898 La Revue de Santé de la Méditerranée orientale, Vol. 10, No 6, 2004

Review Food habits of the Egyptians: newly emerging trends H. Hassan-Wassef 1

SUMMARY Accelerated changes are taking place in the food habits of the present day Egyptians. Examples are drawn from foods that continue to be consumed by those considered guardians of the Egyptian tradition (Coptic Christians and isolated farming communities) and from interpretation of archaeological evidence. Recent decades have witnessed the progressive erosion of the traditional Egyptian diet and the introduction of new foods and eating habits. Sociocultural and economic changes are accelerating this erosion. The main features of the traditional Egyptian way of eating are presented along with a review of the emerging trends and of some of the important factors underlying food consumption patterns. Attention is drawn to the potential risk to health that these new trends represent, in particular to child nutrition and development.

Background Having a rich and fertile soil that is easy to cultivate, and benefiting from favourable This paper is derived from a longitudinal climatic conditions, the Nile valley has study that started 5 decades ago and which since ancient times been renowned for an is aimed at identifying the ancient origins of abundance of cereals and the variety of cul- the foods prepared and consumed by tivated legumes and vegetables it produces present-day Egyptians [H. Hassan-Wassef, [3]. Barring the occasional bad years when unpublished document, 2005]. The study the floodwaters were low, food and agri- focuses on the inhabitants of the Nile valley cultural production adequately provided for and delta, and does not encompass the no- the nutritional and other needs of its people. madic populations of the desert. The pur- The new food crops and fruit trees that pose of this investigation is to define and to were introduced into at various times make known what can be truly labelled did not significantly change the basic tradi- Egyptian foods and food habits. It involved tional crop composition, and consequently, noting how the traditional dietary habits food consumption patterns. The relative evolved in response to a host of external as abundance and rich variety of foods avail- well as internal factors. able in Egypt in comparison to its neigh- For all long-standing food habits and bours resulted in waves of migrants, culinary traditions that have developed especially to rural areas, who easily adopt- through the ages, the end product is a bal- ed the Egyptian way of eating. They did not anced diet in harmony with the physiologi- leave any appreciable mark on local food cal needs of the people and their habits [4]. The case was different for the occupation, climate, agriculture, and natu- higher social classes and the rich urban ral resources [1,2]. The Egyptian has in- dwellers who often copied the eating man- herited an indigenous food system and ners and foods of the succession of foreign traditional food habits that can guarantee a rulers who occupied the country [5]. balanced diet.

1Nutritionist and Public Health Policy Analyst, and former Director, World Health Organization, Geneva, Switzerland. Eastern Mediterranean Health Journal, Vol. 10, No. 6, 2004 899

The ancient agricultural methods and Methods crop composition, which had remained un- changed over thousands of years, allowed The period under review is from the early ample time for food habits to take root and 1950s to the end of the 20th century. for the gradual emergence of a nutritionally Changes in the food habits and in newly balanced diet that is in harmony with the emerging food consumption trends were existing ecosystem and which satisfies the noted. Sources of information varied wide- nutritional requirements of the people. Con- ly. Historical data and evidence were used tinuity was guaranteed through the keepers to define the basic features of the tradition- of culinary tradition, namely the fellaheen al food system, and information collected (farming community) women, and through from the field allowed the identification of the ritual foods of the Copts, the Orthodox current food habits and the emerging Christians of Egypt. The traditional kitch- trends. The study of food habits included ens and earthenware utensils of the fella- collecting information on foods eaten as heen, which have survived till today, have well as on the way they were prepared, contributed to the perpetuation of many food associations and methods of food food habits. conditioning and conservation. The supply, Modernization of the ancient agricultur- availability and accessibility of foods, and al methods started only 200 years ago, thus other factors that influence food habits initiating the first large scale modifications were taken into account. in the crop composition. This agricultural revolution marked the beginning of a series Archaeological evidence and of major irrigation projects and efforts to historical data Archaeological studies and Egyptian collec- control the Nile waters [3]. Up to the time of the Second World War, significant tions in museums around the world yielded changes in food habits essentially followed a wealth of information on the foods con- changes in agricultural policy that deter- sumed by the ancient Egyptians and the evolution of eating habits [6–8]. Accounts mined land use and crop composition. Giv- made by travellers to Egypt through the en the limited total cultivated area of the ages provided valuable descriptions of Nile valley and delta, important increases in land allocations to a particular crop was foods and beverages and of food consump- done at the expense of another, sometimes tion patterns [9,10]. The ancient origins of with repercussions that could potentially foods and of their methods of preparation were identified through a “live” reading of disrupt the balance of the traditional food historical evidence coupled with an intimate system and led to the emergence of nutri- personal knowledge of current food habits. tional disorders in the long term. The wide- spread pellagra (vitamin B3 deficiency) that The ritual foods of the Copts, which have became manifest towards the end of the been transmitted from generation to gener- nineteenth century is a case in point. It was ation for nearly 20 centuries, provide an in- sight into the culinary traditions of the a consequence of the market driven deci- ancients [11]. sion to increase the production of cotton, Historical events that significantly con- which was done at the expense of wheat production. The growing dependence on tributed to changes in food habits were maize flour in lieu of wheat in the making of studied and factors that influenced both the bread, the staple food, soon led to the facilitation of and the resistance to change are described. The impact on the traditional emergence of nutritional deficiency. 900 La Revue de Santé de la Méditerranée orientale, Vol. 10, No 6, 2004

