welcome in this presentation I'm going to be covering the exchange system so I'll describe to you what the exchange system is I'll talk about why and when it was originated and then how we will use it in our course we'll also be going through some practice problems so this will be a good time to make sure you have a calculator and this food list for diabetes book ready to go before we get into that topic I did want to let me pull up my slide here I did want to do a short quiz here we go sorry for all the clicking back and forth here let me pull up my questions I'd like you to take just a few seconds and go through these for yourself and indicate whether you think it's a true or false statement we'll then go over them together okay so the first one what do you think this is actually a very true statement we can have foods that are both nutrient and energy dense something like nuts or seeds or avocados whereas other Foods tend to just be energy dense or nutrient dense so all in all we can have foods that fit into both categories the amdrs these provided recommendations for macronutrients so not vitamins or minerals instead these are the acceptable macronutrient distribution ranges and these were the values of 45 to 65% carbs 10 to 35% protein and 20 to 35% fat number three this is false a food must have less than half a gram of fat per serving this can unfortunately add up with certain types of fats so C be cautious of fat free we'll still want to look at the actual label ingredients number four this is another false statement the FDA does regulate the health claims not the structure function claims and then the fifth one is also false the RDA values are designed to meet 97 to 98% of a population's needs all right so now we're ready to go on to The Exchange system so here we are you might consider pausing me and going through the book yourself just flipping through and getting oriented to it or if you've already done so then we'll move on all right the exchange system is basically a way to categorize Foods we know that there are certain commonalities when we look out at foods and we can put them in categories based on in our case the macronutrients so what we're saying in essence is any exchange of a carbohydrate for example could be 10 pretzels could be two slices of bread could be one cup of rice and in general if we get the serving sizes just right those foods are interchangeable in terms of their grams of carbohydrates proteins and fats okay so we're combining foods that are similar based on their macros it is an excellent planning tool for healthy eating we saw this originate back in the 1960s and70s when we started seeing a higher incidents of diabetes in our population and the premise with diabetes is we're really trying to maintain blood sugar so ensuring that we're eating consistent carbohydrates and whole grain carbohydrates is ideal so the book itself was designed on the on this basis of carbohydrate counting and then taking it a step further to help individuals to manage their blood sugars we now know this can be a healthy way for anybody to eat for you and I with or without diabetes uh so I hope that you'll enjoy learning the tips today and then finally the book is a great resource every time I look through it I find something interesting and new that I hadn't seen before so I do recommend to keep this booklet after you finish the course all right so I recommend to go ahead and get your books open and turn to page nine page nine should look a little something like this this is a great page to put a Post-It note in or mark it or Star it and this summarizes all of the numbers that you would need to use on doing any of your math problems so you'll see these listed out in the book itself next to lists of foods but I find it almost easier just to ignore that and then come back here when I'm doing my math and I promise I'll walk you through all of that here shortly so let's just take a brief look here we have carbohydrates at the top and you'll see that they've grouped about five different types of foods into the carbohydrates so we have plain starches then we have fruits milks non-starchy veggies so what we're saying here these foods are going to be listed as a carbohydrate because they tend to have more carbs than the other two nutrients within the carbohydrate group though starches often go together fruits go together and such so that's why you see it broken down a little bit further so when you actually get into the book uh you'll see many serving sizes of foods listed for example 1/4 of a bagel or one slice of bread and what that will be telling you is this is one serving or one exchange excuse me of a starch and then let's say we eat two servings or slices of that bread then we know that okay one slice is roughly 15 gram of carbs three protein one fat I eat two I'll have to double those numbers so again that will kind of come together for you whenever you see uh the serving sizes looking down here at milks uh the big difference here is certain types of milk products have more fat than others so the fat and the calories will vary but we can break down Foods into fat free reduce or whole non-starchy veggies they have a bit of protein which is unique to them so they're in their own group and then sweets under proteins we have no carbohydrates and we we know that right with meats and fish there's no carbohydrates present in those foods but they do contain protein so we group them based on their protein amount depending on fat they'll have differing amounts of fat which will then affect the calories all right by no means do you need to memorize this uh this is something you'll be able to use on your uh worksheets that you go through and even on the exam I will have this embedded into the uh software program okay so let's