Updated 15 February 2017

Diabetes and diet – food exchange lists

What are food exchange lists for diabetes?

In this article, the dietician, Dr Ingrid van Heerden, discusses one of the most important concepts which is used to work out diabetic diets, namely the Food Exchange Lists.

What are Food Exchange Lists?

Food Exchange Lists are groups of foods which have been classified together because they have certain common characteristics. For example, the Milk Exchange List contains all foods that either contain milk or are derived from milk, such as yoghurt.

In adddition all foods in the so-called ‘full-cream’ milk category contain 12g of carbohydrate, 8g of protein and 8g of fat. If a ‘low-fat’ milk exchange is used, the carbohydrate and protein contents stay the same, but the fat content drops from 8g to 5g per serving. Taken one step further, a fat-free milk exchange would contain no fat, but still provide the same amount of carbohydrate and protein.

The Six Food Exchange Lists

The Six Food Exchange Lists are as follows:

  • Milk (which is divided into full-cream, low-fat, and fat-free subcategories)
  • Meat (which is also divided into high-fat, standard meat, and lean meat subcategories)
  • Bread (which also includes cereals)
  • A-vegetables and B-vegetables
  • Fruit
  • Fat

The idea is that each food in the specific exchange list can be swopped for one of the other items in the same list. For example, half a cup of low-fat milk and half a cup of low-fat yoghurt are interchangeable with each other.

What do these Food Exchange Lists contribute to the diet?

Each one of the food lists makes a specific contribution to the daily diet and it is important to remember that no ONE exchange category can supply all the nutrients needed for a well-balanced diet.

Everyone, including diabetics, needs to eat foods from all six exchange lists every day to make sure that their diets are balanced and that they remain healthy.

These are the foods included in the six Food Exchange Lists and what each category contributes to the diet:

Milk List - milk, yoghurt, buttermilk - supply calcium, phosphorus, potassium, zinc, iodine, magnesium, selenium, B vitamins (particularly vitamin B2 or riboflavin), vitamin D, high-quality protein, carbohydrate, fat.

Meat List - fish, seafood, poultry, red meat, eggs, dry peas, beans, lentils, nuts, seeds, peanut butter, cheese - supply high quality protein, fat, B vitamins (B1, B2, B6, folic acid, niacin, and particularly B12), vitamins A and D, readily available iron and other minerals, essential fatty acids such as Omega-3, which is found in fish and Omega-3 enriched eggs.

Bread List - cereals, porridges, rice, maize meal, pasta, corn on the cob - supply dietary fibre, complex carbohydrates, B vitamins, vitamin E, minerals and trace elements such as chromium, phosphorus, potassium, iron, magnesium, zinc, copper and selenium, plant protein.

A & B Vegetable List - all fresh, frozen and dried vegetables - supply dietary fibre, carbohydrates, plant protein, vitamin C, beta-carotenes, bioflavonoids and other antioxidants, vitamins A and E, folic acid, biotin, calcium, iron, iodine, magnesium, potassium.

Fruit List - all fresh, frozen, and dried fruit, and all fruit juices - supply dietary fibre, carbohydrates, vitamins A, C and E, beta-carotenes, bioflavonoids, antioxidants, potassium, manganese.

Fat list - oil, margarine, salad dressings - supply poly- and monounsaturated fatty acids, vitamin E, essential fatty acids such as Omega-6.

Consult a dietitian

If you are diabetic you need to consult a clinical dietitian who will help you to work out a balanced diet that includes foods from each of these Exchange Lists. By sticking to your diet, doing regular exercise and taking your medication (oral tablets or insulin injections), you will be able to control your blood glucose levels, and your weight. A well balanced diet which is tuned to your needs, will ensure that you feel well and stay healthy.

What about non-diabetics?

Food Exchange Lists can also be used by people of all ages to select a healthy, balanced diet. Basically, the rules for using the Food Exchange Lists, if you are a healthy adult, are as follows:

Eat every day:

2 Milk Exchanges, preferably using the Low- or Fat free categories
2 Meat Exchanges, concentrating on lean meat, chicken and fish, legumes and Omega-3 enriched eggs
4 or more Bread Exchanges, selecting from unprocessed or wholewheat varieties
2-3 Vegetable Exchanges, preferably raw or lightly cooked
2-3 Fruit Exchanges, preferably raw and unpeeled
3 Fat Exchanges, concentrating on poly- or monounsaturated versions

The use of Food Exchange Lists is a simple and effective way of ensuring that you eat a healthy, balanced diet.


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Dr. May currently works as a fulltime endocrinologist and has been in private practice since 2004. He has a variety of interests, predominantly obesity and diabetes, but also sees patients with osteoporosis, thyroid disorders, men's health disorders, pituitary and adrenal disorders, polycystic ovaries, and disorders of growth. He is a leading member of several obesity and diabetes societies and runs a trial centre for new drugs.

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