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Published on March 6, 2008

Author: Jacob

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The Exchange Lists or The Exchange System for Meal Planning:  The Exchange Lists or The Exchange System for Meal Planning B. B. Whitmore, RD Department of Food, Nutrition and Consumer Science California State Polytechnic University, Pomona Exchange Lists:  Exchange Lists Diet Planning The US food Exchange System is intended to help people with diabetes control the levels of glucose and lipids in the blood by: Controlling the grams of carbohydrate and fat they consume. And other diet planners have found the system invaluable for achieving calorie control and moderation Weight loss, gain, CVD diets, HD diets, Renal diets, HTN, CVA diets, hyperlipidemia, atherosclerosis Comparison to the Food Guide Pyramid:  Comparison to the Food Guide Pyramid Food Guide Pyramid Sorts foods by their protein, vitamin, and mineral contents Exchange System Sorts foods into three main groups: Carbohydrates Fats Meat and Meat Alternative/Substitutes Each group is then subdivided into several exchange lists of foods Examples of Exchange lists (Exchange System) :  Examples of Exchange lists (Exchange System) Comparisons: F.G.P. and E.L.:  Comparisons: F.G.P. and E.L. The foods on the list Are not always where you expect them to be Are grouped by their energy nutrient contents rather than their source, appearance, or vitamin or mineral contents Examples: Cheese in the high fat meat list instead of the milk list (FGP) Corn, green peas and potatoes are in the starch list instead of vegetable group (FGP) Olives and avocados are in the fat list instead of the vegetable group (FGP) Bacon is in the fat list instead of the meat group (FGP) Comparisons between the Food Guide Pyramid and The Exchange Lists-continued:  Comparisons between the Food Guide Pyramid and The Exchange Lists-continued Portions are not the same as a serving in the FGP. Example: 1 portion or exchange of meat is 1ounce weight instead of 2 to 3 ounces (FGP) Fat has serving sizes in the Exchange Lists, there are no serving sizes in the Food Guide Pyramid Exchange System Portion Sizes::  Exchange System Portion Sizes: All foods in a given list provide the same amounts of energy nutrients, and the same amount of calories. Persons wishing to control intakes of sodium may find the lists helpful for diet planning. High sodium foods show a salt shaker next to the food. Portion sizes are strictly defined, so that each member of the list provides approximately the same amount of energy (calories) E.L. Portion Sizes-continued:  E.L. Portion Sizes-continued Thus any food can be traded or exchanged For any other food on that list without upsetting the balance of the plan or the total calories. The exchange system alerts consumers to: Grain products containing excess fat like biscuits, muffins, granola, and waffles Encourages users to think of: Nonfat milk as milk, and whole milk as milk with added fat Very lean meats as meats and lean, medium-fat, and high fat meats as meat with added fat There is a free foods list which foods may be limited or eaten freely. They are fewer than 20 calories Exchange Group and Lists-Major Nutrient Contents:  Exchange Group and Lists-Major Nutrient Contents Know How to Calculate:  Know How to Calculate You need to know how to do this: To plan diets that are balanced and contain adequate nutrients for patient/clients Diabetics, Dysphagic patients, Dialysis patients, Tube Feedings, Pediatric patients……. To figure out P.O.’s How much a patient is eating (if at all) The percentage of nutrients consumed Use this information to determine What needs to be added to the diet to balance it Or in case it shows up on an interview form (a surprise test for you) for an internship:) Starch List::  Starch List: Contains many of the same foods that are in the Food Guide Pyramid or the Basic Five Food Plans. However.... Beans, peas and