Is Sushi Good for You?

When prepared safely, raw fish, rice, and seaweed can make for a well-balanced meal

By Althea Chang-Cook

Sushi was maligned before it went mainstream in the U.S. I’ve rewatched the 1985 movie “The Breakfast Club” at least a dozen times, and I always cringe when bad boy character John Bender (Judd Nelson) appears repulsed by the idea of eating the bundles of rice, raw fish, and seaweed.

Thankfully, American palates have changed since then.

“By 1988, Esquire magazine featured actor Michael J. Fox on the cover of an issue focusing on yuppies, casually eating a plate of sushi as a symbol of his sophistication,” says Gil Asakawa, author of “Tabemasho! Let’s Eat!: A Tasty History of Japanese Food in America.”

“Eating sushi, like eating southern-style barbecue, is a celebration of culture with hundreds of years of history behind it,” Asakawa says.

Just how healthy sushi is, though, depends on each ingredient, and how safely the raw fish has been handled from the moment it’s caught to the moment it reaches your table.

Sushi Basics

At restaurants in the U.S. today, you’ll find raw tuna, salmon, yellowtail, and more sometimes stuffed in alongside avocado, cucumber, or pickles. Then they all get wrapped in medium- or short-grain seasoned rice and a sheet of seaweed, creating a three-in-one punch of protein, veggies, and carbs.

It’s sliced into circles and sometimes sprinkled with sesame seeds or drizzled with seasoned mayo before being garnished with a sinus-clearing green gob of wasabi and throat-burning pickled ginger, and finally served with soy sauce on the side.

You’ll also see sliced fish placed over an oblong mound of sushi rice, and cooked options, such as eel and soft-shell crab.

Then there’s sashimi, which is just thinly sliced raw fish, with no rice at all.

About That Raw Fish

Fish, in general, is clearly pretty healthy. It’s a great source of protein, which every body needs, and it’s especially good for your heart. The American Heart Association recommends that most adults consume at least two 3-ounce servings of nonfried fish per week, specifically fatty fish such as tuna, salmon, and black cod.

That’s because fish is typically low in heart-harming saturated fat but high in omega-3 fatty acids. In addition to being heart-healthy, those fatty acids also help keep your lungs and immune system running smoothly. Fish may even support memory, and it’s packed with vitamin D.

There are, however, some health concerns associated with eating fish raw. That’s because fish, like chicken and red meat, can be contaminated with bacteria. And it’s more likely than those foods to contain parasites. That’s usually not a problem when fish is cooked, because heating it to the recommended temperature of 145° F kills most pathogens. But any bacteria or parasites in raw fish could still be alive when you consume it.

For that reason, fish consumed raw should be frozen solid first, says Michael Ciaramella, PhD, seafood safety and technology specialist at New York Sea Grant, a partnership with the State University of New York and Cornell University. That generally means keeping it at -4° F for a week or at -31° F for 15 hours. That can kill the parasites and can help keep bacteria from spreading to dangerous levels.

Even still, consuming raw fish always presents some risk of foodborne illness. For most adults, that risk is manageable, if you choose your restaurants carefully or, when making your own sushi, you choose and handle the raw ingredients properly, says James E. Rogers, PhD, Consumer Reports’ director of food safety and testing.

But pregnant people, children under 5, adults over 65, and people who have health conditions or take medication that weaken their immune system should avoid raw fish because they’re at higher risk for foodborne illnesses, according to the Centers for Disease Control and Prevention.

And everyone should limit consumption of fish high in mercury, such as bigeye tuna, shark, and swordfish, as that heavy metal could lead to or worsen hypertension and neurological disorders. People who are pregnant or breastfeeding, as well as young children, should avoid those fish entirely, because mercury is known to also impair brain development.

Sushi at Restaurants

Sushi in the U.S. is eaten mostly at restaurants, so the safety of the food is largely out of your hands and depends on how carefully the ones you go to source and prepare their food.

Mahmood Abousalem, who manages Azabu sushi restaurants in Miami and New York, says there are some signs that suggest the fish has been handled properly. For one, any raw fish should be served cold, and not look or feel slimy. And, he says, it “should not taste fishy, and the flavor should be subtle, not strong.”

A restaurant’s reputation is worth considering, too. Ratings on Google, Yelp, and similar sites aren’t foolproof, but it would probably be wise to avoid places that have anything other than stellar reviews or even a few mentions of food poisoning, Rogers says.

Some states and municipalities provide more objective information, Rogers says. For example, municipalities in California and Illinois require restaurants to post color-coded placards—green, yellow, or red—to indicate recent food inspection results. New York City requires restaurants to prominently post food safety inspection letter grades on the outside of their establishments.

“Especially when it comes to sushi, I would avoid anything without a top rating,” Rogers says.

