AFLATOXINS
Richard Lawley | February 1, 2013 
What are aflatoxins?
The aflatoxins are a group of chemically similar toxic fungal metabolites (mycotoxins) produced by certain moulds of the genus Aspergillus growing on a number of raw food commodities. Aflatoxins are highly toxic compounds and can cause both acute and chronic toxicity in humans and many other animals. Their importance was first established in 1960 when 100,000 turkeys and other poultry in the UK died in a single event. The cause of this was eventually traced to a toxic contaminant in groundnut meal used in the bird’s feed. The contaminant was later named aflatoxin.
The aflatoxins consist of about 20 similar compounds belonging to a group called the difuranocoumarins, but only four are naturally found in foods. These are aflatoxins B1, B2, G1 and G2. Aflatoxin B1 is the most commonly found in food and also the most toxic. When lactating cattle and other animals ingest aflatoxins in contaminated feed, toxic metabolites can be formed and may be present in milk. These metabolites, aflatoxin M1 and M2, are potentially important contaminants in dairy products.
What foods can be contaminated?
Aflatoxins may be present in a wide range of food commodities, particularly cereals, oilseeds, spices and tree nuts. Maize, groundnuts (peanuts), pistachios, brazils, chillies, black pepper, dried fruit and figs are all known to be high risk foods for aflatoxin contamination, but the toxins have also been detected in many other commodities. Milk, cheese and other dairy products are at risk of contamination by aflatoxin M. The highest levels are usually found in commodities from warmer regions of the world where there is a great deal of climatic variation.
It is important to recognise that, although it is primary food commodities that usually become contaminated with aflatoxins by mould growth, these toxins are very stable and may pass through quite severe processes. For this reason they can be a problem in processed foods, such as peanut butter.
How do they affect human health?
At high enough exposure levels, aflatoxins can cause acute toxicity, and potentially death, in mammals, birds and fish, as well as in humans. The liver is the principal organ affected, but high levels of aflatoxin have also been found in the lungs, kidneys, brains and hearts of individuals dying of acute aflatoxicosis. Acute necrosis and cirrhosis of the liver is typical, along with haemorrhaging and oedema. LD50 (lethal dose) values for animals vary between 0.5 and 10 mg/kg body weight.
Chronic toxicity is probably more important from a food safety point of view, certainly in more developed regions of the world. Aflatoxin B1 is a very potent carcinogen and a mutagen in many animals, and therefore potentially in humans, and the liver is again the main target organ. Ingestion of low levels over a long period has been implicated in primary liver cancer, chronic hepatitis, jaundice, cirrhosis and impaired nutrient conversion. Aflatoxins may also play a role in other conditions, such as Reye’s syndrome and kwashiorkor (a childhood condition linked to malnutrition). Less is known about the chronic toxicity of aflatoxin G1 and M1, but these are also thought to be carcinogens, though probably a little less potent than B1.
Little is known about the level of dietary exposure to aflatoxins necessary to affect health, especially in humans, and diagnosis of chronic toxicity is very difficult. It is generally agreed that the best approach is to minimise the levels in all foods as far as is technically possible and to assume that any dietary exposure is undesirable.
How common is illness?
The incidence of chronic aflatoxicosis in humans is unknown and is almost impossible to estimate because the symptoms are so difficult to recognise. However, human liver cancer is quite common in parts of the world where aflatoxin contamination of food is likely and there may be a link, although this remains unproven.
Acute human aflatoxicosis is rare, especially in developed countries, where contamination levels in food and monitored and controlled. However, there have been outbreaks in some developing countries, notably in sub-Saharan Africa, where maize and groundnuts can be an important part of the diet and where the climate is suitable for rapid mould growth on crops in the field and in storage.
A notable outbreak occurred in India in 1974 when almost 400 people became ill with fever and jaundice after eating maize contaminated with between 0.25 and 15 mg/kg aflatoxin and more than 100 died. Major outbreaks have also occurred in Kenya, the largest in 2004 when 317 people were affected and 125 died, probably as a result of eating contaminated maize.
Where do they come from?
Aflatoxins are produced by at least three Aspergillus species. These are A. flavus, A. parasiticus and the much more rare A. nomius. These moulds are able to colonise a wide range of crops both in the field as non-destructive plant pathogens and in storage, and can grow and produce aflatoxins at quite low moisture levels (approximate minimum Aw 0.82) and over a broad temperature range (13-37oC).
