Low Microbial Diet Guidelines

For people getting chemotherapy, radiation, and/or stem cell transplant, it is important to lower the risk for getting a food related infection.
This diet has foods that have been shown to be safe when properly prepared in the home and hospital kitchen while maximizing healthy
food options. Your doctor or health care provider will let you know when you need to follow these guidelines.

For Stem Cell Transplant Patients: Your health care provider and dietitian will let you know when to start the diet and when the diet is no
longer needed. In general, we recommend the following for stem cell transplant patients:
Autologous transplant patients should follow this diet during the first three months after chemotherapy or transplant
Allogenic transplant patients should follow the diet until you are off all immunosuppressive therapy such as cyclosporine,
prednisone, FK-506 (Tacrolimus®) or MMF (CellCept®) or as decided in a conversation with your doctor.

Food Safety Guidelines

Wash your hands well in hot soapy water before preparing or eating food.
Never choose packages that are ripped or leaking or cans that are dented or jars that are cracked. Safety buttons on metal lids should be
down and not move or make a clicking noise when pushed.
Do not purchase foods if ‘‘sell by’’ or ‘‘best used by’’ date has passed.
Buy cold foods last and get them to a refrigerator or freezer as soon as possible. If you are driving in hot weather, place food inside air-
conditioned car and not in trunk.
Keep the refrigerator temperature at 40OF, the freezer at 0OF.
Wash cutting board with an antibacterial dish soap and hot water.
Use paper towels if possible. Wash kitchen towels often in hot water in the washing machine.
Keep hot foods hot and cold foods cold. Refrigerate or freeze any leftovers immediately.
Eat refrigerated leftovers within 24 hours.

PH1050 (6-13) Page 1 of 6 Low Microbial Diet Guidelines

Food Groups Foods Allowed
Dairy All pasteurized, grade “A” milk and
milk products
Commercially packaged chesses
and cheese products made with
pasteurized milk such as cheddar,
mozzarella, parmesan, Swiss, cream
cheese, cottage cheese, ricotta
cheese and sour cream
Pasteurized yogurt including those
with fruit and live cultures
Dry, refrigerated, and frozen
pasteurized whipped topping
Commercial eggnog
Commercially sterile ready to feed
and liquid concentrate formulas
such as instant breakfast or Boost®
Bread, Grain & All breads, bagels, rolls, muffins
Cereal pancakes, sweet rolls, waffles,
Products French toast
Potato chips, corn chips, tortilla
chips, pretzels, popcorn
Cooked pasta, rice and other grains
All cereals, cooked and ready to eat
including granola
PH1050 (6-13) Page 2 of 6 Low Microbial Diet Guidelines
Foods To Avoid Safe Food Handling Techniques
Unpasteurized or raw milk and Choose only pasteurized milk and
milk products including cheeses cheeses
and yogurt.
Cheeses from delicatessens
Cheese with molds (such as blue
cheese, Stilton, gorgonzola,
Roquefort)
Soft style cheeses such as feta,
brie, queso fresco, queso blanco
Cheeses containing chili peppers or
other uncooked vegetables
including Mexican hot farmers
cheese
Raw (not baked or cooked) grain Patients themselves should not
products (such as raw oats) make (mix or knead) any bread
product containing yeast
Avoid open bulk bins of grains and
snacks at markets
Food Groups Foods Allowed
Meat, fish All meats cooked to well done or
poultry and canned meats (beef, pork, lamb,
Meat poultry, fish, shellfish, game, ham,
Substitutes bacon, sausage, hotdogs)
Eggs cooked until both the white
and yolk are firm
Pasteurized eggs and egg
substitutes cooked
Commercially packaged lunch
meats such as salami, bologna, ham
and turkey
Canned and commercially packaged
hard smoked fish (refrigerate after
opening)
Pasteurized or coked tofu (must be
cut into 1 inch cubes, or smaller
and boiled for a minimum of 5
minutes in water or broth before
eating or using in recipes)
Refrigerated hot smoked seafood
such as salmon or trout if cooked to
160OF or contained in a cooked dish
or casserole
PH1050 (6-13) Page 3 of 6 Low Microbial Diet Guidelines
Foods To Avoid
Raw or undercooked meat,
poultry, fish, game or tofu
Raw, undercooked or “runny” eggs
and egg substitutes
Do not eat foods that include raw
or partially cooked eggs.
Meats and cold cuts from the
delicatessen or meats sliced on a
deli slicer
Hard cured salami in natural wrap
Cold smoked salmon “lox” or
pickled fish
Tempe (tempeh) and Miso
products
Safe Food Handling Techniques
Wash hands before and after
handling raw meat, poultry, or fish.
Put raw meat, fish and poultry into
a plastic bag so the juices will not
contaminate other foods.
Place securely wrapped raw meat,
fish, and poultry into the meat
drawer or on the bottom of the
refrigerator so that the juices will
not leak onto other foods.
Cook or freeze fresh ground meats,
fish, and poultry within 2 days.
Do not refreeze defrosted foods
Do not cross-contaminate. Keep
raw meat, fish, and poultry and
their juices away from other food.
After cutting these foods, wash
utensils, cutting board, knife, and
counter top with hot soapy water.
Cook poultry until it has an internal
temperature of 180OF. It is done
when the juices run clear and it is
white in the middle.
Cook fish until it is opaque or white
and flaky.
Cook ground meat to 160OF. It is
done when it is brown inside. This
is especially critical with
hamburger meat.
Food Groups Foods Allowed
Fruits and Nuts Well washed raw and frozen fruit;
foods containing well washed raw
fruits
Cooked, canned and frozen fruit
Pasteurized juices and frozen juice
concentrates
Dried fruits
Canned or bottled roasted nuts
Shelled roasted nuts and nuts in
baked products
Commercially packaged nut butters
(such as peanut butter, almond
butter, soybean butter)
Vegetables Well washed raw and frozen
vegetables
All cooked fresh, frozen or canned
vegetables, including potatoes
Shelf-stable bottled salsa
(refrigerate after opening)
Fresh, well washed herbs and dried
herbs and spices (added to raw or
cooked foods)
PH1050 (6013) Page 4 of 6 Low Microbial Diet Guidelines
Foods To Avoid
Unwashed raw fruits
Raw berries
Unroasted or raw nuts
Roasted nuts in the shell
Non-pasteurized fruit and
vegetable juices
Fresh fruit salsa or mix found in
the grocery refrigerator case
Non-pasteurized items containing
raw fruits found in the grocery
refrigerator case
Unwashed raw vegetables or herbs
Fresh, non-pasteurized vegetable
salsa found in the grocery
refrigerator case
All raw vegetable sprouts (alfalfa,
radish, broccoli, mung beans all
others)
Salads from delicatessens or salad
bars
Unwashed & uncooked
mushrooms
Do not purchase produce that has
been cut at the grocery store
Safe Food Handling Techniques
Always wash fresh fruits under cool
running tap water before eating.
Throw away fruits that are slimy,
show mold and are bruised or
damaged
Always wash vegetables under cool
running tap water before eating.
Use a scrub brush on potatoes or
carrots if the skins are to be
consumed.
Rinse leaves of leafy vegetables
individually under running water
Packaged salads, slaw mix and
other prepared produce, even
when marked “pre washed” should
be rinsed again under running
water
Do not use commercial rinses to
wash fruits and vegetables
Throw away vegetables that are
slimy or show mold
Food Groups Foods Allowed
Beverages Tap water and ice made from tap
water
Commercially bottled distilled,
spring and natural waters
All canned, bottled and powdered
beverages
Instant and brewed coffee, tea,
cold brewed tea made with boiling
water
Brewed herbal teas from
commercially packaged tea bags
Foods To Avoid Safe Food Handling Techniques
Unboiled Well water, unless tested Choose only pasteurized juices.
yearly and found to be safe
Cold-brewed tea made with warm
or cold water (sun tea)
Unpasteurized fruit and vegetable
juices
Mate’ tea
Wine, unpasteurized beer (Note:
all alcoholic beverages should only
be consumed following physician
approval.)

