Nutrition – neutropenic diet

Tuesday 08 May 2018

I was recently asked about a neutropenic diet (ND) for people with low white blood cell counts which can happen as a result of treatment. When I looked into the subject in more detail I was surprised at the results that I found. No two institutions seem to have the same guidelines. Some were far more relaxed than others. In fact there has been very little case controlled research into these diets to find out how strict a neutropenic diet should be.

It is worth remembering that there are several medical options for managing low blood counts and if you have a low count then you should talk to your doctor about the options.

So what is a neutropenic diet (ND)?

A diet that limits certain foods in order to limit the exposure to bacteria is called a neutropenic diet. ND’s are designed to reduce the risk of food borne illnesses (food poisoning) in individuals whose immunity is low.

Most food contains some bacteria but under normal circumstances our immune systems quickly kill the bacteria so that the food does not make us ill. For people who have low blood counts due to cancer treatment, certain foods may naturally contain too much bacteria and are generally avoided until the blood count improves i.e. the immune system becomes strong again. 

Neutropenic diets are often used in cancer care clinics and hospitals, although as I have said research on them is limited. Over the years numerous approaches to food safety for patients with low blood cell counts has been adopted and then discarded by different institutions.   

The small studies that have been conducted suggest that extensively limiting certain foods is not necessarily more effective than general food safety practices for minimizing risk of food borne illnesses in people with low blood cell counts. One interesting piece of research reported by the American Society for Blood and Bone Marrow Transplantation reported in 2012 had surprising results. The study was carried out by the North Western Memorial hospital, subjecting neutropenic patients to a ND diet versus a general hospital diet. The findings suggested that there was no real benefit in maintaining a low microbial diet. It felt that a more liberal diet would add greater palatability and improved quality of life for the patients. This is interesting and of course relates only to that hospital.

However this does not mean that all ND diets should be abandoned but common sense should be adopted. That is to do things that make the most common sense from an infection risk perspective but at the same time avoiding any unnecessary limitations on dietary intake. Given that some people struggle to eat adequate calories and protein it seems wise to avoid limiting foods that people may enjoy if these foods are believed to be safe.

Minimising infection risk

Along with common sense guidelines, one of the single most important ways to minimize infection risk is to wash hands well and frequently and use paper towels to dry them rather than a towel. Hand washing is a time and tested and effective way to reduce infection risk both in general and among those with low blood counts.

Other common sense recommendations are similar to anyone practicing good food hygiene:

  • Make sure that utensils, chopping boards and cooking work surfaces are clean and use different chopping boards for different ingredients i.e. one for meat and a separate one for vegetables.
  • Wash all fruits and vegetables well and avoid berries and other types of fruit that are difficult to wash.
  • Avoid eating any unwashed produce.
  • Thaw frozen food well and reheat to a high temperature (piping hot) then cool and eat immediately.
  • Do not cross contaminate raw and cooked meats when preparing and storing.
  • Cook meats well.
  • It is best to avoid shop bought sandwiches and salads and sushi.
  • Use only fresh herbs in cooking that have been well washed.
  • Refresh dishcloths and tea towel regularly.
  • Avoiding tasting free food samples in shops.
  • Some people recommend avoiding pates, soft cheeses, unpasteurised products, any foods from the deli counter, and fresh cream cakes.
  • Avoid raw nuts and seeds that have not been roasted.
  • Avoid homemade mayonnaise that uses raw egg yolks or any foods that contain raw eggs, like a soufflé.


Blog originally written by Caroline November 2014 – Updated April 2020

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