• Low-Bacteria Diet

    Neutropenic Diet

    What Is a Low-Bacteria Diet?

    A low-bacteria diet excludes foods that are most likely to contain bacteria or other infection-causing microorganisms.

    Why Should I Follow a Low-Bacteria Diet?

    If you have a weakened immune system, following this diet will reduce your risk of becoming ill from eating food. This diet is often recommended before and after certain cancer treatments. Talk with your doctor about whether you need to follow a low-bacteria diet and, if so, for how long you should follow it.

    Low-Bacteria Diet Basics

    Bacteria and other harmful microorganisms are most likely to be present in raw or fresh foods. Thoroughly cooking foods destroys these microorganisms. For example, fresh vegetables should be cooked until tender, meats should be cooked until well-done, and eggs should be cooked until the yolk is firm.
    Certain food products, such as milk, are treated with a method known as pasteurization. Pasteurization briefly exposes food to high heat that kills any bacteria, without cooking the food. Look for dairy products, juices, and ciders that have the word “pasteurized” on the label.

    Eating Guide for a Low-Bacteria Diet

    Food Category Foods Recommended Foods to Avoid
    Grains
    • Breads, bagels, rolls, and muffins (except those with raw seeds or grains)
    • Pancakes, waffles, and French toast
    • Crackers and pretzels
    • Cooked and ready-to-eat cereals (without raw nuts or oats)
    • Cooked grains, rice, and pasta
    • Breads with raw grains or nuts
    • Cereals with raw grains or nuts
    • Raw oats
    • Uncooked fresh pasta
    • Pasta salad with raw vegetables or eggs
    Vegetables
    • All cooked fresh, canned, and frozen vegetables
    • Well washed raw vegetables and herbs
    • Canned vegetable juices
    • Unwashed raw vegetables or herbs
    • Raw sprouts (eg, alfalfa and mung bean)
    • Commercial fresh refrigerated salsas
    • Buffet or deli salads
    • Potato salad with raw vegetables or eggs
    • Unpasteurized vegetable juices
    Fruits
    • Canned and frozen fruits and juices
    • Pasteurized juices and ciders
    • Well-washed fresh fruits
    • Dried fruits
    • Unwashed fresh fruits
    • Unpasteurized fruit juices
    Milk
    • Pasteurized milk and dairy products (eg, sour cream, yogurt, and whipping cream)
    • Commercial eggnog
    • Commercially packaged cheese made from pasteurized milk (eg, American, Swiss, Parmesan, Mozzarella, and mild and medium cheddar)
    • Pasteurized cottage cheese
    • Processed cheese
    • Unpasteurized milk or yogurt
    • Soft-serve frozen yogurt or ice cream from a machine
    • Eggnog made with raw eggs
    • Unpasteurized and raw milk cheese
    • Moldy cheeses (eg, Bleu, Gorgonzola, Roquefort, and Stilton)
    • Other cheeses: sharp cheddar, Brie, Camembert, and feta
    • Deli cheeses
    • Cheeses with uncooked herbs or vegetables
    • Mexican-style cheeses (eg, queso fresco and queso blanco)
    Meat and Beans
    • Well-cooked meat, fish, poultry, or meat substitutes (eg, tofu)
    • Single-serving cooked, canned, or frozen products
    • Canned chicken or fish
    • Cooked beans, lentils, and other legumes
    • Pasteurized or cooked tofu
    • Well-done eggs
    • Pasteurized egg substitutes
    • Canned and homemade soup (thoroughly heated)
    • Commercially packaged peanut butter
    • Canned or bottled roasted nuts
    • Rare or medium-rare cooked meat, fish, or poultry
    • Undercooked tofu (should be cut into a minimum of 1-inch cubes and boiled for at least 5 minutes in water or broth)
    • Deli cold-cuts
    • Pickled fish
    • Cold smoked fish, lox
    • Raw or undercooked eggs or egg substitutes
    • Cold soups and gazpacho
    • Tempeh products
    • Miso soup and other miso products
    • Roasted nuts in the shell
    • Unroasted (raw) nuts
    Oils
    • Vegetable oil
    • Margarine
    • Mayonnaise
    • Commercial, shelf-stable salad dressing
    • Salad dressings with raw eggs or aged cheese
    • Avocado dressing
    Fats and Sweets
    • Butter, lard, shortening
    • Cream cheese
    • Snack chips (eg, potato, tortilla)
    • Cakes, pies, cookies, donuts
    • Baked custard, pudding, and gelatin
    • Commercial ice cream, sherbet, fruit ice, and popsicles
    • Candy
    • Chocolate
    • Jam
    • Pasteurized honey
    • Soft-serve frozen yogurt or ice cream from a machine
    • Homemade ice cream or sherbet
    • Cream-filled pastries and desserts (unless refrigerated)
    • Raw cookie dough
    • Raw honey
    Beverages
    • Instant and brewed coffee and tea
    • Brewed herbal teas
    • Individual cans or bottles of carbonated beverages
    • Bottled water
    • Canned, bottled, and powdered beverages and sports drinks
    • Instant breakfast drinks
    • Well water
    • Cold-brewed tea
    • Unpasteurized fruit and vegetable juices
    Other
    • Non-dairy creamers
    • Chewing gum
    • Salt, pepper, sugar, and sugar substitutes
    • Ketchup, mustard, BBQ sauce, steak sauce, soy sauce, and other condiments
    • Well-washed dried herbs and spices
    • Gravy and cream sauce
    • Commercial pickles
    • Herbs and spices added to food after cooking
    • Hollandaise sauce
    • Home-canned pickles
    • Uncooked brewer’s yeast
    • Some nutritional supplements (Ask your doctor or registered dietitian.)

    Suggestions

    Here are some general suggestions and guidelines for eating a low-bacteria diet. Consider meeting with a registered dietitian to learn more about this diet and how to make it fit with your lifestyle and eating habits.
      When preparing food:
      • Wash hands before and after preparing food.
      • Thoroughly cook foods and then keep hot until eaten.
      • Do not make bread that has yeast as an ingredient.
      When food shopping:
      • Avoid salad bars, bulk food bins, and food samples.
      When storing and handling food:
      • Keep refrigerated foods cold (below 40˚F).
      • Promptly refrigerate or freeze leftovers.
      • Refrigerate foods after opening (eg, salad dressing, apple sauce, and soy sauce).
      When dining out:
      • Avoid salad bars, delis, and buffets.
      • Use single-serve condiments (eg, ketchup, mustard, mayonnaise, soy sauce, steak sauce, salt, pepper, and sugar).

    RESOURCES

    American Cancer Society http://www.cancer.org/

    American Dietetic Association http://www.eatright.org/

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca/

    Dietitians of Canada http://www.dietitians.ca/

    References

    Diet guidelines for immunosuppressed patients. Fred Hutchinson Cancer Research Center website. Available at: http://www.fhcrc.org/science/clinical/ltfu/patient/diet%5Fguidelines.html . Accessed April 23, 2007.

    French MR, Levy-Milne R, Zibrik D. A survey of the use of low microbial diets in pediatric bone marrow transplant programs. J Am Diet Assoc . 2001;101:1194-1198.

    Low bacterial diet. The Ohio State University website. Available at: http://medicalcenter.osu.edu/patientcare/healthinformation/education . Accessed April 23, 2007.

    The neutropenic diet. Association of Online Cancer Resources website. Available at: http://leukemia.acor.org/neutro.html . Accessed January 3, 2010.

    Nutrition care manual. American Dietetic Association website. Available at: http://nutritioncaremanual.org/auth.cfm?p=%2Findex.cfm%3F . Accessed January 3, 2009.

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