Chemotherapy and Nutrition - Women's Cancer and Surgical Care, P.C.

Food Safety for People Who Are Immunosuppressed

The immune system helps protect you from infection. When your immune system is weakened, it may not be able to rid the body of the bacteria found in some foods. By not eating the foods and drinks listed in the “Not Allowed” section, you are better able to prevent illnesses that may be caused by organisms in foods. The foods and drinks in the “Food Allowed” sections are safe when properly prepared. Talk with Dr. Padilla or your chemo nurse about how long you need to follow these guidelines.

Food Groups	Food Allowed	Not Allowed
Dairy	All pasteurized, grade “A” milk and milk products Commercially packaged cheese and cheese products made with pasteurized milk (e.g., mild and medium cheddar, mozzarella, parmesan, Swiss, etc.) Pasteurized yogurt Dry, refrigerated, and frozen pasteurized whipped topping Ice cream, frozen yogurt, sherbet, ice cream bars, homemade milkshakes Commercial nutritional supplements, liquid and powered Commercial eggnog	Unpasteurized or raw milk, cheese, yogurt, and other milk products Cheeses from delicatessens Cheeses with molds (e.g., blue Stilton, Roquefort, gorgonzola) Sharp cheddar, brie, camembert, feta cheese, farmer’s cheese
Meat and Meat Substitutes	All well-cooked or canned meats (beef, pork, lamb, poultry, fish, shellfish, game, ham, bacon, sausage, hot dogs) Well-cooked eggs (white cooked firm with thickened yolk is acceptable) Well-cooked pasteurized egg substitutes Commercially-packaged salami, bologna, and other luncheon meats Canned and commercially-packaged hard smoked fish, refrigerated after opening Cooked 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	Raw or undercooked meat, poultry, fish, game, tofu Raw or undercooked eggs and egg substitutes Meats and cold cuts from delicatessens or grocery store deli Hard cured salami in natural wrap Cold smoked salmon (fish); lox Pickled fish Tempe (tempeh) products (fermented food made by the controlled fermentation of cooked soy beans with a Rhizopus mold)
Entrees, Soups	All cooked entrees and soups	Fresh, unpasteurized foods using soybean paste
Fruit and Nuts	Canned and frozen fruit and fruit juices Well-washed raw fruits Dried fruits Canned or bottled roasted nuts Nuts in baked products Commercially packaged peanut butter	Unwashed raw fruits Unroasted raw nuts Roasted nuts in the shell Unpasteurized fruit and vegetable juices
Vegetables	All cooked frozen, canned, or fresh vegetables and potatoes Well-washed raw vegetables Fresh, well-washed herbs and dried herbs and spices (added to raw or cooked foods Commercial salsas stored on grocers shelf, not refrigerated until after opening	Unwashed raw vegetables or herbs All sprouts (alfalfa, radish, broccoli, mung bean, all others) Salads from delicatessens or salad bars Commercial salsas stored in refrigerated case
Bread, Grain and Cereal Products	All breads, bagels, rolls, muffins, pancakes, sweet rolls, waffles, French toast (Patients themselves should not make (mix, knead) any bread product containing yeast) Potato chips, corn chips, tortilla chips, pretzels, popcorn All cereals, cooked and ready-to-eat	Raw grain products
Beverages	Tap water and ice made from tap water (If using a water service other than city water service, it is recommended using distilled or bottled water. Water may also be boiled for one minute and stored in a clean covered container in the refrigerator for no more than three days) Commercially bottled distilled, spring, and natural water All canned, bottled, powdered beverages Instant and brewed herbal teas using commercially-packaged tea bags Nutritional supplements, liquid and powdered	Well water (unless tested yearly and found to be free of coli forms) Cold-brewed (sun tea) made with warm or cold water Non-pasteurized commercial fruit, vegetable juices and milk products
Deserts	Refrigerated commercial and homemade cakes, pies, pastries, and pudding Refrigerated, cream-filled pastries Homemade and commercial cookies “Shelf-stable”* cream-filled cupcakes, fruit pies, and canned pudding (any items not eaten must be wrapped and refrigerated after opening) Ices, Popsicle-like products *”Shelf stable” refers to unopened canned, bottled, or packaged food products that can be stored before opening at room temperature	Unrefrigerated, cream-filled pastry products (not “shelf-stable”*)
Fats	Oil, shortening Refrigerated lard, margarine, butter Commercial, shelf-stable mayonnaise and salad dressings (including cheese-based salad dressings; refrigerated after opening) Cooked gravy and sauces	Fresh salad dressings containing aged cheese (e.g., blue Roquefort) or raw eggs, stored in refrigerated case
Other	Salt, granulated sugar, brown sugar Jam, jelly, syrups; refrigerated after opening Commercial (heat-treated) honey Pickles, pickle relish, olives (refrigerated after opening) Candy, gum	Raw or non-heat treated honey; honey in the comb Herbal and nutrient supplement preparations unless okay with your doctor Brewers yeast, if eaten uncooked

Tips for Handling Foods for the People who are Immunosuppressed

Always wash hands with warm soapy water before and after handling foods.
Keep kitchen surfaces such as appliances, countertops, cutting boards and utensils clean with hot, soapy water. To wash food preparation areas (including cutting boards and all utensils) that have come into contact with raw meat, use 1 part bleach to 8 parts water (example: 1 oz. bleach to a cup of water). Use two cutting boards: one strictly to cut meat, poultry and seafood; the other for ready to eat foods, like breads and vegetables.
Use paper towels for drying. If using kitchen towels, wash daily. Replace sponges at least weekly and wash daily with bleach solution or place them in dishwasher and run through a complete cleaning cycle using the heat cycle.
When preparing foods, the hands should be kept away from the hair, mouth and nose. If possible, jewelry (especially rings) should be removed, because they can hold germs.
Dishes and silverware should be washed in hot soapy water, rinsed and air-dried, or washed and dried in the dishwasher on the heat cycle.
Clean the inside of refrigerator regularly with soap and water to control mold.
Check the expiration dates of all foods and discard if expired. Throw out all foods after 72 hours (3 days) in the refrigerator that have been opened, used, or leftover. Keep the refrigerator temperature between 34 F. degrees and 40 F. degrees. Freezer temperature should be below 5 degrees F.
Keep cold foods cold (<40 F. degrees) and hot foods hot (>140 F. degrees); Defrost meat, turkey, and chicken in the refrigerator.
Never use canned foods if the can is swollen, dented, or rusted.
Avoid foods from self-serve, bulk containers.
Avoid salad bars, delis, and buffets.
At the supermarket, pick up perishables last and take them home right away.

Amy Gundelach RN, BSN, OCN