The idea behind the exchange system is that every item within a given category is nutritionally equivalent to every other item on that same list--providing roughly the same amount of carbohydrate, fat, protein, and calories. Using the portion sizes laid out on the lists is important for making the system work. But the big advantage is that--as with carbohydrate counting--you have a lot of flexibility in choosing foods within each category, as long as they add up to the nutritional budget allowed in your meal plan. Fortunately, portion sizes for many of the groups tend to be similar, which helps give you an intuitive grasp of how much you should eat.
- One bread/starch exchange, for example, is usually measured in slices or half cups (as are many vegetable exchanges).
- One meat exchange is generally about one ounce--much smaller, by the way, than the two to three ounces that constitute a serving in the familiar USDA food pyramid.
Like the food pyramid, the exchange system strives to give you a range of nutrients from a variety of foods, but it does so with greater precision. Still, using the exchange system requires guidance. Your dietitian can help you figure out how many exchanges from each group you should eat.
The groupings themselves may take some getting used to because they're organized by calorie and nutrient content rather than source. Cheeses, for instance, are listed with meats rather than milk because their protein and fat makeup are more similar. Corn, green peas, and potatoes appear with starches rather than vegetables because of their high carbohydrate content. Once you're familiar with the system, however, its combination of flexibility and consistency can help you keep blood sugar down while providing enough nutrients.
A dietician can help you create a food-exchange system that suits your needs.
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