If you have diabetes, no doubt you’re aware that healthy eating plays a big role in helping you manage your blood sugars. And chances are, at some point, your doctor, a dietitian, or a diabetes educator has talked with you about healthy eating (aka, your “diet”). If you’ve had diabetes for a long time, you might have been given a “diabetic diet” to follow or a list of foods to eat and foods to avoid. Maybe you were given an “exchange” diet or meal plan. What are these exchanges? And can they be helpful for you?
Why healthy eating matters for diabetes
Managing diabetes can seem like having to follow a bunch of rules — when to take medication, when to check blood sugars, and when to be physically active. And yes, when, what, and how much to eat. Unlike years ago, though, eating for diabetes doesn’t have to mean following a rigid set of rules or eating foods that you don’t like. But it IS important to focus on what, when, and how much you eat, since we know that some foods are more likely to impact your blood sugars than others. Also, if you take certain types of medication, such as insulin or pills called sulfonylureas, the timing of your meals should ideally work with when you take your medicine so that your blood sugars don’t go too low.
Another reason why good nutrition is so important for people with diabetes is to help prevent or delay some of the complications related to this condition, such as heart disease and high blood pressure. An eating plan can also help you reach and maintain a healthy weight, which helps with blood sugar management. Figuring out what to eat can be overwhelming, especially if you’re new to diabetes. There are a number of different meal-planning approaches, and to help sort out any confusion (and misinformation), it’s always a good idea to meet with a registered dietitian. They can work with you to find the meal-planning approach that will work for you, and that is tailored to your lifestyle, food likes and dislikes, and daily schedule. That’s why the “diabetic diets” of old tend not to work — they’re not geared to your individual needs and preferences. In fact, there is no specific diet that you must follow if you have diabetes. What works for some people may not work for you.
What are food exchanges?
One type of meal planning approach uses food exchanges. Food exchanges have been around since 1950 when they were introduced as a publication called Exchange Lists for Meal Planning by the American Dietetic Association (now called the Academy of Nutrition and Dietetics), the American Diabetes Association, and the U.S. Public Health Service. The goal of exchanges lists was to provide a tool for people with diabetes that would provide consistency with meal planning while promoting a wide variety of foods for overall health.
The term “exchanges” has fallen by the wayside somewhat — “choices” is a more user-friendly term — but they mean the same thing. The newest publication is called Choose Your Foods: Food Lists for Diabetes, which you can purchase through the American Diabetes Association here.
How exchanges work
The term “exchange” refers to the fact that each item on a specific food list (e.g., Fruits) can be swapped or “exchanged” with any other item on that list. So, for example, an orange can be exchanged for a peach or an apple. The word “exchange” may also be called a serving or a choice; they mean the same thing. One exchange is “equal” to another in terms of calories, carbohydrate, protein, and fat.
The exchange system categorizes foods into four main groups:
These groups are further divided into lists:
- Starch: breads, cereals, grains and pasta, starchy vegetables, crackers and snacks, beans, peas, and lentils
- Milk and milk substitute: fat-free, low-fat, reduced-fat, whole
- Nonstarchy vegetables
- Sweets, desserts, and other carbohydrates
- Protein: lean, medium-fat, high-fat, plant-based
- Free foods
- Combination foods
- Fast foods
Here’s how each list breaks out in terms calories, carbohydrate, protein, and fat. Keep in mind that these values are approximations.
