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Curry with Dietary Restrictions

h
hungryabbey Oct 14, 2011 07:17 PM

So I have started a dietetic internship rotation in a renal outpatient clinic, and we have a lot of E Indian & S Asian patients for whom curry is a dietary staple. Well, these patients desperately need to limit their Phosphorus, and Potassium, which means no tomatoes, no yogurt, no coconut milk, or any other dairy.
Can anyone use their culinary creativity to help me come up with a way to let them make curry without these ingredients? Please help! It breaks my foodie heart to tell them they need to cut down/out the curry.
Thank you!

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  1. EWSflash RE: hungryabbey Oct 14, 2011 08:56 PM

    Bless you for asking this. I didn't realize that Indians had a lot of diabetes, unless their diets had gotten very westernized. Is that what causes it?

    2 Replies
    1. re: EWSflash
      h
      hungryabbey RE: EWSflash Oct 14, 2011 09:00 PM

      um no. this isnt actually a diabetes issue. its renal disease. and we have a range of cultures,.. its just the curry in particular that Im struggling with finding a substitute.

      1. re: EWSflash
        m
        Muchlove RE: EWSflash Oct 15, 2011 09:44 AM

        I will add that South Asians have huge problems with diabetes and are at high risk of getting it.

      2. m
        micahg RE: hungryabbey Oct 14, 2011 09:04 PM

        Reduce almond milk to a thicker, saucier consistency and use that in place of coconut milk/dairy.

        1. e
          escondido123 RE: hungryabbey Oct 14, 2011 09:28 PM

          Until I learned about curry, I didn't know they included coconut milk, yogurt, other dairy or tomatoes. My container of curry just said to saute onions, saute meat and then add curry powder and stock--would that simple recipe work? I also make curried tuna or chicken salad by just adding it to a mayo based salad along with some chutney, apple and nuts.

          1. mlou72 RE: hungryabbey Oct 14, 2011 11:31 PM

            I'm not much help, I've only dabbled a little bit in Indian cooking. But I have come across some recipes like this without tomatoes or dairy.
            http://www.youtube.com/watch?v=SrECJ5...
            http://www.youtube.com/watch?v=UupVcB...

            They probably don't need to cut out the curry, perhaps just find some older recipes and a little creativity. What about finding someone local who teaches Indian cooking, you might find a valuable resource in that.

            1. t
              tastesgoodwhatisit RE: hungryabbey Oct 15, 2011 12:05 AM

              For more authentic recipes, I know there are some curries that use ground cashews as a base for the sauce.

              If I were trying to make a creamy curry without yoghurt, then I might try experimenting with soft tofu, and adding lemon or tamarind to make it tarter.

              1. paulj RE: hungryabbey Oct 15, 2011 12:17 AM

                Buy or borrow '660 Curries'
                http://www.amazon.com/dp/0761137874/?...
                and browse through that, looking for recipes that meet your criteria.
                Raghavan Iyer uses a broad definition for 'curry', so the book covers a lot of Indian cooking, with at least some awareness of regional variations.

                In a crude sense, coconut milk is more common in the south, yogurt and other dairy in the north. Tomato only dates back 3-500 yrs.

                Does the quantity matter? For example some dishes just use a few tablespoons of yogurt. Aren't certain fruits (e.g. bananas) regarded as good (or this case bad) sources of potassium?

                1. paulj RE: hungryabbey Oct 15, 2011 12:20 AM

                  http://www.davita.com/kidney-disease/...
                  kidney friendly foods from India

                  http://www.nkfi.in/nutrition.htm
                  Indian kidney foundation

                  There are probably more Indian sources

                  1. m
                    Muchlove RE: hungryabbey Oct 15, 2011 03:04 AM

                    Can you define what you mean by "curry"? Indian food encapsulates an enormous variety of dishes, many of which don't include tomatoes, yoghurt or coconut milk.

                    For many Indians who are very proud of their traditional culture, there is no such thing as "curry". For others, it is a term that has become acceptable because so many other people in the world use it. But whether it's a word you use or not, it still covers an enormous range of dishes.

