A Diet for Living with Hypoglycemia Hypoglycemia Association, Inc. Box 165 Ashton, MD 20861-0165 (202)544-4044 Bulletin #7, October 1995, replaces Bulletin #7 Oct 75 & Jan 89. Also replaces Bulletin #120 revised Sep 88. This diet has been compiled from the diets of Harry M. Salzer, M.D. John W. Tintera, M.D., Lloyd Grumbles, M.D., and information compiled by the Hypoglycemia Association, Inc. It is not intended to be medical advice but general guidelines which have been written by lay people dedicated to helping those with hypoglycemia. All cases are individual. If medical advice is needed see a physician. As we revise this diet, the current advice being given for healthful eating is high complex carbohydrates, low fat, low salt, and limited amounts of red meat. This regime is not appropriate for the hypoglycemic who must limit carbohydrates. (Note: Leaflet in diet booklet with information on how much sugar is included in everyday "normal" foods is included at the end.) A Diet for Living With Hypoglycemia General Instructions Start THE DIET with only FOODS ALLOWED. We in HAI have been discussing diet with many individuals for a number of years, and if there is one thing we can contribute to the hypoglycemic's welfare, it is a summation of the joint experiences of many who tried THE DIET. Many persons had been struggling along for a year or more on low carbohydrates, dissatisfied and even frustrated. These individuals had been including items on the NON-RECOMMENDED list. Some individual never improve or do not progress as much as they can until they omit these items. Familiarize yourself with the FOOD ANALYSIS PAGE. We do not count calories, as a rule, we count the grams of carbohydrates and limit them to 100 grams per day. Some persons feel better on 60-100 g of carbohydrates, adjusting up or down to allow for size and occupation i.e. physical labor. Eating less than 60 grams per day may aggravate a return to undesirable symptoms. The National Research Council suggests 55-65 grams (g) of protein for women and men respectively, and higher amounts for growing children. Hypoglycemics may find it helpful to start with 100g of protein or more, and then gradually adjust that amount to suit. Each must determine his own needs. At least 6 weeks is usually required to show marked change. One may feel worse at first as a result of withdrawal symptoms from giving up caffeine, sugars, refined starches, etc. Then one may feel better for a short period of time and then get worse for several weeks before starting to feel better again. Many adjustments, including your thinking, are going on in your body. If one feels worse after starting THE DIET, there are several possible reasons: 1. If THE DIET is drastically different from one's previous diet, one's intestinal bacteria may change also. During this changing one may have diarrhea or constipation. Supplements of acidophilus may be needed. 2. Withdrawal symptoms may occur upon sudden removal of items of addiction such as caffeine, alcohol, drugs, tobacco, refined starches and sugars. There is a question of whether to quit gradually or "cold turkey". These symptoms may be so severe as to discourage a person from continuing. 3. With the increased protein, protein digesting enzymes from the pancreas may be needed, and also hydrochloric acid, which is usually produced by the stomach for the breakdown of food, especially protein. See Bul. #153, p. 2 The Heidelberg Test for hydrochloric acid. Also consult your physician. For a simple test for the hydrochloric acid, if you have no symptoms of an ulcer, sip one or two teaspoons of apple cider vinegar in water with meals. If this relieves after-meal discomfort, hydrochloric acid may be needed. A good breakfast is a MUST and a hearty one is advisable. Bedtime snack is a MUST, and should be larger than other snacks which are usually just one or two bites. Between-meal snacks are as important as THE DIET itself. They help maintain the blood sugar level. Frequency of snacking is an individual matter. If you have taken the Glucose Tolerance Test you should eat your snack about 20 minutes before your blood sugar dropped on the test. This may be as