Black Out Korea

It’s 9:30 pm and my boyfriend and I are heading home from work. On the 15-minute walk home, we run into a middle-aged man, dressed smartly in a suit and tie and carrying a briefcase, completely smashed, singing to himself as he hobbles along. A few minutes later we run into another; this time we have to dart out of the way to avoid his staggering, which traverses the width of the subway overpass.

It’s not every day that we come across two entirely intoxicated businessmen on the short walk home, but it’s common to see scenes such as these in Korea. Drinking is a huge part of the business and work culture in Korea with work meetings often involving large amounts of booze and employees feeling an obligation to participate…heavily. Those with a higher tolerance for alcohol are often more successful in their work environment because they are able to last longer at meetings than their less tolerant coworkers.

I found it very strange the first time I attended a work function in Korea, the amount of alcohol that my otherwise conservative coworkers drank. Our foreign manager got drunk and proceeded to try and discuss work matters with us, which for me was bizarre and unprofessional, but for Koreans, completely normal. The director of our academy, generally hostile and unfriendly towards us, threw back shot after shot and transformed into bubbly and babbling, slurring her words all over the place, and finally calling it a night at 5:00 am after a trip to the local norae-bong, (karaoke room). The next morning it was work as usual, no embarrassment whatsoever at the shenanigans of the night before.

During nights out in bars or clubs, the same drinking habits of middle-aged Koreans can be observed in the youth. Once young Koreans enter university and experience their first taste of freedom from their parents, some go a little overboard. Of course, this is the same in other countries, but the type of pressure that precedes university for the average American or Canadian student cannot, in any way, shape or form, be compared to the suffocation that a Korean student experiences throughout middle school and high school. One night out in a nearby neighbourhood, I came across a young girl passed out right in the middle of the road. Cars were driving around her as her friends attempted to drag her out of there. Although this is the only Korean I’ve ever seen passed out in the middle of the road, Koreans passed out just about everywhere else is standard. At home, (for me at least), if one of your friends passes out at a bar, you take them home, and it’s a bit of an embarrassing ordeal for everyone involved. Here, however, they just cover them with a coat, and continue on with their night.

Check out this link for proof...

www.blackoutkorea.com

Shots, shots, shots, shots, shots…

Soju and makkoli are the drinks of choice in Korea. Soju, meaning “made of something burning”, is the most widely consumed alcoholic drink in South Korea. It is made by collecting the vapour of heated fermented wine, and is composed primarily of potatoes. It has an alcohol content of 25% and boy, does it give you a hangover, but you can’t beat the price (about $1.50 for a 250 mL bottle).

Makkoli is a milky beverage that has sort of a bittersweet taste, and is drunk from a small bowl. It is made from fermented rice and contains about 7% alcohol. The original flavor is not very nice, in my opinion, but it also comes in several fruity flavours, which are more appealing to us fussier drinkers (1).

Korea has a “wet” drinking culture, where a large amount of alcohol is drunk in spirit form. This style of drinking is similar to that of Russia or Finland (2). In recent years, there has been a notable shift from drinking mild fermented beverages with nutritious side dishes to drinking strong liquors without side dishes (1).

The stats

According to the World Health Organization, the rates of alcohol consumption per capita in adults have increased drastically over the past 50 years from 1.0 liter in 1960 to more than 8.0 liters in this decade. The present level of consumption parallels those of other developed countries.

I should mention that alcohol statistics for South Korea varied enormously from study to study, probably as a result of the figures coming from self-reports. The 3^rd Korea National Health and Nutrition Examination Survey conducted in 2005 reported that 59.2% of Korean adults drink alcohol, which is “among the world’s highest”, according to an article published by the American Heart Association (3).

As far as binge drinking goes, it all depends on interpretation of what constitutes a “binge”. The journal article mentioned above defined binge drinking as having 6 or more alcoholic drinks on one occasion, and by this definition, 20.4% of Korean males in the study were considered binge drinkers versus 3.5% of American male adults in a previous study, a significant difference (3).

Alcoholism

When it comes to alcohol dependence, South Korea has low rates. Again, the term “dependence” is hard to define, but the World Health Organization reports the numbers at 12.8% in males and 3.7% in females. The article mentioned a remarkable sex difference when it comes to lifetime prevalence of alcoholism in Korea: it is 20 to 30 times higher in males than in females. It is hypothesized that this may be related to Confucian teachings, which strongly influence Korean culture and state that women should not drink (1).