Their growth is strongly influenced by climate and, although they are found all over the world, they are more common in tropical regions with extreme variations in temperature, rainfall and humidity. A. flavus invasion of groundnut crops in the field is known to be favoured by drought stress and maize crops are vulnerable if damaged by insect pests.
Mould growth and aflatoxin production during storage of crops is also important, especially if drying is inadequate, or storage conditions allow access for insect or animal pests.
Are they stable in foods?
Aflatoxins are quite stable compounds and survive relatively high temperatures with little degradation. Their heat stability is influenced by other factors, such as moisture level and pH, but heating or cooking processes cannot be relied upon to destroy aflatoxins. For example, roasting green coffee at 180oC for 10 minutes gave only a 50% reduction in aflatoxin B1 level.
The stability of aflatoxin M1 in milk fermentation processes has also been studied and although appreciable losses do occur, significant quantities of the toxin were found to remain in both cheese and yoghurt.
How can they be controlled?
The ability of aflatoxin-producing fungi to grow on a wide range of food commodities and the stability of aflatoxins in foods mean that control is best achieved by measures designed to prevent the contamination of crops in the field and during storage, or detection and removal of contaminated material from the food supply chain.
For primary producers
Pre-harvest control of aflatoxins is best achieved through general Good Agricultural Practice (GAP) to include such measures as:
•	Land preparation, crop waste removal, fertiliser application and crop rotation 
•	Use of fungus- and pest-resistant crop varieties 
•	Control of insect pests 
•	Control of fungal infection 
•	Prevention of drought stress by irrigation 
•	Harvesting at the correct moisture level and stage of maturity
The most important and effective control measure in post-harvest handling and storage is the control of moisture content and hence, the water activity of the crop. Ensuring that susceptible crops are harvested at a safe moisture level, or are dried to a safe level immediately after harvest is vital to prevent mould growth and aflatoxin production during storage. The safe moisture level varies between crops – for maize it is approximately 14% at 20oC, but for groundnuts it is much lower, about 7%. These moisture levels must be maintained during storage and transport.
It is also important to ensure that the moisture content does not vary too much in a bulk-stored crop. Small localised ‘wet spots’ can develop mould growth and these can extend to neighbouring areas as the fungus produces metabolic water during respiration. Insect and animal pest damage can also act as focal points for fungal growth.
For food processors
Physical separation of contaminated material can be an effective means of reducing aflatoxin levels in contaminated commodities. For example, colour sorting is often used to remove mouldy peanuts from bulk shipments. Density segregation, mechanical separation and the removal of fines and screenings from grain and nut shipments can also be effective measures.
Chemical decontamination methods have been investigated, especially for material used in animal feed, but most of the methods investigated are impractical, or produce toxic by-products. Biological decontamination has also been considered, and a single bacterial species, Flavobacterium aurantiacum, has been shown to remove aflatoxin B1 from peanuts and corn.
Although decontamination methods for aflatoxin M1 in milk and dairy products have also been investigated, most of these are not practical for the dairy industry. The only really effective control is to minimise the contamination of materials used in animal feed for dairy cows.
For enforcement agencies
Many countries monitor imported commodities that are susceptible to aflatoxin contamination, such as pistachios and Brazil nuts, by sampling and analysis. A number of analytical methods have been developed based on TLC, HPLC and ELISA and there are also rapid screening kits available. However, moulds and aflatoxins in bulk food shipments tend to be highly heterogeneous in their distribution and it is essential to ensure that an adequate sampling plan is used to monitor imported materials.
In some commodities, such as figs, aflatoxins fluoresce strongly under UV-light and this can be used as a rapid screening test for high concentrations.
Are there rules and regulations?
Around 100 countries around the world have regulations governing aflatoxins in food and most include maximum permitted, or recommended levels for specific commodities.
EU
The EU sets limits for aflatoxin B1 and for total aflatoxins (B1, B2, G1 and G2) in nuts, dried fruits, cereals and spices. Limits vary according to the commodity, but range from 2-12 μg/kg for B1 and from 4-15 μg/kg for total aflatoxins. There is also a limit of 0.050 μg/kg for aflatoxin M1 in milk and milk products. Sampling and analytical methods are also specified.
Limits of 0.10 μg/kg for B1 and 0.025 μg/kg for M1 have been set for infant foods.
