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Fishing for Facts
                                                                                          Why public health strategy should promote
                                                                                          plant oils in preference to fish oils
                              by Laura Scott (MSc Nutrition)
                              VVF Snr Nutritionist

                              F ish is s e e min gly pro m ote d a s th e n e w p e nicillin. VV F un c overs th e scie n c e to sh ow th at it is pla nt oils
                              a n d a pla nt b a s e d diet, n ot fish oils, th at are th e re al w a y forw ard for lifelo n g h e alth.

                              Intro d u ctio n                                                                                  DA RT Tri a l
                              People are encouraged to believe that a healthy diet is one which                                 It found that males who had been advised to eat as much as 400g
                              includes fish. The reason being that some fish contain the types of                               of oily fish per week showed a reduction of almost 30 per cent in
                              ‘good’ fat that our bodies need. There is a widespread                                            mortality (death) over two years. Although there were fewer fatal
                              misconception amongst the general public and health professionals                                 heart attacks, the total number of heart attacks wasn’t reduced. It
                              that fish is the only source of these good fats.                                                  is thought that fish oils help to normalise heartbeat rhythms and
                                                                                                                                prevent blood from becoming too sticky and ‘clumping’ (3).
                              There are two reasons why these ideas have become so well                                         Despite this apparent reduction in risk, a follow-up study 10 years
                              established. Firstly, much has been made of the healthiness of the                                later found there were no long-term survival benefits (4).
                              Mediterranean diet, which is based on generous servings of fruits
                              and vegetables, cereals and olive oil and where fish is served in                                 G IS SI Tri a l
                              preference to meat or dairy products. Mealtimes tend to be very                                   This trial looked at people on a Mediterranean diet who had had a
                              social and this may have profound implications for health.                                        heart attack and survived it. Fish oil supplements equivalent to a
                              Secondly, a number of studies have examined the effect of fish in                                 whopping 100g of oily fish per day were given and showed a 20
                              helping to prevent a second heart attack in people who have                                       per cent reduction in mortality (5).
                              already had one attack and these show some protection benefits.
                                                                                                                                LY O N Tri a l
                              F ats in th e Diet                                                                                This was another secondary prevention trial, but instead of fish or fish
                              There’s a lot of confusion about fat and diet, but the truth is that our                          oils, plant-derived omega-3 fatty acids were used. Amazingly, a 70 per
                              bodies can’t function without it. Eating the right kind of fat is,                                cent reduction in mortality was achieved - more than double that of
                              however crucial. What we don’t need are saturated fats, found                                     the fish trials! There was also a significant reduction in coronary
                              mainly in meat, dairy and animal products, but also in many                                       ‘events’ and these protective effects were found to start quickly (6).
                              processed foods. These are strongly linked to high blood cholesterol,                             Four years on, patients were still following the diet and their hearts
                              hardening of the arteries, coronary heart disease, some cancers and                               were still being protected (7). Subsequent studies have confirmed the
                              other degenerative diseases. We do need unsaturated fats - especially                             power of plant omega-3 fatty acids in protecting the heart (8,9).
                              polyunsaturated fats.
                                                                                                                                Pla nt O ils B etter th a n F ish O ils
                              Within polyunsaturated fats are substances called essential fatty                                 Comparing the three main trials shows that:
                              acids, or EFAs - namely omega-6 (linoleic acid - LA) and omega-3                                  • plant oils are far more effective than fish oils in reducing the
                              fats (linolenic acid - LNA). Although olive oil is not an EFA it is                                 chance of cardiac death in high-risk patients;
                              another type of unsaturated fat which has some healthy properties                                 • plant oils reduce the risk of dying from secondary heart attack
                              and it is good to include it in the diet. EFAs - particularly the                                   by more than double that of fish oils;
                              omega-3 fats - help keep the heart healthy.                                                       • plant oils reduce the number of painful, non-fatal heart attacks;
                                                                                                                                • there are long-term survival benefits from consuming plant oils.