Drinking and Driving

We all know the stereotype surrounding Asians and their less than sterling driving skills and, having lived here for almost a year now, I can’t deny that there may be a smidgen of truth behind it. It makes sense then that this tendency for reckless driving, coupled with large amounts of binge drinking, leads to some major trouble on the roads. The rate of car accidents caused by drunken driving in Korea is about 10 times higher than any other developed country. On top of that, the number of alcohol-related traffic deaths has risen by an average of 12.7% every year (1). I myself have witnessed a late night/early morning hit-and-run here, presumably alcohol-related, where a vehicle stopped at a red light was hit from behind by another car that raced away with a damaged and smoking hood, narrowly missing a pedestrian crossing the street. Scary stuff.

The Asian Flush

I couldn’t write a blog about alcohol in Korea without mentioning “the Asian flush”, the red blushing of the skin that occurs in some Asians when they drink alcohol. This reddening in the cheeks and face is caused by a build-up of acetaldehyde in the body, a compound that is normally broken down during alcohol metabolism by the acetaldehyde dehydrogenase 2 enzyme (ALDH2) (4). A polymorphism in the genes that encode for this enzyme, termed the ALDH2*2 polymorphism, is prevalent in Asian populations but extremely rare in non-Asian populations (5). I couldn’t find any reliable statistics for the proportion of Koreans affected by this enzyme deficiency, but it appears to be anywhere from 25 to 50% of Koreans.

Curiously enough, there appears to be a link between the ALDH2*2 polymorphism and protection against alcoholism. It appears that the defect in the normal conversion of acetaldehyde to acetate causes a greater sensitivity to alcohol and accordingly, lower levels of alcohol consumption (5). This explains Koreans’ intolerance to alcohol and low alcoholism rates. It seems that the red glow that embarrasses many people of Asian descent may actually be a blessing in disguise when it comes to alcohol dependence.

One of the things I will miss the most about Korea is being able to drink anywhere: in the bars and clubs open all night long around the city, in convenience stores, on the street, in the park…but I will not miss the puke-filled sinks of the popular clubs or the sight of completely incapacitated individuals of all ages passed out on the street. Much of Korea’s drinking culture appears to be the result of the enormous pressures of everyday life in Korea, whether is be as a stress release from a demanding, holiday-free job, as a display of newfound freedom after a student’s long and grueling journey to university, or as a necessary step in gaining a new business client. It’s a unique drinking culture, but one that I feel warrants some serious scrutiny of the root causes of some of its more detrimental drinking practices.

Sources

(1) World Health Organization. 2004. Country Profile: Republic of Korea. WHO Global Status Report on Alcohol 2004.

(2) Khang YH, Lynch JW and Kaplan GA. 2005. Impact of economic crisis on cause-specific mortality in South Korea. Int J Epidemiol 34: 1291-1301.

(3) Sull JW et al. Binge Drinking and Mortality From All Causes and Cerebrovascular Diseases in Korean men and Women: A Kangwha Cohort Study. 2009. Stroke 40: 2953-2958.

(4) Wikimedia Foundation Inc. 2010. Alcohol Flush Reaction. http://en.wikipedia.org/wiki/Asian_flush. Access date: December 26, 2010.

(5) Wall TL, Carr LG and Ehlers CL. 2003. Protective Association of Genetic Variation in Alcohol Dehydrogenase With Alcohol Dependence in Native American Mission Indians. Am J Psychiatry 160: 41-46.

Children's eating disorders jump in the U.S.

I mentioned children with "disturbed eating attitudes" in my blog about eating disorders in Korea.

Here's an article from the CBC about children's eating disorders in the U.S. There is also mention of Canada's stats...quite alarming really!

A 2001 study published in the Canadian Medical Association Journal found that of 1,739 Ontario schoolgirls aged 12 to 18:

* Twenty-seven per cent said they engaged in bingeing or purging.
* Twenty-three per cent said they were dieting.
* Eight per cent reported self-induced vomiting.

Read more: http://www.cbc.ca/health/story/2010/11/29/eating-disorders-kids-hospitalization.html

Interview with D - A Korean's take on Western food

For those of you who have been following my blog, you may have noticed that I have mentioned a mysterious “D” in some of my previous posts. D is a young Korean woman who I have had the pleasure of getting to know over the past year. She has given me huge insight into Korea’s inner workings, (food, teaching, love/sex, plastic surgery…you name it!), and we have become good friends in the meantime!

Here is an interview with her about her view on Western food from the time she spent at University in the United States. I hope you find it as smart and insightful as I did!

