Doctor Fish: What seems to be the problem?

By Erin Miller

Walking through a touristy district of Bangkok, Thailand, I saw a sign that read “Fish Massage: Only $300 Baht For 30 Minutes!” As always, my imagination ran wild. I pictured a carp, sprawled out across
a massage table, cucumbers over his eyes, a steaming, damp towel over his forehead, relaxing as two Thai ladies massage his little fish spine and fins.

Laughing at myself and this outrageous mental image, my eyes wandered downward to a large fish tank surrounded by a wooden bench. I peered into the water, and it was teeming with small fish. Sitting on the bench were four people, their pant cuffs rolled up to their knees on their glowing legs that dangle in the water, watching amused as hundreds of fish pecked at every inch of their submerged skin.

I was told, in broken English by the women working the tank, that these are “Doctor Fish,” whom for only $5 US, will expertly eat all of the dead skin cells off of my legs and feet, leaving them remarkably silky and smooth. I was slightly curious, but as I looked at her and at the eight legs that were already dangling in the tank, I decided it was much too unusual. Besides, it was dinner time and I would rather be eating fish than have fish eating me.

I never gave it another thought until, many months later and hundreds of miles away, I encountered the same thing in Siem Reip, Cambodia. Suddenly I found myself wondering, “What kind of fish are these, and do they really eat dead skin cells?”, “Why?” and “If these fish live in the lakes and streams here, is it safe to swim or will I be eaten alive?!”

As it turns out, Doctor Fish are not doctors at all…shocking, right?! They are actually a species of toothless fish known as Garra rufa. They are also referred to as nibble fish or the reddish log sucker. They are native to river basins of the Middle East, mainly Turkey, Syria, Iraq, and Iran. According to many “fish spa” websites, the discovery of Doctor Fish consuming dead skin was actually made in the 1800’s, in the natural hot springs in Turkey. Since that initial discovery, they have been used to treat psoriasis and many other skin ailments. By 2006, the idea of using “doctor fish” for smoother, healthier skin had caught on and the little fish made their way to health spas throughout Europe and Asia. Their new found popularity has caused the Turkish Government to legally protect the Garra rufa due to concern of over harvesting and commercial exploitation.

So, why do doctor fish have a penchant for dead skin cells? The answer is as shocking as finding out they are not doctors. They don’t naturally have a penchant for human skin! In nature, Garra rufa feed on aufwuchs (small plants and animals that encrust rocks and other hard surfaces). In thermal waters, these food sources are scarce leaving the ravenous little fish desperate for anything to eat. People’s legs offer a perfect surrogate by offering a buffet line ridden with dead skin cells for the taking. To promote fish feedings, spa owners simply underfeed the fish.

After digging up this information, I began to wonder, “Can that possibly be safe?” Turns out, I’m not the only one wondering. Fish Spas have been banned in many parts of the US, Canada and Europe, over hygiene and health concerns. The CDC (Center for Disease Control), warns of the lack of ability to maintain proper hygiene in aquariums, the risk of spreading disease by using the same fish for multiple patrons, and oddly enough, the lack of ability to sanitize fish between uses! The Health Protection Agency in the UK, while admitting that the chance of risk is low, admits “there is the potential for transmission of a range of infections, either from fish to person (during the nibbling process), water to person (from the bacteria that can multiply in water), or person to person (via water, surrounding surfaces and fish).”

I kind of wish I’d never researched the Doctor fish; now, every time I pass a “Fish Spa” I just see hundreds of starving Garra rufa, swimming in a cesspool of dead skin cells and disease. This is not what I had originally envisioned at all…but then again, my original vision of a carp relaxing with cucumber slices on his eyes wasn’t spot on either. So, if you find yourself with reoccurring skin issues, my recommendation is to visit a real doctor!

Don’t forget to like The Fisheries Blog on Facebook, and follow us on Twitter @FisheriesBlog.  If you would like to receive a weekly email when we post a new article, enter your email address at the top right corner of the page.  Check out other posts, like Adipose fins:vestigial or still useful?

