Navigating St. Patrick’s Day

What picture comes to mind when you think of a St. Patrick’s Day spread? For most people it is corned beef and cabbage, some might even pair it with some soda bread. Maybe a pint of your favorite dark beer or some Irish cream beverages come to mind too. While something like Shepherd’s Pie is always a good (and more authentic) alternative to corned beef and cabbage to celebrate, I thought I’d break down for you how to make dishes you love without the sodium, potassium, and phosphorous that normally is present. I will link to the recipes I use on the header for each section.

Corned Beef: The main thing that puts this out of a CKD diet is the salt and additives that the beef is brined in. I have made what I am about to tell you about in a slow cooker, a pressure cooker, and a traditional oven in a baking pan. I usually leave off the salt completely, 1 tsp has 2325mg of sodium in it, so I tend to season liberally with other flavors to make up for the lack of salt. If I do put in salt, I’ll add 1/16 to 1/6 of a tsp rubbed in well. The salt will help it have an exterior texture that is more moist and what you expect if you are cooking it in the oven, but you know your numbers and what you need more/less of. We do home hemo for mom which is more frequent, so we can be a little more liberal with the sodium, potassium, and phosphorous in the foods we eat. For the Corned beef you need pickling seasoning (check your brand for salt, some include it), oil (I use olive oil), and a chunk of brisket. You want to put about a tbsp of oil on the meat (and salt if you are using it) and rub it into the meat. Put it in the baking dish you are using (I use a 9x11 pan in the oven, my slow cooker interior, or my pressure cooker interior) and then cover it in pickling seasonings and rub those in well too. I usually use a up to 5 tbsp of the seasoning and rub it in, then top with 2 tbsp more. Let this set for an hour or so before you cook it, so the seasonings have a chance to marinate a little, especially if you are using the oven. (If you can cover your dish for cooking in the oven, this will also help.) Cook it until done (usually a few hours for me), and serve!

Shepherd’s Pie: While we tend to think of corned beef and cabbage as the “traditional” Irish meal in the US, it’s actually not what you would find in Ireland. A much more authentic dish would be Shepherd’s Pie, which is relatively easy to make in a kidney-friendly way! I use the linked recipe, but with some substitutions. I don’t do any of the potato instructions, instead, I do the potatoes listed below. I also leave out the 2 tbsp of salt, substitute the aged white cheddar for a plant-based cheddar (like this one) if phosphorous is a problem, and don’t put in any lamb (I know this technically makes it more of a Cottage Pie, not Shepherd’s Pie but…). For this recipe you’ll need 2 tbsp of plant-based butter, 1 cup of shredded aged cheddar or cheddar substitute, pepper (to taste), 1 small onion diced, 2 medium carrots diced, 4 cloves garlic minced, 4 sprigs of fresh thyme, 1-1/2 lbs ground beef (as lean as you can), 1/3 cp tomato paste, 1tbsp all-purpose flour, 3/4 cp beef stock, 1cp fresh parsley chopped (I like Italian parsley). Heat your oven to 375, then melt the butter in a large skillet over medium. Add the onion, carrot, garlic, thyme, and rosemary and cook till the onions are translucent and the carrots are tender (stir it frequently, it should be about 10 minutes). Then you will add your beef, and break it up as you cook it. You want it to have no pink left. You’ll season now to taste with salt (omitting this will still taste great) and pepper to taste. You’ll add the tomato paste next, and stir it to combine with the rest for about 2-3 minutes. Next, sprinkle in the flour and make sure it mixes in. Add the beef stock and cook until the liquid thickens slightly, then you’ll add the parsley to the mix and take out the thyme sprigs. Taste again and re-season with salt (again, you can omit this) and pepper if it needs it. I transfer this at this point into a 9x11 casserole dish, then top it with the instant potatoes from below mixed with the cheddar cheese. Make sure you leave some holes in the potatoes for air to escape as it cooks. Put it on a baking sheet and cook it for 30 mins, then let it sit for 15 minutes before you serve it.

