Food Exchange Lists

Vegetables contain 25 calories and 5 grams of carbohydrate. One serving equals:

½C Cooked vegetables (carrots, broccoli, zucchini, cabbage, etc.)
1C Raw vegetables or salad greens
½C Vegetable juice
If you’re hungry, eat more fresh or steamed vegetables.

Fat-Free and Very Low-Fat Milk contain 90 calories per serving. One serving equals:
1C Milk, fat-free or 1% fat
¾C Yogurt, plain nonfat or low-fat
1C Yogurt, artificially sweetened

Very Lean Protein choices have 35 calories and 1 gram of fat per serving. One serving equals:
1 oz Turkey breast or chicken breast, skin removed
1 oz Fish fillet (flounder, sole, scrod, cod, etc.)
1 oz Canned tuna in water
1 oz Shellfish (clams, lobster, scallop, shrimp)
¾C Cottage cheese, nonfat or low-fat
2 Egg whites
¼C Egg substitute
1 oz Fat-free cheese
½C Beans, cooked (black beans, kidney, chick peas or lentils): count as 1
starch/bread and 1 very lean protein

Fruits contain 15 grams of carbohydrate and 60 calories. One serving equals:

1 small Apple, banana, orange, nectarine
1 med. Fresh peach
1 Kiwi
½ Grapefruit
½ Mango
1C Fresh berries (strawberries, raspberries, or blueberries)
1C Fresh melon cubes
1
⁄8th Honeydew melon
4 oz Unsweetened juice
4 tsp Jelly or jam

Lean Protein choices have 55 calories and 2–3 grams of fat per serving. One serving equals:
1 oz Chicken—dark meat, skin removed
1 oz Turkey—dark meat, skin removed
1 oz Salmon, swordfish, herring
1 oz Lean beef (flank steak, London broil, tenderloin, roast beef)*
1 oz Veal, roast or lean chop*
1 oz Lamb, roast or lean chop*
1 oz Pork, tenderloin or fresh ham*
1 oz Low-fat cheese (with 3 g or less of fat per ounce)
1 oz Low-fat luncheon meats (with 3 g or less of fat per ounce)
¼C 4.5% cottage cheese
2 med. Sardines
* Limit to 1–2 times per week

Medium-Fat Proteins have 75 calories and 5 grams of fat per serving. One serving equals:
1 oz Beef (any prime cut), corned beef, ground beef**
1 oz Pork chop
1 Whole egg (medium)**
1 oz Mozzarella cheese
¼C Ricotta cheese
4 oz Tofu (note this is a heart healthy choice)
** Choose these very infrequently

Starches contain 15 grams of carbohydrate and 80 calories per serving. One serving equals:
1 slice Bread (white, pumpernickel, whole wheat, rye)
2 slices Reduced-calorie or "lite" bread
¼ (1 oz) Bagel (varies)
½ English muffin
½ Hamburger bun
¾C Cold cereal
1
⁄3 C Rice, brown or white, cooked
1
⁄3 C Barley or couscous, cooked
1
⁄3 C Legumes (dried beans, peas or lentils), cooked
½C Pasta, cooked
½C Bulgar, cooked
½C Corn, sweet potato, or green peas
3 oz Baked sweet or white potato
¾ oz Pretzels
3C Popcorn, hot air popped or microwave (80% light)

Fats contain 45 calories and 5 grams of fat per serving. One serving equals:
1 tsp Oil (vegetable, corn, canola, olive, etc.)
1 tsp Butter
1 tsp Stick margarine
1 tsp Mayonnaise
1 Tbsp Reduced-fat margarine or mayonnaise
1 Tbsp Salad dressing
1 Tbsp Cream cheese
2 Tbsp Lite cream cheese
1/8th Avocado
8 large Black olives
10 large Stuffed green olives
1 slice Bacon

Definition
 The word exchange refers to the fact that each item on a particular list in the portion listed may
be interchanged with any other food item on the same list. An exchange can be explained as a
substitution, choice, or serving. Each list is a group of measured or weighed foods of
approximately the same nutritional value. Within each food list, one exchange is approximately
equal to another in calories, carbohydrate, protein, and fat. To use the exchange lists, an
individual needs an individualized meal plan that outlines the number of exchanges from each
list for each meal and for snacks. The American Diabetes Association recommends that because
of the complexity of nutrition issues, a registered dietitian, knowledgeable and skilled in
implementing nutrition therapy into diabetes management and education, be the team member
developing and implementing meal plans. The meal plan is developed in cooperation with the
person with diabetes and is based on an assessment of eating changes that would assist the
individual in achieving his or her target metabolic goals and of changes the individual is willing
and able to make. Because of the accuracy and convenience of the exchange system, the
exchange lists are used for weight management as well for diabetes management.

