LivingHealthy - Latham Centers

with Prader-Willi Syndrome

Paul E. Donahue, Jr.Melanie Silverman, MS, RD, IBCLC

Patrice Carroll, LCSW

LivingHealthy

COOKBOOK SUPPLEMENT: SEASONAL SOUPS, SALADS, AND DESSERTS

LivingHealthy with PWS | 3

AuthorsPatrice Carroll, LCSWDirector of PWS Services, Latham Centers

Paul E. Donahue, Jr.Executive Chef, Latham Centers

Katrina Fryklund, MSPC Director of National Outreach, Latham Centers

Melanie Silverman, MS, RD, IBCLCExpert in PWS Nutrition, Independent Consultant

EditorsDawn Dinnan, MBADirector of Communications, Latham Centers

Katrina Fryklund, MSPCDirector of National Outreach, Latham Centers

PhotographersPaul E. Donahue, Jr. and Katrina Fryklund

Graphic DesignSusie Perry of Perry DesignPocasset, Massachusetts

PrintingSunderland PrintingHyannis, Massachusetts

with Prader-Willi SyndromeCookbook Supplement: Seasonal Soups, Salads, and Desserts

LivingHealthy

CREDITS

with Prader-Willi SyndromeCookbook Supplement: Seasonal Soups, Salads, and Desserts

LivingHealthy

Special thanks for the support of: Brine DiningLatham Centers Kitchen StaffPWSA (USA)Snowy Owl Coffee Roasters

Pictured on Cover:

Chilled Watermelon Soup, page 12

Grapefruit Salad with “Champagne” Vinaigrette, page 31

Blackberry and Blueberry Tart, page 20

Latham Centers is a place of hope, innovation, and excellence. Latham’s therapeutic residential school campus in Brewster and adult program with residential locations throughout Cape Cod and southeastern Massachusetts serve children and adults with complex special needs. Since 1970, Latham Centers has worked with students, adult residents, their families, and outstanding professionals to change lives—and even save lives. Latham is internationally recognized for its expertise in the care of individuals with Prader-Willi syndrome. The non-profit organization is accredited by the Council on Accreditation, and its dedicated, highly trained staff works around-the-clock to achieve its mission. Latham Centers’ service delivery values of mastery, belonging, generosity, and independence help ensure the well-being and happiness of every individual who calls Latham home.

Latham Centers’ mission is to create opportunities for independence, self-worth, and happiness for children and adults with complex special needs.

Copyright© 2019 by Latham Centers, Inc.

LivingHealthy with PWS | 54 | LivingHealthy with PWS

PREFACE TABLE OF CONTENTS

After publishing Latham Centers’ first LivingHealthy with PWS cookbook, we learned a few key concepts that helped to inform this supplement.

• There was a resounding need. Within ten months after publication, we had distributed over 500 copies exclusively through word-of-mouth and online publicity. Professionals across the nation reported that they were implementing our meal plan in their group homes or programs for individuals with PWS.

• It was right on trend. “The Mediterranean diet got the top ranking in U.S. News’ list,” according to a CBS News article published in January 2019. “The heart-healthy diet is rich in fruits, vegetables, fish and whole grains, along with healthy fats like olive oil, nuts, and avocados. Research has shown the Mediterranean diet reduces the risk of heart disease and may have numerous other health benefits, including reduction of LDL, or “bad,” cholesterol, as well as a decreased risk of Alzheimer’s disease, Parkinson’s disease, and cancer.”

• There’s always room for growth, changes, and improvements. Since publishing our first cookbook, we’ve tweaked our menu slightly by adding new recipes and modifying others to incorporate food preferred by our residents. Cookbook readers inquired about more dessert options, and some requested more information about recipe carbohydrates and proteins.

As a result, we have created this cookbook supplement. Mindful of the needs of our audience, this seasonally based supplement includes recipes for soups, salads, and desserts. Soups are easy to make, can be adapted to any season, and prepared in bulk. Varied salads were essential to the first cookbook; in this supplement, we’ve included four homemade salad dressings. Store-bought dressings are often full of unnecessary calories and sodium. Some of these are also listed in bulk so that you can save them for the next time around! Desserts are a highlight of occasional “treat days” for our residents. Planned treat days celebrate holidays, birthdays, and other special occasions. In this supplement, per the request of our readers, we’ve included four desserts associated with each season that are less caloric compared to standard dessert recipes.

We hope you enjoy this supplement and we welcome your feedback at [email protected]. In the words of one PWS Chapter President, “We’re all in this together!”

Best wishes for happy and healthy eating,

Cookbook Co-EditorsKatrina Fryklund, MSPCDirector of National Outreach

Dawn Dinnan, MBADirector of Communications


LivingHealthyCookbook Supplement: Seasonal Soups, Salads, and Desserts


LivingHealthyCookbook Supplement: Seasonal Soups, Salads, and Desserts

SUMMERChilled Watermelon Soup .................................... 12Watermelon, Feta, Basil Salad with Lime Vinaigrette ......................................... 13Orange Creamsicle Smoothie ............................. 14

FALLDairy-Free Roasted Red Pepper Bisque ........... 18Roasted Beet and Blue Cheese Salad with Balsamic Vinaigrette ................................. 19Blackberry and Blueberry Tart (or Cookie!) ..... 20

WINTERDairy-Free Butternut Squash Bisque ................ 24Roasted Winter Squash Salad with Citrus Vinaigrette ........................................ 25Apple Crisp ............................................................. 26

