Category Archives: Specialized Diets

Monitored, restrictive and Specially prepared Diets

Mooie!

enteral-feeding
Night Feeding Via Pump

Ok it’s been a while since I been able to add a new recipe so here goes.  I’m dedicating this to 2 young tubie warriors.  This ones for you, kiddos!

Three years ago, right before Matt had his hip surgery, his digestive tract started giving him problems again.  I was trying to avoid putting him on laxatives so I developed a green smoothie that I had hoped would help him.  I originally put fruit in it and offered it to him to drink.  He liked it (sort of) but he only drank 2oz.  I knew that was not enough to work so I went back to the drawing board.  Then it dawned on me.  He has a g-tube!  He doesn’t need to drink it so I can remove the fruit and add more greens!  It worked.  The added greens allowed me to add more fiber without fighting with him about the taste.  Now when I give him a bolus feeding or hang his bag for his night feeding he smiles and says, “Ooh! Mooie!  Yup.  You got it.  That’s where the name came from.

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Bolus Feeding

Since each child and adult that are g-tube dependent have different issues, I caution you to check with your doctor before changing a feeding regimen and, if you get the ok to to try this, add small amounts at first and watch for adverse effects.  I do not recommend making this smoothie with anything else but a Vitamix.  The Vitamix blends the green so finely that there are little or no leave particles to get caught in the filter of the feeding bag.  If the filter gets clogged that feeding stops and the alarm goes off.  It’s less of a problem for bolus feeding but, if there is difficulty in breaking down solids, it could cause issues.  This is the one that worked for Matt:

  • 1 Cup of peppermint or chamomile tea
  • 2 Tablespoons Organic apple cider vinegar
  • 1oz fresh Aloe Vera (optional)
  • 2oz Avocado
  • 3 Cups packed greens (your choice)
  • 4 tsp organic olive oil
  • 1/4 cup fresh basil leaves

Makes 2 8oz smoothies.  I have also added 1 tsp of fresh pureed ginger when Matthew’s stomach was more upset than usual.  Feel free to experiment with different greens.  Sometimes I will buy the large bag of Power greens or spinach from Costco along with Romaine lettuce hearts.  I also keep a close eye on the local farmer’s market for greens that are on sale.  Parsley is great because it helps settle the stomach.

Hemp Seed

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I recently joined a group that focuses on blenderized diets. Originally my goal was to share my experience in order to help others with g-tubes live healthier lives.  Little did I know I was going to need their help as well.  Because Matthew is getting older and in need of more calories but not able to handle large volumes, I posed a question to the group regarding “milks” that were high in calorie.  Hemp seed milk (something I hadn’t heard of) was on the list.  Since this was coming from a group of people that had lot’s of experience, I began looking into it.

What I found was, it is yet another super food.  So, as always, I dug deeper.  Here’s what I found:

  • Hemp seeds have 9 grams of protein per serving.  They contain all of the essential amino acids making them a complete protein.
  • They are a good source of iron and Zinc.
  • They are an excellent source of Vitamin E, Magnesium and Phosphorus.
  • There is also 2.8mg of Manganese which is 140% of the DV.

Hemp seeds are also over 30% fat but they are rich in omega-3 and omega-6 which is more than both chia seeds and flax seeds.  These fatty acids, in balanced proportions, have been linked to a host of health benefits“The typical American diet contains 14 to 25 times more omega-6 fatty acids than omega-3 fatty acids, which many nutritionally-oriented physicians consider to be way too high on the omega-6 side.

The Mediterranean diet, on the other hand, has a healthier balance between omega-3 and omega-6 fatty acids. Many studies have shown that people who follow this diet are less likely to develop heart disease.”

One bit of information I found was very important to know.  Matthew has a condition called Chronic Thrombocytopenia.  Due to a severe infection he had at the age of 4, Matthew has a lower than normal number of platelets in his blood.  Since platelets are the part of the blood that allows clotting to occur, it is important for me to know that the oil in hemp seed may slow blood clotting.  this is why it is so important for anyone being followed by a physician for any medical condition should research any and all super foods that hit the market and, check with and/or inform your doctor if you have or are interested in adding them to your diet.