Q: How long were you in the United States, and where exactly did you live?

I was in the U.S. for about 2 years, and I lived in Greensboro, North Carolina. It was a really small city.

Q: What did you think of food in the U.S.?

At first, it was just great. Everything was very delicious. I enjoyed it for a while but later it made me fat, and I started to think it was too oily. In Korea, my ordinary meal was just rice with some side dishes, but in the States I had to eat out every time because I was in a dormitory, and every meal was too huge and heavy. I never ate everything at a restaurant. I gained too much weight and so fast, about 8 kilograms.

Q: What was the most surprising thing about American food?

The biggest difference was that the average number of calories in the food was much higher than Korean food. People enjoyed appetizers and desserts. In Korea I eat the meal, mostly vegetables, and usually do not have dessert. The average size of a dish was much bigger than that in Korea.

It is the same with desserts. A cup of ice cream was huge. When I first went to Coldstone, I was surprised that the smallest size of a cup was still too big. It was good the first time, but l started to think like, "Why do people eat that much for no reason?” And for the size of a cup of coffee, the largest size in Korea was “grande”, not “venti”. For me, everything was too much and too big.

Q: What were some other differences between American and Korean food that you noticed?

We do not usually order any drinks in Korea when we eat out. I was surprised that most people had soda or sweet tea during their meal. I think that was one of the reasons that I gained weight.

Also they ate too many fried things. People who control their diet still eat healthily even in the States, but most people eat too much oily food.

One more thing - people in the States eat too much meat. We eat meat sometimes in Korea, but not everyday. I don't think eating meat everyday is a way to be healthy.

Q: Did you eat more American food or Korean food while you were in the U.S.?

I couldn't eat the same as Americans. I was worried that if I kept eating like them, I would suffer from obesity. My body couldn't stand the food that I ate everyday. So I ate subs or salad, or went to Asian restaurants, but the dishes were still huge.

Sometimes I ate Korean food at the only Korean restaurant when I felt sick of eating Western food, but not very often. It was too expensive, because I would compare the price in Korea with the price there.

Q: How about the way of eating, like not sharing your food with other people (something that is common in Korea)? Was that surprising?

It was not that surprising. Since a dish is very big, it could be a good idea for two people to share it, but I knew it was a cultural thing, so I wasn't surprised. In Korea, we do not share food that much like before, especially younger people don't do it that much. But still, we sometimes order food and eat it together - it happens between close friends. Sharing has to be natural in Korea, because we have a lot of foods like big stews that we boil on the table during a meal. I think it's just a cultural difference.

Q: How often do you eat Western food now that you’re back in Korea? What kind of food do you eat?

I'm on a diet now, so I try not to eat Western food except like salad. But before I ate it maybe more than once in a week. They're not original, but I can find Western restaurants everywhere. I liked cheeseburgers and subs. Since the taste of Western food is not the same as what I had there, I sometimes cook for myself things like chicken noodle soup or macaroni and cheese.

I miss cheap hotdogs, buffalo wings, chicken noodle soup at the school cafeteria, burgers at Wendy's (there's no Wendy's in Korea), Chick Fil-a...mostly I can't taste them here.

Q: Anything else to add about your experiences with food in the U.S.?

I think the food in the States is very delicious and I'd like to enjoy it, but it's hard to find healthy options. I prefer Korean food for my everyday meal. It’s just too oily to eat everyday.

Before I went to the States, I couldn't understand the reason why my Western friends said Korean food is very healthy, but I can understand now.


Thank you D! <3

Rice and diabetes

A follow-up to the blog I wrote about white rice and its link to type 2 diabetes ("Like white on rice")...

This was a study published recently in the Korean Diabetes Journal, where overweight and obese Korean women with type 2 diabetes were given smaller rice bowls than the standard (able to hold around 200 kcal of rice), in an effort to curb carbohydrate intake. Body weight decreased in both the overweight and obese groups, and macronutrient balance was obtained. However, it must be noted that the sample size was relatively small and the study period was short, so further research is needed.

Click here for the full article:

The Effects of Small Sized Rice Bowl on Carbohydrate Intake and Dietary Patterns in Women with Type 2 Diabetes

Another study comparing the small rice bowl diet plan to the conventional meal exchange program in type 2 diabetic women showed that the small rice bowl meal plan was as effective as the meal exchange plan in terms of reduction in body weight and increase in glucose control.