SPRINGGazpacho ................................................................ 30Grapefruit Salad with “Champagne” Vinaigrette ......................... 31Vegan Key Lime Pie .............................................. 32

RECIPES

Chef Paul with students after lunchChef salads ready to be served Students welcoming spring at the School Day Games


A Letter from the Chef

To a Special PWS Community,

In 2014, I began working at Latham Centers with the perspective of a chef. I saw a challenge: how can we create a healthy and tasty menu for our residents, many of whom battle with weight gain and have food-seeking behaviors? Since implementing the Mediterranean style diet, I have watched residents collectively lose hundreds of pounds while increasing their calorie counts. Students’ insulin dosages have been reduced, fewer residents rely on CPAP machines, and counless students’ blood sugar levels have been reduced. Now, more than ever, I see more smiles and more energetic residents.

My passion for food has changed to a passion for people.

In our fi rst cookbook, we told you the story of Chris. As he continues to exercise and lose weight, we have been able to increase his calorie count to a high of 1600. Every day he is one step closer to his goal of 150 pounds from a weight of 430 pounds in November, 2016. Because of his healthy lifestyle and weight loss since coming to Latham, he is fi nally ready for a surgery that has been postponed for years. Stories like this encourage me to do more in this fi eld with the support of Prader-Willi syndrome experts such as Melanie Silverman and Patrice Carroll. We continue to witness how the Latham Centers dining program improves the lives of our residents, one meal at a time.

What I fi nd so uplifting are the stories we hear from parents, guardians, and caregivers from around the world. As a result of all program components, including dining and clinical, parents and students who are new to the Latham family see healthy weight loss and happier kids. This reaffi rms for many families who have struggled in their decision that coming to Latham’s residential program was the right choice. One new Latham parent said they tried the recipes in the Latham cookbook and their son loved the baked BBQ chicken, couscous, and caulifl ower potatoes. “We truly feel that [he] is going to fl ourish at Latham.”

Overall, our residents love the Mediterranean style diet, which is trending in 2019. When asked her favorite meal, one student said, “I love the roasted Brussels sprouts!” When asked her biggest accomplishment at Latham Centers, she said, “I’m so proud that I’m losing weight, I’m happy here. I have a wonderful Latham family, and I’m proud because I’m happy.”

Stories like this encourage me to want to do more; to turn over every leaf, because you never know what benefi t is going to come next. I hope this recipe book helps your family as much as our fi rst publication, LivingHealthy with PWS: Cookbook and Nutrition Tips.

Sincerely, Paul E. Donahue, Jr.Executive Chef, Latham Centers

My passion for food

has changed to a

passion for people.

– Paul E. Donahue, Jr.

“ “Snowy Owl Coffee Roasters on Main Street in Brewster is a favorite off-campus gathering spot for our cookbook team. A copy of Latham’s LivingHealthy cookbook is on display at the coffee house for customers to peruse. Chef Paul is pictured at Snowy Owl with Patrice Carroll (left) and Katrina Fryklund during a cookbook supplement planning meeting.

Paul has been cooking in fi ne- and casual-dining restaurants for over 30 years. Soon after he became Executive Chef at Latham Centers in 2014, he realized his true passion was in channeling his enthusiasm for cooking into changing lives for people with Prader-Willi syndrome and other complex special needs. He creates an ever-changing fresh, low-calorie menu based on collaborations with staff and experts, as well as regular interaction with residents about their likes and dislikes. He has become a “celebrity” to our students.


Choosing the right diet sometimes seems impossible, and even more of a challenge with a diagnosis of Prader-Willi syndrome. There is confl icting advice online and from healthcare professionals which makes the choice that much more complicated. One diet has emerged from large data meta-analyses and from positive outcomes at Latham Centers: the Mediterranean Diet. With an emphasis on a variety of fresh foods and healthy fats, the Mediterranean Diet has been shown to reduce the risk of cardiovascular mortality and cancer. Not only are the health benefi ts signifi cant, but the food is delicious. Since Latham Centers has transitioned to the Mediterranean Diet, residents have lost weight and even had to increase their calorie levels to maintain weight.

Each family needs to decide which diet is best for them and must have permission from a physician to start a diet. If you have a family member diagnosed with Prader-Willi syndrome, we encourage you to learn as much as possible about the Mediterranean Diet, talk to your physician, and try some of the recipes in this cookbook. The diet may just be the diet you were looking for!

Melanie Silverman, MS, RD, IBCLC, is a registered pediatric dietitian (RD) and board-certifi ed lactation consultant (IBCLC). She has a Bachelor of Arts in Chemistry and Spanish from Indiana University and a Master’s degree in Clinical Nutrition from Rush-Presbyterian St. Luke’s Medical Center. Melanie began her career as a clinical dietitian at the University of Chicago Medical Center in 1998. She began intensive work in PWS in 2004 and has presented at many national and international PWS conferences on optimal nutrition for patients with PWS. She continues her work with families in PWS and is also the Chief Clinical Offi cer for a telemedicine app called Pacify.

Refl ections on healthy dining at Latham Centers

The Mediterranean Diet has been more than a menu change for the students and adults at Latham Centers – it has been a life-enhancing boost to overall health and wellness! Since we have incorporated the fl avors, textures, and food items of the Mediterranean Diet into our Latham menu, we have seen an increase in energy, satisfaction, and focus throughout our program. We have been able to increase calories and still maintain weight loss. What a pleasure it has been to see an increase in exercise due to higher energy levels, and to note self-reports of better sleep and less daytime fatigue. My only wish is that we made this change sooner!

