What’s the Healthiest Fish to Eat?

John Horton:

Hey there, and welcome to another episode of Nutrition Essentials, a tasty add-on to our popular Health Essentials Podcast. I'm John Horton, your co-host, with registered dietitian Julia Zumpano.

Julia Zumpano:

I'm excited today to discuss our topic: picking the healthiest fish to eat.

John Horton:

You know, Julia, I'm so glad that we're talking about this. We constantly mention fish as a healthy dietary choice, but let's be honest here, there are a lot of fish in the sea, so it can be really overwhelming when you go to the store and you try to pick one of them out for dinner.

Julia Zumpano:

It can be very overwhelming. There's so many options, and you don't know if it's a healthy option or if there's contaminants. So I think we're going to really help break that down for people and allow fish to be a more frequent intake in their dinner table.

John Horton:

Yeah. Well, and we've got the perfect guide on this, on this little fishing expedition, and that would be you. And I know you eat a lot of fish. It seems like it always comes up in the meals that you're eating, and I take it that's for a good reason.

Julia Zumpano:

Absolutely. I love fish, and especially if it's prepared well. I would love to share my thoughts on how to incorporate more fish into everyone's diet.

John Horton:

All right. Well, Julia, I am ready to set sail on this conversation, so let's see what we catch.

So Julia, we're looking at fish here, and I got to be honest, when I go to the store, I get a little overwhelmed when you're looking at all the different types that are in there, and I never quite know which one would be best. So everybody likes lists. So let's get a little “keep and release” menu option here going and talk about, I guess, let's go over three fish that really deserve a little more attention at mealtime.

Julia Zumpano:

Sure. One thing I will say, even I get overwhelmed when I go to pick out fish. So I think it's very important to educate yourself before. And I go to a fish market or a market where the clerk behind the counter is very knowledgeable. So I'll have a full conversation with them about where the fish came from, what the taste and texture of the fish is, how to best prepare it. So it's a lot of education, I think, that has to come into play, too.

John Horton:

Yeah. Use those resources because they are a lot of help.

Julia Zumpano:

Absolutely.

John Horton:

And I know I'll ask them every once in a while, "How do you grill it? What's the best way to bake this?" They have a lot of great tips.

Julia Zumpano:

They're very helpful. So that would be my number one tip.

So the best fish. We're going to start off — I'll name the top three, and then we'll go through them. Sardines, herring and mackerel are the top three.

John Horton:

Well, I've heard of all of them at least because a lot of times, I go there and I don't even know what the fish are. So I feel like I'm off to a good start.

Julia Zumpano:

Great. Wonderful. So sardines provide a variety of benefits. You really can't go wrong. They're a wonderful source of omega-3. They provide about 2 grams of omega-3 fatty acids per 3-ounce serving, which is one of the greatest sources. It's very high in omega-3. And they're the lowest in mercury, which is what makes them the cream of the crop.

So they contain a good source of calcium and vitamin D to support bone health. And they're also very easy to obtain. They're generally found in a can and they're inexpensive. So almost anyone can eat fish any time.

John Horton:

I was going to say, because I mean, I've never had sardines, but I have this image in my head, and I don't know if it's from cartoons or whatever, but that little can where you peel back the top and there's just a bunch of little fish sitting in there.

Julia Zumpano:

That's pretty much what it is.

John Horton:

How do you use them? I mean, you see that, and you're like, "I just don't know what I'm supposed to do with this."

Julia Zumpano:

Well, so they can either be held in olive oil or tomato juice or just in water, and then you can just chop them up like you would … you can use them like tuna. You can make a sardine salad, you can throw it over a salad, you can throw it into pasta, you can just use it as a side dish, as your protein, as a part of a main meal. So there's very many ways you could do it, but just getting your feet wet, I think starting with getting it, first of all, in olive oil or tomato sauce because it does add an extra nice burst of flavor.

So if you're not used to the sardines by themselves, start with adding some flavor. I like to use a lot of garlic and onion and lemon juice on it. I think that tastes wonderful. And then, throw them over some greens or toss them in some noodles. So they are used often in Mediterranean dishes.

