With a neutropenia diagnosis, knowing what to eat when you have low white blood cells counts is crucial to a successful recovery.
A neutropenic diet may be recommended for those with compromised immune systems, whether from undergoing chemotherapy, a stem cell or organ transplant, or infection with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). A regular diet of foods with low amounts of harmful bacteria that also avoids foods that may cause an infection is the focus of treatment.
This diet is just part of the treatment for a blood disorder or disease. While having diagnostic and medical treatments, it is crucial to maintain a good nutrition base in the diet. This may be difficult as many conditions may reduce your appetite or make some foods unappealing.
The neutropenic diet aims to balance nutrition while allowing you to consume a selection of favorite foods. As with most health conditions, therapy is based on the individual and neutropenic diet foods are recommended as part of the treatment.
What Is Neutropenia and a Neutropenic Diet?
Neutropenia refers to low levels of bacterial infection-fighting white blood cells known as neutrophils. In this state, the immune system is weak and may allow infection to set in. It is commonly seen with chemotherapy treatment, as the drugs may hinder the production of white blood cells as they destroy cancer cells.
During chemotherapy, stem cell transplant treatments, and with other blood disorders, the risk for infection is high. These infections may also be caused by bacteria and molds in foods that are part of the neutropenic diet restrictions.
What is a neutropenic diet? It is a nutritional food plan that controls exposure to the amounts of foodborne bacteria a person with low white blood cell counts should avoid.
It focuses on the consumption of cooked meats, poultry, eggs, and pasteurized dairy products. The water used as a beverage and in drinks such as coffee and tea also needs to be treated on a neutropenia diet.
Neutropenia is often caused by blood-based conditions, blood cancers, and the corresponding medical treatments. Use of immune-suppressing medications such as steroids, monoclonal antibodies, and cyclosporine may also lead to neutropenia.
Are You Neutropenic?
Neutropenia can be confirmed with a full blood count (FBC) test. This test shows the number of different cells, such as red blood cells, white blood cells, platelets, and the level of neutrophils, in the blood.
As noted, a neutrophil is a white blood cell that fights infection. These cells are measured in terms of a neutrophil count, which depicts the number of neutrophils per cubic millimeter.
The level of these white blood cells necessary to be diagnosed with neutropenia varies among medical professionals, but primarily follows a similar baseline.
- Neutropenia – levels below 2,000 neutrophils per cubic millimeter of blood.
- Severe neutropenia – levels below 500 neutrophils per cubic millimeter of blood.
Significant symptoms of neutropenia may be nausea, extreme fatigue, mouth ulcers, recurring infections, and appetite loss which may lead to weight loss.
Neutropenic Diet: Foods to Eat and Foods to Avoid
|Food Groups||To Eat||To Avoid|
|Fruits||· Canned, stewed fruits
· Raw fruit (thoroughly washed)
· Dried fruits
|· Unwashed fruits
|Vegetables||· Fresh, canned, frozen vegetables (including potatoes)
· Raw vegetables (thoroughly washed)
|· Unwashed raw vegetables
· All raw vegetables sprouts (radish, broccoli, alfalfa)
· Deli salads
|Dairy||· Pasteurized milk products (whole, 2%, fat-free, chocolate)
· Commercially packaged cheeses (Medium, Swiss, Mozzarella, Parmesan)
· Frozen, pasteurized yogurt (live cultures, fruit)
· Pasteurized whipped topping (dry, refrigerated, frozen)
· Ice cream, ice cream bars, homemade milkshakes
· Sour cream
· Commercial eggnog
|· Unpasteurized milk products
· Cheeses with molds, uncooked vegetables, or from delis (blue, feta, brie).
