Low Microbial Diet Guidelines
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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 air-
conditioned 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.
PH1050 (6-13) Page 1 of 6 Low Microbial Diet GuidelinesFood Groups Foods Allowed Foods To Avoid Safe Food Handling Techniques
Dairy All pasteurized, grade “A” milk and Unpasteurized or raw milk and Choose only pasteurized milk and
milk products milk products including cheeses cheeses
Commercially packaged chesses and yogurt.
and cheese products made with Cheeses from delicatessens
pasteurized milk such as cheddar, Cheese with molds (such as blue
mozzarella, parmesan, Swiss, cream cheese, Stilton, gorgonzola,
cheese, cottage cheese, ricotta Roquefort)
cheese and sour cream Soft style cheeses such as feta,
Pasteurized yogurt including those brie, queso fresco, queso blanco
with fruit and live cultures Cheeses containing chili peppers or
Dry, refrigerated, and frozen other uncooked vegetables
pasteurized whipped topping including Mexican hot farmers
Commercial eggnog cheese
Commercially sterile ready to feed
and liquid concentrate formulas
such as instant breakfast or Boost®
Bread, Grain & All breads, bagels, rolls, muffins Raw (not baked or cooked) grain Patients themselves should not
Cereal pancakes, sweet rolls, waffles, products (such as raw oats) make (mix or knead) any bread
Products French toast product containing yeast
Potato chips, corn chips, tortilla Avoid open bulk bins of grains and
chips, pretzels, popcorn snacks at markets
Cooked pasta, rice and other grains
All cereals, cooked and ready to eat
including granola
PH1050 (6-13) Page 2 of 6 Low Microbial Diet GuidelinesFood Groups Foods Allowed Foods To Avoid Safe Food Handling Techniques
Meat, fish All meats cooked to well done or Raw or undercooked meat, Wash hands before and after
poultry and canned meats (beef, pork, lamb, poultry, fish, game or tofu handling raw meat, poultry, or fish.
Meat poultry, fish, shellfish, game, ham, Raw, undercooked or “runny” eggs Put raw meat, fish and poultry into
Substitutes bacon, sausage, hotdogs) and egg substitutes a plastic bag so the juices will not
Eggs cooked until both the white Do not eat foods that include raw contaminate other foods.
and yolk are firm or partially cooked eggs. Place securely wrapped raw meat,
Pasteurized eggs and egg Meats and cold cuts from the fish, and poultry into the meat
substitutes cooked delicatessen or meats sliced on a drawer or on the bottom of the
Commercially packaged lunch deli slicer refrigerator so that the juices will
meats such as salami, bologna, ham Hard cured salami in natural wrap not leak onto other foods.
and turkey Cold smoked salmon “lox” or Cook or freeze fresh ground meats,
Canned and commercially packaged pickled fish fish, and poultry within 2 days.
hard smoked fish (refrigerate after Tempe (tempeh) and Miso Do not refreeze defrosted foods
opening) products Do not cross-contaminate. Keep
Pasteurized or coked tofu (must be raw meat, fish, and poultry and
cut into 1 inch cubes, or smaller their juices away from other food.
and boiled for a minimum of 5 After cutting these foods, wash
minutes in water or broth before utensils, cutting board, knife, and
eating or using in recipes) counter top with hot soapy water.
Refrigerated hot smoked seafood Cook poultry until it has an internal
such as salmon or trout if cooked to temperature of 180OF. It is done
160OF or contained in a cooked dish when the juices run clear and it is
or casserole 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.
PH1050 (6-13) Page 3 of 6 Low Microbial Diet GuidelinesFood Groups Foods Allowed Foods To Avoid Safe Food Handling Techniques
Fruits and Nuts Well washed raw and frozen fruit; Unwashed raw fruits Always wash fresh fruits under cool
foods containing well washed raw Raw berries running tap water before eating.
fruits Unroasted or raw nuts Throw away fruits that are slimy,
Cooked, canned and frozen fruit Roasted nuts in the shell show mold and are bruised or
Pasteurized juices and frozen juice Non-pasteurized fruit and damaged
concentrates vegetable juices
Dried fruits Fresh fruit salsa or mix found in
Canned or bottled roasted nuts the grocery refrigerator case
Shelled roasted nuts and nuts in Non-pasteurized items containing
baked products raw fruits found in the grocery
Commercially packaged nut butters refrigerator case
(such as peanut butter, almond
butter, soybean butter)
Vegetables Well washed raw and frozen Unwashed raw vegetables or herbs Always wash vegetables under cool
vegetables Fresh, non-pasteurized vegetable running tap water before eating.
All cooked fresh, frozen or canned salsa found in the grocery Use a scrub brush on potatoes or
vegetables, including potatoes refrigerator case carrots if the skins are to be
Shelf-stable bottled salsa All raw vegetable sprouts (alfalfa, consumed.
(refrigerate after opening) radish, broccoli, mung beans all Rinse leaves of leafy vegetables
Fresh, well washed herbs and dried others) individually under running water
herbs and spices (added to raw or Salads from delicatessens or salad Packaged salads, slaw mix and
cooked foods) bars other prepared produce, even
Unwashed & uncooked when marked “pre washed” should
mushrooms be rinsed again under running
Do not purchase produce that has water
been cut at the grocery store Do not use commercial rinses to
wash fruits and vegetables
Throw away vegetables that are
slimy or show mold
PH1050 (6013) Page 4 of 6 Low Microbial Diet GuidelinesFood Groups Foods Allowed Foods To Avoid Safe Food Handling Techniques
Beverages Tap water and ice made from tap Unboiled Well water, unless tested Choose only pasteurized juices.
water yearly and found to be safe
Commercially bottled distilled, Cold-brewed tea made with warm
spring and natural waters or cold water (sun tea)
All canned, bottled and powdered Unpasteurized fruit and vegetable
beverages juices
Instant and brewed coffee, tea, Mate’ tea
cold brewed tea made with boiling Wine, unpasteurized beer (Note:
water all alcoholic beverages should only
Brewed herbal teas from be consumed following physician
commercially packaged tea bags approval.)
Desserts Refrigerated commercial and Unrefrigerated cream filled pastry
homemade cakes, pies, pastries products (not shelf-stable)
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
PH1050 (6-13) Page 5 of 6 Low Microbial Diet GuidelinesFood Groups Foods Allowed Foods To Avoid Safe Food Handling Techniques
Fats Vegetable oils and shortening Fresh salad dressing (or stored in
Refrigerated lard margarine, butter the grocer’s refrigerated case)
Commercial, shelf stable containing raw eggs or cheeses
mayonnaise and salad dressings listed as “Do not eat” under the
including blue cheese and other dairy section
cheese based salad dressings
(refrigerate after opening)
Cooked gravy and sauces
Other Salt, granulated sugar, brown sugar Raw honey, honey in the comb
Jam, jelly, syrups (refrigerate after Herbal and nutrient supplement
opening) preparations, not approved by the
Commercial pasteurized Grade A dietitian
honey Brewer’s yeast (if uncooked)
Catsup/Ketchup, mustard, BBQ
sauce, soy sauce, and other
condiments (refrigerate after
opening)
Pickles, pickle relish, olives
(refrigerate after opening)
Vinegar
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
PH1050 (6-13) Page 6 of 6 Low Microbial Diet GuidelinesYou can also read