USA
US food safety regulations include a limit of 20 μg/kg for total aflatoxins (B1, B2, G1 and G2) in all foods except milk and a limit of 0.5 μg/kg for M1 in milk. Higher limits apply in animal feeds.
Others
Both Australia and Canada set limits of 15 μg/kg for total aflatoxins (B1, B2, G1 and G2) in nuts. This is the same as the international limit recommended for raw peanuts by the Codex Alimentarius Commission.
More information can be found at the FAO web link below.
Where can I learn more?
Food-Info.net: Overview of foodborne toxins – mycotoxins (aflatoxins)
European Mycotoxin Awareness Network (EMAN)
WHO Food Additives Series 40 – JECFA monograph on aflatoxins
FAO Food and Nutrition Paper 81 – Worldwide regulations for mycotoxins in food and feed 2003
When Friends Ask: Why Do You Avoid Adding 
Vegetable Oils? 
Begin by telling them, “The fat you eat is the fat you wear,” and remind them that there is nothing attractive about wearing olive, flaxseed, or corn fat.* For this reason alone, most of your friends and family should steer clear of so-called “healthy oils” derived from plant-foods. Gaining weight can be expected from consuming high-fat whole foods, such as nuts, seeds, avocados and olives, as well as “free oils,” which are usually purchased in bottles. However, the shared propensity for weight gain is where the similarity between unprocessed plant foods and free oils ends.
I consider whole foods, even those with high concentrations of fats, to be health-promoting. However, people interested in losing weight should avoid nuts, nut butters, seeds, seed spreads, avocados, and olives, since they all serve as sources of concentrated, easy to consume, calories. When I was growing up we had nuts in their shells as a special treat for Christmas. Now these same nuts come bare-naked, salted, and sometimes roasted in additional oils—and the twist of the lid of the jar brings effortlessly to your lips (and your hips) handfuls of fat-laden, calorie-concentrated rich food. These same foods, however, may be a welcome addition for growing children and active adults. But they should be used sparingly by most of us.
Chemically speaking, free oils are chains of carbon found in a purified state. Extraction processes have removed all of the other ingredients of the whole food. Thus, free oils are no longer intermixed with the naturally-designed and balanced environment of proteins, carbohydrates, vitamins, minerals, and ten thousand other chemicals found originally in the plants. Free-oils are not food—at best these are medications, causing some desirable effects, and at worst; they are serious toxins causing disease. 
*The main distinction between fats and oils is whether they’re solid or liquid at room temperature.
Oils Are Essential for Health
The human body can synthesize from raw materials almost all of the organic compounds needed to build and maintain itself. However, there are a few basic elements that it cannot synthesize. These must be obtained from the food, and include 11 vitamins, 8 amino acids, and 2 kinds of fat. Fortunately, except for two vitamins (vitamin D from the sun and B12 from bacteria), all of these essential nutrients are made by plants and found in abundant quantities in a diet based on whole starches, vegetables, and fruits.
Fats are made of chains of carbon which differ in length, and the number and positions of double bonds (a chemical term for a dual linkage between carbon atoms). Animals cannot create double bonds after the third and sixth carbon on the chain. Only plants can make this arrangement. The result is that only plants can synthesize omega-3 and omega-6 fats. These are referred to as “essential fats.” We, like all other animals, must get these essential fats directly by eating plants or indirectly by eating animals that ate plants and stored these essential fats in their tissues. For example, fish store the omega-3 fats made by algae—fish cannot synthesize this kind of fat.

Common Fats (fatty acids) 
Linoleic acid is from plants and is the most common kind of omega-6 fat consumed by people. 
Gamma linolenic acid is an omega-6 fat from plants, and in an isolated form, is used as a medication. 
Alpha linolenic acid is from plants and is the most common omega-3 fat consumed.
Eicosapentaenoic acid (EPA) is an omega-3 fat made by animals, including fish, from alpha linolenic acid.
Docosahexaenoic acid (DHA) is an omega-3 fat made by animals, including fish, from alpha linolenic acid.	

