Carefully following a diet which is high in protein, low in carbohydrates, and moderate-to-high in fats is absolutely essential in the treatment of hypoadrenocorticism. This must consist of three well-balanced meals, plus high-protein snacks between meals and after dinner.

     All sugar, starches, and readily available carbohydrates must be eliminated from the diet; this involves not only avoiding them in their usual forms, but also carefully reading all labels on food which is purchased, because many items frequently used unexpectedly contain sugar and sugar products.

     You must remember to also read the labels on so-called "dietetic" foods. Many of these products contain starches or other carbohydrates, so that these labels must be just as carefully read as the labels on regular food products. Salt may be used freely. Additional salt may be given to supplement the amount of salt consumed.

     This diet should be followed very strictly at the beginning of the treatment. When your physician feels the condition has become somewhat stabilized, other foods may be tried, one at a time, for a few days; if there is no adverse effect, that food may then be added to your diet. The diet is a vitally important part of the program; if it is not followed, the effectiveness of the rest of the program will be lost.

     The material on these instruction sheets include the "General Dietary Program", "Foods to Avoid", "Allowable Foods", and "Sample Daily Menus".

     You should eat enough to avoid feeling hungry. (Weight gain is rarely a problem; should it be, it should be treated and dealt with individually). Regular sleeping and exercising habits are quite important. A brief rest in the afternoon may be helpful.

     Learning to relax is most important; unnecessary stress (physical or mental) should be avoided wherever possible.

     Keep in mind that following the diet faithfully represents more than 50 percent of the total program; the efficacy of the other parts of the program administered by your physician hinges on your following this diet. With it, results are often most gratifying; without it, nothing can be accomplished whatsoever.

GENERAL DIETARY PROGRAM

     This suggested menu outline is to be adhered to quite closely at first and modified only after the program and your response to it have been fairly well stabilized. This is to be discussed with your doctor. The time intervals between meals and snacks is designed to provide a steady source of proteins, fats, and slowly available carbohydrate. In this way, the drop in blood sugar which occurs about two hours after each meal can be avoided. Note that in the late afternoon (around 3-5 o'clock) a drop in pituitary adrenal cortical activity occurs and a snack before this time may be especially helpful. Should meal time be delayed for any reason, you may find it necessary to have an additional snack. The allowable foods included In the lists that follow offer enough variety and possible combinations that the diet need never be dull. It can be quite an interesting and delectable adventure. Foods are grouped according to their carbohydrate content and suggestions are given for serving combinations.

SUGGESTED MENU FOR THE DAY

BREAKFAST:	2 eggs and/or ham or bacon 1 slice protein bread or ¼ cup oatmeal 1 glass of milk or other acceptable beverage
MIDMORNING SNACK:	2 oz. meat or fish or 1 oz. cheese, nuts, or protein tablets and ¼ apple or grapefruit
LUNCH:	hamburg patty with melted cheese tossed salad with dietetic dressing sautee mushrooms with butter beverage fresh peach
MIDAFTERNOON SNACK:	same as snack above
DINNER:	Broiled chicken mixed raw vegetables green or wax beans beverage strawberry cheese pie
AFTER DINNER SNACKS:	snack as above every two hours and a generous snack at time of retiring

The following abbreviations are used in the tables:
Arsw - Artificially Sweetened
C - Carbohydrate
F - Fat
P - Protein
t - teaspoon
c - cup

Equivalents:	1 cup - 8 ozs.
	½ cup - 4 ozs.
	¼ cup - 2 ozs. (liquid measure)

Unless otherwise noted, all foods are measured raw.

