The Neutropenic Diet: Everything You Need to Know!

neutropenic precautions - neutropenic diet

What is the Neutropenic Diet?

The neutropenic diet is designed to limit your exposure to foods and drinks that might harbor harmful bacteria that could lead to an infection if you are neutropenic. It is one of the main precautions patients take whilst they are neutropenic. It is often prescribed to cancer patients undergoing chemotherapy and radiation treatment.

Food safety is crucial for people with neutropenia as certain foods and drinks can harbor harmful bacteria that could lead to an infection. You need to be selective about the foods you eat, how you prepare and how you store them. This guide will show you exactly what steps to take if you’ve been prescribed a neutropenic diet. It is based on the guidelines set out by the FDA in their Food Safety for People with Cancer booklet and the Leukemia & Lymphoma Society’s Food and Nutrition Guide (below).

Table of Contents

  1. What is Neutropenia?
  2. The Neutropenic Diet
  3. General Food Safety Tips and Guidelines

 

What is Neutropenia?

Neutrophils, also known as white blood cells (WBC), are your body’s first line of defense against bacteria and viruses that can cause an infection. A healthy person typically has a neutrophil count in the 2,500-6,000/µL range. However, if your neutrophil count drops below 1,500/µL you are considered neutropenic. When your neutrophil count is below 1,000/µL you are considered moderately neutropenic, and severely neutropenic when your neutrophil count is below 500/µL. The lower your neutrophil count the higher your infection risk.

If you are neutropenic your doctor may request that you follow certain neutropenic precautions designed to limit your exposure to potentially harmful bacteria, one of them being the neutropenic diet. The exact precautions taken varies between cancer centers and the severity of the patient’s neutropenia, so you should always follow the recommendations of your doctor when taking neutropenic precautions.

 

The Neutropenic Diet

At first, the thought of having to follow a special neutropenic diet might be scary or confusing but when you understand what it is and what it is designed to do, it is actually quite easy to follow. No fad dieting techniques involved, just common sense food safety.

As your body will require a lot of nutrients and energy to cope and recover from the neutropenia and cancer treatment it is important that you eat a diet full of healthy high-calorie foods that have all the nutrients and vitamins your body needs.

In essence, the neutropenic diet is designed to reduce your risk of infection by limiting the number of harmful bacteria you consume when eating or drinking. Certain foods and cooking techniques allow potentially harmful bacteria to grow and multiply. When a healthy person eats a food containing this bacteria the body’s immune system is easily able to neutralize it. However, because your immune system is highly suppressed when you are neutropenic your body often isn’t able to kill the bacteria. Allowing it to spread and multiply in your body, potentially causing an infection.

In general, the foods that are the most likely to contain harmful bacteria fall into four categories:

  • Uncooked or unclean fresh fruit and vegetables.
  • Uncooked or unpasteurized animal products (unpasteurized milk, raw eggs, etc.)
  • Pre-cooked meats that are eaten cold or that have to be reheated (deli meats).
  • Out of date food or foods that have been exposed to the air for a while.

Cooked Foods (Meat, Fish, etc.)

 

neutropenic diet - cooked food

As a general rule, you should avoid raw fruit, vegetables, and meats, only eating them when they have been thoroughly cleaned and recently cooked until piping hot. This will ensure that any bacteria on your food has been killed.

After cooking, the food should be eaten as soon as possible. Do not eat cooked food that has been left at room temperature for more than one hour.

Safe Foods Foods to Avoid
  • All well-cooked meats, fish, and vegetables.
  • Frozen ready meals can be eaten if they have been stored and cooked according to the manufacturer’s instructions.
  • Rare or medium rare cooked meat, fish, poultry or pate.
  • Reheated food.
  • Cold meat or poultry.
  • Fast food (you don’t know how well the food was prepared and cooked).
  • Shellfish (prawns or oysters).
  • Cooked food from shop deli’s and hot counters (you don’t know how long it has been there for)

Dairy Products

 

neutropenic diet - diary

You should avoid eating any unpasteurized dairy products and any soft cheeses or cheeses with mold as these can contain large quantities of bacteria that could increase your risk of developing an infection.

Safe Foods Foods to Avoid
  • All pasteurized milk products.
  • Sour cream.
  • All unpasteurized milk, yogurt, cheese or cream products.
  • Soft cheese (Brie, Camembert, feta, farmer cheese).
  • Cheese with molds (Blue, Gorgonzola, Roquefort, and Stilton cheeses)
  • Mexican-style cheeses (Queso Fresco and Queso Blanco).

Eggs

 

neutropenic diet - eggs

Well-cooked eggs are safe, but avoid raw and undercooked eggs. No runny yolks, unfortunately. 🙁

Safe Foods Foods to Avoid
  • Well cooked egg recipes (boiled, scrambled, fried, etc.)
  • Shop bought mayonnaise in a jar.
  • Raw or cracked eggs.
  • Undercooked eggs (no runny yolks).
  • Foods that contain raw or undercooked eggs (homemade mayonnaise, deli mayonnaise, hollandaise sauce, egg nog, etc.)

Fruit and Vegetables

 

neutropenic diet - fruit and veg

The surface of fruit and veg are great places for bacteria to live and grow. If you are eating fruit and vegetables it is very important that you eat only cleaned cooked vegetables, canned fruit or thick skin fruits that can be peeled or that have been cooked. Don’t eat any fruit or veg that looks moldy or gone off.

Safe Foods Foods to Avoid
  • All well-cooked canned, frozen or fresh vegetables.
  • Thick skinned fruit that can be peeled (oranges, bananas, etc.)
  • Canned fruit and juices.
  • Pasteurized fruit juices.
  • Dried fruits.
  • Frozen fruits.
  • All raw fruit vegetables.
  • Fresh salads.
  • Sandwiches with salad.
  • Coleslaw, potato salad, etc.

Bread and Cereals

 

neutropenic diet - bread

In general, bread and cereals are safe. However, you should avoid raw nuts and uncooked pasta, etc. as there might be bacteria on the surface.

Safe Foods Foods to Avoid
  • All types of bread, pancakes, muffins, donuts, bagels, etc.
  • All types of cooked and ready-to-eat cereals.
  • All types of cooked grains, rice, pasta, noodles, macaroni, and spaghetti
  • Bread and cereals that contain raw nuts.
  • Uncooked pasta.

Drinks

 

neutropenic diet - coffee

All beverages are safe to consume, however, you want to avoid consuming beverages where the opening of the container has been exposed to the environment for extended periods or where other people have been in direct contact with the opening i.e. people drinking out of large cartons of fruit juice, milk, etc.

Safe Foods Foods to Avoid
  • Tap water (leave the tap run for 30 seconds before filling your glass, also ensure the tap is clean).
  • Bottled and distilled water.
  • Canned drinks (pour the beverage into a glass)
  • Tea, coffee, hot chocolate.
  • Alcohol (speak to your doctor first).
  • Large cartons/bottles of water, juice, milk, etc. where other people might have directly drank from the bottle.
  • Draught beers or drinking straight out of bottled/canned beers.

General Food Safety Tips and Guidelines

neutropenic diet - shopping

Food Storage

Proper food storage is key to good food safety:

  • Dry goods such as breakfast cereals and biscuits should be resealed and stored in a sealed container for up to one week.
  • Moist goods such as milk, meat, etc. should be refrigerated immediately and consumed within 3 days of opening. Any food items stored in the refrigerator should be covered and labeled with the date the item was opened.

Shopping

  • Don’t buy food with damaged or broken packaging.
  • Don’t buy any food from fridges or freezers that are overloaded as the food mightn’t be cold enough.
  • Avoid buying food in large packets. Once they are opened it is hard to reseal them safely so it is best to buy smaller, individual packets. Reducing the risk that bacteria will get inside the packet and grow.
  • Buy your chilled or frozen foods last on your shopping trip so they spend as little time as possible outside of the fridge/freezer.
  • Always check the “best before” or “use by” date on packaging before you buy.

LEAVE A COMMENT