Low-Microbial Diet
These guidelines are intended to minimize the introduction of pathogenic organisms into the
gastrointestinal tract by food while maximizing health food options for immunosuppressed patients.
Persons with decreased immune function due to chemotherapy and radiation are at increased risk of
developing a food-related infection.
The guidelines allow foods that are safe when properly prepared in the home and hospital kitchen. Highrisk foods identified as potential sources of organisms known to cause infection in immunosuppressed
patients are restricted.
The diet guidelines meet the Recommended Daily Intakes of the National Research Council for all
nutrients when following a well-balanced diet. Multivitamin supplements may be required if food intake
is poor.
General Considerations
•
Discard any food with mold (cutting the mold off will not remove harmful organisms).
•
Do not purchase a product after the expiration date shown on the label.
•
All foods must be stored and handled properly to avoid food-related infections and illness. Keep
cold foods cold, hot foods hot and refrigerate leftovers immediately after use.
•
Your dietitian or dietetic technician are sources of information about safe food handling and
selection.
This diet should be followed before and after all conditioning (chemotherapy and/or radiation) therapy.
Your doctor and dietitian will provide guidelines as to when the diet is no longer required.
We recommend that patients receiving chemotherapy alone, peripheral blood stem cell or autologous
transplant patients follow the diet during the first two months after chemotherapy or transplant.
Allogeneic transplant patients should follow the diet until off all immunosuppressive therapy (e.g.,
cyclosporine, prednisone, FK-506, thalidomide, etc.). Prior to the end of these periods, patients and their
caregivers should discuss with their referring physician whether or not the diet or parts of the diet should
be continued.
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Continued
Low-Microbial Diet
Food
Groups
Allowed
Dairy
• All pasteurized, grade “A” milk and milk
products.
• Commercially-packaged cheese and cheese
products made with pasteurized milk (e.g., mild
& medium cheddar, mozzarella, parmesan, Swiss,
etc.)
• Pasteurized yogurt
• Dry, refrigerated and frozen pasteurized whipped
topping
• Ice cream, frozen yogurt, sherbet, ice cream bars,
homemade milkshakes
• Commercial nutritional supplements and baby
formulas (liquid and powdered)
• Unpasteurized or raw milk,
cheese, yogurt, & other milk
products
• Cheeses from delicatessens
• Cheeses containing chili
peppers or other uncooked
vegetables
• Cheeses with molds (e.g.,
bleu, Stilton, Roquefort,
gorgonzola)
• Sharp cheddar, brie,
Camembert, feta cheese,
farmer’s cheese
•
• Raw or undercooked meat,
poultry, fish, game, tofu,
tempe
• Meats & cold cuts from
delicatessens
• Hard cured salami in natural
wrap
• Cold smoked salmon (fish);
lox
• Pickled fish
• Poached or soft cooked eggs
Meat and
Meat
Substitutes
•
•
•
•
Entrees &
Soups
All well-cooked or canned meats (beef, pork,
lamb, poultry, fish, shellfish, game, ham, bacon,
sausage, hot dogs)
Well-cooked eggs (white cooked firm with
thickened yolk is acceptable)
Pasteurized egg substitutes (e.g., Egg Beaters)
Canned and commercially-packaged hard smoked
fish; refrigerated after opening
Cooked tofu. (Must be cut into 1-inch cubes or
smaller and boiled a minimum of five minutes in
water or broth before eating or using in recipes)
• All cooked entrees and soups
Not Allowed
• All miso products (e.g., miso
soup)
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Low-Microbial Diet
Food
Groups
Fruit &
Nuts
Allowed
•
•
•
•
•
•
Canned & frozen fruit & pasteurized fruit juices
Well-washed raw vegetables
Dried fruits
Canned or bottled roasted nuts
Nuts in baked products
Commercially-packaged peanut butter
Not Allowed
•
•
•
•
Unwashed raw fruits
Unroasted raw nuts
Roasted nuts in the shell
Unpasteurized fruit juices
Vegetables
• All cooked frozen, canned or fresh vegetables &
potatoes
• Well-washed raw vegetables
• Fresh, well washed herbs & spices (added to raw
or cooked foods)
• Pasteurized vegetable juices
• Unwashed raw vegetables or
herbs
• Salads from delicatessen
• Commercial salsas stored in
refrigerated case
• Sprouts
• Unpasteurized vegetable
juices
Bread,
Grain &
Cereal
Products
• All breads, bagels, rolls, muffins, pancakes, sweet
rolls, waffles, French toast
• Potato chips, corn chips, tortilla chips, pretzels,
popcorn
• Cooked pasta, rice & other grains
• All cereals, cooked & ready-to-eat
• Raw grain products
• City water supply
• Commercial bottled distilled, spring & natural
waters
• All canned, bottled & powdered beverages
• Instant & brewed coffee, tea; iced brewed tea
made with boiling water
• Brewed herbal teas using commercially-packaged
tea bags
• Commercial nutritional supplements (liquid &
powder)
• Well water (unless tested
yearly & found safe)
• Iced teas brewed with warm
or cold water such as sun tea
• Commercial, unpasteurized
juices
• Mate tea
Beverages
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Low-Microbial Diet
Food
Groups
Allowed
Desserts
• Refrigerated commercial & homemade cakes,
pies, pastries & pudding
• Refrigerated, cream-filled pastries
• Homemade & commercial cookies
• Shelf-stable** cream-filled cupcakes (e.g.,
Twinkies, Ding Dongs), fruit pies (e.g., pop-tarts,
Hostess fruit pies) and canned pudding
• Ices, popsicle-like products
• Unrefrigerated, cream-filled
pastry products (not shelfstable**)
Fats
• Oil, shortening
• Refrigerated lard, margarine, butter
• Commercial, shelf-stable** mayonnaise & salad
dressings (including cheese-based salad dressings;
refrigerated after opening)
• Cooked gravy & sauces
• Fresh salad dressings
containing aged cheese (e.g.,
bleu, Roquefort) or raw eggs,
even if stored in refrigerated
case
• Hollandaise sauce
•
•
•
•
•
• Raw or unpasteurized honey
or sugar
• Non-traditional nutritional
supplements & herbs
• Brewers yeast, if eaten
uncooked
• Delicatessen entrees (e.g.,
pizza, macaroni and cheese,
etc.)
Other
Granulated sugar, brown sugar, powdered sugar
Jam, jelly, syrups; refrigerated after opening
Salt, pepper, cinnamon, nutmeg
Commercially-packaged (pasteurized) honey
Catsup, mustard, BBQ sauce, soy sauce, other
condiments (refrigerated after opening)
• Pickles, pickle relish, olives (refrigerated after
opening)
• Candy, gum
• Commercially packaged frozen entrees (e.g.,
pizza, raviolis, lasagna, etc.)
Not Allowed
** Shelf-stable refers to unopened canned, bottled or packaged food products that can be stored before opening at room
temperature; container may require refrigeration after opening.
Adapted from Fred Hutchinson Cancer Research Center, Seattle, Washington – Clinical Nutrition Department.
UC Davis Health System, Clinical Dietitians, 1/2007.
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