Patrice Carroll is internationally recognized for her expertise in Prader-Willi syndrome. She provides consultation throughout the country and serves as co-chair of the PWSA (USA) Professional Providers Advisory Board. She has been working with individuals and families impacted by PWS since 1995.

Melanie Silverman, MS, RD, IBCLC

Patrice Carroll, LCSW

Healthy, happy, active lifestyles at Latham

“I like all the Special Olympics athletics because I get to get more physically fi t while hanging out with my peers.” – Chris S.

“I like to play basketball and bowl in Special Olympics. I love going to the tournaments because I get to meet all sorts of people.” – Evan

“I like to go swimming because it’s fun.” – Annika

“I am most proud of how much weight I’ve lost and how I won Special Olympics Player of the Year for Massachusetts and for Latham Centers.” – Chris M.

“I am most proud that I learned to ride a bike; I proved so many people wrong!” – Bridget

“I am proud that I’ve done a lot of exercises and lost a lot of weight, and am keeping myself safe!” – Annika

“I’m so proud that I’m losing weight, I’m happy here. I have a wonderful Latham family and I’m proud because I’m happy.” – Chloe

In our students’ words:


SUMMER

Summer can be a wonderful time for fun and adventure. Following some basic safety tips can help to keep your summertime safe.

• Exposure to sun and heat: Heat stroke occurs when a person has prolonged exposure to heat coupled with dehydration. Individuals with PWS are particularly susceptible to sun and heat injury because of difficulties regulating body temperature combined with a lack of sensation, pale skin, and high pain tolerance. Heat stroke is a medical emergency that can cause damage to the brain and other internal organs. If possible, avoid direct sunlight for more than a few minutes, always use sunscreen and hats, and be sure you are close to shade. Stay hydrated and decrease outdoor exercise during peak sunlight hours.

• Bug bites: Bug bites present a unique set of issues for individuals with PWS. Skin picking sites often start with a bug bite, and we all know how quickly those can get out of control. Prevention is key – use bug spray, avoid bright colored clothing, and cover arms and legs when walking through the woods or near standing water.

• Hydration: Staying hydrated is a critical part of summer safety. Dehydration can lead to heat exhaustion, behavioral outbursts, and GI issues. Find out from your pediatrician the best water intake goal for your child and stick to it. Sticker charts and goal wheels are a good way of involving your child and will teach them healthy practices in the process.


CHILLED WATERMELON SOUP Prep Time: 30 minutes, one day in advanceTools Needed: blender or food processor, large bowl, fine strainer

This watermelon soup is an overall sensory experience. It’s served chilled, so it’s soothing on a warm summer day. The pink watermelon makes for an electrically beautiful soup (sometimes we even make it on Valentine’s day!) To top it off, this soup does not require any cooking but needs to chill overnight for all the flavors to blend, so it’s great to make in advance of a busy day.

We have crafted this recipe to serve four at approximately one and a quarter cups per serving. The recipe should make just over five cups. We do not suggest freezing this recipe as it’s best one-day out when it’s fresh and the flavors have blended.

Rice milk is our preferred alternative to cow’s milk, almond milk, or soy milk because we are serving multiple individuals in a seating, many of whom have dairy and nut sensitivities. At home, you could substitute any milk in place of the rice milk. The chart below is an approximation and is dependent on the brand.

INGREDIENTS:2 cups apple juice¼ cup fresh ginger, minced¼ cup fresh mint¼ cup (local) honey½ cup lime juice1 cup unsweetened rice milk1 cup watermelon, dicedOptional (not included in calorie count):1 splash cool water1 tablespoon low-fat yogurt

SERVES: 4

Approximate Calories:

167 per serving

DIRECTIONS:Puree ingredients in blender or food processor.Smooth by straining through fine strainer into large bowl.Chill overnight.

For an extra kick: Serve the next day with a small piece of mint and light drizzle of low-fat yogurt thinned with a splash of water.

WATERMELON, FETA, BASIL SALAD with LIME VINAIGRETTE Prep Time: 30 minutesTools Needed: mixing bowl and whisk

We enjoy using microgreens mix because the leaves are smaller than traditional lettuce and add visual appeal. In this recipe, they also mix well with the sliced basil! Microgreens mix is packed with more nutrients than larger-leaf counterparts such as iceberg lettuce. Microgreens are particularly high in vitamin C, vitamin E, vitamin K, and beta-carotene.

The reduced fat feta cheese is the most caloric ingredient in this dish at approximately 160 calories per half cup (which varies depending on the brand). To reduce the calorie count of the salad, simply reduce the amount of feta cheese. One-half cup of reduced fat feta cheese can contain up to 24 grams of protein.

WATERMELON, FETA, BASIL SALAD INGREDIENTS:½ cup basil, sliced1 cup microgreens½ cup reduced fat feta cheese, crumbled1 cup watermelon, diced

DIRECTIONS:Dice watermelon into half-inch cubes.Crumble feta.Thinly slice basil leaves.Lightly toss all ingredients.

