Wednesday, January 12, 2011

High Quality of Life: There must be something in the water. Or maybe it’s just the port.

The ubiquitous pastry shops of Oporto fill their windows with their tempting concoctions of flour, sugar and butter. Every morning, patrons fill their shops and counters for their daily dose of caffeine and sugar. As a visitor, I have frequently indulged in the Portuguese breakfast experience, skipping my usual bowl of oatmeal. While I’m happily narrowing down my favorites (Pastel de Nata and bolo “de Arroz” and “de Berlim”), I admit I feel a passing moment of guilt as I remember my health and my family history of diabetes.  This prompted me to learn more about the dietary and other social habits of the Portuguese and their effects on their health as a nation. I’ll try to give a brief summary.
As I mentioned, breakfast (if taken at all) is eaten in a shop and consists of a 2oz cup of espresso with a sweet pastry. A small snack in the early afternoon of more coffee and more bread usually tides people over until lunch at 2. Usually the biggest meal of the day, lunch starts with cheese, cured meats, olives, and bread followed by a generous plate of fresh seafood, traditional salted cod or succulent meats with boiled potatoes or fries. Enjoyed with wine and almost always followed by coffee or desserts, it’s no wonder that dinner is often very late (9-10p) and rather light.
Besides the amount of refined sugar, the Portuguese enjoy a fairly balanced diet. In fact, the Portuguese will be the first to tell you all about the benefits of their diet rich in omega-3 fatty acids and heart healthy wine. Unfortunately, diet alone is not able to maintain good health. Rates of adult-onset diabetes and obesity are increasing in Portugal, but individuals are slow to adopt a more conscientious diet. Sugar substitutes are rare in grocery stores as are alternates to sweet pastries in coffee shops.
Generally, European countries are idyllic for pedestrian commuters. Public transportation runs efficiently, and can be more affordable than paying petrol by the liter. It’s said that Europeans are slimmer because of the extra energy expended as compared with their American counterparts. However, Portugal is a bit different from other European countries I’ve visited. The terrain is much more mountainous, and the city streets are steep and undulating, making travel by car more practical. Accordingly, the Portuguese are slightly heavier than other EU countries (Norway 10% obesity rates, Italy 9.8%, Germans 12.9%1). While certainly not as obese as Americans (33.9%), the Portuguese (14.2%) must consider incorporating more active forms of exercise in order to stabilize the nation’s obesity rates. Asking my residents, they agree that exercising is not as common among older generations. However, young people are getting memberships to the growing number of gyms in their cities. Americans should take note.
The leading causes of death in Portugal are (1) cerebral vascular disease and (2) ischemic heart disease. Along with dyslipidemia, diabetes, and hypertension, an important risk factor for vascular disease is **smoking**.  Most Portuguese are aware of the hazards of tobacco use and do have lower rates compared with other EU countries. Yet, tobacco rates are increasing, particularly among the female population. In men, 39.9% aged 25-34 and 44.6% in 35-44 smoke, while in women rates are slightly lower at 17.6% and  21.2%, respectively2,3. While I haven’t questioned all the residents on my team, I’ve had 3/5 admit they were smokers. I was astounded by the number of smokers and the social acceptability of its practice. But then I remembered the long history of US anti-tobacco campaigns; and smoking rates started decreasing only decades later.  
I also going to discuss alcohol consumption and sleeping habits of the Portuguese, but I’m afraid this entry is already too long. Instead, I’ll leave you with some photographic rationale for doing a rotation in Porto. Like the title says…quality of life is ranked 19th out of 111 nations4.  Here’s to everything in moderation(well, except tobacco)!

Every 5th storefront

Bolo de Berlim (...must...moderate...)

simple. fresh. wonderful. (and cheap!!)

If you like wine, you will definitely appreciate the Portuguese varietals.

1. Statistics from the WHO Global Database on Body Mass Index
2. OECD. Health at a Glance 2009: OECD Indicators. OECD Publishing, 2009. p52.
3. Precioso J, Calheiros J, Pereira D, et al. Prevalence and smoking trends in Portugal and Europe. Acta Med Port. 2009 Jul-Aug;22(4):335-48.
4. Economist Intelligence Unit. (2005) The World in 2005. Retrieved 12 January 2011.

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