Food and Culture (5 Ed)

Food and
Culture
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Food and
Culture
FIFTH EDITION
Pamela Goyan Kittler, M.S.

FOOD, CULTURE, AND NUTRITION CONSULTANT
Kathryn P. Sucher, Sc.D., R.D.

DEPARTMENT OF NUTRITION AND FOOD SCIENCE
SAN JOSE STATE UNIVERSITY
Australia Brazil Canada Mexico Singapore Spain

United Kingdom United States
Food and Culture, Fifth Edition
Pamela Goyan Kittler and Kathryn P. Sucher
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CONTENTS
1 Food and Culture 1 Pluralistic Health Care Systems 52

What is Food? 1 Medical Pluralism 52
The Omnivores Paradox 2 Biomedical Healing 52
Self-Identity 2
Symbolic Use of Food 3
3 Intercultural
Cultural Identity 4
What is Culture? 5
Communication 57
The Acculturation Process 6 The Intercultural Challenge 57
Acculturation of Food Habits 6 Intercultural Communication Concepts 58
Verbal Communication 59
Cultural Food Habits 7
Nonverbal Communication 64
Core and Complementary Foods Model 7
Flavor Principles 8 Role of Communication in Health Care 67
Meal Patterns and Meal Cycles 9 Interaction between Provider and Client 67
Developmental Perspective of Food Culture 11 Responsibilities of the Health Care Provider 69
Individual Food Habits 12 Successful Intercultural Communication 69
Food Availability 12 Intercultural Communication Skills 70
Edible or Inedible? 13 Intercultural Counseling 73
Consumer Food Choice Model 13 Intercultural Nutrition Assessment 75
Nutrition and Food Habits 18 Intercultural Nutrition Education 77

The Need for Cultural Competency 18 Culturally Relevant Program Preparation 77
Intercultural Nutrition 23 Implementation Strategies 79
The American Paradox 25
4 Food and Religion 85

Western Religions 86
2 Traditional Health Beliefs Judaism 86
and Practices 37 Christianity 91
Worldview 37 Islam 96
Cultural Outlook 37 Eastern Religions 100
Biomedical Worldview 39 Hinduism 100
What is Health? 41 Buddhism 104
Cultural Definitions of Health 41
Health Maintenance 43
Disease, Illness, and Sickness 45 5 Native Americans 109
Cultural Definitions of Disease, Illness, Cultural Perspective 109
and Sickness 45 History of Native Americans 109
Healing Practices 48 Worldview 112
vi CONTENTS
Traditional Food Habits 114 Traditional Food Habits 182

Ingredients and Common Foods 114 Ingredients and Common Foods: Staples and Regional Variations 182
Meal Composition and Cycle 121 Meal Composition and Cycle 185
Role of Food in Native American Culture and Etiquette 122 Contemporary Food Habits in the United States 190
Therapeutic Uses of Food 122 Adaptations of Food Habits 190
Contemporary Food Habits 123 Nutritional Status 191
Adaptation of Food Habits 123 SCANDINAVIANS 194
Nutritional Status 126 Cultural Perspective 194
History of Scandinavians in the United States 194
Worldview 195
6 Northern and Southern
Traditional Food Habits 195
Europeans 139 Ingredients and Common Foods: Staples and Regional Variations 196
NORTHERN EUROPEANS 139 Meal Composition and Cycle 198
Cultural Perspective 140 Contemporary Food Habits in the United States 199
History of Northern Europeans in the United States 140 Adaptations of Food Habits 199
Worldview 142 Nutritional Status 199
Ingredients and Common Foods 144
Meal Composition and Cycle 150
8 Africans 205
Cultural Perspective 205
Contemporary Food Habits in the United States 152
History of Africans in the United States 206
Adaptations of Food Habits 152
Worldview 209
Nutritional Status 154
SOUTHERN EUROPEANS 156
History of Southern Europeans in the United States 156
Role of Food in African-American Society and Etiquette 220
Worldview 158
Therapeutic Uses of Food 220
Contemporary Food Habits in
the United States 168
Adaptations of Food Habits 168 9 Mexicans and Central
Nutritional Status 168 Americans 235
MEXICANS 235
7 Central Europeans, People of Cultural Perspective 235

History of Mexicans in the United States 235
the Former Soviet Union, and Worldview 237
Scandinavians 173 Traditional Food Habits 240
CENTRAL EUROPEANS AND THE PEOPLE OF THE FSU 173 Ingredients and Common Foods 240
Cultural Perspective 174 Meal Composition and Cycle 247
History of Central Europeans and Russians in the United States 174 Role of Food and Etiquette in Mexican Society 248
Worldview 178 Therapeutic Uses of Food 249
Contents VII
Contemporary Food Habits 11 East Asians 315

in the United States 249
CHINESE 315
Nutritional Status 252 Cultural Perspective 316
History of Chinese in the United States 316
CENTRAL AMERICANS 258
Worldview 318
History of Central Americans in the United States 258
Worldview 259
Etiquette 264
Therapeutic Uses of Foods 264
JAPANESE 334
Contemporary Food Habits
in the United States 265 Cultural Perspective 334
Adaptations of Food Habits 265 History of Japanese in the United States 334
Nutritional Status 265 Worldview 335
10 Caribbean Islanders and
South Americans 275 Therapeutic Uses of Food 342
CARIBBEAN ISLANDERS 275 Contemporary Food Habits in the United States 342
Cultural Perspective 275 Adaptations of Food Habits 342
History of Caribbean Islanders in the United States 275 Nutritional Status 343
Worldview 279 KOREANS 345
Traditional Food Habits 282 Cultural Perspective 345
Ingredients and Common Foods 282 History of Koreans in the United States 345
Meal Composition and Cycle 287 Worldview 346
Contemporary Food Habits in Ingredients and Common Foods 348
SOUTH AMERICANS 296
Cultural Perspective 297 Nutritional Status 353
History of South Americans in the United States 297
Worldview 298
12 Southeast Asians and
Ingredients and Common Foods 300 Pacific Islanders 361
Meal Composition and Cycle 306 SOUTHEAST ASIANS 361
Contemporary Food Habits Cultural Perspective 361
in the United States 307 History of Southeast Asians
Adaptations of Food Habits 307 in the United States 361
Nutritional Status 307 Worldview 365
viii Food and Culture
Traditional Food Habits 371 14 South Asians 441

Ingredients and Common Foods: Staples and
Regional Variations 371
History of Asian Indians and Pakistanis in the United States 441
Worldview 444
Contemporary Food Habits in
the United States 382 Ingredients and Common Foods 447
Adaptations of Food Habits 382 Meal Composition and Cycle 454
Nutritional Status 384 Role of Food in Indian Society and Etiquette 457
PACIFIC ISLANDERS 390
History of Pacific Islanders in the
United States 390 Nutritional Status 461
Worldview 392
Traditional Food Habits 393 15 Regional Americans 473
Ingredients and Common Foods: Staples 393 American Regional Food Habits 473
Meal Composition and Cycle 395 What Is Regional Fare? 473
Role of Food 396 Regional Divisions 475
Therapeutic Uses of Foods 396
The Northeast 475
Contemporary Food Habits in Regional Profile 475
Traditional Fare 477
Health Concerns 484
The Midwest 484
Regional Profile 484
13 People of the Balkans and Traditional Fare 486
the Middle East 407 Health Concerns 492
Cultural Perspective 407 The South 492

History of People of the Balkans and Middle East in the Regional Profile 492
United States 408 Traditional Fare 495
Current Demographics and Health Concerns 506
Socioeconomic Status 410 The West 508
Worldview 412 Regional Profile 508
Traditional Food Habits 417 Traditional Fare 509
Ingredients and Common Foods 417 Health Concerns 518
Contemporary Food Habits G LO S S A R Y O F E T H N I C I N G R E D I E N T S 523
in the United States 431
RESOURCES 535
Nutritional Status 432 INDEX 539
P R E FA C E
he population of the United States is increas- HOW THE BOOK IS ORGANIZED

T ingly heterogeneous, moving toward a plural-
ity of ethnic, religious, and regional groups.
Each of these groups has traditional food habits
The first four chapters form an introduction to
the study of food and culture. Chapter 1 discusses
methods for understanding food habits within
that differslightly or significantlyfrom the
the context of culture, changing demographics,
so-called typical American majority diet.
and the ways in which ethnicity may affect nutri-
Effective nutrition counseling, education, and
tion and health status. Chapter 2 focuses on the
food service require that these variations be
role of diet in traditional health beliefs. Some
acknowledged and understood within the context
intercultural communication strategies are sug-
of culture. It is our goal to provide dietitians,
gested in Chapter 3, and Chapter 4 outlines the
nutritionists, and food service professionals with
major eastern and western religions and reviews
the broad overview needed to avoid ethnocentric
their dietary practices in detail.
assumptions and the nutrition specifics helpful in
Chapters 5 through 14 profile North American
working with each group discussed. We have
ethnic groups and their cuisines. We have chosen
attempted to combine the conceptual with the
breadth over depth, discussing groups with sig-
technical in a way that is useful to other health
nificant populations in the United States, as well
professionals as well.
as smaller, more recent immigrant groups who
We would like to draw attention specifically to
have had an impact on the health care system.
the area of nutrition counseling: In nutrition
Other groups with low numbers of immigrants
counseling, where many therapeutic interventions
but notable influences on American cooking are
are on a personal level, sensitivity to the strong
briefly mentioned.
influence of culture on an individuals food intake,
Groups are considered in the approximate
attitudes, and behaviors is especially imperative.
order of their arrival in North America. Each
. . . Multicultural competence is not a luxury or a
chapter begins with a history of the group in the
specialty but a requirement for every registered
United States and current demographics.
dietitian (Curry, 2000, p. 1,142). A model recom-
Worldview (outlook on life) is then examined,
mended for multicultural nutrition competencies
including religion, family structure, and tradi-
specifically lists (Harris-Davis & Haughton, 2000):
tional health practices. This background informa-
1. Understand food selection, preparation, tion illuminates the cultural context from which
and storage with a cultural context. ethnic foods and food habits emerge and evolve.
2. Have knowledge of cultural eating patterns The next section of each chapter outlines the tra-
and family traditions such as core foods, ditional diet, including ingredients, some common
traditional celebrations, and fasting. dishes, meal patterns, special occasions, the role of
3. Familiarize self with relevant research and food in the society, and therapeutic uses of food.
latest findings regarding food practices The final section explains the contemporary diet of
and nutrition-related health problems of the group, such as adaptations made by the group
various ethnic and racial groups. after arrival in the United States and influences of
the group on the American diet. Reported nutri-
4. Possess specific knowledge of cultural tional status is reviewed, and general counseling
values, health beliefs, and nutrition guidelines are provided.
practices of particular groups served, One or more cultural food group tables are
including culturally different clients. found in each of the ethnic group chapters. The
This book offers information fundamental to emphasis is on ingredients common to the popu-
these competencies. lations of the region. Important variations within
x PREFACE
regions and unique food habits are listed in the BEFORE YOU BEGIN
Comments column of the table. Known adapta-
tions in the United States are also noted. The Food is so essential to ethnic, religious, and
tables are intended as references for the reader; regional identity that dietary descriptions must
they do not replace either the chapter content or be as objective as possible to prevent inadvertent
an in-depth interview with a client. criticism of the underlying culture. Yet as mem-
Chapter 15 considers the regional American bers of two Western ethnic and religious groups,
fare of the Northeast, the Midwest, the South, and we recognize that our own cultural assumptions
the West. Each section includes an examination of are unavoidable and, in fact, serve as a starting
the foods common in the region and general point for our work. One would be lost without
nutritional status. Canadian regional fare is also such a cultural footing. Any instances of bias are
briefly considered. This chapter brings the study unintentional.
of cultural nutrition full circle, discussing the sig- Any definition of a groups food habits implies
nificant influences of different ethnic and reli- homogeneity in the described group. In daily life,
gious groups on North American fare. however, each member of a group has a distinc-
tive diet, combining traditional practices with
new influences. We do not want to stereotype the
NEW TO THIS EDITION fare of any cultural group. Rather, we strive to
Updated U.S. Census and other demographic generalize common U.S. food and culture trends
data. as a basis for understanding the personal prefer-
ences of individual clients.
Expanded information on the diets of many We have tried to be sensitive to the designa-
ethnic groups, including Africans, Asians, tions used by each cultural group, though some-
Latinos, and Middle Easterners. times there is no consensus among members
New Exploring Global Cuisine boxes with regarding the preferred name for the group. Also,
information on the fare of ethnic groups not there may be some confusion about dates in the
specifically covered in the text. book. Nearly all religious traditions adhere to their
New Cultural Controversy boxes that own calendar of events based on solar or lunar
explore current health, nutrition, social, months. These calendars frequently differ from the
and environmental issues related to cultural Gregorian calendar used throughout most of the
food habits. world in business and government. Religious cere-
Updated information on the current dietary monies often move around according to Gregorian
practices and nutritional status of all ethnic dates, yet usually they are calculated to occur in the
groups. correct season each year. Historical events in the
text are listed according to the Gregorian calendar,
New interviews with recent immigrants to using the abbreviations for before common era
the United States regarding how their food (BCE) and common era (CE).
habits have changed after arrival. We believe this book will do more than intro-
New interviews with nutrition practitioners duce the concepts of food and culture. It should
describing their experiences working with also encourage self-examination and individual
different ethnic groups. cultural identification by the reader. We hope that it
Chapter 3 (Intercultural Communication) will help dietitians, nutritionists, other health care
restructuring that divides the chapter into providers, and food service professionals work
two major sectionswith the first part effectively with members of different ethnic, reli-
addressing issues of interest to the general gious, and regional groups. If it sparks a gustatory
reader, and the second part expanding on interest in the foods of the world, we will be per-
this information for use in intercultural sonally pleased. De gustibus non est disputatum!
counseling by the health care professional.
Chapter 15 (Regional Americans) revisions
ACKNOWLEDGMENTS
which consolidate state data and provide We are forever indebted to the many researchers,
new nutritional information of use to the especially from the fields of anthropology and
practitioner. sociology, who did the seminal work on food
Preface XI
habits that provided the groundwork for this University of Central Oklahoma; Claire G. Kratz,
book, and to the many nutrition professionals MS, RD, LDN, Montgomery County Community
who have shared their expertise with us over the College; Yvonne Moody, EdD, Chadron State
years. We especially want to thank the many col- College; Sudha Raj, PhD, Syracuse University;
leagues who have graciously given support and Stacey A. Roush, MS, Montgomery County
advice in the development of the fifth edition: Community College; Dana Wassmer, MS, RD,
Carmen Boyd, MS, LPC, RD, Missouri State Cosumnes River College; Bonny Burns-Whitmore,
University; Arlene Grant-Holcomb, RD, MAE, DrPH, RD, California State Polytechnic University,
California State Polytechnic University, San Luis Pomona; and Donna M. Winham, DrPH, Arizona
Obispo; Carolyn Hollingshead, PhD, RD, State University.
University of Utah; Tawni Holmes, PhD, RD,
CHAPTER
1
Food and Culture
hat do Americans eat? Meat and pota- census. Thus, the proportion of American ethnic
W
As suggested by their
toes, according to popular myth. Theres group members is larger than statistics indicate, names, not even hamburg-
no denying that for every person in the and more important, it is rapidly increasing. ers and french fries are
United States, an average of over half a pound of Asians are one of the fastest-growing ethnic American in origin.
beef, pork, lamb or veal is eaten daily, and more groups in America. Their total population Chopped beef steaks were
introduced to the United
than one hundred pounds of potatoes (mostly as changed by 200 percent in the past two decades.
States from the German city
chips and fries) are consumed annually. Yet the Middle Easterners, who are grouped with Asians of Hamburg in the late
American diet cannot be so simply described. Just in the immigration data, may be increasing at nineteenth century. The
as the population of the United States includes even greater rates. Some researchers estimate American term french fried
numerous cultural groups, the food habits of that the immigrant population from the Middle potatoes first appeared in
Americans are equally diverse. It can no more be East has expanded nearly 700 percent since the the 1860s, was probably
said that the typical U.S. citizen is white, Anglo- 1980s.16 Latinos are numerically the largest non- coined to describe the
Saxon, and Protestant than it can be stated that European ethnic group, followed closely by method used in France for
meat and potatoes are what this citizen eats. African Americans. deep-frying potato pieces
U.S. Census and other demographic data show Each American ethnic, religious, or regional until crisp. Other foods con-
that one in every four Americans is of non- group has its own culturally based food habits. sidered typically American
also have foreign origins,
European heritage, and one in every ten residents Many of these customs have been influenced and
for example, hot dogs,
is foreign-born. Over 500 different ancestries modified through contact with the majority cul- apple pie, and ice cream.
were reported in 2000. Even these figures under- ture and, in turn, have changed and shaped
estimate the number and diversity of North American majority food habits. Today, a fast- Data from the 2001
American cultural groups. The data do not list food restaurant or street stand is as likely to offer Canadian census indicate
members of some white ethnic populations nor pizza, tacos, egg rolls, or falafel as it is hamburgers. that 13.4 percent of the pop-
those of religious or regional groups. Census ter- It is the intricate interplay between food habits of ulation is a visible minority
minology can be ambiguous and confusing for the past and the present, the old and the new, and (nonwhite). The largest
some respondents. For instance, the category the traditional and the innovative that is the hall- ethnic group is Chinese, fol-
Hispanic or Latino (defined as persons born in mark of the American diet. lowed by North American
Latin America, whose parents were born in Latin Indian, East Asian, and
America, who have a Spanish surname, or who Filipino. Asians and Middle
Easterners are the fastest
speak Spanish) is considered an ethnicity, not a
race, and counts Puerto Ricans (who are U.S. cit- What Is Food? growing minorities.
izens) if they reside on the mainland but not if

they live on the island. Furthermore, unautho- Food, as defined in the dictionary, is any sub-
rized immigrants, estimated to be more than 11 stance that provides the nutrients necessary to
million residents, may not be included in the maintain life and growth when ingested. When
2 FOOD AND CULTURE
mammal thrown in for protein? Why do people

choose to spend their time, energy, money, and
creativity on eating? The answers to these ques-
tions, according to some researchers, can be
found in the basic biological and psychological
constitution of humans.
THE OMNIVORES PARADOX

Tom and DeeAnn McCarthy/PhotoEdit, Inc.
Humans are omnivorous, meaning that they can

consume and digest a wide selection of plants and
animals found in their surroundings. The pri-
mary advantage to this is that they can adapt to
nearly all earthly environments. The disadvantage
is that no single food provides the nutrition nec-
essary for survival. Humans must be flexible
enough to eat a variety of items sufficient for
Humans create complex physical growth and maintenance, yet cautious
rules, commonly called most animals feed, they repeatedly consume enough not to randomly ingest foods that are
manners, about how food those foods necessary for their well-being, and physiologically harmful and, possibly, fatal. This
is to be eaten. they do so in a similar manner at each feeding. dilemma, the need to experiment combined with
Humans, however, do not feed. They eat. the need for conservatism, is known as the omni-
Eating is distinguished from feeding by the vores paradox.37, 87 It results in two contradictory
ways humans use food. Humans not only gather psychological impulses regarding diet. The first
or hunt food, but they also cultivate plants and is an attraction to new foods; the second is a pref-
raise livestock. Agriculture means that some erence for familiar foods. The food habits devel-
foods are regularly available, alleviating hand-to- oped by a group provide a framework that
mouth sustenance. This permits the development reduces the anxiety produced by these opposing
of specific customs associated with foods that are desires. Rules about which foods are edible, how
the foundation of the diet, such as wheat or rice. they are procured and cooked safely, how they
Humans also cook, softening tough foods, includ- should taste, and when they should be consumed
ing raw grains and meats, and reducing toxic sub- provide guidelines for both experimentation
stances in other items, such as certain root (based on previous experience with similar plants
vegetables. This greatly expands the number and and animals or flavors and textures) and conser-
variety of edible substances available. Choosing vatism through ritual and repetition.
foods to combine with other foods follows, and
prompts rules regarding what can be eaten with
SELF-IDENTITY
what and creating the meal. Humans use utensils
to eat meals and institute complex rules, com- The choice of which foods to ingest is further
monly called manners, about how meals are con- complicated, however, by another psychological
sumed. And significantly, humans share food. concept regarding eatingthe incorporation of
Standards for who may dine with whom in each food. Consumption is understood as equaling
It is thought that children eating situation are well-defined. conversion of a food and its nutrients into a
are less likely than adults to The term food habits (also called food culture human body. For many people, incorporation is
try new foods, in part or foodways) refers to the ways in which humans not only physical but associative as well. It is the
because they have not yet
use food, including everything from how it is fundamental nature of the food absorbed by a
learned cultural rules
regarding what is safe and
selected, obtained, and distributed to who pre- person, conveyed by the proverbial phrase, you
edible. A child who is pares it, serves it, and eats it. The significance of are what you eat. In its most direct interpretation,
exposed repeatedly to new this process is unique to humankind. Why dont it is the physical properties of a food expressed
items loses the fear of new people simply feed on the diet of our primitive through incorporation. Some Asian Indians eat
foods faster than one who ancestors, surviving on foraged fruits, vegetables, walnuts to improve their brain, and weight lifters
experiences a limited diet.11 grains, and the occasional insect or small may dine on rare meat to build muscle. In other
Chapter 1: Food and Culture 3
cases, the character of the food is incorporated. unpalatable items, such as chile peppers or
Some Native Americans believe that because milk unsweetened coffee, are enjoyed if introduced
is a food for infants, it will weaken adults. The through socially mediated events, such as family
French say a person who eats too many turnips meals or workplace snack breaks. Although the
becomes gutless, and some Vietnamese consume mechanism for the internalization of food prefer-
gelatinized tiger bones to improve their strength. ence and self-identity is not well understood, it is
It is a small step from incorporating the traits considered a significant factor in the development
associated with a specific food to making assump- of food habits.88 A study on the consumption of
tions about a total diet. The correlation between organic vegetables, for example, found that those
what people eat, how others perceive them, and who identified themselves as green (people who are
how they characterize themselves is striking. In concerned with ecology and make consumer deci-
one study researchers listed foods typical of five sions based on this concern) predicted an intention
diets: vegetarian (broccoli quiche, brown rice, avo- to eat organic items independent of other attitudes,
cado and bean sprout sandwich), gourmet (oys- such as perceived flavor and health benefits.100
ters, caviar, French roast coffee), health food Food as self-identity is especially evident in
(protein shake, wheat germ, yogurt), fast food the experience of dining out. Researchers suggest
(Kentucky Fried Chicken, Big Mac, pizza), and that restaurants often serve more than food, satis-
synthetic food (Carnation Instant Breakfast, Cheez fying both emotional and physical needs. A diner
Whiz). It was found that each category was associ- may consider the menu, atmosphere, service, and
ated with a certain personality type. Vegetarians cost or value when selecting a restaurant; and
were considered to be pacifists and likely to drive most establishments cater to a specific clientele.
foreign cars. Gourmets were believed to be liberal Some offer quick, inexpensive meals and play
and sophisticated. Health food fans were equipment to attract families. Business clubs fea-
described as antinuclear activists and Democrats. ture a conservative setting suitable for financial
Fast food and synthetic food eaters were believed transactions, and the candlelit ambiance of a
to be religious, conservative, and fond of polyester bistro is conducive to romance. The same diner
clothing. These stereotypes were confirmed by may choose the first in her role as a mother, the
self-description and personality tests completed by second while at work, and the last when meeting
people whose diets fell into the five categories.93 a date. In Japan restaurants serve as surrogate
Another study asked college students to rate homes where company is entertained, preserving
profiles of people based on their diets. The persons the privacy of family life. The host chooses and
who ate good foods were judged thinner, more pays for the meal ahead of time, all guests are
fit, and more active than persons with the identical provided the same dishes, and the servers are
physical characteristics and exercise habits who expected to partake in the conversation. Ethnic
ate bad foods. Furthermore, the people who ate restaurants appeal to those individuals seeking
good foods were perceived by some students as familiarity and authenticity in the foods of their
being more attractive, likable, practical, methodi- homeland or those interested in novelty and culi-
cal, quiet, and analytical than people who ate nary adventure. Conversely, exposure to different
bad foods. The researchers attribute the strong foods in restaurants is sometimes the first step in The inability to express
moralityfood effect to several factors, including adopting new food items at home.65 self-identity through food
the concept of incorporation and a prevailing habits can be devastating.
Puritan ethic that espouses self-discipline.111 A study of persons with
Food choice is, in fact, influenced by self-iden-
SYMBOLIC USE OF FOOD permanent feeding tubes
tity, a process whereby the food likes or dislikes The development of food habits clearly indicates living at home or in nursing
of someone else are accepted and internalized that for humans, food is more than just nutrients. facilities found they fre-
as personal preferences. Research suggests that quently avoided meals
Incorporation has meaning specifically because
with families and friends.
children choose foods eaten by admired adults people are omnivores and have a choice regarding
They missed their favorite
(e.g., teachers), fictional characters, peers, and what is consumed. Humans use foods symboli- foods, but more important,
especially older siblings. Parents have little long- cally, due to relationship, association, or conven- they mourned the loss of
lasting influence. Group approval or disapproval of tion. Bread is an excellent exampleit is called their self-identities rein-
a food can also condition a persons acceptance or the staff of life; one breaks bread with friends, forced by these daily social
rejection. This may explain why certain relatively and bread represents the body of Christ in the interactions.121
4 FOOD AND CULTURE
Text not available due to copyright restrictions
Christian sacrament of communion. White bread conversely, who one is not. In the Middle East, for
was traditionally eaten by the upper classes, dark example, a person who eats pork is probably
bread by the poor, but whole wheat bread is con- Roman Catholic or Orthodox Christian, not Jewish
sumed today by persons concerned more with or Muslim (pork is prohibited in Judaism and
health than status. A person with money has a Islam). Raviolis served with roast turkey suggest an
lot of bread. In many cultures bread is shared by Italian-American family celebrating Thanksgiving,
couples as part of the wedding ceremony or left not a Mexican-American family, who would be
for the soul of the dead. Superstitions about bread more likely to dine on tamales and turkey. The food
also demonstrate its importance beyond suste- habits of each cultural group are often linked to reli-
nance. Greek soldiers took a piece from home to gious beliefs or ethnic behaviors. Eating is a daily
ensure their safe, victorious return; English mid- reaffirmation of cultural identity (Figure 1.1).
wives placed a loaf at the foot of the mothers bed Foods that demonstrate affiliation with a cul-
to prevent the woman and her baby from being ture are usually introduced during childhood and
stolen by evil spirits; and sailors traditionally are associated with security or good memories.
brought a bun to sea to prevent shipwreck. It is Such foods hold special worth to a person, even if
the symbolic use of a food that is valued most by other diets have been adopted due to changes in
people, not its nutritional composition. residence, religious membership, health status, or
daily personal preference. They may be eaten
during ethnic holidays and for personal events,
CULTURAL IDENTITY such as birthdays or weddings, or during times of
An essential symbolic function of food is cultural stress. These items are sometimes called comfort
identity. Beyond self-identification, incorporation foods because they satisfy the basic psychological
can signify collective association. What one eats need for food familiarity. For example, in the
defines who one is, culturally speaking, and, United States one study found comfort foods for
women required little preparation and tended to be thick, dark brew from Africa and spread it Children younger than age
snacks, such as potato chips, ice cream, chocolate, through their empire) became Greek coffee in two will eat anything and
and cookies; men preferred foods served by their Greece after tensions between the two nations everything. Children
mothers, such as soup, pizza or pasta, steak, and escalated in the 1920s. Examples in the United between three and six years
of age begin to reject cul-
mashed potatoes.122 Occasionally, a person States include renaming sauerkraut liberty cab-
turally unacceptable food
embraces a certain diet as an adult to establish bage during World War I, and more recently,
items. By age seven, chil-
association with a group. A convert to Judaism, for calling french fries freedom fries, when France dren are completely
instance, may adhere to the kosher dietary laws. opposed the United States in the invasion of Iraq. repulsed by foods that their
African Americans who live outside the South may Specific foods are not the only way food can culture categorizes as
occasionally choose to eat soul food (typically symbolize cultural identity. The appropriate use repugnant.91
southern black cuisine, such as pork ribs and of food, also known as etiquette, is another
greens) as an expression of ethnic solidarity. expression of group membership. In the United
The reverse is also true. One way to establish States entirely different manners are required
that a person is not a member of a certain cultural when lunching with business associates at an
group is through diet. Researchers suggest that expensive restaurant, when attending a tea, when
when one first eats the food of another cultural eating in the school cafeteria, when drinking with
group, a chain of reasoning occurs, beginning with friends at a bar, or when dining with a date.
the recognition that one is experiencing a new Discomfort can occur if a person is unfamiliar
flavor and ending with the assumption that this with the rules, and if a person deliberately breaks
new flavor is an authentic marker of other group the rules, he or she may be ostracized or shunned.
members.48 These other individuals may be deni- Another function of food symbolism is to define
grated by food stereotyping, and such slurs are statusa persons position or ranking within a par-
found in nearly all cultures. In the United States, ticular cultural group. Food can be used to signify
Germans are sometimes called krauts, Chinese economic social standing: champagne and caviar
cookies or dim sums, Italians spaghetti ben- imply wealth, mesquite-grilled foods and goat
ders, Mexicans beaners, Irish potatoheads, cheese suggest upward mobility, and beans or pota-
Koreans kimchis, and poor white Southerners toes are traditionally associated with the poor.
crackers (possibly from corncracker, someone Status foods are characteristically used for social
who cracks corn to distill whiskey or from early interaction. In the United States a girlfriend appre-
immigrants to Georgia who survived on biscuits). ciates a box of chocolates from her boyfriend, but
Foods that come from other cultures may also not a bundle of broccoli. Wine is considered an
be distinguished as foreign to maintain group appropriate gift to a hostessa gallon of milk is not.
separation. Kafir, a derogatory Arabic term for In general, eating with someone connotes social
infidel, was used to label some items found in equality with that person. Many societies regulate
areas they colonized, including the knobby Kaffir commensalism (who can dine together) as a means
lime of Malaysia, and Kaffir corn (millet) in of establishing class relationships. Men may eat
Africa. Similarly, when some non-Asian foods separately from women and children, or servants
were introduced to China, they were labeled may eat in the kitchen, away from their employers.
barbarian or Western and named after items In India the separate social castes did not tradition-
already familiar in the diet. Thus, sweet potatoes ally dine together, nor were people of higher castes
were called barbarian yams, and tomatoes permitted to eat food prepared by someone of a
became barbarian eggplants.5 Less provocative lower caste. This class segregation was also seen in
place names are used, too, though the origins of some U.S. restaurants that excluded blacks before
the food are often incorrect, such as Turkey civil rights legislation of the 1960s.
wheat (the Dutch term for native American
corn, which was thought to come from Turkey)
and Irish potatoes (which are indigenous to
Peru, but were brought to the United States by What Is Culture?
immigrants from Ireland). The powerful sym-
bolic significance of food terms leads occasionally Culture is broadly defined as the values, beliefs,
to renaming foreign items in an attempt to assert attitudes, and practices accepted by members of a
a new cultural identity. Turkish coffee (it was group or community. Culture is learned, not inher-
the Ottomans of Turkey who popularized this ited; it is passed from generation to generation
6 FOOD AND CULTURE
through language acquisition and socialization in complementing, rather than competing with, an
a process called enculturation. It is a collective individuals ethnicity. The positive aspects of both
adaptation to a specific set of environmental condi- societies are embraced, and the individual devel-
tions, and cultural behavior patterns are reinforced ops the skills needed to operate within either cul-
when a group is isolated by geography or segre- ture.14 Asian Indians who call themselves
gated by socioeconomic status. Yet culture is not a Indo-Americans or Asian Indian Americans fall
Peter Menzel/Stock, Boston Inc.
static condition. It changes over time, from place into this category, eating equal amounts of Indian
to place, and in response to social dynamics.6 and American foods, thinking and reading
Cultural membership is defined by ethnicity. equally in an Indian language and in English.
Unlike national origin or race (which may Assimilation occurs when people from one cul-
include numerous ethnic groups), ethnicity is a tural group shed their ethnic identity and fully
social identity associated with shared behavior merge into the majority culture. Although some
patterns, including food habits, dress, language, first-generation immigrants strive toward assim-
Typically, first-generation
immigrants remain emotion-
family structure, and often religious affiliation. ilation, due perhaps to personal determination to
ally connected to their eth- Members of the same ethnic group usually have a survive in a foreign country or to take advantage
nicity, surrounding common heritage through locality or history and of opportunities, most often assimilation takes
themselves with a reference participate together with other cultural groups in place in subsequent generations. Asian Indians
group of family and friends a larger social system. As part of this greater com- who identify themselves as being mostly
who share their cultural munity, each ethnic group may have different American do not consider Asian Indian culture
background. status or positions of power. Diversity within each superior to American culture, and they are will-
cultural group, called intrathnic variation, is also ing to let their children date non-Indians. It is
common due to racial, regional, or economic believed that ethnic pride is reawakened in some
divisions as well as differing rates of acculturation immigrants if they become disillusioned with life
to the majority culture.47 in America, particularly if the disappointment is
attributed to prejudice from the majority society.
A few immigrants exist at the edges of the accul-
THE ACCULTURATION PROCESS
turation process, either maintaining total ethnic
When people from one ethnicity move to an area identity or rejecting both their culture of origin
with different cultural norms, adaptation to the and that of the majority culture.68
new majority society begins. This process is
known as acculturation, and it takes place along a
ACCULTURATION OF FOOD HABITS
continuum of behavior patterns that can be very
Ethnocentric is the term fluid, moving back and forth between traditional Culturally based food habits are often one of the last
applied to a person who practices and adopted customs. It occurs at the practices people change through acculturation.
uses his or her own values
micro level, reflecting an individuals change in Unlike speaking a foreign language or wearing tra-
to evaluate the behaviors
attitudes, beliefs, and behaviors, and at the macro ditional clothing, eating is usually done in the pri-
of others. It may be done
unconsciously or in the level, resulting in group changes that may be vacy of the home, hidden from observation by
conscious belief that their physical, economic, social, or political in nature.95 majority culture members. Adoption of new food
own habits are superior to Typically, first-generation immigrants remain items does not generally develop as a steady pro-
those of another culture. emotionally connected to their culture of origin. gression from traditional diet to the diet of the
Ethnorelativism occurs They integrate into their new society by adopting majority culture. Instead, research indicates that
when a person assumes some majority culture values and practices but the consumption of new items is often independent
that all cultural values generally surround themselves with a reference of traditional food habits.83, 96, 116 The lack of avail-
have equal validity, result- group of family and friends from their ethnic able native ingredients may force immediate accul-
ing in moral paralysis and background. For example, Asian Indians living in turation, or convenience or cost factors may speed
an inability to advocate for
the United States who consider themselves to be change. Samoans may be unable to find the fresh
a belief. Prejudice is hostil-
mostly or very Asian Indian may encourage coconut cream needed to prepare favorite dishes,
ity directed toward persons
of different cultural groups their children to speak English and allow them to for instance, or an Iranian may find the expense of
because they are members celebrate American holidays, but they do not purchasing saffron for certain rice recipes prohibi-
of such groups; it does permit them to date non-Asian Indian peers.108 tive. Some immigrants, however, adapt the foods of
not account for individual Other immigrants become bicultural, which the new culture to the preparation of traditional
differences.113 happens when the new majority culture is seen as dishes.95 Tasty foods are easily acceptedfast food,
pastries, candies, and soft drinks; conversely, Researchers have proposed numerous models
unpopular traditional foods may be the first to go. to identify and understand the food habits of dif-
Mexican children living in the United States ferent cultures. Some of these categorizations are
quickly reject the variety cuts of meat, such as tripe, helpful in understanding the role of food within a
that their parents still enjoy. It is the foods most culture, including (1) the frequency of food con-
associated with ethnic identity that are most resist- sumption, as described through the core and
ant to acculturation. Muslims will probably never complementary foods model; (2) the ways in
eat pork, regardless of where they live. People from which a culture traditionally prepares and sea-
China may insist on eating rice with every meal, sons its foods, as examined by flavor principles;
even if it is the only Asian food on the table. (3) the daily, weekly, and yearly use of food, as
found in meal patterns and meal cycles; and (4)
changes in food functions that emerge during
structural growth in a culture, as predicted by the
Cultural Food developmental perspective of food culture.
Habits CORE AND COMPLEMENTARY FOODS MODEL

Food functions vary culturally, and each group Foods selected by a culture can be grouped
creates categorizations reflective of their priori- according to frequency of consumption. The
ties. In the United States, food has been typically expanded concept of core foods states that the sta-
classified by food group (as in the Basic Four ples regularly included in a persons diet, usually
Food Groups: protein, dairy, cereal and grain, on a daily basis, are at the core of food habits.81
fruits and vegetables), by percentage of important These typically include complex carbohydrates,
nutrients (as identified in the Recommended such as rice, wheat, corn, yams, cassava, taro, or
Dietary Allowances [RDA] for energy, protein, plantains. Foods widely but less frequently eaten
vitamins, and minerals), or according to recom- are termed secondary foods. These items, such as
mendations for health. American models, espe- chicken or lettuce or apples, are consumed once a
cially the Basic Four Food Groups and, to a lesser week or more, but not daily. Foods eaten only
extent, the Dietary Guidelines for Americans 2005, sporadically are called peripheral foods. These
describe a culture whose members consume sig- foods are characteristic of individual food prefer-
nificant amounts of milk and milk products. ence, not cultural group habit.
These categories also suggest that Americans Another version of the model suggests that
value food more for nutritional content and in many cultures, especially agrarian societies,
impact on health than for any symbolic use. But the core food is always served with fringe, or
only limited information is provided about U.S. complementary, items to improve palatability
food habits; although these schemes list what (Figure 1.2).71 Because most starchy staples are
foods people eat, they reveal nothing about how,
when, or why foods are consumed.
Other less explicit categorizations are com-
monly used by members of each culture and are
associated with the meaning of food. Examples of
classifications found in both developing and
industrialized societies include cultural super-
Core
foods, usually staples that have a dominant role in Foods
the diet; prestige foods, often protein items or
expensive or rare foods; body image foods, Complementary
Foods
believed to influence health, beauty, and well-
being; sympathetic magic foods, whose traits,
Secondary Foods
through association of color or form, are incorpo-
rated; and physiologic group foods, reserved for, Figure 1.2
Peripheral Foods
or forbidden to, groups with certain physiologic The core and complemen-
status, such as gender, age, or health condition.54 tary foods model.
8 FOOD AND CULTURE
bland and uniform in texture, these flavorful temperature, and other environmental factors in
substances, eaten in small quantities, encourage which grapes are grown. Each region and every
consumption of the core food as the bulk of the vineyard are distinctive, often producing appre-
diet. An added component in this model, some- ciable differences in the resulting product. Yet this
times as a complementary food and sometimes variation is insignificant when compared to how
as a secondary food, is legumes. It has been foods in general are processed for consumption.
hypothesized that these core and complemen- Every technique, from preparation for cooking
tary food pairings often combine to provide (e.g., washing, hulling or peeling, chopping,
nutritionally adequate meals, especially when pounding, squeezing, soaking, leaching, and
legumes are included. For example, in cultures marinating) to cooking (e.g., baking, roasting,
where grain is a core food, sources of vitamins A grilling, stewing, toasting, steaming, boiling, and
and C are needed to approach sufficiency. Rice, frying) and preserving (e.g., drying, curing, can-
breads and pastas, and corn are frequently pre- ning, pickling, fermenting, and freezing), alters
pared with leafy green vegetables, abundant the original flavor of the ingredient. Nevertheless,
herbs, or tomatoes, which are high in these location and manipulation practices alone do not
needed nutrients. Chinese rice with pickled veg- equal cuisine. For that, foods must be seasoned.
etables, Italian noodles with tomato sauce, Historians and scientists speculate there are
Mexican corn tortillas with salsa, and Middle several reasons why herbs and spices have
Eastern pilaf with parsley and dried fruit are assumed such an essential role in food habits.
examples. When the core diet is almost adequate Foremost is palatability. Salt, one of the most
nutritionally, the addition of secondary foods, widely used seasonings, prompts an innate
including legumes (soybean products in China; human taste response. It is enjoyed by most
beans or lentils in Italy; red or pinto beans in people and physiologically craved by some.
Mexico; and chickpeas, fava beans, and lentils in Researchers also suggest that the burn of chile
the Middle East), small amounts of meats, poul- peppers (and perhaps other spices) may trigger
try, fish, and cheeses or yogurt can provide the the release of pleasurable endorphins. Another
necessary balance. recurrent theory on the popularity of seasoning
Changes in food behaviors are believed to early on was to disguise the taste of spoiled meats,
happen most often with peripheral foods and least though evidence for this is limited. A more plau-
often with core foods. A person who is willing to sible assertion is that spices were found effective
omit items that she or he rarely eats is typically in preserving meats. A survey of recipes world-
much more reluctant to change foods eaten daily wide suggested that the antimicrobial activity of
and associated with her or his cultural identity. spices accounts for their widespread use, espe-
Though little has been reported on the signifi- cially in hot climates.10 Other researchers specu-
cance of complementary foods in diet modifica- late that eating chile peppers (and, by extension,
tion, presumably, if complementary items were other hot seasonings such as mustard, horserad-
altered or omitted, the core would no longer be ish, and wasabi) is a benign form of risk taking
palatable. The complementary foods provide the that provides a safe thrill. 90 Additionally, the
flavor familiarity associated with the core. recurrent use of seasonings may provide the
familiarity sought in the omnivores dilemma.86
Theories aside, seasonings can be used to clas-
FLAVOR PRINCIPLES sify cuisines culturally.85, 86 Unique seasoning
The significance of food flavor in a culture cannot combinations, termed flavor principles, typify the
be overestimated. The ways foods are prepared foods of ethnic groups worldwide. They are so
and seasoned is second in importance only to the distinctive that few people mistake their use. For
initial selection of ingredients in the development example, a dish flavored with fermented fish
of food habits. It is no less than the transforma- sauce shouts Southeast Asian, not Chinese,
tion of feeding into eating. Norwegian, or Brazilian. These seasoning combi-
Foods demonstrate variability according to nations are often found in the complementary
location. Much is made, for example, of wine foods of the core and complementary foods model,
terroirthe soil texture, natural minerals, providing the flavors associated with the starchy
drainage, source of water, sun exposure, average carbohydrates that are the staples of a culture.
They usually include herbs, spices, vegetables, characteristic seasoning combinations. Nor is the A few cuisines have
and a fat or oil, though many variations exist. A seasoning in each culture limited to just those extremely limited season-
flavor practice in West Africa is tomatoes, onion, listed. Regional variations are especially prevalent. ings, including the fare of
and chile peppers that have been sauted in palm In China, northern cuisine often includes the flavor the Inuits. Broadly speak-
ing, cuisines offering large
oil. In the Pacific Islands a flavor principle is principle seasonings enhanced with soybean paste,
portions of meat and other
coconut milk or cream with a little lime juice and garlic, and sesame oil. In the south, fermented
protein foods tend to be
salt. Yams taste like West African food when black beans are frequently added, although in the less seasoned than those
topped with the tomato mixture and like Pacific Szechwan region hot bean paste, chile peppers, or with a higher proportion of
Islander food when served with the coconut Szechwan (fagara) pepper is more common. In the grains, fruits and vegeta-
sauce. Some widely recognizable flavor principles specialty cuisine of the Hakka, the addition of red bles, and legumes.
include: rice wine is distinctive. Further, in any culture
where the traditional seasoning combinations are
Asian Indian: garam masala (curry blend
prepared at home, not purchased, modifications to
of coriander, cumin, fenugreek, turmeric,
suit each family are customary.37 Flavor principles
black pepper, cayenne, cloves, cardamom,
are therefore more of a marker for each cultures
and chile peppers)
cuisine than a doctrine.
Brazilian (Bahia): chile peppers, dried
shrimp, ginger root, and palm oil
MEAL PATTERNS AND MEAL CYCLES
Chinese: soy sauce, rice wine, and ginger
root People in every culture dine on at least one meal
French: butter, cream, wine, boquet garni each day. The structural analysis of meal patterns
(selected herbs, such as tarragon, thyme, and meal cycles reveals clues about complex
and bay leaf) social relations and the significance of certain
events in a society.29 The first step in decoding
German: sour cream, vinegar, dill, mustard, these patterns and cycles is to determine what
and black pepper elements constitute a meal within a culture.
Greek: lemon, onions, garlic, oregano, and In the United States, for instance, cocktails
olive oil and appetizers or coffee and dessert are not con-
Italian: tomato, garlic, basil, oregano, and sidered meals (Figure 1.3). A meal contains a
olive oil main course and side dishes; typically a meat,
vegetable, and starch. In the western African
Japanese: soy sauce, sugar, and rice wine nation of Cameroon, a meal is a snack unless cas-
vinegar sava paste is served. In many Asian cultures, a
Korean: soy sauce, garlic, ginger root, black meal is not considered a meal unless rice is
pepper, scallions, chile peppers, and sesame included, no matter how much other food is con-
seeds or oil sumed. A one-pot dish is considered a meal if it
Mexican: tomatoes, onions, chile peppers, contains all the elements of a full meal. For exam-
and cumin ple, American casserole dishes often feature
meat, vegetables, and starch, such as shepherds
Puerto Rican: sofrito (seasoning sauce of pie (ground beef, green beans, and tomato sauce
tomatoes, onions, garlic, bell peppers, topped with mashed potatoes) or tuna casserole
cilantro, capers, pimento, annatto seeds, (tuna, peas, and noodles).
and lard) The elements that define a meal must also be
Russian: sour cream, onion, dill, and parsley served in their proper order. In the United States,
Scandinavian: sour cream, onion, mustard, appetizers come before soup or salad, followed by
dill, and caraway the entre, and then by dessert. In France the
salad is served after the entre. All foods are
Thai: fermented fish sauce, coconut milk, served simultaneously in Vietnam so that each
chile peppers, garlic, ginger root, lemon person may combine flavors and textures accord-
grass, and tamarind The sprig of parsley added
ing to taste. In addition to considering the proper to a plate of food may have
It would be incorrect, however, to assume that serving order, foods must also be appropriate originated as a way to safe-
every dish from each culture is flavored with its for the meal or situation. Some cultures do not guard the meal from evil.
10 FOOD AND CULTURE
Blondie King Features Syndicate. Reprinted by permission.
Figure 1.3
Each culture defines which distinguish which foods can be served at different appropriate varies, however. A traditional serving
foods are needed to consti- meals, but in the United States eggs and bacon of beef in China may be limited to one ounce
tute a meal. are considered breakfast foods, while cheese and added to a dish of rice. In France, a three- or four-
Source: Blondie. Reprinted with olives are popular in the Middle East for the ounce filet is more typical. In the United States, a
special permission of King
morning meal. Soup is commonly served at six- or even eight-ounce steak is not unusual, and
Features Syndicate.
breakfast in Southeast Asia, but in the United some restaurants specialize in twelve-ounce cuts
States soup is a lunch or dinner food, and in parts of prime rib. American tradition is to clean ones
of Europe fruit soup is sometimes served as plate regardless of how much is served, while in
dessert. Cake and ice cream are appropriate for a other cultures, such as those in the Middle East, it
childs birthday party in the United States; wine is considered polite to leave some food on the
and cheese are not. plate to indicate satiety.
Other aspects of the meal message include Beyond the individual meal is the cycle in
who prepares the meal and what culturally spe- which meals occur. These include the everyday
cific preparation rules are used. In the United routine, such as how many meals are usually
States ketchup goes with french fries; in Great eaten and when. In much of Europe a large main
Britain, vinegar is sprinkled on chips (fried pota- meal is customarily consumed at noontime, for
toes). Orthodox Jews consume meat only if it has example, while in most of the United States today
been slaughtered by an approved butcher in an the main meal is eaten in the evening. In poor
approved manner and has been prepared in a societies only one meal per day may be eaten,
particular way. (See Chapter 4, Food and Religion, whereas in wealthy cultures three or four meals
for more information on Judaism.) are standard.
Who eats the meal is also important. A meal The meal cycle in most cultures also
is frequently used to define the boundaries of includes feasting or fasting, and often both.
interpersonal relationships. Americans are Feasting celebrates special events, occurring in
comfortable inviting friends for dinner, but nearly every society where a surplus of food can
they usually invite acquaintances for just drinks be accumulated. Religious holidays such as
In many homes, few meals and hors doeuvres. For a family dinner, people Christmas and Passover; secular holidays such
are eaten as a family. The may include only some of the elements that con- as Thanksgiving and the Vietnamese New Years
term grazing refers to grab-
stitute a meal, but serving a meal to guests Day, known as Tet; and even personal events
bing small amounts of food
requires that all elements be included in their such as births, marriages, and deaths are
throughout the day to con-
sume. There are an esti- proper order. observed with appropriate foods. In many cul-
mated 7 million vending The final element of what constitutes a meal is tures feasting means simply more of the foods
machines in the United portion size. In many cultures one meal a day is consumed daily and is considered a time of
States, with over 100 mil- designated the main meal and usually contains the plenty when even the poor have enough to eat.
lion customers daily. largest portions. The amount of food considered Special dishes that include costly ingredients or
are time-consuming to prepare also are charac-

teristic of feasting. The elements of a feast rarely
differ from those of an everyday meal. There
may be more of an everyday food or several
main courses with additional side dishes and a
selection of desserts, but the meal structure
does not change. For example, Thanksgiving
typically includes turkey and often another
Robert Brenner/PhotoEdit, Inc.

entre, such as ham or a casserole (meat); several
vegetables; bread or rolls, potatoes, sweet pota-
toes, and stuffing (starch); as well as pumpkin,
mincemeat, and pecan pies or other dessert
selections. Appetizers, soups, and salads may
also be included.
Fasting may be partial or total. Often it is just
Special dishes that include
the elimination of some items from the diet, such the transition of a society from producers of costly ingredients or are
as the traditional Roman Catholic omission of indigenous foods to consumers of mass-produced time-consuming to prepare
meat on Fridays or a Hindu personal fast day, foods. Traditionally seasonal ingredients, such as are characteristic of feasting
when only foods cooked in milk are eaten. strawberries, become available any time of year in many cultures.
Complete fasts are less common. During the holy from a worldwide network of growers and suppli-
month of Ramadan, Muslims are prohibited from ers. Specialty products, such as ham and other
taking food or drink from dawn to sunset, but deli meats, which were at one time prepared
they may eat in the evening. Yom Kippur, the Day annually or only for festive occasions, can now be
of Atonement observed by Jews, is a total fast purchased presliced, precooked, and prepack- Feasting functions to redis-
from sunset to sunset. (See Chapter 4 for more tribute food from rich to
aged for immediate consumption.
details on fasting.) poor, to demonstrate
The social dynamic of modernization encom- status, to motivate people
passes new technologies and the socioeconomic toward a common goal
DEVELOPMENTAL PERSPECTIVE OF FOOD shifts that result, such as during the industrial (e.g., a political fundraising
CULTURE revolution when muscle power was replaced by dinner), to mark the sea-
fuel-generated engine power or during the 1990s sons and life-cycle events,
The developmental perspective of food culture with the rise of the information age. Cultural and to symbolize devotion
(Table 1.1) suggests how social dynamics are par- beliefs, values, and behaviors are modified in and faith (e.g., Passover,
alleled by trends in food, eating, and nutrition.107 response to the dramatic structural changes that Eid-al-Fitr, and
It is useful in conceptualizing broad trends in cul- take place. Commoditization typifies associated Communion).
tural food habits that emerge during structural food habits, with foods becoming processed,
changes in a society. marketed commodities instead of home-prepared
Globalization is defined as the integration of sustenance. The fresh milk from the cow in the
local, regional, and national phenomena into an barn becomes the plastic gallon container of pas-
unrestricted worldwide organization. The parallel teurized milk shipped to another part of the
change in cultural food habits is consumerization, country and sold online over the Internet to a
Table 1.1 Developmental Perspective of Food Culture

Structural Change Food Culture Change
Globalization: Local to worldwide organizations Consumerization: Indigenous to mass-produced foods
Modernization: Muscle to fueled power Commoditization: Homemade to manufactured foods
Urbanization: Rural to urban residence Delocalization: Producers to consumers only
Migration: Original to new settings Acculturation: Traditional to adopted foods
Source: Adapted from Sobal, J. 1999. Social change and foodways. In Proceedings of the Cultural and Historical Aspects of Food Symposium. Corvallis:
Oregon State University.
12 FOOD AND CULTURE
consumer who has limited time (and limited preference is most often concerned with more
access to dairy cows) but not limited money. immediate considerations, such as taste, cost, con-
Urbanization occurs when a large percentage of venience, self-expression, well-being, and variety,
the population abandons the low density of rural as explained in the consumer food choice model
residence in favor of higher density suburban and discussed later in this chapter.
urban residence. Often income levels do not
change in the move, but families who previously
survived on subsistence farming become depend-
FOOD AVAILABILITY
ent on others for food. Delocalization occurs when A person can only select a diet from foods that are
the connections among growing, harvesting, cook- available. Local ecological considerations, such as
ing, and eating food are lost, as meals prepared by weather, soil, and water conditions; geographical
anonymous workers are purchased from conven- features; indigenous vegetation; the native animal
ience markets and fast-food restaurants. population; and human manipulation of these
Finally, migration of populations from their resources through cultivation of plants and
original homes to new regions or nations creates domestication of livestock, determine the food
a significant shift from a home-bound, culture- supply at a fundamental level. A society living in
bound society to one in which global travel is the cool climate of northern Europe is not going
prevalent and immigration common. Traditional to establish rice as a core food, just as a society in
food habits are in flux during acculturation to the the hot wet regions of southern India is not going
diet of a new culture and as novel foods are intro- to rely on oats or rye. Seasonal variations are a
duced and accepted into a majority cuisine. Often factor, as are unusual climactic events, such as
wholly new traditions emerge from the contact droughts, that disrupt the food supply.
between diverse cultural food habits. The political, economic, and social manage-
The developmental perspective of food culture ment of food at the local level is typically directed
assumes that cultures progress from underdevel- toward assuring a reliable and affordable source
oped to developed through the structural changes of nourishment. Advances in food production,
listed. Deliberate efforts to reverse that trend can storage, and distribution are examples. However,
be seen in the renewed popularity of farmers mar- the development of national and international
kets in the United States and attacks on fast-food food networks has often been motivated by other
franchises in Europe. Other evidence of resistance needs, including profit and power. The complex-
includes the work of the Slow Food movement ity of the food supply system has been examined
mobilizing against the negative effects of industri- by many disciplinary approaches. Historians
alizationand the seed banks that have opened trace the introduction and replacement of foods
throughout the nation to promote genetic diversity as they spread regionally and globally. Economists
and save indigenous plant populations.41, 107 describe the role of supply and demand, the com-
modity market, price controls, trade deficits, and
farm subsidies (as well as other entitlements) on
access to food. Psychologists investigate how
Individual Food individual experience impacts diet; political sci-
entists detail how fear of biotechnology, bioterror-
Habits ism, and disease (such as the mad-cow or bovine
spongiform encephalopathy scare in Europe) can
Cultural values, beliefs, and practices are usually so alter acceptability. Sociologists document how
ingrained that they are invisible in the day-to-day social structures and relations affect the obtain-
life of the individual. Each person lives within his ment of food; legal experts debate the ethics of
or her culture, unaware of the influences exerted food policies for the poor, the incarcerated, and
by that culture on food habits. Eating choices are the terminally ill. This is only a small sampling of
typically made according to what is obtainable, the factors influencing food availability (see
what is acceptable, and what is preferred: a dietary References). However, except in regions where
domain determined by availability and by what serious food shortages are the norm, availability
each person considers edible or inedible. Within issues are usually not at the forefront of individual
the limitations of this dietary domain, personal food choice.
EDIBLE OR INEDIBLE?
This approach was one of the earliest food habits
models, describing the individual process that
establishes the available, appropriate, and per-
sonal food sphere. Each persons choice of what to
eat is generally limited to the foods found in this Text not available due to copyright restrictions
dietary domain.62
1. Inedible foods: These foods are poisonous
or are not eaten because of strong beliefs
or taboos. Foods defined as inedible vary
culturally. Examples of frequently prohib-
ited foods (or taboo, from the Tongan
word tabu, meaning marked as Holy)
include animals useful to the cultural
group, such as cattle in India; animals
dangerous to catch; animals that have many traditional American foods). Other
died of unknown reasons or of disease; factors, such as religious restrictions (as in
animals that consume garbage or excre- kosher law or halal practices) or ethical
ment; and plants or animals that resemble considerations (vegetarianism), may also
a human ailment (e.g., strawberries or influence food choices.
beef during pregnancy to protect the
5. Edible by me: These are all foods
infant, as described later).
accepted as part of an individuals dietary
2. Edible by animals, but not by me: These domain.
foods are items such as rodents in the
United States or corn in France (where it There are always exceptions to the ways in
is used primarily as a feed grain). Again, which foods are categorized. It is generally
the foods in this category vary widely by assumed, for instance, that poisonous plants and
animals will always be avoided. In Japan, how- Among the most universal
culture. of food taboos is cannibal-
ever, fugu (blowfish or globefish) is considered a
3. Edible by humans, but not by my kind: ism, although anthropolo-
delicacy despite the deadly toxin contained in the gists have discovered
These foods are recognized as acceptable liver, intestines, testes, and ovaries. These organs
in some societies, but not in ones own numerous examples of pre-
must be deftly removed by a certified chef as the historic human consump-
culture. Some East Africans are disgusted last step of cleaning (if they are accidentally dam- tion in European and New
by eggs, for instance, which are associated aged, the poison spreads rapidly through the World excavations.
with excrement.98 Some rural South flesh). Eating the fish supposedly provides a
Africans who consider termites a delicacy tingle in the mouth prized by the Japanese. Insects, such as termites
are repulsed by the idea of eating scorpi- Several people die each year from fugu poisoning. and ants, provide 10 per-
ons, a specialty enjoyed by some cent of the protein con-
Chinese.70 Examples of foods unaccept- sumed worldwide.
able in the United States but acceptable CONSUMER FOOD CHOICE MODEL
elsewhere include giant snails (Africa), An individuals dietary domain is established
dog meat (Asia), iguana (the Caribbean), before he or she sets foot in a restaurant, deli, or
horse meat or blood sausage (Europe), supermarket. The consumer food choice model
and bear paw (Mongolia). (Figure 1.4) explains the factors influencing indi-
4. Edible by humans, but not by me: These vidual decisions within that predetermined food
foods include all those accepted by a sphere.30
persons cultural group but not by the Food selection is primarily motivated by taste.
individual, due to factors such as prefer- Taste is defined broadly by the sensory properties
ence (e.g., tripe, liver, raw oysters), detectable in foods: color, aroma, flavor, and tex-
expense, or health reasons (a low-sodium ture. Humans anticipate a specific food will have
or low-cholesterol diet may eliminate certain sensory characteristics; deviations can
14 FOOD AND CULTURE
Humans can detect approxi- signal that the item is poisonous or spoiled. Many This preference declines in later years, reducing
mately 10,000 different of these expectations are developed through early their significance in food choice; however, it has
odors, though genetics may exposure to culturally determined foods. For been suggested that there are familial differences
determine which odors can example, most core foods are pale white, cream, in preference for high-energy foods associated
be detected. For example,
or brown in color; however, some West Africans with the pleasant taste of sugar and fat lasting into
nearly 50 percent of people
prefer the bright orange of sweet potatoes, and adulthood.66
cannot smell androstenone
(also called boar phero- Pacific Islanders consider lavender appropriate for The opposite is true for bitterness, which is
mone) which is found in the taro root preparation called poi. Should the associated with toxic compounds found in some
bacon, truffles, celery, core item be an unanticipated color, such as green foods and is strongly disliked by most children.
parsnips, boar saliva, and or blue, it may be rejected. Similarly, each food has The ability to detect bitterness decreases with age,
many human secretions; a predictable smell. Aromas that are pleasurable however, and many adults consume foods with
however, researchers have may trigger salivation, while those considered dis- otherwise unpleasant sulfides and tannins,
found people can be taught gusting, such as the odor of rotting meat, can trig- including broccoli and coffee. There are some
to perceive it through daily ger an immediate gag reflex in some people. who remain especially sensitive to certain bitter
sniffing.82 Again, which odors are agreeable and which are compounds, affecting their other preferences as
disagreeable are due, in part, to which foods are well; they tend to dislike sweet foods and opt for
Though the physiological
culturally acceptable: Strong-smelling fermented bland over spicy items. Sour alone is rarely well-
response to disgust, nose
meat products are esteemed by some Inuit liked, but is enjoyed when combined with other
wrinkling, retraction of the
lips, gaping, gagging, and (muktuk) and some rural Filipinos (itog). Strong- flavors, especially sweet. It has been suggested
even nausea, seems instinc- smelling cheese (which is nothing more than the that a preference for the sweet-sour taste
tual, it is actually a cogni- controlled rot of milk) appeals to many Europeans, prompted human ancestors to seek fruit, an
tively sophisticated feeling but even mild cheddar may evoke distaste by excellent source of vitamins and minerals.4, 5, 31
that does not develop in many Asians and Latinos. Appropriate texture is Unlike the tastes of sweet, bitter, and sour,
children until between the likewise predictable. Ranging from soft and which are actively liked or disliked by infants,
ages of four and seven years smooth to tough and coarse, each food has its babies generally are indifferent to salt until about
old. Which items are disgust- expected consistency. Novel textures may be four months of age. Similar to sugar, children
ing in a culture is learned disliked: Some Americans object to gelatinous bits prefer higher concentrations of salt than do
from parents and peers.92
in liquid, as experienced in tapioca pudding or adults. Their preference for salt is shaped by the
bubble tea, yet these foods are popular in China. frequency of exposure to it after birth, and per-
Conversely, some Asians find the thick, sticky haps perinatally. One study found that children
consistency of mashed potatoes unappetizing. born to women who experienced moderate to
Okra, which has a mucilaginous texture, is well- severe morning sickness with dehydration had a
liked in the U.S. South but is considered too slimy stronger preference for salt than children born to
by many residents of other regions. mothers with no morning sickness; other
Some researchers contend The human tongue has receptors for the per- research suggests smaller babies (5.5 pounds or
that there is a fifth type of ception of sweet, sour, salty, and bitter. It is less) may be linked to salt preference.23
receptor on the tongue for hypothesized that food choice in all societies is Finally, taste is influenced by flavor principles,
umami (from the Japanese driven, in part, by an inborn preference for the the characteristic combinations of core and com-
for yummy). It is the taste taste of sugars and fats. These nutrients are plementary foods, as well as traditional grouping
associated with meats,
indicative of foods that are energy dense; a pre- of meal elements. These traditions are important
mushrooms, cheese, and
disposition for sweets and foods high in fat in providing an expected taste experience and
the flavor-enhancer mono-
sodium glutamate (MSG). ensures adequate calorie intake, an evolutionary satisfying a need for familiarity in food habits.
necessity for omnivores with a wide selection of Cost is often the second most important influ-
available foods. Sugars and fats are especially ence on food choice, and income level is the most
pleasurable flavor elements, associated with significant sociodemographic factor in predicting
palatability and satiety (including the texture selection. In cultures with a limited food supply
factor provided by fats, called mouthfeel). due to environmental conditions or in societies
Preferences for sweets (especially when com- where a large segment of the population is disad-
bined with fats) are found during infancy and vantaged, food price is more imperative than taste,
childhood and peak in early adolescence. One dictating nutritional sufficiency and well-being.
study found 45 percent of calories eaten by young The wealthier the society, the less disposable
people came from discretionary sugar and fat.74 income is spent on food, and, as income increases,
food choices change. Typically, the people of Convenience is a major concern in food pur- In addition to salt, other
poorer cultures survive on a diet dependent on chases, particularly by members of urbanized flavor preferences may be
grains or tubers and limited amounts of protein, societies. In some cultures everyones job is near passed on perinatally. A
including meat, poultry, fish, or dairy foods. Only home, and the whole family joins in a leisurely study of women who ate
garlic or a placebo before
a small variety of fresh fruits or vegetables may be midday lunch. In urbanized societies people often
amniocentesis found the
available. People with ample income consistently work far from home; therefore, lunch is eaten
odor of garlic in the amni-
include more meats, sweets, and fats in their diet (a with fellow employees. Instead of a large, home- otic fluid evident from the
trend seen in the global popularity of inexpensive cooked meal, employees may eat a quick fast- garlic-ingesting women.11
American fast foods), plus a wider assortment of food meal. Furthermore, family structure can
fruits and vegetables.32 In the United States the necessitate convenience. In the United States the In 1901, the average
affordability of foods has been found to limit the decreasing number of extended families (with American family spent
purchasing of health-promoting foods, and in help available from elder members) and increas- nearly half (45 percent) of
some cases even families with government subsi- ing number of households with single parents, their income on food. A cen-
dies find it difficult to meet nutritional needs.73 It along with couples who both work outside the tury later, that figure had
is estimated that in 2002, 3.8 million households home and unassociated adults living together all decreased to just 13 percent
had experienced hunger in the previous year.77 reduce the possibility that any adult in the house- of total income.119
One analysis found that making even small dietary hold has the time or energy to prepare meals.
Even when supermarkets
improvements, such as switching from white Studies show, for example, that the greater the
with a greater selection of
bread to whole wheat, regular ground beef to lean number of hours a woman works outside the
healthful foods are avail-
ground beef, and whole-fat cheese to low-fat home each day, the fewer the hours she spends in able, less-acculturated
cheese, can represent a 25 percent increase in the cooking. Only 40 percent of families report cook- immigrants may feel more
cost of food for a low-income family.17, 56 ing at least once a day, and in more than one- comfortable shopping at
The local dietary domain is also a factor in quarter of all homes cooking is done less than stores where their language
obtaining affordable food. A subsistence farmer once a day.36 Convenience spurs the increasing is spoken and ethnic ingre-
may have greater access to fresh foods than a number of take-out foods and meals purchased at dients are stocked.9
person with the same limited income living in a restaurants. For the first time in 2004, the share of
city. In urban areas supermarkets with a cheaper expenditures in the United States for food away The status of food can
selection of foods often choose to locate outside from home surpassed the share spent on food at change over time. In the
low-wealth neighborhoods and residents may homeover $500 billion annually at restaurants early years of the United
States, lobster was so plen-
only have access to high-priced convenience alone. Couples without children spend the most
tiful it piled up on beaches
stores or small, independently run groceries with per capita on meals away from home, though sin-
after storms, but colonists
limited selection.73 A study of foods recom- gles living alone eat out the most often: 42 percent considered it fit only for
mended for patients with diabetes found that only report going to a restaurant or getting take-out at Indians or starving settlers.
18 percent of groceries located in a largely least once a day.34, 75 Take-out foods include not
Hispanic lower-income neighborhood stocked all only items purchased from restaurants and fast- The percent of people
five items, compared to 58 percent of groceries food franchises, but also ready-made hot or cold dining inside restaurants is
located in an adjacent mostly white affluent dishes from supermarkets and warehouse stores. declining, and drive-
neighborhood; notably, a specific comparison of For families short on time but interested in fare through takeout is increas-
bodegas (Hispanic markets) in both neighbor- considered more nutritious and less expensive ing: the consumer never
hoods found that more stores located in the than what is typically found in restaurants or fast- even gets out of the car in
higher income area carried all five items.49 food franchises, easy-meal-prep is available. 24 percent of meals sold.104
Further, access to healthful restaurant dining Centers offering prepared ingredients ready for
varies. Studies suggest that predominantly assembly into dishes, such as lasagna, chicken
African-American and low-income neighbor- casserole, or Salisbury steak with gravy, allow
hoods have more fast-food restaurants per square meal preparation without shopping or cleanup.
mile than in white neighborhoods, with fewer Self-expression, the way in which we indicate
healthy options.13, 61 When nutritious food is who we are by behavior or activities, is important
available and affordable, the prestige of certain for some individuals in food selection, particu-
food items, such as lobster or prime beef, is often larly as a marker of cultural identity. Although the
linked to cost. Protein foods are most associated foods associated with ethnicity, religious affilia-
with status, though difficult-to-obtain items, tion, or regional association are predetermined
such as truffles, can also be pricey. through the dietary domain, it is worth noting
16 FOOD AND CULTURE
they also use more cornmeal and shortening.

Midwesterners buy more roasts, salad dressing,
margarine, and almost 50 percent purchase more
potato chips than average. Carbonated drinks are
also common in the Midwest. In the West fresh
fruits and vegetables, condiments and seasonings,
and cheese are popular, and people consume more
than twice the national average of whole wheat
Image not available due to copyright restrictions bread. Coffee is especially favored.53, 76
Self-identity can be another factor in food
selection, as discussed previously. An environ-
mentalist may be a vegetarian who prefers
organic, locally grown produce, while a gourmet
or foodie may patronize small markets in ethnic
neighborhoods throughout a city searching for
unusual ingredients. Advertising has been
directly related to self-expression, especially self-
identity. Research indicates that in blind taste
tests people often have difficulty discriminating
that every time a person makes a food choice he between different brands of the same food item.
or she may choose to follow or ignore convention. Consumer loyalty to a particular brand is
Ethnic identity may be immediate, as in persons believed more related to the sensual and emo-
who have recently arrived in the United States; or tional appeal of the name and packaging.60 For
it may be remote, a distant heritage modified or example, similar-tasting flake cereals such as
lost over the generations through acculturation. Wheaties (breakfast of champions), Special K,
An individual who has just immigrated to the and Total target sports enthusiasts, dieters, and
United States from Japan, for instance, is more the health-conscious, respectively.
likely to prefer traditional Japanese cuisine than is Advertising also promises food-provided
a third- or fourth-generation Japanese American. pleasure, appealing to the desire of consumers to
Religious beliefs are similar to ethnic identity be seen as popular, fun-loving, and trendy.
in that they may have a great impact on individ- Exploitation of sex to sell hamburgers and beer is
ual food habits or an insignificant influence common, as are suggestions that eating a choco-
depending on religious affiliation and degree of late or drinking a soft drink will add zest to
adherence. Many Christian denominations have living. A study of television food ads targeting
no food restrictions, but some, such as the children found that 75 percent were associated
Seventh-Day Adventists, have strict guidelines with good times, 43 percent with being cool
about what church members may eat. Judaism and hip, and 43 percent with feelings of happi-
requires that only certain foods be consumed in ness.38,115 Such advertising is a reflection of a
certain combinations, yet most Jews in the United larger trend: food as entertainment, the vicarious
Meals and snacks prepared States do not follow these rules strictly (see enjoyment of eating through reading about it or
at home are lower in calo- Chapter 4). watching food-related programs on television,
ries per eating occasion, A person may also choose foods associated also called food porn.78 In the United States
and lower in total fat, satu- with a specific region. In the United States the nearly 150 food/wine magazines are published
rated fat, cholesterol, and food habits of New England differ from those of monthly, almost 500 million food/wine books
salt per calorie than foods the Midwest, the South, and the West, and local are sold annually, and numerous network cook-
prepared away from home. ing/dining shows air daily. The impact of this
specialties such as Pennsylvania Dutch, Cajun,
The Monster Thick Burger at
and Tex-Mex may influence the cooking of all res- media on food choice is as yet unknown. Food
Carls Jr./Hardees has 1,420
calories, nearly a full days idents in those areas. Generally speaking, people entertainment may popularize certain ingredi-
requirement, and the in the Northeast purchase more lunch meats, ents, such as arugula or mangoes, or cuisines,
fastest growing items at all breads, cakes, and butter, and drink more tea than such as Spanish fare or updated traditional
restaurants are fried the national average. In the South, people favor American dishes like kicked-up meatloaf and
chicken dishes.46 sausages, bacon, biscuits, and beans and peas; garlic mashed potatoes. They may also set such a
high standard of preparation and presentation the total amount of food consumed per capita One study showed that self-
that some home cooks feel inadequate, choosing (because elders eat smaller amounts of food).12 identified gourmets par-
to dine out or select prepackaged items instead of Gender has also been found to influence ticipating in online forums
making meals from scratch. eating habits. In some cultures women are pro- were less interested in what
was eaten at a meal than in
Physical and spiritual well-being is another hibited from eating specific foods or are expected
touting their food knowl-
food choice consideration for some individuals. to serve the largest portions and best pieces of
edge superiority.106
Physiological characteristics, including age, food to the men. In other societies food prefer-
gender, body image, and state of health, often ence is related to gender. Some people in the Another aspect of food as
impact food habits. Preferences and the ability to United States consider steak to be a masculine entertainment is competi-
eat and digest foods vary throughout the life food and salad to be a feminine one; or that men tive eating as televised
cycle. Pregnant and lactating women commonly drink beer and women drink white wine. sport. Elite eaters can make
eat differently than other adults. In the United Research has shown that gender differences more than $50,000 a year
States women are urged to consume more food affect how the brain processes satiation in winnings, with records
when they are pregnant, especially dairy prod- responses to chocolate, suggesting that men and such as 46 dozen oysters in
ucts. They are also believed to crave unusual women may vary in the physiological regulation 10 minutes, 8.4 pounds of
food combinations, such as pickles and ice of food intakeperhaps accounting for some baked beans in 2 minutes,
47 seconds, and 11 pounds
cream. They may avoid certain foods, such as food preferences.105
of cheesecake in
strawberries, because they are believed to cause A persons state of health also has an impact on
9 minutes.123
red birthmarks. what is eaten. A chronic condition such as lactose
In some societies with subsistence economies, intolerance or a disease such as diabetes requires Old age is a cultural con-
pregnant women may be allowed to eat more an individual to restrict or omit certain foods. An cept; among some
meat than other family members; in others, preg- individual who is sick may not be hungry or may American Indians and
nant women avoid beef because it is feared that find it difficult to eat. Even minor illnesses may Southeast Asians, individu-
the cows cloven hoof may cause a cleft palate in result in dietary changes, such as drinking ginger als become elders in their
the infant. Most cultures also have rules regarding ale for an upset stomach or hot tea for a cold. 40s.125
which foods are appropriate for infants; milk is Those who are trying to lose weight may restrict
generally considered wholesome, and sometimes foods to only a few items, such as grapefruit or In the United States men
any liquid resembling milk, such as nut milk, is cabbage soup, or to a certain category of foods, are infrequently involved in
also believed to be nourishing. such as those low in fat or carbohydrates. Those meal planning (23 percent),
shopping (36 percent), or
Puberty is a time for special food rites in who are exceptionally fit, such as students or pro-
preparation (27 percent) of
many cultures. In America adolescents are partic- fessional athletes, may practice other food habits,
food. Men who are heads of
ularly susceptible to advertising and peer pres- including carbohydrate loading or consumption households in small fami-
sure. They tend to eat quite differently from of high-protein bars. In other cultures specific lies, those whose wives
children and adults, rejecting those foods typi- foods are often credited with health-promoting work fulltime, and those
cally served at home and consuming more fast qualities, such as ginseng in Asia or chicken soup who are younger are more
foods and soft drinks. A rapid rate of growth at in Eastern Europe. Corn in American Indian cul- likely to be involved in
this time also affects the amount of food that ture may be selected to improve strength or stam- these activities.47
teenagers consume. One survey found teenage ina. Well-being is not limited to physiological
boys down an average of five meals per day, and conditions. Spiritual health is equally dependent Lactose intolerance, the
teenage girls eat four meals.22, 40 on diet in some cultures where the body and inability to digest the milk
The opposite is true of older adults. As metab- mind are considered one entity. A balance of hot sugar lactose, develops
as a person matures. It
olism slows, caloric needs decrease. In addition, and cold or yin and yang foods may be consumed
is believed that only
they may develop a reduced tolerance for fatty to avoid physical or mental illness. (See Chapter 2,
15 percent of the adult
foods or highly spiced items. Elders often face Traditional Health Beliefs and Practices.) population in the world
other eating problems related to age, such as the The final factor in consumer food choice is (those of northern
inability to chew certain foods or a disinterest in variety. The omnivores paradox states that European heritage) can
cooking and dining alone. It is predicted that the humans are motivated psychologically to try new drink milk without some
shift toward an older population in the next two foods. Further, the desire for new flavors may digestive discomfort.
decades will result in both the types of foods pur- also have a physiological basis. Sensory-specific
chased (an increase in fruits, vegetables, fish, and satiety (unrelated to actually ingesting and digest-
pork because elders consume these items more ing food) results when the pleasure from a cer-
often than younger people do) and reductions in tain food flavor decreases after a minute or two of
18 FOOD AND CULTURE
Research on sensory-specific consumption. Introduction of a new food, or even the desire to try new foods. A person may be
satiety suggests people eat the same food with new added seasoning, arouses aware of nutrition messages encouraging reduc-
less food when consuming a the enjoyment in eating again, encouraging the tion of sugars and fats in the diet, as seen in the
monotonous meal, and may search for new flavor stimuli.88 In addition, Dietary Guidelines for Americans 2005, but this
overeat and gain weight
hunger increases the probability that a new food nutrition knowledge is often overridden by the
when abundant variety is
will be liked.7, 11 Marketers take advantage of the primary factor in consumer food choice: taste.
available.88
innate human drive for diet diversity by continual Furthermore, influences on choice may
College education is associ- reformulation and repackaging of processed food change for each person as she or he matures.
ated with fruit consumption products to attract consumers. Food selection in infants (within the dietary
among blacks and veg- Interest in the foods of other regions or cul- domain of available foods provided by parents) is
etable consumption among tures is associated the desire for new taste experi- based almost exclusively on taste factors, with a
Hispanics and whites.26 ences, and also with increased income and strong resistance to new items. Children become
educational attainment. Wealth permits experi- more interested in self-expression as they grow
The Japanese say that for mentation and education can increase wealth. and become sensitive to family and peer pressure.
every new food a person Nutritional knowledge, also affected by educa- Young adults continue to be concerned with taste
tries, life is extended tional attainment, includes the health-promoting and self-expression, to which cost and conven-
seventy-five days. benefits of dietary diversity. ience are typically added, especially in families
One study reported that college students were with children. In middle age, increased income
more likely to try a new fruit, vegetable, or grain may mitigate cost issues; and in old age, health
product if information on the nutritional benefits problems may become a more significant factor
were provided.63 Some researchers have found in food choice than even taste.
that attitudes about the healthfulness of certain
foods is important in food selection, and parents
may purchase foods they consider healthy for
their children even if they would not select those Nutrition and Food
items for themselves. The nutrition knowledge of
the person who plans meals in the home impacts Habits
food selection for all household members.120 It
has been suggested, however, that choices are
THE NEED FOR CULTURAL COMPETENCY
more often influenced by beliefs regarding nutri- In recent years, the significance of culturally
tional quality than the actual nutritional value or based food habits on health and diet has been rec-
health consequences of a food.1, 50, 88, 100 Whether ognized, and the need for intercultural competen-
accurate or misinformed, nutritional knowledge cies in the areas of nutrition research, assessment,
does not always translate into knowledge-based counseling, and education has been cited. Health
food choice: a poll found that six in every ten professionals require skills in discovering rele-
consumers check nutrition labels frequently for vant cultural patterns and cultural changes
calories and fat content, but nearly half of those among the clients and groups they serve, and
who read the information still choose items for need to incorporate a knowledge of these patterns
taste even when they determine the item is bad into interventions (p. 503).117 Data accuracy is
for them.8, 120, 124 dependent on respect for different values and a
What is evident after exploring the consumer trusting relationship between respondent and
food choice model is that many influences on researcher; effective intercultural communication
individual food habits are interrelated. An inborn is a function of understanding and accepting a
preference for foods high in sugar, fat, and salt clients perspective and life experience.17, 39 New
can encourage the consumption of items specifi- standards of nutrition care issued by professional
cally processed to enhance those taste experi- accreditation organizations reflect similar guide-
ences. Such foods are often convenient, and items lines.2, 28 Looking toward the future, it has been
such as soft drinks and sandwich meats may be proposed that health care professionals should
less costly than fruit juice or fresh pork or beef move beyond the theoretical concepts founda-
(though certainly some processed items are tional to cultural sensitivity and relevance to the
more expensive than homemade equivalents). practicalities of cultural competency. Language
Advertisers exploit the need for convenience and skills, managerial expertise, and leadership are
needed to guide diverse communities in healthy

lifestyle changes, to serve hard-to-reach popula-
tions, and to effect change in the health care
system.15
Total
Diversity in the U.S. Population Asians
The growing need for cultural competency is evi- 1 Blacks

Hispanics
dent in current demographic trends. Since the
Non-Hispanic Whites
1970s, the United States has moved increasingly
All Other Races
toward a cultural plurality, where no single ethnic
group is a majority. In 1980 only Hawaii and the
District of Columbia had plurality populations.
Since that time, California, New Mexico, and Texas
0 50 100 150 200 250
have joined the list. Pluralities also exist in several
metropolitan area populations, including Chicago, Figure 1.5
Houston, Los Angeles, Miami, New York City, and Projected U.S. population
Philadelphia. Other urban areas such as Dallas This profile of the general U.S. population is growth, by percentage,
and Las Vegas are approaching plurality popula- notably different than that for health care profes- 20002050.
tion status, with less than the national average of sionals, who are mostly white. Among registered Source: U.S. Census Bureau. 2004.
whites. Nationwide, demographers estimate that dietitians, 85 percent were white in 2004. Though U.S. Interim Projections by Age,
non-Hispanic whites will become less than 50 Asians/Pacific Islanders were well represented at Sex, Race, and Hispanic Origin
percent of the total population by the year 2050. 5 percent, African Americans and Hispanics were http://www.census.gov/
This change can be seen in the dramatic dif- significantly under represented at 5 percent and 3 ipc/www/usinterimproj/
ference in projected ethnic group growth from percent, respectively.3 Researchers note that
2000 to 2050 (see Figure 1.5). Although the total clients from minority populations prefer to
population is expected to increase by about 49 receive health care in settings with minority
percent during that period, over 90 percent of the health care providers; that minority health care
growth will be in minority populations. Gains for providers are more likely to work in underserved
the Asian population are expected at more than areas; and that people from minority groups are
four times the national average, and more than more likely to participate in research studies Respect for diverse view-
three times the national average for the Hispanic when the investigator is from the same ethnic points and individual differ-
population. The black population is expected to background.80 ences is an American
grow by 71 percent, and the group with the Dietetic Association value.
largest projected increase (217 percent) is all Diversity in the Canadian Population
other races, which includes the smaller popula- The Canadian census is conducted differently As of 2004, only seven
tions of American Indians, Native Alaskans, than the U.S. count. Canadians in 2001 were states had populations that
were less than 10 percent
Native Hawaiians, and other Pacific Islanders, as asked to list their ethnicity in an open-ended
minority: Iowa, Maine, New
well as the quickly growing numbers of people of question, and multiple responses listing one or Hampshire, North Dakota,
two or more races. more ethnicities were accepted. This has provided Vermont, and West Virginia.
In actual numbers, Hispanics surpassed a broader picture of ancestry, particularly because
African Americans as the largest U.S. minority single responses and multiple responses were The population of the
population in 2002, representing 14.5 percent of reported separately. For example, of the over 1.3 United States surpassed 300
the U.S. population, compared to 12.8 percent for million Aboriginals (including Native American million in 2006, adding a
blacks. Asians are the third largest minority at 3.6 Indians, Mtispeople of mixed Aboriginal and new person every 11 sec-
percent of the total U.S. population. Much smaller non-Aboriginal heritageand Inuit), 565,040 onds: A baby is born every 8
numbers of Pacific Islanders and Native listed this ethnicity as a single response and seconds, someone dies
Americans were reported, 0.1 percent and 0.9 800,020 listed it as part of a multiple response. A every 13, seconds and
percent, respectively. Notably, many American separate question inquired if the census respon- someone immigrates to the
country every 30 seconds.
ethnic populations have an average age signifi- dent was a member of a visible minority, defined
cantly lower than that of the total population. by the Employment Equity Act as persons, other
Predicted demographic changes are often seen than Aboriginal peoples, who are non-Caucasian
first among children and young adults. in race or non-white in color. The act specifically
20 FOOD AND CULTURE
lists Chinese, South Asians (i.e., Asian Indians, pickled food intake associated with stomach
Pakistanis, Sri Lankans), blacks, Arabs/West cancer or increased availability of fruits and
Asians, Filipinos, Latin Americans, Japanese, vegetables, can be beneficial. Better educational
Koreans, and Pacific Islanders. Immigration opportunities and health care services can also
growth in Canada has dramatically exceeded promote health.
overall population growth in recent years: immi- The specific impact of ethnicity on health
grants in 2001 represented over 18 percent of the status is not well delineated through the limited
total population, and the nation is second only to data available. Researchers caution that using
Australia (22 percent) in proportion of foreign- race or ethnicity in research can be misleading.58
born citizens. Of greater importance, immigra- For example, many studies do not explain how
tion patterns have shifted during the past three participants are categorized. Individuals may
decades. Most recent immigrants are visible self-select differently than investigators, and self-
minorities, with almost 60 percent from Asia and identity may change over time. Even official
20 percent from the Caribbean. Chinese, South classifications may vary. In the United States the
Asian, and black groups are the three largest vis- Office of Management and Budget is responsible
ible minority populations, though the fastest for defining the categories used in all government
growing populations are Arabs/West Asians and work, including the Census. In 1997 the standards
Koreans. Nearly all (94 percent) recent immi- were revised to include five classifications for
grants to Canada have settled in urban areas, par- race: American Indian or Native American, Asian,
ticularly Toronto and Vancouver (largely Chinese Black or African American, Native Hawaiian or
and South Asians), and Montreal (mostly blacks other Pacific Islander, and White. Prior to the
and Arabs). Other urban areas with dispropor- revision, there were only four race groupings
tionately large recent immigrant populations because Asians were combined with Pacific
include Calgary, Edmonton, and Ottawa-Hull. Islanders. Additionally, the two categories for
ethnicity were expanded in 1997 (ethnic members
Ethnicity and Health may be of any race): Hispanic or Latino, and Not
Health is not enjoyed equally by all in the United Hispanic or Latino. These changes from earlier
States. Disparities in mortality rates, chronic definitions can lead to difficulties in interpreting
disease incidence, and access to care are preva- data trends. Further, the factor of race and ethnicity
lent among many American ethnic groups is not sufficiently separated from socioeconomic
(Table 1.2). Poor health status in the United status in many studies, calling into question
States is also associated with poverty (see whether a stated finding is due to race and ethnicity
Cultural ControversyDoes Hunger Cause or whether it is due to income, occupation, or
Obesity? later in this chapter), low educational educational status.
attainment, and immigrant status: Immigrant Nevertheless, race and ethnicity data sug-
health has been found initially better than sim- gesting risks and disparities may be useful to
ilar U.S.-born populations in some research, health care providers as long as the caveats
and is shown to decline with length of stay.43, 102 above are considered and care is taken to avoid
Acculturation to the majority culture is stereotyping a patient by group membership.
believed to be a significant factor in health inde- For example, if age-adjusted mortality rates for
pendent of socioeconomic status. First noted in the United States (2003) are examined, it
heart disease rates, modernization has also been appears that Hispanics are the healthiest popu-
linked to increased blood cholesterol levels, lation with the lowest number of deaths
increased blood pressure levels, obesity, type 2 (thought to be underestimated due to inconsis-
diabetes, and some cancer.43, 101, 102 The stress of tencies in death certificate reporting practices)
adaptation to the pressures of a fast-paced society followed by Asians/Pacific Islanders, Native
is believed to be significant.110 Hereditary predis- Americans/Alaska Natives, Hispanics, whites,
position to developing certain health conditions and African Americans.51 However, these fig-
may also play a role. It is important to note, how- ures obscure significant differences in the preva-
ever, that acculturation is difficult to define accu- lence and progression of certain diseases among
rately and is not an inherent risk factor in itself.79 groups and the diversity of health status within
Some changes in diet, such as a reduction in each broad ethnic designation.
Protein Foods
Protein foods include a wide variety of meat products, dairy
foods, fish, and shellfish, as well as numerous legumes.
Royalty-Free PhotoDisc/Getty Images
Pat OyHara/CORBIS
A. Sausages are eaten in nearly every culture. They come in D. It is estimated that nearly 30 percent of the population
hundreds of types and make use of miscellaneous cuts and worldwide is dependent on fish, such as this dried salmon.
leftovers, such as blood (dark red links).
Royalty-Free Jupiter Images/www.comstock.com

2002 Wisconsin Department of Tourism
B. Dairy products, including yogurt and cheese, are available in E. Legumes, such as beans, peas,
even more varieties. Yet many cultural groups consume only lim- and lentils, are eaten daily in many
ited amounts of milk or other dairy foods. cultures. S. Meltzer/PhotoLink/Getty Images
Courtesy of United Soybean Board
C. Soy products, such as soy milk and bean F. Nuts are an extra source of protein in some regions,
curd (known as tofu or tobu) are especially including many European, Middle Eastern, Indian and tradi-
significant in the diet of many Asians. tional Native American cuisines.
Vegetables
Vegetables are featured in the cuisines of
almost all cultures.
Royalty-Free PhotoDisc/Getty Images
A. Greens, such as this mizuna and bok choy, are especially

common.
Jack Star/PhotoLink/Getty Images

B. Root, tubers and bulb vegetables, such as
beets, carrtos (above), celeriac, gobo, Jerusalem
artichokes, onion, radishes, turnips, and water
chestnuts, are prevalent in many regions.
top, Royalty-Free PhotoDisc/Getty Images; middle, R.F. Images; bottom, Cole Group/Getty Images
Dan Lamont/CORBIS
C. Mushrooms, fungi that are eaten as veg-

etables, are usually edible, but can be
highly toxic. Types include shiitake (large,
D. Examples of vegetables grown on bushes or vines include eggplants, dark brown cap), oyster mushrooms
which come in many shapes (from round to oblong, to long-thin) and (yellow, funnel-shaped), lobster mush-
colors (white, striped, green, orange, purple); chile peppers, which vary in rooms (orange, knobby), and black cloud
heat from mild to mouth-searing; and numerous types of tomatoes. ears (dark, curly fungus).
Table 1.2 Health Disparities: Prevalence of Selected Risk Factors and Chronic Diseases among Minority Populations in the
United States
Men
American Indian Black Hispanic Asian
(n = 751) (n = 3,218) (n = 1,535) (n = 1,655)
Risk factors/ % (95% CI*) % (95% CI) % (95% CI) % (95% CI)
chronic diseases
Obesity 40.1 (36.2-44.0) 26.5 (24.4-28.6) 26.6 (24.1-29.2) 2.7 (1.7-4.1)
Cardiovascular 16.4 (13.6-19.7) 9.9 (8.7-11.3) 7.4 (6.0-9.1) 7.5 (5.6-10.1)
diseases
Hypertension 38.5 (34.6-42.5) 34.5 (32.3-36.7) 20.5 (18.2-23.0) 16.1 (13.7-18.9)
High cholesterol 37.1 (32.5-41.9) 31.4 (29.0-33.9) 35.7 (31.9-39.7) 31.4 (27.6-35.6)
Diabetes 16.8 (14.1-19.9) 11.6 (10.2-13.1) 7.1 (6.0-8.5) 4.8 (3.6-6.4)
No. risk factors/
chronic diseases
0 11.7 (8.8-15.5) 24.8 (22.5-27.3) 25.4 (21.8-29.4) 36.3 (32.3-40.5)
1 26.1 (22.2-30.4) 30.5 (27.9-33.2) 34.6 (30.7-38.8) 37.1 (33.1-41.4)
2 26.4 (22.4-30.9) 22.9 (20.7-25.3) 20.0 (17.0-23.4) 19.3 (15.6-23.8)
3 35.7 (31.2-40.5) 21.7 (19.7-24.0) 19.9 (16.9-23.3) 7.2 (5.6-9.2)
Women
American Indian Black Hispanic Asian
(n = 1,040) (n = 7,735) (n = 2,722) (n = 2,549)
Risk factors/ % (95% CI*) % (95% CI) % (95% CI) % (95% CI)
chronic diseases
Obesity 37.7 (34.4-41.1) 37.6 (36.1-39.2) 28.4 (26.4-30.6) 3.1 (2.3-4.1)
Cardiovascular 13.0 (11.0-15.4) 9.4 (8.5-10.3) 5.6 (4.8-6.6) 5.5 (4.4-6.9)
diseases
Hypertension 36.8 (33.7-40.1) 40.9 (39.4-42.5) 22.4 (20.7-24.3) 17.6 (15.6-19.7)
High cholesterol 33.5 (30.0-37.2) 34.2 (32.5-35.8) 28.9 (26.5-31.5) 23.3 (20.5-26.3)
Diabetes 19.7 (17.2-22.4) 14.5 (13.4-15.7) 8.4 (7.4-9.5) 4.7 (3.8-5.8)
No. risk factors/
chronic diseases
0 17.2 (14.3-20.4) 22.7 (21.1-24.4) 35.9 (32.9-38.9) 57.8 (54.5-60.9)
1 27.6 (24.3-31.2) 28.4 (26.7-30.1) 30.2 (27.6-33.1) 25.8 (22.7-29.2)
2 21.9 (18.9-25.2) 22.2 (20.8-23.7) 18.4 (16.2-20.7) 11.6 (9.6-14.0)
3 33.3 (29.8-37.1) 26.7 (25.1-28.3) 15.5 (13.7-17.5) 4.8 (3.6-6.3)
* Confidence interval.
Includes obesity, current smoking, cardiovascular diseases, hypertension, high cholesterol, and diabetes.
Source: Centers for Disease Control and Prevention (2003). Health Status of American Indians Comparison with Other Racial/Ethnic Populations
Selected States, 2001-2002. Morbidity and Mortality Weekly, 52 (47): 11481152.
22 FOOD AND CULTURE
One study suggests that Studies on type 2 diabetes, for example, indi- percent lower than those in African Americans.
the mortality risk among cate that every other ethnicity (as grouped in the Hispanics in Florida (mostly Cubans) showed
African Americans is higher preceding paragraph) has increased risk above substantially lower rates of kidney failure due to
than for whites even after those of the white population: 1.5 times higher for diabetes than did Puerto Ricans or Hispanics in
adjusting for socioeconomic
Hispanics, 1.52.0 times higher for African the Southwest. This study was noteworthy for its
factors.109
Americans, approximately two times higher for investigation of ethnic and racial as well as
Asians/Pacific Islanders (when Asians are sepa- intraethnic differences, and indicates the com-
A survey of clients listed as
Vietnamese in a population- rated from Pacific Islanders, their risk, when plexity of ethnicity and disease.21
based cancer registry adjusted for body mass index [BMI], is 1.6 times The variable role of ethnicity is also seen in U.S.
found that approximately higher than whites; for Pacific Islanders, the risk infant mortality trends. Although dramatic
20 percent were misclassi- is 3.04.0 times that for whites), and 2.05.0 declines have occurred since 1950, these gains are
fied, producing significant times higher for Native Americans/Alaska not evenly distributed throughout the population.
errors in incidence rate Natives.18,35 Projected rates for 2020 show an even The gap between white and black infant deaths
calculations.114 higher disparity: the diagnosis for whites is has increased; the mortality rate for African
expected to increase 27 percent, while the increase Americans (13.6 percent) is double than for
for African Americans may be as high as 50 per- whites (6.8 percent). Much of the discrepancy is
cent, and for Latinos, 107 percent.24 Closer inspec- attributed to disorders resulting from prematurity
tion reveals considerable variation within these and low birth weight. Variation within broad
broader ethnic designations as well. In Hawaii ethnic designations is also demonstrated. Chinese
native Hawaiians have more than twice the dia- infant deaths are 30 percent lower than for white
betes prevalence rate of the Korean and Filipino infants. Japanese, Filipino, Cuban, Central and
populations and more than three times that of the South American, and Mexican mortality rates are
Chinese population; Japanese, Asian Indians, and also significantly lower than for whites; while
Samoans have all demonstrated rapidly increasing Puerto Ricans, native Hawaiians, and American
rates after moving to the United States compared Indians have mortality rates 26 percent, 33 per-
to other Asian/Pacific Islander groups. Nowhere cent, and 55 percent higher than for whites,
is the difference as great as in Native respectively. Overall, infant deaths in the United
Americans/Alaska Natives, where the prevalence States remain higher than those found in other
rate for diabetes ranges from 1.9 percent in Alaska developed nations, probably due to the excess
Inuit (older than age twenty) to approximately 70 mortality found among some ethnic groups.19, 103
percent for Pima Indians in the Southwest (older Furthermore, a growing number of studies
than age forty-five), who have the highest rates of have documented inequalities in health care
diabetes in the world. Disparities in morbidity and treatment for certain ethnic groups. Preventive
mortality from type 2 diabetes also exist, though it care such as immunizations and cholesterol
is noteworthy that much of this difference is elim- screenings lag behind the U.S. average, and clin-
inated when patients achieve the same degrees of ical care disparities abound. For example,
glycemic control. African Americans are much less likely than
Research comparing both ethnic and racial whites to have renal transplants for kidney dis-
factors in the development of kidney failure ease or coronary artery bypass surgery for heart
among Hispanic men found that in Hispanic disease, but they are significantly more likely
whites, 45 percent of end-stage renal disease was than whites to have lower limbs amputated due
attributed to diabetes, while in non-Hispanic to diabetic neuropathy and gastrostomy tubes
whites only 28 percent was due to diabetes, and used on elder patients. Further, though it is
nearly as many cases were due to hypertension believed that health care access and low health
(27 percent) and other causes. Among Hispanic insurance rates may be a factor in these differ-
blacks, 40 percent of renal failure was attributed ences, studies show even insured new immi-
to diabetes and 26 percent attributed to hyperten- grants and ethnic patients with comprehensive
sion. Nearly the reverse was true for non- government benefits often receive unequal treat-
Hispanic blacks, 40 percent of whose renal failure ment.44, 45, 64, 67, 72 Some researchers are con-
was due to hypertension and 25 percent due to cerned that managed competition in health care
diabetes. Hypertension rates among Hispanics will exacerbate these differences because of cap-
approximate those in whites, which are nearly 50 itated payment programs, reduced access due to
CULTURAL CONTROVERSYDoes Hunger Cause Obesity?
O ne of the most perplexing

problems in nutrition educa-
tion and policy is why
socioeconomic status is associated with
overweight and obesity in the United
of overweight and obesity between ethnic
groups.25, 33
Researchers suggest that food insecu-
rity in households that do not have enough
to eat sometimes or often, or do not have
adults, obesity in children has been found
to be associated with lower household
incomes, lower education levels of parents,
and consumption of high-energy density
foods; and family meals, which improve
States. Rates of overweight, defined as a enough of preferred foods to eat, may lead quality of dietary intake in adolescents
body mass index (BMI)* over 25 but below to overweight and obesity through over- (including reductions in snacking), are sig-
30, and obesity, defined as a BMI over 30, consumption of inexpensive, less nutritious nificantly more frequent in higher-income
have doubled in Americans since the late foods high in fats or sugar. First postulated families.59, 69 Biological factors, such as the
1970s. Risk for overweight and obesity is by a physician in 1995, it was observed taste preference for sweets and fats; psy-
highest in the persons with the lowest that in the cycle of food assistance, where chological factors, including the comfort
incomes and education levels regardless of monthly allocations run out and food provided in such items; and an obesigenic
ethnic heritage, and the risk declines paral- shortages occur episodically, a person may environment that promotes consumption
lel to socioeconomic improvement in most compensate by eating larger portions of of energy-dense items in super-size quan-
studies. Additionally, overweight and obe- higher-calorie foods when available.27 tities may be other variables. Further, it is
sity rates are higher in all other ethnic Further research has strengthened the uncertain as yet whether hunger and food
groups (except for Asians) than in whites. hypothesis, finding that high-energy den- insecurity drive overweight and obesity, or
Since poverty rates are also higher for all sity diets (those that include more fast whether overweight and obesity cause
other ethnic groups (in some cases more foods, snacks, and desserts than fruits, veg- hunger and food insecurity.97
than three times the rate for whites), it etables, and lean protein) are cheaper,
may be that socioeconomic status con- more palatable, and more filling than * Weight in kilograms divided by the square of
tributes to some of the disparity in the risk healthier choices.33, 56 Like obesity in height in meters.
consolidation of services, and protocols (usually obtaining a diet record has cultural implications. The highest percentage of
standardized for white patients) dictated by third- (See Chapter 3, Intercultural Communication.) persons without health care
party payors that disallow variability appropri- Questions such as what was eaten at breakfast, insurance are noncitizens
ate for different populations.42, 94 lunch, and dinner not only ignore other daily (over 40 percent in 2004).
As these examples suggest, ethnicity can be a meal patterns but also make assumptions about Other groups at risk are
significant factor in the development of certain what constitutes a meal. Snacks and the con- foreign-born, low-income,
and ethnic group members.
disease conditions, the way they are experienced, sumption of food not considered a meal may be
and how they are ultimately resolved. (See overlooked. Common difficulties in data collec-
Chapter 2 for further information.) The explosive tion, such as under- or overreporting food
growth of ethnic groups in the U.S. population intake, may also be culturally related to the per-
since the mid-1980s, the rapid movement toward ceived status of an item, for example, or portion
cultural pluralism, and the undeniable connec- size estimates may be an unknown concept,
tion between heritage and health evidence the complicated by the practice of sharing food from
urgent need for cultural competency among other family members plates. Terminology can
American health care providers. be particularly troublesome. Words in one cul-
ture may have different meanings in another
culture or even among ethnic groups within a
INTERCULTURAL NUTRITION culture. Nutritional jargon, such as fiber, may
The study of food habits has specific applica- be unknown or vaguely defined.17
tions in determining nutritional status and Stereotyping is another pitfall in culturally
implementing dietary change. Even the act of sensitive nutrition applications, resulting from
24 FOOD AND CULTURE
Acculturation is so complex the overestimation of the association between calcium in this case might be the daily use of fer-
that it has been difficult to group membership and individual behavior. mented fish sauces or broths rich in minerals
develop accurate assess- Stereotyping occurs when a person ascribes the made from vinegar-soaked bones.
ments for use in health care collective traits associated with a specific group to Likewise, a food habit that the investigator
and research. Neither U.S.
every member of that group, discounting individ- finds repugnant may have some redeeming
nativity nor number of
ual characteristics. A health professional knowl- nutritional benefits. Examples include the con-
years in residence has
proved completely indica- edgeable about cultural food habits may sumption of raw meat and organs by the Inuits,
tive, and it has been sug- inadvertently make stereotypical assumptions which provides a source of vitamin C that would
gested that acculturation is about dietary behavior if the individual prefer- have otherwise been lost during cooking, and
sometimes based more on ences of the client are neglected. Cultural compe- the use of mineral-rich ashes or clay in certain
ethnic stereotyping than on tency in nutrition implies not only familiarity breads and stews in Africa and Latin America.
cultural differences.52, 99 with the food habits of a particular culture, but In addition, physiological differences among
recognition of intraethnic variation within a cul- populations can affect nutritional needs. The
Sometimes culturally based ture as well. majority of the research on dietary require-
food habits have vital nutri- Researchers suggest that health care ments has been conducted on young, white,
tional benefits. One exam- providers working in intercultural nutrition middle-class American men. Extrapolation of
ple is the use of corn
become skilled in careful observation of client these findings to other populations should be
tortillas with beans in
groups, visiting homes, neighborhoods, and done with caution.
Mexico. Neither corn nor
beans alone supplies the markets to learn where food is purchased, what Thus, diet should be carefully evaluated
essential amino acids food is available, and how it is stored, prepared, within the context of culture. One effective
(chemical building blocks of served, and consumed. Participation in com- method is to classify food habits according to
protein) needed to main- munity activities, such as reading local newspa- nutritional impact: (1) food use with positive
tain optimum health. pers and attending neighborhood meetings or health consequences that should be encour-
Combined, they provide events, is another way to gather relevant infor- aged, (2) neutral food behaviors with neither
complete protein. mation. Informant interviewing reveals the adverse nor beneficial effects on nutritional
most data about a group; individual members of status, (3) food habits unclassified due to insuf-
the group, group leaders, and other health care ficient culturally specific information, and (4)
professionals serving the group are potential food behaviors with demonstrable harmful
sources.117 Combining qualitative approaches affects on health that should be repatterned.55
such as in-depth, open-ended interviews with When diet modification is necessary, it should
clients and quantitative measures through ques- be attempted in partnership with the client and
tionnaires is one of the most culturally sensitive respectful of culturally based food habits.
methods of obtaining data about a group.17 Compliance is associated with an approach that
Qualitative information obtained through the is congruent with the clients traditional health
interviews should alert the researcher to nutri- beliefs and practices. (See Chapter 2 for more
tion issues within the group and guide develop- information.) For instance, educators devel-
ment of the assessment tool; the quantitative oped a food guide for Caribbean Islanders
results should confirm the data provided living in the United States that grouped cultural
through the interview in a larger sample. (See foods into three categories: growth, protection,
Chapter 3, for more information.) and energy, reflecting client-group perceptions
Cultural perspective is particularly important of how food affects health.112 A weight-loss pro-
when evaluating the nutritional impact of a gram for African-American women also used
persons food habits. Ethnocentric assumptions ethnic foods and trained black women as group
about dietary practices should be avoided. A food leaders, overcoming a distrust of non-black
behavior that on first observation is judged detri- health care providers common in the African-
mental may actually have limited impact on a American community.57 Educators in West
persons physical health. Sometimes other moder- Virginia developed an interactive computer-
ating food habits are unrecognized. For instance, based intervention with a cooking show format
a dietitian may be concerned that an Asian to help Appalachian women improve confi-
patient is getting insufficient calcium because she dence in selecting and preparing healthy
eats few dairy products. Undetected sources of foods.118
The American experiences have driven the rapidly expanding

market for imported fruits, vegetables, and meat
The National Restaurant
Association reported that
Paradox products, cheeses, and condiments. The growth
in ethnic restaurants has far surpassed that of the
the culinary compass
points mainly toward ethnic
cuisines, foreign flavors,
Food habits are so intrinsic to culture that food restaurant industry as a whole in recent decades.
and imported
terminology is often employed to describe plural- A survey found that Italian, Mexican, Japanese
ingredients.75
ism. Melting pot suggests a blending of different (sushi), Thai, Middle Eastern, and Caribbean fare
ethnic, religious, and regional groups to produce have grown most in popularity in recent years,
a smooth, uniform identity; stew implies a cooking while interest in French, German, Scandinavian,
of various populations to achieve a bland sameness and Soul Food has declined.75 One of the most
with only just a touch of cultural integrity; and recent developments is the success of fast-
tossed salad allows for maintenance of cultural casual ethnic restaurant chains, such as Chipotle,
identity, randomly mixed and coated with a glis- Curry in a Hurry, L&L Hawaiian Barbecue,
tening unity. A more accurate metaphor for the Mama Fus, and Pho Hoa. At the other end of the
American population is the omnivores paradox. American continuum of cuisine, some people
The nation was founded by immigrants, and find considerable satisfaction in the uniformity of
most citizens today are proud of a heritage that, to a meat-and-potato diet. A national trends survey
paraphrase the inscription on the Statue of found plain American food most well liked by
Liberty, accepts the tired, the poor, and the huddled respondents (66 percent).104
masses yearning to be free. Yet many Americans In response to the ambivalence produced by
are also suspicious of cultural difference and the American paradox, the rising interest in new
comfortable with what is familiar. See Figure 1.6. foods and the continued desire for familiar fla-
The same can be said for food habits in the vors, ethnic fare is often adapted to American
United States. tastes and standardized for national consump-
The American paradox, in culinary terms, is tion. Spicing is reduced, protein elements (partic-
that though foods from throughout the world are ularly meats and cheeses) are increased beyond
available, and often affordable, consistency and traditional ratios of protein to starch or vegetable,
conservatism are also needed. At one end of the more desserts and sweets are offered, and items
spectrum, people who are exposed to new foods considered distasteful to the American majority
through travel and those who crave new taste are eliminated. In considering the three most
Italian (other than pizza) 93% Figure 1.6

Mexican 93% Percentage of consumers in
Chinese (Cantonese) 90% the United States who have
Chinese (Mandarin) 74% tried a cuisine at least once,
German 63% 1999.
Greek 58% Source: Based on the National
Cajun/Creole 55%
Restaurant Assoc. Ethnic Cuisines
Japanese (other than sushi) 53%
II survey.
Soul Food 42%
French 34%
Scandinavian 34%
Indian 33%
Japanese (Sushi) 32%
Spanish 28%
Thai 26%
Pan Asian 26%
Mediterranean 26%
Caribbean 24%
Middle Eastern 25%
Latin American 24%
Vietnamese 19%
Korean 16%
Brazilian/Argentinian 13%
26 FOOD AND CULTURE
Cultural Foods in the United States: A Timeline*
toes to North America.

1620s
British traditional midday meal introduced, with meat, fowl, or
fish as its centerpiece served with cornbread or biscuit.
Steamed or boiled pudding is the first course; dessert of fruit 1680s
pie or cake follows. It is eaten with a knife, spoon, and fingers. German Mennonites settle in Pennsylvania, creating
First Thanksgiving occurs in 1621 at Plymouth colony, a ten-day Pennsylvania Dutch fare and popularizing dishes
celebration combining European and Native-American hunting such as scrapple, apple butter, and funnel cakes.
Pre-17th century and harvest feast traditions featuring fowl and venison. William Penn founds first brewhouse in Philadelphia,
Regional American Indian cuisines develop. Dutch colonists at New Amsterdam (present-day Manhattan) featuring English-style ales.
introduce coleslaw, doughnuts, cookies, and waffles.
1500s 1660s
Columbian Exchange: New World foods from the Caribbean and Yams, watermelon, okra, black-eyed peas, eggplant, and
Central/South America (corn, potatoes, tomatoes, chile pep- sesame seeds brought with African slaves who also introduce
pers, peanuts, vanilla, chocolate, etc.) are brought to Europe, the New World foods peanuts and chile peppers to North
Africa, Asia; Old World foods (wheat, rice, sugar, beef, pork, America.
apples, etc.) introduced to the Caribbean and Central/South
America.
Ponce de Leon discovers Florida and most likely brings toma-
1760s
England takes control of Canada from France: French Canadians 1790s
migrate to New England (Franco-Americans) and Louisiana Pineapples introduced to what is now Hawaii by the 1820s
(Cajuns), bringing fish stews, pork pates, boudin sausages, Spanish. First regional American cookbook published in 1824, The
French toast, and other specialties. American Cookery by Amelia Simmons in 1796 is first Virginia Housewife, or Methodical Cook, by Mary Randall,
An English plantation owner in New Smyrna, Florida imports American cookbook; includes recipes for stuffed with recipes for Southern specialties; also foreign dishes,
1,500 indentured servants from Italy, Greece, and Minorca to turkey, a tasty Indian pudding,pomkin pudding such as ropa vieja and gaspacho (Spain), polenta and
work his indigo fields, who in turn bring eggplant, lemons, and (pie), American citron (watermelon) preserves, and vermicelli (Italy), curry after the East Indian manner, and
olives to the region. cornmeal Johnny cakes or Hoe cakes. gumboa West Indian dish (Caribbean).
1770s 1800s
Boston Tea Party occurs; coffee takes hold as a protest First shipment of bananas arrives in the United States.
beverage. First recipe for tomato-based ketchup published in
Thomas Jefferson experiments with crops found in 1812, called love-apple or tomato catchup.
Europe, such as rice, broccoli, cauliflower, eggplant,
savoy cabbage, and olives.
*REFERENCES FOR TIMELINE

Davidson, A. 1999. The Oxford companion to food. New York: Oxford University Press.
Hess, K. 1992. The Carolina rice kitchen. Columbia, SC: University of South Carolina Press.
Katz, S.H. (Ed.). 2003. Encyclopedia of food and culture. New York: Charles Scribners Sons.
Trager, J. 1995. The food chronology. New York: Henry Holt and Company.
1740s
1700s First written record of ice cream in the colonies (served with
Potatoes popularized by Irish immigrants in Boston. strawberries and milk).
1690s 1730s 1750s

Rice cultivation techniques introduced to Carolinas by New England codfish industry trades salt cod for slaves in The Ojibwa obtain complete control of wild rice
Africans are so successful that excess crops sold to British. Africa, who are brought to the Caribbean and traded for stands in the lakes of Minnesota after defeating
Tomatoes popular in coastal Southern cuisines, but else- molasses, which is brought back to the colonies for production the Santee (Dakota) at the Battle of Kathio.
where considered poisonous. of rum. Estimated annual consumption of rum at the time: four
Jesuit and Franciscan priests plant grapes, oranges, lemons, gallons per person.
figs, and olives at California missions.
1860s
Completion of the transcontinental railway shortens the trip between coasts from 120
1840s days to less than one week: California fruits, vegetables, and grains head east; and Eastern
Durgin-Parks Market Dining Room opens in Boston, featuring New England shellfish, especially oysters, go west.
specialties such as chowders, fried cod tongues, and Indian pudding. French, Hungarian, Italian, and German immigrants in California introduce European vari-
Antoines restaurant is founded in New Orleans, offering French-Creole cuisine. etal wine grapes and viticulture techniques.
German immigrants in numerous states found commercial breweries, introduc- Confederate soldiers sometimes survived on boiled, raw (green) peanuts, earning those
ing the lager that became American-style beer. from Georgia the nickname goober grabbers.
First commercial pasta factory opened by Frenchman of Italian descent in Augustus Gutkind begins Goodmans Matzohs in Philadelphia to supply the Passover
Brooklyn. market.
Macao and Woosung, the first recorded Chinese restaurant in United States, Cajun-style hot sauce called Tabasco first formulated by Edmund McIlhenny at Avery
opens in San Francisco. Island, Louisiana.
1830s 1850s
Avocado introduced to Sourdough bread and biscuits, the foundation of gold miners diet in California and the Yukon, is
Florida. baked commercially in San Francisco.
Swiss immigrants introduce Emmentaler cheese, which becomes known in the United States as
Swiss cheese.
American Indian chef George Crum creates potato chips after a diner in his restaurant complains about
his thick-sliced potatoes.
Hazelnut trees introduced from the Mediterranean to Oregonnearly the entire U.S. hazelnut crop is
now grown in the state.
Artichokes, though previously introduced to Louisiana by the French, brought to California by the Spanish,
where they have been so successful nearly the entire U.S. commercial crop comes from the state.
Randolph, M. 1993. The Virginia housewife, or, methodical cook. A facsimile of an authentic early american cook-
book. New York: Dover Publications, Inc.
Simmons, A. 1996. American cookery, or the art of dressing viands, fish, poultry, and vegetables, and the best modes
of making puff-pastes, pies, tarts, puddings, custards and preserves, and all kinds of cakes from the imperial
plumb to plain cake. A facsimile of the second edition. Bedford, MA: Applewood Books.
Smith, A.F. 1994. The tomato in America. Columbia, SC: University of South Carolina Press.
28 FOOD AND CULTURE
1900s
Chop suey, a Chinese-American vegetable and meat dish that may have come originally from
southern China (tsap seui) is popular in chow-chows (Chinese restaurants) in California and New
York.
Foods prepared in the French-fashion are popular, particularly among the upper classes who can
1880s afford to employ cooks knowledgeable in their preparation and dine at expensive restaurants.
Luchows restaurant opens in New York City, popularizing Pistachio tree from Middle East introduced in California and Texas.
dishes found in German-American homes and local beer gar- Coca-cola, combining extracts from African kola nuts, South American coca leaves, and fruit
dens, such as smoked eel, bratwurst, weinerschnitzel, spatzle, syrups, goes on sale in Atlanta as a fountain drink.
and German-style beers. The Kellogg brothers at a Seventh-Day Adventist spa create cereal flakes as a substitute for
Oscar F. Mayer, a German-American butcher, opens sausage meata year later they add malt sweetener to increase appeal.
shop in Chicago, later selling his wieners to grocery stores Loma Linda Foods begins production of health breads and cookies for patients at the Seventh-Day
throughout the region. Adventist Loma Linda Hospital.
B. Manischewitz Co. begins production of kosher products in Broccoli introduced to California by Italian immigrants.
Cincinnati. Worlds Fair in St. Louis popularizes German hamburger sandwiches and frankfurters (later dubbed
Italian immigrants from Naples introduce spaghetti made with hot dogs).
olive oil and tomato paste. First American pizzeria opened by Italian immigrant in New York City.
1870s 1890s
Jewish Cookery, first cookbook on the subject in the United Asian immigrants move into San Joaquin valley of California,
States, by Esther Levy published in Philadelphia. planting large tracts of land. By the 1940s Japanese farmers are
Chinese Pekin (Peking) ducks imported by New York farms. growing two-thirds of all vegetables in the state, creating
Acceptance of four-tined fork makes using a knife to eat out- shortages when they are interned during World War II.
moded; American-style use (transferring the fork from right Chili powder, combining ground dried chile pepper bits with
hand to left when cutting foods) is established. other seasonings, such as oregano, is invented in Texas
Buffalo (a Plains Indian staple), which numbered 30 to 70 million, though attribution is uncertain. Chili stews of beef or goat pop-
are reduced to approximately 1,500 animals, in part due to ular in the region.
prestige of smoked buffalo tongue in urban areas.
Navel oranges introduced to California from Brazil, by way of the
U.S. Department of Agriculture (USDA) in Washington, DC.
1960s
Beef consumption reaches ninety-nine pounds per person in United States, surpassing pork consumption for the first time.
Friedas Finest founded to market specialty produce using samples and recipes in supermarkets; popularizes items such as
Chinese gooseberries (renamed kiwifruit), Jerusalem artichokes (as sunchokes), radicchio, spaghetti squash, blood oranges,
cactus pears, and other items.
Julia Child debuts her cooking show, The French Chef, on public television, demystifying gourmet cooking and promoting French
cuisine.
The first Taco Bell fast-food restaurant opens in Downey, California.
Benihana of Tokyo opens teppanyaki-style restaurant in New York.
Term soul food coined for traditional African American cuisine.
In Atlanta, Lester G. Maddox is ordered by the federal government to serve African Americans at his Pickrick Restauranthe
closes the business instead.
Catfish farming introduced in Arkansas, dramatically increasing production and popularizing the fish nationwide.
Time-Life BooksFoods of the World cookbooks begin with publication of The Cooking of Provincial France by M.F.K. Fisherthe
series introduces international cuisine through twenty specialized volumes (African cooking to wines and spirits) followed in
the 1970s with seven volumes on regional American fare.
1950s 1970s
Trader Vics restaurants in California popularize Falafel stands and restaurants proliferate with increased immigration of Middle Easterners.
Polynesian food, such as luau dishes and pupu Chez Panisse restaurant opens in Berkeley, California, emphasizing fresh, locally grown ingredients, leading to development of a new
platters, as well as the mai tai cocktail, claimed California cuisine and promoting regional fare nationally.
invented by the owner. Nissin Foods USA founded in California to market instant noodle products popular in Japan, such as Top Ramen.
USDA publishes Basic Four food guide. Vietnamese refugees open small restaurants in California, Texas, and other locations featuring traditional pho, sandwiches, and other
items.
Small numbers of immigrants arrive from Thailand, and many open restaurants, introducing fish sauces such as nuoc mam and noodle
dishes, including phad thai.
Paul Prudhomme opens K-Paul Louisiana Kitchen in New Orleans, popularizing Cajun cooking nationwide, one of the first regional food trends.
1940s
Influx of Greek immigrants seeking asylum in areas such as New York, Detroit, and Chicago
popularize items such as souvlaki and gyros in family-run restaurants and street stands.
Ed Obryckis Olde Crab House in Baltimore converts from tavern to restaurant serving
Maryland specialties such as soft-shell crab and crab cakes.
1920s Domestic servants and some housewives take jobs to support the U.S. war effort during
LaChoy Food Products founded to sell canned and jarred bean sprouts. World War II, leading to an increased consumption of convenience foods.
Polish baker Harry Lender opens first bagel plant outside New York, and The Gentlemans Companion, Being an Exotic Cookery Book or, Around the World with Knife,
popularity begins to spread beyond Eastern European enclaves. Fork and Spoon by Charles Baker, a two-volume set, published in 1946, describing dishes
Aplets candy, based on the recipe for Turkish Delight, invented by two and drinks from throughout Europe and Asiaa second two-volume set on the foods and
Armenian immigrants in Washington State. beverages of South America published in 1951.
Marriott Corp. gets its start as a root beer, tamales, and chili con carne Balduccis specialty food shop (founded as a vegetable stand in 1916 by an Italian immi-
stand in Washington, DC. grant) opens in New York, offering an international assortment of foods from Europe, Asia,
The Russian Tea Room opens in New York, popularizing blinis, caviar, and Latin America as well as regional specialties, such as rattlesnake and Cajun andouille.
tea in samovars, and other Russian specialties. The McDonald brothers offer franchises of their hamburger stand, founded in 1940 in
Colombo Yogurt is founded by Armenian immigrants in Massachusetts. Pasadena, California.
1910s 1930s
George Washington Carver extols the virtues of peanuts, soy- Fritos corn chips first marketed in Texas based on a tortillas
beans, and sweet potatoes; he popularizes peanut butter, for- fritas (fried tortilla strips) recipe purchased from a Mexican
merly considered a food for the sick and aged. restaurant owner.
U.S. pasta production increases when imported supplies from Spam is created, becoming a status food in Hawaii and the
Italy are cut off during World War I. best-selling canned meat worldwide.
American cheese first processed in Chicago by J.L. Kraft & Bros. Goya Foods is founded in New York by Spanish immigrants to
(Canadian Mennonite immigrants) by melting bits of cheddar import olives and olive oil, later tapping into the growing
with an emulsifier to produce a smooth, mild cheese-like food. Latino food market.
The fortune cookie created in California.
1980s
Ethiopian restaurants become popular in some cities where immigrants have
settled, introducing items such as injera and berbere.
Yaohan supermarkets of Japan open in California catering to Asian population
2000s
and offering ingredients such as bean sprouts, daikon, seaweed, pickled plums, Americans consume an average of one tortilla per person each dayrepresenting 30 percent of all
fresh fish, and prepared items, including sushi. bread sales, nearly equal to white bread.
Korean immigrants, especially in Los Angeles, introduce Korean barbecue, There are more Chinese restaurants in the United States than McDonalds, Wendys, and Burger King
kimchi, and other specialties through restaurants and markets. restaurants combined.
Fresh fugu fish (which can be highly toxic) is imported for first time for use in $1 out of every $7 in grocery purchases is spent on ethnic items in 2005.
American-Japanese restaurants under F.D.A. supervision. Wine neck-in-neck with beer as favorite American alcoholic beverage.
1990s
Salsa becomes the favorite American condiment when sales exceed those of ketchup.
The term fusion food is used for combining the ingredients and preparation tech-
niques of two or more cultural cuisines, such as Thai chicken pizza.
Chicken consumption per capita first tops beef consumption.
USDA/DHHS release first version of the Food Pyramid.
The Food Network begins television broadcasting.
Spanish tapas restaurants become trendy.
30 FOOD AND CULTURE
In many ways U.S. cooking is founded on

adaptive processes. Hamburgers, hot dogs, and
fried chicken are clearly derived from other cul-
tural fare, yet they are changed through resolution
of the American paradox. Cheese melted over
burgers on a sesame seed bun, chili con carne
poured over frankfurters, and cornmeal-crusted
chicken served with cream gravy and buttermilk
biscuits are nearly unrecognizable from their
European and African origins. And while the
tamale pie in Texas, the saimin noodles in Hawaii,
the tofu lasagna in a vegetarian home, and the
tuna croissant sandwich in the university cafeteria
are not authentic ethnic fare, they are authentic
American foods. It is the unexpected and exciting
ways in which the familiar and the new are com-
bined that make the study of food habits in the
United States such a pleasurable challenge.
CHAPTER 1 REVIEW QUESTIONS

1. Define food and food habits. How does the
omnivores paradox influence a persons food
Becky Luigart-Stayner/CORBIS
choices and food habits?

2. List four factors that may influence an indi-
viduals choice of foods. Pick one and explain
how this factor influences food choices.
3. Define the terms culture and acculturation.
Describe an example of a change in food
Asian tofu is the main ingre- habits that may reflect acculturation.
dient in this vegetarian popular ethnic cuisines in the United States, it is 4. Describe the flavor principles, core foods,
adaptation of shepards pie, unlikely a consumer will find roasted kid at an and meal patterns of your familys diet.
a traditional British entre Italian restaurant, 1000-year-old eggs at a 5. Which of the factors described by the con-
popular in the United States. sumer food choice model currently influence
Chinese take-out counter, or tripe soup at a
Mexican drive-up window. Many Americans are your food choices? Which factors do you
convinced that spaghetti with meatballs, fortune think will stay the same and which do you
cookies, and nachos are authentic dishes, yet they think will change as you age?
are all items created in the United States for
American preferences.104 Even cultural foods pre-
pared at home from cookbooks are often modi-
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San Diego Union-Tribune, August 1 p. D3.
CHAPTER
2
Traditional Health
Beliefs and Practices
H ealth and illness in America are usually U.S. biomedicine, Traditional Chinese Medicine, Biomedicine is the term
considered the specialty of mainstream and Ayurvedic medicine) are reviewed within the used to describe the conven-
biomedicine. Furthermore, health promo- cultural context of health and illness. Specific tional system of health care
tion is based on scientific findings of researchers beliefs and practices are detailed in the following in the United States and
chapters on each American ethnic group. other western nations based
regarding diet, exercise, and lifestyle issues such
on the principles of the
as smoking cessation and stress management; natural sciences, including
disease is treated according to the latest tech- biology, physiology, and
nologies. In reality, health care is pluralistic in the
United States, as well as in most other cultures. It
Worldview biochemistry.
is estimated that 70 to 90 percent of sickness is CULTURAL OUTLOOK Ayurvedic medicine is the

managed outside the biomedical system.41 Many ancient Asian Indian system
people in the United States never consult a physi- Each cultural group has a unique outlook on life, of healing.
cian or allied health care provider when physical based on a common understanding and ranking
or emotional symptoms occur, relying on home of values. These standards typically represent
remedies and popular therapies rather than pro- what is considered worthy in a life well lived.
fessional help. Complementary and alternative They are a collective expression of preferences
medicine is popular with many Americans, and and prioritiesnot absolutesand individuals
consumer spending on such practices and products within a society may hold a spectrum of beliefs.
has more than tripled in the past decade, from However, expectations about personal and public
$11 billion annually to nearly $40 billion.5, 39 When conduct, assumptions regarding social interaction,
biomedical care is sought, it is often in conjunction and assessments of individual behavior are deter-
with these other systems. mined by this cultural outlook, or worldview. This
Culture determines how a person defines perspective influences perceptions about health
health, recognizes illness, and seeks treatment. and illness as well as the role of each within the The term majority describes
Traditional health beliefs and practices can be structure of a society.36, 65, 71 the culture of the predomi-
Majority American values, which are shared nant white, Anglo-Saxon,
categorized in various ways: through the etiology
by most whites and to some degree by many other Protestant population in
of illness (due to personal, natural, social, or
the United States. It is
supernatural causes) or by the cures that are ethnic groups in the United States, emphasize
important to note, however,
employed (the use of therapeutic substances, individuality and control over fate (Table 2.1).
that many ethnic groups
physical forces, or magico-religious interven- Personal accountability and self-help are consid- have contributed to major-
tions). There is no consensus, however, on these ered cultural cornerstones. A recent survey found ity American culture, and
classifications. In this chapter, home remedies, 82 percent of American consumers believe they many individuals may also
popular approaches such as folk and alternative are directly responsible for their own health.83 share characteristic beliefs,
traditions, and professional systems (including Most other cultures worldwide believe that values, and customs.
38 TRADITIONAL HEALTH BELIEFS AND PRACTICES
Text not available due to copyright restrictions
fateincluding the will of God, the actions of they are also future oriented, meaning they are
supernatural agents, or birthright (i.e., astrologi- willing to work toward long-term goals or make
cal alignment or cosmic karma)is a primary sacrifices so that they or their children will reap
influence in health and illness. Although most rewards in the future. The majority members in
cultures have complex practices regarding the the United States are also monochronistic, with a
The concept of preventive maintenance of health, the concept of preventa- preference for concentrating on one issue or task at
health care, such as annual tive health care, such as annual checkups, is a time in a sequential manner. Many other cultural
checkups provided by a bio- unknown in some cultures where fate dominates. groups live in the present and are often polychro-
medical professional, is The significance of fate often coincides with dif- nistic, or comfortable doing many things at once. A
unknown in some cultures ferences in perceptions of time. Many Americans Mexican American who is talking with his grand-
where fate is believed to place great value on promptness and schedules; mother while fixing an appliance and watching a
determine health.
baseball game on television is unlikely to cut the
visit short just because he has a medical appoint-
ment. Immediate interests and responsibilities,
including interpersonal relationships, are more
important than being on time. A few cultures, such
as certain Native American nations, are past ori-
ented, living according to historical direction.
Most majority Americans are very task ori-
ented and desire direct participation in their
Michael Newman/PhotoEdit, Inc.
health care; they feel best when they can do

something. Other cultures place a greater value
on being and feel comfortable with inactivity.
Self-worth is based more on personal relation-
ships than on accomplishments. The expectation
is that the health care practitioner will take
responsibility for treatment. The whole idea of
Chapter 2: Traditional Health Beliefs and Practices 39
the providerclient partnership may be alien to other medical systems can reveal areas of poten- Some majority Americans
Asians, who often expect to be fully directed in tial disagreement or conflict regarding how and find eating a meal a disrup-
their care. While many Americans value patient why illness occurs and the expectations for treat- tion of daily tasks; others
autonomy and confidentiality, other cultural ment before working with a client. Compliance adhere to strict meal sched-
ules. In polychronistic soci-
groups, such as Middle Easterners, believe that increases with clinical approaches that concur
eties, meals are usually
the family should be involved in all health care with the clients worldview.40, 43
leisurely events, a chance to
decisionsthe welfare of the group outweighs enjoy the blessings of food
that of the individual. in the company of family
BIOMEDICAL WORLDVIEW
Americans consider honest, open dialogue and friends.
essential to effective communication, and infor- Biomedicine is a cultural subdivision of the
mality is usually a sign of friendliness. Many American majority worldview. It shares many A U.S. survey on physician-
other cultures prefer indirect communication beliefs with the dominant outlook but differs in a assisted suicide for termi-
techniques and expect a formal relationship with few notable areas.29, 75 There are certainly excep- nally ill patients in pain
everyone but intimate family members. In cul- tions to the biomedical worldview within certain found that 74 percent of
tures where identity with a group is more signifi- specialties, and by some practitioners, yet many whites felt it should be
cant than individuality, social status and of the underlying assumptions are culture-spe- allowed, compared to 70
percent of Hispanics,
hierarchy are respected, which can have an cific. The tendency is for health care providers to
63 percent of Asians, and
impact on the practitionerclient relationship enforce their beliefs, practices, and values upon
51 percent of blacks.73
(see Chapter 3, Intercultural Communication, clients, sometimes unknowingly because they are
for more information). unaware of cultural differences, but more often Some researchers have
Worldview is especially evident in serious, because they believe their ideas are superior. This noted that although the
life-and-death health care decisions. Southeast process is called cultural imposition, and it biomedical community
Asians may appear indifferent to a terminally ill impacts nearly all client care.47 often calls clients whose
family member and have little interest in pro- cultural background differs
longing life because of a faith in reincarnation. Relationship to Nature from the majority hard to
Some African Americans distrust white- Biomedicine adheres to the concept of mastery reach, this term is equally
American health care recommendations regard- over nature. Practitioners are soldiers in the war applicable to health profes-
ing do-not-resuscitate orders in part because on cancer (or other conditions). They fight infec- sionals who refuse to pro-
vide culturally appropriate
they contradict the critical role of faith in tion, conquer disease, and kill pain. Technology
care.43
African-American healing. An Orthodox Jewish is considered omnipotent; its tools are the arsenal
patient may believe that physicians are mandated used to battle pain and illness.
to preserve life and that any person who assists One factor in this approach is the attitude that
death through denial of sustaining care is a mur- health can be measured numerically and that there
derer; a non-Orthodox Jew may believe that no are standardized definitions of disease. Blood and
one should endure unrelievable pain and thus urine analyses, X-rays, scans, and other diagnostic
dying should not be prolonged. Middle tests are used to define whether a patient is within
Easterners traditionally demand that everything normal physical or biochemical ranges. Figures
be done to keep a person alive because death is in falling within designated parameters mean the
Gods hands, and one must never give up hope. patient is functioning normally; if the data are too
Mexican-American family members might view high or too low, the patient is in an abnormal state
death as part of Gods plan for a relative; they that may indicate disease. Diagnosis occurs
might be against anything that would quicken independent of the idiosyncratic characteristics
death, or they may expect the practitioner to of the individual, usually without consideration
make the decision.8, 42, 57 of cultural factors such as ethnic background or
Most health care situations are not cases of life religious faith. Symptoms occurring outside
or death, and worldview encompasses many numerical confirmation are frequently deter-
other, less catastrophic aspects of health and ill- mined to be of psychosomatic origins.29
ness as well. It is useful to examine the biomed-
ical worldview and understand the perspective of Personal Control or Fate?
most U.S. health care providers before learning The conventional U.S. medical system leaves little
about other traditional health beliefs and prac- room for chance or divine intervention. Scientific
tices. Comparisons between biomedicine and rationality dictates that there is a biomedical cause
for every condition, even if it is as yet undiscov- Human Equality

ered. Each individual inherits a certain physiolog- A fundamental premise in American biomedi-
ical constitution and has a personal responsibility cine is that all patients deserve equal access to
to make the choices that prevent illness. Receiving care, although practically speaking cost, location,
immunizations and getting regular checkups are and convenience prevent many patients from
biomedical ways in which an individual can pre- receiving adequate health services. This is a rela-
serve health. Being obese, smoking cigarettes, tively unique perspective; most other societies
consuming immoderate amounts of alcohol, and deliberately ration health care through assessing
failing to manage stress are biomedical examples physical status (e.g., a young person may receive
of how an individual may endanger health. A services denied to a terminally ill older person) or
person who behaves in a manner believed to through socioeconomic status (e.g., the wealthy
cause disease is often stigmatized. can purchase care; the poor are left to whatever
When a person is ill, the biomedical assump- society offers).
tion is that he or she will reliably comply with The biomedical worldview on human equal-
therapy, and that treatment, if undertaken cor- ity differs substantially from the mainstream
rectly by the patient, will alleviate the condition. American outlook in one way, however. A hierar-
The onus of cure is dependent on personal chy of biomedical professionals is strictly observed
behavior. From the patients perspective, there is in the United States, with physicians having the
the presumption that health care professionals highest status and allied health professionals
will provide mistake-free care. Malpractice suits substantially less. Health care workers outside
filed when care was less than perfect have led to the professional system, such as clerical and cus-
extensive charting and record keeping in the U.S. todial workers, and those beyond the reach of
biomedical system. biomedicine, such as folk healers, are accorded
even lower standing. Deference to those of supe-
State of Being rior rank is expected. The client is typically infe-
Congruent with the value on personal control, rior to biomedical professionals within this
biomedical patients are expected to be active hierarchy.
partners in their cure. Complacency and non-
compliance are greatly disliked by biomedical Aging
practitioners. Changes in lifestyle can help pre- Biomedicine supports the majority American
serve health; taking medications and completing worldview in its value on youthfulness. Many
therapeutic regimens can relieve symptomatic aspects of health care practice are dedicated to
pain or cure disease. The biomedical emphasis is postponing the aging process, from plastic sur-
on doing, not being. Other worldviews may gery to the technological prolongment of life. The
expect client passivity and acceptance of adverse fear of aging is so pervasive in the U.S. culture that
conditions. Clients are the recipients of healing, it influences health care outside the conventional
The number of elders in the not participants. biomedical system as well. Numerous alternative
United States is expected to traditions promise everlasting youth through the
double by the year 2050;
Role of the Individual use of certain products. The emphasis on youth-
figures among some ethnic
Similar to the American majority worldview, fulness is in direct conflict with other cultural
groups, such as African
Americans, Asian individuality is honored in U.S. biomedicine, and worldviews that honor the wisdom that comes
Americans, and Latinos, client confidentiality is nearly inviolate. Individuals with aging and that hold high esteem for elders.
show even greater growth. are seen as a single, biological unit, not as mem-
bers of a family or a particular cultural group. It Perceptions of Time
is assumed that a person desires privacy, and Biomedicine is future-oriented, with a focus on
clients are sometimes encouraged by providers to what can be done today so that the client will be
keep medical matters quiet, even if it means with- better tomorrow. Often treatments are unpleas-
holding information from relatives. Treatment typ- ant, invasive, and even painful at the moment of
ically is focused on each client, in keeping with their application, yet the hope is that they will
the beliefs of personal responsibility and the benefit the client in the future. Long-term manage-
providerpatient partnership. ment of disease and illnessprevention strategies
such as diet is even more oriented toward future and some alternative traditions, the emotional The separation between
benefits. needs of the patient are addressed through phys- physical and emotional or
Although being on time for appointments ical therapies. Spiritual intervention is frequently psychological health is so
and taking medications when scheduled are sought concurrently. embedded in American cul-
ture that no English word
valued in clients, biomedical practitioners are
exists to even express the
notorious for their disrespect of the clients time.
concept of mindbody
Clients are frequently asked to arrange non- unity.
emergency consultations weeks or even months
in advance and may be kept waiting on the days
What Is Health?
of their appointments. CULTURAL DEFINITIONS OF HEALTH
Degree of Formality/Degree of Directness Meaning of Health
The established biomedical hierarchy, as well The World Health Organization (WHO) describes
as the emphasis on timeliness, is often reflected health as a state of complete physical, mental,
in the degree of informality observed in dialogue and social well-being, not merely an absence of
between provider and patient. The provider often disease or infirmity. Although comprehensive
addresses the client by his or her first name, yet from a biomedical perspective, this definition
expects the patient to use formal titles in return. does not fit the worldview of many cultural
The provider usually spends limited time on groups, because it ignores the natural, spiritual,
small talk and attempts to get quickly to the prob- and supernatural dimensions of health.
lem; the expectation is the patient will also use Most Native Americans believe that health is
direct approaches. Extensive jargon without achieved through harmony with nature, which
explanation is often employed. includes the family, the community, and the envi-
Biomedical practitioners value honest, open ronment. Africans also emphasize a balance with
communication with patients because it nature and believe that malevolent environmental
enhances their ability to diagnose and treat dis- forces such as those of nature, God, the living, or
ease, and it assists in issues such as informed the dead may disrupt a persons energy and bring
consent. Other cultural worldviews, however, illness. Many African Americans, Latinos, Middle
value indirect or intuitive communication with Easterners, and some southern Europeans
health care practitioners (see Chapter 3, for more attribute health to living according to Gods will.
information). Some cultures also believe that Gypsies maintain health through avoiding con-
the family, not the patient, should be told about tact with non-Gypsies, who are considered inher-
serious conditions.8 ently polluted. Most Asians believe that health is
dependent on their relationship to the universe
Materialism or Spirituality? and that a balance between polar elements, such
Each disease from the biomedical viewpoint has as yin and yang, must be maintained. Some
its own physiological characteristics: a certain Southeast Asians are concerned with pleasing
cause, specific symptoms, expected test results, their ancestor spirits, who may cause accidents or
and a predictable response to treatment. To many sickness when angry. Pacific Islanders believe
biomedical health care providers, an illness isnt that fulfilling social obligations is essential to
real unless it is clinically significant; emotional or health and that disharmony with family or village
social issues are the domain of other specialists. members can result in illness. Asian Indians con- The word health comes from
Biomedicine differs from most traditional health sider mind, body, and soul to be interconnected the Anglo-Saxon term hal,
care approaches in the recognition of the and believe that spirituality is as important to meaning wholeness.
mindbody duality. Nearly all other cultures con- health as a good diet or getting proper rest (see
sider the mind and body as a unified whole. individual chapters on each ethnic group for
Somatization refers to the expression of emotions more details).
through bodily complaints. In biomedical cul- Health in other cultures is less dependent on
ture, somatic symptoms are often interpreted as a symptoms than on the ability to accomplish daily
maladaptive emotional response, yet they are the responsibilities. Among Koreans, there is a strong
most common presentation of psychological dis- desire to avoid burdening their children with
tress in patients worldwide.62 In folk medicine their health problems. Mexican men may ignore
physical complaints because it is weak and The health risks associated with being overweight
unmanly to acknowledge pain. Even within a single cause some providers to presume ill health in
culture, socioeconomic differences may contribute their obese clients. Thinness corresponds to the
to the definition of health; daily aches are tolerated biomedical worldview regarding mastery of
when a weekly paycheck is essential.29 nature, the idea that the intellect can control the
appetite.21
Health Attributes Historically, thinness has been associated
As health is defined culturally, so are the charac- with a poor diet and disease. In many cultures
teristics identified with health. Physical attributes today, including those of some Africans,
are most commonly associated with well-being, Caribbean Islanders, Filipinos, Mexicans, Middle
including skin color, weight maintenance, and Easterners, American Indians, and Pacific
hair sheen. Normal functioning of the body, such Islanders, being overweight is a protective factor
as regular bowel movements, routine menstrua- that is indicative of health as well as an attribute
tion, and a steady pulse, is expected, as is the use of beauty. Many overweight African-American
of arms, legs, hands, and the senses. Undisturbed women, for example, are less concerned about
sleep and appropriate energy levels also suggest weight issues and more satisfied with their
good health. bodies than overweight white women.59, 86 A
Behavioral norms within the context of mar- larger ideal body image is the norm for most
riage, family, and community are sometimes con- black men and women regardless of age, educa-
sidered a sign of well-being. It is the cultural tion, or socioeconomic status.5, 25 Some black
specifics of health characteristics that tend to Caribbean Islanders and Puerto Rican women
vary. Healthy hair in the United States is adver- also report a larger body size as attractive to
tised as clean, shiny, and flake-free. In many cul- family and peers when compared to Anglo,
tures, oily hair is the norm, and dandruff is not a Eastern European-American, and Italian-
significant concern. Americans count on a single, American women.55 Some Hispanic women value
strong pulse of about 72 beats per minute when a heavier profile for themselves, and even if they
resting, while in other medical systems there is opt for a slimmer body personally, they may
more than one pulse of importance to health, and prefer plump children.16, 17, 22 Researchers have
these pulses are a primary diagnostic tool in ill- found that some young African-American and
ness. Pregnancy is a medical condition in the Latina women purposefully contest the majority
United States warranting regular exams by culture emphasis on thinness, substituting self-
biomedical professionals, whereas in many soci- acceptance and nurturance.69
eties pregnancy is a normal aspect of a healthy Researchers have found that attitudes about
womans cycle, and prenatal care is uncommon. weight sometimes change when an immigrant
Generally speaking, Americans expect to be con- enters a culture with different perceptions regard-
tent in their lives; many other cultures have no ing health and beauty. More acculturated Hispanic
such assumptions and do not link happiness with women and children were more likely to choose a
well-being. thinner figure as ideal than those who were less
In Ayurvedic medicine, a
distinction is made acculturated, ideal body image for Samoan women
Body Image in Hawaii varied with whether they identified with
between general health
and optimal health. One area of significant cultural variation regard- Western or non-Western culture, and Puerto
ing health is body image. Perceptions of weight, Ricans living on the mainland United States
In Traditional Chinese health, and beauty differ worldwide. In the United expressed a desire for thinness that is between that
Medicine, 15 separate States there is significant societal pressure to be of their country of origin and that of the majority
pulses are identified, each thin. Although there is no scientific concurrence culture in their new homeland.55, 61, 79 Among
associated with an internal on the definition of ideal or even healthy weight some Native Americans, ideal body size has
organ and each with its for individuals, being overweight is usually changed over time. Elders are more likely than
own characteristics. believed to be a character flaw in the majority younger adults to prefer a heavier profile, and chil-
American culture. Even health care professionals dren demonstrate a desire for even thinner
reportedly make moral judgments about obesity, bodies.24, 66, 81 Some studies also suggest the pres-
depicting overweight persons as weak-willed, sure to be thin may be impacting young persons
ugly, self-indulgent, and fair game for ridicule.12, 80 more than adults: the percentage of normal-weight
teens engaging in unhealthy weight control religions. Preventative care is unusual in many
behaviors did not vary by ethnicity in a national cultures.
examination of high school students, and another Culturally specific health practices differ par-
study found Asian, Hispanic, and American ticularly in those beliefs passed on within fami-
Indian adolescent girls reported similar numbers lies. A small survey of U.S. college students from
of weight-related concerns as white girls; howmany backgrounds revealed notable variation in
ever, African-American girls had fewer weight health habits beyond general concepts regarding
issues.59, 67 Some Native American schoolchildren diet, sleep, and cleanliness.75 Dressing warmly
express a high level of body dissatisfaction, and (Eastern European, French, French Canadian,
concerns about overweight were high in a cohort Iranian, Irish, Italian, Swedish) and avoiding
of third-grade children, with Latinas and going outdoors with wet hair (Eastern European,
African-American girls reporting the same or Italian) were listed by some. Daily doses of cod
greater level of body dissatisfaction than white liver oil (British, French, French Canadian,
and Asian girls.19, 77 German, Norwegian, Polish, Swedish) and
molasses (African American, French, French
HEALTH MAINTENANCE Canadian, German, Irish, Swedish) as a laxative
in the spring were frequently reported mainte-
Health Habits nance measures. Natural amulets were tradition-
Just as with health attributes, there are some ally worn in some families to prevent illness, such
broad areas of intercultural agreement on health as camphor bags (Austrian, Canadian, Irish) or
habits. Nearly all people identify a good diet, suf- garlic cloves (Italian). Faith was important to
ficient rest, and cleanliness as necessary to pre- many of the students, expressed as blessing of the
serving health. It is in the definitions of these throat (Irish, Swedish) and wearing holy medals
terms that cultural variations occur. For example, (Irish), as well as daily prayer (Canadian,
majority Americans typically identify three Ethiopian).
square meals each day as a good diet. Asians may
indicate a balance of yin and yang foods is a Health-Promoting Food Habits
requirement. Middle Easterners may be concerned Food habits are often identified as the most
with sufficient quantity, and Asian Indians may important way in which a person can maintain
be concerned with religious purity of the food. To health. Nearly all cultures classify certain foods
most Americans, keeping clean means showering as necessary for strength, vigor, and mental
daily, while some Filipinos bathe several times acuity. Some also include items that create equi-
each day to maintain a proper hot-cold balance. librium within the body and soul.
In the United States national surveys on General dietary guidelines for health usually A survey of Americans
health risk behaviors note that calorie intake and include the concepts of balance and moderation. reported 95 percent believe
carbohydrate consumption have increased In the United States current recommendations certain foods have benefits
notably in recent years, while the percentage of include a foundation of complex carbohydrates in that go beyond basic
calories from fat has decreased. These data also the form of whole grains, vegetables, and fruits; nutrition.32
show that 52 percent of adults used dietary sup- supplemented by smaller amounts of protein In ancient China, nutrition-
plements, only 30 percent engaged in regular foods such as meats, legumes, and dairy products; ists were ranked highest
leisure physical activity, and 60 percent con- and limited intakes of fats, sugar, salt, and alcohol. among health professionals.
sumed alcoholic beverages.50, 82 Increases in the The Chinese system of yin-yang encourages a bal- The neutral category of
numbers of people seeking preventative medical ance of those foods classified as yin (items that are foods is usually expanded
services (e.g., cholesterol screenings, mammo- typically raw, soothing, cooked at low tempera- by those Asians who prefer
grams) have also been reported.58 Some cultural tures, white or light green in color) with those biomedicine and believe
groups would find these data irrelevant to health classified as yang (mostly high-calorie foods, that traditional health sys-
status. Macronutrient intake may not be associ- cooked in high heat, spicy, red-orange-yellow in tems are unsophisticated.2
ated with disease prevention, and dietary supple- color), avoiding extremes in both. Some staple
ment use may not be familiar. Physical labor is foods, such as boiled rice, are believed to be
often a factor in preserving health, but recreational perfectly balanced and are therefore neutral.
exercise is rare throughout much of the world. Although which foods are considered yin or yang
Alcohol consumption is prohibited by several vary regionally in China, the concept of keeping
Lebanon it is believed that the body must have

time to adjust to a hot food before a cold item can
be eaten. In Mexico the categorization of hot and
cold foods is related to a congruous relationship
with the natural world. Asian Indians associate a
hot-cold balanced diet with spiritual harmony.
Quantity of food is often associated with
health as well. Some African Americans, for
example, traditionally eat heavy meals, reserving
light foods for ill and recuperating family mem-
bers. In the Middle East ample food is necessary
for good health, and a poor appetite is sometimes
regarded as an illness in itself. As discussed pre-
viously, being overweight is frequently associated
with well-being in some cultures.
In addition to balance and moderation, specific
foods are sometimes identified with improved
strength or vitality. In the United States milk
builds strong bones, carrots improve eyesight,
and candy provides quick energy. Chicken soup,
a traditional tonic among Eastern European Jews,
has become a well-accepted cure-all. Navajos
consider milk to be a weak food, but meat and
blue cornmeal are strong foods. Asians call
Mitch Hrdlicka/Getty Images
strengthening items pu or bo foods, including

protein-rich soups with pork liver or oxtail in
China, and bone marrow or dog meat soup in
Korea. Puerto Ricans drink eggnog or malt-type
beverages to improve vitality.
The sympathetic quality of a food, meaning a
The health value of specific characteristic that looks like a human body part
foods varies culturally. In the the body in harmony through diet remains the or organ, accounts for many health food beliefs.
United States, it is said that same, usually adjusted seasonally to compensate The properties of a food entering the mouth are
milk builds strong bones. But for external changes in temperature and for phys- incorporated into physical traits. Some Italians
in certain American Indian iological conditions such as age and gender (see drink red wine to improve their blood, and
cultures, milk is considered a Chapter 11, East Asians). American women sometimes eat gelatin (which
"weak" food. Some Latinos Aspects of the yin-yang diet theory are found is made from animal hooves) to grow longer,
believe milk is only good for stronger fingernails. Throughout Asia and parts
in many other Asian nations, and a similar
children.
system of balance focused on the hot-cold classi- of the United States, ginseng, which is a root that
fication of foods is practiced in the Middle East, resembles a human figure, is believed to increase
parts of Latin America, the Philippines, and strength and stamina. Other foods are believed to
India. Hot-cold concepts developed out of prevent specific illnesses. Americans, for instance,
ancient Greek humoral medicine that identified are urged to eat cabbage-family (cruciferous)
four characteristics in the natural world (air-cold, vegetables to reduce their risk of certain cancers.
earth-dry, fire-hot, water-moist) associated with Oatmeal (high in soluble fiber) and fish (high in
four body humors: hot and moist (blood), cold omega-3 fatty acids) have both been promoted as
and moist (phlegm), hot and dry (yellow/green preventing heart disease.
Ritualistic cannibalism,
especially when the heart bile), and cold and dry (black bile). Applied to Some cultures believe that fresh foods prepared
or liver of a brave and daily food habits, this system usually focuses on at home are healthiest and, in the United States, the
worthy enemy was con- only the hot and cold aspects of food (defined by popularity of locally grown items and organic foods
sumed, is an extreme exam- characteristics such as taste, preparation method, (those produced without the use of chemical addi-
ple of the sympathetic or proximity to the sun) balanced to account for tives or pesticides) has increased in recent years.
qualities of food. personal constitution and the weather. In Vegetarianism, macrobiotics, customized diets that
account for an individuals food sensitivities or family, as well as social and religious duties. A Macrobiotics is a Japanese
allergies, and very low-fat or low-carbohydrate reprieve from personal responsibility for well- diet based on brown rice,
diets are a few of the other ways in which health is being is also given, with care provided by rela- miso soup, and vegetables
promoted by some people through food habits. tives, healers, or health professionals. The role of that was popularized in
sick person provides a socially accepted, tempo- Europe as promoting health
in the 1920s. Serious nutri-
rary respite from the physical and psychological
tional deficiencies have
burdens of everyday life, with the understanding
Disease, Illness, that sickness is not a permanent condition and
been identified in infants
and toddlers on this
and Sickness that recovery should occur.29, 75 restricted diet.18
CULTURAL DEFINITIONS OF DISEASE, Explanatory Models

ILLNESS, AND SICKNESS When unexpected events happen, there is a human
need to explain the origins and causes of seemingly
When health is diminished, a person experiences
random occurrences. Explanatory models congru-
difficulties in daily living. Weakness, pain and
ent with a cultures worldview are used to account
discomfort, emotional distress, or physical debil-
for why good or evil happens to a person or a com-
itation may prevent an individual from fulfilling
munity and to calm individual fears of being vic-
responsibilities or obligations to the family or
timized. In sickness, the explanatory model details
society. Researchers call this experience illness,
the cause of disease, the ways in which symptoms
referring to a persons perceptions of and reac-
are perceived and expressed, the ways in which the
tions to a physical or psychological condition,
illness can be healed and prevented from reoccur-
understood within the context of worldview. In
ring, and why one person develops a sickness while
biomedical culture, illness is caused by disease,
another remains healthy.41
defined as abnormalities or malfunctioning of
The etiology of sickness is of central concern
body organs and systems. The term sickness is
because the reason an illness occurs often deter-
used for the entire diseaseillness process. When
mines the patients outlook regarding the progres-
an individual becomes sick, questions such as
sion and cure of the sickness. In biomedical
how did the illness occur, how are the symptoms
culture three causes of disease are identified:
experienced, and how is it cured ariseanswered
(1) immediate causes, such as bacterial or viral
primarily through cultural consensus on the
infection, toxins, tumors, or physical injury;
meaning of sickness.
(2) underlying causes, including smoking, high
Becoming Sick cholesterol levels, glucose intolerance, or nutri-
tional deficiencies; and (3) ultimate causes, such as
During the onset of a sickness, physical or behav-
hereditary predisposition, environmental stresses,
ioral complaints make a person aware that a prob-
obesity, or other factors.14 The causes of illness
lem exists. The development may be slow and the
are generally more complex. Four theories on the
symptoms may take time to manifest into a dis-
etiology of sickness prevalent in most societies
ease condition, or they may occur suddenly, with
have been described (Figure 2.1): those originat-
little question as to the presentation of illness.
ing in the patient, those from the natural world,
Except in emergencies, an individual usually
those from the social world, and those due to
seeks confirmation of illness first from family or
supernatural causes.29 It is important to note that
friends. Symptoms are described and a diagnosis
in no society do all persons subscribe to any
is sought. A knowledgeable relative is often the
single cause, and there is considerable variation
most trusted person in determining whether a
in degree of belief intraculturally as well as inter-
condition is cause for concern and whether fur-
culturally. Additionally, credence in a cause does
ther care should be pursued; in many cultures, a
not necessarily result in a practice associated
mother or grandmother is the medical expert
with a cause.
within a family. This is a major step in social
legitimization of the sickness. If others agree that Sickness Due to the Patient. First are those
the person is ill, then the individual can adopt a sicknesses that develop within the individual
new role within the family or communitysick patient, usually attributable to a persons consti-
person. In this capacity the sick person is excused tution or lifestyle; that is, an individual has a
from many daily obligations regarding work and genetic or psychological vulnerability to illness or
Sickness Due to the Social World. Sickness

The Supernatural World attributed to social causes occurs around inter-
personal conflict within a community. It is
The Social World common to blame an enemy for pain and suffer-
The Natural World ing. Inadvertent or purposeful malevolence is the
source of illness and disease in many cultures.
The Patient
Among the most common causes is the evil eye.
It is widely believed in parts of Africa, Asia,
Europe, Greece and the Middle East, India, Latin
America, and some areas of the United States that
an individual who stares (especially with envy)
can project harm on another person, even if the
gaze is unintentional. Children are believed to be
Figure 2.1 particularly vulnerable to the evil eye, resulting in
Client theories on the colic, crying, hiccups, cramps, convulsions, and
etiology of sickness. seizures. Among adults, the evil eye can cause
Source: From C. G. Helman disease, either an inherited weakness or emotional
headache, malaise, complications in pregnancy
(1990), Culture, Health, and susceptibility, such as depression. Sickness may
and birth, impotence and sterility in men, and
Illness (2nd ed.). Reprinted with also be due to lifestyle choices. A person in the
insanity.28 Protections against the evil eye include
permission from Butterworth- United States may be blamed for a heart attack if
Heinemann. such practices as placing a red bag filled with
he has become overweight, eats fatty foods,
herbs on an infants crib in Guatemala; knotting
smokes tobacco, and never exercises. A person
black or red string around childrens wrists in
who fails to wear a seat belt and then is injured in
India; leaving children unwashed and unad-
an auto accident may also be found at fault.
mirable in Iran; wearing a charm in the form of a
Responsibility for sickness falls primarily on the
black hand (mano negro) in Puerto Rico; and
patient, although in many other cultures when a
painting a house white and blue to blend with the
persons actions are unfavorable to health, it is
sky, thus avoiding notice, in Greece. Eastern
outside forces that are thought to actually cause
European Jews wear a red ribbon; Sephardic Jews
an illness or accident in retaliation for the
wear a blue ribbon. In Scotland a fragment of the
offense.
Bible is kept on the body, and in Muslim areas of
Sickness Due to the Natural World. Etiology Southeast Asia, a piece of the Koran is worn.75
in the natural world includes environmental Conjury is another frequent social cause of
elements such as the weather, allergens, smoke, sickness. A person with imputed powers to
pollution, and toxins. Wind or bad air is of par- manipulate the natural or supernatural world
ticular concern in many cultural groups, directs illness or injury toward an individual, or
including some Arabs, Chinese, Italians, sells the magic charms or substances necessary
Regarding the 1918
influenza epidemic, the
Filipinos, and Mexicans, because it can enter for a normal person to inflict harm. Conjury is
New York Post reported that the body through pores, orifices, or wounds in practiced by witches (called brujos or brujas in
epidemics are the punish- the body, causing illness. Viruses, bacteria, and Spanish), sorcerers, root doctors, herb doctors,
ment that nature inflicts for parasites are natural biological agents of sick- voodoo or hoodoo doctors (see Chapter 8,
the violation of her laws ness. Humoral systems, which associate various Africans), underworld men, conjure men, and
and ordinances.23 body humors with natural elements (as goofuhdus men, most of whom obtain their
described previously), connect illness and dis- powers from the devil or other evil spirit. For
ease with disharmony in the environment. example, a conjurer might sprinkle graveyard
Astrology, which determines an individuals dust under a persons feet, causing him to waste
fate (including health status) through planetary away, known as fading in rural African-American
alignment at the time of birth, is another natu- tradition. A bundle of sticks placed in the kitchen
ral world phenomenon. Injuries due to natural will cause illness in people who consume food
forces, such as lightning or falling rocks, are prepared there. A brujo can cause illness in
sometimes categorized with this group; how- Latinos through contagious magic, using bits of a
ever, many cultures believe such accidents are persons hair or fingernails when casting a spell.
actually the result of supernatural injunction. Native American conjury often uses animals or
natural phenomena (such as lightning) to attack disorders. Certain symptoms, complaints, and Other names for the evil eye
a victim, or causes natural objects to be inserted behavioral changes are associated with specific in the United States include
into the body, resulting in pain. The witched conditions and are termed folk illnesses or culture- the bad eye, the look, the
Native American may behave in inexplicable, dis- bound syndromes. Examples of such sicknesses narrow eye, and the wound-
ing eye. Those who are vic-
ruptive ways and may be abandoned by the com- are numerous, such as cases of soul loss experi-
tims have been blinked, eye
munity if considered incurable and unable to enced by some Asians, Latinos (who call it susto
bitten, forelooked, or over-
change undesirable conduct.25, 32, 75 There is often or espanto), Native Americans, Pacific Islanders, looked.
an overlap between sickness attributed to the and Southeast Asians. Muso, experienced by
social world and that caused by supernatural young Samoan women as mental illness, and Fear of the evil eye is men-
forces. sudden unexpected nocturnal death syndrome tioned in Talmudic writings,
(SUNDS) suffered by Cambodians (see the previ- the Bible, and the Koran.
Sickness Due to the Supernatural World. In ous section, Sickness Due to the Supernatural
the supernatural realm, sickness is caused by the World) are cases of folk illness due to evil spir-
actions of gods, spirits, or the ghosts of ancestors. its. Strong emotions, particularly fright or anger,
The will of God is a prominent factor in illness cause many folk conditions, such as stroke pre-
and disease suffered by many Jews, Christians, cipitated in bilis or colera in some Guatemalans,
and Muslims. Sickness is sometimes considered a the cooling of the blood and organs in ceeb
punishment for the violation of religious among the Hmong, or the stomach and chest
covenants, and other times it is viewed as simply pain of hwabyung in some Koreans. Psychologi-
a part of Gods unknowable plan for humanity. cal distress is often expressed through somatic
Even those persons who do not follow a specific complaints in some cultures; for instance, an
faith may ascribe illness to fate, luck, or an act of Asian Indian may present symptoms of extreme
God. Some Africans, Asians, Latinos, Middle stress as burning on the soles of the feet, or a
Easterners, American Indians, and Pacific depressed Asian Indian man may experience dhat,
Islanders believe that malevolent spirits can the loss of semen.
attack a person, causing illness. For example, Diet-related folk illnesses are common. High
among Cambodians, death can occur when the blood and low blood among some African
nightmare spirit immobilizes a victim through Americans are examples. Depending on the cul-
sitting on his or her chest and causing extreme tural group, imbalance in the digestive system
fright.1 In other situations spirit possession takes results in numbness of the extremities (si zhi
place. An evil spirit inhabits the body of a victim ma mu) in some Chinese; nausea and the feeling
who then exhibits aberrant behavior, such as of a wad of food stuck in the stomach (empacho)
incoherent speech or extreme withdrawal. Many among Mexicans; and paralysis in some Puerto
Southeast Asians associate caretaker spirits with Ricans (pasmo). The eating disorders anorexia
body organs and life forces that may desert a nervosa (a fear of fat and failure to maintain body
person when angered or frightened, leaving that weight resulting in a weight 15 percent or more
individual vulnerable to sickness. In addition, the below that recommended) and bulimia nervosa
ghosts of ancestors usually protect their living (binge eating followed by the use of self-induced
relatives from harm, but may inflict pain and ill- vomiting, laxatives, enemas, or medications to
ness when ignored or insulted. reduce calorie intake, or the use of excessive exer-
One of the most common causes of sickness in cise or fasting) are sometimes described as a
many cultures is soul loss, when the soul detaches culture-bound syndrome in the United States
from a persons body, usually due to emotional dis- and other westernized nations, associated with
tress or spirit possession. The symptoms typically issues such as the drive to thinness, body image,
include general malaise, listlessness, depression, a maturity, and control.6, 37, 64 In the case of
feeling of suffocation, or weight loss. If left anorexia, it is usually the biomedical culture that
untreated, soul loss can lead to more serious illness. identifies the symptoms as a disease state. Many
anorectics do not consider themselves ill or in
Folk Illnesses need of medical intervention. Such differences
Inasmuch as sickness is culturally sanctioned in the definition of sickness account for why
and explained through culture-specific models, some conditions, such as anorexia or other folk
it follows that each culture recognizes different illnesses, are difficult to cure with biomedical
approaches. Effective treatment of many sick- or recurrent sickness, biomedical, Traditional

nesses depends on agreement between the patient Chinese Medicine, and spiritual approaches
and the practitioner regarding how the illness has would be attempted concurrently.40 The use of
occurred, the meaning of the symptoms, and how multiple approaches is particularly common
the sickness is healed.41 when there are concerns that a condition is cul-
ture specific.38, 51, 53, 63
Research suggests that large numbers of
HEALING PRACTICES Americans obtain health care outside the biomed-
Biomedicine has increasingly focused on disease ical system for minor and major illnesses.6, 34, 41 As
to the exclusion of illness. Biomedical health pro- many as one-third to one-half of patients with
Tony Freeman/PhotoEdit, Inc.
fessionals attempt to diagnose and cure the struc- intractable conditions (i.e., back pain, chronic
tural and functional abnormalities found in renal failure, arthritis, insomnia, headache,
patient organs or systems. In contrast, healing depression, gastrointestinal problems), terminal ill-
addresses the experience of illness, alleviating the nesses such as cancer or acquired immune defi-
infirmities of the sick patient even when disease ciency syndrome (AIDS), and eating disorders seek
is not evident. Healing responds to the personal, unconventional treatment. Nearly all do so without
Body image is one area familial, and social issues surrounding sickness. the recommendation of their biomedical doctor,
where the viewpoint of the integrating multiple therapies on their own.
client may vary from the bio-
Seeking Care Biomedicine is rejected by some people
medical assumptions of the When sickness occurs, a person must make because their experience with care has been
health care provider. Many choices regarding healing. Professional biomed- impersonal, costly, inconvenient, or inaccessible.
anorectics do not consider ical care, if available, is usually initiated when the Further, conventional treatments may have been
themselves in need of med- onset of symptoms is acute or an injury is serious. painful or harmful. Some clients believe that bio-
ical intervention. Nearly all cultural groups recognize the value of medical professionals are hostile or uninterested
biomedicine in emergencies. in ethnic health issues.30, 31, 57 Often, the biomed-
Choice of care often depends on the patients ical approach is incongruent with the patients
view of the illness in cases when the sickness is not perspective on sickness. The health care profes-
life-threatening. In these situations, home reme- sional may express disdain for explanations of
dies are generally the first treatment applied.28, 66 etiology that disagree with the biomedical view-
Therapies may be determined by the patient alone point or dismiss complaints with no discernible
or in consultation with family members, friends, clinical diagnosis as insignificant. Folk healers
Disordered eating is diag-
nosed in all U.S. ethnic or acquaintances. If the remedies are ineffective, if and other alternative practitioners can provide an
groups and is increasing in other people encourage further care, or if the indi- understanding of illness within the context of the
many populations world- vidual experiences continued disruption of work, patients worldview and can offer care beyond the
wide. Some researchers social obligations, or personal relationships, pro- cure of disease, including sincere sympathy and
believe that the role of fessional advice may be sought. The type of healer renewed hope.
acculturation and western- chosen depends on factors such as availability,
ization is significant, and it cost, previous care experiences, referrals by rela- Healing Therapies
has been suggested that tives or friends, and how the patient perceives the No consensus prevails among researchers on the
culture-change syndrome is problem. If the patient suffers from a folk illness, classification of what is called unconventional,
a more appropriate descrip-
a folk healer may be sought immediately because alternative, or folk medical care. Home remedies
tion than culture-bound syn-
biomedical professionals are considered ignorant (i.e., herbal teas, megavitamins, relaxation tech-
drome.46, 78
about such conditions. Otherwise, biomedical niques), popular therapies (i.e., chiropractic,
care may be undertaken, independently or simul- homeopathy, hypnosis, massage), and profes-
taneously with other approaches. A study of sional practices (i.e., those that require extensive
Taiwanese patients revealed that in acute illness, academic training in conventionally recognized
biomedical care was initially sought; but, if medical systems, such as biomedicine, Tradi-
treatment was ineffective, traditional Chinese tional Chinese Medicine, and Ayurvedic medi-
medical practitioners were employed; if there was cine) include a variety of treatments that fall into
no progress in healing, another traditional special- three broad categories: (1) administration of
ist would be tried; and if the patient was still therapeutic substances, (2) application of physi-
afflicted, sacred healers would be sought. In chronic cal forces or devices, and (3) magicoreligious
CULTURAL CONTROVERSYBotanical Remedies
M ore than 80 percent of the

worlds population uses
herbal remedies to treat
illness and optimize health. Technically, an
herbal medicine contains only leafy plants
proponents note that botanicals have been
used for centuries and that reported deaths
each year number in only the hundreds,
compared to over 100,000 deaths due to
prescription druginduced conditions.39, 44
Unfortunately, the explosive, unregu-
lated growth of the industry has resulted
in numerous problems. Of particular con-
cern is the interaction of botanicals when
used with biomedical therapies. For
that do not have a woody stem.20 A more The key word is reported. The Dietary example, gingko biloba reduces the effec-
comprehensive term is botanical, including Supplement Health and Education Act tiveness of some prescription drugs, such
all therapeutic parts of all plants, from the (DSHEA) passed by Congress in 1994 as certain antacids and antianxiety med-
root (e.g., ginseng), the bark (e.g., willow), defines dietary supplements as separate ications, while potentiating others,
the sap (e.g., from aloe), the gum (e.g., from food and drugs and thus outside the including anticoagulants, antidepres-
frankincense) or oil (e.g., from nutmeg), scope of federal monitoring. Manufacturers sants, and antipsychotics.10 In addition,
the flowers (e.g., echinacea), the seeds are exempt from regulations requiring that some botanicals can interact adversely
(e.g., gingko biloba), to the fruit (e.g., bil- complaints, injuries, or deaths due to con- with anesthesia, and others can increase
berries). Botanical remedies often use the sumption of their product be reported to side effects of radiation therapy.32
whole plant, which practitioners claim is the Food and Drug Administration (FDA). Consumers may also experience allergic
superior to using a single active extract Though the FDA retains the right to reactions or poisoning due to interaction
because other components in the plant protect the public from harmful products, between two or more products, and some
may work together synergistically in the the burden of proof is on the government researchers suggest autoimmunity dis-
preparation to enhance the therapeutic to prove that a particular botanical remedy eases may be triggered by use of
value and to buffer any side effects. For this is unsafe. Many manufacturers have volun- immune-boosting herbs in persons pre-
same reason, plants are often combined in tarily adopted good manufacturing disposed to such disorders.7, 11, 45 Further,
formulary mixtures, particularly in processes, and the American Herbal natural products can be adulterated with
Traditional Chinese Medicine. Products Association has created a botani- pesticides, heavy metals (such as mer-
Most consumers select botanical reme- cal safety rating system that classifies cury), or prescription drugs (such as war-
dies instead of biomedicine because they herbs as (1) safe when consumed appropri- farin or alprazolam).15 (Tables of selected
believe they are safer and more effective ately; (2) restricted for certain uses; (3) use botanical remedies for each ethnic group
than prescription drugs or they are treating only under the supervision of an expert; are available through the Food and
chronic conditions for which biomedicine and (4) insufficient data to make a safety Culture book companion website.)
has little to offer in the way of relief. Some classification.
interventions.56, 75 Most patients use unconven- Americans used biologically based remedies, The person most likely to
tional therapies without the supervision of a bio- including high doses of vitamins, during the pre- use complementary and
medical doctor or any other kind of health care vious month.5 Home remedies and health practi- alternative medicine in the
provider. Popular and professional practitioners, tioners other than biomedical professionals often United States is a middle-to
upper-class white or Asian
when consulted, may use one or several of these emphasize the use of botanical medicine, which
woman who is well
treatments in healing a patient. includes whole plants or pieces (particularly
educated in consumer
herbs), and occasionally animal parts, such as health issues and lives in an
Administration of Therapeutic Substances. antlers or organs, or certain powdered mineral urban area in one of the
Biomedical pharmaceutical and diet prescrip- elements. In many cultures healers specialize in Pacific states.5
tions are two of the most common types of ther- the use of herbal preparations; often they are
Medications using digitalis,
apeutics in this category, which also includes elder men or women with intimate knowledge of
opiates, and salicylates,
over-the-counter medications, health food prepa- the natural environment. Root doctors and
common today as biomed-
rations, and prepackaged diet meals, as well as remdemen in the American South, and the ical therapeutics, were first
vitamins and mineral supplements. In a 2002 proprietors of botnicas (herbal pharmacies) used by folk healers.
survey it was estimated that nearly 62 million found in some Latino neighborhoods are a few
through manipulation of the musculoskeletal

system, particularly the correction of posture
problems, mobilization of bone joints, and spine
alignment. Health problems are treated through
restoration of mobility and suppleness.
Several Asian healing therapies can be classi-
fied as the application of physical forces or
devices and are practiced by family members in
the home, by folk healers, by specialists in the
therapies, or by traditional Chinese medical
physicians. Massage therapy, acupressure, and
pinching or scratching techniques are used to
release the vital energy flow through the twelve
Mitch Hrdlicka/Getty Images
meridians of the body identified in Traditional

Chinese Medicine, primarily by relieving muscle
tension so that oxygen and nutrients can be deliv-
ered to organs and wastes removed. Coining is a
related practice in which a coin or spoon is
rubbed across the skin instead of pressing or
Ginseng, a root found in both pinching specific points. Acupuncture is similar
North America and Asia, is examples. In addition to folk healing, both
to acupressure in that it attempts to restore the
one of the most common Traditional Chinese Medicine and Ayurvedic
balance of vital energy in the body along the
herbal remedies used in the medicine make extensive use of botanical medi-
meridians, but it differs in that it stimulates spe-
nation. It reputedly pro- cine (see the chapters on each American ethnic
cific junctures through the insertion of nine types
motes health through group for more details).
increased strength and vital-
of very fine needles. The needles do not cause
Homeopathy also prescribes therapeutic sub-
ity, and may be taken specifi- bleeding or pain. Acupuncture is considered
stances, such as botanical medicine, diluted
cally to treat digestive upset, useful in correcting conditions where too much
venom, or bacterial solutions, and biomedical
anxiety, or sexual impotence. heat (yang) is present in the body. In conditions
drugs. Originating in Germany, homeopathy is
of too much cold (yin), another technique is pre-
based on the concept that symptoms in illness are
ferred, called moxibustion, in which a small
evidence that the body is curing itself, and accel-
burning bundle of herbs (e.g., wormwood) or a
eration or exaggeration of the symptoms speeds
smoldering cigarette is touched to specific loca-
healing. One primary tenant is that like cures
tions on the meridians to restore the balance of
like. Naturopathic medicine also focuses on help-
energy. A similar method is cupping, the place-
ing the body to heal itself, usually through non-
ment of a heated cup or a cup with a scrap of
invasive natural treatments (including some
Naturopathic doctors trained
burning paper in it, over the meridian points.39
physical manipulations, as the following section
in the United States attend a Application of electricity is used in various elec-
describes), although biomedical drugs and sur-
four-year program including trotherapies, primarily to stimulate muscle or bone
gery are used in certain cases. Nutritional ther-
many biomedical disciplines. healing, especially in sports medicine. Biofeedback
apy, based on whole foods and dietary
Doctors of Chiropractic (DC) also uses small electric pulses to teach a person
supplements, is the foundation of naturopathic
are the third largest cate- how to consciously monitor and control normally
gory of health care practi- health maintenance and healing.
involuntary body functions, such as skin tempera-
tioners in the United States, Application of Physical Forces or Devices. ture and blood pressure, to alleviate health prob-
following physicians and Manipulations of the body operate on the shared lems, which include insomnia, gastrointestinal
dentists. Osteopaths are conditions, and chronic pain. Hydrotherapy
premise that internal functioning improves
licensed to prescribe medica-
with minor adjustments of physical structure. involves the application of baths, showers,
tions and perform surgery as
Doctors of Osteopathy (DO) Chiropractic theory states that misalignments of whirlpools, saunas, steam rooms, and poultices to
in all 50 states. the spine interfere with the nervous system, relieve the discomforts of back pain, muscle ten-
interrupting the innate intelligence that regu- sion, arthritis, hypertension, cirrhosis of the liver,
Kur (spa) therapy is popular lates the body, resulting in disease and disorder. asthma, bronchitis, and head colds. In addition to
throughout Europe, particu- Osteopathic medicine proposes that blood and the hydrotherapeutic qualities, the mineral con-
larly in Germany. lymph flow, as well as nerve function, improves tent of the water is considered stimulating.
Magicoreligious Interventions. Spiritual heal-

ing practices are associated with nearly all reli-
gions and cosmologies. They typically fall into
two divisions: those actions taken by the individ-
ual, and those taken on behalf of the individual
by a sacred healer.
In Western religious traditions, God has
power over life and death. Sickness represents a
breach between humans and God. Healing is
integrally related to salvation because both mend
broken ties.85 Living according to Gods will is
W. B. Spunbarg/PhotoEdit, Inc.
necessary to prevent illness, and prayer is the
most common method of seeking Gods help in
healing. Roman Catholics, for example, make
appeals to the saints identified with certain afflic-
tionsSt. Teresa of Avila for headaches, St.
Peregrine for cancer, St. John of God for heart
disease, St. Joseph for the terminally ill, and St.
Acupuncture attempts to
Bruno for those who are possessed are just a few include prayers, blessings, chanting or singing, restore the balance of vital
examples. Pilgrimages to the shrines of these charms, and conjury, as well as the use of thera- energy in the body through
saints are made for special petitions. In Eastern peutic substances (i.e., herbal remedies) and the use of special needles.
religions, health is determined mostly by correct application of physical cures (i.e., the laying on of
conduct in this and past lives, as well as in the hands). Faith healers, most of whom get their
virtuous behavior of ancestors. Religious offer- healing gifts from God, are common among
ings are made regularly; for instance, Hindus many Christian groups. Some are affiliated with
choose a personal deity to worship daily at a certain denominations and rites, such as the
home shrine. Improper actions leading to dishar- Cajun traiteurs of Louisiana, who specialize in
mony within a person, family, community, or the treating one or two ailments through prayers and
supernatural realm can cause sickness. Healing charms associated with Catholicism.9, 49 Others,
occurs through restoration of balance, often such as the sympathy healers of the Pennsylvania
including offerings to the deities or spirits of the Dutch who practice powwowing (also known by
living and dead who have been offended. the German name Brauche or Braucherei), are
Individual healing practices developed out of considered the direct instruments of God.58, 85
religious ritual include meditation, a contempla- Persons with a spiritual calling are often
tive process of focused relaxation; yoga, the con- employed to treat illness. Neng among the Hmong,
trol of breathing and use of systematic body Mexican curanderos (or curanderas), practitioners
poses to restrain the functions of the mind and of voodoo in the American South, and espiritos or
promote mindbody unity; and visualization or santeros (or santeras) in the Caribbean may com- Eighty percent of respon-
guided imagery, induced relaxation and targeted municate with the spirits or saints to heal their dents in a study on faith and
willing away of health problems. Each concen- patients. Ceremonial invocation is the primary healing in the southeastern
trates the power of mind on reducing health therapy, although charms and spells to counteract United States said they
risks, such as stress, high blood pressure, and witchcraft and botanical preparations to ease believe God acts through
decreased immune response, or on alleviating physical complaints are used as well. physicians to cure illness.52
specific medical conditions. Hypnotherapy works Shamans, called medicine men among many
in a similar manner; although it is generally done Native American groups, are sacred healers with Powwowing is not an
with the aid of a hypnotherapist, self-hypnosis American Indian practice;
exceptional powers. They originated in Russia an
the faith healer asks for
can be learned for personal use. estimated 20,000 years ago and spread through- direct assistance from God
In many cases the spiritual skills of the indi- out the world to the indigenous cultures of the in curing the sick person
vidual are inadequate for the problem, and the Americas, Southeast Asia, Indonesia, Polynesia, through the use of charmed
help of a sacred healer is sought. These health and Australia. Remote tribal groups found in objects, such as knotted
practitioners generally work through interven- Africa, India, and Korea have similar healers. A strings or nails, and prayer
tions with the supernatural world, which may shaman is a composite priest, magician, and or incantation.
A study of physician beliefs doctor; the position is passed on from generation and convenient treatment from a warm and
about health and religion to generation, or through a calling that could caring provider. The personal relationship with
found that although 91 per- include fainting spells or convulsive fits due to the healer is as important as the actual therapy
cent of respondents said attacks by spirits. Shamans typically complete (see Chapter 3).
knowledge of a clients
lengthy apprenticeships and are initiated through Biomedical professionals often operate in
faith practices is important
a series of trials simulating death and rebirth. In partnership, knowingly or not, with unconven-
in care, only 32 percent ask
about religious affiliation.13 shamanic systems, sickness is due to spiritual tional health care practitioners. A small study of
crisis, and healing emphasizes strengthening of prostate cancer patients reported that 37 percent
When Navajos dream fre- the soul through redirection of the life forces or, used alternative therapies in conjunction with
quently of death, it is usu- in cases of serious illness, retrieval of the soul, radiation treatment. A separate survey found that
ally considered a sign of which may have been stolen by evil spirits. their physicians believed only 4 percent of these
serious illness. Shamanic practices include visualization tech- patients used any other health care practices.34
niques to create harmony between the patient Researchers suggest care is optimized when
Consultation with a Native and the universe, singing, chanting, prognostica- providers work together rather than at cross pur-
American medicine man tion, dream analysis, and sances. Shamans are poses. Patients are sometimes put in the confus-
may take hours to com- often expert herbalists.3, 72 ing position of choosing between biomedical
plete; some healing cere- and traditional systems that contradict or reject
monies take a week to
each other.53
perform and may cost thou-
Studies suggest that some unconventional
sands of dollars.27
Pluralistic Health therapies are effective, benefiting the patient
physiologically or psychologically, and should be
Care Systems accepted as complementary to biomedical
approaches.56 Cooperative monitoring by a bio-
The enduring popularity of traditional health medical professional can also detect those few
beliefs and practices is based in cultural congru- instances when a home remedy or popular prac-
ency. Healing sickness, with or without the serv- tice is harmful to the patient. Furthermore, bio-
ices of an expert provider, takes place according medical health care providers can adopt certain
to a patients worldview. Humans value what val- healing strategies. Understanding the patients
idates their beliefs and discount anything that perspective on illness and attending to differ-
differs, regardless of statistical data or scientific ences in the patientprovider explanatory models
claims; they give disproportionate credence to is one approach.40 Recommending alternate,
persons they like and respect. experimental biomedical programs in cases of
advanced chronic disease is another.56 A more
comprehensive methodology is offered through
MEDICAL PLURALISM transcultural nursing theory, developed to pro-
Medical pluralism is the term for the consecutive vide cultural congruent care that is beneficial, sat-
or concurrent use of multiple health care sys- isfying, and meaningful to clients.48 Transcultural
tems.14 Although it is often assumed that ethnic nursing theory identifies three modes of effective
minorities, the poor, the less educated, or recent care: (1) cultural care preservation and/or main-
immigrants are most likely to rely on traditional tenance, (2) cultural care accommodation and/or
folk medicine, studies report that the use of heal- negotiation, and (3) cultural care repatterning, or
ers in some groups increases with education and restructuring.
income level. Further, acculturation is not associ- Cultural care preservation and/or mainte-
ated with a rise in the use of biomedical serv- nance is used when a traditional health belief or
ices.70, 74 Medical pluralism is widespread in the practice is known to be beneficial in its effect and
United States. is encouraged by the provider. Cultural care
accommodation and/or negotiation is accom-
plished between the provider and the patient
BIOMEDICAL HEALING (or the patients family) when there is an expecta-
Clients using traditional health practices are gen- tion for care that is outside biomedical conven-
erally seeking to alleviate the difficulties experi- tion. Cultural care repatterning or restructuring
enced in illness through understandable, flexible, occurs when both provider and patient agree that
a habit is harmful to health, and a cooperative plan mental, and social well-being, not merely an In one study, pregnant
is developed to introduce a new and different absence of disease or infirmity? Hmong women showed dra-
lifestyle. Applied to food habits, the culture care 4. Describe there ways that diet may be used to matic increases in accept-
theory acknowledges that some traditional beliefs promote or maintain health using specific ance of invasive procedures,
such as pelvic exams and
and practices regarding diet have beneficial or neu- examples of foods and practices.
blood tests, after viewing a
tral consequences, some have unknown conse- 5. What is meant by folk illnesses or culture-
video in the Hmong lan-
quences, and some may be deleterious to the health bound syndromes? Using one example, guage acknowledging the
of a client (see Chapter 1, Food and Culture). explain how would effective treatment for value of traditional prac-
In addition to specific provider approaches, the the condition differ from the conventional tices and explaining the
health care setting can also help promote biomed- biomedical approach. rationale of the biomedical
ical healing through services desired by clients in a procedures.76
comfortable, welcoming atmosphere. Some health CHAPTER 2 REFERENCES
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77. Talamayan, K.S., Springer, A.E., Kelder, S.H., Intercultural Press.
Gorospe, E.C., & Joye, K.A. 2006. Prevalence of 85. Yoder, D. 1976. Hohman and Romanus: Origins
overweight misperception and weight control and diffusion of Pennsylvania German powwow
behaviors among normal weigh-adolescents in manual. In W.D. Hand (Ed.), American Folk
the United States. Scientific World Journal, 6, Medicine. Berkeley: University of California Press.
365376. 86. York-Crowe, E.E., & Williamson, D.A. 2005.
78. Tsai, G. 2000. Eating disorders in the Far East. Health and appearance concerns in young
Eating and Weight Disorders, 5, 183187. Caucasian and African-American women. Eating
79. Wang, C.Y., Abbot, L., Goodbody, A.K., & Hui, and Weight Disorders, 10, e38e44.
W.T. 2002. Ideal body image and health status in
CHAPTER
3
Intercultural
Communication
N o matter whether a person is interacting socioeconomic status, health condition, religion,

with people from diverse cultural groups educational background, group membership,
at work and in social settings, or traveling sexual orientation, or political affiliation.
to another country for business or pleasure Most people are comfortable conversing with
(Table 3.1), intercultural communication skills those who are culturally similar to themselves.
are needed to successfully negotiate daily life. Communication is sometimes described as an
Intercultural communication is a specialty in action chain,40 meaning that one phrase or action
itself. The field encompasses language and the leads to the next: in the United States, a person
context in which words are interpreted, including who extends her hand in greeting expects the
gestures, posture, spatial relationships, concepts other person to take her hand and shake it, or
of time, the status and hierarchy of persons, the when a person says thank you, a youre
role of the individual within a group, and the set- welcome should follow. Communication is a
ting. This chapter presents a broad and limited whole series of unwritten expectations regarding
overview of intercultural communication concepts, how a person should reciprocally respond, and
as well as information useful in diet counseling such expectations are largely cultural in origin. If
with individuals or with groups in nutrition edu- a person understands the communication action
cation programs. Later chapters on each American chain and responds as expected, a successful rela-
ethnic group provide more specific details as tionship can develop. When a person does not
reported by researchers and practitioners familiar respond as expected, communication can break
with cultural communication characteristics. down, and the relationship can deteriorate.54
When meeting a person for the first time, the
only data speakers usually have to work from
are their own cultural norms. They use these
The Intercultural norms to predict how that person will respond to
their words and what conversational approaches
Challenge are appropriate. They may also use social roles
Observe the nature of each
to determine their communication behavior.
country; diet; customs; the
Researchers use an iceberg analogy (Figure 3.1) Furthermore, speakers modify their words and
age of the patient; speech;
to describe how a persons cultural heritage can actions as they get to know a person individually, manners; fashion; even his
impact communication.54 Ethnicity, age, and gender observing personal cues about communication silence. . . . One has to study
are the most visible personal characteristics idiosyncrasies that vary from cultural or social all these signs and analyze
affecting dialoguethe so-called tip of the ice- customs.37 An employee, for example, may make what they portend.
berg. Beneath the surface, but equally influential, certain assumptions about a supervisor based on Hippocratic writings, fifth
may be degree of acculturation or assimilation, ethnicity, gender, or age, and especially occupational century B.C.E.
58 INTERCULTURAL COMMUNICATION
Table 3.1 If the world contained only 100 people, there would be. . . become a self-fulfilling prophecy. For instance,
61 from Asia 33 Christians 50 Women Asians have a reputation for being restrained in
conversation compared to the typical American
12 from Africa 22 Muslims 50 Men
approach. A nutrition education provider teaching
12 from Europe 16 Non-religious 27 Aged 0-14 a prenatal care program may respond to more
9 from Latin 15 Hindus 66 Aged 15-64 aggressive speakers during a group meeting, fail-
America/Caribbean 7 Indigenous or other 7 Over the age of 65 ing to actively involve a Vietnamese-American
religion followers participant. The Vietnamese-American woman
5 from North America
may feel the provider is disinterested in her ques-
6 Buddhists
1 from Oceania/ tions or comments, becoming even less likely to
Australia/New Zealand 1 Jew offer input at the next meeting, reinforcing the
providers perception that all Asians are quiet.
The challenge is to increase familiarity with
cultural communication behaviors, while remain-
status and then make adaptations. For example, ing aware of personal cues and moving toward an
an employee may start out calling his boss interpersonal relationship as quickly as possible.
Mrs. Smith as a sign of respect for her position
but use the more informal Sue when she
requests that he call her by her first name.
Interpersonal relationships between two indi-
Intercultural
viduals are based mostly on personal communica- Communication
tion preferences; group interactions commonly
depend on cultural or social norms. Misinter- Concepts
pretations at the cultural or social levels of com-
munication are more likely to occur because they Communication uses symbols to represent
are more generalized. As mentioned in Chapter 1, objects, ideas, or behaviors. Thoughts, emotions,
stereotyping occurs if a person overestimates and attitudes are translated into language and
another individuals degree of association with any nonverbal actions (i.e., gestures, posture, eye
particular cultural or social group. Only about contact) to send messages from one person to
one-third of the people from any given group are another. Only the person sending the message
believed to actually behave in ways typified by the knows the meaning of the message: the person
group as a whole.37 Assumptions about how a receiving the message must use what she knows
person of a different cultural heritage should com- about cultural and social norms, as well as what
municate can elicit certain types of reactions based she knows about the speaker personally, to
on norms in that persons culture: stereotyping can interpret the message.
The two components of the message are the
content and the relationship between the speaker
and the receiver. Depending on the situation, the
content or the relationship may assume greater
prominence in interpretation of meaning. Messages
that violate cultural expectations may be accurate
in content but have a negative impact on the rela-
tionship. If the message consistently offends the
Text not available due to copyright restrictions receiver, the relationship will deteriorate and the
message will be disregarded. For example, if a
health professional advises a Chinese client to
increase calcium intake through increased milk
consumption, it is a high-content message but
does little to acknowledge the role of milk in the
Chinese diet. Is the client lactose-intolerant?
Does the client like milk? Does the client classify
milk as health promoting or as a cause of illness?
Chapter 3: Intercultural Communication 59
How does milk fit into the balance of the diet

according to the client? Unless the provider gains
an understanding of how the client conceptual-
izes the situation, the content of the message may
be ignored because the client assumes disinterest
or even disrespect for personal beliefs and expec-
tations. Thus, the providerclient relationship is
weakened. Messages that demonstrate respect
for the individuality of the receiver are called
Tom McCarthy/PhotoEdit, Inc.

personal messages and improve relationships; those
that are disrespectful are termed object messages
and often degrade relationships. Communication
occurs in a continuum between personal and
object messages.54
Verbal messages are most useful for commu-
nicating content, while nonverbal messages usu-
Only the person sending the
ally convey information about relationships. If the message knows the meaning
nonverbal message is consistent with the verbal In most Western cultures, messages usually
of the message the recipi-
message, it can build the relationship and help concern ideas presented in a logical, linear
ent must use what he or she
the receiver correctly interpret the meaning sequence. The speaker tries to say what is meant knows about cultural and
intended by the speaker. When the nonverbal through precise wording, and the content of the social norms, as well as what
message is inconsistent with the verbal message, language is more objective than personal along is known about the speaker
both the relationship and the content are under- the continuum of personal and object messages. personally, to interpret the
mined. Successful communication is dependent This communication style is termed low-context message.
on both verbal and nonverbal skills, each signifi- because the actual words are more important than
cantly impacted by cultural considerations. who is receiving the message, how the words are
said, or the nonverbal actions that accompany
them. Communication in a low-context culture is
VERBAL COMMUNICATION so dependent on words that the underlying mean-
The abstract nature of language means it can only ing is undecipherable if wording is chosen poorly Figure 3.2
be correctly interpreted within context. The cul- or deliberately to mislead the recipient. Nearly Cultural context is so
tural aspects of context are so embedded that a every American has also experienced the obtuse embedded in the individual
professional languages of attorneys or scientists that many people believe it
speaker often believes they are innatethat is,
who fail to convey their message in common ter- is innate and assume all
that all other people must communicate accord- other people share the
ing to the same expectations. Context includes minology. The Swiss, Germans, and Scandinavians
same background.
issues common to cultural worldview, such as the are considered examples of low-context cultures.40
Source: ID: 38626, Published in
role of the individual in a group and perceptions The New Yorker March 10, 1980.
of power, authority, status, and time. In addition,
context in communication also encompasses the
The New Yorker Collection 1980 Peter Steiner from cartoonbank.com.
significance of affective and physical expression

(termed low- or high-context) and level of toler-
ance for uncertainty and ambiguity (called uncer-
tainty avoidance). Verbal communication occurs
within these cultural premises, often operating at
an unconscious level in the speaker (Figure 3.2).
Low- and High-Context Cultures

The context in verbal communication varies cul-
All Rights Reserved.
turally. Conversational context can be defined as

the affective and physical cues a speaker uses to
indicate meaning, such as tone of voice, facial
expression, posture, and gestures.
COMMUNICATION DOS, DONTS, AND DIFFERENCESAfricans*

DO DONT DIFFERENCES
o Wait for a person to extend his or her hand for a handshake. p Speak with your hands in your pockets or on t Some Africans, such as Nigerians
Handshaking may be accompanied or replaced by hugging, your hips. Keep them at your side. and Congolese, may be quite ani-
arm slapping, and/or kissing on both cheeks, depending on mated and assertive when talking.
p Interrupt others when talking.
how well the people know each other. Muslim men and
t In Gambia a left-handed hand-
women may not touch members of the opposite sex. p Wink or make mouth noises, such as whistling,
shake is used to express a warm
which is considered vulgar.
o Stand a little closer than is typical for Americans. Stand or sit farewell, while in South Africa,
upright; do not slouch or lean. Africans feel comfortable p Show affection for members of the opposite two thumbs up indicates approval.
next to others, and strangers may choose to sit right next to sex in public.
t Some Africans point with their
you in public situations.
p Never touch Africans on the head for any chins, their noses, or their puck-
o Make eye contact when meeting, but avert eyes most of the reason. ered lips or stick their tongues out
time. to indicate a direction.
p Show the soles of your shoes or feet; do not
o Ask a lot of questions about the health and well-being of a point with your feet. t Gestures to indicate agreement or
person and his or her family before moving on to other topics. disagreement vary by nation, and
p Cross your legs at the knee; only cross at the
may include clucking the tongue,
o Be prepared for personal comments or criticisms, such as ankles.
clicking the thumbnail on the top
Why dont you have any children?or You are too thin.Use
p Beckon someone with your forefinger; any teeth, rapid nodding, or slapping
a modest, unassuming response such as I have not been
gesture that involves a closed fist or thumbs- the left hand (in a fist) with the
blessed yetor I am not as fortunate as you.Do not ask simi-
up is considered rude. right hand.
lar questions of the other person.
p Make eye contact while eating, and keep t Ethiopians may nod their heads up
o Speak in muted, reserved tones.
conversation to a minimum. and down to indicate attentive lis-
o Expect effusive, exaggerated speech that is heartfelt and earnest. tening.
p Chew gum or yawn openly.
o Casually change topics in a conversation when a delayed t Somalis tend to use their hands
p Talk about politics or current events; do not
response occurs. Unexplained pauses may indicate embar- expressively during conversation.
offer your opinion on controversial subjects.
rassment, disagreement, or anger.
Do not ask about a persons occupation,
o Africans use their right hands for any motions or gestures, income, or cost of items. Do not make any
such as passing items. Use of the left hand is offensive. off-color jokes or discuss sexual situations.
o Talk about your hobbies; express interest in the culture (e.g.,
history, food, sports) of the country.
*Foster, D. 2002. The global etiquette guide to Africa and the Middle East. New York: John Wiley & Sons.
One area of conflict often In cultures with a high-context communica- homogeneous populations with a common
found between blacks and tion style, most of the meaning of a message is understanding of the affective and physical
whites is due to differences found in the context, not in the words. In fact, the expression used in sending the message (see the
in high- and low-context wording used may be vague, circuitous, or incom- following Nonverbal Communication section).
communication. African plete. The content of the language is more personal Asian, Middle Eastern, and Native American cul-
Americans tend to be more
than objective, dependent on the relationship tures are very high-context. Latino societies are
high-context than white
Americans, using cognitive,
between speaker and listener. Attitudes and feel- moderately high-context. American culture is
affective, and physical ings are more prominent in the conversation than thought to be toward the low end, but more
responses that may appear thoughts. Communication in high-context cul- middle-context than many European societies.
disruptive or overly tures is analogous to the saying reading between In low-context cultures, communication is
emotional to whites.33 the lines. Misunderstandings easily occur if either usually explicit, straightforward, and unam-
participant is unfamiliar with the meaning of the biguous. The focus is on the speaker, who uses
nonverbal signifiers being used, such as small eye words to send messages that are often intended
movements or sounds that are made when in to persuade or convince the receiver. In high-
agreement, or disagreement, or when upset. For context cultures, indirect communication is pre-
example, white, majority Americans tend to ferred. Implicit language is used, and many
squirm a bit when uncomfortable with a conver- qualifiers are added; nonverbal cues are signifi-
sation, while the Japanese will quickly suck in air. cant to interpreting the message. The locus of
High-context cultures are most prevalent among conversation is the receiver; the speaker makes
adjustments in consideration of the listeners suggest that indirect, expressive approaches may
feelings.37 Low-context listeners are often impa- be more effective in some intercultural clinical,
tient with high-context speakers, wondering when educational, or counseling settings. Identification
the speaker will get to the point of the conversation. of a culture as either low- or high-context pro-
Low-context listeners also frequently miss the vides a general framework for communication
affective and physical expression in the message. but may be affected by other situational factors.
Health care situations are often extremely low-
context. The conversation is focused on the Individuals and Groups
provider who delivers a verbal message to the client The relationship of the individual to the group is
with little consideration for the nonverbal mes- determined in part by whether a culture is low- or
sage. The communication is high on content and high-context. In low-context cultures the individ-
low on relationship. Clients from high-context ual is typically separate from the group and self- One way to patronize a
cultures are likely to be dissatisfied, even offended, realization is an important goal. Self-esteem is person is to speak in a low-
by such impersonal, objective interactions. dynamic, based on successful mastery or control context mode, elaborating
Communication problems may not be evident to of a situation. In high-context cultures the indi- beyond what is needed for
a low-context clinician until the client leaves and vidual is usually defined by group association, understanding.
never returns. and a person desires oneness with the group, not
Even within low-context
Interactions may range from low- to high- individuation. A mutual dependency exists and
cultures, intimate conversa-
context depending on the situation, regardless of self-esteem is based on how well a person can tions are usually highly con-
the overall cultural preference. In uncomfortable adjust to a situation.38 Individualism is a promi- textual; words and phrases
or embarrassing situations, a low-context com- nent characteristic in Australia, Canada, Great may be significantly short-
municator may be very sensitive and indirect. In Britain, New Zealand, the Netherlands, and the ened or abbreviatedjust
high-context cultures, direct language is frequently United States. Collectivism is especially valued in a look may be enough for
used in intimate relationships. the nations of Denmark, Ghana, Guatemala, understanding.
As an example of low- versus high-context Indonesia, Nigeria, Panama, Peru, El Salvador,
communication in different situations, consider a Sierra Leone, Taiwan, Thailand, and Venezuela.
researcher presenting current nutritional data on In societies emphasizing individuality, a
spinach to a group of other professionals. She will person must communicate to gain acceptance by
probably speak in a relatively monotone voice the group, whether it is the family, the workplace,
and use scientific jargon. She will present her or the community. Communication is used to
points in a sequential manner, support her thesis establish the self within an individual or group
with examples, and then restate her ideas in the relationship. When meeting someone new, the
conclusion. She will probably stand erect and action chain in the conversation is flexible, with
limit the expressive use of her hands and face. few expectations. The two people may focus on
The message is almost entirely in the content of one or the other speaker and often delve into per-
the words she says. In contrast, this same woman sonal preferences, such as favorite restaurants or
might behave very differently when feeding her sports teams. When group identity is the focus of
reluctant toddler spinach for dinner. She might a society, there is no need for a person to seek
smile and make yummy sounds as she offers him acceptance from the group or to communicate
a spoonful or pretends the spinach is a plane individuality. Silence is highly valued. Interactions
coming in for a landing in his mouth. She might between strangers tend to be ritualized, and if the
give him a spoonful of meat or potato, then try action chain is broken, communication cannot
the spinach again. She might even dance around continue. The expectation is that each speaker
his high chair a little or hum a few bars of the old will indicate group affiliation and that such iden-
cartoon theme song about a sailor who liked tity conveys all the information needed to know
spinach. She doesnt try to get him to eat spinach that person.
by explaining its nutrient content, as she did at The role of the individual within the group
her meeting. The message is nonlinear and not can have an impact on health care delivery.
dependent on the content of the words she uses. Within more group-oriented cultures, greater
This is not to say that a health care provider participation is required of their members in
should burst out in song when working with a matters of health and illness, and it may be
client from a high-context culture. But it does expected that relatives will participate in giving
COMMUNICATION DOS, DONTS, AND DIFFERENCESAsians*

DO DONT DIFFERENCES
o Wait for the other person to extend his or her p Speak with your hands. Broad gestures are disdained. t The Chinese and Koreans tend to
hand for a handshake. Asians generally do not But do not speak with your hands in your pockets, be louder, and more expressive
touch each other unless they have a close rela- eitherkeep them at your sides. than the Japanese, especially after
tionship or are familiar with Western customs. getting to know you. They are also
p Hug, slap backs, kiss, or touch a stranger or acquain-
A bow is the traditional greeting gesture. more likely to show anger.
tance in any other way.
o Stand a little farther away than is typical for t Japanese may suck in air noisily to
p Show affection for members of the opposite sex in
Americans. Stand or sit upright; do not slouch demonstrate displeasure or dis-
public.
or lean. comfort.
p Wink or make mouth noises, such as whistling, which is
o Speak quietly, slowly, and in a reserved t Koreans often prefer direct eye
considered vulgar.
manner. Loud or expressive speech is reserved contact to indirect contact; Asian
for friends and family. p Cross your legs at the knee; only cross at the ankles, but Indians use indirect eye contact
do not show soles of shoes. between different social classes,
o Respect silence (do not speak), even if the
but direct contact for equals.
other person pauses for several minutes. p Motion to someone with your forefinger, which is con-
sidered exceptionally rude. t Never touch Southeast Asians on
o Expect giggling or laughing if there is a misun-
their heads for any reason.
derstanding, or in response to unexpected or p Show emotion, which is considered a sign of immatu-
inappropriate behavior. rity among strangers and acquaintances. t Asian Indians use only their right
hands for any motions or gestures,
o Make quick eye contact when first greeting p Chew gum.
such as passing items.
someone, but lower the eyes when speaking to
p Talk about politics or current events; do not offer your
demonstrate deference and esteem. t Some Asian Indians nod their
opinion on controversial subjects. Do not ask personal
heads up and down to indicate
o Talk about your hobbies; express interest in questions, such as inquiring about a persons occupa-
disapproval, and back and forth to
the culture (e.g., history, food, sports) of the tion, income, cost of items, or about their family.
show approval.
country.
*Foster, D. 2000. The global etiquette guide to Asia. New York: John Wiley & Sons.
patient histories, overseeing physical exams, or Greece, Guatemala, Israel, Japan, Korea, Mexico,
making decisions regarding treatment.36 Middle Panama, Peru, Portugal, Turkey, Serbia, and
Easterners expect to go to the hospital with an ill Spain are stronger in uncertainty avoidance than
family member to provide care. Next of kin is the United States, as are most African and other
determined along bloodlines among Latinos, and Asian nations. They typically have a history of
care decisions are often the responsibility of a central rule and complex laws that regulate indi-
grandmother or mother instead of the spouse. vidual action on behalf of the group.38
Koreans prefer the whole family make decisions Cultures with low or weaker uncertainty avoid-
regarding treatment for a terminally ill patient. ance include Canada, Denmark, Great Britain, Hong
Some American Indians are so strongly associ- Kong, India, Indonesia, Jamaica, the Netherlands,
ated with the group it is difficult for them to com- the Philippines, Sweden, and the United States.
municate individual needs, which may be seen as People from these nations are usually curious
narcissistic. about the unknown and different. They are more
informal, willing to accept dissent within a group,
Uncertainty Avoidance and open to change.
Related to the role of the individual in a group is It is important to distinguish the differences
tolerance for uncertainty and ambiguity. Some between risk avoidance and uncertainty avoid-
groups exhibit great discomfort with what is ance. A person from a high uncertainty avoidance
unknown and different; these are defined as high culture may be quite willing to take familiar risks
uncertainty avoidance cultures. They may become or even new risks in order to minimize the ambi-
anxious about behavior that deviates from the guity of a situation. But in general, risks that
norm; high uncertainty avoidance cultures involve change and difference are difficult for
desire consensus. Argentina, Belgium, Chile, people with strong uncertainty avoidance; this is
Columbia, Costa Rica, Croatia, Egypt, France, especially a concern when changes threaten
acceptance by the group. For example, researchers include most African, Asian, Latino, and Middle
suggest African-American women may resist cer- Eastern cultures, including (but not exclusively)
tain preparations or seasonings if family mem- Egypt, Ethiopia, Ghana, Guatemala, India,
bers object or if the foods might undermine Malaysia, Nigeria, Panama, Saudi Arabia, and
ethnic identity. Furthermore, weight loss may be Venezuela. Client empowerment, particularly in
avoided if being thin means the potential loss of a setting goals and objectives, may be resisted by
peer group that values a larger figure.56 people from groups who come from cultures with a
Working with family or peers in a group setting larger power distance; maximum personal respon-
to effect dietary change may be more successful sibility may be preferred by people from groups
for persons with a low tolerance for uncertainty, with a smaller power distance.
especially when the positive value of change is Several cultures are gender oriented as well. In
accepted and group consumption patterns are masculine cultures, power is highly valued. Some,
modified. such as Germany, Hong Kong, and the United
States, are considered masculine due to their
Power, Authority, and Status aggressive, task-oriented, materialistic culture.
The perception of power, or power distance, can Others, such as Italy, Japan, Mexico, and the
strongly influence communication patterns. In Philippines, are characterized as masculine because
low-context cultures, where individuality is sex roles are strongly differentiated. Men are
respected, power or status is usually attributed to accorded more authority in masculine societies.
the role or job that a person fulfills. Power distance In more feminine cultures, quality of life is impor-
is small. People are seen as equals, differentiated tant; men and women share more equally in the
by their accomplishments. It is common for an power structure. More feminine countries can be
individual to question directions or instructions; task oriented and materialistic, such as Denmark,
the belief is that a person must understand why the Netherlands, Norway, and Sweden; but hard
before a task can be completed. A client may work and good citizenship are seen as benefiting
desire a full explanation of a condition and the whole society, not a hierarchy of superiors
expected outcomes before undertaking a specific within an organization or nation. Workplace
therapy. In many high-context cultures, where relationships and an obligation to others are
group identification is esteemed, superiors are characteristically emphasized. Nearly all other
seen as fundamentally different from subordi- nations combine masculine and feminine power
nates. Authority is rarely questioned. For example, qualities. Strong gender orientation can cause
a health care provider counseling an Ethiopian conflict. A health care team, for instance, may
patient with type 2 diabetes may believe that a include several experts, often both women and
culturally sensitive approach is to ask him about men. An Italian-American patient might show
his perceptions of the disease. What does he call little respect for the female members and may
it? How does he think it can be cured? Unknown ignore their directions unless restated by one of
to the provider, the Ethiopian man has a large the male practitioners, regardless of his area of
power distance, and he assumes that the expertise. Even women from masculine soci-
provider is the expert. Why would she ask such eties may find it difficult to accept the author-
questions of him? Doesnt she know what she ity of a female provider. Generally, masculine-
is doing? He expects her to provide all the oriented American health care practitioners can
answers, with little participation from him. He communicate more successfully with most
may even become uncooperative, or fail to ethnic clients by using a less assertive, less auto-
return for a follow-up visit, because he questions cratic approach that includes compromise and
her expertise. consensus.
Although there is usually some combination of
both small and large power distance tendencies in Time Perception
a culture, one is predominant. Some countries with Being on time, sticking to a schedule, and not
small power distance include Austria, Canada, taking too much of a persons time are valued Some Native Americans
Denmark, Germany, Great Britain, Ireland, Israel, concepts in America, but these values are unim- view time as circular, with
the Netherlands, New Zealand, Sweden, and the portant in societies where the idea of time is events blurring into an
United States. Those with larger power distance less structured. Low-context cultures tend to be eternal now.49
COMMUNICATION DOS, DONTS, AND DIFFERENCESEuropeans*

DO DONT DIFFERENCES
o Wait to be introduced by a third person. A quick hand- p Use broad gestures when talking. Avoid touch- t Italians, Greeks, Spaniards, and, in
shake is common between men; wait for a woman to ing, such as backslapping. some situations, Russians, are
extend her hand. Touching is minimal, though hugging more physically expressive and
p Speak with your hands in your pockets. Keep
or air kissing between friends and family members boisterous than other Europeans.
them at your sides.
may occur.
t The Dutch may tap their thumb-
p Back up if a person steps closer, or move for-
o Stand at a distance typically preferred by Americans; nails together to indicate displeas-
ward if a person steps back.
some Europeans may stand a little farther apart or a ure, while the French release a
little closer, though not noticeably different. Stand or sit p Never interrupt a speaker. puff of air through pursed lips to
upright; do not slouch or lean. show annoyance.
o Speak in a tone of voice that is low and reserved. Avoid ankles. t Winking or whistling by members
anger. Emotional decorum and logic are respected. More of the opposite sex is considered
p Point with your finger. Use your chin to indi-
animated conversation is the norm between friends and an appropriate way to meet some-
cate direction.
family. one in Spain (ignore them if unin-
p Use a V sign with the fingers and palm facing terested, make eye contact if
o Respect short pauses as people think something over or as
inward because it is considered obscene interested).
they use silence to defuse confrontation (do not speak).
throughout Europe; the okay sign with fore-
t Germans may initiate a spirited
o Keep facial expression neutral when first meeting some- finger touching thumb is offensive in many
discussion of current events, and
one and in business situations. countries.
opinions are exchanged freely.
o Make direct eye contact to indicate interest, and avert p Chew gum.
t Russians may be suspicious or bur-
eyes to show disinterest or desire for privacy. Looking
p Talk about politics or controversial issues. Avoid dened by compliments: if you
away when someone is making direct eye contact is
discussions of family matters, and do not ask comment favorably on an item in
considered rude.
about family members. Do not make inquiries their home, they may be obligated
o Talk about your hobbies; express interest in the culture about a persons occupation or income. to give it to you as a gift.
(e.g., history, food, sports) of the country. The weather is
a popular topic.
*Foster, D. 2000. The global etiquette guide to Europe. New York: John Wiley & Sons.
The Inuit conception of time monochronistic, meaning that they are interested ability to do many things simultaneously, is
is governed by the tides in completing one thing before progressing to the valued in many organizations today.
one set of tasks is done next. Monochronistic societies are well suited to
when the tide is out, industrialized accomplishments. Polychronistic
another when the tide NONVERBAL COMMUNICATION
societies are often found in high-context cultures.
comes in.
Many tasks may be pursued simultaneously, but High-context cultures place great emphasis on
not to the exclusion of personal relationships. nonverbal communication in the belief that body
The Arabs say, Bukra insha
Allah, which means Courtesy and kindness are more important than language reveals more about what a person is
Tomorrow, if God wills. deadlines in polychronistic groups.40 Exceptions thinking and feeling than words do. Yet customs
occur, however. The French have a relatively low- about touching, gestures, eye contact, and spatial
To many Chinese the gift of context culture but are polychronistic; the Japanese relationships vary tremendously among cultures,
a clock means the same as can become monochronistic when conducting independent of low- or high-context communica-
saying, I wish you were business transactions with Americans. tion style. As discussed previously, such nonver-
dead. Each tick is perceived People who are single-minded often find bal behavior can reinforce the content of the
as a reminder of mortality. working with those performing multiple tasks verbal message being sent, or it can contradict the
frustrating. Monochronistic persons may see words and confuse the receiver. Successful inter-
polychronistic behaviors, such as interrupting a cultural communication depends on consistent
face-to-face conversation for a phone call or being verbal and nonverbal messages. During personal
late for an appointment, as rude or contemptuous. and group interactions, persons move together
Yet no disrespect is intended, nor is it believed that in a synchronized manner. Barely detectable
polychronistic persons are less productive than motions, such as the tilt of the head or the blink of
monochronistic people. In fact, multitasking, the an eye, are imitated when people are in sync and
COMMUNICATION DOS, DONTS, AND DIFFERENCESLatinos*

DO DONT DIFFERENCES
o Wait to be introduced by a third party. A quick, p Place hands on hips when speakingkeep t Guatemalans and Nicaraguans may show
firm handshake between men is common; wait them at your sides, and do not back up when a respect by lowering their eyes when
for a woman to extend her hand and shake it person steps closer to you. listening.
softly. Hugging (the abrazo) and kissing occur
p Use the okay sign with the thumb touching t In Belize, you may be expected to intro-
between friends, family, and even acquain-
the forefinger which is vulgar. duce yourself in group situations.
tances after meeting the first time (wait for
these gestures before reciprocating). p Be offended by winking or whistling by mem- t Chileans, Columbians, Ecuadoreans tend to
bers of the opposite sex, which is considered be more formal and reserved than many
o Stand a little closer than is typical for Americans.
an appropriate way to meet someone (ignore other Latinos.
Stand or sit upright; do not slouch or lean.
them if uninterested, make eye contact if
t Tapping shoulders is a common greeting in
o Speak in a reserved manner when first meeting interested).
Bolivia.
someone or in business situations. Lively dis-
cussion is the norm among friends and family. t Squeezing the earlobe is a sign of pleasure
ankles.
in Brazil, while stroking the underside of
o Expect concurrent conversations and interrup-
p Chew gum (unless it is clearly okay to do so) or the chin with the fingertips indicates
tions when in a group.
yawn openly in public. uncertainty in Argentina.
o Touching is common during conversation, as is
p Talk about politics or controversial subjects t The gesture of a fist with the thumb stick-
the expressive use of the hands.
unless they are introduced by the other ing up between the index and middle fin-
o Eye contact is very direct and should be person, and do not express negative judg- gers is a sign of good luck in Brazil, but
returned; aversion may be insulting. ments even if your opinion is sought. Do not often considered vulgar in other countries.
mention health problems (which are consid-
o Ask questions about a persons family, and be t Gestures with the hand extended and the
ered too personal). Do not inquire about a
prepared to discuss your own family. Bring palm up are generally considered an insult
persons profession or income. Dont make
photos to share. in Chile, and hitting the open palm of the
sexual jokes in mixed company.
left had with the right fist is obscene.
o Talk about your hobbies; express interest in
the culture (e.g., history, food, sports) of the t Haitians indicate lack of understanding by
country. wrinkling their noses.
*Foster, D. 2002. The global etiquette guide to Mexico and Latin America. New York: John Wiley & Sons.
communicating effectively. The ways in which a relationship. The abrazo, a hug with mutual back
person moves, however, are usually cultural and patting, is a common greeting. Touching norms
often unconscious. Although body language is frequently vary according to attributes such as
closely linked to ethnicity, most people believe gender, age, or even physical condition. In the
that the way they move through the world is United States, it is acceptable for an adult to pat
universal. the head of a child, but questionable with another
Misinterpretations of nonverbal communica- adult. Women may kiss each other, men and
tion subtleties are common and often inadvertent. women may kiss, but men may not publicly kiss
More than 7,000 different gestures have been other men. It is admirable to take the arm of an Anthropologists speculate
identified, and meaning is easily misunderstood elderly person crossing the street but rude to do that the handshake, the hug,
when awareness of differences is limited.3 so for a healthy young adult. and bow with hands pressed
Cultures in which touching is mostly avoided together all originated to
Touching include those of the United States, Canada, Great demonstrate that a person
Touching includes handshakes, hugging, kissing, Britain, Scandinavia, Germany, the Balkans, was not carrying weapons.
placing a hand on the arm or shoulder, and even Japan, and Korea. Those in which touching is
In Japan the small bow used
unintentional bumping. In China, for example, expected include the Middle East and Greece,
in greetings and departures
touching between strangers, even handshaking if Latin America, Italy, Spain, Portugal, and Russia. is a sign of respect and
one person is male and the other female, is Cultures that fall in-between are those of China, humility. The inferior
uncommon in public. Orthodox Jewish men and France, Ireland, and India, as well as those in person in the relationship
women are prohibited from touching unless they Africa, Southeast Asia, and the Pacific Islands. always bows lower and
are relatives or are married. To Latinos, touching Health care professionals should take careful longer than the person in
is an expected and necessary element of every note of cultural touching behaviors. Vigorous the superior position.
Asians find it difficult to directly disagree with

a speaker and may tilt their chins quickly upward
to indicate no in what appears to Americans to
be an affirmative nod. Some Asian Indians,
Greeks, Turks, and Iranians shake their heads
back and forth to show agreement and nod up
and down to express disagreement. Puerto Ricans
may smile in conjunction with other facial
Michael Newman/ PhotoEdit, Inc.
expressions to mean please, thank you, excuse

me, or other phrases. The Vietnamese may smile
when displeased. In India, smiles are used mostly
between intimates; an Asian Indian client may
not know what to make of a health care provider
who smiles in a friendly fashion.
Good posture is an important sign of respect
Touching norms frequently in nearly all cultures. Slouching or putting ones
vary according to attributes handshaking is often considered aggressive behav- feet up on the desk are generally recognized as
such as ethnicity, gender, ior, and a reassuring hand on the shoulder may be impolite. In many societies the feet are considered
age, or physical condition. insulting.3 Of special mention are attitudes about the lowest and dirtiest part of the body, so it is
the head. Many cultures consider the head rude to point the toe at a person when ones legs
sacred, and an absent-minded pat or playful cuff are crossed or to show the soles of ones shoes.
Many Asians completely
avoid touching strangers, to the chin may be exceptionally offensive.
Eye Contact
even in transitory interac- Conversely, persons from cultures in which fre-
tions, such as returning quent touching is the norm may be insulted by The subtlest nonverbal movements involve the eyes.
change after a purchase. reticence to a hug or a kiss and may be unaware Rules regarding eye contact are usually complex,
This can be offensive to per- of legal issues regarding inappropriate touching varying according to issues such as social status,
sons who consider physical in the United States. gender, and distance apart. Majority Americans
contact a sign of accept- consider eye contact indicative of honesty and
ance, such as African Gesture, Facial Expression, and Posture openness, yet staring is thought rude. To Germans,
Americans and Latinos. Gestures include overt movements such as waving, direct eye contact is an indication of attentiveness.
or standing to indicate respect when a person African Americans may be uncomfortable with
The one-finger salute is
considered an insult in enters the room, as well as more indirect motions prolonged eye contact, but may also find rapid
many cultures. This gesture such as handing an item to a person or nodding aversion insulting. In general, blacks tend to look
dates back to Roman times, the head in acknowledgment. Facial expression at a persons eyes when speaking and look away
when it was called digitus includes deliberate looks of attention or question- when listening. To Filipinos, direct eye contact is
impudicus (the impudent ing and unintentional wincing or grimacing. Even an expression of sexual interest or aggression.
finger). smiling has specific cultural connotations. Among Native Americans, direct eye contact is
Confusion occurs when movements have sig- considered rude, and averted eyes do not neces-
Koreans say, A man who nificantly different meanings to different people. sarily reflect disinterest. When Asians and Latinos
smiles a lot is not a real
Crossed arms are often interpreted as a sign of avoid eye contact, it is a sign of respect. Middle
man.
hostility in the United States, yet do not have sim- Easterners believe that the minute motions of the
The Japanese demonstrate ilar negative associations in the Middle East, eyes and pupils are the most reliable indication of
attentiveness by closing where it is a common stance while talking. The how a person is reacting in any situation.
their eyes and nodding. thumbs-up gesture is obscene in Afghanistan,
Australia, Nigeria, and many Middle Eastern Spatial Relationships
nations. The crooked-finger motion used in the Each person defines his or her own spacethe
United States to beckon someone is considered surrounding area reserved for the individual.
lewd in Japan; is used to call animals in Croatia, Acute discomfort can occur when another person
Malaysia, Serbia, and Vietnam; and is used to stands or sits within the space identified as invi-
summon prostitutes in Australia and Indonesia. olate. Middle Easterners prefer to be no more
To many Southeast Asians, it is an insolent or than two feet from whomever they are communi-
threatening gesture.25 cating with so that they can observe their eyes.
Latinos enjoy personal closeness with friends and

acquaintances. African Americans are likely to be
offended if a person moves back or tries to
increase the distance between them. Intercultural
communication is most successful when spatial
preferences are flexible.
In addition to distance, the way a person is
positioned affects communication in some cul-
tures. It is considered rude in Samoan and
Tongan societies, for instance, to speak to a
person unless the parties are positioned at equal
levels, for example, both sitting or both standing.
Yogi, Inc./Corbis
Role of Communi-
cation in Health but also the patients family. Dietary modifica- Different cultural expecta-
Care tions in particular may have long-term implica-

tions; if cultural food habits are changed, the new
tions regarding nonverbal
behaviors, such as eye con-
tact and spatial preferences,
Health care providers in the United States take ways of eating may be passed on for generations. can lead to misunderstand-
pride in their technical expertise and mastery of ings in intercultural
knowledge. They spend years understanding bio- INTERACTION BETWEEN PROVIDER communication.
chemical and physiological processes, laboratory
assessments, diagnostic data, and therapeutic
AND CLIENT
strategies; yet little of that time is devoted to how In the time-pressured and cost-constrained setting Health care providers and
valuable information is effectively communicated of health care delivery, object messages are more consumers depend on their
to the client or members of the health care team. common than personal messages, and content is abilities to communicate sen-
Skills are needed for successful communication considered more relevant than the relationship. sitively and effectively with
with these and other participants, such as extended Typically, the health care professional relies on the one another to relieve dis-
comfort, save lives, and pro-
family members or traditional health practitioners, client to provide accurate, detailed information
mote health. Ineffective
despite possible differences in language, ethnicity, about his or her medical history and current communication in health
religious affiliation, gender, age, educational symptoms so that the appropriate diagnosis and care can, and often does,
background, occupation, health beliefs, or other treatment can be determined. The client depends result in unnecessary pain,
cultural factors. on the practitioner to explain any medical condi- suffering, and death (p. 8).54
Words are the primary tool of the clinician tion in terms that are understandable and to
following diagnosis. While the surgeon depends describe treatment strategies and expectations
on the scalpel, most other providers rely on lan- clearly. This basic conversation is repeated
guage to inform and guide patients in the treat- between providers and their clients daily; it is the
ment and lifestyle changes necessary to maintain essence of clinical health care. In practice, how-
or improve health.93 The surgeon has significant ever, this common interaction between provider
control within the surgical setting; in many cases and client greatly underestimates the complexity
the patient is not even conscious. In contrast, the of intercultural communication. Also forgotten in
clinician interacts directly with a patient who has the process is that the empathetic connections
independent, sometimes contradictory, ideas between health care providers and patients can be
about health, illness, and treatment. The provider therapeutic in themselves.100
can control only her or his side of the conversa- Numerous barriers to the sharing and under-
tion; if the words are ineffective, the client may standing of knowledge can prevent successful
reject recommended medications or therapies. communication in the health care setting. For
Although the actions of the surgeon are generally example, a client may be fearful or in pain when
limited to the patient, the advice of the health seeking help, more focused on immediate discom-
care provider often impacts not only the patient, fort than on conversing clearly with the provider.
COMMUNICATION DOS, DONTS, AND DIFFERENCESMiddle Easterners*

DO DONT DIFFERENCES
o Wait to be introduced by a third party. The salaam greeting p Speak with your hands. Broad gestures may t A firm handshake is the
includes a brief, soft handshake (wait for the person to extend convey unintended meaning. But do not speak common greeting in Israel
his or her hand) that may be followed quickly by a touch to with your hands in your pockets or on your hips. and Greece; the salaam is
the heart. Hugging and kissing may accompany the salaam Keep them at your side. not performed.
when the people know each other well. In Islam and Orthodox
p Interrupt others when talking. t Israelis and Greeks speak
Judaism, men and women may not touch members of the
loudly and quickly among
opposite sex. p Wink or make mouth noises, such as whistling,
friends.
which is considered vulgar.
o Stand a little closer than is typical for Americans. Stand or sit
t Greeks, Turks, and Iranians
upright; do not slouch or lean. Middle Easterners feel comfort- p Show affection for members of the opposite sex
may nod the head up and
able next to others, and strangers may choose to sit right next in public.
down in disapproval, and
to you in public situations.
p Never touch Middle Easterners on the head for back and forth in approval.
o Speak in reserved, soft tones. any reason.
t If you compliment an item
o Be prepared for personal questions, such as Why arent you p Show the soles of your shoes or feet; do not point in a Greek home, they may
married? Use a humble, diffident response, such as I have not with your feet. feel they must repay the
been blessed yet. Do not ask similar questions of the other kindness by giving you
person. the item.
ankles.
o Casually change topics in a conversation when a delayed t Winking or whistling by
p Beckon someone with your forefinger; any gesture
response occurs. Unexplained pauses may indicate embarrass- members of the opposite
that involves a closed fist or thumbs-up is consid-
ment, disagreement, or anger. sex is considered an appro-
ered rude.
priate way to meet someone
o Use direct eye contact, and do not be offended by staring.
p Chew gum or yawn openly. in Greece (ignore them if
Show deference to a superior by lowering your eyes when he
uninterested, make eye con-
or she is speaking. p Talk about politics or current events; do not offer
tact if interested).
your opinion on controversial subjects. Do not ask
o Point by turning the right palm upward, and motioning in the
about a persons family, occupation, income, or t Israelis are not offended by
direction.
cost of items. Do not make any off-color jokes or head-touching or showing
o Middle Easterners use their right hands for any motions or ges- discuss sexual situations. the soles of the feet.
tures, such as passing items. Use of the left hand is exception-
ally vulgar.
o Talk about your hobbies; express interest in the culture (e.g., his-
tory, food, sports) of the country.
*Foster, D. 2002. The global etiquette guide to Mexico and Latin America. New York: John Wiley & Sons.
During times of stress, a client is also more likely

to use her or his mother tongue than English if
it is a second language.39 The provider often
assumes the role of the expert, leaving little room
for participation of the client as the authority
on what he or she is experiencing physically or
emotionally.10, 15 The provider may rely on medical
jargon because it is difficult to interpret many
terms without extensive explanations or oversim-
Jeff Dunn/Index Stock Imagery
plification.53, 88 A provider may be most concerned

with the technical aspects of a health problem and
inadvertently ignore the interpersonal dimensions
of the relationship with the patient or may be
too rushed to express care and compassion.20, 54
Furthermore, cultural communication customs
The client depends on the practitioner to explain any medical condition in terms that are may interfere directly with the trust and respect
understandable and to describe treatment strategies and expectations clearly. necessary for effective health care.29
Researchers in effective communication ticularly if recommendations conflict with cultural Participatory research on a
have identified five ways in which misunder- perceptions regarding health and illness.62 Lakota Indian reservation
standings occur that are applicable to the health reported intercultural con-
care setting:5, 38 nections were directly
RESPONSIBILITIES OF THE HEALTH related to the investment of
1. A provider can never fully know a clients CARE PROVIDER time and commitment to
thoughts, attitudes, and emotions, espe- establishing and pursuing
Although communication requires the active meaningful dialogue.49
cially when the client is from a different
participation of at least two persons, the health
cultural background.
care provider has certain responsibilities in inter- Being involved with deci-
2. A provider must depend on verbal and non- actions with clients. The provider often assumes sion-making was signifi-
verbal signals from the client to learn what the superordinate position in the relationship cantly associated with
the client believes about health and illness, because she is accorded that status by the client adherence to medical
and these signals may be ambiguous. or because the client is distracted by pain or advice for whites, while
3. A provider uses his or her own cultural discomfort. In that role, it is the practitioners being treated with dignity
understanding of communication to obligation to understand what is said by the client improved adherence for
interpret verbal and nonverbal signals and to provide the client with the information racial/ethnic minorities in
one survey.4
from the client, which may be inadequate needed to participate in treatment. This may
for accurate deciphering of meaning in require that the clinician be familiar with cultural
another cultural context. norms, listen carefully and seriously to the client
4. A providers state of mind at any given (observing personal cues), take action based on
time may bias interpretation of a clients what is said by the client, plus under-promise and
behavior. over-deliver regarding therapeutic expectations.
Caring and considered communication can
5. There is no correlation between what a
empower the client within the relationship and
provider believes are correct interpreta-
improve treatment efficacy.54, 89
tions of a clients signals or behaviors and
It is believed intercultural communication
the accuracy of the providers belief.
awareness occurs in four stages. First is uncon-
Misunderstandings of meaning are
scious incompetence, when a speaker misunder-
common.
stands communication behaviors but doesnt
The results of ineffective communication in even know misinterpretation has occurred. The
health care can be serious. Noncompliance issues second stage is conscious incompetence, when a
are among the most important for the clinician. speaker is aware of misunderstandings but makes
Patients may reject recommendations or fail to no effort to correct them. Third is conscious com-
return for follow-up appointments because they petence, when a speaker considers his or her own
are dissatisfied with their relationship with their cultural communication characteristics and
health care provider.10, 61, 68 Patients with diabetes makes modifications as needed to prevent misin-
who perceived discriminatory behavior from their terpretations. The final stage is unconscious com-
health provider due to race, age, socioeconomic petence, when a speaker is skilled in intercultural
status, or gender suffered more symptoms and had communication practices and no longer needs to
higher levels of hemoglobin A1C (a blood test for think about them during conversation.45
three-month average sugar levels) than other
patients.74 Conversely, patients who received treat-
ment by health professionals in accordance with
their desired care reported significantly better
Successful
dietary management of their diabetes in another
study.2 Patients often report better outcomes with
Intercultural
traditional healers than with biomedical practi- Communication
tioners because there is more time spent on expla-
nation and understanding of the condition.52 Effective intercultural communication begins
Development of the interpersonal relationship with when the speaker is mindful of his or her own
the practitioner is crucial to a patients under- communication behaviors and is sensitive to
standing and accepting treatment strategies, par- misinterpretations that may result from them.
Practitioner knowledge about a culture does a beginning. Numerous books, articles, and
not necessarily facilitate effective care without courses on health care communication are
awareness of cultural differences and personal available to supplement this brief overview (see
biases.77, 80 A willingness to listen carefully also Table 3.2).
to a client without assumptions or bias and to
recognize that the client is the expert when Name Traditions
it comes to information about his or her expe-
Determine how clients prefer to be addressed.
rience is requisite to successful health care
Majority Americans are among the most infor-
interactions.
mal worldwide, frequently calling strangers and
The mnemonic CRASH has been suggested as
acquaintances by their given names. Nearly all
a useful way to remember the components to cul-
other cultures expect a more respectful approach.
tural competency that underlie effective care:
This can include the use of title or prefixes (Mr.,
Cconsider Culture in all patientpractitioner
Mrs., Miss, Ms., Dr., Sir, Madam, etc.), use of sur-
interactions; Rshow Respect and avoid gratu-
name, and proper pronunciation. Never use
itous familiarity and affection; AAssess/Affirm
Dear, Honey, Sweetie, Fella, Son, or other
intracultural differences due to language skills,
endearments or pejorative terms in place of
acculturation, and other factors, recognizing
proper names.
each individual as an expert on his or her health
Name order is often different than the
beliefs and practices; Sbe Sensitive to issues
American pattern of title, given name, middle
that may be offensive or interfere with trust in the
name, and surname. In many Latin American
relationship, and show Self-awareness regarding
countries a married woman uses her given name
personal biases that may cause miscommunica-
and her maiden surname, followed by de (of )
tion; and Hdemonstrate Humility, apologizing
and her husbands family surname. Children typ-
quickly and accepting responsibility for commu-
ically use their given name, their fathers surname,
nication missteps.82 With CRASH in mind, the
and then their mothers family surname. This
health professional can begin mastery of the
causes confusion because while most Latino men
communication skills needed to promote under-
prefer to be addressed by their fathers family sur-
standing and acceptance from clients of many
name, it is often the name that sequentially is
cultural backgrounds.
placed on the middle name line of forms.
Persons reading the form often assume the
mothers family surname is a Latinos last name.25
INTERCULTURAL COMMUNICATION SKILLS
Middle Easterners use their title, given name,
Reading about culturally based communication and surname. They may also use bin (for men) or
One researcher reports that
the use of cultural food
differences is an intellectual undertaking. bint (for women), meaning of a place or
potlucks among hospital Actually applying intercultural communication son/daughter of. It is not to be confused with
staff members has facili- concepts is much more challenging. Successful the given name Ben (although it is pronounced
tated cultural understand- face-to-face interactions require understanding similarly). If the grandparent of a Middle
ing among employees of cultural communication expectations and being Easterner is well known, his or her last name may
diverse backgrounds.13 familiar with the idiosyncratic style of the other be added to the name order, following the sur-
person. Often there is contradictory informa- name, with another bin. The Vietnamese, Mein,
Studies suggest that the tion to assimilate. The Japanese, for example, Hmong, and Cambodians place the surname
providerclient relationship come from a culture that is male dominated, first, followed by the given name (although many
improves when the client is assertive, and achievement oriented, yet also make the switch to the American name order
also trained in communica- high in uncertainty avoidance, emphasizing with acculturation). The Chinese and Koreans
tion skills. A meeting with
consensus and ritualistic communication prac- use a similar system, including a generational
coaches to guide clients in
formulating appropriate
tices. Should an explicit or implicit approach be name following the family name and before the
questions and to practice used when speaking with someone of Japanese given name (the generational name is sometimes
negotiation techniques heritage? Clearly, much depends on the circum- hyphenated with the given name, or the two
before an appointment has stances surrounding the conversation and the names are run together). Married women in
been successful in some particular people involved. A few guidelines on China and Korea do not take their husbands sur-
health care settings.81 applied intercultural communication skills are name. In Japan the surname is followed by san,
Table 3.2 Intercultural Communication in Counseling