· Unpasteurized yogurt (live and active cultures)
|Meat, Meat Substitutes||· Fully cooked, canned meats (beef, pork, lamb, poultry, fish, shellfish, game, ham, bacon, sausage, hot dogs)
· Commercially packaged luncheon meats (bologna, salami)
· Canned, commercially packaged hard smoked fish
· Cooked tofu (one-inch cubes boiled for five minutes)
|· Raw or undercooked meat, poultry, game, fish
· Deli meats, cold cuts
· Cold smoked fish (salmon)
· Pickled fish
· Tempeh products
|Breads, Grains, Cereals||· All breads, bagels, rolls, muffins, pancakes, waffles, French toast
· Cooked pasta, rice, other grains
· All ready-to-eat, cooked cereals
|· Raw grain products|
|Soups||· All cooked soups||· Miso soups|
|Beverages||· Canned, frozen fruit juices
· Tap water, commercially-bottled distilled, spring, natural water
· All canned, bottled, powdered drinks
· Instant, brewed coffee; tea; cold-brewed tea from boiled water
· Commercial nutritional supplements (liquid, powdered)
|· Unpasteurized fruit and vegetable juices
· Well water (unless tested, free of coliforms)
· Cold-brewed tea made with warm or cold water
· Mate tea
|Desserts||· Refrigerated commercial, homemade cakes, pies, pastries, puddings
· Refrigerated cream-filled pastries
· Homemade, commercial-packaged cookies
· Shelf-stable cream-filled cupcakes
|· Unrefrigerated, cream-filled pastries (not shelf-stabled)|
|Nuts||· Canned, bottled roasted nuts
· Nuts in baked products
|· Unroasted raw nuts
· Roasted nuts in shell
|Fats||· Oil, shortening
· Refrigerated butter, margarine, lard
· Commercial, shelf-stable mayonnaise, salad dressings
· Cooked gravy, sauces
|· Fresh salad dressings with aged cheeses or raw eggs|
|Others||· Fully cooked eggs, egg substitutes
· Potato chips, corn chips, tortilla chips, pretzels, popcorn
· Commercially packaged peanut butter
· Ice made with tap or bottled water
· Thoroughly washed fresh, dried herbs and spices
· Salt, granulated sugar, brown sugar
· Jam, jelly, syrups
· Commercial honey
· Ketchup, mustard, relish, soy sauce, barbeque sauce
· Pickles, olives
· Candy, gum
|· Raw or undercooked eggs
· Commercial salsa stored in refrigerator case
· Raw honey
· Herbal, nutrient supplement preparation
· Uncooked Brewer’s yeast
Consensus Changes in Neutropenic Diet
There is still some controversy surrounding the neutropenic diet, especially in the United Kingdom. This is because research supporting the effectiveness of the diet against bacterial and fungal infections is limited and some results have been conflicting.
The Haematology Group of the British Dietetic Association established standardized recommendations in 2007 to address the inconsistencies. In 2016, the group provided an updated guide to the changes in consensus since then.
For neutrophil counts less than 2,000 neutrophils per cubic millimeter of blood:
|Reheating Meals||Avoid||Follow risk reduction guidelines; consume within 24 hours of cooking or defrosting.|
|Reheating Rice||No restrictions||Avoid|
|Smoked Fish||Avoid||Only eat directly from a freshly opened package|
|Probiotics and Yogurt||Avoid all probiotic, live, and bio products||Avoid probiotic- and bio- labeled products. No restriction on other yogurts, including live cultures|
For neutrophil counts less than 500 neutrophils per cubic millimeter of blood:
|Ice Cream||Allow ice cream supplied according to local regulatory policy||Avoid soft serve ice cream and products from food trucks|
|Ice||Not specified||Allow only if made from suitable water resources|
|Nuts||No restriction||Avoid fresh nuts|
|Smoothies||Avoid||Allow pasteurized or homemade|
*Source: The British Dietetic Association
Tips to Follow for Neutropenic Diet
Living with neutropenia can be difficult and risky, especially as one is more susceptible to infections from food and minor abrasions. Neutropenia and diet appear to go hand-in-hand. There are steps to take and precautions to follow that may help patients avoid outbreaks of harmful, infection-causing bacteria.
- Gently scrub hands clean with warm water and a gentle cleansing soap before preparing meals.
- Use bottled water rather than unfiltered tap water.
- Boil unfiltered or well water before use.
- Use only fruit and vegetables that have been washed and scrubbed before consuming.
- Avoid peeling or cutting food to prevent accidents; have someone complete the task for you.
- Avoid cross-contamination by not using the same surface for raw meats and other foods.
- Packaged produce requires washing, including “pre-washed” goods.
- Wash the tops of canned goods before opening.
- Always adhere to “Best Before” dates on all food packaging.
- Thaw frozen meats, poultry, and fish in the refrigerator.
- Always follow food manufacturers’ recommended cooking times.
- Use a meat thermometer to confirm internal temperature when cooking meat and poultry.
- Consume only raw fruit with a thick peeling such as an orange or banana.
- Avoid raw and undercooked meat, poultry, and fish.
- Cook eggs until the yolks are firm.
- Use only pasteurized dairy products.
- Cut and boil tofu in one-inch cubes before consuming or using in recipes.
- Avoid handling yeast products as with bread dough.
