£
Donate

We're here for you if you want to talk

0808 2080 888

[email protected]

Infection risk and neutropenia

We're here for you if you want to talk

0808 2080 888

[email protected]

Neutropenic diet

Neutropenia weakens your immune system, meaning you can get infections more easily from the bacteria in your food.

Food that’s not stored or cooked properly can be a source of infection. It’s impossible to completely remove all bacteria from your food, but sensible food hygiene rules can make it much less likely to get sick from the food you eat.

We have more information about shopping, cleaning, storing, preparing and reheating food, and eating out.

As well as advising you to follow food hygiene rules, some hospitals may recommend changes to your diet, known as a neutropenic diet.

Do I need to follow a neutropenic diet?

There’s some debate about whether adopting a neutropenic diet could help to reduce your risk of infection. Some studies suggest that avoiding certain foods might help, but the evidence is limited.

Some doctors, dietitians and other healthcare professionals believe it’s important to follow nutritional guidelines to lower your risk of infection. Others give less strict advice and instead encourage patients to eat a varied diet.

Before you make any changes to your diet, speak to your doctor, dietitian or key worker who will be able to advise you on the best approach for you. If your healthcare team does recommend a neutropenic diet, the type of dietary advice you’re given will depend on your neutrophil count.

The types of food you might be advised to avoid are the ones that are most likely to contain germs that could make you unwell. If you’re severely neutropenic (with neutrophil counts below 0.5 x 109/ litre), you’ll be advised to avoid more foods than someone who is neutropenic with neutrophil counts below 2.0 x 109/ litre.

If you’re not advised to follow a neutropenic diet, follow general advice on healthy eating and food hygiene and try to keep eating even if you don’t feel like it. See the tips on boosting your appetite further down.

Neutropenic diet for people who are neutropenic

This advice is for people with neutrophil counts below 2.0 x 10^9/ litre (neutropenia). If your doctor uses different ranges of neutrophil counts, you should follow their advice on which group you fit into.

This diet can be similar to the advice that is given to other people with a weaker immune system.

Avoid these dairy products:

  • all unpasteurised dairy products, such as milk sold on local farms
  • soft cheeses made with unpasteurised milk, such as feta and parmesan
  • homemade or deli paneer and labneh
  • mould-ripened cheeses such as camembert, brie and goat’s cheese
  • blue veined cheeses such as Danish blue and Stilton
  • probiotic or ‘bio’ foods, drinks or supplements such as Yakult™, Actimel™ and ProViva™ yoghurt which is described on the label as ‘bio’ or ‘probiotic’.

Use these alternatives:

  • any pasteurised milk, soya milk, Jersey milk or UHT milk
  • cheeses made with pasteurised milk
  • processed cheese such as Dairylea™, Kraft™, Philadelphia™, and halloumi
  • pasteurised cheeses such as pasteurised parmesan, pasteurised mozzarella and pasteurised goat’s cheese
  • paneer made with pasteurised milk
  • vacuum-packed pasteurised and hard cheeses, such as cheddar and edam
  • yoghurts labelled as being made with live bacteria; or plain, Greek and fruit yoghurts – as long as they are not described as ‘bio’ or ‘probiotic’.

Avoid these meat products:

  • raw and undercooked meat, poultry or fish; such as meat which is still pink
  • smoked meats, such as salami
  • any type of unpasteurised pâté (meat or vegetable).

Use these alternatives:

  • well-cooked meat, poultry and fish
  • tinned meat and fish
  • vacuum-packed cold meats, such as turkey and ham stored below 3°C
  • pasteurised pâté and paste in tins or jars that do not need to be refrigerated.

Avoid these fish products:

  • smoked salmon
  • raw sushi
  • caviar
  • oysters
  • lightly cooked shellfish.

Use these alternatives:

  • vacuum-cooked packed fish eaten straight from a new packet, including vacuum-packed smoked salmon
  • cooked salmon
  • well-cooked shellfish, such as in risotto, stir-fry or curry.

Avoid these egg products:

  • raw eggs or undercooked eggs
  • products using raw or undercooked eggs such as homemade mayonnaise, homemade ice cream, mousse, egg-nog, meringue, hollandaise sauce and béarnaise sauce
  • any dressing containing raw eggs such as Caesar salad dressing.

Use these alternatives:

  • hard-boiled, scrambled or fried eggs, as long as the whites and yolks of the eggs are solid
  • shop-bought mayonnaise and other products made with pasteurised eggs.

Neutropenic diet for people who are severely neutropenic

This advice is for people with neutrophil counts below 0.5 x 10^9/litre (severe neutropenia).

You’re most at risk of catching an infection if you have severe neutropenia. This can happen during a stem cell transplant or while you’re having chemotherapy.

