Consumers are being cautioned about eating sushi and other raw seafood because of a new parasite that can infect the stomach causing serious flu-like symptoms.
You may want to think twice before eating sushi and other raw seafood.
Doctors are warning that with the rise in popularity of sushi in the Western world, there has been a rise in a parasitic infection known as anisakiasis.
According to the U.S. Centers for Disease Control and Prevention (CDC)Trusted Source, anisakiasis can occur when fish or squid containing the infected larvae is eaten raw.
The worms in the infected food can then invade the stomach wall or intestine.
Symptoms of the disease include abdominal pain, nausea, diarrhea, vomiting, abdominal distention, blood and mucus in the stool, and a mild fever.
In a report recently published in BMJ Case Reports, Dr. Joana Carmo and colleagues described the case of a previously healthy 32-year-old man who started to experience stomach pain, low grade fever, and vomiting.
“After a careful interview, he revealed that he recently ate sushi. An upper gastrointestinal endoscopy was performed, and showed on the gastric body, a filiform parasite,” they wrote.
The larva was removed and the patient’s health improved immediately.
Most cases of anisakiasis occur in Japan, where sushi is commonly eaten, but cases of the parasite have been increasingly reported in Western countries.
Is it safe to eat raw fish?
Lauri Wright, PhD, assistant professor in public health at the University of South Florida, and a spokesperson for the Academy of Nutrition and Dietetics, said it’s best to avoid raw fish.
“Raw fish does not provide any additional health benefits over cooked fish, so it is not worth the risk of contaminants or foodborne illness to consume raw,” she told Healthline.
In particular, Wright said, those at high-risk for foodborne illness could suffer severe and life-threatening illness from consuming raw or undercooked fish or shellfish.
“These individuals include those with compromised immune systems or with decreased stomach acidity, as well as pregnant women, infants, young children, and older adults. Raw fish and shellfish consumption is never advised for high-risk individuals. If you’re in this category, thoroughly cook fish and shellfish,” she said.
Katie Ferraro, a registered dietitian, and assistant clinical professor at the University of San Diego and the University of California San Francisco, holds a similar view.
“If you look at different types of foodborne illness, one of the common threads is that raw and undercooked fish and shellfish are often the culprits. Not to say that there aren’t very safe versions of these foods, but for high risk populations … it is wise to avoid these foods,” she told Healthline.
More than parasites
Wright says it’s not just parasitic infections like anisakiasis that people should be concerned about. Other foodborne illness from eating raw or undercooked seafood poses a significant hazard.
“Major types of food poisoning that can result from eating raw or undercooked fish and shellfish include salmonella and Vibrio vulnificus. For raw shellfish connoisseurs, especially raw oyster lovers, you specifically need to know about the risk for V. vibrio infections. V. vulnificus is a bacterium that lives in warm seawater and is not caused by pollution,” she explained.
Despite popular myth, Wright said neither hot sauce nor alcohol will kill bacteria and protect you from food poisoning.
“The best rule of thumb is to follow good food safety practices and properly cook all seafood,” she said. “One other safety tip of interest: If you do decide to eat raw fish, choose fish that has been previously frozen. That’s because freezing will kill any potential parasites present.”
But freezing won’t protect you from everything.
“Unfortunately, freezing doesn’t kill every harmful organism,” she said.
Tips on cooking, storing fish
Both Ferraro and Wright suggested that fish and shellfish can provide valuable nutrients and are good sources of protein, vitamins, and minerals.
These foods are also rich in omega-3 fatty acids, and can help in the reduction of common diseases.
Both suggested it is best to stick to fish and shellfish in cooked varieties, to obtain the benefits without the risk of infection.
Wright said there are some easy ways to avoid foodborne illness and infections from fish and seafood.
At the market, buy fish that is properly refrigerated below 40°F (4°C) or well-packed with ice, and look for fish with shiny, firm flesh that doesn’t have a strong “fishy” odor.
In your fridge, keep fresh fish in airtight containers or well-wrapped for no more than two days. Store fresh, pasteurized, or smoked seafood between 32°F (0°C) and 38°F (4°C), and store live shellfish in well-ventilated containers.
During preparation, keep raw and cooked seafood separate, including using separate chopping boards. Hands, cuttings boards, plates, and utensils should be thoroughly cleaned between holding raw seafood and food that is ready to eat.
As for eating out, if you really want to eat sushi or raw seafood, Wright recommended taking sensible precautions.
“There are a plethora of well-liked raw and undercooked fish and shellfish items on menus today. For healthy individuals, these foods can generally be consumed safely when they’re from reputable restaurants or markets that use fresh, high-quality ingredients and follow proper food safety practices,” she said.