John Horton:

Yeah. Do you have to worry about sodium? It seems like whenever you have stuff in cans like that, sometimes that sodium content creeps up. So is that a concern or something you should watch?

Julia Zumpano:

Absolutely. Yeah, you should. You should watch sodium. Label reading is going to be key. If they're in a tomato sauce, they may have a little more sodium versus water, olive oil. It really depends on how they're preserving it, how much sodium is being added. If it's in water and you drain some of that water and rinse the fish off, you will be able to extract some of that sodium. But the benefits of sardines outweigh the risk of having a little extra sodium. So I would still really encourage eating it, but just maybe making adjustments other ways in your diet to reduce sodium.

John Horton:

OK. Well, it sounds like something you just got to get past that little intimidation when you roll that top back and you see those little fish in there and just-

Julia Zumpano:

…absolutely.

John Horton:

…it sounds like, really, it accents a lot of different things.

Julia Zumpano:

Yeah. And it's really … the more you're exposed to it, the less it'll seem daunting. So I think it's just taking that first plunge.

John Horton:

All right. You are just throwing out ... my job's to throw out the puns here —you're stealing all my good lines.

Julia Zumpano:

I've learned from the best, John. Learned from the best.

John Horton:

All right. Well, let's move on to, I guess, fish number two here, and that would be herring. So why should we be looking for that in the case at the store?

Julia Zumpano:

So you'll see there's a theme here. Herring is also an excellent source of omega-3. Has slightly less than sardines, about one and a half grams per 3-ounce serving. And it also is a lower mercury fish. Now, it does contain mercury, but it does have lower than other fishes, like tuna, king mackerel, swordfish. We'll talk about that later. So it's on the lower end, but still is something you have to be aware of. And oftentimes, it can be pickled and canned. You can purchase it fresh, but I think most people end up choosing it smoked or pickled or canned.

John Horton:

OK. I think I've had pickled herring, and it's an acquired taste, but-

Julia Zumpano:

…it's an acquired taste.

John Horton:

…where people would like it. I know it's a big part of a lot of customs, cultural meals, things like that. It really is an important part of it.

Julia Zumpano:

It is. And just a safe way to go is mustard and dill, is a traditional way that it is served. So trying that out if you're going to give it a try.

John Horton:

All right. So it sounds like with a lot of this, you have to be willing to, as you said, take that plunge and just experiment a little bit and get over maybe a fear of seafood.

Julia Zumpano:

Absolutely. Yeah. I think again, more exposure, the better. Start with fish that you really feel comfortable eating, and then start to venture out from there.

John Horton:

All right. With herring, a lot of times, you hear about things having a real fishy taste, which I mean, what else are fish going to taste like? But does herring have a little bit more of that when people do talk about it?

Julia Zumpano:

I will say that fish that are rich in omega-3 fatty acids do tend to have more of a fishier taste. Those oilier fish are going to have some of that taste. So fresh fish, that's important. Or when it's fresh and canned immediately or pickled immediately, it will dissipate some of that taste, but that oily omega-3s give it some of that fishy taste, too. So again, more acquired.

John Horton:

Yeah. All right. Well, let's look at our third, the top three here, I guess our full fish medal stand, and that would be mackerel, so give us what we need to know on that.

Julia Zumpano:

Sure. Mackerel is also rich in omega-3. It's low in mercury, although you don't want to confuse it with king mackerel. King mackerel is from the Western Atlantic and the Gulf of Mexico and does have a very high mercury content.

John Horton:

OK, so stay away from the king.

Julia Zumpano:

Stay away from the king, limiting to Spanish mackerel to keep mercury levels low. So grilling or poaching mackerel, throwing it over a salad, veggies. So all of these can be prepared very similarly.

John Horton:

OK. And with all of these, I mean, can they be main dishes? I guess sardines, it didn't sound like you're just going to have a plate of sardines. Herring and mackerel, is there a little more along those lines?

