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Diabetes Exchange Diet

Posted July 2, 2008 12:45 AM
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by Maria Adams, MS, MPH, RD

The diabetes exchange system can help you select the right amount of different types of foods to eat each day. Eating a well-balanced diet will help your blood sugar stay within a healthy range.

The Exchange Categories

The exchange system groups foods into one of six categories: starches, meat and meat substitutes, vegetables, fruits, milk, and fats. There are also some foods that are considered “free” foods because they contain such a low amount of calories and/or carbohydrates.

Serving for serving, foods in each of these categories have similar amounts of carbohydrate, protein, and fat. This means that each food in a particular category can be “exchanged” for another food in that same category.

Many foods are made up of more than one food category, so they will not fall nicely into just one of the diabetes exchange categories. These types of foods are known as “combination foods.”

Points to Consider

  • The number of servings, or “exchanges,” from a category that you can consume each day depends on how many calories you need. A dietitian can help you determine your nutrition needs, including total calories and proportion of carbohydrates, fats, and protein that you should be consuming each day.
  • The key to mastering the diabetes exchange system is becoming familiar with the serving sizes for each category, and also how much carbohydrate, protein, and fat the foods in each category typically contains.
  • Distribute your exchanges over the course of a day and be consistent about following this pattern everyday. This will spread out the amount of carbohydrates that you are consuming, which will help regulate your blood sugar.
  • The foods listed below in the starch, fruit, and milk categories contain the same amount of carbohydrates per serving, 15 grams. Since they have similar effects on your blood sugar, these foods can also be “exchanged” because they are generally considered “carbohydrate servings.” For example, you may trade 1 starch serving for 1 fruit or milk serving.
  • A common misconception is that at any given meal, you are limited to eating only the serving sizes listed below, which many people consider small. The exchange system is not quite that restrictive. For example, ½ cup mashed potato counts as 1 serving of starch, or 1 “carbohydrate serving.” But if you are allotted 3 servings of “carbohydrate” at dinner, you could skip other starches, fruits and milks, and choose to have all of your carbohydrate as potato. Thus you would eat 1½ cups of mashed potato. Nonetheless, this is probably a restriction for most people, but perhaps not quite as restrictive as it first may appear.
  • The exchange system is helpful not only in diabetes, but also for regulating weight.

The Exchange Lists

The below tables show each of the different exchange categories, the amount of carbohydrates, protein, fat, and calories one serving of a particular category provides, and examples of different foods and their portion sizes for each category.

Starches

_____ servings per day

  • One starch exchange = 15 grams carbohydrate, 3 grams protein, 0-1 grams fat, 80 calories

Type

One Exchange/Serving

Bagel (varies), 4 ounces

¼ of a bagel (1 ounce)

Bread (white, pumpernickel, whole wheat, rye)

1 slice

Bread, reduced calorie or “lite”

2 slices

Broth-based soup

1 cup

Cooked beans, peas, or corn

½ cup

Cooked cereal

½ cup

Crackers

4-6

English muffin, hot dog bun, or hamburger bun

½

Pasta, rice

1/3 cup

Popcorn, air popped, no fat added

3 cups

Potato

1 small (3 ounces) or ½ cup mashed

Pretzels

¾ ounce

Sweet potato or yam

½ cup

Tortilla

1 small

Unsweetened, dry cereal

¾ cup

Fiber is what makes one carbohydrate better than another. Remember to choose higher fiber breads and bread products for a better effect on your blood sugar.

Non-Starchy Vegetables

_____ servings per day

  • One vegetable exchange = 5 grams carbohydrate, 2 grams protein, 0 grams fat, and 25 calories

Type

One Exchange/Serving

Cooked vegetables

½ cup

Raw vegetables

1 cup

Tomato or vegetable juice

½ cup

Three servings of non-starchy vegetables add up to one serving of “carbohydrate,” meaning a bread, fruit, or milk exchange. For example, if you eat a large salad with 3 cups of vegetables, you should count that as 1 serving of carbohydrate.

Fruits

_____ servings per day

  • One fruit exchange = 15 grams carbohydrate, 0 grams protein, 0 grams fat, and 60 calories

Type

One Exchange/Serving

Canned fruit

½ cup

Dried fruit

¼ cup

Fresh fruit

1 small or 1 cup (eg, cut up or berries)

Fruit juice

½ cup

Although whole fruits and fruit juices have the same amount of carbohydrate (in the servings listed above), it’s usually better to choose the whole fruit more often because it has fiber.