short as 1/2 hour or as long as 2 1/2 hours, but just often enough to prevent symptoms. One soon learns the body's signals requiring the next snack. The best and easiest snack is a small portion saved from the previous meal. Learn to carry a snack with you wherever you go. Excellent for snacks and as a source of minerals are mixtures of nuts and seeds, preferably raw and well chewed. The mixture will tend to provide a more complete protein with balanced amino acids than any one of them alone. Those with the highest amounts of carbohydrates (and this includes peanuts) should be used sparingly at first. (See list of nuts). Cashews which are beans and very high should not be used as first. Dry roasted nuts may contain starch and/or sugar and are not preferred. A daily intake of 1 1/2 oz. (1/2 cup) of nuts is considered to be adequate. Use them for snacks throughout the day rather than eating them all at once. Other snacks could be 1/4 apple sliced in thirds. Carry in zip lock bag wrapped in paper towel to prevent browning. In a cooler carry small portions of meat, chicken, turkey, hard boiled egg, raw vegetables, or cheese. Vary your snacks so that you are not constantly eating the same foods. If you are going to be out 4 hours and you need to eat every hour, carry 4 snacks. If you get caught without a snack take some water and a little salt. "Always carry water". Some people find protein tablets helpful. Avoid those with added sugar. "About Salt": Salt is very important and is not restricted due to the tendency to sodium depletion. (See Bul. #96 & #152). The majority of hypoglycemics tend to have low blood pressure (See Bul. #155). If you have some question on this check with your doctor. Diamond Crystal Kosher salt has no additives. It is not iodized but a kelp tablet or two daily will supply iodine. Hain's Iodized Sea Salt could be used for the table. It helps in handling stress to take some vitamin C (See Bul. #70) with a glass of water and a pinch of salt, adding about 2 oz. of juice. "About Bread": Any bread which contains wheat in any amount is to be avoided. Read the labels. Soy bread made with soy flour and eggs is a good substitute and is filling. Celery, lettuce and other leafy vegetables can be the "bread" of any meal or snack. "About Milk": On a diet with no sugar, milk will begin to taste delicious and will be an easy snack, but not a preferred snack. It contains more carbohydrates than protein. Four glasses of milk, which is considered to be a very large amount, contains 48.4 grams of carbohydrate, one half the day's allowance. continuous large amounts of milk will also deplete the bodies stores of magnesium. (Likewise large amounts of magnesium will cause a depletion of calcium.) For some persons, milk and milk products can cause intestinal problems or muscle pain. Butter is fine. Natural cheeses, the aged cheeses, may be used in moderate amounts. Processed cheeses and cheese food are not preferred. "About Fruit": All fresh fruits are permitted, but note that those high is carbohydrates are to be used sparingly; only one-half banana a week, and just a few grapes. Occasionally you may find a person who cannot tolerate any fruit. Fruit after 4 PM may interfere with sleep for some people. Eat fruit in small portions, along with some protein and fat. In time, a whole fruit, eaten alone, may be tolerated. Not that melons are low in carbohydrate. Before breakfast, fresh fruit taken as a source of bioflavinoids is preferable to juice. Fruit also takes a little longer to digest than juices thereby causing a slower rise in blood sugar. A fast rise results in a rapid fall, which may be avoided. Within twenty minutes of eating the fruit, breakfast must follow with protein and fat to maintain the blood sugar level. Fruit, juices, like milk, must not be used too freely as snacks. Use them in limited amounts, diluted with one half water to one half fruit juice, preferably during the day. The 5 % vegetable juices may be used. Juices and milk are to be considered foods and not thirst quenchers, and they must be counted in the total carbohydrates for the day. Water is always the best thirst quencher. "About Intestinal