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PLANETS texture modified recipe book

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A texture modified recipe book for patients with cancer of the oesophagus or stomach A texture modified recipe book for patients with cancer of the oesophagus or stomach Contents Introduction 3 Patient stories 4 From the dietitian 8 From the Chef 9 Purée food 10 Purée breakfast recipes 12 Purée soups 16 Purée main meals 20 Purée side dishes 30 Purée desserts & snacks 34 Drinks & supplement recipes 38 Soft & bite sized diet 40 Soft & bite size breakfast recipes 42 Soft & bite size main meals 46 Soft & bite size side dishes 54 Soft & bite size desserts & snacks 56 Introduction This recipe book aims to provide you with a selection of easy to prepare, high calorie and protein recipes of a suitable purée or soft texture that may be helpful during chemo or radiotherapy or following surgery for oesophageal or stomach cancer. The recipes in this book will make larger portions than you may be able to manage, so you will be able to divide them into several smaller portions. Each recipe will indicate if it can be stored in the fridge or frozen. Ensure you defrost food thoroughly and cook through. What is texture modification? A texture modified diet will contain carefully selected foods of an appropriate consistency which can be more easily managed if you are struggling with swallowing or pain on eating, or healing following surgery. Food fortification In order to help minimise weight loss, especially when you may only be able to manage small portion sizes it can be helpful to ‘fortify’ your food to maximise its nutritional content. • Avoid foods labelled as ‘diet’ or ‘light’ and choose full fat dairy products. • Add extra butter, cream, evaporated or condensed milk to increase calories. • Add fortified milk to drinks and foods. (see recipe below) Fortified milk recipe • 1 pint (approximately 600ml) full cream milk • 4 heaped tablespoons (60g) skimmed milk powder 1. Add milk powder to a small amount of milk and mix to a paste. 2. Gradually add the remaining milk. 3. Store in the fridge and use instead of normal milk. 2 3 Patient stories The following are advice and tips are from patients with oesophageal or stomach cancer who have followed a purée and soft & bite sized diet... Gordon Oesophagectomy August 2018 Early in 2018 I was diagnosed with cancer of the oesophagus. I had three cycles of chemotherapy after which in August 2018 I underwent an oesophagectomy at Southampton General Hospital. Initial foods by mouth consisted of purée foods including scrambled egg and soups. I was initially also receiving the bulk of my nutrition through a Jejunostomy feeding tube, which was weaned down and stopped in February 2019. I was provided both in hospital and at home with high calorie/protein supplements in the form of Fortisip. We (my carer was an active participant in finding an acceptable diet, a situation I would consider as being almost essential) then tried various commercial varieties such as ‘Complan’. For the first few weeks after leaving hospital I didn’t feel thirsty at all and again my carer became concerned that I would become dehydrated. Given the restricted room available for food intake in my re-arranged insides there was always a tussle for space between solids and liquids and we could not settle on a highly nutritious solution to meet both requirements. As soon as I was able to eat almost anything – I still have difficulty digesting pastry ten months after the op – I started to eat quantities of cheese, puddings and cream. We have now resorted to supermarket sourced ‘protein bars’ such as ‘Nature Valley’ and ‘Graze’ that I munch between the three traditional meals. I also ‘graze’ on nuts, biscuits and fruit. To start with I lost weight, going from 68.5kg down to 63.3kg at the end of April. Since then it has stabilised and we hope to perhaps gain another kilo or two. Not too much because, according to the NHS chart, for someone of my height it is an ‘ideal weight’. I think now, ten months down the track, we are getting things right. A typical daily intake for me is as follows: Breakfast: Coffee, cereal (not too much sugar), toast with a spread of some sort, fruit juice. Lunch: Possibly left-overs from last evening’s meal, eggs in a variety of ways, cheese on toast, soup, a sandwich followed by a piece of fruit. (continued over) 4 Evening meal: A whole variety of dishes; roasts, casseroles, stir fry, salads, curries usually followed after an hour or so by a dessert. All those meals are of very small portions – though getting bigger all the time, some days better than others – so in between meals I have snacks comprising a range of protein bars, biscuits, fruit and cashew nuts by the handful. It seems to be working.I’m feeling stronger all “ ” the time, exercising and enjoying life! Janice Oesophagectomy May 2019 I had an oesophagectomy in May 2019 so I am currently almost 5 months post-op. I won’t lie, up to a month ago I found the whole eating and dietary issues frustrating. A lot of that was down to my impatience in accepting that recovery was going to take a good year or more. However, in the last few weeks, I feel I’ve finally ‘cracked it’ and found a regime that works for me. The day before being discharged from hospital my daughter visited and, between us, we ‘brainstormed’ a list of foods that could be, or were already, puréed. Armed with an extensive list, my daughter shopped for all the items including some baby food containers. She filled the containers with some prepared meals and left them stacked in my fridge and freezer ready for my return. I can’t tell you just how much that helped in the early days at home. Not having to worry about what to prepare and eat to start with was a blessing. Luckily, my husband was happy to see to himself so I could concentrate on my own needs. Some of the foods I stocked up with were: • Tinned custard, semolina and variety of soups. • Potatoes, butternut squash, and carrots. • Whole milk, cream, strong cheese, eggs, creamy yoghurts, butter and ice cream. • Salmon, white fish, skinless sausages. • Jelly cubes (for milk jellies). • Cheese sauce granules, gravy granules and dried