					
	Linoleic	Alpha linolenic	Gama linolenic	Eicosapentaenoic	
	safflower	flax	borage	cold water marine fish	
	sunflower	hemp	black currant seed		
	hemp seed	canola (rapeseed)	primrose		
	soybeans	soybeans			
	walnut	walnut			
	pumpkin	leafy green vegetables			
	sesame	purslane			
	flax	perilla			
Essential Fat Deficiency Is Essentially Unknown
In our bodies these plant-derived, essential fats are used for many purposes including the formation of all cellular membranes, and the synthesis of powerful hormones, known as eicosanoids (prostaglandins, leukotrienes, and thromboxanes). Our requirement is very tiny, and even the most basic diets provide sufficient linoleic acid to meet our requirement, which is estimated to be 1–2% of dietary energy.1 Therefore, in practical terms, a condition of “essential fatty acid deficiency” is essentially unknown in free-living populations.*
Essential fatty acid deficiency is seen when sick patients are fed intravenously by fat-free parenteral nutrition. In these cases, correction of the deficiency can be accomplished by applying small amounts of soybean or safflower oil to their skin—giving you some idea of the small amount of oil we require.2 Plan on your diet of basic plant-foods supplying an abundance of essential fats delivered in perfectly designed packages, functioning efficiently and safely.
*Some people talk about a “relative deficiency” of essential fats created by a large intake of saturated animal fats, synthetic trans fats (as found in margarine and shortenings), and/or omega-6 fats compared to their intake of omega-3 fats, and they believe many of our common chronic diseases are the result of this imbalance.1 This is quite different from true essential fatty acid deficiency which would result in: loss of hair, scaly dermatitis, capillary fragility, poor wound healing, increased susceptibility to infection, fatty liver, and growth retardation in infants and children.1
Free Oils as Medications
When the oils are removed from their natural environments—for example, from the seeds of corn, soybeans, safflowers, or flax, or the fruit of an olive or avocado—they are no longer a food. Yes, they do supply concentrated calories—but the rest of the original nutrition found in the plant parts is absent. In this state, the free oils can display powerful pharmacological effects—some beneficial and some harmful. This would be analogous to removing vitamins and minerals from plants and making supplements. I don’t call supplements food, do you? However, the effects of concentrated, isolated oils are usually even more potent than those seen with supplements.
Omega-3 and omega-6 oils inhibit the aggregation of platelets, slowing down the coagulation of the blood—thus these oils “thin the blood.” This well-known property can be beneficial for reducing the risk of a blood clot forming in the heart arteries—the cause of a heart attack. A common practice is to take omega-3 (fish or flaxseed) pills to reduce the risk of heart disease.3
Omega-3 and omega-6 oils suppress the immune system, reducing inflammation. As medications they have been tried in autoimmune conditions such as rheumatoid arthritis, Crohn's disease, ulcerative colitis, psoriasis, lupus erythematosus, multiple sclerosis, eczema, and psoriasis.4 Other disorders, such as migraine headaches, Alzheimer’s disease, and PMS have also been treated. The reports of benefits are variable and often questionable; as a result, their use has not been well accepted in most medical practices. 
As silly as this may sound, it has been suggested that eating essential fat may cause people to lose weight. However, a 12-week, double-blind evaluation of evening primrose oil as an “anti-obesity agent” on 100 women found no significant difference in the weight loss achieved by those taking primrose oil compared with placebo.5 Fats (and oils) are the metabolic dollar stored for the day when food is no longer available. Even “healthy oils” are moved from the spoon to the flesh with such efficiency that you should assume every drop you eat makes that journey.
Free Oils as Toxins
As with all other medications, there are adverse effects from consuming free oils, when added from a bottle to meals or taken as pills. The most obvious adverse effect is people gain weight when they eat even so-called “healthy oils,” like olive oil. When 54 obese women in a Mediterranean country were studied, these women were found to be following a diet low in carbohydrates (35% of the calories) and high in fats (43% of the calories). Of the total calories from fat, 55% came from olive oil.6 My point: a Mediterranean diet which is loaded with olive oil, rather than fruits and vegetables, will make you fat.
Omega-3 and omega-6 oils thin the blood, which make a person more susceptible to bleeding.7,8 This side effect from taking essential oils to prevent a heart attack could become fatal after an automobile accident or if an artery in the brain were to rupture, such as occurs in a hemorrhagic stroke. 

Do Vegetable Oils Really Prevent Heart Disease?