Sometimes people have g-tubes and don’t have a lot of other medical conditions so just trying out this healthy high calorie food.  Still others, like Matthew, are so complicated medically that research has to be done before even considering it.  Healthy or not, medically complicated or not, my treat all super foods the same.  See what is being said and check it against other websites.  Health food websites tend to only give the health benefits and not the side effects or contraindications.  Medical websites will sometimes do just the opposite.  I choose to look at both sides and decide whether or not it’s something that will benefit Matthew or make conditions worse.  If I am unsure, I check with his doctors.  I especially make sure to alert his GI doctor of any dietary changes I have made.  I also don’t give him anything I haven’t tried myself.

In closing, I follow the “less is more” rule.  In other words, just because a super food has some really enticing health benefits, ingesting lots of it can cause problems.  Look for sites that will give you therapeutic doses and stick to them.  Our goal is to stay out of the doctor’s office, not end up in one.

Hemp Milk

  • Servings: 8
  • Time: 3 minutes
  • Difficulty: Very Easy
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Hemp milk is by far the easiest dairy milk substitute.  There is no cooking and, with the Vitamix, there is no need to run it through a filtration bag.  It is very calorie dense with lots of protein.  It tastes great as is but I’ve added a couple of ingredients for folks who like their milk substitutes a little sweeter.

Ingredients

  • 1 cup hemp hearts
  • 2 1/2 cups of water
  • 4 pitted dates
  • 1 cup of water
  • 2 teaspoons of vanilla

Directions

  1. Place hemp hearts, dates and 2 1/2 cups of water into the Vitamix into the container and secure lid.
  2. Select Variable 1.
  3. Turn machine on and quickly increase speed to Variable 10, then to High.
  4. Blend for 1 minute.
  5. Turn machine off and remove lid.
  6. Add the remaining cup of water and the vanilla and secure lid.
  7. Select Variable 1.
  8. Turn machine on and blend for 30 seconds.

 

Food Tips:

  • It is a good idea to slice the dried pitted dates lengthwise before putting them in the Vitamix.  This will ensure that no part of the pit was left inside during processing at the plant.  I have yet to find any literature that says they are dangerous but the pieces can clog g-tubes.  Even if a piece gets through it could cause problems in the GI tract of someone who already has difficulty processing solid food.
  • If you have time, soak the dates and hemp seed for 30 minutes before blending.  This reduces the amount of sediment and completely removes the need for straining or filtering.
  • One cup of fresh hemp seed milk has about  194 calories.  It has 10 grams of protein and 14 grams of fat so, unless you have a high caloric need, I suggest sticking to the 1/2 cup serving size.  Hemp milk will stay fresh in the refrigerator for 3-4 days.  Drink it straight or add it to smoothies.  It is also a great base for blenderized meals.
  • As with all “Super Foods” take the time to research and steer clear of the idea that “if less is good, more is better.”  This is very important if you are dealing with specialized or restricted diets, on medications or have various health conditions.

 

Time Tip:  Freeze any portion of the milk that will not be used in 3-4 days in ice cube trays.  Store the cubes in labeled and dated freezer bags for up to 6 months.  Since each cube is about an ounce, you can quickly grab what you need without wasting any.

 

Money tip:  Shop around before buying hemp hearts.  They can run as high as 12 dollars a pound in some stores and on line.  Winco has the lowest price at $7.02 a pound.  They can be found in the bulk food section for much less than the prepackaged bags.  It is good to alternate seed/nut milks.  If you are on a tight budget, alternate the types of nut/seed/bean milks you make to save money.  This is also important especially for individuals on blenderized diets to insure balanced nutrition.

