This information will help you follow a low-microbial diet. Eating a low-microbial diet will lower your risk of getting sick while your immune system is weak, such as when you have leukopenia (a low number of white blood cells), after chemotherapy, radiation therapy, or a bone marrow or stem cell transplant.
The first section of this resource has information on how to keep your food safe. The second section explains what foods and drinks are safe to eat and drink while on a low-microbial diet. Don’t make any changes to this diet until you have talked to someone on your healthcare team. This includes your doctor, nurse, nurse practitioner, or dietitian.
People who had an allogeneic or autologous stem cell transplant should follow this diet for the first 100 days after their transplant. Please speak to your healthcare team about whether you need to keep following the diet after the 100-day period is over.
Back to topFood Safety Guidelines
About microbes
Microbes are tiny living things such as bacteria, viruses, yeast, and molds. They can get into food by infecting the animal the food comes from. Microbes can also get into food when it’s being processed or prepared. When microbes get into foods and you eat the foods without proper preparation, they can cause infections. People with leukopenia are at an especially high risk for infection.
Microbes can attach to foods and grow, but you can’t always see, smell, or taste them. They’re more likely to grow on:
- Milk and other dairy food items that aren’t refrigerated.
- Unpasteurized cheeses (such as Brie, blue cheese, and feta).
- Undercooked and raw eggs and foods that have raw eggs (such as cookie dough and Caesar salad dressing).
- Undercooked or raw meat, poultry, and seafood (including smoked seafood such as smoked salmon and trout).
- Certain fruits and vegetables (see the Fruits and Vegetables list in the “What to Eat on a Low-Microbial Diet” section).
- Unpasteurized or untreated juices (such as fresh-squeezed juices).
- Vegetable sprouts (such as raw alfalfa, soy bean, and radish sprouts).
Buying foods that are safe to eat
- Check containers for the expiration date. Buy and use food before that date.
- Don’t buy fruits and vegetables that have cuts, bruises, or mold.
- Don’t buy pre-cut fruits and vegetables at the grocery store. Buy whole produce and clean and cut it at home.
- Don’t buy canned foods if the can has dents or is swollen.
- Don’t buy food in jars if the jar is cracked or the lid isn’t tightly closed.
- Don’t buy packaged or boxed food that isn’t properly sealed.
- Buy only pasteurized dairy products, honey, and fruit and vegetable juices.
- Only buy eggs that are refrigerated. Open the carton to make sure no eggs are broken or cracked.
- Don’t buy foods from self-service bulk containers or bins.
- Don’t taste free samples.
- Don’t buy meats, cheeses, or salads from the deli counter or salad bar.
- Separate ready-to-eat and raw foods. Put raw meat, poultry, seafood, and other raw foods in plastic bags before they go into your shopping cart.
Pick up your milk and other cold and frozen foods at the end of your shopping trip. This decreases the time these items will spend outside of the refrigerator or freezer.
Transporting food safely
- After grocery shopping, go directly home and put your perishable food (food that can go bad quickly) into the refrigerator or freezer right away.
- Never leave perishable foods in a hot car.
- If you need to make a stop after grocery shopping or if your trip from the grocery store to your home is long, place perishable foods in an insulated bag or cooler with ice or frozen gel packs.
Storing food safely
- Store food right after shopping.
- Put eggs and milk on a shelf inside the refrigerator. Don’t store them in the door. The inside of the refrigerator stays cooler than the door area.
- Never leave perishable food out of the refrigerator for more than 1 hour.
Keeping your kitchen clean
- Keep an area of your kitchen clean for preparing and eating food. This will help keep microbes from spreading.
- Use paper towels or a clean cloth to clean kitchen surfaces. Don’t use sponges.
- Use an antibacterial cleaning spray to clean surfaces. Look for products that have bleach or ammonia. Examples are Lysol® Food Surface Sanitizer and Clorox® Clean-Up Cleaner.
Using cutting boards and equipment
- Use thick plastic, marble, glass, or ceramic cutting boards. These materials are nonporous, meaning that food or liquid substances can’t absorb into them. Don’t use cutting boards made from wood or other porous surfaces that can absorb food and liquids.
