Food Safety

• People with decreased immune function due to chemotherapy and radiation therapy are at an increased risk of developing a food-related infection.  The purpose of a low microbial diet is to avoid specific foods that are likely to contain infection-causing organisms, while allowing a variety of healthy food choices.

• When following this diet, you may choose foods to eat from the “Can Eat” column.  You should avoid foods from the “Do Not Eat” column.  You may want to discuss the safety of any of these foods with your dietitian.

• The low microbial diet might be recommended by your physician before, during, and after all conditioning (chemotherapy and/or radiation) treatment.

• Patients who undergo an autologous stem cell transplant should expect to follow this diet for up to 3 months after transplant.  Patients who receive an allogeneic transplant should follow this diet until all immunosuppressive drugs are discontinued.  Please consult your physician and dietitian before discontinuing this diet.

Low Microbial Diet Guidelines

Food Group	Can Eat	Do Not Eat
Fruits and Nuts	● Well-washed raw and frozen fruit except berries● Foods containing well-washed raw fruits● Cooked, canned, and frozen fruit ● Pasteurized juices and frozen juice concentrates ● Dried fruits ● Canned or bottled roasted nuts ● Shelled, roasted nuts, and nuts in baked products ● Commercially packaged nut butters (such as peanut butter, almond butter, soybean butter)	● Unwashed raw fruits● Fresh or frozen berries● Unroasted raw nuts ● Roasted nuts in the shell ● Nonpasteurized fruit and vegetable juices ● Fresh fruit salsa found in the grocery refrigerator case ● Nonpasteurized items containing raw fruits found in the grocery refrigerator case
Entrees Soups and Vegetables	● All cooked entrees and soups● Well washed raw and frozen vegetables including salads● All cooked fresh, frozen, or canned vegetables, including potatoes ● Shelf-stable* bottled salsa (refrigerate after opening) ● Cooked vegetable sprouts (such as mung bean sprouts) ● Fresh, well-washed herbs and dried herbs and spices (added to raw or cooked foods)	● All miso products such as miso soup and miso paste● Unwashed raw vegetables or herbs● Fresh, nonpasteurized vegetable salsa found in the grocery refrigerator case ● Nonpasteurized items containing raw vegetables found in the grocery refrigerator case ● All raw vegetable sprouts (alfalfa sprouts, clover sprouts, mung bean sprouts, all others) ● Salads from delicatessens
Bread, Grain, and Cereal Products	● All breads, bagels, rolls, English muffins, muffins, pancakes, sweet rolls, waffles, French toast● Potato chips, corn chips, tortilla chips, pretzels, popcorn● Cooked grains and grain products, including pasta and rice ● All cereals, cooked and ready-to-eat	● Raw (not baked or cooked) grain products (such as raw oats)● Patients should not mix or knead any bread products that contain fresh yeast.
Beverages	● Boiled well water §● Tap water and ice made from tap water ¶● Commercially bottled distilled, spring, and natural water- see water handout ● All canned, bottled and powdered beverages ● Instant and brewed coffee and tea; cold brewed tea made with boiling water ● Herbal teas brewed from commercially packaged tea bags ● Commercial nutritional supplements, both liquid and powdered ● Commercially sterile ready-to-feed and liquid-concentrate infant formulas (avoid powdered infant formulas if a ready-to-feed or liquid concentrate alternative is available)	● Unboiled well water● Cold-brewed tea made with warm or cold water● Nonpasteurized fruit and vegetable juices ● Mate´ tea ● Wine, nonpasteurized beer (Note: All alcoholic beverages should only be consumed following physician approval)

 

Food Group	Can Eat	Do Not Eat
Fat	● Vegetable oils and shortening● Refrigerated lard, margarine, butter● Commercial, shelf-stable‡ mayonnaise and salad dressings including Blue Cheese and other cheese-based salad dressings (refrigerate after opening) ● Cooked gravy and sauces	● Fresh salad dressings (stored in the grocer’s refrigerated case) containing raw eggs or cheeses listed as ‘‘Do Not Eat’’ under ‘‘Dairy.’’
Desserts	● Refrigerated commercial and homemade cakes, pies, pastries, and pudding● Refrigerated cream-filled pastries● Cookies, both homemade and commercially prepared ● Shelf-stable‡ cream-filled cupcakes (such as Twinkies®, Ding Dongs®) and fruit pies (such as Poptarts® and Hostess® fruit pies) ● Canned and refrigerated puddings ● Ices, popsicles, and similar products ● Candy, gum	● Unrefrigerated cream-filled pastry products (not shelf-stable ‡)● Ice cream and frozen yogurt from an ice cream parlor or fast food restaurant.
Other	● Commercial pasteurized Grade A honey**● Salt, granulated sugar, brown sugar● Jam, jelly, syrups (refrigerate after opening) ● Catsup, mustard, BBQ sauce, soy sauce, other condiments (refrigerate after opening) ● Pickles, pickle relish, olives (refrigerate after opening) ● Vinegar	● Raw honey; honey in the comb● Herbal and nutrient supplement preparations● Brewers yeast, if uncooked

Concern arising from the detection of potential pathogens in food has not been supported by documented evidence of such organisms as the source of opportunistic infections in immunocompromised persons. The potential benefit of food safety recommendations directed specifically toward HCT recipients must be weighed against the uncertain value of such recommendations] and their potential to adversely affect patients‘ nutritional intake and/or quality of life.

*Shelf-stable refers to unopened canned, bottled, or packaged food products that can be stored before opening at room temperature; container may require refrigeration after opening.

* Aseptically packaged, shelf-stable tofu and pasteurized tofu do not need to be boiled. Nonpasteurized tofu must be cut into 1-inch cubes or smaller, and boiled a minimum of 5 minutes in water or broth before eating or using in recipes.

* Rinse under clean, running water before use, including produce that is to be cooked or peeled (such as bananas, oranges, and melon).

* Bring tap water to a rolling boil and boil for ≥1 minute minutes. Store boiled water in the refrigerator. Discard water not used within 48 hours (2 days).

* Recommend using boiled or bottled water if using a water service other than city water service. Please see Water Safety Guidelines in ‘‘Food Safety Guidelines.’’ See Water Safety Guidelines in ‘‘Food Safety Guidelines’’ for approved bottled water treatments.

* Honey products are not allowed for any child less than 1 year of age and not allowed for children with SCIDS until 9 months post transplant.

(Updated 04/01/2010; Original  2002 updated 1/09)