A meal plan should provide a daily allowance of not only carbohydrates, but of fat, protein, and calories. If you have other medical conditions that impact your diet, those factors will also be taken into account.
The dietary exchange system, designed by the two ADAs (the American Diabetes Association and the American Dietetic Association), is based on three major types of foods: the carbohydrate group, the meat and meat substitutes group, and the fat group. Within each food category are a series of lists (i.e., exchange lists) that group foods with similar nutritional profiles. The list breakdown is as follows:
- Carbohydrate Group
o Starch list. 15 g carb; 3 g protein; 0-1 g fat; 80 calories.
o Fruit list.15 g carb; 0 g protein and fat; 60 calories.
o Milk list. 12 g carb; 8 g protein; 0-8 g fat*; 90-150 calories*.
o Vegetable list (non-starchy). 5 g carb; 2 g protein; 0 g fat; 25 calories.
o Other carbohydrate list (e.g. sweets). 15 g carb; other nutrients vary.
- Meat and meat substitutes group
o Very lean list. 0 g carb; 7 g protein; 0-1 g fat; 35 calories.
o Lean list. 0 g carb; 7 g protein; 3 g fat; 55 calories.
o Medium-fat list. 0 g carb; 7 g protein; 5 g fat; 75 calories.
o High-fat list. 0 g carb; 7 g protein; 8 g fat; 100 calories.
- Fat group
o Monounsaturated fat list.
o Polyunsaturated fat list
o Saturated fat list.
* Depends on milk type (e.g., fat-free, reduced fat, whole).
Because each food selection on a given exchange list has a similar nutrient profile, any food choice on the list can be exchanged for another. The main benefit of the system is that it is easy to learn; a dietitian can help build a meal plan that outlines a certain number of exchanges from each list based on caloric and other nutritional requirements. The main drawback is that some people find an exchange-based dietary plan limiting. Combination dishes (such as soups and casseroles) can be difficult to compute exchanges for if the recipe or labeling does not clearly designate the information. Another approach to eating right with diabetes that bypasses this limitation is carbohydrate counting.
Reviewed by Susan Weiner, R.D., M.S., C.D.E., C.D.N. 3/08
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