Understanding the Risks: Why Food Choices Matter During Chemo
Chemotherapy drugs not only target cancer cells but can also impact healthy cells, including those of the immune system. This can lead to a condition called neutropenia, characterized by a low number of neutrophils, a type of white blood cell. When immunocompromised, a person becomes highly susceptible to foodborne illnesses from bacteria like Salmonella, Listeria, and E. coli. For this reason, a special diet, often referred to as a neutropenic or low-microbial diet, is often recommended to minimize exposure to harmful pathogens. Beyond infection, certain foods can exacerbate common side effects such as nausea, mouth sores, and altered taste.
High-Risk Raw and Undercooked Foods
One of the most important categories of foods to avoid is anything raw or not thoroughly cooked, which can harbor dangerous bacteria. The risk of serious infection from these items is significantly higher for chemotherapy patients.
- Meat, Poultry, and Seafood: Any raw or undercooked meat, including sushi, sashimi, rare steaks, and uncooked deli meats like cold cuts or salami, must be avoided. All meat, poultry, and fish should be cooked to the recommended safe internal temperature.
- Eggs: Raw or undercooked eggs, including those in homemade mayonnaise, Caesar salad dressing, or raw cookie dough, are high-risk. Eggs should be cooked until both the yolk and white are firm.
- Sprouts: Alfalfa, bean, and clover sprouts are grown in warm, moist conditions ideal for bacterial growth and cannot be effectively cleaned. They should be completely avoided.
Unpasteurized and Unsafe Dairy Products
Unpasteurized dairy and certain cheeses can also be contaminated with harmful bacteria like Listeria and should be avoided.
- Unpasteurized Milk and Juices: All unpasteurized milk, milk products, cider, and juices should be avoided. Look for products specifically labeled as 'pasteurized'.
- Soft and Aged Cheeses: Cheeses made from unpasteurized milk, such as Brie, Camembert, feta, blue cheese, and queso fresco, should be omitted from the diet.
- Deli Cheeses: Cheeses sliced at deli counters carry a risk of cross-contamination from meats. Pre-packaged, sealed cheeses are a safer alternative.
- Soft-Serve Ice Cream and Yogurt: These products from soft-serve machines or scoop shops can contain bacteria due to the equipment. Sealed, pre-packaged alternatives are safer.
Fruits and Vegetables to Approach with Caution
While fruits and vegetables are crucial for nutrition, some pose a higher risk of contamination if not properly handled.
- Unwashed Produce: Thoroughly wash all fresh fruits and vegetables under running water, even those that will be peeled. Scrub firm produce like melons with a brush.
- Pre-Cut Produce: Avoid pre-cut fruits and vegetables sold in grocery stores due to higher risk of contamination from handling. It is safer to buy them whole, wash, and cut them at home.
- Certain Berries and Leafy Greens: Some fresh produce, such as raspberries and leafy greens like spinach and lettuce, are more difficult to clean effectively. Depending on the severity of immunocompromised status, a healthcare provider might recommend avoiding them.
Managing Chemo Side Effects Through Diet
Beyond foodborne illness, some foods and beverages can aggravate chemotherapy's side effects. Avoiding these can significantly improve comfort and quality of life during treatment.
- Nausea: Fatty, fried, spicy, and very sugary foods should be limited as they can worsen nausea. Also, strong food odors can trigger nausea, so cool or room-temperature foods are often better tolerated.
- Mouth Sores: For patients with mucositis (mouth sores), spicy, salty, or acidic foods and beverages like citrus and tomatoes should be avoided, as they can cause pain and irritation. Crunchy or sharp foods like crackers and chips can also be painful.
- Altered Taste: If food tastes metallic, avoid canned items and use plastic utensils. If food tastes bitter or bland, some patients find that adding extra seasonings or tangy flavors can help.
- Diarrhea: High-fiber foods like whole grains, raw vegetables, and nuts can be difficult to digest during episodes of diarrhea. Opt for bland, low-fiber alternatives like bananas, white rice, and toast.
Comparison of High-Risk vs. Safer Food Choices
| Food Category | Higher Risk | Safer Choice (when prepared properly) |
|---|---|---|
| Protein | Raw/undercooked meat, sushi, deli meats | Thoroughly cooked meat, canned tuna, hard-boiled eggs |
| Dairy | Unpasteurized milk/cheese, soft cheeses | Pasteurized milk/cheese, hard cheeses, store-bought yogurt |
| Produce | Unwashed produce, raw sprouts, bulk salad bar items | Washed and peeled fruits, cooked vegetables, canned fruit |
| Beverages | Unpasteurized cider, fountain drinks, alcohol | Bottled water, pasteurized juices, sports drinks |
| Sweets | Unrefrigerated pastries, raw cookie dough | Pasteurized ice cream, puddings, shelf-stable desserts |
The Importance of Food Preparation and Safety
Adhering to strict food safety guidelines is as critical as knowing what foods to avoid during chemotherapy. Always wash your hands and all food preparation surfaces thoroughly. Use separate cutting boards for raw meat and produce to prevent cross-contamination. Cook all foods, especially meat, poultry, and eggs, to the proper internal temperature and avoid refreezing thawed food. Refrigerate leftovers promptly within two hours of cooking and reheat them thoroughly before eating. For dining out, avoid buffets, salad bars, and street vendors, and ask for all meats to be cooked well-done.
Seeking Professional Guidance
While these guidelines provide a comprehensive overview, it is essential to consult with your oncologist, a registered dietitian specializing in oncology, or a clinical nutritionist. They can provide personalized dietary recommendations based on your specific treatment plan, side effects, and overall health status. For information on food safety and handling, the U.S. Food and Drug Administration (FDA) provides valuable resources.
Conclusion
Managing your diet carefully during chemotherapy is a proactive step toward minimizing risks and improving your comfort throughout treatment. By avoiding high-risk foods that can cause infection and those that worsen specific side effects, you can better support your body during this challenging time. Remember that the goal is not just to restrict but to make informed, safer food choices that aid in your recovery. Prioritizing food safety and seeking expert advice are the cornerstones of a successful nutritional plan during chemotherapy.