Milk

_____ servings per day

  • One milk exchange = 12 grams carbohydrate and 8 grams protein (Fat and calories vary as listed below.)

Type

One Exchange/Serving

0-3 grams fat and 90 calories per serving

Nonfat or low-fat milk

1 cup

Plain, nonfat yogurt

¾ cup

Nonfat or low-fat soy milk

1 cup

5 grams fat and 120 calories per serving

2% Milk

1 cup

Soy milk

1 cup

Yogurt, plain, low-fat

¾ cup

8 grams fat and 150 calories per serving

Whole milk

1 cup

Yogurt, plain (made from whole milk)

¾ cup

Keep in mind that only the milk products that are in fluid form, such as milk and yogurt, typically have carbohydrate. Cheese, on the other hand, is considered a high-fat meat substitute. You can remember this because when cheese is made, the curd (solid) is separated from the whey (liquid).

Meat and Meat Substitutes

_____ servings per day

  • One very lean meat exchange = 0 grams carbohydrate, 7 grams protein, 0-1 grams fat, and 35 calories
  • One lean meat exchange = 0 grams carbohydrate, 7 grams protein, 3 grams fat, and 55 calories
  • One medium-fat meat exchange = 0 grams carbohydrate, 7 grams protein, 5 grams fat, and 75 calories
  • One high-fat meat exchange = 0 grams carbohydrate, 7 grams protein, 8 grams fat, and 100 calories

Type

One Exchange/Serving

Very lean meats and substitutes

Egg substitutes, plain

¼ cup

Egg whites

2

Fish: fresh or frozen cod, flounder, haddock, halibut, trout, tuna

1 ounce

Nonfat or low-fat cottage cheese

¼ cup

Poultry: chicken or turkey, white meat, no skin

1 ounce

Shellfish

1 ounce

Lean meat and substitutes

Beef: round, sirloin, flank, tenderloin, roast, steak, ground round (trimmed of fat)

1 ounce

Fish: herring, salmon, catfish, tuna (canned in oil, drained)

1 ounce

Parmesan cheese

2 tablespoons

Pork: lean pork, such as fresh ham, Canadian bacon, tenderloin, center loin chop

1 ounce

Poultry: Chicken or turkey (dark meat, no skin); chicken (white meat with skin)

1 ounce

Tofu, light

½ cup or 4 ounces

Veal: lean chop, roast

1 ounce

Medium-fat meat and substitutes

Beef: most beef products (ground beef, meatloaf, corned beef, short ribs, prime rib)

1 ounce

Cheese with 5 grams or less of fat per ounce: feta, mozzarella

1 ounce (ricotta 2 ounces)

Egg

1

Lamb: rib roast, ground

1 ounce

Pork: top loin, chop, cutlet

1 ounce

Poultry: chicken (dark meat with skin), ground turkey or ground chicken, fried chicken (with skin)

1 ounce

Sausage with 5 grams or less of fat per ounce

1 ounce

Tofu

½ cup or 4 ounces

High-fat meat and substitutes

Cheeses: all regular cheese (eg, American, cheddar, Monterey Jack, Swiss

1 ounce

Hot dog (beef, pork, or combination)—count as 1 high-fat meat plus 1 fat exchange

1 ounce

Peanut butter

1 tablespoon

Pork: spareribs, ground pork, pork sausage

1 ounce

Processed sandwich meats: bologna, salami

1 ounce

Sausage (eg, Italian, bratwurst)

1 ounce

It is best to choose meats that are lean and very lean more often than medium-fat or high-fat meats.

