Online Health Chat with Maxine Smith, RD, LD

March 19, 2015


March is National Nutrition Month, and the theme is “Bite-size Changes for a Healthy New You.” We all desire a healthy lifestyle to increase the quality of life and to increase longevity, but sometimes the task may seem daunting. Don’t give up. Making “bite-sized” changes can add up to big success. Whether your goal is to simply build a healthier diet for the wellness of your family, to assist in managing a disease or to shed unwanted pounds, the tools to accomplish such goals are available. Knowing the constituents of a healthy diet model and forming realistic goals to help you move forward will be discussed. Strategies to increase your chances of success relating to nutrition, behavior, attitudes and exercise will be explored.

About the Speakers

Maxine Smith, RD, LD, is a registered clinical dietitian who works in the Department of Nutrition Therapy at Cleveland Clinic. Her specialty interests include disease prevention, and weight, lipid and diabetes management. She provides nutrition services to patients in Cleveland Clinic’s preventive medicine and outpatient nutrition areas. Ms. Smith earned her dietetics degree from the University of Akron in Akron and completed an internship at MetroHealth Medical Center in Cleveland. She is a member of the American Dietetic Association and has received a certificate of training in adult weight management.

Let’s Chat About Diet Changes That Can Improve Health

Moderator: Welcome to our chat about Bite-size Changes for a Healthy New You with Cleveland Clinic nutrition specialist Maxine Smith, RD, LD. Maxine, thank you for taking the time to be with us to share your expertise and answer our questions.

Staying on Track

Jules: Whenever I try to change my diet, I last a couple of weeks and then get discouraged, as I can’t seem to keep it up. I am very busy with work and my three children, and I don’t get much help from my husband. Any suggestions?

Maxine_Smith,_RD,_LD: Too many people “bite off more than they can chew.” You may be one of them. First, realize that you can only change yourself. Then use the SMART goal method to be sure that your goal(s) are specific, measurable, attainable and time-bound. If you are not 95 percent sure that you can attain your goal, you should consider the obstacles in the way of reaching it. Are those obstacles things that you have control over? If there is a mountain in the way, you may decide on another route or make a plan to level the plain – or you may decide on another goal altogether. You want to build successes. Even if your goal is very small, by achieving it you will build your confidence, which will motivate you to keep going.

Ahmad: What are a few things that can help me maintain a healthy lifestyle over the long-run?

Maxine_Smith,_RD,_LD: Write down your core values – what is most important to you in life – and frequently compare your choices to these. Stay positive. Self-monitor frequently (i.e., weigh yourself every morning). Surround yourself with positive, healthy people.

Diet Discussions

laura628: I am a healthy 70-year-old female. I haven't eaten red meat in years, but I do eat small amounts of chicken, and I eat fish. Am I missing any healthy nutrients by not eating red meat? I do eat a boiled egg every day, and I eat peanut butter and nuts, also. I also eat fruit and vegetables every day. At my age, is there something I should be adding to or eliminating from my daily diet? One other question: I have started drinking almond milk. I also drink skim milk, which I've been drinking for years. Is almond milk just adding empty calories to my diet or are there nutrients in it that I am benefiting from?

Maxine_Smith,_RD,_LD: It sounds as though you are eating a pretty healthy diet. You are not missing anything by not eating red meat as long as you are eating other protein sources. Absorption of B-12 can decrease with age, and milk is a source of B-12 as well as calcium and vitamin D to help keep your bones strong. If you choose to use almond milk, choose one without added sugar and that is fortified with vitamins B-12, calcium and vitamin D.

JoyD: I have many questions about the 2015 Dietary Guidelines released in February, but will limit to the cholesterol change in position from previous updates. Does the AHA agree that reducing the food stuffs higher in cholesterol is not as major a concern any longer? My cardiologist has limited my cholesterol intake to less than 100 mg per day for the past six years. Do you think this adjustment in thinking will allow me to eat more shrimp and seafood? I eat very little red meat but would welcome having the occasional chicken leg or other higher cholesterol food.

Maxine_Smith,_RD,_LD: The 2015 Dietary Guidelines are not finalized at this point, but yes, most likely, cholesterol will not be a significant concern for the general public. There are individual differences on how people metabolize cholesterol, so that will be important to discuss with your cardiologist.