Bacteria": Lactobacillus acidophilus is very important for the gastrointestinal tract. It aids with digestion and assimilation. It also helps correct gas, bloating, constipation, and diarrhea. It can be found in health food stores. Some vitamin companies have their own brands. Read the contents labels. Yoghurt, with sugar added, is helpful, and buttermilk is a poor substitute but better than none at all. A little milk or whey powder taken with any of these will provide lactose for the continuing growth of the beneficial bacteria in the intestinal tract. Read ALL LABELS of foods, drugs, and vitamins. Many products unsuspectingly contain corn, sugars, starches, or caffeine. "Plant protein" may be either wheat or corn and should be avoided. Carmel coloring is made form corn or burned sugar. Most canned soups contain sugar or starch. Chili sauces, ketchups, some canned and frozen meats, vegetables, salad dressings and mustard contain sugar. Glucose, sucrose, dextrose, lactose, fructose, and sorbos are all sugars. Manitol, hexitol, and sorbitol, technically called alcohols, are sugar derivatives; are slower acting carbohydrates, and cause a lowering of the blood sugar. Some individuals are very sensitive to additives of any kind, even artificial sweeteners. Processed or manufactured foods should be used with care. The best food is that which is closest to its natural form. (Butter is preferred to margarine.) If you find butter constipating, soften it with an equal amount of good quality oil. If you are not getting well fast enough, try a complete vitamin complex (the 1-a-day type), or a Vitamin B complex, desiccated liver tablets or organ meats. It may be very important to check for sensitivity to some of the allowable food. (See Bul. 60, 101, 153 about food sensitivity.) Wheat or wheat products (wheat germ) in even the smallest amount are very suspect. Milk, beef, peanuts, or almost any other food can cause distress or problems for some people, especially the food you like the best and consume most frequently. (See Bul. #76 & #141.) Some are affected by yeast and molds and probably canned tomatoes. Also check your mealtime atmosphere. Stress and tension may hamper the digestion. If your blood sugar drops a normal amount you will get hungry, eat, then be satisfied. If it drops lower you may have intense cravings, a feeling of never being satisfied no matter how much you eat. At an even lower level, you may lose your appetite. A further drop can cause nausea. These levels may differ with each individual. If you lose your appetite or have feelings of nausea, it's time to check your stresses, physical and emotional. Under stress, the body defense system sends its energy to the muscles and nervous system and away from the digestive system until the stress is alleviated. In general, overweights tend to lose on THE DIET, and underweights gain. If you are having difficulty keeping your weight down do not eat less frequently, just eat less each time. If you find yourself hungry after a reasonable meal, try ending it with fat, such as a salad with plenty of dressing. Fat tends to satisfy the appetite. Reversing dinner and breakfast calorie-wise helps to lose weight. For some, milk and milk products make it difficult to lose weight. An additional aid to weight loss is the habit of eating in small bites and chewing well. Cholesterol is usually lowered as long as one eliminates sugars and refined carbohydrates as explained by E.R. Pinckney, M.D. in "The Cholesterol Controversy", (Sherbourne Press, Los Angeles, 1973.) Ham and bacon are usually cured with some sugar, most of which is lost in the curing process. Prepared meats such as cold cuts, frankfurters and sausage usually contain sugar. Some individuals cannot tolerate these. They also may have other additives such as nitrates and nitrites. Some prepared meats are now available without these additives. Spices are permitted. They have been found to produce an abundant flow of saliva, with unusually high enzyme content. Also providing enzymes are raw fruits and raw vegetables. Frequently we are asked, "What can I take for my symptoms?" The answer to that is, " It is not so much you