SERVES: 3


Salad: 87 per cup

Dressing: 63 per Tbsp

LIME VINAIGRETTE INGREDIENTS: Makes approximately ½ cup

1 teaspoon Dijon mustard 2 tablespoons fresh lime juice2 tablespoons rice wine vinegar¼ cup light olive oilPinch salt and pepper

DIRECTIONS:Mix Dijon mustard, lime juice, rice wine vinegar, salt, and pepper. Drizzle oil in while whisking.

Source: https://www.cookinglight.com/microsites/pdf/alternative-milk-spread-1703.pdf


ORANGE CREAMSICLE SMOOTHIECook Time: 10 minutesCool Time: 30 minutesTools Needed: blender and saucepan

Parents of children with PWS have asked us for suggestions on desserts, especially around birthdays. It is customary for a child to receive a birthday cake in celebration, and we do include occasional treat days in our menu planning. We challenge ourselves to devise creative, less caloric desserts that could be served during celebrations. This Orange Creamsicle Smoothie is a perfect example as it is dairy-free, serves a large group, and has only 237 calories for one large serving. If smaller portions are preferred, this recipe in its entirety contains approximately 1422 calories. To find the augmented calorie count for a smaller portion, simply divide the total calories by the number of servings for your family.

For a healthy dessert treat that is more “cake-like,” our 2018 publication, LivingHealthy with PWS: Cookbook and Nutrition Tips, describes how to make Dairy-Free Omega-3 Cupcakes.

INGREDIENTS:Simple Syrup1 cup sugar1 cup water

Smoothie Mixture2 cups ice1 cup non-dairy whipping cream1 quart orange juice

SERVES: 6


237 per serving

DIRECTIONS:To make simple syrupIn a saucepan, bring to boil water and sugar. Cook until sugar is dissolved.Refrigerate approximately 30 minutes or until cool.

To make smoothiePlace ice, non-dairy whipping cream, chilled simple syrup, and orange juice into a blender.Blend until desired consistency


FALL

Back to School and Programs PWS Style: Any transition can be difficult, but the transition from summer to school or program is one of the biggest of the year. Changing schools, teachers, staff, and the introduction of new peers and new social expectations can take a toll on the person with PWS and, in turn, the whole family. Here are some ways to help make the transition a little less challenging.

• Meet the personnel ahead of time. Specifically, meet with teachers, coaches, administrators — anyone with whom your child will be in frequent contact. Most schools will allow for this opportunity.

• Check out the environment. Play on the playground or for older kids, go to the library or outdoor “hang out” spots and let them explore before the introduction of social expectations is upon them.

• Ask. Find out what will be taught this year and start discussing it at home.

• Communicate. Use communication journals or ask for a daily email regarding the day. It will also ease the anxiety of the person in your life with PWS if he or she knows that everyone is on the same page and are communicating daily.

• Calendars. Make a calendar or a visual countdown to the first day of day programs or school.

• Routine. If school or day programs haven’t yet started, start the routine now. Mimic the school day by waking up at a consistent time and eating lunch according to the school schedule.

• Training videos. Request that everyone working with the person in your life with PWS watch one of the training videos for educators working with PWS. Supply them if necessary. The training videos that are available are thorough and extremely helpful and will give your new team more confidence when working with your child.

• Keep it positive. There will be bumps, expect them. Do not criticize teachers or caregivers in front of someone with PWS. Negativity makes forming a relationship next to impossible.

• Back to program shopping. Be mindful of new clothes. If the person in your life has a sensory processing issue, then new clothes and new shoes can be brutal. Wash new clothes several times before introducing them and when possible, buy used, already broken in shoes. Discomfort will add to attention challenges.


ROASTED BEET AND BLUE CHEESE SALAD with BALSAMIC VINAIGRETTE Prep Time: 30 minutesCook Time: 40 minutesTools Needed: saucepan, baking sheet, whisk

Beets are rich in nitrates, nitric oxide, and betaine, all of which can positively impact someone with a PWS diagnosis. Nitrates help increase blood circulation and boost endurance, nitric oxide helps dilate blood vessels which increases blood flow to the brain, and betaine helps to improve digestion. A boost of endurance can increase stamina, an increase in blood flow to the brain can help with memory and concentration, and improved digestion can help regulate bowel movements.

To reduce calorie count in this recipe, halve the amount of blue cheese. One cup of blue cheese is approximately 475 calories. One beet contains approximately one to two grams of protein, and one cup of blue cheese contains approximately 30 grams of protein.

We suggest serving this salad at room temperature, however, you could cool the cooked beets in the refrigerator before serving, or serve as a warm salad by barely cooling the beets once out of the oven.

INGREDIENTS:1 cup blue cheese, crumbled3-4 large beets, boiled1 teaspoon garlic, diced1 tablespoon olive oil1 pinch pepper1 pinch salt

SERVES: 4


Salad: 210 per cup


DIRECTIONS:Preheat oven to 350 degrees F.Boil beets until soft in the center. Check softness by sticking with a fork.Once soft, remove from water and peel while hot.Slice beets.Toss in olive oil, salt, pepper, and garlic.Roast beets in preheated oven for 20 minutes.Remove from oven, let cool to desired temperature, and toss with blue cheese.

BALSAMIC VINAIGRETTEINGREDIENTS: Makes approximately ¾ cup4 tablespoons balsamic vinegar2 teaspoons Dijon mustard 1 teaspoon (local) honey1 teaspoon lemon juice ½ cup light olive oilPinch salt and pepper

DIRECTIONS:Mix balsamic vinegar, Dijon mustard, honey, lemon juice, salt, and pepper. Drizzle oil in while whisking.

