How to Use Diabetics Diet Exchange

How to make use of food exchanges in a diabetic diet

The most widely used procedure for formulating a diabetic diet, and planning appropriate meals is the Food Exchange Lists system. The Food Exchange Lists were first published in 1950 as a joint effort of the American Diabetes Association, the United States Public Health Service and the American Dietetic Association.

 Fundamentally, foods are organised into 6 groups or "exchanges" on the basis of their fat, protein and carbohydrate content:

starch exchanges,

meat/protein exchanges,

vegetable exchanges,

fruit exchanges,

milk exchanges and

fat exchanges.

Every item in each specific group has a similar nutrient composition and is therefore a nutrient equivalent. Let's take a look at each of the six groups:

1. Starch list

Each item in this list contains approximately 15 g of carbohydrate, 2 to 3 g of protein, a trace of fat, and 80 calories. In general, wholegrain products average about 2 g of fibre per serving. Note that certain vegetable items fall under the starch list due their high carbohydrate content, such as potatoes, pumpkin and mealies. 

Examples of starch exchanges include:

Item  Portion size

Bread (white or wholewheat)  1 slice

Wholewheat crackers (eg.Provita)  3 units

Popcorn (popped)  1 - 1½ cups 

Cooked porridge (eg. Jungle Oats)  ½ cup

Cereal (eg. All Bran flakes)  ½ cup

Rice - cooked  ½ cup (65g)

Pasta - cooked (eg. spaghetti) ½ cup (70g)

Potato, baked  1 medium (75g)

Mealie kernels 1 ladelspoon

Butternut/pumpkin - cooked  1 cup (200g) or ½ butternut 

2. Protein list

Each serving of food from this group contains about 7g of protein. The amounts of fat and number of calories vary, depending on the kind of protein chosen - lean, medium-fat and high-fat. The only distinction between the three different types of protein is in their fat and therefore calorie contents. Usually, calculations are made according to medium-fat exchanges, although lean meats should be consumed wherever possible. One protein exchange of each of these items includes:

Item  Portion size

Lean meat  30 g (matchbox size)

Minced meat 1 heaped Tbs

Chicken/turkey (no skin) 1 small drumstick

Fish (low or medium fat) 40g

Tuna fish (canned in water) 1/4 tin (50g)

Eggs 1 egg

Cheese (low-fat, eg.Mozzarella)  30g 

Cottage cheese ¼ tub

3. Vegetable list

Each vegetable serving on this list contains about 5g of carbohydrate, 2g of protein and 25 calories. Generally, most vegetables contain about 2-3g of dietary fibre and are a good source of vitamins and minerals. Fresh and frozen veggies have more vitamins and less added salt and are therefore preferable to canned veggies. 

The serving size for vegetables, i.e. one vegetable exchange is:

Item  Portion size

Cooked veggies 1/2 cup

Raw veggies  1 cup

 4. Fruit list

Each item on this list contains about 15g of carbohydrate and 60 calories. On average, fresh, frozen and dried fruits have about 2g of fibre per serving. Fruit juices contain very little dietary fibre and therefore whole fruit is a better choice. Canned fruits must have no added sugar, such as Natuurlite. 

Examples of a fruit exchange include:

Item Portion size

Apple 1 medium (100g)

Banana  1 medium (120g)

Fruit salad (unsweetened) 1/2 cup (110g)

Grapes  1 small bunch (100g)

Granadillas  3 medium (65g)

Guavas  2 small (120g)

Kiwi fruit  2 small (100g)

Mango 1 small (170g)

Orange/grapefruit  1 medium (170g)

Pawpaw  1 cup (150g)

Peach  1 medium (150g)

Pear 1 small (100g)

Pineapple  5 slices (120g)

Plums  2 medium (200g)

Strawberries  ±15 berries (1 cup or 200g)

Watermelon/sweetmelon  1 slice (200 g)

Dried apples ±5 rings (25g)

Dried apricots ±8 halves (25g)

Dried peaches/pears  ±2 halves (25g)

Raisins  1 heaped Tbs 

Prunes  3 prunes or (25g)

Tinned peaches/pears/pineapple - "lite" 1/2 cup (125 ml)

Unsweetened fruit juice  1/2 cup 

5. Milk list

Each serving of milk or milk products in this list contains about 12g of carbohydrate and 8g of protein. As with the protein list, this list can be divided into three parts based on the amount of fat and calories: skim or fat-free milk, low-fat milk and whole milk. Fat-free milk products should be consumed wherever possible. 

One serving of each of these items, or 1 milk exchange includes:

Item  Portion size

Milk (fat-free) 250 ml

Milk (low-fat) 250 ml (counted as 1 milk exchange and 1 fat exchange)

Yoghurt (fat-free) 1 yoghurt (175 ml)

6. Fat list Each serving on the fat list contains about 5g of fat and 45 calories. All fats are high in calories and should be carefully measured. In addition, fat intake should be modified by substituting saturated fats (animal fats) with unsaturated fats (plant fats). 

One serving, that is, one fat exchange includes:

Item  Portion size

Margarine/butter 1 tsp

Lite margarine 1½ tsp

Butter 1 tsp

Oil (eg. Sunflower, olive, canola) 1 tsp

Low-oil salad dressing 1 Tbs

Olives  7 medium olives

Mayonnaise 1 tsp

Mayonnaise, reduced fat (eg. Trim) 1 Tbs

Peanut butter 1 heaped tsp (10g)

Avocado pear ¼ wedge (35 g)

Peanuts  20 small or 10 large

Almonds 6 whole

Cashews  1 Tbs

Sour cream 2 Tbs

Free foods

A free food is any food or drink that contains less than 20 calories per serving, and can be taken in unlimited amounts. Such foods include:

Sugar-free drinks Radishes 

Carbonated water Lettuce

Unsweetened cocoa powder (1Tbs) Coffee/tea

Sugar-free jelly Pickled dill cucumbers

Celery Sugar-free chewing gum

Cucumber Mustard

Horseradish Vinegar

Fat-free clear soups Herbs and spices

How to use the exchange system:

Based on total calorie requirements, one is allocated a certain number of servings or exchanges from each of the six groups. Calorie requirements would depend on weight, height, age, sex, activity level, etc. Allocations from the six groups are made in accordance with the prudent dietary guidelines to attain a ratio of 55% carbohydrate, 20% protein and 25% fat. The allocations can then be translated into actual foods by consulting with the lists of foods for each group.

Although it may seem complicated, as one gets more and more familiar with the concept of exchange lists, so it becomes easier to use. This system allows for flexibility in one's daily diet and thus helps prevent boredom.

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