TAKE as what you LEAVE OUT." The reason certain foods are to be avoided is that they will cause various problems. If one has eaten some of these, misery and inability to handle stress result. It usually helps at this time to eat fat, protein, salt, Vitamin C (ascorbic acid or the alkaline sodium or calcium ascorbate), and just a little carbohydrate. If one feels like going on a binge, or feels depressed, it helps to take a 500 mg tablet of Vitamin C, a glass of half water an half juice to which has been added a few grains to 1/4 teaspoon of salt (should not taste salty) and follow with some protein and fat. "To Sum Up", apart from supplements as may be needed by the individual, this diet must include salt, fat, Vitamin C, protein and slowly absorbed carbohydrates, which are foods such as vegetables and fruits having the least number of grams of carbohydrate on the foot charts. Absolutely to be avoided are: readily absorbed carbohydrates, caffeine, and alcohol. Non-recommended items should be entirely avoided at the beginning of the treatment. (These medications contain caffeine: empirin, Anacin, B.C., A.P.C, A.S.A. compound, Stanback, aspirin compounds, Caffergot, Fiorinal, Trigesic, 4-way Cold Tablets, Midol, Salfayne, and Coriciden.) Finally, when you feel well enough to try some starches after a period of up to 6 months or less of eating the basic diet, start slowly adding more foods, such as a little baked potato, eating the skin only with some of the potato which adheres. As for the breads, cereals, grains, and flours, those made from rice, barley, whole rye and dried beans may be better tolerated than wheat or corn. One can by now eat more fruit and possibly small amounts of dried fruit. If one feels less well on those items then one should go back to the basic diet again. However, for many of us, THE DIET, with minor changes, must become a way of life. "Further Reading": The Saccharine Disease, T.L. Cleve. Keats Publishing Inc., 36 Grove St., New Canaan, CT 06840, 1984. Feeding Yourself In All Sorts of Circumstances, HAI Bul #164 by Marge Smith, HAI Director. She covers the ups and downs of blood sugar levels with emphasis on ways to keep the blood sugar and energy at a "steady state". Ideas are suggested for cooking, eating out, and socializing. 8 pages $2.00. Why, Tell Me Why, (Questions on THE DIET) HAI Bul #187 Low Blood Sugar by Martin L. Budd, Book Review, Bul. #190 Are You Breathing? Enough? Importance of oxygen in relation to blood sugar. HAI Bul. #191. Bulletins on children's problems, #38, #161, #170, #175, and #179. THE DIET This diet is designed to be adequate in complete proteins and fats and low in simple, slowly absorbed carbohydrates which do not cause a quick rise in the blood sugar. "Upon Awakening": Portion of fruit preferably in the 7 to 10 gram column on the food chart. If no fresh fruit is available, 4 oz. of fruit juice or less, mixed with an equal amount of water. We strongly recommend that you eat breakfast within 20 minutes of consuming this fruit or juice. It is possible to freeze a small serving of watermelon, cantaloupe, or other fruit. Eat before thawed completely. "Breakfast": Eggs -- with butter and/or meat, fish, cheese with raw or cooked vegetable. Water or Herb Tea. "Lunch": Soup (not thickened with wheat flour. Try arrowroot or potato starch); moderately fat meat, fish, cheese, or eggs; salad with sugar free mayonnaise or oil, vegetable with butter. Bev. "Dinner": Same as lunch. "Bedtime": Cheese if tolerated, or portion of protein saved from dinner with salad or vegetable. "If Wakeful at Night": Bedtime type snack. (No fruit). "All Through the Day": Small snacks as frequently as desired -- from every half hour, to two or more hours; one to two teaspoon mixed nuts and seeds, or nut butter; one TBSP cottage cheese, 1-2 tsp. cream cheese or 1/2 oz. cheese; 1/2 oz. meat; 4 oz. vegetable juice or diluted fruit juice. Snack just before you estimate you will be hungry. For "bread" add raw celery, carrots, radishes, cucumbers, olives, lettuce, or cabbage. "Foods Allowed": (if tolerated) ..All fresh or frozen meats, fish, and shell fish. ..Eggs and dairy products such as