Windsor Parkinson Meeting June 25, 2013

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Parkinson Society Southwestern Ontario.png Parkinson SW rgb EN.jpg

Parkinson home.jpg . . Welcomes Guest Speaker : Lauren Flemming

a dietitian with the Sandwich Communuity Health Centre will be presenting " Discussing the proper diet along with swallowing problems that Parkinson's patients may have."

Contents

Talking Points for Parkinson Talk

There is no standard Parkinson’s diet, but today we can go over:

  • factors that may affect maintaining an adequate diet and tips
  • suggestions of things to emphasize in the diet for overall health
  • some of the research or “in the news” topics or therapies related to nutrition.
Left to Right Lauren Fleming MSc,FN,RD,Dietitian
Pat St.Pierre,MSW,RSW


1 ) Basics of a PD Diet (will go over many of these factors in more detail

  • emphasis of fruits and vegetables
  • adequate protein to maintain strength and immunity
  • adequate carbohydrates/ grains and fats to maintain a healthy weight and provide your body with fuel

Goals for good nutrition are to maintain adequate strength and muscle mass, maintain a healthy weight (reserves to work with for immunity) and maintain energy.


2 ) Maintaining a healthy weight & Adequate Diet

  • Weight losses can be common, while weight gain or being overweight can make movements more difficult
  • If underweight goal of weight gain or prevention of further weight loss in order to ensure adequate strength and immunity
  • If overweight, very slow weight may be beneficial if in the obese range. Caution that weight losses cannot be too quick to ensure strength is maintained
  • Many barriers to maintaining a healthy weight or making it difficult to maintain weight: anyone note some barriers that they face?
  • Common barriers: difficulty preparing food if on own, fatigue w/ eating, medication side effects like nausea/ poor appetite & meal timing with medications, trouble swallowing,

Difficulty Preparing own Food

  • Why? Due to fatigue and/or limitations in medication effectiveness

Tips:

  • Build more time in for meal preparation – knowing it may take longer than previously
  • Keep it low stress and enjoyable: prepare meals and foods you like and that aren’t too complicated to prepare. Put on your favorite music or tv show while you are preparing to make the experience more enjoyable
  • Prepare meals at times when you feel the best, you can then store them for later when you have had a chance to rest.
  • Save time and energy by utilizing equipment that can save you energy: food processor/ choppers rather than chopping, crock pot/ microwave or oven rather than standing at the stove top, purchasing foods like frozen vegetables, etc. where they are already washed and chopped to save time. Preparing casseroles, soups, stews, etc. that can be stored for multiple meals can also save time.
  • If you find meal times very difficult, meal delivery services may be useful to help maintain nutrition and enjoy hot meals: meals on wheels, appetito and Just Jeff’s are a few in the area
  • Changes to utensils may also help in meal prep and eating: OTs can assist with finding the right equipment

Fatigue

  • Similar to above

Tips:

  • If possible, plan your biggest meal (most calories if weight loss is an issue) for times when you feel the best. Rather than eating a couple large meals, you may find it less fatiguing to instead have small meals more frequently.
  • Utilize meal services if meal preparation wipes you out and save your energy for eating
  • Rest before a meal
  • Sometimes its easier to drink than eat calories: liquid nutrition supplements like Boost/ Ensure and/or shakes. These can be used to supplement meals.
  • Soft, moist foods can be easier to eat: ground meats, casseroles, eggs, mashed potatoes, soups

Medications:

  • Nausea and poor appetite are common
  • Tips for nausea:
  • Try not to let your stomach get too empty, this can actually cause more nausea and then make you feel worse when you do have food. Small frequent meals can be useful.
  • Try separating liquids from solids in meals and sip rather than gulp
  • Try bland foods when you feel nauseated. Limit acidic or spicy foods which can cause more stomach upset. High fat and fried foods tend trigger some people as well, because they sit in the stomach for a long period of time.
  • Do you find food smells trigger your nausea? Cool or room temperature foods produce less odor than hot foods. Try opening windows or using fans to disperse food smells. Stay away from the kitchen when food is being prepared if that is possible.
  • Rest after eating and limit activity to give food a chance to digest.
  • Many PD medications absorb better on an empty stomach, however for many this can cause nausea. If you need food to reduce nausea, try a low fibre and low fat carbohydrate food like soda crackers or graham crackers which won’t stick around the stomach, or a tea such as ginger tea if you find this calming.