Egyptian food system was assessed in peasants, factory workers, construction terms of food habits and situations where workers) ate at the workplace. there was sustained exposure to alien foods Inspection visits were then made to and habits, e.g. through trade, conquest, kitchens, gardens, and food storage facili- occupation or the settlement of significant ties. Traditional methods for food preser- numbers of migrants from neighbouring vation and food conservation still in use countries. were recorded. The array of spices on the spice shelf was noted. The frequency of Information collected from the field home baking and the use of the traditional Urban and rural communities were visited oven were recorded, as well as the nature in the , on the Mediterranean and form of the cooking utensils, in partic- coast, in Middle and Upper Egypt and in the ular the presence and use made of the an- Nubian regions in the south (Fayoum, Beni- cient traditional ones such as the ghorbal Suef, Minia, Luxor, Aswan, Qalyubia, (sieve made of lamb gut), the matraha Sharkia, Gharbia, Dakahlia, Beheira, Dami- (long-handled wooden board for flattening etta, Alexandria and governorates). ) or the salaya (quern). Home pro- Data were collected over a period of 50 duction and consumption of protein-rich years, in all seasons. Interviews were con- foods was investigated, and the practice of ducted in > 40 households in each gover- the age-old habit of gathering (or buying) norate (> 100 in Cairo and Alexandria and consuming edible wild plants was not- governorates). ed whenever relevant. Food consumption and nutrition-related The proportion that the garden produce information was obtained through a 24- contributed to the total family vegetable hour recall of food consumed the day pre- consumption was estimated and the rea- ceding the interview, followed by in-depth sons underlying the choice of vegetables inter-personal interviews lasting about 1 grown noted. The presence of yard animals hour and group interviews attended by 8– and keeping of animals (especially rabbits 12 housewives, neighbours and relatives and fowl) in urban settings, and the uses from the same location, usually lasting for made of them, was also recorded. 1.5–2 hours. The respondent was mostly The markets and food shops were visit- the housewife, who was responsible for ed and the degree of market dependence feeding the family. The sample was, how- for some food items that contribute to- ever, varied covering variations in age, sex, wards maintaining the integrity of the food education, occupation, income and social system (e.g. dark green leafy vegetables echelon. Information collected was not and dairy products) was assessed. The only on types of food but also the ingredi- growing increase in dependence on the lo- ents used in preparing it, how it was cal bread made from high extraction wheat served, and eating habits. This also includ- produced by a wide network of state subsi- ed management of leftovers, food associa- dized bakeries was investigated. The spe- tions and other details about ritual foods, cial foods consumed during feasts and taboos, variations within the family and religious fasts and rituals, both Muslim and child feeding, and the composition of dry Christian, were noted. uncooked meals. Information was sought Special attention was accorded to urban on eating outside the home, including the dwellers, who represent about 45% of the food consumed by schoolchildren during total population [12] and who are more ex- the school day and what labourers (e.g. posed to factors that can engender signifi- Eastern Mediterranean Health Journal, Vol. 10, No. 6, 2004 901 cant changes in food habits. Changes in the soil, Egypt stood out from its neighbours geographic distribution of food consump- owing to the abundance of cereals and the tion patterns and trends that developed over wide range of edible vegetables that could the past half century among the people liv- be grown. ing in Greater Cairo (which hosts nearly a The Egyptian dietary pattern became quarter of the total population) were also structured around the flood cycle of the noted. The foods and beverages consumed river Nile. The diet was more dependent on outside the home in the 1950s, from fast cereals, dried legumes and preserved foods food outlets and ambulant vendors, were when the land was under water. From ne- compared to the type of foods and bever- cessity, Egyptians perfected a number of ages commonly consumed outside the food preservation techniques over the ages. home fifty years later. These included They preserved cheese, cereals, fruit, le- shops, kiosks, and sidewalk vendors who gumes, vegetables (including dark green sell biscuits, candy and a variety of other leafy vegetables), fish, meat, grains, aro- food items and beverages to children out- matic seeds and condiments. and side school gates. garlic were available all year round. This An attempt was made to identify factors know-how has survived to the present time that enhanced or precipitated changes in and is manifest by the important place that eating habits as well as those which helped dried legumes, cereals and dried and pre- preserve traditions and counteract change. served foods occupy in the diet of the mod- Special attention was accorded to varia- ern Egyptian and in the composition of tions in the supply and demand for dark food stores in a traditional home. green leafy vegetables and to factors influ- The difference in food habits between encing their consumption. An overview is the north and the south of Egypt is a func- given of some of the significant changes in tion of factors such as climate, crop com- food consumption habits that occurred position (conditioned by the type of during the past half century. The emer- irrigation and the agricultural cycle), the gence of manifestations of unbalanced di- daily occupation of the inhabitants and the etary intake was monitored, in particular, degree of exposure to and interaction with among the more vulnerable child popula- external influences. Certain eating habits tion. New trends and factors that under- are dictated by the extreme heat of the mine the food system and the potential summer months where temperatures can health implications of such trends are re- reach well over 40 °C in the south. viewed. Food analysis tables for prepared foods have shown that the traditional food associ- ations and preparation methods contributed Results considerably to raising the nutritional value A balanced heritage of the foods consumed [13]. The Egyptian Certain characteristics of the Egyptian tra- food system is full of examples of the use ditional food system are the outcome of the of such mixtures and of food associations specific ecology of Egypt and the Nile val- that compensate for the essential nutrients ley. A crop composition that remained prac- that may be deficient in 1 component of the tically unchanged for many millennia meal. The classic example is that of the allowed ample time for the development of stewed ful (fava bean) meal, which is the a balanced food system over the ages. Be- most popular and most widely consumed cause of the fertile and easily cultivated food. Taken individually, bread and beans, 902 La Revue de Santé de la Méditerranée orientale, Vol. 10, No 6, 2004 which are the main components, are defi- other ingredients. It is the main component cient in a number of essential nutrients. in all meals. Egyptians eat food with bread, However, the analysis of the prepared ful and not bread with food. Food other than dish, as it is eaten, shows that the presence bread is colloquially referred to as ghomous of the other ingredients has appreciably (literally, a dip): a piece of bread is broken raised the nutritional value of the meal. The off and dipped in the ghomous. Food eaten generous amounts of a mixture of dark with bread can be as simple as salt or a green leafy vegetables and herbs that are mixture of salt, and sesame seeds, commonly added to a variety of dishes in an , white radish leaves, some aged the last few minutes of preparation, e.g. to white cheese, or the more complete meal of cooked colcasia (taro, Colocasia esculenta cooked vegetables or legumes. More re- Schott) and some legumes, is another ex- cently, the habit of eating bread in the form ample. Khodra (greens), used in a propor- of sandwiches using European style white tion of about 1:5 of the dry weight of the bread has taken hold, in particular among legume, is a complementary source of a children. Cheese, processed, tinned or number of vital nutrients. Dark green herbs cooked meats, fried potatoes, pickled aub- and leafy vegetables, eaten daily either ergines, eggs, and even bananas are some fresh or cooked, are an essential ingredient of the fillings that are used. For those who in the Egyptian diet, and are associated with can afford them, the hamburger, pizza or many dishes (Table 1). Dried chickpeas, the generously garnished composite mod- sesame and fenugreek are some food items ern sandwich are becoming popular. that can raise the nutritional quality of the Cereals and legumes constitute the foods they are associated with. The en- mainstay of the diet in the population as a hancement of the nutritional value of foods whole and are the main sources of calories through germination (e.g. fava beans), and proteins [14,15]. The nutritional bal- sprouting (e.g. fenugreek), or fermentation ance of a diet based on a cereal/legume mix is still commonly practised. The latter is is maintained through the regular intake of used in the making of kishk, sun-dried balls small amounts of white cheese or other of wheat fermented in sour milk. dairy products, fresh dark green leafy veg- Maintaining the nutritional quality of the etables, and less regularly eggs, poultry and Egyptian food system depended not only birds, fish and occasionally red meat. Fresh on the types of foods eaten, but also on the and cooked vegetables and fruits complete way they were consumed, on food associ- the system. For the average Egyptian, fruit ations, on methods of food preparation and consumption is not meal-related and is usu- conservation, and also on the quantities ally dependent on seasonal availability. This consumed. The food groups that are con- was not a source of worry for the first gen- sidered the pillars of the traditional Egyp- eration of Egyptian nutritionists as long as tian food system include cereals the essential nutrients provided by a daily (unrefined), legumes, dark green leafy veg- fruit intake were supplied from other etables, other vegetables and fruits, cheese, sources, also consumed fresh. In this re- oils and white and red meat. spect, the was sometimes referred to as the poor man’s apple since it was rich Basic features of the Egyptian diet in vitamin C and was available all year Bread, the staple food, enjoys a very special round (A. Hassan, personal communica- place in the diet. It is still made from high tion). extraction wheat flour or wheat mixed with Eastern Mediterranean Health Journal, Vol. 10, No. 6, 2004 903