                              Fish is a source of EFAs, particularly omega-3 fats, but not all fish
                              contain them. Those that do are principally oily fish such as                                     N o G ain for Lo w-Risk
                              herring, salmon, mackerel, sardines and fresh tuna. White fish,                                   The trials we’ve written about all looked at people who were at
                              such as cod, haddock and plaice, don’t and nor does tinned tuna.                                  high risk of a heart attack. Because people are termed ‘low-risk’, it
                                                                                                                                doesn’t mean they will never have an attack, it simply means they
                              However, the richest sources of omega-3 fats are not fish at all but                              are further down the risk scale. They are those who eat low levels
                              plants. Seed oils such as linseed (flax) and rapeseed (canola) as well                            of saturated fat and therefore can include vegetarians and vegans
                              as soya oil are rich sources as are seeds and nuts themselves -                                   (10,11). When researchers looked at low-risk groups they found
                              particularly walnuts (1). Green leafy vegetables are also a source (2).                           that eating fish had no effect on reducing their chances of dying
                                                                                                                                from a heart attack (12).
                              O m e g a-3 a n d H e art Dis e a s e
                              It’s been known for a long time that people whose diet is based                                   Toxins in F ish
                              largely on fish and is rich in omega-3 have low rates of heart disease.                           Human beings have been so successful at spreading pollution that
                              This led researchers to investigate whether giving fish to people who                             environmental contamination is widespread and all oceans now contain
                              had already suffered a heart attack would prevent them from having                                toxic chemicals. Persistent organic pollutants (POPs) are now part of
C h arity num b er: 1037486




                              another attack. These are ‘secondary prevention trials’ and two of the                            most food chains and they become more concentrated the higher up
                              largest are the DART and GISSI trials, which both used fish-based                                 the chain you go. Mercury, organophosphates, PCBs, dioxins, and
                              omega-3 fats. They did show a reduced risk, but much less publicised                              radioactive pollution in some fish, are all highly toxic to life.
                              was the LYON trial, which used plant oils as a source of omega-3
                              fats. The results of this study showed that plant oils reduced the risk                           Fatty foods have a tendency to ‘soak’ up toxins and so oily fish are
                              of a secondary heart attack by at least twice that of fish oils!                                  particularly prone to absorbing them - the toxins are actually stored


                              VV F, To p S uite , 8 York C o urt, Wild er Stre et, Bristol B S2 8 Q H . Tel: 0117 970 5190. E m ail: info @ ve g etaria n.org.uk We b : www.ve g etaria n.org .uk
in the fatty part of the fish. By eating smaller fish, oily fish take on                               P u blic H e alth Failure
their toxic load and become ever more toxic themselves! POPs are                                       The average UK consumption of oily fish is 53g per person per week
implicated in heart disease, infertility and can harm developing                                       (19). This meagre quantity represents only about a third of a single
foetuses. Responding to a Food Standards Agency 2002 survey, the                                       portion and is a tiny amount compared to the 400g weekly intake of
Consumers’ Association warned that high levels of dioxins and PCBs                                     oily fish which have been used to produce heart benefits in research
in fish and fish oil supplements could “put millions at risk” (13).                                    studies. This shows that all the attempts to get the British public to
                                                                                                       eat fish is a spectacular failure.
M erc ury in F ish
Humans should avoid mercury in their diet as it acts like a poison,                                    Altern ativ e s to F ish O ils
affecting their kidneys, heart and central nervous system (CNS).                                       Seeds, nuts, beans and their oils are the richest-known sources of
Exposure to mercury is a particular risk for unborn children where                                     the ‘good’ fats. Green leafy vegetables also contain these essential
the main organs, especially the CNS, are still developing.                                             fats. Walnuts, linseed (flaxseed) and rapeseed oil (canola) are all
According to a government agency, fish eating is responsible for                                       exceptionally rich in omega-3 fats.
the majority of mercury in people’s diets (14). Following a Food
Standards Agency survey of mercury levels in fish, official advice is                                  The best way to buy and store nuts, seeds and their oils is in very
now for pregnant and breastfeeding women to limit how much                                             small quantities and to keep them in the fridge. This helps to
tuna they eat and for them and children under 16 not to eat shark,                                     ensure that they are as fresh as possible. These oils are not suitable
swordfish or marlin at all. (15)                                                                       for heating as it destroys the beneficial EFAs. Most healthfood
                                                                                                       shops and supermarkets sell packets of nuts and seeds and blended
Other studies have found that over 60 per cent of bluefin tuna                                         plant oils - usually marketed as oils rich in omega-3 and omega-6
caught in the Mediterranean exceed EC ‘safety’ figures.                                                fats. They contain information on how much oil to use each day.