Tips for poor appetite:

  • Small frequent meals
  • Liquids over solids if very poor to maintain calories . focus on calorie containing fluids and limit low calorie fluids if losing weight
  • Emphasize foods you enjoy
  • Proteins and levodopa medication : “protein conundrum”
  • Protein is very important part of a diet as they include amino acid precursors needed to maintain strength, immune system, organ fuction, etc. Also – amino acid precursors are needed for natural dopamine development
  • Unfortunately, studies have shown that protein can interfere with dopamine medications and making them less effective as they are both competing for absorption and the protein wins over the levodopa medication.
  • This may mean if you find high protein foods effect how well your medication works, you may need to avoid protein containing foods 1 hour before and 2 hours after taking the medication. This will leave certain windows in the day for protein containing foods. This website can help you determine those windows: www.livewellwithparkinsons.com
  • Many people find a high protein meal late in the day works best for them (one study has shown positive effects with this) – for those preparing own meals, may be best to prep the meal earlier when you feel better and just heat it up later.
  • Protein foods for late in the day or in the “windows”: ~1 cup of beans, 3-5 oz. of fish, chicken or meat, eggs, nut butters, milk products (including cheeses, cottage cheeses), tofu/ soy products
  • Inside those windows, there are low or no protein foods that you can still consume if you are hungry or need a snack to maintain your weight. Focus on: fats like oils, butters and spreads, avocados (moderate if you want to lose or maintain current weight, eat more if you need to gain weight), vegetables, fruits (dried, fresh, canned, juice) and grains, like dry cereals, breads, crackers, rice, pasta (white has less protein than brown generally). Almond milk and rice milk are both also low in protein.
  • Good news: The dopamine-agonists (pramipexol and ropinirole, for example) do not need this dietetic adjustment! Finally, those who take the MAO-B inhibitors (rasagiline or selegiline) should eat with moderation (but not eliminate) foods that contain high concentrations of tyramine such as air-dried and fermented meats or fish, aged cheeses, most soybean products, yeast extracts, red wine, beer, and sauerkraut.
  • Question: Does caffeine affect the levodopa medication? I was not able to find any negative effects that taking caffeine (like a cup of coffee) along with levodopa medication having a negative effect or limiting the medication’s effectiveness. However, I would ask your pharmacist about this. I would also consider what you may put in your coffee: a considerable amount of milk may affect the absorption (protein containing) and high fat dairy like creams can affect how quickly the medication leaves your stomach.

Trouble eating/ swallowing

  • SLP/ physician as needed: techniques or changes to textures may be needed
  • Soft moist foods are often easier to eat than dry or fibrous foods like red meats: dry foods can get stuck in your mouth or need a lot of moisture to easily go down, while tough, fibrous foods can be fatiguing to eat because they take a lot of chewing and can’t be broken down as much for an easy swallow
  • Cutting food into small pieces and chewing well can assist as can taking time with meals. Sometimes changing the posture and sitting very upright and/or tucking chin towards neck can assist.
  • Sometimes texture changes may be required and/ or separating liquids from solids.
  • For changing textures: use lots of moisture to mince or pureed foods like gravies, sauces and/or broths
  • Difficulty getting enough calories? Calorie containing fluids may help.
  • Question: Foods to assist with swallowing pills. Keep mouth and throat moist by drinking liquids prior to taking pill. Ask your pharmacist whether a medication can be crushed or found in a liquid form for an easier swallow. A carbonated beverage may assist as well if a pill needs to be swallowed whole, as can a double sip (sip of liquid with pill then right after). Try taking a pill with a spoonful or pudding, yogurt, applesauce.

3 ) DIET: Food or nutrients of emphasis Adequate calcium and vitamin D/ MG for bone health

  • Food sources of calcium: milk & milk products, soy/ almond/ rice milks, nuts (esp almonds), beans, salmon, green leafies
  • Food sources of vitamin D: fortified milk/ soy milk/ OJs, fish, liver, egg yolks

Bowel health: fluids/ hydration and combating constipation

  • fibre can help draw fluid intake the stool and make it easier to go, as long as there is also enough fluid to help the process along. Fibre rich foods include: whole fruits, vegetables, beans and lentils, whole grain products, oat products
  • Probiotics - some studies show these help with PD patients and wider variety studies have been completed on constipation and probiotics. Can be found in yogurts, as well as some juices, supplements.
  • Natural laxatives: prunes, licorice

