What to Eat on a Pescatarian Diet (2024)

A pescatarian diet is essentially a vegetarian diet that includes fish and seafood. The term pescatarian is a blend of pesce (the Italian word for fish) and vegetarian. It is also sometimes referred to as pesco-vegetarian.

People choose a vegetarian or pescatarian diet for different reasons that may relate to ethical, environmental, or health considerations.

Adding fish and seafood to an otherwise vegetarian diet can help you get certain nutrients that are often difficult to get through a vegetarian diet alone.

Moreover, combining whole plant-based foods and fish emphasizes a healthy eating pattern that is recommended by several health organizations and the U.S. Department of Agriculture's Dietary Guidelines for Americans.

This article reviews the pescatarian diet, its health benefits and limitations, and what pescatarians can eat.

Health Benefits of a Pescatarian Diet

The pescatarian diet is a version of a vegetarian diet that allows for fish and shellfish.

Admittedly, not all vegetarian diets equate to healthy eating patterns. Some vegetarians may simply avoid meat products but still consume other processed foods or items high in fat and simple sugars as long as they are not made from animal products.

The pescatarian diet relies on whole, plant-based foods, vegetables, fruits, whole grains, nuts, seeds, and fish. These food categories are a staple for most eating patterns experts recommend for general health and disease prevention.

Though there is very little research on the health benefits of pescatarian diets, there is data on the health benefits of vegetarian diets and fish consumption.

A Word From Verywell

A pescatarian diet is high in lean protein and heart-healthy fats, thanks to the inclusion of fish, while still offering the benefits of eating plant-based foods. Any diet that emphasizes fruits, vegetables, whole grains, and fish may provide health benefits. You might choose to follow a pescatarian diet to help manage a health condition such as heart disease or simply as an overall healthful diet.

— ALLISON HERRIES, RDN, MEDICAL EXPERT BOARD

May Improve Heart Health

A pescatarian diet may improve heart health through weight loss, lowering your cholesterol, or mediating inflammation.

Vegetarian or vegan diets can lower total and low-density lipoprotein (LDL) cholesterol levels. Other studies have suggested that vegetarian and vegan diets can lower heart disease risk, but more studies are necessary to confirm these findings.

Several studies of available research on fish intake and heart health have found that higher fish intake is associated with lower heart disease incidence and mortality.

One study found that for every additional 20 grams of fish intake, cardiovascular mortality risk decreased by 4%.

These heart-healthy benefits mainly come from eating fatty fish like salmon, mackerel, or herring. One study suggests that the benefit is lost if eating fried fish, which may increase cardiovascular events.

The American Heart Association and the Dietary Guidelines for Americans recommend eating at least two servings of fatty fish per week.

May Benefit Metabolic Health

There is little consensus on the definition of metabolic health. However, metabolic syndrome is well defined as a group of conditions that increase your risk of diabetes, heart disease, and stroke.

Metabolic syndrome is defined as having three or more of the following:

Large waist circumference
Elevated blood pressure
High blood sugar levels
High triglyceride levels
Low high-density lipoprotein (HDL) cholesterol levels (good cholesterol)

There is no specific diet for metabolic syndrome. There is also no research specific to a pescatarian diet and metabolic syndrome.

However, many foods recommended in a pescatarian diet are considered beneficial for metabolic syndrome. For example, some studies have shown that eating more fish may lower the risk.

Available data suggests that vegetarian diets, compared to standard therapy, can improve:

Blood pressure
Fasting glucose
Hemoglobin A1C
Body weight
Waist circumference
Cholesterol levels

However, the improvements were modest and not without bias in some of the studies. Further research is still necessary.

If you are concerned about your metabolic health or have metabolic syndrome, consult with a registered dietitian nutritionist (RD or RDN) to determine an individualized eating pattern that is best for you.

Could Help Manage Type 2 Diabetes

Guidelines for nutrition therapy in people with type 2 diabetes recommend several healthy eating patterns, including vegetarian, Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and low-fat diets. These diets can also help reduce the risk of developing type 2 diabetes.

These diets also may help with weight loss and reduce markers of increased disease risk (e.g., cholesterol levels).

Because a pescatarian diet is a relatively new regimen, there is not enough research to say it will have similar effects. Yet, the general principles of this diet are a blend of vegetarian and Mediterranean diets, two of the patterns mentioned as acceptable for people with type 2 diabetes.

May Reduce the Risk of Some Cancers

There are few studies specific to pescatarian diets and cancer prevention. However, some research has shown that:

Compared to meat eaters, vegetarians and pescatarians have a lower risk of overall colorectal and prostate cancer.
Plant-based diets may help prevent gastrointestinal (GI) cancers.
Dietary factors associated with reduced cancer mortality include vegetarian diets, fish consumption, Mediterranean diet, and more.

For overall health and cancer prevention, the American Cancer Society recommends an eating pattern that will:

Help maintain a healthy weight
Include a variety of vegetables
Include a variety of whole fruits
Focus on whole grains and limit refined sugars
Limit red and processed meats
Limit heavily processed foods
Limit alcohol

Most of these recommendations are also recommendations for a pescatarian diet.

Possible Anti-Inflammatory Effects

Chronic inflammation can progress as we age and become a leading contributor to diseases like heart disease, cancer, and diabetes.

