Important factors in developing the advisory

1. Joint FDA and EPA AdvisoryWhat You Need to Know about Mercury in Fish and Shellfish – The Public Health MessageDavid W K Acheson M.D.Center for Food Safety and Applied Nutrition, FDA

2. Important factors in developing the advisory • What is known about current levels of MeHg in women of childbearing age in the U.S.? • Levels of MeHg in fish in the U.S. • Who is the target population? • Maintaining the public health balance between the risks of exposure to MeHg an the benefits to be gained from eating fish.

3. NHANES – Blood Mercury Levels in Women of Childbearing Age

4. FDA 2003 Mercury Testing, 12 Species • Samples were fresh, refrigerated or frozen • Each sample tested was composite of 12 individual samples • Tested in FDA laboratories • Used standard methods for total mercury

5. Mercury Data in Selected Fish and Shellfish Previous Data 2003 Data MEAN RANGE n MEAN RANGE n Bluefish 0.30 0.20-0.40 2 0.318 0.139-0.479 21 Croaker 0.28 0.18-0.41 15 0.054 0.013-0.096 21 Grouper 0.27 0.19-0.33 48 0.569 0.072-1.205 20 Crawfish/crayfish NA NA NA 0.028 0.014-0.047 20 Trout Freshwater 0.42 1.22 (max) NA NA NA NA Farm Raised Trout NA NA NA 0.033 0.015-0.110 15 Orange Roughy 0.58 0.42-0.76 9 0.485 0.013-0.762 20 Red Snapper 0.60 0.07-1.46 10 0.154 0.077-0.395 12 Trout Seawater 0.27 ND-1.19 4 0.328 0.022-0.744 20 Tilefish 1.45 0.65-3.73 60 NA NA NA Golden Tilefish NA NA NA 0.208 0.055-1.123 20 Whitefish 0.16 ND-0.31 2 0.068 0.027-0.137 14 Black Sea Bass NA NA NA 0.127 0.058-0.352 20 Sardine NA NA NA 0.016 0.004 - 0.035 21

6. 2003 Testing of Canned Tuna • 75% major brands • 25% store, local or other brands • Representative of the volume and type of major and local brands and packing medium (spring water, broth, oil) in area • Samples collected in Los Angeles, San Francisco, Seattle, Chicago, Dallas, New England, New York, Florida.

7. Mercury Data in Canned Tuna Previous data 2003 data MEAN RANGE n MEAN RANGE n Canned tuna 0.17 0.000-0.75 248 NA NA NA Albacore/white tuna 0.29 ND- 0.49 17 0.358 0.03-.85 170 Light tuna 0.12 ND-0.75 225 0.123 0.00-0.53 119

8. Title of Joint Advisory:What You Need to Know about Mercury in Fish and Shellfish2004 EPA AND FDA ADVICE FOR: WOMEN WHO MIGHT BECOME PREGNANT WOMEN WHO ARE PREGNANT NURSING MOTHERS YOUNG CHILDREN.

9. 2004 Joint Advisory has three main elements Risk/Benefit Message Consumer Advice Additional Information

10. Risk Message Who is at risk WOMEN WHO MIGHT BECOME PREGNANT, WOMEN WHO ARE PREGNANT, NURSING MOTHERS, AND YOUNG CHILDREN

11. Risk Message(continued) Why they are at risk Fish and shellfish are an important part of a healthy diet. Fish and shellfish contain high-quality protein and other essential nutrients, are low in saturated fat, and contain omega-3 fatty acids… Yet some fish and shellfish contain higher levels of mercury that may harm an unborn baby or young child’s developing nervous system. The risks from mercury in fish and shellfish depend on the amount of fish eaten and the levels of mercury in the fish and shellfish.

12. Consumer advice Benefits and risk If you follow advice given by FDA and EPA women and children will receive the benefits of eating fish and shellfish and be confident that they have reduced their exposure to the harmful effects of mercury.

13. Consumer advice How much fish? 3 recommendations 1. Do not eat Shark, Swordfish, King Mackerel, or Tilefish because they contain high levels of mercury

14. Consumer advice(continued) How much fish? 2. Eat up to 12 ounces (2 average meals) a week of a variety of fish and shellfish that are lower in mercury. • Five of the most commonly eaten fish, low in mercury: shrimp, canned light tuna, salmon, pollock, catfish • Another commonly eaten fish, albacore (“white”) tuna has more mercury than canned light tuna. So, when choosing your two meals …, you may eat up to 6 ounces (one average meal) of albacore tuna per week.

