• Derrick W. Spell, MD FACP

Fish - What's the Catch?


Patients and family members often ask me for dietary advice. They frequently inquire about my personal dietary preferences and beliefs. Some of the most common questions revolve around my opinion on fish and seafood. Given the recent explosion of “low-carb/high-protein” diets (like keto, Paleo and Whole30), I would like to reassess the beneficial protein sources and set the record straight on fish!




When you come down to it, the average American today consumes more protein than they require. Documents from the U.S. Department of Agriculture (USDA) show that protein accounts for 18% of total caloric intake for Americans today. The average American acquires about two-thirds of their protein from animal sources, with most of that coming from meat products. This should come as no surprise since protein has been synonymous with meat in our country for generations. (A recent pet peeve of mine is when restaurants ask if you’d like to add “a protein” to your meal. Protein is a macronutrient, not a food item!) We know that animal products like red meat and eggs contain a lot of protein, but they also have a lot of saturated fat and cholesterol. (Only recently have most Americans made the connection between red meat and saturated fat.)


I believe it is more important to focus on the quality of protein instead of the quantity of protein. The quality or type of protein is more significant because current research has consistently demonstrated the deleterious effects of animal protein. A recent study of middle-aged people (ages of 50 and 65) found there was a 75% increase in premature deaths from all causes among those who consumed 20% or more of their calories from protein. Specifically, there was a 400% increase in deaths from cancer and Type 2 diabetes among heavy consumers of animal protein. Interestingly, these bad outcomes were either eliminated or attenuated if the proteins were plant-based. Other studies, like The China Study, have confirmed that mortality rates from heart disease are linked with increased animal protein consumption.


You automatically eat enough protein when you eat a well-balanced diet that is rich in vegetables, legumes, and whole grains! This is one of the many reasons why vegetables, legumes and whole grains make up the foundation of the traditional food pyramid. The Physicians Committee for Responsible Medicine encourages these daily goals: five or more servings of grains, three or more servings of vegetables and two to three servings of legumes like beans and nuts. The American Heart Association (AHA) recommends obtaining most of your protein from a variety of whole grains and vegetables and limiting intake of red meats.


The AHA also advocates eating an assortment of fish twice a week, especially fatty fish with high omega-3 content. Why? There is strong evidence that eating fish in moderation is good for the heart! A recent combined analysis of twenty studies determined that eating one to two 3-ounce servings of fatty fish a week (like mackerel, herring, anchovies and salmon) reduces the risk of dying from heart disease by 36 percent! How? The omega-3 fats found in fish improve blood vessel function and lower blood pressure and heart rate. Omega-3 fats also protect the heart against deadly cardiac rhythms. You can learn more about the AHA recommendations on their official website https://www.heart.org/en.


There are other advantages to regular fish consumption. Additional health benefits include lower risks of stroke, depression and Alzheimer’s disease! Seafood contains several essential vitamins and minerals, including vitamin B12, potassium, calcium and iron. Seafood is also a good source of protein that is low in calories. Most low-fat species of fish (like tuna, mahi-mahi, flounder and sole) contain around 100 calories per 3-ounce portion. (Remember that a 3-ounce serving size of fish is about the size of a computer mouse.) Even the fattier fish only have about 200 calories per serving. (These fatty fish, which are typically found in cold water, are better sources of the heart-healthy omega-3 fatty acids.) Local Louisiana catches like trout and redfish are also tasty options that are packed with protein. Most varieties of fish have at least 20 grams of protein per 3-ounce serving, however the different species have variable nutritional content. For more information visit http://www.seafoodhealthfacts.org/.


I absolutely endorse the AHA guidelines for fish and seafood consumption. I usually eat fish twice a week. I love Japanese cuisine and eat sushi and sashimi weekly. I also enjoy having grilled fish once a week. However, my recommendation does come with a slight catch. Remember to be mindful of the preparation! Avoid all fried seafood as well as any added butter or cream-based sauces.) If you have heart disease or high cholesterol, you may also want to avoid shrimp and crawfish. (They are both full of cholesterol!) Never eat shark, swordfish or king mackerel, as they contain high levels of mercury!


If you want to learn more about proper nutrition and other valuable food choices, please check out my book The Bite-Sized Guide to Getting Right-Sized!

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