cheese, yogurt, butter, cream. ..Fats roughly divided between saturated and unsaturated (See Bul. #63 and #157 on Fats) ..Soybean and soybean products (soy flour and granules), quinoa, amaranth, buckwheat. Check for freshness. .. Plain or salted nuts (not dry roasted); peanut butter with sugar, squash, pumpkin, sunflower, chia, & sesame seeds, nut butters, and seed meals. ..Apple cider vinegar, salt, spices, olives, dill pickles and mayonnaise. ..Herb teas and occasionally sparkling water. ..All fruits and vegetables not listed below. "Avoid Absolutely": ..All sugars and honey, molasses, jelly, syrup, maltose, dextrose, fructose, and artificial sweeteners. ..Potatoes, rice, noodles, macaroni, spaghetti. ..Wheat and wheat product (wheat germ, wheat germ oil). ..Corn and corn products (corn oil, corn oil margarine, grits, hominy, carmel coloring, and fritos. ..Cereals usually contain wheat or corn and are high in starch. Check before using. Oatmeal may be used occasionally -- see Non-recommended list. ..Regular bread, crackers, matzos, potato chips, & pretzels. .. Cakes, pastries, pie candies, chewing gum, cashews, chocolate, and jello. ..Dried peas and beans (except two or three in the soup) .. Dates, raisins, figs, and other dried fruits. ..Coffee, strong tea, postum, ovaltine, cocoa, prine, and grape juices. ..Caffeinated drinks, and other sweet soft drinks. ..All alcoholic beverages, narcotics, drugs which act as stimulators or depressants, and tobacco products. ..MSG (monosodium glutamate). The next items are questionable for the following reasons: 1. Protein bread, as well as BeBole's products contain wheat flour or gluten flour. The wheat products may be very harmful to certain individuals. For most hypoglycemics there is no such thing as a little bit of wheat, and this includes wheat germ. 2. Some doctors say that caffeine should be avoided like the plague. Decaffeinated coffee and very weak teas contain some caffeine. These stimulate the adrenal cortex. Some individuals never improve as much as they should until they give these up. 3. Oatmeal makes some individuals very tired. It is a starch, but seems less harmful than wheat. Cooking oatmeal in twice the amount of water required and pouring it through a strainer removes some starch. 4. Numerous individuals report not feeling as well after using artificial sweeteners. It is suggested that these be used only occasionally if at all. For information: "Sweetener Dearest" by H.J. Roberts, M.D. also 2 cassettes: "Is Aspartame (NutraSweet) Safe?" FAX (407)832-2400. Aspartame Consumer Safety Network, (214) 352-4268. 5. MSG causes CRS (Chinese Restaurant Syndrome) when used in amounts of 1.5g or more. The hypoglycemic-like symptoms which last about 45 minutes are: general weakness and palpitations, headaches, chest pains, numbness or burning sensations at back of neck, tightness about the head, arms and back. (Kwok's disease, New Scientist, 3/6/69) For information: Jack and Adrienne Samuels, 850 DeWitt Place #20B, Chicago IL 60611 (312)642-9333. SAMPLE MENUS The following menus show the possible carbohydrate allowances for two days. If one is still hungry, increase fat. A 15 g vegetable (or 15%) should not be used with a 10g one, or with fruit. Some may not tolerate milk, herb teas, or other foods without a return of symptoms. Each person is different. For many, 15g (or 15%) fruit or vegetable are too much carbohydrate. For other, 10 or 12g fruit or vegetable are too much carbohydrate. One may be able to tolerate these in half portions. These menus are general guidelines showing grams of carbohydrate and protein. You may tolerate less carbohydrate. Normally we do not count grams of fat. It is advisable to drink water throughout the day. Chew food thoroughly to facilitate digestion. Sample Menus Breakfast Car(g) Pro(g) Upon Awakening 1/2 orange 12 or watermelon 12.8 8" diam. 3/4" 20 min later 2 soft-boiled eggs 2 14 with butter 1/2 C. asparagus 3.4 rose hips tea w lemon or 1 pork chop 13 1/2 C. green. beans 6 w butter Snack 1 oz. meat w 8.5 lett. & mayo 1 or 2 T cottage cheese. 