Researchers have calculated that some of those people who eat                                          With whole seeds and nuts, a handful each day is normally
high levels of these oily fish will far exceed the World Health                                        sufficient. Olive oil can be used for cooking.
Organisation’s (WHO) ‘safety’ levels (16, 17). A 2000
government study failed to detect any mercury in vegetarian                                            F ishl e ss Fo o d s
diets and concluded, “it is reasonable to assume that because                                          Fish-like substitutes are available thanks to food technologists who
participants in this study did not eat fish, their dietary                                             have produced imitation fish fingers, scampi, tuna and salmon paté
exposures to mercury will be substantially less than those of                                          that actually taste of fish. They are available in most healthfood shops.
the general population” (18).
                                                                                                       Inte llig e nt Pu b lic H e a lth Pro m otio n
Prote ct a n d S urviv e                                                                               Adding fish to the diet will not bring about long-term good health.
One way mercury harms the body is by acting as a potent free                                           Plant-based vegetarian and vegan diets are the best choice for
radical. Free radicals are unstable molecules that damage body cells                                   optimum health.
and the body’s main defence against them are antioxidants - beta-
carotene (converted to vitamin A), and vitamins C and E. Plant                                         S u m m ary
foods are rich in these antioxidants and plant oils are particularly                                   •    Plant oils are a far healthier source of the essential fats we need.
rich in vitamin E, which stops EFAs from deteriorating or going                                        •    Plant oils halve the risk of heart disease compared with fish oils.
off. Only plant oils, not fish oils, contain protective vitamin E.                                     •    Fish is a spectacularly unpopular food in the UK.
                                                                                                       •    Fish is likely to be contaminated with harmful chemicals.
H o w Mu c h F ish?                                                                                    •    Plant oils are far less likely to turn rancid than fish oils.
The FSA seem as muddled as everyone else about how much fish                                           •    Plant oils as nuts and seeds are the ultimate fast food.
people should eat each week. Some of its publications say two                                          •    Plant-based diets offer protection against many diseases.
servings and others say at least two servings. But, in any case, surveys
show the vast majority of people are unaware of the official advice                                    Our hearts don’t need fish, our brains don’t need fish and our health
and most people are confused by what is meant by oily fish (13).                                       is far better served by plant oils and a well-balanced plant-based diet.


R efere n c e s
1 Buttriss J, 1999. n-3 Fatty Acids And Health. p.1. (BNF)                                             9 Singh RB et al, 2002. Effect of an Indo-Mediterranean Diet on Progression of
2 Pereira C et al, 2001. The Alpha-Linolenic Acid Content of Green Vegetables                          Coronary Artery Disease in High Risk Patients (Indo-Mediterranean Diet Heart
Commonly Available in Australia. Int. J. Vitam. Nutr. Res.;71(4):223-228.                              Study): A Randomised Single-Blind Trial. The Lancet;360:1455-1461.
3 Burr ML et al, 1989. Effects of Changes in Fat, Fish and Fibre Intakes on                            10 Key TJ et al, 1999. Health Benefits of a Vegetarian Diet. Proc. Nutr Soc.;58:271-275.
Death and Myocardial Reinfarction: Diet And Reinfarction Trial (DART). The                             11 ADA Reports. Position of the American Dietetic Association and Dietitians of
Lancet;8666:757-761.                                                                                   Canada: Vegetarian Diets. 2003. JADA;103(16):748-765.