 

The Poopinator


The Poopinator was lovingly named for it’s ability to move “mountains” (insert laughter)! I had reached the end of my rope, tied a knot and was hanging on for dear life when the knot unraveled. Matthew’s KUB showed that he was backed up again and the GI wanted me to do another “clean out”.  Matthew does not suffer from constipation in the typical sense (hard stools).  He suffers from slow transit constipation and lack of sensation so he can’t feel when he has to go and I wanted him off Miralax. We had done it before (more times than I care to remember) but this time was particularly bad. Needless to say I (and I’m sure Matthew) had had enough so I reached out to my Facebook group, “Blenderized RN” for help. I got lots of suggestions for foods that work as laxatives. I tried several individually but they didn’t work. So I put on my mad scientists lab coat and glasses and went to work. And so The Poopinator was born!  No more Miralax!

Ingredients


1 once pureed celery
1 once pureed pumpkin
1 once pureed butternut squash
1 once pureed papaya

Directions

  1. Combine all ingredients in a bowl or small jar and stir.
  2. Using a 60cc syringe, draw up mixture making sure to expel any air bubbles.
  3. Give bolus at a rate that is comfortable for your child.  For example, Matthew does well if I give 20mls at a time and wait 5 minutes in between.
  4. Finish with a water flush.  Use whatever volume your child can handle.  I use 15ccs because Matt can handle it.

If 1 once of each item is too much volume, you can cut them in half. You can also start with only 1 item and see how it works before adding another.For convenience I blend the ingredients separately, freeze them in ice cube trays and store them in labeled and dated freezer bags. That way you use exactly as much of each ingredient without wasting any. Because he gets his bolus in the afternoon, I take out the cubes I want in the morning, put them in a small mason jar and let them defrost in the refrigerator. Be sure to warm the jar slightly before giving the bolus so you don’t end up with an upset stomach.

Here are some other foods that can have a laxative effect: Prunes or prune juice, fresh spinach, black strap molasses, peaches, pears,pineapple, orange, apricots, plums, soaked raisins, flax seed and flax seed oil,Aloe juice and fresh Aloe Vera,coconut oil and sweet potatoes.

Since everyone’s system is different, some things may work too well (causing diarrhea) and some not at all. It can be frustrating but don’t give up. Try foods independently or, like I did, create your own cocktail. Like any good recipe, just remember to write it down so the items and amounts stay consistent.

Homemade “Ripple Milk”

  • Servings: 8
  • Time: about 1hour 5 minutes
  • Difficulty: easy
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The first time I had ever heard of this was on a Facebook group called blenderize RN. Having a teenage boy on a blenderized/pureed diet can be difficult at times. Because of his complicated GI tract and minimal oral experience, it’s hard finding things he can and will eat without slowing his digestion down. Since Matthew drinks his formula, I wanted to increase his calories and protein without adding more formula but do it in such a way as to not upset his very restricted palate. Enter “Ripple” (aka split pea milk). Since everything I blend for him is homemade, I thought I would try making it myself. I added 1 cup to his normal formula recipe and he didn’t even notice. It was so easy and inexpensive, I just had to share.

Ingredients

  • 1 1/2 cups of cooked yellow split peas
  • 3 1/2 cups of water
  • 2 tsp vanilla (optional)
  • 4 pitted dates

Directions

  1. In a medium size sauce pan, bring 1 cup of dry yellow split peas and 4 cups of water to a boil.  Boil for 10 minutes on high then reduce temperature to simmer and cook until peas are soft (about hour).
  2. In the large Vitamix container, add ingredients in the order listed and secure lid.
  3. Select Variable 1.
  4. Turn machine on and increase speed to Variable 10, then High.
  5. Blend for 1 minute or until completely smooth.
  6. Remove milk from blender and repeat steps 2-5 with remaining peas.

Food Tip: This recipe makes a total of 10 cups of milk.  It is thick so if you plan on drinking it, you may want to thin it out a bit.  With 75 calories per cup and 8 grams of protein, it makes an excellent addition to a blended diet.  It can also easily replace cows milk in baking for those who have a dairy free diet.  Milk will stay fresh in the refrigerator for about 4 days.

Time Tip:  Make the full batch and freeze extra milk in ice cube trays then store in labeled and dated freezer bags.  Each cube is about 1 once making measuring a  breeze.

Money Tip: One pound of dry split peas cost around 70 cents a pound at bulk food stores like Winco.  Ripple milk runs about $4.29 for 48oz.  Since I only used 1 cup of dried beans, I made 80oz for only 33 cents!

