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It’s not overstating it to say that I have cited Dr. Artemis Simopoulos’ work in virtually every lecture I have ever given that included the topic of omega-3 fatty acids. She is an incredible human being, indomitable NIH researcher, and absolute legend in her field. In our conversation on New Frontiers, Dr. Simopoulos reviews those essential truths about the evolution of our dietary intake of omega-3 vs. omega-6 fatty acids, the increase in ultra-processed food consumption, and how these play into our health landscape today. She also pulls on some particularly interesting threads around genetic variability in our ability to metabolize fatty acids and the implications of this for inflammatory conditions (of course, almost all chronic diseases have an inflammatory component). This is especially relevant for “rapid metabolizer” populations that tend to over-produce prostaglandins and leukotrienes, compared to resolvins, when exposed to a standard American diet. I know her insights will inform how you personalize your recommendations. – DrKF
Are You a Fast Metabolizer of Omega Fatty Acids? Lessons from a Legend.
Dr. Artemis Simopoulos, a pioneering researcher in nutrition and genetics, discusses her groundbreaking work on the importance of omega-3 and omega-6 fatty acid ratios in human health. She explains how her research at the NIH revealed that humans evolved consuming a 1:1 ratio of omega-6 to omega-3 fatty acids, but modern diets often have ratios as high as 20:1. This imbalance is a significant contributor to the prevalence of chronic disease. Dr. Simopoulos emphasizes the need to balance these essential fatty acids through diet and supplements, highlighting the benefits of the traditional Cretan diet and the dangers of ultra-processed foods. She also discusses genetic variations in fatty acid metabolism and the importance of personalized nutrition.
In this episode of New Frontiers, learn about:
- The ideal ratio of omega-6 to omega-3 fatty acids is close to 1:1, based on evolutionary and clinical evidence
- Modern diets, especially those high in ultra-processed foods, often have unhealthy ratios of up to 20:1 omega-6 to omega-3
- 90 percent of Americans are not consuming enough omega-3 fatty acids
- Imbalanced fatty acid ratios contribute to chronic diseases like obesity, diabetes, and cardiovascular disease
- The traditional Cretan diet provides a model for balanced omega-3 intake throughout daily meals
- Supplementation with omega-3s may be necessary to achieve optimal ratios in modern diets
- Ultra-processed foods not only have poor fatty acid ratios but may contain unknown compounds with potential health effects
- Genetic variations affect fatty acid metabolism, necessitating personalized nutritional approaches
- 80 percent of African Americans, 50 percent of European-originating populations, and 25-50 percent of Asian Americans have genetic variants leading to more rapid metabolism of omega-6 fatty acids
- Genetic variants were helpful for populations’ traditional diets but become a risk when exposed to a standard American diet high in omega-6
- Accelerated metabolism of omega-6 fatty acids can potentially increase risk for inflammatory conditions when combined with a high omega-6 diet
- Balancing omega fatty acids can influence gene expression and potentially slow the aging process
- Simopoulos’ recommendations for the optimal foods to eat
Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine and today, of course, is no exception. If you’re joining me on YouTube, you can see I’m sitting next to really one of the people who has influenced the course of my thinking and my career. Someone whose work I have cited in virtually every lecture I’ve ever given where the topic of omega-3s has come up. She’s just an incredible human being with a wealth of knowledge to share with us today. Let me introduce you to her and we’re going to tuck right into what I think is going to be one of the best conversations I’ve had here on New Frontiers. This is Dr. Artemis Simopoulos, a pioneer in nutrition and genetics. She’s the founder and president of the Center for Genetics, Nutrition and Health, a nonprofit organization in Washington, D.C., and has been involved in cutting-edge research since 1990.
Dr. Kara Fitzgerald: She was at the NIH for many, many years, where she looked carefully at nutrition with a focus on omega-3s and omega-6s and actually the evolution of dietary patterns and dietary pattern changes. She’s known globally for this body of research. She’s published hundreds of pieces in peer-reviewed literature. She’s contributed to or written over 60 books. She currently, and what we’ll be touching on today is her newest book, The Healthiest Diet for You: The Scientific Aspects—there’ll be a link in the show notes. And what else can I say? It’s just a blessing, and I feel really grateful to be able to talk to you today. Dr. Simopoulos, welcome.
Dr. Artemis Simopoulos: Thank you very much for the very nice introduction. I’m very pleased to be here with you.
Dr. Kara Fitzgerald: Yeah. So many of us in the field of functional medicine are well aware of your work. You’ve just shaped our thinking. You are an endocrinologist, so I want to go way back for a minute before we tuck into all of the knowledge that you’ve unearthed for us. You’re an endocrinologist by training. I mean, how did you end up studying omega-6s and omega-3s and looking at evolutionary dietary patterns? What is your background, and what is this journey?
Dr. Artemis Simopoulos: Well, to begin with, I majored in chemistry at Barnard College at Columbia University and then I went to Boston University School of Medicine. At that time, I was interested in pediatrics, particularly in the early development of children. I was director of the neonatology unit at George Washington University Hospital and while I was there, I began to be aware of the metabolic changes in premature, as well as full-term babies, and that was a very new way of thinking. So I made some observations, and then the director of NIH invited me to join NIH. I really did not have to look for a job. And at that time, most of the young doctors at NIH—there were mostly young men who joined the Public Health Service and did not go to war.
Dr. Artemis Simopoulos: I think I was the only young woman at the time at the NIH, so I moved from pediatrics and metabolism into metabolic and endocrine disorders, and many of the endocrine disorders have a genetic component. So I ended up combining genetics, endocrinology, and genetic variation. And the moment you get into that field, you need to understand the evolutionary aspects of diet and the changes that have taken place and how that influences growth and development throughout the life cycle. So it’s not really that unusual.