milk (for making the fortified milk). • Weetabix and instant porridge. (continued overleaf) 5 5 • Some baby foods that I used as a base e.g macaroni cheese that I just added more grated cheese to. • Smoothies I thought the easiest food to eat would be mashed potato enriched with an egg, milk, butter and cheese but I actually found it quite difficult to swallow so stuck to the butternut squash instead (still with everything added). Keeping hydrated was difficult as I’m not a great drinker anyway. You definitely need to drink a good 30 mins before or after food and not at the same time. I kept a jug of fortified milk on the go and used it for cereal, jelly and frozen milk lollies (using Nesquick). I did find that my taste buds changed and I struggled with dairy products in particular. Moving on to soft foods after 4 weeks was bliss. I was so bored with puréed food by that point. I was losing weight but was expecting that and hoped that the loss would slow down with a more varied diet. I still wasn’t keen on the sweet dairy products although I kept trying various yoghurts and desserts. I must say I did spend a lot of money on food but also wasted a large amount of food as well! I eat anything that could be mashed with a fork and found stronger flavours worked for me. • Cottage pie • Spaghetti Bolognese • Tagliatelle • Vegetable curry • Skinless sausage casserole • Cheese omelette with thin cut ham added My ‘go-to’ snacks included: cheese and crackers, buttery cheese straws, mini Babybels, tiramisu, spicy crisp puffs e.g Cheetos. Trying to keep a small portion of food warm enough for the 30 mins needed to eat it was a problem. I overcame it by buying a child’s wide-necked food thermos flask. It certainly kept the food at a reasonable temperature. After a couple of months, I was able to move on to a normal, varied diet. I now eat whatever I fancy and it’s just been trial and error finding the foods that work for me. My portions have increased considerably and I enjoy stir-fries, curries, roast dinners, fry-ups – you name it and I’ll try it. The only thing that I don’t cope with very well is red meat but everything else is fine. I make sure I chew everything thoroughly but it did take some time to realise when I’d eaten enough. Sometimes, that last spoonful was one too many and it would stick in my throat. It would go down eventually but it’s uncomfortable at the time. 6 My taste buds are getting back to normal and I now enjoy chocolate, cream cakes and some desserts again. I always keep a couple of ready meals in the fridge (Marks and Spencer do a range designed for a smaller appetite). I snack on things like crisps, peanuts, cashew nuts, fruit loaf, crumpets, waffles and fruit and nut chocolate bars. At my last weigh-in I had gained over 2kilos so I know the only way is up now and I’m feeling very positive about the future. I now eat whatever I fancy and it’s just been trial and error finding the foods that work for me. 7 7 From the dietitian… We have worked closely with our patients in producing this recipe book to help support you after surgery or during chemo/radiotherapy when you may find your appetite is very low. The recipes are designed to maximise the calorie and protein content, which will help you to better maintain your weight. Eating small portions regularly every few hours over the day can help, as well as serving small portions of food on a side plate or in ramekins so that it doesn’t look too overwhelming. Dietitian, Sarah Davies Don’t feel you have to make everything from scratch, you can often buy foods of an already appropriate texture from supermarkets, for example pots of custard or smooth soup to save you time. Several online ready-made meal companies can deliver good quality meals that have a range of suitable textures, including ‘mini’ or ‘petite’ ranges for smaller portions, which you may find helpful if you are feeling too tired to cook. Choose ‘purée’ or ‘soft and bite sized’ ranges according to which stage of diet you are on. If you require further advice or are worried about your weight or diet please ask to be referred to a dietitian. We hope you find this book helpful! 88 From the Chef… It’s really inspiring for me to read the positivity within the patient stories and learn about the different food plans that have worked for each individual. I can fully appreciate a lack of desire to get creative in the kitchen, especially post surgery, though along with some great existing recipes already in this book, I have put together some of my own that will hopefully encourage you to think positively about food and flavours. There will obviously be days where you may wish to simply blitz up a can of pre prepared soup though if feeling adventurous it would be a pleasure to learn that any of my recipes have been given a run through! Please do enjoy! Blender advice To get a really smooth consistency to your food it is really important that you use a powerful blender. I personally find the Ninja range superb & at an affordable price range. They have some great models from around £49.99 and are available from most supermarkets or it’s worth looking online for a good deal. If your blender fails to create the desired smooth texture, you can pass it through a fine sieve afterwards and discard any ‘lumps’. If the consistency of the food is a little dry, simply add a little extra water whilst blending. Chef, Gary 9 Purée foods 10 What is a purée diet? • A purée diet should be smooth throughout without any bits, lumps, skins or shells. • Food can be puréed using a blender or food processor. • Food can also be sieved to ensure there are no lumps. • Food should be puréed separately so there are individual portions of each food on the plate. This helps to retain the taste and colour of each item and makes it more appealing. • Add additional liquids to blend such as gravy, milk or stock. • Enhance flavours by adding sauces such as smooth mustard, curry powder, soy sauce or lemon juice. Suggested purée meal plan Breakfast 8.00am Drink Mid-morning snack 10.00 -10.30am Drink Lunch 12.00 -1.00pm Drink Mid-afternoon snack 2.30 - 3.00pm Drink Dinner 5.00 - 6.00pm Drink Dessert/ Evening Snack 7.00 - 8.00pm Purée cinnamon porridge Nourishing coffee Purée scrambled eggs Supplement drink Salmon Mousse Glass of milk Cream of chicken soup Supplement drink Purée shepherd’s pie Nourishing malt drink Purée rice pudding 1111 Purée breakfast recipes 12 Cinnamon Porridge • 25g porridge oats • 175g full fat milk • ¼ teaspoon of cinnamon • 1-2 tablespoons of full fat Greek yogurt to serve 1. Put the porridge oats in a saucepan, pour over the milk and sprinkle in a pinch of salt. Bring to the boil and simmer for 4-5 minutes, stirring from time to time and watching carefully that it doesn’t stick to the bottom of the pan. 2. Or you can try this in a microwave. Mix the porridge oats, milk and a pinch of salt in a large microwave-proof bowl, then microwave on High for 5 minutes, stirring halfway through. Leave to stand for 2 minutes before eating. 