What foods should I avoid with low white blood cells?

November 21, 2025 •

4 min read

According to Memorial Sloan Kettering Cancer Center, historically, healthcare providers have advised immunocompromised patients to follow a neutropenic diet. This diet provides essential food safety guidelines to help people with a compromised immune system manage their condition by explaining what foods to avoid with low white blood cells.

Quick Summary

A neutropenic diet is essential for those with low white blood cell counts, emphasizing food safety to prevent infection. It involves avoiding raw or undercooked meats, unpasteurized dairy, certain fresh produce, and buffet-style foods to mitigate the risk from foodborne bacteria.

Key Points

Avoid Raw Foods: To prevent bacterial contamination, avoid eating raw or undercooked meat, poultry, seafood, and eggs. Always cook proteins until well-done.
Choose Pasteurized Over Unpasteurized: Stay away from unpasteurized dairy products, juices, and honey. Opt for commercially packaged, pasteurized alternatives instead.
Prepare Produce with Care: Cook all vegetables thoroughly and wash and peel fresh, thick-skinned fruits. Avoid raw sprouts and unwashed berries.
Steer Clear of Contamination Zones: Refrain from eating at buffets, salad bars, and from street vendors, where food is often exposed and can harbor germs.
Practice Strict Food Hygiene: Wash hands, utensils, and surfaces meticulously to prevent cross-contamination. Use separate boards for raw and cooked items.
Heed Expiration Dates: Always check 'use by' or expiration dates and discard any food showing signs of spoilage, like mold.

A low white blood cell count, a condition known as neutropenia, leaves the body vulnerable to infection. The immune system, which relies on these cells to fight off harmful bacteria and other pathogens, is compromised. For individuals in this condition, paying close attention to dietary choices is critical to reduce the risk of foodborne illness. The primary goal is to avoid foods that are likely to harbor bacteria and other microorganisms.

Raw and Undercooked Foods

Raw and undercooked items are a major source of bacteria that a weakened immune system cannot effectively combat. It is crucial to cook all food thoroughly to a safe temperature to kill these pathogens.

Meat and Poultry: All meat, fish, and poultry must be cooked until well-done, with no pink showing. This includes beef, pork, lamb, and chicken. Deli meats and vacuum-packed meats should also be heated until steaming hot before consumption, as they can still contain bacteria. Raw seafood, such as sushi, oysters, or clams, should be strictly avoided.
Eggs: Eggs should be cooked until both the yolk and white are firm. This means no sunny-side-up, poached, or runny eggs. Any food that contains raw or undercooked eggs, like some homemade mayonnaise, hollandaise sauce, or unbaked cookie dough, must also be avoided.

Unpasteurized Products

Pasteurization is a process that heats liquids to destroy harmful bacteria. Consuming unpasteurized products puts you at risk of serious infection.

Dairy: Avoid milk, cheese, and yogurt that are labeled 'unpasteurized' or 'raw milk'. This also includes certain types of cheeses, especially soft cheeses like Brie, feta, and blue cheese, unless they are confirmed to be made from pasteurized milk. Live and active cultures found in some yogurts should also be avoided.
Juices and Cider: Fresh-squeezed or unpasteurized juices and ciders can contain harmful bacteria. It is safest to stick with pasteurized, commercially packaged juices.
Honey: Unpasteurized or raw honey can contain bacterial spores. Commercially processed, pasteurized honey is generally considered safe.

Fresh and Unwashed Produce

While fruits and vegetables are essential for a healthy diet, they can carry bacteria on their surfaces. The preparation method is key.

Raw Vegetables and Herbs: Raw vegetables, including those found in salads, can harbor bacteria. It is recommended to eat only thoroughly cooked vegetables. Fresh, uncooked herbs and spices should also be used with caution; commercially sealed, pre-packaged options are safer.
Raw Fruits: Unwashed or unpeeled raw fruits should be avoided. Thick-skinned fruits like bananas, oranges, and grapefruit are generally safe if washed thoroughly and peeled before eating. Berries and other delicate fruits should be cooked.
Sprouts: All types of raw sprouts, such as alfalfa, clover, and mung bean sprouts, should be avoided entirely.

High-Risk Processed and Store-Bought Foods

Certain commercially prepared and stored foods can pose a risk due to potential contamination during processing or serving.