Cabbage: Who doesn’t love some buttered cabbage? This is by far the easiest part of a celebration to make kidney-friendly. I use the book at the link in the header, it’s Rachel Allen’s Irish Family Food. I love this cookbook and use it year-round. For the cabbage, you need a pound of cabbage (savoy is best but I usually use just generic green or red cabbage), 2 tbsp plant-based butter, 2 tbsp water, and salt and pepper to taste (you can leave off the salt if you need to cut out some sodium in your meal, substitute it with garlic or another flavor you like). Finely shred the cabbage, then put butter and water into a saucepan over medium heat and get it all melted together. Put the cabbage in the saucepan and season it with salt (or substituted flavor) and pepper. You want to cook it with a lid on for 2-3 minutes, or until it’s just starting to soften. Taste it for flavor and adjust as needed, you’ll want to serve it immediately.

Mashed Potatoes: Finally, the secret ingredient that I wish I’d known about years ago: flaked/boxed mashed potatoes. I like the Idahoan brand, but I’ve also used the 365 and Bob’s Red Mill brands with success. These have a lot less potassium in them from the process of drying them, and it’s easy to substitute the ingredients they call for with kidney-friendly substitutes. Most want unsalted butter, milk, and salt. We use plant-based unsalted butter, and oat milk, leaving out the salt. Instead, I’ll add things like garlic and onion powder, pepper, or whatever flavor I’m feeling like in our potatoes that day. Idahoan Brand has 10mg of sodium and 251 mg of potassium in their original brand flakes. Those numbers jump to 370mg of sodium and 311g of potassium when you make it as directed. By leaving out or reducing the salt, you can get the sodium way down. With a milk substitute, you will decrease the potassium and eliminate the phosphorous that is added.

Colcannon: You know what’s better than buttered cabbage? Buttered cabbage mixed with mashed potatoes. See the mashed potatoes info below, and the buttered cabbage above. You will want a 3/1 ratio on your potatoes based on what this book says. What I do is prepare the potatoes and cabbage as listed in the previous sections, then put them together. I’ll use 1-1/2 cups potatoes to 1/2 cup cabbage, scaling up based on how much I want to be able to serve.

Soda Bread: This one is hard to make kidney-friendly, baking soda has a LOT of salt in it. Most of the info I found for substitutes for baking soda were baking powder or self-rising flour, these also have a lot of salt. What I think I’m going to try this year is halving the baking soda (~1/3 tsp), and adding a beaten egg white (1 large egg white is about 2 tbsp). I’m going to take out the 2 tbsp of egg white from the buttermilk, so that will be close to 1-1/3 cups instead (a little more). I’m also going to leave out the salt, and use a buttermilk substitute. To make fake buttermilk, I use 1 tbsp of lemon juice to 1 cup of my non-dairy milk, I usually use oat milk for baking.

Apple Cake: This is the best sweet treat year-round. I love it. You’ll need 1-3/4cp all-purpose flour, 1/2 tsp baking powder (see egg white instructions here if you can’t do the 200mg of sodium that this will put in the cake) 1/2 cp plant-based unsalted butter, 1/2cp sugar, 1 egg beaten, 1/2 cp oat milk, 1 large apple for cooking (~10.5 oz), 1 tsp ground cinnamon, optional is a plant-based whipped cream. Heat your oven to 350, and butter a 10-inch pie pan. Mix your flour, baking powder (or substitute), and then rub in the butter with your fingertips until you have a breadcrumb texture. Add your sugar, beaten egg, and enough oat milk that it starts to form a loose dough. Put half the dough in the greased pan and reserve the rest for later. Peel, core, and chop your apple into 3/4 in cubes. Put them on the dough in your greased pan and cover them with 1 tbsp of sugar and 1 tbsp of cinnamon. Spoon the remaining dough on top, and then sprinkle your final 1 tbsp of sugar on top of it. Cut a slit in the middle of the top dough and cook for 40 minutes or until it’s golden and crunchy on the outside with soft apples in the middle. When you serve it you can top it with plant-based whipped cream.