Fruits and vegetables: fibre, antioxidants

  • Plenty of vitamins that can be antioxidants that may help reduce cell damage by free radicals caused by things in our environment (sun exposure, pollution, smoking, etc.). Its often suggested to emphasize these antioxidants in vitamin rich foods rather than supplementation that could cause damage in high levels, particularly since too many antioxidants has the opposite effect. Some studies have shown added benefit of these being part of the food form where they are complimented by other vitamins and complexes. Adequate protein

4 ) Questionable therapies & other research:

  • Co-Q10: Co Q10 is over the counter and safe to take, however large, well-designed studies have not shown benefits. In 2011, the National Institute for Neurological Disease and Stroke stopped a large-scale study because benefits to slow progression or symptoms were not found.
  • Coffee : a recent study in 61 people with PD found that there were improvement in movements with 2-4 cups of coffee daily, which can be a safe dose and source of fluid as well. However, larger scale studies are required before this can be more widely recommended.
  • Green tea/ antioxidants: can help body fight free-radicals which can damage the body’s cells (free radicals our produced by factors in our own environment like UV rays, pollution). They are best to get in your diet from fruits, vegetables, tea rather than a pill form as too high doses of antioxidants can be damaging.
  • Homocysteine : Our body has a normal balance of homocysteine, however it appears to be increased in clients with PD. Unknown if high levels may contribute to PD, or if PD leads to higher levels of homocysteine and more research is being done. But it is thought that it may be related to the breakdown of l-dopa. Folate as well as B12 can help to mediate homocysteine levels due to the cyclical process they are involved in, therefore it may be beneficial to ensure adequate levels of folate and B12 in the diet. Many foods are fortified with folate and it is naturally found in green leafy vegetables and beans. B12 is naturally found in animal products and some fortified foods.
  • Magnesium: food and supplement forms. May help with sleep, as well as constipation, and muscle relaxation. Green leafy, nuts, seeds, whole grains, beans/ lentils, bananas
  • Coconut oil/ MCT: no published clinical studies completed yet. Studies likely to come. This oil is high in saturated fats and if using do use in moderation.
  • Omega-3. Ratio of n-3 vs n-6 for inflammatory response balance, most deficient in n-3. DHA a type of n-3 has benefits for brain and prelim studies show that there may be some benefit in slowing progression of PD however larger studies are to be completed. Natural forms: fatty fish, fortified food sources, flax seeds and oils, chia seeds, canola oil or supplement form (fish best)


All about Antioxidants

Antioxidants are substances found naturally in food. They protect your body’s cells from damage caused by harmful molecules called ‘free radicals’. Some free radicals are formed from normal body processes when it uses oxygen. Others come from pollutants such as cigarette smoke. Antioxidants protect your cells from the damage caused by free radicals.

Take a moment, and think of your body like a car. It rusts when the metal in the car reacts with oxygen. If you cover it with a protective coating, it doesn’t rust as quickly. Similarly, eating foods that contain antioxidants every day can help protect your body from free radical damage.

Antioxidants help to keep you healthy and may also help prevent some chronic diseases such as diabetes and heart disease. Antioxidants are found in many different vitamins, minerals such as vitamin C, E and selenium. Phytochemicals, compounds found naturally in plants, may also act as antioxidants. Some phytochemicals are flavonoids, polyphenols and carotenoids.

Here are some sources of antioxidants:

  • Vitamin C: guava, peppers (red, yellow, green), kiwifruit, strawberries, cirtis fruits, papaya, Brussels sprouts, broccoli, leafy vegetables, tomatoes and potatoes.
  • Vitamin E: almonds, sunflower seeds, vegetable oils, leafy vegetables, peanuts & peanut butter, sweet potato and avocado.
  • Selenium: Brazil nuts, fish, shellfish, meat, poultry, grain products, wheat germ, wheat bran, beans, oat bran and eggs.
  • Carotenoids: kale, tomatoes/tomato products, spinach, sweet potato, carrot, leafy vegetables, pumpkin, squash, guava, watermelon, grapefruit.
  • Flavonoids: berries (particularly dark colored), cherries, red grapes, onions, apples, cocoa, green tea.

The best way to get antioxidants is from food! Supplements often have higher amounts than you need and may be harmful. The amounts commonly found in food and in a daily multivitamin mineral supplement are safe.


TIPS TO GET MORE ANTIOXIDANTS

1) Eat more plant foods

  • Fill your plate with at least ¾ plant foods. Think of meat as a garnish rather than the focus of the meal.
  • Add broccoli, spinach, Brussels sprouts, red, yellow & green peppers to stir fry dishes or serve them with a low-fat dip
  • Choose a variety of colourful fruit & vegetables each day. Eat at least 1 dark green & 1 orange vegetable each day.
  • Add strawberries or raspberries to yogurt or smoothie
  • Include whole grains, nuts and seeds, soy products, dried beans, peas and lentils more often.

