Online Health Chat with Maxine Smith, RD, LD

March 1, 2011


Cleveland_Clinic_Host: On average, Americans of all ages consume too few vegetables, fruits, and high-fiber whole grains, and too little low-fat milk, milk products, and seafood; and they eat too much added sugars and sodium, and too many solid fats and refined grains.

To encourage healthier eating habits, the U.S. Food and Drug Administration and the U.S. Department of Agriculture jointly issue Dietary Guidelines for Americans (DGA) every five years. These guidelines are designed to help keep Americans healthy and to prevent major chronic diseases, such as heart disease, cancer, and diabetes.

The focus of the guidelines is on choosing a healthy balance of foods to prevent disease, rather than on individual nutrients. The diet recommended is not a rigid prescription. Rather, it is a flexible approach that incorporates a wide range of individual tastes and food preferences.

But in order to consume foods that comply with the guidelines, you must start by making healthy choices in the grocery store. Such choices can be daunting, especially with the sheer volume of products available. It can also be confusing to evaluate health claims and interpret nutrition labeling.

Maxine Smith 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. 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, 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.

When not counseling patients, she enjoys creating patient education materials, providing lectures, and contributing nutrition expertise to the media.

To make an appointment with Maxine Smith, RD, LD, or any of the other specialists in our Digestive Disease 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

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

Nutrition 101

theo: If there is one "bad" food that you would recommend eliminating from my diet, what would that be?

Maxine_Smith_RD_LD: I am not sure what you eat, but for Americans in general, I would recommend strictly limiting most bakery products. They are a huge source of calories in our diet, and they contain significant added sugar in combination with solid fats that can contribute to obesity and to diseases such as diabetes and heart disease.

grover: How many eggs is it safe to eat a week?

Maxine_Smith_RD_LD: That depends. Eggs are rich in cholesterol, and too much cholesterol in the diet is related to an increase in coronary artery disease. As a general rule, for those without high cholesterol levels and who are not at high risk for heart disease, it is safe to consume about seven eggs a week to keep cholesterol intake under 300 mg. a day. If you are at high risk, however, I would recommend no more than two eggs per week to keep cholesterol intake under 200 mg. per day.

wishing_well: I am pregnant. Is it safe to eat fish?

Maxine_Smith_RD_LD: The 2010 Dietary Guidelines encourage even pregnant and nursing women to eat fish because of the potential health benefits for both the mother and baby. The recommendations are to vary the type, and to aim for 8 to 12 oz. a week. There are limits on some fish because of the mercury content. Limit albacore or "white" tuna to 6 oz. a week, and avoid tilefish, shark, swordfish, and king mackerel.

strawberries: Is Greek yogurt healthier than regular yogurt?

Maxine_Smith_RD_LD: Greek yogurt typically has more protein than regular yogurt (about 16 gm. versus 6 gm.), but it is not necessarily more healthy. No matter what type of yogurt you choose, look for one that is fat-free or at least low-fat and that is not loaded with sugar. Plain yogurt will obviously not have added sugar; and, typically, yogurts that are 100 calories or less for a 6 oz. container will be moderate in added sugar.

memories: Are carbs bad?

Maxine_Smith_RD_LD: Carbohydrate-rich foods include starches (those originating from grains), fruits, and milk-based foods. When most people ask about "carbs," they are asking about the starches. Starches are an important part of a balanced diet and provide nutrients, such as B vitamins -- which are important for energy -- and fiber -- which can fill you up and help prevent disease. The important thing is to choose those that are whole grains without added sugars and fat and, better yet, those that are intact (not milled down into flour) such as whole oats, brown rice, and quinoa.

lindy: I am menopausal and experiencing the weight shift to the abdominal area. I am exercising three times per week. How many calories should I shoot for? What can I cut out? I love sweets, but rarely have them. In fact, I have not even made my birthday cake.

Maxine_Smith_RD_LD: Not knowing your height and weight, I cannot say for sure. Most women need about 1600 to 2400 calories a day to maintain their weight, and will lose at about 1200 to 1800 calories. A dietitian could help you identify a clearer target. Try some low-calorie sweets such as fat-free pudding, low-calorie hot chocolate, or 100 calorie ice-cream bars. Often when you have decreased sweets for a time, you will stop craving them as much.

chillie: When cooking according to portion sizes, is that before or after cooking? For example 12 oz. chicken, 1/2 cup rice, etc.?