Dr. Kara Fitzgerald: Right. So just as you were teasing apart, understanding the influence of genetics on health outcomes, you would be looking at—you know, in my postdoc position, I was under the direction of a nutritional biochemist. So we were looking at enzymes and the cofactors and so forth and how certain dietary patterns would favorably or negatively influence them. Was it something like that?
Dr. Artemis Simopoulos: Right. So at that time, I was doing research in children who had a metabolic disease that was called Bartter syndrome, which was named after the chief of endocrinology at that time. He had described it. And part of the research involved the metabolism of prostaglandins and it was at the time when, in Sweden, they got the Nobel Prize for prostaglandin metabolism. So I began to look into the nutritional aspects of prostaglandins. And that’s how I moved into the omega-3 and omega-6 fatty acids. They’re actually all connected. I just happened to be in the right place at the right time.
Dr. Kara Fitzgerald: Amazing. Yeah. So I was introduced to Dr. Somopoulos through Dr. Charles Serhan, who uncovered specialized pro-resolving lipid mediators—another derivative compound from omega fatty acids. And so, you were looking at prostaglandins, of course, which are also a family of incredibly important compounds. Very interesting. So then that would bring you to dietary patterns. No doubt, looking at this prostaglandin imbalance in this population, the dietary patterns — the amount of omega-6s and omega-3s— I’m imagining was influencing the course of this genetic condition. Is that right?
Dr. Artemis Simopoulos: That is correct. That is absolutely correct. And so in order to be able to understand human metabolism, you need to have very good knowledge of the composition of the diet. You need to know the changes that have taken place. You need to know if there are any specific genetic variants or if there is a family history. So you can bring all these factors together and move forward and that’s exactly what we did when I was chair of the Nutrition Coordinating Committee at the National Institutes of Health. We pulled together all the nutrition programs, not only of the NIH, but of the whole Department of Health and Human Services. What was going on at the CDC, the Centers for Disease Control, what they were doing in nutrition, what the FDA was doing, as well as what all the institutes at the NIH were doing in order to be able to see where the country is. Until that time, there had never been any coordination. So that was another factor that moved me forward.
Dr. Kara Fitzgerald: And now we really have a pretty extraordinary body of research. In fact, when I was looking into your work, we have this incredible body of NHANES data where we’ve been tracking how Americans eat over many years. And it’s from that data—which no doubt you have your fingerprints on—that we know that 90% of Americans aren’t consuming enough omega-3 fatty acids. And I want to go back before you comment on that, and actually, I’ll just throw another stat out because it’s fresh in my mind. Heart failure patients, looking at NHANES data, I think 98% have been shown to be deficient in omega-3 fatty acids. So you are the one who figured out that we evolved with a 1:1 ratio of omega-6s to omega-3s in our diet. We evolved with this radically different ratio of these incredibly important omega-3 and omega-6 fatty acids that produce all these important derivative compounds like the prostaglandins, the leukotrienes, the pro-resolving lipid mediators… You figured that out.
Dr. Kara Fitzgerald: Flash forward now to what— Two other points I want to make from your work is that you also realized that many of us are now consuming a 20:1 omega-6 to omega-3 dietary pattern. A 20:1 ratio. And then in your work, you further teased out that this ratio imbalance is associated with heart disease, with cancer, with allergic diseases, asthma, and on and on and on. So, when I talk about your work in my lectures, I am always attempting to just hit home this point that we are, in modern society today, in the midst of this unwitting massive deficiency that our body really doesn’t even know how to manage well because we evolved with very different metabolic information. So, talk to me about all of that.
Dr. Artemis Simopoulos: Well, let me tell you how it came about. I’m sure you and your audience are familiar with the Seven Countries Study on cardiovascular disease that started 50 years ago. At that time, they put particular attention on the Mediterranean diet and the diet of Crete, and olive oil, and saturated fat. And they didn’t pay any attention to the essential fatty acids, specifically omega-6 and omega-3.
Dr. Artemis Simopoulos: In terms of the fat studies, it was saturated fat and olive oil. Well, when I went back and looked at the data, I was determined to find out exactly what was going on because I noticed that the Seven Countries Study at that time, included Greece, Japan, Holland, Italy, the then-Yugoslavia, and Finland. The people in Crete had the lowest rate of heart disease and they lived the longest. But after the Cretans, you would expect either the Yugoslavians, who included Croatia on the Adriatic, and Italians to be next if the factors were the way they visualized them—olive oil, saturated fat, and fresh fruits and vegetables. But the people that followed the Cretan data were the Japanese, and they were, of course, thousands of miles apart. So, I then decided to figure out what was the common factor between the Japanese and the people of Crete in their diet, or other factors that could account for these similarities in terms of having low cardiovascular disease and long survival.
Dr. Artemis Simopoulos: And in order to do that I had to go back and look at all the data they had collected and I noticed that they had ignored a lot of factors that were very important. When they translated the food frequency questionnaires they put down “fresh fish” rather than fish. In Crete, they only have fresh fish along the seashore. The rest of the island did not have refrigeration at that time, so they really did not pay any attention to the fish in the Seven Countries Study. So when I went back and in detail examined their data, and then I collected my own data, I decided to figure out in detail what they were eating. I found out that the people in Crete ate a lot of fish. Every day they would have sardines and on Fridays they would have herring, which have high amounts of omega-3 fatty acids. They ate a lot of green leafy vegetables on a daily basis, and particularly wild plants. So when I looked at the composition, I found out that the wild green leafy vegetables are full of omega-3 fatty acids.
