Transcript
Low Microbial Diet Guidelines For people getting chemotherapy, radiation, and/or stem cell transplant, it is important to lower the risk for getting a food related infection. This diet has foods that have been shown to be safe when properly prepared in the home and hospital kitchen while maximizing healthy food options. Your doctor or health care provider will let you know when you need to follow these guidelines. For Stem Cell Transplant Patients: Your health care provider and dietitian will let you know when to start the diet and when the diet is no longer needed. In general, we recommend the following for stem cell transplant patients: Autologous transplant patients should follow this diet during the first three months after chemotherapy or transplant Allogenic transplant patients should follow the diet until you are off all immunosuppressive therapy such as cyclosporine, prednisone, FK-506 (Tacrolimus®) or MMF (CellCept®) or as decided in a conversation with your doctor. Food Safety Guidelines Wash your hands well in hot soapy water before preparing or eating food. Never choose packages that are ripped or leaking or cans that are dented or jars that are cracked. Safety buttons on metal lids should be down and not move or make a clicking noise when pushed. Do not purchase foods if ‘‘sell by’’ or ‘‘best used by’’ date has passed. Buy cold foods last and get them to a refrigerator or freezer as soon as possible. If you are driving in hot weather, place food inside airconditioned car and not in trunk. Keep the refrigerator temperature at 40OF, the freezer at 0OF. Wash cutting board with an antibacterial dish soap and hot water. Use paper towels if possible. Wash kitchen towels often in hot water in the washing machine. Keep hot foods hot and cold foods cold. Refrigerate or freeze any leftovers immediately. Eat refrigerated leftovers within 24 hours.
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Food Groups Dairy
Bread, Grain & Cereal Products
Foods Allowed All pasteurized, grade “A” milk and milk products Commercially packaged chesses and cheese products made with pasteurized milk such as cheddar, mozzarella, parmesan, Swiss, cream cheese, cottage cheese, ricotta cheese and sour cream Pasteurized yogurt including those with fruit and live cultures Dry, refrigerated, and frozen pasteurized whipped topping Commercial eggnog Commercially sterile ready to feed and liquid concentrate formulas such as instant breakfast or Boost® All breads, bagels, rolls, muffins pancakes, sweet rolls, waffles, French toast Potato chips, corn chips, tortilla chips, pretzels, popcorn Cooked pasta, rice and other grains All cereals, cooked and ready to eat including granola
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Foods To Avoid
Safe Food Handling Techniques
Unpasteurized or raw milk and milk products including cheeses and yogurt. Cheeses from delicatessens Cheese with molds (such as blue cheese, Stilton, gorgonzola, Roquefort) Soft style cheeses such as feta, brie, queso fresco, queso blanco Cheeses containing chili peppers or other uncooked vegetables including Mexican hot farmers cheese
Choose only pasteurized milk and cheeses
Raw (not baked or cooked) grain products (such as raw oats)
Patients themselves should not make (mix or knead) any bread product containing yeast Avoid open bulk bins of grains and snacks at markets
Food Groups Meat, fish poultry and Meat Substitutes
Foods Allowed All meats cooked to well done or canned meats (beef, pork, lamb, poultry, fish, shellfish, game, ham, bacon, sausage, hotdogs) Eggs cooked until both the white and yolk are firm Pasteurized eggs and egg substitutes cooked Commercially packaged lunch meats such as salami, bologna, ham and turkey Canned and commercially packaged hard smoked fish (refrigerate after opening) Pasteurized or coked tofu (must be cut into 1 inch cubes, or smaller and boiled for a minimum of 5 minutes in water or broth before eating or using in recipes) Refrigerated hot smoked seafood such as salmon or trout if cooked to 160OF or contained in a cooked dish or casserole
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Foods To Avoid Raw or undercooked meat, poultry, fish, game or tofu Raw, undercooked or “runny” eggs and egg substitutes Do not eat foods that include raw or partially cooked eggs. Meats and cold cuts from the delicatessen or meats sliced on a deli slicer Hard cured salami in natural wrap Cold smoked salmon “lox” or pickled fish Tempe (tempeh) and Miso products
Safe Food Handling Techniques Wash hands before and after handling raw meat, poultry, or fish. Put raw meat, fish and poultry into a plastic bag so the juices will not contaminate other foods. Place securely wrapped raw meat, fish, and poultry into the meat drawer or on the bottom of the refrigerator so that the juices will not leak onto other foods. Cook or freeze fresh ground meats, fish, and poultry within 2 days. Do not refreeze defrosted foods Do not cross-contaminate. Keep raw meat, fish, and poultry and their juices away from other food. After cutting these foods, wash utensils, cutting board, knife, and counter top with hot soapy water. Cook poultry until it has an internal temperature of 180OF. It is done when the juices run clear and it is white in the middle. Cook fish until it is opaque or white and flaky. Cook ground meat to 160OF. It is done when it is brown inside. This is especially critical with hamburger meat.