Starch (one choice or exchange): 80 calories, 15 grams carb, 3 grams protein, 1 gram fat
- 1 slice (1 ounce) bread
- 1/2 cup cooked oatmeal
- 1/3 cup cooked rice
Fruits (one choice or exchange): 60 calories, 15 grams carb, 0 grams protein, 0 grams fat
- 1/2 cup frozen raspberries
- 1 small (4 ounce) apple
- 2 tablespoons raisins
Milk and milk substitutes (one choice or exchange)
- One fat-free or low-fat choice: 100 calories, 12 grams carb, 8 grams protein, 0 to 3 grams fat
- One reduced-fat choice: 120 calories, 12 grams carb, 8 grams protein, 5 grams fat
- One whole milk choice: 160 calories, 12 grams carb, 8 grams protein, 8 grams fat
- 1 cup (8 ounces) skim milk
- 1 cup (8 ounces) soy milk
- 1 cup plain yogurt
Nonstarchy vegetables (one choice or exchange): 25 calories, 5 grams carb, 2 grams protein, 0 grams fat
- 1/2 cup cooked broccoli
- 1/2 cup (4 ounces) vegetable juice
- 1 cup sliced cucumber
Sweets, desserts, other carbs (one choice or exchange): 70 calories, 15 grams carb, 0 to 15 grams fat
- 1/2 cup sugar-free pudding
- 1 ounce dark or milk chocolate
- 3 tablespoons barbeque sauce
Protein (one choice or exchange)
- Lean: 45 calories, 0 grams carb, 7 grams protein, 2 grams fat
- Medium-fat: 75 calories, 0 grams carb, 7 grams protein, 5 grams fat
- High-fat: 100 calories, 0 grams carb, 7 grams protein, 8 grams fat
- Plant-based: 7 grams protein; calories, carbs, and fat vary
- 1 ounce steak
- 1 egg
- 4 ounce tofu
Fat (one choice or exchange): 45 calories, 0 grams carb, 0 grams protein, 5 grams fat
- 2 tablespoons avocado
- 1 teaspoon olive oil
- 6 almonds
Free foods are foods and beverages with less than 20 calories and 5 grams or less of carbohydrate per serving.
- 2 teaspoons no-sugar-added jam
- 1 tablespoon fat-free cream cheese
- 2 tablespoons light whipped topping
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Pulling it all together
The current exchange or food choice lists are designed to provide good nutrition, as well as flexibility. Once you get the hang of using these lists, you’ll quickly realize just how flexible they are. Let’s say that you usually eat two slices of whole-wheat toast for breakfast (30 grams of carb), but one day you want something different. You can choose other carb-containing foods that also provide 30 grams of carb. Here’s what that could look like:
- 1/2 cup cooked oatmeal and3/4 cup blueberries
- 1/2 cup plain yogurt and 1 cup diced cantaloupe
- 1 whole English muffin
You might be wondering how much of each food you can really eat. For example, looking at the protein list, you’ll see that one choice is equal to one ounce of chicken. “Who can eat just one ounce?,” you might ask. Remember that these are examples of one choice. Chances are, you’ll have several choices of foods from different groups at each of your meals. Here’s where the meal plan comes in. Your dietitian can provide guidance as to how many choices or exchanges from each food group to aim for at each of your meals and snacks.
Here’s an example of what a dinner meal might look like:
- 2 starches: 2/3 cup cooked quinoa
- 2 vegetables: 1 cup asparagus
- 1 fruit: 3/4 cup fresh pineapple
- 4 protein: 4 ounces broiled fish
- 2 fats: 2 teaspoons olive oil
As long as you stick with the number of exchanges or choices recommended for you, you can put together countless numbers of meals and snacks.
The number of servings or exchanges recommended for each of your meals and snacks depends on several factors, including your age, gender, weight, activity level, and preferences. Again, this is where meeting with a dietitian comes in handy. Of course, you can find many premade meal plans in books and on the internet. They’re often OK to use until you see a dietitian for your own personalized meal plan.
Are food exchanges for you?
The food exchange system isn’t for everyone. Some people find it complicated to use, while others find it quite useful. Once you master it, you’ll likely discover that it’s a well-balanced eating approach that can provide consistency and save you the hassle of counting calories and carbs. You can think of it as a “mix-and-match” approach, swapping out one carb, protein, or fat food for another.
Remember that the main goal of any eating plan for diabetes is to help you keep your blood sugars within a safe range, but eating a variety of food is just as important to make sure that you get the nutrients you need for overall good health. Focus on eating vegetables, fruits, whole grains, legumes, lower-fat dairy, lean protein foods, and healthy fats, while limiting foods high in sodium, added sugars, and saturated fats.