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Neutropenic Diet

Information What is a neutropenic diet? Patients undergoing autologous stem

for Patients cell transplants typically follow this diet
A neutropenic (nu-tro-PEE-nik) diet is for during the pre-transplant chemotherapy
people with weakened immune systems. and for the first 3 or more months after
This diet helps protect them from bacteria transplant. Patients undergoing allogeneic
and other harmful organisms found in stem cell transplants typically follow this
some food and drinks. If your immune diet during the pre-transplant chemo-
system is not working well, your body may therapy and continue on it until they no
have a hard time protecting itself from longer take immunosuppressive drugs.
these bacteria. Cooking foods (like beef, The transplant team will tell the patient
chicken, fish, and eggs) completely makes how long to follow this diet.
sure that all bacteria are destroyed.
People who have had an organ transplant
or who are being treated for HIV/AIDS
Who needs to follow a also may need to follow this diet. If you
neutropenic diet? are not sure if you should follow this diet,
Doctors often recommend this diet before check with your doctor, nurse, or dietitian.
and after certain types of chemotherapy
and other cancer treatments. A blood test General tips
called an absolute neutrophil count (ANC)
can help determine the body’s ability to The following pages list the foods you
fight off infection. Many cancer patients should choose when you are on a
have this blood test done routinely. When neutropenic diet. Foods you should avoid
the ANC is less than 500 cells/mm3, the are also listed. Please check with your
patient is often instructed to follow a doctor, nurse, or dietitian if you have
neutropenic diet. This diet should be questions about the diet or safe food
followed until the doctor tells the patient preparation. Some general tips include:
to resume his or her regular diet. • Avoid all fresh fruits and vegetables,
including all fresh garnishes. Cooked
vegetables, canned fruits, and juices
are fine.
• Avoid raw or rare-cooked meat, fish,
and eggs. Meat should be cooked to the
“well- done” stage. All eggs should be
thoroughly cooked (no runny yolks).

Neutropenic Diet

• Avoid salad bars, fruit bars, and deli

counters. Buy vacuum-packed lunch
meats rather than freshly sliced meats.
• Avoid raw nuts. You may eat baked
Information products with these ingredients.
for Patients
• Make sure all of the dairy products you
eat are pasteurized.
• Avoid yogurt and yogurt products with
live and active cultures.
• Be safe in the way you handle foods.
Wash your hands before handling food.
Wash all surfaces, cutting boards and
cutting utensils thoroughly. Keep hot
food hot and cold food cold. (See the
UPMC patient education sheet Food
Safety: Preventing Foodborne Illness
for more information.)
• At home, you may use tap water. If you
choose to use bottled water, be sure it
is labeled as follows:
° reverse osmosis or
° distillation or
° filtered through an absolute
1 micron or smaller filter
• Well water is OK if it is boiled for at
least 1 minute.

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Neutropenic Diet

Neutropenic Diet

Beverages Foods to Choose Foods to Avoid

- instant and brewed - any others, such as cold

UPMC decaf or regular coffee brewed tea or sun tea
Information and tea
for Patients - individual cans or
bottles of carbonated
- tap water or bottled water
- brewed herbal teas
- all canned, bottled and
powdered beverages and
sports drinks

Starches Foods to Choose Foods to Avoid

(including breads, crackers, - all types of bread, rolls, - breads and rolls with raw
cereal, and potatoes) English muffins, fruit nuts
muffins, bagels, sweet - cereals containing raw nuts
rolls, donuts - raw oats
- waffles - uncooked pasta, pasta salad,
- French toast, pancakes or potato salad with raw
- potato chips, corn chips, vegetables or eggs
tortilla chips, pretzels,
popcorn, crackers,
melba toast
- all types of cooked and
ready-to-eat cereals
- cooked grains, rice, and
pasta, such as noodles,
macaroni, and spaghetti
- cooked white or sweet
potatoes and yams,
French fries, tater tots,
hash browns, etc.