                    2 Replies
                    1. re: Muchlove
                      paulj RE: Muchlove Oct 15, 2011 09:47 AM

                      In this context, everything that the patient eats is relevant. But for ingredients like yogurt, coconut milk and tomatoes, finding substitutes for the sauce rich dishes (generically called curry) may be particularly difficult. For last night's post I did a search on 'kidney diet India', aiming to get at the root of the issue.

                      According to the Indian Kidney foundation
                      "Dried beans and peas such as kidney beans, split peas and lentils " are high in phosphorus. The centrality of pulses in the diet for many Indians might not have occurred to the OP (who is presumably a non-Indian Canadian).

                      1. re: paulj
                        m
                        Muchlove RE: paulj Oct 15, 2011 09:58 AM

                        "In this context, everything that the patient eats is relevant."

                        This is obvious. In my above post I was trying to point out that a wide range of dishes make up the desi diet. Some of these are saucier dishes which are often thought of as "curry". Then there are drier dishes, salads, chutnies, relishes, pickles, savouries, rice dishes, breads, dals, etc. I'll admit that I was probably being a bit picky and just trying to get the OP to realise that the diet is made up of more than just saucy dishes that are full of yoghurt, tomato and coconut.

                    2. luckyfatima RE: hungryabbey Oct 15, 2011 07:21 AM

                      From personal experience I know that dietary restrictions are really hard to adapt to for anyone, and this is true for South Asians, too. For desis (short hand for S. Asians from Pakistan, India, Bangladesh, Nepal, and Sri Lanka) it is impossible to cook many regular daily dishes without the ingredients you mention. Coconut milk is ubiquitous for people from Southern parts of the sub-continent and Sri Lanka. Tomatoes and/or yoghurt are used in 80% of daily curries for many Northerners, for whom coconut milk will not be an issue (Southerners also use yoghurt and tomatoes as well so they will have the hardest time). Tomato-onion-garlic-ginger are the backbone of the masala for many dishes for a lot of regions in the subcontinent.The patients will simply have to make their daily vegetables and meat dishes without these. There are many "curries" which can be done this way. (Your patients don't actually call these dishes curries at home in their native-languages, as Muchlove has pointed out, and as the word doesn't exist as such in any desi language---but they will undoubtedly know exactly what you mean when you say "curry.") You will just have to advise them to go for these dishes. There are many recipes like this, but it will mean limiting a lot of regular favorites. The recipes that don't contain the restricted ingredients are there in the normal cuisines. It will just be a matter of relying on these recipes and avoiding others that contain the restricted foods. Relying on lentils and legumes will be good for this (many lentil dishes call for tomatoes, but those can be omitted). My personal opinion is that substitutions will be rejected, so it is better to simply tell them to make the many dishes that can be made without these things.

                      10 Replies
                      1. re: luckyfatima
                        m
                        Muchlove RE: luckyfatima Oct 15, 2011 08:14 AM

                        I do disagree with you. There are many many sub-continental dishes that do not include coconut, tomatoes or yoghurt. It is true that these are common ingredients but there are still plenty of dishes without them. I find it incredibly frustrating when people make comments like "you can't cook Indian food with onions" and other such nonsense things as if all Indian food is the same.

                        ETA: Sorry luckyfatima, I don't mean to be snippy/rude to you. I guess I just got a little frustrated with the tone of the OP ("It breaks my foodie heart to tell them they need to cut down/out the curry.") as I found it to be a little condescending and ignorant, but this is my own issue. Clearly the OP is trying to be helpful and caring and I shouldn't be such an ass about it.

                        FWIW, I stand by my conviction that the range of dishes consumed in the subcontinent is wide enough that tomatoes, coconut and yoghurt could be avoided. Yes there would be some sacrifices, but it is possible and still delicious and traditional.

                        1. re: Muchlove
                          luckyfatima RE: Muchlove Oct 15, 2011 08:58 AM

                          What exactly do you disagree with? These ingredients are unarguably the backbone of many sub-continental cuisines (as are onions for that matter), but I didn't ever say that there aren't any dishes made without them or that such dishes are rare. On the contrary, I said:

                          "The patients will simply have to make their daily vegetables and meat dishes without these. There are many "curries" which can be done this way."

