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Cancer Diet Tips for Patients With Neutropenia

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Published on May 31, 2019

Julie Lanford, an oncology-certified dietitian, shares the four keys to food preparation and safety for cancer patients on a neutropenic diet. Tune in to learn about an evidence-based nutrition strategy for those with low blood counts or those at risk for infection.


Transcript | Cancer Diet Tips for Patients With Neutropenia

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Julie Lanford:

Hey, everyone.  This is Julie.  I am the cancer dietitian. And if you're not familiar with me, I come over here on Patient Power's page roughly once a month and talk about a variety of different nutrition topics. 

I am an oncology dietitian, which means to be a dietitian you have to have a four-year degree in nutrition and a supervised internship and pass an exam.  And then to be an oncology-certified dietitian I pass an oncology-specific nutrition exam every five years and have a certain number of practice hours.  So I always like to make sure that people know that when I give them the information that I'm sharing it not just from my personal opinion, that it is based on my training and expertise. 

And if you are a patient and you don't have a dietitian, I would encourage you to seek one out.  Some or many treatment centers have oncology on/OPBS staff, so it's really great to utilize that resource.  If you don't have one on staff, there might be one that your insurance company will cover for you to see.  The other thing is if you don't have access to anybody, I am online writing a website that's no charge for anybody to get information from.  So I'd be happy to have you join the community on Cancer Dietitian. 

But really today I'm here on Patient Power's page.  They're a great resource for patients to get all kinds of information, to advocate for yourself and to get the best care.  And today our topic is going to be about nutrition, especially if you have risk for infection. 

So a lot of people during treatment have maybe low blood counts, and that's something that we as dietitians get questions about a lot, so to today we're going to talk about if you've heard of the neutropenic diet, what is that and is it actually legitimate.  We will talk about maybe some foods or a nutrition strategy if your counts are low, what you can do.  And then more importantly, I think is to really pay attention to your food safety techniques at home in your home kitchen.  So we'll cover those three things, of course, in like 10 minutes time, which is really tight, but if you want more information, we will have other resources available to you. 

So, first off, what I'm going to start with is talking about the neutropenic diet, and what I want to do is actually pay attention to first of all what is neutropenia.  Many of you probably are used to looking at your lab results, which is a great practice to be pay attention to your labs, but when we talk about neutropenia we're really looking at blood neutrophils, and that number or what's on your lab work that you're looking at is your absolute neutrophil count or ANC.  And if you're below normal, then we call it neutropenia.  So that just means you're more susceptible to getting sick. 

Mild neutropenia is 1,000 to 1,500 for an ANC count, moderate is 500 to 1,000, and severe is below 500.  So when we're talking about the neutropenic diet or your risk for infection, for the most part we're looking at people who have severe neutropenia.  So your ANC counts are below 500, and a lot of times your doctor is telling you be extra careful, stay away from crowds of people, those kinds of things. 

And in the past we, doctors and nurses and dietitians, would often say, well, your counts are so low we want you to be really careful about the foods that you eat, and they might have suggested that you avoid fresh fruits and vegetables.  And we did that kind of out of extreme caution, but we actually have pretty good data at this point that that's not necessary and that when they've tested the neutropenic diet, which was avoiding those fresh fruits and vegetables and some other things and compared it to like a general hospital diet that we didn't see any better outcomes on the people through the neutropenic diet, and there were some studies that showed worse outcomes. 

So I think where we've arrived from an evidence-based perspective regarding the neutropenic diet and actual food safety when your counts are low is that we want you to use really good food safety practices and err on the side of being cautious.  So safe food handling is really, really important. 

And so those are things where rather than following a specific list of foods that you're not allowed to have we really want you and your caregivers to pay close attention to food handling, which also means that when you go out to eat if your counts are low, you probably want to stay away from things like buffets.  You want to be sure that you're at a restaurant that has a great grade for food safety.  I live in North Carolina, so we do have restaurant grades that you can see when you walk into the restaurant and it says the actual percentage that they got from the health inspector, so those are important things. 

But I think a lot of people don't realize that the rules for the restaurants are pretty strict, and the restaurants may actually be more clean.  Their kitchens are cleaner than a lot of us at home, and so there are some common sense we say food safety recommendations that maybe not everybody actually knows, and they're really important things especially if your counts are low.  But generally cancer patients are at increased risk of infection, so we do like to make sure that they are aware of food safety techniques for them and their caregivers. 

So we'll talk about those, but the second thing that I really want to hit on is talking about foods to boost blood counts, because that's a question that I get from my followers.  Sometimes I'll get an email or they'll ask me on Facebook, well, my counts are low.  What can I do to boost my blood counts?  And, you know, the bottom line is there's not any one food.  I wish that there was some kind of magical food I could tell you to eat, oh, just eat, who knows, blueberries, every single day, and magically your counts will come up, or have—some people I think they ask me about liver or organ meats, because somehow that's going to boost your blood. 

There's no evidence that there's any one food that will boost your blood.  Really, your blood is coming from blood marrow or bone marrow is building up your blood cells, and so we want to keep your whole body healthy so that you're able to produce the blood cells that is you need. 

So that said, what is most important is that you are well nourished.  And when we talk about kind of the building blocks of good nutrition especially doing cancer treatment, we want to build the base.  So the base of your nutrition plan should make sure that you have adequate calories, adequate protein, and that you're meeting the minimum requirements for a variety of nutrients. 

