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I’m noticing that an increasing number of my “vegetarian” friends are claiming to be “pesco-vegetarians.” I even have one who claims to be a vegan, but eats fish twice weekly. What do you recommend? Fish or not?

A vegetarian diet is one that does not include “flesh” foods. Some argue that fish was not included in the term “flesh” in the late nineteenth century; even today many who consider themselves vegetarians include fish as a part of their diet. Our Lord both ate and served fish in His glorified body, which would logically lead to an understanding that fish, intrinsically, is a useful article of diet.

Even Ellen White ate fish during a period in which she claimed she had not eaten any “flesh” foods. This has led some researchers to believe that she did not include fish under the terminology of “flesh,” which usually connoted red meats. She did, however, caution about fish taken from polluted waters.

Since her time the rise in concentrations of mercury, cadmium, PCBs, and dioxin in natural waters has been of many multiples, and we do not feel comfortable recommending fish as a regular article of diet. Of course, we recognize that there are places where the waters are not polluted, and that there’s some evidence of benefits from consuming fish.

Several studies show that the consumption of fish two to three times per week lowers the risk of a nonfatal heart attack by 21 percent, of death from coronary heart disease by 38 percent, and of stroke by 31 percent.1 These studies have been done on individuals “at risk” for cardiac problems, and there have not been conclusive large-scale randomized trials on the protective effects of omega-3 fatty acids in the general population.2

Vegetarians can obtain omega-3 fatty acids from oils such as canola, soybean, olive, and flaxseed, as well as from avocados and walnuts.

There’s a difference between vegetable-based omega-3s (or the alpha-linolenic acid [ALA]) and the marine omega-3s (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]). The marine omegas have been studied more fully than vegetable omegas, and consequently data is not as plentiful for the latter.

The Adventist Health Study II can be expected to shed light on more detailed health-related differences for those consuming vegetarian diets. Preliminary trends from this study are as yet statistically inadequate to make firm recommendations. What is undisputable is that there’s a large difference between meat eaters and all types 
of vegetarians, and that includes the fish-eating vegetarians. When it comes to showing a difference between a total plant-based diet (vegan), the plant-based diet (lacto-ovovegetarian), and the pesco-vegetarian diet (no meat except fish), the data so far is inconclusive because not enough time for follow-up has occurred. It would appear that for all-cause mortality, lacto-ovovegetarians currently enjoy a slight lead. For cardiovascular cholesterol levels and body weight advantages, the total plant-based diet has a small lead. The pesco-vegetarians, while doing better than the meat eaters, trail a little behind those who espouse the other two types of diet.

It might be possible to obtain some of the benefits of marine omega-3s from fish oil capsules, thereby avoiding the risks of pollutants such as mercury. The Consumer Reports team did not find significant amounts of mercury, PCBs, or dioxin in some 16 fish oil capsules they tested.3

The real question, however, is whether consumption of fish oil capsules—or even fish, for that matter—adds any benefit above that conferred by a well-balanced vegetarian diet. We will not know the definitive answer for a couple of years, but to date, the answer appears to be that it does not.  

1 Ka He, Yiqing Song, Martha L. Daviglus, Kiang Liu, Linda Van Horn, Alan R. Dyer, and Philip Greenland, “Accumulated Evidence on Fish Consumption and Coronary Heart Disease Mortality: A Meta-Analysis of Cohort Studies,” Circulation 109 (2004): 2704-2711.
2 JoAnn E. Manson, Shari S. Bassuk, “Marine Omega-3 Fatty Acids and Cardiovascular Disease.”
3 “Omega-3 Oil: Fish or Pills,” Consumer Reports 68, no. 7 (2003): 30-32; The Female Patient 36, no. 11 (November 2011): 12.


Allan R. Handysides, a board-certified gynecologist, is director of the General Conference Health Ministries Department.

Peter N. Landless, a board-certified nuclear cardiologist, is associate director of the General Conference Health Ministries Department.
This article originally appeared in the March, 2012, issue of Adventist World.




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