lentils are also found in the Meat and Meat Substitute List. Regular potato chips are found in the Other Carbohydrates List. Serving sizes are measured after cooking. Contains 15 grams CHO, 3 grams PRO, 0-1 grams fat, and 80 calories If the starchy food contains fat, count as 1 starch exchange plus 1 fat exchange Examples: Biscuits, chowmein (1/2c), corn bread (2in. cube), granola (1/4c), popcorn (3c) stuffing (1/3c) Fruit List:  Fruit List Includes fresh, dried, juices, frozen and canned Labels need to be read. If a fruit contains more than 15 grams of CHO, adjustments are necessary Fresh, frozen and dried fruits have 2 grams of fiber per serving. Whole fruit is preferable to juices Juice have concentrated CHO, and less fiber Choose fruit canned in extra light syrup and ones with no sugar added. Variety is also important, and should be stressed to maximize vitamin, mineral and phyto-nutrient intake Fruit List:  Fruit List One fruit exchange equals 15 grams CHO and 60 calories Examples of some of the exchanges: 1 small apple, orange, banana, kiwi medium peach canned fruit (½ cup) juice (½-1/3 cup-depending on the type) Milk List:  Milk List Includes different types of milk and milk products. Cheese belongs to Meat List, cream in the Fat List Chocolate milk, frozen yogurt, and ice cream belong on the Other Carbohydrate List Non-dairy creamers are on the Free Foods List (with serving sizes) Rice milk is on Starch List, soy milk is on the Medium-fat Meat List. Milk is Based on the Amount of Fat Contained:  Milk is Based on the Amount of Fat Contained Milk Exchanges-continued:  Milk Exchanges-continued Milk and yogurt are good sources of calcium. The more fat in a milk, the higher the saturated fat content. Encourage lower fat varieties If patient/client is lactose intolerant, inform them about lactose reduced, or lactose free milks 1 cup is equal to 8 fluid ounces or ½ pint Contains 12 grams of CHO, 8 grams of PRO. Examples: All beverage milks are 1 cup, evaporated or condensed is ½ cup, NFDM is 1/3 cup dry, non-fat, plain, yogurt is ¾ cup, non-fat or low fat fruit yogurt is 1 cup. Other Carbohydrate List:  Other Carbohydrate List The food choices from this list may be substituted for a starch, fruit or milk choice They are not as nutrient dense as the other carbohydrates The portions are small because that food may contain concentrated sources of CHO/and or fat. Fat-free or reduced fat products contain extra carbohydrate and need to be counted. Fat free salad dressing are included here in large amounts, smaller amounts may be on the Free List One exchange equals 15 grams of CHO, or 1 Starch, or 1 Fruit, or 1 Milk Other Carbohydrates:  Other Carbohydrates Vegetable List:  Vegetable List Vegetables contain small amounts of CHO. Encourage 2 or 3 vegetable choices each day 1 Vegetable Exchange is ½ cup cooked vegetables or vegetable juice 1 cup of raw vegetables Fresh and frozen vegetables have less salt than canned or processed. Rinsing vegetables may reduce salt content but will also rinse off the water soluble vitamins Vegetable List-continued:  Vegetable List-continued Encourage patient to choose more dark green and dark yellow vegetables More color, more nutrient dense Vegetables contain 1-2 grams of fiber per serving. Spaghetti sauce belongs on the Other Carbohydrate List Vegetables such as corn, peas, winter squash and potatoes are on the Starch List. One Vegetable Exchange is 5 grams of CHO, 2 grams PRO, and 25 calories Examples of vegetables: Artichoke, asparagus, beets, broccoli, cabbage, eggplant, okra, onions, peas in pods Meat and Meat Substitutes List:  Meat and Meat Substitutes List One exchanges is 1 oz meat, fish, poultry or cheese or ½ cup beans, peas, and lentils Based on fat content, are divided into very-lean, lean, medium-fat and high-fat lists Encourage very lean and lean meat choices whenever possible. High fat meats contain saturated fat and cholesterol Can raise blood cholesterol levels. Beans, peas, and