4 Ness AR et al, 2002. The Long-Term Effect of Dietary Advice in Men with                              12 Marckmann P & Gronbaek M, 1999. Fish Consumption and Coronary Heart
Coronary Disease: Follow-Up of the Diet and Reinfarction Trial (DART). Europ.                          Disease Mortality. A Systematic Review of Prospective Cohort Studies. Europ. J.
J. Clin. Nutr.;56:512-518.                                                                             Clin. Nutr.;53:585-590.
5 GISSI-Prevenzione Investigators, 1999. Dietary Supplementation with N-3                              13 Consumers’ Association, ‘Fish – what’s the catch’, Which?, p.7-9, October 2002.
Polyunsaturated Fatty Acids and Vitamin E After Myocardial Infarction: Results                         14 COT Statement (2002/04) in December 2002 concerning a FSA survey on the
of the GISSI-Prevenzione Trial. The Lancet;354:447-455.                                                levels of mercury in fish and shellfish.
6 De Lorgeril M et al, 1994. Mediterranean Alpha-Linolenic Acid-Rich Diet in                           15 FSA statement ref: 40/2003, Mercury in imported fish and shellfish, UK
Secondary Prevention of Coronary Heart Disease. The Lancet;343:1454-1459                               farmed fish and their products, July 2003.
7 De Lorgeril M et al, 1999. Mediterranean Diet, Traditional Risk Factors and                          16 Storelli MM et al, 2002. Total and Methylmercury Residues in Tuna-Fish
the Rate of cardiovascular Complications After Myocardial Infarction.                                  from the Mediterranean Sea. Food Add. And Contam.;19(8):715-720.
Circulation;99:779-785.                                                                                17 Storelli MM et al, 2003. Total Mercury and Methylmercury Content in Edible
8 Singh RB et al, 1997. Randomised, Double-Blind, Placebo-Controlled Trial of                          fish from the Mediterranean Sea. J. of Food Protection;66(2):300-303.
Fish Oil and Mustard Oil in Patients with Suspected Acute Myocardial Infarction:                       18 MAFF, 2000, Duplicate Diet Study of Vegetarians.
The Indian Experiment of Infarct Survival-4. Cardiovas. Drugs and                                      19 Food Standards Agency, 2002, The National Diet and Nutrition Survey: adults
Therapy;11:485-491.                                                                                    aged 19 to 64 years, HMSO.


This is o n e in a s erie s of VV F fa ctsh e ets. VV F also p u blish a Fishin g for Fa cts re p ort a n d a fish inform atio n le aflet. F or d etails c o nta ct:
VV F, To p S uite , 8 York C o urt, Wild er Stre et, Bristol B S2 8 Q H . Tel: 0117 970 5190. E m ail: info @ ve g etaria n.org.uk We b : www.ve g etaria n.org .uk

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Fish Factsheet

  • 1. Fishing for Facts Why public health strategy should promote plant oils in preference to fish oils by Laura Scott (MSc Nutrition) VVF Snr Nutritionist F ish is s e e min gly pro m ote d a s th e n e w p e nicillin. VV F un c overs th e scie n c e to sh ow th at it is pla nt oils a n d a pla nt b a s e d diet, n ot fish oils, th at are th e re al w a y forw ard for lifelo n g h e alth. Intro d u ctio n DA RT Tri a l People are encouraged to believe that a healthy diet is one which It found that males who had been advised to eat as much as 400g includes fish. The reason being that some fish contain the types of of oily fish per week showed a reduction of almost 30 per cent in ‘good’ fat that our bodies need. There is a widespread mortality (death) over two years. Although there were fewer fatal misconception amongst the general public and health professionals heart attacks, the total number of heart attacks wasn’t reduced. It that fish is the only source of these good fats. is thought that fish oils help to normalise heartbeat rhythms and prevent blood from becoming too sticky and ‘clumping’ (3). There are two reasons why these ideas have become so well Despite this apparent reduction in risk, a follow-up study 10 years established. Firstly, much has been made of the healthiness of the later found there were no long-term survival benefits (4). Mediterranean diet, which is