Diabetes: Exchange Meal Plan

What is the exchange meal plan?

The exchange meal plan is a food program that balances the amounts of carbohydrate you eat each day. Carbohydrates affect your blood sugar more than any other kind of nutrient. Insulin works with carbohydrates to supply energy for the body. It is important to keep insulin and carbohydrates in balance.

This plan helps you decide what type of food to eat, how much food to eat, and when to eat it. Other meal plans, such as the constant carbohydrate or the counting carbohydrate meal plan, are now used more often than the exchange meal plan.

How does the exchange meal plan work?

For the exchange meal plan, foods are divided into food lists: starch, fruit, milk, fat, vegetable, and meat. The serving sizes of the foods on each list have similar amounts of calories, protein, carbohydrate, and fat content. Foods from each list can be traded or "exchanged" for any other food on the same list because they all have a similar nutritional value. For example, you could exchange a piece of toast for a waffle because they are both on the starch list.

You need a consistent amount of carbohydrate at each meal. Carbohydrates come from the starch, milk, and fruit lists. Your dietitian will figure out the number of calories you need each day. Then, based on your daily calorie requirements, your dietitian will tell you the number and type of exchanges you should eat at each meal. The meal plan helps you eat the correct amount of carbohydrates as well as eat a variety of other healthy foods.

For example, if you need 1500 calories a day, your exchange meal plan might look like this.

 
Example of Numbers and Types of Exchanges for 1500 Calories a Day
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          Breakfast   Snack   Lunch   Snack   Dinner   Snack
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Meat                              1              2       1
Vegetable                                        1
Fat                               1              1
Starch        1          1        1      1       2       1
Fruit         1          1        1
Milk          1                   1              1
-----------------------------------------------------------------

The numbers tell you how many items you can pick from each food list.

You might choose the following menu based on the above plan.

Breakfast: 3/4 cup of cereal (1 starch), 1 cup skim of milk (1 milk), 1/2 banana (1 fruit), grapefruit juice (1 fruit)

Morning snack: small apple (1 fruit)

Lunch: Hot dog bun (2 starch), hot dog (1 meat, 1 fat), 1 cup milk (1 milk), orange (1 fruit)

Afternoon snack: fruit roll-up (1 fruit), 1 1/2 graham crackers (1 starch)

Dinner: 2 ounces of chicken breast (2 meat), 1/2 cup pasta (1 starch), green beans (1 vegetable), bread with butter (1 starch, 1 fat), glass of skim milk (1 milk).

Bedtime snack: 1 string cheese (1 meat) and 6 saltine crackers (1 starch)

The next day, you can choose a completely different menu using the exchange lists. For example, instead of having cereal, you could choose toast from the starch list.

Sugary foods (brownies, sugar, ice cream, cookies, and honey) do not fit into any of the normal exchange lists. These foods are on a list called the "other carbohydrates" list. If you choose to eat a food from the "other carbohydrates" list, you must exchange it for a starch, fruit, or milk exchange. For example, you may plan to eat cereal, milk, a banana, and grapefruit juice for breakfast. If you want to add sugar to your cereal, you will have to give up one of the carbohydrate items from your breakfast, such as the banana, and trade it for the sugar. Because foods on the "other carbohydrates" list are not healthy foods, they are not typically part of a meal plan and need to be exchanged sparingly into your diet.

What foods are on the exchange food lists?

The exchange food lists provide lists of food options. In addition to working with the dietitian, you may want to buy the Exchange Lists for Meal Planning from The American Diabetes Association and the American Dietetic Association (1-800-342-2383).

Examples of types of food in each exchange list are as follows:

Carbohydrates

• Starch List: One starch exchange contains about 15 grams of carbohydrate and 3 grams of protein (80 calories). Examples of items on this list include bread, cereals, grains, starchy vegetables, crackers, and beans.
• Fruit List: One fruit exchange contains about 15 grams of carbohydrate (60 calories) and has essentially no fat or protein. Items on the fruit list include fruits and fruit juice.
• Milk List: One milk exchange contains about 8 grams of protein, 12 grams of carbohydrate with a trace of fat (90 calories). Items on the milk list include different varieties of milk and yogurt.
• Other Carbohydrates List: One "other carbohydrate" exchange has 15 grams of carbohydrate Many of these foods count as a carbohydrate exchange and one or more fat exchanges. This list contains cakes, cookies, ice cream, potato chips, and other foods with carbohydrates.
• Vegetable List: One-half cup of most vegetables (cooked or raw) has about 5 grams of carbohydrate and 2 grams of protein (25 calories) and is considered 1 vegetable exchange. Raw lettuce may be eaten in larger quantities, but salad dressing usually equals 1 fat exchange. Some raw vegetables are higher in carbohydrate, equal to 15 grams carbohydrate and 2 grams protein, and should be considered equivalent to 1 starch exchange in quantity.

Meats and Meat Substitutes

Meats are divided into very lean, lean, medium-fat, and high-fat meats. People with diabetes should try to eat more lean and medium-fat meats and stay away from the high-fat choices.

• Very Lean List: One exchange equals 7 grams of protein and 0 to 1 gram of fat (35 calories). Examples include skinless chicken or turkey, fresh fish, fat-free cheese, and egg whites.
• Lean List: One exchange equals 7 grams of protein and 3 grams of fat (55 calories). Examples include lean pork, lean beef, and cottage cheese.
• Medium-Fat List: One exchange equals 7 grams of protein and 5 grams of fat (75 calories). Examples include ground beef, eggs, and tofu.
• High-Fat List: One exchange equals 7 grams of protein and 8 grams of fat (100 calories). This group includes items such as fried fish, hot dogs, spare ribs, peanut butter, and most cheeses.

Fats

Fats include oils, butter, nuts, bacon, cream cheese, and other fatty foods. A fat exchange is equal to 5 grams of fat and 45 calories. Fats are divided into three lists: monounsaturated fats, polyunsaturated fats, and saturated fats. Saturated fats are the "bad" fats that are linked with heart disease.

Free Foods

A free food contains less than 20 calories or less than 5 grams of carbohydrate per serving. If the food has a serving size listed on its package, it should be limited to 3 servings spread throughout the day. Examples of free foods include fat-free margarine, sugar-free gelatin, diet soft drinks, catsup, soy sauce, and spices.

Combination Foods

Many foods, such as casseroles, are mixed together. Your dietitian can help you figure out how many exchanges to count for combination foods. For example, a cup of lasagna would equal 2 carbohydrate exchanges and 2 medium-fat meat exchanges.