Diet Guidelines for Immunosuppressed Patients

Persons with decreased immune function due to chemotherapy and radiation therapy are at increased risk of developing a food-related infection. The purpose of this diet is to help you avoid specific foods that are more likely to contain infection-causing organisms while allowing maximum healthy food choices. This diet should be followed before and after all conditioning therapy (chemotherapy and/or radiation).

• For autologous transplant patients undergoing chemotherapy treatment only: follow this diet during the first three months after chemotherapy or transplant.

• For allogenic transplant patients: follow the diet until you are off all immunosuppressive therapy such as cyclosporine, prednisone, FK-506 (Tacrolimus^®) or MMF (CellCept^®).

Prior to the end of these time periods, patients and their caregivers should talk to their physician and dietitian regarding whether or not to continue any part of the diet.

DAIRY

May eat

v  All pasteurized, grade “A” milk and milk products including eggnog, yogurt, ice cream, frozen yogurt, sherbet, ice cream bars, milkshakes, processed cheese slices and spreads, cream cheese, cottage cheese and ricotta cheese

v  Dry, refrigerated, or frozen pasteurized whipped topping

v  Commercially packaged hard and semi-soft cheeses such as cheddar, mozzarella, parmesan, Swiss, Monterey Jack, etc.

v  Cooked soft cheeses such as brie, camembert, feta, farmer’s cheese *

v  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)

*Though not completely risk free, the risk of contracting food borne illness from COOKED soft cheeses is low

Do not eat

v  Non-pasteurized or raw milk and milk products made from non-pasteurized or raw milk.

v  Cheeses from delicatessens

v  Cheese containing chili peppers or other uncooked vegetables

v  Cheeses with molds (such as blue, Stilton, Roquefort, gorgonzola)

v  Mexican-style soft cheese such as queso fresco, queso blanco

MEAT AND MEAT SUBSTITUTES

 May eat

v  All meats cooked to well done (see temperature guide attached) or canned meats (beef, pork, lamb, poultry, fish, shellfish, game, ham, bacon, sausage, hot dogs)

v  Eggs cooked until both white and yolk are firm

v  Pasteurized eggs and egg substitutes (such as Egg Beaters®), and powdered egg white (all can be used uncooked)

v  Commercially-packaged salami, bologna, hot dogs, ham and other luncheon meats, heated until steaming

v  Canned and shelf-stable¹ smoked fish (refrigerate after opening)

v  Pasteurized or cooked tofu²

v  Refrigerated smoked seafood such as salmon or trout if cooked to 160°F or contained in a cooked dish or casserole

Do not eat

v  Raw or undercooked meat, poultry, fish, game, tofu1

v  Raw or undercooked eggs and non-pasteurized egg substitutes; no eggs over easy, soft-boiled eggs, or poached eggs.

v  Meats and cold cuts from delicatessens

v  Hard cured salami in natural wrap

v  Uncooked refrigerated smoked seafood such as salmon or trout labeled as “nova-style,” “lox,” “kippered,” “smoked” or “jerky”

v  Pickled fish

v  Tempe (tempeh) products

FRUITS AND NUTS

May eat

v  Well washed³ raw and frozen fruit; foods containing well washed raw fruits

v  Cooked, canned and frozen fruit

v  Pasteurized juices and frozen juice concentrates

v  Dried fruits

v  Canned or bottled roasted nuts

v  Shelled, roasted nuts and nuts in baked products

v  Commercially-packaged nut butters (such as peanut butter, almond butter

Do not eat

v  Unwashed raw fruits

v  Unroasted raw nuts

v  Roasted nuts in the shell

v  Non-pasteurized fruit and vegetable juices

v  Fresh fruit salsa found in the grocery refrigerator case

v  Non-pasteurized items containing raw fruits found in the grocery refrigetor case

ENTRESS, SOUPS

May eat

v  All cooked entrees and soups

Do not eat

v  All miso products (such as miso soup and miso paste)

¹ 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

² Aseptically packaged, shelf-stable tofu and pasteurized tofu do not need to be boiled. Unpasteurized tofu must be cut into 1-inch cubes or smaller, and boiled a minimum of five minutes in water or broth before eating or using in recipes.