Click here for the full article:

Small Rice Bowl-Based Meal Plan versus Food Exchange-Based Meal Plan for Weight, Glucose and Lipid Control in Obese Type 2 Diabetic Patients

South Korea's luxury cattle a source of national pride

An article from CNN on South Korea's cherished Hanwoo beef.

Watch the video for footage of the massive riots following the lift on U.S. imported beef...I was very surprised at how strongly Koreans feel about the issue!

http://edition.cnn.com/2010/WORLD/asiapcf/11/05/southkorea.ilist.beef/index.html

"I have a wife and kids, but these cows are almost the same to me," says farmer Park Young Kil.

Kimchi crisis leaves South Koreans in a pickle

Here's an interesting article, from a month or so ago, about the kimchi crisis in South Korea! Who knew?!

http://www.npr.org/templates/story/story.php?storyId=130371965

It really gives you a sense of just how important kimchi is to a traditional Korean diet...

"I don't know how long I can keep ignoring my grandkids' and my husband's demands for kimchi every meal," said Kim Hyung-sook, who lives in northern Seoul. "You're not Korean if you don't eat kimchi three times a day."

Nutrition transition in South Korea: a unique case

Last semester, when going through a newspaper article about foreign foods with one of my more advanced classes, I was surprised to find out that most of the students had not tried any of the foreign food discussed in the paper, even with some foods coming from places as close to Korea as China or Japan. This was shocking to me; I wouldn’t say Seoul, one of the biggest cities in the world, is lacking in the foreign food department. In the areas with a high concentration of foreigners, there is a wide variety of international cuisine, and even in the more “Korean” neighbourhoods, you can’t walk a block without passing a “Dunkin’ Donuts”, a “Paris Baguette”, and a “Pizza School” (not exactly international cuisine, but definitely indicative of Western influence). Yet, despite this international presence, most of the students seem to stick to a pretty traditional Korean diet for the majority of their meals, cooked by their traditional Korean stay-at-home moms.

When I asked a student how often he ate Western food, he told me that it is rare for him or his family to eat it. It is only on special occasions that they might have a Western meal at Outback Steakhouse or one of the other foreign restaurant chains, something I found slightly surprising considering the number of Western-style restaurants in Seoul.

This led me to wonder…

How does South Korea manage to maintain such a traditional diet in an increasingly globalized world?

And this, in turn, led me to the concept of nutrition transition.

Nutrition transition definition

A nutrition transition is something that happens in middle and lower-income countries as they develop and become more industrialized. Cities grow and begin to offer imported foods from industrialized countries. Unfortunately many of these foods are heavily refined, high in added sugar and saturated fat and low in fiber (1). In other words, it is a shift to, essentially, the “Western diet”, resulting in malnutrition from a lack of high-quality nourishment as well as obesity.

This used to only happen in developed countries, but now it is taking place in developing countries as well. Malnutrition that was once signaled by emaciated bodies is now affiliated with obesity. The change in diet is accompanied by a shift in disease patterns from communicable diseases to chronic diseases (2). All in all, a transition from a traditional diet to a Western diet is never a good thing.

Traditional diet → Western diet = malnutrition + obesity + chronic disease

Although, South Korea modernized a lot earlier than most other Asian countries, its nutrition transition patterns stand out from the rest of Asia. After recovery from the Korean War (1950-1953), South Korea’s economy grew rapidly, and with this growth came the introduction of components from the Western diet, such as fast-food restaurants, which became popular with the younger generation (3).


The studies I looked at examined changes in diet, obesity and overweight, as well as disease and mortality that reflect the nutrition transition in South Korea. I will outline the major trends below. It should be noted, however, that the data was taken from 1995 and 1998 Korean National Health Surveys. Unfortunately, in some areas, I couldn’t find anything more recent because the statistics are in Korean, but I have supplemented the findings of the older studies with recent data where available.

Diet: high in vegetables, low in fat

The studies I looked at highlighted a large increase in animal food products, (meat in particular), and a decrease in cereal intake, (principally rice), in South Korea during the nutrition transition. Rice remained the most consumed food, followed by kimchi (see “Oh holy kimchi” for more info!) (3).

Plant foods, including fruits and vegetables, are central in a Korean diet, with a daily vegetable intake of 280 grams per capita, which is among the highest in Asia (4). Recent surveys show that this large vegetable intake has increased even further in recent years to almost 336 grams per day in 2005, which is remarkable considering this rise is the opposite of what is normally seen in a nutrition transition (5).

