Friday, September 15, 2017

Lemon Parm Pasta - Printer

Lemon Parmigiano Pasta

This is one of my favorite spring and summer pasta dishes.  Requested often when I visit my friends or they come over for dinner.  In addition, it is quick and easy.


Ingredients:

  • 1/2 lb long pasta (spaghetti, fettuccine, etc.)
  • 1/2 onion, chopped
  • 3 lemons (zest of 2 lemons)
  • 1/3 cup olive o
  • 1/4 cup fresh parsley
  • 1/3 cup freshly grated Parmesan 
  • salt/pepper
Total Time: 30 minutes

Start by putting a large pot of water on the stove, as this recipe will not take long to make.


Heat a large skillet big enough to hold the pasta, add the olive oil and onions.  After a few minutes, add the zest of the two lemons and juice from 2 and 1/2.  Reserve the other 1/2 for garnish.  Let cook for about 10 minutes on a medium to low heat (this is called infusing the oil).  Cook the pasta until almost done (al dente), and then add directly to the oil mixture.  You may want to add a little pasta water to moisten up the dish.


Next, add the parsley and salt/pepper and mix.  Turn off the heat and add the parmesan.  Transfer the pasta to a serving bowl, and garnish with lemon slices, more cheese, and parsley.



AmountIngredientsSodium (mg)Phosphorus (mg)Potassium (mg)
1 lb.Pasta - Spaghetti or Fettucini

182
42
1/2 cup Chopped Onion



1/2 cup Olive Oil



1/2 cup Parmigiano Reggiano
28
172

3Lemons

14.3
58
1/4 cup Fresh Parsley




Salt/Pepper









Total for whole recipe
28
368.3
100

Recommended daily intake (Non CKD)
2300
700
4700
2 ozPortion size
7
92.075
25


0.30%
13.15%
0.53%
4 ozPortion size
14
184.15
50


0.61%
26.31%
1.06%


One of the factors we face when attempting to cook healthier meals is finding the right ingredients. All too often we as patients are given broad generalizations about certain foods. The problem is that not all items in those generalizations are created equal


The example in this recipe is Parmesan Cheese. Many people may use those green cans you buy in the grocery store. This is parmesan cheese as many people know it. The problem arises when you read the ingredient list. Among the small about of cheese - not even Parmesan by the away - are a variety of additives including cellulose. Cellulose is a natural component of many plants. A very common food additive and often wood pulp is the cheapest option. Now this isn't going to harm most people, even though it dilutes the product and you will end up using more to get the flavor you are looking for.


In patients with CKD, the kidneys are not going to easily process the added items in your food, because they are not doing their job in the first place. There are other items in this product that only add to shelf life. None of which is good for any of us.


Even those solid parmesan block pieces that are not made in the specific regions of Italy have additional ingredients that are only necessary to make the product cheaper. A true Parmesan cheese only has three ingredients: Milk, rennet (all cheese needs this), and salt. That's it. And it England and Italy if you want to call your cheese Parmigiana, you can't add anything else. It's the law. No such law in many other countries including the U.S. As a matter of fact, Parmesan really doesn't have any guidelines in those other countries.


So why does this make a difference? For one if you use the real stuff you will use less to get all the flavor you are looking for, and thus lowering your phosphorus intake. Second, by using a Parmigiana-Reggianno, you will add enough flavor that you can use less added salt to your food. Less sodium in your diet will mean you will retain less fluid. This is important because carrying extra fluid stresses the body between dialysis treatments, and also is harder on the body when removing it.


Good luck, and eat well!


Pasta/Squash/Carrots/Cream Sauce - Printer



 This dish is based on a very popular food trend, squash spirals. I don’t use a “sprializer” in this recipe, but feel free to break yours out if you have one lying around. You can also buy those pre spiraled packages of veggies that are often found in the produce department. 

     I prefer to use my peeler and and strips with similar shaped pasta like pappardelle or linguine. Having similar shapes will allow you to sneak in some veggies in a dish for those who might be averse. 
    The ease and speed of this recipe allows for you to make a quick meal that will look and taste like a chef stopped by the house to cook for your family. In addition, the kidney friendly nature of this recipe won’t deter those at the table who don’t have those difficulties. 
Ingredients:
  • 1 lb. linguine or pappardelle or other wide pasta
  • 1 zucchini
  • 1 yellow squash
  • 1 cup heavy cream
  • 1 medium sized carrot
  • 3 cloves garlic
  • 8 leaves fresh basil
  • 2 tbsp butter
  • 1/2 cup freshly grated Parmigiana Reggiano
  • Salt/pepper
Directions:
Start by placing a large pasta pot with 4 to 6 quarts of water on the stove and bring to a boil. This dish will not take too long, so once you start cooking your pasta it  won’t be long. 