If you have a neutrophil count below 0.5 your healthcare team may recommend that you follow a stricter diet with a few more restrictions.

If you’re staying in hospital, you should check with your hospital about their policy on food brought in by visitors as different hospitals have different rules about how to prevent infection.

If you have severe neutropenia and you’re advised to follow a neutropenic diet, you’ll need to follow the general guidance for people with neutropenia along with some extra guidelines. We’ve combined these for you below:

Avoid these dairy products:

  • all unpasteurised dairy products, such as milk sold on local farms
  • soft cheeses made with unpasteurised milk, such as feta and parmesan
  • homemade or deli paneer and labneh
  • mould-ripened cheeses such as camembert, brie and goat’s cheese
  • blue veined cheeses such as Danish blue and Stilton
  • probiotic or ‘bio’ foods, drinks or supplements such as Yakult™, Actimel™ and ProViva™ yoghurt which is described on the label as ‘bio’ or ‘probiotic’.
  • ice-cream from ice-cream vans

Use these alternatives:

  • any pasteurised milk, soya milk, Jersey milk or UHT milk
  • cheeses made with pasteurised milk
  • processed cheese such as Dairylea™, Kraft™, Philadelphia™, and halloumi
  • pasteurised cheeses such as pasteurised parmesan, pasteurised mozzarella and pasteurised goat’s cheese
  • paneer made with pasteurised milk
  • vacuum-packed pasteurised and hard cheeses, such as cheddar and edam
  • yoghurts labelled as being made with live bacteria; or plain, Greek and fruit yoghurts – as long as they are not described as ‘bio’ or ‘probiotic’
  • ice-cream from reputable sources, in individual portions, wrapped or in small pots.

Avoid these meat products:

  • raw and undercooked meat, poultry or fish; such as meat which is still pink
  • smoked meats, such as salami
  • any type of unpasteurised pâté (meat or vegetable).

Use these alternatives:

  • well-cooked meat, poultry and fish
  • tinned meat and fish
  • vacuum-packed cold meats, such as turkey and ham stored below 3°C
  • pasteurised pâté and paste in tins or jars that do not need to be refrigerated.

Avoid these fish products:

  • raw sushi
  • caviar
  • oysters
  • lightly cooked shellfish
  • any cold smoked fish including cold smoked salmon

Use these alternatives:

  • cooked salmon
  • well-cooked shellfish, such as in risotto, stir-fry or curry
  • smoked salmon in cooked dishes where the fish is cooked through.

Avoid these egg products:

  • raw eggs or undercooked eggs
  • products using raw or undercooked eggs such as homemade mayonnaise, homemade ice cream, mousse, egg-nog, meringue, hollandaise sauce and béarnaise sauce
  • any dressing containing raw eggs such as Caesar salad dressing.

Use these alternatives:

  • hard-boiled, scrambled or fried eggs, as long as the whites and yolks of the eggs are solid
  • shop-bought mayonnaise and other products made with pasteurised eggs.

Avoid these nuts and snacks:

  • fresh nuts
  • nuts in shells
  • unpasteurised, raw, or ‘farm fresh’ honey and honeycomb
  • deli-counter foods like olives, houmous, shawarma and baklava
  • large bulk packets of food
  • items from pick and mix and jars.

Use these alternatives:

  • cooked nuts and roasted nuts
  • nuts in cans or peanut butter
  • pasteurised or heat-treated honey – try to use individual sachets or portions
  • individual snack-size portions of sweets

Avoid these products:

  • raw unpeeled fruit or vegetables including salad items, stuffed vine leaves, fattoush and tabbouleh
  • raw dried fruit or products containing this such as muesli, Bombay mix and confectionery
  • damaged or over-ripe fruit or veg
  • uncooked herbs, spices and pepper.

Use these alternatives:

  • good quality fruit and vegetables that are well cooked or peeled
  • cooked dried fruit such as in fruit cake, flapjacks or cereal bars
  • tinned fruit
  • cooked herbs, spices and pepper
  • pasteurised smoothies
  • UHT (ultra-high temperature processing) products

Avoid these:

  • non-drinking water
  • water from wells
  • unpasteurised or freshly squeezed fruit or vegetable juice or smoothies
  • bottled still water, including still mineral or spring water
  • water from coolers, domestic water filters and water fountains
  • ice made away from home such as ice in restaurant drinks and slushed drinks such as Slush Puppies.

Use these alternatives:

  • freshly running tap water
  • pasteurised smoothies
  • long-life fruit juices in cartons or jars
  • bottled carbonated water, including sparkling mineral or spring water, and soda water.

