Creamy Macaroni and Cheese

1. For the cheese sauce, in a small sauce pot, melt butter over medium heat. Whisk in flour and continue stirring until well incorporated. Cook for about 1-2 minutes.
2. Whisk in your spices until well incorporated and fragrant.
3. Add your milk in a little at a time, whisking to prevent any clumps. Once all the milk has been added, continue cooking to a simmer and until thick enough to coat the back of a spoon. Remove from the heat and stir in your cheese until melted completely.
4. If it’s still lumpy or the sauce splits, run it through a blender until smooth.
5. (Regular Texture)Cook pasta according to box instructions. Drain, mix with enough cheese sauce to coat. Spoon into a baking dish, top with cheese and under your broiler until bubbly and golden brown.
6. (Mince Texture)Over cook your pasta until it’s soft enough to easily mash with a fork. Drain pasta and rinse under cold water to remove more of the starch. Mince by hand with a fork or pulse in a food processor until the pieces are no bigger than 4mm and fit easily between the spaces of a fork when pressed on *(see Fork test below). Stir in enough of your cheese sauce to coat and serve.
7. (Puree Texture)Over cook your pasta until it’s soft enough to easily mash with a fork. Drain pasta and rinse under cold water to remove more of the starch. Add a portion of the cooked pasta to a food processor. Pulse lightly at first while adding a little cheese sauce at a time. Once it’s soft enough you can continue to puree until smooth, add more sauce or extra milk if necessary. The mixture should easily mound on a spoon, but slide off once tilted **(see Spoon Tilt Test below). To be sure, you can pass the mixture through a sieve to catch any particles that haven't broken down.

• ​Melting cheese into recipes can be a great way to add more calories and protein to the dish. This can be helpful for someone that is trying to prevent weight loss and/or trying to gain weight. 
• For someone that has lactose intolerance, you can try making this with cheese and milk labelled as lactose-free. For someone that follows a vegan diet, you can try making this recipe with vegan cream cheese.
  
• For more variety (with a mince diet), you can also make this recipe using quinoa, couscous, or short grain rice in replace of the macaroni. The rice or grains should not be sticky or gluey and should not separate into individual grains when cooked and served. Rinse the grains well under water before cooking them. It will then require a smooth, non-pouring sauce to moisten and hold the rice together. In this case, the cheese sauce will hold it together. 

Testing:

Mince Diet: For a minced diet, all food should be served finely mashed or chopped to 4 millimeters lump size. Then served in a thick, smooth, non-pouring sauce or gravy.

• *Fork Test: The slots/gaps between the prongs of a standard metal fork typically measure 4 mm, which meets the particle size requirement of foods on a Minced and Moist diet. Use a fork to gently press down on the food and check that the food pieces easily fit between the prongs of the fork

For more information about Minced Diets, please visit:
https://iddsi.org/IDDSI/media/images/ConsumerHandoutsAdult/5_Minced_Moist_Adults_consumer_handout_30Jan2019.pdf

Puree Diet: On a pureed diet, the pureed foods should have a smooth texture with no lumps. They should hold shape on a spoon, but should still be able to easily fall off the spoon when it is tilted.

• **Spoon Tilt Test: The food sample should hold its shape on the spoon and falls off fairly easily if the spoon is tilted or lightly flicked. The food sample should not be firm or sticky.

For more information about Pureed Diets, please visit:
https://iddsi.org/IDDSI/media/images/ConsumerHandoutsAdult/4_Pureed_Adults_consumer_handout_30Jan2019.pdf

Important: If you notice changes in your ability to chew and swallow, it is important to let your doctor know. Your doctor can refer you for a swallowing assessment.