Table 1 Dark green leafy vegetables commonly consumed by Egyptians

Vegetable Mode consumed Common name Latin name Raw Dried Cooked

Aromatic herbs Petroselinum sativum +–+ Coriandrum sativum +++ Anethum graveolens +–+ Chervil (regl el ghorab) Carum amioides +–– Mint Mentha sativa ++– Green leafy vegetables Romaine lettuce Lactuca sativa +–+ Garden rocket (gargeer) Eruca sativa +–– Jew’s mallow (molokheya) Corchorus olitorius –++ Spinach Spinacea oleracea ––+ Mallow (khobeza) Malva parviflora ––+ Swiss chard (sal’) Beta vulgaris –++ Purselane (regla) Portulaca oleracea ––+ Green leaves of roots/bulbs White radish Raphanus sativa +–– Turnip Brassica rapa ––+ Onion (green onion) Allium cepa +–+ Egyptian leek Allium kurrat +–+ Celery Apium graveolens ––+ Leaves of edible plantsa Garden pea Pisum sativa ––+ Cowpea Vigna sinensis ––+ Egyptian bean (lablab or gashrangeig) Dolichos lablab ––+ Okra Hibiscus esculentus ––+ Edible leaves of fruits Vine Vitis vinifera ––+ Edible wild plantsa Hare’s lettuce (go’deid) Sonchus oleraceus +–– Rampion (serees) Campanula rapunculus +–– Prickly goldenfleece (galawein) Urospermum picroides +–– Sheep sorrel (hommeid) Rumex acetosella ––+ Wild lettuce (lebbeen) Lactuca virosa +–– Purselane (regla) Portulaca oleracea +–+ Mallow (khobbeza) Malva parviflora ––+ Sprouted legumes Fenugreek sprouts Trigonella fœnum-græcum +––

aCollected by the peasants from the fields (of clover, wheat and beans) and canal banks, these wild weeds as well as the tender leaves of edible crops are usually gathered for personal consumption. Common local names are given in italics. 904 La Revue de Santé de la Méditerranée orientale, Vol. 10, No 6, 2004

