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Get Your Plate In Shape: Strategies for Transformation

Online Health Chat with Maxine Smith, LD, RD

March 27, 2012

Introduction

You may have made a New Year's resolution to eat a healthier diet. You may have even used the USDA's "Choose My Plate" to set specific goals like filling 1/2 of your plate with fruits and vegetables. You may have started strong but find your resolve waning. If you are transgressing into old habits, you are not alone. The average time that people stick to their resolutions is about 6 weeks. Anyone can radically change their diet for a short period of time. However, for long-lasting transformation, obstacles must be addressed. These obstacles are real and formidable and must be overcome to help both the individual and society eat a healthier diet.

Obstacles to diet transformation are contributed to many factors. They may include culture and traditions; time; financial and energy constraints; dislike of particular foods/food groups; or peer pressure (yes - even adults succumb to this). Also contributing may be limited food choices; internal and external cues to eat particular foods and or particular amounts; hormones; presence of disease and ingrained habits; competing values; and lack of knowledge.

Although these obstacles are real and sometimes seem formidable, you do not want to give up! Eating a well-balanced, variety-filled diet can provide health, energy and longevity that can be life-changing.

During this Web Chat, we will explore practical methods to promote gradual diet transformation using the "Choose My Plate" diagram as a model of a healthy diet.

Maxine Smith, LD, RD has more than 20 years of experience as a registered, clinical dietitian and presently works in the department of Nutrition Therapy at Cleveland Clinic. Her areas of special interest include weight, lipid, and diabetes management, and disease prevention. The majority of her time is spent counseling individuals in Cleveland Clinic’s preventive medicine and outpatient nutrition areas, although she enjoys speaking to groups as well.

Ms. Smith earned her dietetics degree from the University of Akron, Akron, Ohio, and completed an internship at MetroHealth Medical Center, Cleveland, Ohio. She is a member of the American Dietetic Association and is ADA-certified in adult weight management.

Some obstacles that Ms. Smith, herself, has battled include growing up with an Eastern European heritage that included the "clean plate" philosophy. She was raised in a time when nutrition knowledge was limited and white bread and mayonnaise sandwiches were not uncommon.

To make an appointment with Maxine Smith, LD, RD or any of the other specialists in our Digestive Disease Institute’s Center for Human Nutrition at Cleveland Clinic, please call 2016.444.3046 or call toll-free at 800.223.2273, ext. 43046. You can also visit us online at www.clevelandclinic.org/nutrition.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic specialist Maxine Smith, LD, RD. We are thrilled to have her here today for this chat. Let’s begin with some of your questions.


General Questions about www.choosemyplate.gov/

Allie: What do you like the most about the My Plate icon?

Maxine_Smith_LD_RD: My Plate is a more clear representation of the balance required for a healthy diet in comparison to the My Pyramid icon. Many people found the My Pyramid confusing and uninformative. To understand it, one would have to go to the corresponding website. I also like the fact that it emphasizes the importance of plant-based foods in the diet.

jojo3: Does the Choose My Plate work the same for people of all ages? Are the guidelines exactly the same?

Maxine_Smith_LD_RD: That is a good question. The Plate is a general guideline for all ages over 2 to identify the best proportion and variety for a meal. Of course the actual portion sizes will vary based on caloric need.

JuneBug: Where can I get more information on how to interpret the information on the Plate?

Maxine_Smith_LD_RD: Go to choosemyplate.gov on the internet. This site has valuable information such as examples of foods for each food category, recipes, goal setting/tracking programs, a nutrient database of about 8000 foods and an entire section on weight management.

zoe: Is My Plate based solely on serving size?

Maxine_Smith_LD_RD: The focus is primarily food variety and proportion.

Hopeful: How do determine or differentiate categories that seem to cross over one another on My Plate? For example, I think corn is considered a protein and carbohydrate?

Maxine_Smith_LD_RD: Potatoes, corn, starchy beans and peas, and winter squash can be considered part of the grain group, particularly if interested in decreasing calories, although according to the USDA Dietary Guidelines, they would fall in the vegetable category.

eureka: How do you plan a 'menu' or meal plan for people with different dietary needs, without cooking 3 or 4 different meals? My husband is diabetic, I need to lose weight, my son needs to gain weight and my daughter is at a healthy weight.

Maxine_Smith_LD_RD: The Healthy Plate can meet all of their needs. Portion size is key! Healthy fats can be added at the end of meal (e.g., melted canola margarine over buckwheat pancakes or extra olive oil on vegetables) can increase calories for your son/ Cooking basic, healthy foods is key.

brigetta: Would you discuss how you fit fast food and desserts into the My Plate plan? I know in the ideal world they should be totally avoided, but realistically that may not happen.