There are markers of chronic inflammation. A blood level of C-reactive protein (CRP) is probably the most popular.

Again, there are no studies specific to a pescatarian diet, but a vegan diet (compared to a meat-eating diet) can reduce CRP and fibrinogen levels. Adding omega-3 fatty acids to the diet from eating fish could also contribute to anti-inflammatory properties.

Pescatarian Diet vs. Mediterranean Diet

Some may think the pescatarian diet is the same as the Mediterranean diet. Though they both include similar plant-based foods and fish, there are a few differences. For instance, the Mediterranean diet allows meat and poultry. It also emphasizes olive oil as a primary fat source.

The Mediterranean diet also recommends:

Plenty of fruits and vegetables
Whole grains with a high fiber content
Fish to provide omega-3 fatty acids
Limiting saturated fat found in red meat and dairy
Limiting simple carbs and added sugars

What to Eat in a Pescatarian Diet

A pescatarian diet will include many plant-based foods, such as:

Whole grains
Nuts
Legumes
Fruits
Vegetables
Healthy fats, including vegetable oils

It will also include fish and seafood like:

Anchovies
Black cod
Bluefin tuna
Clams
Cobia
Haddock
Hake
Herring
Lobster
Mackerel
Oysters
Pollock
Salmon (including farmed salmon)
Sardines
Scallops
Shrimp
Striped bass
Tilapia
Trout
Whitefish

People following vegetarian and pescatarian diets may also include eggs and dairy.

Nutritional Benefits of Adding Fish to an Otherwise Vegetarian Diet

Fish and seafood are excellent sources of lean protein, meaning they provide fewer calories and fat but a similar amount of protein to red meats.

They also provide a good amount of healthy fats such as omega-3 fatty acids. Omega-3 fatty acids are known to be anti-inflammatory.

The three main omega-3 fatty acids are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Seafood and fish are excellent sources of EPA and DHA.

Consuming fish can help you meet your omega-3 fatty acid requirements if you follow an otherwise vegetarian diet. ALA is available from plant-based sources and then converted to EPA and DHA in the body but only in small amounts. Therefore, getting EPA and DHA from foods like fatty fish is recommended.

Omega-3 fatty acids from fish and seafood promote heart health and lower triglycerides. Some research (but not all) suggests eating fish and seafood may help:

Prevent some types of cancer
Prevent dementia or Alzheimer's
Reduce the risk of age-related macular degeneration
Better manage symptoms of rheumatoid arthritis

Fatty fish that are rich in omega-3 fatty acids include:

Anchovies
Black cod
Fresh or canned tuna
Cobia
Herring
Mackerel
Salmon (including farmed salmon)
Sardines
Sea bass
Striped bass
Whitefish

Certain types of seafood may also be an excellent source of micronutrients. For example:

Canned sardines or salmon (with bones) provide calcium
Oysters are rich in zinc
Clams, oysters, and some fish are good sources of vitamin B12
Oysters and sardines are good sources of iron

Drawbacks of a Pescatarian Diet

Like a vegetarian diet, getting enough of some of the nutrients that usually come from animal sources can prove challenging. This includes nutrients like iron, vitamin B12, zinc, calcium, and protein.

These nutrients are more available when following a pescatarian diet than a vegetarian or vegan diet but only with select types of fish and seafood. For pescatarians, consuming fish and seafood will add to their protein intake.

Moreover, those following a pescatarian diet will want to make sure they include the types of seafood that contain these necessary nutrients. These may include:

Oysters for zinc
Canned sardines or salmon (with bones) for calcium
Clams and oysters for vitamin B12
Oysters and sardines for iron

If you are not a fan of oysters and some of these other specific fish and seafood options, then you will want to pay attention to other good plant-based sources or discuss whether supplementation is advisable with your healthcare provider or RDN.

Another potential drawback of the pescatarian diet is the mercury content of fish. Avoiding the types of fish that have the highest mercury levels is best. These include:

King mackerel
Marlin
Orange roughy
Shark
Swordfish
Tilefish
Bigeye tuna

Who Should Not Follow a Pescatarian Diet

Anyone with a fish or seafood allergy should avoid following a pescatarian diet.

Children and women who are pregnant or nursing should take caution when following a pescatarian diet. Pregnant and breastfeeding people should limit fish intake to two to three 4-ounce servings of low-mercury fish per week. Popular choices for these include sea bass, cod, salmon, and most shellfish.

Similarly, children should have two servings per week. Note that serving sizes differ depending on the child's age.

Further information about the mercury content of particular types of fish and a table of good choices as opposed to fish to avoid are available from the U.S. Food and Drug Administration.

Summary

Eating fish is part of a healthy eating pattern. A pescatarian diet allows fish and seafood along with otherwise vegetarian eating habits. Fish are a great source of lean protein, omega-3 fatty acids, and several key vitamins and minerals.

Though a pescatarian diet offers several health benefits, it is not for everyone.

If you are following a pescatarian diet, make sure you get enough iron, vitamin B12, calcium, and zinc through plant-based foods and fish selection. You should also be familiar with the mercury content of fish and choose those that contain lower amounts of mercury.

Working with an RDN can help you determine the best pescatarian eating pattern for you.