You could also contact your local or state health department to see if more detailed health inspection reports are available, covering things such as food handling, refrigeration, and more.

Finally, many sushi restaurants make preparation a bit of a show, with the chef right there behind a glass window—giving you a view into its food safety practices. So take a peek to see if preparers keep the fish refrigerated, wash their hands, wear and change gloves, use clean knives, and regularly wash surfaces, Rogers says.

Sushi to Go

Many grocery stores, delis, and fish markets now offer premade sushi for takeout. All the precautions that apply in restaurants hold there as well. Raw fish should be cold, and not look slimy or smell too fishy, and the preparer should practice safe food handling techniques. But extra precaution may be needed.

Notably, while prepared sushi can last for several hours, that’s true only if it’s kept cold enough. And it’s hard to be sure that the refrigerated cases where it’s displayed for sale are really kept at the recommended temperatures of 40° F or colder. It’s also hard to know exactly how long that sushi has been sitting there.

Rogers recommends that when you opt for sushi to go, ask the establishment to prepare a fresh batch for you. “Of course, that may not always be possible and is less convenient,” Rogers says, “but it beats getting sick.”

DIY Sushi

More people these days are making sushi at home, in part because of people cooking at home more during the pandemic. That puts you in charge of ensuring that the fish you use is fresh and that good food hygiene practices are followed.

The first step is choosing the right fish. Some fish sold in stores and online are labeled as being sushi- or sashimi-grade, or suitable for eating raw. That’s supposed to mean that the fish has been handled with special care from the moment it’s caught to when it’s sold or delivered to your doorstep.

But there’s no actual verification process to hold companies accountable, says Brian Ronholm, director of food policy at CR. “Ultimately it’s the company making its own determination that it’s safe, so the sashimi-grade claim is only as trustworthy as the company that makes it.”

A good bet is to buy fish that’s still or previously frozen, from a place you trust, Ciaramella says. That could be a grocery or fish store, or even a fishmonger tossing you one at a market. Some online retailers, such as True World Foods and Oceanside Seafood, also sell frozen fish shipped with ice packs to your door. If you shop online for fish that you intend to eat raw, make sure it’s still frozen solid when it arrives. Then keep it frozen until you’re ready to use it.

When it’s time to prepare sushi, let it thaw in the refrigerator. If it has been vacuum-packed, Ciaramella says you should take it out of its wrapping first, because that reduces the risk of botulism caused by toxins that can be in the package.

Then follow scrupulous food handling techniques, making sure to use clean knives and separate cutting boards for fish and the other ingredients, and to wash your hands before and after touching the fish.

And if you want to use fish that has been sustainably sourced, look for fish certified by the Marine Stewardship Council. That organization says it makes sure that the fish are harvested in ways that don’t threaten the population’s long-term health and minimize the effect of fishing on the surrounding ecosystem. Look for fish that have a blue MSC label on the packaging.

Other Sushi Options

If raw fish is just not in your comfort zone, you still have sushi options, though some might not be all that authentic. You can also make some minor tweaks to make sushi even healthier.

Opt for cooked fish. Eel, shrimp, and soft-shell crab in sushi are typically cooked. And many restaurants have come up with versions that may be more appealing to less adventurous eaters.

“Sushi’s evolved in the U.S., ” says Asakawa, the author. That includes adaptations like the California Roll, made from avocado, cucumber, and a “crab stick”—which is actually not crab, but cooked fish—or the Philadelphia Roll, which has cream cheese and smoked salmon.

Consider brown rice. Sushi rice is typically medium- to short-grain white rice seasoned with vinegar, salt, and sugar. But you can ask if the restaurant can substitute it with brown rice. It has more fiber and nutrients than white rice, though not the soft, bouncy texture of typical sushi rice. You could also use brown rice if you’re making sushi at home, but make sure it’s short-grained if you can. That kind tends to stick together better, which is essential to get a nice tight roll.

And if you’re trying to cut out carbs, you could skip the rice altogether and opt for sashimi, plain raw fish, instead.

Add veggies. Get some vegetables in your sushi by ordering rolls that include avocado, cucumber, or carrot. That seaweed in or on your sushi is a vegetable, too, packed with protein, fiber, vitamins, and minerals that may boost gut and heart health, as well as iodine, which is essential for a healthy thyroid gland. To get even more seaweed with your meal, order a green seaweed salad or hijiki, which is made with brown seaweed, as a side dish.

Switch to low-sodium soy sauce. Sodium can raise your blood pressure and put you at higher risk of heart disease and stroke. Low-sodium soy sauce has the same basic flavor as regular soy sauce but about 40 percent less sodium.

The Best Rice Cookers From CR’s Tests

When you’re making sushi at home, having great rice is key. These rice cookers performed best in Consumer Reports’ tests.

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