DAIRY-FREE ROASTED RED PEPPER BISQUE (with Chicken) Prep Time: 30 minutes • Cook Time: 90 minutesTools Needed: sheet pan, grill pan, mixing bowl, plastic wrap, stock pot (medium sized), blender or immersion blender

This bisque recipe serves six to eight people so you can make it in advance and freeze some for next time. For a smaller group, split the recipe in half or freeze a portion for a quick meal-prep down the line! We suggest adding grilled chicken as an optional protein to this recipe – by placing a few pieces on top of the soup, it makes for a fuller looking meal without many added calories. When making the bisque, the “deglaze” instruction means to add liquid to a medley of sautéing ingredients. Bits get stuck to the bottom of the pan; deglazing releases these bits and also stops the garlic from overcooking. As you deglaze, the liquid reduces, resulting in a concentration of flavor.

INGREDIENTS:Bisque1 tablespoon black pepper½ cup carrots, minced½ cup celery, minced¼ cup garlic, minced2 tablespoons kosher salt1 tablespoon light olive oil½ cup onion, minced2 tablespoons fresh oregano 12 red bell peppers1 quart rice milk1 quart vegetable broth¼ cup white cooking wine

Chicken (optional)2 boneless chicken breasts, skinless and diced (approximately 8 ounces per breast)1 teaspoon light olive oilPinch pepperPinch salt

SERVES: 6-8


Bisque: 115 per cup

Chicken: 31 per ounce

DIRECTIONS:BisquePreheat oven to 400 degrees F.Lightly coat peppers with olive oil.Place on sheet pan and place in oven until skin begins to brown and separate from the pepper. Remove from oven, place in mixing bowl. Cover tightly with plastic wrap. Let sit for 30 minutes. Condensation may occur, ignore this. Under running water, peel the skin and remove the seeds. Discard skin and seeds. In medium-size stock pot, sauté garlic, roasted red pepper, celery, carrots, and onions until lightly browned. Add chopped oregano, salt, and pepper. Deglaze pan with white cooking wine. Reduce wine by half. Add vegetable stock and cream. Bring to a boil. Reduce heat, bring to a simmer. Using immersion blender or blender, puree all ingredients. (If using a blender, only fill ¾ so soup has room to expand when blending).

ChickenProtein Tip: An appropriate serving size for boneless, skinless chicken breast is generally four ounces (about the size of the palm of your hand). Four ounces of grilled chicken has about 35 grams of protein and is approximately 124 calories. Therefore, one ounce of chicken has approximately 9 grams of protein and is approximately 31 calories.

Coat and season chicken with olive oil, salt, and pepper. Grill.Dice chicken and place atop soup to add extra protein, extra flavor, and visual appeal.


BLACKBERRY AND BLUEBERRY TART (or Cookie!)Prep Time: 45 minutes • Cook Time: 20 minutesChill Time: 3-24 hoursTools Needed: Two mixing bowls, 8” pie pan or cookie sheet, and saucepan.

Berries are nutritious, delicious, and high in omega-3. You could substitute or mix in strawberries and raspberries, but blackberries contain the most omega-3 per berry, and blueberries help to sweeten the recipe. Berries are also very low in carbohydrates; one half cup of blackberries contains less than 3g of carbs. Amazingly, this recipe is under 200 calories per slice.

We like to utilize a very similar recipe for Fruity Thumbprint Cookies. To convert this recipe to cookies, simply double the tart recipe and halve the filling recipe. First, roll tart batter into balls and place on cookie sheet. Next, cook until cookies’ edges are golden brown. Finally, pull from the oven, and use your thumb to create “thumbprint” in each cookie while still warm— careful that the cookie is not too hot to touch! Let thumbprint cookies rest at room temperature and then add an equal dollop of filling in the thumbprint of each cookie. To finish, place cookies in refrigerator for filling to properly set. To calculate calorie count of the cookies: doubling the tart shell recipe equates to approximately 2290 calories; reducing the filling recipe equates to approximately 221 calories. Example: if one were to create 12 larger cookies, calorie count would be approximately 210 per cookie; if one were to create 16 smaller cookies, calorie count would be approximately 157 per cookie.

INGREDIENTS:Crust2 tablespoons butter, melted2 tablespoons coconut oil, melted 1 cup flour¼ teaspoon salt 3 tablespoons white sugar

Filling1 cup blackberries 1 cup blueberries ¼ teaspoon cinnamon 1 ½ tablespoons cornstarch½ teaspoon lemon juice ¼ teaspoon salt 1/3 cup sugar ¼ cup water, cold

SERVES: 8


190 per slice

DIRECTIONS:To make crustPreheat oven to 350 degrees F.Spray pie pan with non-stick spray or coat with butter.Combine flour, salt, and sugar in one bowl. Combine melted butter and coconut oil in separate bowl. Combine wet ingredients with dry and press crust into bottom of pie pan. Cook for 20 minutes. Remove from oven and let cool.

To make filling In saucepan, combine cinnamon, cornstarch, lemon juice, salt, sugar, and water. Stir until dissolved.Add berries and cook on medium heat until berries start to burst and ingredients start to blend. Mixture will thicken. Pour into tart shell and let sit for 1 hour until room temperature.Place in refrigerator to chill. When serving, remove from refrigerator and let sit at room temperature for approximately 30 minutes. This makes for beautiful pieces of tart; the shell will release from the pan more smoothly.


