Neutropenic Diet Benefits: Fact or Fiction?

 For a number of years the Neutropenic Diet below has been recommended for patients undergoing chemotherpy and stem cell/bone marrow transplants. However, recent studies question the value of following the diet as strictly as it is written. See the article below. Nearly everyone agrees that fresh vegetables and fruits, fresh juices, and raw eggs should be prohibited from the patient's diet. But, the criteria for dietary restrictions vary widely between hospitals.

Neutropenic Diet by gerrymattingly

The Benefit of the Neutropenic Diet: Fact or Fiction? 

Chemotherapy has had a major impact on the survival rates of patients with cancer, particularly those with hematologic malignancies. Neutropenia due to chemotherapy is the major risk factor for infection [1]. Several studies [2, 3] reported the isolation of gram-negative organisms such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella, and Proteus from a variety of foods, particularly salads, fresh vegetables, and cold meats. Aspergillus, a fungus often lethal to patients with prolonged neutropenia, was found to be isolated from food, water, and ice [4].

The movement of these bacteria from the gastrointestinal tract (GI tract) to other body sites, called bacterial translocation [5], is thought to cause many of the infections in patients with neutropenia. Deitch et al. [6] demonstrated that bacteria in the GI tract can travel through the intestinal mucosa to infect mesenteric lymph nodes and body organs. Bacterial overgrowth, immunosuppression, physical disruption of the gut by chemotherapy or radiotherapy, slowed peristalsis due to narcotics or antidiarrheal agents, trauma, and endotoxins are factors contributing to bacterial translocation [7]. Theoretically, bacterial translocation can be decreased by reducing sources of pathogenic bacteria from food and decreasing the bacterial burden of the gut with oral nonabsorbable antibiotics.

The above studies led to the use of the neutropenic diet. The neutropenic diet is also called a sterile diet, low microbial diet, or a low bacterial diet (LBD). However, a standardized definition of the neutropenic diet has not been established [8, 9]. Variations of the neutropenic diet include an exclusively sterile diet (e.g., all foods that have been made sterile by canning, baking, autoclaving, or irradiation), a LBD (well-cooked foods only), or a modified house diet (i.e., a regular diet omitting fresh fruits and vegetables) [8–11].

The benefit of the neutropenic diet has never been scientifically proven [12]. Despite this, neutropenic diets are used in many institutions. A descriptive telephone survey by Todd et al. [11] looked at the use of LBDs for chemotherapy-induced neutropenia among 21 childrens' hospitals and found that (a) 43% of these hospitals used the neutropenic diet for neutropenic non–bone marrow transplant patients and (b) 86% of these hospitals used the neutropenic diet for bone marrow transplant patients. French et al. [13] surveyed 10 bone marrow transplant centers in Canada and northwestern United States and reported that 5 of the 7 responding hospitals used a neutropenic diet. However, the timing of the start of the diet and the food choices that were allowed varied with each institution. In a national survey, Poe et al. [14] found that 66% of responding transplant units enforced some type of modified microbial diet. Smith and Besser [9] surveyed 400 members of the Association of Community Cancer Centers (ACCC) and reported that 78% of the responding hospitals restricted diets of patients with neutropenia. The most commonly prohibited food items in these institutions were fresh vegetables and fruits, fresh juices, and raw eggs. Criteria for dietary restrictions varied between hospitals. The most common reasons for restricted diets were documentation of neutropenia defined as a white cell count <1,000 mm³ and documentation of risk factors for neutropenia such as recent chemotherapy.

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