Neutropenic Diet
Information What is a neutropenic diet?
for Patients
A neutropenic (nu-tro-PEE-nik) diet is for
people with weakened immune systems.
This diet helps protect them from bacteria
and other harmful organisms found in
some food and drinks. If your immune
system is not working well, your body may
have a hard time protecting itself from
these bacteria. Cooking foods (like beef,
chicken, fish, and eggs) completely makes
sure that all bacteria are destroyed.
Who needs to follow a
neutropenic diet?
Doctors often recommend this diet before
and after certain types of chemotherapy
and other cancer treatments. A blood test
called an absolute neutrophil count (ANC)
can help determine the body’s ability to
fight off infection. Many cancer patients
have this blood test done routinely. When
the ANC is less than 500 cells/mm3, the
patient is often instructed to follow a
neutropenic diet. This diet should be
followed until the doctor tells the patient
to resume his or her regular diet.
Patients undergoing autologous stem
cell transplants typically follow this diet
during the pre-transplant chemotherapy
and for the first 3 or more months after
transplant. Patients undergoing allogeneic
stem cell transplants typically follow this
diet during the pre-transplant chemo-
therapy and continue on it until they no
longer take immunosuppressive drugs.
The transplant team will tell the patient
how long to follow this diet.
People who have had an organ transplant
or who are being treated for HIV/AIDS
also may need to follow this diet. If you
are not sure if you should follow this diet,
check with your doctor, nurse, or dietitian.
General tips
The following pages list the foods you
should choose when you are on a
neutropenic diet. Foods you should avoid
are also listed. Please check with your
doctor, nurse, or dietitian if you have
questions about the diet or safe food
preparation. Some general tips include:
• Avoid all fresh fruits and vegetables,
including all fresh garnishes. Cooked
vegetables, canned fruits, and juices
are fine.
• Avoid raw or rare-cooked meat, fish,
and eggs. Meat should be cooked to the
“well- done” stage. All eggs should be
thoroughly cooked (no runny yolks).
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 Neutropenic Diet

• Avoid salad bars, fruit bars, and deli

counters. Buy vacuum-packed lunch
meats rather than freshly sliced meats.
UPMC
• Avoid raw nuts. You may eat baked
Information products with these ingredients.
for Patients
• Make sure all of the dairy products you
eat are pasteurized.
• Avoid yogurt and yogurt products with
live and active cultures.
• Be safe in the way you handle foods.
Wash your hands before handling food.
Wash all surfaces, cutting boards and
cutting utensils thoroughly. Keep hot
food hot and cold food cold. (See the
UPMC patient education sheet Food
Safety: Preventing Foodborne Illness
for more information.)
• At home, you may use tap water. If you
choose to use bottled water, be sure it
is labeled as follows:
° reverse osmosis or
° distillation or
° filtered through an absolute
1 micron or smaller filter
• Well water is OK if it is boiled for at
least 1 minute.

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 Neutropenic Diet

Neutropenic Diet

Beverages Foods to Choose Foods to Avoid

- instant and brewed - any others, such as cold

UPMC decaf or regular coffee brewed tea or sun tea
Information and tea
for Patients - individual cans or
bottles of carbonated
beverages
- tap water or bottled water
- brewed herbal teas
- all canned, bottled and
powdered beverages and
sports drinks

Starches Foods to Choose Foods to Avoid

(including breads, crackers,
cereal, and potatoes)
- all types of bread, rolls, - breads and rolls with raw
English muffins, fruit nuts
muffins, bagels, sweet - cereals containing raw nuts
rolls, donuts - raw oats
- waffles - uncooked pasta, pasta salad,
- French toast, pancakes or potato salad with raw
- potato chips, corn chips, vegetables or eggs
tortilla chips, pretzels,
popcorn, crackers,
melba toast
- all types of cooked and
ready-to-eat cereals
- cooked grains, rice, and
pasta, such as noodles,
macaroni, and spaghetti
- cooked white or sweet
potatoes and yams,
French fries, tater tots,
hash browns, etc.

