"I look at this and if it's full, I know it's going to be a busy night!" Eirini who owns Nektar, a Greek natural products shop near my house said pointing at Trihandiri Seafood as we walked toward our respective shop and home. We ran into one another near the garbage bins in the back of town where I had just unloaded my recycling and she was walking back to her shop after her daily break. Trihandiri is just at the end of our "block" of and is arguably the most popular seafood restaurant on the island because of its value. For diners who care more about the freshest seafood at the best prices than they do ambiance, Trihandiri is THE place.
"There are no cruise ships right now, so all of this is just the island. It's getting busy," she explained. "These days are so long, it gets very tiring."
Eirini and her husband Alessandro work very hard – and their shop is open for long hours – often until midnight or even 1 am in the peak of the tourist season in August. Alessandro is Cuban and fluctuates between multiple languages even in the course of a single sentence – "Kalimera, how are you my friend? Ola kala? Que pasa?" I've heard French and Italian enter the mix too. He accepts answers in any language. Alessandro is up and working early and hard. He schleps, creates displays, unloads inventory, breaks down boxes and using a bicycle is constantly shuttling boxes and packaging back to the recycling bins – saying hi to everyone he encounters along the way. Alessandro uses charm to draw people into the shop and has friendships with just about every business owner up and down the "street".
Eirini is Greek – so in many ways she's the brains on the operation. She places the orders, deals with taxes and compliance, knows everything about every product including where and how they're sourced, speaks fantastic English, forms long-lasting relationships that lead to a stable of devoted regular customers among those who frequent the island. I always get my gifts for people at home from her – something Emily and I did for a decade before that.
However, I disagreed with Eirini's assessment. I can't think of an evening where Trihandiri isn't packed to the gills (pun intended) from 6pm onwards, including with locals. I was also pretty sure there was at still a smaller cruise ship still in port – or at least some people from yachts. There's a vibe to the people who are just visiting for the day. Moreover, Eirini was coming back from her afternoon siesta, but seemed tired already.
Over the winter Eirini had some glands in her neck removed. She's always a little short of breath and has a deep raspiness in her voice from the years of chain smoking. I can see it catching up to her and worry for her. I get the sense she and Alessandro worry for her too. I've seen Alessandro picking up more of her duties so she can rest more.
Despite having all the right ingredients, Greece is not the healthiest of populations.
Or, it is in pockets. The neighboring island of Ikaria (home to the Icarus myth) is where the study that led to the Mediterranean Diet took place. Ikaria is a "blue zone" with a higher than normal set of centenarians. The foods they eat, their local gardening, the way walk more and drive less, swim regularly – all combine to support excellent health.
In theory, all of Greece could be like this – certainly islands like Patmos and Lipsi which really aren't so different from Ikaria. Only products and ideas from the rest of the world have seeped into Greek culture. Depending on whose statistics you place your faith in, roughly 30 percent of Greeks smoke. In 2022, Greece had the highest rate of smoking in the European Union even despite a stringent set of laws passed in 2010 to curtail where people can smoke – similar to California.
As a benchmark, 11.6 percent of Americans smoke.
In public health circles, vaping is considered a harm reduction strategy. If someone is going to be addicted to inhaling nicotine, better to vape than smoke. American have embraced this with 6.5 percent of adults vaping. Greeks less so with only 2 percent vaping.
For the French, smoking is often a form of dieting. In an early episode of Emily in Paris, one of my favorite lines is when Emily asks her French boss, Sylvie to lunch, Sylvie responds, "No, I'm just having a cigarette for lunch today."
Not as much in Greece where 38 percent of the population is overweight and 25 percent obese. Here on Patmos, I see a surprising number of people who because of their weight use their motorscooters as a means to do errands that should be quicker and safer on foot. Childhood obesity is an epidemic in America at 20 percent of children age 2-14 – in Greece it's 37.5 percent.
There are compounding factors to Greece's health problems.
For one thing, Greece has the second largest aging population in the EU – second only to Italy. Roughly 30 percent of the population is 65 and older and projected to reach 37 percent by 2050. Meanwhile Greece has a fertility rate of 1.27 births per woman in 2025 – well below the replacement rate of 2. Only on this statistic, Greece isn't even close to being in the worst position with countries like Poland and Malta battling it out for lowest birth rates at closer to 1.06 births per woman.
It helps to consider about one third of Greece's population lives in the Athens Metro area. Most Greeks are not living that Ikaria life and enjoy processed foods, fast food, work at desks and computers – and all the same factors and challenges as most of the developed world.
Still, here on Patmos one might expect a very healthy population with similar blue zone outcomes as neighboring Ikaria. From what I've gathered, it isn't the case and I don't know all the factors that go into why. Cancer is a pretty frequent visitor to Patmos. I'm told the plumbing may have played a part – that people drank from old lead pipes for far too long. That might play a role.