Gail Ann: If one is trying to eliminate sugar, dairy, gluten and soy from their diet, where does one begin doing so? At present, I eat low-sodium products, no caffeine,
no meat (red or white), no fried foods, no alcohol and no chocolate. Any suggestions? Thank you for answering my question.

Maxine_Smith,_RD,_LD: As you have already successfully made significant diet changes, I suggest that you reflect on how you made those. Did you set small goals? You may want to choose the food group that is most closely tied to your overarching goal. If it is a food intolerance or mild allergy, you may want to keep a food-symptom diary for a couple of weeks and determine which foods are most problematic and start with that one.

Robbie: If I were going to change one thing in my diet, what would be the most important thing I can do to improve it?

Maxine_Smith,_RD,_LD: That is difficult to say without knowing your eating pattern. You may want to get a general healthy diet model such as a Mediterranean Diet or DASH diet (you can find these easily online) and then keep track of what you eat for a week or two and see how your diet compares. This can give you insight as to where you can intervene to start moving in the right direction.

Meal Matters

MmeBetter: I want to start eating more fresh foods but do not have much time to cook, and I travel quite a bit so I find myself throwing food out often. Any ideas?

Maxine_Smith,_RD,_LD: That is an admirable goal. Consider batch cooking on the weekend, particularly foods that take more time to cook. You can then use them for a few days or freeze in individual portions. It takes some planning but frees up so much of your valuable time during the week. Frozen fruits and vegetables are healthy, non-perishable options. There are some great frozen options for whole grains such as quinoa with roasted vegetables and brown rice. Individual servings of vacuum-packed fish and poultry can be quickly defrosted and cooked. Look for the fewest ingredients on a food product. These shortcuts may help.

rmad2015: Is it really not good to skip breakfast if you are never actually hungry in the morning? I have never been hungry before the 11 a.m. timeframe.

Maxine_Smith,_RD,_LD: In the context of weight loss, there is limited evidence to suggest that eating breakfast assists with weight loss. You may miss out on some nutrients by skipping breakfast (such as fiber or calcium), but they could be made up with healthy snacks. Also, be mindful of portion sizes at other meals, as if you eat less frequently, the tendency may be to make up for it with large meals. Again, a healthy snack or two between meals can help with this.

Substances and Supplements

JoyD: My trainer, who is also a dietician, wants me to start taking a protein supplement before I work out each day. I would rather take in the protein via natural foods such as plain Greek yogurt, cottage cheese or eggs. Am I correct in assuming this would be just as acceptable and would allow me to keep the cholesterol and saturated fat intake to a minimum? Could you suggest other high-protein, low-saturated fat alternatives?

Maxine_Smith,_RD,_LD: Yes, real food is always a good way to go. Lean fish, poultry meat or a cup of low-fat milk are other options for protein.

JoyD: The Internet seems to have gone crazy over coconut oil. As a woman with CAD, I do not use it as I have read LDL is higher on a coconut oil diet, and although it also raise HDL, it seems experts are no longer sure that raising HDL cholesterol lowers risk of heart disease. What is your opinion?

Maxine_Smith,_RD,_LD: Coconut oil is very high in saturated fat, and at this time, I would not recommend its use or only in small amounts. There is a relationship between saturated fat and LDL. A higher LDL cholesterol is related to a lower risk of heart disease, but there are healthier ways to increase it, such as increasing exercise and substituting saturated fat with "heart-healthy" fats such as liquid oils, nuts and seeds and avocado.

mweis9: What are your thoughts on taking a turmeric supplement?

Maxine_Smith,_RD,_LD: Curcumin is the active compound in turmeric, which has anti-inflammatory properties. I recommend using this as a spice in cooking (common in Indian dishes) but not necessarily as a supplement. Contents in supplements are not FDA regulated, and there may be interactions and contraindications with medications and various disease states.

mweis9: Another supplement question, actually, two:

  1. If the directions are for "one or two per day" and you decide to take two, does it matter whether you take two once per day, or one twice per day?
  2. Some say "take with food with a small amount of fat." I know that's about absorption, but how important is it? I find myself waiting to take them until I have food in my stomach, but then forgetting altogether.

Maxine_Smith,_RD,_LD: It would depend on what it was. For example, calcium has an established maximal absorption of about 500-600 mg at one time, so it is better to take in a split dose. Often those stating "one or two a day" do not have established safety or efficacy dosages. Some supplements can be enhanced by food intake. You would likely absorb some of the nutrient, even if was limited, so possibly it would be better to take it without food than not at all.