5 3.5 carrot sticks or 1 sardine w 5 6 1/4 med. apple or 1 T nut butter 4 2.5 mixed w sesame seed on celery 4 oz milk 6.1 4.5 Lunch 2 oz beef 1 22 w melt. cheese salad of 1/3 C 9 peas w celery, lettuce, mayo 4 oz tomato juice 5 1/2 med apple 9 or 4 oz tomato juice 5 1/2 avocado w 16 fish salad; (1/2 cup) lettuce, mayo 1/2 med. apple 9 herb tea Snack few mixed nuts 11 9.5 4 oz milk or yogurt or hard boiled egg w 1 7 lemon salt & pepper Snack 1/4 C leftover salad; 1 oz meat 5 4 or 2 T fish salad 2 8 Dinner 2 oz roast 4.4 17 onions & gravy 1 med chd carrot 5.8 1/2 C but zucch 2.5 tossed salad 3 fresh tomato 5 med peach 10 peppermint tea or 2 oz bkd. chicken 17 1/2 bkd. acrn sq. 14 w butter spinach w butter 4.3 coleslaw w shredded 5 carrots, sr. cream, dilut. apple or pineapple jce. peppermint tea Snack 1 oz chees in 2 7 cabbage leaf or 1 oz. chicken w cel. 2 8.5 and mayo. club soda in 2 t. 4.5 froz orange jc Snack 1 oz pt roast 1 8 tossed salad or 1 scrambled egg w 1 14 butter. 1 sl. cheese Total 90.7-97.1 95-97 If wakeful at night: Any previous snack Food Analysis The following lists show the number of grams or percent of carbohydrate in an average serving of about 1/2 cup. A one-half cup portion weights about 100g. Fresh Fruits 7 g avocado, cantaloupe, Casaba melon, honeydew, lemon, olives, rhubarb, strawberries, watermelon. 10 g blackberries, boysenberries, cranberries, coconut, currants, dewberries, grapefruit, oranges, peaches 9.7g, pineapple, red raspberries, limes, tangerines, canned-waterpack: (fruit cocktail, gooseberries, greenage plums, Italian purple plum, 11.9g) 15 g apples 14.5 apricots 12.8 black raspberries grapes-slip skin over 15 g pears 15.3 Loganberries sweet red cherries 17.4 bananas 22 fresh figs 20 grapes, adherent skin 17 mangos 16.8 nectarine 17 persimmons Japanese 20 native 33.5 pomegranate 16.4 plums, Damson 17.8 fresh prune 19.7 Vegetables - Number of grams are for Cooked vegetables except for salad type like celery, cabbage, onions, etc. 3-4 g asparagus, cauliflower, celery, chard, Chinese cabbage, cucumbers, eggplant, lettuce, mustard greens, rhubarb, sauerkraut, spinach, summer squash, radishes, turnip greens 5-7 g carrots (cooked), beets, broccoli, cabbage, collards, dandelion greens, fennel, kale, okra, onions (cooked), peppers, pumpkin, snap beans, tomatoes, turnips 10-12 g carrots (raw), celery root, artichoke, onions (raw), soybeans, peas (edible pod-9.5, frozen-11.8), rutabagas, 8.2, squash (hub-11.7) 15-20 g acorn squash 14 butternut 17.5 cowpeas 20 Jerusalem arti- chokes, raw 16.7 lima beans canned 18 frozen, baby 22.8 frozen Ford. 19 parsnips 15 peas, canned regular 15-16 dietary 13-14 Note: Summer squashes include yellow, zucchini, scallop and spaghetti varieties Beverages and Juices Measured in grams of carbohydrate per 1/2 Cup 5 g coconut milk, soy milk, soy soup, sauerkraut juice, tomato juice, vegetable juice, V-8 juice 10 g blackberry juice, carrot juice, lemon juice, lime juice actual grams apple juice 14.8 apricot juice 18.2 grapefruit juice 13 orange juice 13 pineapple juice 16.8 tangerine juice 13 skim milk 6.1 whole milk 5.9 A scale measuring grams is ideal for counting carbohydrates. A small postal scale is also very useful. 3 1/2 oz = 100 grams. Protein Foods in Grams per oz kidney 9 1/2 chicken 8 1/2 turkey 8 1/2 beef 8 1/2 calves liver 8 1/2 pork 8 veal 8 lamb 7 1/2 beef liver 7 1/2 tuna 8 blue fish 7 1/2 croaker 7 shad roe 7 shrimp 7 sardines 7 2 oz protein - about the size of a deck of cards Nuts and Seeds Per Oz = 2 T Listed here in order of overall value to THE DIET with percentage of carbohydrates and proteins: Seeds Carbohydrate (g) Protein (g) sunflower 5.6 6.8 sesame 4 6 pumpkin 4.2 8.2 Nuts almonds 6 6 pecans 4 2.6 brazil 3 4 filbert 4.8 3.6 Coconut dried & unsweetened 6.5 2 fresh 2.6 1 pistachio 5.5 5.5 Cashew 8.2 4.8 peanuts 7.5 6 peanut butter 7.5 6 Tahini (sesame seed butter) 6 4 Potassium-Rich Foods The salt allowed on THE DIET requires that potassium foods be included daily. We give here in milligrams the potassium content of some foods in portions of 1/2 cup, or 3 1/2 oz or 100 grams. Most fruits and vegetables contain potassium, but these are some of the highest: Almonds 773 Avocados 604 Bananas 370 Beef, cooked 370 Brazil nuts 715 Chicken, cooked light