Peel your squash and zucchini in wide strips. I like to use the skin, so i clean the veggies well before peeling. You will get to the seeds at the center, and that’s where I like to stop. Peel the outer layer of the carrot and discard, them peel as much of the carrot in the same way as the squash and zucchini. Set all the veggies on one plate.


Heat a large skillet that will fit all the pasta on medium heat and melt the butter. As soon as the butter is melted add the minced garlic and saute for just a few minutes. Garlic is sensitive, and if it burns, all the fat that is cooking in will be ruined and you should start over. Burnt garlic cannot be saved, nor the fat it burnt in. 
If you are using dried pasta if will take about 8-11 minutes to cook, about the same time it will take the finish the sauce. If you using fresh pasta, that will only take a few minutes, so time your “pasta in the water” accordingly.
Once the garlic has begun to create an aroma in the kitchen, it’s time to add the heavy cream.  You will want to let the cream reduce about 1/3 to thicken up the sauce. About halfway through the thickening process add the basil to flavor the cream with the herb.
If you have a steaming basket that will fit on top of the pasta water, place the the squash, zucchini, and carrot strips in the basket. Once you add the pasta in the water, put the veggie basket on top of the water and steam veggies while the pasta cooks. 
**The steaming of the veggies will retain more of the vitamins and minerals. Alternatively, cook the veggies in the cream sauce while the pasta cooks.  I like my veggies a little crisp, but you can certainly cook them longer. 
Once the pasta is nearly done, remove the veggies from the steamer and directly to the sauce. This will also flavor the sauce a bit more. 
Next, remove the pasta from the water and add directly to the sauce to finish cooking, stirring to thoroughly mix the pasta, cream sauce and veggies. 
When the pasta is fully cooked, turn off the heat and add the Parmigiana Reggiano cheese, mix, and serve.



More Information

Below you will find the nutritional information for this recipe.   In the past we have been guided to restrict the fat content in our cooking for better health. This long standing thought is being challenged by several new studies.  Although those with high levels of the bad cholesterol should are still considered "at risk" when it comes to the consumption of fats in their diet. 

In addition, the newest studies are now suggesting that certain fats have not been proven to be the biggest culprit in cardio vascular disease. Obesity, diabetes, and the amount of processed sugars in our diets causing those issues have a stronger link than certain saturated fats. 


When we eat foods that may have less calories, we are likely to replace those missing calories with other foods. And often those foods may contain higher levels of minerals that are not good for the CKD patient.


Phosphorous in heavy cream is significantly lower that in all other milk products and because of the higher fat, and thus higher calorie count, you will tend to eat less in your  and keep the phosphorous levels lower in your end product.

Click here to learn more about how this issue.

AmountIngredientsSodium (mg)Phosphorus (mg)Potassium (mg)
1 lb.Pasta - Spaghetti or Fettucini

182
42
2 ClovesFresh Garlic
1.5
13.8
36
2 tbspsButter
3
6.8
6.8
1/2 cup Parmigiano Reggiano
28
172

1 cupHeavy Cream
46
74.4
96
2 tbspFresh Basil (10 to 15 leaves)
0
2.9
15.5
1Zucchini
12.4
47.1
325
1Squash, Yellow
2.6
41.6
276
1Carrot
88
44.8
410
















Total for whole recipe
91
585.4
1207

Recommended daily intake (Non CKD)
2300
700
4700
2 ozPortion size
11
73.175
151

% RDA per portion
0.49%
10.45%
3.21%
4 ozPortion size
23
146.35
302

% RDA per portion
0.99%
20.91%
6.42%

Chicken French - Printer



This recipe is full of good proteins that we all need. They are considered High Biologic Proteins, but the meal will be a little high is phosphorus, so remember to take your binders, if appropriate.

Chicken French served with a a side of pasta and spinach.

2 lbs. Boneless Skinless Chicken Breast - I split them horizontally so they are even and thin.

Ingredients
  • 1 cup all purpose flour

  • 3 eggs

  • 1/4 cup freshly grated Parmesan

  • 1/2 cup olive oil or vegetable oil for frying

  • 1/4 lb (one stick) unsalted butter

  • 2 lemons - zest and juice needed.

  • !/2 cup Sherry wine - You can use another dry white wine, if you want to experiment

  • Fresh garlic is also an option when you make the sauce. I prefer mine without. 

  • Salt/Pepper

  • One more lemon for garish

Start by slicing your chicken breast lengthwise, so you have thinner and consistent sizes for frying.

