MD Mama

Eating Fish: Another Example of Confusing Medical Advice

4 fish.jpgI love fish. I could eat it for dinner every night. But during my pregnancies, I didn't eat it at all, because I was worried that the mercury in it (which is there thanks to pollution, totally our fault) could damage my growing baby's brain. Since there were warnings that I shouldn't have more than two servings a week, and should be careful about which fish I ate, I figured: best to stay away from it entirely.

That wasn't the right thing to do. In staying away entirely, I didn't get the wonderful omega-3 fatty acids that are really good for the brain and eyes of developing babies.

Sometimes "better safe than sorry" isn't the way to go.

I'm not the only one who felt this way. Lots and lots of women did--and do. And since the warnings about mercury also apply to babies and children, lots of parents stopped giving their kids fish. As a pediatrician I've been warning parents about mercury and telling them to limit what they give their children; I'm sure many of those parents took the better-safe-than-sorry approach too.

Recently the Food and Drug Association (FDA) changed the spin a bit. Instead of saying "don't eat more than 12 ounces," they are saying "eat 12 ounces." But will it work?

So much of medicine and health involves balance. There are risks and benefits to absolutely everything. And--here's what's hardest: doing too much of something healthy can be unhealthy, and doing too little of something with risks can be unhealthy too.

There are so many examples. Antibiotics--taking them can be lifesaving, but when we prescribe them too often (especially when they aren't absolutely necessary) it can lead to resistant germs (and side effects). X-rays--too many of them can lead to an increased risk of cancer, but if we don't do them we can miss injuries or other problems, including cancer. Sunshine--too much of it can lead to skin cancer, but too little of it leaves us with not enough Vitamin D (and, for some people, depression). Even exercise, which is crucial for health, can be overdone (think kids with stress fractures from intense practices at a young age). The list goes on and on.

It just gets really confusing. People want to make the right decisions for themselves and their families. They hear "risky" and they shy away, they hear "healthy" and they think that more is better. We doctors don't always help matters. It takes time to really sit with people and explain these concepts, time we often don't have--so the advice comes out like sound bites, and balance is not a sound bite thing.

And to make things harder, balance is very individual: how much fish you should eat, how much you should exercise, which X-rays you should have or whether or not you should be in the sun is going to depend on your particular situation. The advice that works for you might be bad advice for your friend or spouse or kid. Which gets us back to that sound bite problem: it's not just doctors that are guilty of boiling things down to a sentence or two. The information found online, or shared between friends and family, tends to be quick and black-and-white.

I don't have a great solution for this problem. The most important thing, I guess, is to be aware that the problem exists. There are a few simple things in medicine; for example, smoking is bad for you, tanning beds are too, and it's really important to get enough sleep. But most of medicine and health is far from simple. So ask questions when someone gives you advice, or when you hear about the latest greatest or terrible thing.

We doctors need to do a better job with this stuff too. I don't know that we're going to fix the time problem, but we could certainly have handouts we can give patients, or websites we can refer them to, or other ways of shading that black-and-white advice with the gray it deserves.

I'm making more fish at home--and I'm getting those websites ready for my patients. It's a start.

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