Pregnancy All-in-One For Dummies

Book 3

Chapter 3

Knowing What Foods to Avoid

IN THIS CHAPTER

Discovering which foods to avoid and which ones to use caution with while pregnant

Watching out for herbals

Preventing foodborne illnesses and reducing your exposure to food-related toxins

Choosing sweeteners and seafood

When talking about pregnancy nutrition, it’s as important to focus on what you shouldn’t eat as it is to talk about what you should. This chapter gives you a rundown of what foods (and substances) to avoid throughout your pregnancy to keep you and your baby safe. It also helps you reduce your chances of developing foodborne infections (you’re at an increased risk for them now that you have a bun in the oven), discusses food-related toxins, and explains why you should be selective about sweeteners and seafood.

Foods and Beverages That Aren’t Safe during Pregnancy

If you look no further in this chapter than this section, you’ll still have a solid understanding of the foods and beverages that are of the most concern during pregnancy. Table 3-1 spotlights the foods and beverages that are dangerous when consumed while pregnant. Table 3-2 lists the foods that you don’t have to completely avoid but that you do need to be cautious about when eating.

Table 3-1 Foods and Beverages to Avoid during Pregnancy

Don’t Eat/Drink This

Why Avoid It?

Agave nectar

Can cause uterine contractions

Alcohol

Passes to the fetus; increases your risk of miscarriage or stillbirth; can result in fetal alcohol syndrome and brain damage if consumed in excessive amounts

Commercially prepared meat salads (ham, chicken, tuna salad)

Can be contaminated with Listeria bacteria

High-mercury fish (shark, swordfish, king mackerel, tilefish, golden/white snapper)

Can have high levels of mercury

Raw eggs (like those found in cookie dough)

Can be contaminated with Salmonella bacteria

Raw honey

Can be contaminated with bacteria that causes botulism (a serious paralytic illness)

Raw shellfish (oysters, clams)

Can be contaminated with Vibrio bacteria

Raw sprouts (alfalfa, mung bean, clover)

Can be contaminated with E. coli or Salmonella bacteria

Raw or undercooked fish (sushi made with raw fish)

Can be contaminated with various bacteria or parasites

Raw or undercooked meat (pork, poultry, beef)

Can be contaminated with E. coli bacteria

Soft cheeses from unpasteurized milk (Brie, feta, Camembert, blue cheese, queso blanco, queso fresco)

Can be contaminated with E. coli or Listeria bacteria

Unpasteurized (or fresh-squeezed) cider or juice (like orange, cranberry, and other drinkable juices)

Can be contaminated with E. coli bacteria

Unpasteurized (raw) milk

Can be contaminated with various bacteria

Adapted from www.foodsafety.gov/risk/pregnant/chklist_pregnancy.html

Table 3-2 Foods and Beverages to Be Cautious of during Pregnancy

Use Caution with This

Why Use Caution?

Alternative Strategy

Albacore (or white) tuna

Can have moderately high levels of mercury

Limit intake to 6 ounces per week; choose light tuna instead.

Caffeine

Crosses the placenta and can increase the baby’s heart rate; is linked to slowing fetal growth

Limit caffeine to 200 mg maximum or choose decaf beverages instead.

Deli meats (turkey, ham, roast beef), cold cuts (bologna), hot dogs

Can be contaminated with Listeria bacteria

Always cook these meats until they’re steaming hot or 165 degrees or higher (even if the package says precooked).

Homemade ice cream, custard, eggnog, mousse, meringue, and Caesar dressing

May contain raw eggs, which can be contaminated with Salmonella bacteria

Avoid eating it if you don’t know whether raw eggs were used, or use pasteurized eggs if you’re making it yourself.

Liver (beef and chicken)

Contains high levels of vitamin A, which can be toxic, especially in the first trimester

Limit intake and enjoy other meats in place of liver.

Meat spreads or pâté

Can be contaminated with Listeria bacteria

Use canned versions.

Saccharin

Passes to the fetus and may remain in the fetal tissue; may increase cancer risk in offspring

Use the safer sweeteners listed in the section “Being Selective with Sweeteners” later in this chapter, or use small amounts of real sugar.

Smoked seafood

Can be contaminated with various bacteria or parasites

Cook all smoked seafood until it reaches a temperature of 165 degrees or higher.

Stuffing and gravy

Can be contaminated with various bacteria

Cook stuffing until it reaches a temperature of 165 degrees or higher; reheat gravy to a boil.