2) Use small amounts of vegetables oil when you prepare your meals.

  • You can use about 2-3 tbsp of unsaturated fats each day such as canola, olive and soybean oils and non-hydrogenated margarines. This oil can help you absorb some antioxidants better (the size of your thumb tip is about 1 serving!)

3) Stir-fry, steam or microwave vegetables, using just a small amount of water.

  • This helps prevent antioxidant losses into the water

4) Get more Vitamin E by:

  • Sprinkle almonds or sunflower seeds on salads or cereal
  • Add avocadoes to salads, sandwiches and wraps or make a guacamole dip
  • Sprinkle wheat germ on your cereal or add it in when baking muffins
  • Choose fish at least 2x/week such as mackerel, herring, salmon, halibut & tuna

5) Get more flavonoids by:

  • Drink green tea rather than coffee
  • Add berries to cereal, yogurt, salads, low fat frozen yogurt
  • Add apples & red grapes to garden salad or fruit salad

6) Get more selenium by:

  • Make a mixed bean salad or chili
  • Boil soy beans and eat them as a snack or add them to casseroles or soups
  • Include meat, fish, shellfish, poultry, eggs and nuts throughout the day

7) Get more carotenoids by:

  • Have tomato sauce on top of whole wheat pasta or brown rice
  • Roast or bake carrots, sweet potato and squash in the oven
  • Enjoy a tossed salad with spinach, kale and dark leafy vegetables

HEALTHY SOFT FOOD CHOICES

With 3 meals per day: Aim for foods from 4-5 food groups with each meal for BALANCE. Include snacks from ~2 food groups as needed to curb hunger. With smaller meals throughout the day: Aim for smaller portions of foods from 3-4 food groups per meal.
1 GRAINS

  • Hot cereals
  • Cold cereals soaked in milk (aim for less than 6g of sugar)
  • Soft breads and rolls, no crusts (aim for whole wheat)
  • Pastas, soft cooked
  • Rice, soft cooked

2 Fruit

  • Pureed: aim to add little or no sugar (add onto yogurts, cereals, etc. or into smoothies)
  • Soft fruits: avocados, banana, canned fruit in water/ juice
  • Cooked fruits: apples, pears, peaches
  • Finely chopped fruits

3 Vegetables

  • Pureed: use in soups, pasta dishes, etc.; avoid sauces made with cream
  • Soft cooked vegetables (eg., steamed)

4 Milk Products

  • Milk – Aim for 2% fat or less
  • Cottage cheese
  • Yogurt (Greek or regular) – aim for 2% M.F. or less
  • Evaporated milk
  • Skim milk powders
  • Pudding made with low fat milk
  • Smoothie: ½ cup yogurt, ½ cup milk, ½ cup fruit with protein powder

5 Protein (Meat and Alt)

  • Ground meats
  • Soft fish (white fish, salmon, tuna fish w/ low fat mayo)
  • Eggs- scrambled, egg salad. boiled
  • Moist poultry
  • Tofu (try blended in soups)
  • Nut butters
  • Soft cooked meats with low sodium sauces/ broths to moisten

Aim for routine meals to energize your body throughout the day and allow your body time to process and use energy from food.


Increasing your Calories and Protein Intake

Suggestions:

  • Eat or drink frequently. If you have a small appetite, you may want to drink after your meal rather than with (it can fill you up).
  • Choose higher calorie drinks like juices, milk or milkshakes rather than water, tea or coffee.
  • Avoid fat free or low fat products
  • Try to include a meat or alternative (peanut butter, meat, nuts, beans) at every meal.

Using Skim Milk Powder as Protein source It can be a way to boost protein and calories.

Fortified Milk Recipe
Fortified milk can be used instead of regular milk – as a beverage, on cereal, in shakes, in recipes (like cookies or cakes), etc. Per cup: 250 mL of milk 4 tbsp (60mL) skim milk powder

Skim milk powder is a neutral flavoured protein powder: add to foods for extra protein and some extra calories (like a protein powder). 2 to 4 tbsp can be added to foods (Adding a bit of water to form a paste may make it easier to blend into foods). Add to:

  • Anything milk based: shakes, puddings, custards, smoothies, cream soups, milk in cereal, yogurt
  • Mashed potatoes
  • Oatmeal
  • Sauces and gravies
  • Scrambled eggs
  • Meatloaf
  • Casseroles


Foods to boost calories and protein (may need to watch timing of these foods depending on meds)
Suggestions for incorporating foods Cheese

  • Melt cheese on hamburgers, meat loaf and other meats, poultry
  • Add a slice of cheese in sandwiches
  • Use cheese (such as cottage cheese) with fruit or vegetables for a snack
  • Try cottage cheese in casseroles or egg dishes
  • Spread cream cheese on bread, fruit, etc.