African Americans Asians Latinos Middle Easterners Native Americans Majority Whites
Speak quickly, with Speak softly Speak softlymay Speak softly Speak slowly and softly Speak loudly,
affect and rhythm perceive normal quicklycontrol of
white voice as yelling listener
Direct eye contact Avert eyes as sign of Eye contact direct Direct gaze between Indirect gaze when Direct eye contact
when speaking, may respect between members of members of same speaking and listening when speaking and
avert if prolonged same sexmay seem to sexwomen may avert listening prolonged
look away when stareaversion an eyes with men contact rude
listening insult, though women
may avert eyes with men
Interject often Head nodding may indi- Seldom make responses Facial gestures express Seldom make responses Head nodding,
(taking turns) cate active listening to indicate active listen- responses to indicate active listen- murmuring
rarely interject ing or to encourage ing or to encourage
continuationrarely continuationrarely
interject interject
Very quick response Delayed auditory Mild auditory delay Mild auditory delay Delayed auditory Quick response
(silence valued) (silence valued)
Expressive, Polite, restrained, Men restrained, women Expressive, emotional Expression restrained Task-oriented, focused
demonstrative articulation of feelings expressive but not emo-
considered immature tional
Direct approach,
Respectful, direct Indirect approach Indirect approach Indirect approach Indirect approach minimal small talk for
approach (Japanese); direct stories about others urban whitesmore
approach (Chinese, may be metaphors for indirect for rural
Koreans) self whites
Ask direct questions
Assertive questioning Rarely ask questions Will ask questions when Will ask polite questions Rarely ask questions
encouraged yes/no answer consid-
ered complete
Firm handshake,
Firm handshake, May or may not Firm handshake among Numerous greetings, Quick handshake, smile smile
smile exchange soft men, soft handshake salaammay or may
handshake with women not exchange soft hand-
shake, smile
Moderate touching
Touching common Non-touching culture Touching common Touching common Minimal touching
reluctance to touch stand/sit farther away stand/sit closer than between members of
may be interpreted as than majority whites majority whites same gender
rejectionstand/sit stand/sit closer than
closer than majority majority whites
whites
Low- to medium-high
High-context use of Very high-context use of Moderately high- High-context use of Very high-context use context
pictures, graphs, pictures, graphs, charts context pictures, graphs, charts of pictures, graphs,
charts useful important useful charts important
Monochronistic
Polychronistic Polychronistic Polychronistic Polychronistic Polychronistic
punctual
Adapted from D.W. Sue, & D. Sue. Counseling the culturally diverse: Theory and practice. New York: John Wiley & Sons. Copyright 2002.
meaning Mr. or Ms. Given names are only same pattern, using her fathers initial until mar-
used among close friends and intimates. Hindus riage, at which time she uses her given name, fol-
in India do not traditionally use surnames. A man lowed by her husbands given name. Muslims in
goes by his given name, preceded by the initial of India use the Middle Eastern order, and Christian
his fathers given name. A woman follows the Indians use the American pattern.66 There are
numerous other name traditions and preferences sits down and begins the discussion. The client is
of address. When in doubt, it is best to ask. upset because she was being polite and had
expected the health care professional to ask again,
Appropriate Language and then insist that she have something to drink.
Use unambiguous language when working with Typically, Americans not only believe what is
clients who are limited in English. Choose said initially; they also consider answers absolute.
common terms (not necessarily simple words), In some cultures it is acceptable to make a com-
avoiding those with multiple meanings, such as mitment, then decide later to change the terms
to address, which may mean to talk to some- of the agreement or decline altogether. People
one, to give a speech, to send an item, or to con- from these groups assume that one cannot pre-
sider an issue. Vague verbs, such as get, make, dict intervening events or future needs. Further,
and do, may cause confusion. Use specific there can be differences in what is accepted as
verbs, such as purchase, complete, or pre- truth. In the United States truth is considered
pare, when directing clients. objective, supported by immutable facts. In
Slang and idioms may have no meaning in many other cultures, truth is subjective, often
another culture. Many new English speakers based on emotions.41, 66 A Filipino-American
interpret words literally. Hows it going? makes client may report to the practitioner that she has
no sense if one does not understand the meaning not lost any weight on her low-calorie diet this
of it.25 Sports analogies, including score and week. But when she gets on the scale, she weighs
strike out, are indecipherable if the game is three pounds less. Asked about it, the client
unfamiliar. Phrases that suggest a mental picture, explains she is frustrated because she gained
such as run that by me or easy as pie or one-half a pound yesterday and does not feel she
dodge a bullet, are barriers to comprehension.42 is progressing. Understanding that the defini-
Medical jargon is also likely to interfere with tions of truth vary culturally can help explain
communication.88 Some persons with limited some miscommunication.
English skills are embarrassed to admit that they
do not understand what is being said or to ask Use of an Interpreter
that something be repeated. When comprehen- Language can be the most difficult of all intercul-
sion is critical, respectfully request clients to tural communication barriers to overcome. It is
repeat instructions in their own words, or ask estimated that nearly 14 million people living in
that they demonstrate a skill so that misunder- the United States have poor English skills.100
standings can be corrected. Many are recent immigrants, and others view
Avoid asking questions that can be answered their stay in America as temporary and therefore
with a simple yes or no. For example, Do you see no need to learn English.39
understand? will often prompt a positive response According to Title VI of the Civil Rights Act of
in practitionerclient conversations, regardless of 1964, all persons in the United States are guaran-
comprehension level. It is better to ask leading teed equal access to health care services regard-
questionsfor example, What confuses you? less of national origin, which has been interpreted
or Tell me what you dont understand.25 In some to mean that there can be no discrimination
Asian cultures it is impossible to say no to a based on language. Programs not offering access
A professional interpreter request. The Japanese, for instance, have developed to persons with limited English skills may lose
reports that unintended many ways to avoid a negative response, such as federal funding, including Medicare and Medicaid
results due to limited lan- answering maybe, countering or criticizing the reimbursements. However, the regulation is
guage skills can be confus- question, issuing an apology, remaining silent, or vague and difficult to enforce. Compliance is
ing, insulting, or even leaving the room.94 mostly complaint driven. At present, few medical
comic. A friendly physician The direct, explicit communication style of institutions have adequate professional interpreters
meant to ask one of his
majority Americans is predicated on the assump- available to meet the needs of their non-English-
clients, Cuantos aos tiene
usted? (How old are
tion that each person is saying what he or she speaking clientele.
you?). He mispronounced means. This can cause difficulties when convers- Unfortunately, many health care providers
the word as anos, however, ing with persons for whom negotiation is stan- resort to nonprofessional interpreters, such as the
saying, How many anuses dard practice. For example, a practitioner offers clients family or friends, to facilitate communi-
do you have?39 coffee or tea to an Iranian client. She refuses, so he cation. The inadequacies of such interpretations
are numerous. Patients may be reluctant or increase effective communication through an Successful communication
embarrassed to discuss certain conditions in interpreter by using a positive tone of voice in the interpreterclient
front of their relatives, or family members may and avoiding a judgmental or condescending atti- relationship is also depend-
decide that the information provided by the prac- tude. Short, direct phrasesavoiding metaphors ent on intercultural skills.
It has been suggested that
titioner isnt really needed by the patient, so they or colloquialismsand repeating important
translators who build rap-
do not interpret accurately. Untrained interpreters information more than once can improve client
port and trust are more
are often unfamiliar with medical terminology. understanding. effective than those who
One study indicated that 23 to 52 percent of In areas where interpreters are unavailable, are emotionally detached.76
phrases were misinterpreted by nonprofessionals; telephone interpretation services may be an
for example, laxative was the term used for alternative. The AT&T Language Line is available
diarrhea, and swelling was confused with getting throughout the United States and offers inter-
fat. The interpreter tended to ignore questions preters trained in medical terminology in most
about bodily functions altogether.26 Even totally major languages.100
bilingual individuals may not be familiar with
all dialects; the terms used in one part of a coun-
INTERCULTURAL COUNSELING
try may be very different from those used in
another region. Ethical issues arise when chil- Practitioner attitude toward outcomes is perhaps A study on patient partici-
dren are used as interpreters. Children may be the most important element of successful inter- pation in decision-making
frightened of medical procedures, and depend- cultural counseling. A health care provider found that 96 percent of
ence on a child for communication can invert cannot be open-minded if objectives are com- clients want care choices
family dynamics causing unnecessary intergen- pletely preplanned. Participation in a relaxed, offered to them, and want
their opinions sought.
erational stress. give-and-take exchange can reveal issues of pri-
However, 52 percent pre-
Issues regarding informed consent, patient mary concern to the client. An invitation to share ferred to leave the final
safety, and noncompliance occur when interpreta- stories, for example, may address concerns that decision to their physician.
tions are inadequate. Some health care providers cannot be expressed directly. Mutual commit- Well-educated white
attempt to use their personal skills in a foreign ment to shared goals can be developed by attentive women were most likely to
language believing it is better to try to communi- listening to client needs and learning about client want shared decision-
cate directly than to lose some control through expectations.62, 89 This collaboration in defining making; African Americans
interpreters. Although conversing in the lan- and achieving outcomes is the difference between and Hispanics were least
guage of the client is often greatly appreciated, it advocacy and manipulation. Effective intercul- likely.57
is important for the provider not to overestimate tural counseling is an ongoing process of practice
fluency. Obtaining the services of a professional and refinement, requiring an open attitude, cultural
interpreter is warranted in all but emergency situ- knowledge, and intercultural communication
ations when a delay could be life-threatening.39 skills.49, 72
When using an interpreter, the practitioner
should speak directly to the client, and then Pre-Counseling Preparation
watch the client rather than the interpreter during Researchers have made many recommendations
interpretation. If the nonverbal response doesnt regarding effective intercultural communication.
fit the comment, confirmation with the interpreter The basic competencies needed by practitioners
can ensure that the meaning is clear. Sometimes include (1) information transferthe verbal and
an interpreter may appear to answer for the patient; nonverbal ability to convey object messages;
the interpreter may be very familiar with the (2) relationship development and maintenance
patients history based on previous interpretations the ability to create rapport, establish trust, and
for other health providers. Conversely, it may take demonstrate empathy and respect; and (3) com-
an interpreter considerably longer to interpret a pliance gainingthe ability to obtain client
comment than it takes to say it in English, in part cooperation.81
because certain cultural interpretations and Practically speaking, a health care provider
explanations may be necessary.67 The technique cannot be expected to become an expert in inter-
of back interpretation, meaning that instructions cultural communication or to fully understand
are repeated back to the clinician, can prevent the communication modes best suited to each of
miscommunication and open the conversation to the many clients from different cultural her-
any further questions by the client. Providers can itages. Most patients living in the United States
Tab le 3.3 Checklist for Intercultural Nutrition Counseling

Attitudes Knowledge Skills
I am open-minded and willing to be a I understand that although some cultural influences I explain diet rationale in common terms within
learner instead of the expert when it on communication are readily apparent, others are the context of a clients worldview, including
comes to the clients life experiences hidden and require development of a personal concepts regarding the cause, prevention, and
and ways of knowing. relationship so that salient factors in communication treatment of illness; I set realistic goals with
and compliance can be identified. the client.
I am sincerely interested in different
cultural perspectives on reality, and I I know that body language can provide significant I emphasize the continuation of positive cul-
can respect cultural worldviews other information about the clients concerns and feelings; tural food habits and recommend modification
than my own. the relationship can improve or deteriorate through of only those food habits that may be detri-
nonverbal communication. mental to the clients health. I avoid personal
I can tolerate the ambiguities of inter-

bias.
cultural communication. I understand that modification of culturally held
beliefs and behaviors can have significant, long-term I attempt to send nonverbal messages consis-
I can accept that some interactions
effects on the client and the clients family. Attempts tent with my verbal messages.
will be uncomfortable or unfamiliar
to force change may result in ineffective communica-
to me. I engage in effective intercultural communica-
tion and noncompliance by the client.
tion with all participants in the health care
I am patient; I attempt to understand I am familiar with cultural food habits of my clients. system to help clients through illness and
the ideas and feelings of the client.

improve health through supportive personal
I have learned about traditional health beliefs and
relationships, through cooperation with families,
practices.
and through the gathering and sharing of rele-
vant data with other health care professionals.
Source: Adapted from Cassidy, C.M. 1994. Walk a mile in my shoes: Culturally sensitive food-habit research. Journal of the American Dietetic Association, 97, 12881292; Gudykunst, W.B., &
Nishida, T. 1994. Bridging Japanese/North American differences. Thousand Oaks, CA: Sage; Kavanagh, K.H., & Kennedy, P.H. 1992. Promoting cultural diversity: Strategies for health profes-
sionals. Newbury Park, CA: Sage; Kreps, G.L., & Kunimoto, E.N. 1994. Effective communication in multicultural health care settings. Thousand Oaks, CA: Sage; Sanjur, D. 1995. Hispanic
foodways, nutrition, and health. Boston: Allyn & Bacon.
Health care providers note do not expect to be treated as they would in their understanding and experience in her own
that age affects intercul- homeland. But familiarity with intercultural words. The practitioner exerts little control over
tural communication communication attitudes, knowledge, and skills the flow of the response yet elicits data through
because older minority can greatly enhance health care efficacy. careful prompting.2, 52 Useful questions to ask
members are often socially
during the conversation include these:
isolated and may be unwill-
ing to communicate with The In-Depth Interview What do you call your problem? What
health care providers from a The in-depth interview is essential in intercul- name do you give it?
different culture.101 tural counseling to determine many of the ice- What do you think caused it?
berg issues that may affect communication and
Demographic data on prac- Why did it start when it did?
cooperation in health care, including ethnicity,
titioners show a dispropor- What does your sickness do to your body?
age, degree of acculturation or bicultural adapta-
tionate number of whites How does it work?
tion, socioeconomic status, health condition, reli-
(among dietitians, 90.5 per-
cent are non-Hispanic gious affiliation, educational background, group Will you get better soon, or will it take a
whites), suggesting that membership, sexual orientation, or political affil- long time?
intercultural counseling will iation. However, a client may believe that per- What do you fear about your sickness?
become increasingly preva- sonal questions about his background are
What problems has your sickness caused
lent until greater diversity invasive or unnecessary, especially if he comes
for you personally? for your family? at
in the health care profes- from a high-context culture. Direct inquiry may
sions is achieved.84 work?
even suggest to the client that the practitioner is
What kind of treatment will work for your
incompetent because she cannot determine the
problem through indirect methods. sickness? What results do you expect
One culturally sensitive approach is the from treatment?
respondent-driven interview, in which simple, What home remedies are common for
open-ended questions by the provider initiate this sickness? Have you used these home
conversation.15 The client can express her remedies?
Furthermore, information should be requested selection; and translation mistakes (e.g., literal
about traditional healers: translations of food names, use of a brand name
for a generic item, or use of the name for a tradi-
How would a healer treat your sickness?
tional food for a similar American item) are a few
Are you using that treatment?
ways collected data can be invalidated. Frequent
For nutritional assessment within the context consumption of mixed dishes can result in omis-
of the clients condition, questions about food sion of some nutrient sources (as when rice is
habits are appropriate: prepared with dried peas or beans, yet reported
as rice by some Caribbean Islanders) and over- or
Can what you eat help cure your sickness
underestimation of intake due of complications
or make it worse?
in portion-size estimates. Tremendous variability
Do you eat certain foods to keep healthy?
in the amounts of food eaten has been reported
To make you strong? between individuals and cultural groups.41
Do you avoid certain foods to prevent Nutritional variety may be artificially reduced if
sickness? the composition data for a cultural food prepared
Do you balance eating some foods with in significantly different ways among subgroups
other foods? are used without allowances for recipe modifica-
tions. Using food composition data for similar
Are there foods you will not eat? Why?
foods when specific listings on a cultural item are
Learning about how a client understands his unavailable can lead to intake miscalculations if
illness, including expectations about how the ill- numerous substitutions are necessary.
ness will progress, what the provider should do, Food lists derived from data on the U.S. pop-
and what he has established as therapeutic goals, ulation as a whole may miss significant dietary A study of Chinese-
allows the provider to compare her own view of nutrient sources in subgroups. A study compar- American schoolchildren
the illness and to resolve any discrepancies that ing a generalized food frequency questionnaire found that USDA food com-
might interfere with care. Demonstrating sincere with ethnic-specific tools developed for African position databases supplied
interest in cultural health beliefs through an open- Americans, whites, and Mexican Americans information on only 65 per-
cent of the 120 different
ended conversation can elicit the information found improvement in assessing total fat, vitamin
food items identified in the
needed to begin assessment and to determine the A, and vitamin C intake with the modified forms.
three-day diet records.95
most effective approaches for each individual. Calculations increased by 6 to 7 percent for fat
sources, 1 to 3 percent for vitamin A, and 1 to 2
percent for vitamin C when twenty-eight cultural
INTERCULTURAL NUTRITION ASSESSMENT
food items were added to the seventy-four food
Several difficulties in the collection and analysis items typical of the total population.9 Similar
of cultural health data have emerged in recent research also reported a modest increase in nutri-
years. Researchers have discovered that stan- ent estimates for Hispanic, Chinese, and Japanese
dardized tools can introduce systematic bias into respondents.8 A review of food frequency ques-
results or provide misleading information when tionnaires in minority populations, however,
utilized with different cultural populations. found that the number of published examples
Generalized approaches to the use of the 24- was so few, and the methodologies were so
hour food recall, food frequency forms, and varied, that no conclusions regarding how best to
nutrient databases can produce large errors in develop valid, reliable instruments could be
assessment.15, 30, 59, 92 Cultural unfamiliarity with reported. Questions regarding how extensive
concepts such as fiber; terminology differences, questionnaires should be (especially number of
such as using one word for several foods or not included foods), whether food groupings need to
having a name for a certain category of food (e.g., be modified, and how portion size should be
there is no American Indian word for vegetables), standardized remain unanswered.18
or grouping foods by different categories (e.g., by Other assessment tools may be questionable
medicinal properties or status); lack of differenti- in intercultural settings as well. A model used to
ation between meals and snacks; checking phan- determine health attitudes among whites was
tom foods (those not actually consumed) when found unreliable when used with Mexican
not enough traditional items are available for Americans, even after operational adjustments
applicable to a more diverse clientele. Food-based

assessments are more promising but do not pro-
vide data on the psychological or social aspects of
acculturation and are usually limited to use with a
single cultural group.
Furthermore, anthropometric measurement
tools are sometimes inappropriate for certain
populations. Height and weight growth curves
are particularly vulnerable to misinterpretation
due to cultural variation, especially among Asian
groups. Stature prediction equations for whites
were inaccurate for Latinos17, 31, 32, 69 and African
David Young-Wolff/PhotoEdit, Inc.
Americans.44 The predictive value of waist-to-hip

ratios and body mass index (BMI) may vary in
some populations.21, 60, 73, 75 Questions about the
standard BMI cutoff for overweight and obesity
in Asians have been raised due to a high risk for
health problems at lower numbers.64 When per-
cent body fat data was used instead of BMI for
Standardized height and calculating obesity in African Americans and
weight growth curves have whites, the difference in rates between women
not been validated for all
for cultural differences.86 Contradictions were was cut in half (with blacks still more at risk than
ethnic groups and should be
found, for example, between self-administered whites), and the gap for men was widened, with
applied cautiously with
cultural variation in mind. and interviewer-directed questionnaire responses; far more white men identified as obese.19 Even
participants were more likely to express disagree- physiologic calculations, such as basal metabolic
ment about an item when completed individually rate equations, may differ culturally.14, 58
than when asked about it by the interviewer. The development of culturally specific tech-
Cultural attitudes regarding pleasing authorities niques and tools is a critical need in nutritional
are believed to have influenced respondent assessment. For an individual client, switching
answers, calling into question the use of the from a quantitative to a more qualitative
interview as a valid tool for gathering data in this approach can establish trust and cooperation in
Research conducted with ethnic group. In another study on low-literacy initial interviews. The twenty-fourhour recall,
African-American women populations the opposite was found; self- for instance, can be conducted in an open-ended
found that an interviewer- manner, requesting simply that all foods con-
reported data on food frequency questionnaires
administered food fre-
were found unreliable when compared to com- sumed the previous day be remembered.15 This
quency questionnaire was
more feasible, and less bur- ments made by respondents during follow-up eliminates difficulties with obtaining portion
densome for staff and interviews.7 sizes or differentiating meals. The dietitian does
respondents, than multiple A review of acculturation scales and indexes not need to predetermine food items or cate-
twenty-fourhour dietary found that many were unsuited for use in dietary gories. In subsequent meetings, more informa-
recalls.102 interventions or nutrition education programs.86 tion, such as frequency and amount of given
Single-item measures of acculturation, including items, can be requested after explanation of why
The following exercise can broad questions such as How long have you lived these types of data are needed.
demonstrate the difficulty a in the United States? and What language do you When working with many clients of a single
client may have thinking speak at home? provide only introductory infor- cultural heritage, it may be useful to prepare
about foods in unfamiliar mation about a client and resulted in outcome dis- quantitative tools based on qualitative research.
cultural categories: try list- This approach is most successful when done by
crepancies in data collected on dietary fat intake
ing consumption by color. It
requires grouping items
and acculturation in one study.71 Acculturation an investigator already familiar with the specific
such as red tomatoes, raw scales are more comprehensive but also do not groups food culture. A well-intentioned but cul-
beef, strawberries, and red address questions regarding food habit changes. turally biased open-ended question, for example,
Jell-O togethera system In addition, they are typically validated on homo- asking a participant to list any other foods eaten
that makes little sense to geneous population samples, such as college stu- weekly may not prompt the recall of foods eaten
most health professionals.92 dents or hospital patients, and may not be fully seasonally, thus underestimating a particular
nutrient. The burden of negotiating two different Cultural Body image Setting Language Actual relevance
cultural food systems should be on the researcher, Influence Social Interpersonal Perceived Role models
pressure component relevance Cultural
not the study participant.8, 92 Detailed interviews acceptability
with individuals can provide information on Social
reinforcement
appropriate language, categories, concepts, and
formatting of the instruments helpful in cultur-
ally specific nutritional assessment. Phase of Motivation Attendance Learning Behavior change;
Process and skill weight change
Monthly twenty-fourhour recalls of small, acquisition
representative samples are useful in determining
overall consumption patterns, especially where Negotiation Space Tolerance for Ineffectiveness Negotiation Space
seasonal variation occurs.41 Focus groups have
been found effective in selecting food items to Possible
include and quantification measures in the Negative Nonparticipation Drop out Nonadherence Poor result
preparation of multicultural food frequency Outcome
questionnaires.30, 85 Guidance from the targeted Figure 3.3
population is essential.85, 92 Two questions Schematic illustration of
Successful nutrition education strategies for
regarding the accuracy of data collection are sug- how cultural factors might
groups are as dependent on intercultural commu-
gested: First, how do cultural perceptions about influence participation and
nication skills as is nutrition counseling with indi-
food affect the way in which clients report their outcomes at various phases
viduals. For example, researchers have described of the program.
intake? Second, how is the report of intake
how culture can affect program outcomes in a
affected by the clients relationship with the
group weight loss setting.55 Negative results are
interviewer, the setting, and the assessment tool?
possible at any phase of the process, from motiva-
Answers to these questions can suggest cultur-
tion and attendance to skill acquisition and behav-
ally sensitive approaches and improve validity of
ior change (see Figure 3.3). At each point cultural
collected data.15, 83
influences may reinforce or contradict the content
Access to cultural foods composition data and
and context of the education messages conveyed by
culturally specific anthropometric and physiologi-
the health care practitioner. When communication
cal measurements is more problematic. Requests
conflict develops, an inexact period of time exists
for recipes can be used to expand current data-
when the client is willing to negotiate toward reso-
bases, although this technique may be too time
lution of the message. If dissatisfaction continues, a
consuming to complete with every client. Being
poor weight loss outcome results because the
mindful that data analysis is often approximate and
person (1) is never motivated to sign up, (2) drops
that standardized measurements may be question-
out of the program before completion, (3) attends
able, dietary modifications should be made care-
but never learns skills, or (4) learns skills but does
fully and cautiously with all clients from cultural
not apply them in practice. Program designers
backgrounds other than the American majority. A comparison of food com-
must do more than superficially modify the pro-
gram materials and the setting to communicate position tables in nine
European nations exempli-
effectively with a different cultural group. Under-
Intercultural standing the cultural health beliefs, attitudes, and
fies the difficulty in obtain-
ing accurate nutrient data.
Nutrition Education values of a target audience; developing education
programs within the context of those perceptions;
Differences in definitions,
analysis methods, and
and utilizing culturally appropriate, consistent expression made it impossi-
The biomedical paradigm emphasizes behavioral
verbal and nonverbal messages in an accepted ble to compare local tables
change accomplished through one-on-one work
medium increase communication efficacy. with international data.22
with an individual. However, many cultural
groups prefer learning about nutrition in settings
with family members or peers.22 For example, CULTURALLY RELEVANT
researchers have found that while white adolescent
girls demonstrate poor outcomes when counseled
PROGRAM PREPARATION
with their mothers, black adolescent girls show Although health education program models typ-
significantly improved outcomes when their ically advise a step-by-step process of planning
mothers participate in weight loss sessions.12, 56 and execution, the reality is that some aspects of
A recent study comparing preparation and implementation occur concur- created.78 In many cases, the larger, heteroge-
health content tailored for rently. A health educator may begin planning neous audience may be stratified into smaller,
specific cultural audiences with a general idea of goals for a population segmented target groups that share similar cul-
to standard health content group, but will probably modify and refine objec- tural beliefs and attitudes.
found the tailored media
tives as more information about the target audi- Involving members of the targeted audience
emphasizing religiosity,
ence is gathered. Ongoing evaluation may suggest in program planning is one of the best ways to
collectivism, racial pride,
and time orientation more better message formats or more suitable influ- determine cultural orientation.98 Of special note
effective in prompting ence channels as the effort proceeds. Effective is the role of community leaders or spokesper-
women to get mammograms programs are often nonlinear, with each element sons in the process. Seeking the respect, trust,
and increase fruit and in planning and implementation connected and endorsement of influential persons within
vegetable intake.55 through feedback and assessment into a continu- the target audience for a particular nutrition edu-
ous improvement loop. cation program can open intercultural communi-
cation channels otherwise limited to the formal
Targeting the Audience interactions reserved for strangers.50, 63, 76 The
Identification of the target audience in nutrition educator establishes a relationship with the group
It has been suggested that education efforts is among the most important through asking for permission to present the
the services of an ethnogra- steps in program planning. Learning about the health message to its members.
pher can help determine cultural orientation of the group is imperative;
appropriate, effective campaigns to change behaviors aimed independ- Goals and Objectives
assessment methods to
ently at the individual are usually misdirected.11 The next step in intercultural program planning
capture local dietary intake
What appear to be significant needs to the is to define clear and realistic goals and objectives
patterns.48
health educator may be considered unimportant within the cultural context of the target audience.
Canadian researchers found or too difficult to remedy by members of the Even culturally sensitive education messages do
that among reasons aborig- target population. not necessarily translate into sustained modifica-
inal community leaders Definitions of health differ widely among tion of food habits without follow-up support,
supported their food intake cultures (see Chapter 2, Traditional Health Beliefs and overly ambitious expectations are a common
research was documenta- and Practices). A common belief is that illness reason for failure.24, 27 Nevertheless, strategies
tion of the culture, assis- is a matter of heredity, fate, or punishment by emphasizing continuation of positive cultural
tance in land claims to God, or is due to supernatural causes. In a study dietary patterns or portion control rather than
assess toxicological risks, of health perceptions held by hard-to-reach elimination of certain foods are reportedly of
and self-determination.96 populations in the United States, it was found interest to African Americans, Asian Americans,
that though individuals believed that lifestyle Latinos, and Native Americans, as well as whites:
Content of the message can
might impact acute infection, there was almost one study found a barrier to eating healthfully
be critical. For example, one
no association between diet or exercise and was that participants believed they would have to
study on the effects of
public education efforts to chronic disease; respondents had limited moti- give up their cultural heritage and conform to the
reduce bulimic eating vation to improve health behaviors because dominant culture.16, 47, 97 Programs coordinating
behaviors revealed that they felt they had little personal control over objectives with cultural beliefs about the role of
some women learned about their health.97 The role of the individual within food in health, such as balancing yin and yang
vomiting as a weight the group can also affect responsibility for health foods in Chinese meals, can reinforce dietary
control method from the maintenance; in some cultures, the extended change.85 Consulting health care practitioners in
campaign.90 family is held accountable for the health of the targeted community can provide information
each member. on local needs and concerns useful in defining
Demographic information about the target achievable goals and objectives.
audience can guide program development.
Primary language should be identified, as well Triangulation
as gender, average age, socioeconomic status, An especially useful step in the program design
educational attainment, religious affiliation, process is triangulation, a method of confirming
and other iceberg factors in communication. congruence between data collected on the target
Assessment of acculturation or bicultural adap- audience and proposed program goals and objec-
tation is equally important. The more culturally tives (Figure 3.4) 35 Triangulation means that
homogeneous the target population, the more information gathered through one source or
appropriate are the messages that can be method is used to confirm and extend information
gathered through other sources and methods. In

addition to corroboration, triangulation can pro-
vide improved understanding of local issues and
perspectives.
In the triangulation pilot program, commu-
nity nutritionists were interviewed to help define
the target population of young African-American
women and for direction in program develop- Text not available due to copyright restrictions
ment. Then target group women participated in
focus groups and were asked to discuss benefits
and obstacles to healthy eating. A final step sur-
veyed community resources on the availability of
quality food products. When data from the three
qualitative studies were compared, the researchers
found that their target audience was confirmed as
appropriate, that the nutritionists had correctly
identified the need for culturally relevant skill-
building messages, and that there was a barrier to
achieve program goals and objectives due to the through nonverbal modes.76 Body language must
lack or excessive cost of fresh and frozen foods. be culturally congruent with the verbal message
They also discovered that nutritionist recommen- for successful communication to occur. The use
dations regarding an appropriate spokesperson of pictures, cartoons, and photographic images
for the campaign were rejected by the targeted can symbolically enhance content meaning of a
audience. The triangulation process provided message in a high-context culture, as well as aid
concrete data on target population needs and target populations with mixed English language
credible communication channels, directing pro- skills or reading abilities.
gram planning toward culturally relevant inter- Educational messages are most effective when
ventions and resource development. they are more personal than objective; the emo-
tional dimension is as important as the content.
Developing the Message Many researchers recommend the universally The four barriers to healthy
It is believed that the more fundamental the health accepted format of storytelling to deliver the eating identified by African-
message is in relation to a groups survival, safety, message.28, 43 Actors and other celebrities are American women in the tri-
or social needs the more effective it will be inter- especially suited to recounting personal experi- angulation focus groups
culturally.54 The message must satisfy the individ- ences about health issues. Stories can transcend were taste, cost, time, and
uals need to gain knowledge or offer a solution to many cultural boundaries; if a message is tar- lack of information such as
a perceived problem before it is worth a persons geted toward one cultural group yet applicable to recipes, shopping tips, and
time to process the information.11 Messages many audiences, a spokesperson identified with a chart comparing healthful
should be as direct and explicit as allowed within the intended target group also may have broader and unhealthful choices.35
cultural norms.79 Language relevant to the group appeal when using a narrative approach.
should be used in development of the message, A pilot test of the message with targeted audi- More than 20 percent of the
and translation of existing materials should be U.S. population is consid-
ence members can improve success. Focus
ered functionally illiterate,
avoided to prevent inappropriate phrasing and ter- groups can be especially useful in assessing cul- reading below an eighth
minology. Common words used by the target tural appropriateness of education materials and grade level.
audience are effective, although it is important in identifying any resistance triggers inadver-
that they not be used in an insincere or conde- tently included in the message.11, 51, 97
scending way. Written materials should be brief
and prepared at the reading level of the target pop-
ulation.
IMPLEMENTATION STRATEGIES
Marketing experts recognize many cultural Dissemination of a nutrition education message
groups are high-context communicators and should include analysis of cultural influence
have greater abilities than the white American channels and media preferences, development of
majority culture to send and receive messages an effective marketing mix, and evaluation of the
program. Whether a person actually hears, sees, service centers, carnivals, and sporting events are
and understands a message is dependent on fre- a few of the locations where culturally relevant
quency, timing, and accessibility. Exciting, nutrition education materials can be successfully
informative, culturally appropriate messages fail distributed on a smaller scale. Low-income, hard-
if they never reach the target audience.11, 24 to-reach whites, blacks, and Latinos express
interest in nonjudgmental small-group support
Influence Channels meetings similar to Alcoholics Anonymous and
Cultural icons incorporated Influence channels are the ways in which mes- Tupperware-style home meetings with food sam-
into educational messages sage materials are transmitted to the target audi- ples and cooking demonstrations as settings for
should be selected with ence. They include television, video, computers, nutrition education programs.97
care. For example, the owl radio, magazines, newspapers, newsletters, direct
represents wisdom in some mail, and telephones. Marketing Mix
American Indian cultures; in
Each cultural group demonstrates distinct The four Ps of the marketing mix are product,
others the owl is a symbol
for death.43
media-use patterns and is best approached price, placement, and promotion.54 They refer to
through those influence channels. Oral traditions a well-developed message (product) that
Mass media campaigns are are strong among some populations, while writ- advances program goals and objectives at mini-
believed to influence a ten messages are favored by others. Most African mal economic or psychological cost to target
change in health behavior Americans (97 percent) listen to the radio for audience members (price) and presents this mes-
by about 10 percent of the more than thirty hours each week; Latinos enjoy sage in a method congruent with target audience
targeted audience, which television programs focusing on family and rela- media preferences (placement) in such a way that
can be a significant number tionship issues, watching on average fifteen hours the target audience members are encouraged to
in a large campaign. of Spanish programming and ten hours of become more involved in the program, either
English programming each week.65, 78 Asians through phone numbers for further information
Television programs, partic- watch about six hours of native-language televi- or through attendance at group meetings (pro-
ularly medical shows and sion weekly. In a study of Native Americans in motion). Attention to all four areas of the mar-
soap operas, are a primary
California, a majority of respondents reported keting mix assures that the health care message is
source of health care
information in the United
that they would prefer receiving nutrition infor- fully accessible to the target audience.
States.70 mation through newsletters (69 percent) or
videotapes (67 percent); approximately one- Evaluation
Interpersonal follow-up is quarter indicated they would like to receive a visit Process evaluation keeps track of progress
believed to increase efficacy from a health professional, and only 6 percent throughout the program, especially the identifica-
in communicating a com- selected a workshop with family and friends.46 tion of larger community conditions that may be
plex health care message.11 Computer-based, interactive nutrition education presenting barriers to dissemination of the mes-
programs are an emergent educational tool, par- sage. Summative evaluation is used to assess pro-
Use of a self-reported shelf ticularly suitable for audiences with low literacy gram results after completion of the effort.
inventory was found to be
or limited English language skills, as was found Evaluation data are useful in refining intercultural
an effective method in eval-
uating community nutrition
in a study of rural Appalachian women.91 The nutrition education strategies both during imple-
intervention programs with Internet is another promising technology, offer- mentation and in future programs. Publication of
Hispanics, blacks, and ing twenty-fourhour access to health education culturally sensitive nutrition education program
whites.6 materials and easy access to group support results greatly benefits other health professionals
through bulletin boards and chat rooms, and and their clients through shared knowledge about
individualized therapy through e-mail.1, 34, 99 intercultural communication techniques and tools.
According to marketing experts, the most
effective presentation of a message requires a
combination of pictures, sounds, and words in the
broadcast and print media.78 The use of multiple 1. Why is communication with another person
influence channels and frequent repetitions of the or group described as an action chain? Give
message at times when the target audience is lis- an example of an action chain that might
tening or watching is also important. Beyond the occur when you meet (1) a friend, (2) your
mass media, health fairs, neighborhood clinics, new boss, and (3) a young child.
farmers markets and grocery stores, traditional 2. Why is it important to become familiar with
healers, churches, schools, food banks or social other cultures communication behaviors?
Give three examples of nonverbal communi- 11. Brown, J.D., & Einsiedel, E.F. 1990. Public health
cation behaviors. campaigns: Mass media strategies. In E.B. Ray &
3. What is meant by low- or high-context and L. Donohew (Eds.), Communication and Health.
uncertainty avoidance in describing verbal Hillsdale, NJ: Erlbaum.
12. Brownell, K.D., Kelman, J.H., & Stunkard, A.J.
communications? Name one culture that is low-
1983. Treatment of obese children with and with-
context and one culture that is high-context. out their mothers: Changes in weight and blood
How may an individuals relationship to the pressure. Pediatrics, 71, 515523.
group differ between high- and low-context 13. Burner, O.Y., Cunningham, P., & Hattar, H.S.
cultures? How does uncertainty avoidance 1990. Managing a multicultural nurse staff in a
differ from risk avoidance? Give an example. multicultural environment. Journal of Nursing
4. What would be the culturally appropriate Administration, 20, 3034.
verbal address for when you meet the follow- 14. Case, K.O., Brahler, C.J., & Heiss, C. 1997. Resting
ing individuals: an African American, a Latin energy expenditures in Asian women measured
American, a Vietnamese, and an Asian? by indirect calorimetry are lower than expenditures
calculated from prediction equations. Journal of
the American Dietetic Association, 97, 12881292.
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CHAPTER
4
Food and Religion
T he function of religion is to explain the of importance to specific cultures are introduced U.S. law prohibits the census
inexplicable, thus providing humans with in the following chapters on each ethnic group. As from including mandatory
a sense of comfort in a chaotic world. with any description of food habits, it is important questions regarding reli-
Food, because it sustains life, is an important to remember that religious dietary practices vary gion. Independent national
enormously even among members of the same survey data often differ
part of religious symbols, rites, and customs,
from religious group records
those acts of daily life intended to bring about faith. Many religious food practices were codified
regarding membership.
an orderly relationship with the spiritual or hundreds or thousands of years ago for a specific
supernatural realm. locale and, consequently, have been reinterpreted A study on religious affilia-
In the Western world, Judaism, Christianity, over time and to meet the needs of expanding tion in 2001 found the per-
and Islam are the most prevalent religions, populations. centage of self-identified
whereas Hinduism and Buddhism are common As a result, most religions have areas of ques- Christians in the United
in the East. The Western religions, originating tionable guidelines. For example, fish without States had declined in the
in the Middle East, are equated with the worship scales are banned under kosher food laws. Are past decade, while the per-
of a single God and the belief that that God is sturgeon, which are born with scales but lose centage that adhere to non-
them as they mature, considered fit to eat for Christian religions remained
omnipotent and omniscient. It is for God to
relatively constant. The
command and for humankind to obey. This life Jews? Orthodox Jews say no, whereas many
biggest gain was seen in
is a time of testing and a preparation for life Conservative and Reform Jews say yes: smoked
those who practice no reli-
everlasting, when humans will be held account- sturgeon can be found at almost any Jewish deli. gion, nearly doubling from
able to God for their actions on Earth. Hindus, who avoid fish with ugly forms, iden- 8 percent to 15 percent.
The Eastern religions of Hinduism and tify those fish that are undesirable according Younger persons, men,
Buddhism developed in India. Unlike the Western to local tradition. In addition, religious food Asians, and those living in
religions, they do not teach that God is the lord practices are often adapted to personal needs. the West were most likely to
and maker of the universe who demands that Catholics, encouraged to make a sacrifice during say they have a secular out-
humankind be righteous. Rather, the principal Lent, traditionally gave up meat but today may look (see Figure 4.1).28
goal of the Indian religions is deliverance, or lib- choose pastries or candy instead. Buddhists may
eration, of the immortal human soul from the adopt a vegetarian diet only during the period
bondage of the body. Moreover, nearly all Indian when as an elder they become a monk or nun.
religions teach that liberation, given the right Because religious food prescriptions are usually
disposition and training, can be experienced in written in some form, it is tempting to see them
the present life. as being black-and-white. Yet they are among the
This chapter discusses the beliefs and food prac- most variable of culturally based food habits.
tices of the worlds major religions. Other religions See Table 4.1.
86 FOOD AND RELIGION
Catholic, 25.9 the Romans, it had no homeland until the birth of

Israel in 1948.
No Religion, 15 During the Diaspora (the dispersion of Jews
outside the homeland of Israel), Jews scattered and
Hindu, 0.1 settled all over the ancient world. Two sects of
Buddhist, 0.5 Judaism eventually developed: the Ashkenazi, who
Muslim, 0.6 prospered in Germany, northern France, and the
Jewish, 1.4 eastern European countries; and the Sephardim,
originally from Spain, who now inhabit most
southern European and Middle Eastern countries.
Hasidic Jews are observant Ashkenazi Jews who
believe salvation is to be found in joyous com-
munion with God as well as in the Bible. Hasidic
men are evident in larger U.S. cities by their dress,
which includes long black coats and black or fur-
Protestant, 54 trimmed hats (worn on Saturdays and holidays
only), and by their long beards with side curls.
Figure 4.1
The cornerstone of the Jewish religion is the
Self-described religious affili-
ation in the United States
Hebrew Bible, particularly the first five books of
by percentage2001. Western Religions the Bible, the Pentateuch, also known as the books
of Moses, or the Torah. It consists of Genesis,
Source: Kosmin, B.A., & Mayor, E.
2001. American Religious Identifi- Exodus, Leviticus, Numbers, and Deuteronomy.
JUDAISM The Torah chronicles the beginnings of Judaism
cation Survey. New York: The
Graduate Center City University of The Jewish religion, estimated to be 4,000 years and contains the basic laws that express the will of
New York. http://www.gc.cuny. old, started when Abraham received Gods earliest God to the Jews. The Torah not only sets down the
edu/faculty/research_briefs/aris/ covenant with the Jews. Judaism was originally a Ten Commandments, but also describes the right
aris_index.htm nation as well as a religion. However, after the way to prepare food, give to charity, and conduct
destruction of its capital, Jerusalem, and its main ones life in all ways. The interpretation of the Torah
sanctuary, the Temple of Solomon, in 70 C.E. by and commentary on it are found in the Talmud.
In the 2001 Canadian census,
43 percent of the population
was identified as Roman
Catholics, and another Table 4.1 Common Religious Food Practices
30 percent was listed as ADV BUD EOX HIN JEW MOR MUS RCA
Protestant. It is estimated Beef A X
that there are 579,640
Muslims (2 percent of the Pork X A A X X
population), 479,620 All meat A A R A R R R
Eastern Orthodox members, Eggs/dairy O O R O R
329,995 Jews, 300,345
Buddhists, 297,200 Hindus, Fish A A R R R R
and 278,415 Sikhs. Sixteen Shellfish X A O R X
percent of the population
Alcohol X A X X
adheres to no religion.
Coffee/tea X X A
Meat & dairy at same meal X
Leavened foods R
Ritual slaughter of meats
Moderation
Note: ADV, Seventh-Day Adventist; BUD, Buddhist; EOX, Eastern Orthodox; HIN, Hindu; JEW, Jewish; MOR, Mormon; MUS, Muslim; RCA, Roman Catholic.
X, prohibited or strongly discouraged; A, avoided by most devout; R, some restrictions regarding types of foods or when foods are eaten observed
by some adherents; O, permitted, but may be avoided at some observances; , practiced.
Chapter 4: Food and Religion 87
The basic tenet of Judaism is that there is only one New York, Chicago, and Los Angeles. Most Jews
God, and His will must be obeyed. Jews do not in the United States are Ashkenazi: 10 percent
believe in original sin (that humans are born identify themselves as Orthodox, 34 percent as
sinful) but rather that all people can choose to act Conservative, 29 percent as Reform, and the rest
in a right or wrong way. Sin is attributed to human are not affiliated with a specific congregation.
weakness. Humans can achieve, unaided, their
own redemption by asking for Gods absolution (if Kashrut, the Jewish Dietary Laws
they have sinned against God) or by asking forgive- Some people in the United States believe that It is estimated that two-
ness of the person they sinned against. The exis- Jewish food consists of dill pickles, bagels and lox thirds of kosher foods are
tence of the hereafter is recognized, but the main (smoked salmon), and chicken soup. In actuality, purchased by non-Jews,
concern in Judaism is with this life and adherence the foods Jews eat reflect the regions where their including Muslims,
to the laws of the Torah. Many Jews belong to or families originated. Because most Jews in the Seventh-Day Adventists,
attend a synagogue (temple), which is led by a United States are Ashkenazi, their diet includes the
vegetarians, and those with
rabbi, who is a scholar, teacher, and spiritual food allergies, in part due
foods of Germany and eastern Europe. Sephardic to their reputation for
leader. In the United States, congregations are Jews tend to eat foods similar to those of southern
usually classified as Orthodox, Conservative, or safety and purity.35
Europe and the Middle Eastern countries, while
Reform, although American Jews represent a Jews from India prefer curries and other South
spectrum of beliefs and practices. The main divi- Asian foods. All Orthodox and some Conservative
sion among the three groups is their position on Jews follow the dietary laws, kashrut, that were set
the Jewish laws. Orthodox Jews believe that all down in the Torah and explained in the Talmud.
Jewish laws, as the direct commandments of God, Kosher or kasher means fit and is a popular
must be observed in all details. Reform Jews do term for Jewish dietary laws and permitted food
not believe that the ritual laws are permanently items. Glatt kosher means that the strictest kosher
binding but that the moral law is valid. They standards are used in obtaining and preparing
believe that the laws are still being interpreted and the food. Kashrut is one of the pillars of Jewish
that some laws may be irrelevant or out of date, religious life and is concerned with the fitness of
and they observe only certain religious practices. food. Many health-related explanations have been
Conservative Jews hold the middle ground postulated about the origins of the Jewish dietary
between Orthodox and Reform beliefs.34 restrictions; however, it is spiritual health, not
Immigration to the United States physical health or any other factor, that is the sole
reason for their observance. Jews who keep
In the early nineteenth century, Jews, primarily kosher are expressing their sense of obligation to
from Germany, sought economic opportunities in God, to their fellow Jews, and to themselves. The
the New World. By 1860 there were approximately dietary laws governing the use of animal foods
280,000 Jews living in the United States. Peak can be classified into the following categories:
Jewish immigration occurred around the turn of
the century (18801920); vast numbers of Jews 1. Which animals are permitted for food Most gelatin is obtained
moved from eastern Europe because of poverty and and which are not: Any mammal that has from processed pig tissues.
pogroms (organized massacres practiced by the a completely cloven foot and also chews Kosher, gelatin-like products
Russians against the Jews before World War II). the cud may be eaten, and its milk may be are available.
During the Great Depression, Jews continued drunk. Examples of permitted, or clean,
In 2002 the first kosher food
to immigrate into the United States, primarily to animals are all cattle, deer, goats, oxen,
in outer space was served to
escape from Nazi Germany. Their numbers were and sheep. Unclean animals include swine,
astronaut Ilan Ramon on
few, however, because of restrictions in the immi- carnivorous animals, and rabbits. Clean the space shuttle Columbia.
gration quota system. Today Jews continue to birds must have a crop, gizzard, and an
come to the United States, especially from Russia. extra talon, as do chickens, ducks, geese,
Some come from Israel as well. The Jewish popu- and turkeys. Their eggs are also considered
lation in the United States was over 6 million clean. All birds of prey and their eggs are
adults and children in 2003, according to data unclean and cannot be eaten. Among fish,
compiled from local federations; more than one- everything that has fins and scales is per-
half of these Jews live in the northeastern region mitted; everything else is unclean. Examples
of the nation.2 Large populations are found in of unclean fish are catfish, eels, rays, sharks,
and all shellfish. As discussed previously, the blood can drain easily; third, the meat
Orthodox rabbis consider sturgeon a pro- is covered with kosher salt for at least one
hibited food; Conservative authorities list hour; fourth, the salt is rinsed from the
it as kosher. Caviar, which comes from meat; and finally, the meat is rinsed repeat-
sturgeon, is similarly disputed.19 All rep- edly to make sure all blood and salt are
tiles, amphibians, and invertebrates are removed.22 The liver cannot be made
also unclean. kosher in the ordinary way because it con-
2. Method of slaughtering animals: The tains too much blood. Instead, its surface
meat of permitted animals can be eaten must be cut across or pierced several times,
only if the life of the animal is taken by a then it must be rinsed in water, and finally
special process known as shehitah. If an it must be broiled or grilled on an open
animal dies a natural death or is killed by flame until it turns a grayish white color.
Tevilah is the ritual purifica- any other method, it may not be eaten. The 6. The law of meat and milk: Meat (fleischig)
tion of metal or glass pots, shohet (person who kills the animal) must and dairy (milchig) products may not be
dishes, and utensils through be a Jew trained and licensed to perform eaten together. It is generally accepted
immersion in the running the killing, which is done by slitting the that after eating meat a person must wait
water of a river or ocean. neck with a sharp knife, cutting the jugular six hours before eating any dairy products,
China and ceramic items are vein and trachea at the same time. This although the period between is a matter
exempt.
method, which is quick and painless, also of custom, not law.23 Only one hour is
causes most of the blood to be drained necessary if dairy products are consumed
from the carcass.23 first. Many Jews are lactose intolerant and
3. Examination of the slaughtered animal: do not drink milk. However, other dairy
After the animal is slaughtered, it is items such as cheese, sour cream, and
examined by the shohet for any blemishes yogurt are often included in the diet
in the meat or the organs that would render (Kosher cheese must be made with rennet
the animal trefah, meaning unfit for con- obtained from a calf killed according to
sumption. Disease in any part of the animal the Jewish laws of slaughtering). Separate
makes the whole animal unfit to eat. sets of dishes, pots, and utensils for prepar-
ing and eating meat and dairy products
4. Forbidden parts of a permitted animal:
are usually maintained. Separate linens and
Two parts of the animal body are prohib-
washing implements are often employed.
ited. Blood from any animal is strictly for-
Eggs, fruits, vegetables, and grains are
bidden; even an egg with a small bloodspot
pareve, neither meat nor dairy, and can be
in the yolk must be discarded. Heleb (fat
eaten with both. Olives are considered
that is not intermingled with the flesh,
dairy foods, prohibited with meat, if they
forms a separate solid layer that may be
are prepared using lactic acid.
encrusted with skin or membrane, and
Because it is not known how 7. Products of forbidden animals: The only
can easily be peeled off) is also proscribed.
much salt remains on the
The prohibition against heleb only applies exception to the rule that products of
meat after rinsing, Orthodox
to four-footed animals. unclean animals are also unclean is honey.
Jews with hypertension are
often advised to restrict 5. The preparation of the meat: For meat to Although bees are not fit for consumption,
their meat consumption. be kosher, the heleb, blood, blood vessels, honey is kosher because it is believed that it
and sciatic nerve must be removed. Much does not contain any parts from the insect.
The prohibition of the sciatic of this work is now done by the Jewish 8. Examination for insects and worms:
nerve is based on the biblical butcher, although some Jewish home- Because small insects and worms can hide
story of Jacobs nighttime
makers still choose to remove the blood. on fruits, vegetables, and grains, these
fight with a mysterious
This is known as koshering, or kashering, foods must be carefully washed twice and
being who touched him on
the thigh, causing him to the meat. It is accomplished in five steps: examined before being eaten. Kosher-
limp. Because the nerve is First, the meat is soaked (within seventy- certified prepackaged produce is available
difficult to remove, the two hours after slaughter) in tepid water from some suppliers. A processed food
entire hindquarter of the for thirty minutes; second, it is drained product (including therapeutic dietary
animal is usually avoided. on a slanted, perforated surface so that formulas) is considered kosher only if a
Orthodox Rabbinical Council of S. Florida

The Union of Orthodox Jewish Congregations (Vaad Harabonim De Darom Florida)
New York, New York Miami Beach, Florida
O.K. (Organized Kashrut) Laboratories Vaad Horabonim of Massachusetts

Brooklyn, New York Boston, Massachusetts
Vaad Hakashrus of the Orthodox Jewish
Kosher Supervision Service Council of Baltimore
Teaneck, New Jersey Baltimore, Maryland
Asian-American Kashrus Services Atlanta Kashruth Commission

San Rafael, California Atlanta, Georgia
Vaad Hakashrus of Denver
The Heart K Kehila Kosher Denver, Colorado
Los Angeles, California
Vaad Harabonim of Greater Seattle
Chicago Rabbinical Council Seattle, Washington
Chicago, Illinois
Kashruth Council Orthodox Division
Orthodox Vaad of Philadelphia Toronto Jewish Congress
Philadelphia, Pennsylvania Willowdale, Ontario, Canada
Vaad Hakahrus of Dallas, Inc. Montreal Vaad Hair

Dallas, Texas Montreal, Canada
Vaad Harabonim of Greater Detroit and Merkaz Vancouver Kashruth

Southfield, Michigan British Columbia, Canada
Figure 4.2
Examples of kosher food
reliable rabbinical authoritys name or ends with the Day of Atonement, Yom Kippur. symbols.
insignia appears on the package. The most Rosh Hashanah occurs in September or October;
common insignia is a K, permitted by the as with all Jewish holidays, the actual date varies
U.S. Food and Drug Administration (FDA), from year to year because the Jewish calendar is
indicating rabbinical supervision by the based on lunar months counted according to bib-
processing company. Other registered lical custom and does not coincide with the secu-
symbols include those found in Figure 4.2.20 lar calendar. For this holiday the challah is baked
in a round shape that symbolizes life without end
Religious Holidays and a year of uninterrupted health and happiness.
The Sabbath. The Jewish Sabbath, the day of In some communities, the challah is formed like a
rest, is observed from shortly before sundown on bird representing Gods protection. Apples are
Friday until after nightfall on Saturday. Tradition- dipped in honey, and a special prayer is said for a
ally the Sabbath is a day devoted to prayer and rest, sweet and pleasant year. Some families tradition-
and no work is allowed. All cooked meals must be ally consume the head of a fish, or sheep, with the
prepared before sundown on Friday because no wish that Gods will for them is to be at the head,
fires can be kindled on the Sabbath. Challah, a not the tail, of any undertakings in the upcoming
braided bread, is commonly served with the Friday year. Foods with Hebrew names similar to other
night meal. In most Ashkenazi homes the meal words may also be eaten, such as beets (similar to
would traditionally contain fish or chicken or remove and used to pray that enemies be
cholent, a bean and potato dish that can be pre- removed). On the second night a new fruit, one
pared Friday afternoon and left simmering until that hasnt been consumed for a long period of
the evening meal on Saturday. Kugel, a pudding, time, is enjoyed with a prayer for a year of plenty.
often made with noodles, is a typical side dish. Often, the fruit is a pomegranate, which reputedly
contains 613 seeds, the same as the number of
Rosh Hashanah. The Jewish religious year begins commandments listed in the Torah. No sour or
with the New Year, or Rosh Hashanah, which means bitter foods are served on this holiday, and special
head of the year. Rosh Hashanah is also the sweets and delicacies, such as honey cakes, are
beginning of a ten-day period of penitence that usually prepared.
Two breads, or one bread Yom Kippur, the Day of Atonement. Yom Kippur clipped in the humiliation of defeat) triangular-
with a smaller one braided falls ten days after Rosh Hashanah and is the shaped pastries, filled with sweetened poppy seeds
on top, are usually served holiest day of the year. On this day, every Jew or fruit jams made from prunes or apricots and
on Fridays, the beginning of atones for sins committed against God and kreplach (triangular or heart-shaped savory pas-
the Sabbath, symbolic of the resolves to improve and once again follow all tries stuffed with seasoned meat or cheese and
double portion of manna
the Jewish laws. Yom Kippur is a complete fast boiled like ravioli). Purim challah (a sweet bread
(nourishment) provided by
God to help sustain the
day (no food or water; medications are allowed) with raisins) and fish cooked for the holiday in
Israelites when they wan- from sunset to sunset. Everyone fasts, except vinegar, raisins, and spices are often served.
dered in the desert for forty boys under thirteen years old, girls under Seeds, beans, and cereals are offered in remem-
years after their exodus twelve years old, persons who are very ill, and brance of the restricted diet eaten by the pious
from Egypt. women in childbirth. The meal before Yom Queen Esther.
Kippur is usually bland to prevent thirst during
In poor Ashkenazi homes, the fast. The meal that breaks the fast is typi- Passover. Passover, called Pesach in Hebrew, is
gefilte (filled) fish became cally light, including dairy foods or fish, fruits, the eight-day festival of spring and of freedom. It
popular on the Sabbath. and vegetables. occurs in March or April and celebrates the
Similar to the concept of anniversary of the Jewish exodus from Egypt. The
meatloaf, it is made by Sukkot, Feast of Tabernacles. Sukkot is a festi- Passover seder, a ceremony carried out at home,
extending the fish through val of thanksgiving. It occurs in September or includes readings from the seder book, the
pulverizing it with eggs, October and lasts one week. On the last day, Haggadah, recounting the story of the exodus, of
bread, onion, sugar, salt, Simchat Torah, the reading of the Torah (a portion the Jews redemption from slavery, and of the God-
and pepper, then stewing
is read every day of the year) is completed for the given right of all humankind to life and liberty.
the balls or patties with
year and started again. This festival is very joyous, A festive meal is a part of the seder; the menu
more onions.
with much singing and dancing. Orthodox fami- usually includes chicken soup, matzo balls, and
lies build a sukkah (hut) in their yards and hang meat or chicken. When Moses led the Jews out of
fruit and flowers from the rafters, which are built far Egypt, they left in such haste that there was no
enough apart so that the sky and stars are visible. time for their bread to rise. Today matzah, a white-
Meals are eaten in the sukkah during Sukkot. flour cracker, is the descendant of the unleavened
bread or bread of affliction. During the eight days
Hanukkah, the Festival of Lights. Hanukkah is
of Passover, no food that is subject to a leavening
celebrated for eight days, usually during the
process or that has come in contact with leavened
month of December, to commemorate the recap-
foods can be eaten. The forbidden foods are wheat,
ture of the Temple in Jerusalem in 169 C.E.
barley, rye, and oats. Wheat flour can be eaten
Families celebrate Hanukkah by lighting one
only in the form of matzah or matzah meal,
extra candle on the menorah (candelabra) each
which is used to make matzo balls. In addition,
night so that on the last night all eight candles
beans, peas, lentils, maize, millet, and mustard
are lit. Traditionally, potato pancakes, called
are also avoided. No leavening agents, malt liquors,
latkes, are eaten during Hanukkah. Other foods
or beers can be used.
cooked in oil, such as doughnuts, are sometimes
Because milk and meat cannot be mixed at any
eaten as well.
time, observant Jewish families have two sets of
Purim. Purim, a joyous celebration that takes special dishes, utensils, and pots used only for
place in February or March, commemorates the Passover. The entire house, especially the kitchen,
rescue of the Persian Jews from the villainous must be cleaned and any foods subject to leaven-
Ashkenazi Jews tradition- Haman by Queen Esther. It is a mitzvah (good ing removed before Passover. It is customary for
ally avoided pepper during deed) to eat an abundant meal in honor of the Orthodox Jews to sell their leavened products and
Passover because it was deliverance. The feast should include ample flours to a non-Jew before Passover. It is very
sometimes mixed with important that all processed foods, including
amounts of meat and alcoholic beverages. Cus-
bread crumbs or flour by
tomarily, people dress in disguise for the day to wine, be prepared for Passover use and be marked
spice traders.
hide from Haman, to add surprise to gift giving, Kosher for Passover.
In some Sephardic homes or to hide from God in order to overindulge in The seder table is set with the best silverware
matzah is layered with veg- anonymity. Foods associated with the holiday and china and must include candles, kosher
etables and cheese or meat include hamantaschen (literally Hamans pockets, wine, the Haggadah, three pieces of matzot (the
for the Passover meal. but usually interpreted to mean Hamans ears plural of matzah) covered separately in the folds
of a napkin or special Passover cover, and a seder

plate. The following items go on the seder plate:
1. Zroah. Zroah is a roasted shank bone,
symbolic of the ancient paschal lamb in
Egypt, which was eaten roasted.
2. Beitzah. Beitzah is a roasted egg, repre-
senting the required offering brought to the
Temple at festivals. Although the egg itself

was not sacrificed, it is used in the seder as
a symbol of mourning. In this case, it is for
the loss of the Temple in Jerusalem.
3. Marror. Marror are bitter herbs, usually
horseradish (although not an herb), sym-
bolic of the Jews bitter suffering under
slavery. The marror is usually eaten
Typical seder meal.
between two small pieces of matzot.
4. Haroset. Haroset is a mixture of chopped
Fast Days
apple, nuts, cinnamon, and wine. Its
appearance is a reminder of the mortar There are several Jewish fast days in addition to The Torah prohibits the
used by the Jews to build the palaces and Yom Kippur (see Table 4.2). On Yom Kippur and on drinking of wine made by
Tisha bAv, the fast lasts from sunset to sunset and non-Jews because it might
pyramids of Egypt during centuries of
no food or water can be consumed. All other fast have been produced for
slavery. The haroset is also eaten on a the worship of idols. Some
small piece of matzo. days are observed from sunrise to sunset. Most
Orthodox Jews extend
Jews usually fast on Yom Kippur, but other fast days
5. Karpas. A green vegetable, such as lettuce the prohibition to any
are observed only by Orthodox Jews. Extremely grape product, such as
or parsley, is placed to the left of the pious Jews may add personal fast days on Mondays
haroset, symbolic of the meager diet of grape juice or grape jelly.
and Thursdays.32 All fasts can be broken if it is dan-
the Jews in bondage. It is dipped into salt gerous to a persons health; those who are pregnant Cottage cheese is associ-
water in remembrance of the tears shed or nursing are exempt from fasting. ated with Shavout because
during this time. It also symbolizes Additional information about Jewish dietary the Israelites were late in
springtime, the season of Passover. laws and customs associated with Jewish holi- returning home after receiv-
6. A special cup, usually beautifully deco- days can usually be obtained from the rabbi at a ing the Ten Commandments
rated, is set on the seder table for Elijah, local synagogue. The Union of Orthodox Jewish and the milk had curdled.
the prophet who strove to restore purity Congregations of America also publishes a direc- Many dishes served during
of divine worship and labored for social the holiday contain cheese
tory of kosher products.
fillings.
justice. (Elijah is also believed to be a
messenger of God, whose task it will be CHRISTIANITY
to announce the coming of the Messiah
and the consequent peace and divine Throughout the world, more people follow
kingdom of righteousness on Earth.) Christianity than any other single religion. The
three dominant Christian branches are Roman
Shavout, Season of the Giving of the Torah. The Catholicism, Eastern Orthodox Christianity, and
two-day festival of Shavout occurs seven weeks Protestantism. Christianity is founded on
after the second day of Passover and commemo- recorded events surrounding the life of Jesus
rates the revelation of the Torah to Moses on believed to be the Son of God and the Messiah
Mount Sinai. Traditional Ashkenazi foods associ- chronicled in the New Testament of the Bible.
ated with the holiday include blintzes (extremely The central convictions of the Christian faith are
thin pancakes rolled with a meat or cheese filling, found in the Apostles and the Nicene Creed. The
then topped with sour cream), kreplach, and creed explains that people are saved through
knishes (dough filled with a potato, meat, cheese, Gods grace, the life and death of Jesus, and his
or fruit mixture, then baked). resurrection as Christ.
Table 4.2 Jewish Fast Days

Fast Day Time of Year Purpose
Tzom Day after Rosh In memory of Gedaliah, who ruled after the First Temple was
Gedaliah Hashanah destroyed
Yom Kippur 10 days after Rosh Day of Atonement
Hashanah
Tenth of Tevet December Commemorate an assortment of national calamities listed
Seventeenth of Tamuz July } in the Talmud
Taanit Ester Eve of Purim In grateful memory of Queen Esther, who fasted when seeking
divine guidance
Taanit Eve of Passover Gratitude to God for having spared the first-born of Israel; usually
Bechorim only the first-born son fasts
Tisha bAv August Commemorates the destruction of the First and Second Temples
in Jerusalem
For most Christians the sacraments mark the Feast Days. Most Americans are familiar with
key stages of worship and sustain the individual Christmas (the birth of Christ) and Easter (the
worshiper. A sacrament is an outward act derived resurrection of Christ after the crucifixion).
from something Jesus did or said, through which Other feast days celebrated in the United States
an individual receives Gods grace. The sacraments are New Years Day, the Annunciation (March 25),
observed, and the way they are observed, vary Palm Sunday (the Sunday before Easter), the
among Christian groups. The seven sacraments of Ascension (forty days after Easter), Pentecost
Roman Catholicism, for example, are baptism Sunday (fifty days after Easter), the Assumption
(entering Christs church), confirmation (the soul (August 15), All Saints Day (November 1), and
receiving the Holy Ghost), Eucharist (partaking of the Immaculate Conception (December 8).
the sacred presence by sharing bread and wine), Holiday fare depends on the familys country of
marriage (union of a man and woman through the origin. For example, the French traditionally serve
bond of love), unction (healing of the mind, spirit, bche de Nol (a rich cake in the shape of a Yule log)
and body), reconciliation (penance and confession), on Christmas for dessert, while the Italians may
The commemoration of the and ordination of the clergy. serve panettone, a fruited sweet bread (see indi-
Last Supper is called Corpus vidual chapters on each ethnic group for specific
Christi, when Jesus Roman Catholicism foods associated with holidays).
instructed his disciples that
bread was his body and The largest number of persons adhering to one
wine his blood. In Spain and Christian faith in the United States are Roman Fast Days. Fasting permits only one full meal per
many Latin American coun- Catholics (approximately 67 million in 2004 day at midday. It does not prohibit the taking of
tries, Corpus Christi is cele- according to parish records).30 The head of the some food in the morning or evening; however,
brated by parading the worldwide church is the pope, considered infalli- local custom as to the quantity and quality of this
bread (called the Host) ble when defining faith and morals. The seven supplementary nourishment varies. Abstinence
through streets covered sacraments are conferred on the faithful.13 forbids the use of meat, but not of eggs, dairy
with flowers. Although some Roman Catholics immigrated products, or condiments made of animal fat and
to the United States during the colonial period, is practiced on certain days and in conjunction
St. Valentines Day tradi-
substantial numbers came from Germany, Poland, with fasting. Only Catholics older than the age of
tions may date back to
Lupercalia, a Roman festival
Italy, and Ireland in the 1800s and from Mexico fourteen and younger than the age of sixty are
held in mid-February at and the Caribbean in the twentieth century. There required to observe the dietary laws.5
which a young man would are small groups of French Catholics in New The fast days in the United States are all the
draw the name of a young England (primarily in Maine) and in Louisiana. In days of Lent, the Fridays of Advent, and the
woman out of a box to be addition, most Filipinos and some Vietnamese Ember Days (the days that begin each season),
his sweetheart for a day. people living in the United States are Catholics. but only the most devout fast and abstain on all of
these dates. More common is fasting and abstain-

ing only on Ash Wednesday and Good Friday.
Before 1966, when the U.S. Catholic Conference
abolished most dietary restrictions, abstinence
from meat was observed on every Friday that did
not fall on a feast day. Abstinence is now encour-
aged on the Fridays of Lent in remembrance of
Christs sacrificial death.
Some older Catholics and those from other
nations may observe the pre-1966 dietary laws. In
addition, Catholics are required to avoid all food
and liquids, except water, for one hour before
receiving communion.
Eastern Orthodox Christianity

The Eastern Orthodox Church is as old as the
Courtesy of Grossich and Bond, Inc.

Roman Catholic branch of Christianity, although
not as prevalent in the United States. In the year
300 C.E., there were two centers of Christianity,
one in Rome and the other in Constantinople
(now Istanbul, Turkey). Differences arose over
theological interpretations of the Bible and the
governing of the church, and in 1054 the fellow-
ship between the Latin and Byzantine churches Italian-American Catholics
was finally broken. Some of the differences often serve panettone, a
sweet bread with dried fruits,
between the two churches concerned the inter- The first Eastern Orthodox Church in America on feast days, especially
pretation of the Trinity (the Father, the Son, and the was started by Russians on the West Coast in the late Christmas.
Holy Ghost), the use of unleavened bread for 1700s. It is estimated that nearly 3 million persons
the communion, the celibacy of the clergy, and the in the United States are members of the Eastern
position of the pope. In the Eastern Orthodox Lent is the forty days before
Orthodox religion, with the largest following
Church, leavened bread, called phosphoron, is Easter; the word originally
(1,500,000) being Greek.30 Most Eastern Orthodox meant spring.The last day
used for communion, the clergy are allowed to churches in the United States recognize the patri- before Lent is a traditional
marry before entering the priesthood, and the arch of Constantinople as their spiritual leader. festival of exuberant feast-
authority of the pope is not recognized. ing and drinking in many
The Orthodox Church consists of fourteen Feast Days. All the feast days are listed in Table 4.3. regions where Lenten fast-
self-governing churches, five of which Easter is the most important holiday in the Eastern ing is observed. In France
Constantinople, Alexandria (the Egyptian Coptic Orthodox religion and is celebrated on the first and in Louisiana, it is
Church), Antioch, Jerusalem, and Cyprusdate Sunday after the full moon after March 21, but not known as Mardi Gras; in
back to the time of the Byzantine Empire. Six other before the Jewish Passover. Lent is preceded by a Britain, Shrove Tuesday; in
churches represent the nations where the majority pre-Lenten period lasting ten weeks before Easter Germany, Fastnacht; and
of people are Orthodox (Russia, Rumania, Serbia, or three weeks before Lent. On the third Sunday throughout the Caribbean
Bulgaria, Greece, and the former Soviet state of before Lent (Meat Fare Sunday), all the meat in the and in Brazil, Carnival.
Georgia). Three other churches exist independently house is eaten. On the Sunday before Lent (Cheese
in countries where only a minority profess the reli- Fare Sunday), all the cheese, eggs, and butter in the The Ethiopian church is an
gion (Poland, Albania, and the Sinai Monastery). house are eaten. On the next day, Clean Monday, Orthodox denomination
similar to the Egyptian
Additionally, there are four churches considered the Lenten fast begins. Fish is allowed on Palm
Coptic Church. Timkat (Feast
autonomous, but not yet self-governing: Czech Sunday and on the Annunciation Day of the Virgin
of the Epiphany) is the most
Republic/Slovakia, Finland, China, and Japan.15 Mary. The Lenten fast is traditionally broken after significant Christian holiday
The Orthodox Church in America, which is not yet the midnight services on Easter Sunday. Easter of the year, celebrating the
officially recognized, was constituted in 1970.39 eggs in the Eastern Orthodox religion range from baptism of Jesus. Beer brew-
The beliefs of the Orthodox churches are similar; the highly ornate (eastern Europe and Russia) to ing, bread baking, and eating
only the language of the service differs. the solid red ones used by the Greeks. roast lamb are traditional.
Table 4.3 Eastern Orthodox Feast Days

Feast Day Date*
Christmas Dec. 25 or Jan. 7
Theophany Jan. 6 or Jan. 19
Presentation of our Lord into the Temple Feb. 2 or Feb. 15
Annunciation Mar. 25 or Apr. 7
Easter First Sunday after the full moon after Mar. 21
Ascension 40 days after Easter
Pentecost (Trinity) Sunday 50 days after Easter
Transfiguration Aug. 6 or Aug. 19
Dormition of the Holy Theotokos Aug. 15 or Aug. 28
Nativity of the Holy Theotokos Sept. 8 or Sept. 21
Presentation of the Holy Theotokos Nov. 21 or Dec. 4
*Date depends on whether the Julian or Gregorian calendar is followed.
Koljivo, boiled whole-wheat Fast Days. In the Eastern Orthodox religion there Protestantism
kernels mixed with nuts, are numerous fast days (see Table 4.4). Further,
dried fruit, and sugar, must
The sixteenth century religious movement known
those receiving Holy Communion on Sunday as the Reformation established the Protestant
be offered before the abstain from food and drink before the service.
church altar three, nine, churches by questioning the practices of the
Fasting is considered an opportunity to prove Roman Catholic Church and eventually breaking
and forty days after the
that the soul can rule the body. On fast days no away from its teachings. The man primarily respon-
death of a family member.
After the koljivo is blessed
meat or animal products (milk, eggs, butter, and sible for the Reformation was Martin Luther, a
by the priest, it is distrib- cheese) are consumed. Fish is also avoided, but German Augustinian monk who taught theology.27
uted to the friends of the shellfish is generally allowed. Older or more He started the movement when, in 1517, he nailed
deceased. The boiled wheat devout Greek Orthodox followers do not use olive a document containing 95 protests against certain
represents everlasting life, oil on fast days, but will eat olives.
and the fruit represents
sweetness and plenty.
Table 4.4 Eastern Orthodox Fast Days and Periods
The red Easter egg symbol-
Fast Days
izes the tomb of Christ (the
egg) and is a sign of mourn- Every Wednesday and Friday except during fast-free weeks:
ing (the red color). The Week following Christmas until Eve of Theophany (12 days after Christmas)
breaking of the eggs on
Bright Week, week following Easter
Easter represents the open-
ing of the tomb and belief Trinity Week, week following Trinity Sunday
in the resurrection. Eve of Theophany (Jan. 6 or 18)
Beheading of John the Baptist (Aug. 29 or Sept. 27)
The Elevation of the Holy Cross (Sept. 14 or 27)
Fast Periods
Nativity Fast (Advent): Nov. 15 or 28 to Dec. 24 or Jan. 6
Great Lent and Holy Week: 7 weeks before Easter
Fast of the Apostles: May 23 or June 5 to June 16 or 29
Fast of the Dormition of the Holy Theotokos: Aug. 1 or 14 to Aug. 15 or 28
Dates depend on whether the Julian or Gregorian calendar is followed.

Catholic practices on the door of the castle church their members to bake bread (of any type), and One study found that
in Wittenberg. He later broadened his position. A many denominations simply cut up white bread Protestants (especially
decade later, several countries and German prin- (even hot dog buns) of some sort.37 The primary Baptists) were most likely
cipalities organized the Protestant Lutheran holidays of the Protestant calendar are Christmas to be overweight; Jews,
Muslim, and Buddhists,
Church based on Martin Luthers teachings. and Easter. The role of food is important in these
least likely. However, differ-
Luther placed great emphasis on the individ- celebrations; however, the choice of items served
ences in affiliation were
uals direct responsibility to God. He believed that is even more varied than Communion practices, inconsequential when the
every person can reach God through direct prayer determined by family ethnicity and preference data were controlled for
without the intercession of a priest or saint; thus, rather than religious rite. Fasting is also uncom- socioeconomic status and
every believer is, in effect, a minister. Although mon in most Protestant denominations. Some ethnicity. Of significance,
everyone is prone to sin and inherently wicked, a churches or individuals may use occasional fasting, however, was degree of
person can be saved by faith in Christ, who by his however, to facilitate prayer and worship. Only a devotion and risk of
death on the Cross atoned for the sins of all people. few of the Protestant denominations, such as the obesity.16 Other studies also
Consequently, to Luther, faith was all-important Mormons and the Seventh-Day Adventists, have suggest it is certain dimen-
and good works alone could not negate evil deeds. dietary practices integral to their faith. sions of religiosity, not
affiliation, that put individ-
Luthers theology removed the priests mystical
Mormons. The Church of Jesus Christ of Latter uals at risk for overweight
function, encouraging everyone to read the Bible
Day Saints is a purely American institution that and obesity.7, 26
and interpret the Scriptures. The beliefs taught by
Martin Luther established the foundation of most emerged in the early 1800s. Its founder, Joseph
Protestant faiths. Smith, Jr., had a vision of the Angel Moroni, who
Other reformers who followed Luther are told him of golden plates hidden in a hill and the
associated with specific denominations. In the mid- means by which to decipher them. The resulting
sixth century, John Calvin developed the ideas Book of Mormon was published in 1829, and in
that led to the formation of the Presbyterian, 1830 a new religious faith was born.
Congregationalist, and Baptist churches; John The Book of Mormon details the story of two
Wesley founded the Methodist movement in the bands of Israelites who settled in America and
eighteenth century. Other denominations in the from whom certain Native Americans and Pacific
United States include Episcopalians (related to Islanders are descended.31 Christ visited them
the English Anglican Church started under King after his resurrection, and they thus preserved
Henry VIII); Seventh-Day Adventists; Jehovahs Christianity in its pure form. The tribes did not
Witnesses; Disciples of Christ; Church of Jesus survive, but the last member, Moroni, hid the
Christ of Latter Day Saints (Mormons); Church of nations sacred writings, compiled by his father,
Christ, Scientist (Christian Scientists); and Mormon.
Friends (Quakers). The Mormons believe that God reveals himself
The most significant food ordinance in and his will through his apostles and prophets. The
Protestant churches is the Eucharist, also called Mormon Church is organized along biblical lines.
Communion, or the Lords Supper. However, other Members of the priesthood are graded upward in
than a liquid and a bread-like morsel being offered, six degrees (deacons, teachers, priests, elders,
there is little consistency in celebration of this seventies, and high priests). From the priesthood
ordinance. It can signify an encounter with the are chosen, by the church at large, a council of
living presence of God, a remembrance of the twelve apostles, which constitutes a group of ruling
Passover Seder attended by Jesus, a continuity of elders; from these, by seniority, a church president
tradition through community, or an individual rules with life tenure. There is no paid clergy.
spiritual experience. Though wine is traditional, Sunday services are held by groups of Mormons,
many churches switched to grape juice during and selected church members give the sermon.10
Prohibition and continue this temperance prac- To escape local persecution, Brigham Young led
tice. Some churches offer the wine/juice in a the people of the Mormon Church to Utah in 1847.
single cup which is shared, while others provide Today Utah is more than 80 percent Mormon,
small, individually filled cups. Many liturgical and many Western states have significant num-
churches, such as the Lutheran church, offer wafers bers of church members, with an estimated total
similar to Catholic practice. Others, such as number of adherents over five million in 2004.30
Methodists, often use a bread pellet. Some organize The main branch of the church is headquartered
in Salt Lake City, but a smaller branch, the The church adheres strictly to the teachings of
Reorganized Church of Jesus Christ of Latter Day the Bible. The Sabbath is observed from sundown
Saints, is centered in Independence, Missouri. All on Friday to sundown on Saturday and is wholly
Mormons believe that Independence will be the dedicated to the Lord. Food must be prepared on
capital of the world when Christ returns. Friday and dishes washed on Sunday. Church
Joseph Smith, through a revelation, prescribed members dress simply, avoid ostentation, and
the Mormon laws of health, dealing particularly wear only functional jewelry. The churchs head-
with dietary matters.31 These laws prohibit the use quarters are in Tacoma Park, Maryland, near
of tobacco, strong drink, and hot drinks. Strong Washington, D.C., where they were moved after a
drink is defined as alcoholic beverages; hot drinks series of fires ravaged the previous center in Battle
mean tea and coffee. Many Mormons do not use Creek, Michigan.
any product that contains caffeine. Followers are Each congregation is led by a pastor (more a
advised to eat meat sparingly, and to base their teacher than a minister), and all the churches are
diets on grains, especially wheat. In addition, all under the leadership of the president of the gen-
Mormons are required to store a years supply of eral conference of Seventh-Day Adventists.
food and clothing for each person in the family. Adventists follow the Apostle Pauls teaching that
Many also fast one day per month (donating to the human body is the temple of the Holy Spirit.
the poor the money that would have been spent Many of Mrs. Whites writings concern health and
on food). diet and have been compiled into such books as
The Ministry of Healing, Counsels on Health, and
Seventh-Day Adventists. In the early 1800s Counsels on Diet and Foods.4143
Loma Linda Foods began as many people believed that the Second Coming of Adventists believe that sickness is a result of the
a bakery in 1906 providing Christ was imminent. In the United States violation of the laws of health. One can preserve
whole-wheat bread and William Miller predicted that Christ would health by eating the right kinds of foods in moder-
cookies to the Adventist return in 1843 or 1844. When both years passed ation and by getting enough rest and exercise.
patients and staff of Loma and the prediction did not materialize, many of Overeating is discouraged. Vegetarianism is
Linda University Medical his followers became disillusioned. However, one widely practiced because the Bible states that the
Center in southern California. group continued to believe that the prediction diet in Eden did not include flesh foods. Most
was not wrong but that the date was actually Adventists are lacto-ovo-vegetarians (eating milk
The American breakfast
cereal industry is the result
the beginning of the worlds end preceding the products and eggs, but not meat). Some do con-
of the dietary and health coming of Christ. They became known as the sume meat, although they avoid pork and shell-
practices of the Seventh-Day Seventh-Day Adventists and were officially fish. Mrs. White advocated the use of nuts and
Adventists. In 1886 Dr. John organized in 1863.19 beans instead of meat, substituting vegetable oil
Kellogg became director of The spiritual guide for the new church was for animal fat, and using whole grains in breads.
the Adventists sanitarium in Ellen G. Harmon, who later became Mrs. James Like the Mormons, the Adventists do not consume
Battle Creek, Michigan, and White. Her inspirations were the result of more tea, coffee, or alcohol and do not use tobacco prod-
in his efforts to find a tasty than 2,000 prophetic visions and dreams she ucts. Water is considered the best liquid and
substitute for meat, he reportedly had during her life. Mrs. White claimed should be consumed only before and after the
invented corn flakes.
to be not a prophet but a conduit that relayed Gods meal, not during the meal. Meals are not highly
desires and admonitions to humankind. seasoned, and hot spices such as mustard, chili
There were nearly a million Seventh-Day powder, and black pepper are avoided. Eating
Adventists in the United States in 2003 and more between meals is discouraged so that food can be
than 14 million worldwide.30 Besides the main properly digested. Mrs. White recommended that
belief in Christs advent, or second coming, the five or six hours elapse between meals.
Seventh-Day Adventists practice the principles of
Protestantism. They believe that the advent will
be preceded by a monstrous war, pestilence, and
ISLAM
plague, resulting in the destruction of Satan and Islam is the second largest religious group in the
all wicked people; the Earth will be purified by world. Although not widely practiced in the
holocaust. Although the hour of Christs return is United States, Islam is the dominant religion in
not known, they believe that dedication to his the Middle East, northern Africa, Pakistan,
work will hasten it. Indonesia, and Malaysia. Large numbers of people
also follow the religion in parts of sub-Saharan expressed in the creed, There is no God
Africa, India, Russia, and Southeast Asia. but Allah; Mohammed is the Messenger
Islam, which means submission (to the will of of Allah.
God), is not only a religion but also a way of life.18 2. Prayer, salat, performed five times daily
One who adheres to Islam is called a Muslim, he (at dawn, noon, mid-afternoon, sunset,
who submits. Islams founder, Mohammed, was and nightfall), facing Mecca, wherever
neither a savior nor a messiah but rather a prophet one may be; and on Fridays, the day of
through whom God delivered his messages. He public prayer, in the mosque (a building
was born in 570 C.E. in Mecca, Saudi Arabia, a city used for public worship). On Fridays,
located along the spice trade route. Early in sermons are delivered in the mosque after
Mohammeds life he acquired a respect for Jewish the noon prayer.
and Christian monotheism. Later the archangel
Gabriel appeared to him in many visions. These 3. Almsgiving, zakat, as an offering to the
revelations continued for a decade or more, and poor and an act of piety. In some Islamic
countries, Muslims are expected to give
the archangel told Mohammed that he was a
2.5 percent of their net savings or assets
prophet of Allah, the one true God. Mohammeds
in money or goods. The money is used to
teachings met with hostility in Mecca, and in 622
help the poor or to support the religious
he fled to Yathrib. The year of the flight (hegira) is
organization in countries where Islam is
the first year in the Muslim calendar. At Yathrib,
not the dominant religion. In addition,
later named Medina, Mohammed became a reli-
zakat is given to the needy on certain
gious and political leader. Eight years after fleeing
feast and fast days (see the next section
Mecca, he returned triumphant and declared
on dietary practices for more details).
Mecca a holy place to Allah.
The most sacred writings of Islam are found 4. Fasting, to fulfill a religious obligation, to
in the Quran (sometimes spelled Koran or earn the pleasure of Allah, to wipe out
Quran), believed to contain the words spoken by previous sins, and to appreciate the hunger
Allah through Mohammed. It includes many leg- of the poor and the needy.
ends and traditions that parallel those of the Old 5. Pilgrimage to Mecca, hadj, once in a life-
and New Testaments, as well as Arabian folk time if means are available. No non-
tales. The Quran also contains the basic laws of Muslim can enter Mecca. Pilgrims must
Islam, and its analysis and interpretation by reli- wear seamless white garments; go without
gious scholars have provided the guidelines by head covering or shoes; practice sexual
which Muslims lead their daily lives. continence; abstain from shaving or having
Muslims believe that the one true God, Allah, their hair cut; and avoid harming any living If one is unable to attend a
is basically the God of Judaism and Christianity thing, animal, or vegetable. mosque, the prayers are
but that his word was incompletely expressed said on a prayer rug facing
There are no priests in Islam; every Muslim Mecca.
in the Old and New Testaments and was only
fulfilled in the Quran. Similarly, they believe that can communicate directly with God, so a media-
The Kaaba, in Mecca, is the
Mohammed was the last prophet, superseding tor is not needed. The successors of the prophet
holiest shrine of Islam and
Christ, who is considered by Muslims a prophet Mohammed and the leaders of the Islamic com-
contains the Black Stone
and not the Son of God. The primary doctrines of munity were the caliphes (or kalifah). No caliphes given to Abraham and
Islam are monotheism and the concept of the last exist today. A mufti, like a lawyer, gives legal Ishmael by the Archangel
judgmentthe day of final resurrection when all advice based on the sacred laws of the Quran. An Gabriel. During the hadj,
will be deemed worthy of either the delights of imam is the person appointed to lead prayer in each pilgrim touches the
heaven or the terrors of hell. the mosque and deliver the Friday sermon. stone and circles the shrine.
Mohammed did not institute an organized The following prominent sects in Islam have
priesthood or sacraments but instead advocated their origin in conflicting theories on the office of
the following ritualistic observances, known as caliph (caliphate): (1) Sunni, who form the largest
the Five Pillars of Islam: number of Muslims and hold that the caliphate is
an elected office that must be occupied by a
1. Faith, shown by the proclamation of the member of the tribe of Koreish, the tribe of
unity of God, and belief in that unity, as Mohammed. (2) Shiia, the second largest group,
No one claiming title to the who believe that the caliphate was a God-given Muslims are advised against eating more than two-
office of caliphate has been office held rightfully by Ali, Mohammeds son-in- thirds of their capacity, and sharing food is recom-
recognized by all Muslim law, and his descendants. The Shiites (followers mended. Food is never to be thrown away, wasted,
sects since its abolition by of Shiia Islam) are found primarily in Iran, Iraq, or treated with contempt. The hands and mouth
the Turkish government in Yemen, and India. (3) The Khawarij, who believe are washed before and after meals. If eating uten-
1924 following the fall of
that the office of caliph is open to any believer sils are not used, only the right hand is used for
the Ottoman Empire. The
role of the caliphate in
whom the faithful consider fit for it. Followers of eating, as the left hand is considered unclean.
modern Islam is uncertain. this sect are found primarily in eastern Arabia Permitted or lawful foods are called halal. Allah
and North Africa. (4) The Sufis, ascetic mystics alone has the right to determine what may be
who seek a close union with God now, rather eaten, and what is permitted is sufficientwhat is
than in the hereafter. Only 3 percent of present- not permitted is unnecessary.35 Unless specifically
day Muslims are Sufis, and many remain outside prohibited, all food is edible. Unlawful or prohi-
mainstream Islam.9, 40 bited (haram) foods listed in the Quran include:
The status of fish varies by It is estimated that nearly 6 million Muslims live
1. All swine, four-footed animals that catch
sect. Most Muslims consider in the United States; many came from the Middle
anything from the sea their prey with their mouths, birds of prey
East. Most are Sunnis, with only a small percentage
halal; however, some, such that seize their prey with their talons, and
of Shiites, though there is some crossover in wor-
as Shiites, eat only fish with any by-products of these animals, such as
ship and religious celebrations.9 In addition, some
scales.35 pork gelatin or enzymes used in cheese
African Americans believe Allah is the one true
making. If the source of any by-product is
God; they follow the Quran and traditional Muslim
in question, it is avoided.
rituals in their temple services. The movement was
originally known as the Nation of Islam and its 2. Improperly slaughtered animals (including
adherents identified as Black Muslims. A split in carrion). An animal must be killed in a
the Nation of Islam resulted in one faction of Black manner similar to that described in the
Muslims becoming an orthodox Islamic religion Jewish laws, by slitting the front of the
called the World Community of Al-Islam in the throat; cutting the jugular vein, carotid
West. It is accepted as a branch of Islam. The other artery, and windpipe; and allowing the
Black Muslim faction has continued as the Nation blood to drain completely. In addition, the
of Islam under the leadership of Louis Farrakhan. person who kills the animal must repeat
at the instant of slaughter, In the name of
Halal, Islamic Dietary Laws God, God is great. Fish and seafood are
In Islam, eating is considered to be a matter of exempt from this requirement.
Islamic laws consider eating worship. Muslims are expected to eat for survival Some Muslims believe that a Jew or a Christian
to be a matter of worship, and good health; self-indulgence is not permitted. can slaughter an animal to be consumed by
and Muslims are encouraged Muslims as long as it is done properly. Others will
to share meals. eat only kosher meat, while some abstain from
meat altogether unless they know it is properly
slaughtered by a Muslim or can arrange to kill the
animal themselves. Meat of animals slaughtered
by people other than Muslims, Jews, or Christians
is prohibited. Meat from an animal that was
slaughtered when any name besides Gods was
mentioned is also prohibited.4
3. Blood and blood products.
J. Boisberranger/Viesti Associates
4. Alcoholic beverages and intoxicating drugs,

unless medically necessary. Even foods that
have fermented accidentally are avoided.
The drinking of stimulants, such as coffee
and tea, is discouraged, as is smoking; how-
ever, these prohibitions are practiced only
by the most devout Muslims.
A Muslim can eat or drink prohibited food CERTIFIED

HALAL Figure 4.3
under certain conditions, such as when the food is
taken by mistake, when it is forced by others, or M ISLAMIC FOOD AND NUTRITION
COUNCIL OF AMERICA
M Examples of halal food
symbols.
there is fear of dying by hunger or disease. The term
for a food that is questionably halal or haram is
mashbooh, and when in doubt, a Muslim is
customary to sacrifice a sheep and distribute Some devout Muslims also
encouraged to avoid the item. Foods that combine
its meat to friends, relatives, and the needy. avoid land animals without
halal items with haram items, such as baked goods external ears, such as
made with lard or pizza with bacon, ham or pork 3. Shab-i-Barat, the night in the middle of
snakes and lizards.
sausage topping, are also prohibited.3 Muslims Shabanoriginally a fast day, this is now
vary in their observance of the halal diet, however, a feast day celebrated mostly in non-Arab
with the strictest adherence found among the nations, often marked with fireworks. It is
most orthodox believers.14 Foods in compliance believed that God determines the actions of
with Islamic dietary laws are sometimes marked every person for the next year on this night. The month of Ramadan can
fall during any part of the
with symbols registered with the Islamic Food and 4. Nau-Roz, New Years Dayprimarily cele-
year. The Muslim calendar is
Nutrition Council of America (IFNCA) (Figure 4.3), brated by the Iranians, it is the first day
lunar but does not have a
signifying the food is fit for consumption by after the sun crosses the vernal equinox. leap month; thus, the
Muslims anywhere in the world.24 5. Maulud nNabithe birthday of months occur at different
Mohammed. times each solar year.
Feast Days
The following are the feast days in the Islamic Feasting also occurs at birth, after the consum- Women who wish to under-
religion: mation of marriage, at Bismillah (when a child first take voluntary fasts must
starts reading the Quranic alphabet), after circum- seek permission from their
1. Eid al-Fitr, the Feast of Fast Breaking cision of boys, at the harvest, and at death. husbands.
the end of Ramadan is celebrated by a
feast and the giving of alms. Fast Days
2. Eid al-Azha, the Festival of Sacrificethe On fast days Muslims abstain from food, drink,
commemoration of Abrahams willingness smoking, and coitus from dawn to sunset. Food can
to sacrifice his son, Ishmael, for God. It is be eaten before the sun comes up and again after
NEW AMERICAN PERSPECTIVESIslam

y name is Hafsabibi Mojy and I am a student at San Jose State University. I also work as Nutrition Technician in a local med-
M ical center. Although I immigrated from India to the United States in 1994, I am an observant Muslim, especially when it
comes to Islamic food laws. I will shop at special stores in order to buy halal meats, which for me include beef, goat, chicken,
veal and turkey and are more expensive then meat from the supermarket. Most Americans I have met do not know what halal means
and they often think I am a vegetarian, probably because I come from India. It is common for me to call myself a meat-eating veg-
etarian as I only eat meat at home or places where halal is available but otherwise I call myself vegetarian when I am at places
where halal food is not available.
I do fast from sunrise to sunset during Ramadan. It is not hard but it takes a few days in the beginning to get back to the rhythm
of fasting. To me personally I get thirsty more than hungry. My favorite Islamic holiday is Eid Al-Adha or Feast of Sacrifice. It is the
most important feast of the Muslim calendar and lasts for three days. It concludes the Pilgrimmage to Mecca. The feast re-enacts
prophet Ibrahims obedience to God by sacrificing a cow or ram. The family eats about a third of the meal and donates the rest to the
poor. My favorite foods include all Indian meat curry dishes, Biryani (spicy rice pilaf with meat or chicken) and kababs.
Health care that includes dietary modifications may interfere with Islamic food laws. Say for example a patient is on a clear liquid
diet at a hospital . . . there will be very few choices left to give to a Muslim patient as Jell-O will be excluded (Jell-O, considered a clear
liquid because it is liquid at body temperature, contains gelatin which is usually derived from animals and hence will be a non-halal
item). Some vegetarian dishes contain a chicken broth base and hence will be considered non-halal. Even a vegetarian burger can
have wine in it and will be considered non-halal as all alcohol products are also prohibited under Islamic food laws.
it sets. Fasting is required of Muslims during Being. When this state is achieved, there is no cause
Ramadan, the ninth month of the Islamic calendar. and effect, no time and space, no good and evil; all
It is believed that during Ramadan, the gates of dualities are merged into oneness. This goal cannot
Heaven are open, the gates of Hell closed, and the be reached by being a good person, but it can be
devil put in chains. At sunset the fast is usually obtained by transforming human consciousness or
broken by taking a liquid, typically water, along liberation, moksha, into a new realm of divine con-
with an odd number of dates. sciousness that sees individual parts of the universe
All Muslims past the age of puberty (fifteen as deriving their true significance from the central
years old) fast during Ramadan. A number of unity of spirit. The transformation of human con-
groups are exempt from fasting, but most must sciousness into divine consciousness is not achieved
make up the days before the next Ramadan. They in one lifetime, and Hindus believe that the present
include sick individuals with a recoverable illness; life is only one in a series of lives, or reincarnations.
people who are traveling; women during preg- Hindus believe in the law of rebirth, which postu-
nancy, lactation, or menstruation; elders who are lates that every person passes through a series of
physically unable to fast; insane people; and those lives before obtaining liberation; the law of karma,
engaged in hard labor. During Ramadan, it is cus- that ones present life is the result of what one
tomary to invite guests to break the fast and dine thought or did in ones past life. In each new incar-
in the evening; special foods are eaten, especially nation an individuals soul moves up or down the
sweets. Food is often given to neighbors, relatives, spiritual ladder; the goal for all souls is liberation.
and needy individuals or families. There is one Supreme Being, Brahman, and all
In 2006 a French humani- Muslims are also encouraged to fast six days the various gods worshiped by men are partial
tarian group was accused of during Shawwal, the month following Ramadan; manifestations of him. Hindus choose the form of
racism when it deliberately the tenth day of the month of Muhurram; and the the Supreme Being that satisfies their spirit and
served identity soup made ninth day of Zul Hijjah, but not during the pil- make it an object of love and adoration. This
with pork parts to needy grimage to Mecca. A Muslim may fast voluntar- aspect of worship makes Hinduism very tolerant
Muslims in the country.
ily, preferably on Mondays and Thursdays. of other gods and their followers; many different
Muslims are not allowed to fast on two festival religions have been absorbed into Hinduism.
days: Eid al-Fitr and Eid al-Azha; or on the days The three most important functions of the
of sacrificial slaughter: Tashriqthe twelfth, Supreme Being are the creation, protection, and
thirteenth, and fourteenth days of Dhu-al-Hijjah. destruction of the world, and these functions have
It is also undesirable for Muslims to fast exces- become personified as three great gods: Brahma,
sively (because Allah provides food and drink to Vishnu, and Siva (the Hindu triad or trinity). The
consume) or to fast on Fridays. Supreme Being as Vishnu is the protector of the
world. Vishnu is also an avatara, meaning he can
take on human forms whenever the world is threat-
Eastern Religions ened by evil. Rama and Krishna are regarded as two
such embodiments and are also objects of worship.
Hindus believe that the world passes through
HINDUISM repeating cycles; the most common version of the
Hinduism is considered the worlds oldest religion, creation is connected to the life of Vishnu. From
and, like Judaism, it is the basis of other religions Vishnus navel grows a lotus, and from its unfold-
such as Buddhism. Although Hinduism was once ing petals is born the god Brahma who creates the
popular throughout much of Asia, most Hindus world. Vishnu governs the world until he sleeps;
now live in India, its birthplace. The common then Siva destroys it and the world is absorbed
Hindu scriptures are the Vedas, the Epics, and the into Vishnus body to be created once again.
Bhagavata Purana. The Vedas form the supreme The principles of Hinduism are purity, self-
authority for Hinduism. There are four Vedas: the control, detachment, truth, and nonviolence.
Rigveda, the Samaveda, the Yajurveda, and the Purity is both a ceremonial goal and a moral
Aatharvaveda. Each consists of four parts. ideal. All rituals for purification and the elaborate
The goal of Hinduism is not to make humans rules regarding food and drink are meant to lead
perfect beings or life a heaven on Earth but to make to purity of mind and spirit. Self-control governs
humans one with the Universal Spirit or Supreme both the flesh and the mind.
CULTURAL CONTROVERSYMeat Prohibitions
S cientists have calculated that

animal protein comprised over
50 percent of the total daily calo-
ries consumed by prehistoric peoples, a far
higher amount than what most Americans
association between eating pork and the
slow development of diseases, such as
trichinosis, not to mention that other ani-
mals that carry fatal illnesses (e.g., spongi-
form encephalitis or mad cow disease) are
cattle are the primary power source in rural
farming communities due to the expense
of tractors. Further, cattle provide dung that
is dried to produce a clean, slow-burning
cooking fuel, and cows provide milk for the
eat today.7 Further, it is believed that only not avoided. dairy products important in some vegetarian
1 percent of the world population refuses The socioecological theory for why cer- fare. Even dead cows serve a purpose, pro-
to eat all types of meat, poultry, and fish tain meats are avoided suggests that if an viding the very poor with scavenged meat
and that total vegans, who avoid all animal animal is more valuable alive than dead or, to eat and skins to craft leather products.
products, equal only one-tenth of 1 percent. conversely, if it does not fit well into the The value of cattle in India is reinforced by
Humans favor protein foods. Nevertheless, local ecology or economy, consumption will religious custom. Horsemeat in Europe is a
many cultures impose some restrictions on be prohibited.21 Religious dietary codes different example. Though horse consump-
what meats may be consumed, mostly in often reinforce preexisting food practices tion was frequent in early Europe, other
accordance with prevailing religious dietary and prejudices. When reviewing the history cultures who used the animals for travel
laws. The devout of each faith see little of pork in the Middle East, for example, and cavalry often banned it. Asian nomads
reason to ask why a particular food is pro- archeological records show it was part of who roamed on horseback consumed
hibited. It is considered presumptuous or the ancient diet. But by 1900 B.C.E., pork horse milk and blood but only ate the flesh
sacrilegious for humans to question the had become unpopular in Babylonia, in emergencies. It was avoided by the
directives of God or church. Egypt, and Phoenicia, coinciding with an Romans and most Middle Easterners
This has not deterred researchers from expanding population and deforestation of (prohibited for Jews and by custom among
speculating on the rationale of meat the region. Pigs compete with humans for Muslims). During the eighth century, when
taboos. Some have investigated the whole food sources. Additionally, they do not European Christian strongholds came under
field of taxonomy and how animals are thrive in hot, dry climates. Cows, goats, attack from Muslim cavalry in the south
classified as different or unnatural, thus and sheep, on the other hand, can graze and mounted nomads from the west, Pope
abominable due to their physical charac- over large areas and survive on the cellu- Gregory III recognized the need for horses
teristics. The Jewish prohibition against lose in plants unavailable to human in the defense of the church. He prohibited
pork, for example, seems to be because metabolism. And they need no protection horsemeat as unclean and detestable.
pigs do not chew their cud, marking them from the sun. The nomadic Hebrews were However, horse consumption was never
as dissimilar from other animals with cloven unlikely to have herded pigs in their early entirely eliminated, especially during
hooves.11 This theory is supported by the history, and by the time they settled there times of hardship, and gradually religious
omnivores paradox and the psychological was a broad aversion to pigs by many restrictions were eased. By the nineteenth
need for food familiarity. Others have Middle Easterners. The first followers of century, horsemeat had regained favor,
focused on the use of the term unclean in Mohammed were also pastoral people, especially in France and Belgium, where
relation to biblical and Quranic pork prohi- which may explain why the only explicitly it is a specialty item today. Despite the
bitions, claiming that pork consumption is prohibited animal flesh in Islam is pork. initial need for horsepower, the religious
unhealthful. Many researchers discard this The socioeconomic theory is useful in prohibition was unsustainable over time
theory because it is thought that ancient examining other meat prohibitions. In because it contradicted prevailing food
populations could not have made the India, where beef is banned for Hindus, traditions.
The Seven Social Sins Hinduism does not teach its followers to sup- inertia. Those in whom purity predominates form
according to Gandhi are press the flesh completely but to regulate its the first caste, energy the second caste, and inertia
politics without principle; appetites and cravings. The highest aspect of self- the third and fourth castes. Each caste should per-
wealth without work; pleas- control is detachment. Complete liberation from form its own duties, follow its hereditary occupa-
ure without conscience; this world and union with the divine are not possi- tion, and cooperate with the others for the common
knowledge without charac-
ble if one clings to the good or evil of this existence. welfare. Peoples good actions in this life earn them
ter; commerce without
morality; science without Pursuit of truth is indispensable to the progress of promotion to a higher caste in the next life.
humanity; and worship humans, and truth is always associated with non- There are thousands of subdivisions of the
without sacrifice.33 violence, ahimsa. These principles are considered four main castes. The subcastes often reflect a
the highest virtues. Indias greatest exponent of trade or profession, but some scholars contend
this ideal was Mahatma Gandhi, who taught that that the latter was imposed on the former. In real-
nonviolence must be practiced not only by indi- ity, the subcaste is very important to daily life,
Ganesh got his elephant viduals, but also by communities and nations. while what major caste one belongs to makes
head when he angered his One common belief of Hinduism is that the little difference to non-Brahmins (see Chapter 14,
father, Siva, who cut off his world evolved in successive stages, beginning with South Asians). The ideal life of a Hindu is divided
human head. When his matter and going on through life, consciousness, into four successive stages, called asramas. The
mother pleaded with Siva and intelligence to spiritual bliss or perfection. Spirit first stage is that of the student and is devoted
to replace his head, Siva
first appears as life in plants, then as consciousness entirely to study and discipline. The guru
used the head of a nearby
elephant. Hindus honor
in animals, intelligence in humans, and finally bliss becomes an individuals spiritual parent. After
Ganesh through offerings of in the supreme spirit. A good person is closer to the this period of preparation, the student should
the foods he favored. supreme spirit than a bad person is, and a person settle down and serve his or her marriage, com-
is closer than an animal. Truth, beauty, love, and munity, and country. When this active period of
Yoga means yoke, as in righteousness are of higher importance than intel- citizenship is over, he or she should retire to a
yoking together or union. lectual values (e.g., clarity, cogency, subtlety, skill) quiet place in the country and meditate on the
or biological values (e.g., health, strength, vitality). higher aspects of the spirit (become a recluse).
Material values (e.g., riches, possessions, pleasure) The recluse then becomes a sannyasin, one who
are valued least. has renounced all Earthly possessions and ties.
The organization of society grows from the This stage is the crown of human life. The goals
principle of spiritual progression. The Hindu law- of life are dharma (righteousness), artha (worldly
givers tried to construct an ideal society in which prosperity), kama (enjoyment), and moksha
people are ranked by their spiritual progress and (liberation). The ultimate aim of life is liberation,
culture, not according to their wealth or power. The but on their way to this final goal people must
social system reflects this ideal, which is represented satisfy the animal wants of the bodies, as well as
by four estates, or castes, associated originally the economic and other demands of their fami-
with certain occupations. The four castes are the lies and communities. However, all should be
Brahmins (teachers and priests), the Kshatriyas done within the moral law of dharma. Adherence
(soldiers), the Vaisyas (merchants and farmers), and to dharma reflects a unique aspect of Hinduism,
the Sundras (laborers). Existing outside social recog- namely, that practice is more important than
nition are the dalits, untouchables (e.g., butchers, belief. There are no creeds in Hinduism; it is the
leather workers), a group of persons who do not fall performance of duties associated with ones caste
into the other four categories; although this desig- or social position that make a person a Hindu.17
nation was outlawed by the Indian government in Common practices in Hinduism include ritu-
1950, it is estimated that untouchables still consti- als and forms of mental discipline. All Hindus are
tute almost 20 percent of the population.17 advised to choose a deity on whose form, features,
The four castes are represented as forming and qualities they can concentrate their mind and
parts of the Creators body, respectively, his whose image they can worship every day with
mouth, arms, thighs, and feet. The untouchables flowers and incense. The deity is only a means of
were created from darkness that Brahma discarded realizing the Supreme Being by means of ritualis-
in the process of creation. The castes also conform tic worship. Externally, the deity is worshiped as a
to the law of spiritual progression, in that the most king or honored guest. Internal worship consists
spiritual caste occupies the top and the least spir- of prayer and meditation. Mental discipline is
itual the bottom. The Hindus believe that nature indicated by the word yoga. Along with mental
has three fundamental qualities: purity, energy, and discipline, yoga has come to mean a method of
restraining the functions of the mind and their foods prepared by certain groups of people Some Hindu worshipers
physiological consequences. (e.g., actors, artists, carpenters, cobblers, doc- break coconuts on the temple
Hindus can be divided into three broad sects tors, eunuchs, innkeepers, musicians, prosti- grounds to symbolize the
according to their view of the Supreme Being. tutes, and liars, spies, and thieves); foods that spiritual experience. The hard
They are the Vaishnava, the Saiva, and the Sakta, have been contaminated by a person sneezing shell is a metaphor for the
human ego, and once it is
who maintain the supremacy of Vishnu, Siva, and or through contact with a human foot, clothing,
cracked open, the soft, sweet
the Sakti (the female and active aspects of Siva), animals, or birds; milk from an animal that has meat representing the inner
respectively. Different sects are popular in differ- recently given birth; and water from the bottom self is open to becoming one
ent regions of India. Many Hindus do not worship of a boat. No fish or meat should be eaten until with the Supreme Being.12
one God exclusively. Vishnu may be worshiped in it has been sanctified by the repetition of
one of his full (Krishna or Rama) or partial mantras offering it to the gods. Pious Hindus According to legend, Vishnu
embodiments. In addition there are hundreds of may also abstain from alcoholic beverages. rested on a 1,000-headed
lesser deities, much like saints. One is Sivas son, Garlic, turnips, onions, leeks, mushrooms, and cobra between the creation
and destruction of the world.
the elephant-headed Ganesh, who is believed to red-hued foods, such as tomatoes and red
During the festivities of
bring good luck and remove obstacles. lentils, may be avoided. Despite such lengthy Naga Panchami, snakes are
It is estimated that there were nearly 1 million prohibitions, Hindus exert considerable per- venerated at Hindu tem-
Hindus in the United States in 2001, although it is sonal discretion regarding taboo foods.25 ples, and milk is offered to
not known for certain because the religion is not Intertwined in Hindu food customs is the cobras to prevent snakebite.
centered on a temple, and its affairs are not con- concept of purity and pollution. Complex rules
ducted by priests.28 Presumably, a significant per- regarding food and drink are meant to lead to Hindus are encouraged to
centage of the Asian-Indian population in America purity of mind and spirit. Pollution is the opposite practice moderationthey
is Hindu. A small percentage of nonIndian of purity and should be avoided or ameliorated. are advised not to eat too
Americans have become followers of the Hindu To remain pure is to remain free from pollution; early, not to eat too late,
religion. The International Society for Krishna to become pure is to remove pollution. Certain and not to eat too much.
Consciousness, founded in 1966 by devotees of a substances are considered both pure in themselves
Students studying the Vedas
sixteenth-century Bengali ascetic, has the largest and purifying in their application. These include
and other celibates are usu-
number of converts. the products of the living cowmilk products, ally vegetarians and may
dung, and urineand water from sources of special restrict irritating or exciting
Hindu Dietary Practices sanctity, such as the Ganges River. Pure and puri- foods, such as honey.
In general, Hindus avoid foods believed to hamper fying substances also include materials com-
the development of the body or mental abilities. monly employed in rituals, such as turmeric and
Bad food habits will prevent one from reaching sandalwood paste. All body products (feces, urine,
saliva, menstrual flow, and afterbirth) are pollut- The numerous religious
mental purity and communion with God. Dietary
holidays and secular events
restrictions and attitudes vary among the castes. ing. Use of water is the most common method of
celebrated in India include
The Laws of Manu (dating from the fourth purification because water easily absorbs pollu- feasting, which serves to
century C.E.) state that no sin is attached to tion and carries it away. distribute food throughout
eating flesh or drinking wine, or gratifying the the community.
sexual urge, for these are the natural propensi-
ties of men; but abstinence from these bears
greater fruits. Many Hindus are vegetarians.1, 33
They adhere to the concept of ahimsa, avoiding
inflicting pain on an animal by not eating meat.
Although the consumption of meat is allowed,
the cow is considered sacred and is not to be
killed or eaten. If meat is eaten, pork as well as
beef is usually avoided. Crabs, snails, crocodiles,
numerous birds (e.g., crows, doves, domesti-
cated fowl, ducks, flamingos, parrots, vultures,
United Nations/J. Isaac
and woodpeckers), antelopes, camels, boars,

bats, porpoises, and fish with ugly forms (unde-
fined) should also be rejected. In addition, the
laws make many other recommendations regard-
ing foods that should be avoided, including
Water is the beverage of Feast Days BUDDHISM

choice at meals. Standing
The Hindu calendar has eighteen major festivals Siddhartha Gautama, who later became known as
water is easily defiled if it is
touched by a member of a every year. Additional important feast days are Buddha (the Enlightened One), founded this
lower caste; flowing water those of marriages, births, and deaths. Each region Eastern religion in India in the sixth century B.C.E.
is so pure that even an of India has its own special festivals; it has been said Buddhism flourished in India until 500 C.E., when
untouchable standing in it that there is a celebration going on somewhere in it declined and gradually became absorbed into
does not pollute it. India every day of the year. All members of the Hinduism. Meanwhile, it had spread throughout
community eat generously on festive occasions, and southeastern and central Asia. Buddhism remains
these may be the only days that very poor people eat a vital religion in many Asian countries, where it
adequately. Feasting is a way of sharing food among has been adapted to local needs and traditions.
the population because the wealthy are responsible Buddhism was a protestant revolt against ortho-
for helping the poor celebrate the holidays. dox Hinduism, but it accepted certain Hindu con-
One of the gayest and most colorful of the Hindu cepts, such as the idea that all living beings go
festivals is Holi, the spring equinox and the cele- through countless cycles of death and rebirth, the
bration of one of Krishnas triumphs. According doctrine of karma, spiritual liberation from the
to legend, Krishna had an evil uncle who sent an flesh, and that the path to wisdom includes taming
ogress named Holika to burn down Krishnas house. the appetites and passions of the body. Buddha
Instead, Krishna escaped and Holika burned in the disagreed with the Hindus about the methods
blaze. It is traditional for Indians to throw colored by which these objectives were to be achieved.
water or powder at passersby during this holiday. He advocated the Middle Way between asceticism
The ten-day celebration of Dusshera in late
and self-indulgence, stating that both extremes in
September or early October commemorates the vic-
life should be avoided. He also disagreed with the
tory of Prince Rama (one of Vishnus embodiments)
Hindus on caste distinctions, believing that all per-
over the army of the demon Ravana and is a grateful
sons were equal in spiritual potential.
tribute to the goddess Durga, who aided Rama. The
The basic teachings of Buddha are found in
first nine days are spent in worshiping the deity, and
the Four Noble Truths and the Noble Eightfold
the tenth day is spent celebrating Ramas victory.
Path.36 The Four Noble Truths are as follows:
Divali, celebrated throughout India in
November, marks the darkest night of the year, 1. DukkhaThe Noble Truth of Suffering:
when souls return to Earth and must be shown the Suffering is part of living. Persons suffer
way by the lights in the houses. For many, Divali is when they experience birth, old age, sick-
also the beginning of the new year, when everyone ness, and death. They also suffer when
should buy new clothes, settle old debts and quar- they fail to obtain what they want. At a
rels, and wish everyone else good fortune. deeper level, dukkha embodies other con-
cepts, such as imperfection, emptiness,
Fast Days and impermanence.
In southern India the rice
harvest is celebrated in the
In India, fasting practices vary according to ones 2. SamudayaThe Noble Truth of the
festival called Pongal caste, family, age, sex, and degree of orthodoxy. A Cause of Suffering: This is the arising of
new rice is cooked in milk, devoutly religious person may fast more often dukkha. Suffering is caused by a persons
and when it begins to and more strictly than one who is less religious. cravings for life, which cause rebirth. It is
bubble, the family shouts, Fasting may mean eating no food at all or
manifested by an attachment to pleasure,
Pongal! (It boils!). abstaining from only specific foods or meals. It is
wealth, power, and even ideals and beliefs.
rare for an individual to go without any food at
The Hindu calendar is lunar; all, because Hinduism has numerous fast days. 3. NirodhaThe Noble Truth of the
thus, its religious holidays The fast days in the Hindu calendar include the Cessation of Suffering: This is the cessa-
do not always fall on the tion of dukkha. A person no longer suffers
first day of the new and full moon of each lunar
same day on the Western if all cravings are relinquished.
calendar. Every three to five
month; the tenth and eleventh days of each
years the Hindu calendar month; the feast of Sivaratri; the ninth day of the 4. MaggaThe Noble Truth to the Path
adds a thirteenth leap lunar month Cheitra; the eighth day of Sravana; Leading to the Cessation of Suffering:
month (a very auspicious days of eclipses, equinoxes, solstices, and con- This is the Eightfold Path. It is a middle
period) to reconcile the junction of planets; the anniversary of the death way between the search for happiness
months with the seasons. of ones father or mother; and Sundays. through pursuit of pleasure and the search
for happiness through self-mortification

and asceticism. By following this path
(right view, right thought, right speech,
right action, right livelihood, right effort,
right mindfulness, and right concentration),
craving is extinguished and deliverance
from suffering ensues.
The third and fourth phases of the Eightfold
Path (Figure 4.4), right speech and right action,
have been extended into a practical code of conduct
FIGURE 4.4
known as the Five Precepts. These are (1) abstain
The Buddhist Wheel of
from the taking of life, (2) abstain from the taking of
Lawthe spokes rep-
what is not given, (3) abstain from all illegal sexual
resent the Eightfold Path.
pleasures, (4) abstain from lying, and (5) abstain
from consumption of intoxicants because they tend
to cloud the mind. A small number of non-Asians also have more
The person who perfects Buddhas teachings recently converted to Buddhism. Vajrayana
achieves nirvana, a state of calm insight, passion- Buddhism, a Tibetan Mahayana sect also known as
lessness, and wisdom. In addition, the person is Tantric Buddhism, and Zen Buddhism, a Chinese
no longer subject to rebirth into the sorrows of sect that spread to Japan around the year 1200,
existence. Because the ideal practice of Buddhism have gained followers, especially in the West.
is impractical in the turmoil of daily life, Buddhism
has encouraged a monastic lifestyle. The ideal Dietary Practices
Buddhists are monks, following a life of simplicity In both Theravada and
Buddhist dietary restrictions vary considerably Mahayana temples, wor-
and spending considerable time in meditation.
depending on the sect and country. Buddhist shipers may offer food at
They own no personal property and obtain food
doctrine forbids the taking of life; therefore, many the altar, such as apples,
by begging. They are usually vegetarians and are bananas, grapes, oranges,
followers are lacto-ovo-vegetarians (eating dairy
permitted to eat only before noon. The monk pineapples, candy, rice,
products and eggs, but no meat). Some eat fish,
confers a favor or merit (good karma) on those dried mushrooms, and oil.
and others abstain only from beef. Others believe
who give him food.
that if they were not personally responsible for
There are numerous sects in Buddhism and two A Zen Buddhist monastery,
killing the animal, it is permissible to eat its flesh.
great schools of doctrine: Theravada (also known Tassajara, located in central
as Hinayana) Buddhism, which is followed in India California, is famous for
and Southeast Asia; and Mahayana Buddhism,
Feasts and Fasts its vegetarian restaurant
which is followed in China, Japan, Korea, Tibet, and Buddhist festivals vary according to region. From and popular cookbook.
Mongolia.8, 38 Theravada Buddhism is primarily a July to October, Buddhist monks are directed to Macrobiotics is not associ-
remain in retreat and meditate, coinciding with the ated with Zen Buddhism
spiritual philosophy and system of ethics. It places
rainy season and the sprouting of rice in the fields. (see Chapter 2 Traditional
little or no emphasis on deities, teaching that the
Health Beliefs and
goal of the faithful is to achieve nirvana. In The first day of retreat is a time for worshipers to
Practices).
Mahayana, a later form of Buddhism, Buddha is bring gifts of food and articles of clothing to the
eternal and cosmic, appearing variously in many monks; the retreat ends with pravarana, the end
worlds to make known his truth, called dharma. of the rainy season, when worshipers once again
This has resulted in a pantheon of Buddhas who offer gifts to the monks, invite them to a meal, and Buddhist monks in Tibet
are sometimes deified and, for some sects, a hier- organize processions. On three separate days (which carve sculptures in butter
vary according to the regional calendar), Mahayana (as high as fifteen feet) and
archy of demons. Some sects promise the wor-
parade them during an
shiper a real paradise rather than the perfected Buddhists commemorate the birth of Buddha, his
evening in March, lit by
spiritual state of nirvana. enlightenment, and his death; Theravada Buddhists lanterns, for Chogna
The number of Buddhists in the United States celebrate Magha Puja, the Four Miracles Assembly, Choeba, the Butter Lamp
was over 1 million in 2001;28 the majority are immi- in February or March when Buddha appointed the Festival. Afterward they are
grants from Japan, China, and Southeast Asia and first Buddhist brotherhood of monks at a coinci- dismantled and thrown in
their descendants. Based on number of meditation dental meeting of 1,250 disciples at a shrine. In the river, symbolic of the
centers, a majority are believed to be Mahayana.29 April or May they honor the Buddha on a single impermanence of life.
holiday called Vesak. Buddhist monks may fast twice 10. Douglas, D. 2004. Mormonism. In The Encyclopedia
a month, on the days of the new and full moon. of Protestantism, H.J. Hillerbrand (Ed.). New York:
They also do not eat any solid food after noon. Rutledge.
11. Douglas, M. 1966. Purity and danger: An analysis of
concepts of pollution and taboo. New York: Praeger.
CHAPTER 4 REVIEW QUESTIONS 12. Dresser, N. 2005. Multicultural manners: Essential
1. What are the basic tenets of Western and rules of etiquette for the 21st century. New York:
Eastern religions? John Wiley & Sons.
13. Eagan, J.F. 1995. Restoration & renewal: The church
2. Pick two of the following religions and
in the third millennium. Kansas City, MO: Sheed &
describe the dietary laws for food preparation
Ward.
and consumption, and any additional laws for 14. Eliasi, J.R., & Dwyer, J.T. 2002. Kosher and halal:
holy days: Judaism, Hinduism, and Islam. Religious observances affecting dietary intakes.
3. List the Five Pillars of Faith in Islam; and the Journal of the American Dietetic Association, 102,
Four Noble Truths and Noble Eightfold Path 911913.
in Buddhism. 15. Fairnbairn, D. 2002. Eastern orthodoxy through
4. Describe and compare the roles of fasting in Western eyes. Louisville, KY: Westminster John
Islam and Hinduism, using examples of fast- Knox Press.
ing practices in each faith. 16. Ferrano, K.F. 1998. Firm believers? Religion, body
weight, and well-being. Review of Religious Research,
39, 224244.
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CHAPTER
5
Native Americans
T he designation Native American, which reviews both the past and present diet of Native It has been suggested that
includes the greatest number of ethnic American ethnic groups. native Hawaiians be included
groups of any minority population in the as Native Americans; how-
United States, is a term for the indigenous people ever, the history and culture
of these peoples are substan-
of the Americas. It is used for both American
tially different from those
Indians and Alaska Natives, who are American
Indians, Inuits and Aleuts. Each of the approxi-
Cultural Perspective of Native Americans of the
U.S. mainland, Alaska, and
mately 400 American Indian and Alaska Native HISTORY OF NATIVE AMERICANS Canada, so they are discussed
nations has its own distinct cultural heritage. in Chapter 12, Southeast
Over 4.5 million persons of Native American Settlement Patterns Asians and Polynesians.
heritage lived in the United States in 2005 accord- It is hypothesized that the Native Americans came Native American cultures
ing to U.S. Census figures, representing 1.5 percent to North America approximately 20,000 to 50,000 of Mexico, Central America,
of the total population. The vast majority of years ago across the Bering Strait, which links and South America are
American Indians and Alaska Natives today live Asia to Alaska, although some evidence suggests considered in Chapters 9,
west of the Mississippi River. Roughly half live in Mexicans and Central
earlier migrations may have occurred.
Americans and 10,
rural areas, either on government reservations or Archaeological research provides little insight
Caribbean Islanders and
on nearby farms. Native American ethnic identity into the settlement patterns and diversification of South Americans.
varies tremendously, from tenacious maintenance Native American culture in the years before
of heritage to total adoption of the majority culture. European contact in the 1600s. Furthermore, the The U.S. Census uses the
Traditional Native American foods have made Native American languages were entirely verbal, phrase American Indians
significant contributions to todays American diet. so written historical records are nonexistent. and Alaska Natives (abbre-
Corn, squash, beans, cranberries, and maple syrup There are, consequently, enormous gaps in what viated AI/AN), and notes
are just a few of the items Native Americans intro- is known of early Native American societies. that approximately 15
duced to European settlers. Historians question Observations of Native Americans by white set- percent of this population
whether the original British colonists would have tlers have been well documented. These commen- is also of Hispanic ethnicity.90
survived their first years in America without the taries identified three major centers of American
supplies they obtained and the cooking methods Indian culture during the seventeenth century. In
they learned from the Native Americans. The diet the Southeast the sophisticated social organization
of Native Americans has changed dramatically of the Cherokees, Chickasaws, Choctaws, Creeks,
from its origins, yet recent renewed interest in and Seminoles led the Europeans to call them the
American Indian and Alaska Native culture has Five Civilized Tribes. The Iroquois, in what is now
prevented the complete disappearance of many New York State, ruled a democratic confederacy of
traditional foods and food habits. This chapter five nations. Religion and the arts flourished in
110 NATIVE AMERICANS
American society. Before the 1930s, Native

American children were sent to off-reservation
boarding schools where white values were encour-
aged. Later, public reservation schools attempted
similar indoctrination. The BIA program usually
failed to force Native Americans to accept white
values, however. The Native Americans changed
their dress, occupation, and social structure, but
they did not fully assimilate. In many cases their
religious beliefs were strengthened, and their
involvement in crafts, music, and dance was
deepened to support their ethnic identity.
Photo by Laurie Macfee
Current Demographics
Many Native Americans left the reservations for
the employment opportunities available during
Traditional Native American World War II. Some joined the armed services,
foods: Some typical foods where they became fluent in English and the ways
include beans, berries, corn, Pueblo communities adjacent to the Rio Grande
of the majority society. Others took war-related
fish, jerky, maple syrup, and Little Colorado rivers in the Southwest.
industry jobs. In the 1950s and 1960s the BIA
squash, and tomatoes. The introduction of horses, firearms, and metal
Employment Assistance Program was a major
knives changed the lifestyles of many nations,
factor in the continuing out-migration of Native
During the early nineteenth especially those that used the new tools to exploit
Americans from the reservations to the cities. By
century, the Cherokee had the resources of the Great Plains. This initial inter-
2000, two-thirds of all American Indians and
a written language, a bilin- action between white settlers and Plains Indians
Alaska Natives resided in the farms, towns, and
gual newspaper, a school resulted in the development of the stereotype of
system, a court system, urban areas outside of reservations (Figure 5.1).
the buffalo-hunting horseman with feathered
and a Cherokee Nation Among the states, California has the highest
headdress who came to represent all American
constitution.25 They were number of resident American Indians, followed
Indian ethnic groups in the white imagination.
a prosperous tribe; many by Oklahoma and Arizona. However, the greatest
European diseases and the massacre of whole
owned black slaves. percentage of Native Americans is in Alaska (20
nations reduced the numbers of both Native
percent of the total population), followed by
American individuals and ethnic groups. In addi-
Oklahoma and New Mexico (11 percent each).94
tion, many American Indians were forced to
Large urban Native American populations are
migrate west to accommodate white expansion.
found in Los Angeles, New York City, Phoenix,
The hardships of involuntary relocation and the
Tulsa, Anchorage, Oklahoma City, Albuquerque,
deaths caused by illness and assault may have
and Tucson. The remainder of the American
caused the extinction of nearly one-quarter of all
Indian and Alaska Native population resides in
Native American ethnic groups.
rural areas, including reservations. Many first-
Native American lands dwindled as white set-
generation urban Native Americans maintain
tlers moved westward. By the late nineteenth
close ties with the reservation of their ethnic
century, the majority of Native Americans lived
group and travel often between the city and tribal
on lands held in trust for them by the U.S. gov-
land. Members of the second generation living in
ernment, called federal reservations. Still others
urban regions are more likely to think of the city
resided in state reservation communities.
as their permanent home.
Although they were not required by law to live on
reservations, there were few other viable Native
American communities. Socioeconomic Status
The Bureau of Indian Affairs (BIA) took over The socioeconomic status of Native Americans
the administration of the reservations near the declined drastically with the forced migrations
turn of the twentieth century. It established a proof the nineteenth century. Even those Native
gram of cultural assimilation designed to bring American nations that were agriculturally self-
the Native American residents into mainstream sufficient suffered when relocated to regions with
Chapter 5: Native Americans 111
A Warm Springs Reservation

Chetco Umpque
Primary Location of C Nipmuc
Wampanoag
Coos Bay
Cowlitz
Wasco
Weaco
173 American Indian Groups Scaticook
Mohegan
Mashipee
Narrangasett
Pequot Wampenoag
Paugusett
Klickitat Wishram 500 Km Miles Montauk
Siuslaw Yakima-Klickitat Shinecock
Tenino Poosepatuck 100 Km Miles
Makah
Colville Malecite
Selish Kutenai Micmac
Kansen
Puyallup Coeur d Alene Blackfeet Passamaquoddy
Yakima Chippewa
Flathead Pennoscot
Spokan Assiniboine
Nez Perce Atsina Gros Ventre Chippewa
io
Siletz Caruse Sioux e Super r
Walla Walla Mandan Lak
Umatilla Arkara
Sioux Chippewa Mohawk
Northern Hidatsa
Ottawa
Cheyenne
L.
tario
Paiute Menominee
an
Klamath Ottawa
On
Hu
Tolowa Stockbridge Oneida
L. C
Lake Michig
Karok Moduc Crow Sioux
Chippewa Onondaga
ron
Yurok
Hupa Shasta Mi Chippewa Oneida Tuscarona
Wiyot Wintun Shoshone Arapano sso Winnebago Cayuga
Bear River Pit River Shoshone u Brotherton

ie
Seneca
Chippewa
Er
ri
Bannock Sioux
Kato
Shoshone
Potawatomi L.
Winnebago
Pomo Omaha Sac &
Wappo Gosiute Fox
Miwok Maidu Miami Nanticoke
Weshoe Sac &
Iowa Fox Rappahannock
Missouri
Mono Kickapoo Mattaponi
o O hio
ad
Potawatomi Pamunxey
Yokuts
or Chickahominy
Tule River Paiute
ol
Ute Munsee
C
Miwok Chippewa
Tubatuiabal Navajo Eastern
Apache
Chumash Kawaiisu
Serrano Husapa Havesuoa Cherokee
sippi
Vanyume Mohave Tewa Tewa Tiwa Eastern Band Lumbee
Hopi
Cahuilla
Fernandeno~ Chnehuevi Hopi
Zuni
Towa Keresan B
Gabrielino
sis
~ Yavapo Tiwa Catawba
Juaneno Mohave Keresan
Western Altamaha
Mis
Quechan Apache
Luiadno Maricope
Tima Eastern
Diogeeho Apache
Cocopa Papago
Pacific Yaqui
Tiwa
Choctaw Atlantic
Ri
Ocean
o
B Peoria
Quapaw
Creek Ocean
Gr
Modoc
Kaw an
Tonkawa Osage d Wyandot
Seneca
Choctaw Choctaw
Wichita Tunica
e
Paw
Wichita Cherokee Cayuge Alabama Atakapa

Oto Chitimacha
nee
Southern Hourma
Cheyenne
ESKIMOS Iowa
Sac & Seminole
Ki
Wichita Fox Creek

s
ck
an
ap
Caddo Miccosukee
ask
oo
Delaware
ole
Potwatomi Seminole
ap
min
Kiowa Shawnee
Ath
Se
Comanche
Kiowa Apache Choctaw Gulf of Mexico
Chickasaw
ALEUTS Tlingit Biloxi
100 Km Miles
Figure 5.1
Native American nations in
the United States.
poor growing conditions. Further, there were few have jobs in the construction, service, and trans- Source: Adapted and reprinted by
native occupations that were valued in the job portation fields. The Apaches and Dakota have permission of the publisher from
market outside the reservations. BIA education been active in ranching and are known for their Harvard Encyclopedia of
efforts were generally unsuccessful, and most expertise in the rodeo circuit.9, 13 In the Southwest, American Ethnic Groups edited
Native Americans did not begin to find employ- small-scale agriculture and livestock grazing by Stephan Thernstrom, Ann
ment until World War II and the development of are still important among some Hopi, Pueblo, Orlov and Oscar Handlin, p. 61,
Cambridge, Mass.; The Belknap
the BIA Employment Assistance Program. More and Navajo peoples; and traditional crafts such
Press of Harvard University Press,
recently the Indian Self-Determination and as weaving, pottery, and silversmithing are Copyright 1980 by the President
Education Act of 1975 was enacted to promote significant.11, 12, 35 Some Alaska Natives combine and Fellows of Harvard College.
Native American participation in government part-time paid employment with subsistence
and education. living and often find jobs in the fishing and
Economic improvement has been slow. Unem- forestry industries.5, 60, 67
ployment rates in 2000 for Native Americans The overall poverty rate for Native Americans The largest Native
were slightly lower than for the total population; (nearly 26%) in 2000 was double that of the general American populations in
2000 were the Cherokee
however, median earnings were nearly 25 percent population; however, significant tribal differences
(875,000 identified as
lower than average for American Indians. Median were seen. Most Alaska Natives had rates some-
Indian alone or in combina-
earnings for Alaska Natives approached those for what higher than the U.S. average (1523%), while tion with other groups) and
the total population among men, and exceeded poverty levels among the Apache, Navajo, and the Navajo (309,000 identi-
the national average for women. Fewer numbers Sioux approached or exceeded three times the fied as Indian alone or in
of Native Americans are found in management national rates (3439%). Rates of formal education combination with other
and professional positions, while greater numbers have been improving, yet 24 percent of all adult groups).90
Efforts to increase Native Americans have not finished high school organized hierarchies of priests. Yet they all share
prosperity on reservations or obtained an equivalency diploma.90, 94 one characteristic: The religion permeates all
include utilization of aspects of life. Rather than a separate set of beliefs
natural resources and Native American Organizations practiced at certain times in specific settings, reli-
establishment of gambling
Few Native American neighborhoods develop in gion is an integral part of the Native American
operations, which are legal
urban areas. Native Americans who settle in the holistic worldview. Religious concepts influence
on tribal lands.
cities usually arrive as individuals or small family both the physical and emotional well-being of the
groups and typically do not live near others of individual.
The Navajo concept that their nation. Sometimes longtime city residents Many Native American nations have rejected
integrates everything posi- exhibit a sense of superiority over recent arrivals all attempts at Christian conversion, especially in
tive in life, including from the reservations. In general, the difficulties the Southwest. The Navajo, Arizona Hopi, Rio
beauty, goodness, order, of adjusting to urban white society stimulate Grande Pueblos, Potawatomi, Lakota, and Dakota
and harmony, is called many young Native Americans to identify not have retained most of their native religious values
hozho.
only with Native Americans of other nations but and rituals, such as sweat lodge purification rites.
also with people from other ethnic groups. Other religions unique to Native Americans
Religious ceremonies held
by the Native American
Activists for Native American rights often come emerged after European contact, such as the
Church, called peyote from the cities and are not always supported by Drum Dance cult and the Medicine Bundle reli-
meetings, feature singing, Native Americans who live on tribal lands. Native gions, which combine spiritual elements from
prayers, and traditional American organizations have done much to several different ethnic groups. A Paiute vision-
foods such as tripe soup. maintain Indian identity. Most areas with large ary, Wovoka, founded the Ghost Dance religion
Continued success Native American populations have their own in the late 1880s which prophesied an end to
and good health for tribal clubs and service associations. Organizations to white domination through prayer, abstinence
members are entreated. promote ethnic identity have been founded by from alcohol, and ritual dancing.44 In addition,
the Navajo, Pueblos, Tlingit, Haida, and Pomo. religions mixing Christianity with traditional
Other groups such as athletic clubs and dance beliefs have been popular since the late nine-
groups serve the social needs of the panNative teenth century; the Native American Church has
American community. been especially successful. Other groups claim
Christian fellowship but continue to practice
native religions as well. Finally, many Native
WORLDVIEW
Americans now adhere to Roman Catholicism or
Harmony best describes the Native American some form of Protestantism, especially in urban
approach to life. Each individual strives to maintain areas where churches have been established to
a balance among spiritual, social, and physical serve all Native American congregations. In
needs in a holistic approach. Only what is necessary Alaska some Alaska Natives have become adher-
for life is taken from the natural environment; the ents of Russian Eastern Orthodoxy.
belief is the Earth should be cared for and treated
with respect. Generosity is esteemed and compet- Family
itiveness is discouraged, yet individual rights are The primary social unit of Native Americans is
also highly regarded. Personal autonomy is pro- the extended family. Children are valued highly,
tected through the principle of noninterference. and there is great respect for elders. All blood kin
Among the Navajo, for example, an individual of all generations are considered equal; there is
would never presume to speak for another, even a no differentiation between close and distant rela-
close family member. For most Native Americans, tives. Aunts and uncles are often considered like
time is conceptualized as being without beginning grandparents, and cousins are viewed as brothers
or end, and the culture is present-oriented, mean- or sisters. Even other tribal members are some-
ing that the needs of the moment are emphasized times accepted as close kin. In many Native
over the possible rewards of the future. American societies an individual without rela-
tives is considered poor.
Religion Many Native American nations are matrilineal,
Traditional Native American religions vary from an meaning that lineage is inherited from the
uncomplicated belief in the power of a self-declared mother. Traditionally, property was often passed
evangelist to elaborate theological systems with down through women in these tribes, and
decision-making often rested with an elder woman Some Native Americans reject the concept
in the family.10, 133 Today, even in matrilineal that poor nutrition, bodily malfunctions, or an
Lionel Delevingne/Stock,
systems, the men are the family providers and infection by a virus or bacteria can cause sick-
heads of the household; women are typically in ness. An evil external source is often identified
charge of domestic matters. Due to respect for the instead. Some Dakotas, for instance, blame type 2
Boston Inc.
individual within most Native American groups, diabetes on disease-transmitting foods provided
men and women hold equal standing. Native by whites with the intention of eliminating all
American children are expected to assist their Native Americans.75 An outbreak of serious respi-
parents in running the home. ratory infections due to the Hanta virus was The primary social unit
explained by Navajo healers as being due to rejec- of Native Americans is the
Traditional Health Beliefs and Practices tion of traditional ways and adoption of conven- extended family, which
includes all close and
In Native American culture, health reflects a ience foods.92 Some Native Americans attribute
distant kin.
persons relationship to nature, broadly defined as alcoholism to soul loss and the cultural changes
the family, the community, and the environment. due to domination by white society.133
Every illness is due to an imbalance with super- Small bags of herbs (called medicine bundles
natural, spiritual, or social implications. Treatment by certain Plains Indians), fetishes, feathers, or
focuses on the cause of the imbalance, not the symbols may be worn to protect against malevo-
symptoms, and is holistic in approach. The sick lent forces. Fetishes are used when an animal that
individual is at odds with the universe, and com- has been harmed or killed causes an ailment; a
munity and family support is focused on restoring fetish in the form of the animal is rubbed on the
harmony, not curing the disease.95 As explained afflicted body part with appropriate chants.
by the Cherokee medicine man, Sequoyah, Traditional healers often specialize in their
Indian medicine is a guide to health, rather than practice. Navajo medicine men and women usually
a treatment. The choice of being well instead of exert a positive influence in preventing dishar-
being ill is not taken away from an Indian.39 mony through rituals such as the sweat bath to
Traditional Native American medicine is con- promote peace. They also have negative powers,
cerned with physical, mental, and spiritual which can be used to counteract witchcraft or evil
renewal through health maintenance, prevention acts by a persons enemies. Diagnosticians may be
of illness, and restoration of health. called on to identify the cause of an illness
Many causes account for illness. Some Navajos through stargazing or listening (if crying is
believe that witchcraft, through agents such as heard, the patient will die). Hand motions or
animals, lightning, and whirlwinds; transgres- trembling also may be involved, sometimes
sions committed at ceremonial occasions; or evil including painting with white-, blue-, yellow-,
spirits (especially ghosts) may cause fainting, and black-colored sand to produce a picture of
hysteria, or other conditions. Witchcraft may also magical healing power. Other traditional Navajo
take the form of intrusive objects, causing pain practitioners are singers, who cure with sacred
where the object is inserted, as well as emacia- chanting ceremonies, and healers, who have spe-
tion. Possession by a spirit may dislodge the soul, cific responsibility for care of the soul. Among
resulting in a feeling of suffocation (or possession the Oneida, dreamers have the ability to see the
may be a sign of a gift for healing). Soul loss may future and diagnose illness.50 In many Native
also cause mental disorders. Violation of a taboo, American groups, herbalists, often women, assist
whether an actual breach by an individual or in the treatment of illness through the ceremo-
contact with evil objects that have committed nial collection and application of wild plant
mythical breaches, results in general seizures.1, 74 remedies.51 (See Therapeutic Uses of Foods
Traditionally, these beliefs are shared by many later in this chapter for examples.)
Sioux was the French
other Native Americans as well. For example, Among California Native Americans, illness was
term for the Dakota tribes
some Iroquois believe in a similar list of reasons treated first with home remedies. If that proved (including the Dakota,
for illness, adding that unfulfilled dreams or ineffective, non-sacred healers such as herbalists Lakota, and Nakota). It
desires may also be a contributing factor,129 and or masseuses were contacted. If the patient still derives from the word for
some Inuit believe sleep paralysis occurs when did not improve, a diviner would be consulted for snake and is considered
the soul is attacked by malevolent spirits or a diagnosis. If spiritual or supernatural interven- derogatory by some Native
through witchcraft.76 tion was needed, a shaman (medicine man) was Americans.
Navajos believe the soul employed. Consultation with native healers is often cranberries, currants, grapes, persimmons, plums,
(or wind) enters the concurrent with seeking Westernized health and strawberries, as well as vegetables, such as
body at birth and leaves at care.68, 98, 133 beans, corn, and pumpkins, are mentioned by the
deatha childs first laugh New England colonists. They describe rivers so
signals the firm attachment
full of life that fish could be caught with frying
of the soul.
pans, sturgeon so large they were called Albany
Traditional Food beef, and lobster so plentiful that they would pile
up along the shoreline after a storm. Game
Habits included deer, moose, partridge, pigeon, rabbit,
raccoon, squirrel, and turkey. Maple syrup was
The traditional food habits of Native Americans used to sweeten foods. Farther south, Native
The tradition of the Pacific
were influenced primarily by geography and cli- Americans cultivated groundnuts (Apios ameri-
Northwest potlatch reflects mate. Each Native American nation adopted a cana, or Indian potatoes) and tomatoes, and col-
the abundance of the way of life that allowed it to maximize indigenous lected wild Jerusalem artichokes (a starchy tuber
region. Commonly held for resources. Many were agriculturally based soci- related to the sunflower). Native Americans of
important events such as eties, others were predominantly hunters and the Pacific Northwest collected enough food,
marriage or the birth of a gatherers, and some survived mainly on fish. such as salmon and fruit, during the summer to
son, these ostentatious Most of each day was spent procuring food. support them for the rest of the year. Peoples of
feasts with excessive the plains hunted buffalo, and those of the north-
amounts of food were fol- eastern woodlands gathered wild rice; nations of
lowed by lavish gift giving.
INGREDIENTS AND COMMON FOODS the Southwest cultivated chile peppers and
The potlatch established
the wealth and socioeco-
squash amid their corn (see Table 5.1).
Indigenous Foods Native Americans not only introduced whites
nomic status of the host
and was also a method of Archaeological records and descriptions of to indigenous foods but shared their methods of
food distribution among America by European settlers indicate that cultivation and food preparation as well. Legend
nations from different Native Americans on the East Coast enjoyed an has it that the Pilgrims nearly starved despite the
areas. abundance of food. Fruits, including blueberries, plentiful food supply because they were unfamiliar
Table 5.1 Indigenous Foods of the Americas*

Fruits Berries (blackberries, blueberries, cranberries, gooseberries, huckleberries,
loganberries, raspberries, strawberries), cactus fruit (tuna), cherimoya, cherries
(acerola cherries, chokecherries, ground-cherries), grapes (e.g., Concord), guava,
mamey, papaya, passion fruit (granadilla), pawpaw, persimmon (American),
pineapple, plums (American, beach), soursop (guanabana), zapote (sapodilla)
Vegetables Avocado, bell peppers (sweet peppers, pimento), cactus (nopales, nopalitos),
chayote (christophine, chocho, huisquil, mirliton, vegetable pear), pumpkins,
squash, tomatillo, tomatoes
Tubers/roots Arrowroot, cassava (yuca, manioc, tapioca), groundnut, Indian breadroot, Jerusalem
artichoke, jicama, malanga (yautia), potatoes, sweet potatoes
Grains/cereals Amaranth, corn (maize), quinoa, wild rice
Nuts/seeds Brazil nuts, cashews, hickory nuts, pecans, pumpkin seeds (pepitas), sunflower
seeds, walnuts (black)
Legumes Beans (green beans, most dried beans), peanuts
Poultry Turkey
Seasonings/flavorings Allspice, chile peppers (e.g., hot and sweet ), chocolate (cocoa), maple syrup,
sassafras (fil powder), spicebush, vanilla
* Foods native to North, Central, or South America. Some items not indigenous to the United States (e.g., pineapple, potatoes) were popularized
only after acceptance in Europe and introduction by European settlers. Other foods (e.g., avocado, jicama, tomatillo) have become more common
in the United States with the growing Latino population.
with the local foods. One version of the tale is nations were beans, corn, and squash. The cultural A Native American hotel
that Squanto, the sole surviving member of the food groups are listed in Table 5.2. chef, George Crum, is attrib-
Pautuxets (the other members had succumbed to uted with the invention of
Regional Variations potato chips in 1853. Today
smallpox following contact with earlier European
explorers), saved the Pilgrims, who were mostly Native American fare has been divided by regions Americans consume an
merchants, by teaching them to grow corn. He into five major types: northeastern, southern, average of seventeen
plains, southwestern, and Pacific Northwest/Alaska pounds of potato chips per
showed them the Native American method of person each year.
planting corn kernels in mounds with a fish head Native. Although each area encompasses many
for fertilizer and using the corn stalks as supports different Native American nations, they share
Corn is the largest crop
for beans. In Virginia, Native Americans are cred- similarities in foods and food habits.
grown in the United States
ited with providing the Cavaliers, also from Northeastern. The northeastern region of the today. It is the American
England, with enough food to ensure their survival. United States was heavily wooded, with numerous staple grain, although most
freshwater lakes and a long Atlantic coastline. It corn is used for sweeteners
Foods Introduced from Europe provided the local Native Americans, including or animal feed and is ulti-
Foods introduced by the Europeans, especially the Iroquois and Powhatan, with abundant mately consumed in the
the French Jesuits in the North and the Spanish indigenous fruits, vegetables, fish, and game. form of soft drinks, meat,
Most nations also cultivated crops such as beans, and poultry. Some esti-
in the South, were well accepted by Native
mates suggest that up to 30
Americans. Apples, apricots, carrots, lentils, corn, and squash. Many of the foods associated
percent of food eaten in the
peaches, purslane, and turnips were some of the with the cooking of New England have their
United States derives from
more successful new foods. Settler William Penn origins in northeastern Native American recipes. corn.
noted that he found peaches in every large Native The clambake was created when the Narragansett
American farm he encountered barely one hun- and the Penobscot steamed their clams in beach
dred years after they had been introduced to the pits lined with hot rocks and seaweed. Dried
Iroquois. The Europeans also brought rye and beans were simmered for days with maple syrup
wheat. However, few Native American nations (the precursor of Boston baked beans). The dish
replaced corn with these new grains. that today is called succotash comes from a stew
Livestock made a much greater impact on common in the diet of most Native Americans; it
Native American life than did the new fruits and combined corn, beans, and fish or game. In the
vegetables. Cattle, hogs, and sheep reduced the Northeast it was usually flavored with maple
Native Americans dependence on game meats. syrup. Clam chowder, codfish balls, brown bread,
The Creeks and Cherokees of the Southeast fed corn pudding, pumpkin pie, and the dessert
their cattle on corn and fattened their suckling known as Indian pudding are all variations of
pigs and young lambs on apples and nuts. The northeastern Native American recipes. In addition
Powhatans of Virginia fed their hogs peanuts, to clams, the Native Americans of the region ate
then cured the meat over hickory smoke. Lamb lobster, oysters, mussels, eels, and many kinds of
and mutton became staples in the Navajo diet salt- and freshwater fish.
after the introduction of sheep by the Spanish. In Game, such as deer and rabbit, was eaten Maple syrup is produced
addition, the Europeans brought horses and when available. Wild ducks, geese, and turkeys from the sap of the maple
firearms, which made hunting easier, and metal were roasted with stuffings featuring crab apples, tree found in New England
knives and iron pots, which simplified food grapes, cranberries, or local mushrooms. Corn, as and eastern Canada. It
preparation. They also introduced the Native the staple food, was prepared in many ways, such takes forty gallons of sap
Americans to distilled spirits. as roasting the young ears; cooking the kernels or (the entire years produc-
meal in soups, gruels, and breads; steaming it in tion from one mature tree)
Staples puddings; or preparing it as popcorn. Pumpkins to make one gallon of
syrup. Maple sugar is made
The great diversity of Native American cultures and squash were baked almost daily, and beans
by further condensing the
has resulted in a broad variety of cuisines. The were added to soups and stews. Local green leafy syrup until it solidifies.
cooking of one region was as different from that vegetables were served fresh. Sweets included
of another as French food is from German food cherries stewed with maple syrup, cranberry
today. Native American cooking featured local pudding, crab apple sauce, and hazelnut cakes.
ingredients and often reflected the need to preserve Southern. The great variety of foods found in
foods for future shortages. The only staple foods the northeastern region of the United States was
common to many, though not all, Native American matched by the plentiful fauna and lush flora of
Table 5.2 Cultural Food Groups

Group Comments Common Foods Adaptations in the United States
Protein Foods
Milk/milk products High incidence of lactose intolerance No common milk products in traditional diets. Powdered milk and evaporated milk are typical
among Native Americans with a high commodity products, usually added to coffee,
percentage of Native American heritage. cereal, and traditional baked goods; ice cream
is popular with some groups.
Some reports have been made of frequent milk
consumption.
Meat/poultry/fish/ Meat is highly valued, considered healthful. Meat: bear, buffalo (including jerky, pemmican), Beef is well accepted; lamb and pork are also
eggs/legumes Meats are mostly grilled or stewed, deer, elk, moose, opossum, otter, porcupine, popular.
preserved through drying and smoking. rabbit, raccoon, squirrel. Canned and cured meats (bacon, luncheon
Beans are an important protein source. Poultry and small birds: duck, goose, lark, pheasant, meat) may be common if income is limited.
quail, seagull, wild turkey. Game is rarely eaten.
Fish, seafood, and marine mammals: abalone, bass, Meats remain a favorite food.
catfish, clams, cod, crab, eel, flounder, frogs, hal-
ibut, herring, lobster, mussels, olechan, oysters,
perch, red snapper, salmon, seal, shad, shrimp,
smelts, sole, sturgeon, trout, turtle, walrus, whale.
Eggs: bird, fish. Chicken eggs are commonly eaten.
Legumes: many varieties of the common bean
(kidney, navy, pinto, etc.), tepary beans.
Cereals/Grains Corn is primary grain; wild rice is Cornmeal breads (baked, steamed), hominy, gruels, Wheat has widely replaced corn; store-bought
available in some areas. corn tortillas, piki, toasted corn; wild rice. or commodity breads and sugared cereals are
common.
Cakes, cookies, pastries are popular.
Fruits/Vegetables Indigenous plants are major source of Fruit: blackberries, blueberries, buffalo berries, Apples became common after European
calories in diet of some Native American cactus fruit (tuna), chokeberries, cherries, crab introduction.
nations. apples, cranberries, currants, elderberries, grapes, Apples, bananas, oranges, peaches, pineapple
Fruits and vegetables are either gathered or groundcherries, huckleberries, persimmons, have been well accepted; canned fruits are
cultivated; fruit is a popular snack food. plums, raspberries, salal, salmonberries, popular.
strawberries (beach and wild), thimbleberries, Wild berries are still gathered in rural areas.
wild rhubarb. Some traditional vegetables are eaten when
Vegetables: camass root, cacti (nopales), available.
chile peppers, fiddleheads, groundnuts, Indian Green peas, string beans, instant potatoes are
breadroot, Jerusalem artichokes, lichen, moss, common commodity items.
mushrooms, nettles, onions, potatoes, pumpkin, Intake of vegetables is low; variety is limited.
squash, squash blossoms, sweet potatoes, toma- Potato chips and corn chips often are
toes, wild greens (cattail, clover, cow parsnip, popular as snacks.
creases, dandelion, ferns, milkweed, pigweed,
pokeweed, saxifrage, sunflower leaves, watercress,
winter cress), wild turnips, yuca (cassava).
Additional Foods
Seasonings Chiles, garlic, hickory nut cream, onions, peppermint,
sage, salt, sassafras, seaweed, spearmint, and other
indigenous herbs and spices.
Nuts/seeds Nuts and seeds are often an important food Acorn meal, black walnuts, buckeyes, chestnuts,
source; acorns are sometimes a staple. hazelnuts, hickory nuts, mesquite tree beans,
pecans, peanuts, pion nuts (pine nuts), pumpkin
seeds, squash seeds, sunflower seeds, seeds of wild
grasses.
Beverages Herbal teas often consumed for enjoyment, Teas of buffalo berries, mint, peyote, rose hip, Coffee, tea, soft drinks are common beverages.
therapeutic, or spiritual value. sassafras, spicebush, sumac berries, yerba buena; Alcoholism is prevalent.
honey and water.
Fats/oils Traditional diets vary in fat content, from Fats rendered from buffalo, caribou, moose, and other Butter, lard, margarine, vegetable oils have
extremely low in the mostly vegetarian land mammals; seal and whale fat. replaced rendered fats in most regions; seal
cooking of California and Nevada Indians and whale fat are still consumed by Inuits
to very high in the primarily animal- and Aleuts.
based fare of Native Alaskans.
Sweeteners Consumption of sweets is low in traditional Maple syrup, other tree saps, honey. Sugar is primary sweetener; candy, cookies,
diets. jams, and jellies are popular.
the South. Oysters, shrimp, and blue crabs lemonade was made from citrus-flavored
washed up on the warm Atlantic beaches during sumac berries.
tropical storms. The woodlands and swamplands
Plains. The Native Americans who lived in the
teemed with fish, fowl, and game, including bear,
area that is now the American Midwest were
deer, raccoon, and turtle, as well as ample fresh
mostly nomadic hunters, following the great
fruit, vegetables, and nuts. The Native Americans
herds of bison across the flat plains for suste-
of this region, such as the Cherokee, Creek, and
nance. The land was rugged and generally
Seminole, were accomplished farmers, growing
unsuitable for agriculture. Those nations that set-
crops of beans, corn, and squash. Image not available due to copyright restrictions
tled along the fertile Mississippi and Missouri
When Africans were first brought as slaves to
River valleys, however, developed farm-based
America, they were often housed at the periphery
societies supported by crops of beans, corn, and
of farms. Initially a great deal of interaction took
squash.
place between blacks and local Native Americans,
Bison meat was the staple food for most plains
who taught them how to hunt the native game
nations such as the Arapaho, Cheyenne, Crow,
without guns and to use the indigenous plants.
Dakota, and Pawnee. The more tender cuts were
Some of the Native American cooking techniques
roasted or broiled, while the tougher ribs, joints,
were later introduced into white southern cuisine
and other bones with marrow were prepared in
by African-American cooks, and many of the fla-
stews and soups. Pieces of meat, water, and some-
vors typical of modern southern cooking come
times vegetables would be placed in a hole in the
from traditional Native American foods. Hominy
(dried corn kernels with the hulls removed) and
grits (made of coarsely ground hominy) were
introduced to the settlers by the Native Americans.
The chicken dish known as Brunswick stew is an
adaptation of a southern Native American recipe
for squirrel. The Native Americans also made
sophisticated use of native plants for seasoning,
SAMPLE MENU
and they thickened their soups and stews with
sassafras.
The staple foods of corn, beans, and squash
A Traditional
were supplemented with the indigenous wood-
land fruits and vegetables. Blackberries, goose-
Northeastern Indian
berries, huckleberries, raspberries, strawberries, Meal
crab apples, grapes, groundcherries, Jerusalem
artichokes, leafy green vegetables, persimmons Iroquois Soupa,b or Duck with Wild Ricea
(pounded into a paste for puddings and cakes),
and plums were some of the numerous edible Bannocksa, c
native plants. Tomatoes and watermelons were
added after introduction by the Spanish into Indian Puddinga, b or Maple Popcorn Ballsa, c
Florida. The Native Americans of the South also Strawberry Juice
used beechnuts, hazelnuts, hickory nuts, pecans,
and black walnuts in their cooking. The thick,
creamlike oil extracted from hickory nuts was a
Cox, B., & Jacobs, M. 1991. Spirit of the harvest: North American Indian cooking.
used to flavor corn puddings and gruels, and a New York: Stewart, Tabori & Chang.
traditional Cherokee specialty was kanuche, a b
RecipeSource at http://www.recipesource.com/ethnic/americas/native/
soup made from the nuts (often with the addition c
Recipe Goldmine at
of corn, hominy, or rice), is still popular today. http://www.recipegoldmine.com/worldnativeam/nativeam.html
Honey was the sweetener used most frequently,
and it was mixed with water for a cooling drink.
Teas were made from mint, sassafras, or spice-
bush (Lindera benzoin), and during the summer
When bison were unavailable, the plains

nations would hunt deer, rabbit, and game birds.
Fresh leafy green vegetables were consumed in
season, and root vegetables, such as wild onions,
SAMPLE MENU prairie turnips (Psoralea esculenta, also called
breadroot, tipsin, and timpsila), and Jerusalem
artichokes, were eaten throughout the year. Wild
A Traditional rice, a native aquatic grass with an earthy, nutty
flavor, was collected in the northern parts of the
Southeastern Indian Midwest. It was served with bison, venison, or
duck and used as a stuffing for grouse, partridge,
Meal and duck. Wild rice is believed to have tradition-
ally provided as much as 25 percent of the total
Cherokee Pepper Pot Soupa, b or Brunswick Stew a Ojibwa diet, and it was customarily prepared
Corn Ponea, b, c with maple syrup.97 Blackberries, shadberries
(also called Juneberries or saskatoon berries),
Huckleberry Honey Cakea, c, d or Grape Dumplings a, c cherries, crab apples, grapes, persimmons, and
Honey Water plums were available in some areas, but the most
popular fruit was the scarlet buffalo berry
(Shepherdia canadensis), so called because it was
a
Cox, B., & Jacobs, M. 1991. Spirit of the harvest: North American Indian cooking. often served in sauces for bison meat or dried for
New York: Stewart, Tabori & Chang. pemmican. In addition, berries were traditionally
b
RecipeSource at
boiled with bison suet and/or blood to make a
http://www.recipesource.com/ethnic/americas/native/ thick pudding called wojapi.
c
Cherokee North Carolina, Recipes at Southwestern. Some of the oldest Native
http://www.cherokee-nc.com/recipes_main.php American settlements in North America were
d
Recipe Goldmine at
located along the river valleys of the arid
http://www.recipegoldmine.com/worldnativeam/nativeam.html Southwest. Despite the semi-desert conditions,
many Native Americans such as the Hopi, Pima,
Pueblo, and Zuni lived in pueblo (Spanish for
town or village) communities and were
mostly farmers, cultivating beans, chile peppers,
corn, and squash. Others, including the Apache
and Navajo, were originally roving hunters and
gatherers. After the Spanish introduced livestock,
Dried, ground sassafras was ground lined with cleaned buffalo skin. The stew some of these nomadic groups began to raise
called fil (meaning would then be stone-boiled: rocks that had sheep. Mutton has since become associated as a
thread) powder by the been heated in the fire would be added to the traditional staple food of the region.
French settlers of the South broth until the mixture was thoroughly cooked. Until the arrival of livestock, the diet of the
due to the stringy consis-
All parts of the bison were eaten, including the region was predominantly plant based, providing
tency it gave to soups and
liver and kidneys (which were consumed raw a nourishing diet when supplemented with small
stews when boiled. Fil
powder, which often immediately after the animal was slaughtered), game such as rabbit and turkey. Corn was the pri-
includes ground thyme in udder, tongue, and hump. Extra meat was pre- mary food, and at least five different colors of
addition to sassafras, is still served by cutting it into very thin strips and then corn were cultivated. Each color symbolized one
used in Southern cooking dehydrating it in the sun or over the fire. This of the cardinal points for the Zuni, and each had
today. tough, dried meat would keep for several years its own use in cooking. White corn (East) was
and was known as jerked buffalo or jerky. The ground into a fine meal and used in gruels and
The Dakota were reportedly
very healthy when the jerky would be pulverized and mixed with water breads. Yellow corn (North) was roasted and
Europeans first arrived. Men or corn gruel, or, in emergencies, eaten dry. Most eaten in kernel form or off the ear. The rarer red
were typically six feet tall often it was shredded and mixed with bison fat (South), blue (West), and black (the nadir, the
and towered over whites of and berries, then formed into cakes called lowest point beneath the observer) corn was used
the period. pemmican. mostly for special dishes, such as the lacy flat Hopi
bread made from blue cornmeal, known as piki.

Multicolored corn represented the zenith. The
Hopi also attached importance to the color of corn
and cultivated twenty different varieties. In many
areas, corn was prepared in ways similar to those SAMPLE MENU
of the northern Mexican Native Americans
tortillas (flat, griddle-fried cornmeal bread),
pozole (hominy), and the tamale-like chukuviki A Traditional
(stuffed cornmeal dough packets). Juniper ash
(considered a good source of calcium and iron) Great Plains Indian
was often added to cornmeal dishes for flavoring.22
Beans were the second most important crop of Meal
the southwestern region. Many varieties were
grown, including the domesticated indigenous Pemmicana, b, c
tepary beans and pinto beans from Mexico. Both
Stuffed Pumpkina or Buffalo/Bison Stewb
squash and pumpkins were commonly consumed,
and squash blossoms were fried or added to soups Broiled Jerusalem Artichokesa
and salads. Squash and pumpkin seeds were also
used to flavor dishes, and chile peppers were used Chokecherry Puddinga,b or Wojapi (pudding) b
as vegetables and to season stews. Cantaloupes
(also known as muskmelons) were also grown Peppermint Teab
after they were introduced by the Spanish.
When crops were insufficient, the southwestern
a
Native Americans relied on wild plants, and to Cox, B., & Jacobs, M. 1991. Spirit of the harvest: North American Indian cooking.
New York: Stewart, Tabori & Chang.
add variety, tender amaranth greens were eaten
b
in summer. Pion seeds (also called pine nuts) Native Tech: Indigenous Foods and Traditional Recipes at
http://www.nativetech.org/recipes/index.php
flavored stews and soups. Both the fruit (tunas) c
Pemmican: Recipes, Stories and Stores at
and the pads (nopales) of the prickly pear cactus
http://w4.lns.cornell.edu/~seb/pemmican.html
were eaten, as were the pulp and fruit of other
succulents, such as yucca (the starchy fruit
known today as Navajo bananas). A unique
food popular with some Apaches was the root of
the mescal plant, another desert succulent. It
would be baked for hours in a covered, stone-
heated pit until it developed a soft, sticky texture
and a flavor similar to molasses.9 The beans of The Native American ethnic groups inhabiting It was up to the Hopi
the mesquite tree were a staple in some desert this region include Indians as well as Inuits woman to propose marriage
regions; they were ground into a flour and used (Eskimos) and Aleuts, known as Alaska Natives. to a man. She did this by
in gruels, breads, and sun-baked cakes. Native American nations such as the Tlingit and preparing a blue cornmeal
Northwest Coast/Alaska Natives. This culinary Kwakiutl inhabit the northwest coastal area and cake called a piki and
placing it on her intendeds
region incorporates a diverse geographic area. some interior Alaskan regions. The Aleuts live on
doorstep. If the piki was
The climate of the Pacific Northwest coast is the 1,000-mile-long chain of volcanic islands that taken into the house, her
temperate. The luxuriantly forested hills and arch into the Pacific from Alaska called the proposal was accepted.
mountain slopes abound with edible plants Aleutians. The Inuits, including the Yupik and
and game, and the sea supplies fish, shellfish, and Inupiat, live in the northern and western areas of
marine mammals. Farther north, in Alaska Alaska, as well as in Canada, Greenland, and
and Canada, the growing season shortens to only Siberia.
The word Eskimo comes
a few summer months, and temperatures in the The Native Americans of the Northwest Coast from the Algonquin word
winter regularly plunge to minus fifty degrees had no need for agriculture. Food was plentiful, eskimantik, meaning eater
Fahrenheit. Two-thirds of Alaska is affected by and salmon was their staple. The fish were caught of raw flesh. Inuit, meaning
permafrost, and the vast stretches of tundra are annually in the summer as they swam upstream the people, is the name
inhospitable to humans. to spawn. They were roasted over the fire when preferred by the nation.
In contrast to the plenty of the Northwest

Coast, the diet of many Alaska Natives was often
marginal. The Inuits and Aleuts were usually
seminomadic, traveling as necessary to fish and
SAMPLE MENU hunt. Fish and sea mammals, such as seal, walrus,
and whale, were the staple foods. Arctic hare, cari-
bou, ducks, geese, mountain goats, moose, musk
A Traditional oxen (hunted to extinction in Alaska by the
1870s), polar bear, and mountain sheep were con-
Southwestern Meal sumed when available. Some items were boiled,
but many were eaten raw due to the lack of wood
Green Chili Stew a, b, c, d or other fuel. The fat of animals was especially
valued as food. Muktuk (also called muntak or
Blue Corn Breadb, c, d or Frybreada, b, c, d onattak), still a commonly consumed item, con-
Pueb lo Pion/Feast Day Cookiesa, d or Navajo Peach Crispa, b sists of chunks of meat with the layer of fat and
skin attached. Muktuk is typically frozen before
use. Walrus or whale muktuk can also be pre-
a
Cox, B., & Jacobs, M. 1991. Spirit of the harvest: North American Indian cooking. served by rolling it in herbs (with no salt) and fer-
New York: Stewart, Tabori & Chang. menting it in a pit for several months to make a
b
Keegan, M. 1996. Southwest Indian cookbook. Santa Fe, NM: treat known as kopalchen. Akutok, a favored dish,
Clear Light Publishers. was a mixture of seal oil, berries, and caribou fat.
c
Traditional Native American Recipes from The Cooking Post at Even the stomachs of certain game were exam-
http://www.cookingpost.com/recipe.cfm ined for edible undigested foods, such as lichen in
d
Recipe Goldmine at elk and clams in walruses. The limited selection of
http://www.recipegoldmine.com/worldnativeam/nativeam.html wild plants included willow shrubs, seaweed,
mosses, lichen, a few blueberries, salmonberries,
and cranberries. Leaves from an aromatic bush
known as bog shrub (Ledum palustre) were
brewed to make tundra tea (also called Hudson
Bay tea), a beverage still popular today.
Other Native American Cuisines. Many tradi-
Adult salmon, which are fresh, and the eggs, known today as red caviar, tional Native American diets do not fit conve-
normally ocean-dwelling were a favorite treat when dried in the sun into niently within the five major regional cuisines.
fish, swim up rivers to chewy strips. Extra fish were smoked to preserve Among them was the fare of the population
spawn and then die. The them for the winter. In addition, cod, clams, found in what is now Nevada and parts of
Native Americans of the crabs, halibut, herring, shrimp, sole, smelt, stur- California, called Digger Indians by the first
Pacific Northwest believed
geon, and trout were consumed. Ocean mammals whites to encounter them because they subsisted
that salmon were immortal.
such as otter, seal, and whale were also hunted. mostly on dug-up roots, such as Indian bread-
It was thought that the
salmon came yearly to the Bear, deer, elk, and mountain goats were eaten, as root, supplemented by small game and insects. In
rivers to feed the people were numerous wild fowl and game birds. central California, numerous nations, such as the
and then returned to the Despite the abundant fish and game, wild Miwok and Pomo, had an acorn-based diet.
oceans, where they were plants made up more than half the diet of the Acorns contain tannic acid, a bitter-tasting sub-
reborn. The Native Northwest Coast Native Americans. More than stance that is toxic in large quantities. To make
Americans would ceremoni- 100 varieties of indigenous fruits, vegetables, and the acorns edible, Native American women
ously return the fish skele- even lichen were consumed, including acorns, would first crack and remove the hard hull, grind
tons to the river so that this blackberries, blueberries, chokecherries (Prunus the meat into a meal, add water to make a dough,
rebirth could occur. virginiana), desert parsley, hazelnuts, huckleber- and then leach the tannic acid from the dough by
ries, mint, raspberries, salal (Gaultheria shallon), repeatedly pouring hot water through it. Acorns
and strawberries. Camass roots (Camassia qua- were sometimes leached in sandy-bottomed
mash), a bulb related to the hyacinth, were streams as well.
roasted or dried by many Indians of the region. In the rugged northern mountains and
Fresh greens were also popular. plains lived nations such as the Blackfeet, Crow,
Shoshone, and Dakota, who were nomadic hunters

of game. Although many may have hunted bison
at one time, they were limited to the local bear,
deer, moose, rabbits, wildfowl, and freshwater
fish when the expansion of other Native
Americans and whites into the Midwest pushed
them northward and westward. Wild plants
added variety to their diet. For example, the
Nez Perc baked camass roots in a covered pit
with heated rocks, which caramelized the starch
providing a sweet, onion-like flavor. The cooked
roots were made into gruel or dough for bread.41
Bettmann/CORBIS
MEAL COMPOSITION AND CYCLE
Daily Patterns
Traditional meal patterns varied according to
ethnic group and locality. In the Northeast, one
large, hearty meal was consumed before noon, Inuit women preparing a
and snacks, such as soup, were available through- dead seal for butchering.
out the day. In some tribes, no specific meal time
was standard. The men were served first, and
stood or sat while they consumed the meal in
silence. Women and children ate next.
Serving two meals per day was more common
in the Southwest. The women would rise before
dawn to prepare breakfast, eaten at sunrise. The
afternoon was spent cooking the evening meal, SAMPLE MENU
which was eaten before sunset. Two meals per
day was also the pattern among the Native
Americans of the Pacific Northwest.
In regions with limited resources, meals were
A Northwest Coast
often monotonous. The two daily meals of the Indian Meal
southwestern Native Americans, for example, reg-
ularly consisted of cornmeal gruel or bread and Barbecued Clamsa or Fresh Salmonc
boiled dehydrated vegetables. No distinction was
made between morning or evening menus. Other Elk Stew with Acorn Dumplingsa, b
dishes such as game, fresh vegetables, or fruit
were included when seasonally available. The Steamed Fiddlehead Fernsa, b
single meal of the northeastern Native Americans
Whipped Raspberry (Soup)a, b
often included roasted game; the Northwest Coast
Native Americans frequently included some form
of salmon twice a day in addition to the many
local edible greens and roots.
Food was simply prepared. It was roasted over a
Cox, B., & Jacobs, M. 1991. Spirit of the harvest: North American Indian cooking.
the fire or in the ashes, or cooked in soups or New York: Stewart, Tabori & Chang.
stews. The northeastern and Northwest Coast b
Astray Recipes at http://www.astray.com/recipes/
Native Americans steamed seafood in pits; south- c
Kwakuitl Recipes at http://www.hallman.org/indian/recipe.html
western Native Americans baked cornmeal bread
in adobe ovens called hornos. (After the intro-
duction of hogs, flat breads were commonly fried
in lard.) Seasonal items were preserved by drying
ROLE OF FOOD IN NATIVE AMERICAN

CULTURE AND ETIQUETTE
Historically, many Native American nations, espe-
cially in the inland regions, experienced frequent
food shortages. As a result, food is valued as sacred
and, in the holistic worldview of most Native
American groups, food is also considered a gift of
the natural realm. In some nations elaborate cere-
monies accompanied cultivation of crops, and
prayers were offered for a successful hunt.
The men in many nations were traditionally
responsible for hunting or the care of livestock.
The job of food gathering, preparation, and stor-
age usually belonged to the women, who also
Bettmann/CORBIS
made the cooking utensils, such as watertight

baskets or clay pots.35, 50 In predominantly horti-
cultural societies, both men and women were fre-
quently involved in cultivation of the crops.
Among the nations of the Northeast, the men ate
Baking bread in a
southwestern outdoor oven. first, followed by women and children. In the
them in the sun or smoking them over a fire; for Southwest, men prepared the game they caught
Members of the Blackfoot meat, fish, and oysters, special wood was often and served it to the women.
tribes traditionally avoided used to impart a distinctive flavor. Other foods Sharing food is an important aspect of most
fish because they live in were ground into a meal or pounded into a paste. Native American societies today. Food is usually
rivers and lakes with the In Alaska, meats, greens, and berries were pre- offered to guests, and in some tribes it is consid-
sacred underwater people served in fermented (aged) blubber. All nations ered rude for a guest to refuse food. It is also impo-
known as Suyitapis. Some lite to eat in front of others without sharing.131 Any
liked sweets, but they were limited to fruits and
still prefer not to eat fish extra food is often given to members of the
today, and have disdain for
dishes flavored with maple syrup, honey, or other
indigenous sweeteners. extended family. In some nations of the Southwest,
the fishing industry.45 Other
Native Americans, such as
meals are prepared and eaten communally. Each
some Navajo, also avoid
Special Occasions woman makes a large amount of one dish and
fish. Many Native American religious ceremonies were shares it with the other families, who in turn share
accompanied by feasts. Among the northeastern what they have prepared. Many Native Americans
At the end of the traditional Iroquois, seasonal celebrations were held for the find the idea of selling food inconceivable; it is
Onondaga meal, guests maple, planting, strawberry, green corn, harvest, suggested that this is one reason there are few
were expected to express and New Years festivals. The southern nations restaurants featuring Native American specialties.
thanks to their host. held an elaborate Green Corn Festival in thanks for
Children were taught that a plentiful summer harvest. No one was allowed to
failure to do so would result
eat any of the new corn until the ceremony was
THERAPEUTIC USES OF FOOD
in a stomachache.120
complete. Each home was thoroughly cleaned, The role of food in spiritual and physical health is
Among the nations of the
the fires were extinguished, and all old pieces of still important for many Native Americans, and
Southwest, food is consid- pottery and clothing were replaced with newly many food plants provide medicine in some form.
ered a valuable gift from a made items. The adult men bathed and purged Corn is significant in some healing ceremonies.
woman to a man or from a themselves with an emetic. When everything and Cornmeal may be sprinkled around the bed of a
woman to another woman. everyone were thoroughly clean in body and spirit, patient to protect him or her against further ill-
A present of firewood, a central fire was lit by rubbing two sticks together, ness. Corn pollen may be used to ease heart palpi-
clothing, or game is consid- and each hearth fire was relit with its flames. The tations, and fine cornmeal is rubbed on childrens
ered more appropriate from feasting on new corn then began. Amnesty was rashes. Navajo women drink blue cornmeal gruel
a man to a woman. granted for all offenses except murder, and the to promote the production of milk after childbirth,
festival signified the beginning of a new year for and Pueblo women use a mixture of water and
marriages, divorces, and periods of mourning. corn ear smut (Usti Lago maydis, a kind of fungus)
to relieve diarrhea and to cure irregular menstrua-

tion. A similar drink was given to Zuni women to
Contemporary Food
speed childbirth and to prevent postpartum hem-
orrhaging. Corn silk tea was used as a diuretic and
Habits
was prescribed for bladder infections.66 Native American ethnic identity is changing.
Numerous other indigenous plants are used by Traditional beliefs and values are often in direct
Native Americans for medicinal purposes. For conflict with those of the majority society, and
example, agave leaves (from a succulent common Native Americans self-concept has undergone
in the Southwest) are chewed as a general tonic, tremendous changes in the process of accultura-
and the juice is applied to fresh wounds. Another tion. Three transitional adaptations of members
succulent, yucca, was considered a good laxative of the Ojibwa (also called Chippewa), identified
by the Hopi. Pumpkin pastes soothe burns. Chile by three different lifestyles, may serve as a model
peppers are used in compresses for arthritis and for the adaptations made by members of other
applied directly to warts. Infusions are used for Native American groups.93 The first stage of adap-
many remedies, such as wild strawberries or tation is traditional; during this stage parents and
elderberry flowers for diarrhea and mint tea to grandparents speak the Ojibwa language at home,
ease colic, indigestion, and nausea. The Ojibwa practice the Midewiwin religion, and participate
boiled blackberry roots to prevent miscarriages, in Native American cultural activities such as
and sumac fruit and roots to stop bleeding. feasts and powwows. The second stage is more
Traditionally, maple sugar lozenges were used for acculturated. English is the primary language,
sore throats. Bitter purges and emetics are admin- although some Ojibwa also is spoken. Catholicism
istered because they are distasteful and repugnant is the preferred religion, and the family is involved
to any evil spirits that might cause illness.118 in activities of the majority society. In the third
Food restrictions are still common during ill- Ojibwa lifestylethe pan-traditional stagethe
ness. Depending on the nation, many Native family speaks either English or Ojibwa exclu-
Americans believe that cabbage, eggs, fish, meat, sively; practices a religion that is a combination of
milk, onions, or organ meats should be eliminated Native American and Christian beliefs, such as
from a patients diet. Conversely, some foods may the Native American Church; and is actively
be considered important to maintain strength involved in activities of both traditional Native
during sickness, such as meat among the Seminole American and white societies.
in Florida,61 and both meat and blue cornmeal
among the Navajo.101 The Navajo may avoid sweets
during pregnancy to prevent having a weak
ADAPTATION OF FOOD HABITS
infant.95 Some foods are prohibited after childbirth, Food habits reflect changes in Native American
such as cod, halibut, huckleberries, and spring ethnic identity. Many Native Americans eat a diet
salmon for Nootka women of the Northwest Coast. that includes few traditional foods. Others are
Native Americans found many plants had psy- consciously attempting to revive the foods and
chotherapeutic properties. They were used to dishes of their ancestors.
relax and sedate patients, to stupefy enemies, and
to induce hypnotic trances during religious cere- Ingredients and Common Foods
monies. The opiates in the roots of California pop- When Native Americans were uprooted from The Winnebago nation held
pies dulled the pain of toothache, for example. their lands and their known food supplies, many feasts at the onset of any
Lobelia was smoked as an antispasmodic for immediately became dependent on the foods epidemic in an effort to halt
asthma and bronchitis. In the Southwest, knobs provided to the reservations. One study evaluat- the spread of illness.
from the peyote cactus were used to produce hal- ing the diets of Havasupai Indians living on a
Some Native Americans
lucinations, sometimes in combination with other reservation in Arizona found that 58 percent of
steeped willow bark as a
intoxicants. Jimsonweed (Datura stramonium) the subjects ate only foods purchased or acquired
tea for use as a pain killer. It
was traditionally used to keep boys in a semicon- on the reservation during the twenty-four-hour is high in salicylic acid, the
scious state for twenty days so that they could recall period.117 Commodity foods currently active ingredient in aspirin.
forget their childhood during Algonquin puberty include items such as canned and chopped
rites.33 It is still used today by some Native meats, poultry, fruit juices, peanut butter, eggs,
Americans for medicinal and ritual purposes. evaporated and powdered milk, dried beans,
instant potatoes, peas, and string beans. American heritage of the woman in charge of the
Researchers report that many of these foods, such food supply in the home directly affected the con-
as kidney beans, noodles, and peanut butter, are sumption of traditional foods in that home.115
discarded by the Navajo; powdered milk may also Corn and corn products, such as hominy, were
be rejected because it is disliked or is considered among the most popular traditional foods; game
a weak food suitable only for infants or the eld- meat, hickory nuts, raspberries, and winter
erly.74 On some reservations, large supermarkets squash were the least commonly served. Among
provide a selection of foods similar to that found Cherokee teenagers, traditional items such as fry
throughout the United States; however, on more bread, bean bread (corn bread with pinto beans),
remote reservations and in many rural areas and chestnut bread (made from chestnuts and
access to markets is very limited.1, 127 Other cornmeal) were well accepted. Although more
sources of food include gardening (reportedly than 80 percent of the adolescents were familiar
practiced by between 43 and 91 percent of rural with typical Cherokee dishes, including native
Native Americans), fishing, hunting, gathering greens and game meat (bear, deer, groundhog,
indigenous plants, and raising livestock. One rabbit, raccoon, squirrel, and wild boar), these
study of California Miwok, for instance, reports foods were rarely eaten.110 Pima consume tradi-
that 67 percent of respondents recall that their tional items, such as tepary beans and cactus
grandparents harvested wild greens, nuts, stew, mostly at community get-togethers.104 A
berries, and mushrooms, and that 47 percent of small sample of children from four different
respondents continue to supplement their diet Native American communities recorded that
this way.55 A national Canadian survey reported only 7 out of 1,308 items listed in food recalls for
that 66 percent of aboriginal peoples obtained the study were traditional.80 California Miwok list
some of their meat, poultry, and fish through mostly southwestern items such as beans, rice,
hunting and fishing; 10 percent obtained most in and tortillas as those they most associate with
this way; and 5 percent obtained all this way.122 Native American foods and recall numerous
These supplementary food sources are limited by items eaten by their grandparents but not con-
seasonality and, in some cases, by state and federal sumed now, such as squirrel, rabbit, deer, acorn
hunting and fishing laws.127 Native Americans mush, and certain insects. Access to wild game is
living in urban areas have the same access to food limited due to hunting restrictions. Navajo
as other city dwellers. women eat traditional foods infrequently, with
Over the years traditional foods were lost and the exception of fry bread, mutton, and tortillas.
substitutions were made. For example, beef is a Blue cornmeal mush (with ash), hominy, and
commonly accepted substitute for game among sumac berry pudding are a few of the native
many Native American ethnic groups. Fry bread dishes consumed occasionally.130 Dakota women
is another example. It is a flat bread made from of all ages take pride in traditional foods but pre-
wheat flour typically fried in lard, and has been pare them only when it is convenient or for spe-
prepared in the Southwest for about one hundred cial occasions. A study of Sencotan Indians in
years, and in other regions for even less time. British Columbia found that marine foods, espe-
Though made from ingredients introduced by cially salmon, retain social and economic impor-
the Europeans, it is one of the items most often tance within the community.81 Among some
identified as traditional among Indians Baffin Inuit, traditional foods (e.g., sea and land
throughout the nation,31 and is often served at mammals, fish) make up about one-third of
Native American festivals. It has been suggested energy intake. Men were found to eat more tradi-
that the substitution of Western foods, especially tional items than women.70 A study of Yupik Inuit
commodity items, in the preparation of tradi- found that younger respondents (ages 1419) ate
tional Indian dishes has adversely affected the significantly fewer traditional foods than did the
Some Native Americans
nutritional value of these foods.128 oldest respondents (ages 4081).8
use the phrase way back
foods to differentiate
Traditional foods make up less than 25 per- Broader efforts to preserve traditional and
between indigenous cent of the daily diet among the Hopi. Older Hopi adapted Native American food traditions are also
traditional foods and those women lament the fact that younger Hopi are no underway. Notably, the group Renewing
developed after European longer learning how to cook these dishes.71 In a Americas Food Traditions (RAFT), a coalition of
contact. study of Cherokee women, the degree of Native organizations dedicated to bringing the foods of
Table 5.3 Americas Top Ten Endangered Foods

Chapalote Corn Considered the original cultivated corn with small ears, coffee-colored kernels, and
a flinty flavor
Chiltepin Pepper Pea-sized, very hot wild chile pepper native to the Southwest considered the ancestor of
most varieties used todaydrought, diminishing habitat, and unscrupulous harvesting
threatens this chile with extinction
Eulachon Smelt Pacific Northwest source of oil that has suffered serious declines in populationfurther,
traditional methods of processing are gradually being lost
Gulf Coast Sheep Introduced to the Southeast by the Spanish in the 1500s, this breed adapted well to the
humid conditions of the region, providing excellent meat and woolnewer breeds are
lessening their popularity
Java Chicken One of the first chicken breeds introduced to the United States, these birds now number
only about 100
Marshall Strawberry An heirloom fruit discovered in Massachusetts in 1890 but grown commercially in the
Pacific Northwestvery intense flavor
Native American Indigenous plants cultivated by the Native Americans for seeds and oilbrought to
Sunflowers Europe as an oil sourcepopularity of the oil led to growing a single improved
variety, and this one type is now susceptible to numerous rust diseasesfew sources
of the original seeds remain
Pineywoods Cattle A foraging breed introduced by the Spanish to Florida, particularly suited to conditions
in the South, and popular with early Native American ranchersapproximately
200 animals are left
Seminole Pumpkin A pear-shaped pumpkin grown on vines that use trees for supportfound in the
Everglades but rarely cultivated today
White Abalone The deepest inhabitant of West Coast Abalone, it has neared extinction due to the popularity
of its sweet meatnow being bred in a recovery program designed to save it
Source: Nabhan, G.P., & Rood, A. 2004. Renewing Americas Food Traditions (RAFT): Bringing cultural and culinary mainstays of the past into
the new millennium. Flagstaff, AZ: Center for Sustainable Agriculture at Northern Arizona University.
the past into the present, have listed over 700 Fried foods were preferred for breakfast, and
endangered food items (see Table 5.3). Support of lunch and dinner consisted of one boiled meal
communities attempting to recover and conserve and one fried or roasted meal. Pima in Arizona
food traditions is their primary goal.83 prefer eggs, bacon or sausage, and fried potatoes
for breakfast, while Southwest specialties, such as
Meal Composition and Cycle tacos, tamales, and chili con carne, are common
Little has been reported regarding current Native at other meals. A study comparing Indians in New
American meal patterns. It is assumed that three England living on reservations to those living in
meals per day has become the norm, especially in urban areas found baking and boiling remain
families without income constraints. One or two favored preparation methods by respondents
main meals is reportedly the norm for northern living on reservations, whereas urban residents
Plains Indians131 and irregular meals have been were more likely to fry items. Grilled meats and
described among Alaska Natives.43 smoked fish were also common ways of cooking.31
Few studies have detailed meal composition Snacking on foods such as fruit, soft drinks, Meat portions among
for Native Americans. Many Northern Plains potato or corn chips, sunflower seeds, crackers, northern Plains Indians are
Indians enjoy soups or sandwiches at lunch, with cookies or cake, candy, and ice cream is common reportedly large, typically
a large meal of fried meats, potatoes with gravy, in some Native American groups.43, 55, 131 Eating at five to eight ounces per
canned vegetables, and fruit for dinner.131 Navajo fast-food restaurants is popular among the serving.131
women were found to eat fry bread or tortillas, Navajo and some younger Plains Indians,130, 131
potatoes, eggs, sugar, and coffee most frequently. but is infrequent among the Pima.104
Special Occasions from the conditions associated with under-

The adoption of the new Numerous traditional celebrations are main- consumption, such as infectious diseases, to
Cherokee Nation constitu- tained by Native American tribal groups.65 conditions associated with overconsumption,
tion (following their forced Among the largest is the five-day Navajo Nation including obesity, type 2 diabetes, and cardiovas-
dislocation) is commemo- Fair held each Labor Day weekend; the Pawnee cular disease.24
rated on September 6. The Veterans Day Dance and Gathering where ground Studies of current Alaska Native eating habits
event honors reunification
meat with pecans and corn with yellow squash are suggest that diets high in refined carbohydrates
of all Cherokees and is cele- (starchy and sugary foods) and fat, and low in
brated over the Labor Day
served; the Miccosukee Arts Festival and the
Seminole Fair in Miami, where alligator meat is fruits and vegetables, are common. The protein
weekend with a State of the and nutrient of Alaska Natives has declined
Nation address, parade, arts featured; the Iroquois Midwinter Festival held in
January to mark the new year; the Upper during the past several decades, as many foods
and crafts, and games.
Mattaponi Spring Festival in Virginia over obtained through hunting and gathering were
Memorial Day weekend; the three-day Creek replaced by processed, canned, and packaged
Nation Festival and Rodeo; the Yukon items.57 The estimated carbohydrate content of
International Storytelling Festival at which wild the Alaska Native diet before contact with
game such as caribou and musk ox are available; Westerners was exceptionally low (3 to 5 percent
and the Apache Sunrise Ceremony which features of daily calories) due to a dependence on sea
gathered foods such as amaranth leaves and the mammals and fish. Within only a few generations,
pulp and fruit from the saguaro and prickly pear that figure had increased to 50 percent of total
cacti. More local festivities are also common. calories, much of it from low-nutrientdensity
Pueblo Feast Days are observed in honor of the foods.82, 96 Research on Alaska Natives has also
Catholic patron saint of each village with a soup of shown low intakes of calcium, iron, phosphorus,
posole (hominy) and beef or pork ribs. Northwest magnesium, zinc, vitamins A, C, D, and E,
Coast potlatches are common in the spring, fea- riboflavin, and folic acid, as well as fiber, omega-6,
turing herring roe, fish or venison stews, and omega-3 fatty acids. Traditional Alaska Native
euchalon, salmon, and other traditional foods. diets have been found lower in fat and carbohy-
Many Dakota mark the In addition, there are all-Indian festivals that drates, and higher in protein, phosphorus, potas-
anniversary of the Wounded draw attendees from throughout the country, such sium, iron, zinc, copper, magnesium, manganese,
Knee Massacre (December 29) as OOdham Tash Indian Days in Casa Grande, selenium, and several vitamins, including A, D, E,
with mourning prayers and Arizona; the Red Earth Festival in Oklahoma City; riboflavin, and B6. 72, 73, 84, 88
a spirit plate of blessed food and the Gallup Intertribal Indian Ceremonial in A similar transition occurred in the diets of
to nourish the dead.
New Mexico. Native Americans may also eat tradi- American Indians in other parts of the nation;
tional foods on special occasions such as birthdays, and today, refined carbohydrates are prominent
but for holidays of the majority culture, other foods in the diet. Studies have identified white breads,
are considered appropriate. For example, turkey tortillas, potato chips, french fries, and candy as
with all the trimmings is served by Dakotas for the top contributors of energy for many Native
Thanksgiving and Christmas.3 Americans.23, 31, 80, 108, 112 Of particular note is the
consumption of sweetened beverages, including
soda and fruit-flavored drinks, estimated to be 15
NUTRITIONAL STATUS to 27 percent of all carbohydrates consumed, and
as much as 17 percent of daily calories.8, 23, 112, 114, 124
Nutritional Intake High-fat foods, including fried foods and processed
Research on the nutritional status of Native meats and beef dishes, are another significant
Americans is limited. Severe malnutrition was source of energy.
documented in the 1950s and 1960s, including A low intake of fruits and vegetables is prevalent
numerous cases of kwashiorkor and marasmus. in the diets of both Native American adults and
Today, low socioeconomic status and lack of such adolescents.23, 31 Of Indians in California, 60 percent
things as transportation, fuel, refrigeration, and said they had not eaten any fruit the previous day,
running water contribute to an inadequate diet and 28 percent reported they had not consumed
for some Native Americans. In general, however, any vegetables.56 Among the Lakota of South
recent changes in morbidity and mortality figures Dakota, nearly 60 percent stated they ate fruit only
suggest that Native Americans have transitioned two to eight times a month; nearly half reported
eating vegetables (including potatoes) over five accounts for these figures.48 Postnatal mortality
times weekly.46 A study of Catawba showed rates are nearly 60 percent higher for American
47 percent ate less than one fruit daily, and Indians and Alaska Natives compared to the total
87 percent consumed only one vegetable or less.28 population, and sudden infant death syndrome is
The vegetable most often consumed in a study of particularly problematic.20 Breastfeeding has tra-
Native American women in Oklahoma was french ditionally been considered the proper way to feed
fries; and only tomatoes, tossed salad, green beans, infants among most Native Americans. Among
potato salad, and mashed potatoes were also the Navajo in one study, elders reported that breast-
mentioned in the list of the top fifty-three items fed infants were better able to hear traditional
most often eaten.114 Barriers to increased con- teachings and were better disciplined. It also
sumption of fruit and vegetables included cost, demonstrated that the children are loved. Eighty-
availability, and quality. one percent of subjects initiated breastfeeding.
Native American nutrient intake has been Most added infant formula within the first week
compared to that of the general population in a few and used this combined feeding practice for more High rates of lactose intol-
studies. It is notable that among both children than five months.132 Other estimates of breast- erance have been reported
and adults, few differences are found. One large feeding show rates of 24 to 62 percent.53, 109 Baby- for both Native Americans
study in three states reported that median intakes bottle tooth decay, due most often to extended and Alaska Natives. The
of vitamins A and C and folate were low for both occurrence among individu-
use of a bottle with formula, milk, juice, or soda,
als, however, is related to
American Indians and the total population.107 A affects more than one-half of all Native American
percentage of Native
comparison of dietary calcium intake among and Alaska Native children. American heritage.
African American, Native American, and white Overweight and obesity are prevalent among
women in North Carolina found that although Native Americans. National data suggest obesity
whites ate significantly more high-calcium foods rates of 37 to 40 percent among American Indian
than did Native Americans, none of the respon- adults in 2002, approximately 20 percent above
dents were consuming recommended levels of the average for the total population.21, 78 In another
the mineral through their food.4 Other researchers survey, the highest obesity rates were found in
who investigated rural Native American and Native Americans living in Alaska, and the lowest
white children in Oklahoma suggest that their in the Pacific Northwest.29 Though definitions of
diets are more influenced by factors such as overweight and obesity vary in other research, the
poverty and living in a rural area than by cultural trends are consistent. Group-specific studies report
or structural issues related to race or ethnicity.112 83 percent of Havasupai subjects and 60 percent of
Nutrient deficiencies in Native American adults Seminoles were identified as obese; 63 percent
and children may occur, but with the exception of of Navajo women and 33 to 50 percent of Navajo
Alaska Natives, most studies suggest dietary ade- men were overweight; and 61 percent of Indians
quacy similar to that of the total U.S. population. residing in Oklahoma were overweight or
Life expectancy has improved over recent obese.17, 117 In some groups, such as the Inuits,
years, yet disparities are still found. In Arizona the overweight was traditionally desirable as a visible
average age of death from all causes for American demonstration of wealth during times of priva-
Indians is just under age fifty-five, compared to tion.60 Among the Navajo, elder men and women
the national average of seventy-two years. Rates prefer a heavier body shape.126 Comprehensive
for the total population of Native Americans are studies of Native American school children and
better, but still 10 percent below average for men, adolescents show consistently higher weight-for-
and 8 percent below average for women.85, 119 height ratios than for white, black, or Hispanic
Native American mothers are more likely to be populations, while body mass index (BMI) rates
younger than the general population and less likely over the 85 percentile varied, up to 50 percent for
to be married. Thirty percent of American Indian girls, and nearly 50 percent for boys.7, 18, 58, 109, 134
and Alaska Native women do not receive prenatal Figures on obesity contradict some nutri-
care during the first trimester of pregnancy. Yet the tional intake data, which show the caloric intake
number of lowbirth-weight infants and neonatal of many Native Americans to be normal or less
deaths is lower than that for the total U.S. popu- than the recommended dietary allowances.
lation.85 Some researchers have suggested that Metabolic differences in obese Native Americans
under-registration of very lowbirth-weight infants may be a factor, 24, 107, 133 or lower rates of energy
Some Native Americans expenditure through exercise may contribute: and those living in Mexico found rates in Arizona
believe diabetes is caused American Indians and Alaska Natives report lack to be more than five times those found in Mexico,
by eating too much sugar. of leisure-time physical activity at higher rates suggesting that genetic predisposition alone does
Others associate it with a than any other U.S. ethnic group.29, 78 However, a not account for high prevalence in the United
high intake of salt.105
study of Hualapai women of Arizona indicated States and that a Westernized environment may
that the daily caloric intake of obese women was be a factor.99 Higher rates of diabetes are found
A diet high in simple carbo- significantly higher than for the non-obese among Alaska Natives who have significant
hydrates has led to an women. Sweetened beverages and alcoholic bev- increased intake of nonindigenous protein (i.e.,
increase in dental caries. erages accounted for the differences. Researchers beef, chicken), carbohydrates (i.e., white bread,
This problem was virtually investigating Zuni adolescents suggest that potatoes or rice, soft drinks), and fat (i.e., butter,
unknown among Native underreporting of foods and/or alcohol may shortening), combined with a lower intake of
Americans before European account for low reported energy intakes.23, 116, 127 native foods such as salmon, caribou, berries,
contact. Dieting behaviors among adult Native American and seal oil; and higher rates are found among
women mostly involve healthy approaches such Pima Indians who consume an Anglo diet when
Alaska Natives suffer the as eating more fruits and vegetables and exercis- compared to Pima who consume a traditional
highest incidence of botu-
ing more, according to one study, although skip- diet.82, 128 Some researchers suggest the difference
lism in the world, due
ping meals, fasting, and disordered eating such as is due to the dietary change from indigenous
mostly to the way in which
indigenous foods, such as self-induced vomiting were also mentioned; 10 starches to the refined flours and sugars of the
seal, are butchered on the percent engaged in binge eating. A national adapted diet. Traditional starches are harder to
ground, then stored for long survey of Native American youth revealed that digest and absorb, leading to lower blood sugar
periods in plastic bags over 40 percent reported binge-eating behavior levels and insulin responses that may be protec-
underground.100 with vomiting rates of 4 to 6 percent. Frequent tive in the development of diabetes.14 Other
dieting was also common. All disordered eating researchers suggest the increased intake of fat in
occurred more frequently among overweight the modern Native American diet may be respon-
respondents.87, 103 sible for the increase in type 2 diabetes.40, 113 (See
The incidence of type 2 diabetes mellitus, Cultural Controversy feature.)
especially among some Native Americans of the Associated with obesity and type 2 diabetes is
Plains and Southwest, is estimated to be between a dramatic increase in the prevalence of heart
two and four times that of the general population. disease among Native Americans during the last
A study of American Indians over the age of twenty-five years; heart disease is now the lead-
forty-five in four states found rates of 33 percent ing cause of death. Rates of cardiovascular dis-
in men and 40 percent in women living in North ease for Native Americans have surpassed those
Dakota and South Dakota, 38 percent in men and of the total population in many locations, and are
42 percent in women residing in Oklahoma, and often more fatal.47, 54 Additional risk factors
65 percent in men and 72 percent in women in include high rates of cigarette smoking, elevated
Arizona.77 The Pima Indians are believed to have cholesterol levels, and hypertension.38, 78 Elder
the highest rate of type 2 diabetes in the world, urban Native Americans are especially at risk.69
affecting 70 percent of all adults over the age of American Indians have the highest rates of
forty-five. Rates of the disease among children gallbladder disease in the United States, accom-
are also increasing substantially, and it has been panied by an increased risk for gallbladder
noted that acanthosis nigricans (a patchy darken- cancer.24, 102 End-stage renal disease is also a con-
ing of the skin) is an independent marker for cern, particularly associated with type 2 diabetes,
insulin resistance in Native American young- with incidence up to twenty times higher than in
sters.27, 34 The death rate from type 2 diabetes is the general population.16, 79, 131 Gastrointestinal
more than three times as high for Native infections, particularly gastroenteritis and bacil-
Americans as for the total population.119 Notably, lary dysentery, are also prevalent.
diabetes was rare among Native Americans fifty The incidence of alcoholism among Native
years ago.91 Americans has decreased in recent years, but it
One theory for the high rates of type 2 dia- still remains a significant medical and social
betes among Native Americans is genetic predis- problem. High unemployment rates and loss of
position.2 However, a comparison of type 2 tribal integrity, ethnic identity, and self-esteem
diabetes among Pima Indians living in Arizona are frequently cited as reasons for substance
CULTURAL CONTROVERSYType 2 Diabetes, Thrifty Genes,

and Changing Theories
S cientific theory sometimes takes on a

life of its own, existing in the public
memory long past the time it has
been modified or disproved. Such is the
case with the thrifty gene hypothesis. In
age, type 2 DM was rarely diagnosed in
urban pediatric clinics as recently as the
early 1990s, but type 2 DM is now increas-
ing rapidly as a proportion of all newly
diagnosed cases of diabetes in children.63
totally account for high prevalence rates
through differences in diet and activity
levels between diabetic and non-diabetic
members in certain Native American
groups.28, 32, 113, 123, 127, 128
the 1960s when researchers first proposed Among Native Americans, prevalence rates These data beg the question: Why do
that certain Native Americans might be vary from between 4 and 70 percent of some Native Americans develop type 2 DM
predisposed to developing diabetes melli- adults over the age of forty-five, depend- at rates many times above that of the
tus (DM) due to a feast-or-famine metabo- ing on group, with the lowest rates seen in white U.S. population? Researchers pro-
lism compromised by a modern diet, type 1 Alaska and the highest found in the pose that the development of type 2 DM is
DM had not yet been fully differentiated Southwest. In a few Native American much more complex than previously
from type 2 DM. Four decades later, our groups a unique genetic mutation has been thought, including factors in three
understanding of the disease has identified as the cause, as in the Oji-Cree of domains: political-economic (such as
improved, revealing a complexity that Canada, who have type 2 DM rates of 40 ongoing stress, unavailability of healthy
defies simple explanations.86 percent among adults.49 foods, and barriers to health care access),
What is now known as type 1 DM Yet attempts to find a universal thrifty etiological (both genetic and non-genetic),
results from a complete lack of insulin in gene that predisposes other Native and cultural (including traditional health
the body and is not correlated to lifestyle. Americans to the disease have been unsuc- beliefs, values regarding body image,
Type 2 DM is more common; it is associated cessful. It was initially argued that a norms about exercise, etc.).106 Of particular
with normal or reduced levels of insulin metabolism adapted to a diet plentiful at interest are theories regarding the roles of
and the inability to use insulin efficiently, times (feast periods) interspersed with historical trauma (similar to posttraumatic
and it is closely correlated with obesity and food shortages (famine periods) could not stress syndrome)15 and prenatal adaptation
limited physical activity. Both types of dia- cope with the constant abundance of the to malnutrition and gestational diabetes in
betes result in high levels of blood glucose modern diet, resulting in high insulin Native American mothers resulting in
that over time can cause lifelong disability responses and type 2 DM. The theory col- increased rates of type 2 DM.6 Genes alone,
and death. Diagnosis of type 2 DM has lapsed when researchers were unable to thrifty or not, cannot completely explain
increased by more than 65 percent in the find a specific mechanism that causes an what has become a problem of epidemic
general adult population over the past ten ethnic predisposition to developing dia- proportions in much of the Native
years. Long considered a disease of middle betes. Further, it has been difficult to American community.
abuse among both reservation and urban Native American worldview, traditional health beliefs,
Americans. The rate for alcohol-related deaths differences between nations, and the history of
is more than five times that of the general U.S. each group was considered essential to effective
population.119 interaction.121 Of particular importance is recog-
nition of diversity within Native American
Counseling groups and understanding of local culture.
A survey of Native American nurses identified Access to biomedical health care may be limited
attitudes, skills, and knowledge needed to serve for some Native Americans because of low income
Native Americans successfully. They listed being or inadequate transportation. Many are also limited
open-minded, avoiding ethnocentrism, and to care through the Indian Health Service (IHS)
using intercultural communication skills, espe- which has a federal trust to provide health
cially the ability to listen carefully and to provide services to all Native Americans who are mem-
respectful silence. Learning about the Native bers of tribes recognized by the U.S. government.
It began operation under the BIA in 1924 and was into account cultural traditions. Among the
placed under what is now called the Department of Navajo, the patient should be asked directly for
Health and Human Services in 1955. It operates his medical history, because even family mem-
forty-three hospitals and works in collaboration bers may believe that they have no right to speak
with state, tribal, and private health care facilities to for another. However, family members are often
provide comprehensive services. Under the Indian consulted in making medical decisions.
Self-Determination and Education Assistance Act It is estimated that more than one-half of
of 1975, tribes are given the option of staffing and Native Americans speak their native language
managing IHS programs in their communities. in addition to English. Native American lan-
However, the number of Native American health guages are primarily verbal, and some Native
professionals is limited, and intercultural care is the Americans may experience difficulties with
norm rather than the exception in many facilities. written information or instructions. Further,
Unfortunately, medical technologies widely avail- some English words, such as germ, may not
able to the general population may not be offered exist in Native American languages.92 It has been
through the IHS, which is severely limited in fund- reported, for example, that increasing vegetables
ing. For example, daily single-dose, long-acting in the diet of some Native Americans has met
medications for managing type 2 diabetes may not with resistance because the closest equivalent
be in the formulary because they are more expen- Native American word for vegetable is weeds.59
sive than the same medication with dosing two to Many Native Americans are comfortable with
three times each daydespite efficacy studies periods of silence in a conversation, using the
showing improved outcomes with single-dose time to compose their thoughts or to translate
therapies.119 responses. A yes or no response may be consid-
Some Native Americans hold beliefs that ered a complete answer to a question, and a
cause them to avoid biomedical treatment in gen- Native American may answer, I dont know, if
eral. For example, pregnancy is often considered he or she thinks that a question is inappropriate
a healthy state, and Native American women may or does not wish to discuss the topic. Stories or
not seek prenatal care for this reason. Some older metaphors may be used to make a point.133
Native Americans report fear of nonNative Information may be withheld until she feels she
American providers, and others find biomedical can trust the provider. Saving face and avoiding
physicians too negative because of impersonal conflict are crucial, and a Native American may
care. Disclosure of risks may also be regarded as not ask questions during an interview because
negative, in violation of a positive approach to that would suggest that the health care provider
life.19 Some Native Americans may be angry was not communicating clearly. Among the
about their condition and may blame illnesses Navajo, direct questioning by the provider sug-
such as diabetes on a Western conspiracy. Some gests that the practitioner is unknowledgeable or
are suspicious of federal and state government incompetent. Open-ended questions are pre-
and may be hesitant to sign any forms.133 ferred. The very concept of a dietary interview
One social worker reports that her clients at a may be interpreted by some Native Americans as
dialysis center in Arizona are so accustomed to interference with their personal autonomy.
friends and family members with kidney failure Emphasis on how personal health promotes the
that they fatalistically expect a similar outcome welfare of the clients family and community can
for themselves and are sometimes relieved when be effective.52
it finally happens.62 Research shows that many Nonverbal communication is very sophisti-
Native Americans believe that renal failure, cated among some Native Americans. It has been
amputations, and blindness are inevitable conse- reported that some children may not be taught to
quences of diabetes.91 Traditional attitudes about speak until other senses are developed.129 A
time may cause delays in seeking carethe Native American client may expect the practi-
importance of finishing a current project or com- tioner to intuit the problem through nonverbal
mitment may outweigh that of keeping an techniques rather than through an interview.37
appointment with a health provider. Although a smile and a handshake are customary,
In general, both verbal and nonverbal com- a vigorous handshake may be considered a sign
munication with Native Americans must take of aggressiveness. Native Americans often sit at a
distance, and direct eye contact may be consid-
National Heart, Lung, and Blood Institute/National Institutes of Health

ered rudethe health professional should not
interpret averted eyes as evidence of disinterest.
Quiet, unhurried conversations are most con-
ducive to successful interaction.
Researchers note that one-on-one diet educa-
tion in a clinical setting is often ineffective
with Native Americans.127 Counseling can be
improved through recognition of the strong oral
tradition found in most Native American groups.
The preferred learning style for many Native
Americans is in an interactive, informal, and
cooperative setting. Talking with clients, instead
of to clients, can improve efficacy. For many
Native Americans, it is the relationship estab- Figure 5.2
lished with the caregiver, not the content of the The logo for the Building Healthy Hearts for American
conversation, that is important. The sharing of Indians and Alaska Natives Initiative depicts the drum as
personal stories, in particular, can elicit informa- a focal point in tribal traditional life. The drum is a living
tion and address issues that are uncomfortable thing to be treated with deep respect, and the act of
for clients to address directly. In group settings, drumming is connected to the heartbeat. The shape of
talking circles can be effective because they facil- the drum represents the circle of life, reminding us that
itate communication and demonstrate equality we are all linked with one another. The drumsticks sym-
bolize the four directions, which in turn are associated
among all participants.52, 53, 64 Developing a
with the four stages of life: east, the newborn; south,
nutrition model that tells the story of changes to
the adolescent; west, the adult; and north, the elder.
traditional foodways and resulting conse-
quences, using culturally appropriate narrative
and imagery, has also been recommended A study of Native American veterans found a
(Figure 5.2).26 greater use of traditional therapies in areas where
A client may have misconceptions about bio- biomedical facilities were less accessible.129 Other
medicine. Because the Navajo health system clas- research suggests that though combining tradi-
sifies illness by cause rather than by symptom, tional and biomedical approaches is common, up
clients may have difficulty understanding the to 40 percent of some American Indians use only
necessity for a physical exam or medical history. traditional healing.89 Some Indians believe a
There may also be the expectation that medica- biomedical practitioner is needed to cure any
tion can cure illness and that an injection is white mans disease, and traditional healers,
needed for every disorder.74 Very low compliance such as herbalists and medicine men and women,
rates among some Native Americans on special or shamans, will frequently decline to treat
diets have been reported.59 A Native American conditions unfamiliar to them, referring patients
may be confused about recommendations for to Westernized health care instead. 25, 59, 128
weight loss because slimness is associated with Compliance is most effective when traditional An elder in one study has
disease or witchcraft. practices are accepted and encouraged as an expressed concerns that
Native American clients may follow tradi- integral part of complete care. healing ceremonies may not
tional health practices instead of, or in conjunc- An in-depth interview is necessary to deter- be performed properly
tion with, biomedical therapies. One study of mine not only ethnic identity but also degree of today and that they are
urban Native Americans found that 28 percent acculturation. Traditional medical beliefs and done for the money or for
practiced traditional Native American medicine; customs, if practiced, should be acknowledged. prestige.30
researchers speculate that the use of herbs, spe- Personal dietary preferences are of special
Traditional care can cost
cial food items, teas, and purification rituals may importance due to the variety of Native thousands of dollars and a
be even more prominent in rural regions and on American foods and food habits. Note taking large time commitment:
reservations.36 On one Navajo reservation it was may be considered exceptionally rude, so hours for consultation
found that 90 percent of clients visiting a bio- memory skills or a tape recorder may be prefer- and up to a week for a
medical clinic had first sought traditional care.42 able during the interview. ceremony.42
PRACTITIONER PERSPECTIVESNative American

Lorraine Whitehair, RD, MPH, RN, CDE
Worked at Indian Health Services for over ten years,
Tribal RD for a number of years, and currently works for CDC
I was born in Oljato, Utah, a rural Navajo reservation located 150 miles northeast of Farmington, New Mexico. After graduating from
high school, I worked as a nurses aid in a small, fifteen-bed hospital near my home in Utah. Later, I completed a bachelors degree
in nutrition science at the University of Utah and a dietetic internship and a masters degree in public health at the University of
California, Berkeley. As a registered dietitian I have worked with the Navajo nation for approximately twelve years.
Briefly, how would you describe the Navajo foods?
Traditionally, during the fifties, sixties, and early seventies, gardening and sheepherding was our livelihood. We hauled all our water
and used wood-burning stoves for cooking. My parents told us of Navajo native foods when they were young, some of which I have
never seen. My mother told me she spent many days grinding corn for the winter. One stew made by parents was ad Alth ta nash
besh, meaning boiled with several mixtures. It had melon seeds, local wild green plants, and a variety of plant seeds, and wild onions,
and was thickened with corn meal. When I was young we grew watermelon, cantaloupe, fresh corn, and summer and winter squash.
Other favorites included boiled mutton backbone in green chili stew, grilled mutton ribs, liver and greater omentum (the fatty tissue
that covers the stomach) in an open-face sandwich with onions or green chili in a tortilla. We may not have had as much mutton as
we wanted, but we had plenty of fruits and vegetables during the summer months.
Traditional food eaten today includes corn prepared many different ways from fresh to dried or ground into meal in varying
degrees of texture. One recipe for fresh corn is called Kneel down Breadbecause it is prepared in a sitting position. A one-fourth cup
of the ground corn is placed in corn leaves, wrapped and tied together. It is then placed in a large hole that is dug in the ground and
is cooked by building a fire on top. All parts of the sheep and goat are used for food. This includes the head, intestine, organs, skin,
hoofs, and blood. Blood sausage and liver sausage are very popular. The stuffed intestine is made by wrapping the greater omentum
with the intestine. It is then grilled on hot coals until crispy.
Most elderly like simple, unmixed foods. Older people dislike marinated meats. They prefer the meats cooked plain. I would say
Navajo native food is fairly bland, although men like to eat with very hot chili and raw, fresh onions.
How much has Western food culture influenced the current diet?
In the past three to four decades our diet has changed significantly. Our level of physical activity also decreased at the same time.
Popular foods now include spam, canned meat, cold cuts, ramen noodles, chips, candy, sodas, and flavored fruit drinks.
Are there any foods that would be difficult or easy to modify in the diet?
Yes. Fried bread would be hard to modify. People enjoy the texture of bread cooked in hot oil, which makes the recipe difficult to alter.
Intestine wrapped in greater omentum is the one that could be easy to modify. Replace the intestinal fat with thick sliced vegeta-
bles like onions, carrots, cabbage, green peppers, and celery. Ramen noodles, a non-traditional food, are easier to modify as well
I suggest to my clients that they add a variety of vegetables (frozen and fresh) and muscles from beef, chicken, or pork and decrease
the serving size, since the noodles contain fat. People seem to like it with fresh ginger as well.
What advice would you give to new RDs working with Native Americans?
Learn about the history of the people. Learn about the way of life then and now. The Navajo people value family and community.
There is a saying which states, Know who you are and where you came from.That is to know your clan system. Introductions are a
very important part of interaction with people on the Navajo reservation. As time consuming as it may be, establishing good intro-
ductions helps establish trust, kinship, and credibility. Making a good introduction about your family clan (family background) is a
cultural practice, and it is believed to help make business meetings successful. For elderly clients you may address them as your
mother (Shi ma) or your father (Shi yes ah ) even though they are not related to you.
For the middle aged and elderly population, living in harmony with the surroundings is important. Parents and grandparents
spend a great deal of time talking about being respectful of kinship, elderly people, and nature, including land and living creatures.
We are to look toward living in harmony with our surroundings. Illness is often thought of as a result of an interruption of harmony.
(Continued)
We enjoy laughing. There is great pleasure in tastefully teasing when appropriate. We have many jokes about life on the reser-
vation, our first boarding school experiences, interaction with people in towns, schools, and medical clinics, and meeting with public
health officials. We have many animal stories that are funny, and they also teach. For example, I use this story to help teach my
clients about diabetes:
Two Birds
Two birds, Jay and Woody, lived near the Interstate 40 highway fifty miles west of Albuquerque, New Mexico. Jay loves to pick up
foods that are left by humans who were traveling back on Interstate 40 highway from Albuquerque, New Mexico. The most common
foods that were left along the highway were french fries, hamburgers, shakes, pies, cookies, ice cream, fried chicken, biscuits, potato
chips, fried bread, and candy bars. Jay always invited Woody to help him eat the leftover foods that were thrown near the highway.
He would tell Woody about the delicious food he had for the day. He would say, You do not have to hunt for your food. It is there
along the road.Woody told Jay the food he was eating was not good for him. Woody faithfully hunted for his food supply. He worked
to store his food daily so that he would have enough for an emergency during the winter months. Daily, Woody flew long distances
to get his food. Meanwhile, Jay had been steadily gaining weight. He also had difficulty flying moderate distances. In the fall both
birds wanted to visit distant relatives near Albuquerque. Jay was not able to complete the trip to Albuquerque. He experienced short-
ness of breath and exhaustion half way to Albuquerque. Jay and Woody decided that Woody should go alone to see their distant rel-
atives. In early spring Jay became very ill after a flu he had developed following a large snow storm. He had frequency of urination,
tiredness, sores on his toes not healing, and blurred vision. His doctor told him he had diabetes. Jay took the news very hard. He did
not want to change his diet. Woody begged Jay to eat more healthfully. In the end Jays diet changed back to eating whole grains,
nuts, and seeds to help control his blood sugars. He also had to retrain his wings to fly longer distances daily, which helped bring his
good cholesterol (HDL) in excellent ranges. His doctor was very happy to see Jay living more healthfully.
CHAPTER 5 REVIEW QUESTIONS 3. Bass, M.A., & Wakefield, L.M. 1974. Nutrient
intake and food patterns of Indians on Standing
1. In Native American culture what is considered Rock Reservation. Journal of the American Dietetic
the cause of illness? How may this influence Association, 64, 3641.
the treatment of a medical disorder, like type 4. Bell, R.A., Quandt, S.A., Spangler, J.G., & Case, D.
2 diabetes? 2002. Dietary calcium intake and supplement use
2. Pick two regional classifications of traditional among older African American, white, and Native
Native American cuisine. Describe the simi- American women in a rural southeastern commu-
larities and differences between these two nity. Journal of the American Dietetic Association,
102, 844847.
classifications in food and their preparation.
5. Benson, D.E. 2000. Tlingit. In Gale Encyclopedia
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one therapeutic use of a non-corn item by J. Lehman (Eds.). Farmington Hills, MI: Gale
Native Americans. Group.
4. What is Indian fry bread? Is it a traditional 6. Benyshek, D.C. 2005. Type 2 diabetes and fetal ori-
food? Why or why not? gins: The promise of prevention programs focusing
5. What factors have increased the incidence of on prenatal health in high prevalence Native
type 2 diabetes among Native Americans? American communities. Human Organization, 64,
192200.
7. Bernard, L., Lavallee, C., Gray-Donald, K., &
Delisle, H. 1995. Overweight in Cree schoolchildren
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1994. Cultural aspects of caring for Navajo Indian eating in the rural, southern United States:
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CHAPTER
6
Northern and
Southern Europeans
S ome of the largest American ethnic groups

come from northern and southern Europe
(see the map in Figure 6.1). Immigrants from
these regions began arriving in what is now the
United States in the sixteenth century and are
now a sovereign country. Although quite northern,
the climate is temperate due to the warming
influence of the Gulf Stream, and the lowlands
are arable.
Just across the English Channel is France,
still coming, significantly influencing American regarded for centuries as the center of Western
majority culture. Many foods and food habits we culture politically, as well as in the arts and
consider to be American were introduced by these sciences. Its capital, Paris, is one of the worlds
settlers. The northern European idea of a meal, most beautiful and famed cities. France con-
consisting of a large serving of meat, poultry, or fish tains some of the best farmland in Europe, and
with smaller side dishes of starch and vegetable, three-fifths of its land is under cultivation. It
was quickly adopted and expanded in the United is especially well known for premium wine
States to include even bigger portions of protein production.
foods. Adaptations of some southern European spe- In 1607 people from Great Britain began
cialties have become commonplace American fare. immigrating to what has become the United
Each ethnic group from northern and southern States. They brought with them British trade
Europe has brought a unique cuisine that was com- practices and the English language, literature,
bined with indigenous ingredientsblended with law, and religion. By the time the United States
the cooking of Native Americans, other Europeans, gained independence from Britain, the British
and Africans; and flavored with the foods of and their descendants constituted one-half of the
Latinos, Asians, and Middle Easternersto form American population. They produced a culture
the foundation of the typical American diet. This that remains unmistakably British-flavored, even
chapter discusses the traditional foods and food today. The French came to the United States later
habits of Great Britain, Ireland, France, Italy, and in smaller numbers, yet they have made sig-
Spain, and Portugal and examines their contribu- nificant regional contributions. Belgium, situated
tions to the cooking of the United States. northeast of France, shares many French food
habits but has had very little influence on the
American diet due to the relatively low number
Northern Europeans of immigrants to the United States. The tradi-
tional foods of northern Europe and their influ-
Great Britain includes the countries of England, ence on American cuisine are examined in the
Scotland, Wales, and Northern Ireland. Ireland is next section.
140 NORTHERN AND SOUTHERN EUROPEANS
SCOTLAND
UNITED
KINGDOM
North
NORTHERN
IRELAND Sea
Dublin BELGIUM
The
Hague
London
WALES
IRELAND Brussels
ENGLAND
Paris
Atlantic
Ocean Bay of FRANCE
Biscay ITALY
Ad
Rom riat
ic
L
e
Se
PORTUGA
SPAIN a
on
Lisb
Tyrrhenian
Madrid Sea
Figure 6.1 Mediterranean Sea
Northern and southern
Europe.
CULTURAL PERSPECTIVE By the eighteenth century, British immigra-

tion had slowed. After independence, British
History of Northern Europeans immigration to the United States further
in the United States declined due to American hostility and disap-
Immigration Patterns proval by the British government. However,
Great Britain. The British who immigrated in reported arrivals of British in the nineteenth cen-
the seventeenth century settled primarily in New tury increased substantially. Early in the century
England, Virginia, and Maryland. While many most immigrants were families from rural areas
originally came to avoid religious persecution, of southern and western England and Wales. In
such as the Puritans in New England and the the latter half of the century, the majority of
Catholics in Maryland, most later immigrants immigrants were from large English towns; many
earned their passage to America by signing on as were seasonal unskilled workers who repeatedly
indentured servants. returned to Britain.
Chapter 6: Northern and Southern Europeans 141
It is said there have been Scots in America as

long as there have been Europeans on the conti-
nent. More than one hundred towns and cities in
the United States bear Scottish names, and it has
been estimated that 1.5 million Scots immigrated
to America. Although the majority of Scots came
during the eighteenth and nineteenth centuries,
400,000 immigrated between 1921 and 1931,
when Scotland suffered a severe economic
depression. The Scottish settled over most of the
United States and were often professionals or
skilled laborers.
Although British immigration did not decline
in the early twentieth century, the United States

was no longer the country of first choice for those
leaving Great Britain. During the Great Depression
in the 1930s, more British people returned to
Britain than came to America. After World War II,
an increase in immigration was attributable to
Traditional foods of northern
British war brides returning to the United States Europe. Some typical foods
with their American husbands. Since the 1970s, include apples, bacon, beef,
blight that destroyed their principal crop in
British immigration has been constant at about cheese, cream, French bread,
1845 resulted in death by starvation of 1 million
10,000 to 20,000 persons per year. oatmeal, salt cod, and tripe.
Irish people.
The Irish Catholics were the first great ethnic
Ireland. The first Irish people to immigrate in
minority in American cities, and their early history
substantial numbers to the United States were the
set the pattern for later minority immigrant groups.
descendants of Scottish Presbyterians who had The Odd Fellows, a British
They settled in the northeastern cities and were
settled in Northern Ireland in the seventeenth fraternal society founded to
at the bottom of the socioeconomic ladder. The
century. Large-scale immigration began in the support the working class,
Scotch Irish, who were often of relatively high
eighteenth century, and by 1775 there were an was established independ-
economic standing and Protestant, found it fairly ently in the United States
estimated 250,000 Scotch Irish living in the
easy to move into mainstream American society; when the first lodges were
American colonies. Most of the immigration was
however, the Irish Catholics were often stereo- opened in Baltimore and
the result of an economic depression brought on
typed as drunkards, brawlers, and incompetents. Boston during the early
by a textile slump in Ireland.
The Irish achieved success with painful slowness. nineteenth century.22
Initially, the Scotch Irish settled in Pennsylvania.
For many, their first entry into the American
Before long the direction of Scotch-Irish immi- The Scots have been stereo-
mainstream came by way of city politics.
gration was westward to the frontier, first up the typed as thrifty, or stingy.
Delaware River and then beyond the Susquehanna France. Immigration directly from France has Scotch tape was so named
into the rich farmlands of the Cumberland been the smallest, yet most constant, of that from with the hope it would
Valley. The Scotch Irish played an important role any European country, but the return rate has suggest an economical
in the settlement of the trans-Allegheny region been high. Most of the estimated 1 million per- product.26
and eventually clustered around the site of sons who have immigrated to the United States
Pittsburgh and in other areas of southwestern from France have been middle-class and skilled
Pennsylvania. They also settled in the frontier and have come for economic opportunity.
regions of western Maryland, the Shenandoah A smaller number came because of religious
Valley of Virginia, and the backcountry of Georgia. persecution. More than 12,000 Huguenots
Irish Catholics started to arrive in the United (French Protestants) settled in the American
States by 1820, and their immigration reached colonies in the eighteenth century. They were
an apex between 1840 and 1860, when approxi- considered to be excellent skilled workers.
mately 2 million people arrived. The impetus Generally, French people who settled in the
to leave Ireland was not only religious persecu- United States were eager to assimilate and able to
tion but also repeated crop failures. The potato do so because they were economically successful.
Canadian census data from Few pockets of French culture remain in the In the 1950s the Irish were overrepresented as
2001 reported 5.9 million of United States, with the exception of southern clergymen, firefighters, and police officers. Today
English ancestry (almost Louisiana, originally a French holding, and northern there are disproportionately more in law, medi-
20 percent of the total pop- New England. However, the Frenchness of these cine, and the sciences; and Irish Catholics are
ulation), 4.6 million of
areas is probably due more to the influence of more likely than other whites to attend college
French heritage (over
French Canadian immigration than to direct French and to pursue advanced graduate degrees.49
15 percent of the total
population), 4.1 million of immigration. French Canadians are the descen- Although Irish Catholics have to some extent
Scottish heritage (almost dants of explorers and settlers who came from assimilated into mainstream American society,
14 percent of the total France, primarily Normandy and Brittany, during they still remain an identifiable ethnic group.
population), and 3.8 million the seventeenth century. They established New Persons identifying themselves as of Scottish
of Irish background (about France in what is today known as Canada. When and Scotch Irish heritage totaled over 11 million
12 percent of the total the English gained control of Canada, many in the 2005 census estimate. They are well assimi-
population). French Canadians moved to the United States; in lated, though pockets of Scotch-Irish popula-
some instances they were deported from Canada. tions can still be found in certain Appalachian
Most settled in northern New England, especially communities.
Maine, and their descendants are known as Franco-
Americans. Others from Acadia (Nova Scotia, New French. Over 9.5 million Americans listed French
Brunswick, Prince Edward Island, and part of as their ancestry in the 2005 U.S. Census survey.
Maine) relocated, often not by choice, to central An estimated fewer than 40 percent of French
and southern Louisiana; their descendants are Americans are descended from immigrants who
known as Cajuns. came to the United States directly from France.29
More than 2.2 million people of French-
Current Demographics and Socioeconomic Canadian descent live in the United States as of
Status 2005, many of whom make their home in the
British and Irish. The British assimilated into Northeast.13 The French Canadians who settled in
American mainstream society easily. Distinct the New England states worked in factories that
groups from specific regions of Great Britain can processed textiles, lumber, and bricks. Since 1950
still be found, however. For example, Cornish there has been an increase in the percentage of
immigrants of the nineteenth century were often Franco-Americans holding white-collar jobs, but
miners, and their descendants are still living in they still lag behind other ethnic groups econom-
certain old mining regions, such as Grass Valley, ically. Compared to the French who immigrated
California; Butte City, Montana; and the areas directly from France and assimilated rapidly into
around Lake Superior. The Welsh who immi- American culture, the descendants of French
grated in the nineteenth century were miners and Canadians have clung to their heritage, including
mill workers. They settled in the mid-Atlantic language, customs, and religious affiliation.
and midwestern states, especially Ohio and In Louisiana more than 800,000 are of Acadian
Pennsylvania; many were Baptist, Calvinist, or ancestry, with smaller populations located along
Methodist. Remnants of Welsh communities in sections of the Gulf Coast, and one small colony
the United States still celebrate St. Davids Day remaining in northeastern Maine.24 The Cajuns
(the feast day of the patron saint of Wales) and settled in rural and inaccessible areas of southern
the annual festival of the National Gymanfa Ganu Louisiana, the bayous, and along the Mississippi
Association (an assembly that sings Welsh folk River. Primarily farmers, fishermen, and herders,
songs). It is estimated that there were nearly they were self-sufficient and kept to themselves.
29 million Americans of English or British ancestry Today they are still rural, but their occupations
in 2005. reflect local economic conditions.
Close to 5 million Irish Catholics have immi-
The Welsh honor the patron Worldview
grated to the United States, and in 2005 there
saint of Wales, St. David, by
wearing a leek stalk on were approximately 34 million Americans who Religion
their lapel. St. David identi- claimed Irish descent. Although they started out British. Nearly all early British immigrants to
fied his followers by placing on a lower economic rung than other older immi- America were Protestant. Although many came
a leek in the brim of their grant groups, they are now scattered throughout to escape persecution by the Church of England,
caps. the occupational structure. others maintained this faith and established
congregations throughout the American colonies. Irish. Many of the characteristics of the Irish
The Church of England in the United States family in the nineteenth century persisted into
became the Episcopal Church during the late the twentieth century. Irish Catholics tended to
eighteenth century. marry at a late age, have large families, and
British ethnicity was often expressed through divorce rarely. Today, however, most first- and New England Puritans and
religious affiliation, particularly with the Episcopal, second-generation Irish Catholics are likely to English Quakers were
Methodist, Baptist, and Quaker faiths. Many immi- marry outside their group and, with increasing among the first in the
grants established distinctively English congre- frequency, outside Catholicism. Traditionally the United States to promote
gations, but within a generation most became father was the breadwinner in the Irish Catholic free public education.
indistinguishable from other American churches. family, but the mothers position was a strong
Today, Americans of British descent participate in one. Daughters were often as well educated as
most U.S. faiths. sons. The Irish peoples relatively egalitarian atti-
tudes toward sex roles may be responsible for the
Irish. Religion is a cornerstone of Irish Catholic high concentration of Irish American women in
society, and in the United States it is centered on professional jobs and white-collar work.
the parish. Over time the Catholic Church in
America came to be dominated by the Irish, often French. The Franco-Americans in New England
to the resentment of other Catholic immigrants. maintained many French traditions through their
The church spared no effort to aid its members; it continued contact with French relatives in Quebec.
established schools, hospitals, and orphanages They had little desire to acculturate. During the
across the United States. The church helped to 1930s, due to the Great Depression and new laws
bridge the cultural gap for many Irish immigrants restricting reentry into the United States, the bond
through advice, job placement, savings clubs, and to Canada weakened, which diminished new
temperance societies. Today, religion plays a less French Canadian immigration. Today the descen-
important role in Irish Catholic life, although the dants of the French Canadians speak French infre-
role of the Irish in the church is still significant. quently and often marry outsiders. Family ties are
still strong, but, as with the Cajuns, family size
French. Among French Americans, Franco- has decreased. Franco-American women have
Americans, and Acadians, the Catholic Church traditionally had higher status and more authority
provided the nucleus of the community, gave it than their counterparts in France.
stability, and helped preserve the language and Until the twentieth century, Cajuns lived in
traditions of the people. The church today still rural areas in extended family households with as
plays a central role. many as ten or twelve children per couple. The
whole family worked as a unit, and decisions that
Family
affected the group were made jointly by all the
British. The immigrant English family formed the
adults. Until 1945, many Cajuns were illiterate
model for the typical American family. It included a
and spoke only Cajun French. The use of Cajun
father, a mother, and their children. This family
French was prohibited by the public schools in
group sometimes resided near other relatives, but
1921; as a result, many younger Cajuns today do
more often established solitary households. The
not speak or understand French. The average
father was in charge of the public and business
family size today is smaller, and there is more
aspects of the family, while the mother con-
marriage outside the community, but Cajuns still
trolled the domestic and social responsibilities.
retain strong ties to their families.
Traditionally, the oldest children in the home were
well educated and were sent to private schools, Traditional Health Beliefs and Practices. Many
if affordable. Such an education was considered of what are characterized as American majority
an investment in the future, and children were cultural beliefs regarding health originated in
expected to continue the family business and to northern Europe. For example, when students
maintain the familys social position. Due to the sim- were surveyed on family home remedies,54 those
ilarities between the British family and the emerging of British, Irish, and French descent shared similar
American family, new immigrants from England health maintenance practices such as a good diet,
assimilated quickly. It was very common for British plentiful sleep, and daily exercise. Fresh air, clean-
immigrants to marry non-English spouses. liness, and keeping warm and dry were also
commonly mentioned. The Irish traditionally Ingredients and Common Foods

wear protective religious medallions. Staples and Regional Variations
Among the British and the Irish there is the Great Britain and Ireland. Animal products are
more generalized belief that good health is of key importance in Great Britain and Ireland.
dependent on proper attitude (which includes Some form of meat, poultry, or fish is present at
religious faith) and a rigorous, regular lifestyle. most meals, in addition to eggs and cheese. In
Many northern Europeans associate a moderate Britain and Ireland, lamb is a commonly eaten
diet with maintaining bowel regularity, and laxa- meat, as is roast beef, which is often made for
tive use is common. Stomach ailments may be Sunday dinner with Yorkshire pudding (a popover
explained as due to food that is too spicy, spoiled, cooked in meat drippings). Pork is often served
or incompatible (causing an allergic reaction). as sausages (bangers) and bacon. Various game
The traditional French lifestyle, which fea- birds are also eaten. The cultural food groups list
tures leisurely meals and little structured exer- (Table 6.1) includes a more complete detailing of
cise, presents a paradox to researchers. Although ingredients.
the French consume more total saturated fat and The British and Irish diets also contain a variety
cholesterol than Americans, their death rate of seafood. A well-known fast-food item is fish
from heart disease is less than one-half of that in and chips. The fish is battered and deep-fried,
the United States. Scientists speculate that some served with fried potatoes, and seasoned with
other protective factor in the French diet or salt and malt vinegar. Salt-dried fish, including
lifestyle may account for this discrepancy, such ling, cod, and pollack, was traditionally served
as the higher intake of wine or more frequent with a white sauce and potatoes for meatless days
walking. Genetic factors do not appear to be a by Irish Catholics.51 Preserved fish is also found as
cause. Studies comparing the French with an appetizer, or at breakfast. Examples are smoked
Americans of French ancestry have not been Scottish salmon and kippers, which are a salted
reported. The French Canadians who settled in and smoked fish.
A pub, or public house, is
Louisiana brought numerous traditional remedies Dairy products and eggs also play an impor-
a bar that serves beer, wine, to the region. tant role in the diet of the British and Irish. Eggs
hard liquor, and light meals. Today, Americans of French descent in are traditionally served for breakfast, and cheese
The British pub is often the Louisiana, including the Cajuns and urban dwellers is the key ingredient in the traditional plough-
place where friends and of all socioeconomic groups, often use home reme- mans lunch served in pubs. It consists of a piece
family meet to socialize. dies and consult folk healers. Salves of whiskey and of cheddar cheese, bread, pickled onions, and a
camphor or sheeps tallow and turpentine are pint of beer. Other cheeses produced in England
In 2006 the Stilton Cheese considered beneficial for colds. Tobacco smoke is are the slightly nutty Cheshire and Stilton, a blue
Makers Association commis- blown into the ears to cure earaches. A string of cheese. In Ireland a market for hand-crafted farm-
sioned the production of a garlic is tied around the neck of a baby with
perfume with the aroma of
house cheeses has developed over the past decade.
worms. Red flannel pouches filled with camphor They include both fresh, soft cheeses and aged
the blue cheese, called
Eau de Stilton, as part of a
or asafetida are worn to prevent illness. It should types (often flavored with herbs or other season-
marketing campaign. be noted that some Americans of French descent ings), from cows or goats milk. One cheese that
living in the region may also consult practitioners has gained international acclaim is Cashel blue,
of voodoo for health problems (see Chapter 8, which is produced in Tipperary, Ireland.
Africans for more details). Devonshire, England, is known for its rich
Oatcakes, called bannocks, cream products, such as double cream (which
were traditionally eaten to has twice as much butter fat as ordinary cream)
celebrate the pagan Celtic TRADITIONAL FOOD HABITS
and clotted cream, a slightly fermented, thick-
holiday of Beltane on May 1. The influence of France on the food habits of ened cream. It is often spread on scones, biscuits
One section was burnt or
Great Britain and Ireland and vice versa has led to made with baking powder.
covered with ash; the
unlucky person who
many similarities in the cuisines of these coun- Though not the main focus of the meal, breads
received the marked portion tries, although the ingredients of southern French are not overlooked. In Ireland soda bread, a bread
was sacrificed (in more cooking differ in that they are more like those of made with baking soda instead of yeast, was tra-
recent times the victim Mediterranean countries. The influence of these ditionally prepared every day to accompany the
would leap through a small northern European cuisines on American foods meal and remains popular today. Another version
bonfire three times instead). and food habits has been extensive. was made of cornmeal. Wheat flour is commonly
Table 6.1 Cultural Food Groups: Northern European