But she emphasized the risks of eating raw fish and seafood far outweigh the benefits.
“There are no health benefits of consuming raw fish or sushi over cooked fish. Therefore, we do not recommend consuming sushi or any raw fish/seafood,” she said.
There are several practical reasons people cook fish before eating it, rather than simply serving it raw.
Most importantly, cooking kills bacteria and parasites that can cause disease.
Nevertheless, some people prefer the texture and taste of raw fish. It is especially popular in Japan as part of dishes like sushi and sashimi.
But how safe is raw fish? This article reviews the risks and benefits.
Raw fish dishes are growing in popularity. Here are a few examples:
- Sushi: A category of Japanese dishes, sushi is characterized by cooked, vinegered rice and various other ingredients, including raw fish.
- Sashimi: Another Japanese dish that consists of finely sliced raw fish or meat.
- Poke: A Hawaiian salad traditionally made with chunks of raw fish that are seasoned and mixed with vegetables.
- Ceviche: A lightly marinated seafood dish popular in Latin America. It typically consists of raw fish cured in lemon or lime juice.
- Carpaccio: Common in Italy, carpaccio is a dish originally consisting of finely sliced or pounded raw beef. The term may also cover similar dishes consisting of other types of raw meat or fish.
- Koi pla: A Southeast Asian dish consisting of finely chopped raw fish mixed with lime juice and various other ingredients, including fish sauce, garlic, chilis, herbs and vegetables.
- Soused herring: Marinated raw herring that is common in the Netherlands.
- Gravlax: A Nordic dish made up of raw salmon cured in sugar, salt and dill. It is traditionally eaten with mustard sauce.
These dishes are an important part of food culture around the world.
SUMMARY: Raw fish is a major ingredient in various dishes from around the world, including sushi, sashimi and ceviche.
A parasite is a plant or animal that feeds off another living organism, known as the host, without offering any benefits in return.
While some parasites do not cause any obvious acute symptoms, many may cause serious harm over the long term.
Parasitic infections in humans are a major health problem in many tropical countries. Many of them are transmitted by infected drinking water or improperly cooked food, including raw fish.
However, you can minimize this risk by buying raw fish from trusted restaurants or suppliers that have properly handled and prepared it.
Below is an overview of some of the main parasitic diseases that can be transmitted to humans after eating raw or undercooked fish.
Liver flukes are a family of parasitic flatworms that cause a disease known as opisthorchiasis.
Infections are most common in tropical regions of Asia, Africa, South America and Eastern Europe (1Trusted Source).
Researchers estimate that around 17 million people worldwide, most in Southeast Asia, are affected by opisthorchiasis.
Adult liver flukes reside in the livers of infected humans and other mammals, where they feed on blood. They may cause an enlarged liver, bile duct infection, gallbladder inflammation, gallstones and liver cancer (2Trusted Source).
The main cause of opisthorchiasis seems to be consuming raw or improperly cooked fish. Unwashed hands and dirty food preparation surfaces and kitchen utensils also play a role (3Trusted Source, 4Trusted Source).
Fish tapeworms are transmitted to people who eat raw or undercooked freshwater fish or sea fish that spawn in freshwater rivers. This includes salmon.
They are the largest parasite known to infect humans, reaching a length of up to 49 feet (15 meters). Scientists estimate that up to 20 million people may be infected worldwide (5Trusted Source, 6Trusted Source).
While fish tapeworms often don’t cause symptoms, they may cause a disease known as diphyllobothriasis.
The symptoms of diphyllobothriasis are usually mild and include fatigue, stomach discomfort, diarrhea or constipation (7Trusted Source).
Tapeworms may also steal substantial amounts of nutrients from the host’s gut, especially vitamin B12. This may contribute to low vitamin B12 levels or deficiency (8Trusted Source).
Parasitic roundworms may cause a disease called anisakiasis. These worms live in marine fish, or fish that spend a part of their lives in the sea, such as salmon.
Infections are most common in regions where fish is frequently eaten raw or lightly pickled or salted, including Scandinavia, Japan, the Netherlands and South America.
Unlike many other fish-borne parasites, Anisakis roundworms cannot live in humans for very long.
They try to burrow into the intestinal wall, where they get stuck and eventually die. This may cause a severe immune reaction leading to inflammation, stomach pain and vomiting (9Trusted Source, 10Trusted Source).
Anisakiasis may also cause immune reactions even if the worms are already dead when the fish is eaten (11Trusted Source).
Another family of parasitic roundworms may cause a disease known as gnathostomiasis (12Trusted Source).
These worms are found in raw or undercooked fish, poultry and frogs in Southeast Asia, Latin America, India and South Africa. However, infection is rare outside of Asia.
