Health Matters

Guidelines for the Low

Microbial Diet

This diet is prescribed when you have had a recent bone marrow
transplant or have a low neutrophil count. A neutrophil is a type of
white blood cell. Your white blood cell count tells how well your
body can fight off infections.

This diet may reduce the risk of illness from foods containing
microbes. Microbes include bacteria, viruses, yeast or molds.

The first section of these guidelines covers food safety. The second
section covers diet guidelines. Continue to follow these guidelines
until you have spoken to someone on your healthcare team. This
includes your doctor, nurse, or dietitian.
FOOD SAFETY GUIDE
What Makes Food Unsafe?
Harmful microbes can attach to foods and grow. You cannot
always see, smell, or taste them.

Microbes are more likely to be found on:

 Milk and other dairy food items that are not refrigerated.
 Undercooked and raw eggs and foods that have raw eggs.
 Undercooked or raw meat, poultry and seafood.
 Certain fruits and vegetables (listed on page 9-10).
 Unpasteurized or untreated juices, for example, fresh
squeezed juices.

Buying Food that is Safe to Eat

 Do not buy canned foods if the can has dents or is swollen.
 Do not buy food in jars if the jar is cracked or the lid is not
tightly closed.
 Open egg cartons to see if any are broken or cracked. Only
buy eggs that are refrigerated in the store.
 Separate ready-to-eat and raw foods. Put the raw meat,
poultry, seafood and other raw foods in plastic bags before
they go into your cart.
 When grocery shopping, pick up milk and other cold foods
last. This shortens the time they are not refrigerated.
 Check containers for the expiration date. Buy and use food
before that date.

Storing Food Safely

 Store cold food immediately after shopping.
 Keep your refrigerator at 33-40°F.
 Keep your freezer at 0°F or below.
 Put eggs and dairy inside the refrigerator; do not store
them in the door. The temperature in the back is cooler
than the door storage area.
  Store leftovers in a shallow container. To cool leftovers
faster, put them in the freezer or refrigerator as soon as you
finish eating. Use them within 1-2 days to prevent spoilage.

Handling Food Safely

 Thoroughly rinse fresh produce under running tap water.
This includes produce with skin and rinds. Rinse thick-
skinned produce under warm, running warm tap water or
scrub with a clean vegetable brush. Then, cut or peel. Never
use bleach or detergent to wash fresh fruits and vegetables.
 Remove and throw away any damaged or bruised areas on
produce.
 Separate raw meats and produce from ready-to-eat food.

Preparing Food Safely

 Thaw foods by using only one of the following methods:
o In the refrigerator one day before cooking.
o In the microwave, using defrost setting. Cook right
away.
 Cook to proper temperatures (see cooking temperatures
chart on page 3).
 Use a food thermometer to test the temperatures of cooked
and reheated foods.
 Reheat leftovers to 165°F.
 Cook meat until it is no longer pink and the juices run
clear. Do not eat hamburgers and other meat products if
the meat looks undercooked.
  Cook fish until it flakes.
 Cook egg white and yolks until they are firm.

Cooking Temperatures
Use tools such as thermometers and temperature charts to help
you cook and avoid potential food-borne illnesses. Place your
thermometer inside of the food item before reading the
temperature.

Cooking Temperature Guidelines

Food Item Safe Minimum Temperatures
Egg and Egg Dishes
Eggs Cook until yolk and white are firm
Egg Dishes & Egg Sauces 160°F
Poultry, Meat and Meat
Mixtures
Turkey, Chicken, & Duck 165°F
Whole Pieces, & Ground
Beef, Veal, Lamb, Pork 160°F
Ground
Beef, Veal, Lamb, Pork 145°F with a 3-minute rest time
Steaks, Roasts, & Chops
Cured Ham 165°F
Seafood/Fish 145°F
Leftovers 165°F
Leftovers
 Sauces, soups, and gravies should be reheated by bringing
them to a boil.
 When microwaving food or reheating leftovers, stir, cover
and rotate food for even heating. Heat food until it reaches
at least 165°F throughout for 15 seconds using a food
thermometer.
 Be sure to let the food cool so you do not burn your mouth.
 Eat reheated leftover foods within one hour.

As a rule of thumb: WHEN IN DOUBT, THROW IT OUT!

Kitchen Cleanliness
Prepare and eat food in a clean area to prevent the spread of
microbes.

