North African Roots of the Med Diet
By Kelly Leblanc, MLA, RD, LDN
Today’s Dietitian
Vol. 25 No. 5 P. 16
Mention the Med diet and thoughts of Italy or Greece usually come to mind. However, the many food staples, flavorful spices, and dishes of this renowned eating pattern have their roots in Northern Africa, a region that had enormous influence on the cuisine as we know it today.
In the United States, the first window into the Mediterranean diet began with the Greek island of Crete. However, the Mediterranean diet as we know it today represents the broader pattern of eating found throughout the Mediterranean region, including North Africa, southern Europe, and parts of the Middle East. Today, approximately 27 countries surround the Mediterranean Sea, with similar climates and many shared foods.
“Most of the Mediterranean basin was under the rule of North Africa for 500 years, so of course, there was an enormous influence on Mediterranean cuisine as a whole,” explains culinary historian Jessica B. Harris, PhD. For example, there was shared use of spices, olive oil, nuts, and fruit. North African food and culture have been shaped primarily by the Berbers and Egyptians, with some influences from Spanish and Portuguese explorers as well as other Arab nations. Today, Morocco, Algeria, Tunisia, Libya, and Egypt are the North African countries that border the Mediterranean Sea. (Given this historical and geological context, one can surmise that the Mediterranean diet has its roots in North Africa.)
“While the offerings may change as you travel around the region, the basics remain the same,” explains Rosie Schwartz, RD, who describes the Mediterranean diet as an eating pattern based on “a foundation of an abundance of plant-based foods, such as vegetables, fruits, pulses (eg, lentils and chickpeas), nuts and seeds, and whole grains along with only small amounts of animal foods and the use of olive oil.”
Media portrayals of the Mediterranean diet often focus on Greek and Roman origins, leaving a vast array of ingredients, recipes, and cultural identities in the shadows. However, many nutrition advocates are taking great care to introduce people to the history and diversity of foods and flavors that contribute to the Mediterranean diet.
“In the 1990s and early 2000s, we began bringing food writers, chefs, dietitians, scientists, and journalists to Morocco, Tunisia, Turkey, and other Mediterranean destinations so they could introduce an American audience to these diverse cultural food traditions,” says Sara Baer-Sinnott, president of nutrition at Oldways, a nonprofit food and nutrition organization and creators of the Mediterranean Diet Pyramid.1
As the dietetics profession reckons with the need for more culturally inclusive nutrition guidance, celebrating the African roots of countless nutritious Mediterranean food staples is one way practitioners can push back against the narrative that the “best” diet originates only in Europe. Restoring cultural ownership of healthful eating for people of North African descent paints a more vivid, more historically accurate, and more delicious picture of the Mediterranean diet.
Health
“Eating patterns, vs individual foods, appear to offer maximum health benefits,” Schwartz says. The Mediterranean diet is filled with food combinations that reflect the synergistic effects of nutrition, such as cooking tomatoes in olive oil to increase lycopene absorption.2 Schwartz explains that the synergistic effect of foods is especially beneficial because “when you put them together, their action is much more powerful than each on its own.”
The Mediterranean diet is perhaps one of the most widely researched eating patterns in the world. Following a Mediterranean diet is linked with a reduced risk of heart attack and stroke,3 a decreased risk of certain cancers (eg, colorectal, head and neck, respiratory, gastric, liver, and bladder),4 a slower progression of atherosclerosis,5 and many markers of healthy aging.6
Diverse prospective cohort studies demonstrate that the health benefits of consuming a Mediterranean diet apply to people of many racial and ethnic backgrounds. A 2023 analysis of more than 119,000 people in the Nurses’ Health Study and Health Professionals Follow-up Study, found that following a Mediterranean diet (as measured by the Alternate Mediterranean Diet Score) was inversely related with death from CVD, cancer, respiratory disease, and neurodegenerative disease in different racial and ethnic groups, including Hispanic, Black, and white individuals.7
In a cohort of Black, Hispanic, and white low-income mothers, greater adherence to the Mediterranean diet was linked with a 22% lower risk of preeclampsia.8 In a 2022 study in the Journal of Nutrition, Health, and Aging, which used country level food supply as a proxy for intake, a higher Mediterranean diet score was linked with higher life expectancy and higher healthy life expectancy across all 130 countries studied.9
“The Mediterranean diet best represents the win-win of taste and health,” says Carolyn O’Neil, MS, RD, who says this attribute makes it less of a restrictive “diet” and more of a sustainable, enjoyable lifestyle change. She explains that “while being plant forward with a celebration of fruits, vegetables, grains, legumes, nuts and seeds, the Mediterranean diet includes delicious wines, flavorful cheeses, naturally sweet dates and honey, with seafood and meats in small portions that add to the enjoyment of meals.”
