The Mediterranean diet in Levantine and North African

In short

The Mediterranean diet has more high-quality clinical trial evidence behind it than any other dietary pattern for reducing cardiovascular disease, type 2 diabetes and several cancers.
Most of its core foods, including olive oil, pulses, whole grains, fish, fresh vegetables and fermented dairy, are staples of Levantine and North African cuisines already.
The research from the landmark PREDIMED trial showed a 30 percent reduction in major cardiovascular events in high-risk adults who followed a Mediterranean diet supplemented with extra olive oil or nuts.
Adopting this diet does not mean importing foreign foods. It means eating more of the traditional foods your grandparents ate and less of the processed food that replaced them.
The key shifts are: more olive oil, more legumes, more vegetables, more fish, less processed meat, less refined carbohydrate, and less added sugar.

What this article covers

What is the Mediterranean diet, actually?
Why this is essentially Levantine and North African food
What does the evidence actually show?
Olive oil: the food that does the most work
Pulses and legumes: the ignored protein source
Fish: how often and what kind
What to eat less of, without abandoning your food culture
How to start without changing everything at once

What is the Mediterranean diet, actually?

The term Mediterranean diet refers to the traditional dietary patterns of countries bordering the Mediterranean Sea as they were documented in the 1950s and 1960s, before industrialised food spread across the region. It was described initially by American researcher Ancel Keys, who noticed that populations in southern Italy, Greece and Crete had dramatically lower rates of heart disease than American populations despite higher fat intake, because the fat they ate came mainly from olive oil rather than animal sources.

The pattern has since been studied intensively. A 2021 overview in the Journal of Internal Medicine by Guasch-Ferre and Willett, reviewing decades of evidence, concluded that it is among the most evidence-backed dietary patterns in existence for reducing cardiovascular disease, type 2 diabetes, certain cancers and overall mortality. The landmark PREDIMED trial, a randomised controlled trial involving 7,447 adults at high cardiovascular risk across Spain, found a 30 percent reduction in major cardiovascular events in those assigned to a Mediterranean diet supplemented with olive oil or nuts, compared to a low-fat diet.

The pattern is not a single rigid prescription. It is a collection of principles: abundant olive oil, abundant vegetables and fruits, whole grains rather than refined, pulses and legumes eaten several times a week, fish at least twice a week, moderate dairy, very little red or processed meat, and a strong cultural tradition of eating together and eating slowly.

Why this is essentially Levantine and North African food

The foods that define the Mediterranean diet, when listed without the Italian or Greek context, read like a description of a traditional Lebanese, Syrian, Jordanian, Egyptian or Moroccan table: olive oil as the primary fat, hummus and ful (broad beans) as the protein base, tabbouleh and fattoush as vegetable dishes, labneh and laban as fermented dairy, grilled fish, pita bread made from whole wheat, fresh herbs everywhere. These are not imported concepts for Arab readers; they are the foods that existed in this region for centuries.

A study published in Scientific Reports in 2025, examining diet quality in Lebanese adults, found that Mediterranean diet adherence was associated with higher dietary diversity and better phytochemical intake in this population. Another study examining adolescents in North Lebanon found that family meals were one of the strongest predictors of Mediterranean diet adherence, which reflects an aspect of Arab food culture that is genuinely protective: eating together, eating what the household cooks, and not relying on individual packaged meals.

The problem is not that these foods do not exist in Arab countries; they do. The problem is that consumption of them has declined sharply over the past generation as processed food, fast food and soft drinks have taken their place. A meze table with hummus, labneh, tabbouleh, olives and grilled fish is a Mediterranean diet plate. The question is how often it appears compared to the shawarma wrapper, the fast-food bag and the soft drink.

Mediterranean diet foods and their Arab equivalents

Mediterranean food	Arab equivalent	How often
Olive oil	Zeitoun oil, used in cooking and dipping	Daily
Legumes	Hummus, ful, adas (lentil soup), fasolia	Several times a week
Whole grains	Burghul (bulgur), whole wheat pita, freekeh	Daily
Fish	Samak mashwi, sardines, sea bass, salmon	Twice a week or more
Fermented dairy	Labneh, laban (yoghurt drink), ayran	Daily or most days
Vegetables	Fattoush, tabbouleh, grilled vegetables, salata	With every meal
Nuts	Walnuts, almonds, pistachios, pine nuts	Daily as snacks
Herbs	Za'atar, parsley, mint, coriander	Daily in cooking

What does the evidence actually show?

The PREDIMED trial, published and subsequently re-analysed to confirm its findings, remains the strongest direct evidence. Participants who followed a Mediterranean diet supplemented with extra-virgin olive oil (roughly four tablespoons per day) or with a handful of mixed nuts daily had significantly fewer strokes, heart attacks and cardiovascular deaths over five years of follow-up compared to those advised to reduce all dietary fat. This was a trial in people already at elevated cardiovascular risk, so the absolute benefit in lower-risk people is smaller, but the direction of effect is consistent.

