Rethinking Diet For Patients With Weakened Immune Systems
- A bone marrow transplant replaces original bone marrow with healthy bone marrow through an IV drip and the transplant will weaken a patient's immune system.
- The neutropenic diet (also called a sterile diet, low microbial diet, or a low bacterial diet), is a way of eating that may reduce the risk of developing bacterial infections from certain types of foods.
- Neutropenic diets remain in place in many institutions even though their usefulness is controversial.
- A new study present at American Society of Hematology (ASH) Annual Meeting confirms that a restrictive diet is an unnecessary burden for patients' quality of life.
"A bone marrow transplant is a therapy where your bone marrow and your blood cells are completely replaced by someone else's bone marrow cells and blood cells," says Dr. Jun Choi, a hematologist-oncologist at NYU Langone's Perlmutter Cancer Center.
Read MoreNeutropenic diet
Low-microbial diet, also know as neutropenic diet, is an eating plan for people with weakened immune systems. It involves choosing foods and preparing them in a way that lowers your risk of foodborne illness.“Infections represent a significant risk to patients receiving stem cell transplantation for hematologic malignancies, especially during periods of neutropenia. Historically, restrictive diets or ‘low microbial’ diets have been used in an effort to reduce that risk during periods of neutropenia early after transplant” - Dr Matthew J. Pianko, a hematologic oncologist at the University of Michigan told SurvivorNet in an exclusive interview.
The neutropenic diet is named after a medical condition called neutropenia. Neutrophils are an important type of white blood cell that help fight infection. When the neutrophil count drops dangerously low, people are considered neutropenic. Neutropenic people can easily get bacterial infections from food and become ill.
The basic principles of this diet involve practicing proper food safety and avoiding foods that are more likely to expose you to microbes and bacteria.
The basic principles of this diet involve practicing proper food safety and avoiding foods that are more likely to expose you to microbes and bacteria. It consists in avoiding meat or eggs that are undercooked, unpasteurized dairy products (like milk, cheese, and eggnog), deli, processed, and cured meats (including salami, bologna, hot dogs, and ham) and uncooked/unwashed fruits and vegetables.
Some believe that people who've had a stem cell transplant typically need to avoid food prepared in restaurants or other establishments for 100 days.
Challenging Current Beliefs
Some very interesting data is being presented at American Society of Hematology (ASH) Annual Meeting. A prominent study demonstrated that neutropenic diet did not change the rate of fever infection in patients with weakened immune systems.
"These results will surely be met with a big cheer from the entire transplant community, especially patients. Going forward, patients can eat what they choose." says Dr. Jane Winter, a hematologist at the Robert H. Lurie Comprehensive Cancer Center at Northwestern University and ASH president.
The Neutrodiet Multicenter Randomized Trial
Phase III trials represent one of the highest level of scientific evidence available in medicine and that is exactly the type of study we are talking about.
According to Dr Pianko, the NeutroDiet multi-center randomized trial compared neutropenic diets to standard diets after stem cell transplant and evaluated the rates of infection with either types of diet. The Neutrodiet study results showed that neutropenic diets do not reduce the risk of infection in patients treated with stem cell transplantation compared with standard diet. This finding suggests patients do not benefit from a ‘low microbial’ restrictive diet after stem cell transplant, and could allow patients to enjoy a better quality of life while recovering from stem cell transplant by avoiding restrictive diets.
“Does this mean patient’s can eat whatever they want after transplant? In my opinion, no – added Dr Pianko. – “There is likely still a role for patients after stem cell transplant to continue to avoid foods which confer infection risk in individuals with normal immune systems, such as raw seafood, meat products, or unpasteurized dairy products. Other than that, this study supports the idea that patients can choose what they want to eat after transplant”.
“The Neutrodiet study are likely to change practice and may improve patient’s quality of life after transplant” – Dr Matthew Pianko, a hematologic oncologist at the University of Michigan tells SurvivorNet.
Other Scientific Findings
There are no published guidelines on how to use a low-microbial diet. Nor the National Comprehensive Cancer Network (NCCN), or the American Society of Hematology have guidelines on neutropenic diet.
Other recent trials also examined infection rates in children undergoing cancer treatment. A group of 42 pediatric chemotherapy patients was either put on the neutropenic diet or a standard indian diet. They concluded that neutropenic diet was not effective in reducing febrile neutropenia rate and was associated with higher rate of neutropenic enterocolitis when compared to the standard diet.
And another very recent study published that the British Medical Journal came to a similar conclusion. The authors of this randomized controlled trial concluded that neutropenic diet did not prevent infections or reduce mortality in patients with acute leukaemia.
Eating a Balanced Diet
Based on the current findings, there's not enough evidence to prove that the neutropenic diet prevents infection. But that’s not an excuse for you to eat unhealthy.
Eating a healthy diet is important to get the right amount of nutrients your body needs. You should eat an overall healthy dietary pattern that emphasizes a variety of fruits and vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes, and non-tropical vegetable oils. Also, limit saturated fat, trans fat, cholesterol, sodium, red meat, sweets and sugar-sweetened beverages.
It’s common knowledge that ultra-processed foods are unhealthy. Ultra-processed include pre-packaged products like soups, sauces, frozen pizzas, microwave meals, and foods like hot dogs, ham, salami, bacon, french fries, sodas, sausages, store-bought cookies, cakes, candy, ice cream, and many more.
Regular consumption of unhealthy foods also leads to obesity and cardiovascular disease and can impact one's overall mortality rate. Try to make healthy food choices as often as possible.
Instead of cakes and cookies and hot dogs, opt for healthier choices at the grocery store and while ordering takeout. Steer towards leafy greens, "good" fats like salmon and almonds, antioxidant-rich fruits like blueberries, "superfoods" like green tea, and more. Your body and your long-term health will thank you!
The Bottom Line
Despite the lack of evidence on neutropenic diet, there is consensus among scientists, physicians and experts that eating a healthy and balanced diet is the best option. Make sure to share all your concerns with your doctor and discuss your treatment options to get the support you need. Remember, be pushy, be your own advocate… don't settle!
Questions to Ask Your Doctor
- What is the evidence on Neutropenic Diet? Does it really work?
- Should I also consider nutritional supplements now or in the future?
- Am I at high risk for infections?
Learn more about SurvivorNet's rigorous medical review process.