Dietary guidelines and food safety: For immuno-suppressed/compromised patients

Jenifer Theresal J*

Senior Dietician, Kauvery Hospital, Tennur, Trichy, India

*Correspondence: dietary.ktn@kauvery.in

Background

The immune system helps protect the body against contractible illnesses, such as a cold and the flu. Nutrition is an important part of ensuring that the immune system stays strong.

What’s the difference between immunocompromised and immunosuppressed?

Both terms refer to deficiencies in the normal function of the immune system. So, whether a person is immunocompromised or immunosuppressed, their body will be less effective at fighting off infections

Immunocompromised

Immunosuppressed
This usually me ans that a health condition is affecting a patient’s ability to fight infections. Examples of conditions that can affect a patient’s immune system include HIV, cancer, diabetes, malnutrition, and some genetic disorders. When people use this term, they usually refer to a condition that has been induced deliberately. Doctors may prescribe patients with immunosuppressant drugs for a variety of reasons, which we’ll discuss below.

Definitions

  1. People who are immunosuppressed have a reduced ability to fight infections and other diseases. This may be caused by certain diseases or conditions, such as AIDS, malnutrition, and certain genetic disorders. It may also be caused by certain medicines or treatments, such as anticancer drugs, radiation therapy, and stem cell or organ transplant.
  2. An immunocompromised (im-YOU-noh-KOM-pruh-mized) diet is also called a low bacterial diet (Another name for the neutropenic diet is the low-microbial diet). This diet is used to help decrease the amount of bacteria for a person who has a weakened immune system. People who had a transplant are at a higher risk to get sick from contaminated foods or drinks.

Causes of Immunosuppression

Immunosuppression may be caused by a number of systemic illnesses. These include, but are not limited to the following

  1. Renal and/or hepatic failure
  2. Infection of the central nervous system
  3. Systemic lupus erythematosus
  4. Rheumatoid arthritis
  5. Corticosteroids
  6. Immunoglobulins
  7. Antimetabolites
  8. Biological alkylating agents
  9. Ionizing radiation.

Principle of Diet

The neutropenic diet is an eating plan for people with weakened immune systems. It involves choosing foods and preparing them in a way that lowers your risk of foodborne illness. If you have a weakened immune system, your doctor or Dietician may recommend that you follow a neutropenic diet to limit your exposure to harmful microbes and bacteria.

Diet Guidelines for Immunosuppressed Patients

Immunosuppressed Patients have decreased immune function because of chemotherapy and/or radiation therapy or from taking medications to suppress your immune system. This means that you are at increased risk of developing a food related infection. The purpose of this diet is to help you avoid specific foods that are more likely to contain infection-causing organisms while allowing maximum healthy food choices.

Some Common Foods to Avoid

  1. Raw or undercooked meat and poultry. Especially ground beef and salami. All meat should be cooked well done.
  2. Raw or undercooked shellfish, fish and smoked fish
  3. Unpasteurized beverages, such as fruit juice, milk and raw milk yogurt.
  4. Soft cheeses made from unpasteurized milk.
  5. Uncooked eggs, unpasteurized eggs and foods made from raw egg such as homemade raw cookie dough and homemade mayonnaise.
  6. Raw sprouts
  7. Unwashed fresh fruit and vegetables. Before eating, wash all fruit and vegetables even if you are going to peel off the skin.
  8. Avoid well water unless it has been tested, filtered, or boiled for one minute before drinking. At home, it’s okay to drink tap water or bottled water. It is also recommended that if you have a well for your water source, a water filter should be installed on the tap or where the water enters the house. You can get your water tested at no cost. If a filter is needed and cannot be afforded, you can boil your drinking water. To sterilize water keep it at a rolling boil for at least one minute, or three minutes at altitudes above 2000 meters (about 6,562 feet).

Safe Usage of Restaurant Foods

  1. In general, eating foods from restaurants or other establishments that serve food is discouraged due to inability to ensure food safety.
  2. Always use your best judgment when choosing a restaurant. Many restaurants post their inspection scores, the higher the score, the safer the restaurant.
  3. Food to be made fresh, and use single serving condiment packages.
  4. Avoid fountain beverages and ice from ice machines.
  5. Make sure transport time is less than one hour and try to keep hot foods hot and cold foods cold (i.e. using insulated carry containers or coolers). It may be a good idea to re-heat foods prior to serving.
  6. Avoid raw fruits and vegetables when getting foods from restaurants.

 

Special category

Immunocompromised diet for Bone Marrow Transplant patients

General nutrition

Adequate nutrition is an important part of the recovery process. It helps protect the body from infection and repair the tissue damage caused by preparative chemotherapy or radiation therapy.

Calcium, vitamin D and phosphorus

Some medications (mainly corticosteroids) can compromise bone health. Good nutritional status, weight bearing exercise, and adequate calcium, vitamin D and phosphorus will help to build strong bones.

Potassium and magnesium

Certain medications, or diarrhea and vomiting can cause electrolyte imbalances. Potassium and magnesium are important for proper nerve function and muscle control. Magnesium also aids in bone growth and metabolism. Even after discharge from the hospital, it is common to require potassium and magnesium supplementation. It can also be obtained through the food sources listed below.

 

Calcium

Vitamin D

Phosphorus

Potassium

Magnesium
Milk, Buttermilk Fortified Milk Bran Cereal Baked Potato, Yam Bran Cereal
Yogurt, Yogurt Drink Sea Foods Corn bread Dried Apricots, Raisins Brown Rice
Broccoli, Spinach Fortified Cereals Beans Sea Foods Beans
Hard Cheese Cod-Liver Oil Black-Eyed Peas Bran Cereal Sunflower Seeds
Dried Figs Sunlight Dark Chocolate Avocado, Tomato Almonds, Cashews
Whole Sesame Seeds Liver Yogurt Banana, Mango Spinach, Chard
Sea Foods Egg Yolk Milk, Cheese, Soy Milk Beans Avocado
Molasses, Black-Strap Walnuts, Almonds Milk, Yogurt Dried Figs
Sea Foods
Jenifer

Dt. Jenifer Theresal J,

Senior Dietician

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