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  eggs, or fresh herbs
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