Overview

Eating safely if you have neutropenia

Important

This information is produced for adults under the care of Guy’s and St Thomas’ hospitals. We usually give you the information after an assessment or appointment. Your dietitian or other health professional may give you different guidance, depending on your specific medical needs.

It is important to check with a health professional before making any changes to your diet. Please contact your dietitian if you have any questions or concerns.

If you are not a patient at Guy’s and St Thomas’ hospitals, please contact a GP or specialist health professional.

This information is intended to help you if you:

  • are having cancer treatment, such as chemotherapy, a stem cell transplant or a bone marrow transplant
  • may get neutropenia

Neutropenia is a condition where you have a low number of white blood cells called neutrophils in your blood.

If your neutrophil level decreases, you are more likely to get an infection from germs like bacteria or fungi. This is because your immune system may not work as well as usual.

It is important to take extra care if you have neutropenia and make sure that you eat safely. If your neutrophil level is less than 1.5 x 109/L, you will need to follow this guidance. Your cancer (oncology) team can tell you your neutrophil level.

During your hospital stay

If you are staying in hospital, all food that we give you will meet safety regulations and be safe to eat.

It is still important to take safety precautions. 

Do

  • wash and dry your hands before meals
  • store food correctly and check that the use-by date has not passed
  • cover food when opened and use it within 24 hours
  • eat any food brought in while it is hot or make sure that this is stored correctly in the fridge
  • make sure that any food brought in has come from clean, reputable shops, and been stored and cooked according to the manufacturer's instructions
  • make sure that the food hygiene rating is 5 if you order any takeaways

At home

Here is some guidance on how to eat safely at home:

Do

  • wash and dry your hands before cooking and eating
  • protect any cuts and wounds before handling food
  • keep raw and cooked meats separately when storing them
  • store raw meats at the bottom of the fridge to prevent contamination
  • use different chopping boards for fruit and vegetables, cooked meats and raw meats
  • clean all surfaces in a suitable way before and after cooking
  • check the use-by and sell-by dates before buying or eating food
  • always cover your food to prevent contamination
  • defrost food in the fridge rather than at room temperature
  • make sure that all reheated food is piping hot before eating it (the food needs to reach 70C or above for 2 minutes)
  • avoid buffet food and open salad or deli bars in restaurants and supermarkets
  • make sure that the food hygiene rating is 5 if you go to a restaurant or order a takeaway

Don't

  • do not overload your fridge or freezer because this can increase the temperature and make food unsafe to eat
  • do not reheat rice or takeaway food, as harmful bacteria can survive the heating process

Food safety guidance

The following table lists foods that it is best to avoid if you have neutropenia and safer options:

  Foods to be avoided Safer options

Meat and poultry
  • Raw or undercooked meat and poultry, such as meat that is still pink or rare steak
  • Smoked or cured (coated with salt) meat, such as salami and Parma ham
  • Unpasteurised (raw) pâté
  • Well-cooked meat and poultry (the juices should run clear and there should be no pink showing)
  • Smoked or cured meat that is cooked and piping hot
  • Cooked, cold, sliced meats from a packet, which you eat according to the manufacturer's advice
  • Pasteurised meat or paste in a tin or jar with the bacteria removed by a special heating process
Fish and shellfish
  • Smoked fish, such as smoked salmon and trout (there is a risk of getting a bacterial infection called listeriosis)
  • Sushi with raw fish
  • Raw or lightly cooked shellfish (you need to avoid this for life)
  • Vacuum-packed fish that you eat straight from a new packet
  • Well-cooked shellfish, such as prawn curry
  • Well-cooked fresh, frozen or tinned fish
Milk and yoghurt
  • Unpasteurised milk and yoghurt (they can be found in some markets and from farms)
  • Probiotic foods, drinks or supplements containing live bacteria and yeasts, such as Yakult®, Actimel®, Proviva® and Kefir®
  • Yoghurt described on the label as probiotic
  • Pasteurised milk and yoghurt (those found in supermarkets are pasteurised)
  • Any yoghurt that does not describe itself as probiotic, such as live, plain, Greek and fruit yoghurts
Cheese
  • Soft, ripened cheeses, such as brie, camembert, goats' cheese and blue-veined cheese like blue stilton
  • Soft goats' and sheep's cheeses
  • Cheese made with unpasteurised or raw milk, such as parmesan
  • Pasteurised cheeses (you need to check the labels but most hard cheeses are fine)
  • Processed cheese, cream cheese, Kraft® natural cheese and cottage cheese
  • White stilton cheese
  • Soft unpasteurised cheeses that have been thoroughly cooked until steaming hot
Eggs
  • Raw or undercooked eggs
  • Raw egg products, such as homemade mayonnaise, homemade ice cream, mousse, eggnog (a drink made from milk, sugar and eggs, often mixed with alcohol) and Hollandaise sauce (a creamy sauce made from egg yolk, melted butter and lemon juice)
  • Duck, goose or quail eggs, unless cooked thoroughly until the whites and yolks are solid
  • Cooked eggs, such as hard-boiled eggs and scrambled eggs
  • Mayonnaise that you buy in the shops and other products made with pasteurised egg
Fruit and vegetables
  • Unwashed fruit, vegetables and salad
  • Damaged or overripe fruit and vegetables
  • Uncooked sprouted seeds
  • Fresh fruit and vegetables that have been washed well
  • Tinned fruit
  • Freshly prepared, washed salad
  • Sprouted seeds that have been cooked until they are steaming hot throughout before eating
Ice cream
  • Unpasteurised ice cream
Other types of foods
  • Black pepper, herbs and spices that you buy as loose products (without packaging) from deli or farm shops
  • Foods that you buy loose (without packaging) from "refill stations", such as cereals, nuts and dried fruits
  • Black pepper, herbs and spices that are pre-packed in fresh sealed jars from the supermarket
  • Sealed packages that you buy from the supermarket, such as cereals, nuts, dried fruits and biscuits

Useful information

The following organisations publish useful information about eating safely if you have neutropenia:

Blood Cancer UK

Eating safely with neutropenia

British Dietetic Association

Neutropenic dietary advice for haematology patients (May 2023)

Macmillan Cancer Support

Food safety when your immunity is low 

Print this resource

Resource number: 5484/VER1
Last reviewed: May 2024
Next review due: May 2027

A list of sources is available on request.

Trusted Information Creator. Patient Information Forum

Contact us

If you have any questions or concerns, please contact the cancer (oncology) dietitians in the nutrition and dietetics department.

Phone: 020 7188 2010 (Monday to Friday, 9am to 5pm)

If we cannot answer your call, please leave us a message and we will phone you back.

Email: [email protected]

We aim to reply to emails within 2 working days.

Pharmacy medicines helpline

If you have any questions or concerns about your medicines, please speak to the staff caring for you. You can also contact our pharmacy medicines helpline.

Phone: 020 7188 8748, Monday to Friday, 9am to 5pm

Email: [email protected]

We aim to reply to emails within 2 working days.

Related content

Do you have any comments or concerns about your care?

Contact our Patient Advice and Liaison Service (PALS)

Is this health information page useful?