Introduction

The health benefits of fish and seafood have been well documented and widely promoted in recent years. Fish is low in saturated fat, a good source of high-quality protein, and a healthy alternative to red meat.¹ It provides the body with essential vitamins and minerals, including iron, zinc (from shellfish), and vitamins A, B, and D. Omega-3 fatty acids found in fish such as salmon, rainbow trout, sardines, oysters, and sole are also beneficial, particularly in terms of cardiovascular health. Preliminary evidence suggests that early exposure to omega-3 fats may enhance brain development as well.^2-8

At the same time, fish are vulnerable to contamination by toxic industrial pollutants, such as mercury, as well as polychlorinated biphenyls (PCBs), dioxins, flame retardants, and other lipophilic chemicals.¹ These pollutants accumulate in fish flesh (mercury) or fatty tissue (PCBs), exposing people who eat them.

Health care providers are confronted with the need to offer useful dietary guidance to patients in the presence of these conflicting recommendations about the risks and benefits of consuming fish and seafood. This Quick Reference Guide, developed jointly by the Association of Reproductive Health Professionals (ARHP) and Physicians for Social Responsibility (PSR), reviews the scientific evidence on toxic fish contaminants and offers guidelines to assist clinicians in communicating with patients about the risks and benefits of eating fish. The guidelines also provide concrete suggestions for day-to-day consumption of fish and other seafood. Our recommendations rely mostly on the seafood choices guidelines released by the Institute of Medicine (IOM) in 2006, but also take into account the recommendations issued jointly by the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA)⁸ in 2004 on mercury levels in fish and shellfish.^1,9 The ARHP/PSR guidelines also address the health risks posed by lipophilic contaminants, such as PCBs.

Developing fetuses are particularly vulnerable to common fish contaminants, and infants and children remain vulnerable due to rapid brain growth and development. The guidelines provided here are most important for pregnant and breastfeeding women and for young children. Because these pollutants build up in the body over time, a woman’s dietary habits throughout her early life can influence the exposures of her future children.¹⁰ A woman who is contemplating pregnancy in the future can lower her blood mercury level by careful eating for 6 to 12 months before becoming pregnant, but PCBs accumulate over time, and lifelong vigilance is required to minimize maternal body burden. All women of childbearing age—even adolescent girls—should follow the recommendations summarized at the end of this Quick Reference Guide. It is also important to acknowledge that there is limited data on which to base recommendations, these guidelines should be viewed as provisional and subject to revision as more is learned or as effective measures are taken to eliminate toxic pollutants from our environment.