15. Consumer advice(continued) How much fish? 3. Check local advisories about the safety of fish caught by family and friends in your local rivers and coastal areas. If no advice is available, eat up to 6 ounces (one average meal) per week of fish you catch from local waters, but don’t consume any other fish during that week. .

16. Consumer advice(continued) How much fish Follow these same recommendations when feeding fish and shellfish to your young child, but serve smaller portions.

17. Additional Information 1. What is mercury and methylmercury? Mercury occurs naturally in the environment and can also be released into the air through industrial pollution. Mercury falls from the air and can accumulate in streams and oceans and is turned into methylmercury in the water. It is this type of mercury that is harmful to your unborn baby. Fish absorb the methylmercury as they feed in these waters and so it builds up in them. It builds up more in some types of fish and shellfish than others, depending on what the fish eat, which is why the levels in the fish vary.

18. Additional Information 2.I'm a woman who could have children but I’m not pregnant - so why should I be concerned about methylmercury? If you regularly eat types of fish that are high in methylmercury, it can accumulate in your blood stream over time. Methylmercury is removed from the body naturally, but it may take over a year for the levels to drop significantly. Thus, it may be present in a woman even before she becomes pregnant. This is the reason why women who are trying to become pregnant should also avoid eating certain types of fish.

19. Additional Information 3. Is there methylmercury in all fish and shellfish? Nearly all fish contain traces of methylmercury. However, larger fish that have lived longer have the highest levels of methylmercury because they've had more time to accumulate it. These large fish (swordfish, shark, king mackerel and tilefish) pose the greatest risk. Other types of fish are safe to eat in the amounts recommended by FDA and EPA

20. Additional Information 4. I don’t see the fish I eat in the advisory. What should I do? • If you want more information about the levels in the various types of fish you eat, see the FDA food safety website www.cfsan.fda.gov/~frf/sea-mehg.html or the EPA website at www.epa.gov/ost/fish.

21. Additional Information 5. What about fish sticks and fast food sandwiches? Fish sticks and “fast food” sandwiches are commonly made from fish that are low in mercury

22. Additional Information 6. The advice about canned tuna is in the advisory, but what’s the advice about tuna steaks ? Because tuna steaks generally contain higher levels of mercury than canned light tuna, when choosing your two meals of fish and shellfish, you may safely eat up to 6 ounces (one average meal) of tuna steak per week.

23. Additional Information • What if I eat more than the recommended amount of fish and shellfish in a week? One week’s consumption of fish does not change the level of methylmercury in the body much at all. If you eat a lot of fish one week, you can cut back for the next week or two. Just make sure you average the recommended amount per week.

24. Additional Information 8. Where do get information about the safety of fish caught recreationally by family or friends? Before you go fishing , check your Fishing Regulations Booklet for information about recreationally caught fish. You can also contact your local health department for information about local advisories. You need to check local advisories because some kinds of fish and shellfish caught in your local waters may have higher or much lower than average levels of mercury. This depends on the levels of mercury in the water in which the fish are caught. Those fish with much lower levels may be eaten more frequently and in larger amounts.

25. Additional Information • For further information about the risks of mercury in fish and shellfish call the U.S. Food and Drug Administration's food information line toll-free at 1-888-SAFEFOOD or visit FDA's Food Safety Website www.cfsan.fda.gov • For further information about the safety of locally caught fish and shellfish, visit the Environmental Protection Agency’s Fish Advisory website www.epa.gov/ost/fish or contact your State or Local Health Department. A list of state or local health department contacts is available at www.epa.gov/ost/fish. Click on Federal, State, and Tribal Contacts.

26. Outreach and Education • General and specialized media • Over 9000 print and electronic media outlets focused on women (e.g. American Baby Magazine, Family Circle, Good Housekeeping etc.) • Physicians, nurses, health departments • 30 women’s health associations through the Office of Women’s health • Membership organizations • (e.g. American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Nurse Midwives, Women's Infant and Children Program) • “Grass roots” education to high fish eating populations

27. Outreach and Education • Develop brochures in English and Spanish • Develop Federal-State working group to coordinate methylmercury advisories • Utilize the FDA regional public affairs specialists and USDA extension agents for community outreach. • “Food Safety for Moms-to-be” (35,000 video, power point, brochures etc.)

28. Evaluation: FDA Consumer Survey Is the message getting out there? Nationwide phone survey Measures consumer trends on food safety knowledge, attitudes, and behaviors

29. Conclusions • The advisory is designed to balance the positive benefits of fish yet provide information on how to be confident that exposure to the harmful effects of mercury have been reduced. • Goal is to have provide information regarding which fish to choose – list of lower mercury fish. • Planned outreach to ensure we get the correct message out.