WINTER

A compilation of Tips by Patrice Carroll, LCSW, for chilly winter days:

• Allow a person with PWS to create their own goals and resolutions; success is more likely!

• Create expectations around broken routines and winter vacations — often the excitement for the upcoming days can cause anxiety.

• After each holiday, get back into a routine as soon as possible. Holidays bring anxiety for many reasons. Being off a routine is extremely difficult for a person with PWS.

• Use lotion frequently during the winter months. Dry skin can crack and itch, and lead to picking.

• Limit outdoor exposure during very cold weather. People with PWS have a higher risk of hypothermia. Know the signs!

• Be sure not to skip exercise just because you need to stay indoors. Use exercise videos, exercise games on gaming systems (our kids love Wii Fit), or have a dance party!

• Prepare for a snow day and keep a secret stash of games and crafts for days that you might be without power or stuck inside.

• Fish, fish oil, and egg yolks are great sources of Vitamin D for those months when there is less opportunity for sun exposure. Always check with your child’s doctors before starting any supplements.


ROASTED WINTER SQUASH SALAD with CITRUS VINAIGRETTE Prep Time: 40 minutesCook Time: 30 minutesTools Needed: sheet pan, blender, saucepan

There are many types of winter squash suitable for this recipe, ranging from acorn to butternut squash. “Winter” describes the class of squash when growers harvest the squash once the fruit is fully mature. Because this implies a harder rind or skin, it is imperative that you remove the “flesh” from the “skin,” as it would be difficult for someone with PWS to digest.

Winter squash is rich in vitamins A, C, B6, and B3, as well as fiber. It also contains a high level of omega-3. While vitamins like B3 and A help repair skin damage, fiber improves digestion, and omega-3 helps decrease hyperactivity, impulsiveness, restlessness, and agitation.

When selecting squash, you may consider taste, consistency, proteins, and carbohydrates. One cup of cubed acorn squash contains approximately 1g protein and 15g carbohydrates; one cup of cubed butternut squash contains approximately 1.5g protein and 16g carbohydrates; one cup of cubed spaghetti squash contains less than 1g protein and approximately 7g carbohydrates.

SERVES: 4


Salad: 130 per cup


CITRUS VINAIGRETTE INGREDIENTS:Makes approximately 2 cups¼ cup cider vinegar½ teaspoon black pepper1 teaspoon brown sugar½ cup light olive oil 1 cup orange juice 2 tablespoons shallots, minced1 cup white cooking wine

DIRECTIONS:Cook wine and shallots in a saucepan until wine is reduced by 75%.In blender, add wine reduction, orange juice, brown sugar, black pepper, cider vinegar. Puree. Drizzle olive oil into the blender as it’s blending. Drizzle preferred amount of citrus vinaigrette atop salad.

DAIRY-FREE BUTTERNUT SQUASH BISQUE Prep Time: 40 minutes Cook Time: 30 minutesTools Needed: food processor, frying pan, large saucepan

Our Butternut Squash Bisque is a great way to warm up on a chilly day, has many health benefits, and is simple to make. Our recipe contains rice milk, so it’s dairy-free and low in sugars. Butternut squash is an excellent source of dietary fiber which can relieve common GI problems such as constipation and bloat. Pureeing the soup creates an easy to digest, smooth consistency. One cup of cubed butternut squash contains approximately 16g of carbohydrates and 1.5g of protein.

INGREDIENTS:1 tablespoon allspice, ground4 cups apple cider 2 tablespoons brown sugar, packed1 large butternut squash, peeled, gutted, and chopped2 tablespoons cinnamon, ground 4 tablespoons margarine 1 tablespoon nutmeg, ground1 cup unsweetened rice milk1 white onion, chopped

DIRECTIONS:Dice onions. Sauté with one tablespoon margarine in frying pan for 5 minutes, set aside. Peel butternut squash. Remove seeds and fibers with large spoon and discard (or compost). Chop butternut squash into approximately ½ inch cubes.Boil cider, butternut squash, and onions. Once butternut squash begins to break down in cider, remove from heat and let sit for 10 minutes. Puree in food processor with remaining margarine. Add remaining ingredients.Puree again. Serve warm.

Makes

Approximately 6 cups


260 per cup

SQUASH SALAD INGREDIENTS:Mesclun or mixed greens1 tablespoon light olive oil1 pinch pepper1 pinch salt2 winter squashAdditional vegetables such as carrots, peppers, onions, or other salad fixings to your preference.

DIRECTIONS:Preheat oven to 375 degrees F. Cut the squash in half. Remove seeds, discard. Lightly coat flesh with oil, salt, and pepper. Place on sheet pan skin-side down. Roast until brown, approximately half hour. Let cool.Remove flesh from rind/skin. One option is to deeply score the flesh in a checkered pattern, cutting down to the shell/skin. Using a large spoon, scoop out of shell/skin in cube shapes. The second option is to simply scoop the flesh from the shell/skin using a large spoon. Lay greens on a plate with preferred vegetables. Top with warm or room-temperature squash.