Adaptations in the
Group Comments Common Foods United States
Protein Foods
Milk/milk products The English and Irish drink milk as a beverage. Cheese (cow, sheep, and goat milk), cream, milk, sour
Cheese is eaten daily. cream, yogurt
Meat/poultry/fish/ Meat, poultry, or fish is usually the centerpiece Meat: beef (roasts; variety cuts such as brains, kidneys, The Irish consume more
eggs/legumes of the meal. liver, sweetbreads, tongue, and tripe), horsemeat, animal protein.
Meats are generally roasted or broiled in Great lamb, oxtail, pork, rabbit, snails, veal, venison
Britain; also prepared as stews or in pies. Poultry and small birds: chicken, duck, goose, par-
Smoked, salted, or dried fish is popular in tridge, pheasant, pigeon, quail, thrush, turkey
England. Fish and shellfish: anchovies, bass, clams, cod, crab,
crawfish, haddock, herring, lobster, mackerel, mullet,
mussels, oysters, perch, pike, pompano, salmon,
sardines, scallops, shad, shrimp, skate, sole, sturgeon,
trout, whiting
Eggs: poultry and fish
Legumes: kidney beans, lentils, lima beans, split peas
Cereals/Grains Wheat bread usually accompanies the meal. Barley, hops, oats, rice, rye, wheat Corn and corn products
In Britain and Ireland oatmeal or porridge is are consumed more.
common for breakfast.
Fruits/Vegetables Potatoes are frequently eaten in Ireland. Fruits: apples, apricots, cherries, currants, gooseberries, Native and transplanted
Arrowroot starch is used as thickener, and grapes (many varieties), lemons, melons, oranges, fruits and vegetables,
tapioca (from cassava tubers) is eaten. peaches, pears, plums, prunes, raisins, raspberries, such as bananas,
rhubarb, strawberries blueberries, okra, and
Vegetables: artichokes, asparagus, beets, brussels sprouts, squash, were added to
cabbage, carrots, cauliflower, celery, celery root, the diet.
cucumbers, eggplant, fennel, green beans, green
peppers, kale, lettuce (many varieties), leeks, mush-
rooms (including chanterelles, cpes), olives, onions,
parsnips, peas, potatoes, radishes, salsify, scallions,
sorrel, spinach, tomatoes, turnips, truffles, watercress
Additional Foods
Seasonings British and Irish dishes emphasize naturalness Angelica (licorice-flavored plant), bay leaf, capers, chile Cajun and Creole cooking
of foods with mild seasoning, served with peppers, chives, chocolate, chutney, cinnamon, are highly spiced. Stews
flavorful condiments or sauces used to taste. cloves, coffee, cognac, fennel seeds, garlic, ginger, are thickened with fil
French dishes are often prepared with com- horseradish, juniper berries, mace, malt vinegar, powder (sassafras).
plementary sauces or gravies that enhance marjoram, mint, mustard, nutmeg, oregano, paprika,
food flavor. parsley, pepper (black, white, green, and pink), rose-
mary, saffron, sage, shallots, sweet basil, Tabasco
sauce (and other hot sauces), tarragon, thyme,
vanilla, Worcestershire sauce
Nuts/seeds Nuts especially popular; used primarily in Nuts: almonds (sweet and bitter), chestnuts, filberts
desserts. (hazelnuts), pecans, walnuts (including black)
Seeds: sesame
Beverages Alcoholic beverages consumed as part of the Beer (ale, stout, bitters), black and herbal tea (mint,
meal. anise, chamomile, etc.), cider, coffee, gin, hot
chocolate, liqueurs, port, sherry, whiskey, wine (red,
white, champagne, and fruit/vegetable)
Fats/oils Butter used extensively in cooking of northern Butter, goose fat, lard, margarine, olive oil, vegetable
and central France; olive oil more common in oil, salt pork
southern regions of the country.
Sweeteners Honey, sugar Molasses and maple syrup
are used as sweeteners.
Irish Americans use more
sugar than members of
other groups.
Ireland from the New World in the seventeenth

century, are the mainstay of the Irish diet and are
found in British fare as well. Potatoes are found in
stews or pies, such as stobhach Gaelach, an Irish
stew of lambs neck, and shepherds or cottage pie,
a meat pie made of leftover ground meat and
onions and topped with mashed potatoes.
Mashed potatoes are often just referred to as
mash, as in bangers and mash (sausages and
mashed potatoes). Some side dishes made of
potatoes are boxty, a type of potato pancake or
PhotoLink/Getty Images
dumpling; bubble and squeak, a dish made of

leftover cabbage and potatoes chopped and fried
together; and colcannon, mashed and seasoned
boiled white vegetables with onions or leeks.
Berries are popular in puddings, pies, and jams.
Fish and chips are classic pub Kitchen gardens are still found in many areas,
food in England and Ireland, providing tomatoes, cucumbers, watercress, and
typically served with malt used for baking, and oatmeal is eaten as a porridge
other items. Farmers markets, featuring fresh
vinegar. for breakfast in Scotland or used in making bread
local produce, are increasingly popular.
and biscuits throughout Britain and Ireland. Biscuits,
One unusual vegetable of the region is sea-
or biskcake, in England can refer to bread, cake,
weed. Laver is a purple seaweed (called nori in
cookies, crackers, or what are known in America
Japan) that is a specialty in Wales and parts of
as biscuits. Scottish shortbread is an example of a
northern coastal England. It is customarily boiled
sweet, buttery biscuit.
into a gelatinous paste, then mixed with oatmeal
Fruits and vegetables are limited to those that
and formed into patties that are fried. Known as
grow best in cool climates. Potatoes, brought to
laverbread, these cakes are traditionally served
at breakfast with bacon. Dulse, a red algae eaten
in Ireland, can be consumed fresh, but is usually
dried, then chewed like beef jerky for a snack, or
flaked and added to soups or warm milk.
The most common beverages consumed by
adults in Ireland and England are tea, beer, and
SAMPLE MENU
whiskey. Tea, which has become synonymous
with a meal or break in the afternoon, was intro-
An Irish Pub Supper duced to England in 1662 by the wife of Charles
II. Drunk with most meals and as a refreshment,
strong black tea is preferred, served with milk
Steak/Beef and Guiness Piea, b and sugar. Frequently consumed alcoholic bever-
ages include beer and whiskey. The British and
Brown Breada, b
the Irish do not drink the bottom-fermented style
Apple Crumb lea, b of beer common in the United States. Instead, in
Britain the pubs usually serve bitters, an amber-
Stout colored, top-fermented beer, strongly flavored
with hops, while in Ireland, a favorite is stout, a
dark, rich beer that can provide substantial calo-
a
Johnson, M.M. 2006. The Irish pub cookbook. San Francisco: Chronicle Books. ries to the diet. Both beers are served at cellar
b
Recipes from the Irish Kitchen at http://www.irishabroad.com temperature and are naturally carbonated.
Whiskey is made in both Ireland and
Scotland, but the Irish are usually credited with
its invention and name. In Ireland it is distilled
from mashed, fermented barley. Scotch, or
Scotch whisky (spelled without an e), is distilled

from a blend of malted whiskey (in which the
barley germinated before fermentation) and
unmalted whiskey. Scotch is traditionally a much
stronger, smokier-tasting beverage than Irish
whiskey. Other alcoholic drinks popular in
Britain are gin, Port (a brandy-fortified wine
made in Portugal), and Sherry (a fortified wine
from Spain). A less common beverage but still
popular in some regions is mead, a type of honey
wine made from the fermentation of honey and
water. The Welsh prefer a stronger, highly spiced
variety called metheglyn.
France. The cooking of France has traditionally

been divided into classic French cuisine (haute
or grande cuisine) and provincial or regional
cooking.17 Classic French cooking is elegant and
Courtesy of Grossich and Partners

formal, mostly prepared in restaurants using the
best ingredients from throughout the country.
Provincial cuisine is simpler fare made at home
or local cafes featuring fresh local ingredients.
Broadly speaking, butter and cream enriches
many dishes in the northeastern and central
regions of the country, while lard, duck fat, and
goose fat flavor foods in the northwest and south Tea time in Great Britain has
central areas.61 In the southeast olive oil is promi- drink used to clear the palate during meals in become an afternoon meal,
nent. Seafood and lamb are specialties of the Louisiana. Another alcoholic drink produced in with small sandwiches,
north, while pork is common in the regions bor- the region is Bndictine, named after the Roman scones (on the second rack of
dering Belgium and Germany. Beef and veal are Catholic monks who still make it at the monastery the silver tray), and an
assortment of cookies and
favorites in the central areas, and in the south- in Fecamp. Normandy is also renowned for its
pastries.
ernmost regions near Spain, fish is a specialty. rich dairy products; its butter is considered one
Cold weather fruits and vegetables are featured in of the best in France. Camembert, a semisoft
northern dishes, while temperate, Mediterranean cheese with a mild flavor, and Pont-lvque, a
produce is the mainstay in southern areas. In the hearty aromatic cheese, are produced in the area.
north foods are subtly seasoned. In the south Dishes from Normandy are often prepared with Colcannon was customarily
garlic flavors many dishes. rich cream sauces. Crpes, very thin, unleavened served for the harvest
The ancestors of most French Americans are pancakes, originated in this region; they are typ- dinner and on Halloween in
from two of Frances northern provinces, Brittany ically served topped with sweet or savory sauces Ireland. For Halloween,
and Normandy. Brittany, known as Bretagne, is or rolled with meat, poultry, fish or seafood, coins were wrapped and
located in the northwest; its shores are washed by cheese, or fruit fillings. buried in the dish so the
children could find them as
the English Channel and the Bay of Biscay. Champagne, bordered by the English Channel
they ate.
Seafood, simply prepared, is common, and deli- and Belgium, has a cuisine influenced by the
cate Belon oysters are shipped throughout France. Germanic cultures. Beer is popular, as are
Mutton and vegetables from the region are said to sausages, such as andouille and andouillette, large
have a naturally salty taste because of the salt and small intestinal casings stuffed with pork or
spray. Apples are the prevalent fruit, and cider is lamb stomach. Charcuterie, cold meat dishes
The term honeymoon
widely exported. such as sausages, pts, and terrines, which often originated with the
Located along the English Channel and east of are sold in specialty stores, are especially good European custom of newly-
Brittany is Normandy, also known for its seafood from this region. Pt is a spread of finely ground, weds drinking mead for the
and apples. Calvados, an apple brandy, is thought cooked, seasoned meats. A terrine is commonly first lunar month following
to be the mother of applejack, an alcoholic apple made with leftover meats cut into small pieces, their wedding.
Tomatoes were introduced mixed with spices and a jelling substance, then in the shell; coq au vin, rooster or chicken cooked
to Europe in 1523 from the baked in a loaf pan. Throughout the world, in wine; and buf bourguignon, a hearty red wine
New World. Reaction was Champagne is probably best known for its natu- beef stew. In Burgundy the red wines are prima-
mixed; some people rally carbonated wines. Only sparkling wines rily made from the pinot noir grape and the white
thought they were poison-
produced in this region can be legally called wines from the chardonnay grape. The great
ous, while others believed
champagne in France. wines of the area are usually named after the vil-
they brought luck. Tomato-
shaped pin cushions devel- The province that borders Germany, Alsace- lages in which they are produced; for example,
oped from the latter Lorraine, has been alternately ruled by France Gevrey-Chambertin, Vosne-Romane, and Volnay.
superstition. and Germany. One of its principal cities is Cassis, a black currant liquor, is also produced in
Strasbourg. Many German foods are favored in the region, and brandy from Cognac is a specialty.
Belgians are renowned for the region, such as goose, sausages, and sauer- To the east, along the border with Switzerland,
their beers. One specialty kraut. Goose fat is often used for cooking, and is the mountainous Franche-Comte region,
ale is lambic, a fruity brew one of the specialties of the area is pt de fois known for its exceptionally tender and flavorful
distinctive for its use of gras, pt made from the enlarged livers of force- Bresse chicken.
unmalted (raw) wheat and fed geese. Another famous dish is quiche The other major wine-producing region of
open-tank fermentation
Lorraine, pie pastry baked with a filling of cream, France is Bordeaux, which is also the name of its
with wild yeast.
beaten eggs, and bacon. Alsace-Lorraine is a principal city. Famous for its hearty dishes, the
Fresh cream in France, wine-producing area; its wines are similar to the term la bordelaise can mean (1) prepared in a
called fleurette, is often German Rhine wines but are usually not as sweet. seasoned sauce containing red or white wine,
added to sauces or whipped Distilled liquors produced in the region are marrow, tomatoes, butter, and shallots; (2) use of
for dessert. Also popular is kirsch, a cherry brandy, and the brandy eau de vie mirepoix, a finely minced mixture of carrots,
crme frache, cream that is de framboise, made from raspberries. onions, and celery seasoned with bay leaves and
fermented until it is thick- Located south of Normandy and Brittany in thyme; (3) accompanied by cpes, large fleshy
ened and slightly tangy. the west-central part of France is Touraine, the mushrooms; or (4) accompanied by an artichoke
province that includes the fertile Loire valley. and potato garnish. A red Bordeaux wine is full-
Along the river one can see the beautiful bodied and made primarily from the cabernet
chateaux or palaces built by the French nobility. sauvignon grape. (In Great Britain, Bordeaux is
Known as the garden of France, Touraine pro- called claret.) Among the wines produced are St.
duces some of the finest fruits and vegetables in Julien, Margaux, Graves, St. Emilion, Pomerol,
the country. A dry white wine produced in the area and Sauternes, a sweet white dessert wine.
is Vouvray. In the north-central region is the area In the south of France is Languedoc, famous
surrounding the city of Paris called the Ile-defor cassoulet, a complex dish containing duck or
France, the home of classic French cuisine. Some goose, pork or mutton, sausage, and white beans,
of the finest beef and veal, as well as a variety of among other ingredients. Provence, located on
fruits and vegetables, are produced in this fertile the Mediterranean Sea, is a favorite vacation spot
region. Brie, semisoft and mild flavored, is the because of its warm Riviera beaches. Provence is
best-known cheese of the area. Dishes of the Ile-de- also known for the large old port city of Marseilles,
France include lobster lamricaine, lobster pre- its perfumes from the city of Grasse, and the
pared with tomatoes, shallots, herbs, white wine, international film festival in Cannes.
and brandy; potage St. Germain, pea soup; filet de The cooking of Provence is similar to that of
buf barnaise, filet of beef with a barnaise Italy and Spain. Staple ingredients are tomatoes,
sauce; and tarte tatin, an upside-down apple and garlic, and olive oil; la Provenal means that a
caramel tart. dish contains these three items. Other common
Located southeast of Paris is Burgundy, one of food items are seafood from the Mediterranean,
the foremost wine-producing regions of France. artichokes, eggplant, and zucchini. Popular
Burgundys robust dishes start to take on the dishes from the region are bouillabaisse, the
flavor of southern France; they contain garlic and famed fish stew made with tomatoes, garlic, olive
are often prepared with olive oil. Dijon, a princi- oil, and several types of seafood, seasoned with
pal city, is also the name of the mustards of the saffron, and usually served with rouille, a hot red
region, prepared with white wine and herbs. pepper sauce; ratatouille, tomatoes, eggplant, and
Dishes of the area are escargot, snails (raised on zucchini cooked in olive oil; salade Nioise, a salad
grape vines) cooked in a garlic butter and served originating in Nice, containing tuna, tomatoes,
olives, lettuce, other raw vegetables, and some-

times hard-boiled eggs; and pan bagna, a French
bread sandwich slathered with olive oil and con-
taining a variety of ingredients, such as anchovies,
tomatoes, green peppers, onions, olives, hard- SAMPLE MENU
boiled eggs, and capers. One unique specialty
item in the region associated with haute cuisine
is black truffles. This costly, pungent under- A French Lunch
ground fungus flavors or garnishes many classic
French dishes. Pt a, b * and Baguette
Cooking Styles. Although the ingredients used in Quiche (Seafood, Onion, or Lorraine)a, b
the countries on the opposite sides of the English
Channel are not substantially different, their cook- Green Salad
ing styles vary greatly. British and Irish food is
described as simple and hearty fare that developed Selection of Cheeses (e.g. Brie, Pont-l Evque,)
out of rural, seasonal traditions.3 French cuisine Fresh Fruit or Tarte aux Pommes (Apple Tart)a, b
is admired for its fresh ingredients, attention to
detail, and technical proficiencyand it is imitated Wine
around the world.
Great Britain and Ireland. Both the British and a

Child, J., Bertholle, L., & Beck, S. 2001. Mastering the art of French cooking
the Irish take pride in the naturalness of their (Vol. I). New York: Knopf.
dishes and their ability to cook foods so the flavors b
French Food and Cook at http://www.ffcook.com
are enhanced rather than obscured. In recent *Can be purchased at a specialty cheese shop or delicatessen.
years the eating local movement (see Chapter 15,
Regional Americans, for more details) and gov-
ernment programs promoting regional specialties
have lead to a renewed interest in traditional fare.16
Meat is usually roasted or broiled, depend-
ing on the cut, and lightly seasoned with herbs
and spices. Strong-flavored condiments such as Pudding is a steamed, boiled, or baked dish that
Worcestershire sauce (flavored with anchovies, may be based on anything from custards and fruits
vinegar, soy, garlic, and assorted spices) on roast to meat and vegetables. An example of a sweet pud-
beef or mint jelly on lamb are often served. ding is plum pudding, which is served traditionally
Chutneys, highly spiced fruit or vegetable pickles at Christmas. It is a steamed dish of suet, dried and
originally from India, are also popular. Leftover candied fruit, and other ingredients. Trifle is a lay-
meat is finely chopped, then served in a stew, pie, ered dessert made from custard, pound cake, rasp-
or pudding. Offal, parts of the animal often dis- berry jam, whipped cream, sherry, and almonds.
carded, such as lambs brains, pigs tail, and calf s France. Classic French cuisine implies a carefully
heart, have become trendy items in England appre- planned meal that balances the texture, color, and
ciated for both their traditional heritage and the flavor of the dishes, similar to the harmony found
ecological/ethical value of using the whole animal. in musical compositions or paintings.45 The soul
While most Americans think of pies and pud- of French cooking is its sauces, often painstak-
dings as being sweet desserts, in Britain and ingly prepared from stocks simmered for hours
Ireland this is not necessarily the case. A pie is a to bring out the flavor. A white stock is made
baked pastry consisting of a mixture of meats, from fish, chicken, or veal; and a brown stock is
game, fish, and vegetables, or fruit, covered with made from beef or veal.7
or enclosed in a crust. A Cornish pasty is an indi- Sauces are subtly flavored with natural ingre-
vidual pillow-shaped pie filled with meat, onions, dients, such as vegetables, wine, and herbs. They
potatoes, and sometimes fruit. Another well- must never overwhelm the food, but rather com-
known British dish is steak and kidney pie. plement it. The five basic sauces are espagnole
The first eating chocolate (or brown sauce), made with brown stock, mire- In recent years classic French cuisine has
was introduced by the poix, and roux (thickening agent made from flour merged with a rediscovery of regional fare to
British in 1847. Europeans cooked in butter or fat drippings); velout, made create what is known as nouvelle cuisine (new
now consume twenty to with white stock, roux, onions, and spices; bchamel cuisine).45 The practice of nouvelle cuisine has
twenty-five pounds of
(or cream sauce), made with white stock, milk, popularized French cooking worldwide and
chocolate per person each
and roux; tomato, made with white stock, toma- influenced the development of local specialties
yeartwice the amount
eaten by U.S. citizens. toes, onions, carrots, garlic, and roux; and, hol- with an emphasis on fresh ingredients. An appre-
landaise, which combines egg yolks and drawn ciation for the cooking of other nations, espe-
butter (barnaise is similar, flavored with tar- cially those of Asia, has occurred in France, and
ragon). Examples of classic cold sauces are mayon- many dishes now use foreign seasonings or use
naise and vinaigrette, a mixture of vinegar and oil. exotic techniques and presentations.
Some common rules in preparing French
dishes are (1) never mix sweet and sour flavors in
the same dish; (2) never serve sweet sauces over Meal Composition and Cycle
fish; (3) do not under- or overcook food; (4) with Daily Pattern
Potted is an English term the exception of salad and fruit, do not serve Great Britain and Ireland. In Britain four meals
for fish, meat, poultry, or uncooked food; (5) always use the freshest, best- are traditionally served each daybreakfast,
game pounded with lard tasting ingredients; and (6) wine is an integral lunch, tea, and an evening meal (dinner). In the
or butter into a coarse or part of the meal and must complement the food. nineteenth and early twentieth centuries, break-
smooth pt, then preserved French breads and pastries are particularly fast was a very substantial meal, consisting of oat-
in jars or pots. Deviled noteworthy. Breads are typically made with white meal; bacon, ham, or sausage; eggs (prepared
describes a dish prepared
flour, shaped into long loaves (e.g., thin baguettes), several ways); bread fried in bacon grease; toast
with a spicy hot sauce or
seasoning.
rounds, braids, or rings, then baked in a wood- with jam or marmalade; grilled tomatoes or
fired oven. Sweeter breads, such as eggy brioche mushrooms; and possibly smoked fish or deviled
or buttery, flaky croissants, are between breads kidneys. All this was washed down with tea. In
and pastries. Specialty doughs, such as cream puff Scotland oatmeal is usually eaten for breakfast,
pastry, multilayered puff pastry, and the classic while in England today, packaged breakfast cere-
sponge cake gnoise, are used to create the numer- als are often eaten during the week, and the more
French breads are consumed
ous desserts of France, such as cakes, petits fours extensive breakfast is reserved for weekends and
at every meal, and include
baguettes, braids, rings,
(small, bite-size pastries), and tarts. Chocolate, special occasions.
and sweeter versions such fresh fruits, and pastry cream thickened with egg Lunch was originally a hearty meal and still is
as brioche (with little yolks enrich these pastries. on Sundays, but during the week it is squeezed in-
topknots). between work hours. It may include a meat pie,
fish and chips, or a light meal at the pub with a
pint of bitters or stout. Both Sunday lunch and
the weekday dinner are much like an American
dinner. They consist of meat or fish, vegetable,
and starch. The starch is often potatoes or rice,
and bread also accompanies the meal. Dessert
(often called pudding) follows the main course.
In the late afternoon in Britain and Ireland,
most people take a break and have a pot of tea
and a light snack. In some areas a high tea is
served. This can be a substantial meal that includes
potted meat, fish, shrimp, ham salad, salmon
K Sanchez/Cole Group/Getty Images
cakes, fruits, and a selection of cakes and pas-

tries. High tea is associated with working-class or
rural families who have maintained the custom
of a large lunch, with high tea serving as dinner.
It is thought that the upper British classes add the
term high to tea as a dinner when it is served
occasionally in place of dinner as a novelty or to
children as an informal substitute for dinner. appreciated, while in Ireland a bottle of wine to
Whether snack or meal, the British often just call serve with the meal is also common. In France a
it tea. dessert-style wine or after-dinner liqueur is the
best beverage to give.
France. The French eat only three meals a day In the small town of
breakfast, lunch, and dinner. Second helpings are Special Occasions. Christmas and Easter are the Palmiers, the city council
uncommon, and there is very little snacking most important Christian holidays celebrated in has banned any ready-
between meals. Breakfast, in contrast to the made or mass-produced
England, Ireland, and France. Ireland and France
British meal, is very light, consisting of a croissant food (e.g., frozen pizza)
are predominantly Catholic countries and tend to
from the local school cafe-
or French bread with butter and jam, and strong observe all the holy days of obligation and patron teria to ensure our kids stay
coffee with hot milk or hot chocolate. The French saints days. France commemorates the beginning healthy, teach them the
breakfast is what is known in the United States as of the French Revolution on July 14, Bastille Day. taste of proper French food,
a continental breakfast. Lunch is traditionally and help keep our small
the largest meal of the day and, in some regions Great Britain and Ireland. The British celebrate farmers in business. 25
of France, businesses close at midday for two Christmas by serving hot punch or mulled wine;
hours so people can return home to eat. The meal roast beef, goose, turkey, or ham; plum pudding
usually starts with an appetizer (hors doeuvre) and mincemeat (or just mince) pies; and, after-
such as pt. The main course is a meat, fish, or ward, port with nuts and dried fruit. The plum In Britain a piece of
egg dish accompanied by a vegetable and bread. pudding is traditionally splashed with brandy and mincemeat pie is eaten at
If salad is eaten, it is served after the main course. then flamed before being served. Mincemeat pies midnight on New Years Eve
were originally prepared with seasoned, ground while making a wish for the
Dessert at home is usually cheese and fruit. In a
meats, suet, and fruit, but today they are usually upcoming year.
restaurant, ice cream (more like a fruit sherbet or
sorbet), cakes, custards, and pastries are served made with only dried and candied fruit, nuts, and
in addition to fruit and cheese. Wine is served spices. Boxing Day, the day after Christmas, is
with the meal and coffee after the meal. Dinner is when friends and relatives visit one another.
similar, but traditionally a lighter meal with a Foods served at Easter include hot cross buns
starter course of soup or appetizer, then a main and Shrewsbury simnel. In ancient times the
dish, followed by a cheese course. However, meal cross on the buns is believed to have symbolized
patterns are changing in France. The popularity both sun and fire; the four quarters represented
of fast foods and shorter lunch periods is result- the seasons. Today the cross represents Christ
ing in a more American pattern of smaller lunch and the resurrection. Shrewsbury simnel is a rich
followed by larger dinner. spice cake topped with twelve decorative balls of
marzipan originally representing the astrological
Etiquette. The fork is not passed from the right signs (It is also served on Mothers Day). Another
hand to the left hand when cutting food in holiday celebrated throughout Great Britain is
England and Ireland. Instead the fork remains in New Years Day on January 1.
the left hand, and the knife in the right. The two The Scottish traditionally eat haggis on New Robert Burns once wrote
are often used together to scoop food onto the Years Eve. It is a sheeps stomach stuffed with a that haggis was the great
fork. All dishes are passed to the left. When not pudding made of sheeps innards and oatmeal. chieftain o the puddin
eating, the hands should be placed in ones lap. In After it is served, adult diners drench their por- race. Nevertheless, Scottish
Ireland a small plate to the left of the setting is tions with Scotch whisky before eating. It is also government officials
used for placing potato peelings.18 the traditional entre (served with neeps,
recommended in 2006 that
France is similar to Great Britain in the use of haggis be served to children
mashed turnips, and tatties, mashed potatoes) no more than once a week
the fork and knife. For example, lettuce in a salad on Burns Night, commemorating the national
should not be cut, but folded into a small, easy-to- due to its high fat and
poet Robert Burns (January 25). St. Patricks Day sodium content.
eat packet. The French also pass dishes to the left. began as a religious commemoration for the
They do not usually use bread plates but place patron saint of Ireland. The Irish-American
their portion directly on the table. In contrast to custom of eating a corned beef and cabbage meal
England and Ireland, it is considered impolite to on March 17 is now as popular in Ireland as it is
put your hands on your lap. The wrists should be in America.
rested on the table with the hands in view.
Chocolates are appropriate gifts to bring to a France. In France the main Christmas meal is
dinner. In England a bottle of champagne is served after mass on the night of December 24.
soda. Nausea is abated with an infusion of flies or

chicken gizzards, sassafras tea is used to cleanse
the blood, and garlic is ingested for worms.
CONTEMPORARY FOOD HABITS

IN THE UNITED STATES
Adaptations of Food Habits
Robert Brenner/PhotoEdit, Inc.
Ingredients and Common Foods

British and Irish. Many American dishes have
their origins in Great Britain. The Puritans,
adapting Native American fare, made a pudding
with cornmeal, milk, molasses, and spices. Today
this is called Indian pudding. Pumpkin pie is
St. Patricks Day in just a custard pie to which the Native American
Savannah. squash, pumpkin, is added. Apple pie has been so
Two traditional dishes are a boudin noir and boudin well accepted we say, American as apple pie,
blanc, also known as black pudding and white despite its English heritage. Syllabub, a milk and
pudding (dark blood sausage or a light-colored one wine punch drunk in the American South at
made from veal, chicken, or pork with milk) and Christmastime, is also an English recipe.
a goose or turkey with chestnuts. In Provence the
French. French cooking has had less influence
Christmas Eve meal is meatless, usually cod, but the
on everyday American cooking (except for french
highlight is that it is followed by thirteen desserts.
fries), but there are probably few cities that dont
The members of the French On Shrove Tuesday (Mardi Gras) the French
have a French restaurant (which may or may not
Foreign Legion are feast on pancakes, fritters, waffles, and various
nicknamed boudin, be owned by a French immigrant).
biscuits and cakes. During Lent, no eggs, fat, or
because the red blanket roll French Americans adapted their cuisine to the
meat is eaten. Dishes served during Lent often
they wear across their available ingredients and other ethnic cooking
contain cod or herring. Cod is also the traditional
chests resembles a black styles. The best example of this is found in
dish served on Good Friday; in some regions,
pudding. Louisiana, where Creole and Cajun cooking devel-
lentils are eaten to wash away ones sins. Easter
oped. Creole cooking is to Cajun cooking what
marks the return of the normal diet, and eggs are
French grande cuisine is to provincial cooking.
often served hard-boiled (also colored), in
Some dishes may sound typically French, such
omelets, or in breads and pastries. French toast
as the fish stew bouillabaisse, but it is made
(crotes dore) is a traditional Easter dish. Also
with fish from the Gulf of Mexico, not from the
common are pies filled with minced meats.
Mediterranean. Even the coffee is slightly differ-
Therapeutic Uses of Food. Most northern ent, flavored with the bitter chicory root.
Europeans share a belief that a good diet is Ingredients for Cajun cooking reflect the envi-
essential to maintaining health. Traditional home ronment of Louisiana: Bayou Cajun foods are
remedies for minor illnesses include chicken soup, from lake and swamp areas, while prairie Cajun
tea with honey or lemon or whiskey, hot milk, or dishes are found in inland areas. Fish and shellfish
hot whiskey with cloves. Practices less common abound, notably crawfish, crabs, oysters, pom-
today are taking sulfur with molasses as a laxative pano, redfish, and shrimp, to name just a few.
Gumbo is the African Bantu and regular use of cod liver oil. Some Irish Shellfish is commonly eaten raw on the half shell
word for okra. Americans may use senna (Cassia actifolia) (oysters) or boiled in a spicy mixture. Gumbo and
weekly to cleanse their bowels.60 jambalaya are often made with seafood. Gumbo is
The name for the popular
Cajun music style, zydeco, is
Home remedies popular with Americans of a thick, spicy soup made with a variety of seafood,
derived from the French French descent include infusions made from meat, and vegetables. It is thickened with either
term for green bean, haricot magnolia leaves, elderberry flowers, sassafras, or okra or fil powder and then ladled over rice.
(pronounced ar-ee-ko) citronella, which are prescribed for colds. Sore Jambalaya, also a highly seasoned stew made with
because it is snappy, like throats are treated by gargling herbal teas or hot a combination of seafood, meats, and vegetables,
a bean. water with dissolved honey, salt, and baking was brought to New Orleans by the Spanish.
Originally made only with ham (jambon), it was

later modified. The base for these stews and
gravies is roux; however, the Cajun roux is unique
in that the flour and fat (usually vegetable oil) are
cooked very slowly until the mixture turns brown
and has a nutlike aroma and taste.
Other key ingredients in Cajun cooking are
rice (which has been grown in Louisiana since
Courtesy of the Louisiana Office of Tourism

the early 1700s), red beans, tomatoes, chayote
squash, eggplant, spicy hot sauce, and a variety of
pork products. One of the better known hot
sauces, Tabasco, is produced in the bayous of
southern Louisiana from fermented chile pep-
pers, vinegar, and spices. A deep-fried rice fritter,
calas, is the Louisiana version of a doughnut.
Other rice dishes are red beans and rice and dirty
rice. Dirty rice derives its name from the fact that La boucherie: French-speaking
its ingredients, bits of chicken gizzards and liver, Cajuns in Louisiana maintain
kettle, covered with pie crust. It is slowly cooked
give the rice a brown appearance. Cajun boudin the hog-butchering traditions
after chicken stock has been added through vents
sausages are a specialty. Boudin blanc is made of their past. Before the days
in the crust. of refrigeration, everyone in
with pork and rice; boudin rouge has pork blood
Maple syrup is commonly used. One unique the community helped
added to it. Cochon de lait, a suckling pig roasted
breakfast dish is eggs poached in the syrup. prepare the meat and lard.
over a wood fire, is prepared at Cajun festivals in
Maple syrup is also served over bread dumplings Participants went home with
central Louisiana. Fricot is a popular soup made
or just plain bread. Franco-Americans appreciate fresh pork cuts and spicy
with potatoes and sausage or shredded meat.
wine and distilled spirits. One unusual combina- sausages called boudin. La
Cracklings, known as gratons, are fried, bite-size boucherie continues today at
tion of both is caribou, a mixture of white
bits of pork skin (often with meat attached) pop- many Cajun festivals.
whiskey (a distilled, colorless liquor) and red
ular in some regions.
wine, which is drunk on festive occasions. (See
Pecan pralines are a famous New Orleans
also Chapter 15.)
candy. Pecans are native to Louisiana; pralines are Crawfish are also known as
large, flat patties made from brown sugar, water or Meal Composition and Cycle crayfish (especially in New
cream, and butter. Another confection eaten often British and Irish. American food habits have Orleans), crawdads,
with coffee is beignets, round or square puffed been greatly influenced by British and Irish immi- crawdaddy crab (in the
French doughnuts dusted with powdered sugar. grants. Meal patterns and composition are very Great Lakes area), clawfish,
and mudbugs, among
French toast, or pain perdu, is another French spe- similar to those in Great Britain. The typical meal
others. They are small
cialty that was transported to New Orleans and is of a meat, poultry, or fish main dish served with crustaceans that look like
now familiar to most Americans. vegetable and starch side dishes, and often bread, miniature lobsters, found
The cuisine of French Americans in New continues to this day. Though English Americans in the fresh waters of
England tends to be traditionally French, but it is also consumed a hearty breakfast that often Louisiana, Lake Michigan,
influenced by common New England foods and included ham or bacon and eggs, in more recent California, and the Pacific
food habits. Franco-Americans use more herbs years, time constraints and health concerns have Northwest.
and spices than other New Englanders and take changed this pattern on weekdays; weekend
time to prepare the best-tasting food. Traditional breakfast sometimes reverts to the more British-
French dishes are pork pt, called creton by the style meal.
Franco-Americans, and the traditional Yule log Festive meals also reflect the British and Irish Cornish pasties are still
cake (bche de Nol) served at Christmas. Franco- influence. A traditional Christmas dinner includes popular in parts of the
American cuisine offers numerous soups and stews. roast turkey or ham, stuffing, and mashed veg- country where immigrants
One of the most elaborate of the stews, which is etables. For dessert a pie is customary, often from Cornwall came to work
also called a pie, is cipate, known as cipaille, si-pallie, mincemeat. Two holidays Americans think of as in the mines, such as the
Upper Peninsula in Michigan,
six-pates, and sea pie in some areas. A typical being typically American, Thanksgiving and
where May 24 was declared
recipe calls for chicken, pork, veal, and beef, plus Halloween, are actually of British and Irish
Pasty Day in 1968.
four or five kinds of vegetables layered in a heavy origin. Thanksgiving combined the tradition of
an old British harvest festival with the Pilgrims Cajuns sponsor many local festivals, such as the
celebration of surviving in their new environ- crawfish, rice, and yam festivals.
ment. In Great Britain and Ireland, Halloween, or Franco-Americans, like their French ances-
All Hallows Eve, is believed to have originated in tors, serve meat pies on religious holidays. The
ancient times. Ghosts and witches were thought special pie for Easter has sliced hard-boiled eggs
likely to wander abroad on Halloween night. laid down on the bottom crust and then a layer of
cooked meat topped with well-seasoned pork and
French. Americans of French descent have
beef meatballs. For Christmas, tourtire, a pie
adopted the American meal cycle with the main
made with simmered seasoned pork, is eaten
meal in the evening. In Louisiana the best-known
cold after midnight Mass.
celebration is Mardi Gras, culminating on Shrove
Tuesday, just before the beginning of Lent. In
A study in France found that New Orleans there are parades, masquerading, Nutritional Status
consumption of mineral and general revelry; the festival reaches its climax The influence of the British and French on
water provided up to
at a grand ball before midnight. After this day American cuisine is undoubtedly one reason the
25 percent of total daily
and night of rich eating and grand merriment, U.S. diet is high in cholesterol and fat, and low in
intake of calcium and
6 to 7 percent of magnesium the forty days of fasting and penitence of Lent fiber and complex carbohydrates. Current research
in participants.19 begin. In the Cajun countryside, Mardi Gras is in Europe suggests continuing similarities. A
celebrated with run: Men on horseback ride recent survey of dietary habits found that con-
Vitamin D status in Irish from farmhouse to farmhouse collecting chick- sumption of potatoes, animal protein, processed
women was found to be ens and sausages to add to a community gumbo. foods, margarine and butter, and sweets is rela-
suboptimal, especially in Participants enjoy beer, boudin, and faire le tively high in the United Kingdom.53 In France,
winter months, in a 2006 maque (make like a monkey, or clowning consumption of added animal fats and oils is
study.27 around) at each stop. During the rest of the year, high.35 Estimated prevalence of overweight and
CULTURAL CONTROVERSYThe French Paradox
R esearchers have been puzzling

over what they call the French
paradox: Why is it that French
men have the lowest death rates from
cardiovascular disease (CVD) of all indus-
antioxidant resveratrol. It is believed these
agents prevent platelet aggregation and cell
proliferation, as well as elevate high-density
lipoproteins in the blood.9, 10, 46 Other
researchers have suggested that the betaine
of the French, their moderate portion sizes,
and their infrequent snacking.
Other researchers are less enthralled with
the virtues of the French diet and lifestyle.
Two British researchers have suggested that
trialized nations despite high intake of in inexpensive wines (from the addition of prior to the 1980s, the French actually had a
dietary fats and cholesterol and high beet sugar to increase alcohol content) significantly lower intake of fat and choles-
rates of smoking, hypertension, and could be significant because it may lower terol than did the people of Great Britain.
diabetes? Although mortality rates over- plasma homocysteine levels, an independ- What seems like a paradox is actually a time
all in France are only 8 percent lower than ent risk factor in arteriosclerosis.38 Folate lag, and they predict CVD mortality rates
those in the United States and 6 percent from a high consumption of fruits and will increase in France when the long-term
less than those in Great Britain, CVD vegetables may work similarly in reducing effects of adverse dietary changes begin to
deaths are 36 percent and 39 percent homocysteine levels.41 One study found that take their toll.33 Analysis of CVD trends sug-
fewer than in the United States and Great although 84 percent of respondents con- gests this may be the case.2, 5 A French scien-
Britain, respectively. sumed more than 30 percent of their calories tist has proposed that the failure to report all
Numerous hypotheses have been postu- each day from fat and 96 percent consumed CVD deaths and high rates of alcohol-related
lated. Most often mentioned is the relation- more than 10 percent of their calories daily deaths among young French men accounts
ship between drinking wine with meals, from saturated fats, the French sample rated partially for the paradox.11 Further study of
particularly red wine, which is high in car- very high in overall diversity of their diet.12 the French diet and improved statistical
dioprotective ingredients such as the Other factors may be the high activity levels analysis may finally solve the riddle.
obesity (body mass index [BMI] >25) is over 60 in these populations, and may not show overt
percent for women and nearly 70 percent for men clinical symptoms until middle or late adulthood.)
in England; over 50 percent for women and over 60 A study on the causes of inherited chylomicrone-
percent for men in Ireland; and over 35 percent for mia indicates that the frequency of lipoprotein
women and nearly 50 percent for men in France.30 lipase deficiency is very high among French
Although few studies have been conducted on the Canadians.37 Franco-Americans may also have
nutritional status of Americans of French, Irish, high rates of this genetic defect, leading to elevated
and British descent, it is assumed that they have the triglycerides and the necessity of a very low-fat diet.
same nutritional advantages and disadvantages as
the general American population. Counseling. Studies of people in France suggest Historically, Mac before a
that the French are likely to undertake many activ- family name meant son of,
Nutritional Intake. Very little has been reported ities at once, change plans frequently, ignore whereas O signified
on the diets of northern Europeans living in the schedules, and communicate indirectly with enthu- descended from.
United States. A study to determine differences in siastic body language.21 Direct, intense eye contact
mortality from coronary heart disease examined
Irish brothersone group in Ireland, one group
living in the United States (Boston)and a third
control group of first-generation Irish Americans
NEW AMERICAN PERSPECTIVESIrish
in Boston.32 Although there was no significantly
different relative risk for death from heart disease
JOHN CASEY, Retired
among the three groups, it was found that their
diets varied significantly. The Boston brothers came to the U.S. in 1956 from Ireland when I was twenty-six years old.
and the first-generation Irish Americans had a
higher intake (as a percentage of caloric intake)
of animal protein, total fat (more vegetable and
I I first lived in New York City where plenty of other Irish live. When I left
Ireland, it wasnt as well-off as it is now, and food was not plentiful, and
it was mostly grown locally. You raised pigs and killed two a year, and that
less animal), sugar, fiber, and cholesterol, and a provided the bacon for the rest of a year. The foods we ate every day were
lower intake of starch. The Irish brothers had a bread, butter, milk, and eggs. My dad owned a food shop, so we had a bit
higher caloric intake than the Boston brothers more of other foods. When I came to America, I was overwhelmed by the
and the first-generation Irish Americans, yet amount of food available and all the different types. I had never had juice
their relative weight was significantly lower. with breakfast, didnt know what a grapefruit wasthought it was a
It is commonly assumed that a high rate of very big lemon. Other foods that I tried for the first time were water-
alcoholism prevails among Irish Americans; how- melon, turkey, hamburgers, corn on the cob, and french fries. I like all of
ever, little has been reported confirming or refut- them except the watermelon.
ing this belief. One comparative study found that In Ireland the main meal of the day was lunch, and what we usually
Irish-American men had higher rates of excessive had was all boiled together, like a New England boiled dinner but without
drinking, and more physical, psychological, as much meat and usually no meat. On sick days we got toast and tea. But
sexual, and/or occupational problems with alco- the bread was only toasted on one side. When I first got toast here, it was
hol misuse than did Puerto Rican men.31 toasted on both sides, and I wasnt sure if you buttered both sides as well.
It should be noted that prevalence rates for The three biggest holidays in Ireland are Christmas, Easter, and St. Patricks
celiac disease, which requires a gluten-free diet, Day. Christmas was the biggest feast daybacon, eggs, and sausage for
are high for persons of northern European her- breakfast and for the main meal we had goose with dressing and mashed
itage, particularly in the English (1.2 percent) potatoes, plus custard for dessert. For Easter we often had mutton, and
and Irish (0.82 percent).57 Prevalence for heredi- the childrenif it was affordablegot chocolate Easter eggs, just like
tary hemochromatosis, which may be treated here. St. Patricks Day wasnt as much fun because it fell during Lent, and
with a low-iron diet (and avoidance of alcohol and the pubs were closed.
foods or supplements high in vitamin C), are also I eat a lot of different foods now, more than I did when I was younger,
high (estimated to be 0.54 percent in whites).43 and I like Chinese and German food, but I miss Irish bacon. My grandchil-
Though it is hypothesized that the gene for the dren are still trying to get me to order different flavors of ice cream, but I
disease is Celtic in origin,50 a study of French will only eat vanilla. When I first came to America, Ireland didnt have
Canadians also noted a high prevalence rate.20 (It enough food, and Americans ate too much. Today, both the Irish and
should be noted that both celiac disease and Americans eat too much.
hereditary hemochromatosis are often undetected
Some Cajuns think that is important. Among the English and Irish, less by the Alps, which form its northern border.
being thin means a person eye contact between strangers or acquaintances Spain, located to the west of France (the Pyrenees
is puny or unattractive.34 is common. The English are low context in their Mountains form a natural border between the
communication style, yet prefer understatement two countries), occupies the majority of the Iberian
Cajuns may believe that Peninsula. Portugal sits on the western end of the
and somewhat indirect discussion compared to
milk and fish should not be
Americans. The Irish are high context, direct, and peninsula and includes the Azore and Madeira
consumed at the same meal.
often effusive. The French are very low context Islands located in the Atlantic Ocean (the Cape
and can be exceptionally direct.18 Most northern Verde Islands were formerly a Portuguese territory,
Europeans use a quick, light handshake when but they gained independence in 1975). Most of
The market for processed greeting one another. It is important to note, how- southern Europe enjoys a warm Mediterranean cli-
spaghetti sauce in the ever, that most Americans of British, Irish, or mate except in the cooler mountainous regions.
United States is more than French descent are completely acculturated. Immigration to the United States from south-
$500 million annually. Americans of British and Irish descent are ern Europe has been considerable, primarily
often stoic in the face of illness and reserved in the from the poorer regions of southern Italy. Many
Southern Italian immigrants communication of their symptoms. Some Irish Americans, even those of non-European descent,
were often considered believe that the best way to stay healthy is to avoid enjoy Italian cuisine in some form. The foods of
genetically inferior to doctors unless very ill. The British, Irish, and Spain and Portugal are similar to those of Italy
Americans. Many became French all tend to be more formal than Americans and France due to the shared climate and history
the victims of violence. In and politeness is expected. Socioeconomic status of Greek and Roman influence in the region,
1890 eleven Italians were and religious practice are likely to have greater but their preparations differ. The following sec-
lynched in New Orleans impact on foods and food habits than country of tion reviews the traditional diets of Italy, Spain,
after the chief of police was origin. The in-depth personal interview should and Portugal. The influence of these cuisines on
assassinated by alleged reveal any notable ethnically based preferences. American fare is also discussed.
Mafia members.47
CULTURAL PERSPECTIVE
Southern Europeans History of Southern Europeans
Traditional foods of southern in the United States
Europe. Some typical foods Southern European countries lie along the
Immigration Patterns. The majority of immi-
include almonds, artichokes, Mediterranean Sea and include Italy, southern
grants from southern Europe were Italians, who
basil, cheese, eggplant, France, Spain, and Portugal. Italy, shaped like a
swelled the population of U.S. cities on the east-
garlic, chickpeas, olive oil, boot, sticks out into the Mediterranean and
olives, onions, pasta, ern seaboard during the late nineteenth and early
includes the island of Sicily, which lies off the
prosciutto, salt cod, sweet twentieth centuries. Next in number were the
boot toe. Italy is separated from the rest of Europe
bread, and tomatoes. Portuguese, primarily from the Azore Islands.
Smaller numbers of Spanish immigrants have
been reported.
Italians. According to immigration records,

more than 5 million Italians have settled in the
United States. The majority came from the poorer
southern Italian provinces and from Sicily between
1880 and 1920. Although earlier immigrants from
northern Italy settled on the West Coast of the
United States during the gold rush, most of these
later immigrants settled in the large industrial
cities on the East Coast. Many Italians who arrived
faced discrimination and hostility, and, in response,
formed concentrated communities within urban
centers, often called Little Italies.47 Several

cities still boast Italian neighborhoods such as
the North End in Boston and North Beach in
San Francisco.
Many Italians came to America for economic Verde Islands, and they often located in the whal- Among the Basques, it is
reasons; more than one-half of the immigrants, ing ports of New England and Hawaii. They were said that the Devil once
mostly men, returned to their homeland after accu- followed in the 1870s by immigrants hoping to came to the region to learn
mulating sufficient money. Peasants in their native escape poverty. They arrived with little education their language, Euskera, so
that he could entrap the
land, Italians in the United States often became and few skills, but were willing to do farm labor
inhabitants. He gave up
laborers in skilled or semiskilled professions, espe- in California and Hawaii, and work in the service
after seven years when he
cially the building trades and the clothing industry. trades of northeastern cities. was only able to master
Immigration from Italy fell sharply after World After World War II, a small number of two words: bai and ez (yes
War I; however, more than 500,000 Italians have Portuguese from Macao, a Portuguese settlement and no).
immigrated since World War II. on the coast of China near Hong Kong, settled in
California. They were well educated and many
Spaniards. More than one-quarter of a million
held professional jobs. A much more significant
people from Spain have immigrated to the United
number of Portuguese, more than 150,000, entered
States since 1820. However, the majority of the
the United States after 1958, again mostly from
Spanish-speaking population in the United States
the Azore Islands, following a series of volcanic
comes from the American acquisition of Spanish
eruptions that devastated the region. It has been
territories and the immigration of people from
estimated that the Portuguese currently have
Latin American countries (see Chapters 9 and 10
one of the higher rates of new arrivals among
for more detail).
European groups.
The earliest Spanish settlers arrived during
colonial times, establishing populations in what is Current Demographics and Socioeconomic
now Florida, New Mexico, California, Arizona, Status
Texas, and Louisiana. A majority were from the Italians. Today there are approximately 17 million
poorest regions of southern Spain and the Canary Americans of Italian descent,4 most of whom live
Islands.8 Half of all other Spanish immigrants to in or around major cities. Economic conditions
the United States came later in the nineteenth and improved during the 1980s in Italy, and immi-
early twentieth centuries, due to depressed eco- gration from the nation slowed significantly.
nomic conditions in Spain. In 1939, after the fall However, there are still nearly 500,000 immigrants
of the second Spanish republic, a small number of born in Italy who make their homes in the United
refugees immigrated for political reasons. States today.
Additional Spanish immigrants were from the Economically, Italian Americans shared in the
Basque region, located in northeastern Spain on general prosperity after World War II, and today
the border with France (there are also French most are employed in white-collar jobs or as skilled
Basques). The Basques are thought to be one of the laborers. Four generations of Italians living in the
oldest surviving ethnic groups in Europe; they lived United States have been identified. The elderly
in their homeland before the invasion of the Indo- living in urban Italian neighborhoods are one
Europeans around 2000 B.C.E. Their language, group, those who are middle age and living in
Euskera, is not known to be related to any other either urban or suburban settings are the second
living language. Though the earliest Basque immi- group, the well-educated younger Italian Americans
grants to America were fishermen and whalers of subsequent generations living in mostly subur-
who probably arrived before Columbus, most came ban areas are the third, and the very recent immi-
in the mid-nineteenth century, arriving first in grants from Italy are the fourth.23 These groupings
California for the Gold Rush, then spreading north can be expected to change as each grouping ages,
and east throughout the West. Many emigrated and with increased assimilation: only 20 percent of
from South America, where they had first settled, Italian Americans born after 1940 married other
and were listed as Chileans (the umbrella term Italian Americans.
used for all South Americans at the time). An accu-
Spaniards. People who report Spanish, Spaniard,
rate estimate of their numbers is impossible.52
or Spanish-American heritage were over 1.1 million
Portuguese. Beginning in the early nineteenth in the 2005 U.S. Census estimates and are now
century, two waves of Portuguese immigrants grouped with Hispanics in the U.S. Census. Seven
arrived in the United States. Early immigrants percent were born in Spain. Most are well-integrated
were primarily from the Azore Islands and Cape into their communities, although larger populations
are found in New York and Tampa, Florida. A dis- Spaniards. Most Spaniards are Roman Catholic.
tinctive group of Isleos, descendants of Canary The Jesuit Order was founded in Basque country
Island immigrants, is found in southern Louisiana. and has significantly influenced Basque devo-
The Basques settled mostly in the rural regions of tion. Basque Americans are involved in their
California, Nevada, Idaho, Montana, Wyoming, parishes, and there is the expectation that reli-
Colorado, New Mexico, and Arizona and became gion is part of daily life and sacrifice.
ranchers. Some Basque immigrants, however,
were drawn to the mining jobs of West Virginia Portuguese. The Roman Catholic Church also
and the rubber and steel plants of Ohio, Illinois, helped the Portuguese ease into the mainstream
Michigan, and Pennsylvania. Though the 2005 of American life. Local churches and special
census estimates report 59,000 Basque Americans, parishes often sponsor traditional religious festas
it is thought that this number may underrepre- that include Portuguese foods, dances, and color-
sent the total population, which may be as high as ful costumes.
100,000.52 Today most Basque descendants are Family
involved in some aspect of animal husbandry or Italians. The social structure of rural villages in
small business; few have entered other professions. southern Italy was based on the family, whose
Newer Basque communities now exist in Con- interests and needs molded each individuals atti-
necticut and Florida because jai alai (a Basque tudes toward the state, church, and school. The
sport) facilities were established there. family was self-reliant and distrusted outsiders.
There are over 1.2 million Portuguese. As of 2005 over 1.3 million Americans Each member was expected to uphold the family
Canadians of Italian were of Portuguese descent. In 2000, 50,000 claimed honor and fulfill familial responsibilities. The
ancestry according to the Cape Verdean ancestry, and 4,000 reported Azore father was head of the household; he maintained
2001 census figures. Islands heritage. (Immigrants from the Cape his authority with strict discipline. The mother,
Verde and Azore islands and those from Madeira although subordinate, controlled the day-to-day
Boise, Idaho is considered activities in the home and was often responsible
may not feel Portuguese. Instead they identify
the Basque capital of the for the family budget. Once in America, the chil-
with their island or city of origin.) Initially the
United States.
Portuguese Americans on the West Coast were dren broke free of parental control due to economic
farmers and ranchers, but eventually their necessity. Although sons had always been allowed
descendants moved into professional, technical, some independence, daughters soon gained their
and administrative positions.40 On the East Coast freedom as well because they were expected to
the descendants of the Portuguese who settled in work outside the home like their brothers.
the whaling ports now make up a significant part Education eventually also changed the family.
of the fishing industry, though only 3 percent of Early immigrants repeatedly denied their chil-
all Portuguese Americans work in this occupa- dren schooling, sending them to work instead.
tion. The percentage of Portuguese families living However, by 1920, education was considered an
in poverty is half that of the U.S. average. important stepping stone for Italian Americans.
Spaniards. In the traditional Spanish family, the

Worldview father spent much of his time working and social-
Religion izing outside the home, while the mother devoted
Italians. In Italy the Roman Catholic Church was her life to her children. Typically, one daughter
a part of everyday life. Immigrants to America, would choose not to marry and would care for her
however, found the church to be more remote parents as they aged. In the United States, Spanish-
and puritanical, as well as staffed by the Irish. American families are usually limited to imme-
The church responded by establishing national diate members, although the obligation to parents
parishes (parishes geared toward one ethnic remains stronger than for most Americans. An
group with a priest from that group), that helped elder may live part of the year with one child, then
immigrants adjust to America. Some religious part of the year with another child. Independent
festivals, part of daily spiritual life in Italy, were living and retirement homes are also common. The
transferred to America and are still celebrated Basque family was customarily an extended one.
today, such as the Feast of San Gennaro in New Basques in Spain are prohibited from marrying
Yorks Little Italy. non-Basques, but in the United States many
Basques marry other nationalities. Basques accept are reputed to cause deformities and, if a woman A tortilla in Spain is an egg
all members who marry into their family. does not eat a food she smells, she may suffer a omelet, not the cornmeal
Spanish women hold unique status among miscarriage. Little has been reported regarding flatbread eaten by the
southern Europeans. Class distinctions are more Spanish and Portuguese health practices. Mexicans. It is believed
that the Spanish called
important than gender when it comes to educa-
the Mexican bread by
tional and professional attainment. The Basque
women are historically recognized for their equal-
TRADITIONAL FOOD HABITS that name because of its
similar shape.
ity. Since ancient times their duties have been as Although the foods of the southern European
valued as those of men, and jobs are often not countries are similar, as detailed in the Cultural
gender-specific. Food Groups list (Table 6.2), there are notable dif-
ferences in preparation and presentation. Many
Portuguese. Like the Italians, the Portuguese have
Americans think of Italian cooking as consisting
close family solidarity and have had some success
of pizza and spaghetti. In reality, these dishes are
in maintaining the traditional family structure.
only a small part of the regional cuisine of south-
Grown sons and daughters often live close to
ern Italy, the original homeland of most Italian
their parents, and family members try to care for
Americans. Spanish food is mistakenly equated
the sick at home. Family structure is threatened,
with the hot and spicy cuisine of Mexico. Although
however, when women must work or generational
Mexico was a colony of Spain, the foods and food
values change. Men tend to dominate the family
habits of the two countries differ substantially.
and, as a result, some Portuguese-American women
Portugal and Spain have very similar cuisines, but
marry outside the group.
most of the Portuguese immigrants to the United
Traditional Health Beliefs and Practices. States are from the Azore Islands and the island of
Traditional Italian health beliefs include concepts Madeira. Their diet was less varied than that of
common in the American majority culture as the mainland Portuguese.
well as concerns associated with folk medicine.
Fresh air is believed necessary to health, and Ingredients and Common Foods
some older Italian Americans maintain that the Foreign Influence. The Phoenicians and Greeks, Olive oil is labeled according
heavy air of the United States is considered who settled along the Mediterranean coast in to method of processing
unhealthy compared to the light air of Italy. ancient times, are believed to have brought the and the percent of acidity,
Well-being is defined as the ability to pursue olive tree and chickpeas (garbanzo beans) to the from extra virgin to
normal, daily activities. There is the expectation region. In addition, fish stew, known as bouilla- virgin (or pure) olive oil.
In the United States only
that health declines with age. baisse in France and zuppa di pesce alla marinara
the oils derived from the
Some Italian Americans believe that illness is in Italy, may be of Greek origin. The Muslims first press of the olives can
due to contamination (through an unclean or brought eggplants, lemons, oranges, sugar cane, be called virgin; a blend of
sick person) or heredity (blood). Older immi- rice, and a variety of sweetmeats and spices. refined and virgin olive oils
grants may also think that sickness occurs Marzipan, a sweetened almond paste used exten- developed to reduce acidity
because of drafts (surgery may be avoided so that sively in Italian desserts, and rice flavored with must be labeled pure.
organs will not be exposed to air), the suppres- saffron, as in the northern Italian dish risotto alla
sion of emotions (i.e., anxiety, fear, grief), or Milanese, are both believed to have Muslim ori-
supernatural causes. Some Italians believe that a gins. In Spain the Muslim influence is also seen
minor illness can be attributed to the evil eye and in saffron-seasoned rice and in the use of ground
that serious conditions result from being cursed nuts in sauces, candies, and other desserts.
by a malicious person or God.28,48,54 Saints may be It was the food of the New World colonies,
implored for protection, good luck charms worn, however, that shaped much of Italian, Spanish,
or, more traditionally, the practices of a maghi and Portuguese cuisine. Chocolate, vanilla, toma-
(witch) used to avoid illness. Although many toes, avocados, chile peppers, pineapple, white
Italians do not profess a belief that God punishes and sweet potatoes, corn, many varieties of
sin with a curse, there is often a fatalistic approach squash, and turkey were brought back from the
to terminal illness as being the result of Gods will. Americas. The tomato is of particular importance
Problems in pregnancy are sometimes thought to to the character of southern European cooking.
be due to diet by Italian Americans, especially Asian ingredients have had a significant impact
those of older generations. Unsatisfied cravings on the fare of Portugal and, to a lesser degree, the
Table 6.2 Cultural Food Groups: Southern European

Protein Foods
Milk/milk products Most adults do not drink milk but Cheese (cow, sheep, buffalo, goat), milk It is assumed that second- and third-
do eat cheese. Dairy products generation southern Europeans drink
are often used in desserts. Many more milk into their adulthood than
adults suffer from lactose their ancestors did.
intolerance.
Meat/poultry/fish/ Dried salt cod is eaten frequently. Meat: beef, goat, lamb, pork, veal (and most More meat and less fish are eaten than in
eggs/legumes Small fish, such as sardines, are variety cuts Europe.
eaten whole, providing Poultry: chicken, duck, goose, pigeon,
substantial dietary calcium. turkey, woodcock
Fish: anchovies, bream, cod, haddock,
halibut, herring, mullet, salmon, sardines,
trout, tuna, turbot, whiting, octopus, squid
Shellfish: barnacles, clams, conch, crab,
lobster, mussels, scallops, shrimp
Eggs: chicken
Legumes: chickpeas, fava and kidney beans,
lentils, lupine seeds, white beans
Cereals/Grains Bread, pasta, or grain products Cornmeal, rice, wheat (bread, farina, a variety
usually accompany the meal. of pastas)
Fruits/Vegetables Fruit is often eaten as dessert. Fruit: apples, apricots, bananas, cherries, First- and second-generation southern
Fresh fruits and vegetables are citron, dates, figs, grapefruit, grapes, Europeans generally eat only fresh
preferred. lemons, medlars, peaches, pears, fruits and vegetables. Fruit and
pineapples, plums (prunes), pomegranates, vegetable consumption tends to reflect
quinces, oranges, raisins, Seville oranges, general American food habits by the
tangerines third generation
Vegetables: arugala, artichokes, asparagus,
broccoli, cabbage, cardoon, cauliflower,
celery, chicory, cucumber, eggplant,
endive, escarole, fennel, green beans, let-
tuce, kale, kohlrabi, mushrooms, mustard
greens, olives, parsnips, peas, peppers
(green and red), pimentos, potatoes,
radicchio, swiss chard, tomatoes, turnips,
zucchini
Additional Foods
Seasonings Dishes using similar ingredients in Basil, bay leaf, black pepper, capers, cayenne
Italy, Spain, and Portugal often pepper, chocolate, chervil, cinnamon,
differentiated by distinctive use cloves, coriander, cumin, dill, fennel, garlic,
of herbs and spices. Seasoning leeks, lemon juice, marjoram, mint,
in Azore Islands and Cape Verde mustard, nutmeg, onion, oregano, parsley
Islands is usually very mild. (Italian and curley leaf), rosemary, saffron,
sage, tarragon, thyme, vinegar
Nuts/seeds Nuts commonly used in desserts Almonds, hazelnuts, pignolis (pine nuts),
and added to some entrees and walnuts, lupine seeds
side dishes.
Beverages Coffee, chocolate, liqueurs, port, Madeira,
sherry, flavored sodas (e.g., orzata), tea,
wine
Fats/oils Olive oil flavors numerous dishes; Butter, lard, olive oil, vegetable oil Use of olive oil has decreased.
used for deep-frying in Spain.
Sweeteners Honey, sugar
dishes of Spain and Italy. From India and the Far Pasta comes in dozens of
East came coconuts, bananas, mangoes, sweet forms in Italy, including thin
oranges, and numerous spices, such as pepper, strings, flat ribbons, tubes,
nutmeg, cinnamon, and cloves. spirals, sheets, and shapes
that resemble wheels,
bowties, little ears, hats, rice,
Staples and other items. It is found
Italy. Although the cooking styles and ingredi- fresh or dried.
ents vary from region to region in Italy, some
general statements can be made about ingredi-
ents. Pasta is the quintessential dish throughout
the nation. It is prepared fresh, from dough made
with the addition of eggs, or dried, from a dough
M Lamotte/Cole Group/Getty Images

made without eggs. It is traditionally served three
ways: with sauce (asciutta), in soup (en brodo), or
baked (al forno). There are literally hundreds of
pasta shapes, such as thin, round strips, includ-
ing spaghetti (from the Italian word for string)
and capelli dangelo (angel hair); flat strips such
as linguini and fettucini (ribbon); tubular
forms, such as macaroni, penne, and the larger
manicotti; and sheets such as lasagna and pap-
pardelle. There are additional forms, such as spi- topped with migas (fried bread crumbs com- The Italians eat more rice
rals (e.g., fusilli, rotelle), shells (conchiglie), bined with garlic, bacon, and ham). Tortilla than any other Europeans.
little ears (orechiette), bowties (farfalle), and Espaola (potato omelet) is perhaps the national Thomas Jefferson supposedly
small barley- or rice-shaped orzo. The most dish, eaten as appetizers, entrees, snacks, and as a smuggled rice out of Italy to
common pasta in Italy is tagliatelle, a medium- filling for bocadillo (sandwiches). Sausages, such the United States, where his
first attempts to cultivate it
width flat noodle.61 as the paprika- and garlic-flavored chorizo and
were unsuccessful.
In the north, fresh pastas are more common, the blood sausage called morilla, are common.
and stuffed versions made with bits of meat, Serrano (meaning from the mountains) ham
cheese, and vegetables, such as ravioli, are espe- is a salty, dry-cured meat served in paper-thin
cially popular. Pasta in the north is also frequently slices that has gained worldwide acclaim. Seafood Cods tongues are
topped with rich cream sauces. In the agriculturally is popular in coastal regions. Meats are often com- a specialty enjoyed by all
poorer south, the pasta is generally dried, and it is bined with vegetables in savory stews. Each southern Europeans. Though
usually served unfilled with a tomato-based sauce. region has its own recipe for paella, which typi- they are an especially
succulent strip of meat from
Other broad differences are that northern fare cally includes saffron-seasoned rice topped with
inside the fishs mouth, they
uses more butter, dairy products, rice, and meat chicken, mussels, shrimp, sausage, tomatoes, and are not actually tongues.
than the south, which is notable for the use of peas. Cocido, a stew of chickpeas, vegetables (e.g.,
olive oil, more fish, and more beans and vegeta- cabbage, carrots, potatoes), and meats (e.g., beef,
bles, such as artichokes, eggplants, bell peppers, chicken, pork, meatballs, sausages), also varies
and tomatoes. Garlic is found throughout the from area to area, but is always served in three
nation, though it is more popular in the north. courses. The strained broth with added noodles
Other seasonings common to all of Italy are parsis eaten first, followed by a plate of the boiled veg-
ley, basil, and oregano. Anise, cinnamon, nutmeg, etables, and concluded with a plate of cooked
mace, and cloves are also used in many dishes. meats. Crusty bread is served with the meal.
Garlic and tomatoes flavor many Spanish The name gazpacho may
Spain. The rugged terrain in Spain is suitable for dishes, for example, gazpacho, a refreshing pureed have come from the
raising small animals and crops, such as grapes vegetable soup that is usually served cold, vinegar-and-water drink
and olives. Spain is the largest producer of olives and zarzuela (meaning operetta), a fresh called posca, reportedly
in the world. Entres usually feature eggs, lamb, seafood stew. Olive oil is also a common ingredient offered to Christ on the Cross.
pork, poultry, or dried and salted fish (especially used in almost all cooking, even deep-frying pas-
cod, called bacalao). Eggs are consumed day and tries, such as the ridged, cylindrical doughnuts
night. They are enjoyed fried in olive oil, often known as churros. Sauces accompany many dishes.
Olives and olive oil are found Portuguese; they are said to have as many recipes
in numerous southern for bacalhau (dried salt cod) as there are days in
European dishes. Spain is the the year.42 Sardines are often grilled or cooked in
primary producer of olives a tomato and vegetable sauce. Lamprey is a pop-
worldwide.
ular food in northern Portugal, where it is often
prepared with curry-like seasonings. Shellfish,
such as clams, are often combined with pork or
other meats in stewed dishes. Chourio, similar to
the Spanish pork sausage, chorizo, and linguia, a
pork and garlic sausage, are often eaten at break-
fast. Other typical dishes are cacoila, a stew made
from pig hearts and liver, then served with beans
or potatoes; isca de figado, beef liver seasoned
with vinegar, pepper, and garlic, then fried in
olive oil or lard; and assada no espeto, meat roasted
on a spit. A common soup is caldo verde, or green
broth, made from kale or cabbage and potatoes.
A unique dry soup of bread moistened with oil or
vinegar and topped with anything from meat,

chicken, or shellfish and vegetables is called aordu.
Fava beans, chickpeas, and lupine seeds (tremo-
cos) are added to some dishes. Rice and fried pota-
toes are so popular they are often served together.
Crusty country breads and, in the north, a corn-
meal bread called broa also accompany the meal.
Portuguese sweet breads, pan doce, and dough-
Linguia comes from the Alioli is made from garlic pulverized with olive
nuts, malassadas, are also specialties. Desserts
Portuguese word meaning oil, salt, and a little lemon juice. It is served with
tongue, a reference to the
often feature fruit, such as bananas, grapes, and
grilled or boiled meats and fish. Another popular
shape of the sausage. figs, as well as eggs and almonds. Puddings, cus-
sauce, called romescu, is sometimes mixed with
tards, and sponge cakes are popular.
alioli to taste by each diner at the table. It com-
Sweets were a traditional
bines pureed almonds, garlic, paprika, and toma-
source of income for Regional Variations
toes with vinegar and olive oil. Fruit, particularly
Portuguese convents, and Italy. Some of the regional specialties in the north-
the names of many pastries oranges, is popular for dessert, sometimes served
ern area of Lombardy, around Milan, are risotto,
reflect this past, including in custard. One favorite is membillo, a quince
a creamy rice dish cooked in butter and chicken
papas-de-anjo (angel puffs) paste served with slices of a salty sheeps milk
stock, flavored with Parmesan cheese and saf-
and gargantas de friera cheese known as Manchego. Spains best-known
fron; polenta, cornmeal mush (thought to have
(nuns waddles).42 dessert is flan, a sweet milk and egg custard
been made originally from semolina wheat),
topped with caramel. Wine usually accompanies
often served with cheese or sauce; and panettone,
the meal. Sangria, made with red or white wine
a type of fruitcake. Veal is very popular, served in
and fresh fruit juices, is served chilled in the
the stew known as osso buco and in veal piccata
summer. Spain is probably most famous in the
(chops that are pounded very thin, then breaded
United States for its Sherries, which are wines
and pan-fried, topped with lemon juice, capers,
fortified with added brandy. Sherries can be dry
and minced parsley). The cheeses of the region
or sweet and are categorized by the length of time
include Gorgonzola, a tangy, blue-veined cheese
they are aged. They are often described as having
made from sheeps milk, and Bel paese, a soft,
a nutty flavor.
mild-flavored cheese. The area is also known for
Portugal. Portuguese fare shares some simi- its apperitifs, such as bittersweet Vermouth.
Italian folklore has it that larities in ingredients with Spanish cuisine, but Venice, located on the east coast and known
basil can only develop its a more generous addition of herbs and spices, for its romantic canals (although the city actually
full flavor if the gardener including cilantro, mint, and cumin, distinguishes consists of 120 mud islands), has a cuisine centered
curses daily at it. the cooking. Fish dominates the diet of the on seafood. Its best-known dish is scampi, made
from large shrimp seasoned with oil, garlic, pars-

ley, and lemon juice. Inland is Verona, famous for
its delicate white wines, such as Soave. Turin, the
capital of the western province of Piedmont, is
known for its grissini, the slender breadsticks
popular throughout Italy, and bagna cauda
(meaning hot bath), a dip for raw vegetables
consisting of anchovies and garlic blended into a
paste with olive oil or butter. A summer favorite
is vitello tonnato, braised veal served cold with a
spicy tuna sauce. Located on the northwest coast
of Italy, Genoa is known for its burrida, a fish stew
containing octopus and squid, and pesto, an herb,
cheese, and nut paste (usually made with basil),
which has become popular in the United States.
Moving westward, the city of Bologna is the
center of a rich gastronomic region known as
Emilia-Romagna. Pasta favorites of the area
include lasagne verdi al forno, spinach-flavored
lasagna noodles baked in a ragu (a meat sauce
typically made with four different meats and red
wine), and a white sauce, flavored with cheese;
and tortellini, egg pasta stuffed with bits of meat,
cheese, and eggs, served in soup or a rich cream
sauce. It is traditionally served on Christmas Eve.
Cole Group/Getty Images

A similar stuffed pasta is cappelleti, named for its
shape, a little hat. Cured meats are a specialty of
the region, including salami and sopresseta (sim-
ilar to salami but rougher textured); mortadella, a
pork sausage (similar to American bologna);
pancetta (a salt-cured bacon); prosciutto, a raw, Fish and shellfish are
smoked ham (served thinly sliced, often as an a favorite in Italy, Spain, and
appetizer with melon or fresh figs); and culatello (colored by bits of spinach) served with butter and Portugal.
(a milder and creamier ham than prosciutto). grated Parmesan cheese, called fettucini Alfredo.
Parmesan cheese, a sharply flavored cows milk The term alla Fiorentina refers to a dish gar-
cheese with a finely grained texture, also comes nished with or containing finely chopped
from the area, as does aceto balsamico di Modena spinach. Whole grilled fish and wild game dishes
(or di Reggio Emilia), a vinegar made from the are popular. Rosemary flavors many dishes of the
white Trebbiano wine grapes. When labeled region. Tuscany is also famous for its full-bodied
tradiziolone, it means the vinegar has been twice red wine, Chianti, and its use of chestnuts, which
fermented and aged in wood casks for at least are featured in a cake eaten at Lent called casta-
twelve years, which intensifies and sweetens the gnaccio alla Fiorentina.
flavor, and thickens it into a syrupy consistency. Rome, the capital of Italy, has its own regional
Those labeled condimento are imitations of vine- cooking and is probably best known for fettucine
gar blends and reduced aging. Alfredo, long, flat egg noodles mixed with butter,
Florence, the capital of Tuscany, has a long cream, and grated cheese. Another dish is saltim-
history of culinary expertise. In 1533 Catherine de bocca (meaning jumps in the mouth)thin
Medici (the Medici family ruled Florence) mar- slices of veal rolled with ham and cooked in
ried into the royal family of France. She is often butter and Marsala wine. Gnocchi, which are
credited with introducing Italian fareat the time dumplings, are eaten throughout Italy, but in
the most sophisticated cuisine in Europeto Rome they are made out of semolina and baked
France. Florence is renowned for its green noodles in the oven. Fried artichokes are popular at Easter
time, as is roast baby lamb or kid. Pecorino found in every region of the nation, they are espe-
romano is the hard sheeps milk cheese of Rome, cially popular in the southern regions.56
similar to Parmesan but with a sharper flavor. Most Spanish dishes prepared in the United
Forks were originally The capital of Campania in southern Italy is States reflect the cooking of Spains southern
two-prongedthe three- Naples, considered the culinary capital of the region, with its seafood, abundant fruits and
pronged fork was created in South. Pasta is the staple food, and a favorite way vegetables, and Muslim influence. Fried fish,
Italy for eating pasta. of serving it is simply with olive oil and garlic, or arroz negro (rice blackened with squid ink), and
mixed with beans, in the soup pasta e fagiole. salmorejo (a fresh tomato soup thickened with
The art of making ice cream
Pizza is native to Naples and is said to date back bread crumbs and garnished with Serrano ham
is credited to the Chinese,
to the sixteenth century, perhaps originating with and hard-boiled egg) are popular dishes. Central
who brought it to India;
from there it spread to the toppings for the savory flatbread known as focca- Spain has a more limited diet; roast suckling pig
Persians and Arabs. The cia. Another form of pizza is calzone, which is and baby roast lamb are favorites. Garlic soup
Muslims brought it to Italy, pizza dough folded over a filling of cheese, ham, starts many meals. In the northwest, fish is
and it was a Sicilian, or salami, then baked or fried. The areas best- common, and often fills empanadas (small pastry
Francisco Procopio, who known cheeses are Mozzarella, an elastic, white turnovers). Octopus flavored with paprika is a
introduced ice cream to cheese originally made from buffalo milk; specialty. In the Basque provinces lamb is the pri-
Paris in the 1660s. The Provolone, a firm smoked cheese; and Ricotta, a mary meat, and charcoal-grilled lamb is a specialty.
British discovered it soon soft, white, unsalted cheese made from sheeps Seafood, such as bacalao al pil-pil (dried salt cod
after and later brought ice milk and often used in desserts. Sicily and other cooked in olive oil and garlic), bacalao a la viz-
cream to America.
regions of southern Italy use kid and lamb as caina (dried salt cod cooked in a sauce of onions,
their principal meats. It is sometimes prepared garlic, pimento, and tomatoes), and angulas (tiny
alla cacciatore (hunters style), with tomatoes, eel spawn cooked with olive oil, garlic, and red
olives, garlic, wine, or vinegar (and sometimes peppers), is a favorite in some Basque areas. Other
anchovies)a method also used with wild boar, popular dishes include garlic soup, babarrun
venison, and chicken. Along the coast, fresh fish, gorida (red beans with chorizo), and pipperrada
such as tuna and sardines, are used extensively; vasca (eggs with peppers). Simple rice puddings
baccala, dried salt cod, is often served on fast or fruit compotes are typical desserts.
days. The North African influence shows up in
Sicily in the use of couscous, called cuscus in Portugal. Though Portuguese cuisine varies
Italy, which is commonly served with fish stews. from north to south, from hearty soups and stews
Southern Italys cuisine is probably best known to a more refined, lighter style of entre, the largest
for its desserts. Many examples can be found in regional differences occur between the main-
Italian-American bakeries and espresso bars: can- land and the islands. The foods of the Madeiras,
noli, crisp, deep-fried tubular pastry shells filled the Azores, and the Cape Verde Islands include
with sweetened ricotta cheese, shaved bittersweet tropical ingredients imported from both Africa
chocolate, and citron; cassata, a cake composed of and the Americas. In Madeira, which attracts
sponge cake layers with a ricotta filling and a many tourists from throughout Europe, avoca-
chocolate- or almond-flavored sugar frosting; dos, cherimoya, guava, mango, and papaya are
gelato, fruit or nut (e.g., black currant or pista- featured in its dishes. Corn is common, as is
chio) ice cream; and granita, intensely flavored couscous. Honey cakes and puddings reflect the
During the nineteenth ices. Spumoni is chocolate and vanilla ice cream influence of other European nations. In the
century, Madeira wine was with a layer of rum-flavored whipped cream con- Azores and Cape Verde Islands, fare varies signif-
sent to other European taining nuts and fruits. Another popular sweet is icantly from island to island and even city to city.
nations in the holds of ships zeppole, a deep-fried doughnut covered with pow- Bananas, corn, cherimoya, passion fruit, pineap-
where it became very hot. dered sugar. The sweet white wine fortified with ples, and yams are prominent. Aorda dazedo is
Instead of ruining the wine,
grape spirits, Marsala, is also a specialty in the one specialtya mixture of cornbread, vinegar,
it aged it more quickly
region. It develops a deep-tawny color when aged. onions, garlic, saffron, and a little lard boiled
Madeira that had circum-
navigated the globe twice together and eaten for breakfast. Beef is the pre-
became popular in England. Spain. The cooking of Spain can be divided ferred meat, and seafood such as cockles, limpets,
Today, it is heated during broadly by preparation methods. In the north, crab, lobster, and octopus is eaten in many
aging to simulate voyage stewing is most common. In the central regions, areas. Little fat or oil is added to dishes; and
conditions. roasting is favored. Though deep-fried foods are spicing is mild, often limited to onion, garlic,
salt, and pepper. Tea is the preferred beverage. Traditional Italian lunches
Portugal is famous for its rich sweet wines: Port are large, often ending with
(from the northern region) and Madeira (from fruit and cheese. On special
the islands), which are fortified with grape spir- occasions, pastries, such as
twice-baked cookies called
its at the start of fermentation. They can be con-
biscotti, or ice cream is
sumed young, or aged for forty or more years,
served with coffee or
becoming drier, more nutty, and smoother in espresso.
flavor. They are popular with dessert or as after-
dinner drinks.
Meal Composition and Cycle
Daily Patterns
Italy. A traditional Italian breakfast tends to be
light, including coffee with milk (caffe latte), tea,
or a chocolate drink, accompanied by bread and
jam. Lunch is the main meal of the day and may be
followed by a nap. It usually starts with an appe-
tizer course of antipasti, such as ham, sausages,
Many businesses close for several hours in the Espresso, which means made
pickled vegetables, and olives; or crostini, crispy
afternoon to accommodate lunch and a nap. Tea expressly for you, is made
slices of bread with various toppings, such as from finely ground dark roast
and pastries (merienda) are eaten between 5:00 and
tomatoes or cheese. Next is minestra (wet course), coffee through which water
6:00 p.m. and more tapas are enjoyed at 8:00 or
usually soup, or asciutta (dry course) of pasta, is forced by steam pressure.
9:00 p.m. Finally supper, including three light
risotto, or gnocchi. The main course is fish, Cappuccino is espresso topped
courses such as soup or omelets and fruit, is
meat, or poultry, roasted, grilled, pan-fried, or with frothy, steamed milk.
stewed. It is served with a starchy or green veg-
etable, followed by a salad. Bread is served with
the meal, often with olive oil and balsamic vine-
gar for dipping. Dessert often consists of fruit and
cheese; pastries or biscotti (crunchy twice-baked
cookie slices) and ice creams are served on spe- SAMPLE MENU
cial occasions. Dinner is served at about 7:30 p.m.
and is a lighter version of lunch. Wine usually
accompanies lunch and dinner. Coffee or espresso An Italian Lunch
is enjoyed after dinner, either at home or in a cof-
feehouse. Marsala may be served with cheese Crostini a, b, c
before the meal for a light appetizer course, or
after dinner. It is also often used in the preparation Spaghetti con Cozze (Spaghetti with Mussels) a, c
of desserts. One such sweet, now prepared all over
Europe, is zabaglione, a wine custard. Chicken Saltimboca b, c
Spain. By American standards, the Spanish Sauteed Spinach

appear to eat all the time. The traditional pattern, Biscotti and Espresso b,c
four meals plus several snacks, is spread across
the day. A light breakfast (desayuno) of coffee
or chocolate, bread, or churros is eaten about
a
8:00 a.m., followed by a midmorning breakfast Hazin, M. 2004. Marcella says. . . New York: HarperCollins Publishers.
around 11:00 a.m. of grilled sausages, fried squid, b
Casella, C. 2005. True Tuscan. New York: HarperCollins Publishers.
bread with tomato, or an omelet. A light snack, c
Italian Cooking & Living at http://www.italiancookingandliving.com/recipes/
tapas, is consumed around 1:00 p.m. as a prelude to
a three-course lunch (comida) at around 2:00 p.m.,
consisting of soup or salad, fish or meat, and
dessert, which is often followed by fruit and cheese.
milk, is followed by lunch in the early afternoon.

This is traditionally the largest meal of the day,
and even in urban areas often includes several
courses. Unlike the Spanish pattern, the evening
SAMPLE MENU meal in Portugal is usually eaten earlier. As in
Spain, red wine usually accompanies the meal.
Etiquette. Italy, Spain, and Portugal share many
Spanish Tapas etiquette rules. The fork remains in the left hand,
and the knife remains in the right hand. The knife
Croquetas a, b can be used to help scoop food onto the fork.
Bread is not served with butter and should be
Spanish Potato Tortilla (omelet) a, b placed on the edge of the main plate, or next to it
Empanadas a, b on the table. Manners regarding the consumption
of pasta include using your fork to twirl the pasta
Gambas (grilled shrimp) a, b against the edge of the plate or bowl (never use a
spoon to help with this), and never slurping. Bread
Fried Almonds, Pieces of Cheese, Sausage Bites may be used daintily to soak up extra sauce, but
should not be used to mop the plate. When not
Sherry, Beer, or Sangria a, b eating, the hands should be kept above the table
with the wrists resting on the edge.18
When in someones home, or at a hosted
meal, never start eating until the host has said
a bun appetito (in Italy), buen apetito (in Spain),
Von Bremzen, A. 2005. The new Spanish table. New York: Workman Publishing.
b
or bom appetite (in Portugal). In Italy, when
Spain-Recipes.com at http://www.spain-recipes.com
invited to someones home, it is considered rude
to discuss any serious topic before a meal is
shared. Chocolates are considered a good hostess
gift when invited for dinner in all three nations.
In Italy wine is appreciated if enough is brought
for all guests; wine should be avoided as a gift in
Spain and Portugal, where hosts have likely
Legend has it that consumed between 10:00 p.m. and midnight. Tapas chosen favorites to accompany the meal.
zabaglione was created to are usually served in bars and cafs and are
increase male vigor by a Special Occasions
accompanied by Sherry or wine; the variety of
Franciscan monk who tired Italy. Italy celebrates few national holidays, prob-
tapas is tremendous; it is not unusual for more
of hearing the confessional ably because of its divided history. Most festas are
than twenty kinds to be offered on a menu. They
complaints from women local and honor a patron saint. Other significant
are differentiated from appetizers in Spain in that
about their tired husbands. religious holidays are usually observed by fami-
they are strictly finger foods, such as olives,
lies at home, although some cities, such as Venice,
almonds, croquetas (fried croquettes with fish,
have a public pre-Lenten carnival. In some areas
ham, cheese, etc.), stuffed mushrooms, shrimp,
The word tapas means of the United States where southern Italians pre-
sausage bits, pieces of cheese, and other small
lids, and the first tapas dominate, St. Joseph, the patron saint of Sicily, is
bites. The evening meal may be skipped if a sub-
were pieces of bread used honored during Lent. Breads in the shape of a
stantial number of tapas are eaten at night. The
to cover wine glasses to cross blessed by the parish priest, pasta with sar-
main meal of the day is lunch, which is generally
keep out flies. dines, and other meatless dishes are featured.
eaten at home and consists of three hefty courses.
Among Italian Americans it is traditional to serve
Portugal. Portuguese meal patterns are similar seven seafood dishes on Christmas Eve. During
to those of Spain, often starting out with the day the Easter holidays, Italian-American bakeries
around 8:00 a.m. with espresso coffee and a roll sell an Easter bread with hard-boiled eggs still
with marmalade, or pastel de nata, a cinnamon- in their shells braided into it. Special desserts
flavored custard tart in puff pastry. A morning may accompany the holiday meal, such as panet-
coffee break, including coffee served with hot tone, amaretti (almond macaroons), and torrone
(nougats) at Christmastime and cassata at Easter. of the festival takes place on the last day, Sunday, It was the Spanish in the
Colored, sugar-coated Jordan almonds, which the with a procession to the church and the crowning 1600s who first added sugar
Italians call confetti (meaning little candies), of a queen after the service. The donated food to the bitter chocolate bev-
are served at weddings. (originally distributed to needy persons on Sunday erage native to Mexico. Its
afternoon but now often served at a free commu- popularity spread quickly
Spain. The most elaborate of Spanish festivals is through Europe, even
nity banquet) is blessed by the priest. The most
Holy Week, the week between Palm Sunday and though certain clerics tried
traditional foods at the feast are a Holy Ghost to ban it due to its associa-
Easter. It is a time of Catholic processions; con-
soup of meat, bread, and potatoes, and a sweet tion with the heathen
fections and liqueurs such as coffee, chocolate,
bread called massa sovoda. The bread is some- Aztecs. Although the
and anisette (licorice flavored) are served. Holiday
times shaped like little doves, called pombas. Also Spanish are fond of choco-
sweets include tortas de aceite, cakes made with
celebrated in the United States is the Feast of the late, it is used mostly as a
olive oil, sesame seeds, and anise; cortados rel-
Most Blessed Sacrament, which was started in beverage and is rarely added
lenos de cidra, small rectangular tarts filled with to pastries or confections.
New Bedford, Massachusetts, by four Madeirans
pureed sweetened squash; torteras, large round
in gratitude for their salvation from a shipwreck en
cakes made with cinnamon and squash and dec-
route to the United States in 1915. It attracts over
orated with powdered sugar; and yemas de San
150,000 visitors on the first weekend in August
Leandro, a sweet made by pouring egg yolks
for music, dancing, and traditional foods such as
through tiny holes into boiling syrup. It is often In the Portuguese town
linguia, bacalhau, fava beans, assada no espeto,
served with marzipan. Amarante the Festa de So
and cacoila. The Festa de Sennor da Pedra is held Gonalo is held the first
Special dishes are also prepared for Christmas
later in the month. This Azore Islands tradition weekend in June. Dating
and Easter. The Basques eat roasted chestnuts and
includes a parade and similar traditional foods. back to pagan times, it is
pastel de Navidad, individual walnut and raisin
Other festivities not mentioned here are associ- traditional for unmarried
pies, at Christmas; an orange-flavored doughnut,
ated with the Madeiran cult of Our Lady of the men and women to
called causerras, is featured on Easter. At New
Mount (a shrine on the island of Madeira). exchange phallus-shaped
Years it is customary for the Spanish (and the cakes as tokens of their
Portuguese) to eat twelve grapes or raisins at the Therapeutic Uses of Food affection for each other.
twelve strokes of midnight to bring luck for each
Little has been reported on the therapeutic uses
month of the coming year. In rural areas of Portugal,
of food by Americans of southern European
people traditionally collect
Portugal. Christmas Eve typically features two descent. Some Italians, particularly older immi-
medicinal plants for home
meals in Portugal: dinner and a postmidnight grants, categorize foods as being heavy or remedies on Quinta-Feira da
Mass buffet in the early hours of Christmas morn- light, wet or dry, and acid or nonacid.48 Espiga (Ear of Wheat
ing. Dinner often includes a casserole of bacalhau Heavy foods, such as fried items and red meats, Thursday or Ascension Day),
and potatoes, as well as meringue cookies known are considered difficult to digest; light foods, the fortieth day after
as suspiros (sighs). The buffet offers mostly including gelatin, custards, and soups, are regarded Easter.
finger foods, such as fried cod puffs and sausages. as easy to digest and appropriate for people who
In America the Holy Ghost (Spirit) Festival is are ill. Wet and dry refers to how foods are pre-
the most popular and colorful social and religious pared (with or without ample broth or fluid), as
event in the Portuguese community. It is not widely well as to their inherent qualities. For example,
celebrated in Portugal and probably came to the leafy greens such as escarole, spinach, and cab-
United States with immigrants from the Azores. bage are considered wet. A wet meal is served
Although the origins of the event are obscure, it once a week by some Italian Americans to cleanse
is believed to date back to Isabel (Elizabeth) of out the system. Wet meals, especially soups, are
Aragon, wife of Portugals poet-king, Dom Diniz considered necessary when a person is sick
(1326). One story is that the festival derives its because illness is associated with dryness in the
character from the belief that because Isabel was body. Citrus fruits, raw tomatoes, and peaches The Spanish American
Isleos of Louisiana
particularly devoted to the Holy Ghost, she wanted are thought to be acidic foods that may cause skin
marinate shrimp in vinegar
to give an example of charity in the annual distri- ailments and are avoided if such conditions exist. with olives and onions,
bution of food to the poor. Other Italian beliefs about foods are that liver, make almond-honey
The week-long festival is usually scheduled red wine, and leafy vegetables are good for the nougat, and use ample olive
sometime after Easter and before the end of July. blood and that too many dairy products make the oil (instead of the butter
It is held at the local church or Hall of the Holy urine hard (kidney stones). A clove of garlic and lard favored in nearby
Ghost (also called an IDES Hall). The main event may be eaten each day to prevent respiratory Cajun cooking).
infections, and a raw egg or dandelion greens nations, and lowest in the southern areas.36 In
may be consumed for strength and vitality.28 general, the Mediterranean diet, which is typified
Both balsamic vinegar and olive oil, which are in southern Italy and Spain, has been characterized
served with bread at meals, are believed to be as health promoting due to a high intake of com-
health-promoting foods in Italy. plex carbohydrates, a high intake of protective phy-
tochemicals, and a low intake of fat with a higher
proportion of monounsaturated fats from olive oil
CONTEMPORARY FOOD HABITS as compared to saturated animal fats.15,55,58 The
IN THE UNITED STATES greater emphasis on grains, legumes, vegetables,
and fruits; lower intakes of meat and dairy foods;
and promotion of wine in moderation differenti-
It is generally assumed that second- and third- ate the Mediterranean diet from that recom-
generation Americans of southern European mended by U.S. health officials.59 However, a study
descent have adopted the majority American by the Italian Association for Cancer Research has
diet and meal patterns, preserving some tradi- found that cancer rates increased as food habits
tional dishes for special occasions. These assim- changed in Italy; pasta consumption has fallen,
ilated Americans consume more milk and meat and meat intake has quadrupled since 1950;
but less fish, fresh produce, and legumes than changes toward a more westernized diet are
their ancestors. Olive oil is still used often, found in Spain and Portugal as well.14,39 Rates of
although not exclusively; pasta remains popular overweight and obesity in Italian women are rela-
with Italians. tively low, but are over 50 percent in men. In
Spain, rates exceed 50 percent for men and women;
Nutritional Status in Portugal, overweight and obesity in women
Descendants of southern Nutritional Intake. Little research has been approach 50 percent, and in men, 60 percent.30
Europeans may have a conducted on the nutritional intake of southern
higher incidence of lactose European Americans. It can be assumed that they Counseling. The conversational style of southern
intolerance than other suffer from dietary deficiencies and excesses sim- Europeans is animated, warm, and expressive.
European groups. ilar to those of the majority of Americans. A Feelings are more important than objective facts
study of elderly Portuguese immigrants in in a discussion. Shaking hands with everyone in
Alcohol consumption
among the Basques in Spain
Cambridge, Massachusetts, found that dinner the room in greeting and leaving is appropriate;
is high, especially for men.1 was the main meal of the day, and the subjects some men include pats on the back, and women
had moderate intake of breads and grains and may quickly embrace or kiss on the cheeks. Eye
low intake of fruits, vegetables, and dairy prod- contact among elders tends to be frequent and
ucts. Although dairy intake was low, many of the quick, whereas younger people may prefer steady
An Italian proverb states
subjects ate sardines, a rich source of calcium. eye contact. Touching is very common, especially
that after age forty, a The subjects reported low consumption of sweets between members of the same sex. It has been
person can expect a new and alcohol, although the researcher stated that noted that Italian-American clients are open,
pain every morning. the Americanized Portuguese diet tends to be willing to detail symptoms with their health-care
high in sugar and fat.44 One study comparing professional, and expressive with chronic pain
Some Italians believe that body weights of American and Italian women although some women may demonstrate high
wine mixed with milk in the with polycystic ovary syndrome found that levels of modesty and may resist discussing per-
stomach causes too much though the BMIs for the American women were sonal topics.28,54 Italian Americans may seek
acid, so milk is avoided at significantly higher, the total calorie intake and medical advice from family and friends before
meals and consumed mostly dietary constituents were similar, suggesting consulting a health professional. They express
with snacks.
unknown genetic or lifestyle components may preference for providers who are warm and
play a role.6 empathetic (sympatico) and disdain those who
According to a survey of European dietary are perceived as arrogant and unapproachable
Some diet books advocate a habits, a majority of the population in Italy con- (superbo).
traditional Mediterranean sumes more plant products than protein, and Recent Italian immigrants or those who are
diet to promote weight loss approximately equal amounts of both are con- elders may be very concerned about the qualities
and lessen the risk of heart sumed in Spain.53 In addition, meat consumption of their blood or may have many gastrointestinal
disease. is highest in the northern regions of these complaints. There may be confusion regarding
hypertension, which is considered high or too CHAPTER 6 REFERENCES

much blood, and anemia or low blood pressure,
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CHAPTER
7
Central Europeans,
People of the Former
Soviet Union, and
Scandinavians
Central Europeans
T he European settlers from central Europe,
the former Soviet Union (FSU), and
Scandinavia were some of the earliest and
largest groups to come to the United States.
Though many arrived as early as the 1600s and
and the People of
the FSU
most had come before the beginning of the Central Europe stretches from the North and
twentieth century, the upheavals of two world Baltic Seas, south to the Alps, and east to the
wars and the collapse of the Soviet Union have Baltic States. It includes the nations of Germany,
led to continuous immigration from these Austria, Hungary, Romania, the Czech Republic,
regions during the last century (see the map in Slovakia, and Poland, as well as Switzerland and
Figure 7.1). Liechtenstein. Most of the countries share common
The influence of immigrants from central borders; Austria, Hungary, the Czech Republic,
Europe, the FSU (especially Russia), and Romania, and Slovakia are situated south of
Scandinavia on American majority culture, Germany and Poland. Switzerland, an isolated
especially in the area of cuisine, is substantial. nation, is surrounded by Germany, Austria, France,
Bread baking, dairy farming, meat processing, Italy, and Liechtenstein. The climate of central
and beer brewing are just a few of the skills Europe is harsher and colder than that of southern
these groups brought with them. Their expertise Europe, but much of the land is fertile.
permitted the expansion of food production The FSU includes the Commonwealth of
and distribution that encouraged nationwide Independent States or CIS (the Russian Federation,
acceptance of their ethnic specialties, leading Armenia, Azerbaijan, Belarus, Georgia, Kazakstan,
to the creation of a typical American cuisine. Kyrgyzstan, Republic of Moldavia, Tajikistan,
This chapter focuses on the traditional and Turkmenistan, Ukraine, and Uzbekistan) and the
adapted foods and food habits of Germans, Baltic States (Estonia, Latvia, and Lithuania),
Poles, and other central European groups; extending east to the border with China and the
Russians and other FSU populations; and Pacific Ocean. Its vast geography includes the Arctic
Danes, Swedes, and Norwegians. and parts of the Middle East. Except in the southern
174 CENTRAL EUROPEANS, PEOPLE OF THE FORMER SOVIET UNION, AND SCANDINAVIANS
ESTONIA
RUSSIAN FEDERATION
LATIVIA
LITHUANIA
POLAND BELARUS
GERMANY
CZECH
REPUBLIC UKRAINE
SLOVAKIA
LIECHTENSTEIN MOLDOVA KAZAKSTAN
HUNGARY
SWITZERLAND ROMANIA GEORGIA
Cas
UZ KYRGYZSTAN
AUSTRIA Black Sea BE
KI
pian
ST
TU AN
ARMENIA RK
S
ME
ea
Figure 7.1 NIS TAJIKISTAN

TA
Central Europe, Scandinavia, N
AZERBAIJAN
former Soviet Union.
Eastern Europe is the term republics, the harsh winters of the region affect CULTURAL PERSPECTIVE
sometimes used to define the agricultural capacity.
region that is also called The large number of immigrants from central History of Central Europeans and Russians
European Russia (the west- Europe and parts of the FSU made significant in the United States
ern half of the country; east of contributions to the literature, music, and cui- Immigration Patterns
the Ural Mountains is known
sine of the United States. Many central European Germans. For almost three centuries, Germans
as Siberia or Asian Russia).
Before the breakup of the
foods have become standard American fare. have been one of the most significant elements in
USSR, eastern Europe was Imagine a baseball game without hot dogs and the U.S. population. According to U.S. Census
sometimes used to describe beer or a picnic without potato salad. This sec- figures, one in every six Americans is of German
those countries under Soviet tion explores these and other food customs of descent, making this the largest ethnic group in
control (e.g., Czechoslovakia, central Europe and the FSU and their impact on the nation. Germans are also one of the least visi-
Hungary, East Germany). the American diet. ble of any American group.
Chapter 7: Central Europeans, People of the Former Soviet Union, and Scandinavians 175
The earliest German settlement in the American

colonies was Germantown, Pennsylvania, founded
in 1681. By 1709 large-scale immigration began,
primarily from the Palatinate region of south-
western Germany. Many of the immigrants, who
were mostly of Amish, Mennonite, or other reli-
gious minority faiths seeking freedom from dis-
crimination, settled in Pennsylvania. The majority
were farmers who steadily pushed westward
searching for new lands for their expanding fami-
lies. Those in Pennsylvania, Ohio, and Indiana
became known as the Pennsylvania Dutch.
Immigration dropped off after 1775, but an eco-
nomic crisis in Europe once again prompted

numerous Germans to come to the United
States. Approximately 5 million Germans immi-
grated to America between 1820 and 1900. Like
the earlier settlers, most were farmers who
arrived with their families, although by the end
of the century there were increasing numbers of Traditional foods of central
young, single people who were agricultural Europe and the FSU. Some
laborers and servants. Many of these settled in immigration occurred between 1860 and 1914, typical foods include beets,
the Mississippi, Ohio, and Missouri River val- mostly for economic reasons. The early phase cabbage, ham, herring,
leys, the Great Lakes area, or the Midwest. Most was dominated by Poles (approximately 500,000) kasha, potatoes, rye bread,
Germans avoided the southern United States, from German-ruled areas of Poland (Pomerania sausages, and sour cream.
but there are sizeable German settlements in and Poznan) and by Poles who worked in west-
Texas and New Orleans. ern Germany. German Poles often became part
A third significant phase of immigration began of the German or Czech communities or estab-
after the turn of the twentieth century, when lished farming settlements in the Southwest
approximately 1.5 million Germans arrived. Many and Midwest.
were unmarried industrial workers seeking The number of Polish immigrants from
higher pay, and others were the descendants of Germany began to decline after 1890, but the slack
Germans who had settled in ethnically isolated was taken up by the arrival of more than 2 million
colonies in Russia as early as the sixteenth cen- Poles from areas under Russian and Austrian
tury. Discrimination and the revolution of 1917 rule. The German Poles left their homeland to
led to their departure. Most of these third phase become permanent settlers, but the Russian and
immigrants joined growing numbers of second- Austrian Poles came as temporary workers.
and third-generation Germans living in urban Although 30 percent returned to Poland, many
areas. Cities with considerable German popula- eventually moved back to the United States per-
tions included Cleveland, New York, Toledo, manently. The Austrian and Russian Poles tended Small numbers of
Detroit, Chicago, Milwaukee, and St. Louis. to settle in the rapidly developing cities of the Mid- Schwenkfelders from south-
German Russians, however, tended to settle in Atlantic and Midwestern states, especially Chicago, ern Germany, members of a
Buffalo, and Cleveland. pacifist religious sect similar
rural areas, especially in Colorado.
Polish emigration after World War I was usu- to Quakers, settled in
During the 1930s, many of the German Pennsylvania in the mid-
immigrants were Jewish refugees. After World ally not for economic reasons. Most (more than
1700s. They introduced
War II, displaced persons of German descent and 250,000) left because of political dissatisfaction:
crocus flowers, source of the
East German refugees made up the sizeable government instability and dictatorship in the
spice saffron.
German immigrant group who settled in the 1920s and 1930s, the German invasion and occu-
United States. pation from 1939 to 1945, and the pro-Soviet The word Dutch is a corrup-
communist government after 1945. Many settled tion of Deutsch, meaning
Poles. Poles have arrived in the United States in urban areas in which there were substantial German and has nothing
continuously since 1608. The largest wave of existing Polish populations. More recently, small to do with the Netherlands.
numbers of younger Poles have taken advantage before World War II. Those who decided to remain
of the freedom resulting from post-communist in America later sent for their wives and families.
rule to come to the United States. The majority settled in the industrial Northeast
and Midwest; they labored in coal mines, steel
Other Central Europeans. Nearly 4 million
mills, and oil refineries.
Austrians, Hungarians, Czechs, Slovaks, and Swiss
Immigrants from Switzerland came to the
have come to the United States, primarily during
United States for economic opportunities. The
the late nineteenth and early twentieth centuries,
majority arrived prior to World War I, seeking
for economic and political reasons.
jobs as artisans or professionals in the urban areas
The Gypsies are an insular Austrian immigration patterns are not entirely
of New York, Philadelphia, Chicago, Cincinnati,
ethnic group found known because Austrians and Hungarians were
throughout the world. St. Louis, San Francisco, and Los Angeles.
classified as a single group in U.S. statistics until
When they first arrived in Another group without national boundaries
1910. More than 2 million Austrians are believed
Europe in the 1300s from found throughout central Europe (as well as in
to have come to the United States searching for
India, they were mistaken northern and southern Europe) is the Gypsies, also
economic opportunities in the decade following
for Egyptians. Their name known as Roma. Gypsy immigrants to the United
derives from this error. 1900. Most were unskilled, and many were fathers
States are not counted in U.S. Census figures. There
Those from eastern and who left families in Austria with the hopes of
are an estimated 100,000 to 1,000,000 Gypsies in
southeastern Europe are the making their fortune. Many Austrians never found
America, from a variety of Gypsy groups and
Rom, and some Gypsies the advancement they were seeking, and approxi-
speaking different dialects.20 Though they origi-
prefer the name Roma. mately 35 percent returned home. A second,
nate from numerous European countries, the
smaller wave of immigration occurred in the
majority living in the United States are believed to
1930s, when 29,000 well-educated, urban Austrian
have come from central Europe.
Jews fled Hitlers arrival.
The first group of Hungarians arriving in the Russians and People of the FSU. Russian immi-
United States was several thousand political grants originally came to Alaska and the West
refugees following the revolution of 1848. Most Coast, rather than to the eastern states. Most of
were menwell educated, wealthy, and often their settlements were forts or outposts used to
titled. Later Hungarian immigrants who arrived protect their fur trade and to shelter missionaries.
at the turn of the century were often poor, When Russia sold Alaska to the United States in
young, single men who found job opportunities 1867, half of the settlers returned home and many
in the expanding industrial workplace. Many of the others moved to California. Subsequent
worked in the coal mines of eastern Ohio, immigration was primarily to the East Coast,
West Virginia, northern Illinois, and Indiana. although some Russians (Molokans, followers of
Cities that developed large Hungarian popula- a religion that had rejected the Russian Eastern
tions were primarily located in the Northeast Orthodox Church) immigrated to the West Coast
and Midwest. More than 50,000 additional in the early twentieth century.
Hungarians entered the United States as refugees Russians, mainly impoverished peasants seek-
after World War II and the 1956 uprising against ing a better life, began to arrive in large numbers
the communist government. They first settled in during the 1880s. Over 1.5 million were Jews
the industrial towns populated by earlier seeking freedom from persecution as well as eco-
Hungarian immigrants, but many, mostly pro- nomic opportunity. A second wave of immigrants
fessionals, soon moved to other cities that came after the 1917 revolution, when more than
offered better jobs. 2 million people fled the country; 30,000 settled
Czech immigrants initially tended to be farm- in the United States. After World War II, only
ers or skilled agricultural workers who settled in small numbers of Soviet refugees, primarily Jews,
the states of Nebraska, Wisconsin, Texas, Iowa, and were allowed to emigrate. Following the breakup of
Minnesota, often near the Germans. Later Czech the Soviet Union, nearly 200,000 Russians settled
immigrants were skilled laborers; they settled in in the United States between 1990 and 1993. The
the urban areas of New York, Cleveland, and settlement patterns of Russians are similar to those
especially Chicago. of other immigrants from central Europe. For
The majority of the Slovak immigrants were the later wave of immigrants the port of entry was
young male agricultural workers who arrived New York City. Many remained in New York, and
others settled in nearby industrial areas that offered German-composed music was banned, German- Many recent refugees from
employment in the mines and factories. named foods were renamed, and German books the FSU have been admitted
The largest populations of immigrants from were burned. As a result, German Americans rapidly to the United States due to
the FSU are from the Ukraine, Lithuania, and assimilated, abandoning the customs still common ethnic or religious persecu-
tion. In one study, immi-
Armenia. Lengthy Russian domination of the in other ethnic groups, such as ethnic associations
grants reported they feared
region hinders estimates of the total numbers in and use of their oral and written language.
for their safety and felt they
the United States because some settlers were listed could not live openly as Jews
Poles. Polish Americans form one of the largest
as Russians in immigration figures. It is believed due to anti-Semitism.33
ethnic groups in the United States today. In 2005 it
that the first significant number of Lithuanians,
was estimated that there were more than 9 million
approximately 300,000, arrived in the United
Americans of Polish descent; many still live in the
States following the abolition of serfdom in
urban areas of the Northeast and upper Midwest
1861.13 Nearly 30,000 refugees fleeing Soviet con-
where their ancestors originally settled. Economi- Based on 2001 census data,
trol came following World War II. The largest
cally, the third-generation Polish American has it is estimated that there are
influx of Ukrainian immigrants occurred in the almost 3 million Canadians
moved modestly upward, but the majority of
1870s, when almost 350,000 men were recruited of German descent and
Polish Americans still live just below or solidly
to work the Pennsylvania mines as strikebreakers. at middle-class level. Forty-five percent of the 817,000 of Polish ancestry.
A majority settled in that state, though smaller males have white-collar jobs, and 40 percent of In addition, 1 million
numbers found factory work in Ohio, New York, working Polish women are semiskilled or
Canadians list their heritage
and Michigan. Later immigrants, including as Ukranian, and over
unskilled laborers. Poles have been active in the 300,000 report Russian
80,000 Ukrainians displaced by World War II, formation and leadership of U.S. labor unions.
favored the urban centers of the Northeast. origins.
More recent immigrants usually possess higher
Significant Armenian immigration began in occupational skills and educational backgrounds Seventy-three percent of
1890, when immigrants came for economic oppor- than earlier immigrants. the population in
tunity. A second wave of Armenians from Turkey Switzerland speaks Swiss
who were seeking escape from persecution arrived Other Central Europeans. There is continued German, 20 percent speaks
following the two world wars. More than 60,000 confusion over Austrian ethnicity dating back to Swiss French, and 5 percent
Armenian refugees have come since the 1980s, changing national boundaries and names. It is speaks Swiss Italian; in
settling primarily in Los Angeles, with smaller believed that although only 781,000 Americans addition, most Swiss speak
numbers joining the older American communities identify themselves as being of Austrian descent in one or two other languages.
in Boston, New York, Detroit, Chicago, and the the 2005 U.S. Census figures, as many as 4 million
agricultural region of Fresno, California. U.S. citizens may actually be of Austrian ancestry.25
Though early immigrants settled mostly in the
Current Demographics Northeast, the largest populations of Austrian Poles are often stereotyped
and Socioeconomic Status Americans are now found in New York, California, as uneducated and back-
Germans. There are more than 49 million and Florida. At the turn of the century, Austrians ward, and are frequently
Americans of German heritage in the nation today, were involved in clothing and tailoring, mining, and the brunt of Polish jokes.
according to 2005 census estimates. Wisconsin- the food industry, including bakeries, meatpacking
Minnesota-North Dakota-South Dakota-Nebraska- operations, and restaurants. Today, Austrians are
Iowa is considered the German belt; however, only found in a diverse range of occupations.
the Pennsylvania Dutch, the rural-dwelling In the 2005 U.S. Census figures more than
Germans from Russia who settled in the Midwest, 1.5 million Hungarian Americans were estimated
and a few concentrated communities in Texas to be in the United States. Most settled originally
retain some aspects of their cultural heritage.44 in the Northeast, but younger generations have
Germans differ little from the national norms migrated to California and Texas, while many
demographically, although they are slightly higher Hungarian retirees have moved to Florida.60
in economic achievement and are generally con- Economically, the Hungarians differ little from
servative in attitudinal ratings. The high degree other central European immigrants. Most live in
of German acculturation is attributed to their urban areas and work mostly in white-collar occu-
large numbers, their occupations, and the time pations. First- and second-generation Hungarian
of their arrival in the United States. Further- Americans encouraged their children to become
more, entry of the United States into World War I engineers, a science that was respected by the
created a storm of anti-German feeling in America. Hungarian aristocracy at the turn of the century.
Nearly 1,600,000 Americans of Czech descent Russians and People of the FSU. In 2005
were identified in the 2005 U.S. Census estimates. approximately 3 million Russian Americans were
Most Czechs now live in cities or rural non-farm living in the United States. They have mostly moved
areas26 and are very acculturated. Cities and states out of the inner-city settlements to the suburbs,
with large Czech populations are California, especially in the Northeast. A 20,000-member
Chicago, Iowa, Minnesota, Nebraska, New York community of Russian Molokans is in California.35
City, Texas, and Wisconsin. Occupationally, only a Figures from the 2005 census estimate reported
small number of Czech Americans are still farmers; 963,000 Americans of Ukrainian descent, 712,000
Many Czech immigrants a majority of Czechs now hold sales, machinist, of Lithuanian heritage, and 421,000 of Armenian
immediately Americanized or white-collar jobs. Many Czechs have been suc- ancestry. In the past decade one-third of FSU
their names upon arrival in cessful in industry, founding businesses that pro- immigrants are from Russia, one-third are from
the United States.39 duce cigars, beer, and watches. the Ukraine, and the remaining third are from all
There are over 800,000 Americans of Slovak other FSU nations. These recent immigrants have
descent, according to the 2005 U.S. Census figures. settled in urban areas, including New York,
Actual numbers may exceed 2 million when those Chicago, Los Angeles, Boston, Detroit, and San
originally misidentified as Czechoslovakian or Francisco. Today, 70 percent of Ukrainians are
Hungarian are included.2 The first two generations found in Pennsylvania, and 40 percent of
of Slovaks grew up in tightly knit communities Armenians are living in California.
anchored by work, church, family, and social activ- Since World War II, the relations between the
ities. The third and fourth generations have sought Russian-American community and American
higher education, work in white-collar jobs, and society have largely been dependent on the politi-
live in the suburbs; median family income is far cal relations between the United States and Russia.
above the national average. Cultural ties are still During the 1950s, anti-Soviet and anticommunist
strong among the later generations of Slovaks. sentiments in the United States caused many
More than 1 million citizens declared Swiss Russian Americans to assume a low profile that
ancestry in the 2005 U.S. Census estimates. Most hastened their acculturation. Since the bulk of
Swiss were multilingual and often multicultural Ukrainian and Lithuanian immigration occurred
when they arrived, assimilating quickly into several generations past, most of these populations
American culture. The few Swiss who come to the are assimilated. Armenians, who are typically well
United States today work mostly in the U.S. educated and English-speaking on arrival, have also
branches of Swiss companies.46 found it easy to adapt to U.S. society.
After arrival in the United States, Gypsies Immigrants recently arriving from Russia and
retained their reputation for roving; their exact the FSU have come from relatively advanced educa-
numbers are unknown, and they are a very tional and professional backgrounds. Estimates are
mobile population, often living in trailer parks. nearly half of Russian immigrants have a university
Many renovate apartments and houses to accom- degree. Most have professional experience, many as
modate large social gatherings, then pass the engineers, economists, scientists, or physicians. In
homes on to other Gypsy Americans when they addition, many Armenian Americans own their
move. It is estimated that approximately half live own businesses and have income levels that are
in the rural areas of the south and west, and half well above average; however, higher than average
live in urban regions. The cities with the largest numbers of families who have recently immigrated
concentrations of Gypsies are Los Angeles, San from Armenia fall below the poverty line.53
Francisco, New York, Chicago, Boston, Atlanta,
Dallas, Houston, Seattle, and Portland. Traditionally Worldview
tinkers and traders, Gypsies have been very suc- Religion
cessful at independent trades, such as house Germans. The majority of German immigrants
painting and asphalt paving, and service work such were Lutheran; a minority were Jewish or Roman
as body-fender repair and dry cleaning. Gypsies Catholic. Today the Pennsylvania Dutch and the
have also entered the car dealership profession in rural Germans from Russia faithfully maintain
large numbers. Women are a strong presence in the their religious heritage.
mystical arts, including fortunetelling. The Gypsies Both groups are primarily Protestant, mostly
divide the urban regions of America to minimize Lutheran or Mennonite. Mennonites are a religious
competition between Gypsy-owned businesses. group derived from the Anabaptist movement,
which advocated baptism and church member- Gypsy culture is structured to preserve purity and The Amish and Mennonites
ship for adult believers only. They are noted for to avoid contamination through contact with non- are referred to as the Plain
their simple lifestyle and rejection of oaths, public Gypsies. Some Gypsy Americans are Christians, People. The more liberal
office, and military service. The Amish, a strict often members of fundamentalist congregations, and worldly members of the
Lutheran and Reformed
sect of the Mennonites, follow the Bible literally. and several churches have specifically combined
Churches are called the
They till the soil and shun worldly vanities such Gypsy spiritual concepts with Christian practices.
Gay Dutch,Fancy Dutch,
as electricity and automobiles. Their life centers or Church People.
Russians and People of the FSU. Except for
on Gelassenheit, meaning submission to a higher
the Soviet Jews, the primary organization of the
authority through reserved and humble behavior, In 301 AD Armenia became
Russian-American community today is the Russian
and placing the needs of others before the needs the first nation to adopt
Orthodox Church. Religion has always played a
of the individual. Christianity as its state
central role in the Russian community, and the
religion.
Poles. Most Polish immigrants were devout Orthodox Church has tried to preserve the culture.
Catholics; they quickly established parish churches However, the largest branch of the Eastern church,
in the United States. The Catholic Church is still a officially known as the Orthodox Church in
vital part of the Polish-American community, America (formerly the Russian Orthodox Church
although Polish Americans have been found to outside Russia), now includes people from other
marry outside the church more than other Catholics. central European and FSU countries, and the
Russian traditions have been deemphasized.
Central Europeans. Austrians are mostly
Among Ukrainian Americans, more belong to
Roman Catholic and have been actively involved
the Roman Catholic Church than to the Eastern
in promoting Catholicism in America. In 1829
Orthodox faith. Lithuanians are also predomi-
the Leopoldine Stiftung was founded in Austria to
nantly Roman Catholic; however, there are small
collect money throughout Europe to introduce
numbers of Protestants, Jews, and Eastern
religion to the U.S. frontier, resulting in more than
Orthodox followers. Most Armenians are mem-
400 Catholic churches established in the East, the
bers of the Armenian Apostolic Church (an
Midwest, and in what was known as Indian
Eastern Orthodox faith noted for allowing its Eastern Orthodox priest
country. There are also small numbers of Austrian
blessing the Coca-Cola plant
Jews. The majority of Hungarians are Catholic,
in Moscow, 1996.
although in the United States, nearly 25 percent
are Protestant.
In Europe most Czechs were Roman Catholics,
but one-half to two-thirds of nineteenth century
Czech immigrants from rural areas left the church
and were considered free thinkers who believed
in a strong separation of church and state.
Subsequent generations now belong to a variety
of faiths. Religion is still an important factor in
the lives of Slovaks. Most are Roman Catholics
who attend services regularly. First- and second-
generation Slovaks usually send their children to
parochial schools supported by the ethnic parish.
Traditional spirituality for the Gypsies is derived
from Asian Indian religions, such as Hinduism and
Zoroastrianism (see Chapter 2, Traditional Health
Beliefs and Practices, regarding eastern religions,
and Chapter 14, Asian-Indians and Pakistanis for
more information on Asian Indian faiths). While
traditions and customs vary by tribe and to a cer-
AP/Wide World Photos
tain degree by the host culture, Gypsies are thought

to be united in their worldview, called romaniya.
Many believe in God, the devil, ghosts, and pre-
destination. Most of all they adhere to the concept
that persons and things are either pure or polluted.
members to make decisions on issues such as Gypsies customarily maintain extended fami-
birth control and homosexuality without reli- lies, although in the United States more nuclear
gious influence), although some Americans of families have been established. When traveling was
Armenian descent are Protestants or members of common, multifamily groups (smaller than tribes)
the Armenian Rite of the Roman Catholic Church. would temporarily band together. Affiliation with
Family this group, called a kumpania, often continues
Germans. The traditional German family was today. The father is in charge of all public matters,
based on an agricultural system that valued large but women may make most of the family income
families in which every member worked in the and manage all money matters. Women also retain
fields to support the household. Even when some power through their ability to communicate
German immigrants moved to urban areas, family with the supernatural world. Usually Gypsies do
members were expected to help out in the family not date, and arranged marriages are still common.
business. Most German families today are assumed Russians. Traditionally Russians lived in very
to have adopted the smaller American nuclear con- large family groups with women legally dependent
figuration. The exception may be among the on their husbands. This structure changed, how-
Pennsylvania Dutch, particularly the Amish, who ever, with the education and employment oppor-
continue to have large families of seven to ten chil- tunities offered to women during the communist
dren. It is not unusual for an Amish person to know rule of the Soviet Union. Most women worked,
as many as seventy-five first cousins or for a grand- and families became smaller. Even when employed
parent to have thirty-five grandchildren.30 Many fulltime, however, women remained responsible
Amish families are finding it difficult to maintain for all household chores. In the United States,
traditional values due to growing contact with the Russian family structure has shrunk even further.
majority culture through suburban sprawl. Russian couples have significantly fewer children
Poles. Traditionally the Polish-American family than the national average for American families.
was patriarchal, and the father exerted strong Education is emphasized, especially if it can
control over the children, especially the daughters. be obtained at a Russian-language school. Many
The mother took care of the home, and, if the chil- first-generation immigrants attempted to main-
dren worked, it was near the home or the fathers tain ethnic identity by restricting their children
workplace. Since the 1920s, the overwhelming to spouses from their immediate group, but mar-
majority of Polish-American families have been riage to non-Russians is now the norm.
solely supported by the fathers income; wives Since many of the Ukrainian and Lithuanian
and children have rarely worked. immigrants in the nineteenth century were men,
most were forced to intermarry with other ethnic
Other Central Europeans. Tight nuclear fami- groups. The men dominated the household, the
lies typify traditional Austrian households. women ran the home, and the extended family was
Although the father is in charge of family finances, the norm. Ukrainian and Lithuanian families have
it is the mother who rules home life. Assimilation since moved toward a more typically American
in the United States has led to a deterioration of composition with just two working parents and
the nuclear family, including an increased divorce children. In many ways Armenian homes are also
rate. Traditional Czech and Hungarian families similar to the average American household. Both
were male dominated and included many relatives. parents usually work, and education is a high pri-
In the United States, participation in church activi- ority. Nearly 70 percent of second-generation
ties, fraternal societies, and political organizations Armenian Americans obtain a college degree. It
often served to replace the extended family for has been noted, however, that most Armenian chil-
both men and women. The role of women has dren retain respect for elders after acculturation,
become less circumscribed; children are typically which is uncommon in other cultures, and tight-
encouraged to pursue higher education and pro- knit families have allowed many Armenians to pass
fessional careers. Family ties are strong among the on traditional customs.53
Slovaks. Parents are respected; they are frequently
visited and cared for in their old age. Weddings are Traditional Health Beliefs and Practices.
still a major event, although they are not celebrated German biomedicine makes extensive use of
for several days as they once were. botanical remedies, though continued use is not
documented in German Americans. A study of from unclean dictates much of Gypsy life. The body
German Americans elders in Texas showed that is an example of this dichotomy. The upper body is
many believe illness is caused by infection or pure, as are all its secretions, such as saliva. The
stress-related conditions.51 Some Germans believe lower half is impure and shameful. Care is taken
sickness is an expected consequence of strenuous to avoid contamination through contact of the
labor. Health is maintained by dressing properly, upper body by the lower body (only the left hand
avoiding drafts, breathing fresh air, exercising, is used for personal care). Menstrual blood is
doing hard work, and taking cod liver oil. A few especially impure. Purity is also maintained by
respondents mentioned the importance of reli- avoiding public places that non-Gypsies (who are
gious practices and that suffering from illness is a considered unclean) frequent and by not touch-
blessing from God. Numerous home remedies are ing contaminated surfaces, as well as by the use
common (see Therapeutic Uses of Foods section of disposable utensils, cups, and towels when in
for more information). impure locations (e.g., hospitals).
The Pennsylvania Dutch traditionally believed Gypsies divide illnesses into those that are Symptoms of colic in Amish
a hearty diet high in meats, dairy products and due to contact with non-Gypsies, and those that infants are attributed to a
grain foods was important for maintaining are Gypsy conditions caused by spirits, ghosts, condition known as liver-
good health. Many use home remedies, homeo- the devil, or breaking cultural rules. Home reme- grown, which can only
pathic preparations, and healers to treat illness. dies and Gypsy healers (usually older women be cured with sympathy
healing.
Sympathy healing is especially well developed. versed in medicinal lore) are considered best for
This traditional folk practice uses charms, Gypsy illnesses. Non-Gypsy conditions are suit-
spells, and blessings to cure the symptoms of able for treatment by non-Gypsy physicians,
disease. It is called either powwowing (though though a non-Gypsy folk healer such as a curan- The Poles say, A doctors
not related to Native American beliefs and dero may be consulted as well. mistakes are covered in
practices) or by its German name, Brauche or Natural cures and alternative medicine are earth.
Braucherei. There is a strong religious founda- used extensively in Russia and the nations of the
tion to the practice, and the healer acts as Gods FSU and are often integrated with a biomedical
instrument, requesting Gods direct assistance therapy.64 For example, cupping is used for res-
Gypsy women are tradition-
in treatment. Powwow compendiums still in piratory illnesses. Saunas, massage, steam baths,
ally prohibited from touch-
use today offer everything from household tips and balneotherapy (bathing in mineral springs) ing food, water, or utensils
to cures for warts, burns, toothache, and the are often prescribed in conjunction with bio- intended for other family
common cold. The Amish in particular sub- medical approaches; mud baths may be used members during their period
scribe to sympathy healing, the laying on of for hypertension, and sulfurated hydrogen or following childbirth.
hands to diagnose illness, and reflexology (foot baths for cardiac ailments. In addition, homeo-
massage thought to benefit other areas of the pathic preparations and herbal remedies are
body, such as the head, neck, stomach, and back), popular.12, 33, 50, 64 Magic and the occult may be
as well as the use of herbal home cures, espe- used to cure illnesses due to supernatural
cially teas.22, 42, 64, 65 causes. Psychics and znakarki (elder women
Polish American elders in Texas have reported who whisper charms and sprinkle water with
that a shortage of medical supplies in Poland led magic powers) may be employed for chronic
to the widespread use of faith healers.51 Although conditions that biomedicine cannot ameliorate.
such healing practices are not documented in the In the Siberian region of Russia, sickness was
United States, many Polish Americans are deeply traditionally attributed to spiritual crisis, soul
religious and believe that faith in God and the loss, evil spirits, breach of taboos, or curses.
wearing of religious medals will help to prevent Treatments used by shamans (magicoreligious
illness. Other health-maintenance beliefs include healers) included realigning life forces or
avoidance of sick people, a healthy diet, sleep, retrieving the soul through visualization tech-
keeping warm, exercise, a loving home, and niques, singing, chanting, prognostication, dream
avoidance of gossip. analysis, and sances.3, 12 Russians who do not
Gypsies have unique health beliefs.53 Health is believe in any occult practices may blame illness
maintained through marim, a system of purity on other factors outside their control, including
and pollution that may be related to Asian-Indian social conflict, political problems, war, poor
beliefs (see Chapter 14). The separation of clean medical care, and starvation.5
TRADITIONAL FOOD HABITS such as salmon, with mushroom and rice filling.
In Lithuania, lamb-stuffed pockets served with sour
Ingredients and Common Foods: Staples cream are called kulduny. A specialty product of
and Regional Variations Russia is buckwheat (an Asian grain), which has
Legend has it that it was The regional variations in central European and a very distinctive, nutty flavor, especially when it
the Mongols who showed FSU cuisine are minor. The exceptions are the foods is toasted. The groats (hulled and crushed grains)
the central Europeans how of the southern CIS nations, such as Armenia. (See are prepared in ways similar to rice, especially as
to broil meat, make yogurt The Cooking of Armenia in this chapter.) The side dishes and stuffings.66 Buckwheat meal is used
and other fermented dairy temperate climate of the region and proximity to to make baked goods.
products, and preserve cab-
the Arabs, Turks, and Greeks have resulted in a cui- Next to bread, meat is the most important ele-
bage in brine.
sine similar to Middle Eastern fare (see Chapter 13, ment of the diet. Pork is the most popular. Schnitzel
People of the Balkans and the Middle East). is a meat cutlet, often lightly breaded and then
Ingredients in traditional central European and fried. Ham is served fresh or cured. Poland is
FSU dishes were dictated by what could be grown famous for its smoked ham, and in Germany,
in the cold, often damp climate. Common ingre- Westphalian ham is lightly smoked, cured, and
dients are potatoes, beans, cabbage and members cut into paper-thin slices. Beef is also common.
of the cabbage family, beets, eggs, dairy products, In Germany, Sauerbraten, a marinated beef roast,
pork, beef, fish and seafood from the Baltic Sea, is the national dish. It is also rolled around vari-
freshwater fish from local lakes and rivers, apples, ous fillings, such as bacon, onions, and pickles, to
rye, wheat, and barley (see Table 7.1 for the cultural make Rouladen. Veal is especially popular in
food groups). Foods were often dried, pickled, or Lithuania. Poultry is well liked. Germans often
fermented for preservationfor example, cucum- eat roast goose stuffed with onions, apples, and
ber pickles, sour cream, and sauerkraut. herbs on holidays. In Russia, chicken is stewed on
Bread is a staple item, and there are more than special occasions, and breaded chicken cutlets
one hundred varieties of bread. Because the cli- called kotlety are common. A famous Russian dish
mate in central Europe and FSU makes wheat is chicken Kievbreaded, fried chicken breasts
harder to grow, bread is often made with rye and filled with herbed butter. Game meats are a favorite
other grains; thus it is darker in color than bread in many areas, especially deer, wild boar, and rabbit.
made from wheat flour. Common types are whole A well-known German dish is Hasenpfefferhare
wheat, cracked wheat, white, black, rye, pumper- cooked in red wine with black pepper. In Poland,
nickel, caraway, egg, and potato. Cornmeal breads bigos (hunters stew), made of venison, hare,
are found in more southern nations such as and vegetables (some form of cabbage is always
Romania. Soft pretzels are a favorite in Germany added), is traditional. Geese and duck are widely
and in Switzerland; they are sometimes sliced to eaten, also.
make sandwiches. Noodles and dumplings abound In the past, meat was often scarce and expen-
and are often served as side dishes. Boiled sive; thus many traditional recipes stretched it as
dumplings (called knedliky in Czech, Kndel in far as possible. Dishes common throughout the
German, and kletski in Russian), can be made region consist of seasoned ground meat mixed
with flour or potatoes and with or without yeast. with a binder such as bread crumbs, milk, or eggs,
Sptzle are tiny dumplings common in southern then formed into patties and fried. In Germany,
Germany. They are made by forcing the dough ground beef (and sometimes pork or veal) is served
through a large spoon with small holes into the hot raw on toast as steak tartare. Ground meat is also
Frankfurter means a water. Stuffed dumplings, filled with meat, liver, used to stuff vegetables (such as stuffed cabbage)
sausage from the German bacon, potatoes, or fruit, are called Maultaschen or pastry, or is cooked as meatballs, such as
city of Frankfurt; Weiner (German), pierogi (Polish), pelmeni (Russian), Knigsberger Klopse topped with capers and a
means one from Vienna. In
or varenyky (Ukrainian). Related to the filled white sauce. Cut-up meat is often served in soups,
the United States the name
dumpling is stuffed pastry dough, which is baked stews, or one-pot dishes. In Germany a slowly
hot dog became popular
in the late 1800s because of or fried. It is customarily filled with meat or simmered one-pot dish of meat, vegetables, pota-
the sausages resemblance cabbage. Small individual pastries are called toes, or dumplings is called Eintopf. Hungary is
to a dachshund; stories pirozhki in Russian, and a large oval pie is known known for its gulys, a paprika-spiced stew known
about a cartoonist invent- as a pirog (also called a kulebi). One elaborate as goulash in the United States. Sweet Hungarian
ing the nickname are myth. version, kulebiaka, usually includes a whole fish, paprika is ground, dried, red chile peppers to
Table 7.1 Cultural Food Groups: Central European and Russian/FSU

Protein Foods
Milk/milk products Dairy items, fresh or fermented, are fre- Milk (cow, sheep) fresh and fermented (buttermilk, Milk products are still frequently consumed
quently consumed. sour cream, yogurt), cheese, cream or increased.
Whipped cream is popular in some areas;
sour cream popular in other regions.
Meat/poultry/fish/ Meats are often extended by grinding and Meat: beef, boar, hare, lamb, pork (bacon, ham, pigs Consumption of meat and poultry has increased;
eggs/legumes stewing. feet, head cheese), sausage, variety meats, veal, use of variety meats has decreased.
Russians tend to eat their meat very well venison Sausages and other processed meats are often
done. Fish: carp, flounder, frog, haddock, halibut, herring, eaten.
mackerel, perch, pike, salmon, sardines, shad,
shark, smelts, sturgeon, trout
Shellfish: crab, crawfish, eel, lobster, oysters, scallops,
shrimp, turtle
Poultry and small birds: chicken, Cornish hen, duck,
goose, grouse, partridge, pheasant, quail, squab,
turkey
Eggs: hens, fish (caviar)
Legumes: kidney beans, lentils, navy beans, split peas
(green and yellow)
Cereals/Grains Bread or rolls are commonly served at all Barley, buckwheat, corn, millet, oats, potato starch, More white bread, less rye and pumpernickel
meals. Dumplings and kasha are also rice, rye, wheat bread are eaten.
common. Breakfast cereals well accepted.
Numerous cakes, cookies, and pastries are
popular.
Rye flour is commonly used.
Fruits/Vegetables Potatoes are used extensively, as are all the Fruits: apples, apricots, blackberries, blueberries, sour Tropical fruits may be eaten.
cold-weather vegetables. cherries, sweet cherries, cranberries, currants, dates,
Cabbage is fermented to make gooseberries, grapefruit, grapes, lemons, lingonber-
sauerkraut. ries, melons, oranges, peaches, pears, plums, prunes,
Fruits and vegetables are often preserved by quinces, raisins, raspberries, rhubarb, strawberries
canning, drying, or pickling.
Fruit is often added to meat dishes. Vegetables: asparagus, beets, broccoli, Brussels sprouts, Greater variety of vegetables consumed; salads
cabbage (red and green), carrots, cauliflower, popular.
celery, celery root, chard, cucumbers, eggplant,
endive, green beans, kohlrabi, leeks, lettuce, mush-
rooms (domestic and wild), olives, onions, parsnips,
peas, green peppers, potatoes, radishes, sorrel,
spinach, tomatoes, turnips
Additional Foods
Seasonings Central Europeans tend to season their Allspice, anise, basil, bay leaves, borage, capers, car- Saffron is a popular spice in Pennsylvania Dutch
dishes with sour-tasting flavors, such as away, cardamom, chervil, chives, cinnamon, fare.
sour cream and vinegar. cloves, curry powder, dill, garlic, ginger, horserad-
ish, juniper, lemon, lovage, mace, marjoram, mint,
mustard, paprika, parsley, pepper (black and
white), poppy seeds, rosemary, rose water, saffron,
sage, savory (summer and winter), tarragon,
thyme, vanilla, vinegar, woodruff
Nuts/seeds Poppy seeds are often used in pastries; Nuts: almonds (sweet and bitter), chestnuts, filberts,
caraway seeds flavor cabbage and bread. pecans, walnuts
Seeds: poppy seeds, sunflower seeds
Beverages Central Europeans drink coffee; Russians Beer, hot chocolate, coffee, syrups and juices, fruit Soft drinks common.
drink tea. brandies, herbal teas, milk, tea, kvass, vodka, wine
Many varieties of beer are produced.
Hungarians and Austrians tend to drink more
wine than other central European people.
Fats/oils Butter, bacon, chicken fat, flaxseed oil, goose fat, Commercial salad dressings, non-dairy creamers
lard, olive oil, salt pork, suet, vegetable oil added to diet.
Sweeteners Honey, sugar (white and brown), molasses
After diners eat smoked eel which sugar has been added. As chile peppers are southern areas of the FSU), sour cream, and fresh
on pumpernickel bread in a New World food, it is thought the Hungarians cream are also common ingredients in sauces,
some restaurants of north- used black pepper to season their food before the soups, stews, and baked products. In Austria and
ern Germany, the waiter discovery of the Americas. Germany, whipped cream is part of the daily diet,
pours inexpensive Schnapps Ground meats are also made into sausages. In served with coffee or pastries.19
over their hands to rid them
Germany there are four basic categories of sausage Traditionally, cold weather fruits and vegeta-
of a fishy odor.
(Wurst). Rohwurst, similar to American-style liver- bles added variety to the diet. Red and green cab-
wurst, is cured and smoked by the butcher and can bage is ubiquitousfound fried, boiled, fermented
be eaten as is. Examples include Teewurst, a raw, as sauerkraut, and added to stuffings, soups, and
The national dish of spiced pork sausage that is spreadable like pt, stews. Potatoes are equally popular. They are most
Switzerland is cheese and Mettwurst, a mild, sliceable pork sausage. often boiled, or roasted and sliced. One German
fondue (chunks of bread Bruhwurst (the frankfurter or Wienerwurst is one specialty found in the northern area of the country
dipped into melted cheese). type) is smoked and scalded by the butcher; it may is called Himmel und Erde (heaven and earth),
The Swiss are known for
be eaten as is or heated by simmering. Kockwurst, a boiled dish of potatoes and sliced apples topped
their zesty cheeses with
holes, such as Emmenthal
which is like a cold cut, may be smoked and is fully with fried bacon and onions. Other root crops
(the original Swiss cheese) cooked by the butcher. Leberwurst (liverwurst), such as beets and kohlrabi accompany many
and Gruyre. Blutwurst (blood sausage), and Size (head cheese) meals. Cucumbers are frequently pickled or served
are examples. Bratwurst, similar to sausage links, is dressed with vinegar for a salad. Onions and mush-
sold raw by the butcher and must be panfried or rooms flavor numerous dishes. Wild mushrooms
grilled before eating. The Polish are famous for are so popular in Poland that they are often used as
Green vegetables as a group kielbasa, a garlic-flavored pork sausage. In Austria a meat substitute on religious fast days.66 Temperate
are called wloszczyzna in some sausages are called Wieners. Two popular vegetables, including tomatoes and eggplant, are
Polish, meaning Italian sausages with both the Czechs and Slovaks are found in the more southern nations of the FSU,
commodities, since so
jaternice, made from pork, and jelita, a blood and are now widely available throughout the
many were originally
imported from the southern
sausage, which can be boiled or fried. region. Cauliflower and tomatoes are the favorite
nation.8 Fresh- and saltwater fish and seafood are often vegetables in Germany today.21 Common fruits
eaten fresh, smoked, or cured. Trout, carp, and include apples, cherries, plums, and berries, though
eel are popular throughout much of the region. In imported bananas are a favorite in Russia.15
Germany herring is commonly pickled and eaten In much of central Europe sweets are enjoyed
as a snack or at the main meal, sometimes as daily. They are eaten at coffeehouses in the morn-
Rollmops, wrapped around a bit of pickle or onion. ing or afternoon, or bought at the local bakery and
In Russia smoked salmon and sturgeon are con- served as dessert. There are numerous types, such
sidered delicacies, as is caviar, which is roe from as cheesecakes, coffee cakes, doughnuts, and nut-
sturgeon. Caviar is classified according to its quality or fruit-filled individual pastries. Apple, cherry,
and source. Beluga, the choicest caviar, is taken raspberry, chocolate, almond, and poppyseed are
from the largest fish and has the largest eggs; its favorite flavors. Austria is reputed to be the home
color varies from black to gray. Sevruga and osetra, of apple strudel, made from paper-thin sheets of
taken from smaller sturgeon, have smaller eggs dough rolled around cinnamon-spiced apple pieces.
and are sometimes a lighter color. Sterlet, or impe- They are also known for Sachertorte, a chocolate
rial caviar, is from a rare sturgeon with golden sponge cake with apricot or cream filling. Germany
roe. The finest caviar is sieved by hand to remove is famous for Schwarzwlder Kirschtorte (Black
membranes and is lightly salted. Less choice roes Forest cake), a rich chocolate cake layered with cher-
are more heavily salted and pressed into bricks. ries, whipped cream, and Kirsch (cherry liqueur).
Though some fish is consumed in Poland, it is not Branch cake, galeziak, which looks similar to a
a popular food, and is in some cases associated gnarled log, is a popular pastry from Lithuania that
with shortages endured during Soviet rule.31 is also found in Poland, where is it is known as
Dairy products are eaten daily. Cheeses may be sekacz or pyramid cake. Dobosch torte, a multi-
served at any meal, from the fresh, sweet varieties, layered sponge cake with chocolate filling and
such as Lithuanian farmers cheese, to the strongly caramel topping, is a favorite in Hungary. Though
flavored aged types like German Limburger. Fresh fresh fruits are eaten infrequently, cooked fruits,
milk is drunk; butter is the preferred cooking fat. such as the berry pudding called kisel in Russia,
Buttermilk (a thick type called kefir is popular in are common desserts throughout the region.
EXPLORING GLOBAL CUISINEArmenia
L egend is that following the flood, vegetables are cultivated, used fresh, dried, instead of rice in many areas. Lahjuman, an
Noahs Ark first found land in and pickled. Apricots, grapes, lemons, per- Armenian pizza made with lamb, vegetables,
Armenia and that the nation was simmons, pomegranates, quince, bell and feta cheese, is a favorite, as is keshkeg, a
founded by his descendents. One of the peppers, cabbage, cucumbers, eggplants, lamb or chicken stew that includes whole
first countries to adopt Christianity, okra, squash, and tomatoes are examples. hulled wheat kernels called zezads.
Armenia has been ruled by a succession of Olives and olive oil are common; however, Dinner begins with a selection of mezze
conquerors, from Rome to Russia, and lamb fat is often preferred for cooking. (appetizers) served with the anise-flavored
today is surrounded by Muslim nations. Its Dishes are seasoned with onions, garlic, aperitif raki. Soups follow, made with
fare reflects this unique past. Bread is so lemon juice, sesame seeds, allspice, basil, yogurt, eggs, and lemon, or tomatoes,
important there that the Armenian word cumin, fenugreek, rosemary, and mint. often with added lentils, meatballs, or even
for it is also used colloquially for meal or Honey flavors most desserts.59 fruit. Salads are also served regularly, often
food in general.17 Lamb is a staple, Armenian cuisine has been significantly with the main course of kebabs, stew, or
though chicken and beef are also popular. influenced by neighboring Greeks, Turks, casserole. Every meal includes bread, such
Pork is rarely consumed, dating back to Persians, Syrians, and other Arabs. Shared as pita, lavash, or choeregArmenian
pre-Christian biblical prohibitions. Freshwa- dishes include the chickpea puree called yeast rolls. Dessert is usually fruit, with
ter fish such as trout and sturgeon (including hummus, tabouli bulgur salad, grilled pastries on special occasions. Traditional
its roe, caviar) are well liked. Yogurt, known kebabs, kufta (meatballs), meat turnovers beverages include coffee, tea, and tahn
as mahdzoon, is consumed daily in soups, known as boereg, meat- or grain-stuffed yogurt thinned with water and flavored
salad dressings, and beverages, as are vegetables called dolma, and paklava with mint. Armenians are world-acclaimed
cheeses such as feta and mozzarella-like (baklava). Many dishes have a distinctly vintners. Wine and brandy made from
string cheese, which are often flavored Armenian twist. Pilaf, also called plov, is grapes, raisins, apricots, or other fruits are
with spices or herbs. Numerous fruits and preferred with bulgur and vermicelli frequently consumed.
In central Europe the most common hot bev- lemon or raspberry fruit syrup for a refreshing Sachertorte was the subject
erage is coffee. In Russia, strong tea diluted with summer beverage. In Russia and other FSU of a famous Viennese court
hot water from a samovar is consumed instead. A nations a sour beer fermented from rye bread or battle regarding who had
samovar is a brass urn, which may be very beets, called kvass, is popular. It is slightly sweet the rights to claim the orig-
ornate, heated by charcoal inserted in a vertical and fizzy and sometimes flavored with black cur- inal recipeit was known
as the Sweet Seven Years
tube running through the urns center. Although rant leaves, caraway, mint, or lemon. Mead, a beer-
War due to the length of
southwestern Germany, Austria, and Hungary like product fermented from honey, is a Polish the case.63
produce excellent white wine, the most popular specialty. Schnapps, a fruit brandy made from
alcoholic drink in the region is beer. The Czechs fermented fruit, such as cherries, is popular in
are known for pilsner beer, which is bitter tasting Germany. Vodka, which is commonly drunk in
but light in color and body. German beers can be Poland and Russia, is a distilled spirit made from
sweet, bitter, weak, or strong and are typically potatoes. It is served ice cold and often flavored
bottom-fermented (meaning the yeast sinks with seasonings, such as lemon or black pepper.
during brewing). Lager, a bottom-fermented beer In Poland the vodka goldwasser contains flakes of
that is aged for about six weeks, is the most pure gold.
common type. Bock beer is the strongest flavored,
has a higher than average alcohol content, and is Meal Composition and Cycle
Sharing food is essential to
sometimes called liquid bread. Mrzenbier, a beer Daily Patterns Gypsy culture. The harshest
midway between a pilsner and a bock beer, is served Central Europe. In the past, people of this punishment that can be
at Oktoberfest (see section on Special Occasions) region ate five or six large meals a day, if they could imposed on an individual is
in Munich. Weissbier is a light, top-fermented afford it. The poor, and usually the people who to be banned from commu-
beer brewed from wheat, and often mixed with a worked the land, had fewer meals, which were nal meals.
often meatless. Today modern work schedules

have changed the meal pattern, resulting in three
meals with snacks each day.
In Germany and the countries of central
Europe the first meal of the day is breakfast, which
consists of bread served with butter and jam.
Sometimes breakfast is accompanied by soft-
boiled eggs, cheese, and ham. In Poland tea served
in glasses is the traditional beverage. The tea is
sucked through a sugar cube held between the
teeth. At midmorning many people have their
second breakfast, which may include coffee, tea, or
hot chocolate, and pastries, bread, and fruit, or a
small sandwich. Lunch is the main meal of the day.
Eising/Getty Images
In the past, people ate lunch at home, but today

they are more likely to go to a cafeteria or restau-
rant. A proper lunch begins with soup, followed by
a fish course, and then one or two meat dishes
served with vegetables, and perhaps stewed fruit.
Many German foods have been adopted in the United States, including lager-style beer, pork or veal Dessert is the final course, usually served with
sausages, and pretzels. whipped cream. A quicker and lighter lunch may
consist of only a stew or a one-pot meal.
A break is taken at mid-afternoon, if time per-
mits. It typically includes coffee or tea and cake
or cookies. The evening meal tends to be light,
usually including salads and an assortment of
pickled or smoked fish, cheese, ham, and sausages
SAMPLE MENU eaten with a selection of breads. In Germany this
meal is called Abendbrot, meaning evening
bread. However, westernization and shorter
German Abendbrot lunch hours mean that nearly a third of Germans
now eat smaller lunches with a larger meal than
A Selection of Sausages, Sliced Ham, and Cheeses Abendbrot in the evening.21
(Westphalian Ham, Teewurst, etc.)* Gypsies customarily eat two meals each day, first
Herring (Salad) in Cream Saucea, c * thing in the morning and in the late afternoon.
Meals are typically social occasions, featuring the
Pumpernickel Bread, Small Rolls dishes common in their adopted homeland;
Potato Salad,a, b, c Beet Salad,a, b, c Pickles stews, fried foods, and unleavened breads are
especially popular.
Mohnkuchen (Poppyseed Cake)a, b
Beer or White Wine Russia and the FSU. In czarist times the aris-
tocracy ate four complete meals per day; dinner
a
was the largest. The majority of the population
Heberle, M.O. 1996. German cooking: The complete guide to preparing classic and never ate as lavishly or as often. The meal that
modern German cuisine, adapted for the American kitchen. New York: HP Books.
b
peasants ate after a long days work is still the
German Recipes at http://www.sheries-kitchen.com/
recipes/german/german1.htm basis of a typical diet in present-day Russia, as
c
German Recipes at http://www.ustash.com/recipes/list/33
well as in some parts of the FSU, including the
Ukraine. Three hearty meals a day are common,
*Can be purchased at German-style delicatessen
with the largest meal consumed at lunch. Snacking
is rare. The staples are bread; soup made from
beets (borscht, which is of Ukrainian origin), cab-
bage (shchi), or fish (ukha); and kasha (cooked
porridge made from barley, buckwheat, or millet).43

In Lithuania, soup is often replaced by salads. Tea,
kvass, vodka, or beer usually accompanies meals.
One part of the traditional czarist evening
meal, zakuski (meaning small bites), is still part
of dinner in Russia today. This traditional array
of appetizers starts the meal, and may range from
two simple dishes, such as pickled herring and
cucumbers in sour cream, to an entire table spread
with countless hors doeuvres. An assortment of
zakuski usually includes a variety of small, open-
faced sandwiches topped with cold, smoked fish;
anchovies or sardines; cold tongue and pickles; and
ham, sausages, or salami. Caviar, the most elegant
of zakuski, is served with an accompanying plate
of chopped, hard-boiled eggs and finely minced
onions. Other zakuski include marinated or pick-
led vegetables, hot meat dishes, and eggs served a
variety of ways.
Etiquette. Central Europeans tend to be more

formal than most Americans. In Germany guests
are generally not invited for dinner but may be
asked for dessert and wine later in the evening. If
Lottie Davies/Getty Images

you are invited for a meal at a home or restaurant,
the invitation may indicate c.t. (cum tempore),
meaning you can arrive up to fifteen minutes late,
or s.t. (sine tempore) meaning to be exactly on
time. Do not begin the meal before the host says,
Guten Appetit. In Poland people do not begin a Russian appetizers, called
meal until everyone is served and the host says, the table with the wrists resting on the edge. Pass zakuski, often feature blini
smacznego. In the Czech Republic and Slovakia all dishes to the left. Wine and vodka may be poured topped with sour cream,
the host says dobrochot; in Hungary it is jo in tumblers instead of glasses specific for each smoked salmon or caviar,
atvadyat. In Russia wait for the host to say pree beverage, and will usually be refilled as soon as and chives.
yat na vah appeteetah. The word for hospitality in they are emptied. Vodka is traditionally consumed
Russia is khlebosolstvo, meaning bread and salt. in one shot.
Bread is traditionally served with both butter and a
Special Occasions. The majority of central
small bowl of salt for dipping to welcome diners.66
European holidays have a religious significance,
Appropriate hostess gifts are good quality dessert
although some traditions date back to pre-Christian
wines, candies, or pastries. Do not bring vodka in
times. The two major holidays in the region are
regions where it is commonly served, because it
Christmas and Easter. Many of the American
suggests your host does not have enough on hand. Fast foods, including
symbols and activities associated with these holi- American hamburger fran-
In the Czech Republic, Slovakia, and Hungary, Jack
days, such as the Christmas tree and the Easter chises, are very popular
Daniels whiskey is particularly appreciated.9
egg hunt, were brought to the United States by throughout the region. In
The continental European style of eating with
central European immigrants. Germany, street stands
the fork in the left hand and the knife in the right
offering bratwurst and cur-
is common throughout the region. Do not switch Germany. Germany is a land of popular festivals.
rywurst (sausage with curry
utensils when eating. In Germany knives are only Nearly all are accompanied by food and drink. seasoning) and french fries
used when absolutely necessary. Cutting potatoes, Probably the best-known celebration is Munichs are common. Dner kebabs,
pancakes, or dumplings with a knife is an insult to Oktoberfest, which lasts for sixteen days from Turkish-style lamb in pita
the cook or host because it suggests that these items late September through early October. Founded bread, are another favorite
are tough. When not eating, keep your hands above in 1810 to commemorate the marriage of Prince in Germany and in Russia.
In Hungary a gift-giving Ludwig of Bavaria, it is now an annual festival lamb sculptured from butter or white sugar.
tradition called komatl with polka bands and prodigious sausage-eating Before the feasting begins, one of the eggs is
includes an exchange of and beer-drinking. shelled, divided, and reverently eaten. The
sweets, fruit, and wine. It is Advent and Christmas are the holiest seasons crowning glory of the meal is the babka, a rich
customarily done between in German-speaking countries. The Christmas tree, yeast cake. All the foods are blessed by the priest
girls to establish lifelong
a remnant of pagan winter solstice rites, is lit on before being served. On Christmas Eve, tradition-
friendships, and to support
women after childbirth.54
Christmas Eve when the presents, brought not by ally a fast day, a meal of soup, fish, noodle dishes,
Santa Claus but by the Christ Child, are opened. The and pastries is served when the first star of the
Christmas tree is not taken down until Epiphany, evening is seen.31 One popular soup, barszcz
January 6. A large festive dinner is served on Wigilijny, a cousin to Russian borscht, is made with
Marzipan, a paste of ground Christmas Day, and it is customary for families mushrooms as well as beets. Carp is usually the
almonds and sugar, is com- to visit one another. Foods served during the fish served on Christmas Eve. A rich Christmas
monly used in desserts and Christmas season include carp on Christmas Eve cake, makowiec, is shaped like a jelly roll and
candies throughout central and roast hare or goose accompanied by apples and filled with black poppy seeds, honey, raisins, and
Europe. nuts on Christmas Day. Brightly colored marzipan almonds. Jelly doughnuts, paczki, are eaten on
candies in the shape of fruits and animals are tra- New Years Eve, while on New Years Day bigos is
ditional Christmas sweets. Other desserts pre- washed down with plenty of vodka.
In the Polish Easter meal the pared during the season are spice cakes and
dairy products, meats, and cookies (Pfeffernsse and Lebkuchen), fruit cakes Austria, Hungary, the Czech Republic, and
pastries symbolize the fer- (Stollen), cakes in the shape of a Christmas tree Slovakia. At Christmastime the Czechs eat carp
tility and renewal of spring-
(Baumkuchen), and gingerbread houses. four different ways: breaded and fried, baked with
time, while the horseradish is dried prunes, cold in aspic, and in a fish soup. The
a reminder of the bitterness
On Easter Sunday the Easter bunny hides col-
ored eggs in the house and garden for the children Christmas Eve meal might also include pearl barley
and disappointments in life. soup with mushrooms, fruits, and decorated
to find. Ham and pureed peas are typically served
for Easter dinner. Candy Easter eggs and rabbits are cookies. Christmas dinner features giblet soup with
One customary Christmas
Eve dish in Poland is karp po also part of the festivities. noodles, roast goose with dumplings and sauer-
zydowsku, chilled slices of kraut, braided sweet bread (vanocka or houska),
carp in a sweet-and-sour
Poland. Christmas and Easter are the two most fruits and nuts, and coffee. Kolaches, round yeast
aspic with raisins and important holidays in Poland, a predominantly buns filled with poppy seeds, dried fruit, or cottage
almonds. It is of Jewish Catholic country. On Easter the festive table may cheese, are served at the Christmas meal and on
origin, dating to when feature a roast suckling pig, hams, coils of sausages, most festive occasions. For Easter a baked ham or
Poland was a haven for Jews and roast veal. Always included are painted hard- roasted kid is served with mazanec (vanocka dough
in the fourteenth century. boiled eggs, grated horseradish, and a Paschal with raisins and almonds shaped into a round loaf).
The Slovaks break the Advent fast on Christmas
Vanocka, a Christmas bread Eve by eating oplatky, small, wafer-like Communion
popular in the Czech bread spread with honey. The meal may contain
Republic. wild mushroom soup, cabbage and potato
dumplings, stuffed cabbage (holubjy), and mashed
potato dumplings covered with butter and cheese
(halusky). A favorite dessert is babalky, pieces of
bread sliced, scalded, and drained and then rolled
in ground poppy seeds, sugar, or honey. Mulled
wine usually accompanies this meal, as do assorted
poppy seed and nut pastries and a variety of fruits.
For Easter the Slovaks prepare paska, a dessert in
Courtesy of Florida State News Bureau
the form of a pyramid containing cheese, cream,

butter, eggs, sugar, and candied fruits, decorated
with a cross. The meal, blessed by the priest on
Holy Saturday, includes ham, sausage (klobsa),
roast duck or goose, horseradish, an Easter
cheese called syrek, and an imitation cheese ball
made from eggs (hrudka).
In Hungary the most important religious holi- after midnight Mass are pascha, similar to the The term pascha comes
day is Easter. Starting before Lent, pancakes are Slovak paska but decorated with the letters XB from the Hebrew word for
traditionally eaten on Shrove Tuesday; sour eggs (Christ is risen); kulich, a cake made from a very Passover, Pesach.
and herring salad are served on Ash Wednesday. rich, sweet yeast dough baked in a tall, cylindrical
During Easter week, new spring vegetables are mold; and red or hand-decorated hard-boiled eggs.
enjoyed, as well as painted Easter eggs. The Good On Pentecost (Trinity) Sunday (fifty days after
Friday meal may include a wine-flavored soup, Easter), kulich left over from Easter is eaten.
stuffed eggs, and baked fish. The biggest and most Twelve different dishes, representing the
important meal of the year is the feast of Easter twelve apostles, are traditionally served during the
Eve, which consists of a rich chicken soup served Russian and Ukrainian Christmas Eve meal. One of
with dumplings or noodles, followed by roasted the dishes is kutia, or sochivo, a porridge of wheat
meat (ham, pork, or lamb), then several pickled grains combined with honey, poppy seeds, and
vegetables, stuffed cabbage rolls, and finally a stewed dried fruit consumed when the first stars of
selection of cakes and pastries served with coffee. Christmas Eve appear. A festive meal is served on
The Christmas Eve meal, which is meatless, usu- Christmas Day. On New Years Day children receive
Most Christmas food tradi-
ally features fish and potatoes. The Christmas Day gifts, and spicy ginger cakes are eaten. A pretzel-
tions in Russia did not sur-
meal often includes roast turkey, chicken, or shaped sweet bread, krendel, is eaten on wedding vive the Soviet-ruled period
goose accompanied by roast potatoes and stuffed anniversaries and name days (saints days are cele- when religious ceremonies
cabbage, followed by desserts of brandied fruits or brated as birthdays in the Eastern Orthodox faith). were discouraged.15
fruit compote and poppy seed and nut cakes.
In addition to Christmas and Easter the Therapeutic Uses of Foods. A study of German Ukrainians set a place at the
Austrians celebrate Fasching (a holiday also American elders found that they sometimes table for the spirits of dead
known in southern Germany). Originating as a use home remedies to treat minor illnesses. ancestors at Christmas.
pagan ceremony to drive out the evil spirits of
winter in which a procession would parade down
the main street of a town ringing cow bells, it
developed into a multi-day carnival associated
with Lent. In Vienna, over 300 sumptuous balls
are held during the event, including those hosted
by the coffee brewers and the confectioners of the SAMPLE MENU
city. Doughnuts, fritters, and other sweets are
typical festival food.
A Russian Dinner
Russia and the FSU. Before the 1917 revolution,
Russians celebrated a full calendar of religious Pirozhki (Baked Turnovers)a, b
holidays, including 250 fast days.66 Fish was sig-
Shchi (Cab bage Soup)a, b
nificant on days when it was allowed, but at other
fast meals, mushrooms were so common as entrees Kotlety (Chicken Cutlets)a, b
that they became known as forest meat.15 Today,
the observant still does not eat any animal products Kasha with Mushrooms (Buckwheat Groats)a, b
during fasts (see Chapter 4, Food and Religion
Fruit Compote
for the fast days in the Eastern Orthodox Church).
The most significant holiday is Easter, which Vodka and Beer
replaced a pre-Christian festival that marked the
end of the bleak winter season. The Butter
Festival (maslenitas) precedes the forty days of a
Visson, L. 2004. The Russian heritage cookbook. Woodstock, NY:
Lent. One food eaten during this period is blini, The Overlook Press.
raised buckwheat pancakes. Blini can be served b
Russian Cuisine at http://www.ruscuisine.com/
with various toppings such as butter, jam, sour
cream, smoked salmon, or caviar. Butter is the
traditional topping because it cannot be eaten
during Lent. Traditional foods served on Easter
Malzbier is a German beer Chicken soup is used for diarrhea, vomiting, or CONTEMPORARY FOOD HABITS
(1 percent alcohol) that is sore throat. Tea is taken for an upset stomach,
considered appropriate for
and milk with honey is commonly used for a
young children and nursing cough.51 Traditionally, the Pennsylvania Dutch Adaptations of Food Habits
mothers.
believe cold drinks are unhealthy and that eating Ingredients and Common Foods. The central
meat three times a day is the cornerstone of a European and Russian diet is not significantly dif-
good diet. Herbal teas are consumed for a variety ferent from American fare. Immigrants made few
of complaints.22, 65 changes in the types of foods they ate after they
Polish American elders reportedly believe came to the United States. What did change was the
that sauerkraut is good for colic, as are tea and quantity of certain foods. Most central European
soda water. Chamomile tea is used for cramps, immigrants were not wealthy in their native lands,
tea with dried raspberries and wine for and their diets had included meager amounts of
colds, cooked garlic for high blood pressure, meat. After immigrating to the United States, they
and warm beverages (milk, tea, or lemonade) increased the quantity of meat they ate considerably.
for coughs. Tea with honey and alcoholic The people of eastern Pennsylvania, where there
spirits may be used to help sweat out an is a large concentration of German Americans,
illness. 10, 51 still eat many traditional German dishes adapted
Gypsies have unique health beliefs, many to accommodate available ingredients. Common
involving food. For example, Gypsies tradition- foods include scrapple (also called ponhaus), a
ally think that fresh food is the most nourishing pork and cornmeal sausage flavored with herbs
and that leftovers are unwholesome. Canned and cooked in a loaf pan, served for breakfast
and frozen items may be mistrusted as not with syrup; sticky buns, little sweet rolls thought
being fresh. Many Gypsies believe that non- to be descended from German cinnamon rolls
Gypsies carry disease, and they may insist on known as Schnecken; schnitz un knepp (apples
using disposable plates and utensils any time and dumplings), a one-pot dish made from
they must eat in a public place. Insufficient boiled ham, dried apple slices, and brown sugar,
intake of lucky foods, such as salt, pepper, topped with a dumpling dough; boova shenkel,
vinegar, and garlic, can predispose a person to beef stew with potato dumplings; hinkel welschkarn
poor health. Home remedies, such as tea with suup, a rich chicken soup brimming with tender
crushed strawberries, asafetida (called devils kernels of corn; apple butter, a rich fruit spread,
dung), and ghost vomit (Fuligo septica), are very much like a jam; schmierkaes, a German cot-
common.18, 53 tage cheese; funnel cake, a type of doughnut;
Russians and people of the FSU ascribe shoofly pie, a molasses pie thought to be descended
health benefits to many different foods. Butter from a German crumb cake called Streuselkuchen;
is considered good for eyesight, dill for dys- fastnachts, doughnuts, originally prepared and
pepsia, and honey for flatulence.12 Respiratory eaten on Shrove Tuesday to use up the fat that
infections may be treated with gogomul, a mix- could not be eaten during Lent; and sweets and
ture of egg yolk, sugar, milk, and baking soda.33 sours, sweet-and-sour relishes, such as coleslaw,
Teas made from raspberry, chamomile, euca- crabapple jelly, pepper relish, apple butter, and
Ghost vomit (Fuligo septica) lyptus, and cornsilk are used for numerous bread-and-butter pickles, served with lunch and
is a myxomycete or slime complaints. Some alcoholic beverages are of dinner. Saffron crocuses were cultivated in parts
mold. The thin, yellow, particular therapeutic repute. Kvass, the slightly of Pennsylvania, and the seasoning was used to
creeping mass is found on fermented beverage made from bread, is color many dishes dark yellow, from soups to a
rotting wood and other believed to be good for digestion and to cure traditional wedding cake known as Schwenkfelder.
decaying material, where it hangovers. Balsam, flavored vodka, is tradition- Much of German cooking has been incorpo-
eats bacteria.
ally used to cure everything from the common rated into American cuisine. Many foods still
cold to alcoholism. More recently, vodka distilled have German names, although they are so
Some Russian-American
mothers fear that cold milk with medicinal herbs, such as ginseng or common in the United States that their source is
may cause illness in their schizandra, has become a favorite supplement unrecognized (e.g., sauerkraut, pretzels, pickles).
child and leave milk at consumed as a shot or added to tea or coffee. Other foods contributed by the Germans are
room temperature for hours Full, hearty meals are considered important in hamburgers, frankfurters, braunschweiger (liver
to warm it.45 maintaining health.45 sausage), thuringer (summer sausage), liverwurst,
jelly doughnuts, and pumpernickel bread. Beer

production, especially in Milwaukee, was domi-
nated by the Germans for more than one hundred
years. German immigrants created a lager-style
beer that is milder, lighter, and less bitter than
typical German beer; it can now be described
as American-style beer (see also Chapter 15,
Regional Americans).
Courtesy Pennsylvania Dutch Visitors Bureau

Meal Composition and Cycle. Third- and
fourth-generation central European, Russian,
and FSU Americans tend to consume three meals
a day (with snacks), and meal composition is
similar to that of a typical American meal,
although more dairy products and sausages may
be eaten. Some traditional foods and ingredients
may not be available in areas without large cen-
Pennsylvania Dutch funnel
tral European or Russian populations.
cake is an unusual dough-
Little dietary acculturation was found in a nut made by pouring the
study of recent immigrants from Russia and other August 20, St. Stephens Day; and the third is the
batter through a funnel or
FSU countries.45 An increased quantity of familiar attempted revolt known as the Revolution of from a pitcher into the hot oil
foods, particularly soured milk, sour cream, kefir, 1956 on October 23. in a swirled pattern.
homemade cheeses, cold cuts, and eggs, and a Among the Amish, many national holidays,
greater variety of fruits (including citrus, bananas, such as the Fourth of July and Halloween, are not
mangoes, pineapples, kiwis, and fruit juices) and observed. A second day of celebration is added to
vegetables (especially broccoli, cauliflower, spinach, Christmas, Easter, and Pentecost: the first day is
Sauerkraut Yankees was a
red cabbage, and mixed salads) are consumed in reserved for sacred ceremonies, the second day derogatory nickname for
the United States, but are incorporated into tradi- for social and recreational activities. Most Amish the Pennsylvania Dutch
tional dishes and meal patterns. Breakfast cereals celebrate all holidays quietly with family. during the Civil War.
are well accepted, and traditional grains such as
barley, buckwheat, and millet are consumed less Nutritional Status On average, Americans
often. Favorite American items include soft drinks, drink thirty-five gallons of
Nutritional Intake. Very little has been reported
beer per person annually.66
ice cream, yogurt, commercial salad dressings, on the nutritional intake of acculturated central
nondairy cream, and whipping cream. Coffee is European or Russian Americans. Recent European-
consumed more often and soups less often, espe- wide studies show the diets of central Europeans
In the 1800s fried oysters
cially at dinner. Snacking on fruit, milk, bread, are among the highest in animal products, pota-
with a glass of Schnapps
pastries, sandwiches, and candy is becoming toes, sweets, and refined/processed items in was a popular Pennsylvania
more common. Europe.49 Consumption of fats and oils of animal Dutch breakfast for men.
Many central European and Russian-American origin was highest in Germany: the mean daily
families serve traditional foods at special occa- intake for added fats and oils was sixty-six grams
sions. On October 11, Polish Americans celebrate for men living in Potsdam.32 Rates of overweight
Pulaski Day, a national day of remembrance that and obesity are 60 percent for German women
features a large parade in traditional apparel and nearly 75 percent for German men. Slightly
down the streets of New York City. The Austrians lower rates are found in the Czech Republic,
and Czechs typically observe St. Nicholas Day Slovakia, and Hungary.23 Recent immigrants
(December 6), when apples and nuts are put in from Russia and other FSU nations were found to
the stockings of well-behaved children, and coal consume a diet high in saturated fats, sodium,
is given to the naughty ones. Hungarian Americans and sugar.45 It is reasonable to assume central
observe three unique holidays in the United European, Russian, and other FSU Americans may
States with a combination of patriotic and reli- be at risk of developing cardiovascular disease
gious activities. The first is March 15, commem- and other conditions associated with high-fat
orating the revolution of 1848; the second is items (particularly red meats, processed meats,
and dairy products) popular in their traditional Wilsons disease, and metachromatic leukodys-
cultures and American fare. trophy. Rates of both infant mortality and unfa-
High rates of gastric cancer Recent immigrants from Russian and FSU vorable birth outcomes are high; overall life
in Lithuania are believed to nations may suffer some nutritional deficiencies expectancy is low.47
be due in part to a high con- due to inadequate consumption of fruits and veg-
sumption of salted and Counseling. Communication difficulties may
etables. Low intakes of riboflavin and vitamin C occur with recent or older central European or
cured meats and fish.52 are reported.48 High rates of diabetes, hyperten- Russian immigrants. Language barriers may
sion, hyperlipidemia, and cardiovascular disease necessitate the use of a competent translator.
are found in Russian-speaking immigrants. Good manners and formality are expected in
Tuberculosis incidence has been increasing dra- German conversations. Education is respected,
matically in Russia in recent years and is thus a and the use of titles is important.9 Honesty and
concern for new immigrants. Nearly 80 percent directness are appreciated. Germans are mono-
of immigrants from Russia are thought to be chronistic and prefer to deal with one topic at a
from the regions most affected by the Chernobyl time. Direct eye contact is a sign of attentiveness
nuclear power accident of 1979. Increases in and trust. A handshake is used in greeting, but
leukemia and thyroid cancer in this population there is little other touching between acquain-
have been noted.1 tances. Poles tend to speak more quietly than
A study of recent immigrant Russian mothers Americans and feel uncomfortable with loud
found strong support for breast feeding. All but behavior. Discussions about politics are avoided.
one of ninety participants breast fed their infants Direct eye contact and a handshake during a
exclusively or partially for an average of twenty- greeting and when leaving are appropriate.
eight to thirty weeks, regardless of whether the German Americans, as well as other central
babies had been born in Russia or the United European Americans, emphasize self-reliance
States.27 This contrasts with health reports from and may avoid health care. Polish Americans may
Russia, where breast feeding is discouraged, and be reluctant to express pain and often deny symp-
infant nutrition has been compromised by inade- toms of illness.10 Compliance problems develop if
quate supplies of formula. High rates of iron- medication is seen as a last resort, taken only until
deficiency anemia (affecting 25 to 50 percent of symptoms disappear.
children) and endemic goiter have been reported.1 Many Amish still speak a German dialect, so an
Since the Chernobyl nuclear power accident, interpreter may be necessary to provide care. The
some Russians may resist having x-rays taken Amish are often reserved and respectful and expect
because they fear radiation exposure.33 to be treated in a similar manner. Modesty is
Heavy alcohol use has been reported in important to the Amish, and wearing conservative
Russia, certain FSU nations, and Poland.7, 16, 48, 62 clothing when counseling clients is appropriate.
Some researchers are concerned that immigrants Modern health technology is not in conflict with
from these countries may continue similar drink- traditional Amish religious precepts; however, it
ing patterns; however, data are limited.10, 64 Low may be avoided unless absolutely necessary, such
rates of alcoholism have been reported among as during a medical emergency.64 Photos are not
Russian-speaking immigrants.48 allowed, though x-rays and other scans are
A small study of Gypsies in Boston found high accepted if their necessity is explained. Educational
rates of hypertension, type 2 diabetes, and vascu- materials should not include pictures of the Amish,
lar disease, affecting between 80 and 100 percent nor illustrations representing human faces. A
Some Russian Americans of the population over age fifty. Approximately survey of physicians with experience treating the
favor homemade cheeses 85 percent were obese. Chronic renal insufficiency Amish noted more problems with digestive disor-
made with unpasteurized was also a problem.57, 58 In Europe researchers ders, obesity, and chronic bed-wetting than with
milk, risking Listeria mono-
have found high rates of dyslipidemia, obesity, and non-Amish clients.22 The doctors opinion was that
cytogenes infection.11
insulin resistance, suggesting a predisposition for the Amish eat a diet higher in fat and salt than the
Eggs are sometimes used metabolic syndrome (for more information on this non-Amish, which may contribute to these prob-
raw in uncooked dishes by topic, see Chapter 14).28, 29 Genetic problems due to lems; however, the Amish showed fewer symptoms
Russian and FSU Americans, high rates of consanguinity show Gypsies at risk for of heart disease and alcoholism than non-Amish
putting them at risk for several metabolic conditions, including phenylke- patients. Conditions regarding maternal and child
Salmonella poisoning. tonuria, galactokinase deficiency, citrullinaemia, health are common, and hereditary diseases,
including phenylketonuria and other metabolic communication is direct, and may be loud or Gypsies may reject injec-
disorders, are more prevalent among the Amish expressive.64 Direct eye contact is the norm. A tions for fear that some-
than the U.S. population as a whole.64 quick three kisses on the cheeks or a handshake is thing impure from the
In working with Gypsy-American clients, health used in greeting, and touching becomes more outside will contaminate
care providers should be aware that English is usu- prominent with familiarity. Russians may consider the pure inner body.
ally a second language and that illiteracy is it impolite to sit with the legs splayed or with an
Health care providers work-
common. However, Gypsies are often very adaptive ankle resting on the knee. ing with Russians report
and may use many forms of communication, Preventative screenings are uncommon in the that some immigrants
depending on the situation. Gypsies believe that FSU, and clients may not understand the need for believe potatoes cause type
the measure of a mans worth is in his girth the procedures.33 Counseling and mental health 2 diabetes.
weight gain is associated with health, weight loss issues were avoided by elderly Russian immi-
with illness.20 Gypsies will often not seek treatment grants in one study, perhaps due to the social and
until an emergency develops. Numerous family economic stigma associated with psychological
members will come with a client to provide sup- disorders in Russia.5 These Russian clients
port, often bringing food, because most Gypsies expected extensive help with personal problems
consider food prepared by non-Gypsies impure.53 and information on social services from their pri-
Russians expect formality between acquain- mary provider. An increased perception of pain
tances, and first names are saved for close friends and somatic symptoms are common; many
and relatives. Some Russians may initially respond Russian Americans do not believe U.S. physicians
to any question that requires an affirmative or neg- understand their ailments or treatments.50
ative answer with a no; in most cases, however, Culture-specific illnesses, such as avitaminosis
NEW AMERICAN PERSPECTIVESRussian

Clara Schmidt
emigrated from the Moldova Republic (formerly Moldavia in the former Soviet Union), first to Israel in 1988, and then to
I the Unites States to be near my son. I was an English professor in the Soviet Union and Israel. My family was originally
from Romania.
In the Soviet Union we had enough food but not in abundance. Food was very important to us because of previous shortages, and
as a result we were forced to finish everything we were served. Food was never thrown away. In the morning we might have tea with
a bread sandwich of butter and jam and/or possibly an egg. Snacks were not typical, but it might be a sandwich or fruit. It was some-
thing you brought with you if you went out, since you couldnt purchase them. Dinner was at lunch time (1:003:00 PM) and was the
biggest meal of the day. We ate at home, and the meal was served when my father came home. The meal included soup (vegetable,
chicken, or beet/cabbage), salad of several types of vegetables, meat, or fish with potatoes/rice, and fruit for dessert. We drank soft
drinks with the meal. Supper was from 6:00 to 8:00 PM and could include sausage, vegetables, bread, and maybe leftovers, dairy
(yogurt, cottage cheese), or cottage cheese pancakes with sour cream.
My diet changed the most after I immigrated to Israel. We ate less soup, less fat, and more fresh fruit and vegetables year round.
We ate much less meat and of course no pork. In Israel I learned to love avocadoes and hummus (chickpea dip), and I still eat them
here. In the United States we started to eat the American way. Dinner, now the main meal, was closer to 5:00 or 6:00 PM. It might
include chicken soup with vegetables, lamb, cooked fish (not fried), and vegetables. One thing I love here is barbequed lamb ribs.
Breakfast has changed to cereal/oatmeal, yogurt, and fruit. Lunch is now a sandwich or salad. I have switched from tea to coffee,
and it is something I cant do without. Other things I couldnt change in my diet would be limiting fruit, vegetables, and dairy prod-
ucts. For special occasions I still prepare family recipes, like Georgian chicken with walnuts, chicken necks stuffed with chopped
liver, and a three-layer sour cream cake with honey and nuts.
My impression of American eating is that some Americans count every calorie they eat, but the food they eat is not tasty, and that
most Americans eat a lot of very tasty but unhealthy food. Fast foods taste good, but the amount of fat is awfulseems like it is all
meat and fried food. I prefer plain food, but made at home.
or dysbacteriosis, are unfamiliar diagnoses in seventeenth century. Jonas Bronck, a Dane,

the United States.12 Injections are preferred over arrived in 1629 and bought a large tract of land
oral medications, and lifestyle modification such from the Native Americans that later became
as diet and exercise may be a new concept for some known as the Bronx in New York City.
clients. One study found that patients frequently
self-medicate with drugs obtained from the FSU Immigration Patterns. The majority of Scandi-
and often cut the dosage of prescriptions obtained navians arrived in the United States in the 1800s,
in the U.S. because they are considered too led by the Norwegians and the Swedes. During
strong.33 Russian clients are often very assertive the nineteenth century, no other country except
in their requests because aggressive behavior was Ireland contributed as large a proportion of its
necessary to receive attention in the Russian health population to the settlement of North America
care system. However, some Russian-speaking as Norway. During the 1900s an additional
immigrants may be reluctant to discuss any infec- 363,000 Norwegians, more than 1,250,000 Swedes,
tious diseases for fear of being ostracized within 363,000 Danes, and 300,000 Finns entered the
their community. United States.
Many Americans of central European and The peak years of Scandinavian immigration
Russian decent are highly acculturated. An in-depth to the United States were between 1820 and 1930.
interview can determine any communication The population of all the Scandinavian countries
preferences or traditional health practices. had grown substantially, resulting in economies
that could not absorb the unemployed and land-
less agrarian workers. In Sweden the problem was
magnified by a severe famine in the late 1860s.
Scandinavians For the Norwegians there was the additional lure of
freedom that America offered, and the chance for
Few Icelanders have made The Scandinavian countries include Sweden, emancipation for the peasant class. Scandinavian
their home in the United Norway, Denmark, Finland, and Iceland. With the immigrants typically settled in homogeneous
States; the 2005 U.S. Census exception of Denmark and the island of Iceland, communities.
indicates approximately they are located north of the Baltic and North seas Norwegians and Swedes often moved to the
51,000 Americans claim and share common borders with each other and homestead states of the Midwest, especially Illinois,
Icelandic descent. Minnesota, Michigan, Iowa, and Wisconsin.
Russia. Most of the population in Scandinavia is
concentrated in the warmer southern regions; the One-fifth of all Swedish immigrants settled in
harsher northern areas extend above the Arctic Minnesota. Pockets of Finns and Danes also settled
Circle. Norways weather is more moderate than in this region, but they were fewer in number.
that of Finland and Sweden because its long west- Many Norwegians and Swedes later moved to the
ern coastline is washed in the temperate North Northwest, working in the lumber and fishing
Atlantic Drift. Denmark juts into the North Sea to industries. The shipping industry attracted some
the north of Germany, and its capital, Copenhagen, Norwegians to New York City, where they still
is directly opposite from Sweden. Numerous live in an ethnic enclave in Brooklyn. Although
Scandinavians have made their homes in the Swedes and Norwegians are often associated with
United States. This section reviews the traditional the rural communities of the Midwest, by 1890
foods of Scandinavia and the Swedish, Norwegian, one-third of all Swedes lived in cities, and many
and Danish contributions to the American diet. Norwegians were seeking opportunity in the
urban areas. Chicago and Minneapolis still have
CULTURAL PERSPECTIVE large Scandinavian populations.
The Danes, in an effort to preserve their eth-
History of Scandinavians in the United States nicity, developed twenty-four rural communities
Legend is that the Norsemen (ancient Scandina- between 1886 and 1935 in which, for a set number
vians), renowned seafarers and explorers, first of years, land could be sold only to Danes. The best
discovered North America and colonized as far known of these communities are Tyler, Minnesota;
west as Minnesota in the thirteenth and four- Danevang, Texas; Askov, Minnesota; Dagmar,
teenth centuries. The documented presence Missouri; and Solvang, California. Today most
of Scandinavians in America dates back to the Danes live in cities, primarily on the East or
West coasts. The largest concentrations of Danes Lutheran churches joined together to create the The Scandinavians intro-
are in the Los Angeles area and in Chicago. Evangelical Lutheran Church in America (ELCA) duced the cast iron stove to
Following World War I, U.S. immigration from in 1987. Those Scandinavians who are not Lutheran the United States in the
Finland dropped significantly as Finns chose other often belong to other Protestant churches, includ- early 1800s. Cooking was
countries for emigration. As the Finnish population ing Methodist, Mormon, Seventh-Day Adventist, previously done in fire-
places and brick ovens.
stagnated, ethnic identity became very difficult to Baptist, Quaker, and Unitarian.
maintain. Second- and third-generation Finns are
highly acculturated. Family. The nuclear Scandinavian family was
at the center of rural life. Families were typically Adherents of one Finnish
Current Demographics and Socioeconomic Lutheran sect, the
large, and the father was head of the household.
Status. According to the 2005 U.S. Census, there Laestadians, often marry
Kinship ties were strong: families were expected to
within their ethnic group,
are approximately 1.4 million Danes, 4.2 million pay the way for relatives remaining in Scandinavia even going to Finland to
Swedes, 4.6 million Norwegians, and 646,000 Finns to come to the United States, where they would find partners of the same
and their descendants now living in the United be given a room, board, and help in finding faith.61
States. Most Scandinavians assimilated rapidly into employment. The power of the father diminished
American society, rising from blue-collar to white- and family size decreased as the Scandinavian
collar jobs within a few generations. Americans became more integrated in main-
A majority of Scandinavian immigrants were stream society. Among the Finns, it has been
literate in their own language and often produced noted that when both parents work, they may
local newspapers, periodicals, and books. choose to have only one child.61
Education was valued as a way to improve eco-
nomic standing. The Danes opened folk schools Traditional Health Beliefs and Practices.
designed to foster a love of learning in their com- Information on traditional Scandinavian health
munities, as well as two liberal arts schools. beliefs and practices is very limited. Fish was
Norwegians and Swedes established many col- considered necessary for good health. In Norway
leges. The Finns founded summer schools where cough and cold confectionaries (such as lozenges
traditional Finnish culture and religion were and pastilles) are very popular over-the-counter
taught. Women often had educational opportuni- remedies. A current Norwegian study also found
ties in these schools that were unavailable to them that 56 percent of cancer patients use herbs and
in Scandinavia. dietary supplements primarily to boost immune
Today, many Norwegians and Swedes have function.24 The Finns believe in natural health
continued farming in the Midwest or have taken care, practicing massage, cupping, and bloodlet-
jobs in the construction industry. However, nearly ting. Further, the sauna (a traditional steambath)
one-third of Norwegians are employed in manage- is reputed to have therapeutic qualities. It is used
ment or specialty professions, while many Swedish by Finns when ill and even by midwives during
Americans have moved into engineering, architec- childbirth. It is considered a remedy for colds,
ture, and education.14, 34 Danes entered a variety of respiratory or circulatory problems, and muscu-
occupations, but they were most prominent in lar aches and pains.61
raising livestock and dairying. Urban Danes today One health practice in Sweden that has been
are not associated with specific occupations.40 widely adopted in the United States is Swedish
Finnish American men have been active in fields massage, also known as therapeutic massage. It is In Scandinavia they say,
such as natural resources management, mining a deep muscle technique that uses five main Danes live to eat,
engineering, and geology, while women have been strokes to provide relaxation, increase circula- Norwegians eat to live, and
attracted to nursing and home economics.61 tion, and promote healing. Swedes live to drink.
Worldview The cooking of Finland

TRADITIONAL FOOD HABITS mixes Swedish and Russian
Religion. The majority of Scandinavians who elements, such as smrgs-
immigrated to the United States were Lutheran, Scandinavian fare is simple and hearty, featuring bords, pirozhkis (meat
though each nationality had its own branch of the the abundant foods of the sea and making the turnovers), and blini (thin
church, and within each branch numerous sects best use of the limited foods produced on land. buckwheat pancakes).
were represented. Factionalism was common Scandinavian cooking often reflects the preser- Vodka is preferred over
until many of the Scandinavian and German vation methods of previous centuries. Fish was aquavit.
Table 7.2 Cultural Food Groups: Scandinavian

Protein Foods
Milk/milk products Dairy products, often fermented, are Buttermilk, milk, cream (cow, goat, reindeer);
used extensively. cheese, sour cream, yogurt
Meat/poultry/fish/ Fish is a major source of protein, often Meat: beef, goat, lamb, hare, pork (bacon, ham, More meat and less fish are consumed.
eggs/legumes preserved by drying, pickling, fer- sausage), reindeer, veal, venison
menting, or smoking. Fish and shellfish: anchovies, bass, carp, cod,
crab, crawfish, eel, flounder, grayling, had-
dock, halibut, herring, lobster, mackerel,
mussels, oysters, perch, pike, plaice, roche,
salmon (fresh, smoked, pickled), sardines,
shrimp, sprat, trout, turbot, whitefish
Poultry and small birds: chicken, duck, goose,
grouse, partridge, pheasant, quail, turkey
Eggs: chicken, goose, fish
Legumes: lima beans, split peas (green and
yellow)
Cereals/Grains Wheat is used less than other grains. Barley, oats, rice, rye, wheat More wheat used, fewer other grains.
Rye is used frequently in breads.
Fruits/Vegetables Fruits with cheese are frequently Fruits: apples, apricots, blueberries, cherries, A greater variety of fruits and vegetables
served for dessert. cloudberries, currants, lingonberries, are obtainable in the United States than
Preserved fruits and pickled vegeta- oranges, pears, plums, prunes, raisins, rasp- in Scandinavia but may not be eaten.
bles are common. berries, rhubarb, strawberries
Tapioca (from cassava) is eaten. Vegetables: asparagus, beets, cabbage (red and
green), carrots, cauliflower, celery, celery
root, cucumber, green beans, green peppers,
nettles, kohlrabi, leeks, mushrooms (many
varieties), onions, parsnips, peas, potatoes,
radishes, spinach, tomatoes, yellow and
white turnips
Additional Foods
Seasonings Savory herbs and spices preferred. Allspice, bay leaf, capers, cardamom, chervil,
Cardamom is especially associated cinnamon, cloves, curry powder, dill, garlic,
with Scandinavian sweets. ginger, horseradish, lemon juice, lemon and
orange peel, mace, marjoram, mustard, mus-
tard seed, nutmeg, paprika, parsley, pepper
(black, cayenne, white), rose hips, saffron,
salt, tarragon, thyme, vanilla, vinegar
Nuts/seeds Marzipan (sweetened almond paste) is Almonds, chestnuts, walnuts
used in many sweets.
Beverages Coffee, hot chocolate, milk, tea, ale, aquavit,
beer, vodka, wine, liqueurs
Fats/oils Butter is often used. Butter, lard, margarine, salt pork
Sweeteners Sugar (white and brown), honey, molasses
traditionally dried, smoked, or pickled, and milk Ingredients and Common Foods: Staples
was often fermented or allowed to sour before and Regional Variations
being consumed. Scandinavians still prepare a
The traditional cooking of Scandinavia is hearty.
large variety of preserved foods and prefer
Spices were expensive in the past, and most dishes
their food salty. The basics of the Scandinavian
diet are given in the cultural food groups list feature the natural flavors of ingredients with
(Table 7.2). subtle seasoning. Black pepper, onions, and dill
are used in many recipes, and juniper berries add Though beef is available, veal is more commonly Whey, a byproduct of
interest in others. Caraway, cloves, nutmeg, and consumed. Mutton and lamb are used in roasts cheese making, was tradi-
cardamom flavor many baked goods. and stews, such as the Norwegian frikl (lamb tionally mixed with water
Scandinavians are probably best known for with cabbage), and are also dried or salt-cured, to make a refreshing bever-
then thinly sliced and used like ham. In the more age in Norway, northern
their use of fish and shellfish, such as cod, herring,
Sweden, and Iceland.
mackerel, pike, salmon, sardines, shrimp, and northern areas reindeer is raised and is a popular
trout. It is so common that in restaurants the lunch meat. Other game meats such as elk, venison, and
special is often listed simply as dagensratt (fish of hare are hunted in the fall and considered a delicacy.
the day).66 In Norway the fish-processing industry Poultry is not especially well-liked; however, pickled
is believed to date back to the ninth century, and goose and stuffed fresh goose are eaten, as are
today, Scandinavian dried salt cod is exported all certain game birds, such as grouse.
over the world. Popular fish dishes include salmon Historically, meat was in limited supply, so it was
marinated in dill, called gravlax; smoked salmon, stretched by chopping it and combining it with other
known as lox; and the many varieties of pickled ingredients, resulting in many traditional dishes.
herring. Fish sticks and fish baked with cheese and Scandinavians eat many vegetables, such as
breadcrumbs are common homestyle dishes. onions and cabbage, stuffed with ground pork,
Cream and butter are used in many dishes, veal, or beef. The Swedes are known for their
especially in Denmark, which has a slightly warmer meatballs served in cream gravy or brown sauce,
climate than the other Scandinavian nations. and the Danes for frikadeller, which are patties of
White sauce made with milk and minced parsley ground pork and veal, breadcrumbs, and onion
tops many Danish dishes, such as roast bacon, eel, fried in butter. The Norwegians prepare kjttkaker,
and herring, as well as boiled and cured meats.4 minced beef cakes seasoned with a bit of ginger that
One Swedish specialty is known as Janssons fres- are pan-fried, then boiled, and served with brown
telse (temptation) and includes anchovies and gravy. Beef hash made with beets and onions is
grated potatoes baked in a cream and onion sauce. another example. Sausages are also very common.
Considerable quantities of fermented dairy prod- Cold weather vegetables, including potatoes,
ucts are used throughout the region, such as sour cabbage, kale, Brussels sprouts, carrots, celery root,
cream, cheese, buttermilk, and yogurt-like products, cucumber, beets, turnips, onions, and leeks are
including filmjok (Sweden) and skyr (Iceland). widely available. Rutabagas, sometimes called
Sour cream in particular is added to soups, sauces, Nordic oranges or swedes, are a customary side
and dressings for salads and potatoes. In Norway it dish.41 Yellow and green split pea soups with pieces
is traditional to prepare an oatmeal porridge known of ham or pork are a winter specialty throughout
as rmmegrt with sour cream, and the dish is still Scandinavia, sometimes served with pancakes.
found at many festive occasions. Fish, such as fried Wild mushrooms are a specialty in some areas of
trout or herring, is also customarily served with a Finland and Norway. Though vegetables were tra-
sour cream sauce and boiled potatoes. Denmark is ditionally served cooked, fresh salads have become
renowned for its cheeses, such as semi-firm, popular in recent years. Apples, cherries, prunes,
mellow, nutty-tasting Tybo (usually encased in red and several varieties of berries (particularly lin-
wax); firm and bland Danbo; semisoft, slightly gonberries) are typical fruits, often stewed or made
acidic Havarti; rich, soft Crma Dania; and Danish into preserves that are sometimes served with meat.
blue cheese. Jarlsberg, a Swiss-style cheese, is a well- Bread is a staple food item and is often pre-
known Norwegian product, but brunost, a sweet, pared from rye flour, though wheat, barley, and
brown cheese made from cows milk mixed with oats are also used. Scandinavian breads may or
goats milk and served in thin slices on brown bread, may not be leavened, vary in size and shape, and
is most popular in the nation.41 Cheese is eaten may be white, brown, or almost black in color.
daily for breakfast, on sandwiches, and as snacks. Some are crisp, such as Norwegian flatbrd and
Though fish is popular in many parts of Swedish knckebrd, and are similar to hardtack
Scandinavia, the more inland areas feature many or crackers. A thin, round bread called lefse (also
meat dishes. In the southern regions pork is par- known as lompe in Norway) is made with a
ticularly common. Roast loin stuffed with prunes potato and wheat flour dough, then cooked on an
and apples is a favorite in Denmark, which is also ungreased griddle. It may be used to wrap a sausage,
noteworthy for its smoked ham and bacon. or be eaten with butter and sugar or jam and
improved the buttery yeast dough by adding jam

and other fillings. A Finnish specialty is pulla, a
braided sweet bread popular at breakfast.
Milk is well liked as a beverage in Scandinavia.
Other common drinks are coffee, tea, beer, wine,
and aquavit. Aquavit, which means water of life,
is liquor made from the distillation of potatoes or
grain. It may be flavored with an herb such as
caraway and is served ice cold in a Y-shaped
glass. It is downed like a shot and often followed
by a beer chaser.

Daily Patterns. The Scandinavians eat three
meals a day, plus a coffee break midmorning, late
in the afternoon, or after the evening meal.
Breakfast is usually a light meal consisting of bread
or oatmeal porridge, cold cereal, eggs, small pastries,
Courtesy of Denmark Cheese Association
cheese, fruit, potatoes, or herring. Sour cream or

yogurt-like fermented milk may be served to eat
with cereal. Fruit soups may be served in the winter.
Milk and coffee or tea accompany the meal.
Traditionally, lunch in Denmark is smrrebrd,
which means buttered bread, an open-faced sand-
wich eaten with a knife and fork. Buttered bread is
topped with anything from smoked salmon to sliced
Danish smrrebrd: Danish boiled potatoes with bacon, small sausages, and
Fontina and Havarti cheeses,
folded like a handkerchief. In Sweden a recent tomato slices. Smrrebrd may also be served as a
ham, salami, and smoked
salmon are a few of the top-
innovation is Tunnbrd, a very thin, wheat tortilla- late afternoon or bedtime snack. Today, Danes are
pings typical of the open- like bread that is sold as fast food, rolled around as likely to pick up a quick sandwich made with a
face sandwiches known in fillings such as mashed potatoes, sausages, or bagel or Italian bread as they are to eat smrrebrd.
Denmark as smrrebrd. shrimp salad and condiments such as pickles, A buffet meal in Sweden is the smrgsbord
mustard, and ketchup. Dumplings are a favorite (bread and butter table), a large variety of hot and
in Norway, often made from potatoes. cold dishes arrayed on a table and traditionally
Desserts, whether they are served after a meal served with aquavit. Ritual dictates the order in
or at a coffee break, are rich but not overly sweet. which foods are eaten at a smrgsbord.6 The
Most are made with butter and also contain cream Swedes start with herring, followed by other fish
or sweetened cheese and the spice cardamom. dishes, such as smoked salmon and fried fins.
Aebleskivers are spherical Danish pancake puffs, Next are the meats and salads (pts and cold
When Scandinavians toast, sometimes stuffed with fruit preserves. During cuts), and the final course before dessert is com-
they say skoal, which
Advent, they are filled with whole almonds. prised of hot dishes, such as Swedish meatballs
probably derives from the
word for skull. Ancient
Another popular dessert is pancakes or crpes and mushroom omelets. Today, the smrgsbord
Norsemen used the empty served with preserved berries or jam. The Scandi- is rarely served except at special occasions. More
craniums of their enemies navians use almonds, almond paste, or marzipan typically, Swedes consume a hot lunch that might
as drinking vessels. in desserts as often as Americans use chocolate. include pea soup, brisket or hash, and mashed
One regional dessert specialty is kransekake, a stack rutabaga at the school or work cafeteria.56
of progressively smaller frosted almond pastry If lunch is light sandwiches, dinner is complete,
At one time llebrd, a rings. The Danes are best known for their pastries often including an appetizer, soup, entre, vegeta-
Danish rye bread porridge or, as they call them, Wienerbrd (Vienna bread). bles, and dessert. Potatoes are usually served with
made with nonalcoholic The pastries were brought to Denmark by Viennese the evening meal. If a hot meal is eaten at lunch,
beer, was a favorite break- bakers a century ago when the Danish bakers went a more informal supper with convenience foods
fast for children. on strike. When the strike was over, the Danes it preferred. Italian items are especially popular.
For example, the three most common dishes served and green peas is preferred. Boiled potatoes are a Veal Oscar, veal topped with
in Swedish homes today are boiled Falun sausage common side dish at all the meals. A selection of a barnaise sauce, white
(a Swedish specialty made of beef, veal, and pork), cookies and cakes complete the meal. Women tra- asparagus, and lobster or
spaghetti with meat sauce, and pizza.56 Milk, beer, ditionally demonstrated their proficiency in the crab, is named after Swedish
King Oscar II (18721907), a
or wine accompanies the meal. Coffee or wine may kitchen by offering at least seven types of sweets, a
renowned gourmet.
be served with dessert. If a dessert wine is served, custom still followed in many homes today.41
coffee will follow the end of the meal. In Sweden a Christmas smorgasbord with
twenty or thirty dishes featuring ham, herring,
Etiquette. As with many other Europeans,
and other traditional fare is served. In Denmark
the fork remains in the left hand, and the knife
roast duck, goose, or pork is served with brown
remains in the right one. Despite the prevalence
gravy. Typical side dishes are red cabbage and
of sandwiches in Scandinavian menus, only
caramelized potatoes. Rice pudding with whipped
bread is eaten with the hands at the table; sand-
cream and hot cherry sauce is also traditional. In
wiches are consumed using the fork and knife.
Finland the meal starts with pickled herring and
Pass dishes to the left. When not eating, keep your
salmon, then continues with ham, and vegetable
hands above the table with the wrists resting on the
casseroles of potatoes, carrots, or turnips. Prunes
edge. In Finland it is important to wait for the host
are usually featured in one dessert, followed by
to initiate eating. In Norway a male guest of honor
cookies and pies. In recent years, other European
is expected to thank the hosts on behalf of all
Christmas specialties such as Stollen, panettone,
guests. Wine is expensive throughout Scandinavia,
and bche de Nol have also become popular.36
so it is always appreciated as a hostess gift.9
Dozens of cookies and cakes are prepared for
Special Occasions. Social occasions are usually the Christmas season. The cookies are often fla-
marked with food in Scandinavia. In Sweden, vored with ginger and cloves; the Christmas tree
conferences and meetings always offer milk and may be hung with gingerbread figures. Deep-fried,
coffee with sweets, such as cinnamon buns, open- brandy-flavored dough, known as klejner, klener,
faced sandwiches, or fruit. Sandwich cakes, which or klentter, is also popular. The traditional holi-
are layers of bread with fillings such as pt, ham, day beverage is glgg, a hot alcoholic punch.
and sliced sausages, garnished with mayonnaise, Midsummers Day (June 24) is a popular sec- Eating lutefisk has become a
shrimp, and herbs, are served mid-afternoon ular Scandinavian holiday. It features maypoles, symbol of ethnic identity in
whenever a crowd gathers for an event. bonfires, and feasting. In Sweden, fish accompa- some Scandinavian-
December is the darkest month of the year in nied by boiled new potatoes and wild strawberries American communities.
Scandinavia, and Christmas celebrations are a wel- are eaten; in Norway, rmmegrt is served; and in
come diversion. The Christmas season lasts from Finland, new potatoes with dill and smoked salmon
Advent (4 weeks before Christmas) until January are typical festive fare.
13, Saint Canutes Day. In Sweden, on the morning
of December 13, St. Lucias Day, the eldest daugh- CONTEMPORARY FOOD HABITS
ter in the home, wearing a long white dress and a IN THE UNITED STATES
crown of lingonberry greens studded with lit can- Midsummers Day is still
dles, serves her parents saffron yeast buns and Adaptations of Food Habits observed by many
coffee in bed. However, the climax of the season is Scandinavians assimilated quickly into American Scandinavian Americans.
on Christmas Eve, when the biggest, richest, and society, yet their diet did not change significantly In some areas of the United
most lavish meal of the year is eaten. because many of their food habits are similar to the States, it has become
In Norway traditional foods eaten on Christmas diet of the American majority, including three Svenskarnas Day (Swedes
Eve begin with rice porridge sprinkled with sugar meals per day containing ample dairy products and Day), celebrating Swedish
and cinnamon. Buried in the dish is one blanched animal protein. Many Scandinavian foods have culture and solidarity.
almond; the person who receives it will have good been adopted by all Americans (see Chapter 15 for
St. Urhos Day (March 16)
fortune in the coming year. Lutefisk, a dried salt more information). was invented by Finnish
cod soaked in lye, then boiled, is customary in the Americans as a spoof on St.
north. In the east, pork ribs and sausages with Nutritional Status Patricks Day. It commemo-
cabbage are served; in the west, a dried lamb rib Nutritional Intake. Very little has been pub- rates the saints driving out
specialty with mashed rutabaga is favored, while in lished on the nutritional status of Americans of the grasshoppers from
the south, cod or halibut served with a white sauce Scandinavian descent. In Scandinavia estimated Finland.
prevalence of overweight and obesity in Finland

is nearly 50 percent for women and almost
70 percent for men. Figures are somewhat lower
in Denmark, Norway, and Sweden.23, 38 Finns
purportedly have high rates of heart disease,
stroke, alcoholism, depression, and lactose intol-
erance;61 and a recent study of schoolchildren
found a high prevalence of celiac disease.37
Because both their traditional diet and the
well-accepted typical American diet are high in
cholesterol and saturated fat, Scandinavian
Americans may be at increased risk of developing
cardiovascular disease and other conditions asso-
ciated with the westernized diet.
Counseling. Scandinavians are often low-context

communicators and highly analytical. Emotions
are controlled; superficiality and personal inquiries
Susanna Blavarg/Getty Images
are avoided. Swedes and Finns are comfortable

with silence during a conversation. As a rule, Danes
are a little more informal than other Scandinavians
or northern Europeans and may use first names.
Danes and Swedes make and maintain direct eye
contact, whereas Norwegians and Finns make
Crayfish are a specialty in Scandinavia, where they are boiled and seasoned with dill, then direct eye contact intermittently. A brief, firm
served chilled at summer festivals with aquavit, vodka, or beer. handshake is used in greetings. Other touching is
infrequent, reserved for friends and relatives.
Scandinavians are likely to avoid discussion of
illness until necessary. Some may consider sickness
indicative of either physical or moral weakness.
An in-depth interview should be used to establish
SAMPLE MENU any traditional health beliefs of clients, as well as
dietary patterns.
A Swedish Lunch CHAPTER 7 REVIEW QUESTIONS

Yellow Split Pea Soup a, b 1. Briefly describe the traditional health prac-
tices and beliefs of the Russians, Germans,
Swedish Meatballs a, b and Scandinavians.
New Potatoes with Dill a, b 2. What were the common staples of central
Europeans, Scandinavians, and people of the
Pepparkakor (Gingersnaps)a, b former Soviet Union (FSU)? What were their
methods of preservation?
Milk or Beer
3. List two well-known prepared foods associated
with Germany, Poland, FSU, one Scandinavian
a
country, and one other central European coun-
Henderson, H. 2005. The Swedish table. Minneapolis: try. Describe three sausages that can be found
University of Minnesota Press.
b
in Germany or Poland. List four American
Scandinavian Cooking at http://scandinaviancooking.com
foods that are thought to be descended from
eastern European countries.
4. What is zakuski in a Russian meal? What foods
may be included? What is a smorgasbord in
Scandinavian countries? What foods might Cultures of Europe, D. Goldstein & K. Merkle
be included? (Eds.). Strasbourg, France: Council of Europe
5. Describe a traditional Christmas or Easter Publishing.
dessert for three countries in Central Europe, 16. Grogan, L. 2006. Alcoholism, tobacco, and drug
FSU, and one Scandinavian country. use in the countries of Central and Eastern Europe
and the former Soviet Union. Substance Use and
6. Describe the religion, world view, and food
Misuse, 41, 567571.
and health beliefs attributed to Gypsies.
17. Haik Poghosyan, S. 2005. Armenia: Insights into
traditional food culture. In Culinary Cultures of
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CHAPTER
8
Africans
A frican Americans are one of the largest cul- more similar to that of the Middle East; see The terms African American,
tural groups in the United States, including Chapter 13, People of the Balkans and the black, and black American
nearly 38 million people in 2005, more Middle East) and their contributions to U.S. are used interchangeably in
foods and food habits. The historical influence research literature. African
than 12 percent of the total American population.
of West African, black slave, and southern American is usually the pre-
The majority are blacks who came originally from
ferred term because it
West Africa, although some arrived from the cuisines on current African-American cuisine is
emphasizes cultural her-
Caribbean, Central America, and, more recently, examined. itage. However, black or
from the famine- and strife-stricken East African black American is used by
nations. A small number of Americans of African many African Americans
heritage are white, primarily immigrants from who feel these terms more
the nation of South Africa. Cultural Perspective accurately reflect their cur-
Most African Americans are the only U.S. citi- rent identity. Some recent
zens whose ancestors came by force, not choice. Africa is the second largest continent in the world immigrants from Africa
Their long history in America has been charac- and has a population estimated in 2000 at more resent the use of African
American by persons who
terized by persecution and segregation. At the than 784 million people. It straddles the equator,
have lived in the United
same time, blacks have contributed greatly to the and much of its climate is tropical, yet rainfall
States for generations.
development of American culture. The lan- varies tremendously (see Figure 8.1). Rainforests,
guages, music, arts, and cuisine of Africa have grassland savannas, high mountain forests, and
mingled with European and Native American temperate zones are found in the far south and
influences since the beginnings of the nation to along the Mediterranean.
create a unique American cultural mix. In the north, the Sahara, the largest desert in
African Americans live with this difficult the world, stretches from the Atlantic to the Red
dichotomy. They are in many ways a part of the Sea, separating the Arabic northern African
majority culture because of their early arrival, nations (Morocco, Algeria, Tunisia, Libya, and
their large population, and their role in the Egypt) from the sub-Saharan western, eastern,
development of the country. Much of their and southern regions. Numerous ethnic groups
native African heritage has been assimilated, have evolved in Africa, and it is estimated that
and their cultural identity results more from between 800 and 1,700 distinct languages are
their residence in the United States than from spoken. Cultural identity is strong. The long his-
their countries of origin. Yet they are often more tory of conflict and conquest on the continent has
alienated than other ethnic groups from white never completely eliminated tribal affinity; most
American society. This chapter discusses sub- destabilization in individual nations today arises
Saharan African cuisines (North African fare is over ethnic issues.
206 AFRICANS
Atlantic Mediterranean Sea

Ocean
El Aain
RA N
HA R
SA STE
E
W
MAURITANIA
GAMBIA
Nouakchott
MALI ERITREA
NIGER
CHAD
Asmera
SE
Khartoum
N
Dakar Niamey
EG
A
A
Bamako
Banjul IN Ouaga
L
K dougou- N'Djamena SUDAN DJIBOUTI Djibouti

Bissau RO
GUINEA
BUAS
BENIN
Conakry F Abuja
GHANA
GUINEA- SOMALIA
BISSAU COTE Addis Ababa
N
D'IVOIRE NIGERIA
O
Freetown
O
CENTRAL AFRICAN
Abidjan Accra
ER
SIERRA REPUBLIC ETHIOPIA

LEONE Porto-
M
Novo Bangui
CA
Monrovia
TOGO
pala
Mogadishu
KamDA
LIBERIA Yaounde
O
AN
Kisangani KENYA
NG
UG
Libreville
CO
Nairobi
GABON
RWANDA
ville
zza
Bra Democratic BURUNDI Kigali
Bujumbura
Republic of Congo Indian
TANZANIA Ocean
Dar es Salaam
Luanda
MALAWI
ANGOLA Lilongwe
ZAMBIA E
Lusaka
U
Q
BI
Atlantic Harare M
ZA
Ocean NAMIBIA ZIMBABWE
M
O
Windhoek
BOTSWANA
o
ut
Gaborone
ap
M
SWAZILAND
LESOTHO
SOUTH AFRICA
Figure 8.1 Cape Town
Sub-Saharan Africa.
HISTORY OF AFRICANS IN THE traders sold twenty West Africans to colonists

in Jamestown, an early English settlement.
UNITED STATES
More than 425,000 slaves were subsequently
The arrival of black indentured servants taken imported legally, ancestors of the majority of
forcefully from West Africa preceded the arrival black Americans residing in the United States
of the Mayflower in America. In 1619 Dutch today.
Chapter 8: Africans 207
Enslavement slave period, combining both white and West

The institution of slavery was well established African influences.
before the first blacks were brought to North After the end of slave importation in 1807, the Slaves working in kitchens
black Creole population swelled. By law, slavery built outside plantation
America. European slave traders negotiated with living quarters (due to fire
African slave suppliers for their human cargo; was a lifelong condition, and the children of
female slaves were slaves as well. Although most danger) were asked to whis-
which West Africans became slaves and which tle as they brought food
sold slaves depended on intertribal conditions. slaves worked on farms and on cotton, tobacco,
to the main house to pre-
The European traders kept some records of tribal sugar, rice, and hemp plantations, many others
vent them from sampling
affiliation, but none of place of origin. It is believed worked in mines and on the railroads. A large along the way.
that more than one-half of the slaves in the United number of slaves were found in the cities doing
States came from the coastal areas of what are now manual labor and service jobs. It was during this The word Creole has numer-
Angola and Nigeria. Others came from the regions period of rapid growth in the African-American ous definitions, mostly
that are today Senegal, Gambia, Sierra Leone, population that separate racial group identities describing Africans and
Liberia, Togo, Ghana, Benin, Gabon, and the began to form in the United States. Europeans who moved to
the U.S. South and Latin
Democratic Republic of Congo (formerly Zaire).
These political identities are relatively recent,
Emancipation America during the colonial
The movement to free the slaves began with the period. Creole Negro (typi-
however, and the slaves identified with their cally translated black
tribal groups, such as Ashanti, Bambara, Fulani, American Revolution. Many of the northern
Creole) was the term used
Ibo, Malinke, or Yoruba, rather than with a spe- states banned slavery from the beginning of inde- for Africans who developed
cific country or Africa as a whole. The tribal vil- pendence. By the 1830s there were 300,000 free their own American culture
lages of West Africa were predominantly persons of color living in urban areas outside of influenced by the British,
horticultural. Individuals viewed their existence the South. Tension between states that supported Spanish, and French settlers
in relation to the physical and social needs of the slavery (the Confederacy) and those that opposed in the region.
group. The extended family and religion were the it (the Union) was one factor that led to the Civil
foundations of tribal culture. It was especially dif- War (called the War between the States in the
ficult for individuals to be separated from their South) in 1861.
tribe because identity was so closely associated In 1862 President Lincoln signed the
with the group. It is perhaps for this reason that Emancipation Proclamation. Union victory over
enslaved individuals held on tenaciously to their the Confederacy in 1865 and the subsequent rat-
African traditions. African language, ornamenta- ification of the Thirteenth Amendment gave all
tion (i.e., scarification and teeth filing), and other blacks living in the United States their freedom.
customs were very threatening to slave owners. Some left the South immediately, searching for
New slaves, usually in small groups from eight to relatives and a better life. However, most
thirty, were often housed at the perimeter of remained in the South because they lacked the
plantations until they became acclimated. They skills needed to begin an independent life; for
learned English in two or three years through instance, fewer than 2 percent of former slaves
contact with Native Americans or white inden- were literate. After emancipation, former slave
tured servants. When they became sufficiently owners continued to exploit African-American
acculturated, they would be allowed to work in labor through tenant farming and sharecropping.
positions closer to the main plantation house. Under this system black farmers were perpetually
This initial period of separation allowed in debt to white landowners. Slowly, as competi-
slaves to maintain many cultural values despite tion for skilled farm labor increased, working
exposure to slaves from other tribal groups, conditions for black Americans in the South
indentured servants of different ethnic groups, improved. Literacy rates and political representa-
and the majority culture of the white owners. At tion increased. At the same time, racial persecu-
the same time, frontier farming was sufficiently tion by white supremacists, such as members of
difficult that slave owners were quite willing to the Ku Klux Klan, became more frequent.
learn from the slaves agricultural expertise; At the turn of the twentieth century, depressed
therefore, intercultural communication was conditions in the South and industrial job oppor-
inevitable. Instead of becoming totally accultur- tunities in the northern states prompted more
ated to the ways of the owners, slaves developed a than 750,000 African Americans to settle in the
black Creole, native-born culture during the early Northeast and Midwest. Most were young men,
208 AFRICANS
and the majority moved to large metropolitan seeking escape from ethnic and civil conflicts in
areas, such as New York, Boston, Detroit, Chicago, the region (some more recent Ethiopian and
and Philadelphia. The influx of southern blacks Somali immigrants are also fleeing war). Less
was resented by both whites and the small num- than 1 percent of the black population is of
bers of middle-class blacks who had been well Caribbean or Central American descent.
accepted in the northern cities. Laws that estab-
lished racial segregation were enacted for the first Socioeconomic Status
time in the early 1900s, resulting in inner-city African Americans continue to suffer from the
African-American ghettos. discriminatory practices that began with their
Because of poor economic conditions through- enslavement, yet it is estimated that 70 percent
out the country, there was a pause in African- are making steady economic progress. The black
American migration north during the Great middle class is growing, and the economic gap
Depression. The flow increased in the 1940s, and between blacks and whites is narrowing as blacks
in the following thirty years more than 4 million increasingly enter fields such as business, health
African Americans left the South to settle in other care, and law. Nevertheless, three in ten suffer the
regions of the country. This migration resulted in disadvantages of poor education, underemploy-
more than a change in regional demographics. It ment, and persistent poverty.14 According to 2002
meant a change from a slow-paced rural lifestyle census figures, high school graduation rates are
to a fast-paced, high-pressured, urban industrial slightly lower for blacks than for whites, and
existence. fewer blacks go on to complete college educa-
In the 1960s the movement against the injus- tions. The African-American unemployment rate
tices of separate but equal laws (which permit- is more than double that of whites, and median
ted segregation as long as comparable facilities, income is substantially lower.105 In 2005 nearly
such as schools, were provided for African one in every four black families (24.7 percent)
Americans) gained momentum under the lead- lived below the poverty line, and three times as
ership of blacks such as Martin Luther King, Jr. many black children lived in poverty (30 percent)
Violent riots in city ghettos underscored the need as did white children (10 percent).
for social reform. Civil rights activism resulted in Many African Americans believe they are not
the repeal of many overtly racist practices and completely accepted in American society. Blacks
passage of compensatory laws and regulations isolated in urban ghettos frequently experience
meant to reverse past discrimination, as typified alienation. Frustration, hopelessness, and hostil-
by federal affirmative action requirements. ity often result. At the same time, discrimination
has promoted ethnic identity among African
Current Demographics Americans, due in part to a shared history of per-
Some Somali refugees are Today slightly more than one-half of African secution. Although Americans of African descent
Bantus who were first dis- Americans live in the U.S. South, most in suburban are geographically, politically, and socioeconom-
placed to Kenya. An esti- areas. Since 1988 more blacks have been moving ically diverse, there is a strong feeling of ethnic
mated 8,000 to 12,000 were to the South than to the northern states, reversing unity, as demonstrated by the black pride move-
admitted to the United the demographic trend northward established in ment of recent years.
States in 20032004.
1900. The remaining African-American popula- Socioeconomic status for recent immigrants
tion is found predominantly in northeastern and from Africa varies greatly according to U.S.
midwestern urban areas.105 As of 2000, approxi- Census data.142 Many Nigerians come to the
mately 2 percent of Americans of African descent United States for educational opportunity. Nearly
are identified as recent immigrants; over 200,000 30 percent have advanced college degrees.
from the West African nations of Nigeria and Nigerians who choose to stay often find employ-
Ghana; more than 100,000 from the horn of ment in academia, while others choose to open
Africa nations of Ethiopia and Somalia; over their own businesses.131 Most immigrants from
60,000 from the Eastern African countries of Ghana are also well educated, with many obtain-
Kenya, Tanzania, and Uganda; and 66,000 from ing jobs in management and the professions.
South Africa. In addition, small populations from Ghanaian women often work as teachers, nurses,
Eritrea (17,000) and Sudan (19,000) have arrived and secretaries, though some are pursuing busi-
in recent years, many of whom are refugees ness careers.143 Ethiopians in the United States
graduate from high school at rates similar to those Religion is as essential to African American
of whites, and nearly 60 percent have college culture today as it was to African society. For many
degrees. However, many are underemployed, black Americans the church represents a sanctu-
working in low-level service jobs. Approximately ary from the trials of daily life. It is a place to meet
14 percent of Ethiopian families in the United with other African Americans, to share fellowship
States live below the poverty line. Education levels and hope. More than 75 percent of African
in immigrants from Eritrea are far lower. Americans belong to a church. The largest denom-
Approximately 85 to 90 percent of women in ination is the National Baptist Convention of the
Eritrea were functionally illiterate in 1999.116 High U.S.A. Others with large African-American follow-
school graduation rates are far below the U.S. aver- ings include the Methodist Episcopal churches and
age, and small numbers obtain a college degree. Pentecostal denominations, such as the Church of
Nevertheless, 23 percent of Eritrean immigrants God in Christ. A small percentage of African
held jobs in management and the professions Americans who are Muslim are members of either
(particularly engineering) in 2000. The number of the World Community of All Islam or the Nation
Eritrean families living in poverty was 19 percent. of Islam (see Chapter 4, Food and Religion, for
Recent Somali Bantu refugees are largely illiterate more information about this religion).
with little or no education. In Kenya those who Recent immigrants from Africa adhere to a Atlanta is home to a large
were employed worked in farming, construction, variety of faiths. Approximately one-quarter of population of South African
cleaning, cooking, and other manual labor jobs. Africans today are Muslim (the fastest growing Jewish immigrants.87
Most have never lived with modern conveniences religion on the continent) and one-quarter are
such as electricity or plumbing.118 Christian, mostly Protestant. Many Ethiopians The Eastern Orthodox
Church in Ethiopia prohibits
Many immigrants from Sudan have college or and Eritreans follow an Eastern Orthodox faith
the consumption of pork, a
advanced degrees according to the U.S. Census that is similar to, but separate from, the Egyptian
practice that may reflect
data. In addition to jobs in management and the Coptic Church. In addition, it is believed that early Judaic influences in
professions, similar numbers are employed in nearly one-half of the African population partici- the region.
production and transportation, as well as in sales pates in traditional tribal religions or combine
and office work, and average salaries are low. In elements of several faiths.
1999, 27 percent of Sudanese families lived in
poverty. Kenyans who immigrate to the United Family
States are typically well educated, and over half of The importance of the extended family to African
adults over the age of twenty-five were college Americans has been maintained since tribal
graduates. Over 48 percent worked in manage- times. It was kinship that defined the form of
ment or professional jobs, particularly in the African societies. During the early slave period
technology sector. South Africans are also often the proportion of men to women was two to one,
well educated. Over 50 percent hold college and the family structure included many unre-
degrees, and over 60 percent work in manage- lated members. As the black Creole population
ment or professional careers. Other South increased, nuclear families were established but
Africans have come to the United States for entre- were often disrupted by the sale or loan of a
preneurial opportunity.87 parent. The extended family provided for dislo-
cated parents and children.
WORLDVIEW In 2002, 43 percent of African-American fam-
ilies were headed by women (compared to 13
Religion percent of white families).105 The family network
Spirituality was integral to African tribal society, often includes grandparents, aunts, uncles, sis-
and indigenous religious affiliations were main- ters, brothers, deacons or preachers, and friends.
tained by most slaves despite attempts to convert Such extended kinship still supports and protects
blacks to Christianity. Although the first black individuals, especially children, from the prob-
church, a Baptist congregation, was founded in the lems of a discriminatory society. The extended
1770s in South Carolina, it was only after American family has been found to be equally valued by
religious groups became involved in the antislavery both wealthy and poor African Americans.
movement that the black Creole community Most families in Africa today are still extended,
responded with large numbers of conversions. and multigenerational homes are typical for
210 AFRICANS
recent immigrants to the United States. Children dead. Life events can be influenced by these forces,
are highly valued, and elders are often responsi- and a person can, in turn, influence these forces
ble for helping to make family decisions. Many toward good or evil.
immigrants keep in close touch with relatives in Health is maintained through harmony.
Africa and often send money for support. Disharmony and illness occur when someone
African societies are highly patriarchal, and (living or dead), the gods, or nature is inten-
in most cases women are expected to be sub- tionally malevolent. As described by one African
servient to men. Marriages are often arranged by expert:
parents, typically with an exchange of property.
Even if it is explained to a patient that he has
In the United States women may work as often as
malaria because a mosquito carrying malaria
men, but are expected to maintain the house and
parasites has stung him, he will still want to
raise the children in addition to their jobs.156 In
know why that mosquito stung him and not
15 to 38 percent of households, grandparents are
another person. The only answer which people
responsible for childcare.142 In many homes fric-
find satisfactory to that question is that some-
tion between couples is common when women
one has caused (or sent) the mosquito to
no longer agree to be subservient to their hus-
sting a particular individual, by means of magi-
bands. Spousal battery and divorce rates are
cal manipulations (p. 169).104
reportedly high among Ethiopians.86 Kenyan
women who come to the United States are often One example of how a person may become ill is
well educated, and for them the stresses of the evil eye, whereby one person causes illness
gender role changes are not as difficult. However, and misfortune by sending negative energy
many Kenyans worry about the loss of tradi- through an evil gaze.156 A traditional African
tional values as their children adapt to life in healer must first diagnose the illness, determine
America, and conflict between parents and chil- the supernatural cause of the illness, then dis-
dren is common.128 Intergenerational difficulties lodge the evil and take measures to prevent reoc-
are also seen in many Nigerian families where, currence. The healer often uses herbs and other
traditionally, strict obedience was expected of natural prescriptions to treat the symptoms and
children, who were not allowed to question or may depend on the spirits of the ancestors to
contradict their parents.131 Ghanaians promote transmit medical knowledge. Bleeding, massage,
cultural traditions from the numerous Ghanaian dietary restrictions, chants, and charms may
associations formed to support the immigrant complete the cure.
community. Traditionally, these associations in The health beliefs and practices of some
Africa were strictly limited to specific ethnic, African Americans reflect traditional African
cultural, political, or economic groups. Those in concepts as well as those encountered through
the United States, however, generally have more early contact with both Native Americans and
open memberships. Ghanaians located in rural whites. It is often difficult to determine the ori-
areas may belong to associations found in nearby gins of a specific practice, and it is also likely that
cities.143 both blacks and whites adhere to similar beliefs.
In some areas of Africa, Somali Bantus marry young, between the ages Some Americans of African heritage maintain
including parts of Kenya of fourteen and sixteen, and women typically health by eating three meals each day, including a
and Sudan, and among the have their first child around the age of fifteen. hot breakfast. Laxatives may be used regularly,
Somali Bantu, men may The family group often includes cousins or other and cod liver oil may be taken to prevent colds.
take multiple wives to kin who have become part of the home. Divorce Vicks VapoRub may also be ingested for colds. A
ensure that enough chil-
and remarriage are common. It is estimated that copper or silver bracelet is sometimes worn for
dren are born to pass on the
31 percent of Somali Bantu refugees are less than protection; if it is removed, harm will occur. If the
fathers lineage. In other
nations, such as Ethiopia, six years old.118 skin darkens around the bracelet, illness is
polygamy is prohibited.88, impending and precautions, such as more rest
118, 123, 128 Traditional Health Beliefs and Practices and a better diet, should be undertaken. 77, 99, 136
Africans view life as energy rather than matter. A One study of black men found that they
person lives transitionally on earth, interacting defined health as more than simply lack of ill-
with all environmental forces, from those of the ness. The ability to support their family, fulfill
gods and nature to those exerted by the living and social obligations, and maintain emotional and
spiritual well-being was also important. Self-

empowerment was one method used to combat
the difficulties of racism and poverty thought to
undermine good health.124 Prayer for health is
common, practiced by more than half of blacks
in one study.74 Some African Americans believe
that illness is a punishment from God, and
many feel that God acts through physicians to
heal patients.104 Stress is frequently cited as the
cause for poor health. It is considered by some
blacks to be the source of hypertension; like-
wise, worriation results in diabetes.79, 124
Others, especially in the rural South, believe
that illness is due to evil spirits or witchcraft. A

person may be hexed, fixed, mojoed, or
rooted by someone with supernatural skills.
Healers and conjurers are needed to fix or
trick the evil. The resulting illness can be
cured by herbal treatments, incantations, or
Traditional African-American
magical transference. For example, a toad is
foods. Some typical foods of
placed on the head of someone with a headache, due to bad luck or fate, in the frequent use of the southern black diet
and when the toad later dies, the headache will home remedies, and in a preference for natural include bacon, black-eyed
disappear.77, 98 therapies by some blacks,18, 59, 156 as in the popu- peas, chayote squash, corn,
Best known of traditional healers are the prac- larity of garlic pills found in one study.74 greens, ham hocks, hot
titioners of voodoo, also called hoodoo. This sauce, okra, peanuts, water-
combination of African and Catholic beliefs is melon, and sweet potatoes.
thought to have originated in the Caribbean (see
Chapter 10, Caribbean Islanders and South Traditional Food
Americans); where it is still practiced in the
South, it was also likely influenced by European Habits
witchcraft.20 The men and women practitioners
can use voodoo magic for good or evil. They cure What are traditional African-American foods
unnatural illnesses (those of supernatural cause) foods of Africans in the seventeenth and eigh-
through casting spells, the use of magic powders teenth centuries, foods of the slaves, or foods of
and gris-gris, bags worn around the neck with the black South since emancipation? African-
Poison made from the
powders, animal bones or teeth, stones, and/or American cuisine today often includes elements
Acokanthera shrub, tradi-
herbs. Other healers include traditional herbalists from each of these diets. tionally used on arrow tips,
or root doctors, and spiritual, sympathy, or faith is so deadly that it can
healers who derive their powers from God. A INGREDIENTS AND COMMON FOODS cause cardiac arrest within
patient may choose to use one or all such healers minutes. Some African
to treat an illness, and the specialty of one may Historical Influences herbalists use it to treat
overlap into another.60 A root doctor, for exam- African-American foods offer a unique glimpse snakebite, parasitic infec-
ple, may apply home remedies or may use into the development of a cuisine. Even before tion, and other conditions.76
charms like a conjurer to remove (or even send) West Africans were brought to the United States,
evil. In most cases, healers of all kinds use a holis- their food habits had changed significantly due to There has been a resur-
gence in voodoo since the
tic approach and spend a great deal of time on a the introduction of New World foods such as cas-
1960s as part of a general
patient, providing a feeling of spiritual as well as sava (Manihot esculenta, a tuber that is also called
interest in alternative
physical well-being. manioc), corn, chiles, peanuts, pumpkins, and health practices.
Few African Americans today believe in tomatoes during the fifteenth and sixteenth cen- Pharmacies and mail-order
African witchcraft or employ root doctors. turies. The slaves brought a diet based on these companies in the South do a
However, the influence of traditional healing new foods and native West African foods, such brisk business in voodoo
practices is still found in the idea that ill health is as watermelon, black-eyed peas, okra, sesame, supplies.
212 AFRICANS
and taro. Adaptations and substitutions were formed the dough into bite-sized scoops that
made based on available foods. Black cooks were used like spoons to eat stew. Palm oil was
added their West African preparation methods to the predominant fat used in cooking, giving
British, French, Spanish, and Native American many dishes a red hue. Peanut oil, shea oil (from
techniques to produce American southern cui- the nuts of the African shea tree), and occasion-
sine, emphasizing fried, boiled, and roasted ally coconut oil were used in some regions. The
dishes using pork, pork fat, corn, sweet potatoes, addition of tomatoes, hot chile peppers, and
and local green leafy vegetables. The cuisines of onions as seasoning was so common that these
other African regions have had little impact at items were simply referred to as the ingredients.
this point on the typical American diet, although Most dishes were preferred spicy, thick, and
recent immigrants may continue to prepare and sticky (mucilaginous).
consume traditional fare. Legumes were popular throughout West
Africa. Peanuts were especially valued and were
African Fare eaten raw, boiled, roasted, or ground into meal,
Throughout Africa women West African. Knowledge of West African food flour, or paste. Cow peas (Vigna ungulculata, nei-
cultivate nearly all food habits before the nineteenth century is incom- ther a standard pea nor a beanblack-eyed peas
that is consumed, while plete. It is mostly based on the records of North are one type of cow pea) were eaten as a substi-
men grow export crops. African, European, and American traders, many tute for meat, often combined with a staple starch
of whom considered the local cuisine unhealthy. such as corn, yams, or rice. Bambara groundnuts,
Taboos against eating eggs
Most West Africans during the slave era lived in similar to peanuts, were also common. Nuts and
still exist in some areas of
preliterate, horticulturally based tribal groups. seeds were frequently used to flavor and thicken
Africa, including beliefs
that they make childbirth There was a heavy dependence on locally grown sauces. Mango seeds (called agobono, og bono, or
difficult and that they foods, although some items, such as salt and fish apon), cashews, egusi (watermelon seeds, usually
excite children. (usually salt-cured), could be traded at the daily dried and ground), kola nuts, and sesame seeds
markets held throughout each region. were popular.
Historically, staple foods varied in each local- Many varieties of tropical and subtropical
ity. Corn, millet, and rice were used in the coastal fruits and vegetables were available to West
areas and Sierra Leone. Yams were popular in Africans, but only a few were widely eaten. Ackee
Nigeria. Cassava (often roasted and ground into a apples, baobab (both the pulp and seeds from the
flour known as gari) and plantains were the fruit of the baobab tree), guava, lemon, papaya
dietary foundation of the more southern regions, (also called pawpaw), pineapple, and watermelon
including the Congo and Angola. The arid were the most common fruits. Many dishes
savanna region of West Africa bordering the included coconut milk. In addition to starchy staple
Sahara Desert was too dry for cultivation, so roots and the flavoring ingredients of onions,
most tribes were pastoral, herding camels, sheep, chile peppers, and tomatoes, the most popular
goats, and cattle. In the north these animals were vegetables were eggplant, okra, pumpkin, and the
eaten; in other regions, local fish and game were leaves from plants such as cassava, sweet potato,
Kola nuts are a bitter nut consumed. Insects such as termites and locusts and taro (also called callaloo or cocoyam).
with twice the caffeine con- were consumed in many regions of Africa and are West African cuisine today remains very sim-
tent of coffee beans. The still considered a treat in some areas. Chickens ilar to that of the past. Fish is favored, and little
original recipe for Coca- were also raised, though in many tribes the eggs meat is consumed. A mostly vegetarian fare has
Cola, invented in 1886, were frequently traded, not eaten, and the chicken developed based on regional staples such as
included extracts from coca itself was served mostly as a special dish for beans, yams, and cassava. Gari foto is a popular
leaves and kola nuts. guests. Chicken remains a prestigious meat in Nigerian specialty often eaten for breakfast; it
many regions today. combines gari (cassava meal) with scrambled
Pods from the flowers of
There were many similarities in cuisine eggs, onions, chiles, and tomatoes and is some-
roselle (Hibiscus sabdariffa)
throughout West Africa. Most foods were boiled times served with beans. Stews featuring root
are used to make bissap
rouge, a sweet beverage or fried, and then small chunks were dipped in a vegetables, okra, or peanuts and flavored with
popular in Senegal. They sauce and eaten by hand. Starchy vegetables small amounts of fish, chicken, or beef are
are also used in the popular including yams, plantains, cassava, sweet pota- common. Curries are popular in Nigeria, often
herbal tea called Red toes, and potatoes were often boiled, then served with dozens of condiments and garnishes,
Zinger.67 pounded into a paste (called fufu). Each diner such as coconut, raisins, chopped dates, peanuts,
dried shrimp, and diced fruits. Pili-pili, a sauce of

chile peppers, tomatoes, onion, garlic, and horse-
radish, is usually offered at the table so that each
diner may spice dishes to taste.
Deep-fried fish, fried plantain chips, and balls
made from steamed rice, black-eyed peas, yams,
or peanuts are snack foods available at street
Photo courtesy of the World Health Organization/P. Almasy

stalls in urban areas. The favorite West African
sweet is kanya, a peanut candy. Chin-chins, sweet
fried pastries topped with sugar and flavoring
such as cinnamon or orange zest, are also popular.
Bananas are commonly baked and flavored with
sugar, honey, or coconut for dessert. Sweetened
dough balls prepared from millet or wheat flour
are a specialty in many areas; in Ghana they are
called togbei (sheep balls) and are brightly col-
ored with food dye before being deep-fried. They
are served for special occasions such as birthdays
and weddings. Market scene in Ghana, West Africa.
Ethiopian, Eritrean, Somali, and Sudanese.

