Safe Fish or "Just Trying to Make Consumers Feel Good"?

(Following is a guest post written by  a friend of mine, Marc Joseph, MS.  Marc has a masters degree in Nutrition and a nutrition consulting practice based in the East Bay with clients from around the U.S.  Several years ago, he experienced a life-changing illness caused by mercury toxicity. When the Harvard and Institute of Medicine studies on fish intake came out, I asked him to share his thoughts with us since he's a pro on the subject.)

These were a few of the headlines after the release last week of two studies examining the health benefits and risks of eating fish:

Seafood benefits found to outweigh risks (Boston Globe)

Eat more fish, study urges, despite toxin risk (Reuters)

Seafood not your health foe, studies say (SJ Mercury News)

The first study, a meta-review* completed by researchers at the Harvard School of Public Health and published in the Journal of the American Medical Association, boldly suggested that regular fish consumption could reduce the risk of heart attack death by 36 percent and the overall risk of death by 17 percent.

(* A meta-review is a review of the existing body of research.  Perhaps the Harvard meta-review excluded studies like this one, "Mercury in fish poses heart risk for middle-aged men"?)

The second study, a report completed by the Institute of Medicine (IOM), was more balanced in its review of the research. It concluded only that the regular consumption of fatty fish may reduce the risk of heart disease, while "contaminants that may be present in seafood may pose a risk to some especially susceptible groups of people."

A More Balanced View

Just reading the headlines, one could easily draw the conclusion that concerns about toxins in seafood are overblown and that there's really nothing to be concerned about unless you're a pregnant woman, a prospective mother, or a small child. Fortunately, the NY Times presented a much more balanced perspective in their coverage:

The Harvard study, to be published in the Journal of the American Medical Association today, said the benefits of eating fish high in omega-3’s strongly outweighs risks from contaminants like PCB’s and dioxin found in high concentrations in fish like farmed salmon. Calling those risks “greatly exaggerated,” Dr. Darius Mozaffarian, one of the two authors, said, “Seafood is likely the single most important food one can consume for good health.”

Dr. Marion Nestle, a professor of nutrition, food studies, and public health at New York University, who described the “very sunny Harvard study” as “astonishing,” remains unconvinced. “The report’s conclusion that the risk of death can be reduced by 36 percent is just stunning,” she said. “It would indeed make eating fish the single most important decision you can make for your health. But those of us who have been in nutrition for a long time have seen miracle foods come and go: vitamin E for heart disease, beta carotene to prevent cancer; now it’s fish.”...

...The report from the Institute of Medicine tells the government that much more research is needed. Dr. Malden C. Nesheim, chairman of the institute’s committee and a provost emeritus at Cornell, said, “We are quite cautious because the studies we looked at are not controlled for all the variables, and we can’t distinguish between the effects from omega-3’s or replacement of other foods in the diet.”

The NY Times reporter then exposed some of the behind-the-scenes political maneuvering:

The National Oceanic & Atmospheric Administration [NOAA] had requested the institute’s report because it said consumers were confused about how much and what kind of fish they should eat. The two studies, which conflict in important aspects, seem unlikely to provide much clarity. “The high degree of certainty in one report and the extreme caution in the other,” said Rebecca Goldberg, a senior scientist with Environmental Defense, an advocacy group, “will make people more confused than ever.”

To the surprise of Institute of Medicine officials, NOAA sponsored the hastily called press conference at which the Harvard report was released, even though that study conflicted with the one prepared by the institute. “We’re just trying to make consumers feel good*,” said William T. Hogarth, assistant administrator for fisheries of the National Marine Fisheries Service*, part of NOAA.

[* emphasis added]

Major environmental and groups noticed the inconsistencies as well:

Both reports have come under criticism from environmental groups and from the Consumers Union. “In addition to being concerned about the failure of the JAMA and I.O.M. reports to address the risks of mercury in tuna,” said the consumer organization, “we are also concerned that both reports dismiss concerns about PCB’s in most fish.”

“These reports are urging Americans to eat more seafood as if it were a crisis,” Dr. Goldberg said. “According to NOAA’s own statistics, per capita consumption of seafood has risen from 14.8 pounds in 2001 to 16.6 pounds in 2004.”

Jane Houlihan, the research director of the Environmental Working Group, another advocacy group, said, “The Harvard study reads like an advertisement for the seafood industry.”...

...“Once again pregnant women are being told it’s O.K. to eat tuna,” Ms. Houlihan said. “The reality is, 90 percent of women would exceed government’s level for a safe dose of mercury if they ate six ounces of albacore tuna every week as the F.D.A., E.P.A and now I.O.M. recommend.”