Raw Coconut Milk

  • Servings: 8
  • Time: 30 minutes
  • Difficulty: easy
  • Print

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When I was a little girl growing up in Massachusetts, one of my favorite memories was making coconut beans and rice with my grandma. It was an old family recipe from Jamaica that was made during the holidays. When we were making it, the wonderfully sweet smell of fresh coconut filled the house. I can remember sitting at the kitchen table with a cheese grater grating the coconut meat by hand and placing it on cheese cloth. I can also remember the stern look I got from her when she caught me sneaking a piece to nibble on. It was my dad’s job to “milk” the coconut. The cheese cloth containing the shredded coconut was tied and placed in a pot of boiling water for 20 minutes then squeezed and measured. My dad was the only one tough enough to handle the job. All of this took lots of time but the final dish was like no other. It was a labor of love so we didn’t mind.

Fast forward to the present. Because of the Vitamix, I can make fresh coconut milk in a fraction of the time, no scraped knuckles from the grater, with less mess and nary a burn from scalding water.

Ingredients

Prepare fresh coconut

6oz fresh coconut meat

4 cups of water (total)


Directions

  1. Place coconut meat into the container and secure lid.
  2. Select Variable 1.
  3. Turn machine on and quickly increase speed to Variable 10, then High.
  4. Blend for 30 seconds or until a fine mash is formed using the tamper to press the coconut meat into the blades.
  5. Turn machine off, remove lid, scrape container with a Vitamix spatula, add 2 cups of the water and replace the lid.
  6. Select Variable 1.
  7. Turn machine on and quickly increase speed to Variable 10, then to High.
  8. Blend for 1 minute then pour contents into a Vitamix filtration bag to extract the milk.
  9. Return the mash in the filtration bag to the Vitamix container and add the remaining 2 cups of water.
  10. Repeat steps 6-8.

Food Tip: Save the coconut water extracted prior to removing the meat from the shell to drink separately.  Coconut milk is VERY high in fat calories so watch how much you drink (about 256 calories per 4oz serving). It is an excellent way to boost the calories in a blenderized or pureed diet for people with volume intolerance. Raw coconut milk will only stay fresh in the refrigerator for 4-5 days so freeze any unused milk and/or coconut water in ice-cube trays and store in dated labeled freezer bags. Always test for allergies by giving a small amount (1-2 tsp) over the course of 4-7 days.

Time Tip: Coconuts typically contain 12-14 oz of meat. Freeze any unused meat in a dated and labeled freezer bag for future use.

Money tip: Coconuts are less expensive during the holidays so stock up, process and save.

For more information on picking and processing fresh coconuts, please see my blog post on that topic.

Basic Blend

This is one of those “what we had for dinner” blends.  The picture and the recipe are spoon thick because it can just as easy be used for someone on a pureed diet.  To make it thinner for bolus or pump feeding, just add more turkey stock or bone broth if you happen to have some.  You may notice that the stock is green.  That’s because I blended the meal right after I had made a green smoothie.  By not washing out the container, I saved time and water.  Plus all of the extra nutrients from the green smoothie are now in the dinner blend!

1/2 cup of turkey or chicken stock

2 cups steamed or raw broccoli

1/2 cup brown rice

6oz (approx. 1 cup) cooked turkey or chicken

  1. Place all ingredients in the container in the order listed and secure lid.
  2. Select Variable 1.
  3. Turn machine on and quickly increase speed to variable 10, then to High.
  4. Blend for 1 minute, using the tamper to press the ingredients into the blades.

Food tip: This recipe is great for starting out.  None of the ingredients are commonly associated with food allergies.  Raw broccoli is a little harder to digest so, if the blend causes gas, steam the broccoli first.

Time Tip: If you are blending for a little one, freeze the blend in ice cube trays for quick easy 1 oz portions.  Depending on the caloric need, use batch blending and store in feeding specific quantities.