 Counter Tops
o Use paper towels or clean cloths instead of sponges to clean
kitchen surfaces.
o Use an antibacterial cleansing spray to clean surfaces. Look for
products that have bleach or ammonia. Examples are Lysol® Food
Surface Sanitizer and Clean-Up Cleaner. *

 Cutting Boards and Equipment

o Use one cutting board for fresh-washed produce and bread
and a separate one for raw meat, poultry and seafood. This
will prevent a ready-to-eat food from picking up bacteria
from raw meat, poultry or seafood.
o Wash cutting boards and brushes with hot, soapy water
after each use. Rinse with clean water. Air dry or pat dry
with clean paper towels. You can also wash solid acrylic,
 plastic or glass boards, solid wood boards and produce
brushes in a dishwasher.
o Disinfect both wooden and plastic cutting boards with a
mixture of one tablespoon of unscented, liquid chlorine
bleach per gallon of water. Flood the surface with the
bleach solution. Allow it to stand for more than five
minutes. Rinse the board with clean water. Air dry or pat
dry with clean paper towels.
o All plastic and wooden cutting boards wear out over time.
Throw away cutting boards when they are worn or have
hard-to-clean grooves or cracks.

*Use of brand names is for educational purposes only and does not constitute an
endorsement.

 Personal Cleanliness
o Clean hands and good personal hygiene are essential.
Wash your hands with soap and water:
 Before you prepare or eat food.
 After you prepare raw meat, poultry, fish,
and seafood and before you prepare other
foods.
 After you use the restroom.
 After you clean or change a child.
 After you cough, sneeze or blow your nose.
 After you handle garbage.
 After you treat a cut or wound.

 Safe Water
 o Safe water is water that is free of contaminants or
contains an amount of contaminants deemed
acceptable by the federal government.
o If you are not sure if your water is safe, check with the
local health department or boil or filter water. Use
commercially bottled water if you think the tap water
may not be safe.
o Never drink water from lakes, rivers, streams, springs
or wells.

Eating out at Restaurants:

Choose restaurants carefully. Local health departments inspect
restaurants to make sure that they are clean, and that they follow
safe food practices. You can find out how your local restaurant of
choice did on recent health inspection by going to your local
Department of Health (DOH) website; for example:
http://www.nyc.gov/html/doh/html/rii/index.shtml.
You can also ask your local restaurant about their food safety
training rules. This is good to know when you are planning to eat
out.

 Order all foods to be well done.

 Do not order foods that may have raw meat and fish or raw
eggs, such as Caesar salad dressing, Hollandaise Sauce,
sushi and sashimi, tartare and some homemade ice creams
or custards, mousse and tiramisu.
 Ask the wait-staff if you are not sure of the ingredients in
your meal.
  Do not eat foods from buffets and salad bars.
 Request that foods are cooked fresh and not served from
steam tables or kept warm by heat lamps.
 Request single serving condiments. Multiple customers
may use open containers.
 Do not eat soft-serve ice cream and soft serve frozen
yogurt. The dispensers may not be cleaned on a regular
basis.
 Always order a whole or personal pizza. Do not order single
slices since they are often kept warm under heat lamps.

Herbal Supplements:
Do not take homeopathic remedies or herbal products including
Traditional Chinese Medicines.

 There are no federal standards for these products in the

United States. They may be contaminated during
production or storage.
 Contaminated products may be a health risk and may cause
infection.
 Herbal products may interfere with or change the activity
of a prescription medicine.
  Always talk to your physician before taking any
homeopathic remedy or herbal product that is not
prescribed.

GUIDELINES FOR A LOW MICROBIAL DIET

Food Group Recommended Not Recommended
Breads, •All breads, rolls, •Foods with raw (not
Grains, and bagels, waffles, cooked or baked) grains
Cereals French toast,
•Undercooked or raw
muffins, sweet rolls,
brewer’s yeast
and pancakes
•Breads, rolls, and
•Potato chips, corn
pastries in self-service
chips, tortilla chips,
bins
pretzels, and
popcorn •Un-refrigerated cream-
filled pastry products
•Any cooked or
ready-to-eat cereal
purchased pre-
packaged from a
store
•Cooked rice,
pasta, and other
grains
Milk, Dairy Pasteurized Unpasteurized
Products,
•Grade A •Raw milk, cheese,
Formulas, and
commercially yogurt, or other milk
Dairy
available milk and products
Substitutes
milk products
•Eggnog (homemade)
• Commercial
•Soft-serve ice cream or
eggnog
yogurt
•Soy milk, rice milk,
•Un-refrigerated, cream
and oral
filled pastry products
supplements such
as Ensure® or
Cheese
Glucerna®*
•All mold-ripened
•Yogurts, including
cheeses, such as
those made with
 live cultures Roquefort, Muenster,
blue cheese, sharp
•Sour cream
cheddar, feta cheese
•Puddings made at
•Soft cheeses such as:
home or purchased
brie, farmer’s cheese,
Milk, Dairy pre-packaged from
camembert, or Mexican
Products, a store
style cheese (Queso
Formulas, and •Pre-packaged ice Blanco or Queso Fresco)
Dairy cream, frozen
Substitutes •Prepared in
yogurt, sherbet,
(cont’d) popsicles, ice
delicatessens
cream bars, and •Containing chili peppers
fresh homemade or other uncooked
milkshakes vegetables
•Commercially
sterile ready-to-
feed and liquid
concentrate infant
formulas
•Dry, refrigerated,
or frozen
pasteurized
whipped topping