ALLOWABLE FOODS

MEAT, FOWL, FISH, SHELLFISH
	Excellent sources of protein. Serve ¼ lb. or more for meals; 1/8 lb. for snack. Read labels carefully.
CHEESE, DAIRY PRODUCTS, EGGS
	Excellent source of protein. Cream cheese and cottage cheese have roughly half the protein value of most other cheeses. To help restore and maintain proper bacterial flora of the stomach, it is recommended that you have an occasional serving of acidophilus milk or plain yogurt.
NUTS
	Good source of protein. Listed here in order of overall value to this diet.
	pignolias pumpkin or squash kernels butternuts black walnuts brazilnuts pecan nuts
VEGETABLES - 3% Carbohydrate
	beet greens celery chicory Chinese cabbage chives cucumbers endive escarole fennel lettuce olives parsley dill and sour pickles poke radishes rhubarb, raw watercress
VEGETABLES - 6% Carbohydrate
	asparagus bamboo shoots bean sprouts broccoli cabbage, raw cauliflower chard collard greens, raw dandelion greens egg plant kale leeks mustard greens mushrooms okra green onions peppers pimentos peas, edible pod rhubarb, cooked sauerkraut spinach summer squash tomato turnip turnip greens water chestnuts zucchini
VEGETABLES - 10% Carbohydrate
	artichoke, globe or French beans, green or wax carrots celeriac cabbage, cooked brussels sprouts collard greens, cooked chervil garden cress kohlrabi onion, raw rutabaga tomato puree
VEGETABLES - 15% Carbohydrate
	(should not be used with 10% bread, gravy, breaded meats or fruit) Artichoke, Jerusalem beets parsnips peas pumpkin salsify soybeans squash, Hubbard or winter DeBoles spaghetti and macaroni (if allowed by physician)
FRUITS - 7% Carbohydrate
	avocado rhubarb
FRUITS - 10% Carbohydrate
	boysenberries cantaloupe casaba melon coconut, fresh cranberries, raw fruit salad (no grapes) gooseberries honeydew melon lemon lime muskmelon strawberries
FRUITS - 15% Carbohydrate
	apples apricots blackberries cherries dewberries elderberries grapefruit loganberries oranges peaches pears pineapple plums raspberries tangerines youngberries
NOTE: Although bananas contain 23% carbohydrate some physicians allow up to two small bananas per week, spread in small amounts through the week, taken with protein, because of the high potassium content. Recommended only where necessary on physician's advice.
BEVERAGES - No Carbohydrate
	Arsw carbonated soft drinks (No Cola) clear broth herb teas Sanka if tolerated weak tea if tolerated
BEVERAGES - 5% Carbohydrate gm per ½ cup
	sauerkraut juice tomato juice V-8 juice vegetable juice milk
BEVERAGES - 10% Carbohydrate gm per ½ cup
	blackberry juice carrot juice lemon lime pomegranate
BEVERAGES - 15% Carbohydrate gm per ½ cup
	apricot juice (not nectar) grapefruit juice loganberry juice orange juice pineapple juice raspberry juice tangerine juice
BREAD, CRACKERS, FLOUR, etc. ONLY AS ALLOWED BY PHYSICIAN
	No more than three slices a day (or the equivalent) of protein bread or crackers made of oat, soya, high gluten, and/or Jerusalem artichoke flours. Do not serve more than one slice at any one time. Not to be served with gravy (using any of the above flours), breaded meats, heavy sauce, 15% vegetables, or desserts are included in the menu.
CONDIMENTS
	All condiments are allowed. On prepared relishes, pickles, dressings, ketchup, mayonnaise, bouillon, soup, sauce, mustard, etc. carefully check labels for sugar or starch.
SALT
	Allowed in unrestricted amounts because of the tendency to sodium depletion. During hot weather we advise supplementary salt in the form of tablets to replace the loss due to perspiration.
ARTIFICIAL SWEETENERS
	Sacchrine, sodium cyclamate, calcium cyclamate, sucaryl. Sweet N Low only if tolerated. Note: Sorbitol and manitol are used in many products labeled as dietetic. These are generally not well tolerated by hypoglycemics and unless otherwise specified by your physician should be avoided.
FATS
	Fats are essential for steroid production and the use of butter, cream, whole milk (if tolerated), and salad oil is necessary to obtain a well balanced diet, in addition to the fats naturally present in other foods in the diet.

