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It isn’t just familiarity. Some people experience some fish sauces as having vividly foul flavor. This includes people who routinely eat anchovies, cured fish, etc.

It is clearly an issue of sensitivity.

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Worcestershire sauce is a fish sauce that's used all over American cuisine, especially BBQ.
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Yep. But unlike, say Red Boat, I don’t know anyone who thinks it has a strong rancid taste.
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Yeah. Technically I suppose you could describe it as a fish sauce but definitely more on the umami and vinegar side. I'm also not sure the degree to which Worcestershire Sauce is especially a mainstream American condiment. I have a jar in my cupboard. Not sure how many houses do.
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Worcestershire is a mainstream condiment in America. There is a pretty diverse range of American cuisine that has it as a common ingredient.

You don’t use much when you use it but I somehow go through a bottle every couple years.

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But barbecue sauce with it absolutely is
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Its midwesterners. There’s a fish tradition in most other parts of the country.
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Nah fish sauce is different. You can give most midwesterners fish and chips or worcestershire and they’ll be fine with it. But many will find fish sauce initially pungent and repulsive until they get used to it
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