Peanut Butter/ Nut Butter

  • Blend into milkshakes
  • Swirl warm into ice cream, yogurt, hot cereal
  • Use as a dip for vegetables or fruit

Eggs

  • Use extra eggs to make French toast, add to pancake mix
  • Mix hardboiled eggs with mayonnaise for spread
  • Try a whole egg or egg white omelet, quiche or frittata for lunch or dinner
  • Swirl a raw egg into a bowl of hot soup (letting it cook)

Nuts and seeds

  • Add ice cream, pudding, muffins
  • Look for softer nuts, such as walnuts, cashews

Meats, fish, poultry

  • Meats are full of a protein that has a high biological value (Full of the kinds of protein your body needs)

Yogurt (2% or higher, Greek or regular)

  • Have as a snack or dessert or use as a topping or dip
  • Add skim milk powder for added protein

Legumes: beans, peas and lentils

  • Add to soups and casseroles
  • Beans and lentils can be a great high protein dip, sauce, spread

Tofu

  • Add to thicken soups and sauces (blend in soft silken tofu

Milk

  • Make pudding with milk or buy a milk based pudding like Kozy Shack
  • Use a higher fat milk and/or fortify
  • Drink instead of water, add to teas, coffees

Low protein ways to boost calories
Wheat Germ or granola or milled flax seeds

  • Add to yogurt, ice cream or pudding for added calories

Unsaturated oils

  • Dip a crusty bread in olive oil mixed with cheese or vinegar
  • Add into pasta water to cook pasta
  • Blend into smoothies to add healthy fats and calories

Avocado

  • Mash up and add as a spread on bread or dip
  • Eat as a snack or slice on top of a salad, wrap

Dried fruits

  • Add into cereals, baked goods
  • Process into a thick spread for toast

Fruit juices

  • Add to smoothies or just mix fruit juices with fruit (can add almond or rice milk for creaminess)
  • Drink on own as source of fluid
  • Use with cereal in place of milk

Canned fruit in juice or light syrup

  • Use as snacks or on top of cereals

Cookies, cakes and sweets

  • Added sugars can help boost calories and often are high in fats as well

Don’t need to gain weight but need ways to maintain your energy and intake with low protein? Meal and snack ideas include:

  • Salads: can top with dried fruits, canned fruits (like mandarin oranges), oil or oil/ vinegar dressings or other dressings like ranch
  • Trail mix: mix together dried fruits and a mixture of cereals
  • Canned fruits: if you need to lose weight, look for those canned in juice or water, to gain weight look for those canned in syrups
  • Puddings: look for those not in the refrigerated section
  • Beverages: juices, almond and rice milks are low in sodium. You can mix these with fruits for a simple smoothie
  • Fruit salads: need to gain weight? Add shredded coconut to your fruit salad
  • Cooked vegetables: stir fried, steamed and topped with sauces of your choice. Can have alone or on top of rice, cous cous or pastas (avoid quinoa if protein effects your medications as this is a complete protein).
  • Raw veggies: dip with salad dressings
  • Breads: have your favorite breads toasted or plain and top with things like jams, margarines or crushed fruit.
  • Pasta with tomato sauce or rice with a sweet and sour sauce. Add veggies if you would like.

Keep in mind you still need protein in your life for overall health and it should not be avoided at all times. Take advantage of those windows of time around your medication and/or perhaps focus on a more protein heavy meal late in the day.

It is also important to note that most foods to contain some protein, therefore portion control of the low protein foods mentioned above is key.


