Dietitian's Journal

Wednesday
Jun122013

An Honest Kitchen "Makeovers"

Today on the dietitian's side of Green & Berries I'm pleased to feature a guest post by Kathyrn Elliott and Lucinda Dodds who have just released issue #6 of An Honest Kitchen, their beautiful, appetizing and intelligent digital publication about cooking, eating and enjoying "real food that's good for you." 

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Kathryn and I (Lucy) were challenged by a reader to makeover some classic recipes, to give the An Honest Kitchen treatment to some favourite family meals, we jumped at the opportunity. What a fun idea, one with a practical and healthy outcome.

We researched what types of meals people turned to most often and what we discovered was that a lot of recipes, particularly traditional ones, required a pathetic amount of vegetables. We knew straight away that many could do with a makeover right there. If you're going to eat five portions of vegetables per day, the minimum required for good health, then dinner will probably – for most of us - need to contain at least three. That's not going to happen if a recipe asks for one carrot and half an onion between four people.

We also discovered that cutting back on the amount of oil you cook with, and on the cream and cheese while you’re at it, works a treat, with no compromise on flavour if you use other flavouring tools. Plus, keeping a good sense of what the proportions of your plate should look like by following our 50/25/25 rule (see below) keeps everyone happy and healthy.

Here are some of our thoughts on how to makeover any recipe you already love:

Double the vegetables.

Simply to double (or triple) the quantity of the vegetables given in any recipe. (Although you don't need to do this with ours!)

It's easier to add extra vegetables to your meal if you chose those which take a similar amount of time to cook. Pay attention to whether the recipe you want to makeover uses relatively quick cooking vegetables (e.g. zucchini, snow peas and spinach) or ones which take longer (e.g. carrots, pumpkin (winter squash), beetroot and onions).

Canned tomatoes and frozen peas count! Adding these can be a convenient way to get more vegetables into soups and stews particularly.

A half or whole bunch of chopped spinach or other greenery right at the end of the cooking works almost every time.

If in doubt, add a big green salad. One handful of salad is roughly equal to one vegetable portion.

Cut back on the oil you use

We find almost everything can be cooked in one or two tablespoons of olive oil.

Keep some measuring spoons by the stove as pouring by eye alone can be wildly inaccurate.

Start the cooking off at a slightly lower temperature than normal when using less oil, and stir more regularly at the beginning to prevent food sticking or browning too quickly.

Cut back on or replace the cheese and cream

If a favourite recipe uses cream you can use either natural yoghurt or yoghurt that has been whisked together with some ricotta in its place. If you're using just yoghurt, stir this through at the end, right before serving, to prevent it from splitting.

Reduce the overall quantity of cheese used, and make it a strong tasting cheese like vintage cheddar, feta or parmesan to boost flavour.

Instead of cream and/or cheese to lift a meal, try mustard, fresh herbs, sundried tomatoes, shoyu, chilli or citrus. Any of these can help the flavours to hum beautifully.  

Change the portions on your plate

Make vegetables about half of the bulk of each meal.

There's no need to go “carb free”, but aim to make the grain or potato portion of your meal about ¼ of the bulk on your plate. Cook less of these foods and replace some of them with vegetables.

Think about whether you need to reduce your portion of protein containing foods like meat, chicken, fish, eggs and tofu. Aim for a piece of meat or chicken the size and thickness of your palm, or a piece of fish the size of your hand. As a general rule, make the protein portion of your meal about ¼ of the bulk on your plate.

A good rule is the 50/25/25 rule, a simple guideline to what your dinner plate should look like - 50% vegetable, 25% protein and 25% cereal (or potato).

So. What does a Makeover recipe look like? I’m glad you asked.