The exchange system categorizes foods into three main groups: Carbohydrates, Meat and Meat
Substitutes, and Fats. Foods are further subdivided in these three groups into specific exchange
lists. The Carbohydrate Group contains the Starch, Fruit, Milk, Sweets and desserts (other
carbohydrates), and Vegetable lists. Foods from the Starch, Fruit, Milk, and Sweets lists can be
interchanged in the meal plan, as they each contain foods with 60 to 90 calories and
approximately 15 grams of carbohydrate. The Meat and Meat Substitute Group contains food
sources of protein and fat. The group is divided into four lists: Very Lean Meats, Lean Meats,
Medium-Fat Meats, and High-Fat Meats, allowing the user to see at a glance which meats are
low-fat and which meats are high-fat. The lists have foods containing 35, 55, 75, and 100
calories, and 1, 3, 5, and 8 grams of fat, respectively. The Fat Group contains three lists:
Monounsaturated Fats, Polyunsaturated Fats, and Saturated Fats. Each food source contains an
average of 45 calories and 5 grams of fat. The exchange lists also identify foods that contribute
significant amounts of sodium. A sodium symbol is shown next to foods that contain 400 mg or
more of sodium per exchange serving.

Advantages and Disadvantages

An advantage of the food exchange system is that it provides a system in which a wide selection
of foods can be included, thereby offering variety and versatility to the person with diabetes.
Other advantages of the lists are: (1) they provide a framework to group foods with similar
carbohydrate, protein, fat, and calorie contents; (2) they emphasize important management
concepts, such as carbohydrate amounts, fat modification, calorie control, and awareness of high-
sodium foods; (3) by making food choices from each of the different lists a variety of healthful
food choices can be assured; and (4) they provide a system that allows individuals to be
accountable for what they eat. Furthermore, with an understanding of the nutrient composition
of the exchange lists, nutrient values from food labels can be used and a wider variety of foods
can be incorporated accurately into a meal plan.

Helpful Hints for Using the Exchange Lists

 Cereals, grains, pasta, breads, crackers, snacks, starchy vegetables, and cooked beans,
peas, and lentils are on the starch list. In general, one starch exchange is ½ cup cereal,
grain, or starchy vegetable; one ounce of a bread product, such as one slice of bread; one-
third cup rice or pasta; or three-fourths to one ounce of most snack foods.
 Fresh, frozen, canned, and dried fruits and fruit juices are on the fruit list. In general, one
fruit exchange is: one small to medium fresh fruit, one-half cup of canned or fresh fruit or
fruit juice, or one-fourth cup of dried fruit.
 Different types of milk and milk products, such as yogurt, are on the milk list. One cup
(eight fluid ounces) or two-thirds cup (six ounces) of fat-free or low-fat flavored yogurt
sweetened with a non-nutritive sweetener are examples of one exchange.
 Vegetables are included in the Carbohydrate Group and are important components of a
healthful diet. However, since three servings of vegetables are the equivalent of one
carbohydrate serving, one or two servings per meal need not be counted. This was done
to encourage consumption of vegetables and to simplify meal planning.
 Meat and meat substitutes that contain both protein and fat are on the meat list. In
general, one exchange is: one ounce meat, fish, poultry, or cheese; or one-half cup beans,
peas, lentils.
 In general, one fat exchange is: one teaspoon of regular margarine, mayonnaise, or
vegetable oil; one tablespoon of regular salad dressings or reduced-fat mayonnaise; or
two tablespoons of reduced-fat salad dressings.
 •A free food is any food or drink that contains less than 20 calories or less than five
grams of carbohydrate per serving. Foods with approximately 20 calories should be
limited to three servings per day and spread throughout the day.
 Some foods are in one list, but they may fit just as appropriately in another list. For
example, foods in the Starch, Fruit, and Milk lists of the Carbohydrate Group each
contribute similar amounts of carbohydrates and calories and may be interchanged. If
fruits or starches are regularly substituted for milk, calcium intake may be decreased.
Conversely, regularly choosing milk instead of fruits or starches may result in inadequate
fiber intake. Foods from the Other Carbohydrate list of the Carbohydrate Group, the
Combination Foods list, and the fast foods list are also interchangeable with the Starch,
Fruit, and Milk lists. However, most of the dessert-type foods on the Other Carbohydrate
list are higher in sugars and fat and need to be eaten within the context of a healthful meal
plan.
 Beans, peas, and lentils are included in the Starch list of the Carbohydrate Group. The
serving size (usually one-half cup) is counted as one starch and one very lean meat for
vegetarian meal planning. If individuals are not practicing vegetarians, or use these foods
less frequently and often as side dishes rather than main dishes, the very lean meat
exchange does not need to be counted—one-half cup is equivalent to one starch.
 Skim and reduced-fat milks are recommended for adults and children over two years of
age, rather than whole milk.
 Meat choices from the Very Lean or Lean Meat lists are encouraged. However, it is not
necessary to add or subtract fat exchanges when using meat lists that differ from those
ordinarily consumed.
 Whenever possible, monounsaturated or polyunsaturated fats should be substituted for
saturated fats.
The exchange lists are updated periodically and a database is kept of the macronutrient
composition of each food, thus assuring the accuracy of the lists. For health professionals, the
macronutrient and calorie values of the exchange lists provide a useful and efficient tool for
evaluating food records and for assessing nutrition adequacy.

