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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

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