CROCKPOT RECIPES

Savory Bean and Spinach Soup Makes: 6 servings Ingredients 3 14-ounce cans vegetable broth 1 15-ounce can tomato puree 1 15-ounce can small white beans or Great Northern beans, drained and rinsed 1/2 cup uncooked brown rice 1/2 cup finely chopped onion 1 teaspoon dried basil 1/4 teaspoon salt 1/4 teaspoon black pepper 2 garlic cloves, chopped 8 cups coarsely chopped fresh spinach or kale leaves Finely shredded Parmesan cheese Directions 1. In a 3-1/2- or 4-quart slow cooker, combine vegetable broth, tomato puree, beans, rice, onion, basil, salt, pepper, and garlic. 2. Cover; cook on low-heat setting 5 to 7 hours or on high-heat setting 2 1/2 to 3 1/2 hours. 3. Just before serving, stir in spinach or kale and sprinkle with Parmesan cheese. Nutrition facts per serving: 150 calories, 9g protein, 31g carbohydrate, 3g fat (1g saturated), 8g fiber

Gingered Beef and Vegetables Makes: 6 servings Ingredients 1 1/2 pounds boneless beef round steak, cut into 1-inch cubes 4 medium carrots, cut into 1/2-inch-thick slices 1/2 cup sliced scallions 2 garlic cloves, minced 1 1/2 cups water 2 tablespoons reduced-sodium soy sauce 2 teaspoons grated fresh ginger 1 1/2 teaspoons instant beef-bouillon granules 1/4 teaspoon crushed red pepper 3 tablespoons cornstarch 3 tablespoons cold water 1/2 cup chopped red bell pepper 2 cups loose-pack frozen sugar snap peas, thawed Cooked rice Directions 1. In a 3-1/2- or 4-quart slow cooker, combine beef, carrots, scallions, and garlic. In a medium bowl, combine the 1 1/2 cups water, soy sauce, ginger, bouillon, and crushed red pepper; pour over mixture in cooker. 2. Cover; cook on low-heat setting 9 to 10 hours or on high-heat setting 4 1/2 to 5 hours. 3. If using low-heat setting, turn to high-heat setting. In a small bowl, combine cornstarch and the 3 tablespoons cold water; stir into meat mixture along with bell pepper. Cover; cook 20 to 30 minutes more, or until thickened, stirring once. Stir in sugar snap peas. Serve with rice. Nutrition facts per serving: 350 calories, 29g protein, 35g carbohydrate, 10g fat (4g saturated), 3g fiber

Barbecue Pulled Chicken From EatingWell: February/March 2006, July/August 2012 8 servings | Active Time: 25 minutes | Total Time: 5 1/2 hours Ingredients 1 8-ounce can reduced-sodium tomato sauce 1 4-ounce can chopped green chiles, drained 3 tablespoons cider vinegar 2 tablespoons honey 1 tablespoon sweet or smoked paprika 1 tablespoon tomato paste 1 tablespoon Worcestershire sauce 2 teaspoons dry mustard 1 teaspoon ground chipotle chile 1/2 teaspoon salt 2 1/2 pounds boneless, skinless chicken thighs, trimmed of fat 1 small onion, finely chopped 1 clove garlic, minced Preparation Stir tomato sauce, chiles, vinegar, honey, paprika, tomato paste, Worcestershire sauce, mustard, ground chipotle and salt in a 6-quart slow cooker until smooth. Add chicken, onion and garlic; stir to combine. Put the lid on and cook on low until the chicken can be pulled apart, about 5 hours. Transfer the chicken to a cutting board and shred with a fork. Return the chicken to the sauce, stir well and serve. Serve with a bun or English muffin and salad or cabbage. Or add the filling into a boston leaf lettuce for a lettuce roll up! Per serving :364 Calories; 13 g Fat; 3 g Sat; 5 g Mono; 93 mg Cholesterol; 32 g Carbohydrates; 30 g Protein; 4 g Fiber; 477 mg Sodium; 547 mg Potassium

Crock Pot Italian Sloppy Joe Skinnytaste.com 1 lb Italian turkey sausage, removed from casing 1/2 cup chopped onions 3 cloves garlic, minced 1 red bell pepper, chopped in 1/2-inch pieces 1 green bell pepper, chopped in 1/2-inch pieces 1 1/3 cups crushed tomatoes (Tutorosso) 1/2 tsp dried rosemary salt and fresh cracked pepper, to taste For serving:

  • 6 whole wheat 100 calorie potato rolls**
  • 6 slices reduced fat provolone (Sargento)
  • 1 cup baby spinach

Directions: In a medium non-stick skillet, cook the sausage over medium-high heat, breaking up as it cooks into small bits until cooked through, about 5-6 minutes. Add onions and garlic, and cook another 2 minutes. Transfer to the slow cooker and add the bell peppers, crushed tomatoes, rosemary and fresh cracked pepper. Cover and cook on low 4 hours. Makes 3 1/2 cups. To serve, place heaping 1/2 cup of meat on a roll and if desired, top with cheese and baby spinach. Servings: 6 • Size: 1 sandwich Calories: 316 • Fat: 11.4 g • Protein: 27 g • Carb: 27.4 g • Fiber: 14 g • Sugar: 7.6 g Sodium: 461.5 mg (without the salt)

