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Fish and eggs on a plant based diet: what the doctors say
Fish and eggs on a plant based diet: what McDougall, Esselstyn, Barnard, Ornish and other doctors say, where they agree and differ, with sources.
Updated . For education only, not medical advice.
Our view
Nearly every doctor on this site who treats patients with food keeps both fish and eggs off the plate, from John McDougall and Caldwell Esselstyn to Neal Barnard, Dean Ornish and Alan Goldhamer12345. Their reasons overlap: like any animal food, fish and eggs supply cholesterol, fat and animal protein with no fiber, and fish adds pollutants that pile up along the food chain678.
Fish carries the healthier reputation, so it draws most of the debate: Walter Willett reads his data as giving pescatarians a slight edge over vegans, while the Ornish program leaves fish out because the diet that reversed heart disease never contained it94. Headlines that credit eggs or fish with a single benefit tend to come from questionnaire studies, which a 2026 video on Jeff Nelson’s VegSource channel treats as the wrong place to look1011.
We give more weight to the clinicians who have watched cholesterol and arteries respond in their own patients, and their verdict is that neither food is needed121314.
Where they agree
On fish, the low-fat doctors agree it brings what other flesh brings: Caldwell Esselstyn puts muscle from fins in the same group as muscle from hooves and wings, and Rip Esselstyn says that fish clean of mercury and PCBs still delivers animal fat, cholesterol and protein136. McDougall wrote in 2003 that, calorie for calorie, fish outdoes beef, pork and chicken in cholesterol while offering no fiber, carbohydrate or vitamin C1. Barnard adds that salmon, often sold as a slimming food, takes some 40 percent of its calories from fat in the Atlantic kind and about half in Chinook7. Asked about fish protein in 2006, T. Colin Campbell said it raises blood cholesterol just as the other animal proteins in the studies he cited did15.
Pollutants are the second shared worry: McDougall explains that fish take up industrial chemicals with their food and that bigger fish concentrate more of them, Peter Rogers names mercury and PCBs, and the Ornish program’s site lists toxins alongside cholesterol81617.
On eggs, Barnard and Rip Esselstyn both object to the yolk for its cholesterol and to the white as animal protein nobody needs1819. Esselstyn’s FAQ rules out egg whites as well, and Goldhamer counts eggs among the foods a healthy diet can do without205.
Where they differ
The disagreements come down to whether a little fish helps, whether egg whites are acceptable, what kind of study can settle the question, and positions some doctors held in earlier decades9211122.
A little fish or none
Willett said on a 2020 panel that pescatarians fare a bit better than vegans in the data he knows, though not by enough to draw a sharp line between them9. Ornish answers from his own trials: his program’s site says fish was not part of the lifestyle that reversed heart disease, and in 2022 he said older heart diets with more fish, chicken and a few eggs a week only slowed the clogging of arteries412. In an interview posted in 2011 he had already said that eating fish and chicken in place of part of the red meat does little for cholesterol23. Rogers went further in 2022 and called eating fish a bad idea, citing its saturated fat and the fats that cooking oxidizes24.
Egg whites
The Ornish nutrition guidelines, in their 2022 version, still allowed egg whites, while Esselstyn’s FAQ excludes them as animal protein2120. Barnard and Rip Esselstyn side with Esselstyn and treat the white as protein people can skip1819. Christopher Gardner, a researcher rather than a clinician, said in 2015 that he was mostly vegan yet ate eggs from his own backyard hens25.
What kind of evidence counts
Barnard points to Harvard cohort data in which replacing meat, dairy, eggs or fish with plant protein went with lower death rates26. A 2026 video on Nelson’s VegSource channel questioned a study tying eggs to less Alzheimer’s disease, noting that results like these come from diet questionnaires people fill in themselves, and said in its own words that the egg industry funds research of this sort1027. Its preferred test is to compare whole dietary patterns by their long-term results rather than single foods11. Hana Kahleova reported in 2022 that, in a PCRM trial, leaving out meat, poultry and fish was the strongest predictor of weight loss on a vegan diet28.