meat 411 dark meat 321 Cod, cooked 407 Flounder 587 Filberts 704 Haddock 348 Halibut 525 Liver, beef 380 Liver, calf 453 Liver, pork 395 Milk, fresh 144 Milk, dried skim 1,725 Peanuts, roasted 701 Pecans 603 Pistachio nuts 972 Rabbit 368 Rockfish 446 Salmon 361 Sardines 590 Shad 377 Soy flour 1,660 Squash, winter baked 461 Sweetbreads 433 Tomato puree 426 Turkey, light meat 411 dark meat 398 Veal 500 Walnuts 450 Weakfish 465 Restaurant suggestions: hamburgers, cheeseburgers (without bun); chef's salad, vegetable salad, fish or chicken salad; plain vegetables in butter; baked or broiled fish or meat, (if breaded -- remove breading). Do not neglect to drink water throughout the day. Sip in small amounts at mealtime. A Diet for Living With Hypoglycemia Phase II There comes a time when hypoglycemics can become less strict with their diet and use more carbohydrates. This occurs at about six months for some. For others, it may take a year or longer. But during this entire time, everyone on the basic diet is encouraged to carefully try some small amounts of the 20% vegetables or a little extra fruit, both as a test for carbohydrate tolerance, and in getting the body gradually adjusted to a good-sense general diet. Apparently some people think the basic diet is "forever". The part that is forever is the exclusion of sugar, refined flour, drugs, and any man-made and man-changed food. It appears to be a fact that we can never return to our former ways, according to reports of members who have tried over a period of 28 years. What stabilized hypoglycemic can do is change their diet to what seems best for them. What foods can now be carefully tried? Dried beans, white potato, fresh corn, brown rice, other grains such as millet, barley, amaranth, quinoa, bananas, grapes, sweet potatoes, honey, blackstrap molasses, a little more fresh fruit. At first we work them in gradually, and eventually uses some of them every day, and during this period keep notes about any symptoms. A physician suggests that we allow five days to elapse after testing a food in order to allow the body to eliminate completely the food tested before eating another "test" food. For example, potatoes one day, dried beans the fifth day after that, brown rice the fifth day after that, then on the same time schedule, fresh corn (1/2 ear), oatmeal, whole rye crackers or bread, etc. In this manner, one will not clutter up the system with a food which tends to cause a problem. The items which are most likely to cause problems are the grains, wheat being the most likely and brown rice the least. (In addition, wheat and cow's milk intolerance appear to occur together.) Then again, oats may be disastrous for some. Each grain should be tested for reactions as indicated above which is a way of determining what you can and cannot tolerate. One item to avoid is fructose, not the fructose in fresh fruit which is present in small amounts and balanced with other nutrients, but the powdered fructose which is highly concentrated and used as a sweetener. Nutritionists report that it must be converted to glucose by the liver which converts some glycogen for storage, but most is released into the blood stream as glucose which not only raises the blood sugar too quickly, but also increases the levels of triglycerides (blood fats). It also produces more fat in the liver, and other unhealthy effects. Artificial sweeteners have been found not to be tolerated well by hypoglycemics. When searching for menu and recipe ideas, many recipes can be found in ordinary cookbooks at the library. Just leave out items in the recipes which are not permissible in your diet and substitute another food which is. For thickening use potato flour, barley flour, arrowroot flour, oat flour or rice flour. Cream sauce can be made with barley flour or stir in an egg yolk at the very end and heat briefly. Recipes to Work Into Your Diet Gradually - Zucchini sauteed in butter with onion, green pepper, and chopped tomato. Add a few kidney beans. - Asparagus omelet with grated cheese. Small boiled potato with skin butter. - Sliced raw breast of chicken sauted in butter. Fresh corn (1/2 ear). - Avocado half filled with cottage cheese, topped with some pineapple cubes. Add a few seeds: pumpkin, sunflower, sesame, etc. Chew well. - Saute fish in butter. 