lentils are good sources of fiber. Meat does not contain fiber. Some processed meat may contain carbohydrate. If levels of carbohydrate exceed 15 grams, count it as a CHO choice as well as a meat choice. Meat and Meat Substitutes List Nutrient Content:  Meat and Meat Substitutes List Nutrient Content Meat and Meat Substitutes List:  Meat and Meat Substitutes List Be familiar with some approximate measures: 1 ounce of cheese is the size of a 1inch cube 1 ounce of meat is about the size of a thin-sliced luncheon deli meat 2 ounces of meat is 1 small chicken leg or thigh or ½ cup cottage cheese or tuna 3 ounces meat is about the size of a deck of cards, or 1 medium pork chop, 1 small hamburger patty, ½ of a whole chicken breast Meat and Meat Substitutes List:  Meat and Meat Substitutes List Have patient/client limit choices from high-fat group to 3 times per week or less Select grades are leanest meat. Hamburger meat usually contains spices and added fat. Choose meat that contains 5 grams of fat or less per serving. Dried peas, beans and lentils are also found on the Starch List Peanut butter is found in the Fat List as well as the High-fat Meat List Bacon is also found in the Fat List as well as the High-fat Meat List Peanut butter and bacon in small amounts are counted as Fats, larger amounts are High-fat Meats Fat List :  Fat List Fats are divided into 3 groups-based on the type of fat they contain: Monounsaturated Polyunsaturated Saturated. Small amounts of MUFA and PUFA are linked to health benefits, while saturated fat is linked with heart disease/other health problems. Generally, one fat exchange is 1 teaspoon of regular margarine or vegetable oil, or one tablespoon of regular salad dressing. One fat exchange is 5 grams of fat and 45 calories Fat List:  Fat List Encourage patient/client to select margarine with oil as the first ingredient Soft margarine contain more PUFA or MUFA than saturated. Partially hydrogenated or hydrogenated fats should be avoided.Low fat margarine contain water and it may be the first ingredient with liquid oil being the second ingredient Peanut butter and bacon in small amounts are counted as Fats, larger amounts are High-fat Meats Fat-free salad dressing are on the Other Carbohydrate List and the Free-Food List Most fat-free products are on the Free Foods List. Fat List:  Fat List Free Foods List:  Free Foods List A free food is less than 20 calories Or less than 5 grams of carbohydrate per serving. Portions should be spread out during the day. Foods eaten with a serving size should be limited to 3 servings per day Foods without a serving size can be eaten as often as the person wants. Free Foods List-Examples:  Free Foods List-Examples Breaking Down Commonly Eaten Combination Foods::  Breaking Down Commonly Eaten Combination Foods: Combination Foods:  Combination Foods Must be broken down into single foods Most fast food/restaurants have combination foods Educate client/patient to break apart food combinations into single groups CHO Fat Meats Then into single foods Short Quiz:  Short Quiz How would you figure out the exchanges for a typical fast food lunch? 1 Regular Hamburger-plain 1 order Regular Fries 1 Large diet soda 1 Soft-serve cone Fast Food Breakdown:  Fast Food Breakdown Regular Hamburger 2 CHO, 2 medium-fat meats Regular Fries 2 CHO, 2 fats Large diet soda Free food list Soft-serve cone -2 CHO, 1 fat Total = 6 CHO, 3 fats, 2 medium fat meats Grand calorie total = 6(80)+3(45)+2(75)= ? One More Quiz??? Italian Restaurant Style:  One More Quiz??? Italian Restaurant Style Mixed Green Salad (1 cup) with Italian fat free dressing, (1/8 cup) Minestrone Soup (1 cup) 2 rolls (small) Cheese pizza (1/2 of a 10 in. pizza, thin crust) Fruit pie with a scoop of ice cream (1/6 of an 8 in. pie; 1/2 cup of ice cream) Decaffeinated coffee Answers to Quiz:  Answers to Quiz Salad 1 VEG, Italian fat free dressing, (1/8 cup)= 2 tablespoon= Free List Minestrone Soup Most likely 2 CHO (with