Foods to avoid on a low-bacteria diet

After a blood and marrow transplant, your child’s immune system will be weak. Children with weak immune systems are more likely to get sick from harmful bacteria in food. Because of this, your child will need to avoid foods that may contain harmful bacteria. The diet that they follow is called a low-bacteria diet.

How long must my child be on a low-bacteria diet?

A low-bacteria diet starts on day 0, the day your child receives the blood or bone marrow transplant.

• After an allogeneic transplant, your child should stay on the diet for six months.
• After an autologous transplant​, your child should stay on the diet for three months.

General guidelines to minimize bacteria

• Hand washing: Always wash your hands before and after handling food.
• Water: If you use well water, make sure to have it tested regularly, even if you only use it for bathing and cooking.
• Eating out: When eating in restaurants, choose off-peak hours when the restaurant is less likely to be busy, if possible. Take-out or pick-up is better than delivery, as you can ensure the food is freshly made. Choose well-cooked items only, and ask for all food to be freshly made. Avoid salads, smoothies, and other cold items from restaurants, if possible. Ask for freshly made items at fast-food restaurants.
• Eating out: Do not eat at salad bars, buffets or from street vendors, as there is a higher risk of food contamination.
• Food from home: as long as food is fresh, and carefully prepared, you are welcome to bring in food from home to the hospital. Try to transport it in a cooler and then you can reheat it in the hospital.
• Food that is meant to be eaten hot or cold should not sit at room temperature for longer than two hours.

Foods to avoid on a low bacteria diet

Vegetables and fruits to avoid

• All raw sprouts including alfalfa, bean, mung and clover.
• Salads prepared in stores, delicatessens and restaurants.
• Grapefruits and tangelos (and all products that contain these fruits) if your child takes cyclosporine or tacrolimus.

Food safety tips

• Carefully wash all fruit and vegetables under clean, cold running water just before using, even if you will peel them. Use a vegetable scrubber for produce with thick skin.
• Even if you buy pre-washed fruit and vegetables, wash them again.
• Make sure that all fruits and vegetables are fresh. Throw them away if they look old or are bruised, slimy or mouldy.
• Berries are hard to clean. Soak and rinse them at least twice before eating.

Milk and milk products to avoid

• Unpasteurized or raw milk, cheese, yogurt or other dairy products.
• Cheese from the delicatessen (unless pre-packaged).
• Cheese containing chili peppers, herbs or other uncooked vegetables.
• Cheese with moulds, such as blue cheese, Stilton, Roquefort or Gorgonzola.
• Uncooked soft cheese, such as Brie, Camembert.

Food safety tips

• Keep dairy products cold at all times and always check best before dates.
• Do not give your child dairy products after the best before date.

Meat and meat alternatives to avoid

• Raw or undercooked meat, poultry, fish, bacon or tofu
• Raw or undercooked eggs (white and yolk should be hard), or any products containing raw or undercooked eggs, such as meringue.
• Meat and cold cuts from delicatessens (unless pre-packaged, in which case, heat it until steaming hot before serving).
• Fermented soy products such as tempeh and miso.
• Sushi (raw fish), cold smoked salmon, lox, or pickled fish.
• Raw and unshelled nuts and seeds (roasted nuts and seeds are allowed).

Food safety tips

• Never defrost meat, poultry or fish at room temperature. Always defrost in the refrigerator, or in a bowl of cool water in the refrigerator.
• Keep raw and cooked meat, poultry or fish separate and on different plates, dishes or trays.

Desserts to avoid

• Store-bought pastries that contain cream or custard (unless freshly made).
• Meringue.

Fats to avoid

• Refrigerated salad dressings containing blue cheese.
• Salad dressing containing raw eggs (store-bought mayonnaise and Caesar salad dressings are allowed).

Drinks to avoid

• Juice bars and fresh pressed juices. All fruit or vegetable juices, and apple cider should be pasteurized.

Other foods to avoid

• Raw or unpasteurized honey (all children under 12 months of age should avoid honey).
• Discuss herbal medicines and non-traditional supplements with your child’s health-care team before using.

Vitamin D is important!

If your child received steroids, doesn’t like milk or dairy products, or struggled to eat and drink well during their treatment, they may be at a higher risk for weak bones. Vitamin D is important for your child’s bones because it helps support bone growth and overall bone health and may be an important part of your child’s recovery after a blood and marrow transplant. Vitamin D supplements are available in drops, liquids, pills or gummies. Ask your health-care team about a vitamin D supplement for your child before going home.