go through the book now and this will be flipping the page on to page 11 uh page 11 introduces you to the big star group and then the remaining pages are going to be basically dividing them out even further so we know that bread based products will all be relatively similar while serials are similar and such so as you flip through these Pages where we have bread grains crackers the serving sizes that you see listed let's say 20 oyster crackers that is going to be equivalent to one starch exchange okay so you don't need to remember there 20 crackers anymore you'll just see it from your practice problems on as one starch uh another example is the popcorn on the same page three cups of popcorn that is the serving size listed so three cups is a equivalent to about one starch which is the 15 G carbs three protein one fat 80 calories all right so that's how the book is broken down uh to give us more of these whole numbers if we were going back to someone with diabetes we might tell them you can have two starches with your breakfast so they would then go through these lists and pick and choose what they wanted so maybe it would be 16 animal crackers we'll know that one serving of that eight crackers is one star so if they ate 16 animal crackers that's going to be two total starches okay so a little bit of math and going back and forth but I think once you get the hang of working with the problems it'll it'll click for you so here are just some of the ones I chose to include on the slide these are straight from the book uh flipping on we have fruits so fruits are listed more on just a few pages and they'll give you ideas for whole fruits as well as fruits that you eat many of so the grapes or if you had uh raisins or something along those lines so as you're looking on those lists the portion size will be the or the serving size as they label it in here you'll want to look at that so the first one there one small apple we're going to be able to say that as one fruit Exchange if I ate two small apples I would have consumed two fruit exchanges all right so moving on I'm going to overview the milks in this category we have the varying amounts of fat in milk hence the differences and I listed a few here it looks like from page 26 where we've got the milk group and the milk substitutes it is worth noting that milks like almond or coconut may not even have a substantial amount of protein so whenever you're looking at the choices pres serving you might see that they're listed as one carb and they don't actually have additional protein in it next in the book we have non-starchy veggies uh these are rather easy to remember they're pretty much any non-starchy vegetable which those are listed on page 30 uh yeah page 30 in your book and what's easy to remember is one cup raw or half a cup cooked that is equivalent to one vegetable exchange and that makes sense right if you had one cook one cup of carrots and you cooked them down they were raw to begin with now they're cooked down they'll likely make about half of a cup cooked okay so the big theme there is paying attention to is the food cooked or is it raw the next section is the protein section so I've recreated the the segment here of the table uh some great tips on healthy eating with protein and then they get into these four categories or lists so they'll have lean all the way up to high fat and then plant-based proteins as well as you're looking through the pages and I'm on page 34 35 here you'll see numbers like 1 o or two slices or something pretty small that's okay we are not taking these as an actual amount we would consume for a meal we're just using these as overall factors to consider when we're planting macronutrients okay and what I mean by that is one could eat 6 ounces of steak fairly easily not the 1 o listed here so again these are just going to show you the values in terms of the numbers and the calculations an actual amount of what someone might eat might actually be five starches seven lean meats for a meal the last group is the fat group they've broken it down into their health uh Health segments if you will so healthy fats and then not so healthy fats but um we don't we'll learn those in a few weeks so for now you can just refer to the the group as a ho and you'll see some pretty small amounts here so with something like a mayonnaise one teaspoon is considered one fat so if we have three teaspoons of mayo then we need to remember that that is actually three fat exchanges and that's where the calories and grams of fat can add up okay all right we've just got a few more to go through and then we'll get into those practice problems skipping ahead a bit here I wanted to combine this with the carbohydrates as these tend to be carbohydrate foods and then we'll talk about combination Foods so just a few minutes ago I discussed carbohydrates uh the foods in these lists tend to be heavy in carbs mainly sugar and not protein or any substantial amount of protein okay so basically sugary items and you'll seea foods like Jello-O puddings soda is on on these list as well very concentrated sweet Foods a couple of the examples I listed um you can you can see there so most of the time we would be consuming well I tried to do the math in my head there but quite a bit of sugar whenever it comes to something like that regular soda so if we're looking at 2 and 1/2 carbs or 2 and a half starches then we're getting close to over 200 calories with this all right so you can look through those next up are the combinations and these are back on page 44 so in page 44 on whoops they've got some different examples of styles of food and how much one well how much one consumes in relation to what those exchanges are so here are some of the ones that I picked out in our case and you see it at the bottom of