                          and

                          "You will just have to advise them to go for these dishes. There are many recipes like this, but it will mean limiting a lot of regular favorites. The recipes that don't contain the restricted ingredients are there in the normal cuisines." Note that I said "cuisines" on purpose because the sub-continental cuisines are so diverse, and nowhere did I imply that 'all South Asian food is the same.' My "these dishes" = the many that don't contain those ingredients, which I say are "regular."

                          And finally,

                          "My personal opinion is that substitutions will be rejected, so it is better to simply tell them to make the many dishes that can be made without these things." Once again, I said "many dishes can be made without these things...I should have said 'are made without these things, in fact.'

                          I agree that the OP's query represents the challenges that patients of of color or of minority backgrounds face when engaging a mainstream institution, in this case, the health care system, where their culture is misunderstood or not known and so these people can be marginalized by the institution that exists to serve them. I think it is a great thing that the OP is reaching out to get more knowledge about how s/he can better serve her patients.

                          1. re: luckyfatima
                            m
                            Muchlove RE: luckyfatima Oct 15, 2011 09:13 AM

                            I just disagree that it's going to be so completely impossible. I suppose in that way we are basically agreeing.

                            I would also like to point out that some South Asians do not consume onions. And in some communities onions have only more recently started to be added to more and more dishes whereas older traditional versions do not contain them.

                            You may have missed my edit whilst you were writing, but I did admit that this is just my own problem with my perception of the original post of this thread. I acknowledge that the OP is very caring and considerate and perhaps I'm just a giant ass.

                            1. re: Muchlove
                              w
                              will47 RE: Muchlove Oct 15, 2011 10:31 AM

                              Hing is often used as a substitute for onions / garlic in pure vegetarian cooking, which often prohibits the use of the "5 pungent spices".

                              1. re: will47
                                m
                                Muchlove RE: will47 Oct 15, 2011 10:50 AM

                                It's not just use as a substitute actually. It's also used because it has powerful digestive properties (hence its use in dal) and a long history of usage in traditional Indian medicine.

                                Now if this diet bans hing I may cry...you'll have to drag it from my cold, dead hands!

                              2. re: Muchlove
                                luckyfatima RE: Muchlove Oct 15, 2011 11:34 AM

                                Yes, practicing Jains, Krishna devotees, Kashmiri Pandits, as well as a few other communities don't eat onions, and some people give them up for prescriptions of ayurveda or for specific fast days. Not to mention that some communities don't use onions but use types small of shallots or, for example, the scallion-like Kashmiri praan common in Muslim Kashmiri cuisine...Too much diversity in sub-continental cuisine to recommend one particular diet to the patients if even when discussing onions there is such variety in terms of use and omission. I still maintain that in a general way onions are an unarguable backbone of many subcontinental cuisines despite the fact that I am well aware that onions don't go in everything and several communities' cuisines don't use onions at all.

                                I think in modern times and for urban, metropolitan people, for those who cook with a lot of tomatoes and yoghurt, it is a very modern phenomenon to have these items year-round. Many people live in less urban settings in South Asia, or in localities where the electricity goes out frequently. In places where it gets cold (Himalayan and foothill regions), yoghurt will not set for part of the year, so dishes are made differently by the season. Tomatoes are not available year round, either, so dishes may contain them at one time in the year, and not in another. If you live in a city where the electricity goes out for a few hours or more each day during the summers, freezing tomatoes to use out of season is not an option. Anyway, my point is that people adapt. I do think it will be a challenge cooking without these things for people who use them frequently, as they (especially tomatoes) are a backbone ingredient in many daily dishes...but there are many alternatives that are already a normal part of the cuisine so it will be a matter of abstaining and making alternative dishes rather than re-inventing in order to meet these dietary restrictions.

                                1. re: luckyfatima
                                  m
                                  Muchlove RE: luckyfatima Oct 15, 2011 11:46 AM

                                  I think we are pretty much agreeing, and for the record it was never my intention to p*ss you off or get into a silly argument,

                                  Round here, tomatoes are used quite a bit but I think more people could live without them whereas yoghurt would be a big difficulty. People wrap their containers in towels, keep it near the heater, etc. so they can have it in winter.

