The theory behind the neutropenic diet was first introduced in the 1960s. As a part of the treatment strategy for immunocompromised oncology patients, the goal was to eliminate foods that may increase exposure to harmful bacteria or organisms. The neutropenic diet is also known as the low bacterial, low microbial, and the immunosuppressed diet.
In recent years, the data to support use of the neutropenic diet have all but disappeared, causing most clinicians to move away from this restrictive diet. However, there are new diet recommendations to help navigate food safety and a balanced diet in patients with leukopenia.
What is leukopenia?3,4
Leukopenia refers to a low white blood cell count. This condition can occur with AIDS, lupus, malaria, alcoholism, bone marrow cancer, after an organ transplant, or as a result of chemotherapy or radiation. Infection is the primary concern with leukopenia because of the lack of adequate immune defense from the body, which can be life-threatening.
Neutrophils are a type of white blood cell. In a healthy adult, the absolute neutrophil count (ANC) ranges from 2,500 to 6,000 mm3. Neutropenia occurs when the ANC is less than 1,000 mm3.
Research behind the neutropenic diet2,5
In theory, the rationale behind the neutropenic diet makes sense. If the immune system is compromised, avoiding food-based sources of bacteria should protect against infection. The neutropenic diet traditionally eliminates undercooked eggs or meat, deli or luncheon cold cuts, raw fruits and vegetables, and dairy products and cheeses that are unpasteurized.
However, current research does not support this theory. In available studies, research conclusions show that this diet unnecessarily restricts certain food groups and does not improve overall infection or mortality rates.
What are the current recommendations?2
Transitioning away from the neutropenic diet, nutrition experts now recommend a more balanced diet with special food safety concerns. Many of the foods previously avoided can be safely consumed with the correct food handling and preparation. Consider the following recommendations as part of your patient education to help improve food variety and nutrient intake for this group of patients.
Fresh fruits and vegetables
- Rinse exterior dirt and then soak in fresh water for 2 minutes.
- Re-rinse under running water before consuming the fruit or vegetable.
- Use a small, sanitized vegetable brush to help remove surface dirt.
- Remove and avoid eating produce areas with bruising.
Fruits and vegetable juice
- Drink pasteurized versions only. (Hint: They often require refrigeration!)
- If pasteurization of the juice is unknown, consider boiling to kill any harmful bacteria before drinking or avoid altogether.
- Cook before eating to kill harmful bacteria.
- Avoid eating sprouts from a restaurant.
Meat or deli products
- Ensure proper cooking or preparation with a safe internal temperature before consuming.
- Do not consume raw meat products.
Milk and cheese
- Choose products made with pasteurized milk.
General food safety recommendations
- Store fruits and vegetables at the right temperature. Items prepared should be refrigerated within a two-hour timeframe.
- Transport perishable food items with ice and a cooler.
- Separate meat and fruit/vegetable cutting boards to avoid cross contamination.
Stacey Phillips, MS, RD is a clinical dietitian working with general medicine, oncology, CKD, renal transplant recipients and living kidney donor patients. Outside of her work, Stacey is passionate about improving the resources available to individuals with chronic kidney disease and actively participates on several renal dietitian committees.
Dietitians On Demand is a nationwide staffing and recruiting company for registered dietitians, specializing in short-term, temporary and permanent-hire positions in acute care, long term care and food service positions. We’re dedicated to dietitians and helping them enhance their practice and excel in the workplace. Check out our job openings, request your coverage, or visit our store today!
Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med. 1966;64(2):328-340.
Nutrition Care Manual. Special Food Safety Concerns. Available at: https://www.nutritioncaremanual.org/. Accessed January 31, 2022.
Neutropenic Diet. UPMC Hillman Cancer Center. Available at: https://hillman.upmc.com/patients/community-support/education/miscellaneous/neutropenic-diet. Accessed February 12, 2022.