the slide we're going to count a carbohydrate when they listed as a carb in the book the same as a starch so the very first one you learned the 15 gr of carbs three protein one fat that's what we're going to refer to as carbohydrate finally we have free foods these are going to be very low calories so not very significant in terms of adding much of macronutrient to the diet all right so near the end of the book they also Identify some additional snacks that one can consume throughout the day and a table on alcohol so that's a little bit more advanced we're not going to go into that with our class but you can certainly glance through it on your own all right so I went through that with you and you may have gotten it or you may be thinking what the heck is she talking about uh that is the challenge with some these online courses where we don't necessarily get to talk through it as well so what I've created on the next few slides is kind of an interactive activity if you want to think of it as that uh if and if you want to use it as that so I'm going to have a few practice problems that I'll go through I strongly recommend for you to pause me and try to come up with the answers on your own and then move on so that way you can either see the answers if they're in the slides or listen to me walk through the the answers so now is a good time to pause me uh look at the items on the slide here and then see if you could determine the exchanges and then the amounts of macronutrients and calories okay so hopefully you have worked this out you have probably been a little annoyed going through the book it does take some practice ractice the first time uh you work on these problems a lot of flipping back and forth but once you get the hang of where things are located it does go smoother so let's take a look at how I set this up so first off I recommend to go through the foods that were presented the cherries the yogurt the granola and find that food in the book okay so look up the food find it see which category it's in and see how it lines up in that category so for for the 12 fresh cherries I went to page 21 this is a section in Fruit so on page 21 I could see varying amounts of fruit that are about one fruit exchange and there you see those cherries now I will always give you nice round numbers you should not be doing uh too much with fractions or anything along those lines so um I do try to keep it fairly simple in that regard next up we also had 2/3 cup of plain Greek yogurt with this snack so we looked up our Greek yogurt this was on page 26 so go there if you need to on page 26 we can find it verbatim there the plain Greek yogurt so that's my fat-free milk two starches what did this come from so you can assume it's the granola uh we'll look up granilla to clarify how much and when we look at this page page 14 14 it'll tell us that 1/4 of a cup of granola is one starch so in this snack we ate half of a cup so we've got to double that and that's the extent of the difficulty in terms of math that you'll find here okay so we're usually just increasing by these set values so that's answer to part one so I wanted to know the exchanges you tell me it's a fruit a fat-free milk and two starches perfect well then I ask you tell me the numbers so this is where page n can be quite handy you can find these values on each page where you found the cherries where you found the yogurt the granola so you'll see at the top or the very bottom of the page uh that it gives you the 15 31 80 for the starches and so on so forth but page n has the grand table of them all so I find it easier to take my Exchange es that I determined and then go do my math at one time so I put him down here one fruit I can see is 15 and grams and 60 calories the non-fat milk I go based off of my chart there are its values two starches I had to double so that's where the numbers increased and then here are my final numbers all right so I hope that that was one that you felt comfortable with I'm going to give you one more and this time you don't have the answers so I'd like you to first off determine the exchanges in this lunch so what I mean by that you're going to tell me are these six proteines and five carbs two milks so on so forth you're going to actually go through the book look up the foods and jot down next to them what they are as an exchange so take a few minutes and then go ahead and go forward when you're ready so here we are and I'll briefly run through this one here you can find two ounces of turkey on page 34 okay it's under the lean protein under poultry so I can see that the 1 oz is going to be one lean protein I'm eating 2 ounces with my sandwich so that's two lean proteins I have two slices of bread uh that's kind of an easy one but hopefully you still did look it up and on page 13 it listed one slice of bread as one starch So within this meal we've consumed two starches the Mayo that was one fat you can find that on page 41 and I'll tell you exactly what type of mayo in this case the regular mayo and this lined up to be uh what you see in the the table there leaf lettuce this is a freebie this really isn't much of anything so I would not count this as uh an exchange of anything now if we ate a cup of leaf lettuce then yes we would count it as a non-starchy veggie but just a little bit or a few slices of tomato not not a concern the veggie juice this is going to be on page 30 under I think it's under tomato juice or vegetable juice yep uh half of a cup is going to be one non-starchy we we kind of cook it down right we process vegetables into juice so the the smaller serving there is why it's one2 Cup being one non-starchy okay and then the last one there uh we've got the orange this one was exactly as you see in the book so one fruit so we've determined these