These guidelines are for patients with decreased immune function, such as those with low white blood cell counts (absolute neutrophil count less than 1,000 mm3). If you have had a transplant, please refer to the transplant diet guidelines, Diet Guidelines for Transplant Patients.
Individuals with decreased immune function are at increased risk of developing a food-related infection. You can decrease your risk of food-borne illness through proper preparation of food and drinks. Some food and drinks are more likely to contain harmful bacteria and germs.
Discuss the safety of these or other foods with a dietitian or your doctor, who can advise you about when you do or do not need to follow the diet guidelines described here. Also, read our Food Safety Guidelines to learn about safe food preparation practices.
Milk and Dairy Products
- Eat or drink only pasteurized milk, yogurt, cheese, or other dairy products (pasteurized, grade-A milk and milk products).
- Avoid soft mold-ripened and blue-veined cheese including Camembert, Roquefort, Stilton, Gorgonzola, and blue cheese.
- Avoid Mexican-style cheeses, such as queso blanco fresco, since they are frequently made from unpasteurized milk and are associated with a higher rate of foodborne illness.
- Cook eggs thoroughly until the yolk and white are solid, not runny.
- Do not eat foods that may contain raw eggs, such as hollandaise sauce, raw cookie dough, homemade mayonnaise, and Caesar salad dressing. If you prepare these foods at home, use a pasteurized egg product instead of eggs in the shell. (You can find pasteurized eggs in the dairy case at your supermarket; Egg Beaters® is one example.)
Meat, Poultry, Fish, and Tofu
- For meat and poultry, use a food thermometer to ensure a proper temperature when cooked.
- Red meat and ground beef: minimum internal temperature of 160° F.
- Ground poultry: internal temperature of 165° F.
- Whole poultry: internal temperature of 180° F.
- Casseroles: internal temperature of 165° F.
- For hot dogs, “ready-to-eat” sliced lunch meats, cold cuts, and summer sausage, heat in the microwave or oven until steaming before eating.
- Cut tofu into 1-inch cubes or smaller and boil for five minutes in water or broth before eating or using in recipes. (Note: This process is not necessary if using aseptically packaged, shelf-stable tofu, such as Mori-Nu® silken tofu).
- Do not eat meat, poultry, or fish that is spoiled, raw, or undercooked.
- Do not eat raw or lightly cooked fish, shellfish, lox, sushi, or sashimi.
- Avoid deli meats.
Fruits and Vegetables
- Wash raw fruits and vegetables under cold, running water. Fruit and vegetable “cleaners” or “sprays” are not necessary.
- Do NOT use soap to wash produce since soap can cause diarrhea if not thoroughly rinsed off the food.
- Choose shelf-stable salsas and salad dressings. Avoid fresh salsas and salad dressings found in the refrigerated section of the grocery store. Choose shelf-stable salsas and salad dressings instead. (Shelf-stable refers to unopened canned, bottled, or packaged food products that can be stored at room temperature before opening; the container may require refrigeration after opening.)
- Do not eat any raw vegetable sprouts, such as alfalfa, radish, broccoli, mung bean, or other sprouts.
Bread, Grain, and Cereal Products
- Avoid “bulk bin” sources of cereals, grains, or other foods.
Desserts and Sweets
- Enjoy commercially packaged sweets, such as cookies, cakes, pies, and other shelf-stable items. Twinkies®, Chips Ahoy®, and frozen treats are acceptable. Avoid unrefrigerated, cream-filled pastry products.
- Do not consume raw honey or honeycomb. Select pasteurized commercial, grade-A, heat-treated honey.
- See our Water Safety Guidelines.
- Do not drink water straight from lakes, rivers, streams, or springs.
- It is recommended to use distilled or bottled water if using a water service other than city water service.
- Homemade juices are acceptable if consumed within 2 hours of juicing. Do not drink unpasteurized fruit or vegetable juices.
- Make tea with boiling water, using commercially packaged tea bags. Do not drink sun tea.
- Order cooked fruits, vegetables, and entrees.
- Avoid raw fruits and vegetables, such as salad, garnishes, and other raw produce items when dining out. Raw fruits and vegetables are encouraged at home.
- Ask that food be prepared fresh in fast-food establishments. (It may help to order the product prepared slightly differently from standard, such as without pickles.)
- Ask if fruit juices are pasteurized.
- Avoid fresh salsa and guacamole.
- Ask for single-serving condiment packages. Do not use public self-serve condiment containers.
- Avoid salad bars, delicatessens, buffets, smorgasbords, potlucks, sidewalk vendors, and food trucks. These are high-risk food sources due to potential improper food storage or holding temperature.
- Check the general condition of the restaurant. Are the plates, glasses, and utensils clean? Are the restrooms clean and stocked with soap and paper towels? How clean the restaurant looks may indicate the level of care taken while preparing the food.