There was a time when I could totally recite what a neutropenic patient should and should not eat. I remember how hard it was to tell a patient they shouldn't juice while on chemo because the physician I worked with at the time felt like if they were giving an oxidant therapy, the patient shouldn't be eating things so high in antioxidants. Whew! Glad that's over. I am going to start by explaining neutropenia. When a patient undergoes chemotherapy, or other therapies in which the good cells are attacked along with the bad ones, there is always that high risk the white blood cells are going to be some of those cells attacked. The white blood cells help provide protection against infection, particularly the neutrophils. You physician will be checking your blood work on a regular basis.
Most chemotherapy agents that affect the white blood cells have a nadir (where cells are at their lowest point) of around 7-10 days. Some agents have different nadirs. Your health care provider can give you an estimate as to when your cells will drop the lowest. Medications can be given by subcutaneous injection that may keep the white counts from dipping so low. You may have experienced a Neulasta injection the day after treatment, or receive daily Neupogen injections. Even if you receive these injections, it is not a sure fire way to prevent neutropenia. You were probably instructed to take your temperature daily while on chemotherapy or other treatments that affect the blood. An elevated temperature can be the first sign of infection when you have a low white count, before you even have symptoms. If this happens, don't mask it with Tylenol and go about your business. Let your provider know. OK, so now you have a general understanding about neutropenia. So now, you ask, what does my food have to do with being neutropenic?
As I mentioned before, when your white count is low, you do not have the "fighters" against infection in full force. So, what that means is you do not have the defense system of most people. I can eat anything I want or be around hundreds of germs or invaders, and my immune system will take over and fight the battle for me and I won't become sick. This includes food. Many foods are laden with fungus, bacteria, or germs and most people can eat these foods without ill effects. Not the neutropenic patient. You must be careful and avoid certain foods during a neutropenic episode. I remember the hospital even made sterile ice during the hospitalizations of neutropenic patients.So, what food should you avoid? all unpasteurized dairy products, cheezes that are not individually wrapped (stay away from blue cheese), raw veggies, salads, salad bars, uncooked herbs and spices, dried fruits, raw fruits, raw nuts, bakery breads, bakery items, raw soups, raw or undercooked meats, pickled fish, sushi, raw oysters, raw fish, unpasteurized juices, butter from tubs, potato/macaroni salads, well water, egg nog, apple cider, spring water, raw eggs, fresh salad dressings, raw honey, and unrefrigerated pastry products. (those are the highlights)
The basic idea is raw, uncooked, not previously frozen foods. Wow, I know you are saying about now, WHAT CAN I EAT? You may eat all pasteurized grade "A" dairy products, pasteurized yogurt, all cooked canned or frozen fruits and veggies, thick skinned fruits like oranges and bananas (wash first), cooked herbs and spices, all breads and packaged pastries, ice creams, commercial nutritional supplements like liquid and powdered meal replacements, roasted nuts, cooked pastas, rice, and cereals (ready to eat OK, too), chip products, all well cooked meats, well cooked eggs, commercially packaged lunch meats (not at the deli), canned beverages, tap water (not well, and bottled distilled or natural is best), pop tarts (healthy, huh?), refrigerated jams, condiments, pickles, salt, sugars, shortening, (sticks better). This is by now means a complete or exhaustive list. You may have a list from your physician. If not, write me, and I will send you a list. This brings me to eating healthy on a neutropenic diet. According to this list, it would be OK for you to go to a fast food restaurant and get a burger, (no fresh veggies), fries, and a canned pop. Healthy and nourishing right? NOT! The problem with this diet is EVERYTHING is cooked and prepackaged. Nothing is fresh and alive. Since I consider it very important to nourish our cells with living healthy food, then what can you do? I would make sure on the days you aren't neutropenic, that you are taking in as many healthy foods as possible.
I LOVE green smoothies, and this is a way to get ton's of healthy fruits and veggies inside to nourish those cells. Smoothies are nutritious and also easy to digest. They are great to make when you have a sore mouth, or you have an aversion to food because of the chemo or other treatments. I usually use a huge blender, and start with healthy water. I add several handfuls of greens, like spinach, then I add some nutritional protein powder if I like,bananas, and frozen fruit of my choice. The problem with neutropenia, is you can't use the fresh greens and and fresh fruits (except bananas). So, guess what? I thought about using FROZEN spinach or greens! Yes! Frozen greens, and use frozen fruits. Keep the bananas, good water, and healthy protein powders. So, there you go! You CAN make a healthy smoothie with allowed foods. You could even use some pasteurized plain yogurt. Another idea is to make hearty soups. You could use cooked barley, and tons of veggies all cut up, and then add a little cooked meat if you like. Whole grain breads for sure! So there you go! How does that sound! I got so excited when I thought about healthy alternatives I just had to start writing about it.
Part two in this series will be giving you recipes! Then I want you to write and tell me how you liked what you made. I especially want to know about the green smoothies. Oh, I forgot to tell you, you don't taste the greens in a green smoothie. Only the fruits. For now, those ideas will give you a little to chew on. Someone may just get brave and make up a smoothie without a recipe. You don't really need one. A little dab of this, a handful of that… Blend up your frozen spinach (you can let it thaw first) with the water first, and blend for at least a minute, then slowly add in the rest until you have it to taste where you want it! Let me know how you like this! Pass this on to you friends or family on chemotherapy!
Joyce Harrell, RN, OCN is an Oncology Certified Registered Nurse and Wellness Coach. Joyce provides live and virtual workshops on a variety of subjects relating to the health, wellness, and self-care of nurses, caregivers, and cancer patients during and after treatment. Joyce utilizes the Wellness Inventory Assessment as a tool and offers individual and group coaching sessions on a variety of wellness and self-care topics. You can find her blog at www.poweruphealthcoaching.com.