Undercooked eggs

Can be contaminated with Salmonella bacteria

Cook eggs until both the yellow and white parts are firm.

Adapted from www.foodsafety.gov/risk/pregnant/chklist_pregnancy.html

A Warning on Herbals

warning Even though herbal supplements may appear to be “natural,” they don’t undergo the same safety testing that food products and over-the-counter and prescription medications go through. For that reason, you should avoid herbal products in food and supplements during pregnancy — a feat that’s easier said than done these days, because herbals are found not only in supplements but also in many foods. Read labels carefully and watch out for these common herbal products in particular:

· Agave

· Aloe

· Black cohosh

· Ephedra

· Ginkgo biloba

· Ginseng

· Goldenseal

· Saw palmetto

· Willow bark

· Yohimbe

Focusing on Foodborne Illnesses

Throughout your pregnancy, you and your growing little one are at high risk for getting sick thanks to immune system issues. Your immune system is weaker because your body is so busy growing another person, and your baby’s immune system is still developing and not even close to operating at full strength. Consequently, fending off the pesky, disease-causing bugs found on door handles, in the air, and in your food is much more difficult when you’re pregnant.

warningFoodborne illnesses, which occur when you eat something that contains a type of bacteria, parasite, or virus that makes you sick, can cause miscarriage or premature delivery in serious cases. In really severe cases, exposure to these harmful organisms can cause death. The best-case scenario for you is a little bit of dehydration and fatigue, but your baby can suffer a variety of problems.

The following sections fill you in on five pesky “bugs” — living organisms that are too small to see but can bring you to your knees — that pregnant women are particularly susceptible to. You can find out how to protect yourself from contracting a foodborne illness from these little buggers.

Campylobacter

Campylobacter jejuni bacteria are one of the major causes of diarrheal foodborne illness in the United States. These bacteria grow in raw or undercooked poultry, other meats, and seafood as well as in unpasteurized milk and untreated water. In fact, some studies have found Campylobacter in up to 100 percent of the poultry tested in retail stores.

warning Symptoms occur two to five days after infection and include diarrhea, fever, muscle aches, vomiting, and nausea. In pregnant women, infection of Campylobacter can be transmitted to the placenta and can cause miscarriage, stillbirth, or preterm delivery.

The good news is that most modern water-treatment systems easily destroy Campylobacter, so the water you drink from your tap is completely safe. To prevent Campylobacter infection from spreading in your home, cook meats to proper temperatures and don’t cross-contaminate cutting boards and knives.

E. coli

E. coli bacteria have many strains, and all animals, including humans, have E. coli in their intestines. One specific strain — E. coli O157:H7 — contains toxins that damage the lining of the intestines, causing hemorrhagic colitis, an acute disease. E. coli contamination typically happens when people don’t properly wash their hands after using the restroom, when raw meats aren’t properly handled, or when fruits and vegetables aren’t properly washed. Manure (animal feces) is often used as a natural fertilizer, especially for organic produce, so it’s no surprise that E. coli outbreaks often happen because of contaminated produce.

E. coli contamination typically affects the digestive tract the most; symptoms include diarrhea and bloody diarrhea. The biggest risk of E. coli infection during pregnancy is dehydration, which can cause miscarriage or premature labor in severe cases. E. coli bacteria are also the most common cause of urinary tract infections in pregnant women.

remember To prevent E. coli contamination, follow these simple steps:

· Cook all meats well to their proper temperatures (see Table 3-3).

· Drink juices and milk only if they’re pasteurized.

· Wash all fruits and vegetables well, whether they’re organic or conventionally grown.

· Wash all cutting boards and knives between uses with different foods.

Table 3-3 Minimum Meat Temperatures

Meat

Minimum Temperature

Precooked ham

140 degrees

Fish

145 degrees

Pork roasts and chops*

145 degrees

Beef steak or roasts*

145 degrees

Casseroles containing meat or eggs

160 degrees

Ground beef, lamb, and pork

160 degrees

Ground poultry

165 degrees

Chicken breasts

165 degrees

Whole poultry

165 degrees

Leftovers containing meat or eggs

165 degrees

* The U.S. Department of Agriculture (USDA) recommends a three-minute “rest time” for these meats. In other words, allow the meat to sit (or rest) for three minutes before you carve or consume it.