Julia Zumpano:

All three of these would be a source of protein. So a main dish, in a dietitian's eyes, is balanced, right? So it would have a carbohydrate, a complex carb, a protein and a vegetable. So this would be a portion of that main dish. So it would serve as the protein portion of the dish. So yeah, all of these would be considered … I didn't mention that, but really the key here is that these are all great sources of protein. That is the main benefit of fish, is that it's an excellent lean source of protein that provides these additional health benefits of omega-3 fatty acids, which most of us have heard the benefits of omega-3, I mean they reduce inflammation, they help lower blood triglycerides, they help with platelet aggregation, which means how sticky your plates get, so what platelets get in your blood platelets. It helps with blood clotting, so reducing blood clots, and helps with lowering blood pressure, has been shown to support cognitive improvements, and so decrease cognitive decline and improve cognitive function.

John Horton:

Right. Well, and this is why we always talk about eating fish. I mean, it seems like over and over again, whenever we have these conversations, it's always, "Eat fish." Fish fit into the Mediterranean diet. They fit in all these different diets we talk about as being really healthy, just nutritious eating plans.

Julia Zumpano:

Yeah. And when you look at how and why this originated, when we look at areas called Blue Zones — Blue Zones are areas where the incidence of chronic disease is very low, and people have studied these Blue Zones and their lifestyle, and one frequent recurrence is that they're consuming a lot of fresh fish.

John Horton:

All right. Well, now, let's go … we kind of went through our all-stars here, so now let's talk about three fish that maybe folks might want to de-emphasize a little bit or just not lean on all the time. We don't want to call them bad or anything because they all have good things about them, but maybe just not the most ideal. The first one I know I was really surprised because it always seems like a go-to fish for a lot of people, and that would be tilapia. So why is that maybe not as great for us as what I think a lot of us believe?

Julia Zumpano:

So the reason it's not is because although it is a lean source of protein, it lacks omega-3, so it does not provide all those benefits that we discussed. Now, that doesn't necessarily mean that you can't consume it, but if you are going to consume fish, it is important to include fish that's high in omega-3, especially if you're going to have some that aren't to kind of offset that. So that would be the main reason that that was chosen.

John Horton:

You want to get the biggest splash possible.

Julia Zumpano:

Exactly. Exactly. And again, that doesn't make it bad. It's still an excellent source of protein. And if you're like, "Well, that's the only kind of fish I like," then I would say, "Go for it and consume it and continue to eat it." So it's not something that you should take off your grocery list. The point here is to encourage fish that are high in omega-3 because most Americans are not getting enough omega-3.

John Horton:

Yeah. And I feel like tilapia, it's so prevalent. I mean, it seems like one of those things you always see when you're at the store. So you just kind of gravitate toward it because it's there and it's pretty easy to cook. It seems a little less intimidating than some of the other ones. So it's kind of natural you go that way.

Julia Zumpano:

Absolutely. It's not fishy, it's very mild, it's very light, it's flaky. Again, it's easy to cook and prepare, and it is very readily available, so it's totally understandable.

John Horton:

Yeah. All right. Well, that's a great tip there.

The next one is another one that I think we all kind of lean on, and that would be tuna.

Julia Zumpano:

Yes. So tuna's probably, I don't have stats on this, but the most frequently consumed fish, I think, because it's so easily readily available. Canned tuna is so convenient. And then sushi, tuna is a big foundational fish in sushi, specifically quick, easy sushi, like grocery store sushi even.

So fresh tuna is a great source of omega-3. It is one of those good sources, although it is also high in mercury. So you do really need to be cautious on how much tuna you consume. The general guideline that I provide for my patients is 6 ounces of tuna per week, 6 ounces of canned tuna per week. So that's what I really try to keep it at. There are other ways that you can incorporate more tuna. So albacore tuna tends to have higher levels of mercury versus the canned chunk light tuna has lower levels. So just be mindful there.

John Horton:

Wow. I would not think that. I always think that's the better kind.

Julia Zumpano:

So just because it's better … so that's another thing, better, like salmon, doesn't mean that it's necessarily void of everything else. So yes, albacore is a great type of tuna. It's a meatier tuna. It's a good quality one. But again, the bigger fish feed on bigger fish and they're more likely to have more mercury. So size matters here. If you see the sardines are very tiny, so they are the lowest risk for mercury.