Dr. Artemis Simopoulos: So all of a sudden, I found things that they had not even considered in the Seven Countries Study. Then I went and looked over the Japanese data, and the Japanese eat fish every day, so the common factor was not the saturated fat or the olive oil; the common factor were the essential fatty acids and the fact that they had plenty of omega-3s, much higher amounts than other populations and they had a fascinating ratio omega-6 to omega-3 that was 1:1.
Dr. Kara Fitzgerald: Amazing.
Dr. Artemis Simopoulos: Yeah.Then I moved on to look at the composition of the eggs from the chickens that foraged for their own food. Their eggs had a ratio of omega-6 to omega-3 almost 1:1, whereas the USDA egg had a ratio of 20:1. So, there was more evidence. So all of a sudden, I saw these enormous differences that had been totally ignored and when it’s something new, it’s not easy for people to accept it right away.
Dr. Artemis Simopoulos: But I had very good data. I knew the data. We had brought hard-boiled eggs from our own farm in Greece and our own salmon to the NIH and I measured them at the NIH, so no one could could tell me that this was not true data. We were confident in pointing out that throughout evolution, humans evolved on a diet that was balanced in omega-6 and omega-3 fatty acids. In fact, they had more omega-3s than omega-6s if you go all the way back. What happened in the U.S. food supply is that right after the Second World War, they began to use vegetable oils such as safflower, sunflower, corn oil, and cottonseed—that were not used before in such high amounts because they had to provide calories to people at the end of the second world war. So without knowing the effects of omega-6 fatty acids, they went ahead and bleached the oils, they made them taste better, they looked good, and they flooded the food supply in both the U.S. and Europe with all these oils.
Dr. Artemis Simopoulos: So, not only did we develop a deficiency in omega-3s, but we also had an excessive amount of omega-6. That’s why you ended up— Just think of the poor cells being faced with this abnormal ratio, and they had to respond to the metabolic changes. So this it. I mean, this is very factual. When you look at the fact that they had totally ignored the essential fatty acids, to me, it’s very hard to explain scientifically. It’s just a matter of omitting key data and not doing accurate research.
Dr. Kara Fitzgerald: I’m just so grateful to be able to share this. This is extraordinarily pivotal. It’s so important. I mean, so I think what you’re saying is that your work was brought to the forefront—eventually, I mean it took a while—for us to have an appreciation of eating fish. I mean, this is something everyone takes for granted. It’s so fundamental, but it started with your work. Your second investigation on that original Seven Countries Study, deciding to go in there and tease it apart.
Dr. Kara Fitzgerald: And then you had that background in genetics, so you’re thinking about nutrition and nutritional influence. You’re aware from your early work looking at that prostaglandin genetic condition, so you had that lens to be able to figure this out. Bravo.
Dr. Artemis Simopoulos: You see how everything came together, though.
Dr. Kara Fitzgerald: Yeah. It’s extraordinary. It’s interesting, and in fact, I’ll put in the show notes every paper that we reference. And, of course, Dr. Simopoulos’s books as well. And again, she’s got a beautiful discussion on the Crete diet, and all of this we’ll put that into the show notes. I’ll also link to Charlie Serhan’s podcast, where he has a similar story of serendipity in his discovery of the all-incredible resolvins coming from omega-6s and omega-3s as well. So then you took this information and you began to look at this extraordinary imbalance and tie it to different disease states.
Dr. Kara Fitzgerald: I want to talk about that journey as well. So not just heart disease but really everything. And, in fact, probably we can pin this— I mean, there are all sorts of imbalances happening, and we’ll talk about ultra-processed foods more broadly— but you could pin this fundamental change in omega-6 to omega-3 ratio to the chronic diseases that exist today that we’re grappling with.
Dr. Artemis Simopoulos: It’s because the omega-6 and the omega-3 essential fatty acids are two families that have opposing properties: physiological, biochemical, and clinically. It became very obvious that when you have high amounts of omega-6 fatty acids and you produce a lot of proinflammatory metabolites, called eicosanoids because they have 20 carbon atoms. These are prothrombotic (they increase the tendency for thrombus formation), and they are proinflammatory. And we know from clinical studies and animal experiments that inflammation is at the base of all chronic diseases—whether it is cardiovascular disease, whether it is cancer, if it is arthritis, or obesity— it is an inflammatory disease.
Dr. Artemis Simopoulos: Obese people have proinflammatory cytokines, as do people with diabetes. So it began to show right away that these essential fatty acids— and they are essential because the body cannot make them and we have to get them from our diets— are very important for normal growth and development in terms of brain function and metabolism, not only for chronic diseases but also for neurodegenerative diseases. Charlie’s work is based on the differences we found between omega-6 and omega-3 because his resolvins come from omega-3s and they are anti-inflammatory and pro-resolving. So it’s really a continuation. To me, it’s very exciting.
Dr. Kara Fitzgerald: It’s extraordinary and hopefully, both of you will be honored for your body of research. The fact that you both have contributed to changing the trajectory of health outcomes with your discoveries, not just in the U.S. but in the world.
Dr. Artemis Simopoulos: It is amazing, you know, that Dr. Sirhan, or Charlie, spent six years at the Karolinska Institute. He worked with the very best people, who were the ones that originally described prostaglandin metabolism.
Dr. Kara Fitzgerald: Yeah. That’s right, that’s right. It’s just six degrees of separation. The other piece that’s extraordinary about his discovery is that if the animal model he was using were not fed a high omega-3 diet, he would have never seen the resolvins. He wouldn’t have been able to see them; certainly, he wouldn’t have been able to pick them up in humans. I mean, we weren’t making them with our incredibly skewed diet. He was looking at this model where they happened to be fed an abundance of omega-3s, and hence, he discovered–
Dr. Artemis Simopoulos: But he knew of my work and if you look at some of his early papers, he refers to our work and he refers to the ratio. He supported the ratio right away, and it’s important.