3. Stir through the cinnamon and drizzle with Greek yogurt to serve (you can thin this down with some more milk if needed). Storage: Refrigerate Weetabix, Peanut Butter & Banana Smoothie • ½ a banana • 2 tablespoons of smooth peanut butter • Approximately 250ml full fat milk • 1 Weetabix biscuit (or shredded wheat) 1. Slice the banana into the blender. 2. Add the peanut butter and 3 tablespoons of the milk. 3. Blend together until well combined. 4. Crush the Weetabix into the mixture. 5. Add the remaining milk and blend until smooth. Storage: Refrigerate 13 Purée Scrambled Eggs • 2 eggs • 6 tablespoons of single cream or approximately 60ml of full fat milk • Butter 1. Lightly whisk the eggs, 6 tbsp of single cream or full fat milk and a pinch of salt together until the mixture has just one consistency. 2. Heat a small non-stick frying pan for a minute or so, then add a knob of butter and let it melt. 3. Pour in the egg mixture and let it sit, without stirring, for 20 seconds. Then stir with a wooden spoon, lifting and folding it over from the bottom of the pan. 4. Once cooked through, place eggs in your blender and blend until smooth (you may need to add a little more milk to give the correct consistency). Storage: Refrigerate Fruity Greek Yogurt Smoothie • 250ml Full fat Greek yogurt (or pineapple flavoured Greek yogurt) • 50ml full fat milk • ½ a banana • 30g fresh or frozen mango • 30g fresh, tinned or frozen peach slices 1. Place the yogurt and fruit into the blender and mix until smooth (if using frozen fruit you may need to let this defrost for a few moments to make it easier to blend). 2. Add additional milk to thin down as required. Storage: Refrigerate 14 15 Purée soups All soups can be kept in the fridge for 1-2 days or frozen 16 Cream of Chicken Soup • 2 tablespoons of olive oil • 600ml chicken stock • 1 medium onion, chopped • 175ml double cream • 1 medium leek, thoroughly washed and chopped • A pinch of pepper • 2 large chicken breast fillets (chopped) 1. Heat the oil in a pan, add the onion and cook until softened. 2. Add the leek and cook for a further 5 minutes. 3. Add the chicken, stock and seasoning and bring to the boil for 2 minutes then reduce to a simmer. 4. Allow to simmer for 25 minutes until the chicken is cooked through. 5. Add the cream then blend until smooth. Lamb and Vegetable Soup • 2 tablespoons of olive oil • 800ml vegetable stock • 400g lamb mince • 150ml full fat milk • 1 medium onion, choppe d • 120g skimmed milk powder • 3 large carrots, peeled & cho ppe d • 100ml double cream • 1 medium potato, peeled & chopped 1. Heat the oil in a pan and add the lamb and onion and cook for 5 minutes, breaking up the lamb into small pieces. 2. Add the carrot and cook for 10 minutes until soft. 3. Add the potato and stock and bring to the boil, then reduce to a simmer for a further 30 minutes. 4. Combine the milk with the skimmed milk powder then add to the pan with the cream and season. 5. Blend the soup until smooth. 17 Pea and ham soup • 2 tablespoons of oil • 1 medium onion, chopped • 1 medium potato, peeled and finely chopped • 400ml vegetable stock • 600g frozen garden peas • 100g cooked ham, finely chopped • 300ml full fat milk • 100g skimmed milk powder • 30g parmesan 1. Heat the oil in a pan and add the onion. Cook for 5 minutes until soft 2. Add the potato and stock and season. Boil for 15 minutes until the potato is soft. 3. Stir in the peas and ham and cook for another 10 minutes 4. Mix the milk with the skimmed milk powder and then add to the soup along with the parmesan. 5. Blend the soup until smooth and then sieve to ensure all pea shells are removed. Seafood chowder • 1 tablespoon of olive oil • 1 medium onion, finely chopped • 1 tablespoon of plain flour • 2 small potatoes, peeled and finely chopped • 600ml fish or vegetable stock • 300ml full fat milk • ½ teaspoon of grated nutmeg • 170g salmon, chopped into small chunks • 150g cod, chopped into small chunks • 60ml single cream • 200g frozen prawns (thoroughly defrosted) 1. Heat the oil in a saucepan and add the onion. Cook for 5 minutes until soft, then add the flour and cook for a further 2 minutes. 2. Add the potatoes and stock and bring to the boil for a minute then turn down to a simmer and cook for around 15 minutes until the potatoes are soft. (continued over) 18 3. Add the milk and nutmeg with the salmon and cod and cook for 5 minutes. 4. Add the cream and prawns and simmer for 5 minutes until cooked through. 5. Blend the soup until smooth. Sweet potato and lentil soup • 3 tablespoon of olive oil • 1 large onion, finely chopped • 10g minced ginger (or ginger paste) • 10g minced garlic (or garlic paste) • 600g sweet potatoes, peeled and finely chopped • 200g dried red lentils • 400g tin of coconut milk • 800ml vegetable stock • 100ml double cream • 120g skimmed milk powder 1. Heat the oil in a saucepan then fry the onions, garlic and ginger for 5 minutes. 2. Rinse and drain the lentils. 3. Add the sweet potatoes, lentils, coconut milk and stock and simmer for 30 minutes until the potatoes are soft. 4. Mix together the cream and skimmed milk powder then add to the soup. 5. Blend until completely smooth (you may need to sieve the soup to ensure the lentils are completely blended). 19 Purée main meals 20 Salmon Mousse • 125g smoked salmon • 50g cream cheese • 25g crème fraiche • The juice of ½ a lemon 1. Place all of the ingredients in your blender and combine until smooth. 