Although there is no special penchant dry biscuits of all shapes that are salty or for excessive salt seasoning, Egyptians lightly sweetened, and containing a mixture tend to consume more salt during the sum- of aromatic or oily seeds such as fennel, mer months through eating old white aniseed, caraway, sesame or linseed are cheese, olives, pickled vegetables, and salt- widely consumed. Dried fruit pastes or ed fish. The last is a regional habit popular cooked honey are the traditional sweet fill- in the very hot southern governorates. Salt, ings for some of these biscuits. For the av- cumin and coriander seeds have been the erage Egyptian, sweetmeats and desserts main seasoning agents since ancient times. are not a regularly consumed food item but Till now, is absent from many are more related to religious feasts and var- of the kitchen shelves of the more isolated ious other celebrations. For the Prophet southern villages of the Nile valley. Egyp- Muhammad’s birthday, a wide variety of tians are not lovers of hot chilli peppers like sugar-based sweetmeats and colourfully their western and southern neighbours. decorated sugar dolls and knights on horse- They tend to follow the Eastern Mediterra- back are produced. This tradition, particu- nean countries in this respect. Vinegar and lar to Egypt, is a legacy of the Fatimid limes have been extensively used since an- period (969–1171 AD) when the crafts- cient times [16] in food preparation and in manship for cane sugar artistry flourished. particular in the making of pickled vegeta- The heritage of ritual food habits and bles and olives. culinary traditions of the Copts [11] repre- Traditionally, the diet is low in saturated sents an unbroken continuity with ancient fats, and oil is commonly used for cooking habits. The foods consumed during the rather than butter. Deep-frying is an im- meatless fasts that are observed for about ported habit that is less than 200 years old. two thirds of the year are derived with ce- At the present time, it is used in the cooking reals, legumes, vegetables, green leafy veg- of the very popular fried fava bean patties etables and fruits. Given their pre-Christian known as ta’ameyya or , a relatively origin, these foods are eaten by all Egyp- new introduction. Recipes tend to be sim- tians, though to a lesser extent by those ur- ple and straightforward, and ingredients are ban dwellers who have adopted imported usually mixed raw and cooked in the oven food habits. in earthenware pots or boiled. Slow cook- The Muslim fasting month of Ramadan ing overnight is used for stewing cereals is associated with a set of traditions related and dried legumes such as wheat and fava to food that make many people eat a richer beans. Steaming continues to be done in diet during the non-fasting hours that ex- specially designed pots, metal now replac- tend from sundown to sunrise. Consump- ing the original earthenware utensils. Birds tion of dried fruits, all kinds of nuts, and fish are often grilled. Pigeon and quail oriental desserts rich in fat and sugar, as can also be eaten stuffed with fereek well as a daily cooked meal for breaking the (rubbed green wheat) or rice. Larger birds fast often adds up to a higher calorie con- such as poultry, geese and ducks are usual- tent than the usual, non-fasting, daily in- ly boiled. The traditional method of searing take. Meat and poultry consumption is the boiled bird or meat for a few minutes in increased as families tend to serve meat a very hot traditional oven has now been each day even if they did not usually eat replaced by frying in oil or clarified butter. that much meat. The government makes The Egyptian is not traditionally renowned special provision for the nationwide in- for having a sweet tooth. A wide variety of crease in food consumption during Ra- Eastern Mediterranean Health Journal, Vol. 10, No. 6, 2004 905 madan. Preparations for this month involve Table 2 Some traditional non-alcoholic the import of large quantities of nuts and beverages still consumed in Egypt dried fruits, to which are added the local dates and peanuts. However, alongside this Traditional beverages rich food, 2 traditional food items appear daily on nearly every table in rich and poor Cold infusions Red sorrel (karkadeh) Hibiscus sabdariffa homes alike. These are ful, stewed fava beans, and all kinds of dark green leafy Carob (kharrub) vegetables (Table 1). Licorice drink (erq’soos) A wide variety of drinks and beverages Dom Hyphaene thebaica are an important component of the food Hot infusions system as they are consumed in consider- Tea (black) able amounts during the hot summer Coffee months. Many of the traditional drinks Fenugreek (whole) based on natural products (e.g. karkadeh (ground) and fenugreek) are known to have a benefi- Hibiscus (karkadeh) cial effect on health (Table 2). Their re- (ground) placement by commercially produced Mint leaves carbonated drinks, other soft drinks and Cumin seeds fruit nectars entailed a significant increase Fennel seeds in the daily sugar intake apart from depriv- Caraway seeds ing the body of the health benefits of the Aniseed natural beverages. The habit of consuming Barley small glasses of sweetened black tea is also Juice (freshly pressed) popular. It is an important source of ready Sugar cane, pomegranate and other fruits in calories for workers during the long inter- season val between the waking up drink and the Composite recipes next meal. While tea drinking can be la- Moghat (traditionally given to parturient belled a national habit, coffee drinking is mothers, with ground wild pomegranate root less popular. Generally speaking, coffee is as the basic ingredient) Sahlab (a milk drink made with ground orchis rarely consumed among the fellaheen and root as the main ingredient) Orchis latifolia manual labourers; it is more common in ur- ban populations. The serving of unsweet- Sherbets and syrups (now mostly commercialized) ened coffee at a wake is, however, a Rose petal syrup Violet petal syrup traditional custom observed by most Egyp- Fruit based syrups, made from juice of tians. mulberries, pomegranate, strawberries, etc. It may be opportune to comment on the Syrups made from concentrated extracts of way that meat is perceived by Egyptians tamarind and carob and its place in the diet. With plenty of fish Reconstituted sun-dried sheets of fruit pulp in the river and poultry and pigeons in the Apricot (qamareddin) back yard, red meat is not a regular element Mango in the diet of the fellaheen, or for the aver- Other (salted) age Egyptian with a limited income, or for Pickling water of turnips the Copts who observe a meatless fast for Seasoned water of boiled chickpeas more than half the year. Meat is more com- monly consumed on Fridays (the religious 906 La Revue de Santé de la Méditerranée orientale, Vol. 10, No 6, 2004 day of rest for Muslims) and is eaten during often cooked and served apart. Fruit may feasts or for meals celebrating special oc- or may not be eaten at the main meal. It is casions. Well-to-do households that can af- more usual to end the meal with a glass of ford it tend to consume high amounts of tea or other hot infusion (Table 2). animal protein. Meat tends to be regarded For the majority of the fellaheen, manu- as a status symbol or a prestige item for al labourers and artisans, the midday meal households with limited incomes. Never- consumed at the workplace is a smaller and theless, the ancient habit of serving several usually uncooked meal made up essentially meat dishes when giving a banquet [6] con- of bread eaten with cheese and/or fava tinues to be the practice. Today, families beans, onions and green leafy vegetables, with modest incomes still make a point of often accompanied by tomatoes, pickled serving 2 or more meat dishes when enter- aubergines, or other pickled vegetables. taining guests. Till about 2 decades ago, the main cooked meal for millions of public sector Meals and meal patterns employees, who worked 6 days a week The first meal of the day is small. It is made from 08.00 to 14.00, was at around 15.00. up of a drink taken alone or accompanied With the new 5-day working week and by a piece of bread, a dry biscuit, a bowl of longer working hours adopted by the stewed whole wheat, or just some broken growing private sector as well as some of dry bread soaked in milk or other hot infu- the government institutions and services, sion. Children usually have a glass of milk there has been a shift of several hours in or tea with milk and a sandwich. What the the timing of the main cooked meal. The average Egyptian refers to as “breakfast” is presence, in this group, of relatively high what is eaten between the waking up drink salaried private sector and banking employ- and the main cooked meal. It is a between- ees who already lead a modern lifestyle meal snack of varying importance, from a makes this group a prime consumer of the few dry biscuits to a cheese sandwich or modern type of fast foods (Table 3). The more often a ful or ta’ameyya (fried bean main meal is consumed upon return home, patty) sandwich or a pastry. i.e. around 18.00 hours. This late timing The Friday breakfast, eaten at leisure brings it nearer to the traditional timing of and en famille, is a more generous meal. the main cooked meal eaten by peasants Stewed beans, eggs, green leafy vegeta- and labourers at the end of their long work- bles, onions, tahina (sesame paste) salad, ing day. However, it appears that the 2 eat- ta’ameyya, pickled vegetables, cheese, ing patterns, the old and the new, stewed whole wheat (belila) or home made sometimes co-exist. Those who have eaten noodles, butter or cream, honey, molasses at 18.00 can again eat a full cooked meal if and all kinds of jams are some of the food invited out. A rapidly growing demand has items that can appear on a Friday breakfast been observed among urban populations table. with long working hours for the modern The main cooked meal is usually made take-away type of meals commonly con- up of bread eaten with cooked vegetables sumed at the workplace. For them, this is a or legumes, with pickles and green leafy between-meal snack and not counted as a vegetables or a finely chopped mixed salad meal. Many of them tide over this period on the side. Meat, for those who can afford with only beverages and a pastry. it, is cooked with the vegetables and less Eastern Mediterranean Health Journal, Vol. 10, No. 6, 2004 907