Maxine_Smith_LD_RD: Consider the components of the meal. For example, if you had a grilled chicken sandwich you would have lean protein and grains (although not the healthiest grain!) You could complement this with a side salad, sliced apples and a low-fat milk or yogurt.

EdithM: I know that the My Plate graphic replaced the pyramid, but can't figure out where things like nuts should go on the plate since there is no category for fats/oils/use sparingly.

Maxine_Smith_LD_RD: This is a problem with the Plate. Small amounts of healthy oil, especially when replacing unhealthier carbs, can be disease protective. A general rule of thumb is about 2 tsp. per meal, 1 tsp. for weight loss.

Jenny8: I like to eat 4 to 5 small meals a day instead of 3 so that I don't get hungry and snack. How can I incorporate the plate?

Maxine_Smith_LD_RD: That can be a wonderfully healthy way to eat. Split the Plate up and save a group for snacks such as a piece of fruit and low-fat cheese for a snack or "mini-meal" and a salad and a cup of vegetable-barley soup for your meal.

Holly324: Can you incorporate the plate when you're eating out at a restaurant?

Maxine_Smith_LD_RD: Absolutely. Keeping this diagram in mind can help keep portions in check. The problem in a restaurant is that fat "sneaks" into most dishes. Ordering foods "dry" with sauces/butter/dressing on the side can make your meal much healthier and slash calories. Most restaurants pile on grains (as they are less expensive) so ordering a side of pasta, with chicken/fish, steamed vegetables and/or a side salad and a bowl of berries for dessert can fit the bill.

EdithM: Are there any recipes associated with the ChooseMyPlate website? Or recipe sites that you particularly recommend?

Maxine_Smith_LD_RD: Absolutely, go to ChooseMyPlate.gov. They have some fabulous and fun tools such as food-trackers, Spanish handouts and many other resources.

jk: Where do carbs fit into this plan?

Maxine_Smith_LD_RD: The carbohydrate groups are the fruits, grains and dairy. Vegetables have small amounts also.


Losing Weight

high_ground: I am obese and considering gastric bypass. Would following the My Plate guidelines take away the need for this surgery? If I do have the surgery, how do these guidelines then apply?

Maxine_Smith_LD_RD: You can definitely lose weight by using the Plate as a guideline. The important factor would be to choose lean protein sources, and strictly limiting the foods with added fat or sugar. Dairy products should be 0%-1% fat. Discuss the weight loss options with your physician/dietitian.

EdithM: Does the timing of meals matter? Is it still true that you should avoid eating late at night, or right before you sleep, whenever that might be?

Maxine_Smith_LD_RD: In the big scheme of things, total calorie balance is what matters when controlling weight. There is some evidence that metabolic rate slows down when eating late. Also, theoretically, you will not burn as much fat during the night if you have available calories in your stomach.

chinup: When one is dieting do you make changes to My Plate? When one reaches their dieting goal, what then?

Maxine_Smith_LD_RD: The Plate is designed to promote disease PREVENTION and not necessarily for weight loss. Choosing very lean protein sources, limiting portion sizes and added fats will keep the calories down to about 500 calories per plate. If you need to reduce calories further, you can save the fruit or dairy for between meals.

serendipity: I am trying to lose weight. If I ate all of the food on the MyPlate diagram, I would gain weight. How can I use this to lose weight?

Maxine_Smith_LD_RD: If one considers that the plate is 9" (the size of a standard paper plate), the portions will be on the smaller side in comparison to typical American portions, which are most often quite excessive. MyPlate would provide about 500 calories per plate, including a teaspoon of fat such as oil or margarine. Also, choose lean protein sources, non-fat dairy sources, and foods prepared without fat (e.g., baked potato vs. mashed potatoes made with butter).


Gaining Weight

HI: My son is very skinny and could stand to gain weight. What changes would you make to help him?

Maxine_Smith_LD_RD: Fat has more than twice the calories of carbohydrate and protein. Adding HEALTHY fats is key. These include peanut butter, nuts, avocado (guacamole), extra olive oil while cooking and salad dressing. Frequent snacks can also add calories.


Food Choices

Pinehurst: If you were going to advise someone avoid one food what would it be?

