The neutropenic diet

 

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The Neutropenic diet

Patients who have undergone a Stem Cell Transplant will have lowered blood counts for a period of time after their transplant recovery. This period of time varies from patient to patient.  Allogeneic transplant patients will take as much as twice as long as Autologous transplant patients to recover full immune function. 

During this period of reduced immune function there will be much lower than normal neutrophil counts. Neutrophils are the primary infection fighting white blood cells. Patients must do everything they can to avoid unnecessary exposure to bacteria in order to avoid overwhelming the immune system. This means strict dietary rules to follow.

The Neutropenic diet shown below seeks to reduce the amount of food introduced into the body that has high levels of bacteria. While there are many good bacteria in our food there are also many bad bacteria. Healthy people have immune systems that can easily deal with the bad bacteria, but such is not the case for those with reduce immune function. 

Below is a guide to foods that are allowed, and those that you should avoid during this period to reduce your risk of bad bacteria.

  • Allogeneic patients should follow this for about  4-6 months post transplant
  • Autologous patients should follow this for 1-3 months post transplant

Click here to download a printable version

 

FOOD GROUPS

ALLOWED

NOT ALLOWED

Dairy

All pasteurized, grade "A" milk and milk products.

Commercially-packaged cheese and cheese products made with pasteurized milk (i.e. mild and medium cheddar, mozzarella, parmesan, Swiss, etc.)

Pasteurized yogurt

Dry, refrigerated, and frozen pasteurized whipped topping

Ice cream, frozen yogurt, sherbet, ice cream bars, homemade milkshakes

Commercial nutritional supplements and baby formulas, liquid and powdered

Unpasteurized or raw milk, cheese, yogurt, and other milk products

Cheeses from delicatessens

Cheeses containing chili peppers or other uncooked vegetables

Cheese with molds (i.e. blue, Stilton, Roquefort, gorgonzola)

Sharp cheddar, brie, camembert, feta cheese, farmer's cheese

Vegetables

All cooked frozen or canned vegetables.

All cooked herbs and spices (add at least 5 minutes before end of cooking)

Raw vegetables, salads

Caesar Salads with Caesar dressing

Pepper

Garnishes

Uncooked herbs and spices

Fruits and Nuts

Canned and frozen fruit and fruit juices

Thick skinned fruits (oranges, bananas)

Melons cut up and used immediately

Canned or bottled roasted nuts

Nuts in baked products

Commercially packaged peanut butter

Dried fruits

Raw fruit; foods containing raw fruits

Unpasteurized fruit and vegetable juices

Raw nuts

Roasted nuts in the shell

Precut fresh fruits

Bread, Grain, and Cereal Products

All breads, bagels, rolls, pan-cakes, sweet rolls, waffles, French toast

Potato chips, corn chips, tortilla chips, pretzels, popcorn

Cooked pasta, rice, and other grain

All cereals, cooked and ready-to-eat

Raw grain products

Bakery breads, cakes, donuts, muffins

Potato/macaroni salad

Entrees, Soups

All cooked entrees and soups

All miso products (i.e. miso soup)

Meat and Meat Substitutes

All well-cooked or canned meats (beef, pork, lamb, poultry, fish, shellfish, game, ham, bacon, sausage, hot dogs)

Well-cooked eggs (white cooked firm with thickened yolk acceptable, i.e. hard boiled, over hard)

Pasteurized egg substitutes (i.e. Egg Beaters)

Commercially-packaged salami, bologna, and other luncheon meats

Canned and commercially-packaged hard smoked fish, refrigerated after opening

Cooked tofu (which must be cut into 1" cubes or smaller and boiled a minimum of five minutes in water or broth before eating or using in recipes)

Raw or undercooked meat,, poultry, fish, game, tofu

Meats and cold cuts from delicatessen

Hard cured salami in natural wrap

Cold smoked salmon, lox

Pickled fish

Tempe (tempeh) products

Sushi

Raw oysters/clams

 

 

Beverages

Tap water

Commercial bottled distilled and natural waters

All canned, bottled, powdered beverages

Instant and brewed coffee, tea; cold brewed tea made with boiling water

Brewed herbal teas using commercially-packaged tea bags

Commercial nutritional supplements, liquid and powdered

Well water (unless tested yearly and found safe)

Cold-brewed tea made with warm or cold water sun tea

Egg nog

Fresh apple cider 

Homemade lemonade

Spring water

Fats

Oil, shortening

Refrigerated lard, margarine, butter

Commercial shelf-stable mayonnaise and salad dressings (including cheese-based salad dressings, refrigerated after opening)

Fresh salad dressings containing aged cheese (i.e. blue, Roquefort) or raw eggs, stored in refrigerated case

Desserts

Refrigerated commercial and homemade cakes, pies, pastries, and pudding

Refrigerated cream-filled pastries

Homemade and commercial cookies

Shelf-stable cream-filled cupcakes (i.e. Twinkies, Ding Dong), fruit pies (i.e. Poptarts, Hostess frit pies), and canned pudding

Unrefrigerated cream-filled pastry products (not shelf-stable)

Cream or custard filled donuts

Other

Salt, granulated sugar, brown sugar

Jam, jelly, syrups (refrigerated after opening)

Commercially-packaged (pasteurized) honey 

Catsup, mustard, BBQ sauce, soy sauce, other condiments (refrigerated after opening)

Pickles, pickle relish, olives (refrigerated after opening)

Raw or unpasteurized honey

Herbal and non-traditional (health food store) nutritional supplements, Chinese herbs

Brewers yeast, if eaten uncooked


Click here to download a printable version

 

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