Neutropenic Diet
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.
General Tips
The following pages list the 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. Some general tips include:
- 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. (See the UPMC patient education sheet Food Safety: Preventing Foodborne Illness for more information.)
- 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.
Neutropenic Diet
Beverages
Foods to Choose | Foods to Avoid |
---|---|
Instant and brewed decaf or regular coffee and tea | Any others, such as cold brewed tea or sun tea |
Individual cans or bottles of carbonated beverages | |
Tap, bottled and distilled water Ice made with tap water |
|
Brewed herbal teas | |
All canned, bottled and powdered beverages and sports drinks |
Starches (including breads, crackers, cereal, and potatoes)
Foods to Choose | Foods to Avoid |
---|---|
All types of bread, rolls, English muffins, fruit muffins, bagels, sweet rolls, donuts | Breads and rolls with raw nuts |
Waffles | Cereals containing raw nuts |
French toast, pancakes | Raw oats |
Potato chips, corn chips, tortilla chips, pretzels, popcorn, crackers, melba toast | Uncooked pasta, pasta salad, or potato salad with raw vegetables or eggs |
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. |
Dairy products
Foods to Choose | Foods to Avoid |
---|---|
Pasteurized milk; fat-free milk, 2% milk, whole milk, buttermilk, or chocolate milk | Unpasteurized milk or yogurt |
Sour cream | Milkshakes made with non-commercial ice cream or made in a blender |
Milkshakes using individual cartons of ice cream and milk, or homemade milkshakes | Yogurt or soft ice cream from a machine |
Commercial eggnog | Eggnog made with raw eggs |
Commercial supplements such as instant breakfast drinks liquid and powdered drinks |
Yogurt and yogurt products made with live and active cultures |
Commercial frozen milkshakes | |
Refrigerated and frozen pasteurized whipped topping |
Cheese
Foods to Choose |
Foods to Avoid |
---|---|
Commercially packaged cheese (for example, American, Swiss, Parmesan, mozzarella, cheddar) | Unpasteurized and raw milk cheese |
Pasteurized cottage cheese, ricotta cheese | Cheeses with molds (for example, blue, Gorgonzola, Roquefort, and Stilton cheeses) |
Processed cheese (for example, Velveeta) | 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)
Foods to Choose | Foods to Avoid |
---|---|
Cakes, pies, and cookies |
Cakes with raw nuts Raw, un -baked cookie dough |
Baked custard, pudding, and gelatin | Soft ice cream or yogurt from a machine |
Commercial ice cream, sherbet, fruit ice, and Popsicles | Non-commercial or homemade ice cream or sherbet |
Refrigerated cream-filled pastries and desserts | Cream filled pastries that are not refrigerated |
Candy, including chocolate | Candy with raw nuts |
Pasteurized honey and syrup | |
Chewing gum |
Fats
Foods to Choose | Foods to Avoid |
---|---|
Butter or margarine | Avocado dressing |
Cream cheese, sour cream, salad dressings, or mayonnaise |
Fresh salad dressing containing aged cheese, raw |
Oil- all types | |
Shortening used in cooking | |
Non-dairy creamers |
Fruits and fruit juices
(These foods may be restricted during severe neutropenia and during your hospital stay.)
Foods to Choose | Foods to Avoid |
---|---|
Canned fruits and juices | All fresh fruits except those listed in the “Foods to Choose” column |
Pasteurized frozen juices | Unwashed raw fruit |
Pasteurized cider and apple juice | Unpasteurized fruit juices |
Thick-skinned fruits such as raw bananas, grapefruit, and oranges that are washed in cold water, and peeled by a nurse or family member | |
Frozen fruits | |
Dried fruits |
Meat (includes fish, poultry, dried beans, eggs, meat substitutes, and soups)
Foods to Choose | Foods to Avoid |
---|---|
Well-cooked meats, beef, lamb, pork and pork products, poultry, game, fish, shellfish, hot dogs, sausage, bacon | Rare or medium rare cooked meat, fish, or poultry |
Canned tuna or chicken (with no raw vegetables) | Stir-fried foods |
Cooked baked beans and all other cooked legumes, dried beans, casseroles, stews, and entrées | Cold cuts from delicatessens |
Frozen entrees | Cold meat or poultry |
Pasteurized or cooked tofu | Fast food |
Eggs, well-done | Raw eggs |
Pasteurized egg substitutes (for example, Egg Beaters) and powdered eggs | Eggs not well-cooked, such as sunny-side-up (runny yolk) |
Canned and homemade soup (heated well) | Old soups and gazpacho, all miso products such as paste and soup |
Sushi | |
Sashimi |
Vegetables
Foods to Choose | Foods to Avoid |
---|---|
All well-cooked canned, frozen or fresh vegetables | All raw vegetables |
Canned vegetable juices | Stir-fried vegetables |
Fresh salads | |
Fresh sauerkraut |
Miscellaneous
Foods to Choose | Foods to Avoid |
---|---|
Individual packages of salt, sugar, and pepper used after cooking | Spices, herbs, or seasonings added to foods after cooking (except for allowed items) |
All other herbs or seasonings added during cooking | Uncanned or home-canned pickles and kosher pickles |
Low-sodium seasoning added during cooking | Freshly-made peanut butter |
Gravy and cream sauce | Hollandaise sauce |
Commercial peanut butter Jam and jelly |
Raw nuts |
Commercial pickles processed in jars or cans | Roasted nuts in shell |
Lactaid drops | |
Canned or bottled roasted nuts | |
Nuts in baked goods | |
Shelled, roasted nuts |
Dietary supplements
Foods to Choose | Foods to Avoid |
---|---|
Commercial high-calorie/high-protein drinks, puddings, and snack bars if approved by a doctor or nurse | Supplements and vitamins (unless approved by a doctor or nurse) |
Sample diet
Breakfast
1- large egg scrambled
Medium biscuit with 1tsp butter and 1 tsp Jelly
1/2 cup apple juice
1/2 cup 2% milk
Coffee or tea
Morning snack
1cup dry cereal
1 cup 2% milk
2 Tbsp dried fruit
Lunch
Baked Meat loaf/ gravy
1/2 cooked corn
1/2 cup canned peaches
Slice wheat bread
Butter or margarine
Coffee or tea
1 cup 2% milk
Afternoon snack
1 cup of milkshake or high protein drink
Dinner
3 ounces Baked or Roasted Chicken
1/2 cup oven fried potatoes
1/2 cup glazed carrots
Dinner roll with butter or margarine
1/2 cup fruit cocktail
Coffee or tea
Evening Snack
Slice pound cake with whip topping
Revised January 2013