APPLE CRISP Prep Time: 40 minutesCook Time: 35 minutesTools Needed: 9”x13” baking dish, two mixing bowls

Everyone loves a warm apple crisp around the holidays. You’ll notice that for the filling, we use light olive oil in replacement of butter, however for the crumble topping, we utilize butter. This cuts down on calories but does not hinder the delicious buttery taste of the crumble topping. We also cut calories by stretching a dish typically meant for 12 people to 14. Between these two techniques, the serving of a delicious homemade traditional dessert has less than 300 calories.

INGREDIENTS:Filling12 medium apples, peeled, de-seeded, sliced1 teaspoon cinnamon 2 tablespoons light olive oil½ teaspoon nutmeg 1 cup sugar

Crumble Topping 1 cup whole wheat flour1 cup light brown sugar, packed1 cup oats4 tablespoons unsalted butter, melted

DIRECTIONS:Preheat oven to 350 degrees F. Peel, slice, and de-seed apples.In “dry ingredients” bowl, mix cinnamon, nutmeg, and sugar. Add apples and olive oil. Toss to coat.Bake in baking dish at 350 degrees F for 15 minutes.In second mixing bowl, add whole wheat flour, brown sugar, oats, and melted butter.Remove apples from oven and crumble whole wheat flour topping on apples.Bake until brown, approximately 20 minutes.

Serves: 14


290 per piece


SPRING

Spring is a great time of year to get out of the house, get physically active, and take advantage of the warming weather. Careful planning of outings and reinforcement of expectations helps set up individuals with PWS for success, leading to greater independence in the community. Ongoing support is crucial for reinforcing appropriate behaviors and enhancing social skill development. Repeated practice and discussion of trips boosts the individual’s confidence in his/her ability to navigate community outings with fading staff support. Our residents’ favorite outings are ones in which they can meet members of the community, learn new things, and engage in exciting activities. Some of their favorite activities are:

• Beach walks• Bike trails• Libraries• Local museums• Movies• Recreational resources in the community (YMCA, Planet Fitness)• Senior centers• Shopping malls• Structured restaurant visits• Trips to Boston (Red Sox, Bruins, Aquarium, Science Museum)• Whale watches/boating excursions


Our residents fill out a sheet prior to their birthday which helps outline their special treat options.

GAZPACHO Prep Time: 40 minutesRefrigeration Time: 1 dayTools Needed: mixing bowl/storage bowl

Our Gazpacho is an incredibly simple recipe that makes for a beautiful, nutrient-packed chilled soup. It involves no stove or oven and is great for a hot day. Central to this cookbook is our consideration of calories, omega-3, carbohydrates, and protein. This summer soup is no exception; green peppers, summer squash, and zucchini are all high in omega-3! To add extra omega-3s to this recipe, we recommend sautéing some leeks and including them in the chilled soup. Omega-3s can help fight depression and anxiety, improve eye and brain health, reduce symptoms of ADHD in children, fight inflammation, and are good for your skin (www.healthline.com).

While this recipe does not contain much protein as it is rich with vegetables, it does contain many simple carbohydrates. Complex carbohydrates are common in bread, cereals, and pasta, and simple carbohydrates are common in fruits and vegetables.

INGREDIENTS:1 tablespoon basil, chopped1 cup carrots, peeled and diced1 bunch cilantro, rough chop1 cup cucumbers (approx. 8 inches), peeled and deseeded, diced1 cup large green pepper, deseeded and diced½ cup red onion, peeled and diced1 cup medium summer squash, diced1 cup tomatoes, diced2 quarts low-sodium V8 Juice¼ cup Worcestershire Sauce1 cup medium zucchini, diced

DIRECTIONS:To deseed cucumber, cut in half along the long edge and remove using a teaspoon. Peel and dice all other vegetables as needed. Chop cilantro. Combine all ingredients. Stir. Let sit overnight. Sprinkle with basil topping. Serve cold.

Makes 6-8 servings


96 per cup

GRAPEFRUIT SALAD with “CHAMPAGNE” VINAIGRETTE Prep Time: 30 minutesTools Needed: blender, saucepan

According to the USDA National Nutrient Database, one whole pink grapefruit has 104 calories, while one whole white grapefruit has 78 calories. Pink grapefruits tend to be a bit sweeter than white grapefruits and can make for a pretty salad if one can spare the extra calories. Grapefruit contains extra nutrients great for someone with PWS such as vitamin C, which helps strengthen immune systems, and dietary fiber, which helps maintain bowel movements. Check with your doctor to make sure grapefruit does not interact with your child’s medications.

We suggest refrigerating the grapefruit for a day as it will preserve the fresh flavor and make it easier to peel or cut. Despite having a slightly higher calorie content than romaine lettuce, we suggest using mesclun greens because they are more visually appealing and contain more nutrients.

Serves: 4Calories:

Salad Pink Grapefruit – 40 per cup White Grapefruit – 30 per cup


GRAPEFRUIT SALAD INGREDIENTS:1 white or pink grapefruit, segmented4 cups mesclun greens (10 calories per cup)Additional fresh vegetables such as carrots, peppers, onions, or other salad fixings to your preference

DIRECTIONS:Refrigerate grapefruit for one night.Slice or peel and segment the fruit. Place atop greens and vegetables of your choice.

