The Diabetic Food Exchange System Is Not a Weight-Loss Plan

Recent­ly, I saw that a friend of mine had post­ed on her refrig­er­a­tor a sim­pli­fied list of food exchanges for dia­bet­ics. She does not have dia­betes, so I asked her why she would need that list. She said that she wants to lose weight. I tried to explain that the exchange sys­tem is not a weight-loss plan. Its pur­pose is to help peo­ple with type 1 dia­betes (insulin-depen­dent dia­betes) fig­ure out how much insulin to inject. And it does not do a par­tic­u­lar­ly good job at that. She said that she was using the list to help her count calo­ries.

I tried to explain that count­ing calo­ries is not an effec­tive way to lose weight. She looked at me as if I’m nuts. She believes that she knows far more about dietet­ics and weight con­trol than I do. After all, she has been diet­ing for years because of her stub­born weight prob­lem. She there­fore has years of expe­ri­ence in count­ing calo­ries and esti­mat­ing por­tion sizes. She’ll diet and lose a few pounds, then gain them right back. I have no per­son­al expe­ri­ence with diet­ing. Because I have eat­en a low-fat, high-fiber, starchy diet all of my adult life, I have nev­er been over­weight. I just eat grains and beans and veg­eta­bles and fruit until I feel full.

The dia­bet­ic exchange sys­tem is an approach to meal plan­ning. It was intro­duced in 1950 by the Amer­i­can Dia­betes Asso­ci­a­tion and the U.S. Pub­lic Health Ser­vice. It has been revised sev­er­al times since then. The pur­pose of the exchange sys­tem is to help peo­ple with type 1 dia­betes esti­mate how much car­bo­hy­drate (sug­ar and starch) is in a meal. Once they know that, they can fig­ure out how much insulin they will need to keep their blood sug­ar from going too high or too low after they eat the meal.

Before the exchange sys­tem was intro­duced, peo­ple with type 1 dia­betes often end­ed up eat­ing a strict, bor­ing diet. To keep their blood sug­ar sta­ble, they often ate the same amount of the same foods day after day. The exchange sys­tem made it easy for them to add vari­ety to their diet. For exam­ple, it tells them that a slice of bread has the same car­bo­hy­drate con­tent as a 6-inch tor­tilla or a third of a cup of rice. In oth­er words, the per­son with type 1 dia­betes could exchange a slice of bread for the tor­tilla or the rice. Of course, non­di­a­bet­ic peo­ple would not need to count carbs or wor­ry about exchang­ing one car­bo­hy­drate source for anoth­er. Their pan­creas auto­mat­i­cal­ly makes as much insulin as they need.

Some mod­ern experts on dia­betes do not rec­om­mend the exchange sys­tem, not even for dia­bet­ics. One prob­lem with the dia­bet­ic exchange sys­tem is that it includes many foods that are not good for human beings in gen­er­al and that are par­tic­u­lar­ly bad for human beings with dia­betes. For exam­ple, the exchange sys­tem includes lists of meats, dairy foods, eggs, and fish, as well as lists of fats and processed junk foods. Ani­mal-source foods are fat­ten­ing because they con­tain lots of fat but no fiber or starch. Ani­mal-source foods also con­tain cho­les­terol. The fat and cho­les­terol can clog the arter­ies, lead­ing to heart attacks and stroke, par­tic­u­lar­ly in peo­ple with dia­betes. Ani­mal-source foods also con­tain way too much pro­tein. An over­load of pro­tein is bad for the kid­neys, which are already stressed by the dia­betes. Heav­i­ly processed “junk” foods also con­tain too much fat or con­cen­trat­ed sug­ar and lit­tle or no fiber.

Anoth­er prob­lem with the dia­bet­ic exchange sys­tem is that fat intake and exer­cise lev­els also affect insulin require­ments. For this rea­son, Dr. John McDougall dis­cour­ages his dia­bet­ic patients from using the exchange lists or count­ing carbs. Instead, he encour­ages them to eat a con­sis­tent­ly high-car­bo­hy­drate, low-fat diet, to boost their insulin sen­si­tiv­i­ty.


Insulin dos­es are then based on their recent require­ments and their activ­i­ty lev­els. (Exer­cise is some­times called the invis­i­ble insulin because it decreas­es blood sug­ar lev­els.)


Sci­en­tists have known since the 1920s that high-car­bo­hy­drate, low-fat diets are good for peo­ple with dia­betes. Yes, starchy and sug­ary foods do deliv­er a lot of sug­ar (glu­cose) to the blood­stream. But a low-fat diet also makes the body much more sen­si­tive to insulin, whether the insulin is being inject­ed or being pro­duced nat­u­ral­ly by the pan­creas.

In the 1940s, Dr. Wal­ter Kemp­n­er of Duke Uni­ver­si­ty had astound­ing suc­cess in using a diet based on noth­ing but rice, fruit, and fruit juice for patients with type 1 or type 2 dia­betes. When patients lost too much weight on that low-fat diet, Kemp­n­er told them to add some pure sug­ar to their diet. The patients who fol­lowed Kempner’s “rice diet” got bet­ter con­trol of their blood sug­ar. The patients with type 2 dia­betes became undi­a­bet­ic. Even the patients with type 1 dia­betes need­ed small­er dos­es of insulin. The patients’ over­all health also improved. Their blood pres­sure came down. Their eyes, heart, kid­neys, and feet were health­i­er.

The exchange lists might be use­ful for peo­ple with type 1 dia­betes, as long as they eat only from the lists of low-fat, plant-based foods. How­ev­er, the exchange lists are not use­ful for weight loss, not even for dia­bet­ics. My non­di­a­bet­ic friend was using the dia­bet­ic exchanges as a way to count calo­ries. Yet calo­rie count­ing and por­tion con­trol do not work well for weight con­trol, which is why my friend remains over­weight despite her repeat­ed attempts at diet­ing. The rea­son is sim­ple: calo­rie count­ing and por­tion con­trol are unnat­ur­al acts.

Wild ani­mals nev­er count calo­ries. They nev­er lim­it their por­tions. Nor do they ever sign up for step aer­o­bics. Wild ani­mals stay slim, even when they are sur­round­ed on all sides by their favorite food, because they eat the kind of food that is right for them. It has the right calo­rie den­si­ty: the right num­ber of calo­ries per pound of food. If they need more calo­ries, their appetite will nat­u­ral­ly lead them to eat more food. Once they meet their need for calo­ries, they stop feel­ing hun­gry. As a result, they eat just enough food to main­tain a healthy weight.


If you are over­weight, chances are that the prob­lem is not your metab­o­lism or a lack of will-pow­er. You are sim­ply eat­ing foods that are too rich. Rich foods pro­vide too many calo­ries per pound of food. As a result, you may have to overeat to feel full. If you stop eat­ing rich, fat­ty foods and instead base your diet on unre­fined starch­es and veg­eta­bles, your appetite will be sat­is­fied by a rea­son­able amount of food. As a result, your weight will nor­mal­ize itself, even if you eat enough food to feel full.

Behind Barbed Wire_PrintNote: For more infor­ma­tion about how insulin works, and how diet affects body weight and blood sug­ar lev­els, see my book Thin Dia­betes, Fat Dia­betes: Pre­vent Type 1, Cure Type 2.

Leave a Reply

Your email address will not be published. Required fields are marked *