Blood and Marrow Transplant Nutrition Guidelines
Why should my child follow this diet?
The purpose of this diet is to help decrease the risk of infection from food. The diet will start at admission. You will stay on the diet until at least day +100 because this is the time when you are most at risk for infections. Your physician will make the decisions concerning diet restrictions following day +100.
Low Bacteria Diet
Dairy
Pasteurized milk or yogurt and cheeses made from pasteurized milk are allowed. Cultured yogurt is allowed. If you have diarrhea, milk may be limited. (Lactose, the sugar in milk, can increase diarrhea.) Commercially made nutritional products, supplements, and infant formulas are allowed. Cheese from delicatessens or cheese with molds (e.g., blue, stilton, Roquefort, gorgonzola), sharp cheddar, brie, camembert, feta, or farmer's cheese are not allowed. Soft serve ice cream, frozen yogurts or sherbets from bulk machines are not allowed.
Meats and meat products
All meats must be thoroughly cooked (no raw pink color remaining). Raw egg products and raw meats are not allowed. Only commercially packaged lunch meats are allowed--no deli meats or cold cuts. Cold smoked salmon, shell fish, sushi, lox, pickled fish, or tempeh are not allowed.
Fruits and Nuts
Canned, dried or cooked fruits are allowed. Fresh bananas, oranges, melons or other thick skinned fruits that have been washed before cutting or peeling are allowed. Smooth-skin fruits that are washed well with no bruising and thickly peeled (such as apples, peaches, pears) are allowed. Any fruit that is rough skinned or cannot be peeled (such as strawberries, grapes, raspberries, etc.) are not allowed. Fruit juices must be pasteurized.
Canned or bottled roasted nuts or nuts in baked goods are allowed. Commercially-packaged peanut butter is allowed. Raw nuts or nuts roasted in the shell are not allowed.
Vegetables
All cooked frozen, canned or fresh vegetables are allowed. Raw vegetables that can be washed and thickly peeled (cucumber or carrots) are allowed. Rough-surfaced vegetables (broccoli, asparagus, cauliflower) must be blanched for at least 1 minute under a rolling boil. Raw vegetables that cannot be peeled or blanched (lettuce or other leafy greens), raw vegetable sprouts, salads from delicatessens, uncanned, commercial salsas are not allowed.
Bread, grains and cereals
No restrictions other than raw grain products.
Fats / Spices / Condiments / Misc.
Oils, crisp bacon, butter, margarine, cream cheese, commercial mayonnaise and dressings are allowed. Herbs, spices and pepper must be added to foods before cooking. Only sterilized black pepper is allowed after cooking. Salt, granulated sugar and brown sugar are allowed. Jam, jelly, syrup, pasteurized honey are allowed (refrigerate after opening.) Pickles, pickle relish, olives are allowed (refrigerate after opening.) All desserts except unrefrigerated cream-filled pastries are allowed.
Beverages
Tap water, commercial bottled, spring, and natural waters are allowed. Canned, bottled, powdered beverages are allowed. Instant and brewed coffee, tea made with boiling water and brewed teas are allowed. Commercial nutritional supplements are allowed. Well water is not allowed. Cold-brewed tea or Maté tea are not allowed.
Fast food
Fast food may be brought to you. It is best for family to visit the restaurant at non-busy times and ask for the food to be prepared fresh. Use good judgment. If the restaurant looks dirty and employees are not using clean food-handling techniques, choose another restaurant. Request that sandwiches be made without toppings. Buffet restaurants are not allowed.
Tube feedings
Wash tops of cans before opening. Never place more than eight hours of feeding in the bag at a time.
Food safety guidelines for the family
The best way to decrease infections from food is to follow the food safety guidelines below.
Hand washing
Hand washing is your first defense in food safety. Hands should be washed before and after food preparation and prior to eating. Hand washing should also occur after using the bathroom, smoking, diapering, sneezing, handling pets and taking out garbage. Complete hand washing takes about 15-30 seconds using soap and warm running water. When working with children a good activity to perform is making them complete the alphabet song while washing their hands.