Maxine_Smith_LD_RD: Processed red meat. There is a linear relationship between processed red meat and disease risk such as colon cancer. Fortunately, there are increasingly available "unprocessed" alternatives. These are a step in the right direction despite the fact that they are most often still salted which may be included in the definition of processed meat.

wakonda: Is red meat really all that bad for you, especially if I buy very lean cuts?

Maxine_Smith_LD_RD: There is an association between red meat consumption and disease such as diabetes, heart disease and some cancers that appear to be unrelated to the fat content in the meat. A more liberal recommendation for red meat would be to consume no more than 18 oz. of cooked red meat a week and minimize consumption of grilled red meat.

loni: Can juice replace the fruit or vegetable?

Maxine_Smith_LD_RD: According to My Plate, it can. However, this should be limited to once a day, especially in the case of fruit, as it is a concentrated source of natural sugar and is lacking in fiber. Go low-sodium with the vegetable juices as they are typically very high in sodium.

i_am_here: When choosing fruits and vegetables, do you need a variety? My son likes corn, apples, and watermelon. What do I do?

Maxine_Smith_LD_RD: A "rainbow of colors" of fruits and vegetables is the way to go. Plant nutrients (phytonutrients) group together, quite often based on color and then work together to protect the body. Does he like smoothies? This is a great way to disguise all types of fruits and vegetables. Blended fruit and vegetables juices can offer more variety. Keep introducing fruit and vegetables possibly cooked in various forms. Don't give up!

just_right: I have always read that chicken is the most healthy meat. Is it better to eat mostly chicken or is it better to eat a variety of meats?

Maxine_Smith_LD_RD: There is less disease risk (heart disease, diabetes and some cancers) with consumption of poultry and fish. Red meat is not necessary in a diet and should be limited to no more than twice a week. This includes pork. Unfortunately, the Plate does not make that clear.

M1986: I crave salty foods. How do I get rid of these cravings?

Maxine_Smith_LD_RD: The Plate does not identify the benefits of restricting salt or sodium in the diet. The good news is that your taste buds adjust to less sodium in the diet. Decrease the amount gradually and give yourself a few months to reach your goal. Pretty soon salty foods will not be pleasurable!

EdithM: Can you list some sources of lean proteins--something besides chicken?

Maxine_Smith_LD_RD: Fish is a fabulous, cardioprotective protein source. Eggs, legumes (starchy beans), nuts, nut-butters and tofu are other options.


Vegetarian Diets

katrina: I am trying to eat a vegetarian diet. How can I get the protein that I need?

Maxine_Smith_LD_RD: It is good that you are concerned because many people who start eating a vegetarian diet simply eliminate the meat from their diet and compromise their protein needs. Rich protein sources include lentils, legumes, nuts/seeds, soy products (such as tofu or soy meat substitutes), eggs, and dairy products. You need to be intentional about consuming these foods several times throughout the day.

Francois: Can an unbalanced largely vegetarian diet with too much emphasis on fruits and vegetables and drinking too much water by a stress prone person result in zinc deficiency over a period of a few years? Can zinc deficiency among other things affect immunity and the health and number of lymphocytes in blood and thus facilitate stubborn respiratory infections?

Maxine_Smith_LD_RD: Zinc deficiency can depress immune function and the availability of zinc from a plant-based diet is not as high as an animal-containing diet. Phytates, or plant compounds, can reduce absorption. Soaking foods such as beans, grains, and seeds in water for several hours can improve the availability. Leavened bread is also a better choice over unleavened. Rich sources of zinc in a vegetarian diet are fortified breakfast cereals, baked beans, cashews, chickpeas, cheese, and milk.


Beverage Intake

girls_night_out: I thought that wine is good for you? Why is it not represented on the Plate diagram?

Maxine_Smith_LD_RD: Alcohol, in moderation, can help decrease disease risk, particularly cardiovascular risk. The benefits do not outweigh the risks, however, until about mid-age. Also, it is not recommended to start drinking solely for health purposes as there are some risks associated with alcohol consumption.

Hud1: I am lactose intolerant and can't drink milk without getting horrible gas pains. Do I really need to drink the milk that is indicated on the plate diagram?

Maxine_Smith_LD_RD: Dairy in the diet will provide protein and other minerals, very importantly calcium. Some people who are lactose intolerant can tolerate fermented or aged form of dairy such as yogurt or hard cheeses (0% or low-fat preferably) or soy milk could be an alternative. There is also controversy among the medical community in regards to the amount of dairy that is necessary in the diet.

EdithM: How much water should you drink daily? There was the advice about eight 8-oz glasses of water per day, but then my daughter said they were teaching them in health class to drink an amount based on a percentage of body weight.