Older views
Nathan Pritikin’s program in 1982 let patients have modest portions of lean beef, white-meat chicken and low-fat fish, and he reported that a six-week trial of his own, with three quarters of a pound daily of fish or chicken, left his cholesterol between 105 and 1082229. Denis Burkitt, in an interview posted in 2013, said his household ate fish and poultry in place of most red meat and thought that the healthier choice30. McDougall himself spent about two decades as an angler who ate the big tuna and salmon he caught, as he wrote in 2007, and said in 2016 that he had sworn off seafood some 15 years earlier3132.
What each expert says
JMJohn McDougall
McDougall’s newsletter of February 2003 held that the Japanese remain healthy despite fish, not because of it, since it serves as a small side to their rice33. He also wrote that fish lacks fiber, carbohydrate and vitamin C and that its acid-forming protein promotes bone loss1. Once a keen fisherman, he gave up seafood around 20013132.
Esselstyn treats fish like meat and fowl, all of it muscle that comes with animal protein, fat and cholesterol13. In a 2023 talk his list of foods to give up included eggs, turkey, chicken, fish and meat, and his FAQ excludes egg whites too220.
Campbell prefers to talk about whole foods rather than rank one animal protein against another34. Asked about fish protein in 2006, he said that in the studies he cited every animal protein raised blood cholesterol while the plant proteins did not15.
Barnard notes that salmon gets roughly 40 to 50 percent of its calories from fat and contains no fiber7. He describes a large egg as a heavy dose of cholesterol with some saturated fat, the yolk holding both and the white adding protein we do not need318.
Ornish’s program does not recommend fish, since the diet that reversed heart disease in his research left it out, and its site points to the cholesterol and toxins that come with fish protein417. Its 2022 guidelines still made room for egg whites21.
Goldhamer said in 2026 that a diet without animal foods such as meat, fish, eggs and dairy, and without added oil, salt and sugar, does well whether it is raw or cooked5. In another 2026 talk he said that a diet centered on meat, fish, eggs and dairy grows very different gut bacteria from a diet of plants35.
In 2022 Rogers judged eating fish a bad idea because of its saturated fat and the fats damaged by cooking24. He also warned that fish often carries mercury and PCBs16.
In his 2016 calorie density talk, Novick put the traditional Okinawan intake of fish at about 15 grams a day, roughly half an ounce36. Their calories came mostly from sweet potatoes, so in his view they were potato eaters rather than fish eaters36.
A 2026 video on Nelson’s VegSource channel argued that asking whether eggs prevent Alzheimer’s disease misses the point, because the answer comes from food frequency questionnaires10. It added that egg producers fund such studies and that the useful comparison is between whole eating patterns over the long run2711.
In a 2018 talk Rip Esselstyn said that fish without mercury, PCBs or dioxins still supplies animal fat, cholesterol and protein6. He rejects the whole egg: the yolk for its cholesterol, more than 212 milligrams, and the white because it is a dense dose of animal protein19.
Willett sees room for fish: speaking on a 2020 panel, he said any move toward a healthy plant based diet is worth making, and that pescatarians come out slightly ahead of vegans in his data, though the gap is small9.
Pritikin’s 1982 program permitted modest portions of low-fat fish, white-meat chicken and lean beef, ideally from grass-fed cattle, though he saw little benefit in them beyond making the diet feel familiar2214. He said his patients lost their taste for beef, and fish or poultry became a small garnish for them rather than the main dish14.
Kahleova said in 2022 that, in a PCRM trial, avoiding meat, poultry and fish predicted weight loss on the vegan diet better than anything else, with eating beans in second place28.
Burkitt, who said he was no vegetarian, had red meat at home roughly every third week, choosing fish and poultry the rest of the time as the healthier option30. He saw no reason for vegetarians to add meat, yet would not rule on diets that also drop milk or eggs, since he felt he lacked the authority to judge them37.
We leave fish and eggs out, as most of the clinicians above do and as their programs advise245. Whether a small amount of fish matters for a particular person is a question for your own doctor. This page is education, not medical advice.
Each small number links to its reference below: the video at the exact second, or the page where it was said.