exchanges our next step now that we know these is to determine the overall amounts of nutrients that's my question there at the bottom so great time to put me on pause and see if you could come up with these answers okay if you're ready I'm going to go on so here I've just outlined what we came up with and here I'll show you the math so I like to do tables uh when I'm Jing down things on on notepad paper just so that I make sure that I'm doing my math correctly uh you I have a different system that's totally fine if you can get the same numbers at the end that's what I'm looking for so the big use here we had to multiply by two for the items we cons consume two of and then everything else lined up nicely and we've got our grand values so a few things I wanted to go over before we go through few more examples is uh a little bit more on some of the exchanges uh some of the questions that could come up about this for you so the first one I alluded to the exchanges are not serving sizes okay they're they're just a way to calculate amounts of macronutrients in food so when we see small amounts like 1 o that doesn't mean that that is how much we would want someone to eat of it okay so just keep that in mind we're just using these as factors to calculate overall macronutrients uh foods you may have identified that some are not where you think they are uh bacon is not not really considered a meat based on its macronutrients so it's going to be found in the fat group and then whenever we see something that is a sweet or a dessert and we see one carb written then you're reminded to count this carb as a starch so that way it makes the numbers easier uh if you're wanting to get into the depths of this the sweets desserts and others they'll have one about the same number of grams of carbohydrates but the grams of fat and calories will vary and can vary quite significantly so I don't want us to have very inaccurate numbers so for us we're just going to count one carb sko as one starch and you'll see that whenever you get to doing the problems so why the heck are am I killing you with this stuff what what's my goal well this is a great way to plan meals so what I mean by that we have a chart in our profession that we can use use that's based on a good percentage of the macronutrients you see the amdrs that we've used up here and then we break it down into calorie levels and then even exchange levels so if someone came to me and said hey I want an organized way to eat that's going to give me balance variety moderation so on so forth then we could calculate how many calories they need and then pick one of these columns and then create a day of food with them okay and that's ultimately what we do with these uh types of applications in the real world so I've listed this here so if I have a client I'm meeting with I'm going to calculate their calorie needs which we'll learn that later this semester then we're going to go back and see how many exchanges of what foods we're wanting to provide and then we can create a day of food in terms of guidelines and then actual examples of foods so this is what I was talking about earlier with uh folks who had diabetes where we could tell them hey to manage your blood sugar we need to have starch at every meal and snack but for example we can't have more than three at a meal so they can then go through and basically create some days of food for themselves that are that they know are going to be helpful for managing blood sugars uh say for example someone didn't want an afternoon snack we could just Shuffle those exchanges into other meals and snacks so this was just an example um not a prescriptive one or anything so from there I created an example of breakfast that would fit in and that's a pretty tasty balanced breakfast in my opinion okay so this was a difficult presentation to record uh as I had several of my notes Pages out here as well as my book but I do hope that it was informative uh I went back and forth on whether I should record anything or whether I should just give you guys the practice problems so hopefully listening to me has helped you to learn this so in terms of what you need to know is being comfortable with these types of problems these types of calculations looking up the exchange for that food item and then calculating out the macronutrients and calories okay now the inevitable question is what about the exam I will give you a copy of that main table and you'll be able to do anything and everything you need correctly with just that table okay and I've got an example here of that on the next few slides I just threw out some more uh for you guys if you have been fast with this and you feel comfortable and you want to work on a few more practice problems here you go uh the answers are going to be in the note section of the PowerPoint so you'll need to download the PowerPoint and then you'll see the notes in the or the answers excuse me in the notes section so you're looking at exchanges and then in this case you're calculating grams of macros the last slide here uh just a few random Foods you're going to calculate what those exchanges are and then also how many total calories in this case and you'll see my answers if you want to to check your work also on blackboard I did create and post a just some practice problems with these that you can work through as well as the answers sometimes this stuff trying to go back to my beginning slide here uh sometimes this stuff can be confusing when you see it for the very first time there we go um but once you get into the habit of using these lists and this book and and of itself it really will become second nature so thank you for listening and like I said I do hope it's been informative get to working on some practice problems and I wish you the best