This balance is important because it “means folks are more likely to keep coming back for more and add Mediterranean-inspired dishes to their everyday menus for the long haul,” O’Neil adds.
While different parts of the Mediterranean have their own signature dishes, the overall Mediterranean diet pattern is based on a similar structure of legumes, vegetables, fruits, whole grains, olive oil, nuts, herbs, spices, and fish. From vivid spice markets and fragrant, tender tagines to the warmth of a Mediterranean sunset, North African cuisine is a delight for the senses.
Grains
One of the most ubiquitous dishes in North African cuisine is couscous. Not technically a grain, couscous is a tiny, round, wheat-based pasta that cooks quickly into little granules. In a reflection of North Africa’s great influence on Mediterranean cuisine, a 2006 survey of French adults found that couscous was the most popular dish in all of France, coming in ahead of chicken or “le steak-frites.”10
Pearl couscous is a bit larger in size (similar to the Italian grain fregola or the ancient grain sorghum), while other varieties of couscous are much smaller (reminiscent of quinoa or fonio). As with any wheat-based product, couscous can be made from either refined wheat or whole wheat. Whole wheat couscous, which contains more fiber, protein, and many essential nutrients, is worth seeking out to add more nutrition to a dish. Wheat itself (alongside grapes and olives) is part of the “trinity” of the Mediterranean diet, as it has nourished Mediterranean people for centuries. Parts of North Africa, including modern-day Lebanon and Egypt, are a part of the “Fertile Crescent,” where settled farming (including wheat farming) is believed to have emerged.
Barley is another traditional grain in North African cuisine. Bread in this region traditionally was made from barley, as it was cooked into a flatbread to make it more portable. In Tunisia, barley grits often are added to bread to give it a nuttier flavor and texture. Today, this chewy grain is known for its role in heart health and regulating cholesterol due to its soluble beta glucan fiber. To ensure a product contains whole grain barley, look for “whole” or “hulled” barley instead of “pearled” barley.
Proteins
For those looking to explore plant-based protein sources, look no further than the cuisines of North Africa. Beans and legumes are eaten frequently, especially chickpeas, lentils, and fava beans. For example, Moujaddara is a dish made of pureed lentils and spices, popular throughout North Africa, the Middle East, and Lebanon. Ful medames is a hearty stew of warmed fava beans stirred with olive oil, lemon juice, and garlic. Traditionally, it’s served for breakfast in Egypt, but it’s tasty any time of day.
Throughout the Mediterranean, eggs are a hearty vehicle for vegetables. Shakshouka is an iconic North African dish in which eggs are cooked in a splendid mixture of harissa (a red pepper condiment), fresh tomatoes, tomato paste, peppers, garlic, and cumin.
Perhaps the most iconic dish from North Africa is a tagine, which is named for the conical pottery the stew is cooked in, which slowly tenderizes the meat (often lamb, sheep, beef, or goat). “If there’s one cooking technique to take home with you from North Africa, it’s how to use a tagine,” O’Neil says, adding that for those without a tagine dish at home, it’s still possible to re-create North African food memories using a Dutch oven.
Produce
Dates, which typically are the first food eaten to break the fast following Ramadan, are plentiful throughout North African cuisine. Other popular fruits include apricots, pomegranates, persimmon, prunes, and raisins, which are used in sweet and savory dishes. Fruit and nuts are included in most tagine recipes, but tagines also can be vegetable based.
Vegetables are featured prominently, especially carrots, tomatoes, artichokes, and peppers. “North African cuisine offers an incredible variety of choices for those who have a vegan or vegetarian food style,” Schwartz says, adding that “dips, soups, breads, and stews are all delicious common selections.”
Spices and Herbs
“What leaps to mind first when thinking of the cuisine of North Africa is the word fragrance,” says O’Neil, who as a journalist, tasted her way through North Africa in the 1990s with Oldways. “Rose water, citrus zest, and aromatic spices such as cinnamon elevate savory dishes just as adding a colorful scarf or sparkling jewels to a dress takes it to another level of elegance.”
North African cookery is characterized by aromatic spices. Popular spice blends and spreads include ras el hanout (a spice blend that usually includes allspice, cumin, cardamom, ginger, nutmeg, cinnamon, cloves, and turmeric), harissa (a spicy red pepper paste), chermoula (a sauce/marinade or topping often made with a blend of herbs, such as cilantro, aromatics including ginger and cumin, and oil and lemon juice), and dukkah (a crumbly mixture of nuts, herbs, and seeds). Schwartz is particularly fond of chermoula, which can be stirred into a vegetable soup, used as a marinade for grilled fish, or drizzled over sauteed squash.