Advice after a stem cell transplant

Although you may no longer be neutropenic after a stem cell transplant, your immune system still takes time to fully recover.

After your stem cell transplant, you might need to continue with some of the dietary restrictions listed above. Your healthcare team or dietitian can talk to you about this.

If you’ve had a stem cell transplant from a donor (an allogeneic transplant), you’ll be taking drugs which suppress your immune system (immunosuppressant drugs), which can make you more at risk of infection. It’s important to follow a few key tips to reduce your risk of infection at this time:

  • Wash your hands frequently.
  • Buy and store food safely.
  • Store food in small individual packets if possible.
  • It’s recommended to avoid eating away from home for around six weeks post-transplant.
  • When eating away from home, choose good quality restaurants and avoid takeaways and food sold from street vendors, marketplaces, salad bars, buffets, all you can eat restaurants, delicatessens and ice-cream vans until you’re off immunosuppressant medications. You should always check food hygiene ratings.
person-typing-on-computer

Talk to other people affected by blood cancer

Hear from and connect with people who understand.

Join our Online Community Forum

Tips to improve your appetite

If you’re neutropenic it’s important to try and maintain your weight by eating regularly and maintaining a varied diet.

This will help your body to rebuild damaged tissues, fight infection, cope with any side effects from your treatment, and make sure you are getting all the nutrients your body needs to recover and keep strong.

You can use some of these tips to help improve your appetite. Your treatment team and dietitian should also be able to give you some advice about how to improve your appetite.

Try not to get out of the habit of eating. You need to eat to stimulate your appetite even if you might not feel like it. Your appetite may come and go, so it’s important to make the most of the times when you do feel like eating.

Don’t worry if you’re not eating ‘normal’ foods at ‘normal’ times – if you fancy cereal at midnight, enjoy it. See ‘It’s OK to snack’ below.

Large portions can seem overwhelming. You can tempt your appetite by making your food look attractive such as using small portions on small plates and adding garnishes such as lemon or parsley.

Sometimes the smell of food will be appetising while at other times it might put you off. If this happens, try to keep away from the kitchen while food is being prepared, or eat cold foods, which often smell less.

You could experiment with different foods. You may find that you like things you do not usually eat.

Some fresh air or a short walk before a meal may help to stimulate your appetite. You should also try to relax and enjoy what you eat. Eat slowly and chew your food well, and try to rest before and after eating. Do accept offers from friends and relatives to help with cooking and shopping.

You should keep hydrated by drinking a range of drinks at regular intervals throughout the day. However, avoid drinking while eating meals as this may fill you up and spoil your appetite.

Drinking a small glass of wine, beer, sherry or your favourite drink half an hour before your meal may help to boost your appetite. Check with your doctor first.

If you have a freezer, try to prepare food in advance when you feel like cooking, and store it for when you’re not feeling well. Convenience foods are also a useful standby and can be just as nourishing.

If you have severe mouth ulcers or mucositis (a sore mouth) and these are making eating difficult see your specialist nurse or a dietitian for advice. Adding calories through supplements, high energy milkshakes, or adding cheese or cream that is safe to eat may help in this case. Sipping water, sucking ice lollies or ice cubes can be helpful with mucositis.

If you have severe diarrhoea (frequent watery poos) as a result of treatment, certain foods may be difficult to digest. Seek advice from a specialist nurse or dietitian if this is proving difficult for you.

If you’re staying in hospital for treatment and find hospital food unappetising, ask your family and friends to bring you in snacks. Always check if this is OK with your hospital unit.

Be positive about what you eat – every extra mouthful helps.

Eating a balanced diet

Eating a healthy diet is important to get the right amount of nutrients your body needs. Even if you’re neutropenic, try to eat a variety of foods including:

  • fruit and vegetables
  • bread, pasta, rice, potatoes and other starches
  • meat, fish, eggs, beans and other non-dairy proteins
  • milk and dairy foods
  • fatty and sugary foods.

We have more information about blood cancer and eating well.

Energy (calories)

It’s important to try to eat the right amount of food each day. Your body needs energy to keep you alive and stay strong. You can get energy from the calories you eat in food.

As a guide, an average man needs around 2,500kcal (10,500kJ) and an average woman needs 2,000kcal (8,400kJ) a day, to maintain a healthy body weight.

Everyone is different and may need different amounts of calories. If your energy intake becomes too low you’ll start to lose weight, which might make you feel tired and weak.