Next prepare your breading station, just 2 parts in this recipe.  Place your eggs in one bowl, and whisk.  Combine your flour, salt, pepper, and Parmesan in the next bowl and mix thoroughly.

Set up a frying pan on medium high heat large enough to hold half of the cut chicken.  Add your oil to warm up while you prep the chicken.

Dip the chicken in the egg mixture and hold over the bowl to drain well. Now run the chicken through flour mixture and let excess flour fall off. Place on a separate plate and continue with chicken until you have enough to fill the frying pan with one layer.

Place the chicken in the frying pan carefully and cook for about 5-6 minutes per side, or until the chicken reaches a golden brown color on each side.  I like to prepare the next batch of chicken while the first is frying. Flip the chicken once, and remove to a clean plate when done.


The chicken can be prepared ahead of time and finished when you are ready to serve dinner.

The sauce is where we find some controversy in the recipe.  Amounts and type of alcohol vary, and I am a big fan of finding your own sweet spot through experimentation. My recipe is a little lemon friendly, but I like it that way.

I have used the same frying pan (with most of the excess oil removed, but not the "bits" from the breading).  On a medium heat level, add the butter and let melt in the pan.  When the butter is almost melted, add the lemon zest and juice. Let sit for a about 2 minutes and them add the wine.  Turn up the heat to a medium high, and let the sauce reduce and thicken.

Friday, September 8, 2017

Hot Sauce recipe. Video/Survey



Click the photo to watch the video

A very quick survey below. 
It is very important to get your feedback about the video, content, and the presenter of the video. This will help us make future videos.


This project has been a pilot program so far and we hope to be able to continue producing these videos. By filling out this brief survey, you will be helping us and possible funders evaluate the interest in this type of program.  Thank you so very much for your support. 

Click here for Print Version

Tuesday, September 5, 2017

Squash and Carrot pasta in a cream sauce - Video





The surveys are meant to assist us in making these videos.  We need to hear your opinions and your ideas so we can continue to make more videos. Thanks for your help

A story of Proteins.

       




 Proteins. We hear plenty about them in our discussions about health and nutrition. They are another necessary aspect of diet for all individuals. For Chronic Kidney Disease (CKD) patients the discussion is even more important, and it changes as the disease progresses. 

What is a protein? Well, Webster (that’s a dictionary for you younger folk) defines protein as a nutrient found in food, such as meat, milk, eggs, and beans. Proteins are made up of chains of amino acids with varying sizes. Sounds like high school science class again. Ugh. 

Proteins and amino acids are the building blocks of life. That makes them really important. They help the body build and repair tissues. They are needed for strengthening bones, muscles, skin, and blood. If you are a dialysis patient this is extremely pertinent for all those needle sticks and the risk of infection.
   
Ok, so these proteins have chains of amino acids each of different length and combinations. (I know, science - but it will be short and will be helpful in the end)

Amino acids are broken down into three categories. 
1. Essential
2. Nonessential

3. Conditional

There are 9 essential amino acids ( I’m not going to list all the scientific names). They are they ones that the body cannot produce itself and we get them from the food we eat. 

CKD patients are tested for Albumin in their blood each month. This looks at the protein levels in the body that come from these sources.

The nonessential amino acids are ones that our bodies will produce even if we don’t get it from the food we eat. 

The conditional amino acids are ones that our bodies don’t need unless we are sick or the body is in stress

So, essential amino acids are ones that our bodies need and we have to attain through food  

Ok, a quick bit about kidney disease. CKD covers a range of patients, and the stages are designed to correlate to kidney function each individual has at a given time. You may hear your doctor or caregiver talk about your "GFR". Hold on, I'll try to make this easy. 


Glomerular Filtration Rate (see why they use the abbreviation?) is a math formula that takes into account a bunch of different things: Age, race, gender, serum creatinine rate, etc. Let's leave it at that. It's the best way to figure out how well your kidneys are filtering your blood.

If your doctors say you are in Stage 1 though 4 (Stage 5 or End Stage Renal Disease requires dialysis) you will be told to limit your protein intake. The proteins are larger molecules and the kidneys will have a hard time removing them from the blood. If you are at Stage 5, dialysis will remove the proteins from the blood, and often quite a lot of it. 


Once you are at Stage 5, you are told to start to increase your protein intake again, but in a limited manner. Remember to talk to your doctor about the specifics for you. 

That brings us to the food with these essential amino acids that are the building blocks for proteins. Have I lost you yet? I hope not because this is important stuff.