With the growing industrialization of the pattern. Some work 8-hour shifts with no country, meal times for industrial workers lunch break while others can work for a have also been changing, with no unified long day with a 1-hour midday break. For

Table 3 Changes in availability of fast food from 1950 to 2000 in different outlets in traditional and western style neighbourhoods

Type of food Neighbourhood Traditional Western 1950 2000 1950 2000

Fast food outlet Hamburger meal – – – + Pizza – – – + Fried chicken – – – + Grilled chicken – – – + Cafeteria style shops –– ±± Grilled pigeons ± + + + Grilled and + + + + Ful (fava beans) and ta’ameyya (fried bean patty) meal + + + ± Koshari (rice and lentil dish) + + – ± Veal head, offal and rice sausage + + – – Fixed stand/counter Feteera, pastry with a variety of fillings + + – – Fried fish + + + + Grilled fish + + + + Grilled beef or chicken shawerma sandwiches – – ± + Western style panini sandwiches with composite filling – – – + Simple sandwiches + + + ± Regheef el-hawawshi, minced meat in flat local bread + ± – – Mobile cart or stand Koshari, rice and lentil dish + + – – Ful and ful sandwiches + + + + Shamsi a bread and old white cheese + ± – – Ambulant vendor Borek, pastry with white cheese filling + + + – Semeet, bread rings with rumi (hard) cheese or dokkab ++ ++ Veal head, offal and rice sausage + ± – –

+ available, ± occasionally available, – not available. aTraditional Upper Egyptian bread. bMixture of salt with ground cumin and sesame seeds and other aromatic ingredients. 908 La Revue de Santé de la Méditerranée orientale, Vol. 10, No 6, 2004