CHAMPAGNE VINAIGRETTE INGREDIENTS:Makes approximately 1 ½ cups¼ cup champagne vinegar½ teaspoon black pepper½ cup ginger ale½ cup light olive oil 2 tablespoons shallots, minced1 cup white cooking wine

DIRECTIONS:Cook wine and shallots in a saucepan until wine is reduced by 75%.Place in blender, add ginger ale, black pepper, champagne vinegar. Puree. Drizzle olive oil in the blender as it’s blending. For visual appeal, place mesclun greens and vegetables on a plate, top with segments of grapefruit/portion, and drizzle with the appropriate amount of dressing.


VEGAN KEY LIME PIE Prep Time: 40 minutesCook Time: 10 minutesFreeze Time: 3 hoursTools Needed: food processor or blender, muffin tin (16 muffins)

Key lime pie is a delicious reminder of warm weather. This key lime pie recipe was given to us by a local restaurant owner after she learned about our Mediterranean style diet, low in carbohydrates and dairy. This recipe is vegan and can be made gluten-free by substituting gluten-free graham crackers for regular graham crackers. It is super tangy and a nontraditional approach to key lime pie. We serve the pie in muffin tins which makes for fun, individual and equal portions for each person. Traditional, store-bought key lime pie may include close to 500 calories per serving. This recipe totals approximately 320 calories per serving.

The fat-free graham crackers equate to approximately 6g carbohydrates per serving and less than 1g of protein. Two cups of cashews equate to approximately 9g carbohydrates per serving and 5g of protein.

Serves: 16


320 per serving

INGREDIENTS:Crust½ cup Earth Balance “butter,” melted2 ½ cups fat-free graham crackers, crushed

Filling¾ cup light agave nectar2 cups cashews, soaked1 can coconut milk½ cup coconut oil, melted6 limes, zested and juiced

DIRECTIONS:To make crustPreheat oven to 350 degrees F.Grind graham crackers in food processor. Add melted Earth Balance.Divide crust into muffin cups (16). Press crust into the bottom with a back of a spoon. Bake for eight minutes. Remove from oven and let cool.

To make filling Juice and zest limes.Blend together cashews, coconut milk, coconut oil, lime juice, half of the lime zest, and agave. Blend until smooth.Pour onto cooled crusts and tap on counter to get rid of air bubbles. Top with remaining lime zest.Freeze for three hours or until solid.Once frozen, pop out of muffin tins.

Latham Centers thanks Zia Auch, Chef/Owner of Brine Dining in Eastham, Massachusetts for donating this recipe to Latham’s program.


Mediterranean Diet

Overview of the diethttps://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

Key principles of the diet http://www.eatingwell.com/article/16372/8-ways-to-follow-the-mediterranean-diet-for-better-health/

Recipe Ideas http://www.eatingwell.com/recipes/18314/cuisines-regions/mediterranean/

Omega-3s

What are they?https://www.hsph.harvard.edu/nutritionsource/omega-3-fats/

How much do people need?https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/

Top 20 List of Foods Ranked as Quality Sources of Omega-3 Fatshttp://www.whfoods.com/genpage.php?dbid=84&tname=nutrient

https://tools.myfooddata.com/nutrient-ranking-tool.php?nutrient=Omega-3&foodgroup=Vegetables&sortby=Highest&servsize=Common&list=Simple https://www.healthline.com/nutrition/17-health-benefi ts-of-omega-3#section2

Lists of Vitamin and Mineral Rich Foods

https://www.health.harvard.edu/staying-healthy/the-best-foods-for-vitamins-and-minerals

https://www.accessdata.fda.gov/scripts/InteractiveNutritionFactsLabel/factsheets/Vitamin_and_Mineral_Chart.pdf

https://www.webmd.com/food-recipes/guide/vitamins-and-minerals-good-food-sources#1

Helpful Websites for Calorie Countinghttps://www.fatsecret.com/calories-nutrition/https://www.calorieking.com/https://www.myfi tnesspal.com/food/calories/https://www.healthline.com/health/milk-almond-cow-soy-ricehttps://www.cookinglight.com/microsites/pdf/alternative-milk-spread-1703.pdfhttps://goodcalculators.com/cooking-conversion-calculator/

Recommended Websites

We have prepared a list of reputable websites for additional nutritional support for you and your family. Please be aware, with new research, some of these sites may become outdated over time. One timeless nutrition recommendation found throughout this cookbook and these sites is that fresh food is best. We hope you can incorporate as much fresh food as possible into your meals.

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Afterthoughts…

Connect online with Latham’s PWS expert! Weekly tips for the PWS community are posted on Latham Centers’ blog. Written by Patrice Carroll, Latham’s Director of PWS Services, the Tip of the Week is posted at https://www.lathamcenters.org/blog/category/tip-of-the-week/

Stay up to date with new recipes! Latham Centers will print new recipes in modules. Please visit us at LathamCenters.org for announcements about new cookbook modules and email us at [email protected] with any questions or ideas.

Stay up to date on all things “PWS” in our Newsletter! Latham Centers publishes a quarterly LivingHealthy with PWS Newsletter. Features include seasonal weather and holiday preparation, highlights from our Children’s and Adult Services Programs, ways to get involved in the PWS community, and helpful tips for parents, guardians, and caregivers. To be added to our newsletter distribution list, email [email protected].

Visit us if you choose a Cape Cod vacation! Latham Centers’ Admissions Team invites you to schedule a campus tour and learn more about our services and our outreach. Cape Cod is a wonderful place to visit any time of the year and we welcome your inquiries at [email protected].

Sunderland will need to pop in the new ISBN along with price code – we think it should be $15 – but want to double check our cost for the print job.

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