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 Neutropenic Diet

Dairy Products Foods to Choose Foods to Avoid

- pasteurized milk; fat-free - unpasteurized milk or yogurt

milk, 2% milk, whole - milkshakes made with non-
UPMC milk, buttermilk, or commercial ice cream or
chocolate milk made in a blender
Information
for Patients - sour cream - yogurt or soft ice cream from
- milkshakes using a machine
individual cartons of - eggnog made with raw eggs
ice cream and milk, or - yogurt and yogurt products
homemade milkshakes made with live and active
- commercial eggnog cultures
- commercial supplements
such as instant breakfast
drinks
- commercial frozen
milkshakes
- refrigerated and frozen
pasteurized whipped
topping

Cheese Foods to Choose Foods to Avoid

- commercially packaged - unpasteurized and raw milk

cheese (for example, cheese
American, Swiss, - cheeses with molds (for
Parmesan, mozzarella, example, blue, Gorgon-
cheddar) zola, Roquefort, and Stilton
- pasteurized cottage cheese cheeses)
- processed cheese (for - soft cheeses (for example,
example, Velveeta) Brie, Camembert, feta,
farmer cheese)
- cheeses containing
uncooked vegetables
- Mexican-style cheeses, such
as queso fresco and queso
blanco

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 Neutropenic Diet

Desserts Foods to Choose Foods to Avoid

(and other sweets) - cakes, pies, and cookies - cakes with raw nuts
- baked custard, pudding, - soft ice cream or yogurt from
and gelatin a machine
UPMC
- commercial ice cream, - non-commercial or homemade
Information
for Patients sherbet, fruit ice, and ice cream or sherbet
Popsicles - cream filled pastries that are
- refrigerated cream-filled not refrigerated
pastries and desserts - unbaked cookie dough
- candy - candy with raw nuts
- jam and jelly
- pasteurized honey and
syrup
- chocolate
- chewing gum

Fats Foods to Choose Foods to Avoid

- butter or margarine - avocado dressing

- cream cheese, sour - fresh salad dressing containing
cream, salad dressings, aged cheese, raw eggs,
or mayonnaise or fresh herbs
- oil
- shortening used in
cooking
- non-dairy creamers

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 Neutropenic Diet

Fruits & Fruit Juices Foods to Choose Foods to Avoid

* These foods may be - canned fruits and juices - all fresh fruits except those
restricted during severe - pasteurized frozen juices listed in the “Foods to
neutropenia and during - pasteurized cider and Choose” column
UPMC your hospital stay. apple juice - unwashed raw fruit
Information - thick-skinned fruits such - unpasteurized fruit juices
for Patients as apples, raw bananas,
grapefruit, and oranges
that are washed in cold
water, and peeled by a
nurse or family member*
- frozen fruits
- dried fruits

Meat Foods to Choose Foods to Avoid

(includes fish, poultry, - well-cooked meats, beef, - rare or medium rare cooked
dried beans, eggs, meat lamb, pork and pork meat, fish, or poultry
substitutes, and soups) products, poultry, game, - stir-fried foods
fish, shellfish, hot dogs, - cold cuts from delicatessens
sausage, bacon - cold meat or poultry
- canned tuna or chicken - fast food
(with no raw vegetables) - raw eggs
- cooked baked beans - eggs not well-cooked, such
and all other cooked as sunny-side-up (runny
legumes, dried beans, yolk)
casseroles, stews, and - cold soups and gazpacho, all
entrees miso products such as paste
- frozen entrees and soup
- pasteurized or cooked - sushi
tofu - sashimi
- eggs, well-done
- pasteurized egg substi-
tutes (for example, Egg
Beaters) and powdered
eggs
- canned and homemade
soup (heated well)

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 Neutropenic Diet

Vegetables Foods to Choose Foods to Avoid

- all well-cooked canned, - all raw vegetables

frozen or fresh vegeta- - stir-fried vegetables
UPMC bles - fresh salads
Information - canned vegetable juices - fresh sauerkraut
for Patients

Miscellaneous Foods to Choose Foods to Avoid

- individual packages of - spices, herbs, or seasonings

salt, sugar, and pepper added to foods after cooking
used after cooking (except for allowed items)
- all other herbs or - uncanned or home-canned
seasonings added during pickles and kosher pickles
cooking - freshly-made peanut butter
- low-sodium seasoning - hollandaise sauce
added during cooking - raw nuts
- gravy and cream sauce - roasted nuts in shell
- commercial peanut butter
- commercial pickles
processed in jars or cans
- Lactaid drops
- canned or bottled
roasted nuts
- nuts in baked goods
- shelled, roasted nuts

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 Neutropenic Diet

Dietary Supplements Foods to Choose Foods to Avoid

- commercial high- - supplements and vitamins

calorie/high-protein (unless approved by a doctor
UPMC drinks, puddings, and or nurse)
Information snack bars if approved
for Patients by a doctor or nurse

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