Egyptians this is not a main meal. This pat- For those whose main meal is con- tern is similar to the traditional pattern of a sumed at lunch time, the evening meal is midday meal consumed at the workplace lighter and usually made up of what is re- and the main cooked meal eaten upon re- ferred to locally as dry foods (i.e. without a turn home in the evening. The group that sauce). Leftovers from lunch are often works a straight 8-hour shift without a served again in the evening. Some of the break will return home for the main meal in common evening meal components apart a pattern similar to that of public sector from bread include fava beans and lentil employees, except that they have no access based dishes, cheese, dark green leafy veg- to the pre-main meal snack. etables, pickled vegetables, tomatoes and There is a rapidly growing number of cucumbers. Melon or watermelon eaten working women at all social levels. Chil- with white cheese and bread make up a dren who return from school at an earlier popular summer menu. For children, a time than their working parents do not al- favourite nutritious evening meal is bread ways have a meal upon their arrival home. dipped in a molasses-tahina mix. Tinned They may have to wait for the return of foods such as mackerel, sardines, tuna, their parents to eat with them. Parents do beef, processed beef or poultry can be eat- not seem to mind that their children tide en with bread or made into sandwiches this long period between breakfast and the with a salad or pickled vegetables on the main meal with a sandwich, a soft drink, side. Few households serve a second candy, or with any of the rapidly growing cooked meal at night. This is usually re- array of junk foods [17]. This means that served for the instances when guests are the peak hunger period for the growing invited. child is appeased with foods of doubtful A food habit that has survived till today nutritional quality, which are often eaten is that of nibbling different snacks. Nib- under little control or supervision. As a bling is favoured following the evening consequence, the children are poor eaters meal, and snacks are more often consumed when they sit at the main meal [18,19]. The outdoors during the long summer evenings. ill-effects on the health of children of a cy- With television watching, nibbling (and cle of irregular mealtimes and nutritionally food consumption in general) can continue imbalanced food intake may be further late into the night. Traditional snack foods complicated by long hours of television (Table 4) comprise a variety of different watching accompanied by more consump- food items and continue to be enjoyed by tion of junk foods, soft drinks, candy and the rich and the poor of all ages. Some of sweets [20]. While the rise in the incidence them are highly nutritious and can repre- of iron deficiency anaemia and obesity sent a non-negligible supplement to the dai- among children has already been reported ly nutrient intake of a child. Their [21], no investigation has yet been under- replacement by sweets, candy and junk taken of the set of symptoms and com- foods is much less advantageous to the plaints that are commonly reported these food system. days by the mothers themselves. These symptoms include constipation, irritability The onset of change and recurrent headaches that are not related In the mid 20th century, the basic elements to any sickness. of the traditional Egyptian diet were for the Eastern Mediterranean Health Journal, Vol. 10, No. 6, 2004 909 larger part still preserved, more so among Table 4 Some traditional snack food the rural communities and the Copts whose consumed by Egyptians diet and ritual foods are little affected by change. The legacy of the succession of Traditional snack food external influences leading to changes in Legumes food habits was more evident in the larger Green chick peas (malana) urban communities and the coastal towns. Boiled chick peas The higher social classes were much more Roasted chick peas readily influenced by the food habits of the Green fava beans (ful herati) foreign ruling elite. Most of the influence Roasted germinated fava beans (ful meqeli) was eastern Mediterranean and, to a lesser Germinated fava beans extent, European, North African and Arab Lupine (soaked and boiled) (Arabian peninsula). The simply prepared Sprouted fenugreek seeds foods of the traditional diet gave place to Roasted peanuts elaborate dishes requiring complex, lengthy Vegetables preparation and generous amounts of clari- Egyptian red carrots fied butter, with less attention to the con- Romaine lettuce sumption of fresh vegetables. Deep-frying, Tubers (habb el aziz) the use of rich, composite sauces and the Tiger nuts growing popularity of rich sweetmeats and Grains and seeds desserts containing nuts and soaked in Popped corn (maize) heavy syrup considerably raised the overall Grilled fresh corn on the cob intake of sugars and saturated fats. White Roasted wheat grains Roasted pumpkin seeds bread, in many instances, replaced the tra- Roasted cucurbit seeds ditional high extraction local bread. Many Roasted melon seeds of the nutritionally valuable traditional food Fruits associations were ignored. For people liv- Christ thorn (nabq) ing in poverty or those with limited in- Jojoba (ennab) comes, changes were more related to the Golden berry (harankash) need to cope with rising food costs and to Dom palm fruit making nutritionally correct choices. By Sycamore fig necessity, they depended on the cheaper Prickly pear traditional foods and the subsidized local Other bread. For this group, the continued con- Sugar cane sumption of fresh dark green leafy and oth- er vegetables was a nutritionally valuable traditional habit. A series of changes in the food habits prior preparation or guidance on how to and lifestyles of the rural populations fol- deal with new situations and new food lowed the acceleration of rural develop- products. ment programmes (and modernization) Two major developments directly influ- which gradually ended the traditional isola- enced changes in food habits. The first was tion of the fellaheen. Rural populations be- the creation of a nationwide network of came exposed to a host of unfamiliar cooperative societies, game’eyya ta’awo- external influences and lifestyles with little neyya, (a successor to the food rationing 910 La Revue de Santé de la Méditerranée orientale, Vol. 10, No 6, 2004 system introduced during the Second The last decades of the twentieth centu- World War) to serve as distribution outlets ry witnessed a further acceleration of for subsidized or price-controlled foods. change in the form and substance of the These cooperatives were instrumental in Egyptian diet. Change was accelerated by introducing rice, a hitherto unfamiliar food the liberalization of the market and the for the southerners who