Really Really Super Safe Food

Photo: Chef Ian Windslade's delicious slow cooked salmon with cherry tomatoes in a miso-yuzu broth at Market in W Hotel Buckhead, Atlanta.

Eating out when you're immune function is down.

Going through the rollercoaster of chemotherapy for treatment of cancer or other illnesses is physically and mentally challenging enough. Add to that the addition of cautionary lists of foods to avoid when the immune system is weakened and even the everyday enjoyment of eating a bunch of grapes or grabbing a deli sandwich with friends can be taken away, too. When a friend of mine who is undergoing chemotherapy for a kidney condition told me her physician recommended she avoid eating all raw fruits and vegetables I wanted to learn more about the nuances of current food safety advice for cooking and dining out.

Tiffany Barrett, clinical dietitian specialist at the Emory Winship Cancer Institute at Emory University Healthcare in Atlanta, explains that the level of concern in avoiding potential pathogens in foods is related to the level of immune defense indicated by white blood cell counts because the lower the level of white blood cells (which fight infection), the higher the concern for food safety risks. “So I do not recommend all chemo patients avoid raw produce. The potential risks include food borne illnesses due to bacteria on the produce, especially produce that cannot be washed effectively. I educate the patient on cross contamination and handling of food.”

Washing produce thoroughly is emphasized and thick-skinned fruit such as oranges and bananas which can be peeled are preferred over thin skinned uncooked fruit such as grapes or apples.
For patients who must avoid even the slightest risk of eating raw produce (including bone marrow transplant patients), Barrett recommends fully cooked fruits and vegetables or commercially frozen or canned produce to receive the benefits of healthy eating. A baked apple rather than a raw apple is a simple and delicious solution.

Dining out can present several risks and challenges because of the unknowns of what is going on behind the scenes with sanitation. What might be perfectly safe for healthy customers could sicken someone with a weakened immune system so advice includes avoiding all salad bars and buffets and requesting that meat and fish be cooked to well- done. If patients are advised to avoid public spaces, they can still enjoy foods from their favorite restaurants as take-out but make sure to reheat dishes when you get them home to at least 165 degrees F or until their steaming hot. Throw out leftovers after 24 hours.

Other potentially hazardous foods because of the bacteria they may contain include unpasteurized milk and cheeses, blue cheeses, brie and other soft cheeses, undercooked eggs, unroasted raw nuts, unpasteurized fruit and vegetable juices, honey in the comb, cold smoked salmon and certainly no sushi or raw shellfish. Barrett says specialized yogurts with live and active cultures are on the “foods to avoid” list at Emory, too, “Little is known about their potential harm to a weakened immune system. Yogurt has been debated here every year. And every cancer center has different guidelines.”