By Julia Quam, MSPH, RDN and Kellie Casavale, PhD, RD, Nutrition Advisor, ODPHP
There is confusion among many Americans, particularly women who are pregnant or breastfeeding and parents and caregivers of young children, regarding seafood consumption. The 2015-2020 Dietary Guidelines for Americans encourages us to eat a greater variety of protein foods. One way to do this is to choose seafood twice a week in place of meats, poultry, or eggs. Seafood, which includes fish and shellfish, is recommended for the total package of nutrients it provides. However, the average American is eating much less seafood than recommended. Whether that’s due to taste preferences, lack of confidence with buying or preparing seafood, or concern about potential contaminants like methyl mercury, health professionals have an important role. You can help to clear up confusion and encourage patients and clients—particularly women who are pregnant or breastfeeding and parents and caregivers of young children—to include seafood as part of an overall healthy eating pattern.
Guidelines for the General Population
The Dietary Guidelines for Americans recommends that adults consume about eight ounces per week of a variety of seafood, including at least some choices higher in the omega-3 fatty acids EPA and DHA, because seafood has been associated with heart health benefits. People can consume more seafood than the amounts recommended in the Healthy U.S.-Style Eating Pattern (e.g., more than eight ounces for those consuming 2,000 calories a day), but should focus on seafood choices that are low in methyl mercury.
To encourage seafood choices that are higher in EPA and DHA and lower in methyl mercury, health professionals can suggest choices such as:
- Atlantic and Pacific mackerel (not king mackerel)
Guidance for Women who are Pregnant or Breastfeeding
The Dietary Guidelines for Americans recommends that women who are pregnant or breastfeeding eat between eight and twelve ounces of a variety of seafood per week from choices that are lower in methyl mercury. Current intake is low— an FDA analysis found that over twenty percent of women who were pregnant reported eating no fish in the previous month; for those who did report eating fish, half ate less than two ounces per week. Eating seafood is especially important for this population because it is associated with improved infant health outcomes. However, women who are pregnant or breastfeeding also need to limit or avoid some types of seafood higher in methyl mercury because those can affect the developing brain and nervous system. Balancing the risks and benefits of seafood consumption can seem complicated and may lead some pregnant or breastfeeding women to limit or avoid seafood altogether. They should not.
This makes it crucial for health professionals to provide clear, evidence-based guidance about the importance and safety of seafood consumption. Fortunately, a new resource from the FDA and EPA can help. This printable chart makes it easier for women capable of becoming pregnant, those who are pregnant or breastfeeding, and parents and caregivers of young children to navigate what types and how much seafood to consume to limit methyl mercury intake.
The chart divides seafood into best choices, good choices, and choices to avoid. Women capable of becoming pregnant and those who are pregnant or breastfeeding can use this tool to select two to three four-ounce servings per week from the best choices list to support a healthy eating pattern while keeping their methyl mercury consumption well within safe levels. It also provides guidance on which types of seafood to limit to 4 ounces per week listed under good choices. Those they should not eat are listed under choices to avoid. The seafood varieties they should not eat are bigeye tuna, king makerel, marlin, orange roughy, shark, swordfish, and tilefish (from the Gulf of Mexico).
Guidance for Young Children
The new resource from FDA and EPA provides advice for young children, starting at age 2. Consuming two servings per week from the best choices category can keep methyl mercury exposure conservatively under limits. The chart also provides guidance on which types of seafood to limit to one serving per week from the good choices category. The serving sizes suggested for young children in the FDA and EPA guidance vary from one to four ounces depending on the age of the child. Young children also shouldn’t eat fish in the choices to avoid category.
Women who are pregnant or breastfeeding and parents and caregivers of young children should also check local fish advisories when eating seafood caught by family or friends. If no advisory is available, they can eat up to one serving and no other fish that week. These groups should also avoid consuming raw fish, which can lead to food-borne illness.
Five Strategies for Incorporating Seafood into Healthy Eating Patterns
Health professionals can help patients and clients understand how seafood consumption supports an overall healthy eating pattern. A healthy eating pattern incorporates a variety of vegetables, fruits, grains, low-fat and fat-free dairy, and protein foods, while limiting saturated and trans fats, added sugars, and sodium. These strategies can help health professionals encourage patients and clients to incorporate seafood into their own healthy eating patterns.
- Discuss realistic ways to incorporate seafood into your patients and clients’ typical eating patterns. Ask them to share his or her family’s favorite seafood dish and brainstorm how to lighten it up if necessary, perhaps by baking or broiling instead of frying or using oil instead of butter. For some, substituting seafood for higher saturated fat meat or poultry entrees one to two times per week may be an easy shift.
- Address individual barriers. If an individual says that seafood is too expensive or goes bad too quickly, suggest less expensive, longer lasting options like canned or packaged tuna or salmon or frozen fish fillets or shellfish. If he or she doesn’t know how to prepare seafood or doesn’t have time, offer quick and easy preparation ideas like baking or broiling.
- Help patients and clients enjoy fish while limiting sodium intake. Suggest preparing fish with sliced lemons or lemon juice and fresh or dried herbs and spices rather than salt or high-sodium seasoning blends. Encourage clients to use the Nutrition Facts label to look for lower sodium versions of packaged and canned seafood products.
- Reassure individuals that seafood is an important part of a healthy eating pattern. The seafood consumption advice issued by the FDA and EPA for women who are pregnant or breastfeeding and parents and caregivers of young children is based on a highly cautious approach, so individuals can be confident that if they follow this advice and meet the Dietary Guidelines recommendations for seafood, they’ll reap the health benefits of seafood while limiting exposure to methyl mercury.
- Understand that seafood is just one component of a healthy eating pattern. If a person is vegetarian or vegan, allergic to seafood, or simply doesn’t like it, that’s ok! There are many ways to eat a healthy diet. Focus the conversation on other healthy changes that fit the person’s needs and lifestyle.