John Horton:

But like you said, if you love your tuna sandwich or something like that, have one during the week, but it's just maybe that's not the thing you want to base your entire fish consumption around.

Julia Zumpano:

Absolutely. Absolutely. So again, 6 ounces a week. Fresh tuna is another way to go. If you are going to get canned tuna, there are different companies that have put out more strict guidelines and testing for the amount of mercury. So I do tend to encourage my patients to gravitate toward those brands that will make sure that they have the lowest mercury in their canned tuna and that they monitor and check it.

John Horton:

Yeah. Is there something in particular you can look at on the label that will really announce that?

Julia Zumpano:

It will just say it on the label. Like some of the name brands will indicate that, like “safe catch” or it'll say “lowest in mercury” or “monitored for mercury.” So it will indicate that there.

John Horton:

So kind of lean that way if you're going to eat tuna, try to get those.

Julia Zumpano:

Absolutely. Yes.

John Horton:

All right. And then the third one, which I didn't even realize was a thing, was imported catfish. Why would that be a little bit of a concern?

Julia Zumpano:

Yeah, so 90% of catfish is imported. So it often comes from contaminated water that may contain dangerous chemicals and antibiotics. So if you love your catfish, choose farm-raised varieties from America or waters that are in the U.S. ideally, or Asian carp, which has a similar taste.

John Horton:

OK. We don't necessarily have to go, what is it, noodling, where you go catch them yourself?

Julia Zumpano:

No, you can. Might not be a bad idea. I do feel like people who fish and catch fish are way more likely to consume it.

John Horton:

There you go.

Julia Zumpano:

That's a way to get you more motivated to consume more fish in your diet.

John Horton:

Well, we kind of went through those three to focus on, three maybe to de-emphasize.

A big fish that we didn't have on that list, but everybody's so familiar with it and you find it in so many restaurants and at the store would be salmon. And it sounds like there's a big difference in whether you eat wild salmon or farm salmon. So we wanted to spend a little bit of time breaking that down and which way we should lean if you're at the store and you want to throw some salmon on the grill for dinner tonight.

Julia Zumpano:

Yes, absolutely. So this is definitely a confusing topic for most people. So the popularity of salmon has depleted the wild stock, swimming in the open waters. So in response, farmed salmon has become more common. But farmed salmon, which is typically Atlantic salmon, can contain more fat and has the likelihood of having other chemical exposures to it. Wild-caught salmon, meanwhile, is usually one of five different types of salmon, and they tend to have less exposure because of what they're fed and then the water that they're swimming in.

John Horton:

OK. And I think the one people are most common [familiar] with the wild salmon would be sockeye, which I know is fabulous when you have that. And even the color seems different when you look at the wild salmon versus the farmed.

Julia Zumpano:

Absolutely. The other piece though that throws the color off is sometimes color can be added to farm-raised fish, which can change the brightness and the color of the fish. So if you notice, wild salmon is more of its natural color, doesn't have that bright, maybe even an orange hue. And a lot of the farm-raised salmon, they put color in it to enhance it.

John Horton:

Yeah. The wild is almost like, it can be like a deep red sometimes.

Julia Zumpano:

Yes, yes. And the different parts of the fish can have different color. So it's not very uniform in color, where you'll see some of the farm-raised fish options are more uniform, the color's more uniform even throughout the fish.

John Horton:

OK. So you said nutritionally, wild salmon kind of gets the edge for having fewer calories, less saturated fat.

Julia Zumpano:

Absolutely. You're definitely going to come across less with wild salmon. So just keep that in mind. I know wild salmon may not be always the easiest to find. It may be more expensive. So just do your best of filtering in wild salmon as often as you can financially afford or as attainable for you.

So you don't have to be fearful of eating farm-raised fish. It's OK. Our bodies are designed to remove toxins. But we do have a level that is too much, and we do have a level that we want to keep below. So it's just important to be mindful of how often you're eating farm-raised fish. And when you have the opportunity to purchase it wild, do so.

John Horton:

Yeah. And it's all about making choices, and you get a little variety in it. Like you said, nothing wrong with having it every once in a while. But maybe on a consistent basis, or if you have a choice, go for the wild over farmed.