Food Groups Fruits and Nuts
Vegetables
Foods Allowed Well washed raw and frozen fruit; foods containing well washed raw fruits Cooked, canned and frozen fruit Pasteurized juices and frozen juice concentrates Dried fruits Canned or bottled roasted nuts Shelled roasted nuts and nuts in baked products Commercially packaged nut butters (such as peanut butter, almond butter, soybean butter) Well washed raw and frozen vegetables All cooked fresh, frozen or canned vegetables, including potatoes Shelf-stable bottled salsa (refrigerate after opening) Fresh, well washed herbs and dried herbs and spices (added to raw or cooked foods)
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Foods To Avoid
Safe Food Handling Techniques
Unwashed raw fruits Raw berries Unroasted or raw nuts Roasted nuts in the shell Non-pasteurized fruit and vegetable juices Fresh fruit salsa or mix found in the grocery refrigerator case Non-pasteurized items containing raw fruits found in the grocery refrigerator case
Always wash fresh fruits under cool running tap water before eating. Throw away fruits that are slimy, show mold and are bruised or damaged
Unwashed raw vegetables or herbs Fresh, non-pasteurized vegetable salsa found in the grocery refrigerator case All raw vegetable sprouts (alfalfa, radish, broccoli, mung beans all others) Salads from delicatessens or salad bars Unwashed & uncooked mushrooms Do not purchase produce that has been cut at the grocery store
Always wash vegetables under cool running tap water before eating. Use a scrub brush on potatoes or carrots if the skins are to be consumed. Rinse leaves of leafy vegetables individually under running water Packaged salads, slaw mix and other prepared produce, even when marked “pre washed” should be rinsed again under running water Do not use commercial rinses to wash fruits and vegetables Throw away vegetables that are slimy or show mold
Food Groups
Foods Allowed
Foods To Avoid
Beverages
Tap water and ice made from tap water Commercially bottled distilled, spring and natural waters All canned, bottled and powdered beverages Instant and brewed coffee, tea, cold brewed tea made with boiling water Brewed herbal teas from commercially packaged tea bags
Unboiled Well water, unless tested yearly and found to be safe Cold-brewed tea made with warm or cold water (sun tea) Unpasteurized fruit and vegetable juices Mate’ tea Wine, unpasteurized beer (Note: all alcoholic beverages should only be consumed following physician approval.)
Desserts
Refrigerated commercial and homemade cakes, pies, pastries and pudding Refrigerated cream filled pastries Cookies, homemade or commercial Shelf stable cream filled cupcakes (such as Twinkies, Ding Dongs) and fruit pies (such as Poptarts and Hostess fruit pies) Canned and refrigerated puddings Popsicles and similar products Candy, gum
Unrefrigerated cream filled pastry products (not shelf-stable)
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Safe Food Handling Techniques Choose only pasteurized juices.
Food Groups Fats
Other
Foods Allowed Vegetable oils and shortening Refrigerated lard margarine, butter Commercial, shelf stable mayonnaise and salad dressings including blue cheese and other cheese based salad dressings (refrigerate after opening) Cooked gravy and sauces Salt, granulated sugar, brown sugar Jam, jelly, syrups (refrigerate after opening) Commercial pasteurized Grade A honey Catsup/Ketchup, mustard, BBQ sauce, soy sauce, and other condiments (refrigerate after opening) Pickles, pickle relish, olives (refrigerate after opening) Vinegar
Foods To Avoid
Safe Food Handling Techniques
Fresh salad dressing (or stored in the grocer’s refrigerated case) containing raw eggs or cheeses listed as “Do not eat” under the dairy section
Raw honey, honey in the comb Herbal and nutrient supplement preparations, not approved by the dietitian Brewer’s yeast (if uncooked)
Dining Out Suggestions Eat early to avoid crowds Avoid fast food restaurants Ask that food be prepared fresh in restaurants – ask for food to be made without raw toppings such as lettuce, tomato, onion, etc. Request single-serving condiments packages (Ketchup, mayonnaise, mustard) and avoid self-serve bulk condiment containers (salsa) Avoid high-risk food sources including salad bars, delicatessens, buffets and smorgasbords, potlucks and sidewalk vendors Avoid raw fruits and vegetables when dining out including fresh squeezed juices or smoothies Be sure the utensils are set on a napkin or clean tablecloth or placement rather than directly on the table If keeping leftovers, put the food in the container yourself rather than having the server take your food to the kitchen to do this
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