A dietitian tells how to make a nutritious batch of macaroni and cheese

Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Nutrition is important all the time, but it can be especially challenging for someone who's in cancer treatment. So today I'm talking with Katie Krawczyk. She's the Upstate Cancer Center's registered dietician nutritionist, and she agreed to share a macaroni and cheese recipe that's easy to prepare and maybe a little more nutritious than you might expect. Welcome back to "The Informed. Patient" Ms. Krawczyk.

Katie Krawczyk: Hi, Amber. Thanks for having me.

Host Amber Smith: Now today I wanted you to talk to us about one of the most popular comfort foods, macaroni and cheese. It's something people may crave, and you have some ideas for how to make a version that's more nutritious than opening up a box, but it's still pretty easy to prepare. I know you need three pans -- a pot for the pasta, a sauce pan, and a saute pan or deep skillet, right?

Katie Krawczyk: Yep, and then also a casserole dish to bake this in the oven.

Host Amber Smith: And a large bowl to mix everything?

Katie Krawczyk: Yep. And during the recipe, I can kind of shed light into ways to maybe cut down on those dishes as an option.

Host Amber Smith: Perfect. Let's start with a shopping list. What are the items that people need to have ready?

Katie Krawczyk: The first ingredient is a half a pound of pasta, preferably a whole wheat pasta is going to offer a little bit more fiber and texture to this dish. And you can use any shape. It can be the medium shells, a rotini, elbow or ziti.

The next ingredient is 4 tablespoons of butter,

1/4 cup of flour,

2 cups of milk.

Host Amber Smith: Let me ask you about the milk. Does it need to be cow's milk? Or can it be an alternative? And, does it matter the fat content? Does it need to be whole milk or low fat?

Katie Krawczyk: No, this is a very forgiving recipe. You do not need to use cow's milk. You can use any milk of your liking, could be almond or soy or any other lactose-free milk. Just make sure it's the unflavored. You don't want chocolate or vanilla in this dish, of course.

Host Amber Smith: All right. But you do have some spices in there?

Katie Krawczyk: Yes, you can use fresh or a dried grated nutmeg, 1/2 a teaspoon,

salt and pepper, just to taste, roughly a 1/2 a teaspoon of each,

Katie Krawczyk: 2 teaspoons of grated Parmesan cheese,

1/2 a tablespoon of olive oil,

half of a small cauliflower that should be chopped,

1 1/2 cups of fresh spinach.

Host Amber Smith: Now, let me ask you,on the spinach, baby spinach, regular, or does it matter?

Katie Krawczyk: Any type of spinach will work here. You can even use a frozen spinach.

Host Amber Smith: All right. And if you use regular spinach, do you need to cut off the stems?

Katie Krawczyk: Nope. Once those are sauteed, those get nice and soft, along with the leaves.

Host Amber Smith: And then there's gotta be cheese in here, right?

Katie Krawczyk: Yep. Last but most important is 1/2 a cup of mozzarella cheese, shredded.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast with your host, Amber Smith. I'm talking with Katie Krawczyk. She's the registered dietician nutritionist who works at the Upstate Cancer Center, and she's walking us through preparation of macaroni and cheese. Listeners can find this recipe connected to this interview on our website at Upstate.edu/Informed.

So for the directions, the pasta's supposed to cook in boiling water until it's barely aldente, meaning that it still has a bit of a bite. Do you get the water boiling and then add the pasta? Or can the pasta be in the pot as the water comes to a boil?

Katie Krawczyk: You want to get the water to a full boil before adding that pasta. And when we say aldente, usually the package will give you an estimated time frame for what that would be. So it'd be at the lower end of that cooking time.

Host Amber Smith: And what about, I know some people like to put salt in their boiling water. Does that do anything? Or, should you, or should you not do that?

Katie Krawczyk: You can add a little bit of salt here. There's room within the recipe to add it a little bit later and that's just to taste. Oftentimes I don't add salt at this time. I just cook the pasta within the water. But I know that's a little bit kind of procedure-like for some families to add it to their pasta while it cooks.

Host Amber Smith: Or oil? Will the pasta get sticky if you don't put oil in it?

Katie Krawczyk: Not at this time. Once it, when it's boiling, you don't have to add oil.

Host Amber Smith: All right. While that's boiling can you walk us through how to make the rest of the dish?

Katie Krawczyk: Sure. And, and don't forget, we're gonna preheat our oven to 350 at this time.

And then, so while that pasta's cooking, in our other skillet, you're going to warm up the skillet, heat the olive oil. You're going to add some chopped cauliflower and saute it until it's soft, which is going to take around 10 minutes. Just before that soft and around that 10-minute mark, you want to add the spinach to that same skillet with the cauliflower, until it's wilted, which will happen pretty quickly, within two to three minutes.

And then at this time, if you want to season it with that salt and pepper, you can do so.

Host Amber Smith: So, let me back up and ask you about the cauliflower, cutting it up. How small should the pieces be?

Katie Krawczyk: They should really be like bite-size pieces.

Host Amber Smith: Okay. Do you melt this over medium or medium high? Where would you put the temperature?

Katie Krawczyk: Medium heat to saute.

Host Amber Smith: Okay. So that takes care of the vegetables. Do you add anything more to this pan or?

Katie Krawczyk: Nope, at this time, that's the only thing that will go in that pan.

Host Amber Smith: Okay. So that's the vegetables. What about the sauce?

Katie Krawczyk: Now the cheese sauce ... again, I mentioned you can possibly cut down on a pot here. So at this time, your pasta's likely done cooking. So you can remove that from the pot, drain it in a collander, leave it in that collander, return that pot to the stove where we can make our cheese sauce, or also known as a roux.