oil add 1 fat) 2 rolls 2 CHO Cheese pizza (1/2 of a 10 in. pizza, thin crust) 4 CHO, 4 medium-fat meats, 2 fats Pie and ice cream 3 CHO, 2 fats; and 2 CHO, 2 fats Decaffeinated coffee-Free list Success of the Plan:  Success of the Plan The users must be educated as to portion sizes. Teach them a typical member (item) from each list. The users must know how to separate mixtures of foods such as pizza, casseroles and soups The users need to interpret food labels while using the exchange system If user knows that foods on the Starch list con-tain 15g of CHO, and the Vegetable provide 5; Can interpret the label perhaps on a lasagna dinner that lists 37 grams of carbohydrates as 2 starches (mostly noodles) and 1 vegetable as the tomato sauce Teach people to use their own plan to create a menu.. :  Teach people to use their own plan to create a menu.. Example: Breakfast plan calls for 2 starches 1 fruit and 1 nonfat milk. Select 1 bowl of shredded wheat with banana slices, 1 cup of non-fat milk or a bagel and a bowl of melon (1/3 melon) topped with non-fat yogurt. If they wanted butter on the bagel, “steal one fat from lunch”. If they want pancakes with strawberries and milk, they could “take 2 fat exchanges from lunch or dinner”. Tailor education to each individual’s learning potential. May take many counciling sessions. Diet Patterns for Different Energy Intakes :  Diet Patterns for Different Energy Intakes One example of the ADA2000 Calories Meal Pattern (A Hospital Plan) (2000 calories with milk and three nourishments) :  One example of the ADA2000 Calories Meal Pattern (A Hospital Plan) (2000 calories with milk and three nourishments) One example of the 2100 Calories Meal Pattern (A Hospital Plan) (2100 calories with milk and two nourishments) :  One example of the 2100 Calories Meal Pattern (A Hospital Plan) (2100 calories with milk and two nourishments) Quiz Again????:  Quiz Again???? You have a Physician Diet Order (PDO) for a Diet Education (DE) and a ADA1800 diet for a newly diagnosed Type II Diabetic. The Diet Tech has already interviewed patient/client and has found that he likes to eat: A small breakfast Donut or bagel with cream cheese and coffee Snack at 10:00 am Bag of chips or candy bar A fast food lunch (biggie size) Large Dinner-Mexican or Italian food Plan a hospital type diet for this patient or client into his normal meal plan Variation on a Quiz:  Variation on a Quiz The Physician Diet Order (PDO) for the diet you just completed has just been changed. Due to some renal complications, patient now is on a 60 gram PROTEIN, ADA1800 diet, low sodium and low phosphorous. Calculate protein grams and arrange diet so that it conforms to the above order. Remember that protein is found in the Meat, CHO, Other CHO and Milk Lists. Where is phosphorous found? 1800ADA Diet:  1800ADA Diet How to do this::  How to do this: Look up ADA1800 Plan Or calculate yourself Estimate amts. of exchanges for each meal Based on patient/client’s own meal patterns Have patient check blood glucose to make sure diet is not interfering with control If it is, adjust as necessary May need to decrease dinner servings and add PM (HS) snack May need to decrease CHO servings Variations on a Food Exchange Theme::  Variations on a Food Exchange Theme: Combining Food Guide Pyramid Plan with the Exchange Lists Helps choose foods that provide all nutrients Promotes adequacy, balance and variety Exchange system uses calorie control and moderation Listas de Intercambios para Planes de Alimentacion Great tool for educating Spanish speaking persons Pictures depict commonly eaten Hispanic food choices For More Information on Exchange Lists :  For More Information on Exchange Lists Contact American Diabetes Association for a copy of the Exchange Lists for Meal Planning 1 (800) 232-3472 Or if you are an American Dietetic Association Member, contact 1(800) 366-1655 (Less expensive if you are an RD.)

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