An abundance of research over the past several decades has conclusively shown that following an eating plan that emphasizes plant-based foods offers significant health benefits. It lowers the risk of cardiovascular diseases; many cancers; neurological and cognitive diseases like dementia, Parkinson’s disease and Alzheimer’s disease; diabetes; obesity – the list is almost endless. And at the bottom line of this list is ample scientific proof that a vegetarian diet reduces risk of death from any cause.
Eating only plant-based foods – a vegetarian diet – is for many the best choice for healthy eating. But it isn’t the only choice. Another option is to add fish and seafood to your meal plans. This is called a pescatarian diet, from pesce, the Italian word for fish.
Why choose a pescatarian diet? “It is sometimes challenging to get enough protein from a vegetarian diet alone, so this type of diet makes it easier to have a diet rich in enough protein,” says Aileen Birkitt, a registered dietician and owner of Nutrition 4 You in North Kingston, Rhode Island. Pescatarian diets tend still to be rich in plant proteins and nutrients and low in saturated fat. “The addition of seafood to the vegetarian diet means that the diet will be higher in omega-3 fatty acids,” she adds. "Some of the benefits of increased omega-3 fatty acids in the diet might be improvements in triglycerides, blood pressure, joint pain, arthritis and improved mood."
The diet also has other benefits. “This diet is easier to follow than a strict vegetarian diet as it gives people more food choices, especially more sources of high protein,” Birkitt says. And the added protein and fats add to satiety, the feeling of being full, so it’s more satisfying.
Pescatarian by Any Other Name
A similar type of eating plan is the Mediterranean diet. Cultures that live on or near the Mediterranean Sea have long lived on plant-based foods, seafood, nuts and dairy – and, occasionally, small amounts of meat.
In 1993, the Harvard T.H. Chan School of Public Health, along with Oldways Preservation and Exchange Trust and the Europe Office of the World Health Organization, created the Mediterranean Diet Pyramid to promote this way of eating. They realized that residents of Greece, Crete and southern Italy had low chronic disease rate and longer life expectancy – even with little advanced health care. These experts attributed their good health to their diet of fruits and vegetables, beans, nuts, whole grains, fish, olive oil and small amounts of dairy and red wine.
This way of eating has continued to show science-based health advantages in the nearly 30 years since that pyramid was built:
- A 2013 study in the American Journal of Clinical Nutrition showed this type of diet reduced the risk of overall mortality.
- A 2018 study in JAMA Network Open revealed that women who ate this way had 25% less risk of developing cardiovascular disease over 12 years; the diet lowered inflammation, blood sugar and body mass index, among other factors.
- A 2008 study in the New England Journal of Medicine discovered that subjects on this eating plan were best able to maintain weight loss over a six-year period.
- A 2014 study in the BMJ, a peer reviewed medical journal, found that subjects who more closely followed the diet had longer telomeres, a specific component of DNA. Longer telomeres have been linked to lower risk of chronic disease and death.
- A 2013 study in Annals of Internal Medicine found that women who ate a Mediterranean/pescatarian-style diet were 46% more likely to experience healthy aging, defined as living to 70 years or more without any chronic diseases or serious loss of mental, cognitive or physical health.
What to Eat
A pescatarian or Mediterranean diet is primarily focuses on plant-based foods like:
- Whole grains.
- Beans and other legumes.
- Nuts and seeds.
- Herbs and spices.
- Healthy fats.
Protein and other nutrients not usually found in plants come from:
- Fish and seafood.
- Eggs and dairy, like cheese or yogurt.
- Other animal products if you choose.
The Mediterranean pyramid recommends fish and seafood at least twice a week. Eggs and dairy products like cheese and yogurt can be eaten most or all days. Red meat and other animal products should be eaten only rarely – or, in the case of a pescatarian, never.
The pyramid suggests that it’s better to eat more fruits and vegetables and less animal protein and dairy foods, but each individual should decide how much food to eat at each meal, depending on his or her levels of physical activity and body size.
Healthy fats are a key ingredient of the diet. Olive oil and natural fats from foods like avocado, nuts, seeds and fish – especially oily, omega-3-rich fish like salmon and sardines – can actually lower the risk of heart disease, even when consumed at moderate to high levels.
Water is recommended as your main beverage. However, a moderate intake of wine, especially red wine, with meals has been shown to have heart-healthy benefits. Health experts say to keep it to one to two glasses of wine a day for men and one glass a day for women. But if you don’t drink now, the benefits aren’t so great that you should start.
What Are the Disadvantages?
Nothing is perfect, of course, and a pescatarian diet comes with some warnings. Seafood may contain mercury, which can damage the brain and nervous system. “If someone is eating too much high-mercury fish such as king mackerel, orange roughy, swordfish, tilefish, ahi tuna and bigeye tuna, they will have higher mercury levels which can have negative health consequences,” Birkitt says. “Nursing and pregnant women, women of childbearing age and young children need to be most careful when choosing seafood options.”
Birkitt recommends fish and seafood lower in mercury, such as wild and Alaska salmon, tilapia, shrimp, scallops, sardines, oysters, cod, haddock and pollock, among others. Be sure to include fish high in omega-3, with salmon being one of the highest sources.
It is always wise to talk to your primary care doctor and other doctors about your eating plans before you make any big diet changes.
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