American Dietetic Assn. Revises ‘Exchange Lists’ for Diabetics

For the first time in a decade, the “exchange lists” used for the past 36 years by diabetics as an aid to control their specialized diets have been revised. The American Dietetic Assn. announced the new revisions at its annual meeting in Las Vegas last week. Dietitians predict the changes will please not only diabetics but thousands of dieters and other nutrition-conscious people.

The exchange system, first established by the American Diabetic Assn. and the American Dietetic Assn., simply places similar foods in the same category and lists portion sizes so that diabetic or other users could “trade off” foods within the same food groups or categories.

The latest revisions reflect a more positive upbeat attitude of healthful eating rather than restrictive dieting. Gone are the lists of forbidden foods and “no-no’s.” In fact, the phrase “don’t eat” doesn’t even appear in the revised text.

Separate Poster

These new lists have been issued in the form of a booklet that includes a separate poster, “Healthy Food Choices,” that attractively presents the revised guidelines for diabetics and the general population.

“If you have to control your diet because of illness such as diabetes or heart disease, if you want to lose weight, or if you simply want to eat healthfully, this is a good way to plan your meals,” said Marion J. Franz, a registered dietitian and chairman of the joint committee that revised the list.

The new “Exchange Lists for Meal Planning,” a joint publication of the American Dietetic Assn. and the American Diabetic Assn., not only has a contemporary “new look” but also allows greater food variety than the previous lists for those who need to control their weight and calorie intake.

This widely used list, which also has been the basis for programs such as Weight Watchers International Inc., has changed in the following ways:

-- It increases the percentage of carbohydrate foods like whole grains, starches, fruits and vegetables to 50% to 60% of the total calories in the diet, up from 40% to 50%, putting this Starch/Bread List in the No. 1 position in the lineup of the six food group categories.

-- The publication recommends that Americans at least double their fiber intake from the current average of 10 to 15 grams a day to 30 to 40 grams a day. “Fiber in foods may help to lower blood glucose and blood fat levels,” the booklet says. Higher fiber foods are marked with a green symbol in the revised lists. (High-fiber food choices include fresh fruit instead of juice and whole-grain bread and cereals.)

-- The new list lowers the amount of calories from fat to 30% rather than 35% of total calories. In addition to limiting amounts of salad dressing, nuts and margarine, as the booklet suggests, Franz pointed out that one of the easiest ways to lower fat intake is to reduce the portion size of all protein foods. (Larger servings of protein usually mean more fat since there is some fat even in the leanest of protein foods. In a four-ounce serving of sole there are about 220 calories, 108 of these from fat. In an equal portion of chicken breast with skin there are about 300 calories, 180 from fat.) From the High Fat Meat Category, four ounces of Cheddar cheese have about 400 calories, of which 288 calories are fat. Foods low in fat content or high in polyunsaturated fat are in bold type for emphasis.

-- High-sodium foods such as processed and convenience foods, cheeses and salad dressings are now marked with a red symbol. This will make identification easier for those who want to follow the recommendation that sodium intake should be between 1,000 and 3,000 milligrams per day, according to Franz.

-- Desserts and casseroles are added to the new lists to add some pizazz to meal planning. Food favorites like granola bars, cookies and frozen fruit yogurt are no longer forbidden but are now permitted in the Foods for Occasional Use List. Another new list, Combination Foods, permits other favorites like pizza, chow mein and homemade casseroles.

Although the booklet recommends that alcohol be avoided altogether, it suggests those who want to include alcohol in their diets should consult a registered dietitian for advice. Franz, for instance, said an occasional drink of one to two ounces of alcohol two to three times per week is considered acceptable for most healthy people, according to the revised guidelines.

-- Another new addition to the booklet is a fold-out page of management goals, which includes a section for reporting daily body weight.

It is the hope of the American Diabetic Assn. and the American Dietetic Assn. that the new revisions will make it easier not only for the diabetic but the general population to adhere to a long-term healthful eating plan by allowing more flexibility and variety.

Franz said the committee responsible for the revisions was extremely pleased with the finished product, and the “exchange lists” were an educational tool that will help diabetics and the general population make positive, realistic changes in their life style in small, attainable steps.

To order a copy of the “Exchange Lists for Meal Planning,” and the poster “Healthy Food Choices,” send a check or money order for $1.25 plus 50 cents shipping and handling to: The American Dietetic Assn., 430 N. Michigan Ave., Chicago, Ill. 60611, or the American Diabetes Assn., 1660 Duke St., Alexandria, Va. 22314.