What Fruits Should Be Avoided During Chemo?

October 19, 2025 •

3 min read

According to the American Cancer Society, certain chemotherapy treatments can weaken the immune system, making food safety and dietary choices critically important. Knowing what fruits should be avoided during chemo can help mitigate treatment side effects and reduce the risk of infection.

Quick Summary

This guide explains which fruits to avoid during chemotherapy, detailing the risks associated with certain citrus fruits, potential drug interactions, and the importance of food safety for those with low immunity.

Key Points

Grapefruit Interaction: Compounds in grapefruit can dangerously interfere with the metabolism of certain chemotherapy drugs, potentially increasing their toxicity.
Acidic Fruit Irritation: High-acid fruits and juices, such as lemons, oranges, and pineapple, should be avoided if you develop painful mouth or throat sores.
Infection Risk: Unwashed fruits or difficult-to-clean berries can carry bacteria, posing an infection risk for patients with weakened immune systems on a neutropenic diet.
Safe Alternatives: Safer fruit choices include thoroughly washed and peeled thick-skinned fruits, cooked fruits, or commercially canned and pasteurized products.
Consult Your Doctor: Always consult your healthcare provider or a registered dietitian to determine the best fruit choices and safety precautions for your specific treatment plan.

Navigating Fruit Choices During Chemotherapy

Undergoing chemotherapy can lead to a compromised immune system and side effects like mouth sores and nausea, making careful dietary planning essential. While fruits are generally a healthy part of a cancer-fighting diet, certain types and preparations can pose risks. The primary concerns revolve around specific drug interactions, irritation from acidity, and the heightened risk of foodborne illness due to neutropenia (a low white blood cell count). Always consult with your oncologist or a registered dietitian before making changes to your diet during treatment.

The Critical Grapefruit Warning

One of the most important fruits to avoid is grapefruit, including its juice and related products like marmalade made from Seville oranges. Grapefruit contains compounds called furanocoumarins that can block an enzyme (CYP3A4) in the small intestine responsible for metabolizing certain drugs. This can cause higher-than-intended levels of medication to enter the bloodstream, potentially leading to increased toxicity and severe side effects. This interaction is particularly dangerous with specific chemotherapy drugs, such as paclitaxel, docetaxel, and vincristine, as well as other medications like statins and some anti-anxiety drugs. It is crucial to check with your healthcare team to see if your specific medication is affected.

Acidic Fruits and Mouth Sores

Chemotherapy can often cause mucositis, or mouth and throat sores, which are aggravated by acidic foods and drinks. If you develop these painful sores, avoiding highly acidic fruits and juices is strongly recommended. The acid can sting and irritate the delicate tissue, making eating and drinking very uncomfortable.

Fruits to be cautious with due to acidity:
- Lemons
- Limes
- Oranges
- Pineapple
- Tomatoes (often considered a fruit)
- Kiwi

Instead, opt for milder, low-acid alternatives like bananas, melons, or canned and cooked fruits.

The Neutropenic Diet and Raw Produce

For some patients, particularly those with blood cancers like leukemia or those undergoing intensive chemotherapy, the risk of infection is so high that doctors may recommend a neutropenic diet. This food safety-focused plan typically advises avoiding all raw fruits and vegetables, even washed ones, as they can carry bacteria that a weakened immune system cannot fight off.

Raw fruits to avoid on a neutropenic diet:
- All unwashed fruits
- Fruits with rough or thin skins that are hard to clean, such as raspberries, blackberries, and strawberries
- Pre-cut or pre-packaged fresh fruit

For these patients, cooking, canning, or freezing fruits can make them safe to eat.

Comparison Table: Fruits to Avoid vs. Safer Alternatives


Reason for Concern	Fruits to Be Cautious With	Safer, Low-Risk Alternatives
Drug Interactions	Grapefruit, Seville oranges	Oranges (unless you have mouth sores), apples, bananas, berries
Acidity & Mouth Sores	Lemons, limes, oranges, pineapple, tomatoes	Bananas, melons, applesauce, canned peaches, nectars
Infection (Raw/Unwashed)	Unwashed produce, pre-cut fruit, berries, grapes	Well-washed and peeled thick-skinned fruits (bananas, mangoes), cooked or canned fruits, pasteurized juices

Simple and Safe Fruit Preparation

Regardless of your specific immune status, practicing excellent food safety is paramount. The American Cancer Society recommends thorough washing, but additional precautions are wise when you're immunocompromised.

Proper Washing: Even if you're not on a neutropenic diet, wash all fresh produce under running water. Use a vegetable brush to scrub items with firm skins like apples, melons, and citrus.
Cooking: If your doctor advises avoiding raw produce, cooking fruits is a safe and delicious option. Examples include baked apples, poached pears, and homemade fruit compotes.
Canning and Freezing: Commercially canned or frozen fruits are safe alternatives. Ensure any packaged goods are not past their use-by or expiration date.
Pasteurized Juices: Opt for pasteurized fruit juices to ensure any harmful bacteria have been eliminated.

Conclusion

Fruits are a vital source of vitamins, minerals, and antioxidants, but a thoughtful approach is needed during chemotherapy. Avoiding grapefruit is essential due to potential drug interactions, while limiting acidic fruits helps manage mouth sores. For those with compromised immunity, a temporary switch to cooked or safely prepared fruits is a necessary precaution to prevent infection. Always discuss your dietary plan with your oncology team to ensure it supports your treatment and recovery while minimizing risks. For more reliable information on managing your diet during cancer treatment, consider resources from reputable organizations like Cancer Research UK.

Frequently Asked Questions

No, grapefruit should be strictly avoided during chemotherapy as it can interfere with how certain drugs are metabolized, potentially leading to dangerous side effects or increased drug toxicity.

If you have mouth sores, avoid acidic fruits like lemons, oranges, limes, pineapple, and tomatoes. Their high acid content can cause pain and irritation.

Berries like raspberries and blackberries can be difficult to clean thoroughly and may be restricted on a neutropenic diet for immunocompromised patients. Cooked or frozen varieties are often safer.

A neutropenic diet is a food safety plan for patients with low white blood cell counts. It often requires avoiding all raw fruits and vegetables, washed or not, to prevent infection from bacteria.

Yes, canned and cooked fruits are generally considered safe because the heat used in processing or preparation eliminates harmful bacteria. They are often recommended for those on a neutropenic diet.

Safe, non-acidic fruit options include bananas, melons (like honeydew), applesauce, and canned peaches or pears.

For immunocompromised patients, it is best to avoid store-bought pre-cut fruit entirely due to the higher risk of contamination during preparation and handling.