Listeria

Listeria is a type of bacteria that can grow even below the “safety zone” of temperatures (less than 40 degrees), where most other bacteria can’t. It can grow in unpasteurized milk and cheese, refrigerated ready-to-eat meats (like cold cuts and deli meat), poultry, and seafood. Fruits and vegetables that haven’t been properly washed can also be contaminated, especially if manure was used as a fertilizer.

warningListeria causes an infection known as listeriosis. Symptoms occur a few days to several weeks after infection and can include fever, chills, muscle aches, diarrhea, headache, stiff neck, and confusion. Pregnant women are 20 times more likely to get listeriosis than other healthy adults. In fact, about one-third of listeriosis cases in the United States involve pregnant women. Listeriosis is especially dangerous in the first trimester because it can cause miscarriage, but it also poses a risk to the baby after birth. It can cause mental retardation, paralysis, seizures, and developmental problems in the brain, heart, and kidneys.

remember Here are some steps you can take to reduce your risk of contracting listeriosis:

· Heat deli meats, cold cuts, hot dogs, and smoked seafood to steaming hot if you choose to eat them. Even when these meats are fresh and cold out of the refrigerator, they can have high levels of listeria.

· Check the labels on soft cheeses like Brie, Camembert, feta, blue cheese, Gorgonzola, and queso blanco or fresco to make sure the ingredient list includes pasteurized milk. If it doesn’t, don’t buy the cheese!

· Avoid refrigerated pâtés or meat spreads. Eat them only if they’re canned and shelf stable (meaning they’re safe to shelve without refrigeration).

· Wash fruits and vegetables prior to eating them. Simply rub your produce well while holding it under running water.

Salmonella

Salmonella bacteria is carried by animals and is found in raw meats. It also exists in soil, so it can contaminate fresh fruits and vegetables. Salmonellosis is one of the most common foodborne illnesses in the world. In pregnant women, it can pass to the fetus and cause miscarriage or developmental delays in the baby. Symptoms for Mom include fever, nausea, vomiting, diarrhea, and stomach cramps, but a woman can be infected without experiencing any symptoms.

warning Raw sprouts, like alfalfa and broccoli sprouts, are one of the most common produce items to carry Salmonella. Because sprouts are so difficult to wash properly, you should completely avoid them while pregnant. Eggs are another major source of Salmonella contamination. Eat pasteurized eggs, and cook your eggs thoroughly until both the whites and yolks are firm. If you’re eating a dish that contains eggs, make sure it’s cooked well.

Other ways to prevent Salmonella poisoning include washing all fruits and vegetables thoroughly and cooking meats to their proper temperatures (refer back to Table 3-3).

Toxoplasma

Toxoplasma gondii is a parasite found in undercooked or raw meats that causes an illness called toxoplasmosis. It lives in the soil, so unwashed fruits and vegetables can also be contaminated. This parasite is the main reason water can make you sick in some countries; fortunately, the water supply in the United States is treated and safe.

warning Pregnant women are at a 20 to 50 percent higher risk of developing the toxoplasmosis infection. Symptoms include swollen glands, muscle pain, a stiff neck, and fever, but not all pregnant women experience symptoms. Even if you don’t experience signs of toxoplasmosis infection, your baby could be infected. Infection in babies can cause mental retardation, blindness, and hearing loss.

remember Heating meats to their proper temperatures before eating them is key to preventing toxoplasmosis because heat destroys the infection-causing parasite. Make sure you separate raw meat in the grocery cart and your refrigerator, and use a separate cutting board and clean knife when preparing meat at home. Also wash all fruits and vegetables before eating them.

warning Cat feces can also carry Toxoplasma (especially if your cat is a mouse hunter outside), so if you can, ask someone else to change out the cat litter, or use disposable gloves and give your hands a thorough wash if you’re doing it yourself. Also be sure to wash your hands after handling your cat, especially before preparing meals, and keep your cat off all food preparation and eating surfaces in your home. Keep your cat’s risk low by feeding him dry or canned food, not raw meat scraps.

Because Toxoplasma exists in the soil, use gardening gloves while digging in the soil outside and wash your hands thoroughly before touching your mouth or your food.

Tackling Food-Related Toxins

The microorganisms that cause foodborne illnesses aren’t the only things that can harm you and your baby. Toxins can also be found in foods as well as in the containers that house them. This section reveals three toxins that are of particular concern during pregnancy and explains how you can reduce your (and your baby’s) exposure to them.