traditionally con- “open door” economic policy, which gave sumed fereek (rubbed green wheat) in- rise to indiscriminate and uncontrolled con- stead. Equipped with cold storage facilities sumer desire for imported commodities for the distribution of frozen foods, the co- and western lifestyles [20]. The spread of operative societies were the end point in a this trend was facilitated by the rapid social cold chain for the distribution of imported mobility [23] that followed in the wake of frozen foods. Subsidized imported meat the 1952 revolution and the access by mid- and chicken were important supplements dle income and low income groups of the to the food system during the economically population to the much higher earnings of difficult decades after the end of the war. family members working in the Gulf coun- The Egyptians, who always preferred to tries. This increase in the purchasing pow- eat freshly slaughtered meat or poultry, er of Egyptians was also a result of the were very slow in accepting frozen meats. gradual increase in the per capita gross do- The same cold chain served to distribute mestic product over the same period cheap frozen fish from Lake Nasser, which [24,25]. reached the tables of a growing number of Government efforts to extend the public Egyptians, adding a precious source of broadcasting (radio and television) service high quality protein. Cooperatives also to all the inhabited areas in the country served as outlets for the sale of price- brought inside homes images of unfamiliar controlled chicken and eggs produced by modern lifestyles. Aggressive marketing the growing numbers of state-backed com- campaigns for the modern foods that ac- mercial chicken farms. All these develop- companied the new lifestyles found their ments led to an increase in the consumption mark in the targeted population of youth of animal protein in groups of the urban and children. The phenomenal popularity of population with modest incomes. junk foods among children does not seem The second development was the estab- to be confined by any socioeconomic or lishment of a network of mechanized bak- geographic barriers, making this group a eries producing mainly the high extraction prime consumer of junk foods. Families in local bread, and to a lesser extent, a thin flat all walks of life were overtaken by the de- white bread known as shami bread. These mands of the unfamiliar lifestyles and pat- bakeries, using subsidized flour and selling terns, in particular, the longer working a price-controlled loaf, produced bread that hours and the inevitable change in the eat- was considerably cheaper for the fellaheen ing pattern. Deprived from the support tra- than home production. Home baking be- ditionally enjoyed as members of an came reserved for special occasions, feasts extended family, parents in the modern nu- and celebrations. The younger generations, clear families found themselves ill equipped both rural and urban, are turning more to and unable to cope. Problems were felt white bread, preferring the European-style more where both parents worked or in loaf. They find it more suited to their sand- families with a woman as head of house- wiches [22]. old. The ability to cope was further cur- Eastern Mediterranean Health Journal, Vol. 10, No. 6, 2004 911 tailed by the low purchasing power of low- fected those food elements, such as high income families. extraction bread, legumes, fresh dark green leafy vegetables, and other vegetables and fruits, which are the pillars of the system Discussion and which have high nutritional value. It became evident towards the end of The variety and abundance of food in the last century that the healthy diet of Egypt over the ages preserved it from Egyptians, developed over thousands of change [3]. The food balance of the coun- years and which had till then retained its try started to break down in the middle of essential features, was progressively losing the 20th century, which marked the start of some of its essential elements and rapidly food importation and the beginning of a disintegrating. The rapidity of change in gradual decline in the tradition of food self- food habits accompanied equally rapid so- sufficiency [4]. The demands of an in- cial and economic transformations. The creasing population that were not paralleled changes were accelerated in the 1970s with by an increase in the total inhabited and cul- the liberalization of the economy. It is ap- tivated surface area widely surpassed local parent that people at all levels of society food production. In 1947, there were 19 were overwhelmed by the rapidity of the million inhabitants living on 4% of the total change. surface area of Egypt. This rose to almost The change was quicker to take hold in 66 million living on about 5.3% of the sur- the urban populations, which represent face area in the year 2000. It took several nearly half the total population of the coun- centuries for the Egyptian diet to develop try. Not having access to nutrition guid- and take root. The Egyptians who were ance, they adopted ready solutions that well settled in their habits were not all able were not backed by nutritional awareness to adjust to or cope with the rapid changes or discrimination. These new choices were that occurred during the past half century, made easy by a higher purchasing power and in particular the past 2 decades. Those and a strong desire for modernization. The changes were in the greater part related to choices were also influenced by aggressive the modernization and industrialization of advertising campaigns and the easy acces- the country. The increase in the number of sibility of junk food, candy and soft drinks. women working outside the home, women It is disturbing to observe the way heads of household and nuclear families did present day Egyptians are trading their di- not make matters easier. Little help or guid- etary heritage for unbalanced, unhealthy ance was offered on how to adapt to a foods. Much time and effort could be spent changed pattern of life or on how to make on a fine analysis of the causal web of fac- the right choices to ensure a balanced daily tors that makes the Egyptian lose grip on food intake. the traditional diet. It would be more cost- The traditional diet of Egyptians is made effective to investigate why the new trends up of basic elements regarded as the essen- are taking hold, to find ways to protect tial components of the system. Any chang- good food habits and to identify the inter- es in food habits strong enough to disrupt ventions or the means which would pre- the balance of the system without being serve the integrity of a balanced food compensated for will, unless corrected, system. lead to malnutrition and ill health. It would be a cause for concern if the imbalance af- 912 La Revue de Santé de la Méditerranée orientale, Vol. 10, No 6, 2004

