What is the exchange meal plan?
The exchange meal plan is a food program that balances the
amount of carbohydrate your child eats each day.
Carbohydrates (carbs) affect your child's blood sugar more
than any other kind of nutrient. Insulin works with carbs
to supply energy for the body. It is important to keep
insulin and carbs in balance.
This plan helps your child decide what type of food to eat,
how much food to eat, and when to eat it. As your child
gets more comfortable with his eating, he may want to change
to a more flexible meal plan such as the constant
carbohydrate or the counting carbohydrate meal plan.
How does the exchange meal plan work?
In the exchange meal plan, foods are divided into food lists
(starch, fruit, milk, fat, vegetable, and meat). The foods
on each list have a similar number of calories, protein,
carbs, and fat in them. Foods from each list can be traded
or "exchanged" for any other food on the same list because
they all have a similar nutritional value. For example, you
could exchange a piece of toast for one waffle because they
are both on the starch list.
Your child's dietitian will tell you the number and type of
exchanges your child should eat at each meal. To do this,
your dietitian will need to figure out the number of
calories your child needs each day. Most children under
age 14 need 1000 calories per day plus 100 calories for each
year of age.
1000 calories + (# of years x 100 calories) = # of calories
needed per day
For example, a 5-year-old would need 1500 calories.
1000 calories + (5 years x 100 calories) = 1500 calories/day
After calculating the number of calories your child needs
each day, the dietitian will make a meal plan. Your child
needs a consistent amount of carbohydrate at each meal.
Carbohydrates come from the starch, milk, and fruit lists.
The meal plan helps your child eat the correct amount of
carbs as well as eat a variety of other healthy foods.
For example, if your daughter needs 1500 calories a day, her
exchange meal plan might look like this.
Breakfast Snack Lunch Snack Dinner Snack
-------------------------------------------------------------
Meat 1 2 1
Vegetable 1
Fat 1 1
Starch 1 1 1 1 2 1
Fruit 1 1 1 0 0
Milk 1 1 1
-------------------------------------------------------------
The numbers tell you how many items your child can pick from
each food list. Notice that the carbs (starch, fruit, milk)
are equal for breakfast, lunch, and dinner and that they are
also included in snacks.
Your daughter might choose the following menu based on the
above plan.
Breakfast: 3/4 cup of cereal (1 starch), 1 cup skim of milk
(1 milk), 1/2 banana (1 fruit), grapefruit juice (1 fruit)
Morning snack: small apple (1 fruit)
Lunch: Hot dog bun (2 starch), hot dog (1 meat, 1 fat), 1
cup milk (1 milk), orange (1 fruit)
Afternoon snack: fruit roll-up (1 fruit), 1 1/2 graham
crackers (1 starch)
Dinner: 2 ounces of chicken breast (2 meat), 1/2 cup pasta
(1 starch), green beans (1 vegetable), bread with butter (1
starch, 1 fat), glass of skim milk (1 milk).
Bedtime snack: 1 string cheese (1 meat) and 6 saltine
crackers (1 starch)
The next day, your child could choose a completely different
menu using the exchange lists. For example, instead of
having cereal, she could choose toast from the starch list.
Sugary foods (brownies, sugar, ice cream, cookies, and
honey) do not fit into any of the normal exchange lists.
These foods are on a list called the "other carbohydrates"
list. If your child chooses to eat a food from the "other
carbohydrates" list, he must exchange it for a starch,
fruit, or milk exchange. For example, your son plans to eat
cereal, milk, a banana, and grapefruit juice for breakfast.
Then he decides he wants to add sugar to his cereal.
Because sugar is an "other carbohydrate," he would have to
give up one of the carbohydrate items from his breakfast,
such as the banana, and trade it for the sugar. Because
foods on the "other carbohydrates" list are not healthy
foods, they are not typically part of a meal plan and need
to be exchanged sparingly into your child's diet.
What foods are on the exchange food lists?
The exchange food lists provide lists of food options. In
addition to working with the dietitian, you may want to buy
the Exchange Lists for Meal Planning from The American
Diabetes Association and the American Dietetic Association
(1-800-342-2383).
Examples of types of food in each exchange list are as
follows:
Carbohydrates
Starch List: One starch exchange contains about 15 grams
of carbohydrate and 3 grams of protein (80 calories).
Examples of items on this list include bread, cereals,
grains, starchy vegetables, crackers, and beans.
Fruit List: One fruit exchange contains about 15 grams of
carbohydrate (60 calories) and has essentially no fat or
protein. Items on the fruit list include fruits and
fruit juice.
Milk List: One milk exchange contains about 8 grams of
protein, 12 grams of carbohydrate with a trace of fat (90
calories). Items on the milk list include different
varieties of milk and yogurt.
Other Carbohydrates List: One "other carbohydrate"
exchange has 15 grams of carbs Many of these foods
count as a carb exchange and one or more fat exchanges.
This list contains cakes, cookies, ice cream, potato
chips, and other foods with carbohydrates.
Vegetable List: Vegetables have such a small amount of
carbohydrate and protein that it is usually not necessary
to count them as an exchange. However, they are
important for good nutrition. Your child should eat
vegetables every day.
Meats and Meat Substitutes
Meats are divided into very lean, lean, medium fat, and high
fat meats. People with diabetes should try to eat more lean
and medium fat meats and stay away from the high fat
choices.
Very Lean List: One exchange equals 7 grams of protein
and 0 to 1 gram of fat (35 calories). Examples include
skinless chicken or turkey, fresh fish, fat-free cheese,
and egg whites.
Lean List: One exchange equals 7 grams of protein and 3
grams of fat (55 calories). Examples include lean pork,
lean beef, and cottage cheese.
Medium Fat List: One exchange equals 7 grams of protein
and 5 grams of fat (75 calories). Examples include
ground beef, eggs, and tofu.
High Fat List: One exchange equals 7 grams of protein
and 8 grams of fat (100 calories). This group includes
items such as fried fish, hot dogs, spare ribs, peanut
butter, and most cheeses.
Fats
Fats include oils, butter, nuts, bacon, cream cheese, and
other fatty foods. A fat exchange is equal to 5 grams of
fat and 45 calories. Fats are divided into three lists:
monounsaturated fats, polyunsaturated fats, and saturated
fats. Saturated fats are the "bad" fats that are linked
with heart disease.
Free Foods
A free food contains less than 20 calories or less than 5
grams of carbs per serving. If the food has a serving size
listed on its package, it should be limited to 3 servings
spread throughout the day. Examples of free foods include
fat-free margarine, sugar-free gelatin, diet soft drinks,
catsup, soy sauce, and spices.
Combination Foods
Many foods, such as casseroles, are mixed together. Your
dietitian can help you figure out how many exchanges to
count for combination foods. For example, a cup of lasagna
would equal 2 carb exchanges and 2 medium-fat meat
exchanges.