Maxine_Smith_RD_LD: Typically, it is after cooking.

lily: What are the advantages/disadvantages to sugar substitutes? I have heard reports stating that sugar-free products are not always better for you.

Maxine_Smith_RD_LD: The use of sugar-substitutes is advocated for weight loss as a replacement for sugar. Some, such as sucralose, are considered safe even during pregnancy, and the most common are approved by the FDA for safety. There is some controversy as to the possibility that they may stimulate appetite, although the research at this time does not strongly support this.

Making Choices

leaper: It seems that I have to make so many changes in my diet to eat well, and then I get frustrated and give up? What can I do?

Maxine_Smith_RD_LD: Set one or two goals to work on each month, such as " I will eat a serving of vegetables with lunch and dinner daily." Reaching one new goal will drive you to set another new goal and you will continue to improve your diet.

bell_tower: I am trying to eat more cheese because I do not like milk and my doctor tells me I need more calcium for my bones, but my daughter says cheese has a lot of fat? Should I be eating more cheese or not?

Maxine_Smith_RD_LD: Cheese is rich in calcium but, unfortunately, in the full-fat/"regular" version, it is laden with the unhealthy saturated fat. There are many lower-fat cheeses available. If you are not melting the cheese (such as on a salad), consider a fat-free cheese. If you are melting the cheese, look for a 1.5% or 2% cheese, or a soy-based cheese. You may also consider a calcium supplement. Discuss this with your physician.

fish_food: I don't get much sun, as I work indoors and in the north; and I am concerned that I don't get enough vitamin D. My mom has osteoporosis and I don't want the same to happen to me. How can I get more vitamin D in my diet?

Maxine_Smith_RD_LD: Many Americans are concerned with this nutrient. Most of the vitamin D in the United States is consumed from fortified foods, including milk, fortified breakfast cereals, and some fish such as salmon and tuna.

weezer2: Are there other sources of cholesterol to limit consumption besides eggs? I do have a 'just over the border' cholesterol number and will limit to two eggs per week, but where else should I look to cut down?

Maxine_Smith_RD_LD: Cholesterol is found in animal products, particularly higher-fat animal product. So choosing non-fat dairy products, non-fat/low-fat cheese, and lean protein foods (look for those with 3 gm. of fat or less per oz. -- read the Nutrition Facts!) will help to decrease cholesterol intake.

nbarney: What's the deal with nuts?

Maxine_Smith_RD_LD: Nuts have been highly promoted as a part of a healthy, Mediterranean diet, and they are associated with less heart disease and other diseases. However, they are loaded with calories. A shot glass-full four to five days a week is a good amount, or lay out your nuts on a 3x3 sticky note, not a paper towel. Some nuts are higher in saturated fat -- such as cashews, macadamia nuts, and Brazil nuts -- so focus on the others.

kristen: I am looking for different daytime snack ideas other than just a piece of fruit or vegetables?

Maxine_Smith_RD_LD: These are some options: trail mix, low-fat yogurt, peanut butter on whole grain crackers, popcorn, and salsa or hummus with baked chips. Try a fruit and vegetable dip made from yogurt or low-fat salad dressing; kid's love to dip!

jjb: How can you help make yourself feel full? I am trying to watch what I eat and my portion sizes, but I’m always feeling hungry even after eating.

Maxine_Smith_RD_LD: Research suggests that high-protein foods and high-fiber foods promote a feeling of fullness. Also, the weight of foods and beverages affect satiety. Drink plenty of non-caloric fluids and be sure to identify if you are truly "stomach" hungry.

sally: In your opinion, what is the best milk to drink? There are so many different options out there.

Maxine_Smith_RD_LD: Unsweetened, non-fat cow’s milk and unsweetened soy milk are going to provide the most complete protein. Rice milk and almond milk are lower in protein.

sabrina: Is Cool Whip® bad for you if you are trying to substitute for real whipping cream? What is the difference between regular, light and fat-free?

Maxine_Smith_RD_LD: The fat-free whipped products are the best, yet are still high in sugar. Light will be reduced in fat, while fat-free will mean less than 0.5 gm. of fat per serving.

Dietary Guidelines

charlie: Buying good foods can be very confusing. What you have been told is good or bad, you are later told are not so good or so bad (i.e., yogurt, cheese, eggs, juice, etc.). How do you make an honest but informed decision?