The other most notable trend is concerning fat intake. The daily per capita fat intake has more than doubled from 16.9 grams in 1969 to 41.5 grams in 1998. Although this represents a considerable increase, the proportion of energy that Koreans get from fat is still significantly lower than other Asian countries (3).

Currently, contribution of fat to total energy remains below 20% as is recommended by Korean nutritionists (6). One theory regarding the low fat intake is that it can be linked to Korea’s high carbohydrate consumption, which makes up a large portion of total energy intake. Carbohydrate intake has not declined rapidly in South Korea as it has in other developing nations. Another theory relates to Koreans’ method of cooking which involves using only small amounts of sesame-seed oil (7).

Obesity/overweight rates: low but problematic

Rates of obesity are markedly low in South Korea, but rates of overweight are quite a bit higher. In 1998, rates of obesity in adults were 1.7% for men and 3.0% for women (3), and ten years later, in 2008, data indicated that 4.0% of Korean men were obese versus 3.6% of Korean women (8). Rates of overweight in 1998 were 24.3% for men and 23.5% for women (3). Data from 2001, just three years later, shows overweight statistics of 29.6% in adult men and 25.9% in adult women (this is the most recent data I could find) (9).

Although rates of both obesity and overweight have increased, prevalence of obesity in South Korea is much lower than in Western countries, and also lower than that of other Asian countries as well (3). Overweight is a bit more of a problem, however (more to come on this…).

Disease and mortality: a late transition

Disease patterns in South Korea have shifted from communicable diseases to non-communicable diseases, as is the norm in a nutrition transition, but this shift occurred in the 1970s, compared to the 1940s in the United States and 1950s in Japan. The rate of death from infectious and parasitic diseases (per 100,000 people) decreased from 23.2 people in 1985 to 11.7 people in 1999 (3).

Today, Koreans continue to maintain a relatively low level of non-communicable diseases compared to other countries of similar economic development (6).

“Sin-To-Bul-Yi: A body and a land are not two different things”


“Sin-To-Bul-Yi” is a concept promoted in South Korea that means a person should eat foods produced in the land in which he or she was born and is living. This is just one of many movements to retain the traditional diet in Korea. These methods range from TV programs promoting local food to the government putting on workshops to train the public in traditional cooking methods (7). The Korean Dietetic Association (KDA) also plays a large role in publicity and education. They provide nutrition services, hold seminars, monitor food and nutrition information in the media, and distribute educational materials, among other things (3).

Despite the internationalization that has occurred in South Korea, fat intakes have not increased to the extent that they have in other countries, nor have obesity rates, thanks, in part, to huge efforts on the part of the Korean government and other associations. This case is an exception to the usual cases of nutrition transition that have occurred around the globe.

It would be valuable for other Asian countries, (and any country, really), to examine South Korea’s tactics in the hope that they too can prevent the remnants of their traditional diet from slipping away, at the inestimable expense of their health.

Sources

(1) Popkin B. 2010. What is the nutrition transition? http://www.cpc.unc.edu/projects/nutrans/whatis. Access date: October 5, 2010.
(2) Wikimedia Foundation Inc. 2010. Nutrition transition. http://en.wikipedia.org/wiki/Nutrition_Transition. Access date: October 5, 2010.
(3) Lee MJ, Popkin BM and Kim S. 2002. The unique aspects of the nutrition transition in South Korea: the retention of healthful elements in their traditional diet. Public Health Nutrition 5(1A): 197-203.
(4) Kim SW and Popkin BM. 2000. Reply to salt consumption during the nutrition transition in South Korea [letters to the editor]. Am J Clin Nutr 72: 199-201.
(5) Lee JS and Kim J. 2010. Vegetable intake in Korea: data from the Korean National Health and Nutrition Examination Survey 1998, 2001 and 2005. Br J Nutr 103 (10): 499-506.
(6) Kim CI. 2010. The Korean Experience: Dietary Transition. www.who.or.jp/AHP/docs/200409/abstract3.pdf. Access date: October 27, 2010.
(7) Kim SW, Moon SJ and Popkin BM. 2000. The nutrition transition in South Korea. Am J Clin Nutr 71: 44-53.
(8) Organisation for Economic Cooperation and Development. 2010. OECD Health Data 2010. http://stats.oecd.org/Index.aspx?DatasetCode=HEALTH. Access date: October 27, 2010.
(9) Cho SJ, Ministry of Health and Welfare. 2002. Nutrition Overview – Republic of Korea. www.wpro.who.int/internet/resources.ashx/NUT/kor.pd. Access date: October 27, 2010.