Millions of Americans suffer from diabetes, and nearly all are required to make dietary changes as a result. By maintaining a certain diet, diabetics can keep their blood sugar within an ideal range. In general, all diabetic diets limit excess fat and calories while providing adequate amounts of necessary nutrients. One of the most popular meal planning strategies for diabetics is the exchange system. This strategy involves a prescribed number of food group exchanges (or servings), recognizing foods that contain carbohydrates, identifying the amount of carbohydrates and swapping foods with similar carbohydrate content for meal variety. Exchanges are built on the fact that several of the main food groups contain carbohydrates, and that keeping track of carbohydrate intake helps maintain stable blood sugar levels.
Grains and Starchy Vegetables
Most people know that grains are a major source of carbohydrates. The exchange system says that one exchange, or serving, of a grain contains 15g of carbohydrate. For example, one tortilla is equal to one starch exchange, as is one half of an English muffin. Both of these contain 15g of carbohydrate and so will have similar effects on blood sugar. Other exchange equivalents for grains are: 1/3 cup pasta, 1/2 cup bran cereal, and 1/3 cup white rice. Starchy vegetables, such as potatoes, corn and pumpkin, also fall into this exchange category because they're rich in carbohydrates. Exchange equivalents for some starchy vegetables are 1/2 cup mashed potatoes, 1/2 cup corn cob and 1 cup pumpkin.
Milk and Yogurt
Milk and yogurt, which contain a carbohydrate called lactose, are tracked using the exchange system. One exchange from this group contains 12g carbohydrate. The exchange equivalents are 1 cup milk (skim, low-fat, or whole) and 2/3 cup plain yogurt. Foods from this category can also contribute to fat exchanges. As a general rule, fat-free or low-fat products contain 0g to 3g fat, reduced-fat products contain 5g fat, and full-fat products contain 8g fat.
Fruit
Fruit is an important source of carbohydrates that can often be overlooked when counting carbs. One exchange of fruit contains 15g carbohydrate, mostly in the form of fructose. Equivalents include a medium apple, a small banana (4 oz.), 3/4 cup blueberries, 3/4 cup cubed pineapple, 1/2 cup unsweetened applesauce and 1/2 cup orange juice. Fruit exchanges add up quickly, so try not to overdo it.
Dessert
Desserts are recognized as danger foods by most diabetics, and they contain lots of carbohydrates. Exchanges containing 15g carbohydrates include about half a can of soda (5 oz.), two chocolate chip cookies, 1/4 cup pudding, 1/2 glazed doughnut, 1/2 cup ice cream, and two fun-size candy bars. Sweeteners such as jelly, syrup and honey also fall into this exchange group. Because portion sizes are usually larger than the amounts listed here, you should keep track of how many exchanges you really use. For example, drinking a 12-oz. can of soda uses up 2 1/2 exchanges.
Meat/Meat Substitutes
Meat and meat substitutes provide protein and are therefore an important part of a healthy diet. Each meat exchange contains 7g protein; the carbohydrate level is low and not important to monitor. Equivalents include 1 oz. beef, 1 oz. hard cheese, 2 egg whites, 1/4 cup ricotta cheese and two slices of pork bacon. Foods from this category also contribute to fat exchanges, with lean meat exchanges containing 0g to 3g fat, medium-fat meat exchanges containing 4g to 7g fat, and high-fat meat exchanges containing 8g fat and more.
Fats
Fats are considered in the exchange system because too much dietary fat isn't healthy for diabetics. Each exchange contains 5g fat. Some equivalents are six almonds, 2 tbsp. avocado, 1 tsp. olive oil, 1 tsp. butter, 1 tsp. regular mayonnaise, 1 tbsp. regular salad dressing, and 1 tbsp. cream cheese. When choosing fats, try to use monounsaturated or polyunsaturated fats (good fats) and avoid saturated and trans fats (bad fats).
Free Foods
Some foods are considered free in the exchange system. Containing little carbohydrate and less than 20 calories, each of these foods can be eaten without being tracked: water, mustard, garlic, spices, hot pepper sauce, salad greens, unsweetened tea and unsweetened coffee.
What Else Should I Know?
The exchange system typically begins with an appointment with a dietitian, who assesses your nutritional needs and recommends a specific number of exchanges for each food group. In general, women need three to four carbohydrate exchanges per meal, and men need four to five. Carb exchanges are then supplemented with fat and protein exchanges. Once you're familiar with the various serving sizes and exchange categories, it's easy to begin using the method to diversify your meals.