Mountainous plains and lowland valleys cover
much of Ethiopia, Eritrea, and Somalia, and the
climate is mostly arid. Though Ethiopia is land-
locked, Eritrea and Somalia have lengthy coastal
access along the horn of Africa. Millet (including SAMPLE MENU
a variety unique to the region called teff ),
sorghum, and plantains are the staple foods pro-
duced, and coffee is the leading export crop. Other A West African Meal
foods common to the region include barley,
wheat, corn, cabbage, collards, onions, kale, and Spicy Fried Plantainsa, b
potatoes, as well as peanuts and other legumes.
Enset, a plantain-like plant, is a staple in the high Groundnut Chop/Stew over Ricea, b
mountainous regions of Ethiopia. Some chicken,
fish, mutton, goat, and beef are available. Ginger Beera, b or Green Tea with Mint
Historically, Ethiopian cuisine had minimal Tropical Fruit Salada, b
outside influences, though a large number of
Muslims now living in the nation have introduced
certain halal dietary practices in some regions a
Jackson, E.A. 1999. South of the Sahara: Traditional cooking from the lands of
(see Chapter 4 for more information on religious West Africa. Hollis, NH: Fantail.
dietary practices). More significant has been the b
The Congo Cookbook at http://www.congocookbook.com
Ethiopian Eastern Orthodox religion, which has
facilitated the development of vegetarian fare due
to the restricted intake of animal proteins.
Examples include yataklete kilkil, a garlic- and
ginger-flavored casserole, and yemiser selatta, a
lentil salad. A mixture of ground legumes called
mitin shiro is added to most vegetarian stews. can be prepared either way.158 Doro wat is one Ethiopians claim that coffee
Wat, meaning stew, is the national dish of popular example, featuring chicken and whole originated in the region of
Ethiopia. Typically thick and spicy, wat may hard-boiled eggs. Yemiser wat is made with red Kaffa, where it derived its
include legumes, meats, poultry, or fish. Milder lentils, sega wat with beef, and yebeg wat with name. Historically the
versions are known as alechas, and most stews lamb. Wat is served with rice or the traditional beans were made into wine.
214 AFRICANS
millet or corn beer, is commonly consumed, as is

coffee, especially espresso (introduced by the
Italians).
Eritrean and Somali food is very similar to
SAMPLE MENU Ethiopian, with the exception of more frequent
use of seafood. For example, a typical meal
includes a spicy stew, often with beef, lamb, kid,
An Ethiopian Dinner or fish, eaten with injera-like breads, known in
Somalia as anjeero. The Eritreans often consume
Kitfo a, b, c their bread with shuro, a thick paste made from
chickpeas, onions, tomatoes, and a touch of
Doro Wat a, b berbere, similar to Ethiopian mitin shiro. In addi-
tion, though many Eritreans belong to the Coptic
Bamia Alichab or Vegetable Alecha c Eastern Orthodox faith and adhere to the pro-
scriptions on meat, nearly all Somalis are
Injera a, c Muslim and follow halal dietary practices. Camel
Fruit juice, Tej c, or Ethiopian Coffee milk is consumed in some areas, and in Somalia,
sweetened tea is consumed frequently. In Eritrea
coffee is preferred, and a bitter, fermented barley
a
Hafner, D. 2002. A taste of Africa: Traditional and modern African cooking.
beverage called sowa is served at most meals. On
Berkeley, CA: Ten Speed Press. special occasions a wine similar to tej, called
b
Harris, J.B. 1998. The Africa cookbook: Tastes of a continent. New York: mez, is popular.
Simon & Schuster. Former Italian occupation of the region intro-
c
The African Cookbook at duced numerous dishes. Favorites include spaghetti,
http://www.africa.upenn.edu/Cookbook/about_cb_wh.html lasagna, pasta, seafood, and frittata, a scrambled
egg dish made with green peppers and onions.116, 158
In some parts of Ethiopia and Eritrea and through-
out Somalia, Asian Indian-influenced items, such as
curried dishes, unleavened breads such as roti and
chapati, and vegetable- or meat-stuffed fritters
known as sambosa are also common.69
Ethiopian flat bread called injera. Injera is pre- The Sudan, which bridges the desert regions
pared with a spongy, fermented dough made of North Africa and the tropical forests of West
from teff cooked in a very large circular loaf on a and East Africa, has a cuisine reflecting both
griddle. (Sometimes wat is prepared with added Middle Eastern and African influences. For
pieces of injera in the stew, known as fitfit.) example, fava beans or a salad of cucumber and
Another variation of this flat bread, known as yogurt might be served at the same meal as an
kocho, is made with enset. okra stew and kisra, the Sudanese staple bread
Ethiopian foods are frequently flavored with a similar to injera.
hot spice mixture known as berbere, which
Sukuma wiki is Swahili for includes allspice, cardamom, cayenne, cinna- East African. The climate and topography of
stretch the week and is a mon, cloves, coriander, cumin, fenugreek, ginger, Kenya, Tanzania, and Uganda are well suited to
stew of leftover meats and nutmeg, and black pepper. Niter kebbeh, clarified farming and ranching. Cassava, corn, millet,
vegetables popular in butter with onions, garlic, ginger, and other sorghum, peanuts, and plantains are the founda-
Kenya. spices, is added to many dishes, including kitfo, a tion of the diet. Crops grown for export include
raw ground beef specialty. Salted and sweet coffee, tea, cashews, and cloves. Cattle are raised in
Zanzibar, an island just off
cheeses are common. Honey (sometimes con- the northern plateaus of Kenya; they are consid-
the coast of Tanzania, was
known as the Spice Island in sumed with the bee grubs) is especially popular as ered a gift of the gods (especially among the
the 1800s. It was a trade a sweetener and is used in savory dishes such as Maasai tribe), and they indicate wealth. The abun-
center between East and alechas, and desserts such as baklava, a drier ver- dant game animals are also often sacred, although
West and supplied most of sion of the Greek pastry.88 It is also fermented to specific taboos vary from region to region. Eating
the cloves used worldwide. make tej, a mead-like beverage. Tella, home-brewed fish and seafood is common along the coast.
The cuisines of East Africa are predominantly or jams are popular. Many pastries are available,
vegetarian, influenced in part by Arab, Asian too, such as tarts made with raisins, sweet pota-
Indian, and British fare. Breads are common at toes, coconut, or custard. Cookies are a favorite.
every meal, including chapatis, kitumbua, a rice Koeksister are braided crullers that are deep-fried
fritter, and mandazi, slightly sweetened doughnut- and dipped in a cinnamon syrup, and soetkoekies
like bread. In Kenya the national dish is ugali, a are spice cookies flavored with the sweet wine
very thick, doughy cornmeal porridge. Ugali is Madeira.
also found in Tanzania. Mashed beans, lentils,
corn, plantains, and potatoes are also popular. The Slave Diet
Coconut milk, chile peppers, and curry spice When West Africans were forcefully taken from
blends flavor many dishes. In Uganda, which is their tribes, they were not immediately separated
inland and less influenced by foreign cuisines, from their accustomed foods. Conditions on the
peanuts are a staple food used in everything from slave ships were appalling, but most slave traders
stewssuch as beef, tomato, and onion stew with did provide a traditional diet for the tribal mem-
peanut butter sauceto desserts. Plantains are bers on board. The basic staples of each region,
the core food of Tanzania. They are used in soups plus dried salt cod (which was familiar to most
(with or without beef), stews, fritters, custards, and West Africans), were fed to the slaves in minimal
even wine. Coconut milk is a frequent flavoring, as quantities. Chile peppers and the native West
is curry powder. Throughout the region, dishes African malagueta peppercorns were used for
made with taro greens or other leafy vegetables and seasoning because they were believed to prevent
side dishes of local grains and produce, such as dysentery. It wasnt until the Africans were sold in
eggplant and papaya, round out the cuisine. America that significant changes in their cuisine
occurred.
South African. South Africa has a very temperate The diet of the field workers was largely
climate favorable to many fruits and vegetables dependent on whatever foods the slave owners
uncommon in the rest of the continent, such as provided. Salt pork and corn were the most
cucumbers, carrots, apricots, tangerines, grape- common items. Sometimes rice (instead of corn),
fruit, quinces, and grapes. The cuisine has been salted fish, and molasses were included. Greens,
strongly influenced by the European settlers of the legumes, milk, and sweet potatoes were occa-
region, including the Dutch, British, and French. sionally added. The foods provided, as well as
Muslim slaves imported from Malaysia and India their amount, were usually contingent on local
have also had a significant impact on South availability and agricultural surplus.
African fare. Mutton, beef, pork, fish, and seafood Hunger was common among the slaves. Some The nutritional results of
are popular. slave owners allowed or required their slaves to the limited slave diet were
South African meat specialties include maintain garden plots or to plant needed vegeta- seen in the many cases of
sosaties, skewered, curried mutton; bredie, a bles around the periphery of the cotton or pellagra, beriberi, and
mutton stew that may include onions, chiles, tobacco fields. Okra and cow peas from Africa sore-mouth caused by
deficiencies in vitamin A
tomatoes, potatoes, or pumpkin; frikkadels, were favored, as well as American cabbage, col-
and many of the B vitamins.
braised meat patties; bobotie, a meatloaf flavored lard and mustard greens, sweet potatoes, and Malnourishment also left
with curry and topped with a custard mixture turnips. Herbs were collected from the surround- African Americans vulnera-
when baked; and biltong, meat strips dried and ing woodlands, and small animals such as opos- ble to malaria, yellow fever,
preserved over smoke. Grape-stuffed chicken or sums, rabbits, raccoons, squirrels, and an cholera, and other diseases
suckling pig is sometimes served for special occa- occasional wild pig were trapped for supplemen- common in the South.
sions. Spicy fruit or vegetable relishes called chut- tary meat. Children would often catch catfish and
ney (for more information see Chapter 14, South other freshwater fish.
Asians); atjar, unripe fruit or vegetables pre- During the hog-slaughtering season in the A slave folktale describes
served in fish or vegetable oil with spices like fall, variety pork cuts, such as chitterlings the land of Diddy-Wah-
tumeric and dried chiles; and fresh grated fruit or (intestines, pronounced chitlins), maw Diddy, where roast hogs
vegetable salads flavored with lemon juice or (stomach lining), tail, and hocks, would some- and chickens run about
vinegar and chiles accompany the dishes. times be given to slaves. Some slaves were calling, Eat me! and there
are fritter ponds of oil.
Sweets are very common. Dried fruits, fruit encouraged to raise hogs and chickens. The
leathers called planked fruit, and fruit preserves eggs and the primary pork cuts were usually
216 AFRICANS
(thickened with okra or the herb sassafras, which

when ground is called fil powder), such as the
southern specialty gumbo zherbes, nearly identical
to a recipe from the Congo. Green leafy vegetables
(simply called greens) became a separate dish
instead of being added to stews, but they were still
cooked for hours and flavored with meat.
Ingredients familiar to West Africans, such as nuts,
beans, and squash, were used for pie fillings.
Bonnie Kamin/PhotoEdit, Inc.
Foods-after Abolition of Slavery

The food traditions of African Americans did
not change significantly after emancipation,
and they differed little from those of white
farmers of similar socioeconomic status. One
Many traditional southern exception was that pork variety cuts and salt
foods, such as fried chicken,
pork remained the primary meats for blacks,
corn bread, spicy stews, bean sold to raise cash for the purchase of luxury
dishes, and simmered
while whites switched to beef during the post-
foods. Chickens, a prestigious food in West
greens, reflect West African Civil War period.
Africa, continued to be reserved for special
influences. occasions.
West African cooking methods were adapted African-American Southern Staples
In the years following to slave conditions. Boiling and frying remained The traditional southern African-American cui-
emancipation, chickens the most popular ways to prepare not only meats sine that evolved from West African, slave, and
were known as preachers but also vegetables and legumes. Bean stews post-abolition fare emphasizes texture before
birds because they were maintained popularity as main dishes. Corn was flavor; the West African preference for sticky
commonly served to the substituted for most West African regional foods continues. Pork, pork products, corn, and
minister when he came
staple starches and was prepared in many forms, greens are still the foundation of the diet. The
calling on Sunday.
primarily as cornmeal pudding, cornmeal cultural food groups list (Table 8.1) includes
The phrase living high on breads known as pone or spoon bread, grits other common southern black foods. (For infor-
the hog comes from the (coarsely ground cornmeal), and hominy mation about the food habits of blacks from the
post-abolition period, and (hulled, dried corn kernels with the bran and Caribbean, see Chapter 10; for more informa-
meant that a family was germ removed). Pork fat (lard) replaced palm tion on foods of the South, see Chapter 15,
wealthy enough to eat the oil in cooking and was used to fry or flavor Regional Americans.)
primary pork cuts, such as everything from breads to greens. Hot pepper Pork variety cuts of all types are used. Pigs
chops and ham. sauces were used instead of fresh chiles for feet (or knuckles) are eaten roasted or pickled;
seasoning. No substitutions were available for pigs ears are slowly cooked in water seasoned
many of the nuts and seeds used in West African with herbs and vinegar and then served with
recipes, although peanuts and sesame seeds gravy. Bits of pork skin (with meat or fat
remained popular. attached) are fried to make cracklings.
Food for the slave field workers had to be Chitterlings also are usually fried, sometimes
portable. One-dish vegetable stews were common, boiled. Sausages and head cheese (a seasoned loaf
as were fried cakes, such as hushpuppies (per- of meat from the pigs head) make use of smaller
haps named because they were used to quiet pork pieces. Barbecued pork is also common. A
whining dogs), and the cornmeal cakes baked in whole pig (or just the ribs) is slowly roasted over
the fire on the back of a hoe, called hoecakes. the fire. Each family has its own recipe for spicy
Meals prepared at home after a full day of labor sauce, and each has its opinion about whether the
were usually simple. pork should be basted in the sauce or the sauce
The slaves who cooked in the homes of slave should be ladled over the cooked meat. Other
owners had a much more ample and varied diet. meats, such as poultry, are also popular.
They popularized fried chicken and fried fish. Occasionally, the small game that was preva-
They introduced sticky vegetable-based stews lent during the slave period, such as opossum
Table 8.1 Cultural Food Groups: African American (Southern United States)
Protein Foods
Milk/milk Dairy products are uncommon in diet Milk (consumed mostly in desserts, such as Blacks in urban areas may drink milk more
products (incidence of lactose intolerance puddings and ice cream), some buttermilk; often than rural blacks.
estimated at 6095 percent of the cheese
population).
Milk is widely disliked in some studies;
well accepted in others.
Few cheese or fermented dairy
products are eaten.
Meat/poultry/fish/ Pork is most popular, especially variety Meat: beef, pork (including chitterlings, ham Pork remains primary protein source;
eggs/legumes cuts; fish, small game, poultry also hocks, sausages, variety cuts) prepackaged sausages and lunch meats
common; veal and lamb are infre- Poultry: chicken, turkey are popular.
quently eaten. Fish and shellfish: catfish, crab, crawfish, perch, Small game is rarely consumed.
Bean dishes are popular. red snapper, salmon, sardines, shrimp, tuna Variety cuts are considered to be soul
Frying, boiling are most common Small game: frogs, opossum, raccoon, squirrel, food and eaten regardless of socioeco-
preparation methods; stewed dishes turtle nomic status or region.
preferred thick and sticky. Eggs: chicken Frying is still popular, but more often at
Protein intake is high. Legumes: black-eyed peas, kidney beans, evening meal; boiling and baking are
peanuts (and peanut butter), pinto beans, second most common preparation
red beans methods.
Cereals/Grains Corn is primary grain product; wheat Biscuits; corn (corn breads, grits, hominy); Store-bought breads often replace biscuits
flour is used in many baked goods. pasta; rice (toasted at breakfast, used for sand-
Rice is used in stew-type dishes. wiches at lunch).
Fruits/Vegetables Green leafy vegetables are most popu- Fruits: apples, bananas, berries, peaches, Fruits are eaten according to availability
lar, cooked with ham, salt pork, or watermelon and preference; intake remains low.
bacon, lemon and hot sauce; broth is
also eaten.
Intake of fresh fruits and vegetables Vegetables: beets, broccoli, cabbage, corn, Green leafy vegetables (greens) are pop-
is low. greens (chard, collard, kale, mustard, poke- ular in all regions; other vegetables are
weed, turnip, etc.), green peas, okra, pota- eaten according to availability and pref-
toes, spinach, squash, sweet potatoes, erence; intake remains low.
tomatoes, yams
Additional Foods
Seasonings Dishes are frequently seasoned with Fil (sassafras powder), garlic, green peppers,
hot-pepper sauces. hot-pepper sauce, ham hocks, salt pork or
Onions and green pepper are common bacon (added to vegetables and stews),
flavoring ingredients. lemon juice, onions, salt, pepper
Nuts/seeds Nuts often used in ways similar to tra- Peanuts, pecans, sesame seeds, walnuts
ditional West African dishes, such as
nut- or seed-based desserts.
Beverages Coffee, fruit drinks, fruit juice, fruit wine, soft

drinks, tea
Fats/oils Butter, lard, meat drippings, vegetable

shortening
Sweeteners Honey, molasses, sugar Cookies (and candy) are preferred snacks.
218 AFRICANS
bacon, or ham, plus hot chile peppers (or hot-

pepper sauce) and lemon. As the water evapo-
rates, the flavors intensify, resulting in a broth
called pot likker. Both the greens and the liquid
SAMPLE MENU are served; hot sauce is offered for those who
prefer a spicier dish. Other common vegetables
include black-eyed peas, okra, peas, and toma-
A Traditional Black toes. Onions and green peppers are frequently
used for flavoring.
Southern Supper Corn and corn products are as popular in
southern black cuisine today as they were during
Fried Chickena, b with Biscuitsa, b the slave period. Corn bread and fried hominy
are served sliced with butter. Wheat flour biscuits
Macaroni and Cheesea, b are also served with butter or, in some regions,
gravy. Dumplings are sometimes added to stews
Collard Greensa, b and greens.
Sweet Potato Piea, b or Pound Cakea, b Squash is eaten as a vegetable (sometimes
stuffed) and as a dessert pie sweetened with
Fruit Juice or Iced Tea molasses. Sweet potatoes are also used both ways.
Other common desserts include bread pie (bread
pudding), crumb cake, chocolate or caramel
a
Tillery, C.Q. 1996. The African American heritage cookbook. New York: cake, fruit cobblers, puddings, and shortcake, as
Citadel Press. well as sesame seed cookies and candies.
b
The Chitterling Site at http://www.chitterlings.com
MEAL COMPOSITION AND CYCLE
Daily Patterns
Historically, two meals a day were typical in West
Africa, one late in the morning and one in the
evening. Snacking was common; in poorer tribes,
snacks would replace the morning meal and only
Goober, the nickname for and raccoon, is eaten. More often the meal dinner would be served. Food was eaten family
peanut, comes from the includes local fish and shellfish, such as catfish, style or, more formally, the men were served first,
Angolan word for the crab, or crawfish. Frog legs and turtle are popular then the boys, then the girls, and last the women.
legume, nguba. in some areas. Meats, poultry, and fish are often Sometimes men gathered together for a meal
combined in thick stews and soups, such as without women. Mealtimes often were solemn;
gumbos (still made sticky with okra or fil people concentrated on the attributes of the food,
powder) that are eaten with rice. They may also and conversation was minimal.
be coated with cornmeal and deep-fried in lard, The West African tradition of frequent snack-
as in southern-fried chicken and catfish. ing continued through the slave period and after
The vegetables most characteristic of south- emancipation. Meals were often irregular, per-
ern African-American cuisine are the many vari- haps due to the variable hours of agricultural
eties of greens. Food was scarce during the Civil labor. The traditional southern-style meal pat-
War, and most southerners were forced to exper- tern was adopted as economic conditions for
iment with indigenous vegetation, in addition to both blacks and whites improved. Breakfast was
cultivated greens such as chard, collard greens, typically large and leisurely, always including
kale, mustard greens, spinach, and turnip greens. boiled grits and homemade biscuits. In addition,
Dockweed, dandelion greens, lambs quarter, eggs, ham or bacon, and even fried sweet pota-
marsh marigold leaves, milkweed, pigweed, toes would be served. Coffee and tea were more
pokeweed, and purslane were added as accept- common beverages than milk or juice.
able vegetables. Traditionally, the greens are Lunch, called dinner, was the main meal of the
cooked in water flavored with salt pork, fatback, day. It was eaten at mid-afternoon and featured a
boiled entre, such as legumes or greens with ham, Other holiday meals, especially Christmas,
or another stew-type dish. Additional vegetables feature menus similar to the Sunday meal, but
or a salad may have been served, as well as pota- with added dishes and even greater amounts of
toes and bread or biscuits. Dessert was mandatory food. Turkey with cornbread stuffing and baked
and was usually a baked item, not simply fruit. ham are often the entrees; other vegetable dishes,
In some homes a full supper of meat, vegetables, such as corn pudding, sweet peas, and salads, are
and potatoes was served in the evening. Poorer typical accompaniments. A profusion of baked
agricultural families often ate only two of these goods, including yeast rolls, fruit cakes and cob-
hearty meals a day. Today few southern African blers, custard or cream pies, and chocolate,
Americans, or whites, continue this traditional caramel, and coconut cake, round out the meal.
meal pattern in full. The Southern-style breakfast Some blacks eat symbolic foods on New Years
might be served just on weekends or holidays, for Eve, such as fish for motivation, greens for
example. As in the rest of the country, a light lunch money, black-eyed peas for good luck, and rice
has replaced the large dinner on most days, and for prosperity.14
supper has become the main meal. Southern black cuisine is particularly well
Meal traditions vary for recent African immi- suited to buffet meals and parties. A pan of Traditionally, African
grants to the United States today. Throughout gumbo, a pot of beans, or a side of barbecued ribs Americans in the South
West Africa, three meals a day are typical, though can be stretched to feed many people on festive believed that heavy meals
in some areas, only two meals are consumed occasions. Informal parties to celebrate a birth- would stay with a person;
during periods of privation, such as just before day, or just the fact that its Saturday night, are light meals were appropri-
ate only for infants and
the harvest.56 Ethiopians, Eritreans, and Somalis still common. Traditional Southern food is also
invalids.
usually eat one or two meals a day, snacking in served at Juneteenth celebrations held in many
between. In Eritrea and Somalia, fool, which is a African-American communities to commemo-
puree made from chickpeas in Eritrea, and pinto rate the emancipation of the slaves.
beans in Somalia, is a popular breakfast item. The African-American holiday of Kwanzaa has
Food is typically offered on a communal plate, gained popularity in recent years. Created in
and individuals use bread to scoop up what is southern California in 1966, Kwanzaa recognizes
desired. Meals are often joyous and noisy. Three the African diaspora and celebrates the unity of all
meals each day are common in East Africa, and people of African heritage. It begins on December
in Kenya many people also stop for British-style 26 and runs through New Years Day. Each day a
tea in the afternoon. However, in many areas new candle is lit to symbolize one of seven prin-
meals are limited to two daily when food is in ciples: unity, self-determination, collective work
short supply. Traditionally, men were served first, and responsibility, cooperative economics, pur-
followed by women, and then children dined. In pose, creativity, and faith. The holiday culminates
South Africa a Westernized pattern of three with a feast featuring dishes from throughout
meals, with dinner the largest, is usually followed. Africa, the Caribbean, the U.S. South, and any
other region where Africans were transported.
Special Occasions Recent African immigrants may celebrate Ethiopians in rural regions
Sunday dinner had become a large family meal many religious holidays, especially those associ- of Africa may fast every
during the slave period, and it continued to be the ated with the Eastern Orthodox and Islamic Wednesday and Friday (no
main meal of the week after emancipation. It was faiths. In Nigeria, child-naming ceremonies are food from sunrise to noon;
a time to eat and share favorite foods with friends particularly important celebrations.131 A grand- no animal products of any
type until sunset) according
and kin, a time to extend hospitality to neighbors. mother performs the ritual, offering symbolic
to their Eastern Orthodox
Many southern African Americans still enjoy foods to the infant, including water (purity), oil
faith.
a large Sunday dinner, usually prepared by the (power and health), alcohol (wealth and prosper-
mother of the house, who begins cooking in the ity), honey (happiness), kola nuts (good fortune),
early morning. The menu would probably and salt (intelligence and wisdom). Following the
include fried chicken, spareribs, chitterlings, pigs tasting, the name is whispered to the child, then
feet (or ears or tail), black-eyed peas or okra, announced aloud to the attendees. The family
corn, corn bread, greens, potato salad, rice, and and guests then enjoy a meal together. Many
sweet potato pie. Homemade fruit wines, such as Nigerian Americans continue the custom in the
strawberry wine, might also be offered. United States.
220 AFRICANS
THERAPEUTIC USES OF FOOD

Many African Americans maintain health by
eating three hearty meals each day, including a
hot breakfast. Numerous other beliefs about food
and health are noted among small numbers of
African Americans living in the rural South.
Some of these dietary concepts were brought to
other regions of the country during the great
Merritt Vincent/PhotoEdit, Inc.
migrations and may be found among black

elders. The conditions known as high blood
and low blood are one example. High blood
(often confused with high blood pressure and
high blood sugar levels) is most prevalent and
thought to be caused by excess blood migrating
to one part of the body, typically the head. High
Kwanzaa, the African-
blood is caused by eating excessive amounts of
American holiday celebrated
rich foods, sweet foods, or red-colored foods
from December 26 through
January 1 each year, culmi- ROLE OF FOOD IN AFRICAN-AMERICAN (beets, carrots, grape juice, red wine, and red
nates with a feast featuring meat, especially pork). Low blood, associated
SOCIETY AND ETIQUETTE with anemia, is believed to be caused by eating
dishes from throughout
Africa, the Caribbean, the In the American South food has traditionally too many astringent and acidic foods (vinegar,
U.S. South, and other regions been a catalyst for social interaction, and lemon juice, garlic, and pickled foods) and not
where Africans now live. Southern hospitality is renowned. For some enough red meat. Other blood complaints
blacks, eating is an intimate or a spiritual include thin blood that cannot nourish the
experience that is shared with others.4 Food is body, causing a person to feel chilly; bad blood,
lovingly prepared for family and friends, and due to hereditary, natural, or supernatural con-
food is considered an important factor in the tamination; unclean blood when impurities
cohesiveness of African-American society. collect over the winter months and the blood car-
Eritrean Americans let In Africa today sharing food is still an impor- ries more heat; and clots, when the blood thick-
fellow immigrants know tant social activity, often accompanied by loud ens and settles in one area, associated with
they have the alcoholic conversation and gaiety. Food is offered to menstruation or stomach and leg cramps.23, 78, 135
barley beverage called sowa anyone who is in the home, and in some Tea made from the yellowroot shrub
for sale by putting a tin can nations, such as Nigeria, it is common for (Xanthorhiza simplicissima) is thought to cure
on a tall stick placed in
extended family members to drop by unan- stomachache and fever and used to treat diabetes.
front of their house.116
nounced for a meal.131 In many urban areas, Some blacks also believe peppermint candies are
Western styles of dining are practiced. However, helpful in diabetes. Sassafras tea or hot lemon-
in rural regions meals are often served commu- flavored water with honey is considered good for
nally and consumed with the hands. Only the colds, and raw onion helps to break a fever.
right hand may be used for eating, and the left Turpentine sweetened with sugar reputedly cures
hand should not touch anything on the table. intestinal worms when consumed orally, while a
Although it is usually a sign of respect or affec- mixture of figs and honey will eliminate ring-
tion to feed a bite of food directly into another worm. Goats milk with cabbage juice is used to
persons mouth, it is considered exceptionally cure a stomach infection. In some areas eggs and
rude to pass food from one persons hand to milk may be withheld from sick children to aid in
another persons hand.55 In Uganda diners stay their recovery.23, 75, 136
seated until all people have finished eating, and Pica, the practice of eating nonnutritive sub-
sticking ones legs out or leaning on an elbow is stances such as clay, chalk, and laundry starch, is
not acceptable.108 In Eritrea an invitation to one of the most perplexing of all food habits prac-
coffee means a visit of over an hour, with a min- ticed by African Americans, whites, and other
imum of three cups consumed in a ritual that ethnic groups. Studies have determined that pica
includes the burning of incense. 116 is most often practiced by black women during
pregnancy and the postpartum period, and that or Southern heritage. Even in the South, many Pica is the Latin word for
rates are unchanged since the 1970s (information traditional foods and meal patterns have changed magpie, a bird known for its
on pica among other ethnic groups or age groups due to the pressures of a fast-paced society. indiscriminate diet. More
in the United States is limited). It is common in Nevertheless, the same foods consumed by blacks unusual pica items report-
edly consumed include cig-
the South, where anywhere from 16 to 57 percent and by whites are likely to have different mean-
arette butts and toilet
of pregnant African-American women admit to ings within each cultural context, and blacks
air-freshener blocks.
pica. But pica is also found in other areas of the often report that their food habits are uniquely
country where large populations of African African American.4 Geophagy, or clay eating, is
Americans reside. In rural regions the substance common among the men,
ingested is usually clay. In urban areas laundry women, and children of
starch is often the first choice, though instances ADAPTATIONS OF FOOD HABITS Africa. It is done to alleviate
of women who ate large amounts of milk of mag- Ingredients and Common Foods hunger, to soothe the irrita-
nesia, coffee grounds, plaster, ice, and paraffin tion of intestinal parasites,
Food preferences do not vary greatly between for spiritual purposes in
have also been reported. Many causes for pica
blacks and whites in similar socioeconomic connection with the swear-
have been postulateda nutritional need for
groups living in the same region of the United ing of oaths, and for med-
minerals, hunger or nausea, a desire for special
States. Comparisons do show that African ical reasons. Active trade in
treatment, and cultural tradition are the most
Americans choose items such as pork (especially clay tablets and disks is
common hypotheses. One study found pica was found at some markets.
chops, bacon, and sausage), poultry, fresh fish
more common among women with limited social
and seafood, sugar, and non-carbonated fruit
support. Another theory suggests it may be In one qualitative study,
drinks far more often than the general popula-
related to obsessive-compulsive disorder (OCD). older African-American
tion. African-American households also pur-
Reasons for pica reported by women include respondents felt strongly
chase fewer fruits and vegetables, fewer dairy
flavor, anxiety relief, texture, and the belief that that being black influenced
products, less cereal and baked goods, fewer food choices, and that all
clay prevents birthmarks or that starch makes the
snack foods (such as potato chips), and less coffee blacks liked similar foods.
skin of the baby lighter and helps the baby to slip
than do any other households, however.112 Fast Younger respondents were
out during delivery.19, 43, 72, 75, 127
foods are popular, and one study determined that more likely to state that
Recent immigrants from Africa may hold tra-
there are nearly 60 percent more fast-food restau- their ethnicity had little
ditional beliefs about maintaining health through
rants in predominantly black neighborhoods effect on their preferences.4
a balance of proper diet, exercise, good relations
than in mainly white neighborhoods.16
with family and community, emotional well-
The popularity of soul fooda term coined
being, and spirituality.156 Poor diet is identified as
in the 1960s for traditional Southern black cuisine
a tangible cause of some conditions, and overweight
is notable. It is associated with fresh meats and
is often valued as a sign of health. Meat con-
vegetables made from scratch and thoroughly
sumption may be associated with longevity.
cooked. Items are preferred well spiced.4 Many
Many people in Africa have limited access to bio-
African Americans have adopted this cuisine as a
medical care and make extensive use of botanical
symbol of ethnic solidarity, regardless of region
home remedies. In Nigeria, for example, unripe
or social class. Today soul food serves as an
plantains and dried soursop (a tropical fruit) are
emblem of identity and a recognition of black
two treatments used for diabetes.115
history for many African Americans.

Contemporary Food While the common foods that African Americans
eat reflect geographic location and socioeco-
Habits in the nomic status, meal composition and cycle have
changed more in response to work habits than to
United States other lifestyle considerations. The traditional
Southern meal pattern of the large breakfast with
Most researchers have noted that the food habits fried foods, followed by the large dinner with
of African Americans today usually reflect their boiled foods and a hearty supper, has given way
current socioeconomic status, geographic loca- to the pressures of industrial job schedules. One
tion, and work schedule more than their African seminal study80 showed that Southern breakfast
222 AFRICANS
habits were maintained for only eighteen months NUTRITIONAL STATUS

after migration to the North and then were replaced
with a meal typically consisting of sausage and The nutritional status of African Americans is
biscuits or toast. difficult to fully characterize because a limited
Research indicates that some African Americans number of studies have addressed this popula-
no longer identify certain foods or preparation tion, and conflicting data exist. In general, how-
methods, such as okra and yams, and one-pot ever, research has shown that African Americans
meals, as African in origin.4 Many of the items nutritional intake is similar to that of the general
known to be traditional fare are not eaten often, population and varies more by socioeconomic
including pigs feet and chitterlings (some of these status than by ethnicity.
foods are also associated with the poor, and respon-
dents may be reluctant to admit eating such items). Nutritional Intake
The exception was greens, which were identified The Healthy Eating Index (HEIdeveloped by
most often as a traditional African-American food the USDA Center for Nutrition Policy and
and were also the most popular with respondents: Promotion), which measures compliance with
78 percent eat greens at least once a month.25 Food Guide Pyramid recommendations and
African Americans throughout the country other dietary factors, such as total fat, saturated
now eat lighter breakfasts and sandwiches at a fat, sodium and cholesterol intake, and variety,
noontime lunch. Dinner is served after work, and found a mean score of sixty-one for blacks, just
it has become the biggest meal of the day. slightly below the national population mean of
Snacking throughout the day is still typical sixty-three. However, a larger percentage of
among most African Americans. In many house- African Americans were determined to have poor
holds meal schedules are irregular, and family diets compared to the total population, 21 per-
members eat when convenient. It is not unusual cent to 16 percent, respectively. Low intakes of
for snacks to replace a full meal. dairy products and vegetables and higher intakes
A popular dessert made by Frying is still one of the most popular meth- of sodium were contributing factors.9 African
Ugandan Americans is ods of preparing food. An increase in consump- Americans have been reported to have diets high
peanut orange cake, made tion of fried dinner items suggests that the in fatsimilar to that of the typical American
by adding orange zest, vine- customary method of making breakfast foods has dietassociated with high meat intake, the pop-
gar, and peanut butter to been transferred to evening foods (which were ularity of frying, and fast food consumption.17, 36,
cake batter.108 57, 132
traditionally boiled) when time constraints pre- The percentage of calories from animal
vent a large morning meal.80 Boiling and baking proteins for blacks is often greater than for
are second to frying in popularity.145 African whites, however, due in part to a high intake of
Americans use convenience foods and fast foods fatty meats, such as bacon and sausage.35, 138
as income permits. Ninety percent of midlife African-American
Research is limited on the food habits of more women in one year-long study reported they
recent African immigrants. It has been noted that intended to reduce their fat consumption, yet 77
among Somalis, cheese, sodas, and sweetened percent consumed over 30 percent of the daily
fruit drinks are very popular. Recipes are being calories as fat, and 61 percent consumed more
adapted to available ingredients. For example, than 10 percent of total calories as saturated fat.36
wheat flour or pancake mix is now used to make High intake of cholesterol has been found in
anjeero.68 A study of Sudanese Americans found some studies.36, 37
that foods typically consumed at breakfast and Dairy foods are consumed less often by
lunch included fava or lentil beans made with African Americans than by whites.36, 141
feta cheese, vegetables, and sesame oil; eggs, fried Approximately 60 to 95 percent of adult Americans
liver, meat and vegetables stews, bread, salad, of African descent are lactose intolerant. Some
fresh fruit, yogurt, custard, Jell-O, and highly studies show that milk is widely disliked and
sweetened tea. Frying, stewing, sauting in avoided; others indicate milk is consumed as often
sesame oil (which was called boiling), ferment- by blacks as it is by whites. One trial found that lac-
ing, and grilling were the most common methods tose digestion in African-American adolescent
of preparation. Baking and steaming was girls improved on a dairy-rich diet.122 The neces-
extremely rare.44 sity of consuming dairy products is debatable, and
research on older women reported that dietary On average, black men live 6.4 years less than
calcium intake was similar between blacks and white men in the United States, and black women
whites; however, grain products, such as fortified live 4.6 years less than white women. However,
cereals, were the primary source of the nutrient for the gap in life expectancy is far greater for certain
the African-American respondents.110 subpopulations. African-American men living in
Many African Americans diets are low in fruits, high-risk inner-city neighborhoods are likely to
vegetables, and whole-grain products and low die twenty-one years earlier than Asian-American
intakes of dietary fiber have been reported.36, 37 women in general. Life expectancy rates have not
Even as income increases, fresh produce is some- improved substantially since the 1980s and are
times ignored in favor of increased expenditure not explained by ethnicity, income, or health care
on meat and other protein foods. However, it is access alone.111
noteworthy that many dietary comparisons use Morbidity and mortality rates for black moth-
food frequency data without defined portion ers and their infants are also disproportionately
sizes. A study of rural blacks found that when high. Maternal deaths are over three times higher
portion size was explained, participants ate on for African Americans than for whites, and infant
average larger portions of fruits and most veg- deaths are more than two times higher.112 Dietary
etables than standard definitions, increasing factors, a large number of teenage pregnancies,
their daily intake of fruits and vegetables by and inadequate prenatal care may contribute to a
a significant two-thirds serving.26 Further, higher incidence of low-birth-weight infants
national surveys suggest that prevalence of low (13.55 percent, almost double the rate for
fruit and vegetable intake among blacks is only whites).112 Low mean daily folate intake is of par-
slightly higher than among whites and may be ticular concern because it is associated with a
more typical of the general American food pat- greater risk of both preterm delivery and low
tern than of ethnic variation, except among some birth weight.133 Overall, African-American
lower-income groups with limited access to fresh women are three times more likely than whites to
produce.7, 157 have a preterm infant of very low birth weight
Nutrient intake deficiencies may be found (less than 1,500 grams). Researchers several years
among some African Americans living at or near Some studies report African-American moth- ago questioned whether
poverty levels in the United States, especially ers breast-feed their infants at higher rates than iron and calcium require-
among older study subjects. Rural African- white mothers, though others suggest low rates of ments for blacks differed
American elders consumed fewer servings of breast feeding.21, 33 One study found that the from whites, based on evi-
dence that blacks have
meats, fruits, and vegetables, and fats, oils, primary reason low-income women do not initi-
lower hemoglobin levels
sweets, and snacks than whites in one survey.155 ate breast feeding is fear of passing dangerous
and higher serum ferritin
The most frequent insufficiencies are of calories, things to their infants through the milk.45 Some levels independent of iron
iron, and calcium.36, 59, 102, 110 Deficiencies in vita- blacks differ somewhat from whites in regards to intake, and a substantially
mins D, E, B6, folate, potassium, copper, sele- which solid foods they feed their infants and how lower risk of osteoporosis
nium, and zinc have also been reported. 5, 37, 46, 99 soon after birth these are introduced. One-third than whites.93, 97 Limited
Insufficient intakes are often similar to, or only of low-income mothers offered non-milk liquids data have been reported
marginally lower than, those of whites living in or solids to their infants at seven to ten days, 77 that confirm or refute these
the same location, however.100, 110 Although sig- percent did so by sixteen weeks, and 93 percent theories.
nificant dietary differences have been reported in by sixteen weeks.22
some studies, a review of the literature on black Overweight is a common problem for adult
elders low nutrient intake compared to white Americans of African descent. Estimates show
elders questioned the significance of reported that 37 percent of black women and 32 percent of
deficiencies: study samples were small, and black men are obese (compared to 23 percent of
actual anthropometric, clinical, and biochemical white men and women).101 The gap between
data confirming differences were sparse.50 In black and white men is not as large as for black
deficiencies typical of the standard American and white women. By age forty, 80 percent of
diet, it is noteworthy that use of vitamin and black women are overweight, compared to 61 per-
mineral supplements, which sometimes provides cent of white women.15 Adolescents and children
sufficiency in whites, is lower in the black are also at risk, especially girls.41, 92 Fat patterning
population.5, 46, 110 has also been shown to differ between African
224 AFRICANS
A study of different black Americans and whites. African Americans may standards may be confounded by differences in
subgroups found that have more upper-body and deep-fat depositions socioeconomic status.41
dietary intake and risk of than whites.159 Studies propose that African-American
cardiovascular disease dif- Excess weight gain may be attributed to many women do not necessarily equate being over-
fered significantly between
factors, including difference in body size ideal, weight with being unattractive and that they are
non-Hispanic blacks born in
preference in body shape by members of the less preoccupied with dieting than are white
the United States and non-
Hispanic blacks/Hispanic opposite gender,10, 130 and a more permissive women.94, 137 Research on disordered eating in
blacks born outside the attitude regarding obesity.15, 42 Though some African Americans has been limited and contra-
United States. Both immi- research suggests income and education levels dictory. Some studies suggest black women have
grant groups had better are inversely associated with the risk for obesity, lower rates of dieting and are protected from
CHD risk profiles and fewer especially among children,92, 127 one large study of eating disorders due to a collective acceptance of
conditions related to CHD.96 adolescents found that the prevalence of over- larger body size.113, 125, 146 Other researchers sug-
weight remained elevated or even increased with gest low rates are due to an assumption that dis-
socioeconomic status among African-American ordered eating does not affect blacks (hence
girls.62 An environment that promotes high African-American girls are often excluded from
intake of fast foods and limits access to healthy studies) and that pressures to conform to societal
items may be another factor.79, 92, 99, 157 A seden- norms regarding weight are eroding any possible
tary lifestyle is also more prevalent among African preexisting cultural buffers, especially among
Americans and is not associated with income, children and adolescents.109, 121, 126, 149
education, occupation, marital status, poverty Concurrent with obesity is a disproportion-
levels, or other indicators of social class.32, 127, 130 ately high rate of type 2 diabetes mellitus among
Data from one study found families living in low- African Americans, with a prevalence rate in
income areas and those with higher percentages 2004 of 12.3 percent for blacks, compared to 6.8
of minority residents were significantly less likely percent for whites.31 Weight gain in African
to have access to recreational facilities.63 In addi- Americans substantially increases risk.134 A
tion, a desire to consume traditional African- higher rate of death due to the disease has been
American foods and to care for others through reported among blacks, and diabetes has also
cooking, and a lack of family support were barri- been found to increase the rate of deaths due to
ers to weight loss cited in studies.15, 79 ischemic heart disease, especially among
Some researchers have suggested standard African-American women.147 Some studies sug-
anthropometric measures may be inappropriate gest a genetic predisposition may be a factor. For
for African Americans. One study found that example, blacks had slightly lower levels of
when body mass index (BMI) values were com- insulin sensitivity than whites after adjusting for
pared to body fatness, black women had lower diet.37 Other studies propose that environment is
body fatness than did white women with identi- an important factor. One study of diabetes in
cal BMI numbers.49 A similar evaluation reported blacks from Ghana, African Americans, and
that when the percentage of body fat is used to whites demonstrated that fat metabolism in
measure obesity instead of BMI, rates for African Americans was more similar to whites
African-American women drop dramatically, than to Ghanaians.8
and rates for white men exceed those for black Hypertension is a leading health problem for
men.27 BMI does not account for differences in African Americans. Their incidence of high
fat-free mass, such as muscle and bone, which blood pressure is almost 70 percent higher than
accounts for the discrepancy between measures. that of the white population. Although statistics
Weight-for-height growth charts as indicators of on the ratio of normotensives to hypertensives by
percentage of body fat and the use of waist-to-hip ethnic group are limited, the data suggest that
ratios in defining heart disease risk have also blacks have the highest proportion of hyperten-
been found misleading in some studies.35, 71 sives of any group (see Cultural Controversy fea-
However, a study of overweight and obesity in ture). In addition, African Americans with
children did not find significant differences in hypertension are more likely to develop condi-
rates when using national standards for assess- tions secondary to hypertension, including high
ment compared to African-American specific rates of end-stage renal disease. Many studies
standards, and cautioned that ethnicity-specific suggest that the risk of high blood pressure in
CULTURAL CONTROVERSYHypertension in African Americans:

Slaves, Racism, Genes, and Diet
B lack Americans have the highest

prevalence of hypertension in
the world. Yet black Africans
have substantially lower rates. What hap-
pened in the transition to account for this
depression, and depression is associated
with increased BMI, which in turn produces
elevated blood pressure.6, 82 Notably, these
factors increase rates of hypertension in
both blacks and whitesit is the number
suggest that the wide acceptance of a
theory with so little justification is sympto-
matic of latent racism in the scientific com-
munity and a desire to perpetually
differentiate African Americans as physio-
difference? and severity of negative stressors that logically defective or abnormal.83 Other
More than 27 percent of non-Hispanic differ. scientists find the idea of genetic adapta-
white adults in the United States have Another more controversial theory tion for low salt intake plausible.95, 144
hypertension, also known as high blood regarding HBP and African Americans is What is known with more certainty is
pressure (HBP).* In comparison, the age- known as the Slavery Hypothesis. that many African Americans retain a rela-
adjusted prevalence in non-Hispanic black Proponents suggest that most blacks origi- tively high amount of the salt they ingest,
men and women is 40.5 percent.30, 89 nated from regions of Africa with meager and this salt sensitivity is a factor in HBP.150
Blacks in the United States develop HBP salt resources, and over generations their Other minerals may also play key roles:
earlier in life, have higher rates of severe bodies adapted to the deficiency by Low intakes of calcium, magnesium, and
hypertension, and have a greater risk of becoming efficient at salt retention. When potassium are associated with hyperten-
death from renal failure, stroke, and heart these blacks were brought as slaves to the sion. (In a biological twist of fate, salt
attack associated with the condition.51 Caribbean and the United States, those retention may be associated with calcium
Studies show sub-Saharan African blacks who were best able to conserve salt may retention, which could account for why
have a low prevalence of HBP, though rates have avoided death due to dehydration or many black women have high bone min-
increase with urbanization.138, 154 mineral-depleting fever, vomiting, and eral density and low rates of osteoporosis
Intermediate to high prevalence has been diarrhea. Because a large percentage of despite low calcium intake.) Several studies
reported for Caribbean blacks.38, 66 slaves died within the first four years of have suggested that lowering salt intake
One hypothesis for these HBP differ- captivity, survival from these endemic ill- while increasing calcium, magnesium, and
ences in black Africans and black nesses could hypothetically have assured a potassium intake may reduce hyperten-
Americans is an increase in negative envi- genetic selection for salt retention.65, 152, 153 sion.40, 54, 84, 85 Whatever the causes behind
ronmental stressors. Studies have demon- Some scientists have refuted this high rates of hypertension in African
strated an association between theory, pointing to a lack of historic evi- Americansgenetics, environment, or a
hypertension and low socioeconomic dence for low-salt diets in Africa, uncer- combination of bothfood habits will
status. Research also suggests that chronic tainty in the number of slave deaths during undoubtedly be a part of the solution.3, 139
discrimination and the struggle for social transportation, the unknown causes of
acceptance can lead to ongoing stress and these deaths, and skepticism regarding the *Hypertension is defined as a systolic (heart-pumping)
an increased prevalence of HBP. 2, 91, 151 possibility of quick genetic changes in pressure of at least 140 mm Hg and a diastolic
Stress may also result in increased rates of response to physical duress. Further, critics (heart-resisting) pressure of at least 90 mm Hg.
blacks is not due to diet alone.37 Hypertension double the age-specific death rate from strokes,
has been found to be a potent risk factor for also believed to be due in part to high rates of
coronary heart disease (CHD) in blacks, espe- high blood pressure.29
cially women (whereas having diabetes was not Rates of iron-deficiency anemia among
predictive for CHD). The incidence rate for CHD African Americans are higher than for whites at
in African-American women is higher than for every age, regardless of sex or income level. This
white women, but lower in African-American incidence remains excessive even after adjust-
men than in white men.81 Blacks also have nearly ments for differences in hemoglobin distributions
226 AFRICANS
Certain nutritional supple- are made using reference standards appropriate condition.117 Studies of Ethiopian women in the
mental beverages, such as for blacks.12 Pica may result in anemia among United States found that most breast fed their
PediaSure, are reported pregnant women and newborns. Hookworm can infants on average four months, and breast feeding
popular with some Somali also be a cause in the rural South. Other blood is acceptable in public. Going back to work and
immigrants who consume
disorders resulting in anemias prevalent in reduction in mothers milk were the primary rea-
them to gain weight.68
African Americans include alpha-thalassemia, sons given for cessation.48, 106 Somali immigrants
Iron overload due to exces- sickle-cell disease, and glucose-6-phosphate often associate fatness with health and may over-
sive amounts of iron in the dehydrogenase deficiency. Researchers have also feed their children.68 The Somali Bantus are in
diet may affect up to one- suggested that undiagnosed celiac disease in particularly poor health due to acute or chronic
third of sub-Saharan blacks may underlie some cases of iron-defi- malnutrition when living in African refugee
Africans.61 ciency anemia.21 camps prior to arrival in the United States. Most
Little has been reported on the nutritional have little knowledge of American foods. The
Chewing khat (Catha edulis) adequacy of the traditional diet of recent prevalence of low-birth-weight infants is high,
is an ancient practice in Africans. Studies in Israel of Ethiopian immi- and weaning often occurs before six months due
parts of the Middle East and grants found deficiencies in vitamin D (resulting to subsequent pregnancy. Diarrheal diseases and
Africa. The bitter leaves con-
in rickets in children), iodine (due in part to food infections are common. Post-traumatic stress
tain the alkaloid cathinone,
which has amphetamine-
goitrogens), and calcium. Vitamin A deficiency syndrome is also frequently found.118
like effects. It is widely used has led to xerophthalmia and blindness in many
regions. Consumption of enset, common in many Counseling
at social occasions with beer
chasers; nearly half of the parts of Ethiopia, is associated with esophageal Many African Americans have limited access to
urban population in parts cancer.11, 53, 107 Among Sudanese immigrants in health care. Cost, including time off from work,
of Ethiopia chews khat the United States, blindness due to trachoma is is often an issue. In 2005 one-third of working
regularly. Khat may delay also common. High rates of extreme malnutri- age blacks lacked health care insurance at some
gastric emptying, resulting tion, malaria, typhoid, hepatitis B, HIV infection, point during the year.39 Self-reliance is highly
in lack of appetite and Dengue fever, tuberculosis, syphilis, dental prob- valued and may lead to delay in seeking care or
constipation.69 lems, diabetes, and parasitic infection have also minimization of symptoms. Furthermore, an
been reported.1, 123 attitude that fate determines wellness may
Dietary changes of Ethiopians in Israel are restrict medical visits. When a doctors care is
marked. A survey of teens found that within eight- sought, it is usually for treatment of symptoms
een months of arrival, only 30 percent maintained (often after home remedies have been tried)
a traditional diet, 60 percent consumed a mixed rather than for prevention of illness and health
diet, and 15 percent ate only Israeli foods.140 More maintenance.58 Many blacks are present-oriented,
than half of daily calories came from snacks and and flexible scheduling and on-time policies
fast foods, especially sweets and soft drinks. Most may be helpful.56
milk products were disliked, with the exception of Some African-American clients feel patronized
hot chocolate, a favorite with the youth. Fat intake by non-black providers and may choose to suffer
increased, while fruit and vegetable intake at home rather than submit to humiliation. Others
decreased. Though obesity is unusual, glucose may be suspicious or hostile when working with
intolerance is common, and the prevalence rate of non-black health care professionals. Such attitudes
type 2 diabetes increased from 0.4 percent to are rarely directed specifically at the health care
between 5 and 8 percent within a few years. Over worker; instead, they are an adaptation to what is
20 percent of men also developed hypertension perceived as a prejudicial society.34,56 Some
after immigration.24 In Australia immigrants from African Americans may not consider themselves
Ghana experienced similar changes in diet and active participants in their interaction with
health status. Fat intake accounted for 33 to 35 providers and may not communicate needs or
percent of total calories, and overweight was questions. This is sometimes done to test the
observed in 71 percent of men and 66 percent of competency of the provider, who is expected to
women. High rates of diabetes, hypertension, and diagnose without help from the client.77 It may
dyslipidemia were reported.129 also be a reflection of the belief that their health
In Nigeria some women believe that edema care is out of their control, up to luck or destiny.156
during pregnancy is an indication that the infant African-American conversational style is fully
is male, and treatment may not be sought for the engaged and very expressive.156 Interjections of
NEW AMERICAN PERSPECTIVESNigerian

Nkechi Onuekwusi
University student, majoring in nutrition
Both my parents are Nigerian. They came to the United States in the late 1970s to attend college. They met at school and eventually
ended up in Texas. Although I grew up in Texas, I ate Nigerian food at home along with American food. Even in Texas, if there are
enough Nigerians living in town, there will be a Nigerian grocery store. Unfortunately, its harder to find Nigerian foods in Austin, but
many of the ingredients can be found at the local grocery store. Nigerian food is mostly white rice, several types of meat, fish, lots of
fruit including plantains, and vegetables. Meat is often cooked as stews. Legumes, nuts, and starchy vegetables are also a big part
of the diet, including yams. And we use palm oil to cook with. We typically eat three meals a day. Breakfast might be akara (a fried
bean dish) or moyin-moyin (ground-up beans made into a paste with tomatoes, spices, and maybe even vegetables and then
wrapped in foil and steamed). Bread and tea are often eaten at breakfast, and even oatmeal sometimes. My mother often eats fruit
with a rice stew that includes okra and a starchy vegetable paste called fufu to dip into the stew. Fufu, however, is more typically con-
sumed at lunch, and fruit is a snack food. Dinner would again be rice and another stew, like jollof, that usually includes meat or fish.
My parents diet has not changed much, and they still mostly cook Nigerian food at home. Since I am a student I eat more
processed food, but my diet is still high in fruits and bread. I crave certain Nigerian foods like meat pies, suyabeef coated with
spices and ground peanuts, roasted on a stick; and chin chintiny square fried dough covered with sweet spices, nutmeg.
The only time we make American food at home is for Thanksgiving. Once my mom decided to make Thanksgiving, but she cooks
the Nigerian waynot measuring anythingand except for the turkey everything came out awfulthe pies were soupy and
everything tasted bad. Now my sisters and I do the cooking for Thanksgiving, and it is the typical American Thanksgiving foodno
Nigerian food.
agreement or disagreement are frequent. Words gas and constipation that can accompany pica
are often spoken rhythmically and passionately. may be harmful during pregnancy.19 Traditional
Response time is very quick. When counseling health practices, such as using diet to cure high
African Americans, it is helpful to be direct yet and low blood, may complicate some nutrition
respectful. Eye contact is made while speaking, counseling. Pregnancy is sometimes considered
but prolonged eye contact is considered rude. to be a high blood state, and pregnant women
African Americans may avert their eyes while lis- will avoid red meats. Patients who confuse hyper-
tening; however, some blacks may interpret rapid tension with high blood may eat astringent foods,
eye aversion as an insult. Attentive listening is which are often high in sodium, to balance the
more important than eye contact to many blacks. condition. Home remedies for diabetes, such as
A firm handshake and smile are the expected peppermint candies or yellowroot bush tea,
greeting; hugging and kissing may also be should also be investigated. A client is unlikely to
included. Touching is common, and reluctance to mention any use of other healers.64 It may be
touch may be interpreted as personal rejection. useful to directly inquire whether a rural African
Nonnutritive food intake during pregnancy American believes an illness is due to outside
may be missed unless information about pica is forces or witchcraft and what additional treatment
solicited during the interview. Most women who is being sought.
eat clay, laundry starch, or other nonfood items Counseling recommendations should be action-
will willingly list the items consumed when asked or task-oriented. Several studies of African
directly about the habit. The nutritional effects of Americans have suggested family-oriented pro-
pica are uncertain. Possible problems include grams and group classes may be more successful
excessive weight gain (from laundry starch), than individual counseling, and use of community
aggravated hypertension (from the sodium in resources, such as churches, can provide additional
clay), iron-deficiency anemia, and hyperkalemia.93 support for nutritional change.79, 120 Culturally rel-
Furthermore, over-the-counter remedies for the evant education may include elements of spirituality,
228 AFRICANS
ethnic pride, group planning, and the use of peer 2. Compare similarities and differences in West
counselors.52, 86, 90, 148 Diets that limit traditional and East African traditional cuisines. What
African-American foods are often resisted by countries have influenced East African cuisine?
clients, due to preference, expense, family desires, 3. Name the presented symbolic foods used in
and ethnic identity.15, 79, 119 One study found that the Nigerian child-naming ceremonies, and
blacks felt socially isolated when restricted to non- explain what they symbolize.
traditional foods.73 Researchers have suggested 4. Describe three therapeutic uses of food
that because many African Americans take pride among African Americans. What is pica, and
in the adaptations made in their cuisine due to his- why is it practiced?
torical circumstances, the potential for dietary 5. For African Americans, how might diet affect
improvement associated with environmental the incidence and treatment of hypertension
change is high.4 and type 2 diabetes mellitus?
Little information is available regarding
counseling recent immigrants from Africa.
Recommendations for Ethiopians include use of CHAPTER 8 REFERENCES
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CHAPTER
9
Mexicans and
Central Americans
Mexicans
L atinos are the largest non-European ethnic
group in the United States, representing
13 percent of the total population. Yet
Latinos are not a single cultural group, coming
from more than twenty-five Latin American
Estados Unidos Mexicanos, the United Mexican
States, is the northernmost Latin American
The term Latino describes
people originally from
Mexico, the Caribbean, and
country. Though Mexico seems logically a part of
nations with diverse ethnic populations. Though Central America, it is geographically a part of Central and South America.
a majority share Spanish as a common lan- It suggests culture of Latin
North America. It is more than one-fourth the size
guage of origin, others speak English, French, heritage, not exclusively of
of the United States, with 756,065 square miles of Spanish background. For
Portuguese, or a native Indian dialect as their territory. The varied geography includes a large example, Haitians and
mother tongue. central plateau surrounded by mountains except Brazilians are both Latinos
Immigrants from Mexico and the countries of to the north. Coastal plains edge the country but speak French and
Central America bring a rich cultural history (see along the Gulf of Mexico and the Pacific. The Portuguese, respectively.
Figure 9.1). The Olmec culture, known for its separate Baja peninsula is found in the west, and Hispanic is preferred by
sophisticated sculpture, existed in southeastern the Yucatn peninsula juts out in the southeast. some, though there is no
Mexico as early as 1200 B.C.E. The great Aztec, Snow-capped volcanoes, such as Orizaba, clear definition of this
Mayan, and Toltec civilizations thrived while Popocatpetl, Ixtacchiuatl, and El Chichn, and term. It can mean born in
Europe was in its dark ages. Their independent frequent earthquakes also affect the landscape. The Latin America,ancestors
mastery of astronomy, architecture, agriculture, born in Latin America,
climate ranges from arid desert in the northern
and art astonished later explorers. Spanish occu- Spanish surnames, or
plains to tropical lowlands in the south. Spanish speaking.
pation of Mexico and Central America intro- Almost two-thirds of Mexicans are mestizos
duced new ideas and traditions, most notably that is, of mixed Indian and Spanish ancestry.
Roman Catholicism; British, French, and Thirty percent are native Indians, and about 10
Austrian intrusions also provided minor contri- percent are whites of Spanish descent. Spanish is
butions. The foods of Mexico and Central the official language. Only 1.5 percent of Mexicans
America reflect the native Indian and European speak a single Indian language, mostly Nahuatl.
heritage of the region. This chapter examines
Mexican cuisine and the food habits of CULTURAL PERSPECTIVE
Americans of Mexican descent. An overview of
recent immigration from Central America and History of Mexicans in the United States
the traditional fare is also included. The follow- Immigration Patterns. Mexican immigration
ing chapter reviews Latinos from the Caribbean patterns have changed over the years since
Islands and South America. the Mexican-American War clearly defined the
236 MEXICANS AND CENTRAL AMERICANS
UNITED STATES
North Gulf of Mexico

Pacific MEXICO
Ocean Mexico
City CUBA
BELIZE
GUATEMALA
EL SALVADOR
PANAMA
Figure 9.1 HONDURAS
Mexico and Central NICARAGUA
America. COSTA RICA
U.S.-Mexican border. Today, Mexicans living in Mexicans lived in what is now the American
America and their descendants can be classified Southwest for hundreds of years before the
in the following groups: (1) Chicanosthose who United States declared its independence in 1776.
are born in the United States (from the descen- Although they welcomed American settlers, they
dants of the wealthy Mexican landowners who soon found themselves outnumbered, and their
controlled the area from California to Texas in economic and political control of the region
the eighteenth and early nineteenth centuries to weakened. At the end of the Mexican-American
the children of the most recent arrivals), as well War in 1848, the 75,000 Mexicans living in the
as those who immigrated from Mexico and ceded territories became U.S. citizens.
became U.S. citizens; (2) Bracerosthose who Between 1900 and 1935, it is estimated that
work here legally but remain Mexican citizens; 10 percent of the Mexican population, approxi-
and (3) unauthorized migrantsthose who enter mately 1 million persons, emigrated north to
the country illegally. It should be noted, however, the United States. Then, during the Great
that use of identifiers may vary regionally or by Depression, tens of thousands of unauthorized
generation. For example, many who live in New migrants, plus those admitted legally under the
Mexico prefer the terms Spanish American or 1917 contract labor laws, were repatriated and
Hispano, while in Texas, Tejano is popular. While sent back to Mexico.
many younger Mexican Americans take pride in After the Great Depression, the need for cheap
being a Chicano, some older Mexican Americans labor increased. The Bracero program was created
associate the name with unsophisticated immi- to meet this need. Thousands of Mexicans were
grants and may be insulted by use of the term.45 offered jobs in agriculture and on the railroads.
Chapter 9: Mexicans and Central Americans 237
Following World War II, the continued need for Socioeconomic Status. Mexican Americans The term Chicano came
farm workers encouraged additional immigration, occupy three main socioeconomic classes. There from the Aztec word for
resulting in a total of over 4.5 million contracts are the migrant farm workers, who maintain a Mexicans, Meshicano.
(some individuals obtained multiple contracts over culturally isolated community; the residents of the
several years) issued to Mexican nationals urban barrios, who also are segregated from much
between 1942 and 1964. In the past thirty-five of American society; and a growing number of
years, Mexicans have been the largest single acculturated middle-class Chicanos. Unauthorized
group of legal immigrants to the United States. migrants tend to move in with family members
who already reside in the United States. Usually,
Current Demographics. Census estimates from this is in a predominantly Latino neighborhood The 2001 Canadian Census
2005 list nearly 27 million Chicanos and where they can live inconspicuously among the listed more than 36,000
Braceros in the United States (of whom over 9 residents while becoming familiar with the residents of Mexican
million were born in Mexico), accounting for 59 American social and economic systems. Specific heritage and an additional
percent of the Latino population.137 The majority data on Mexican Americans is limited because 41,000 of Latin of
unspecified nationality.
of Chicanos live in California and Texas. they are often grouped with data for all Hispanics.
However, the settlement pattern for new immi- Despite a rapidly growing Chicano middle to
grants has changed since the 1990s, becoming upper class, many Americans of Mexican descent
more nationwide. Destination states for Mexican have low socioeconomic status. Median family
Americans are now Florida, Georgia, Idaho, incomes are 30 percent below the national average,
Minnesota, Nevada, New York, New Jersey, and more than 23 percent of families fall below
Oregon, and Utah. Eighty percent of the immi- the poverty level.137 This is due in part to a dis-
grants from Mexico settle in U.S. cities such as proportionate number of Chicanos employed in
San Diego, Los Angeles, San Antonio, and unskilled or semiskilled labor. Although only
Chicagoand more recently, Dallas, Houston, 3 percent of Mexican Americans are currently
Las Vegas, Minneapolis, New York City, and working in agricultural jobs, more than 50 percent
Phoenix.40 Many recent immigrants, legal and are employed in manufacturing or service occupa-
unauthorized, settle in the urban Latino neigh- tions. Approximately 16 percent hold professional
borhoods called barrios. or managerial positions. Just 55 percent of Mexican
Research on unauthorized migrants suggests Americans graduate from high schoolone study
that between 11 and 12 million were living in found the figure is only 16 percent for adults who
the United States in 2006, a majority of whom were born in Mexico, but rates rise to 80 percent
came from Mexico.126 Economic pressures in among third-generation Mexican Americans. Yet,
Mexico have increased the number of Mexican this is still lower than for blacks and whites. Less
immigrants entering the United States each year. schooling and fewer skills may account for up to
Many are attempting to escape the life-threaten- three-quarters of the wage gap with whites.3, 60
ing poverty affecting many of the populace. The Research on unauthorized migrants of all Some immigrants from
U.S.-Mexican border is 1,931 miles long, most of nationalities indicates that over 7 million were Mexico seeking migrant
it in unpopulated desert regions. More than 1.5 employed in 2005, accounting for nearly 5 percent agricultural jobs are
million Mexicans are apprehended each year as of the civilian workforce. They hold 24 percent of Mexican Indians (mostly
they attempt to enter the United States illegally. all jobs in farming, 17 percent in cleaning, 14 Mixtecos from Oaxaca),
who speak neither English
Some estimates suggest that twice that number percent in construction, and 12 percent in food
nor Spanish.
may cross successfully. Political pressures in the preparation.126
United States regarding taxpayer support of
services for unauthorized residents have led to Worldview
increased border security, immigration limits, Chicanos, Braceros, and unauthorized migrants
and social program restrictions. The long-term frequently live in culturally homogeneous com-
effectiveness of these changes in preventing illegal munities. Many proudly maintain their ethnic
entry into the country and their effect on immi- identity, speaking Spanish and enjoying Mexican
gration patterns are unknown. What is certain is music and food. The concept of la Raza (meaning
that the economic disparities between the two the people) was first promoted in the 1960s as a
nations will continue to draw Mexicans to the pride and solidarity movement for all persons of
United States. Latin American heritage.
When exposed to the mainstream American Children are cherished in the Chicano family.
society, however, immigrants from Mexico can be Families are typically large among new immi-
highly adaptive. Some Chicanos are completely grants and first-generation families, but research
assimilated. They may speak no Spanish and suggests lower rates of marriage and improvements
consider themselves white or simply American. in educational attainment and socioeconomic
Others are successfully bicultural. Cross-cultural status for women of subsequent generations
marriages are becoming more common, especially result in the birth of fewer children and smaller
in the northern regions of the United States. families.71 Children are taught to share and to
work together; sibling rivalry is minimal. When
Religion. Approximately 75 percent of Ameri-
possible, an extended family is the preferred
cans of Mexican descent are Roman Catholics
living arrangement for many Mexican Americans.
(nearly one in every four U.S. Catholics are of
When a girl turns fifteen Grandparents are honored and are often
Hispanic heritage). Traditional religious cere-
years old, her family hosts involved in child care. Because of space limitations
a quincinera, an elaborate monies, such as baptism, communion, confirma-
in the United States, however, many Chicano
coming-out party with tion, marriage, and the novenas (nine days of
elders live in separate apartments. During periods
music, feasting, and prayer for the deceased) are important family
of hardship, other relatives such as aunts, uncles,
dancing. events (see Chapter 4, Food and Religion). Yet
and godparents willingly accept the care of chil-
despite their numbers within the laity, they are
dren. Girls were traditionally raised differently
underrepresented within the institutional church;
from boys and were kept at home to learn house-
only 6 percent of U.S. priests are Latinos.
hold skills; they were carefully chaperoned in
A strong faith in the will of God influences
public. Although such strict supervision dimin-
how many immigrants from Mexico perceive
ished with successive generations born in the
their world. Many believe they have no direct
United States, family expectations may limit the
control over their own fate. Nearly all Mexican
educational and professional attainments of
Americans who are not Catholic practice
some young women.
Protestant faiths. Evangelical churches are partic-
ularly popular in urban areas.
Traditional Health Beliefs and Practices.
The Chicano Family. The most important social Traditional health care in Mexico includes ele-
unit in the Chicano community is the family. In ments of Indian supernatural rituals combined
contrast to American majority society, the with European folk medicine introduced from
well-being of the family comes before the needs Spain. Beliefs and practices are closely interre-
of the individual. lated with the culture, resulting in a health
The Chicano father (or eldest male relative) system widely shared throughout Latin America.
is typically the head of the household. He is the Most Mexican Americans are familiar with the
primary decision maker and wage earner. conditions specific to the culture, and many use
Machismo, roughly translated as manhood, is the traditional cures.
Aztec medicine was a highly the word for the pride and self-worth a man Health is a gift from God, and illness is
developed system featuring feels when fulfilling his obligations and duties almost always due to outside forces (unless one
an elite group of certified to his family and community. In traditional is being punished by God for ones sins). An
practitioners with access to Mexican culture the wife is a homemaker, the individual must endure illness as inevitable.
a zoo and a herbarium for person who provides all childcare and holds the Prayer is appropriate for all illness, and beseeching
research. It was abolished
family together. Women are expected to be sub- the saints for intervention through the lighting
during the Spanish
servient to their husbands. In America, however, of candles on behalf of a sick person is common.
conquest.
this role is changing. One-half of Mexican- Pilgrimages may be made to religious shrines,
American women work outside the home, are especially those devoted to the Virgin Mary or
responsible for household management, and St. Francis.
are likely to be involved in family decisions. Health care is traditionally sought from a hier-
Men rarely increase involvement in chores as archy of healers.113, 158 Treatment is first discussed
women increase their hours of employment. with seoras or abuelasmothers, grandmothers,
Some women find that their new roles are occa- wives, or older female neighbors who are the health
sionally in conflict with their self-concept as experts in each family. Home remedies, especially
mother and caregiver. teas and over-the-counter remedies such as Pepto
Bismol, Alka Seltzer, and Vicks VapoRub, are nearly shaking, headaches, bad dreams and too much
always tried first before outside help is sought.104, 113 sleep, and ennui.9, 94, 173 A type of susto known as
Laxatives and enemas are common. If a cure is espanto, which occurs when an individual is so
not found, a yerbero (herbalist), sobador (massage frightened by a ghost that the soul leaves the
therapist or occupational therapist), or a patera body, is the most typical form of the disorder.
(a midwife who also specializes in the care of small Susto is considered a serious condition, associ-
children) may be consulted. Traditional herbal rem- ated with other illnesses such as epilepsy and
edies, homeopathic cures, and amulets are available infectious diseases. Mild susto is sometimes
at pharmacies called botnicas.94 Therapeutic treated at home with sugar or sugar water. More
items may also be sold at religious fiestas. serious susto, particularly when the soul is
When an ailment is unresponsive to these involved, must be cured by a curandero and may
cures, the services of a healer known as a curandero require lengthy treatment. Susto is also believed
(or curandera if the healer is female) are sought. to be a cause of nervios, a condition affecting pri-
Curanderos are esteemed members of each com- marily adult women (nervios may also cause
munity who see patients without an appointment susto). Symptoms include crying attacks, sleep
and customarily do not charge for their services, problems, headache, trembling, sadness or hope-
though they may accept gratuities.158 Their healing lessness, ill-temper, lack of appetite, stomachache,
powers may be God-given at birth, learned, or feeling of choking, chills, itching, and general
received through a calling.155 Curanderos are body ache. Nervios responds best to sedatives
sought for a broad range of complaints, such as (provided by a biomedical physician), prayer, or
marital problems, infertility, alcoholism, and massage. Unlike susto, nervios cannot be cured by
business failure, as well as for specific illnesses, a traditional healer. Nervios is often a chronic Studies report that susto
including diabetes and cancer. They are important condition in response to poor diet, alcoholism, is associated with an
in diagnosing the underlying causes of a condition, drug use, or other underlying health behaviors. increased risk for other
which may be natural or supernatural in nature. Some Mexicans believe that nervios can cause illnesses and a higher
Thus, diabetes in a client may be due to lifestyle diabetes if not cured. mortality rate.9
and diet, amenable to biomedicine, or it may be Feeling too much rage and suffering from
due to evil spirits or witchcraft, in which case bio- revenge fantasies can result in bilis, a condition
medicine is ineffective.158 Curanderos specialize where excess bile is thought to spill into the
in somatic ailments and are essential to curing blood, causing symptoms such as loss of appetite,
illnesses due to supernatural causes. In regions vomiting, headaches, nightmares, and inability to
where witchcraft is practiced, a curandero can urinate. Envidia is another ailment taking the
counteract the hexes or spells of a brujo (a person form of various illnesses (some terminal) caused
who works on behalf of the devil). Faith is crucial by the emotion of envy among ones friends and
to the success of a curandero. Prayer is his or her neighbors. A persons success may be tempered by
primary treatment; the lighting of candles or the the misfortune of envidia.
use of wood or metal effigies formed in the shape A problem caused by the displacement of
of the afflicted body part (called milagros or organs in infants is caida de la mollera, or fallen
exvoto) may also be used. Cleansing rituals are fontanel. It occurs from a fall, yanking the nipple
applied in certain conditions. out of a babys mouth too quickly, or holding a baby
Illness is believed to be due to (1) excessive vertically when it is too young. The fontanel
emotion, (2) dislocation of organs, (3) magic, or appears depressed, and the palate is believed to
(4) an imbalance in hot or cold; or (5) is consid- drop, preventing the infant from feeding. The
ered an Anglo disease, such as pneumonia and inability to suckle and a change in stools are symp-
appendicitis.155 Treatment is based on the cause toms, and serious weight loss may occur. Tight caps
of the disorder. on the infant can help prevent the condition, and
Susto is an ailment considered due to exces- the application of salt poultices or olive oil (fol-
sive emotionsuch as smoldering anger or lowed by a dip in water accompanied by prayers)
shameusually associated with a specific event. may be used to treat it. The baby may be held
The response may be physical, physiological, or upside down and shaken gently, the hair pulled, the
psychological, and symptoms include anxiety, fontanel sucked, or the palate pressed up with a
depression or sadness, lack of appetite, paleness, finger or thumb to reposition the fontanel.
employed. Treatment consists of prayer, pinching

the spine, and stomach massage to restore a proper
hot-cold balance.
TRADITIONAL FOOD HABITS

Mexicans are very proud of their culinary heritage,
which is a unique blend of native and European
foods prepared with Indian (mostly Aztec) and
Spanish cooking techniques. There are even
some French and Viennese influences from the
Maximilian reign. The resulting cuisine is both
spicy and sophisticated.
Ingredients and Common Foods

Many people associate the cooking of Mexico
with chile peppers. Although chile peppers are
used frequently, not all Mexican dishes are hot
Traditional Latin American and spicy. Other New World foods such as beans,
foods. Some typical foods cocoa (from the Aztec word for bitter), corn,
include achiote, avocado, Mal de ojo (evil eye) is a condition with super-
and tomatoes add equally important flavors to
bacalao, black beans, cas- natural origins. Children are considered especially
the cuisine. These indigenous ingredients were the
sava (yuca), chile peppers, vulnerable to the ailment, which has flu-like
cilantro, corn tortillas, basis of Indian fare throughout Mexico before the
symptoms, including fever and headache. It is
jcama, papaya, plantains, arrival of the Spanish.
caused when one person, usually inadvertently,
pinto beans, pork, tomatillos, casts a strong, admiring look on another person. Aztec Foods. The Aztec empire had an estimated
and tomatoes.
Irrational behavior and mental disabilities are population of 25 million people at its peak in the
often attributed to mal de ojo. This condition can fifteenth century. About one-quarter of the popu-
One researcher has shown result in death, so prompt diagnosis and cure are lation was an elite class of nobles supported by the
that some Mexican dishes imperative. A curandero is required for treatment. remaining 75 percent of the Indian slave populace.
reflect Islamic culinary tra- A cleansing ritual is performed that includes The capital city of Tenochtitln was surrounded
ditions (which arrived via sweeping over the ill individual with an egg, by lakes on which were built chinampas, rich
Spain), such as aromatic then breaking the egg into a saucer. The egg is agricultural fields of mud scooped from the lake
nut-thickened sauces, fruit read to see whether the cure has been effective. bottoms. These drought-resistant fields are believed
pastes, and sugar figurines It may be read immediately or left under the bed to have produced enough food to feed 180,000
(see Chapters 6 and 13).88
overnight before examination. Prayers, herb teas, people annually. The monarchy stored surplus
and sweeping with herb bundles may also be part crops to protect against famine. The Aztecs were
Chile (with an e) comes
from the Nahuatl word chilli.
of the treatment. also known for their animal husbandry and game
Foods like the powders, Mal aire (bad air or wind) may cause headaches protection laws.
sauces, and stews made and colds,94 and mal puesto (witchcraft) accounts Documents from early Spanish expeditions
with chile peppers are for certain other disorders, such as swelling, recorded in glowing terms the enormous variety
conventionally called chili trembling, or paralytic twitching. of foods enjoyed by the Aztec nobility.87 More
(with an i). Empacho, a digestive ailment characterized by than 1,000 dishes are described. Montezuma II
nausea, gas, and weakness, is widely known reportedly ate up to thirty different items per
The scientific name for the throughout Latin America. Empacho is sometimes meal, each kept warm on a pottery brazier. These
cacao tree is Theobroma, classified as an illness due to eating too many hot items included roast turkey, quail, and duck; fish,
meaning food of the gods. or cold foods, or a hot-cold imbalance in the crab, lobster, frog, turtle, newt, and insect dishes
stomach due to emotional upset (see Therapeutic garnished with red, green, or yellow chiles;
Uses of Foods section in this chapter). The direct squash blossoms; and sauces of chiles, tomatoes,
cause is believed to be a ball or wad of food adhered squash seeds, or green plums.89 Chocolatl, a hot,
to the stomach. Herb teas are administered at unsweetened chocolate drink made from native
home, and if they are ineffective, a curandero is cacao beans, was the most popular beverage.
Corn was the staple grain. Legumes, fruits,

and vegetables were plentiful; turkeys and dogs
were domesticated for meat; and some game was
available, including deer, peccary, and rabbits.
The notable deficiency of the Aztec diet was a con-
sistent source of fat or oil, and the average Indian
ate a mostly vegetarian diet of corn and beans.87
Spanish Contributions. The Spanish arrived in
Mexico with cinnamon, garlic, onions, rice, sugar
cane, wheat, and, most importantly, hogs, which
added a reliable source of domesticated protein
and lard to the native diet. These additions com-
Courtesy of San Antonio Light Collection; copy from the Institute of Texas Cultures at San Antonio
bined with indigenous ingredients produce the
classic flavors and foods of Mexican cuisine, such
as corn tortillas with pork filling; tomato, chile,
and onion sauces or salsas; rice and beans; and
pan-fried boiled beans, known as frijoles refritos,
or, as they are incorrectly called in English, refried
beans. The Spanish also introduced the distillation
of alcohol to native Mexican fermented beverages;
tequila and mescal were the result.
Staples. The cuisine of Mexico is very diverse,
and many inaccessible regions have retained
their native diets. Others have held on to tradi-
tional foods and food habits despite Aztec or
Spanish domination. The diets of still other areas
differ because of the availability of local fruits,
vegetables, or meats. The majority of poor
Mexicans have little variety in their diet; some
subsist almost entirely on corn, beans, and Handmade tortillas, made
squash. This divergence makes it difficult to from masa harina (a type of
typify Mexican foods in general (Table 9.1). One-dish meals are typical, almost always cornmeal) or wheat flour, are
Nevertheless, some foods are found, in varying served with warm tortillas. Hearty soups or stews the staple bread of Mexico.
forms, throughout Mexico. called caldos are favorite family dinner entres. In this photograph, taken
Tortillas are the flat bread of Mexico. Tradition- Casseroles known as sopas-secas, using stale tortilla in a tortilla factory, the
ally they are made by hand. Corn kernels are pieces, rice, or macaroni, are eaten as main dishes. lime-soaked corn kernels
heated in lime solution until the skins break and Stale tortillas can also be broken up and softened in are pulverized on a stone
metate. On the right
separate. The treated kernels, called nixtamal, are a sauce to make chilaquiles, which are served as a
a tortilla is patted into a flat
then pulverized on a stone slab (metate). The side dish or light entre. They can also be soaked in circle by hand.
resulting flour, masa harina, is combined with milk overnight, and then pureed to make a thick
water to make the tortilla dough. Small balls of dough. This dough is used to prepare gordos, which
the dough are patted into round, flat circles, are fat-fried cakes, or bolitos, which are added to
about six to eight inches across. The tortillas are soup and are similar to dumplings.
cooked on a griddle (often with a little lard) until Meats are normally prepared over high heat. Corn is believed to have
been domesticated from
soft or crisp, depending on the recipe. They are typically grilled, as in carne asada (beef
extinct wild varieties
Beans are ubiquitous in Mexican meals. They strips), or fried, as in chicharrnes (fried pork rind). in southern Mexico
are served in some form at nearly every lunch Slow, moist cooking (stewing, braising, etc.) may somewhere between 8000
and dinner and are frequently found at breakfast, also be used. These techniques help to tenderize and 7000 B.C.E. It spread
too. They are often the filling in stuffed foods and the tough cuts that are generally available, as does south into Central America
are common in side dishes, such as simmered marinating, another common preparation method. and north into what is now
frijoles de olla (out of the pot) and frijoles refritos. Nearly all parts of the animal are used, including the United States.
Table 9.1 Cultural Food Groups: Mexican

Protein Foods Common Foods Adaptations in the United States
Milk/milk products Few dairy products are used (incidence Milk (cow, goat), evaporated milk, caf con Aged cheese is used in place of fresh
of lactose intolerance estimated at lche, hot chocolate; atole; cheese cheese; more milk (usually whole) is
two-thirds of the population). Dairy consumed; ice cream is popular.
products are used more in northern
Mexico than in other regions.
Meat/poultry/fish/ Vegetable protein is the primary Meats: beef, goat, pork (including chicharrnes Traditional entres remain popular.
eggs/legumes source for majority of rural and and variety cuts) Fewer variety cuts are used.
urban poor. Poultry: chicken, turkey Protein intake may decline in second-
Pork, goat, poultry are common meats. Fish and seafood: camarnes (shrimp), generation Mexican Americans.
Beef is preferred in northern areas and huachinango (red snapper), other
seafood in coastal regions. firm-fleshed fish
Meat is usually tough, prepared by Eggs: chicken
marinating, chopping, grinding Legumes: black beans, chickpeas (garbanzo Beans are eaten less frequently.
(sausages are popular), or slicing beans), kidney beans, pinto beans
thinly. It is cooked by grilling, frying,
stewing, or steaming, and is usually
mixed with vegetables and cereals.
Cereals/Grains Corn and rice products are used Corn (masa harina, pozole, tortillas); wheat Wheat tortillas are used more than corn
throughout the country; wheat (breads, rolls, pan dulce, pasta); rice tortillas; convenience breads are used.
products are more common in the Increased consumption of baked sweets,
north. such as doughnuts, cake, and cookies, is
Principal bread is tortilla; European- noted.
style breads and rolls are also popular. Increased consumption has occurred of
sugared breakfast cereals.
Fruits/Vegetables Vegetables are usually served as part Fruits: bananas, carambola, casimiroa, cheri- Fruit remains popular as dessert and snack
of a dish, not separately. moya, coconut, custard apple, granadilla item; apples and grapes are accepted
Semitropical and tropical fruits are (passion fruit), guanbana, guava, lemons, after familiarization.
popular in most regions (limited limes, mamey, mangoes, melon, oranges,
availability in north). papaya, pineapple, strawberries, sugar cane,
sweet sop, tuna (cactus fruit), zapote
Vegetables: avocados, cactus (nopales or nopali-
tos), calabaza criolla (green pumpkin),
chilechili peppers, corn, jcama, lettuce,
onions, peas, plantains, potatoes, squashes
(chayote, pumpkin, summer, etc.), squash
blossoms, sweet potatoes, tomatillos, toma-
toes, yams, yuca (cassava)
Additional Foods
Seasonings Food is often heavily spiced; 92 vari- Anise, achiote (annatto), chiles, cilantro Use of spices depends on availability.
eties of chiles are used. (coriander leaves), cinnamon, cocoa, cumin,
Regional sauces are typical. epazote, garlic, hoja santa, mace, onions,
vanilla
Nuts/seeds Seeds are often used in flavoring. Pions (pine nuts), pepitas (pumpkin seeds),
sesame seeds
Beverages Atole, beer, coffee (caf con lche), hot choco- Noted are increased consumption of fruit
late, soft drinks, pulque, mescal, tequila, juices, Kool-aid, soft drinks, and bever-
whiskey, wine ages with caffeine; and decrease in use
of hard spirits.
Fats/oils Traditional diet is relatively low in fat. Butter, manteca (lard) Fat intake increases, including use of may-
onnaise and salad dressings.
Sweeteners Spanish-influenced pastries, candies, Sugar, panocha (raw brown cane sugar)
and custards/puddings are popular.
the variety cuts and organs. Sausage, such as spicy A large variety of chile
pork or beef chorizo, is especially popular. peppers are used in Mexican
Mexico is famous for its stuffed foods, such as cuisine, providing complexity
tacos, flautas, enchiladas, tamales, quesadillas, of flavor, heat (very mild to
incendiary), and color
and burritos. These are found throughout the
(yellow, orange, red, green,
country, with regional variations. Tacos are the
brown, and black).
Mexican equivalent of sandwiches. Tortillas,
either soft or crisply fried, are filled with any-
thing from just salsa to meat, vegetables, and
sauce. Flautas (flutes) are a variation on the
taco, with tortillas tightly rolled around the fill-
ing, then fried until crispy. They may be served
with a red or green chile sauce or guacamole.
Enchiladas are tortillas softened in lard or sauce
and then filled with meat, poultry, seafood,
cheese, or egg mixtures. The tortilla rolls are then
baked covered with sauce. Tamales are one of the
oldest Mexican foods, dating back at least to the
Aztec period. Dough made with either masa
harina or leftover pozole (hominy) is placed in
corn husks (in the north) or young leaves of avo-
cados or bananas (in the south). The leaves are
folded and then baked in hot ashes or steamed
over boiling water. The tamale may be plain,
filled with a meat or vegetable mixture, or sweet-
ened for a dessert (tamales dulce). After cooking,
pine nuts, and raisins. Dulce de leche is made by Epazote, a pungent herb
the husk or leaf is unfolded, revealing the aro-
boiling condensed milk down until the sugars with minty overtones, is
matic tamale. Quesadillas are tortillas filled with added to many dishes,
caramelize and it thickens. It is used as a spread
a little cheese, leftover meat, sausage, or vegetable, especially those with beans;
or hardened to make candy. A similar, distinctive,
then folded in half and heated or crisply fried. because it is thought to
Mexican specialty is cajeta, made like dulce de leche
Burritos are popular in northern Mexico. They reduce flatulence.
but using goats milk flavored with cinnamon. It is
are similar to tacos, but large, thin, wheat flour
eaten by itself as a pudding or used to top fresh
tortillasinstead of corn tortillasare folded
fruit or ice cream.
around a filling such as beans with salsa.
The most common beverage in Mexico is
Vegetables are usually part of the main dish or
coffee, which is grown in the south. Soft drinks
served as a substantial garnish. Potatoes, greens,
and fresh fruit blended with water and sugar,
tomatoes, and onions are most common. Chile
called aguas naturales, are also favored. Adults
peppers are used extensively in seasonings and
drink milk infrequently, except in sweetened, fla-
sauces, and are stuffed, as in chiles relleos and the
vored beverages such as hot chocolate with cin-
Independence Day dish chiles en nogada, garnished
namon, or caf con leche (coffee with milk). The
with the colors of the Mexican flagwhite sauce,
most popular alcoholic beverage in Mexico is
green cilantro, and red pomegranate seeds.
beer. The Mexican wine industry is also develop-
Sugar cane grows well in Mexico, and sweets
ing rapidly, in part due to a 1982 ban on the
of all kinds are popular. Dried fruits and vegetables,
import of foreign wine. Men may drink alcoholic
candied fruits and vegetables, and sugared fruit
beverages at occasions when they gather socially.
or nut pastes are eaten alone and used in more
In addition to tequila and mescal, whiskey is typ-
complex desserts. The Spanish make many
ically served at these times.
desserts with eggs, and some of these recipes have
been adopted in Mexico. Flan, a sweetened egg Regional Variations
custard topped with caramelized sugar, is the most Mexican Plains. The northern and central
common. Huevos reales is another popular dessert, regions of Mexico, nearly half the nation, consist
made with egg yolks, sugar, sherry, cinnamon, of mostly arid plains and high mountain valleys.
Menudo is a tripe and The Indians who originally inhabited the area Cheese (see Table 9.2) is more common in the
hominy soup believed to were called Chichimecs (sons of the dog) by the north than in other parts of Mexico, and one
have curative properties, Aztecs because of their seminomadic lifestyle. specialty is queso flameado (called queso fundido
particularly for hangovers. Their diet probably consisted of corn, beans, in the Guadalajara area), which is a fondue-like
It is a popular weekend
squash, greens, cactus fruit (tuna), and young dish sometimes topped with chorizo crumbles
breakfast dish.
cactus leaves (nopales). They also hunted small and served with fresh tortillas and salsa. Wheat
game and ate domesticated poultry, such as products are more popular as well, particularly
turkey. When the Mexican Indians mixed with the wheat tortillas.
Indians of the American Southwest, they adopted A very popular dessert of northern Mexico is
pions (also called pine nuts or pignolis), pump- buuelos, which may be made at home or pur-
kin, and plums. Some specialties of the region, chased at street stands. Circles of sweet pastry
such as hominy-based stews known as pozoles dough are fried until they slightly puff. They are
and salads made with sliced, cooked nopales, eaten fresh, sprinkled with sugar and cinnamon,
reflect this history. Due to the limited variety of or broken up and added to hot cinnamon-laced
foods available, traditional preparations emphasize syrup. Caf con leche is a common accompaniment
the natural flavors of the ingredients; and sauces, to buuelos.
Placement of a worm from when used, feature simple seasoning. The sap of the maguey cactus (century plant)
the maguey plant in a The Spanish introduced longhorn cattle to the is credited with being a reliable substitute for
bottle of mescal or northern plains, as well as dairy cows and wheat. fresh water in the arid countryside; it is called
tequilasupposedly a It is the only area in Mexico where beef is fre- aguamiel or honey water. Tequila is probably
signature of authenticity quently consumed, often served as steaks or in the best-known beverage of the region, made
was actually begun as a
stews. Another favorite way to prepare beef is to from the distillation of fermented aguamiel,
marketing gimmick.
air-dry it in thin slices called cecinas, which are known as pulque. Pulque is the sour, mildly alco-
similar to American chipped beef but more holic beverage that was drunk throughout
assertive in flavor. Cecinas can be used in stews or Mexico before the arrival of the Spaniards. The
soups; they can be fried or used as fillings for Spaniards, lacking grain, tried their distillation
other foods. In Chihuahua, beef is shredded and methods on the pulque, producing mescal, a harsh
then fried to make a snack known as mchomos. brew. Tequila is the more refined, twice-distilled
Goat and sheep are also raised. Spit-roasted kid, version of mescal. It is produced in the central-
cabrito al pastor, is served in the Monterrey area, western state of Jalisco around the towns of Tequila
and birriakid or lamb stewed in a sauce flavored and Tepatitlan from the maguey subspecies
with roasted chiles and vinegaris a specialty in Agave tequiliana.
Guadalajara. This area is also known for barbacoa,
a method of pit-roasting meats that are first Tropical Mexico. The southern coastal areas of
wrapped in maguey leaves (see below). Cow cheeks eastern Mexico include hot lowlands and tropical
(or more traditionally, the whole head) and kid forests. Seafood and freshwater fish are prominent
are commonly prepared this way in the more in the cuisine. Red snapper with a Spanish-influ-
northern sections, while in the more central enced sauce of tomatoes, garlic, onions, olives,
regions lamb is preferred.128 capers, and chiles, called Huachinango a la
In the Baja Peninsula and along the Gulf of Veracruzana (from Veracruz), is a specialty.
California and Gulf of Mexico coasts, fish is Arroz a la Tumbada, rice cooked and seasoned
important in the diet. Huachinango, red snapper, with tomatoes and garlic, topped with fresh fish,
is a specialty, cooked in orange sauce, used as a shrimp, octopus, crabs, and clams, is another
filling in tacos, or served chilled, marinated in favorite. It is often served in individual clay pots.
vinegar with onions and chiles. Shark is found on Tamales and tostadas stuffed with shrimp are
the eastern coast, shredded and layered between also popular. One unusual food enjoyed in some
tortillas and beans in the dish from Campeche areas is black iguana.83
known as pan de cazn.82 Shrimp and clams are Tomatoes, green tomato-like tomatillos, chay-
other favorites. In the more inland areas, fish ote squash, onions, jcama (a sweet, crispy root),
from freshwater lakes are available, such as bananas and starchy plantains, carambola (star
pescado blanco, a small whitefish that is popularly fruit), cherimoya (custard apple), guanbana
served fried or added to soups. (soursop), guava, mamey (a type of plum), mango,
Table 9.2 Traditional Mexican Cheeses

Fresh: Unripened cheeses that do not melt, but soften when heated. Often used in stuffed foods and as a garnish on top
of dishes.
Queso blanco Crumbly cows milk cheese similar to a soft, dry, fresh mozzarella. Sometimes made by using lemon
juice to coagulate the milk, providing a distinctive flavor. Sold commercially in blocks.
Queso fresca A fine-grained, creamy farmers cheese or pot cheese. Sometimes called queso metate when
formed in a traditional stone grinder. Often made daily in homes; sold commercially in small
rounds.
Queso panela A salty, semi-soft white cheese formed in small baskets that leave an imprint. Is often served cubed or
sliced with chorizo sausage or guava paste.
Ranchero seco Drier version of queso fresco with much stronger flavor (similar to Romano); curds are broken apart
and remolded during processing. Used grated over foods.
Requesn Milky, ricotta-like cheese good for fillings, spreads, and desserts.
Soft: Smooth, aged cheeses that melt well when heated, often used for baked dishes.
Queso aejo Aged queso fresco that is firm and salty, similar to feta.
Queso asadero Buttery, mild cheese that tastes like Provolone but with the slightly stringy texture of aged
Mozzarella; used in queso flameado.
Queso Chihuahua Mild, cheddar-like yellow cheese formed in large wheels, introduced by Mennonites in the farming
communities of Chihuahua.
Queso Oaxaca Tangy string-cheese from the city of Oaxaca. Sold in balls.
Firm: Semi-hard or hard aged cheeses, often eaten thinly sliced or added for flavoring to dishes.
Queso aejo enchilada Strong, salty cheese made from longer aged aejo, coated with spicy ground chiles.
Queso Cotija Sharp goats milk cheese that is crumbled over beans or salads, sometimes called Mexican
Parmesan. From the Michoacan city of Cotija.
Queso Manchego Spanish-style, full-bodied, hard cheese that is served shaved with fruit or eaten with snacks, beer, or
other drinks.
pineapple, yuca (a tuber also called cassava or which are often cut into very thin strips after Avocado comes from the
manioc), and zapote (the fruit of the sapodilla roasting), chipotle (dried, smoked jalapeo chiles), Nahuatl word for the fruit,
tree) are just a small sampling of the produce de arbol (long, very thin, curved green or red ahuactl, meaning testicle,
available in this area. Avocados are also cultivated. chile used fresh and dried), guajillo (long, thin, which avocados resemble
They vary in size from two to eight inches across, dark red chile used primarily dried), habaero while hanging from the
tree.
in skin color from light green to black, and in (lantern-shaped, yellow, orange, or dark red, added
flavor from bland to bitter. Their succulent, fresh to sauces but removed before serving, or
smooth flesh is added to soups, stews, and salads. roasted and chopped into dishes), pasilla (dried
They are most popular in guacamolemashed chilaca chiles), jalapeo (short, three-inch chiles
avocado with onions, tomatoes, chile peppers or with smooth green or red skin and blunt end,
ground chiles, and cilantro, the pungent leaf of used fresh in salsas and sauces, or sliced and The chemical heat of chiles
the coriander plant. Guacamole is used as a side pickled), mulato (dried chile with very dark comes from the alkaloid
dish, a topping, or a filling for tortillas. brown, wrinkled skin, and sweet overtones, often capsaicin, found mostly in
More than ninety varieties of chile peppers are used to make molessee below), pequin (tiny, oval the fleshy ribs and seeds
inside the fruit. One theory
found in the region, varying enormously in degree chiles used whole in stews, added pureed in sauces,
as to why chile-eating is
of hotness (see Figure 9.2). In general, the smaller soups, salsas, or pickled as a table condiment), pleasurable is that capsaicin
the chile the hotter it is, and each variety develops poblano (large, heart-shaped, black-green chiles may cause the body to
more heat as it ripens. The heat also intensifies that are often stuffed), and serrano (small, two-inch release pain-killing endor-
when it is dried. Some of the more common vari- dark green or red, torpedo-shaped chiles that are phins in reaction to irrita-
eties include ancho (dried, red-ripened poblano often chopped to add zest to salsa and cooked tion, creating a comfortable,
chiles), chilaca (thin, ribbed, dark green chiles dishes or sliced and pickled, known as escabeche). gratified feeling.
poultry is marinated in sour orange juice, garlic,

and cumin before steaming. A popular sliced
pork dish, poc chuc, also uses sour orange juice
to tenderize the meat before grilling. Bitter lime
juice is featured in a specialty of the area called
sopa de lima, a chicken and vegetable soup made
Pure Capsaicin 15,000,000-16,000,000 with bits of fried tortillas. Lime juice is also
Habaero 150,000-577,000 found in frijoles con puerco, a traditional dish of
Scotch Bonnet 150,000- 325,000 black beans with pork served weekly in most
Tepin (wild) 80,000-240,000 homes of the region. Some foods are pickled in
Pequin 70,000-100,000 citrus juice, including vegetables such as onions,
Cayenne 30,000-50,000
Aj 30,000-50,000
and other items, including fish and oysters.
Scoville Scale of Hotness for De Arbol 15,000-30,000 Achiote is the other hallmark seasoning of the
Selected Chile Peppers: Serrano 8,000-22,000 region, a bright red, nutty-flavored seed mixed
Scoville units, defined as Chipolte 5,000-8,000 with sour orange juice and mild spices to make a
the amount of sugar water Jalapeo 2,500-8,000 flavorful paste called recado colorado, used to
needed to dilute chile Guajillo 2,500-5,000
coat foods before cooking.
pungency to the point it no New Mexico 500-2,500
Anahei 500-2,500 Shrimp are a local specialty; the long coastline
longer burns the mouth, of the Yucatn along the Gulf of Mexico provides
Pasilla 1,000-2,000
is one measure of chile
Mulato 1,000-2,000 ample seafood. Grouper with recado baked in
hotness. It is a subjective
Ancho 1,000-2,000 banana leaves is one example, and fish soups are
scale, and hotness may vary Chilaca 1,000-2,000
within each variety due to also common. Eggs are prominent, served with
Poblano 1,000-2,000
seed lineage, soil, and climate, tortillas, black beans, cheese, tomato sauce, and
Pimento 0
as well as taster individuality. Sweet Bell 0 fried plantains, or wrapped in tortillas and served
High Pressure Liquid with a pumpkin seed sauce. Sauces of the region
Chromotography (HPLC ) is are often thickened with toasted squash seeds.
another measure, but does
not account for differences in Southern Mexico. The foods of southern Mexico
capsaicin release properties, are similar to those of the Yucatn in that they are
which also affect chile heat. more tropical and more Indian-influenced than
the foods of other regions. Cacao trees are culti-
Achiote is called annatto in Yucatn. The cuisine of the Yucatn peninsula vated in this area, and chocolate flavors both
the United States. Made reflects its unique history. It was isolated from savory and sweet dishes. In particular, the
from the seeds of a tropical the rest of the country by dense, mountainous renowned sauces of the region, moles (probably
tree, achiote is sometimes jungles until modern times. Many of the residents from the Aztec word for sauce with chiles, molli),
used to color Cheddar-style are descendants of the Mayans, the early Indian sometimes include unsweetened chocolate. Chiles,
cheeses, ice creams, mar-
dynasty of the region. Some regional favorites tomatoes, nuts, raisins, sesame seeds, avocado
garine, and some baked
date from this time. For example, one popular leaves, and seasonings are other typical ingredients.
goods.
preparation method is to steam foods wrapped in The complex, spicy sauces are the base for thick
banana leaves, called pbil. Traditionally, food stews with added pork, beef, poultry, or game,
was cooked this way in an outdoor pit, but today though some recipes call for the mole to be
it is prepared more often in a covered pot. poured over the top of the meat. In Oaxaca mole
Salbutes, small corn tortillas (some made with manchamanteles (meaning stew that stains the
black bean paste so that they are black in color), tablecloth) is a deep-red sauce with yams,
are often fried until they puff up, then layered pineapple, plantains, and chicken or pork. Mole
with lettuce or cabbage, tomato, onion, bell negro, another Oaxacan specialty, includes dark
pepper, and pbil-cooked meats. In some versions roasted chiles, blackened tortillas, and chicken.
the black beans are stuffed inside the pocket of The best-known mole in Puebla is Poblano de
the puffed tortilla, in which case the treat is guajolote, a rich brown sauce served with turkey.
known as panucho. Other variations include mole amarillo (an orange-
Citrus fruits flavor some dishes of the region. colored sauce) and mole coloradito (a brick-red
For example, in the recipe for chicken pbil, the version also known as mole roja). Mole verde is
yet another example, popular along the coast, and dessert. Today, the courses may be combined
made with green chiles and tomatillos. Hoja or, often, fewer are served. For example, soup, a
santa (Piper sanctum), an herb with a peppery, sopa-seca, or a vegetable dish may precede the
anise flavor, seasons the saucethe large leaves entre. When possible, an afternoon rest period
of the herb are also used to wrap steamed and (siesta) follows this meal. Merienda is a light meal
grilled foods in the region. of sweet rolls, cake, or cookies eaten around 6:00
Poultry, goat, and pork are the most popular p.m. Coffee, hot chocolate, or atole accompanies
meats of the region. One favorite is pork cut into the sweets. Cena, a light supper (often leftovers),
thin strips and coated with ground chiles to make follows between 8:00 and 10:00 p.m. This meal
cecina enchilada (a version of the northern recipe may be skipped entirely or expanded into a sub-
above). It is frequently served as a topping on stantial feast on holidays or other formal occasions.
crunchy, platter-sized baked tortillas called tlayuda, Recently many Mexicans have adopted the
which also include layers of black beans (more American habit of eating a light lunch (sometimes
popular in the south than pintos), cabbage, salsa, called almuerzo) and a heavy supper, eliminating
tesajo (thinly sliced beef), asiento (bits of pork merienda altogether.
skin fried in lard), chorizo, and cheese. Game, Snacking is frequent in urban Mexico;
such as venison and quail, are eaten in some munching occurs from morning to midnight.
areas. One delicacy of the region is chapulines, a Antojitos, or little whims, include foods made
grasshopper found in the corn fields. They are with masa, such as tostadas (called chalupas in
pan-fried with chiles, garlic, salt, and lemon juice northern Mexico), fried tortillas topped with
and traditionally served with beer or mescal.103 shredded lettuce, cheese, or meat. These may be
Hot chocolate, coffee, atole (a warm beverage of eaten as a snack or served for a light supper.
thin cornmeal and milk gruel) and horchata, a Nearly every block offers street-side food vendors,
sweetened rice-based drink, are favorite beverages. providing everything from fresh fruits to grilled
Ice creams, including those made with fresh vanilla meats. Pasteleras offer coffee, chocolates, and
bean, and fruit ices are popular, as is chocolate flan. pastries. In addition, many neighborhoods feature
an open-air market that also sells ready-to-eat
Meal Composition and Cycle foods. Cantinas are popular gathering places.
Daily Patterns. In families where income is not Originally males-only drinking establishments,
limited, the preferred meal pattern is four to five many now welcome women and families.
daily meals: desayuno (breakfast), almuerzo Botanas, roughly translated as cocktail foods,
(coffee break), comida or almuerzo (lunch), are small plates of items that go well with alcoholic
merienda (late afternoon snack), and cena beverages (especially beer), such as cheese,
(dinner). Most meals are eaten at home and sausages, fritters, tortillas with beans or salsa,
served family-style. If there are too many people and sometimes Anglicized Mexican dishes such
to sit at the table, each one is served individually as guacamole with tortilla chips, or other non-
from the stove. Mexican items, such as hummus. The term is
Desayuno is a quick, early breakfast, which often used for appetizers of any kind.
features pan dulce (sweet bread, pastry, or cake)
or fresh fruit, served with caf con lche. Late Special Occasions. Sundays, family celebrations
morning is when almuerzo (similar to brunch) is (such as weddings, baptisms, and quincineras),
eaten, often including tortillas, eggs, meat, beans and holidays are typically times when more diffi-
left over from the previous night, bolillos (wheat cult preparations are served. For example, home-
rolls), pan dulce, and fruit. Coffee and hot choco- made tamales or moles are labor-intensive and
late are the preferred beverages. may require numerous ingredients, so these
Comida is traditionally the largest meal of the foods are often reserved for special occasions.4
day, traditionally eaten in the early afternoon. A Turkey, arroz con leche (rice pudding), and pastel
complete comida includes several courses, indi- des tres leches, a rich sponge cake lightly soaked
vidually served. Customarily this would include a in three types of milk (whole or cream, condensed
soup, a sopa-seca (including items that would be milk, and evaporated milk) and then topped with
considered side dishes in the United States, such whipped cream, are other festive foods eaten
as seasoned rice), a main course, beans, salad, throughout the year.
for adultsadditional days, for deaths due to

certain causes, such as accidents, are identified in
some regions). Sugar paste is used to mold skulls
and skeletons of the dead, known as alfeique
SAMPLE MENU (a word of Arab origin), which are colorfully dec-
orated with icing. Altars for the dead are set up in
homes with a bowl of water to quench the thirst
A Traditional Oaxacan of the spirit, his or her favorite foods, pan de
muerto, sugar skulls, fruit pastes, and dulce de
Comida calabaza (pumpkin cooked with brown sugar).
Coffee, chocolate, atole, soft drinks, and preferred
Chilaquiles (Tortilla Casserole) a, b alcoholic beverages are offered as well.24 After
the departed soul has absorbed the essence of the
Chicken or Pork Coloradito (Mole Rojo) a, b, c meal through the aromas, the family eats the
remaining food.
Simmered Black Beans a, b and Rice
Christmas festivities, called posadas, frequently
Fresh Tropical Fruit or Fruit Ice/Sherbet a, b feature piatas, brightly decorated papier-mch
animals and figures that are filled with sweets.
Fruit Juice or Beer Blindfolded children take turns swinging a large
stick at the hanging piata until it breaks and
candies fly everywhere. In some regions buuelos
a
Martinez, Z. 1997. The food and life of Oaxaca: Traditional recipes from are a Christmastime treat, drenched in syrup and
Mexicos heart. New York: Macmillan. served in pottery bowls, which when empty are
b
Oaxacas Tourist Guide: Recipes at smashed on the street for good luck. On Christmas
http://www.oaxaca-travel.com/guide/index.php?lang=us Eve a salad of fruits, nuts, and beets is served.
c
The Mole Page at http://www.ramekins.com/mole/recipesmole.html
Role of Food and Etiquette in Mexican Society
In family-centered Mexican society, food-related
activities facilitate interactions between family
members and help delineate family roles. Meal
planning is usually the wifes responsibility.
Depending on economic status, food is prepared
Many foods are associated with specific holi- by the wife or by servants supervised by her,
days. For example, Da de los Santos Reyes (also because Mexican foods can be laborious to pre-
called Da de los Reyes Magos, or Three Kings pare.89 The final dishes are greatly appreciated by
Day) on January 6 is customarily celebrated with all who partake in the meal, and it is considered an
rosca de reyes, a raisin-studded, ring-shaped loaf insult not to eat everything that is served. In rural
of bread. Baked inside the bread is a figurine of areas, food sharing is an important social activity,
the infant Jesus, and the person who receives it is reflecting the Indian worldview. To reject offered
obligated to give a party on Candelaria Day food or drink is a severe breach of social conduct.
(February 2). Candelaria Day includes a mass, Even refusal of an invitation to dine may be con-
followed by games and sweets such as tamales sidered rude, though not attending an agreed
dulce and pink-tinted atole.142 upon event is often completely acceptable.50
During Lent, capirotada is a traditional dessert. No guest should begin eating at a Mexican
Many families have their own recipe for this holiday meal until the host says Buen provecho!50
bread pudding, often made with honey or brown Mexicans share many dining rules with Europeans.
sugar, cinnamon, nuts, raisins, and cheese. The fork remains in the left hand and the knife in
Another holiday food is bread decorated with a the right one. No switching is done when cutting
skull and crossbones (pan de muerto) eaten on food. When not eating, the hands should remain
Dias de los Muertos (Days of the Dead, November above the table, with the wrists resting on the
1 and 2) as part of a large feast honoring the edge. Dishes are passed to the left. Portions are
deceased (the first day for children, the second usually large, and it is all right to leave some food
on your plate. Leaving the table for any reason Sour foods are thought by some to thin the blood Early researchers were
before others are finished with the meal is impolite. and are avoided by menstruating women because perplexed by the absence
they are thought to increase blood flow; acidic of the niacin deficiency
Therapeutic Uses of Food foods may also be avoided because they are said disease, pellagra, in
to cause menstrual cramps (menstruation is Mexicans who consumed a
Some Mexican Indians and rural poor practice a
corn-based diet. Pellagra
hot-cold system of diet and health. It is believed considered a hot condition by some, and a cold
was common in the
to have derived from the Arab system of humoral condition by others). southern United States
medicine brought to Mexico by the Spanish, Though the hot-cold system of food classifica- where corn was also a
combined with the native Indian worldview. tion is practiced by small numbers of Mexicans, staple. It was found that
Although it has parallels with other classification one study reported that Latinos are more likely when the corn kernels
systems, such as the Asian practice of yin-yang than whites to consider certain foods herbal were prepared for masa
(see Chapter 11, East Asians, for details), the medicines, and other research suggests home harina, the alkaline lime
Mexican system is only applied to foods and to remedies are common.13, 34, 39 For example, solution used to soften
the prevention and treatment of illness. It does chamomile is believed by many to cure colic, them released the niacin
not encompass moral or social beliefs. menstrual cramps, anxiety, insomnia, and itching that was bound to a
eyes. Mint and anise tea are also prepared for protein.93
The Mexican hot-cold theory is based on the
concept that the worlds resources are limited and nausea, gas, diarrhea, and colic. Garlic is chewed
must remain in balance. People must stay in har- for yeast infections in the mouth, toothache pain,
mony with the environment. Hot has the conno- and stomach disorders; boiled peanut broth is
tation of strength; cold, of weakness. When the used to cure diarrhea; boiled corn silk is taken for
theory is applied to foods, items can be classified kidney pain; honey and water are given to infants
according to proximity to the sun, method of for colic; oregano is used for fever, dry cough,
preparation, or how the food is thought to affect asthma, and amenorrhea; and papaya is thought to
the body. Meals balanced between hot and cold help cure digestive ailments, asthma, tuberculosis,
foods are considered to be health promoting. and intestinal parasites.113, 155
Unbalanced meals may cause illness. Thus a typ- Of particular interest are remedies for hyper- Some Mexicans avoid cold
ical comida in a rural village would consist of rice tension and diabetes. Hypertension may be air and drafts after eating
(hot), soup (made with hot and cold ingredients), treated with garlic, passion flower, or linden chiles (which are classified
and beans (cold). flowers. The leaves of sapodilla tree, known as as hot) to avoid causing a
zapote blanco, which act as a strong sedative, are sudden imbalance in their
Although the hot-cold classification of foods
bodies.
does vary, items generally considered hot are also used in a tea to lower blood pressure.34, 113
alcohol, aromatic beverages, beef, chiles, corn For diabetes, several botanical remedies are used.
husks, oils, onions, pork, radishes, and tamales. Sage tea is common, as are infusions made from
Cold foods include citrus fruits, dairy products, tronadora root (trumpet flower) and prodigiosa
most fresh vegetables, goat, and tropical fruits. leaves and flowers (bricklebush). Preparations
Some foods, such as beans, corn products, rice made with Indian plantains (matarique), papayas,
products, sugary foods, and wheat products, can bitter gourds, aloe vera juice, and prickly pear
be classified as either hot or cold depending on cactus (both the tuna and nopales) are also
how they are prepared. popular.31, 34 Several of these remedies have
Illnesses are also believed to be hot or cold been shown to have potent diuretic or hypo-
and are usually treated with a diet rich in foods glycemic properties.
of the opposite classification. Examples of hot
conditions include pregnancy, hypertension, CONTEMPORARY FOOD HABITS
diabetes, indigestion, susto, bilis, and mal de
ojo.113 In particular, many Mexican women
increase their intake of cooling fruits, such as The foods of Mexico have significantly influenced
melons, mangoes, and bananas, and avoid hot, cooking in regions of the United States bordering
spicy foods and chiles during pregnancy. Some the nation. Four separate regional variations
also believe that very cold foods, including have been identified (see Chapter 15, Regional
cucumbers, tomatoes, and watermelon, can Americans, on regional U.S. foods for more
create a sudden imbalance. Examples of cold information).129 The first region is Texas, where
conditions are pneumonia, colic, and empacho. Mexican food has often been modified into
In the late nineteenth and completely American dishes, such as tamale pie The second region is New Mexico, where a
early twentieth century, and nachos. Other foods retain slightly more of single chile pepper developed for the region, known
chili con carne stands were their Mexican heritage, such as chili con carne, as the New Mexico chile, dominates seasoning. It
common in San Antonio, which was developed just after the Mexican- is mildly pungent, used green in chile verde and
offering a spicier version
American War in the 1850s. It probably began as red in chile colorado. Unlike the complex sauces of
of the Texas stew made by
a chile colorado (red chile stew), but was tamed by southern Mexico that include numerous types of
Latina women in the
community, who were reducing the spicing and diluting the traditional ground chiles and different seasonings, these
known as the Chili Queens. meat dish with beans. Barbecued chile-spiced northern-Mexico influenced sauces are often
They were shut down in the meat kebobs called anacuchos and capriotada made simply with ground red chile pepper, water,
1930s due to supposed with whiskey sauce known as drunken pudding garlic, oregano, and salt to taste. Pork replaces
health concerns.129 are other examples of Tex-Mex creativity. The beef, kid, and lamb in many dishes. The third
most commonly used chiles in Tex-Mex cooking region is Sonora, encompassing both the
American chefs, such as are anchos and jalapeos, though pequins are also Mexican state and southern Arizona. As in New
Stephen Pyles and Mark popular in some dishes, and a favorite seasoning Mexico, milder chiles are preferred (in this case,
Miller, are creating gourmet is cumin. Beef is commonly ground rather than Anaheims), and in some recipes the seasoning is
fusion Mexican dishes, such shredded for stuffed dishes.69 The Mexican so tepid that chile has been dropped from the
as pate de foie gras stuffed
restaurant staple in the United Statesknown as name, resulting in carne verde, for example.129
tamales, and apple-red
a combo plate, featuring a selection of enchiladas, Beef is the favored meat, and a traditional dried
chile chutney rolled pork.
This style is also now found tacos, and other stuffed items served with rice beef jerky, machaca, is still used, shredded, for
in the upscale restaurants and beans all at one timeis also thought to be a stuffed foods. Large, finely textured wheat tortillas
of Mexico City as well.129 Texas invention.129 are a specialty, and this region may be the original
home of burritos and their deep-fried version,
chimichangas.
The fourth and final region is along the
California border, where the fluid movement of
people back and forth between the nations has
resulted in fare that cannot be claimed by either
SAMPLE MENU nation as its own, nor as a cuisine unique to the
area.147 Numerous American fast-food franchises
are established in Mexico, and on the U.S. side
A Border Dinner taco shops and Latino grocery stores offer
Mexican dishes. However, most businesses pro-
vide a mix of products, even the franchise restau-
Fresh Red Salsa a, b and Tortilla Chips
rants. For example, Mexicans can purchase
Chimichangas a, b, c hamburgers and fries with jalapeos on the side,
and diners in the United States can order
Arroz a la Mexicana (Red Rice) a, b American burritos filled with refried beans,
carne asada, and french fries.
Refried Beans The market for Latino foods throughout the
United States has grown dramatically since the
Almond Pudding a, b
1980s when the fare of Texas, New Mexico, and
Arizona gained national recognition. It is now a
a more than 3 billion dollar a year industry.129
Tausend, M. 1997. Cocina de la familia: More than 200 authentic recipes from
Mexican-American home kitchens. New York: Simon & Schuster. In the 1990s sales of salsa surpassed those of
b
Southwestern Recipes at
catsup for the first time, and salsa has contin-
http://www.recipegoldmine.com/sw/sw.html ued to dominate the condiment market.
c
Chimichanga History and Recipe at Tortillas and tortilla chips are also selling well.
http://whatscookingamerica.net/History/Chimichanga.htm At the same time that Americanized Mexican
foods, such as tacos in hard shells and fajitas,
are spreading throughout the country, an
appreciation of authentic regional Mexican fare
is also increasing.
Adaptations of Food Habits most vegetables, rice, and pasta, and increased
consumption of breads, cereals, margarine, may-
Ingredients and Common Foods. Many Mexicans onnaise, butter, potato chips, and french fries.108
in the United States eat a diet similar to that of Intake of eggs and of American-style cheese also
their homeland. Recent immigrants, those who increases with these subjects. Whole milk, which
live near the U.S.-Mexican border, and migrant is preferred among Mexican-born subjects, is
workers are most likely to continue traditional replaced with low-fat or non-fat milk by U.S.-
food habits. born subjects. Soda intake is high in all genera-
Chicanos and Mexicans who are well estab- tions, although the U.S.-born subjects prefer diet
lished in the United States often become more sodas. Coffee is popular in all groups. Alcohol
acculturated. An early marketing study noted that intake in general increases, with beer consump-
Mexican immigrants living in the southwestern tion among males especially popular (increasing
United States are more likely to eat a diet with a 51 percent).
high intake of red meats, white bread, sugared A preference for sweet or carbonated beverages Though consumption
cereals, caffeine-containing beverages, and soft usually increases in the United States. Soft drinks, decreases with acculturation,
drinks than their socioeconomic counterparts in Kool-aid, and juices are popular with meals and it is estimated that Mexican
Mexico or white neighbors. This suggests that, as snacks. More acculturated Mexican Americans Americans eat more beans
rather than adopting a diet that fell somewhere buy many prepared and convenience foods. than any other group in the
between the food habits of Mexico and those of United Statesthirty-four
Baked goods are usually purchased, including
pounds per person annually,
the United States, the Mexican immigrants in the tortillas (often wheat tortillas are chosen over
compared to six pounds per
survey accepted the stereotypical American con- corn), breads, pan dulce, and even special person each year for
sumption patterns of the 1950s through 1970s.162 desserts like flan. Extra income is usually spent whites.69
In the intervening years, other studies have on meats, especially more expensive cuts such as
offered confirmation of these data. Studies on steaks and pork chops, and processed meats,
Latinos in southern California (who would be such as hot dogs and bologna.115, 147
predominantly Mexican American) and Mexican
Americans living in Washington have found Meal Composition and Cycle
higher intakes of fast foods, convenience items, Daily Patterns. Little current data on the meal
salty snacks, chocolate, and added fat at the table patterns of Mexican migrant farm workers have
with bread and potatoes, combined with lower been reported, but older data indicate that tradi-
intakes of beans, peas, fruits, and vegetables tional foods are preferred for most meals. These
associated with acculturation. 8, 59, 114, 117 include eggs, beans or meat, and tortillas, or pan
A more comprehensive study has detailed dulce for breakfast; a large lunch of beans, tortillas,
these changes. In a large sample of Mexican and meat, or a soup or stew; and a lighter dinner
Americans, it was found that the greatest dietary of tortillas, beans or meat, and rice or potatoes.
changes occurred between the first generation As in Mexico, vegetables tend to be served as part
born in Mexico and the second generation, born of a soup or stew. Fruit remains a typical snack
in the United Stateschanges between the and dessert, especially familiar varieties such as
second generation and third generation were less bananas, oranges, mangoes, guava, pineapple,
significant. The exception was consumption of strawberries, and melon.19, 36
corn tortillas, which decreased 69 percent Chicanos more often adopt the American
between the first and second generations with an meal pattern of small breakfast, small lunch, and
additional 30 percent drop observed between the large dinner; and meal-skipping may occur. As
second and third generations.108 Conversely, tortilla consumption declines, breads and breakfast
intakes of some items remained relatively constant cereals have become popular with all family
between generations, particularly those of beef, members, and sandwiches are a common lunch
green vegetables other than salad, and some fruits item. Meats and cheese become more prevalent at
(bananas, apples, oranges and orange/grapefruit meals, beans are eaten less frequently, and veg-
juice, and cantaloupe). etables are served as side dishes. Snacking has
Specific changes seen between the Mexican- been found to increase, especially in the evenings,
born subjects and the first generation of U.S.-born and is associated with education. College graduates
subjects included reduced consumption of legumes, are more likely to snack daily than are those who
attended only elementary or high school.108, 109, one study that included holiday practices of
142, 143
Soda, Kool-aid, juice, beer, and coffee are migrant workers,19 no main dish preferences
consumed with meals or snacks throughout the were found for Easter, and tamales were favored
day. Milk is considered a superfood for children, for Christmas. Turkey with mashed potatoes was
but adults, especially men, may consider it to be the most popular Thanksgiving entre, indicating
a juvenile drink. Milk is often flavored with choco- that this American holiday was adopted along
late, eggs, and bananas in a drink called licuado; with its traditional foods.
mixed with coffee; or mixed with cornmeal to In addition to religious holidays, two secular
make atole. Some adults reject milk completely, celebrations are significant in the Mexican-
saying that they are allergic to it (it is estimated American community. The first is Mexican Inde-
that two-thirds of Latinos are lactose intolerant). pendence Day on September 16, commemorating
Changes in preparation methods may also the war of liberation from Spain. Observations
occur. Recent immigrants may not know how to emphasize ethnic unity, such as mariachis and
use the baking and broiling apparatus on an oven traditional clothing. Foods the color of the Mexican
and may continue to fry and grill foods outdoors. flag, such as white rice, green avocado, and red or
Newer immigrants sometimes avoid canned and green chile peppers, are eaten. Cinco de Mayo
frozen foods because they do not know how to (May 5), the second secular holiday celebrated, is
prepare them. Soup is prepared at home three more widely recognized by all ethnic groups
times more often by Hispanics than by non- throughout the United States even though the mean-
Hispanics according to one marketing survey, but ing of the event (remembrance of a historic victory
this rate drops significantly with acculturation.119 over France) is often forgotten amid the parades,
General spending patterns, however, suggest that piatas, and Aztec dancing that typify the day.
cooking at home is still common: Hispanics spend More recently, Mexica Aztec New Years Day
more than double the average for flour and 166 has emerged as a celebration in some Mexican-
percent more on dried beans.115 Single women, American communities. It welcomes the begin-
those with larger families to feed, and those who ning of the Aztec solar year, comprised of eighteen
identify more with their Mexican heritage have periods of twenty days each, plus several separate
been found more likely to shop at small ethnic days of reflection. Four signsrabbit, reed,
groceries that often have fewer healthy food flint, and houseare used to designate each
options and may charge more for items such as year, along with a number between one and thir-
low-fat milk compared to whole milk.8, 163 teen, resulting in a fifty-two-year cycle. Each new
Hispanics frequent restaurants more than any cycle begins with an elaborate New Fire Ceremony
other ethnic group in the United States. Among that involves fasting and sacrifice. The annual
Mexican Americans favorite types of establish- event emphasizes indigenous Indian identity, as
ments (in order of popularity) are fast food, opposed to the Latino or Hispanic ethnicity that
pizza, Mexican fast food, Chinese, coffee shops, incorporates aspects of European culture, such as
and full-service Mexican.44 One study of Latina use of the Spanish language. Some Catholic
women in the Los Angeles area found that Latinos disapprove of the holiday.118, 2006
younger, employed women with lower incomes
who had lived more years in the United States Nutritional Status
preferred fast-food restaurants, stating that dis- Nutritional Intake. It can be difficult to deter-
tance, price, and a child-friendly environment mine health statistics on Chicanos, Braceros, and
were deciding factors in choice of establishment.8 unauthorized migrants because they are often
grouped with whites or other Latinos in collected
Special Occasions. The Mexican custom of data. Information from research on Latinos can be
reserving foods requiring extensive preparation, used cautiously, since Mexicans comprise a major-
such as tamales and enchiladas, for Sunday and ity of the total Latino population. Nevertheless,
In Mexico the prevalence holiday meals is continued in the United States.4 some nutritional problems have been identified
of malnutrition resulting in Even if such dishes are only served occasionally in both new and acculturated immigrants from
stunting of children varies at family celebrations, Mexican Americans recon- Mexico through studies of Spanish-surnamed
between 10 and 35 percent nect with their heritage through the preparation patients, especially those residing in Texas, the
depending on region.145 and consumption of these traditional items.129 In Southwest, and California.
Life expectancy for Mexican Americans is received prenatal care were also more likely to say A study of child-feeding
similar to that of whites in the United States they planned to breast-feed.21 Over 50 percent of practices by Mexican-
despite disadvantages such as higher rates of Mexican-American women in a national survey American mothers
poverty, lower levels of educational achievement, breast fed, and by six months, 23 percent were found extensive
and reduced access to health care. Overall mor- still breast feeding.90 In Mexico breast fed babies child-initiated snacking
and widespread use of
tality rates as well as cause-specific mortality are often given other fluids, including formula,
bribes, threats, and
rates are lower for Mexican Americans compared water, and sweetened herbal teas to reduce colic punishments to
to whites when controlled for gender, age, nativ- or cure diarrhea,102 a practice that may continue encourage eating.81
ity, marital status, socioeconomic status, and in the United States. Babies are usually weaned
demographic variables. (One notable exception is from the breast to the bottle. Long-term use of
mortality among younger Mexican Americans, the bottle or sleeping with one at night, with
ages eighteen to forty-four, who have elevated milk or sweetened liquids (i.e., Kool-aid, fruit
mortality risks, mostly due to external causes of juice, tea) is sometimes a problem, resulting in
death.)75, 76, 112 Researchers propose several rea- iron-deficiency anemia and tooth decay among
sons for the lower-than-expected mortality rates toddlers (baby-bottle tooth decay).18, 78
in Mexican Americans. Some report that nativity Mexican Americans have the highest compo- Rural Hispanic elders were
outside the United States is a factor, accounting nent scores on the USDA Healthy Eating Index more likely to report
for health-promoting lifestyle differences.76 (HEI) of all ethnic groups in the United States, inadequate intake of
Others suggest the discrepancy is an artifact of indicating good compliance with the Food Guide vegetables and problems
changes in classification of deaths from use of Pyramid recommendations, especially dietary meeting basic nutrition
needs than were rural
Spanish surname to use of Hispanic-origin ques- variety and high fruit consumption, but also a
white elders in one study.98
tions in vital statistics.153 Others have described high intake of sodium. Respondents born in Another study of more
underascertainment in the National Death Index Mexico had slightly higher scores than U.S.-born urban elders, however,
when compared with data from a large survey of respondents.11 Most studies agree with the HEI found similar intakes of
Hispanic elders.127 Another theory is that older findings that dietary quality may decline with calories and nutrients
immigrants return home to Mexico before they acculturation. Fat and cholesterol intake increases, between Hispanics and
die and are therefore not listed in vital statistics while intake of beta-carotene, vitamin C, and fiber whites, though food
figures, resulting in a mortality advantage due to decreases3, 108 due primarily to increased consump- choices varied.124
what has been dubbed salmon-bias effect.96, 122 tion of high-fat snacks, fried foods, eggs, cheese,
Similar trends are seen in infant mortality sta- and milk and decreased consumption of legumes,
tistics. The birth rate among Hispanic women is fruits, and vegetables.47, 59, 114 Researchers caution,
nearly twice that of white women, and the birth however, that acculturation is difficult to measure,
rate among women aged fifteen to eighteen is and different methods may result in different
more than three times as high. Nearly 25 percent findings. A study of low-income Hispanic women
of Mexican-American women receive no prenatal in San Diego found that when acculturation was
care during the first trimester of pregnancy.112 defined as number of years in the United States,
Despite these risk factors, rates for low-birth fat intake did not change. When defined as being
weight infants and infant mortality are lower for born in the United States, greater consumption of
Mexican Americans than for the total population convenience foods and chocolate was found.
(see Cultural Controversy: Breaking the Mold). When preference for speaking English at home
In a multi-site study of Mexican mothers, it was considered, lower intake of beans and peas
was found that over 95 percent breast fed their was noted. When acculturation was defined as
infants in the first week of life.102 Some studies being born in the United States and a preference for
link increased breast feeding with immigrants speaking English at home, a higher consumption
born outside the United States.25 Others suggest of salty snacks, high-fat foods, and convenience
the association is not so straightforward. In one items was reported.117
study intention to breast feed in Mexican-American Some research indicates total protein intake
mothers at the Texas border was associated with may also decline with the length of stay in the
women who were born in Mexico and had previ- United States.61, 108 Low protein consumption
ously breast fed and those who had completed high combined with low iron and vitamin C intake
school in Mexico. However, U.S.-born women who sometimes results in low hemoglobin levels
were college educated, married, and those who among young children and pregnant women.18, 136
CULTURAL CONTROVERSYBreaking the Mold: The Mexican-

American Immigrant Experience
O ne of the assumptions regarding

assimilation is that life improves
continually for immigrants the
longer they reside in the United States.
Yet recent studies of the largest immigrant
One study even suggests that internal
migration also improves health, showing
that Mexican-American women born
outside the U.S. community where they
give birth have better pregnancy outcomes
that selective migration occurs (only healthy
women come to the United States), that
deaths during pregnancy may be greater
(thus skewing the data), or that infant
deaths are underreported in the foreign-
population contradict this model. Foreign- than women born in the community.167 born Mexican-American community
born Mexican Americans are found to be A comprehensive review of statistics on (which may include high numbers of
healthier overall, to eat slightly better diets, adolescents was even more revealing. unauthorized residents). Other theories
and to have lower rates of infant mortality The longer a subjects family had lived in emphasize the protective factors of the
than U.S.-born Mexican Americans with the United States, the poorer the subjects Mexican culture.62 Research suggests that
foreign-born parents and for U.S.-born health and the more likely the subject was pregnant foreign-born Mexican-American
Mexican Americans with U.S.-born to engage in risky behaviors, even after women behave in ways different from
parentsdespite higher rates of poverty controlling for neighborhood, family, those who are born in the United States.
and less access to medical care.11, 67, 86, 108 education, and income variables. Mexican Intake of nutrients, including protein,
The scientific community expressed Americans who were born in the United folate, vitamin C, iron, and zinc, is better;
little interest about differences in immigrant States with U.S. parents had significantly smoking and alcohol consumption rates
health status associated with place of birth higher rates of health problems (including are substantially lower.1, 66, 121 Other
until researchers in the late 1980s discovered obesity, asthma, and missing school due factors considered important to positive
a startling trend. Poor, disadvantaged to illness) compared to those who were pregnancy outcomes, such as adequate
women who had immigrated from Mexico born in Mexico. Health risk behaviors, weight gain and prenatal care, are less
were giving birth to babies who were as determined by sexual experience, likely in foreign-born Mexican Americans.
healthy as those of white U.S. women delinquency, violent behavior, and use Researchers suggest these negatives may
with overall higher levels of income and of controlled substances, were more than be compensated for by greater community,
education. Rates of premature births, double in U.S.-born Mexican-American family, and spousal support, and less
low-birth-weight rates, and newborn death adolescents with U.S. parents than in accumulative acculturation stress.30, 80, 86, 121
rates among the immigrant women were Mexican-American youth born in Mexico.67 Determining the reasons that place of birth
equal to or less than those for whites.30, 51, 57 Suddenly, the assimilation model of is so significant will help researchers devise
The foreign-born women also demonstrated health was in question. What accounts for a new assimilation model and suggest
better birth outcomes and fewer maternal such significant differences? approaches for improving the diet,
disorders than Mexican-American women Most hypotheses have addressed the pregnancy, and health outcomes for all
who were born in the United States.62, 121 disparities in birth outcomes, suggesting Mexican Americans.
However, excessive rates of low iron intake or low limit consumption of these nutrients.38, 65, 66, 136, 172
blood iron status among Americans of Mexican These problems may be exacerbated by intestinal
descent have not been confirmed. infections (the leading cause of death in Mexico),
A study on the prevalence Deficiencies of calcium and riboflavin are such as amoebic dysentery, especially among new
of iron overload disorders in common, often due to low consumption of dairy arrivals. Among pregnant women, deficiencies
Hispanics suggests the rate products. Although the traditional Mexican diet may be ameliorated by supplement use.66
may be slightly higher than includes good sources of vitamins A and C, thi- Nutritional inadequacies may contribute to
among whites.48 amin, niacin, B6, folate, phosphorus, zinc, and other diseases. In the southwestern United States,
fiber, low intakes of these nutrients by Mexican the mortality rates for pneumonia and influenza
Americans have been reported; inadequate are higher for persons with Spanish surnames than
income or lack of traditional ingredients may for whites. Deaths of Latinos from tuberculosis in
New Mexico and Los Angeles have been nearly in Mexican-American elders is high, including
double those of whites in those regions. heart disease, angina, hypertension, and arthritis,
In contrast to the problem of undernutrition is and complications such as vision impairment,
the prevalence of obesity in persons of Mexican reduced mobility, and incontinence are burden-
descent26.6 percent of men, and 25.4 percent some.14 Death rates from diabetes are estimated
of women in 2006.28 One study found only one- to be over 64 percent higher for Hispanics than
quarter of Mexican-American women to be of for whites, and this difference is even greater in
normal weight39 percent were overweight, and the counties along the Mexican border.26 Further,
41 percent were obese.7 Overweight in children diabetes mortality rates are higher for Mexican
(when defined as BMI95 percentile) has also Americans than for any other Hispanic group.152
been reported, often at rates equal to, or slightly One study found that Mexican Americans have
higher than, those for whites, between 15 and very high rates of metabolic syndrome, a clustering
24 percent for both boys and girls.41, 52, 125 Low of conditions that leads to type 2 diabetes and
socioeconomic status and leisure-time physical heart disease, including insulin resistance, hyper-
inactivity, which is lower among Mexican tension, and dyslipdemia. Using ethnic specific
Americans than among African Americans or guidelines, prevalence in Mexican-American
whites, are thought to be factors in high rates of men was 40 to 50 percent, and for women, 44 to
overweight. 7, 33, 56 Cultural ideal weight may be 46 percent.49 One study reported prevalence of
greater for some Mexicans than for Anglo- high blood pressure in older Mexican-American
Americans, and traditionally, Latina women women to be two to three times that of same-aged
believed it was normal to gain weight after mar- white women independent of other factors;92
riage. Extra weight may indicate health and well- however, other data suggest rates of hypertension
being, not only for adults but also for children, in Mexican Americans is very similar to that of
and some parents may not recognize that their whites.6, 70
children are overweight.42 However, research Data on dyslipdemia show lower prevalence in
suggests that many Hispanic adults and children Mexican Americans than in whites, but treatment
perceive themselves as being overweight and are rates were also significantly lower.70 Estimated
dissatisfied with their body image.141, 149, 157 ten-year coronary heart disease mortality risk
Unhealthy dieting practices are prevalent in some was found heterogeneous in Mexican Americans
Latinos, and it is believed that Hispanic girls are at in one study. U.S.-born, Spanish-speaking men
high risk of developing eating disorders.21, 139, 157 and women were at highest risk, Mexican-born
Several studies have shown that the risk of men and women at lowest risk, and U.S.-born,
developing diabetes mellitus is nearly two times English-speaking men and women at intermediate
higher in Hispanics than in the white population, risk.156 Researchers have noted the heart-healthy
and the risk increases disproportionately for elements of the traditional Mexican diet.38 Though
every five kilograms of weight gain.150 Prevalence studies on cardiovascular mortality risk relative
of type 2 diabetes in Mexican Americans is to whites are contradictory, 77, 91, 116, 123 and sub-
approximately double that for whites;32 however, population risk varies, cardiovascular diseases
in one study Mexican Americans were more are the number one cause of death in Hispanic
likely than whites to be diagnosed and treated.70 adults.112 Further, the incidence of ischemic
This high rate is not explained by the incidence of stroke and intracerebral hemorrhage is higher for
obesity, age, or education, but may be related to Mexican Americans.110
percentage of Indian heritage.20, 63 Research sug- A higher prevalence of gallbladder disease has
gests that Hispanics have greater insulin resistance been found in Mexican Americans, and a higher
than African Americans and whites, and their rate is found in those born in the United States,
lower sensitivity may be due to a higher intake of compared to those born in Mexico. Diet may be
carbohydrates.37 Impaired fasting glucose levels involved in some cases, but more recent research
have also been found in Mexican-American ado- suggests a genetic vulnerability may be a more
lescents at rates nearly double those of the total important factor.133, 159 Knowledge of osteoporo-
youth population.166 Complications from diabetes, sis and risk-reducing behavior was low among
including kidney failure and diabetic retinopathy, Hispanic women in Chicago.54 Cavities are
are also more prevalent.68, 132 Overall, comorbidity common among Americans of Mexican descent,
as is gingivitis. Studies show that nearly one-third Attitudes may differ from American biomedical
of all immigrants from Mexico never receive any beliefs. For instance, it is sometimes considered
dental care. Migrant workers and their children inappropriate for men to acknowledge illness.154
are especially at risk.95, 120 People who go on working despite bad health are
A study was done of Alcohol intake was found to increase by 47 respected. Modesty and privacy are highly
Tarahumara Indians in percent between Mexican Americans who were valued; thus a woman may wish to be treated by
Mexico to observe the born in Mexico and the first generation of a female caregiver and a man by a male caregiver.
effects of a high-calorie, Mexican Americans born in the United States.108 Studies suggest that anywhere from 20 to 81
high-fat, low-fiber diet on a In one study one in three Latinos admitted to percent of Mexican Americans use home reme-
population that tradition-
drinking hazardous amounts of alcohol, and 36 dies,94, 104 and Latinos in one survey used the
ally consumes a low-fat,
high-fiber diet. After five
percent had a lifetime diagnosis of alcohol services offered at their local botnica inter-
weeks, blood cholesterol abuse or dependence.148 Mexican-American changeably with those offered by their biomedical
levels increased 31 percent, men drank greater quantities, less often, than provider.55 Another study found that increased
and triglyceride levels white men, and Mexican-American women have use of herbal remedies by Mexican-American
increased 18 percent; all low alcohol consumption rates that increase women corresponded with fewer visits to bio-
subjects also gained with acculturation.138 medical practitioners. This association may be
weight.100 related to lack of medical insurance, which was
Counseling. Access to biomedical health care also found to be a factor in use of traditional
Licorice root, known as may be limited for Americans of Mexican medicines.94 Sixty-one percent of surveyed
yerba dulce or orozs, may descent, especially for Braceros and unauthorized Hispanic elders in New Mexico reported drinking
be used as a general tonic herbal teas to maintain health, alleviate stress,
migrants. Income may restrict doctor visits, and
or for infections, coughs,
transportation to clinics may be unavailable. and cure minor ailments.39 The most commonly
ulcers, and menstruation
problems. It can be toxic in Over 37 percent of Mexican Americans do not consumed infusions included peppermint (called
large quantities or taken have health insurance.112 Further, 43 percent of both yerba buena and poleo), chamomile (man-
over long periods, and may Mexican Americans report that they speak zanilla), lavender (alhucema), and osha (related
potentiate the effects of Spanish at home and that they are not proficient to parsley). However, it is important not to assume
hypotensive drugs.34 in English.137 Spanish-speaking clients may be adherence to certain folk beliefs, such as the hot-
uncomfortable with interviews conducted in cold classification of foods and illness. Though
Chagas disease, caused by English. Those who believe God or fate deter- prevalent among some people in Mexico, these
Trypanosoma cruzi, may be mines health may be unwilling to undertake pre- traditional practices may be limited in the United
found in some Mexican ventative procedures.169 States (even among healers), and younger, urban
immigrants who have
The communication style of Latinos is high- clients may be offended by use of such backward
consumed chinche de
context and non-confrontational; a warm, digni- theories.4, 94, 158
compostela (an insect with
reputed aphrodisiac fied relationship is most effective and crucial in Traditional healers, such as curanderos, are
properties). difficult health care situations. Words are chosen consulted by anywhere from 4 to 21 percent of
carefully, and silence may be used to defuse dis- the Mexican-American population.74, 104, 140 Those
agreement.50 Kindness and graciousness are who consult curanderos often believe that healers
appreciated.169 Touching a client with a hand- are most effective for symptoms caused by folk
shake is important, though men should wait for illnesses. In one small sample nearly 26 percent
women to extend their hands first. Eye contact of Mexican-American women had personally
varies, and some Mexican Americans consider used the services of a curandero; however, even
prolonged eye contact impolite. However, it is larger numbers (almost 39 percent) had seen a
best to maintain eye contact initiated by a client, sabador.94 However, it should be noted that use of
as looking away may be thought rude. Mexican traditional healers does not prevent a client from
Americans often sit and stand closer together also seeking biomedical care concurrently.169
than Anglos do. Most Latinos are present-oriented Although traditional practices are most common
and polychronic (able to do several things at once). in poor, rural regions, most Mexican Americans
Inflexible appointments can be problematic for are knowledgeable about folk conditions: Studies
some Latino clients, who may prefer walk-in in Texas report that mal de ojo had been diag-
clinics.155 Latinos may be uninterested in lengthy nosed and treated in 63 to 70 percent of Mexican-
indirect discussion of a condition and prefer a American homes surveyed, susto was known in
direct, action-oriented approach. 37 to 62 percent, and empacho in 27 to 48 percent.
Mal de ojo was known in 70 percent of homes, ethnic group least likely to discuss the use of
and cada de mollera in 34 percent.140, 158 Another alternative and complementary therapies with
study showed 71 percent of homes had a family their biomedical care providers.58
member who had suffered from nervios, and that Family participation in health care is common,
46 percent had experienced it personally.9 and members should be consulted in both
Mexican-American women in southern California making a diagnosis and prescribing treatment.
also demonstrated familiarity with these ill- They may have specific ideas about the cause of
nesses.94 Sometimes multiple etiologies are inte- an illness and the best approach for a cure; their
grated. For example, some Mexican Americans confidence and cooperation can help ensure
believe that diabetes, which is an Anglo disease, client compliance. One study found that family
is caused by eating a diet high in fat and sugar, involvement in serious choices about issues such
but also due to experiencing strong emotions or as life support is more important to Mexican
chronic susto.31, 130 Americans than patient autonomy.15 Dietary
Most traditional health beliefs and practices changes may affect family members and social
among Mexican Americans support the emotional interactions; thus, gaining family support has
well-being of a client and do not interfere with also been suggested to increase compliance.73, 164
therapy. Many researchers have suggested that folk An older study of Mexican-American families
conditions provide an important release valve in living on the TexasMexico border found that the
Latino cultures, especially for men who are expec- husband traditionally exercised control of the
ted to endure pain. Disorders due to outside causes food budget and food purchases.170 The wife did
are not blamed on an individual, and the resulting the actual meal planning, shopping, and prepara-
irrational behavior or lethargy is excused.155 tion. Women identified strongly with their food-
Several potentially harmful situations are related tasks within the family structure. Because
noteworthy. Suboptimal medication use has been their self-concept and status in the family and
noted, especially in diabetes treatment where community are related to their abilities as a cook
intake is inconsistent, and in situations where and homemaker, nutrition intervention and advice
prescription drugs are mixed with home reme- may be perceived as an accusation of inadequacy.
dies.46, 85 For example, diabetes and hypertension More recent research shows that Mexican-
may be treated with botanical remedies in addi- American women who are more acculturated are
tion to prescribed oral medications, risking likely to have a shared meal decision-making
excessive hypoglycemic and hypotensive activity, style. However, they face greater barriers to
respectively. Clients consult friends and neigh- making healthy eating changes due to resistance
bors about effective treatments and are unlikely from family members, and they are more likely to
to disclose home remedies to their physicians.131 eat at fast-food restaurants, eat more saturated
Digestive complaints such as empacho are some- fat, and make fewer efforts to increase fiber
times treated with toxic lead- or mercury-based intake than are women who maintain traditional
medications, such as greta, azarcn, and asogue.53 meal preparation roles.4
The condition of cada de la mollera in infants Children are also an important influence on
has been associated by some health practitioners food habits in some households. Those raised in
with severe diarrhea and dehydration, resulting the United States may be the only English-speaking
in the depressed fontanel.53 Failure to Thrive members of the family and may be responsible for
Syndrome may also be a concern. Providers translating in the market. These children have been
should be aware of these possibilities when pre- found to prefer foods that they have seen adver-
sented with this disorder. In some regions, a tea tised on television. The adoption of new foods is
made from the psychoactive wormwood (the influenced by the presence of bilingual children
toxic ingredient formerly found in the alcoholic in the family.36 Researchers studied newly immi-
beverage absinthe) is used for diarrhea. Though grated Latinos in the San Francisco area and found
not widely used, vibora de cascabel (dried rat- that the importance of the family unit can be
tlesnake powder) can be a source of salmonella used to motivate changes in food habits.79 Adults
and botulism. Finally, babies may be given home unwilling to make changes that would benefit
remedies made with honey, a known cause of their own health may make those same changes
infant botulism. In one study, Latinos were the to improve the well-being of their children.
Queso fresco, traditionally As with all clients, an in-depth interview is Guatemala, and Nicaragua. Millions of residents
made from raw milk, is crucial in effective nutrition counseling. Experts are estimated to have been displaced in these
responsible for more food- in the health care of Latinos recommend that countries, about one-third of whom have emi-
borne illness than any other health professionals who work often with Latinos grated. Many moved to Mexico, and a substantial
cheese in the United
learn Spanish. Familiarity with Spanish medical number have continued on to the United States.
States.12
terminology is the minimum proficiency needed They are known as the foot people because
Latinos listen to radio pro- for meaningful communication. Further, inter- many have literally walked to the United States.101
gramming in greater num- ventions should be tailored to account for differ- Less is known about this group, except that they
bers than do Anglos. An ences in acculturation.8 are often younger, poorer, and less educated than
evaluation of a Spanish the previous immigrants from the region.
radio nutrition course found
it improved both nutrition- Current Demographics and Socioeconomic
related knowledge and Central Americans Status. Just over 5 percent of U.S. Latinos are
selected practices in both from the seven nations of Central America, a
rural and urban sample The seven nations of Belize, Guatemala, El majority of whom arrived since 1980.137 Exact
populations.168
Salvador, Honduras, Nicaragua, Costa Rica, and figures are unknown, however, because it is
Panama make up Central America, an isthmus believed that many Central Americans may enter
connecting North America to South America. the United States illegally at the border with
The eastern coastal region edges the Caribbean Mexico and are undistinguished from unautho-
Sea. An 800-mile chain of active volcanoes and rized Mexicans. Most of these recent immigrants
mountains, beginning at the Mexican border in have settled in California, Texas, and Florida. The
the north and continuing with only one break largest populations are the 1.2 million Salvadorans,
into central Panama in the south, forms the tem- 759,000 Guatemalans, 459,000 Hondurans, and
perate backbone of the region. Central America is 281,000 Nicaraguans. It is believed that there may
similar to the rest of Latin America in history of be an equal number of unauthorized migrants
foreign intervention and heterogeneous culture. from these countries living in the United States as
well.111, 151 Immigration from Costa Rica, Belize,
CULTURAL PERSPECTIVE and Panama is minimal, with fewer than 350,000
altogether from these other Central American
History of Central Americans nations listed in the 2005 U.S. Census estimates.160
in the United States Nearly one in every four Central Americans is
Immigration Patterns. Central American immi- born in the United States. Central American
grants to the United States have arrived in two immigrants, even those from the first wave, are
distinct waves. Early records are inexact because slow to naturalize, and only 20 percent of Central
separate statistics on Central Americans were not Americans in the United States have obtained
kept by the U.S. Census Bureau until the 1960s. citizenship.137 Those who are not refugees often
Even today they are usually listed with immi- return to Central America for visits and maintain
grants from South America in most demographic active contact with their homeland. Those who
studies. Until the early 1980s, immigrants to the are have sought asylum, and those who are unau-
United States were of two groups. The first were thorized migrants cannot visit their homelands
well-educated professional men who arrived in without fear of persecution or difficulties in
search of employment opportunities. The second returning to the United States.
were women, who often outnumbered the men Many immigrants live in neighborhoods
two to one, coming in search of temporary where other Central Americans reside, especially
domestic jobs. These Central American immi- in Los Angeles and Miami. Smaller numbers locate
grants were largely urban residents and settled in Houston, Chicago, Washington, DC, and New
mostly in New York, Los Angeles, San Francisco, York City. Central Americans are a very heteroge-
Miami, and Chicago, where they blended into neous population, however, and it is a mistake to
existing Latino communities. assume similar settlement patterns for each group.
The second major wave began in the late Identity is sometimes more related to race and class
1970s and early 1980s, with the exodus of than to country of origin. The majority of immi-
refugees from the brutal civil wars in El Salvador, grants before the 1980s were white professionals;
more recent refugees are predominantly Ladino

(mixed Spanish and Indian heritage) or Indian
campesinos (peasants). Even among recent immi-
grants, differences in associations are found.
Hispanic Guatemalans, for example, may assimi-
late into the broader Latino community, while
Mayan Guatemalans, some of whom do not
speak Spanish, often establish ethnic enclaves.72
Significant numbers of black Central Americans
have immigrated from Belize and Panama. Little
is known about these specific groups, though
many black Panamanians choose New York City
as their home.35
Some socioeconomic data on Central
Americans are combined with statistics on South
Americans. Information on the first wave of
Central American immigrants suggests that they
are a middle-class population with income and
education levels well above many other Latino
groups. American-born children of these first
immigrants graduate from high school in num-
Bettmann/CORBIS
bers greater than whites.
These figures do not reflect the large numbers
of recent immigrants employed as migrant farm
workers, gardeners, domestic cleaners, dishwashers,
and foodservice workers, as well as those placed
in other low-skilled jobs. According to U.S. Census A Mayan chocolate container.
data on foreign-born Central Americans, recent improved over that of other Central Americans.
Salvadoran immigrants often find work in the Eighty-two percent have completed high school,
construction, manufacturing, and hospitality 22 percent have college degrees, two-thirds work
industries. Just 34 percent have graduated from in management, professional, or sales and office
high school, and 41 percent have less than ninth jobs, and poverty levels are below the U.S. average.
grade education. Families falling below the poverty Information on unauthorized residents is Guatemalan Americans
line comprise 20 percent of the Salvadoran popu- scanty. It is thought that they often face difficul- prefer to be called Chapines.
lation in the United States. 161 Guatemalan ties in obtaining employment and education The term was originally a
immigrants share a very similar socioeconomic opportunities.111 In addition, disposable family derogatory term for
profile. Honduran immigrants have slightly higher income may be impacted by money sent to support residents of Guatemala City
but has new meaning in the
levels of educational attainment, but greater relatives still living in the homeland.
United States, reflecting
numbers of families live in poverty. Foreign-born
Worldview ethnic pride.
Nicaraguans also have slightly higher levels of
education, and more work in retail and in the The large numbers of recent immigrants from
education, health, and social service fields. Their Central America suggest that ethnic identity is
poverty levels are also lower. Immigrants from preserved by many new residents in the United
Belize and Costa Rica have similar educational States. For example, Salvadorans often establish
attainment (about 70 percent have graduated highly insular neighborhoods within the larger
from high school), and both groups often work in Latino community, where an immigrant can live
the education, health, and social service sectors. and conduct business exclusively with other
The poverty rate for Belize families is 16 percent, Salvadorans.111 Guatemalans are a more diverse
and for Costa Rican families it is 14 percent. The population of immigrants, and it is the Mayan
socioeconomic status of foreign-born Panaman- communities that are most likely to keep tradi-
ians, who as a group have been in the United tional beliefs and practices.72 In contrast,
States for a longer period of time, is significantly Nicaraguans are dispersed among other Latinos
and are adapting more to the pan-Latino com- were forced to immigrate separately. Some married
munity rather than retaining their own heritage outside the Central American community for
exclusively.151 immigration benefits; others found that when
One unique Central American immigrant their families were reunited, children had become
population in the United States is the Garifuna, more independent.111
who are black Caribs from the eastern, coastal
areas of Belize and Honduras. Traditionally, men Traditional Health Beliefs and Practices.
traveled great distances for work, leaving the A good diet, especially consumption of fruits and
women to farm and raise children. Today, their vegetables, fresh air, and regular hours, are thought
way of life is threatened by coastal development necessary to preserve health by many Central
for tourism and lack of government support. Americans.84 Exercise is considered important by
Garifuna men often come to the United States for some Guatemalans and Panamanians, though the
employment, sending much of their earnings concept of structured exercise is unfamiliar to
home in an effort to save their culture.99 some Central Americans.17, 134, 135 Salvadorans
believe that being too thin can cause sickness,
Religion. Most Central Americans are Roman
and Americans are considered at risk for ill
Catholic. Some Guatemalans observe Catholic
health because they are so thin.
practices while adhering to Mayan religious
Some Central Americans view health as a bal-
beliefs; participation in native religions declines
ance between the spiritual and social worlds. For
in the United States because they are usually
most, health is a gift of God, and prayer is often
dependent on sacred locations in Guatemala.
used to restore harmony during illness.134, 146
Evangelical and fundamentalist denominations,
Some Nicaraguans believe in witchcraft, practiced
such as the Pentecostal Church, have attracted
by brujos or brujas who can assume the shape of
many Central Americans after they arrive in the
animals and have the power to cure illness.
United States. Small storefront congregations
Guatemalans consider outside forces to be the
that involve active participation and those
cause of some illnesses, which include diseases
churches that offer traditional Central American
sent by Satan to punish unbelievers and sickness
social activities in addition to worship have been
due to witchcraft. Traditional healers include
especially successful.
curanderos and sabadores, as well as jeberos
Family. Central Americans highly value family (herbalists) and espiritistas who treat witchcraft
and extended kinship. It has been noted that with prayer. Naturalist doctors (sometimes called
some apartment buildings in Latino neighbor- naturopaths) who work in association with natu-
hoods are rented entirely to several families from ralist shops that provide botanical remedies may
the same village in Central America. The father is be used by some Guatemalans.171 Priests may also
traditionally the undisputed head of the house- be sought to help with prayers for health.
hold and provider for the family. Many Costa A balance of hot and cold is also necessary to
Ricans define the term family as having both a health and can be disrupted by sudden exposure
father and mother in the home.29 However, some to extremes in temperature or strong emotions.
studies suggest this dominance is changing, and In addition to susto and mal de ojo, other folk
shared decision-making between men and conditions include bilis and clera, which in
women is becoming more common.134, 135 extreme cases are associated with anger and gen-
Children are often carefully controlled, especially eral distress and precipitate stroke. In a survey of
daughters. Hispanic immigrants (with a large sampling of
Mayan creation myths The roles of the men and women often Central Americans) regarding beliefs about
describe how humans were change even further in the United States, where hypertension, respondents reported that clera
improved over time. They women are sometimes more easily employed, and susto may lead to high blood pressure, as may
were first made of mud, and husbands must take on some domestic living at too high an altitude or having too much
then wood, and finally responsibilities. Family disintegration has taken blood. 2, 105
perfected when their flesh
place in some refugee camps, where overcrowding In the culturally diverse region of Nicaraguas
was made from corn dough.
and unemployment led to intergenerational east coast, more than 200 plants with traditional
conflict prior to immigration to the United medicinal uses have been identified. One study
States.105 In other situations, family members reported rural ethnic groups in Nicaragua were
found to use traditional healing practices more Corn is eaten mostly as tortillas. Enchiladas in Health care is politicized in
often than urban residents of mixed heritage.10 Central America are open-faced sandwiches sim- some Central American
Another survey, however, found that more than ilar to Mexican tostadas. They typically feature countries. Modern clinics
three-quarters of respondents in an urban barrio meat covered with pickled vegetables such as and health promotion were
associated with leftist
used herbal remedies.2 cabbage, beets, and carrots. Known as mixtas in
reforms in Nicaragua, for
Guatemalans believe that strength is main- Guatemala, the tortilla is spread first with gua-
example. In the 1980s,
tained through the quantity and quality of a camole, then topped with a sausage and pickled rightist rebels targeted
persons blood. In urban regions of Guatemala, cabbage. In El Salvador a stuffed specialty is health facilities and urged
researchers have noticed the emergence of new called pupusas. A thick tortilla is filled with citizens to return to tradi-
categories of food items, such as strong or health- chicharrnes, cheese, or black beans and then tional health practices.
promoting foods, perhaps due to the influence of completed with another tortilla; the edges are
modern health promotion concepts.105 sealed and the pupusa is then fried. They are tra- The Mayan word for corn,
Over-the-counter remedies, such as analgesics ditionally served with pickled cabbage. Tamales wah, also means food.
and cough suppressants, are commonly used by are also common, often stuffed with poultry or
Guatemalan Americans, although they are con- pork. They are called nactamal in Nicaragua, In Guatemala refried black
beans (frjoles volteados) are
sidered weak by Guatemalan standards. Medica- where the dough is flavored with sour orange
fondly called Guatemalan
tions (including antibiotics) and herbs, such as juice, and the filling includes meat, potatoes, rice,
caviar.
chamomile, are sometimes brought to immigrant tomatoes, onions, sweet peppers, and mint. Black
families by new arrivals from Guatemala. tamales are served on special occasions in
Guatemala, stuffed with a mixture of chicken,
chocolate, spices, prunes, and raisins. Empanadas,
TRADITIONAL FOOD HABITS small turnovers made with wheat flour dough
Ingredients and Common Foods and filled with a savory meat mixture, are popular.
French bread, introduced from Mexico, is
Central American cuisine offers many of the foods
eaten regularly in the form of small rolls in
common throughout Latin America. The native
Honduras and Guatemala. In El Salvador, French
Indian dishes remain prominent in the highland
bread is used with native turkey and pickled veg-
areas, Spanish influences are found in the low-
etables to make sandwiches. Coconut bread is a
land regions, and the cooking of the multicultural
specialty on the Caribbean seacoast. Rice is often
eastern coast shares many similarities with
fried before boiling, cooked with coconut milk,
Caribbean Islander fare. The northern nations
or, in Costa Rica, served as pancakes.
have foods similar to those of southern Mexico;
Soups and stews are popular throughout
the southern countries have been more greatly
Central America, often including fruit or fruit
influenced by European and African cuisines.
juices. Beef, plantains, and cassava in coconut
Staples. Early Mayan records indicate that the milk, spicy beef stew, beef in sour orange juice,
foundation of their diet was corn and beans, sup- pork and white bean stew, chicken cooked in fruit
plemented with squash, tomatoes, chiles, tropical wine; mondongo (Nicaraguan tripe soup), sopa de
fruit, cocoa, and some game. Indian foods were hombre (a mans soup) made with seafood, and
particularly important in the development of plantains in coconut milk are a few specialties. In
Guatemalan cuisine but gradually become less Guatemala the stews of meat and poultry, such as
significant in the south of Central America. Rice, pepin and jocon, are thickened with toasted
introduced by the Spanish, has become a staple in squash seeds. Meat, poultry, and fish are fre-
most regions. (See the cultural food groups listed quently roasted as well.
in Table 9.3.) Fruits and vegetables are numerous. Although
Beans are eaten daily. Black beans are especially bananas, coconut, plantains, yuca (cassava),
popular in Guatemala, while red beans are common tomatoes, sweet peppers, cabbage, chayote squash
in other nations. Beans are served simmered with (known as huisquil in Guatemala), mangoes
spices (called frijoles sancochadas in El Salvador), (considered an aphrodisiac in Guatemala),
pureed, or fried and are often paired with rice. In oranges, and avocado predominate, cabbage,
Nicaragua red beans and rice fried with onions cauliflower, carrots, beets, radishes, green beans,
are called gallo pinto (painted rooster) due to lettuce, spinach, pumpkin, breadfruit, passion fruit
the colors of the dish. (granadilla), pineapples, mameys, and nances
Table 9.3 Cultural Food Groups: Central Americans

Protein Foods Adaptations in the United States
Milk/milk products Milk is not widely consumed as a Milk (evaporated), cream; cheese (aged and Milk and hard cheese may be disliked by
beverage, but evaporated milk and freshcrumbly farmers cheese type) Guatemalans, but increased intake
cream are popular in some regions. reported for Salvadorans.
Meat/poultry/fish/ Legumes are important in the cuisine Meat: beef, iguana, lizards, pork (all parts, Bean dishes remain popular.
eggs/legumes and are often served with rice. All including knuckles, tripe, and skin), venison
types of meat/poultry are eaten, Poultry: chicken, duck, turkey
but pork is popular throughout the Fish and shellfish: clams, conch, flounder,
region. Eggs are commonly served. mackerel, mussels, sea snail, shark, shrimp,
Fish and shellfish are consumed in sole, tarpon, turtle
the coastal regions. Sea turtle eggs Eggs: poultry, turtle
are popular. Legumes: beansblack, chickpeas, fava,
kidney, red, white
Cereals/Grains Rice and corn are the predominant Corn (tamales, tortillas), rice, wheat Tortillas may be replaced by breads.
grains of the region. Wheat flour (bread, rolls)
breads are common.
Fruits/Vegetables Tropical fruits are abundant. Some Fruits: apples, bananas, breadfruit, cherimoya, Increased intake of potato chips has been
temperate fruits such as grapes coconut, custard apple, grapes as well as reported.
and apples are also available. raisins, guava, mameys, mangoes, nances,
Salads and pickled vegetables oranges (sweet and sour types), papaya,
are popular. passion fruit, pejihaye, pineapples, prunes,
sour-sop, sweetsop, tamarind, tangerines,
zapote (sapodilla)
Vegetables: asparagus, avocados, beets, Increased consumption of vegetable
cabbage, calabaza (green pumpkin), salads.
carrots, cauliflower, chayote, chile peppers,
corn, cucumbers, eggplant, green beans,
hearts of palm, leeks, lettuce, loroco flowers,
onions, pacaya buds (palm flowers), peas,
plantains, potatoes, pumpkin (ayote),
spinach, sweet peppers, tomatillos,
tomatoes, watercress, yams, yuca
(cassava), yucca flowers (izote)
Additional Foods
Seasonings Cilantro (fresh coriander) and epazote Achiote (annatto), chile peppers, cilantro,
are important herbs. Sour orange cinnamon, cloves, cocoa, epazote, garlic,
juice gives a tang to some food; onions, mint, nutmeg, thyme, vanilla,
coconut milk flavors others. Achiote Worcestershire sauce
is used to color foods orange.
Nuts/seeds Palm tree nuts, pepitoria (toasted squash
seeds)
Beverages Hot chocolate and coffee, grown in the Coffee, chocolate, tropical fruit drinks, alcoholic Increased intake of soft drinks.
region, are favorite hot beverages. beverages (rum, beer, and fermented or
Refrescas, cold drinks, are made with distilled fruit, sugar cane, and grain drinks)
tropical fruit flavors. Boj, chicha, and
venado are locally made alcoholic
beverages.
Fats/oils Lard is the most commonly used fat. Butter, lard, vegetable oils, shortening Lard and shortening use may decrease;
vegetable oils and mayonnaise may
increase.
Sweeteners Honey and sugar are used as Honey, sugar, sugar syrup Increased intake of candy is noted.
sweeteners.
(similar to yellow cherries) are also common.

Flowers from yucca, palms (pacaya buds), and
loroco (Fernandia pandurata) are eaten as vegeta-
bles throughout the region.16 Starchy fruit from
the peach palm (pejibaye) and spiny palm (coy-
oles) are especially popular in Costa Rica and
Honduras. Onions and garlic flavor many dishes.
Salads and pickled vegetables are common as
appetizers, as side dishes, and on sandwiches.
Coffee, grown throughout the region, is a pop-
Courtesy of the Florida Division of Tourism

ular drink, usually consumed heavily sweetened.
Hot chocolate is another favorite, and fresh milk,
if consumed, may be sweetened with added
sugar. Refrescas, cold beverages, are made in
tropical fruit flavors, such as mango and pineap-
ple. Tiste, a Nicaraguan favorite, is made with
roasted corn, cocoa powder, sugar, cold water,
and cracked ice. Beer is widely available.
Fermented beverages such as boj (from sugar Tropical fruit from
Latin America.
cane) and chicha (a wine made from fruit or
grain, fortified with rum) are consumed. Venado
Rice is also common. Queso blanco (a fresh cheese)
is a common distilled drink made from sugar
or meat is added whenever resources permit.
cane. Sweets, such as the praline-like candy
Dinner in wealthier areas usually includes soup,
called nogada, sweetened baked plantains, ices
meat or poultry (sometimes fish), tortillas or
made with fruit syrups, custards, rice puddings,
bread, and substantial garnishes such as avocado
and cakes or fritters flavored with coconut or
salad, fried plantains, and pickled vegetables.
rum, are eaten as snacks and for dessert.
Appetizers, such as slivers of broiled beef, bites of
Regional Variations. Although many foods of meat- or cheese-filled pastry, and soft-boiled Though iguana is eaten
Central America are similar, they are often fla- turtle eggs, are eaten in some urban regions throughout Central America
vored with local ingredients for a unique taste. before dinner; dessert may also be served, typically and parts of Mexico, South
Coconut milk flavors many dishes in Belize and including custards, ice creams, cakes, or fritters. America, and the
Honduras; seafood specialties include conch and Caribbean, it is especially
Special Occasions. Celebrations in Central popular with Indians in
sea turtle. The foods of El Salvador are often fried
America are focused on Catholic religious days. Nicaragua.
and feature many indigenous flavors including
Christmas, Easter and Lent, saints days (includ-
corn, beans, tomatoes, chiles, and turkey. Achiote
ing All Saints Day), and even Sundays may mean
is common in mild seasoned Guatemalan fare.
a change in fare. Special dishes include the
The juice of sour oranges is mixed with sweet
cheese-flavored batter bread called quesadilla
peppers or mint in many Nicaraguan recipes.
that is served in El Salvador on Sundays; sopa de
Costa Ricans prefer foods simmered with herbs
rosquillas, a soup made with ring-shaped corn
and seasonings such as cilantro, thyme, oregano,
dumplings traditionally eaten on the Fridays of
onion, garlic, and pimento; rice is also frequently
Lent in Nicaragua; gallina rellena Navidena, a
consumed. Panamanian fare is more interna-
Nicaraguan Christmas dish of chicken stuffed
tional in flavor; one specialty is sancocho, a stew
with papaya, chayote squash, capers, raisins,
of pork, beef, ham, sausage, tomato, potato, squash,
olives, onions, and tomatoes; and plantains
and plantains.
served in chocolate sauce during Semana Santa
(the Holy Week before Easter) in Guatemala.
Meal Composition and Cycle Chicken in tomato sauce (guisado), chicken
Daily Patterns. As in other Latin American served with cornmeal porridge, or stews thick-
regions, beans and corn are the cornerstones of ened with masa harina are Indian specialties
the daily diet, eaten at every meal by the poor. eaten at ceremonial occasions. In some areas the
left hand and the knife in the right one. However,

certain more Americanized groups, such as some
Nicaraguans, may eat in the American fashion of
using the fork in the right hand, switching to the
SAMPLE MENU left when cutting food. When not eating, the hands
should remain above the table, with the wrists
resting on the edge. Bread or tortillas may be
A Guatemalan Dinner served (typically without butter) and should be
placed on the side of the plate. It is acceptable to
scoop up small bits of food with pieces of tortilla.
Chicken Jocon a, c or Chicken with Pineappleb, c
Dishes are passed to the left. Diners are expected
Rice to clean their plates, so taking small portions is
appropriate. Asking for seconds is considered a
Frijoles Volteados (Refried Black Beans) a, b compliment.
Guacamole a, b Radish Salad,a, c Therapeutic Uses of Foods

Banana Bread a, b or Coconut Candy a Some Central Americans follow the hot-cold
theory of health and illness, and some also go
Hot Chocolate or Coffee by the need to balance wet-dry. Guatemalan
Americans commonly believe that diarrhea is
caused by hot weather and can be alleviated by
a
consuming cold drinks, such as Kool-aid or
Marks, C. 2004. False tongues and Sunday bread:
A Guatemalan and Mayan cookbook. Takoma Park, MD: Takoma Books. Gatorade.105 However, ice cubes may be avoided
b during hot weather. Panamanians may avoid
Guatemalan Recipes at http://www.recipezaar.com
c
cold foods when sick, but in one sample, none
Guatemalan Cuisine & Recipes at http://www.whats4eats.com
applied hot-cold principles to daily meals.134, 135
Guatemalans also appeared not to balance hot
and cold foods; however, it has been suggested
that the practice is so enculturated that it is done
without conscious effort.135 Fatty foods and
highly spiced dishes may also be avoided by both
Guatemalans and Panamanians when ill.
Chocolate was so prized in stews are provided by the village headman to Herbal remedies are popular throughout
Mayan culture that cacao serve the community. In Guatemala All Saints Central America, especially teas. Studies of
beans were used as Day is celebrated with a unique salad called Guatemalans and Panamanians found that the
currency. fiambre. These enormous salads involve a family teas were consumed to maintain health, and
social event at which as many as fifty friends and even more often, to cure minor illness.134, 135
In Guatemala eggs poached relatives share the creation.97 They feature veg- Examples include teas such as manzanilla
and served with a seasoned
etables (e.g., green beans, peas, carrots, cauli- (chamomile) for improving circulation, menstrual
broth are used to treat
hangovers.
flower, beets, radishes, cabbage) mixed with cramps, and flu or colds; banana leaf and
chicken, beef, pork, and sausages and then art- hierbabuena (mint) for good digestion and regu-
fully garnished with salami, mortadella, cheese, larity; and lemon for general health. Rosa de
asparagus, pacaya buds, and hard-boiled eggs. Jamaica (hibiscus) was used for respiratory illness,
The dressing is either a vinaigrette or a sweet- diarrhea, and urinary tract infections, while
and-sour sauce. papaya leaf tea was considered good for gastritis
and as a laxative. Lime, fig leaf, and grapefruit
Etiquette teas were consumed for anxiety and alleviation
Dining customs in Central America are often of stress. Notably, avocado, garlic, ginseng, and
similar to those of Mexico. For example, no guest valleriana were mentioned as remedies for
should begin eating at a meal until the host says hypertension and diabetes among Panamanians.
Buen provecho!50 Most Central Americans eat Coca leaves, the source of cocaine, are also
European-style, with the fork remaining in the reported to be used medicinally in some areas.10
CONTEMPORARY FOOD HABITS While milk, fruit juice, and fresh salad intake
IN THE UNITED STATES increased, some Salvadorans sampled consumed
inadequate servings of dairy products, fruits, and
Adaptations of Food Habits vegetables.144
There is scant information on the Central American Health workers in Florida report that Anecdotal reports suggest
diet in the United States. Low rates of assimilation Guatemalan refugees believe that if a food is tasty that hamburgers, hot dogs
among many Central American immigrants are and does not cause stomach discomfort, it must (served in tortillas topped
assumed to result in preservation of traditional be good to eat. High intake of candy, soft drinks, with pickled cabbage), and
and potato chips has been noted. Milk, which is pasta are popular with
food habits. Most Central American ingredients
many Guatemalan
are available in the Latino communities where often not well tolerated, may be avoided. WIC
Americans.
they settle. One study found that more than half (Supplemental Food Program for Women,
of Honduran women living in New Orleans con- Infants, and Children) nutritionists found that
tinued to consume a diet very similar to what some food supplements, including milk and
they ate in their homeland.43 Rice, beans, fruit cheese, are disliked because of their taste or texture
juices, tortillas, cheese, bananas or plantains, and are sometimes discarded.105
beef, and eggs were the items eaten most often.
Few new foods were added by a small number of Nutritional Status
women, and only kiwi fruit, plums, canned veg- Nutritional Intake. Limited data on the nutri-
etables, and olive oil were used by more than 10 tional status of Central American immigrants
percent of the sample. Prepared items, especially have been published. Those who arrive after
hamburgers (eaten by 30 percent of respon- spending time in refugee camps may suffer high
dents), fried chicken, pizza, and regional dishes, rates of malnutrition resulting in diseases such as
such as jambalaya and Cajun foods (13 percent beriberi, pellagra, scurvy, and vitamin A defi-
for each dish), were other new items consumed ciency problems, especially in children younger
by a few of the Honduran women. Some also than the age of five. Infectious diseases often
reported baking more foods, frying less, and follow; tuberculosis and parasites are common.17
using more vegetable oil instead of lard or Endemic infections may cause problems as well.
coconut oil in cooking. A meal was defined as Chagas heart disease, resulting from infections
having courses, including meat of some sort, and with Trypanosoma cruzi (found in most of
requiring the diner to sit down. Though the Central America), presents symptoms similar to
women reported skipping meals, this sometimes other coronary artery conditions. U.S. outbreaks
meant that they ate a sandwich for lunch, which of cyclosporiasis due to contaminated raspberries
was not considered a meal. imported from Guatemala in 1996 and 1997 sug-
Salvadoran refugees report that, in general, gest another source of infection. Rates of sickle-
the quality of their diet has declined since arriv- cell anemia were found to be high (5.7 percent)
ing in the United States. They state that in El among mostly Central American adolescents in
Salvador more foods were made at home from Los Angeles, and this disease appears to be asso-
fresh ingredients; they believe that in the United ciated with this population independent of
States more processed items and junk foods are African heritage.64
eaten, and some nutritious foods are too costly to Infant mortality rates for Central Americans
consume.17 However, findings from another in the United States are below the average for
study of Salvadorans found that there were some whites.27 Low-birth-weight infants were not
beneficial dietary changes after immigration to found to be a problem among Central Americans
the United States. Though intake of high-sugar in a Chicago study. Even those at significant
and high-fat foods such as jams or jellies, soft personal or environmental risk (i.e., living in
drinks, ice cream, mayonnaise, and vegetable oil low income, urban neighborhoods) showed no
increased, consumption of lard, shortening, and excessive low birth weight.30 Researchers report
fatty meats including chicharrones and sausage that Guatemalans consider breast feeding
decreased. Bean dishes such as frijoles sancocha- healthy for infants but impractical. Breast feeding
dos remain popular, although other traditional often is used as supplementation to formula and
items including pupusas, tamales, and plantain solid foods for the first two to three years of a
empanadas were eaten significantly less often. childs life.105
A study of Salvadoran-American youth aged Failure to utilize health care is also thought to be
six to eighteen years in Washington, DC found a due to cost: a high percentage of young adults of
prevalence of overweight double that of the Central/South American origins were uninsured
Lactose intolerance may be national average and 1.7 times higher than for in one study, with the highest rates (73 percent)
prevalent among Central Mexican-American children in national surveys. among those who were not U.S. citizens.23
Americans. Thirty-eight percent were overweight (BMI 95 Further, nearly 57 percent of Central Americans
percentile), and another 22 percent were at living in the United States report that they do not
risk for overweight. Overweight in this sample speak English well.137
was associated with elevated blood pressure, Most immigrants from Central America are
Illness is a sign of weakness
among some Guatemalans,
body fat percentage over 30 percent, and early present oriented, though many are also poly-
and a person may be stig- puberty.106 chronic, viewing time more as a circle than a
matized because he or she An occupational hazard for many Central straight line.50 They typically view health from
is unable to fulfill responsi- Americans employed as U.S. farm workers is pes- day to day, believing that they have no control
bilities. ticide or herbicide poisoning. Exposure occurs over the future. The concept of scheduled
when labor codes are unenforced or through appointments may be unfamiliar, and there is
worker mishandling of the dangerous products. little interest in arriving on time. Touching is
used to communicate feelings. Men usually
Counseling. Access to biomedical heath care embrace close friends, and women are likely to
can be especially difficult for Central Americans. hug all acquaintances. Salvadorans, Guatemalans,
Many are economically and linguistically isolated and Nicaraguans prefer a light handshake that is
within their communities; others are unautho- lingered over. Men should wait for a woman to
rized residents avoiding detection by authorities. extend her hand before shaking, however. Eye
NEW AMERICAN PERSPECTIVES

Margaret K. Ward, MS, RD, LD/N
I have worked with Hispanic clients, primarily Mexican Americans, since 1990 when I returned to the western states after living
eight years in the Midwest. In my experience many of the clients/patients tend to cook without recipes. The less acculturated
client/patient tends to use many more basic or less processed foods. They may or may not have been influenced by American
food practices to the extent that they use less lard (manteca) and more oil (though the vegetable oils chosen are not necessarily the
best/healthiestchoices). I would say its dependent upon the length of time the person has been in the United States and their level
of acculturation. If theyve been here a while and are learning English, they tend to acquire more of the Western food culture. Also,
the number and age of children can have an effect. Families with older, school-aged children tend to acculturate more because of
the influences of school and interaction with American children.
My advice to new health care professionals working with this community is to acquire Spanish-language skills as soon as possi-
ble!!! I began my learning in the clinic; then in desperation I took two semesters of Spanish in the community college to acquire the
grammatical background that the clinic wasnt providing. Facility in the language is critical to communication. Im a teacher of nutri-
tion; if I cant communicate with my student, Im not able to do my job very well. Having good Spanish skills made working with
clients on modifying the diet much easier, and most Mexican foods can be modified to meet nutritional needs.
Dont be afraid to make mistakes with Spanish-language speakers. I have found that my Hispanic patients have almost always
been extremely forgiving of my horrible Spanish. They seem to appreciate any attempt that one makes to communicate with them
in their language. The worst that will happen if you do make an error is that youll both laugh. I have several Spanish error stories.
One took place in the Women, Infant and Children (WIC) clinic when a post-partum patient returned for a follow-up hemoglobin
determination, which was low again the second time. We reviewed the foods to include in her diet to increase her hemoglobin, and
I again encouraged her to continue her prenatal vitamin use. At the end of my spiel, I told her that if she took her vitamins and ate
well that she would sentarse bien. Unfortunately, I told her that she would sit well, rather than feel well (which is sentirse bien).
contact may be direct when speaking, but it is food habits, health practices, and nutritional
often downcast when listening politely. status are available. In addition, information
Salvadorans use their hands expressively, but it is from family members or community experts
considered impolite to point with the fingers or may be needed.
the feet. Most Central Americans have a different
sense of personal space than do Anglos and
prefer to sit and stand closer than is comfortable
for many whites, but backing away may be seen 1. Compare and contrast the staple foods of
as an insult. Mexicos different regions.
Central Americans are high-context communi- 2. Describe the hot-cold system of diet and
cators, using a calm, measured voice and emotional health practiced traditionally by Mexicans.
restraint, except among family and friends. A 3. List two regional U.S. foods that are modifi-
respectful, yet warm and caring speaking style is cations of Mexican recipes. First describe the
most effective.50 possible original dish, and then explain how
Culturally based descriptions of symptoms it is modified.
were found among Guatemalans in Florida.105 4. Which countries make up Central America?
Weak heart referred to palpitations or dizziness; Roughly, what are the demographics of
weak stomach meant indigestion; and weak immigrants in the United States from Central
nervous system was applied to headaches or America?
insomnia. Taking blood samples was very anxiety 5. Compare the traditional health beliefs and
provoking because of the Guatemalan belief in the practices of Mexicans and Central Americans.
need for strong, ample blood. Anemia was associ- 6. Describe the food staples of Central America.
ated with weak blood, to be cured by eating iron. 7. What are the most common health problems
Guatemalans also identify susto and nervios as ill- of Mexicans and Central Americans and their
nesses (see Traditional Health Beliefs and Practices decedents living in the United States? How
in previous Mexican section) found more often in may acculturation to the American diet con-
women than men. If not treated, these conditions tribute to these problems?
are thought to cause diabetes.9 Guatemalans
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ochtimes.com/tools/printer.asp?id=39393
CHAPTER
10
Caribbean Islanders
and South
Americans
L atinos from the Caribbean Islands and South Lesser Antilles. The largest island is Cuba, and When Columbus landed in
America often seem more different from one the smallest islands are barely more than exposed the Bahamas in 1492, he
another than similar. Their homelands vary rocks. Most were claimed at one time by Spain, believed he had discovered
Britain, France, the Netherlands, Denmark, or a new route to Indonesia
from the tropics of the islands and northern
the United States, but now include the independent and called the native people
Brazil to the highland plains of Argentina and the
Indians.The Caribbean
snow-topped mountains of Peru. Their ethnic nations of Antigua/Barbuda, the Bahamas,
Islands later became known
backgrounds include native Indian, Spanish, Barbados, Cuba, Dominica, Dominican Republic, as the West Indies.
Portuguese, French, British, Danish, Dutch, Grenada, Haiti, Jamaica, St. Christopher/Nevis,
African, Asian Indian, Chinese, Italian, German, St. Lucia, St. Vincent/Grenadines, and Trinidad Data from the 2001
and Japanese. And though Roman Catholicism is and Tobago, as well as the U.S. territory of Puerto Canadian census show that
practiced by a majority, many others follow Rico. Many islands, such as the Virgin Islands over 150,000 immigrants
Protestant faiths, Judaism, and numerous indige- (U.S.) and Martinique (France), are still under from Jamaica have settled
nous Afro-European religions including voodoo, foreign control. in the city of Toronto.
santeria, and candombl. The islands are uniformly scenic. The tropical
One commonality between Caribbean Islanders warmth and torrential rains provide the ideal
and South Americans is a variety of regional fares climate for a lush plant cover that includes
with few national cuisines. Dishes typically com- numerous indigenous fruits and vegetables. Later
bine native ingredients with foods introduced immigrants found the region suitable for imported
from Europe, Africa, and Asia, with a broad prefer- crops. The Caribbean Islands share a history of
ence for strong, spicy flavors. This chapter reviews domination by foreign powers and political tur-
Caribbean Islanders and their fare, focusing moil. Native Indians, Europeans, blacks from
on Puerto Ricans, Cubans, and Dominicans. A Africa, and Asians from China and India have
summary of South Americans is also presented intermarried over the centuries to produce an
(see Figure 10.1). Other Latinos are covered in extremely diverse population.
Chapter 9, Mexicans and Central Americans.
History of Caribbean Islanders
Caribbean Islanders in the United States
Immigration Patterns. It is estimated that the
More than 1,000 tropical islands in the Caribbean Latino population in the United States was more
stretch from Florida to Venezuela. They include than 41 million people as of 2005, and Caribbean
the Bahamas, the Greater Antilles (Jamaica, Islanders accounted for just over 20 percent of
Cuba, Hispaniola, and Puerto Rico), and the that total. Residents from Puerto Rico constituted
276 CARIBBEAN ISLANDERS AND SOUTH AMERICANS
BAHAMAS
North
Atlantic
PUERTO RICO Ocean
CUBA
VIRGIN ISLANDS
ST. KITTS AND NEVIS
HAITI DOM. DOMINICA
JAMAICA
REP. BARBADOS
Caribbean GRENADA
TRINIDAD AND TOBAGO
Sea
Caracas GUYANA
VENEZUELA SURINAME
Bogot FRENCH GUIANA
COLOMBIA
Quito
ECUADOR
PERU
BRAZIL
Lima
La Paz Brasilia
BOLIVIA
PARAGUAY
CHILE
Asuncin
Buenos
Santiago URUGUAY
Aires
Montevideo South
ARGENTINA Atlantic
Ocean
Figure 10.1 FALKLAND

ISLANDS (U.K.)
Caribbean Islands and
South America.
the largest group, followed by those from Cuba they are technically not immigrants. They come
and the Dominican Republic. In addition, there to the mainland as U.S. citizens and are free to
were small groups of immigrants from other travel to and from Puerto Rico without restriction.
Caribbean nations, most significantly from Over half the population of Puerto Rico resides
Jamaica and Haiti. on the mainland of the United States, and the
number of Puerto Ricans who live in New York
Puerto Ricans. Puerto Ricans differ from most City is almost double the number living in San
other people who come to the United States in that Juan, the largest city in Puerto Rico.
Chapter 10: Caribbean Islanders and South Americans 277
Small numbers of political exiles from Puerto in 2000 it became a check-off category).10 Four Terms of identity vary for
Rico arrived in America in the 1800s, but most immigration groups have been identified.110 The Puerto Ricans, including
returned home when Puerto Rico became a U.S. first was during the Trujillo era (19301960), when Puerto Rican American,
possession. Others arrived when unemployment political dissidents came to the United States to Borrinqueo or Boricua
(used by those who prefer
increased in the depressed agricultural economy of escape the regime of President Rafael L. Trujillo.
the native Tano Indian
the island during the 1920s and 1930s. It was after The second group came during the post-Trujillo name for the island), and
World War II that the largest number of Puerto era (19611981), when improved social and eco- Nuyorican(used by second-
Ricans moved to the mainland. Unlike other immi- nomic conditions slowed emigration to a trickle. generation Puerto Ricans
grants, the Puerto Rican population in the United The third is the flotilla group (19821986) living in New York City).
States is in continual flux. Many Puerto Ricans live Dominicans who left the country by boat, seeking
alternately between the mainland and the island, escape from oppressive poverty, hoping for a new
depending on economic conditions. In many years start in the United States. The fourth group includes
the number of Puerto Ricans leaving the mainland those who have left since the early 1980s, many of
will be greater than the number arriving. whom are urban Dominicans better educated
than those they leave behind, seeking employment
Cubans. Cubans have immigrated to the United opportunity. Some Dominicans enter the U.S.
States since the early nineteenth century. In the mainland after making Puerto Rico their home.
early years the majority were those who found The numbers of unauthorized Dominicans, or
economic conditions disadvantageous or who those who return to the island, are unknown.
were politically out of favor with the current
government. Current Demographics
The majority of Cubans came to the United Puerto Ricans. The number of Puerto Ricans
States after Fidel Castro overthrew the dictator- living on the U.S. mainland approached 4 million
ship of Fulgencio Batista in 1959. In the three in the 2005 census estimates. Nearly 25 percent of
years following the revolution, more than Puerto Ricans make New York State their home,
150,000 Cubans arrived in America. Most of with an estimated 900,000 living in New York
these were families from the upper socioeco- City.42 In the 1930s Puerto Ricans began moving
nomic group fleeing the restraints of commu- into East Harlem, which became known both as
nism. Commercial air travel between Cuba and El Barrio and as Spanish Harlem. Approximately
the United States was suspended after the Cuban 800,000 Puerto Ricans now reside in New York
Puerto Ricans living in
missile crisis in 1962. Airlifts of immigrants City, and because Puerto Ricans are a young pop-
Puerto Rico are not counted
from 1965 to 1973 increased the total number of ulation, they now constitute nearly one-quarter in the U.S. Census totals. If
Cubans in the United States to nearly 700,000. of the students in the citys public schools. Boston, all Puerto Ricans were
Due to the political differences between the two Chicago, Philadelphia, Newark, Cleveland, Miami, included, they would consti-
countries, most Cubans have not been subject to San Francisco, and Los Angeles also have sub- tute nearly 20 percent of all
the usual immigration quotas. stantial Puerto Rican communities. Latinos in the United States.
Immigration from Cuba slowed with the end of
the airlifts. In 1980 another large group of 110,000 Cubans. In 2005 census estimates, Americans of
Cubans arrived in Florida in private boats (the Cuban descent totaled 1.5 million. Many prefer to
Mariel boatlift) seeking asylum. Unlike earlier live in the Miami area, which is sometimes called
immigrants, these recent arrivals, called marielitos, Little Havana. The climate is similar to that of
were mostly poor, unskilled laborers. They were their homeland, and the Cuban population in the
often single and black. Today a trickle of exiles con- region is the largest in the United States. Efforts
tinues to come to the United States. Some arrive by to resettle exiles in other areas have been only
boat and others go through legal immigration moderately successful. Cubans living in Los
channels from a neutral third country. Angeles, Chicago, New York City, and Jersey City
and Newark, New Jersey, often choose to move to
Dominicans. Information on early immigrants Miami after gaining job skills. Those Cubans who
from the Dominican Republic is limited because remain in other cities are most likely to be
prior to 1990, Dominicans were counted within employed in technical or professional occupations.
the broader Hispanic category in the U.S. Census Nearly all Cubans who live in the United States
data (in 1990 Dominican was a write-in category; are urban dwellers.
of Cuban Americans are employed in professional,

technical, managerial, sales, or administrative
support positions, and annual family income is
high relative to other Latino groups, earnings are
below the national average, and 15 percent of
Courtesy of the Metro Dade Department of Tourism
Cuban Americans live below poverty level.96

Large numbers of Dominican professionals
have immigrated to the United States; however,
most obtain lower-paying jobs in manufacturing
and service industries, including restaurant work
and home care.76 Dominicans have the lowest
median family income of all Latinos in the United
States, and more than 27 percent live in poverty.96
Though some Jamaicans are limited by their lack
of skills, a majority hold professional, manage-
Cuban cafeteria, Miami,
Florida.
ment, technical, or sales jobs. Haitian immigrants
Dominicans. As of 2005, approximately 1.1 million have usually come from poor segments of their
Dominican Americans had settled in the United society and have entered migrant labor and service
States, over 42 percent of whom arrived after positions. It is estimated that nearly one-third of
1990.96 The majority lived in the urban areas of Haitians in Miami are unemployed.113
New York, New Jersey, Massachusetts, and Educational rates for first-generation immi-
Florida. It has been estimated that as many as grants from the Caribbean are very similar to those
300,000 unauthorized migrants also reside in of other Latinos. Figures from 2000 show that for
those regions.10 adults, both Puerto Ricans and Cuban Americans
graduate from high school at a rate somewhat
Many recent Haitian immi- Other Caribbean Islanders. Steady immigra-
below that of the general population (63 percent);
grants are refugees seeking tion to the United States during the 1990s had
however, rates of high school attendance are lower
asylum from political insta- increased numbers of other Caribbean Islanders
bility in the island nation.
for those who were born in Puerto Rico or Cuba.
in 2005 to over 840,000 Jamaicans and nearly
In contrast, Cubans graduate from college at rates
700,000 residents from Haiti.96 Unofficial esti-
Jamaican Americans often close to those of the general population, and nearly
mates suggest that unauthorized immigrants
refer to themselves as double those of Puerto Ricans.96 Cuban Americans
from these nations may double or triple these
Jamericans. English is the are also more likely than any other Latino group
figures.82, 113 Jamaicans have settled in the cities
official language of to pay for education; nearly one-half have attended
of the Northeast and South, including New
Jamaica, though many private schools. Just over half of adult Dominican
Jamaicans in the United York City, Philadelphia, Baltimore, Atlanta, Miami,
Americans have graduated from high school, with
States prefer a Creole patois Ft. Lauderdale, and Orlando. Haitians often choose
rates slightly lower among those who were foreign
or an Afro-Caribbean dialect to live in New York City, Miami, Chicago, New
born.96, 114 Nearly three-quarters of adult Jamaican
for everyday use.82 Orleans, Los Angeles, and Boston.
Americans who are foreign born are high school
Socioeconomic Status. Immigrants from the graduates.114 Dominicans in New York have
Caribbean vary in both economic and educa- demonstrated their commitment to education
tional attainment. Among Latinos, Puerto Rican through political involvement, such as running for
Americans have the highest rate of unemploy- control of local school boards.10 Statistics of school
ment (in 2000, it was more than double the attainment of Haitians in the United States are
national average), and Cuban Americans have usually combined with those of other Latinos and
the lowest. More than 25 percent of Puerto are not generally available for individual groups.
Ricans live in poverty, over three times the rate Among foreign-born Haitian adults, 62 percent
for non-Hispanics. However, it should be noted have graduated from high school.114
that second-generation mainland Puerto Ricans Many factors influence socioeconomic differ-
living in regions outside New York may have a ences among Latino groups from the Caribbean.
different socioeconomic profile, with signifi- Puerto Ricans living on the mainland are free to
cantly higher rates of college graduation and travel between the United States and their home-
white-collar employment.42 Though nearly half land, and the frequent changes in residence may
hamper socioeconomic improvement. Many followers of the church. The role of the Catholic
Puerto Ricans have chosen to reside in New York Church has been less important in the Caribbean
City, where as a new ethnic minority they took over than in other regions of Latin America and is less
the decayed neighborhoods previously occupied by significant to immigrants in the United States.
African Americans. In general, their low education For example, the number of Puerto Ricans living
levels and undeveloped job skills translate into on the mainland who are Catholic has declined
unemployment and low-level employment. since the 1960s, approximating 70 percent today,42
Furthermore, some Puerto Ricans, Dominicans, and it is estimated that only 64 percent of Cuban
Jamaicans, and Haitians face biases similar to that Americans born in the United States are followers
experienced by African Americans because many of the faith.9 However, higher percentages of
are of African heritage. Racial distinctions are not Catholics may be found in other Caribbean
as significant in the Caribbean Islands, and more Islander groups who have been in the United
overt discrimination is a new challenge for some States for shorter periods of time. For instance,
immigrants.82 In contrast, Cubans in the United about 95 percent of Dominicans are adherents to
States are mostly political refugees who emigrated Roman Catholicism.74
out of necessity, not choice. There are a dispropor- A number of other religions are practiced in
tionate number of Cubans in the United States from the islands, including Protestantism and Judaism.
the upper socioeconomic levels, and although For example, a majority of Jamaicans, who at one
many lost all their material goods when they emi- time lived under British rule, belong to Protestant
grated, they brought upper-class values, includ- congregations, such as the Church of God and
ing the importance of educational and financial Seventh-Day Adventists. Folk religions are found
success. Instead of displacing any ethnic minority as well. The best known of these is voodoo, a
in Florida, they immigrated in such numbers that unique combination of West African tribal rituals
they immediately became the dominant ethnic with Catholic beliefs and local customs. Saint
group. This is not to say that there are no well- Patrick is associated with the African snake deity
educated, wealthy Puerto Ricans living on the Damballah, for example, and St. Christopher is
mainland or no poor Cuban Americans. However, identified with Bacoso, the god responsible for
circumstances surrounding their immigration infectious illness. Certain rites, such as repeating
have influenced the general socioeconomic status the Hail Mary, making the sign of the cross, and
of both groups. baptism, are practiced in conjunction with ancestor
worship, drums, and African dancing. Worship is
Worldview family based, and there is no central leadership
or organization of activities. Typically ceremonies
Ethnic identity is strongly maintained in the Puerto are conducted for annual events such as Christmas
Rican, Cuban, and Dominican communities in and the harvest and for funerals.
the United States. Puerto Ricans on the mainland Voodoo originated in Haiti, although very It is believed that 25 per-
continue close ties with the island, frequently similar Afro-Catholic cults are found on the other cent of Cuban Americans
returning to visit family and friends. Cubans believe islands. In Cuba and Puerto Rico they are called born in the U.S. have no
it is important to retain their heritage because they santeria. Many followers of voodoo or santeria religious affiliation.9
cannot return. Dominicans often consider their are also members of Christian faiths and do not
stay in the United States temporary and may believe there is any contradiction in practicing
resist acculturation in order to maintain their both religions simultaneously.9 Rastafari is another
identity. In all three groups Spanish may be spoken Afro-Caribbean faith indigenous to Jamaica. Rastas
exclusively in the home and used frequently to practice a natural, simple lifestyle typified by bare
conduct business within the community.10, 42, 74 In feet, loose clothing, dreadlocks, and sacramental
contrast, Caribbean Islanders who suffer dysfunc- use of marijuana. It is also considered a political
tions due to the immigration process, and those movement due to Rastafari opposition to tradi-
who are unauthorized residents, often try to blend tional government and support for repatriation of
into existing Latino communities or assimilate into blacks to Africa.
mixed ethnic neighborhoods.82, 113
Family. The Puerto Rican family is based on the
Religion. A majority of Caribbean Islanders are concept of compadrazgo, which means co-parent-
Roman Catholics, although many are not faithful ing. Grandparents, aunts and uncles, cousins, and
godparents are all considered part of the imme- West Africa.79 Gender roles are inflexible, with
diate family, responsible for the care of children.42 men responsible for farming and providing for
Men are the heads of households as well as being the family, and women in charge of the household
in charge of community matters. The oldest boys in budget, marketing, and childcare. Haitians have
the family are expected to help with supervision maintained more traditional families than some
of younger siblings, particularly daughters. other Caribbean groups living in the United States.
Women maintain the home. Men are expected to Typically men still head the family, though Haitian-
be aggressive; women are traditionally reserved. American women often insist on a greater role
As in most Latino cultures, age is respected and in making decisions than is customary in Haiti.
elders are honored. Younger children are taught Haitian children are still expected to obey their
to defer even to older children. Duty to family is parents, bring honor to their family, and to reside
extremely important.23 at home until marriage. Haitian Americans estab-
Traditional Cuban families are also patriarchal lish a close network with other Haitian immigrants
and extend to include relatives. Godparents are and keep in touch with family and friends remain-
significant in childrearing. Children are deferen- ing in Haiti. Those who are unable to return for
tial to elders and well chaperoned in public. political reasons may sponsor voodoo ceremonies
Caribbean Islander families often change in the in their behalf.113
United States. Women, who work in greater num-
bers than men, and who may make a higher Traditional Health Beliefs and Practices. Many
income, often gain greater authority within the Caribbean Islanders hold health beliefs similar
home, and Caribbean Islander children gain to those of other Latin American cultures. For
greater autonomy in the United States. Economic example, Puerto Ricans, Cubans, Dominicans, and
pressures, American values of individualism and Haitians often believe that illness is a punishment
equality, and intergenerational stress are often from God, or that fate determines life and death.
cited as responsible for nontraditional adaptations. Prayer, the lighting of candles to saints, and the
Studies of early immigrants have shown that one- laying on of hands are important ways of main-
third of Dominicans, for example, lived in nuclear taining health and curing disease.37, 59, 94 Many
family groupings in the United States even though Dominicans employ the promesa, a promise or obli-
only 1 percent did so in the Dominican Republic. gation to be performed by a supplicant in exchange
Dominican women in the United States also had for maintenance or restoration of health.74 In
fewer children than those on the island.10 Another addition, some believe that all individuals have a
dramatic change is in the number of households guardian angel who protects them from evil. Some
headed by women, which totaled nearly 34 percent also believe illness can be caused by evil spirits or
of all Dominican families in 2000 (three times the the devil, particularly Dominicans and Haitians.
national average).96 It is thought that in some cases The conditions of empacho, susto, nervios, and
men who were unable to support their families mal de ojo are known by many Puerto Ricans, but
have deserted them, often leaving uneducated not by all.37 Of special note is nervios, which takes
and unskilled women to manage alone.10 Among several forms.12, 43 Someone who has experienced
Jamaican Americans, parents often separate when trauma as a child may become a nervous person
the wife or husband comes first to the United States for life, ser nervioso, with crying bouts, headaches,
to obtain employment and establish residency. stomach maladies, and a tendency toward violence
Long periods apart often result in divorce or in men. This condition can be tempered by use of
abandonment, and single-parent households are herbal teas and talking with family members, reli-
common. Children may lapse in school atten- gious advisors, or mental health professionals.
dance, and gang activity among adolescents is of Padecer de los nervios is a mental illness associated
concern in the community.82 with depression that develops in adults. It is treated
According to U.S. Census Among the rural population of Haiti, common- with the help of psychologists or psychiatrists.
data, more Dominican law marriage is frequent, and it is acceptable for Ataques de nervios, also known as ataques, is a
women than men have a man to maintain several different households hysterical reaction to stressful events. It may
immigrated to the U.S. as long as he supports each wife and their children. include acute breathing difficulties, frenzy, or the
This placaj system is believed to be a remnant sudden onset of illness. Nervios is a problem found
of the polygamous societies found in parts of more often in women than men, and it is associated
with a weak character.3 In general, nervios is treated only clients they knew personally from
helped by prayer, massage, sedatives, and herbal within their communities. In the United States the
teas. Physicians and mental health specialists are healers expanded their practice to include strangers
also useful. Other folk conditions reported by and clients of all ethnicities. They typically accepted
Puerto Ricans include pasmo, a type of paralysis a wide variety of physical and psychological cases.
due to an imbalance of hot and cold, and fatique, When possible, the healers preferred to consult
acute breathing difficulties. Pasmo is cured with the entire family in order to gain full support
through folk remedies, while fatique responds to for recommended treatment.
emergency care provided by a physician. More serious conditions, such as those due to
Haitians are especially concerned with the supernatural causes, particularly witchcraft, require
flow of blood, considered essential in the balance the cures associated with voodoo and santeria.
of hot-cold categories. Many blood irregularities Voodoo priests (hougans or bokors) or priestesses
are recognized, classified as hot, cold, weak, thin, (mambos) or spiritualist healers, known as espiritos
thick, dirty, and yellow.66 Febles occurs when there and santeros, intervene with the saints on behalf
is insufficient blood or anemia due to poor diet. of a bewitched person (practices related to those
The condition is characterized by general weak- of the American South; see Chapter 8, Africans).
ness and is cured by eating items such as liver, red Santeros specialize in soul possession and mental
meat, pigeon meat, cows feet, or leafy green veg- disorders. Dreams may play an important role in
etables. Sezisman is a disruption of normal blood health care because they are a connection with the
flow, due to sudden emotional trauma or chronic supernatural world. Ancestors provide instruc-
ill-treatment by others. It can cause vision loss, tions to an individual regarding health behaviors
headaches, high blood pressure, or stroke. It is through dreams. Brujos (witches) and curenderos Serious conditions, such as
treated with relaxation, cold compresses, sipping (healers) (see Chapter 9) may also be sought for sickness due to supernatural
cool water, or drinking coffee mixed with rum.21 medical care. causes, may require the cures
Haitian women may be encouraged to eat red fruits associated with the healing
and vegetables (such as beets or pomegranates) to practice of santeria.
strengthen their blood.79
Gaz (gas) is another common condition for
some Haitians. Gas may settle between the ears,
causing headache, in the stomach, causing indi-
gestion, or in other parts of the body, where it
causes pain. Eating leftovers (especially beans) is
one cause of gas.21 A nursing mother may undergo
a thickening of her milk, which causes headaches
or depression in the woman and impetigo in her
baby. Move san is a more serious condition in
which a nursing mother experiences fright or neg-
ative emotions, causing her milk to spoil, resulting
in diarrhea and failure-to-thrive syndrome in her
infant.79 Some Haitians believe mal dyok (evil eye)
can also cause illness.
The traditional healing practices common in
the Caribbean are more closely related to African
beliefs than the Arab-Spanish humoral system
used in hot-cold applications. Mild conditions are
treated through an informal system of older women
Francoise de Mulder/Corbis
(mothers, grandmothers, or neighbors) who are

knowledgeable about the use of teas, herbs,
amulets, and charms.122 A study of Dominican
healers found that the women learned their skills
from relatives or through spiritual guidance.98
When at home in the Dominican Republic, they
Dominicans often believe the best way to treat Dutch, Danes, Africans, Asian Indians, and Chinese
illness is to use a traditional healer who will con- have all had an impact on the cuisine. The basic
sult with Catholic saints on which home remedies diet is similar throughout the region, with regional
are appropriate for the symptoms.74 This allows variations found on each island. In recent years
Dominicans to address the spiritual and emotional tourism has helped spread specialties from one
aspects of physical problems as well as seek nation to another in order to meet visitor expec-
symptom relief. Many Haitians recognize two types tations about what dishes are available, and the
of illness. The first is natural illness, due to a poor global economy has furthered the development
diet, blood conditions, bone displacement, or cold of a pan-Caribbean cuisine.52
drafts and other environmental factors. These can
Indigenous Foods. Columbus likened the West
be cured by home remedies or visits to biomedical
Indies to paradise on Earth. The islands are natu-
practitioners. The second is supernatural illness,
rally laden with fresh fruits and vegetables origi-
due to angry spirits. These can only be treated
nally from Central or South America, including
by a voodoo manger mort (feast for the dead)
the staple cassava (two varieties of tuber, bitter
ceremony.21 Cubans often consider santeria a link
and sweet, also known as manioc and yuca; tapioca
to their past and may use a biomedical provider
is a starch product of manioc), acerola (Barbados
for relief of physical symptoms but employ a san-
cherry, a small, sour fruit with exceptionally high
tero to help them restore balance or counteract the
vitamin C content), avocados, bananas and plan-
circumstances that led to their illnesses.94
tains, some varieties of beans, calabaza (a type of
Good hygiene, especially daily bathing, is done
to promote health among Puerto Ricans. Some pumpkin), cashew apples (fruit of the cashew nut),
Puerto Ricans, Dominicans, and other Caribbean cocoa, coconuts, corn, guavas, malanga (a mild
Islanders practice a modified version of the hot- yam-like tuber sometimes called cocoyam, yautia,
cold classification system in their diet, and some tannier, or tannia), mammee apples (a small
use it for categorizing illness (see Therapeutic Uses green fruit with flesh reminiscent of apricots),
of Foods in this chapter).59, 98 Dominican healers papayas (sometimes called pawpaws), pineap-
may consider junk food, red meat, lack of exercise, ple, sapodilla or naseberry (a small fruit with
emotional distress, contact with negative people, aromatic flesh that has a gritty texture similar to
and environmental stresses as some contributing pears), soursop (a fruit with a cotton-like con-
factors in health problems.98 Haitians consider sistency), several types of squash (including
eating well, cleanliness, and regular sleep essential chayote, called chocho or christophene in the
to health. Laxatives or enemas may be used to islands), sweet potatoes, and tomatoes. Fish and
refresh the bowel, remove impurities, and prevent small birds are also plentiful.
acne in children.21 As in other Latin American areas, chile peppers
Most Caribbean Islanders use herbal teas, and grow profusely in the West Indies. Extremely hot
A study of Dominican heal- varieties are favored, including Scotch bonnet and
over-the-counter medications are often used to
ers in New York City found bird peppers (also called tepinssee Chapter 9, for
that they often return to relieve symptomsDominicans may also take
baths with herbs or flowers. Many Americans of more information on chiles). The native cuisine
the Dominican Republic to
Caribbean Island heritage are also likely to use makes frequent use of these for flavoring, espe-
collect herbs and prepare
home remedies or visit a bontnicas (herbal cially in pepper sauces, such as coui, a mixture of
botanical supplies.98
pharmacy) or a bodega (small market) to purchase cassava juice and chiles. Other native seasoning
cures (including antibiotics obtained without includes allspice, recao (Eryngium foetidum, a
prescription)69 as a first step in treating symptoms.94 pungent herb also known as culantro, long
Cassava contains hydro- cilantro, or shandon beni), and annatto (achiote).
cyanic acid, which is toxic in
One study notes that some Dominicans refer to
home remedies of all types as zumos, a word that Because of the abundance of fresh fruits and
large amounts. The acid
strictly translated means juices. 6 vegetables year-round, traditionally there was little
must be leached out and
need for preparation or preservation of foods.
the tuber cooked before it
can be eaten safely. TRADITIONAL FOOD HABITS Consequently, cooking techniques were underde-
veloped in the native populations. Cassava was
The American word barbe-
Ingredients and Common Foods baked most often in a kind of bread, made from
cue is probably derived from Caribbean food habits are remarkably similar for pressed, dried, grated cassava that was fried in a flat
barbacoa, the Arawak Indian an area influenced by so many other cultures. The loaf. Fish and game were either covered with mud
term for grilling meats. indigenous Indians, the Spanish, French, British, and baked in a pit or grilled over an open fire.
Foreign Influence. The Europeans who settled and slices of avocado or fried plantains in the Nearly all parts of the akee
in the Caribbean were impressed with the abundant Dominican Republic), morcillas (a type of blood fruit contain hypoglycins,
supply of native fruits and vegetables. Yet they sausage), flaky pastry turnovers with meat, poul- which can cause fatal hypo-
longed for the accustomed tastes of home. The try, seafood, or fruit fillings, and fried corn cakes glycemia. Most akee prod-
ucts are banned in the
Spanish brought cattle, goats, hogs, and sheep to (known as surrulitos in Puerto Rico). Foods from
United States.
the islands, in addition to introducing rice. Plants Africa found throughout the region include
introduced for trade by the Europeans included callaloo (a dish of taro or malanga greens cooked
breadfruit, coffee, limes, mangoes, oranges (both with okra), dried salt cod fritters (called bacalaitas
sweet and sour varieties), and spices such as ginger, in Puerto Rico, these cakes have a different name
nutmeg, and mace. The African slaves brought in on nearly every island, from arcat de marue to
to work the sugarcane fields cultivated akee (a mild, stamp and go), foofoo (okra and plantain), and
apple-sized fruit), yams, okra, and taro (also called coocoo (cornmeal-okra bread). Dishes from India
eddo or dasheen; both the roots and the leaves are and Asia are also common on many islands,
eaten). The demand for Asian ingredients by later although they are better known in the areas
immigrants resulted in the introduction of soybean where cheap labor was most needed: the French-,
products, Asian greens, lentils, and tamarind to British-, and Dutch-dominated islands (few
the Caribbean. Asians immigrated to Puerto Rico, Cuba, or the
Dominican Republic). Curried dishes, called kerry
Staples. Legumes are eaten throughout the in the Dutch-influenced islands and colombo on
Caribbean, most often in the dish rice and peas. the French-influenced islands, and variations of
Rice with red (kidney) beans is popular in Puerto pilaf are considered Caribbean foods. Chinese cui-
Rico and is also found in the Dominican Republic sine is also popular and Chinese-owned restaurants
and Jamaica (where the dish is nicknamed coat are omnipresent.
of arms). In Cuba black beans with rice are pre- The most popular beverage in the Caribbean
ferred, called Moros y Cristianos (Moors and is coffee. It is often mixed with milk and is con-
Christians, a reference to Spanish history). In sumed at meals, as a snack, and even as dessert,
Haiti black-eyed peas (a type of cowpea from flavored with orange rind, cinnamon, whipped
Africa) are combined with the rice. The legumes cream, coconut cream, or rum. Some of the most
in all countries are prepared similarly, flavored expensive coffee in the world is produced in the
with lard and salt. Onions, sweet peppers, and Blue Mountains of Jamaica, where the cool, mod-
tomatoes or coconut milk are added in some vari- erately rainy climate is ideal for coffee cultivation.
ations. Other popular legumes include pigeon peas, Most of the rich beans are exported to England
popularly known as gungo (originally from Africa, and Italy, although small amounts can be found
often cooked with rice, also), lentils (from India), in the United States.
chickpeas (also known as garbanzo beans, intro- The most important beverage in the Caribbean,
duced from Europe), and bodi beans (another at least historically, is the spirit distilled from
variety of cowpea eaten as a green bean, also called fermented molassesrum. This alcoholic drink
Chinese long beans). is believed to have originated on the island of
Examples of other foods common throughout Barbados in the early 1600s as a by-product of sug-
the West Indies are found in the Cultural Food arcane processing. Molasses is the liquid that
Groups list (Table 10.1). They include native Indian remains after the syrup from the sugarcane has
foods such as cassava bread, chili sauces, and been crystallized to make sugar. It is fermented,
pepper pot (a meat stew made with the boiled naturally or with the addition of yeast, and then
juice of the cassava, called cassarep). Tamales and distilled to make a clear, high-proof alcoholic
pasteles are steamed cornmeal, cassava, or plantain beverage. Rum can be bottled immediately or aged
dough packets with savory (such as meat, seafood, in oak casks from a few months to twenty-five
or cheese) or sweet (including coconut or guava) years. Caramel is added to achieve the desired
fillings. European-influenced items popular in color. Nearly every island produces its own variety
many Caribbean countries include escabeche (fried, of rum.
marinated fish, seafood, or poultry), asapao (a thick The molasses produced in the West Indies
rice soup with chicken, pork, or seafood, often was crucial to the development of the region
garnished with Parmesan cheese in Puerto Rico during the seventeenth and eighteenth centuries.
Table 10.1 Cultural Food Groups: Caribbean Islands

