Neutropenic Diet

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What is the neutropenic diet?

The neutropenic diet is an eating plan for people with weakened immune systems. It involves choosing foods and preparing them in a way that lowers your risk of foodborne illness. If you have a weakened immune system, your doctor may recommend that you follow a neutropenic diet to limit your exposure to harmful microbes and bacteria.

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Are there other names for this diet?

Another name for the neutropenic diet is the low-microbial diet.

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How does the neutropenic diet help people with cancer?

Following a neutropenic diet can help prevent foodborne illness in someone with a weakened immune system. People with cancer may have a weakened immune system due to the disease. Chemotherapy, radiation therapy, and a stem cell transplant can also cause a weakened immune system.

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What are the basic principles of the neutropenic diet?

The basic principles of this diet involve practicing proper food safety and avoiding foods that are more likely to expose you to microbes and bacteria. People who’ve had a stem cell transplant typically need to avoid food prepared in restaurants or other establishments for 100 days.

Guidelines can be broken up into three categories: foods to avoid, food preparation, and food storage.

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Food Guidelines

  • Avoid raw and undercooked meat, as well as deli, processed, and cured meats (including salami, bologna, hot dogs, and ham) unless heated until steaming hot.
  • Avoid smoked seafood, typically labeled as “lox,” “kippered,” “nova style,” or “jerky.”
  • Avoid raw fish and shellfish.
  • Avoid raw and undercooked eggs.
  • Avoid salad bars, buffets, and potlucks.
  • Avoid unpasteurized products, such as unpasteurized dairy items (like milk, cheese, and eggnog), as well as unpasteurized honey, juice, and cider.
  • Avoid fresh and packaged foods that are past their “use by” and expiration dates.
  • Avoid consuming raw sprouts of any kind, including alfalfa, clover, radish, and mung bean sprouts.
  • Avoid leftovers older than 48 hours. It is important to follow proper food storage and reheating guidelines if you plan to prepare food ahead of time or save leftovers.
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Food Preparation Guidelines

  • Proper hand washing is the first important step in food safety. Wash your hands with warm soapy water for 20 seconds.
  • Thoroughly rinse fresh fruit and vegetables under warm running water. Scrub or brush produce to remove excess dirt. Even melon, oranges, and other thick-skinned fruits that are peeled before eating should be washed to avoid introducing bacteria into the fruit when cutting it.
  • Use separate cutting boards for meat and produce, and avoid wooden cutting boards.
  • Use clean dishes to serve cooked food. Never reuse a dish that has held raw meat or fish without properly cleaning it with soap and warm water.
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Food Storage Guidelines

  • Avoid keeping food on the counter longer than necessary.
  • Check that your refrigerator is set at 40 degrees Fahrenheit (F) or below.
  • Bacteria grow best between 40 and 140 degrees F.
  • Refrigerate or freeze fresh or frozen food immediately after purchase.
  • Refrigerate or freeze leftover food within two hours of eating.
  • Leftovers must be eaten within 48 hours and reheated one time only. This includes open packages of commercially sold hot dogs, deli meats, cheeses, and other packaged items.
  • Refrigerate or freeze food immediately after purchase.
  • Defrost food in a refrigerator, in cold water, or by microwaving followed by immediate cooking. Do not defrost food on the counter.
  • Avoid putting hot food in a refrigerator, which can cause the temperature inside to rise. Place hot food in a shallow pan or dish to cool quickly.
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What are the foods you can eat on the neutropenic diet?

