Diabetic exchange help needed...
- PRSMDave Jan 8, 2002 01:57 PM
So my doctor and dietitian have decreed that I Shall Lose Weight or suffer their increasing scorn and maledictions. The dietitian has put me on a restricted caloried diet using the Diabetic Exchanges.
That's fine, except that I got what's supposed to be the 'complete' list of exchanges, and it seems to be geared toward rural Minnesotans... they even give the exchanges for tuna-noodle hotdish.
What's there is a fine base off of which I can cook a decent breadth of food (last night was Korean-style pepper beef over rice), but the problem is that a lot of ingredients which I consider very common are not on the list, and searching for the exchanges on the 'Net has proved useless.
We're talking about things like fish sauce (for use in nuoc mam and in making pad woon sen), rice paper (we want goi cuon, Vietnamese salad rolls), glass noodles (are they a vegetable or a starch?), lotus root, &c. It's not just Asian ingredient lists that have got stuff missing, but that's where we feel the pinch the most.
Does anyone have or know where I can get a more comprehensive list of these exchanges? I find it really hard to believe that no one has done the exchanges on 'ethnic' food, and it astounds me that a diet that's been around this long is so completely non-portable to non-American cuisine.
I'm hoping the Hounds can help me here...if I have to eat a Subway sandwich or a chicken Caesar salad (with nonfat dressing, of course) for lunch one more day in a row, I may up and lose what's left of my mind.
Let me start by saying I am not a doctor. I am a cook who has and has had over the years diabetic clients. I have not found the source book you are looking for, and I have looked. However, I have read about it and talked to some nutritionists about it and I think a fair amount can be figured out with some food sense (which judjing by your posts, you seem to have).
Like everything in life, balancing is the key to your health. If you question the starch and sugar content of one meal, make your next meal unquestionable. The fish sauce I use has anchovies, salt and water and is a source for sodium only. I'm sure in your exchange manual, there are American items that seem to straddle both veggies and starch, corn, root vegetables, etc. I would imagine lotus root would fall there.
My trouble is I cook for other people and stock their fridge, so I cant always be there to tell them that this meal has more starch, so should be two small meals instead of one big one, or this meal is all protein so eat that one after the higher starch meal. You, however, with your food knowledge and, I imagine, penchant for reading ingredients lists should be able to apply your knowledge to foods that are not in the exchange lists.
One big problem with Asian food is the ubiquitous use of sweeteners and thickeners, both of which are strictly limited on a diabetic diet. However, there are honey's made for diabetics, and purees for thickeners. Maybe you will be the one to write the book.
good luck and good health.
You need to draw up a list of these questions to take to the dietician. My experience with "exchange" diets is that there are certain things you are allowed to exchange, because they are essentially equivalent.
Ask if, ounce per ounce, rice noodles can be substituted for wheat noodles, and if not, why not? Keep in mind that rice paper wrappers are essentially sheets of rice noodle.
Also, fish sauce is basically salt water. It should be possible to exchange it with soy sauce. If they say no, make sure they have some reason (like it is necessary to limit your intake of salt) so it isn't just that they're too lazy to look up on an up-to-date list.
Is there a list of basic foods you have to work with, or only the prepared foods of their choice? Try and get them to give you a recommendation for info and exchange of raw ingredients.
Exchanges are usually intended for people who don't know enough about nutrition to manage their intake intelligently.
(N.B. This is a reply to several people and rather than write multiple responses, I'm writing just one - the Chowhound Productivity Virus kept in check! )
I asked the dietitian about some of the stuff when I got it and she said to look on the Internet, which I suppose is a valid response when you don't know, though a starting point might have been better.
There are a very few "composed dishes" listed on the exchange list, mostly it's raw ingredients. This might irk others more than me, since I'm used to cooking fairly elaborate meals with only a few ingredients per dish.
