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Wednesday, July 24, 2013

Rice-topped Shepherd's Pie (dialysis diet)

This one is mostly for me. I originally started this blog as an easy way to share the couple dozen recipes I recommended frequently to people who needed to prepare meals in advance, but it's also been useful for me to document how I've changed recipes that I want to make again.

So this is one of those recipes.  It's from a cookbook called Cooking for David that provides recipes for folks on dialysis.  I'm cooking for a loved one who has been experiencing worsening chronic kidney disease (CKD) and is now receiving dialysis treatments.  Side note...Boy, have I learned about food and the kidneys lately.  Lemme tell you, if you've been diagnosed with diabetes (and CKD is likely in your future if you have poorly managed diabetes) and think the diabetic diet is restrictive, that's NOTHING compared to the CKD/dialysis diet.  Keep your kidneys (and pancreas) healthy people...life is not fun when they don't work.

So back to the recipe...you don't futz with dialysis recipes.  This is so hard for me.  There's a pretty strict limit on potassium and phosphorus intake, in addition to sodium, protein and liquid limits and it's different for each patient.  Unfortunately, potassium and phosphorus are nutrients that aren't required to be listed on nutrition labels the way sodium, carbohydrates, protein and fat grams are so it's hard to know just how much you're getting unless you follow a tested recipe very closely or use a renal diet food analyzer like this one: http://www.davita.com/food-analyzer/

Also unfortunately, the foods that are high in potassium and phosphorus are healthy foods...whole grains, many fruits and veggies, nuts and beans, dairy products.  "Low sodium" products are also a minefield as most aren't simply made with less salt, but with a potassium salt substitute (not necessarily a bad thing for those of us with functioning kidneys...in fact here is a report of a study suggesting that more than high sodium intake alone, a combination of high sodium and low potassium puts you at higher risk for cardiac problems... but it's problematic for renal patients. Also a reminder that when buying packaged foods, "low" anything oftens means "substitute" rather than just "less" of whatever the reduced ingredient is).  So again, the takeaway is that you follow the recipe, don't add extra veggies (crazy, right?), don't substitute whole grain products and read labels.

Shepherd's Pie is a family fave here.  I was excited to see a kidney-friendly recipe that substituted low-potassium/phosphorus white rice for the usual high-potassium/phosphorus potato-cheese crust (did you know that a potato has more potassium than a banana...my dance teacher always said that, but I thought she was full of it).  It did use a lot of high-sodium sauce additions though..."no salt added" beef stock, additional beef bouillon granules, Worcestershire sauce, Kitchen Bouquet (who even has this any more anyway?).  I checked the labels on all my stock/bouillon/sauce options and settled on a vegetable base bouillon made without potassium salts and a healthy slug of red wine (which I also checked on the Davita food analyzer) instead of all that other stuff.  I made it with long grain white rice...I might try arborio rice next time for a creamier, more potato-y texture.

And so to bring it all back to where I started...my husband requested that I make a note of what I did so I can make this recipe again in the future...soon, preferably.  No pictures because I prepped it ahead for my family to cook on my late night at work.

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Sunday, July 7, 2013

Prosciutto Jalapeno Poppers

This is the quick'n'easy version of The Pioneer Woman's jalapeno poppers (which is delicious).  I made these guys with half jalapenos and half sweet mini peppers to give my kids a non-spicy option.  Worked very well.

The OR calls for a cheddar-cream cheese-scallion mixture that I circumvent by using herbed cheese such as Boursin or Laughing Cow, or when I ran out of that, sticks of Brie (yes, Brie is my "backup" cheese LOL)

The OR also calls for wrapping the poppers in pieces of uncooked bacon which is scrumptious.  I happened not to have any bacon on hand, but I had prosciutto so I used that (yes, prosciutto is my "backup" pork product LOL).  The nice thing about using the prosciutto is that it's already cooked so the cooking time for the poppers can be (read: needs to be) shortened from the hour originally called for.  I think using long, narrow strips of thin-sliced ham could work too in lieu of prosciutto or bacon.

The OR also calls for brushing the poppers with barbecue sauce or jelly such as apricot jelly.  I think beer jelly or garlic jelly would be OUTSTANDING here, but no sauce/jelly on top is good too (and is what I did this go-round).

I have made these in vast quantities for parties and you can absolutely make them ahead and freeze them.  I dithered about whether to freeze them before cooking or after, and decided that after cooking was less likely to result in a squishy jalapeno shell (since freezing uncooked veggies tends to make them, well, squishy).  I "revived" them for the party by baking them again for about 30 minutes to heat through and crisp the bacon back up.  To make them in advance to freeze, pull them out of the oven about 10 minutes before the final cooking time.  That way, the 2nd round of baking doesn't overbrown or burn them.

You can use toothpicks if you need to get the bacon/prosciutto/ham to stay in place, but it's a lot less time-consuming and easier to eat if you just wrap them so that the ends of the meat slice are on the bottom of the pepper.  Gravity will do the rest to keep them in place.

Lastly, the OR offers a variation wherein you place a thin slice of peach on top of the cheese before wrapping in bacon. This sounds weird, but is ohmygawd good...I highly recommend it.

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