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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.

Rice-topped Shepherd's Pie
Makes 6 servings

1 1/4 lbs. ground beef
1/2 cup chopped onion
1/2 cup chopped carrot
1 tbsp fresh herbs (savory, marjoram, rosemary, thyme, sage, parsley would all be good here)
1 tbsp flour
3 tbsp red wine
1 cup vegetable bouillon (1 tsp veggie base + 1 cup water)
1/2 cup frozen peas
pepper to taste

3 cups cooked white rice (from 1 cup dry)
1/2 cup low fat sour cream
1/4 cup egg beaters

Brown the beef over medium-high heat.  It's ok if a little sticks to the bottom of the pan, just don't abjectly burn it.  Add the onion and carrots and saute about 5 minutes over medium, until softened.  Add the herbs and flour and cook 1 minute.  Pour in the wine, scraping up all the browned bits from the pan.  Add the peas and bouillon and simmer until thickened, about 5-10 minutes.  Season with pepper to taste.

Meanwhile combine the rice, sour cream and egg beaters.  Spread the meat mixture in a deep 9x9 pan or other 3-quart-ish casserole dish.  Spread the rice mixture on top.  Wrap well.  Fridge or freeze, if desired.

To bake, thaw the casserole if needed (if you're using a ceramic or glass pan, let it stand about 30 minutes at room temp before putting in the hot oven).  Bake a cold casserole 30-45 minutes covered at 400F (if you've just prepped the casserole, skip this part).  Then uncover and bake another 10-15 minutes until the top is lightly browned.

Calories: 388
Carbohydrate: 33 g
Potassium: 426 mg
Phosphorus: 232 mg
Sodium: 256 mg

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