View from Israel: Improving Health with a Shopping Cart

It was our great pleasure to meet dietitian Hadas Hardoon at the recent Oldways Supermarket Dietitian Symposium. Hadas joined us as our guest to learn more about supermarket dietetics in America and put in motion ideas to influence what people put in their shopping carts in Israel. For the past seven years she has been working at Clalit Health Services, the largest health service in Israel. She is the head dietitian in the diabetes department and is responsible for counseling and lecturing patients and medical staff about up-to-date nutrition. She has also established the Israeli PCOS (polycystic ovary syndrome) nutrition center.  We asked Hadas to talk with us upon her return home and reject on some of the differences she observed between supermarkets in Florida and what she is accustomed to in Israel.

OLDWAYS:  While attending the Oldways Symposium in St. Petersburg, Florida, you visited several local grocery stores.  What surprised you the most about them, and how did they differ from the stores where you shop at home

HADAS:  Coming from Israel, I was looking forward to comparing the grocery experience. I visited three local grocery stores and each of them surprised me in different ways. From the décor to the products and brands, it was an eye opening experience to compare them to what I see on a regular basis in Israel.

At Trader Joes, I was positively surprised by the overall design.  It was interesting to see the effort they put into the appearance, with colorful paintings throughout the store. Also I was surprised that the store was exclusively selling only the store brand, which is something we dont see in Israel.

At Rolling Oats, a locally owned natural foods market, I was surprised by the wide variety of beveragespro+prebiotic, and the large number of gluten- free food and vegan products.

I also visited Publix, which reminded me most of the supermarkets in Israel. What surprised me the most though, was the special room they have for the dietitian, something we can only dream about in Israel!

In Israel, we have a wide variety of low fat cheeses (like 5% cottage cheese). We also have a great variety of yogurts. Most of them are between 0%-1.5% fat. I also noticed a similarity in the amount and types of breads. Grocery stores in Israel sell a large selection of whole wheat bread, and many of them are also low in calories (only 35 calories a slice).

We have a special tag for diabetes on many products.  The tag is managed by the Israeli Diabetes Association and indicates fiber, sugar, and calories per serving.

OLDWAYS:  What are the typical food shopping habits in your country 
HADAS:  Typical shopping habits are difficult to characterize, but I will try to specify some things that I see in almost every shopping cart.

First of all, I see all a lot of fruits and vegetables (usually between a quarter to half the cart). Secondly chicken, turkey (we eat it the entire year) and beef; and thirdly, 5% cottage cheese, hummus, and pita bread are the typical basics. Based upon what I saw in Florida, I would say that in my country we buy more food in each trip.  Average Israelis go to the supermarket once a week but usually the cart looks like they buy products for a whole month.

OLDWAYS: How would you describe the typical Israeli diet today
HADAS:  Because I am a clinical dietitian it’s easiest for me to describe it as a daily menu.  In general, we have four traditional menus: Israeli, Arab, Russian, and Ethiopian. 

The Israeli menu is divided to Moroccan food, Iraqi food, Eastern Europe food.

The typical Israeli diet:

Breakfast:
Coffee/tea
Bread (pita/whole wheat)
5% cheese/avocado/Arab cheese labane+ olive oil
Fresh Vegetables (mainly cucumber and tomatoes)

In between:
Fruit, 1 or 2

Lunch:
Chicken (mainly)/legumes
Carbohydrate: pasta/ potato/sweet potato/ buckwheat/ rice/couscous
Vegetables- almost always! Fresh or cooked

In between:
Coffee+ cookies or fruit

Dinner:
Basically like the morning.
Sometimes also with tuna/egg

The Arab population tends to eat their lunch at 4 o clock, and then they usually only eat fruit for dinner. Whereas the Russian newcomers tend to eat their dinner like their lunch. Because Israel is such a melting pot, it is interesting to see different traditions reflected in the foods too.

OLDWAYS:  Do the health challenges facing people in your country parallel those in the US  (Diabetes, heart disease, etc.) 
HADAS:  Sadly, our health challenges are exactly the same as yours. The obesity epidemic is growing, and the diabetes and heart disease trends are also on the rise.  Like in the US, many Israelis seek fast answers and fixes, and bariatric surgeries are becoming more and more popular.

OLDWAYS:  Do you think the Israeli medical community is tuned in to the connection between diet and health  What positive changes do you see 
HADAS:  The medical community is very tuned in to the connection between diet and health. Especially concerning obesity and diabetes, heart diseases, NHFLD, dyslipidemia and sleep apnea.  Unfortunately, most of them do not believe that their patients will change their unhealthy lifestyles, and they usually rush into drug therapy instead of looking at nutrition and diet as the first line of defense.

OLDWAYS:  What steps would you like to take to help people improve their diets 
HADAS:  First of all, I work in the largest public healthcare service in Israel where I see and treat around 80 patients a week. Unfortunately, most of them are returning patients. I see my job as a place to improve as many people’s lives, through healthier lifestyles, as I can.  In addition through my work at a fertility clinic I see much improvement when it comes to healthy pregnancy.

I believe, and this is the reason I was so happy to attend the Oldways conference, that some of what we need begins with supermarket dietitians. The opportunity to have a person that will escort the shopper and improve health through their shopping cart and not through pills is going to make a difference when it comes to public health.