The Exchange System

“We don’t use them anymore,” said my certified diabetes educator when I asked for a copy of the exchange lists used for meal planning.

Many doctors, however, still use the exchange system. This meal planning system has survived for some 50 years—despite being somewhat eclipsed in recent years by the more precise practice of carb counting.

Especially for those recently diagnosed with diabetes who are just beginning to make dietary changes, the exchange system helps to keep things simple. In addition, it’s versatile, and it teaches sound nutrition.

How Does the System Work?

The exchange system groups similar kinds of foods into various exchange lists—for instance, there’s a fruit list, a vegetable list, a starch list, and others. Portion sizes are specified for each food. You should be able to “exchange” any food on a list for another food on the same list, because they are designed to have the same amount of calories, carbs, fat, and so on.

The starch list, for example, includes bread, tortillas, pasta, rice and starchy vegetables like potatoes. Each serving provides approximately the same nutrients, and they are all interchangeable in your meal plan.

Your meal plan tells you how many servings from specific lists you can have at each meal. Meeting with a registered dietitian is the best way to help you individualize the plan and to determine the calorie count and distribution of meals that are right for you.

If you’ve been frightened by expectations of a diet that tells you what you can’t eat, you’ll be delighted to discover that new, popular options are available on today’s exchange lists. This versatility, while not all-inclusive, provides plenty of choices and will help you adhere to the plan.

Those who don’t know the difference between a carb and a calorie soon learn. The exchange system shows that carbohydrates, which raise blood glucose, come in a variety of packages. This system, which helps to build a balanced meal plan, has optimal nutrition built into it. Following your plan is a living experiment that takes nutrition out of the textbook and puts it on the table.

For those trying to lose, gain or maintain weight, a meal plan based on the exchange system can show you exactly what you need to do to achieve your goals if it has been individualized to suit your needs by a dietitian. Problem areas become easy to spot: Are your portion sizes correct? Are you eating enough fat? Are you following the plan but still having problems? If you think the exchange system might work for you, you can consult these resources:

  • American Dietetic Association: phone (800) 366-1655; or visit the Web site at
  • The dietitian at your local hospital. You can visit the American Association of Diabetes Educators Web site,, to locate a dietitian who is a certified diabetes educator.

Sample Breakfast

1 small orange = 1 fruit exchange

1 6-inch tortilla = 1 starch exchange

1 scrambled egg = 1 protein exchange cooked in 1 teaspoon of olive oil = 1 fat exchange

1 tbsp. salsa = free food exchange

1 cup plain, nonfat yogurt = 1 low-fat milk exchange

1 cup coffee = free food exchange

2 tbsp. cream = 1 fat exchange

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