Erin Miller and her husband, Carl, have grabbed life by the horns and are living every day to the fullest.  After an extended trip to southeastern Asia, they almost immediately took off on a through hike of the Pacific Crest Trail, and are currently 400 miles into the trip.  They each write a quick and highly entertaining daily journal of their current adventure with pictures if you would like to follow along

9 Comments Add yours

  1. Dus Le says:

    It's funny, I just recently heard about this also! One of my friends tried to convince me to try it, but the thought of fish sucking on my feet and lower legs turned me off. Plus, I was scared they would tickle haha! Good to know that infection is possible, in case I change my mind on a whim in the future. Now I know for sure I won't be trying this out EVER.


  2. Great article. This practice has been around for some time, though more recently other — presumably easier to acquire — species have been thrown into the mix. You can now find “fish massage” tanks filled with anything from Chinese algae eaters (Gyrinocheilus aymonieri) to cichlids.

  3. Hayley says:

    What if it’s in the wild? Going to a thermal spring tomorrow that has these. Is it safe to swim if these fish are present in the water?

  4. Your comments are not at all true. At least not at all fish spas. I am an American and I own a fish spa in Mexico. First of all, what happens when you starve fish? Answer: They eat each other! So no, I do not, have not or would I ever starve my fish. Besides eating dead skin they are fed twice daily. Secondly, in a good fish spa such as mine, the water goes through 8 filters that sterilizes the water every 6 minutes. Then there are large UV lights that kill any bacteria. Everyone’s feet are sprayed and cleaned with a mild antibacterial, biodegradable soap and then rinsed before being allowed in. Each person has their own tank. We don’t put multiple people in the same tank. While cleaning the feet and legs we look for any open wounds. Any small wound is covered with a waterproof bandaid and anyone with anything more than the size of a scratch is not allowed in. We have 490 reviews on Tripadvisor and there has never, ever been a single issue with infection.
    Such terrible misinformation is unbelievable. Also, you have misquoted the CDC which says PETA has made some claims about starving the fish. These claims are simply NOT true. I’m sure not a single member of PETA has ever had a fish spa. And we all know about the animals killed by PETA without any chance at adoption so they hold zero credibility in my opinion. Check the CDC website for yourself. It clearly states there has never been a confirmed case of any type of contagion from having a “fish pedicure”. It’s really not even a fish pedicure, it’s called Ichtiotherapy, which is fish therapy. By the way, you failed to mention Garra Rufa fish have no teeth. They cannot break the skin. There is no danger to anyone. Now having said all that, I personally would not like to put my feet in dirty water that might indicated the systems were not set up properly. If you decide you want to try a fish spa, ask questions about filters and hygiene. It’s important to know before you did your feet in. Tell them you have a sore and see what they say. Use common sense. You wouldn’t hire a dentist or a doctor without knowing something of their repute on or getting a referral, would you?
    Garra rufas are algae eaters. Dead skin has a similar composition to algae; it’s pure protein and perfectly healthy for the fish. Although, in my opinion their food should be supplemented with vegetable algae, protein, vitamins and minerals which a good spa should keep on hand and feed them daily.
    In addition the fish can sometimes get sick and need to be treated with a variety of fish Meds. If this happens, even though fish diseases are not contagious, we shut down any tank with sick fish until treatment is over and the fish are healthy and ready to work again. Every fish spa should do this and hopefully every fish spa owner values their product. If you see larger fish in the spa, it’s a good sign they know how to keep their fish healthy and happy as the fish have a life span up to 7 years and can grow to 3 inches.

    1. marie theberge says:

      wow..good information..i me in quebec and would like to have a fish spa..where can whe get good information on how to start one ?I sent a e-mail to doctor fish and got no reply ! could i build my owne ?

      1. Victoria says:

        The answer is you can’t. I wasted $50 on a book that was useless. I spent a year studying how to take proper care of the fish and how to set up the equipment properly. I went through a lot of trial and error before I got it right.

    2. Mrs P says:

      PETA claims to be an animal advocacy group but euthanizes a huge percentage of the animals they “rescue”.

  5. Janak Fletcher says:

    Good information.

  6. D says:

    I did have a fish manicure in 2017. Just like Victoria Jackson stated in earlier comments, my feet were cleaned and inspected, then sprayed with some type of antibacterial spray. The fish just nibbled. It didn’t hurt.

Please leave a thought provoking reply. We reserve the right to remove comments deemed inappropriate.

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.