Not all proteins we eat will have all the essential amino acids. Those that do are called proteins of high biologic value. Proteins that are missing one or more of the essential parts are considered of low biologic value.  More science terms. When will it end.

Biologic value is determined by how fast and efficient the body can use the nutrients absorbed in proteins. 

Yes, this is all pretty important for our diets.

You can also combine certain foods with proteins that might be of low biologic value themselves, but together they will provide the body with all the essential amino acids and become high biologic value foods. 

I find this interesting when you look at foods throughout history that have been combined and how they make high biologic values proteins. Certain foods have lasted through long periods of time and been maintained as a staple in many diets.  

Some examples are rice and beans, hummus, pasta fagioli (pasta and beans). Typically the ingredients in these foods are inexpensive and readily available. Combining them provides all the essential amino acids the body needs - especially when meat products were not easily obtained or too expensive. 
For CKD patients these combinations also raise the level of phosphorus in our diets. Healthy kidneys will dispense of the excess phosphorus but the CKD patient does not. 

This buildup of phosphorus in our bodies can cause calcium deposits in our veins, arteries, and other organs. It can also cause changes in our bodies that lead to pulling the calcium from our bones making them weaker. 

Anyone who has been on dialysis will  tell you that phosphorus is a big concern for the patient, as we are constantly being monitored and told about our levels. In addition, your nutritionist will ask lots of question about your weekly diet to help you cut out items that may be causing an elevated level in your blood work. 

That makes some of these food combinations good on the protein count, but bad on the phosphorus count. 

But we still need to get our protein up and keep our phosphorous levels in range. Each food item is going to have a rating for essential amino acids. Some of the high biologic  level proteins are eggs, chicken, and beef. These also have higher levels of phosphorus, but often not as high as those combinations discussed above. 

We will try to provide you with recipes that can help you get those proteins with food that we hope you will enjoy, without elevated phosphorus and other danger minerals in your body.  And please remember to talk to your doctor and nutritionist to help you guide your specific needs.

Below you will find links to the recipes so far.

Recipes:

Protein Diet Program Articles and links









Lemon Parmesan Pasta Video/survey


Lemon Parmesan Pasta Video






 We do not ask for any personal information. The survey is to get your feedback about the the video content, production, and the quality of information. 

Please take a few minutes to give us your feedback. 

Thank You!

Monday, August 14, 2017

Milk and Phosphorus


Milk and Phosphorus

Chronic Kidney Disease (CKD) patients, and especially those on dialysis - referred to as End Stage Renal Disease (ESRD) - are told to limit the intake of milk and dairy products. 

The reason for this is the nutritional contents of milk. One cup of whole milk (8 oz.) contains about 10% of the recommended daily intake (RDI - I know, so many initials to remember), 22% of phosphorus, and 23% of saturated fat. That’s very high for a glass of milk.  Especially because you will find phosphorus in nearly all of the foods we eat. So getting almost one quarter of your RDI in a small glass of milk could  push you over the recommended limit. 

So why is this a problem? People with functioning kidneys can process out excess amounts of nutrients through urination. Have you ever heard the joke about certain vitamins and supplements? It just creates expensive urine. 

That’s right, if you ingest more nutrients that your body needs, you just pee it out. That’s not to say that there isn’t value to those supplements, it means you should listen to your doctor or dietician about what your body is deficient in, and the appropriate amounts needed to supplement. 

For those of us with depleted kidney function, our bodies don’t process out the extra minerals like phosphorus. The result is that those minerals stay in our blood and can do damage to our bodies. The National Kidney Foundation (NKF) website tells us “High phosphorus levels will end up pulling calcium from our bones, making them weak.” This can lead to dangerous calcium deposits in blood vessels and other organs. None of that is good. 

Controlling the phosphorus in CKD patients is left up to diet and binders in pill form, that don’t allow for absorption of all the phosphorus into our system. Of course they also have some unpleasant side effects. and some of those pills are hard to swallow, both figuratively and literally - they are fairly large.

So that’s why high phosphorus is a problem, especially in CDK patients. 

With all this information it’s easy to see why nutritionists and doctors tell their patients to limit their intake. 

But there are some positive sides to these products, especially if you have ESRD and are on dialysis.  They have lot’s of protein and other nutrients which we need like vitamin A and B12. 

To begin with let’s discuss the contents of milk.  One of the big concerns is the fat (we will discuss that issue later and in another section). Let’s look at exactly what we are drinking: 
                         Milk Product           Fat Content

Whole 3.25%
Reduced Fat            2%

Low Fat 1%

Skim 0%



Milk comes out of the cow as whole milk. Making the lower fat products is done using a “separator”, spinning the milk fat out of the whole milk to the desired level of fat content.  But all of these lower fat products contain higher amounts of Phosphorus and Potassium than most nutritionists like to see in a serving for dialysis or CKD patient. In fact, lowering the fat content in milk slightly increases the amount of phosphorus and potassium. 

