Low-Bacteria Diet

Neutropenic Diet

by Maria Adams, MS, MPH, RD

En Español (Spanish Version)

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.o... . 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://medicalcent... . 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.

Last reviewed March 2013 by Dianne Scheinberg Rishikof MS, RD, LDN
Last Updated: 3/15/2013

EBSCO Publishing is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

To send comments or feedback to our Editorial Team regarding the content please email us at healthlibrarysupport@ebscohost.com

Editorial Policy

[ Aurora clinical research ]