Common knowledge is vegetable oils are protective against heart disease, but there is evidence that questions the real life benefits:
•	Serial angiograms of people’s heart arteries show that all three types of fat—saturated (animal) fat, monounsaturated (olive oil), and polyunsaturated (omega-3 and -6 oils)—were associated with significant increases in new atherosclerotic lesions over one year of study.9 Only by decreasing the entire fat intake, including poly- and monounsaturated-oils, did the lesions stop growing. 
•	Dietary polyunsaturated oils, both the omega-3 and omega-6 types, are incorporated into human atherosclerotic plaques; thereby promoting damage to the arteries and the progression of atherosclerosis.10 
•	A study in African green monkeys found when saturated fat was replaced with monounsaturated fat (olive oil), the olive oil provided no protection from atherosclerosis.11 
•	One of the most important clotting factors predicting the risk of a heart attack is an elevated factor VII. All five fats tested—rapeseed oil (canola), olive oil, sunflower oil, palm oil, and butter—showed similar increases in triglycerides and clotting factor VII.12 
Most likely, the heart benefits of a Mediterranean diet are due to it being a nearly vegetarian diet. The Mediterranean diet is a good diet in spite of the olive oil.13 	
Free oils may be toxic to the body tissues. Both omega-3 and omega-6 fats are associated with an increased risk of opacification of the lens of the eye, resulting in cataracts.14
Omega-3 and omega-6 oils could benefit people with autoimmune disorders. On the other hand, excessive intake of these fats may actually aggravate these disorders.15 More importantly, we need our immune system functioning at full capacity to fight off infections and cancer. Free oils have been demonstrated to suppress many natural microbe killing mechanisms (with a marked decrease in cytokine, tumour necrosis factor-alpha and interferon-gamma).16 
Research on animals suggests the omega-6 variety of oils is very cancer-promoting and the omega-3 variety may be beneficial for cancer prevention.17 However, this may not be the case. In one animal experiment on colon cancer, a fish oil diet and a safflower oil diet induced, respectively, 10- and 4-fold more metastases (number) and over 1000- and 500-fold more metastases (size) than were found in the livers of rats on the low-fat diet.18 Other, animal experiments also have shown essential fats to be cancer promoting.19,20 Most importantly, population studies tell us that, worldwide, the lower the total fat intake, the less the risk of common cancers, such as breast, colon and prostate.21-23

Practical Ways to Eliminate Oils in Cooking

Don’t add vegetable oils when cooking
Use non-stick pots and pans
Brown or soften vegetables in water
Sauté with non-fat liquids
Replace oil in baking with fruit or tofu
Use commercial fat-replacers
Lighten texture with carbonated water
Detailed information on cooking without oil	
The Final Step
Not a day goes by that I don’t hear someone say to me, “My diet is completely vegan, but I am still 40 pounds overweight.” The oily sheen on her face and hair are a clear give away that she hasn’t been willing to stop adding the half cup of extra virgin olive oil to her spaghetti sauce. Many people fall short of their health and appearance goals because they have yet to eliminate all the added vegetable oils from their cooking. Eating out is a major stumbling block. More often than not, even after using the best communication skills with the waiter, the diner plate still glistens with an oil slick. Avoiding free vegetable oils is the last important hurdle for people seeking better health. Take the final step—just say “No” to these really unessential added oils. 
References:
Salt’s OK?
Effect of reduced dietary sodium on blood pressure. A meta-analysis of randomized controlled trials by Julian Midgley in the May 22/29, 1996 issue of the Journal of the American Medical Association (JAMA 275:1590) found, “Dietary sodium restriction for older hypertensive individuals might be considered, but the evidence in the normotensive population does not support current recommendations for universal dietary sodium restriction.” The authors looked at 56 previous studies. People with high blood pressure showed an average drop in systolic blood pressure (top number) of 3.7 mm Hg and 0.9 mm Hg for diastolic pressure (lower number) when the sodium in a person’s diet was reduced by one teaspoon of salt (2300 mg) a day. For people without high blood pressure the reduction in blood pressure for the same salt reduction was 1 mm Hg systolic and 0.1 mm Hg for diastolic pressure. Older people with high blood pressure showed a greater responses to salt reduction.
The average daily sodium intake for adults in the US per day is 3900 mg. If the general population decreased sodium intake by 2300 mg as seen in these studies they would be consuming only 1600 mg of sodium a day to achieve these reductions in blood pressure. This low intake would be impossible to achieve for almost everyone in our society. Even if this could be attained the benefits would be minuscule. It has been assumed that prevention of heart disease is accomplished with a low sodium diet. However, a recent study showed those people who ate the least sodium had the highest risk of a heart attack (Hypertension 25:1144, 1995). Other studies suggest low-salt diets may raise cholesterol and triglycerides (Am J Hypertens 4:416, 1991; Hypertension 11:743, 1993).
