Thank You Very Much, 
but I Don't Care for Fish
By E. Noel Preston, MD

   When I was a small boy there weren't any supermarkets. My mother did her grocery shopping all over town -- Tanner's Grocery, where she bought produce, canned goods, meat, cheese, butter and eggs, Leon's Bakery (my favorite, where Leon spelled backwards is Noel), which smelled like powdered sugar, honey, and chocolate, and where she bought coffee cakes, cookies, cakes, and pies, and Fowler's Fish Market, which smelled like fish instead of chocolate and had an enormous metal red snapper outlined in pink neon light that swung from a pole sticking out over the sidewalk. Fowler's was my least favorite but most fascinating place. At eight years old, I was comfortably able to stare through the large glass windows of Mr. Fowler's display cases at rows and rows of huge fish, all nearly as big as I was, laid out side by side on great mounds of cracked ice. Their heads always pointed straight at me at the front of the case, their mouths were always open and had dozens of sharp teeth, and their eyes were all the size of Roosevelt dimes that seemed to follow me wherever I went.

   Fortunately my mother didn't like cooking and we didn't have fish that often, but when we did, I usually choked on a fishbone. Sometimes we would go out to dinner at the New England Oyster House, and I could have shrimp newburg or scallops, and that was about it for my childhood seafood dining experience. In high school biology class, we dissected fish and learned about liver flukes and fish tapeworms, and I found validation for not wanting to eat fish.

   A few years ago I read about ciguatera fish toxin, and that settled it as far as my eating fish on purpose was concerned. Ciguatera is a toxin from a microscopic parasite that inhabits tropical reefs and is found in reef fish from Florida and Hawaii. It has also been found in tropical and subtropical waters of the West Indies, India, and the Pacific Rim, and has been detected in over 400 species of tropical fish. The toxin cannot be inactivated by freezing or cooking, does not make the fish sick, and might affect fish from one side but not the other of the same reef. It attacks people who eat the fish about three to eight hours after they eat, and causes severe gastrointestinal symptoms. The neurologic symptoms, however, sound at least 40 times worse. Ciguatera poisoning causes constant and extreme pain and itching of the arms and legs, and victims have said it feels as if their hands and feet have been drenched with scalding water. The gastrointestinal symptoms last about three to five days, and the neurologic symptoms last about three to five weeks! Ciguatera passes from small fish to the larger fish that eat them and then pass on to the even bigger fish that eat the large fish -- so the bigger a reef fish you eat, the more toxin you consume and the worse symptoms you will have. What is a reef fish? Remember the letters B-A-G-S, which stand for barracuda, (also sea bass), amberjack, grouper, and snapper. If you still want to eat a reef fish, follow this advice: When you go on vacation in the tropics, don't eat fish the local residents won't eat. Don't ever eat barracuda, which has higher levels of ciguatera than other fish. Don't eat fish from an ocean reef that has been disturbed by a storm, earthquake, volcano, shipwreck, or anything else that disrupts the natural balance of the reef. And don't eat fish that weigh more than five pounds.

   Mercury poisons fish by contaminating the ocean from underground volcanos or by industrial pollution. Here again, the mercury is concentrated in fish the higher one goes up the food chain, so the ones with the highest levels of mercury are the large predator fish such as shark, swordfish, and king mackerel. Sushi lovers beware! Mercury damages the developing neurologic system, and so pregnant women, women of childbearing age, nursing mothers, and young children should avoid eating predator fish.

   Commercial fisheries raise salmon in ocean "farms" enclosed by large pens or nets. The fisheries feed the salmon processed fish food, which is made from smaller fish that are ground up and pressed into flakes or pellets. Insecticides, fertilizers, pollutants and toxins make their way up the food chain and are thought to reach high levels in the salmon that eat the commercial fish food. Scientists at Indiana University have found farm salmon to have much higher levels of polychlorinated biphenyls (PCB's), which are known human carcinogens, than wild salmon. Farm salmon can also be infested with sea lice and carry fish viruses, and since the farm salmon frequently escape their pens, they contaminate wild salmon and other species. Do farm salmon glow in the dark? Probably not, but they sure don't seem natural, now do they?

   Scromboid poisoning is due to faulty refrigeration and bacterial contamination of scromboid fish, which include mahi mahi, albacore tuna, bluefin and yellowfin tuna, mackerel, and sardines. These fish contain high levels of histidine, and if the fish spoils, bacteria convert the histidine to histamine. Anyone who eats this histamine-laden fish could then develop severe allergy symptoms such as itching, rash, hives, tingling of the face and arms, throbbing headaches, swollen eyelids, nausea, vomiting, and diarrhea. This sort of poisoning does not require moving up the food chain so one could just as easily be infected by eating a small fish as a larger one. The lesson here is that a good fish shouldn't smell fishy.

   And so if you enjoy seafood, I'm happy for you and wish you the best -- but please don't think I'm hoping you will offer to share. Thank you very much, but I don't care for fish!

E. Noel Preston, M.D. is a pediatrician in solo practice in Peachtree Corners. 6063 Peachtree Parkway, Suite 202-A, Norcross. (770) 448-1553.

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