Macaroni & Cauliflower Cheesy Bake

Our inspiration for this was, of course, the traditional macaroni cheese. For our Makeover version we've added in plenty of vegetables; cauliflower and frozen spinach, plus some red lentils which are cooked in with the pasta. You’ll be getting at least three portions of vegetable per serve. By making a lighter sauce based on yoghurt, ricotta the calorie/kilojoule is drastically reduced. Easier, healthier and still delicious. Makes 4 serves

1 small - medium head of cauliflower, about 800g (a generous 1 ½ lbs)

180g (6 ½ oz) macaroni

¼ cup red lentils

90g (3 ¼ oz) frozen spinach

10-ish sprigs of fresh thyme

6 pieces sundried tomato

70g (2 ½ oz) strong tasting Cheddar

½ cup natural yoghurt

150g (5 ¼ oz) fresh ricotta

1 tablespoon wholegrain or Dijon mustard

1 slice wholegrain bread

1 tablespoon parmesan

1 large handful of mixed leaves per person

Preheat the oven to 220°C (430°F).

Chop the cauliflower & cook the pasta: Bring a large saucepan of water to the boil. While you are waiting for the water, very roughly chop the cauliflower. Once the water is boiling add the macaroni and red lentils. Cook for about 4 minutes and then add the cauliflower and frozen spinach. Continue cooking until the pasta is al dente and the cauliflower is soft. Drain, making sure you reserve some of the cooking water.

While the pasta is cooking, make the cheese sauce: Remove the thyme leaves from the stalk and place these in a large bowl. Roughly chop the sundried tomatoes and grate the Cheddar. Add these to the thyme, together with the yoghurt, ricotta and mustard. Mix well. Once the macaroni and vegetables are cooked, pour these into the cheese sauce. Add ¼ cup of the reserved cooking liquid. Season with lots of black pepper and then gently fold together, so the ingredients are well combined. Don't worry if it looks a bit sloppy at this stage.

Make the crunchy topping: Place the wholegrain bread and parmesan on a chopping board and run a knife through, chopping until the mixture resembles very rough breadcrumbs.

Bake the pasta: Tip the pasta and cauliflower into a baking dish. Scatter the bread and parmesan mixture over the top. Place in the oven and cook for 15 - 20 minutes, until the topping is golden brown.

To serve: Place a large handful of salad leaves on each plate and then serve with the Macaroni and Cauliflower Bake.

 

For more ideas on making over the meals you love take a look at our publication An Honest Kitchen: Makeovers.

An Honest Kitchen is a regular publication all about real food that's good for you. Each issue is full of simple recipes, practical cooking information and healthy eating advice. Our latest edition, Makeovers, in which we revamp popular meals is available in e-format from 11 June.

(All photographs above by Lucinda Dodds)

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Giveaway: I (Elaine) wholeheartedly agree with Kathryn's and Lucy's healthy eating philosophy and appreciate their great ideas for making over recipes to enhance health without compromising flavour. As a dietitian, I want to help promote their work. So I will be purchasing a copy of An Honest Kitchen, Makeovers (Issue #6) to give away to a lucky Greens & Berries reader. To enter, comment on this post. You can simply say "count me in" but feel free to share your favourite tip (Kathryn's and Lucy's or you own) for making over a favourite family recipe. The contest will run until the end of June July 15th when I will draw a random number & award the prize to the corresponding comment number. Good luck and good eating to all!

Wednesday
Mar202013

"Do not let your patients starve....[feed] by the safest, simplest, most effective route"

Hello, all. This is a surprise to you as much as me: posting two days in a row. I've decided to follow my impulse and begin featuring the resources listed in the previous entry.

First, a resource commissioned by the National Institute for Health and Clinical Excellence (U.K.) in 2006:

National Collaborating Centre for Acute Care, February 2006. Nutrition support in adults - Oral nutrition support, enteral tube feeding and parenteral nutrition. National Collaborating Centre for Acute Care, London (PDF)

Although this resource is several years old, I discovered  it only this past January while I was searching the literature on enteral nutrition delivery topics (e.g., methods, schedules, transitions).  