Mercury

Mercury is a metal that exists naturally in the environment, but industrial pollution produces high levels that enter the air and water supply in large amounts. Humans typically come into contact with mercury by eating fish. Mercury builds up in your bloodstream and passes to your baby, and although it does eventually leave your body naturally, it can take more than a year to do so. For that reason, limiting your exposure to high-mercury fish is vital, ideally even before you become pregnant (for a list of the most popular high-mercury fish, refer back to Table 3-1).

Nearly all fish have some mercury because they feed on mercury-containing organisms. But some fish have decidedly lower mercury levels than others. Head to the later section “Hitting the Seafood Counter” for a list of safe and unsafe fish to eat during pregnancy.

warning Symptoms of mercury poisoning can include itching; burning skin; sensitivity in hands, feet, and mouth; lack of coordination; impairment of peripheral vision; muscle weakness; and speech impairment. However, you may not notice any symptoms at all from mercury poisoning. But even if you don’t have any symptoms, your baby will. Mercury can affect your baby’s developing nervous system, and the effects can carry on through childhood. To play it safe and still satisfy your seafood craving, eat no more than 12 ounces of low-mercury fish each week throughout the course of your pregnancy.

Pesticides

Very little evidence connects pesticides to significant risk to unborn babies. However, large amounts of pesticides can lead to low-birth-weight babies, premature labor, or miscarriage.

tip One surefire way to reduce your exposure to pesticide residue on the produce you’re eating is to go organic when it comes to the following fruits and vegetables, which tend to have the most pesticide residue: apples, bell peppers, blueberries, celery, cherries, grapes (imported), kale and collard greens, nectarines, peaches, potatoes, spinach, and strawberries. If you don’t go organic with your fruits and vegetables, be sure to wash all dishes, cutting boards, and utensils that may have been exposed to any pesticide residue before using them again.

Plastics

Plastics contain several potentially harmful chemicals. Leading the pack are bisphenol A (BPA), which makes plastic clear and strong, and phthalates, which make plastic more flexible. Unfortunately, many foods come in packages made from these materials. Here’s what you need to know about these chemicals and how they relate to your pregnancy:

· BPA has been linked to miscarriage and negative effects on the brain and prostate gland in fetuses and children.

· Phthalates have been connected to birth defects, specifically in male genitals, and after-birth exposure to these harmful chemicals can still have negative effects on the reproductive systems of baby boys.

tip Heating plastics can leach some of the BPA and phthalates from the containers into the food you consume; to reduce your (and your baby’s) exposure to toxins found in plastics, follow these steps:

· Heat only those plastics that are made specifically for cooking. Avoid any plastics that have the number 7 or the letters PC (which stand for polycarbonate) in a triangle on the container.

· Don’t microwave food in plastic containers. Transfer your food to a ceramic or glass container before warming it up.

· Wash plastics by hand to prevent exposing them to high heat in the dishwasher.

Being Selective with Sweeteners

If you’ve ever looked at the ingredient list for a box of cookies, a can of soda, or even a loaf of bread or jar of peanut butter, you’re probably well aware that sugar isn’t the only sweetener out there. Many foods and beverages contain nonnutritive sweeteners, which sweeten food without contributing significant calories. (Nonnutritive sweeteners are also commonly referred to as artificial sweeteners, although not all of them are artificial.) Other foods are made with nutritive sweeteners, which do contribute calories.

remember It’s important to note that in order to be in the food supply in the United States, a food ingredient or food additive must go through an approval process with the U.S. Food and Drug Administration (FDA). The agency is responsible for reviewing safety studies to ensure that every food ingredient and food additive is safe to eat. The safety data reviewed must include safety for everyone — children, adults, the elderly, and pregnant and lactating women. The FDA uses panels of scientists to rigorously review all data available on that particular food ingredient in an objective and independent fashion.

That being said, you may still have some concerns about whether a particular sweetener is safe to consume during pregnancy. This section gives you the information you need to make your own decisions regarding whether to include the following sweeteners in your diet.

warning Even if you never pick up a blue or pink packet of sweetener, you may be consuming nonnutritive sweeteners without realizing it, depending on the foods and beverages you’re eating and drinking. If you prefer to avoid everything artificial (including artificial colors and flavors) throughout your pregnancy, you need to diligently read ingredient lists on food labels.