Fats

_____ servings per day

  • One fat exchange = 0 grams carbohydrate, 0 grams protein, 5 grams fat, and 45 calories

Type

One Exchange/Serving

Monounsaturated

Avocado

2 tablespoons (1 ounce)

Oil (canola, olive, peanut)

1 teaspoon

Olives

9-10 large

Peanut butter

2 teaspoons

Tahini paste

2 teaspoons

Polyunsaturated

Margarine

1 teaspoon

Mayonnaise, regular

1 teaspoon

Mayonnaise, low-fat

1 tablespoon

Salad dressing, regular

1 tablespoon

Saturated

Bacon, cooked

1 slice

Butter, stick

1 teaspoon

Coconut, sweetened, shredded

2 tablespoons

Cream cheese, reduced fat

1½ tablespoons

Cream cheese, regular

1 tablespoon

Cream, half and half

2 tablespoons

Shortening or lard

1 teaspoon

Sour cream, reduced fat

3 tablespoons

Sour cream, regular

2 tablespoons

Try to limit the amount of saturated fat you eat, since it is the “bad fat” that will raise your bad LDL cholesterol.

Free Foods

  • One free food exchange contains less than 20 calories or 5 grams of carbohydrate per serving
  • Note: If a serving size is given, limit to three servings per day.

Type

One Exchange/Serving

Bouillon, broth or consommé

N/A

Candy, hard, sugar free

1 candy

Carbonated or mineral water

N/A

Coffee

N/A

Cream cheese, fat-free

1 tablespoon

Creamers, nondairy

1 tablespoon

Diet soft drinks, sugar-free

N/A

Drink mixes, sugar-free

N/A

Garlic

N/A

Gelatin dessert, sugar-free

N/A

Herbs, fresh or dried

N/A

Horseradish

N/A

Jam or jelly, light

2 teaspoons

Ketchup

1 tablespoon

Lemon or lime juice

N/A

Margarine spread, fat-free

4 tablespoons

Mayonnaise, fat-free

1 tablespoon

Mustard

N/A

Nonstick cooking spray

N/A

Pickles, dill

1½ large

Salad dressing, fat-free or low-fat

1 tablespoon

Salsa

¼ cup

Soy sauce

N/A

Spices

N/A

Tabasco or hot pepper sauce

N/A

Tea

N/A

Vinegar

N/A

Whipped topping, light or fat-free

2 tablespoons

Wine, used in cooking

N/A

Worcestershire sauce

N/A

Sweets, Desserts, and Other Carbohydrates

  • One exchange on this list = 15 grams carbohydrate, or 1 starch, or 1 starch, or 1 fruit, or 1 milk

Type

Serving Size

Exchanges per Serving

Angel food cake, unfrosted

1/12 cake (2 ounces)

2 carbs

Brownie, small, unfrosted

2 inch square (about 1 ounce)

1 carb, 1 fat

Cake, frosted

2 inch square (about 2 ounces)

2 carbs, 1 fat

Doughnut, plain

1 medium (1½ ounce)

1½ carbs, 2 fats

Gingersnaps

3

1 carb

Honey

1 tablespoon

1 carb

Ice cream

½ cup

1 carb, 2 fats

Ice cream, low-fat

½ cup

1½ carbs

Milk, chocolate, whole

1 cup

2 carbs, 1 fat

Pudding, sugar-free (made with low-fat milk)

½ cup

1 carb

Sports drink

8 ounces

1 carb

Sugar

1 tablespoon

1 carb

Syrup, regular

1 tablespoon

1 carb

Yogurt, frozen, low-fat

1/3 cup

1 carb, 0-1 fat

Combination Foods

Type

Serving Size

Exchanges per Serving

Chili with beans

1 cup (8 ounces)

1 carb, 2 medium fat meats

Cream soup (made with water)

1 cup (8 ounces)

1 carb, 1 fat

Lasagna

1 cup (8 ounces)

1 carb, 2 medium fat meats

Pizza, cheese, thin crust

¼ of 10 inch (5 ounces) pizza

2 carbs, 2 medium-fat meats, 1 fat

Veggie burger (soy based)

3 ounces

1 carb, 1 lean meat

RESOURCES:

American Diabetes Association
http://www.diabetes.org

National Institute of Diabetes & Digestive & Kidney Diseases
http://diabetes.niddk.nih.gov/

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca/

Dietitians of Canada
http://www.dietitians.ca/

References:

American Diabetes Association website. Available at: http://www.diabetes.org . Accessed January 31, 2006.

Powers M. American Dietetic Association Guide to Eating Right When You Have Diabetes. John Wiley & Sons, Inc: Hoboken, NJ; 2003.



Last reviewed May 2008 by Dianne Scheinberg, MS, RD, LDN

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Copyright © 2007 EBSCO Publishing All rights reserved.

Source: EBSCO
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