based on generous servings of fruits and vegetables, cereals and olive oil and where fish is served in G IS SI Tri a l preference to meat or dairy products. Mealtimes tend to be very This trial looked at people on a Mediterranean diet who had had a social and this may have profound implications for health. heart attack and survived it. Fish oil supplements equivalent to a Secondly, a number of studies have examined the effect of fish in whopping 100g of oily fish per day were given and showed a 20 helping to prevent a second heart attack in people who have per cent reduction in mortality (5). already had one attack and these show some protection benefits. LY O N Tri a l F ats in th e Diet This was another secondary prevention trial, but instead of fish or fish There’s a lot of confusion about fat and diet, but the truth is that our oils, plant-derived omega-3 fatty acids were used. Amazingly, a 70 per bodies can’t function without it. Eating the right kind of fat is, cent reduction in mortality was achieved - more than double that of however crucial. What we don’t need are saturated fats, found the fish trials! There was also a significant reduction in coronary mainly in meat, dairy and animal products, but also in many ‘events’ and these protective effects were found to start quickly (6). processed foods. These are strongly linked to high blood cholesterol, Four years on, patients were still following the diet and their hearts hardening of the arteries, coronary heart disease, some cancers and were still being protected (7). Subsequent studies have confirmed the other degenerative diseases. We do need unsaturated fats - especially power of plant omega-3 fatty acids in protecting the heart (8,9). polyunsaturated fats. Pla nt O ils B etter th a n F ish O ils Within polyunsaturated fats are substances called essential fatty Comparing the three main trials shows that: acids, or EFAs - namely omega-6 (linoleic acid - LA) and omega-3 • plant oils are far more effective than fish oils in reducing the fats (linolenic acid - LNA). Although olive oil is not an EFA it is chance of cardiac death in high-risk patients; another type of unsaturated fat which has some healthy properties • plant oils reduce the risk of dying from secondary heart attack and it is good to include it in the diet. EFAs - particularly the by more than double that of fish oils; omega-3 fats - help keep the heart healthy. • plant oils reduce the number of painful, non-fatal heart attacks; • there are long-term survival benefits from consuming plant oils. Fish is a source of EFAs, particularly omega-3 fats, but not all fish contain them. Those that do are principally oily fish such as N o G ain for Lo w-Risk herring, salmon, mackerel, sardines and fresh tuna. White fish, The trials we’ve written about all looked at people who were at such as cod, haddock and plaice, don’t and nor does tinned tuna. high risk of a heart attack. Because people are termed ‘low-risk’, it doesn’t mean they will never have an attack, it simply means they However, the richest sources of omega-3 fats are not fish at all but are further down the risk scale. They are those who eat low levels plants. Seed oils such as linseed (flax) and rapeseed (canola) as well of saturated fat and therefore can include vegetarians and vegans as soya oil are rich sources as are seeds and nuts themselves - (10,11). When researchers looked at low-risk groups they found particularly walnuts (1). Green leafy vegetables are also a source (2). that eating fish had no effect on reducing their chances of dying from a heart attack (12). O m e g a-3 a n d H e art Dis e a s e It’s been known for a long time that people whose diet is based Toxins in F ish largely on fish and is rich in omega-3 have low rates of heart disease. Human beings have been so successful at spreading pollution that This led researchers to investigate whether giving fish to people who environmental contamination is widespread and all oceans now contain had already suffered a heart attack would prevent them from having toxic chemicals. Persistent organic pollutants (POPs) are now part of C h arity num b er: 1037486 another attack. These are ‘secondary prevention trials’ and two of the most food chains and they become more