Is there a banana hiding in your sandwich?

There aren’t too many “nutrition emergencies” in the hospital setting. But when a patient has a critically high potassium level they shoot to the top of our must-see list. Potassium, which is an important nutrient for most people, can become dangerously high in kidney patients and can lead to serious and immediate complications, including a heart attack if high enough.

Last week, one of my patients developed a high potassium level which was pretty unusual for her, since she is very well informed about her kidney diet. Her doctor ordered a repeat test and sure enough it came back critically high again. This individual lives in a retirement home and assured me that there were absolutely no changes to her diet. We went through all the foods she’d been eating and the only difference was that she mentioned she was getting more sandwiches than usual and wasn’t crazy about the low sodium deli-meat. This was truly an “aha” moment for me and I immediately contacted the manager at her retirement home. Sure enough – all of their new, low sodium deli meats were treated with potassium lactate and potassium chloride!

I’ve written about potassium additives before and talked about the potential dangers in using meats and meat products with potassium lactate but this is the first time I’ve seen a critical event that is clearly caused by consuming these meats. Just three slices of this deli meat provides more potassium than a banana!

It’s hard to predict how prevalent these additives will become but my patient’s story is an important lesson: If you aren’t preparing your own meals or shopping for the ingredients make sure to ask questions! As for us? When our patients move to any care facilities we’ll be sure to address this!

Check out these guidelines for cooking a roast beef to make your own sandwich meat:

And then try out this fantastic recipe from the Kidney Community Kitchen:

Grilled Beef Steak Sandwich with Melted Onions
3 tbsp (45 mL) olive oil
2 tbsp (30 mL) red wine vinegar
4 cloves garlic, minced
½ tsp (2 mL) hot pepper flakes
1 lb (500 g) Beef inside round or Sirloin tip marinating steak/medallions
1 sweet onion, sliced
1 baguette, white, quartered and halved lengthwise
½ bunch arugula, trimmed

1. Combine 2 tbsp oil, vinegar, garlic and hot pepper flakes in sealable freezer bag. Set aside 2 tbsp of marinade. Using fork, pierce meat all over; add to marinade in bag. Refrigerate for 8 to 12 hours.

2. Remove steak from bag. Discard used marinade. Grill steak over medium-high heat, about 3 to 4 minutes per side for medium-rare. Let steak rest on carving board for 10 minutes.

3. Meanwhile, pan-fry onion in remaining oil over medium heat in non-stick skillet for 10 minutes or until softened and golden. Toss with reserved marinade.

4. Slice steak thinly on the diagonal. Drape slices of steak on each baguette bottom piece. Top each with warm onions and arugula.

For nutrition information:

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