- Throw out worn or hard-to-clean cutting boards.
- Wash cutting boards and knives with hot soapy water before using them to cut the next food.
- As an extra precaution, you can also wash your cutting boards with a kitchen sanitizer. Rinse off the sanitizer with hot water before using the cutting board.
- Use separate cutting boards for fresh produce and for raw meat, fish, seafood, or poultry.
- Never place cooked food on a cutting board or plate that previously held raw food.
Handling food safely
- Wash your hands thoroughly with soap and warm water for at least 20 seconds:
- Before preparing or eating food
- After preparing raw poultry, meat, fish, or seafood
- After handling garbage
- Thoroughly rinse fresh fruits and vegetables. Never use bleach or detergent to wash produce.
- To properly wash produce, run under warm tap water and scrub skin with a clean vegetable brush.
- Even if you plan to peel a fruit or vegetable, wash the skin and rind before cutting or peeling (for example, bananas, oranges, melons, and avocados).
- Separate and thoroughly wash all salad greens. Re-wash all produce even if it’s “pre-washed”.
- Thaw foods by using one of the following methods:
- Put the food item in the refrigerator 1 day before cooking.
- Use the defrost setting on a microwave. Cook right away.
- Keep your refrigerator at a temperature of 33 °F to 40 °F (0.6 °C to 4.4 °C). Keep your freezer at a temperature of 0 °F (-17.8 °C) or below.
- Don’t eat hamburgers and other meat products if the meat looks undercooked. Cook the meat until it’s grey and the juices run clear.
- Cook fish until it flakes and shellfish until it’s cooked-through and opaque.
- Cook egg whites and yolks until they’re firm.
- Use a food thermometer to check that all foods are cooked to the minimum internal temperatures listed in the chart below. Check the temperature at the center of the thickest part of the food.
- Don’t share food with other people.
- Always remember: when in doubt, throw it out!
Food | Safe Minimum Internal Temperatures |
---|---|
Egg and Egg Dishes | |
Eggs | Cook until yolk and white are firm |
Egg dishes | 160 °F (71 °C) |
Egg sauces | 160 °F (71 °C) |
Ground Meat and Meat Mixtures | |
Turkey and chicken | 165 °F (74 °C) |
Beef, hamburgers, veal, lamb, and pork | 160 °F (71 °C) |
Fresh Beef, Veal, and Lamb | |
Well done | 170 °F (77 °C) |
Fresh Pork | |
Well done | 170 °F (77 °C) |
Ham | |
Raw or fresh | 160 °F (71 °C) |
Precooked, cured ham | 140 °F (60 °C) |
Poultry | |
All products | 165 °F (74 °C) |
Seafood (Fish and Shellfish) | |
All (raw or fresh) | 145 °F (63 °C) |
Eating leftovers
- Refrigerate leftovers in shallow containers right after eating.
- Reheat the following leftovers to an internal temperature of at least 165 °F (74 °C) for at least 15 seconds:
- Poultry
- Stuffed meat, poultry, or fish
- Ground meat
- Pork, beef, veal, and lamb
- Hard-boiled eggs
- When reheating leftovers in the microwave, stir, cover, and rotate the food so that it heats evenly.
- Sauces, soups, and gravies should be reheated by bringing them to a boil.
- Be sure to let the food cool so you don’t burn your mouth.
- Eat reheated leftovers within 1 hour of reheating.
- Don’t eat leftovers more than 2 days old.
- Don’t eat any food that has already been reheated once.
What to Eat on a Low-Microbial Diet
Breads, Grains, and Cereals
What to eat | What to avoid |
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Milk and Dairy Products
What to eat | What to avoid |
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All pasteurized dairy products, including:
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All unpasteurized dairy products, including:
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Eggs
What to eat | What to avoid |
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Meat, Meat Substitutes, Poultry, and Seafood
What to eat | What to avoid |
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Fruits and Vegetables
What to eat | What to avoid |
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Drinks
What to drink | What to avoid |
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Nuts
What to eat | What to avoid |
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Condiments and Miscellaneous
What to eat | What to avoid |
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Desserts
What to eat | What to avoid |
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Eating Outside the Home and Take-Out
What to eat | What to avoid |
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Eating out at restaurants
You can eat out while on a low-microbial diet unless you had a stem cell transplant. If you had a stem cell transplant, see the “Guidelines for people who had a bone marrow or stem cell transplant” section below.
