Pesto Pasta, Tagliatelle of Courgette and Baby Spinach: a CardioKit recipe

Green Leafy Vegetables, Vitamin K and Anticoagulation

“Why would you ever buy a factory pre-made Pesto?”

(Photo by Tara Fisher)

We are in the process of writing a new Omega-3 polyunsaturated fatty acid article but in the meantime here is a fresh dish in honour of the 1st (rainy) day of Summer. It takes advantage of plentiful seasonal courgettes which can be cut on a mandolin (or potato speed peeler) to make ‘tagiatelle’ which can then be combined with traditional pasta. We find that 50g of pasta per person is enough — increasing the vegetable content and reducing the refined carbohydrate content. You can go even healthier with wholegrain pasta but in reality the additional fibre content of the veg in this dish will reduce the combined glycaemic profile of the meal, i.e. the healthy elements make is slower release. If you were to go extreme and replace all the pasta with courgette you would probably have a less satisfying and filling meal experience and end up compensating later (or lack the energy derived from sensible carbohydrate consumption) — especially if you go for your brisk walk after the meal.

This recipe is packed with healthy protective ingredients including garlic, nuts, extra-virgin olive oil and importantly dark green leafy vegetables. This pattern of ingredients (labelled as ‘Mediterranean’) consistently appears in dietary intervention trials which have shown positive effects against cardiovascular risk factors and disease — this includes the original DASH (Dietary Interventions to Stop Hypertension) and more recent PREDIMED trials. There appears to be multiple mechanisms including anti-inflammatory, blood pressure and ‘cholesterol’ lipoprotein balance properties.

You will not miss the extra pasta and in fact in each mouth-full it becomes unclear where the pasta ends and the courgette tagliatelle takes over. These simple fresh flavours and textures compliment each other perfectly — hot peppery notes (fresh garlic and olive oil), mellow comforting richness (pasta, parmesan and pine nuts) and clean perfumed bite (basil, spinach and courgette). Pair this with a simple sliced tomato and onion salad (dressed with a little olive oil and balsamic vinegar) for the perfect combination.

One final comment — our patients who take Warfarin have been told to avoid excess green leafy vegetables because the Vitamin K content will effect the anticoagulation (INR) balance. This is only true if you have a sudden change in your diet involving these ingredients. It seems counterintuitive to avoid a protective diet if you have established cardiovascular conditions. If you already consistently eat green leafy vegetables and have stable Warfarin dosing this is not be a problem but it still complicates a change to a new healthier diet and causes anxiety. The new oral anticoagulants (NOACs) have changed the landscape and provide alternative options. If you are in this position with unstable anticoagulation because of variation in diet you should consider the option of changing Warfarin to one of the new (and more convenient) agents in conjunction with your doctor. The overall take home message is that anticoagulation is not a reason to avoid these protective foods.

For two servings:


  • 100g linguine pasta (50g per person)
  • 2 medium courgettes
  • 2 large handful of baby spinach
  • 1 large garlic clove
  • big bunch of basil leaves
  • 2 small handfuls of pine nuts (dry toasted)
  • fresh grated parmesan — handful
  • extra-virgin olive oil
  • salt and black pepper
  1. Make the tagliatelle of courgette by taking long length slices of the courgette in the largest toothed setting on your mandolin. If you don’t have a mandolin place the courgette flat on a chopping board and take long ‘wafer’ slices with a potato speed peeler until you get to the soft watery centre. Then turn the courgette and repeat until you have the core left which can simply by chopped and added.
  2. Put the pasta on to boil in plenty of salted boiling water — boil the kettle and add 1 litre (per 100g pasta) to a large pan with a teaspoon of salt. When you have a rolling boil add the pasta and cook for around 10–12 minutes as per the packet instructions.
  3. You need a large bowl to combine all the ingredients at the end. Wash the spinach (if not pre-washed), drain and place in the bowl.
  4. While the pasta is cooking you can make the pesto. We like to make the pesto in a mortar and pestle for that chunky, fresh-made texture but you can add all the ingredients straight into a blender or food processor.
  5. Toast the pine nuts in a dry pan over a medium heat shaking regularly when they start to colour until golden brown.
  6. Start of by bashing a whole peeled garlic clove with a pinch of salt for extra abrasion until a paste. Now add the basil leaves and do the same. Last add the pine nuts and Parmesan. At this point you will need to start drizzling the olive oil to loosen the mixture. Continue to bash, stir and combine with olive oil until you have a chunky mixture but loose enough to stir into your pasta.
  7. The pasta should nearly be ready. Throw in the courgette tagliatelle for the final 2 minutes (less if you have gone for the wafer thin speed peeler option) to soften but retain a slight bite (‘al-dente’).
  8. Drain and immediately add the hot pasta into the bowl with the spinach and stir. The heat of the pasta will wilt and soften the spinach. Now add your pesto and mix thoroughly. Season with black pepper and a final fresh sprinkle of parmesan. You do not need to add any additional salt as the cheese and other elements have enough.

How can something so delicious and healthy be prepared so quickly — literally a 20 minute dish!

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