Dr. Kara Fitzgerald: It’s absolutely important. So with this 1:1 ratio of omega-6s to omega-3s, our cellular machinery just evolved being bathed in a very different ratio of prostaglandins, of leukotrienes, and of resolvins. And there are many, many, many of them. I just want to point out to the listeners, in fact, if I can find a decent pathway chart, I’ll put that in the show notes as well so you can at a glance look at these derivative compounds that we’re talking about here coming from omega-3s and omega-6s. I mean, this is why we’re changing it. So we evolved with a much different body of information there, and you have been able to tease out, pretty exquisitely, different disease associations and then publish on it. How did you do that? Looking at the relationship with rheumatoid arthritis, with different autoimmune conditions, cancer, and so forth. Speak about that work.
Dr. Artemis Simopoulos: I was lucky that I was at the NIH, which is really the biggest and the best research center in the world. People there collaborate, so if I really wanted to go and look at someone who was following persons with cardiovascular disease or arthritis and the type of studies they were doing, I would ask them to measure this or measure that. I was not working in a vacuum. I was working in the best place I could possibly be working to do this work because these were new ideas, and you had to overcome the run-of-the-mill type of knowledge that they were spitting around.
Dr. Kara Fitzgerald: Very exciting. Yeah. Go ahead.
Dr. Artemis Simopoulos: Yeah. I was going to say that if you if you want to show the pathways between omega-6 and omega-3, I can send you some simpler ones, or you can use some from the papers. But there is no question that they are physiologically and metabolically distinct, and they have opposing properties, which is very important. So you can imagine if you have this type of situation and you have 20 times as much of one or the other it can be overwhelming. And when those that are much higher are pro-inflammatory, and then you find out all the chronic diseases have inflammation as a basis, it’s not that difficult to to begin to—
Dr. Kara Fitzgerald: To begin to piece it together.
Dr. Artemis Simopoulos: It’’s just that for such a long time people have focused on high carbohydrate, low carbohydrate, high fat, low fat, saturated fat and they never really thought in terms of cellular metabolism, inflammation and cytokine storms. And now that they are doing that, I have no problem with anyone because people accept the importance of the ratio.
Dr. Kara Fitzgerald: Yes, yes, it’s come a long way. I mean, it’s firmly established. We still have far to go, but we understand. People know now, at least if they don’t know why, they know fish is good.
Dr. Artemis Simopoulos: Yes. And green vegetables.
Dr. Kara Fitzgerald: And green veggies. Yes. I want to put a pin in that because I want to ask you about the Crete diet. I actually want to ask you about your diet as well. But I wanted to just point out to our listeners— and you might have some comments on this— is that the inflammation that can ensue from the omega-6 derived eicosanoids… So this is the prostaglandins and the leukotrienes. The leukotrienes are more towards allergic-type presentations, and then the prostaglandins can feed all of the other forms. They’re exquisitely potent. The interesting thing about this pathway is that it’s really fundamental to what you’re saying; any type of inflammation. So any phenotypic presentation of inflammation, be it pain, be it skin, be it brain, be it autoimmune, or allergic, sources to these original prostaglandins.
Dr. Artemis Simopoulos: Yes. So it becomes very important then to understand the evolutionary aspects of diet and genetic variation because there are populations that have genetic variants in the metabolism of the essential fatty acids. For example, as you go from the parent fatty acids down to the 20-carbon atoms, there are enzymes, and some people are very rapid metabolizers. So, you can have two groups of people with the same amount of omega-6 and omega-3, and those who are rapid metabolizers will produce a lot more prostaglandins than leukotrienes, and therefore more inflammation, and therefore they increase their risk for chronic diseases. So, even at the best when you start with a balanced ratio, you would still, within the population there are going to be individuals that will produce extra prostaglandins and leukotrienes, and less of Charlie’s resolvins. Therefore it will be very important to know how to balance the metabolism of these people.
Dr. Kara Fitzgerald:Well, speak to that. What are some of the variants in those enzymes, and who might be vulnerable to this?
Dr. Artemis Simopoulos: Right. The enzymes are called desaturases—there’s desaturase 1 and desaturase 2. They are given numbers. The people who are rapid metabolizers who have higher amounts of these enzymes in this country are mostly African Americans. About 80% of African Americans in the U.S. have very high intake of the omega-6 fatty acids because they eat a lot of fried foods, but at the same time they have the enzyme that they produce more of the prostaglandins and leukotrienes, and less of the resolvins. So they are much more prone. And I’ll tell you how this came about.
Dr. Artemis Simopoulos: Whenever you have a genetic variant you have it because at one time it was very beneficial. The environment changes and through evolution things change. So what happened is, in Africa, the population lived along the seashores, lakes, and rivers, and they were getting their omega-3 fatty acids directly from fish and also the animals were grazing and grass has omega-3s. When they moved from this environment into the central part of Africa, and therefore, they no longer had access to omega-3 fatty acids from fish or a lot of the green leafy vegetables and they developed the need to be able to try to make larger amounts. And by doing that they ended up producing more of the omega-6 and the omega-3 fatty acids, and trying through this genetic variant to formulate some kind of a balance so they wouldn’t have only a lot of omega-6.