2. Season with salt and pepper to taste and serve. Storage: Refrigerate Fish Pie • 2 skinless and boneless white fish fillets (approximately 200g) • 2 skinless and boneless smoked haddock fillets (approximately 200g) • 400ml full fat milk • 50g butter • 3 heaped tablespoons of plain flour (50g) • A pinch of nutmeg 1. Put the fish in the frying pan and pour over the milk. 2. Bring the milk to the boil then reduce and simmer for 8 minutes. 3. Lift the fish onto a plate and strain the milk into a jug to cool. Flake the fish into large pieces in a baking dish. 4. Melt the butter in a pan, stir in the flour and cook for a minute over a moderate heat. Take off the heat then pour in a little of the milk from the jug and stir until blended. 5. Continue to add the milk gradually, mixing well until you have a smooth sauce. Season with nutmeg and pepper to taste. 6. Add to a blender with the fish and blend until smooth. 7. Layer in a small dish with creamy mashed potato on top (see recipe in side dishes section). 8. Heat the oven to 200°c and bake for 30 minutes. Storage: Refrigerate or freeze 21 Mediterranean inspired chicken & chorizo casserole chickpea - spinach - fresh basil This recipe is inspired by big Mediterranean flavours. The strong flavours from the chorizo flavour the whole dish and make it a pleasure to eat. The recipe will give a generous 4 - 6 portions though likely more for smaller appetites. • 100g diced chorizo • 200g diced chicken thigh • 1 onion, diced • 1 stick celery, diced • 1 carrot, diced • 1 tin of chick peas, drained • 2 tins chopped tomatoes • 200g baby spinach leaves, washed • Handful fresh basil • Juice of one lemon • Salt and pepper Gary’s 1. Start with a hot pan and colour the chorizo on all sides (no need for any oil) 2. Add the chicken and stir in - cook for a few minutes 3. Add the onion, carrot and celery - cook for about 5 more minutes over a gentle heat (lid on) 4. Add the tinned chickpeas and tomatoes - bring to the boil and simmer for 30 minutes, stirring occasionally 5. Add the baby spinach and fresh basil 6. Add salt and pepper and lemon 7. Blend until smooth 8. Enjoy 22 Mild red lentil & butternut squash curry coconut - lime - lemongrass This simple recipe is for a mild curry with Asian flavours. You can replace the squash with chicken if desired but I personally love a vegetarian curry and you get plenty of calories from the coconut milk and the red lentils. You can omit the chilli if wanting a milder version or add one or two extra in. Again, allows for 4 - 6 generous portions. • 1 butternut squash, diced • 1 onion, diced Gary’s • 4 cloves garlic, crushed • 1 inch fresh ginger, grated • 1 stick lemongrass, diced • 1 green chilli, de-seeded • Juice of two limes • Bunch fresh coriander • Teaspoon mild curry powder • Dash of fish sauce • Teaspoon turmeric • 200g red lentils • Two tablespoons soy sauce • Coconut oil for cooking 1. In a hot pan, heat the coconut oil and add the garlic, ginger, lemon grass and onions - sweat for a few minutes 2. Add the squash, chilli and curry powder - cooking for 5-10 minutes until starting to soften (keep lid on) 3. Add the coconut milk and bring to the boil - simmer for twenty mins 4. Meanwhile, boil the red lentils in 400ml water for five minutes with the turmeric (the water should evaporate whilst they cook) 6. Add the cooked lentils (drained) into the sauce 7. Add the lime juice, fish sauce and soy sauce 8. Blend until smooth 9. Enjoy 23 Vegetarian ‘Shepherd’s pie’ puy lentils - butter beans - root vegetables minted gravy Very fond of vegetarian food?..... I’ve included this recipe which works really well with the lentils replacing the meat. Plenty of flavour from the vegetables and served with buttery mash and additional gravy, it’s a real treat. • 200g puy lentils (cooked) • 1 onion, chopped • 1 stick celery, chopped • 1 carrot, chopped • 1/2 small swede, chopped • 4 cloves garlic, chopped • 1 tin butter beans, drained • Tablespoon tomato purée • Teaspoon dried mint • Teaspoon dried mixed herbs • Salt and pepper Gary’s 1. In a hot pan, sweat the onions with the dried herbs for a few minutes 2. Add the other vegetables and cook for a further ten minutes (lid on) 3. Add the tomato purée and red wine 4. Add the lentils and butter beans 5. Add the Worcester sauce and salt and pepper 6. Add the gravy 7. Simmer for 30 minutes 8. Blend until smooth adding a little extra water or gravy if necessary 9. Serve with the mash and extra gravy 24 Mash Ingredients • 40g potato, diced • 100g butter • Salt and pepper • Dash grated nutmeg (optional) • Teaspoon Dijon mustard 1. Bring the potatoes to the boil and simmer for 20 minutes until soft 2. Drain and beat with a whisk until smooth - avoid using the blender which will break down all the starch, causing loss of the natural texture we all love in a good mash. As long as it’s given a good beat with a sturdy whisk it will become smooth or you can use a ricer, putting through twice. 3. Add salt and pepper, butter and mustard Chef Gary’s Top Tips Invest in some reusable tubs. They are great for portioning and storing food when batch cooking. You can then prepare food ahead of time and freeze for when you need something that’s quick, healthy and nutritious. Purée down tinned rice pudding for a quick dessert that is packed full of calories. When the texture is one dimensional it’s so important to add flavour to keep you interested and looking forwards to mealtime. A little extra salt, sugar or lemon juice can go a long way. As long as you can purée them to a fine texture, add fresh herbs to any recipe to give dishes extra flavour. Basil is great with tomato based dishes and coriander pairs brilliantly with coconut or curried recipes. As you move forwards, by using the pulse on the blender, you can leave some texture in the dishes. All my recipes can of course be left ‘unblended’ if catering for other family members or friends. 25 Minced beef • ½ tbsp sunflower oil • 30g onion (finely chopped) • 30g carrots (finely chopped) • 100g minced beef (or substitute for Quorn mince) • 1 tablespoon of tomato purée • 200ml beef stock • 2 tablespoons of Worcestershire sauce 1. Heat the oil in a medium saucepan and soften the onions and carrots. 