What’s On the Exchange List for an 1,800-Calorie Diabetes Diet?

For years, public health authorities, such as the American Diabetes Association (ADA) and the Academy of Nutrition and Dietetics (ADN), recommended that people with diabetes use an “exchange list” to plan their meals and snacks.

This strategy divided foods into groups based on similarities in calorie and carbohydrate contents. In practice, people were able to exchange food items within each group for one another, making it easy to estimate carb content of complex meals.

These organizations no longer recommend the diabetes exchange diet. Today, the ADA recommends the “Diabetes Plate” as a way to construct wholesome meals to help manage weight and avoid blood sugar spikes.

The plate method is flexible and can be used within many different healthy eating patterns, such as the Dietary Approaches to Stop Hypertension (DASH) diet, Mediterranean diet, or various plant-based, low-fat, or low-carb approaches.

Some people, however, may still find it helpful to refer to the older system of diabetes exchanges.

Consult your doctor or a registered dietitian before starting this or any other diet plan. A diabetes eating plan is highly individualized based on your needs, so working with a healthcare professional ensures you’re following the best plan for you.

Starches are a significant source of carbohydrates in the diet, according to an article published in the Journal of Diabetes Investigation. People with diabetes need to control the amount of starch in their diets to help manage blood sugar.

The nonprofit Diabetes UK suggests that whole grains offer a better option for blood glucose control than refined grains, so consider starches carefully.

According to older guidance from the ADN, a starch exchange is equal to:

• 1 slice of bread, such as white, pumpernickel, whole wheat, or rye
• 2 slices of reduced-calorie or “lite” bread
• 1/4 (1 oz) bagel
• 1/2 English muffin
• 1/2 hamburger bun
• 3/4 cup cold cereal
• 1/3 cup rice, barley, or couscous, cooked
• 1/2 cup pasta, bulgur, or cooked cereal
• 1/2 cup corn, green peas, or sweet potato
• 3 oz baked sweet or white potato
• 3 cups air-popped or lite microwave popcorn
• 3/4 oz pretzels

Fruits are a source of carbohydrates in the diet. According to the ADN, a fruit exchange is equal to the following:

• 1 small apple, orange, or nectarine
• 1 medium peach
• 1/2 medium banana
• 1 kiwi
• 1/2 grapefruit
• 1/2 mango
• 1 cup fresh berries, such as strawberries, blueberries, or raspberries
• 1 cup fresh melon cubes or 1/8 honeydew
• 4 oz unsweetened fruit juice
• 4 tsp jelly or jam

Cleveland Clinic recommends prioritizing whole fruit over juice. The added fiber in the fruit helps control hunger and prevent blood sugar spikes.

Dairy does not naturally contain a large amount of carbohydrates. However, your doctor may recommend unsweetened yogurts and low-fat or fat-free milk to limit your intake of saturated fat and the risk of heart disease.

An exchange is equal to:

• 1 cup fat-free or 1 percent milk
• 3/4 cup plain nonfat or low-fat yogurt
• 1 cup artificially sweetened yogurt

Meats are a source of healthy protein and unhealthy saturated fat. The ADN divides its meat exchange by calories and fat content into lean, medium-fat, and high-fat protein sources.

A meat exchange is equal to the following within these categories:

Lean Protein (45 Calories, 2 Grams Fat)

• 1 oz ground beef (90 percent lean)
• 1/2 oz beef jerky
• 1 oz fish, including fresh, frozen, and canned
• 1 oz pork (leaner cuts, such as tenderloin)
• 1 oz ham or Canadian bacon
• 1 oz sliced turkey
• 1 oz lamb
• 1 oz shellfish, including shrimp, crab, and scallops

Medium-Fat Protein (75 Calories, 5 Grams Fat)

• 1 oz prime beef cuts, ground beef, or corned beef
• 1 oz ground beef (85 percent lean)
• 1 oz pork cutlets or shoulder
• 1 medium whole egg
• 1 oz skin-on poultry

High-Fat Protein (100 Calories, 8 Grams Fat)

• 2 slices bacon
• 1 hot dog
• 1 oz pork sausage
• 1 oz salami or bologna

The ADA advises that nonstarchy vegetables are nutritious, low-calorie, and an important part of a diabetes diet.