Dr. Artemis Simopoulos: What happened is this genetic variant that was very helpful for their metabolism and their brain in the Sahara—today, with a high amount of omega-3s, it increases their proinflammatory state, so it increases the risk for heart disease and cancer. So, you have then a population in Europe where 50% are rapid metabolizers and 50% are average/normal. Among the indigenous population, the American Indians for example, they have exactly the opposite. They don’t have enough enzyme to proceed with the metabolism to form prostaglandins, leukotrienes, resolvins, and so forth. So, you really need to give them either fish oils or fish and make sure. The same is true with the Arctic population. And then in Asia, again, it’s about 25 to 50% that are rapid metabolizers. So, you have two considerations. One is the change in the food supply, which mostly came about because the food industry likes to make ultra-processed food and it’s very cheap. And so this way, they can have a situation where you have to do something about it because you have the genetic variant. At this time, we’re in no position to go around changing the genetics, though I think in the future we’ll probably do that. What you have to do is change the composition of the food supply—lower the omega-6 and raise the omega-3, and try to bring a balanced ratio.
Dr. Kara Fitzgerald: Yeah. Yeah. I recall that South Asians, who tend to be—there’s a larger vegetarian/vegan population were, I think, the fast metabolizers. They had desaturases that were able to take the shorter-chain omega-3s and move them down to EPA and DHA, which was great when they were eating a diet that was really dense in green vegetables and high in omega-3s. But then they come here to the U.S. where everything is omega-6, and then you’re rapidly metabolizing to all the pro-inflammatory prostaglandins.
Dr. Artemis Simopoulos: Right. So, what helps them in India, for example, or Southeast Asia, they come here and they have these enzymes that now produce tremendous amounts of omega-6.
Dr. Artemis Simopoulos: So that’s why I think, eventually, we should be able to develop a type of society where people understand family history, they understand genetic variation, and they understand the risks. They understand that what we become is a result of the interaction between our genes and our environment, and nutrition is the most important environmental factor. We really need to think of a diet that is nutritionally balanced and, at the same time, in terms of the environment, does not injure the environment. The diet has two very important columns, I would say. One is the nutritional composition, and the other is how that affects the environment, because you don’t want to have problems with the environment. But I think there are enough young people now who are moving in that direction.
Dr. Kara Fitzgerald: Definitely becoming more savvy and concerned and aware and, yeah, just caring about that. Yeah. In clinic, we measure omega-3 and omega-6 fatty acids all the time and we look at the ratios and so forth. We don’t yet have access to looking at the pro-resolving lipid mediators or, you know, we can’t look at the leukotrienes and prostaglandins as readily to see what people are making, which hopefully will become available to us.
Dr. Kara Fitzgerald: To your point, we can see who’s biased towards producing these pro-inflammatory compounds. You can get some information by making sure they’ve got enough EPA and DHA, and making sure that their arachidonic acid is low. So, you have some information, but not quite as much as we could, because we know when it’s biased towards the omega-6 picture that you’re describing, this prostaglandin dump—they’re not making the resolvins. And that’s the case in a lot of the chronic diseases that we see ubiquitously in the world, not just in the U.S. And so, just for me as a doctor treating patients and being aware of this, I really hope for the day that these laboratory investigations are available so that I can be assured that my patient is creating the appropriate ratios.
Dr. Artemis Simopoulos: But I’m glad you are measuring it. And we have recommended repeatedly that they need to be, because dietary histories are not adequate, but you can measure them directly in the blood. You can measure red cell membrane phospholipids and know exactly– And there are studies that show very clearly—I mean, in the Women’s Health Study almost ten years ago they showed that when they measured the red cell membrane phospholipids for omega-6 and omega-3, and followed them for ten years, those that had higher amounts of omega-6 are the ones who became obese. So you can actually, more or less, predict who is going to be obese by knowing what they’re eating relative to essential fatty acids. And there’s no question that the proinflammatory state leads to—and omega-6 fatty acids themselves lead to—the enlargement of fat cells as well as increasing their number. Whereas omega-3 fatty acids stimulate brown adipose tissue, and you lose weight.
Dr. Kara Fitzgerald: Incredible.
Dr. Artemis Simopoulos: With omega-3, you lose weight; with omega-6, you gain weight.
Dr. Kara Fitzgerald: Let me just say, because some people are probably listening—a lot of folks are clinicians in functional medicine, so they know these pathways— but some people are going to be thinking, why did we even evolve with omega-6? Why do we even need this pro-inflammatory, pro-aging, incredibly damaging, obesogenic fatty acid? So talk about that.
Dr. Artemis Simopoulos: Well, the thing is, we don’t really need it. It’s just that the food industry is creating foods that are high in omega-6 fatty acids. And so today, if you go to the supermarket and you see what people are buying—I’ll tell you, I’m surprised—the majority of people are buying food that comes in boxes or it’s frozen. And a much smaller number of people buy fresh fruits, vegetables, fish, or even buy flour to make bread or their own pies. And all these ultra-processed foods are very high in omega-6 fatty acids, and they have a higher ratio. And we have very good evidence for that. And then Dr. Hall at the NIH did this excellent study under complete, controlled metabolic conditions, where he was able to measure everything that the people ate, as well as their energy expenditure.
Dr. Artemis Simopoulos: It was 20 people and for the first two weeks, half of them selected their own foods from ultra-processed foods. Two weeks later, the same people were selecting from little-processed or unprocessed foods. When they looked at their biochemical findings, those who selected the ultra-processed foods had eaten faster, they ate 500 more calories, and they had gained two pounds, whereas the other people had lost two pounds, and they had not eaten extra calories. So what is very important—I went back and looked at the data and calculated the ratio of omega-6 to omega-3. And so the ultra-processed had the ratio of 11.1 to 1, where those who were the little processed and unprocessed had a ratio of 5 to 1. It becomes very difficult in the US, unless you make a very special effort, to try to bring the ratio below 4 to 1.