The effects on type 2 diabetes risk are also well documented. A 2021 overview found that Mediterranean diet adherence is associated with 20 to 30 percent lower risk of developing type 2 diabetes in prospective studies, mediated partly through better weight management, better blood glucose control and reduced inflammation. For a region where type 2 diabetes is already at high and rising prevalence, this is directly relevant.

The mechanism behind these effects involves several overlapping pathways. A 2023 paper in Nutrients examined the Mediterranean diet's effects on gut microbiota and found that its high fibre content and polyphenol-rich foods (olive oil, vegetables, nuts, fermented dairy) significantly diversify the gut microbial community, which is increasingly understood to affect inflammation, insulin sensitivity and cardiovascular risk. The diet's anti-inflammatory properties are not a marketing claim but a measurable biological effect.

30% reduction in major cardiovascular events in the PREDIMED trial

20-30% lower risk of developing type 2 diabetes with Mediterranean diet adherence

5+ servings of vegetables and fruit recommended daily in the traditional pattern

Olive oil: the food that does the most work

Extra-virgin olive oil is the single most researched food within the Mediterranean pattern and the one with the clearest evidence of benefit. The PREDIMED trial used about 50 millilitres, roughly four tablespoons, of extra-virgin olive oil per day as its intervention, and that dose produced the observed cardiovascular benefit. The oil's effects come partly from its monounsaturated fatty acid content, which improves cholesterol ratios, and partly from its polyphenols, which are anti-inflammatory compounds found in the unrefined oil but largely absent in refined vegetable oils.

The critical distinction is extra-virgin versus refined or light olive oil. Extra-virgin oil is cold-pressed from fresh olives and retains its polyphenols. Refined olive oil and many blends sold as olive oil in supermarkets have been heat-processed and stripped of most of their beneficial compounds. The oil in PREDIMED was extra-virgin, and the phrasing matters. Olive oil from Syria, Lebanon, Palestine and Jordan is among the finest in the world and is widely available locally, often at lower cost than imported European brands.

Using olive oil for cooking as well as dressing is both safe and appropriate. The polyphenols degrade at very high sustained temperatures, but normal cooking temperatures do not destroy the monounsaturated fat profile. Frying in extra-virgin olive oil at moderate heat is within the parameters of traditional Mediterranean cooking.

Pulses and legumes: the ignored protein source

Hummus, ful medames, lentil soup, fasolia, freekeh with chickpeas, mujaddara. These dishes are beloved, cheap, widely available and nutritionally exceptional. Pulses and legumes are high in plant protein, high in dietary fibre, low in fat, rich in folate and iron, and have a low glycaemic index, meaning they raise blood sugar slowly and keep hunger at bay for longer than refined carbohydrates do.

In the Mediterranean dietary pattern, legumes are eaten several times a week, not as a side dish but as the protein centrepiece of a meal. In traditional Arab cooking, this is exactly what they were: ful in the morning, lentil soup for lunch, hummus throughout the day. The shift away from this pattern toward meat, processed food and takeaway as the primary protein sources is nutritionally backwards from the evidence perspective.

Mujaddara, a dish of lentils, rice and caramelised onions dressed with olive oil, is nutritionally close to perfect: complete protein from the combination of legume and grain, fibre from both, healthy fat from the olive oil, and flavour from the onion. It is inexpensive, filling, and its glycaemic impact is modest. If you eat it a few times a week instead of equivalent meals of white rice with minimal protein, you are materially improving the quality of your diet.

Fish: how often and what kind

Traditional Gulf and Levantine diets both centred on fish as the primary animal protein before the oil era shifted wealth and food patterns. The Mediterranean dietary pattern recommends fish at least twice a week, with a preference for oily fish such as sardines, mackerel, salmon, sea bass and mullet, which are high in omega-3 fatty acids. These omega-3s are the form most directly linked to cardiovascular benefit, and they are abundant in the fish that swim in the Mediterranean and the Gulf.

Sardines, which are cheap and available across North Africa, the Levant and the Gulf, are among the most nutritionally dense foods you can eat. A tin of sardines in olive oil contains protein, omega-3, vitamin D, calcium (from the soft bones) and selenium. The Mediterranean diet in its original form was not an expensive diet; it was the diet of fishing communities and smallholders who ate what was local and seasonal.

Grilling and baking preserve the omega-3 content better than deep-frying, which damages the fragile fats. A grilled sea bass with lemon, herbs and olive oil served with tabbouleh and labneh is one of the most nutritionally complete meals it is possible to eat and is found in its essential form on tables from Beirut to Casablanca.

Simple steps toward a more Mediterranean eating pattern

1Switch cooking oil to extra-virgin olive oil and use it for dressing too
2Eat a pulse-based meal (hummus, lentils, ful, fasolia) at least three times a week
3Add a large fresh salad with herbs and olive oil to your two main meals
4Replace one red meat meal per week with grilled or baked fish
5Snack on a handful of walnuts or almonds instead of packaged snacks
6Eat labneh or laban with meals rather than processed sauces or spreads
7Reduce soft drinks to a maximum of one per week and replace with water or herbal tea

What to eat less of, without abandoning your food culture

The traditional Mediterranean diet is not defined only by what it includes but by what it excludes or limits. Red and processed meat appears rarely in the pattern: a few times a month, not daily. The saturated fat in processed meats (sausages, deli meats, cured meats) has consistent associations with cardiovascular disease in the evidence. This does not mean eliminating lamb or beef from Arab cooking; it means they appear as flavouring and occasional centrepieces rather than daily staples.