Julia Zumpano:

Absolutely, yes. And although they do say that farmed fish has higher omega-3, but it's honestly because it's the ratio of fat is so much higher. So when you look at the fat ratio for wild-caught fish, the omega-3 is less in gram dosages, but in ratio omega-3 versus saturated fat, it's higher. So just that is important to keep in mind.

John Horton:

OK. Well, good thing you brought up omega-3s because I know, before we end things here, I want to make sure we focus on two big things that we've been talking about. And that would be omega-3s and mercury and those contaminants. And just to, I guess, dive in a little bit more about why omega-3s are so important and why some of these other things can be a little alarming.

So let's start with the good first. So with omega-3s, let's lay out a little bit all the good that they do for folks, I guess, especially when it comes to heart health.

Julia Zumpano:

Sure. So they have very many benefits from a cardiovascular standpoint. So they help with lowering blood triglycerides. And triglycerides are blood fats that are part of your lipid panel, which is where your cholesterol is also found because your cholesterol is a fat. But they're a little bit different. They are oftentimes not able to be lowered with cholesterol-lowering medication because they are a fat that's a byproduct of excess calories. So it's really important that diet changes will really influence the reduction of blood triglycerides, and it has been proven that omega-3s lower that. So it can reduce risk of heart attack because these blood fats can cause plaque buildup in the lining of your arteries. So that's why the reduction of triglycerides can reduce your risk of heart disease.

John Horton:

Yeah. [inaudible 00:22:57] think, just eating, it makes such a big difference when it comes to how your blood's flowing, and just like you said, all that gunk that can build up.

Julia Zumpano:

Absolutely. It also helps your platelets be less sticky, so less likely to form clots, which are also important because that reduces your risk of stroke.

Omega-3s are a natural blood thinner, so you do have to be mindful if you are on a blood thinner. So just be very cautious and make sure you tell your doctor that you're eating fish regularly. But that's normally a good thing is to have thinner blood versus thicker blood that clots. So that's also a benefit.

It also has been shown to help with lowering blood pressure. And from another perspective, it can really help lower inflammation, which can affect cardiovascular disease, but overall, helps the whole body. So omega-3 fatty acids combat inflammation and reduce inflammation, which we know, all chronic disease stems from inflammation.

John Horton:

Yeah. Do most people get enough omega-3s in their diet, or is this kind of something where it's in things like fish, things that people don't necessarily eat all the time?

Julia Zumpano:

Not at all. I will say with counseling patients, very rarely do I see someone who's consuming fish the recommended two to three times a week. And if they are, it's sometimes not the most desirable fish. They might be eating fried fish out at a restaurant. So I think most Americans are nowhere near the amount of omega-3 they need.

John Horton:

OK. And it sounds like it's something that we could really benefit from.

Julia Zumpano:

Really, we can. And the way that we look at it is we compare the omega-3 to omega-6 ratio, and that really kind of tells us overall how our omegas are faring in our system. So we ideally want to have a 2 to 1 ratio. So of course, we're going to have a little more omega-6 versus omega-3, but some studies are saying that we have a 20 to 1 ratio. That means we have 20 times more omega-6 versus omega-3. And we know omega-6 is very beneficial, but it can be very inflammatory if we're consuming too much. So the way to offset that ratio is to decrease the omega-6, but also increase the omega-3.

John Horton:

And that would be eating fish is a good way to do that, which is why we're talking about it here. All right. So we know omega-3s are mega good. Let's talk about mercury, which we know is not good, and something that you want to stay away from. What are some of the health concerns that come out of having a little too much mercury slip into your diet?

Julia Zumpano:

Sure. So specifically, pregnant women and nursing women are the ones that should be the most cautious. Because eating fish high in mercury can lead to developmental delays in a growing fetus, and can also cause some brain damage in children. So that's definitely the number one reason we want to avoid mercury. It can also lead to a lot of negative neurological effects. If you're consuming too much mercury, it's a metal, and we want to make sure we keep a low exposure to that. As I mentioned, our body has the ability to excrete some of it, but if you're having more than your body can handle, that's when it starts to get to be a problem.