You can eat plenty of nonstarchy vegetables, as they’re so low in calories and carbs. One vegetable exchange equates to 1 cup raw or 1/2 cup cooked vegetables or vegetable juice.

Nonstarchy vegetables include:

• Artichokes
• Broccoli
• Carrots
• Cauliflower
• Cucumbers
• Eggplant
• Green beans
• Mushrooms
• Spinach
• Zucchini

People following the 1,800-calorie diabetes diet can have three fat exchanges a day. Unsaturated fats, such as those found in oils and nuts, are better choices for heart health.

A fat exchange is equal to the following:

• 1 tsp oil
• 1 tsp butter or 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
• 1/8 avocado
• 8 black olives
• 10 stuffed green olives

People with diabetes need to manage their blood pressure, cholesterol, blood sugar, and weight to help manage their medical condition and prevent complications.

The ADA advises addressing these health needs through a meal plan that emphasizes fresh produce, lean protein, and whole grains over high-fat, high-sugar, processed foods.

The right diet plan for you depends on what you like to eat, other health conditions you might have, cultural backgrounds, how active you are, and elements such as your food budget.

Ask your diabetes educator or a registered dietitian for help planning a daily menu, as no single eating approach works for all people with diabetes.

Here’s what you might eat in a single day on the diabetes exchange diet.

Pick Whole Over Refined Grains at Breakfast

A typical breakfast might include:

• A poached egg
• A serving of fresh fruit, such as half a grapefruit
• Two slices of toast with 1 tsp spread and 8-oz glass of skim milk

Another option could be:

• 1 1/2 cup whole-grain, unsweetened breakfast cereal
• 1/2 cup sliced fruit
• 1/4 cup unsalted nuts, like almonds
• 1 cup skim milk

Go for Lean Protein at Lunch

Lunch could be:

• A whole-wheat turkey sandwich
• 3/4 oz of pretzels
• A side salad topped with fat-free dressing
• 3/4 cup sliced fruit

Use low-sodium, skinless turkey or chicken breast, or drained canned light tuna instead of fattier cuts of red meat whenever possible. Pick condiments low in fat, like mustard or reduced-fat mayonnaise.

A meatless, high-protein lunch could feature:

• 1 cup low-sodium black bean soup garnished with 1/4 cup grated reduced-fat cheese
• Baked tortilla chips with salsa
• Fruit

Work in Plenty of Vegetables With Dinner

The ADA advises that a person with diabetes should aim to fill at least half their plate with nonstarchy vegetables, such as broccoli, carrots, asparagus, beets, salad greens, tomatoes, cabbage, or cauliflower.

For instance, dinner may be:

• 3 oz roasted, skinless chicken breast
• 1 1/2 cup cooked dark leafy greens, such as spinach
• A whole-grain bread roll
• Fruit

Another example might be:

• 3 oz lean pork roast
• 1 1/2 cup steamed green beans
• 1 cup roasted sweet potatoes or winter squash
• 1/2 piece of fruit

Low- or Nonfat Dairy for Snacks

Midmorning, afternoon, and evening snacks can help people with diabetes keep their blood sugar levels stable, as long as they avoid sugary treats and choose options dense with lean protein.

Snacks could consist of one of the following:

• 6 oz yogurt
• Low-fat cheese paired with whole-wheat crackers
• A glass of skim milk served with a toasted low-fat, whole-grain waffle spread with 1 tbsp nut butter

Pick low- or nonfat dairy products, which provide far less fat than whole-milk items and have an equally low glycemic index.

If you don’t eat dairy, you can substitute calcium-fortified plant milk or yogurt.