What is a Neutropenic Diet?

A neutropenic (nu-tro-PEE-nik) diet is for people with weakened immune systems. This diet helps protect them from bacteria and other harmful organisms found in some food and drinks. If your immune system is not working well, your body may have a hard time protecting itself from these bacteria. Cooking foods (like beef, chicken, fish, and eggs) completely makes sure that all bacteria are destroyed.

WHO NEEDS TO FOLLOW A NEUTROPENIC DIET?

Doctors often recommend this diet before and after certain types of chemotherapy and other cancer treatments. A blood test called an absolute neutrophil count (ANC) can help determine the body’s ability to fight off infection. Many cancer patients have this blood test done routinely. When the ANC is less than 500 cells/mm3, the patient is often instructed to follow a neutropenic diet. This diet should be followed until the doctor tells the patient to resume his or her regular diet.

Patients undergoing autologous stem cell transplants typically follow this diet during the pre- transplant chemotherapy and for the first 3 or more months after transplant. Patients undergoing allogeneic stem cell transplants typically follow this diet during the pre-transplant chemotherapy and continue on it until they no longer take immunosuppressive drugs. The transplant team will tell the patient how long to follow this diet.

People who have had an organ transplant or who are being treated for HIV/AIDS also may need to follow this diet. If you are not sure if you should follow this diet, check with your doctor, nurse, or dietitian.

WHO NEEDS TO FOLLOW A NEUTROPENIC DIET?

Below is a list foods foods you should choose when you are on a neutropenic diet. Foods you should avoid are also listed.

PLEASE CHECK WITH YOUR DOCTOR, NURSE, OR DIETITIAN IF YOU HAVE QUESTIONS ABOUT THE DIET OR SAFE FOOD PREPARATION.

Avoid all fresh fruits and vegetables, including all fresh garnishes. Cooked vegetables, canned fruits, and juices are fine.
Avoid raw or rare-cooked meat, fish, and eggs. Meat should be cooked to the “well- done” stage. All eggs should be thoroughly cooked (no runny yolks).
Avoid salad bars, fruit bars, and deli counters. Buy vacuum-packed lunch meats rather than freshly sliced meats.
Avoid raw nuts. You may eat baked products with these ingredients.
Make sure all of the dairy products you eat are pasteurized.
Avoid yogurt and yogurt products with live and active cultures.
Be safe in the way you handle foods. Wash your hands before handling food. Wash all surfaces, cutting boards and cutting utensils thoroughly. Keep hot food hot and cold food cold.
At home, you may use tap water. If you choose to use bottled water, be sure it is labeled as follows:
- Reverse osmosis or
- Distillation or
- Filtered through an absolute1 micron or smaller filter
Well water is OK if it is boiled for at least 1 minute.

FOODS FOR A SUCCESSFUL NEUTROPENIC DIET

Beverages

Instant and brewed decaf or regular coffee and tea
Individual cans or bottles of carbonated beverages
Tap, bottled and distilled water. Ice cubes made with tap water
Brewed herbal teas
All canned, bottled and powdered beverages and sports drinks

Any others, such as cold brewed tea or sun tea

Starches (including breads, crackers, cereal, and potatoes)

All types of bread, rolls, English muffins, fruit muffins, bagels, sweet rolls, donuts
Waffles
French toast, pancakes
Potato chips, corn chips, tortilla chips, pretzels, popcorn, crackers, melba toast
All types of cooked and ready-to-eat cereals
Cooked grains, rice, and pasta, such as noodles, macaroni, and spaghetti
Cooked white or sweet potatoes and yams, French fries, tater tots, hash browns, etc.

Breads and rolls with raw nuts
Cereals containing raw nuts
Raw oats
Uncooked pasta, pasta salad, or potato salad with raw vegetables or eggs

Dairy Products

Pasteurized milk; fat-free milk, 2% milk, whole milk, buttermilk, or chocolate milk
Sour cream
Milkshakes using individual cartons of ice cream and milk, or homemade milkshakes
Commercial eggnog
Commercial supplements such as instant breakfast drinks. Liquid and powdered drinks
Commercial frozen milkshakes
Refrigerated and frozen pasteurized whipped topping

Unpasteurized milk or yogurt
Milkshakes made with non-commercial ice cream or made in a blender
Yogurt or soft ice cream from a machine
Eggnog made with raw eggs
Yogurt and yogurt products made with live and active cultures

Cheese

Commercially packaged cheese (for example, American, Swiss, Parmesan, mozzarella, cheddar)
Pasteurized cottage cheese, ricotta cheese
Processed cheese (for example, Velveeta)

Unpasteurized and raw milk cheese
Cheeses with molds (for example, blue, Gorgonzola, Roquefort, and Stilton cheeses)
Soft cheeses (for example, Brie, Camembert, feta, farmer cheese)
Cheeses containing uncooked vegetables
Mexican-style cheeses, such as queso fresco and queso blanco

Desserts (and other sweets)

Cakes, pies, and cookies
Baked custard, pudding, and gelatin
Commercial ice cream, sherbet, fruit ice, and Popsicles
Refrigerated cream-filled pastries and desserts
Candy, including chocolate
Pasteurized honey and syrup
Chewing gum

Cakes with raw nuts. Raw, un-baked cookie dough
Soft ice cream or yogurt from a machine
Non-commercial or homemade ice cream or sherbet
Cream-filled pastries that are not refrigerated
Candy with raw nuts

Fats

Butter or margarine
Cream cheese, sour cream, salad dressings, or mayonnaise
Oil (all types)
Shortening used in cooking
Non-dairy creamers

Avocado dressing
Fresh salad dressing containing aged cheese, raw eggs, or fresh herbs

Meat (Includes fish, poultry, dried beans, eggs, meat substitutes, and soups)

Well-cooked meats, beef, lamb, pork and pork products, poultry, game, fish, shellfish, hot dogs, sausage, bacon
Canned tuna or chicken (with no raw vegetables)
Cooked baked beans and all other cooked legumes, dried beans, casseroles, stews, and entrées
Frozen entrées
Pasteurized or cooked tofu
Eggs, well-done
Pasteurized egg substitutes (for example, Egg Beaters) and powdered eggs
Canned and homemade soup (heated well)

Rare or medium-rare cooked meat, fish, or poultry
Stir-fried foods
Cold cuts from delicatessens
Cold meat or poultry
Fast food
Raw eggs
Eggs not well-cooked, such as sunny-side-up (runny yolk)
Old soups and gazpacho, all miso products such as paste and soup
Sushi
Sashimi

Vegetables

All well-cooked canned, frozen or fresh vegetables
Canned vegetable juices

All raw vegetables
Stir-fried vegetables
Fresh salads
Fresh sauerkraut

Miscellaneous

Individual packages of salt, sugar, and pepper used after cooking
All other herbs or seasonings added during cooking
Low-sodium seasoning added during cooking
Gravy and cream sauce
Commercial peanut butter. Jam and jelly
Commercial pickles processed in jars or cans
Lactaid drops
Canned or bottled roasted nuts
Nuts in baked goods
Shelled, roasted nuts

Spices, herbs, or seasonings added to foods after cooking (except for allowed items)
Uncanned or home-canned pickles and kosher pickles
Freshly made peanut butter
Hollandaise sauce
Raw nuts
Roasted nuts in shell

Dietary Supplements