolic acid, which may boost memory and other cognitive functions. Daily teas made from sage, rosemary, marjoram, and mint—all containing diuretics and anti-inflammatories—may explain Ikaria’s very low dementia rate. Adding ample culinary herbs, preferably fresh, to cooked dishes captures some of those nutrients as well.
  • COFFEE: They like their coffee strong on Ikaria. Two to three cups a day of Turkish-style Ikarian coffee have been shown to reduce mortality rates for both men and women in recent studies.
  • HONEY: Islanders use Ikarian honey—dark, thick, and rich—as a medicine to treat everything from colds and insomnia to healing wounds. Besides stirring it into coffee or tea, many older folks also take it neat, by the spoonful, first thing in the morning and again at night before dinner.

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