Buffets and Salad Bars: These are high-risk environments where food is left out for extended periods and handled by many people. It is best to avoid them completely.
Street Vendors: Foods prepared and sold by street vendors carry a higher risk of contamination due to unknown preparation and sanitation standards.
Fresh-Made Items: Avoid freshly made items from refrigerated grocery store cases, such as fresh deli salads, fresh-ground peanut butter, or cold-brewed teas.
Expired or Moldy Foods: Always check expiration dates and discard any food that shows signs of mold, regardless of the type.

Comparison of High-Risk vs. Safer Food Options


Food Category	High-Risk Foods to Avoid	Safer Alternatives to Consume
Protein	Raw/rare meat and poultry, deli meats, sushi, runny eggs	Well-cooked meats, canned tuna, hard-boiled eggs
Dairy	Unpasteurized milk/cheeses, mold-ripened soft cheese	Pasteurized milk, hard and processed cheeses
Produce	Raw vegetables, unwashed fresh fruits, sprouts, salad bars	Well-cooked vegetables, canned fruits, washed/peeled thick-skinned fruits
Beverages	Unpasteurized juices/cider, raw honey, cold-brewed tea	Pasteurized juices, cooked honey, brewed hot tea/coffee
Miscellaneous	Buffet items, fresh-ground nuts/nut butters, expired foods	Canned/bottled roasted nuts, packaged nut butters, fresh food

Important Food Safety Practices

Beyond avoiding specific foods, proper food handling is paramount to minimizing infection risk.

Hand Washing: Wash hands thoroughly with soap and warm water for at least 20 seconds before and after handling any food.
Cross-Contamination: Use separate cutting boards and utensils for raw meats and produce to prevent the spread of bacteria. Never place cooked food back onto a plate that held raw food.
Storage: Refrigerate leftovers promptly and consume them within a short period, typically no more than three days. Ensure hot foods stay hot and cold foods stay cold during serving.
Water: For tap water, if from a city supply, it is generally safe. If using well water, boil it for at least one minute before drinking. Check that bottled water is labeled as distilled, filtered, or treated with reverse osmosis.

Consult Your Healthcare Provider

While these guidelines are broadly recommended for individuals with low white blood cells, specific dietary needs can vary. It is essential to consult with your doctor, nurse, or a registered dietitian before making any significant changes to your diet. They can provide personalized advice based on your individual health status, treatment plan, and overall nutritional needs. Following their guidance will ensure that you are protecting your health while still meeting your nutritional requirements.

Conclusion

Protecting your health with low white blood cells is crucial, and food safety is a critical component of that protection. By avoiding raw or undercooked meats, unpasteurized dairy and juices, certain fresh produce, and high-risk prepared foods like buffets, you can significantly reduce your risk of foodborne infection. Always pair these dietary precautions with strict food safety and hygiene practices. Before making any changes to your diet, consult your healthcare provider for personalized recommendations to ensure your nutritional needs are met safely during this time. For more information on food safety, you may visit the National Cancer Institute's nutrition resource page at(https://www.cancer.gov/about-cancer/treatment/side-effects/appetite-loss/nutrition-hp-pdq).

Frequently Asked Questions

A neutropenic diet is a specialized food plan designed for individuals with a weakened immune system, specifically a low white blood cell count (neutropenia). The diet focuses on minimizing the risk of infection by avoiding foods and beverages that may harbor harmful bacteria.

Yes, but with caution. You should only eat fresh fruits that have thick skin, like bananas and oranges, and they must be thoroughly washed and peeled immediately before consumption. Many experts recommend avoiding thin-skinned or difficult-to-clean fruits, such as berries.

Raw and undercooked meats are a common source of foodborne bacteria, such as E. coli and Salmonella. With a compromised immune system, your body cannot fight these bacteria effectively, and the resulting infection can be severe.

It is generally safer to prepare food at home where you have control over food safety and preparation. If dining out, you should avoid buffets, salad bars, and street vendors. Ask for all meats to be cooked well-done and inquire about food handling practices.

Unpasteurized dairy products like raw milk and certain soft cheeses can contain harmful bacteria like Listeria. To be safe, only consume dairy products, including milk, yogurt, and cheese, that are labeled 'pasteurized'.

Leftovers can be safe if they are stored correctly and not kept for too long. Reheat all leftovers until they are steaming hot. Most guidelines suggest consuming refrigerated leftovers within three days.

Tap water from a municipal supply is usually safe. For bottled water, choose those labeled as distilled, filtered, or treated with reverse osmosis. If using well water, boil it for at least one minute before drinking.