Patient education: Low-bacteria diet (The Basics)

How do germs get in food? — Bacteria and other germs are often found in or on the food we eat. Food can also be contaminated with germs as we prepare it. Germs are so small that we can't see, smell, or taste them. The more bacteria and other germs are in a food, the higher the chance that the food could make you sick.

Cooking and storing food properly are 2 ways to lower the amount of bacteria and germs in food. Most of the time, the immune system is able to protect the body from any germs that are in the food we eat. The immune system is the body's infection-fighting system.

Why do I need a low-bacteria diet? — Your doctor might recommend following a low-bacteria diet if your immune system is weaker than normal. When your immune system is weak, your body cannot fight infections as well.

Examples of things that can weaken your immune system include:

●Cancer treatments, including chemotherapy and radiation

●Medicines you take after a transplant

●Other medical conditions

What can I eat and drink on a low-bacteria diet? — It is safe to eat and drink things that have been cooked to a high temperature. Cooking with heat kills germs. Foods that have been treated with heat, light, pressure, or other methods to kill germs are "pasteurized" and are also safe to eat. This includes most foods that are canned and commercially made. Some examples:

●Grains – Breads, bagels, rolls, muffins, chips, pretzels, popcorn, pasta, rice, grains, cookies, cakes, pies, pastries, cooked and ready-to-eat cereals.

●Fruits – Canned fruit, stewed fruit, dried fruit, fresh fruit that is thoroughly washed and peeled.

●Vegetables – Cooked vegetables that have been fresh, frozen, or canned. Fresh, raw vegetables that are thoroughly washed and peeled if possible.

●Dairy – Milk, ice cream, and yogurt products that are pasteurized. Cheese and cheese products made with pasteurized milk. These must be commercially packaged. This includes cheeses like mild or medium cheddar, mozzarella, parmesan, and cream cheese.

●Meats, poultry, seafood, and proteins – Meats that are fully cooked (not rare or medium rare), eggs with a firm white and fully cooked yolk. Commercially packed salami, bologna, and other luncheon meats. Canned meat, fish, and meat spreads. Commercially packaged nut butters, cooked tofu, roasted nuts, egg substitutes.

●Other items – Tap water, commercially packaged bottled water, coffee or tea made with boiled water. Commercially prepared nutritional supplements, condiments, honey that has been pasteurized or commercially prepared.

What foods and drinks should I avoid on a low-bacteria diet? — Raw or undercooked foods are more likely to have bacteria and germs. Some examples:

●Grains to avoid – Raw grain products including raw dough and cream-filled pastries that are not "shelf stable."

●Fruits to avoid – Raw, unwashed, unpeeled fruits. Fruit juice that has not been pasteurized.

●Vegetables to avoid – Raw, unwashed, unpeeled vegetables or herbs. Vegetable sprouts including alfalfa and bean sprouts, salad bar items, juice that has not been pasteurized.

●Dairy to avoid – Dairy products that are raw or have not been pasteurized, cheese from the deli, cheeses with mold like blue cheese or gorgonzola. Soft cheeses like feta, brie, Roquefort, or goat cheese. Soft serve ice cream or frozen yogurt, kefir. Mexican style cheeses like queso fresco or queso blanco.

●Meats, poultry, seafood, and proteins to avoid – Undercooked meats, rare or medium rare meats, undercooked eggs, unroasted raw nuts, freshly sliced cold cuts from the deli, smoked or pickled fish, lox, sushi, raw oysters or clams, tempeh.

●Other items to avoid – Well water (unless it has been tested and found to be safe), coffee or tea that is not made with boiled water. Fresh salad dressings, raw honey, miso, brewer's yeast, aioli, kombucha.

How can I safely prepare food?

●Wash your hands with soap and water before cooking and after handling raw meat, poultry, fish, or raw eggs.

●Thaw frozen foods in the refrigerator or microwave. Do not leave food out to thaw. Marinate foods in the refrigerator, not at room temperature.

●Wash fresh fruits and vegetables under running water. Peel fruits and vegetables when possible.

●Use separate cutting boards and knives for meats and other foods. Do not use wooden cutting boards if possible. Do not let the juice from uncooked meat, poultry, or fish touch other foods. Use clean dishes to serve food.

●Heat hot foods to 165°F (74°C) or higher. Keep the food hot at a minimum temperature of 140°F (60°C) until ready to eat.

How can I safely store food?

●Set your refrigerator at 33 to 40°F (0.6 to 4°C) or lower.

●Set your freezer at 0°F (-17.8°C) or lower.

●Store cold foods in the refrigerator. Take them out when you are ready to eat or drink them, and use within 2 hours. Do not keep mayonnaise or dairy products out of the refrigerator for longer than 30 to 60 minutes.

●Put away cold foods right away when you get home from the store. Consider taking a cooler to keep food cold if it is very hot outside.

●Throw away food if the expiration date has passed.

●Throw away leftovers or open packages of food that have been in the refrigerator for more than 2 to 3 days.

●Store eggs and dairy in the back of the refrigerator where it is cooler, not in the door.

What else should I know? — If possible, avoid items from places where food might be left out for a long time. Examples include:

●Salad bars

●Steam tables

●Bulk food bins

●Store samples

●Street vendors

●Multi-use condiment containers

Also, avoid getting food and drinks from places where you are not sure how the food or equipment has been handled or cleaned. Examples include:

●Precut food at the store

●Self-serve ice or drink dispensers

●Drinking fountains

●Soft serve ice cream or frozen treats from machines

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