Overview of the neutropenic diet

This neutropenia A diet is a way of eating that reduces the risk of bacterial infections from certain types of foods. Also known as a low-microbial diet, it is often recommended for people with severely compromised immune systems, such as cancer patients undergoing chemotherapy.

The neutropenic diet is named after a medical condition called neutropenia. neutrophils is an important type of white blood cell (WBC) that helps fight infection. When the neutrophil count drops to dangerously low levels, people are considered neutropenic. People with neutropenia can easily catch bacteria from food and get sick.

This article will review the main features of neutropenic diets and discuss their effectiveness.

Food Safety in Neutropenia

Although the neutropenic diet has some controversy, the FDA does support safe food handling practices for people with neutropenia. Prevention of bacterial transmission is the main goal of a neutropenic diet. While most healthy people recover quickly from foodborne illness, those with weakened immune systems may not.

Your main line of defense against infection is good hand washing. Proper food preparation and storage can also reduce the risk of contracting bacteria from food.

Food Prep Guide

Bacterial contamination often occurs during food preparation. Follow these guidelines when preparing a neutropenic diet for yourself or a loved one:

  • Wash your hands with warm soapy water for 20 seconds before and after preparing meals.
  • Wash and scrub vegetables thoroughly with water before chopping or peeling them. Wash the lettuce leaves one at a time.
  • Wash and scrub raw fruit, including thick-skinned fruits such as oranges and melons.
  • Rinse “pre-wash” salad.
  • Throw away food that smells bad or shows signs of spoilage.
  • Wash the tops of canned foods with soap and water before opening.
  • Use different utensils to eat and taste food while cooking.
  • Throw away eggs with cracked shells.
  • Use separate cutting boards for meat and produce.
  • Use a meat thermometer to ensure meat is cooked to the proper temperature.
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Some oncologists use the mnemonic “PICKY” to help people remember safe eating habits. The letters in “PICKY” stand for:

  • Practice hand washing.
  • Check food before cooking.
  • Clean and scrub fruits and vegetables.
  • Keep all cooking surfaces clean.
  • Unpalatable, moldy food should be thrown away.

Food Storage Guidelines

Once you’re ready, here’s how to safely store the food you consume on a neutropenic diet:

  • Keep hot food hot (over 140 F).
  • Keep cold foods refrigerated (below 40 F).
  • Eat thawed food right away. Do not refreeze.
  • Avoid leaving food on the counter for extended periods of time.
  • Do not thaw meat, seafood or chicken at room temperature. Use a microwave or refrigerator instead.
  • After purchasing perishable foods, eat them within two hours.
  • Leftovers should be eaten within 48 hours and reheated only once.
  • Eggs, cream and mayonnaise should not be left out of the refrigerator for more than an hour.

foods to avoid

Depending on the advice of your oncology team, you may be advised to avoid certain foods while undergoing cancer treatment. Foods commonly avoided in a neutropenic diet include:

  • Raw meat and seafood (including sushi)
  • raw or fresh nut butter
  • Anything that contains raw eggs (including Caesar dressing or homemade mayonnaise)
  • Soft and Aged Cheese
  • Unpasteurized cheese, milk, fruit and vegetable juices
  • Fermented dairy products, such as kefir
  • Bulk Grains and Grains
  • Uncooked or raw brewer’s yeast
  • Unrefrigerated Cream Pastry
  • Uncooked vegetable sprouts, such as alfalfa, bean sprouts, and clover sprouts
  • raw honey or honeycomb
  • Water from lakes, springs, streams or wells
  • Herbal Replenishment Water
  • refrigerated grocery store salsa


Although a neutropenic diet has been prescribed to cancer patients for many years, there is no scientific evidence that it reduces infection rates during cancer treatment. In fact, these strict recommendations may do more harm than good.

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Patients undergoing chemotherapy often experience reduced quality of life due to fatigue, loss of appetite, and stress. Not allowing cancer patients to eat and drink satisfying food can lead to nutritional deficiencies and depression.

A 2018 study of children receiving immunosuppressive chemotherapy concluded that neutropenic diets should be replaced with FDA-approved food safety guidelines.

In addition, the neutropenic diet is not standardized, which means that there are no published guidelines for how to properly follow it. Instead, each cancer center adjusts dietary requirements to its own preferences. This can lead to inconsistency and confusion for patients.

A 2019 study American Journal of Clinical Oncology, The study, which evaluated five randomized trials involving 388 people receiving chemotherapy, concluded that the use of a neutropenic diet was not associated with a reduced risk of infection.

Potential challenges

Maintaining good nutrition during cancer treatment can be complicated by other side effects of chemotherapy. Some of these include:

  • Mouth ulcers: Mouth pain is common during chemotherapy. It is crucial to choose foods that are less likely to irritate your mouth. Avoid acidic foods such as citrus and tomato products. Avoiding foods with sharp edges, such as toast or chips, can also help.
  • Changes in taste: Some cancer drugs can cause a metallic or salty taste in the mouth. Choosing foods with strong flavors and eating with plastic utensils can help improve this side effect.
  • Nausea and vomiting: Nausea and vomiting can interfere with the desire and ability to eat. There are several remedies available to relieve these symptoms. Discuss with your oncology nurse the options that are best for you.
  • Loss of appetite: Chemotherapy and radiation therapy can reduce appetite. Working with a certified nutritionist can help you maintain your calorie intake during this time.
  • Cancer fatigue: Fatigue is a common symptom during cancer treatment. Not having the energy to buy groceries or prepare meals can negatively impact your health. Using a grocery delivery service and seeking help from others is critical to maintaining your health.

Other ways to reduce the risk of infection

In addition to safe eating habits, there are other ways to reduce your risk of developing infections during cancer treatment:

  • Avoid contact with birds, turtles and reptiles such as lizards and snakes.These animals can carry bacteria salmonella, For people with severely suppressed immune systems, this can be life-threatening.
  • Assign the task of cleaning the litter box to a family member or friend.Litter boxes are a common source of parasitic infections called Toxoplasmosis.
  • Avoid crowds or enclosed spaces, such as airplanes, especially during cold and flu season.

People at risk for neutropenia usually take Neulasta or Neupogen. These drugs stimulate the production of neutrophils, thereby reducing the risk of infection.


A neutropenic diet is a nutritional plan for people whose immune systems have been weakened by cancer treatment. Since contaminated food can lead to bacterial infections, a neutropenic diet recommends safe handling of food in addition to avoiding certain types of food.

However, studies have not shown that a neutropenic diet reduces the risk of infection. As a result, some oncology clinics emphasize safe food handling practices rather than following a strict neutropenic diet. Discuss with your oncology nurse how to stay infection-free during cancer treatment.

Frequently Asked Questions

  • Is a neutropenic diet still recommended?

    Although there is no evidence that a neutropenic diet reduces infection rates during cancer treatment, your oncology team may continue to recommend it. Talk to your oncologist before starting any new diet during chemotherapy.

  • Does neutropenia make you tired?

    While neutropenia alone does not usually cause fatigue, in combination with other side effects of chemotherapy, it can cause feeling tired and exhausted.