What to Do

Omega-3 fats found in fish clearly are beneficial for heart, brain, and immune system health. There's a great overview of those benefits discussed in this article, "Omega-3 Fatty Acids: Vital to a longer, healthier life."  And the truth is that the majority of people do not take in adequate amounts of these healthy fats.

Unfortunately, though, many fish are contaminated with toxins such as mercury.  Do yourself and your family a favor.  Use a simple online calculator like this one to help plan safe seafood consumption.

(While you're there, ask yourself why government agencies responsible for advising consumers on safe fish consumption haven't put together such easy-to-use tools?  The IOM, in fact, recommended the creation of such tools in their report.)

Better yet, to ensure adequate Omega-3 fat intake, include regular consumption of fish oils that have been tested to be free of contaminants such as heavy metals, PCBs, etc. There's a good list of safe products here.

Risks Not Imaginary

I can attest to the risk of toxin exposure through fish consumption firsthand. Several years ago, I began noticing some changes in my own health, including chronic fatigue, difficulty concentrating, memory loss, eczema, hair loss, increased blood pressure, and more.

Fortunately, I read an article in the local newspaper about mercury poisoning caused by high fish consumption. The signs and symptoms discussed in the article closely matched those that I was experiencing. The similarities made sense, as I had increased my fish consumption in recent years (mostly light-chunk canned tuna, a supposedly safer choice).

I quickly stopped that, researched the different available treatment options, and put together a recovery plan.  Nutrition, along with safely removing existing heavy metals, played a key role in the recovery process. As a result of the efforts, all of the poisoning symptoms nearly resolved or entirely disappeared.

Prompted by that experience (as well as the clear need for a greater focus on preventive and nutritional approaches in health care), I returned to school to obtain a Masters degree in nutrition.  Today, as part of my nutrition counseling practice, I help people with mercury poisoning and other chronic conditions recover through a combination of dietary changes and nutritional supplementation, as well as safe removal of heavy metals when applicable.

~Marc Joseph, MS

Marc Joseph uses science- and evidence-based nutritional therapies to help people prevent and recover from chronic conditions through his nutritional counseling practice, Marc Joseph Nutrition. He also speaks to groups of all types on nutrition-related topics and regularly writes on such topics on his blog and elsewhere.

Comments

[Melanie]

Oceana, a non-profit based in Washington, currently has a campaign which is focused, in part, on making consumers more aware of the FDA advisories on mercury contamination. They have been working with grocery store chains across the country to get the FDA advice posted at the seafood counter in your local grocery store! They have a “Green List” of stores that have already volunteered to post the advisory, and a red list of all the stores that have not. Their website, www.oceana.org/mercury, is really interesting and informative...I recommend a visit!

[Marc Joseph]

I think it's great that Oceana and other groups are pushing for greater disclosure about mercury in stores that sell fish.

I'm not sure, though, how many people actually see the signs. I've gone to a couple of Whole Foods (on Oceana's "Green List"), and the signs were placed on the wall to the very side of the fish counter. Most people probably buy fish and never even see the signs.

There really needs to be a concerted government education effort that clearly lays things out for consumers through press releases, media coverage, and website tools. The IOM recommended those actions in its report. We'll see...

[FB]

What can you tell me about Shellfish? I think I've read where there are high amounts of cholesterol (the bad kind?) in most shellfish so it should be eaten in moderation. Salmon too. Is this true and if so how does this fit into the push towards
natural foods.

[Marc Joseph]

FB,

Shellfish is fine in moderation. The original research that estimated shellfish cholesterol levels used less sophisticated testing methods that weren't able to distinguish between cholesterol and other sterols. As a result, cholesterol levels looked higher than they actually were.

Summary here:
http://www.mayoclinic.org/news2006-rst/3337.html

Longer explanation here:
http://www.raysahelian.com/shellfish.html

Here's a table with the cholesterol content of various foods:
http://www.webdietitian.com/document/CVTopic/topic
/pencvdietarycholesterol

Shrimp, crab, and lobster tend to have the highest cholesterol levels. Salmon is lower and has higher levels of healthy Omega-3 fats.

It's important to note (and not well-known) that the average person's body generates about 1000 mg of cholesterol per day from both external sources (diet) and internal sources (created by the body's cells).

The average daily dietary cholesterol intake is ~600 mg, of which only about one-half is absorbed, or ~300 mg.

So, the typical diet only supplies less than one-third of your daily cholesterol. The rest is produced by cells in your body -- about 20% by cells in your liver and the other 80% by other cells in the body. Statins work by inhibiting an enzyme that is involved in producing cholesterol in the liver.

Note that, using the table in the link above, you'd have to eat more than 3/4 lb. of shrimp or crab to take in 600 mg of cholesterol. I wouldn't recommend eating that much regularly, but it helps put things into perspective.