It’s important to choose the restaurant carefully. Local health departments inspect restaurants to make sure that they’re clean, and that they follow safe food practices. You can find out how your local restaurants did on a recent health inspection by going to your local Department of Health (DOH) website. To find out about restaurants in New York City, go to the following website: www1.nyc.gov/site/doh/services/restaurant-grades.page
You can also ask your local restaurants about their food safety training rules. When you go out to eat, follow the guidelines below.
- Order all foods to be fully cooked and meats to be well done.
- Don’t order foods that may have raw eggs (such as Caesar salad dressing, fresh mayonnaise or aioli, and hollandaise sauce).
- Ask the wait staff if you aren’t sure of the ingredients in your meal.
- Don’t eat foods from buffets and salad bars.
- Ask that your foods be cooked fresh and not served from steam tables or stored under heat lamps.
- Ask for single-serving condiments, such as ketchup and mustard packets. Open containers may be used by many customers.
- Don’t eat soft serve ice cream and soft serve frozen yogurt. The dispensers may contain bacteria if they’re not cleaned often.
- Always order a whole or personal pizza. Don’t order individual slices, since they’re often stored under heat lamps.
Guidelines for people who had a bone marrow or stem cell transplant
People who had an allogeneic or autologous stem cell transplant shouldn’t eat out at restaurants for the first 100 days after their transplant. Please speak to someone on your healthcare team if you have any questions or concerns about eating out before or after the 100-day period.
Avoid supplements
Don’t take supplements, homeopathic remedies, or herbal products (such as St. John’s wart, traditional Chinese medicines) unless discussed with your MSK medical team. Because there are no federal standards for these products in the United States, the way they’re processed and stored may pose a health risk. Microbes in these items can also cause an infection. Also, the products themselves could interfere with or change the activity of a prescription medication.
Safe drinking water
Never drink from lakes, rivers, streams, springs, or wells.
If you’re unsure if the tap water is safe, check with the local health department or boil or filter the water. Drink bottled water if you think the tap water may not be safe. Note that most water filtration devices will not make the water safe if the water supply hasn’t been chlorinated.
If you use well water that isn’t tested daily for bacteria, you must boil it. Bring the water to a rolling boil for 15 to 20 minutes. Store boiled water in the refrigerator. Throw away any boiled water that you don’t use within 48 hours.
Back to topResources
Use the resources below to find additional information about preventing foodborne illness and the safe handling, storage, and preparation of food.
Government websites with information and news about foodborne illnesses, recalls, and regulations:
- United States Department of Agriculture (USDA) Food Safety and Inspection Service
www.fsis.usda.gov - U.S. Department of Health & Human Services Food Safety Information
www.foodsafety.gov - U.S. Food & Drug Administration (FDA)
www.fda.gov/ForConsumers/default.htm - Centers for Disease Control and Prevention Food Safety
www.cdc.gov/foodsafety/
Fight BAC! Partnership for Food Safety Education
A website with practical tips about how to keep food safe.
www.fightbac.org
USDA “Ask Karen”
A web-based question and answer system that allows visitors to read previously asked questions and submit new questions about foodborne illnesses and safe food handling, storage, and preparation.
www.fsis.usda.gov/wps/portal/informational/askkaren
NYC Department of Health and Mental Hygiene Restaurant Inspection Information
A website where you can search for New York City restaurant inspection results and grades.
www1.nyc.gov/site/doh/services/restaurant-grades.page
The Safe Food Information Line
Call this number to contact the U.S. FDA by phone.
888-723-3366
Nutrition services at MSK
Call this number to schedule an appointment with one of MSK’s registered dietitians or nutritionists.
212-639-7312