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Treatment Support Guidelines > Diet for Immune Suppressed

Last update: 04/04/2014

Diet for Immunosuppressed

Adapted from:  Fred Hutchinson Nutritional Guidelines for the profoundly
immunosuppressed patients undergoing stem cell transplant. 
 
These guidelines should NOT be considered a substitute for your doctor's advice.
TOPICS
Low Bacteria Diet | Food Tips for Managing Nausea and Oral Health  
Safe Shopping List for Nausea
Allowed in BEVERAGE GROUP
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All canned, bottled, powdered beverages
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Instant and brewed coffee

See caution on brewed teas =>
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Commercial bottled distilled, spring and natural waters
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Tap water - but only if from a validated city water service
Avoid in BEVERAGE GROUP
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Well water - unless tested yearly and found  safe (boil for 5 minutes if unsure)
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Un-pasteurized fruit ciders
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Brewed herb teas (NEW) 

Bacillus cereus is an emerging pathogen that causes invasive disease in immunocompromised hosts. A case-control study, prompted by a clinical case, demonstrated an association between dietary tea ingestion and B. cereus bacteremia. Policies designed to interrupt transmission of this pathogen to susceptible patients should be considered. Source


Allowed in DAIRY GROUP 
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All pasteurized milk and milk products, including cheese
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Non-dairy pasteurized cream products
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Dry, refrigerated and frozen pasteurized whipped topping; Ice cream;, frozen yogurt
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Sherbet, ice cream bars, milkshakes
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Commercial nutritional supplements and baby formulas - liquid and powdered
Avoid in DAIRY GROUP
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Un-pasteurized or raw milk products, including yogurts
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Cheeses containing chili peppers or uncooked vegetables
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Sharp cheddar, brie, camembert, feta cheese, farmers cheese
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Yogurt ("pasteurized" stated on label)
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Cheeses with molds, including: blue, Stilton, Roquefort, Gorgonzola
Allowed in DESSERT GROUP (see Caveat 1)
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Refrigerated commercial or homemade cakes, pies, pastries and pudding
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Homemade and commercial cookies
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Shelf-stable cookies, cream-filled cupcakes, fruit pies, pastries, pop tarts and puddings, Ices, popsicle-like products
Avoid in DESSERT GROUP
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Un-refrigerated cream-filled pastries,  cakes, cookies, and pies
Allowed  in FRUITS & NUTS GROUP
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Canned and frozen fruits and fruit juices
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Thick-skinned fresh fruits
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Well washed raw fruit
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Dried fruits
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Canned or bottled roasted nuts
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Nuts in baked products 
Avoid in FRUITS & NUTS GROUP 
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Unwashed raw fruits
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Thin-skinned fruits
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Un-roasted, raw nuts, nuts in a shell
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Salads from delicatessens
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Commercial salsas stored in refrigerated case of store
Allowed in BREADS & GRAIN GROUP
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Cooked and dry ready-to-eat cereals
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Cooked and canned legumes: lentils, split peas
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All breads, bagels, rolls, chips, crackers, muffins, pancakes,  popcorn, sweet rolls, waffles
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Refrigerated cream-filled pastries (see Caveat 1)
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Cooked pasta, rice, and other grains 
Avoid in BREADS & GRAIN GROUP
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Unrefrigerated, cream-filled pastry products
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Raw grain products
Allowed in  FATS GROUP (See Caveat 2)
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Oil, shortening,  lard, margarine and butter -  refrigerated after opening
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Commercial shelf-stable mayonnaise and salad dressings (including Roquefort, Blue cheese dressings) - when  refrigerated  after opening
Avoid in FATS GROUP
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Fresh salad dressings containing aged cheese  
(e.g., blue, Roquefort) kept in refrigerated  case in store
Allowed in OTHER GROUP (see Caveat 1)
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Soups
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Salt and granulated sugars, brown sugar
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Jams, jelly, syrups - refrigerated after opening
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Pasteurized honey
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Condiments refrigerated after opening, including
catsup, mustard, BBQ sauce, 
olives, pickles, relish; soy sauce,
vinegar candy, gum
Avoid in OTHER GROUP
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Raw or un-pasteurized honey
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Herbal and non-traditional (health food store) nutrient supplements (check with doctor before taking any supplements)
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Brewers yeast, if eaten uncooked
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All miso products (e.g., miso soup)
Allowed in MEAT GROUP
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All well cooked meats:  poultry, fish, shellfish, ham, bacon,  sausage and hot dogs
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Well cooked eggs (white cooked firm with thickened yolk is acceptable)
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Pasteurized egg substitutes (e.g., Egg Beaters)
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Commercial packaged salami, bologna, other luncheon meats. Hard smoked fish, refrigerated after opening
Avoid in MEAT GROUP
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Raw or undercooked meats
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Pickled fish
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Cold smoked salmon, lox (or other fish)
Allowed in VEGETABLE GROUP 
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All canned and frozen vegetables and potatoes
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Cooked fresh vegetables
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Well washed raw vegetables and fresh herbs (check with your doctor first)
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Dried herbs and spices (may be added during or after cooking and to raw foods) 
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Bottled and canned salsa, refrigerated after opening
Avoid in VEGETABLE GROUP
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Unwashed raw vegetables 
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Salads from delicatessens 
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Commercial salsas stored in refrigerated case of store

