This work puts the risks and benefits of a mercury acquisition through a fish-dominated diet in the context of the other endemic health problems in the Amazon. Fish consumption rate was assessed after determining mercury concentrations in the most consumed fish and in hair of women at fertile age (15 to 45 years of age), living in remote localities of the Rio Negro basin (not impacted by gold mining). Fish-meals were consumed once a day (7.1%) but in most cases (78.6 %) at least twice a day with an estimated mean fish consumption rate of 170.5 g (range 23 to 293 g). The fish-species most preferred were Tucunarés (Cichla spp), Pacus (Mylossoma aureum and Myleus micans), Piranhas (Sarrasalmus spp), Cará (Satanoperca jurupari), Jaraquí (Semaprochilodus taeniurus). The mean Hg concentration in these species varies widely (38 to 592 ng g(- 1)) but 27% of samples had Hg concentrations above 500 ng g(- 1), and only 7% were above 1000 ng g(- 1). The hair-Hg concentrations ranged from 6.5 to 32.6 microg g(- 1) with 82% of them having concentrations above 10 microg g(- 1) (w.w.) hair. Hair-Hg concentrations were positively correlated with women's age (r=0.4500; P=0.0111). Clinical evaluation did not detected symptoms (paraparesis, tremor, numbness of limbs, sensory disturbances) compatible with Minamata disease, but there was a high (71%) incidence of clinical history of malaria. Fish is an abundant natural resource, rich in essential nutrients and important to the diet of 'ribeirinhos' of Brazilian Amazonia. We hypothesize that lack of basic medical care in these communities outweighs risk of naturally occurring fish-MMHg. Therefore food habits based on fish consumption is part of a successful strategy for survival and should be considered as a health asset.