HIGH PROTEIN, LOW CARBOHYDRATE DIETARY PROGRAM

SAMPLE DAILY MENUS

BREAKFAST
	2 poached eggs ham, bacon or pork sausage if desired leftover cooked vegetables Sanka 3 oz. slice roast beef lettuce, tomato, olives Sanka ½ grapefruit cheese omelet weak tea 1/3 cup oatmeal or I slice buttered protein bread 2 raw eggs blended with one cup orange juice weak tea
LUNCH (to carry)
	3 oz. can salmon lettuce radishes brazil nuts milk ½ ham and cheese sandwich (3 oz.) carrot sticks pecan nuts V-8 juice 2 devilled eggs celery stuffed with peanut butter lettuce and green pepper salad Sanka
LUNCH (Restaurant)
	Cheeseburger - no bun lettuce and tomato dill pickle Sanka Chef's salad Oil - vinegar dressing Sanka V-8 Western omelet Green salad light tea
LUNCH (at home)
	tuna salad with celery cheese wedge lettuce, olives, radishes herb tea open-faced toasted cheese and tomato sandwich vegetable salad with dressing milk sauteed beef liver hickory smoked bacon avocado, tomato, lettuce Sanka
SUPPER (Restaurant)
	lobster with butter broccoli lettuce hearts (check dressing) melon in season Sanka onion soup (without crouton) steak - mushrooms green beans fresh strawberries with unsweetened whipped cream Sanka filet flounder broiled tomato tossed salad celery and radishes weak tea or milk
Note: When dining in restaurants it's best to avoid ordering peas or carrots as they are often cooked with a bit of sugar.
SUPPER (at home)
	Baked ham carrots buttered cabbage wedge herb tea cream cheese ball rolled in chopped nuts lamb chops baked acorn squash cucumber - watercress salad with dressing Arsw junket made from tablets De Boles arti-macs spaghettini tomato sauce with meat balls and sausage short-cooked sliced green peppers escarole salad with dressing Sanka

FOODS TO AVOID

BEVERAGES TO AVOID
	alcoholic beverages caffeine cocoa coffee cola grape juice ovaltine papaya juice postum prune juice soft drinks strong tea
VEGETABLES TO AVIOD
	barley corn and corn products dried beans and peas hominy potatoes rice shell beans (lima & others) sweet pickles sweet relishes sweet potatoes yams
FRUIT TO AVOID
	blueberries dried fruits fruits canned in syrup grapes guava huckleberries mango plantain
MEAT TO AVOID
	*canned meat *cold cuts *hot dogs *salami *sausages scrapple
*Usually packed with some form of sugar as preservative. Check labels for exceptions.
PASTA TO AVOID
	macaroni matzoh meal noodles spaghetti
BREADS TO AVOID
	bread cereal crackers grits matzoh pancakes pizza rolls waffles
DESSERTS TO AVOID
	cake cashews chestnuts chewing gum chocolate cookies custards dessert topping ice cream JELL-O pastry pie potato chips pretzels puddings
SWEETS TO AVOID
	candy caramel honey jam jelly malt marmalade molasses sugar syrup

     Dextrose, fructose, glucose, hexitol, lactose, maltose, manitol, sorbitol, sucrose are all forms of sugar and are not allowed when used in the form of artificial sweetener.

     Most canned soups and juices, ketchups, mayonnaise, mustard, salad dressings, and some canned vegetables contain sugar or starch. Read labels carefully.

DRUGS TO AVOID

     Stanback and Aspirin compounds, APC, anacin, Caffergot, medication containing caffeine, Empirin, 4-way Cold Tablets, BC, Salfanyne, Midol, Trigesic, medication containing alcohol, narcotics and drugs which act as stimulants or depressants.