Host Amber Smith: Okay. Let me ask you about the pasta one more thing: when you bring the pasta into the collander, does it need to be rinsed or cooled?

Katie Krawczyk: No, it does not. You can just drain and leave it there.

Host Amber Smith: Okay. All right. So tell me more about this roux.

Katie Krawczyk: Okay, the roux or the cheese sauce, we're gonna start with that sauce pan. We're gonna melt butter, and then we're going to add some flour. And using a whisk, we're going to stir it into the butter for about one to two minutes, until the mixture turns to a very light golden brown. Then we're going to whisk in the milk, any milk of your choice, a little bit at a time, and the sauce will gradually start to thicken, and keep whisking until that milk has been all incorporated. This is a over, still, that medium heat. And then we're going to reduce the heat and allow it to just simmer a little bit. You can stir throughout, gently, until that whole mixture is smooth and thick.

Host Amber Smith: So I get a little scared with cooking with milk, because it can burn pretty quickly on the stove top, right?

Katie Krawczyk: Yeah. So you do want to keep an eye on it. Pay attention and continue to kind of stir every minute or so throughout.

Host Amber Smith: And so it'll thicken naturally on its own?

Katie Krawczyk: Yeah. Thicken while stirring.

Host Amber Smith: OK. When do you add the spices?

Katie Krawczyk: Once that has thickened, you can add the nutmeg and the cheese.

Host Amber Smith: And just, as they say, fold in the cheese?

Katie Krawczyk: Yep. Continue to stir or fold in.

Host Amber Smith: Now does it stay on the same heat temperature, or do you move the panoff to the side?

Katie Krawczyk: You can keep it on the heat as we add that cooked pasta from your collander. Add that to your roux or cheese sauce. And then also add in your vegetables, the cauliflower, spinach, and, the rest of the cheese, if needed. Stir that up, and then you're going to pour that whole mixture into your casserole dish. And then that is going to go into the oven to bake for 20 to 25 minutes, or until that top is golden brown.

Host Amber Smith: So everything ultimately ends up in that one pan, and then you put it in the casserole dish?

Katie Krawczyk: Yes, exactly.

Host Amber Smith: Well, what does the cauliflower and the spinach do to the taste of the cheesy mac and cheese flavor? What does it do to that?

Katie Krawczyk: That's gonna add a little bit of texture, a little bit of variety to what's coming in on that fork, which oftentimes patients are looking for something that just sounds a little bit different to them, to kind of spark their appetite. And again, it's adding a little bit extra fiber and a serving of vegetables for the day. So you're getting that combination of not only your cheese and shells, but also that crunch from the cauliflower and spinach.

Host Amber Smith: And I know we put in a cup and a half of spinach, seems like a huge amount, but it shrinks down considerably. So it is not gonna overwhelm this casserole dish. It's still gonna look like macaroni and cheese, right?

Katie Krawczyk: Right. That raw spinach can be kind of a big volume, but that cooks down to be very nicely incorporated.

Host Amber Smith: Now let me ask you on the casserole dish, does it need to be greased or olive oiled before you put all of this in it?

Katie Krawczyk: Yeah, that will help with the washing, afterward, to grease your casserole dish first, before adding in that full mixture.

Host Amber Smith: And then, do you need to cover it with foil while it's baking, or does it just go in the oven uncovered?

Katie Krawczyk: You don't need to cover it with foil. If you do notice while it's baking that it's turning too brown to your liking on the tops, that cheese, you can cover it, but you shouldn't need to cover it.

Host Amber Smith: And how long does it bake for?

Katie Krawczyk: For about 20 to 25 minutes And again, just kind of watch that top. When it turns golden brown, that means it's good. You can remove it from the oven.

Host Amber Smith: So what do you like about this recipe, as a dietician, for someone who's in cancer treatment?

Katie Krawczyk: I like that it adds, it kind of sneaks in that serving of vegetables. And it's something just a little bit different than your typical mac and cheese. It's a little bit more hearty, where it may give patients a little bit more, stimulate your appetite as something different to try.

Host Amber Smith: How does it work in terms of leftovers? Because if you have this huge casserole pan, can you have it for dinner and then have some for lunch the next day or two?

Katie Krawczyk: Absolutely. That's another good thing about this dish is you put in the work once. You bake it. But it can be utilized for leftovers the next day, for lunch or dinner, just reheating in the microwave.

Host Amber Smith: Could it be prepped ahead of time or even baked ahead of time and then frozen so that you would have a casserole ready to thaw and cook later?

Katie Krawczyk: Yes. You can even take it step by step of doing some things ahead of time, such as boiling the pasta, and then putting that in the refrigerator with a little bit of olive oil so it doesn't stick. And you can saute the vegetables first, or you can even, there's an option to use frozen vegetables instead of fresh, where that would take away some of that cooking time. You can also steam or microwave the cauliflower first. That will allow the saute time to be cut in half. And then to freeze it, you can take them out, put the whole casserole in the freezer, or you can put it into individual portions and freeze it that way into Tupperware.

Host Amber Smith: And then you have it ready for, for when you need it.

Katie Krawczyk: Yep.

Host Amber Smith: This has been very nice of you to walk us through how to put this macaroni and cheese together, and I appreciate you making time for that.

Katie Krawczyk: I hope that patients will utilize this recipe and find it comforting. And it's generally accepted by the whole family. So not only patients maybe going through treatment, but it is a good dish for everybody.

Host Amber Smith: My guest has been registered dietician nutritionist, Katie Krawczyk from the Upstate Cancer Center. " The Informed Patient" is a podcast covering health science and medicine brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/Informed. This is your host Amber Smith thanking you for listening.