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Neutropenic Diet

Dairy Products Foods to Choose Foods to Avoid

- pasteurized milk; fat-free - unpasteurized milk or yogurt

milk, 2% milk, whole - milkshakes made with non-
UPMC milk, buttermilk, or commercial ice cream or
chocolate milk made in a blender
for Patients - sour cream - yogurt or soft ice cream from
- milkshakes using a machine
individual cartons of - eggnog made with raw eggs
ice cream and milk, or - yogurt and yogurt products
homemade milkshakes made with live and active
- commercial eggnog cultures
- commercial supplements
such as instant breakfast
- commercial frozen
- refrigerated and frozen
pasteurized whipped

Cheese Foods to Choose Foods to Avoid

- commercially packaged - unpasteurized and raw milk

cheese (for example, cheese
American, Swiss, - cheeses with molds (for
Parmesan, mozzarella, example, blue, Gorgon-
cheddar) zola, Roquefort, and Stilton
- pasteurized cottage cheese cheeses)
- processed cheese (for - soft cheeses (for example,
example, Velveeta) Brie, Camembert, feta,
farmer cheese)
- cheeses containing
uncooked vegetables
- Mexican-style cheeses, such
as queso fresco and queso

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Neutropenic Diet

Desserts Foods to Choose Foods to Avoid

(and other sweets) - cakes, pies, and cookies - cakes with raw nuts
- baked custard, pudding, - soft ice cream or yogurt from
and gelatin a machine
- commercial ice cream, - non-commercial or homemade
for Patients sherbet, fruit ice, and ice cream or sherbet
Popsicles - cream filled pastries that are
- refrigerated cream-filled not refrigerated
pastries and desserts - unbaked cookie dough
- candy - candy with raw nuts
- jam and jelly
- pasteurized honey and
- chocolate
- chewing gum

Fats Foods to Choose Foods to Avoid

- butter or margarine - avocado dressing

- cream cheese, sour - fresh salad dressing containing
cream, salad dressings, aged cheese, raw eggs,
or mayonnaise or fresh herbs
- oil
- shortening used in
- non-dairy creamers

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Neutropenic Diet

Fruits & Fruit Juices Foods to Choose Foods to Avoid

* These foods may be - canned fruits and juices - all fresh fruits except those
restricted during severe - pasteurized frozen juices listed in the “Foods to
neutropenia and during - pasteurized cider and Choose” column
UPMC your hospital stay. apple juice - unwashed raw fruit
Information - thick-skinned fruits such - unpasteurized fruit juices
for Patients as apples, raw bananas,
grapefruit, and oranges
that are washed in cold
water, and peeled by a
nurse or family member*
- frozen fruits
- dried fruits

Meat Foods to Choose Foods to Avoid

(includes fish, poultry, - well-cooked meats, beef, - rare or medium rare cooked
dried beans, eggs, meat lamb, pork and pork meat, fish, or poultry
substitutes, and soups) products, poultry, game, - stir-fried foods
fish, shellfish, hot dogs, - cold cuts from delicatessens
sausage, bacon - cold meat or poultry
- canned tuna or chicken - fast food
(with no raw vegetables) - raw eggs
- cooked baked beans - eggs not well-cooked, such
and all other cooked as sunny-side-up (runny
legumes, dried beans, yolk)
casseroles, stews, and - cold soups and gazpacho, all
entrees miso products such as paste
- frozen entrees and soup
- pasteurized or cooked - sushi
tofu - sashimi
- eggs, well-done
- pasteurized egg substi-
tutes (for example, Egg
Beaters) and powdered
- canned and homemade
soup (heated well)

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Neutropenic Diet

Vegetables Foods to Choose Foods to Avoid

- all well-cooked canned, - all raw vegetables

frozen or fresh vegeta- - stir-fried vegetables
UPMC bles - fresh salads
Information - canned vegetable juices - fresh sauerkraut
for Patients

Miscellaneous Foods to Choose Foods to Avoid

- individual packages of - spices, herbs, or seasonings

salt, sugar, and pepper added to foods after cooking
used after cooking (except for allowed items)
- all other herbs or - uncanned or home-canned
seasonings added during pickles and kosher pickles
cooking - freshly-made peanut butter
- low-sodium seasoning - hollandaise sauce
added during cooking - raw nuts
- gravy and cream sauce - roasted nuts in shell
- commercial peanut butter
- commercial pickles
processed in jars or cans
- Lactaid drops
- canned or bottled
roasted nuts
- nuts in baked goods
- shelled, roasted nuts

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Neutropenic Diet

Dietary Supplements Foods to Choose Foods to Avoid

- commercial high- - supplements and vitamins

calorie/high-protein (unless approved by a doctor
UPMC drinks, puddings, and or nurse)
Information snack bars if approved
for Patients by a doctor or nurse

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service
at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.
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your health care needs. Ask your own doctor or health care provider any specific medical questions that you have.