Protein Foods
Milk/milk products Few dairy products are used; incidence Cows milk (fresh, condensed, evaporated), caf More milk and cheese are consumed.
of lactose intolerance is assumed to con leche, caf latte; aged cheeses
be high.
Infants are given whole, evaporated, or
condensed milk.
Meat/poultry/fish/ Traditional diet is high in vegetable pro- Meats: beef, pork (including intestines, organs, More beef and poultry are eaten as income
eggs/legumes tein, especially rice and legumes; red variety cuts), goat increases, though pork intake may
and kidney beans are used by Puerto Poultry: chicken, turkey decline.
Ricans, black beans by Cubans. Fish and shellfish: bacalao (dried salt cod), bar- Less fresh fish is consumed.
Pork and beef are used more in racuda, bonito, butterfish, crab, dolphin fish Traditional entres remain popular.
Spanish-influenced countries. (dorado), flying fish, gar, grouper, grunts, land
Dried salt cod is preferred over fresh crabs, mackerel, mullets, ostiones (tree oysters),
fish; some seafood specialties. porgie, salmon, snapper, tarpon, turtle, tuna
Eggs are a common protein source, Eggs: chicken
especially among the poor. Legumes: black beans, black-eyed peas, chick-
Entres are often fried in lard or olive oil. peas (garbanzo beans), kidney beans, lima
beans, peas, red beans, soybeans
Cereals/Grains Breads of other countries are well Cassava bread; cornmeal (fried breads, surrulitos, Short-grain rice is still preferred. More
accepted. puddings); oatmeal; rice (short-grain); wheat wheat breads are eaten.
Fried breads are popular. (Asian Indian breads, European breads, pasta)
Fruits/Vegetables Starchy fruits and vegetables are eaten Fruits: acerola cherries, akee, avocados, bananas Temperate fruits are substituted for tropical
daily; leafy vegetables are consumed and plantains, breadfruit, caimito (star apple), fruits when latter are unavailable. More
infrequently. cashew apple, cherimoya, citron, coconut, fresh fruit is eaten.
Great diversity of tropical fruits is avail- cocoplum, custard apple, gooseberries, Starchy fruits and vegetables are still
able, eaten mostly as snacks or granadilla (passion fruit), grapefruit, guava, frequently consumed.
dessert. guanbana (soursop), jackfruit, kumquats, Low intake of leafy vegetables is often
Lime juice is used to cook (a marinat- lemons, limes, mamey, mangoes, oranges, continued.
ing method called escabeche or papayas, pineapple, pomegranates, raisins,
ceviche) meats and fish. sapodilla, sugar cane, sweetsop, tamarind
Vegetables: arracacha, arrowroot, black-eyed
peas, broccoli, cabbage, calabaza (green
pumpkin), callaloo (malanga or taro leaves),
cassava (yuca, manioc), chiles, corn, cucum-
bers, eggplant, green beans, lettuce, malan-
gas, okra, onions, palm hearts, peppers,
potatoes, radishes, spinach, squashes (chay-
ote, summer, and winter), sweet potatoes,
taro (eddo, dasheen), tomatoes, yams
Additional Foods
Seasonings Aromatic, piquant sauces are often Anise, annatto, bay leaf, chiles, chives, cilantro
used to flavor foods. Very hot chiles (coriander leaves), cinnamon, coui (chiles
popular in some regions. mixed with cassava juice), garlic, mace,
nutmeg, onions, parsley, pimento (allspice),
recao (culantro), scallions, thyme
Beverages Teas of all sorts are common and are Beer, coffee (caf con leche), teas, soft drinks, Fruit juice and soft drink consumption may
often thought to have therapeutic milk, rum, Irish moss (seaweed extract), sorrel increase.
value. Rum is especially popular and
is often added for flavoring to foods
and beverages.
Fats/oils Butter in French-influenced countries; coconut
oil; ghee (Asian Indian clarified butter); lard
in Spanish-influenced countries; olive oil
Sweeteners Sugar cane products, such as raw and unre-
fined sugar and molasses
The Caribbean Islands were one corner of the Starchy foods have a central role in Puerto Rican Many well-known mixed
infamous slave triangle, formed when molasses cuisine, traditionally consumed at nearly every drinks were developed in
was shipped to New England for distillation into meal as a side dish or in soups and stews. They are the Caribbean with rum.
rum, rum was shipped to Africa and exchanged known as viandas and include bland-tasting, white Planters punch is an adap-
for slaves, and slaves were shipped to the West or creamy colored roots, tubers, and fruits that must tation of the recipe from
India for panch (lime juice,
Indies to work in the sugarcane fields. be cooked, such as cassava, malanga, potatoes,
sweetening, spirit, water,
Juices made from tropical fruits such as lime, sweet potatoes (white or yellow are preferred), and spices) and was proba-
otaheite apple (also called ambarella, originally yams, celery root, breadfruit (and breadfruit seeds), bly invented by the British
from Polynesia), pineapple, roselle (also known as under-ripe bananas, and plantains.23 One especially in the eighteenth century.
Jamaican sorrel, brought from Africa), soursop, popular preparation is mofongo, fried and mashed The daiquiri, a popular mix
and tamarind are common. Ginger often spices plantains flavored with either pork cracklings or of lime juice, sugar, and rum,
the juice mixtures, and coconut milk or condensed bacon. Calabaza and carrots are considered vegeta- was created in the 1890s
milk may also be added. bles because their starch content is lower and they and named after a Cuban
are a significant source of vitamins; ripe bananas town. The cuba libre (rum
Regional Variations. Despite the similarities in and coke with a slice of
foods throughout the Caribbean, some regional are considered a fruit that is eaten raw.
Pork is a favorite meat in Puerto Rico, espe- lemon) is popular through-
differences are notable. Same-named dishes pre- out the Caribbean and
pared on one island may not taste the same on cially roast pork adobo. It is also used frequently
Central America.
another island due to variations in ingredients and for added flavor in the form of salt pork, ham,
seasoning. For example, butter is the preferred cracklings, or bacon. Beef and goat are also con-
cooking fat in French-influenced countries, sumed. One very popular stew is sancocho, which
whereas lard is more popular in Spanish-influenced includes beef short ribs, calabaza, malanga, yams,
nations. Coconut oil is common in Jamaica. In and corn. Chicken is very popular, frequently
British-influenced countries, dishes often include prepared with rice as arroz con pollo, which is
scallions, parsley or cilantro, and thyme. On usually served with stewed beans (known as
French-influenced islands roux (flour blended habichuelas guisada), or in asopao. Land crabs
with butter or oil, then cooked until browned) is and ostiones, a type of oyster that grows on the
used to thicken stews and sauces, and sauce chien roots of mangrove trees,121 are eaten, as is some
(dog sauce) is a popular fresh condiment served seafood, including shrimp, lobster, and conch,
with pork, chicken, and seafood, made with olive often prepared as soups or stews. Fresh fish is not
oil and lime juice seasoned with ginger, garlic, consumed frequently (though a few dishes, such
scallions, parsley, chiles, allspice, and thyme. A as escabeche, are popular), but dried salt cod, called
similar preparation known as sauce ti-malice is bacalao, is used in many dishes. It is soaked and
found in Haiti. Spanish-influenced islands use drained before use to remove some of the salt and
more piquant seasonings with less heat, including then added to numerous dishes including serenata,
a greater use of tomatoes, onions, annatto, and a mixture of cod and potatoes. Variety meats are
sweet bell peppers. featured in several national dishes, such as mon-
Each island is also known for its specialties. In dongo (tripe soup), lengua relleno (stuffed tongue),
addition to rice and red beans, Puerto Rican fare is rinones guisados (calf kidneys), and sesos empana-
notable for its use of distinctive flavorings, such as dos (calf brains).52
alcaparrado, a pickle mix of capers, olives, and Fritturas, or finger foods, are also a specialty,
pimento, and recaito, an aromatic blend of recao, consumed as snacks or appetizers or added to
onions, garlic, and bell peppers. Sofrito, an all- meals. They include simple fritters (e.g., banana,
purpose sauce that is the foundation for many squash, or bacalaitos); alcapurrias (starchy veg-
Puerto Rican dishes, combines alcaparrado and etable dough stuffed with spicy beef, pork rind,
recaito with tomatoes. All ingredients are then fried poultry, or seafood and then fried); piones
in lard colored with annatto seed until a thick paste (plantain strips wrapped around sausage, poul-
is formed. Some foods are seasoned with adobo, try, or seafood fillings and fried); pastilillos (fried
a mixture of lemon, garlic, salt, pepper, and other meat or cheese turnovers); and cuchifritos (deep-
spices. Ajilimojili sauce is a puree of bell peppers, fried chitterlings or variety meats). Empanadillas,
garlic, olive oil, and lemon juice. Sazn, a commer- small baked turnovers typically filled with ham,
cial spice blend that is primarily MSG (monosodium beef, lobster, conch, or cheese, are also a favorite.
glutamate, used to enhance flavors), is a popular Sweets including cakes, pastries, puddings, and
seasoning as well.23 cookies are popular for desserts and snacks.
a sauce of olive oil, juice from limes or sour

oranges, onions, and garlic.
The western parts of the island are more urban
and cosmopolitan, especially around Havana,
SAMPLE MENU where Spanish and Asian culinary influences are
evident. Picadillo is a type of beef hash flavored
with the traditional Spanish ingredients featured in
A Puerto Rican Lunch alcaparrado (the same mix of olives, raisins, and
capers used in Puerto Rico), as well as Caribbean
Escabeche (Escovitched Fish) a, b tomatoes and chile peppers. Picadillo is served
with fried plantains or boiled rice, or topped with
Surrulitos c or Carib bean Johnnycake a fried eggs. Other Spanish-influenced beef dishes
are ropa vieja (old clothes), spicy beef strips
Arroz con Pollo (Peppery Chicken and Rice) a, b, c cooked until they begin to shred, and brazo gitano,
a cassava dough pastry filled with corned beef.
Habichuelas Guisado (Stewed Beans) a, c Roast pork is popular, and eggs are often prepared
Plntanos en Alimbar (Candied Plantains/Baked Bananas) a, c as Spanish-style potato omelets. In addition, the
rice and beans are usually served separately in
Fruit Juice, Beer, and Coffee with Milk this region. Asian ingredients are less prominent,
but notable. Chicharrnes de pollo is prepared
with small pieces of chicken marinated in lime
juice and soy sauce, breaded, and then fried in
a
DeMers, J. 1997. Caribbean cooking. New York: HPBooks. lard. Another example is arroz salteado, a fried
b
Cocina Criollo at http://www.hechoenpuertorico.org/comida rice dish made with eggs, shrimp, and vegetables
c
The Boricua Kitchen at http://www.elboricua.com/recipes.html cooked in olive oil and seasoned with soy sauce.
Fish are eaten in western coastal areas, and one
specialty is grilled or stewed crocodile.52 Fruit
pastes, such as those made from guava, are typi-
cal desserts, sometimes served with a slice of
salty cheese. Spanish-style egg desserts are also
found, especially custards, flans, and puddings.
One specialty is tembleque, the Puerto Rican ver- Turrones, a nougat candy made with peanuts, is a
sion of Spanish-style flan. Flans are also flavored Cuban favorite.
with chocolate, coconut, pineapple, pumpkin, or Stews are a specialty in the Dominican Republic.
rum. Candied ripe plantains and baked bananas Examples include pollo guisado (chicken with
are a common fruit-based sweet in Puerto Rico, bell peppers, tomatoes, onions, and olives, sea-
also found throughout the Caribbean. soned with oregano), mondongo (similar to the
Nearly 70 percent of food in Puerto Rico is Puerto Rican tripe soup), and stews made with
imported from the mainland.23 American dishes fish or seafood, such as shrimp, conch, or her-
are common, especially among younger diners. ring. Best known is the Dominican version of
Pizza, canned spaghetti, hot dogs, canned soups, sancocho, made with several kinds of meats
and cold cereals have become favorites.23 (including pork, chicken, beef, and Spanish-style
Cuba is noted for the prominent use of black longaniza pork sausage), plus numerous starchy
beans in its cuisine. In addition to black beans vegetables cooked in sour orange juice. On spe-
and rice, spicy black bean soup is very popular. cial occasions additional types of meats (e.g.,
As in Puerto Rico, viandas are standard fare, goat, ham) are added to make sancocho prieto.
especially in the more rural eastern sections of Stews are often served with rice and red beans,
the island where Indian heritage is prominent. and cassava bread.
Examples include foofoo (cassava balls) and tostones Locrio is another Dominican favoritea rice
(plantain slices that have been pressed to make dish that has its origins in Spanish paella (see
them larger and thinner, then fried in olive oil). Chapter 6, Northern and Southern Europeans,
Meats and viandas are often served with mojito, for more information), but differs in that only a
single item, such as chicken, shrimp, or sardines,

distinguishes each version. Other common dishes
include chicharrnes de pollo (prepared like the
Cuban recipe), rice with chicken and pigeon peas,
and mangu (mashed plantains topped with olive
oil-fried onions). Salads are especially popular in
the Dominican Republic. A few feature lettuce
and tomatoes, but more often cooked vegetables
such as okra, potatoes, chayote squash, or cabbage
are cooled and dressed with oil and vinegar.
Avocado and hearts of palm (a specialty of the
island) are featured in other versions. Habichuelas
con dulce is a unique Dominican dish served as a
side dish or as a dessert, combining red beans,
coconut milk, evaporated milk, whole milk, sugar,
and butter.74 Desserts include fruit compotes,
Spanishstyle flan, plantains or guavas with
Courtesy of the Florida News Bureau

caramel sauce, coconut biscuits, or sweet potato
or squash puddings.
Jamaica specialties include akee and salt cod,
curried goat, bammies, a type of cassava bread,
mackerel rundown, cooked in coconut milk
with vegetables, and jerked foods (see Exploring
Global Cuisine box for more information). Haiti
is known for its banana-stuffed chicken dish A typical Cuban meal
called poulet rti la crole and barbecued goat includes savory picadillo
with chile peppers (kabrit boukannen ak bon (right), black beans and rice,
piman). Griot is another popular dish made with with sugar to caramelize it (a technique thought bread, and flan (a Spanish-
pork that is first marinated in seasoned sour to have been brought by Africans).52 Soups and style custard) for dessert.
orange juice, then boiled, and then fried. Patties, stews are also popular. Soups are sometimes served
a curried meat turnover, are a Haitian specialty in two coursesthe strained broth first, followed
now served throughout the Caribbean. Common by the cooked meats and vegetables. Leafy vegeta-
Haitian side dishes include cornmeal mush and bles are sometimes ingredients in soups, stews, and
diri a djon djon (also called riz noir, or black rice, stuffed foods, and only served uncooked as part
this is rice cooked in a broth made by boiling of the lettuce and tomato salads found in many
dried mushrooms native to the island called regions, including Puerto Rico, Cuba, and the
Djon-djon mushrooms (used
djon djonthe mushrooms themselves are not Dominican Republic. Fruits are eaten infrequently to make rice) are usually
consumed). Curaao is famous for its orange- in many areas but are found fresh in some desserts available wherever groups of
flavored liqueur of the same name, and in Dominica and as snacks. Haitians have settled. They
crapaud or mountain chicken, a large, tasty Ethnic heritage and social class determine are often found in packets,
frog, is considered a delicacy. In Barbados many which dishes are served.52 A poor native Indian packed with spices, at street
more unusual seafood dishes are popular, includ- may eat mostly cassava, tomatoes, and chiles with stands in New York City.
ing those made with flying fish, green turtles, and a bit of salted fish at every meal. An Asian Indian
sea urchins. may serve typically Asian-Indian meals adapted Pickapeppa sauce is a
to Caribbean ingredients, such as a curried dish Jamaican specialty, made
Meal Composition and Cycle garnished with coconut, fried plantains, and from tomatoes, mangoes,
raisins, tamarind, vinegar,
The most typical aspect of a Caribbean meal is its pineapple. Most menus, however, consist of a mul-
and chiles. The sweet and
emphasis on starchy vegetables with some meat, ticultural mix, such as European blood sausage and tangy condiment is so pop-
poultry, or fish served with rice and beans. Breads accra, West African-style fritters made from the ular that it was hoarded
of all sorts are now common in many areas. Meats meal of soybeans or black-eyed peas. More meats when a strike halted pro-
are frequently fried or grilled. Sometimes before and foreign dishes are consumed by wealthy duction, causing a world-
meat is added to mixed dishes it is cooked first Caribbean islanders and some reportedly visit the wide shortage.120
whichever meal is largest, lunch or dinner. Bread

puddings with rum sauce are favored. Sodas, fruit
juice, beer, or rum accompany the meal. Restaurants
are widely available in the cities, serving traditional
SAMPLE MENU Puerto Rican cuisine, as well as international fare,
such as Spanish, Italian, and Japanese. Snacking
is prevalent, particularly on fried items, such as
A Caribbean Sampler bacalaitos, surrulitos, and cuchifritos.
Toast and coffee is a customary breakfast in
Patties (Haiti, Jamaica)a, b Cuba, often followed by a midmorning coffee break
with pastries or cakes. Lunch and dinner menus
Fritters-Black-eyed Pea, Salt-Cod, or Conch (Pan-Island)a, b, c are similar, with meat, poultry, or fish (if available)
served with fried plantains, rice and black beans,
Callaloo Soup (Pan-Island)a, b and often cassava. Custards and puddings (bread
or rice) are typical desserts. Coffee is served after
Puerco Asado (Cuban Pork Roast)a, b, c the meal. Lunch is typically the largest meal of the
Mang (Dominican Republic)a, d day, even in urban areas, and dinner is often
leisurely, and may include beer, rum, or wine.
Black Cake/Rum Cake (Pan-Island)b Snacking on fruit, fruit juices, batidas (fruit juice
blended with milk and ice), or ice cream is frequent.
a
In the Dominican Republic, breakfast may be
DeMers, J. 1997. Caribbean cooking. New York: HPBooks. just bread and coffee, but more often it is larger,
b
Caribbean Recipes at http://www.recipezaar.com/recipes/caribbean including eggs, cheese, and salami or longaniza
c
Cuban Recipes at http://www.recipehound.com/Recipes/cuba.html sausage (scrambled together, or each fried sepa-
d
Aunt Claras Kitchen Dominican Cooking at rately), fried or mashed plantains, and espresso or
http://www.dominicancooking.com/dominican-recipes/ hot chocolate. Lunch is usually the biggest meal of
the day. Traditionally served between noon and
2:00 p.m., it is known as La Bandera Dominicana
(the Dominican flag), a plate with rice and beans,
a meat or chicken dish, and saladincorporating
colors similar to those found on the national
banner.74 Plantains or other starchy vegetables may
United States weekly to shop for groceries.52, 74 also accompany lunch. Dessert always follows, and
American fast foods have become popular through- espresso or sweetened coffee with milk ends the
out the region with rich and poor alike. meal. American meal patterns are influencing
many Dominicans, and abbreviated lunches are
Daily Patterns. Meal patterns vary somewhat becoming more common, including only a main
The Hot Potato is a Puerto throughout the region. Three meals each day, with dish, dessert, and coffee. When lunch is the main
Rican fast food chain that lunch the largest meal, is typical in most regions. In meal of the day, dinner is light, consisting of scram-
offers baked potatoes with Haiti, however, two meals a day is not uncommon. bled eggs or soup, and fried plantains or cassava
28 different toppings, from In Puerto Rico the traditionally large lunch bread. But when lunch is light, dinner is more
whipped butter or sour and smaller dinner are gradually changing to a substantial, similar to the traditional lunch.
cream to tuna melt and
dining schedule similar to that on the mainland, Jamaicans often include fish at breakfast,
chicken noodle soup.
especially in urban areas. Toast and coffee are a including sardines, mackerel, herring, or salt cod.
common breakfast, though eggs are popular as Other common items are eggs, fried plantains,
well, often served as a Spanish-style omelet. cornmeal porridge, and bammies. On the week-
Lunch and dinner menus may be similar, starting ends, liver with bananas is a breakfast specialty.
with soup (such as black bean, or chicken with Lunches and dinners are similar to those of other
Cubans today receive ration rice), followed by a stew served with rice and Caribbean Islanders, including soups, rice, and
books for obtaining items beans, fried plantains, and chayote squash. Quick peas with added beef, chicken, or curried goat,
such as meat, which is lunches, such as fast food fare, may replace the pork stews, fish dishes, and tossed salad or sweet
available in limited supply. full meal. Dessert is usually eaten daily, following potatoes on the side.28
EXPLORING GLOBAL CUISINESpecialty Cooking of Jamaica
T he nearly half-million Americans bay leaves, brown sugar, or other season- pork, red meat, salt, and artificial additives
of Jamaican ancestry have had ings. The spices are moistened with a little are prohibited. Some Rastas will eat
significant impact on U.S. pop oil, lime juice, or soy sauce to make a chicken or fish (but shun bottom feeders
culture. Calypso, reggae, the Rastafari reli- paste. Traditionally, the meat is rubbed such as shrimp and lobster, scaleless fish
gion, and dreadlocks are among the many with the jerk blend and marinated for such as shark, and any fish more than
cultural additions. In cuisine, two regional several hours. It is then grilled in a pit over twelve inches long). In general, milk,
specialties have piqued American interest: Jamaican pimento (allspice) wood, covered coffee, soft drinks, and alcohol are not
jerk and i-tal. with banana leaves, typically one to four consumed. I-tal foods are ideally eaten raw
Jerk is believed to be related to the hours, depending on the meat. Though or cooked over a fire (microwave ovens are
dried meat called jerky. Legend is that the pork and chicken are found at every street avoided by many Rastas), prepared and
technique was created by escaped African jerk stand in Jamaica, more recently the served using pots, dishes, and utensils
slaves known as Maroons (from the cooking technique has been applied to made from natural products, such as wood
Spanish word for untamedcimarron) turkey, fish, seafood, and even vegetables. or earthenware. A woman is not allowed
who spiced and smoked wild pig meat to Jerk pork is used to make jerk sausage in to prepare food for others when she is
preserve it. Today, the word jerk is used to some parts of Jamaica. For a complete meal, menstruating. Typical i-tal dishes include
identify the wet spice mixture used as a rice and peas, cassava bread, or cornsticks rice and peas, cassava bread, baked yams,
barbecue seasoning. It includes allspice, accompany the meat.67, 120 vegetable stews, cornmeal porridge,
black pepper, cinnamon, ginger, nutmeg, I-tal, meaning vital, is the Rasta way sauted plantains, and freshly squeezed
thyme, scallions, and extremely hot Scotch of life. Applied to food it emphasizes juices. Thyme, cinnamon, allspice, coconut,
bonnet chile pepperssome recipes also simple, unprocessed vegetarian fare. Fruit, and reputedly marijuana are used to
call for garlic, onions, ground coriander, vegetables, and grains are permitted, while flavor foods.82, 120
Special Occasions. The early European domi- Other holidays reflect the multicultural his- Catholic Dominicans may
nance in the West Indies resulted in an emphasis tory of the islands. Carnival is celebrated in some skip breakfast or fast for
on Christian holidays. Christmas is important, Caribbean countries such as Trinidad and Tobago several days during Lent
especially in the Spanish-influenced islands that and is similar to Mardi Gras in the United States. to please God by their
are predominantly Catholic. In Puerto Rico paste- The pre-Lenten festivities feature parades of danc- sacrifice.74
les are prepared to celebrate Christmas. Similar to ing celebrants; many are elaborately costumed as
Mexican tamales, pasteles are a savory meat mix- traditional European or African figures. Food
ture surrounded by cornmeal or mashed plantains, booths that line the parade route provide a day-
wrapped in plantain leaves, and steamed. Carolers and-night supply of carnival treats. Fried Asian
traditionally stop at houses late at night to request Indian fritters are particularly popular.
hot pasteles from the occupants. Christmas Eve, Examples of nonreligious events include the
Noche Buena, includes Mass and a feast with day-long birthday open house on Curaao for
lechn asado (spit-roasted pig), morcillas, rice with friends, relatives, and acquaintances. Thanks-
pigeon peas, coquito (rum and coconut milk), and giving is observed in Puerto Rico. Turkey,
special desserts such as rice pudding and coconut stuffed with a Spanish-style meat filling, is the
custard. In the Dominican Republic a whole- main course. Rum cake (also known as black
roasted pig is also customary, served with rice cake) is a fruitcake specialty of the Caribbean,
and peas, and a salad. Cubans associate pasteles especially in Jamaica, where it is served at wed-
(large turnovers) or pastelitos (smaller turnovers) dings, Christmas, and other special occasions.
with the holidays as well, but make them with a Dominican cake, a citrus-flavored cake with a
dough that is similar to French puff-pastry, stuffed cooked pineapple filling, topped with a caramelized
with spicy meat or cheese fillings, or sweet fillings, sugar meringue, is popular in that nation for all
such as guava, mango, or coconut. holidays and events.
Puerto Ricans may sprinkle Traditionally, Sunday meals emphasize fresh foods, such as soup, are eaten in the evening.
sugar around their houses meats when available, especially beef or pork Although the specific classification of items varies
to ward off evil on Ao roasts. In the Dominican Republic lunch on Sunday from person to person, one guideline for Puerto
Nuevo (New Years Eve) and is very large and may last into the early evening. Ricans indicates bananas, coconuts, and most veg-
eat twelve grapes at mid-
On many islands Sundays are also times when etables are cold; chiles, garlic, chocolate, coffee,
night to bring prosperity.23
picnics are enjoyed, called da del campo (field evaporated milk and infant formula, and alcoholic
day) in Spanish-speaking nations. One dish often beverages are hot.47 Cool foods include fruit,
served is carne fiambre, a selection of cold cuts chicken, bacalao, whole milk, honey, onions, peas,
served with pickles, olives, and green salad.35, 52 and wheat. Excessive intake of cool or cold foods
can make a cold condition, such as a cough, develop
Etiquette. In Puerto Rico forks and knives are into a chronic illness, such as asthma.
held European stylethe fork in the left hand Pregnancy, defined as a hot condition by most
and the knife in the right hand with no switching Puerto Ricans, is a time when a hot-cold balance
hands for cutting food. This pattern is also the is practiced carefully, and hot foods are avoided.
norm in Cuba, though in the Dominican When infants suffer from hot ailments, including
Republic both European-style and American- diarrhea or rash, infant formula may be replaced
style use of utensils is accepted. In these nations with whole milk, or cooling ingredients such as
dishes are passed to the left, and when not eating, barley water, mannitol, or magnesium carbonate
hands should be kept visible, with the wrists rest- may be added to the formula. High-calorie tonics
ing on the edge of the table. In Puerto Rico it is (eggnogs and malts are popular types) are taken
impolite to start eating until a host says, Bon by some Puerto Ricans to stimulate the appetite
appetite! while in Cuba and the Dominican and provide strength or energy. These are consid-
Republic it is rude to eat before the host says, ered especially appropriate for pale children and
Buen provecho!35 for pregnant or postpartum women.
Food may be in short supply in some parts of Research with Dominican Americans suggests
the Caribbean, and respectful behavior is expected the use of hot-cold classifications for numerous
when eating. For example, in Cuba vegetables and conditions. Examples cited are excessive cold
fruits should not be consumed with the hands. In causing asthma and fibroids, whereas peri-
Puerto Rico food should not be wasted, and one menopausal hot flashes are a hot problem.6, 98
should not take more than one can eat. Home remedies given to children for asthma
include warming foods, such as oils (whale, cod
Therapeutic Uses of Food liver, almond, and castor), honey or royal jelly (bee
Some Caribbean Islanders adhere to a hot-cold larva food), onion, garlic, oregano, lemon, and aloe
classification system of diet and health similar vera juice. Beets combined with molasses are used
to that found in Mexico (see Chapter 9, on by traditional Dominican healers to treat fibroids
Mexican therapeutic uses of food). In addition (and may be used by some Caribbean Islanders
to the categories of hot and cold, Puerto Ricans to lower blood pressure or treat arthritis and
add cool. Imbalances in hot and coldfor ulcers).28, 38 Research on Dominican mothers sug-
example, sitting in the shade of a tree after being gests that nutritional practices during lactation
out in the suncan cause illness even years may sometimes include avoidance of certain pro-
after the imbalance has occurred.106 Haitians tein foods and increased intake of fluids such as
believe that women are warmer than men and malt beer, milk, orange juice, chocolate milk, and
that a person cools as he or she ages.66 Among noodle soup.101 Formula may be withheld from
Caribbean Islanders, it is mostly Puerto Ricans, sick infants and tea provided instead.
Dominicans, and Haitians who follow dietary Haitians apply the hot-cold theory, including
and disease hot-cold classifications, and only the heavy-light categories, to a broader number
small numbers are strict adherents. of conditions impacting health. A persons life cycle,
The hot-cold theory of foods practiced in the a womans reproductive cycle, the climate, and
Caribbean sometimes includes not only the cate- the time of day are categorized, and must be bal-
gory of cool foods, but also those considered anced to maintain health.79 For example, heavy
heavy or light. A balance of hot-cold elements is foods should be eaten in the morning, and light
attempted at meals, and heavy foods, such as foods in the evening. Environmental forces (such
starches, are consumed during the day, while light as wind, or seeing a lightening strike) and social
interactions can disrupt equilibrium and result in readily available through Puerto Rican and Cuban- Marijuana may be smoked,
illness. Women and their newborn infants may American markets. Cubans, for example, may added to foods, or prepared
spend the first month after birth in seclusion to consider drinking strong coffee a way to maintain as a tea to treat conditions
avoid excessive chilling. their ethnic identity; by comparison, Americans such as asthma, vision
problems, and diabetes in
Therapeutic use of food is not limited to balanc- drink weak coffee.90 Changes do occur, however,
Jamaica.
ing hot-cold conditions. Some Haitians believe that as immigrants settle into culturally mixed commu-
certain illnesses in infants can be caused if a nurs- nities and children grow up as Americans. Rum was believed to cure
ing mothers milk is too thick or too thin. Further, Little current data on Caribbean Islander food many types of disease and
if a woman is frightened while breast feeding, her habits in the United States are available. One older injury in the seventeenth
milk goes to her head, causing a headache in her study compared the diet of three groups of women and eighteenth centuries.
and diarrhea in the baby. Gaz, another condition, from Puerto Rico: (1) those living in New York As late as 1892 a physician
causes pain in the shoulders, back, legs, or appen- (forward migrants), (2) those who had lived on prescribed Cuban rum for
dix, and headaches, stomachaches, or anemia. the mainland but later returned to the island the six-year-old future king
Foods such as corn or a tea made from garlic, (return migrants), and (3) those who never lived of Spain when he suffered
cloves, and mint are home remedies for gaz.113 on the mainland (nonmigrants). It was found from a fever. The royal
family was so impressed by
Other Caribbean Islanders, including Cubans, that nonmigrants and return migrants ate more
his quick recuperation that
do not generally subscribe to the hot-cold theory starchy vegetables, sugar, and sweetened foods they granted the maker of
but often use food-based home remedies.28, 94 One than did forward migrants. Forward migrants ate the rum, the Bacardi family,
study of Hispanics in the Miami area reported a greater variety of foods, including more beef, the right to use the Spanish
75 percent had used herbal cures during the previ- eggs, bread, fresh fruit, and leafy green vegeta- coat of arms on their label.
ous twelve months. Cubans reportedly use grape- bles. Puerto Rican women who had lived on the
fruit and garlic for hypertension, chayote to calm mainland quickly reverted to their traditional
nerves, and beets to treat anemia and flu. Star food habits when they returned to the island.54
anise tea is consumed to relieve intestinal pain and Recent research on Afro-Caribbean immigrants
flatulence in adults and colic in infants. Other teas (mostly Jamaicans) in Great Britain found that
used for stomach aches include those made with traditional items such as fish (boiled, baked, or
aloe vera or spearmint. Teas with cinnamon, sour fried), chicken (fried, roast, or curried), home-
orange, or honey and lemon are used for colds and made soups, rice and peas, plain rice, and boiled
coughs. Cinnamon tea is also believed useful for potatoes were consumed by respondents several
menstrual cramps. Gastrointestinal parasites are times each week. However, some foods, including
treated with pumpkin seed tea. Linden leaf, also patties, salt cod fritters, akee and salt cod, callaloo,
popular, is used for anxiety.88, 94 breadfruit, and cassava were consumed infre-
Some non-Hispanic Caribbean Islanders quently. Few Western foods were popular: eighty-
believe cassava helps prevent heart disease and three percent ate hamburgers less than once a
cancer. Plantains are also used to decrease the risk month, and similar numbers reported rarely eating
of heart disease, as well as for treating hyperten- pizza, pasta, butter, and margarine.103
sion, ulcers, and constipation. Teas are used for
many ailments, including lemon grass tea for fever, Ingredients and Common Foods. Research on
and ginger tea for indigestion and flatulence the food habits of Caribbean immigrants in the
(ginger may also be added to rum for diabetes). United States is limited. It is thought that rice,
Cerasse tea, made from Asian bitter melon (which beans, starchy vegetables, sofrito, and bacalao
has hypotensive properties), may be consumed to remain the basis of the daily diet of many Puerto
lower blood sugar levels, and wild sage (ma Bbzou) Ricans who live on the mainland. Poultry is used
tea is also used to treat diabetes.28 when possible, and egg intake decreases. Because
of Cuban Americans greater discretionary income,
CONTEMPORARY FOOD HABITS IN THE their diet usually includes additional foods, such
UNITED STATES as more pork and beef. Recent poorer immigrants
from Cuba, including the marielitos, are more
Adaptations of Food Habits restricted in what foods they purchase, however,
Traditional food habits are easily maintained in the and may follow a diet that is closer to the subsis-
self-sustaining immigrant communities of Spanish tence-level Puerto Rican regimen.
Harlem in New York City and Little Havana in An older study of Puerto Rican teenagers in
Miami. Ingredients for Caribbean cuisine are New York found that, consistent with traditional
food habits, there is little diversity of food items New York City suggest that some traditional
in their diet.29 However, in another study, Puerto dietary practices are discontinued; for example,
Rican women on the mainland were reported to eat the main meal is eaten in the evening instead of at
a greater variety of foods than those on the island.54 noon. Although some Haitians adhere to hot-cold
According to marketing studies, Caribbean classifications of food, they may differ from those
Islanders accept some American foods, especially used in Haiti.66
convenience items, and purchase frozen and One older study reported that many low-
dehydrated products when they can afford to do income Latina women living in New York did not
so. The proportion of meat in the diet often plan menus far in advance and that this hampered
increases on the mainland, as does the consump- their ability to add variety to their diets.45 It
tion of milk (and other dairy foods) and soft was found that food shopping serves as a social
drinks.18, 47, 101 Intake of leafy vegetables continues occasion for many of the women and is one of
to be low. Local fruits often replace the tropical the few opportunities they have to get out of the
fruits of Puerto Rico. house; thus they may go to the grocery store more
More recent data regarding Dominicans in the often than is really necessary. The investigators
United States indicate that only small changes reported that nearly half of the women questioned
have occurred in consumption patterns. Protein preferred to fry main dishes. Boiling was the
and fat intake has increased slightly, mostly due second choice, baking third. Broiling food was a
to eating more meat, while carbohydrate intake distant fourth choice. The researchers noted that
has decreased. Dominican women reported that in many low-income households the oven or broiler
their diet was more varied and abundant than in element may not work, restricting food prepara-
their homeland.101 tion methods to frying and boiling.
In a study of elderly Cubans A study of Hispanics over the age of fifty-five
living in the United States, in Massachusetts, including Dominicans, Puerto Special Occasions. It is assumed that many
it was found that conven- Ricans, and other Latino groups, made dietary Caribbean Islander holiday food traditions are
ience items were some- comparisons among less-acculturated Hispanics, retained after immigration to the United States.
times used to prepare more-acculturated Hispanics, and non-Hispanic Several events have been added to the annual cal-
traditional foods: aluminum
whites. It was found that rice was the major endar, however, often featuring traditional foods
foil in place of banana and music of the region. One of the largest is the
leaves for tamales and contributor of energy for both groups of Hispanics,
compared to bread for non-Hispanic whites. But West Indian Carnival that has been held annually
packaged crescent rolls for for over sixty-five years in New York City. The
pastele dough.90 Hispanics who had lived in the United States for
at least twenty years had macronutrient pro- carnival celebrates the cultures of the Caribbean,
files closer to non-Hispanic whites than to less- featuring an enormous parade, music competi-
tions, and street vendors selling items such as
acculturated Hispanics, with a lower consumption
curried goat and Jamaican jerk barbecue. In June,
of complex carbohydrates and an increased con-
cities with large Puerto Rican populations often
sumption of simple sugars.7
host Puerto Rican Day parades. The Dominican
Meal Composition and Cycle. The meals of Day Parade is held every August in New York City.
Puerto Ricans residing on the mainland are similar Major reggae music festivals with ample Caribbean
to those of people on the island, with a few food are held throughout the United States on
changes. A light breakfast of bread and coffee February 6Bob Marleys birthday.
may be followed by a light lunch of rice and beans
or a starchy vegetable, with or without bacalao. Nutritional Status
Often this traditional midday meal becomes a Nutritional Intake. There is limited information
sandwich and soft drink, however. A late dinner on the nutritional status of Caribbean-American
consists of rice, beans, starchy vegetable, meat if immigrants to the United States. The few studies
In Haiti protein foods are
available, or soup. Salad is included in some homes. available suggest several health trends in these
served first to the father in
the household; leftovers go Many researchers have reported an increase in the immigrants that have important nutritional
to the wife and children. amount of snacking between meals, mostly on implications. Health disparities for Hispanics
This pattern is believed to high-calorie foods with little nutritional value.47, 101 compared to the general population have been
continue in Haitian- Dominicans have started eating lighter reported, including lower rates of preventative
American homes. lunches.101 Interviews with Haitians living in care (such as inoculations and screenings) and
health care insurance coverage, and higher rates of Recent data on breast feeding practices are A study of Latina mothers in
risk factors.14 More specifically, disparities among limited. One anecdotal report on Puerto Rican Connecticut found embar-
different Caribbean Islander groups have been women states that breast feeding is common.23 rassment in public was the
identified. In general, Puerto Ricans have the worst However, earlier studies found breast feeding primary reason for early ces-
health indicators and Cubans have the best.46 infrequent among Puerto Rican, Cuban, and sation of breast feeding.107
Differences among Puerto Ricans have also been Haitian women in the United States, and in a
reported between those living on the mainland more recent study, overweight Hispanic women
and those living in Puerto Rico, with those living in New York were found less likely to initiate and
on the mainland experiencing more physical more likely to discontinue breast feeding than
illness and having less access to health care.50 lower-weight women. This finding is significant
Low socioeconomic and education levels are when obesity rates in this population are con-
often associated with some disparities.8, 44, 46 In sidered (see below).62 Those few who started
a study of elders finding chronic health condi- breast feeding often switched to bottle feeding
tions, such as disability and diabetes, more after two to four weeks. Whole milk, condensed
prevalent in Puerto Ricans than in whites living milk, and evaporated milk were frequently fed to
in the same neighborhoods, the researchers infants, as were juices. Solid food typically was
hypothesized that physiological responses to life introduced at a young age.25, 63
stress may be mediated by nutritional status, par- When the traditional Caribbean diet is limited
ticularly intake of B vitamins and antioxidants, because of low income, it inevitably results in low
and that this may account for some of the differ- intake of many vitamins and minerals. The empha-
ence in Puerto Ricans.112 sis on carbohydrates and vegetable protein, with a
Mortality data suggest that though Puerto low consumption of leafy vegetables and often fruit,
Rican and Cuban men have lower overall rates provides inadequate intake of calories, vitamins A
compared to whites, younger men die in dispro- and C, iron, and calcium. An older study indicated
portionately higher numbers (often due to prevent- that the only foods consumed by at least one-half of
able causes). Among Puerto Ricans, those who are recent Cuban immigrants were eggs, rice, bread,
born in Puerto Rico have lower mortality rates than legumes, lard and oils, sugar, and crackers.41 Of the
those born on the mainland.53 same group, 79 to 100 percent reported never
Nearly 10 percent of Puerto Rican infants born eating leafy green vegetables or fresh fruits. Dietary
on the mainland are of low birth weight, and over variety and micronutrient content were found
13 percent are born preterm. These factors con- low in Puerto Ricans and Dominicans living in
tribute to a high infant mortality rate. Nationally, Massachusetts.7 Other broader studies of Hispanics
infant mortality rates for Puerto Ricans living on in New York and Boston suggest higher rates of
the mainland are 40 percent higher than for whites, fruit and vegetable intake, but still below national
and one earlier study of Puerto Ricans in New and state norms.70 Deficiencies of B1, B12, folate,
York reported an infant mortality rate 70 percent and sulfur amino acids have been reported.1 One
higher than that of the total population. Risk study of Puerto Rican and Dominican elders found
factors including poverty, young maternal age, that the high prevalence of B12 deficiency was due
low educational attainment, and inadequate to insufficient intake, and that supplementation or
prenatal care are positively correlated with these frequent consumption of fortified cereals reduced
figures.15, 115 The numbers for low birth weight, the risk of insufficiency.65 Low iron intake among
preterm delivery, and infant mortality are even African-Caribbean Islanders has been reported in
higher in Puerto Rico; however, one study found Great Britain.118 Anthropometric measurements
recent arrivals from the island had lower infant and physical observation suggested that 20 percent
mortality rates than Puerto Ricans who had lived of the children under fifteen years of age showed
for an extended period on the mainland.68 High signs of malnutrition, 37 percent of the men and
rates (8.2%) of low-birth-weight infants have 17 percent of the women had adipose tissue
also been reported in the Haitian-American measurements consistent with adult marasmus,
community, associated with hypertension and and 12 percent of the immigrants suffered from
preeclampsia.86 In contrast, the infant mortality anemia. Evidence from a Florida study suggests
rate of Cuban-American babies is well below the many recent immigrants, especially refugees from
national average. Haiti, are malnourished.25
Many native Puerto Ricans suffer from parasitic that suggested a high risk for overweight among
diseases, including dysentery, malaria, hookworm, Puerto Rican populations with low energy con-
filariasis, and schistosomiasis. Older studies found sumption.45, 54 Low levels of physical activity70 and
as many as one-third of Puerto Rican school chil- cultural norms regarding weight and health may
dren in New York City were found to be infected be significant factors of being overweight among
with parasites,47 and it is believed that 60 percent Caribbean Islanders. Puerto Ricans, Cubans, and
of the rural population in Cuba has also contracted Haitians often associate well-being with being
parasitic illnesses. A study of children from Cuba gordita, or a little fat. This is particularly true for
found 19 percent tested positive for intestinal par- children, even when a thinner body ideal is desired
asites, and suggested rates may be much higher.31 by mothers.22 Thinness is thought by some
Further, 23 percent of these children had elevated Caribbean Islanders to be indicative of poor health
blood lead levels. Puerto Rican children living in due to emotional or psychological conditions.21, 66
New York City have also been found to be at high Some researchers have found heritability is
risk for lead toxicity.13 These conditions can involved in the development of the clustering of
contribute to general poor health and nutritional health characteristics (including obesity/waist
deficiencies among poorer immigrants. circumference, insulin resistance, hypertension,
In contrast to the malnutrition evident in some and dyslipidemia) known as metabolic syndrome
areas of Puerto Rico and Cuba, some studies sug- in Caribbean-Hispanic families.72 Persons with
gest rates of overweight and obesity are higher metabolic syndrome are at increased risk for type
than national or state averages in some Caribbean 2 diabetes and cardiovascular disease. Studies
IslanderAmerican populations. Data suggest that indicate that the prevalence of type 2 diabetes
64 percent of Puerto Rican men are overweight mellitus is two to three times higher among Puerto
and obese (with obesity rates of 19 to 29 percent), Ricans and Dominicans than among whites; Cuban
and 59 percent of women are overweight and Americans develop the condition at rates slightly
obese (with obesity rates ranging from 24 to higher than whites.17, 20, 50 African-Caribbean
40 percent).24, 33, 50 Overweight and obesity in women also developed impaired glucose metabo-
Cuban Americas is reportedly 70 percent of men lism at rates nearly double those for white women
(with obesity approximately 20 percent) and after gestational diabetes in one study (50% and
60 percent of women (with obesity estimated 28%, respectively).64 Rates of renal failure due to
at just over 20 percent).24 Among Hispanic ele- diabetes among men are reportedly higher for
mentary school students in New York City, both Hispanic blacks and Hispanic whites than
who are assumed to be primarily of Puerto Rican for non-Hispanic blacks and whites.19
and Dominican heritage, 31 percent were obese The prevalence of hypertension is similar
(BMI 95 percentile) compared to 20 percent of between Caribbean Islander Americans and
students overall,109 and Hispanic preschool chil- whites.2 Rates of mortality due to hypertension,
dren enrolled in New York City Women, Infants, however, vary between groups. Puerto Ricans have
and Children (WIC) programs were twice as the highest rates of all Latinos, approximately
likely as black children to be overweight.84 13 percent above whites. Higher rates of diabetes,
One study reported that Research on Puerto Rican and Dominican which is a risk factor for high blood pressure,
Haitian women had less elders found that obesity (as measured by BMI may be one reason for the discrepancy.2 In com-
visceral adipose tissue than and central waist circumference) was associated parison, Cuban Americans have the lowest rates,
white women with the with a traditional diet based on rice and beans 39 percent below those of whites. Deaths from
same waist circumference. and poultry and oil and that this diet was more hypertension are higher for men than for women
Ethnic-specific standards
prevalent among less acculturated subjects.71 In in all Hispanics. It has been noted that a high
may be needed to fully
contrast, studies of Puerto Rican women in prevalence of hypertension and intercranial
assess disease risk in this
population.27 Connecticut report factors associated with atherosclerosis, as well as high rates of noncom-
acculturation resulted in an approximately pliance regarding medications, is a contributing
54 percent increase in obesity.33, 49 Calorie and factor in strokes among black Caribbean
fat intake is reportedly high in many Caribbean Islanders in Miami.61 Though Hispanics overall
Islander groups.39, 112 Further, larger portion size experience cardiovascular disease at rates lower
has been noted in some research on Caribbean than the national average, there is some evidence
Islanders.103, 112 These data dispute older research that it may be higher than average among some
subpopulations, such as in Hispanic women between members of the same sex, who may hug The rates of type 1 diabetes
living in New York City. Heart disease is still the freely. Even if touching within a group is not in Puerto Rican children on
leading cause of death among Hispanics.70 direct, passing items (such as a piece of paper) the island are the highest of
Chronic liver disease and cirrhosis are from practitioner to client (or to every client in all children living in the
ranked as the sixth most common cause of a classroom situation) increases the personal Americas.
death among Hispanics. Men are more likely to connection.23 Direct eye contact is expected
Lactose intolerance is
drink heavily than women. Among Puerto throughout the Caribbean, with some variations. thought to be a problem
Rican men, 17 percent reported drinking one or Looking away suggests disrespect or dishonesty among many Caribbean
more ounces of alcohol each day; 9 percent of among Cubans; Dominicans maintain eye contact Islanders, although esti-
Cuban men have similar drinking habits.4 depending on the situation, and men are more mated incidence has not
Dental health is problematic for Puerto Ricans likely to look directly at one another than are been reported.
and Cuban Americans, who have higher rates of women; Haitians may avert their eyes from
filled cavities and missing teeth than do authority figures.
Mexican Americans. Puerto Ricans also have a Puerto Ricans are open about physical and
high prevalence of periodontal disease.56 emotional complaints, although they may hesitate
to ask questions because this might be interpreted
Counseling. Counseling Americans of Caribbean as disrespectful. Adequate time and consideration
descent is similar to counseling other Latino of symptoms are necessary for both diagnosis and
clients and patients (see Chapter 9) Language the client-provider relationship. High degrees of
problems may make interviews difficult, health modesty are found in both women and men, who
beliefs may differ from those of the provider, and may prefer health providers of the same gender. In
access to medical care may be limited. For example, contrast, Haitians may expect a quick physical
census figures show 93 percent of Dominicans examination (with a stethoscope) and a fast, accu-
speak Spanish at home, and 54 percent are not rate diagnosis. Lack of a prescription to address a
proficient in English.96 The idea that God or fate complaint may be seen as incompetence. Haitians
determines the outcome of illness may also inter- may also assume that men are physicians and
fere with seeking health care. For example, women are nurses.21
Puerto Ricans perceive diabetes as a chronic con- Puerto Ricans and Cubans are typically present
dition and believe that complications of the dis- oriented, and may have a relativistic view of time.
ease are unavoidable.12 One study found Puerto Flexible appointments and relaxed attitudes
Ricans in New York engaged in preventative regarding timeliness can help facilitate interactions
behaviors, such as getting vaccinations or choles- with these Caribbean Islanders. It has been sug-
terol testing, at rates below state averages.51 gested that time limitations should be explained at
Illness may be viewed as a sign of personal weak- the outset of the appointment so clients know what
ness among Haitians, revealed only to family to expect.35, 59, 94
members for as long as possible. In addition, A few traditional Puerto Rican hot-cold prac-
some Haitians may believe that supernatural ill- tices may be problematic. Pregnant women may
ness is worsened if biomedical treatment is used avoid iron supplements, which are classified as
and may delay seeking care until very ill.21 Lack hot. Infant formula diluted with mannitol or mag-
of health insurance coverage varies among nesium carbonate to cool it (see Therapeutic Uses
Caribbean Islander groups. Only 50 percent of of Foods section) may cause diarrhea in infants.
Haitian immigrants in one study had coverage,100 A mother may cool a hot medication, such as vita-
with rates of coverage for Puerto Ricans esti- mins or aspirin, by providing a cool beverage with
mated at 82 to 86 percent, and for Cubans, 71 to it, possibly fruit juice or milk of magnesia.47
76 percent.36, 83, 111 Puerto Ricans also may interpret high blood pres-
Caribbean Islanders use an expressive conver- sure as being too much blood or thick blood; con-
sational style. Respect and politeness are prac- versely, low blood pressure means weak blood or
ticed, but it is not considered rude to interrupt a anemia. Hypertension may be treated with herbal
speaker. Periods of silence are uncommon.35 teas.116 Some Puerto Ricans believe that ulcers
Shaking hands in greeting and in leaving is cus- lead to cancer.
tomary, firmly between men, and less vigorously A study of Long Island Cuban Americans
with women. Touching is very common, especially showed that 20 percent acknowledged some degree
of belief in santeria. Some Dominicans believe that used by Dominicans during a medical crisis.
biomedicine is not responsive to their spiritual and As soon as symptoms subsided, the prescription
emotional needs and that traditional healers pro- therapies were replaced with home remedies.
vide the treatments needed to address all aspects Dominicans often express concern about taking
of illness.74 Estimates of espirito and santero use chemicals and worry that biomedical prescrip-
vary considerably, from 1 to 23 percent.12, 94 Many tions cause addiction and serious side effects.6, 98
people who use traditional folk healing practices In addition, sharing prescription medications
and practitioners may be unwilling to admit to with family members or friends is common
these folk practices or use them only in time among Americans of Cuban, Dominican, and
of stress.90 Haitian heritage.21, 94, 98 Some Haitians reportedly
The Centers for Disease Biomedical prescriptions may also present have difficulty with dietary compliance.66
Control and Prevention difficulties. Many medications available only by Research on a diverse group of Latinos in New
issued a warning about a prescription in the United States are readily avail- York reported that physicians were the primary
Dominican product used as able over the counter or through the black market source of health care information, followed by tele-
an antiperspirant, and to in Latin American countries. Overuse, inappro- vision. Radio was a source for a small percentage of
treat burns and foot fungus.
priate use, and addiction can occur. For example, respondents, particularly Haitians.87 Educational
Litargirio (also called
litharge), a yellow or peach-
one study found that New York Latinos did not programs with Puerto Ricans may be more suc-
colored powder, has been understand that antibiotics are useful only for cessful if a respected member of the community is
shown to cause lead toxicity certain infectious conditions, and they were enlisted in support of the project, and women often
in children who use it.16 obtained without prescription to treat pain. A respond better if men in the family approve of
study regarding Metamizole (dypyrone), a toxic their participation.23 Caribbean Islanders are high
nonsteroidal anti-inflammatory drug banned in context communicators, and the relationship and
the United States, found that 28 percent of process are as important as the results.35
Hispanics surveyed in Miami had purchased it in A Caribbean Islander client may be of African,
their homelands, and 13 percent had used it in the Asian, European, or Indian descent; however, the
previous year.40, 69, 93 Another study found that island of origin is equally important in determin-
medications for chronic conditions were only ing ethnic identity and diet. A black from Puerto
Rico, for example, is more likely to eat Latino
foods than African dishes or soul food. Early
researchers working with low-income Latinas
NEW AMERICAN PERSPECTIVESPuerto Rican and black women in New York recommended
that significant attention be placed on the clients
socioeconomic status, a suggestion still valid
Paula Velazquez
today.45 Diet therapy for a poor Puerto Rican
was born and raised in Puerto Rico and came to the United States immigrant is likely to require a different approach
I when I was thirteen years old. In Puerto Rico I grew up on a farm, and
my diet included rice and beans and products that we grew, such as
fresh green bananas, sweet potatoes, and plantains. When my parents
than that for a wealthy Cuban immigrant within
the context of the basic Caribbean cuisine. An in-
depth interview should be conducted with each
went to town to shop, that was when we ate meat and bread. Once a year client of Caribbean descent to establish country
we had pork for Christmas and turkey for Thanksgiving because these ani- of origin and ethnic identity. The clients degree of
mals were raised by my parents for the holidays. My sister still owns the acculturation, socioeconomic status, use of tradi-
farm, and I try to get back for visits. tional heath practices, and personal food prefer-
Here in the United States I live with my aunt and uncle, and their diet ences also should be determined.
is high in meat, vegetables, and healthyfoods. They are in their eighties
and still very healthy. The food that made the biggest impression on me
when I came to the U.S. was mashed potatoes. I had never seen or eaten
mashed potatoes, and it took me a while before I would even try them. South Americans
The second thing was having meat every daythat was really a treat.
However, my favorite foods are bread and then the vegetables. I like all South America is a vast land that features the
kinds of seafood. I will eat seafood rather than meat. Meat I could give up rugged ridge of the Andes Mountains stretching
but not bread and vegetables. from north to south. Highland plains, tropical
rainforests, temperate valleys, and desert dunes
extend from where the mountain peaks slope Census estimates, many South American popula-
toward the coastal edges of the continent. tions have almost doubled since 2000. There were
Extremes in the terrain and climate limit agricul- approximately 730,500 Americans of Colombian
ture in many areas. The continent contains twelve ancestry, 436,000 from Ecuador, 412,000 from
independent nations: Argentina, Brazil, Bolivia, Peru, 204,000 from Guyana, 303,500 from Brazil,
Chile, Colombia, Ecuador, Guyana, Paraguay, 186,000 from Argentina, 102,000 from Chile,
Peru, Suriname, Uruguay, and Venezuela. In 164,000 from Venezuela, 65,500 from Bolivia,
addition, France retains control of the territory 60,000 from Uruguay, 15,000 from Paraguay, and
called French Guyana, and Great Britain claims 74,500 listed as Other South American. Some
the Falkland Islands. population experts believe that South Americans
Numerous native Indian groups populated the are seriously undercounted in the United States.
continent prior to settlement by the Europeans. Many are unauthorized residents, overstaying their
Although the Spanish were the first to arrive, sig- visas, obtaining falsified documents, or entering
nificant numbers of Portuguese, Italians, and via Mexico or Puerto Rico. There may be more than
Germans also settled in South America. Forced 350,000 uncounted Brazilians57 and more than
labor from West Africa introduced blacks to the 300,000 unauthorized Ecuadorans living in the
continent, followed by Asian-Indian workers after United States.81
slavery was outlawed. Indian and mixed Indian- Most South Americans settle in the Northeast, When Chileans came to San
European populations live in the tropical highlands, especially New York and New Jersey. In New York Francisco to participate in
Creoles (descendants of the Europeans) have con- City, Colombians, Ecuadorans, and Peruvians have the gold rush of the mid-
centrated in the southern, temperate regions of established ethnic enclaves in Queens, and Little nineteenth century, they
the continent, and parts of northeastern Brazil are Brazils are found in both Queens and Manhattan. established a community
populated primarily by blacks and mulatto black called Chilecito, complete
Miami and Los Angeles also host large South
Europeans. In more recent times, Japanese immi- with its own newspaper. In
American populations from most nations. In addi-
the smaller mining towns,
gration to South America has become notable. tion, Brazilians are found in Pennsylvania and Chileans lived together in
Washington, DC; Chileans have settled in Texas; Chilitowns where they
CULTURAL PERSPECTIVE Colombians have clustered in Stamford, Con- spoke Spanish and cooked
necticut, the urban areas of Illinois, and California; traditional meals.
History of South Americans and Peruvian neighborhoods have developed in
in the United States Houston, Chicago, and Washington, DC.
Immigration Patterns. The first documented Most South American immigrants are proud
South Americans in the United States were Chileans of their heritage and differentiate themselves
who came to California to participate in the gold from Americans of Mexican, Caribbean, or Central
rush. It is believed that several thousand worked American background. Brazilians in particular
in the mines. Approximately half returned to Chile, resent being mistaken as Hispanics who speak
and those who remained quickly intermarried Spanish (Portuguese is their official language).
and were absorbed into the general population. Some South Americans suffer from discrimina-
Prior to the 1960s, all South American immigrants tion directed toward Mexican Americans or Latinos Several thousand Chinese
were counted as Other Hispanics in the U.S. Census. in general. Others, who are mostly of European Ecuadorans (approximately
Specific figures regarding the individual nations heritage, are not recognized as Latinos but may 1 percent of the total
before this time are uncertain but are thought to be continue the prejudices between some South Ecuadoran-American popu-
minimal. Most South American immigration has Americans. For example, there may be lingering lation) live in New York,
occurred in the past twenty years during periods hostilities between Bolivians and Chileans. where they settle mainly in
of land reform, economic hardship, or political Latino neighborhoods,
Second- and third-generation South Americans
repression. Jobs and educational opportunities are speaking mostly Spanish
often leave homogeneous neighborhoods and and some Chinese.
the primary attractions for the majority of immi- relocate into mixed communities.
grants, though significant numbers of political
Canada offered special
exiles are from Argentina and Chile. Socioeconomic Status. Few data are available on entry to Chileans seeking
the socioeconomic status of Americans of South political exile in the 1970s
Current Demographics. South Americans American descent who have lived in the United and 1980s, so large popula-
accounted for only 5 percent of Latinos in the States for extended periods. Most data are related tions are found in Toronto
United States in 2005. Yet according to U.S. to foreign-born immigrants who have come in and Montreal.
the past twenty-five years. Regardless of arrival one-third of Brazilians reported working in the
date, a majority of immigrants from South America service industry, and there were more Brazilian
come to the United States in search of employ- families living in poverty than the national aver-
ment opportunities. Many are well-educated age. Data on unauthorized Brazilian workers
professionals; however, they sometimes find that indicate that men find employment in restau-
their credentials are not accepted after arrival, rants, construction, and as street vendors or shoe
forcing them to accept positions in the sales, shiners. Women tend to work in cleaning jobs or
service, trade, and labor fields, such as restaurant child care.77
work, construction, child care, or textile and Census data show that foreign-born Argen-
garment industry jobs. It is believed that many tineans, Bolivians, and Chileans in the United
second- and third-generation Americans of South States have also arrived with high levels of educa-
American ancestry obtain advanced education tional attainment.114 Though some professionals
and work in professional occupations. must sometimes accept jobs below their skill
Foreign-born Columbians arrive in the United levels,11, 30, 99 family poverty rates are very low in
States with overall education levels slightly lower these populations.114 Over forty percent of foreign-
than the U.S. average, though some are profes- born Venezuelans have obtained a college degree.
sionals with college degrees who hope to find Forty percent work in professional or manage-
employment commensurate with their skills.114 ment careers,114 particularly in the oil industry,
Many Columbians have been successful as entre- banking, and in media, such as publishing, radio,
preneurs,108 and others have found employment and television.119 Despite this success, the per-
in management, the education, health, and social centage of families living in poverty is near the
services fields, the service industry, in manufac- national average. Foreign-born Paraguayans who
turing, and in sales. However, slightly higher num- live in urban areas typically find jobs in the serv-
bers of Columbians live in poverty than the U.S. ice industry. Women often work in hotel house-
average. Most Ecuadorans who come to the keeping. Some men have found employment in
United States are from the working class,81 and agriculture, settling in California or Kansas.80
nearly 40 percent of foreign-born immigrants do Uruguayans who come to the United States are
not have a high school education.114 Many work either middle-class professionals or blue-collar
A large number of costeo in the service industry and manufacturing, and workers who held jobs in their homeland as
immigrants from the coastal the percentage of families who live in poverty is skilled or unskilled laborers.105 Thirty percent are
regions of Colombia have above the national average. Yet, some Ecuadorans employed in management and professional
settled in Chicago. Costeos have found success founding restaurants, travel careers, and larger numbers work in sales, office
are typically well educated, offices, and other services. Family poverty rates are jobs, and the service industry.
often holding professional more than 20 percent above the U.S. average.
degrees in medicine, engi- Though over 40 percent of Peruvians hold Worldview
neering, accounting, and
agricultural, fishing, and farming jobs in their Religion. South Americans are overwhelmingly
architecture.108
homeland,89 nearly three-quarters of foreign-born Roman Catholic, a legacy of the European conquest.
Among the most visible immigrants have found employment in manage- In most nations approximately 90 to 95 percent of
South American immigrants ment and professional occupations, in the service the population is a member of the Catholic Church,
are the Otaveleo Indians industry, and in sales or office work.114 Those from and its influence is seen in many South American
of Ecuador. Colorful wool Guyana have also obtained jobs in those fields, institutions. The constitution of Argentina offers
clothing and blankets are with over 30 percent employed in sales and office protections for Catholicism, and in Ecuador politi-
exported throughout the work. Nursing is a preferred field for some Afro- cal leadership is established through sponsorship
Americas, and itinerant Guyanese women.78 Family poverty rates are much of local fiestas in honor of the saints. The Catholic
Otaveleo salespeople lower than the national average for both groups.114 faith is taught in Peruvian public schools.
travel to major cities to
Foreign-born Brazilians arrive with high levels In some regions the practice of Catholicism is
promote the products. The
street vendors wear tradi-
of education, and they have occupational success often blended with other belief systems. In Peru,
tional Indian apparel, often as a group, taking jobs in management, technical Incan gods may be included in Catholic rites, for
operating illegally, and fields, the service industry, sales, and as manu- example, and in Venezuela the Cult of Maria Lionza
after a period of time return facturing operators or fabricators.114 However, mixes indigenous, Catholic, and African practices.
to Ecuador to attend college census data suggest that there are some immi- Religious syncretism is greatest in Brazil. Spiritism,
or begin a career.81 grants who are not doing as well. In 2000, almost which was imported from France originally,
combines Christian precepts with scientific prin- by a Colombian priest. A majority of Guyanese
cipals. Popular with the upper middle class of the Americans belong to an Episcopal church headed
country, adherents communicate with the dead by a Guyanese priest and often also send their
through spiritual mediums. Umbanda is very children to church-run schools with Guyanese
common in rural areas and among the urban teachers. In addition, Some Guyanese Americans
poor, combining several Afro-Brazilian faiths frequent Unity Centers, which function as com-
with spiritism and the idea of Christian charity. munity centers and promote spirituality but are
Candombl is probably the best known of the not affiliated with any organized religion.78 As
mixed religions, an Afro-Brazilian faith founded many as one-third of Ecuadoran Americans
by blacks in the Bahia region that is now prac- belong to Protestant denominations.81 How many
ticed nationwide by followers of all ethnicities.117 South Americans who come to the United States
African-derived beliefs dealing with earthly mat- and practice blended religions is unknown.
ters such as health and wealth are combined with
Family. Family life is important in all South
Catholic cosmology. Yoruba deities called orix
American societies. In Argentina, Spanish and
or orisha are venerated with rites of worship that
Italian traditions have shaped family structure.
include animal sacrifice, feasting, and dancing. The extended family usually gathers together at
Over twenty orixs are recognized in Brazil and least once a week and on holidays as well.
most are correlated with a Catholic entity: Oxal, Grandparents are involved in most family deci-
god of creation, with Jesus Christ; Ex, the mes- sions, and children often stay at home until mar-
senger god, with the devil; Ogun, god of war and riage. In Brazil extended family members typically
iron-craft, with St. Anthony or St. George; Oxoosi, live close to one another, and daily visits are
god of affluence, with St. Sebastian; Omolu, god of common. Relatives mentor children through rites
plagues and illness, with St. Lazarus; and Oxum, of passage such as confirmation, graduation, the
the fertility goddess (also called the goddess of start of a career, and marriage.
vanity), with the Virgin Mary. Each orix is associ- The father is the head of the household in
ated with certain personality traits, day of the week, Chilean homes, but the mother makes all deci-
color, plants, animals, foods, and drinks; and each sions regarding the family. In Colombia the father
person has an orix owner of his or her head who holds all authority, and children are taught to obey
influences individual temperament and behavior. their parents. Ecuadoran families follow two
Protestant missionaries were active in South models: Spanish-influenced families are ruled by Agnosticism is prevalent
America during the twentieth century and were the father, who has few responsibilities to the home in some Peruvian cities,
especially successful in Guyana, where a majority especially among the
other than financial support; in Indian-influenced
of Guyanese attend the Episcopal church, and well-educated elite.89
families, the father and mother share more power
in Ecuador, where in some regions as many as and household responsibilities. In Peru extended
40 percent practice some Protestant faith. In Brazil families typically include godparents, who sponsor
the Baptist, Pentecostal, Seventh-Day Adventist, baptisms and provide both social and economic
and Universalist denominations are most popular. assistance. Families are predominantly patriarchal,
Chilean Protestants are usually members of the though more so in the Spanish-speaking upper
Pentecostal or Seventh-day Adventist churches, and middle classes than in poor, rural Indian
though those of German ancestry often follow the homes. In contrast to most of South America, the
Lutheran or Baptist faiths. Small numbers of Jews Venezuelan family has changed rapidly in the past
and Buddhists are also found in South America, in decades due to increased national prosperity.
total less than 1 percent of the population together. Much of the population has relocated to urban
Most South Americans who emigrate to the centers. Many families have declined in size, and
United States are Roman Catholic and very the extended family is less common.
involved with their local parish. In some areas, In many areas of South America it is unac-
particularly the Bronx in New York City, tension ceptable for women to work outside the home.
between parishioners of Irish or Italian descent Even those with a profession traditionally stay at
and South American immigrants caused the home after marriage. Among some Indian groups,
South Americans to leave the traditional Roman however, women contribute to the well-being of
Catholic faith. Colombians, for instance, formed the family through farm work, and in the urban
a church based on charismatic Catholicism led areas of Venezuela many women have outside
jobs but remain responsible for household chores. prohibitions of ones orix, including certain food
In Chile women are usually involved in local and beverages, colors, therapeutic herbs, beaded
social and political issues. necklaces, and other limitations. The priest or
Most South Americans prefer to immigrate as priestess also serves as the local curendiero, diag-
family groups, though financial pressures often nosing physical and spiritual problems, prescrib-
demand that a single family member become estab- ing healing herbal baths or botanicals, and
lished in the United States before the rest of the manipulating occult forces. In Ecuador either a
family follows. Individual immigrants commonly healer, called a curandero, or a witchdoctor, called
move to neighborhoods where relatives, godpar- a brujo, treats many illnesses in small villages. In
ents, or friends have settled. They depend on these Peru urban residents typically obtain biomedical
contacts for housing and support. This system of health care, but in rural regions home remedies
mutual assistance is maintained after the immedi- and ritual magic are often preferred.89
ate family arrives, bringing more relatives into the Herbal teas are a favorite remedy throughout
extended family. Colombians and Ecuadorans often most of South America, where street stands and
broaden their relationships beyond national bound- small markets called yerbeteras sell medicinal
aries to form strong bonds with other Latinos. botanicals for home use.75 Numerous plants, many
Many families suffer from the stresses of unfamiliar in the United States, are used thera-
American informality and freedom. Men lose some peutically. Soursop leaves are used to treat diabetes,
authority over wives and children, and women and the seeds of the guaran are thought to relieve
find it difficult to adjust to working outside the fatigue and help with weight loss. Retained urine
home. Furthermore, many upper- and middle-class is treated with avocado leaves, and papaya leaves
women, who had paid help with the housework are considered useful in getting rid of intestinal
in South America, must learn to balance a job worms. Rue is taken for uterine pain and as an
with responsibility for running a home. abortive, and black nightshade is used for coughs.
Pau d arco, the bark of a tree native to Brazil,
Traditional Health Beliefs and Practices. There is widely used to treat rheumatism, diabetes, vene-
are few data available on how Americans of South real diseases, yeast infections, enlarged prostate,
American heritage maintain health or how they and several cancers.
approach illness. Brazilians often attribute bad
The candombl patus, health to liver problems or an imbalance between TRADITIONAL FOOD HABITS
amulet bags hung around hot and cold, such as drinking a glass of cold
the neck to ward off evil water on a hot day or taking a cool shower after Ingredients and Common Foods
(containing plant pieces, eating a hot meal. Many South Americans self- Staples. The cooking of South America is similar
sacred items, and devo- diagnose or seek health advice from their mothers to that of other Latin American regions in that it
tional writings), may have
or friends. They then visit a pharmacist where they combines some native ingredients and preparation
been introduced to Bahia
in the late nineteenth can purchase many medications, such as antibi- techniques with the foods of colonial Europeans.
century by black Muslims otics, by the pill. The diet is largely corn based and spiced with chile
who wore similar pouches Most Brazilians associate faith with health. pepper (see Table 10.2).Tomatoes are common,
that held inscriptions from Catholics may believe in fate and seek intervention and in tropical areas cassava (called yuca) is a
the Koran.117 from patron saints when ill. Spiritists employ popular tuber. Pumpkins, bananas, and plantains
homeopathy, exorcism, past-lives therapy, acupunc- are consumed often. Beef, rice, onions, and olive
ture, yoga therapy, and chromotherapy to cure oil, introduced by the Spanish and the Portuguese,
sickness.57 Followers of candombl believe that are eaten regularly. Tropical fruits, such as those
Coca leaves, the source of health is maintained by achieving balance between found in the Caribbean (see above), are plentiful
cocaine, are indigenous to the earthly and spiritual spheres. The pai-de-santo in many regions. However, South American fare
South America and were
or babalorix (high priest) or the me-de-santo or also features a number of ingredients used infre-
traditionally chewed for
ialorix (high priestess) may be hired to read the quently in the dishes of other Latin American
their stimulating proper-
ties. In Columbia a new car- oracle of a personal orix, for example, so that an areas. Potatoes, which were first cultivated by the
bonated soda made from individual can improve his or her relationship with Incas on mountain terraces, are particularly
the leaves, Coca Sek, was the deity.117 Harmonious relations with ones orix important in the highlands of Peru and Ecuador.
recently introduced as an can maximize ax (vital force). Spiritual equilibrium Sweet potatoes (the orange-fleshed root vegetable
alternative to colas. is maintained by observing the preferences and usually called yams in the United States) are also
Table 10.2 Cultural Food Groups: South Americans

Protein Foods
Milk/milk products Milk is not usually consumed as a beverage Cows, goats milk; evaporated milk; fresh and aged Available cheeses are sometimes substituted for
but used in fruit-based drinks and added cheeses unavailable traditional cheeses.
to coffee. Many milk-based desserts are
enjoyed.
Meat/poultry/fish/ Beef is a foundation of the diet in parts of Meat: alligator, armadillo, beef (including variety Less acceptable meats such as guinea pig may
eggs/legumes Argentina, Brazil, Paraguay, and cuts), capybara, frog, goat, guinea pig (cuy), iguana, no longer be eaten.
Uruguay. Some game meats are con- llama, mutton, pork, rabbit, tapir
sumed. Fish and seafood are significant Poultry: chicken, duck, turkey
in coastal regions, popular as ceviche in Fish and shellfish: abalone, bass, catfish, cod (including
Ecuador and Peru. Beans are commonly dried salt cod), crab, eel, haddock, lobster, oysters,
consumed. scallops, shrimp, squid, trout, tuna
Eggs: chicken, quail, turtle
Legumes: beans (black, cranberry, kidney), black-
eyed peas
Cereals/Grains Cuzcuz, made from cornmeal, is prepared in Amaranth, corn, rice, quinoa, wheat
parts of Brazil; arepa, cornmeal bread, is
staple in some areas. Pasta is popular in
Argentina, Paraguay, and Uruguay. Rice
and corn puddings are a favorite.
Fruits/Vegetables Tropical and temperate fruits are plentiful Fruits: Abiu, acerola, apples, banana/plantains,
and popular, added to savory and sweet cashew apple (caj), caimito, casimiroa, cherimoya,
dishes. Fruit compotes and fruit pastes custard apple, feijoa, guava, grapes, jackfruit,
are enjoyed. Potatoes are a staple in the jabitocaba, lemons, limes, lulo (naranjillo),
Andes. Cassava flour and meal are mammea, mango, melon, olives, oranges (sweet
common in many areas; tapioca is used and sour), palm fruits, papaya, passion fruit,
in desserts. peaches, pineapple, pitango, quince, raisins,
roseapple, sapote, soursop, sweetsop, strawberries,
sugar cane
Vegetables: abipa (jicama), arracacha (apio), avocado,
calabaza (green pumpkin), cassava (mandioca;
yuca), green peppers, hearts of palm, kale, okra,
oca, onions, roselle, squash (chayote, winter),
sweet potatoes, tomatoes, yacn, yams
Additional Foods
Seasonings Toasted cassava meal, farinha, is sprinkled Achiote, allspice, chiles (aji, malgueta, pimento),
over foods in Brazil. Spicy hot foods are cilantro, cinnamon, citrus juices (lemon, lime, and
preferred in many areas; salsas are sour orange), garlic, ginger root, oregano, paprika,
common. parsley, scallions, thyme, vinegar
Nuts/seeds Coconut and coconut milk are added to Brazil nuts, cashews, coconut, peanuts, pumpkin
numerous dishes. Peanut sauces flavored seeds
with chiles are common in the Andes.
Beverages Coffee is often served concentrated, then Batidas (tropical fruit juices, sometimes made with
diluted with evaporated milk or water. alcoholic beverages), coffee, guaran, soft drinks,
Mat is more popular than coffee or tea sugarcane juice, tea, yerba mat and alcoholic
in parts of Argentina, Brazil, and beverages: beer, cachaa (sugarcane brandy), pisco
Paraguay. (grape brandy), chicha (distilled corn liquor), wine
Fats/oils Dend oil flavors and colors many dishes in Dend (palm) oil, olive oil, butter Vegetable or peanut oil is substituted for
the Bahia region of Brazil. dend oil.
Sweeteners Sugar cane, brown sugar, honey
native to the region. A white root similar to a mild has the taste and texture of a sweet turnip) are
carrot, known as apio or arracacha, is found in commonly eaten raw and cooked in Bolivia,
Colombia, Peru, and Venezuela; oca (a tuber simi- Brazil, Colombia, Ecuador, and Peru; and the tuber
lar to the potato in appearance but with leaves known as ahipa (called jicama in the United States
like clover) and yacn (an elongated tuber that and Mexico) is native to the Amazon River basin.
Beans, a foundation food in many Latin and tomatoes is preferred for Venezuelan hallacas.
American regions, are common in most South A favorite in Argentina, Bolivia, Brazil, Chile, and
American countries yet not eaten at every meal. Ecuador are humitas, which feature fresh kernel
Other legumes and nuts, such as peanuts and or ground cornmeal dough wrapped around a
cashews, are used often in dishes. Indigenous variety of savory or sweet meat, fish, or vegetable
meats, including llama, deer, rabbit, wild pig, capy- fillings.
bara, tapir, and cuy (guinea pigs who are raised for
Regional Variations. National differences exist,
consumption), are consumed in some areas. Fish,
although there are few clearly distinctive divisions
such as anchovies and tuna, and shellfish, particu-
in South American fare. Several countries share
larly shrimp, crab, spiny lobster, oysters, clams,
similar dishes, and only a few nations have well-
giant sea urchins (evisos), and giant abalone
developed regional cuisines.
(locos), are significant foods in the extensive coastal
regions. Iguana is consumed occasionally, and alli- Peru and Ecuador. The cooking of Peru and
gator is a specialty in some areas. Ecuador is divided into the highland fare of the
A favorite way to prepare meats in South Andes and the lowland dishes of the tropical
America is grilling. Traditionally, sides of beef, coastal regions. The cuisine of the mountain areas
whole lambs, hogs, and kids (young goats) are is among the most unique in South America, pre-
hung over smoldering wood to slowly cook for serving many ingredients and dishes of the Inca
hours in a method called asado. Today a grill is Indians. Potatoes are eaten at nearly every meal
used more often. Steaks and marinated kebobs and often for snacks. Over one hundred varieties
(which often include organ meats) are favorites. are cultivated. Ocopa, boiled potatoes topped with
Another, even older cooking tradition is to steam cheese sauce and chile peppers or peanuts, is a
foods in a pit oven. In Peru this method is called typical dish in Peru. In Ecuador fried potato and
a pachamanca and typically includes a young pig cheese patties, called llapingachos, and potato
or goat with guinea pigs, chickens, tamales, pota- cheese soup served with slices of avocado, known
toes, and corn tucked around layers of hot stones as locro, are common. Traditionally the tubers are
and aromatic leaves and herbs.73 In Chile a curanto preserved by freezing in the cold night air and
is closer to an elaborate coastal clam bake, including then drying in the hot daytime sun. Papa seca are
shellfish, suckling pig, sausages, potato patties, boiled first and then dried until the potatoes are
peas, and beans layered with seaweed. rocklike chunks that must be rehydrated before
Stuffed foods are also common, including pastry consumption; chuo are not cooked before drying
turnovers filled with savory meat, fish, or cheese and are often ground into a fine potato starch.
fillings. They are called empanadas in Argentina, Corn is also grown in the mountains. Some vari-
which specializes in a turnover with a flaky, eties have kernels the size of small strawberries
Spanish-style dough enriched with indigenous that when prepared as hominy are known as mote
ingredients such as mashed potatoes, cassava, or and are a popular snack item. Bananas and plan-
corn. The turnovers are usually baked, but some- tains are cooked as savory chips and made into
times they are fried. Fillings are as many as there flour for breads and pastries.
are cooks. Chopped meat, olives, raisins, and onions The foods of Peru and Ecuador are preferred
are popular. In Chile the turnovers may be filled picante and feature abundant use of chile peppers
with abalone, and in Brazil, where they are known in both the highlands and along the coast. Salsa
Llapingachos is traditionally as empadinhas, a spicy shrimp mixture is tradi- de aj, a combination of fresh chopped chile, onion,
served with crunchy, fried tional. In Bolivia, where they are called salteas, and salt, is served as a condiment at most meals.
corn kernels (sprinkled with the turnovers are filled with cheese. Tamale-like Orange- or yellow-hued dishes are favored; along
salt) called maiz tostadas. steamed packets of dough-wrapped fillings are the coast, annatto colors foods, and in the Peruvian
also popular throughout South America. In Peru highlands an herb known as palillo is used. Charqui,
In the rural villages of
chapanas are made with cassava dough, while in dried strips of llama meat, is a specialty of the
Ecuador, a popular alcoholic
drink is costa, traditionally Ecuador bollos are formed around cooked chicken Andes. Anticuchos, chunks of beef heart marinated
made from the yucca plant meat with plantain dough. In Brazil a freshly in vinegar with chiles and cilantro, then skewered
by women who chew and grated corn kernel dough is mixed with coconut and grilled, are a spicy Peruvian favorite also
spit out the pulp to facili- and cassava (and no filling) to prepare pamonhas. from the Andes. Rabbit dishes are also popular in
tate fermentation. Ground cornmeal dough flavored with annatto the region. Along the coast, seafood dominates
the diet. The region is famous for its ceviches

(also spelled cebiche), a method of preparing
fresh fish, shrimp, scallops, or crab by marinating
small raw chunks in citrus juice. The acidity of
the juice cooks the fish and turns it opaque. At
many beaches cevicherias offer the dish as a snack
or light meal with beer. Chopped onion, tomato,
avocado, and cilantro are often added. In Peru
ceviche is typically garnished with sliced sweet
potato. Chucula is a thick plantain and milk bev-
erage flavored with cinnamon popular along the
coastal regions of Ecuador.60 Pisco, a grape brandy
Yoshio Tomii/SuperStock
that originated in Peru, is a national favorite, often
mixed with orange juice to make the refreshing
drink called yugeno.
Argentina, Chile, Bolivia, Uruguay, and

Paraguay. Hearty, ample fare with an emphasis
on beef exemplifies the cooking of these southern A market in Pisaq, Peru.
nations. Argentina is a major beef-producing and peaches) or carbonada en zapallo (veal stew
region, and its people eat more beef per capita than cooked in a pumpkin). In Paraguay soups reveal The term for food in
in any other country worldwide. The temperate European inspiration, such as bori-bori, beef with Argentina is el puchero, lit-
weather permits the cultivation of numerous fruits cornmeal and cheese dumplings, and so o-yosopy, erally the stew.The poor
and vegetables, notably strawberries, grapes, and beef soup with bell peppers, tomatoes, and are said to not have enough
Jerusalem artichokes (known as topinambur in vermicelli or rice, topped with Parmesan cheese. money to buy the stew.75
Chile). The cooking of Argentina, Chile, Paraguay,
and Uruguay has been influenced more by their
immigrant populations than by the numerous small
Indian groups native to the area. The Spanish intro-
duced cattle, and the Italians brought pasta. Smaller
numbers of Germans, Hungarians, and other cen-
tral Europeans have added their foods as well. SAMPLE MENU
The national dish of Argentina is matambre,
which means to kill hunger. A special cut of
flank steak is seasoned with herbs, then tradi- An Ecuadoran Dinner
tionally rolled pinwheel fashion around a filling
of spinach, whole hard-boiled eggs, and whole or Cebiche de Pescado (Fish Ceviche) a, b
sliced carrots, and then tied with a string and
poached in broth or baked. Matambre can be Locro (Potato Soup) a, c
served as a main course, but it is often chilled
Humitas (Fresh Corn Tamales) a, b
first and offered as a cold appetizer. Grilled steaks
are particularly popular in Argentina and sur- Chucula (Plantain and Milk) a or Juice
rounding nations. In Paraguay steaks are typi-
cally served with sopa Paraguay, a cornmeal and
cheese bread. In Uruguay beef is eaten nearly as a
Kijac, M.B. 2003. The South American table. Boston: Harvard Common Press.
often as in Argentina, although mutton and lamb b
Ecuadoran Recipes at http://www.galapagosonline.com/
are also common. predeparture/Food/Recipes.htm
Robust soups and stews are everyday fare. In c
Ecuadoran Cuisine & Recipes at http://www.whats4eats.com/4rec_ecuad.html
Bolivia beef stew is made with carrots, onions,
hominy, and chuo. The stews of Argentina often
pair meat with fruits as well as vegetables, such as
carbonada criolla (beef cooked with squash, corn,
Fish soups and stews are popular in Chile, which Examples in Venezuela include ropa vieja (old
has an extensive coastline and plentiful seafood. clothes), shredded flank steak served in a sauce
Clam or abalone chowder with beans (chupe de loco) made with tomatoes, onions, and olive oil; and
and congrio (an elongated, firm-fleshed fish that pabelln caraqueo, flank steak served on rice
looks a little like an eel) cooked with potatoes, with black beans, topped with fried eggs, and
onions, garlic, and white wine is a specialty. garnished with fried plantain chips. Dishes with
National favorites include pasta (e.g., spaghetti, more indigenous flavors include arepa, the staple
ravioli, and lasagna), which is served in many cornmeal bread of Venezuela that is formed into
homes on Sundays in Argentina. It is considered one-inch-thick patties and cooked on a griddle (it
auspicious to eat it on the twenty-ninth of every is sometimes stuffed with meat or cheese before it
month as well. In Chile, beans are especially pop- is fried), cachapas, tender cornmeal crepes, and
ular, and seafood is eaten regularly. Wines from mashed black beans, known as caviar criollo or
the temperate midlands of the country are con- native caviar. Tropical fruits, such as guavas and
sidered some of the best on the continent. Pisco is pineapple, are often sweetened and dried to make
consumed in both Bolivia and Chile, where it is favorite snacks of fruit leathers and fruit pastes.
mixed with lemon juice, sugar, and egg whites to
Guyana. Guyana has a cuisine widely influenced
make a pisco sour. In Bolivia legs from the giant
by its proximity to the Caribbean, as well as by the
frogs found in the Andean Lake Titicaca are a spe-
many immigrants from throughout the world who
cialty, and chicha, a distilled corn liquor, is popular.
have called Latin America home. For example, one
Pizza is popular in both Although coffee is consumed throughout the
national favorite is pepper pot, a stew made with
Argentina and Uruguay. area, another caffeinated beverage is equally popu-
a variety of meats and onions and flavored with
lar in some regions. Called mat, it is an infusion
the Caribbean cassava-based sauce cassareep (see
made from the leaves of a plant (Ilex paraguariensis)
Chapter 9). Other common dishes similar to those
in the holly family native to Paraguay. Served hot
in the Caribbean include salt fish cakes, blood
or chilled, mat is consumed nearly every after-
pudding, coocoo (cornmeal and okra bread),
noon with small snacks in Paraguay and in parts
cookup rice (rice with black-eyed peas or split
of Argentina. The dried, powdered leaves are called
peas), bammies, and ginger beer. Caribbean
yerba and are traditionally mixed in a gourd with
desserts are common, such as the dense fruitcake
boiling water. A special metal straw is inserted to
known as black cake, and konkee, a tamale
drink the brew.
made from sweetened cornmeal, coconut milk,
and raisins wrapped in banana leaves, then
Colombia and Venezuela. The fare found in
boiled. African influence is found in foofoo, a
Colombia and Venezuela is colonial Spanish in
pounded plantain paste like African fufu, and
character, cooked with olive oil, cream, or cheese
stews made with fish or meat, plantains, onions, and
and flavored with ground cumin, annatto, parsley,
okra (see Chapter 8). Dumplings, called metamgee,
cilantro and chopped onions, tomatoes, and garlic.
are made from starchy vegetables and are often
Yet native tastes are still evident. Guascas, or
added to stews. Asian foods include Indian cur-
huascas (Galinsoga parvilora Lineo), an herb native
ries, roti (flat bread), the use of dal (a type of
to Colombia, provides a flavor similar to boiled
legume; see Chapter 14, South Asians), and
peanuts in soups and stews. Hot chile pepper
Chinese noodle dishes. One national specialty is
sauces are served on the side of most dishes.
Portuguese garlic pork, which is marinated in
Tropical fruits and vegetables, including avocados,
vinegar, then fried. The country is famous for
bananas and plantains, naranjillo (a small, orange
One of the more unusual Demerara sugar, a very rich, brown-colored, and
fruit related to tomatoes used for its tart juice),
specialties of Colombia is crumbly raw cane sugar named for a region in
pineapple, and coconut milk or cream are other
hormiga culona, a dish Guyana. It is the source of Demerara rum, a
common regional ingredients.
made from the big- Guyanese specialty.
bottomed ants found in the
In Colombia Bogat chicken stew (made with
Santandor region. Toasted chicken, two types of potatoes, and cream) and Brazil. The cooking of Brazil is very different
ants, which taste similar to sancocho (a boiled dinner traditionally made with from that of other South American countries due
popcorn, are favorite road- beef brisket or other roast, and ample starchy veg- to Portuguese and African influences. The
side treats during the June etables such as potatoes, sweet potatoes, plantains, Portuguese arrived in the sixteenth century, looking
season for insects. or cassava) are typical Spanish-influenced dishes. for land to cultivate sugar cane. They contributed
dried salt cod and linguia to the diet, stews known

as cozidos made with many different meats and
vegetables (known as cocido in Portugal), and a
variety of exceptionally sweet desserts based on
sugar and egg yolks, such as caramel custards and SAMPLE MENU
corn (canjica) or rice (piro de arroz) puddings fla-
vored with coconut. African slaves put to work on
the sugar plantations brought foods unknown in A Brazilian Celebration
nearby countries, such as dend oil (a type of
palm oil) and okra. Spicy dishes were preferred. Feijoada Completa (Black Beans with Meats) a, b, c
In West Africa malagueta peppercorn, a small,
hot grain, was used to season foods; in Brazil Farofa (Toasted Manioc Meal) a, b, c
Africans adopted a very small, mouth-searing chile
pepper indigenous to the area and also called it Braised Collard Greens a, b, c
malagueta. It is typically minced and added to
dend oil, often with dried shrimp and grated Brazilian Rice a, b
ginger root, to make a hot sauce. Coconut Bread Puddinga or Torte de Banana (Banana Pie) b
Although Indian, Portuguese, and African
tastes and textures have influenced cooking Capirinhas,a, b, c Beer or Juice
throughout Brazil, nowhere are they more promi-
nent than in the state of Bahia. Known as Afro-
Brazilian fare, or cozinha baiana, this cuisine is a
Kijac, M.B. 2003. The South American table. Boston: Harvard Common Press.
famous for fritters made from dried shrimp, b
Marias Cookbook at http://www.maria-brazil.org
dried salt cod, yams, black-eyed peas, mashed c
Cook Brazil at http://www.cookbrazil.com
beans, peanuts, and ripe plantains fried in dend
oil. Vatap, another specialty, is a paste made with
smoked dried shrimp, peanuts, cashews, coconut
milk, and malagueta chiles. It is used as a filling
for black bean fritters called aracanj and some-
times served with rice as an entree.
The national dish of Brazil is feijoda completa,
which originated in Rio. Black beans cooked with In the far South the cuisine has been influ- Churrrascaria rodizio restau-
smoked meats and sausages are served with rice, enced by the foods of Argentina. Grilled meats rants have opened in many
sliced oranges, boiled greens, and a hot sauce are a favorite in Brazil, especially in the South, U.S., European, Japanese,
mixed with lemon or lime juice. Toasted cassava home of the frontiersmen known as gauchos, and Australian cities in
meal, called farinha, is sprinkled over the top like who herded cattle on the grassland plains. Sides recent yearsanywhere
Parmesan cheese. Farinha is served with most of beef were traditionally staked at the edges of a steak is appreciated.
dishes and is often mixed with butter and other bonfire for slow cooking in a method called
Avocado batidas, made with
ingredients, such as bits of meat, pumpkin, plan- churrasco. The popularity of the outdoor barbecue the ripe vegetable, milk,
tains, or coconut milk to create crunchy side dishes led to churrascaria rodizio, restaurants located in sugar, and lime, are favorites
called farofa. Rice or cornmeal porridge called piro cities throughout the nation that specialize in in Colombia and in Brazil but
is another type of side dish. Middle Easterners spit-roasted beef, pork, lamb, and sausages are disliked in other South
who immigrated to the southeastern areas of Brazil brought to the table on large skewers and carved American nations.85
brought the concept of couscous to the country to taste. Specialties include picanha (rump roast)
and adapted the dish to native ingredients. and beef heart. Assorted side dishes such as
Cuzcuz paulista is prepared with cornmeal in a salads, potatoes, condiments, and desserts round
cuzcuzeiro, which looks like a colander on legs out the meal. Brazilians in the South also drink
that is inserted over a pot of boiling water to mat, which they call chimmaro. Coffee, rum, and
steam. The basket of the cuzcuzeiro is first lined beer are common beverages in Brazil, but several
with seafood or poultry and vegetables, which other drinks are also popular. Guaran is a deli-
flavors the cornmeal as it cooks and looks deco- cious, stimulating carbonated soft drink made
rative when the cuzcuz cake is inverted. from the seeds of the native guaran fruit, which
contain caffeine. Cachaa (called aguardiente in Special Occasions. Catholic traditions have
other South American nations) is an alcoholic influenced many South American holidays. A rich
beverage, often compared to brandy, distilled from Christmas Eve dinner is traditional in most nations,
sugar cane. It is used to make batidas, a refresh- often with a roast, such as lechn (suckling pig) in
ing punch with fruit juice, or caipirinhas, mixed Brazil and cuy or lechn in Ecuador. Italian special-
with a little lime juice, sugar and mint, then con- ties including torrone and panettone are Christmas
sumed over ice. items in Argentina, where Epiphany is another sig-
nificant religious holiday (see Chapter 6).
Meal Composition and Cycle Easter is important in many homes, and
Daily Pattern. Three meals a day are traditional Carnival (Carnaval) festivities featuring dancing,
among middle-class and affluent South Americans, parties, and traditional fare are popular in Brazil,
with an afternoon snack often added. The poor, Ecuador, Peru, and Uruguay. Americans from
especially those in rural areas, are often limited these countries sometimes celebrate with parties
to an early breakfast with a large dinner during the three days before Lent. During the time
around 6:00 p.m.75 of Lent, animals associated with water habits, such
Ecuadorans prefer coffee For those who can afford more than two as alligators, armadillos, capybaras, iguanas, and
boiled to a thick consis- meals daily, breakfast is typically light, often turtles, were traditionally classified as fish; thus
tency and then mixed with bread or a roll with jam and a cup of coffee, the Catholic Church permitted their consumption
hot water or milk and sugar served black or with milk. A more complete meal on meatless days.75 These game meats are still con-
to taste.
features fresh fruit or pastries and occasionally sidered Lent specialties in some regions.
ham or cheese. Lunch is usually the main meal, Saint Johns Day is a favorite in Brazil, featuring
consumed leisurely with family or friends. foods made with corn and pumpkin, and it is also
Appetizers such as fritters, humitas, or empanadas celebrated by the Otavaleos of Ecuador with all-
may start the meal, followed by a meat or seafood night feasting and dancing. In Peru All Souls Day
stew or a grilled meat dish. Side dishes may include on November 2 includes gifts of food and family
rice, beans, farofa, fried potatoes, and greens such picnics at the gravesites of deceased kin. Also sig-
as kale. Salads, typically featuring cooked vegeta- nificant for many Americans of South American
bles, are popular in some areas, including Brazil, descent are the Independence Days observed in
and are served with the meal. Dessert, most often various nations. Brazilian Americans honor their
flan or another sweet custard or pudding, is usu- Independence Day on September 7 with day-long
ally served. In Argentina the time spent relaxing festivities in Boston, New York, and Newark, New
and socializing after lunch is called la sombremes Jersey. Americans from Chile sponsor traditional
and sometimes includes a nap. Dinner is tradi- food and craft booths for fairs to celebrate their
tionally lighter, sometimes just cold cuts, a seafood Independence Day on September 18. Colombian
salad, or a serving of soup or stew, and usually eaten Americans consume tamales, empanadas, arepas,
Pan de jamn, a soft, white
around 9:00 each evening, often continuing past and other specialties on their Independence Day,
bread made with swirls of
sliced ham, green olives, midnight. Beer, wine, fruit juice, and soft drinks July 20. In Ecuador primer grito (first cry of inde-
and raisins, is traditionally are beverages commonly consumed at meals. pendence) is held on August 10 and is officially
served at Christmas and An afternoon break is typical in much of marked as Ecuador Day in New York City.
New Years in Venezuela. South America: coffee is typically consumed in Independence Day in Peru is July 28. The Day of
Argentina, Colombia, Ecuador, and Brazil; tea is Tradition is popular in the Argentinian-American
The cornmeal cheese bread served in the late afternoon in Chile and Uruguay; community, with customary foods, folk music, and
known as sopa Paraguay is and mat is popular in parts of Argentina, Paraguay, equestrian displays by men dressed as gauchos.
enjoyed by Paraguayans at Uruguay, and Brazil. Snacks eaten with the beverage
nearly all special occasions, are often fruit, cachapas or arepa, sandwiches, or Etiquette. Traditionally, women prepared meals
including birthdays and
a pastry. Street vendors offering coffee, fruit juice, and served them to men, who consumed their
weddings.
and snacks throughout the day are common in food first. Women would eat after the men fin-
Los Quince, a party held urban areas. Unlike wealthier South Americans, ished. This custom is continued in many rural, and
when a girl becomes an the poor often skip lunch and eat a large dinner. even some urban, homes in South America today,
adult at age 15 in Argentina, The meal may consist of soup or a serving of stew especially among families of Indian ancestry.75
typically includes a fancy with a side dish of potatoes, plantains, cassava, corn, European-style dining is common in most of
dinner and dancing. or rice and beans, depending on the region. South America. The fork is kept in the left hand,
and the knife in the right, with no switching for CONTEMPORARY FOOD HABITS Guasacaca, a creamy avo-
cutting food. Bread is often served without butter cado sauce similar to
IN THE UNITED STATES Mexican guacamole except
and placed on the side of the plate. It is the only
food that should be eaten with the hands. All Adaptations of Food Habits for the addition of olive oil,
is often used instead of
other items, including fruit, require cutlery. Very little has been reported on the adapted food mayonnaise on sandwiches
Salads, however, should not be cut. Instead the habits of South Americans living in the United and hamburgers by
lettuce should be folded into bite-sized packets States. Many continue cooking their favorites Venezuelan Americans.85
with the fork. In Brazil even sandwiches are eaten from home, though recipes are often adapted to
with a knife and fork. All items are passed to the accommodate U.S. ingredients or to improve
left. The hands should remain above the table acceptability (e.g., cuy is not often prepared).
when not eating, with the wrists resting on the Substitutions for unavailable ingredients, such as
edge. In Colombia it is impolite to start a meal feta cheese for fresh farmers cheese or peanut oil
until the host says, Buen provecho! In Bolivia it for dnde oil, are common. Sometimes the fact
is an insult to pour wine with your left hand or to that certain customary ingredients are unobtain-
hold the bottle at the base when pouring, which able makes other dishes that can be prepared tra-
is interpreted to mean you dislike the person for ditionally more popular in the United States than
whom the glass is intended.35 these dishes are in their countries of origin. For
instance, llapingachos is probably eaten more often
Therapeutic Uses of Foods. Candombl orixs by Peruvian Americans than by Peruvians.85
are associated with certain foods, and followers Among Chileans, many find it difficult to adapt
honor their deity by eating those items. to typical American schedules with a work day
Examples include white corn, white beans, rice, that begins earlier than in Chile (difficult after a
porridge, yams, and water with Oxal; rice, late dinner) and has a short lunch period pre-
black beans, black-eyed peas, and roasted corn cluding a leisurely meal. The diets of poorer
with Omolu; black beans with Ogun; farofa Chileans may improve in the United States where
made with dend oil, black beans, honey, steak food is less expensive.11
with onions, and chachaa with Ex; tapioca,
pudding, cooked corn, and a ginger-flavored Nutritional Status
drink called alu with Oxoosi; and pudding, Nutritional Intake. There are minimal data on
banana, ximxim (chicken stew), and champagne the nutritional status of Americans of South
with Oxum. A hot-cold system of medicine, American descent. Parasitic infection, iron-
most likely introduced by European immi- deficiency anemia, and protein-calorie malnutri-
grants, has also been adapted by candombl tion are common in many rural areas of South
healers, treating hot conditions associated with America and in some crowded urban neighbor-
hot orixs with cool prescriptions associated hoods as well. Chronic Chagas disease involving the
with cool orixs. Classification is inconsistent, esophagus and colon is endemic in some regions
however, and cold conditions are rarely treated and may be a risk factor in cardiovascular disease.
with hot remedies.117 Studies in South America reveal trends that
Some South Americans may adhere to more may be applicable to the population in the United
general hot-cold classifications not associated States, particularly recent immigrants. Overweight
with candombl.75 Foods that are hot in temper- and obesity is prevalent in some regions, with
ature, or irritating to the stomach, may be reported rates for BMI 25 of 46 percent in one
avoided during fevers, for example. Conditions Colombian adult sample, 52 percent in a study of
such as menstruation, pregnancy, and lactation Ecuadoran elders, and 33 to 45 percent in Brazilian
also require specific foods. In addition, some studies.5, 97, 102, 104 Reports on obesity show rates of
people believe that certain foods should be BMI >30 of 12 percent in a study of Brazilian
eaten at specific times of day, such as fruit, adults, 31 percent of one adult sample in Paraguay,
which is considered wholesome in the morning and 64 percent in postmenopausal women in
but harmful in the evening. Some South Argentina.26, 58, 104 An increase in overweight and
Americans avoid combinations of some foods, obesity in Bolivian women has been reported.92
such as eating acidic fruits at the same time as Among Brazilians, traditional diets low in calorie
drinking milk. density and high in fiber were associated with
lower BMI, while more Westernized diets with some Venezuelans use Spanglish, a mixture of
foods high in added fats (especially butter, mar- Spanish with English. Of those who do not speak
garine, and fried snacks) and sugars (particularly English at home, over 47 percent reported they
soft drinks) were associated with a higher BMI. do not speak English very well. 96
In the research on Ecuadoran elders, many were South Americans tend toward formality in
deficient in vitamins and minerals despite high their interactions with others. Conversations
rates of overweight, including vitamins B12, D, are often reserved, with little emotional expres-
and folate, as well as iron and zinc. sion. However, Venezuelans are noteworthy for
Concerns regarding the development of their directness, and Brazilians are typically
metabolic syndrome (the clustering of symp- restrained with strangers but very animated with
toms related to heart disease and diabetes) have family and friends.35 Most South Americans
been published. Hypertension is common in prefer to sit and stand closer than is usual in
many populations: 50 percent in Colombian the United States. Direct eye contact is
elders, 39 percent in postmenopausal Ecuado- common throughout South America, except in
ran women, 42 and 46 percent respectively in Colombia, where eye contact may be avoided
Guyanese women and men over fifty years old, with authority figures or elders, or in embar-
33 percent in postmenopausal Argentinean rassing situations as a sign of subordination.
women, and over 25 percent in Paraguayan Most South Americans are present oriented
elders.5, 32, 48, 55, 95 Type 2 diabetes rates are in the and polychronic, which may result in relaxed
4 to 8 percent range. Excessive central body attitudes toward appointment and treatment
fat was found in one group of overweight schedules. Generally speaking, immediate inter-
Brazilian subjects.97 A study in Ecuador reported ventions are valued more than either preventive
41 percent of postmenopausal women had or long-term care. In Argentina a patient is often
metabolic syndrome.48 Research in Venezuela protected from a negative prognosis.
estimated that one-third of the adult population The role of traditional health beliefs and
in the region had metabolic syndrome associ- practices is largely undocumented, though it is
ated with dyslipidemia. Among men, rates varied assumed that as in other Latin American nations,
widely by ethnicity and were highest in those of only small numbers of people adhere completely
mixed heritage (37%), followed by whites and to any single folk system. Homeopathic remedies
blacks. The lowest rates (17%) were found in and over-the-counter antibiotics sent from
the Indian group.34 family members still in South America may be
obtained, and faith healers may be sought by
Chileans commonly use Counseling. Access to health care may be limited some immigrants.
both their paternal and for some Americans of South American heritage. One study of women with type 2 diabetes
maternal surnames. In some countries, such as Chile, preventive living in Southeastern Brazil reported that
health practices are uncommon and care may not many found dietary restrictions burdensome.
be sought except in emergency situations.11 One Some were concerned with loss of autonomy,
study that grouped Central and South American and others mentioned cravings for sweets.
Latino women found that 36 percent of those Some felt sadness when following the diet.
women had no health insurance, and 22 percent Many mentioned that they had no symptoms of
did not have a usual biomedical clinic or physi- diabetes, and therefore believed dietary restric-
cian for care.36 Unauthorized South Americans tions were unnecessary. Compliance was poor
living in the United States illegally typically have in this group.91
no medical insurance and may avoid contact with An in-depth client interview should be used
any government agency. Nearly 90 percent of South to determine South American country of
Americans do not speak English at home, prefer- origin, preferred language, and length of stay
ring to maintain their native languages, including in the United States. Clients socioeconomic
Spanish, Portuguese, or various Indian languages. status, degree of acculturation, and use of tradi-
Guyanese Americans may speak a Creole language tional health practices may be significant
that combines African dialects with English, and factors in care.
CHAPTER 10 REVIEW QUESTIONS 8. Borrell, L.N., Dallo, F.J., & White, K. 2006.
Education and diabetes in a racially and ethni-
1. Pick one Caribbean country and summarize cally diverse population. American Journal of
the worldview of their countrymen living in the Public Health, 96, 16371642.
United States. Include an example of the use of 9. Buffington, S.T. 2000. Cuban Americans. In Gale
the hot-cold system for cause or treatment of an Encyclopedia of Multicultural America, R.V.
illness. Describe the types of traditional healers Dassanowsky & J. Lehman (Eds.). Farmington
used in this region. Hills, MI: Gale Group.
2. Select one indigenous food found in the 10. Buffington, S.T. 2000. Dominican Americans. In
Caribbean. Describe its taste and use in recipes Gale Encyclopedia of Multicultural America, R.V.
from the region. Next, select a foreign food
that was brought to the region and still com- 11. Burson, P.J. 2000. Chilean Americans. In Gale
monly consumedprovide a recipe. Which Encyclopedia of Multicultural America, R.V.
foods are now the staples of the diet? Describe Dassanowsky & J. Lehman (Eds.). Farmington
a holiday meal in one Caribbean country plus Hills, MI: Gale Group.
the specialties of the island. 12. Caban, A., & Walker, E.A. 2006. A systematic
3. What have become common health problems review of research on culturally relevant issues for
for people from the Caribbean living in the Hispanics with diabetes. Diabetes Educator, 32,
United States? If you were a nutritionist, how 584600.
would you modify the diet in the treatment 13. Carter-Pokras, O., Pirkle, J., Chavez, G., & Gunter,
of these disorders? E. 1990. Blood lead levels of 411-year-old
Mexican American, Puerto Rican, and Cuban
children. Public Health Reports, 104, 388393.
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109. Thorpe, L.E., List, D.G., Marx, T., May, L., 118. Vyas, A., Greenhalgh, A., Cade, J., Sanghera, B.,
Helgerson, S.D., & Frieden, T.R. 2004. Childhood Riste, L., Sharma, S., & Cruickshank, K. 2003.
obesity in New York City elementary school Nutrient intake of an adult Pakistani, European
students. American Journal of Public Health, and African-Caribbean community in inner city
94, 14961500. Britain. Journal of Human Nutrition and Dietetics,
110. Torres-Saillant, S., & Hernandez, R. 1998. The 16, 327337.
Dominican Americans. Westport, CT: Greenwood 119. Walker, D. 2000. Venezuelan Americans. In Gale
Press. Encyclopedia of Multicultural America, R.V.
111. Trevino, F.M., Moyer, M.E., Valdez, R.B., & Dassanowsky & J. Lehman (Eds.). Farmington
Stroup-Benham, C.A. 1991. Health insurance Hills, MI: Gale Group.
coverage and utilization of health services by 120. Walsh, R., & McCarthy, J. 1995. Traveling Jamaica
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to excess development of chronic disease in healing and healers by six Latinos living in New
Puerto Rican adults living in the Northeastern England: A preliminary study. Journal of Tran-
USA. Journal of Medical Investigation, 52, 252258. scultural Nursing, 10, 136142.
CHAPTER
11
East Asians
Chinese
A sia is one of the worlds largest continents,
stretching from the Ural Mountains and Suez
Canal in the East and the Arctic Circle in the
North, to the tropical peninsulas of India and
Southeast Asia. It encompasses almost one-third of
Chinese civilization is more than 4,000 years old
and has made numerous significant contributions
in agriculture, the arts, religion and philosophy,
the world land mass and nearly two-thirds of the and warfare. Silk and embroidered brocade cloth,
global population. Asia is divided into the regions of intricate jade sculpture, Chinese porcelain and
East Asia, Southeast Asia, and South Asia. Though lacquerware, book printing, Confucianism, Taoism,
the continent has historically included parts of and gunpowder are just a few examples. The name
Russia and several nations of the former Soviet China, meaning middle kingdom, or center of the
Union (sometimes known as Central Asia) and the world, is probably derived from a ruling dynasty
Middle East (sometimes called West Asia, or Asia of the third century B.C.E.
Minor), the people of these countries are culturally Chinas landscape is dominated by the valleys
distinct from the rest of Asia and are covered in of two great rivers, the Huang (Yellow) River in the
Chapters 7, Central Europeans, and 13, People of North and the Chang Jiang (Yangtze) in the South.
the Balkans and the Middle East, respectively. The climate is monsoonal, with most of Chinas
East Asia is defined as China (the Peoples rainfall occurring in the spring and summer
Republic of China), Taiwan (Republic of China), months. The northern plain through which the
Japan, the Democratic Peoples Republic of Korea Huang River flows is agriculturally very fertile.
(North Korea), the Republic of Korea (South The area is cold, and sometimes the severe winter
Korea), and the Mongolian Peoples Republic (see results in a growing season of only four to six
Figure 11.1). Immigrants from these nations, par- months. In the South the Chang Jiang River starts
ticularly China and Japan, have been coming to the in Tibet, traverses the southern provinces, and
United States since the 1800s. Many settled on the eventually empties into the China Sea near the city The most famous European
West Coast, where the majority of their descen- of Shanghai. South of the mouth of the Chang traveler to China was Marco
dants still live. In recent years large numbers from Jiang delta is a rugged and mountainous coastline Polo in the late thirteenth
off which are located the islands of Hong Kong and century, who is said to have
throughout the region have arrived in the United
brought Chinese noodles to
States; many are refugees from political oppres- Taiwan. The southern provinces are warmer and
Italy. The Italians, however,
sion, while others seek education and employment wetter and have a longer growing season (six to were undoubtedly making
opportunities. This chapter introduces the peoples nine months) than in the North. pasta long before the times
and cuisines of China, Japan, and Korea. Southeast The population of China is estimated to exceed of Marco Polonoodles are
Asians are discussed in Chapter 12, Southeast 1.2 billion people, more than four times as large as thought to have been
Asians and Pacific Islanders, and South Asians are the population of the United States. The Chinese developed independently in
considered in Chapter 14, South Asians. have a heterogeneous society with numerous each region.
316 EAST ASIANS
MONGOLIA
NORTH KOREA
Sea of
Japan
Beijing Pyongyang
Seoul SOUTH
KOREA Tokyo
CHINA
JAPAN
East
BHUTAN China
NEPAL Sea Pacific
Ocean
INDIA TAIWAN
MYANMAR Hong Kong
BANGLADESH
LAOS Philippine Sea
South
Bay of Bengal THAILAND China PHILIPPINES
Bangkok
Sea Manila
CAMBODIA
VIETNAM
SRI LANKA BRUNEI

MALAYSIA
PAPUA
SINGAPORE
NEW GUINEA
Figure 11.1 IN
D O N ESIA
China, Japan, and Korea.
ethnic and racial groups. The Chinese language gold rush to California; many Chinese still refer to
is equally diverse, with many dialects, some of America as the Land of the Golden Mountain. As
which are incomprehensible to people of other mining became less lucrative, the Chinese opened
Chinese regions. their own businesses, such as laundries and restau-
rants, but also found employment in other occupa-
Chow-chow is a vegetable CULTURAL PERSPECTIVE tions. The Central Pacific Railroad, which joined
relish made with mustard the Union Pacific as the first cross-country line,
brought to the United States
History of Chinese in the United States was built primarily by 10,000 Chinese workers.
by Chinese railroad workers. Immigration Patterns. The first major surge in By 1870 there were 63,000 Chinese, mostly
Its name may derive from the Chinese immigration to the United States occurred male, in the United States, nearly all on the West
Chinese word for mixed,cha. in the early 1850s when the Chinese joined in the Coast. Another 120,000 Chinese are estimated to
Chapter 11: East Asians 317
have entered the United States during the follow- a quarter of all Asians in the nation. Approximately The first Chinese restaurants
ing decade. Racial discrimination against Asians two-thirds are foreign-born, but of those, half are in the United States opened
increased as their numbers swelled. By 1880 naturalized citizens.117 More than 40 percent of in San Francisco in 1849. Over
Chinese immigration slowed to a trickle due to the Chinese population in the United States have 40,000 Chinese restaurants
are in operation today.99
exclusion laws directed against Asians. The Chinese arrived since 1990. Large numbers of Chinese
also immigrated to Hawaii, and when the islands Americans are found today in California, New
were annexed by the United States in 1898, approx- York, Hawaii, Texas, New Jersey, Massachusetts,
imately 25,000 Chinese were living there. Illinois, Washington, and Maryland.
Most early Chinese immigrants were from the As of 2000, estimates are that there are over
southeastern Guangdong province of China, for- 420,000 Taiwanese living in the United States.
merly referred to as Canton. Most were young Taiwanese Americans have settled in areas
men with no intention of stayingthey came to where professional employment opportunities,
make their fortune and then return to China and particularly in the sciences, are available.
their families. Many married before coming to Sizeable populations are found in the Los
the United States, and more than half returned to Angeles area (which includes the community of
China. By the 1920s the Chinese population in Little Taipai), Houston, San Jose, New York City,
the United States had dropped to 1870 levels. Atlanta, Baltimore, Boston, Chicago, Cincinnati,
In each city where the Chinese settled, they San Diego, Washington, DC, and New Jersey. The number of Chinese-
usually lived within a small geographic area known Four types of Chinese-American households American women in the
as Chinatown. Large Chinatowns evolved in San have been identified.39 First are the sojourners, United States did not equal
Francisco, New York, Boston, Chicago, Philadelphia, mostly men born in the early twentieth century, men until the 1970s.
Los Angeles, and Oakland, California. These neigh- who came to the United States with the intent of
borhoods offered protection against a sometimes returning after accumulating some wealth.
hostile social and economic environment; assimi- Political changes in China have stranded this group
lation was not an option. Conditions were often in urban Chinatowns throughout America. The
crowded and unusual in the predominance of men, second type are sojourners who were successful
but were tolerated with the expectation of eventual in bringing their wives to the United States.
return to China. It was not until 1943 that Chinese These elderly first-generation couples still live in
could become naturalized U.S. citizens. Chinatown neighborhoods, although their chil-
dren have often moved from the area. The third
Current Demographics and Socioeconomic type of household is established by new immi-
Status. When the exclusion laws were repealed grant families. Often one member will arrive to
in 1943, people from many Asian countries once establish residency, and then family members
again entered the United States. Chinese immi- will follow. These immigrants usually settle with
grants who have arrived since World War II are other Asians, often in Chinatowns, where the
usually not from Guangdong. They are urban parents speak Chinese and children learn English
dwellers from other regions and are generally in school. Although many families include two
better educated than earlier immigrants. wage earners or combine the incomes of extended
Political instability in the Peoples Republic members, they may remain poor due to low
of China has led to a recent exodus of Chinese. salaries, large families, and supporting relatives
Following the pro-democracy uprising in Tianan- in the homeland. Chinese-American households
men Square in 1989, U.S. immigration laws were of the fourth type include acculturated suburban
changed with the Chinese Student Protection Act families. These families include both new immi-
of 1992. More than 41,000 Chinese residents were grants who are white-collar professionals and
granted visas and are eligible for citizenship under those Americans of Chinese descent who have
the provision. Furthermore, the return of Hong lived in the United States for several generations.
Kong to mainland China and the uncertainty of Both parents may be college educated, often with
Taiwans future have led to increased immigration specialization in engineering and the sciences.
from these islands. Unlike other immigrants of previous generations,
The 2005 U.S. Census estimates that more these affluent Chinese families live in areas with
than 2.8 million Chinese (including Taiwanese) university or defense research facilities, including
are living in the United States, representing nearly the metropolitan areas of the Silicon Valley
318 EAST ASIANS
(California), Houston, Seattle, Pittsburgh, San Early Religion. The ancient faith of China was
Diego, and Dallas. probably a mixture of ancestor worship and respect
Chinese Americans value education, and there for the forces of nature and the heavenly bodies.
are disproportionately large numbers (48 percent The supreme power was either Tien (Heaven) or
according to 2000 census figures) with college and Shang Ti (the Supreme Ruler or the Ruler Above).
graduate degrees.117 High levels of educational One gained favor with the spirits by the correct
attainment often translate into well-compensated performance of ceremonies. These beliefs and
professional employment. Over half work in practices were later incorporated into subsequent
management, professional, or related occupations, Chinese religions.
while others have successfully opened their own Ceremonies for the dead are a prominent
businesses, particularly small markets, dry clean- Chinese religious practice. The dead are supposed
ing, and restaurants.141 to depend on the living for the conditions of their
Americans of Chinese descent are so well existence after death. In turn, the dead can influ-
known for their successful transition in the United ence the lives of the living.
States that a stereotype has developed, obscuring
Confucianism. Confucius was a sage, one of
what is in reality a divided population.141 Though
many who gave order to Chinese society by defin-
many Chinese Americans are in the upper and
ing the ways in which people should live and
middle classes, immigrants who came before the
work together. Confucianism incorporated the
1950s were often poorly educated, and many found
ceremonies of earlier religions, with the following
work in sweatshops. Even those who had college
cornerstones:
degrees were sometimes unable to find jobs suitable
to their skills due to discrimination. In addition, 1. Fatherly love and filial piety in the son
small numbers of recent immigrants have also (i.e., children are expected to obey their
found work in low-paying service jobs or manu- parents and adults are expected to take
facturing. Estimates indicate 28 percent of foreign- care of their children).
born Chinese in the United States do not have a 2. Tolerance in the eldest brother and
high school diploma.140 humility in the younger.
A large percentage of Taiwanese Americans
3. Proper behavior by the husband and
have immigrated to the United States since 1980,
submission by the wife.
Early immigrants and their mostly seeking professional opportunities. Two-
descendants, as well as thirds of the foreign-born population have obtained 4. Respect for ones elders and compassion
many current immigrants college degrees, and 64 percent work in manage- in adults.
from Hong Kong, speak ment and professional jobs, with another 22 percent 5. Allegiance to rulers and benevolence by
Cantonese, a dialect that is
employed in office work and sales. Family poverty leaders.
difficult to understand by
rates are very low.140 More recently, some immi-
Chinese immigrants who Inherent in these relationships is the ideal of
speak Mandarin. grants called taikongren (literally meaning astro-
social reciprocity, which means that one should
nauts) have chosen transnational business careers,
treat others as one would like to be treated. To
2001 census data report living in the United States while their families
enhance harmony in the family and in society as
over one million Canadians remain in Taiwan, traveling frequently between
a whole, one must exercise self-restraint. An indi-
of Chinese heritage. the two nations.48
vidual must never lose facemeaning a persons
Worldview favorable name and position in societybecause
that would defame the whole family. Many of
Religion. Most Americans of Chinese descent
these values influence Chinese behavior today.
are not affiliated with a specific church. Religious
practices are often eclectic, a combination of Taoism. The Taoist, like the Confucianist, believes
ancestor worship, Confucianism, Taoism, and that heaven and humanity function in unison and
Buddhism. Many early Chinese immigrants were can achieve harmony, but under Taoism people are
not formally schooled in any religion; instead, subordinate to natures way. There is a fundamental
Confucius also developed beliefs and practices were passed orally from gen- duality within the universe of interacting, opposite
protocols for cooking and eration to generation. Spirituality is integrated principles or forcesthe yang (masculine, positive,
eating that were practiced into family and community life. Daily living bright, steadfast, warm, hard, and dry; sometimes
in China until the nine- includes avoiding any actions that might offend referred to as shen) and the yin (feminine, nega-
teenth century.40 the gods, nature, or ancestors. tive, dark, cold, wet, mysterious, and secret; also
called kwei) (Figure 11.2). Everything in nature discouraged. Chinese parents may be very strict,
contains both yin and yang, and a balanced unity and children are commanded to honor the family.
between them is necessary for harmony. This bal- Many of these ideas conflict with American ideals
ance occurs when Tao, the way of nature, is allowed of equal rights and freedom of speech and may
to take its course unimpeded by human willfulness. lead to intergenerational conflict in the Chinese-
Taoism advocates a simple life, communion with American home.
nature, and the avoidance of extremes.
Traditional Health Beliefs and Practices.
Buddhism. Buddhism grew during the Tang Chinese medicine includes a complex humoral Figure 11.2
dynasty but then suffered a slow decline. The system of professional practice by physicians, Yin-yang symbol. This
Mahayana sect dominated in China, blending known as Traditional Chinese Medicine (TCM), symbol represents the
with traditional Chinese beliefs and resulting in as well as correlated folk remedies used by fundamental duality of
a unique Chinese form of Buddhism. Ten schools laypersons at home. Health beliefs and practices the universe and the bal-
of Buddhism flourished in China at one time, have developed over generations, incorporating ance between the forces
but only four were left by the twentieth century. Confucian, Taoist, and Buddhist concepts regard- of yang (light) and yin
The two dominant schools in China are Chan ing the interdependencies of man and nature and (dark). Each force has a
(Zen Buddhism in Japan) and Pure Land (see the need for balance and moderation in life.
little of the other in it
Chapter 2, Traditional Health Beliefs and (indicated by the dot of
Professional TCM follows texts prepared the opposite color).
Practices, for more information). between approximately 2500 B.C.E. and the third
Chinese-American Spirituality. Both Catholic century B.C.E., outlining the dynamic equilibrium
and Protestant churches were established in the of forces necessary for health. These include the
early Chinatown neighborhoods, usually organized five elements, or five evolving phases, of fire, earth,
by the Chinese dialect spoken in the area. Few first- metal, water, and wood, each of which may become
generation Chinese Americans joined Christian unbalanced, much as fire consumes wood or wood
religions, but converts were found in subsequent (as a tree) absorbs the earth. These elements cor-
generations. Others maintain aspects of Buddhism, respond with five organs: the heart, spleen, lungs,
Taoism, or spirit and ancestor worship in their kidneys, and gallbladder, respectively. Associations
daily lives, keeping small altars at home in which with secretions (perspiration, saliva, mucous, spit,
Most Chinese believe in
to offer respect and perform the rites that will and tears); the seasons (summer, late summer, fengsui, the way in which
preserve good relations with the gods and bring autumn, winter, and spring); colors (red, yellow, a home should be situated
good fortune. white, blue, and green); tastes (bitter, sweet, pun- and its furnishings arranged
Only a minority of Taiwanese belong to gent, salty, and sour); and directions (south, center, to promote optimal flow
Protestant faiths in their homeland; however, west, north, and east); as well as times of day, of energy and personal
Baptist, Presbyterian, and several smaller evan- odors, sounds, and emotions may also occur.31, 37, 74 well-being.
gelical churches have found Taiwanese followers This system was further elaborated some-
in the United States. Services are conducted in where between the third and sixth centuries by the
Mandarin or Taiwanese dialects, and the church
serves as a social network for the immigrant com-
munity. Buddhism has also gained adherents in Botanical remedies are usu-
recent years.48 ally combined in formulary
mixtures in traditional
Family. Confucian teachings about correct rela- Chinese medicine.
tionships are still important for many Chinese-
American families, even if they have become
Christians. Chinese-American families are usu-
ally patriarchal. Women are traditionally taught
to be unassuming and yielding. They live by the
formula of thrice obeying: Young girls are sub-
missive to their fathers, wives are subordinate
to their husbands, and mothers obey their sons.
Photo by Kathy Sucher
Children are expected to be quiet, acquiescent,

and deferential to their elders.
Harmony in the family is the ideal, so children
are taught not to fight or cry. Showing emotion is
320 EAST ASIANS
Chinese physicians were adoption of Buddhist principles of hot and cold have been identified, each characteristic of one or
traditionally paid for their humoral medicine, which were congruent with more organs. For example, tou yun (or tou hun) is
services when the client the Taoist system of yin and yang.2, 84 The concept vertigo, the most common complaint made by
was healthy. Payment of harmony was refined to include a balance of Chinese patients worldwide. Dizziness or a con-
stopped if the client
these opposites; illness develops when disequilib- fused state of mind indicates significant imbalance
became ill.
rium occurs. Organs such as the liver, heart, spleen, and serious illness. It is a nonspecific condition
kidneys, and lungs are yin, as is the outside and thought to originate from anger or anxiety mani-
the front of the body. The gallbladder, stomach, fested in liver, heart, or kidney dysfunction (if the
intestines, and bladder are yang, as well as the patient is a young man, too much sexual inter-
body surface and the back. Outside forces, such course or masturbation may be believed to be the
as the seasons, are also defined as yin (winter/ cause). Liver disorders develop from suppressed
spring) and yang (summer/fall) and illnesses hostility. Anger is discouraged in Chinese culture
associated with these times may fall into corre- and may accumulate in the liver, causing it to
sponding categories. expand and attack other organs. This diagnosis is
Symptoms of disease usually reflect an imbal- common for many gastrointestinal complaints.
ance between yin and yang. When there is an Generalized stomachaches are believed to be due to
excess of yang, acne, rashes, conjunctivitis, hemor- eating bitterness in life, often including an inade-
rhoids, constipation, diarrhea, coughing, sore quate diet when one is young. Anxiety, nervous-
throat, ear infections, fever, or hypertension may ness, or the stronger emotion of fear results in heart
occur. Anemia, colds, flu, frequent urination, palpitations.102 Most Chinese prefer this integrated
nausea, shortness of breath, weakness, and weight approach to health.76
loss suggest that an excess of yin is the problem. Many Chinese maintain health through a
Also associated with yin and yang is the condition properly balanced diet, moderation in activities
of the blood. Weak blood (yin) may develop during and sleep, and avoidance of sudden imbalance
growth or pregnancy, postpartum, and in old age. caused by forces such as wind. Qi must flow
Treatment includes yang therapies, particularly freely and blood must be strengthened through
the intake of herbs and certain foods. nourishment. For instance, if an individual is
The vital force of life is qi and is equated with imprudent and celebrates too much by eating
energy, air, and breath. Qi flows along twelve excessive yang foods (see the section Therapeutic
defined meridians in the body, and some condi- Uses of Foods), indigestion or a hangover may
tions are related to the disruption of qi or to occur. Eating yin foods, which are often bland, is
excessive qi. Other types of energy that must be the remedy.2 One study of Chinese Americans
balanced for health include jing, sexual or pri- found that 94 percent used home remedies to
mordial energy, and sheng, spiritual energy or the treat illness.76 When home cures are ineffective,
essence of consciousness.31, 84 advice from a TCM physician may be sought.
Other lesser forces that may influence health Diagnosis is made through taking an extensive
include wind (including natural drafts and those history, and examination of the client, particularly
resulting from fans, air conditioners, exposure, or palpitation of pulses and evaluation of the tongue.
a symptom that rhymes with the Chinese word for Through this process a medical pattern is detected,
wind); poison, which is somewhat related to the in contrast to determining a specific disease or
Western concept of allergies; and fright, a condi- condition based on symptoms or laboratory test-
tion in children that includes listlessness, anorexia, ing. It is the medical pattern that determines the
low fever, and crying. Fright is believed to occur appropriate intervention, not the illness.
when the soul becomes scattered and is mostly Treatment for nearly all illness involves the
limited to Chinese from Taiwan and Hong Kong.39 restoration of harmony. Therapy may emphasize
A major difference between Chinese medicine dietary and lifestyle changes, or attempt to bal-
and U.S. biomedicine is the idea that the body ance the organs so that emotional balance results.
Jade charms are worn to and mind are unified, governed by the heart. Nearly every visit to the doctor results in a botanical
keep children safe and to There is no English word to describe the concept. remedy, and most medicinal herbs are only avail-
bestow health, fertility, Emotions are often somaticized, meaning that able through prescription. For instance, ginseng
long life, power, and feelings are related to specific conditions. More may be used to fortify qi, and antelope horn can
wisdom on adults. than 500 symptoms corresponding to emotions help cool too much yang in the liver.84 Formulary
mixtures of five to ten substances are common.
The New Yorker Collection 2005 Alex Gregory from cartoonbank.com. All Rights Reserved.
Most TCM remedies are prepared as decoctions,
taken in a single dose. The client owns the pre-
scription and can reuse it when symptoms occur
or share it with family and friends.
Acupuncture is another traditional Chinese
treatment. It involves the use of nine types of
exceptionally thin metal needles inserted at various
points on the body where the qi meridians surface.
Meridians are considered yin or yang and corre-
spond with specific organs. The needles are placed
to facilitate a balanced flow of qi, restoring har-
mony to the afflicted organ, mostly for symptoms
of excess yang. Acupuncture may be performed by
a TCM physician or by a specialist. Another, less
common, therapy is moxibustion. Small bundles of
dried wormwood are heated and carefully applied
to certain meridians, usually to balance a yin con- Figure 11.3
dition. Moxibustion is particularly used during Traditional Chinese Medicine
labor and delivery. Massage or therapeutic exercise is a humoral system that
is another traditional therapy, found more often introduced ingredients that have been incorpo-
incorporates Confucian,
in China and rarely in the United States. rated into local cuisines. Some foods now common
Taoist, and Buddhist con-
TCM physicians practicing in the United States in China, but not indigenous, are bananas, peanuts, cepts regarding the interde-
do not have specified training and competency and chile peppers. pendencies of man and
varies. Word-of-mouth recommendations are nature and the need for bal-
common within the Chinese community. TCM Ingredients and Common Foods ance and moderation in life.
practitioners may use first aid on injuries or broken Staples. Traditional Chinese foods are listed in Source: New Yorker Cartoon Bank,
bones, prescribe herbs, perform acupuncture or www.cartoonbank.com; image
Table 11.1. In China numerous fruits, vegetables,
ID 121130, originally published in
moxibustion, or they may diagnose the condition and protein items are consumed but few dairy
The New Yorker on July 25, 2005.
and provide a recommended course of therapy by a products, whether fresh or fermented, are eaten.
specialist in one of these practices. Asians con- Grains are the foundation of the diet. As recently
cerned with humoral conditions use TCM (often as 1985, 75 percent of grain crops were grown by
concurrently with biomedical therapies), and in rural farmers for home consumption. In recent
recent years these practitioners have attracted a decades, however, productivity has improved,
growing multi-ethnic clientele. One study reported and a move away from self-production of foods
that 32 percent of Chinese immigrants had has occurred, especially in the amount of food The custom of throwing rice
returned to China or Taiwan during the previous consumed away from home. This has resulted in at newlyweds is believed to
two years for treatment of a condition.76 an overall reduction of grain product consump- come from China, where
tion, though it is still a staple.34 rice is a symbol of fertility.
Rice is essential in the cuisine of southern
China, believed to have been introduced to the
The Chinese eat a wide variety of foods and avoid region from India in the first century B.C.E. It is so
very few. This may have developed out of neces- common that people in southern China greet
sity, as China has long been plagued with recur- each other by asking, Have you had rice today?
rent famine caused by too much or too little There are approximately 2,500 different forms of Congee may be eaten at any
meal in Hong Kong, where a
rainfall. Chinese cuisine largely reflects the food rice, but the Chinese prefer a polished, white,
family version topped with
habits and preferences of the Han people, the long-grain variety that is not sticky and remains lobster is popular. In Taiwan,
largest ethnic group in China, but not to the firm after cooking. Short, sticky, glutinous rice is congee is also consumed
exclusion of other ethnic groups cuisines. For used occasionally, mainly in sweet dishes. throughout the day, some-
example, Beijing has a large Muslim population Although it is usually steamed, rice can also be times as the dish known in
whose restaurants serve lamb, kid, horse meat, made into a porridge called congee, eaten for Chinese-American restau-
and donkey, but no pork. Foreigners have also breakfast or as a late-night snack, with vegetables, rants as sizzling rice soup.
322 EAST ASIANS
Table 11.1 Cultural Food Groups: Chinese

Protein Foods
Milk/milk products Dairy products are not routinely used Cows milk, buffalo milk Many Chinese consume dairy products,
in China. Many Chinese are lactose especially milk and ice cream, some
intolerant. cheese. Some alternative sources of cal-
Traditional alternative sources of calcium cium may no longer be used.
are tofu, calcium-fortified soy milk,
small bones in fish and poultry, and
dishes in which bones have been
dissolved.
Meat/poultry/fish/ Few protein-rich foods are not eaten. Meat: beef and lamb (brains, heart, kidneys, More meat and poultry are consumed,
eggs/legumes Beef and pork are usually cut into bite- liver, tongue, tripe, oxtails); pork (bacon, ham, though some traditional protein sources
size pieces before cooking. roasts, pigs feet, sausage, ears); game meats are still popular
Fish is preferred fresh and is often (e.g., bear, moose)
prepared whole and divided into Poultry: chicken, duck, quail, rice birds, squab
portions at the table. Fish: bluegill, carp, catfish, cod, dace, fish tripe,
Preservation by salting and drying is herring, king fish, mandarin fish, minnow,
common. mullet, perch, red snapper, river bass, salmon,
Shrimp and legumes are made into sea bass, sea bream, sea perch, shad, sole,
pastes. sturgeon, tuna
Eggs: chicken, duck, quail, fresh and preserved
Shellfish and other seafood: abalone, clams,
conch, crab, jellyfish, lobster, mussels, oys-
ters, periwinkles, prawns, sea cucumbers (sea
slugs), sharks fin, shrimp, squid, turtle, wawa
fish (salamander)
Legumes: broad beans, cowpeas, horse beans,
mung beans, red beans, red kidney beans,
split peas, soybeans, white beans, bean paste
Cereals/Grains Wheat is the staple grain in the North, Buckwheat, corn, millet, rice, sorghum, wheat Chinese Americans eat less fan and more
long-grain rice in the South. tsai. The primary staple remains rice, but
Fan (cereal or grain) is the primary item more wheat bread is eaten.
of the meal; tsai (vegetables and
meat or seafood) makes it tastier.
Rice is washed before cooking.
Fruits/Vegetables Many non-Asian fruits and vegetables Fruits: apples, bananas, custard apples, More temperate fruits are consumed.
are popular. Potatoes, however, are coconut, dates, dragon eyes (longan), figs,
not well accepted. grapes, kumquats, lily seed, lime, litchi,
Vegetables are usually cut into bite-size mango, muskmelon, oranges, papaya, pas-
pieces before cooking. sion fruit, peaches, persimmons, pineapples,
Slightly unripe fruit is often served as plums (fresh and preserved), pomegranates,
a dessert. pomelos, tangerines, watermelon.
Both fresh fruits and vegetables pre- Vegetables: amaranth, asparagus, bamboo More raw vegetables/salads are eaten.
ferred; seasonal variation dictates shoots, banana squash, bean sprouts, bitter Data on overall consumption trends are
the type of produce used. melon, cassava (tapioca), cauliflower, celery, contradictory.
Many vegetables are pickled or pre- cabbage (bok choy and napa), chile peppers,
served. Fruits are often dried or Chinese broccoli (gai lan), Chinese long beans,
preserved. Chinese mustard (gai choy), chrysanthemum
greens, cucumbers, eggplant, flat beans, fuzzy
melon, garlic, ginger root, green peppers,
kohlrabi, leeks, lettuce, lily blossoms, lily root,
lotus root and stems, luffa, dried and fresh
mushrooms (black, button, cloud ear, wood ear,
enoki, straw, oyster, monkeys head), mustard
root, okra, olives, onions (yellow, scallions,
shallots), parsnip, peas, potato, pumpkin,
seaweed (agar), snow peas, spinach, taro, tea
Table 11.1 Cultural Food Groups: Chinese (Continued)

melon, tomatoes, turnips, water chestnuts,
watercress, wax beans, water convolvus,
winter melon, yams, yam beans
Additional Foods
Seasonings Complex, sophisticated seasoning Anise, birds nest, chili sauce, Chinese parsley Many Chinese restaurants use MSG, but it
combinations common. Various (cilantro), cinnamon, cloves, cumin, curry is not usually used in the home.
tastes appreciated, such as the powder, five-spice powder (anise, star anise,
moldy flavor of lily flower buds. clove, cinnamon or cassia, Sichuan pepper),
Spice and herb preferences distin- fennel, fish sauce, garlic, ginger, golden nee-
guish regional cuisines. dles (lily flowers), green onions, hot mustard,
mace, monosodium glutamate (MSG), mus-
tard seed, nutmeg, oyster sauce, parsley,
pastes (hoisin, sweet flour, brown bean,
Sichuan hot beans, sesame seed, shrimp),
pepper (black, chile, red, and Sichuan), red
dates, sesame seeds (black and white), soy
sauce (light and dark), star anise, tangerine
skin, tumeric, vinegar
Nuts/seeds Nuts and seeds are popular snacks and Almonds, apricot kernels, areca nuts, cashews,
may be colored or flavored. chestnuts, ginkgo nuts, peanuts, walnuts;
sesame seeds, watermelon seeds
Beverages In northern China the beverage Beer, distilled alcoholic spirits, soup broth, tea
accompanying the meal often is
soup. In the South, it is tea.
Alcoholic drinks, usually called wines,
are rarely made from grapes. They
are either beers or distilled spirits
made from starches or fruit.
Fats/oils Traditionally lard was used if afford- Bacon fat, butter, lard, corn oil, peanut oil, Fat intake increases with consumption of
able. In recent years, soy, peanut, or sesame oil, soybean oil, suet fast foods and snacks
corn oil is more common.
Sweeteners Sugar not used in large quantities; many Honey, maltose syrup, table sugar (brown Sugar consumption has increased due to
desserts made with bean pastes. and white) increased intake of soft drinks, candy,
cakes, and pastries.
meat, or fish added for flavor. Congee is also fed with bits of shrimp, crab, and vegetables (called Birds nest soup is served
to people who are ill. Rice flour is used to make sui mai) or more substantial, bread-like versions, sometimes at special
rice sticks, which can be boiled or fried in hot oil. filled with spiced pork, minced beef, or sweetened occasions. It is made from
Wheat is also common throughout China, bean paste, then baked, steamed, or pan-fried. the cleansed nests of
swallows from the South
although it is used more often in the North than Buckwheat is grown in the North and commonly
China Sea. The nests are
the South. It is popular as noodles, thin wrap- made into noodles.
made of predigested
pers, dumplings, pancakes, and steamed bread. The Chinese eat a variety of animal protein seaweed and are bland in
Noodles are popular in soups, or pan-fried, then foods. Pork, mutton, chicken, and duck are common flavor yet very expensive.
topped with meats and vegetables that have been in many regions (see Regional Variations below). They are reputedly an
stir-fried separately. Thin, square wheat-flour Fish and seafood of all kinds are specialties. Eggs aphrodisiac.
wrappers are used to make steamed or fried egg are frequently consumed. They are sometimes
rolls with a meat, vegetable, or mixed filling and cooked as thin omelets in which to wrap foods or
wontons (in which the wrapper is folded over the to add to mixed dishes. However, eggs are most
filling), served either fried or in soup. Spring often prepared cooked, then salted and brined,
rolls, similar to egg rolls, are made with very thin, and are particularly popular in southern China.97
round, wheat-flour wrappers. Dumplings can be Thousand-year-old eggs (also called hundred-year-
small steamed bundles made with wontons filled old, century, and pine flower eggs) are duck or
324 EAST ASIANS
in soy sauce, tea, or other flavored liquids until

they shrink and become very chewy. They are
eaten for breakfast and snacks.100 More unusual
items include snakes, frogs, turtles, sea cucumbers
(also known as sea slugs, shell-less echinoderms
related to starfish and sea urchins), and seahorses.
The Chinese also raise many kinds of insects for
consumption, such as scorpions, which are pre-
pared fried or in soups.82
In China soybeans are known as the poor mans
cow, as they are made into products resembling
milk and cheese. Soybeans are transformed into an
amazing array of food products that are indispen-
sable in Chinese cooking (see Table 11.2). Other
beans are also popular, made into pastes, flour, or

even thin, transparent noodles known in the United
States as cellophane noodles or bean threads.
Chinese cuisine makes extensive use of veg-
etables. Many are those known in other regions of
Traditional foods of China. the world such as asparagus, broccoli, cabbage,
Some typical foods include chicken eggs cured for three months in a lime, cauliflower, eggplant, green beans, mushrooms,
bitter melon, bok choy, ash, and salt mixture. The whites become black onions, peas, potatoes, radish, and squash.
Chinese eggplant, ginger root, and gelatinous; the yolks turn greenish. In Taiwan Chinese varieties may differ, however. For instance,
long beans, lotus root, mush-
a similar specialty called iron eggs is common. leafy bok choy and wrinkled napa cabbage are
rooms, oyster sauce, pork,
long-grain rice, shrimp, soy
Chicken, pigeon, or quail eggs are cooked repeatedly preferred over European types; long beans, small
sauce, and water chestnuts.
Table 11.2 Common Chinese Soy Bean Products
Soy sauce Cooked soybeans that are first fermented and then processed into sauce. The southern
Chinese prefer light-colored soy sauce in some dishes over the darker, more opaque
kind used in Japanese and some regional Chinese cooking.
Soy milk Prepared with soaked soybeans that are first pureed, then filtered, and then boiled to
produce a white, milk-like drink.
Doufu (tofu) Made by boiling soy milk and then adding gypsum, which causes it to curdle. The excess
liquid is pressed from the bean curd, producing a soft or firm, bland, custard-like
product. Doufu can be purchased fresh, frozen, smoked, dried, sweetened, or in
sheets to make wrapped dishes.
Fuyu (sufu) Sometimes called Chinese cheesebean curd is fermented in brine and 100-proof
liquor. The aroma is tangy but the flavor is mild, except when chile peppers are
added to the process.
Black bean sauce Cooked fermented soybeans preserved with salt and ginger. Black beans are usually
added as a flavoring in dishes.
Brown bean sauce Similar to black bean sauce, but made with yellow soy beans.
Sweet bean sauce Similar to soy sauce but with reduced spicing and added sugar. It is common in
northern Chinese cooking.
Hoisin sauce Thick, brownish-red sweet-and-sour sauce that combines fermented soybeans, flour,
sugar, water, spices, and garlic with chilesoften used in southern Chinese
cuisine.
Oyster sauce Thick brown sauce prepared from oysters, soybeans, and brine that is also used in
southern Chinese fare.
Chili bean paste Very hot, thick paste made from brown bean sauce spiced with mashed chile peppers
and vinegar. A favorite in Sichuan cuisine.
purple eggplant, gai lan (Chinese broccoli, also bamboo leaf-green (95 proof), fen (made from rice, In some regions two longans
called Chinese kale), gai choi (Chinese mustard), 130 proof), hua diao (yellow rice wine), mou tai or litchis are placed under
and the large white icicle radish are featured in (made from sorghum, 110 proof), and red rice the pillows of newlyweds
many dishes. One popular squash variety is called wine. Beer is also very popular. because their names sound
like the words to have
a winter melon (when immature it is called fuzzy Most Chinese food is cooked, and very little raw
children quickly.92
melon); it is pale green and mild in flavor. food, except fruit, is eaten. Cooked foods may be
Mushrooms of all types, including black mush- eaten cold. Common cooking methods maximize In China a marriage is
rooms (a Japanese native also called shiitake), the the limited fuel available and include stir-frying, consummated when the
tiny enoki, grayish oyster mushrooms, straw mush- steaming, deep-fat frying, simmering, and roasting. new in-laws officially accept
rooms, and dried kinds such as cloud (or wood) In stir-frying, foods are cut into uniform, bite-size a cup of tea from the bride.
ears flavor numerous dishes. Lily buds, snow peas pieces and quickly cooked in a wok (a hemispheri- If the groom dies before the
(pea pods), bamboo shoots, chrysanthemum cal shell of iron or steel) in which oil has been wedding, the bride-to-be is
greens, water chestnuts, bitter melon, water con- heated. The wok is placed over a gas burner or in a said to have spilled her tea.
volvulus, and lotus root are other, more distinctively metal ring placed over an electric burner. Food can
Asian, vegetables found in Chinese cuisine. also be steamed in the wok. Bamboo containers,
The Chinese eat fresh fruit infrequently, occa- perforated on the bottom, are stacked in a wok
sionally for a snack or for dessert, and it is pre- containing boiling water and fitted with a domed
ferred slightly unripe or even salted. Chinese cover. Roasted food is usually bought from a com-
dates (jujubes), persimmons, pomegranates, and mercial shop, not prepared in the home.
tangerines are favorites. A few fruits are typically The Chinese usually strive to obtain the freshest Unlike northern or southern
preserved in syrups, such as pungent kumquats, ingredients for their meals, and in most American Chinese cooking, Taiwanese
yellow-orange loquats, longans (dragon eyes), and Chinatowns it is common to find markets that sell fare makes ample use of
litchis, a tropical fruit with creamy, jellylike f lesh. live animals and fish. However, because of seasonal herbs such as basil and
Traditionally people cooked with lard if they availability and geographic distances, many Chinese parsley. Vodka is a popular
alcoholic beverage; the most
could afford it. In recent years, soy, peanut, or foods are preserved by drying or pickling.
popular brand is named for
corn oil is more common. Until recently sugar the infamous Mongolian
Regional Variations. China is usually divided
was not used in large quantities; many desserts ruler, Ghengis Khan.23
into five culinary regions characterized by flavor
were made with sweetened bean pastes.
or into two areas (northern and southern) based
Hot soup or tea is the usual beverage accompa-
on climate and the availability of foodstuffs. In
nying a meal. Tea, used in China for more than
recent years, however, regional differences have
2,000 years, was first cultivated in the Chang Jiang
diminished due to increased global influences,
valley and later introduced to Western Europe in
particularly television.91
the seventeenth century. There are three general
types of tea: green, black (red), and oolong (black Northern. This area includes the Shandong and
dragon). Green tea is the dried, tender leaves of the Honan regions of Chinese cooking. The Shandong
tea plant. It brews a yellow, slightly astringent area (Beijing is sometimes included in this area,
drink. Black tea is toasted, fermented black-colored sometimes considered a third division of northern
leaves; it makes a reddish drink. Black tea is com- cooking) is famous for Peking duck and mu shu
monly drunk in Europe and America. Oolong tea is pork, both of which are eaten wrapped in Mandarin
made from partially fermented leaves and is a wheat pancakes topped with hoisin sauce. Honan,
Taiwanese specialty. Some teas in China are fla- south of Beijing, is known for its sweet-and-sour
vored with fruits or flowers, such as black tea with freshwater fish, made from whole carp caught in
litchis, or orange blossoms, or oolong with jasmine. the Huang River. Much of the North is bordered by
Other infusions of fruits or flowers are called tea, Mongolia, whose people eat mainly mutton.
including longan and chrysanthemum. Pearl tea, Grilling or barbecuing is a common way of One hundred people were
or bubble tea, made with chewy, pea-size balls of preparing meat in this area. One specialty is the killed in China during 1995
tapioca that are sucked up through large straws, Mongolian hot pot, featuring sliced meats and by exploding Mongolian
was also created in Taiwan and has become popu- vegetables cooked at the table in a pot of broth hot pots in restaurants. A
lar with Chinese youth worldwide. simmering over a charcoal brazier. The food is government crackdown is
addressing safety issues
Chinese alcoholic drinks are often called wines, eaten first, and the broth is consumed as a beverage
and the use of opium in
but they are not usually made from grapes.40 They afterward. (See also the box on Mongolian Fare.)
hot pot dishes.
are typically distilled alcohols made from grains or Northern China has a cool climate, limiting the
from fruit, such as plums. A few examples are amount and type of food produced. Traditionally,
326 EAST ASIANS
EXPLORING GLOBAL CUISINEMongolian Fare
T he Mongolians once ruled an empire over charcoal in a specially designed hot milk pie. Kumys, a wine distilled from
that stretched from China to Europe. pot that sits on the table. It is also added to fermented milk (traditionally mares milk),
In more recent times, it has been soups, stuffed into pancakes, and served on is a Mongolian specialty and consumed at
colonized by Russia and China. Today, it is sesame seed buns.96 many occasions.
an independent nation reestablishing its Dairy foods are numerous, prepared Millet is the staple grain in Mongolia.
cultural identity through shared language, from cow, sheep, goat, or camels milk. It is cooked like a porridge or roasted until
customs, and cuisine. There are three types of butter (liquid, it pops like popcorn. Flour is made from
Historically, Mongolians consumed red yellow, and white), a type of milk doufu, millet, buckwheat, or wheat and cooked as
foods (meat) and white foods (dairy), and sour milk (similar to yogurt), milk leather fried pancakes or steamed flat breads. Tea
this tradition continues today with the (made from the film skimmed off boiled is consumed at every meal and with snacks.
addition of some grain products. Meats, milk and air-dried), and fresh cheese. Milk Three meals a day are typical, consumed
especially mutton, goat, and beef, are is added to tea, called Mongolian tea, with the fingers. Special occasions include
favorites (camel meat is eaten when avail- sometimes with a little salt or fried millet.3 Lunar New Years and the Naadam festival,
able, though it is banned in some areas). Cheese is mixed with sugar and flour and a three-day event featuring wrestling,
Meat is enjoyed barbecued on a grill or then baked, to make a dessert known as archery, and horse races.
foods were often preserved, resulting in a prefer- delicate thickened sauces, and the use of vegetable
ence for salty flavors. In general, its staples are oil instead of lard. The Cantonese are known for
millet, sorghum, and soybeans. Winter vegetables dim sum (small bites, such as sui mai, pork ribs,
such as cabbage, turnips, and onions are common. meatballs, and other tidbits) served with tea. The
A delicacy from this area is braised bear paw. Hot staple foods of the South are rice and soybeans.
clear soup is the beverage that usually accompa- As in the North, a variety of vegetables from the
nies a meal. cabbage family are used, as well as garlic, melon,
Southern. Southern China is divided into three onions, peas, green beans, squashes, and a range of
culinary areas: Sichuan-Hunan, Yunnan, and Canto- root-like crops, such as taro, water chestnuts, and
nese (with Fukien and Hakka regional specialties). lotus root. Southern cooking uses mushrooms of
Sichuan-Hunan (some English translations still many types to enhance the flavor of the foods and
use the term Szechuan or Szechwan), which is an takes advantage of an abundance of fruits and nuts.
inland region, features fare distinguished by the Fish, both fresh and saltwater, are popular. Also
use of chiles, garlic, and the Sichuan pepper fagara. important are poultry and eggs. Pork is the preferred
Typical dishes include hot and sour soup, camphor meat. Tea is the beverage served with meals.
and tea-smoked duck, and an oily walnut paste Along the coast, Fukien provincial fare includes
and sugar dessert that may be related to the nut numerous seafood dishes and clear broths. Paper-
halvah of the Middle East. Yunnan cooking is dis- wrapped foods and egg rolls are thought to have
tinctive in its use of dairy products, such as yogurt, originated there. In the city of Shanghai, chefs spe-
fried milk curd, and cheese. Dishes are often hot cialize in new food creations and elaborate gar-
and spicy, and some of the best ham and head nishes. Red foods are also a specialty due to the use
cheese in China are found in this area. of red wine paste (a sediment remaining after the
Dumplings shaped like
animals, such as birds or Cantonese cooking is probably the most fermentation of rice wine) on pork, on poultry, in
frogs, are specialties in familiar to Americans, because the majority of soups, and even in dumpling dough.93
Xian. A dim sum banquet Chinese restaurants in the United States serve A southern regional specialty is Hakka cuisine,
may feature several dozen Cantonese-style food. It is characterized by stir- sometimes called the soul food of southern
varieties. fried dishes, seafood (fresh and dried or salted), China. The Hakkas fled to the South in the fourth
century B.C.E. when the Mongols invaded the

North. They remained an insular ethnic group,
preserving their traditional language, dress, and
foods. Their fare is hearty and robust, featuring
dishes made with red rice wine and pungent sea- SAMPLE MENU
sonings, cooked for a lengthy time, often in clay
pots. Salt-baked chicken, greens simmered with
pork fat, and meat-stuffed doufu are examples. Cantonese Dim Sum
Spring Rolls a, b or Fried Wontons a, b
Daily Patterns. The Chinese customarily eat
three meals per day, plus numerous snacks. Break- Sui Mai (Shao Mai) a, b
fast often includes the hot rice or millet porridge,
congee, which in southern China may be seasoned Tea Eggs a, b
with small amounts of meat or fish. In northern
China hot steamed bread, deep-fried crullers, Chinese Spare Ribs a, b
dumplings, or noodles are served for breakfast.
In Taiwan both southern- and northern-style Pearl Balls (Meatballs Coated with Rice) a, b
breakfasts are popular. In urban areas lunch is a
Egg Custard Tartlets a, b
smaller version of dinner, including soup, a rice
or wheat dish, vegetables, and fish or meat. Sliced Jasmine Tea or Chrysanthemum Tea
fruit may be offered at the end of the meal.
Although the Chinese are receptive to all types of
food, the composition of a meal is governed by spe-
a
cific rulesa balance between yin and yang foods Simonds, N. 1994. Classic Chinese cuisine. Boston:
and the proper amounts of fan and cai. Fan includes Houghton Mifflin Co.
b
all foods made from grains, such as steamed rice, About: Chinese Cuisine at
noodles, porridge, pancakes, or dumplings, which http://chinesefood.about.com/library/blrualpha.htm
are served in a separate bowl to each diner. Cai
includes cooked meats and vegetables, which are
shared from bowls set in the center of the table. Fan
is the primary item in a meal; cai only helps people
EXPLORING GLOBAL CUISINETibetan Fare
T he Chinese-controlled province of cream, and sometimes tea to make flat- brewed tea, is consumed throughout the
Tibet has a unique fare due to the tened balls consumed with tea or soup. day. Sour milk, milk solids preserved
isolation provided by its locale in The zampa can also be used to make from the crispy oil process, and the milk
the Himalayan Mountains. The founda- momos, a Tibetan dumpling filled with film skimmed from boiled milk and
tion of the diet is zampa, a toasted flour meat. Yak and mutton are common, but then dried are all consumed. Cabbage,
produced from barley or buckwheat. It most Tibetans who are Buddhist do not radishes, onions, garlic, leeks, and
is traditionally mixed with the butter eat pork, poultry, or fish.92 Dairy products potatoes are available. Wine, made
obtained from yaks, cows, or sheeps are also prevalent. Butter-tea, made by from barley or buckwheat, is served at
milk (called crispy oil), sugar, milk or churning crispy oil, milk, and salt with special occasions.
328 EAST ASIANS
eat the grain by making the meal more tasty. A meal alcoholic drinks should not be consumed alone,
is not complete unless it contains fan, but it does not and when the toast gambei (bottoms up) is made,
have to contain cai. At a banquet the opposite is true. everyone at the table drains their glass.
An elaborate meal must contain cai, but the fan is Though strict rules regarding dining behavior
usually an afterthought and may not be eaten. are observed in China, it is not uncommon to play
Street stalls and tea houses provide snacks and games at the table during a meal.97 This is especially
small meals when away from home. Though true at banquets, with guests joining and leaving
restaurants were traditionally uncommon in the game as they please. Multiple conversations
rural areas, today they are found throughout the may take place at once, and interruptions are fre-
nation. The Chinese all-you-can-eat buffet, which quent. It is considered polite to compliment the host
originated in the United States, is now found in throughout the meal on the deliciousness of the
some regions. Other American restaurant ideas food and on his or her good taste and wisdom.32
that have made their way to China include fast-
food franchises and food courts.97 Special Occasions. Traditionally the Chinese
week did not include a day of rest. Consequently,
Chopsticks were likely Etiquette. The traditional eating utensils are there were numerous feasts to break up the con-
invented as an extension of chopsticks and a porcelain spoon used for soup. tinuous workdays. Chinese festival days do not
the fingers. They are made Teacups are always made out of porcelain, as are fall on the same day each year because their cal-
from bamboo, ivory, or rice bowls. Few foods are eaten with the fingers, endar is lunar. Celebrations are traditionally yang
plastic. Chopsticks are used though that is changing somewhat in China occasions because heat symbolizes activity, noise,
in most countries that have
today, where it is sometimes acceptable to pick up and excitement in China.2 Yang foods, such as
been influenced by China,
wrapped or stuffed items, such as dumplings.98 meats, fried dishes, and alcoholic beverages, are
including Japan (where the
chopsticks are shorter and All courses of a meal are traditionally served at featured at festive banquets (see Therapeutic
have rounded rather than once. Each place setting includes a bowl of rice or Uses of Foods). Most Chinese homes are small
squared sides and more noodles, and each diner then takes what is desired and unsuited to entertaining, so special meals
pointed tips) and Korea from the communal serving plates. At the meal with guests are generally held at restaurants.97
(where the chopsticks are all diners should take equal amounts of the cai The most important festival is New Years,
typically made of metal, dishes, and younger diners wait to eat until their which can fall any time from the end of January
the same length as the elders have started; it is rude to reject food. It is also to the end of February. Traditionally the New
Japanese type, but flatter). considered bad manners to eat rice or noodles Year was a time to settle old debts and to honor
Chopsticks are found with the bowl resting on the table; instead, it should ancestors, parents, and elders. The New Year hol-
frequently in Vietnam
be raised to the mouth. It is rude to pick at your iday season begins on the evening of the twenty-
(the Chinese type), though
food or to lick your chopsticks. Laying your chop- third day of the last lunar month of the year. At
forks, spoons, and fingers
are also commonly used. sticks across the top of the rice bowl or dropping that time the Kitchen God, whose picture hangs
Other Southeast Asian them brings bad luck. It is also improper to stick in the kitchen and who sees and hears everything
cultures use chopsticks only chopsticks straight up in a rice bowl because in in the house, flies upward to make his annual report
occasionally, mostly for rice some areas this symbolizes an offering to the dead. on the family to the Jade Emperor. To ensure that
or noodles. Any bones or other debris should be placed on his report will be good, the family smears his lips
the small plate at each place setting, or on the with honey or sweet rice before they burn his pic-
table next to the rice bowl. ture. A new picture of the Kitchen God is placed in
Proper Chinese behavior at the table was first the kitchen on New Years Eve. Food preparation
outlined over 4,000 years ago, and many practices must be completed on New Years Eve, as knives
remain unchanged.97 Rules include not making cannot be used on the first day of the year because
noises while eating (except when consuming soup, they might cut luck. Deep-fried dumplings, made
when slurping facilitates cooling the soup and from glutinous rice and filled with sweetmeats, and
expresses pleasure), not grabbing food, not eating steamed turnip and rice flour puddings are usually
quickly, not putting food back on the communal included in the New Years Day meal.
plate after tasting it, and not picking ones teeth. During the New Year festivities, only good
Beverages, such as tea, should be served to others omens are permitted and unlucky-sounding words
at the table before pouring for ones self, and the are not uttered. Foods that sound like lucky words,
cups should not be filled to the brim. Both hands such as tangerine (good fortune), fish (surplus),
are used to offer a cup of tea, and the cup should chicken (good fortune), chestnuts (profit), and
be taken with both hands as well. Wine and other doufu ( fu means riches), are eaten. Friends and
relatives visit each other during the first ten days colder by the infusion or removal of heat. Foods According to the Chinese, a
of the new year, and good wishes, presents, and classified as yin or yang vary from region to child is one year old at birth
food are exchanged. Children receive money in region. Acculturated Chinese Americans may be and becomes two years old
small red envelopes. Traditionally the Feast of uncertain about some categorizations and thus after the New Year.
Lanterns, the fifteenth day of the first month, identify many foods as neutral.
The New Years dragon
ends the New Years season and is marked by the Typically, hot foods are eaten in the winter by
dance and firecrackers are
dragon dancing in the streets and exploding fire- menstruating women and for fatigue. Pregnancy thought to inhibit the yin
crackers to scare away evil spirits. is considered a cold condition, and birth is a dan- element and promote the
Ching Ming, the chief spring festival, falls 106 gerously cooling experience. Postpartum women yang forces. Red, the color
days after the winter solstice. Families customar- often remain indoors and eat hot foods, such as of yang, is used throughout
ily go to the cemetery and tend the graves of their chicken fried in sesame oil and pigs feet simmered the New Years season.
relatives. Food is symbolically fed to the dead and in vinegar, for four to six weeks after delivery.112
then later eaten by the family. Sweets and alco- This period is known as tso yueh-tzu, doing the
holic beverages are popular offerings. Duan wu, month. In addition to eating warming items, raw
the Dragon Boat Festival, is held on the fifteenth and cooling foods are avoided, as is contact with
day of the fifth month to commemorate the cold air, wind, and water (bathing in hot water
drowning death of a famous third-century B.C.E. with ginger in it is permitted after a few days).
poet. A boat race and special dumplings are tra- Other conditions caused by too much yin and
ditional. The Moon Festival occurs at the end of that respond to eating more yang foods include
September on a full moon (fifteenth day of the colds, flu, nausea, anemia, frequent urination,
eighth lunar month). Because the moon is a yin shortness of breath, weakness, and unexplained
symbol, this festival was traditionally for women, weight loss. It is also believed that as a person
but today it also symbolizes the togetherness of grows older, the body cools off and more hot
the family. It is sometimes called the harvest fes- foods should be eaten.
tival or moons birthday. Large round cakes filled Conditions due to excessive yang that improve
with spices, nuts, fruit, or red bean paste, called with an increase in yin food intake include con-
moon cakes, are typically eaten during this event. stipation, diarrhea, hemorrhoids, coughing, sore
throat, fever, skin problems, conjunctivitis, ear-
Therapeutic Uses of Food aches, and hypertension. Cool foods are consumed
Most Chinese believe eating the proper balance of in the summer, for dry lips, and to relieve irritability.
yin and yang foods is necessary to assure physical In addition to yin and yang, some foods are
and emotional harmony and to strengthen the believed to affect the blood or promote wound
body against disease (see Chapter 1, Food and healing and are labeled pu, or bo, meaning
Culture). Extra care should be taken with chil- strengthening. This classification is separate
drens diets because they are more susceptible from the concept of yin and yang but often used
to imbalance. in conjunction with it; most strengthening foods
Hot foods generally include those high in are also categorized as hot. The yin condition of
calories, cooked in oil, and irritating to the weak blood (most associated with pregnancy,
mouth and those that are red, orange, or yellow in postpartum, and surgery) is treated with specific
color. Examples include most meats, eggs, chile hot items such as protein-rich soups made with
peppers, tomatoes, eggplant, persimmons, pome- chicken, pork liver, eggs, pigs feet, or oxtail.
granates, onions, leeks, garlic, ginger, and alco- Other health-promoting foods identified by
holic beverages. Cold foods are often low in Chinese Americans include royal jelly (made
calories, raw or boiled/steamed, soothing, and from honey), bee pollen, lin chih (edible fungus),
green or white in color. Many vegetables and rattlesnake meat, dog meat, roasted beetles,
fruits are considered cold items, as are some barley juice, garlic, dong gwai (angelica, a celery-
legumes. Pork, duck, crab, clams, shrimp, snake like herb), fruit juice, and milk. Too many of cer-
meat, and honey also are classified as cold in tain yang items, however, can cause the blood to
some regions. Staples, such as boiled rice and thin, and these foods are avoided for conditions
noodles, and other commonly eaten foods, such such as hypertension.2, 73, 74, 134
as soy sauce and red or black tea, are typically Ginseng is the best-known health-promoting
placed in a third, neutral category.2, 73, 97 Some Chinese food. It is made from an herb (genus
food preparations can make foods hotter or Panax) found in Asia and the Americas. The root
330 EAST ASIANS
is boiled until only a sediment remains, then expressed preference for American foods.134 Meat
powdered for use in teas and broths. Ginseng and poultry intake increases, while some tradi-
reputedly cures cancer, rheumatism, diabetes, tional protein items like pigs liver and bone
sexual dysfunctions, and complaints associated marrow soup often remain popular. Greater
with aging. It is most often used as a restorative consumption of protein foods, in addition to
tonic. Taro root is also thought to have therapeu- increased intake of fast foods, soft drinks, candy,
tic properties, such as improving eyesight, curing and pastries, results in higher fat and sugar intake
vaginal discharge, reducing weakness, and pro- among more acculturated Chinese Americans.
moting multiple births; it will also bring good The impact of acculturation on fruit and veg-
luck if eaten on the fourth day of the first lunar etable intake is less clear. Traditional fruits and
month.92 Bitter orange is used to alleviate bloating vegetables may be replaced by more commonly
and constipation. Guava, which has some hypo- available American items, such as potatoes,
glycemic properties, is used for diabetes.17 Other lettuce, apples, peaches, and watermelon.121, 134
popular remedies include deer antlers, rhinoc- Some studies have found that greater fruit and
eros horns, and pulverized sea horses.130 The vegetable intake is associated with acculturation,
concept like cures like (sympathy healing) is education level, and income.75, 120 Among families,
seen in many food cures for specific illnesses.58 however, data indicate that pressure to maintain
Walnuts (which resemble brains) are eaten as a a traditional diet by elders living at home results
remedy for headaches in Hong Kong and to in a higher intake of fruits and vegetables among
increase intelligence in China.97 Red jujubes may all members.122
be consumed for strengthening blood, soups Even though milk is not a familiar item in the
made with bones are used for treating broken typical Chinese diet, several studies suggest that
bones, and male genital organs from sea otters, milk is consumed by nearly half to three-quarters of
deer, or other animals are eaten to cure impotence. Chinese Americans in the United States.120, 124, 134
In 1718 a Jesuit missionary Some food taboos have been noted during Cheese, yogurt, and ice cream have also been found
in Quebec discovered an pregnancy. Soy sauce may be avoided to prevent to be well accepted.
American species of ginseng dark skin, and iron supplements may not be One study found that dietary variety increased
that is nearly identical to taken because they are thought to harden the after immigration to the United States,75 and
the Chinese variety. babys bones and make birth difficult. Shellfish another noted that U.S.-born Chinese women
Growing demand in China
may also be shunned for the same reason.10 have a more varied diet than Chinese American
led many Americans,
including Daniel Boone, to women who were foreign born.131 Respondents
hunt the root for export. ate more breads, cereals, dairy foods, meats, veg-
etables, and ethnic items, such as Italian and
Eating crab and persim-
IN THE UNITED STATES Mexican foods.
mons together is one food Adaptations of Food Habits
taboo practiced by some Meal Composition. Skipping meals and increased
Chinese Americans elders
Generally speaking, changes in the eating habits
snacking have been reported in Asian students
because these foods repre- of Chinese Americans correlate with increased
and in Chinese-American and Chinese-Canadian
sent extreme hot and length of stay in the United States, particularly in
women.75, 103, 121 Surveys of Chinese in North
extreme cold and may be subsequent generations. Dinner often remains
America suggest that traditional foods are the
poisonous if mixed. the most traditionally Chinese meal, whereas
choice of older, less acculturated adults, and their
breakfast, lunch, and snacks tend to become more
preferences sometimes influence household
Americanized. Younger persons are also more
meals.13, 14, 122 Lunches and dinners may consist
likely than their elders to accept American fare.
mainly of Chinese-style foods, while breakfasts
Ingredients and Common Foods. Most Ameri- are more variable. Many Chinese Americans
cans of Chinese descent regularly consume attempt to balance hot and cold items in their
several Chinese foods, such as rice, pork, seafood, diets. Other studies suggest that the use of yin
soup broth, soybean products, cooked vegetables, and yang in the diet may diminish over time and
tea, and fruit.13, 138 One preliminary study sug- that Chinese Americans may practice some
gests that the majority (88%) of foreign-born aspects of it but without knowledge as to why
immigrants prefer Chinese fare at home, although certain food combinations are preferred.14, 74, 97
younger respondents (ages twenty to thirty-four) Stir-frying, simmering, and steaming remain the
favored cooking methods.134, 153 In one study more intake is satisfactory, perhaps due in part to the use A study of Asian college stu-
acculturated respondents found cooking Chinese of iron-containing cooking tools, such as woks.153 dents found fast foods and
meals was inconvenient.122 Obesity and overweight are found to be low sweet/salty snacks very
Americans of Chinese descent usually celebrate among Chinese Americans.65, 81, 114 In one national popular. Intake of fats,
sweets, dairy products, and
the major Chinese holidays of New Years and the survey Chinese were found to have very low
fruit increased, while intake
Moon Festival with traditional foods. Chinese- median body mass indexes (BMIs) when com-
of meats and vegetables
American Christians sometimes combine the pared to the general U.S. population. However, decreased.103
spring festival of Ching Ming with Easter festivities. median BMI and proportion obese went up sig-
In addition, some Chinese Americans recognize nificantly for U.S.-born subjects when compared
the founding of the Peoples Republic of China to foreign-born subjects.65 In a study of Chinese-
(mainland China) on October 1 (on the solar American children, 33 percent were reported
calendar) or the establishment of the Republic overweight (BMI 85th percentile); however, the
of China (Taiwan) on October 10 with cultural mothers degree of acculturation was found
performances and banquets. inversely associated with risk.16
Concerns that overweight and obesity may
Nutritional Status become problematic in this population as demo-
Nutritional Intake. The traditional Chinese graphics change over time are as yet unconfirmed.
diet is low in fat and dairy products and high in Research on anthropometric measures indicates
complex carbohydrates and sodium. As length of that weight-to-height ratios underestimate obe-
stay and the number of generations living in the sity in Chinese Americans when skinfold meas-
United States increase, the diet becomes more urements are also taken.90 Chinese heritage was
like the majority American diethigher in fat, found to modify waist circumference measure-
protein, sugar, and cholesterol, and lower in comments and metabolic risk factors.66 Calculated
plex carbohydrates. Research on women in the energy requirements may differ as well. Predictive
United States and Canada reported even less equations for basal metabolic rate (BMR) and for
acculturated respondents consumed milk, ate resting energy expenditure (REE) are found to
cheese, ate fast foods, and snacked regularly,120 overestimate BMR and REE in adult Chinese
and another study of women including foreign- Americans. There is concern in some Asian
born Chinese Americans, U.S.-born Chinese nations about the increasing incidence of eating
Americans, and white Americans revealed that disorders in young women.11, 70, 147
all three groups consumed more than recom- Studies of type 2 diabetes in Asians show
mended levels of fat in their diets, suggesting unadjusted rates lower than in whites. Yet studies
that some changes in food consumption may indicate that when adjusted for BMI, Asians are
occur very quickly.124 The U.S.-born cohort also 60 to 74 percent more likely than whites to
demonstrated high levels of nutrition knowledge, develop the condition.81, 125 Further, data suggest
and their diet contained a higher concentration that weight gain associated with incidence of type
of nutrients than either the foreign-born Chinese 2 diabetes was particularly detrimental in
Americans or the white Americans.131 Asianseach five-kilogram gain increased risk
Some Americans of Chinese descent continue by 84 percent, nearly double the increase found
to avoid fresh dairy products because of lactose in any other ethnic group in the study. Data on
intolerance, which may be found in as many as diabetes specific to Chinese Americans are
75 percent of Asians. Low calcium intake has been sparse, but these pan-Asian studies suggest type 2
reported in some samples.53, 124 Alternative cal- diabetes may become a significant health issue if
cium sources are bean curd, soy milkif fortified overweight and obesity rates grow.
with calciumand soups or condiments made It is generally assumed that many Chinese eat
with vinegar in which bones have been partially a diet high in sodium, which may contribute to
dissolved. However, as noted previously, many high blood pressure. Hypertension rates among
Chinese Americans do consume milk, cheese, Chinese Americans are lower than for whites, but
and yogurt, as well as leafy green vegetables, and one study found Chinese subjects are 30 percent
calcium deficiency should not be presumed. Low more likely than whites to have high blood pressure
vitamin A and C intake has been observed in when adjusted for age, BMI, prevalence of diabetes,
some Americans of Chinese descent, but iron and smoking.59 In that study one-third of Chinese
332 EAST ASIANS
Americans with hypertension were treated but specifically has been reported. Clonorchiasis, a
uncontrolled; however, the difference from the liver fluke infection of the biliary passage or pan-
percentage for whites was not significant when creatic ducts, has been identified in 25 percent of
controlled for socioeconomic status. Another immigrants from Hong Kong and a smaller
study found that when compared to whites, number of those from China.41 Also noted are
Chinese Americans who suffered from stroke had high rates of certain inherited conditions, includ-
higher risk profiles, including history of hyper- ing thalassemias and glucose-6-phosphate dehy-
tension, history of diabetes, and higher levels of drogenase deficiency.142
A study of acculturation and blood lipids and glucose.30 Hypertension is con- Studies do not typically differentiate Chinese-
diet in Chinese-American sidered a yang condition and is often treated by American immigrant groups. Compared to immi-
women found that Chinese- the consumption of yin foods.95 grants from the mainland, recent Taiwanese
language newspapers and Low rates of cardiovascular disorders have Americans are more likely to experience conditions
friends were primary been found among Americans of Chinese descent. due to overconsumption than underconsumption.
sources of nutrition infor-
However, cardiovascular disease rates in China Obesity has increased dramatically in Taiwan
mation.121
increased 60 percent between 1993 and 2003, during the past several decades; impaired fasting
paralleling increased rates of overweight and glucose occurs at rates three times that of the general
obesity, diabetes, and hypertension.143 Prevalence U.S. adult population, and age-adjusted prevalence
in the United States may also increase with these of type 2 diabetes (9.2%) is nearly double.15, 35
changes in first-generation immigrants, as well as
with possible changes in subsequent generations. Counseling. Americans of Chinese descent accept
Cancer risk, especially for colorectal and breast personal responsibility for their health; keeping
cancers, has been found to increase with length healthy is considered an obligation to family and
of stay in the United States, and cancer is now the society. However, biomedical health care is under-
leading cause of death in Chinese Americans. utilized. Language barriers are thought to be one
Inadequate preventative screenings and dietary issue. Only 15 percent of Chinese Americans speak
changes, including lower intake of protective English at home, and nearly 50 percent report
foods (e.g., soybean products) and higher intake that they speak English less than very well.117
of saturated fats, are thought to be factors. Rates Low income, long work hours, and inconvenient
of liver cancer among men and cervical cancer locations are other reasons believed to limit
among women are significantly higher than access. Lack of health care insurance is another
among whites.16, 47, 146 factor, which may be due to expense, or because
Infant mortality rates for Chinese Americans purchasing insurance is sometimes seen as inviting
are very low.80 Most studies report low-birth- death.76, 142, 149 Mistrust of biomedicine, especially
weight rates among Chinese Americans similar its possible side effects, is also found.76, 77 The con-
to those of whites. However, some researchers cept of preventive checkups is unfamiliar to many
suggest that the definition of low birth weight Chinese Americans.22, 69
may be inappropriate for Chinese infants who are Perhaps because Chinese Americans frequently
typically smaller than the U.S. average.36 New believe that hospitals are where a person goes to
recommendations for maternal weight gain in die, hospitalization rates of Chinese Americans are
Chinese women have recently been proposed.148 lower than for any other ethnic group in America.
Breast feeding is reportedly common in China,130 Blood tests, thought to permanently diminish the
and 65 percent of Chinese women in Australia blood supply, are of particular concern to some
breast fed their infants in one study.26 However, a Chinese clients who may avoid all biomedical
study of first-generation Chinese immigrants in health care for this reason.
France found that only 10 percent of new mothers Some Chinese Americans favor biomedical
initiated breast feeding, and that young children providers of Chinese heritage, citing common lan-
were weaned to a diet low in dairy products and guage, mutual sympathy, and flexible appoint-
fresh fruit and high in soft drinks.119 ments (many Chinese are polychronic).76 Effective
High rates of tuberculosis, parasitic infection, treatment is the primary concern for most clients,
and hepatitis B have been found in many recent however. Preferred communication style is formal
Asian-American immigrants. Limited information and includes unrushed dialogue (focusing on time
regarding prevalence among Chinese immigrants is considered offensive), detailed explanation of the
origins and symptoms of any condition in under- Chinese-American women may be very modest,
standable terms, simple treatment, and a positive especially regarding touching. Traditionally, Chinese
outlook. Chinese patients consider it important to women were never touched by male health care
maintain hope. When possible, terminal illness providers (today, more than 90 percent of obste-
should be discussed first with family members to tricians and gynecologists in China are women).
determine how and when a client is informed. Symptoms would be discussed by pointing to an
Medical confidentiality is not widely practiced.39 alabaster figurine.103 If a male must do an exami-
The Chinese have a quiet conversational nation, a formal, polite attitude, explanations of all
approach, especially with strangers and acquain- procedures, and avoidance of tension-relieving
tances. Some speakers may pause during conver- jokes or comments will help the client feel more at
sation as a sign of thoughtfulness. Interruptions ease.39 Furthermore, within the family, sons receive
should always be avoided. Many Chinese avoid more concern and attention over minor symptoms
confrontation and may initially say yes to ques- than daughters. Women consequently may not
tions that require a positive or negative response. believe that their complaints warrant care.
Asking questions can be interpreted as disrespect, a Researchers are unsure how many Chinese
sign that the person speaking is being unclear. Americans use Traditional Chinese Medicine. The
Surprise or discomfort may be expressed by quickly majority are believed to first self-diagnose and
and noisily sucking in air.4 If a person is offended, self-prescribe at home before seeking outside
he or she may become very direct and even loud in care, although the reasons why certain foods or
expressing anger. Conversations between friends or medications are consumed for an illness (particu-
family members are often animated.32 Eye contact larly the complementary use of yin and yang) are
is made briefly during introductions, but indirect often lost through acculturation.14, 74 Biomedicine
eye contact is standard. Direct eye contact may be is completely accepted by many Chinese Americans;
interpreted as confrontational. one unpublished study found that 88 percent
Elder or less acculturated Americans of Chinese of foreign-born Chinese-American subjects pre-
descent may show deference to authority by means ferred biomedical care for the treatment of illness.134
of acceptance and submission. In the hospital set- Others consider biomedicine best in the treat-
ting, patients are often silent rather than voicing ment of acute symptoms, and TCM best for chronic
complaints; providers should not necessarily conditions.76 For example, a client with type 2
accept this as compliance but should actively seek diabetes may consult a biomedical physician
information about patient satisfaction. Emotional regarding symptoms but, when he or she finds
displays are considered immature, but most that no immediate cure is offered, may seek a
Chinese patients are willing to discuss feelings in TCM doctor to restore balance to the body and
conjunction with somatic symptoms (see the sec- treat the actual cause of the disease.
tion Traditional Health Beliefs and Practices).142 Practitioners of TCM are often consulted con-
The traditional Chinese greeting is a nod or a currently with biomedical care in an effort to
slight bow from the waist while holding palms maximize the chances of a cure. Few conflicts in
together near the chest, often without a smile. therapies have been identified, although the
Traditionally, surnames come first, followed by active agents in most herbal medicines remain
given names, and women do not customarily take unidentified in biomedical terms. It is possible
their husbands last name when married, so sur- that a formulary preparation might be additive
names may differ within the same family. Use of
any titles demonstrates respect. Touching between
strangers and acquaintances is uncommon.149
Even handshaking may be inappropriate (wait for
Image not available due to copyright restrictions
the extended hand, especially with women),
except for westernized Chinese Americans and
people from Hong Kong. Hugging, kissing, and
back-patting should be avoided. Good posture is
expected, and slouching or putting ones feet on a
desk is considered rude. Personal space is typi-
cally farther apart than in Western cultures.32
334 EAST ASIANS
with a prescribed medication, producing excessive and acculturation may significantly impact dietary
response, such as taking guava juice with hypo- intake of Chinese Americans, and individual pref-
glycemics. Conversely, a TCM product taken for a erences should be determined.
different condition might counteract a drug ther-
apy. For example, bitter orange peel (which con-
tains synephrine, a chemical similar to stimulant Japanese
ephedrine) may be taken for constipation, thus
reducing the effectiveness of a clients hypoten- The multi-island nation of Japan is off the coast
sive prescription. Providers should encourage of East Asia and has approximately the same lati-
traditional practices if desired by a client, but ask tude and range of climate as the East Coast of the
for information regarding herbal medicines con- United States. The capital of Japan is Tokyo,
sumed. A prescription from a TCM doctor remains located on the island of Honshu. Today Japan is a
in possession of the client, who may reuse it if prosperous country of over 127 million people
symptoms reoccur or who may share it with that has overcome the limitations of a mountainous
family and friends. Some prescriptions are passed geography, a rugged coastline, and few mineral
along from generation to generation; others are resources. Perhaps Japans greatest natural resource
obtained directly from China. Occasionally, a client is the sea, which provides one of the richest fishing
may present multiple burn marks from moxibus- grounds in the world.
tion, and the clients use of this treatment should
be determined before presumption of abuse. CULTURAL PERSPECTIVE
A Chinese client expects that the provider will
perform few tests and ask a limited number of History of Japanese in the United States
questions during an examination. Recommenda- Immigration Patterns. Significant Japanese
tions on diet, relaxation, and sleep are desired as immigration to the United States occurred after
an integral part of treatment. Long-term therapy 1890 during the Meiji era. The immigrants were
intended to cure a disease is preferred over short- mostly young men with four to six years of edu-
In Asia nurses perform only term surgical solutions or invasive treatment, even cation from the rural southern provinces of Japan.
medical procedures. Family at the expense of pain or discomfort from symp- Most came for economic opportunities and many
members stay at the hospi- toms. Most Chinese clients are resolved to die at eventually returned to Japan. They settled prima-
tal to provide feeding, home (many actually return to China), and their rily in Hawaii and on the West Coast of the United
bathing, and general care wishes should be accommodated. States and often worked in agriculture, on the
for the patient.
Few compliance problems have been noted. railroads, and in canneries. Like the Chinese before
In 2004 the U.S. Food and
One difficulty that sometimes arises is the issue them, Japanese immigrants opened small busi-
Drug Administration banned of lengthy or continuous medication. Many nesses, such as hotels and restaurants, to provide
the Chinese herb ma huang Chinese are accustomed to single-dose Chinese services for their countrymen. In contrast to the
(ephedra), a methampheta- remedies and may discontinue a prescription if Chinese, many Japanese became farmers, ran plant
mine-like stimulant with directions are not thoroughly explained. Many nurseries, and were employed as gardeners. The
serious side effects such researchers have remarked on the difficulty of Japanese prospered within their ethnic commu-
as heart attack, stroke, eliminating high-salt items (e.g., soy sauce) from nities. Most Japanese women came to the United
seizures, and psychosis. In a Chinese fare and recommend reduction as a goal States as picture brides: Their marriages were
subsequent lawsuit, a court in cases where a low-sodium diet is required.18 arranged by professional matchmakers, and they
ruling partially overturned Dairy products may be accepted when clients were married by proxy in Japan. They did not
the ban, permitting small
become familiar with the foods.124 One study of usually meet their husbands until they disem-
amounts to be included in
diet preparations.
nursing home residents found a significant dislike barked from the ship in the United States. Among
of western foods among Chinese elders.12 Japanese Americans, first-generation immigrants
An in-depth interview should tactfully be born in Japan are called Issei, second-generation
conducted to identify which traditional practices, Japanese Americans born in the United States are
if any, are followed by a client. Even when con- known as Nisei, and the third and fourth genera-
cepts such as yin and yang are considered primi- tions are known as Sansei and Yonsei, respectively.
tive or rustic by some Chinese Americans, they Discrimination against the Japanese was
may still adhere to certain food combinations commonplace. The Issei were classified as aliens
learned at home without knowing why. Birthplace who were ineligible to become naturalized U.S.
citizens, and in 1913 land ownership became

illegal in California. Although many bought
land in the names of their children, who were
Americans by birth, Japanese-owned and -leased
land was reduced by half in the 1920s. In 1907
the Japanese government had informally agreed
to limit the number of emigrants, and in 1924
the Japanese Exclusion Act halted Japanese
immigration completely.
World War II heightened the prejudice against
the Japanese on the West Coast. After Japan
attacked Pearl Harbor, all West Coast Japanese,
even if they were U.S. citizens, were evacuated to
war relocation camps, and many remained there
for the duration of the war. Most lost or sold their
businesses as a result of internment. Nevertheless,
Kevin Fleming/Corbis
many Nisei volunteered for combat duty and
fought in Europe.
Current Demographics and Socioeconomic

Status. After the war, most Japanese Americans
Japantown, San Francisco.
resettled on the West Coast, and the most dis-
criminatory laws were repealed or ruled uncon-
stitutional. The successful postwar recovery of and public sector positions, however, and believe
Japan resulted in reduced emigration to the that they suffer from the stereotype of being too
United States, usually far below the quota allotted unassertive for upper management.27 Over 85,000 residents of
Japanese ancestry were
under current immigration laws. According to Worldview living in Canada in 2001.
2005 U.S. Census estimates, 833,000 Japanese
Americans live in the United States, a majority of Religion. Early Japanese immigrants usually
joined a Buddhist temple (Pure Land sect) or a
whom reside in California or Hawaii. Many West
Christian church after arriving in America. The
Coast cities have a section of town called Little Heikegani crabs are believed
church frequently provided employment and an to be reincarnations of
Tokyo or Japantown, and a small number of
opportunity to learn English. Today, it is thought drowned warriors due to
older Japanese still live in these homogeneous
that there are more Japanese Americans who belong the face-like markings on
neighborhoods. Most Japantowns contain Japanese
to Protestant faiths than who follow Buddhism.117 their shells.
Americanowned restaurants, markets, and other
Shintoism, the indigenous religion of Japan,
small businesses, as well as Chinese churches or
does not have a formal organization, but its beliefs
Buddhist temples.
are a fundamental part of Japanese culture. The
More than 95 percent of Japanese Americans
Shinto view is that humans are inherently good.
live in culturally mixed urban and suburban
Evil is caused by pollution or filthinessphysical
areas. Americans of Japanese descent are unique
as well as spiritual; goodness is associated with
for a nonwhite ethnic group in the high rate of
purity. Evil can be removed through ritual purifi-
citizenship, degree of assimilation, and economic
cation. Shinto deities, called kami, represent any
mobility they have experienced.117 Over 90 per-
form of existence (human, animal, plant, or geo-
cent of all Japanese Americans have graduated
logic) that evokes a sense of awe. Kami are wor-
from high school, and of the third-generation
shipped at their shrines as ritual expression of
Sansei, many of whom were born in the reloca-
veneration and thankfulness. Prayers are also
tion camps, 88 percent have attended college and
said for divine favors and blessings, as well as for
most hold professional jobs. In 2000, median
avoidance of misfortunes and accidents.
family income was 40 percent above the national
average, and fewer than 10 percent of families Family. Until World War II the structure of the
lived in poverty. Some Japanese Americans have Japanese-American family had its roots in Japan
noted that few Asians are found in top private and was similar to that of the Chinese due to the
336 EAST ASIANS
strong influence of Confucianism. In addition, the Sansei couples generally form dual-career
rigid pattern of conduct that evolved in Japan households. Nearly 50 percent marry outside their
during the sixteenth century resulted in the follow- ethnic group. The societal problems prevalent in
ing practices among the Issei and their descendants: majority American homes, such as spousal abuse,
1. Koko. Filial piety defines the relationship have surfaced among Japanese Americans as well,27
between parents and children, between and it is not known if the family values that have
siblings, and between individuals and their thrust Americans of Japanese descent into educa-
community and rulers. (See the Chinese tional and financial success will continue in the
religion section on Confucianism in the first fully assimilated fourth-generation of Yonsei.
part of this chapter for further explanation.)
Traditional Health Beliefs and Practices. Early
One outcome is that the Issei expect their
Japanese health beliefs involved Shinto concepts
children to care for them in their old age.
of purity and pollution. Health was maintained
2. Gaman. Most Japanese believe it is virtu- through cleanliness and avoidance of contami-
ous to suppress emotions. The practice of nating substances such as blood, skin infections,
self-control is paramount. and corpses.42 Botanical remedies were used,
3. Haji. Individuals should not bring shame particularly purgatives, in the prevention and
on themselves, their families, or their com- treatment of disease.
munities. This Japanese cultural concept When Buddhism was introduced in the sixth
exerts strong social control. century, the concept of harmony was applied
4. Enryo. There is no equivalent word in within the context of Japanese culture to mean a
English, but many Japanese believe it persons relationship with nature, family, and
is important to be polite and to show society. Imbalance resulting from poor diet,
respect, deference, self-effacement, insufficient sleep, lack of exercise, or conflict with
humility, and hesitation. Thus, some family or society disrupts the proper flow of energy
older or less-acculturated Americans of within the body, leading to illness. Chinese prac-
Japanese descent are neither aggressive tices such as acupuncture, moxibustion, and
nor assertive. massage were accepted as ways to restore the
Japanese clan or village affiliation has tradi- energy flow along the meridians of the body
tionally been much weaker than in China, and (see the section Traditional Health Beliefs and
Japanese immigrants arrived in the United States Practices in the section about Chinese people in
prepared to raise nuclear families similar to those this chapter). The application of yin and yang in
in white America. Even when picture brides were health and diet was limited in Japan.
trapped in unhappy marriages, they persevered The more complex herbal medications of
on behalf of their children. Most Issei women China were brought to Japan as kanpo. However,
worked alongside their husbands to support the the numerous plants, animals, and minerals
family financially. necessary for kanpo were not widely available
The internment of Japanese Americans during on the islands, so its use was confined to the elite,
World War II brought further changes in family urban aristocracy until recent times. Practitioners
structure and accelerated acculturation into main- of the profession were called kanpo-i and under-
stream society after the war. In the camps very low went rigorous training.
wages were paid and the pay was the same for Kanpo-i approached each case individually,
everyone; thus the father could no longer be the reviewing symptoms carefully and in detail before
primary wage earner. The camps were run demo- determining the best combination of therapies
cratically, but positions of authority could be held and medications for the specific patient. Diagnosis
Japanese physicians were
only by American citizens, so the younger genera- was an art that recognized that symptoms may
polled to discover why they
began prescribing tradi-
tion held these more prestigious jobs. The camps present differently in every consultation.71 Western
tional herbal remedies; a also allowed the Japanese to work in a wider range biomedicine was introduced to Japan in the six-
majority said they were of fields than those available to them on the outside. teenth century with the arrival of the Portuguese. It
influenced by pharmaceuti- After their internment, the Nisei no longer had to was widely embraced; Japanese kanpo-i were
cal company salespeople follow the few occupations of their parents, and required to retrain if they wished to continue work-
and advertising. many chose to follow different paths. ing as doctors. The majority of Japanese Americans
migrated to the United States during the time

when kanpo was rarely practiced, and they were
often unfamiliar with its therapies.
Since 1960 Japan has been in the middle of
a kanpo boom.71 Concerns about the side effects
of biomedical therapeutics and a growing interest
in holistic and herbal healing have prompted
the resurgence.
Kanpo-i take a generalized approach, using
natural medications with broad effects to stimulate
the immune system. Some herbs also have known
bacteriostatic action or anti-inflammatory prop-
erties. Small doses of the medications are taken
for lengthy periods of time to promote gradual

improvement. Physicians trained in biomedicine
are also prescribing kanpo for many clients (though
without the extensive education of kanpo-i); mass
production of herbal medications by pharmaceu-
tical companies began in the 1970s. Traditional foods of Japan.
Stress-induced illness is of particular concern Some typical foods include
in Japan. Work-related fatigue and symptoms of daikon, dried sardines,
meal so that the visual appeal reflects balance
anxiety and depression have risen dramatically in Japanese eggplant, Japanese
among the foods and the environment. For
the past decade.113 An estimated 10,000 men die pickles, nori (seaweed), red
example, a summer meal may be served on glass beans, shiitake mushrooms,
annually from koroshi (literally death from over-
dishes so that the meal looks cooler, while a short-grain rice, shrimp, soy
work, but referring to suicide). The healing
September meal may include the autumn colors sauce, and wheat noodles.
industry in Japan is an estimated $30 billion-a-
of reds and golds.
year business.28 Stress-reducing therapies, called
iyashi, include herbs, teas, and ten-minute massage Ingredients and Common Foods
parlors. One aquarium provides overnight accom-
Japans mountainous terrain and limited arable Sea urchin roe, called uni, is
modations in its tank rooms, where visitors can
land have contributed historically to a less-than- thought to enhance male
sleep to relaxing music in the company of swaying sexual potency in Japan,
abundant food supply. Even today much of
jellyfish. Spas offer specialized soaking alternatives, where wholesalers pay up
Japans food supply is imported.
such as bathing in coffee, green tea, red wine, or to $100 per pound for it.
sake, to rejuvenate and energize clients. Researchers Staples and Regional Variations. The basic foods California imposed strict
report such activities result in reduced levels of of the Japanese diet are found in the Cultural Food urchin harvesting laws to
stress hormones as measured in saliva tests.137 Groups list (Table 11.3). Several key ingredients prevent extinction along the
Napping on the job and at school has also gained were adopted from China, including rice, soy- coast. Maine suffers from
some acceptance following studies on how short beans, and tea. Rice (gohan, the word for cooked similar overharvesting.
rests can improve productivity.29, 135 rice, and also for meal) is the main staple eaten
with almost every meal. In contrast to the Chinese,
the Japanese prefer a short-grain rice that contains
more starch and is stickier after cooking.
Japanese ingredients, as well as cooking and eating Rice mixed with rice vinegar, called su, is used
utensils, are very similar to those of the Chinese, in sushi, one of the most popular Japanese spe-
due to Chinas strong influence on Japan. Yet cialties in both Japan and abroad. Sushi rice is
Japanese food preparation and presentation are formed with fish and seafood to make decorative,
unique. The Japanese reverence for harmony within bite-sized mounds served with soy sauce for dip-
the body and community and with nature has ping. Types of sushi include Nigirisushi, which
resulted in a cuisine offering numerous prepara- features rice topped with items such as sliced raw
tion methods for a limited number of foods. Each fish or squid (called sashimi), cooked octopus,
item is to be seen, tasted, and relished. The Japanese crab or shrimp, omelet strips, or roe of salmon
also place an emphasis on the appearance of the (ikura), sea urchin (uni), or flying fish (tobikko),
338 EAST ASIANS
Table 11.3 Cultural Food Groups: Japanese

Protein Foods
Milk/milk products Japanese cooking does not utilize Milk, butter, ice cream First-generation Japanese Americans drink little
significant amounts of dairy products. milk and eat few dairy products. Subsequent
Many Japanese are lactose intolerant. generations eat more dairy foods.
Soybean products, seaweed, and small
bony fish are alternative calcium sources.
Meat/poultry/fish/ Soybean products and a wide variety of fish Meat: beef, deer, lamb, pork, rabbit, veal Dried fish and fish cakes are available in the
eggs/legumes and shellfish (fresh, frozen, dried, smoked) Poultry: capon, chicken, duck, goose, partridge, United States, but some varieties of fresh fish
are the primary protein sources in the pheasant, quail, thrush, turkey are not.
Japanese diet. Fish and shellfish often Fish: blowfish, bonito, bream, carp, cod, cuttlefish, Japanese Americans eat more poultry and meat
eaten raw. eel, flounder, herring, mackerel, porgy, octopus, than fish.
Chicken is used more often than beef; red snapper, salmon, sardines, shark, sillago,
price is the limiting factor in meat snipefish, squid, swordfish, trout, tuna, turbot,
consumption. yellowtail, whale
Shellfish: abalone, ayu, clams, crab, earshell, lobster,
mussels, oysters, sea urchin roe (uni), scallops,
shrimp, snails
Legumes: adzuki, black beans, lima beans, red beans,
soybeans
Cereals/Grains Short-grain rice is the primary staple of the Wheat, rice, buckwheat, millet Rice is still an important staple in the diet and
diet and is eaten with every meal. usually eaten at dinner.
Wheat is often eaten in the form of
noodles, such as ramen, somen,
and udon.
Fruits/Vegetables Fresh fruits and vegetables are the most Fruits: apples, apricots, bananas, cherries, dates, figs, Fewer fruits and vegetables are eaten; freshness
desirable; usually eaten only grapes, grapefruits (yuzu), kumquats, lemons, is less critical.
in season. limes, loquats, melons, oranges, peaches, pears,
Many fruits and vegetables are preserved, pear apples, persimmons, plums (fresh and pickled),
dried, or pickled. pineapples, strawberries, mikan (tangerine)
Vegetables: artichokes, asparagus, bamboo shoots,
beans, bean sprouts, broccoli, brussels sprouts, beets,
burdock root (gobo), cabbage (several varieties),
carrots, chickweed, chrysanthemum greens,
eggplant (long, slender variety), ferns, ginger,
ginger sprouts and flowers (myoga), and pickled
ginger (beni shoga), green onions, green peppers,
gourd (kanpyo, dried gourd shavings), kudzu,
leeks, lettuce, lotus root, mizuna, mushrooms
(shiitake, matsutake, nameko), okra, onions, peas,
potatoes, pumpkins, radishes, rhubarb, seaweed,
snow peas, shiso, sorrel, spinach, squash (including
kabocha), sweet potatoes, taro, tomatoes, turnips,
watercress, yams
Additional Foods
Seasonings Sugar, shoyu, and vinegar are a basic Alum, anise, bean paste (miso), caraway, chives,
seasoning mixture. Shoyu and mirin dashi, fish paste, garlic, ginger, mint, mirin, MSG,
can vary in strength; amounts used will mustard, red pepper, sake, seaweed, sesame seeds,
vary according to taste. shiso, shoyu, sugar, thyme, vinegar (rice), wasabi
(green, horseradish-like condiment)
Nuts/seeds Chestnut, gingko nuts, peanuts, walnuts; poppy
(black and white), sesame seeds
Beverages Green tea is the preferred beverage with Carbonated beverages, beer, coffee, gin, tea Japanese Americans drink less tea and more
meals; coffee or black tea is drunk with (black and green), sake, scotch milk, coffee, and carbonated beverages.
western-style foods.
Sake or beer is often served with dinner.
Fats/oils The traditional Japanese diet is low in fat Butter, cottonseed oil, olive oil, peanut oil, sesame Japanese Americans consume more fats and oils
and cholesterol. seed oil, vegetable oil because of increased use of western foods and
cooking methods.
Sweeteners Honey, sugar Increased use of sugar; sweet desserts are noted.
sometimes wrapped in a strip of seaweed; deliberate eating of each course after expressions When a family moves to a
Makisushi, a roll of sushi rice, often including of appreciation for the presentation. new home, they give soba
cucumber (kappamaki), tuna, mushrooms, or other Soybean products and a wide variety of fish and noodles to the neighbors
fillings, then wrapped in a sheet of seaweed and shellfish (fresh, dried, or smoked) are the primary on either side and across
the street as a gesture of
sliced into individual pieces; and Chirashisushi, protein sources. Fresh fish and shellfish are often
friendship.
with the topping ingredients literally scattered over eaten raw. Beef, pork, and poultry are also popular
a large mound of rice and eaten with chopsticks. but very expensive. One specialty is Kobe (or Tajima)
Rice is also made into noodles, although those beef, from a Japanese breed of cattle that is fed beer
made from wheat (known as udon, somen, and as an appetite stimulant and regularly massaged to Kaiseki ryori meals have
ramen) or buckwheat (soba) are more commonly relieve stress. It often costs more than one hundred recently become trendy in
consumed. Other noodles made from less famil- dollars per pound. Pork is a favorite as cutlets. both Japan and the United
iar starches, such as kudzu, are also eaten. Chicken, which is often served as teriyaki sauce- States, costing up to $100
Soybean products are an important compo- glazed skewers, may also be very thinly sliced and per person at restaurants
nent of Japanese cuisine. Tofu (bean curd), soy served raw like sashimi.152 Only small amounts of featuring the ceremonial
menu.
sauce (shoyu), and fermented bean paste (miso) meat, poultry, or fish are added to the vegetables in
are just a few. Miso comes in numerous varieties. traditional Japanese recipes. Japanese fare does not
Those made with the addition of rice are most use many dairy foods.
popular; however, miso mixed with barley is Fresh fruits and vegetables are the most desir-
found in western regions, and plain miso with just able and are eaten only when in season. As in
soybeans and salt is favored in a few central areas.46 China, many Asian and European varieties are
Red miso (akamiso) is very salty and is used most consumed (see the section Staples in the Chinese
often. White miso (shiromiso) is sweeter, often part of the chapter). A few favorites include herbs
used in cooked salads. Specialty misos, with and greens such as chrysanthemum greens,
added vegetables such as kombu or daikon, or sea- mizuna (potherb), and shiso (perilla, a member
soned with shiso, are also available. Sugar, shoyu, of the mint familythe red variety is used to
and vinegar are a basic seasoning mixture for color pickled foods); many tubers, including gobo
foods. Teriyaki sauce (shining broil) made from (burdock root, which is shaved and leached in
soy sauce and mirin, a sweet rice wine, is another water to remove bitterness), sweet potatoes, a small
common flavoring for foods. Shoyu and mirin can variety of taro, and yams; and others such as daikon
vary in strength, and the amounts used depend on (a white radish similar to the Chinese radish, but
personal taste. In addition to soy beans, small, red longer, up to twelve inches in length), edamame
adzuki beans are significant in Japanese cuisine, (young soybean pods boiled in salt water, then
most often made into sweetened red bean paste popped open for a snack, often with beer), kabocha
and a popular red bean jelly dessert (similar to (winter squash), shiitake mushrooms, and the
gelatin) called yo-kan. winter tangerine known as mikan. Pickled vegeta-
Green tea is served with most meals. Tea was bles are available year round and are eaten exten-
originally used in a devotional ceremony in Zen sively. Fresh fruit is a traditional dessert.
Buddhism. The ritual was raised to a fine art by The Japanese use large amounts of seaweed and
Japanese tea masters, and as a result, they also set algae in their cooking for seasoning, as a wrapping,
the standards for behavior in Japanese society. or in salads and soups. There are many types. Nori
Today the tea ceremony and the accompanying is a paper-thin sheet of algae that is rolled around
food (kaiseki ryori) remain a cultural ideal that sushi. Kombu is an essential ingredient in dashi, or
reflects the search for harmony with nature and soup stock made from dried bonito fish and sea-
within ones self. The meal features six small courses weed. Misoshiru is a popular soup made with dashi
balancing the tastes of sweet, sour, pungent, bitter, and miso (either red or white miso can be used).
and salty. The tea used for the ceremony is not the Wakame and hijiki are used primarily in soups and
common leaf tea usually used for meals, but rather salads. Aonoriko is powdered green seaweed used
a blend of ground, dry tea or a tea powder. Hot as a seasoning agent.
water is added to the tea, and the mixture is Japanese dishes are classified by the way the
whipped together using a handmade whisk, food is prepared (see Table 11.4). Tempura is an
resulting in a frothy green drink. Diners demon- example of an agemono dish. Adapted from a dish
strate their sophistication and sensitivity through introduced in the sixteenth century by the Catholic
340 EAST ASIANS
Table 11.4 Selected Japanese Cooking Styles

Suimono Clear soups, such as dashi or misoshiru
Yakimono Broiled or grilled food (often marinated), such as teriyaki or yakitori
Nimono Foods (usually a single item) simmered in seasoned water or broth, such as fish in sake-flavored
broth, served hot or at room temperature
Mushimono Steamed foods, such as chawanmushi
Agemono Deep-fried foods, such as deep-fried tofu or katsu, usually served with a dipping sauce
Aemono Fresh or cooked mixed foods tossed with thick sauces, such as salad with miso dressing
Sunomono Mixed salads with vinegared dressing, such as crab and cucumber with rice vinegar and soy sauce
dipping sauce
Chameshi Rice cooked with other ingredients, such as chicken, fish, vegetables (especially mushrooms)one
specialty is rice with red adzuki beans, served for celebrations
Men rui Noodle dishes, served hot or cold (plain or topped with fish or vegetables) with dipping sauce, or in a
broth with items such as meats, seafood, tofu, and vegetables
Nabemono Foods that are cooked at the table and one-pot dishes (usually a type of nimono dish), usually hearty
combinations, such as sukiyaki and shabu shabu
Portuguese for religious fast days, it consists of Japanese foods are usually cut into small
shrimp and sliced vegetablessuch as eggplant, pieces if the item is not naturally easy to eat with
carrots, sweet potato, lotus root, and green chopsticks, and dishes are frequently modified
beanslightly battered and deep-fried. Katsu is for children, as it is believed that adult recipes are
another agemono dish of deep-fried breaded pork too spicy for them. Cooking style varies from
cutlets or fish filets. Sukiyaki is a simmered beef region to region in Japan. Kyoto is known for its
dish usually prepared at the table. The name means vegetarian specialties, Osaka and Tokyo are
broiled on the blade of the plow and probably known for their seafood, and Nagasakis cooking
dates back to ancient times.132 The current version has been greatly influenced by the Chinese.
of sukiyaki is mislabeled, however, because it is a
nimono-style, not a yakimono-style food. Shabu
shabu, a nabemono dish of small pieces of beef and
vegetables cooked in broth at the table, is similar Daily Pattern. Traditionally the Japanese eat
to a Mongolian hot pot (see Chinese Regional three meals a day, plus a snack called oyatsu. Simple
Specialties above). After the meat and vegetables meals, such as breakfast and lunch, are often
are cooked and eaten, the broth is ladled into ichiju--issei, meaning soup with one side. For
bowls and consumed. Teriyaki is one type of grilled example, breakfast usually starts with a salty
yakimono dish, as is yakitori (grilled, marinated sour plum (umeboshi), followed by rice gar-
chicken skewers). Teppanyaki is a Japanese term nished with nori, soup, and pickled vegetables. A
for stovetop grilling. The style familiar to U.S. diners side dish such as an egg or fried fish is served
was invented to take advantage of the tourist trade. with the rice. A nabemono can replace the side
A small grill in Japan is Beef, chicken, shrimp, and vegetables are cooked dish, which often happens at lunchtime. The
called a hibachi, meaning on a hot grill in the center of a large table, then meal is typically simple and often consists only
fire bowl. served with ponzu, a soy sauce and citrus juice of rice topped with leftovers from the previous
mixture. Chawanmushi, a savory egg custard in night. Sometimes hot tea or dashi is added to the
Sansai ryori is a style of
which meats and vegetables are cooked, is a typical rice mixture. A bowl of noodles cooked or served
cooking with fresh wild
herbs and vegetables such steamed mushimono dish. with meats, poultry, or fish and vegetables is a
as goosefoot, mugwort, Seafood, fish, fruits, and vegetables that are popular alternative to leftovers. One such dish is
nettles, ferns, and bracken. pickled in a mixture of miso, soy sauce, vinegar, oyakodon, which means parent and child on
It is considered the essence and the residue from sake production are known as rice, a mixture of boiled chicken and scrambled
of spring. tsukemono, and they are served at nearly every meal. eggs on a bed of rice.
Dinner is usually ichiju--sansei, meaning soup Dishes on the left are picked up with the right Myoga ginger is prized in
and three sides, including rice, soup, and tsuke- hand, and dishes to the right are lifted with the Japan for its tender shoots
mono, and three dishes: a raw or vinegared fish, a left hand. It is impolite to serve sake, beer, or tea in the spring and its flower
simmered dish, and a grilled or fried dish.46 Pink to oneself. Each diner is obliged to fill his or her buds in the fall.
pickled ginger (beni shoga) garnishes many meals, neighbors glass whenever it is half-empty.
and soy sauce is usually available. The pungent, Guests are usually entertained at restaurants,
Kombu sounds like the word
green, horseradish-like condiment called wasabi where the host chooses the menu in advance.
for happiness, and it is
may also be offered, and it is mixed in small indi- The meal may include frequent toasts, particu-
often presented as a hostess
vidual bowls with soy sauce to taste. larly kampai (bottoms up). Games may be gift by guests.
The Japanese tend not to serve meals by played at the table after the meal. Karaoke singing
courses. Instead, all the dishes are presented at the is common, and guests are expected to good- The Japanese use 25 billion
same time in individual portions, each food in its naturedly participate.32 sets of disposable wood
own bowl or plate. The soup, however, is some- chopsticks in restaurants
times served last or near the end of the meal, and Special Occasions. In Japan there are numerous annually. Nearly all are
tsukemono may be placed on a communal plate festivals associated with the harvesting of specific made in China, which has
for diners to add according to their personal pref- crops or with local Shinto shrines or Buddhist recently restricted produc-
temples. The most important and largest celebration to preserve forests,
erence. Traditionally desserts were not common
tion in Japan is New Years. The Japanese share prompting skyrocketing
in Japan; meals usually ended with fruit.
many holiday traditions with the Chinese. Homes prices and fears of short-
In addition, the Japanese often eat a boxed meal ages in Japan.
called bento. A pleasing assortment of at least ten are cleaned thoroughly, and all debts are settled
items is packaged attractively for consumption at before the New Year; food is also prepared ahead
school, picnics, or even between acts at the theater. so that no knives or cooking will interfere with
Some restaurants specialize in bento meals. the seven-day event. The Japanese celebrate New
Snacks include several kinds of sweets, rice Years on January 1. The New Years foods consist
crackers, or fruit. Traditional Japanese confec- of ten to twenty meticulously prepared dishes
tions include mochi gashi (rice cakes with sweet served in a special set of nesting boxes. Each dish
red bean paste), manju (dumplings), and yo-kan. symbolizes a specific value, such as happiness,
Green tea is served after all meals except when prosperity, wealth, long life, wisdom, and dili-
western-style food is eaten; then coffee or black gence. For example, fish eggs represent fertility,
tea is served. Beer or sake (rice wine, usually mashed sweet potatoes and chestnuts protect
served warm) may be served with dinner. against bad spirits, and black beans represent a
Eating out is common. Numerous small willingness to keep healthy through hard work
restaurants specialize in certain preparations, and sweat.
such as sushi, yakitori, or noodle dishes. Restaurant An important New Years food is mochi, a rice
windows often display their menu items with cake made by pounding hot, steamed rice into a Historically, rice was often
plastic replicas of their dishes. sticky dough. Traditionally a Buddhist o sonae in short supply in Japan,
mochi is set up in many homes. A large rice cake so eating the round rice
Etiquette. The Japanese, like the Chinese, eat with represents the foundation of the older generation cakes, mochi, at New Years
chopsticks and follow many of the same customs and is placed on the bottom, and a smaller rice represented wealth and
regarding their use (see the section Etiquette in cake symbolizing the younger generation is prosperity.
the Chinese part of the chapter); the rice bowl is placed atop it, followed by a tangerine indicating
not held as closely to the mouth, however. Soups generations to come. The o sonae mochi is as
are consumed directly from the bowl; the only meaningful to the Japanese as a Christmas tree is
dish eaten with a spoon is chawanmushi. Slurping to Americans, preserving good fortune and hap-
soups and noodles is permitted and may be seen piness for future generations. Another special
as a sign of appreciation. Tea should always be food is ozoni, a soup cooked with mochi, vegeta-
silently sipped.32 bles, fish cakes, and chicken or eggs. A special rice
Traditionally the Japanese eat their meals at wine called otoso is consumed to preserve health
low tables, in a kneeling position with the heels in the coming year. Japanese Buddhist temples
tucked under the buttocks. In less formal situations usually hold an Obon festival in the second or
men may sit cross-legged and women with their third week of July to appreciate the living, honor
legs tucked to the side. Shoes are removed first. the dead, and comfort the bereaved. Food and
342 EAST ASIANS
dancing are a traditional part of the holiday.

Certain birthdays are considered either haz-
ardous or auspicious in Japanese culture. When a
man turns forty-two or a woman becomes thirty-
three, special festivities are held to prevent mis-
fortune. Age sixty-one marks the beginning of
second childhood, and a person dons a red cap
for this honor. At age seventy-seven a person puts
on a long red overcoat, and at the most propitious
birthday of all, age eighty-eight, the celebrant
Gary Conner/PhotoEdit, Inc.
may begin wearing both the hat and the coat.
Therapeutic Uses of Food

Although the use of yin and yang is not as prevalent
among the Japanese as it is among the Chinese,
there are many beliefs about the harmful or benefi-
The o sonae mochi is traditional in Japanese Buddhist homes at New Year s, symbolizing cial effects of specific foods and food combinations.
prosperity and happiness in the future. Traditionally certain food pairs, such as eel and
pickled plums, watermelon and crab, or cherries
and milk, are thought to cause illness.
Pickled plums and hot tea, which are cus-
tomarily eaten for breakfast, are believed to pre-
vent constipation. Both pickled plums and rice
porridge, called okayu, are thought to be easily
digested and well tolerated during recovery
from sickness.
SAMPLE MENU
A Japanese Family IN THE UNITED STATES
Dinner Adaptations of Food Habits
Little recent information on the food habits of
Japanese Americans has been reported, but avail-
Misoshiru (Miso Soup) a, b
able data suggest the adoption of a westernized
Sashimi a, b diet continues with each subsequent generation in
the United States. It is thought that when accultur-
Tempura a or Yellowtail Teriyaki b ated Japanese Americans eat a typical American
diet, they may eat more rice and use more soy
Pickled Cucumber a, b sauce than non-Asians. Traditional foods are still
prepared for special occasions. A westernized diet
Steamed Rice, Pickled Ginger, Wasabi, and Soy Sauce
is increasingly followed even in Japan. Bread and
Sake (Rice Wine) or Green Tea butter are becoming staples, and consumption of
meat, milk, and eggs is increasing.
A detailed study of Nisei and Sansei (mothers
a
Fukushima, S. 2001. Japanese home cooking. and daughters) reported several trends in dietary
Boston: Periplus. acculturation.60 Compared to the predominantly
b
Yasuko-sans Home Cooking at http://www.nsknet. Japanese diet consumed by the Issei who immi-
or.jp/~tomi-yasu/index_e.html grated to the United States, Nisei women in the
study continued to eat rice daily but added other
starches, such as breads and cereals. Traditional
protein sources, including seafood, tofu, and eggs,
were often replaced with more meats and dairy
items. Condiments such as soy sauce and miso were resistance was greater in the Japanese-American
consumed less often, while butter and margarine men when compared to Japanese subjects, and
intake increased substantially. When compared to increased intra-abdominal fat deposits were
their mothers, the Sansei daughters consumed less found.6 Among women, intra-abdominal fat
rice and more pasta, ate less dried fish and more increased with menopause.33 Intra-abdominal fat
cheese, consumed fewer traditional preserved or deposition was found predictive of type 2 diabetes
pickled foods and more fresh fruits and vegetables in Japanese Americans independent of total
(particularly potatoes), and used less butter and adiposity, family history, and other risk factors.9
margarine. The Sansei women also ate fewer A genetic predisposition for diabetes combined
Japanese-style sweets and more salty snacks. Green with increased fat consumption, especially
tea consumption declined with the Sansei daugh- animal fats, may account for the disproportion-
ters, and soft drink consumption increased. ately high rates.
Notably, meal consumption became more irregular Earlier studies suggest Japanese-American
with the Sansei, and eating out and use of take-out elders may have a low intake of calcium because
foods were significantly more common. of limited consumption of dairy products.53 The
Japanese have a high incidence of lactose intoler-
Nutritional Status ance. Although seaweed, tofu, and small bony
Nutritional Intake. The traditional Japanese diet fish contain calcium, they may not be eaten in
is high in carbohydrates and very low in fat and adequate amounts to provide sufficient intake.
cholesterol. Most cooking fats are polyunsaturated, Prevalence of osteoporosis may be higher than
and butter is rarely used. Japanese Americans, among whites (see Dairy Foods, BMD, and
however, consume a more typically American diet, Osteoporosis). Calorie consumption and meat
and this change may contribute to increased intake have also been found to decline with age in
incidence of several diseases. According to classic Japanese Americans.
epidemiological studies, mainland Japanese The traditional Japanese diet tends to be high
Americans have a higher risk of developing colon in salt from soy sauce, dashi, miso, monosodium
cancer and heart disease than the Japanese in glutamate (MSG), dried preserved fish, and pickled
Hawaii, and those in Hawaii have a higher risk vegetables. Rates of conditions sometimes linked
than the Japanese in Japan.79, 145 More detailed to high-sodium diets, such as hypertension, stroke,
evaluation has shown Japanese Americans have and stomach cancer, are extremely high in Japan
more rapid atherosclerosis progression than do but have been dropping as the Japanese adopt
Japanese men and women.144 It has been postu- western fare.
lated that the increase is caused by diet because it Infant mortality rates for Japanese Americans
is correlated to a higher intake of cholesterol and are lower than those for the general population.80
animal fat and a lower intake of dietary fiber. However, a study comparing pregnancy outcomes
Other cancers, such as those of the breast and in Japanese Americans noted that U.S.-born moth-
rectum, have also increased in Japanese Americans ers are significantly more likely to have low-birth-
as their stay in the United States lengthens. weight infants than are foreign-born mothers.1
Changes in diet have also been implicated in A comparison of Asian (Chinese, Japanese, A small percentage of
the high rates of type 2 diabetes found among and Korean) alcohol consumption habits found Asians lack the ability to
Japanese-American men.33, 86 Among Nisei men that Americans of Japanese heritage had the most metabolize alcohol well.
in one study, the rates for diabetes were twice that permissive attitude toward drinking, particularly This inherited condition
for similarly aged white men living in the same among women. Japanese-American men had high causes immediate skin
flushing (reddening) and
region of the United States and four times that for rates of heavy drinking (nearly 30%) and the fewest
may even result in heart
similarly aged men in Japan.139 Data showed that abstainers (16%). Japanese-American women
palpitations when alcohol
the Japanese-American men were consuming showed similar trends, with the highest rates of is consumed. This reaction
carbohydrate, protein, and fat proportions simi- heavy drinking (almost 12%) and the lowest may contribute to the
lar to the overall American diet, but with fewer number of abstainers (27%). Although the number number of abstainers in
total calories. (Though the rate of overweight and of women engaged in chronic heavy drinking is the population.
obesity has been found to be higher in U.S.-born lower than for white American women, the rates
Japanese Americans than in foreign-born Japanese for men were comparable. Friends who drink and
Americans, total rates are low.)65 However, insulin social occasions where drinking was expected were
344 EAST ASIANS
CULTURAL CONTROVERSYDairy Foods, BMD, and

Osteoporosis
O steoporosis, which means

porous bone, affects 10 mil-
lion women and 2 million men
in the United States. Another 16 million
have low bone mineral density (BMD),
whites, and 4 percent of blacks have
osteoporosis. At every age, blacks had the
highest BMD, and Asians had the lowest.
However, when adjusted for weight, age,
and other risk factors, the researchers
tive, slowing bone mineral loss after
menopause.43, 83 Yet, if prevalence for low
BMD and osteoporosis among Asians is
higher than previously calculated, and if
fractures are increasing, do nondairy foods
which may put them at risk of developing report the relative risk for fracture was provide adequate calcium intake? Or, if the
the disease. Osteoporosis is characterized highest in whites and Hispanics, followed intake of traditional calcium-rich foods
by reduced height, a stooped spinal defor- by Native Americans, blacks, and Asians. declines with acculturation in the United
mity, and over 1.5 million bone fractures Differences in fracture rates among Asians States (and westernization worldwide), are
annually, most often of the spine, the hip, are also seen. Chinese Americans have the dairy foods needed to provide the calcium
and the wrist. The causes of osteoporosis lowest incidence of hip fracture compared no longer being consumed?
are not completely understood. to whites, followed by Korean Americans, Recently, some physicians and activist
Contributing factors include ethnicity, then Japanese Americans.64, 118 Protective groups have suggested that federal nutri-
family history, low calcium intake, insuffi- factors that lower the risk for fracture in tion policy is racist because it recommends
cient weight-bearing exercise, smoking, Asians may be diminishing, however. Hip two to three daily servings of dairy prod-
high alcohol consumption, and low levels fracture rates are rising dramatically in ucts. They claim this recommendation can
of estrogen in women and testosterone in Japan, Hong Kong, and among the Chinese be harmful to most U.S. blacks, Asians,
men.89 in Singapore.57, 62, 101 Hispanics, and Native Americans because
White women have long been consid- Dietary recommendations regarding each of these groups has a high percentage
ered at highest risk for osteoporosis. In osteoporosis have traditionally emphasized of lactose-intolerant individuals.7 It is
particular, thin white women have been a high intake of calcium-rich foods. Dairy known that lactase deficiency alone does
thought most vulnerable because higher foods are considered good sources because not affect the BMD of women,127 and some
body mass is related to better BMD. in addition to calcium they also contain studies have found that lactose maldiges-
However, recent findings in a study of vitamin D, which enhances absorption of tion can improve with consumption of
postmenopausal U.S. women cast doubt the mineral. While many Asians do not eat dairy foods.115, 133 More research on the
on the assumption that osteoporosis is a dairy foods, it has been thought that they bioavailability of calcium in different foods
white womans disease.5 Data from the obtained adequate calcium from eating and the role of diet in the development of
National Osteoporosis Risk Assessment small fish with bones (e.g., sardines), min- BMD, osteoporosis, and fractures is needed
Initiative indicated that almost 12 percent of eral-rich fish sauces, and ample dark green to determine whether dairy food recom-
Native American women, about 10 percent leafy vegetables. Some scientists also sug- mendations are sensible for all Americans
of Asians and Hispanics, 7 percent of gest that soybean intake may be protec- or simply ethnocentric.
significant influences on consumption among unbalanced life as well as an impediment to ful-

men.19 This study confirms previous work indi- filling personal obligations. Japanese Americans
cating that alcohol consumption may be more were found less accepting of pain behaviors than
frequent than previously assumed among Japanese whites in one study.45
Americans, although behavior problems related Formality and politeness are essential conver-
to drinking have not been widely reported.151 sational elements in Japan. Addressing Japanese
elders or Japanese American Issei, and some
Counseling. Japanese-American values such as Nisei, by their first names is insulting. Sansei and
placing the family before the individual, preserving Yonsei are often more informal.42 Emotional dis-
harmony with society, and respecting and caring plays are avoided, especially of anger. The Japanese
for elders may have a positive impact on health.27 are nonconfrontational and may be reluctant to
Illness may be regarded as both a symptom of an say no even when the answer to a question is
negative. Waving a hand in front of the face with two nations. The Democratic Peoples Republic Korea is called Choson by
the palm outward indicates Im unsure or I dont of Korea (North Korea), with the capital city of Koreans, meaning Land of
know. Conversational style is typically indirect, Pyongyang, has a communist government. The Morning Calm.
and frequent pauses, up to several minutes, are Republic of Korea (South Korea) is a democracy
common. It is usually best to remain silent during supported by the United States. Seoul is the coun-
such pauses. Direct eye contact is disrespectful trys capital. Both nations desire the reunification
glancing around or downcast eyes are expected. of Korea through political and military domina-
Smiling can indicate pleasure but is also used to tion of the other.
hide displeasure. Sucking in air through the teeth
can also be a sign of discomfort or anger.
The Japanese are a non-touching culture,
and they often stand or sit farther apart than do History of Koreans in the United States
most Americans. Their communication style is Immigration Patterns. Early Korean immigra-
extremely high-context, and the slightest gesture tion to the United States was severely restricted by
may have meaning (see Chapter 3, Intercultural the isolationist policies of Korea. A small number
Communication, for more details). Broad hand of Koreans arrived before 1900, most of whom
or body gestures may be misconstrued. Though were Protestants seeking to escape discrimination
touching between strangers or acquaintances is and further their education in America.
infrequent, most Japanese Americans are com- Between 1903 and 1905 Christian missionaries
fortable with a light handshake. The traditional recruited more than 7,000 Korean men, women,
greeting is a bow from the waist with palms and children to work in Hawaiian sugarcane fields.
against thighs. The lower the bow and the longer In 1905, when Korea was under Japanese rule,
it is held, the more respect is shown for the status overseas emigration of Koreans was barred, and
of the other person.32 Slouching and putting ones in 1907 the United States entered a gentlemens
feet on a desk are signs of disinterest. agreement with Japan limiting both Japanese and
Japanese Americans often believe that the Korean immigration. During the next seventeen
health care provider is a knowledgeable authority years, only picture brides and oppressed political
figure who will meet their needs without assis- activists were permitted entry. In 1924 the Japanese
tance. Most Americans of Japanese descent expect Exclusion Act was applied to Koreans as well,
to be directed in their health care, yet are insulted preventing all immigration. Most early Korean The status of Koreans in the
if they are ordered to do anything that they feel immigrants worked as field hands or in domestic United States during World
requires only an explanation. Criticism of a service; many first- and second-generation Koreans War II was unique. Many
clients health habits can lead to embarrassment living in urban areas were barred from profes- remained technically
and loss of effective communication. Concrete, sional jobs and established small businesses such Japanese citizens and as
structured approaches based on information as vegetable stands and restaurants.88 such were declared enemy
gathered through an unhurried, in-depth inter- aliens (although none were
Between 1959 and 1971, nearly all Korean immi-
view that determines degree of acculturation and interred). Yet many Koreans
grants were the wives and children of U.S. soldiers had been involved for years
personal preferences are most effective. who fought in the Korean War. Following relax- in anti-Japanese activities.
ation of U.S. immigration laws in 1965, the num- They wore I am Korean
bers of Korean immigrants increased, including buttons to distinguish
many college-educated, middle-class professionals themselves from Japanese
Koreans and their families. residents.
The mountainous peninsula that forms Korea is Current Demographics. The Korean immigrant
suspended geographically and culturally between population has increased dramatically in recent
China and Japan. Korea has historically been years. According to 2005 census estimates, over
caught in the middle of both Chinese and Japanese 1.2 million Koreans are living in the United
expansionism yet has maintained a homogeneous States, over half of whom have arrived since 1980.
population with an independent, distinctive More than 75 percent of Koreans in America were
character. Little land is arable, and the climate born in Korea, and 40 percent of those have
fluctuates between cold, snowy winters and hot, become citizens.117 Large numbers of immigrants There were approximately
monsoonal summers that limit agriculture signifi- to the United States relocated first from North 101,000 Canadians of Korean
cantly. The peninsula is currently divided into Korea to South Korea, seeking greater freedom. ancestry in the 2001 census.
346 EAST ASIANS
experience with nonconformity in Korea as

Christians in a Confucian and Buddhist society.49
NEW AMERICAN PERSPECTIVESKorean Almost 44 percent have college degrees, and large
numbers work in management and professional
Michael Han, Foodservice Management positions. However, family median incomes were
am a Korean American born in South Korea, and my parents moved to slightly below the U.S. average, and poverty rates
I the United States in 1979 when I was eight months old. Members of
my fathers family came over first and then we followed.
We pretty much ate Korean meals at home. Most meals consisted of
were above the national percentage. Some Koreans
who do not find the economic prosperity they
seek in the United States return to Korea.
A notable conflict persists in the immigrant
short-grain (sticky) rice, kimchi, with a soup/stew. The soup contains
meat (including Spam) and vegetables. My father really likes meat, so we Korean community. Korean Americans may not
probably had more than other Korean families, and really unusual is that accept recent immigrants who demand imme-
he added butter as well. Now he adds olive oil instead because his cho- diate social standing based on prior status in
lesterol is too high. Once in a while we would have Korean barbecue, but Korea. Recent professional immigrants are some-
that was for special occasions or as a treat. Dessert was mostly fruit. times contemptuous of Korean war brides, who
When I was young I wanted to eat more American food. For a while my are considered uneducated and lower class.
mom would make pancakes for breakfast on the weekend, and when she The large numbers of new arrivals may serve to
stopped, I was really upset. Now I eat American food for breakfast and coalesce the Korean community because they share
lunch but not dinner, and I usually have rice once a day. My aunt has taken similar experiences in acculturation and are a
over making kimchi for the family, but I dont live that close to her, so I significant percentage of the growing Korean-
only get it once in a while. When I do have itI eat it all the time, so my American population.
supply only lasts a week.
In general, it would be hard to get a Korean in the United States to Worldview
modify the amount and type of rice they eat, and I dont think they would
Religion. In South Korea Buddhism and Con-
ever give up pickled, spicy vegetables like kimchi.
fucianism are the majority religions. Approximately
28 percent of South Koreans are Christian, and
smaller numbers adhere to shamanism (belief in
natural and ancestral spirits) and the national
Koreans coming to America hope to find economic Korean religion Chundo Kyo, formerly known as
opportunity and to avoid any North KoreanSouth Tonghak (a mixture of Confucian, Taoist, and
Korean conflict that may arise in the future. Large Buddhist concepts). In North Korea all religious
numbers of Koreans have settled in California, beliefs other than the national ideology of Marxism
particularly Los Angeles. Other states with signifi- and self-reliance are suppressed.
cant populations include New York, Illinois, New The first Korean immigrants at the turn of
Jersey, Texas, Washington, Virginia, Pennsylvania, the century were Christians attracted to the
Maryland, and Hawaii. Difficulties in adjustment United States as a religious homeland. Many
have led Korean Americans to form expatriate suffered discrimination in the largely Confucian/
communities in many areas. Buddhist society of Korea. Although specific fig-
Socioeconomic Status. Many Koreans must ures are unknown, it is believed that many
accept temporary or permanent nonprofessional recent immigrants to the United States are also
employment due to language difficulties or Christian. Over 2,000 Korean Protestant churches,
licensing restrictions.88 Families working together some with as many as 5,000 members, serve the
toward the success of a small business and the community.88 A study of elder Korean immi-
The economic success of purchase of a home are common. Korean-American grant women in Washington, DC, indicated that
South Korea has lured thou- 85 percent were Christian (Baptist, Methodist,
descendants of the 1903 to 1905 immigrants to
sands of second-generation
Hawaii are securely middle class. Contributing Presbyterian, and Catholic), 10 percent prac-
Korean Americans to immi-
grate there, where they factors include high achievement in education ticed ancestor worship (veneration of ancestors
have taken positions in and professionalism; quick mastery of English often coexists with other religious practices),
marketing, public relations, (faster than Japanese and Chinese immigrants of and 5 percent were Buddhist.105 Other research
and the entertainment the same period); and a greater willingness to suggests that larger numbers of Buddhists have
industry. give up Korean traditions, perhaps due to their immigrated.
Family. Hundreds of years of Confucianism in without impairment, and to not be a burden on

Korea have significantly influenced family struc- ones children.105 A good appetite is a significant
ture regardless of current religious affiliation. indicator of health.
Family is highly valued, and loyalty to ones The Korean system of health and illness is
immediate and extended family is more impor- closely related to Chinese precepts (see the section
tant than individual wants or needs. Generational Health Beliefs and Practices in the Chinese part
ties are more important than those of marriage, of the chapter). The proper balance of um (yin)
and parents are especially close to children. and yang must occur to maintain health, influenced
Korean Americans often invite family members in by the relationships of the five evolutive elements
Korea to join them in the United States, and (fire, water, wood, metal, and earth) and ki (vital
extended families are not uncommon. energy). Too much or too little of these forces
In Korea a male is always the head of the results in illness. For example, cold, damp, heat, or
family; if a father is unable to fulfill that role, the wind can enter a body through the pores and then
eldest son (even if still a child) takes on that interfere with ki and weaken yang. Symptoms of
responsibility. Birth sequence orders lifes events the imbalance include indigestion, arthritis, and
within the family, and older male children are tra- asthma. Other disruptive causes such as physical
ditionally awarded privileges, such as advanced exhaustion, eating too much or too little food, and
education, that younger children and daughters spiritual intervention (by ancestors or super-
are denied. The role of women is to take care of natural deities) may also result in disease.20
the house and care for children. Parenting tends Both digestion and circulation are prominent
to be authoritative, and any child over the age of in the maintenance of health, because energy is
five years exhibiting inappropriate behavior absorbed into the body through the stomach
brings disrespect upon the entire family.116 Elders when food is mixed with air or one of the forces,
are esteemed and cared for in Korea. The two and the blood distributes this vital energy. Good-
major birthday celebrations in Korean culture quality food is restorative, but too much food can
occur at age one and when an individual reaches block ki, resulting in cold hands and feet, cold
age sixty, meaning that the person has survived a sweats, or even fainting.105 A few Koreans attrib-
full five repeats of the twelve-year cycle of life and ute diabetes to eating too much rich food, such as
attained old age. The opinions of elders are meat, sugar, or honey, and getting too little exer-
respected, and after age sixty a person is allowed cise. Blood conditions that interfere with the dis-
to relax and enjoy life. tribution of vital energy include a lack of blood; a
Many changes occur in the Korean family after drying or hardening of the blood (typical in old
immigration to the United States. For example, the age, causing indigestion, neuralgia, and body
marriage bond often becomes more important aches); and bad blood, caused by a sudden fright,
than obligations to ones parents. Few elders main- which can result in chronic pain.
tain traditional arrangements of living with an Korean-specific folk illnesses often include
eldest sons family. Some live with unmarried somatic complaints that are an expression of psy-
children or with married daughters, or live alone. chological distress.106 Excessive emotions such as
Many elders feel that they are now a burden to joy, sadness, depression, worry, anger, fright, and
their children and that old age is a negative experi- fear are believed to result in certain physical
ence instead of a privilege.105 Male dominance has conditions. Hwabyung, attributed most often to
declined with increased participation of women anger, victimization, or stress, is associated with
in the workplace, yet most married women assume poor appetite, indigestion, stomach pain, chest
total responsibility for home and their job and pain, shortness of breath, weight gain, and high
often are not paid for their work if employed in a blood pressure among other symptoms. A study
family-owned business. Divorce rates are report- of middle-age Korean women found that nearly
edly high, and intergenerational conflict increases 5 percent suffered from hwabyung, with rates
with length of time in the United States.88 higher in women of lower socioeconomic status,
those who lived in rural areas, those who were
Traditional Health Beliefs and Practices. separated or divorced, and those who smoked or
Traditional Korean concepts related health to drank alcohol.109, 111 Han, which causes a painful
happiness, to the ability to live life fully, to function lump in the throat, occurs when a person suffers
348 EAST ASIANS
disappointments and regrets, such as guilt over bitter, hot, and salty tastes are combined in all
the neglect of ones children, parents, or spouse. meals, and foods are often seasoned before and
Shinggyongshaeyak, resulting from stress (espe- after cooking. Five colorswhite, red, black, green,
cially from oversensitivity and lack of happy and yelloware also important considerations in
interactions with family and friends), can cause the preparation and presentation of dishes.
insomnia, weight loss, and nervous collapse.
Traditional cures include use of a shaman or spiri- Staples. Korean cooking is based on grains fla-
tual mediator (mansin or mudang) to determine vored with spicy vegetable and meat, poultry, or fish
whether the cause of an illness is due to dishar- side dishes. Korean staples are listed in Table 11.5.
mony with ones ancestors or natural and supernat- Rice is the foundation of the Korean diet. Rice
ural forces.20 Sacred therapeutic rituals to rectify cooking is an important skill in Korea; the rice
such spiritual disruptions are conducted with the must be neither underdone nor overcooked and
patient, the family, and sometimes the community. mushy. Short-grain varieties are usually preferred,
Hanyak is the traditional approach to natural both a regular and glutinous (sticky) type, the latter
cures in Korea. It is typically practiced by a hanui. most often in sweets. Long-grain rice, called
When a client visits a hanui, he or she obtains a Vietnamese rice in Korea, is available but not
medical history, observes how the patient looks, common. Millet and barley are used, most often
listens to the quality of the voice, and takes the as extenders for rice.
patients pulse. More than twenty-four pulse con- Noodles are also an important staple and are
ditions are defined, from floating to sunken, and made from wheat, buckwheat, mung beans, and
smooth, vacant, or accelerated.104 Hanyak medica- from the starch of sweet potatoes and the kudzu
tions are classified according to their plant, animal, plant (a ubiquitous vine).126 The buckwheat variety
or mineral source, and mixed in ways to balance is often used in cold dishes. Fritters, dumplings, and
um (yin), yang, and ki. Other physical therapies to pancakes flavored with scallions, chile pepper, and
restore harmony and vital energy, such as acupunc- sometimes fish or meat placed directly in the batter
ture, moxibustion, cupping, and sweating (see before cooking are other popular grain dishes.78
Chapter 2), may also be applied. In the United States Vegetables are served at every meal. Chinese
the hanui may use some biomedical procedures in cabbage (both bok choy and napa), European
conjunction with traditional practices. It has been cabbage, and a long white radish (similar but not
reported that some hanui take blood pressures and identical to the Japanese daikon radish) are eaten
In order to make an accu- body temperatures. Some even offer the conven- most often. Eggplant, cucumbers, perilla (a mint-
rate diagnosis, a hanui must ience of taking hanyak prescriptions in pill form family green also called shiso), chrysanthemum
determine a clients charac- so that bitter-tasting broths or teas are avoided.104 greens, bean sprouts, sweet potatoes, and winter
ter through questions, such Many professional Korean health practices melon are also very popular. Vegetables are added
as Do you like meats or have been popularized and may be used as home to soups and braised dishes and are often served
vegetables?What season remedies. In the United States, where access to tra- individually as hot or cold side dishes. Pickled,
is your favorite?Do you ditional healers may be limited in some regions, fermented vegetables are included at every meal,
worry much? or Are you the mother or grandmother in the home often usually in the form of kimchi, which comes in
stubborn?104 takes responsibility for administering these cures. many types, based on seasonal availability of pro-
Some Koreans believe that a persons fate is deter- duce. A common version of kimchi is made with
mined by the forces of um and yang at the moment shredded Chinese cabbage and white radish,
of birth. Christian Koreans may believe strongly in heavily seasoned with garlic, onions, and chile
The preparation of kimchi faith healing and in fate as determined by God. peppers, then fermented. Cucumber, eggplant,
every autumn is a special turnip, and even fruits or fish are sometimes
family event. In the past added. Some recipes are mild, but most are very
a familys wealth was TRADITIONAL FOOD HABITS
hot. Seaweed is eaten as a vegetable, including
demonstrated by the ingre- Ingredients and Common Foods
dients in their kimchi, with
kelp and laver (called kim). Kim is brushed with
rare vegetables and fruits Korean cuisine is neither Chinese nor Japanese, sesame oil, salted, and toasted to make a condi-
used by the most affluent. although it has been influenced by both styles of ment. The seaweed called wakame in Japan is
Today, Koreans consume cooking. It is a distinctly hearty Asian fare that is used in Korean soups.61
over 70 pounds per capita highly seasoned and instantaneously recognizable Fruits are eaten mostly fresh. Crisp, juicy Asian
annually. as Korean by its flavors and colors. Sweet, sour, pears (known as apple pears in the United States)
Table 11.5 Cultural Food Groups: Koreans

Protein Foods
Milk/milk products Milk and milk products are generally Milk, yogurt, and cheese product con-
not consumed or used in cooking. sumption increases.
Meat/poultry/fish/ Beef and beef variety cuts are especially Meat: beef, variety meats (heart, kidney, liver), Beef, pork, and poultry consumption rises.
eggs/legumes popular. Barbecuing is a popular oxtail, pork Fish is eaten frequently. Many still con-
method for cooking meat. Fish and shellfish: abalone, clams, codfish, crab, sume tofu several times a week. Younger
Fish and shellfish, either fresh, dried, or cuttlefish, jellyfish, lobster, mackerel, mullet, Korean Americans may consume more
salted, are eaten throughout Korea. octopus, oysters, perch, scallops, sea cucum- pork products.
Soybean products are added to many ber, shad, shrimp, squid, whiting
dishes. Poultry and small birds: chicken, pheasant
Eggs: hen
Legumes: adzuki, lima beans, mung beans, red
beans, soybeans
Cereals/Grains Rice is the most important component Barley, buckwheat, millet, rice (short-grain Rice consumption declines, but it is still
of the Korean diet. glutinous), wheat eaten every day. Breads, cereals, and
Noodles made from wheat, mung pasta popular with well-acculturated
bean, or buckwheat flours are an Korean Americans.
important staple.
Fruits/Vegetables A wide variety of fruits are consumed. Fruits: apples, Asian pears, cherries, dates Increased intake of fruits and vegetables is
Vegetables are often pickled and are (jujubes, red date), grapes, melons, noted. The majority eat kimchi daily.
eaten at every meal. oranges, pears, persimmons, plums,
pumpkin, tangerines
Vegetables: bamboo shoots, bean sprouts, beets,
cabbage (Chinese, European), celery, chives,
chrysanthemum leaves, cucumber, eggplant,
fern, green beans, green onion, green pepper,
leaf lettuce, leeks, lotus root, mushrooms,
onion, peas, perilla (shiso), potato, seaweed
(kim), spinach, sweet potato, turnips, water
chestnut, watercress, white radish
Additional Foods
Seasonings Sweet, sour, bitter, hot, and salty Chile peppers (kochujangfermented chile
tastes are combined in all meals. paste), Chinese parsley (cilantro), chrysan-
Dishes are often seasoned during themum greens, cinnamon, garlic, ginger
and after cooking. root, green onions, MSG, hot mustard, red
pepper sauce, pine nuts, rice wine, saewujeot
(fermented fish sauce), sesame seed oil,
sesame seeds, soy sauce, sugar, vinegar,
sea salt
Nuts/seeds Chestnuts, gingko nuts, hazelnuts, peanuts,
pine nuts, pistachios, sesame seeds, walnuts
Beverages Herbal teas are popular, as well as rice Barley water, beer, coffee, fruit drinks, green Hot barley water is still the preferred bev-
tea. They are commonly served after tea, honey water, jasmine tea, magnolia erage and is served after the meal.
the meal. flower drink, rice tea, rice water, rice wine, Increased consumption of soft drinks.
Soup or barley water is used as a bever- soju (sweet potato vodka), spiced teas (gin-
age with the meal. seng, cinnamon, ginger), wines made from
other ingredients
Fats/oils Animal fat is rarely used. Sesame oil, vegetable oils
Sweeteners Sweets are made for snacks and special Honey, sugar Cookies and other sweets popular with
occasions. Korean American youth.
350 EAST ASIANS
are very popular; apples, cherries, jujubes (red and peanuts, and toasted, crushed sesame seeds
dates), plums, melons, grapes, tangerines, and are frequent additions as ingredients or garnish.
persimmons are also common. Seasonings are the soul of Korean cooking.
One of the most popular Fish and shellfish are eaten throughout Korea. Garlic, ginger root, black pepper, chile peppers,
black market commodities Fresh fish dishes are preferred near the coast or scallions, and toasted sesame in the form of oil or
in Korea is the diced pork in river regions, but dried or salted fish is more crushed seeds flavor nearly all dishes. Ginseng is
and gelatin product Spam. common in the inland areas. Saewujeot, a Korean added to some soups.61 Prepared condiments,
fermented fish sauce, is made from tiny shrimp- such as soy sauce, toenjang (fermented soy bean
like crustaceans. Saewujeot flavors many dishes. paste), fish sauce (saewujeot), and hot mustard are
Beef and beef variety cuts are especially popular also frequently added to foods. Kochujang, a fer-
in Korea.152 Cubes, thin slices, or small ribs of mented jam-like chile paste, is prepared by each
marinated beef are barbecued or grilled at the family on March 3 and then traditionally stored for
table over a small charcoal brazier or gas grill. use throughout the year in black pottery crocks.
Bulgogi, grilled strips of beef flavored with garlic, Marinades and dipping sauces are common.
onions, soy sauce, and sesame oil, is best known. Soup or a thin barley water is used as a bev-
Another Korean specialty is the fire pot (sinsullo), erage. Herbal teas are very popular; ginseng tea
similar to the Mongolian hot pot, featuring beef flavored with cinnamon is a favorite. Ginger,
It is believed that a
or liver, cooked egg strips, sliced vegetables (e.g., cinnamon, or citron can also be used separately
Portuguese Catholic priest
mushrooms, carrots, bamboo shoots, onions), and to make a spice tea. A common drink is rice tea,
introduced chile peppers
into Korea in the sixteenth nuts that are cooked in a seasoned broth heated made by pouring warm water over toasted,
century. They were quickly over charcoal. After the morsels of food have been ground rice or by simmering water in the pot in
adopted and have become eaten, the broth is served as a soup. Chicken and which rice was cooked. On special occasions,
ubiquitous in the cuisine. poultry are not especially popular in Korea. wine might be served. Wines are made from rice
Soybean products, however, are common, includ- and other grains; some include various flower
ing soy sauce and soy paste. Bean curd, made blossoms or ginseng as flavorings. Beer is also
from soybeans (tobu) or mung beans (cheong-po), well liked. Milk and other dairy products are
is a favorite. Mung beans, adzuki beans, and other generally not consumed or used in cooking.
legumes are steamed and added to many savory
Korean street vendors shred- and sweet dishes. Nuts, such as pine nuts, chestnuts, Meal Composition and Cycle
ding cabbage for the prepa- Daily Patterns. Three small meals, with frequent
ration of the spicy vegetable snacking throughout the day, are typical in Korea.
pickle kimchi.
Breakfast was traditionally the main meal in
Korea, but today is more likely to be something
light, caught on the run. Soup is almost always
served at breakfast, along with rice (usually as
gruel). Eggs, meat or fish, or vegetables may top
the meal. Kimchi and dipping sauces are the usual
accompaniments.
Lunch is typically noodles served with broth
of beef, chicken, or fish and garnished with shell-
fish, meat, or vegetables. Supper is more similar
to breakfast, but with steamed rice. In many
modern homes, it has become the main meal of
the day. Snacks are widely available from street
vendors, including grilled and steamed tidbits of
all types. Sweets, such as rice cookies and cakes,
or dried fruit (especially persimmons) are also
Michael Freeman/CORBIS
popular snacks.
Rice is considered the main dish of each meal.
Everything else is served as an accompaniment to
the rice and is called panchan. For dinner, at least
one meat or fish dish is included, if affordable,
and two or three vegetables are usually served.

Kimchi is always offered. Soup is very popular
and is served at most meals. Individual bowls of
rice and soup are served to each diner, and
panchan dishes are served on trays in the center
of the table for communal eating. Wine may
be served before the meal with appetizers
such as batter-fried vegetables, seasoned tobu,
pickled seafood, meatballs, or steamed dumplings.
Gary Conner/Photo Edit, Inc.