Dr. Artemis Simopoulos: You know, there are studies done with women who have migraine headaches, and migraine is very much dependent on omega-3 fatty acids to be able to control it. And so they tried not to use supplements, but to see if they could do it through the diet. And after a lot of trials, eventually they were able to bring it down to about 3:1, but it became very difficult because you already have a population that is used to eating certain foods.
Dr. Kara Fitzgerald: Yeah. That’s right, it would be hard. And we’re not getting those beautiful wild greens from the Isle of Crete. Even if we get very high-quality organic greens, they’re not likely to be as dense in omega-3s.
Dr. Artemis Simopoulos: But I think what you can do is you can change the cooking oils. You can use either any of the monounsaturated oils. Of course, in the Mediterranean region they use olive oil. But then in Turkey, where they don’t have olive trees, for example, they’re along the Black Sea and in Bulgaria and Georgia. In these countries, they have a lot of hazelnuts.
Dr. Artemis Simopoulos: So they make oil out of the hazelnuts, which is highly monounsaturated. And then in Hawaii, they make it from macadamia nuts. In other parts of South and Central America, they make it from avocado. So you can use a high monounsaturated oil, and then you can combine it with a little bit of canola oil to add omega-3 to it. Now, what I find fascinating is that when you look around the world through the ages, practically every continent produced omega-3 oils. For example, in northern Europe, it was always the production of rapeseed oil. And they still grow it. They grow rapeseed, and the rapeseed oil has a ratio of 2:1 omega-6 to omega-3, which is a very good ratio. In Canada, the indigenous populations had flaxseed. Flaxseed oil is omega-3, again with a ratio of 2:1. And then you go down to South America, they have chia. Chia has omega-3.
Dr. Artemis Simopoulos: In Japan and in northern China they have perilla oil. And then in the Middle East, they eat a lot of legumes and l egumes contain omega-3s. So that’s why in my latest book, The Healthiest Diet for You: Scientific Aspects, I explain all of this. The last chapter tells you exactly how to have a diet that will be balanced in omega-6 and omega-3 fatty acids. I think it’s one of the most important aspects of good health. A balanced ratio.
Dr. Kara Fitzgerald: One of the most powerful. Yes. Now, some people in this country—and I’m going to guess that people are thinking about this listening to our conversation—believe that canola oil, or the way that canola is made today in this country— probably the non-organic, more industrially produced canola— is not healthy, and people stay away from it altogether. But you think there’s a place for using it.
Dr. Artemis Simopoulos: Well, let me tell you, I have heard those statements, but I have not seen any proof. Have you?
Dr. Kara Fitzgerald: You know what? I cannot pull—I don’t know that I have. I have to say, there’s no paper in my mind.
Dr. Artemis Simopoulos: The reason they make that statement is because you have organic canola, which is fine. And then you have the canola that actually is genetically modified and there are a lot of people who believe that if you have genetic modification, you have a problem. The trouble is that when they switched from canola to genetically modified canola, they should have labeled the differences, and they should have followed it, but the FDA at that time elected not to examine that. Although I am not worried about the genetic modification of canola oil, at the same time, I know that neither I nor anybody else has the data to say it is 100% safe or it is 100% bad. So if you have any doubts, don’t use canola. Use some organic canola if you want to. So there are other ways to overcome that.
Dr. Kara Fitzgerald: Yeah, that’s right, that’s right. Okay. So I want to go back to that Kevin Hall paper where you looked at the omega-3s and omega-6s, and that will be in the show notes, folks. 11:1. So in this ultra-processed group, they were consuming 11:1, omega-6 to omega-3 and that is the recommended amount to be consuming from the FDA. I mean, last I checked, 11:1 was actually considered okay by…
Dr. Artemis Simopoulos: Well, the FDA is behind the times when it comes to a lot of scientific information. To this day, the FDA does not distinguish between omega-6 and omega-3 on the label. The FDA puts down PUFAs. Now, you tell me how irresponsible this is.
Dr. Kara Fitzgerald: Yeah, yeah.
Dr. Artemis Simopoulos: How can we possibly have the best research in one of the best countries in the world and have a regulatory agency that does not keep up with the research?
Dr. Kara Fitzgerald: Yeah, the research that’s being done within the National Institutes of Health.
Dr. Artemis Simopoulos: I’ll give you another example because I describe that in the book. You know, Dr. Van Vliet at Duke went ahead and did metabolomic studies looking specifically at the individual cell components and part of the cell in people who ate a hamburger that came from an animal that was grass-fed, and then took another group of people and fed them those imitation hamburgers, or fake, if you want to call them. He then measured through metabolomics the various peptides in the blood of the individuals and he found enormous differences between the two. In fact, he found something like 127 different peptides in the person who ate the fake hamburger compared to the person who ate the grass-fed one. Now, a lot of these peptides—we don’t even know what they are or what they do, but they are not there when you eat a diet that is consistent with evolution versus an ultra-processed or imitation food. Now, why would anybody want to eat one of those fake hamburgers?
Dr. Kara Fitzgerald: I mean, there’s a huge vegan movement, and I guess to your earlier point—how do we raise cattle in a way that really respects the environment? Is that doable, do you think? Have you thought about that?
Dr. Artemis Simopoulos: Yes, I have thought about that. And there are two approaches to it. One is, I think they have to be grass-fed. And the other is that we should cut down on the amount of meat we eat. We ought to eat less meat and even less fish and then balance the two, and then eat more green leafy vegetables, fruits, legumes, and smaller fish. Legumes are a very good source of protein, and they are delicious. You know, you cannot go around eating hamburgers, hot dogs, and French fries your whole life.
