Recently, questions were raised about diet when diagnosed with neutropenia. This summary is a result of the need for a user friendly guide for what to do when you are neutropenic.

First and foremost, what is neutropenia and why does it occur? Primarily, “neutropenia refers to low levels of bacterial infection-fighting white blood cells known as neutrophils. In this state, the immune system is weak and may allow infection to set in. ” (source https://www.doctorshealthpress.com/food-and-nutrition-articles/diet-articles/neutropenic-diet-foods-to-eat-avoid/). Frequently seen when a patient is undergoing cancer treatments like chemotherapy, it can also be caused by chronic infections. When the neutrophils fall below a certain level of less than 500 neutrophils per microliter of blood, a patient is classified as having severe neutropenia (see also https://www.nhs.uk/conditions/low-white-blood-cell-count/). At that point, if the condition is caused by your cancer treatments or a poor immune system, you will start on corticosteroids and drugs that rebuild the white blood cells like colony-stimulating factors (source: https://pubmed.ncbi.nlm.nih.gov/26554885/ ).

So how can you avoid neutropenia? You really cannot, most likely, if your cancer treatments are responsible or you have a severely compromised immune system. But there are common sense tips you can employ to prevent infections and to stay relatively safe.

At this point, I feel it necessary and important to explain that I am referring to both bacterial and viral infections, (https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=34&ContentID=21859-1) and there are some very common sense things you are do at home to aid in fighting infection. The following chart is derived from the Cleveland Clinic article from above:

• Wash your hands frequently with soap and water. Wash your hands before and after you eat, after you use the toilet, after touching pets or things outside of your house, and after you cough or sneeze.
• Keep and use an alcohol-based hand sanitizer with you when you leave the house.
• Make sure you get the flu shot as early as you can, if your doctor says you can do this.
• Stay away from crowds of people and people who are sick.
• Do not share eating utensils, cups, food or beverages with other people.
• Do not share towels, razors or toothbrushes with other people.
• Wash raw fruits and vegetables.
• Keep raw meats, fish and poultry away from other foods.
• Use hot water and soap to clean the kitchen surfaces before you start cooking.
• Cook foods completely to the proper temperature.
• Use gloves if you are gardening in the dirt or working in the yard.
• It is best to not pick up pet waste. If you have to do so, use gloves. Wash your hands when you are done.
• Use a soft toothbrush to brush your teeth at least two times per day.
• Take a shower each day. Use lotion so your skin does not dry out and crack.
• Eat a healthy diet.
• Tell your doctor if you might need dental work so he or she can prescribe antibiotics before the work is done, if necessary.
• Do not get body piercings or tattoos.
• Do not swim in lakes or ponds.
• Avoid becoming constipated if you can.

The big problem, I feel, is keeping the kitchen clean (and avoiding constipation). This is where many of us spend much of our time, prepping meals. So many of us now have costly granite and quartz countertops, and I do not know about you, but when we had our quartz countertops installed, the cleaning instructions stated to avoid the heavy cleaning products on the market. Wiping the kitchen surfaces with a soft cloth was the standard.

But then covid hit and we were told to ramp up the use of our antibacterial hand sanitizers and to clean more often than (admittedly) most of us were doing pre-covid. I feel the attached explains what we can use to clean the kitchen surfaces, noting that the key is to use plain water to remove any residue left behind from your cleaning product of choice: https://graniteselection.com/blog/how-to-disinfect-quartz-countertops-during-covid-19/ Please note that this article prefers 70% isopropyl alcohol to other options. I found it interesting that the article mentions changing your clothes after you clean! In a recent Zoom chat, one of our members mentioned that they change their clothes after they have been out of the household! This seems like very good wisdom considering the current climate, not to mention if you are neutropenic! I am also sharing another article that talks about the cleaning efficacy of many beloved household brands (and if your area actually has CLOREX brand bleach, let me know, and I will come visit you and stock up on it. I have not seen that brand here since pre-covid!) https://bestlifeonline.com/best-disinfectants-coronavirus/?utm_source=msn&utm_medium=feed&utm_campaign=msn-feed

And now for the cream. The real reason I started this article, was to see what was recommended to eat / not to eat. This turns out to be very controversial. Of all the sites I trolled, I found that the Doctor Health Press one mentioned previously, handled the controversy well. But to sum up, the main thing was to firmly avoid: deli meats, un-cooked or under-cooked meats and eggs, watch the expiration dates on foods closely, thaw frozen meat/fish in the refrigerator and cook / eat within 24 hours, allow foods to fully cool before placing in the refrigerator, do not reheat rice, and do not eat leftover foods after 24 hours (check out https://www.doctorshealthpress.com/food-and-nutrition-articles/diet-articles/neutropenic-diet-foods-to-eat-avoid/ for some great food tips and recipe ideas).

And for those of us who love our fresh fruits and vegetables, especially now that summer is here and the farmer’s markets are in full swing, WASH YOUR PRODUCE THOROUGHLY. One other beloved cleaning product which has several uses is baking soda, and https://www.armandhammer.com/en/articles/how-to-clean-fruits-and-vegetables gives awesome tips all of us can use to safely (and without chemicals) to remove toxic residue from veggies and fruit. And no need to buy expensive “produce sprays” when you can get no-name brand baking soda for sometimes as little as 50 cents in the USA. A little box goes a long way to having the confidence that any potential toxins have been washed away. You must soak the produce in a cold water/baking soda solution for about 10 minutes to best results.

In summary, neutropenia is a serious medical condition of concern. A person who has low neutrophils must take precautions to remain as healthy as possible. This article puts some of the most necessary information at your fingertips. But, as always, let your common sense rule. Do not place yourself in risky situations, avoid food of an unknown source (hence, you might want to avoid eating in restaurants for some time), and keep things as clean as possible at home.