Despite the many advantages the exchange lists offer, they may not be the most appropriate
meal-planning tool for many persons. For instance, they are not appropriate for those who cannot
understand the concept of "exchanging" foods. Because the exchange booklets are written at a
ninth- to tenth-grade reading level, individuals must be able to either read at this level or
understand the concept of exchanging foods. For an individual to use them effectively, several
educational sessions, and practice, may be required.

Historical Background
In 1950, the following problems that had led to inconsistencies in food recommendations for
persons with diabetes were identified: (1) methods used to estimate the composition of a diet
were prolonged and needlessly precise; (2) there were many inconsistencies in the inclusion or
restriction of foods; and (3) sizes of recommended portions were often stated in impractical
amounts that were difficult to measure. Recognizing these facts, the food values given in table 1
were established. By combining foods of similar composition into food exchange lists, long and
extensive lists of foods could be greatly abbreviated.

The first major revision of the exchange lists was published in 1976. The goals at that time were:
to be more accurate in the caloric content of listed foods, to emphasize fat modification, and to
provide for individualized meal plans to be used with the exchange lists.

The next revision of the exchange lists occurred in 1986. The goals of this revision were to
ensure the exchange lists would reflect the principles of nutrition and to develop a database of
the nutrient composition of the foods listed. Using the data from the database, revisions in the
nutrient values assigned to some exchanges were made. For example, the Fruit list was changed
from 10 grams of carbohydrate to 15 grams, with a subsequent increase in calories from 40 to 60
per exchange serving, to reflect the content of typical fruit portions.

The goals of the 1995 revision were: (1) to group carbohydrate food sources into one section to
provide more flexibility in food choices; (2) to update the lists of foods and the database,
primarily to add fat-modified foods, vegetarian food items, and fast foods; and (3) to allow for
more accurate calculation of exchanges from nutrient information on labels, recipes, and
prepared foods. The most significant revision in the 1995 revision was in the order and grouping
of the lists. The Carbohydrate Group was listed
1950 FOOD VALUES FOR CALCULATING DIABETIC DIETS

Group Amount Weight Carbohydrate Protein Fat Energy

(grams) (grams) (grams) (grams) (calories)
Milk, whole ½ pt 240 12 8 10 170
Vegetable, as desired — — — — —
Group A
Vegetable, ½ cup 100 7 2 — 36
Group B
Fruit varies — 10 — — 40
Bread varies — 15 2 — 68
exchanges
Meat 1 oz 30 — 7 5 73
exchanges
Fat exchanges 1 tsp 5 — — 5 45
SOURCE: Caso, E. K., Journal of the American Dietetic Association.

NUTRIENT VALUES IN ONE

SERVING FROM EACH EXCHANGE LIST
Groups/Lists Carbohydrate Protein Fat Calories
(grams) (grams) (grams)
Carbohydrate Group
Starch 15 3 0–1 80
Fruit 15 — — 60
Milk
Fat-Free 12 8 0–3 90
Reduced-Fat 12 8 5 129
Whole 12 8 8 150
Sweets, Desserts, and Other 15 varies varies varies
Carbohydrates
Vegetables 5 2 — 25
Meat and Meat Substitute Group
Very Lean — 7 0–1 35
Lean — 7 3 55
Medium-Fat — 7 5 75
High-Fat — 7 8 100
Fat Group — — 5 45
SOURCE: American Dietetic Association and American Diabetes Association, 2003.

first and included the Other Carbohydrates list, which lists foods containing carbohydrate and
fat, such as sweets, pie, cake, and ice cream. Foods on the Other Carbohydrate list usually
provide 1 to 2 carbohydrate choices and 1 to 2 fat exchanges, and they may be interchanged with
items on the Starch, Fruit, or Milk lists and the Fat list, if appropriate.

The American Diabetes Association and the American Dietetic Association published the latest
version of the Exchange Lists for Meal Planning in January 2003. Food lists were updated and
the Other Carbohydrate list was renamed the Sweets, Desserts, and Other Carbohydrates list.
Each list begins with generalized servings of exchange. The nutrient values from the 1995 and
2003 exchange lists are the same and are listed in table 2. Also included in the booklet are a
listing of free foods (foods containing less than 20 calories and 5 grams of carbohydrate);
combination foods (entrees, frozen entrees, soups), and fast foods.

Marion J. Franz