Cancer: Healthy Eating for Adults and Children with Low White Cell Counts (Low Microbial Diet) HF#476

Your white blood cell count tells how well your body can fight off infections.  Because you have a low white cell count, you are at greater risk of getting sick from foods containing microbes.  Microbes (which include bacteria, viruses, yeasts and molds) can get into food during processing or preparation.

 

This handout includes suggestions for food safety, healthy eating and water safety to help you avoid food-borne illness.  Using safe food preparation methods is always important, but you may only need to follow the low microbial diet for a short time.  Your doctor will provide guidelines as to when the diet is no longer needed. 

 

FOOD SAFETY SUGGESTIONS

 

Safe Food Handling

• Wash hands often – before, during and after you prepare food, and before eating.  Use plenty of warm water and soap, and wash hands for at least 20 seconds. 
• Clean work surfaces and utensils with plenty of hot water and soap.  Use paper towels or clean cloths instead of sponges. 
• Use separate cutting boards for raw meat, poultry and seafood than you use for other foods.  Choose plastic, glass or marble cutting boards instead of those made of wood. 
• Check “sell by” and “use by” dates – do not use if the food is out of date.
• Thaw meat, fish, and poultry in the refrigerator – not on the counter. 
• Wash fruits and vegetables well, under running water before peeling and/or cutting.
• When microwave cooking, use a loose-fitting lid or vented plastic wrap to cover food.  Rotate the cooking dish and stir often.  Bacteria can survive in cold spots of food.

Safe Food Storage

• Keep cold foods cold (less than 40°F) and hot foods hot (greater than 140°F).  Purchase a food thermometer to check your food in storage and during cooking.
• Store eggs inside the refrigerator, not in the door.  The temperature inside the refrigerator is more consistent.
• Do not leave cooked meats or other foods out at room temperature for longer than 2 hours.
• Use leftovers within 2 days.  Reheat to 165°F.  Reheat only once

Grocery Shopping

 

• Do not buy or use goods from cans that are rusted, swollen or dented.
• Check that packaged and boxed foods are sealed.
• Select fruits and vegetables that look and smell fresh.
• Avoid foods from delis, including prepared salads and sliced meats and cheeses.
• Avoid tasting free food samples.
• Shop for perishables last and take them home right away.

Special Tips for Eating Out

Check the condition of the restaurant.  Are the plates, glasses and utensils clean?  Are the restrooms clean and stocked with soap and paper towels?  How clean the restaurant looks may tell the amount of care taken while preparing the food.

• Ask that food be prepared fresh in fast food places. 
• Ask if fruit juices are pasteurized.
• Avoid raw fruits and vegetables; save these items for home, where you can wash them and prepare them safely.
• Ask for single serving, packaged condiments.
• Avoid salad bars, delis, buffets, potlucks and sidewalk vendors.

 

 

Healthy Eating Suggestions

 

Food Groups	Recommended	Not Recommended
Fruits and Vegetables	Well-washed and peeled thick skinned fruits (such as citrus, bananas, melons, apples) Well-washed raw vegetables Cooked and canned fruits and vegetables Cooked frozen fruits and vegetables Pasteurized juices and frozen juice concentrates Commerically packaged dried fruits Shelf-stable bottled salsa (refrigerate after opening) Cooked vegetables sprouts (such as mung bean sprouts Fresh, well-washed herbs, and dried herbs and spices (added to raw or cooked foods)	Unwashed fresh fruits or vegetables Fresh fruits or raw vegetables that cannot be thouroughly cleaned (such as strawberries, raspberries, peaches, plums) Any frozen berries Non-pasteurized items containing raw fruits or vegetables found in the grocery refrigerator case (such as fresh salsa) Unwashed fresh herbs Raw vegetable sprouts (alfalfa sprouts, clover sprouts, mung bean sprouts) Salads from the deli

 

Food Groups	Recommended	Not Recommended
Bread, Cereal, Rice and Pasta	All breads, bagels, rolls, English muffins, muffins, pancakes, sweet rolls, waffles and French toast Potato chips, corn chips, tortilla chips, pretzels, popcorn Cooked grains and grain products, including pasta and rice All cereals, cooked and ready-to-eat	Raw (not baked or cooked) grain products (such as raw oats)
Dairy	All pasteruized Grade 'A' milk and milk products (such as yogurt, ice cream, frozen yogurt, sherbet, milkshakes, eggnog, cottage cheese, cream cheese, ricotta cheese, processed cheese slices and spreads) Dry, refriegerated or frozen pasteurized whipped topping Commerically packaged hard and semi-soft cheeses (such as cheddar, mozzarella, paremsan, Swiss, Monterey Jack) Cooked soft cheeses (such as brie, camembert, feta, farmer's cheese)	Non-pasteurized or raw milk products made from non-pasteurized or raw milk Soft-serve ice cream or frozen yogurt Cheeses from the deli Goat cheese Uncooked soft cheeses Cheese containing chilii peppers or other uncooked vegetables Cheeses with molds(such as bleu, Stilton, Roquefort, gorgonzola
Meats, Beans and Nuts	Well-cooked meats and seafood (poultry>165°F; ground beef >160°F, beef, pork, fish >145°F) Canned meats and fish Eggs cooked untl both white and yolk are firm Pasteruized eggs and egg substitutes (such as Egg Beaters® ) Powdered egg white (can be used uncooked) Commerically packaged salami, bologna, hot dogs, ham and other lunch meats, heated until steaming Canned and shelf-stable smoked fish (refrigerate after opening) Pasteurized or cooked tofu Bacon cooked crisp (made at home) Canned or bottled roasted nuts Nuts in baked products Commercially packaged nut butters (such as peanut butter, almond butter, soybean butter)	Raw or undercooked meat, poultry, fish, game, tofu Raw or undercooked eggs and non pasteurized egg substitutes (no eggs over easy, soft boiled or poached eggs) Meats and cold cuts from the deli Hard cured salami in natural wrap Mollusks (clams, mussels, oysters) Uncooked refrigerated smoked seafood such as salmon or trout labeled as 'nova-style,' 'lox,' 'kippered,' 'smoked,' or 'jerky' Raw fish (such as sushi) Tempe (tempeh) and miso products Unroasted raw nuts Roasted nuts in the shell

