High-Risk Raw and Undercooked Foods
Chemotherapy drugs suppress the bone marrow's production of white blood cells, which are crucial for fighting infection. This condition, known as neutropenia, means that even common foodborne pathogens like Salmonella and Listeria can cause severe, life-threatening illness. For this reason, avoiding certain raw or undercooked foods is a top priority for patients undergoing chemo.
Animal Products
- Raw or undercooked meat, poultry, and fish: This includes raw oysters, clams, sushi, sashimi, and rare or medium-rare steaks. All animal proteins should be cooked to their recommended safe internal temperatures.
- Raw or runny eggs: Avoid soft-boiled, over-easy, or poached eggs, as well as foods made with raw eggs, such as homemade mayonnaise, hollandaise sauce, and raw cookie dough.
- Refrigerated pâtés and meat spreads: These products, often not heated to kill bacteria, are considered high-risk. Deli meats and hot dogs should also be heated until steaming hot before consumption.
Produce
- Unwashed fruits and vegetables: Always wash all fresh produce thoroughly, even if labeled as 'pre-washed'.
- Raw sprouts: Alfalfa, mung bean, and clover sprouts are grown in warm, moist conditions ideal for bacterial growth and should be avoided unless thoroughly cooked.
- Salad bars and buffets: Self-service food areas pose a higher risk of contamination from multiple people handling the food. It's best to avoid them.
Unpasteurized and Unsafe Dairy
Dairy products that have not been pasteurized pose a risk of containing harmful bacteria, including Listeria. Pasteurization is a heat treatment process that destroys these pathogens, making it a critical step for immunocompromised individuals.
- Unpasteurized milk and juices: Ensure all dairy products and juices you consume have been pasteurized by checking the label.
- Soft cheeses: Many soft cheeses, especially blue-veined varieties like Brie, Camembert, Roquefort, and feta, are made with unpasteurized milk and should be avoided.
- Raw honey: While potentially having health benefits, raw honey can also contain spores that cause botulism, posing a risk to those with weakened immune systems.
Dangerous Drug and Drink Interactions
Certain foods and drinks can interfere with how chemotherapy drugs are metabolized, leading to increased drug levels in the bloodstream and potentially dangerous side effects.
- Grapefruit and grapefruit juice: This citrus fruit contains compounds that can block the liver enzyme CYP3A4, which is responsible for breaking down many chemotherapy drugs. The resulting higher concentration of medication can lead to serious toxicity. It is crucial to check with your oncology team about any potential interactions with your specific chemotherapy regimen.
- Alcohol: Alcohol places an additional strain on the liver, the same organ that metabolizes many chemo medications. It can also worsen side effects like nausea and mouth sores and cause dehydration. For these reasons, intake should be limited or avoided entirely, especially around infusion times.
Navigating Meals Out and Deli Items
When you're out, exercising caution is the best strategy for avoiding foodborne illness. This applies not just to dining in restaurants but also to grocery shopping.
- Restaurant Dining: Choose restaurants with high health inspection scores. Request that meat, poultry, fish, and eggs be cooked well-done. Send back any food that appears undercooked. Food served steaming hot is generally safer than cold foods.
- Deli Counters: Avoid cold cuts and processed meats sliced at the deli counter, as they carry a higher risk of Listeria contamination. Opt for sealed, pre-packaged deli meat instead.
- Food Temperature: Store and reheat leftovers properly. Foods left at room temperature for prolonged periods are at risk of bacterial growth. Refrigerate or freeze leftovers within two hours of cooking.
A Comparison of Safe vs. Unsafe Food Practices
| Food Category | Safe Practice During Chemo | Unsafe Practice to Avoid |
|---|---|---|
| Meat & Poultry | Thoroughly cooked to safe internal temperatures; steaming hot deli meats | Raw or undercooked meats, including sushi, rare steaks, deli counter cold cuts |
| Eggs | Fully cooked until yolk and white are solid (e.g., scrambled, hard-boiled) | Raw or runny eggs (soft-boiled, over-easy), homemade dressings with raw egg |
| Dairy | Pasteurized milk, cheese, and yogurt; hard cheeses are generally safer | Unpasteurized (raw) milk, soft cheeses like Brie, Camembert, or Roquefort |
| Produce | Washed and scrubbed raw fruits and vegetables; cooked sprouts | Unwashed raw produce, raw sprouts (alfalfa, mung bean), pre-cut salads |
| Beverages | Pasteurized juices, water, herbal tea, limiting caffeine | Alcohol, grapefruit juice, unpasteurized juices, raw honey |
Conclusion
While undergoing chemotherapy, dietary restrictions are not about depriving yourself but about protecting your compromised immune system from unnecessary risks. By focusing on cooked foods, pasteurized products, and practicing diligent food hygiene, you can maintain your nutritional health safely. Always communicate with your oncology team or a registered dietitian before making any major dietary changes or incorporating supplements. Your care team can provide personalized guidance to manage side effects and ensure your diet supports your treatment effectively. For more information on food safety, visit the Canadian Cancer Society. Eating well and safely is a crucial part of your overall treatment plan.