Slow Cooked Black Eyed Peas with Ham (SkinnyTaste) 8 oz smoked lean ham steak, diced (or a ham bone would be perfect) 1 pound dried black-eyed peas, rinsed and soaked overnight 2 bay leaves 1 tsp olive oil 1 medium onion, diced 2 cloves garlic, diced 1 red bell pepper, stemmed, seeded, and diced 1 jalapeno chile, seeded and minced 1 tomato, diced 1/2 tsp chili powder (I used chipotle) 1-1/2 teaspoons cumin salt to taste 1 tsp ground black pepper Directions Soak peas overnight in 6 cups of water. The next morning, drain peas and add to slow cooker. Add 4 cups of water, bay leaves and ham. Cover and cook on high 6 hours or until the beans are tender. After 6 hours, in a large frying pan, add oil and sauté onion, garlic, bell pepper, jalapeño pepper, and tomato until soft, about 6 minutes. Add to the slow cooker and season black eyed peas generously with salt, cumin, chili powder and black pepper. Cover and cook on high 1 to 1 1/2 more hours. Discard bay leaves and serve. Servings: 8 • Serving Size: 1 cup Calories: 161.4 • Fat: 1.6 g • Protein: 9.3 g • Carb: 29.2 g • Fiber: 6.7 g

Crock Pot 3 Bean Turkey Chili (SkinnyTaste) Ingredients:

  • 1.3 lb (20 oz) fat free ground turkey breast
  • 1 small onion, chopped
  • 1 (28 oz) can diced tomatoes
  • 1 (16 oz) can tomato sauce
  • 1 (4.5 oz) can chopped chilies, drained
  • 1 (15 oz) can chickpeas, undrained
  • 1 (15.5 oz) can black beans, undrained
  • 1 (15.5 oz) can small red beans, undrained
  • 2 tbsp chili powder

For the Topping:

  • 1/2 cup chopped red onion
  • 1/2 cup chopped fresh cilantro for topping
  • shredded cheddar to top (extra pts)

Directions: Brown turkey and onion in a medium skillet over medium high heat until cooked through. Drain any fat remaining and transfer to crock pot . Add the beans, chilies, chickpeas tomatoes, tomato sauce and chili powder mixing well. Cook on high 6-8 hours. Servings: 12  Serving Size: 10.8 oz Calories: 206.3 • Fat: 1.4 g • Protein: 16.8 g • Carb: 31.8 g • Fiber: 9.0 g

Slow-Cooker Vegetarian Lasagna From EatingWell: November/December 2011 Serve with: a green salad. 8 servings | Active Time: 30 minutes | Total Time: 2 hours on High or 4 hours on Low Ingredients

  • 1 large egg
  • 1 15- to 16-ounce container part-skim ricotta
  • 1 5-ounce package baby spinach, coarsely chopped
  • 3 large or 4 small portobello mushroom caps, gills removed (see Tip), halved and thinly sliced
  • 1 small zucchini, quartered lengthwise and thinly sliced
  • 1 28-ounce can crushed tomatoes, partially drained
  • 1 28-ounce can diced tomatoes, drained
  • 3 cloves garlic, minced
  • Pinch of crushed red pepper (optional)
  • 15 whole-wheat lasagna noodles (about 12 ounces), uncooked
  • 3 cups shredded part-skim mozzarella, divided

Preparation 1. Combine egg, ricotta, spinach, mushrooms and zucchini in a large bowl. 2. Combine crushed and diced tomatoes and their juice, garlic and crushed red pepper (if using) in a medium bowl. 3. Generously coat a 6-quart or larger slow cooker with cooking spray. Spread 1 1/2 cups of the tomato mixture in the slow cooker. Arrange 5 noodles over the sauce, overlapping them slightly and breaking into pieces to cover as much of the sauce as possible. Spread half of the ricotta-vegetable mixture over the noodles and firmly pat down, then spoon on 1 1/2 cups sauce and sprinkle with 1 cup mozzarella. Repeat the layering one more time, starting with noodles. Top with a third layer of noodles. Evenly spread the remaining tomato sauce over the noodles. Set aside the remaining 1 cup mozzarella in the refrigerator. 4. Put the lid on the slow cooker and cook on High for 2 hours or on Low for 4 hours. Turn off the slow cooker, sprinkle the reserved mozzarella on the lasagna, cover and let stand for 10 minutes to melt the cheese. Per serving :414 Calories; 14 g Fat; 8 g Sat; 4 g Mono; 63 mg Cholesterol; 48 g Carbohydrates; 28 g Protein; 7 g Fiber; 641 mg Sodium; 829 mg Potassium