Money Tip:  Buying meat on sale is the best way to save money. For example, I buy an extra turkey during Thanksgiving and keep it in the freezer.  I cook it up some time later as a Sunday dinner, turn some of the leftovers into turkey enchiladas and setting aside at least a cup for blending.  Then I boil the carcass to make a a quick turkey stock or, if I have time, turkey bone broth.  Also, buy broccoli in bulk at a club store.  Use as much fresh as you can eat in 4 days and steam the remainder before freezing in 1-2 cup portions for later use.

 

 

Matthew’s Green Smoothie

ATTENTION: Make sure to get clearance from your doctor before trying any blenderized diet.

My Helper
My Helper

1 cup of peppermint or chamomile tea
2 oz of Avocado
2 oz of fresh Aloe Vera (optional)
3 cups of greens
Makes 2 cups

Bolus Feeding Syringe
Bolus Feeding Syringe

1. Place all ingredients into the Vitamix in the order listed and secure lid.
2. Select Variable 1.
3. Turn machine on and quickly increase speed to 10, then to High.
Blend for 1-2 minutes or until very smooth (no visible leaves).

Night Feeding Via Pump
Night Feeding Via Pump

Food Tip: When using this smoothie in the enteral feeding pump, it is vital that there are no leaf particles. Because the bag tubing, extension tubing and g-tube are all small in diameter, small bits of leaves can get caught and cause the pump to alarm and stop the feeding due to “No flow out”. Green smoothies do not work well without some type of fat in them. Outside of the health benefits, that’s why the avocado is added.Also, if formula is normally given, it is best to combine the smoothie with the formula and mix well. It has been my experience that straight green smoothies without the formula mixed in tend to separate. The pureed greens are lighter than the water so the water will go though the pump leaving the greens stuck in the feed bag.  If Aloe Vera is used it must be food grade.  Do not use fresh Aloe Vera unless you know how to properly prepare it.

Time Tip: How much smoothie to give depends on total volume and tolerance. It is best fresh within 2-3 days so I store the remaining smoothie in a container that allows me to shake it up before pouring.

Money Tip: Since they are going to be blended, buy greens in bulk and freeze any portion you do not use within 3-5 days. That way there is no waste from greens gone bad in the refrigerator.  Fresh frozen greens such as kale and spinach break up easily once frozen allowing for easy measuring and blending.

Hirschsprung’s Disease

Because this blog is a recipe blog as well as  an informative blog, I will often use links to pass on information.  Because of content, some information has no place in the context of my recipes.  This is such a link. It will explain the disease so you can get a better picture of what struggles I have balancing Matthew’s diet.  Matthew’s condition was surgically corrected at 8 months old.  The surgeon was quick to tell me that he is unable to tell the quality and the quantity of the remaining nerve cells in Matt’s colon so future problems could arise. And arise they did. When I post about the green smoothie I now use in his feeding pump, I will reference this link in “Did You Know?”:

http://www.mayoclinic.org/diseases-conditions/hirschsprungs-disease/basics/symptoms/con-20027602

Pureed Whole Grain Pancakes

All of my pureed diet recipes must pass a taste test.  I feel, if I won’t eat it, why would anyone else?  I sampled this recipe and it a tasted like an amped up Cream of Wheat.  I had one of my girls taste it and she cleaned the plate!

GE

1/3 cup of water
4 pancakes (or 4oz by weight)

  1. Add ingredients the Vitamix container in the order listed and secure lid.
  2. Select Variable 1.
  3. Turn machine on and increase speed to Variable 10.
  4. Blend for 10-15 seconds using the tamper to press the ingredients into the blades.

Food Tip: Serving this warm with maple syrup has all of the flavor of my whole grain pancakes minus the chewing. Increase or decrease the water 1 tablespoon at a time to reach the desired consistency.

Food Tip: If fiber needs to be restricted, use my whole grain pancake recipe but use ½ cup of oat flour, ½ cup quinoa flour and ½ cup of all purpose flour instead of the combination listed.

Money Tip: Of course you can use a prepared pancake mix or frozen pancakes but those will always more expensive.

Time Tip: As with all of my pureed recipes, any leftovers can be frozen in ice cube trays and stored in Ziploc bags for future use.