I would be more concerned with potential toxins (heavy metals, PCBs) in seafood, as well as with antibiotics used in farm-raised species (e.g., shrimp). These levels, of course, vary depending on where the seafood was sourced.

I would also be more concerned with overall intake of saturated fat and trans fat, both of which are positively correlated with greater risk of cardiovascular disease.

There are actually several different types of saturated fat. Some may promote higher bad cholesterol levels, while others may be neutral in their effect. Moderation is key.

Trans fats, on the other hand, are bad all around.

Cholesterol is an important chemical compound in the body. It's used for hormones, bile salts, and even vitamin D. But there are several types (LDL, HDL, etc.), and ratios between those different types may be just as important as overall levels for predicting heart disease risk.

Cholesterol is often not the biggest problem in heart disease. Inflammation is. More on that here:

http://www.marcjosephnutrition.com/heart-disease.html

Marc
http://www.MarcJosephNutrition.com

[Linda]

What are some "safe" seafoods to eat? Farm raised? Alaskan Salmon? Where can I find good seafood without any contaminates?

[Marc Joseph]

Linda,

In the original post above, see the "What to Do" section. There, you'll find a link to an online calculator that helps identify safer types of fish.

Unfortunately, there aren't any fish that have no contaminants. It's just some have more or less than others.

The best bet for getting healthy omega-3 fats found in fish on a regular basis is by taking fish oil supplements that have been tested for contaminants.

In the "What to Do" section in the original post above, you'll also find a link to a list of safe supplement products.

Regarding wild vs. farm-raised salmon, it all depends on the conditions in which the fish are raised and what they're fed. In general, wild-type fish are preferred.

Some research suggests that farm-raised salmon may be much higher in PCBs. You can read more about that issue here (see the related articles in the right-hand column of this link as well):

http://www.ewg.org/issues/siteindex/issues.php?issueid=5007

Hope that's helpful,

Marc
http://www.MarcJosephNutrition.com

[Sharon Lear]

When I tried to access the links, such as the one that lists safe fish, I got a message saying that my server couldn't find it - I have an iPhone.

[Joe]

I'm sorry but I agree with articles authored by credible scientists in a peer reviewed journal more than environmental groups whose focus is NOT human health nutrition, but Ocean conservation. Why aren't populations who consume extremely high amounts of fish (for example the Japanese) suffering from acute or for that matter chronic Mercury exposure? In fact, they are found to be even more healthy than Americans with lower rates of heart disease despite eating so much more fish than we do. So you can make all the claims you want about mercury poisoning in fish but there is ABSOLUTELY NO EVIDENCE. It sounds what the author of this blog had is chronic promote his own nutritional counseling business disease. Who diagnosed him with mercury toxicity??? Did he have his blood tested? What were the levels? Have they gone down since changing his diet, or has his bank account gone up from exploiting this fake crisis by convincing people who are tired that they are suffering from Mercury toxicity? Remember this fact: there has never been a single documented medical case of mercury toxicity from eating fish in the United States (EVER!).

[Marc Joseph]

Joe,

I'm sorry you feel so strongly in opposition. That's certainly your right.

I am curious, though. It seems odd that you posted such a vitriolic reply to a blog post made two years ago. Are you affiliated in any way with a company or organization that could be negatively affected by scrutiny of mercury in the environment?

For a good overview of mercury toxicity, including that from eating fish, here's a useful book/resource:

Diagnosis Mercury
http://diagnosismercury.org/

It's written by a San Francisco MD who has found that many of her patients have developed mercury poisoning from regularly eating higher mercury fish.

If you're waiting for definitive proof published in multiple peer-reviewed journals, you may be waiting a long time. (And that holds true for many environmental toxins.)

The accusation you make that I'm trying to profit from the illness of others in a disreputable way is baseless and bordering on slander. I am an ethical practitioner with a legitimate background and charge reasonable fees. I've helped people with metal toxicity and many other chronic conditions to improve their health.

Regarding who diagnosed me, no one. As people with metal toxicity are well aware, it's extremely difficult to find a knowledgeable practitioner who understands how to identify and treat it.

An unknowledgeable practitioner will run the blood test to which you refer. Since metals clear quickly from the blood and urine, such tests are typically irrelevant except in acute exposure cases. For chronic, low-level exposure, the metals slowly accumulate in the tissues.

In any event, I had many of the symptoms of mercury poisoning. I stopped eating fish, safely replaced my amalgam fillings, nutritionally supported my body, and did a safe chelation protocol to reduce my body's metal burden.

Subsequently, all of my symptoms proceeded to disappear. I don't think that was a coincidence.

Joe, if you, or anyone else reading the original post, wishes to eat fish, especially larger fish higher in mercury, on a regular basis, that's your right.

All I can do is share my opinion and experience.

Best of health,

Marc Joseph, MS
http://www.MarcJosephNutrition.com