John Horton:

OK. And you had mentioned if you're pregnant or breastfeeding, and a lot of times the recommendations with that are just really not to eat fish, right? Or is even just a little amount OK sometimes?

Julia Zumpano:

So avoid them completely. And even the moderate-mercury ones are probably ones you really want to caution with while you're pregnant. But the low-mercury fish are very safe to eat.

John Horton:

OK. And that's where, then, it's hard to know which fish have the most mercury. And it's not like they have it on the label where you're going to find it, like grams of protein or something like that. I know the FDA has a helpful guide out there in their advice about eating fish that kind of labels the best, good, and avoid fish.

Julia Zumpano:

Yup.

John Horton:

But I know there's kind of a simple way to look at it, and you've already hinted at that, and it kind of has to do with size.

Julia Zumpano:

Right. Smaller the fish, the less mercury. The larger the fish, the more mercury. Those big bottom-feeder fish, those huge fish are the ones that are going to have the highest in mercury. So think of king mackerel, shark, swordfish, tile fish, orange roughy, tuna, marlin. Those are all very high sources. And yes, the FDA puts out a great one-sheet handout that gives everything to you in one handout. So you just can have a glance that has best choice, good choice and choices to avoid. So that's the best thing to do.

John Horton:

Yeah, it's really easy to find. And if you just Google it, you'll be able to find it. I'm looking at it right now. Some of the best choices would even be like anchovies, catfish, cod, crawfish, flounder, mullet, oyster, pickerel, salmon, on and on it goes.

Julia Zumpano:

The shellfish are all on there. So shellfish, as we all know, they're small, so they're very safe.

The other benefit to this handout is it gives you exactly how much fish is advised per age for children, for pregnancy and then general recommendations. So it breaks it down. So generally, on average, a serving is about an ounce for ages 1 to 3, et cetera. It goes up by ounces as age increases. And the recommendation is about eating two servings a week from the best choice list for children. And then, pregnancy is one serving is 4 ounces. And generally, we recommend more than two to three servings a week. Again, best choices.

So you can definitely eat fish when you're pregnant, when you're nursing and as a child. You just have to be aware of which fish are the highest in mercury and which are the best choices.

John Horton:

All right. Well, use that resource. Look it up if you're curious about it. Really easy to find, and you will find a huge list on there that will help guide you.

So Julia, you've walked us through a ton of stuff or I guess sailed us through a lot of different options here. Bottom line, when it comes to fish, what would you advise people when they're considering working it into their meal plans and getting a little more in their diet?

Julia Zumpano:

I would start with fish that you're comfortable with and start to consume that more frequently, regularly in the diet. And then, every week when you go back to the grocery store, try a new fish, try to add something new in and start to expand your variety from there. I don't recommend someone jumping right into fish that they're not comfortable with or they may not particularly know how to prepare or like. I would say go slowly because, oftentimes, that can deter someone from trying to get it if they have had a bad experience.

John Horton:

Yeah. Well, and it does take some time. I was always nervous buying stuff to grill or things like that because you feel like you don't know what you're doing. But once you start a little bit, it's really not as hard as what you think. And you get that perfect fish off the grill or out of something you baked and man, it really is good.

Julia Zumpano:

I think grilling is a great way to start because it doesn't smell like your home. Most people feel comfortable on a grill. Fish cooks very quickly. It takes anywhere between seven to 12 minutes to cook. And again, depending on the size, but it cooks very quickly. You can marinate it quickly and easily. So I think that's a great way to go.

John Horton:

Well, I got to say, as a child from the shores of Lake Erie, you can't beat walleye either. And the last time I know I went fishing, I still have a little bit up in the freezer. Man, nothing beats it for dinner.

Julia Zumpano:

Yeah, that's a good one.

John Horton:

All right. Well, Julia, thank you so much. This was a fabulous discussion, and I think everyone should hopefully feel a little more comfortable when they go to the store. They look over all those fish and get a little confident in picking one up.

Julia Zumpano:

Absolutely.

John Horton:

All right. Well, if you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, eat well.

Speaker 3:

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