I have to be honest, ironmom, your comment about the exchanges being for people not intelligent enough to be able to balance their nutrition was a little excessive. What the exchanges purport to do is simplify the math required when adding calories together. I'd much rather be able to separate (ingredients into serving exchanges) and then (serving exchanges into daily menus) than have to do it directly, if I have to count the calories. It makes it easier for me to cook that way. Not all of us took health courses in high school, remember, and when I was in high school, people still believed in 'the four food groups'. Say rather that the vast majority have not kept up with advances in nutrition science and you're much closer to the truth, I suspect.
As for simply increasing exercise - yes, I do plenty of exercise - an hour and a half 5 days a week in the gym and deliberately live in a city where walking is by far the best option (parking being such a nightmare) but then ate more food to feel 'full'. The other problem is that when I am stressed out, I calm down by cooking.
I was just hoping that someone would have the Magic List of Exchanging handy. I guess not :) One of these days I will sit with the calorie-to-exchange conversion charts and make a list of the foods we eat and their exchanges. I'll post it here when I've got somewhere with it :)
Thanks for all your help.
How about exercise (just taking a 3-4 mile daily walk) and moderation in eating? I can see now why foie gras is out!
I forwarded your request to my diabetic chowhound sister. She doesn't do exchanges anymore (since they figured out she was type I not type II), but she's also a health educator. Here's her response:
There's a book called "Exchanges for All
Occasions" that has lists for various
ethnic foods. It's probably available on
Amazon. That's probably the best bet if
the issue is what to do about eating in
For packaged foods and cooking at home,
what I would suggest is that he learn what
each exchange represents (for example, a
starch exchange is 12-15g carbohydrate; a fat
exchange is 5g fat, etc.). Then look at the
nutrition information on the package and
see how many exchanges a portion is. (This
takes practice, but after a while it becomes
pretty easy. I still remember all my exchange
information from 4 years ago.)
[note from me: counting grams seems easier than counting calories -- fewer of them, at least! Also, it really doesn't matter how you categorize your food -- just weigh the noodles and convert the grams to exchanges]
For things that don't have the nutrition
information, there are ways of estimating.
It helps to know that a tablespoon is about
14g, so even the fattiest sauce can't have
more than 14g fat per T. (Even mayonnaise
has only 11g.) If you've got some exotic
vegetable, use the listed exchange for the
most similar vegetable you can find in the
book -- you won't be too far off. Same for
After a while, he should be able to eyeball
his portions. For weight-loss, portion control
doesn't have to be as exact as it does for
re: Ruth Lafler
Please thank your sister for her help - I'm going to gather all the foods that we want to eat and use those grams-per-exchange to figure it out. I'll post here when I'm through.
Fish sauce, by the way (called the dietitian) counts as soy sauce - free in reasonable quantities.
Just a thought...
If you know someone who reads Korean, ask them to search Korean web sites. Maybe Korea has an equivalent of the American Diabetes Association -- and they might have an exchange list.
although i don't have the list you seek either, i do have two very good diabetic cook books that have all kinds of source material in the back and one of them had a recipe for cold rice noodle salad with peanut dressing.
it calls for 12 oz of cellophane noodles and 2 T of chopped peanuts among other things (those being the only starchy). it counts as 3 charbo's, 1 veg and 1 fat. don't know if that helps at all.
they're both from the joslin diabetes center, written by frances t. giedt and bonnie s. polin, ph d- the joslin diabetes quick and easy cookbook, and written by the same authors in opposite order-the joslin diabeytes healthy carbohydrate cookbook. the second seemed to be more ethnically oriented than the first.
hope that's of a little assistance,
You may want to pick up a copy of Barbara Kraus' "Calories and Carbohydrates" and consider counting grams of carbohydrates instead of measuring your intake by counting exchanges. Though it may not cover all the specialty items you consume, you may be able to compare them to similar entries and approximate your numbers accordingly. Also, be sure to check the backs of packages for nutritional data. Unless it's written in a foreign language, it should provide you with the info you need to know. Good luck!!