                                  We're in a city but the electricity in my area is truly crap. I don't think anyone here really takes their fridge that seriously, people shop often and don't try to keep veggies for too long. Tomatoes do seem to be available all the time, they just vary in price.

                                  I will mention that I live in potato land. Onions are important but people are used to occasionally doing without them (for instance many round here recently went onion and garlic free for navaratri). Potatoes OTOH are pretty much a constant. Had dins with my neighbour the other day and bless her both sabziya had potato - aloo baigan with gravy for the wet dish and aloo karela for the dry! In my family we are less potato orientated and if potato is present it is usually only in one dish!

                                  1. re: Muchlove
                                    paulj RE: Muchlove Oct 15, 2011 12:18 PM

                                    Apparently onions and garlic are fine for a kidney diet.

                                    One source also says that some of these minerals are leached out of vegetables during cooking. So potatoes that have first been boiled in water might be acceptable.

                                    1. re: paulj
                                      m
                                      Muchlove RE: paulj Oct 15, 2011 12:38 PM

                                      The discussion on onions and garlic was admitedly a little OT for this thread, just an aside on how generalisations can be difficult to pin down!

                                      Interesting about the pre boiling thing. I suppose this could be useful for all vegetables but I guess this is going to make them rather non-nutritious! I'm wondering, do patients of this diet have problems with poor nutrition as a result of the things they must avoid?

                                    2. re: Muchlove
                                      luckyfatima RE: Muchlove Oct 15, 2011 12:53 PM

                                      Sure, no offense taken.Definitely with you on the potato thing.

                          2. m
                            Muchlove RE: hungryabbey Oct 15, 2011 09:28 AM

                            I just had a thought: soya yoghurt may be useful here. It's definitely not the same but in stuff it should be somewhat ok.

                            I think what you need to do is talk to each patient individually. They are all going to have personal ideas on the subject, and particular dishes that they will miss.

                            In terms of daily meals you can assure them that with a few changes they can continue to eat desi or east asian food. When it comes to particular dishes with forbidden ingredients, they may have to get creative. Soy yoghurt as a sub for regular yoghurt, perhaps almond milk for instead of coconut milk, etc. There will be some things that they just can't replicate, like pure freshly set dahi (yoghurt) to go with a meal. But this is something that people from any culture would experience. Hopefully they can try some substitutes and come to a happy half way.

                            2 Replies
                            1. re: Muchlove
                              paulj RE: Muchlove Oct 15, 2011 09:34 AM

                              Though you need to be careful about suggesting substitutes. For example, why is coconut milk bad, but not almond milk? In one list all 'nuts' are high in phosphorus.

                              1. re: paulj
                                m
                                Muchlove RE: paulj Oct 15, 2011 09:38 AM

                                Sorry, I do not know any of the details of the diet beyond what the OP has stated. If there are other restrictions that include other nuts (though coconuts are rather different), vegetables, etc. then it will be mcuh harder.

                            2. luckyfatima RE: hungryabbey Oct 15, 2011 09:31 AM

                              Re: The OP, I am glad that you asked for South Asian and E. Indian and not just "Indian" as probably you have a diverse range of South Asian patients including Indian, Pakistani, and Bangladeshi origin patients. Rather than telling them to eat boiled chicken breast and sending them home, you are trying to find out how to advise them based on what their typical diets so that they will have success with trying to improve their health through diet. The cuisines in these countries are actually very diverse, so it would be difficult to make a suggested menu pamphlet that would be suitable for all Indians, let alone all people in the region. I hope that if you guys have a very heavy desi clientele, the clinic would consider hiring a medical professional of a South Asian background, who while not knowing everything about all of the diverse cuisines of the patients, will likely have some general understanding of what the patients' diets are actually like (know deeper than "curry" anyway). You will have patients who don't eat onions, patients who eat fish everyday, patients who eat fried foods every day, patients who are vegetarian, who don't eat beef but eat other meat, who don't eat pork, etc...and the way all of these people prepare their "curries" is very highly contingent on their regional origin, religion, and ethno-linguistic background. So, while you will have to make some generalizations in order to give any advice, at the same time you must retain an understanding that your Asian patients have very diverse diets. Their cuisines have many dishes made without the restricted ingredients. However, for people of many backgrounds, giving up the restricted items (I think tomato would be the hardest) will be difficult, yet simply require brainstorming and a shift to recipes that are already present in the cuisine. Without knowing the specific background of the individual patient, it is too hard to suggest any dishes by name...you will have to leave that up to the patients and their families.