Maxine_Smith_RD_LD: Nutrition research continues to be refined, and as it is, a food that was once considered to be a healthy food may not be and vice versa. Fresh foods that are minimally processed are typically going to be healthy foods. Dairy foods and meats should be chosen in their lowest fat versions. The 2010 Dietary Guidelines For Americans (DGA) is a great resource that is based on a vast amount of evidenced-based research. Google 2010 Dietary Guidelines and you will find the report.

Clapper: What are the current guidelines?

Maxine_Smith_RD_LD: The key recommendations include:

  • Increase fruits and vegetables.
  • Consume at least 1/2 of your grains as whole grains.
  • Increase your intake of fat-free or low-fat milk/milk products.
  • Choose a variety of protein foods.
  • Increase the amount and variety of seafood, and choose seafood in place of some meat and poultry.
  • Replace protein foods that are higher is solid fats with those that are lower calories and solid fats.
  • Use oils to replace solid fats.
  • Choose more nutrient-dense foods.

Check out the entire document! Google 2010 Dietary Guidelines and you will find the report.

daddyo: I have heard that you shouldn’t eat much beef or pork – mostly chicken and fish. What are your recommendations? I do not like fish and I am starting to grow feathers!

Maxine_Smith_RD_LD: The Dietary Guidelines don't promote a red meat restriction but DO promote using a variety of lean protein sources in the diet. If you do not like fish, include protein sources such as nuts; nut butters; legumes (such as kidney beans and garbanzo beans); soy products, such as tofu or soy crumbles; eggs; and lean dairy products for protein sources.

jacksprat: What are the ‘real’ recommended food portions? How do they vary with age? My teenage sons eat a lot at meal time.

Maxine_Smith_RD_LD: Food portions have definitely grown out of proportion over the years; however a rapidly growing child may need larger portions of food. The DGA has a handy chart in Appendices 6 and 7 that will provide suggested calorie needs and the portions of foods to meet those needs within the particular food groups. It is very handy!

The Grocery Store

Cathytoth: I understand that when going to the grocery store, they say it is very important to have a list prior to going, so that you stay on track with your purchases. What does a good healthy list consist of?

Maxine_Smith_RD_LD: Think of the perimeter of the store. Include lots of fresh fruits and vegetables on your list to start. Then add low-fat dairy products such as fat-free milk and yogurt, fat-free or low-fat cheeses. Add lean protein sources such as seafood, fresh poultry, and lean meats. Whole grain breads, pasta, brown rice, and other grains can be included, as well as unsalted nuts and seeds. This could be the foundation of your grocery list.

Jkettering: What tips do you have on navigating the grocery store to make healthy purchases?

Maxine_Smith_RD_LD: As stated before, stay around the perimeter. Go with a list and stick to the list! Choose fresh foods to start. Frozen vegetables and fruits, if unadulterated with lots of sauces and sugar, can also be healthy foods. Limit the processed meats.

juju: Do you have any programs where you actually take people out to the grocery store and teach them how to make better choices when shopping? Something like this might be more easily understood when experienced firsthand

Maxine_Smith_RD_LD: Participants in the Lifestyle 180® program have this opportunity ( Heinen's stores also provide Cleveland Clinic dietitian speakers in the stores at selected times.

Family Matters

sabrina: Do you have any suggestions for picky eating toddlers? My daughter has a daily vitamin, but does not want to eat fruits or vegetables. Help!

Maxine_Smith_RD_LD: I know this is frustrating but be patient! A child may need to be introduced to a food 10 times or so before it is accepted. Sometimes "sneaking" small chopped or pureed vegetables into a sauce or into a casserole can disguise them. Putting them in a fruit smoothie is another, well-received option. Also try preparing them in a different manner, such as roasting vegetables that can be a "finger-food."

jackwhite: My children eat healthy, regularly meals. They also eat a lot of junk food throughout the day. Some I buy, but mostly they buy themselves or share with friends. They are not overweight and get plenty of exercise. Is this OK?

Maxine_Smith_RD_LD: It sounds as though you are doing your best to provide healthy meals for your children and are promoting healthy eating habits. Choosing foods high in added sugars and solid fats, which are abundant in many "junk foods," may increase risk of disease down the road. However, even after eating healthy foods and meeting their needs, there are about 300 calories or so left for the "junk" or the SoFAs (added sugars and solid fats). One "junk" food a day is a good rule. Encourage healthy snacks such as nuts and low-fat string cheese.

hello: What are my options when I have three kids and am working off a very strict budget? Eating healthy is very expensive.