“Herbs and spices don’t just add taste,” Schwartz says, “[they also] add disease-fighting weaponry such as antioxidant, anti-inflammatory, and anticancer action.” Research also demonstrates that adding herbs and spices can make lower-sodium meals more palatable, meaning that these seasonings can be a great strategy to help individuals add flavor without relying heavily on the salt shaker.11,12
Baer-Sinnott says that when Oldways updated the Mediterranean Diet Pyramid in 2008, a group of scientists recommended that herbs and spices be added because they give regional expression to Mediterranean cooking. In other words, herbs and spices can make a dish Tunisian or Moroccan or Italian, depending on the ones used.
Beverages
As you taste your way through North Africa, you may notice that one Mediterranean specialty is less common at the dinner table: wine. Because Islam is a predominant religion in many North African countries, alcohol consumption (which is prohibited in Islam) is infrequent compared with other parts of the Mediterranean.
That said, North African hosts have beautiful ways of expressing their hospitality. Reflecting on a trip to Morocco, O’Neil recalls “the ceremony of a refreshing yet very hot mint tea expertly poured from a silver pot often three to four feet above the cup to add more oxygen to the tea and liven up the essence of mint in every sip.”
As more Americans experiment with zero-proof beverages, the herbal teas of North Africa have become a delicious option that enable consumers to sip and savor Mediterranean customs.
Embracing Cultural Food Traditions
As part of a respectful, culturally responsive practice, uplifting the African origins of classic Mediterranean dishes is one place to start. However, learning and unlearning doesn’t end here.
Today, there are more opportunities than ever for dietitians seeking an immersive educational experience in a particular culture or cuisine. From the Academy’s dietetic practice groups to legacy organizations such as Oldways, continuing education can and should be a part of every dietitian’s travel experience. “The great thing about travel is that learning about different world cuisines can actually help people improve their diets,” O’Neil says. “This is a concept registered dietitians should embrace and share with their clients.”
Exploring a culture through its food is a starting point for broadening horizons and seeking diverse expertise on food and nutrition practices.
For those seeking to travel from the comfort of their own screen, there are a growing number of continuing education opportunities that focus on global food cultures and customs, or how different ethnic heritages are impacted by various health and nutrition conditions and what best practices look like in those particular communities.
Studies show that making culturally sensitive modifications to diet programs can lead to improvements in blood pressure, weight, and other health parameters.13 By bringing to light a culinary legacy of healthful eating for people of diverse backgrounds, dietitians are better poised to challenge the conventional, whitewashed perception of a healthful diet and redress the health disparities faced by communities of color.
“As the diversity of our society continues to expand, in order to counsel clients and patients about their diets, it’s critical that we understand their traditions and cultures,” Schwartz says.
— Kelly LeBlanc, MLA, RD, LDN, is the director of nutrition at Oldways, a nonprofit dedicated to improving public health by inspiring individuals and organizations to embrace the healthful, sustainable joys of the “old ways” of eating—heritage-based diets high in taste, nourishment, sustainability, and joy. LeBlanc holds a BS in nutrition from the University of Texas, where she completed her dietetic internship, and also holds a master’s degree in gastronomy from Boston University, with a concentration in food policy.
Shakshouka
Serves 6
Shakshouka is a North African dish made by poaching eggs in spicy tomato sauce. It looks impressive for the amount of work and the cost of the ingredients. Serve it for brunch or for a quick dinner.
Ingredients
1 T olive oil
1 small yellow onion, diced
1 clove garlic, minced
1 red bell pepper, diced
2 (14-oz) cans no-salt diced tomatoes, or about 4 cups ripe diced tomatoes
2 T tomato paste
1/2 tsp mild chili powder
1 tsp cumin
1 tsp paprika
Pinch of cayenne pepper, or more to taste
Pinch of sugar (optional, to taste)
Salt and pepper, to taste
6 eggs
1 T minced fresh parsley, for garnish
Directions
1. Heat the olive oil in a large skillet or Dutch oven over medium-high heat. Add the diced onion and sauté until translucent, about 5 minutes. Add the garlic and sauté until fragrant, about a minute more. Add the diced bell pepper and cook until softened, about 7 to 10 minutes.
2. Add the tomatoes, tomato paste, and spices to the skillet and bring to a simmer. Add a little bit of spice at the beginning so you can adjust to your preference. Reduce the heat to low and simmer for about 5 minutes, until the sauce begins to reduce. Adjust the spices and other seasonings to taste.