So most people are able to do that just with a good overall healthy diet.  The challenge in oncology and with working in cancer is that a lot of times you don't feel like eating, and so people don't realize, oh, I'm not eating that often.  Or you skip meals, or there might be a day when you just mostly drink your nutrition.  And so we do want to pay attention.  If it's a day here or a day there, you could get away with that. But if it becomes more of like a routine that you skip a meal or that you're not getting adequate calories and protein, that does take a toll on your body, and it makes it hard for your body to generate new blood cells or even to be able to support some of your cells that maybe were damaged as a side effect of your chemo or your other types of treatment.  And we need those calories, the protein and all the other nutrients to build that up. 

So the answer to are there any foods that boost your blood counts? No.  But can healthy eating boost your blood counts? Yes.  And sometimes healthy eating means let's just get enough calories and protein, and that might be milkshakes or Boost or Ensure, whatever nutrition supplement drink you're using.  But if you're able to eat foods, we want you to get a good overall variety of foods in your diet.  So that's kind of the short and the long answer about that. 

And then the last thing that we're going to talk about is food safety.  So that's that piece about, well, the traditional neutropenic diet isn't really evidence-based.  It's not necessarily what we recommend, however it is really important if your counts are low, that you do practice almost like vigilant food safety.  And so there are four keys to food safety.  So the four keys are cleaning your food, keeping them separate from other foods that might contaminate them, cooking them to proper temperatures that would kill any bacteria that might be there, and then chilling them in the refrigerator promptly so that you're not letting your food sit out. 

So with cleaning it, the first step to keeping your food clean is to actually wash your hands.  So we talk a lot about hand washing, especially in flu season, but every time you go to prepare food, whoever's preparing it, of course you need to wash your hands, scrub them between your fingers, under your nails, all the way up your wrist every time you're getting ready to prepare food. 

Then you want to wash your food off.  You don't need to use soap or special washes but make sure that you're washing like your fresh fruits and vegetables.  You can wash them.  Use a scrub brush.  It's better than using soap.  You don't want to put soap on your food, because it's hard to get it off.  And then making sure that the surfaces in your kitchen are clean. 

The next thing is don't cross-contaminate your foods.  So a lot of people kind of have been taught this.  If you are cooking meat and you use a cutting board for the raw meat, don't use that same cutting board for your fruits and vegetables to cut on.  You want to keep those separate.  You want to make sure if you're grilling your food and you're taking the raw meat out to the grill, don't reuse that same plate when you get your cooked food off the grill.  You want to keep that raw meat separate from the cooked food. 

Same thing, you know, fruit and vegetable handling, we don't see an increased risk in bacterial infection by eating fresh fruits and vegetables as long as they are handled properly.  Now, if you are concerned, because some people think, well, I don't know about, you know, I've heard about food?borne illnesses like from lettuce, people had those outbreaks.  If you're concerned about the fresh fruits and vegetables and you don't know where they got picked or how they were handled and it just makes you nervous, you can choose to eat cooked fruits and vegetables or canned fruits and vegetables.  Those kinds of things do help to maintain control over exposure to bacteria. 

Cooking them to proper temperatures is another thing that you want to do.  Some people will need to use a food thermometer to make sure that the inside of the meats are cooked all the way to the temperatures that are recommended.  I'm not going to go through all those temperatures, but there's going to be a link in the comments that gives you a web page you can go to that gives you all kinds of information about how much temperature you should cook your meats to. 

And then the last thing is to make sure that you chill foods promptly.  So a lot of us have heard, you know, nightmare stories about going to a potluck or a picnic, and somebody had prepared a meal and it was potato salad or whatever it is that then made everybody sick, and it's not the food itself.  It's the fact that the food maybe sat outside at room temperature or hotter than room temperature for a little bit too long.  So the best thing to do for food safety is for anyone preparing food for you or a loved one is to make sure that once that food is prepared and served that it moves to the fridge sooner later than later. 

And if it's a big pot of food that's hot, it's better to separate it into smaller dishes that will refrigerate thoroughly quickly, rather than putting a huge pot of hot food in the fridge that's going to take hours for that whole thing to cool down.  So those are some of the tips regarding food safety. 

What I always like to tell my patients is that we want you—if you're able to eat fruits and vegetables, we want you to eat more of those, because they give you so much good nutrition.  And there are ways even if your counts are low for you to make sure that they're still food safe but that you can include them in your diet.  Because once you start restricting what you're able to eat, it also makes it really hard to meet your nutrition needs because you might not feel like eating the same thing over and over and over again. 

Especially for those of you who might be on a maintenance therapy or something that's going to last a long time, you don't want to have to restrict your food intake unnecessarily.  If there's a good reason to hold some boundaries around the food you're eating, that's, of course, a good strategy, but you want to make sure you're doing it with your doctor's advice and with your dietitian, if there's one available to you, but also something that takes into account what you prefer to eat.  What do you like to eat?  What gives you, you know, nourishment and joy when it comes to something that you have to do multiple times a day. 

So that's the quick and dirty tips on your eating for a low blood count.  And if you have any questions, I'll kind of keep an eye on the comments to see if there are any questions that come up that need clarification.  And hopefully this was helpful to you and answered some questions.  So thank you, Patient Power for hosting this, and I look forward to seeing you next month. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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