- Do not re-heat cooked rice.
- Avoid restaurant or take-out foods as preparation techniques are unknown.
- Purchase only vacuum-packed deli meats.
- Avoid deli counters and salad bars.
- Purchase food in small amounts or packages.
- Choose food products from well-organized freezers to ensure food has remained frozen.
- Check “Best Before” dates to ensure purchasing the freshest products.
- Use an insulated bag or cooler to transport food home from store.
- Store food at recommended temperatures.
- Keep raw food separate from cooked food, especially meat and poultry products.
- Maintain a refrigerator temperature of between 32 and 41 degrees Fahrenheit and a freezer temperature of below minus 1 degree Fahrenheit.
- Place cooked foods on the top shelf in the refrigerator, with all raw or defrosting food on the bottom shelf in a container.
- Avoid overloading the freezer or refrigerator.
- Allow cooked food to cool before storing in the refrigerator.
- Wash hands with warm water and a gentle cleansing soap before handling cooked and uncooked foods.
- Dry hands with paper towels.
- Attend to a cut or abrasion with waterproof protective covering.
- Regularly wash, disinfect, and change clothes, towels, cloths, and bedding.
- Clean and disinfect food preparation surfaces, insides of microwaves and refrigerators, and sink waterspouts frequently.
- Do not allow pets near food storage, counters, and dishes.
- Do not reheat cooked rice.
- Consume all cooked or defrosted foods within 24 hours.
- Reheat food only once.
- Follow manufacturer’s recommendations when reheating food in microwave.
- Only consume food that is fully cooked.
- Avoid salad bars, buffets, market and street vendors, and food trucks.
- Do not eat food on display such as kebab meat.
Neutropenic Diet Sample Menu
1 large egg, scrambled
1 medium biscuit with 1 teaspoon of butter and 1 teaspoon of jelly
½ cup of apple juice
½ cup of 2% milk
Coffee or tea
1 cup of dry cereal
1 cup of 2% milk
2 tablespoons of dried fruit
Baked meatloaf with gravy
½ cup of corn, cooked
½ cup of canned peaches
1 slice of wheat bread
Butter or margarine
1 cup of 2% milk
Coffee or tea
1 cup of milkshake or high-protein drink
3 ounces of chicken, baked or roasted
½ cup of oven-fried potatoes
½ cup of carrots, glazed
1 dinner roll with butter or margarine
½ cup of canned fruit cocktail
Coffee or tea
1 slice of pound cake with whip topping
Tips to Improve Your Appetite
With neutropenia, it is crucial to maintain a healthy lifestyle by choosing the right foods to help maintain a healthy weight. However, certain disorders and infections may cause your appetite to decrease. All of the following precautions may help boost your desire to eat, and restore affected tissues.
- Eat small snacks every two hours based on neutropenic diet foods such as yogurt, crackers, or cereal.
- Place small portions on small plates to avoid feeling overwhelmed by the amount of food.
- Use garnishes of lemon or parsley to entice your senses.
- Avoid drinking any beverage with meals to avoid filling up too fast.
- Savor each bite of food.
- Maintain a regular schedule of eating, even when you don’t feel hungry.
- Eat what you want when you can, as the appetite is easily suppressed.
- Choose to eat the foods you want despite the hour of the day.
- Have milkshakes or nutritional supplement beverages to choose from if the presence of mouth sores discourages your appetite.
- Try new and different foods from time to time as your liking may change.
- Taking a walk or enjoying fresh air may motivate you to eat.
- Be aware of the aroma of food, as it may either stimulate hunger or squash the desire to eat.
- Prepare cold dishes and meals if the aroma of cooked food suppresses the appetite.
- Alcohol drinkers may trigger hunger with a small glass of beer, wine, or liquor one-half hour before meals.
- Have dishes prepared in advance and stored in freezer for quick meals.
A neutropenic diet is designed as part of the treatment for the white blood cell disorder known as neutropenia. To increase the neutrophils count, which is essential to fight infections, a diet of foods with low bacteria counts is recommended.
The diet restricts consumption of raw meats and fish, deli products, unfiltered water, unpasteurized dairy products, and certain cheeses. The neutropenic diet does allow fresh fruits and vegetables, thoroughly cooked and commercially packaged meats, fish, poultry, and most breads and grains.
Neutropenia also requires modifications to one’s lifestyle with precautions and steps to take to prevent further complications and recurring infections. By following these, and a neutropenic diet, the neutropenia condition may be better managed and the healing process may be shorter.
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