Neutropenic Diet

If you have a weakened immune system, following a neutropenic diet (sometimes called a "low-bacteria diet") will reduce the risk of becoming ill from eating food. This diet is often recommended before and after certain cancer treatments and during recovery after an organ or bone marrow transplant. It is important to follow these guidelines until the immune system returns to normal. Periodic measurements of the blood count (which includes a "neutrophil count" as part of the white blood count) help to guide your caregiver on the status of the immune system after chemotherapy or transplant surgery.

Bacteria and other harmful microorganisms are most likely to be present in raw or fresh foods. Thoroughly cooking foods destroys these microorganisms. For example, fresh vegetables should be cooked until tender, meats should be cooked until well-done, and eggs should be cooked until the yolk is firm.

Certain food products, such as milk, are treated with a method known as pasteurization. Pasteurization briefly exposes food to high heat that kills any bacteria. Look for dairy products, juices, and ciders that have the word "pasteurized" on the label.

GENERAL GUIDELINES

  • Check expiration dates on all products before you buy them. Be sure nothing you buy is past the expiration date.

  • Wash the following items with soap and hot water before and after touching food:

  • Counter tops.

  • Cutting boards (wash these in a dishwasher if you have one).

  • All cooking utensils.

  • All silverware.

  • All pots and pans.

  • The food preparer should wash hands frequently with warm soapy water and dry with paper towels. This is especially important after touching raw meat, chicken, eggs, and fish.

  • Wash dishes in hot soapy water or in a dishwasher. Air dry dishes. Do not use a cloth towel.

  • Keep perishable food very hot or very cold. Do not leave perishable items at room temperature for more than 10 to 15 minutes.

  • All perishable foods should be cooked thoroughly. No rare meat should be eaten.

  • Thaw frozen foods in the refrigerator overnight or quickly in the microwave. Do not thaw food on the counter.

  • Refrigerate leftovers promptly in airtight containers.

  • Use leftovers only if they have been stored properly and have been around for no more than 24 hours.

  • Avoid fresh flowers.

  • Add margarine, butter, gravy, cheese, and non-fat milk powder to appropriate items. This can be helpful if there are problems with frequent dry mouth.

  • When food shopping, avoid salad bars, bulk food bins, food samples, and snacks that are out in the open.

  • When dining out:

  • Avoid salad bars, delis, and buffets.

  • Use single-serve condiments (such as ketchup, mustard, mayonnaise, soy sauce, steak sauce, salt, pepper, and sugar).

Check with your caregiver after blood work is done to see when this neutropenic diet can be liberalized.

SPECIFIC EXAMPLE GUIDELINES

Beverages

  • Recommended: Boiled well water. Bottled spring water and tap water. Other beverages not listed below.

  • Avoid: Raw, unpasteurized milk. Eggnog or milkshakes made with raw eggs. Fresh apple cider.

Meat, Fish, Eggs, Poultry

  • Recommended: Home prepared meat and fish salads. Pre-packaged sandwich meats. Well-cooked shellfish.

  • Avoid: Uncooked or rare meat, fish, eggs, or poultry. Commercially prepared meat and fish salads. Sushi or sandwich meats from the deli.

Dairy Products

  • Recommended: Pasteurized or lactacid milk or yogurt. Pre-packaged ice cream or frozen yogurt. Pre-packaged hard cheeses, such as cheddar, colby, monterey jack, or swiss. Pre-packaged soft cheeses, such as cottage cheese, cream cheese, or ricotta.

  • Avoid: Soft serve ice cream or frozen yogurt. Hand-packed ice cream or frozen yogurt. Feta, brie, camembert, blue, gorgonzola, and queso fresco cheeses. Any imported cheeses and any cheese sliced at a deli.

Breads, Cereals, Rice, Potatoes, Pasta

  • Recommended: All pre-packaged or homemade breads, muffins, cakes, rolls, donuts, cookies and crackers. All boxed hot or cold cereals (except those with dried fruit or nuts). Cooked potatoes, rice, and noodles.

  • Avoid: Bakery breads, muffins, cakes, donuts, cream or custard filled cakes. Commercially prepared potato or macaroni salad. Popcorn (due to dental problems).

Vegetables and fruits

  • Recommended: All well-washed and thoroughly cooked vegetables. All cooked or canned fruits. Raw, thick-skinned, well-washed fruits (unbruised), such as oranges, grapefruits, melons, bananas, or tangerines.

  • Avoid: Raw vegetables and salads. Uncooked thin skinned fruits, such as apples, peaches, grapes, plums, nectarines, kiwi, strawberries, etc. Dried fruits.

Nuts

  • Recommended: Processed peanut butter. Packaged roasted nuts. Cooked nuts (in cookies, cakes, etc.).

  • Avoid: Raw nuts. Uncooked nuts. Unprocessed nuts.

Condiments and Spices

  • Recommended: All cooked, fresh, or canned spices (add at least 5 min. prior to end of cooking). Ketchup, mustard, and mayonnaise, served in separate containers with clean utensils. Sugar, jelly, and honey served from clean containers with clean utensils.

  • Avoid: Uncooked spices. Raw honey. Anything from a family container that is not freshly washed.

Restaurant Foods and Miscellaneous

  • Recommended: Thoroughly cooked frozen dinners. Thoroughly cooked frozen pizza. Canned entrees.

  • Avoid: Do not eat at restaurants while in neutropenia or use take out deli food even if it is behind the counter. Avoid all salad bars while in neutropenia. Avoid all self-serve buffets while in neutropenia.

Ask your caregiver for information/recommendations regarding poor appetite and weight loss during cancer treatment if needed.