“Wait a minute. Higher you say?” Yes. Not only do I say it, but so do all of the nutrition data experts, and scientists. The reason for this anomaly is that by removing the fat you are increasing the concentration of the other parts that make up milk, and thats where most of the Phosphorus and Potassium live. 

Milk is made up of about 87% water, 3.5% proteins, 3.7% fat, 4.9% lactose, and .07 % minerals (This is by weight, hence the slight difference in fat by volume.) Separating the milk fat from the rest of the milk increases the concentration of the products left in the lower fat milk. Since we are removing a lower concentration part from the higher concentration part, what’s left will have more of those nutrients by volume.  

In addition, by spinning out the fat molecules, you also remove some of the fat soluble nutrients that milk provides. After the spinning process, Vitamin A and D are usually adding back into the product, making it fortified. 

Speaking of labeling on Milk (weren’t we?), pasteurization is a heating and holding process that destroys organisms that can cause disease, without hurting the nutritional content of the milk or other product. Thanks Louis!

Next the milk is homogenized. Why? I’ll tell you why. Remember the old way of making cream - letting the milk sit for a short while and having all the fat rise to top and skimming it off? Of course you do. Well, homogenization is another spinning process that standardizes all the fat molecules to a small size, thus making it more difficult to separate on the stores refrigerator shelf, or anywhere else for that matter.  

Why is all this important to CDK patients? Understanding. The more we understand about the food we eat the more we will be able to evaluate all foods to help us with a healthier diet for our disease. 

So what about some of those other milk based products? For instance, the cream that in removed from the milk? Good question and I’m glad you asked. 

Let’s look at the phosphorus and potassium content in some of these products in one cup of each product. The RDI is in parenthesis:

Product Phosphorus Potassium Calcium 

Whole Milk    222 mg (23%) 348 mg (10)      276 mg(28%)    

2% milk 245 mg (25%) 397 mg (11%) 314 mg (31%)

1% milk 245 mg (25%)    397 mg (11%) 314 mg (31%)

Skim             276 mg (28%)    448 mg (13%) 352 mg (35%)

1/2 and 1/2 230 mg (23%)      315 mg (9%) 245 mg (25%)

Heavy Cr.    148 mg (15%) 178 mg (5%) 155 mg (15%)

Light Cr.      146 mg (15%) 232 mg (7%) 165 mg (16%)

As you can see, going from whole milk at 3.25% milk fat to skim increases all three minerals in each product. Using heavy cream drops all three of these in half, and diluting the heavy cream to decrease the fat content, starts to bring in back up , but not to levels of of the other milk products. 

This chart is a little deceiving.  While it is very reasonable to drink or use 8 oz of whole milk or the lesser fat products, you would not be very likely to consume that much heavy cream in a serving. If you are someone who puts milk or cream in your coffee, you are likely to use more of the less fattened up product than with the higher fat products. 

In a recipe I always use heavy cream instead of any other milk product. This may sound counterintuitive based on all the mental beatings we have been through concerning low fat diets, and low fat products. But as you see in the chart, it lowers some of the dangerous minerals in the diet of the CKD patient. 

As for the fat content, there is plenty of new data from current and more professional studies that are telling us that fat is not the problem we have been led to believe it is.  It does not increase the cause of heart disease. It does not increase your bad cholesterol enough to cause problems, unless you are genetically predisposed to high cholesterol. 

In fact, it is not even the cause of obesity. The new studies are showing that sugar, more specifically processed sugars, are linked to obesity, high LDL cholesterol (the bad one), diabetes, and other related issues including heart disease.  I will go into more detail about fats in another section on this site, but the basic principle in some studies is that when we reduce the good fats in our diet, we end up replacing the calories from those fats with something else. That something else is usually sugar, and more specifically processed sugar. This is where we find ourselves consuming products that cause the above mentioned problems.  

This has led me to discount the large concerns about higher saturated fat products concerning my health and diet, for better control over proven risk factors for CKD patients, like phosphorus and potassium. 

In essence, I use Heavy cream for my recipes and I avoid most low fat products. The extra fat in the heavy cream will make you fuller, faster. With the calories coming from foods that I know about, rather than snacks and foods I do not know about, I can help control the dangerous levels of phosphorus in my diet. 


Links to recipes on this topic:

Pasta and Squash in a Cream Sauce


Here are some links to sources I have used for information above: