Neutropenic Diet and Safe Food Handling While on Chemotherapy

Recommendations for Avoiding Food Related Infections

washing vegetables in sink
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Chemotherapy targets your fastest-growing cells, which includes hair, skin, cancer, and blood cells. Your neutrophils, the white blood cells that fight infection, commonly become low from chemotherapy. This makes you more prone to infection.

Avoiding certain foods and safely handling foods are ways to prevent yourself from getting sick while neutropenic.

 

Let's read about safe food handling tips and food restrictions from the Centers for Disease Control and Prevention, or CDC, and American Cancer Society, or ACS, for people with neutropenia.

Recommendations from the CDC 

Recommendations from the CDC, as with most healthcare agencies and oncologists begin with careful hand washing. Note that most people do not wash their hands properly. You may even wish to watch a YouTube video on proper hand washing, as you might be very surprised! Recommendations include:

  • Wash your hands frequently
  • Avoid raw meats and eggs—be sure to cook all the way through to kill any germs
  • Wash raw fruits and vegetables
  • Avoid sharing food with anyone
  • Do not share any personal eating utensils, like drinking cups or forks
  • Keep household surfaces, like kitchen counter and table, clean

Recommendations from the ACS

According ​to the American Cancer Society, there are many things you can do to reduce your infection risk while eating or cooking.

These include:

  • Wash your hands with warm, soapy water for 20 seconds before and after making food and eating.
  • Refrigerate foods at or below 40° F,
  • Keep hot foods hot (warmer than 140° F) and cold foods cold (cooler than 40° F).
  • Eat defrosted foods right away—do not refreeze them.
  • Do not thaw meat, seafood, or chicken at room temperature—use the microwave or refrigerator.
  • After buying or making perishable foods, eat them within 2 hours. 
  • Eggs, cream, and mayonnaise-based foods should not be unrefrigerated for more than one hour—if so, throw them out.
  • Wash fruits and vegetables thoroughly—like the leaves of lettuce one at a time—with water before cutting or peeling. Do not use chemical-based rinses. (Note: Bacteria present on the skin of foods such as melons can be introduced into the foods with cutting).
  • Still rinse "pre-washed" food products, like salads.
  • Avoid raw vegetable sprouts.
  • Toss fruits and vegetables or any foods that are slippery, slimy, moldy, or smell funny.
  • Avoid purchasing pre-cut veggies at the store (for example, precut melon or cabbage).
  • Use soap and water to wash the tops of canned foods.
  • Use a different utensil for eating and tasting foods while cooking. 
  • Toss out eggs with cracked shells.

Food Restrictions

Depending on your oncologist and the center where you are undergoing chemotherapy, you may be advised to avoid certain foods. 

Avoiding raw meats, seafood, eggs, and fruits and vegetables is recommended by the CDC and ACS.

Your doctor may also recommend avoiding:

  • Raw nuts or fresh nut butters.

  • Any foods that may contain raw eggs (such as Caesar salad dressing or made from scratch Hollandaise sauce).

  • Certain soft and aged cheeses, especially if imported such as Brie, Gorgonzola, Rocquefort, Camembert, Feta, and Ricotta. Make sure any cheese you eat has been pasteurized.

  • Mexican-style cheeses such as Queso Fresco.

  • Bulk-bin sources of cereals and grains.

  • Cream-filled pastries that are not refrigerated.

  • Raw honey or honeycomb.

  • Possibly well water and no water straight from a water source (such as from a lake, spring, or stream).

  • Unpasteurized fruit and vegetable juices.

  • Vitamin supplemented water.
  • Refrigerated salsas and salad dressings in the grocery store.

Future of the Neutropenic Diet

Oncologists are now putting more of an emphasis on safe food handling techniques, as opposed to restricting foods.

Chemotherapy already takes a huge hit on a person's body and their appetite. Further restricting foods may actually worsen any underlying nutritional deficiencies. 

More studies need to be done on the infection rate in people on a strict neutropenic diet versus a general diet with safe food handling techniques. 

What Should I Do?

Practicing safe food handling techniques is important for you and your family. It's a good idea, regardless of whether or not you are neutropenic or have a weak immune system.

If you are neutropenic, please follow the nutritional advice of your oncologist and/or dietician who specializes in treating patients with cancer. 

Preventing Infections During Chemotherapy

In addition to safe food practices, there are many ways in which you can reduce your risk of developing an infection during chemotherapy, especially when your white blood cell count is low. We often think about friends who have a cough or a runny nose, but our pets can be a source of infection as well. Reptiles such as lizards, snakes, and turtles often carry Salmonella, as do birds. Avoiding crowded conditions is helpful, and you may wish to use a mask when in these situations or when flying. Learn more about how to lower your infection risk during chemotherapy.

Sources:

American Cancer Society. Nutrition for the Person with Cancer During Treatment. Updated 07/15/15. https://www.cancer.org/treatment/survivorship-during-and-after-treatment/staying-active/nutrition/nutrition-during-treatment/weak-immune-system.html

Braun, L., Chen, H., Frangou, H. et al. Significant Inconsistency Among Pediatric Oncologists in the Use of the Neutropenic Diet. Pediatric Blood and Cancer. 2014. 61(10):1806-1810.

Centers for Disease Control and Prevention. Preventing Infections in Cancer Patients. Updated 10/25/17. https://www.cdc.gov/cancer/preventinfections/index.htm

Jubelirer, S. The Benefit of the Neutropenic Diet: Fact or Fiction?. Oncologist. 2011. 16(5):704-707.