Instructor’s Manual1 for Chapter 13: People of the Balkans and the Middle East Learning Objectives 1. List the countries that are in the Balkan region and those that are in the Middle East. 2. Discuss the immigration patterns, historical socioeconomic influences, and current locations of the people of the Balkans and the Middle East who are in America today. 3. Compare the typical religions, family structures, and traditional health beliefs and practices of the people of the Balkans and the Middle East—before and after immigration to the U.S. 4. Discuss the differences between the staples and regional variations in ingredients—both for the nations of the Balkans, and for the Middle East. 5. Identify key foods for each of the food groups for Greece and the other nations of the Balkans and how these foods have been adapted in the U.S. 6. Identify key foods for each of the food groups for the nations and regions of the Middle East and how these have been adapted after immigration to the U.S. 7. Describe the impact of religion on the foods of the Middle East and list each celebration that has specific dishes associated with it. 8. Identify health concerns and counseling strategies associated with the nutritional intake of these groups. Chapter Summary The southeast European nations of the Balkan Peninsula and the countries of the Middle East are in close proximity to Africa, central Europe, and Asia. The region is a crossroads of ideas, values, and trade goods. Many immigrants from these regions have come to the U.S. in search of economic opportunities and political stability. Many retain a strong ethnic identity. This chapter examines the cuisine of the Balkans and the Middle East, its role in the U.S. diet, and the changes that have occurred in the U.S. The Balkans are composed of the nations of Greece, Albania, Bosnia-Herzegovina, Montenegro, Serbia, the Republic of Macedonia, Croatia, Slovenia, Bulgaria, and Romania. The Middle East is composed of the countries of Bahrain, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Saudi Arabia, Syria, Turkey, the United Arab Emirates, and Yemen. Also part of the population of this region are distinct ethnic groups who do not have a homeland: the Palestinians, the Kurds, and the Chaldeans and Assyrians. The North African countries of Algeria, Morocco, and Tunisia are considered Middle Eastern as well. Geographically much of the Balkans is considered temperate in climate and is suited for agriculture. Greece and the Middle East are arid and agriculture is limited. Arable land is concentrated along the seacoast and in some plains and in the river valleys. Religions differ across the countries and Judaism, Christianity (particularly Eastern Orthodox) and Islam are all represented in this area. In common to all of them, faith is fundamental to daily life across these countries. Immigration to the U.S. is covered for each of the countries that have had significant numbers of people immigrate. From the Balkans, Greek and Croatian immigrants settled in the U.S. From the Middle East, the major influx of Middle Easterners occurred after WWII. Israelis, Persians from Iran, Turks, and Arabs 1 By Tawni Holmes, Ph.D., R.D., University of Central Oklahoma 1 have moved here in significant numbers. Middle Easterners form one of the fastest growing immigrant groups in the U.S. The percentage of immigrants who are Muslim has increased over time. Many of the nations have large religious majorities, and religion is often a defining factor in life. In Greece, the Greek Eastern Orthodox Church is the major affiliation; in Serbia, it is the Serbian Orthodox Autonomous Church. Most Croatians and Slovenians are Roman Catholics. Most Arab immigrants from the Middle East are Muslim. Most Israeli Americans are followers of Judaism. The family and family honor are important in Greece, and many Greek Americans have strong family ties and emphasize the importance of Greek culture to the children. The Arab culture is strongly patriarchal, and extended families often live together, except Egyptians. The family demands conformity and subordination of the individual’s will and interest to the roles and responsibilities associated with group membership. Gender roles are strongly delineated. Modesty and chastity of the women in the family relate to family honor. Immigration to the U.S. creates change in the traditional family structure. In the Balkans, physical fitness is thought essential to good health. In the Middle East, cleanliness, diet, and keeping warm and dry are cited as important for health. Some Middle Easterners ascribe illness to wind or air. In this region, humoral medical theories are held—hot and cold are the most important. “God’s will” determines all aspects of life and death—illness may be viewed as a punishment from God. Folk remedies are