Neutropenic Diet And Safe Food Handling While on Chemotherapy

Recommendations from the CDC and ACS

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 

  • 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

  • Wash 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 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.
  • Still rinse "pre-washed" food products, like salads, under water 
  • 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 (e.g., melon, 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 (e.g. Caesar salad dressing)

  • Certain cheeses, aged (e.g. Brie, Gorgonzola)

  • Mexican-style cheeses

  • 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 (e.g. lake, spring)

  • Unpasteurized fruit and vegetable juices

  • Vitamin supplemented water
  • Refrigerated salsas and salad dressings in 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. 

Sources

Aftandilian CC, Milotich C, & Sakamoto KM. The neutropenic diet...still ageless? Oncology (Williston Park). 2012 Jun;26(6):586,588-9.

American Cancer Society. ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention. 

American Cancer Society. Nutrition for the Person with Cancer During Treatment.

Centers for Disease Control and Prevention. (2015). Preventing Infections in Cancer Patients: Neutropenia and Risk for Infection.

Smith LH & Besser SG. Dietary restrictions for patients with neutropenia: a survey of institutional practices. Oncol Nurs Forum. 2000 Apr;27(3):515-20.

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