Cheese
•Processed cheese
slices and spreads,
cream cheese,
cottage cheese,
and ricotta cheese
•Commercially
packaged hard and
semi-soft cheese
such as mild and
medium cheddar,
mozzarella,
parmesan, Swiss
•Cooked soft
cheeses such as
brie, camembert,
 feta, and farmer’s
cheese
Eggs •Well-cooked eggs •Undercooked or raw
(white and yolk are eggs, and non-
Eggs (cont’d) firm) pasteurized egg
substitutes
•Pasteurized eggs,
pasteurized egg •Salad dressings
substitutes and containing raw eggs
powdered egg
whites
Meat, Meat •All well-cooked •Undercooked or raw
Substitutes, meats (see Food meats, poultry, fish,
Poultry, and Safety Guidelines including rare or medium-
Seafood for temperatures) rare items; smoked or
pickled fish and meats
•Cooked tofu (cut
that have not been
into 1-inch cubes
further cooked; miso
and boiled for at
products, tempeh
least 5 minutes), or
pasteurized tofu •Freshly sliced deli meats
or meats from street
•Commercially-
vendors
prepared cold cuts
sold in a sealed •Beef jerky (hard cured
package such as salami in natural wrap)
salami, bologna,
• Raw shellfish, raw fish
ham if cooked
(including caviar),
until steaming hot
sashimi or sushi, or
(165ºF) before
ceviche
eating and
discarded within 48 • Raw or cooked
hours of opening mollusks (clams,
mussels, oysters)
• Thoroughly
cooked fish and • Smoked seafood such
other seafood as salmon or trout
labeled as “nova style,”
• Canned meats
“lox,” “kippered,”
and meat spreads
“smoked,” or “jerky”
• Canned and shelf- unless cooked to 160°F
stable smoked fish or contained in a cooked
dish or casserole
• Refrigerated pates and
 meat spreads
Fruits and • Well-washed raw • Unwashed raw fruits,
Vegetables fruits and vegetables, or herbs
vegetables
• Any fresh raw fruits and
Fruits and
• Cooked and vegetables that cannot
Vegetables
canned fruits and be thoroughly washed
(cont’d)
vegetables such as: blueberries,
strawberries, raspberries,
• Cooked frozen
peaches, plums, and
fruits and
grapes (they tend to get
vegetables
mold around their stems)
• Thoroughly
• Any frozen berries and
washed thick
other thin skinned frozen
skinned,
fruits (grapes)
unblemished fruits
before peeling, e.g. • Non-pasteurized fruit
citrus, bananas and and vegetable juices
melons; as slicing
• Fresh fruit salsa or
through the skin or
fresh vegetable salsa
rind can
found in the grocery
contaminate the
refrigerator case
inner fruit
• Vegetarian sushi
• Pasteurized juices
and frozen • Non-pasteurized items
concentrates containing raw fruits or
raw vegetables found in
• Commercially
the grocery refrigerator
packaged dried
case
fruits
• All raw vegetable
• Shelf-stable
sprouts
bottled salsa
(refrigerated after • All salads from
opening) delicatessens or salad
bars
• Cooked vegetable
sprouts
• Fresh, well-
washed herbs and
dried herbs and
spices added to
raw or cooked
foods (except
 pepper which
should be added to
foods prior to
cooking only)
Beverages • Boiled well water • Unpasteurized eggnog
or apple cider and other
• Tap water and ice
unpasteurized fruit or
made from tap
vegetable juices
water
• Reconstituted protein
• Water:
powder beverages
Commercially
unless approved by your
bottled distilled,
registered dietitian
spring, and natural
waters • Unpasteurized beer,
such as microbrewery
• Pasteurized fruit
beers and those that are
and vegetable
not shelf-stable
juices
• Wine
• Bottled, canned,
or powdered • Fountain beverages
reconstituted
• Tea made with loose
beverages
leaves
• Instant and
brewed coffee
• Hot brewed teas
using commercially
packaged tea bags
• Pasteurized soy,
rice, and almond
milk (in addition to
other pasteurized
dairy substitutes)
• Commercial
nutritional
supplements
including Ensure®,
Boost®*
Nuts and Dried • Factory packaged • All nuts or dried fruits
Fruit nuts, dried fruits, that are sold open and in
and raisins bulk, as in some health
 • Roasted nuts from food or specialty stores
a can or jar, shelled
• Raw nuts or raw nut
• Nuts in baked butters
goods such as
Nuts and Dried • Roasted nuts in the
peanut butter
Fruit (cont’d) shell
cookies
• Freshly made peanut
• Commercially
butter, not commercially
packaged nut
packaged
butters (such as
peanut butter,
almond butter,
soybean butter)
Condiments/ • Salt and sugar • Raw or unpasteurized
Miscellaneous honey, honey comb
• Jellies, syrup and
jams (refrigerate • Whole or ground
after opening) pepper, unless
thoroughly cooked in
• Catsup, mustard,
food
BBQ sauce, soy
sauce, other • Fresh salad dressings
condiments containing raw eggs,
(refrigerate after cheeses, or ground
opening) pepper
• Commercial, heat- • Herbal and nutrient
treated honey supplement preparations
• Pickles, pickle
relish, olives
(refrigerate after
opening)
• Vinegar
• Vegetable oils
and shortening
• Refrigerated
margarine and
butter
• Commercial,
shelf-stable
mayonnaise and
salad dressings,
 including blue
cheese and other
cheese-based
salad dressings
(refrigerate after
Condiments/ opening)
Miscellaneous
• Cooked gravy and
(cont’d)
sauces
Desserts • Refrigerated • Non-refrigerated cream-
commercial and filled pastry products
homemade cakes, (not shelf stable)
pies, pastries, and
• All desserts in self-
pudding
service bins
• Refrigerated
cream-filled
pastries
• Cookies, both
homemade and
commercially
prepared
• Shelf-stable
cream-filled
cupcakes (such as
Twinkies®, Ding
Dongs®)* and fruit
pies (such as Pop-
tarts® and
Hostess® fruit
pies)*
• Candy and gum
Eating Outside • All foods • Non-pasteurized fruit
the Home recommended on juices/dairy products, for
previous food example juice bars such
groups must come as Jamba Juice®*
directly off
• Raw fruits or vegetables
grill/stove-not
including salad bars,
served on steam
sidewalk stands, and
table or under heat
desserts with fresh fruit
lamps, such as
freshly made pizza, • Delicatessen meat
 hamburger directly • Buffets/smorgasbords
off grill
• Potlucks and sidewalk
• Single serving vendors
condiment
Eating Outside • Soft serve ice cream
packages (do not
the Home and yogurt
use pump serve
(cont’d)
containers)