Crock Pot Santa Fe Chicken Skinnytaste.com Servings: 8 servings  Size: 1 cup Calories: 190 • Fat: 1.5 g • Fiber: 5.6 g • Carbs: 23.1 g • Protein: 21 g

  • 24 oz (1 1/2) lbs chicken breast
  • 14.4 oz can diced tomatoes with mild green chilies
  • 15 oz can black beans (rinse)
  • 8 oz frozen corn
  • 1/4 cup chopped fresh cilantro
  • 14.4 oz can fat free chicken broth
  • 3 scallions, chopped
  • 1 tsp garlic powder
  • 1 tsp onion powder
  • 1 tsp cumin
  • 1 tsp cayenne pepper (to taste)
  • salt to taste

Combine chicken broth, beans, corn, tomatoes, cilantro, scallions, garlic powder, onion powder, cumin, cayenne pepper and salt in the crock pot . Season chicken breast with salt and lay on top. Cook on low for 10 hours or on high for 6 hours. Half hour before serving, remove chicken and shred. Return chicken to slow cooker and stir in. Adjust salt and seasoning to taste. Serve over rice or tortillas and your favorite toppings.

A few more website ideas: Crockpot Recipes to prep ingredients in advance and keep in freezer (just thaw and cook in crockpot!): http://www.ringaroundtherosies.net/2012/02/freezer-cooking.html *hopefully prep can mostly be done seated and maybe with the help of family. Aim to do a shop where you can get ingredients for multiple make-aheads, and keep in freezer. Each bagged meal could be multiple dinners/ lunches. Freezer meal ideas: http://www.sixsistersstuff.com/2011/12/fresh-food-friday-20-tried-and-true.html BREAKFAST RECIPES Steel Cut Oats in the Slow Cooker (Overnight Oats) ¾ cup steel cut oats 1 cup water 2 cups 1% milk 1 tsp cinnamon Dash of nutmeg ¼ tsp all spice or pumpkin pie spice Pam

Makes 3-4 servings Place all ingredients in the slow cooker and put slow cooker on low for 8-10 hours. You may need to spray the slow cooker with Pam to avoid the oats from sticking. Steel cut oats are heartier than regular oats, so aim for closer to ½ cup than ¾ cup. In the morning include add-ins as desired, such as: sweetener, protein powder, crushed nuts, dried fruit, fresh fruit, frozen fruit, canned fruit, cocoa powder, low fat yogurt.

Overnight Oats in a Mason Jar ¼ cup quick oats ½ cup milk or milk alternative ¼ banana, sliced (freeze the rest for smoothies) ½ cup fruit of choice (e.g., berries fresh or frozen and thawed) Sweetener of choice Pinch of cinnamon 1-2 tbsp protein powder (optional)

Place all ingredients in the jar and shake well. Place in fridge until morning and if desired, add crushed nuts or bran in the morning for a crunch.

French Toast in a Mug 2 slices whole wheat bread 1 egg 3 tbsp 1% milk Pinch of cinnamon 1 tsp vanilla 1 large mug Pam Spray your mug with pam to make it non stick. Cube your bread and place it in the mug (can be cubed in advanced and placed in a bag). In a separate small bowl, whisk together 1 egg, 2 tbsp milk, vanill and cinnamon (add other spices if desired). Pour liquids over bread and press the bread down with a fork several times to get all the bread to soak up some moisture. Stick it in the microwave: start with 1 minute then add 10 seconds as needed until the bread is no longer wet.

++++++++++++++++++++++++++++++++++++

Hello, I have updated my talking points with some answers to the questions asked and this gives some more detail on some of the things discussed, as well as some more info that the group may be interested in. I have also attached the resources handed out, do note I did expand a bit on the increasing calories and protein resource.

Thanks,

Lauren Fleming MSc.FN, RD

Dietitian

Sandwich Community Health Centre

Windsor Essex Community Health Centre

Phone: (519) 258-6002

Fax: (519) 258-7896

lfleming@wechc.org


www.wechc.org


Mailing Address: 1585 Ouellette Avenue

Windsor, Ontario

Canada

N8X 1K5


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Use Rick's online contact form HERE.


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