Food Tips for Managing Nausea and Maintaining Oral Health

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Getting adequate nutrition and liquids can be a challenge when you are experiencing nausea as a result of treatment.  
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Notify your doctor when the medications you are taking are not adequate to control the nausea
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Obtain prescriptions prior to treatment so that you can have medications on hand and begin to take them on time. 
 

General Food Safety Tips:

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Drink lots of liquids through a straw to bypass mouth sours. 
  
Hydration is important for all of these reasons: Fight constipation, 
reduces risks associated with medications that might affect the bladder and kidneys, 
Supports healing and general health.
 

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Boil well water or any liquids you suspect might not be free of bacteria.

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Have smaller portions, more frequently, instead of fewer larger meals.

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Cook foods until tender and soft.

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Avoid hot foods because they can burn the mouth and have stronger odors.

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Prepare cool dishes that will have less odor.  

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Use a cleaned blender to prepare purées and soups - to aid in digestion  

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Wash your hands before preparing and eating foods.

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Rinse your mouth with a saline,  baking soda, and water often, and after all meals. 

Safe foods shopping list - for managing nausea

Informing your health care provider is also extremely important so that your symptoms
can be monitored and prescribed medications can be modified if necessary.

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Limit 
 
Foods that are rich, sugary, and high in fat
Caffeine
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BEVERAGES - sip liquids slowly thru a straw: 
 
Seltzers
Ginger ale or tea
Tea with low-fat milk
Bottled water
Pasteurized fruit juices
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PROTEIN: 
 
Whey protein drink (for nutrition), blend with low fat milk
Egg - well-cooked, scrambled with toast
Chicken cutlet - broiled with light seasoning
Fish - non-oily - broiled neutral-tasting, such as flounder and scrod
Beans and rice - cooked, but do not season with strong spices
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GRAINS
 
(Be sure to rinse mouth after eating - see General Tips, above)
Crackers
Pretzels
Toast 
Pastina, Noodles - add to mild soup stocks
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FRUITS & VEGETABLES
 
Cooked, jarred and canned vegetables and fruit are safest
Baby food
Canned fruit - pears, apple sauce
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COOL SNACKS for liquid
 
Popsicles
Sherbet
Gelatins - flavored
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Resources
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Managing Nausea and Vomiting 
ccn.aacnjournals.org
  | cancerbackup.org.uk | thedietchannel.com 

 

Caveat 1:
Avoid excessive sugar. See Oral Health
Caveat 2:
Avoid fatty foods; they can contribute to nausea. 
 
Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
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