I Wonder About Weight

Sasqua: I feel that I eat pretty healthy and don’t eat a lot, but I can’t figure out why I am not losing weight. Why is this?
Maxine_Smith,_RD,_LD: There are some medical reasons that may interfere with weight loss, such as low thyroid function or sleep apnea, so begin with a visit to your doctor. If your doctor has ruled-out any medical reason that would interfere with weight loss, start keeping a food diary and writing down every bite, lick or taste and the amount you eat. Do it right away, not depending on memory. It can be eye-opening when you put it down on paper.

Robin: I am in my late 60s and my doctor is suggesting that I change my diet and lose weight. Is that realistic at my age?

Maxine_Smith,_RD,_LD: You very likely have some well-established habits and traditions relating to food at this point of life, but it is never too late. You may have figured out that making radical changes can lead to quick results but are not sustainable. Coming up with a plan to make smaller changes over time may be more sustainable.

A10: When I look at the BMI chart, it tells me that I need to lose 50 pounds, and I have not weighed that since junior high. My blood pressure is high and I don’t want to go on medication. How much weight do I really need to lose to drop my blood pressure?

Maxine_Smith,_RD,_LD: Good news: You can start getting results with only a 3 percent to 5 percent weight loss. This may be a less intimidating goal for you.

Meghan: I have started exercising at the gym three times a week, and I walk my dog every day, and the scale isn’t budging. I am getting frustrated. Why am I not losing weight?

Maxine_Smith,_RD,_LD: First, commend yourself for taking an important step to improve your health. It is easy to offset the calories that you burn in exercise with an increase in calories from food/beverages. Consider using a calorie tracking app to look at this balance. You may also be building muscle while decreasing fat; if this is the case, your waist should be getting smaller – this is a good measurement to track.

rmad2015: What time of day is it best to exercise?

Maxine_Smith,_RD,_LD: Whenever your "sweet spot" is. When does it best work in your day? When can you be most consistent? When does it energize you the most? Exercising too close to bed may keep you up, but others find it helps them to sleep better. Experimenting is good.

Nada: I've just started juicing. Is this a good way to lose weight?

Maxine_Smith,_RD,_LD: Fruit is high in a natural sugar called fructose. Fructose can "rev up" fat storage. The fibers in whole fruit help slow down this process. You are also eliminating important nutrients by throwing out the skin and pulp. I encourage people to eat whole foods so their garbage disposal is not healthier than they are.

StayWell123: One healthy lifestyle coach told me that weight loss is about 70 percent to 80 percent about food intake and 20 percent to 30 percent exercise. Exercise is important for many reasons, but that alone will not get weight off if you need to lose some weight. Do you agree?

Maxine_Smith,_RD,_LD: You are correct in that research has identified that diet changes alone will promote significantly more weight loss than exercise alone. However, that does not mean that you will not lose weight with exercise. The problem is that people tend to overestimate the amount of calories they burn during exercise and then they rationalize that they can eat more, and they wind up eating more calories than they burned off. Exercise can help increase impulse control, increase metabolic rate and improve mood, which all assist with weight control.

Curbing Your Sweet Tooth

Spence: I am trying to give up sugar, and I do really well until a holiday or birthday party, and then I give in and am back on sugar. Any ideas?
Maxine_Smith,_RD,_LD: An “all or nothing” approach may not work well for you. You may decide to work in a modest serving of a “sweet” once in a while. Setting some boundaries by deciding ahead of time how often that will be is important, i.e., having a sweet once a week. If there are leftovers, get them out of your immediate reach (give them away, through them out). Remind yourself why you don’t want to eat sugar-rich foods in the first place.

Peggy: I am trying to quit eating sugar but it seems to be in everything! Where do I begin? A few of my friends are doing a “sugar fast.” Do you recommend that?

Maxine_Smith,_RD,_LD: You are correct. Sugar is in many foods. It is estimated that 75 percent to 80 percent of the food products in the grocery store have a form of added sugar. There is no harm from doing a sugar fast, but it may not be sustainable. It may be more realistic to consider healthier substitutions and making gradual changes. For example, for the first week, compare the sugar content of various cereals and switch to a lower sugar cereal, or better yet, one without any, such as whole oats with some fresh fruit for sweetness. You can then gradually train your taste-buds to prefer a less sweet taste.

rmad2015: Can eating “healthy” sweet food such as fruits increase cravings for unhealthy sugary foods such as cakes, etc.?