                              1. 4
                                4Snisl RE: hungryabbey Oct 15, 2011 09:40 AM

                                I'm going to agree with paulj and say that it would be helpful to check out some Indian cookbooks and recognize a range of South Asian dishes that do not rely on yogurt, tomatoes or coconut milk.

                                Most of the curries I've learned in the Bengali community are a saute of onion, ginger and spices in the sauce base, with meat, fish and/or vegetables added to cook in the sauce. Vegetables are often simply sauteed with onion and spices (e.g. cumin seeds, ground tumeric, etc.).

                                This is a case where the rich diversity of southeast Asian cusine is an asset....what are the most common dishes that require the use of yogurt, coconut milk, or tomatoes? Are lentils posing a problem as well?

                                1. goodhealthgourmet RE: hungryabbey Oct 15, 2011 09:47 AM

                                  one more thing to note: lentils and garbanzos are phosphorus-rich staples of East Indian and South Asian cuisines so you might want to caution the patients to watch their intake.

                                  5 Replies
                                  1. re: goodhealthgourmet
                                    m
                                    Muchlove RE: goodhealthgourmet Oct 15, 2011 09:53 AM

                                    See now this is going to be a problem if dal is off the menu! I was also thinking about it and potassium is present in most fruits and veggies, no? My, this diet really does sound very unhealthy when you think about it!

                                    Can we have a bit more info on what is absolutely not allowed, what is allowed in small amounts, etc.?

                                    1. re: Muchlove
                                      4
                                      4Snisl RE: Muchlove Oct 15, 2011 10:24 AM

                                      hungryabbey might have a specific set of standards at her institution, but this looks like the general standards about renal diet that I learned:

                                      http://www.mcw.edu/Nephrology/Clinica...

                                      Basically, people need to watch (and potentially limit) intake of fluid, potassium, phosphorus, sodium and protein. (Our kidneys do a lot!) I think that specifics about how much is allowed varies in terms of the individual person.

                                      1. re: 4Snisl
                                        m
                                        Muchlove RE: 4Snisl Oct 15, 2011 10:47 AM

                                        Thanks for that, I wasn't sure about googling because there is a LOT of "medical" information on the internet!

                                        From the lists on that page one other food that catches my eye is potatoes. Although potatoes are a relatively "recent" addition to the South Asian diet, many people eat potatoes very very often. We're talking at pretty much every meal. Now this is not everyone and it's something I've noticed more in the North, but it's worth picking up on.

                                        Another one to note is greens. Now that is a bummer, and it's probably something that many would not think of because it's such a healthy food so they would just assume it's good for you. Although greens aren't a big thing on South Asian restaurant menus, they are an important part of the local diet and there are particular greens dishes that some will identify strongly as a "comfort food" dish.

                                        I didn't see yoghurt on that particular list but I was wondering if it was just yoghurt or all dairy. South Asian tea and coffee is made with a lot more milk than Western versions, and although the serving sizes are small, often they are drunk frequently. In general, I think yoghurt is going to be a stumbling point for many. It's used in cooking and as a side dish all over the country. The South may not be as crazy over paneer as the North but yoghurt is still very important.

                                        Aha, sodium. It's a stereotype that often proves to be true that South Asians use a lot of salt. This may be a problem area, but it can be overcome because after a while of eating less salty food, patients will become used to it.

                                    2. re: goodhealthgourmet
                                      luckyfatima RE: goodhealthgourmet Oct 15, 2011 11:42 AM

                                      That's really very limiting if lentils and large legumes are off-limits.