Comments
Because the study was funded by Campbell’s Institute for Research and Technology (salty Campbell’s soups) the research and conclusions are suspect. A series of articles in the May 18, 1996 issue of the British Medical Journal take serious issue with the conclusions of this article and attribute the industry’s pressure to the lag in progress in getting people to cut their salt intake (312:1239). They state, “Faced with a growing scientific consensus that salt increases blood pressure and the fact that most dietary salt comes from processed foods, some of the world’s major food manufacturer’s have adopted desperate measurers to try to stop governments from recommending salt reduction. Rather than reformulate their products, manufacturers have lobbied governments, refused to cooperate with expert working parties, encouraged misinformation campaigns, and tried to discredit the evidence.”
However, there is more to high blood pressure than salt; and more to heart disease than high blood pressure. Blood pressure decreases on the average 6 mm Hg systolic and 3 mm Hg diastolic in 24 hours in my patients at St. Helena Hospital (analysis of 1068 patients). If the blood pressure was initially over 150/90 then the drop was 20 mm Hg systolic and 11 mm Hg diastolic in one day. Furthermore most of the people on blood pressure medications were taken off of their medications between the first and second readings. These fantastic results are obtained because of three general changes.
First, the pump action of the heart is decreased by removing people from their stressful environments and by stopping their coffee.
Second, the volume of fluid the heart must pump around is decreased by lowering the sodium and increasing the potassium by feeding a starch-based diet.
Third, the resistance to blood flow is decreased when the vegetable and animal fats are removed from the diet. Fats make the blood cells stick together, increasing the resistance to flow.
High blood pressure is a sign of poor circulation and disease of the blood vessel system. The vessels are diseased by an unhealthy diet (high fat and cholesterol, low fiber) and an unhealthy lifestyle (smoking, no exercise). Your efforts should be to correct the underlying problems.
Salt: The Scapegoat for the Western Diet 
https://www.drmcdougall.com/forums/viewforum.php?f=15&sid=0a024acc07f0ba43f8b0f9321e290c24https://www.drmcdougall.com/forums/viewforum.php?f=15&sid=0a024acc07f0ba43f8b0f9321e290c24During my seven years of medical school and residency training, which began forty years ago, I learned two—only two—dietary lessons to share with my patients: switch from butter to margarine and reduce salt. Both pearls were supposed to save my patients from heart attacks and strokes, but neither did. The trans fats in margarine actually promote artery disease. Their dangers are so well recognized that the state of California, New York City, Philadelphia, Boston, Brookline, and Montgomery County, MD have banned the use of these synthetic fats in restaurants. Remaining is only one pillar of knowledge from my basic education, “Don’t eat salt.”
Sodium restriction is today the most widely publicized non-medication recommendation for heart disease and stroke prevention. Unfortunately, this advice has proven ineffective. Despite the vast amount of scientific research that has been published over the past seventy years, there is still little agreement as to the efficacy, safety, and acceptability of dietary salt reduction.1 In 2007, the authors of the Third National Health and Nutrition Examination Survey (The NHANES III study) representing nearly 100 million US adults reported that there is “ a robust, significant, and consistent significant inverse association between dietary sodium and cardiovascular mortality.”2 This means people who eat more salt have a lower risk of death from heart disease and stroke. 
Even if less salt meant better health, people’s eating habits are near impossible to change, simply because so few of us are able to successfully make the transition to what are considered to be unpalatable foods. Our biological craving for salt has made this an unachievable goal. Focusing on an impossible dream—“eat low salt”—does, however, assure no consequential health changes will occur in our society—and that means consumers continue their same buying habits, food companies remain highly profitable, people remain sick, and drug companies enjoy record profits. In contrast, a meaningful message, like “stop eating meat and cheese, and instead focus your diet on rice and potatoes,” would revolutionize the world—but those now in control of governments and “health” organizations representing profitable businesses don’t want to see that day come anytime soon. The status quo will indeed continue until the truth about salt becomes accepted. 