1/2 cup brown rice. - Surprise omelet with asparagus, spinach, or peas. Top with cheddar cheese. - Potato soup. Add a coarsely grated potato to 2/3 cup boiling water. Cook, stirring occasionally for 1 to 2 minutes. Season with butter and salt. Top with chopped cooked egg. - Golden oatmeal - stir raw egg in while cooking oatmeal. - Cold chicken and potato salad or lamb stew with barley or beef stew with carrots. - Baking potato, well scrubbed, cut into 4 lengths. Dry with paper towel. Rub with melted butter. Bake. When browned, slit and insert butter, salt and sliver of cheese. Easy for kids to eat out of hand. - Black-eyed peas cooked with sauteed onions. Top with cottage cheese. - Chili con carne - ground beef, chopped onion, celery, green pepper; add kidney beans, canned tomato sauce (check labels), thin with water if necessary. Add brown rice. - Cold kidney beans combined with minced scallion, chopped dill pickle, chopped celery, mayonnaise. Or use lima beans - check label for sugar. For a list of available literature and prices please send a large #10 self- addressed stamped envelope (55 cents) to: Hypoglycemia Association, Inc. 18008 New Hampshire Avenue, Box 165 Ashton, Maryland 20861-0165 For information on meetings call: Recorded message (202)544-4044 in Washington, D.C. So you think you don't eat much sugar? Here are the approximate amounts of refined sugar (added sugar, in addition to the sugar naturally present) hidden in popular foods. Food Item Size Portion Teaspoons of sugar BEVERAGES cola drinks 6 oz. glass 3 1/2 cordials 3/4 oz glass 1 1/2 ginger ale 6 oz 5 highball 6 oz glass 2 1/2 orangeade 8 oz glass 5 root beer 10 oz bottle 4 1/2 Seven-Up 6 oz glass 3 3/4 soda pop 8 oz bottle 5 sweet cider 1 cup` 6 whiskey sour 3 oz glass 1 1/2 CAKES AND COOKIES angel food 4 oz piece 7 apple sauce cake 4 oz piece 5 1/2 banana cake 2 oz piece 2 cheese cake 4 oz piece 2 choc. cake (plain) 4 oz piece 6 choc. cake (iced) 4 oz piece 10 coffee cake 4 oz piece 4 1/2 cup cake (iced) 1 6 fruit cake 4 oz piece 5 jelly roll 2 oz piece 2 1/2 orange cake 4 oz piece 4 pound cake 4 oz piece 5 sponge cake 1 oz piece 2 brownies (unfrosted) 3/4 oz 3 chocolate cookies 1 1 1/2 Fig Newtons 1 5 gingersnaps 1 3 macaroons 1 6 nut cookies 1 1 1/2 oatmeal cookies 1 2 sugar cookies 1 1 1/2 chocolate eclair 1 7 cream puff 1 2 donut (plain) 1 3 donut (glazed) 1 6 CANDIES average choc.milk bar 1 1/2 oz 2 1/2 chewing gum 1 stick 1/2 chocolate cream 1 piece 2 butterscotch chew 1 piece 1 chocolate mints 1 piece 2 fudge 1 oz square 4 1/2 gumdrop 1 2 hard candy 4 oz 20 Lifesavers 1 1/2 peanut brittle 1 oz 3 1/2 CANNED FRUITS AND JUICES canned apricots 4 halves & 1 T syrup 3 1/2 canned fruit juices 1/2 cup 2 canned peaches 2 halves & 1 T syrup 3 1/2 fruit salad 1/2 cup 3 1/2 fruit syrup 2 T 2 1/2 stewed fruits 1/2 cup 2 DAIRY PRODUCTS ice cream 1/3 pt (3 1/2 oz) 3 1/2 ice cream cone 1 3 1/2 ice cream soda 1 5 ice cream sundae 1 7 malted milk shake 10 oz glass 5 DESSERTS, MISCELLANEOUS apple cobbler 1/2 cup 3 blueberry cobbler 1/2 cup 3 custard 1/2 cup 2 french pastry 4 oz piece 5 fruit gelatin 1/2 cup 4 1/2 apple pie 1 slice (average) 7 apricot pie 1 slice 7 berry pie 1 slice 10 butterscotch pie 1 slice 4 cherry pie 1 slice 10 cream pie 1 slice 4 lemon pie 1 slice 7 mince meat pie 1 slice 4 peach pie 1 slice 7 prune pie 1 slice 6 pumpkin pie 1 slice 5 rhubarb pie 1 slice 4 banana pudding 1/2 cup 2 bread pudding 1/2 cup 1 1/2 chocolate pudding 1/2 cup 4 cornstarch pudding 1/2 cup 2 1/2 date pudding 1/2 cup 7 fig pudding 1/2 cup 7 Grapenut pudding 1/2 cup 2 plum pudding 1/2 cup 4 rice pudding 1/2 cup 5 tapioca pudding 1/2 cup 3 berry tart 1 cup 10 blancmange 1/2 cup 5 brown Betty 1/2 cup 3 plain pastry 4 oz piece 3 sherbet 1/2 cup 9 SYRUPS, SUGARS, AND ICINGS brown sugar 1 T 3 chocolate icing 1 oz 5 chocolate sauce 1 T 3 1/2 corn syrup 1 T 3 honey 1 T 3 Karo syrup 1 T 3 maple syrup 1 T 5 molasses 1 T 3 1/2 white icing 1 oz 5 OTHER White bread 1 slice 1/2 Corn flakes + 1/2 tsp sugar 4 to 8 Hamburger or hot dog roll 3