I just try to be aware of what I am eating, in terms of whether or not it includes any carbos, if so, how much carbos, that is in terms of number of different food items on my plate that are carbos, and how much quantify of each of those items I am going to consume.
It also helps to have an idea of how many grams of carbos per standard portion are in any given food item. I also always read the labels for carbo content before deciding on what I will be preparing for a meal. The real problem I find when reading lables is when portion sizes for the same products from different food processors are not equal. But I can still get a sense of how significant my carbo intake might be. That coupled with the feedback of checking my blood sugar every morning, and then charting it over time, seems to work for me in managing my blood sugar.
I was originally given exchange lists by a dietician, but have not used them in ages. I think you have to figure out, through trial and error, what "management techniques" work the best for you in controlling your diabetes.
Ah, if this is non-medical, I'll chirp in. Follow this very rigorously to lose weight, then follow it in a slightly more relaxed mode to keep it off. Dont bother counting, just follow a few principles. It's key not to deprive yourself of good food, but to concentrate on good foods that are less fattening when made in their best way. A sense of deprivation will destroy your success.
Keep in mind alcoholic drinks add weight; exercise subtracts it.
Note: A diabetic diet won't address chloresterol, so keep sat-fat control in mind, too. If the fat's collecting around your middle, it's probably accumulating in your heart, too.
First, fast or semi-fast a day or two to shrink your stomach (lots of liquids, though). Then, eat a wide variety of foods that are highly nutritious. (When we eat less nutritious foodstuffs our body clamors for more.) Never eat more than a few ounces of any one food. And if you've made it yourself, you know what's in it.
I don't know how much girth has to go. If you are talking 50-60 + overweight, you should have medical and nutritionist advice. But if you are not battling a problem of serious proportions , you should concentrate less on the pounds than on changing the habits that put them there. Simple, abstemious meals can be occasionaly punctuated by ones that include a richer dish.
1. No sugar, sweet syrups, etc. (And the ersatz sweetners don't cut it in my experience.)
2. Cut out anything that has been commercially prepared. I'm convinced that processed foods have appetite stimulants added to them - and too much salt. This of course includes all sorts of snack food other (other than home made pop-corn without butter - experiment with spices).
3. Eat lots of mostly fresh fruit and veggies as close to their natural state as possible. If they must be cooked steaming, grilling, and roasting is best. Also use these to sate any residual hunger and your yen for sweets.
4. Grill, broil, or roast meats, and fish (which can also be poached).
5. Stop buying bread, crackers, and bread products. And when you must, try something like pumpernickel which may have a little more nutrition per calorie than others.
6. Most of us need SOME starchy food, but avoid empty calories: hot whole grain cereals for breakfast such as oatmeal with a little yogurt, some fresh fruit; beans, potatoes (sweets are particularly nutritious).
7. Most of all, for the duration, just give up those dishes that can't be made without lots of fattening ingredients. Find new (to you) foods that are naturally lo-cal or less-cal. Ersatz this or that will not satisfy your taste for the real thing and will probably leave you so hungry that you eat more than you would of the real thing. (I've pretty much given up Corned Beef Specials since they've elimated the fat. They're still pretty fattening but the taste satisfaction has gone.)
8. As for dairy if you must (this is a chlorestoral issue as well as calories): I find yogurt indispensable: it's naturally less fattening than butter, cream, sour cream, etc. and works with either a baked potato (mixed with a lot of garlic & parsley or other herbs of choice) or as dessert with fruits mixed in. I find the Stonyfield 1% acceptable, but even the regular yogurt is less fattening than butter, etc.
If you're a cheese freak, switch to the strong flavored blues, parmesan, or other cheeses that are so strong that a little goes a long way; eat them much less often (maybe once a week, skip meat that day) and in smaller quantities. And the same with eggs.
Personally, I can't give up chocolate. Good luck.