FOOD GROUPS FOODS TO INCLUDE
Breads and Grains
  • All breads, rolls, bagels, English muffins, waffles, French toast, muffins, pancakes, and sweet rolls
  • Potato chips, corn chips, tortilla chips, popcorn, and pretzels
  • Any cooked or ready-to-eat cereal purchased prepackaged from a store
  • Rice, pasta, and other cooked grains
Milk and Dairy Products
  • Commercially available pasteurized milk and milk products, such as sour cream and whipped cream
  • Commercially pasteurized yogurts, including those made with live cultures
  • Commercially packaged processed cheese slices and spreads, cream cheese, cottage cheese, and ricotta cheese
  • Commercially packaged pasteurized cheese, such as American, cheddar, mozzarella, Monterey jack, Swiss, and Parmesan
  • Soft cheeses clearly labeled “made from pasteurized milk,” including goat cheese and feta
  • Commercially packaged ice cream, frozen yogurt, sherbet, popsicles, ice cream bars, and puddings, as well as fresh homemade milkshakes
  • Commercially sterile, ready-to-feed, and liquid concentrate infant formula
Egg Products
  • Well-cooked eggs (firm white and yolk) and pasteurized egg substitutes (such as Egg Beaters®, powdered eggs, or liquid egg whites)
  • Runny or well-cooked pasteurized eggs, such as Davidson’s Safest Choice® Pasteurized Eggs
Meat and Meat Substitutes
  • Well-cooked fresh meat (pork, beef, and lamb), poultry, bacon, and sausage
  • Thoroughly cooked fresh fish and seafood, such as salmon, tilapia, cod, shrimp, lobster, and crab (take extra caution with shellfish that’s in the shell, such as lobster, and be sure to cook it fully through until it’s opaque)
  • Cooked tofu or pasteurized or shelf-stable tofu
  • Cooked fermented products, including miso and tempeh
  • Commercially prepared hot dogs and sliced deli meat sold in a sealed package (such as salami, bologna, ham, and turkey) that are cooked until steaming hot.
  • Canned meats and commercially packaged beef or turkey jerky
  • Canned fish (tuna and salmon) and shelf-stable smoked fish
Fruits and Vegetables
  • Well-washed raw fresh fruits and vegetables without cuts, bruises, or mold, such as apples, pears, peaches, peppers, salad greens, carrots, cucumbers, and tomatoes
  • Well-washed and peeled thick-skinned fresh fruits and vegetables, such as citrus fruits, bananas, avocados, mangos, and melons
  • Cooked and canned fruits and vegetables
  • Well-washed frozen fruits and vegetables
  • Pasteurized juices and frozen concentrates
  • Commercially packaged dried fruits
  • Shelf-stable bottled salsa (refrigerate after opening)
  • Fresh, well-washed herbs
  • Dried herbs and spices
Beverages
  • Tap water and ice, if your water is from a city water supply or a municipal well serving a highly populated area
  • Water from private wells or small community wells only if the well is tested daily for bacteria; if the well isn’t tested daily, boil the water before using it
  • Commercially bottled distilled, spring, and natural waters
  • Pasteurized fruit and vegetable juices
  • Bottled, canned, or powdered beverages
  • Hot coffee
  • Hot teas using commercially packaged tea bags
  • Homemade iced tea and iced coffee made from hot (boiling) brewed tea or coffee, as long as you store it in the refrigerator and drink it within two days
  • Pasteurized soy milk and other nondairy milks, such as almond, rice, and coconut milk
  • Commercially made liquid nutritional supplements, such as Ensure® and Boost®
Condiments and Miscellaneous
  • Salt and sugar
  • Jellies, syrup, and jams (refrigerate after opening)
  • Pasteurized or flash-pasteurized honey
  • Packaged ground black pepper, herbs, and spices
  • Ketchup, mustard, barbecue sauce, and soy sauce (refrigerate after opening)
  • Pickles, pickle relish, and olives (refrigerate after opening)
  • Vinegar
  • Vegetable oils and shortening
  • Refrigerated margarine and butter
  • Commercially made, shelf-stable mayonnaise and salad dressings, including Caesar, blue cheese, and other cheese-based salad dressings (refrigerate after opening)
  • Cooked gravy and sauces
  • Commercially packaged roasted nuts
  • Commercially packaged raw almonds or hazelnuts (required by law to be pasteurized), or other raw nuts labeled “pasteurized”
  • Nuts in commercially packaged or homemade baked goods
  • Commercially packaged nut butters and nut-free butters, such as peanut, sunflower, and soybean
Desserts
  • Refrigerated, commercially made, and homemade cakes, pies, pastries, and puddings
  • Refrigerated cream-filled pastries
  • Commercially packaged and homemade cookies
  • Shelf-stable cream-filled cupcakes and fruit pies
  • Commercially packaged ice cream and frozen yogurt 
  • Packaged candy and gum
Neutropenic Diet Recipes

A weakened immune system after chemotherapy may get a boost with a neutropenic diet. View our neutropenic recipes that can help fight infections and strengthen your system.

Learn more
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What are foods to avoid on the neutropenic diet?

FOOD GROUPS FOODS TO AVOID
Breads, Grains, and Cereals
  • Undercooked or raw brewer’s yeast
Milk and Dairy
  • Raw milk
  • Homemade eggnog and yogurt
  • Cheese made from unpasteurized milk, often including soft cheeses, such as Brie, farmer’s cheese, Camembert, Mexican-style cheese (such as queso blanco and queso fresco), goat cheese, and mozzarella made with unpasteurized milk (safe if cooked until melted)
  • Mold-ripened cheeses, such as Roquefort, Stilton, Gorgonzola, and blue cheese
  • Rind on cheeses, such as Brie, as it often contains mold 
  • Soft-serve ice cream and frozen yogurt
  • Unrefrigerated cream-filled pastry products that are not shelf stable
  • Fermented dairy products, such as kefir
  • Cheese sliced at the deli counter
  • Cheese that contains chili peppers or other uncooked vegetables
Egg Products
  • Undercooked unpasteurized eggs and egg products
  • Raw eggs and foods containing raw eggs, such as homemade Caesar dressing, freshly made mayonnaise and aioli, and raw cookie dough
Meat and Meat Substitutes
  • Undercooked or raw meats and poultry, including rare or medium-rare items
  • Uncooked or raw tempeh, miso products, and tofu
  • Freshly sliced deli meats and meats from street vendors
  • Raw or partially cooked fish and shellfish, including caviar, sashimi, sushi, ceviche, “lemon-cooked” fish, and cured fish
  • All clams, mussels, and oysters (raw or cooked)
  • Smoked seafood, such as salmon or trout labeled as “nova style,” “lox,” “kippered,” or “jerky” (unless cooked to 160 degrees F or incorporated in a cooked dish or casserole)
  • Refrigerated pâtés and meat spreads
  • Hard-cured salami in a natural casing
Fruits and Vegetables
  • Unwashed raw or frozen fruits, vegetables, and herbs
  • Any raw or frozen rough-textured fruits and vegetables that can’t be thoroughly washed, such as strawberries, raspberries, blackberries, broccoli, and cauliflower (OK if cooked)
  • Precut fresh fruits and vegetables, such as precut melon
  • Unpasteurized and fresh-squeezed fruit and vegetable juices (unless prepared at home)
  • Fresh fruit or vegetable salsa found in a grocery refrigerated case
  • Vegetarian sushi, unless it’s homemade, because it may be prepared near raw fish
  • All uncooked vegetable sprouts, including alfalfa, bean, and clover sprouts
  • Salads from delis or salad bars
Drinks
  • Unpasteurized eggnog, cider, and fruit or vegetable juices
  • Unpasteurized beer (such as microbrewery beers and those that aren’t shelf stable) and wine*
  • Fountain soda and other fountain beverages
  • Tea made with loose leaves, cold-brewed tea, sun tea, kombucha, and mate tea
  • Iced or cold-brewed coffee or tea from restaurants or coffee shops