Genetic pools may also. Before a Patmian couple can marry – and often as the begin dating seriously – they have to undergo genetic testing to see how closely they are related. Not if they are related – but how close or distantly. The old Patmos families have all mixed over centuries to where distinction doesn't come easily – unless you marry a non-Patmian, which is becoming far more common with younger generations. Now that Patmian kids commonly go to Athens or elsewhere for college and work experience, they have the opportunity to date outside the Patmos pool. Still, even for those who don't leave the island, a romance turned marriage with a visiting foreigner isn't unheard of. I know a number of teens to early twenties who have one Patmian and one foreign parent. Thanks to his mom, one of the waiters at the Atherion Cafe looks astonishingly Dutch and speaks fluent English with a hint of a Dutch accent even though he hasn't spent that much time in the Netherlands. His Greek friends don't seem to care.
Of course, one of the saddest parts of cancer on Patmos – and perhaps the reason it's so devastating and lethal – is simply lack of screening. Patmos' Health Center – a clinic/emergency room facility may be free, but it's for acute care. People don't typically get annual physicals and there is no such thing as the family doctor because the physicians are brought on something akin to a rural medicine program and rotate sometimes several times per year. I'm told sometimes the physicians on duty are Swiss doctors doing a residency rotation.
The diligent visit doctors in Athens or Rhodes when they go vacations or trips. There they can get preventive care and see specialists. Only for those who aren't consistent in their visits to off-island care, they are typically symptomatic when they are diagnosed with cancer – and in so many cases, it's really too late.
Our friends on Ikaraia, on the other hand of a hospital, several public health centers and numerous private doctors on the island. Ikaria has a recorded population of 8,843 – almost three times Patmos' and is almost seven times as big – 90 square miles compared to Patmos' 13. Ikaria has a lower population density, but an overall higher aggregate population able to garner more resources.
All of this to say, you can be looking at the same blue water and even see Ikaria across the strait, but it's not necessarily the same blue zone.
What are the lessons here? Well first, don't marry your cousins – or anyone who is a cousin at any level. That seems to make a real difference. The Dutch-Patmian kid is a sharp looking dude who is probably healthy as a horse. Same the British-Patmian teenager who waits at his parents' restaurant down the street.
Secondly, don't smoke or vape. It's nasty – I have no idea why people are still doing it. Unless you're on the Sylvie diet – which at least makes sense in its own way, even if it remains a bad choice.
Third, it might help to have less coffee than the average person here seems to. Not just coffee, but dark, intense, serious-business coffee. The kind that complements cigarettes and motor oil. So basically, what the Fonz probably drank.
Moreover, if you want Ikarian health, you have to work the Ikarian system. They grow a lot of their own food. For elders, gardening and tending the land is part of staying active. they're also eating the food that grows naturally in their environment – eggplant, peppers, zucchini, onions, spinach, etc. Their ingredients are both fresh and limited. The supermarket has a LOT of stuff, very little of which is really that healthy. Greeks have access to most of the same products as Americans right down to packs of Starbucks on the coffee aisle and more kinds of cookies, crackers and sugar-cereals than you can count. Toucan Sam followed his nose to Patmos and met up with the Cookie Crook on Aisle Six.
I'm no paragon of health, so take whatever I say with a grain of Aegean sea salt – but I have watched locals and learned that the healthiest options are outside the supermarket. I get my meat from Tassos the Butcher and produce either from the produce shop or the produce trucks in the front of town each morning. The price and quality is better than the supermarket, even if the selection is not as broad. And really, if everyone only bought from those two shops and the trucks – they would be 70 percent of the way to the Ikaria plan (both Tassos and the produce shop sell pulses and grains like gigante beans, brown rice, bulgur, etc and even fresh eggs from someone's local farm).
For me personally, Patmos usually works well for my health. I typically drop a few pounds while making no sacrifices. Is it the walking, the diet, feeling less stressed? Could it be the fact that food here is grown and produced differently than in the US – ie certain pesticides and chemicals are banned in the EU? Probably some of that too. It could well be that the sun and splendorous blues are mood elevators – it's a world that visually registers higher.
Maybe all of it.
Interestingly, I almost always lose weight when I spend time outside the United States – even when I put no restrictions on what I eat. In Nepal, my clothes were becoming loose and I was definitely stress-eating momos, burfis and other Indian sweets. Nepal was the hardest part of the year-long voyage for me in 2010.
So who knows? It may not be Ikaria, but we all know what happens when those overachievers fly too high…. I can make Patmos work for me – and the kids too when they get here – NEXT WEEK. We'll have our blue zone right here – every day.