Dr. Kara Fitzgerald: Yeah. To your point about small fish, and then I want to talk a little bit about the Crete diet in your book. But I want to hear about you and your diet and your farm that you referenced that you got these amazing eggs from. So, I’m curious about all of that, but I want to mention the fact that in my patient population, over the course of practicing medicine, when I first started I looked for toxins and I did see mercury from time to time. Now, I would say that in the majority of my patients who are regularly consuming fish, they’ve got mercury and it’s distressing to me. I’m curious about your thoughts on this. Fish are essential for us. Essential. And yet it’s harder and harder to do it in a safe way.
Dr. Artemis Simopoulos: Yeah, well, the mercury in fish, I think it is a problem and the question is how much mercury is present. And when it’s measured—because they have done studies where they’ve measured the mercury in fish and they have studies with pregnant women, since you don’t want high mercury levels in pregnant women— and they found out that the effect of the amount of mercury that is in fish today, in those clinical studies, was not injurious to the baby. In fact, it would be more injurious if the mother didn’t have any omega-3s.
Dr. Kara Fitzgerald: Oh, interesting. Interesting. Well, you know what? It wouldn’t be the first time I’ve heard that the additional nutrients present in fish can protect from the mercury. For instance, the selenium can bind mercury.
Dr. Artemis Simopoulos: Right. And don’t forget, for example, in Greece, people eat a lot of octopus which has about 100 micrograms of selenium per 100 grams, which is really only one serving. So, one serving provides enough selenium for the day. So, you need to have a very good picture of the composition of the diet. That’s why I think that when they talk about dietary patterns, they don’t tell you how much of the important nutrients are, or are not, in the food that you eat. You need to know the composition and you need to find ways to improve the composition because the current food supply is injurious to health and leads to chronic diseases, like obesity, diabetes, cancer and arthritis. I mean, there’s arthritis everywhere.
Dr. Kara Fitzgerald: Yeah, yeah. So tell me how we do this. How do we actually do it? I think you outline it in your book, but maybe you can share a bit about the Crete diet and what you’re eating. How do you attempt to maintain such a broad micronutrient intake?
Dr. Artemis Simopoulos: Well, let me tell you, I, of course, am on a Greek diet. I was born in Greece, I was brought up in Greece, I buy omega-3 enriched eggs. If I’m going to eat eggs, I make sure they’re omega-3 enriched. I also drink a lot of water, I don’t drink any alcohol, and I eat a lot of fruit.
Dr. Artemis Simopoulos: For example, in the morning, I have fruit and then I have herbal tea and then I make a bread that has walnuts, raisins and honey, and it’s made with whole wheat, and I eat that for breakfast. And then I always eat salads or soups with vegetables and either chickpeas, beans, lentils, or mung beans. It’s always a legume. A soup made with legumes and vegetables. Sometimes I may have a piece of fish or meat, and I prefer lamb over beef. I usually don’t snack, but if I do, it’s either fruit or nuts. I like mixed nuts, especially walnuts because they are high in omega-3s, as you know, and almonds are very good. They’re very high in protein. You can have that.
Dr. Artemis Simopoulos: And then for dinner, sometimes I make a spinach pie, which has eggs, milk, cheese, spinach, and a lot of herbs, or I make chicken pie that lasts a week and just eat it intermittently, and so forth. So it is not difficult. And I try not to eat out, but when I do, I would say it’s mostly fish.
Dr. Kara Fitzgerald: Well, that sounds pretty delicious.
Dr. Artemis Simopoulos: Sometimes I do have a cheeseburger. Sometimes I do. It’s not that I don’t but I don’t do it that often. Probably less than once a month.
Dr. Kara Fitzgerald: Well, I’m glad to hear that it’s once in a while.
Dr. Artemis Simopoulos: I go to a place where they put arugula, tomato, and lettuce on their cheeseburgers.
Dr. Kara Fitzgerald: That sounds very good. Out of curiosity, are you supplementing with omega-3s?
Dr. Artemis Simopoulos: Yes, I was just getting to that. In the diet of Crete— and this is a very important point—when I looked at everything they ate on a daily basis I noticed that the omega-3 fatty acids were present in every meal, and that ratio was balanced.
Dr. Artemis Simopoulos: Now, eating fish twice a week, which is the recommendation, is not enough, because what do you do on the other two or three days when you don’t eat any fish? Particularly in Western diets that we’re talking about. That’s why I take supplements. Actually, all my friends and I have been taking omega-3 supplements since the 1985 NIH conference where we were all convinced of importance of omega-3s.
Dr. Kara Fitzgerald: Wow.
Dr. Artemis Simopoulos: This way it’s like the diet of Crete because they have to be there all the time.
Dr. Kara Fitzgerald: Yes, I agree.
Dr. Artemis Simopoulos: So I don’t know how you can get away from supplements.
Dr. Kara Fitzgerald: Yes, that’s right. Especially in the Western diet, to your point. And now, of course, we can supplement even with resolvins. We have access in supplementary form to the specialized pro-resolving mediators (SPMs), so that’s cool as well and I use those frequently in my practice.
Dr. Kara Fitzgerald: I just want to mention two other things in closing. I know that we’re really at time here but in addition to being a clinician, I’ve been conducting research looking at biological age, specifically looking at epigenetics and gene expression related to diet and lifestyle. We know omega-3s are really important for longevity. People who’ve got a nice amount—
Dr. Artemis Simopoulos: They decrease the rate of the aging process.