Acesulfame K

Acesulfame K (brand name Sunett and commonly called Ace-K) is a nonnutritive sweetener that’s used quite frequently in food products, often in combination with other nonnutritive sweeteners. You can find acesulfame K listed among the ingredients of more than 4,000 foods, including soft drinks, ice cream, chewing gum, baked goods, breakfast cereals, and canned fruits. Although you may also find packets of acesulfame K, it’s not as popular as the other nonnutritive sweeteners in packet form.

remember The FDA has found acesulfame K to be safe for use in pregnancy in moderation. What’s moderation? The acceptable daily intake (ADI) is set at an equivalent of 2 gallons of an acesulfame-K containing beverage every day.

Agave nectar

Agave nectar is a natural, nutritive sweetener that comes from the tequila plant. You find agave as a sweetener option in natural food stores and in some coffee and tea houses.

warning Just because something is natural doesn’t mean it’s safe. In terms of pregnancy safety, agave is surrounded by controversy. For instance, some people link it to cramping or increased risk of miscarriage. Agave contains a large number of saponins, which are naturally occurring substances that can cause uterine contractions. For this reason, you may want to avoid agave while pregnant. After all, it’s better to be safe than sorry.

Aspartame

Aspartame (brand names Equal and Nutrasweet) is one of the most widely known nonnutritive sweeteners. You find it in the blue tabletop sweetener packets as well as in a wide variety of soft drinks, chewing gum, yogurt, and many reduced-sugar items. The FDA has approved the use of aspartame for pregnant women, but many experts still recommend using caution with how much you consume. In fact, the ADI for aspartame is set at about 97 packets or 20 cans of diet soda each day. As long as you’re not downing can after can of diet soda, you’ll be fine adding a couple of blue packets to your foods or beverages and eating a few aspartame-containing foods per day.

warning Aspartame breaks down to phenylalanine, so if you have phenylketonuria (PKU), steer clear of this sweetener.

High-fructose corn syrup

High-fructose corn syrup (HFCS) is an inexpensive nutritive sweetener that many manufacturers use to sweeten their foods. In recent years, HFCS has drawn a lot of blame for the ever-increasing number of diabetes and obesity cases in the United States. However, scientific studies don’t support this theory. HFCS is no worse for you than table sugar; however, it does contain calories without nutritional value.

HFCS is simply syrup made from cornstarch mixed with fructose, another type of sugar found naturally in fruit. HFCS is actually very similar in composition to table sugar. You can find HFCS in a wide variety of products, including soft drinks, yogurts, candy, cookies, crackers, and condiments. Studies have determined that HFCS is safe to consume when you’re pregnant, but remember that it does have calories. (To be exact, it has 16 calories per teaspoon — the same as table sugar.)

Honey

Honey contains trace amounts of minerals, as well as dormant Clostridium botulinum bacteria, which can cause a severe paralytic illness known as botulism. The honey you find on store shelves has been pasteurized to eliminate the toxins created by the bacteria, but you may find raw honey at farmers’ markets.

warning Avoid eating raw, unpasteurized honey while pregnant. And don’t feed children under age 1 any type of honey because they don’t have mature enough immune systems to break down and destroy the bacteria.

If you want to eat pasteurized honey while pregnant, remember that it does contain calories (21 per teaspoon), so be careful how much you use as you sweeten your tea.

Saccharin

The pink sweetener packets you see on many restaurant tables contain another well-known nonnutritive sweetener called saccharin (brand name Sweet’N Low). Saccharin isn’t used in as many food products as other nonnutritive sweeteners, which is nice because the safety of saccharin during pregnancy is questionable. To date, no studies prove that saccharin is harmful in pregnant humans, but some animal studies have shown increased cancer risk in offspring when mothers consume the sweetener during gestation.

warning For many years, saccharin was on the National Institute of Health’s list of possible cancer-causing agents because of some older studies. However, more recent studies haven’t confirmed the cancer findings, so the institute removed saccharin from the list in the 1990s. Even so, because saccharin crosses the placenta and may remain in fetal tissue, many health professionals recommend that you don’t use it during pregnancy.

Stevia

Stevia (brand names Truvia and PureVia) is the new kid on the block when it comes to nonnutritive sweeteners. You find it in the green tabletop packets as well as in many foods, including yogurts, soft drinks, juices, and ice cream. Stevia is a natural sweetener that comes from the stevia plant. This plant contains several sweet components, one of which is called rebiana. On food labels, you may see rebiana (rather than stevia) in the ingredient list. The ADI for rebiana is 29 packets or 64 ounces of rebiana-sweetened beverage every day.

