Making Sense of the Diabetic Exchange Diet

If you look at dietary exchange lists and feel confused, you are not alone.

Long columns of foods and serving sizes can be overwhelming to the eye, but these lists are useful.

A complete exchange diet plan includes an exchange list for each of the food groups. It helps people plan meals that manage carbs and blood glucose, maintain a healthy weight, and receive optimal nutritional value for overall well-being.

What's on an Exchange List

It may help to think of each exchange list as a vending machine. All of the items in a particular vending machine have, per serving size given, the same amount of carbs, protein, fat and calories. Or, to view it another way, the food items in each machine are interchangeable meal-planning selections.

The items in a particular exchange list are called exchanges because they are interchangeable. Though the foods taste different, you can swap one item for another as they have similar dietary value.

There are typically separate exchange lists for:

• Starches and breads
• Vegetables
• Fruits
• Milk (with sub-lists for skim, low-fat and whole products)
• Meats (with sub-lists related to percentages of fat)
• Fats

If you know how many grams of carbohydrate you can have per meal, and you know each item in an exchange list contains an equal number of carbs, meal planning becomes easier.

Using the Lists

1. Work with your doctor or dietician to create a plan that meets your specific needs and ask questions until you understand how to implement the plan. Keep a record of your meal and snack food exchanges, and have measuring cups handy to serve yourself the correct portion sizes.
2. The items on the Starch/Bread Exchange List each contain 15 grams of carbohydrate, 0-3 grams of protein, 0-1 grams of fat, and about 80 calories. Whenever possible, choose whole-grain foods from this list as they have more nutritional value than processed grains. Most people are allowed one or two selections from this list per meal, depending on their plan.
3. Though starchy vegetables, such as potatoes, can be a comfort food, the non-starchy vegetables on the Vegetable Exchange List are a wise choice. They provide vitamins, minerals and fiber without adding much in the way of carbs of calories. A half-cup of cooked non-starchy vegetables such as peapods or onions typically has 5 grams of carbs or fewer.
4. Like the starch selections, items on the Fruit Exchange List each have 15 grams of carbohydrate per serving size indicated. They contain no fat or protein and have about 60 calories each. Eating a wide variety of fruits each week will boost your well-being with a cornucopia of vitamins, minerals and antioxidants.
5. The low-fat and fat-free selections on the Milk/Diary Exchange List have about 12 grams of carbohydrate, 8 grams protein, 0-3 grams of fat, and about 100 calories. Follow your doctor or dietician’s recommendation concerning how much fat you should include in your diet.
6. On the Meat Exchange List, most item portions are one ounce, have 0 carb grams, 7 grams protein, and 0-8 grams of fat. Calories may be 45-100 per ounce of meat. Chances are your healthcare team will recommend choosing lean meats or non-meat protein sources (e.g., lentils, edamame, hummus) most of the time. The exchange list makes lean choices easy by separating meats into lean, medium fat, and high fat sub-groups.
7. When using the Fats Exchange List keep your physician’s recommendations in mind. Choose the healthy fats and oils, such as olive oil, whenever possible.

American Diabetes Association, Livestrong
Photo credit: Gabriele Cantini / flickr