The main symptoms are stomach pain, vomiting, appetite loss and fever. In some cases, it may cause skin lesions, rashes, itching and swelling (13Trusted Source).
Depending on where in the host’s body the parasitic larvae migrate, the infection may cause serious problems in various organs.
SUMMARY: Regularly eating raw fish increases the risk of parasitic infections. Many fish-borne parasites can live in humans, though most of them are rare or only found in the tropics.
Another reason why fish is cooked is the risk of food poisoning.
The main symptoms of food poisoning include upset stomach, nausea, vomiting and diarrhea.
One study from the US found that about 10% of imported raw seafood and 3% of domestic raw seafood tested positive for Salmonella (17Trusted Source).
However, for healthy people, the risk of food poisoning from eating raw fish is generally small.
People with weak immune systems, such as the elderly, young children and HIV patients, are more susceptible to infections. These high-risk groups should avoid raw meat and fish.
Currently, about 12 in every 100,000 pregnant women get infected in the US (18Trusted Source).
SUMMARY: Another risk associated with eating raw fish is food poisoning. People with weak immune systems should avoid eating raw meat and fish.
Persistent organic pollutants (POPs) are toxic, industrially produced chemicals, such as polychlorinated biphenyls (PCBs) and polybrominated diphenyl esters (PBDEs).
One study found that the amount of POPs was about 26% less in cooked salmon compared to raw salmon of the same type (24Trusted Source).
The way this works is not entirely clear, but appears to be associated with the loss of fat from fish fillets while they are being cooked.
Although cooking fish may be effective at reducing your exposure to many contaminants, it may not work on all contaminants (26Trusted Source).
SUMMARY: Cooking fish appears to reduce the levels of certain contaminants, including PCBs, PBDEs and mercury.
There are a few health benefits to eating raw fish.
First, raw fish doesn’t contain contaminants that form when fish is fried or grilled. For instance, fish cooked under high heat may contain varying amounts of heterocyclic amines (27Trusted Source).
Observational studies have associated a high intake of heterocyclic amines with an increased risk of cancer (28Trusted Source).
In short, certain aspects of nutritional quality may degrade when fish is cooked.
Additionally, there are other benefits to eating raw fish that have nothing to do with health. Not having to cook saves time, and the appreciation of raw fish dishes helps maintain cultural diversity.
SUMMARY: Raw fish does not contain contaminants that may form during the cooking process. It may also provide higher levels of certain nutrients, like long-chain omega-3 fatty acids.
If you enjoy the taste and texture of raw fish, there are several ways you can reduce the risk of parasitic and bacterial infections.
- Only eat raw fish that has been frozen: Freezing fish for a week at -4°F (-20°C), or for 15 hours at -31°F (-35°C), is an effective strategy for killing parasites. But keep in mind that some household freezers may not get cold enough (31Trusted Source).
- Inspect your fish: Checking the fish visually before you eat it is also useful, but may be insufficient since many parasites are hard to spot.
- Buy from reputable suppliers: Make sure to buy your fish from trusted restaurants or fish suppliers that have stored and handled it properly.
- Buy refrigerated fish: Only buy fish that is refrigerated or displayed under a cover on a thick bed of ice.
- Make sure it smells fresh: Don’t eat fish that smells sour or overly fishy.
- Don’t keep fresh fish for too long: If you don’t freeze your fish, keep it on ice in your fridge and eat it within a couple days of buying it.
- Don’t leave fish out for too long: Never leave fish out of the refrigerator for more than one or two hours. Bacteria multiply quickly at room temperature.
- Wash your hands: Clean your hands after handling raw fish in order to avoid contaminating the food you handle afterwards.
- Clean your kitchen and utensils: Kitchen utensils and food preparation surfaces should also be properly cleaned to avoid cross-contamination.
While freezing doesn’t kill all bacteria, it stops their growth and can reduce their numbers (32Trusted Source).
Although marinating, brining or cold-smoking fish may reduce the number of parasites and bacteria they contain, these methods are not entirely reliable for preventing disease (33Trusted Source).
SUMMARY: The best way to get rid of parasites in raw fish is to freeze it at -4°F (-20°C) for at least seven days. Freezing also stops bacterial growth, but does not kill all bacteria.
Eating raw fish is associated with a higher risk of parasitic infections and food poisoning. However, you can minimize the risk by following a few simple guidelines.
For starters, always buy your fish from reputable suppliers.
Additionally, raw fish should be previously frozen, as freezing it at -4°F (-20°C) for a week should kill all parasites.
Store thawed fish on ice in the fridge and eat it within a couple of days.
Following these guidelines, you can enjoy raw fish both at home and in restaurants at minimal risk to your health.