Dr. Kara Fitzgerald: They do. As does the Mediterranean diet, these diets dense in these incredible phytonutrients that we’ve been talking about. One of the very exciting things for me in my research is seeing that probably a fundamental mechanism prompting this cascade of important metabolic information for healthy living is changing epigenetics. Changing gene expression. So I wanted to just bring that up because there are papers starting to come out really pinning that to the Mediterranean diet and omega-3s. So really two pieces that you’re very responsible for putting on the map for us we’re seeing as we really look carefully at gene expression, epigenetics, biological age, and all of that.
Dr. Artemis Simopoulos: Yes, and don’t forget that nutrients influence gene expression, and genetic variants influence metabolism of nutrients. That’s why we established the Society of Nutrigenetics/Nutrigenomics.
Dr. Kara Fitzgerald: It’s essential. It’s very important.
Dr. Artemis Simopoulos: It’s moving slowly, but it’s certainly the science of the future.
Dr. Kara Fitzgerald: Yes, we’re at a neat inflection point and certainly your many years of effort in moving the needle on health in our country is bearing fruit. But to your point, it’s slow but it’s there. Your work is indelibly imprinted on all of us. I know my mom, for example, is going to just—She’ll be very excited about this particular conversation. But all of us are really starting to understand it, not just those of us who are in the field.
Dr. Artemis Simopoulos: I want to say one thing about the book.
Dr. Artemis Simopoulos: I wrote it during the the time of Covid when everybody was in lockdown, and it became obvious to me that what we needed wasn’t another cookbook or another recipe book. What’s needed is a book that presents science accurately but as easily as you can to reach the people who are interested in learning more about health and nutrition. But also, it will be something that teachers are going to use in high schools to teach the students to be curious about their food and what it means. And to also get more of the science out to dieticians and nutritionists and in medical schools, schools of public health, and doctors, because doctors have to know more.
Dr. Kara Fitzgerald: We will, without question, feature your book on the website and we will put it on our various social media platforms. Yeah, it’s incredibly important work.
Dr. Artemis Simopoulos: What I wanted to tell you is that you can download it for free. I really want people to definitely get to read the book.
Dr. Kara Fitzgerald: That’s beautiful, and we will get it out into the world for you as much as we possibly can.
Dr. Artemis Simopoulos: I thought you were the right person for it.
Dr. Kara Fitzgerald: Dr. Simopoulos, again, thank you, thank you, thank you! I hope that I get to meet you in real life, in person, beyond Zoom—it’s been such an honor.
Dr. Artemis Simopoulos: We’ll have to meet with Charlie, maybe the three of us. Maybe sometime in Boston.
Dr. Kara Fitzgerald: I would absolutely, absolutely be honored. I would love it. And thank you so much for coming and sharing your amazing wisdom with us.
Dr. Artemis Simopoulos: You are so very welcome. I really enjoyed it. And your enthusiasm.
Dr. Kara Fitzgerald: Thank you so much. To be continued. [Leave only if necessary] Okay. Take care.
Dr. Artemis Simopoulos: Bye bye.
Artemis P. Simopoulos, M.D., the author of The Healthiest Diet for You: Scientific Aspects (her latest book), is the Founder and President of the Center for Genetics, Nutrition and Health, a nonprofit educational organization in Washington, D.C. since 1990. A graduate of Bar- nard College, Columbia University, with a major in Chemistry, and a graduate of the Boston University School of Medicine, she is a physician and endocrinologist whose research at the National Institutes of Health (NIH) was on the nutritional aspects of genetic and endocrine disorders; evolutionary aspects of diet and fatty acids; and the importance of a balanced ratio of omega-6/omega-3 fatty acids in health and disease and in growth and development. Dr. Simopoulos is a world authority on essential fatty acids and was nutritional adviser to the Office of Consumer Affairs at the White House. She is the author of The Omega Diet; The Healing Diet and has completed a Chapter for the Encyclopedia of UN- ESCO on “Omega-3, Omega-6, Omega-9 Fatty Acids: Sources, Metabolism and Supplements.” She is currently Consulting Editor to Lifestyle Genomics. Dr. Simopoulos has edited over 60 books and journal supplements in addition to publishing over 370 scientific papers. She has received many awards, has been Visiting Professor and Keynote Speaker worldwide.
Email: cgnh@verizon.net
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I am pleased to have found the interview, as this is such an aspect of health which does not typically get enough attention. I am, however, very curious why it the interview Dr. Artemis Simopoulos stated there are no olive trees in Turkey.
Here is the quoted text from your interview that I’m referring to:
“Dr. Artemis Simopoulos: (00:41:51) But I think what you can do is you can change the cooking oils. You can use either any of the monounsaturated oils. Of course, in the Mediterranean region they use olive oil. But then in Turkey, where they don’t have olive trees, for example, they’re along the Black Sea and in Bulgaria and Georgia. In these countries, they have a lot of hazelnuts.”
~~~~~~~~~
-Olives have been grown in Turkey for over 3,000 years, and the oldest olive mill is thought to date back to the 6th or 7th century BCE.
Olive orchards abound in the coastal zone, along the Aegean coastal regions where the Mediterranean climate prevails.
-The harvest season is marked by festivals, rituals, and social practices, including community efforts to harvest the olives. At the end of the harvest, the olives left on the trees are donated to the community’s poorest members.
-In the 2022/23 crop year, Turkey produced a record-high 421,000 tons of olive oil and 735,000 tons of table olives. Turkey is one of the world’s top five olive oil producers.
Olive trees fruit every other year, producing very little fruit in the alternate years.
-The yield of olives per tree in Turkey is generally low compared to other countries, such as Italy. Factors that affect yield include climate, soil, water conditions, and the age of the trees.
Harvest
Thanks again for access to the interview.
-EN
SO Grateful for this conversation. Fascinating and so important. Thank you, Artemis! and thank you so much Kara for making this information available to us! I’m passing it around, must be heard.