Sucralose

Sucralose is one of the newer nonnutritive sweeteners out there, and it goes by the brand name Splenda. You find it in the yellow tabletop sweetener packets as well as in soft drinks, yogurts, ice creams, and other reduced-sugar items. The FDA has approved the use of sucralose in pregnancy, but as with aspartame, you should use moderation with the amount you consume. The ADI for sucralose is equivalent to about 28 packets of sucralose each day, so definitely stick with less than that amount.

technicalstuff Even though sucralose claims to be “made from sugar,” it has been chemically altered not to be absorbed by the body, so it belongs in the classification of artificial sweeteners.

Hitting the Seafood Counter

Fish should definitely be on your weekly shopping list. After all, eating fish and seafood is especially good for your health during pregnancy (and while nursing). Fish contains protein and iron, two nutrients you need while pregnant (see Book 3, Chapter 2 for why these nutrients are so important). Plus, eating fish has been linked to reduced risk of cardiovascular disease and reduced risk of dying from any cause in adults. The benefits you get from eating fish come mainly from the omega-3 fatty acids that are so prevalent in many fish and seafood. These same omega-3s, especially DHA and EPA, are part of the building blocks of the brain, which is why pregnant women and young children should get plenty of DHA and EPA.

remember All these benefits sound great, but what about the bad things you’ve heard about fish, like mercury, polychlorinated biphenyls (PCBs), and dioxin? Although these contaminants are important to be aware of, many experts believe that the benefits of eating fish outweigh the potential risks. Just to be safe, though, the Environmental Protection Agency (EPA) and the FDA have come up with a recommendation that pregnant women eat no more than 12 ounces of seafood per week.

You can minimize any potential seafood-related risks even more by choosing the right kinds of fish to include in your max of 12 weekly ounces. The following sections outline the fish to watch out for as well as the safest fish to eat.

Knowing which fish to be cautious of

The main concern with fish is mercury. Mercury occurs naturally in the environment and is present in trace amounts in almost all fish, but most of the mercury comes from industrial pollution that gets into the water. Bacteria in polluted water change the mercury into a form called methylmercury, which can be toxic. Fish consume the methylmercury by eating the organisms that live in and absorb the water.

warning Methylmercury passes from your blood to your baby and can have a negative effect on his developing nervous system. Fish that are highest in methylmercury are the larger, predatory fish because they spend their days eating smaller fish, who’ve eaten even smaller fish, who’ve eaten teeny-tiny fish, who’ve eaten the organisms that absorbed methylmercury. Avoid the following high-mercury fish while pregnant and nursing, and don’t feed them to small children:

· King mackerel

· Shark

· Swordfish

· Tilefish (also known as golden bass)

Although fish that contain moderate amounts of mercury are safe for most people to consume, pregnant women and women who are nursing should avoid the following moderate-mercury fish:

· Ahi tuna

· Chilean sea bass

· Grouper

· Mahi mahi

· Marlin

· Orange roughy

· Spanish mackerel

Aim to eat the lower-mercury fish listed in the next section rather than their moderate- or high-mercury counterparts.

tip If you’re worried about eating fish because of PCBs and dioxins (chemical contaminants found in the environment), keep in mind that the levels found in fish are similar to those found in beef, chicken, and pork. In fact, only 9 percent of the PCBs and dioxins in the U.S. food supply come from fish and seafood; the other 90 percent come from other foods. If you eat fish caught in local waters, check the local fish advisories to see whether they warn about contaminated waters.

Discovering which fish are best

The EPA and FDA recommend that pregnant or nursing women choose fish and seafood that are low in mercury to get the recommended limit of 12 ounces per week. Choose from these low-mercury options:

· Anchovies

· Catfish

· Cod

· Light tuna (not albacore, or “white,” tuna, which is safe to consume only in 6-ounce amounts per week as part of your overall fish allowance)

· Pollock

· Salmon (not smoked salmon or fresh salmon jerky, which may contain harmful bacteria)

· Sardines

· Shrimp, crab, clams, and scallops

· Tilapia

tip Not sure what 12 ounces of fish looks like? A 3-ounce portion is the standard recommended portion size. For 12 ounces, you could have four servings of one of the following 3-ounce portions: six large shrimp, six large scallops, a tuna salad sandwich, or a 3-ounce fillet that fits in the palm of your hand.