common. Biomedicine is well established and western therapies are considered strong and effective. There are many indigenous ingredients in common throughout the Balkans and the Middle East— especially wheat, olives, dates, and sheep. Rice, chickpeas, and lemon are also commonly used. The most significant differences between Balkan and Middle Eastern foods are due to various religious dietary restrictions as well as proximity to other global cuisines. Wheat is the dominant grain, and bread is consumed at every meal. Greece and the other Balkan nations use leavened breads, while leavened flat breads are more common in the Middle East. Cracked wheat kernels are used in various dishes. Dumplings and pasta dishes are eaten throughout the region. Rice is also a staple grain in the Middle East and some Balkan regions. Rice is used in dishes mixed with meat, poultry, or legumes. Legumes are important throughout the regions. Chickpeas, fava beans, black beans, and lentil are popular. A traditional cooking method for vegetables is called yiachni or yakhini. Vegetables are frequently stuffed with meat or a rice mixture. Olives and olive oil are significant regional foods. Fresh fruits are preferred in the Balkans; and in the Middle East, fruits are often cooked into savory dishes. Fresh milk is not widely consumed in the Balkans or Middle East, although some is used in cooking. Yogurt and cheeses are more typically used. Cheese is often made from goat’s, sheep’s or camel’s milk. All meats and seafood are eaten with some exceptions: no pork is eaten in Muslim countries, and neither pork nor shellfish are eaten by observant Jews in Israel. Lamb is the most widely used, although pork is popular in the Balkans. Numerous spices and herbs are used. Fruit juice and coffee are consumed throughout the region. Mint teas are popular throughout the Middle East. There are regional variations. In the Balkans there is a division between the European-influenced fare of Croatia, Romania, Serbia, Slovenia, and the other northern nations and the Middle Eastern-influenced foods of the southern countries of Albania and Greece. The people of the northern Balkans use pork and veal, cooler-weather fruits and vegetables, and fresh dairy. There are five variations in Middle Eastern cuisine: Greek/Turkish, Arabic, Iranian, Israeli, and North African. In addition, the chapter reviews information about Romanian and Albanian foods and Moroccan cooking (boxed sections). The Maghreb is a region of North Africa that related to the traditional Berber regions. Nations in this region include Morocco, Algeria, Tunisia, Mauritania, and Libya. 2 In the Balkans, three meals a day are common with the main meal at midday. In Greece and southern Balkan nations, the main meal of the day is in the early afternoon. In the Middle East, lunch is the main meal of the day with grains, meat, and vegetables typically eaten. Turkish meals are larger, and dinner is the main meal of the day. Hospitality is a duty throughout these regions, and the status of the family is determined by how a guest is treated. In the Middle East, the foods and in what order they are given to a guest reflect the status of the guest. On special occasions, food is used to celebrate religious occasions, weddings, and births. The chapter discusses the many feast and fast days in the Eastern Orthodox Church. The traditional foods served on the Islamic religious observances vary from country to country. Iftar is the meal that breaks the fast during Ramadan. Eid al-Fitr is the celebration at the end of Ramadan. Israel celebrates the traditional Jewish holidays and keeps the Sabbath. The amount of food eaten relates to health. Ample meals are regarded as a means to prevent illness. Poor appetite is considered as a disease in itself or as a symptom of health problems. It is believed that illness can be caused by shifts in hot and cold in food or by eating incompatible foods together. It is assumed that when these groups move to the U.S., over time, fewer traditional foods are eaten except for on special occasions. Typical ingredients and commonly eaten foods are reviewed. Greeks continue to use olive oil and to eat salads and fruits before and after meals respectively. Greek Americans maintain traditional meal patterns, but the main meal of the day is now dinner. Many Arab Americans still eat their main meal at midday, and extended family may dine together daily. The traditional diet of the countries bordering the Mediterranean is higher in monounsaturated fats and omega-3 fatty acids and may be associated with decreased risk for heart disease and high blood pressure. Arab men living in the Arabian Peninsula may be at risk for metabolic syndrome. The Middle East is a very high-context culture, which has lead to misconceptions in the provider-patient relationship.