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The Karuk people are intimately dependent upon salmon both physically and culturally. Salmon has been both the primary food and the basis of the prosperous subsistence economy of the Karuk people since time immemorial. The elimination of traditional foods including multiple runs of salmon, Pacific Lamprey, Sturgeon and other aquatic species has had extreme adverse health, social, economic, and spiritual effects on Karuk people. With the loss of the most important food source, Spring Chinook salmon in the 1970s, the Karuk people hold the dubious honor of experiencing one of the most recent and dramatic diet shifts of any Native tribe in the United States. This report details the health effects of the loss of traditional foods on the Karuk Tribe. Physical health is linked to food quantity and quality, culture, economic conditions and mental health. In addition to data on disease rates, this report addresses the broader social, economic and cultural impacts of the loss of traditional food on Karuk tribal health. Particular attention is paid to salmonid species because of their central importance as food, their remarkably recent and dramatic decline, and the link made by fisheries scientists between salmonid species decline and the presence of the Klamath River dams currently up for re-licensing under FERC. This report expands the documentation and analysis of the Preliminary Report released in 2004. Data on health and economic status of the Karuk Tribe have been updated, and in some cases new disease frequencies are reported to replace earlier calculations. The methodology of this study builds on the preliminary report in three important ways …