³ Rinse under clean, running water before use, including produce that is to be cooked or peeled (such as bananas, oranges and melon

VEGETABLES

May eat

v  Well washed3 raw and frozen vegetables

v  All cooked fresh, frozen or canned vegetables, including potatoes

v  Shelf-stable1 bottled salsa (refrigerate after opening)

v  Cooked vegetable sprouts (such as mung bean sprouts)

v  Fresh, well washed3 herbs and dried herbs and spices (added to raw or cooked food

Do not eat

v  Unwashed raw vegetables or herbs

v  Fresh, non-pasteurized vegetable salsa found in the grocery refrigerator case

v  Non-pasteurized items containing raw vegetables found in the grocery refrigerator case

v  All raw vegetable sprouts (alfalfa sprouts, clover sprouts, mung bean sprouts, all others)

v  Salads from delicatessens 

BREAD, GRAIN, AND CEREAL PRODUCTS

May eat

v  All breads, bagels, rolls, English muffins, muffins, pancakes, sweet rolls, waffles, French toast

v  Potato chips, corn chips, tortilla chips, pretzels, popcorn

v  Cooked grains and grain products, including pasta and rice

v  All cereals, cooked and ready-to-eat

Do not eat

v  Raw (not baked or cooked) grain products (such as raw oats)

BEVERAGES

May eat

v  Boiled well water⁴ 

v  Tap water and ice made from tap water

v  Commercially-bottled distilled, spring and natural waters⁵ 

v  All canned, bottled and powdered beverages

v  Instant and brewed coffee and tea; cold brewed tea made with boiling water

v  Herbal teas brewed from commercially-packaged tea bags

v  Commercial nutritional supplements, both liquid and powdered

v  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)

Do not eat

v  Unboiled well water

v  Cold-brewed tea made with warm or cold water

v  Non-pasteurized fruit and vegetable juices

v  Mate´ tea

v  Wine, unpasteurized beer

v  (Note: All alcoholic beverages should only be consumed following physician approval.)

⁴ Bring tap water to a rolling boil and boil for 15-20minutes. Store boiled water in the refrigerator. Discard water not used within 48 hours (2 days).

⁵ 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”.

⁶ See Water Safety Guidelines in “Food Safety Guidelines” for approved bottled water treatments.  

DESSERTS

May eat

v  Refrigerated commercial and homemade cakes, pies, pastries and pudding

v  Refrigerated cream-filled pastries

v  Cookies, both homemade and commercially prepared

v  Shelf-stable3 cream-filled cupcakes (such as Twinkies^®, Ding Dongs^®) and fruit pies (such as Poptarts^® and Hostess^® fruit pies)

v  Canned and refrigerated puddings

v  Ices, popsicles and similar products

v  Candy gum

Do not eat

v  Unrefrigerated cream-filled pastry products (not shelf-stable³)

FATS

May eat

v  Vegetable oils and shortening

v  Refrigerated lard, margarine, butter

v  Commercial, shelf-stable3 mayonnaise and salad dressings including Blue Cheese and other cheese-based salad dressings (refrigerate after opening)

v  Cooked gravy and sauces

Do not eat

v  Fresh salad dressings (stored in the grocer’s refrigerated case) containing raw eggs or cheeses listed as “Do Not Eat” under “Dairy”.

OTHERS

May eat

v  Commercial pasteurized Grade A honey⁷

v  Salt, granulated sugar, brown sugar

v  Jam, jelly, syrups (refrigerate after opening)

v  Catsup, mustard, BBQ sauce, soy sauce, other condiments (refrigerate after opening)

v  Pickles, pickle relish, olives (refrigerate after opening)

v  Vinegar

Do not eat

v  Raw honey; honey in the comb

v  Herbal and nutrient supplement preparations (refer to Guidelines for Use of Herbal and Nutrient Supplements in Patient & Caregiver Resource Manual)

v  Brewers yeast, if uncooked

⁷ Honey products are not allowed for any child less than one year of age and not allowed for children with SCIDS until 9 months posttransplant.

 

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