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A catch to eating a lot of fish
By Jane E. Allen
Los Angeles Times
May 26, 2003

As more people turn to seafood as a source of lean protein, the risk of mercury poison rises. Choosing the right varieties could help.

Lee Flynn thought she had a healthy lifestyle. She was thin and active and she ate well- with lunches of tuna and fresh vegetables and dinners of halibut, sea bass or swordfish.

Yet she spent over a decade plagued by fatigue, stomachaches and headaches, as if she had a "wicked hangover," Her hair started falling out. Memory lapses made her think she was losing her mind.

"I really felt something was poisoning me, but I couldn't find the source," said Flynn, 59.

The Sausalito anthropologist and documentary filmmaker eventually ended up in the office of Dr. Jane Hightower, a San Francisco internist. When Hightower heard that Flynn was eating fish nine times a week, she immediately ordered a blood test for mercury. A heavy metal that accumulates in the flesh of fish, especially the popular predatory varieties, mercury can also accumulate in people who eat those fish.

The test's stunning result: Flynn's mercury level was 20.6 micrograms per liter of blood. A safe level is about 5, according to the federal Environmental Protection Agency.

Like Flynn, many adults and children may be unwittingly overdosing on mercury, say Hightower and some public health activists, and it's likely that most of them are going undiagnosed.

In recent years, fish has become the food of choice for millions of Americans trying to eat more healthfully, with per capita consumption at about 15 pounds, a 20% increase since 1980.

People on weight-loss diets turn to fish as a lean alternative to beef. Bodybuilders go for the protein: it's not unusual for them to polish entire cans of tuna. Others are drawn to the cardiovascular benefits of Omega-3 fatty acids in fish. Restaurants, meanwhile, are expanding their portions, often serving as much as a pound at a time (a normal portion is 3 or 4 ounces.)

The health benefits are undeniable - and some people may suspect the warnings are overblown. This past week, researchers at the American Psychiatric Assn. Meeting announced that fish rich in omega-3s may prevent
depression late in pregnancy and after childbirth. A study a week earlier in the Lancet found that children in the Seychelles Islands whose mothers ate a lot of fish during pregnancy showed no signs of health problems.

Even though California supermarkets recently began posting warnings about mercury in fish and the federal government has advised pregnant women to limit their fish intake, some people still don't get the message - or don't understand the cumulative effects. Furthermore, physicians aren't trained to"think fish" when patients complain of mental fuzziness, fatigue, hair loss
and tingling hands and feet. All can point to thyroid problems, multiple sclerosis, chronic fatigue syndrome or menopause.

Last November, Hightower published a report in the online journal Environmental Health Perspectives, a publication of the National Institutes of Health, on 123 patients, 89% of whom had excessive mercury (mercury poisening) she traced to fish. The study was one of the first to document mercury levels in people eating more than two servings of fish a week. To date, Hightower has documented 300 cases of elevated mercury levels in her patients, mostly upper-income professionals, including a 4-year-old girl practically living on canned tuna.

"Mercury is a known poison," Hightower says. "By definition, this means it is harmful and can make one ill or even kill."

Mercury occurs naturally, but is mostly a byproduct of coal-burning, mining and other industries. Once in the water supply, it forms methyl mercury, which lingers in fish flesh. As big fish eat smaller fish, they absorb more of the heavy metal, making predators like swordfish, shark, tuna and halibut the most toxic; smaller fish like salmon and shellfish the least. Although
fresh tuna tends to have more mercury than canned varieties, levels in canned tuna can vary from nearly undetectable to 1 part per million, the level beyond which the Food and Drug Administration prohibits its sale.

Methyl mercury is especially damaging to the developing brains of fetuses and children. The FDA advises pregnant women to eliminate shark, tilefish, king mackerel and swordfish, and limit eating of other fish to 12 ounces a week.

But high mercury levels don't always produce symptoms.

Clarissa Lee, a 30-year-old pre-school teacher from San Francisco, was eating lots of swordfish, sea bass and halibut last summer while visiting Boston, Martha's Vineyard and the Hamptons. In August, she told her gynecologist that she and her husband wanted to have a baby. The doctor heard about all the fish and ran a mercury test. Lee's level was 37. Lee
gave up fish for a while, got her mercury levels down and now indulges in the occasional salmon. As for Flynn, she gave up fish for almost two years. She now eats fish a couple times a month, but never touches the predators. Her mercury levels are normal, her memory is back and she feels good.

"Do anything to excess," Lee says, " and that's when you get into trouble."

Mercury in seafood

The worst
These fish have the highest mercury levels. Pregnant women, nursing mothers and small children are advised to avoid them.
King mackerel, shark, swordfish, tilefish.

In between These fish can be high in mercury; they should be consumed only occasionally.
Halibut, lobster, mahi-mahi, orange roughy, red snapper, tuna.

The best
These fish tend to have the lowest mercury levels. But some may still contain other contaminants, including PCBs.
Catfish, founder, sole, salmon, sardines, shellfish (includes clams, crab, oysters and shrimp), tilapia.