Can a Neutropenic Diet Help With Multiple Myeloma?

Medically Reviewed by Sabrina Felson, MD on June 25, 2022
5 min read

If you have multiple myeloma – a rare blood cancer – you may have a weakened immune system. This may put you at a higher risk of catching an infection or getting sick. You may be encouraged to follow a neutropenic diet, which can help lower your risk of getting sick from harmful bacteria and other organisms found in some foods.

Many treatments for multiple myeloma – including chemotherapy, radiation, and a stem cell transplant (especially during the first 30 days) – can all lead to a weakened immune system. If you have multiple myeloma, you may become neutropenic, or have a low blood cell count, which can make it hard for your body to fight an infection. It can also take time for your immune system to rebound after treatment.

A neutropenic diet – sometimes called a low-microbial diet – involves avoiding certain foods that have a higher risk of containing harmful germs and bacteria, as well as being cautious when preparing and storing foods to lower the risk of getting sick.

Some doctors advise all cancer patients having treatment to follow a neutropenic diet, while others feel the diet does not help prevent infection. Some people with a very low neutrophil count are considered severely neutropenic and may be encouraged to follow even stricter guidelines. It’s important for you to discuss your diet, blood cell count, and risk factors with your doctor.

Here’s what you need to know about the neutropenic diet, what you can eat, what to avoid, and other tips to help you manage your food intake during treatment:

A neutropenic diet involves avoiding foods that have a high risk of carrying harmful bacteria that can make you sick. It’s also important to take extra care when preparing and storing food to ensure there is as little risk as possible of catching a foodborne illness.

  • Raw and undercooked meat
  • Deli, processed, and cured meats (such as salami, bologna, hot dogs, and ham) unless they are heated and served hot
  • Raw fish and shellfish
  • Raw and undercooked eggs
  • Salad bars, buffets, and potluck meals
  • Unpasteurized dairy products including milk, cheese, and eggnog
  • Unpasteurized honey, juice, and cider
  • Any foods that are past their “use by” and expiration dates
  • Raw sprouts, such as alfalfa, clover, radish, and mung bean sprouts
  • Leftovers that are more than 48 hours old

  • Breads and grains, including rolls, bagels, waffles, muffins, pancakes, chips, rice, pasta, and ready-to-eat cereal
  • Pasteurized dairy products you can buy at the store, including milk, cheese, sour cream, and yogurt (even those with live cultures)
  • Pasteurized soy and nondairy milks, such as almond, rice, and coconut milks
  • Ice cream, frozen yogurt, sherbet, ice pops, and puddings all commercially made and sold in stores
  • Homemade milkshakes
  • Well-cooked or runny pasteurized eggs, and pasteurized egg substitutes
  • Well-cooked fresh meat (pork, beef, and lamb), poultry, bacon, and sausage
  • Thoroughly cooked fresh fish and seafood – but be extra cautious with shellfish in a shell, such as lobster, and be sure to cook it thoroughly until it is opaque
  • Cooked, pasteurized, and shelf-stable tofu
  • Cooked fermented foods, such as miso and tempeh
  • Commercially prepared hot dogs and deli meats that are sold in a sealed package and cooked until steaming hot
  • Canned meats
  • Canned fish, such as tuna and salmon
  • Well-washed fruits and vegetables – but make sure they do not have cuts, bruises, or mold
  • Cooked and canned fruits and vegetables
  • Well-washed frozen fruits and vegetables
  • Pasteurized juices and frozen concentrates
  • Commercially packaged dried fruits
  • Shelf-stable bottled salsa (refrigerate it once it is opened)
  • Fresh, well-washed herbs
  • Dried herbs and spices
  • Salt and sugar, and packaged ground black pepper
  • Coffee, and tea using commercially made tea bags
  • Tap water and ice, if your water is from a city or municipal water supply or well. Water from a private well can be used when the well water is tested daily for bacteria and the water is boiled before using it.
  • Refrigerated pies, cakes, pastries and pudding – both homemade and commercially made
  • Packaged and homemade cookies
  • Shelf-stable cupcakes and fruit pies
  • Leftover food, safely stored, within 48 hours of when it was cooked

You shouldn’t take supplements, herbal products, or other homeopathic remedies without discussing them first with your oncologist (your doctor who is treating your multiple myeloma). Your doctor can tell you if those products will interfere with your medications or cancer treatment, or if they could pose a risk due to possible bacteria that could make you sick.

It is recommended that you eat homemade or commercially packaged foods found in the store, and avoid most fast food – especially buffets, potluck meals, etc.

But it is safe to eat pizza purchased at a restaurant – just ask for it to be left uncut. You can then cut it at home with a clean knife.

First and foremost, it is important to always wash your hands well before handling or preparing food.

Here are some tips for safely cooking and preparing food:

  • When you purchase fresh food, be sure to store it in the refrigerator or freezer right away.
  • Buy a food thermometer, so you can check to be sure you are cooking food – including meat and casseroles – to a safe temperature.
  • When you go to the grocery store, use freezer bags to make sure that frozen or cold foods do not get too warm.
  • Do not defrost food on the counter, and be sure to cook food right after it is defrosted.
  • Always wash your hands before cooking and after touching raw meat.
  • Avoid using wood cutting boards, and use different cutting boards for your meat and vegetables.
  • Wash any dishes or utensils that touch raw meat with soap and water right away.
  • Label leftovers so you are sure to use them within 48 hours.

You can prepare meals ahead of time and freeze them to use when you aren’t feeling well or have a busy day. You can also ask a partner or caregiver to help you prepare food.

It can be helpful to purchase good storage containers to safely store food. When you are packaging away leftovers, remember to label them with a “use by” date.

When you go out, be sure to bring safe snacks with you – such as protein bars, packaged nuts, crackers, or other snacks – so you always have something safe to eat. You can also bring bottled or canned drinks. If you must eat out, be careful to choose a good, quality restaurant and avoid street vendors and buffets.