No Salt, No Sale
As an Internal Medicine Resident in training, thirty-two years ago, one of my jobs was to convince my patients with severe kidney disease to eat “salt-less” butter and “salt-less” cheese. “You must be kidding, doc, this tastes like a glob of grease,” was a common response. Salt is said to bring out the flavors of a good steak—it had better, because no one enjoys plain boiled beef. Salt is a powerfully pleasing taste. The tongue’s tip is covered with taste buds specifically for detecting saltiness. This was not a mistake of nature. We are designed to seek salt—causing us to consume essential minerals, including sodium. Without minerals, life would be impossible. Pleasure is the reward for correct behaviors. Under natural conditions our senses don’t harm us. The food processing industries have, however, found clever ways to turn our natural instincts against us. 
The overpowering taste of salt tricks us into eating foods that innately repulse human beings.This flavoring will disguise the repugnant tastes of animal flesh and cow’s milk secretions, which are the real sources of body damage. Eighty percent of the salt consumed by people following the Western diet is irreversibly intermingled with our processed foods. That’s why scientific research, especially studies of the eating habits of various populations, incriminates salt, because it is mixed up with and made indistinguishable from bacon grease. Any benefits seen when people attempt a traditional low-sodium diet result from giving up the fat, cholesterol, refined flour, and sugar in their salt-laden “junk” food—from breakfast burritos to monster burgers. The sodium is incidental—an innocent bystander, rather than the villain. 
So let me state a more moderate, socially acceptable, politically correct, viewpoint. Eating salt is not wrong when it is added in small amounts to otherwise healthy ingredients, like starches and vegetables. The basic ingredients of McDougall meals are very low sodium; you then add salt to taste. You will find a shaker full on every table at every McDougall Program. Dr. McDougall’s Rightfoods meals in a cup contain a separate package of seasonings with salt. Salt makes the McDougall Diet enjoyable from the start, even for the uninitiated carnivore. The way we serve salt, consumption is at your discretion, you are in control. If you choose, taste adaptation to lower sodium is easily achieved in a short time—which will make friends, relatives, dietitians, and personal physicians content. 
Salt, The Body Efficiently Regulates Salt
Human kidneys efficiently conserve sodium and excrete potassium. They were evolved (designed) this way because the natural diet of humans has been, until recently, high in potassium (starches, vegetables, and fruits) and low in sodium (salt was a rare and expensive commodity). Fortunately, human evolution and design also made our bodies able to survive at the other extreme with kidneys that efficiently conserve potassium and eliminate all the sodium you can eat. (Death from eating excess potassium or sodium is rare in an otherwise healthy person, unless the ingredient is given in large amounts, rapidly and/or without sufficient amounts of fresh water.) When a low-sodium diet is consumed, the intestines increase their sodium absorption, and the kidneys reduce the loss into urine. If the diet is high in salt then the opposite physiologic changes occur. Healthy bodies never mismanage this life-sustaining regulation.
Humans consume a wide range of sodium from less than 250 mg/day to over 30,000 mg/day. For example, a sodium intake of about 200 mg daily has been documented in the Yanomamo Indians living in the Amazon Basin of Brazil.5 In 1959, the daily ration of Korean soldiers included 30,000 mg of crude sea salt a day (11,000 mg of sodium daily).6 Farmers in Northern Japan have been reported to consume daily 27 grams of salt (10,000 mg of sodium).6 People following the rich Western diet consume on average 3,500 mg of sodium daily. 
A basic diet of starches, vegetables, and fruits (the McDougall Diet) with no added sodium provides less than 500 mg of sodium daily. Adding a half-teaspoon of salt to the surface of your McDougall dishes daily adds about 1100 mg of sodium—making the total daily intake 1600 mg. The “low-sodium diet” fed to a hospitalized patient, following a massive heart attack, under the expert guidance of doctors and dietitians, contains 2000 mg of sodium. Now you understand why I am comfortable putting the saltshaker on the dining tables at our programs.

The body so effectively conserves precious minerals that sodium deficiency from any natural diet is unknown. Even Ironman triathlon runners competing in 12-hour long races require no sodium supplementation.7 However, illness from too little sodium in the body rarely can be caused by perfuse and prolonged sweating and/or diarrhea, extreme water drinking, and/or diuretics (commonly). Too much sodium has been blamed for causing hypertension, osteoporosis, kidney stones, and cancer.