Maxine_Smith,_RD,_LD: A person can be "conditioned" to the taste of sweet just as they can to salt. Fruits in whole form are not typically as sweet as pastries, candy, soda etc., so it would be unlikely. Dried fruits and fruit juices can be quite sweet, however, and could raise the sweet taste threshold. Stick with whole fruits.

Added Complications

rebma02: Any tips/advice for someone with PCOS who struggles with weight loss no matter how much they watch what they eat or how much they exercise? Are there any types of foods they should be eating?

Maxine_Smith,_RD,_LD: Weight loss can be challenging with PCOS. There is not much evidence to support one type of diet over another for weight loss. The best diet for you is the one that drives calorie intake down and that you can sustain. Consider a Mediterranean-type diet that is based on unprocessed whole foods and is very limited in sweets, foods with added sugars and fruit juice.

mweis9: What is PCOS?

Moderator: PCOS refers to polycystic ovarian syndrome, which is a hormonal imbalance that occurs in some women. For additional information please go to:

Lucyinthe Skies: If you could name the top five bite-sized changes, what would they be? Menopause has wreaked havoc on my physique.

Maxine_Smith,_RD,_LD: It is difficult to say, not knowing your history. It really depends on a self-evaluation of your eating habits. These are some areas to consider when making small changes:

  1. Plan meals for the next day or week. Lack of planning is common.
  2. Write down everything you eat right after you eat it (including portion size).
  3. Start reading labels and becoming aware of foods with added sources of sugar, and then consider substitutions.
  4. Cut back on alcohol if you drink.
  5. Limit portion sizes and snacking.
  6. Choose lean, low-fat animal foods.

MissDem: I used to be quite active, but the arthritis in my knees is keeping me from exercising. The weight just keeps coming on, what can I do?

Maxine_Smith,_RD,_LD: If you haven’t already, discuss this with your doctor so you have an understanding of what is safe to do and what is not. Possibly, you are able to do some exercises that relieve the force on your knees such as water exercises or using a bike or elliptical machine. Upper body and core exercises are other possibilities. If you are less active, you will need fewer calories and will need to change some habits. Consider cutting down on portion sizes, particularly any sweets, starches or fried/high fat foods.

General Information

JoyD: I subscribe to Nutrition Action Healthletter (Center for Science in the Public Interest) and was wondering if you are familiar with the Center and if so, if this is a good source of information for consumers? Thank you.

Maxine_Smith,_RD,_LD: It is a fine newsletter with a focus on promoting unbiased consumer health messages and advocating for creation of government health policies based on science. It is always good to read other, science-supported points of view, as what constitutes “good nutrition” isn’t always cut and dry.


Moderator: That is all of the time we have for questions. Thank you everyone for participating today; and thank you, Maxine, for your insightful answers to our questions about making bite-size changes for health.

Maxine_Smith,_RD,_LD: It was, truly, my pleasure. Thank you all for the great questions, which I'm sure will be helpful to others also. Keep pressing on, step-by-step toward a healthier you.

For Appointments

To make an appointment with Maxine Smith, RD, LD, or any of the other specialists in our Digestive Disease and Surgery Institute, Department of Nutrition at Cleveland Clinic, please call 216.444.3046 or toll-free at 800.223.2273, ext. 43046, or visit us online at

For More Information

On Cleveland Clinic

The Center for Human Nutrition provides evaluation, education and treatment to people who have disease-related nutrition problems. Additionally, the Center is involved with a multitude of programs to promote health and wellness. Both of these efforts are driven by a dedicated team of registered dietitians, dietetic technicians, nurses, pharmacists, physicians and surgeons who work together to provide comprehensive support for patients with specialized nutrition needs.

Cleveland Clinic Health Information

Learn more about diet changes to improve your health.

Diet Nutrition & Healthy Lifestyle Help Reduce Cancer Risk

For additional health information, visit

Managing Your Health
MyChart® is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to:

An online second opinion from a Cleveland Clinic specialist is available as a service for patients who have received a diagnosis and are unable to travel to Cleveland, OH. For more information please visit

This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2015. The Cleveland Clinic Foundation. All rights reserved.