Which food is allowed on a neutropenic diet?

December 11, 2025 •

4 min read

According to MD Anderson Cancer Center, a neutropenic diet is sometimes prescribed for those with weakened immune systems to protect against foodborne bacteria. This diet centers on avoiding foods that may contain harmful microbes and focusing on safe preparation, but knowing which food is allowed on a neutropenic diet can be confusing.

Quick Summary

A neutropenic diet emphasizes safely prepared foods, such as thoroughly cooked meats and pasteurized dairy, while strictly avoiding raw or undercooked items to reduce infection risk. Adhering to strict food safety and hygiene protocols is essential.

Key Points

Well-Cooked Proteins: All meat, poultry, and fish must be cooked thoroughly until well-done to eliminate bacteria.
Pasteurized Dairy Only: Opt for pasteurized milk, cheese, and yogurt, and avoid unpasteurized or raw milk products.
Cooked and Safe Produce: Eat cooked, canned, or frozen vegetables. Choose thick-skinned, washed, and peeled raw fruits like bananas and oranges.
Avoid Raw Foods: Steer clear of raw or undercooked items, including sushi, deli meats (unless heated), raw eggs, and sprouts.
Practice Excellent Hygiene: Maintain strict kitchen cleanliness, wash hands frequently, and use separate cutting boards for raw meat and produce.
Check Labels: Ensure dairy, juices, and other processed foods are commercially packaged and pasteurized.
Consult Your Provider: Discuss your specific dietary needs with a healthcare professional, as guidelines can vary depending on your treatment.

Understanding the Neutropenic Diet

For individuals with a weakened immune system, often due to cancer treatments like chemotherapy, the risk of infection from common foodborne bacteria is significantly higher. A neutropenic diet, also known as a low-bacterial or low-microbial diet, is designed to reduce this risk by focusing on foods and preparation methods that minimize exposure to harmful microorganisms. Though some debate exists over its necessity in all cases, especially due to its restrictive nature, proper food safety is universally recommended. The foundation of this diet is simple: cook all foods thoroughly, avoid raw ingredients, and ensure all products are pasteurized and hygienically handled.

Safe Food Choices on a Neutropenic Diet

Following a neutropenic diet means being diligent about what you eat. The goal is to choose foods that are unlikely to harbor bacteria and to prepare them in a way that kills any potential pathogens. This includes a wide range of proteins, grains, and dairy products, as well as carefully selected and prepared fruits and vegetables.

Proteins

Well-cooked meats: All fresh meat, poultry, and fish must be cooked until well-done, with no pink remaining. For ground meats, poultry, beef, and lamb, internal temperatures should reach recommended safety levels.
Canned and shelf-stable products: Canned tuna, salmon, or chicken are safe options. Canned and commercially packaged beef or turkey jerky are also permitted.
Pasteurized eggs: Eggs should be cooked thoroughly until both the yolk and white are firm. Pasteurized egg substitutes are also safe.
Cooked tofu: Tofu should be cooked thoroughly to eliminate any potential bacteria.

Dairy

Pasteurized dairy products: All milk, cheese, and yogurt should be pasteurized. This includes commercially packaged cheeses like cheddar, American, and mozzarella.
Commercially packaged items: Commercially made ice cream, sherbet, and puddings are typically safe. Shelf-stable or pasteurized cream cheese and ricotta are also allowed.

Fruits and Vegetables

Cooked and canned produce: All cooked, frozen, or canned vegetables are safe. Cooked, canned, or pasteurized frozen fruits and juices are also acceptable.
Washed and peeled raw fruits: Thick-skinned fruits that are thoroughly washed and peeled immediately before eating, such as bananas, oranges, and mangoes, can be included.
Washed raw vegetables (varies by center): While older guidelines advised against all raw produce, some modern protocols allow well-washed raw vegetables without cuts or bruises, like carrots, peppers, and cucumbers. Always confirm with your healthcare provider.

Grains and Starches

Packaged and cooked grains: All commercially packaged breads, cereals, crackers, rice, and cooked pasta are allowed.
Cooked potatoes: Cooked potatoes, sweet potatoes, and yams are safe.