Salt Does Raise Blood Pressure—A Little 
The major concern for eating salt is elevated blood pressure, which is a risk factor for strokes, heart attacks, and kidney disease. Randomized clinical trials show that lowering the intake of sodium by 1725 to 2300 mg a day (from a previous higher salt intake) lowers the systolic blood pressure (top number) by 1 to 5 mmHg and the diastolic (bottom number) by 0.6 to 3 mmHg.8* The largest blood pressure responses to sodium intake are seen below 2300 mg per day. Individual sensitivities to sodium are highly variable. People of African descent and patients with underlying diseases, such as diabetes and kidney disease, have a greater rise in blood pressure in response to salt intake.
*Note for comparison: On the McDougall Diet without any limitation of salt added to the foods at the table, the average reduction in blood pressure (for people starting at 140/90 mmHg or greater) in 7 days is 15 mmHg systolic and 13 mmHg diastolic; and blood pressure medications are almost always stopped the first day of the program. 
A “no added sodium diet” is not enough. 
Salt is a combination of sodium and chloride, but only the sodium component is commonly reported and discussed. However, just as important are other ingredients in the foods, including chloride and potassium.9 In experimental models of hypertension, dietary sodium with anions other than chloride does not cause hypertension.10 The rise in blood pressure from increased sodium chloride intake is blunted by a diet that is high in potassium or low in fat; in other words a diet of starches, vegetables, and fruits counteracts the negative effects of common salt.11 Plant foods are inherently low in sodium, chloride, and fat (exceptions being nuts, seeds, avocados, etc.) and high in potassium. In plants there are thousands of ingredients, some identified and many others to be discovered, that keep the blood pressure low, the blood vessels strong, and the body healthy. On the Western diet, sodium serves first and foremost as a marker for how much pizza, fried chicken, bacon, and egg croissants people eat. 

People following vegetarian diets have been consistently found to have lower blood pressure, irrespective of their sodium intake; and indigenous communities in which hypertension is rare typically consume a diet that resembles far more of a vegetarian than a western, urban diet (even when their native diet may be very high in sodium).12 When these people migrate to the city and westernize their diets with more animal products and processed foods they develop hypertension, type-2 diabetes, heart disease, and obesity. It’s the basic foods, not the salt that underlies health and disease.
Other Salt Concerns 
Salt restriction can be lifesaving for people with severely damaged hearts and kidneys. Sensitive people can develop swelling (edema) from salt; reported as swollen feet after a couple of salty tomato juices on a long airplane ride or swollen fingers after a Chinese dinner. Because food is made less palatable, salt restriction results in lower calorie intake, and hopefully, more loss of excess weight. (Salt contains no calories.) 
Sodium also causes the kidneys to lose calcium. However, this is not an important factor in the cause of osteoporosis or kidney stones.13-15 Furthermore, the potassium and alkaline materials (carbonate yielding citrates) found in a healthy plant-food-based diet compensate for the calcium losing effects of the sodium (and the acidic animal proteins).13
Stomach cancer (gastric adenocarcinoma) is the second leading cause of cancer death worldwide. It has been suggested that consumption of salty foods causes this cancer; however, current research does not support this belief.16 Consumption of red and processed meat, and the lack of fruits and vegetables, has been well established to be the real cause of this deadly cancer.17,18
Effective Diet Therapy 
In 1939 Walter Kempner, MD introduced the rice diet for the treatment of serious medical problems, including severe hypertension, congestive heart failure, kidney failure, and diabetes at Duke University School of Medicine.19,20 In 2002 I visited the Rice Diet Clinic in Durham, North Carolina and compared notes with the doctors working at this famous facility (Dr. Kempner retired in 1992 and died in 1997 at age 94). Patients with many ailments have had their health restored with the Kempner diet of rice with fruit, and later on, vegetables and a few animal products. As a result of the pioneering work of Dr. Kempner, for almost 70 years diet therapy has been available for every doctor to cure his or her patients. The greatest obstacle to widespread deployment of this treatment has been the unfamiliar taste of the rice-based-meals due to preparation without any added salt. My 32 years of diet-focused medical experience has taught me that the major benefits of the rice diet are from the rice. Understanding that salt is not a health issue (except for the very ill) has allowed me to design a program that works for you and I for a lifetime, because it tastes good. 
References: 
1) Fodor JG, Whitmore B, Leenen F, Larochelle P. Lifestyle modifications to prevent and control hypertension