concentrated the higher up largest are the DART and GISSI trials, which both used fish-based the chain you go. Mercury, organophosphates, PCBs, dioxins, and omega-3 fats. They did show a reduced risk, but much less publicised radioactive pollution in some fish, are all highly toxic to life. was the LYON trial, which used plant oils as a source of omega-3 fats. The results of this study showed that plant oils reduced the risk Fatty foods have a tendency to ‘soak’ up toxins and so oily fish are of a secondary heart attack by at least twice that of fish oils! particularly prone to absorbing them - the toxins are actually stored VV F, To p S uite , 8 York C o urt, Wild er Stre et, Bristol B S2 8 Q H . Tel: 0117 970 5190. E m ail: info @ ve g etaria n.org.uk We b : www.ve g etaria n.org .uk
  • 2. in the fatty part of the fish. By eating smaller fish, oily fish take on P u blic H e alth Failure their toxic load and become ever more toxic themselves! POPs are The average UK consumption of oily fish is 53g per person per week implicated in heart disease, infertility and can harm developing (19). This meagre quantity represents only about a third of a single foetuses. Responding to a Food Standards Agency 2002 survey, the portion and is a tiny amount compared to the 400g weekly intake of Consumers’ Association warned that high levels of dioxins and PCBs oily fish which have been used to produce heart benefits in research in fish and fish oil supplements could “put millions at risk” (13). studies. This shows that all the attempts to get the British public to eat fish is a spectacular failure. M erc ury in F ish Humans should avoid mercury in their diet as it acts like a poison, Altern ativ e s to F ish O ils affecting their kidneys, heart and central nervous system (CNS). Seeds, nuts, beans and their oils are the richest-known sources of Exposure to mercury is a particular risk for unborn children where the ‘good’ fats. Green leafy vegetables also contain these essential the main organs, especially the CNS, are still developing. fats. Walnuts, linseed (flaxseed) and rapeseed oil (canola) are all According to a government agency, fish eating is responsible for exceptionally rich in omega-3 fats. the majority of mercury in people’s diets (14). Following a Food Standards Agency survey of mercury levels in fish, official advice is The best way to buy and store nuts, seeds and their oils is in very now for pregnant and breastfeeding women to limit how much small quantities and to keep them in the fridge. This helps to tuna they eat and for them and children under 16 not to eat shark, ensure that they are as fresh as possible. These oils are not suitable swordfish or marlin at all. (15) for heating as it destroys the beneficial EFAs. Most healthfood shops and supermarkets sell packets of nuts and seeds and blended Other studies have found that over 60 per cent of bluefin tuna plant oils - usually marketed as oils rich in omega-3 and omega-6 caught in the Mediterranean exceed EC ‘safety’ figures. fats. They contain information on how much oil to use each day. Researchers have calculated that some of those people who eat With whole seeds and nuts, a handful each day is normally high levels of these oily fish will far exceed the World Health sufficient. Olive oil can be used for cooking. Organisation’s (WHO) ‘safety’ levels (16, 17). A 2000 government study failed to detect any mercury in vegetarian F ishl e ss Fo o d s diets and concluded, “it is reasonable to assume that because Fish-like substitutes are available thanks to food technologists who participants in this study did not eat fish, their dietary have produced imitation fish fingers, scampi, tuna and salmon paté exposures to mercury will be substantially less than those of that actually taste of fish. They are available in most healthfood shops. the general population” (18). Inte llig e nt Pu b lic H e a lth Pro m otio n Prote ct a n d S urviv e Adding fish to the diet will not bring about long-term good health. One way mercury harms the body is by acting as a potent free Plant-based vegetarian and vegan diets are the best choice for radical. Free radicals are unstable molecules that damage body cells optimum health. and the body’s main defence against them are