2. When soft, add the minced beef and cook until browned. Then add the tomato purée and Worcestershire sauce and fry for a few minutes. 3. Pour over the stock and then simmer for 30-40 minutes. 4. Place the mixture into a blender and blend until smooth. Serve into small portions. Ideal with mashed potato or purée vegetables (see sides section). Storage: Refrigerate or freeze Shepherds’ pie • 350g minced beef (or substitute for Quorn mince) • 2 tablespoons of olive oil • 1 small onion, chopped • 100g mushrooms (optional) • 2 medium carrots, peeled and chopped • 2 tablespoons of tomato purée • 350ml beef stock • 50g butter • 50g flour 1. Heat the olive oil in a pan and add the onions and soften. 2. Add the mince and brown through. (continued over) 26 3. Add the mushrooms and carrots. Cover with a lid and leave to cook on a medium heat, stirring regularly. 4. Make a roux sauce by melting the butter in a separate pan. Using a whisk add the flour and whisk well until combined. 5. Add the beef stock a little at a time to the roux, still mixing well to make a thick sauce. 6. Add this sauce with the tomato purée to the beef mixture and stir well. 7. Transfer to the blender and mix until smooth. 8. Place in a small dish and top with creamy mashed potato (see side dishes section). 9. Bake in the oven for 15-20 minutes until cooked through. Storage: Refrigerate or freeze Purée chicken • 100g of diced chicken breast • 1 small onion chopped • 100ml chicken stock • ½ a chopped leek • 1 tablespoon of chicken gravy granules • 1 teaspoon of oil 1. Heat the oil in a pan then add the onion, leek and chicken and cook through. 2. Add the chicken stock and simmer for 15 minutes. 3. When cooked, add the gravy granules then transfer to the blender and blend until smooth. Ideal to serve with creamy mashed potato. Storage: Refrigerate or freeze 27 Macaroni cheese • 3 tablespoons of butter • 350g of pasta (penne or spiral pasta) • 1 teaspoon garlic paste • 1 teaspoon mustard • 3 tablespoons plain flour • 500ml full fat milk • 250g cheddar cheese • 50g grated parmesan 1. Boil the pasta until cooked then drain and set aside. 2. Meanwhile melt 2 tablespoon of butter in a saucepan. 3. Add the garlic paste and English mustard and cook for 1 minute. 4. Stir in 3 tablespoons of plain flour and cook for 1 more minute. Gradually whisk in 500ml of the milk until you have a lump-free sauce. 5. Simmer for 5 minutes, whisking all the time until thickened. 6. Take off the heat and stir in the cheddar and parmesan. 7. Add the pasta then blend with the sauce until smooth. Add extra milk if you need to thin the mixture down. Storage: Refrigerate 28 Red lentil Dahl • 250g red lentils • 1 teaspoon turmeric • A pinch of salt • 2 tablespoons sunflower oil • 1 teaspoon cumin • 1 medium onion, finely chopped • 50ml cream 1. Put the lentils in a pan of 800ml of water and bring to the boil. 2. Add the turmeric and salt and simmer uncovered for 15 minutes. Stir occasionally until the lentils have broken down completely to a purée (the consistency of a smooth thick soup). 3. Heat the oil in a separate pan and add the onion. Cook for 5 -10 minutes until soft. 4. Add the onion, cumin and cream to the lentils then blend until smooth. Storage: Refrigerate or freeze 29 Purée side dishes 30 Creamy mashed potato • 6 medium potatoes, peeled and chopped into chunks • 60g butter • 100ml double cream 1. Place the potatoes in a pan and cover with cold water 2. Bring to the boil then cover with a lid and reduce to a simmer for 20 minutes until the potatoes are soft. 3. Drain the remaining water, add the cream and butter and gently heat. 4. Mash the potatoes or beat. Storage: Refrigerate or freeze Hint: Try adding cream cheese or mustard to give extra flavour Cauliflower cheese • 150g cauliflower florets • 1 level tablespoon of cornflour • 2 tablespoons of full fat butter or olive oil spread • 150ml full fat milk • 30g cheddar cheese, finely grated 1. Wash the cauliflower then steam for 8-10 minutes until soft. 2. To make the sauce combine the flour, butter and milk in your blender. 3. Transfer into a microwaveable container and microwave for 45 seconds then stir through. 4. Microwave for another 15-30 seconds until the sauce starts to thicken then stir in the grated cheese. 5. Combine the cauliflower and sauce in the blender until smooth. Add additional milk if required. Storage: Refrigerate or freeze 31 Sweet potato and carrot purée • 250g carrots, chopped • 250g sweet potato, chopped • 1 tablespoon of garlic purée • 25g butter 1. Put the sweet potato and carrots into a pan of boiling salted water and cook for around 15 minutes until soft. 2. Drain the vegetables then stir through the garlic purée and butter. 3. Blend until smooth. Storage: Refrigerate or freeze Hint: You could also try adding 100g parsnip Butternut squash purée with ginger • 1 butternut squash, halved lengthways and deseeded • Olive oil • 4cm piece of fresh root ginger, peeled and finely grated • 3 tablespoons of butter • 2 tablespoons of double cream or crème fraiche • Nutmeg (optional) 1. Preheat the oven to 200°c 2. Rub a little olive oil into the cut side of the butternut squash then roast in the oven on a baking sheet for around 45 minutes or until soft. 3. Scoop out the flesh with a spoon and set aside (discard the skin) 4. In a pan melt 2 tablespoons of butter and add the ginger and cook for 5 minutes. 5. Place the cooked squash and ginger in the blender and blend thoroughly until smooth. 