                                      1. re: luckyfatima
                                        goodhealthgourmet RE: luckyfatima Oct 15, 2011 01:35 PM

                                        i suggested they should *watch* their intake, not prohibit them completely. besides, i'm sure the intake of these potentially problematic ingredients varied wisely across her patient population, and since nutrition is extremely individualized the OP will have to address these things with each patient on a case-by-case basis. once she has a better idea of each person's dietary picture she can adjust accordingly.

                                    3. h
                                      hungryabbey RE: hungryabbey Oct 15, 2011 03:32 PM

                                      Wowy. I am blown away atthe responses here.
                                      I do appologize if my original post came off sounding condescending at all. It is not a "racialized" issue, as I have a hard time telling anyone to cut down on the foods they love for health reasons. This just becomes even more amplified when you throw cultural traditions in the mix.
                                      Im sorry I didnt go into detail on the exact geo origins of our patients.. I just know that this week alone I have heard a lot of requests for curry, all made with preparations that are not ideal on a kidney diet (and yes, moderation is okay, but curry seems to be a daily meal which may be problematic).
                                      I also didnt want to overwhelm anyone with all of the foods they can and cant have, b/c the list is exhaustive. So yah, almond milk (all nuts), soy milk are out as they're too high in K and PO4. I guess I was hoping to come up with something to replace the moisture of the tomatoes.. something LIKE pureed pumpkin but pumpkin is also high in K. Tofu is also really high in K and PO4 so that isnt acceptable.
                                      But, perhaps if I recommend just using curry powder with oil, and adding moisture with stock perhaps? Would that work?
                                      And then, if it fits within their dairy allowance for the day, a little bit of yogurt?

                                      2 Replies
                                      1. re: hungryabbey
                                        paulj RE: hungryabbey Oct 15, 2011 04:55 PM

                                        The spices in curry powder, or a made from scratch blend shouldn't be a problem. Garlic and ginger are other key flavoring ingredients. Onions can be blended into a paste, or just sliced. Either way, if the stew is cooked long enough the onions disintegrate, and provide much of the body. Often yogurt (or cream) is added near the end to add some richness; or it is at the beginning to marinate the meat.

                                        I suspect many of the patients are elderly. Are they living alone, or (more likely) as part of an extended family? If alone they might not be up for the longer traditional preparations; if part of an extended family, it may be hard to prepare meals that others like and still meet the restricted needs of the patients.

                                        I wonder if part of the problem, both with the disease and the diet, has to do with diet that includes more rich meat curries in the Mughlai tradition http://en.wikipedia.org/wiki/Mughlai_...
                                        Chicken tikka masala with yogurt, tomato and cream finish is emblematic of that rich diet, and may be the kind of 'curry' your patients have a hankering for.

                                        Drier dishes, which can be still be well spices, might be easier to adapt. Keema, for example, is a relatively dry ground meat dish that can be made without these forbidden ingredients (just meat, spices, onions, some vegetables, almost no sauce). Cauliflower can be cooked with whole spices like mustard seed and fennel without a sauce.

                                        1. re: paulj
                                          h
                                          hungryabbey RE: paulj Oct 16, 2011 10:34 AM

                                          Yes, from what I understand based on the info they give me about preparation, the dishes are either made with tomatoes, cream, yogurt or coconut milk, or some combo of these ingredients, none of these are ideal for them to be eating everyday in the context of the rest of their diet. But I can maybe find some recipes for these drier versions and at least have some alternative for them. Thank you.

                                      2. 4
                                        4Snisl RE: hungryabbey Oct 17, 2011 03:42 PM

                                        I remember internship, and how challenging renal diets could be with patients. I think one of the best things is helping people realize that eventually, staying within their guidelines will become more second-nature, even if it seems overwhelming right now.

                                        I also remember how interesting it was to decide to adapt certain recipes....and times where it seemed best to just learn some "new favorites" instead of tweaking an old favorite with results that hardly resembled the original. :) This can be highly subjective, of course.

                                        Anyway, good luck! Please keep us updated on popular or well-accepted recipes you find!

                                        1 Reply
                                        1. re: 4Snisl
                                          h
                                          hungryabbey RE: 4Snisl Oct 17, 2011 06:21 PM

                                          Thanks for the tip! I will let you know what happens and if I get any feedback.

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