Desserts Refrigerated commercial and Unrefrigerated cream filled pastry

homemade cakes, pies, pastries products (not shelf-stable)
and pudding
Refrigerated cream filled pastries
Cookies, homemade or commercial
Shelf stable cream filled cupcakes
(such as Twinkies, Ding Dongs) and
fruit pies (such as Poptarts and
Hostess fruit pies)
Canned and refrigerated puddings
Popsicles and similar products
Candy, gum

PH1050 (6-13) Page 5 of 6 Low Microbial Diet Guidelines

Food Groups Foods Allowed Foods To Avoid Safe Food Handling Techniques
Fats Vegetable oils and shortening Fresh salad dressing (or stored in
Refrigerated lard margarine, butter the grocer’s refrigerated case)
Commercial, shelf stable containing raw eggs or cheeses
mayonnaise and salad dressings listed as “Do not eat” under the
including blue cheese and other dairy section
cheese based salad dressings
(refrigerate after opening)
Cooked gravy and sauces
Other Salt, granulated sugar, brown sugar Raw honey, honey in the comb
Jam, jelly, syrups (refrigerate after Herbal and nutrient supplement
opening) preparations, not approved by the
Commercial pasteurized Grade A dietitian
honey Brewer’s yeast (if uncooked)
Catsup/Ketchup, mustard, BBQ
sauce, soy sauce, and other
condiments (refrigerate after
opening)
Pickles, pickle relish, olives
(refrigerate after opening)
Vinegar
Dining Out Suggestions
Eat early to avoid crowds
Avoid fast food restaurants
Ask that food be prepared fresh in restaurants – ask for food to be made without raw toppings such as lettuce, tomato, onion, etc.
Request single-serving condiments packages (Ketchup, mayonnaise, mustard) and avoid self-serve bulk condiment containers (salsa)
Avoid high-risk food sources including salad bars, delicatessens, buffets and smorgasbords, potlucks and sidewalk vendors
Avoid raw fruits and vegetables when dining out including fresh squeezed juices or smoothies
Be sure the utensils are set on a napkin or clean tablecloth or placement rather than directly on the table
If keeping leftovers, put the food in the container yourself rather than having the server take your food to the kitchen to do this

PH1050 (6-13) Page 6 of 6 Low Microbial Diet Guidelines