Maxine_Smith_RD_LD: There are several tactics you can use. First of all, buy generic or off-brands. Often a company will market the same product under a generic and a name brand. Shop at discount stores and choose produce that is in season and possibly on a reduced rack. Great soups can be made from slightly old vegetables. Ripe fruits can be frozen in chunks and used for smoothies. Potatoes and eggs are less costly and packed with nutrition. "Thin" more expensive foods -- such as meat -- with nutritious whole grains -- such as brown rice or whole wheat pasta.

patterns: When cooking for a family with members of various ages, how do you account for ages when trying to come up with a balance ‘family’ diet?

Maxine_Smith_RD_LD: Healthy foods are basically the same for all ages, and it is good to introduce the healthier versions of foods at a very early age so that their tastes become acclimated to those foods. The portion sizes, of course, will vary amongst the ages.

Food Labeling

swings: When looking at a food label, what is the first thing you should look at?

Maxine_Smith_RD_LD: It really depends on what your goal is. If you are trying to lose weight compare calories on similar products. If you have high blood pressure and are trying to limit salt, compare sodium on labels. If you have a high risk for heart disease you may want to focus on saturated fat and cholesterol. Decide what your goal is and this will guide you; otherwise, you may be overwhelmed!

BNP: I am trying to increase whole grains but am very confused by the labeling. How can I tell if the bread I am buying is whole grain?

Maxine_Smith_RD_LD: It can be very confusing and the labeling may be quite deceptive. Just because something says, "made with whole grain", "cracked wheat", "15 grain", "steel cut", etc. does not mean that it is whole grain. If a product states it is “100% WHOLE grain” or "whole" is the first word on the ingredient label, it will contain significant whole grain.


flowers: My blood pressure is high. I don't have a lot of time to cook, so I buy a lot of frozen dinners, but they are so high in sodium. Do you have any suggestions?

Maxine_Smith_RD_LD: Look for those containing 500 to 600 mg. (or less) of sodium per serving, and complement the meal with some fresh fruit and/or a salad that is naturally low in sodium. Use non-commercial salad dressing -- such as oil and vinegar -- as condiments can be quite high in sodium. Also, look for frozen meals that are specifically designed to be lower in sodium.

lowdown: I have been hearing lately that sea salt is the better salt for you. What do you think?

Maxine_Smith_RD_LD: Salt is salt! It is the sodium that counts and they are both high in sodium.

General Questions

nystrom: What is the difference between a dietitian and a nutritionist?

Maxine_Smith_RD_LD: In some states, anyone can call himself or herself a nutritionist. A registered dietitian however, has a minimum of a bachelor's degree and has completed an internship followed by an exam that then credentials him or her as a registered dietitian.

tell_it: It seems that there are so many overweight Americans. Is this just my perception or a lot of hype?

Maxine_Smith_RD_LD: No. You are absolutely correct. This is a big problem that individuals, public policy makers, and food companies have to work together to solve. About 70% of adults and 30% of children are overweight.

msjazmine: Is there a way to "save" fresh herbs. I buy them but they tend to waste away, i.e., cilantro, parsley, basil, lemon grass, etc.

Maxine_Smith_RD_LD: Absolutely. To make them last a bit longer, put the stems in a glass of water in your refrigerator. You can also freeze them; they won't look as pretty when thawed, but can be used in salad dressings, soups, etc. Frozen herbs are also sold in some store (typically in "tubes")

nystrom: So, is whole wheat the same or different from whole grain? And which is better?

Maxine_Smith_RD_LD: Grains can be confusing! Food companies may want to portray a food as being healthier than it is and use some deceiving terms. Whole wheat is a type of whole grain so they are both considered healthy. Whole corn, whole oats, and whole rye are examples of other whole grains.


Cleveland_Clinic_Host: I'm sorry to say that our time with registered dietician Maxine Smith, RD, LD is now over. Thank you again Maxine for taking the time to answer our questions about 'Grocery Shopping to Optimize Nutrition: Will the New Guidelines Affect Your Choices?'

Maxine_Smith_RD_LD: Thank you for joining me in this chat! I enjoyed answered your questions and hope that this will help you in your grocery store choices.

More Information

Thank you for chatting with us today. Part of Cleveland Clinic's Digestive Disease Institute, our Center for Human Nutrition is one of the only centers in the nation offering comprehensive services, including specialized teams for nutrition therapy, intestinal rehabilitation and transplant nutrition, and nutrition support.