Dessert is seldom eaten, although fresh fruit
sometimes concludes the meal. Hot barley water
or rice tea is served with the meal.
Drinking is a social ritual, practiced mostly by
men. Distilled beverages like soju, a sweet potato
vodka, are consumed with snacks like spicy squid
or chile peppers stuffed with beef. Korean Americans celebrate
A special category of foods, called anju, are Sol, New Year s, on the first
considered an alternative to a full meal. Analogous Both Koreans and Korean Americans cele- full moon.
to tapas in Spain (see Chapter 6, Northern and brate several holidays throughout the year. The
Southern Europeans), they are small dishes espe- first is New Years, called Sol, a three-day event at
cially well suited to eating while socializing and which traditional dress is worn and the elders in
drinking.152 Examples include scallion-flavored the family are honored. Festivities include feasts,
pancakes usually accompanied by Korean rice games, and flying kites. On the first full moon, in
wine, mukhuli, Japanese-style sashimi, quail eggs, a tradition reflecting ancient religious rites,
bits of pork, raw crab in chili paste, or dumplings. torches are lighted, and firecrackers are set off to
These items are often served as appetizers in frighten evil spirits away. Shampoo Day (Yadu
Korean-American restaurants. Nal) on June 15 is when families bathe in streams
to ward off fevers. Thanksgiving (Chusok) is a fall
Etiquette. Chopsticks and soup spoons are the
harvest festival; duk, steamed rice cakes filled
only eating utensils used in Korea. In the past,
with chestnuts, dates, red beans, or other items,
seating was around a low, rectangular table on
are associated with the holiday.
the floor, and young women were assigned the
A special ceremony is observed on a childs At Korean weddings sweet-
awkward corner seats (today most tables are set
first birthday. He or she is dressed in traditional ened dates rolled in sesame
with chairs). Traditionally, elders are served first, seeds are tossed at the
clothing and placed among stacks of rice cakes,
and children are served last at the meal. It is con- bride by her in-laws to
cookies, and fruit. Family and friends offer the
sidered polite to fill the soy sauce dish of the ensure health, prosperity,
child objects symbolizing various professions,
people one is sitting beside. Food is always passed and numerous children.
such as a pen for writing or a coin for finance,
with the right hand, and a communal beverage
and the first one accepted is thought to predict
may be passed for all to share.
his or her future career.88
Special Occasions. Korean cooking was histori-
cally divided into everyday fare and cuisine for Therapeutic Uses of Food
royalty. The traditions of palace cooking and food Many Koreans follow the um and yang food clas-
presentation, including the use of numerous sification system. Little has been reported about
ingredients in elaborate dishes, are seen today in specific foods, although Koreans are believed to
meals for special occasions. At a meal celebrating adhere to categorizations similar to other Asians:
a birthday or holiday, or one shared with guests, um (cold) foods include mung beans, winter melon,
more dishes are served and both wine and dessert cucumber, and most other vegetables and fruits;
are offered. For special occasions, Koreans offer meats (e.g., beef, mutton, goat, dog), chile peppers,
a thick drink of persimmons or dates, nuts, and garlic, and ginger are considered yang (hot) foods.
spices, or a beverage made with molasses and Preparation of healthy, tasty food is an impor-
magnolia served with small, edible flowers float- tant way that Korean women show affection for
ing on top. family and friends.78, 105 Good appetite is considered
352 EAST ASIANS
Dog meat soup is eaten by a sign of good health. Foods that are believed to A study of pregnant Korean-American women
some men to enhance their be health promoting include bean paste soup, suggests that certain foods, such as seaweed soup,
strength and physical beef turnip soup, rice with grains and beans, beef, and rice, are thought to build strength during
prowess. broiled seaweed, kimchi, and ginseng tea. Ginseng this difficult time.72 Food taboos during pregnancy
products are often used to promote health and often involve the concept of like causes like. For
Boyak is often given as a gift,
stamina and to alleviate tiredness. One very popu- instance, eating blemished fruit may result in a
particularly to ones parents,
to promote long life. lar tonic, called boyak, combines ginseng and deer baby with skin problems. Other such items men-
horn or bear gallbladder.104 tioned are chicken, duck, rabbit, goat, crab, sparrow,
More than one-half of Korean-American pork, twin chestnuts, and spicy foods. Although
respondents in one survey reported using gin- most food avoidance was attributed to personal
seng, with older women more likely to use such preference and availability, many of the women
products than men or younger women.150 Other acknowledged familiarity with the traditional
home remedies commonly used include ginger beliefs. Korean women traditionally consumed
tea, yoojacha (hot citrus beverage), bean sprout seaweed soup, miyuk kook, three times a day for
soup, and lemon with honey in hot water. seven weeks after the birth of a child to restore
Restorative herbal medicines, vitamin supple- their strength.
ments, meat soups, bone marrow soup, and sam-
gyetang (game hen soup) also were mentioned by CONTEMPORARY FOOD HABITS
subjects as useful when feeling weak. IN THE UNITED STATES
Ingredients and Common Foods. A survey of
Korean Americans in the San Francisco area
showed that many traditional Korean food habits
continue after immigration to the United States.
Nearly all respondents ate rice at one meal every
day, and two-thirds ate kimchi daily. Beef and
SAMPLE MENU beef variety cuts were consumed regularly, and
fish was eaten at least once a week. Sesame oil/
seeds and vegetable oils were used more often
Dinner in Korea than butter or mayonnaise. Soy sauce, soybean
paste, kochujang, and garlic were the most popular
Soybean Sprout Soupa, b condiments. More than 40 percent of Korean
Americans surveyed consumed tobu several times
Bulgogi (Korean Barbecue Beef)a, b a week. Pork and pork products were not com-
Seasoned Tobu (Bean Curd),a, Chrysanthemum Leaf Salada monly eaten, although younger respondents
Seasoned Eggplanta reported more frequent use of these foods than
older subjects. Length of stay in the United States
Steamed Rice, Kimchi had little impact on diet.38 Among Korean-
American adults in Chicago, only one-third
Apple Pear reported increased intake of beef, dairy products,
bread, coffee, and soda (combined with decreased
Barley Water or Ginseng Tea consumption of fish and rice), and a majority con-
tinued to follow Korean dietary patterns.52
a A national study of mostly first-generation
Kwak, J. 1998. Dok Suni: Recipes from my mothers Korean kitchen. New York:
St. Martins Press. Korean Americans found similar trends. Regular
b
Korean Recipes at AllFoodRecipes at http://korean. consumption continued of some traditional dishes
allfoodrecipe.com/index.shtml and ingredients, such as rice, kimchi, garlic, scal-
lions, Korean soup, sesame oil, Korean stew, soy-
bean paste, and kochujang. Frequently consumed
American foods included oranges, low-fat milk,
bagels, tomatoes, and bread. Regularly eaten foods
common to both cultures included onions, coffee, but traditional Korean dishes were favored for
apples, eggs, beef, carrots, lettuce, fish, and tea. The dinner.67 Survey data suggest that hot barley water
researchers found that most respondents had served after meals is still the preferred beverage
access to Korean items, but as participation in of Korean Americans.38
American social life increased, acceptance of Korean Americans observe traditional Korean
American foods increased. Persons who had some- holidays (see Special Occasions in this section) as
one familiar with Korean fare to cook for them were well as other events, such as Buddhas birthday
more likely to continue eating traditional dishes (April 8), Korean Memorial Day (June 6), South
than were those who cooked for themselves.68 Korean Constitution Day (July 17), and Korean
In contrast, one study of Korean Americans, in National Foundation Day (October 3). Fathers
New York found that while less acculturated adults are honored on June 15. In addition, Christian
consumed a relatively traditional Korean diet, well- Americans of Korean descent celebrate the major
acculturated adults consumed significantly more religious holidays.
bread, cereals, spaghetti, ham, green salad, corn,
chocolate, candies, and diet soft drinks.50 Another Nutritional Status
study reported that well-acculturated Korean- Nutritional Intake. Few health studies focusing
American mothers were less likely to prepare on Korean Americans have been published. Most
Korean dishes at home and were more likely to research on Asian Americans combines heteroge-
dine out.108 Research on Korean, Korean-American neous Asian and sometimes Pacific Islander popu-
and American adolescents found that Korean- lations. One study found that Korean Americans
American teens adopted a diet in-between that of maintained a relatively traditional diet and that
traditional Korean and American food patterns, even with the addition of some American foods,
eating less rice and kimchi, but more cookies and 60 percent of calories came from carbohydrates
other sweets and soft drinks.110 and only 16 percent from fat.52 Higher intakes of
Although milk and dairy products are not vitamins A and C, beta-carotene, B3, and fiber are
consumed in Korea, these foods are often well associated with a more traditional diet. High
accepted in the United States. One study indicated sodium intake is also common when Korean
that more than one-half of the subjects reported foods are preferred.50, 52, 107, 110 Korean Americans
drinking milk or eating yogurt or cheese one or who adopt more American foods are reported to
more times each week.38 Another study of preg- consume more calories and have higher intakes
nant Korean-American women reported a similar of total fat, saturated fat, cholesterol, B1, vitamin E,
finding that 56 percent of respondents drank milk folate, iron, and zinc. Calcium, which is often
daily.72 Korean-American adolescent boys were deficient in the Korean diet, is increased with the
found to consume milk at 22 percent of meals, and use of dairy products.
teen girls drank it at 17 percent of meals.110 Age-adjusted mortality rates for Korean
It should be noted that many changes in the Americans are lower than for the general popula-
traditional diet have been observed in Korea. A tion, although infant mortality rates are some-
study of adolescents found only 30 percent con- what higher than those for whites.36, 63, 80 The
sumed a diet dependent on rice and kimchi, while leading cause of death among Koreans is stomach
70 percent ate a modified diet with added bread, cancer; higher incidence of stomach, liver, and
noodles, cookies, pizza, and hamburgers.129 Recent esophageal cancers have been found among
immigrants from Korea may prefer a more west- Korean Americans as compared to whites.47, 51
ernized diet than earlier immigrants, even when Factors associated with a risk of these cancers in
length of stay is shorter. the Korean diet include consumption of soybean
paste and kimchi, high sodium intake, and possi-
Meal Composition and Cycle. Little has been bly toxins resulting from the food fermentation
reported regarding Korean-American meal com- process. Aflatoxins are also sometimes found in
position and cycle. It is assumed that because Korean soy sauce.123 In addition, the rate of hep-
Korean meal and snacking patterns are similar to atitis B (responsible for most liver cancer) is very
those in the United States, three meals a day high in Korean Americans.
remain common. One study found American Information on obesity in Korean Americans
foods were most popular at breakfast and lunch, is limited. A study of Korean-American women
354 EAST ASIANS
found that the proportion of overweight and obe- behavior, confirmed in another study indicating
sity was only 9 percent in foreign-born subjects, that, for 77 percent of Korean Americans, drink-
compared to 31 percent in U.S.-born subjects.107 ing occurred at social occasions.151
Data suggest that length of stay in the United States
is positively correlated with being overweight. A Counseling. Korean-American clients are simi-
survey of Korean Americans in California deter- lar to many Asians in that language barriers may
mined 38 percent were overweight, and 8 percent interfere with counseling. Proficient translators
were obese when Asian-specific criteria were used, and cultural interpreters are often crucial to effec-
and men were more likely than women to be over- tive communication. Studies suggest that com-
weight or obese.21 While these figures fall below pared to other Asian-American groups, Korean
national norms, changes in diet associated with Americans have lower rates of health insurance
acculturation may put this population at risk for coverage. As many as one in every three may be
even greater weight gains. It has also been reported uninsured, reducing use of biomedical care.44, 54,
128
that many Korean Americans do not exercise regu- Cultural attitudes may also interfere with
larly.24 In general, Asians and Pacific Islanders in health care. A client may be ashamed of needing
the United States develop type 2 diabetes at rates help and fear being a burden to other family
significantly higher than those of the white popu- members during illness. Many Korean Americans
lation. One study in Hawaii found that Korean avoid screening exams.116 The stresses of accul-
Americans had a prevalence rate twice that of turation may be especially severe in the Korean-
whites, and self-reported rates in a sample of American community due to the large number of
middle-age and older Koreans in Chicago were recent immigrants.
almost three times higher.25 Koreans use a quiet, nonassertive approach to
Korean Americans appear to be at risk for conversation. Emotional expression over pleasant
hypertension. Though some studies report high topics may be animated, but during confrontation,
blood pressure rates in Korean Americans below emotional displays are avoided.32 Loud talking or
the U.S. average of 24 percent, others have found laughing is considered impolite (although some
rates 25 percent higher.25, 54, 56 Notably, national Koreans may laugh excessively when embarrassed).
rates reported in Korea show hypertension affecting A measured, indirect approach to topics is appre-
25 to 45 percent of the population. Family history ciated. Koreans may be hesitant to say no or to
is the major risk factor, though gender (Korean- disagree with a statement. Instead, tipping the
American men have higher rates than do head back and sucking air through the teeth are
women), higher levels of education and accultur- often used to signal dissension. Direct eye contact is
ation, lack of exercise, and obesity may also be expected, and it is used to demonstrate attentiveness
significant. No correlation with diet (including and sincerity. Koreans use few hand gestures when
alcohol, spicy food, or salt intake) has been talking. Touching is uncommon, except for a light,
noted.136 Research suggests Korean Americans introductory handshake between men. Hugging,
diagnosed with high blood pressure are less likely kissing, and back patting should be avoided, as
to take hypertension medications or to follow their should crossing ones legs or putting feet on the
physicians advice on losing weight or lowering furniture. Rising whenever an elder enters the room
sodium intake.55, 56 Incidence of death from heart and touching the palm of the left hand to the elbow
disease also has been found to be very low. of the right arm when shaking hands or passing an
Korean Americans have Koreans have higher alcohol consumption rates item to an elder is considered respectful.4, 85
high rates of glucose-6- than some other Asian groups. Older data on alco- The family is responsible for all its members
phosphate dehydrogenase hol consumption patterns in Korean Americans and is usually involved in health care. In one study
deficiency disease. suggest that 25 percent of Korean-American men it was found that most Korean Americans believed
can be characterized as heavy drinkers, while a patient should not be told of a terminal illness,
44.5 percent abstain completely; less than 1 percent and the family should make any life support deci-
of Korean-American women are heavy drinkers, sions, although younger, better educated, and
and 75 percent are abstainers. This prevalence rate wealthier Korean Americans were more open to
of alcohol abuse among men is equivalent to that of patient autonomy.8 It also is helpful to determine
the general U.S. population.19 Having friends who who is head of the household (often the father,
drink was a major factor in predicting drinking eldest son, or other male member). Some Koreans
find biomedical health systems very unsatisfactory. 3. What are the basic tenets of Confucianism As with other Asians who
They become frustrated when a physician relies on Taoism and Buddhism? How might these reli- use moxibustion or cupping,
lab tests to determine illness, especially if they are gions influence Asian food culture? it is important for health
told there is no reason for a specific complaint, or 4. Describe what is meant by Traditional Chinese care providers to determine
Medicines, Kanpo and Hanyak. How might these the cause of burns and
conversely, that some problem exists even though
bruises on clients before
they have no symptoms. They also may disagree be integrated into the Chinese, Japanese and
assuming abuse has
with the cause of a complaint; some somatic symp- Korean meaning of a balanced diet and life?
occurred.
toms may result from emotional distress, yet 5. What are the stables of the Asian diet? Describe
mental illness is highly stigmatized. Furthermore, some common foods derived from soybeans.
they may expect physical treatments (i.e., acupunc- What are different types of tea from Asia
ture or cupping) from the provider and are likely to describe how they differ, including their taste.
want a permanent cure.105 Inconvenient hours and 6. How did the Chinese influence the cuisine and
the need for an appointment may also discourage world view of the Koreans and the Japanese?
the use of biomedical health care. Provide two example of their influence, one
In the United States clients often administer each in Korea and Japan.
home remedies and consult shamans or hanui
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CHAPTER
12
Southeast Asians
and Pacific
Islanders
S outheast Asians and Pacific Islanders live in

similar tropical regions and may share some
common ancestors, yet their cultures have
diverged markedly over the centuries. The coun-
tries of Southeast Asia have developed under hun-
opportunities. In contrast, the majority of main-
land Southeast Asians who have come to the
United States have arrived since the 1970s as
refugees from the political conflicts of the region.
dreds of years of Chinese domination. Spanish The Philippines. Substantial immigration from
expansionism in the Philippines and French occu- the Philippines to the United States started in
pation in Vietnam were also significant. In contrast, 1898 after the country became a U.S. territory.
Asian and European contact in the Pacific Islands Approximately 113,000 young male Filipinos trav-
was limited until the eighteenth century, and sub- eled to the Hawaiian Islands between 1909 and
sequent foreign influence almost completely over- 1930 to work in the sugarcane fields. Many of these
whelmed the traditional indigenous societies. immigrants later moved to the U.S. mainland.
Southeast Asians and Pacific Islanders are some These early immigrants were considered U.S.
of the newest, youngest, and fastest-growing pop- nationals and carried U.S. passports, yet they were
ulations in the United States. More than 2 million not allowed to become citizens or own land. Most
mainland Southeast Asians and Filipinos have were uneducated peasant laborers from the island
arrived since 1975; the number of Pacific Islanders of Illocos. Because they were not permitted to bring
has increased by 50 percent since 1990. This section their wives or families, social and political clubs
discusses the cultures and cuisines of the South- replaced the family as the primary social structure.
east Asians who have immigrated in substan- In 1924 the immigration of Filipinos slowed The only Filipinos allowed
tial numbers to the United StatesFilipinos, as a result of Asian exclusion laws (see Chapter 11, to apply for U.S. citizenship
Vietnamese, Cambodians, and Laotiansas well East Asians, for more information). After World prior to 1946 were those
as those Pacific Islander groups with significant War II, it became legal for Filipinos to become U.S. who had enlisted in the U.S.
citizens, and the number of immigrants increased. Navy, Naval Auxiliary, or
American populationsnative Hawaiians, Samoans,
Marine Corps during World
Guamanians, and Tongans. Significant numbers of Filipinos arrived in the
War II; had served at least
United States after 1965 when the U.S. immigra-
three years; and had an
tion laws were changed, and by 1980 more than honorable discharge.
Southeast Asians 350,000 had emigrated to mostly urban areas.
Two-thirds of the Filipinos who arrived after
CULTURAL PERSPECTIVE World War II qualified for entrance as professional
or technical workers. Yet discrimination against
History of Southeast Asians in the United States Asians often forced Filipinos into low-paying jobs.
Immigration Patterns. Most Filipinos immigrate Little Manilas formed in many California cities,
to the United States for educational and economic and similar homogeneous neighborhoods were
362 SOUTHEAST ASIANS AND PACIFIC ISLANDERS
VIETNAM
LAOS
THAILAND South PHILIPPINES

China
CAMBODIA Sea
M
I C
R
O
N
E
S
I
A
M A L A Y S I A
M E
L
A
N
E
S
I
I SO A
NEW GUINEA LO
N D M
ON
O N E S I A IS
LA
N
D
S
NEW
CALEDONIA
Indian Ocean
AUSTRALIA
Figure 12.1
Southeast Asia and the
Pacific Islands.
found in Chicago, New York City, and Washington, The first occurred when South Vietnam fell to the
DC, where some Filipinos opened small service North in 1975, and 60,000 Vietnamese left the
businesses to meet the needs of their community. country with the assistance of the United States.
Another 70,000 managed to flee on their own.
Vietnam. Vietnamese immigration to the United Most of these refugees had been employed by the
States is characterized by three distinct waves. United States or were members of the upper classes.
Chapter 12: Southeast Asians and Pacific Islanders 363
Hawaiian Islands
M
P
I
O
C
L
R
O
Y
N
N
E
E
S
S
I
I
A
VANUATU
FIGI
NEW
CALEDONIA
South Pacific Ocean
NEW
ZEALAND
Figure 12.1
Southeast Asia and the
Pacific Islands (continued).
They immigrated in intact family groups and were The third phase of immigration started in 1978,
able to bring their property with them. From 1975 when increasing numbers of ethnic Chinese living
to 1977 another wave of Vietnamese left for polit- in Vietnam fled the country, again by boat. This
ical or economic reasons, often escaping by sea. wave of immigration was accelerated by the
Many of these boat people left their families Chinese invasion of northern Vietnam in 1979.
and what little money they had to find freedom. This second group of boat people left with no
financial resources, and many lost family mem- United States, forcing them to accept blue-collar
bers escaping in unseaworthy vessels that were jobs when they first arrive. Over time, many pro-
easy prey for pirates. After being rescued, the fessionals do obtain licensing or accreditation
boat people often lived for several months, even and work as physicians, nurses, or lawyers. Nearly
years, in refugee camps in various Southeast 40 percent are employed in professional or man-
Asian countries before coming to the United States. agement careers.118 Others are employed in the
In addition, the United States and Vietnam devel- sales and service industries, or in construction,
oped the Orderly Departure Program (ODP) in and this group is economically better off than
1979 to bring imprisoned former South Vietnamese previous immigrants, many of whom are now
soldiers and the approximately 8,000 Amerasians, poor, elderly single men. A schism has developed
children of U.S. fathers and Vietnamese mothers, in the Filipino-American community between
to the United States. pre-1965 immigrants, who believe the newer
immigrants are ungrateful for the advances
Cambodia and Laos. Cambodian and Laotian
achieved by the older generation, and the more
immigration to the United States did not begin
recent immigrants, who find the older generation
until the United States granted asylum to the resi-
nave and uneducated.87
dents of the refugee camps along the border with
Thailand in 1976 to 1979. International concern
Vietnamese. More than 700,000 Vietnamese have
about the large numbers of refugees and the con-
entered the United States since 1975, and the total
ditions in the camps prompted accelerated admit-
Vietnamese population, including those born in
tance of Southeast Asian immigrants worldwide.
America, was estimated at over 1.4 million in
Many of the refugees were members of tribal
2005 by the U.S. Census, indicating it has more
populations who lived in the isolated mountain-
than doubled since 1990. Some were initially
ous regions of Southeast Asia, including the
sponsored by American agencies or organizations,
Hmong and Mien (ethnic Chinese populations
which provided food, clothing, and shelter in
who migrated south to escape persecution in the
cities throughout the United States until the
eighteenth century).
Vietnamese could become self-supporting. Many
Current Demographics and Socioeconomic Status Vietnamese Americans have since relocated to
Filipino. The Filipino-American population has the western and Gulf states, probably because the
more than doubled since 1980. Over 2.2 million climate is similar to that of Vietnam.
Filipinos live in the United States, according to Vietnamese Americans live primarily in urban
2005 census estimates. Almost half reside in areas. Many are young and live in large households
California, with significant populations of more with grandparents and other relatives. The first
than 30,000 Filipinos found also in Hawaii, Florida, wave of Vietnamese immigrants was well edu-
Illinois, New York, New Jersey, Texas, and cated, could speak English, and had held white-
Washington.87 It should be noted that Filipino collar jobs in Vietnam. Many of them had to accept
Americans are a very heterogeneous group who blue-collar jobs initially and had difficulties sup-
come from different cultural groups within the porting their extended families. The boat people
Philippines and often speak a variety of native were even less prepared for life in the United States
languages.15, 87 because they often had no English language skills,
There were over Though two of every three Filipino Americans were illiterate, had less job training, and did not
327,000 Canadians of are foreign-born, citizenship rates are higher have support from an extended family.
Filipino heritage in the than in other Asian groups. Educational attain- Language acquisition has been important in the
2001 census. ment is also high. Nearly 44 percent of Filipino Vietnamese community,12 and many immigrants
Americans hold college degrees.118 Family median have made the decision to assimilate as quickly as
During the 1920s and
incomes are 30 percent above the national aver- possible, even changing their Asian names, such
1930s, Filipinos were often
barred from restaurants,
age, combined with poverty rates approximately as Nguyen, to something more Anglicized, such as
swimming pools (and other half that of the general U.S. population, both due Newman. Education is highly valued, and a childs
recreational facilities), and to higher earnings and, sometimes, to pooled academic achievement is considered a reflection
movie theaters because of income of several adults living in each household. on the whole family. High school dropout rates
their dark skin and heavy Some Filipinos find that their education or are very low among Vietnamese Americans, and
accents. professional experience is not recognized in the almost half attend college, compared to 40 percent
of white Americans. However, when all Vietnamese have been identified. Refugee resettlement serv-
Americans are counted, including the adults who ices dispersed the Hmong, irrespective of family
immigrated later in life, over 38 percent have less clan associations, in fifty-three American cities.
than a high school education, and lower than U.S. Secondary migration of Hmong Americans has
average numbers have college degrees.118 reunited clan groups, mostly in the suburban and
Vietnamese have high rates of employment, rural communities of Minnesota (St. Paul has
but often in low-paying jobs. They are prominent the largest single population, over 25,000) and
in the fishing and shrimping industry in the Gulf Californias Central ValleyFresno, Merced,
States, and others hold positions in manufactur- Sacramento, Stockton, Chico, Modesto, and Visalia. In 2001 the Canadian
ing and transportation. Those who obtain college It is believed that nearly all Mien live in four states: Census reported approxi-
degrees often prefer technical professions, such California, Oregon, Washington, and Alaska. mately 187,000 residents of
as engineering. Median family income is below Poor fluency in English and low education Southeast Asian heritage,
the U.S. average, and poverty rates are higher. levels have hindered economic achievement for 151,000 of whom were
Laotian Americans. Only 50 percent of adults have Vietnamese.
Cambodian. The 2000 U.S. Census identified
completed high school.118 Current Laotian stu-
approximately 178,000 Americans of Cambodian There are five major tribes
dents are generally believed to do well in school,
descent, but it is thought that this figure may under- among the Hmongthe
but higher-than-average high school dropout rates
estimate actual numbers due to a low response rate White Hmong, the Black
and lower-than-average college attendance rates
by Cambodians unfamiliar with American society Hmong, the Blue Hmong,
have been noted.11 Many Laotians hold low-paying
in the census count.9 Over 90 percent have arrived the Red Hmong, and the
jobs in transportation and as machine operators, Flowery Hmongnamed
since 1990.118 Nearly half of Cambodian Americans
fabricators, and laborers, yet it is estimated that according to legend by the
reside in California, with the greatest populations
only 18 percent live in poverty. colors of clothing they were
found in Long Beach and Stockton. Another large
Nearly 60 percent of Americans of Hmong forced to wear by the ancient
Cambodian community has developed in Lowell,
descent have less than a high school education, Chinese for identification
Massachusetts. Texas, Pennsylvania, Virginia, New
and most Hmong are employed in blue-collar jobs purposes. Most Hmong
York, Minnesota, and Illinois also have significant
or manual labor.10, 118 Some enterprising Hmong refugees in the United States
numbers of immigrants. come from the White and
women have been successful in marketing the
Adjustment to American life has been diffi- Blue tribes.
traditional Hmong needlecraft known as paj ntaub.
cult for Cambodians, most of whom came from
The colorful wall hangings, pillows, and bed cov-
rural regions where they worked as farmers. Over 100,000 Thais have
erings have become popular among collectors of immigrated to the United
They have a high unemployment rate (although
native arts. Median family income is among the States since the 1970s; most
the probability of employment increases with
lowest of all immigrant groupsover 35 percent have settled in Los Angeles,
length of stay), and those who work have found
below the national normand poverty rates of New York, and Texas. They
employment mostly in service jobs, manufactur-
more than 37 percent are more than three times are known for their rapid
ing, transportation, and manual labor. Median
the U.S. average. acculturation.117
family income is 30 percent below the national
average, and nearly 30 percent of Cambodians
Worldview
live below the poverty level. Low levels of educa-
tion have limited economic success for many Religion. Many Southeast Asians hold beliefs
Cambodian Americans. More than half of adult dating back to the ancient religions prevalent before
men and women have less than a high school the introduction of Buddhism, Catholicism, and
education.118 Low dropout rates among younger Islam. Most believe in spirits and ghosts, especially
Americans of Cambodian descent may contribute of ancestors, who have the ability to act as guardians
to better economic outcomes in the future.9 against misfortune or cause harm and suffering.
Ideas about spirit intervention have often been
Laotian. About 168,000 nontribal Laotians live incorporated into Eastern and Western religious
in the United States, according to 2000 U.S. practices or survive as significant superstitions.
Census figures. Most Laotians have settled in the
California cities of Fresno, San Diego, Sacramento, Filipino. The majority of Americans of Filipino
and Stockton. Large populations are also found descent are Roman Catholics, although it is esti-
in Amarillo and Denton, Texas; Minneapolis, mated that as many as 5 percent are Muslim.
Minnesota; and Seattle, Washington. Another Religion significantly affects the worldview of
170,000 Hmong and approximately 25,000 Mien Filipinos, especially elders. Many hold that those
who lead a good life on Earth will be rewarded spheresthat which is visible, containing humans,
with life after death. Human misfortunes come nature, and material objects, and that which is
from violating the will of God. One should accept invisible, containing spirits. The shaman acts as
ones fate because supernatural forces control the an intermediary between the two; some spirits,
world. Time and providence will ultimately solve such as those of ancestors, are available to those
all problems. who arent shamans. Women are generally respon-
sible for making contact with these more accessi-
Vietnamese. Nearly 70 percent of Vietnamese ble spirits.
Hmong ancestors are fed at Americans are Buddhists, and 30 percent are It has been suggested that many Hmong
every festive occasion with Roman Catholic. Small numbers of Protestants became Protestants because they believed it was
a little pork and rice placed also are found. Those who are Buddhists follow necessary to gain entry to the United States or in
in the center of the feast the Mahayana sect, influenced particularly by the deference to their church sponsors. Some try to
table. Chinese school of Chan Buddhism (Zen Buddhism combine ancestor worship with their new faiths
in Japan) called Tien in Vietnam. Buddhists believe so as not to offend the spirits.2 Small numbers of
In Thailand miniature that their present life reflects their past lives and
Thai temples are built and
other Hmong belong to a modern Hmong religion
also predetermines their and their descendants called Chao Fa (Lord of the Sky), started by a
posted on pedestals next to future lives. They consider themselves as part of
a home to shelter the prophet in the 1960s who encouraged the Hmong
a greater force in the universe (see Chapter 4, to break with both Laotian and Western ways.
family ancestors. Such spirit
houses are believed to
Food and Religion, for more information about
Buddhism). Family. Southeast Asians share a high esteem
prevent the ghosts from
moving in with the family for the family, respect for elders, and interde-
Cambodian. The predominant religion in Cam- pendence among family members. Behavior that
and causing trouble.
bodia is Theravada Buddhism, which places would bring shame to the familys honor is
greater emphasis on a persons efforts to reach avoided, as is direct expression of conflict. Social
spiritual perfection than does the Mahayana sect, acceptance and smooth interpersonal relation-
which employs the help of deities. Merit through ships are emphasized.
good deeds, the participation in religious ritual,
and the support of monks and temples is critical Filipino. The Filipino family is highly structured.
to ones progress through reincarnation. Although At the center is the extended family, containing
some Cambodian Americans have converted to all paternal and maternal relatives. Kinship is
Christian faiths, most still practice Buddhism, often extended to friends, neighbors, and fellow work-
in temples established in apartments or homes. ers through the system of compadrazgo. Lifelong
relationships are initiated through shared Roman
Laotian. Almost all Laotians are also Theravada Catholic rituals, particularly the selection of god-
Buddhists. Making merit for Laotians includes parents and baptism of new babies. Community
the expectation that every man will devote some obligations created through this system include
time in his life to living as a practicing monk, shared food, labor, and financial resources.
either before marriage or in his old age. In the The first Filipino immigrants were single men
United States men find it difficult to fulfill their hoping to make their fortune and return to the
obligation to the faith. Women may become nuns Philippines. They developed surrogate family sys-
for periods in their lives as well, especially if wid- tems of fellow workers who lived together, with
owed. Most Laotians in the United States worship the eldest man serving as patriarch. More recent
at Buddhist temples with Cambodians or Thais immigrants have come as whole families and have
who share their religious practices. been able to maintain much of their social organ-
About half the Hmong population in the ization. For example, as many as 200 sponsors
United States is now Christian as a result of French may be appointed in a Filipino-American bap-
and American missionary work in Laos and tism, although individual commitment may be
conversions after arrival. Baptists, Presbyterians, less than if it were held in the Philippines.87
Mormons, Jehovahs Witnesses, and members of Filipino children are adored by the family and
the Church of Christ have actively recruited the are typically indulged until the age of six. At that
Hmong. The other half of Hmong Americans prac- time, socialization through negative feedback
tice animism, shamanism, and ancestor worship. (e.g., shame) begins. Children are taught to be
They believe that the world is divided into two obedient and respectful, to contain their emotions
and avoid all conflict, and to be quiet and shy.

Politeness is emphasized.4 People must avoid sham-
ing themselves or their families; discord is mini-
mized by the use of euphemisms and by sending
go-betweens in sensitive situations. The prestige of
a family may be measured by how well children
adhere to traditional values. Though Filipino par-
ents often support their children in advanced edu-
cation and professional careers, women may be

discouraged from attending schools where they
would be beyond family supervision.109
Vietnamese. The extended Vietnamese family
has been modified in the United States to adapt to
American norms. A nuclear family is more typical,
though somewhat larger than the average family
in the United States. Close relatives are encouraged
The traditional Vietnamese
to move into homes next door or in the same likely to the large numbers of men killed in recent extended family home is less
neighborhood. years during conflicts in Cambodia. Furthermore, common in the United States,
Family values are in transition. The father is Cambodian-American women are permitted but relatives often live near
traditionally the undisputed head of the house- formal education, and their financial contribu- each other.
hold, but patriarchy is diminishing as women tions are needed to help support the whole family.
attain higher levels of education and professional Differences between immigrants who have lived
achievement. American-style dating has become most of their lives in Cambodia and the children
common. Although most Vietnamese marry of these immigrants raised in the United States A Cambodian proverb
within their ethnic group, women are more likely (with no memory of Cambodia) can be enormous states, If you dont take
than men to wed non-Vietnamese mates. Divorce in terms of language, acculturation, and values. It your wifes advice, youll
is uncommon.12 has been noted that many Cambodian teenagers have no rice the next year.
The level of intergenerational conflict is suffer from identity problems.9
When Cambodians wed, a
reportedly high.12 Children are often the first to
Laotian. Most families are agriculturally based in Buddhist monk cuts a lock
learn English and acculturate more easily than
Laos. Extended members live and work together of hair from both the bride
their parents, causing value conflicts and loss of and groom to mix together
in the fields to support the whole family. In Laos
respect for elders. The role of elders is also chang- symbolically in a bowl.
men represent the family in village affairs, and
ing. Old age is valued in Southeast Asia, but in the
women run the home. Great significance is given
United States older relatives are often physically
to the site of the familys house; it is believed that
isolated from their peers and even younger
as long as the site exists, the family will exist.
family members and may be linguistically iso-
Extended families are still important to
lated within the larger community.
Laotian Americans due to dependency on rela-
Cambodian. Large extended families are common tives for social and economic support. Although
in Cambodia; children are considered treasures. nuclear families have become the norm, extended
Cambodians are notable in that their traditional members tend to live nearby each other. Women
kinship system was bilateral, emphasizing both the have attained nearly equal status with men in the
paternal and maternal lines. The family was pri- United States, and it is not unusual for Laotian
marily a matriarchy until the 1930s, when French men to share responsibility for household chores.
influence strengthened the authority of the father. Laotians have a notably low divorce rate.11
Today men are responsible for providing for their Hmong-American families are among the
families, while women make all decisions regard- youngest and largest in the United States: more
ing the family budget. than half of all Hmong are under the age of 18.118
It has been difficult for Cambodian Americans Typical family size is about six members; the
to retain their traditional family structure in the Asian average is 3.7, and the white American
United States. A large percentage of Cambodian average is just 3.1. These large families are usu-
homes are headed by single women, due most ally nuclear, reflecting numbers of children rather
than relatives. Extended family members are often supernatural world, particularly the intervention
located nearby, and families frequently congregate of malevolent spirits or the ghosts of angry
with other families from the same traditional clan ancestors. Chinese medical practices involving
from Laos, sometimes pooling resources.103 yin and yang or the five evolutive elements (see
Men remain the heads of households in Chapter 11) are considerations in some areas of
America. Women are traditionally held in high mainland Southeast Asia, while the Mexican
regard in their roles as mothers, yet it has been hot-cold theory is more prevalent in the
noted that fathers are assuming a much larger Philippines (see Chapter 9, Mexicans and
role in childcare in the United States.103 Children Central Americans).
are the heart of the home, and much of family life Religious precepts regarding rewards for
revolves around them. At age five, however, chil- making merit, or performing good deeds, and
dren are expected to behave as adults. punishment for violating Gods will are also
As in some other Southeast Asian groups, a involved in health maintenance. In the most gen-
generation gap has developed between recently eral terms, keeping healthy requires personal
arrived immigrants and their westernized chil- harmony with the supernatural world, nature,
dren. Teenage runaways have become increasingly society, and family fulfilled through ones obliga-
common among the Hmong.10 Some Hmong cus- tions to ones ancestors, ones religion, and ones
toms have come in direct conflict with U.S. laws. kin and community. Illness is usually defined by
Polygyny, marriage to more than one wife, is its cause, not its symptoms.
unusual but not illegal in Laos (by custom, Most Filipinos adhere to the concept of bahala
Hmong men marry the widows of their deceased na, meaning that life is controlled by the will of
brothers and support their nieces and nephews). God and by supernatural forces. If a person
Clan leaders might wed several women to estab- behaves properly, shows consideration of others
lish political connections, and having several and sensitivity in relationships, fulfills debts and
wives was indicative of wealth. The practice that obligations, shows gratitude, and avoids shame,
has received the most press in the United States, he or she is rewarded with health in this life and
however, is the kidnapping of young women and eternal life after death.4 Many Filipinos believe
enforced marriage. Traditionally, girls married that illness is a punishment for transgressions
between the ages of fourteen and eighteen after a against God. Religious medals are worn for pro-
bridal price (paid by the groom) was agreed to tection from evil.
by both families. If no agreement was reached, Spanish control of the islands administered
the couple could elope, and a mediator would help through Mexico led to the adoption of some
to settle the differences. If the bride was unwill- aspects of humoral medicine in the Philippines,
ing, the groom could kidnap the girl, and the including not only the hot-cold theory, but also
marriage would be recognized after some pay- the condition commonly known as wind or air
ment to the brides family was arranged. Men who (mal aire in Mexico; see Chapter 9, Mexican
have attempted this in the United States have been Traditional Health Beliefs and Practices section).
charged with abduction and sexual assault, often Supernatural illnesses in the Philippines are
by the young women involved. Many Americans most often due to the unhappy ghosts of ones
of Hmong descent believe that it is best to wait ancestors, although witchcraft, or the powers of
until a woman is in her late teens or early twenties animal spirits, may also be involved. Usog or
to wed; arranged marriages are still common. tuyaw occurs when a person transmits illness
Hmong marriages are Conversion to Christianity has split many through the power of the evil eye or the use of
traditionally formalized at Hmong families when some members change hands, fingers, words, or even physical proximity.93
a two-day feast featuring faiths and others retain their traditional beliefs. Undesirable traits or conditions can be transferred
a roasted pig. Conflict over marriage traditions is especially magically through contact with a person or object.
prevalent. A pregnant woman will try to gaze upon beau-
tiful objects or people and avoid looking at a
Traditional Health Beliefs and Practices. person with a deformity to prevent a similar
Southeast Asian health concepts typically com- occurrence in her fetus. Some believe if a preg-
bine facets of multiple belief systems. Indigenous nant woman craves dark-skinned fruit, her infant
ideas about the origins of illness center on the will have a dark complexion.109, 150 Some Filipino
Americans who believe in supernatural causes of that opening; and coconut oil may be rubbed into
disease do not think that these forces apply in the the skin to block the pores. Whooping cough and
United States, because ghosts and spirits cannot mental illnesses are two of the more serious con-
cross the ocean, nor can they survive in the noisy ditions that can be caused by wind.
cities where many Filipinos now live. Balance is also important in other areas as
In the Philippines health is maintained well. Any rapid change is avoided, such as going
through the balance (timbering) of natural and from the activity of heavy exercise to the inac-
supernatural elements.4,15,93,150 A person is thought tivity of showering (thus a short rest period is
to be predisposed to certain illnesses, and the needed in-between). Emotional restraint is main-
timing of external events contributes to the devel- tained when possible,15 because strong emotion
opment of disease. Unbalanced conditions, such as may cause certain symptoms of illness. For
working too much, overeating, excessive drinking, instance, some Filipinos feel that excessive anger
inadequate diet or sleep, unhygienic conditions, or envy is a hot condition and great fright or joy
infections, accidents, emotional stress (especially is a cold condition. Somaticized complaints are
fright or anxiety), or loss of self-esteem, may increase common.105, 109
a persons vulnerability, as do factors such as the Flushing is used to cleanse the body of impuri-
season and the weather. ties or evil forces through perspiration, flatulence,
Three practices are used to produce balance: vomiting, or menstrual blood.150 Vinegar mixed
heating, protection, and flushing. It is widely with water, salt, and chile peppers is one example of
believed that a warm body is needed to prevent a flushing treatment, taken to stimulate sweating.
illness. Heating means that a person balances hot Several types of traditional healers are
and coldwhether through exposure to the ele- common in the Philippines: midwives, masseurs,
ments or through eating the right proportions of curers (who diagnoses through evaluation of the
foods classified as hot or coldso that warmth pulse), arbularyos (herbalists), and shamans,
is maintained and overheating is avoided. For who cure supernaturally caused illness through
example, cold or cooling foods, such as orange use of folk remedies. In urban regions, where
juice, are not consumed first thing in the morn- belief in ghosts and spirits is not as prevalent,
ing. Bathing, often twice per day, is also used to faith healers are gaining in popularity. Faith healers
maintain warmth in the body. Any imbalance, do not diagnose illness but cure it through prayer,
whether too hot or too cold, is believed to cause anointing with oil, and the laying on of hands,
illness by reducing blood flow, causing loss of which transmits a sacred healing energy to the
appetite, and lowering of the bodys ability to patient.93, 109, 150
fight off sickness. For example, a nursing mother For the Vietnamese, health is related to personal
who becomes overheated by too much sun or destiny. How one behaved in past lives and the
from exposure to a hot kitchen may find that her number of good deeds performed by ones ances-
milk has become rancid, producing colic or diar- tors determine ones experiences in this life.
rhea in the baby.61 Specifics on the application of Current behavior, such as pleasing good spirits and
hot and cold classifications and treatment vary avoiding evil spirits, can also impact health. Similar
tremendously from person to person. to the Filipinos, pregnant Vietnamese women may
Protection safeguards the body from natural avoid funerals or ugly objects or leaving their
and supernatural forces. For instance, a layer of homes at the times malevolent spirits are active
fat is needed to protect the body from external (noon and 5:00 p.m.). The use of divination,
cooling. Wind is of special concern. It may cause through fortune-telling, astrology, or physiognomy
disease directly through drafts or be absorbed (the shape of the body, especially the head, as it
through the pores or any wounds. Wind that is correlates to the mind), is popular for predicting
too cold or too hot affects the blood, causing how a person might expect his or her life to pro-
increased or decreased circulation, resulting in a ceed and what interventions might be needed to
general malaise and increased susceptibility to prevent certain negative experiences.102, 106
illness. A postpartum woman avoids bathing for Traditionally, the Vietnamese believe that the
nine to forty days after birth of the baby to pre- human body is sustained by three separate souls:
vent wind from entering her vagina; a newborns one that encompasses the life force, one that repre-
umbilicus is bound to keep wind from entering sents intelligence, and one that embodies emotions.
In addition, nine vital spirits provide assistance Hmong men ages twenty-five to forty who were
to the souls. Soul loss can be an important and the earliest immigrants to the United States.2
life-threatening reason for illness. Typically, strong Although biomedical hypotheses have been pro-
feelings, especially fright, can cause the soul to posed to account for the fatal syndrome, such as
leave the body.139 heart irregularities or sleep apnea, none has been
Among the ethnic Chinese- The Chinese medical system is commonly proven. It is now believed the phenomenon
Vietnamese immigrants, used by ethnic Chinese Vietnamese and by some known as sleep paralysis is involved.30, 66 Some
many are Traditional other Vietnamese as well. Maintaining a balance researchers believe that death is caused within
Chinese Medicine of yin and yang, especially through diet and the the cultural context of the nightmare experience.
practitioners. treatment of disease, is a primary consideration Specifically, the nightmare spirit, dab tsog, enters
in health. Like the Filipinos, wind (or air) is some- the room at night and the victim wakes to the
times seen as a cause of illness. Some Hmong are sensation of the spirit sitting on his or her chest; he
also concerned with hot, cold, and wind as well. or she is unable to move and is terrified. Although
Hmong women are reportedly thought to be in many immigrants report having experienced
a cold condition immediately following birth nightmares in Southeast Asia, the attack by the
(having lost hot blood) and must avoid cold spirit does not usually result in death. Cultural
drinks, cold drafts and wind, and sexual inter- disruptions are believed to have intensified the
course to reestablish balance.63 episodes. A Hmong man in the United States is
Laotians often wear copper Cambodians, Laotians, and Hmong are also often unable to perform his obligations to ances-
or silver bracelets or colored concerned with spiritual intervention in health. tor spirits and may also have difficulties in fulfill-
strings around their wrists, Laotians identify thirty-two spirits that oversee the ing his role as breadwinner and head of household.
necks, and ankles to keep thirty-two organs of the body.11 The Hmong recog- Guilt and depression create increased vulnerability
their souls from leaving. nize the world of the invisible, where the spirit of to fatal nightmare experiences. Post-traumatic
White string is used by
every animal, tree, and rock resides, amid the souls stress disorder, panic attacks, exposure to chemical
families; red or black
of the living, ancestor spirits, caretaker spirits, and warfare agents, or blood electrolyte imbalances
strings are tied on by
shamans during ritual cere- evil spirits. Ancestor spirits require special consid- may be other risk factors.66, 139
monies. eration because if they become angry, they may Traditional healers are typically specialized
leave their progenies or fail to protect them from practitioners among mainland Southeast Asians.
evil. The Laotians have elaborate rituals called They may provide services for broken bones, skin
baci, mostly performed at all special occasions by infections, or objects stuck in the throat. Hmong
older men who have been monks, that bind the herbalists (kws tshuaj) treat natural disorders,
spirits to their possessor. Among the Hmong, the such as menstrual problems, impotence, infertility,
loss of ones soul, usually due to strong emotional stomach disorders, and diarrhea, with teas and
distress, is the single most important cause of poultices.63 Hmong shamans treat patients for
illness. It generally results in malaise and weight spiritual disorders at great personal risk due to
loss, leading to more serious disease. Related to interaction with the spirit world.111 They heal con-
soul loss is the condition called ceeb, or fright ditions such as mental illness, hypertension, dia-
illness. Ceeb typically occurs in children (although betes, breathing difficulties, and fainting. In many
it can happen to adults as well) if they are in an cases they often deal with lost souls. Magic healers
accident, chased by a dog, startled by a noise, or are not spiritually chosen for their profession but
plunged into cold water. The soul becomes discon- may interface with the spirit world to treat injuries
nected; the blood cools down and slows, resulting and stones (such as those found in kidneys, or
in a chilling effect that begins in the extremities those placed in bodies by evil spirits). Monks may
and can progress to the vital organs.26 lead religious rituals. Among most Southeast
Unique to Southeast Asians in the United States Asians, minor illnesses may be treated by anyone
is the unexplained condition known as sudden with healing experience, typically a grandmother
unexpected nocturnal death syndrome (SUNDS), or mother in the home. The family takes respon-
In parts of Southeast Asia when a seemingly healthy person dies in his sibility for the illness of an individual and will
opium is traditionally or her sleep. It is especially prevalent among usually exhaust all remedies available within the
grown in home herb Cambodians, Laotians, and Hmong, although it house before seeking outside help.103
gardens for use as a pain may occur in other immigrants from the mainland Botanical remedies are very popular with
killer.103 as well. It was a leading cause of death among many mainland Southeast Asians living in the
United States. Cambodians, Laotians, and Hmong pastries for dessert, whereas Filipinos frequently Mien rituals involving
sometimes maintain herb gardens for easy access have Spanish-style custard flan. As in China and ancestor spirits require a
to therapeutic ingredients. Some immigrants fre- Japan, the staple foods are rice (primarily long- genealogical record of the
quent Chinese herbalists or will buy imported grain), soybean products, and tea. A meal is not family going back ten gen-
erations.
products from Asia.53 Herbs and other substances considered complete unless rice is included.
(e.g., rhinoceros horn, black chicken dung, dead Instead of soy sauce, however, Southeast Asians
turtle, or chicken parts) are prepared as teas, often season their food with strongly flavored
broths, steam inhalants, or balms.67, 103 Physical fermented fish sauces and fish pastes.
therapies may include massage; cupping (a heated
cup or a cup with a small amount of burning paper Ingredients and Common Foods: Staples
is placed over a certain spot on the body until the and Regional Variations
fire goes out, leaving a round red spot on the skin);
Filipino. Filipino fare has blended Malaysian,
moxibustion (burning a small bundle of herbs on
Polynesian, Spanish, and Chinese influences into
the skin or using a lit cigarette); and coining (rub-
a distinctive cuisine. There are three principles in
bing a coin or spoon dipped in tiger balm or euca-
Filipino cooking: First, never cook any food by
lyptus ointment across the skin with pressure),
itself; second, fry with garlic in olive oil or lard;
scratching, or pinching affected areas. In most
and third, foods should have a sour-cool-salty
cases the therapy is used to release any bad wind or
taste.138 For example, adobo, one of the most pop-
excess heat and to restore balance to the body.24, 103
ular Filipino preparations, combines marinated
Religious rituals are also used to intervene on
chicken, pork, and sometimes fish or shellfish,
behalf of an ill person. Hmong soul callers perform
that is then fried with garlic in lard and then
the Mandate of Life ceremony to return a lost soul
braised in soy sauce, vinegar, garlic, chile pep-
to its host body, and the Mien appeal to ancestor
pers, bay leaf, and peppercorn with whatever
spirits to protect family members and assist in heal-
vegetables are on hand, such as plantains, pota-
ing. These rituals sometimes include animal offer- Traditional foods of
toes, greens, or bamboo shoots.159 Filipinos tradi-
ings. A butchered animal, typically a chicken, pig, or Southeast Asia and the
tionally used a clay pot for cooking but now use a
occasionally a cow, is purchased from a packing- Pacific Islands. Some typical
large wok called a kawali, especially for frying. foods include coconut, dried
house prior to the ceremony; then it is cooked and
They tend to leave the food in longer than the anchovies, dried mango,
consumed after the rite as part of a feast. Its soul
Chinese do, to allow it to absorb more fat. The French bread, lemon grass,
is offered in exchange for the victims missing
common foods of the Philippines are listed in lime, nuoc mam, pineapple,
soul.63, 103 In Vietnam small shrines are sometimes
Table 12.1. pork, rice, rice paper, rice
constructed to appease ancestor spirits or the souls
sticks, taro root, and water
of premature infants who have died and still chestnuts.
wander the Earth. Offerings may also be made to
the Goddess Quang Am for good health. Among
Catholic Vietnamese and Filipinos, appeals are
made to the Virgin Mary; group prayer has assumed
significance for many Protestant Southeast Asians.
It has been noted that Christian Hmong often
avoid the use of shamans, soul callers, and other
traditional practitioners, depending on the clergy
and the power of prayer to promote physical and
spiritual healing. Herbs, however, may still be
used at home.63, 111

The cuisines of Southeast Asia have many ingre-
dients in common, but food preparation methods

and meal patterns reflect the foreign cultures
that have influenced each nation. For example,
the Vietnamese often serve cream-filled French
Table 12.1 Cultural Food Groups: Filipino

Adaptations in the
Protein Foods
Milk/milk products Filipinos make one of the few native cheeses Evaporated milk (cow, goat), white cheese (carabao) Consumption of milk and
in Asia, from carabao (water buffalo) milk. other dairy products
U.S. influence has resulted in the availability of has increased.
many western dairy products.
Many Filipinos may be lactose intolerant.
In desserts, coconut milk is frequently used in
place of cows milk.
Meat/poultry/fish/ Protein intake is often dependent on income. Meat: beef, carabao, goat, pork, monkey, variety meats Consumption of fish has
eggs/legumes (liver, kidney, stomach, tripe), rabbits decreased; intake of
Poultry and small birds: chicken, duck, pigeon, sparrow meat, poultry, and eggs
Fish and shellfish: anchovies, bonita, carp, catfish, crab, has increased.
crawfish, cuttlefish, dilis, mackerel, milkfish, mussels,
prawns, rock oyster, salt cod, salmon, sardines, sea
bass, sea urchins, shrimp, sole, squid, swordfish,
tilapia, tuna
Eggs: chicken, fish
Legumes: black beans, black-eyed peas, chickpeas,
lentils, lima beans, mung beans, red beans, soy-
beans, white kidney beans, winged beans
Cereals/Grains Rice is the main staple and is usually eaten at Corn, oatmeal, rice (long- and short-grain, flour, Rice is not usually eaten
every meal. noodles), wheat flour (bread and noodles) at breakfast but is eaten
at least once per day.
Fruits/Vegetables Vegetables are often consumed in mixed Fruits: apples, avocados, banana blossoms, bananas
stews, stir-fries, and soups. Braised (100 varieties), breadfruit, calamansi (lime), citrus
vegetables may be consumed as entree or fruit, coconut, durian, grapes, guava, jackfruit, Java
side dish. plum, litchi, mangoes, melons, papaya, pears,
Pickled fruits and vegetables are very popular. persimmons (chicos), pineapples, plums, pomegran-
ates, pomelo, rambutan, rhubarb, star fruit,
strawberries, sugar cane, tamarind, watermelon
Vegetables: amaranth, bamboo shoots, bean sprouts, More green vegetables
beets, bitter melon, burdock root, cabbage, carrots, are consumed. More
cashew nut leaves, cassava, cauliflower, celery, raw vegetables/salads
Chinese celery, drumstick plant (sili leaves), eggplant, are eaten.
endive, garlic, green beans, green papaya, green pep-
pers, hearts of palm, hyacinth bean, kamis, leaf fern,
leeks, lettuce, long green beans, mushrooms, nettles,
okra, onions, parsley, pigeon peas, potatoes, pump-
kins, purslane, radish, safflower, snow peas, spinach,
sponge gourd, squash blossoms, winter and summer
squashes, sugar palm shoot, swamp cabbage, sweet
potatoes, taro leaves and roots, tomatoes, turnips,
water chestnuts, watercress, yams
Additional Foods
Seasonings Food is spicy, but the variety of spices used is Atchuete (annatto), bagoong, baggong-alamang, chile
limited. Regional cooking is differentiated in peppers, garlic, lemon grass, patis, seaweed, soy
part by seasoning preferences. sauce, turmeric, vinegar
Nuts/seeds Betel nuts, cashews, kaong (palm seeds), peanuts, pili
nuts
Beverages Soy milk, cocoa, coconut juice, coffee with milk, tea Chocolate milk is
substituted for soy milk.
Soft drinks are popular.
Fats/oils Traditional diet is considerably higher in fat Coconut oil, lard, vegetable oil
than are other Asian cultures.
Sweeteners Brown and white sugar, coconut, honey
Rice is the foundation of the diet, and the

long-grain variety accompanies the meal. It is
typically steamed or fried (the preferred method
of serving leftover rice). Garlic fried rice is a
favorite, topped with bits of meat, sausages, and a
fried egg. Vinegar, additional garlic, and a spicy
vegetable/fruit pickle called atchara are added to
taste. A common bread, pan de sal, is made from
rice flour. Noodles are also used extensively.
Pancit is a popular dish made with rice, wheat, or
mung bean noodles mixed with cooked chicken,
Photo by Kathy Sucher

ham, shrimp, or pork in a soy and garlic-flavored
sauce. Short-grain, glutinous rice is used for
sweet desserts such as puto, a fluffy cake made
from rice, sugar, and sometimes coconut milk.
The amount of meat, poultry, or fish a family
eats depends on economic status. Pork, chicken, Two traditional Filipino
and fish are popular, added as available to mixed use carabao (water buffalo) milk to make one of the disheslumpia (similar to
dishes such as sinigang, a soup of fish or meat few native cheeses in Asia, kesong puti. Carabao an egg roll) and pancit
(noodles cooked with meat
cooked in water with sour fruits, tomatoes, and milk is also popular in desserts, such as ice cream,
or shrimp in a soy- and
vegetables; puchero, a beef, chicken, sweet potato, flan, and pastille candies.
garlic-flavored sauce).
tomato, and garbanzo bean stew with an eggplant A common seasoning, used instead of salt and
sauce; gulay, fried fish with vegetables; and found throughout Southeast Asia, is fermented
lumpia, the Filipino version of egg rolls, stuffed fish paste or sauce. In the Philippines the powerful
with pork, chile peppers, and vegetables like paste is called bagoong and tastes somewhat like
In Filipino culture sticky,
hearts of palm. Other traditional dishes popular anchovies, although it can be made from a variety
glutinous rice cakes symbol-
for special occasions include chicken relleno, a of fish. A similar paste made of shrimp is known ize the cohesiveness of the
whole chicken stuffed with boiled eggs, pork, as bagoong-alamang. Patis is translucent amber family.
sausage, and spices; paella, a Spanish recipe for fish sauce. To obtain the popular sour-cool taste,
saffron-flavored rice typically topped with chicken, palm vinegar, or a paste made from either the Among the more unusual
sausage, pork, seafood, tomatoes, and peas; and cucumber-like vegetable called kamis or the pulp Filipino specialties is balut,
lechon, a whole roasted pig. of the tamarind pod, may be used. Kinilaw, a eaten occasionally as
Filipinos use all parts of the animal in their Filipino specialty, uses sour ingredients to mari- snacks. These partially
cooking; in addition to the pork meat, for exam- nate and pickle raw foods, including fruits and developed duck eggs are
ple, the pig variety cuts might show up in various vegetables, but also meats, organs, and seafood. soft-boiled and sold warm
by street vendors. Salt and a
soups or mixed stews, such as dinuguan, consist- Bagoong, patis, lime (calamansi) wedges, and vine-
little vinegar are added to
ing of diced pork, chicken, or entrails cooked in gar flavored with chilies are frequently placed on
the embryonic birds before
pigs blood and seasoned with vinegar and hot the table so that each diner may add saltiness or they are popped whole into
green chile peppers or sausage such as garlicky sourness to taste. the mouth.
longaniza. The skin is commonly fried to make A principal food in many Pacific Islands is the
sitsaron (similar to the Mexican chicharrnes or coconut, and it is widely used in Filipino cooking.
American cracklings), which are eaten as snacks In addition, copra (dried coconut kernels used for
or pulverized to top noodle dishes. oil extraction) is an important export crop. It takes
Due to the U.S. influence in the Philippines, approximately one year for a coconut to mature,
many western dairy products are available, but but if picked at six months, the soft, jellylike
cows milk is used infrequently. Evaporated milk coconut meat can be eaten with a spoon and is
is a common ingredient in leche flan, a custard, a popular delicacy. The coconut plant provides
and in halo-halo, a parfait-like dessert consisting several food products, including beverages, cook-
of shaved ice, coconut milk, mung beans, purple ing liquids, and even a vegetable. The sweet, clear
yam pudding (ube), boiled palm seeds (kaong), liquid found in young coconuts is the juice or
corn kernels, pineapple jelly, and other ingredients. water. It is consumed fresh but is not used in
Halo-halo can be bought premixed with just the cooking. Coconut cream, which is used for cook-
shaved ice needed for completion. Rural Filipinos ing along with coconut milk, is the first liquid
Durian is an acquired taste. extracted from grated, mature coconut meat. After sauce and shrimp paste, are preferred in the
Its odor, which has been the cream is removed, coconut milk is made by northern areas. Foods are typically boiled or
likened to rotting onions adding water to the meat and then squeezing the steamed. Saluyot (okra leavesnot related to
mixed with gasoline, is so mixture. Coconut milk is used primarily in spe- okra), a spinach-like green with a slippery texture
strong that some apartment
cial dishes. Coconut palm blossom sap can be when cooked, and drumstick plant leaves, called
buildings in Asia ban the
fermented to produce a strong alcoholic drink sili, are especially popular in the North.
fruit.
called tuba, which when distilled is known as Rice is grown in the central region of Luzon,
lambanog. Hearts of palm, sometimes called known for its freshwater fish and richly sauced
palmetto cabbage, is the firm, greenish inner dishes flavored with onions and garlic. One deli-
core of the tree; it is used as a vegetable. Bananas, cacy is rellenong manok, a deboned chicken stuffed
durian (a large, strong-smelling, sweet fruit with a with sausage, vegetables, and ground pork mixed
creamy texture), jackfruit, mango, papaya, and with raisins and spices, topped with a tangy red
pineapples are also popular. sauce. Stir-frying is the most common cooking
Regional cooking styles are divided into four technique. Coconut products and tropical fruits
regions: Luzon (the largest group of islands, also predominate. Sweetened rice dishes such as
In rural regions, raw pork is
heavily salted and then
home to the nations capital, Manila), Bicolandia, suman, a snack made from rice (cassava or plan-
stored in jars for many the Viscayan Islands, and Mindanao.51 Luzon is tains can be used) steamed in banana leaves or
months until it ripens. made up of various ethnic groups, and the cuisine corn husks, are a specialty.
Called itog, small amounts has been strongly influenced by the Spanish. Bicolandia is an ethnically homogeneous
are added to other dishes Ocean fish, such as prawns, milkfish (bangus), region that came in contact with both Malaysian
to enhance their flavor. and halibut, as well as the ample use of anchovy and Polynesian cooking. Foods are spicy hot
with chile peppers, balanced by copious use of
coconut milk and cream. Taro leaves cooked in
coconut milk with ginger and chiles are one
example of the unique blend of foods found in
this area. Viscayan Islands fare also reflects its
heritageabundant use of seafood (including
SAMPLE MENU a distinctive fermented shrimp paste called
guinamos) and seaweed, as well as many dessert
specialties, such as candies and pastries devel-
A Filipino Lunch oped due to the sugarcane plantations in the
area. The Mindanao region was heavily influ-
enced by the Indonesians and Malaysians. The
Lumpia (Egg Rolls)a, b, c
many ethnic groups living there are predomi-
Sinigang (Chicken in Sour Broth)a, c nantly Muslim, so little pork is consumed (see
Chapter 4). Sauces made from peanuts and chiles
Pork Adoboa, b, c are popular, as are curries and other spicy dishes,
such as piarun (fish spiced with chiles) and tiola
Steamed Rice sapi (boiled beef curry).
Pancit Guisado (Sauted Rice Noodles)a, c
Vietnamese, Cambodian, and Laotian. Ingre-
Halo-halo (Shaved Ice Dessert) a, b or Puto (Steamed Rice Cakes)a, b dients are similar in all the mainland Southeast
Asian countries, but recipes and meal patterns
vary. Indigenous fish and seafood, tropical fruits
a
Gelle, G.G. 1997. Filipino cuisine: Recipes from the Islands. and vegetables, and glutinous rice were the foun-
Santa Fe: Red Crane Books. dation of the native diets. The Chinese intro-
b
Filipino Recipe at www.filipinorecipe.com duced long-grain rice, soy products, stir-frying,
c
Filipino Recipes at www.recipesource.com hot pots, fried pastries, and chopsticks to areas
they ruled. French regional occupation popular-
ized such items as French bread, meat pts,
asparagus, potatoes, pastries, and strong coffee.
Indian and Malaysian influence is seen in the
EXPLORING GLOBAL CUISINEThe Cooking of Malaysia,

Singapore, and Indonesia
M alaysia, which includes a nations (with the exception of Bali, which every meal, fresh, preserved, in baked
western section contigu- is mostly Hindu), while Singapore is prima- goods and puddings, and deep-fried as
ous with Thailand and rily Christian. fritters.
an eastern section on the island of Borneo, Rice, both long-grain and glutinous, is Coconut flavors many foods, and sea-
extends south into the gap between the foundation of the diet. It is often sonings are used liberally, including chiles,
Southeast Asia, the Philippines, and steamed, but it is also popular fried, fresh coriander, ginger, lemongrass, pan-
Australia (see Figure 12.1). At its tip is the prepared as sticky rice balls, and especially danus leaf, pepper, and turmeric. Lemons,
independent city-nation of Singapore. as noodles. Noodles are typically stir-fried, limes, unripe mangoes, tamarind, or vinegar
Indonesia, comprised of over 10,000 islands added to soups, or topped with mixed veg- is usually added for a sour taste. The most
(mostly uninhabited), arches eastward from etables, fish, or meat. They are eaten at distinctive cooking in the region is Nyonya
Malaysia and includes Bali, Borneo (now nearly all meals, and often for snacks. One fare, found especially in Singapore, which
known as Kalimantan), Java, New Guinea, Indonesian favorite is nasi goring, Chinese combines Chinese preparations (often pork-
and Sumatra. The region lies along the fried rice topped with a European-introduced based) with Malaysian seasonings, particu-
equator and contains a majority of the fried egg. Steamed rice in Malaysia is often larly coconut, turmeric, and lemongrass.
worlds tropical rainforests. The fertile land is served with both an Indian-influenced cur- All courses are served at once in
conducive to the cultivation of the herbs and ried meat or fish and a Chinese stir-fried Malaysian, Singaporean, and Indonesian
spices brought by Asian, Middle Eastern, and vegetable. Fish is very common (often meals, and the dishes are categorized by
European traders, including chile peppers, fried) and eaten by all groups except some preparation technique, not ingredients.160
cinnamon, cloves, cumin, ginger, nutmeg, vegetarian Buddhists (who prefer tofu- or For example, sambals are fried dishes sea-
and pepper. Parts of Indonesia are still tempeh-based dishes). Beef and poultry soned with chiles (or the name for just a
known as The Spice Islands. are popular but costly in much of Malaysia chili dipping sauce); satays are delicate,
The cuisines of Malaysia, Singapore, and Indonesia, while pork is uncommon in grilled kebabs (of Middle Eastern origin)
and Indonesia have been greatly influenced majority Muslim areas. The exception is served with spicy dipping sauces; croquettes
by the diversity of their populations: native Singapore, a wealthier nation, which (from the Dutch influence) are fried rice,
Malays, Chinese, Asian Indians, Pakistanis, includes abundant meat and egg dishes in meat, vegetable; or fruit fritters; and sayur
Arabs, Thais, Eurasians, Melaka Portuguese its fare. Temperate vegetables introduced are soupy dishes with ample sauce for dip-
(Malaysian Portuguese), and Peranakan from the Middle East and Europe, such as ping rice balls. In most areas forks and
(southern Chinese and Malaysian or tomatoes, eggplants, and potatoes, are spoons are used (knives are rarely available).
Indonesianthe women are called usually added to soups and rice dishes The Chinese often use chopsticks, and Asian
Nyonya and men are known as Baba).149 instead of being served separately. Salads Indians frequently employ their right hand
Further, the numerous religious practices of are popular, however; an example is to scoop up food.149 One tradition is univer-
the regionIslam, Hinduism, Buddhism, Indonesian gado gado, a mixture of cooked sal in the region: street vendors. Meals and
Christianity, and Judaismhave played a vegetables (including cabbage, green snacks are usually available around the
role in the fare. Today, Malaysia and beans, and carrots) dressed with a peanut clock at food stalls and small eateries, and
Indonesia are predominantly Muslim sauce. Tropical fruits are eaten at nearly al fresco dining is a daily event.
curries and coconut milk-flavored dishes of east- paper is used as egg roll or wonton wrappers. In
ern and southern Southeast Asia. The common the dish cha gio, the moistened paper is wrapped
foods of mainland Southeast Asians are listed in around a variety of meats, fish, vegetables, and
Table 12.2. herbs and then deep-fried. Often the rice paper is
Rice, both long- and short-grain, is the staple filled with meat, fresh herbs, and vegetables at
of the diet. Rice products, such as noodles, paper, the table. Dried rice noodles (sticks) are called pho,
and flour, are used extensively. In Vietnam rice which is also the name of the popular noodle-based
Table 12.2 Cultural Food Groups: Mainland Southeast Asian

Adaptations in the
Protein Foods
Milk/milk products Most Southeast Asians do not drink milk and may be Sweetened condensed milk, whipping cream It is expected that younger
lactose intolerant. Southeast Asians will
Sweetened condensed milk is used in coffee; whip- increase their use of dairy
ping cream is used in pastries. products. Ice cream is pop-
ular; milk and cheese are
often disliked.
Meat/poultry/fish/ The traditional Southeast Asian diet is low in protein. Meat: beef, lamb, pork, goat, venison; variety meats of all types Meat, lamb, and eggs
eggs/legumes Fish, poultry, and pork are common; most parts Poultry and small birds: chicken, duck, quail, pigeon, sparrow, are eaten more; fish,
of the animal are used (brains, heart, lungs, doves shellfish, and duck are
spleen). Eggs: chicken, duck (both embryonic and unfertilized), fish eaten less because of
Fish and shellfish: almost all varieties of fresh- and saltwater price.
seafood, fresh and dried
Legumes: chickpeas, lentils, mung beans (black and red),
soybeans and soybean products (tempeh, tofu, soy milk),
winged beans
Cereals/Grains Rice is the staple grain and is usually eaten with Rice (long- and short-grain, sticks, noodles), wheat (French Intake of baked goods
every meal. bread, cakes, pastries) increases.
French bread is commonly eaten.
Fruits/Vegetables Hearty garnishes of fresh vegetables are Fruits: apples, bananas, cantaloupe, coconut, custard apple, Use of fruits and vegetables is
commonly added to dishes. The Vietnamese eat a dates, durian, figs, grapefruit, guava, jackfruit, jujube, dependent on availability
considerable amount of fruit and lemon, lime, litchi, longans, mandarin orange, mango, and price. It is expected
vegetables, fresh and cooked. orange, papaya, peach, pear, persimmon, pineapple, plum, that use of fruits and veg-
Fruit is often eaten for dessert or as a snack. pomegranates, pomelo, raisins, rambutan, roselle, sapodilla, etables will decline.
star fruit, soursop, strawberries, tamarind, watermelon
Vegetables: amaranth, arrowroot, artichokes, asparagus, Fresh vegetables and herbs
bamboo shoots, banana leaves and flowers, betel leaves, are sometimes grown in
beans (yard-long and string), bitter melon, breadfruit, backyard gardens.
broccoli (Chinese and domestic), cabbage (domestic,
Chinese, savoy, napa), calabash, carrot, cassava (tapioca),
cauliflower, celery (domestic and Chinese), chayote squash,
Chinese chard, Chinese radish (daikon), chrysanthemum,
corn, cucumber, eggplant (domestic and Thai), leeks, lotus
root, luffa, matrimony vine, mushrooms (many varieties),
mustard (Chinese greens), okra (domestic, lady finger),
peas, peppers, potato, pumpkin (flowers, leaves), spinach,
squash, sweet potatoes (tubers, leaves), taro (root, stalk,
leaf, shoots), tomatoes, turnips, water lily greens, water
chestnuts, water convolvulus, was gourd, yams
Additional Foods
Seasonings Fermented fish sauce, as well as soy sauce, is often Allspice, alum, basil, black pepper, borax, cayenne pepper,
used. Fresh herbs are very popular garnishes in chile pepper, chives, cinnamon, coconut milk, fresh coriander,
Vietnamese dishes; typical Cambodian fare is curry powder, fennel, galanga, garlic, ginger, kaffir lime
delicately seasoned; Thai dishes are frequently leaves, lemon grass, lemon juice, lily flowers, lotus seed,
very hot and spicy, with several types of curry and mint, MSG, nuoc mam (and other fermented fish sauces and
chile peppers especially popular. pastes), paprika, saffron, star anise, tamarind juice, vinegar
Nuts/seeds Almonds, betel nuts, cashews, chestnuts, macadamia nuts, Peanut butter is often
peanuts, pili nuts, walnuts; locust seeds, lotus seeds, pumpkin disliked.
seeds, sesame seeds, watermelon seeds
Beverages Beverages are usually drunk after the meal or with Coffee, tea, sweetened soybean milk, a wide variety of fruit Carbonated drinks have
snacks or desserts. and bean drinks, hot water, hot soup, beer increased in use.
Fats/oils Bacon, butter, lard, margarine, peanut oil, vegetable oil The Vietnamese have
increased their use of
butter and margarine.
Sweeteners Sweets are luxury foods. Cane sugar, candy The use of sweetened
products has risen in the
United States.
soup in Vietnam. In Laos the sticky, glutinous Shoppers choose from a wide
short-grain rice is more prevalent than long- selection of tropical fruits and
grain types (traditionally formed into small balls vegetables in a Southeast
to use as scoops for other foods), and the very Asian street market.
thin Chinese-style rice noodles are common.
Wheat is used to make French bread, noodles,
and some pastries.
Fried noodles topped with meats and vegeta-
bles are a favorite. Fish and shellfish are the pre-
dominant protein food on the mainland. Even
landlocked Laos depends on freshwater varieties.
Fish, shrimp, and squid are often preserved
through salting and drying. Poultry is widely avail-
able, and pork or goat is eaten in wealthier areas.
Beef is used occasionally. Religious prohibitions
often influence which meats are consumed. Like
other Asians, the people of mainland Southeast
Asia do not use appreciable amounts of dairy
products. However, soy milk is a common bever-
age. Soy products, particularly a chewier version of
tofu (soybean curd) called tempeh, are common.
Mainland Southeast Asians frequently con-
sume vegetables, cooked in stir-fries and stews
or uncooked in salads and pickles. Especially
noteworthy are the many shredded vegetables
and unripe fruits, such as cabbage, papaya, car- widely consumed. Banana leaves are used to wrap In Vietnam, com, meaning
rots, cucumber, radishes, jicama, and bean sprouts rice, vegetables, and meats for steaming in both cooked rice, is the same
topped with fish, poultry, meat, or peanuts and Cambodia and Laos. Pineapple, papaya, limes, word used for food.
spicy hot dressing. One example is goi go, a mangoes, and mangosteens are common, as are
Vietnamese specialty featuring cabbage and Vietnamese Buddhists eat
soursop, star fruit, guavas, custard apples, durian,
soybean products on the
chicken. Greens and leaves are often used to wrap jackfruit, and tamarind (a pod with very tart
first, fifteenth, and last day
foods, such as collard greens for Cambodian pulp). Oranges, lemons, melon, and sugar cane of the lunar month, when
steamed fish and la lot (betel leaves) used for are also popular. meat is prohibited.
Vietnamese spring rolls stuffed with minced beef. In Vietnam foods are customarily seasoned
Further, fresh herbs and spices, including basil, with a salty sauce made from fermented fish Furr, a soup containing
coriander leaves, chile peppers, galangal (similar called nuoc mam. It can be transformed into a hot pork, noodles, garlic, and
to young ginger root), garlic, ginger, kaffir lime sauce, nuoc cham, with the addition of chiles, hemp (marijuana) leaves, is
leaves, lemon grass, and mint, are often added to vinegar, sugar, garlic, and citrus fruit juice. In a Laotian specialty.
foods as they are served, providing distinctive Cambodia the fermented fish sauce is called tuk-
flavors and color to many dishes. Both Laotian trey; a stronger fish paste is also used, known as
laap, a spicy ground meat or fish dish (tradition- prahoc. The Laotian version of fish sauce is nam
ally prepared uncooked), and Vietnamese grilled pa; pa dek is the fermented fish paste.
lemon grass beef, bo nuong xa, are served with a Tea is the preferred beverage throughout
substantial garnish of basil, mint, and coriander mainland Southeast Asia. In Vietnam it is served
leaves. Due to the strong influence of the French, before and after meals but not during the meal.
the Vietnamese also frequently eat asparagus, Tea is often blended with flowers such as rose
green beans (haricots), and potatoes; though the petals, jasmine blossoms, chrysanthemums, and
French had less impact on the cuisine of surround- lotus blossoms (which are especially popular).
ing nations, subsequent Vietnamese rule has pop- Coffee is popular in French-influenced areas,
ularized these vegetables in other regions as well. usually served with large amounts of sweetened
Tropical fruits are available, although in some condensed milk added to it. Broth is traditionally
areas bananas and plantains are the only fruit consumed at meals, and in poorer, rural regions,
such as where the Hmong live, it is the only bev- soups, vermicelli soups, and both sweet and salty
erage besides water that is commonly available. rice cakes. The climate of the South is tropical.
In wealthier areas, men may drink beer, and Cooking is simpler and seasoning is stronger;
women and children consume soft drinks during curries and spicy Indonesian-style peanut sauces
meals. Soybean drinks and fruit drinks are are favorites. Coconut milk and caramel flavor
common; rice wine or whiskey is served at spe- many dishes. Clay pot cooking is common. One
cial occasions. specialty is tidbits of grilled meats, fresh vegeta-
Without fish sauce or salt, Regional variations are prominent, especially bles, and fruits such as guava, mango, green
life is nothing, according to in Vietnam.123 The Chinese influence is stronger papaya, pineapple, or starfruit wrapped in a let-
a Vietnamese saying. in the North than in other regions. Hot pots, stir- tuce leaf, according to personal preference, that
fried foods, and chao (rice gruel similar to congee) can be dipped in salty or spicy sauces. Sweets are
Numerous small, wild are especially popular. Soups are a specialty, par- more popular in the South than in other areas.
animals are consumed in
ticularly pho bo ha noi, a delicate broth to which Khmer cooking of Cambodia features north-
Southeast Asia. In 2005
rice noodles, sliced beef, bean sprouts, herbs, and ern Indian, Malaysian, and Chinese elements.
a new species of rodent,
related to the porcupine, other seasonings are added immediately before Though French cooking is much admired, it has
was discovered by scientists serving. Mein go is a chicken noodle soup served never been integrated into the Khmer kitchen.104
for sale in a Laos market. in a similar manner. Other favorites include Aromatic seasonings are preferred, particularly
Called kha-nyou, it is stuffed tofu, bun cha (grilled pork over noodles), the paste known as kroeung, made fresh for each
roasted whole, then eaten and snails (stir-fried, simmered in beer, or dish from pulverized herbs and spices such as
by crunching up the small minced with garlic). The central region is known galangal, garlic, kaffir lime leaves, lemon grass,
bones, and spitting out the for sophisticated gastronomy. Presentation is shallots, and turmeric. A touch of spice is achieved
larger ones.108 emphasized and seasonal cooking reigns. with chile peppers, particularly in curried dishes,
Specialties include a sauce similar to nuoc mam though it is usually moderated by the use of
made from shrimp called mam tom, shrimp pt coconut milk. Sweet ingredients such as ripe fruit
grilled on sugar cane, spicy pork sausages, sweet or sugar are often included as a contrast to the
sour flavor provided by vinegar, lime juice, or
tamarind. Salty fish sauce or soy sauce is always
added, as are bitter herbs for balance. Amok, fish
in coconut milk steamed in a banana or collard
leaf, is a national favorite as is num banh choc, a
rice noodle and fish soup. In some areas dishes
SAMPLE MENU featuring wild foods such as land crabs, snakes,
and locusts are found.
Laotians prefer glutinous rice over long-grain
A Vietnamese Dinner types. Added vegetables and fish make up the
basic diet, with eggs, poultry, and beef included
Asparagus and Crabmeat Soupa, b as affordable. In rural areas game such as deer,
squirrels, ducks, quail, lizards, frogs, snakes, and
Braised Bean Curda, b or Grilled Beef with Lemongrassa, b grasshoppers are common. Meats are frequently
stewed or grilled, though a salty beef jerky pre-
Stir-Fried Vegetables
pared with nam pa is a specialty. Coconut cream
Steamed Rice or milk, nam pa and pa dek, lime juice, fresh
coriander leaves, garlic, lemon grass, and mint
Fruit Juice or Iced Coffee with Evaporated Milk are typical seasonings. Hot chile peppers add heat
to most foods, though the extent of their use
varies regionally. Spicy salads consisting of fresh
a
Routhier, N. 1999. The foods of Vietnam. New York: Stewart, Tabori & Chang. vegetables or shredded immature papaya topped
b
Vietnamese Recipes & Cuisines at www.vietnamese-recipes.com with lime juice, palm sugar, and chile pepper
dressing are popular. Chinese and French influ-
ence via Vietnam is seen in some areas where
French bread, croissants, spring rolls, and a soup
similar to pho are popular foods.
Hmong fare traditionally differs from Laotian In Vietnam a traditional breakfast is large and
cooking and shares some similarities with may consist of soup with rice noodles topped
Vietnamese cuisine. Long-grain rice is favored with meat or poultry; a boiled egg with meat and
and stir-frying, steaming, and roasting are pickled vegetables on French bread; chao with
common preparation methods. Though rice and bits of leftover meat and vegetables; steamed rice
vegetables are the foundation of the diet, families cakes or Chinese-style crullers; or glutinous rice
sometimes raise chickens, ducks, pigeons, and or boiled sweet potatoes with sugar, coconut, and
pigs. These foods are supplemented with wild chopped roasted peanuts. A strong cup of coffee
game and fish, crabs, and snails. Seasonings, may accompany the meal. Lunch and dinner typ-
however, are similar to Laotian, though the ically include rice, fish or meat, a vegetable dish,
Hmong use soy sauce in addition to fish sauces. and a broth with vegetables or meat. Fresh veg-
Hmong who were forced from the mountains to etables and pickled garnishes are served with the
the lowlands during Southeast Asian conflicts meal. All items are served at once, and individual
have added many Laotian foods to their meals. diners place whatever foods they wish over their
portion of rice and flavor it as desired with nuoc
Meal Composition and Cycle mam and other condiments. French bread with
meat or shrimp pt may be substituted for a
Daily Pattern
lunch or dinner meal. In late afternoon tea or
Filipino. The traditional meal pattern in the
coffee may be enjoyed with a sweet custard, pastry,
Philippines is three meals a day. Breakfast is
candy, or piece of fruit.
garlic fried rice with eggs or broiled fish, sausage,
Cambodians also eat family style. Soups are
or meat, plus coffee or hot chocolate; bread may
often served for breakfast and accompany the
be substituted for rice. Especially popular are
main course at nearly every other meal. Steamed
sweet, cheesy rolls called ensaymada. Lunch and
or fried rice or rice noodles are the centerpiece of
dinner are similar in size and composition. Both
lunch and dinner, accompanied by grilled or
are often large meals, characteristically including
steamed freshwater fish and seafood, and less fre-
soup, rice, a crispy or chewy dish (such as fried
quently poultry, pork, or beef. Fresh salads are
fish), a salty dish (meat or poultry cooked in fish
common. Fruit is often eaten as dessert, though
sauce or soy sauce), a sour dish (flavored pre-
very sweet rice or corn dishes are also popular.
dominantly with vinegar or tamarind), a noodle
Tea and coffee with condensed milk are usually
dish, and often, an adobo dish. Fresh fruit or
consumed with the meal, and fruit juices, soft
dessert concludes the meal. If the meal features
drinks, and beer may be available. In Laos gluti-
mostly Spanish-style items, the courses are
nous rice, fish, poultry or meat, soup, and a
served consecutively. If the meal features more
cooked vegetable dish or fresh salads make up
Filipino-style dishes, all courses are served
most meals. Chile pepper paste is the standard
together, including dessert.159
In addition to meals, two snacks, called condiment. Tea, coffee with condensed milk, and Turo-turo are fast-food
meriendas, are consumed in the midmorning and rice wine or rice whiskey round out the menu. stands in the Philippines,
late afternoon. Meriendas may be small or may specializing in rice bowls
consist of substantial amounts of food, such as Etiquette. Filipinos generally dine at tables topped with foods
fritters, pastries, fruits, ensaymadas, lumpia, or equipped with lazy Susan turntables so that according to the customers
almost anything else except rice, which is served dishes are accessible to everyone. Traditionally, preference. Other hot items
no one starts eating until the eldest male at the are also available.
only at meals.
table begins. Many Filipinos use a western style
Vietnamese and Other Mainland Southeast of dining with forks, knives, and spoons. Others
Asians. Mainland Southeast Asians eat two or employ just forks and spoons. The spoon is used
three meals a day with the number of meals and to hold the food down while the fork is used to
the amount of food consumed often based on pull bits away. The food is then pushed onto the
income. Snacking is uncommon. Southeast Asians spoon with the fork and eaten. Chopsticks may
do not usually associate particular foods with be used for Chinese dishes. In some rural areas
breakfast, lunch, or dinner. For example, soups fingers are still more commonly used.159 In such
are especially popular and are often consumed cases only the right hand is used for dining. Small
with every meal. mounds of rice are rolled between the index
finger, middle finger, and thumb to form a ball good life, and hot chocolate. Other specialties
that is dipped into a sauce, then pressed into a bit eaten during the Christmas season are puto bum-
of meat or poultry and popped whole into the bong, a rice flour delicacy cooked in a whistling
mouth. It is considered rude to take the last bits bamboo kettle, and bibingka, a glutinous rice
of food from the central platter.45 cake cooked in a clay pan topped with salted egg
In Vietnam it is polite to wait for the eldest slices, kesong puti cheese, and a bit of coconut.
person to be served and then, after everyone else A midnight Mass is also held on New Years
is served, to ask him or her if it is okay to eat. It is Eve, but many Filipinos attend parties to celebrate
a breach of good manners to refuse any offer of the holiday instead. Again, a midnight supper
food, yet when served, only small amounts of any consisting of fiesta foods is traditional. There is
single dish should be taken. If sufficient amounts also a superstition that eating seven grapes in
remain, seconds will be offered.45 Throughout succession as the clock strikes midnight will
mainland Southeast Asia, an empty plate or cup bring good luck in the coming year. For birth-
indicates that the diner is still hungry or thirsty. days, pancit is eaten to ensure a long life.
Leaving a small amount of food or beverage sig- There are numerous Filipino practices and
nals satiety. customs associated with Easter, beginning with
Traditional dining in Vietnam is done on a low observances on Ash Wednesday. Late on Easter
table with family gathered round, sitting cross- Eve, young children are awakened to partake of
legged on mats. Both hands customarily rest on special meat dishes, such as adobo and dinuguan,
the table while dining, and conversation is limited. in the belief that if they do not do so, they will
In contrast, dinner is a time for socializing in become deaf. In May, fiestas honoring the Virgin
Laos. The food is served on a low rattan tray, and Mary often include family feasts.
women gather on one side, the men on the other
side. Each diner eats from the dishes as desired. Vietnamese and Other Mainland Southeast
It is said that you can trace A variety of utensils are used to eat in South- Asians. Of all Vietnamese holidays, Tet, the New
the penetration of Chinese east Asia mainland nations. Chopsticks are used Years celebration, is the most important. Tet is
rule in Vietnam by the areas for most dishes in most of Vietnam, though observed at the end of the lunar year (end of
in which chopsticks are spoons and fingers are considered appropriate for January or beginning of February) just after the
common, compared to certain foods and in some areas. Rural Laotians rice harvest. In Vietnam the first Tet ritual is an
those where hands are
often eat with their fingers, using balls of sticky observance at the family gravesites. Offerings of
still most frequently used
rice to scoop up fish and meats and vegetables cake, chicken, tea, rice, and alcohol, as well as
to dine.138
and sauce; however, spoons are used as needed. In money, are made at the graves, and then the family
urban areas forks are now common. Hmong typi- picnics on the offerings.
cally employ forks and spoons, and Cambodians The second ritual, held on the twenty-third
use spoons, chopsticks, or fingers dependent on day of the twelfth lunar month, is to celebrate the
the food. departure of the Spirit of the Hearth, Ong Tao. He
is represented by three stones on which the cook-
Special Occasions ing pots are placed and is honored by a small
Hospitality is very Filipino. In the predominantly Catholic Philip- altar. Like the Chinese Kitchen God, Ong Tao
important to the Filipinos, pines, religious festivals and saints days are returns to the celestial realm each year and
and food gifts to express numerous (see Chapter 4). On all special occa- reports on the familys behavior. After the family
love or appreciation are sions it is customary to serve plenty of food makes an offering to symbolize his departure,
common. buffet-style with a roasted pig (lechon) as the cen- they share a feast including glutinous rice cakes
terpiece. The Filipinos claim to have the longest and a very sweet soybean soup. One week later
Christmas season in the world, from the first the family celebrates Ong Taos return to their
Sunday of Advent in late November or early hearth. The following day is the first day of Tet.
December to January 6. The midnight Mass cele- Guests (especially those with favorable names,
brated on Christmas Eve is usually followed by such as Tho, meaning longevity) are entertained
the traditional media noche, a midnight supper of with tea, rice alcohol, red-dyed watermelon
fiesta foods such as roast ham, sweet potatoes, seeds, candied fruits, and vegetables.
banana flower salad, niaga, a dish made of boiled Special dishes prepared for the week-long cel-
meat, onions, and vegetables whose name means ebration include banh chung, glutinous rice cakes
filled with meat and beans and boiled in banana qualities or their effect on the body, not on their
leaves, squid soup, stir-fried young seasonal veg- spiciness or temperature. Although the classifica-
etables, pork with lotus root, and sometimes a tion of certain foods varies regionally, avocados,
special shark fin soup. alcoholic beverages, coconuts, nuts, legumes,
Many Vietnamese, including those in America, spices, chile peppers, and fatty meats are generally
celebrate the Buddhist holiday called Trung considered hot items; tropical fruits, vegetables,
Nguyen, or Wandering Souls Day. It occurs in the milk and dairy foods, eggs, fish, and lean or inex-
middle of the seventh lunar month and is cele- pensive meats are regarded as cold.32, 105 A balance
brated with a large banquet prepared in honor of is attempted at meals between hot and cold ele-
the lost souls of ancestors.12 Traditionally the ments. The reason Filipino dishes contain so many
Vietnamese did not commemorate birthdays but ingredients may be to ensure this balance.
rather honored their ancestors on the anniversary Some illnesses are characterized as hot or
of their death with a special celebration and meal. cold and are treated with foods of the opposite
In the United States it is now more common to cel- category. Diarrhea and fevers are hot; colds
ebrate birthdays. and chills are cold. Other food beliefs are based
The largest holiday of the year in Cambodia is on sympathetic qualities (like causes like); for
also New Years, Chaul Chnam, which begins on instance, pregnant women may avoid dark foods
April 13 and lasts for three days. Prayers and spe- to prevent their babies skin from being too dark.
cial foods like fried coconut and fried bananas Sometimes the meaning behind a therapeutic
rolled in coconut are offered to the New Year food use is more obscure; horseradish leaves and
Angel, who descends with either blessings or ill broth seasoned with ginger are believed to pro-
will. The Water Festival, held in November after mote milk production in nursing mothers, and
the seasonal rains have ended, features colorful fish heads and onions are considered brain food
floats in local rivers. by some Filipinos. Honey, as well as certain
Most Laotian holidays are religious in origin herbs such as thyme, marjoram, and chamomile, A feast is held by the
and are celebrated at local temples. Pha Vet, which is used to treat diabetes. Licorice root is consid- Hmong following the birth
occurs in the fourth lunar month, commemorates ered a general tonic, especially beneficial during of a child. Included are two
the life of Buddha. Boon Bang Fay, held in the sixth times of stress. Some elderly Filipinos have chickens representing the
lunar month, also honors the Buddha with a fire- adopted the Asian Indian practice of chewing parents, a boiled egg
signifying the child, and a
works display. Among the Hmong and other areca nuts (also called betel nuts), which is
small lit candle symbolic of
Laotians the New Years celebration is a major believed to prevent tooth decay, although it the ancestor spirits whose
event. It begins with the first crow of a rooster on leaves permanent stains. blessing and protection are
the first day of the new moon in the twelfth lunar The Department of Health in the Philippines sought.
month, usually in December. The highlight of the has approved several herbal remedies as safe and
festivities is the world renewal ritual, which effective, including ampalaya (bitter melon, pre- Licorice root, which con-
involves an elder who chants while holding a live pared as a side dish or as a juice) for diabetes, tains glycyrrhizin, can cause
chicken. He circles a tree three times clockwise to bawang (garlic) to lower blood cholesterol levels fluid retention and increase
remove the accumulated evil of the previous year and reduce blood pressure, ulasaming bato (pep- blood pressure if consumed
and then circles the tree three more times counter- peromia, which is eaten as a salad or brewed into in large amounts.
clockwise to invoke good fortune in the upcoming tea) for arthritis and gout, and sambong (an
year. The bad luck collects in the blood of the indigenous herb) as a diuretic.110
chicken, which is traditionally taken to a remote
location and slaughtered. Customarily considered Vietnamese and Other Mainland Southeast
a good time to meet future wives and husbands, Asians. Many Vietnamese follow the Chinese
New Years was the one time each year when yin-yang theory of health and diet (see Chapter 11,
Hmong from different clans celebrated together. Chinese Therapeutic Uses of Foods section).
Yin is known as m and yang is called duong. As
Therapeutic Uses of Food in the hot-cold system, classification is based on
Filipino. When the Spanish came to the Philip- intrinsic characteristics rather than temperature
pines, they introduced the Mexican hot-cold theory or spiciness. Examples of duong (hot) foods are red
of health and diet (see Chapter 9). Foods are clas- meat, unripe fruit, ginger, garlic, coffee, and alco-
sified as being hot or cold based on their innate holic beverages. m (cold) items include noodles,
bananas, oranges, gelatin, and ice cream.19, 106 without much difficulty, although some of the
Some foods, such as rice, pork, eggs, chicken broth, familiar tropical fresh fruits and vegetables are
teas, and sweets, are classified as neutral.94 Not only not available. Older data suggest that most
must a balance be maintained within a meal, but Filipinos still eat rice every day but not with every
extremes are also avoided during certain condi- meal, and their diets tend to contain a greater
tions, such as pregnancy. As with Filipinos and variety of foods, especially more milk, green veg-
other Asians, illnesses are defined as m and etables, meat, and sweets than they did in the
duong, and are sometimes caused by eating too Philippines.81 Meriendas are not eaten as often.
many m or too many duong foods. During preg- Filipinos born in the United States frequently
nancy, which is duong, hot foods are avoided, and consume a typically American diet. Breakfast
equilibrium is restored by eating foods of the oppo- consists of cereal, toast, eggs or meat, juice, and
site type; during the postpartum period, which coffee; sandwiches, salads, and sodas are common
is m, cold foods are avoided. Yin and yang con- at lunch; and dinner is usually a meat or fish dish
cepts are less prevalent among Cambodians and served with rice or potatoes, followed by dessert.
Laotians, although some hot and cold beliefs exist Traditional Filipino items may appear at some
regarding specific foods and certain conditions. meals, such as eating longaniza sausage at break-
The Chinese medical system details other influ- fast or eating halo-halo (sometimes topped with
ential elements in health, including the five flavors vanilla ice cream) for dessert.41
of sour, bitter, sweet, pungent, and salty; these
Though overall tastes are harmonized in many Vietnamese dishes. Vietnamese and Other Mainland Southeast
consumption of fish by Vietnamese believe that ingestion of specific organ Asians. A study conducted in Washington, DC,
Vietnamese Americans is meats will benefit the like internal organs. For found that 30 percent of the Vietnamese house-
thought to be lower than in example, consumption of liver will produce a holds surveyed had changed their eating habits
Vietnam, data show they stronger liver. Some Vietnamese believe that eating since coming to the United States.147 Although
have the highest intakes of
gelatinous tiger bones (produced by prolonged most continued to eat rice at least once a day,
recent Asian immigrants,
particularly of shellfish.128
cooking) will make them strong. Concurrently, they ate more bread or instant noodles at lunch
some foods may be injurious because they resem- and more cereal at breakfast. Respondents also
ble certain disorders. Pregnant women may refuse reported consuming more meat and poultry and
to eat ginger because the multilobed root is thought less fish and shellfish than in Vietnam, mainly
to cause polydactyly (too many digits) in babies. because of cost. Pork and pork products were still
The therapeutic value of some foods is unre- preferred to beef. They also reported consuming
lated to yin or yang or how they look. Some fewer bananas and more oranges, fruit juices, and
Vietnamese eat chile peppers to get rid of worms, soft drinks. These findings are similar to those
or noodles with roasted rice paper and shrimp reported in a survey conducted in the 1970s
sauce for curing the flu. Cambodians may drink among Vietnamese living in northern Florida.36
water with bitter melon for fevers. Vietnamese More than 90 percent of Vietnamese-American
women may consume large amounts of salty adolescents in another study were found to prefer
foods during pregnancy,100 and mothers may their native diet, although a majority listed items
avoid feeding chicken or duck to their babies to such as steak and ice cream as being among their
prevent them from becoming deaf or mute.152 favorite foods. Soft drinks and milk were well
Hmong women eat a diet of rice, chicken broth, liked; cheese and peanut butter were strongly dis-
black pepper, and herbs for a month after giving liked. Only a small percentage of the teens snacked
birth,70 and some clans have specific taboos regularly.140 A more recent study on the same pop-
against eating certain foods, such as heart.115 ulation reported that Vietnamese-American high
school students in Massachusetts consumed more
CONTEMPORARY FOOD HABITS fruits and vegetables than did other ethnic groups,
IN THE UNITED STATES and fewer dairy products. Over 28 percent ate at
least five fruits or vegetables each day; however,
Adaptations of Food Habits only 8.5 percent consumed the recommended
Filipino. Little current information on the food number of dairy servings. Notably, fruit and veg-
habits of Filipino Americans has been reported. etable consumption increased with degree of
Most are able to obtain traditional foodstuffs acculturation, but decreased with age.155
EXPLORING GLOBAL CUISINEThai Fare
T here are approximately sixteen flavor. Beef, chicken, and pork are into the nam prik), salads (nam prik is the
times more Filipino Americans common. Duck is a favorite. dressing), noodle dishes, dumplings, fried or
and ten times more Vietnamese Thai food differs from that of its grilled foods, and highly spiced raw pork
Americans than there are Thai Americans in Southeast Asian neighbors because of its called nam. Noodle dishes are usually eaten
the United States. Yet Thai cooking is more flavors. It is one of the hottest cuisines in the for breakfast and lunch. Phad Thai
familiar to the general population than world, with lavish use of chile peppers. stir-fried noodles cooked with bits of meat,
either Filipino or Vietnamese fare. Thai Several varieties of basil, fresh coriander seafood, and vegetables bound with eggs,
restaurants have introduced the distinctive leaves and root, galangal, garlic, ginger root, then topped with peanuts and nam prikis
cuisine in many parts of the United States, kaffir lime leaves, lemon grass, mint, and an example. Sweets such as coconut cus-
even where few Thai Americans live, and tamarind are typical seasonings. In addition, tards and fruit jellies are preferred snacks.
dozens of cookbooks have further popular- curried dishes are eaten daily. There are Thai cooking began as a court cuisine,
ized the cuisine. three types of curry sauces: yellow, which and this heritage is most obvious in the
The country of Thailand is located on are smooth, mild, Indian-like sauces that evening meal.138 Dinner often includes
the southern end of the archipelago that is include spices such as cardamom and appetizers, such as deep-fried chicken
Southeast Asia. The hot, monsoonal cli- turmeric; red, which are chunkier, hotter, wings stuffed with ground pork and shrimp
mate is ideal for rice cultivation. Long- and typically include ample fresh red chiles or pastries shaped like delicate flowers. The
grain rice is the foundation of the diet, and coconut milk; and green, which are pre- main meal traditionally features steamed
though short-grain glutinous rice is used pared with fresh green chiles whose heat is rice, soup, a curried dish, a fried dish, and a
for snacks and desserts and is preferred in excruciating for all but the most experienced salad of raw vegetables and grilled poultry,
the regional Issan cuisine of the Northeast palates. Fermented fish products, such as beef, or seafood. Mee krob, a volcanic-
(similar to Cambodian fare, also known for nam pla (similar to the Vietnamese sauce looking mound of stir-fried noodles and
its culinary use of insects).49 Noodles made called nuoc mam) and kapi (a paste made meats or seafood cooked with sugar until
of rice, wheat, or mung beans are also from fish or shrimp), are added to most caramelized, is a favorite addition. Various
common. Both tropical and temperate dishes. Nam prik, a sauce that combines nam prik accompany the dishes. All dishes
fruits and vegetables are prominent in the nam pla or kapi with other ingredients like are served at the same time. Fingers and
cuisine. Seafood from the lengthy coast, garlic, chile peppers, shallots, lime juice, spoons are the usual implements, and forks
especially shrimp, is popular. Dried herring- tamarind, palm sugar, and peanuts, comple- are available for pushing food into the
like fish (which are sometimes smoked as ments dishes such as yam (fresh vegetables spoon. The meal usually concludes with
well) are often flaked into rice for added rolled up into a leafy package and dipped elaborately carved fruits.
A survey of Cambodian and Hmong families mostly unfamiliar with baked products, such as Some young Hmong women
indicated some similar trends. While traditional bread or cookies, and most strongly disliked both avoid eating gizzards
items were preferred by the adults, both milk and cheese. It was found that many Hmong because they are believed
American and native foods were acceptable to the grow their own vegetables and seasonings (espe- to toughen the placenta
and make birth difficult.
children. Most-liked items among the adults cially varieties difficult to obtain from grocery
included steak, oranges, candy, and soft drinks, stores) in backyard gardens. Most children ate
all of which are prestige foods in Cambodia and three meals, often including a free lunch at
Laos. Least-liked items included cheese, choco- school. Snacking was uncommon, although more
late milk, and milk.141 A detailed study of poor prevalent among children.70 In a study limited to
Hmong immigrants in California revealed that fish consumption, it was reported that Laotians and
the majority of adults (52 percent) consumed two Mien were most likely to harvest fish and seafood
meals each day of rice, greens, and meats. Pork locally, and that Mien (23 percent) and Hmong
was the preferred meat, although chicken, turkey, (90 percent) frequently consumed the entire fish,
fish, and eggs were also eaten. The adults were including head, bones, eggs, and organs.128
have high rates of hypertension and serum cho-

lesterol levels equal to those of white Americans.
Filipinos may have a genetic inability to process
large amounts of sodium in their diet.146 Alcohol
consumption among Filipinos is also positively
associated with increased blood pressure; how-
ever, low rates of drinking have been reported.17, 136
Life expectancy rates for Filipino Americans
are higher than for the general population.69 The
impact of hypertension and high blood choles-
terol levels on the health of Filipinos is unclear;
there may be significant errors in identifying
Filipinos as an ethnic group in some health sta-
tistics. However, heart disease is the leading
cause of death in mortality statistics for Filipinos,
and cerebrovascular diseases are third. Cancer
David Weintraub/Stock, Boston Inc.
risk is low among Filipinos, although incidence

reportedly shifts from that in the Philippines to
that in the United States with length of stay,50 and
risk for malignancies of the lip, oral cavity, phar-
ynx, liver, and thyroid are above the national
average.69, 122 While relative risk is low, it is
noteworthy that survival rates among Filipino
Americans who do develop cancer are lower than
Vietnamese restaurants, especially those featuring the noodle for white Americans.34, 72
soups called pho, have become popular in many communities
Infant mortality rates are slightly below
where Vietnamese immigrants have settled.
those for the general population.96 However,
when compared to white, Chinese-American, and
Japanese-American women, Filipino Americans
A survey of Thai Americans Food purchasing and preparation as well as
have relatively high rates of preeclampsia, gesta-
found that the number of meal patterns are also changing. Southeast Asian-
meals per day decreased tional diabetes, low-birth-weight infants, and
American women report that men frequently
(breakfast was frequently preterm delivery (before 37 weeks).46, 76, 116 When
help with shopping or cooking. Vietnamese,
skipped) and that the compared to other Asian groups, Filipino
Cambodian, and Laotian adolescents often are
consumption of American neonates are also at increased risk for death from
involved in food purchases, and surveys indicate
foods increased while the infection, and post-neonatal infants from respi-
as many as 60 percent of girls and 35 percent of
intake of many Thai foods ratory distress syndrome.29
decreased.143 boys have total responsibility for fixing dinner
Data on overweight and obesity in Filipino
each evening. Southeast Asian women living in
Americans are sparse. Median body mass indexes
the United States are more likely to have a job or
(BMIs) in men and women are close to those of
to attend adult education classes than in their
whites in the United States, and while rates of
homeland, relinquishing some household respon-
overweight and obesity are higher than in most
sibilities to other family members. Further, many
other Asian groups, they are lower than in the gen-
families report a significant decline in eating meals
eral population.79 One study of adolescents found
together.70, 140, 141
that approximately 22 percent of boys and 13 per-
cent of girls exceeded the 85 greater than or equal
Nutritional Status to percentile for BMI, rates lower than for most
Nutritional Intake other Asians and for all other ethnic groups.114
Filipino. The traditional Filipino diet is higher Filipinos often suffer from type 2 diabetes
in total fat, saturated fat, and cholesterol than mellitus (rates two to three times the U.S. aver-
most Asian diets. Urban Filipinos living in the age). Data on Filipino-American women in San
United States tend to have even higher intakes of Diego (ages 5069 years) found a risk for type
these dietary components. Filipino Americans 2 diabetes of 36 percent, compared to 9 percent
for whites, and the prevalence rates for adults in marginal,70 particularly among children.126
Texas were 16 percent for Filipino Americans Anemia rates among refugees have been found to
compared to just over 6 percent for the U.S. total vary from 6 to 37 percent,1, 22, 31 although genetic
population.7, 38 Hyperglycemia rates were similar traits such as a high prevalence of hemoglobin E
among women living in the Philippines, in trait thalassemia syndromes may also cause
Hawaii, and in California.6 Filipina women in the anemia unrelated to iron intake.
United States have been found to have larger Certain conditions common among recent
waist circumferences and a higher percentage of immigrants from Southeast Asia may compro-
visceral adipose tissue than white women despite mise their nutritional status. These include
lower rates of overweight and obesity, suggesting tuberculosis, usually the inactive form (approxi-
more research is needed on development of type mately 4 percent of refugees are denied entry to
2 diabetes and the clustering of symptoms called the United States due to active casesbetween
metabolic syndrome (which is also higher in 50 and 60 percent of immigrants in the United
Filipinas) in nonobese populations.5, 7 Rates for States test tuberculin positive);58 intestinal para-
hyperuricemia (resulting in gouty arthritis) and sites, which can contribute to anemias, fatigue,
glucose-6-phosphate dehydrogenase deficiency and weight loss; malaria; liver, and renal disease,
(causing anemia unrelated to iron intake) are also whose contributing factor is the presence of hep-
higher than for white Americans. It should also atitis B surface antigens (chronic HBV rates have
be noted that alpha thalassemia (hemoglobin H been estimated at between 5 and 15 percent);58,160
disease) is also prevalent among Filipinos and and dental problems caused by chronic malnu-
results in a hypochromic microcytic anemia, espe- trition and, in the United States, excessive con-
cially during an infection or when oxidant drugs sumption of sweets. There is concern that the
are taken. persistence of continued parasitic infection sug-
Although Filipinos consume more milk and gests ongoing transmission; asymptomatic infec- Certain Filipino dishes are
cheese than other Asians, many are lactose intol- tion is common, and poor compliance with very high in purines, a con-
erant4 and calcium intake may therefore be lim- treatment may account for the excess cases.92 cern for patients with gout;
ited. Dried fish, fish sauce, and fish paste may Malnutrition contributes to the prevalence of dinu-guan, for example,
often includes pork liver,
provide calcium, but amounts vary depending on short stature in recent immigrants.22
kidney, heart, and small
the source and quality of the product. One older Life expectancy is higher for Vietnamese
intestine.
study found some Filipino Americans have poor Americans than for the general population.69 The
intakes of calcium and vitamin A.81 Some leading cause of death is cancer, followed by High rates of B12 deficiency
Filipinos may be at risk for calcium deficiency, heart diseases, and then pulmonary diseases. and iron-deficiency anemia
particularly newer immigrant women during Malignancies of the lung, liver, prostate, colon, have also been reported in
pregnancy and postpartum.109 Areca nuts may be and stomach are most common in men, while Thai vegetarians.113
chewed by older men, resulting in stained teeth. those of the cervix (five times the rate for whites
in the U.S.), breast, lung, colon, and stomach are
Vietnamese and Other Mainland Southeast most common among women.95 This mortality
Asians. Food intake data suggest that the cal- profile is different from that of the general popu-
cium intake of mainland Southeast Asians is low, lation and that of some other Asians, in which
although this observation does not account for heart disease is the leading cause of death (see
fish sauces and other traditional foods that may Filipinos above). One researcher suggests the
contain sufficient calcium. An analysis of broth excess rates may be due, in part, to registry mis-
made with acidified bones reported that one classification of Vietnamese Americans.145
tablespoon provided nearly as much calcium as Findings suggest that obesity rates are cur-
one-half of a cup of milk.120 Vietnamese have been rently very low among Vietnamese Americans. A
reported to have high rates of lactose intolerance. study comparing the BMIs of different Asian sub-
Riboflavin, magnesium, and zinc consump- populations found Vietnamese had the lowest
tion was found to be less than 80 percent of the median; however, the data also suggest overweight
RDA in adults among the Hmong.70 Deficiencies increases with length of stay in the United States.79
during pregnancy include riboflavin; vitamins When recent Vietnamese immigrants were com-
B6, D, and E; folacin; calcium; phosphorus; potas- pared with Australians, BMI was found to be sub-
sium; and magnesium.97 Iron intake may also be stantially less than in whites, but waist-to-hip
ratios were higher. Essential hypertension is asso- low birth weight and other potentially adverse
ciated with higher BMI and insulin resistance in risk factors such as nutritional deficiencies,
Vietnameseeven when higher BMI levels fall inadequate utilization of prenatal care, and low
below the threshold of overweight in whites.18, 151 socioeconomic status. Hmong, Laotian, and
Small studies on a Vietnamese population in Cambodian infant mortality rates may be the
Mississippi reported 44 percent of subjects were exception. Hmong infant mortality rates were
hypertensive, 58 percent had high total blood reported to be slightly elevated in comparison to
cholesterol (often with high HDL levels), and 35 other Asian groups,97 and death statistics from
percent had high triglyceride levels.43, 121 California found that Laotian infant mortality
Scant data are available on the Cambodian- rates (in which Hmong may be counted) were
American and Laotian-American populations. nearly double the state average.25 In a study of
Death rates from California show these popula- California Asian groups, Cambodian and Laotian
tions may be at risk for several conditions.25 The women had adverse maternal risk profiles and
diabetes mortality rate for Cambodians was over higher death rates than whites for neonates, post-
45 percent above the state average, and for natal infants, and infants.29
Laotians it was almost 38 percent higher. The dis- Nearly all babies are breast fed in mainland
parity in stroke deaths was even more startling: Southeast Asia for periods of about one year.
nearly double the average rate for Cambodians, Studies on infant feeding practices of Americans
and almost 65 percent higher in Laotians. of Southeast Asian descent reveal a dramatic
Though the statistical samplings are small, the decline; breast feeding is reduced to only 9 to 26
figures suggest these conditions may be of con- percent of postpartum women. Work, schooling,
cern. It should be noted that Hmong and Mien physical discomfort, embarrassment, and the
may be subpopulations within the groups, since ready availability of formula through hospitals
only nationality was noted. and the Supplemental Food Program for Women,
Preliminary data suggest rates of obesity, dia- Infants, and Children (WIC) were cited as reasons
betes, hypertension, cardiovascular diseases, and for not breast feeding. Some women mentioned
kidney failure are increasing significantly among that they believed formula was nutritionally supe-
Hmong.63 High ratios of waist-hip measurements rior to breast milk.52, 119, 129, 148 Southeast Asian
predicted high blood glucose in one study of women generally introduce solid foods later (at
Hmong in Wisconsin. Low adherence to medica- about 8 months) than do whites (5 months) or
tion schedules for the control of hypertension has African Americans (about 4 months). However,
also been noted.64 Hmong are also reported to many Southeast Asians associate overweight with
have higher rates of liver, stomach, cervical, and health and may try to overfeed babies.
Some Southeast-Asian nasopharyngeal cancer, as well as elevated rates Southeast Asians typically calculate age on a
women avoid taking of leukemia and non-Hodgkins lymphoma.89, 121 lunar calendar, often starting with being one year
supplements during Hmong may choose to have no treatment for old at birth. Reported age may differ as much as
pregnancy because they cancer if it involves the removal of body parts, two years from Western chronological age, which
fear the baby will grow too can distort the use of standardized growth curves.
and the mortality rate was found to be three to
big for delivery.
four times higher in Hmong women than in other Some Vietnamese parents may claim, however,
The Mien in California have Asians, Pacific Islanders, or whites.157 that their children are younger than they are to
been found to be at high Recent immigrants have been reported to enroll them in lower school grades; this allows the
risk for trichinosis infection have a high incidence of low-birth-weight infants children to catch up in their schooling.
due to the use of raw pork as a result of poor maternal weight gain during
in dishes such as laap. pregnancy. Traditionally, Southeast Asians gained Counseling
less weight during pregnancy in order to have an Filipino. Americans of Filipino descent may
easier birth and overeating was discouraged.19, 46 accept illness as fate, tolerating symptoms until
One study found that the birth weights of babies the severity forces them to seek care. Relatives,
of Southeast Asians with longer residence are close neighbors, and traditional healers may be con-
to the U.S. average; these groups are believed to sulted before obtaining biomedical service.
have benefited from medical and nutritional Language barriers may be significant. For exam-
care.40, 82 Infant mortality rates for most Southeast ple, some Filipino languages do not recognize
Asians are reportedly low, however, regardless of gender, and there may be some confusion with
pronouns. In 2000 over 24 percent of Filipinos regions were more familiar with traditional med-
reported they did not speak English well; never- ical practices than immigrants from urban areas,
theless, the assumption that an interpreter is who were more likely to rely on over-the-counter
needed may offend those who have mastered the therapeutics.93
language.118 Due to the strong family orientation, relatives Some Filipinos believe that
The communication style of many Filipino play a significant role in a Filipino clients treat- fat is a protection against
Americans is very high context,109 and expression ment and recovery. For most effective treatment, becoming too cold and
is formal and polite. Confrontation is avoided, the provider should discuss diet modifications losing vital energy; thus,
and all attempts to maintain harmony will be with family members as well as with the patient. being overweight is
preferred to being too thin.
made, including the use of silent pauses and Compliance may be motivated by desire to fulfill
laughter to hide embarrassment.45 Raising ones familial obligations and participate in social life. Some Filipino elders prefer
voice or losing emotional control is considered The in-depth interview should be used to deter- their food soft and warm
rude and immature. Positive expression, no mine the patients degree of acculturation, use of and will reject beverages
matter the situation, is expected. traditional medical practices, and personal food with ice.142
Filipino elders should not be addressed by habits.
their first names, as this is disrespectful. Health
care practitioners are often considered to be Vietnamese and Other Mainland Southeast
authority figures, so responses to questions may Asians. Southeast Asian access to health care
be deferential; Filipinos will avoid voicing dis- may be limited by lack of health insurance. Data
agreement. Many Filipinos avoid situations in are limited, but it is estimated that 27 percent of
which self-esteem may be lost, and thus health those living in California are uninsured. Among
care providers should be sensitive in discussing Vietnamese, 42 percent of those who have no
certain subjects, such as socioeconomic back- health insurance report that they have no usual
ground. Modesty may make other topics uncom- source of health care, compared to only 10 percent
fortable to discuss as well, including sexuality of Vietnamese with health insurance.21 One study
(handled best by a provider of the same gender as of recent Vietnamese immigrants found that
the client) and shameful conditions such as demographic variables such as poverty and mar-
tuberculosis or mental illness. ital status were the most influential factors in
Soft handshaking is the common greeting, health care access.73 Language barriers may also
although an eyebrow flash (quick lifting of the exist. Large numbers of Southeast Asians do not
eyebrows) may be used between acquaintances.8 speak English well: Vietnamese (62%), Hmong
Avoid any other touching, and keep hands (57%), Cambodians (54%), and Laotians (53%).118
exposed at the side of the body, not in pockets. In one study Vietnamese Americans with limited
Direct eye contact between peers of the same English proficiency considered quality translation
gender may occur, but in general quick contact services essential to care, expressing a preference
and aversion is more common, particularly when for professional, gender-concordant interpreters
addressing someone in a position of higher instead of the use of family members.98
authority. Further, direct eye contact between Similar to Filipinos, some Southeast Asians
men and women may be interpreted as an believe that illness is in the hands of God, spirits,
expression of sexual interest or aggression. or fate. For example, a study of college students
Filipinos may expect quick results from their found that over 38 percent of Hmong participants
health providers and will switch to other healers believe developing osteoporosis is due to chance
if they feel progress is too slow.93 or luck (though Vietnamese students were more
Unknown numbers of traditional healers are likely to attribute the condition to diet).99
used by some Filipino Americans. An older study Furthermore, some Southeast Asian Americans
in Los Angeles reported that most respondents, may deny discomfort and pain until it becomes
independent of education level, still adhered to intolerable, or until all home remedies prove inef-
many traditional beliefs about the cause of ill- fective. Many Southeast Asians also philosophi-
ness, including unbalanced conditions such as cally regard quality of life to be more important
eating too much or eating the wrong combination than length of life, believing that personal illness
of foods, working too hard, or being punished for or suffering will diminish in the next reincarna-
ones sins against God. Immigrants from rural tion. As a result, a client may be very ill before
deciding to go to a clinic or hospital. Traditionally, difficult to obtain because patients in Southeast

prevention of disease occurs primarily through Asia are often not informed of the name of their
harmonious living; most Southeast Asians have condition or of what medicines are prescribed.115
Traditional therapies such little experience with medical checkups or treating A very polite, unhurried, and reserved con-
as coining or moxibustion a condition when no symptoms are present.63, 73, 88 versational style is appreciated by most Southeast
may leave marks on the Trust is a significant issue in Southeast-Asian Asians. Excited, informal, or frank speech may be
skin; abuse should not health care. Experiences with medical personnel considered rude.88, 115 Many Hmong prefer an
necessarily be presumed. in refugee camps have left many immigrants attitude of caring and respect, showing warmth
Hmong may prefer suspicious of biomedicine in general. Many through smiling and using a positive approach
unseasoned foods when Americans of Southeast Asian descent believe that negative statements and outcomes should be
hospitalized and may desire western practitioners do not understand their avoided.13, 63 The Vietnamese place a high value
water that is boiled before medical needs and are disrespectful of their tradi- on social harmony; both Confucian and Buddhist
drinking.115 tional practices; many are fearful of invasive labo- belief systems encourage modesty. The clinician
ratory tests, especially the taking of blood because should be aware that, in general, Southeast-Asian
Some Southeast Asians this may upset the bodys balance. Surgery may be clients will be agreeable to avoid disharmony or
may not distinguish
avoided and even autopsies denied due to fears to please the questioner. When angry or embar-
between fruit juices and
fruit-flavored beverages in
about the relationship between the body and soul. rassed, Southeast-Asian Americans may laugh to
food recalls. Privacy issues may also be of concern. For exam- mask their emotion. Proper posture and appear-
ple, the need to completely undress or the use of ance are important. In addition, certain nonver-
hospital gowns, breast and pelvic exams, and dis- bal forms of communication should be carefully
cussions about family planning should be post- observed. The head is considered sacred, and it is
poned until a client-provider relationship has extremely offensive to pat or even touch the head
been established, preferably between a provider of of an adult or child without permission. The feet
the same gender as the client.63, 67, 88 Acceptance of are the lowest part of the body, and thus it is
invasive procedures, such as having blood taken impolite to point with the foot or show the bot-
and pelvic exams, was reportedly increased in one toms of ones shoes. It is also rude to snap ones
study of pregnant Hmong women by the use of a fingers or signal by using an upturned index
videotape on prenatal care narrated in the Hmong finger since this is how dogs are called. Respect is
language.135 shown by giving a small bow of the head when
Southeast-Asian clients desire a full descrip- greeting elders and by using both hands to present
tion of their disorders and therapies, and interpreter any item to the client.
fluent in a clients dialect and culture may be Numerous studies have noted that refugees
essential to communication. For example, one from mainland Southeast Asia are at special risk
study found that the concept of chronic illness for mental health problems, due to the horrors of
did not exist in Hmong healing practices, and war, difficulties in escape, lengthy camp confine-
there were no words or explanations for condiment, and the extreme cultural differences
tions such as hypertension and diabetes. There between their homeland and the United States.
was confusion among respondents between Posttraumatic stress disorder is common. One
curing and controlling an illness.62 Differences in study of the Hmong suggests, however, that levels
medical concepts and technologies require care- of depression, anxiety, hostility, and other symp-
ful explanation of procedures to help clients over- toms of adjustment problems may gradually
come fears and to enhance compliance. resolve with length of stay.154 Adherence to tradi-
Treating a Southeast-Asian American client tional health beliefs varies, often according to
requires communicating with their relatives as whether new religious faiths have been adopted;
well. Health care decisions may be the responsi- Christian churches strongly discourage ancestor
bility of family elders or the family as a whole. and spirit worship.26 Some studies suggest that
Developing a relationship with relatives and the majority of immigrants continue certain
enlisting their cooperation can significantly practices, such as the use of botanical home
increase compliance. Cambodians, for example, remedies and coining (see the section Traditional
prefer that health decisions be discussed first Health Beliefs and Practices), for many years
with the eldest male family member before talking after arrival54, 67 although the costs and incon-
to the patient.62, 63, 88 Medical histories are often venience of some traditional cures, including
difficulties in obtaining animals and herbs, the

disintegration of clan ties, and the scarcity of
shamans present barriers in some communities.2 NEW AMERICAN PERSPECTIVESVietnamese
Southeast Asians frequently develop a medical
pluralism, accepting those theories and thera- HAN LE, Student
peutics most congruent with their acculturation was born in Vietnam but came to the United States when I was about a
experiences.
Adherence to traditional health beliefs and
practices, such as hot and cold theories and the use
of herbal remedies, is reportedly high among
I year old. My parents left Vietnam in 1976. My grandparents got us and
about thirty-five other people out on a boat. We first went to a refugee
camp in Malaysia, and after a few months we were able to settle in
Southern California.
many Southeast Asians.24, 63, 73 It is not unusual for At home we ate a traditional diet, and I still do. Rice and noodles are
Southeast Asians to consult both biomedical prac- staple foods. Breakfast is a French bagecette with pt and ham (there is
titioners and healers for relief of symptoms. The a lot of pork in the diet). Lunch is soup or a bowl of rice with one entre,
Vietnamese usually characterize U.S. biomedicine usually a leftover from dinner. There are always three things for dinner:
as yang (hot) and traditional Vietnamese medicine (1) always soup, (2) a stewed meat entre, and (3) vegetable stir fry.
as yin (cold). Biomedicine is seen as fast-acting, Fruit is usually served for dessert. Snacks are commonly fruit or sticky
temporary, and likely to have side effects. It is rice. Western foods that I eat now are dairy products such as milk,
useful for emergency situations. Vietnamese med- cheese, and yogurt; cereal for breakfast; and more sweets for dessert.
icine is considered slow-acting, gentle, without Vietnamese have always eaten a lot of sugar but not as desserts. I lost
side effects, a permanent cure, or useful in preven- all my baby teeth due to cavities because I was given so much candy. In
tion. Some immigrants believe it is important to Vietnam only children from wealthy families got candy, so it was a real
counteract the yang impact of biomedical thera- treat here.
pies with yin herbal remedies.139 It has been When we first came over, our neighbors gave my parents cereal to
reported that some Vietnamese Americans rou- try, and they liked it. At that time my parents hardly spoke or read
tinely reduce the dose or duration of prescription English, and there were very few Vietnamese markets. Because the
medications because they are considered too cereal box had pictures of cats and dogs on it, when they went to the
strong or appropriate for larger people, or because grocery store they bought a box of something with pictures of cats or
they have side effects. Medication is frequently dogs on it, but it turned out to be pet food. They ate the whole box, but
ceased when symptoms are alleviated.54, 139 Similar they did put sugar on it because it wasnt sweet enough. This was not an
practices have been found in the Hmong.103 uncommon problem when the Vietnamese first immigrated to the
Little is known about the active agents in United States. A friend was enrolled in WIC while she was pregnant and
Southeast-Asian herbal remedies, and some may had vouchers to buy WIC food at the market. She recognized the word
be of concern. High levels of lead have been cheese and she bought cream cheese and ate one package every day
found in paylooh, an orange powder ingested for during her pregnancy.
rashes or fever. A case study found that the use of When counseling Vietnamese, it is important to remember that our
slang nut (the source of strychnine) was not toxic meal is not complete unless it contains rice or noodles. Therefore you
as applied in Cambodia, but is poisonous when should not recommend eliminating these elements of the diet but rather
used in the United States without the leaves it is just decrease their amount.
traditionally wrapped in.63, 75
Hospital nurses report that numerous con-
flicts have developed around traditional
Vietnamese birthing practices.139 Because the post-
partum period is defined as yin (cold), women system and promote milk production.19 Hmong
avoid exposure to cold and wind (see the section women also consider the postpartum period a
Traditional Health Beliefs and Practices). Clients cold condition.
may refuse to get out of bed soon after birth and An in-depth interview is critical in order to
refuse to take a shower or wash their hair. m determine the patients country of origin (a
foods, such as cold beverages and vegetables, patient may be offended if grouped with all other
may be refused even if prepared in a culturally Southeast Asians), length of time in the United
sensitive manner. Women may consume alco- States, and any immediate health problems.
holic beverages because they are duong, and alco- Degree of acculturation and personal food prefer-
hol is also thought to cleanse the reproductive ences should also be noted.
Pacific Islanders Micronesia, and Melanesia. As conditions on one

island grew too crowded, colonization of sur-
rounding islands occurred. That trend continues,
The Native Hawaiian Pacific Islanders are the peoples inhabiting some
with economic opportunity the primary motiva-
Government Reorganization of the 10,000 islands of Oceania. Polynesia,
Act of 2005 proposes that tion for Pacific Islander immigration to the
Micronesia, and Melanesia are the three areas that
Native Hawaiians have the United States and other nations.
make up the Pacific region. Polynesia includes the
same legal status as major islands and island groups of Hawaii,
American Indians and Hawaiians. When British explorer James Cook
American Samoa, Western Samoa, Tonga, Easter first arrived in Hawaii, approximately 300,000
Alaska Natives, including
Island, and Tahiti and the Society Islands. The Native Hawaiians were living on the islands.
a governing body that can
negotiate with federal and 2,000 small islands of Micronesia include Guam, European diseases introduced by the explorers
state authorities over land Kiribati, Nauru, the Marshall and Northern and missionaries decimated the population, and
deposition. It needs Mariana Islands, Palau, and the Federated States of by 1910 only a little more than 38,500 persons of
legislative approval to Micronesia. Although the boundaries of Melanesia Hawaiian ancestry remained. A high rate of inter-
take effect. are not exact, it includes the nations of Fiji, Papua marriage has resulted in a population with few
New Guinea, Vanuatu, the Solomon Islands, and Hawaiians of full native heritage. A large number
the French dependency of New Caledonia. of Hawaiians have migrated to the mainland
Although the area is geographically similar, United States, but the census figures do not reflect
consisting of mostly small, tropical coral or vol- such interstate relocations.
canic islands, the Pacific Islanders are a racially
and culturally diverse population. European, Samoans. In 1951 the Pago Pago naval base that
American, and Japanese influences have been employed many Samoans moved to Hawaii, and
extensive. Today there are greater numbers of many Samoans followed. Increasing population
some Pacific Islander groups living in the United pressures and a deteriorating economy encouraged
States than in their native homelands. further immigration. Once in Hawaii, Samoans
sometimes move to the mainland United States
in search of broader job availability and for wider
CULTURAL PERSPECTIVE educational opportunities for their children. A
A rendering of the chain of immigration between Hawaii and the
Resolution, the ship used History of Pacific Islanders
West Coast has been created, with Samoans estab-
by James Cook to explore in the United States
lished in the mainland helping extended family
Polynesia. Many Pacific Immigration Patterns. Since the first settlement members to settle nearby.
Islander cultural traditions of the island Oceania, the migration of popula-
disappeared after European tion groups has been very fluid among Polynesia, Guamanians. Following attainment of citizen-
discovery of the islands in
ship in 1950, many Guamanians enlisted in the
the 18th century.
U.S. armed forces seeking better employment.
Some moved to Hawaii and the West Coast of the
U.S. mainland. By the early 1970s, approximately
12,000 Guamanians had immigrated, mostly
Chamorros (native Micronesians). Major popula-
tions have settled in San Diego, Los Angeles, San
Francisco, the Seattle area, and Hawaii.
Tongans. The immigration of Tongans to the

United States did not begin until population
pressures in the 1960s decreased economic oppor-
tunities in Tonga. Under the strict hereditary
social structure, only the eldest son in a family
may inherit land, leaving younger men with
Bettmann/CORBIS
little economic mobility. Unlike most other Pacific

Islanders, Tongans usually immigrate directly
to the U.S. mainland rather than settling first
in Hawaii.
Current Demographics and Socioeconomic construction, janitorial or maintenance jobs, or

Status as security guards.60 Low pay, large immediate
Hawaiians. More than 151,000 U.S. citizens were families, and responsibilities for extended family
self-identified as Native Hawaiians in the 2005 members in Samoa often translate into a poor
U.S. Census estimate, representing the largest per- standard of living.35 Median family income is
centage (38 percent) of American Pacific Islanders, among the lowest of all Pacific Islanders and is
and approximately 260,000 are Native Hawaiian well below the national average. Approximately
in combination with other races. Over half live in 20 percent of Samoans live in poverty.60 Nearly
Hawaii: 20 percent of the total state population one-quarter of Samoan adults have not completed
has some Native Hawaiian heritage. The remain- high school, though college attendance rates are
ing Hawaiians live primarily on the West Coast, slightly higher than the national average. Samoans
mostly in California. Scant socioeconomic data often find social adjustment difficult because their
are available, but reports indicate that some titled rank from Samoa is unrecognized in the
Hawaiians occupy the lowest economic strata in United States.
the state of Hawaii, along with other Pacific
Guamanians. The 2005 U.S. Census statistics
Islander immigrants, living mostly in rural and
indicate over 76,000 Guamanians are residing in
semirural regions.156 Hawaiian heritage is less of
the United States. Many are Chamorros, although
a handicap on the mainland where Hawaiians
self-identification figures are unclear on the exact
have a cultural advantage over other Pacific
percentage. The Chamorros often become part
Islanders (through extensive exposure to American
of Pacific Islander communities (with Samoan
society) and often enter the middle class. Overall,
and Tongan immigrants). Large populations of
median family income is close to the national
Guamanians are found in Hawaii, California,
average, and poverty rates are only slightly above
Washington State, and Washington, D.C.134
the total U.S. figure. College attendance rates for
Over one-quarter of Guamanians work in pro-
adults are higher than the U.S. average, although
fessional or management positions, and nearly
graduation rates are much lower.60
one-third are employed in office and sales jobs.60
Similar to Native Hawaiians, median family income
Samoans. Probably more Samoans are living Nearly 10,000 Fijians live in
is just below the U.S. average, and poverty rates
outside Samoa than in American and Western the United States according
are near the national average. Nearly 50 percent
Samoa combined. The 2005 U.S. Census figures to 2000 U.S. Census data,
of Guamanian adults have attended college, though
showed over 56,000 people of Samoan heritage primarily in California. Most
graduation rates are well below the national aver- are of Asian-Indian descent,
alone lived in the United States, most of whom
age. Additionally, 22 percent of adults have not were originally indentured
were born in America. Data from 2000 suggest
graduated from high school. Some Guamanians, laborers in Fiji, and follow
over 128,000 Samoans total (alone and in combi-
particularly Chomorros, may suffer the same dis- the Islamic or Hindu faith.
nation with other ethnicity) are U.S. residents.60
crimination and economic hardships as some other Though overall educational
The largest groups are found in Honolulu, Los
Pacific Islander groups. attainment is low, median
Angeles, the San Francisco Bay area, and Salt family income approaches
Lake City. Smaller numbers have settled in Laie, Tongans. Nearly 27,000 Tongans live in the United the national average,
Hawaii; Oakland, California; and Independence, States according to U.S. 2000 Census figures. Many and poverty rates are
Missouri. Religion is a factor for some immi- are Mormons and are aided in their immigra- significantly lower than
grants: Samoan Mormons tend to migrate to tion by their church, and most move to commu- the norm.60
Mormon centers such as Salt Lake City when they nities of other Pacific Islanders in San Francisco,
move to the United States. Although most Samoan Los Angeles, Dallas, Fort Worth, and in Salt Lake The 2000 U.S. Census
immigrants to the mainland are from American City. A small community of Tongans has also reports nearly 6,000
Samoa, approximately 15 to 20 percent come located in Hawaii.144 residents from the Marshall
Islands, most of whom are
from the independent nation of Western Samoa. Educational attainment in the U.S. Tongan
foreign-born. Many have
Though nearly one-third of Samoans in the community is lownearly 35 percent of adults
extremely low educational
United States work in office and sales jobs, and have not graduated from high school. Tongans attainment, median family
18 percent hold management and professional are more likely than most other Pacific Islanders income nearly 50 percent
positions, another 30 percent of Samoans in the to work in the construction, maintenance, and below the national average,
United States are employed in unskilled or extraction jobs. Many also report employment and poverty rates over
semiskilled labor such as assembly line jobs, in the production and transportation fields.60 38 percent.60
Though median family income is close to the paycheck (or weekly contribution) and providing
national norm, sharing earnings with relatives for the household needs. The good of the whole
in Tonga is expected,33 and nearly 20 percent of family is considered before the benefit to the indi-
Tongans live in poverty. vidual, and most Pacific Islanders are guided by
their desire to avoid bringing shame on their
Worldview family. In Guam this interdependence is known as
Religion. Pacific Islanders follow a wide variety of inafamaolek and extends not only to family and
religions, often according to which missionary community, but to national affiliation as well.134
groups were active in their homeland. Hawaiians The stresses of acculturation in the United
practice mostly Protestantism, Buddhism, or States usually occur due to moving from a society
Shintoism. Samoans are largely Methodist, in which there is little anonymity (with individual
Catholic, Mormon, and Anglican. Chomorros are behavior reflecting on the whole family or village)
primarily Catholic, and Tongans in the United to a society in which Pacific Islanders are often
States are mostly Mormon. Religion is often promi- marginalized or even invisible if misidentified as
nent in the lives of Pacific Islanders, and ministers Asians or Filipinos. Most Pacific Islanders main-
usually are held in high esteem. In Samoa nightly tain close contact with their homeland and fulfill
readings from the Bible are common in most their obligation to family by sending financial
homes, and prayers are offered at every meal.35 support. Trips back to the islands for political and
social events are common.
Certain fish in Hawaii were Family. Although most native religions were
reserved for royalty, and abandoned, many concepts central to Pacific Traditional Health Beliefs and Practices. Religion
women rarely consumed Islander culture remained within the structure of and medicine were closely linked in Pacific Islander
fish, though they were families. For example, on many islands social rank culture, and the loss of many traditional health
permitted to eat shellfish. and power were established by birth order within beliefs and practices occurred with the adoption of
the extended kinship system or clan, and even nonnative faiths. Although folk healers specializing
within families, younger siblings deferred to their in herbs, massage, or religious and/or spiritual
older brothers and sisters. Elders were respected. intervention work in Pacific Islander communities
The senior male in the group, whether in the village both in Hawaii and on the U.S. mainland, their cur-
or in a family, managed all group matters. In rent use is not well documented. Traditional prac-
Hawaii women and men were segregated under the titioners are identified with a broad range of
kapu system, each with specific roles and responsi- Eastern and Western religious affiliations and offer
bilities. Extended families were the foundation of a wide spectrum of services. Their clientele are also
society, and children were raised usually by grand- extremely diverse, often crossing ethnic or reli-
parents, aunts and uncles, and even remote kin gious lines to seek effective care.133
rather than by just the parents. Household compo- Many Native Hawaiians believe lokahi, har-
sition was flexible, and all members were obligated mony between individuals, nature, and the gods, is
to support the extended family, resulting in sub- essential to good health. Hawaiian healers typi-
stantial redistribution of resources. Generosity and cally practice massage (hoolomilomiused for
sharing were highly valued. Any social transgres- conditions such as childbirth, asthma, congestion,
sions committed by the individual were the bronchitis, inflammation, and rheumatism),
responsibility of the whole family. In Samoa, if the herbal medicine (laau lapaau), and/or conflict
In Samoa a serious offense violation was severe, the family could be disinher- resolution (hoononpono, meaning make things
by an individual can be ited from their land and stripped of any social title. rightused to remove emotional obstacles to
ameliorated by an ifoga Some of these same practices are continued by healing). Meditation, deep breathing, and Chinese
(literally a lowering). The Pacific Islanders today. Unlike many immigrant Traditional Medicine may also be employed.
extended family positions
groups, they typically maintain extended families Healing is initiated at the end of each session with
themselves in front of the
in the United States. Responsibility for child rear- spiritual blessings.28, 65, 74
victims home and remains
there until invited in and ing is shared among family members (children It is reported that more than 300 Hawaiian
forgiven. They formally may move freely between homes), and household botanicals and animal- or mineral-based cures
apologize through the chores are assigned according to age and gender. were available traditionally, with over fifty-eight
presentation of gifts The oldest man (or occasionally the oldest woman) remedies for respiratory problems alone.101, 156
and cash. in the home assumes control, collecting everyones Today, only thirty plants are estimated to be
used regularly. Examples include aloe vera for

burns, hypertension, diabetes, and cancer; plantain
leaves to reduce blood sugar levels in diabetes;
polokai (black nightshade) for asthma, coughs,
and colds; and wild ginger for gastrointestinal
problems, ulcers, and asthma. Native Hawaiians
also practice home remedies. For example, drink-
ing seawater followed by fresh water is believed to
be a general tonic.
Samoans believe that health is maintained
through a good diet, cleanliness, and harmony in
Isabelle Rozenbaum/Getty Images

interpersonal relationships. An individual is at
high risk of illness if he or she does not fulfill
family obligations or support village life. The con-
cept of balance is essential: disruptions in inter-
personal relationships, working too hard, sleeping
too little, or eating the wrong foods can cause dis-
location of the toala (the center of ones being
located just beneath the navel) to another part of Taro root is a staple in the
the body, where it induces pain, poor appetite, or Pacific Islands, served boiled
other symptoms.68, 77 Treatment typically requires items, including sugar cane and pineapple, were or pounded into a paste
called poi. The leaves are
the restoration of balance. A family may get brought by European plantation owners.
also consumed.
together to openly air disputes so that harmony Pacific Islander fare, especially in Hawaii, has
can be reestablished, or massage by an elder may been influenced by European missionaries and
be used to gently coax the toala back into posi- traders, as well as by the significant numbers of Hysterical behavior,
tion. A traditional Samoan healer may be con- Japanese, Chinese, Korean, Filipino, and Asian- especially by women, was
sulted to cure certain folk illnesses, particularly Indian agricultural workers who arrived in the called ghost sickness by
those due to supernatural causes, such as spirit eighteenth and nineteenth centuries. Each group the Tongans and attributed
possession by malevolent ghosts or the actions of added its own cooking to that of the Pacific to possession by the spirit
ancestor spirits angered by a persons conduct. Islanders, but these foods did not meld into a of a deceased female
One such condition is musu, a mental illness in single cuisine. Instead, each recipe retains its ancestor. Another traditional
young men and women typified by extreme with- traditional character, and dishes from several illness occurs in infants
drawal. Healers may be herbalists, masseuses, different cultures may be served at each meal (see when the fontanel does not
also Chapter 15, Regional Americans, for more close (mavae ua).
bone setters, midwives, taulasea (a general prac-
titioner familiar with Samoan sicknesses), power information on Hawaiian fare). Foreign flavors
Traditionally, Samoan men
healers (who provide spiritual interventions), or are less noteworthy outside Hawaii and are some- obtained full-body tattoos,
diviners (specializing in the determination of why times limited to only a few influences. in part to help them
an illness has occurred). Massage, herbal reme- empathize with the pro-
dies, and communication with the supernatural Ingredients and Common Foods: Staples longed pain of childbirth
elements are the usual therapies.35, 71 Starchy vegetables are the mainstay of the tradi- suffered by Samoan women.
tional Pacific Islander diet (Table 12.3). These
include the root vegetable taro, which is a little
denser and more glutinous than the white potato;
The cooking of the Pacific Islands developed breadfruit, with a fluffy, bread-like interior; cas-
without benefit of metal pots, pans, and utensils, sava; and yams. These foods were often cooked
and many foods were eaten raw. The indigenous and then pounded into a paste. In Hawaii taro
cuisine was probably based on breadfruit, taro, root paste eaten fresh, or partially fermented, is
cassava, yams, and perhaps pigs and poultry. called poi (a word that originally referred to the
Fruits were also widely available, although those pounding method). When food was scarce, the
often associated with the Pacific region, such as Native Hawaiians survived on the purplish-colored
coconuts and bananas, were not introduced from poi, sometimes with a little seaweed or fish added
Indonesia until approximately 1000 C.E. Other to it. Although taro root is also a staple in Samoa,
Table 12.3 Cultural Food Groups: Pacific Islanders

Adaptations in the
Protein Foods
Milk/milk products Milk and other dairy products are uncommon. Increased intake of milk
Many Pacific Islanders are lactose intolerant. has occurred.
Meat/poultry/fish/ Pork is the most commonly eaten meat. Meat: beef, pork Dietary changes
eggs/legumes Soybean products are used by Asian residents. Poultry and small birds: chicken, duck, squab, turkey often occur before
Winged beans are a popular legume on Eggs: chicken, duck immigration. Many are
some islands. Fish and shellfish: ahi, clams, crabs, crawfish, eel, dependent on imported
lobster, mahimahi, mullet, octopus, salmon, sardines, foods such as canned
scallops, sea cucumber, sea urchin, shark, shrimp, meats and fish.
swordfish, tuna, turtle, whale
Legumes: beans (long, navy, soy, sword, winged),
cowpeas, lentils, pigeon peas
Cereals/Grains Europeans introduced wheat bread, and Asians Rice, wheat Increased intake of bread
brought rice and noodles. and rice is noted.
Fruits/Vegetables Starchy vegetables are the mainstay of the Fruits: acerola cherry, apples, apricot, avocado, banana, The traditional starchy
diet. They were often cooked and pounded breadfruit, citrus fruits, coconut, guava, jackfruit, vegetables have
into a paste. kumquat, litchis, loquat, mango, melons, papaya, decreased in use and
More than 40 varieties of seaweed are eaten. passion fruit, peach, pear, pineapple, plum, prune, may only be consumed
Cooked greens are popular. soursop, strawberry, tamarind at special occasions.
Fruits are an important ingredient. Immature Vegetables: arrowroot, bitter melon, burdock root,
coconuts are considered a delicacy. cabbage, carrot, cassava, cauliflower, daikon,
Arrowroot is used to thicken puddings and eggplant, ferns, green beans, green pepper,
other dishes. horseradish, jute, kohlrabi, leeks, lettuce, lotus root,
mustard greens, green onions, parsley, peas, seaweed,
spinach, squashes, sweet potato, taro, ti plant,
tomato, water chestnuts, yams
Additional Foods
Seasonings Food is not highly seasoned but often flavored Curry powder, garlic, ginger, mint, paprika, pepper,
with lime or lemon juice and coconut milk or salt, scallions or green onions, seaweed, soy sauce,
cream. tamarind
Nuts/seeds Nuts are a core ingredient. Candlenuts (kukui), litchi, macadamia nuts, peanuts
Beverages Coconuts provide juice for drinking and sap for Cocoa, coconut drinks, coffee, fruit juice, kava (alcoholic Increased consumption
fermentation. beverage made from pepper plant), tea of sweetened fruit
beverages and soft
drinks has occurred.
Fats/oils Coconut oil and lard are the preferred fats. Butter, coconut oil or cream, lard, vegetable oil and Use of vegetable oils
shortening, sesame oil and mayonnaise has
increased.
Sweeteners Sugar
it is usually boiled but not pounded. Arrowroot is taro root, yam, ti plant, and sweet potatoes, are
used to thicken puddings and other dishes. The very popular. One specialty is to wrap foods in ti or
Europeans introduced wheat, and bread is eaten taro leaves, then steam the packets for several
in some areas; for instance, Portuguese sweet hours. The musky flavor of the leaves permeates
bread is known as Hawaiian bread in Hawaii. the entire dish, called laulau in Hawaii.138 Another
Asian settlers popularized both short- and long- specialty known as luau combines chopped taro
grain rice, as well as noodles. leaves with chicken or octopus and coconut milk.78
Fish hooks are symbolic More than forty varieties of seaweed are con- Fish and seafood are abundant in the Pacific
of good luck in Hawaii. sumed. Cooked greens, including the leaves of the Islands, and in some regions they were eaten at
every meal. Mullet is one of the most popular

fishes, but many others, including mahimahi
(dolphin fish, not related to the mammal),
salmon, shark, tuna, and sardines are also con-
sumed. A tremendous variety of shellfish is avail-
able, such as clams, crabs, lobster, scallops,
Porterfield/Chickering/Photo Researchers, Inc.

shrimp, crawfish, and sea urchins, as well as many
local species. Eel, octopus, squid, and sea cucum-
bers are also eaten. Although some fish and
seafood was stewed or roasted, some was also
eaten uncooked, marinated in lemon or lime juice,
which turns the fish opaque much the same as
cooking it. A popular Hawaiian specialty is lomi-
lomi, made with marinated chunks of salmon,
tomatoes, and onions, served with or without poi
as an appetizer. A similar Samoan dish, called oka, Pork was traditionally the
is also made with chunks of raw fish marinated in most commonly eaten meat,
a mixture of lemon juice and coconut cream. traditional gelatin-like Hawaiian dessert, is made particularly for ceremonial
Pork is the most commonly eaten meat, espe- from coconut milk sweetened with sugar. occasions. The pig and other
cially for ceremonial occasions. Traditionally it was Traditional Pacific Islander fare was not highly foods were cooked in a
cooked in a pit called an imu in Hawaii, a himaa in seasoned. The flavors of lime or lemon juice,
stone-lined pit over coals.
Samoa, and an umu in Tonga. A fire was built over coconut milk or cream, and salt predominate,
the stones lining the pit, and when the coals were with occasional use of ginger, garlic, tamarind, Hawaii is a leader in
hot, layers of banana leaves or palm fronds were and scallions or onions. Coconut oil and lard are aquaculture. As early as
added. The pig and other foods, such as breadfruit the preferred fats, providing a distinctive taste to 1778, Captain Cook reported
and yams, were placed on the leaves, then covered many dishes. Foreign spices, such as Asian Indian 360 fish farms on the island
with more leaves and sealed with dirt. In some curry blends, and sauces, such as soy sauce, have
of Kauai, producing an
cases water was poured over the rocks just before estimated 2 million pounds
been incorporated into some dishes. of fish annually.
the pit was closed, steaming the foods instead of
baking them. The pit was left sealed for hours until
the food was completely cooked. Meal Composition and Cycle
Chicken is widely available, as are eggs. Daily Patterns. Traditional meals included poi
Limited grazing land kept beef from becoming a or boiled taro root, breadfruit, or green bananas;
frequently eaten item. Milk and other dairy prod- fish or pork; and greens or seaweed. In Samoa,
ucts are also uncommon. Soybean products are Guam, and Tonga, most dishes are cooked in
used by Asian residents, and winged beans are a coconut milk or cream. Although the evening
popular legume on some islands. supper was generally the largest meal, little dis-
Fruits and nuts are important ingredients in tinction was made between the foods served at
Pacific Islander cuisine. Bananas, candlenuts the two or three daily meals. When food was pit-
(kukui nuts), citrus fruits, coconuts, pineapples, cooked, amounts suitable for two or three days at
guavas, litchis, jackfruit, mangoes, melons, a time were prepared. Fresh fruit was eaten as
papayas, passion fruit, and vi (ambarella) are a snacks. Beverages made from coconut juice or
few of the widely available varieties. Fruits are sap were common. The Asians introduced vari-
eaten fresh or added to dishes such as Samoan ous teas, including those made from lemon grass
papaya and coconut cream soup (supo esi) and and orange leaves. In Samoa a drink made from
deep-fried dumplings filled with pineapple or ground cacao beans mixed with water, called
The enzyme papain,
bananas (pani keki). Coconuts provide juice for koko samoa, is traditional. Kava, a bland, mildly
extracted from papayas,
drinking, sap for fermentation, and milk or cream intoxicating beverage, remains a popular drink in is used in some meat
used in numerous stewed dishes (coconut milk many regions. It is made from the chewed or tenderizers. In Hawaii
can also be made into foods resembling cheese ground root of the native pepper plant, mixed papaya juice is applied to
and buttermilk). Immature coconuts are consid- with water in a stone bowl. It reputedly tastes a jellyfish stings to reduce
ered a delicacy throughout the Pacific. Haupia, a little like dirt or licorice. the pain.
canoe or house, or a prolific harvest or abundant

catch was celebrated with a luau, featuring a whole
pig, poultry, fish, and vegetables cooked in the
imu. In Samoa the feast is sometimes preceded by
SAMPLE MENU a kava ceremony, in which the beverage is dis-
tributed ritualistically to guests who are expected
to drain the cup in one gulp. Traditionally kava
A Native Hawaiian was offered as a gesture of hospitality and for
occasions such as the ordination of a new chief.
Dinner In Tonga, where umu-cooked food accompanies
celebrations such as the commemoration of a royal
Lomi-Lomi (Marinated Salmon) a, b, c birthday, special coconut frond stretchers are
woven for transporting the massive amounts of
Chicken Luau (Chicken with Taro/Spinach Leaves) a, c food prepared for the occasion.
Holidays celebrated in the Pacific Islands are
Poi (fermented taro root) a or Sweet Potatoes c usually those associated with religious affilia-
Haupia (Coconut Dessert) a, b, c or Guava Cake a, b, c tion. In addition, Hawaiians also honor Prince
Kuhio on March 26 and the Kamehameha Dynasty
Fruit Juice or Coffee on June 11. Samoans feast nearly every Sunday,
and almost all denominations celebrate White
Sunday on the third Sunday of October, venerat-
a
Laudan, R. 1996. The food of Paradise: Exploring Hawaiis culinary heritage. ing children. After a special service featuring reli-
Honolulu: University of Hawaii Press. gious recitations by children, a festive meal is
b
Local Kine Recipes at www.hawaii.edu/recipes served, and children are waited on by the adults
c
Luau Foods and Recipes at www.gohawaiiabout.com/cs/recipes in their extended family.35 Guamanians celebrate
the Liberation Day on July 21 with parades, fire-
works, and feasting.134 King Tuafaahau Tuopu IVs
birthday is a national holiday in Tonga.144
Role of Food
Food holds particular importance within most
Pacific Island cultures. Sharing food is a way of
Red salt, made from salt Etiquette. Most Pacific Islanders consider hospi-
demonstrating generosity and support for family
mixed with iron-rich earth, tality an honor, and outsiders are usually exempt
is a Hawaiian specialty, and village. It is also a way of expressing pros-
from traditional manners. In Samoa, for example,
traditionally reserved for perity or social standing. Many events are cele-
it is considered rude to eat in front of someone
important feasts.78 brated with feasting, and food is eaten to excess
without sharing. When eating a meal, respect
as part of the ceremony in some regions.
should be shown for the food because it repre-
Traditionally, gender roles were defined by food
sents the hosts generosity; this includes not talk-
interactions. Boys and girls were often raised
ing during the meal.35 Most hosts will not eat
similarly until the age of eight or nine, at which
until a guest is satisfied. As in many societies, it is
time they were separated for training in food
impolite to refuse food, although a guest is not
procurement (farming and fishing) or food
obligated to eat every morsel served. At some
preparation (cooking and food storage).
Samoan celebrations, for example, a large box of
Throughout the Pacific Islands, gifts of food are
food may be placed on the table for each guest.
given often. Because the gifts are given without
The diner samples items from the box until full,
expectation of reciprocity, it is a serious affront
then brings the remaining food home to share
to reject any item presented.
with his or her extended family.42
When drinking kava, it is
Special Occasions. Throughout the Pacific Therapeutic Uses of Foods
considered polite to drip
a few drops onto the ground Islands special events were commemorated with Numerous botanicals are used by Native Hawaiians
and say manuia as feasting, often including pit-roasted foods. In as cures. Most notable is the pepper plant (Piper
a blessing before quaffing. Hawaii weddings, childbirth, completion of a methusticumrelated to the betel vine), which is
used to make kava or awa. It is sometimes used meats, fried foods, foods cooked in coconut milk, Areca nuts are used
medicinally as an analgesic or narcotic. In diluted white rice, and sweetened beverages and a low throughout the Pacific
form, it is used as a sedative and given to teething intake of produce have been noted.112 Nutrient- Islands, and in Hawaii they
infants. Noni (Indian Mulberry) is consumed as a rich native foods, such as fish, yams, papayas, and are considered a stimulant.
Guamanians are especially
juice for anorexia, renal problems, urinary tract mangoes, were rarely consumed by Guamanian
fond of chewing them. The
infections, hypertension, diabetes, musculoskeletal children in another study.112 Traditional starches,
practice is traditionally
pain, to boost the immunes system, and to prevent such as taro root and cassava, are often reserved passed from grandparent to
cancer.65 Turmeric is consumed as a blood cleanser, for special-occasion feasts.44 grandchild and is common
and breadfruit is made into a tea to treat high Little has been reported on Pacific Islander at social occasions.
blood sugar and elevated blood pressure. food habits in the United States. A study compar- Chomorrans chew them
ing the intakes of Western Samoans (living in a after meals.134
poorer, less westernized culture) to those of
CONTEMPORARY FOOD HABITS American Samoans (living in a wealthier, more
IN THE UNITED STATES westernized culture) found that the Western
Samoans ate a diet higher in total fat due to a
Adaptations of Food Habits reliance on coconut cream compared to a diet
Ingredients and Common Foods. In Hawaii higher in protein, cholesterol, and salt due to
todays population often eats fare that combines higher consumption of processed foods eaten by
elements of Eastern and Western foods, typified American Samoans.48
by the plate lunch: rice heaped with one or two Older studies on Samoans who have moved to One study of children in
types of meat, poultry, or fish (such as teriyaki Hawaii show diets with greater variety of foods; Guam found that 26 percent
beef, spaghetti and meat sauce, fried mahi-mahi, traditional foods only contribute minimally to ate at least three meals
pit-cooked pork, curry, or SPAM) covered with daily intake, and items such as rice, bread, sugar, each week at fast-food
beef, canned fish, milk, soft drinks, and sweet- restaurants, and 53 percent
gravy, served with a scoop of macaroni or potato
consumed at least two cans
salad, and eaten with chopsticks. Soy sauce is the ened fruit beverages make up most of the diet.59
of sweetened soda daily.80
most common condiment.78 Ethnic cuisines and Available health statistics indicate that a diet sub-
typical American dishes are also widely con- stantially higher in fat and simple carbohydrates Research on Asian, mixed
sumed. Snacking is prevalent and may include and lower in fruits, vegetables, and fiber has been ethnicity, and white adoles-
noodles topped with meat (saimin), steamed adopted by many immigrants. cent girls in Hawaii found
pork rolls (manapua ) or a large ball of glutinous that all groups could bene-
rice with a bit of pickled daikon or teriyaki tuna Meal Composition and Cycle. Three meals each fit from increased intake of
tucked in the middle (musubi). Crack seed is day are common for most Pacific Islanders. Break- fruits, vegetables, and cal-
especially popular, consisting of dried, salted, and fast is most often cereal with coffee. More tradi- cium-rich foods.39
sugared fruits (e.g., guava, sliced ginger, lemon tional meals may be eaten for lunch and dinner; a
peel, mango, plum) that provide a sweet-and- few Hawaiians still eat poi once or twice a day.
sour flavor experience. Some are also seasoned Fruit appears more often as part of the meal rather
with spices, such as anise. The seed kernels (in than as a snack. It is believed that Sunday feasting
whole preserved fruit) are traditionally cracked among Samoans is still prevalent.
open with the teeth, adding extra flavor and
giving the descriptive name to the treats.78 Nutritional Status
The dietary changes made by other Pacific Nutritional Intake. Serious nutritional deficien-
Islanders often begin before immigration to the cies are uncommon in most Pacific Islander diets.
mainland United States. Most Pacific Islanders in A high calorie intake generally guarantees nutri-
their homelands are highly reliant on imported tional sufficiency. However, research on Samoans
foods, particularly processed items such as in Hawaii indicated that fewer calories were con-
canned meats and fish, cooking oil, mayonnaise, sumed than in Samoa and that riboflavin, cal-
cookies, breakfast cereals, and soft drinks. One cium, and iron intake was low.59 Further, a study
study on Samoa indicated that 80 percent of all of children in Guam found that three-quarters
foods found in one market were from the United consumed fruits and vegetables less than once
States, New Zealand, or Australia.131 Consumption daily.80 Rice, meat, powdered fruit drinks, milk,
of native foods, such as taro and coconut, and fortified cereals were the primary sources of
increases on Sundays.59 In Guam a high intake of vitamins and minerals in the diets of Guamanian
children in other research. Low intakes of cal- weight gains in infants throughout the Samoan
cium, vitamin E, and folate were identified.112 islands).116
Hawaiians and Samoans born in 1992 had Research on infant feeding practices in
lower than the U.S. average life expectancy, while Hawaii suggests that the percentage of Hawaiians
Guamanians were expected to live longer than in Hawaii breast feeding their babies is more than
average.69 Hawaiian data indicate that life 50 percent. Another approximately 30 percent mix
expectancy for Hawaiians is lower than that for breast feeding with a bottle. Native Hawaiian
whites and Asians living in the state.50 Heart dis- women were more likely to introduce solid foods
ease is the leading cause of death for Samoan to their infants before four months of age than
Americans and Native Hawaiians, with rates esti- whites, Filipinos, or Japanese women in Hawaii;
mated to be 44 percent higher than in the general sweetened beverages and baby food desserts were
population.69, 91 Comparative data specific to common items included in the infants diets.
California found deaths from coronary heart dis- Tooth decay due to excessive consumption of
ease were over 2.5 times the average for the state sweetened beverages in a bottle is three times the
population among some Pacific Islanders U.S. average among children five years old and
Samoans had rates 1.5 times higher, Guamanians younger in Hawaii.55
1.3 times higher, and Native Hawaiians 1.1 times Chronic disease rates associated with west-
higher.25 Deaths from strokes were also notably ernization are of primary concern. Obesity rates
higher. High total cholesterol levels are also noted among Pacific Islanders are some of the highest
among Hawaiians and Samoans. The few studies in the world, regardless of where they live. Native
on diet suggest that nearly all fat in the tradi- Hawaiian and Samoan adults show average body
tional Pacific Islander diet is saturated (36% of mass indices that exceed those used to define
calories from coconut fats alone) and that satu- obesity in the general American population.3, 37 A
rated fats are also predominant in acculturated study of Samoans living in Western Samoa and
diets.59 Hypertension is slightly higher among Hawaii showed large weight gains with increasing
Native Hawaiians than among whites in Hawaii, modernization. In rural Samoa the prevalence for
and in one study of low-income Pacific Islanders being overweight was 33 percent for men and
in the state, rates were five times the reported 46 percent for women; in Hawaii the prevalence
average for whites.153 Native Hawaiians show a was 75 percent for men and 80 percent for women.
higher incidence rate for cancers of the breast, Sixty-six percent of Native Hawaiians are thought
cervix, uterus, esophagus, larynx, lung, pancreas, to be overweight or obese, and a study on Asian
stomach, and multiple myeloma than whites. Americans reported 74 percent of Pacific
Survival rates are also generally lower.72 Cancer Islanders were in that category.44, 86, 153 In a study
mortality rates for Chomorros in Guam suggest of Hawaiian preschool children, 27 percent of
this group suffers disproportionately from cancers Samoan two to four year olds were overweight
of the mouth and pharynx, lung and bronchus, (BMI 95th percentile), a rate double that of any
colon-rectum-anus, breast, and prostate when other ethnic group.14
compared to U.S. averages.57 Obesity may be caused directly by overeating
Infant mortality data suggest that Native (within the context of family and church activities)
Hawaiians have rates above the national average combined with inadequate physical exercise, and
in all categories.96 California data also report sig- indirectly because overweight was an aesthetic
nificantly higher rates of infant deaths among preference in the traditional cultures. Heredity
Samoans and Pacific Islanders, though for Native may be a factor in the rate of obesity in Pacific
Hawaiians and Guamanians, infant deaths were Islanders, or it may be due in part to the change
nearly half those of the total population despite in the types and amount of carbohydrates con-
higher rates of low-birth-weight neonates.25 In sumed.84 A small study of Native Hawaiians who
a study comparing perinatal outcomes in U.S. ate as much of traditional starchy vegetables and
Asian and Pacific Islander subgroups, Pacific greens as they desired supplemented with small
Islanders were found to be at increased risk for amounts of fish and poultry reduced total calorie
gestational diabetes, and 25 percent of births intake, lost weight, and lowered their blood
exceeded 4,000 grams (high birth weights are pressure and total serum cholesterol. Those
also reported in American Samoa, as are rapid who were diabetic reduced or eliminated their
insulin requirements.130 Lower levels of physical a comprehensive approach to care, which may
activity among Pacific Islanders may be another involve religious rituals, including prayer.
factor.27, 80, 83 Additionally, researchers have found Samoan Americans generally seek care for
that when Pacific Islanders are compared to symptomatic relief and are typically uninterested
whites with the same percentage of body fat, the in long-term approaches to disease prevention or
Pacific Islanders have higher BMIs, suggesting management.71 Low compliance rates in the treat-
greater nonfat density. BMI cutoffs for over- ment of hypertension and diabetes in Pacific
weight and obesity that are standardized for Islanders have been noted. A study on Native
whites may need to be modified.124 Many Pacific Hawaiian health needs found that cultural differ-
Islanders value a larger body size. One study in ences were a primary reason for underutilization
Hawaii found that while Pacific Islanders believe of services.85 Further, some Pacific Islanders
whites and Europeans should be slim, they also believe that illness is the will of God and may delay
think that Pacific Islanders should be overweight obtaining care until symptoms are advanced.
or obese.153 Though Samoans living in western- Language difficulties or linguistic isolation
ized New Zealand identified a slim body as ideal, may also occur. According to the 2000 U.S.
those who were above normal weight did not con- Census, nearly one-third of Tongan Americans
sider themselves to be obese and were positive and nearly 20 percent of Samoan Americans do
about their body size and health.20 Research in not speak English well. Rates for Guamanians are
Micronesia reported that many mothers of over- close to 15 percent.60 Samoans expect exceptional
weight children associate thinness with illness.23 politeness in interactions; showing irritation,
Risk for type 2 diabetes mellitus is also high anger, or other hostile emotion is considered rude Many Pacific Islanders are
for Pacific Islanders.86 Prevalence estimates are and a sign of weakness.35 A reserved conversa- lactose-intolerant; it is esti-
the highest for Native Hawaiians (two to six times tional style and the desire to maintain harmony mated that 50 percent of
the 5 to 7 percent prevalence among whites) and may result in some Pacific Islanders enduring Samoan adults do not toler-
from 9 to 16 percent for Samoans.37, 56, 132 Health pain rather than expressing it.158 Judgmental or ate milk.127
statistics from California and Hawaii suggest accusatory attitudes regarding lifestyle (especially
In Guam an extremely high
mortality rates from diabetes are 1.6 to 3.7 times weight gain) may cause Pacific Islanders to avoid
prevalence of both
higher for Pacific Islanders than for the general further counseling. amyothrophic lateral sclero-
population.25, 37 Studies have found, however, that When entering a room, Samoans walk around sis (called letigo) and
Polynesians and Pacific Islanders are not intrinsi- to greet each person with a smile and handshake. Parkinsonism dementia
cally insulin resistant, and that most risk for dia- Eye contact is expected. Both Samoans and (known as bodig) has been
betes is accounted for by high rates of overweight Tongans are concerned that all participants in a reported. Incidence has
and obesity.86, 132, 153 Central body adiposity is also conversation be at an equal level; for example, decreased significantly in
predictive.125 It is postulated that Samoans may everyone should be sitting on mats or in chairs. It is recent years, however, sug-
be especially susceptible to the kidney damage offensive to stand while speaking to someone who gesting environmental
associated with hypertension because end-stage is sitting. When seated, legs should be crossed or causes may be to blame.137
renal failure is a common cause of death in kept close to the body; extended legs or pointing
Estimates indicate that over
American Samoan diabetes patients. ones feet at a person is considered poor manners.35
40 percent of immigrants
One study reported that weight-loss interven- from the Marshall Islands
Counseling. Concepts regarding the role of the tions based on traditional Hawaiian foods were do not speak English well.60
individual in health care may be an issue for Pacific well accepted by Native Hawaiians, particularly
Islander American clients. Biomedicine presumes those who emphasized cultural values and pro-
that better health depends on behavior changes vided group support. However, most participants
made by a client. Pacific Islanders view the role of found it difficult to adhere to the diet long-term,
the individual as interdependent on the group and citing difficulties in obtaining fresh produce and
may not take responsibility for personal health.44 the pressures of an obesogenic environment.47 A
Family members may expect to be involved in the study in Micronesia found significant cultural
care of sick relatives, and decisions regarding treat- conflict in homes where mothers attempted to
ment are often made through consultation with the restrict the food intake of their overweight chil-
entire family.158 Because health is defined as a har- dren. Food is associated with love, and grandpar-
monious balance of the physical, social, natural, ents who perceive grandchildren as too thin often
and spiritual worlds, many Pacific Islanders prefer accuse mothers of inadequate care.23
EXPLORING GLOBAL CUISINEAustralian and New Zealand Fare
T he large island continent of Most meats and fish are simply prepared, by wars). Puddings and custards are especially
Australia and the two-island roasting, pan-frying, braising or poaching, popular. Both countries claim pavlova, a
nation of New Zealand are thought and grilling. Traditionally, seasoning was meringue and fruit dish topped with
to have been initially populated by peoples very limited, but today, an international whipped cream, as a national dessert.
from Southeast Asia. Centuries later, array of herbs and spices are used. For exam- Three meals each day are the norm. In
Polynesians traveled to New Zealand, inter- ple, in New Zealand, Asian Indian lamb cur- Australia an afternoon break for tea or beer
mingling with the existing native peoples ries and Greek gyros are popular. Minced and is customary, and in New Zealand many
to become the Maoris. Despite a shared ground meats appear in numerous dishes. In people break for morning and afternoon
heritage, there are only a few similarities Australia shepherds pie(ground lamb tea. Australia is noteworthy for its beers
between the cooking of Southeast Asia and topped with mashed potatoes) and ham- and hearty wines, beverages that New
the Pacific Islands and the fare of Australia burgers topped with fried eggs and beet Zealand is also successfully producing.
and New Zealand. British colonization of slices are common. Battered, fried sausages The Aboriginal foods of Australia,
the countries in the eighteenth and nine- are a favorite snack in New Zealand. In both called bush tucker, include kangaroo,
teenth centuries overwhelmed the original nations individual steak, sausage, bacon, and wombat, emu, duck, fish, shrimp, snakes,
inhabitants and their culinary traditions. egg, or fish pies (consumed with tomato and lizards, witchetty grubs, and wild
Meat is the mainstay of the Australian sauce or ketchup) are popular. plants such as yams, onions, wattle seeds,
and New Zealand diets. Beef is most popular Numerous fruits and vegetables are and quandong (a peach-like fruit). Most
in Australia, especially steak, served with grown in the mild climate. Potatoes, beets, foods were prepared simply over a fire, in
fried eggs or stuffed with oysters (carpet- peas, carrots, and corn are typical accom- the ashes, or boiled. Foods introduced by
bagger steak). Lamb is favored in New paniments to meals, though more exotic Polynesians formed the foundation of the
Zealand (and also well liked in Australia), produce, such as eggplants, feijoas, Maori diet in New Zealand, such as kumara
typically roasted and served with mint sauce kiwifruit (Chinese gooseberries), pineapple, (sweet potatoes), taro, and ti plants. Native
or barbecued. Other meats and poultry are and tamarillos are also available. Bread greens and fruits were also available. Fish,
uncommon in both nations, though some rounds out the meal. Sweets are eaten seafood, birds, and sea mammals provided
wild game, particularly venison, boar, duck, daily. Scones are common, as are biscuits protein (there were no indigenous land
and pheasant, is found in New Zealand. Fish (cookies) such as lamingtons (chocolate mammals in the islands). The Polynesian
and seafood, however, are eaten often, coconut) and ANZAC biscuits (oatmeal influence is also seen in the use of the
including shrimp, oysters, scallops, spiny lob- cookies provided to the Australian and New hangi, a pit-roasting method similar to imu
ster, and crawfish (called yabbies in Australia). Zealand Army Corps during the world used for ceremonial occasions.
Little has been reported on the role of healers It should be noted that hepatic toxicity and liver
among Pacific Islander Americans. Samoans in failure due to kava consumption were reported in
American Samoa, Hawaii, and California were 2002, leading to its ban in several European
found to use indigenous healers and traditional nations and consumer advisory warnings by the
practices, such as massage therapy, in numbers U.S. Food and Drug Administration. Proponents
comparable to the U.S. population in general of the beverage claim nontraditional misuse of the
approximately 41 percent. Those with the strongest product accounts for the adverse reactions.107
Samoan women are beliefs in Samoan-specific illnesses were the most An in-depth interview should be used to
traditionally treated to likely to utilize alternative care.90 In another study determine if a client has any traditional health
a rich coconut drink called Hawaiian adolescents were found to use tradi- beliefs or practices regarding a specific condition
vaisalo after childbirth. tional practices based on access and desire for and if religious affiliation is a factor. Due to the
alternative approaches irrespective of health insur- paucity of research, coworkers or a clients family
ance status.16 Little has been reported on the safety members may provide significant information
and efficacy of Pacific Islander herbal remedies. regarding particular Pacific Islander groups.
CHAPTER 12 REVIEW QUESTIONS Hawaii, and San Diego. Diabetes Research and
Clinical Practice, 71, 306312.
1. Pick one typical Filipino dish and describe it. 7. Araneta, M.R.G., Wingard, D.L., & Barrett-
Explain how it conforms to the principles of Conner, E. 2002. Type 2 diabetes and metabolic syn-
Filipino cooking. Pick one or two ingredients drome in Filipina American women: A high-risk
and discuss whether they are due to an influ- nonobese population. Diabetes Care, 25, 494499.
ence from another culture and why that 8. Axtell, R.E. 1991. Gestures: The dos and taboos of
might have happened. body language around the world. New York: Wiley.
2. Describe the traditional health and dietary 9. Bankston, C.L. 2000. Cambodian Americans. In
beliefs for the prevention and treatment of
disease in one Southeast Asian immigrant Hills, MI: Gale Group.
group. How does the concept of balance for 10. Bankston, C.L. 2000. Hmong Americans. In Gale
maintenance of health fit within Southeast Encyclopedia of Multicultural America, R.V.
Asian health beliefs? Dassanowsky & J. Lehman (Eds.). Farmington
3. Pick one type of traditional healer used in Hills, MI: Gale Group.
Southeast Asian countries. Describe this type 11. Bankston, C.L. 2000. Laotian Americans. In Gale
of healers practice and research whether they Encyclopedia of Multicultural America, R.V.
currently practice in the United States. Dassanowsky & J. Lehman (Eds.). Farmington
4. List the indigenous foods of the Pacific Hills, MI: Gale Group.
Islands. Pick two from your list, describe how 12. Bankston, C.L. 2000. Vietnamese Americans. In
they might be prepared today, and discuss
whether they are considered to have any spe- Hills, MI: Gale Group.
cial dietary or health properties. 13. Barrett, B., Shadick, K., Schilling, R., Spencer, L.,
5. Processed meat products, such as SPAM, are Del Rosario, S., Moua, K., & Vang, M. 1998.
common in the Philippines and Pacific Hmong/medicine interactions: Improving cross-
Islands. What is SPAM, where does it come cultural health care. Family Medicine, 30, 179184.
from, and how did it become prevalent in the 14. Baruffi, G., Hardy, C.J., Waslien, C.I., Uyehara,
Southeast Asian and Pacific Island diet? S.J., & Krupitsky, D. 2004. Ethnic differences in
Include a recipe using SPAM. the prevalence of overweight among young chil-
dren in Hawaii. Journal of the American Dietetic
Association, 104, 17011707.
15. Becker, G. 2003. Cultural expressions of bodily
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142. Storz, D. 1998. Filipino culture. News and Views: 154. Westermeyer, J., Neider, J., & Vang, T.F. 1984.
The Newsletter of the San Jose Peninsula Dietetic Acculturation and mental health: A study of
Association, 29, 7. Hmong refugees at 1.5 and 3.5 years postmigra-
143. Sukalakamala, S., & Brittin, H.C. 2006. Food tion. Social Science and Medicine, 18, 8793.
practices, changes, preferences, and accultura- 155. Wiecha, J.M., Fink, A.K., Wiecha, J., & Hebert, J.
tion of Thais in the United States. Journal of the 2001. Differences in dietary patterns of
American Dietetic Association, 106, 103108. Vietnamese, white, African-American, and
144. Swain, L. 2000. Pacific Islander Americans. In Hispanic adolescents in Worcester, Mass. Journal
Gale Encyclopedia of Multicultural America, R.V. of the American Dietetic Association, 101, 248251.
Dassanowsky & J. Lehman (Eds.). Farmington 156. Winters, E., & Swartz, M. 2000. Hawaiians. In
Hills, MI: Gale Group. Gale Encyclopedia of Multicultural America, R.V.
145. Swallen, K.C., Glaser, S.L., Stewart, S.L., West, Dassanowsky & J. Lehman (Eds.). Farmington
D.W., Jenkins, C.N., & McPhee, S.J. 1998. Hills, MI: Gale Group.
Accuracy of racial classification of Vietnamese 157. Yang, R.C., Mills, P.K., & Riordon, D.G. 2000.
patients in a population-based cancer registry. Cervical cancer among Hmong women in
Ethnicity & Disease, 8, 218227. California, 1988 to 2000. American Journal of
146. Tamir, A., & Cachola, S. 1994. Hypertension and Preventive Medicine, 27, 132138.
other cardiovascular risk factors. In N.W.S. Zane, 158. Yehieli, M., & Grey, M.A. 2005. Health matters: A
D.T. Takeuchi, and K.N.J. Young (Eds.), Confronting pocket guide for working with diverse cultures and
Critical Health Issues of Asian and Pacific Islander underserved populations. Boston, MA: Intercultural
Americans. Thousand Oaks, CA: Sage. Press.
147. Tong, A. 1986. Food habits of Vietnamese immi- 159. Zibart, E. 2001. The ethnic food lovers compan-
grants. Family Economic Review, 2, 2830. ion: Understanding the cuisines of the world.
148. Tuttle, C.R., & Dewey, K.G. 1994. Determinants Birmingham, AL: Menasha Ridge Press.
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immigrants in northern California. Journal of the Southeast Asian renal exchange list. Journal of the
American Dietetic Association, 94, 282286. American Dietetic Association, 89, 8592.
CHAPTER
13
People of the
Balkans and
the Middle East
T he southeast European nations of the Balkan ethnic group), and the Chaldeans and Assyrians
Peninsula and the countries of the Middle (Semitic ethnic groups). The 2000 U.S. Census
East are in close proximity to central Europe, also lists the North African counties of Algeria,
Africa, and Asia. The region has traditionally Morocco, and Tunisia as Arab nations, and these
been a cultural crossroads of ideas, values, and are thus considered Middle Eastern as well.
material goods and is often considered the cradle Geographically, much of the Balkans is con-
of Western civilization. Many immigrants from sidered temperate in climate and is suited to agri-
the Balkans and the Middle East have come to the culture. In Greece, however, and in most of the
United States in search of economic opportunity Middle East, aridity limits cultivation. Even in
and political stability. They frequently retain a the desert regions, distinct areas of arable land
strong ethnic identity, exhibited in their strong exist along the seacoasts and in some plains and
religious faith and in their maintenance of tradi- valleys, such as the Fertile Crescent (a plain in
tional food culture. This chapter examines the Iraq fed by the Euphrates and Tigris rivers) and
cuisine of the Balkans and the Middle East, its the Nile River valley of Egypt.
role in the U.S. diet, and the changes that have Greece dominated or greatly influenced its
occurred in the United States. Balkan and Middle Eastern neighbors in ancient
times, and, in turn, it was conquered and ruled
by the Turkish Ottoman Empire for four cen-
turies in the modern era. These hundreds of
Cultural Perspective years of Greek and Turkish hegemony facilitated
the spread of products, especially foods,
The Balkan nations include Greece, Albania, throughout the region and stretched cultural An Arab is commonly defined
Bosnia-Herzegovina, Montenegro, Serbia (includ- influence to both the southern states of the as a person who speaks
ing the two autonomous provinces Kosovo and Former Soviet Union (see Chapter 7, Central Arabicthe term does not
Vojvodina), the Republic of Macedonia, Croatia, Europeans, People of the Former Soviet Union, and refer to a particular religious
Slovenia, Bulgaria, and Romania. Countries of the Scandinavians) and to North Africa. Despite such belief. Iranians speak Farsi
and call themselves Persians.
Middle East include Bahrain, Egypt, Iran, Iraq, commonalities, however, populations within the
The Turks, whose nation is
Israel, Jordan, Kuwait, Lebanon, Oman, Saudi nations of the Balkans and the Middle East are
geographically divided
Arabia, Syria, Turkey, United Arab Emirates, and very diverse in religious affiliation. Judaism, between Europe and Asia,
Yemen (see Figure 13.1). In addition, there are sev- Christianity (particularly Eastern Orthodox), and speak modern Turkish, a
eral notable groups who do not have a homeland Islam all have substantial numbers of followers language that evolved from
in the region, including the Palestinians (an Arab in the region. Faith is fundamental to daily life in Arabic but is written with
ethnic group), the Kurds (an Indo-European both the Balkans and the Middle East. the Latin alphabet.
408 PEOPLE OF THE BALKANS AND THE MIDDLE EAST
SLOVENIA
HUNGARY
ROMANIA
SER
CROATIA
BIA
BOSNIA Caspian Sea

AND HER- BULGARIA
ZEGOVINA
MONTENEGRO
GREECE
ALBANIA TURKEY
REPUBLIC
OF MACEDONIA
SYRIA
Mediterranean Sea
LEBANON
ISRAEL IRAQ IRAN
JORDAN
KUWAIT
EGYPT BAHRAIN
SAUDI
ARABIA
OMAN
UNITED ARAB
EMIRATES
Figure 13.1 YEMEN

The Balkans and the
Middle East.
HISTORY OF PEOPLE OF THE BALKANS men from rural agricultural areas who came to
AND MIDDLE EAST IN THE UNITED STATES America primarily for economic opportunities.
Many came to make their fortune and go back to
Balkans their homelandapproximately 30 percent of early
Until 1992, the nations of
Immigration from Greece has occurred primarily Greek immigrants returned to Greece. A bitter
Serbia, Croatia, Slovenia, in two waves. The first lasted from the late 1800s civil war from 1946 to 1949 and a military coup
Bosnia-Herzegovina, to the 1920s, when the restrictive Immigration in 1967 resulted in numerous Greek refugees who
Montenegro, and Macedonia Act of 1924 was imposed; the second wave sought asylum in the United States. While most
were the states of a single started after World War II and has not yet ended. settled in New York, Detroit, Chicago, and other
country known as Yugoslavia. The early Greek immigrants were mostly young cities of the Midwest, a large community developed
Chapter 13: People of the Balkans and the Middle East 409
A large Greek community

developed in Tarpon Springs,
Florida, based on diving for
sponges.
Van Bucher/Photo Researchers, Inc.

in Tarpon Springs, Florida, supported by diving More specific nationalities have been recognized
for sponges. Some Greeks were attracted to since the 1930s, yet it has only been in recent years
mining and railroad work in the West. that Palestinian has been defined as an immigration
During the 1850s and 1860s, numerous category, and it is standard practice to combine
Croatian immigrants from the area of Dalmatia Chaldeans with Assyrians.
arrived in the United States. Most migrated to the Early Arab immigrants arrived at the turn of the
southern and western regions where they had a twentieth century seeking economic opportunity.
substantial impact on the oyster fisheries of Most were Christians from the area that is today
Mississippi and the fig, apple, grape, and plum Lebanon and Syria, although small numbers of
horticulture of northern California. The many Turkish Muslims also came during this period. Most
Serbs who immigrated to the United States in this settled in New England and the Midwest and were
period were unskilled laborers who obtained employed in the textile, shoe, and wire factories.
Though large numbers of
industrial jobs in the Northeast. Croatian and The major influx of Middle Easterners began in
Kurds have been displaced
Serbian immigration increased following World the years following World War II. A high percent- due to conflicts in the Middle
War II, including professionals, such as engineers age of immigrants from Jordan, Egypt, Lebanon, East, most refugeesover
and physicians, seeking better job opportunities. Iraq, and Syria were Christian Palestinians who 500,000have gone to
The largest number of Slovenian immigrants initially fled Israel when it was declared a state. Europe. Much smaller num-
arrived between 1880 and World War I, though After first settling in refugee camps, many later bers have come to the
exact figures are not available because many were immigrated to the United States when Israel won United States, particularly
listed as Austrians. Most were farmers seeking the 1967 war against neighboring Arab countries. Nashville, Salt Lake City,
economic opportunity. They settled initially in Political unrest and Islamic revolution in Iran led and San Diego.
the rural Midwest, forming self-sustaining ethnic to a large exodus of Persians beginning in 1976.
communities with Slovenian churches, schools, Many were members of the wealthy Iranian elite; Around the turn of the
twentieth century, an elite
businesses, and social organizations. others were Jewish and Christian minorities,
group of Arab artists, writ-
including Chaldeans and Assyrians. In addition, ers, and poets settled in
Middle East many Turks and Arabs who came to the United New York City. They called
Statistics on immigration from the Middle East States for their college education elected to stay their literary circle the Pen
are inexact. Until 1900, all immigrants from the in the country to establish their careers. A similar League; the best-known
area were called Egyptians. Later arrivals were situation is reported for Israelis, who immigrated member was Kahlil Gibran,
typically termed Syrians or Turks from Asia. in small but steady numbers to America for author of The Prophet.
advanced education and professional, managerial, Beginning in the early 1990s, nearly 200,000
or technical jobs. Bosnian refugees seeking refuge from ethnic
cleansing in that region were resettled in the
United States. Many left their homeland suddenly,
CURRENT DEMOGRAPHICS AND with little time to pack or prepare for life in a new
SOCIOECONOMIC STATUS country. Nearly all are Muslim, and most were not
comfortable in the small number of Bosnian-
People of the Balkans Serbian or Bosnian-Croatian communities already
The 2001 Canadian Census More than 1.2 million people claimed Greek ances- scattered throughout the United States. A majority
lists over 215,000 residents try in the 2005 U.S. Census estimates. New York have chosen to live in homogeneous Bosnian
of Greek ancestry, 97,000 City has the largest concentration of Greek Muslim neighborhoods in New York, St. Louis,
Croatians, and much Americans, followed by California, Illinois, Chicago, Salt Lake City, St. Petersburg, Florida, and
smaller populations of Massachusetts, and Florida. In recent years Greek
Serbians and Slovenians. Waynesboro, Pennsylvania.75 Significant popula-
Americans have moved progressively south and tions are found in California as well.22 Though
west in the United States. Early Greek immi- approximately half of Bosnian refugees arrived
grants preferred to live in urban areas. The Greeks unskilled in any profession, they are known for a
sought economic independence by opening small strong work ethic and find employment wherever
businesses, especially in candy production and it is available, frequently as bakers, factory workers,
restaurants. The rate of self-employment among or in the service industries, especially in hotels.75
Greek Americans is still very high; unemploy- Those who do have professional training are often
ment rates are low, and the percentage of families limited by a lack of English skills or by credential-
living below poverty is also below the U.S. aver- ing difficulties. Average income is believed to be
age. Greek Americans can be found in all occupa- low, and one small survey in California found that
tions, particularly managerial, professional, over half of Bosnian refugee families interviewed
technical, and service jobs.53 relied on some form of government assistance.22
Over 400,000 Croatian Americans and almost
170,000 Americans of Serbian descent lived in Middle Easterners
Nearly 80 percent of Iraqi the United States in 2005. Most originally settled Demographic figures for Middle Easterners are
Americans are foreign-born, in the mining regions of Pennsylvania, Ohio, and more problematic. Some older immigrants may
and over 60 percent have other Midwestern states; mining also attracted deny their Arab ancestry due to a history of discrim-
arrived since 1990. Many sizable populations to Colorado, Nevada, Arizona, ination in the West, and more recent arrivals may
came as refugees following and California.44, 100 Nearly 175,000 Slovenian refuse cooperation with government-sponsored
the first Gulf War.10 Americans were identified in the 2005 U.S. Census surveys due to negative experiences in their
data. Although many Slovenian immigrants also homelands and fear of mistreatment following the
became involved in mining, others moved to September 11, 2001 attacks on the United States.
industrial urban areas in search of jobs. Forty Immigration figures suggest, however, that Arabs
percent live in Ohio; Cleveland has the largest are one of the fastest growing ethnic groups in the
Slovenian community in the nation. Other states nation, increasing from approximately 200,000 in
with notable Slovenian populations include 1970 to over 1.5 million in 2000. This growth is
Pennsylvania, Minnesota, Wisconsin, California, even more dramatic if a poll on Arab ancestry
Colorado, Michigan, Florida, and New York. is correct in estimating that the Arab population
Many Croatians, Serbians, and Slovenians who is actually closer to 3.5 million.96 In addition, there
first arrived in the United States were unskilled are another half-million Americans of Middle-
laborers in agriculture or industry.33 Education Eastern descent from the non-Arab populations
was valued and second-generation immigrants of Israel, Iran, and Turkey. One noteworthy change
obtained the training needed to secure white- in recent immigration from the Middle East is in
collar employment. Over time, most Americans religious affiliation. In 1970 only 15 percent of
of Croatian, Serbian, and Slovenian descent have immigrants from the region were Muslim; in 2000,
assimilated into the U.S. mainstream, working in that figure increased to 73 percent.12
all sectors of the economy. All three groups have In 2005 the census estimated 464,000 self-
incomes that are less than the Greeks, but declared Americans from Lebanon, 154,000 from
approaching the U.S. average. Syria, 178,000 from Egypt, 165,000 of Palestinian
heritage, 62,000 from Morocco, 54,000 from Jordan, in 2000.10 Data also show smaller numbers than Two locally owned
and 47,000 from Iraq. A movement toward pan- the U.S. average worked in the service industries, McDonalds restaurant
Arab Americanism is seen in the number of U.S.- with the exception of Moroccans, who were operations in Dearborn,
born Arabs who are selecting Arab or Arabic as employed in this sector at a rate more than double Michigan, offer halal
chicken nuggets to their
their background instead of a national affiliation.96 that of U.S. workers in general. Nearly every Arab-
Muslim clientele.
Approximately 20 percent of Arabs are now listed American group in 2000 reported high school
in this category, nearly 400,000 in 2005. Unofficial graduation rates exceeding those of the total U.S. U.S. Census data and immi-
estimates of these populations are often two to population, and the percentage of Arabs with col- gration figures suggest that
three times larger. lege degrees is far higher than the national norm.10 nearly 10 percent of Middle
Over one-third of Arabs have settled in Median family income was above average, yet dif- Easterners in the country
California, New York, and Michigan. The largest ferences were marked between different Arab are here as undocumented
concentration of Muslims, numbering over 300,000 groups. Some, such as Lebanese and Syrian residents.12
(including those from areas other than the Middle Americans, fall below the U.S. family income
East) is in the Detroit metropolitan area. Smaller norm. Poverty rates slightly exceeded the U.S.
Arab communities are developing in New Jersey average for Egyptians and Jordanians and were
(which has the largest population of Egyptians), approximately 50 percent higher for Palestinians
Virginia, North Carolina, Connecticut, Alabama, and Moroccans. Poverty levels approximately
and New Mexico.96 In addition, Syrians often double the U.S. rate were found in those groups
settle in Rhode Island, Moroccans often choose identified as Arabs alone and Iraqis (about 25 and
Washington, D.C., and Illinois is notable for host- 26 percent, respectively). These figures suggest
ing the largest number of Palestinians in the United that while Arab Americans as a whole are doing
States, as well as substantial populations of Iraqi, well economically, there are significant subgroups
Assyrian, and Chaldean heritage.96 Small num- that have not prospered.12
bers of Palestinians are also found in parts of the Over 375,000 Americans of Iranian heritage Persia was the conventional
Northeast, the South, and in California.61 The were living in the United States according to 2005 European name for Iran,
Chaldean population, which may exceed 300,000, census figures; however, some experts estimate as used until the early twenti-
is also located in Detroit and San Diego. Total many as one million Iranians live in the nation, eth century; many Iranian
numbers of Assyrians and Kurds are significantly many of whom are non-immigrants, including stu- immigrants prefer the des-
ignation Persian American.
smaller. Most Arabs choose urban areas of residents and visitors.31 Nearly two-thirds are thought
dence, and ethnic neighborhoods have developed to reside in Southern California, and another large
in cities with substantial Arab populations. These population is found in New York City. Many who
communities help preserve Arab culture within immigrated following the 1979 Iranian revolution
what is often viewed as an alien American society. were among the well-educated elite who spoke
Many Arabs suffer discrimination and accept English fluently and were skilled in the professions,
marginalization as a necessary part of living in such as engineering, medicine, pharmacy, den-
the United States.1 Despite these experiences by tistry, and law. Others arrived in the United States
some, foreign-born Arabs become U.S. citizens at with substantial savings from their livelihood in
rates 25 percent higher than the average for all Iran and have significant earnings from rental
foreign-born residents.10 properties and other investments. This group has
Early Arab immigrants found it easy to assim- been economically successful in the United States.
ilate into American society, in part because a It is also reported that many Iranian immigrants
majority of them were Christian.1 Many survived are self-employed.31 Data on foreign-born Iranians
as peddlers and then later opened family busi- show that over half hold college degrees, and
nesses, usually dry goods or grocery stores. A tra- median household income far exceeds that of the
dition of entrepreneurship among Arabs continues average U.S. family.102 These statistics suggest that
today, and nearly one in five owns his or her own total Iranian-American income is high, even
business. Even families that started with unskilled though it is believed that estimates are skewed by
employment or small businesses have made sub- large numbers of students who are employed only
stantial economic progress through schooling. part-time, lowering average earnings.
Over four in every ten Arab Americans worked in Turkish Americans numbered 164,000 in the
management or professional jobs, and approxi- census estimates of 2005. Immigration prior to
mately 30 percent held sales and office positions 1965 was severely limited by quotas, yet included
Few Middle Easterners a disproportionate number of engineers and job skills that assure an easy transition in the
approximately 150,000 in physicians. Since that time, the numbers of United States, and over half hold professional,
totalhad made their Turkish immigrants have increased, most seek- managerial, or technical positions. They are
home in Canada as of the ing educational and occupational opportunity. prominent in the fields of medicine, architecture,
2001 census. The largest Homogeneous neighborhoods, supported by entertainment, and education. Approximately
group is Arabs, at 71,000.
Turkish-American organizations, have been estab- one-third are self-employed in the garment
lished in many cities, including New York City, industry, or in small businesses catering to the
Boston, Chicago, Detroit, Los Angeles, San Israeli community, including restaurants, night-
Francisco, and Rochester. Smaller populations are clubs, and retail shops.93 Average earnings are
found in New England, the Midwest, and parts of believed to be higher that the U.S. norm.
the South, including Maryland, Virginia, Texas,
and Georgia.4 Census statistics on foreign-born
Turkish Americans indicate higher rates of high
WORLDVIEW
school and college graduation than the U.S. norm, Religion
and median household income slightly above the Religion is often the defining factor in Balkan
U.S. family average.102 Turkish Americans are found and Middle Eastern life. Though affiliation varies,
in most employment sectors and are solidly strong devotion is common. Many congregations
middle class in socioeconomic status. remain insular in the United States, serving the
Immigration from Israel began in the 1950s and needs of a specific ethnic group, and there is little
1960s following independence of the nation. The interest in proselytizing to outsiders.
Israeli-American population in the United States
was nearly 126,000 in 2005, a figure considered a People of the Balkans. The ethnicity of Greek
significant undercount when compared to the immigrants was affirmed mostly by religion; it
count in the large Israeli communities of New York, was said that a person was not Greek by birth but
California, Michigan, Florida, and Illinois.93 This through the active affiliation with the Greek Eastern
is due in part to the heterogeneous character of Orthodox Church. The first Greek Orthodox
the Israeli population. Estimates indicate one-third Church in America was founded in New Orleans
to over one-half of recent immigrants were not in 1864. Most Greek Americans today still belong
born in Israel but had migrated there from other, to the church, which continues to be the center of
mostly European, nations.14 Earlier arrivals were Greek community life. The word orthodox comes
typically listed by their country of origin, not as from the Greek for correct (orthos) and wor-
Israeli. It is also believed that significant numbers, ship (doxa). A fundamental belief of the Greek
about 30 percent of immigrants as of 1980, and Orthodox faith is that an individual attains com-
15 percent as of 1990, were Palestinian Israelis.15 plete identification with God through participation
Jewish Israelis often settle in established Jewish in the numerous religious services and activities
communities, such as Queens and Brooklyn in sponsored by the church. Although the Greek
New York City, or West Hollywood and the San Orthodox Church is conservative and tradition-
Fernando Valley of Los Angeles. Arab Israelis usually resistant to change, some accommodations
ally prefer the metropolitan regions where other have been made in the United States; for instance,
Arabs have settled, such as Detroit and Chicago.93 the service typically is conducted both in Greek
Most Israelis today come to the United States and English, and modern organ music accompanies
for educational and professional opportunities; the liturgy (see Chapter 4 for more information
most are of European heritage, typically middle about Greek Orthodoxy).
or upper class, and a significant number are Most Serbs also belong to the Eastern Orthodox
single men and women.34 Some arrivals are also faith, as members of the Serbian Orthodox
seeking security and escape from the political Autonomous Church. A majority of Croatians
unrest in the region. It has further been reported and Slovenians are devout Roman Catholics, wor-
that Israeli immigrants are often Sephardic Jews shipping primarily in multiethnic congregations.
of Middle Eastern or North African descent (see A small number of Slovenians are Protestants
Chapter 4, Food and Religion, for more informa- known as Windish. Windish churches have helped
tion) who suffered discrimination by Ashkenazi to maintain Slovenian ethnic identity through
Jewsthe majority in Israel.93 Most possess the services conducted in a Slovenian dialect. Small
populations of Croatian Muslims are found in Family The tall white hats worn
Cleveland and Chicago. by professional chefs are
People of the Balkans. The traditional Greek thought to have originated
Early Bosnian-Croat immigrants were mostly home is strongly patriarchal. The head of the
members of the Catholic Church, and Bosnian- with the tall black hats
household is the unquestioned authority, with worn by Eastern Orthodox
Serb immigrants followed the Eastern Orthodox responsibility for supporting the immediate family priests.
religion. An estimated 68 Serbian Orthodox and elder parents. In addition, he is accountable
churches exist in the United States, serving both for the family reputation within the community.
the worship and social needs of each community. The Greek term for this pride and obligation to
The majority of recent Bosnian refugees are Sunni family is philotomo, meaning love of honor. Each
Muslims. Regardless of faith, many Bosnians are family member is expected to behave in ways that
more secular than observant, attending services maintain family dignity and status.
on major holidays only, or not at all. Intermarriage Obligation to family and community has less-
between Bosnians of different religious beliefs is ened somewhat in the Greek-American commu-
not uncommon.22, 75 nity. Extended families have become less common
Middle Easterners. Early Arab immigrants were due to assimilation pressures and secondary Of the 90,000 Jews living in
primarily Christians belonging to the Eastern migration to other areas of the country. Children Iran in 1987, 55,000 have
Orthodox (particularly the Egyptian Coptic are doted on, and parents often put their welfare since left, including 35,000
Church) or the Latin rite Maronite, Melkite, or first. Yet obedience and respect for elders are who have immigrated to
Chaldean churches. Although Christian Arabs expected, and intergenerational conflict is less the United States.
are still a majority in America, more recent common among Greek Americans than in many
immigrants follow Islam, and the number of other immigrant groups.
Arab Muslims in the United States is growing Greek women have traditionally focused on Greeks traditionally consid-
rapidly. Most belong to the Sunni sect. Many family, home, and church. Even after coming to ered education or career
Arab Muslims in the United States have made the United States, many Greek-American women achievement among
several adaptations to accommodate their reli- continue in this role. Some even cut themselves women unfeminine or even
off from non-Greeks in an attempt to retain their un-Greek.
gious practices to American society. Most signif-
icantly, the Friday Sabbath prayer has been ethnicity and pass on Greek culture to their chil-
moved to Sunday, and many Muslims cannot ful- dren.53 However, growing numbers are trying to
fill their obligation to pray five times daily due to balance their duty to family and community with
work or school limitations (see Chapter 4 for personal interests in education or pursuing a career.
more information about Islam). Education is valued for Greek men but often con-
Though the vast majority of Iranians in the sidered unnecessary for women. Greek men earn
United States are members of the Muslim Shiite college degrees at nearly twice the rate of Greek
sect, small numbers of Iranian religious women. In addition, though many women are
minorities have come to the United States seek- encouraged by their parents to marry within the
ing freedom from persecution, including Jews, Greek community, increased exposure at school
Catholics, Anglicans, Protestants, and members and on the job has led to a rise in interethnic and
of the Bahai faith (a Muslim offshoot that has interreligious marriages.
renounced its ties to Islam and preaches gender Croatian and Serbian families are also tradi-
equality, world brotherhood, and pacifism). tionally patriarchal. Extended families are the
Most Turkish Americans are Sunni Muslims, and norm, often including friends as well as relatives.
many worship at Arab or Pakistani mosques.4 Among Croatians, communal living may involve
Presumably, most Israeli Americans are fol- taking in boarders. Both Croatians and Serbians
lowers of Judaism. However, unlike other Middle have become well acculturated in the United
Eastern groups, Israelis who immigrate may be States. The tradition of older generations caring
among the least orthodox of Jews in Israel. Many, for children has allowed many Croatian and
upon arrival, choose to join Reform congregations Serbian women to take advantage of educational
or are unaffiliated with a synagogue. Those who do and career opportunities, and the authority of the
choose to adhere to Conservative or Orthodox prac- father has lessened. Slovenian Americans are also
tices may face barriers in the United States because assimilated. The extended family structure typi-
businesses remain open on the Friday Sabbath, and cal in Slovenia is rarely found among Slovenians
finding kosher foods may be difficult. in the United States, who prefer nuclear families.
American women of Slovenian descent are active Arabs there is a preference for marriage between
in the home, church, and Slovenian schools and cousins, with the exception of Egyptians and
are increasingly involved in politics. some Arab Christians.1 Only after an engagement
Bosnians traditionally maintained extended announcement is made are young men and
family homes, but conflict in the region and migra- women allowed to date, and then only when
tion to urban areas has resulted in more nuclear chaperoned. A familys honor is related to the
families living apart from relatives.75 In the United modesty and chastity of the women in the home:
States the extended family structure is important A woman is chaste before her wedding and faith-
to newer arrivals but difficult for some refugees ful after. Actual or alleged violations of moral
who had no family members already established codes by a young woman are considered evidence
in the country. While strong family bonds sup- that her mother has failed in her responsibilities;
port new immigrants, Bosnian women (who are inappropriate sexual conduct also brings shame
not employed outside the home) and elders are on her male relatives. Interethnic marriages are
often dependent on extended family and may strongly discouraged by both Muslims and
become isolated within the larger community.22 Christians, especially for women. It is preferable to
Traditionally, Bosnian husbands and wives both marry someone of a different ethnic group and
work, but responsibility for the home remains with the same religious affiliation than to marry outside
the woman. Bosnian children assimilate quickly to the religion. However, intermarriage between
American culture, and some parents are frustrated Egyptian men and American women is not
by their inability to instill Bosnian cultural values uncommon and may occur in other Arab groups
and to maintain the Bosnian language within the as well.74 Children of these couples are usually
home. Some refugees believe kinship ties and the raised in the Muslim faith.
integrity of the family are weakened with continu- Most Iranians and Turks establish homes sim-
ing exposure to American society.22 ilar to those of Arabs, headed by the father or
eldest sons, and centered on an extended family
Middle Easterners. Traditionally, Arab cultures network for support. Traditionally, Iranian fami-
center on a strong patriarchal family whose honor lies worked to place members in all significant
must be maintained. The family demands con- sectors of the society (through marriage and
formity and subordination of individual will and employment) in order to ensure family status and
interest, but in return the members of the family security.31 Immigration to the United States often
are protected and can identify with the familys results in difficulties maintaining an extended
status. Families often live with extended mem- family household for many Middle Easterners.
bers in a single home or, for well-to-do Arabs, in Family ties remain strong among Arabs, Iranians,
a family compound. An exception is Egyptians, and Turks; however, nuclear families are the norm
who traditionally live in nuclear family groups, for most immigrants. It is still common for grand-
often far from other relatives.74 parents to live with their children and grandchil-
The teachings of the Quran state that men and dren, yet in some more acculturated families
women are considered equal but with different roles (such as in many Lebanese homes) daughters are
and responsibilities. Children are valued in Arab no longer solely responsible for the care of elders,
families, and sacrifice for the good of the children a duty they now share with their brothers.37
is common. Men are obligated to provide economic The role of women of Middle-Eastern heritage
security for children, while women are expected in the United States is changing for those who are
to socialize them, including the preservation of engaged in American society, and the customar-
religious and cultural values. Due to the strict ily strict separation of private and public spheres
patriarchy, it is the role of women to provide the has blurred with increased numbers of women
love and comfort in a home as well. The relation- seeking college degrees and professional careers.31
ship between mothers and daughters is very For example, dating is becoming more accepted
intimate. There is also a strong bond between as segregation of the sexes cannot be maintained
mothers and sons, especially the first-born son.66 in most schools, nor in the American workplace.
Marriage contracts in the Middle East are often Yet, more traditional Middle-Eastern women are
arranged between children to establish political sometimes isolated in their home life. Some
and business alliances through kinship. Also among Iranian women, for instance, feel that their limited
authority has decreased since arriving in the United years manufacturing or tourism activities have
States, that they spend more time on household provided income for some. At one time children
chores, and that they are less involved in family were raised by age level and all members partici-
decisions and in mosque activities.31 More accul- pated in community meals. Today, most families
turated Arab women may also experience serious live independently and may choose whether to
setbacks in acceptance of their Americanized eat with the group. Children are given commu-
conduct every time a large influx of new and con- nity tasks, and teens are often assigned workdays
servatively minded Middle Eastern women settles once a week.
in their area. After arrival in the United States, the nuclear
Many second- and third-generation Middle family structure continues with support from
Easterners in America think that their parents are Jewish organizations and a network of Israeli-
old-fashioned. Adoption of American practices, American groups. Though Israeli homes are tradi-
such as personal autonomy and self-determination, tionally patriarchal, Israeli-American women are
contradicts the Middle Eastern emphasis on doing typically well educated and over half are employed,
what is best for the good of the family, increasing often in professional positions. Israeli immigrants
intergenerational conflict between parents and are often concerned that their cultural values will
children. Acculturation also may result in the be lost if their children become acculturated, and
reduction of a fathers authority in some Middle that their children may become too competitive or
Eastern homes, though filial respect is usually too materialistic.93 Many Israeli parents strive to
retained. Pressures for children to adhere to family preserve ethnic identity by enrolling their children
expectationsfrom participation in arranged in religious training, Jewish summer camps, and
marriages to denial of college attendancecan folk dancing classes, and by sending them to Israel
be substantial, however, and not all children reject to learn about their heritage.
the values of their parents. Researchers note that
among Iranian Americans, the stresses of living Traditional Health Beliefs and Practices
in the United States lead some children of immi- People of the Balkans. In many parts of the
grants to embrace their heritage.31 While some Balkans, physical fitness is thought essential to
Arab groups, such as Egyptians and Syrians, are good health and is also considered necessary in
especially well acculturated, and some subgroups the development of good character. Team sports,
within each population are fully integrated water activities, gymnastics, skiing, hiking, and
within the U.S. society, resistance to American bicycling are common forms of exercise.33, 64
culture can be strong among a small number of Among some Greeks, eating a good diet, relax-
Middle Eastern immigrants. The attempt to retain ation, adequate sleep, and keeping a positive
ethnic identity takes many forms, and it cannot mental attitude are equally important to main-
be assumed that assimilation is automatic, espe- taining health.84, 92
cially for new immigrants who may arrive with Traditionally, most health care was provided
the intention of returning to their homeland by grandmothers or mothers at home. Many
when conflicts subside, or are fearful of discrim- people kept an herbal pharmacy available for Muslims often have serious
ination in the United States. For example, some preparation of therapeutic teas. In Greece, castor concerns about raising their
Arab immigrants seek to insulate their families oil is taken to clean the bowels, quinine is used to children in America.
Permissive attitudes about
from the influences of American society by iso- relieve pain, chamomile tea is sipped to get rid of
dating and drinking and
lating them within homogeneous enclaves, and cramps, and a sore throat is treated with honey
pressure to practice inde-
ethnic identity is so important to most Turkish and lemon. Examples of Bosnian cures also include pendent thought prompt
Americans that unlike most Arabs and Iranians chamomile, as well as elder, rose hips, and some immigrants to send
(who have very high rates of citizenship), Turks mint.33, 64, 92 Cupping (see Chapter 2, Traditional their children, especially
who seek naturalization are often ostracized Health Beliefs and Practices, for more information) their daughters, to the
within their communities.1, 4 in a manner similar to the Asian method, except Middle East for schooling.
A majority of Israelis live in nuclear families. that the skin is cut with a razor first to allow the
A unique family structure is seen in the rural set- blood out, is done by a few Greeks to treat colds and
tlement cooperatives of Israel called kibbutzim. chest ailments. More severe conditions and serious
Families live and work communally in a kibbutz, injuries were treated by neighborhood experts,
and though many are agriculturally based, in recent for instance, the midwives and bone-setters used
in Croatia.44, 92 Some people in the Balkans believe anger is a lack of control that can upset the social
that the evil eye of one who envies a person can order and cause others to become narahat. Sorrow
cause accidents or illness. Greeks may use ritual or grief is another public expression, but in contrast
prayer, the sign of the cross, or wear blue amulets to anger, sadness is considered the poetic manifes-
with an eye in the center or garlic as a precaution tation of fully experiencing the tragedy of the
against a jealous gaze. When receiving a compli- human condition. Naharati qalb (heart distress) is a
ment (a form of envy), it is also customary to spit folk condition typified by fluttering of the heart due
two or three times to keep harm away.53, 92 to the strong expression of anger or sadness.36, 86
A long-standing tradition of home health care
Middle Easterners. Cleanliness, diet, and keep- exists among Middle Easterners. Folk remedies are
ing warm and dry are all Middle Eastern factors common, such as rubbing kohl (a dark powder
important to maintaining health. Some Middle made mainly from the chemical element antimony
Easterners believe that illness is due to wind or and used mostly as a cosmetic) on the umbilical
air in certain situations. Lebanese Muslims believe cord of an infant to help it dry. Herbal therapies
that following childbirth, a woman is especially are especially prevalent, and it is believed that
susceptible to wind; showers and baths are avoided approximately 200 plant species are used in Arab
for ten days to prevent wind from entering the traditional medicine today.94 Examples include
veins and causing sickness. An infant is vulnera- yarrow for diabetes and khella (a member of the
ble to wind through the umbilicus, so the babys parsley family) for kidney disorders. Palestinians
stomach is wrapped at all times with a band use most traditional remedies as both food and
called a zunaad.66 medicine; for instance, caraway is used for diges-
Traditional humoral medicine is important in tive disorders and to increase milk flow in nursing
the health practices of Iranians. Though traditional mothers, mallow is used as a laxative, and olive
humoral theories identify four bodily humors, in oil to treat urinary tract infections, prostate con-
practice Iranians are only concerned primarily ditions, and cancer.2 Other cures include snake-
with hot and cold. Each person is born with a phys- root as a diuretic, lavender for kidney stones, and
iological temperament dependent on the ratio of rue as an analgesic and sedative. In Iran foxglove
humors, which varies by gender, age, and race blossoms are used especially for nervous condi-
women, for instance, are considered colder than tions, some digestive problems, to strengthen
men, and younger persons are hotter than older blood, relieve fear, and for pains of unknown
peopleand can be influenced by diet, climate, etiology; rocket seeds are taken to clean dirty
geographical location, and certain conditions, blood, and for fever, constipation, and nausea; and
such as childbirth.86 Sickness can be caused by mint tea with coriander seeds is used to promote
the consumption of too many hot items or too sleep.62, 86 In Turkey nettle, oleander, and thyme
many cold foods (see Therapeutic Uses of Foods are used therapeutically for cancer. Other com-
section), but individual conditions and symptoms monly used herbal remedies include St. Johns
are not classified as being hot or cold. Iranians are wort, rosemary, sage, and hawthorne.81
also concerned with the amount of blood they have, Cupping (see previous Chapter 2 reference) is
The Sufis, members of an which in turn is associated with numerous ail- used by some Middle Easterners to cure chronic
ascetic and mystical Islamic ments, including thinness (due to lack of proper leg pain, paralysis, headaches, and obesity. Another
sect, define health as an nourishment), weakness, irritability, lethargy, therapy that is sometimes applied is called wasm,
existential state of absti- and headaches. Kam kuhn, blood deficiency due or cauterization. A heated iron rod is used to
nence, patience, and self- to excessive bleeding from injuries, menstruation, place symbolic burn marks on the patient, for
examination, resulting in or a poor diet that prevents the making of blood, example, below the anus to treat diarrhea and
harmony with the universe.
is the source of these symptoms. under the ear lobe to cure a toothache. The burns
Iranians use the term narahati for undifferen- are then treated with special herbal poultices.30
Zamzam water from the
Mecca Valley is collected by
tiated feelings of physical and emotional discom- Though superstition is discouraged in Islam,
Muslims pilgrims who comfort. Most often it is expressed privately and in a many Arabs retain some beliefs in magic and
plete the Hadj to be shared nonverbal form through sullenness, anorexia, supernatural causes of illness. As in the Balkans,
with family and friends at and, among women, bouts of crying. Expressions the evil eye is feared by some Arabs, who may
homeit is thought to of anger are considered the public expressions of place blue beads on infants to protect them, or wear
have curative powers. the condition and are usually discouraged because amulets.66 In Iran some believe the evil eye is the
cause of cheshm-i-bad, the occurrence of a sudden

or unexplained illness.36 Some Arabs attribute
mental illness to possession by the devil, or by
jinn (spirits who can be good or evil).60
Iranians often put their health into the hands
of God. Tagdir, meaning Gods will, is thought to
determine all aspects of life and, ultimately, death.
Throughout the Middle East illness is sometimes
seen as a punishment from God. However, bio-
medical practice is well established in the Middle
East, and for the most part, Western therapies are
considered strong and effective.60

Traditional Food
Habits
Traditional foods of the
The origins of most Balkan and Middle Eastern Balkans and the Middle East.
dishes may never be known because the geo- Russia (beet soup is also popular). But despite Some foods include almonds,
chickpeas (garbanzo beans),
graphical, political, and economic history of the these distinctions, foods are far more similar
couscous, cracked wheat,
region has resulted in similar food cultures. Many than different. dates, eggplant, feta cheese,
ingredients in the Balkans and the Middle East, figs, filo dough, garlic, lamb,
including wheat, olives, and dates, are indigenous. INGREDIENTS AND COMMON FOODS lemon, olives, pita bread,
Sheep were first domesticated in the region over and yogurt.
10,000 years ago. Other foods, such as rice, chick- Staples
peas, and lemons, gained widespread acceptance The common ingredients used in Balkan and
after introduction. Yet most countries in the area Middle Eastern cooking are listed in Table 13.1.
claim one dish or another prepared by all ethnic Wheat, thought to have been cultivated first in
groups to be their own invention. this region, is consumed at every meal as bread.
Culinary commonalities extend beyond the Leavened loaves are typical in Greece and the
arbitrary designation of the Balkan and Middle other Balkan nations, and leavened flat breads
Eastern nations. As previously mentioned, North are more common in the Middle Eastern coun-
Africa is sometimes considered part of the Middle tries. However, both loaves and flat breads are
East and shares numerous dishes of the region. In found throughout the region. Pita or pida, a thin,
addition, the southern nations of the former Soviet round Arabic bread with a hollow center (known as At ancient Greek weddings
Union, the southern regions of central Europe, and pocket bread in the United States), is a common the bride and groom were
parts of South Asia exhibit influences as well. type, as is lavash, a larger, crisp flatbread (also showered with wheat
The most significant differences in Balkan called cracker bread). kernels.
and Middle Eastern foods are due to various reli- Besides bread, wheat doughs are also used to
gious dietary restrictions and proximity to other make pies and turnovers prepared in a variety of
global cuisines. For example, the Christian popu- sizes and shapes. Bread dough, short crust, or
lations of Croatia, Serbia, and Slovenia frequently paper-thin pastry sheets called filo or phyllo are
consume pork, a favorite of neighboring central all used. Savory pies may contain meat, cheese,
Europeans. Yet Christian Greeks, who have no eggs, or vegetables. Desserts are usually filled
pig prohibitions, eat pork only occasionally, pre- with nuts or dried fruits. An example of a fried
ferring lamb and goat, similar to adjacent Middle meat- or cheese-filled pastry that can be served
Easterners. Alcoholic beverages are banned for hot or cold is sanbusak. Traditionally half-moon
Muslims and are avoided in most Middle Eastern shaped, it is popular in Syria, Lebanon, and
nations, though widely consumed in Turkey, per- Egypt. A similar turnover is called burek in
haps due to historical associations with nearby Slovenia and boereg in Bulgaria and Romania.
Table 13.1 Cultural Food Groups: Balkan and Middle Eastern

Protein Foods
Milk/milk products Most dairy products are consumed in fer- Cheese (goats, sheeps, cows, and camels), milk More cows milk and less sheeps, camels, and
mented form (yogurt, cheese). Whole (goats, sheeps, camels, and cows), yogurt; butter- goats milk are drunk. Ice cream is popular.
milk is used in desserts, especially pud- milk, cream Feta is the most common Middle Eastern cheese
dings. Sour cream and whipped cream available in the United States.
are common in northern Balkan nations.
High incidence of lactose intolerance is
reported.
Meat/poultry/fish/ Lamb is the most popular meat. Meat: beef, kid, lamb, pork, rabbit, veal, many Lamb is still very popular. More beef and fewer
eggs/legumes Pork is eaten only by Christians, not by variety cuts legumes are eaten.
Muslims or Jews. Poultry: chicken, duck, pigeon, turkey
Jews do not eat shellfish. In Egypt, fish is Fish and shellfish: anchovies, bass, bream, clams, cod,
generally not eaten with dairy products. crab, crawfish, eels, flounder, frog legs, halibut,
Legumes are commonly consumed. lobster, mackerel, mullet, mussels, oysters, redfish,
salmon, sardines, shrimp
Eggs: poultry, fish
Legumes: black beans, chickpeas (garbanzo beans), fava
(broad) beans, lentils, navy beans, red beans; peanuts
Cereals/Grains Some form of wheat or rice usually accom- Bread (wheat, barley, corn, millet), barley, buck- Bread and grains are eaten at most meals. Pita
panies the meal in the Balkans and wheat, corn, farina, millet, oatmeal, pasta, rice bread is commonly available.
Middle East. (long-grain and basmati), wheat (bulgur, couscous)
Fruits/Vegetables Fruits are eaten for dessert or as snacks. Fresh Fruits: apples, apricots, avocado, barberries, berg- Fewer fruits and vegetables are consumed.
fruit and vegetables are preferred, but if amots, cherries, currants, dates, figs, grapes, Olives are still popular.
they are not available, fruits are served as lemons, limes, melons (most varieties), oranges,
jams and compotes and vegetables as peaches, pears, plums, pomegranates, quinces,
pickles. Eggplant is very popular. raisins, strawberries, tangerines
Vegetables are consumed often; sometimes Vegetables: artichokes, asparagus, beets, broccoli,
stuffed with rice or a meat mixture. Brussel sprouts, cabbage, carrots, cauliflower,
celeriac, celery, corn, cucumbers, eggplant, grape
leaves, green beans, green peppers, greens,
Jerusalem artichokes, leeks, lettuce, mushrooms,
okra, olives, onions, peas, pimientos, potatoes,
spinach, squashes, tomatoes, turnips, zucchini
Additional Foods
Seasonings Numerous spices and herbs are used. Ajowan, allspice, anise, basil, bay leaf, caraway seed,
Lemons are often used for flavoring. cardamom, cayenne, chervil, chives, chocolate, cin-
namon, cloves, coriander, cumin, dill, fennel, fenu-
greek seeds, garlic, ginger, gum arabic and mastic,
lavender, linden blossoms, mace, mahleh, marjoram,
mint, mustard, nasturtium flowers, nutmeg, orange
blossoms or water, oregano, paprika, parsley, pepper
(red and black), rose petals and water, rosemary,
saffron, sage, savory, sorrel, sumac, tamarind, tar-
ragon, thyme, turmeric, verjuice, verbena, vinegar
Nuts/seeds Ground nuts are often used to thicken Almonds, cashews, hazelnuts, peanuts, pine nuts,
soups and stews. pistachios, walnuts; poppy, pumpkin, sunflower,
sesame seeds
Beverages Coffee and tea are often flavored with car- Coffee, date palm juice, fruit juices, tea and herbal
damom or mint, respectively. infusions, yogurt drinks; beer, wine, brandy
Aperitifs are often anise flavored. Alcoholic
beverages are prohibited for Muslims,
but consumed in most of the Balkans,
Turkey, and Israel.
Fats/oils Olive oil is generally used in dishes that are to Butter, olive oil, sesame oil, various nut and veg- Olive oil is still popular.
be eaten cold. For most deep-frying, corn etable oils, rendered lamb fat
or nut oil is used; olive oil is preferred for
deep-frying fish. Clarified butter (samana)
is also popular. Sheeps tail fat is a delicacy.
Sweeteners Coffee and tea are heavily sweetened. Honey, sugar
Dessert syrups are flavored with honey, rose
water, or orange-flower water.
Fatayeh is another specialty served as a snack,

featuring bread dough topped with cheese, meat,
or spinach and baked like a pizza. Tiropetas are
Greek flaky turnovers stuffed with cheese. In Serbia
a cheese and egg pie called gibanjica is popular. A
dessert made with filo dough, baklava or paklava,
can be purchased at every bakery and caf through-
out the Balkans and Middle East. The sheets of
dough are layered with a walnut, almond, or pista-
chio filling and then soaked in a syrup flavored
with honey, brandy, rose water, or orange blossom
water. It is often cut into diamond shapes.
Dave Bartruff/CORBIS
Raw kernels of cracked whole wheat are used
in a number of Balkan and Middle Eastern dishes.
When the kernels are first steamed and then dried
and crushed to different degrees of fineness, the
cracked wheat is called burghul or bulgur.
Assorted Egyptian pastries
Unripened dried but not cracked wheat kernels
made with filo dough,
are known in Arabic markets as fireek. All vari- couscous, and nuts.
eties of wheat kernels are typically cooked as side variety of rice, basmati, is used in Iran for khoresh,
dishes or made into tabouli, a popular salad con- rice topped with stewed meat, poultry, or legumes.
taining onions, parsley, mint, and various fresh Rice is frequently added to soups and stuffings
vegetables. Another Arab specialty is kishka, made for poultry and vegetables in both the Balkans
by blending bulgur with yogurt, drying the mixture and Middle East.
in the sun, then grinding it into a powder that can A large variety of legumes are another impor- In Bosnia-Herzegovina,
later be reconstituted with water to make a filling tant ingredient in both Balkan and Middle Croatia, Serbia, and Slovenia,
for pita or thinned enough for soup. In Serbia Eastern cooking. Cooked, pureed chickpeas are pida usually refers to filo
wheat kernels are cooked with sugar, dried fruits, the base for hummus, often served as an appetizer dough, not pocket bread.
and ground nuts to make koljivo. or as a dip. Ground chickpeas or fava beans are
Dumplings filled with meat are called cmoki sometimes formed into small balls and then fried
in Slovenia and are stuffed with fruit for dessert. and served as a main course (taamia) or in pita
In Turkey, cheese or meat dumplings are known bread with raw vegetables (falafel). A common
as manti. A few pasta dishes are found in the breakfast food is foul, slowly simmered fava or
Balkans, such as the Greek pasta with baked lamb black beans topped with chopped tomato, garlic,
or goat and tomatoes called yiouvetsi and maca- lemon juice, olive oil, and cilantro (fresh coriander
roni baked with cheese, ground meat, tomato leaves). Lentils are especially popular in the soups
sauce, and bechamel sauce called pastitsio. A dish of some areas.
similar to Italian pasta with beans is prepared. In Many vegetables are used, though eggplant is Eggplant caviar, which is a
the Middle East vermicelli is often added to rice, the most popular in the Middle East, Greece, and cooked salad, and baba
and noodles are found in a few dishes, such as southern Balkan regions. A common cooking ganouj, an unusual smoked
Syrian chicken with macaroni. method for Middle Eastern vegetables (the Greek eggplant puree, are very
In addition to wheat, rice is also a staple item term is yiachni; the Arabic word is yakhini) is to popular appetizer dishes
served throughout the
in Middle Eastern cuisine and found in some combine them with tomatoes or tomato paste
Middle East.
Balkan regions. The long-grain variety is used to and sauted onions together with a small amount
make pilaf or pilav, a dish that commonly accom- of water, then cook until the vegetables are soft
panies meat or poultry. The rice is first sauted in and very little liquid remains. Vegetable salads
butter or oil in which chopped onions have been (freshly sliced tomatoes or cucumbers are
browned. It is then steamed in chicken or beef common) and cold, cooked vegetable salads are
broth. Saffron or turmeric may be added to give eaten. Vegetables are frequently stuffed with a
the dish a deep yellow color. meat or rice mixture. Moussaka or musaka is a
Polo is the Iranian version of pilaf, but a final Balkan specialty made with minced lamb, egg-
step in its preparation produces rice with a crunchy plant, onions, and tomato sauce baked in a dish
brown crust known as the tah dig. A more fragrant lined with eggplant slices. The Turks prefer imam
Table 13.2 A Glossary of Selected Olives

Olives originated in the Middle East and spread throughout the Mediterranean. They are picked unripe (green, with dry, firm flesh and bitter-tasting) or when fully
ripened (black, oilier, soft textured, and milder in flavor). Raw olives are inedible and must be cured in salt (also called dry-cured) or in a brine, oil, wine, or lye solu-
tion before they can be consumed. Both the stage at which they are harvested and the type of curing process affect the flavor of the final product.
Aleppo (Middle East) Small, dry-cured black olive (with wrinkled, chewy texture) named after a Syrian city
Amphissa (Greek) Dark purple olives with nutty flavor
Gaeta (Italy) Medium black olives, dry-cured (with wrinkled texture) or brine-cured (with smooth purplish flesh)
Kalamata (Greece/Middle East) Large, deep-purple with crunchy texturesalt cured, packed in vinegar (sometimes with preserved lemon in Morocco)
Kura (Middle East) Large green olive with hard flesh cracked to allow penetration of brine, bitter flavored, also called Middle Eastern
cracked green
Manzanilla (Spain) Small to large green olive usually pitted and stuffed with other ingredients (e.g., pimento, garlic, almonds)
Middle Eastern Green Small, brine-cured olives packed with olive oil, herbs, and often chile peppers
Moroccan Dry-Cured Medium black, dry-cured with wrinkled flesh and bitter flavor, used mostly in cooking
Nabali (Middle East) Dark green olive with soft texture, brine-cured, and often packed with lemon, garlic, and vinegargrown in Israel (including
the Palestinian territories) and Jordan; also called mushhan, baladi or Roman olives
Naphlion (Greece) Dark green, brine-cured, packed in olive oil
Nioise (France) Small, sour, salt-cured purplish black olives
Picholine (France) Small, mild, salt-cured light green olives
Sicilian (Italy) Very large, green olive, brine-cured, somewhat sour
Thassos (Greece) Small, dry-cured black olives (with wrinkled texture), intense tart flavor
bayildi (meaning the priest fainted), eggplant melons, pomegranates, and quince are favorites.
filled with tomatoes, onions, and garlic, stewed in Pears, plums, and pumpkins are well liked in the
olive oil and served cold.79 Grape or cabbage leaves more temperate climates of the northern Balkan
are stuffed to make the specialties known as dolma nations. A distinctive characteristic of Middle
or sarma. Potatoes, particularly enjoyed in the Eastern fare is the addition of fruits to savory
northern Balkan nations, are also found in some dishes; apricot sauce tops meatballs in Egypt and
Middle Eastern stews and side dishes. Vegetables chicken in Syria. Fruits are also often served
are frequently enjoyed raw, mixed together in a dried or as jams and compotes. Slatko is a Balkan
salad, or preserved as pickles. Sauerkraut is eaten specialty featuring fruits simmered in thick
in Croatia, Serbia, and Slovenia. syrup. Fruit juices (especially lemon) and syrups
The olive tree contributes in many ways, par- flavor many foods.
ticularly to Greek and Middle Eastern cooking. Fresh milk is not widely consumed in the
Olives prepared in the Middle Eastern way have a Balkans or Middle East, though it is used in pud-
much stronger flavor than European or American dings and custards. Dairy products are usually
olives; they often accompany the meal or are fermented into yogurt or processed into cheese.
served as an appetizer (see Table 13.2). The olive Yogurt is eaten as a side dish and served plain
is also a source of oil, which is frequently used in (unsweetened) or mixed with cucumbers or
food preparation, although butter, clarified butter other vegetables. It is diluted to make a refreshing
The term yogurt is Turkish.
(samana), and most vegetable oils, as well as ren- drink. Cheese is usually made from goats, sheeps,
In Syria and Lebanon the
fermented milk product is
dered lamb fat and margarine, are found in the or (in the Middle East) camels milk. The most
called laban; in Egypt, laban Balkans and Middle East. Olive oil is generally widely used cheese is feta, a salty, white, moist
zabadi; and in Iran, mast. used in dishes that are to be eaten cold. For most cheese that crumbles easily. Myzithra, a soft pot
deep-frying, corn or nut oil is used, but olive oil cheese, is a by-product of the feta process. Lebneh
Camels milk, unlike other is preferred for deep-frying fish. or labni is a fresh cheese made by draining the
commonly consumed animal Fruits are preferred fresh, eaten for dessert or whey from salted yogurt overnight. Haloumi is a
milks, is high in vitamin C. as snacks. Apricots, cherries, figs, dates, grapes, springy, semisoft cheese that is sometimes flavored
with mint. It holds its shape when cooked, and

pieces can be grilled quickly on both sides for a hot
treat. Kaseri is a firm, white, aged cheese, mild in
flavor and similar to Italian provolone. Kashkaval
is a hard, tangy ewes milk cheese, sometimes called
the Cheddar of the Balkans.
Almost all meats and seafood are eaten in the Image not available due to copyright restrictions
Balkans and Middle East, with the exception of
pork in Muslim countries and pork and shellfish
among observant Jews in Israel. Lamb is the most
widely used meat, though pork is very popular in
the northern Balkan areas. Grilling, frying, grind-
ing, and stewing are the common ways of preparing
meat in the region. A popular dish is kabobs, mari-
nated pieces of meat threaded onto skewers then
grilled over a fire. Vegetables, such as onions or
tomatoes, are sometimes added to the skewers.
Souvlaki or shawarma is very thin slices of lamb
(or chicken) layered onto a rotisserie with slices of
fat (resulting in a single roast), grilled, then carved Coffee is a favorite (see Is Coffee Beneficial for In the Middle East coffee is
and served. In Greece thin slices of souvlaki are Health?) across the entire region, consumed consumed highly sweet-
folded into pita bread with tomatoes, cucumber, throughout the day at home and in cafes. It is fre- ened at happy occasions; it
and yogurt to make the sandwich-like treat gyros. quently flavored with cardamom and copious is drunk black and bitter at
Meatballs, called kofta, are favorites, eaten as snacks amounts of sugar. Traditionally the drink is made funerals.
or served with stewed vegetables. A whole roasted in a long-handled metal briki, producing a
lamb or sheep is a festive dish prepared for parties, strong, very thick, and often sweet brew served in
festivals, and family gatherings. small cylindrical cups. It is called Turkish coffee
Numerous spices and herbs are used in the in Turkey and Serbian coffee in Serbia. Tea is
Balkans and Middle Eastern seasoning as a result equally popular in many nations and is served
of a once-thriving spice trade with India, Africa, sweetened and flavored with mint, or fruit such
and Asia. Common spices and herbs are dill, garlic, as dates or raisins.
mint, cardamom, cinnamon, oregano, parsley, and The Balkan countries are well known for their The Arabs were the first to
pepper. Sumac, ground red berries from a nontoxic wines and distilled spirits. Civek is a ros served mix gum arabic with sugar
variety of the plant, is sprinkled over salads to throughout Slovenia, and a high-proof brandy to produce chewing gum.
give a slightly astringent flavor; it is mixed with made from plums called sljivovica is available in The Greeks prefer to chew
thyme to make the Arabic seasoning mix called both Serbia and Slovenia. Best known in the on the licorice-flavored
resin mastic (source of the
zaatar. Other typical Middle Eastern spices include United States are the Greek specialties retsina
verb masticate).
mahleb, made from the ground pits of a cherry-like (white wine with a resinous flavor), ouzo and arak
fruit, and ajowan, small, black carom seeds with (anise-flavored aperitifs), and metaxia (orange-
a thyme-like flavor. The juice of unripe lemons, flavored brandy). Although observant Muslims
verjuice, is used to provide a sour taste to dishes. do not drink alcohol, several Middle Eastern
Ground nuts are often used to thicken soups and nations (e.g., Iraq, Israel, and Turkey) produce
stews. Sesame seeds are crushed to make a thick wines and spirits. Raki, a Turkish version of arak,
sauce, tahini, which is used as an ingredient in is traditionally consumed with appetizers.
Arabic cooking and in a sweet dessert paste known
as halvah. Regional Variations
Fruit juice is popular as a beverage through- Balkan. All Balkan nations combine both
out the Balkans and Middle East, and sometimes European and Middle Eastern elements in their
fruit syrups or flower extracts are mixed with ice cooking. The noteworthy division is between the
(or in the past, snow) to make the refreshing more European-influenced fare of Bosnia-
beverage known as sharbat in Arabic or s,erbet Herzegovina, Croatia, Romania (see Romanian
in Turkish (origin of the English word sherbet). Fare), Serbia, Slovenia, and the other northern
CULTURAL CONTROVERSYIs Coffee Beneficial for Health?
D espite the importance of wheat

in the diet of Western nations,
it can be argued that the most
important Middle Eastern product consumed
worldwide is coffee. Over 500 billion cups
leaders became concerned that men were
spending more time drinking coffee than
attending mosque services, and that politi-
cally subversive activities were being
planned in the coffeehouses. This led to
nervous system stimulant. Chlorogenic acid
is a phenolic compound that works as an
antioxidant. Over the years, coffee has
developed a bad reputation, related to
studies on the development of ulcers, heart
are consumed annually. Coffee is currently their closure in some areas, but efforts to disease, cancer, and birth defects. Beginning
grown in over fifty countries and is second enforce a permanent ban among Muslims in the 1980s, many health-conscious people
only to petroleum in global trade activity failed due to coffees broad popularity. began to cut consumption or switch to
and value. The International Coffee Organi- During this period, coffee was success- decaffeinated coffee.
zation reports that exports increased fully grown in the Arabian Peninsula nations, Recent research, however, is leading to
17 percent in 2006, and it is becoming and the product was improved by dark- redemption of the beverage. Coffee has
increasingly common in tea-drinking roasting the beans. The beverage spread been exonerated as a causative agent in
nations such as Japan, China, and India. with the expansion of the Turkish Ottoman many gastrointestinal disorders, in most car-
Coffee is indigenous to Ethiopia, but it Empire, especially in southern Europe, where diovascular conditions, and in almost all
was the Arabs who first brewed and popu- the social tradition of coffeehouses was well cancers.9, 41, 51, 54 Even the association with
larized the beverage after it was introduced accepted. The Middle East became the first birth defects has been disproved.11 Instead,
to the region sometime around the tenth major exporter of beans through the research suggests that moderate consump-
century.18 It is said that a Sufi sheikh was Yemenese port of Moccha. However, some tion of three to four cups each day may
first to note the ability of coffee to promote sixteenth-century Catholics believed that actually offer health benefits, reducing the
wakefulness, and it became widely used by coffee was the beverage of Satan due to its risk of metabolic syndrome,42 coronary heart
worshippers to increase stamina and to association with infidels. Popular legend is disease,5, 65 type 2 diabetes,95, 104 several
produce a mystical euphoria.98 The Sufis that plans to prohibit coffee were foiled cancers,7, 17, 28 rheumatoid arthritis,55 and
called it qahwah (thought to be the origin when Pope Clement VIII asked to taste the possibly Alzheimers disease.6 Studies on the
of the term coffee), a word originally used brew and immediately claimed it so good effect of coffee on hypertension are contra-
for wine. By the early 1500s it had become that Christians should make it their own. dictory.41, 106 Coffee is still suspect in bladder
a secular beverage consumed in Middle Historical controversies aside, the most cancer, spontaneous abortion, and impaired
Eastern social settings, especially coffee- significant issue regarding coffee in modern fetal growth, and may aggravate some
houses, where men could drink and discuss times has been its impact on health. Coffee gastrointestinal disorders.13, 41 Researchers
the matters of the day. The coffeehouses contains numerous active ingredients, most caution that coffee is not for everyone and
attracted philosophers and poets, and in notably caffeine and chlorogenic acid. that people with hypertension, children,
Istanbul they were known in jest as Caffeine is an alkaloid that is classified with elders, and pregnant women are most
schools of knowledge. 98 Some Islamic cocaine and amphetamines as a central susceptible to adverse effects.
nations and the foods of the southern countries, consumed. Veal is popular for stew and is some-
including Albania (see Albanian Fare) and Greece, times seasoned with paprika. One popular dish
with a decidedly more Middle Eastern flavor found in most of the Balkan countries is cevapi
(Greek cooking is considered with Turkish fare in (or cevapcici), grilled elongated kebobs of spicy
the following section). minced meat that are often eaten on somun (a
The use of pork and veal, the selection of fruits thick pita bread) or lepinja (a small, flat roll). In
and vegetables, and the popularity of fresh dairy Bosnia they are usually made with beef, or a beef
products are all characteristics of central European and lamb mixture, served with chopped onions,
cooking in the northern Balkans. German-style cottage cheese, and an extra-rich sour cream called
sausages, pork roasts, and hams are frequently kajmak. Large, thin meat patties made from lamb
and beef, known as pljeskavica, are considered culinary areas: Greek/Turkish, Iranian, and Arabic, One specialty of North
the national dish of Serbia but are also a favorite and the other defines five divisions: Greek/Turkish, African cooking is mirqaz (or
with Bosnians and Croatians. Middle Eastern Arabic, Iranian, Israeli, and North African (see merguez) sausagewhich
style grilled meats are also found in some areas, Moroccan Cooking). Certainly every region has is also popular in France
made from lamb or other
especially in Bosnia-Herzegovina. some unique recipes and cooking methods, but the
meats, seasoned with chiles,
Potatoes, cabbage, and cucumbers are typical similarity in fare throughout the region is striking.
cinnamon, dried rose petals,
vegetables, and many families gather wild mush- The cooking of Greece and Turkey has evolved and other seasonings, then
rooms. Ajyar, made with roasted red bell peppers through an extensive exchange of ingredients and typically sun-dried and
and eggplant, seasoned with garlic and vinegar, is preparation techniques. Both cuisines feature more packed in olive oil.
popular throughout the Balkans. It comes in many meat (especially grilled), fish and seafood, cheese,
versions, from sweet to hot (flavored with chile butter, and olive oil than in the fare of neighboring
peppers), and is served as a condiment with grilled Middle Eastern countries. Both the Greeks and
meats, as a salad on a mezze plate (typically with a Turks prefer using flatware to fingers when eating.
selection of sliced sausages or smoked meats, Similar distinguishing dishes include filo dough
cheeses, hard-boiled eggs, and sliced tomatoes) or layered with spinach and feta filling (spanakopita
spread on bread. Vegetables are sometimes stuffed in Greece, ispanakli borek in Turkey); fish roe
with meat and rice mixtures similar to those in the (caviar) dip made with olive oil and bread (tara-
Middle East, but with a Balkan flavor due to the use masalata in Greece and tarama in Turkey); salads
of bell peppers, onions, potatoes, or cabbage leaves. with fresh greens, tomato, cucumbers, olives, and
In Bosnia-Herzegovina these stuffed items are called lemon juiceolive oil vinaigrette (the Greek version
sarma or dolma and may be served in the tureen in adds feta cheese; the Turkish recipe includes more
which they have been heated.75 Cooler weather vegetables, such as green peppers); the lemony,
fruits such as apples, berries, peaches, pears, and egg-enriched sauce used to thicken soups and top
plums are more common. They are found in meat and vegetable dishes (avgolemono in Greece,
desserts, such as sweet dumplings and strudels, and tebiye in Turkey); yogurt cake; and anise-flavored
preserved as compotes. Fruit juices are favorites alcoholic beverages. Yet many differences exist.
and an important industry in the region. Greeks prefer small pastries, such as the specialty
Buttermilk is frequently consumed and fresh butter cookie, kourabiedes, for snacking and
cheeses are well liked, often combined with herbs dessert, while the Turkish sweet tooth is more often
for mezze or mixed with eggs and honey or sugar satisfied with fruit compotes, rich custards, and
for cheese-filled dessert pastries. Cream enriches candy, including lokum, also known as Turkish
soups, stews, casseroles, and sauces. Sour cream delight. More significantly, consumption due to
or whipped cream tops many dishes. A specialty religious affiliation varies. Feasting and fasting
dairy product found throughout the region is a rules for the Eastern Orthodox of Greece and the
heavy, crme fraiche-like product called smetana Muslims of Turkey differ tremendously (see
(in Slovenia), vrhnje (in Croatia), or pavlaka (in Chapter 4 on religious food culture).
Bosnia-Herzegovina). In Croatia it is added to Arab fare, based originally on the cooking of Syrian food is often spicier
cottage cheese and seasoned with onions, garlic, nomadic tribes and later influenced by the foods than that of other Arab
of surrounding nations, features more grains, nations. They are known for
radish or horseradish, and paprika, then eaten
legumes, and vegetables than the Greek, Turkish, their small baked lamb pies
with cornbread.
Israeli, or Iranian diet. In Syria and Lebanon the seasoned with cayenne
The definitive northern Balkan treat is a sweet called sfeehas.
yeast bread rolled with a rich walnut, butter, cream, national dish is kibbeh, a mixture of fine cracked
and egg filling. It is widely known as potica and in wheat, grated onion, and ground lamb pounded Tharid was reputedly
some areas as povitica or kolachki. Some versions into a paste. This mixture can be eaten raw or Mohammeds favorite dish.
are more savory, flavored with tarragonothers grilled, and with a great deal of dexterity it can be
are sweeter, with dried fruits. Variations include made into a hollow shell, then filled with a meat
cream cheese, poppy seed, and pumpkin fillings. mixture, and deep-fried. In Jordan a specialty is
Whipped cream tops many sweet versions. mansafflat breads layered with yogurt are
placed on a communal platter and then topped
Middle Eastern. There are two schools of with a mound of rice pilaf and shredded lamb or
thought about the number of regional cooking chicken. A broth mixed with whey or yogurt is
areas in the Middle East. One identifies three poured over the top, then the dish is garnished
The Iranians call their with nuts. The national dish of Egypt is ful Later trade routes between China and Syria
breads nan and bake many medames, cooked fava beans seasoned with oil, (the Silk Road) and between India and Africa
of them, such as nan-e lemon, and garlic, sprinkled with parsley, and crossed through Iran, introducing rice, tea, egg-
lavash and nan-e barbari, in served with baladi, a whole-wheat type of pita plants, citrus fruits, tamarind, and garam masala
a clay bread oven known as bread. Many soups and stews include legumes, (the spice blend used in curried dishes) from
a tanoor. Both the name and
and some salads include grains, such as tabouli. these eastern cuisines. Though the cooking of Iran,
oven were brought by the
Persians to northern India,
Pieces of pita bread are added to many dishes as usually called Persian cuisine, is very similar to
where naan flatbreads are well. Tharid is a casserole of layered flatbread with other Middle Eastern foods, it is famous for its
baked in tandoor ovens. meat stew found in many Arab nations. Fatout is sophisticated rice dishes and its use of fruits for
a popular preparation in Yemen, combining flavoring. The national dish is chelo kebab, which
toasted bread with honey, with scrambled eggs, or is thinly sliced pieces of marinated, charcoal-
any other food; fattoush is a Lebanese favorite grilled lamb served over rice seasoned with
with greens, tomatoes, radishes, cucumbers, butter, egg yolks, saffron, and sumac. Soups and
onions, and pieces of pita bread. Another feature sauces are given a sweet and sour taste by com-
of Arab cooking is the use of variety meats. Lamb, bining different ripe and unripe fruits, such as
goat, and beef are costly; thus, all parts of the oranges, barberries, cherries, dates, grapes,
animal are used, with brains, chitterlings, heads, plums, pomegranates, quinces, and raisins with
and feet considered delicacies. Pacha is an Iraqi astringent seasonings, including lemon juice,
Israelis with prickly person- soup of sheep heads, stomach, and trotters served vinegar, tamarind, and sumac.
alities are sometimes called with ample bread and pickled vegetables. Israel probably has the most varied foods and
by the nickname sabra after Iran is the most eastern of Middle Eastern food culture because its cuisine blends indige-
the cactus of the same nations. It spans a region between the warm nous Middle Eastern cooking with that of the
name. A U.S. native known
Persian Gulf and the cold Caspian Sea, encompass- many Jewish immigrant groups who have settled
as the prickly pear cactus, it
ing several agricultural climates suited to a wide in the area since nationhood. Hummus and pita
was first exported to the
Middle East in the nine- variety of fruits and vegetables. Its dominance of bread may appear at the same meal as German
teenth century; Israel is one the Middle East, parts of the Balkans, and areas of schnitzel, Hungarian-style goulash, or Italian
of the largest sabra growers India during the Persian Empire dispersed indige- pasta.78 American immigrants introduced bagels;
worldwide, selling the fruit nous products such as spinach, pomegranates, and Russians brought kasha and borscht. Chocolate
to Europe, Africa, and Asia. saffron throughout the region. mousse cake, linzertorte, and coconut macaroons
EXPLORING GLOBAL CUISINERomanian Fare
R omania is a nation poised common foods include walnuts, filberts, soups are eaten with whole-grain bread;
between the West and the East. olives, sour cream, and sheep and goat one example is ciorba, a soup made with
Some describe Romanian food cheeses. The national bread is mamaliga, vegetables (e.g., peppers, onions, sauerkraut,
as pastoral with Turkish and Hungarian which is like the Italian polenta. It is sliced tomatoes) and meat (usually ground) or fish
overtones. However, there are also many and spread with butter or topped with and then flavored with sour ingredients (e.g.,
Italian and central European influences. cheese, meats, or fruit for dessert. Another sauerkraut juice, pickle juice, or vinegar).
Beef, veal, mutton, lamb, pork, chicken, specialty is pastrama (from the Turkish Cake is a traditional dessert, but custards
geese, and duck are popular. Freshwater meaning to keep), which is lamb, beef, (including one similar to Italian zabaglione)
fish such as pike and catfish are harvested pork, or goose cured (spicing varies, from and souffls are also eaten. Romanian bever-
from the Danube and other rivers. Cabbage, garlic and black pepper to allspice, nutmeg, ages include wine (red, white, sweet, dry)
red and green peppers, leeks, tomatoes, and hot red pepper) and then smoked. and tuica, a plum and wheat brandy. Most
onions, radishes, and lettuce are common Ground meats are also popular, made into Romanians belong to the Eastern Orthodox
vegetables. Temperate fruits, particularly patties, stuffed into cabbage leaves, or as Church and adhere to the numerous feasting
grapes, plums, and berries, are eaten. Other sausages. One-dish meals such as stews and and fasting days of the church calendar.
EXPLORING GLOBAL CUISINEAlbanian Fare
A lbania was not of interest to In wealthier areas, three meals a day are vegetable side dishes and pickles. Dessert
most Americans until the civil typical with a mid-afternoon snack of thick may include pastries but is typically a fruit
war in the Serbian province of Turkish-style coffee or tea consumed with compote. Few legumes are consumed, but
Kosova focused attention on the plight of pastries, nuts, or fresh fruit, called sille. A nuts (especially walnuts) are added to
the Kosovar Albanians. Albanians, living in complete lunch or dinner begins with numerous sweet and savory dishes.
a country bordered by Greece, Macedonia, mezze (appetizers), such as salads, pickles, One of the most distinctive characteris-
Serbia, and Montenegro, have often been fish and seafood, omelets, spit-roasted tics of Albanian fare is the differentiation
involved in regional discord and shifting lamb or entrails, and baked variety meats. made between vegetables and fruit. Only
national boundaries.52 Years of foreign rule Examples include liptao, a feta cheese salad vegetables are pickled and served as side
have left their mark on Albanian cuisine: garnished with bell pepper, deli meats, sar- dishes, and fruits are only eaten fresh,
pastitsio and feta cheese from Greece, ver- dines, and hard-boiled egg; and soup-like as desserts or as preserves. There are no
sions of imam bayaldi and halvah from tarator, yogurt flavored with garlic and olive crossover items, such as a fruit pickle or
Turkey, omelets and tomato sauces from oil and mixed with vegetables, such as a vegetable-sweetened filling for a pie.
Italy, boereg from Armenia, and borscht cucumber. These are usually consumed with Vegetables and fruits are also prepared
from Russia. Other dishes including dolma, a glass of the distilled Turkish specialty, raki, separately and not mixed together in
kofta, shish kebabs, moussaka, and baklava or a beverage made from fermented cabbage dishes.43 In addition, though regional
are popular throughout the region. called orme. The meal follows with soups, specialties were once common, years of
In the poorest rural regions of Albania, meat, or cheese-stuffed vegetables or communist rule during the first half of
farmers and shepherds are often limited to casseroles; pilaf-like dishes or pies filled the twentieth century encouraged con-
a diet of cornmeal bread, cheese, and yogurt, with vegetables, cheese, and/or ground formity, and many culinary differences
with added lamb or mutton when affordable. meats called byrek; and an assortment of have diminished.19
are as popular as baklava. Furthermore, many of vendors ply pastries and ice cream throughout the
Israels citizens adhere to the kosher laws of the day. Late evening visits to cafes or coffee houses
Jewish religion (see Chapter 4 for more informa- often include small kebabs, meatballs, vegetable
tion on Jewish dietary practices). salads and pickles, and other tidbits to accompany
coffee, wine, or plum brandy.
MEAL COMPOSITION AND CYCLE In Greece and the southern Balkan nations
the traditional breakfast typically consists of
Daily Patterns bread with cheese, olives, or jam and coffee or
The Balkans. People in Balkan countries eat tea. The main meal, eaten in early afternoon,
three meals a day. The main meal is at midday, usually begins with mezze or appetizers, such as
and in the hotter climates a short nap follows. hummus, baba ganouj, tiropetes, and dolmas,
Dinner is lighter and is served in the cooler often consumed with a small glass of ouzo: the
evening hours. Snacking is prevalent. actual selection of included items varies by the
In the northern regions a light breakfast of inclination of the homemaker and affordability.
bread with preserves or honey and tea or coffee is Next a meat stew, meatballs, kebabs, vegetables
most common. Lunch usually includes soup, a stuffed with chopped meat, or a bean dish is
casserole of meats and vegetables, or a fish dish, served with a salad of raw seasonal vegetables,
bread and cheese, and a fruit compote or pastry for yogurt or cheese, and fruit for dessert. Roasted or
dessert. Dinner is often leftovers or another soup or baked whole meats are served on weekends,
stew; sweet dumplings may also be served. Wine is accompanied by cooked vegetables, salad, and
the typical beverage for both lunch and dinner, dessert. Late afternoon and early evening are
though buttermilk, fruit juices, and soft drinks are times when neighbors and friends may drop by
consumed in some areas. In urban regions street for some sweets and a cup of coffee or glass of
EXPLORING GLOBAL CUISINEMoroccan Cooking
M orocco is one of five ingredients, depending on the chef and its couscous is also used to describe the finished
nations that make up the intended purpose; medicinal herbs such dish: the steamed grain topped with a mix-
Maghreb, a region of as belladonna or reputed aphrodisiacs ture of lamb with chickpeas and vegeta-
North Africa differentiated from the Middle (such as the pulverized beetle known as bles, fish with fennel, dates with cinnamon
East by its substantial populations of Spanish fly) may also be added.107 Garlic, (for dessert), or other popular versions.
nomadic Berbers, also including the coun- onions, lemons (some preserved through Moroccan stews, tagines, are slow-cooked in
tries of Algeria, Tunisia, Mauritania, and brining), almonds, and sweet peppers also ceramic pots and feature any combination
Libya. Although there are very few flavor many dishes, and some are heated of meats, poultry, fish, organ meats, veg-
immigrants to the United States from the with the chile pepper and garlic paste etables, and fruits. Mechoui is spit-roasted
Maghreb, many Moroccan restaurants have condiment called harissa (from Tunisia, lamb or kid. The meat is first rubbed with
opened, advertising an exotic dining experi- where foods are preferred very spicy). Rose cumin and garlic, and then cooked until it
ence at low tables amid pillowed opulence, water and orange-blossom water are also can be pulled off with the fingers. Bastilla
often with belly-dancing entertainment. commonly used. Foods are also flavored by or bstila (from the Spanish word for pastry
The cooking of Morocco is predomi- the preferred cooking fats of the region, or pie, pastel) is the quintessential
nantly Berber in origin, strongly influenced zebeda (a sour fresh butter) and smen (a Moroccan dish: sheets of warqa (a dough
by neighboring Arabic fare and, to a much preserved clarified butter often seasoned similar to filo, though thinner) enclose
lesser degree, through interchange with with herbs; it is traditionally stored for layers of ground almonds mixed with
sub-Saharan Africa and the southern months underground until cheese-like). sugar and cinnamon alternating with
European countries of the Mediterranean. Couscous is a staple eaten throughout pigeon or chicken meat. The layers are
It is noteworthy for its exquisite seasonings. the Mahgreb, where it is known by many bound with a lemony egg sauce, and the
Spices, such as allspice, anise, cardamom, names. It is made from a dough of hulled, pie is baked until golden. The crispy crust
cayenne, cumin, cinnamon, cloves, mace, crushed (not ground) grains of semolina is often sprinkled with sugar and cinna-
malagueta pepper (see Chapter 8, Africans), wheat (other grains prepared the same mon before serving. Cooked or marinated
nutmeg, turmeric, and saffron, are com- way, such as barley and millet, are also vegetable salads usually start a meal, and
bined with herbs, including basil, fresh called couscous) mixed with water and fresh fruit and nuts add the finishing
coriander, lavender, marjoram, mint, ver- processed into very small pellets and dried. touch. All foods are eaten with the first
bena, and zaatar. One mixture, ras el hanout, It is traditionally cooked in a specialized three fingers of the right hand, and bread
includes between ten and twenty-five steamer known as a couscousire. The word is used to sop up sauces.
ouzo. A light supper is served in the late evening. of mezze (such as hummus, tabouli, vegetables in
Throughout the day, mezze are widely available yogurt, and bowls of nuts), a soup, and cheeses.
from street vendors and cafes for snacking. Dessert is usually included, typically a piece of fresh
fruit, a pastry, or a custard or pudding. Diluted
Middle East. In most Arabic countries coffee yogurt drinks or water is served while eating, fol-
or tea is often served first for breakfast around lowed by sweetened tea or coffee. Dinner in the
7:00 or 8:00 a.m., followed by a light meal that early evening is light, consisting of foods similar
might include bread, cheeses, beans, eggs, olives, to those eaten at breakfast, soup, or leftovers from
jam and bread, and plain yogurt. Lunch is the main lunch. All the dishes in a meal are customarily
meal of the day, eaten in the early afternoon. It is served at once in Egypt, Iraq, and Yeman, and in
customarily bread, rice or bulgur, and a vegetable courses in Jordan, Lebanon, and Syria.109
or legume casserole, a meat or poultry stew, or, Turkish meals vary slightly from the Middle
where available, a fish or seafood dish. Fresh or Eastern pattern. Breakfast (often served a little
cooked vegetable salad or onions and olives are later than in Arabic nations) varies regionally, but
common side dishes. Additional items, depending is often substantial, with leavened bread or simit (a
on region and affordability, may include a selection chewy or crunchy ring-shaped roll resembling a
bagel in shape, but richer in flavoralso found in