As the Foreward states (and we dietitians know so well):

Malnutrition is both a cause and a consequence of ill-health. It is surprisingly common in the UK [Canada, too, I would add - ee], especially in those who are unwell. Many older people and those with any long-term medical or psycho-social problems are chronically underweight and so are vulnerable to acute illness. Even people who are well-nourished eat and drink less if they are ill or injured and although this may only be short-lived as part of an acute problem, if it persists the person can become undernourished to an extent that may impair recovery or precipitate other medical conditions (page 2).

Also from the Foreward:

The aim of these guidelines is to improve the practice of nutrition support by providing evidence and information for all healthcare professionals, patients and their carers so that malnutrition whether in hospital or in the community, is recognized and treated by the best form of nutrition support at the appropriate time....

[M]any of the recommendations in this guideline are derived from a combination of clinical evidence, clinical experience and expertise. Many are also quite general, applying to all patients with malnutrition whatever their disease or care setting. However, all healthcare professionals who have contact with patients should find the recommendations relevant for we believe that they contain an obvious, simple message:

'Do not let your patients starve and when you offer them nutrition support, do so by the safest, simplest, most effective route.’

Other versions of this guideline, including a quick reference guide (PDF), are available on the NICE Nutrition Support in Adults Web page.

If you are a clinician working with malnourished patients or clients, I highly recommend you add this valuable document to your library. I've found it to be a practical -- and necessary -- complement to the key A.S.P.E.N. documents I refer to in everyday practice, including the 2009 Enteral Nutrition Practice Guidelines.

Tuesday
Mar192013

Favourite Enteral Nutrition Resources

Hello, all. Welcome to my first post of 2013 -- just in time for the Vernal Equinox. Much as I love to blog, I've had to set aside this activity to create time and mental space for another series of workshops at which I'm a presenter.

As part of my preparation, I've been digging deep into the literature. (And yes, I'm still digging in the garden -- more on this soon). I've added new resources to my frequently used favourites and would like to share some of them with you now.

 

Enteral Nutrition (Tube Feeding)

Key references for guidelines, standards and safe practices

American Society for Parenteral & Enteral Nutrition (A.S.P.E.N.) Professional Resources

Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, Lyman B, Metheny NA, Mueller C, Robbins S, Wessel J and A.S.P.E.N. Board of Directors. A.S.P.E.N. Enteral Nutrition Practice Recommendations. JPEN J Parenter Enteral Nutr. 2009;33:149-167.

National Collaborating Centre for Acute Care, February 2006. Nutrition support in adults - Oral nutrition support, enteral tube feeding and parenteral nutrition. 

Ethics

Blackmer J. Artificial feeding post-stroke: A medical and ethical perspective. 2010. [Presentation slides in PDF format. Available for download from the Champlain Regional Stroke Network Web site] 

Fluid & electrolyte balance

Basic Principles of Fluid and Electrolyte Balance (free e-book available on the ESPEN site.)

Dickerson RN, Brown RO. Long-term enteral nutrition support and the risk of dehydration. Nutr Clin Pract. 2005;20:646-653.

Whitmire SJ. Nutrition-focused evaluation and management of dysnatremias. Nutr Clin Pract. 2008;23:108-121.

Gastroenterology

Matarese LE. Nutrition and fluid optimization for patients with short bowel syndrome. JPEN J Parenter Enteral Nutr. 2013;37:161-169. 

University of Virginia School of Medicine, Articles in Practical Gastroenterology, Enteral Nutrition

 Home Tube Feeding

Brown PA, Quesada O, Scott F. Tube feeding using the bolus method. [Patient information fact card. ©2006 Memorial Sloan-Kettering Cancer Center, 2009.]

The OLEY Foundation  - Founded in 1983 by Lyn Howard, MD and her patient, Clarence "Oley" Oldenburg, the Oley Foundation is a national, independent, non-profit 501(c)(3) organization that enriches the lives of patients dependent on home intravenous (parenteral ) and tube feeding (enteral ) through education, outreach, and networking. The Foundation also serves as a resource for consumer's families, clinicians and industry representatives, and other interested parties.