Shamrock Shake: This is a mostly US treat, but since McDonald’s is everywhere now it’s a common name for this type of beverage. I think of it as being more of a Grasshopper but without the alcohol and with a whole lot of green food coloring. You’ll need 2 cups of non-dairy ice cream (I like coconut-based ones for sweet shakes like this), 3/4 cups of coconut cream, green food coloring, 1/4 tsp mint extract (I prefer extract to flavoring, it blends better in my experience), optional is a dairy-free whipped cream and some sprinkles. You’ll toss the 2 cups of non-dairy ice cream, 3/4 cups of coconut cream, 10 drops of green food coloring, and 1/4 tsp mint extract into your blender and blend it until it’s smooth. Top it with whipped cream and sprinkles if you’d like.

Dark Beer: Definitely check with your care team on this one, I’m not that educated on alcohol since we don’t really drink in our family. However, we do occasionally enjoy a beer or mixed drink, and based on the research I’ve done a dark beer like Guinness Draught Stout (12oz.) has about 25mg of sodium and 96mg of potassium. These are safe levels based on lab results and will be different for each person. Obviously avoiding alcohol, in general, is good if you can when you are on a kidney-friendly diet, your body just can’t process it. This is one to skip if you can in my opinion.

Irish Cream (Alcoholic or Non): The key to Bailey’s seems to be sweetened condensed milk, cocoa/chocolate syrup, instant coffee, and vanilla extract. I found a couple of replica recipes online, and here is what I would do to make them kidney-friendly. 1/10th or so of a can of sweetened condensed milk has 35mg of sodium and 140mg of potassium. This is a condensed milk product, so phosphorous will also be high. (It also has 22g of carbs and 22g of sugar if you are diabetic.) This seems like a lot for most dialysis patients. I would recommend making a version yourself using a can of coconut milk and simmering the water out of it on the stovetop. The recommendation I found online says to put 1/4 cup of sugar into one can of full-fat coconut milk and bring it to just under a boil. You’ll then let that simmer for 30 mins to cook off the water. You can substitute heavy cream with a can of full-fat coconut milk as well. Make sure you check the sodium and potassium in your coconut milk though, some brands have more than others. For the chocolate syrup, mix together cocoa powder and water, and add some sugar to taste (again, check with your care team). You want the consistency to be runny, but still a bit slow. For your coffee granules, talk to your care team about different options. I have found that the Medaglia D’Oro brand (https://www.medagliadoro.com/) works really well and has a good flavor. Vanilla and Almond extracts shouldn’t have anything you need to avoid, but always check labels. Like the beer above, I would skip the alcoholic version of this if you can. Again, alcohol without kidneys is not a great combo. (Wikipedia about what makes a whiskey an Irish one, and a list of distilleries and brands that make them. https://en.wikipedia.org/wiki/Irish_whiskey) To make this you will need 14 oz of sweetened condensed milk substitute, 1cp of full-fat coconut milk, 2 tbsp of substitute chocolate syrup, 1 tsp instant coffee grounds, 1 tsp vanilla extract, and 1 tsp almond extract. Put all the ingredients in the blender and blend on high for 20-30 seconds (until smooth and mixed). Shake it before you use it.

I hope you will enjoy these recipes as much as my family does, and that you have a safe and fun holiday.

Resources Used:

Kidney-Friendly Corned Beef and Cabbage: http://www.nxstagekidneycare.com/navigator/recipes/un-corned-beef-and-cabbage

Shamrock Shake Recipe: http://www.dinneratthezoo.com/shamrock-shake-recipe/

Whole Milk Substitutes: https://www.acouplecooks.com/whole-milk-substitute/

Baking Soda Substitutes: https://www.allrecipes.com/article/baking-soda-substitute/

Bailey’s Recipe 1: http://www.allrecipes.com/recipe/23534/original-irish-cream/

Bailey’s Recipe 2: htts://aseasyasapplepie.com/homemade-baileys-irish-cream/#Irish_cream_recipe

Sweetened Condensed Milk Subs: http://www.tasteofhome.com/article/sweetened-condensed-milk-substitute/

Irish Cream Info: http://en.wikipedia.org/wiki/Baileys_Irish_Cream

Whiskey Info: http://en.wikipedia.org/wiki/Irish_whiskey