Cleaning equipment
All items used to prepare food must be cleaned with soap and warm water before and after each use. Use separate cutting boards and utensils for raw and cooked foods and clean well after use. Maintain a clean refrigerator and freezer and keep them at the correct temperatures - 40°F (4°C) for the refrigerator and 0°F (-18°C) for the freezer. Towels and dish clothes should be changed daily. Dirty sponges should be discarded and replaced weekly. Utensils and equipment can be sanitized using a solution of 1/4 cup bleach to 4 cups of water or 1 tablespoon bleach to 1 cup water.
Shopping
Frozen foods should be solid and refrigerated foods chilled. Notice the "sell by" (length of time grocer can keep products) and "use by" (length of time product is best eating quality) labels found on packaging. Purchase frozen and refrigerated foods last before going through the checkout.
Storage
Cupboards and pantries should be kept clean, dry, dark and cool. High temperatures are harmful to canned goods. Rotate food stock in pantry, freezer, and refrigerator so the oldest items are used first. When storing food in the refrigerator or freezer, all foods should be wrapped and sealed in storage containers; place small portions of foods in shallow containers for faster cooling; label and date containers before freezing; discard foods with mold or past expiration dates.
Preparation
Thaw meat, fish, and poultry in the refrigerator with a dish underneath to catch drippings. Wash tops of canned foods before opening. Do not use the same utensil for tasting and stirring. Meats should be well done (no pink remaining). Wash fruits and vegetables with running water prior to peeling and cutting. Do not give your child any food that you think could be starting to spoil. When using a microwave oven use a lid or vented plastic wrap for complete heating, stir and rotate frequently for even cooking.
Dining out
Arrive early to avoid crowds and request to sit in a secluded area in a high-back booth, if possible. When at fast food restaurants, ask for food to be prepared fresh and without extra trimmings (mayonnaise and other sauces).
Tube Feedings
Wash the tops of the cans before opening. Never place more than eight hours of feeding into the bag at a time.
Herbal Supplements
Herbal supplements and health food store nutrition supplements should be avoided. Please let you transplant physician know if you are taking any medications not prescribed by him or her.
Consumable Water and Other Liquids
Bottled Water
There are two acceptable forms of bottled water. You may use bottled water that has been processed to remove Cryptosporidium, a type of bacteria known to cause gastrointestinal infection. There are three processes a manufacturer can use to do this including reverse osmosis, distillation, and one micron absolute filtration. The other acceptable form is bottled water from a naturally protected source, such as a deep artesian well. To confirm that specific bottled water has undergone one of the above processes, you may contact the International Bottled Water Association (IBWA) at 1-800-928-3711. If the IBWA does not have information on a specific brand, you may call the bottler directly. Ask if any of the above processes were used to assure the removal of Cryptosporidium.
Well Water
Well water must be tested yearly for Escherichia coli forms. The test results must be negative if the water is to be used for consumption while following the immunosuppressed diet recommended. The water should be tested immediately prior to your child's return home after transplant. Spring is an appropriate time to perform annual testing since water runoff may contaminate the water supply. If construction is occurring near your well, more frequent testing should be performed.
Distilled Water
Distilled water can be made at home by bringing tap water to a rolling boil for one minute and storing it in a clean, covered container in the refrigerator. Discard after 72 hours.
Water Filters
If you use a water filter, the following specifications must be met:
- The filter must be labeled as meeting the American National Standards Institute Standard #53 by NSF International.
- The filter must be installed immediately before the water tap.
- The filter must be capable of removing particles less than one micrometer in size.
- The filter must be maintained per manufacturing guidelines.
For a list of approved filtration systems, call the NSF International at 1-800-673-8010 or visit their web site at www.nsf.org and search under product service listing for bottled water or drinking water treatment units.
Contact Us
For additional information on this or any Health Topic, please call the Family Resource Center, 513-636-7606, or your pediatrician.
Patient Education Program IV 4019
Rev. 3/08