Coping Well with Home Enteral Nutrition: Words of Wisdom from Resilient Adult Consumers - The Utah Dietetic Association developed this self-help manual.  “Resilient HEN consumers who participated in a research study provided the majority of the information and strategies. They offered suggestions and insights based on their personal experiences."  This document is stored on Lucy's Real Food for the Tube, another site worth exploring.

Saturday
Nov102012

An Honest Kitchen #5: "Seasonal Desserts"

A
house is beautiful not because of its walls,
but because of its cakes.

~ Old Russian saying

 

T
here is a place for dessert, even in the healthiest of diets and to be honest, without the occasional dessert, life would be blander, paler and a lot less sociable.


     ~ An Honest Kitchen, Seasonal Desserts
by Kathryn Elliott & Lucinda Dodds

 

Because I wholeheartedly agree with the "old Russian" and believe Kathryn and Lucy have created something very special with Seasonal Desserts, I've purchased two copies of this e-Magazine to give to two very lucky Greens & Berries readers.

And I'm going to keep this post short and sweet.

Simply stated, Seasonal Desserts makes my cooking tastier, healthier and more creative. Here's why:

1) Nutrition savvy: Kathryn Elliott writes in an engaging, sensible, positive way on how to eat well without feeling deprived.
2) Warmth and beauty: Lucy's gorgeous film photographs are visual comfort food.
3) Reliability: Recipes have been triple-tested recipes to ensure consistent results.
4) Honesty: Recipes consist of basic, wholesome ingredients and clearly-explained methods.
5) Deliciousness:  The creative ingredient combinations please the palate.
6) Value: The 60-page (PDF) e-Magazine features ten seasonal recipes, many more healthy eating and food preparation tips, seasonal food guides and a wise reflection on the benefits of "a cup of tea", which I highly commend to myself as much as you, dear readers.

Berry and Hazelnut Cranachan

Chocolate Date Honey Balls

Disclosure: I was a recipe-tester for two recipes in this issue; you can see the results from my test kitchen in the preceding photographs. But I'm also a dietitian and try to be a critical, honest, fair evaluator. I followed the recipes exactly and the results were delicious and, in real life, much prettier. (My kitchen doesn't have the best light and I'm not a skilled food stylist.) The photographs, however, are truthful and authentic, which is in the spirit of An Honest Kitchen.

How to win a copy of Seasonal Desserts? Just leave a comment here. You're welcome to simply say "hello, count me in." But I'd love if you shared a story about how a dessert made a special or everyday occasion sweeter, brighter and more sociable.

You can double your chances of winning by going to my newish blog, More Greens & Berries, and leaving a comment on any post.

And though I have my biases about recipes, cookbooks and food bloggers I will be completely unbiased when selecting the two winning entries. Each comment will be assigned a number in consecutive order, based on its time stamp, and I'll use an online random number generator to select winners. (You can read more details in the fine print, below.)

Good luck to all!

 

An Honest Kitchen links:

An Honest Kitchen (new web site)
Limes & Lycopene (Kathryn Elliott's Web site)
Nourish Me (Lucinda Dodd's Web site)

 

The fine print about the give-away:  Excluding my immediate family, any dessert-lover in the world -- and beyond -- can enter! I will be purchasing two copies of the e-magazine, Seasonal Desserts, and sending the download link to two randomly selected commenters, one commenter on Greens & Berries, and one commenter on More Greens & Berries. I will be assigning each comment a number in chronological order based on the time stamp of the comment; i.e., the first commenter will be #1, the second #2, etc. I'll be using a random number generator to select the winners. Contest closes at midnight (2400 hrs, PST) Friday, November 16th.

Tuesday
Nov062012

I'm back with a give-away....

Details in the next post but here's a hint about the give-away item.

And if you're curious about my whereabouts and whatabouts during the past few months, I've balanced a very busy 5 months of work with gardening, long walks with Piper to favourite places, and a few weekends in the country.