South Louisiana is renowned for its Cajun cuisine. One of the staples of a festive Acadiana feast is a rich, roux-based rice dressing mixed with finely chopped liver. It was this very delicacy that observant nurse practitioner Stella Souther linked to increased vitamin K levels in her cardiac clients.

 

At the time, Souther was working in the warfarin (Coumadin) clinic in a Lafayette hospital, where she monitored patients with cardiac conditions including atrial fibrillation, heart valve replacement and recent heart attack. These patients, who were at increased risk for developing blood clots, were taking warfarin, an anticoagulant with potentially dangerous side effects. When a patient has unusually high prothrombin time (PT) and international normalized ratio (INR) results, warfarin can cause bleeding.

 

To prevent that risk, patients taking warfarin are advised to maintain a consistent intake of vitamin K, known as the clotting vitamin. Vitamin K reduces the effects of warfarin, rendering the drug ineffective. Foods containing high amounts of vitamin K include vegetables such as spinach, kale, cabbage, cauliflower, collard or turnip greens and Brussels sprouts; beverages including cranberry juice, green tea and alcohol – and liver. “The goal isn’t to eliminate those foods – it’s consistency with a diet,” Souther explained. “It’s lifestyle.”

 

During her extensive career as a registered nurse and nurse practitioner, Souther noticed a disturbing trend among her Cajun patients. When coming in for their regular blood tests, some clients were out of their therapeutic ranges for PT and INR levels. Souther had taught them how important it was to watch their vitamin K intakes, but their sheepish dispositions revealed that they might be hiding something. “I noticed that there was something more in their facial expressions and body language,” Souther observed. 

 

After doing some digging, Souther discovered that some of her Cajun clients were overindulging in one of two things. “We could tell when their INR was off, because they either had a few drinks, or had been to a birthday party or picnic where there was something going on,” she recalled.

 

Reluctantly, her patients finally admitted that they had eaten the forbidden liver-laden rice dressing. But, these proud Cajuns did not want their hosts to make a fuss over them. “They would say, ‘I didn’t want to be trouble,’ or they didn’t want their families to ‘got out of their way’ for them by making rice dressing without the liver,” Souther said. “So, to not disappoint their families, they ate the rice dressing.”

 

Feeling frustrated, Souther talked with other nurses about how patients could have their rice dressing – and eat it, too. She pondered how manufacturers substituted sugar-free substances for diabetics and sucked the fat out of products for high-cholesterol patients. “So, why can’t they take the liver out of right dressing?” she thought. “That way, people can have it anytime they want, and not feel guilty.”

 

Souther put together a power point presentation about her liver-free dressing idea. The Church Point resident wanted to discuss her data with a local Cajun food company. After doing some research, she decided on the perfect partner – Opelousas-based Savoie’s Sausage and Food Products, Inc.

 

The shy Southern belle enlisted the support of her colleague, retired nurse Carolyn Comeaux, to present her idea to Savoie’s. She went straight to the top, contacting Vice President Robert van Leeuwen, head of marketing, sales and strategic planning, who agreed to meet with her. At first, he was skeptical. “In the past, we had been getting calls from people who just didn’t like the taste of liver and wanted a product without it, but we had felt that there was insufficient volume to make it economical for us to make it here,” he said.

 

At the meeting in the spring of 2009, Souther presented facts and figures regarding the number of people visiting Coumadin clinics who would benefit from switching to a liver-free version. After doing some taste-testing, Souther and van Leuween gave the new product a thumbs-up. “In my opinion, the big container of the regular one needs to go out, and this one needs to come in, because it tastes really good,” she said with a laugh.

 

Wanting to emphasize the educational component, Souther and Comeaux created a brochure touting the benefits of the liver-free dressing. The sleek pamphlet explains the dietary concerns with foods containing vitamin K. “The goal of the pamphlet was to reinforce some education issues, and also, to let people know that they had a choice – ‘I can eat it when I want, and it won’t affect my vitamin K, because there’s no liver in here,’” Souther explained. “My goal is to still communicate with the patients as to what they are eating and not eating.”

 

To meet this goal, Souther is distributing the pamphlets to doctors’ offices and clinics. Dr. Chi Pham, an internist in Lafayette, is one of the physicians who agreed to keep the brochures in her office. “A lot of patients have inquired about it,” reported Kasi Romero, Dr. Pham’s nurse. “It’s a good idea, because the product has less cholesterol and fat than the other dressing.”

 

The liver-free version was released to the market in mid-December, starting with independent grocers in Acadiana. Initial results were encouraging. “People liked the flavor,” van Leeuwen reported. From there, the mix was introduced to corporate stores, including Super 1 Foods, Rouse’s, Market Basket, Brookshire’s Grocery, Wal-Mart, Winn Dixie, Albertson’s and some H-E-B stores in Houston. “Since then, it has been taking off quite nicely,” he said. “It’s about a quarter of what we sell in our regular 16-ounce containers.” Recently, the product became available nationwide on the cajungrocer.com website.

 

Currently, Savoie’s has a share of over 50 percent of the rice dressing mix market. Its goal with the liver-free mix is to capture eight percent of that market. “We feel that, especially with the encouraging results we have so far, it’s going to be about eight percent of the total rice dressing mix market,” Van Leeuwen confirmed.