What Not to Eat During Chemotherapy

Foods That Risk Infection During Chemotherapy

poached egg on bread
What foods should you avoid during chemotherapy treatment?. Jodie Louie/Moment/Getty Images

Are there any foods you should avoid during chemotherapy? If you've heard there are some foods that are taboo, why is that? Having an understanding of how some foods could be dangerous can help you stay healthy as you limit your already side-effect-limited food choices during chemo.

When you're going through chemotherapy—and even for awhile after—your formerly favorite comfort foods may not taste the same.

Your beloved chocolate may take on a metallic aftertaste, or the childhood staple of mac-n-cheese can start to taste like wallpaper paste. It's an unfortunate side effect of some chemotherapy drugs. They can affect your taste buds in the oddest of ways—you might even develop a taste for foods you never used to enjoy.

What are Some Foods Taboo During Chemotherapy?

At the same time, chemotherapy also suppresses your immune system, which may impact what you should and should not eat until your immune function is back to its full potential. Many people experience neutropenia related to chemotherapy. Neutropenia refers to a reduced number of the type of white blood cells called neutrophils. These are the type of white blood cells which fight off any bacteria which enter our bodies. Ordinarily, when we eat foods containing harmful bacteria, these white blood cells fight them off and we are not aware of their presence.

Chemotherapy can change that.

Certain foods—think raw or under-cooked—can actually make you sick. If your immune system is already tied up fighting on other fronts, the sickness can become more serious than a case of diarrhea or a bellyache. According to the United States Department of Agriculture, 48 million Americans suffer food borne illnesses annually.

If your immune system is weakened, the chance of severe illness, hospitalization and even death increases with one of these illnesses.

Not only are ordinary infections worse than they otherwise would be, but you are more likely to develop infections that would never even begin if your immune system was in good order.

Foods to Avoid During Chemotherapy

Your oncologist or oncology nurse may have already informed you of the foods to avoid during chemotherapy but make sure you read to the bottom of this list. There will be times during chemo when your white blood cell count is higher or lower than others, but it's best to be safe and avoid certain foods even if you've just had your blood checked and it's normal. Most often, your white blood cells count will be lowest (at its nadir) 10 days to two weeks following a chemotherapy infusion, but this can vary. Foods to avoid include:

  • Unpasteurized dairy and under-cooked eggs – If it's got a runny yolk, avoid it. If it comes straight from the udder, avoid it.
  • Raw seafood – Oysters, sushi and other kinds of raw or undercooked seafood should be off the menu for now.
  • Unwashed fresh fruits and vegetables – Even the "ready-to-eat" salad mixes and veggies must be carefully washed and peeled again, if possible.
  • Raw honey and associated products – For the same reason you don’t feed it to babies; raw honey products can carry the botulism toxin and make you ill.
  • Moldy cheeses – Think brie and blue cheese. Remember, the mold that gives these cheeses their taste and color is actually a fungus. A fungus which a healthy immune system normally deals with, but which a compromised immune system may not.
  • Foods out of dented cans – The dents can actually compromise the integrity of the contents of canned foods and allow bacteria to form.
  • Raw nuts and fresh-made nut butters should be avoided.

Foods Made With Foods to Avoid

An important point and one that has resulted in too many infections, is that some of the taboo foods above can be "hidden" in other products. Don't forget to exclude foods made with the above products, such as raw eggs in hollandaise sauce, Caesar salad dressing or homemade mayonnaise. When in doubt, talk to your physician before eating the food in question.

Eating Out During Chemotherapy

If you are immunosuppressed (have bone marrow suppression from chemotherapy), eating out may have to take a hiatus for now. Think about how many hands the restaurant-prepared food you eat travels through. There's the warehouse and transport to the restaurant, the unpacking and storing in the facility, the people who set up and prep the food to be cooked, the chef, the waitress and so on. Although a virtual buffet of germs may not actually be present on your food, is it worth the risk?

Speaking of buffets, they should be avoided during and shortly after your chemotherapy, when your body has the least chance of fighting off common germs. Sneeze-shields (those little Plexiglas or glass dividers making you feel safe from sprayed sneezes) are not foolproof, nor is there any guarantee that patrons aren’t revisiting the buffet with used plates, bowls and utensils. Similarly, avoid any delicatessen or self-serve salad bars—opt instead to purchase the meat, lettuce and toppings and clean them yourself at home.

Food Prep During Chemo

We've all heard the adage that we are supposed to keep hot foods hot and cold foods cold—but these are the specifics. Perishable foods should not be left out for protracted munching. After any meal or snack is served, the food should be packaged safely and refrigerated within at least two hours of preparation.

  • Cold foods must be kept at or less than 40 degrees Fahrenheit
  • Hot foods must be kept at or hotter than 140 degrees Fahrenheit

It's okay—and actually encouraged—to use multiple spoons, cutting and preparation surfaces, and pans while cooking. You don't want to contaminate the bacon by stirring it with the same fork used to whip your raw eggs, for example. Be sure to use a cutting surface that is not made of wood or another permeable surface while chopping or preparing raw meats—wood can harbor bacteria despite how well you wash it.

If you love a nice, blood red center on your beef, consider swapping it for some well-cooked poultry—at least until your chemotherapy is over. Whatever meat you choose, make sure it is cooked through. The best way to do this is not by "eyeballing it" or depending on a recipe's cook time; use a meat thermometer to ascertain if your meat is thoroughly cooked and remember:

  • Poultry should be cooked to 165 degrees at the thickest part
  • Red meat should be cooked to 160 degrees at the thickest part
  • Reheated casseroles and leftovers should be heated to 165 degrees.

Be sure your meat thermometer is not placed too shallow and it is not touching the bone if there is one, as both mistakes could cause a false reading.

Hand Washing is Important

One of the most important things you can do, not just before eating or preparing food but often, is to wash your hands. It's been shown too-many-times-to-count that careful hand washing by yourself and others around you can do wonders in decreasing the risk of infections.

Mnemonic for Eating During Chemotherapy

Oncologists realize that the information we just shared on eating during chemotherapy can be hard to remember—especially at a time when you are learning a massive number of facts about cancer which you probably never wanted to know. The mnemonic is "piccy" and goes as follows:

P - Stands for pasteurized, in other words, making sure foods such as dairy products have been heated (pasteurized).

I - Stands for inspect. Take a careful look at any foods you eat (inspect them) before eating. For example, look for any cuts or breaks in veggies or fruits, or molds growing on other foods.

C - Stands for clean. Not only should you make sure to clean the foods you eat, but be wary of cutting boards and other surfaces your food may come in contact with that may not be clean. You may want to add hand washing by yourself and anyone helping to prepare your food to this letter.

C - This C stands for cook. Cook any meats thoroughly including fish and seafood.

Y - Stands for yuck. Mark dates on any leftovers in your fridge and throw them promptly. Consider that in order to identify a bacteria, scientists place a dab on a plate and let it grow for awhile in a fridge. Avoid making your own petri dishes in your own fridge.

Bottom Line - Eating During Chemotherapy

Avoiding foods that can cause infection in addition to coping with mouth sores, taste changes, sometimes nausea or a loss of appetite from chemo can be difficult. That said, there are now several cookbooks that have been designed for people with cancer which take not only food restrictions due to infection risk in mind, but are also designed with recipes to help people cope with the eating-related side effects of treatment.

Sources:

Centers for Disease Control and Prevention. Preventing Infections in Cancer Patients. Updated 11/18/15. http://www.cdc.gov/cancer/preventinfections/patients.htm

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