* Talk with your doctor before consuming any alcoholic beverages.

Condiments and Miscellaneous
  • Raw or unpasteurized honey and honeycomb
  • Whole or fresh ground black pepper served tableside at restaurants
  • Shared condiment containers at restaurants (ask for individual packets)
  • Fresh salad dressings (stored in a grocery refrigerated case) containing raw eggs or cheeses, such as Caesar salad dressing
  • Herbal and nutritional supplements
  • All nuts that are sold open and in bulk, as in some health-food or specialty stores
  • Unpasteurized raw nuts
  • Roasted nuts in the shell, such as pistachios or peanuts in the shell
  • Freshly ground peanut butter or nut butters (not commercially packaged)
Desserts
  • Unrefrigerated cream-filled pastry products that are not shelf stable
  • Soft-serve ice cream and frozen yogurt
  • Ice cream scooped at a restaurant
  • Unpackaged after-dinner mints (such as those found at diner check-out counters)
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Are there medications to avoid while on the neutropenic diet?

Don’t take supplements, homeopathic remedies, or herbal products (such as St.-John’s wort or traditional Chinese medicines) unless you’ve discussed it with your cancer care team. Because there are no federal standards for these products in the United States, the way they’re processed and stored may pose health risks. Microbes in these items can also cause an infection. In addition, the products themselves could interfere with or change the activity of a prescription medication.

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What are some tips for people on the neutropenic diet?

  • Ask caregivers to prepare some of your favorite meals at home.
  • Try frozen, commercially packaged foods.
  • Although most people on the neutropenic diet are advised to avoid eating restaurant food, one exception is pizza. Ordering a fresh, uncut pizza poses little risk if you cut it yourself at home.
  • When you go out, you may want to pack snacks ahead of time, such as protein bars, packaged roasted nuts, and packaged crackers. Take along canned soda, seltzer, or juice too.
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What are tips for caregivers helping people who are on this diet?

  • Make sure that you have a good supply of containers for storing food.
  • Label leftovers with a “use by” date so you know to dispose of uneaten contents after 48 hours.
  • Consider taking freezer bags or other cooling containers with you to the grocery store to ensure that food stays cold.
  • Purchase a food thermometer to ensure that food is cooked to a safe temperature. This includes whole or ground meats as well as mixed dishes, such as casseroles. Do not rely on the color of the meat to ensure doneness.

Here are some basic guidelines on the safe minimum internal temperature of common foods.

FOODS SAFE MINIMUM INTERNAL TEMPERATURE
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, 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)

 

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Where can I learn more about the neutropenic diet and how to prevent foodborne illness?

Refer to our low-microbial diet resource for further information.

Use the resources below to find additional information about preventing foodborne illness and the safe handling, storage, and preparation of food.

US Department of Agriculture (USDA) Food Safety and Inspection Service
Website
Provides the latest information on food recalls.

US Department of Health and Human Services Food Safety Information
Website
Includes tips on how to handle and prepare food safely.

US Food and Drug Administration
Website
Extensive information on food safety and nutrition.

Centers for Disease Control and Prevention Food Safety
Website
Resources on food-borne illness, including prevention and symptoms.

Fight BAC! Partnership for Food Safety Education
Website
An extensive consumer-friendly website dedicated to providing education on how to keep food safe.

USDA’s Ask Karen
Website
An easy-to-search database featuring answers to common questions about foodborne illness and safe food handling, storage, and preparation. You can submit a new question if you don’t see yours.

New York City Department of Health and Mental Hygiene Restaurant Inspection Information
Website
Search for New York City restaurant inspection results and grades.

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