Comparing Allowed and Restricted Foods


Food Category	Allowed on Neutropenic Diet	Avoid on Neutropenic Diet
Meat & Poultry	Well-cooked chicken, beef, pork; canned tuna; commercially packaged, heated deli meat	Rare/medium-rare meat; sushi; raw seafood; deli meat directly from the counter
Dairy	Pasteurized milk, cheese, yogurt, ice cream; shelf-stable dressings	Unpasteurized milk or yogurt; soft cheese (Brie, Feta) unless cooked until steaming hot; blue cheese
Fruits	Canned fruits; frozen fruits; thoroughly washed and peeled thick-skinned fruits	Unwashed raw fruit; unpasteurized juices; berries or other raw fruits that cannot be peeled
Vegetables	Cooked, frozen, or canned vegetables; washed and scrubbed firm produce	Raw vegetables (especially leafy greens) unless washed thoroughly; unpeeled raw produce; sprouts
Eggs	Well-cooked eggs (firm yolk and white); pasteurized egg substitutes	Raw or undercooked eggs (runny yolks); foods containing raw eggs, like certain salad dressings
Nuts & Spreads	Commercially packaged roasted nuts; commercially packaged nut butters	Raw nuts; nuts from bulk bins; fresh-ground nut butters

Food Preparation and Safety Guidelines

Beyond just choosing the right ingredients, proper food handling is paramount to a successful neutropenic diet. The CDC provides guidelines for preventing infections, which are especially critical for those with low neutrophil counts. Key practices include:

Hygiene: Wash hands with warm, soapy water for at least 20 seconds before and after handling food. Use separate cutting boards for raw meats and fresh produce to avoid cross-contamination. Sanitize all utensils and surfaces with hot, soapy water.
Storage: Keep cold foods below 40°F and hot foods above 140°F. Store leftovers in shallow containers to cool quickly and consume them within 48 hours. Never thaw frozen items on the counter.
Cooking Temperatures: Always use a food thermometer to ensure meats, poultry, and seafood are cooked to the recommended safe minimum internal temperatures.
General Avoidances: Stay away from buffet-style restaurants, salad bars, and deli counters. Avoid food and condiments in shared containers.

A Varied and Safe Approach

While the traditional neutropenic diet was highly restrictive, modern approaches, often called 'food safety guidelines,' are more flexible. The emphasis has shifted to ensuring all food, particularly high-risk items, is handled with extreme caution rather than eliminating entire food groups. A balanced, nutrient-dense diet is crucial for recovery, and unnecessary restrictions can limit important nutrients. Always consult with a registered dietitian or your oncology team to create a meal plan that is safe and meets your nutritional needs. They can provide the most current recommendations based on your specific treatment and health status. The best practice is to focus on thoroughly cooked meals, pasteurized products, and impeccable kitchen hygiene, rather than adhering to outdated, overly strict rules. Blood Cancer UK offers updated perspectives on eating safely.

Conclusion

For those on a neutropenic diet, focusing on safe food preparation is more critical than blanket restrictions. Allowed foods include thoroughly cooked meats, fish, and eggs, along with pasteurized dairy products and commercially packaged grains. Cooked, canned, or certain washed and peeled fresh fruits and vegetables are also safe additions. By adhering to strict kitchen hygiene and cooking protocols, individuals can maintain a varied and nutritious diet while significantly reducing the risk of foodborne infection. It is vital to discuss specific dietary needs and restrictions with your healthcare provider to ensure the safest and most effective plan for your situation.

Frequently Asked Questions

Older guidelines for a neutropenic diet often restrict all raw vegetables. However, some modern protocols, and many cancer centers, now permit raw vegetables that can be thoroughly washed and scrubbed, such as carrots or peppers, especially if they have a smooth surface. Always follow the specific advice of your healthcare provider.

Yes, but with precautions. You can eat fresh, thick-skinned fruits like bananas, oranges, and mangoes, provided they are thoroughly washed and peeled right before eating. Fruits that cannot be peeled or thoroughly scrubbed, such as berries, should be avoided or cooked.

No, yogurt or other dairy products containing live or active cultures are generally not recommended on a neutropenic diet because of the potential for introducing microbes. Stick to pasteurized dairy without active cultures.

Leftovers are acceptable but must be handled with care. They should be refrigerated promptly within two hours of cooking and consumed within 48 hours. Reheat leftovers thoroughly to a steaming hot temperature.

No. Only commercially packaged, roasted nuts without the shell are allowed. Raw nuts, nuts from bulk bins, and roasted nuts in their shells should be avoided due to the risk of bacterial contamination.

Tap water from a municipal supply is generally safe. Bottled water should be labeled as distilled, filtered, or purified via reverse osmosis. Well water must be boiled for at least one minute before use.

Individuals with neutropenia have very low white blood cell counts, which compromises their ability to fight off infections. Bacteria that are harmless to others can cause severe illness in a neutropenic person, making strict food safety measures critical.