 

 

Fats and  Oils	Vegetable oils and shortening Refrigerated lard, margarine, butter Commerical, shelf-stable mayonnaise and salad dressings, including Blue cheese and other cheese-based salad dressing (refrigerate after opening) Cooked gravy and sauces	Fresh salad dressings (stored in the grocery refrigerator case) containging raw eggs or cheeses listed in the "Not Recommened" column noted earlier
Desserts	Refrigerated commercial and homemade cakes, pies, pastries and pudding Refrigerated cream-filled pastries Cookies, both homemade and commercially prepared Shelf-stabled cream-filled cupcakes (such as Twinkies, Ding Dongs) and fruit pies (such as Poptarts® and Hostess® fruit pies) Canned and refrigerated puddings Popsicles and ices Candy,  gum	Un-refrigerated cream-filled pastry products (not shelf-stable) Cookie dough containing raw eggs

 

Other	Commercial pasteurized grade A honey Salt, granulated sugar, brown sugar Jam, jelly, syrups (refrigerate after opening) Catsup, mustard, BBQ sauce, soy sauce, other condiments (refrigerate after opening) Pickles, pickle relish, olives (refrigerate after opening) Vinegar	Raw honey; honey in the comb Herbal and nutrient supplement preparations Brewers yeast, if uncooked
Beverages	All canned, bottled and powdered beverages Instant and brewed coffee Herbal teas brewed from commerically packaged tea bags Commerical nutritional supplements, both liquid and powdered Commerically sterile ready-to-feed and liquid concentrate infant formulas (avoid powdered infant formulas if a ready-to-feed or liquid concentrate alternative is available)	Fountain beverages Non-pasteurized fruit and vegetable juices, apple cider or eggnog Tea made with loose leaves Wine Non-pasteurized beer  (Note: Alcoholic beverages should only be consumed after physician approval)

 

Nutritional Supplements
Until your eating habits return to normal, a balanced multi-vitamin with 100% of the “daily value” is best.   There is no evidence that large doses of certain vitamins are helpful.  In fact, large doses may cause harm.  This does not include those prescribed by your doctor.
Ask your doctor before taking any herbals or supplements.  Some can be toxic or contain mold.  For further questions see Health Facts for You #5720.

WATER SAFETY GUIDELINES
You may want to check with your local health department and water utility about your water source as well as the safety of tap water.

Tap Water
In most cases, tap water from a city water supply or municipal well is thought to be safe if the water is disinfected.  However, not all communities disinfect their public water supplies.  In this case, it should probably not be assumed to be safe.  We suggest checking with your local community to see if they disinfect the water.  If they do not disinfect, then the water should brought to a rolling boil for one minute before drinking.  Large amounts of water can be boiled and then stored in your refrigerator.

If you use a water filter on your household water tap, these specifications must be met:

• The filters must be designed to filter by reverse osmosis or can remove particles less than or equal to 1 micrometer in diameter
• The water tap filter must be installed immediately before the water tap

Portable water filters (such as Brita® or Pur® system) as well as refrigerator-dispensed water and ice machines do not meet the standards.
For a list of approved systems, call the National Sanitation Foundation International, at 1-800-673-8010 or visit their home page at www.NSF.org (Go to the section entitled “Home Water Treatment Devices”).

 

Well Water
Well water must be tested at least once a year and if possible more often to make sure it is free of germs and chemicals.  The water should be tested right before the start of your cancer treatment. The test results must be negative for germs and chemicals, before you can drink it.  If you have further questions about contaminants in your well you can check the Centers for Disease Control website at: http://www.cdc.gov/ncidod/dpd/healthywater/factsheets/contaminants.htm

 

Safe Water Sources (not from a city water or municipal well supply.)

 

• Boiled and Distilled Water -  Bring tap water to a rolling boil for 1 minute.  Distilled water can be  made using a home distiller.  Store in a clean, covered container in the refrigerator and discard within 72 hours.
• Bottled Water-  Look for water labeled reverse osmosis treated, distillation, or filter capable of removing particles less than or equal to 1 micrometer in diameter.

To confirm that specific bottled water has undergone one of the above processes, contact the International Bottled Water Association (IBWA) at 1-800-928-3711, or visit their home page at www.bottledwater.org (Go to the section titled “What is IBWA” and click on the link “Brand List”).  If the IBWA does not have information on a specific brand, call the bottling company directly.

 

If you are a patient of UW Health and have further questions, please contact your doctor for a referral to a UW Health nutritionist.

 

Donna Weihofen, MS, RD 600 Highland Avenue Madison, WI 53792-1510 (608) 263-9128

Megan Waltz, MS, RD 600 Highland Avenue Madison, WI 53792-1510 (608) 263-8265

 

 

The Spanish version of this HFFY is # 483

 

 

 

 

 

 

 

 

 

 

 

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 08/14/2012

Copyright © 03/26/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#476

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