Take Out • Freshly made • Any food that is not

pizza not sliced or freshly made to order
reheated Fast food, such as
McDonalds® and
• Well done
Subway®*
hamburger just off
the grill • Avoid reheated foods
Juice bars, such as
• French fries just
Jamba Juice®*
cooked
Leftovers • Refrigerate • Leftovers more than two
immediately after days old
eating in shallow
• Any leftover food that
dishes to allow for
has already been
rapid cooling
reheated once
• Refer to Food
Safety Guidelines
for proper reheating
References and Additional Food Safety Resources
Food Safety and Inspection Service
www.fsis.usda.gov
http://www.fsis.usda.gov/PDF/Cutting_Boards_and_Food_Safety.p
df
Government Food Safety information:
www.foodsafety.gov
U.S. Department of Health and Human Services Food and Drug
Administration
www.cfsan.fda.gov
Centers for Disease Control and Prevention
www.cdc.gov.foodsafety
Centers for Disease Control and Prevention
Emerging Infectious Diseases
www.cdc.gov/eid
Partnership for Food Safety Education (Fight BAC!)
www.fightbac.org
“Ask Karen” (Web-based automated response system-available 24/7)
http://www.fsis.usda.gov/Food_Safety_Education/Ask_Karen/inde
x.asp?src_location=IWT&src_page=Home
New York City Department of Health and Mental Hygiene Restaurant
Inspection Information
www.nyc.gov/html/doh/html/rii/index.shtml
For More information:
Call your nearest FDA office. Look for the number in the blue pages
of your phone book.
Or call one of the FDA’s toll-free numbers: (888) SAFE-FOOD (723-
3366)
(888) INFO-FDA (463-6332)
This information is brief and general. It should not be the only source
of your information on this health care topic. It is not to be used or
relied on for diagnosis or treatment. It does not take the place of
instructions from your doctor. Talk to your health care providers
before making a health care decision.
Copyright NewYork-Presbyterian Hospital. 2014. All rights reserved.
* Useof brand names is for educational purposes only and does not constitute an
endorsement.