3. For the eggs, create space in the sauce for each egg with a ladle or large spoon. Rest the spoon in the sauce and crack the egg on top. Gently remove the spoon and allow the egg to settle in the space left behind. Repeat for the remaining 5 eggs. Cover and simmer for 10 to 15 minutes, checking regularly, until the eggs are cooked to your liking. Garnish with minced parsley and serve.
Nutrient Analysis per serving
Calories: 140; Total fat: 2 g; Sat fat: 2 g; Cholesterol: 187 mg; Sodium: 100 mg; Total carbohydrate: 10 g; Dietary fiber: 2 g; Total sugars: 6 g; Added sugars: 0 g; Protein: 8 g
— Source: Oldways Recipe and Photo Courtesy of oldwayspt.org
‘Everything Green’ Chickpea Salad
Serves 4
Chickpeas are a staple ingredient throughout North Africa and much of the Eastern Mediterranean, where they show up in a variety of stews, dips, and salads. Mint, scallions, and chives are delicious in this lemony chickpea salad. However, this is your chance to use “everything green” you’ve got in your fridge. Spinach, arugula, parsley, and other herbs and leafy greens would be delicious, too.
Ingredients
1 can chickpeas, drained and thoroughly rinsed
1/4 cup mint, finely chopped
2 T chives, finely chopped
2 scallions, finely chopped
Juice of 3 lemons
3 T extra virgin olive oil
2 tsp dried oregano
Directions
1. In a large salad bowl or mixing bowl, combine all ingredients.
2. The salad can be served at room temperature or chilled. It will taste best when given a few hours or left overnight to chill in the refrigerator to allow the flavors to meld together.
Nutrient Analysis per serving
Calories: 200; Total fat: 12 g; Sat fat: 1.5 g; Sodium: 150 mg; Total carbohydrate: 19 g; Dietary fiber: 6 g; Total sugars: 4 g; Added sugars: 0 g; Protein: 6 g
— Source: Oldways Recipe and Photo Courtesy of Sara Baer-Sinnott. oldwayspt.org
References
1. Willett WC, Sacks F, Trichopoulou A, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995;61(6 Suppl):1402S-1406S.
2. Rinaldi de Alvarenga JF, Tran C, Hurtado-Barroso S, Martinez-Huélamo M, Illan M, Lamuela-Raventos RM. Home cooking and ingredient synergism improve lycopene isomer production in Sofrito. Food Res Int. 2017;99(Pt 2):851-861.
3. Delgado-Lista J, Alcala-Diaz JF, Torres-Peña JD, et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. Lancet. 2022;399(10338):1876-1885.
4. Morze J, Danielewicz A, Przybyłowicz K, Zeng H, Hoffmann G, Schwingshackl L. An updated systematic review and meta-analysis on adherence to Mediterranean diet and risk of cancer. Eur J Nutr. 2021;60(3):1561-1586.
5. Jimenez-Torres J, Alcalá-Diaz JF, Torres-Peña JD, et al. Mediterranean diet reduces atherosclerosis progression in coronary heart disease: an analysis of the CORDIOPREV randomized controlled trial [published correction appears in Stroke. 2021;52(11):e754]. Stroke. 2021;52(11):3440-3449.
6. Shannon OM, Ashor AW, Scialo F, et al. Mediterranean diet and the hallmarks of ageing. Eur J Clin Nutr. 2021;75(8):1176-1192.
7. Shan Z, Wang F, Li Y, et al. Healthy eating patterns and risk of total and cause-specific mortality. JAMA Intern Med. 2023;183(2):142-153.
8. Minhas AS, Hong X, Wang G, et al. Mediterranean-style diet and risk of preeclampsia by race in the Boston birth cohort. J Am Heart Assoc. 2022;11(9):e022589.
9. Sezaki A, Imai T, Miyamoto K, et al. Association between the Mediterranean diet score and healthy life expectancy: a global comparative study. J Nutr Health Aging. 2022;26(6):621-627.
10. Bourke J. Hop off, frogs' legs—couscous is the top dish. The Guardian. https://www.theguardian.com/world/2006/apr/02/france.jasonburke. Published April 1, 2006. Accessed February 15, 2023.
11. Dougkas A, Vannereux M, Giboreau A. The impact of herbs and spices on increasing the appreciation and intake of low-salt legume-based meals. Nutrients. 2019;11(12):2901.
12. Cox GO, Lee Y, Lee SY. Drivers of liking in a model retorted creamy tomato soup system with varying levels of sodium, fat, and herbs. J Food Sci. 2019;84(9):2610-2618.
13. Reicks M, Gold A, Tran N, LeBlanc K. Impacts of a taste of African heritage: a culinary heritage cooking course. J Nutr Educ Behav. 2022;54(5):388-396.