antioxidants - beta- carotene (converted to vitamin A), and vitamins C and E. Plant S u m m ary foods are rich in these antioxidants and plant oils are particularly • Plant oils are a far healthier source of the essential fats we need. rich in vitamin E, which stops EFAs from deteriorating or going • Plant oils halve the risk of heart disease compared with fish oils. off. Only plant oils, not fish oils, contain protective vitamin E. • Fish is a spectacularly unpopular food in the UK. • Fish is likely to be contaminated with harmful chemicals. H o w Mu c h F ish? • Plant oils are far less likely to turn rancid than fish oils. The FSA seem as muddled as everyone else about how much fish • Plant oils as nuts and seeds are the ultimate fast food. people should eat each week. Some of its publications say two • Plant-based diets offer protection against many diseases. servings and others say at least two servings. But, in any case, surveys show the vast majority of people are unaware of the official advice Our hearts don’t need fish, our brains don’t need fish and our health and most people are confused by what is meant by oily fish (13). is far better served by plant oils and a well-balanced plant-based diet. R efere n c e s 1 Buttriss J, 1999. n-3 Fatty Acids And Health. p.1. (BNF) 9 Singh RB et al, 2002. Effect of an Indo-Mediterranean Diet on Progression of 2 Pereira C et al, 2001. The Alpha-Linolenic Acid Content of Green Vegetables Coronary Artery Disease in High Risk Patients (Indo-Mediterranean Diet Heart Commonly Available in Australia. Int. J. Vitam. Nutr. Res.;71(4):223-228. Study): A Randomised Single-Blind Trial. The Lancet;360:1455-1461. 3 Burr ML et al, 1989. Effects of Changes in Fat, Fish and Fibre Intakes on 10 Key TJ et al, 1999. Health Benefits of a Vegetarian Diet. Proc. Nutr Soc.;58:271-275. Death and Myocardial Reinfarction: Diet And Reinfarction Trial (DART). The 11 ADA Reports. Position of the American Dietetic Association and Dietitians of Lancet;8666:757-761. Canada: Vegetarian Diets. 2003. JADA;103(16):748-765. 4 Ness AR et al, 2002. The Long-Term Effect of Dietary Advice in Men with 12 Marckmann P & Gronbaek M, 1999. Fish Consumption and Coronary Heart Coronary Disease: Follow-Up of the Diet and Reinfarction Trial (DART). Europ. Disease Mortality. A Systematic Review of Prospective Cohort Studies. Europ. J. J. Clin. Nutr.;56:512-518. Clin. Nutr.;53:585-590. 5 GISSI-Prevenzione Investigators, 1999. Dietary Supplementation with N-3 13 Consumers’ Association, ‘Fish – what’s the catch’, Which?, p.7-9, October 2002. Polyunsaturated Fatty Acids and Vitamin E After Myocardial Infarction: Results 14 COT Statement (2002/04) in December 2002 concerning a FSA survey on the of the GISSI-Prevenzione Trial. The Lancet;354:447-455. levels of mercury in fish and shellfish. 6 De Lorgeril M et al, 1994. Mediterranean Alpha-Linolenic Acid-Rich Diet in 15 FSA statement ref: 40/2003, Mercury in imported fish and shellfish, UK Secondary Prevention of Coronary Heart Disease. The Lancet;343:1454-1459 farmed fish and their products, July 2003. 7 De Lorgeril M et al, 1999. Mediterranean Diet, Traditional Risk Factors and 16 Storelli MM et al, 2002. Total and Methylmercury Residues in Tuna-Fish the Rate of cardiovascular Complications After Myocardial Infarction. from the Mediterranean Sea. Food Add. And Contam.;19(8):715-720. Circulation;99:779-785. 17 Storelli MM et al, 2003. Total Mercury and Methylmercury Content in Edible 8 Singh RB et al, 1997. Randomised, Double-Blind, Placebo-Controlled Trial of fish from the Mediterranean Sea. J. of Food Protection;66(2):300-303. Fish Oil and Mustard Oil in Patients with Suspected Acute Myocardial Infarction: 18 MAFF, 2000, Duplicate Diet Study of Vegetarians. The Indian Experiment of Infarct Survival-4. Cardiovas. Drugs and 19 Food Standards Agency, 2002, The National Diet and Nutrition Survey: adults Therapy;11:485-491. aged 19 to 64 years, HMSO. This is o n e in a s erie s of VV F fa ctsh e ets. VV F also p u blish a Fishin g for Fa cts re p ort a n d a fish inform atio n le aflet. F or d etails c o nta ct: VV F, To p S uite , 8 York C o urt, Wild er Stre et, Bristol B S2 8 Q H . Tel: 0117 970 5190. E m ail: info @ ve g etaria n.org.uk We b : www.ve g etaria n.org .uk