Maxine_Smith_LD_RD: A rule of thumb is 1 ml per calorie needed, so it would be more appropriate to base FLUID intake on body weight. Most people consume fluids according to need, so it is not a big issue. Typically 6-8 8oz. cups is sufficient. Of course, if one is very active, they may need more. Anything that melts at room temperature is fluid. It doesn't have to be solely water.

RDF71: When looking at the plate, it looks like dairy is a glass. How do I know how much dairy to consume? Can it be things other than milk?

Maxine_Smith_LD_RD: The dairy indicated would represent approximately an 8 oz. glass of non-fat/1% milk or yogurt. It is controversial as to the amount of dairy necessary in the diet. Some experts favor no more than 1-2 servings a day as there is an association between high dairy intakes and prostate and ovarian cancer.


General Questions

nurse2many: Why is it so hard for people with chronic health conditions to stick changing their eating habits?

Maxine_Smith_LD_RD: I empathize with you as it is hard enough for people without chronic health conditions to change eating habits! Eating is multi-faceted, with physical as well as emotional and spiritual aspects. Setting very small, realistic, measurable goals for 2-3 months and realizing success can start you on your way!

EdithM: Can you tell me if stevia is an acceptable sweetener to use?

Maxine_Smith_LD_RD: Stevia is approved by the FDA. Most scientific organizations including the Academy for Nutrition and Dietetics support use of non-nutritive sweeteners. Long-term studies, of course, are not available at this time.

Wm290: Why do the USDA dietary guidelines say to eat only 1/2 of your grains as whole grains and not all of them?

Maxine_Smith_LD_RD: Basically, this is to ensure that folate needs will be met for women who may become pregnant. Outside of this subgroup, yes, it would be healthier to consume only whole-grains as they provide more fiber and other nutrients and result in more stable blood-sugars. If you are a woman who may become pregnant and are getting your folic acid needs from a vitamin for instance, 100% whole-grains would be the way and even better choose grains that are not cut or ground.

hyde: How does this meal plan work for athletes, who may have different dietary considerations?

Maxine_Smith_LD_RD: This diagram would help meet the needs for most athletes. Many overestimate the amount of protein necessary for athletes. Based on the calorie burn, portions may need to increase. The timing of fueling for exercise can be important. If you want to fine-tune your athletic needs consider meeting with a registered dietitian. A sports dietitian or any outpatient dietitian can help in this area.

BigSigh: I crave sweets. How often can I have them as they are not indicated on the Plate?

Maxine_Smith_LD_RD: According to the USDA Dietary Guidelines, a small amount of calories are available after meeting nutritional needs for sweets. Dessert once or twice a week or a very small dessert (e.g., 2 small cookies) would typically fit as part of a healthy diet.

SpinachLover: Portion size refers to the amount of the cooked food, right? So how do you know the correct amount to cook in order to get the proper portion size? I know if you sauté fresh spinach, what looks like a huge amount ends up being maybe 1/4 cup if you are lucky.

Maxine_Smith_LD_RD: This may take some practice. A 4 oz. portion of raw meat, for example, will typically shrink by 1 oz. after cooking. In general, ½ cup of a cooked vegetable is equivalent to 1 cup of a raw vegetable.

EdithM: If you are not able to have an egg or something like it, can you give suggestions on adding protein to breakfast, especially breakfast on the run?

Maxine_Smith_LD_RD: Some high protein breakfast ideas include: yogurt ( Greek is particularly high in protein), skim milk, cottage cheese, peanut/almond butter on whole wheat toast, very low-fat cheese, leftover meat/fish/poultry, a handful of nuts, or a smoothie with protein


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Cleveland Clinic specialist Maxine Smith, LD, RD is now over. Thank you Ms. Smith for taking the time to answer our questions today about Get Your Plate In Shape: Strategies for Transformation.

Maxine_Smith_LD_RD: It was my pleasure to be with you. Thank you for all of your wonderful, thoughtful questions. If you desire an individualized, personal plan, the dietitians at Cleveland Clinic would love to help meet your needs.


More Information

Cleveland_Clinic_Host: To make an appointment with Maxine Smith, LD, RD or any of the other specialists in our Digestive Disease Institute’s Center for Human Nutrition at Cleveland Clinic, please call 216.444.3046 or call toll-free at 800.223.2273, ext. 43046. You can also visit us online at www.clevelandclinic.org/nutrition. A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit eclevelandclinic.org/myConsult

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