6. Return to the pan and add the remaining butter and nutmeg if you are using this. Stir through the cream or crème fraiche. Storage: Refrigerate or freeze 32 Purée ratatouille • 50g aubergine • 50g courgette • 40g red or yellow pepper • 2 tablespoons of olive oil • 200g passata • 1 small onion, finely chopped • 30g mushrooms • ½ garlic clove peeled and crushed • 1 tablespoon of red wine vinegar • 50ml single cream (optional) 1. Heat the oil in a casserole dish or saucepan and cook the onions and garlic on a low heat for 10 minutes until soft with the lid on. 2. Add the peppers, aubergine and courgettes. Season with salt and pepper and cook for a further 20 minutes with the lid on. 3. Pour in the passata and red wine vinegar and cook for another 5 minutes without the lid 4. Transfer to your blender and blend until smooth. Stir through the single cream to add additional calories before serving Storage: Refrigerate or freeze 3333 Purée desserts & snacks 34 Banana dessert • 1 medium banana, peeled and sliced • 10g ground almonds • 1 teaspoon maple syrup • 2 tablespoons double cream • 20g skimmed milk powder • 1 teaspoon vanilla extract 1. Freeze the banana slice for at least 2 hours 2. Blend the frozen banana, almonds, maple syrup, cream, skimmed milk powder and vanilla extract into a creamy smooth texture. Add some extra milk if it is difficult to blend Storage: Refrigerate or freeze Rice pudding • 120g pudding rice • 700ml full fat milk • 50g sugar (or swap for sweetener) • 200ml cream • 1 teaspoon of vanilla extract • ½ teaspoon of ground cinnamon • 75g ground almonds • A pinch of salt • 100g skimmed milk powder 1. Blanch the rice in a pan of boiling water for 3 minutes 2. In another pot mix 600ml of milk with the sugar, cream, vanilla extract, cinnamon and salt and bring to the boil 3. Add the blanched rice and ground almonds and simmer for 30 minutes, stirring occasionally 4. Combine with the remaining 100ml of milk and skimmed milk powder 5. Blend until completely smooth and then serve into small portions Storage: Refrigerate 35 Vanilla custard • 1 pint of full fat milk • 55ml single cream • 1 vanilla pod or ¼ teaspoon of vanilla extract • 4 egg yolks • 30g caster sugar • 2 level teaspoons of cornflour 1. Bring the milk, cream and vanilla to simmering point gradually over a low heat. 2. Remove the vanilla pod if used. 3. Whish the egg yolks, sugar and cornflour together in a bowl until well blended. 4. Pour the hot milk and cream mixture into the egg mixture, whisking all the time with a balloon whisk. 5. Return to the pan and stir over a low heat until thickened. Storage: Refrigerate Spiced pear (ideal with the vanilla custard) • 2 pears, peeled, cored and cut into small chunks • A small pinch of cinnamon • A splash of full fat milk 1. Steam the pear for 8-10 minutes until tender. 2. Transfer to the blender and add a splash of milk and cinnamon and blend until smooth. 3. Can be frozen into ice cube trays. Storage: Refrigerate 36 Lemon mousse • 150g lemon curd • Zest of ½ a lemon • 150ml of double whipping cream 1. Put two-thirds of the lemon curd in a large bowl with the zest and cream. 2. Beat with an electric whisk until it holds its shape. 3. Dribble over the rest of the lemon curd, marbling the curd as you add it. 4. Transfer into small pots or glasses. Cover with clingfilm and freeze for 30-40 minutes until set. Storage: Refrigerate 37 Drinks and supplement recipes 38 Nourishing malt drink • 150ml full fat milk • 1 heaped tablespoon milk powder • 3 teaspoons of malted drink powder such as Ovaltine or Horlicks • 2 tablespoons cream Nourishing coffee • 150ml full fat milk • 1 heaped tablespoon milk powder • 1 teaspoon coffee powder • 2 tablespoons of cream Chocolate mocha pots • 1 teaspoon of coffee granules dissolved in a splash of boiling water • 25g butter • 100ml of chocolate Fortisip • 200g plain chocolate broken into chunks • 50g Muscovado sugar (or swap for sweetner) 1. Place all of the ingredients in a small pan and stir gently over a low heat until it has fully melted 2. Pour into small espresso size cups and allow to cool 3. Transfer to the fridge to set Cappuccino • 1 sachet of instant cappuccino mix • 110ml of hot water • 1 bottle of neutral of mocha flavoured Fortisip 1. Put the water, cappuccino mix and Fortisip in a saucepan. Mix well and heat gently until at serving temperature Fortisip milk jelly • 1 packet of blackcurrant or raspberry jelly • 400ml of Strawberry Fortisip • 100ml boiling water 1. Cut the jelly into cubes and place in a bowl 2. Add the boiling water and stir until the jelly is dissolved 3. When cooled slightly, add the Fortisip 4. Mix thoroughly and transfer to small containers and leave in the fridge to set What is Fortisip? You will initially be prescribed high calorie supplement drinks such as Fortisip Compact Protein. This will help you to maximise your nutritional intake. They are available in 8 flavours through your GP: vanilla, strawberry, banana, mocha, peach/mango, berries, neutral, and hot tropical ginger. They can also be frozen into ice cube trays or ice lolly moulds. 3399 soft & bite sized diet 40 What is a soft and bite sized diet? • A soft diet should be of fork-mashable consistency and require some chewing. • Avoid crunchy, sharp foods with skins and doughy foods such as bread. • Continue to aim for small regular meals and snacks over the day. Suggested soft and bite size meal plan Breakfast 8.00am Drink Mid-morning snack 10.00 -10.30am Drink Lunch 12.00 -1.00pm Drink Mid-afternoon snack 2.30 - 3.00pm Drink Dinner 5.00 - 6.00pm Drink Dessert/ Evening Snack 7.00 - 8.00pm Overnight oats Fortified cappuccino Pancakes and crème fraiche Supplement drink Salmon fish cakes Glass of fortified milk Flapjack Supplement drink Beef casserole with pepper mash Nourishing malt drink Tiramisu 41 Soft & bite sized breakfast recipes 42 No-bread eggs benedict • 1 ripe avocado, destoned • 2 slices of ham or smoked salmon • 2 eggs • 2 tablespoons mayonnaise • 1 teaspoon mustard • 2 teaspoons white wine vinegar 1. Bring a saucepan of water to the boil 2. Scoop the avocado flesh into a bowl and season with salt and pepper. Mash with the back of a fork and leave to one side 3. Once the water is boiling carefully crack in the eggs and poach at a gentle simmer for about 4 minutes until the yolk is still runny 4. While the eggs are poaching make the hollandaise sauce. Whisk together the mayonnaise, mustard and vinegar with 3 tablespoons of warm water 5. Once cooked layer the ham or salmon with the mashed avocado then top with poached eggs and spoon over the sauce Storage: Refrigerate Overnight Oats • 120g rolled oats • 120ml full fat Greek yogurt • 220ml full fat milk • ½ tablespoon honey or maple syrup (or sweetener) • 1 teaspoon vanilla extract To make ‘coconut latte’ overnight oats substitute full fat milk for 170ml coconut milk, do not use vanilla extract and instead add: • ½ teaspoon ground cinnamon • 60ml brewed coffee 1. Place all of the ingredients into a large glass container and mix well 2. Put the top on the container & refrigerate for at least 2 hrs or overnight Storage: Refrigerate 43 Potato waffles You will require a waffle iron • 300g peeled potatoes, chopped • 2 tablespoons butter • 1 onion, finely chopped or grated • 1 garlic clove finely chopped • 30g plain flour • 2 eggs 1. Boil the potatoes in a pan of water for around 15 minutes or until soft 2. Meanwhile melt the butter in a pan over a medium heat. Add the onion and garlic and cook until soft 3. Preheat the waffle iron according to the manufacturer’s instructions 4. Drain the potatoes when cook then combine with the onion mixture, flour, eggs and season with salt and pepper. Mix in a large bowl until well blended 5. Scoop the batter into the waffle iron and cook until golden brown Storage: Refrigerate Hint- Ideal to serve with scrambled egg, ham, mushrooms or a combination of toppings 44 Pancakes with banana and crème fraiche • 55g plain flour • 1 egg • 100ml full fat milk • 25g butter • 1 banana • Crème fraiche • Handful of raspberries or blackberries (optional) 1. Sift the flour with a pinch of salt into a large mixing bowl 2. Make a well in the centre of the flour and break in the egg 3. Whisk together and gradually add the milk until a smooth consistency 4. Melt 25g butter in a pan and add half of this to the batter mix and whisk in 5. Get the pan very hot with the remaining butter, then turn down to a medium heat 6. Add about 2 tablespoons of batter to the ban and tilt the pan to completely cover in the batter and thin 7. Cook the pancake on each side until golden but not too crispy 8. To make the fruit purée spoon the berries into a sieve and push through to remove any pips. Serve with crème fraiche Storage: Refrigerate 45 Soft & bite sized main meals 46 Salmon fish cakes • 4 medium potatoes, peeled and chopped into small pieces • 350g skinless and boneless salmon, flaked • Zest of 1 lemon • 1 tablespoon plain flour • 15g fresh chives, finely chopped • 1 medium egg • 30g grated parmesan • 2 tablespoon olive oil 1. Preheat the oven to 180°c 2. Put the potato pieces in a pot of boiling water and cook for 10-15 minutes until soft 3. Drain and mash the potato and allow to cool 4. Add the flaked salmon, lemon zest, flour, chives, egg and parmesan to a large bowl 5. Mix with the mashed potato until well combined 6. Divide the mixture into 8 cakes and shape 7. Place on a baking tray and brush with olive oil 8. Cover with tin foil and bake for 10-15 minutes until cooked through Storage: Refrigerate or freeze Smoked fish chowder • 450g smoked haddock fillet • 170g carrots, peeled and • 60g butter finely chopped • 1 onion, finely chopped • 150ml single cream • 2 tablespoons plain flour • 230g potatoes, peeled and finely chopped 1. Boil 1 litre of water in a saucepan then reduce to a simmer and cook the haddock for about 10 minutes until tender. (continued overleaf) 47 2. Drain the haddock and keep the water to use as stock later 3. Flake the haddock removing any skin and bones 4. Heat the butter in a pan and add the onion and cook until soft 5. Stir in the flour and cook for a minute then gradually add the water back as stock. Bring to the boil stirring constantly 6. Add the potatoes and carrots and simmer for 10 -15 minutes until tender 7. Stir in the flaked fish and cream. Season and serve Storage: Refrigerate Salmon curry • 1 tablespoon olive oil • 1 small onion, sliced • 2 garlic cloves, crushed • ¼ chilli, deseeded and sliced finely • 1 teaspoon milk curry powder (or medium if preferred) • 1 tin salmon or approximtely 200g fresh salmon fillet • 1 spring onion, chopped • 2 tablespoons tomato purée • Boiled brown rice 1. Heat the oil in a pan over a medium heat. Add the onion and garlic and cook until soft 2. Add the chilli and cook for another minute 3. Add 5 tablespoons of water and stir then turn down the heat to a simmer for 5 minutes until the water evaporates 4. Add the tin of salmon, spring onion, tomato purée and salt and pepper 5. Simmer until cooked and soft then serve with a small amount of cooked rice Storage: Refrigerate or freeze 48 Pesto chicken • 1 tablespoon olive oil • 2 small chicken breast fillets, sliced • 1 garlic clove, crushed • 1 tablespoon green or red pesto • 200ml crème fraiche • 10 cherry tomatoes • Boiled rice or pasta 1. Heat the olive oil over a medium heat. Add the chicken and cook for 405 minutes until brown on all sides 2. Immerse the cherry tomatoes in boiling water for a few seconds then carefully remove and peel off the skin 3. Add the onion, garlic, pesto and peeled tomatoes. Cook for 5 -10 minutes stirring continuously 4. Ensure the chicken is tender and fully cooked then stir in the crème fraiche 5. Serve with cooked rice or pasta Storage: Refrigerate 49 Beef and Swede Casserole • 2 tablespoons olive oil • 2 onions, finely chopped • ½ celery stick, sliced finely • 500g diced braising beef • 700ml beef stock • 500g swede, peeled and diced • 300g potatoes, diced • 3 thyme sprigs • 1 bay leaf • Mashed potato to serve 1. Heat the oil in a saucepan or casserole dish 2. Fry the onions and celery for a few minutes until turning brown 3. Add the beef and brown all over for 3-4 minutes 4. Add the stock, swede, potatoes, thyme and bay leaf. Bring to the boil then reduce the heat 5. Simmer for an hour or transfer to a slow cooker if preferred 6. Cook until the beef is tender then remove the thyme and bay leaf before serving Storage: Refrigerate or freeze Moussaka • 500g potatoes, peeled • 3 tablespoons olive oil • 1 red onion, sliced finely • 500g lamb mince • 2 garlic cloves, crushed • 1 teaspoon mixed spice • 500g carton of passata • 2 aubergines, sliced finely • 300ml crème fraiche • 150g grated cheddar 1. Boil the potatoes whole for 20 minutes until soft then drain and allow to cool 2. In another pan add 2 tablespoons of olive oil and fry the onion until softened 3. Add the lamb and fry for 5 minutes until cooked 4. Add the garlic, mixed spice and passata & bring to a simmer 5. Heat the oven to 200°c 6. Warm a new pan over a high heat and add a little oil. Cook the aubergines on each side 7. Once cool slice the potatoes into thick slices 8. In an ovenproof dish layer the potatoes, then aubergines, then a layer of lamb mince mixture and repeat until all of the ingredients are