Greece where they are called koulouri), cheese,
butter, tomatoes, olives, and jam served with
sweetened tea. Eggs, soups or sausages are
common additions in some areas. Lunch, eaten SAMPLE MENU
around noon, and dinner, served between 6:00
and 8:00 p.m., are also plentiful meals, especially
dinner, which is the main meal of the day. It begins A Greek Mezze
with a selection of mezze (mezeler in Turkish) Olives and Cheeses (such as Kaseri or Myzithra)
served with raki. Items may include lamb meat-
balls, dolma, stuffed mussels, fried squids, baba Taramosalata (Caviar Dip)a, b or Hummus (Chickpea Dip)
ganouj, hummus, and vegetable salads. These Tzatziki (Cucumber Yogurt Dip)a, b
appetizers are followed by the olive oil course, fea-
turing vegetables such as eggplant, tomatoes, or Pita Bread
leeks stewed in olive oil. Kebabs, casseroles, or Spanakopita (Spinach and Cheese Triangles)a, b
stews are the centerpiece of the meal, served with
pilaf and bread. Fresh fruit such as melon, baklava, Dolmas (Stuffed Grape Leaves)a, b with Avgolemono
or rice pudding follows, and the sweets are con- (Egg and Lemon Sauce)a, b
sumed with coffee. In some regions, tripe soup Ouzo or Wine
with vinegar and garlic may be eaten after dinner,
served with alcoholic beverages. Turkish meals are a
typically served in courses. Harris, A. 2002. Modern Greek: 170 contemporary recipes from the
Mediterranean. San Francisco: Chronicle Books.
In Iran breakfast is usually a selection of flat b
Eat Greek Tonight at http://www.eatgreektonight.com
breads served with feta or other cheeses, sweet-
ened whipped cream, and jam. In some regions
offal soup or halim (a savory wheat porridge with
meats and vegetables) is preferred.8 Lunch and
dinner are similar, usually with rice, a meat or
poultry dish (roasted, or as kebabs or ground
meat), often a vegetable salad, flat breads, some
feta cheese or yogurt, and a selection of chopped
herbs (such as mint, basil, and dill). A meat or
vegetable stew is frequently substituted for the SAMPLE MENU
meat or poultry course, served over the rice.
Fruit, especially melon or grapes, is a typical
dessert, and tea or a yogurt drink accompanies An Arab Sampler
the meal. Traditionally, the dishes are all served
at one time and eaten communally. Baba Ganousha, b with Pita Bread
Weekday breakfasts in Israel are customarily Kofta (Kebabs) in Yogurt Saucea, b
light: coffee with some pita and olive oil and zaatar,
European-style breads with jam or other spread, Tabouli (Bulgur Salad)a, b
or a selection of cheeses, yogurt, and chopped Olive and Orange Salad a, b
vegetables and fruit. Sabbath breakfasts, however,
Baklava a, b or Stuffed Datesa (or Apricots)b
are somewhat heartier. European Jews may choose
coffeecakes or pancakes, and Arabic Jews may Arabic Coffee or Mint Tea
select bureks, kataif (a sweet, stuffed pancake), or
sabikh (an Iraqi dish of pita bread topped with a
fried eggplant, hard-boiled egg, tahini, and a Salloum, H., & Peters, J. 2001. From the land of figs and olives. New York:
Interlink Books.
mango pickle). The traditional Israeli breakfast b
Middle Eastern Recipes at http://www.sudairy.com
buffet associated with Kibbutz life is offered at
some restaurants, featuring a more typically
Middle Eastern selection of flat breads, cheeses,
vegetables, and olives, often with added eggs,
ones, are made to feel welcome and are automati-

cally offered food and drink. In the Balkans it is
likely to be fruit compotes, candies, and butter-
milk, coffee, plum brandy, or, in Greece, ouzo or
SAMPLE MENU arak. In the Middle East it may be a few dates and
water or an extensive choice of mezze served with
coffee, tea, or raki. Even if food is initially refused,
A Persian Lunch it will be offered again, and a guest must accept
because refusal is considered an insult. Invited
Olives and Pistachios guests bring a gift, often candy or other sweets,
which the host must open immediately and serve.
Khoresh-e Fesenjan (Chicken Stew with Walnuts Hospitality is even offered to clients in the office
and Pomegranate over Rice) a, b setting, and failure to make guests or clients com-
fortable may create extreme embarrassment for
Cucumber, Tomato, and Onion Salad a, b
all parties.86
Feta Cheese and Lavash In the Middle East, a guests status is indicated
by which pieces of food are offered, and the order
Fresh fruit or Sholeh Zard (saffron pudding) a, b in which the items are served. Status is based on
sex, age, family, and social rank. For example, a
Tea dignitary or head of the family is served the best
portion first. In Saudi Arabia and other nations of
the Arabian peninsula, the honored seat at the
a
Batmanglij, N.K. 2000. New food of life: Ancient Persian and modern Iranian table is in the middle of the table, while in Egypt,
cooking and ceremonies. Washington, DC: Mage Publishers.
b
it is at the head of the table.26 In some areas, such
Iranian/Persian Recipes at as some parts of Yemen, it is customary for women
http://www.ee.surrey.ac.uk/ Personal/F.Mokhtarian/recipes/#P5
to eat separately from men.109 Guests are tradition-
ally entertained in a separate room before the meal,
at which time scented water is provided so they
may wash their hands. The dining table might be a
large, round metal tray, resting on a low stool or
platform, and the diners sit around it on cushions.
baked goods, and other selections. The midday Western-style dining is found occasionally, espe-
meal is the largest in most homes, beginning with cially in Middle Eastern restaurants. In Iran food
hummus or tahini served with pita bread, then a is traditionally served on a rug. The meal is set
saladof ten cucumbers, tomatoes, and onions out in several bowls placed on the table or rug
followed by items appropriate to a meat or dairy and then shared by the diners. After the meal, the
meal (see Chapter 4 for more information on Kosher guests leave the table, wash their hands, and then
rules). The evening meal, typically eaten around have coffee or tea.
8:00 or 9:00 p.m., is usually light with cheeses, Several rules of etiquette apply to eating in the
yogurt, salads, and eggs. Some families serve all Middle East. One should always wash ones hands
the dishes of the meal at once, while others serve before eating. In Muslim regions the guests thank
them in courses, often depending on heritage. Allah before and after the meal. Other Middle
Street stands offer falafel, kebabs, shawarma, and Easterners may say Sahain! (bon appetite!) to
other snacks, and fast-food restaurants, especially start the meal, and Daimah (may there always
those serving hamburgers or pizza, are popular be plenty) to end it.26 Three fingers of the right
Spoon sweets (seasonal
with many Israelis. Fruit juices, soft drinks, and hand are used if forks or spoons are not offered.
fruits, vegetables, nuts, or
rose petals preserved in a
beer are common meal beverages. The left hand should not be used in any food-
heavy, sweet syrup) are a related manner (including passing food), and
Greek specialty specifically
Etiquette women should not touch any food that is to be
reserved for guests, offered Throughout the Balkans and the Middle East, hos- eaten by a Muslim man who is not her immediate
by the spoonful on arrival as pitality is a duty and a familys status is measured family member. Rice should be taken from the
a sweet welcome. by how guests are treated. Guests, even uninvited communal bowl and rolled into a small ball with
the fingers before dipping it into stews or sauces. on Christmas. Among Serbians, the most auspi- In Yemen qat (the herb
Licking the fingers after eating is expected, and cious day of the year is Krsna Slava, Patron Saints with amphetamine-like
appreciation is shown in some areas by making Day. This holiday dates back to the worship of properties called khat in
eating noises.20 It is rude to fill ones own cup, and protective spirits in pagan times; today each family Ethiopiasee Chapter 8)
is frequently chewed in
it is expected that a diner will refresh his or her honors its self-chosen patron saint with a sump-
social and business settings.
neighbors cup as soon as it is half empty. It is also tuous feast and dancing that may last for two to
considered polite to continue eating until everyone three days. The family customarily announces the
else is finished because if one person stops the others annual open house with a small advertisement in
feel compelled to stop, too. One should leave a little the local newspaper. Krsni kolac is a ritual bread
food on ones plate to indicate satisfaction with the prepared for the occasion, decorated with the reli-
abundance of the meal. Most conversation takes gious Serbian emblem Samo sloga Srbina spasava
place before and after the meal, and limited discus- (Only Unity Will Save the Serbs) as well as grapes,
sion of pleasant and joyful things takes place while wheat, birds, flowers, barrels of wine, or other rep-
dining. It is important to compliment the host and resentations made in dough. Slovenians celebrate
hostess on their hospitality. St. Nicks Feast. Gifts are distributed to children
by St. Nick, dressed as a bishop, who admonishes
Special Occasions the youngsters to be good. The grape harvest and
In Balkan and Middle Eastern countries food winemaking are traditionally commemorated with In Greek Orthodox tradition
plays an important role in the celebration of reli- numerous vintage festivals and St. Martins Feast. the egg represents life, and
gious occasions and in the observance of certain There are also feasts and fasts connected with red is the color of the blood
events such as weddings and births. In the Eastern Islamic religious observances. Traditional festive Christ shed. The breaking of
Orthodox Church there are numerous feast and fast foods vary from country to country and may also the red-dyed egg symbolizes
vary seasonally since the Muslim calendar is lunar, the resurrection.
days (see Chapter 4). The most important religious
holiday for the Greeks is Easter. Immediately after and holidays fall at different times each year. Iftar
For New Years the Greeks
midnight Mass on Holy Saturday, the family shares is the meal that breaks the fast during Ramadan,
prepare a sweet spicy bread
the first post-Lenten meal. It traditionally begins the month in which Muslims fast from sunrise to called vasilopitta with a coin
with red-dyed Easter eggs and continues with sunset; it is common to dine with relatives and baked into itthe person
mayeritsa, a soup made of the lambs internal neighbors. The meal usually starts with a bever- who gets the piece with the
organs, sometimes flavored with avgolemono, a tart age, preferably water, followed by an odd number money has good luck in the
egg, and lemon. The Easter Sunday meal usually of dates and coffee or tea. A large meal, served upcoming year (the Serbs
consists of roast lamb, rice pilaf, accompanying after prayers, includes moist and hearty dishes. have the same tradition for
vegetables, cheese, yogurt, and a special Easter Regular items eaten during Ramadan include Christmas Day).
bread called lambropsomo that is decorated with soups, fruit juices, cheeses, and fresh or dried
whole dyed eggs. Dessert usually includes sweet fruit. Traditional sweets include kataif, which
pastries made with filo dough and koulourakia, a refers to a pancake or a shredded wheat dough
traditional Greek sweet bread cookie, sometimes dessert and, in Turkey and Iran, rose-flavored rice
shaped into a hairpin twist or wreath or coiled in puddings. In some Muslim homes, the post-fast
the shape of a snake (which the pagan Greeks meal is considered a feast with elaborate dishes
worshipped for its healing powers). Easter is pre- that emphasizes the Muslim virtues of hospitality
Kahk is a sweet Egyptian
ceded by the pre-Lenten holiday of Apokreas, and community, while in other homes a more bread made with ample
which is similar to Carnival or Mardi Gras and moderate meal is thought to be in keeping with butter and nuts that is
features costumed events and parties with ample the purposes of the fast.98 The dawn meal is usu- served at all special
merrymaking, food, and music. In addition to reli- ally light, and salty foods are avoided because occasions.
gious holidays, Greek Americans typically celebrate water is not allowed during the fast.
Greek Independence Day on March 25. It is com- The holiday Eid al-Fitr follows the end of
memorated with parades in traditional dress, folk Ramadan and is described as a cross between the
dancing, songs, and poetry readings. feasting of Thanksgiving and the festivity of
The Easter meal in Croatia is typically lamb or Christmas. Typically family, friends, and neighbors
ham and pogaca, an Easter bread with painted gather to celebrate; in areas with large Muslim
eggs on top that is similar to the Greek lambrop- populations, Eid al-Fitr may be held at the local
somo. Christmas Eve features a meal of cod, and a fairgrounds with games, rides, and many food
stuffed cabbage and sauerkraut dish is customary vendors. The other major holiday observed by Arab
Some non-Christian Arab Muslims is Eid al-Adha, the Feast of Sacrifice held food practices). The Shabbat, or Sabbath, occurs
Americans celebrate the in conjunction with the annual pilgrimage (Hadj) from sunset Friday to sunset on Saturday evening.
birth of Jesus on Christmas; to Mecca (see Chapter 4). All businesses close for the day and work activities
Jesus is considered a In Turkey Eid al-Fitr is known as Seker Bayram, are prohibited. The Friday meal is served on a table
prophet in Islam.
meaning sugar festival. It is traditional to set with white linen and includes the symbolic
exchange small gifts with friends, and for four days Kiddush cup of wine that is shared by all diners.
children are given sweet treats, such as lokums or In Ashkenazi homes a representative menu would
chocolates. On the tenth day of the first lunar include gefilte fish, a leavened, braided loaf of
month of the Islamic calendar, Turks celebrate the egg-rich challah bread, a roast chicken, a noodle
martyrdom of Mohammeds grandson and the day pudding called kugel, and fruit or cake and tea for
Noah was able to leave the ark. They prepare asure, dessert. In Sephardic households a more Middle
or Noahs pudding, made from the ingredients Eastern meal would be typical, such as pilaf, roast
remaining after the receding of the flood waters: lamb, cooked eggplant or stuffed dolma, pita bread,
fresh and dried fruits, nuts, and legumes. Kurban and honey-soaked filo pastries with coffee for
Bayram is a day of remembrance for when the dessert. Jews from other regions have favorite
prophet Abraham nearly sacrificed his son, Ishmael. Sabbath menus as well. For example, an Ethiopian
Families customarily sacrifice a sheep or a goat and family might serve chicken doro wat and caraway-
distribute it to family, friends, and community char- flavored dabo bread. Since all work, including
ities. Another special occasion in Turkey is National cooking, is banned on the Sabbath, only foods
Sovereignty and Childrens Day on April 23. It com- prepared during the day on Friday can be con-
memorates the establishment of the Grand sumed on Saturday. Stews that can simmer
National Assembly in 1923 and specifically honors overnight on the stovetop are popular dishes for
all children. The following day has become Turkish the midday meal following morning services,
American Day in the United States, featuring such as cholent, also known as hamim in Israel.
parades in traditional dress and other festivities. Every family has its own version, though most
In Iran the most significant holiday of the year include beans and potatoes. The Lebanese and
is Muharram, which commemorates the martyr- Syrians use white beans, the Brazilians use black
dom of the grandson of Mohammed in the seventh beans, and the Moroccans add rice. Most Ashke-
century. It is a time of communal mourning and nazi recipes use beef brisket, and some Sephardic
penitence for Shiites, and often features sholeh zard, versions include sausages. In most homes whole
a sweet rice pudding flavored with saffron. Another eggs cooked in their shells are buried in the stew.
celebration marking the spring equinox is Nau Roz, Other religious holidays offer a similar variety of
In Greece and the Middle which features a meal, called haft-sinn, including a food traditions based on nationality of origin.
East sugared almonds
ceremonial table setting where the Quran, a mirror Israelis also observe the secular Yom Ha-Atzmaut,
(Jordan almonds) are served
at weddings to ensure to reflect life, sweets, bread, cheese, and seven items Independence Day, on the fifth day of Iyar (a spring
sweetness in married life. starting with the letter s representing rebirth, good month in the Jewish lunar calendar). Celebrants
fortune, love, happiness, health, and other wishes view parades, hold barbecues, and watch fireworks.
The name of the Jewish for the new year are displayed. Foods and other Street vendors sell falafel, ears of corn, and numer-
Sabbath stew cholent comes goods starting with s may include serke (vinegar), ous sweets, including candied fruits and nuts,
from the French for warm, seeb (apple), sanjed (dried fruit or olives), sumagh sesame seed candy, and European cakes and tortes
chaud, and slow, lent.78 (sumac), samanu (a sweet sprouted wheat kernel with whipped cream.
pudding), seer (garlic), sonbul (hyacinth), sabzi
(sprouted seeds), or sekeh (coins). Readings from Therapeutic Uses of Foods
the Quran are followed with a traditional meal of Fresh foods are considered best, and canned or
herbed rice (sabzu polo) and an herbed omelet frozen foods are often avoided by Middle
(kuku-ye sabzi) served with fish. The number 7 Easterners to preserve health. The amount of
probably relates to the seven days of the week food eaten is of special concern in the diet. Ample
or the seven planets of the ancient solar system. meals are needed to prevent illness, and poor
On the thirteenth day of Nau Roz, it is customary appetite is regarded as a disease in itself or as a
to have a picnic. generalized complaint signifying that ones life is
The traditional holidays of the Jewish calendar not as it should be. Food deprivation is believed
are observed in Israel (see Chapter 4 for Jewish to cause illness.71, 82, 86
Some Middle Easterners also believe that ill-

ness can be triggered by hot-cold shifts in food,
especially in people with weak or susceptible con-
stitutions. In Iran eating too many hot foods may
result in headaches, sweating, itching, and rashes.
Excessive amounts of cold foods can cause dizzi-
ness, nausea, and vomiting.36, 62, 86 Foods and drinks
of the opposite category can ameliorate these
Courtesy of World-Health Organization/P. Merchez

conditions. For example, citrus fruits or a sour
lemonade called ablimu is used for headaches
and acne. Nausea is treated with tea or a sweet
similar to rock candy. Classifications can vary,
but examples of hot foods include lamb, eggs,
onions, garlic, carrots, bell peppers, apples, dates,
quinces, chickpeas, wheat, almonds, walnuts, pis-
tachios, honey, and tea. Cold foods can include
beef, cucumbers, tomatoes, eggplant, grape leaves,
grapes, lemons, sour cherries, apricots, mulberries, Middle Eastern market.
pomegranates, rice, yogurt, coffee, and beer. The
temperature (not spiciness) can cause a shift in
the body from hot to cold and vice versa, and it is
believed the digestive system must have time to is beneficial for the respiratory system. Red onion
adjust to one extreme before a food of the oppo- bulbs and their leaves (which are added to salads)
site temperature can be introduced. In addition, are consumed to help with diabetes and cancer.
though illness may be related to hot-cold imbal- They are also eaten to ease liver disease, which is
ances, Iranians do not consider certain conditions treated with asparagus and artichokes, too.94
as being hot or cold. Thus, a symptom such as Many foods have a multiplicity of therapeutic
coughing requires specific treatment unrelated to uses. Some Palestinians, for example, consider
classification: consuming cold turnips is considered garlic to be good for colic, nausea, kidney infec-
beneficial, while cold pickles are deemed harmful.86 tions, intestinal worms, ulcers, genitourinary
Some Middle Easterners also believe certain infections, prostate conditions, and tumors, and
combinations of incompatible foods are damaging as an aphrodisiac.2
to health. For example, Egyptians do not consume
fish at the same time as dairy products. Other
Middle Easterners avoid eating sour foods with
milk and legumes with cheese. Iranians believe Contemporary Food
consumption of melon with yogurt causes wind in
the stomach and gastrointestinal disorders. Habits in the
Many special foods are associated with child-
birth. Eggs cooked in garlic and chicken soup are
United States
frequently consumed by Lebanese women after
childbirth. When a woman gives birth to a girl in
ADAPTATIONS OF FOOD HABITS
Iran, coldness is neutralized with a diet high in There is scant information on the adaptation of The demand for properly
hot foods to ensure a male child in the next preg- Balkan or Middle Eastern diets in the United slaughtered (halal) meat
nancy. Saffron custard garnished with nuts is States. It is assumed that, as in other immigrant among Muslims in the
thought to help Iranian women regain strength groups, increasing length of stay is correlated with United States has led to
post-partum, while Palestinian women consume Americanization of the diet, with traditional increased numbers of Arab
halal markets.
oats, coriander, or fennel. dishes prepared and eaten only for the main meal
The division between food and medicine is or for special occasions. It is less likely that reli-
somewhat blurred in the Middle East, especially gious dietary practices, such as adherence to halal
in Arabic nations.2 Turnips are considered good or kosher law, change significantly after arrival in
for the kidneys and urinary tract, while cauliflower the United States.
Ingredients and Common Foods and high in monounsaturated fats and omega-3
Greek Americans still use olive oil extensively, fatty acids (due to a low intake of meats combined
although they use less of it than their immigrant with high consumption of olive oil, fruits, and
relatives.103 Salads still accompany the meal, and vegetables), lowers the risk of cardiovascular
fruit is often served for dessert. Vegetables are pre- disease and cancer.24, 57, 69 Studies on the impact
pared in the traditional manner. Lamb is still very of the Mediterranean diet on the development
popular; for special occasions, roasted leg of lamb of metabolic syndrome conditions (including
is substituted for the whole animal. Consumption obesity, hypertension, and type 2 diabetes, as well
of beef and pork has increased, whereas consump- as cardiovascular disease) have been contradic-
tion of legumes has decreased. Cereal and grain tory.23, 73 In addition, the role of alcohol con-
consumption among Greek Americans remains sumption, particularly wine, in the Mediterranean
high, and bread, rice, or cereal products are usually diet is not yet fully understood.90 What is known
included in every meal. Greek Americans consume is that the number of people consuming this tradi-
more milk than their immigrant parents, and ice tional diet is declining with the Westernization of
cream is very popular. the region. Since the 1960s, the Greeks have been
One small study of first-generation Egyptians consuming significantly less olive oil and more
found that traditional wheat bread remained alcohol.59 Rates of overweight and obesity in
commonly consumed, though intake of legumes, Greece are nearly 50 percent for women and almost
especially fava beans, was somewhat lower than 75 percent for men.45 A recent study in Lebanon
when the immigrants had lived in Egypt. Snacking found younger adults were eating fewer fruits, veg-
and eating out had become much more prevalent, etables, and legumes, while consuming more meat
and soft drinks were more popular.67 and sugar and drinking more soft drinks and alco-
holic beverages, than older adults.77
Sparse data on Bosnian immigrants has shown
that 8 percent of first-time patients seeking care
Greek weddings in the Greek Americans maintain traditional meal pat- at a refugee medical clinic were diagnosed with
United States offer a blend terns, but the main meal of the day is now hypertensive disease, and another 4 percent pre-
of Greek and American dinner.103 They prefer an American-type breakfast sented with diabetes. Thirty-six percent of those
foods; for example, the and lunch, but dinner is more traditional. However,
wedding cake is served in a smaller surveyed subset desired care for
they have adapted Greek recipes to make them less chronic disease management. Providers report a
along with baklava.
time-consuming to prepare and to include fewer need for diet and exercise counseling due to diets
fats and spices. It is assumed that the meal pattern high in sugar, fat, and meat, and low in salads,
for most Americans of Croatian, Serbian, and fruits, and grains. Some refugees have stated they
Slovenian heritage is much acculturated. have little time for exercise beyond work-related
Reportedly many Arab Americans still eat physical activity. Dental problems were signifi-
their main meal at midday.63 Members of the cant, and alcohol abuse may be seen in some
extended family may dine together daily, with the refugees.22, 64
women who stay at home cooking for employed Research suggests that Arab men living in the
female relatives.82 However, a recent study of Arabian Peninsula region may be as susceptible
Egyptian immigrants found that though the to the clustering of risk factors in metabolic syn-
midday meal remained substantial, the main drome as are some other ethnic groups, such as
meal of the day had become dinner.67 Asian Indians (see Chapter 14, South Asians,
for more information). High prevalence of undi-
Life expectancy for adult agnosed type 2 diabetes and hypertension, and
Albanians is very high
NUTRITIONAL STATUS
high rates of insulin resistance, low levels of high
despite very low socioeco- Nutritional Intake density lipoprotein (HDL) cholesterol, and a
nomic status, and some
researchers hypothesize
Very little has been reported on the nutritional tendency toward abdominal obesity were found.
that this is due to a diet composition of the Balkan-American or Middle Coronary heart disease, diabetes, hypertension,
high in monounsaturated EasternAmerican diet. However, research on the and cancer are the primary health concerns
fats from olive oil and low diets of nations bordering the Mediterranean in Arab countries.76 Studies of men and women
intake of animal products (particularly Greece) often report that the tradi- in Turkey, where cardiovascular disease is the
due to privation.19, 32 tional diet there, one that is low in saturated fats most common cause of death, have also reported
strikingly low serum levels of HDL cholesterol and consumption of extra fluids before dawn, fast- Some researchers note that
unrelated to diet, obesity, or lifestyle.68, 91, 101 ing was safe for many of the women. It was also Muslim women who, for
Limited research on Arabs living in the United noted that immigrant Muslim women fasted on religious reasons, com-
States has reported similar health trends. One study average more days than did women born in the pletely cover their bodies
and heads with clothing
of Arab-American adults found that 29 percent of United States.94
when outdoors may be at
men and 37 percent of women were obese (body Cross-cultural research on breast feeding
risk for vitamin D
mass index [BMI] 30), with central obesity reported that 82 percent of Iranian-American deficiency.82
(as measured by waist-to-hip ratio) found in over mothers in the study exclusively breast fed their
50 percent of both men and women. High blood infants. This high rate was attributed to a strong Kurdish and Iraqi refugees
pressures were noted in about 20 percent of the social network of support for the practice. In to the United States may
adults.38 Rates of type 2 diabetes in Arab Americans Turkey, mothers sometimes nurse their sons have been exposed to chem-
in Michigan aged twenty to seventy-five years were longer than daughters because breast milk is ical weapons. They have also
found to be very high: over 15 percent for women believed to increase strength.27, 29 had high rates of malnutri-
and 20 percent for men, with rates of impaired Though rates of celiac disease in the Middle East tion, parasitic infection,
fasting glucose and glucose intolerance above are estimated to be below those in northern hepatitis B, and tuberculo-
32 percent in women, and almost 50 percent in Europeans (see Chapter 6, Northern and Southern sis; and the prevalence of
glucose-6-phosphate dehy-
men.47 When analyzed further, the data suggest Europeans), it is considered the primary cause of
drogenase deficiency is
that lack of acculturation was associated with chronic diarrhea in Iran and may contribute to iron
also significant in this
diabetes risk, as was consumption of Arabic deficiency, malnutrition, rickets, and short stature population.3, 39, 58
foods, being an older age at time of immigration, in children.21, 89, 99 Thalassemia syndromes may
unemployment, and reduced activity in Arab also be prevalent in Middle Easterners.105
organizations.48 The age-adjusted prevalence of
metabolic syndrome was found to be between 23 Counseling
and 28 percent of Arab-American adults in one Considerable discomfort and irritation have been
study, and the most common component was low noted between health care practitioners and their
levels of HDL cholesterol.49 Low HDL cholesterol Middle EasternAmerican clients, much of it due
levels in Arab-American women were accompa- to cultural differences.63 Most difficulties evolve
nied by high triglyceride levels in another study.40 from misunderstandings in the provider-patient
Data on cancer incidence in Arab/Chaldean relationship. Though there are considerable simi-
adults indicate that, when compared to the non- larities in culture between people of the Balkans
Arab white population, the men have dispropor- and the Middle East, even among those immi-
tionately high rates of leukemia, multiple myeloma, grants who share Arabic as a language there can be
and liver, kidney, and urinary bladder cancers, while notable differences in dialect, ethnic background,
women have greater proportions of leukemia and and socioeconomic status.46 Religious affiliation
thyroid and brain cancers.97 However, the leading and degree of orthodoxy are equally important.
causes of cancer-related deaths in Arab Americans Furthermore, English language skills vary greatly.
are lung, colorectal, and breast cancers.16 Among Arabs, for example, fewer than 14 percent of
The effects of Ramadan fasting have been Lebanese Americans spoke English less than very
explored among Muslims. Though hunger increases well, compared to 42 percent of Iraqi Americans
in some fasters, there were no significant changes in the 2000 census.10 Language and communication
in body weight noted in one study.25 Increases in problems are significant health care access issues
uric acid blood levels have been noted when weight according to some recent Arab immigrants.60 Many
loss occurs in nonobese men, however, which may Bosnian refugees, especially women and elders
be related to high rates of kidney stones and angina who are homebound, have poor English skills and
pectoris reported in some epidemiological surveys lack of interpreter services is one barrier to health
conducted during the month-long fast.35, 80 A care services.22
majority of pregnant women go through Ramadan, Interactions are highly contextual throughout
and one study suggested that with certain precau- the Balkans and the Middle East, meaning that
tions, such as excluding women with medical risk body language and general atmosphere are as
factors (including diabetes and history of preterm important to communication as words, if not more
deliveries or renal stones), increased prenatal so (see Chapter 3, Intercultural Communication).
visits, avoiding strenuous exercise, staying cool, People in the Middle East spend time getting to
know one another before any business is dis- may make the final decisions regarding care,
cussed. Offering coffee or tea at the beginning of their presence should be valued and their opin-
any interaction helps to establish a warm and ions fully solicited. However, if the client is a
hospitable atmosphere with many Balkan or woman, she may ask to have her husband or father
Middle Eastern clients.26, 63 sign medical forms, presenting liability issues
Direct eye contact is expected and necessary to regarding consent.108
interpret meaning, so Middle Easterners usually Balkan- and Middle EasternAmericans value
sit or stand quite close when conversing with inti- biomedicine and have considerable respect for
mates but may retain a larger distance with authority figures.108 They may be hesitant to ask
strangers.108 Greeks may smile when angry. questions when confused, however, or they may
Nodding ones head up and down or back and provide answers that are designed to please the
forth can be very confusing. Traditionally, moving provider. The health provider may have to assess
the chin up and down meant no and back and and give advice about a medical or dietary prob-
forth meant yes or I dont understand. But lem without the client explaining his or her
many Greeks and Middle Easterners use the needs. If the provider does not repeat the offer to
American protocol, so it is difficult to know help, the client may believe that the provider is
whether the gesture is affirmative or negative. indifferent. Privacy is strongly protected, and
Touching between members of the same sex is clients may resist disclosing information about
frequent, including handshaking, patting, shoul- themselves and their families to strangers until a
der slapping, hugging, and kissing. Contact trusting relationship is established. Concerns
between members of the opposite sex is prohibited regarding confidentiality may also inhibit discus-
in some Middle EasternMuslim cultures and sion of some medical concerns, especially for
avoided in most. Extended eye contact between Bosnian refugees and many Arab Americans.
men and women can be considered a sexual over- There may be suspicion regarding questions
ture (staring between members of the same sex is about religious affiliation or socioeconomic data.
acceptable). The left hand is not used for any social Fear of racial profiling may occur.46 Further,
purposes, nor to pass documents or administer shame about certain conditions may cause non-
medications.26, 85 In general, it is best to wait for compliance when a client is in public situations.
Middle Easterners to extend their hand in greeting Diabetes, for example, may be associated with
before making any unwanted contact. Proper pos- male impotence and female infertility. Strategies
ture is a sign of respect, and crossing ones legs, for adhering to diet modifications without disclo-
pointing with the foot, or showing the sole of the sure of the cause can increase efficacy.56
shoe is considered impolite. In Turkey one should A study of Middle Eastern immigrants from
stand when an elder enters a room. several countries representing five ethnic groups
Due to the significance of how the message is found that, in general, immigrants who perceived
communicated to Americans of Balkan or Middle themselves as more traditionally ethnic experi-
Eastern background, providers may find that enced more physical complaints and had lower
some of their clients are more receptive to verbal morale. Immigrants who were more acculturated
than to written information. A few minutes for reported better health.72 Complaints by clients of
general questions about the well-being of other Balkan or Middle Eastern heritage are frequently
family members or personal interests of the client generalized or nonspecific, sometimes indicating
should be allowed at the beginning of the interac- anxiety or depression in a patient who does not dis-
tion.84 It is important to speak kindly, softly, and tinguish culturally between physical and mental
respectfully.86, 108 Individual clients may be inex- health. This may be particularly true with Bosnian
perienced with making independent decisions, refugees, who sometimes present with ill-defined
thus options should be kept to a minimum to symptoms and may suffer from anxiety, depres-
avoid overwhelming the client with too many sion, and post-traumatic stress disorder.22, 108
choices.56 Family members, especially an elder Middle Eastern Americans may expect the
male relative, may insist on participating in all health care provider to make decisions for them
conversations, even those that customarily take and be responsible for the consequences. They
place in the office between only the practitioner may also demand the services of the top expert or
and the patient. Because these family members the department head because the expectation is
NEW AMERICAN PERSPECTIVESEgyptian

Miral Maamoun, MD
am an Egyptian citizen and lived in Cairo for twenty-six years. Before coming to the United States, I graduated from medical
I school as a general practitioner and worked as a GP for two years before I got married to my husband who is a PhD graduate stu-
dent in the United States.
In Egypt I used to eat three meals a day and snack on fruits once a day. Breakfast usually included fava beans, baladi bread,
cheese, and a cup of milk. Sometimes falafel is added to the menu and occasionally a hot wheat cereal called Beleela. Lunch is the
main meal of the day and is eaten around three oclock. It contains rice or pasta together with vegetables and meat. Chicken was my
favorite meat, but I also ate fish twice a month.
Dinner was served around 8:00 p.m., and it included a choice of three of the following: cheese, baladi bread, yogurt, eggs, falafel,
fava beans, tomatoes, cucumbers, fried egg plant, and/or mashed potatoes. Water was the typical beverage with meals.
Once I came to U.S., the first thing that changed was the timing of my meals. Meals became two hours earlier than what I was used
to. I tried to keep the quantity and quality of the food at lunch the same as in Egypt, but my husband felt too full to continue his work-
day with comfort after that, and he liked a lighter lunch of just soup, fruits, or one-third the quantity of the traditional lunch. Thus,
dinner became the usual Egyptian lunch. In addition, we added one more meal before bedtime, which is usually a cake with milk.
The first time I invited friends over for lunch on Saturday, I was surprised that they knocked on my door at twelve oclock. Of
course I was in the middle of cooking, and I was not even ready to host them. My husband was not even home. It was kind of embar-
rassing. I called my husband, who came right away, and the women ended up with me in the kitchen helping me with the cooking.
They told me that it was too much food for lunch, and I should have mentioned that I was serving dinner. I was thinking dinner when
I invited them, but I said lunch as it used to be the main meal we invite people over to share.
When I first came to the United States, I was impressed and tempted by the variety of food available and by how easy it was to
prepareall those ready-made sauces, dressings, appetizers that you didnt have to prepare; frozen food already peeled, cleaned,
and ready to cook. I used to spend a lot of time cleaning and peeling in Egypt, so now cooking is easier for me. I tried not to change
the use of fava beans and baladi bread in my diet. I cant resist the taste as these dishes made with fava beans can be done in many
different delicious ways. I did have to replace the baladi bread with whole-wheat toasted bread as it is the closest to it, and I cant
find the traditional baladi bread here.
My dietary advice to an Egyptian who has not yet acculturated is to have a good breakfast of traditional foods in reasonable quan-
tity, eat lunch with more vegetables and less meat, and snack on fruits around three oclock. Fruits can be the desserts, and only
occasionally eat American-style desserts. Dinner can remain the same as the traditional Egyptian dinner of yogurt, low-fat cheese,
milk, beans, salad, and vegetables. Before-bedtime meals can still be fruits. If they are acculturated, I would recommend that they
watch the portion size of their diet and have extra lean meat if they have to eat meat more than once a dayand perhaps try to go
back to the traditional meals on weekends for a change.
that they will receive the best care from the most It is considered sacrilegious to presume death
senior, most powerful person in the system.63 because only God can make that final decision,
Female health care providers may face added dif- and hope must always be maintained.
ficulties in gaining the trust and respect of Balkan Muslim clients usually feel most comfortable
and Middle Eastern clients due to cultural norms with providers of the same gender.85, 108 One study
regarding gender. Clients may believe that the of Middle EasternAmerican parents indicated
more intrusive the medical procedure, the more that they did not choose health care providers
effective the treatment.71 A poor prognosis should based on ethnicity.70 Access, referrals, and effec-
be discussed with the family first and revealed in tiveness were factors in their choice. In contrast,
stages, preferably over several appointments. another study found that less acculturated Greek
Among Iranians, the disclosure of bad news too Americans preferred seeing counselors (for psycho-
quickly can cause a patient to become narahati.86 logical services) of the same ethnic background.87
Consistent care from a single provider is most explain how the recipe reflects the ingredi-
successful and may eliminate many communica- ents of the region.
tion difficulties. 4. What are common health problems associated
Practitioners report that many Bosnian clients with peoples from the Balkans or the Middle
did not understand the importance of taking pre- East? Pick one group and a health disorder, and
scribed medications, and some did not follow describe that groups cultural beliefs regarding
instructions on how they should be taken or dis- the cause and appropriate treatment of that
continued their use when side effects occurred.64 disorder.
Though few studies have been conducted to 5. In several countries from these two regions,
Many pregnant Muslim- assess the continuing use of traditional health food and illness may be classified as hot or
American women in one practices in the United States, it is believed that cold. What does this mean? Provide examples.
study reported that they did Bosnians frequently take herbal cures and alcohol-
not discuss Ramadan fasting based tinctures simultaneously with biomedical
with their prenatal care therapies.108 There are little data about the thera- CHAPTER 13 REFERENCES
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CHAPTER
14
South Asians
S outh Asia is the geographic region comprising supplying the plains of the South before emptying Fewer than 50,000
the nations of India, Pakistan, Bangladesh, into the Arabian Sea. Pakistan received its inde- Sri Lankans, Nepalese,
Sri Lanka, Nepal, and Bhutan (see Figure 14.1). pendence from India in 1947 to provide a homeland and Bhutanese combined
Immigrants from South Asia, mostly India and for the Muslim minority of that nation. It was a have immigrated to the
bitter split. Two wars between the countries have United States. As many as
Pakistan, are one of the fastest-growing populations
150,000 Bangladeshis are
in the United States. been fought since independence, and tensions
estimated to live in the
India is a culturally complex country with a continue over the province of Kashmir. Though
nation (many may be
population of more than 1 billionnearly four Pakistan is an Islamic state, it is divided into four undocumented), most of
times that of the United States. The sophisticated regions, each with its own cultural groups and whom have arrived since
civilization began approximately 4,000 years ago languages: Punjab, Sindh, Baluchistan, and the 1990.45, 108
and is the source of some of the most influential North-West Frontier Province (NWFP).
religions, art, architecture, and foods in the world. While India and Pakistan share a past, Asian
The South Asian subcontinent contains the fertile Indians and Pakistanis each bring distinctive
Indus and Ganges river basins, as well as parts of contributions when they move to the United States,
the Himalayan mountain range; it varies in climate particularly in their traditional foods and food
from extensive desert regions to jungle forests to habits. This chapter examines the customary
the worlds largest mountain glaciers. The people diets of India and Pakistan and the changes that
of India are as diverse as its geography and climate. occur when immigrants from these countries
People from virtually every racial and religious move to America.
group have migrated to or invaded India at some
time in history, and each group has brought its own
language and customs. As the different races and
religions intermingled, other cultures were created. Cultural Perspective
One result is that there are currently 15 separate
languages recognized by the Indian government. HISTORY OF ASIAN INDIANS AND PAKISTANIS
Nearly 300 languages are actually spoken in India,
and there are approximately 700 dialects.
The Islamic Republic of Pakistan, located to Given the complexity of South Asian culture, it is
the northwest of India, encompasses some of the not surprising that the immigrants to the United
most rugged territory in the world. The Himalayan States from India and Pakistan differ from other
Mountains stretch across the North, including immigrant groups in several ways. Most signifi-
the second-highest peak in the world, K2. The cantly, the majority arriving in America are not
Hindukush range defines the northwestern region. escaping political or economic pressures in their
From these mountains spills the Indus River, homeland. Since 1965, when the national quota
442 SOUTH ASIANS
CHINA
AFGHANISTAN
PAKISTAN
BHUTAN
NEPAL
INDIA
BANGLADESH
Arabian Sea Bay of Bengal
SRI LANKA
Figure 14.1
India and Pakistan.
Confusion over the term system was temporarily dropped from U.S. the early twentieth century. Many were employed
Indian (does it mean a immigration laws, the majority of South Asian by the railroads, and others established large
Native American or an Asian immigrants have been from the upper socioeco- farms. They faced overt discrimination and per-
Indian?) has made it difficult nomic classes. They were somewhat acculturated secution. Newspapers warned of the Hindoo
to find consensus on a at the time of arrival, often fluent in English, and invasion; anti-Asian Indian feelings brought
designation for Asian Indians
acquainted with many American customs. about the expulsion of Asian Indians from
living in the United States.
Washington logging communities and in 1907
Indo-American has emerged Immigration Patterns
as the term preferred by sparked violent riots in California. Although such
many Asian Indians. Asian Indians. The first immigrants to the extreme bigotry lessened in time, the Asian-
United States from India were members of the Indian immigrant population remained small
Sikh religion, who arrived on the West Coast in until after World War II.
Chapter 14: South Asians 443
Relaxed immigration laws encouraged Asian Some Asian Indians coming to the United
Indians, especially well-educated urban profes- States in recent years are exiles from regions
sionals, to come to America in the 1960s and where Indian immigration in the past has been
1970s. Economic and social adjustment was a substantial, such as East Africa, Fiji, and Guyana.
priority for this group, although many Asian- These immigrants often feel unwelcome in Indo-
Indian traditions continue within the privacy of American communities, and form separate
the home. These immigrants formed a self- enclaves.11
reliant community and discouraged comparison The relative affluence of Americans of Asian-
or identification with other ethnic groups.79 Indian heritage is due mostly to a well-educated
Pakistanis. Though Muslims from northern population: nearly 64 percent held a college or In the early 1900s it was not
India certainly came to the United States prior to graduate degree in 2000.94 Many were employed unusual for single Sikh men
the founding of Pakistan, immigration from the in professional or white-collar occupations in India, living in the United States
nation technically began in 1947. However, prior such as college professors, engineers, physicians, to marry Mexican-American
to 1965, only 2,500 Pakistanis moved to the and scientists, and most continue their careers in women and start families.
United States. Beginning in 1965, when certain the United States. Nearly 60 percent of Indo-
immigration quotas were lifted, thousands have Americans hold management or professional
been arriving from Pakistan each year. jobs.94 Newer immigrants have found success in
small business and franchise ownership involving
Current Demographics and Socioeconomic many members of their extended family. Motel
Status and hotel ownership is especially common, and it
Asian Indians. According to U.S. Census esti- is estimated that over 37 percent of these busi- Over 700,000 Canadians of
mates for 2005, the Asian-Indian population has nesses nationwide are run by Indo-Americans.79 Asian-Indian descent and
increased more than 500 percent during the pre- Median family income is 30 percent above the nearly 75,000 of Pakistani
vious twenty-five years, from 400,000 to an esti- descent were listed in the
national norm, and family poverty rates are well
mated 2.3 million. Indo-Americans are now the 2001 census.
below average.94
second largest Asian population in the nation. Many Asian Indians come to the United States U.S. Census data show
Over 75 percent of Indo-Americans are foreign- to complete their college or postgraduate education. median household income
born, and most of them have arrived since 1980.94 They are often unmarried or have left their spouses for foreign-born
Asian Indians have settled throughout the United and children in India. It is not uncommon for the Bangladeshis is almost
States, but especially in the metropolitan areas of families to join the student in America after he or 25 percent below the U.S.
California, New York, and New Jersey, as well as she has become financially established. norm, and nearly 18 percent
in Illinois, Maryland, Massachusetts, Michigan, of families live below the
Ohio, Pennsylvania, and Texas. There are also sev- Pakistanis. As of 2000, census figures suggest poverty level.108
eral Asian-Indian settlements in the agricultural the number of Pakistani Americans is over 150,000,
regions of California.79 three-quarters of whom are foreign-born immi-
Small numbers of Asian Indians coming to grants, nearly all of whom have arrived since 1980.94
America today are from rural towns and villages. A majority have come from large cities and have
They are less educated and have experienced less settled in the urban areas of New York City,
exposure to Western society than previous Indian Chicago, Philadelphia, and Los Angeles. Though
immigrants. There are also fewer professionals many associate primarily with others from their
among them. Many recently arrived Indians are ethnic groups, particularly Sindhis, Punjabis, and
self-employed in jobs that serve their Asian-Indian Baluchis, the Pakistani community is united at
immigrant community, such as restaurateurs, the national level.80
importers, and travel agents. These newcomers The immigrants who first arrived after 1965
often identify more with their immediate ethnic were typically well-educated professionals seeking
subgroup community, such as the Gujaratis, employment in professions such as law, medi-
Bengalis, Marathis, or Tamils, than with the wider, cine, computer technology, and teaching. Many
pan-Indian community.79 The religion, language, students obtaining advanced degrees also chose
and social class of each cultural subgroup retains to stay in the United States. Over 54 percent of
greater importance for recent immigrants than for Pakistani Americans hold a college degree.94
previous immigrants from India, and their adjust- However, Pakistanis are often grouped with
ment to American culture is often more difficult. Asian Indians and Arabs in data collection, so
444 SOUTH ASIANS
little is known specifically regarding their socio- Most come from the upper castes of Brahmans
economic status. It is believed that most Pakistani and Kshatriyas. As with all cultural practices, it is
Americans are solidly middle class or upper important to remember that even within a group
middle class. Home ownership is valued and may there is great diversity of individual beliefs and
be higher than average compared to other recent customs.
immigrant groups.
Though family income for all Pakistani Religion
Americans is slightly above the U.S. median, family Asian Indians. The influence of religion on Indian
poverty levels are more than 20 percent above the culture is ubiquitous. Every aspect of life and
national average, suggesting some subgroups may death is affected not only by individual religious
not be as economically successful as the income affiliation, but also by the Hindu ideology that
figures imply.94 In recent years less educated and pervades Indian society.
less acculturated Pakistani Americans have immi-
Hinduism. Nearly 85 percent of Indians are
grated, sometimes sponsored by relatives and
Hindus. Hinduism is an ancient faith, believed to
sometimes seeking employment opportunities.
have developed in India between 2000 and 1500
These newer arrivals often do manual labor or
B.C.E. from the Aryan hymns and prayers known
factory work, or open businesses to serve the
as the Vedas mixed with elements from traditional
Pakistani community, such as restaurants, markets,
Dravidian religion (see Chapter 4, Food and
newspaper stands, and travel agencies. Further,
Religion, for more information about Hinduism
small numbers of Pakistanis have settled in rural
and other major Indian religions).
areas, doing field or cannery work and other blue
The Hindu Society of India established com-
collar jobs.80 Pakistani Americans may suffer
munity organizations to serve the religious needs
employment and housing discrimination due to
of early Asian-Indian immigrants to the United
prejudice against Muslims.
States. Many Hindu temples now exist in regions
where Asian Indians have settled, with services
WORLDVIEW and religious ceremonies conducted by Brahman
The Caste System in India priests (who are often employed part-time in
other occupations). However, temple attendance
The untouchables were The traditional Indian caste system, which influ-
may be limited to significant religious events.
considered impure ences the social structure of many Asian-Indian
because of their contact Small shrines are often created in Asian-Indian
groups, is the Hindu method of ordering an indi-
with cattle carcasses and apartments or houses so that prayer and medita-
viduals role in society. A more encompassing
their consumption of tion may take place at home.
term is jati, which is the organization of all aspects
scavenged beef.
of Hindu life, including actions, places, things, Islam. Today the Islamic religion in India is
and symbols, not just people. Caste categories are second only to Hinduism in number of followers;
A reverence for all life, called
ahimsa, is fundamental to hereditary. There are four main castes associated one in every nine Asian Indians is a Muslim. Islam
Asian-Indian ideology. It is with certain professions (although members are was brought to India by traders from Persia, and
reflected in the religions not necessarily employed in these jobs): the it expanded with the Muslim invasions of the
native to India, as well as in Brahmans (priests), Kshatriyas (soldiers), Vaisyas northern regions beginning about 1000. The
the vegetarian diet that (merchants or farmers), and the Sudras (serfs). Islamic Moghul Empire dominated the country
many Indians follow. These castes are divided into more than 1,000 for nearly 800 years. The influence of Islam is
subcastes, usually according to occupation. seen today mostly in northern India.
The Moghul culture Existing outside the caste system are individuals
combined Persian and Buddhism. Buddhism developed as a protestant
considered so impure that they are called
Indian influences, as revolt against Hinduism. Its founder, known as
untouchables. Although the laws discriminating
seen in the architectural Gautama Buddha, lived in India during the fifth
against untouchables were repealed in 1949, this
masterpiece of the period, century B.C.E. Although it is a popular religion in
the Taj Mahal. group of the desperately poor continues to occupy
other parts of Asia, Buddhism is followed by less
the lowest stratum in Indian society.
than 1 percent of Asian Indians today.
The caste system has permeated Indian society
despite the fact that it is an exclusively Hindu Jainism. This branch of Hinduism developed at
classification. Americans of Asian-Indian descent about the time Buddhism emerged. The Jains
often continue to identify proudly with their caste. believed that all living things have souls. Some
wear masks to prevent breathing in insects and Judaism. Four small Jewish communities were The kirpan has become a
sweep a path in front of them to prevent stepping established in India when Jews fled persecution civil rights issue in some
on any creatures. Orthodox Jains are strict vege- in Greece, Palestine (under Roman domination), U.S. public schools, pitting
tarians. Approximately 2 percent of Indians are Iraq, and Germany. The largest populations are religious freedom against
Jains; in the United States, Jains have established found in Bombay and Calcutta. provisions restricting
weapons on campus.
their own temples for worship.
Animism. The oldest religions in India are those
Sikhism. The Sikh religion differs from Hinduism practiced by the small tribal populations that live
in its belief in a single God. It is best known for its in isolated regions of the Himalayas. They wor-
military fraternity, although most Sikhs in India ship spirits associated with natural phenomena, a
are farmers. Male Sikhs wear a turban and follow religious practice known as animism. In the past
the five Ks: uncut hair (kes), a comb worn in the they have practiced such varied social customs as
hair (kanga), short pants (kaccha), a steel bracelet polyandry (having more than one husband) and
worn on the right wrist (kada), and use of a special head hunting.
saber (kirpan). Each has a spiritual meaning; for Pakistanis. Nearly 98 percent of Pakistanis are
example, the short pants symbolize self-restraint; Muslim (approximately three-quarters are Sunni
the bracelet, obedience; and the comb, purity of and one-quarter are Shiite). Small numbers of
mind. In the United States many Sikhs continue Pakistanis are Hindus, Christians, Sikhs, and
these traditions, though some men forgo uncut Zoroastrians. In the United States, families attend
hair to better fit into American society.79 Although a local mosque at least once a week, and men often
Sikhs are only 2 percent of the population in attend daily. Religious education for children is
India, it is reported that they make up nearly one- expected, often occurring on weekends, and may
third of Asian Indians living in California. include instruction in Arabic (so that the Quran
Christians. It is estimated that Christians make can be read in its original language). There are
up 3 percent of the Indian population. One form few strictly Pakistani congregations, and some
of Christianity emerged when the Syrians, who followers may only attend on special holidays if
migrated to the Malabar Coast of southwest India there is no local mosque and they must travel
in 345 C.E., intermarried with native people. Syrian long distances for services.
Christians do not observe Hindu dietary laws, but
Family
they do participate in the caste system. Their
agricultural community is operated with farm Asian Indians. The husband is the head of the
laborers who can be described as serfs. Another household in the traditional Indian family. The
Christian community developed at the former wife usually does not work outside the home and
Portuguese colony of Goa, farther north on the is expected to perform all duties related to house-
southwest coast. Approximately half of citizens keeping and childcare. She obtains help in these
are Catholic, known as Goan Christians, and the responsibilities from the extended family and, in
city is dedicated to St. Catherine. some homes, from servants. If the wife does hold
a job, she can depend on the help of relatives. Chil-
Zoroastrianism. More than 1,200 years ago the dren are expected to show respect for their elders;
Parsis fled from religious persecution in Persia to parents may choose what career a child should
northern India. The religion they brought is pursue. Dating is uncommon in India, and many
known as Zoroastrianism, an ancient faith that marriages are arranged by families based on sim-
venerates Ahur Mazda, the wise god of fire. The ilarities in caste, education, religion, and upbring-
sacred fires of Zoroastrianism are tended in ing between prospective husbands and wives.
temples protected from the sun and from the eyes In the United States most Indo-Americans live
of unbelievers. The Parsis have adapted many of in nuclear families, and strains in the traditional
their practices to blend into Indian society but structure often occur. Asian-Indian women are
have maintained their faith through private more likely to work in America than in their
schooling of their children. Parsis are considered homeland, yet they lack the support system of an
the most Westernized of all Asian Indians, and extended family. Elders may also find themselves
significant Parsi communities are found in New cut off from their traditional role of advisors and
York and Los Angeles. may not have opportunities for involvement in
446 SOUTH ASIANS
certain religious activities that would fill their lives immediate members, though close relatives such
in India. Some Asian Indians, especially women as grandparents or aunts and uncles may live in
raised in India, find it difficult to adjust to these the home for extended periods. Some women
changes. More men than women choose to become prefer a traditional role. They may remain at
U.S. citizens. home throughout the day and may never acquire
Children who grow up in the United States English language skills. Others straddle a middle
usually insist on making their own career choices. ground, working during the day, interacting with
Dating has become more acceptable, but most non-Pakistanis, and returning at night to don tra-
parents strongly discourage relationships with per- ditional garb and perform customary religious
sons of other ethnic or religious backgrounds.79 and family chores.
Though most parents do not choose their childs Many young Pakistani Americans are not
spouse, many Asian-Indian children still defer to allowed to date, and marriages are still frequently
their parents opinions; young male students in the arranged. In the most conservative homes, girls
United States sometimes ask their families in India may be withdrawn from public schools in the
to find suitable wifes for them. seventh grade to prevent mixing with boys. If
Elders are well respected in Indian culture, and private segregated schools are unavailable or
it is considered auspicious to have a senior at any unacceptable, girls may be schooled at home or not
social function.114 Older women are considered at all. Other Pakistani teens are well integrated
experts in family matters. Traditionally, the oldest into American life and education, continuing on
sons are expected to care for their parents, who in to college and often attaining advanced degrees.
turn often help out with caring for children in the
family. Some Indo-Americans continue the practice Traditional Health Beliefs and Practices
of having elder parents in the home, and others Asian Indians. Traditional medicine in India
(with parents who still live in India) host their has a long and distinguished history. Several
mothers or fathers for months at a time. systems have developed over several thousand
In India marriage is consid- The family is seen as the way to preserve years, the most important of which is Ayurvedic
ered the beginning of a Indian values and beliefs while living in America. medicine, which established the humoral concepts
relationship from which Even after establishing permanent residence, a of the body that were later adopted in Greece
love develops over time. majority of Asian Indians regard their national and eventually evolved into biomedicine as it is
identity as more Indian than American.103 There practiced today.
is also strong interest in sponsoring the immigra- Ayurvedic medicine developed into its current
tion of relatives to the United States. Most Asian form between 500 B.C.E. and 500 C.E.; it is based
Indians have found successful adjustment in the on Sanskrit texts and the writings of practitioners.
United States through educational and economic Ayur means longevity and veda means science
achievement in American public life, while main- or knowledge. The purpose of the Ayurvedic
taining an emphasis on Asian-Indian culture system is to ensure a long and active life so that
within the privacy of their home life. the wisdom of elders may be passed down to future
generations. Ayurvedic physicians, called vaidyas,
Deepak Chopra, an Pakistanis. The traditional Pakistani home is are trained at government-supported schools that
Indian-born physician, strongly patriarchal. The husband is often the only grant degrees based on an established curriculum.
has popularized Ayurvedic wage earner in the family, and the wife is expected Their diagnosis focuses on who the person is that
medicine in the United to stay inside the house to raise the children.80 has the illness: their tastes, their work habits,
States through his best- She is allowed out to do essential chores such as their character, and their life history. Evaluation of
selling books and videos.
shopping, but other activities require that she be the pulse, the face, the eyes, and the nails provides
accompanied by her husband. Faith is the center- further data. A persons constitution, including
piece of family life for Muslims, and modesty for temperament and preferences in food, is believed
women is prized. to be determined at birth.
Women are not allowed to have contact with Ayurvedic therapy uses diet, herbal remedies,
unrelated men after puberty, and inappropriate and meditation to reestablish equilibrium
touching could bring shame on the entire family between the sick person and the universe, includ-
and make a young girl unsuitable for marriage. In ing the social, natural, and spiritual worlds. Diet
the United States most households include the is considered most significant.
Foods are classified as hot or cold depending therapeutic properties.21, 58, 68 Medications available Meditation is the quiet
on their effect on the body and must be balanced only through prescription in the United States can consideration of religious
for each condition (see Therapeutic Uses of Food be purchased over the counter in India. Widespread teachings to understand
section later in this chapter). In addition, more use of antibiotics and mixing of therapeutics have faith and to achieve spiri-
tual enlightenment. It is
than 700 plants and animal substances are listed been reported.86
practiced by Hindus and
in the Ayurvedic texts for prescriptive use.
Pakistanis. Little has been reported on the tra- Buddhists, and by some
Because the mind, body, and soul are all considered Christians and Muslims
ditional health beliefs and practices of Pakistanis,
to be interconnected parts of the whole system, as well. Transcendental
though it has been noted that complementary care
meditation is used to address imbalance in the meditation (TM) is associ-
may be sought concurrently with biomedicine.34
spirit of a person. ated with yoga and has
A recent study found 23 percent of a sample of
Ayurvedic medicine has declined somewhat no affiliation with any
young, well-educated residents of Karachi sought
in popularity in India as Westernized medicine specific religion.
the help of healers, known as hakims.81 Similar to
has become more established and is frequently
the same-named practitioners in India, hakims
perceived as a paraprofessional practice. Folk
use Islami-Tibb, a humoral form of medicine
beliefs about health and illness are found in some
adapted from traditional Arab systems and
regions. For example, Yunani or Unani-Tibb
related to Indian Unani-Tibb. Therapeutic herbs
medicine is common in the northern areas of Homeopathy is well
or botanicals are used to maintain balance in the
India. It is an Arabic system that has been modified accepted throughout
body and to cure a variety of ailments, such as
by Indian practitioners known as hakim. It is a India and Pakistan.
common colds, coughs, cancer, leprosy, and
humoral system that identifies four humors
reproductive disorders. Respondents who used
yellow bile, black bile, phlegm, and bloodand
such services reported that they believed hakims
four qualitiesheat, cold, moisture, and dryness.
were reliable and inexpensive; those who did not
Health is sustained through balance of these
visit hakims questioned their effectiveness and Pakistani hakims sometimes
humors and qualities. Illness is treated by com-
safety. Ayurvedic medicine is also available. use exotic preparations, such
plementary remedies; for example, disease due to
Prophetic healing, prayer, and home remedies such as those made from opium
too much cold is cured with a hot therapy. Diet is
as honey are often used to treat minor conditions poppies or monitor lizard oil,
an important therapeutic tool, and advanced
or to seek protection from malign influence.81, 101 in their treatment programs.
conditions are often treated first with a fast, or
limitation of intake, to allow the digestive system
to rest.100 Siddha medicine, another humoral
system, is developed within Tamil culture and is
found mostly in southern India. Older practices,
Traditional Food
such as the use of shamans, bonesetters, and Habits
snakebite healers, are found in some rural regions.
Home remedies such as herbal infusions and It is difficult to generalize about Indian cuisine
poultices are prevalent in India, often derived because of the diverse geography and heteroge-
from Ayurvedic prescriptions or other traditional neous population of the country. Foods vary north
practices, but administered by home diagnosis. to south, east to west, region to region, and among
Many are known to have pharmacological activity, religious and caste groups. The cooking of Pakistan
and several are contraindicated in certain medical is considered similar to aromatic northern Indian
conditions or toxic in some preparations. Examples fare, though with Persian and Afghani influences,
include aloe vera for obesity, liver problems, and including a greater emphasis on meat dishes and
both high and low blood sugar levels. Licorice a preference for onions, ginger, and garlic.
root is used for indigestion and stomach aches,
urinary tract problems, constipation, colds, and INGREDIENTS AND COMMON FOODS
coughs. Black nightshade is considered helpful in
heart disease and liver problems. Diabetes is Staples
treated with numerous cures, including pellitory, India. Few foods are eaten throughout all of
neem, gu-dmar, and puncture vine.107 Recent sur- India. Grains and legumes predominate in the
veys of more remote areas of the country have frequently vegetarian cooking, with added veg-
identified numerous previously unknown plants etables and fruits. Dairy items often supplement
used by local inhabitants, many with demonstrated the diet. The types of ingredients and preparation
448 SOUTH ASIANS
Hindi term for dried beans, peas, and lentils,

which come hulled, skinned, whole, and split (in
some literature the British word pulse is used
instead). Dal is also the name for the dish made
when they are boiled and seasoned. They are also
commonly added to rice or soups, prepared as
seasoned purees, or ground into flour to make
distinctive breads (see Table 14.1).
Dairy foods are significant in most regions.
Fermented milk products such as yogurt are found
throughout most of the country, as is the cooking
fat ghee, which is pure, clarified butter (this butter,
known as usli ghee, is too expensive for daily use
in many homes, so vegetable shortening, also

called ghee, is often used instead). Seasonings are
distinctive. Masalas are mixtures of spices and
herbs that can be either fresh and wet or dried and
powdered. Coriander, cumin, fenugreek, turmeric,
Traditional foods of India. black and cayenne pepper, cloves, cardamom, cin-
Some foods typical of the namon, and chile peppers are a common blend
traditional Indian diet include methods vary by locality and, often, according to that is called curry in western countries. Other
amchoor (mango powder), religious practices. typical spices and herbs include ajwain (carom or
basmati rice, broccoli, coconut, Rice is the grain most commonly consumed, loveage seeds), amchoor (unripe mango powder),
cucumber, eggplant, ghee, and the average Indian eats half a pound of it asafetida (a pungent powdered resin), coconut,
herbs and spices (black pepper, fresh coriander, garlic, mint, saffron, and tamarind
each day. This amount, however, varies consider-
cardamom, chiles, fresh
ably by region, and it is most popular in the (the sour pulp of a bean pod).12 Beyond these
coriander, cloves, coriander
seeds, cumin, garlic, ginger southern and eastern areas of the nation. generalities, the staples of the Indian diet are best
root, mint, mustard seeds, Wherever it is consumed, long-grained rice is classified by region.
nutmeg, tamarind, and preferred. Wheat, used primarily in breads, is The greatest division in diet is seen between
turmeric), lentils, peas, another staple. Legumes are consumed daily by northern and southern India. Northern cuisine is
plantains, and yogurt. nearly all Asian Indians. Dal (or dhal) is the characterized by the use of wheat, tea, a large
Table 14.1 Selected South Asian Dals

English Hindi Common Preparations
Black lentils (black gram) Urad dal Black skins with creamy insidesboiled, added to rice or vegetables, seasoned with mustard oil (Bengal);
often ground for flatbreads (e.g., pappadams) or fermented and combined with rice flour to make
flatbreads (e.g., idli, dosas).
Black-eyed peas Lobhia Boiled, seasoned with onions, ginger, garlic (in the North), ginger, asafetida, mustard oil (in the West), or
coconut (in the South).
Chickpeas (Bengal gram) Channa dal Most commonly used dal in Indiaboiled, added to curries, chutneys, rice (pulao); pureed (sambar);
roasted whole for snacks; ground into flour (besan) and added to curries, used for deep-fried fritters;
made into thick, sweet puddings for dessert.
Green peas Mutter dal Boiled, added to curries, rice (pulao) or pureed.
Hyacinth beans Valor Boiled, often seasoned with coconut, ginger, and jaggery; sprouted in soups, salads.
Lima beans Pavti Boiled, mixed with vegetables (esp. potatoes, eggplant), added to curries; made into fritters or patties.
Madras beans (horse gram) Kulith Assertive earthy flavorboiled, added to curries; powdered for soup.
Mung beans (green gram) Moong dal Brownish greenboiled with spices, added to rice (khichri), made into dumplings; sprouted for salads.
Red lentils Masur dal Salmon coloredboiled, often mashed and added to meat for kebabs or curries (most common in the North).
Yellow lentils (yellow split peas) Toor (Arhar) dal Pale yellowboiled, often pureed with seasonings, or added to rice (khichri); mashed with other dals or
rice to make pancakes (adai).
EXPLORING GLOBAL CUISINEVegetarianism in India
T he ancient Indian diet featured a Yet the definition of vegetarianism in are found in the northwestern and central
variety of meats, such as cows, bulls, India is elusive. It is usually considered a regions (see map). Overall, it is believed
buffalos, horses, rams, goats, and symbol of piety in the Brahman castes and that 30 percent of Indians are strict
pigs, in addition to wild game including may be a necessity among the poor. vegetarians, abstaining from all meat,
deer, alligator, and tortoise. The vegetarian Abstinence from meat and poultry is poultry, fish, and eggs but consuming milk,
ethic entered India slowly, probably begin- most common; however, nearly all Indian yogurt, and other dairy products.
ning with the bulls and barren cows used vegetarians consume milk products, and
for sacrifice by the Aryans. Later, prohibitions some eat eggs. Fish is problematic because
were extended to the milk cow and the draft it is an inexpensive food where available.
bull, as well as the village pig (a useful Except in the state of Gujerat (where the
scavenger) and the village cock. Over time, influence of Jainism has been especially
a more general concern for animal life strong), a large percentage of people living
developed, though meat eating (especially in coastal regions eat fish, sometimes
in the upper classes) was difficult for many justifying it as fruit of the sea. Other Text not available due to copyright restrictions
Indians to forgo. Buddhist and, later, Jain Indians practice vegetarianism only on
doctrines reinforced the concept of ahimsa, days of religious observance or as they
and vegetarianism became more widely age and become more devout. Some
practiced. It is often suggested that only in sources suggest that vegetarianism is
India, with its enormous variety of avail- most prevalent in southern India due to
able fruits, vegetables, and grains, could the Muslim influence found in the North.
such a broad acceptance of a vegetarian Indian census data show this is not the
diet prevail.1 case. The highest percentages of vegetarians
number of eggs, garlic, dried or pickled fruits and Pakistan. Pakistani fare combines the spices of The word curry is believed
vegetables, and use of dry masalas that are aromatic India, such as cumin, turmeric, and chile peppers, to be the English adapta-
rather than hot. These foods are typical of a cooler with the more typically Arab flavors of cinnamon, tion of a southern Indian
climate, where wheat grows better than rice and cloves, and cardamom. It is distinctive for its ample term for sauce, kari. Curry
where fruits, vegetables, herbs, and spices are avail- use of garlic, ginger, and onions in many savory powder is not a single spice
but a complex blend of sea-
able only seasonally. Boiling, stewing, and frying and even some sweet dishes.
sonings that varies according
are the most common forms of cooking. In the Wheat is the staple of Pakistan, and flatbreads,
to the cook and the dish.
south steaming is the preferred method of food similar to those in northern India, accompany The closest Indian equivalent
preparation. Rice, coffee, fresh pickles (some known every meal. Dalia, the Pakistani version of Middle- is garam masala.
as chutney), pachadi (seasoned yogurt side dishes Eastern bulgur, is cooked with water or milk to
called raytas in northern India), wet, spicy-hot make a porridge. Other commonly consumed In Bombay it is lawful for a
masalas, and fresh fruits, vegetables, herbs, and grains include rice, usually the nutty-flavored vegetarian to refuse to sell
spices are fundamental to the cuisine. Again, these basmati rice cooked as pulao (cooked in a manner his or her property to a non-
foods reflect the regional agricultural conditions. similar to Turkish pilau) and khichri (mildly spiced vegetarian.
Many Asian Indians are vegetarians, and most mixture of rice and legumes). Corn is popular in
use some milk products but avoid eggs (see some areas, typically ground into meal and made
Exploring Global Cuisine: Vegetarianism in India). into bread flavored with mustard greens and
Pork is eaten in some communities in the west, served with butter. Barley, sorghum, and millet are
lamb and beef are eaten in many areas of the available but consumed less frequently. Legumes,
north, and fish and poultry are eaten in several especially chickpeas and lentils, are served daily,
coastal regions. The cultural food groups list is usually as one of several side dishes. One favorite
found in Table 14.2. is cholay, chickpeas or whole dried peas cooked
450 SOUTH ASIANS
Table 14.2 Cultural Food Groups: South Asian

Protein Foods Common Foods Adaptations in the United States
Milk/milk products In general, milk is considered a beverage for Fresh cows buffalos, asss milk; evaporated milk; More cheese is consumed by Asian Indians; ice
children in India; consumed by some cream used in Pakistan; fermented milk products cream is popular with Asian Indians and
adults in Pakistan. Fermented dairy prod- (yogurt, lassi); fresh curds very popular; fresh Pakistanis.
ucts popular. cheese (paneer); milk-based desserts, such as
kheer, khir, kulfi, barfi, and Pakistani puddings.
Meat/poultry/fish/ Sophisticated vegetarian cuisine in India; Meats: beef, goat, mutton, pork Consumption of legumes decreases; meat intake
eggs/legumes legumes primary protein source; meat Poultry: chicken, duck increases.
and poultry very popular in Pakistan. Fish and seafood; Bombay duck, carp, clams, crab, Meat may be added to traditional Indian
Hulled, split legumes, grains, and seeds, herring, lobster, mackerel, mullet, pomfret, vegetarian dishes.
such as lentils, are known as dals. sardines, shrimp, sole, turtle Fast foods are popular.
Legumes are typically prepared whole or Eggs: chicken
pureed, or used as flour to prepare baked, Legumes: beans (kidney, mung, etc.), chickpeas,
steamed, or fried breads and pastries. lentils (many varieties and colors), peas
Beef avoided by Hindus; pork prohibited for (black-eyed, green)
Muslims.
Cereals/Grains More than 1,000 varieties of Indian rice are Rice (steamed, boiled, fried, puffed), wheat, Use of American-style breads occurs in place of
cultivated. Basmati is preferred in Pakistan. buckwheat, corn, millet, sorghum roti; breakfast cereals are popular.
Wheat used mostly in northern India and
Pakistan; rice in southern India.
Most breads (roti) are unleavened.
Fruits/Vegetables More than 100 types of fruit and 200 types Fruit: apples, apricots, avocados, bananas (several Decreased variety of fruits and vegetables is
of vegetables are commonly used in types), coconut, dates, figs, grapes, guava, jackfruit, available; decreased vegetable intake results
India. limes, litchis, loquats, mangoes, melon, nongus, for Asian Indians.
Fruits and vegetables may be used in fresh oranges, papaya, peaches, pears, persimmons More fruit juice is consumed by Asian Indians.
or preserved pickles, called rayta (north- (chicos), pineapple, plums, pomegranate, pomelos, Salad is well accepted by Asian Indians.
ern India/Pakistan), pachadi (southern), raisins, starfruit, strawberries, sugar cane, Use of canned and frozen produce increases.
or chutney. tangerines, watermelon
Fruits often costly in Pakistan. Vegetables: agathi flowers, amaranth, artichokes,
bamboo shoots, banana flower, beets (leaves and
root), bitter melon, Brussels sprouts, cabbage,
carrots, cauliflower, collard greens (haak), corn,
cucumbers, drumstick plant, eggplant, lettuce, lotus
root, manioc (tapioca), mushrooms, mustard greens,
okra, onions, pandanus, parsnips, plantain flowers,
potatoes, pumpkin, radishes (four types, leaves and
roots), rhubarb, sago palm, scallions, spinach, squash,
sweet potatoes (leaves and roots), tomatoes, turnips,
yams, water chestnuts, water convulvus, water lilies
Additional Foods
Seasonings Aromatic (northern) and hot (southern) Ajwain, amchoor, asafetida, bay leaf, cardamom (two Spice use depends on availability.
combinations of fresh or dried spices and types), chiles, cinnamon, cloves, coconut, fresh
herbs accentuate or complement food coriander, coriander seeds, cumin, dill, fennel,
flavors. Pakistani fare similar to northern fenugreek, garlic, kewra, lemon, limes, mace, mint,
Indian but with ample use of ginger, mustard, nutmeg, pepper (black and red), poppy
garlic, and onions. seeds, rose water, saffron, tamarind, turmeric
Nuts/seeds Nuts and seeds of all types are popular; Almonds, betel nuts and leaves, cashews, peanuts, Paan tray may be limited to betel nuts and
used to thicken korma sauces in India pistachios, sunflower seeds, walnuts spices.
and garnish desserts in Pakistan.
Beverages Tea is common in northern India/Pakistan, Coffee, tea, water flavored with fruit syrups, sugar Increased consumption of soft drinks and coffee
coffee in southern India. Coffeehouses cane, spices, or herbs; alcoholic beverages such as is noted for Asian Indians.
are favored meeting places. fermented fruit syrups, rice wines, beer Alcoholic beverages are widely accepted by
Asian Indians (women may abstain); con-
sumed by very few Pakistanis.
Fats/oils Coconut oil, ghee (clarified butter), mustard oil, Purchased ghee is often made from vegetable oil
peanut oil, sesame seed oil, sunflower oil instead of butter.
Sweeteners Sugar cane, jaggery (unrefined palm sugar), molasses Candy and sweets are enjoyed by Asian Indians
but not overconsumed; cookies may replace
flatbreads as snacks for Pakistanis.
with ginger, garlic, onions, tomatoes, chile peppers, are ladoos, balls made from sweetened besan and
cumin, and turmeric. Besan (chickpea flour) is garnished with nuts. A Pakistani dessert specialty
used for breads and batters for fried foods. is ras malai, which may be best described as a
Dairy foods from cows and water buffaloes rich cheesecake without a crust. Special-occasion
are another staple in the diet. Whole-milk yogurt desserts may be garnished with silver leaf. Tea is
(dahi) is used to prepare raytas (yogurt and veg- consumed throughout the day. It is usually heavily
etable side dishes) that are eaten with every meal. sweetened and boiled with milk, flavored with
Lassi (the diluted yogurt beverage found in India), cinnamon or cardamom. Other popular beverages
paneer (Indian-style pot cheese), fresh milk, cream, include lassi, sharbat (fruit juice), and sugar-cane
and ice cream are other common dairy foods, juice. Carbonated drinks are uncommon, and
consumed regularly or added to other dishes. alcohol is prohibited for Muslims.
Lamb, mutton, goat, beef, and chicken are
Pakistani favorites. Pork is rarely eaten due to the Regional Variations
Muslim majority, and nearly all meats are Northern India. The influences of the Moghul
processed according to Islamic halal guidelines period are still found in the cooking of northern
(see Chapter 4). Meat or poultry is served at lunch India, where Muslim influence was most promi-
and dinner if affordable. Beef stew, called nihari, nent. The royal court fare of that time featured
is an example of pot roasting (dum), a popular lavish meat and rice dishes flavored with expensive
preparation technique. Braising (korma or qorma) aromatic seasonings, nuts, dried fruits such as
is also common, as is the Indian charcoal tandoori raisins, and yogurt or cream. Ample use of ghee
style of cooking. Bhuna is a method of slowly and sugar was also characteristic. Many similarities
frying wet seasonings (such as onions, ginger, between the foods of this region, Pakistan, and
and garlic), then adding dry spices to make a
thick paste, then vegetables, and finally bits of
meat to make a curried dish. Biryani rice is
another specialty, a highly seasoned pilau
(including saffron) with added meat. Yogurt or
amchoor is used to marinate both meats and
poultry. Minced and ground meat dishes are
especially popular, and meats are sometimes SAMPLE MENU
extended with ground legumes. Kababs can be
grilled or pan-fried patties; koftay are fried meat-
balls (sometimes dipped in besan batter first) Pakistani Midday Meal
served with a curry sauce. Ghee is the preferred
cooking fat, although some Pakistanis must use Lamb Korma (Qorma)a or Beef Koftaa
less costly vegetable oils.
Both tropical and temperate vegetables and Sambals: Imli (Tamarind) Chutney,a
fruits are available, though not consumed in large Rayta (Yogurt Condiment),a Cholay a
amounts. Apples, apricots, cabbage, carrots, cauli-
Chapati*
flower, cucumbers, dates, grapes, guavas, mangos,
onions, oranges, papayas, peas, plums, pome- Tea
granates, potatoes, pumpkin, spinach, tamarind,
and watermelon are common. Vegetables are typ-
ically added to raytas, chutneys, curried dishes, *Store bought
and stews. Fruits are expensive in many regions. a
Fauzias Pakistani Recipes at
Desserts are popular, especially ice cream http://www.angelfire.com/country/fauziaspakistan/recipes
and puddings made from rice, besan, carrots, b
PakiRecipes at
bread, or vermicelli noodles. Cardamom, cloves, http://www.pakirecipes.com
ginger, poppy seeds, aniseed, saffron, almonds, or
pistachios flavor many sweets. One unique pudding
dating from the Moghul period includes both
ginger and garlic. Fried fritters are consumed, as
452 SOUTH ASIANS
Green tea is made in a modern-day Iran are still evident due to this yogurt sauce before cooking), although the leav-
samovar in the Indian state shared history. ened bread known as naan is also typically baked
of Kashmir, a method that Basmati rice is commonly served as a pilaf in in a tandoor. This method of cooking is associated
may have been introduced northern India, and biriyani rice with seasoned with the state of Punjab, and though few homes
to the region from Russia chicken, lamb, or beef is popular. Meatballs have tandoor ovens, it has been popularized
via central Asia.100
(kofta) made with ground meats or with meat throughout the nation (and with many visitors)
Samosas, angular, deep-
and dal mixtures are a specialty, as are skewered by specialty restaurants.
fried turnovers with spicy pieces of broiled or grilled meats (kababs). The northwestern region is characterized by
potato, vegetable, cheese Northern specialties include kormaa curried the large percentage of Hindus and Jains and high
or meat stuffings and lamb dish with a nut- and yogurt-thickened numbers of vegetarians. In the state of Punjab,
served with chutney, are sauceand masala chicken. Peanut and sesame where the national capital Delhi is situated, many
thought to be variations of oils are used in many preparations.100 The dishes cooler weather vegetables associated more with
Middle Eastern sanbusak.24 of the North, particularly in Kashmir (which temperate climates than tropical ones, such as
boarders Pakistan and has a significant Muslim cabbage, carrots, cauliflower, potatoes, tomatoes,
A comfort food in many population), are often seasoned with saffron.11, 14 and turnips, are used. Onions and garlic, infre-
parts of India is khichri, a Bread, which is called roti in northern India, quently used in most of India, are common sea-
combination of vegetables is eaten daily. Examples include whole-wheat sonings. Dairy products, including milk and
sauted with rice and dal in
flatbreads, such as chapatis, which are cooked on buttermilk in addition to yogurt and paneer, are
an ample amount of ghee.
Khichri is usually served
a griddle without oil until they puff up, and puris, consumed more often in this area than in any
with kadhi, a curry made which are deep-fried, usually in ghee. Paratha, a other Indian region.100 In the state of Rajasthan,
with yogurt and besan. griddle-fried roti, is used as a wrapping for spiced barley, millet, and, later, corn were the primary
vegetable fillings. A rich, leavened bread of the grains grown in the region and are featured in
region, called sheermal, is flavored with rose water. many breads. Today, wheat is becoming much
Fresh cheese made from buffalo milk (similar to more prominent. Aromatic spices such as cumin
cottage cheese) called paneer is added to many and cardamom are found in many dishes, and red
dishes, or skewered and grilled. Milk desserts are chiles add zing. A little farther south is the state
favored, such as carrot pudding (gajar halva) and of Gujarat, which specializes in vegetarian dishes
rice pudding with cardamom (kheer). flavored with green chiles and ginger.100 Sweet-
In northern and northwestern India a special and-sour dishes are also featured, usually
cylindrical clay oven heated with charcoal and achieved by pairing sugar with a sour fruit
called a tandoor is used. Tandoori cooking is indigenous to the region called kokum (related to
identified particularly with lamb and chicken mangosteen and tamarind). The combination is
dishes (the meat is often marinated in a spicy found in savory dishes as well as in desserts, and
Samosas, spicy deep-fried
especially in the drink kokum sharbat.
turnovers. Coastal India. The coastal region offers a
number of seafood specialties and fish prepared
in a variety of ways, including fried, steamed,
boiled, curried, and stuffed with herbs. For
example, in the northeastern state of Bengal
(which includes the city of Kolkataformerly
known as Calcutta), prawns are a specialty even
Courtesy Raga Restaurant, New York, NY Taj Group of Hotels
in the more inland areas. Freshwater fish, mostly

those from numerous rivers and estuaries, are
consumed by most Bengalis every day. A favorite
along the coast is bhapa, steamed packets of fish
(or vegetables) seasoned with mustard seed and
spices, such as cumin, asafetida, and nigella
(a small black seed with subtle bitterness called
kalonji in Hindi). A dessert version features
sweetened yogurt. The inland dishes of Bengal
are noteworthy for their use of poppy seeds.
Mumbai (formerly known as Bombay), located
on the west coast in the state of Maharashtra, where there is the smallest percentage of vegetar- A French Christian colony
boasts a dried, salted fishwhich is thin, bony, ians in the nation, fish or seafood is eaten often, on the east coast of India at
and strongly flavoredknown as Bombay duck. as is chicken. Black pepper is a favorite seasoning, Pondicherry introduced
It is usually prepared fried. Other coastal foods often combined with coconut, green chiles, and baguettes, croissants, pt,
and French-style desserts
eaten by the people of the region Marathis include karhi (curry leaves, an herb with a citrus-like,
into the regional fare.
numerous curried fish dishes as well as shrimp, tangerine flavor). A large Muslim population pre-
crab, and lobster. In inland areas Marathis are pares traditional biryanis and cooks lamb with The English words pepper,
known for adding peanuts to their dishes, and for garlic, anise, and ground chile peppers. In the sugar, and orange are all
bhakris, a crispy, traditional flatbread made from large state of Andhra Pradesh, dishes are typically derived from Asian-Indian
rice flour (sorghum flour is used in some rural seasoned with tamarind (which is also used for terms for those foods.
areas) and cooked on an ungreased griddle. The beverages), gongura (the leaves of roselle, a type
tiny state of Goa, which is south of Mumbai, is of hibiscus also used in African cooking), and
home to many Christians. Fish is eaten daily, but red chile peppers. Andhran fare is reputedly the
pork is also popular. The most famous dish of the hottest in all of India. Throughout the South,
region is vindaloo, a hot-and-sour pork curry deep-fried salty foods and sweets are favored
seasoned with coconut, vinegar, tomatoes, and snacks, such as the syrup-soaked, orange-colored
ample chile peppers. pretzels called jalebis.
Southern India. The menus of the south feature
numerous steamed and fried rice dishes. A coarse
red rice with a smoky flavor called rosematta is
favored in some parts of southeastern India,
including the state of Tamil Nadu (home of the
Tamils), and may be mixed with other grains.115
Rice is even served puffed, as in a snack called SAMPLE MENU
bhelpuri. Other grains, such as semolina wheat,
are also popular cooked as a cereal known as
uppama, which may include vegetables. Dals, A Southern-Indian
particularly chickpeas and lentils, accompany
nearly every meal in the form of a spiced pure Vegetarian Dinner
known as sambar or as a thin, crisply fried roti
called pappadams. Fermented black lentil flour Aviyal (Spicy South Indian Vegetable Curry) a, b
mixed with rice flour is used at breakfast for
steamed cakes called idli and for spicy, fried Sambar (Seasoned Dal) a, b, c
pancakes called dosas. A mixture of different dals
(and sometimes rice) is cooked, seasoned with Steamed Rice
chile peppers, and mashed into a thick, unfer-
Pineapple Pachadi a, c
mented puree that is fried for the savory pan-
cakes known as adai, traditionally served with Pappadams* (Spicy Fried Flatbread)
jaggery or coconut chutney. Fresh milk curds are
also served for breakfast. Water (with the meal)
Highly spiced vegetable curries, such as aviyal,
include such southern ingredients as bananas, Mango Lassi b, c or Chai a, c (following the meal)
banana flowers, bittermelons, coconut, drumstick
plant, green mango, and jackfruit seeds, in addition
to potatoes, cauliflower, and eggplant. Pandanus *Store-purchased, fried before serving
a
leaves, with a flavor reminiscent of mown hay, Kaimal, M. 2000. Savoring the Spice Coast of India: Fresh flavors from Kerala.
New York: HarperCollins.
are used to season some dishes. Coconut milk is
b
often used in curries and sauces, and coconut Indian and Pakistani Recipes at http://www.recipesource.com
c
oil is commonly used for frying.100 Refreshing South Indian Recipes at http://www.south-indian-recipes.com
yogurt-based pachadi and spicy, pickled fruits or
vegetables, such as chutney, accompany the main
course. In the state of Kerala (in the southwest),
454 SOUTH ASIANS
Balti cooking, from the Pakistan. Pakistani fare consists of many regional exist, including root vegetables, because insects
Kashmir region (claimed by variations. In Punjab the royal cooking style of might be killed when the tubers are harvested
both Pakistan and India), the Moghul period still influences a preference and honey, because bees might be killed when it
uses a wok-like karahi pan for elaborate, rich dishes. Tandoori fare is popular, is gathered from the hive. They also refuse to eat
to stir-fry aromatic curries
and the karahia deep, cast-iron pot shaped any foods made with eggs, or blood-colored
seasoned with fresh corian-
something like a wokis used to deep-fry foods. foods such as tomatoes and watermelon. Water
der, mint, and fenugreek
served with flatbreads Fish is a common food in Sindh, which has a must be boiled (and re-boiled after six hours)if
instead of rice. lengthy coastline, and is prepared as fritters, boiled water is unavailable, distilled water may be
kababs, steamed, or curried. Spit-roasted meats permitted.1, 100
are a specialty in Baluchistan. Called sajji, the Sikh cuisine is noted for its use of wheat, corn,
whole lamb or chicken is skewered on a small and sugar and the complete abstinence from
pole, then the poles are inserted into the dirt alcohol and beef (pork is permitted). Sikhs are
around a large fire. The poles are rotated by hand also prohibited from consuming halal meat.
as the meat cooks, assuring even roasting. The Some Sikhs are vegetarians and may avoid eggs.
North-West Frontier Province, which is populated Many Sikh dishes are prepared in pure usli ghee,
by eight different tribes, has a simple cuisine that which gives them a richness not found in some
emphasizes rice, dal, and lamb. More locally, in other religious fare.60, 100 The Syrian Christians
the valley of Hunza, a distinctive fare developed are renowned for their beef (tenderized by mincing
due in part to the limitations of its high altitude. or marinating), duck, and wild boar dishes. Goan
Wheat predominates, traditionally baked as a Christians are unique in Indian cooking for their
flatbread (phitta) in hot ashes. Maltash, a strongly use of pork. They make western-style sausages
flavored aged butter, is prized, and kurutz, a salty and have such specialties as a vinegar-basted
dry cheese, flavors soups. Wild thyme and turmeric hogs head stuffed with vegetables and herbs.89
are common seasonings. Apricots and apricot Most Jews in India keep kosher. The Parsis blend
kernels are eaten as snacks, while oil extracted Indian and Persian elements in their cuisine,
from the kernels is used in cooking.29 exemplified by dishes such as dhansak, an entre
combining lamb, tripe, lentils, and vegetables.
Religious Variations Eggs, such as ekurispicy scrambled eggsare
In addition to region, religious affiliation may especially popular.
greatly influence food habits, especially in India. Dietary variations due to religious practice are
Religious groups have varying dietary practices, limited in Pakistan because of a large Muslim
yet their cooking is Indian in flavor. majority. The small number of Hindu, Christian,
The relationship between food and spirituality Sikh, and Zoroastrian Pakistanis are assumed to
is very complex in Hinduism. Eating is an integral adapt their food habits in ways appropriate to
part of each persons spiritual journey and defines their faith (see Chapter 4).
ones role within society (see Special Occasions
and Role of Food in Indian Society). For exam- MEAL COMPOSITION AND CYCLE
ple, each caste traditionally was associated with
different food habits.100 Brahmans were generally Daily Patterns
Chai, a north Indian spe- vegetarians. Kashatriyas consumed meat, and Asian Indians. Meal patterns in India, though
cialty, was created as a way vaishyas consumed meat depending on their not consistent across regions and classes, vary
of using inferior-grade tea locale and whether it was availablefarmers less than the foods served. Two full meals with
leaves by boiling them with often had more access than merchants. Sudras ate substantial snacks are typical. Early risers enjoy a
spices, sugar, and milk.100 meat, but typically only when it was provided for rich coffee or tea boiled with milk and sugar.
them as leftovers. Breakfast, usually eaten between 9:00 and
Muslims avoid all pork and pork products but 11:00 a.m., consists of rice or roti, a pickled fruit or
are not vegetarians. Orthodox Jains may only eat vegetable, and a sambar or other dal dish, which
innocent foods that avoid injury to any life and may be left over from the previous evening. At
are therefore strict vegetarians. In addition, there 4:00 or 5:00 p.m., similar foods or snack items are
are twenty-two prohibited foods (e.g., fruit with eaten with coffee or tea. The main meal of the day
small seeds or tender new greens) and thirty-two follows between 7:00 and 9:00 p.m.89 Texture,
other items that may have the potential for life to color, and balance of seasoning are all important
factors in an Indian meal. A menu customarily fruit and vegetables (sometimes with added meat Traditionally six tastes
includes at least one rice dish; a curried vegetable, or shrimp) and flavored with amchoor or tamarind, (sweet, sour, salty, bitter,
legume, or meat dish; a vegetable legume side called chaat, are popular. Snacks sweetened with pungent, and astringent)
dish; a baked or fried roti; a fruit or vegetable sugarcane, molasses, or jaggery are usually milk- and five textures (foods that
pickle; and a yogurt rayta or pachadi. Sometimes based, as are the saffron-spiced khir, the Indian need to be chewed, those
that need no chewing, those
a dessert is served, usually fruit. ice cream called kulfi, and the candy barfi,
that are licked, those that
Water is the most common drink consumed although nuts, coconut, sesame seeds, or lentils are sucked, and those that
with meals, though milk and buttermilk are also are also used. Bengalis are noted for their sweet- are drunk) were balanced in
prevalent, especially in the North and West. shops, which prepare numerous specialties, such an Indian meal.
Sugarcane juice, fruit juice, and sodas are popular as sandesh, a delicate curd candy, and singhara
in urban areas. Alcoholic beverages are not (a sweet version of the samosa filled with coconut It is illegal to bring betel
widely consumed, though rice beer, home-brewed and jaggery).14 A snack may also include a cool- leaves into the United States.
rum made from molasses, toddy (a brandy-like ing beverage, such as the sweetened, diluted There is a black market for
drink made from palm sap), and melon wine are a yogurt drink called lassi or the fruit juice known paan obtained in Canada
few traditional beverages still popular in some as shurbut. and other countries.
rural regions. Many Westernized Asian Indians, Restaurants are becoming increasingly popular
McDonalds restaurants in
particularly men, drink beer or scotch. in India, and Western fast-food franchises are found
India do not serve beef
Courses are not presented sequentially in an in many regions. Chinese and Thai establishments hamburgers but offer
Indian meal. They are placed on the table all at are also common, particularly in urban areas. instead selections such as
once, with savory dishes eaten at the same time Pakistanis. Breakfast, if consumed, is a light meal paneer wraps and spicy
as sweets. Typically, an individual serving of rice in Pakistan, consisting of fried flatbreads such as potato burgersall items
or breads is served surrounded by a selection of puris, a sweetened porridge, or a legume dish. are made with egg-free
other foods, such as curried dishes, dals, rayta, Traditionally, however, only two meals a day are mayonnaise.82
or pachadi, and pickled fruits or vegetables. eaten. Lunch and dinner are large meals and if
Diners may combine tastes and textures accord- affordable, include a meat, poultry, or fish dish,
ing to personal preference. The meal concludes and sambals: side dishes such as curries, cholay,
with the passing of the paan tray. Paan is a com- raytas and other fresh vegetable or fruit salad-
bination of betel (areca) nuts and spices, such as like mixtures, chutneys, and pickles selected for a
anise seed, cardamom, and fennel, wrapped in balance of flavors and textures. Flat breads and
large, heart-shaped betel leaves secured with a tea are served with the meal.
clove. It is chewed to freshen the breath and to Dessert often follows, and paan may be chewed
aid digestion. afterward. Khat, a plant with mild amphetamine-
Snacking is very popular in India. In cities and like properties, is often added to the betel leaf roll
small towns snacks are sold in numerous small (see Chapter 8, Africans). Snacking is common
shops and by street vendors. In villages they are and hearty, including fried items such as meat,
prepared at home. A clear distinction is made poultry, or fish fritters and patties, stuffed pastries
between meals and snacks. Many Indian lan- and flatbreads, kababs, sandwiches, spicy salad-
guages have specific words to define each form of like mixtures, roast beef or chicken, and, in urban
eating. In southern India the word tiffin is used to areas, Western fast food.
distinguish a snack from a meal. The coffee or tea Traditionally, meals were served on large trays
drunk before breakfast or in the late afternoon is and eaten with the hands while sitting on the
considered tiffin. A meal is not a meal unless the floor. Many Pakistanis today have been influ-
traditional staple prepared in the traditional enced by European customs and consume their
manner, such as boiled rice in southern India meals at tables using flatware and cutlery.5
(or roti in northern India), is served. This means
that no matter how substantial the snackand Special Occasions
some include more food than a mealit is still Asian Indians. Another aspect of Indian culture
called tiffin. affecting daily diet is the concept of feasting and
Spicy snacks served with chutney often consist fasting. As with other Indian food habits, feasting
of batter-fried vegetables, pancakes with or with- and fasting activities are complex and vary greatly
out a filling, or fried seasoned dough made from from person to person and group to group. No
wheat or lentils. Savory salad-like mixtures of diced occasion passes in India without some special
456 SOUTH ASIANS
celebrated everywhere with gifts of sweets.

Another holiday, Janmashtami, commemorates
the birth of Krishna. As a boy, Krishna and his
friends would steal butter or curds hung high in
earthen containers. This story is recreated
during the celebration as young boys attempt to
break elevated clay pots full of curds.
Non-Hindu harvest festivals also feature feasts.
They are dedicated to wheat in the North and rice
in the South. At the three-day rice festival in Pongal,
Staffan Wildstrand/CORBIS
dishes made from the newly harvested rice are

ceremonially fed to the local cows. The ten-day
festival of Onam in Kerali culminates with a feast
served by the local women, including thirty to
forty dishes ranging from fiery curries to foods
sweetened with a combination of molasses, milk,
Fast-food street vendor sells and sugar.
his food in Karachi, Pakistan. Asian-Indian Muslims may dine with friends on
Eid al-Fitr at the end of Ramadan and Eid al-Azha
food observance: regional holidays, community
(see Chapter 13, People of the Balkans and the
celebrations, and personal events such as births,
Middle East). Christians celebrate Christmas and
weddings, funerals, and illness. A devout Hindu
Easter in India.
may feast or fast nearly every day of the year (see
The decorative red or yellow Chapter 4). Fasting. Fasting is also associated with special
dot that Hindu-Asian Indian occasions in India. It accompanies both religious
women apply to their fore- Feasting. Feasts serve as a method of food dis-
and personal events. An orthodox Hindu may fast
heads represents joy or tribution throughout the community. They are
more days a week than not. However, the term
prosperity. It is omitted generally observed by presenting large amounts
fast includes many different food restrictions in
during fast days. of everyday foods and sweets of all kinds to the
India, from avoidance of a single food item to
appropriate holy figure; all members of the com-
complete abstinence from all food. A person might
munity then eat the food. Feasts may be the only
adopt a completely vegetarian diet for the day or
time that the poor get enough to eat.
eat foods believed to be spiritually purer, such as
Some foods are associated with certain con-
those cooked in milk (see the section Purity and
cepts. Rice and bananas both symbolize fertility,
Pollution in this chapter). Individuals rarely suffer
for example. Betel leaves represent auspiciousness;
from hunger because of fasting in India. In fact,
ghee, purity; salt, hospitality and pleasantness;
more food may be consumed on fast days than on
mango, hospitality and auspiciousness; and betel
a non-fast day.
nuts and coconuts, hospitality, sacredness, and
Muslims in India also fast, notably during the
auspiciousness.
month of Ramadan. No food or drink is consumed
Most festivals are Hindu in origin, and although
between sunrise and sunset (see Chapter 4 for
many are observed nationwide, each is celebrated
more information). Sikhs may fast on the days of
differently according to the region.
the full moon.60
Holi is a spectacular holiday in the North,
featuring reenactments of Krishnas life, fire- Pakistanis. Most Pakistanis follow the Islamic
works, and colored powders tossed everywhere. calendar, fasting for the month of Ramadan and
Celebrants snack at bazaar booths. Dussehra is celebrating the feast days of Eid al-Fitr and Eid al-
a ten-day holiday observed in both the North Azha (see Chapter 4). Several secular holidays are
and the South. A special dish is prepared each also observed, including Pakistan Day (March 23),
Sweets represent prosperity day, and every day that dish is added to those Independence Day (August 14), and the birthday
because they often include prepared the previous days, culminating in an of the national founder, Jinnah (December 25).
costly ingredients and may enormous feast on the last evening after a torch- Special occasions are marked by dishes that use
be decorated with silver or light parade of ornamented elephants. Divali, costly ingredients, such as silver leaf and nuts,
gold leaf. the festival of lights, is the New Years holiday and feature numerous sweets.
ROLE OF FOOD IN INDIAN SOCIETY consumer or by other foods that have been eaten, Food served in brass
are jhuta. Those foods that are identified as jhuta dishes is less vulnerable to
AND ETIQUETTE pollution than is food in
vary by religious sect. The term jhuta is also used
The importance of food in Indian culture goes for garbage and offal. clay dishes.
far beyond mere sustenance. Sanskrit texts
describe how Asian-Indian Women and Food
From earth sprang herbs, from herbs food, The role of women in food preparation is extremely A Hindu woman is
from food seed, from seed man. Man thus important throughout Indian culture. Feeding the traditionally considered
family is an Indian womans primary household impure during her menses
consists of the essence of food. . . . From food and is prohibited from
are all creatures produced, by food do they duty. She is responsible for overseeing the pro-
curement, storage, preparation, and serving of all cooking or touching any
grow. . . . The self consists of food, of breath, food that is to be consumed
of mind, of understanding, of bliss. (Achaya, meals. Because arranged marriages are common,
by others.
1994, p. 61) training in kitchen management is considered
essential for a Hindu woman in obtaining good
In a society that traditionally experienced fre- marriage offers. It is generally believed that a
quent famines and chronic malnutrition, food is woman cannot be completely substituted for in
venerated. Complex traditions have developed the kitchen, for she imparts a special sweetness to
around when, how, and why foods are prepared, food. If the wife is unable to perform food-related
served, and eaten. duties, a daughter or daughter-in-law may substi-
tute, and in multi-family homes, the mother-in-
Purity and Pollution law assumes control of the kitchen. If servants
Many Hindu dietary customs are meant to lead to help in meal preparation, it is still important for
purity of mind and spirit. Pollution is the opposite the woman of the house to serve the food directly
of purity, and polluted foods should be avoided or from the chula (stove) to the table. This often
ameliorated. To be pure is to be free of pollution. requires many trips.
The Hindu classification system of jati is used
to evaluate the relative spiritual purity of all Etiquette
foods. Purity is determined by the ingredients, Traditionally only foods cooked and served by a Many Brahmans were
how they are prepared, who prepares them, and member of an equal or superior caste could be historically employed as
how they are served. Some foods, such as milk, consumed by any Hindu. The customs were such cooks, because everyone
are inherently pure. Raw foods that are naturally that a Brahman would not eat food if the shadow could eat food prepared by
protected by a husk or a peel are less susceptible from a member of another caste fell on it.100 Only this caste.
to pollution. Pakka (meaning cooked) foods are members of the same caste ate together.
those that are fried or fat-basted during prepara- Untouched leftovers can be given to a member of
tion, preferably in ghee. Pakka foods are relatively a lower caste, such as servants, but polluted left-
unrestricted due to their high degree of purity overs are eaten only by scavengers of the lowest
and often include fried breads and many sweets. caste. Today, Asian Indians adhere to these com-
Pakka foods are considered appropriate for serv- mensal rules to various degrees, however. An
ing at temples and at community feasts, because orthodox Hindu attempts to follow them at all
they are pure enough for anyone to consume.100 times. A more modern Hindu might adhere to
Kaccha (meaning undercooked) foods are them only during holy services and holidays.
those that are boiled in water, baked, or roasted. Most Westernized Indians eat in restaurants and
Kaccha foods are more susceptible to pollution use convenience products in cooking, ignoring
than pakka foods and must therefore be treated how and by whom the food was prepared.
carefully during serving and consumption. They The consumption of jhuta foods also varies
include many of the foods that are central to the among Hindus. Historically, laborers and warriors
daily diet, such as rice and dal, and are typically were allowed to eat meat to help keep up their
only served within the home. strength. Some Brahaman subcastes, though pri-
Some foods, such as alcohol and meat, are jhuta, marily vegetarian, permit consumption of impure
meaning that they are innately polluted. Jhuta foods that are plentiful in their region, such as
foods are those that are by their very nature impure. fish in the coastal areas and lamb in the north.
All leftovers, unless completely untouched by the Other sects are so rigid that even inadvertent
458 SOUTH ASIANS
intake of polluted food results in spiritual disaster. forks, and knives, or with just the fingers. When
Members of the International Society for Krishna eating with the hand in the North, only the fin-
Consciousness (see Chapter 4) believe that if they gertips are used to delicately scoop up food
accidentally eat a prohibited animal food, they with bits of bread, whereas in the South, the
will lose human form in their next life and assume bread and food are dexterously rolled into the
the form of an animal that is the prey of the palm, then popped into the mouth.52 Food being
animal they ate. served to others should never be directly touched
Hospitality is highly valued in Hindu homes, with the hand, nor should a diner refill his or
where serving a guest is considered equivalent to her glass, waiting instead for neighboring
serving God.100 Traditionally the male head of the diners to do so, and carefully tending to their
household was responsible for seeing that any drinks whenever their glass is half empty. If
guests, pregnant women, or elderly persons were alcohol is served, a guest is expected to make a
well fed before he could sit down to eat. The order toast to the health of the host (after the host
of serving today is more likely to be guests, oldest toasts the guests). However, any verbal thanks
men, remaining male diners, children, and then for the meal are considered very rude, and only
women. In some situations men and women may a quick nod with the head while holding the
Cows milk is thought to be separated while eating.32 However, more hands palm to palm and saying namaste (see
increase intelligence; Westernized Asian Indians are often relaxed Counseling) is appropriate.32
buffalos milk is believed to about these customs, and in some homes each
strengthen the body. diner goes his or her own way at meals.100 THERAPEUTIC USES OF FOOD
Food is served in small individual bowls from
serving trays called thalis. The thalis may be Asian Indians
silver or brass, with matching bowls. Originally, Ayurvedic medicine is based on the premise that
the thalis were simply banana leaves and the each human is a microcosm of the universe. As
Traditional Indian thali
bowls were earthenware, and these are still used such, the body experiences the three inevitable
(individual silver serving tray),
today in some rural areas or when disposable laws of nature (also called universal tendencies)
featuring a selection of roti
(flat breads), fruit and veg- trays and bowls are desired. of creation (sattwa), maintenance (rajus), and
etable pickles, such as Only the right hand is used in dining, which may dissolution (tamas).107 The fundamental elements
chutneys, and yogurt-based be done with spoons (the most common utensil), of fire, water, and wind also have their counter-
pachadi or rayta. parts in the humors of the bodybile (pitta),
phlegm (kapha), and wind (vata). Pitta regulates
metabolic activities and resulting heat. Kapha
provides structure and support through bone and
flesh, and vata represents movement of muscle and
semen. Health is maintained through a careful
balance of humors and substances in the body
according to each persons internal constitution
and external experiences.
When pitta is in balance, digestion is comfort-
able and a person is content; balanced kapha pro-
Courtesy Raga Restaurant, New York, NY Taj Group of Hotels
duces physical and emotional stability, strength,

and stamina; vitality and creativity are the results
of balanced vata.63 Good digestion is critical
because food is transformed into the body
humors and substances when it is cooked by the
digestive agnis (fires), producing food juices
and wastes. Food that is indigestible is harmful
because it is believed to accumulate in the intes-
tines and decompose, sending toxins into the
bloodstream; excessive waste or too little waste is
an imbalance that causes illness.86
Foods are classified according to which humors milk (particularly with almonds and saffron) and Garlic is found in many
they enhance or inhibit. For example, pomegranate rice porridge are thought to ensure proper devel- Ayurvedic remedies, and
increases vata and reduces pitta and kapha. opment of the fetus. Fenugreek seeds in butter- an old Indian proverb
Molasses does the opposite: it increases pitta and milk are given for nausea, and butter or ghee is states: Garlic is as good as
ten mothers.
kapha and reduces vata. Some foods are also believed to make the body supple and ease delivery
grouped according to their universal tendencies. of the baby.
Mung beans, for instance, are considered sattawic, Food taboos for infants and young children
chile peppers are rajasic, and nutmeg is tamasic. may also be practiced. A survey of Indian mothers
Furthermore, the hot-cold classification system is found that many believed spicy foods and mangoes
used for foods, depending on how they affect the were too hot and caused diarrhea, bananas caused
body. The specific identification of an item as hot colds, and fried foods were considered difficult to
or cold varies regionally; for example, lentils and digest and the source of coughs. A small percentage
peas are considered hot in western India, but cold also reported that sweets and salty foods were
in northern India. Generally wheat, spices, and avoided to prevent diabetes and hypertension,
seasonings (except mustard and sesame seeds), respectively.102
chicken, and oils are classified as hot; rice, leafy Numerous dietary remedies are listed for
vegetables, fruits (except mango, papaya, and minor illness. Barley water is consumed for a fever;
jackfruit), dairy products, honey, sugar, pickles, vomiting is treated with milk. Coconut water,
and condiments are considered cold.1 The hot or buttermilk, anise seed oil, and pomegranate flowers
cold nature of a food can be altered through the are all considered helpful for diarrhea. A powder
method of preparation. The use of hot spices or called ashtachooran (a mixture of asafetida, salt,
roasting may make a cold food hot; conversely, ginger, pepper, cumin, and ajwain) is added to
soaking a hot food in water or blending it with honey for indigestion. Ginger tea or garlic soup is
yogurt can change it into a cold food.86 Many used to treat colds. Gooseberries and hibiscus
foods are considered incompatible in Ayurvedic flower tea are considered general tonics.1, 59
medicine, such as honey with ghee, rice with vine- Bittermelon and fenugreek seedsused to treat
gar, and honeydew melon with yogurt, because of diabeteshave been found to work clinically as Curcumin, a chemical found
conflicting properties which overwhelm the agnis hypoglycemic agents.51 in turmeric (used in many
curry spice blends), has
and diminish digestion. It is widely believed that a highly spiced diet is
anti-inflammatory and
Although a balance of foods according to necessary in the tropical Indian climate to stimu- immunomodulatory proper-
humoral effect, universal tendencies, and hot-cold late the liver. One food habit that may result in ill ties, and has been reported
is essential to health, the exact proportions of health is the common practice of disguising oth- to be beneficial in arthritis,
each change with age, gender, physical condition, erwise undrinkable water with flavorful herbs asthma, cardiovascular dis-
and the weather. Traditionally, six seasons are and spices. Cholera, dysentery, and typhoid are ease, diabetes, Alzheimers
recognized, each with certain dietary recommen- endemic in many regions. disease, and some cancers.43
dations. During winter, when digestion is thought
to be strongest, roasted or sour and salty dishes Pakistanis
are preferred as well as sweets; in summer and Limited data suggest that a hot-cold system of
during the monsoons, when digestion is thought classification is used by some Pakistanis. Items
to be weak, salty, sour, and fatty foods are avoided.1 considered hot and therefore avoided during
The way foods are eaten is as important as which summer include beef and potatoes. Cold foods
foods are consumed. To maximize digestion of avoided during winter include chicken, fish,
foods, a person should eat in a quiet atmosphere, and fruit.33 Folk remedies are very common in
sip warm water throughout the meal, and sit for a Pakistan, for everything from colds and flu to
short while after dining.63 asthma and jaundice.81 Eggs, curds, ginger,
Pregnancy is considered to be a normal and honey, and poppy seeds are just a few of the foods
healthy condition; however, certain food taboos used therapeutically. One study of infant feeding
are sometimes followed. Women especially avoid practices during periods of diarrhea found that
extremes in foods that are too hot or too cold. most mothers continued to breast-feed, and those
Lime juice with honey is a general tonic, believed who also provided solid foods considered khichri
to prevent excessive bleeding at birth, while cows and bananas good for curing diarrhea.69
460 SOUTH ASIANS
Contemporary Food survey on acculturation patterns revealed that

nearly 75 percent of Indo-Americans believe it
Habits in the is acceptable for non-vegetarians to eat beef;
44 percent indicated that it is acceptable for veg-
United States etarians to eat beef.103 It may take vegetarian
Indians seven years to complete the transition to
beef consumption, if it occurs.
ADAPTATIONS OF FOOD HABITS As yet, the reasons vegetarians become non-
Asian Indians vegetarians have not been stated conclusively. It
has been suggested that vegetarianism may lose
Americans of Asian-Indian descent have usually
its social and cultural significance in the United
been exposed to American or European lifestyles
States. Data regarding the influence of factors
in India and may be familiar with a Westernized
such as gender, income, region of origin in India,
diet before immigration to the United States. Yet
and length of stay in America have been contra-
even the most acculturated Indo-Americans con-
dictory. Variables that affect acculturation include
tinue some traditional food habits. Most accept
gender (men tend to change their food habits
American foods when eating out, but many prefer
more readily than women because women are
Asian-Indian foods when at home.103
the traditional food preparers in Indian society),
In 2006 a shortage of dal Ingredients and Common Foods. Very little age (children raised in the United States prefer
in the United States caused research has been conducted on the food habits American foods), marital status (single unmarried
wholesale prices to rise over of Asian Indians in the United States. One study men are the most acculturated, married men with
500 percent and caused of Asian Indians in Pennsylvania suggested that families in India next, and married men with fam-
home cooks to dilute acculturation takes place in two phases.37 Typically, ilies in the United States are least acculturated),
favorites, such as sambar, caste (depending on whether caste members used
the first lasts for two to three years, often while
with water.51
the immigrant is a student. Interaction with main- meat or alcohol in India), and region (Asian Indians
stream American society may be limited during from rural areas are often stricter vegetarians than
this period. The recent immigrant prefers to asso- those from the cities).
ciate with members of the same caste, regional, A study of Asian Indians living in Cincinnati
or linguistic group; experience with American found several changes in the types of foods they
foods often includes only fast foods. Male Asian- ate.57 Foods that subjects used frequently in India
Indian students are often unable to cook and may but that were in only low to moderate use in
rely heavily on purchased meals. Many Asian- the United States were ghee, yogurt, dal, roti,
Indian immigrants will eat hamburgers because rice dishes, and tea. Foods that were in low to
of their availability and low cost. Sometime during moderate use in India but in frequent use in the
the next ten years, Asian Indians who stay in the United States were fruit juice, canned or frozen
United States longer than four years enter the vegetables, American bread, dry cereals, cheese
second phase of acculturation. They are usually and cheese dishes, and soft drinks. Coffee con-
employed by American businesses and are raising sumption also increased.
families. They keep their social interactions with A small study of Asian Indians living in New
Americans separate from those with other Indo- York City and Washington, DC compared the diets
Americans. They might serve meat and alcohol of residents who lived in the United States for
to American guests, for example, and vegetarian more than ten years to those who had lived in the
dishes to Indian guests. United States for less than ten years. Few signifi-
Early research on Asian-Indian immigrants cant differences were identified, though longtime
reported some vegetarians become meat eaters residents reported a greater preference for tradi-
when living in America. In one early study, one- tional meals at dinner and on weekends than did
third of those who were vegetarians in India more recent immigrants. Regardless of length of
became non-vegetarians in the United States.57 residence, consumption of roots/tubers, vegetables
Eating eggs began soon after arrival, progressing oils, legumes, white bread, and tea remained about
to chicken, and finally to beef.37 It is estimated the same as in India. Ghee intake decreased for
that non-vegetarian Asian Indians take between both groups; cheese, fruit juice, and whole-wheat
two months and one year to accept beef. One bread intake increased. Cola beverages, low-fat
milk, pizza, mayonnaise, and cookies were popular or a sandwich. Rice remains the core of the Asian Indians who are prac-
American items. Nontraditional foods that were evening meal, and 60 percent of households ticing Muslims rarely begin
never or rarely consumed included egg substitutes, reported serving it daily. Fish consumption, eating pork in the United
nondairy creamer, nonfat milk, peanut butter, hot which is closely associated with Bengali ethnic States. They may drive long
dogs, and hamburgers. The authors note that many identity, actually increases in American homes distances to purchase halal
or kosher meats to fulfill
American processed foods and baked goods are compared to those in India. Fish is served with
traditional Muslim dietary
now available in India and that recent immigrants rice and dal, seasoned with cumin, fennel, fenu- laws.
have incorporated these items into their diets greek, nigella seed, and mustard seed. The portion
before coming to the United States.83 size of fish has doubled to about eight ounces, Chaat houses, specializing
Research that compared dietary intake of and this meal is eaten at approximately half of all in the small, usually cold
Asian-Indian immigrants originally from different dinners. Rice with other items, for example, roast dishes of mixed fruits,
regions of India found some differences in food chicken, is consumed at other main meals. vegetables, legumes, and
use. Those from the North were more likely to Dishes are usually prepared Bengali-style by meats topped with tangy
use fat spreads, such as butter or margarine, while sauting, stewing, or braising. dressing, are trendy gather-
those from the southern areas of India were more ing spots for Asian-Indian
likely to eat starchy foods and fried chicken. Pakistanis Americans.
Immigrants who came from western India ate Many Pakistani Americans are believed to con-
significantly less fruit and eggs than those from sume at least one traditional meal each day, usually
the North and South.48 dinner, when the family can gather and discuss
A majority of Americans of Asian-Indian the days events.80 American-style convenience
descent make an effort to obtain traditional food foods are popular for breakfast and lunch; cereals,
products. Many markets in the United States spe- pizza, hamburgers, sandwiches, fried fish, and
cialize in Indian canned and packaged food prod- cookies replace the flatbreads, stews, and curries
ucts, including spices, and many stores provide typically consumed for these meals. Research on
mail orders. Fresh foods are more difficult to find. Pakistani immigrants in Norway found that
Some fruits and vegetables can be bought at Asian dinner had become the main meal of the day and
specialty markets, and Indian bakeries featuring that meals on weekends included more traditional
sweets and tiffin items have opened in some foods than did meals during the week.71 Restau-
areas. Even in an older study done in the Midwest, rant meals may be avoided by some Pakistani
100 percent of Indians interviewed reported that Americans if halal meats are unavailable.10
their traditional foods were available.57
NUTRITIONAL STATUS
Meal Composition and Cycle. Asian-Indian
Nutritional Intake
eating patterns may become more irregular in the
United States, possibly because of the pressures of Research on Asian Indians is noteworthy for the
a faster-paced lifestyle. Breakfast is the meal most dramatic health changes that have occurred
commonly omitted; snacking occurs between one among urban Indians in India and immigrants to
and three times per day and may be more common Western nations, suggesting adverse effects of
in women than in men.83, 112 Many Americans of dietary differences and a sedentary lifestyle. In
Asian-Indian descent eat American foods for comparison, there is scant data on Pakistani and
breakfast and lunch. Traditional Indian evening other South-Asian immigrants, especially those
meals are preferred if native foods and spices are in the United States. However, the limited studies
available. Yet dinners at home may also be influ- show some similarities in trends, which may be
enced by U.S. food habits in that more meat, expected due to a shared genetic heritage with
poultry, or fish may be eaten, and American breads Asian Indians.
may be served in place of roti. Asian Indians. Limited data on the nutritional
Recent research on Bengali Americans illus- status of Indo-Americans suggest that in general,
trates many of these changes. Dinner is now the many meet recommended intakes for grains and
main meal of the day, and breakfast is a little vegetables but do not meet those for fruits, dairy
larger than is traditional, usually consisting of products, or meats, poultry, and fish.49 Intake of
toast or cereal and milk, with tea.90 Lunch, unless dietary fat approximates that of the U.S. popula-
brought from home, was typically pizza, a salad tion but is often higher than fat intake in India.
462 SOUTH ASIANS
Energy, carbohydrate, and protein intakes may mortality rates when compared to deaths from all
increase with length of stay.47 Figures on fiber other causes.28, 70, 78 Cardiovascular risk was
intake are less conclusive. Though one study found found to increase in Asian-Indian immigrants
older immigrants consumed ample amounts, with length of stay in one study.105 Hypertension
others suggest fiber intake is low, even among rates in Indo-Americans are variableslightly
vegetarians.47, 48, 93 below the prevalence in whites in some studies
Rates of vegetarianism vary Micronutrient intake is less studied. A study and above the average in others.2, 41, 76
among Indo-American on older Gujarti Americans found that intakes of This clustering of conditionsa high waist-to-
groups. A study of immi- vitamins D and B6 were low and that intakes of hip ratio indicative of abdominal fat, insulin resist-
grants from different calcium, magnesium, potassium, manganese, ance or glucose intolerance, high triglyceride levels,
regions of India found that copper, zinc, and selenium were marginal. The low HDL cholesterol levels, and hypertensionis
the highest rates (61%)
researchers questioned dietary sufficiency in this considered the hallmark of metabolic syndrome
were from the western
states, compared to rates
group given the possible reduced bioavailability (see Cultural Controversy: Does Metabolic
of only 21 percent in immi- of some micronutrients due to a relatively high Syndrome Exist?).9, 74 It is especially associated
grants from the South and intake of fiber, especially among vegetarians.47 with Asian Indians, and they may have the highest
14 percent in those from Obesity rates in Indo-Americans are lower rates of all ethnic groups.73, 77, 85 Researchers are
the North.48 than among African Americans and whites in the studying numerous other factors related to these
United States, and average body mass index issues in an attempt to fully understand the role
Iron intake may be low (BMI) is less than that found in blacks, Mexican of genetic predisposition and environmental
among some Indo-American Americans, and whites.64, 73 However, BMI does influence (such as diet, inactivity, and stress) in
vegetarians; however, sub- increase with urbanization and migration, and the condition.17, 20, 25, 96
stantial amounts of iron are Asian Indians have a higher percentage of body It should be noted that a vegetarian diet does
obtained through the use of
fat in relation to BMI than other groups.27, 67 In not necessarily provide protection from these
traditional iron cookware.61
addition, Asian Indians have increased amounts health problems seen in many Asian Indians.
of visceral fat, even in nonobese persons.9, 41, 109 High carbohydrate intake may increase triglyc-
Since a higher percentage of body fat, fat pattern- eride levels, and low protein consumption was
ing, and abdominal adiposity are associated with associated with increased visceral fat in one
increased rates of insulin resistance and dyslipi- study.72, 112 Asian Indians on a vegetarian diet were
demia, this suggests that some Asian Indians who less insulin sensitive than white vegetarians and
are not overweight by national standards are, consumed less fiber.99 Asian-Indian vegetarians
nonetheless, metabolically obese. 7, 84, 97 have also been found to have higher BMIs, more
High rates of insulin resistance and dylipi- body fat, and more abdominal fat than do white
demia, especially high triglyceride levels and vegetarians.26, 93 In addition, Asian Indians have
low high-density lipoprotein (HDL) cholesterol significantly higher plasma homocysteine levels
levels, are associated with increased risk for type (a risk factor for cardiovascular disease), thought
2 diabetes and cardiovascular disease in Asian to be due in part to low levels of vitamin B12
Indians.7, 75, 116 Data show that Asian Indians (from low animal protein consumption).19
develop diabetes at an earlier age and at higher The most prevalent cancers in Asian-Indian
prevalence rates than whites and most other men are of the lung and prostate. Colorectal can-
ethnic groups.96, 109 Overall prevalence of diabetes cers, leukemias, and liver cancers are also
in Indo-Americans has been estimated to average common. Asian-Indian women suffer from breast
18 percent in adults,46, 109 compared to 6 percent cancer most often, followed by lung and colorectal
for the general U.S. population, and is higher cancer. Women also have high rates of ovarian and
than rates for other Asians, blacks, Hispanics, uterine cancers, as well as cancers of the pancreas.22
whites, and many Native American groups. Oral cancers are also common in South Asians,
However, research suggests the rates are skewed due in some subgroups to chewing of paan with
toward younger persons, and after the age of 70 betel nuts.3
years, the prevalence is similar to that found in Despite high socioeconomic status, few births
similarly aged blacks and Hispanics. Rates of car- to teen mothers, and good prenatal care, Asian-
diovascular disease for Indo-Americans are esti- Indian women in one study were more likely to
mated to be three times higher than for whites, have adverse birth outcomes than blacks, Hispanics,
and data show that it has earlier onset and higher and whites.35 These included high levels of low
CULTURAL CONTROVERSYDoes Metabolic Syndrome Exist?
I n 1988 a diabetes researcher proposed

that a cluster of risk factors likely to
increase the development of both
type 2 diabetes and cardiovascular disease
often occurred in the same person, and that
and well above those for black men. Insulin
resistance rates in Asian Indians may be
among the highest worldwide, resulting in
an increased prevalence of metabolic
syndrome developing at a younger age
and not verified by scientific study.
Prevalence rates differ depending on what
guidelines are used, with substantially
higher rates found when using more ethnic-
specific measurements.30, 106 Even proponents
the common factor was insulin resistance,* than in most ethnic groups.73 One study in of establishing consistent criteria cannot
a problem that frequently develops in over- India (using the same method of calculation agree on a name, with many researchers
weight, sedentary people. He called the in the U.S. rates cited above) found a meta- preferring the term insulin resistance
disorder syndrome X, noting that it was bolic syndrome rate of 41 percent in urban syndrome. Of particular concern is whether
characterized by insulin resistance or adults over age twenty.85 Researchers there is clinical value in the metabolic
glucose intolerance, high triglyceride levels, suggest that variability in insulin sensitivity syndrome diagnosis. Some researchers
low high-density lipoprotein cholesterol among individuals is due half to genetic argue that each symptom should be
levels, and hypertension.91 Ten years later, predisposition and half to environmental managed individually.92 Others suggest
the disorder was recognized by the World factors (25 percent to overweight and that a greater emphasis should be placed
Health Organization, who chose the term obesity, and 25 percent to inactivity).92 Those on therapeutic strategies that address all
metabolic syndrome to describe it and populations who are genetically predisposed risk factors simultaneously and target the
added increased waist circumference to the to develop insulin resistance are also more underlying causes, usually through lifestyle
criteria.44 Then, in 2005, newspaper headlines susceptible to the adverse effects of over- changes (especially diet and exercise).36
declared, Metabolic Syndrome Doesnt Exist, consumption. Combining both approaches may be most
based on concerns voiced by some health Metabolic syndrome is reported to effective. Pending the outcome of this
organizations.104 This brief history reflects double the risk of developing cardiovascu- debate, one thing is certain: many ethnic
continuing differences in scientific opinion. lar disease and increase the risk for type 2 groups in the United States are at increased
Researchers suggest that over 47 million diabetes by five times.44 In addition, it is risk for type 2 diabetes and cardiovascular
people worldwide have the disorder. In the also associated with other conditions, such disease, and rates of these conditions will
United States the estimated prevalence in as fatty liver disease, polycystic ovary syn- increase as these vulnerable populations
adults over twenty years old is 27 to 34 drome, some cancers, and sleep apnea. grow in numbers.
percent.30, 31 Rates increase dramatically What is at issue then? There is no
with age (nearly 50 percent higher in people agreement among scientists as to which *Insulin resistance occurs when the cells in the body
over age 60) and vary by ethnicity. Mexican risk factors and what number of factors are no longer as efficient at using the insulin they
Americans have a significantly higher are needed for a diagnosis of metabolic need to metabolize glucose (blood sugar). The body
prevalence than whites, for example, and syndrome. Three prominent health groups produces more insulin to compensate, and if this
reaction is not enough, glucose intolerance develops,
though African-American men have lower have published guidelines, and the defini- increasing the amounts of sugar found in the blood.
rates than white men, black women have tion of the syndrome differs in each. Further, Glucose intolerance usually develops into type 2
rates slightly above those for white women the measurement standards are ill defined diabetes over time.
birth weight, mental retardation, and fetal mortal- resistant during late pregnancy, and nearly half of
ity. Other research comparing perinatal outcomes all Asian-Indian women who developed gestational
among Asians and Pacific Islanders reported diabetes had metabolic syndrome following
Asian-Indian/Pakistani women had the highest birth.62, 95 Scientists are uncertain as to why this
risk for preterm delivery, gestational diabetes, paradox of poor birth outcomes in a population
and low birth weight at term.88 Studies in Canada with few environmental risk factors exists.
and Britain have found that South Asian women A study comparing neonatal feeding practices
were more likely than whites to become insulin of whites and Indo-Americans in the United States
464 SOUTH ASIANS
Some researchers and Asian Indians in India found that whites Overweight and obesity in adults is estimated at
hypothesize that fetal relied on health professionals for advice, while 25 percent in the nation, associated with increased
stresses, especially low Indo-Americans sought information from family age, being female, urban residence, being literate,
birth weight and possible and friends during the first six months and from higher socioeconomic status, and higher intake
protein deprivation after health professionals thereafter.56 It is common of meat.42 Adults living in wealthier neighbor-
birth, may contribute to
practice in India to avoid breast feeding colostrum hoods of Karachi reported higher rates of type 2
insulin resistance in Asian
Indians.9, 113
to newborns due to various concerns such as caus- diabetes and cardiovascular disease when com-
ing indigestion or diarrhea, or that it is bad for the pared to those living in impoverished Karachi
infants health. The researchers report that all white, households.39 Of particular concern is a fat distri-
76 percent of Indo-American, and 32 percent of bution pattern that favors abdominal fat, even at
Indian mothers initiated breast-feeding within normal weight levels.15
Bangladeshi men living in an hour of birth. Twenty-four percent of Indo- Pakistanis in Britain had a higher average
Britain had substantially American women and 68 percent of Indian BMI and higher intake of calories from fat than
greater risk for cardio- mothers delayed breast-feeding for several days, Europeans or Afro-Caribbean immigrants in one
vascular disease based on in part to find an auspicious time to start based study.111 When compared to other South Asians,
smoking, dyslipidemia, and on astrological conditions.54 Prelacteal feeds were Pakistani men were found to have higher rates of
diabetes rate (26 percent
prepared for the infants during this period, diabetes than Asian-Indian men (22 percent and
of the sample) than did
Asian Indians and Pakistanis,
including honey (which is thought by some Asian 15 percent, respectively). Dyslipidemia in Pakistani
suggesting variability in Indians to help rid the infant of meconium) and Americans, including high serum triglyceride
South Asian subgroups.13 water with sugar, glucose, or jaggery and season- levels and low HDL cholesterol levels, was identi-
ings such as asafetida, cumin, and aniseed. fied in a Chicago study.53 Though these data on
Iodine deficiency and goiter Another study noted that the longer an Indo- Pakistanis are limited, this clustering of risk factors
are endemic in the Kashmir American woman has lived in the United States, is similar to that found in Asian Indians and may
region. the less likely she is to use traditional feeding be indicative of metabolic syndrome.
practices.54 These same researchers found Asian-
IndianAmerican women breast fed for shorter Counseling
durations and introduced formula and solids ear- Asian Indians. The majority of Indo-Americans
lier than did white women.55 are very familiar with biomedicine, and health
care access is considered good. Though informa-
Pakistanis. Little has been reported on the tion on health care insurance rates of Asian Indians
consumption patterns of Pakistani Americans. is limited, aggregate data on South Asians show
Malnutrition has been noted in some regions of most insurance is obtained through employment,
Pakistan where droughts limit the food supply, and it is assumed that high employment rates in
and some studies estimate stunting occurs in 40 the Indo-American community translate into high
to 50 percent of all Pakistani children, with stunt- rates of coverage.16 English fluency is prevalent,
ing in female children three times more likely and only 23 percent of Indo-Americans report they
than in male children.8 Rural children have been speak English less than wella small number
found at potential risk for underconsumption of given the high percentage of first-generation
micronutrients even when ample food is avail- immigrants in the population. The largest dialects
able. Vitamin D and iron deficiencies have been spoken in the United States are Hindi, Gujerati,
found in pregnant Pakistani women living in and Bengali. Many Asian Indians whose native
Norway, in part due to low intake of supplements; tongue is another dialect will also speak Hindi.79
low levels of plasma vitamin D are also a concern Traditional expectations regarding social
in South Asian children living in England. Low interactions may present problems in the provider
bone mineral density and a risk for early osteo- client relationship.86 A client may not disagree
porotic fractures in both men and women from with or correct a provider in situations where the
South Asia have been noted.6, 18, 38, 40, 66 client believes that the provider is superior in
In contrast, overconsumption is more of a status, and compliance may be assumed because
concern for Pakistanis living in urban areas and the client does not indicate otherwise. If the
in Westernized nations. Children living in client does not feel that treatment is satisfactory,
Pakistan cities were found to have a high intake he or she will typically change providers rather
of calories, sugar, total fats, and cholesterol.38 than confront the problem. Conversely, if a client
believes that she or he is an equal with the Asian-Indian women are often less vocal than Asian Indians may have
provider, the client may desire a social rather than men and may be very uncomfortable with a male difficulty digesting fresh
professional relationship with the provider. The health care provider. Men do not touch women in milk; estimates also
client may also feel entitled to special privileges, either informal or formal situations; physical indicate that 60 percent
of adults in Pakistan are
such as immediate access to the provider and exams of women are unusual. Female gynecolo-
lactose intolerant.4
longer appointments. Some Americans of Asian- gists and obstetricians may be preferred. Family
Indian descent may feel cheated if exhaustive members may accompany a patient, especially a Conditions that may be
testing procedures or invasive therapies are not woman, as a chaperone during an appointment. of concern in some Asian
provided for their condition.86 The chaperone expects to participate in any dis- Indians and Pakistanis
A polite, respectful, direct yet leisurely style of cussion of the client and to oversee the exam include beta-thalassemia,
communication is preferred by most South (privacy among spouses and siblings is limited). which is a commonly inher-
Asians.114 Loudness is discouraged, whereas self- Family members may also assume responsibility ited disorder, and a high
control and occasional periods of silence are for all but the most technical care of a patient prevalence of glucose-6-
valued. Small talk is significant, and rushing is during hospitalization; it is their obligation to phosphate dehydrogenase
considered rude. A direct no is considered feed, bathe, and support a relative. If cost is an deficiency in some tribal
groups from the North-West
impolite, so an evasive negative response is the issue in obtaining health care, the male head of
Frontier Province of Pakistan.
norm. Feelings and faith may be more important the household may receive priority over women,
than objective facts in making decisions.32 girls, or elders in a traditional Asian-Indian home.
Though India is a relatively low-context Americans of Asian-Indian descent may pro-
culture,32 several nonverbal communication cus- vide more information regarding their condition
toms among Asian Indians are significant. Most than the practitioner may feel is warranted.
Indian Hindu, Sikh, and Christian men and Ayurvedic medicine focuses on a persons role
women avoid contact with the opposite sex in within the cosmos, so details about what a client is
public, and contact between men and women in eating, sleep patterns, and changes in the weather
public is completely prohibited by Muslims. may be important to a client. Most clients expect
Direct eye contact between men and women who lifestyle advice, particularly regarding diet, as part
are not related may be interpreted by some less of their therapy.63, 86 Some clients may expect a
acculturated South Asians as suggestive.114 The complete history and physical exam to be under-
traditional greeting is to nod with the head while taken at each appointment, while others assume
holding the hands palm to palm beneath the chin that the practitioner can diagnose simply by taking
and saying namaste (I honor God within you), a pulse and without prying into what may be per-
but Westernized Indians will use a handshake ceived as personal issues. The practitioner should
(it is best to wait and follow the clients lead). proceed cautiously with questioning until the
Some Asian Indians (especially those from South clients expectations have been determined. Indo-
India) indicate agreement by head wobbling, Americans have strong opinions about the thera-
which resembles the way Americans shake their peutic value of medications. Injections are believed
heads back and forth to indicate the negative.32 most potent, and in India a patient might receive
Informal smiles are used between equals only between one and four shots each visit. Capsules
superiors do not generally smile at subordinates are thought to be more effective than tablets, and
or vice versa. colorful tablets more potent than white tablets.
In both India and Pakistan the left hand is Furthermore, the medication becomes more
never used for any social purposes, including effective through the skill of the provider; thus, it
handshakes, giving an item to another person, or is imperative that the provider personally hand
pointing. The head is considered the seat of the the prescription to the client.
soul; patting or touching another persons head Little information has been reported regarding
should always be avoided. Conversely, the feet the use of Ayurvedic medicine or folk remedies
and shoe soles are considered the dirtiest parts of by Asian Indians living in the United States.
the body, and it is impolite to point with the foot Research suggests that home remedies, Ayurvedic
or show the bottom of ones shoe.32 All that said, medicines, and homeopathic prescriptions are
it should be noted that most Indo-Americans are used frequently, most often for minor ailments or
highly acculturated and can converse in a style when biomedical therapies were ineffective.
comfortable for Americans. Traditional cures are often used concurrently with
466 SOUTH ASIANS
biomedicine.87 Although most herbal preparations same gender. A very soft shake of the right hand,
are compatible with biomedical therapies, some then touching the heart, is known as the salaam
have potent therapeutic effects (see Traditional and is the traditional greeting between men.
Health Beliefs and Practices discussed previously), Handshaking may be used with Westerners,
and thus it is important to ascertain which remedies though it tends to be an adaptation of the salaam
are in use. Further, a study of herbal medicines and is light. Men and women do not use the
purchased in South Asian grocery stores found salaam or shake hands in the American style
that one in every five contained potentially harmful unless the woman is westernized. Many Pakistanis
levels of lead, mercury, or arsenic.98 maintain an expression of serious attention in
An in-depth interview should be used to estab- interactions with acquaintances.
lish the clients religious affiliation and degree of Pakistanis are similar to Asian Indians regarding
adherence, length of residency in the United States, certain nonverbal communication styles.32 No eye
and degree of acculturation, as well as vegetarian contact or only peripheral glances may be pre-
or non-vegetarian preferences. Clients should also ferred between men and women, for example. A
be asked about Ayurvedic practices, particularly Pakistani should never be touched on the head
those regarding diet and home remedies. without requesting and receiving permission to
do so, the foot should never be used to point, and
Pakistanis. There has been little reported
the soles of shoes should not be shown when
specifically on counseling Pakistani-American
seated. Only the right hand should be used to
clients. Most are familiar with biomedicine. Few
touch people and pass objects, including papers
data are available on health insurance coverage for
Pakistanis. A study of South Asians (combining and money. Slouching and leaning are inappro-
Asian Indians, Pakistanis, and Bangladeshis) priate in most circumstances. Pakistanis may
found that one in every five was uninsured and stand closer than is comfortable for Americans,
that lack of insurance prevented 31 percent of and it is considered rude to back away.
adults and 29 percent of children from obtaining Islamic rules regarding modesty may require
One Ayurvedic remedy for women to seek care only from other women.
diabetes uses ginger and medical care at least once during a two-year
period.16 Higher-than-average rates of poverty Exposure of clients, even when men are examining
rock candy.
may contribute to health care access problems. men, should be limited.34 In Pakistan, families
Mental illness is highly stig- Though fewer than 10 percent of Pakistanis may be responsible for providing food or medicine
matized in India. Complaints speak only English at home, another 60 percent for ill members who are hospitalized. Pakistanis
of headache, leg tingling, reported speaking it well.94 The remaining 32 in Great Britain report that family care often
or burning on the soles of percent speak English less than very well, which includes prayer and massage.23 Women may be
the feet may be related to presents potential language difficulties in some discouraged from decision-making, which is tra-
psychological distress in ditionally the responsibility of a husband or older
clinical situations. It should be noted that although
recent immigrants. male relative.
Urdu is the official language of Pakistan, only 8
percent of Pakistanis speak it as their native Many South Asians in Scotland (Pakistanis
tongue. Nearly half of Pakistanis speak Punjabi, and Asian Indians) believe American medications
and the remainder are divided between six or are superior to those from their homeland. A study
seven other languages or dialects. In addition, the on use of oral hypoglycemic agents found that
literacy rate in the country is only 38 percent.80 some patients assumed they should only take the
In contrast to Asian Indians, Pakistanis tend medication if they had symptoms, while others
to prefer indirect, restrained communication and worried about long-term use or adverse effects if
avoid confrontation. They are more high-context taken with other drugs or certain traditional
than Asian Indians, and meaning is interpreted foods.65 Clients sometimes reduce intake without
through the specifics of the social situation and the supervision.
use of symbolic language.32 In general, loud expres- An in-depth interview, including assessment of
sion and body motions are avoided, and many education level and acculturation status, is necessary
gestures, including winking and whistling, are to determine appropriate therapeutic approaches for
considered vulgar. Pakistan is essentially a non- Pakistani-American clients. Accommodation of
touching culture, but hugs and other expressions Muslim dietary laws and individual preferences in
of warmth are found between intimates of the nutritional counseling is most effective.
PRACTITIONER PERSPECTIVEAsian Indian

Gita Patel, MS, RD, CDE, LD
am from India and have been a practitioner in the United States for close to thirty years, and many of my clients are South Asians.
I I would describe the typical South Asian meal as containing a lot of variety on the plategrains (rice and bread), beans (lentils),
salad ingredients in the raytas, along with vegetables. The meal also contains several condiments, such as pappadams and pick-
led mangos, etc.all these ingredients help to balance the meal, which is important since many South Asians from India are veg-
etarians. For South Asians living in the United States, the typical fast foods that have crept into the diet tend to be those that can be
vegetarian, such as pizza. Inexpensive convenience foods are bagels, pasta, and ramen noodles. Many South Asians will go out to eat
in Mexican and most Asian restaurants.
Preparation of South Asian food is labor intensive, and bac k home there are often servants to help in the kitchen. Here,
especially for younger South Asian men who are not married, the ingredients may be hard to find, and they will have to prepare
their own food. So it is not uncommon that they will go out to eat and, even though they are vegetarian, will sometimes even
eat hamburgers.
South Asians have a very high rate of type 2 diabetes and heart disease, so my advice to many of my clients is to eat smaller por-
tions of rice and bread, increase their intake of vegetables and lentils, and be aware of the sodium content in food, especially pick-
les. I always ask about desserts and sweets in their diet since they are common in the diet. I never tell my clients to eliminate bread
and rice in their diet since I know they wont do it. Instead, I tell them how much they can eat. Same with fruit, but I tell them to eat
whole fruit and not consume it as juice.
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CHAPTER
15
Regional Americans
I n Boston they eat beans. In Philadelphia they

eat cheesesteak. In Kansas City they eat bar-
becue, and in Seattle they drink caf lattes.
A person from Montana is no more likely to eat
grits (ground hominy) than a person from
These figures reflect regional tastes and spe-
cialties. Tea in the Northeast dates back to colo-
nial times, and the strong German influence in
some areas accounts for the popularity of hot
dogs and lunch meats. Pork and corn have long
Clinton, Montana, hosts
the Testicle Festival each
September: two days
of feasting on Rocky
Mountain oysters
(marinated, sliced,
Mississippi is likely to eat Rocky Mountain oysters been a foundation of southern fare. The first law of
breaded, and deep-fried)
(deep-fried beef testicles). Just as certain fare is the Midwestern meal is save room for dessert,30
on toasted bread and
associated with ethnicity and religious affiliation, while the popularity of spices, seasonings, and enjoying live country music.
local food preferences are central to American Mexican food in the West reflects a history of Over 4,500 pounds of beef
regional identity. ethnic diversity in the Southwest and California; testicles are consumed
While most Americans expect uniformity in the current craze for coffee drinks began in the annually at the event.
some food products, such as the breakfast cereal Pacific Northwest. This chapter profiles the Vinita, Oklahoma, sponsors
they buy in the grocery or the burger they purchase Northeast, South, Midwest, and West regions and a Calf Fry Festival on the
at a fast-food franchise, American cuisine is any- examines traditional fare, noting significant culi- first Saturday after Labor
thing but homogeneous. Consumption data illus- nary variations and trends in American regional Day, featuring Prairie
trate many differences. People in the Northeast food habits. Nutritional concerns are also noted. oysters and fries.
spend the most annually on frozen meats, bread
and cracker products, certain meats and fish (espe-
cially lamb, hot dogs, lunch meats, ham, and fresh
fish), butter, tea, and iced tea mixes. Those in the American Regional
South spend more on pork (particularly sausage),
hamburger and round steak, cornmeal, shorten-
Food Habits
ing, canned vegetables, dried beans and peas, and
WHAT IS REGIONAL FARE?
refrigerator biscuits. Beef roasts, frozen foods,
salad dressings, canned pie filling, baking choco- Regional fare has traditionally been home-style
late, brown sugar, potato chips, and carbonated food prepared with local ingredients, dependent
beverages are above-average sellers in the Midwest; on agricultural conditions and seasonal availability.
fresh and dried fruits, fresh vegetables, cereals and Most families made do with what they could grow,
grains (especially flour, rice, pasta, and non-white gather, or barter. Local foods are the most signifi-
bread), chicken and canned ham, cheese, spices cant of several factors that influence the develop-
and seasonings, Mexican foods, pies and tarts, and ment of a particular regional cuisine. The spicy
coffee are purchased more often in the West.21,35 cooking of the Southwest with its emphasis on
Beer is preferred in the Midwest and South, while corn, beans, and chiles could not have been created
wine dominates in the West and Northeast.24 in the upper Great Lakes area, which produces
474 REGIONAL AMERICANS
NEW
Flavored mustards
Berries1 Berry conserves ENGLAND
Salad dressings
Grapes Organic fruit Clam
Apple sauce
Kadota figs sweetener chowder
Apple butter
Plums Beer
Butter Cheddar cheese
Cherries Margarine Maple syrup
Berry juice Sparkling
Honey mineral BOSTON
Cheddar cheese water Cheese Cream cheese Boston
Processed
potatoes5 Wild rice Neufchtel cheese cream pie
Whole potatoes Sharp cheddar
Dried fruits2 MILWAUKEE CAPE COD
Flavored mustards Pickles Chocolate Cranberry
Olives Pork roast Beer Cocoa powder juice
Corned beef Sarsaparilla Choc. syrup
Carrots
brisket
Misc. fresh NEW YORK
vegetables Cheese
Bread CITY
Canned tomatoes BBQ Cheesecake
Herb vinegars Chili mix
Popcorn sauce Seltzer water
Vegetable oils3 Sirloin KANSAS Hot dog buns
Marinated Cheese
CITY Sweet potatoes
vegetables Hot pepper
Fruit jams4 sauce
Cheese Taco shells
Tomato juice Chili spices
Apple butter
Peach
Organic apple sauces
Mexican foods juice
Carrot juice
Chili seasoning
Catsup
Hot sauce
Burritos
Salsa
BBQ sauce
Biscuits Cajun coating THE SOUTH
Spiced peanuts mixes Hush puppies Key lime mangrove
Grapefruit juice Hot sauce Hush puppy mix honey dressing
Rolls Orange Juice Cajun seasoning Taco sauce Mango dressing
Bread Okra pickles Steak sauce Lime fruit juice
Sugar Bloody Mary mix Gumbo mix cooler
Basmati rice Crab & Shrimp
Jalapeno slices boil mix
*Listed in order from most to least frequent occurrence.

1Gooseberries, boysenberries, blackberries, strawberries, blueberries, red raspberries. 2Apples, peaches, figs, prunes, raisins. 3 Walnut, olive, pecan. 4Black raspberry, strawberry,
apricot, kiwi. 5Hash browns, tater tots, golden fries, potatoes OBrien, crinkle cuts, homestyle potatoes, cottage fries, shoestrings, potatoes au gratin, scalloped potatoes,
instamash potatoes.
Figure 15.1
Foods associated with
places. wheat, fish, and dairy foods. Before the advent of fare, and the northern Italian-Mexican-Asian
Source: de Wit, C. W. Food-place
food preservation and refrigerated shipping, local mix found in California cuisine. Religious food
associations on American product
labels. Geographical Review, 83,
items were not only freshest and tastiest, but also habits are a factor in areas where large numbers
323330. Copyright 1992. most economical. Strong associations with place of a specific faith have congregated. For instance,
Reprinted with permission by and food suggest the importance placed on the the majority of Mormons live in Utah, and
American Geographical Society. superior quality of local items. Even today, with Mormons do not drink alcohol, tea, coffee, or
a global assortment available, there is a certain other stimulating beverages. Alcohol purchases
cachet to Maine lobsters, Vermont maple syrup, in Utah are strictly controlled through limited
Georgia peaches, Florida oranges, Idaho pota- availability at state-run outlets. Sweets are allowed,
toes, and Washington apples (see Figure 15.1). however, and are well integrated into family
A study of places and Ethnic and religious practices also affect the activities. The people of Utah eat twice as much
foods found that Texas, development of regional fare, particularly spe- candy per capita as the U.S. average.25
California, Vermont, cialty foods. Jewish bagels in New York, German A third factor in regional foods is local history,
Oregon, and Louisiana were doughnuts called Fastnachts in Pennsylvania, Cajun which is often associated with certain dishes. A
the states with the most Frenchstyle sausages in Louisiana, West African good example is the Kentucky stew called burgoo.
food associations and that influenced hoppin John in South Carolina, south- Legend has it that the mixture of poultry and
place names enhanced the ern Italianflavored pizza in Chicago, Cornish red meat with vegetables dates back to the Civil
perception that an item was
pasties in Michigan, and Mexican-inspired chili War when a chef for the Confederate cavalry at
authentic, distinctive, and
con carne in Texas are just a few examples. Most Lexington created the stew from native black-
high quality.12
regional cuisine is a blend of several ethnic ele- birds, game, and greens. There is no single recipe
ments, such as the BritishNative American dishes for the dish, but today it typically includes chicken,
of New England, the African-French-Spanish- pork, beef, or lamb; and cabbage, potatoes, toma-
BritishNative American mlange that is southern toes, lima beans, corn, and okra. It is seasoned with
Chapter 15: Regional Americans 475
cayenne. Burgoo is traditionally served at picnics, Steel Belt and the Silicon Valley; or by the char-
political rallies, and sporting events, including acteristics of the population, as in Indian Lands
Derby Day. Current trends can be an influence as and the Bible Belt. Historical divisions, such as
well. Some dishes sweep through one region but the Mason-Dixon Line, or political divisions,
never gain national acceptance, such as caviar pie including state boundaries, can also be used.
(layered hard-boiled eggs, scallions, caviar, and Geographers suggest that traditional regions con-
sour cream) in the Southeast, or loco moco (a bowl tain elements of all these variables, characterized
with rice topped with a ground beef patty, then an as a synergistic relationship between a people and
egg over easy, and gravy) in Hawaii. Other trends the land that develops over time and is specific to
start out regionally and then catch on country- the locality. Such regional identity is dynamic,
wide, such as the salsas of the Southwest. more of a process than a delineation, subject to
Economics contribute to the popularity of cer- changes in population, economy, ecology, and
tain foods. One study found that some of the best other factors.26,41 Ideally the people who live in an
markets for beer in the country are in the poorest area, through their voluntary affiliation and their
areas. Wine is popular in upper-income regions, mutual agreement on group boundaries, define
which are often the worst beer markets despite each region.8 Most often, however, geographic
the growing popularity of local brewpubs.14 considerations are used to set arbitrary regional
Households with incomes below $20,000 a year divisions independent of cultural relationships.
spend about $1,400 per capita on food, buying The U.S. Census Bureau and the U.S. Depart-
more white bread, bacon, pork chops, luncheon ment of Commerce list four regions with nine
meats, and eggs per person than the U.S. average. subdivisions for data collection purposes: North-
On the other end of the socioeconomic spectrum, east, Midwest, South, and West (see Table 15.1).
households with incomes more than $100,000 Although these categories group states with dis-
annually spend over $4,725 on food, with above- tinctively different cuisines together, such as
average purchases in almost every category, espe- Florida and Texas, or Alaska and Hawaii, most
cially expensive cuts of beef, lamb, fresh fish and demographic and food consumption data are pre-
seafood, dairy products, biscuits/rolls, fruits, presented in this four-region format (see Figure 15.2).
pared salads, nuts, and snack foods.35 Upscale It is useful for detecting broad trends, as long
consumers are more likely to be exposed to as results are not overgeneralized to smaller
unique culinary ideas when dining out in trendy populations who may observe alternate regional
full-service restaurants and to be willing to pay boundaries.
for new or unusual food items.
This blending of physical, cultural, historic,
current, and economic conditions in a region
produces what researchers call a taste of place,
The Northeast
from the French gout de terroir.53 Elementally, the
taste of place is the identification of certain ingre-
REGIONAL PROFILE
dients or dishes with an area. At a deeper level, it The states of the U.S. Northeast include those of
is the emotional connection between people and New England (Connecticut, Maine, Massachusetts,
a local heritage, an appreciation for the regional New Hampshire, Rhode Island, and Vermont)
characteristics that create flavors unlike those and those of the Mid-Atlantic region (New Jersey,
found anywhere else in the nation, or the world. New York, and Pennsylvania). The New England
area features a rugged, irregular Atlantic coast-
line with many protected bays. Rolling hills and
REGIONAL DIVISIONS
valleys that gradually become densely forested
The United States has been divided numerous mountains extend west. The region is noted for
ways. Sometimes regions are delineated by ter- its spectacular autumn weather and colorful fall
rain, as in the Great Plains, or marked by major foliage, followed by harsh winters. The Mid-
rivers or mountain ranges, as in the Mississippi Atlantic states are farther south and more tem-
River Valley or the Appalachians. Sometimes perate in climate. Sandy beaches and estuaries
areas are defined by similarities in climate, as in line the long coast. The ridges, river valleys, and
the Sun Belt; by economic affiliation, as in the fertile plateaus of the Adirondack, Appalachian,
Table 15.1 U.S. Regional Divisions

Northeast
New England Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont
Mid-Atlantic New Jersey, New York, Pennsylvania
Midwest
East North Central Illinois, Indiana, Michigan, Ohio, Wisconsin
West North Central Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota
South
South Atlantic Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina,
Virginia, West Virginia
East South Central Alabama, Kentucky, Mississippi, Tennessee
West South Central Arkansas, Louisiana, Oklahoma, Texas
West
Mountain Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming
Pacific Alaska, California, Hawaii, Oregon, Washington
Blue, Catskill, and other mountain ranges criss- supplanted by European settlements. The colo-
cross much of the three states. Freshwater lakes nial immigrants from England, Germany, the
dot the region and provide the northern bound- Netherlands, and France were followed by new-
ary along Lake Ontario and Lake Erie. comers from Ireland, Italy, Portugal, Poland, and
Despite differences in climate and geography, other central and eastern European countries,
Figure 15.2
the entire Northeast shares a common early his- particularly in the Mid-Atlantic states. African
Regional divisions in the
tory of sophisticated Native American societies Americans from the South and more recent
United States.
WA
Midwest ME
MT ND
Northeast
VT
MN
OR NH
SD WI NY MA
ID
MI CT RI
WY
IA PA
NE NJ
OH
NV IL IN
DE
UT
CO MD
KS
CA MO WV
VA
KY
NC
AZ TN
NM OK
AR SC
AL GA
HI MS
LA
TX
West AK
FL
South
1% 4% 9%c
11%a American Indian or Hispanic or
Alaska Native Latinob
1%
4% Asian Non-Hispanic
2% Black or African
American
Native Hawaiian or
other Pacific Islander
Some other race
Two or more races
77%
White
91%
Population % by Race Hispanic % of Population
a
Mostly in New York and New Jersey. bMay be any race. cMostly in New York and New Jersey.
Figure 15.3
immigrants from the Caribbean, Central America, the many rivers and lakes (see Table 15.2). In
Demographics in the
Africa, and Asia have added to the diversity of New England, seafood, such as clams, lobster, Northeast, 2000.
some parts of the Northeast (see each chapter on scallops, and fish, especially cod, has been promi-
ethnic food habits for more immigration details). nent. Indigenous game, including wild turkey
Although only 19 percent of the total U.S. pop- and venison, supplemented the poultry, pork,
ulation is found in the Northeast,20 over two-thirds and beef brought by early immigrants. The foun-
of Puerto Ricans living on the mainland reside dation of the diet was traditionally corn, and
there, and over one-third of all Asian Indians in many dishes of the region reflect its importance.
the United States have settled in the region. Beans have also made a substantial contribution.
Disproportionately large populations of blacks Root vegetables (potatoes, onions, beets, turnips,
and Latinos reside in New York and New Jersey. rutabagas, carrots, etc.) quickly added to the veg-
Yet the rest of the Northeast is still predominantly etable selection. Wild berries, including blueber-
white (see Figure 15.3), including large percent- ries, cranberries, gooseberries, and cloud berries
ages of Italians, Ukrainians, Portuguese, French (which look like bleached blackberries), grapes,
Canadians, Russians, Lithuanians, Slovaks, and and beach plums were the main fruits consumed Fudge was originally a
maple sugar candy popular
Poles. Nearly half of all American Jews also live in until the apple orchards planted by immigrants
in New England in the
the Northeast, primarily in New York, New Jersey, became productive. Maple sugar sweetened many
1800s. When cocoa became
and Massachusetts. foods in New England. Even when molasses and widely available, the
Compared to national figures, the Northeast cane sugar became widely available, maple syrup chocolate version was
has a lower percentage of persons under the age of was preferred for many dishes. developed.
fifteen, and a higher proportion of persons over the The warmer weather and fertile lands of the
age of sixty-five. Data from the 2000 Census also Mid-Atlantic states have provided more native Shad migrate from the
show that the Northeast has the highest population foods than New England. The coastal waters offer ocean up freshwater rivers
density of all regions and the highest number of clams, oysters, mussels, scallops, and crabs, while to spawn in early summer.
people living in metropolitan areas (nearly 90%). the estuaries shelter ducks, geese, and turtles. Shadberries (also known as
Average household income was highest as well, the Passenger pigeons once darkened the skies with Juneberries) are a popular
treat that ripen at the same
highest nationally in New England, at $48,382 per their massive numbers, and bison roamed the area
time the fish arrive each
year, while above average in the Mid-Atlantic divi- around Lake Erie. Freshwater fish such as catfish,
year.
sion at $44,370 annually. Approximately 9 percent eels, pickerel, salmon, shad, smelt, trout, and
of persons in New England live in poverty, 12 per- whitefish were plentiful; at one time, shad, a fla- Salmon served with fresh
cent in the Mid-Atlantic. vorful relative of the herring, was the most numer- peas is a Fourth of July
ous of all freshwater fish in the United States. Both tradition for many New
the flesh and roe were commonly eaten. Englanders.
TRADITIONAL FARE Introduced foods also flourished in the region.
The cooking of the Northeast features the abun- Cabbage, potatoes, yams, carrots, peas, apples,
dance of the Atlantic, the plenty of native and pears, cherries, peaches, and strawberries were
introduced produce, and the freshwater wealth of easily grown. Tomatoes thrived in the hot summers.
Table 15.2 Northeastern Specialties

Group Foods Preparations
Protein Foods
Milk/milk products Cream; cheddar and cream cheese Cream soups, sauces, puddings; ice cream
Meats/poultry/fish/ eggs Native game, particularly venison and New England boiled dinner; scrapple; red-
turkey flannel hash
Preserved meats, such as corned beef,
pastrami, salt pork, ham, bacon,
sausages
Seafood prevalent, especially clams, Fish stews, soups; clam chowder; clam bakes;
lobster, oysters, scallops oyster or lobster loafs
Salt and freshwater fish, such as salt cod Cod cakes; shad bakes; gefilte fish
and shad
Numerous beans (e.g., cranberry, kidney, Baked beans; succotash
lima)
Cereals/Grains Corn, wheat, rye Cornmeal porridges, puddings, and breads
Dumplings
Baked goods savory and sweet pies, cakes,
doughnuts, waffles, pretzels, bagels
Fruits/Vegetables Apples, blueberries, cranberries, grapes Applesauce, apple butter; fruit puddings, pies
Cabbage, fiddlehead fern fronds, Coleslaw; sauerkraut; ferns on toast; potatoes
potatoes mashed, fried, creamed, baked, scalloped,
hashed, as croquettes, salad
Additional Foods
Seasonings Salt, pepper, onions, saffron
Nuts/seeds Black walnuts, butternuts
Beverages Apple cider, hard cider, applejack; ale, New York State white, red, sparkling wines;
beer; rum, whiskey; wine sherry, port
Fats/oils Lard, butter
Sweeteners Maple sugar; molasses Maple sugar candies, maple syrup pie; chocolates
Although New Jersey is now one of the most indus- farming and husbandry. History abounds with
trialized states in the nation, it is still known as tales of how the first settlers were dependent
the Garden State due to the success of these early on the skills and generosity of local Indians in
agricultural efforts. Wheat, which was difficult preventing starvation (see Chapter 5, Native
to grow in New England, did well in the Mid- Americans). Corn dishes were especially signifi-
Atlantic. At one time New York provided all the cant. Cornmeal porridge cooked into a mush-like
wheat consumed in the Northeast and much of consistency was a Native American food called
the South. samp by the early colonists. It was often prepared
with another cornerstone of the Indian diet,
New England beans. New Englanders used cornmeal to make
The cuisine of New England has been shaped pre- an adaptation of the traditional English dish
dominantly by Native American preparation known as hasty pudding. The settlers would
techniques combined with British homestyle pour cornmeal porridge into a loaf pan to firm up
cooking. Roasting, boiling, and stewing are pre- overnight, then slice it and serve it topped with
ferred. Dishes are often made with cream, and cream. This new dish, often flavored with maple
strong seasonings are avoided. People of the syrup or molasses, was named Indian pudding.
region take pride in simple fare. Steamed, baked, and boiled puddings were
The immigrants of the early seventeenth cen- eaten daily in New England homes. They were
tury were mostly tradespeople, inexperienced in known as grunts (steamed dough and berries),
slumps (baked puddings), and flummeries what is called chipped beef today), and fried salt The oldest continually
(a British molded oatmeal or custard pudding). pork topped with cream gravy. New England operating cheese factory
As in England, a pudding could be savory or states without access to the coast were more in the United States was
sweet and was generally served at the beginning dependent on meat, poultry, and dairy products. founded in 1822 in
Healdville, Vermont.
of the meal. Breads were also a mainstay. Many Today, New Hampshire is acknowledged for the
Manufacturers have
were dense, baked without any leavening (reliable quality of its butter, and Vermont is famous for its
expanded into the
leavenings such as baking powder and baking cheeses, such as cheddar and the similar but European-style cheese
soda were not available until the mid-1900s). milder Colby. (e.g., Brie, Camembert)
Homegrown yeast from potatoes, hops, or the Beans were eaten regularly in early New market in recent years;
dregs of beer barrels was used in some recipes. England. Best known are baked beans flavored the largest producer of feta
Cornbread cooked in a skillet over the fire was with molasses or maple syrup and salt pork, a cheese in the nation is
most common. Rye, which grows well in cooler recipe adapted from the Native American dish. found in Vermont.
climates, was often combined with cornmeal to Traditionally the Puritans prepared a large pot of
make a popular bread called ryaninjun (from beans on Saturday morning, simmered them over The Maine bean pot is
Rye n Injun). Stewed pumpkin was some- the fire all day, and then ate them with Boston based on the Indian method
of placing the ingredients
times added for a moister loaf. Boston brown brown bread for dinner to start the Sabbath
in a pot that is then buried
bread is a traditional recipe of the regiona (observed from sundown to sundown). Leftovers
in a pit over embers, a so-
steamed loaf made with whole wheat and rye were kept warm on the hearth for Sunday break- called bean hole.
flours (sometimes with cornmeal as well) and fast with codfish cakes and for Sunday lunch.38
flavored with molasses. Boston is still known as Bean Town due to its
Pork, cod, or beef flavored most main dishes. long association with baked beans. In Maine a
Long winters required that most meats and fish version called bean pot is made with indigenous
be preserved, and few recipes called for fresh yellow-eye, cranberry, or kidney beans.
cuts. Salt pork, bacon, smoked pork, dried salt Pies made with suet pastry were served at
cod, corned beef, and dried beef were common, most meals. Savory kinds included an American
usually braised or stewed with vegetables. The version of the British steak and kidney pie,
New England boiled dinner is typical. This one- chicken pot pie (later topped with biscuits instead
pot meal is still popular throughout the region of pie crust), a ground pork and onion pie sea-
and usually includes corned beef brisket sim- soned with allspice called tourtire introduced by
mered for hours with potatoes, onions, carrots, French Canadians in the region (served tradition-
turnips, and, traditionally, beets. Cabbage is added ally at Christmas or New Years), clam pie, lobster
toward the end of the cooking time. Seasoning is and oyster pie, and a salt cod pie covered with
mild, often just a little black pepper. Leftovers are mashed potatoes. Sweet pies were also popular,
often chopped up the next day and heated in a especially apple pies, made with fresh apple slices,
skillet with a little cream and sometimes some dried rings, or even applesauce. Mincemeat, a tra-
bacon and more onions to make another New ditional English treat combining savory and sweet
England specialty known as red-flannel hash, so- ingredients, was featured at many meals because
called because the cooked beets would bleed into the filling of meat, dried fruits, nuts, and rum or
the other ingredients during frying. A dried salt other alcoholic preservative aged well, becoming
cod and potato version of the New England boiled tastier over time. Today, Vermont fried pies (fried
dinner is prepared in Massachusetts, called Cape applesauce turnovers flavored with cinnamon)
Cod turkey. Plymouth succotash is another and apple pie topped with sliced cheddar cheese
example. Although this Native American dish are Vermont favorites, while in New Hampshire, During the colonial period,
(see Chapter 5) is often associated with southern apple pie is sometimes drenched in maple syrup. dried salt cod was
fare today, it was popular in the Northeast during Blueberry pie is a specialty in Maine. exchanged for fruit in the
Mediterranean and for
colonial times. It combined corned beef, turkey No discussion of New England fare is com-
molasses in the Caribbean
or chicken, beans, corn, potatoes, and turnips. plete without further detailing the use of fish and
(the molasses was then
Other variations featured just vegetables or com- shellfish in coastal areas. In Massachusetts, for used to make rum). Cod
binations of meats, poultry, and fish. example, cod helped sustain the earliest popula- traders in Massachusetts
Other popular dishes included dried beef tions, and Cape Cod, the peninsula that curls out became wealthy and were
rehydrated in boiling water and served with into the Atlantic, was so named in 1602 for an nicknamed the codfish
cream sauce over bread or potatoes (precursor to abundance of the fish. The Puritans used it in aristocracy.
The name chowder may boiled and baked dishes, soups, stews, hash, and, are strict. In addition to steamed or grilled lob-
come from the French term most notably, codfish cakes. These cakes, which ster tail, a specialty in Maine and other coastal
for an iron pot, chaudire, or are also called codfish balls, are still a sign of areas is lobster rolls, which take two forms (both
the Welsh word for a fish regional affiliation for some residents of the served on toasted, fluffy white bread buns): plain
soup, jowter.
Boston area. In Connecticut shad was enjoyed by meat drenched in butter, or meat mixed with
the Native Americans of the region but disdained mayonnaise, celery, onions, and lemon juice.
An unusual vegetable
found in Maine is by the earliest Europeans in the area due to its Clams, oysters, and scallops are also New
fiddlehead fern fronds. multitude of tiny, difficult-to-remove bones. By England favorites. The clambake, in which clams,
The ferns are eaten fresh the mid-eighteenth century Connecticut resi- corn, and other items such as onions, potatoes, or
on toast or in fiddlehead dents had changed their opinion of shad, espe- lobster are steamed in a pit on the beach, shares
pie, similar to a quiche. cially the roe, which they fried quickly in butter. some similarities with American Indian seafood
They are also sold canned Traditionally, American Indians would plank the feasts, and was enjoyed as a way of connecting
and frozen.23 fish and slowly cook it at the edge of hot coals, a with what New Englanders in the early nine-
method still practiced today at shad bakes where teenth century believed was their Puritan past.34
the fillets are placed on an oak board with strips Clams are also featured in the cream-based soup
of bacon, then grilled or smoked. known as clam chowder. One version, the cream-
Lobster is a specialty, especially in Maine. based Boston clam chowder, is known nationally.
The Indians of the area consumed the meat, used It is typically garnished with Boston crackers or
the discarded shells for fertilizer, and formed the oyster crackers, the slightly sweet, small, dry bis-
claws into pipes. British settlers mostly added the cuits invented by Massachusetts sea captains for
meat to mixed fish dishes, and later colonialists use on long journeys aboard ship. In Rhode
added it to salads, sauces, soups, and fried cro- Island tomato-based red clam chowder, a soup
quettes.38 Commercial trapping began in the late inaccurately attributed to Manhattan, is popular.
1800s with the advent of shipping by train and the Clams called steamers are just thatsteamed
development of the canning industry. The lobster and served with the broth and melted butter
supply diminished rapidly, increasing its pres- (a bucket of steamers is often the first course of
tige and popularitytoday trapping regulations a lobster dinner). Oysters were typically prepared
with cream and breadcrumbs in a dish called
scalloped oysters, or served in oyster stew. In
Lobster is a specialty of Rhode Island they were especially popular among
Maine, though it is also the nineteenth-century elite, who served them in
trapped in other New pies (raw oysters in cream sauce topped with bis-
England coastal states.
cuit dough), as patties, creamed, curried, and, for
New Years Eve, pickled with eggnog to wash
them down. Today they are commonly broiled
with bacon or breaded and deep-fried. Bay, sea,
and Digby scallops are prepared similarly to oys-
ters. In Maine two less common shellfish special-
ties are found. The first is mussels (the state
provides nearly two-thirds of those shellfish con-
sumed nationally), and the second is sea urchin
roe (uni), served at local restaurants and sushi
bars, or exported to Japan.25
There are two fruits particularly associated
with the New England area. The first is cranber-
Jeff Greenberg/ Visuals Unlimited, Inc.
ries, known as sassamanesh and ibimi (meaning

bitter or sour) by some Native Americans, who
ate them fresh with maple syrup, or dried and
added to pemmican. It was the Dutch who intro-
duced the term Kranbeere, meaning crane berry,
because the flower resembles the head of a crane.
Cranberries grow exceptionally well in the sandy
peat bogs of eastern Massachusetts, where they

were first cultivated in the early 1800s. They are
used primarily in juices and sauces, though in
recent years, dried cranberries have become popu-
lar as snacks or added to baked goods. The second SAMPLE MENU
fruit is wild or low-bush blueberries, which are
used mostly in baked goods. Maine grows nearly
100 percent of this variety in the United States. A New England Supper
New England desserts are mostly fruit based.
In addition to the puddings and pies already dis- New England Boiled Dinner a, b, c
cussed, pandowdies (baked fruit layered with
bread), shortbreads (fruit preserves, biscuits, and Boston Brown Bread a, c
cream), and roly-polys (fruit rolled up in bis-
cuit dough, then baked) were other favorites. Blueberry Pie b, c or Apple Pandowdy with Maple Syrup a
Pound cakes and fruitcakes were enjoyed but
were difficult to make before commercial leaven-
a
ing and reliable ovens were available. Jamison, C.A., & Jamison, B. 1999. American home cooking.
No sweet is as associated with New England, New York: Broadway Books.
b
particularly Vermont, as is maple syrup. The Oliver, S.L. 1995. Saltwater foodways. Mystic, CT: Mystic Seaport Museum.
c
sweet sap of the sugar maple tree had long been New England Recipes at www.newenglandrecipes.com
used by Indians of the Northeast to cook beans and
meats and to flavor other items (see Chapter 5).
The syrup was an everyday sweetener in colonial
kitchens throughout the region until cane sugar
became more affordable. Maple syrup production
peaked in the 1880s, and the sweet has since
become a costly item. Vermont specialties include
sugar-on-snow (hot syrup poured over fresh snow colonists were from England, many settlers in One New England dessert
to make a chewy taffy eaten with pickles or dough- New Jersey, New York, and Pennsylvania came popular throughout the
nuts), maple syrup pie (with a filling of cream, from the Netherlands and Germany. They provided nation is chocolate chip
eggs, and syrup), and maple sugar candies. a distinctively different flavor to foods, including cookies, which were created
Tea and apple cider were consumed daily in a greater use of pork (especially sausages) and by Ruth Wakefield in 1930
colonial times. Hard cider, an alcoholic beverage at the Toll House Inn in
dairy products, more baked goods, and stronger
Whitman, Massachusetts.
caused by the fermentation of sugars in apple seasonings. Later immigrants from southern and
cider, was also favored. Many New Englanders eastern Europe contributed many specialties.
Boston cream pie, a favorite
would start their day with a pint of beer or ale Further, the warmer climate and fertile farmlands in New England, is not a
made from barley, corn, pumpkins, persimmons, offered a greater variety of ingredients to the cooks pie but a custard-filled
or spruce bark. Rum, as well as whiskey made of New York, New Jersey, and Pennsylvania. white cake covered with
from rye, was available. Wine from dandelions or The Dutch in the mid-1600s brought wheat to chocolate icing. It probably
gooseberries was a specialty, and an American the New York area, which at the time was known derives from a popular colo-
version of the English drink called a syllabub, as New Netherland. They also grew barley, buck- nial dessert called pudding
containing apple cider, sherry or wine, and wheat, and rye. Although these were preferred cake that included cake,
whipped cream, was served at special occasions. grains, the Dutch used what they called turkey custard, and usually fruit
Today, apple cider remains a regional specialty, wheat (corn) to make a boiled milk and corn- or jam.
particularly in New Hampshire. meal porridge known as Suppawn that was eaten
daily at breakfast. This same porridge was topped
Mid-Atlantic with meats and vegetables for lunch, then baked
Many of the influences on New England fare are to make the hearty dish called Hutspot, an
seen in the foods of the Mid-Atlantic states as American adaptation of a stew common in the
well. Native American fare was combined with Netherlands.
immigrant preferences to produce a new regional Dairy cattle provided ample milk, butter, and
cuisine. Unlike New England, where most of the cheese. The Dutch were among the first settlers
wealthy enough to import sugar, brandy, choco- the vegetables favored by the Pennsylvania Dutch.
late, and numerous spices, including pepper, Potatoes are eaten mashed, fried, creamed, baked,
cloves, cinnamon, and saffron. Many Dutch spe- scalloped, hashed, as croquettes, as dumplings, in
cialties of the region have made their way into stews and soups, and as potato salad. Cabbage is
American cooking, including pickled cabbage; also ubiquitous, mostly as sauerkraut and slaw.
Kool sla (from the Dutch word for cabbage), Apples are particularly popularfresh, as apple-
now known as coleslaw; and headcheese, a ball- sauce, in pastries, as cider, and in preserves such
shaped sausage made from the head and feet of as the thick, sweet spread known as apple butter.
the hog. Doughnuts, crullers, pancakes, and waf- Many fruits and vegetables are pickled or preserved.
fles were also introduced by the Dutch. Examples include spiced pears, pickled watermelon
Better a burst stomach During the same period, German immigrants rind, sweet pickles, and corn relish. Dark rye
than wasted food is a arrived in the United States. Many were religious breads, cornbreads, yeast rolls, potato rolls, cinna-
Pennsylvania Dutch saying. outcasts (mostly Mennonites, with smaller num- mon rolls and sticky buns, Streuselkuchen (cof-
bers of Amish, Schwenkfelders, and other sects) feecakes with a sugar-crumb topping), doughnuts
Small half-moon pies were who made their home in the tolerant colony of (called Fastnachts), and buckwheat pancakes are
called preaching pies by
Pennsylvania (see Chapter 7, Central Europeans, just a few of the baked goods found in the region.
the Pennsylvania Dutch
people of the Former Soviet Union, and Scandi- The Pennsylvania Dutch also make numerous
because they were used to
appease restless children navians). They became known as the Pennsylvania desserts, especially pies (see Chapter 7).
during church services. Dutch, a corruption of the German word Deutsch, Though generally considered a rural cuisine,
which means German. Although some German Pennsylvania Dutch fare was well accepted in
religious communities remained isolated (and are the early urban centers of the state, such as
even to this day), many German immigrants gradu- Pittsburgh, Allentown, Bethlehem, and Reading.
ally became integrated into the broader populations Even Philadelphia, which was founded by English
of Pennsylvania and surrounding states. Likewise, Quakers, favored German foods. Scrapple has
many German foods of the region have become become so associated with the city that it is often
an indistinguishable part of American cuisine. called Philadelphia scrapple, despite its country
Pork was the foundation of the German diet, beginnings. It is eaten for breakfast, often drizzled
and immigrants brought ham, pork chops, pork with catsup, and is used to make deep-fried cro-
Schnitzel (pounded into thin slices), bacon, salt quettes or to stuff vegetables like green peppers
pork, pickled pigs knuckles, Souse (jellied pigs and cabbage for dinner. Lebanon bologna is a
feet loaf), maw (stomach stuffed with meat and Pennsylvania Dutch smoked beef sausage that
vegetables), and a German version of headcheese. has become a state specialty. It is traditionally
Every part of the hog was used, and leftovers sliced, battered, or dipped in bread crumbs, fried,
would be stretched with lima beans to make a and served with sauerkraut and mashed pota-
Pennsylvania version of baked beans or with toes. Although the origins are lost to history,
dried green beans and potatoes (Bohne mit Philadelphia pepper pot, a soup made with tripe,
Schinken unGrumberra). The best-known left- onions, potatoes, and black peppercorns, is most
overs dish is scrapple, still popular throughout likely a Pennsylvania Dutch recipe and is some-
the state. Scrapple is a combination of ground times served with dumplings. Cheesesteak
pork or sausage, cornmeal porridge, and spices (grilled strips of beef topped with American
formed into a loaf, sliced into thick slabs when cheese and grilled onions in a toasted Italian roll),
firm, and fried in butter. It is typically served the quintessential Philadelphia sandwich, was
with fried eggs, applesauce, and maple syrup. In supposedly invented during the 1930s when a
addition, smoked and fresh sausages were con- frankfurter pushcart vendor was accidentally sent
sumed daily. Chicken stews and soups, made sub- beef instead of his standard order of hot dogs.
stantial with homemade noodles or dumplings, The hearty fare of the Dutch and Germans
were also popular with the Pennsylvania Dutch. combined with many traditional items also found
Beef was used in the braised roast known as sau- in New England, such as puddings, savory pies,
erbraten and in the smoked, cured dried beef and seafood soups and stews, to produce Mid-
called Bndnerfleisch. Atlantic cuisine. Later immigrants to the Mid-
Asparagus, green peas, sugar peas (called Atlantic region introduced foods that have
Mennonite pod peas), and rhubarb are a few of become associated with certain cities and states.
Notably, southern Italians in New York and New Bagels, introduced by Polish
Jersey brought pizza, spaghetti with tomatomeat immigrants, were paired
sauce, calzone, cannoli, gelato, and espresso. with an 1872 New York
Eastern European Jews introduced pastrami, invention, cream cheese; the
chewy doughnut-shaped roll
smoked salmon and whitefish, chopped liver, and
was popularized nationwide
other deli items. Particularly in New York, other
during the 1990s.
Eastern European, Russian, Greek, Chinese,
Caribbean Island, and Middle Eastern cuisines
became popular, due in part to numerous ethnic
eateries (see chapters on each group for more
information). New York is noteworthy for the
influence of its restaurant fare. Taverns, boarding
houses, oyster houses, and coffeehouses served
the needs of those eating out in the late eigh-
teenth and early nineteenth centuries. The first
European-style bakery was opened in 1825, and
delicatessens serving the Jewish community were
Mia Foster/PhotoEdit, Inc.

established in the 1880s. Full-service continental-
style restaurants became popular in the mid-
1800s. By the turn of the century, New York City
had become the gastronomic center of the nation.
Many dishes created for elite diners are now
American specialties, such as Waldorf salad
(originally a mixture of apples and celery in may-
onnaise served at the Waldorf-Astoria), vichys- of ice cream and the first ice cream soda. The city Buffalo wings, deep-fried
soise (chilled leek and potato soup from the gained a reputation for a high-quality product, chicken wings drenched in
Ritz-Carlton), Lobster Newburg (lobster tail and ice cream molded into flowers, fruits, ani- spicy (often using Tabasco
topped with a Madeira-flavored cream sauce), mals, or holiday icons is still a specialty. Another sauce) seasoned butter and
and the dessert baked Alaska (from Delmonicos). confectionery contribution was affordable choco- served with celery and blue
cheese dressing, evolved in
New Jersey, often called the garden basket of late. Commercial production of chocolate for
Buffalo-area bars during
New York due to its numerous commercial crops, beverages and bonbons began in Pennsylvania the 1960s. No one has
is also known for its contributions in food tech- during the late 1700s, though it was so costly it established the exact
nology. Scientific work on hybridization has was considered a luxury item. Milton Hershey of origins of the appetizer.
yielded new, improved varieties of peaches, Derry Church was the first manufacturer of
tomatoes, and sweet potatoes. Food-processing chocolate for the mass market beginning in 1905 The duck sold as Long
techniques developed in New Jersey include con- when he reduced his expenses by making uni- Island duckling in restau-
densed, canned soups (the Campbell Soup form bars instead of fancy novelties. Two years rants nationwide was first
Company); inspected, bottled milk (the Borden later he introduced Hersheys Kisses. brought to the region by
Company); and the first application of pasteur- Several beverages are associated with the a Chinese sea merchant in
ization to milk at a small farm outside Princeton. Mid-Atlantic states. American beer, a heavy, top- the 1870s.
Black tea, in convenient individually sized bags, fermented beverage similar to English ale, was
was introduced in Hoboken in 1880 (the Thomas J. first commercially produced during the late sev-
Lipton Company). enteenth century in Pennsylvania. Two hundred
In addition to the Dutch and Pennsylvania years later, a German immigrant to Philadelphia
Dutch cookies, doughnuts, pies, pancakes, and founded the first brewery that made a bottom
waffles of the region, other sweets have gained fermented beverage. The new, lighter beer known
nationwide acceptance, especially those from as lager, or pilsner, soon became synonymous
Pennsylvania. Philadelphia was one of the first with beer in the United States (see Chapter 7).
cities to enjoy ice cream, perhaps as early as 1782. New York is second only to California in wine
An ice cream parlor with frozen treats, cakes, production, including white (Chardonnay, White The word cookie is derived
syrups, and cordials was opened in 1800, and the Riesling, and Seyval-Villard varietals), red (small from the Dutch word for a
following years saw the first wholesale distributor amounts of Cabernet Sauvignon and Merlot), and small cake, Koeckje.
The Midwest
REGIONAL PROFILE
SAMPLE MENU The Midwest is known as the Great Plains region
of the United States. The earliest American set-
tlers and European immigrants in the area found
A Mid-Atlantic Brunch a vast, flat terrain covered by tall prairie grasses.
Oak-wooded hills and low mountain ridges
Philadelphia Scrapple a, c with Eggs ringed the territory. The rich soil irrigated by the
extensive Mississippi and Missouri river systems
Pecan Sticky Buns b, c proved ideal for wheat, corn, and numerous
fruits. The region is still renowned for its agricul-
Toast with Apple Butter a, b, c tural productivity, which is why it is nicknamed
Americas breadbasket.
Bagels and Cream Cheese The Midwest encompasses twelve states with
21 percent of the total land area and just over
23 percent of the total U.S. population.19 It is
a
Cunningham, M. 1996. Fannie Farmer cookbook: Anniversary. divided into the east north central region (Illinois,
New York: Knopf.
b
Indiana, Michigan, Ohio, and Wisconsin), and
Jamison, C.A., & Jamison, B. 1999. American home cooking.
the west north central region (Iowa, Kansas,
New York: Broadway Books.
c
Minnesota, Missouri, Nebraska, North Dakota,
Recipe Source at www.recipesource.com
and South Dakota).
The states of the east north central (ENC) area
are bounded by the Great Lakes, which temper
the climate, ensuring milder weather than that
experienced by other areas of the Midwest.
Although the French were the first Europeans to
explore the region, it was Americans from the
Northeast states, as well as Virginia and Delaware,
who were the first pioneers. Later immigrants
Coffee milk, similar to sparkling wines as well as some fortified wines,
from Germany, Switzerland, Scandinavia, Central
chocolate milk but made such as sherry and port. New Jersey is the state
with coffee syrup, is the Europe, and the Cornwall area of England were
where hard apple cider was first distilled to pro-
official state beverage of attracted by the fishing, dairy, mining, lumber,
duce the apple brandy known as applejack,
Rhode Island. and meat-packing industries. The west north
sometimes called New Jersey lightning.
central (WNC) states are geographically near the
center of North America, exposed to long win-
ters, short summers, and extreme temperatures.
HEALTH CONCERNS Most Americans who settled the territory were
Connecticut, Maine, State-specific data suggest that people living in homesteaders, interested in the inexpensive land
Massachusetts, New the New England states are often healthier than and farming opportunities. They came from New
Hampshire, and Vermont the U.S. average, while those in the Mid-Atlantic England and the Mid-Atlantic states, followed by
repeatedly rank in the top states are closer to national norms (see chapters new immigrants from Germany, Scandinavia,
ten healthiest states in on each ethnic group for population-specific and Central Europe, particularly Poland.
various annual assessments
data).1 Low-birth-weight data follow similar As suggested by the history of immigration to
using factors such as
trends; however, mortality data are mixed. A the area, the Midwest has the largest percentage
mortality rates, risk
behaviors, crime rate, motor noteworthy risk behavior is heavy drinking; the of whites in the nation (see Figure 15.4). Over
vehicle accidents, per-capita prevalence is 20 percent higher than the national half of all U.S. citizens of Czech and Norwegian
spending on health care, average in Massachusetts, New Hampshire, ancestry live in the Midwest, as well as large
and health insurance Rhode Island, and Vermont. Pennsylvania is numbers of people of Finnish, Croatian, Swedish,
coverage. notable for its exceptionally high death rates German, and Polish heritage. There are below-
(more than 20% above the U.S. average) from average numbers of blacks throughout the
heart disease, stroke, and cancer (see Table 15.3). Midwest; the exceptions are in Ohio, Michigan,
Table 15.3 Northeast State-Specific Health Data Compared to National Averages, 20012002
CT ME MA NH NJ NY PA RI VT
Overweight a
AVG AVG AVG AVG AVG
No Leisure-time Exercise b AVG AVG AVG
Diabetes c AVG AVG AVG AVG AVG
Hypertension d AVG AVG AVG AVG
High Blood Cholesterol e
AVG AVG AVG AVG AVG AVG AVG
Dont Consume 5 Fruits/Vegs. f AVG AVG AVG
Heavy Drinking g
AVG AVG AVG
Low-Birth weight h AVG AVG AVG
Deaths from Heart Disease i
AVG AVG AVG
Death from Stroke j AVG AVG AVG
Death from Cancer k
AVG AVG AVG
a
U.S. prevalence = 58.4 percent (overweight defined as body mass index [BMI] >25.0)
b
U.S. prevalence = 25.8 percent (persons who did no leisure-time physical activity in past month)
c
U.S. prevalence = 6.6 percent (self-reported data based on number of persons who were told they had condition by a health professional)
d
e
f
U.S. prevalence = 77.6 percent (adults who do not consume at least 5 fruits/vegetables per day)
g
U.S. prevalence = 5.1 percent ( >2 drinks/day in the past month for men, >1 drink per day in the past month for women)
h
U.S. prevalence = 7.3 percent (live births of infants weighing <2,500 grams)
i
U.S. age-adjusted death rate per 100,000 = 245.8
j
k
AVG similar to national average
slightly above national average
slightly below national average
significantly above national average
significantly below national average
exceptionally above national average
exceptionally below national average
Sources: Ahluwalia, I.B., et al. 2003. State-specific prevalence of selected chronic disease-related characteristicsBehavioral Risk Factor Surveillance System, 2001. National Center for Health
Statistics. 2004. Chartbook on trends in health of Americans. Hyattsville, MD: U.S. Government Printing Office. MMWR Surveillance Summaries, 52, (SS08); 180. Centers for Disease Control. 2003.
Profiling the leading causes of death in the United States: Heart disease, stroke, and cancer. Available at http://www.cdc.gov/nccdphp/publications/factsheets/ChronicDisease/
and Illinois, which have slightly above-average of all Hmong counted in the 2000 U.S. Census The number of farms in the
African-American populations. Native Americans, lived in the region, with large populations in United States has dropped
Latinos, and Asians/Pacific Islanders are also Minnesota and Wisconsin. Other Southeast Asians from 5.7 million in 1900 to
underrepresented, although there is a large pop- have not tended to settle in the area, however. 2.1 million in 2000; during
ulation of Latinos in Illinois, approaching the Additional recent immigrant populations of note this period the average size
of each remaining farm has
national average, and above average numbers of include Asian Indians in Illinois and Michigan,
more than tripled.
Native Americans in the Dakotas. Overall, Illinois Koreans in Illinois, Middle Easterners in Michigan,
has the most diverse population in the Midwest; and Russians in Illinois and Ohio.
nearly one in every three residents is nonwhite. The Midwest has the lowest percentage of
One immigrant group that has made the people living in metropolitan areas in the United
Midwest home is Laotians, including Hmong, States, approximately 74 percent. Average house-
who have arrived since the 1970s (see Chapter 12, hold income is slightly above the national average
Southeast Asians and Pacific Islanders, for immi- in the ENC, at $43,497 according to 2000 Census
gration history and food habits). Over 45 percent figures, and slightly below in the WNC at $40,600.
1% 2% 5%
10%
American Indian or Hispanic or
1%
Alaska Native Latino*
2%
1% Asian Non-Hispanic
Black or African
American
Native American or
Some other race
Two or more races
83%
White
95%
Figure 15.4
Demographics in the However, the Midwest has the lowest proportion adopted from the Indians of the region, used first
Midwest, 2000. of people living below the poverty level, about for game such as venison, then later for beef. Other
10 percent for both the ENC and the WNC. wild meats, poultry, and fish, such as rabbit, squir-
rel, woodchuck, opossum, raccoon, skunks, duck,
quail, sturgeon, and trout, were widely available.
TRADITIONAL FARE
Even bear meat was consumed.56 Native fruits
Midwestern fare is usually described as no-frills included persimmons, blueberries, bush cranber-
homestead and farm food, exemplifying what is ries, gooseberries, ground cherries, grapes, and
called typical American cuisine (see Table 15.4). many types of nuts. Later settlers brought wheat
Prime meat or poultry is prepared simply, served and oats, as well as apples, cherries, peaches, and
with vegetables, potatoes, and fresh bread. berries. Fishing provided salmon, smelt, trout, and
Hearty breakfasts start the day, robust soups and other freshwater fish; dairying, particularly
stews replenish body and spirit, and homespun cheese-making, offered further food variety.
desserts round out the meal. Today, agricultural products are still signifi-
The American buffet-style The Midwest is a region of food traditions main- cant in the region. In addition to wheat and corn,
meal may have originated tained over generations. Beef and pork are preferred soybeans are a primary crop in Illinois and Ohio,
with the traditional thresh- meats, although better cuts are affordable today, grown for oil (used in products such as mar-
ers dinner served to feed and variety cuts may be consumed less often than in garine, mayonnaise, salad dressing, and for indus-
migrant farm workers in the settlement days. Canning (and more recently freez- trial purposes), meat substitutes, and animal feed.
Midwest.
ing) to preserve summers bounty is still a common Apples are a major crop in Michiganlocal
The highlight of a box social
activity. Bread is sometimes baked at home, and preparations include apple salad, apple meat loaf,
is when lunches or suppers pies make use of seasonal fruits. Midwestern hos- and apple bread. The French introduced sour
in a basket (the box) are pitality, which began with festive sorghum pulls, European cooking cherries to Michigan, where
auctioned off anonymously. group apple peelings, and canning parties, is con- nearly all of these nationally used fruits are pro-
The buyer then eats the boxs tinued through buffets, box socials, pitch-in or duced. One unusual Illinois specialty is horserad-
contents with its preparer. potluck suppers, strawberry socials, corn roasts, ish. German immigrants brought the eastern
In the nineteenth century, it and fish boils popular throughout the region. European food to the state, and the pungent,
was a way for single women gnarly root thrived. Nearly 85 percent of the
and men to mingle and East North Central global supply is grown in the Illinois.
meet prospective partners.
The earliest American settlement in the ENC Dairying remains important in some regions
region was in Marietta, Ohio, in 1788. The people as well. Wisconsin is the leading U.S. producer of
Indiana is best known as
the worlds top popcorn who came to the area from the original colonies milk, sweetened condensed milk, butter, and
producer. were mostly farmers who survived in their new cheese. Dairying was sparked by the arrival of
homes on hogs, corn, beans, squash and pump- Swiss farmers to the state in the 1840s. They
kins, cabbage, and potatoes. Corn was eaten at brought their expertise in breeding livestock and
every meal as porridge or as baked or fried breads. making cheese. Colby, a hard cheese similar to
Sun-dried or smoked meat strips called jerky were cheddar, is an original Wisconsin cheese that was
Table 15.4 Midwestern Specialties

Protein Foods
Milk/milk products Milk, buttermilk, butter, cream, cheeses Cream gravy, fondue, rmmegrt, skyr
Meats/poultry/fish/eggs/ Native game, including buffalo, venison, Jerky, booyaw, Hasenpfeffer
legumes beaver, raccoon, opossum, turkey,
prairie chickens (grouse), pheasant
Pork in all forms, especially salt pork, Ham with gravy, pork chops, barbecued pork, hot
hams (country ham and Westphalian dogs, Bubbat
ham), and sausages (bratwurst, Beef pot pie, stew, barbecued brisket, bierocks,
weinerwurst, kielbasa); beef pasties, Cincinnati chili
Oysters shipped from the East Coast
Freshwater fish, especially smelt, Fish boils, fried trout or smelt
sturgeon, trout, and whitefish
Dried beans Baked beans with salt pork or bacon
Cereals/Grains Corn, wheat, rye, oats, wild rice Cornbreads, porridges; oatmeal; bannocks; rye
breads, pumpernickel; biscuits, dumplings
(including stuffed, such as pierogi and
verenikas)
Baked goods, especially fresh fruit pies (apple,
cherry, persimmon, rhubarb), iced cakes,
strawberry shortcakes, strudel, kolaches, butter
cookies, pancakes, aebelskivers, Danish pastries
Fruits/Vegetables Apples, berries (blueberries, elderberries,
strawberries), cherries, grapes, Applesauce; apple butter, fritters, bread, salad;
peaches, persimmons, rhubarb fried apples, candied apples; fruit jams and
Cabbage, onions, peas, potatoes, jellies
rutabagas, turnips, wild mushrooms Sauerkraut, sauerkraut balls; coleslaw;
potatoesboiled, fried, baked, as dumplings,
salad; onion pie
Additional Foods
Seasonings Salt, pepper; parsley, dill; cinnamon,
ginger, nutmeg, saffron; molasses Most foods are preferred mildly spiced
Nuts/seeds Almonds, black walnuts, hickory nuts,
pecans; poppy seeds Nut pies, almond paste; nut candies; poppy seed
cakes and pastries
Beverages Apple juice, beer, wine, apple brandy
Lager-style (American) beer
Fats/oils Butter, lard
Sweeteners Sugar, honey, molasses, sorghum
created in 1885. Another variety developed in millions in pork sales when he founded the Chemists working at Ford
Wisconsin is brick, a semisoft cheese with holes Chicago meatpacking industry; Gustavus Swift, Motor Company in 1937
and a flavor described as sweet, nutty, and spicy. who made his fortune in hams and sausages; Oscar trying to create a synthetic
Italian cheeses, including ricotta, mozzarella, Mayer, a German immigrant who got his start in wool discovered that soy-
beans could be made into
provolone, Romano, and Parmesan, are special- the hot dog business as a butcher in Chicago; Louis
analog protein products,
ties of northern Wisconsin, while blue cheese is Rich, a Russian immigrant who became involved in
such as bacon, by spinning
made in the caves near Milwaukee. poultry processing and founded a turkey luncheon vegetable protein fibers and
Contributions in food processing from ENC meat empire; and James Lewis Kraft, a grocery flavoring them to taste like
states have extended beyond regional importance clerk who came up with the idea that home- meat.
to influence the development of American cuisine. delivered, uniform pieces of cheese would be
Many of these changes took place in Illinois during more popular than freshly cut wedges from a
the late 1800s and early 1900s. Historical accounts large wheel. He later introduced processed and
include stories about Phillip Armour, who made prepackaged cheeses, including Velveeta.
served with fried biscuits (made with a yeast dough

that puffs up into spheres when dropped into hot
oil, then slathered with butter while still warm).
In areas where European immigrants congre-
gated in numbers, regional ethnic fare developed.
For example, the Michigan Dutch (actually from
the Netherlands, not Germans like the Pennsylvania
Dutch) brought ham croquettes, pea soup, sauci-
2002 Wisconsin Department of Tourism
jzenbroodjes (now known in English as pigs-in-

a-blanket), and double-salted licorice. In Ohio the
fare of European immigrants was more broadly
integrated into the regional cuisine: Germans
popularized sausage, ham, potato, and cabbage
dishes, such as the unusual Ohio specialty called
sauerkraut balls (deep-fried sauerkraut and ham
fritters served with mustard sauce); Polish immi-
grants introduced pierogis (boiled dumplings tra-
Wisconsin is known for its
dairy foods, especially cheeses ditionally stuffed with potatoes, cabbage, onion,
such as Colby and brick. Developments were not limited to Illinois. In and/or meat, or fruit), kielbasa sausage, and strudel
Ohio an Austrian immigrant, Charles Fleischmann, (flaky pastry rolls filled with sweetened fruit,
created the first standardized yeast cakes for nuts, poppy seeds, or cheese). Fish boils, pickled
baking (he later formed a distillery that produced fish, and meatballs are just a few of the items
the first American gin). Michigan is probably adopted from Scandinavian immigrants in
best known for its role in the creation of the U.S. Wisconsin. Some European foods are so well
cereal industry. The city of Battle Creek was accepted that their ethnic associations have been
home to two health sanitariums during the late forgotten. Eastern Europeans brought to Wisconsin
nineteenth century. The first was founded by their pork or veal sausages, which are now con-
The origins of meatloaf, the
Seventh-day Adventist leader Ellen Harmon sidered state specialtiesSheboygan is the self-
quintessential Midwestern
White, who advocated vegetarianism. Her medical proclaimed Bratwurst Capital of the World. In
beef dish, are unknown.
It may have come with director was Dr. John Kellogg, inventor of corn- other cases European influence has been more
German immigrants who flakes (see Chapter 4, Food and Religion). C. W. limited, seen mostly in one or two dishes, such as
sometimes added rye bread Post, a dissatisfied Kellogg patient, started his Swiss cheese fondue in Indiana, and in Michigan,
as an extender, or sauer- own health institute in Battle Creek. He created a a dish with French roots known as booyaw or
kraut for moisture, to coffee substitute, Postum (a blend of wheat boolyaw (perhaps from the term bouillon), a game
ground meat dishes.25 berries, bran, and molasses), and a cereal based stew featuring venison or whatever else was
on his own recipe for digestive problems, called available (including rabbit, woodchuck, squirrel,
Fish boils combining fish,
Grape-Nuts. muskrat, or duck), salt pork, carrots, potatoes,
potatoes, onions and
Each group of pioneers in the region brought and onions.
salt were begun by
Scandinavians as an favorite dishes. Baked beans, meat pot pies with Other dishes with ethnic origins have been
efficient way to feed the biscuit topping, and succotash were preferred by adapted to Midwestern tastes, losing much of
workers at lumber camps. settlers from New England. In Ohio these settlers their heritage along the way. For example, Ohio is
Today, fish boils at the stuffed meats with breadcrumbs, a practice still probably best known nationally for Cincinnati
edge of Lake Michigan popular in the state. The people from New York chili. It is an all-beef version created by Greek and
are annual tourist events and Pennsylvania favored sausages, sauerkraut, Macedonian immigrants in the 1920s, flavored
in Wisconsin. pickles, and relishes when they moved westward. with a balanced blend of sweet spices (e.g., cin-
In Indiana, where the earliest pioneers came from namon, allspice, cloves, and nutmeg) and hot
Pierogi producers in Ohio
the South, pork is especially popular, including spices (garlic, cumin, black pepper, and dried
today offer such innovative
fillings as taco and Cajun roasts and chops, and sometime the whole roasted chiles). Some researchers note the similarities
beef. pig. Sausage patties and ham are common for between the seasoning of Cincinnati chili and
breakfast, typically served with pancakes or bis- dishes such as pastitsio or moussaka (see Chapter 13,
cuits, cream gravy, and fried apples. The southern People of the Balkans and the Middle East).27
influence is also seen in batter-fried chicken Chili parlors found throughout Ohio (and parts
of nearby Kentucky) serve the mild chili one- kringle (pretzel- or ring-shaped flaky pastry with Wisconsin fare is sometimes
way (just the meaty stew), two-way (over fruit, nut, cheese, or butterscotch filling). called white cooking.
spaghetti), three-way (spaghetti, chili, topped Beer is especially associated with the Midwest, Whitefish (from the Great
with grated cheese), four-way (spaghetti, chili, particularly Wisconsin. The first breweries were Lakes) and white meat
(pork, veal, or chicken)
topped with cheese and diced onions), or five- located in the southwestern section of the state
combined with white dairy
way (spaghetti, chili, cheese, onions, and finished and produced the ales and stouts favored by
products (such as farmers
with kidney beans). English settlers. By the middle of the nineteenth cheese, cottage cheese,
The origins of some dishes reflect the succes- century, however, ten breweries producing German- cream cheese, fresh cream,
sion of immigration to an area. Cornish pasties style lagers and pilsners had been founded in or sour cream) are favored.16
are an example. Miners from Cornwall arrived in Milwaukee, including plants owned by Frederich
Michigans Upper Peninsula to excavate iron and Miller, Frederich Pabst, and Joseph Schlitz. At Deep-dish Chicago-style
copper in the 1840s, bringing their traditional the beginning of the 1900s, there were over 300 pizza is baked in a skillet.
lunch specialty called pasties (see Chapter 6, breweries statewide, but Prohibition and consoli- It is an American adaptation
Northern and Southern Europeans). This com- dation in recent years have reduced that number of the pizza brought to
plete meal-in-a-turnover often featured venison to eight. the region by Italian
immigrants from Naples.
in the Michigan versions, with potatoes and
turnips the common vegetable filling. Apples West North Central
were the most popular fruit used for the dessert In the WNC states the settlers of the midnine-
end of the pastry. When immigrants from teenth century came to farm the fertile land of
Finland came in the following years, they adopted Iowa, Kansas, Minnesota, and Missouri. Harsh
the dish, which was similar to piiraat and kukko, winters and a scarcity of provisions limited vari-
Finnish pastries filled with meat or fish, rice, and ety in many early pioneer homes. Homemakers
vegetables. The origins of the dish are claimed by of the period describe burying melons in sand,
many Finns in the region, though those of Cornish which with luck would stay fresh until Christmas.
descent point out that the Finnish turnovers are Other cooks would prepare up to a hundred fresh
not pasties because the filling is mixed instead of
layered.28 Todays pasty shops, often featuring
untraditional fillings (e.g., pizza ingredients), are
common throughout the Upper Peninsula (U.P.)
and in cities where U.P.ers (Yoopers) have set-
tled, such as Detroit.
Sweets, especially baked goods, hold a special SAMPLE MENU
place in the cooking of the East North Central
states. Traditional items such as hickory nut
cookies and pies are found in many areas. In
Indiana dessert favorites include steamed or
A Great Lakes Sampler
baked persimmon pudding; pork cake, a moist
dessert made with sausage or salt pork, molasses, Cheese Pierogi a, c
brown sugar, flour, dried fruits, and spices that is
Bratwurst or Kielbasa
a Christmas tradition in some Indiana homes;
and sweet cream pie, pastry filled with a heavily Apple Sauerkraut b, c
sweetened custard that is popular all year. In
Michigan apple fritters, caramel-covered apples, Danish Kringle b, c or Sour Cherry Pie a, c
candied apples, and Dutch apple kock (cake) are
common. Elderberry flower fritters dipped in
a
powdered sugar are also a specialty. In Wisconsin Fertig, J.M. 1999. Prairie home cooking. Boston, MA: Harvard Common Press.
many popular desserts have retained their for- b
Fussell, B. 1997. I hear America cooking. New York: Penguin Books.
eign names, including German kuchen (yeasted c
Cooks.com at www.cooks.com
coffee cake, often with a fruit and cream filling
and crunchy, sugary streusel topping) and schaum
torte (meringue topped with ice cream and/or
whipped cream and fresh fruit); and Danish
fruit pies at a time, covering the extras with snow Missouri due to the large number of Southerners
for use throughout the winter months. Parched who settled the state. Missouri is well known for
corn, herbs, bark, or root brews replaced coffee.29 its country hams, which are cured with salt, then
Prestige foods were often unavailable, so ample, smoked and hung to age in the cool winter
even excessive, amounts of common foods became months. The resulting meat is red, salty, and dry
symbolic of hospitality in the Midwestern fron- in texture. It is traditionally served with biscuits
tier. The more western areas of the WNC states, and red-eyed gravy made from ham drippings,
which are drier and less suitable for crops, pro- coffee, and flour.
vided limited opportunities for agriculture. The Beef is more significant in Kansas, Nebraska,
region attracted trappers, traders, and prospec- and the Dakotas. Before the introduction of cattle
tors. Wild game, such as bear, buffalo, elk, deer, to the region, over 30 million bison roamed the
and small mammals, as well as turkeys, prairie Great Plains, providing sustenance, clothing,
chickens (grouse), quail, doves, and frogs, was shelter, and fuel to the local Native Americans.
Tomato juice is the official hunted; the meat or oil was often sold in settle- American settlers and European immigrants also
state drink of Ohio.
ment towns. These regional foods were first doc- ate what they called hump-backed beef, at least
umented in an American cookbook in 1902.2 until other meats became widely available.
One grizzly bear would pro-
vide ten gallons of pure, ren- As in the ENC region, pioneers from New However, the huge bison herds interfered with
dered fat worth seventy-five England and the Mid-Atlantic states contributed expanding settlements, the railroads, and Texas
dollars in the late 1800s.29 dishes eaten frequently in their eastern homes: cattlemen, who drove their longhorns through
Baked beans and pies of all sorts became as the prairie states to the slaughterhouses of the
The ring-necked pheasant common as sausages and sauerkraut. One north- North and East. The bison were systematically
was introduced to the eastern specialty that became surprisingly popu- eradicated, providing unimpeded access to the
United States from China lar throughout the Midwest was oysters. By the grazing lands of the plains. Today Kansas is
when a shipment was sent mid-1800s the live shellfish were shipped regu- famous for its corn-fed beef, and cattle are the
to Oregon. It quickly natu- larly to the region packed in barrels filled with most important agricultural commodity in the
ralized throughout much of
wet straw. One English visitor commented that state. Steaks, beef stews, barbecued beef, and
the nation and became the
the rich consumed oysters and Champagne and hamburgers are all Kansas favorites. In South
state bird of South Dakota,
where it is typically prepared the poor [ate] oysters and lager bier.30 One 1859 Dakota early settlers introduced longhorn cattle
roasted with salt pork or in recipe for small birds, such as magpies, suggested from Texas; they were soon joined by Scottish
a casserole with onions.25 stuffing a breaded oyster into each bird before cattle, including Aberdeen, Angus, and Herefords.
roasting over a hot fire.29 Immigrants from Scotland were soon exporting
Some corn is exported, and Irrigation improved crop production through- beef to their homeland. Cattle ranching is a major
some is used for food prod- out the region, and today corn, wheat, soybeans, industry in the state, though sheep and hogs are
ucts, including sugars, and sugar beets are widely cultivated. Barley, also important commodities. South Dakota is one
syrups, cornstarch, and dis- oats, sunflowers, rutabagas, and rye are other of the only states in the WNC that features lamb
tilled spirits; most grain crops in some areas. Wild rice, called a grain but dish specialties.
goes for feed. It takes
actually the triangular-shaped seed of an aquatic Despite a preference for pork or beef, poultry
approximately four pounds
of corn to produce one
grass found in shallow rivers and lakes, is a is well represented in WNC state fare. Chicken
pound of meat. Minnesota specialty (see Chapter 5). Though with dumplings or noodles, pan-fried chicken
Missouri is too hilly for grain crops, the terrain is with cream gravy, and chicken or turkey pot
well suited for nut trees. Eastern black walnuts pies (topped with pastry or biscuits) are classic
are native to the area. The nuts are strongly fla- Midwestern dishes.
vored with a slightly bitter aftertaste and are the Several notable religious communities were
primary ingredient in black walnut pie. Pecans, founded in WNC states. In Iowa the Amish who
too, are indigenous to the state. They are popular settled around Kalona grew all of their own food
in pies, candies, cookies, and cakes. Further, over and butchered all of their own meat, traditions
7,000 beekeepers take advantage of the wood- still practiced today. Cornbread with tomato juice
lands in the state to provide another specialty of gravy, stews or hashes with potatoes and peas,
the regionhoney. fried meats and eggs, and fresh fruit pies are
Iowa is noteworthy for its commercial hog common dishes. A group of German Lutherans,
farms, which produce 25 percent of all pork con- known as True Inspirationists, settled in seven
sumed in the nation. Pork is also a favorite in Iowa villages in 1859 to form what is known as
the Amana Colonies. They lived communally, holidays and festivals, including the German Arthur Bryants is the most
with everyone eating three enormous meals and Catholic city New Ulm and the Danish town Askov. famous of the Kansas City
two coffee breaks each day in a large dining hall. In Nebraska the Swiss introduced plum tarts barbecue restaurants. It
The weekly menu was set and included and a specialty called Thuna, breadsticks topped was started by African
American Charlie Bryant in
Mehlspeisen (literally flour desserts, such as with creamed greens thickened with flour. Czech
the 1920s. He called it a
simple puddings) on Tuesdays and boiled beef settlers brought jaternice (pork sausage), jelita
grease house. 31 It has been
every Wednesday. The Colonies now serve German (blood sausage), and houska (a sweet, braided called the single best
specialties to visiting tourists in several large bread). Swedish yeasted waffles and Hungarian restaurant in the world.52
restaurants. German-Russian Mennonites (who chicken paprika are other examples of European It was one of the first
had first migrated from Germany to southern contributions in the state. In Missouri the French integrated businesses in
Russia) came to Kansas in the 1870s. They brought introduced crpes and brioche to the region. They the city.
German-style foods familiar in Pennsylvania also made hard cider from apples, wine from
Dutch areas, such as chicken noodle soup, pannative grapes, and brandy from peaches. In North Dairying is common in
cakes, sausages, and buttermilk pie. They also Dakota the Norwegians brought spekejtt (smoked, several WNC states.
introduced verenikas (their term for pierogis) dried lamb), rulleplse (cold, spicy rolled beef), Minnesota is one of the top
butter and cheese produc-
served with cream gravy. Beef rolls stuffed with and stsuppe (fruit soup) and baked goods, includ-
ers in the nation, and Iowa
bacon, onions, and pickles similar to German ing the large pyramid of almond paste and
is known for the develop-
Rouladen, and sausage-filled buns called Bubbat meringue rings called kransekake. A large popu- ment of American blue
are other Kansas dishes brought by the German- lation of settlers from Iceland smoked mutton, cheese, introduced in the
Russian Mennonites. made skyr (a sweet, cultured milk product simi- 1920s by Maytag Dairy
European influence was seen in secular settle- lar to yogurt), fried kleinur (doughnuts), and Farms.
ments as well. German-Russian yeast dough baked vinarterta (a multilayered cardamom-fla-
turnovers (typically filled with beef, cabbage, and vored cake with fruit fillings) for dessert. The Pierogi are known as
onions) are common throughout the Great Plains. Scotch Irish introduced colcannon (mashed pota- pelmeni by some Russians;
They were derived from the Russian pirozhki. The toes, onions, and cabbage), and the French varenyky by Ukrainians;
turnovers are called bierocks in Kansas and the Canadians came with croissants and cassoulet and verenikas by German
Russian Mennonites.
Midwestern regions east and south of that state, (see Chapter 6).
and they are known as runsas in Nebraska and A unique cuisine of the Midwest is found in
The Danish community
the northern Midwest areas. the Ozark Mountains of Missouri. Contrary to of Askov, Minnesota, has
In Minnesota, German immigrants brought immigration trends in urban areas, the people an annual festival
hogs and dairy cattle and introduced their dark who came to the Ozarks gradually arrived from commemorating the
rye breads, including pumpernickel. Specialties other states in small groups and were scattered rutabaga. Although the
such as Hasenpfeffer (stewed rabbit), Sptzle (tiny throughout the region. They were known as tuber is commonly called
dumplings), and Maultaschen (a sort of German backwoodsmen, and they existed on hunting, a Swede or Swedish
ravioli filled with ground ham, eggs, onions, and fishing, gathering, and cultivation of corn, turnip, Danes are believed
sometimes spinach) were other common German beans, squash, and various tubers.31 Hogs were to have introduced the
dishes. Preserved fish were a mainstay for the let loose to forage until butchering time in rutabaga to the region.
Scandinavians. Pickled fish, smoked fish, and December or January. The people of the Ozarks
salt-cured fish were popular, particularly the were known for their stews made from opossum,
Norwegian dish known as lutefisk (see Chapter 7), raccoon, or squirrel. Sorghum was used to
served with butter and potatoes. Ham, bacon, sweeten foods, ginger root was brewed for beer,
Swedish meatballs, and Danish frikadeller (fried, and sassafras was steeped for tea. Today the
breaded ground beef and veal patties) were con- Ozarks are best known as a vacation and retire-
sumed. Dark breads and the thin Norwegian ment destination.
potato pancake called lefser are still common, as Popular desserts in the WNC states include
are butter cookies (especially at Christmas) and fruit pies and frosted cakes. Czech kolaches are
Danish aebleskivers, traditionally served with a specialty found throughout the region. These
chokecherry or blueberry syrup or jam. The yeasted buns are baked with an indentation
Scandinavian concept of the smrgsbord was on top that is filled with sweetened cheese,
introduced to the nation in Minnesota (see poppy seeds, or fruit (apple, apricot, cherry,
Chapter 7). Several ethnic communities in and prune are traditional) and sprinkled with
Minnesota maintain their culinary heritage at sugar or streusel before they are baked. The
The South
REGIONAL PROFILE
SAMPLE MENU Most southerners say the South is more an atti-
tude than a location. This perhaps explains why
there are so many definitions of the region, such
A Hearty Plains as those states below the historic Mason-Dixon
Line or those south of the culinary grits line
Lunch (the divide between where grits are eaten and
where they arent). While no one questions that
Chicken Noodle Soup a, b, c Alabama, Arkansas, Florida, Georgia, Louisiana,
Kentucky, Maryland, Mississippi, the Carolinas,
Meatloaf a, b, c Tennessee, Virginia, and West Virginia are clearly
part of the South, the borderline states of Delaware,
Mashed Potatoes Missouri, Oklahoma, and Texas can be argued for
Pickled Cucumbers (Cucumbers in Vinegar) a, c inclusion either way. Using the U.S. government
definition, Missouri is considered part of the
Apricot Kolaches a, c Midwest, while Delaware, Oklahoma, and Texas
are part of the South.
The lands of the South are varied. They
a
Fertig, J.M. 1999. Prairie home cooking. Boston, MA: Harvard include the fertile coastal plains along the
Common Press. Atlantic and Gulf coasts, the rolling hills leading
b
Stern, J., & Stern, M. 2001. Square meals: Americas favorite comfort food up to the mountains (called the Piedmont in most
cookbook. New York: Lebhar-Friedman Books. states), the rugged Appalachian and Ozark moun-
c
Babis Czech Recipes from the Dumpling Newsletter at tain territories, the lowlands of the Mississippi
www.dumplingnews.com/recipes Delta, and the high desert plains of the western
reaches. The climate also ranges from the warm,
moderate Atlantic states and the hot, humid Gulf
Coast states to the hot, dry weather in parts of
Texas and Oklahoma.
The development of the South was in many
ways independent from that of the northern
Scandinavian dessert kransekake is also found United States. During colonial times, southern
in many communities. states were predominantly agricultural, growing
tobacco, wheat, corn, rice, and indigo (a blue
dye). The plantation system that emerged in the
HEALTH CONCERNS coastal regions was characterized by commercial
Measures of health in the Midwest approach the farms owned by aristocratic English or French
national average in many ways, with a few immigrants and worked by African slaves. Each
notable state differences (see chapters on each plantation was a self-sufficient, independent
ethnic group for population-specific data).1 operation providing cash crops and food products
Several states have lower-than-average rates of for use by each household. It was a comfortable,
low birth weight, including Iowa, Minnesota, leisurely lifestyle for the upper classes, enlivened
Nebraska, North Dakota, South Dakota, and by occasional visits to the cultural centers of
Wisconsin. Significantly higher-than-average Atlanta, Charleston, or New Orleans. For the lower
rates of heavy drinking are found in Michigan classes, which included the slaves and the poor
and Minnesota, with the highest rate in the nation farmers of the inland hill and mountain regions,
found in Wisconsin (more than 40% above aver- it was a hand-to-mouth existence.
age). Deaths from coronary heart disease are During the period when the northern areas of
exceptionally high in Iowa and North Dakota (see the nation became more urbanized and industri-
Table 15.5). alized, the South remained rural and agricultural,
Table 15.5 Midwest State-Specific Health Data Compared to National Averages, 20012002
IA IL IN KS MI MN MO NE ND OH SD WI
Overweight a
AVG AVG AVG AVG AVG AVG AVG AVG AVG AVG AVG
No Leisure-time
Exercise b AVG AVG AVG AVG AVG AVG
Diabetes c
AVG AVG AVG
Hypertension d AVG AVG AVG AVG AVG
High Blood
Cholesterol e AVG AVG AVG AVG AVG AVG AVG AVG AVG
Dont Consume 5
Fruits/Vegs. f AVG AVG AVG AVG AVG AVG AVG AVG
Heavy
Drinking g
Low Birth Weight h
AVG AVG AVG
Deaths from Heart
Disease i AVG AVG AVG AVG AVG
Death from Stroke j
AVG AVG
Death from Cancer k
AVG AVG AVG AVG AVG
a
U.S. prevalence = 58.4 percent (overweight defined as BMI >25.0)
b
c
d
e
f
g
h
U.S. prevalence = 7.3 percent (live births of infants weighing <2500 grams)
i
j
k
Sources: Ahluwalia, I.B., et al. 2003. State-specific prevalence of selected chronic disease-related characteristicsBehavioral Risk Factor Surveillance System, 2001. National Center for
Health Statistics. 2004. Chartbook on trends in health of Americans. Hyattsville, MD: U.S. Government Printing Office. MMWR Surveillance Summaries, 52, (SS08); 180. Centers for
Disease Control. 2003. Profiling the leading causes of death in the United States: Heart disease, stroke, and cancer. Available at http://www.cdc.gov/nccdphp/publications/factsheets/
ChronicDisease/
adding cotton as a major crop. Differences of ever. The South continues to preserve its identity,
opinion regarding the role of the federal govern- in part, through its cuisine.
ment in state issues, particularly slavery, led to Over one-third (35%) of Americans make
the Civil War in the mid-1800s. After losing the their home in the South, the highest percentage
war, the South regrouped in the late nineteenth of the U.S. population in any region.20 It is divided
century. The traditions and practices that give the into the South Atlantic states of Delaware, Florida,
South its character became more important than Georgia, Maryland, North Carolina, South
CULTURAL CONTROVERSYEating Local
I ngredients for the average American

meal travel 1,500 to 2,500 miles
before being served on a plate. The
concept of food miles, defined as the dis-
tance food travels from where it is grown
infrastructure (roads, airports, etc.) are
other issues. Eating local reduces depend-
ence on foreign countries for a vital com-
modity. In many cases small farmers cannot
compete with the lower costs of mass pro-
Critics maintain that food miles are an
inexact indicator of environmental or social
impact. One company producing organic
health bars found ingredients sent by ship
from overseas produced fewer total carbon
to where it is purchased and eaten,40 is duction and centralized distribution used in dioxide emissions than when sent by truck
used to understand the farm-to-consumer agribusiness. Instead of cultivating crops across the United States, even though the
marketing chain. Research suggests food foundational to the diet, such as wheat, food miles were greater.7 Goods shipped in
miles in the United States may have they switch to more profitable, nonessential very large trucks often produce less damage
increased by over 25 percent since 1980.18 specialty foods. Further, food that travels to the environment than those brought to
Why do food miles matter? Advocates long distances changes hands more often, market by dozens of smaller trucks.47 Eating
in the eating local movement, who pro- increasing susceptibility to contamination or local can also be elitist, especially when it is
mote consumption of locally grown foods terrorist activity. Local foods are usually associated with moral superiority, increasing
instead of foods shipped across several fresher and require less packaging to protect the gap between socioeconomic classes.42
states or imported from other nations, use the product. They benefit the broader com- For some people it is too expensive to pur-
food miles to explain the significance of munity through creation of jobs and increas- chase produce at a farmersmarket, or it is
purchasing choices. Food that travels long ing the human connection between the too time-consuming to cook from scratch. In
distances harms the environment through food producer and the food consumer.18 addition, many ethnic cuisines in the United
increased use of gasoline and higher carbon Groups such as Locavoresand sponsors of States are dependent on imported ingredi-
dioxide emissions, leading to more air pol- the Eat Local Challengehelp persons inter- ents. Even persons dedicated to the concept
lution and global warming. Higher levels of ested in the movement consume only foods find it difficult at times to give up chocolate,
noise, traffic congestion, and wear on the from within a one hundred-mile radius. coffee, and spices such as black pepper.44
Carolina, Virginia, West Virginia, and the District British ancestry, Scotch-Irish ancestry, Cuban
of Columbia; the East South Central (ESC) states ancestry, and Cajun ancestry (see Figure 15.5).
of Alabama, Kentucky, Mississippi, and Tennessee; The population of the South is notable for its
and the West South Central (WSC) states of high numbers of Protestant Christians and low
Arkansas, Louisiana, Oklahoma, and Texas. Over- numbers of people without religious affiliation.
all, the South has below-average numbers of Baptist and evangelical faiths are especially
Asians and Pacific Islanders, Latinos, and Native popular. The highest percentages of Protestants
Americans, but above-average numbers of African in the nation are found in the East South Central
Americans: 56 percent of all U.S. blacks live in the states and the West South Central states: approxi-
South (see Figure 15.5). However, the very size of mately 70 percent of persons in Alabama,
the southern population means that significant Mississippi and Louisiana.
numbers of most ethnic groups reside in the region. Three-quarters of the population in the South
For example, 35 percent of all Native Americans live in metropolitan areas. Census data from 2000
One song in the South goes, and 33 percent of Latinos live in the South; both show that average household income in the South is
South is my blood and
Florida and Texas host above-average populations near the national average in the South Atlantic divi-
South my bone/So haply
of Latinos. While only 20 percent of U.S. Asians sion ($41,202) but below average in the East South
formed on pork and
pone . . . You say: South? are found in the South, larger numbers of some Central states ($34,355) and the West South Central
Where can that be?/ groups, such as Vietnamese, Pakistanis, and Asian states ($37,127). Poverty rates for individuals show
Chewing my sugarcane, Indians, reside there. In addition to African similar trends: average in the South Atlantic (12%),
I repeat:/Why in all we like Americans, groups with disproportionately large but highest in the nation in the EWC and WSC
to cook and eat.55 representation in the South include persons of states at approximately 16 percent.
1%a 2% 12%c
American Indian or Hispanic or
19%
Alaska Native Latinob
Asian Non-Hispanic
1% Black or African
4% American
1% Native Hawaiian or
Some other race
72% Two or more races

White 88%
a
Mostly in Oklahoma. bMay be of any race. cMostly in Texas and Florida.
Figure 15.5
TRADITIONAL FARE The white settlers discovered a region with Demographics in the South,
plentiful fruits, nuts, game, fish, and seafood. 2000.
The foods most associated with the South reflect Native strawberries, blackberries, blueberries,
both the bounty of the plantation and the scarcity huckleberries, ground cherries, persimmons,
of the slave diet. Corn dishes, pork, sweet potatoes, muscadine grapes, beechnuts, hickory nuts, and
and greens began as the foundation of southern pecans covered the land. Bream, catfish, perch,
fare and remain characteristic components today. pike, and trout filled the rivers, while oysters, We eat everything but the
(See Chapter 8, Africans.) clams, and crab were abundant along the coast. squeal is a saying in the
The southern lifestyle has fostered a culture of In Florida pompano, red snapper, shrimp, spiny South about pigs.
graciousness and cordiality. The isolation of the lobster, and conch were widely available. Diamond-
plantations meant socialization was limited in back terrapin, sea turtles, and alligators were Settlers of the South liked
frequency but lengthy in duration. Hours of found in many waterways; and bear, deer, opos- opossum because of its
travel to nearby homes typically resulted in fatty meat. It was typically
sum, rabbits, raccoons, squirrels, turkey, grouse,
overnight visits or extended stays. Parties, balls, baked with sweet potatoes,
ducks, and quail were prevalent in woodland colloquially called possum
picnics, barbecues, and seafood feasts were all areas. Indians of the region grew corn, beans, n taters.
occasions for get-togethers. For the slaves, pumpkin, squash, sweet potatoes, and sunflowers.
Sunday meals with extended kin were the pri- Most of the first white settlers in the region The Barrier Islands off the
mary way to maintain family connections. In the were farmers who established plantations. They coast of Georgia and South
hills and mountains of the South, the difficulties brought wheat, hogs, cattle, poultry, cabbage, Carolina are the last area
of subsistence farming necessitated friendly rela- potatoes, and fruit trees, including apples. where the Gullah dialect is
tionships between neighbors. Poor families often Africans were imported as laborers. They intro- spoken, a unique patois of
survived through regular sharing of food. As a duced southern staples, such as peanuts, okra, English and several West-
result of these conditions, the South has become watermelon, and sesame seeds, and taught the African languages. The food
synonymous with hospitality. of the islands is typically
farmers of the lowland coastal areas how to suc-
The first European explorers in the South southern, and features
cessfully grow and harvest rice.19 It was these tra- specialties such as broiled
Atlantic states were the Spanish, who arrived in ditional foods of the Native Americans, the chitterlings (instead of
Florida in 1513 and founded St. Augustine in European settlers, and the African slaves that boiled and fried), smoked
1565. They were soon followed by the English, combined to create the foundation of southern mullet, and cornbread with
who started in Virginia and spread north and fare (see Table 15.6). sorghum syrup.10
south along the Atlantic coastline during the sev-
enteenth and eighteenth centuries into Delaware,
Maryland, the Carolinas, Georgia, and eventually South Atlantic
into Florida. The Native American population at Plantation hospitality was famous in the South
the time numbered in the hundreds of thousands, Atlantic region. A description of a meal served to
including the members of the Powhatan, Cherokee, guests in Georgia from the early 1800s listed
Chickasaw, Choctaw, Creek, and Seminole tribes turtle soup, trout, ham with sweet potatoes,
(see Chapter 5). turkey with a cornmeal and walnut stuffing, rice,
Table 15.6 Southern Specialties

Protein Foods
Milk/milk products Buttermilk, milk Cream gravy
Meat/poultry/fish/ Native game, including buffalo, venison, raccoon, opos- Brunswick stew, squirrel stew, possum n taters, turtle soup
eggs/legumes sum, badger, squirrel, turkey, ducks, alligator, diamond-
back terrapin
Pork in all forms, especially country-cured and Smithfield Ham on beaten biscuits, sliced ham and red-eye gravy; barbe-
hams; beef, mutton, kid cued pork; souse (head cheese); chitterlings; Texas-style bar-
becued beef, chili con carne, son-of-a-bitch stew; cabrito
Chicken Fried chicken with cream gravy, chicken and dumplings
Crab (blue, stone), crawfish, conch, oysters, shrimp, spiny Crab, shrimp, or crawfish boils; crab cakes; she-crab soup;
lobster; ocean fish, such as mullet, pompano, shad; fresh- conch chowder; oyster stew; shrimp pilau; shrimp Creole;
water fish, particularly catfish jambalaya; gumbo; touffe; fish muddle; fried catfish
Chicken eggs Scrambled eggs and brains, scrambled eggs and ramps
Dried beans; peanuts Baked beans, butter bean custard; peanut soup, peanut brittle
Cereals/Grains Corn, rice, wheat, buckwheat Hominy, grits, corn pone, hush puppies, cornbread, spoon
bread; rice pilaus; beaten biscuits; buttermilk or sour milk
biscuits; buckwheat pancakes
Fruits/Vegetables Apples, huckleberries, key limes, oranges, mayhaw, peaches, Preserves and pickles; fried pies; key lime pie; ambrosia;
watermelon peach pie
Wild greens (cochan, creases, dandelion, dock, lambs quar- Greens simmered with fat back or salt pork, consumed with
ters, poke, sorrel, and ramp), domesticated greens (e.g., pot likker; poke salad (sallet); fried ramps; hoppin John;
mustard, turnip), black-eyed peas, cabbage, okra, ramps, coleslaw, fried okra, okra stews; sweet potato pie
sweet potatoes
Additional Foods
Seasonings Chile peppers (especially birds eye); fil; celery, garlic, Pepper sherry, chili powder, hot sauce; High Holy mayonnaise;
onions, green peppers; bourbon, sherry, whiskey barbecue sauce
Nuts/seeds Black walnuts, hickory nuts, pecans; sesame (benne) seeds Nut cakes, brittles, glazed pecans, pecan pie, pralines; sesame
seed candies and cookies
Beverages Buttermilk; bourbon, corn whiskey, Sherry, Tennessee Whiskey and bourbon are added to barbecue sauces, baked
whiskey goods, candies
Fats/oils Lard
Sweeteners Sorghum syrup Used over pancakes, grits, cornbread, in coffee
Social events in early West asparagus, and green beans, followed by orange hitting the dough repeatedly with a rolling pin to
Virginia centered on church sherbet to cleanse the diners palates before con- produce pockets of air for leavening, are a favorite
and civic activities. They tinuing with cold venison, cheese, corn fritters in many areas.
were called soups, because with syrup, and sweet potato pie.25 Traditional Country hams, ribs, fatback, cracklings, and
when people gathered to southern fare, such as Georgia squirrel stew, ham, chitterlings were traditionally produced from
meet, they would all bring
hoecakes, okra with tomatoes, and biscuits served hogs, and remain important today. In Maryland
ingredients to make enough
soup to feed the group.
with preserves, was served at family meals as well. one recipe that is popular, particularly in the
Hot breads are the cornerstone of every meal southern sections of the state, is stuffed ham. It
in the states of the South Atlantic, primarily calls for inserting greens (e.g., cabbage, kale,
cornbreads (see Table 15.7) or biscuits. In and/or watercress) flavored with onions, mustard
Virginia spoon bread is a specialty, a cornbread seeds, and cayenne into deep slits of the ham. The
enriched with eggs and milk then cooked until it ham is served cold and is often the centerpiece of
forms a crust on the top but remains custardy the Easter meal. In Virginia Smithfield ham is a
underneath. In Delaware the biscuits are made specialty, adapted from the process used by the
with sour milk. Beaten biscuits, prepared by local Powhatan Indians to salt-cure and smoke
Table 15.7 Southern Cornbreads

