Neutropenic Diet | Guidelines, Foods to Eat & Avoid

What is a Neutropenic Diet?

A neutropenic diet is a specialised diet with a very low bacterial count designed to minimise the risk of infections from contaminated food and drinks for people with weakened immune systems. When the immune system is weak, the body will find it difficult to protect itself from certain food bacteria and will require a 'clean' diet to prevent infections. Neutropenic diet is crucial for those undergoing:

Immune suppression following transplant procedures (e.g., bone marrow, heart or kidney)
Cancer patients undergoing chemotherapy or radiotherapy
Viral infections for example in the case of HIV or AIDS Aplastic anemia

By focusing on a clean diet, individuals can significantly reduce exposure to harmful bacteria and pathogens in contaminated food or drinks.

Neutropenic Diet: Do's & Don'ts

The rule-of-thumb is to have cooked foods and avoid all raw food items. This is because heat during cooking makes sure that all microorganisms in the food are destroyed. It is advisable to practice safe food handling to ensure food is hygienic to minimize exposure to bacterial and food contamination. Here are some tips on safe food handling:

Always clean hands, food utensils and equipment with warm soapy water before eating
Wash raw materials thoroughly before cooking Choose vegetables that are fresh and not damaged
Use separate chopping boards for meat and vegetables to prevent cross contamination and use plastic chopping boards as they can be more easily cleaned
Clean mouth of canned or bottled foods before opening
Ensure that canned foods are properly packaged and within expiry date before purchasing
Keep hot foods hot (above 63°C) and cold foods cold (below 5°C) Cook food thoroughly until well done, especially meat and eggs
Thaw frozen foods in the microwave or in the chiller. Never thaw at room temperature
Discard all leftover food if not consumed within 4 hours after cooking
For easily perishable foods (e.g. custard, pudding, egg, and food items made with cream, discard within 1 hour after cooking if not consumed)
Order a la carte food items and avoid pre-prepared foods which may be left cold for a period of time such as buffet, fast food, salad or sandwiches on the shelf

The Complete Neutropenic Diet Guide

Foods To Include in a Neutropenic Diet	Foods To Avoid on a Neutropenic Diet
Bread, cereals, rice and pasta
· Commercially-packed bread, rolls, pancakes, waffles · Fully-cooked rice, pasta, noodles, oats, ready-to-eat breakfast cereals · Cooked potato, sweet potato, or yam · Biscuits, crackers, cookies, french toast	· Bread, buns, cakes, doughnuts & muffins in bakeries left exposed · Raw oats or muesli · Potato salad, pasta salad or those added with raw eggs · Uncooked cookie dough
Meat, fish, poultry, nuts, beans, eggs & nuts
· Well-cooked fresh meat or fish · Fully-cooked egg · Canned tuna or meat with no raw vegetables · Tofu (cook in < 1-inch cubes) Canned food (e.g., baked beans, legumes, meat, soup) to be well heated/ fully-cooked · Commercially-packed nuts roasted without shells	· Raw or partially cooked meat, fish or poultry · Cold ham, sausages, salami from the deli section · Partially cooked egg · Raw Seafood (eg oyster, sashimi) · Miso paste & miso soup · Pate (liver, usually served cold) · Tempe products (fermented-soy) · Roasted nuts in the shell
Fruits
· Canned fruits or frozen fruits · Fruit juices in tetra pack (pasteurized) · Uncut fresh fruits with skin (e.g. whole pear, apple) · Cut fruits and freshly squeezed juice to be consumed immediately)	· Dried fruit & nuts mix (e.g. raisin, prunes) · Pre-prepared cut fruits · Pre-Prepared or unpasteurized fruit juice
Vegetables
· Well-cooked fresh, canned or frozen vegetables · Vegetable juices in tetra pack (pasteurized) · Cooked herbs and spices	· Raw vegetables (e.g. salad, ulam) · Uncooked vegetable juice · Uncooked herbs & spices or pepper · Fresh sauerkraut & raw garnishes
Milk, yogurt & cheese
· All pasteurized milk, cheese & yogurt Commercially-packed ice cream & sherbet · Milk supplements & infant formula · Commercially-packed whipped cream, thickened cream, or sour cream (consume once opened, do not keep for later)	· All unpasteurized dairy products · Homemade or soft-serve ice cream · Cheese seasoned with herbs & vegetables · Moldy cheese (e.g blue cheese, Stilton) · Soft cheese (e.g Brie, Camembert, Feta, Farmer’s cheese) or those from the deli section · Yogurt from a machine or those made from live cultures · Pre-made smoothies or milk shakes
Fats & Spreads
· Butter, margarine, oil, shortening Commercially-packed salad dressing · Peanut butter	· Avocado dressing · Fresh salad dressing · Raw or unpasteurized honey
Beverages
· Boiled water, distilled water, reverse osmosis (R.O.) water · All bottled beverages	· Unboiled water · Ice-blended drink
Others
· Freshly baked cakes & pastry · Individually packed jam, jelly & syrups	· Fast food · Unrefrigerated bakery items containing cream or custard · Traditional herbal supplement or Chinese herbs · Brewer’s yeast, if eaten uncooked

Key Takeaways on the Neutropenic Diet

Following a neutropenic diet is crucial for individuals with weakened immune systems, as it helps minimize the risk of infections from contaminated food and drinks. Adhering to the recommended food guidelines and avoiding high-risk items can support your health and recovery. Always consult your healthcare provider for personalised advice to ensure you’re making the best food choices for your condition.

The Complete Neutropenic Diet: Essential Foods to Eat and Avoid

What is a Neutropenic Diet?

Neutropenic Diet: Do's & Don'ts

The Complete Neutropenic Diet Guide

Foods To Include in a Neutropenic Diet

Foods To Avoid on a Neutropenic Diet

Key Takeaways on the Neutropenic Diet