used, ensuring an aubergine layer is on top 9. Spread the crème fraiche over the top and sprinkle with cheddar 10. Bake in the oven for 10 minutes or until the top is golden Storage: Refrigerate or freeze 50 51 Vegetarian lasagne • 1 red pepper, deseeded and cut into chunks • 2 courgettes, sliced • 1 small aubergine • 2 garlic cloves • 1 red onion, finely chopped • Olive oil • 250g Quorn mince • 1 tablespoon Worcestershire sauce • 1 tin tomatoes • 1 teaspoon oregano • 450ml full fat milk • 25g butter • 40g plain flour • 70g cheddar • 30g parmesan • 120g lasagne sheets 1. Heat the oven to 220°c 2. Put the peppers, courgettes, aubergines, half the garlic and half the onion into a roasting tin. Season and drizzle with olive oil then roast for around 30 minutes until tender 3. Heat 2 tablespoons of olive oil in a pan and add the remaining onion and garlic and fry for a few minutes until soft. Add the Quorn mince, Worcestershire sauce, tomatoes and oregano and simmer for 5 minutes 4. In a separate pan put the milk, butter, flour and seasoning. Heat and whisk until thickened and smooth. Stir in the cheddar and parmesan 5. Layer the Quorn mince mix, roasted vegetables, lasagne sheets and cheese sauce alternately in an ovenproof dish 6. Cook for around 40 minutes at 200°c until golden Storage: Refrigerate or freeze 52 Swedish meatballs • 250g mince beef • 1 garlic clove, chopped • ½ onion, finely chopped • ½ egg • 2 tablespoons chopped fresh parsley • Olive oil • 1 tablespoon butter • 20g plain flour • 250ml beef stock • 120ml cream • 1 teaspoon Worcestershire sauce • Pasta (tagliatelle or penne) 1. To make the meatballs mix together the beef, garlic, onion, egg and parsley in a bowl. If the mixture is very thick add a little more egg 2. Using a tablespoon roll out meatballs from the mixture 3. Heat oil in a pan over a medium heat and add the meatballs and cook for about 10 minutes until browned, turning occasionally. 4. Remove the meatballs and leave to cool on a paper towel 5. To make the sauce melt the butter in a pan and whisk in the flour until golden brown. Slowly whisk in the beef stock and cook until thickened 6. Add the cream, Worcestershire sauce and season with salt and pepper. 7. Add the meatballs and coat in the sauce then sprinkle with parsley. 8. Boil the pasta in water until soft then serve with the meatballs Storage: Refrigerate or freeze 53 Soft & bite sized side dishes 54 Spinach mash • 500g potatoes, peeled and chopped • 100g spinach • 60ml single cream • 20g butter 1. Boil the potatoes in a pan of water until soft 2. In a separate pan steam the spinach leaves until wilted. When cool squeeze out excess liquid 3. Blend the spinach with the butter until almost smooth 4. Mash the potato in a large bowl then stir in the spinach purée and cream Storage: Refrigerate or freeze Pepper mash • 1 red pepper, quartered with seeds removed • 500g potatoes, peeled and chopped • 60ml single cream • 20g butter 1. Roast the pepper under a hot grill, skin side up until it blackens. 2. Leave to cool then peel the skin from the pepper then blend until smooth 3. Meanwhile boil the potatoes in a pan of water until soft 4. Mash the potato in a bowl then stir in the butter, cream and pepper purée Storage: Refrigerate or freeze Hint: You could use the purée side dish recipes within this book and mash with a fork rather than blend completely 55 Soft & bite sized desserts & snacks 56 Hummus and butter biscuits For the biscuits: For the hummus: • 160g plain flour (whole wheat or white) • 1 tablespoon sugar • Pinch of salt • 80ml water • 4 tablespoons unsalted butter • 1 400g tin of chickpeas • 1 small clove of garlic • 1 tablespoon tahini • 1 lemon • Olive oil 1. Preheat the oven to 200°c 2. Line a baking sheet with parchment paper 3. Put the flour, sugar and salt in a food processor 4. Add the butter and blend until the butter is fully incorporated 5. With the mixer still running, add the water and blend until it forms a smooth dough 6. Once smooth remove the dough from the blender and divide into 4 equal pieces 7. Lightly flour the work surface then roll each dough piece into a large triangle, turning frequently to stop it sticking to the surface 8. Use a pizza cutter or knife to cut into approximately 3cm squares. 9. Place onto the baking sheet and cook until lightly browned for about 10 minutes 10. To make the hummus; drain the chickpeas and add to the blender. Peel and add the garlic and tahini with a good squeeze of lemon juice and 1 tablespoon of olive oil 11. Season with a pinch of salt and blend until smooth. Add extra lemon juice or a splash of water if needed Storage: Refrigerate hummus, store biscuits in an airtight container 57 Tiramisu • 600ml double cream • 175g pack sponge fingers • 250g mascarpone (full-fat) • 25g dark chocolate • 5 tablespoons golden caster sugar • 2 teaspoons cocoa powder • 300ml strong coffee (2 tablespoons coffee granules in 300ml boiling water) 1. Put the double cream, mascarpone and caster sugar in a large bowl and whisk until completely combined 2. Pour the coffee into a shallow bowl and dip in the sponge fingers a few at a time for a few seconds until nicely soaked but not too soggy 3. Grate the dark chocolate coarsely 4. In a large dish form alternating layers of sponge fingers, then a layer of cream mixture and topped with chocolate and cocoa powder. Repeat until all the ingredients have been used up Storage: Refrigerate for up to 2 days Flapjacks • 115g rolled oats • 55g butter • 200g no added sugar, seedless Jam (try fig, apple or pomegranate) • Dark chocolate for drizzling 1. Heat the oven to 180°c 2. Melt the butter and jam in a large pan over a gentle heat 3. Add the oats and stir until well combined 4. Press into a greased square tin or cake tin 5. Bake in the oven for 25-30 minutes until brown 6. Melt some dark chocolate and drizzle over the flapjack to serve 7. Once cool cut into small pieces 58 Apple sponge pudding • 2 large cooking apples, peeled and cored • 85g caster sugar (or swap for sweetener) • 3 tablespoons cold water • ½ egg • Finely grated zest and juice • 1 teaspoon baking powder of 1 lemon • 65g plain flour 1. Quarter the apples and place in a saucepan with
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