Chemo patient’s weak immune system restricts food choices

Going through the roller coaster of chemotherapy for treatment of cancer or other illnesses is physically and mentally challenging enough. Add to that the addition of cautionary lists of foods to avoid when the immune system is weakened and even the everyday enjoyment of eating a bunch of grapes or grabbing a deli sandwich with friends can be taken away, too.

When a friend of mine who is undergoing chemotherapy told me her physician recommended she avoid eating all raw fruits and vegetables, I wanted to learn more about the nuances of food safety advice for cooking and dining out.

Tiffany Barrett, clinical dietitian specialist at the Winship Cancer Institute at Emory University, explains that the level of concern in avoiding potential pathogens in foods is related to the level of immune defense indicated by white blood cell counts. The lower the level of white blood cells (which fight infection), the higher the concern for food safety risks.

“So I do not recommend all chemo patients avoid raw produce. The potential risks include foodborne illnesses due to bacteria on the produce, especially produce that cannot be washed effectively. I educate the patient on cross contamination and handling of food,” she said.

Washing produce thoroughly is emphasized, and thick-skinned fruit that is peeled, such as oranges and bananas, is preferred over thin-skinned uncooked fruit such as grapes or apples.

For patients who must avoid even the slightest risk of eating raw produce (including bone marrow transplant patients), Barrett recommends fully cooked fruits and vegetables or commercially frozen or canned produce to receive the benefits of healthy eating. A baked apple rather than a raw apple is a simple and delicious solution.

Dining out can present several risks and challenges. What might be perfectly safe for healthy customers could sicken someone with a weakened immune system, so advice includes avoiding all salad bars and buffets and requesting that meat and fish be cooked to well done.

If patients are advised to avoid public spaces, they can still enjoy food from their favorite restaurants as take-out. But make sure to reheat dishes when you get them home to at least 165 degrees or until steaming hot. Throw out leftovers after 24 hours.

Other potentially hazardous foods because of the bacteria they may contain include unpasteurized milk and cheeses, blue cheeses, brie and other soft cheeses, undercooked eggs, unroasted raw nuts, unpasteurized fruit and vegetable juices, honey in the comb, cold smoked salmon, sushi and raw shellfish. Barrett says specialized yogurts with live and active cultures are on the “foods to avoid” list at Emory, too.

“Little is known about their potential harm to a weakened immune system,” she said. “Yogurt has been debated here every year. And every cancer center has different guidelines.”

Carolyn O’Neil is a registered dietitian and co-author of “The Dish on Eating Healthy and Being Fabulous!” E-mail her at carolyn@carolynoneil.com.