It's OK to snack

If you’re struggling to take in enough calories, eat little and often – try having a small snack every two hours. Good snacks might include some of the following, but make sure they’re suitable if you've been advised to follow a neutropenic diet:

  • biscuits, scones, cakes and muffins
  • fruit (frozen and tinned)
  • ready-made desserts, such as yoghurt, crème caramel, trifle and mousse
  • sandwiches
  • cheese and crackers, cheese straws and cubes
  • crisps, roasted nuts and savoury biscuits
  • small pieces of pizza, flans or sausage rolls
  • fun-sized chocolate bars
  • crumpets, croissants, toast and breakfast cereal.

Nutritional supplements

Sometimes, you might not be able to get all the nutrients your body needs from food alone. If this happens to you, your dietitian or another healthcare professional might suggest that you take nutritional supplements alongside your normal diet.

These supplements are prescription drinks that can be stored unopened at room temperature. Once they’re opened, you can keep them in the fridge for up to 24 hours or outside the fridge for up to four hours. Always check the manufacturer’s guidelines.

Recipe ideas

These are simple recipes that won’t take long to make. But if you’re suffering from fatigue or not feeling well, ask someone else to cook for you. Don’t be afraid to take up someone’s offer of help. You should check with your healthcare team or dietitian that these recipes are safe and appropriate for you.

Preparation time: 15 minutes. Cooking time: 45 minutes.

Ingredients:

  • ½ tbsp olive oil,
  • 1 small onion,
  • 1 clove of garlic,
  • 1 tomato,
  • ½ tbsp tomato purée,
  • ¼ tsp each of chilli, coriander, cumin and turmeric powder,
  • 125g chicken breast,
  • ½ tbsp pasteurised natural yoghurt,
  • 65g basmati rice,
  • 80g cauliflower,
  • ½ tbsp fresh coriander.

Instructions:

  • Heat the oil in a large, non-stick saucepan or frying pan, and fry the onion until soft.
  • Add the garlic, tomato, tomato purée, chilli and spices. Cook for a few minutes. Then add two tablespoons of water and allow to reduce.
  • Add the chicken and cook for 10–15 minutes on a medium heat. Then add in the yoghurt, stirring slowly. Season with black pepper and simmer for a further 5–10 minutes.
  • Meanwhile, cook the rice following the packet instructions and boil or steam the cauliflower until tender.
  • Garnish the curry with coriander, and serve with rice and cauliflower.

Preparation time: 10 minutes. Cooking time: 20 minutes.

Ingredients:

  • 1tsp olive oil,
  • 2 lightly beaten eggs,
  • 4 roughly chopped semi-dried tomatoes,
  • 25g pasteurised feta cheese,
  • 50g mixed salad leaves.

Instructions:

  • Heat the oil in a small frying pan, add the eggs and cook, swirling the eggs with a fork as they set.
  • When the eggs are still slightly runny in the middle, scatter over the tomatoes and feta cheese.
  • Fold the omelette in half, and make sure the eggs are cooked through.
  • Cook for 1 minute more before sliding onto a plate and serve with a mixed leaf salad.

Preparation time: 2 minutes. Cooking time: 15 minutes.

Ingredients:

  • 75g dry spaghetti,
  • 100g frozen mixed vegetables,
  • 130g white pasta sauce from a jar,
  • 50g tinned tuna.

Instructions:

  • Boil the spaghetti in a sauce pan for 10-12 minutes, adding the mixed vegetables for the last five minutes. Drain.
  • Pour the white pasta sauce into the pan with drained tuna and heat for one minute.
  • Return the spaghetti and vegetables to the pan and stir to heat through. Season to taste.

Preparation time: 10 minutes.

Ingredients:

  • 70ml pasteurised whipping cream,
  • 1 ripe banana,
  • ½ heaped tbsp sugar,
  • ¼ juice of a lemon.

Instructions:

  • Whisk the cream until thick.
  • Peel the banana and mash with the sugar and lemon juice.
  • Add the mashed banana mixture to the cream and stir together.
  • Chill before serving.

Preparation time: 5 minutes.

Ingredients:

  • 50g frozen mixed berries,
  • 75g full fat Greek yoghurt,
  • 1–2 tsp honey/golden syrup.

Instructions:

  • Blend all the ingredients together in a food processor to make a smooth ice-cream texture and serve in a bowl.

Preparation time: 10 minutes.

Ingredients:

  • 1 banana peeled and sliced,
  • 125ml pasteurised milk of choice,
  • ½ tsp honey, grated nutmeg,
  • 1tsp chopped, toasted hazelnuts.

Instructions:

  • Blend the banana with milk, honey and a little grated nutmeg until smooth.
  • Pour into a large glass and top with the toasted, chopped hazelnuts to serve.
Rob and family having fun cooking

Living well

Practical tips and real stories to help you with everyday life

Living well with or after blood cancer

We're here for you if you want to talk

0808 2080 888

[email protected]