One of the important approaches in a of the Egyptian food system. This practical multi-pronged strategy to improve the nu- approach would need to highlight those tritional quality of the Egyptian diet would foods that are better adapted to the de- be the creation of nutritional awareness and mands of modern life and provide informa- developing the capacity for nutritional dis- tion on meal composition and on ways of crimination among the Egyptian public. reducing food preparation time. It should This could be achieved through the mobili- draw attention to foods that combine low zation of well-informed and coordinated cost with high nutritional value. Guidance support from those involved in monitoring in managing child feeding will need to be the nutrition situation and in formulating based on the results of a comprehensive policy and interventions that could preserve evaluation of the situation and the problems the nutritional quality of the traditional food that children face. system. Their task would be to promote an All approaches in a strategy to protect evolution of the food system and enable it the traditional system will need to be adapt- to cope with and accommodate the chang- ed to the demands and requirements of all es that have occurred. The information socioeconomic strata of the population in generated could become instrumental in the all situations and settings, whether wealthy creation of an enlightened consumer and a or deprived, rural or urban. consumer society that would have the The shortcuts and easy solutions that power to influence and shape the food mar- offer themselves, such as the consumption ket. of the new fast foods, may solve immediate A second approach, complementary to problems and satisfy immediate needs in the above, would be to support and guide the short term. In the long term, however, families in adjusting meal patterns and ignoring the needs of children or compla- composition to cope with new lifestyles cency about the types of food that they and changes in daily routine. No carefully consume will certainly give rise to malnu- planned adjustment has been made to ac- trition. Iron deficiency anaemia, obesity commodate the long working hours which and undernourishment are becoming more have been in operation now for nearly 2 and more common among Egyptian chil- decades. Egyptian families were not ade- dren [21]. Correcting the dietary deficien- quately prepared to cope with the problems cies alone will not solve the problem. Help that the longer working day created. Shift- and guidance needs to be provided to reor- ing the main cooked meal to late afternoon ganize family meals in a way that satisfies has been the solution adopted by most fam- the nutritional needs of children. ilies. The problem of no provision for a The growing trends for increased con- meal on children’s return from school, sumption of fast food, junk food, sweets commonly the case in nuclear families and candy instead of the more wholesome where both parents are working, and in the traditional snacks, and for consuming soft absence of the support of the traditional drinks with a high calorie content instead of extended family, has not been properly in- the traditional natural beverages are viewed vestigated. as a social and a market phenomenon. A third approach would be to help fam- These products have become popular with ilies regain confidence in traditional foods all ages and all social groups. Aggressive and in the possibility of eating modern marketing campaigns are finding fertile, meals without losing the essential features ground especially among the younger gen- Eastern Mediterranean Health Journal, Vol. 10, No. 6, 2004 913 erations. The cost on health of the spread national campaign for promotion of change of these habits is high because of the higher is decisive enough, the market will follow calorie and fat intake, lower intake of vita- because this is where the profit lies. Once mins and minerals, unaccustomed increase the market responds and reflects the de- in the daily intake of animal proteins, and sires of enlightened, discriminating con- most importantly exposure to toxic sub- sumers, they will then become its strongest stances and mutagens identified in some ally when it promotes modified, healthier fast food meals and in junk foods that often products. contain artificial colours, flavours, and uni- dentified food additives [26] What the Egyptians do not know is that Conclusion the traditional diet that they are abandoning Egypt has a valuable heritage of a well- is what the western world is now seeking established and balanced diet which per- to eat [2,27]. Also, from a nutritional point sisted practically unchanged for the best of view, the uncontrolled consumption of part of 5000 years. This valuable indige- these modern foods does not represent nous food system must be protected and progress, but a regression. The intellectual compensated for losses suffered through impulse to blame market forces is mis- the adoption of new food habits. A number placed. The market is only a reflection of of appropriate interventions need to be the desires of the people at a given point in identified suited to the current circum- time and space. Industry makes extensive stances for each sector of the population. studies into the behavioural patterns of the These interventions should be able to pro- people in order to be able to satisfy them tect the essential features of the traditional and, in turn, to guarantee their own gains. system and offer options to compensate It is the duty of nutritionists to work on a for deficiencies. An enlightened and dis- medium/long-term basis to shape those de- criminating consumer can shape the mar- sires. This would be instrumental in en- ket and reverse the ill effects of the trend couraging the government to develop a towards excessive consumption of fast policy to shape the market according to the foods and other unhealthy foods. Reorgani- new desires that we have helped to form. zation and adjustment of mealtimes and The case of a soft drink company respond- meal composition to meet the demands of ing to the desire to consume less sugar by altered lifestyles would be a valuable back- producing a diet version of their cola, and up to the discriminating consumer. Nutri- removing the stimulating substance in the tionists need to formulate a multi-pronged drink and marketing a decaffeinated ver- national policy for teaching nutritional dis- sion are examples of response to the de- crimination, not only nutritional education, sires of the discriminating client. so as to enable people to differentiate the Interdictions do not give rise to results. good from the bad, in relation to “me” and When nutritionists succeed in shaping hab- “my needs”. This is an exercise that needs its by the creation of a discriminating con- to start with the younger generation in par- sumer, a strong consumer society will in ticular in schools. turn be able to influence the market. If a 914 La Revue de Santé de la Méditerranée orientale, Vol. 10, No 6, 2004

Acknowledgement life-long research contributed to a better understanding of the traditional wisdom This work is dedicated to the memory of that guided the evolution of Egyptian food my mentor and teacher, Professor Ali Has- habits across the ages. san, the father of nutrition in Egypt. His

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