Cornbread Made with white cornmeal, eggs, and water. No sugar is added. Baked in a pan, sliced into
squares, served with butter, honey, or sorghum syrup.
Cracklin bread Usually yellow cornmeal bread with added pork cracklings for flavor, traditionally cooked in a
frying pan on the stove.
Spoon bread Yellow cornmeal bread made with eggs and milk. Baked slowly in a pan until golden crest
forms on top and center remains custard-like.
Corn pone Yellow cornmeal and water (lard added if available) mixed into a stiff dough, formed into
sticks (sometimes called corn sticks) or patties (sometimes called hoecakes) and
cooked in a skillet.
Hush puppies Yellow cornmeal and water dough, with added egg and buttermilk if available, formed into
balls and deep-fried.
venison. A Smithfield ham is similar to a country famous for its shellfish. The state is indented by Recent immigrants to
ham (see the West North Central states of the the largest estuary in the nation, Chesapeake Bay, Delaware include numerous
Midwest), but it is made with the shank end of which teems with oysters, clams, scallops, and Central Americans,
the leg and with the bone in. It is first rubbed crabs. Oysters were so common that many set- particularly Guatemalans,
who are attracted to jobs in
with salt, sugar, and pepper for curing, then tlers in the region ate them three times a day:
the poultry industry.
smoked over hickory, and then hung to age. The raw, fried, baked, fricasseed, in seafood stews, in
meat differs from a country ham in that it is saltier, chowder, in oyster stuffing for turkeys, and over
darker in color, and leaner. The flavor is very steaks. Crabs were equally versatile. A regional
strong, and it is traditionally eaten in very thin specialty is blue crabs, a swimming crab so
slices on biscuits or fried with red-eye gravy (made named because the underside of the large claws is
with the ham drippings and coffee) and served blue. They are traditionally steamed over water
with fried apples. Another Native American game flavored with vinegar and seasoned with salt,
dish adopted by the southern settlers, Brunswick pepper, ground ginger, celery and mustard seeds,
stew, became a mainstay throughout the region.
There are many variations, but most contain
chicken, ham or salt pork, corn, beans, potatoes, Fried chicken is the
quintessential dish of the
onions, tomatoes, and lots of black pepper.
South. It is often served with
Chicken dredged in cornmeal or flour and cream gravy and biscuits.
fried in lard, traditionally served with cream gravy,
is the quintessential dish of the region. Though
popular throughout the entire South, poultry is
especially associated with Delaware. The first
broilers in the nation were marketed in the state
during the 1920s when an excess of chicks
prompted an enterprising egg producer to sell the
birds when they reached about two pounds at six-
teen weeks of age. This was far younger than most
chickens were sold at the time and yielded a tender
bird that could be roasted or broiled instead of
Matthew Klein/Royalty-Free CORBIS
stewed or fried. It was the beginning of a national

industry, and today broiled chicken is the state
dish of Delaware. Roasters are also popular in
Maryland where other chicken specialties include
pot pies and chicken seafood stews.
Seafood is especially important in the South
Atlantic coastal areas. Maryland, for example, is
and paprika. Because they are small, half a dozen in Georgia. Shrimp are common in the Carolinas,
or more are served to each diner, with plenty of including shrimp pt or butter-sauted shrimp
beer to wash them down. The meat is used to with grits for breakfast, and deep-fried shrimp
make one of Marylands most esteemed dishes, and rice croquettes. In Delaware one specialty
crab cakes. The crab is mixed with a little may- called muddle (a stew of miscellaneous fish
onnaise, cracker crumbs, and a spicy seasoning with potatoes and onions) capitalizes on coastal
of cayenne, dry mustard, and hot sauce, and then resources. A variation unique to South Carolina
formed into small patties and fried. They are is pinebark stew, a muddle flavored with bacon,
served with lemon wedges and tarter sauce. Crab named for the tiny roots of pine trees that sea-
soup (with beef stock and bacon) and deviled soned it traditionally, or because it was cooked
crabs (baked in the shell and topped with bread over a pine bark fire. Also common in the state
crumbs) are other common preparations. Another are frogmore stew, a spicy seafood, sausage, and
noteworthy shellfish of the region is soft-shell corn combination similar to gumbo, and she-
craba blue crab that has shed its hard shell crab soup similar to that of Maryland but gar-
during a molt. The new papery shell is completely nished with a spoonful of Sherry and a dollop of
edible, but it begins to harden after only a day. unsweetened whipped cream.
Blue crabs are often kept in tanks until they shed Long-grain rice is common in many parts of
their hard shells to time harvesting of the soft- the South Atlantic region. A variety of rice native
shell crabs. The whole crab is served deep-fried. to Madagascar was found suitable for the coastal
Green turtle, served as The Florida waterways and coastline also offer plain climate of South Carolina, and thousands of
grilled or baked steaks, or a profusion of seafood. Red snapper, pompano acres of tidal lands were diked and flooded to
added to stews and soups, (a very large, meaty fish), mullet, and tarpon are support the crop. By 1700 it was well established,
is a Florida specialty. a few of the fish commonly available; shellfish thanks in part to the skills of slaves from the rice-
includes shrimp (several varieties), spiny lobster growing regions of Africa. It became known as
Conchas is the Spanish word
(similar to those of New England, but without Carolina Gold (due to its amber color when
for conch mollusk, a term
that has become the nick-
claws), conch (a large mollusk), and stone crabs ripe). The rice was traditionally boiled instead of
name of residents of the (only the very large claw is eatenthe claw is steamed to produce individual fluffy grains that
Florida Keys. removed when the crab is caught, and then the did not stick together. French Huguenots who
crab is thrown back in the water to grow a new settled in South Carolina during the seventeenth
one). Many of Floridas specialties have developed century are thought to have introduced pilau (also
out of this unique ocean larder. Red snapper fil- spelled purlow, or pullow), which has become a
lets are baked with orange juice. Pompano is specialty of the region. It is characterized by com-
stuffed with shrimp, seasoned with Sherry, and bining a single additional ingredient with rice,
baked, or prepared en papillote (with a nod to the which is first simmered in an aromatic broth
French influence of the Gulf Coast states). Spiny (reserved from cooking the secondary ingredi-
lobster tails are stuffed with fish and grilled, ent) until dry, then mixed with the other food.
Hoppin John is served on while stone crab claws are traditionally boiled Shrimp pilau and okra pilau are examples.
New Years Eve in South and served with garlic butter or mustard sauce. African-influenced hoppin John, made with
Carolina and other parts of Rock shrimp, a hard-shelled, white shrimp that black-eyed peas and rice, is also a pilau. Molded
the South because eating tastes like a cross between lobster and shrimp, rice dishes that are baked until they form a
the rice and black-eyed has become a trendy restaurant item throughout golden crust are called rice pies or rice casseroles.
peas is thought to bring the country. Conch fritters and conch chowder Some include layers of meat or fish. One unusual
good luck in the upcoming (made with onions and tomatoes, seasoned with rice dish found in Georgia is Country Captain
year. Worcestershire sauce, oregano, and bay leaves) Chicken, invented by a sea captain from Savannah
are popular. who used Indian spices to liven up his routine
Unlike most states of the
Elsewhere in the region, oyster roasts (similar fare aboard ship. It is a curried chicken that
South Atlantic, neither corn
to a New England clam bake) are favorites in includes tomatoes and green peppers and is
nor rice grows well in the
cool, damp climate of West South Carolina, served with hoppin John, bis- served over rice. In the Carolinas rice breads, such
Virginia. Buckwheat, how- cuits, and small sandwiches, such as a crab omelet as philpy (cooked rice added to cornbread), and
ever, thrives. Buckwheat on slices of bread. Oyster suppers, informal feasts desserts, such as rice pudding, are also found.
pancakes served with featuring oysters cooked over a fire in the moon- Certain crops historically associated with the
whole-hog sausage and light, then served with melted butter, are popular South Atlantic states have been in the region so
applesauce are a specialty.
long they are occasionally mistaken as native of the South Atlantic. In Virginia English settlers Green tomato slices dipped
foods. Some accounts state that Native Americans favored roasted beef dishes, mutton, and in cornmeal and pan-fried
of the region cultivated melons. Melons are not Yorkshire pudding. In Georgia a French nuance are popular throughout the
native to the New World, although it is possible can be seen in the popularity of dishes such as South. In Maryland they are
served for breakfast.
they were brought to Florida by the Spanish crab souffl; common German-style dishes
explorers of the sixteenth century, in which case include sauerkraut and pepper pot soup; and the Palmetto palms are so
the Indians may have been growing them for per- Scots brought scones and haggis (hogs stomach prevalent in Florida that
haps one hundred years by the time white settlers stuffed with oatmealsee Chapter 6). In South they are known as swamp
arrived from the North. Tomatoes are a food that Carolina a French influence was seen in many cabbage.
the Spanish may have brought to the region from dishes, particularly elaborate desserts like
elsewhere in the Americas. They also introduced Huguenot torte (a sponge cake with pecans and Charlotte russe was created
peaches to the Carolinas, which at one time were so apples) and charlotte russe (a special cylindrical by the great French chef
plentiful they were used as hog feed. Today South mold lined with ladyfingers, then filled with Antoine Carme in honor of
the Russian czar Alexander
Carolina is the largest producer of peaches in the Bavarian cream and garnished with strawberries
in 1815. It is a favorite spe-
South, second only to California in the nation. and whipped cream). In Florida Greek immi-
cial occasion dessert in
Oranges, the foundation of the Florida citrus grants who came to Tarpon Springs for sponge South Carolina.
industry, were another early introduction by the fishing jobs at the beginning of the nineteenth
Spanish. Later, grapefruit were hybridized from century (see Chapter 13) introduced traditional
pummelos that had been brought from the dishes such as moussaka (stuffed eggplant),
Caribbean, and other citrus fruits, such as tan- spanakopita (spinach- or cheese-filled phyllo
gerines, tangelos, and Persian (also known as dough pastries), and gyros (pita bread sand-
Tahiti) limes, were introduced. Key limes, small, wiches). In West Virginia lasagna, fagiole (pasta
thin-skinned yellow limes with juicy, green flesh, with beans), minestra (vegetable soup), and can-
were discovered in the Florida Keys. It is not noli are popular in the area around Clarksburg
known where the limes came from, but it is where more than half the population is of Italian
assumed that they drifted to the islands from the descent.10
Caribbean. They are grown mostly in home gar- One notable ethnic group in North Carolina is Thomas Jefferson brought
dens and are renowned for their tangy flavor. the German Moravians, persecuted German many French specialties to
Today, 70 percent of the U.S. citrus crop is grown Protestants who had immigrated to Pennsylvania his home in Monticello,
such as boeuf la daube
in Florida (nearly all the oranges are processed originally but moved south in the early 1700s
(jellied beef) and crpes. He
into juice). Florida is also known for other subtrop- when they discovered that much of that land was
also brought Italian foods,
ical crops, such as avocados, guavas, kumquats, already claimed. The Moravians established an including pasta, to the
mangoes, papaya, and pineapples, as well as early insular German community near the Winston- United States. His daughter,
ripening crops, such as tomatoes and strawber- Salem area, founding a wholesale produce busi- Mary Randolph, is credited
ries. Sugarcane is grown in the south of the state, ness that sold local fruits and vegetables in mar- with introducing macaroni
and sabal palmetto palms grow like weeds, pro- kets extending to Philadelphia. They were best and Parmesan cheese,
viding the delicacy known as hearts of palm. In known for their baked goods, such as sugar cakes which evolved into the
Georgia pecans, peanuts, and watermelon are (a yeasted, potato bread dough covered with brown American dish, macaroni
commonly cultivated. Vidalia onions, thought to sugar and cinnamon before baking) and citron with cheddar cheese.
be exceptionally sweet due to the mild Georgia tarts (tarts with lemon curd filling). Moravians
weather and the low-sulfur soil around Vidalia in commemorate special occasions, including
Toombs County, Georgia, are a specialty crop sold November 17 (the founding of North Carolina),
throughout the nation. Mayhaw jelly, made from with Love Feasts featuring wine, creamy coffee,
the cranberry-like fruit of the native mayhaw tree, and cakes topped with a nut frosting. At Christmas,
is a particular favorite in Georgia and other states paper-thin ginger spice cookies and a sweet bread
along the Gulf Coast. Another native fruit found studded with raisins and candied citron, sprinkled
in the South Atlantic is muscadine grapes and with sliced almonds, are specialties.
scuppernongs (the bronzy white version of mus- In recent years a more significant culinary
cadines), which are used to produce jams, jellies, influence in Florida has been the contributions of
pies, and wine. Cuban immigrants to the Miami area (see
Immigrants from Europe have contributed Chapter 9, Mexicans and Central Americans).
only limited ingredients and dishes to the foods Arroz con pollo is made with chicken and rice,
flavored with the Cuban combination of toma- fruitcakes, and pies are common. Peach pie is
toes, olives, capers, raisins, and chile peppers. the consummate Georgia dessert, although
Black beans, traditionally prepared with rice and recipes vary. Some are custard pies topped with
salt pork or ham, are common. So-called Cuban sliced peaches, others are two-crust pies, and
sandwiches, with roast pork, ham, sausage, cheese, some are individual deep-fried pies. Pecan pie is
and dill pickle filling mounded on Cuban bread, popular as well. Key lime pie, a specialty from
are fast-food favorites. Flan, a baked custard with Florida now found throughout the South, tradi-
caramel topping (sometimes flavored with orange), tionally includes a lime custard filling covered
has become a popular dessert. with a meringue topping but can also be made
The connection between Cuban cuisine is not the only spicy food found as a chiffon pie (folding the meringue into the
the Caribbean and South in the South. Many settlers, especially in South custard to lighten it and then topping the pie
Carolina was so strong that, Carolina and Georgia, had lived first in Barbados with whipped cream). Ambrosia, made with
according to historian Peter and other Caribbean Islands. They brought a taste sliced oranges and grated coconut, is another
H. Wood, some legal docu- for tropical flavors and spicy seasonings. Fruit Florida dessert common in other states of the
ments of the seventeenth
and vegetable pickles were common, for example, region. Puddings and custards were an everyday
century refer to Carolina in
mango chutney from India, which was also made treat in the early days of settlement, made with
ye West Indies.19
with other local fruits and called Indian pickle. leftover cornmeal, rice, or bread; chocolate was
Coca-Cola was invented by Today, Jerusalem artichoke, okra, green tomato, a favorite but costly, so it was used only at spe-
an Atlanta pharmacist in squash, and watermelon rind pickles are still pop- cial occasions. Today, bread puddings are still
1886 as a headache remedy. ular condiments in the region. In Georgia very favorites. Candies, such as divinity with nuts and
Dopeis a slang term for cola small (one-fourth to one-half inch) scorching hot nut brittles, are specialties.
drinks in parts of the South. birds eye peppers (also known as tepin chiles) are The cooking of the more rural inland areas of
sometimes crushed and placed at the bottom of a the South Atlantic states differed from the more
Benne (sesame) seeds were bowl before adding soup or stew. Pepper Sherry, populated coastal areas. During the early 1800s,
introduced to the South by made by infusing incendiary Scotch Bonnet chiles Scotch Irish immigrants searching for religious
African slaves. In South
in sherry, is a popular condiment added to dishes freedom began making their homes in the Blue
Carolina brown sugar benne
for zing in South Carolina. Ridge, Cumberland, and Great Smoky mountains
wafers and benne brittle
(made with sesame seeds Desserts have always had a place on the South of the Appalachians. They also spread west to the
instead of nuts) are popular Atlantic table. Tea breads and cakes (such as Sally Kentucky and Tennessee frontier. English and
desserts. Lunn cake, best described as a sponge-cakelike some Welsh settlers moved from the coastal
bread, which is popular throughout the region), South Atlantic states inland to the hilly Piedmont
areas. Germans from Pennsylvania traveled
south along the Shenandoah Valley into Virginia
Key lime pie, which has a and North Carolina. Hogs n hominy (pork and
lime custard filling and is corn) kept the pioneers going until they estab-
traditionally covered with
lished small farms. Frontier meals were robust.
meringue, can also be made
For example, the noon meal might consist of
as a chiffon pie (folding the
meringue into the custard to ham, bacon or sausage, chicken or grouse, game
lighten it and then topping meat, dumplings or biscuits, cornbread or grits,
the pie with whipped cream). gravy, sweet potatoes, and boiled greens served
with coffee, milk, or corn whiskey.
Traditionally every bit of the pig was con-
Michael Lamotte, Cole Group/PhotoDisc/Getty Images
sumed on Appalachian farms, including the

snout, or rooter (which was roasted), the tail
(which was added to stews), and the brains
(which were usually boiled, mashed, and scram-
bled with eggs). Bacon and cabbage, and ham
with cream gravy were typical entrees, while bar-
becued pork with spicy hot sauce on the side was
prepared for special occasions. Most families kept
a dairy cow and a breeding cow for a few calves
each year. Fresh beef was preferred. When a cow
was slaughtered, it would be shared with neigh-

bors, who would later return the favor.
Game supplemented the diet, especially squir-
rel, rabbit, raccoon, opossum, turtle, and frogs.
Badger, considered by some a dish of last resort, SAMPLE MENU
was known as bombo in North Carolina hill
country. Brunswick stew is a favorite. Wild greens
were well loved by adults in the Appalachians, but A Southeastern Luncheon
not so popular with children.39 Poke, creases
(similar to watercress), dandelion, lambs quarters, Fried Oysters a, b, c
dock, sorrel, and ramp (a particularly assertive
wild onion) were added to soups, stews, potatoes, Shrimp Pilau b, c
or eggs, or cooked as a side dish. Poke salad is rep-
resentative: a cooked salad (from the English tradi- Okra with Tomatoes a, c
tion) in which the greens are parboiled, then fried
in bacon or fatback grease until tender. They are Biscuits or Cornbread
seasoned with salt, pepper, and hot sauce or vine- Ambrosia a
gar. Domesticated greens such as mustard and
turnip greens were also common.
Other than greens, green beans, hominy, a
Lewis, E., & Peacock, S. 2003. The gift of Southern cooking. New York:
sweet potatoes, potatoes, okra, and beets were the Alfred A. Knopf.
most frequently consumed vegetables. Cornbread b
Jamison, C.A., & Jamison, B. 1999. American home cooking. New York:
(sometimes with cracklings added), biscuits, Broadway Books.
dumplings, and/or grits were served at every c
Southern U.S. Cuisine at www.southernfood.about.com
meal. Pinto beans, called soupbeans, were
common, served with cornbread crumbled on
top or a dollop of pickled vegetable relish (i.e.,
cabbage, bell peppers, green tomatoes, onions,
chile peppers). Watermelon was a favorite fruit,
eaten fresh or preserved as pickles or jam.
Applesauce, apple pies, and fried apple slices were
popular. Honey was the most common sweetener, East South Central and West South Central
even consumed alone as a dessert. Thick, caramel- The early fare of the East South Central and West
colored sorghum syrup was also used, poured South Central states was similar to that of the
over cornbreads or used to sweeten coffee. Atlantic states but with more significant French
Many of these foods are still favored in the overtones. Immigrants from France settled in the
Appalachians today, though research suggests Gulf Coast region during the seventeenth cen-
changes in preparation techniques and the use of tury, and at the end of the eighteenth century,
convenience food items are increasing as depend- French Acadians from Canada relocated to
ence on hunting and farming decreases.48 A Louisiana (see Chapter 6). They were joined by
survey of senior adult Appalachians found that white American and English settlers arriving
they were interested in lower-fat diets and had from the North. Plantation life in the region was An unusual Appalachian
switched to baking and broiling instead of frying. similar to that of the South Atlantic, except that it Mountain treat called a
Shortening has replaced lard in many dishes. was more dependent on cotton than on tobacco. sonker is preserved in the
Many also use items such as cornbread mixes The tradition of the big southern breakfast and annual festival named in its
honor held at Mount Airy,
instead of preparing foods from scratch.51 dinner may have originated in the region and was
North Carolina, each year. It
However, even those who have relocated to other the norm for plantation owners and their city is a deep-dish fruit or sweet
areas may maintain their heritage by regularly associates. Coffee and mint juleps were available potato pie made with
consuming fried chicken with gravy, soupbeans, for early risers. Late morning repasts included breadcrumbs or biscuit
skillet cornbread, biscuits and gravy, fried pota- eggs, grits, biscuits, cornbreads or muffins, waf- dough or pie crustthere
toes, green beans cooked in lard, and other foods fles, and several meats, such as ham, sausage, or is no agreement on how to
typical of Appalachian fare.48 fried chicken. A large dinner with soups, stews, prepare it.10
Spice cookies called cry and dishes similar to those at breakfast was con- oyster bakes and fish muddle served with corn
babies were made by sumed in the early afternoon; supper was a lighter dumplings are other Mississippi coastal favorites.
Virginia settlers in the version of dinner. It is the inland foods of the ESC states that are
Appalachians to appease Pork and corn remained key to the cooking most associated with the region, however.
distressed children.
of the ESC and WSC. The cornbread in this area Sumptuous breakfasts are still common in some
is made from white cornmeal without the addi- areas. In western Tennessee, for instance, the
tion of sugar. The French added their recipes for meal may feature eggs, tomatoes, potatoes, and
soups, stews, fricassees, and baked goods to the cornmeal biscuits with sorghum syrup. During
southern mix, as well as their appreciation for the winter, thick slices of Tennessee country ham
good eating. The resulting cuisine is found in with grits and red-eye gravy are often served with
some form throughout the Gulf Coast, from the meal; in the summer, fried chicken is more
Mobile, Alabama to Beaumont, Texas. The French common. ESC dinners and suppers also include
factor accounts for such adopted and adapted many traditional items. Fried chicken is found
specialties as bouillabaisse (a French fish stew); throughout the region. In Alabama chicken and
fish cooked en papillote (in paper packets with a dumplings, ham balls (fried fritters), and
velout sauce); and sauce mahonaise (home- Brunswick stew (made with a whole hogs head)
made mayonnaise), particularly High Holy may- are specialties. In many areas biscuits and corn-
onnaise (a fanciful, Anglicized term for aoli) breads such as sweet potato biscuits, crackling
made with fresh garlic and served with shrimp or bread, hoecake bread (cornmeal and water
cucumbers. Creole cuisine, a blending of French, cooked in a frying pan), and beaten biscuits are
Spanish, African, English, and Native American eaten daily. Tennessee pork sausages are a spe-
cooking, is unique to New Orleans. It is a com- cialty, as is spiced beef (marinated in vinegar,
plex fare with many refined dishes; celery, toma- brown sugar, and seasonings, then simmered and
toes, bell peppers, onions, and garlic are the sliced thinly). In the eastern region of the state,
hallmark flavorings. barbecued ribs prepared with a tomato-whiskey
Cajun fare, created by the French Acadians, is sauce are a favorite. Hominy, greens, okra, green
mostly limited to the bayou country of Louisiana, beans, black-eyed peas, peas, butter beans (simi-
Oysters were so prevalent in though its gumbos, jambalayas, and touffes lar to lima beans, but slightly smaller), rutabagas,
the early days of Mississippi have become popular throughout the region (see and turnips are typical side dishes of the region.
that the streets of Biloxi Chapter 6). While Oklahoma and Texas are both Many of these foods are cooked in lard or fla-
were paved with oyster southern in attitude and enjoy many specialties vored with pork. In Kentucky, for example, green
shells. of the South, such as grits, greens, Gulf Coast beans are simmered with bacon throughout the
seafood, and Brunswick stews, their dishes are day to make a smoky, mushy stew.
In Kentucky over 1.5 million also influenced by Native American, central Game meats are prevalent in some areas.
squirrels are killed each
European, and Latino cooking. Beef is the domi- Squirrels and frogs are featured in certain dishes
year for their meat. The
nant meat; barbecue is prevalent; and hot, spicy from Alabama. Early settlers in Kentucky
brains, known as Kentucky
caviar, are a specialty in seasoning emboldens their dishes. depended on game. Bear meat was popular
some areas. They are The fare of the ESC states is more homoge- because it could be smoked like pork and was
usually mixed in with neous than that of the WSC region. Alabama, fatty enough to provide bacon. Burgoo, a stew
scrambled eggs or added to Kentucky, Mississippi, and Tennessee share many traditionally made with wild birds and game
burgoo. Health officials are culinary traditions. The French influence is lim- meats such as squirrel, is the signature dish of
concerned the brains may ited to the coastal areas, where dishes feature Kentucky. It is still made this way in some areas,
be a source of Creutzfeldt- seafood as the main ingredient. In Alabama shrimp though most current versions use chicken, pork,
Jacob disease, the human are especially prevalent, prepared fried, boiled in beef, or lamb; cabbage, potatoes, tomatoes, lima
version of mad cow disease. seasoned water, with rmoulade sauce, and beans, corn, okra, and cayenneand some vari-
stuffed into mirleton (chayote squash), avocados, ations add fil powder, curry powder, or bourbon.
The differences between
and other vegetables. Plump, local oysters, called In eastern Tennessee the diet was historically
the western and eastern
halves of Tennessee were so Bon Secour oysters, are plentiful and popular closer to Appalachian fare than the plantation
pronounced that during the throughout the Gulf Coast. In Mississippi rock style of the western half of the state. Deer, rac-
Civil War, the East sided shrimp and blue crabs are typically boiled, served coon, opossum, squirrel, and wild turkey were
with the Union, and the with an assortment of seasonings, such as vinegar, primary meats for the settlers of the area and are
West joined the Confederacy. lemon juice, birds eye chiles, and cloves. Outdoor still consumed occasionally today.
In Mississippi catfish up to one hundred or syrup and a hint of fresh mint), traditionally
pounds can still be caught in the rivers and lakes served in a silver cup. Bourbon also flavors stews,
of the state, but most are now farmed in ponds. hams, pound cakes, fruitcakes, and bourbon balls
Although the first catfish farms were started in (a candy made with chocolate, crushed vanilla
Arkansas, Mississippi is the leading producer in wafers, pecans, corn syrup, and bourbon). Whiskey
the nation, with over 250 million pounds har- is associated with Tennessee. In 1866 Jack Daniel
vested annually. Traditionally catfish is deep- purchased a corn whiskey still and added an
fried in a cornmeal crust and served with hush extra refinement to the distillation process, using
puppies and coleslaw. Newer recipes include fried maple wood charcoal to filter the whiskey before
strips served with barbecue sauce or mustard, aging it in charred oak barrels. This produced a
and catfish pt.10 flavor distinct from bourbon, and the liquor
Sweets in the ESC states are favorites. In became known as Tennessee whiskey. Moon pies are a
Alabama seasonal pies were popular, especially The foods of the WSC states (Arkansas, Chattanooga, Tennessee,
dewberry (the first ripe fruit of the summer Louisiana, Oklahoma, Texas) share some similar- confection that have
season) and peach. Fried pies, a southern spe- ities due to geographical proximity but also vary become an obsession in the
cialty, are thought to have originated in the state. due to historical influences. Arkansas exemplifies South. They are graham
cracker sandwiches with a
Small circles of pie crust are filled with fruit (typ- the region. It is at the crossroads of the South, the
marshmallow filling cov-
ically peaches or peach preserves in Alabama), Southwest, and the Midwest. The diverse terrain ered in chocolate, vanilla,
then folded into a half-moon shape, crimped, in the state includes the fertile alluvial plains of banana, or caramel icing.
deep-fried, and sprinkled with powdered sugar. the Mississippi River in the southeast of the During the Great
Rich, chocolaty Mississippi Mud Pie has become state, the dry pasturelands of the Southwest, the Depression, a moon pie and
popular nationwide, while butter bean custard orchards and wheat fields of the Northwest, and an RC Cola were called a
pie is a local specialty of the region, made with the rocky hills and mountains of the Ozarks in working-class dessert
mashed butter beans cooked as a sweet pudding the Northeast. Settlers were mostly of English or because both could be had
flavored with cinnamon, cloves, and nutmeg. Scotch-Irish heritage, and they brought the foods for a dime.
Banana pudding is another favorite. Pecans are they prepared in their home states, such as cured
native to Mississippi and added to breads, sugar hams, sausages, baking soda biscuits, and
glazed, orange glazed, and baked in the syrupy molasses pies from the North, and fried chicken,
sweet pecan pie. Many farms in eastern Tennessee buttermilk biscuits, sweet potatoes, and peach
had at least one apple tree, providing fruit for cobblers from the South. Barbecued beef and
apple butter and pies. Funnel cakes, undoubtedly pinto beans are found in the areas of the state
introduced by German immigrants, are topped adjacent to Texas,25 and in the Ozarks the fare is
with sorghum syrup. Fried pies were also popular. similar to that found in the Missouri section of
Traditional beverages consumed in the ESC the mountains (see previous section on the cook- Corn whiskey was often dis-
states include buttermilk and coffee, though iced ing of the Midwest), with pork, game meats tilled illegally in the secrecy
tea and soda (most often called pop) are more (especially baked opossum and raccoon), corn, of night to avoid federal tax
popular now. Sassafras tea is common in eastern beans, and greens the foundation of the diet. agents and thus became
Tennessee. Perhaps the best known food prod- Arkansas specialties include pork chops with known as moonshine.
Other names for the potent
ucts of the region are alcoholic beverages. cream gravy (sometimes made with bits of sausage
brew include corn likker
Bourbon was developed in Kentucky. Many of the in it) and pan-fried chicken that is then baked with and white lightning.
early Scotch-Irish settlers in the state discovered a Creole sauce. Arkansas is also the leading pro-
farming corn for corn whiskey was more prof- ducer of rice in the nation. Ducks, which are
itable than farming it for cornmeal. It is thought attracted to the rice paddies, are a specialty in the
that the first corn whiskey aged in oak barrels, region, roasted over a fire, baked with bacon and
creating the characteristic flavor of bourbon, was basted with wine or port, and prepared as gumbo.
produced in Bourbon County, Kentucky, in the Catfish have long been an Arkansas favorite,
late eighteenth century. In 1860 a further refine- dredged in cornmeal and fried, or in catfish stew.
Peaches were brought to
ment occurred when it was accidentally discovered Catfish is traditionally served with hush puppies Arkansas by the Cherokee
that charred oak barrels added not only a touch (deep-fried cornmeal biscuits) and coleslaw. who had relocated in the
of color, but also a favorable smoky taste. The Fare in the other WSC states overlaps with state after being forced
favorite bourbon drink of Kentucky is the mint that of Arkansas. The hilly north areas of from their homes in the
julep (bourbon sweetened with a touch of sugar Louisiana feature dishes with pork and cornmeal. South Atlantic.
One specialty of north- The southern portions of Oklahoma are called It is the differences in the cuisines of the WSC
eastern Texas is rattlesnake, Little Dixie, and a study of foods in the eastern states that are most noteworthy. Unlike Arkansas,
which is chopped into bite- portion of the state found that pork, fried chicken, Louisiana was colonized by the French, who
size pieces, marinated in beer catfish, biscuits and cream gravy, cornbread, established several fortified settlements along the
and vinegar, coated with
fried okra, and black-eyed peas were frequent Gulf Coast, including Nouvelle-Orlans (New
cornmeal, and deep-fried.
items in local eateries. However, grits and butter- Orleans) in the 1700s. African slaves were brought
Chuck wagon fare was a milk were rarely offered.33 In the affluent eastern in to work the plantations, and thousands of
cooking style all its own, region of Texas, southern-style dishes frequently French Acadians from Canada and French Creoles
dependent on the skills and feature costly ingredients and tend to be richer from Haiti seeking refuge arrived.
whims of the cowboy chefs (with extra butter, eggs, and cream) than versions Fish and seafood are more important than
called Cookie or Miss from other southern states. Cornbreads, biscuits, pork in the southern regions of Louisiana. The
Sally. Beans, cornbread, hominy and grits, black-eyed peas, okra, sweet famous stews of the area, bouillabaisse, gumbo,
sourdough biscuits, and potato pie, bread pudding, and pralines are a few and jambalaya, are examples of dishes made from
coffee were the staples, but common items. Rice is an important crop, and coastal plenty. Shrimp is the primary seafood
some specialties were
southern-style rice dishes are popular. industry in Louisiana, marketed throughout the
created on the trail, includ-
Other similarities in the WSC states are found. nation fresh and frozen. It is commonly served
ing son-of-a-bitch stew
(known as son-of-a-gun Cooking in parts of Oklahoma is similar to food boiled with lemon butter or with sauce piquante
stew in more genteel in southwestern Arkansas, as seen in the greater (tomatoes, green peppers, onions, bay, vinegar,
circles) made with beef use of flour instead of cornmeal. Although the and hot sauce) over rice, a dish often called shrimp
organs, including tongue, Oklahoma territory was not officially opened up Creole. Shrimp is also added to stews and to
brain, liver, heart, and to settlement by whites until 1889, land-hungry stuffings for vegetables. Oysters are commonly
kidneys. homesteaders invaded the state before then (they served raw, on the half shell, and by the dozen in
were called Sooners). African Americans, many the many oyster bars of New Orleans. They are
The term Creole is often of whom had been held as slaves by the Indians, traditionally slurped with a squeeze of lemon juice
used to describe Europeans
purchased land in the region after abolition. Most and a dash of hot sauce or a sauce mixed to taste by
born outside Europe and is
settlers established small family farms. The each diner with catsup, vinegar, and horseradish.
applied, for example, to the
descendants of the original plains regions in the state are arid, and droughts Oysters, too, are added to soups and stews.
French and Spanish occurred regularly. The fare in this region of Crawfish, which look like miniature lobsters,
immigrants to New Orleans. Oklahoma derived more from scarcity than from are found in the all the fresh waterways of the
ethnic and regional preferences of the settlers. state. They have become the ethnic emblem of
Rabbit and turnip stew was flavored with flour- Cajuns and the regional symbol of southern
thickened gravy, while beef and wheat berries Louisiana. Over 100 million pounds are produced
were the primary ingredients of Oklahoma Stew. annually. Some are harvested from the wild, but
Baking soda biscuits were common, and black most are cultivated in approximately 300 craw-
blizzard cake (a pound cake whose name refers fish farms. They are typically served at a craw-
to the frequent dust storms in the region) was fish boil, where they are cooked in water
a specialty. seasoned with cayenne, salt, and herbs. Potatoes
In the Northeast and panhandle areas of Texas, or corn are often added for side dishes. The craw-
settlers also scraped out a living on small family fish are placed in a gigantic mound in the center
farms, surviving on corn, beans, and native game of the table, and each person takes and peels as
and fish. When wheat proved a successful crop in many as desired. Only the meat in the tail and the
the region, cornbreads were replaced with bis- claws is edible, along with the fat found in the
cuits. In the western areas of the state, beef has head, which is extracted with a finger or sucked
always been popular. It is served traditionally as out appreciatively. Crawfish are also prepared
stews and steaks. Chicken-fried steak was one fried, stuffed, as fritters, in soups and stews, in
specialty created to treat tough cutsthe steak is pies, and as touffe (meaning smothered) in a
cut thinly, then pounded with a mallet, coated in spicy tomato sauce.
It is said that when a Cajun
baby is nine days old, the flour, and fried. It is served with a ladleful of gravy Other regional specialties include rice dishes,
mother sticks the childs made with coffee. Bread or tortillas and pinto such as the fried cakes called calas, red beans and
finger down a crawfish hole beans often round out the meal. Today, Texas pas- rice, and dirty rice (cooked with gizzards). Rice is
to be pinched. This is what turelands are the leading producer of cattle, sheep, also the foundation of dishes like gumbo and jam-
makes a Cajun a Cajun.17 and lambs in the nation. balaya. Baked goods and sweets are specialties,
including French petits fours, crpes, beignets

(deep-fried squares similar to doughnuts), and
pralines (pecan candies). Caf au lait, a favorite
beverage in New Orleans, is a dark roasted coffee
(sometimes flavored with chicory root) prepared
with equal amounts of hot milk. Caf brlot is a
sweetened dessert coffee flavored with brandy
and curaao (orange liqueur).
Restaurant fare in New Orleans is renowned.
Among the nationally recognized dishes created
by local chefs are oysters Rockefeller (baked on a
bed of salt with a rich spinach sauce), oysters
Bienville (baked with a bchamel sauce and green
pepper, onions, pimento, and cheese), Bananas
Foster (sliced bananas cooked in butter, brown
Louisiana Tourism
sugar, rum, and banana liqueur served over
vanilla ice creamit started out as a breakfast
specialty), and Ramos gin fizz (a shaken or blended
cocktail with cream, gin, lemon juice, orange Crawfish is a specialty in
flower water, and egg whites). Street food is southern Louisiana that has
equally tasty in the city. Fried oysters, sliced scrambled eggs with spring onions, are more become popular in other
tomatoes, and onions with tarter sauce on a common but have not been accepted into the areas of the South.
french bread roll are especially popular. They are broader Oklahoma cuisine.33 Other ethnic fare is
called peacemakers, from the nineteenth cen- available in Oklahoma but not widely consumed.
tury when men would bring one home as a sur- Some Italian-American foods are consumed,
prise for dinner after a fight with their wives. Po such as spaghetti and meatballs, particularly
boy (for poor boy) is another name for the around Krebs in the southeastern region of the
sandwich, although a po boy may also refer to a state. Sauerkraut, potato soup, and dark breads
sandwich with deli meats, sausages, and cheeses are evidence of German-Russian influence, and
with or without gravy or tomatoes. A muffeletta central European traditions are maintained at
sandwich is yet another version, usually includ- heritage festivals. A few Tex-Mex items such as
ing a chopped olive salad with the meats and chili con carne have become very popular. Sandwiches with deli meats
cheeses on a whole round loaf of seeded Sicilian- Ethnic cuisine is much more evident in Texas. and cheese on a french
style bread. The state is the size of New England, the Mid- bread roll are found
Oklahoma started its U.S. history as Indian Atlantic states, Ohio, and Indiana combined. It throughout the country.
In addition to being called
Territory, lands set aside in the 1820s for the was occupied by Native Americans, claimed by
po boys in New Orleans,
Native American tribes that had been dispos- the Spanish and French, ruled by Mexico, and they are also known as
sessed of their homes in the Gulf Coast areas. Five existed as an independent nation before it bombers (upstate New
major Indian groups lived in the region: Cherokee, became part of the United States in 1846. Germans, York), Cuban sandwiches
Chickasaw, Choctaw, Creek, and Seminole. They Czechs, and Poles emigrated from Europe to cen- (made with roast pork in
were primarily agrarian, growing corn, beans, tral Texas, attracted by land grants. Sausages, ham, Miami), grinders (New
and squash. They gathered indigenous foods sauerbraten, sauerkraut, pumpernickel bread, England), heros (New
(such as acorns, chestnuts, creases, grapes, potato salad, potato dumplings, bierocks, and York City), hoagies
Jerusalem artichokes, hickory nuts, persimmons, strudel are popular in areas where the Germans (Philadelphia), Italian meat
ramp, and sorghum) and hunted small game (see and other central Europeans settled. Czech sandwiches (Chicago), and
Chapter 5). Today Native Americans make up kolaches and Polish poppy seed cake are baked for submarine sandwiches
(from a World War II naval
approximately 8 percent of the total population in festive occasions. One Texas specialty is German
base in Connecticut).
the state, over eight times the national average. fried liver (dredged in cornmeal, cooked in
Traditional foods, such as a Cherokee soup made bacon drippings, and served with bacon strips). Texas caviar is black-eyed
with hickory nut cream, called kanuche, and The most distinctive Texan fare evolved in pea salad, seasoned with
game dishes, are served mostly at ceremonial the south of the state, where Mexican and chiles and garlic and served
occasions. Fry bread and adapted dishes, such as Spanish influence added their flavors to dishes. on tortilla chips.
One regional specialty is chili con carne, known

in Texas as a bowl of red, which began as beans,
progressed to beans with beef, and is now typi-
cally an all-beef stew flavored primarily with hot
chili powder. Barbecue is also favored. Unlike
barbecue in other regions of the country (e.g.,
Kansas City), there are two sauces involved in
Texas barbecue. The first, called the mop, or sop,
is used to marinate the meat before cooking and
for basting the meat on the spit or grill. (The term
mop for the sauce basted on barbecued meat may
J. Griffis Smith/TxDOT
have come from the use of a clean mop to slap the

sauce on whole carcasses.) The second sauce is
served on the side with the cooked meat.
Although barbecued beef is most associated with
the state, barbecued goat kid (cabrito) is almost
Barbecue is a traditional as popular in the southern sections. The unifying
Tex-Mex method for element in most of these foods is that they are
preparing food. Some authentic Mexican foods, such as tortillas, preferred hot and spicy. In addition to chili
tamales, chalupas, salsas, guacamole, and buue- powder, chile peppers are used in many dishes.
los (see Chapter 9) were accepted by white settlers Numerous varieties are added, but worth men-
Death from strokes is so in the region. However, most foods in the area are tion is the tepn chile, the indigenous precursor to
high in parts of the south- adapted dishes with Mexican overtones, often domesticated pequin chiles. They are among the
eastern United States that referred to as Tex-Mex cuisine. Examples include hottest of all chiles (also called birds eye pep-
the region has been dubbed tamale pie, nachos, and most tacos and enchi- pers, described previously). Chiles often flavor
the Stroke Belt. ladas, which usually feature nontraditional fillings. foods in Texas not normally associated with the
spice, such as cornbread and jelly. In addition to
chile peppers, other fresh fruits and vegetables
are now prevalent in southern Texas due to irri-
gation. Cantaloupe, pink grapefruit, peaches,
sugarcane, and tomatoes are a few examples of
specialty crops.
SAMPLE MENU
HEALTH CONCERNS
A Gulf Coast Supper Health risk indicators in the South tend to be
higher than in the rest of the nation (see chapters
on each ethnic group for population-specific
Deviled Crab a, b data).1 Florida and West Virginia have average or
Chicken and Sausage Gumbo a, b, c above average rates in every health risk and mor-
tality categoryAlabama, Arkansas, Kentucky,
Pecan Pralines a, b, c or Mississippi Mud Pie a, b Mississippi, and Oklahoma show a similar pro-
file with the exception of heavy drinking, which
is below average. Lack of leisure time exercise,
a
Barker, A. 2003. The best of Cajun and Creole cooking. New York: diabetes, low birth weight, and mortality rates
Gramercy Books. are of concern in many states. Only the percent-
b
Claiborne, C. 1987. Craig Claibornes Southern cooking. New York: Times Books. age of heavy drinking is substantially lower in
c
The Creole and Cajun Recipe Page at www.gumbopages.com some areas. Death rates in West Virginia are par-
ticularly high, greatly exceeding the national
averages for heart disease (30 percent higher),
stroke (20 percent higher), and cancer (25 percent
higher). (See Table 15.8.)
Table 15.8 South StateSpecific Health Data Compared to National Averages, 20012002
AL AR DE FL GA KY LA MD MS NC OK SC TN TX VA WV
Overweight a
AVG AVG AVG AVG AVG AVG AVG AVG AVG AVG AVG
No Leisure-Time Exercise b
AVG AVG AVG
Diabetes c AVG AVG AVG AVG
Hypertension d
AVG AVG AVG
High Blood Cholesterol e
AVG AVG AVG AVG AVG AVG AVG AVG AVG AVG
Dont Consume 5 Fruits/Vegs. f
AVG AVG AVG AVG AVG AVG AVG AVG AVG AVG
Heavy Drinking g AVG AVG
Low Birth Weight h AVG AVG
AVG
Death from Stroke j
AVG
Death from Cancer k AVG AVG AVG AVG
a
b
c
d
e
f
g
h
U.S. prevalence = 7.3 percent (live births of infants weighing <2,500 grams)
i
j
k

Sources: Ahluwalia, I.B., et al. 2003. State-specific prevalence of selected chronic disease-related characteristicsBehavioral Risk Factor Surveillance System, 2001. National Center for Health Statistics. 2004. Chartbook on trends in health of
Americans. Hyattsville, MD: U.S. Government Printing Office. MMWR Surveillance Summaries, 52, (SS08); 180. Centers for Disease Control. 2003. Profiling the leading causes of death in the United States: Heart disease, stroke, and cancer. Available
at http://www.cdc.gov/nccdphp/publications/factsheets/ChronicDisease/
The West and Washington. Approximately 22 percent of

Americans reside in the West,20 and, of these, over
half live in California. Large numbers of many
REGIONAL PROFILE ethnic groups reside in the West (see Figure 15.6).
The western United States is the largest region in Compared to total U.S. figures, five times as
the nation, encompassing an enormous diversity many Pacific Islanders and nearly twice the
of lands, from the icy tundra of Alaska to the Asians, Latinos, and Native Americans are part of
tropical volcanic islands of Hawaii. The tallest the western population. This includes dispropor-
mountains in the country, vast fertile valleys and tionate numbers of total Inuit, Japanese, Aleut,
coastal plains, stretches of scenic desert, and Filipinos, Salvadorans, Chinese, Vietnamese,
temperate rainforest add to the variety. It is the Mexicans, American Indians, and Koreans.
history of the open wilderness that links this African Americans and whites fall below the U.S.
region. Indigenous peoples adapted their lifestyles average in the region. Among whites residing in
to fit each climate and terrain. Pueblo Indians western states, there are large numbers with
made their homes in the cliffs and cultivated Danish and Spanish ancestry and Yugoslavian
corn, beans, chiles, and squash; the Inuits of heritage (including those from what are currently
Alaska lived in ice igloos and hunted sea mam- Croatia and Serbia). In 1991, 31 percent of immi-
mals and fish for food; and the native Hawaiians grants to the United States settled in the West,
enjoyed such fresh abundance that they cooked 23 percent in California.
few dishes (see Chapter 5 and Chapter 12). The Furthermore, a few individual western states
first whites in the West were explorers, trappers, report notable ethnic population figures. Asians
miners, and tradershardy individuals (mostly and Pacific Islanders account for over half the
men) seeking their fortune. Emigrants came population in Hawaii, for example. Latinos are a
from every direction: the Spanish and Mexicans large percentage of both the New Mexico and
from Mexico in the South, Russians from the California populations. Arizona and New Mexico
North, Chinese and Japanese from the West, and host large numbers of American Indians; Alaska
the numerous pioneers of northern and southern Natives, including Inuits and Aleuts, who make
European descent (mostly English, Scottish, up 15 percent of the population in Alaska.
Welsh, Danes, Swedes, Slavs, Italians, and Greeks) Though only 40 percent of persons living in the
from the Midwest, looking for new farming, West adhere to a Christian faith, the highest
ranching, and fishing opportunities. The West is percentage of Christians in the nation reside in
the most diverse region not only in climate and Utah (80 percentnearly all are Mormons) and
terrain but also in population. large numbers are also found in New Mexico
The West is divided into the Mountain states (58 percentmany are Roman Catholics).
of Arizona, Colorado, Idaho, Montana, Nevada, The West has a higher than national average
Figure 15.6 New Mexico, Utah, and Wyoming and the Pacific proportion of young people under age fifteen and
Demographics in the West, states of Alaska, California, Hawaii, Oregon, a lower than average percentage of persons over
2000.
2%a
8%
American Indian or 24%d Hispanic or
5%
Alaska Native Latinoc
1%b
Asian Non-Hispanic
12% Black or African
American
Native Hawaiian or
4% other Pacific Islander
Some other race
68% Two or more races 76%
White
a
Mostly in Hawaii. bMostly in Alaska, New Mexico, and Arizona. cMay be of any race. dMostly in New Mexico and California.
age sixty-five.20 Despite the vast open space of the Immigrants from other countries came to the
region, over 86 percent of the population lives in West in search of mining and railroad jobs,
metropolitan areas. Average household income including the Chinese and Mexicans. Both of
according to 2000 Census data is near the national these groups enjoyed highly seasoned foods and
average in the Mountain states at $41,554 and promoted the use of chile peppers. Other groups,
well above average in the Pacific states at $46,707. such as the Italians, Japanese, and some Greeks,
Persons living in poverty are just about the national became involved in fishing and introduced spe-
average: 12 percent in the Mountain region and cialties such as seafood cioppino (a seafood stew
13 percent in the Pacific states. using local fish and shellfish) and teriyaki. Many
immigrants opened restaurants and markets to
serve the needs of the booming towns. German
TRADITIONAL FARE sausages, Italian cannoli, and Chinese stir-fried
The West was largely unknown to whites before dishes were all available. Still other immigrants European visitors to the West
the nineteenth century. Adventurous trappers and arrived looking for farmland; they planted the fer- were appalled by both the
traders made their way into the territory from the tile Pacific coastal regions and the California poor quality of food and
Great Plains, often surviving on dried bison meat. Central Valley with temperate fruits and vegeta- the manners practiced by
Miners who followed the gold and silver strikes in bles such as apples, pears, dates, grapes, plums, the inhabitants. They com-
prunes, cherries, artichokes, avocados, broccoli, plained of frenzied, rushed
the California Mother Lode, Colorados Pikes
meals eaten with knives
Peak, Montanas Grasshopper Creek, and the brussels sprouts, lemons, grapefruit, and oranges.
used like forks and handker-
Alaska Klondike prepared their own meals, usu- chiefs used like napkins.
ally pork, beans, and hardtack (tough, dry, The Mountain States
The boarding house reach
unleavened bread or biscuits) three times a day. Cuisine in the Mountain states varies considerably came about in response to
Some were dependent on the way stations, hotels, between the North and South. Cooking in Idaho, service at the earliest way
and boarding houses that opened to support the Montana, Utah, and Wyoming was influenced by stations, where a meal was
rush.29 Neighborly hospitality, so common in the the American and European settlers and features offered at one time only to
Midwest and South, disappeared in the name of the foods available in the cooler climates of the any and all comers on a
profit; miners were charged the maximum for northern ranges and plains. Meats are a specialty. single platter placed in the
supplies (e.g., eggs for a half dollar each, potatoes The fare in the southwestern states of Arizona and middle of a large table.29
for a dollar a pound, and a box of apples for $500), New Mexico is shaped by the limitations of the
One innovative seafood
and a meal would cost about three dollars in a desert and the significant Native American,
recipe was the Hangtown
local establishment. The farmers and ranchers Spanish, and Mexican presence in the area. The fry, a platter of scrambled
who later made their way westward frequently foods of Colorado and Nevada are mostly northern eggs with fried oysters and
consumed game with cornbreads and potatoes to states in their cooking, with some southern state bacon on the side, created
complete the meal. Sourdough breads and bis- influences. in Placerville, California
cuits were common with settlers in the Mountain Bighorn sheep, deer, pronghorn antelope, (known at the time as
states, California, and Alaska. Mashed potato or a elk, moose, javelina (wild pig), bear, and bison Hangtown), during the
milk and flour starter was left out to catch wild were prevalent in many parts of the North. 1860s for a miner who had
yeast and begin fermentation. Once going, the Recreational hunting is popular in the region, just struck it rich.
starter was kept indefinitely, replenished each and game meats are favorites. Venison with huck-
time a little was used as leavening (see Table 15.9). leberry sauce is a specialty in Idaho, and in
The growth of towns and the success of irriga- Montana it is prepared roasted, or as chili con
tion increased the food supply. Expensive goods carne, or into meatballs in a spicy tomato sauce.
such as wines and chocolates became available, Both venison and antelope are favorites in
and eastern specialties, including Long Island Wyoming. Tenderloin, sirloin, and T-bone steaks
duck and Smithfield ham, were offered at restau- are cut; the ribs and sirloin tips make roasts
rants. Depending on the region, potatoes, corn, (sometimes marinated and braised in wine, vine-
apples, wheat, and hops prospered; cattle, dairy gar, and spices); the brisket, flank, and plate are
cows, and sheep became plentiful. In Alaska and used for stews or hamburgers; the hams are
Hawaii, white settlers faced different challenges. smoked; and miscellaneous meat is used to
With the arrival of experienced fishermen, more make Polish sausage or salami. In Nevada deer
of the Pacific coast seafood was utilized. Salmon, are ranched for consumption. Numerous game
crab, oysters, and clams were especially popular. birds are found as well, including geese, ducks,
Table 15.9 Western Specialties

Protein Foods
Milk/milk products Milk, cheese (Cheddars such as Cougar Gold, Monterey Jack,
Tillamook); Basque sheeps milk cheeses
Meat/poultry/fish/ Native game, including buffalo, deer, elk, moose, antelope, Game meat steaks, roasts, stews (such as chili con carne),
eggs/legumes mountain sheep, mountain goats, bear, javelina (wild pig), hamburger, sausages; beaver tail
beaver, rabbit
Beef, mutton and lamb, pork Steaks; beef enchiladas, tamales, chimichangas, pirozhki;
teriyaki; Indian tacos; Pueblo pozole; lamb spit-roasted or
roasted with chiles; chorizo; luau (pit-cooked) pork
Clams (e.g., geoducks), crab (Dungeness, king, snow), oysters, Clam chowder, Seattle clam hash; cioppino, steamed crab, crab
shrimp, squid cocktails, fried calamari; grilled or poached salmon,
Salmon, tuna, halibut, mackerel, sardines, anchovies, mahi lobimuhennos (salmon chowder); sushi, sashimi, teriyaki;
mahi, bonito, marlin, snapper; freshwater fish, particu- trout grilled with bacon
larly trout
Chicken eggs Hangtown fry
Dried beans Chickpeas with lamb, chickpea pudding; Basque beans; lentil
soup with lamb, lentil and sausage casserole, white beans
cooked with pimento and cheese; split-pea soup
Cereals/Grains Wheat, corn Sourdough breads, biscuits, pancakes; sopapillas; fry bread;
panocha; capriotada; whole-wheat Mormon bread;
bara brith; malasadas; Hawaiian bread; tortillas (corn or
wheat); piki; Asian noodle dishes (e.g., saimin) and
dough-wrapped foods (egg/spring rolls, lumpia, wonton);
fortune cookies
Fruits/Vegetables Apples, apricots, wild and cultivated berries, cactus fruit, Fresh fruit desserts; fruit added to roasts or poultry stuffings;
cherries, dates, figs, grapes, kiwifruit, lemons, oranges, preserves, jellies, wines; cold fruit soups
peaches, pears, pineapple, plums, prunes, sugarcane
Artichokes, avocados, asparagus, broccoli, breadfruit, Fresh vegetable side dishes; mesclun salads; guacamole;
cauliflower, chile peppers, eggplant, jicama, nopales, Basque potatoes; squash patties; poi
olives, onions, specialty lettuces (arugala, radicchio,
rocket), tomatoes, tomatillos, potatoes, taro root,
zucchini
Additional Foods
Seasonings Chile peppers (especially New Mexico/Anaheim, Jalapeo/ Fresh chiles, dried chile powders, smoked chiles, pickled
Chipotle, Serrano); cinnamon, cilantro, epazote, cumin, chiles; salsas; red or green chile sauces; mole sauce; fresh,
garlic, oregano, mint, safflowers (dried petals), yerba dried, powdered, roasted, pickled garlic
buena; chocolate; vanilla
Nuts/seeds Almonds, hazelnuts, macadamia nuts, pine nuts (pion
seeds), pumpkin seeds
Beverages Varietal wines; coffee; tea (chamomile, Brigham Young); Coffee drinks (lattes, etc.); picn punch
hot chocolate
Fats/oils Olive oil
Sweeteners Sugar from beets, cane Sugarcane is eaten fresh in Hawaii
pheasant, partridge, grouse, and wild turkeys. Cattle and sheep ranching are the dominant
Trout is farmed in the
Magic Valley of Idaho, Pheasant roasted with apples or in a pie is a agricultural activities of the Mountain states.
providing over half of all favorite in Wyoming. Fish, such as sockeye salmon, Colorado is the leading producer in the nation of
the commercial trout bass, and catfish, is available in thousands of lamb, known as Rocky Mountain lamb. In addi-
consumed in the United freshwater lakes and streams. Mountain trout is a tion, bison is raised and processed as a specialty
States. regional specialty. meat in the region. Pork is farmed in Montana,
and poultry, especially turkey and eggs, is pro- settled in Idaho and Nevada, working first as
duced in Utah. shepherds and later as land-owning sheep ranch-
Forage is grown to support meat production ers. Initially only men came, later bringing their Colorado is the highest
in the region, though wheat, oats, barley, sugar families. Women did most of the cooking, provid- state in the nation, with an
beets, hops, lentils, beans, cherries, and apples ing meals for the ranchers such as biscuits with average elevation of nearly
are cash crops in some areas. Potatoes are syn- sheeps milk cheese and coffee for breakfast, and 6,800 feet. Pioneer cooks
onymous with Idaho. They are grown primarily Basque beans (pinto beans with lamb or pork), had difficulties making
baked goods at high alti-
in the volcanic soils of the Snake River plain, lamb stews, or Spanish-style potato omelets for
tudes. Extensive experimen-
where ten billion pounds are harvested annually, the main meal. They introduced sourdough bread tation found that leavening
approximately one-third of national production. and a pencil-thin version of the spicy Spanish must be reduced and oven
Sixty percent are frozen, dehydrated, or milled sausage chorizo. Basque potatoes, still a favorite temperatures raised to
into flour. Peppermint and spearmint (grown for in the region, is a sliced potato, onion, and bacon produce satisfactory breads
their oils used in flavorings) are specialty crops in casserole. Basques often established hotels, which and cakes.
the state. Native berries are a regional favorite, served as meeting places for Basques doing busi-
especially in Montana, including huckleberries, ness in the area and for new immigrants. The Legend is that the famous
which are made into breads and pies, and sour- hotels became famous for their four- or five- Denver (or Western)
tasting chokecherries, which are used in pies, course meals served family-style, and non-Basque sandwich, made with an
cakes, preserves, jellies, and wine. visitors often came for the food. Chickpea and omelet containing ham,
onions, and green peppers
Settlers of the region often brought their meat stews, spit-roasted lamb, and even tradi-
between slices of bread,
favorite foods. For example, Wyoming attracted a tional seafood dishes such as bacalao al pil-pil was invented by a Chinese
diversity of immigrants, many of whom opened (dried salt cod cooked with garlic and olive oil) chef making eggs foo
bakeries, confectionery stores, and restaurants. were offered when the ingredients were available. yung with available
French croissants, Middle Eastern halvah (sesame Red wine, chamomile tea, and picn punch (a ingredients.23
seed candy), German schnitzel, and Chinese beverage no longer common in Spain but still
wonton soup were reportedly available in south- available where Basques live in the United States, Basques from Nevada may
eastern Wyoming as early as 1900.25 In Montana made from bitter orange picn liqueur, brandy, have introduced sourdough
Scandinavians who arrived from Minnesota to grenadine, and soda water) were popular drinks. bread to San Francisco,
work in lumbering brought yellow split-pea soup, In Utah another group that has maintained where it has become
cold fruit soups, Swedish meatballs, and ham with many of their food traditions is the Roman Catholic a signature item.
cherry sauce. Borscht, cheese-filled pastry shells Italians who originally came from Calabria for
(vatroushki), and cherry desserts were favored by mining and railroad jobs in the late nineteenth cen-
the Russians. The Scots made oatmeal porridge tury. They often grow Mediterranean vegetables
and Mulligatawny stew with mutton, and central and seasonings, such as eggplants, tomatoes,
Europeans brought stuffed cabbage, dumplings endive, fava beans, fennel, zucchini, garlic, parsley,
filled with fruit or cheese, and pancakes rolled and basil, in home gardens. Everyday fare includes
around cherries. In Idaho lobimuhennos (a salmon bread sticks, pastas, minestras (see Chapter 6),
chowder) was brought by the Finns; and bara salads, and fresh fruits for dessert. Specialties such
brith, a bread studded with currants, was favored as goat meats and goat cheeses, variety meats
by the Welsh. Many dishes in Idaho today feature cooked up with eggs in a frittata or in a spicy stew,
local ingredients with European nuances, such as boiled chickens feet, and deep-fried squash patties
split-pea soup, lentil soup with lamb, white beans made with chopped squash and squash blossoms
cooked with pimento and cheese, and ham with are traditional favorites. Outdoor baking ovens
apple casserole. Apple jelly is added to mayonnaise used by the first settlers are still found in the
to make salad dressing. Prunes are used in pre- region.37, 43
serves and desserts, such as prune-whip pie and Utah is also home to a large population of
prune pudding.25 In Colorado chile peppers and Mormons (nearly 80 percent of all residents in the
other spices came with the Mexicans, and dishes state), who settled there in the early 1800s in order
such as chicken or turkey cooked in mole sauce to escape the persecution suffered in Ohio, Illinois,
(a rich blend of spices, nuts, and unsweetened Missouri, and other areas where the members of
chocolate) became popular throughout the state. the Church of Jesus Christ of Latter-Day Saints had
One of the most notable ethnic groups in the lived. Many were of northern European descent,
northern Mountain states is the Basques, who particularly British and Scandinavians, and they
Brigham Young tea or brought a preference for hearty foods. Ham, pot When the Spanish arrived in the sixteenth
Mormon tea is also the roast, roast beef, stews, and fried chicken remain century, they introduced many of the foods that
name for a Native American favorite entrees, often served with homemade became elemental in the cooking of the Indians
brew common in the arid whole-wheat bread or buttermilk biscuits. Spicing in both the United States and Mexico, including
areas of the Southwest
is usually mild. Hamburger bean goulash, a Utah wheat, hogs, sheep, and cattle, as well as choco-
made from Ephedra
specialty, is thought to be a denatured version of late and other items obtained through trade in
nevadenis.
chili con carne.25 Milk gravy, made with browned the Americas. The Spanish explorers were fol-
flour, pork drippings, milk, and seasoned with lowed by Mexican-born settlers who established
black pepper, was served with so many foods small farms called haciendas, ranchos, and
that cowboys riding through the area dubbed it estancias beginning in the late 1500s along the
Mormon dip. Potatoes, red cabbage, green beans, banks of the Rio Grande in New Mexico and in
and peas are still common side dishes. The southern Arizona. Anglo-Americans (those who
Mormons are well known for their love of sweets, spoke English) followed, first to New Mexico and
and desserts are prominent in the diet. Layer then into Arizona, adding to the population of
cakes, fruit pies, strawberry shortcake, fruit can- Spanish Americans (mostly of Mexican and
dies, chocolates, and ice cream are still commonly Native American ancestry who spoke Spanish)
consumed. Sour cream raisin pie is a popular Utah and Native Americans. The ethnic heritage of the
dessert that recalls the sweetened milk custards region is evident in the many Native American
and dried fruits of early pioneer days. Another celebrations, adobe villages, and numerous
notable favorite is pepparkakor, a Scandinavian examples of Spanish architecture that still exist.
ginger cookie often Anglicized as pepper cook- Nowhere is the blending of Native American,
ies. Mormons do not drink alcohol or stimulating Spanish-American, and Anglo-American culture
beverages such as coffee or tea; lemonade and more evident than in southwestern fare. Wheat
Brigham Young tea (sweetened hot water with tortillas became a staple in parts of the American
milk) are traditional beverages. Southwest and in northern Mexico. Hearty beef
In the southwestern regions of the Mountain or lamb stews replaced the mostly vegetarian ver-
states, a warm climate conducive to agriculture is sions, and fry bread, made with wheat flour and
combined with insufficient rain to grow most cooked in lard, became common. Popular dishes
crops without irrigation. Some of the most scenic in Arizona and New Mexico with Native
terrain in the nation, from the majestic Grand American and Spanish or Mexican roots include
Canyon to the broad plains of the Sonoran menudo (spicy tripe soup flavored with mint),
Desert, is found in Arizona. New Mexico is a mix pozole (hominy flavored with pork, chile peppers,
of high desert plateaus, portions of the Great and often epazote or oregano), chimichangas
Plains, and sections of the Rocky Mountains. (wheat tortillas wrapped around a beef or chicken
Southwestern fare reflects the arid conditions and vegetable filling, then deep-fried), green chili
and the preferences of the people who settled the stew (beef, tomatoes, onions, and a variety of
region, especially the Native Americans, the green chile peppers), chickpeas with lamb, and
Spanish, and the Mexicans. Indian tacos (fry bread folded and filled with
Native Americans who lived in the region meats, cheeses, vegetables, and salsa). Indian
prior to European contact, particularly Pueblo roasted lamb with red and green chile peppers,
peoples, cultivated small amounts of corn, beans, Spanish arroz con pollo (updated with chiles),
chile peppers, squash, and pumpkins. Pine nuts and Mexican chilaquiles, enchiladas, tamales,
(pion seeds) were indigenous foods. Juicy quesadillas, and flautas are other common dishes
fruits (called tunas, or Indian figs) and the young in the region. Chile peppers, onions, garlic,
pads (nopales) of the saguro and prickly pear oregano, yerba buena, epazote, safflower blossoms
cactus were other native items. Small game, such (dried and powdered, reminiscent of saffron), and
as rabbit, provided meat in the diet. They pre- abundant amounts of mint flavor savory dishes.
The official state question pared stews flavored with chiles and very thin, Toasted pumpkin seeds or pine nuts from the
in New Mexico is Red or blue corn tortillas called piki. Other tribes, such native pion tree were added to spice blends for
green? referring, of course, as the Navajo and Apache, were initially hunters sauces, providing a nutty flavor to roasted meats
to chile pepper sauce who roamed the region in search of big game and and poultry. Today almonds are used in the
preference. wild plants (see Chapter 5). same way.
Sweets depend on chocolate, vanilla, cinnamon, Meat stews flavored with

and other spices. Popular desserts include anise chile peppers are popular in
cookies called biscochitos (a Christmas specialty), New Mexico.
the light, deep-fried wheat flour puffs called
sopaipillas served with honey or cinnamon syrup,
and flan. Puddings are also common, including
panocha (similar to Indian pudding from the
Northeast, but made with wheat kernels and fla-
vored with cinnamon), and capriotada (bread
pudding with pine nuts, raisins, and mild cheese,
traditionally served with a caramel sauce).
Agriculture in Arizona has expanded with
Stockbyte/Picture Quest/Jupiter Images

irrigation. Grapefruit, lemons, melons, and figs
flourish in the region. Two vegetables popular in
Mexico have found success in the state as well.
Tomatillos, a relative of the ground cherry that
looks a little like a green tomato in a papery husk,
and jicama, a crispy tuber related to the morning
glory, have both been transplanted from Mexico
to Arizona. Tomatillos are added to salsa verde
and other green sauces, and the sweet peaflavored the foundation of the diet, leached of tannins and The strings and wreaths of
jicama frequently provides a crunch in local processed as a meal or flour. Western Oregon and dried red peppers known as
salads. New Mexico is the leading producer of Washington are endowed with a wealth of native ristras are made from ripe
chile peppers in the United States. There is no New Mexican/Anaheim
foods, including deer, elk, antelope, rabbits, beaver,
consensus on the common names for the hun- chile peppers.
muskrats, ducks, geese, greens, wild mushrooms,
dreds of varieties, nor is there a single heat classi-
fication system. Mild New Mexican (also called
Anaheim) chiles, medium hot ancho chile (the
name for dried, ground poblano chiles), hotter
jalapeos (sliced, pickled jalapeos are sprinkled
on nachos; smoked jalapeos are called chipotles),
and very hot serrano chiles are the most popular SAMPLE MENU
in southwestern cuisine.
The Pacific States A Southwestern Supper

No region in the United States is as diverse as the
Pacific states. Significant variations in climate, Posole/Pozole a, b, c
terrain, and settlement history have led to the devel-
opment of very different cuisines in the three Fresh Flour Tortillas
coastal states of California, Oregon, and Washington Jicama Saladb or Nopalitos Salad a
and that of the two states separated from the con-
tinental nation: Alaska and Hawaii. Biscochitos a, b, c or Flan c
The climate of the Pacific coast states ranges
from cool and moist in the northern areas near
the Canadian border to hot and dry in the south- a
Cox, B., & Jacobs, M. 1996. Spirit of the West: Cooking from ranch house to
ern deserts abutting Mexico. Parallel mountain range. New York: Artisan.
ranges run north-south through the region, divid- b
Fussell, B. 1997. I hear America cooking. New York: Penguin Books.
ing the states into different agricultural zones. The c
Cocinas de New Mexico at www.vivanewmexico.com
foods of the Native Americans depended on their
location. Those near the Pacific survived on
clams, mussels, and fish, with local berries and
greens. In inland areas of California, acorns were
and a multitude of berries. In the eastern sec- chinook, sockeye, dog, humpback, and silver)
tions of the states, however, high prairie-like were sent fresh to West Coast markets or pickled
plateaus and near-desert conditions exist (see and shipped in barrels to Hawaii, South America,
Chapter 5). the East Coast, and Europe. Iced fish was also sent
Although there are other The first whites to settle in California were the to Europe, where it was smoked, then returned to
incidents of cannibalism Spanish in the eighteenth century. They built sev- the United States. Washington still leads the nation
in U.S. history, one of the eral presidios (forts), pueblos (small farms), and a in total salmon catch and products. Oysters are
most famous occurred in series of missions (each one day apart in travel another specialty. The small native Olympia oyster
18461847 when a group time), with the purpose of protecting their claim is a favorite, but overharvesting has greatly
of eighty-seven settlers
to the territory. The Spanish cultivated numerous reduced availability. Pacific oysters, which were
coming from Illinois to
California was stranded in
crops, including wheat, olives, grapes, and oranges imported from Japan in the early 1900s, are the
the mountains of the Sierra in the lands surrounding the missions, and species consumed most often on the West Coast,
Nevadas during the winter planted native foods including corn, beans, and though European flat oysters are also harvested.
months. Almost half the tomatoes as well. Cattle and hogs were raised. Oysters are typically served on the half shell in the
people in the Donner Party Many of the local Indians were forced into the region, although bacon-wrapped broiled oysters,
perished from hunger, and missions as laborers. When Mexico took control oyster fritters, barbecued oysters, oyster loaf, and
those who made it survived, of the state in the early nineteenth century, much oyster stew are common cooking preparations.
in part, through eating of the mission territory was redistributed as Dungeness crab, named for the town of Dungeness
the dead. grants to resident families who founded wealthy on the Olympic Peninsula, are caught during the
rancheros producing mostly beef. Despite Spanish winter months. In California sardines were the
claims to the contrary, many other European leading catch during the early twentieth century.
powers sought access to California riches. Russia, As their numbers diminished due to overfishing,
in particular, established colonies in northern other fish, such as tuna, salmon, halibut, mackerel,
California to support its fur trade along the Pacific and anchovies, became the predominant catch.
coast and in Alaska. Trappers were the first whites Dungeness crab, traditionally eaten steamed with
to explore Oregon and Washington. Significant melted butter and lemon or in crab cocktails, and
settlement from other states did not occur in the squid, served deep-fried or over pasta, are popular.
region until the discovery of gold in California Abalone, a large, flat-shelled mollusk that clings to
during the 1840s and the opening of the Oregon rocks off the California coast, is a specialty. The
Trail to pioneers from New England, the Midwest, tough muscle must be pounded into a thin steak to
and the South, who came to make their fortunes tenderize it before cooking. It has a delicate, sweet
in the new frontier of the West. Regardless of flavor and is typically lightly floured and sauted
ancestry, most early settlers adapted their cuisines in butter.
to the local natural pantry. Many early settlers in the Pacific coastal states
Floating oystering Coastal seafood was a mainstay for many set- started small farms, which over the years have
communities were tlers. In Oregon items familiar in Atlantic fare, grown into a significant industry. California pro-
established in the Puget particularly clams, were favored. Over two dozen duces more than half the fruits and vegetables con-
Sound area during the late varieties (e.g., butter, horse, Japanese littleneck, sumed nationally and accounts for nearly the entire
1800s. Families would rake Manila, razor) live in the sands of the Pacific U.S. production of avocados, artichokes, garlic
the mudflats at low tide for
Northwest. Clam chowder, adapted with whatever (some of which are processed as granules and
prized Olympia oysters.
local settlers could rustle up, including rice, toma- powder), walnuts, almonds, apricots, nectarines,
Steamboat merchants
would later come by at high toes, and cabbage, was common.23 Geoduck (pro- olives, dates, figs, pomegranates, prunes, and per-
tide to purchase burlap nounced gooey-duck) clams are a large, bivalve simmons. It leads the nation in growing numerous
bags full of oysters from the native to Oregon and Washington with necks other crops as well, such as lettuce, broccoli, grapes,
gatherers. (siphons) that can stretch several feet. A geoduck lemons, strawberries, and melons. Furthermore,
may weigh up to fifteen pounds, although most are 90 percent of all raisins consumed in the world are
in the two- to three-pound range. The body is produced in California. Specialty fruits, such as
sliced and pounded into thin steaks (similar to kiwifruit and feijoa (a small, green, egg-shaped
abalone), and the neck is usually minced or fruit native to Brazil that tastes a little like pineap-
ground for soups or stews. Washington also has ple and eucalyptus with mint nuances), are now
an abundance of seafood. Beginning in the 1800s being grown. In Oregon fruit, such as pears (mostly
the five species of salmon in the region (king or Bartlett, with some Anjou, Bosc, Comice, Seckel,
and Winter), apples, prunes, plums, cherries, and California produces more
domestic berries, have proved very successful. An than half of the fruits and
Oregon specialty is hazelnuts (also called filberts). vegetables consumed in the
The trees were introduced from France in the nation and takes pride in
a cuisine based on fresh,
1800s, and today nearly all hazelnuts consumed in
local ingredients.
the United States are grown in the state.
Washington leads the nation in the production of
both apples and cherries. Apples are especially
associated with the state: Grown on the eastern
slopes of the Cascade mountains, they require
extensive hand labor to thin each cluster of blos-
soms to a single king blossom and to pick any
fruit that appears after the initial crop sets. This
process produces exceptionally large, well-formed
apples. Nearly the entire crop is devoted to Red
Delicious and Golden Delicious varieties, although
several other types are grown in small amounts,
such as Fuji, Gala, Granny Smith, and Winesap.
Hops, Walla-Walla onions (a cool weather sweet
Paul Barton/CORBIS
onion that is a different variety from the sweet
onions grown in Georgia and Hawaii), mint, and
spearmint are specialty crops.
Dairying is significant in the Pacific states,
with California first in milk production nation-
wide. Best known are the cheeses of the region,
including several Cheddar styles such as Cougar with fresh berries or dried fruit, as well as various
Gold from Washington, Tillamook from Oregon, fruit pies, soups, preserves, jams, and jellies.
and Monterey Jack (a mild, white cheese) from Few distinctively ethnic flavors are found in the Schnitzel sandwiches, thin,
California. More recently, French-style chvre cooking of Washington, and limited influence from breaded, and fried veal
goat cheeses and blue cheeses have become the settlers of Oregon is seen in German items or pork cutlets served
specialties. (schnitzels, sauerbraten, sage sausages, stuffed cab- between slices of bread,
The abundance of seafood, dairy products, bage, sauerkraut, and strudels) and southern-style were invented in the United
States and introduced to
and fruits and vegetables in the region has led to fried chicken served with biscuits and hominy.
Germany by American
the creation of cuisines that emphasize what is In contrast, thousands of Chinese, Italian, and soldiers. They are popular in
fresh and local. In California celebrity chefs, such Japanese immigrants came to California in the some parts of Oregon.10
as Wolfgang Puck and Alice Waters, have popu- early twentieth century, lured by jobs in farming,
larized dishes such as pasta with chanterelles and ranching, fishing, fish processing, meat pack- Both San Francisco and Los
grilled duck breasts, goat cheese salad with ing, and the canning of fruits and vegetables. Angeles claim to be the
arugula and radicchio, poached salmon with Agriculture continues to draw immigrants from place where fortune cookies
fresh basil and olive butters, and pears and figs Mexico and Central America looking for migrant were invented. Sometime
poached in Zinfandel with Cassis cream (by Alice farm work. Other recent immigrants adding to between 1907 and 1916 a
Waters, founder of the restaurant Chez Panisse the diversity of the state include Vietnamese, Chinese chef created the
in Berkeley)all examples of the California Cambodians, Laotians (particularly Hmong), popular treat, probably as a
restaurant promotion. The
approach to cooking. Other trendy items started Koreans, Asian Indians, Ethiopians, Filipinos, and
idea of the written fortune
in California include mesclun salads (made with Samoans. Many California specialties are attributa- may date back to the
a mixture of baby lettuces) and roasted garlic, ble to the ethnic preferences of the population. The twelfth century, when
which can be added to salads and stews or spread Mexicans brought corn tortillas, refried beans, Chinese insurgents plotting
on bread like butter. Grilled fish, especially guacamole, and popular filled dishes like tacos and the overthrow of Mongolian
salmon and halibut, is a specialty in all three enchiladas. Italians introduced northern Italian rule distributed their plans
states. In Oregon abundant use of fruit is seen in favorites, such as polenta and pesto, as well as inside moon cakes.
both savory and sweet dishes, such as fruit soups, seafood dishes, such as the tomato-based fish stew
poultry stuffed with prunes or apricots, and salads made with local fish and Dungeness crab called
E. & J. Gallo, headquartered cioppino and fried calamari (squid). The Chinese varietals include Cabernet Sauvignon, Merlot,
in Modesto, California, is offered authentic stir-fried dishes, wontons, egg Syrah, and Zinfandel among red wines and
the largest wine producer rolls, and adapted dishes such as chop suey and for- Chardonnay and Sauvignon Blanc among whites.
in the world. It controls tune cookies. The Japanese added sukiyaki, Sparkling wines, which may be made from red or
approximately 30 percent of
teriyaki, tempura, sushi, and other favorites to the white grapes, and dessert wines are also special-
the national market and
mix. Armenians in the Central Valley brought fla- ties of the state. Oregon wines have gained a rep-
over 50 percent of exported
U.S. wines. vorful lamb skewers, dolma (rice- and lamb- utation for quality, especially for cool weather
stuffed eggplant or grape leaves), and specialty varietals such as Pinot Gris (a white wine) and
Coffee drinks such as lattes desserts such as baklava. Newer immigrants have Pinot Noir (a red grape used in French-style bur-
have become a specialty popularized hot Thai dishes, Vietnamese pho, gundies). Washington is best known for its white
item associated with
Filipino lumpia, and Indian tandoori cooking and wines, such as Chenin Blanc, Gewrtztraminer,
Seattle. The city is home to
flat breads in the state (see the chapter specific to and White Riesling. In more recent years fruit
the Starbucks Corporation,
which started the trend of each ethnic group for more details). wines, such as those made from blackberries, cur-
U.S. coffee bars (modeled California, Oregon, and Washington are rants, cranberries, or peaches, have become
after Italian espresso bars) famous for their wines. The European settlers of common, especially in Oregon.
in 1984. There were almost the mid-nineteenth century first introduced the The cooking of Alaska has been hampered in
8,000 Starbucks coffee bars superior varietal grapes used in French and its development by the limited variety of foods.
nationwide in 2006. German wine making to California. Today there The climate and terrain are by no means uniform
are many premier wine regions in the state, throughout the state, with warmer regions found
including Napa Valley, Sonoma, Santa Cruz, along the coastal panhandle extending south into
Monterey, San Luis Obispo, and Santa Barbara. Canada, around the Yukon River Delta, and the
The Central Valley accounts for most of the grapes protected Matanuska Valley in the south-central
cultivated for the bulk wine market. Successful region, but there is little land suited for agricul-
ture. The Indians, Inuits, and Aleuts of the region
lived primarily on seafood and game. Wild
berries and roots were harvested in the short
summer months (see Chapter 5). The first per-
manent white settlement in Alaska was on
Kodiak Island. The Russians arrived in the 1700s
SAMPLE MENU to hunt fur seals. They brought kasha, a cooked
buckwheat porridge, buckwheat blini, and soups
of fish or cabbage. Pirogs, large filled pastries,
A Pacific Northwest were made with fish, game, or cabbage. At Easter
they prepared traditional dishes such as the rich
Dinner fruitcake called kulich (see Chapter 7). A rush of
prospectors searching for gold arrived in the
Acorn Squash and Apple Soup a, b Klondike area in the 1800s. Supplies were
severely limited, and the new settlers lived on
Cedar Planked Salmon a, b little more than flour, bacon, salt pork, lard, and
a bit of coffee or tea. Most kept a sourdough cul-
Mixed Greens Salad Garnished with Oregon Blue Cheese and
ture going to make breads and biscuits.
Roasted Hazelnuts
Sourdough specialties included poppy seed
Blackberry Cob b ler a, b or Pinot Noir (Red Wine) Poached Pears b potato bread, rye bread with caraway seeds, and
whole-wheat bread. Kelp was collected at the
coast, and wild flowers were boiled to make
a
Schreiber, C. 2000. Wildwood: Cooking from the source in the Pacific Northwest. syrup. Some miners hunted to supplement their
Berkeley, CA: Ten Speed Press. diets, and game, such as deer, caribou, moose,
b
Cooks.com at www.cooks.com Dall sheep, rabbits, and ptarmigan, was avail-
able. Game meats are still popular today, includ-
ing steaks, roasts, and hamburgers made from
moose meat, and caribou meat sausages and
Swiss steaks.
Sheep are now raised on the Aleutian Islands, the same meal, however, representing the states The Hawaiian pupu platter
providing lamb for the mainland. Cattle ranches diverse heritage. Popular Hawaiian foods include with bite-size snacks
are found on Kodiak Island and in the Delta and those with Japanese origins, such as teriyaki- epitomizes the international
Matanuska. Reindeer herds were imported to grilled meats and fish, sashimi (raw, thinly sliced nature of food in the state.
Typical appetizers include
Alaska in the late 1800s from Siberia and fish), and noodle dishes such as saimin, an island
lomi-lomi; rumaki (water
Scandinavia in the hopes they would become a adaptation of ramen noodles, topped with pork
chestnutchicken
profitable meat source. Many starved to death and frequently eaten for lunch. The Chinese liverbacon skewers);
when the ranges were overgrazed, and others are brought wok cooking, dim sum, long-grain rice, Chinese chicken wings,
thought to have become part of caribou herds. soybeans, bok choy, lotus root, kumquats, litchi, spareribs, wontons, and
Today, some reindeer in the Seward Peninsula are and ginger to the region. Scottish scones and dumplings; roast pork; poi;
raised for meat and for supplying antlers to Asia. shortbreads are available, and Portuguese sweet coconut chips; Portuguese
More important are the dairy operations provid- bread is so common it is often called Hawaiian sausage; Korean meatballs;
ing fresh milk, butter, and cream. Potatoes are the bread. Another Portuguese specialty, malassadas curried fritters; or small
most successful crop, but vegetables such as cab- (fried doughnuts without a hole), is especially kumaki skewers of meat,
bage, cauliflower, and rhubarb also grow in the popular, and local variations made with poi or chicken, or fish.
region. Many of the vegetables attain gigantic pro- macadamia nuts are novelty items. Filipino fish
The Parker Ranch on the
portions in the long daylight hours of summer; for sauces and lumpia (Filipino-style egg rolls),
island of Hawaii has
example, cabbages may reach seventy pounds, Korean kimchi (hot cabbage relish) and spicy beef 60,000 head of cattle and
and rhubarb sometimes grows four feet tall. dishes, and Indian curries are other contributions. is second in size only to the
Seafood is the main commodity in Alaska, Historically sugarcane is the most important King Ranch in Texas.
ranking first nationally in quantity and value of crop in Hawaii, accounting for 20 percent of the
the yearly catch. Salmon, herring, and halibut are raw sugar produced nationally. But soaring costs
the most prevalent fish. Shrimp and crab, includ- and environmental concerns have put most sugar-
ing Dungeness, Snow (also known as Tanner), cane plantations out of business. Pineapples have
and limited King crabs, are trapped during the also been a significant commodity, though pres-
winter months. Most are frozen or canned for sures from Asia are reducing their profitability.
export to the rest of the United States and Japan. Hawaii grows most of the worlds supply of
In Hawaii a mild tropical climate and abun- macadamia nuts and also exports famous kona
dant natural food resources greeted the earliest coffee, grown on the western slopes of the island of
inhabitants. The volcanic islands are believed to Hawaii. Cattle ranches are found on the islands of
have been first settled by Polynesians from the Maui, Hawaii, and the privately owned Niihau;
Marquesa Islands and Tahiti in the fifth century. most provide beef for local consumption. Seafood, Salmon and other seafood
The foundation of their diet was starchy vegeta- another Hawaiian specialty, is also mostly fished are favorites in Alaska and
bles such as taro root (traditionally made into the Pacific Northwest.
poiboiled, pounded into a paste, and slightly
fermented), breadfruit, plantains, cassava, and
yams. Seafood and possibly pork and chicken
were also eaten (see Chapter 12). British explor-
ers discovered the islands in the late 1700s; the
area became a major American port for whaling
ships in the nineteenth century, and Japanese,
Chinese, Korean, Filipino, and Asian Indian agri-
cultural workers came to support the developing
pineapple and sugarcane industries.
Traditional native dishes and foods introduced
to the islands by the many immigrants coalesced
into Hawaiian fare. Unlike some areas of the
nation, where various foreign contributions have
Buddy Mays/CORBIS
melded into a single cuisine with occasional

European, Latino, or Asian overtones, many dishes
in Hawaii maintain their ethnic integrity. Foods
from different cultures are commonly served at
Maui onions are considered for Hawaiian markets, although some tuna is New Mexico, Utah, and Washington all boast
the sweetest in the world canned and exported. In addition to tuna, common average or below U.S. average figures in every
by Hawaiians, that is. They food fish include mahi mahi (also called dorado), health risk and mortality category. Certain spe-
are the same variety as the bonito, mackerel, and snapper. cific state data are noteworthy. High rates of heavy
Vidalia onions of Georgia.
drinking are found in Arizona, California, and
Nevada. Death from stroke is nearly 25 percent
HEALTH CONCERNS above U.S. rates in Oregon. Some of the highest
In general, people living in the West are healthier percentages of overweight in the nation are found
than the national average (see chapters on each in Alaska (almost 10 percent higher than the U.S.
ethnic group for population-specific data).1 Idaho, average). (See Table 15.10.)
Table 15.10 West StateSpecific Health Data Compared to National Averages, 20012002
AK AZ CA CO HI ID MT NV NM OR UT WA WY
Overweight a AVG AVG AVG AVG AVG AVG AVG AVG AVG
No Leisure-Time Exercise b AVG AVG
Diabetes c
AVG
Hypertension d
AVG AVG AVG AVG
High Blood Cholesterol e AVG AVG AVG AVG AVG AVG AVG AVG
Dont Consume 5 Fruits/Vegs. f AVG AVG AVG AVG AVG AVG AVG AVG AVG AVG AVG AVG
Heavy Drinking g
AVG AVG AVG AVG
Low Birth Weight h
AVG AVG
Death from Stroke j AVG
Death from Cancer k
AVG
a
b
U.S. prevalence = 25.8 percent (adults who did no leisure-time physical activity in past month)
c
U.S. prevalence = 6.6 percent (self-reported data based on number of adults who were told they had condition by a health professional)
d
e
f
g
h
U.S. prevalence = 7.3 percent (live births of infants weighing <2500 grams)
i
j
k
Sources: Ahluwalia, I.B., et al. 2003. State-specific prevalence of selected chronic disease-related characteristicsBehavioral Risk Factor Surveillance System, 2001. National Center
for Health Statistics. 2004. Chartbook on trends in health of Americans. Hyattsville, MD: U.S. Government Printing Office. MMWR Surveillance Summaries, 52, (SS08); 180. Centers
for Disease Control. 2003. Profiling the leading causes of death in the United States: Heart disease, stroke, and cancer. Available at http://www.cdc.gov/nccdphp/publications/
factsheets/ChronicDisease/
EXPLORING GLOBAL CUISINECanada
C anada is the second largest A foundation of the diet is many vari- filling is thickened with oats instead of
nation in the world in area, a eties of potatoes, such as Yukon Golds, potatoes, a British contribution.
diverse land with rainforests, purple-fleshed potatoes, and Russets Specialty foods of the region include
vast prairies, deciduous forests, and sparse grown for their length (to make french leeks, oyster mushrooms, white asparagus,
tundra regions. There are more lakes and fries) or their roundness (for chips). In Nova endive, apples (often used to make hard
inland waters in Canada than in any other Scotia new potatoes are combined with apple cider), and strawberries. Lamb,
country. It is a nation rich in natural baby peas, beans, and carrots and flavored rabbit, game birds, salmon, and cod are
resources, especially abundant freshwater with butter and cream to make Scottish popular. Quebec produces 70 percent of the
fish and seafood, game, and fertile farm- hodge podge. The Acadians make potato worlds maple syrup, which is used to flavor
land. The country is divided into ten dumplings the size of baseballs (poutine many products including viande bou-
provinces and three territories. rpe) and serve them as a main course, canesalt pork smoked in the maple
Canadian regional fare reflects indige- side dish, or even as dessert with molasses. sugar shack so that it is sweetened by the
nous foods and the preferences of the Rappie pie is another Acadian specialty vapors of the bubbling pots; maple sugar
groups who have significantly impacted the made from grated potatoes that are pickles; and even maple sugar wine. Maple
nation historically: Native Americans and squeezed dry, then cooked with enough sugar pie is a specialty. Dairying is signifi-
immigrants from Great Britain and France, chicken broth to equal the extracted potato cant in the region. In addition to traditional
with added flavors from smaller popula- juices until the potatoes are jellylike. It can French cheeses like Brie, Quebec produces
tions of immigrant groups from northern be topped with cooked chicken, meat, or oka (also called Trappist monk cheese),
Europe and Asia. Though there are many clams, flavored with molasses, and covered similar to Port Salut; Swiss-style raclette;
nationally known foods, from apple pies with bacon or salt pork before it is baked. and several chvres (goat cheeses). Other
and cinnamon buns to lobster and Cheddar Fish and chips (sometimes made with common dishes include cretons (a pork
cheese, much of Canadian cooking is lobster) are a tradition in the Atlantic pt), cipaille (a layered meat pie, some-
dependent on local ingredients. They pro- Provinces that is regaining popularity. times prepared with game), and fves au
vide an overview of five culinary regions: Other foods of the region include fresh lard (baked beans).3, 9
the Atlantic Provinces, Quebec, Ontario, the spring shoots of Salicornia europaea (called
Prairies, and British Columbia.50 crowfoot, glasswort, or samphire greens) Ontario
and fern fronds. Rhubarb, strawberries,
saskatoonberries (known as shadberries or The cooking of Ontario originally emphasized
Atlantic Provinces the foods favored in Great Britain. The Scots
Juneberries in the United States), and
The cooking of the Atlantic Provinces uses blueberries are seasonal favorites. Lamb brought scones, shortbread, and haggis, and
seasonal ingredients prepared as dishes dishes and meat pies are common British the Irish added a love of potatoes. Cookbooks
familiar to the Acadians and British immi- foods found in the region.11, 36 from the late nineteenth century include
grants who settled the region, with a little many recipes for game, beef, and poultry as
German influence found in Nova Scotia. entrees and numerous descriptions of sweet
Seafood is preeminent, including lobster, Quebec and savory pies and puddings. Two ethnic
oysters, clams, and mussels, as well as cod, The cuisine of Quebec is influenced by the communities have influenced the cuisine of
salmon, haddock, halibut, smelt, and French country roots shared by many of the Ontario: the native Cree and Iroquois, and
herring. Lobster and corn boils are popular residents. Yet even the most traditional of the German Mennonites who came to
in summer, and clamburgers with a little dishes, such as the meat pie called tour- the Waterloo County from Pennsylvania
fat rendered from salt pork poured over the tire, vary according to the area where they (Pennsylvania Dutch). Indian foods include
top are an Acadian specialty. Planked are prepared. In Charlevoix tourtire is corn and bean soups made with venison or
salmon and Solomon Gundy (pickled made with cubed meat instead of ground pork; bannocks baked in an oven, fried in
herring) are also common. Malpeque Bay meat, and in Saguena-Lac-St-John it is pan, or wrapped around a stick over a fire;
oysters and Prince Edward Island (P.E.I.) more of a layered dish. In the Mauricie it is and many game dishes. Moose muzzle was
mussels are renowned worldwide. made with salmon, and in Quebec City the a specialty. Mennonite foods include those
(Continued)
EXPLORING GLOBAL CUISINECanada (Continued )
traditional in Pennsylvania, such as smoked for sausages and to wrap strips of meat British Columbia
hams, sausages, headcheese, dumplings, that were then grilled over a smoky fire in The West Coast of Canada was settled by
doughnuts, preserves and relishes, and the dish colorfully called Crow-Indian-Guts. British trappers and traders, not farmers. The
numerous pies. Wild meat, fowl, and fish are Bison calves were pit-roasted. As the herds relatively wealthy populace quickly became
often cooked by the Canadian Mennonites. diminished in the early nineteenth century, reliant on imported foods. As early as 1886,
Fried trout and pot pies made with pigeons cattle took their place. Chuck wagon and fresh fruit was being shipped to the region
or rabbit are examples.13, 46, 49 range cooking were specialties. Coffee, from California. Although Chinese, Japanese,
Ontario is also known for its plentiful beans, and sourdough breads, biscuits, and and Asian Indians began to immigrate to the
fruits. Specialties include Dutch apple pies pancakes were mainstays, though fresh West Coast in the 1880s, their ethnic fare
topped with streusel, apple or rhubarb coffee beef dishes were the favorites, particularly was isolated within each of their communi-
cakes, apple dumplings, apples baked in fried steaks and stews. Prairie oysters ties, while most residents favored the mildly
a crust and drenched in caramel sauce, (breaded, fried beef testicles) were popu- seasoned foods of colonial England.22 The
peach crisps, and blueberry jam. Fruit is used lar. Some of the cowboy terms applied to globalization of cooking brought native
to complement meats and poultry and is foods indicated their role in the diet, such ingredients and Asian influences to the fore-
added to cabbage salads, mashed rutabagas, as baked wind pills(beans), paper- front of British Columbia cuisine. Indigenous
and even spicy chili sauces. Wines are pro- weights (hot biscuits), and yesterday, greens, such as miners lettuce and the new
duced in the region, including an unusual today, and forever (hash).6, 45 shoots of thimbleberries or salmonberries,
dessert wine that has become popular in Foods of the Prairie farm families often are lightly dressed as salads; camass bulbs
recent years known as icewine (similar to the included dishes from immigrant home- are served as side dishes; and the many wild
German version known as Eiswein). It is lands, such as roast beef and Yorkshire berries of the region (including thimbleber-
made from White Riesling or Vital grapes pudding, stews, pot roasts, chicken and ries, salal, salmonberries, huckleberries,
that are allowed to ripen until they shrivel dumplings, stuffed cabbage, sauerkraut, saskatoonberries, red elderberries, and soap-
and the sugars become concentrated. They and pierogies (see Midwest section for more berries) are used in savory sauces for meats,
are harvested after they freeze; the small information). The Prairies are the breadbas- in fresh desserts, in preserves, and in juices
amounts of the remaining intensely sweet ket of Canada, and wheat is a significant and teas. Sushi and samosas are now avail-
juice are pressed from the grapes and fer- crop, evident in the many traditional baked able at delicatessens along with the sand-
mented. It is described as having an goods of the region used by the settlers. wiches and soups. Canadian native foods
ambrosial flavor reminiscent of honey, apri- Biscuits accompanied many meals, includ- used in traditional Asian dishes offer new
cots, peaches, oranges, tea, and toffee. 4, 6, 58 ing bannocks, gems (similar to muffins, flavors, such as Filipino sinigang with salmon
cooked in fluted cups), and fried biscuits. instead of pork, Chinese pork and cod
The Prairies Other common items included pound braised with garlic, or Japanese geoduck
The Prairie Provinces of Canada are red cakes, tea cakes, banana bread, shortbread, clam sashimi. Four major varietal
meat country. Bison sustained the few chocolate cake, carrot pudding, matrimo- grapegrowing regions have developed in
Native Americans and white pioneers who nial cake (date squares), sour cream raisin British Columbia, producing well-respected
made their homes in the region in the early pie, cinnamon buns, strawberry shortcake, Chardonnay, White Riesling, Pinot Blanc, and
years. The meat was barbecued or dried to and ethnic breads like Dutch Kringle bread, Pinot Noir wines.32, 54, 57
make pemmican. The intestines were used French bread, and Ukrainian paska.15
CHAPTER 15 REVIEW QUESTIONS 3. Compare and contrast the preparation of

beans, corn, and apples in different regions of
1. List and describe three factors influencing the United States.
regional cuisine. Pick one region and sum- 4. Describe one unique recipe associated with
marize its influences. a particular region of the United States that
2. How did Native American foods/cooking you were not familiar with prior to reading
methods influence regional U.S. cuisine? Chapter 15. Would you try it? Why or why not?
5. Based on health statistics, which region of Northern Bounty: A Celebration of Canadian

the country would you choose to live in to Cuisine. Toronto: Random House.
stay healthy? What dietary factors may be 14. Edmondson, B. 1998. The line between beer and
influencing these health statistics? If you wine. American Demographics, 1, 819.
wanted to eat unhealthy one day, which 15. Fraser, M. 1995. Canadas breadbasket: Decades of
change. In J.M. Powers & A. Stewart (Eds.), Our
regional cuisine would you try? Why?
Northern Bounty: A Celebration of Canadian
6. You have decided to eat local. What does
Cuisine. Toronto: Random House.
this mean, and what foods would be available 16. Fussell, B. 1997. I Hear America Cooking. New
for you to purchase? List some of the argu- York: Penguin Books.
ments for eating local. 17. Gutierrez, C.P. 1984. The social and symbolic uses
of ethnic/regional foodways: Cajuns and crawfish
in South Louisiana. In Ethnic and regional food-
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20. Hobbs, F., & Stoops, N. 2002. Demographic trends
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Our Northern Bounty: A Celebration of Canadian Hilton, M.E. 2005. Apparent Per Capita Alcohol
Cuisine. Toronto: Random House. Consumption: National, State, and Regional Trends,
7. Bower, A. 2006. True green: At Clif Bar, saving the 19772003. Bethesda, MD: National Institute on
earth begins with a hard look at its own business. Alcohol Abuse and Alcoholism.
Time Magazine, July 2, 2006. At www.time.com/ 25. Lee, H.G. 1992. Taste of the states: A food history of
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8. Brown, L.K., & Mussell, K. 1984. Introduction. In 26. Lipard, L.R. 1997. The lure of the local: Senses of place
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Knoxville: University of Tennessee Press. 27. Lloyd, T.C. 1981. The Cincinnati chili culinary
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Toronto: Random House. 30. Mandel, A. 1996. Celebrating the Midwestern table.
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13. Duncan, D. 1995. Ontario cooking: Cuisines in 32. McWatters, H. 1995. British Columbia wines take
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Our Northern Bounty: A Celebration of Canadian 47. Smith, A., Watkiss, P., Tweddle, G., McKinnon, A.,
Cuisine. Toronto: Random House. Browne, M., Hunt, A., Treleven, C., Nach, C., &
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42. Powell, J. 2005. Dont get fresh with me! The New Traditional native plant foods in contemporary
York Times, July 22, 2005. At www.nytimes.com/ cuisine in British Columbia. In J.M. Powers &
2005/07/22/opinions/22powell_cm.html A. Stewart (Eds.), Our Northern Bounty: A
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(Eds.), Our Northern Bounty: A Celebration of Celebration of Canadian Cuisine. Toronto:
Canadian Cuisine. Toronto: Random House. Random House of Canada.
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Bounty: A Celebration of Canadian Cuisine. (Eds.), Our Northern Bounty: A Celebration of
Toronto: Random House. Canadian Cuisine. Toronto: Random House.
GLOSSARY OF ETHNIC INGREDIENTS
Abalone (paua): Large, flat mollusk with finely textured, sweet flesh in Apio: See Arracacha.
the broad muscular foot that holds it to rocks (must be pounded Apios: See Groundnuts.
before use). It is common in the waters off Asia, California, Apon seeds (agonbono): Seeds of the wild mango commonly used in
Mexico, and New Zealand. Available fresh, frozen, canned, and West Africa. Basis of the soup known as agonbono.
dried. Areca nuts: See Betel.
Abiu (caimito): Yellow egg-shaped or round fruit native to the Arracacha (apio; Peruvian carrot): Starchy white root of the carrot
Amazon; popular throughout Brazil and Peru. Translucent white family with flavor similar to chestnuts and parsnips used in South
flesh with caramel-like flavor. America, especially Colombia, Peru, and Venezuela.
Acerola cherries (Barbados cherries): Exceptionally sour Caribbean Arrowroot (chee koo): Many varieties of a bland, mealy tuber found in
berries resembling small, bright red cherries with orange flesh. Asia and the Caribbean. When made into a powder, it is used to
Achiote: See Annatto. thicken sauces and stews.
Adzuki bean (aduki, azuki; red bean): Small, dark red bean used pri- Artichoke (carciofo): Globelike vegetable member of the thistle family,
marily in Japanese cooking, often as a sweetened paste. with multiple edible bracts (leaves) crowning the undeveloped
Ahipa: See Jicama. edible flower (the heart). The flavor is slightly sweet. Popular in
Ajowan (ajwain; carom; omum or lovage seeds): Similar to celery Middle Eastern and southern European dishes.
seeds in appearance and to thyme in flavor. Used in Asian-Indian Arugula (rocket): Small member of the cabbage family native to the
and Middle Eastern cooking. Mediterranean; the peppery leaves are popular in salads through-
Ajwain: See Ajowan. out Europe.
Akee (ackee, ache; seso vegetal; pera roja): Red fruit with three seg- Asafetida (devils dung): Dried resin with a pungent odor reminiscent
ments containing large inedible seeds and flesh resembling scram- of burnt rubber, which nonetheless imparts a delicate onion-like
bled eggs. Nearly all parts toxic, causing fatal hypoglycemia. flavor. It is available as a lump or powder and is commonly used
Fresh, dried, frozen akee banned in United States; some canned in Asian-Indian dishes.
types permitted. Asian pear (apple pear): Round, yellow fruit from Asia with the crisp-
Alligator: Reptile native to rivers and swamps throughout the south- ness of an apple and the flavor of a pear.
ern Gulf Coast region, from Florida to Texas. Mild white meat, Atemoya: Hybrid of the cherimoya and sweetsop. See Cherimoya;
with texture similar to veal. Tail and other parts eaten. Sweetsop.
Almond paste: Arab confection of ground almonds kneaded with sugar Aubergine: See Eggplant.
or cooked sugar syrup (some brands also contain egg white) used Avocado (aguacate; alligator pear; coyo): Pear-shaped to round fruit
in many European and Middle Eastern desserts. Marzipan is a with leathery skin (green to black) and light green, buttery flesh.
type of almond paste made with finely ground, blanched almonds. Native to Central America. Numerous varieties; eaten mostly as a
Amaranth (tampala; yien choy; Chinese spinach): Leafy, dark green vegetable, though considered a fruit in some cuisines.
vegetable similar to spinach; red and purple leaf varieties, also. Bacalao (bacalhau, baccala): Cod preserved by drying and salting,
The high-protein seeds can be ground into flour and used in popular in northern and southern European cooking (especially
baked products, or boiled and eaten as cereal. Popular throughout Portuguese). Must be soaked, drained, and boiled before use.
Asia and Latin America. Bagoong: See Fish paste.
Ambarella (hog or Jew plum; kadondong; otaheite or golden apple; vi- Bagoong-alamang: See Shrimp paste.
apple): Small, oval-shaped fruit with very strong flavor native to Bambara groundnut (Congo goober; kaffir pea): Legume very similar
Polynesia but also found in Southeast Asia and Caribbean. Used to peanuts, native to Africa.
unripe for preserves and ripe in desserts. Bamboo shoot (juk suhn): Crisp, cream colored, conical shoot of the
Amchoor (amchur; khati powder): Dried, unripe mango slices or bamboo plant. Used fresh (stored in water) or available canned in
powder, with a sour, raisin-like flavor. brine (whole or sliced).
Angelica root: Herb with a licorice-flavored root common in European Banana flower (plantain flower): Native to Indonesia and Malaysia,
dishes. Usually available candied. Used medicinally in China. bananas are now found in most tropical regions. Male inflores-
Annatto (achiote, atchuete): Seeds of the annatto tree used to color cence of the plant (female inflorescence that develops into fruit not
foods red or golden yellow. Used in Latin America, India, Spain, eaten) is sheathed in inedible red-purple petals. Starchy interior
and the Philippines. In the United States annatto is added to some must be boiled repeatedly to remove bitterness; used fresh in
baked goods, Cheddar-style cheeses, ice creams, margarines, and salads, cooked in curries, soups, or as side dish in palm oil or
butter for color. May be cooked whole in oil or lard to produce the coconut milk.
right hue or used as a ground spice. Bangus: See Milkfish.
524 GLOSSARY OF ETHNIC INGREDIENTS
Baobab (monkey bread, lalu powder): Slightly sweet seeds from the Blood orange: Old variety of orange with deep marooncolored flesh,
large fruit of the native African baobab tree. Used roasted or sometimes streaked with white. Intense sweet-tart flavor.
ground. Pulp of the fruit is also consumed. Common in Spain and North Africa.
Basmati rice: See Rice. Blowfish (bok; fugu; globefish; puffer): A popular Japanese specialty,
Bean curd (cheong-po, tempeh, tofu, tobu): Custard-like, slightly rub- blowfish contain a deadly neurotoxin in the liver and sex organs.
bery white curd with a bland flavor made from soybean milk. Must be carefully prepared by expert; flesh has a slight tingle
Japanese bean curd (tofu) tends to be softer than Chinese, which when eaten.
is preferred for stir-fried dishes. A chewier version common in Bok choy (Chinese chard; pak choi; white cabbage): Vegetable of the
Southeast Asia is called tempeh. Cheong-po, a Korean bean curd, cabbage family with long, white leaf stalks and smooth, dark green
is made from mung beans. leaves used in Chinese cooking.
Beans: See specific bean type. Boonchi: See Long bean.
Bean sprouts (nga choy): The young sprouts of mung beans or soy- Bottlegourd: See Calabash.
beans popular in Asian cooking (sprouts may also be grown Boxthorn: See Matrimony vine.
from the tiny seeds of alfalfa or peas, also from legumes). The Breadfruit: Large, round, tropical fruit with warty green skin and
crisp 1- to 2-inch sprouts are eaten fresh or added to stir-fried starchy white flesh popular in nearly all tropical regions. It must
dishes. be cooked. Unripe, green fruits are generally prepared as a veg-
Belgian endive: See Chicory. etable, boiled, fried, or even pickled. In South Pacific may be
Berbere: Ethiopian spice mix (typically very hot) used to season many fermented to make poi-like starchy dish. Ripe, yellow-fleshed
foods, usually including allspice, cardamom, cayenne, cinnamon, fruit usually sweetened and served as dessert. Available canned;
cloves, coriander, cumin, fenugreek, ginger, nutmeg, and black frozen.
pepper. Breadroot (Indian breadroot; prairie turnips; timpsila; tipsin): Hairy
Bergamot orange: Pear-shaped orange with exceptionally tart flesh. perennial plant (Psoralea esculenta) with large brown root eaten
Rind used to flavor dishes in the Mediterranean and North Africa; by Native Americans of the Plains and adopted by European
oil extracted from rind flavors Earl Grey tea. immigrants who knew it as pomme de prairie.
Betel (areca nuts; catechu): The heart-shaped leaves of the betel vine Brinjal: See Eggplant.
(related to black pepper) are used to wrap areca nuts (from the Buckwheat (kasha): Nutty-flavored cereal native to Russia (where it is
Areca palm; the nuts are usually called betel nuts because of their called kasha), sold as whole seeds (groats) and ground seeds (grits
use with betel leaves) and spices for paan in India. Betel nuts and if coarsely ground, flour if finely ground). It is common in Russian
leaves are chewed together in many Southeast Asian countries and and eastern European cooking.
in India to promote digestion. May stain teeth red. Buffalo berry: Scarlet berry of the Sheperdia genus, so called because it
Bindi: See Okra. was usually eaten with buffalo meat by Native Americans of the
Birds nest: Swallows nests from the cliffs of the South China Sea made plains.
from predigested seaweed; added to Chinese soups or sweetened Bulgur (bulghur, burghul): Nutty-flavored cracked grains of whole
for dessert. Must be soaked before use. wheat that have been precooked with steam. Available in coarse,
Bitter almond: An almond variety with an especially strong almond medium, and fine grades.
flavor, often used to make extracts, syrups, and liqueurs. Grown in Burdock root (gobo): Long thin root with thin brown skin and crisp
the Mediterranean region, bitter almonds are used in European white flesh and an earthy, sweet flavor. Popular in Asian cooking.
dishes. They contain prussic acid and are toxic when raw (they Cactus fruit (cactus pears, cholla, Indian figs, pitaya, sabra, strawberry
become edible when cooked) and are unavailable in the United pear, thang long): Succulent fruit of various cacti popular in
States. numerous nations. Red prickly pear cactus fruitcactus pears,
Bitter melon (balsam pear; bitter gourd, foo gwa): Bumpy-skinned cholla, Indian figs, sabra, tunacommon in Mexico, U.S.
Asian fruit similar in shape to a cucumber; pale green when ripe. Southwest, Central America, Israel and some other Middle
The flesh has melon-like seeds and an acrid taste due to high qui- Eastern countries, Australia, South Africa, and Italy. Fruit of the
nine content (flavor and odor become stronger the longer it organ pipe cactus sold in the United States as strawberry pear or
ripens). pitaya. Fruit of saguaro cactus, nopales cactus, and apple cactus
Bitter orange: See Seville orange. eaten in desert areas of Mexico and U.S. Southwest. Climbing epi-
Black bean (frijol negro; turtle bean): Small (less than 1.2 inches) phytic cacti common in South America, Australia, Israel, and
black bean used extensively in Central American, South Vietnam; one variety called thang long red pitaya or dragon fruit.
American, and Caribbean cooking. Cactus pads (nopales, nopalitos): Paddles of the prickly pear cactus or
Black beans, fermented: Black soybeans salted and fermented to pro- nopales cactus commonly eaten in Mexico and parts of the U.S.
duce a piquant condiment. Used in Chinese cooking as a season- Southwest, fresh, cooked, or pickled. Available canned.
ing or combined with garlic, ginger, rice wine, and other ingredients Cactus pears: See Cactus fruit.
to make black bean sauce. Caimito: See Star apple.
Black-eyed peas (cow peas; crowder peas): Small legume (technically Caj: See Cashew apple.
neither a pea nor a bean), white with a black spot, native to Africa Calabash (bottlegourd; calabaza; West Indian pumpkin): Gourd-like
and southern Asia. fruit of a tropical tree native to the New World.
Black mushrooms: See Mushrooms. Calabaza: See Calabash; Cushaw
Glossary of Ethnic Ingredients 525
Calamansi (calamondin, Chinese or Panama orange, golden or scarlet Chickpeas (Bengal gram dal, chana dal, garbanzo bean): Pale yellow,
lime, musk lime): Small sour lime native to China but widely dis- spherical legume popular in Middle Eastern, Spanish, Portuguese,
tributed in Indonesia and the Philippines, also available in and Latin American cooking. Can be purchased canned or dried.
Southeast Asia, Malaysia, and India. Prized for its sour flavor in Chico: See Zapote.
Filipino cooking. Chicory (Belgian endive, witloof): European chicory plant. Leaves used
Callaloo (cocoyam): Edible leaves of root vegetables, especially ama- as salad green; bitter root roasted to prepare a coffee substitute.
ranth, malanga, and taro. Callaloo is sometimes the name of a dish Often added to dark coffee in Creole cooking.
made from these leaves. Chile pepper: Although chile peppers, or chiles, are often called hot
Camass root: Sweet bulb of the camass lily common in the U.S. Pacific peppers, the fruits are not related to Asian pepper (such as black
Northwest. pepper) but are pods of capsicum plants, native to Central and
Candlenut (kemini; kukui nut): Oily tropical nut sold only in roas- South America. The alkaloid capsaicin, found mostly in the ribs of
ted form (toxic when raw). Popular in Malaysia, Polynesia, and the pods, is what makes chile peppers hot. In general, the smaller
Southeast Asia. the chile, the hotter it is. More than 100 varieties are available,
Cng cua: See Peperomia. from less than one-quarter inch in length to over eight inches
Cannellini: See Kidney bean. long. Used fresh or dried. Common types include mild pods (see
Capers: Small gray-green flower buds from a bush native to the Peppers), slightly hot peppers such as Anaheim (also called
Mediterranean; commonly pickled. California or New Mexico chile) and Cayenne (used mostly dried
Carambola: See Star fruit. and powdered as the spice cayenne); dark green, medium hot
Cardoon: Member of the artichoke family resembling a spiny celery Jalapeo (often available cannedwhen smoked are known as
plant, popular in Italian cooking. Chipotle); spicy, rich green Poblano (used fresh, or ripened and
Cashew apple (caj): The fleshy false fruit attached to the cashew nut. dried, called Ancho); hot Serrano (small, bright green or red); and
Native to Brazil, it is also eaten in the Caribbean and India. very hot Chile de Arbol, Japones, Pquin (tiny berry-like pepper,
Casimiroa (white sapote, zapote blanco): Dark green to yellow fruit exceptionally hot, also known as bird or birds eye peppers), Piri-
native to Central America; resembles an Asian pear. Soft, white piri (favored in West Africa for sauces and marinades; also name
flesh is eaten fresh or prepared as jellies, ices, milkshakes, and of dishes that include some form of the pepper) and Tabasco
fruit leather. (small, red chiles, often used dried and for sauce of same name).
Cassarep: Caribbean sauce made from the juice of the bitter variety of Those with extreme heat include Habanero and Scotch Bonnet;
cassava cooked with raw sugar. similar varieties native to the Caribbean.
Cassava (cocoyam; fufu; manioc; yuca): Tropical Latin American Chile pepper sauce/paste (harissa, kochujang, pili-pili, Tabasco): Fiery
tuber (now eaten in most tropical areas of the world) with rough condiments based on hot chile peppers. Sauce typically made
brown skin and mild white flesh. Two types exist: bitter (poi- from fermented chile peppers, vinegar, and salt (Tabasco sauce is
sonous unless leached and cooked) and sweet. Flour used in the best-known U.S. brand). Pastes often include other ingredi-
Africa (gari), the Caribbean, and Brazil (farinha). Cassava starch ents, such as garlic and oil (Chinese-style and North African
(fufu) is used to make the thickening agent tapioca. Leaves also harissa). Pili-pili used in West Africa made with the piri-piri
consumed. chile (see Chile peppers) and other ingredients such as tomatoes,
Caviar (red caviar, ikura, tarama, tobikko): Fish roe from a variety of onions, or horseradish. Korean kochujang includes soybeans and
fish eaten worldwide, including sturgeon (technically the only roe is fermented.
that is called caviar), salmon (red caviar, ikura in Japan), flying Chili powder: Ground, dried chile peppers, often with added spices
fish (tobikko), carp (tarama, most often made into a paste with such as oregano, cumin, and salt.
lemon juice and other ingredients, in Greece called taramasalata), Chinese date (dae-chu; jujube): Small Asian fruit (not actually belong-
herring, and mullet. Sturgeon caviar graded according to size and ing to the date family) usually sold dried. Red dates are the most
quality. popular, but black and white are also available.
Celeriac (celery root): Gnarled, bulbous root of one type of celery, with Chinese parsley: See Coriander.
brown skin, tan flesh, and nutty flavor. Chitterlings (chitlins): Pork small intestines, prepared by boiling or
Cpes: See Mushrooms. frying.
Chanterelles: See Mushrooms. Chokecherry: Tart, reddish black cherry (Prunus virginiana) native to
Chayote (christophine, chocho, huisquil, mirliton, vegetable pear): the Americas.
Thin-skinned, green (light or dark), pear-shaped gourd. Native to Cholla: See Cactus fruit.
Mexico, it is now common in Central America, the Caribbean, the Chrysanthemum greens (chop suey greens, crowndaisy greens, sook-
southern United States, and parts of Asia. gat): Spicy leaves of a variety of chrysanthemum (not the American
Cheong-po: See Bean curd. garden flower), popular in Asian stir-fried dishes, especially in
Cherimoya (anona, custard apple, graviola): Large, dimpled, light Korea.
green fruit native to South America. White, creamy, flesh has a Cilantro: See Coriander.
flavor reminiscent of strawberries, cherries, and pineapple. See Citron: Yellow-green, apple-size citrus fruit. Valued primarily for its
also Custard apple. fragrant peel that is used raw to flavor Indonesian foods, and
Chicharrnes (pork cracklings): Deep-fried pork skin, fried twice to candied in European baked goods. Available crystallized and as
produce puffy strips. preserves.
Citronella: See Lemon grass. Custard apple (anona roja, bullocks heart, mamon): Green-skinned,
Clotted cream (Cornish cream, Devonshire cream): Very thick cream irregular (heart-, spherical-, or ovoid-shaped) fruit about 3 to 6
made by allowing cream to separate from milk, then heating it inches in diameter, with granular, custardy flesh. Flavor sweet but
and cooling it so that it ferments slightly. Finally, the cream is considered inferior to related fruits such as cherimoya and sweet-
skimmed from the milk (although Cornish cream is skimmed sop. See also Cherimoya.
before heating and cooling). Popular in southwest England, where Cuttlefish (inkfish): A mollusk similar to squid, but smaller. Available
it is spread on bread or used as a topping for desserts. fresh or dried.
Cloud (wood) ears: See Mushrooms. Daikon (icicle radish, white radish, mooli): Relatively mild white
Coconut cream: High-fat cream pressed from fresh grated coconut. radish common in Asian cooking. The Japanese variety is the
Coconut milk: Liquid extracted with water from fresh grated coconut. largest, often 12 inches long, and is shaped like an icicle. The
Cocoplum: Bland plum with white flesh native to Central America, Chinese variety tends to be smaller.
found in the Caribbean, Central America, and Florida. Eaten fresh Dals: Indian term for hulled and split grains, legumes, or seeds. Many
or dried. types are available, such as lentils and split peas.
Cocoyam: See Callaloo; Cassava. Dashi: Japanese stock made from kelp and dried fish (bonita). Dashi-
Conch: Large, univalve mollusk found in waters off Florida and no-moto is the dried, powdered, instant mix.
Caribbean (where it is sometimes called lambi). Chewy meat Dilis (daing): Small fish related to anchovies, dried and salted. Used in
valued for its smoky flavor; can be bitter. Used especially in soups Filipino dishes.
and stews. Dragons eyes: See Longan.
Copra: Dried coconut kernels used in the extraction of coconut oil. Drumstick plant (horseradish tree, malunggay, reseda, sili leaves): Small,
Coriander (cilantro, Chinese parsley, dhanyaka, yuen sai): Fresh leaves deciduous tree native to India, now popular in India, Southeast
of the coriander plant with a distinctive soapy flavor, common in Asia, the Philippines, and West Africa. Fern-like leaves (very spicy
Asian, Middle Eastern, Indian, and Latin American cooking. flavor), flowers, seeds (resembling bean pods but not a legume),
Seeds used as spice; root used in Thai cooking. and roots (indistinguishable from horseradish) consumed.
Corn smut (huitlacoche): Fungus (Ustilaginales) that grows on corn Duhat: See Jambolan.
ears. Prized in Chinese, Mexican, and Native American cooking. Durian: Football-size spiked fruit with a strong odor reminiscent of
Couscous (cuscus, cuzcuz): Small granules of semolina flour used as a gasoline or rotten onions and sweet, creamy flesh prized in Malaysia,
grain in African, Italian, Brazilian, and Middle Eastern dishes. Southeast Asia, and parts of China.
Cow pea: See Black-eyed pea. Edamame: See Soybean.
Cracked wheat: Cracked raw kernels of whole wheat used in Middle Eddo: See Taro.
Eastern cooking. Eggplant (ai gwa, aubergine, brinjal, melananza, nasu): Large, pear-
Crawfish (crawdad, crayfish, mudbug): Small freshwater crustacean, shape to round member of the nightshade family with smooth,
4 to 6 inches long, that looks and tastes something like lobster. thin skin (white or deep purple in color) and spongy, off-white
Found in Europe and the United States (California, Louisiana, flesh. Native to India, where it is called brinjal, it has a mildly
Michigan, and the Pacific Northwest). The names crawfish and bitter flavor. Especially popular in Mediterranean and Asian cui-
crayfish are also applied to the langostino, a saltwater crustacean sine. Asian varieties known as Japanese (nasu) and Chinese (ai
that lacks large front claws. gwa) eggplant are widely available; the Thai type is small, round,
Crme frache: Slightly thickened, slightly fermented cream popular in and white with green stripes and is less common.
France. Egusi: See Watermelon seeds.
Culantro (bhandhani, ngo gai, recao, siny coriander): Herb (Eryngium Elderberries: Small shrubs up to 20 feet. Numerous species found
foetidum) that is close relative of cilantro (see Coriander); however, throughout northern hemisphere. In the United States the small,
looks more like a dandelion with a pungent flavor reminiscent of dark purple berries used fresh and in preserves, pies, and wine.
crushed beetles. Used interchangeably with cilantro in the Blossoms fried as fritters.
Caribbean and Central America, especially associated with Puerto Enoki: See Mushrooms.
Rican sofrito. Seasons Thai curries, Malaysian rice dishes, Indian Epazote (Mexican tea; pigweed, wormseed): Pungent herb related to
chutneys and snacks; larger leaves used as a wrap for foods in pigweed or goosefoot (and sometimes called by these names).
Vietnam. Reportedly high in riboflavin, carotene, calcium, and iron. Found in Mexico and parts of the United States. Often added to
Curry leaves (kari): Herb with tangerine overtones used throughout bean dishes to reduce gas.
India, Sri Lanka, and in parts of Malaysia. Fresh leaves are briefly Farinha: See Cassava.
fried in ghee, then added to dishes before other seasoning. Not Fava bean (broad bean, brown bean, horse bean, Windsor bean): Large,
usually a component of curry powder. green, meaty bean sold fresh in the pod. Smaller white or tan fava
Curry powder: The western version of the fresh Asian-Indian spice beans are dried or canned and cannot be used interchangeably with
mixture (garam masala) used to flavor curried dishes. Up to the fresh beans. Common in Italian and Middle Eastern cooking.
twenty spices are ground, then roasted, usually including black Feijoa (pineapple guava): Small (up to 3 inches), ovoid fruit with
pepper, cayenne, cinnamon, coriander, cumin, fenugreek, ginger, greenish skin and white flesh. Flavor is similar to strawberries and
cardamom, and turmeric for color. pineapple with minty overtones. Shrub native to central regions of
Cushaw (calabaza, green pumpkin): Round or oblong winter squash South America, but now also found in California, Australia, and
with yellow flesh and a flavor similar to pumpkin. New Zealand.
Fennel (finnochio, sweet anise): Light green plant with slightly bul- Gravlax: See Salmon, cured.
bous end and stalks with feathery, dark green leaves, a little like Greens: Any of numerous cultivated or wild leaves, such as chard, col-
celery. Used as a root vegetable, especially in Italy (known as lard greens, creases, cochan (coneflower), dandelion greens, dock,
finnochio). Delicate licorice or anise flavor. kale, milkweed, mustard greens, pokeweed, purslane, and spinach.
Fenugreek (methi): Tan seeds of the fenugreek plant, with a flavor sim- Grits: Coarsely ground grain, especially hominy, which is typically
ilar to artificial maple flavoring. Essential in the preparation of boiled into a thick porridge or fried as a side dish. Served often in
Asian-Indian spice mixtures. Leaves, called methi, also commonly the U.S. South.
eaten. Ground-cherries (Cape gooseberries, poha, golden berries): Yellow
Fiddlehead ferns: Young unfurled fronds a specialty dish of the U.S. fruit that looks similar to a tiny husked tomato, from a bush native
Northeast and southeastern Canada. Roots were eaten by Native to Peru or Chile. Now popular throughout Central and South
Americans. America, Central and South Africa, and the South Pacific. Also
Fil powder: See Sassafras. available in Australia, China, India, Malaysia, and the Philippines.
Fish paste (bagoong, kapi, pa dek, prahoc): Thick fermented paste made Groundnuts (apios, Indian potatoes): South American tuber Apios
from fish, used as a condiment and seasoning in the Philippines and americana eaten by Native Americans, adopted by European set-
Southeast Asia. tlers. Different from Africa groundnuts (referring to either
Fish sauce (nam pla, nam prik, nuoc mam, patis, tuk-trey): Thin, salty, peanuts or Bambara groundnuts).
brown sauce made from fish fermented for several days. Asian Guanabana: See Soursop.
fish sauces vary in taste from mild to very strong, depending on Guapuru: See Jaboticaba.
the country and the grade of sauce. Filipino patis is the mildest; Guarana (Brazilian cocoa): Shrub, Paullinia cupana indigenous to the
Vietnamese nuoc mam is among the most flavorful. Nuoc cham is Amazon. Dried leaves and seeds of the fruit are used to make a
a sauce made from nuoc mam by the addition of garlic and chile stimulating tea (containing caffeine) or mixed with cassava flour
peppers. to form sun-dried sticks.
Five-spice powder: A pungent Chinese spice mixture of anise, cinna- Guava (araca de praia, cattley guava, waiwai): Small sweet fruit with
mon, cloves, fennel seeds, and Szechuan pepper. an intense floral aroma, native to Brazil. Skin is yellow-green or
Fufu: See Cassava; Yam. yellow, and the grainy flesh ranges from white or yellow to pink
Fugu: See Blowfish. and red. Many varieties are available, including strawberry guava
Fuzzy melon (hairy melon, mo gwa): Asian squash similar to zucchini (also known as cattley guava, araca de praia, and waiwai) and
with peach fuzzlike skin covering. Called fuzzy. pineapple guava. Guava is popular as jelly, juice, or paste.
Gai choy: See Mustard. Guayo: See Mamoncilla.
Gai lan (Chinese broccoli, Chinese kale): Thick, broccoli-like stems Guineps: See Mamoncilla.
and large, dark or blue-green leaves, with slightly bitter flavor. Headcheese: Loaf of seasoned meat made from the hogs head and
Used especially in stir-frying. sometimes also feet and organs.
Garbanzo bean: See Chickpea. Heart of palm (palmetto cabbage, palmito): White or light green inte-
Gari: See Cassava. rior of the palm tree, especially popular in the Philippines.
Geoduck: Large (up to 15 pounds) clam native to U.S. Pacific Available canned.
Northwest, with neck or siphon as long as 3 feet. Neck used in Hickory nuts: Tree indigenous to North America, in same family as
soups, stews; body sliced for steaks. pecans. Eaten fresh, roasted, or ground into meal or pressed for a
Ghee: Clarified butter (usli ghee) from cows or buffalo milk used in cream-like fluid by Native Americans; used in confections in the
India. The term ghee is also used for shortening made from palm U.S. South.
or vegetable oil. Hog peanut: A high-protein underground fruit that grows on the root
Ginger root: Knobby brown-skinned rhizome with fibrous yellow- of the vine Falcata comosa in the central and southern United
white pulp and a tangy flavor. Used sliced or grated in Asian States. The peanut has a leathery shell that can be removed by
dishes. Immature root with milder flavor used in some prepara- boiling or soaking. The nut meat can be eaten raw or cooked.
tions, particularly pickled ginger popular in Japanese cuisine and Hoisin sauce: Popular Chinese paste or sauce, reddish brown in color,
candied ginger. Dried, ground ginger provides ginger flavor with- with a spicy sweet flavor. It is made from fermented soybeans,
out the bite of fresh. rice, sugar, garlic, ginger, and other spices.
Ginkgo nut: Small pit of the fruit of the ginkgo tree (ancient species Hominy (posole, pozole): Lime-soaked hulled corn kernels (yellow or
related to the pine tree), dried or preserved in brine, common in white) with the bran and germ removed. Traditionally prepared
Japan. by some Native Americans with culinary ash, which increases
Ginseng: Aromatic forked root with bitter, yellowish flesh, used in potassium, calcium, iron, phosphorus, and other mineral values.
some Asian dishes and beverages; best known for therapeutic Ground, commonly called grits (see Grits).
uses. Hot pepper: See Chile pepper.
Glutinous rice: See Rice. Huisquil: See Chayote.
Granadilla: See Passion fruit. Icicle radish: See Daikon.
Grape leaves: Large leaves of grape vines preserved in brine, common Ikura: See Caviar.
in Middle Eastern cooking. Imli: See Tamarind.
Graviola: See Cherimoya. Indian breadroot: See Breadroot.
Indian fig: See Cactus fruit. Kidney bean (cannellini, red peas): Medium-size, kidney-shaped bean,
Indian potato: See Groundnuts. light to dark red in color (a white variety is popular in Europe, espe-
Irish moss (carrageen): Gelatinous seaweed extract added to milk or cially Italy, where they are known as cannellini). The flavorful beans
rum as a beverage in the Caribbean. are common in Europe, Latin America, and the United States.
Jaboticaba (guapuru, sabara): Brazilian shrub or small tree with 0.5- Kochujang: See Chile pepper sauce/paste.
to 1.5-inch fruit clustered like grapes. Gelatinous pulp is mild Kohlrabi (tjin choi tow): Light green or purple bulbous vegetable that
and sweet. grows above the soil and produces stems bearing leaves on the
Jackfruit: Large (up to 100 pounds) fruit related to breadfruit and figs, upper part. A member of the cabbage family, it can be eaten raw
native to India, now cultivated in Asia, Malaysia, and Southeast or cooked.
Asia. Two varieties are widely eaten, one with a crisp texture and Kola nut: Bitter nut of the African kola tree (extracts from this nut
bland flavor, the other softer and sweeter. Immature fruit is usually were used in the original recipe for Coca-Cola).
prepared like other starchy vegetables such as breadfruit and plan- Kudzu (ge gen, Japanese arrowroot): Japanese vine valued for its
tains, or pickled. Sweeter types are popular as dessert. Available tuberous root (up to 450 pounds) that is dried and powdered for a
dried or canned. starch used in sauces and soups and to coat foods before frying.
Jaggery: Unrefined sugar from the palmyra or sugar palm common in Now found in much of Asia and U.S. Southeast where it is best
India. known for its growth rate of up to 1 foot per day. May alleviate
Jagua: See Mamoncilla. hangovers or induce sobriety.
Jambolan (duhat, Indian blackberry, jaman, Java plum, rose apple, voi Kukui nut: See Candlenut.
rung): Small sour fruit grown in India and Southeast Asia, especially Kumquat (kin kan): Small, bright orange, oval fruit with a spicy citrus
the Philippines. Used primarily in preserves, juices, and sherbets. flavor common in China and Japan. Also available in syrup and
Jerusalem artichoke (sunchoke, sunroot): Small nubby-skinned tuber candied.
that is the root of a native American sunflower. It is neither from Laverbread: Thick pure of laver (see Seaweed) that is baked. Used in
Jerusalem nor related to the artichoke, though the flavor when sauces and stuffings in Great Britain.
cooked is similar. It is used raw and cooked. Lemon grass (citronella root): Large, dull green, stiff grass with lemony
Jicama (ahipa, sa got, singkamas, yambean): Legume with medium to flavor common in Southeast Asian dishes. Available fresh, dried,
large tuber with light brown skin and crisp white flesh, indigenous or powdered.
to Brazil. Used raw in Latin American cuisine, it has a sweet, bland Lily buds (golden needles, gum chum): The buds of lily flowers used
flavor, similar to peas or water chestnuts. Also found in Asia, both fresh and dehydrated in the cooking of China.
where it is typically stir-fried or added to other cooked dishes. Lingonberry (low-bush cranberry): Small wild variety of the cran-
Jujube: See Chinese date. berry found in Canada and northern Europe. Usually available as
Juneberries (saskatoons, serviceberries; shadbush): Red to deep preserves.
purple berries on large bush native to the Great Plains region of Litchi (lychee): Small Chinese fruit with translucent white flesh and a
the United States and Canada. White blooms in June associated thin brown hull and single pit. The flavor is grape-like but less
with shad migratory run on East Coast; favorite of Native sweet. Available fresh and canned. Dried litchis, also called litchi
Americans. nuts, have different flavor and texture.
Juniper berry: Distinctively flavored dark blue berry of the juniper Lobster: Ocean-dwelling crustacean valued for its sweet flesh. Two main
evergreen bush, native to Europe. Used to flavor gin. species consumed in United States. American lobster (Homarus
Kadondong: See Ambarella. americanus) found from Labrador to North Carolina; meat from
Kaffir lime (ichang lime, makrut, wild lime): Aromatic citrus popular large claws and tail, premature eggs called coral, and liver eaten.
in Southeast Asia, especially in Thai cooking. Juice, rind, and Spiny lobster (Panulirus argus and other species) looks similar to
leaves used to flavor curries, salad dressings, and sauces. American lobster but is a different animal. Found in warm waters
Kamis: Sour, cucumber-like vegetable native to the Philippines. Used from North Carolina to Brazil; small claws, only tail meat eaten.
to achieve a sour, cool flavor in Filipino cooking. Longan (dragons eyes): Fruit of an Asian Indian tree related to litchis.
Kang kong: See Water convolvulus. Used fresh, canned, or dried.
Kanpyo (kampyo): Ribbons of dried gourd used mostly for garnishing Long bean (boonchi, dau gok, sitao, yardlong bean): Roundish Asian
dishes in Japan. bean, 12 to 30 inches long. Similar in taste to string beans, long
Kaong: See Palm nuts. beans are softer, and chewier, less juicy, and less crunchy than
Kapi: See Fish paste. string beans.
Kasha: See Buckwheat. Long-grain rice: See Rice.
Kava: See Pepper plant. Loquat (nispero): Slightly fuzzy yellow Asian fruit about 2 inches
Kemini: See Candlenut. across, easily peeled, with tart peach-flavored flesh. Cultivated
Kewra: See Pandanus. worldwide; available fresh, dried, and in syrup.
Key lime (dayap, nimbu, West Indian or Mexican lime): Small, tart Lotus root (lian, lin gau hasu, renkon, water lily root): Tubular veg-
lime indigenous to the Caribbean, popular in Florida Keys; also etable (holes, as in Swiss cheese, run the length of the root, pro-
used in east and north Africa, India, and Malaysia. Known best as ducing a flower-like pattern when the root is sliced) with
primary ingredient in key lime pie. brownish skin and crisp, sweet, white flesh. Becomes starchy
Khati powder: See Amchoor. when overcooked or canned.
Lox: See Salmon, smoked. Milkfish (awa, bangus): Silvery, bony fish with oily flesh especially
Luffa (cee gwa, Chinese okra, loofa, padwal, silk melon): Long, thin- popular in Filipino cooking.
skinned Asian vegetable, a member of the cucumber family, with Millet: Cereal native to Africa, known for its high-protein, low-gluten
spongy flesh. Immature luffas consumed fresh, stir-fried, and in content and ability to grow in arid areas. The variety common in
curries; mature luffa becomes bitter. Also see Sponge gourd. Ethiopia is called teff.
Lulo: See Naranjillo. Mirin: Sweet rice wine used in Japanese dishes.
Lupine seeds (tremecos): Bitter seeds of a legume used primarily for Miso: Fermented soybean-barley or soybean rice paste common in
fodder. Must be leached in water before eating. Japanese cooking. Light or white (shiro miso) is mild flavored;
Macadamia nut: Round, creamy nut native to Australia, now grown in dark or red (aka miso) is strongly flavored. Also available sweet-
Africa, South America, and Hawaii. ened and as powder.
Mahi-mahi (dolphinfish, dorado): A saltwater finfish found in parts of Mizuna: See Mustard.
the Pacific and the Gulf Coast (not the mammal also known as Morels: See Mushrooms.
dolphin). Mullet (ama ama): Finfish of two families that can be black, gray, or
Mahleb: Middle Eastern spice made from ground black cherry ker- red. The flesh is a mix of dark, oily meat and light, nutty-tasting
nels, which impart a fruity flavor to foods. meat. The texture is firm but tender.
Makrut: See Kaffir lime. Mung beans (green gram dal, mung dal): Yellow-fleshed bean with
Malagueta pepper (grains of paradise, guinea pepper): Small West olive or tan skin used in cooking of China, India. See also Bean
African berries related to cardamom, with a hot, peppery flavor. curd; Bean sprouts.
In Brazil the term refers to a tiny Pequin chile pepper. Mushrooms: Fresh or dried fungi used to flavor dishes throughout the
Malanga (cocoyam, tannier, yautia): Caribbean tuber with cream- world. Common Asian types include enoki (tiny yellow mush-
colored, yellow, or pinkish flesh, dark brown skin, and nutty rooms with roundish caps), oyster mushrooms (large, delicately
flavor. Name also applied to other tubers (see Taro). flavored gray-beige caps that grow on trees), shiitake (dark brown
Mamey (sapote): Medium-size egg-shaped fruit with brown skin and with wide flat caps, available dried as Chinese black mushrooms),
soft flesh ranging in color from orange to yellowish to reddish. It straw mushrooms (creamy colored with bell-like caps), and cloud
has a flavor similar to pumpkin. See also Mammea. ears or wood ears (a large, flat fungus with ruffled edges, available
Mammea (mamey apple): South American fruit with reddish-brown dried). Popular mushrooms in Europe, available both fresh and
skin and bright yellow flesh that tastes like peaches. dried, include chanterelles (a golden mushroom with an inverted
Mamoncilla (guayo, guineps, jaguar, macao, Spanish lime): Small 1- to cap), morels (a delicately flavored mushroom with a dark brown
2-inch green fruit found in the Caribbean and South America that wrinkled cap), and porcini or cpes (large brown mushrooms with
grow in clusters like grapes but have thicker skin and distinctive caps that are spongy underneath; also called boletus).
sweet, citrusy flesh around a large seed. Musk lime: See Calamansi.
Mango (mangoro, mangue): Fruit native to India, now found through- Mustard (Chinese green mustard, gai choy, kyona, mizuna, potherb):
out Africa, Asia, Latin America, and parts of the South Pacific. Though best known for the condiment made from its seeds,
Yellow to red when ripe, averaging 1 pound in weight. The flesh is greens of several varieties are popular in Asia, called gai choy in
pale and sour when the fruit is unripe, bright orange and very China (dark green-reddish leaves), mizuna (small yellowish,
sweet when it is ripe. Used unripe for pickles and chutneys, ripe as notched leaves) in Japan. Usually steamed, boiled, or stir-fried.
a fresh fruit. Root also consumed.
Manioc: See Cassava. Nam pla: See Fish sauce.
Marzipan: See Almond paste. Nam prik: See Fish sauce.
Masa: Dough used to make tortillas and tamales. Made fresh from Nance: Small, yellow tropical fruit native to Central America and
dried corn kernels soaked in a lime solution, or from one of two northern South America. Similar to cherries with a slightly tart
flours available: masa harina (tortilla mix made from dehydrated flavor. Two varieties are available.
fresh masa) or masa trigo (wheat flour tortilla mix). Napa cabbage (celery cabbage, Chinese cabbage, Peking cabbage,
Mastic: Resin from the lentisk bush that has a slightly piney flavor, wong bok): Bland, crunchy vegetable with broad white or light
used to flavor Middle Eastern foods. Available in crystal form. green stalks with ruffled leaves around the edges. Several types
Matai: See Waterchestnut. are available, similar in taste.
Mate: Plant in holly family native to South America. Dried, powdered Naranjilla (lulo): Walnut-size, orange-skinned, green-fleshed fruit
leaves, called yerba, are brewed to make a stimulating tea (con- indigenous to the Americas, used mostly for its juice. Particularly
taining caffeine) that is popular in Argentina, Brazil, and popular in Central America.
Paraguay. Naseberry: See Zapote.
Matrimony vine (boxthorn, wolfberry): Asian vine with culinary and Nigella seed (black cumin, black onion, kalonji): Small, black seeds
medicinal uses; both leaves and fruit are used in China. native to Europe, North Africa, and the Middle East. Sometimes
Mayhaw: Type of hawthorn tree found in U.S. South. Its fruit looks like used as a substitute for black pepper, the flavor of the seeds (which
cranberries. Tart apple flavor. Used in preserves, syrups, and wines. are related neither to cumin nor onions) is pungent, slightly bitter.
Methi: See Fenugreek. Added to spice mixtures in India and the Middle East, sprinkled
Mikan: Japanese citrus related to tangerines and mandarin oranges. on savory breads and cakes in both regions, as well as in Eastern
Eaten fresh, frozen, and canned in syrup. Europe.
Nispero: See Loquat. Papaya (kapaya, pawpaw, tree melon): Thin-skinned green (under-
Nku: See Shea nut. ripe), yellow, or orange fruit with sweet flesh colored gold to light
Nongus (palmyra): Fruit of the palmyra palm, grown in India, orange to pink; native to Central America, now found throughout
Indonesia, and Malaysia primarily as a source of sugar. See also the tropics. Mexican (large and round) and Hawaiian (smaller and
Jaggery. pear shaped) varieties are commonly available. The shiny round
Nopales, Nopalitos: See Cactus pads. black seeds are edible. Unripe papaya is used in pickles; the ripe
Nuoc cham: See Fish sauce. fruit is eaten fresh.
Nuoc mam: See Fish sauce. Paprika: Powdered red peppers especially popular in Hungarian
Oca: Tuber of Andean plant (Oxalis tuberosa). Resembles a pink cooking. Paprika is made from several types of pods related to
potato. Tastes lemony when fresh, sweet after storage. Used in bell and chile peppers. Paprika is usually designated sweet or hot.
South America, prepared like potatoes or eaten fresh. Spanish paprika, used in Spanish and Middle Eastern dishes, is
Okra (bindi, ladys fingers): Small, green, torpedo-shaped pod with more flavorful.
angular sides. A tropical African plant valued for its carbohydrates Passion fruit (granadilla, lilikoi): Small oval fruit with very sweet,
that are sticky and mucilaginous. Used as a vegetable and to gelatinous pulp. Its berries are used dried; leaves brewed to make
thicken soups and stews. herbal tea.
Olive: Fruit of a tree native to the Mediterranean. Green olives are pre- Patis: See Fish sauce.
served unripe. Large, soft Kalamata olives are a medium size, pur- Pawpaw (Hoosier banana, Poor Mans banana, tree melon): Light
plish Greek olive. Dark olives (such as Nioise) are picked in orange fruit that tastes like a cross between a banana and a melon.
autumn, often cured in salt, with a tannic flavor. Ripe, black olives Native to the Americas, it is approximately 6 inches long. See also
are smooth-skinned and mild-flavored or wrinkled with a strong Papaya.
tannic flavor. Peanuts (groundnuts, goobers, monkey nuts): Legume native to South
Olive oil: Extracted from the olive flesh, it is labeled according to per- America, introduced to Africa by the Portuguese, then brought to
cent acidity, from extra virgin to virgin (or pure). U.S. labeling laws the United States in the 17th century by black slaves. Eaten raw,
restrict the use of the term virgin to only olive oil made from the roasted, or pulverized into peanut butter. Popular in Africa and
first press; virgin olive oils mixed with refined olive oils to reduce the United States; used in some Chinese, Southeast Asian, and
acidity are labeled pure. Asian-Indian dishes.
Ostiones: Oyster native to the Caribbean that grows on the roots of Pejibaye (peach palm): Fruit of a Central American palm, especially
mangrove trees. popular in Costa Rica.
Otaheite apple: See Ambarella. Peperomia (cng cua): Small plant with heart-shaped leaves Peperomia
Oyster mushrooms: See Mushrooms. pellucida found throughout Central and South America, Africa,
Oyster sauce: Thick, brown Chinese sauce made with soy sauce, oys- and Southeast Asia. Used as a culinary herb in Vietnam, and as a
ters, and cornstarch. medicinal herb in the Philippines, Polynesia, and parts of Latin
Pacaya bud: The bitter flower stalk of the pacaya palm found in Central America.
America. The edible stalk is about 10 inches long and is encased Pepitas (cushaw seeds): Pumpkin or squash seeds, typically from
in a tough green skin, which must be removed before cooking. cushaw, common in Latin-American cooking. May be hulled or
Pa dek: See Fish sauce. unhulled, raw or roasted, salted or unsalted.
Palillo: Peruvian herb, used dried and powdered to provide a yellowish- Pepper plant (Piper methysticum): Leaves of the South Pacific plant
orange color to foods. used to produce the intoxicating beverage called kava or awa.
Palmetto cabbage: See Heart of palm. Peppers: Misnamed pods of the capsicum plants native to South and
Palm nuts (kaong): Seeds from palms; pounded into palm butter in Central America (not actually related to Asian pepper plants,
West Africa. Also boiled and added to halo-halo mix in Philippines. which produce black pepper). Peppers are divided into sweet and
Available canned, in syrup. hot types (see Chile pepper). Sweet peppers include bell peppers
Palm oil (aceite de palma, dende oil): Oil from the African palm, (green, red, yellow, and purple), pimentos, and peppers used to
unique for its red-orange color, used extensively in West African make paprika (see Paprika).
and Brazilian Bahian cuisine. Crude oil contains high levels of Perilla (shiso; beefsteak plant; quen-neep): Aromatic herb with dis-
carotenoids and tocopherols; refined oil deodorized and decol- tinctive minty flavor; green or red. Available fresh or pickled. Used
orized, significantly reducing nutritional value. Oil from the seed mostly as a seasoning or garnish in many Japanese and Korean
of the palm fruit high in saturated fats; should be labeled palm dishes; sometimes served as a side dish or to wrap rice and other
kernel oil, but often mislabeled as palm oil. items.
Pandanus (flowerskewra, screw pine; leavesduan pandan, Pigeon pea: Small pea in a hairy pod (a member of the legume family,
pandan, rampa, screw pine): Perfume essence of the male screw- but not a true pea) common in the cooking of Africa, the
pine flower Pandanus fascicularis used primarily in north Indian Caribbean, and India. Yellow or tan when dried.
cooking. Screw-pine leaves Pandanus amaryllifolius reminiscent Pignoli: See Pine nut.
of mown hay, used to flavor the foods of Southeast Asia, Malaysia, Pigweed: See Amaranth; Epazote.
South India, Bali, and New Guinea. Fresh withered leaves used in Pili nut: Almond-like nut of a tropical tree found in the Philippines
rice puddings and as wrappers for steaming foods in Thailand. eaten raw and toasted. Popular also in Chinese desserts.
Bright green screw-pine essence also available. Pili-pili: See Chile pepper sauce/paste.
Pine nut (pignoli, pion seed): Delicately flavored kernel from any of Southeast Asia, Australia, and Florida. Used to make a tart tea
several species of pine tree. Pine nuts are found in Portugal popular in Egypt and Senegal and a rum-laced punch in the
(most expensive type), China (less costly, with a stronger taste), Caribbean. Also used for chutneys, preserves, and candies. Young
and the U.S. Southwest. Common in some Asian, European, leaves are eaten raw as salad or cooked as greens.
Latin American, Middle Eastern, and Native American dishes. Sabra: See Cactus fruit.
Pink bean (rosada): Small oval meaty bean that is a light tannish pink Saewujeot: See Shrimp paste.
in color. Saffron: Dried stamens of the crocus flower. It has a delicate, slightly
Pinto bean: Mottled bean similar to kidney beans, especially popular bitter flavor and bright red-orange color. Available as threads or
in U.S. Southwest and Mexico. powder.
Pitanga (Surinam cherry, Brazilian cherry): Small, bright red, ribbed Sa got: See Jicama.
fruit of shrub or small tree Eugenia uniflora native to northeast- Salal: Thick-skinned black berries of a native American plant in the
ern South America; found also in the Caribbean and Florida. Thin heath family. Used fresh and dried, good for preserves. Leaves
skin with orange flesh that melts in the mouth. Sweet with a used for tea.
slightly bitter bite. Salmon, cured: Salmon fillets cured in a mixture of salt, sugar, and dill
Pitaya, Pitahaya, Pitajaya: See Cactus fruit. weed, common in Sweden (where it is known as gravlax), Finland,
Plantain: Starchy type of banana with a thick skin, which can be green, and Norway.
red, yellow, or black. There are many varieties, ranging in size Salmon, smoked: Raw, tender salmon slices lightly smoked and cured
from 3 to 10 inches. The pulp is used as a vegetable and must be in salt produced in Norway, Nova Scotia, and Scotland. Smoked
cooked. It is similar in taste to squash. Flower also consumed (see salmon soaked in a brine solution is called lox, a Jewish specialty.
Banana flower). Salmon roe: See Caviar.
Poha: See Ground-cherries. Salt pork: White fat from the side of the hog, streaked with pork meat,
Poi: See Taro. cured in salt.
Porcini: See Mushrooms. Saluyot (jute, okra leaves, rau day): Leaves from Southeast Asian jute
Posole, Pozole: See Hominy. bush with slippery texture when cooked (not related to okra).
Prahoc: See Fish paste. Added to soups and stews in Filipino cooking.
Prairie turnips: See Breadroot. Samphire (beach asparagus, glasswort, sea pickle, pousse-pied):
Prickly pear: See Cactus fruit; Cactus pads. Several species of samphire thought to have originated in Brazil,
Pulses: Term used especially in India for edible legume seeds, including but now found worldwide, especially in Australia and the South
peas, beans, lentils, and chickpeas. Pacific. Yellow- and purple-skinned varieties are available. Passion
Quinoa: Cereal native to the Andes, typically prepared like rice. Also fruit is often made into juice.
available as flour and flakes (hojuelas). Sapodilla: See Zapote.
Radicchio: Magenta-colored, slightly bitter member of the chicory Sapote: See Zapote.
family used throughout southern and northern Europe. Saskatoons: See Juneberries.
Rambutan: Bristly, juicy, orange or bright red fruit used in Southeast Sassafras (fil powder): Native American herb used to thicken soups
Asian cooking; related to the litchi. and stews.
Ramp: Strong-flavored indigenous American onion that tastes some- Screwpine: See Pandanus.
what like a leek. Both leaves and bulbs are edible. Sea cucumber (sea slug): Brown or black saltwater mollusk up to 1 foot
Recao: See Culantro. in length. They lack a shell, but have a leathery skin and look some-
Red bean: Small, dark red bean native to Mexico and the south- thing like smooth, dark cucumbers. Sold dried, they are rehydrated
western U.S. for Chinese dishes, becoming soft and jellylike, with a mild flavor.
Red caviar: See Caviar. Sea urchin roe (uni): Small, delicate eggs of the spiny sea urchin, popular
Red pea: See Kidney bean. in Japan.
Rice: Grain native to India. More than 2,500 varieties are available Seaweed (kim): Many types of dried seaweed are used in Chinese,
worldwide, including basmati rice (small grain with a flavor sim- Korean, and Japanese dishes, including aonoriko (powdered green
ilar to popcorn, very popular in India and the Middle East); brown seaweed), kombu (kelp sheets), and nori (tissue-thin sheets of dark
rice (unmilled rice with the bran layer intact; can be short-, green seaweed, also known as laver). Also popular in the Pacific
medium-, or long-grain); glutinous rice (also called sweet or pearl Islands. See also Irish moss; Laverbread.
rice; very short grain and very sticky when cooked); long-grain Serviceberries: See Juneberries.
rice (white, polished grains that flake when cooked, common in Sesame seeds (benne seeds): Seeds of a plant native to Indonesia. Two
China and Vietnam); and short-grain rice (slightly sticky when types are available: tan colored (white when hulled) and black
cooked, popular in Japan and Korea). Rice flour is used to prepare (slightly bitter). Untoasted sesame paste popular in the Middle
rice noodle, rice paper, and baked products. East (tahini); toasted sesame paste and powdered seeds common
Roseapple (pomarrosa, kopo): Small, thin-skinned pink or red fruit in Asia, especially Korea. Widely grown for their oil. Light sesame
native to Southeast Asia with somewhat spongy flesh that has oil is pressed from raw seeds, dark oil from toasted seeds; the dark
slightly acidic flavor. oil has a strong taste and is used as a flavoring.
Roselle (Florida cranberry; karkadeh; red sorrel; sorrel): Pods of a Seville orange (bitter orange; naranja aria, sour orange): Orange with
hibiscus plant relative, common in Africa, the Caribbean, tough skin and dark flesh native to Mediterranean. Inedible raw;
juice used in liqueurs (Grand Marnier, Cointreau, Curaao) and in Star apple (caimito): Purple, apple-size fruit with mild, gelatinous,
cooking of the Mediterranean, Caribbean, Central America, and lavender-colored flesh native to the Caribbean. Seeds form a star
Korea. around the center.
Shadbush: See Juneberries. Star fruit (carambola): Small, deeply ribbed, oval fruit with thin skin
Shallot: Very small bulb covered with a reddish, papery skin, related shaped like a star when sliced. Green and sour when unripe,
to onions but with a milder, sweeter flavor. yellow and slightly sweet (though still tart) when ripe. Unripe fruit
Shea nut (bambuk butter, nku): Nut from the African shea tree, grown is used in Indian and Chinese dishes. Ripe it is eaten fresh.
for its thick oil, called shea nut butter or shea nut oil. Strawberry pear: See Cactus fruit.
Shiitake mushrooms: See Mushrooms. Straw mushrooms: See Mushrooms.
Shiso: See Perilla. Sumac: Sour, red Middle Eastern spice made from the ground berries
Short-grain rice: See Rice. of a nontoxic variety of the sumac plant.
Shoyu: See Soy sauce. Sunflowers: Native to the United States (genus Helianthus); over 60
Shrimp paste: Strongly flavored fermented Asian sauce or paste made varieties. Seeds eaten by Native Americans raw, dried, and pow-
from small dried shrimp or similar crustaceans. Many types are dered (in breads). Unopened flower head can be cooked and eaten
available (bagoong-alamang is the Filipino variety; saewujeot is like an artichoke. Petals are dried and used like saffron in
the Korean type). Southwest.
Singkamas: See Jicama. Sweet peppers: See Peppers.
Snail (escargot): Small, edible land snail (a common variety of garden Sweetsop (annona blanca, ata, sugar apple): Sweet, white-fleshed fruit
snail, cleansed with a commercial feed), popular in France. Giant, related to the cherimoya, custard apple, and soursop.
baseball-sized snails popular in parts of Africa and the South Pacific. Szechwan pepper (fagara): Aromatic berries with a hot flavor popular
Snow pea (Chinese pea pod, ho lan dow, mange-tout, sugar pea): Flat, in some Chinese and Japanese dishes.
edible pod with small, immature peas. Tabasco sauce: See chile pepper sauce/paste.
Sorghum (guinea corn, kaffir corn): Cereal common to tropical Tahini: See Sesame seeds.
regions of Africa with seeds produced on a stalk. In the Tamarind (imli, tamarindo): Tart pulp from the pod of the tamarind
Appalachians, Ozarks, and the U.S. South, sorghum is often bean. Available in the pod, as a paste, in a brick, or as a liquid con-
processed to make sweet syrup. centrate. Unripe pulp used extensively in flavoring numerous
Sorrel (dock, sour grass, wild rhubarb): Small, sour green popular in foods and beverages, especially Asian Indian and Latino dishes, as
Europe and parts of United States. See also Roselle. well as Worcestershire sauce and prepared salad dressings. Ripe
Sour orange: See Seville orange. pulp eaten fresh.
Soursop (guanabana): Large (often 12 inches long) rough-skinned Tampala: See Amaranth.
fruit with cottony, fluffy flesh that can be white, pink, or light Tannier (tannia): See Taro; Malanga.
orange. Native to northern South America or the Caribbean, now Tapioca: See Cassava.
found in many parts of the Americas, Africa, India, China, Taramasalata: See Caviar.
Southeast Asia, Malaysia, and South Pacific. Often made into juice Taro (cocoyam, eddo, dasheen, tannier, malanga, yautia): Starchy
or conserves. underground vegetable similar to cassava with brown hairy skin
Soybean: Small high-protein bean common in Asia. Many varieties of and white to grayish flesh, common in the Caribbean and
different colors, including black, green, red, and yellow, are available; Polynesia. In Hawaii the boiled, pounded taro paste called poi is a
immature beans in the pod (called edamame) popular in Japan. staple in the traditional diet. The young shoots and large leaves are
They are used fresh, dried, and sprouted, most often processed into also eaten (see Callaloo; Malanga).
sauces, condiments, and other products (see Bean curd; Bean sprout; Tarpon: Large silver fish of the herring family found off the coasts of
Hoisin sauce; Miso; Oyster sauce; Soy milk, Soy sauce). Mexico and Central America.
Soy milk: Soybeans that are boiled, pureed, then strained and boiled Teff: See Millet.
again to produce a white milk-like drink. Tempeh: See Bean curd.
Soy sauce (shoyu, tamari): Thin, salty, brown sauce made from fer- Tepary beans: Small, high-protein bean with wrinkled skin. Grows
mented soybeans. Several types are available. Chinese and Korean wild in the U.S. Southwest.
soy sauces tend to be lighter in flavor than the stronger, darker Ti: Tropical plant popular in Polynesia (not related to tea). Ti leaves are
Japanese shoyu. Very dark soy sauces, such as Chinese black soy used to wrap food packets, and the root is eaten and brewed for a
sauce and Japanese tamari may be thickened with caramel or beverage.
molasses. Tilapia: Small freshwater fish with sweet, firm, white flesh.
Spicebush: Shrub (Lindera benzoin) with spicy-smelling bark and Timpsila: See Breadroot.
leaves; red berries. Used to make Native American teas. Tipsin: See Breadroot.
Spiny lobster: See Lobster. Tobikko: See Caviar.
Sponge gourd (luffa): Immature vegetable consumed in Asia fresh and Tobu, Tofu: See Bean curd.
in soups; tough fibrous skin used for sponges (loofah), filters, and Tomatillo (husk tomatoes, miltomate): Small, light green, tomato-like
stuffing. fruit surrounded by a green or tan papery husk, common in
Star anise: Eight-armed pods from a plant in the magnolia family, with Mexico. The flesh is slightly tart and is eaten cooked, usually in
an anise-like flavor. Native to China. sauces and condiments. Available fresh or canned.
Tremecos: See Lupine seeds. White radish: See Daikon.

Truffle: Black (French) or white (Italian) fungus found underground. Wild rice: Seeds of a native American grass.
Truffles vary from the size of small marbles to as large as tennis Winged bean: Edible legume called the soybean of the tropics. All parts
balls and are distinctively flavored, similar to a wild mushroom. of the plant are consumed, including the shoots, leaves, flowers,
Available fresh or canned. pods and seeds, and tuberous root. The pods are large, from 12 to
Tuk-trey: See Fish paste. 24 inches long, and feature wing-like flanges.
Tuna: See Cactus fruit. Winter melon (dong gwa, petha, wax melon/gourd): Round green-
Turtle: Popular in Caribbean, Central America, and U.S. South. skinned member of the squash family with a waxy white coating
Diamondback terrapin (Malaclemys terrapin) is the primary and translucent white green or pink flesh. Similar in taste to zuc-
ingredient in turtle soups of the Atlantic states. Green turtle chini, it is used cooked in Chinese dishes. Called fuzzy melon when
(Chelonia mydas) is a sea turtle, commonly eaten as steaks or immature, winter melon when mature. See also Fuzzy melon.
stews. Other turtles eaten occasionally (including eggs) are alliga- Witloof: See Chicory.
tor snapping turtle, common snapping turtle, and loggerhead Wolfberry: See Matrimony vine.
turtle. Wong bok: See Napa cabbage.
Ugli fruit: Citrus fruit that is a cross between a pommelo and a man- Worcestershire sauce: Sauce developed by the British firm of Lea and
darin orange, with a very bumpy yellow-orange skin and a sweet Perrins including anchovies, garlic, onions, molasses, sugar or
orange-like flavor. Especially popular in Jamaica. corn sweetener, tamarind, and vinegar, among other ingredients.
Uni: See Sea urchin roe. Yacn (yakon, leafcup): Sweet-tasting root, Polymnia sonchifolia, with
Usli ghee: See Ghee. brown skin and white flesh native to Andes. Eaten throughout South
Verjuice: Juice of unripe lemons used in Middle Eastern fare to give a America; in some regions confusingly called jicama (See Jicama).
tang to dishes. Yam (ame; yampi; cush-cush; mapuey): Tuber with rough brown
Voi rang: See Jambolan. skin and starchy white flesh (not related to the orange sweet potato
Wasabi: Light green Japanese condiment from root of plant similar to called yam in the United States). Numerous varieties; may grow
horseradish with a powerful pungency. Available fresh or pow- quite large, up to 100 pounds. Found in all tropical regions. Yam
dered; green-dyed horseradish often sold as wasabi. paste called fufu in West Africa.
Water chestnut (matai): Aquatic, walnut-size tuber with fibrous brown Yambean: See Jicama.
peel and crunchy, sweet, ivory-colored flesh. Available fresh or Yard-long bean: See Long bean.
canned. Yautia: See Malanga; Taro.
Water convolvulus (kang kong, ong choi, rau muong, water spinach) Yerba buena: A variety of mint used in some Native American teas.
Plant related to sweet potato valued primarily for its sprouts and Yuca: See Cassava.
young leaves. Natives to China; significant crop in Southeast Asia, Yucca (Navajo banana): Spiky-leaved desert plant (Yucca baccata) with
Malaysia, and South India. large, pulpy fruit that ripens in summer. Eaten fresh, boiled,
Watermelon seeds: Seeds often eaten in Africa (called egusi, toasted baked, or dried into fruit leather.
and ground or pounded into meal or paste for thickening soups Zapote (chico, black sapote, naseberry, sapodilla): Drab-colored fruit
and stews) and in Asia (toasted as a snack; sometimes flavored or of the sapodilla tree (which is the source of chicle used in chewing
dyed red). gum). It has granular, mildly sweet flesh, which can be yellow, red,
White bean: Three types of white bean are widely used: cannellini (see or black. The zapote is a member of the persimmon family. Potato
Kidney bean); Great Northern beans, which are large, soft, and valued primarily for its sprouts and young leaves. Native to China;
mild tasting; and the smaller, firmer navy beans. significant crop in Southeast Asia, Malaysia, and South India.
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Roberts, C. 1992. Cultural perspectives on food and nutrition. Gastronomica: The Journal of Food and Culture. This gorgeous quar-
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Resources 537
ONLINE RESOURCES Catholic Encyclopedia (http://newadvent.org/cathen): This compre-

hensive resource includes articles on feasting, abstinence, and
Ethnic fasting with detailed histories.
Asian and Pacific Islander Health Forum (http://www.apiahf.org): India Divine (www.indiadivine.com): Comprehensive listing of arti-
Health fact sheets on Asian and Pacific Islander groups; links to cles on philosophy, mysticism, meditation, alternative health
other health sites. practices, scriptures, and more.
BlackHealthCare (http://www.blackhealthcare.com/): Culturally ori- Islamic Information Page (http://www.islamic-knowledge.com): A
ented and ethnically focused health articles on a variety of topics well-organized, comprehensive site providing links on all aspects
of interest to African Americans. of Islamic life, from faith and family to health, nutrition, and
Cultural and Ethnic Food and Nutrition Education Materials: A medical issues.
Resource List for Educators (http://www.nal.usda.gov/fnic/pubs/ Judaism and Jewish Resources (http://shamash.org/trb/judaism.html):
bibs/gen/ethnic.html): annotated site run by the Food and Well-organized resource listing of Jewish Web sites, with links
Nutrition Information Center (FNIC) of the United States including kosher organizations, kosher recipes, and kosher wines, as
Department of Agriculture. well as those on religion and holidays. For information on Jewish
EthnoMed (http://ethnomed.org/ethnomed/): An ethnic medicine genetic diseases (with information on Crohns, Gauchers, ulcerative
guide from the Harborview Medical Center, University of colitis, etc.) see the Mazornet Guide (www.mazornet.com/genetics/).
Washington. Provides somewhat inconsistent information on the Orthodox Christian Information Center (http://www.orthodoxinfo
groups profiled, but everything presented is reviewed by members .com/): Provides extensive guidance on fasting. Click on Church
of the target community for accuracy. (Old) Calendar within the text to get more information on the
Indian Health Service (http://www.ihs.gov): Information about health Orthodox calendar.
programs and resources for American Indians and Alaska Natives. Seventh-Day Adventist Church (http://www.adventist.org): The official
MedlinePlus (www.nlm.nih.gov/medlineplus/): Government site is a site of the faith; the church manual provides information on health
great resource for quick updates on African-American, Asian and temperance under the standards for Christian living.
(including Pacific Islander), Hispanic, and Native American
(including Alaska Native) health issues. Each listing (under
Botanical/Alternative Health
Health Topics) includes latest news, prevention, research, diseases A Mini-Course in Medical Botany (www.ars-grin.gov/duke/syllabus/):
and conditions, organizations, statistics, and information specific Excellent source of information on phytochemicals, ethnic plant
to seniors, teens, and women. uses, GRAS botanicals, and more, with a link to the search site to
Multicultural Health Clearinghouse (http://www.mckinley.uiuc.edu/ obtain data by plant name or active ingredient.
multiculturalhealth): An exceptional site run by the University of Herbal Remedies Index (www.pccnaturalmarkets.com/health/Index/
Illinois with information on U.S. ethnic group health needs and Herb.htm): Lengthy listing of botanical remedies with description,
links to other cultural health sites. traditional use, and helpful information on activity and con-
National Alliance for Hispanic Health (www.hispanichealth.org): traindications. A commercial site.
Health information of interest to Latinos. Catalog of resource HerbMed (www.amfoundation.org): Database maintained by the
materials offers several useful brochures. Alternative Medicine Foundation with information on evidence
New Mexico State University Transcultural and Multicultural Health for activity, warnings, preparations, mixtures, and mechanisms of
Links (http://web.nmsu.edu/~ebosman/trannurs/): Listing of sites action. An enhanced version requires subscription, though daily
for numerous religious, ethnic, and special populations. use rates are available.
Nutrition Education for New Americans Project (http://monarch.gsu. Jiva Ayurvedic (www.ayurvedic.org/ayurveda/): A site that offers exten-
edu/multiculturalhealth): Excellent bilingual nutrition education sive information on beliefs and practices. Includes brief research
handouts, including culturally appropriate food pyramids, infor- reviews and an online consultation system.
mation for parents and mature adults, and some diabetes materials. National Center for Complementary and Alternative Medicine
The project no longer has any funding, but the Web site provides (http://nccam.nih.gov): This center run by the National Institutes
free downloading of any handout. Thirty-six different languages. of Health conducts research and disseminates information on
Refugee Health/Immigrant Health (www3.baylor.edu/~Charles_ complementary and alternative medical practices. Their CAM on
Kemp/refugees.htm): This site is one of the best for exploring the PubMed (www.nlm.nih.gov/nccam/camonpubmed.html) limits
traditional health beliefs and practices of recent immigrant your search to their citation index.
populations. Tropical Plant Database (www.rain-tree.com/plants.htm): Search by
World Food Habits Bibliography (http://lilt.ilstu.edu/rtdirks): An out- common or scientific name, condition, plant properties, or
standing listing of research in the field of food and culture. Search recorded ethnobotanical uses. A commercial site.
by region or topic (such as eating attitudes, festivals and feasting,
and taboos).
Foods and Cooking
Culinary History Timeline (www.foodtimeline.org/food1.html): This
Religious fun links site is set up chronologicallyfrom articles on prehis-
Buddhism and Medical Ethics (www.changesurfer.com/Bud/ toric diet to the slow food movement with numerous ethnic and
BudBioEth.html): An introduction to Buddhist perspective on cultural topics. A companion site (www.foodtimeline.org) pro-
abortion, death and dying, and euthanasia with numerous links. vides links on specific foods.
538 RESOURCES
Epicurus (www.epicurus.com): Sponsored by a leading food and hos- herbs and spices listed, indexed alphabetically, by region,
pitality industry consultant, this site features a monthly e-zine and by part used in cooking; glossary of spice mixtures.
with short, informative articles on foods, beverages, herbs, and Great links.
spices; interviews with chefs and hoteliers; and breaking food International Food Composition Directory (http://www.fao.org
news, as well as tantalizing recipes. Information on some ethnic /infoods/directory_en.stm): Resources of the International
ingredients and cultural food events. Network of Food Data Systems (INFOODS) under the auspices of
Food Composition Resource List for Professionals (http://www.nal. the Food and Agricultural Organization (FAO) of the United
usda.gov/fnic/pubs/bibs/gen/97fdcomp.htm): These food compo- Nations, including listings for published and online food compo-
sition resources are all available from the National Agricultural sition tables worldwide.
Library, including books, U.S. government publications, software Sallys Place (http://www.sallys-place.com): An overview of several
databases, and journals. There is also a contact for assistance with international cuisines can be found at this site. Recipes, restau-
specific requests and a bulletin board. rants, and ingredient sources are listed in some. Another useful
Food Museum (www.foodmuseum.com): Described as a one stop page on this site lists professional food organizations, including
source for food exhibits, news/issues, resources, food history, descriptions and addresses.
answers to your food questions, book reviews and just plain fun. RecipeSource.com (www.recipesource.com): This site has a searchable
Good for history information. online archive of recipes that has catalogued over 70,000 recipes
Foodbooks.com (www.foodbooks.com): Serious books for serious from throughout the world. Search by ethnic group or type of dish.
cooks and an outstanding collection of food history volumes as well. Excellent selection, though recipes in ethnic categories are often
Gernot Katzers Spice Pages (http://www.uni-graz.at/~katzer/engl/): not traditional.
Well-maintained site is run by an Austrian chemist. Over 100
P H O TO C R E D I T S
2 Tom and DeeAnn McCarthy/PhotoEdit, Inc. 216 Bonnie Kamin/PhotoEdit, Inc.

6 Peter Menzel/Stock, Boston Inc. 220 Merritt Vincent/PhotoEdit, Inc.
11 Robert Brenner/PhotoEdit, Inc. 240 Photo by Laurie Macfee
16 Scott Teven 241 Courtesy of San Antonio Light Collection; copy from Institute
30 Becky Luigart-Stayner/CORBIS of Texan Cultures at San Antonio
38 Michael Newman/PhotoEdit, Inc. 243 PhotoLink/Getty Images
44 Mitch Hrdlicka/Getty Images 259 Bettmann/CORBIS
48 Tony Freeman/PhotoEdit, Inc. 263 Courtesy of the Florida Division of Tourism
50 Mitch Hrdlicka/Getty Images 278 Courtesy of the Metro Dade Department of Tourism
51 W. B. Spunbarg/PhotoEdit, Inc. 281 Francoise de Mulder/CORBIS
59 Tom McCarthy/PhotoEdit, Inc. 287 Courtesy of the Florida News Bureau
66 Michael Newman/ PhotoEdit, Inc. 303 Yoshio Tomii/SuperStock
67 Yogi, Inc./CORBIS 319 Photo by Kathy Sucher
68 Jeff Dunn/Index Stock Imagery 324 Photo by Laurie Macfee
76 David Young-Wolff/PhotoEdit, Inc. 333 Wellcome Library, London, Museum No: A164587
91 Michael Newman/PhotoEdit, Inc. 335 Kevin Fleming/CORBIS
93 Courtesy of Grossich and Bond, Inc. 337 Photo by Laurie Macfee
98 J. Boisberranger 342 Gary Conner/PhotoEdit, Inc.
103 United Nations/J. Isaac 350 Michael Freeman/CORBIS
110 Photo by Laurie Macfee 351 Gary Conner/PhotoEdit, Inc.
113 Lionel Delevingne/Stock, Boston Inc. 367 Michael Newman/PhotoEdit, Inc.
117 LaFarge, 1956, with permission from Crown 371 Photo by Laurie Macfee
Publishers, Inc. 373 Photo by Kathy Sucher
121 Bettmann/CORBIS 377 PhotoLink/Getty Images
122 Bettmann/CORBIS 384 David Weintraub/Stock, Boston Inc.
131 Published with permission from the Traditional Indian Health 390 Bettmann/CORBIS
Education Program of the California Rural Indian Health Board, Inc. 393 Isabelle Rozenbaum/Getty Images
141 Photo by Laurie Macfee 395 Porterfield/Chickering/Photo Researchers, Inc.
146 PhotoLink/Getty Images 409 Van Bucher/Photo Researchers, Inc.
147 Courtesy of Grossich and Partners 417 Photo by Laurie Macfee
150 K Sanchez/Cole Group/Getty Images 419 Dave Bartruff/CORBIS
152 Robert Brenner/PhotoEdit, Inc. 421 R. & S. Michaud/Woodfin Camp & Associates
153 Courtesy of the Louisiana Office of Tourism 431 Courtesy of World-Health Organization/P. Merchez no fee
156 Photo by Laurie Macfee request re-use
161 M Lamotte/Cole Group/Getty Images 448 Photo by Laurie Macfee
162 PhotoLink/Getty Images 452 Courtesy Raga Restaurant, New York, NY Taj Group of Hotels
163 Cole Group/Getty Images 456 Staffan Wildstrand/CORBIS
165 PhotoLink/Getty Images 458 Courtesy Raga Restaurant, New York, NY Taj Group of Hotels
175 Photo by Laurie Macfee 480 Jeff Greenberg/Visuals Unlimited, Inc.
179 AP/Wide World Photos 483 Mia Foster/PhotoEdit, Inc.
186 Eising/Getty Images 488 2002 Wisconsin Department of Tourism
187 Lottie Davies/Getty Images 497 Matthew klein/Royalty-Free CORBIS
188 Courtesy of Florida State News Bureau 500 Michael Lamotte, Cole Group/PhotoDisc/Getty Images
191 Courtesy Pennsylvania Dutch Visitors Bureau 505 Louisiana Tourism
198 Courtesy of Denmark Cheese Association 506 J. Griffis Smith/TxDOT
200 Susanna Blavarg/Getty Images 513 Stockbyte/PictureQuest/Jupiter Images
211 Photo by Laurie Macfee 515 Paul Barton/CORBIS
213 Photo courtesy of the World Health Organization/P. Almasy 517 Buddy Mays/CORBIS
540 PHOTO CREDITS
Color Inserts Vegetables, page 3:

a) Royalty-Free PhotoDisc/Getty Images
Starch Foods, page 1: b) Jack Star/PhotoLink/Getty Images
a) Royalty-Free Jupiter Images/www.comstock.com c) Dan Lamont/CORBIS
b) Becky Luigart-Stayner/CORBIS d) top, Royalty-Free PhotoDisc/Getty Images; middle,
c) Danny Lehman/CORBIS R.F. Images; bottom, Cole Group/Getty Images
d) Wolfgang Kaehler/CORBIS
e) Andrew Unangst/Royalty-Free CORBIS Fruits, page 4:
f) Royalty-Free PhotoDisc/Getty Images a) Dean Uhlinger/Royalty-Free CORBIS
b) Andrew Unangst/Royalty-Free CORBIS
Protein Foods, page 2: c) L. Hobbs/PhotoLink/Getty Images
a) Royalty-Free PhotoDisc/Getty Images d) Wolfgang Kaehler/CORBIS
b) 2002 Wisconsin Department of Tourism e) Kevin R. Morris/CORBIS
c) Courtesy of United Soybean Board f) E. Carey/Cole Group/Getty Images
d) Pat OyHara/CORBIS
e) Royalty-Free Jupiter Images/www.comstock.com
f) S. Meltzer/PhotoLink/Getty Images
INDEX
Crack seed 397 Ajwain see Seeds, carom Apricots 420, 454, 491
Sweets and sours 190 Ajyar 423 Aquavit 198
Abalone 302, 514 Alaska Natives see Native Arabs see Middle Easterners
Acadians see Northern Americans Aracanja 305
European Albanian fare 425 Arak 421
Accra 287 Albanians see also Balkans, Arapaho Indians see Native
Achiote 246, 282 people of Americans
Acorda dazedo 164 Alcaparrado 285, 286 Argentineans see South
Acorns 120 Alcohol see also each type Americans
Acupuncture/accupressure prohibitions against 96, 98, 103 Armadillos 306
50, 321 spending patterns and types Armenians see also Russians
Adobo 285, 371, 380 475 and People of the FSU
African Americans see Africans Alechas 214 traditional diet 182
Africans 216218 Aleut see Native Americans Arrowroot 394
adaptations of food Alligators 306 Arroz con pollo 285, 499, 512
habits 221 Almonds Artichokes 164
counseling 226228 confetti 167 Asafetida 190, 448
demographics 208 marzipan 159, 188, 198 Asapao 283
East African fare 214215 romescu sauce 162 Asian Indians
emancipation 207208 Ambrosia 500 adaptations of food habits
Ethiopean, Eritrean, Somali, Amchoor 448 460461
Sudanese fare 213214 Am-duong system 382 caste systerm 444
etiquette 220 Amish see Pennsyvania Dutch coastal fare 452453
family 209210 Anisette 167 counseling 464466
history of in United States Antipasti 165 demographics 443
207208 Apache Indians see Native etiquette 457458
ingredients and common Americans family 445446
foods 211218 Appalachian fare 500501 feasting/fasting 455
meals 218219, 221222 Apples 115, 147 immigration to United
nutritional intake 222226 applejack 484 States 442443
post-abolition diet 216 bread 486 ingredients and common
religion 209 butter 190, 482 foods 447449, 450
role of food 220 cake 489 meals 454458, 461
slave diet 215216 calvados 147 northern fare 451452
socioeconomic status candied 489 nutritional intake 461464
208209 caramel-covered 489 purity/pollution 457458
South African fare 215 casserole 511 religion 444445
Southern African-American cider 481, 482 religious food habits 454
fare 216218 dumplings 520 socioeconomic status 443
special occasions 219 fried 497 southern fare 453
therapeutic uses of foods fritters 489 special occasions 455456
220221 in pastry 520 therapeutic uses of foods
traditional health beliefs jelly 511 458459
210211 meatloaf 486 traditional health beliefs
West African fare 212213 pie 1, 152, 479, 520 446447
Aguas naturales 243 salad 486 women and food 457
Ahimsa 103, 444, 449 strudel 184 Asian pears 348
Aioli 502 types of 515 Assyrians see Middle Easterners
Ajowan 421, see Seeds, carom Washington 515 Asure 430
542 INDEX
Atjar 215 Basil 162163, 377 Kobe 339

Atole 247 Basques see also Southern matambre 303
Australian/New Zealand fare 400 Europeans patties 287
Austrians see Central Europeans traditional dishes 164, 511 prohibitions against 101, 103
Avgolemono 423, 429 Bastilla 426 raw 182, 377
Aviyal 453 Batidas 288, 306 ropa viejo 286
Avocados 245 Beans 424, see also Soybeans sauerbraten 182, 482
Awa see Kava baked 115, 479, 519 spiced 502
Ayurvedic medicine 48, Basque 511 steak 490
446447, 458459 black 246247, 260, 430 steak and kidney pie 149, 400
Azoreans see also Southern bodi 283 stew 490
Europeans butter 502 sukiyaki 340
traditional dishes 164165 chickpeas 419, 448449, 451, testicles 473, 520
453 Beer
Baba ganouj 419, 425, 427 cholent 430 Australian 400
Bacalao 285 consumption data 251252 bitters 146
a la vizcaina 164 cranberry 479 bock 185
al pil-pil 164, 511 curd 324, 339, 350, 377 lager 185, 191, 483, 489
Badger 501 fava 162, 214, 419, 511 lambic 148
Bahai 413 foul 419 pilsner 185, 483, 489
Bahala na 368 frijoles 241, 261 rice 455
Bahn chung 380381 ful medames 424 stout 146
Baked Alaska 483 garbanzo 159 weissbier 185
Baklava 185, 214, 419, 516 green 502 Beignets 153, 505
Baladi 424 hyacinth 448 Belizeans see Central Americans
Balkans, people of indigenous 119 Bengalis see Asian Indians
adaptations of food habits kidney 479 Berbere 214
431432 lima 448 Besan 451
counseling 433436 madras 448 Betel 377, 455
demographics 410 mung 350, 448 Betel leaves 456
etiquette 428429 pinto 219, 501, 503504, 511 Bhutanese 441
family 413414 red 261, 504 Bibingka 380
immigration to United refried 241, 250, 515 Bierocks 491, 505
States 408409 soy 324, 339 Bilis 249, 260
ingredients and common white 430, 511 Biomedicine
foods 417423 with pasta 164, 499 definition of 37
meals 425426, 428430, 432 with rice 260, 283, 504 worldview 3941
nutritional intake 432433 yellow-eye 479 Birds nest 323
religion 412413 Beef 516 Biscuits 218, 400, 496, 503
socioeconomic status 410 assada no espeto 162, 167 Bison 117118, 490, 510, 520
special occasions 428429 barbecue 503 Bitter melon 325, 453
therapeutic uses of foods barbecued 302, 490 Black walnuts 490
430431 bo nuong xha 377 Blackfeet Indians see Native
traditional health beliefs bulgogi 350 Americans
415416 carbonada 303 Blacks see Africans
Baluchis see Pakistanis carne asada 241, 250 Blini 189, 516
Bamboo shoots 325 carpetbagger steak 400 Blintzes 91
Banana flower 380, 453 cecinas 244 Blood
Bananas Foster 505 chicken-fried 504 bad 220, 347
Bangladeshis 441, 443 chipped 479 hardening of 347
Bannocks 144, 519520 corned 151, 479 high-low 47, 220
Bara brith 511 in Argentinean fare 303 kam kuhn 416
Barbecue 218219, 302, 305, in Australian/New Zealand thin/thick 281, 416
340, 350, 500 fare 400 unclean, dirty 220, 281
Kansas City 491 in India 454 weak 267, 281
Texas 506 in Northern Mexico 244 yellow 281
Index 543
Blueberries Immigration to United petit fours 150, 505

pie 479 States 105 poppy seed 188189, 505
wild 481 Southeast Asians 366 pound 481, 520
Body image see Weight and health Buffalo see Bison sachertorte 184, 185
Boereg 417 Bulgogi 350 schwartzwalder kirschtorte 184
Bok choy 324, 348 Bulgur 419 stollen 188, 199
Bolivians see South Bunuelos 244, 506 torte de aciete 167
Americans Burdock root 339 vanocka 188
Bombay duck 453 Burek 417, 427 vinarterta 491
Booyaw 488 Burghul 419 Calalloo 212, 283
Borscht 186, 424425, 511 Burgoo 474475, 502 Calas 504
Bosnians see Balkans, Butter 420 Caldo verde 162, 164, 483
people of clarified 420, 426, 448 Camass 120121
Boston brown bread 479 crispy oil 327 Cambodians see also Southeast
Botanical remedies 49 ghee 451, 456 Asians
Bouillabaisse 148, 502, 504 maltash 454 nutritional status 385386
Braceros see Mexicans samana 420 traditional food habits
Brazilians see also South smen 426 374375, 379382
Americans usli ghee 448 Camel 326, 420
traditional fare 304306 Buttermilk 184, 197, 423, Canadian fare 519520
Bread 248, see also each type 455, 503 Candies
at Communion 95 Byrek 425 barfi 455
dark 182 brittle 500
symbolic use of 34, 429 Cabbage chocolate 167
Breadfruit 393, 517 bok choy 324, 348, 517 confetti 167
Breadroot see Prarie turnip bubble and squeak 146 divinity 500
Breakfast cereal 96, 488 colcannon 146, 491 double-salt licorice 488
Breastfeeding coleslaw 482 halvah 511
Africans 223 kimchi 348, 353, 517 lokum 423, 430
Asian Indians 464 napa 324, 348 maple sugar 481
Caribbean Islanders 293 pickled 261, 482 nogada 263
Chinese 332 salad 191 sandesh 455
Mexicans 253 sauerkraut 148, 190, 482, 488, sugar-on-snow 481
Middle Easterners 433 505, 515, 517 torrone 166167
Native Americans 127 soup 186 Candomble 299, 307
Pacific Islanders 398 stuffed 182, 188, 189, 420, Cannoli 164, 483, 499, 509
Russians and People of the 511, 520 Cape Verdeans see also Southern
FSU 192 Cachaca 306 Europeans
Brioche 150, 491 Cactus 119, 244, 512 traditional dishes 164165
British 145147, see also Caipirinhas 306 Capriotada 248, 250, 513
Northern Europeans Cajun cooking 152153 Capybara 302, 306
cooking style 149 Cakes Cardiovascular disease
nutritional status 154155 babka 188 Africans 225
traditional food habits black blizzard 504 Asian Indians 462
144147 Boston cream pie 481 Balkans, people of 432
Broa 162 buche de noel 92, 199 Caribbean Islanders
Brujos/brujas 47 cherry 184 294295
Brunswick stew 117, 497, 501502 dobosch torte 184 Chinese 332
Buckwheat 182, 187, 189, 323, French 150 Filipinos 384
327, 516 fruit 481 French paradox 154
Buddhism galeziak 184 health disparities in 21
beliefs 104105 kransekake 198, 491492 Japanese 343
Chinese 319 krendel 189 Koreans 354
dietary practices Linzertorte 424 Mexicans 255
105106 makowiec 188 Middle Easterners 432433
feasting/fasting 105106 panetonne 92 Native Americans 128
544 INDEX
Cardiovascular disease (Continued) ingredients and common Italian 162, 164

Pacific Islanders 398 foods 261263 Mexican 245
Vietnamese, Cambodians, meals 263 Minnesota 491
Laotians 385386 nutritional intake 265266 Pakistani 451, 454
Caribbean Islanders religion 260 prohibitions against 431
adaptations of food habits socioeconomic status 258259 pub food 144
291292 special occasions 263264 Spanish 162
counseling 295296 therapeutic uses of foods 264 Wisconsin 486487
demographics 277278 traditional health beliefs Cheesesteak 482
etiquette 290 260261 Chelo kebab 424
family 279280 Central Europeans Cherokee Indians see Native
immigration to United States adaptations of food habits Americans
275277 190191 Cherries
ingredients and common counseling 192193 cake 184
foods 282287 demographics 177178 dumplings 511
meals 287288, 292 etiquette 187 Kirsch 184
nutritional intake 292295 family 180 kolaches 491
religion 279 immigration to United States Michigan 486
socioeconomic status 278279 174176 prohibitions against 342
special occasions 289290, 292 ingredients and common foods sauce 199
therapeutic uses of foods 182185 Cheyenne Indians see Native
290291 meals 185186, 191 Americans
traditional health beliefs nutritional intake 191192 Chicanos see Mexicans
280282 religion 178179 Chicha 263, 304
Caribou 516 socioeconomic status 177178 Chickasaw Indians see Native
Carnival/Carnaval 189, 289, 306 special occasions 187189 Americans
Carp 184, 188 therapeutic uses of foods Chicken 340, 395
Cashews 212 189190 and dumplings 482, 490
Cassata 164 traditional health beliefs as prestige food 212, 216
Cassava 114, 245, 283, 393 180181 buffalo wings 483
bread 282 Cevapi 422 Country Captain 498
fufu 212 Ceviche 303 fried 218, 488, 490, 497,
gari 212 Cha gio 375 502, 515
juice 283, 304 Chaat 455, 460 gallina rellena Navidena 263
meal 305 Chai 454 guisado 263
Cassoulet 148, 491 Chaldeans see Middle Easterners masala 452
Catawba Indians see Native Challah 89, 90, 430 pollo guisado 286
Americans Chalupas 506 pot pie 479, 497
Catfish 218, 503504 Champagne 148 prohibitions against 383
Caviar 184, 187 Chapatis 215, 452 relleno 373
Guatemalan 261 Charcuterie 147 spit-roasted 454
Kentucky 502 Charlotte russe 499 symbolic use of 381
pie 475 Chayote squash 153, 244, 502 tandoori 452
prohibitions against 88 Cheese Chicken-fried steak 504
Texas 505 Asian Indian 452 Chickpeas see Beans
Caviar criollo 304 Balkan and Middle Eastern Chilaquiles 241, 512
Ceeb 370 420421 Chile peppers see also Chile
Central Americans British 144 sauce/paste, Chili
adaptations of food buffalo milk 451452 jelly 506
habits 265 Californian 515 types of 245246
counseling 266267 Canadian 519 Chile peppers in
demographics 258259 Danish 197 Asian Indian fare 453
etiquette 264 Filipino 373 Caribbean fare 282
family 260 fondue 488 Korean fare 350
immigration to United States French 148 Mexican fare 245246
256258 goat 148, 511, 515, 519 Moroccan fare 426
Index 545
New Mexican cooking 513 Chomorros see Pacific Islanders cafe brulot 505
South American fare 300, 302 Chopsticks 328, 380, 397 caffe latte 165
Southeast Asian fare 378, 379 Chowder 480, 497 espresso 165
Southern cooking 500 Christianity 9196 Hawaiian 517
Texas fare 506 Eastern Orthodox 9394 in Caribbean fare 283
West African fare 212 Protestantism 9496 in Seattle 516
Chile rellenos 243 Roman Catholicism 9293 in Southeast Asian fare
Chile sauce/paste Churrasco 305 377, 379
harissa 426 Churros 161, 165 milk 484
kochujang 350 Chutney Serbian 421
pili-pili 213 British 149 Turkish 421
rouille 148 Indian 449 Coining 50, 371, 388
soy bean 324 South African 215 Colera 260
Tabasco 153 Cilantro 243, 263, 284285, Columbians see South Americans
Chileans see South Americans 303304 Comfort food 4
Chili con carne , history of 250 Cioppino 515516 Communication
Chili Cipaille 153, 519 action chain 57
Cincinnati 488489 Clamburgers 519 eye-contact 66
con carne 250, 505, 506, 509 Clams health care and 6769
green 512 butter 514 high-low context 5961
sauce in Canada 520 chowder 480 iceberg model of 5758
spice mix 214 clambake 115, 480 intercultural 6978
Chimichangas 250, 512 geoduck 514, 520 intercultural counseling 7375
Chin-chins 213 horse 514 intercultural nutrition
Chinese littleneck 514 assessment 7577
adaptations of food habits 330 Manila 514 intercultural nutrition
counseling 332334 razor 514 education 7780
demographics 317318 steamers 480 name traditions 7072
etiquette 328 Coca-cola 212, 500 nonverbal 6467
family 319 Cocido 161, 305 object messages 59
immigration to United Coconut personal messages 59
States 316317 alcohol 374 touching 6566
ingredients and common cream 373, 395 use of an interpreter 7273
foods 321327 hearts of palm 374 verbal 5964
meals 327331 immature 373, 395 Conch 285, 498
New Years 328329 juice 373, 395 Confucianism 318
northern fare 325326 milk 212, 215, 261, 287, 304, Contemporary food habits, Native
nutritional intake 331332 374, 453 American 125126
religion 318319 oil 395 Cookies
socioeconomic status 317318 pudding 395 amaretti 166
southern fare 326327 soup 395 biscochitos 513
special occasions 328329 Cocoyam 212 biscotti 165
therapeutic uses of foods Cod 197 biscuits, British 146
329330 bacalao 164, 285 bourbon balls 503
traditional health beliefs bacalhau 162 chocolate chip 481
319321 baccala 164 fortune 515
Chiropractic 50 balls 480 hammentaschen 90
Chocolate 167 cakes 480 koulourakia 429
bars 483 Cape Cod turkey 479 kourabiedes 423
hot 165, 240, 373 fritters 283 lamingtons 400
pie 503 lutefisk 198, 491 lebkuchen 188
Choctaw Indians see Native salt 479 Matrimonial cake 520
Americans serenata 285 Moravian 499
Chokecherries 114, 120, 491, 511 Coffee pepper 512
Cholay 449, 451, 455 and health 422 pfeffernusse 188
Cholent 89, 430 cafe au lait 505 Scandinavian spice 199, 512
546 INDEX
Cookies (Continued) Russians and People of the ethnicity 6

shortbread 481, 519520 FSU 192193 perspective 2324
suspiros 167 Scandianvians 200 worldview 3739
Coriander 448 South Americans 308 Cupping 371, 415, 416
Corn Southeast Asians 386389 Curanderos/curanderas 51, 239,
ear smut 122123 Southern Europeans 260, 300
grits 216, 501 168169 Curry in
hominy 117, 119, 124, 216, Couscous 305, 426 African fare 214215
244, 500 Crab 323, 337, 453 Caribbean fare 283
Indian 115, 117118 blue 497498 Filipino fare 374
origins of 241 deviled 498 Hawaii 517
pollen 122 Dungeness 514, 517 Indian fare 448, 453
products 490 King 517 Pakistan 451
silk tea 123 prohibitions against 330, 342 Thai fare 383
symbolic use of 118119 Snow 517 Curry
Cornmeal soft-shell 498 leaves 453
hasty pudding 478 stone 498 masalas 448
arepas 304 Cranberries 480481 origins of 449
atole 247 Crawfish 153, 218, 395, 400 Cuy 302
broa 162 etouffee 504 Czechs see Central Europeans
cornbread 497 fried 504
cracklin bread 497, 501 stuffed 504 Dakota Indians see Native
hoe cakes 216, 502 Cream Americans
hushpuppies 216, 497, 503 clotted 144 Dal 304, 452453, 455, 460
mamaliga 424 creme fraiche 148 types of 448
piki 119, 512 double 144 Danes see Scandinavians
polenta 162, 515 fleurette 148 Danish pastries 198
pone 216, 497 kajmak 422 Dates 417, 424
samp 478 pavlaka 423 beverage 351
skillet cornbread 501 smetana 423 cookies 520
sopa Paraguay 303 sour 184, 197, 423 jujubes 325, 350
spoon bread 216, 496497 whipped 184, 423 Day of the Dead 248
surrelitos 283 Creek Indians see Native Demographics see also each
sweet potato 502 Americans ethnic group chapter
therapeutic use of 122123 Creole cooking 152153 Canada 1920
ugali 215 Crepes see Pancakes United States 1, 19
Costa Ricans see Central Cretons 519 Dende oil 305
Americans Croatians see Balkans, people of Denver sandwich 511
Counseling Croissants 150, 378, 491 Diabetes
Africans 226228 Crow Indians see Native Africans 224
Asian Indians 464466 Americans Asian Indians 462
Balkans, people of 433436 Cuban sandwiches 500 Balkans, people of 432
Caribbean Islanders Cubans see also Caribbean Caribbean Islanders 294
295296 Islanders Chinese 331
Central Americans 266267 Cuban, traditional cooking ethnicity and risk 22
Central Europeans 192193 285286 Filipinos 384385
Chinese 332334 Culantro 284 health disparities in 21
intercultural 7375 Culture Japanese 343
Japanese 344345 acculturation 6 Koreans 354
Koreans 354355 assimilation 6 Mexicans 255
Mexicans 256258 biomedical 3941 Middle Easterners
Middle Easterners 433436 communication skills 6973 432433
Native Americans 129133 competency and 1824 Native Americans
Northern Europeans 155156 congruent care 5253 113, 128
Pacific Islanders 399400 definition of 56 Pacific Islanders 399
Pakistanis 466 enculturation 6 Pakistanis 464
Index 547
South Americans 308 tortilla 159 gefilte 90, 430

thrifty gene theory 129 yemas 167 lomi-lomi 395, 517
Vietnamese, Cambodians, Egyptians see Middle muddle 498, 502
Laotians 385386 Easterners oka 395
Dim sum 326, 517 Eid al-Fitr 429430 prohibitions against 85, 94,
Dinuguan 373, 380 Empacho 240, 280 122, 156, 431
Divali 104 Empanadas 261, 302 raw 337
Dolma 185, 420, 423, 425, 430, 516 Enchiladas 512 sashimi 337, 339, 517, 520
Dominicans see also Caribbean Ensaymada 379 sushi 337, 339
Islanders Enset 213 Flan 162, 243, 286, 373,
Dominicans, traditional cooking Envidia 239 500, 513
286287 Epazote 243, 512 Flautas 243, 512
Dosas 453 Eritreans see Africans Flushing 369
Doufu 326 Ethiopeans see Africans Flying fish 287
Duck 383, 454, 503 Evil-eye 4647, 240, 260, 280, Folk illnesses 4748, see also each
breast 515 416417 ethnic group chapter
eggs 323324 Food habits
Long Island 483 Fagiole 164, 499 acculturation of 67
Peking 325 Faith healing 51 availability and 1213
tea-smoked 326 Falafel 419, 427, 430 consumer choice model 1318
Dumplings 163, 182, 341, 423, Fan/cai 327328 convenience and 15
491, 519 Farinha 305 core and complementary food
Durian 374, 377 Farofa 305 model 78
Fastnachts 190, 482 cost and 1415
East Asians see Chinese, Feijoa 514 definition of 2
Japanese, Koreans Feijoda completa 305 developmental perspective
Eastern Orthodox Fenugreek 448 model 1112
beliefs 93 Fern fronds 480, 519 edible-inedible 13
fasting 94 Fettucini Alfredo 163 flavor principles 89
feasting 9394 Fiambre 264 health-promoting 4345
in the Balkans 412413 Fijians see Pacific Islanders hot-cold 4445
in the Middle East 413 File powder 118, 152, 216, 502 meals 911
Eating local movement 494 Filipinos see also Southeast Asians nutrition and 1823
Ecuadorans see South nutritional status 384385 self-expression and 1516
Americans traditional food habits 371, taste and 14
Edamame 339 373374, 379382 variety and 2, 1718
Eel 184, 395 Filo 417, 423, 426 well-being and 17
Eggplant 148, 453 Finns see Scandinavians yin-yang 4345
baba ganouj 419 Fish sauce/paste Food
caviar 419 bagoong 373 cultural identity and 4
ratatouille 148 kapi 383 definition of 12
stuffed 420, 425, 429 nam pa 377 endangered 125
Eggrolls 323, 375 nam pla 383 incorporation of 2
Eggs nuoc mam 377 indigenous 114
balut 373 pa dek 377 local 494
duck 323324, 373 patis 373 miles 494
Easter 9394, 152 saewujeot 348 prestige 7
ekuri 454 tuk trey 377 self-identity and 23, 16
flan 162, 243, 373, 500, 513 Fish soup status 5
frittata 511 bouillabaise 148, 152 stereotyping and 5
iron 324 Mediterranean 159 symbolic use of 23
omelets 161, 511 Fish see also each type sympathetic use of 7, 44
prohibitions against 94, and chips 144, 519 taste 14
212, 454 bhapa 452 Foofoo 283, 286, 304
roasted 91 boils 487, 488 Franco-Americans see Northern
thousand-year-old 323324 escabeche 285 European
548 INDEX
French breads 150, 261, 377, 520 Grapes Hazelnuts 515

French fries 1 leaves 420, 499 Health
French see also Northern muscadine 499 body image 4243
Europeans scuppernong 499 definition of 4143
cooking style 149150 Grasshoppers 378 disparities in 2021
nutritional status 154155 Greeks see Balkans, people of folk illnesses 4748
paradox 154 Greens chrysanthemum 325, 348 food habits and 4345
sauces 150 Greens cooked 216, 501 healing therapies 4852
traditional food habits Greens new shoots 519, 520 illness and 4548
147149 Grits 216, 498, 500, 502 mainenance of 4345
Frikadeller 197, 491 Guacamole 245, 506 pluralistic care 5253
Frikkadels 215 Guamanians see Pacific Islanders Herring pickled 184, 197, 519
Frogmore stew 498 Guarana 305306 Herring Solomon Gundy 519
Frogs 218, 287, 490, 501 Guatemalans see Central Hiada Indians see Native
Fry bread 121, 124, 505, 512 Americans Americans
Fudge 477 Gujar halva 452 Hibachi 340
Fufu 212 Gujeratis see Asian Indians Hickory nuts 117, 489, 505
Ful medames 424 Gulyas 182 Hinduism
Funnel cakes 191, 503 Gumbo 152, 218, 503504 ahimsa 103, 444, 449
Fuul/fool 219 Guyanese see also South beliefs 100, 102103
Americans caste systerm 102
Gado-gado 375 traditional fare 304 dietary practices 103104
Galangal 377, 383 Gypsies see also Central fasting 104
Garlic 148, 161, 377, 449, 459 Europeans feasting 104
aioli 162, 502 therapeutic uses of holidays 103104
bagna cauda 163 foods 190 Immigration to United States
production of 514 traditional health 103
prohibitions against 103 beliefs 181 in India 444
Gaz 281 Gyros 421, 499 Hmong see Southeast Asians
Gazpacho 161 Homeopathy 50, 447
Gelato 164, 483 Haggis 151, 499, 519 Hominy see Corn
Gems 520 Haitians see Caribbean Islanders Hondurans see Central Americans
German-fried liver 505 Hakim 447 Hopi Indians see Native
Germans see also Central Halal 9899, see also Islam Americans
Europeans Halim 427 Hops 515
influence on American Hallacas 302 Horse meat, prohibitions against
cuisine 190191 Halo-halo 373 101
nutritional status 191192 Halvah 421, 511 Horseradish 91, 188
traditional food habits Ham Hot cross buns 151
182186 country 490, 496, 502 Hot-cold system
Ghanaians see Africans croquettes 488 Caribbean Islander 290291
Ghee 448, 451 culatello 163 definition of 4445
symbolic use of 456 fritters 502 Filipino 368369
Ghost vomit 190 proscuitto 163 Hmong 370
Gibanjica 419 Serrano 161 in Ayurvedic medicine
Ginger 305, 350, 377, 383, 517 Smithfield 496497 447, 459
beer 491 stuffed 496 Mexican 249
pickled 341 Westphalian 182 Middle Easterner 416, 431
prohibitions against 382 Hamburger bean goulash 512 South American 307
Gingerbread 188 Hamburgers 1, 490 Hotdogs 1, 182
Ginseng 329330 Hanyak 348 Houska 491
Glogg 198 Harissa 426 Hualupai Indians see Native
Gnocchi 163, 165 Hasenpfeffer 182, 491 Americans
Goose 188189, 198 Haupia 395 Huckleberries 511, 520
Granita 164 Hawaiians see Pacific Islanders, Humitas 302,
Grapefruit 499 Regional Americans Hummus 419, 424, 427
Index 549
Hungarians see Central traditional food habits Kava 395, 396, 400
Europeans 161164 Kefir 184
Hwabyung 347 traditional health beliefs 159 Kenyans see Africans
Hypertension and African Khat 226, 455
Americans 225 Jackfruit 374, 377, 395, 453 Kheer 452
Jainism 444445 Khichri 449, 452
Ice cream Jalebis 453 Khir 455
baked Alaska 483 Jamaicans see also Caribbean Ki 347
gelato 164, 483 Islanders Kibbeh 423
granita 164 I-tal and jerk cooking 289 Kid 164, 244, 287, 302,
history of 164 Jambalaya 152, 504 426, 511
kulfi 455 Japanese Kikui nuts 395
sodas 483 adaptations of food habits Kimchi 348, 353, 517
Idli 453 342343 Kirsch 184
Iftar 429 counseling 344345 Kishka 419
Iguana 244, 302 demographics 335 Kiwifruit 514
Imam biyaldi 419420, 425 etiquette 341 Knishes 91
Indian family 335336 Kola nuts 212
pickle 500 immigration to United States Kolaches 188, 491492, 505
tacos 512 334335 Koljivo 94, 419
Indians see Native Americans, ingredients and common Koreans
South Asians foods 337340 adaptations of food habits
Indonesian cooking 375 meals 340342 352353
Injera 214 New Years 341 counseling 354355
Inuit see Native Americans nutritional intake 343344 demographics 345346
Inupiat see Native Americans religion 335 etiquette 351
Iranians see Middle Easterners socioeconomic status 335 family 347
Iraqis see Middle Easterners special occasions 341342 immigration to United States
Irish see also Northern European therapeutic uses of foods 342 345
cooking style 149 traditional health beliefs ingredients and common
nutritional status 154155 336337 foods 348350
traditional food habits Jerk 289 meals 350351
144147, 149150 Jerky 118, 486 New Years 351
Iroquois Indians see Native Jerusalem artichoke 118, 303 nutritional intake 353354
Americans Jicama 244, 301, 513 religion 346
Islam Jordanians see Middle Easterners special occasions 346
beliefs 9698 Judaism therapeutic uses of foods
Eid al-Fitr 99, 429430 beliefs 8687 351352
fasting 99100 fasting 9091 traditional health beliefs
feasting 99 holidays 8991 347348
five pillars of 97 immigration to United Koresh 419
Halal dietary laws 9899 States 87 Korma 451452
Halal symbols 99 in Israel 413 Kosher laws 8789, see also
holidays 99100 Kashrut/Kosher laws 8789 Judaism
Immigration to United Kosher symbols 89 Koulouri 427
States 98 Passover Seder 9091 Kreplach 9091
in Pakistan 445 Jujubes 325, 350 Kringle 489, 520
in the Balkans and Middle Kroeung 378
East 413 Kaiseki ryo-ri 339 Krsni kolac 429
Nau Roz 99, 430 Kale 162 Kugel 89, 430
Ramadan 100, 429 Kalonji 452 Kulfi 455
Islami-Tibb 447 Kanpo 336337 Kulich 189
Israelis see Middle Easterners Kanuche 117, 505 Kumquats 325, 517
Italians see also Southern Karahi 454 Kumys 326
Europeans Kasha 186, 424, 516 Kurds see Middle Easterners
nutritional status 168 Kataif 427, 429 Kutia 189
550 INDEX
Kvass 185 Lobster 114, 285, 302, 395, Meals 379381

Kwakiutl Indians see Native 400, 453 African 218219
Americans boils 519 Asian Indians 454455, 461
Kwanzaa 219 croquettes 480 Balkans, people of 425426,
grilled 498 428430, 432
Laap 377 Newberg 483 Caribbean Islanders 287288
Ladoos 451 rolls 480 Central Americans 263
Lakota Indians see Native Loco moco 475 Central European 185186
Americans Locrios 286 Chinese 327331
Lamb 115, 149, 164, 453 Locusts 378 cycle of 1011
chelo kebab 424 Lokahi 392 definition of 911
dried 197, 491 Lomi-lomi 395, 517 Japanese 340342
kebabs 421 Longans 325 Korean 350351, 353
Mulligatawny stew 511 Loquats 325 Mexicans 247, 251252
New Zealand 400 Lotus roots 325, 517 Middle Easterners
paschel 91, 188 Luau 394, 396 426430, 432
roasted 432 Lumpia 373, 379, 516517 Native American 121122
Rocky Mountain 510 Lupine seeds 162 Northern European 150151
shawarma 421 Pacific Islanders 395397
souvlaki 421 Macadamia nuts 517 Pakistanis 455456
spit-roasted 426, 454, 511 Macaroni and cheese 499 Russian and FSU 186187
stew 512 Madeira 164165 South Americans 306
Lambropsomo 429 Mahimahi 395, 517 Southern European 165166
Laotians see also Southeast Asians Mahleb 421 Meat patties
nutritional status 385386 Makerel 287 bobotie 215
traditional food habits Malagueta pepper 215, 305, 426 frikadeller 197, 491
374375, 379382 Malassadas 162, 517 frikkadels 215
Latkes 90 Malaysian cooking 375 patties 287
Laulau 394 Mamaliga 424 pljeskavica 423
Lavash see Pita bread Mango 283, 374, 378, 395, 448 Meat see also each type
Lebanese see Middle Easterners green/unripe 375, 453 prohibitions against 88, 9294,
Lefse 197 pastries 289 96, 98, 101, 103, 105, 123
Lemon grass 377, 383 seeds 212 Meatballs
Lemons symbolic use of 456 kofta 421, 452
ablimu 431 Manti 419 Korean 517
preserved 426 Maple syrup 115, 118, 153, kotfay 451
unripe juice 421 481, 519 kufta 185
Lentils 215, 419, 449, 453 pickles 519 Swedish 197, 511
black 448, 453 pie 481 Meatloaf
red 448 therapeutic use of 123 apple 486
yellow 448 wine 519 origins of 487
Lily buds 325 Marathis see Asian Indians Mein go 378
Limes Marijuana 289, 291 Mein see Southeast Asians
calamansi 373 Marsala 164165 Mennonites see Pennsylvania
kaffir 377, 383 Marshall Islanders see Pacific Dutch
key 499 Islanders Menudo 244, 512
leaves 377, 383 Marzipan see Almonds Mescal 244
Persian 499 Masalas 448449 Mesclun salad 515
pie 500 chicken 452 Metabolic syndrome and
Lingonberries 197 Massa sovada 167 health 463
Liptao 425 Mate 304 Metaxia 421
Litchis 325, 517 Matzah 90 Mexicans 237
Lithuanians see Russians and Maultacshen 491 adaptations of food habits
Peoples of the Former FSU Mayhaw 499 251252
Llama 302 Mead 147, 185 Aztec fare 240
Lobimuhennos 511 tej 214 Chicano family 238
Index 551
counseling 256258 traditional fare 486492 Naan 452

demographics 237 West North Central cooking Nachos 506
etiquette 248249 489492 Nakota Indians see Native
immigrant health 254 Milk gravy 512 Americans
immigration to United States Milk Nam prik 383
235237 cajeta 243 Narahati 416, 435
influence on American camel 420 Narragansett Indians see Native
cuisine 249250 carabao 373 Americans
ingredients and common foods dulce de leche 243 Native Americans 114121
240243 leather 326 adapatation of food habits
meals 247, 251252 mare 326 123125
Mexican Plains fare 243244 Milkfish 374 counseling 129133
nutritional intake 252256 Millet demographics 109, 110
religion 238 injera 214 etiquette 122
role of food 248249 popped 326 family 112113
socioeconomic status 237 porridge 326 harmony and 112, 113
Southern Mexican fare teff 213 history of 109110
246247 tella 214 meals 121122, 123125
special occasions Minestra 165, 499, 511 Northeastern diet of 115
247248, 252 Mint julep 503 Northwest Coast/Alaska Native
therapeutic uses of Miwok Indians see Native diet of 119121
foods 249 Americans nutritional status 126129
traditional health beliefs Mizuna 339 Plains diet of 117118
238240 Mochi 341 religion 112
Tropical Mexican fare Mole sauces 246247, 511 role of food 122
244246 Mongolian socioeconomic status 110112
Yucatan fare 246 fare 326 Southern diet of 115, 117
Mezze 185, 423, 425427 hot pot 325 Southwestern diet of 118-
Middle Easterners tea 326 special occasions 122, 135
adaptations of food habits Moon pies 503 therapeutic uses of foods
431432 Moose 516, 519 122123
counseling 433436 Moravians 499 traditional health beliefs
demographics 410412 Mormons 9596 113114
etiquette 428429 fare 512 Naturopathy 50
family 414415 Moroccans see also Middle Nau Roz 99, 430
immigration to United States Easterners Navajo Indians see Native
409410 fare 426 Americans
ingredients and common Moussaka 419, 425, 499 Nepalese 441
foods 417421, 423425 Moxibustion 50, 321, 371, 388 Nervios 239, 280
meals 426430, 432 Muffeletta 505 New England boiled dinner 479
nutritional intake 432433 Muktuk 120 Nez Perce Indians see Native
religion 413 Mullet 395 Americans
socioeconomic status Mushrooms Niaga 380
410412 black 325 Nicaraguans see Central
special occasions 429430 cloud 325 Americans
therapeutic uses of foods enoki 325 Nigerians see Africans
430431 oyster 325 Niter kibbeh 214
traditional health beliefs shiitake 325, 339 Noni 397
416417 straw 325 Noodles 383
Midwestern Americans wild 184, 189, 197 buckwheat 323, 339, 348
demographics 484 Muslim dietary laws 9899, cellophane 324
East North Central cooking see also Islam fried 377
486489 Muslim see Islam pancit 373
health concerns 492, 493 Mussels 480 pho 375, 377
socioeconomic status Mussels P.E.I. 519 ramen 339
484486 Musu 393 rice 375
552 INDEX
Noodles (Continued) Middle Easterners 432433 ostiones 285

somen 339 Native Americans 126129 pickled 480
Spaetzle 182 Northern Europeans 154155 Puget Sound 514
udon 339 Pacific Islanders 398399 raw 497, 504
Northeastern Americans Pakistanis 464 Rockefeller 505
demographics 476477 Russians and People of the sandwich 505
health concerns 484 FSU 191192 scalloped 480
Mid-Atlantic cooking 481483 South Americans 307308 stew 480, 497, 504, 514
New England cooking 478481 Southeast Asians 384386 supper 498
socioeconomic status 477 Southern Europeans 168
traditional fare 477483 Nyonya cooking Paan 455
Northern Europeans see Singapore fare Pachadi 449, 453, 455
adapatation of food habits Pacific Islanders
152154 Oatmeal 146 adaptations of food
cooking styles 149150 rommegrot 197 habits 397
counseling 155156 Obesity see also Weight counseling 399400
demographics of 142 and health demographics 391392
etiquette 151 hunger and 23 etiquette 396
family 143 Octopus 163, 244, 337, 394395 family 392
immigration to United States Ojibwa Indians see Native immigration to United States
140142 Americans 390
ingredients and common foods Okra 212, 216, 498 ingredients and common
144159 Olive oil 159, 419420 foods 393395
meals 150151, 153154 in health 432 meals 395396
nutritional intake 154155 torte de aciete 167 nutritional intake 398399
religion and 142143 Olives 159, 166 religion 392
socioeconomic status of 142 origins of 417 role of food 396
special occasions 151152 types of 420 socioeconomic status
therapeutic uses of Omnivores paradox 2, 1718 391392
foods 152 Oneida Indians see Native special occasions 396
traditional health beliefs Americans therapeutic uses of foods
143144 Onions ramp 501 396397
Norwegians see Scandinavians Onions Vidalia 499 traditional health beliefs
Nuoc mam 377 Onions Walla Walla 515 392393
Nutrition Onondaga Indians see Native Paczki 188
cultural competency in 1824 Americans Paella 161, 373
disparities in 2021 Opossum 216, 491, 495, 501, 503 Pakistanis
diversity and 1920 Oranges 499 adaptations of food
ethnicity and 2023 ambrosia 500 habits 461
intercultural counseling 7375 sour 263, 286 counseling 466
intercultural nutrition assess- Osteopathy 50 demographics 443444
ment 7577 Osteoporosis and dairy foods 344 family 446
intercultural nutrition educa- Ouzo 421, 426 immigration to United States
tion 7780 Oysters 480 443
intercultural 2324 bacon-wrapped 514 ingredients and common
Nutritional status baked 497 foods 449451, 454
Africans 222226 barbecued 514 meals 455, 456
Asian Indians 461464 Bienville 505 nutritional intake 464
Balkans, people of 432433 bon secour 502 religion 445
Caribbean Islanders 292295 breaded 490 socioeconomic status
Central Americans 265266 curried 480 443444
Central Europeans 191192 fricasseed 497 special occasions 456
Chinese 331332 fried 497, 514 therapeutic uses of foods 459
Japanese 343344 loaf 514 traditional health beliefs 447
Koreans 353354 Malpeque Bay 519 Paklava see Baklava
Mexicans 252256 Olympia 514 Palestinians see Middle Easterners
Index 553
Palm Pennsylvania Dutch see also Pit-cooking 115, 119, 121, 244,
flowers (pacaya) 263264 Central Europeans 395, 400
hearts of 374 traditional food habits Pizza 164, 483, 489
oil 212, 305 190191, 482483, 520 Plantains
palmetto 499 traditional health beliefs 181 baked 263
seeds 373 Penobscot Indians see Native fried 213, 246, 263, 283
toddy 455 Americans fritters 215
Panamanians see Central Pepian 261 in coconut milk 261
Americans Persians see Middle Easterners mangu 287
Pancakes 326, 482 Persimmons 325, 351 mofongo 285
adai 453 Peruvians see South Americans paste 212
aebleskivers 198, 491 Pesto 163, 515 tostones 286
blini 189, 195 Phad thai 383 wine 215
buckwheat 189, 195, 482 Philadelphia pepper pot 482 Plums 420
crepes 147, 491, 499, 505 Philpy 498 brandy 421
dosas 453 Phitta 454 pickled 340, 342
Korean 348 Pho 375, 377 prohibitions against 342
mu shu 325 Phyllo see Filo Pocket bread see Pita bread
potato 99, 197, 491 Pibil 246 Poi 393, 395, 517
Pancit 373, 380 Pica 220221 Poke salad 501
Pandanus 453 Picadillo 286 Polenta 162, 515
Pandowdies 481 Pichon 511 Poles see also Central
Panettone 162, 166 Pickapeppa sauce 287 Europeans
Papayas 395 Pierogis 182, 488, 491, 520 nutritional status 191192
Pappadams 453 Pies traditional food habits
Paprika 182183, 422 apple 115, 152 182186
Paraguayans see South blueberry 479 Polo 419
Americans buttermilk 491 Pombas 167
Parsis see Zoroastrianism chicken pot 479 Pomegranate 424
Paska 189, 520 dewberry 503 Pomegranates 89, 325
Passover 9091, see fish 400, 479, 503 Pomo Indians see Native
also Judaism key lime 500 Americans
Pasta 161, 419, 483, 499, maple sugar 481, 519 Pompano 498
505, 511 meat 154, 519 Popcorn 115, 486
Pasteles 283, 289 mincemeat 151, 479 Poppyseeds 184
Pasties 149, 153, 489 Mississippi mud 503 Pork 424
Pastitsio 419, 425 peach 500, 503 boar 182, 454
Pastrama 424 Pies pecan 503 brains 500
Pate 147, 148, 153, 378379 prune-whip 511 cacoila 162, 167
Pautuxet Indians see Native seafood 479 chicharrones 241
Americans sonkers 501 chitterlings 215, 496
Pavlova 400 sour cream raisin 512, 520 chops 503
Peaches 503 steak and kidney 149, 400 cracklings 153, 218, 285,
cobblers 503 steak 479 373, 496
pie 500, 503 tourtiere 154 head cheese 218, 482
Peanuts 212, 375, 453, 499 Piki 119, 512 loin 197
Pears 514515 Pilaf 419, 449, 451 maw 482
Peas Pilau 498, see also Pilaf mu shu 325
black-eyed 212, 283, 448, 498 Pima Indians see Native pancetta 163
cow 212 Americans pigs-in-a-blanket 488
green 448 Pine nuts 119, 244, 512 prohibitions against 88, 98,
symbolic use of 219 Pineapples 395, 517 101, 460
yellow 197 Pirog 182, 516 raw 374
Pecans 499, 503 Pirozhkis 182, 491 roasted 283, 285, 422
Pelmeni 182, 491 Pisco 303, 304 salt 215, 479
Pemmican 118 Pita bread 417, 424 schnitzel 482
554 INDEX
Pork (Continued) Puerto Ricans see also Caribbean congee 321, 323
sitsaron 373 Islanders dirty 153, 504
snout 500 traditional cooking 285286 flour 375
souse 482 Pulao see Pilaf fried 373, 379
suckling 153, 289, 373, 380 Pummelos 499 glutinous 321, 348, 375,
Port 147 Punjabis see Pakistanis 377, 383
Portuguese see also Southern Pupus 517 Hoppin John 498
Europeans Pupusas 261 long-grain 321, 373, 375, 419,
nutritional status 168 Puris 452, 455 448
traditional food habits 162, Puto 380 noodles 375
164165 pancakes 453
Posole/pozole 119, 244, 512 Qi 320321 paper 375
Potatoes 146, 184, 394 Quesadillas 243 pilaf 419
chuno 302 Quiche 148 pongal 104
croquettes 482 Quinceneras 23, 247 pudding 451, 452
dumplings 519 puffed 453
history of 300301 Raccoon 117, 124, 218, 227, 486 short-grain 337, 348
hodge podge 519 Radish sushi 337
Idaho 511 daikon 339 wild 118, 490
lefse 197, 491 icicle 325 wine 339, 379
llapingauchos 302 white 348 with beans 260, 283, 504
lorco 302 Raisins 514 with chicken 285, 499, 512
pancakes 90 Raisins pie 512, 520 Roe
salad 482 Raki 185, 421, 427 flying fish 337
sweet 300, 394, 400 Ramadan 100, 429, see salmon 337
vichyssoise 483 also Islam sea urchin 337, 480
Yukon gold 519 Ramos fizz 505 sturgeon 184, 187
Potawatomi Indians see Native Rapie pie 519 tarama 423
Americans Ras el hanout 426 Roly-polys 481
Potica 423 Rastafariani 279 Roman Catholicism 9293
Poutine rapee 519 Ratatouille 148 beliefs 92
Powhatan Indians see Native Raytas 449, 455 Romanian fare 424
Americans Recao 282, 285 Rommegrot 197
Powwwowing 51 Red-eye gravy 490, 490, 502 Roselle 212, 285, 453
Prarie turnip 118, 120 Refrescas 263 Roti 452
Pretzels 190 Regional Americans see also Rouladen 182
Protestantism beliefs 9495 Northeastern Americans, Rum 283, 291
Prune Midwestern Americans, cake 289
kolaches 491 Southern Americans, Rumaki 517
pie 511 Western Americans Russian-Germans 491, see
pudding 511 definition of foods 473475 Russians and People of the
Pudding divisions of 475, 476 Former FSU, Regional
black 152 Reindeer 197, 517 Americans
bread 513 Religion see also Buddhism, Russians and People of the FSU
coconut 395 Christianity, Hinduism, adaptations of food habits
Indian 115, 152, 478 Islam, Judaism 190191
kisel 184 Eastern 85, 100106 counseling 192193
kugel 89, 430 Western 85, 86100 demographics 178
panocha 513 Rhubarb 482, 517, 519 etiquette 187
plum 149 Rice family 180
prune 511 basmati 419, 452 immigration to United States
rice 430, 498 biryani 451453 176177
saffron 431, 455 bread 498 ingredients and common
Yorkshire 144, 499, 520 cakes 341, 380381, 453, 504 foods 182185
Pueblo Indians see Native Carolina gold 498 meals 186187, 191
Americans chao 378 nutritional intake 191192
Index 555
religion 179180 jaternice 184, 491 poppy 184, 188, 189,

socioeconomic status 178 jelita 184, 491 452453, 491, 505
special occasions 189 kielbasa 184, 488 pumpkin 512
therapeutic uses of foods Lebanon bologna 482 sesame 212, 500
189190 linguica 162, 305 watermelon 212
traditional health beliefs longaniza 373 wattle 400
180181 merguez 420 Seminole Indians see Native
Rutabagas 197, 490, 491, 520 morcillas 283 Americans
Ryaninjun 479 morilla 161 Sencotan Indians see Native
mortadella 163 Americans
Sabikh 427 sopresseta 163 Serbs see Balkans, people of
Saffron 190, 419, 426 venison 509 Seventh-Day Adventist 96
buns 198 weiner 184 Shabu shabu 340
cake 190 wurst 184 Shad 477, 480
pudding 431, 455 Scandianvians Shadberries 118, 477, 519
Saimin 397, 517 adaptations of food Shamans 51, 113, 348, 366,
Salal 120, 520 habits 199 370, 447
Salmon 120, 477 counseling 200 Sharbat 421, 451
gravlax 197 demographics 195 Shark 244, 395
lomi-lomi 395, 517 etiquette 199 Shawarma 421, 427
lox 197 family 195 Shea oil 212
planked 519 ingredients and common Sheermal 452
smoked, Scottish 144 foods 196198 Sherry 147, 162, 166, 498
soup 511 meals 198199 Sherry pepper 500
types of 514 nutritional intake 199200 Shintoism 335
Salsa 241, 250, 302, 506, 513 religion 195 Shiso 339, 348
Saltimbocca 163 socioeconomic status 195 Shortbread 519
Saluyot 374 special occasions 199 Shortcake 512
Salvadorans see Central traditional health beliefs 195 Shoshone Indians see Native
Americans immigration to United States Americans
Sambals 375, 455 194195 Shrewsbury simnel 151
Sambar 453 Schaum torte 489 Shrimp 166, 244, 285, 395, 453
Samoans see Pacific Islanders Schnapps 185 creole 504
Samosas 452, 455, 520 Schnecken 190 croquettes 498
Samovar 185 Schnitz un knepp 190 dried 305
Sanbusak 417 Schnitzel 182, 424, 482, 511 fried 498
Sancocho 285, 304 sandwiches 515 fritters 305
Santeria 51, 279, 281 Scones 144, 400, 519 paste 305, 373, 374
Sardines 162, 164, 166, 395, 514 Scorpians 324 pate 378, 379, 498
Sarma 420, 423 Scots see Northern European pilau 498
Sashimi 337, 339, 517, 520 Scrapple 190, 482 rock 498
Sassafras 117, 118, 491, 503 Sea urchins 287, 302, 324, scampi 162163
Satays 375 337, 480 Shurbut 455
Sauce Seaweed Siddha 447
chien 285 dulse 146 Sikhism 445
mahonaise 502 hijiki 339 food habits 454
piquante 504 kelp 348, 516 Simit 426
Sauerbraten 182, 482, 505 kim 348 Sindhis see Pakistanis
Sauerkraut 184, 190, 482, kombu 339 Singapore fare 375
505, 515 laver 146, 348 Sinigang 373, 520
balls 488 nori 339 Slijovica 421
Sauerbraten 515 wakame 339, 348 Slovaks see Central
Sausages Seeds 421 Europeans
boudin 152, 153 carom 421, 448 Slovenians see Balkans,
bratwurst 184, 488 mango 212 people of
chorizo 161, 243, 511 nigella 452 Smorgasbord 198, 491
556 INDEX
Snails Guyanese fare 304 immigration to United

escargot 148 immigration to United States 156
stir-fried 378 States 297 ingredients and common
with beer 378 ingredients and common foods foods 159165
Snakes 324, 378, 504 300306 meals 165166
Snapper 244 meals 306 nutritional intake 168
Soda bread 144 nutritional intake 307308 religion and 158
Sofrito 285 Peruvian/Ecuadoran fare socioeconomics 157158
Soju 351 302303 special occasions 166167
Somalis see Africans religion 298299 therapeutic uses of foods
Sopa Paraguay 303 socioeconomic status 297298 167168
Sopaipillas 513 special occasions 306 traditional health beliefs 159
Sorghum 213, 491 therapeutic uses of foods 307 Southwestern fare see Western
syrup 501 traditional health beliefs 300 Americans
Sorrel 501 South Asians see Asian Indians, Souvlaki 421
Soul food 5, 221 Pakistanis Sowa 214
Soup see also each type Southeast Asians Soybeans 486
at breakfast 379 adaptations of food habits doufu 324
beet 186, 424, 425 382384 edamame 339
birds nest 323 counseling 386389 fuyu 324
cabbage 186 demographics 364365 meat substitute 487
chicken 44, 378, 491 etiquette 379380 milk 324, 337
coconut 395 family 366368 miso 339
crab 499 Filipino fare 371, 373374 sauce 324
fish 303, 502, 504 immigration to United States shoyu 339
fruit 197, 491, 511 361364 soup 380
lemon/egg 423, 429 ingredients and common tempeh 377
noodle 375, 378, 379 foods 371379 tobu 350
offal 427, 429 meals 379381 tofu 339, 350
pea 197, 488, 511 nutritional intake 384386 Spaetzle 182
pho 375, 377 religion 365366 Spanakopita 423, 499
potato 483 socioeconomic status Spaniards see also Southern
seafood 261, 480, 515516 364365 Europeans
sheeps head 424 special occasions 380381 nutritional status 168
soybean 380 therapeutic uses of foods traditional food habits
therapeutic uses of foods 44 381382 161162, 164
tripe 244, 261, 286, 482, 512 traditional health beliefs Spice Islands 375
vegetable 499, 511 368371 Spumoni 164
wild mushroom 188 Vietnamese, Cambodian, Squash blossoms 511
Sourdough 511, 516, 520 Laotian fare 374375 Squid 163, 337, 351, 395,
Soursop 244, 282, 285, 377 Southern Americans 427, 514
Souse 482 demographics 493494, 495 Squirrel
South Africans see Africans East South Central/West South brains 502
South Americans Central cooking 501506 stew 491
adaptations of food health concerns 506507 Sri Lankans 441
habits 307 socioeconomic status 494 Steak tartare 182
Argentinean/Chilean/ South Atlantic cooking Stereotyping
Bolivian/Uruguayan/ 495501 definition of 2324
Paraguayan fare 303304 traditional fare 495506 through food 5
Brazilian fare 304306 Southern Europeans Stir-frying 325, 378, 516
Columbian/Venezuelan adaptations of food Streuselkuchen 190, 482
fare 304 habits 168 Strudel 184, 423, 505, 515
counseling 308 counseling 168169 Sturgeon 114, 486
demographics 297 demographics 157158 prohibitions against 85, 88
etiquette 306307 etiquette 166 Succotash 115, 479
family 299300 family 158 Sudanese see Africans
Index 557
Sudden unexpected nocturnal Tepanyaki 340 Central Europeans 180181

death syndrome 370 Tequila 244 Chinese 319321
Sufis 416, 422 Teriyaki 339, 516, 517 Japanese 336337
Sukiyaki 340, 516 Tet 380 Koreans 347348
Sumac 421, 424 Tex-Mex fare 506, see also Mexicans 238240
Sushi 337, 339, 516, 520 Mexicans Middle Easterners 416417
Susto 239, 260, 280 Thai see also Southeast Asians Native Americans 113114
Swedes see Scandinavians Thai fare 383 Northern Europeans 143144
Sweet potatoes 212 Thalis 456 Pacific Islanders 392393
Swiss see Central Europeans Tharid 424 Pakistanis 447
Syllabub 152, 481 Therapeutic uses of foods Russians and People of the
Syrians see Middle Easterners Africans 220221 FSU 180181
Asian Indians 458459 Scandianvians 195
Tabouli 424, 426 Central Americans 264 South Americans 300
Tagine 426 Central Europeans 189190 Southeast Asians 368371
Tahini 421 Chinese 329330 Southern Europeans 159
Tamales 243, 283, 304, 512 Japanese 342 Trifle 149
pie 506 Koreans 351352 Trout 184, 197, 486, 510, 520
Tamarind 373, 377, 383, 424, Mexicans 249 Truffles 149
448, 453 Native American 122123 Tuna 164, 339, 395
Tamils see Asian Indians Northern Europeans 152 Turkey 246, 252
Tandoori cooking 452, 453, 516 Pacific Islanders 396397 Turks see Middle Easterners
Tangerine Pakistanis 459 Turmeric 419, 448, 449, 459
mikan 339 Russians and People of the Turtle 117, 218, 287, 306, 498
symbolic use of 341 FSU 189190
Taoism 318319 South Americans 307 Ugali 215
Tapas 165, 166 Southeast Asians 381382 Ukranians see Russians and
Tapir 302 Southern Europeans 167168 Peoples of the Former FSU
Tarama 423 Thuna 491 Um-yang 347, 348
Taro Ti plant 394, 400 Unani-Tibb 447
leaves 212, 283, 394 Tibetan fare 327 Uni 337
root 393395, 400, 517 Tiffin 455 Uppama 453
Taste Timbering 368 Uruguayans see South Americans
of place 475 Time perception 4041, 6364
role in food choice 13 Tiropetas 419, 425 Varenyky 182, 491
sensory properties 1314 Tlingit Indians see Native Vatapa 305
Tea Americans Veal 182, 197, 422
as a meal 150151 Tobikko 337 Oscar 199
bags 483 Tofu/doufu 326 roasted 186
black 146, 185, 186, 325 Tomatillos 244, 513 Vegetarianism
Brigham Young 512 Tomatoes 212, 241, 419, 489 and health 461
bubble 325 green 499, 501 in Buddhism 105
butter 327 Tongans see Pacific Islanders in Hinduism 103
chai 454 Tortillas 119, 159, 241, 504 in India 449
chamomile 511 chips 250 In Indo-Americans 461
flower 325, 377 piki 512 in Seventh-Day Adventism 96
green 325, 339 Tourtiere 154, 519 meat prohibitions 101
Mongolian 326 Traditional Chinese Medicine 48, progression to meat
Mormon 512 319321 consumption 460
oolong 325 Traditional health beliefs and Venezuelans see South
rice 350 practices Americans
Tegiyeh 423 Africans 210211 Venison
Tej 214 Asian Indians 446447 braised in wine 509
Tella 214 Balkans, people of 415416 chili con carne 509
Tempeh 377 Caribbean Islanders 280282 cold 495
Tempura 339340, 516 Central Americans 260261 roasted 509
558 INDEX
Venison (Continued) Japanese 343 sparkling 484, 516

sausages 509 Koreans 353354 Washington state 516
stew 182 Mexicans 255 Witchcraft 4748, 113, 211, 239,
with huckleberries 509 Middle Easterners 432433 240, 260, 300, 417
Verenikas 491 Native Americans 127128 Witchitty grubs 400
Verjuice 421 Northern Europeans 154155 Wok 325, 517
Vermouth 162 Pacific Islanders 398399 Wontons 323, 375, 517
Vichyssoise 483 Pakistanis 464 Worldview
Vietnamese see also religious affiliation 95 biomedical 3941
Southeast Asians Russians and People of the comparison of common
nutritional status 385386 FSU 191 values 3739
traditional food habits Scandianvians 199200
374375, 379382 South Americans 307308 Yams 393
Vindaloo 453 Southern Europeans 168 fufu 212
Vinegar Vietnamese, Cambodians, gari 212
balsamic 163 Laotians 385386 leaves 394
palm 373 Welsh see Northern European pudding 373
with chiles 373 Western Americans Yerba buena 512
Vodka 185 demographics 508509 Yin-yang
balsam 190 health concerns 518 Chinese 50, 318320,
goldwasser 185 Mountain State cooking 327, 329
sweet potato 351 509513 definition of 4445
Voodoo 46, 211, 279, 281 Pacific State cooking Vietnamese 370, 389
513518 Yogurt 182
Waldorf salad 483 socioeconomic status 509 drinks 420, 426, 451
Walrus 120 traditional fare 509518 filmjok 197
Wasabi 341 Whale 120 laban 420
Wasm 416 Whiskey 146147 lassi 451, 455
Wat 213, 430 bourbon 503 marinated meats 451, 452
Water corn 503 mast 420
chestnuts 325 Wild rice 118 prohibitions against 431
convolvulus 325 Wine skyr 197
Watermelon 211, 499 California 516 sour milk 326
pickled 482, 501 Canadian 520 Yorkshire pudding 144, 499, 520
prohibitions against 342 chicha 263, 304 Yuca 114, 245
seeds 212 Chinese 325 Yucca 119
Weight and health civek 421 Yupik see Native Americans
Africans 223224 French 148
Asian Indians 462 fruit 219, 516 Zaatar 421, 426
Balkans, people of 432 maple syrup 519 Zabaglione 165
body image 4243, 224, melon 455 Zakuski 187
255, 294 mirin 339 Zampa 327
Caribbean Islanders 294 New York state 483484 Zamzam water 416
Central Europeans 191 Oregon 516 Zapote 245
Chinese 331 plantain 215 Zoroastrianism 445
eating disorders 4748, 128, retsina 421 food habits 454
224, 255 rice 325, 339, 350, 379 Zuni Indians see Native
Filipinos 384 sangria 162 Americans

Food and Culture (5 Ed)

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Food and Culture (5 Ed)

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Food and

Pamela Goyan Kittler, M.S.

Kathryn P. Sucher, Sc.D., R.D.

Australia Brazil Canada Mexico Singapore Spain

Executive Editor: Peter Adams Text Designer: Kaelin Chappell

Library of Congress Control Number:

1 Food and Culture 1 Pluralistic Health Care Systems 52

Nutrition and Food Habits 18 Intercultural Nutrition Education 77

The American Paradox 25

4 Food and Religion 85

Traditional Food Habits 114 Traditional Food Habits 182

7 Central Europeans, People of Cultural Perspective 235

Contemporary Food Habits 11 East Asians 315

Traditional Food Habits 371 14 South Asians 441

Cultural Perspective 407 The South 492

he population of the United States is increas- HOW THE BOOK IS ORGANIZED

izens) if they reside on the mainland but not if

mammal thrown in for protein? Why do people

THE OMNIVORES PARADOX

Humans are omnivorous, meaning that they can

Text not available due to copyright restrictions

Habits CORE AND COMPLEMENTARY FOODS MODEL

are time-consuming to prepare also are charac-

Robert Brenner/PhotoEdit, Inc.

Table 1.1 Developmental Perspective of Food Culture

they also use more cornmeal and shortening.

needed to guide diverse communities in healthy

The growing need for cultural competency is evi- 1 Blacks

Royalty-Free Jupiter Images/www.comstock.com

A. Greens, such as this mizuna and bok choy, are especially

Jack Star/PhotoLink/Getty Images

C. Mushrooms, fungi that are eaten as veg-

CULTURAL CONTROVERSYDoes Hunger Cause Obesity?

O ne of the most perplexing

The American experiences have driven the rapidly expanding

Italian (other than pizza) 93% Figure 1.6

Cultural Foods in the United States: A Timeline*

toes to North America.

*REFERENCES FOR TIMELINE

1690s 1730s 1750s

In many ways U.S. cooking is founded on

CHAPTER 1 REVIEW QUESTIONS

choices and food habits?

is estimated that 70 to 90 percent of sickness is CULTURAL OUTLOOK Ayurvedic medicine is the

Text not available due to copyright restrictions

health care; they feel best when they can do

for every condition, even if it is as yet undiscov- Human Equality

Lebanon it is believed that the body must have

strengthening items pu or bo foods, including

CULTURAL DEFINITIONS OF DISEASE, Explanatory Models

Sickness Due to the Social World. Sickness

approaches. Effective treatment of many sick- or recurrent sickness, biomedical, Traditional

CULTURAL CONTROVERSYBotanical Remedies

M ore than 80 percent of the

through manipulation of the musculoskeletal

meridians of the body identified in Traditional

Magicoreligious Interventions. Spiritual heal-

of Agriculture/U.S. Department of Health and low-income Pacific Islanders. Journal of Cultural

N o matter whether a person is interacting socioeconomic status, health condition, religion,

How does milk fit into the balance of the diet

Tom McCarthy/PhotoEdit, Inc.

significance of affective and physical expression

Low- and High-Context Cultures

turally. Conversational context can be defined as