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Nutrition

Low Microbial Diet

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A neutropenic diet, also known as a low microbial diet, provides protection from bacteria and other harmful organisms found in certain foods and drinks. This diet is catered for people with a weakened immune system, as when the immune system is not working well, the body has a hard time protecting itself from bacteria.

During cancer treatment, particularly chemotherapy and radiation therapy, your immune system is often compromised, making it more susceptible to food-borne illnesses. It is important for you to observe food safety practices - basically steps taken during the handling, preparing and storage of food that reduces the risk of food-borne illness.

It is advisable for patients who are under pre-transplant chemotherapy and patients undergoing transplant to follow the neutropenic diet to reduce the risk of food contamination (as the neutrophil/ white blood cell count is significantly lower).

The following list provides tips on foods you should choose and those you should avoid. Please check with your doctor and/or dietitian if you have questions about the diet or safe food preparation.

General tips:

  • All dairy products must be pasteurized, avoid soft cheeses
  • All fresh fruits and vegetables must be well washed under running water
  • All juices must be pasteurized
  • No pre-cut vegetables and fruits; no salads
  • No raw sprouts
  • All meat, poultry, seafood, egg and tofu must be fully cooked
  • No raw nuts
  • All seasonings to be added during cooking, avoid all other garnishes
  • No expired foods

Food Group Foods to Choose Foods to Avoid
Fruits
  • Well-washed fruits
  • Fruits with thick skin
  • Dried fruits in sealed packet
  • Pasteurized fruit juices
  • Unwashed fruits
  • Unpasteurized juices
  • Mouldy fruit even if the mould is removed
Vegetables
  • All cooked fresh, frozen, and canned vegetables
  • All well-washed fresh vegetables
  • Pasteurized vegetables juices
  • Unwashed raw vegetables
  • Commercially prepared fresh salsa
  • Raw sprouts
  • Unpasteurized vegetable juices
Grain and starches
  • All bakery products
  • All bakery products (without custard or cream fillings)
  • All cooked grain products like rice, pasta, oats, wheat, barley, potatoes, chips and popcorns
  • Raw grain products
Dairy products
  • Pasteurized and UHT dairy products
  • Commercially packaged cheese and cheese products made with pasteurized milk (e.g., Cheddar, Mozzarella, Parmesan, Swiss, etc.)
  • Pasteurized whipped cream topping
  • Ice cream, sherbet (commercially sealed)
  • Commercial nutritional supplements (liquid and powdered)
  • Unpasteurized dairy products
  • Cheeses from Delicatessen
  • Cheeses with moulds (e.g., Bleu, Roquefort)
  • Refrigerated cheese-based salad dressing
  • Soft served ice cream and yogurt
  • Yogurt with live and active cultures
Meat and meat alternatives
  • All well-cooked fresh or canned meats, poultry, fish, seafood, eggs and tofu
  • Raw or undercooked meat, poultry, fish, seafood, eggs and tofu
  • Sushi and sashimi
  • Meats and cold cuts from delicatessen
  • Miso products
Nuts and legumes
  • Cooked beans, peas, lentils and nuts
  • Roasted nuts
  • Nuts in baked products
  • Commercially-packaged peanut butter or nut spread
  • Raw nuts
  • Non-commercially prepared peanut butter or nut spread
Fat
  • Commercially made butter, margarine, cream cheese and salad dressing
  • All homemade sauces and salad dressings with raw eggs
Miscellaneous
  • Pasteurized honey
  • Candy, gum, jelly
  • Bottled water or canned drinks
  • Unpasteurized honey
  • Herbal supplements
  • Cold brewed tea
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