The physician, and in some situations the dietitian, prescribes the amounts of carbohydrate, protein, and fat that are to be used in measured diets. Using the values for the exchange lists, the dietitian, dietetic technician, or nurse calculates the number of exchanges to be furnished by the diet.

The steps in diet planning are listed below.

1.   Become familiar with the patient’s usual pattern of meals, the food likes and dislikes, and so on. Whether the patient eats at home, carries lunches, or eats in a restaurant will affect the planning. The amount of money that can be spent, the preparation facilities, and the cultural patterns must be considered.

2.   Include basic foods to ensure adequate levels of minerals and vitamins: 2 cups milk (3 or more for children and pregnant or lactating women); two servings vegetables; two servings fruit, including a good source of ascorbic acid; four to five exchanges meat; wholegrain or enriched bread and cereal.

3.   List the carbohydrate, protein, and fat values for the milk, vegetables, and fruit.

4.   Subtract the carbohydrate value of these foods (74 in the example) from the carbohydrate level prescribed (150 gm). Divide the difference by 15 to determine the number of bread exchanges (5 in the example).

5.   Total the protein values of the milk, vegetables, and bread exchanges (30 in the example). Subtract from the protein prescribed (70). Divide the difference by 7 to determine the number of meat exchanges (6 in the example).

6.   Total the fat values for milk and meat (18 in the example) and subtract from the total fat prescribed (70). Divide the difference by 5 to determine the number of fat exchanges (10 in the example).

7.   Check the calculations to be certain that they are correct. It is not a good idea to split the bread, fruit, and meat exchanges into half.

8.   Divide the total exchanges for the day into meal patterns according to the physician’s diet order and the patient’s preference.

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