Refined carbohydrates, including white bread eaten in large amounts at every meal, white rice as the bulk of every plate, and pastries and sweets consumed frequently, are also not part of the traditional pattern. Bread in the original Mediterranean diet was whole-grain and eaten in modest quantities with olive oil and vegetables. The modern version of Arabic cuisine has drifted toward larger bread portions, sweeter pastries and more refined carbohydrates than the traditional version contained.

Sugar, particularly in the form of sweetened beverages, is one of the largest deviations from the traditional pattern across Arab populations today. The occasional glass of sharab or a piece of mamoul is entirely within the spirit of a balanced diet; a can of cola with every meal is not. The shift is one of frequency and volume, not a prohibition on any food.

How to start without changing everything at once

The research consistently shows that partial adherence to the Mediterranean diet still produces measurable health benefits. You do not need to transform your entire diet overnight. Studies using Mediterranean diet adherence scores find a dose-response relationship: the more Mediterranean principles you follow, the greater the benefit, but even moving from low to moderate adherence reduces risk.

The most evidence-backed change you can make today in an Arab kitchen is to increase olive oil use and increase pulse consumption. These two shifts alone begin to approximate the Mediterranean pattern and are entirely compatible with traditional Arab food culture. Adding more vegetables to every meal and eating more fish are the next two changes with the strongest evidence.

Do not import the diet by buying Italian or Greek products you do not recognise. Your local olive oil, your local lentils, your local sardines and your local labneh are the real thing. The Mediterranean diet, properly understood, is a Levantine and North African diet. The evidence that validates it is largely evidence about the foods you grew up eating.

You can log your meals in Sihtak to see how often you eat the core Mediterranean-pattern foods over a week. Even a rough log helps you spot whether the lentils, fish and vegetables are as frequent as the takeaways and soft drinks.

Frequently asked questions

Is the Mediterranean diet expensive?

In its original form it is one of the cheapest diets in the world. Lentils, chickpeas, sardines, eggs, seasonal vegetables, olive oil and whole-grain bread are not expensive foods. It becomes expensive if you replicate it using imported Italian or Greek branded products. Buy local olive oil, local pulses and local fish. These are cheaper than the processed alternatives they replace.

Can I follow a Mediterranean diet as a vegetarian?

Yes. The traditional Mediterranean diet was largely plant-based, with fish and small amounts of meat and dairy providing the animal protein. A vegetarian version built around pulses, nuts, whole grains, vegetables, eggs and labneh fits the pattern well. Vegans should supplement vitamin B12 and pay attention to iron and zinc from plant sources.

Does olive oil cause weight gain?

Olive oil is calorie-dense, so very large amounts can contribute to excess calorie intake. But in the PREDIMED trial, participants were asked to consume around four tablespoons of extra-virgin olive oil per day in addition to their usual diet, and they did not gain more weight than the control group. Fat does not automatically cause fat accumulation; total calorie balance matters, and olive oil is highly satiating.

Is hummus actually healthy?

Hummus is one of the most nutritionally complete foods in Arab cuisine. It provides plant protein from chickpeas, healthy fat from tahini and olive oil, fibre, folate, iron and magnesium. Eaten with vegetables rather than excessive amounts of white bread, it is an excellent food. Commercial hummus often contains more salt than home-made, so check labels if buying ready-made.

What about coffee and tea in a Mediterranean diet?

Neither is excluded. Coffee and tea are consumed in Mediterranean countries in substantial quantities, and moderate coffee consumption (two to four cups per day) is associated with lower cardiovascular risk in most large studies. Traditional Arab coffee and green tea both contain polyphenols and antioxidants. The concern is adding large amounts of sugar or flavoured syrups.

Can this diet help with existing diabetes?

Yes. The Mediterranean diet is associated with better blood glucose control, lower HbA1c levels and better cardiovascular outcomes in people with type 2 diabetes compared to low-fat diets. The high fibre from legumes and whole grains slows glucose absorption. The anti-inflammatory effects of olive oil and vegetables help insulin sensitivity. Ask your doctor before making large changes if you are on medication, because your doses may need adjusting as your control improves.

Is meze eating healthier than three large meals?

The meze pattern, many small dishes eaten together with conversation and bread, tends to produce slower eating, better satiety signalling and more dietary variety in one sitting than a single large plate. Eating slowly gives the brain time to register fullness, which typically takes 15 to 20 minutes after the stomach begins to fill. A meze table of hummus, labneh, tabbouleh, olives, raw vegetables and fish is close to optimal.

Sources

This content is for health education only and is not a substitute for medical advice. If you have symptoms that worry you, see your doctor.