Tuesday, January 10, 2012

What not to eat when immunocompromised.

Sam teaching her nephew about Typhoid Fever
      This will undoubtedly seem an odd topic for someone whose blog was originally a food-oriented blog, but I was recently asked for advice on what should be avoided by someone who is taking a strong immunosuppressant, such as CellCept. I should stress that I am not a nutritionist or dietician. I am, however, a microbiologist by training.  One could reasonably argue that I am a little paranoid; I probably am. But I also think it's safe to say that I'm a little more aware than most of common causes of food poisoning. So here is my opinion, for whatever it's worth.  

Foods I avoid while on CellCept:
1.   Sushi/Sashimi: This one breaks my heart, as I love sushi. But any sushi or sashimi that is uncooked (contrary to popular belief, sashimi is more likely to be uncooked than sushi) is not a good idea. Why? Simply because raw fish always carries a risk of infection, but the results of such an infection are far more serious for those of us who are immunocompromised.

2.   Steak Tartare (or any other uncooked meat): For the same reason. Anyone might get sick from under-cooked meat, but the infection has the possibility of raging out of control in an immunocompromised person.

3.  Any product containing un-cooked eggs. Cookie dough made with eggs, some chocolate mousses, etc, are all probably not a great idea.

4.   Unpasteurized dairy products or apple juice. Bacteria that might not be a big deal for healthy people can cause what are known as opportunistic infections in those whose immune systems are under-par. I know that many people believe that there are "good" bacteria in unpasteurized dairy products, and that is sometimes true. However, there's also an increased chance of either "bad" bacteria, or bacteria that are normally not "bad," but become so when they are in a body with a poor immune system.

If you find yourself really immunocompromised, I would recommend looking up dietary restrictions designed for chemotherapy patients. Most people on immunosuppressants for autoimmune disease are not as suppressed as cancer patients, but the guidelines may be helpful for some. Typical suggestions include things like avoiding soft-serve ice-cream (whose machines can harbor bacteria like B. cereus, deli meats (which can have Listeria bacteria), and many others. And, the most horrifying of all, such patients are not allowed to eat fresh fruit like raspberries! Even many vegetables are suspect, as are nuts. But, as I say, that level of care is probably not necessary for most lupus patients. If you have any doubts on the subject, or wonder about a particular food, please ask your physician. (S)he can give you far better and more tailored advice than I can.

On an unrelated but slightly weird side-note, some medications interact very badly with grapefruit juice. I don't think that CellCept is one of them, but it's worth checking your prescriptions with a pharmacist if you're a grapefruit fan.


  1. would you add things like fresh raspberries that can have fabulous "fun guys" ;)? i know fresh uncooked fruits and veggies that could not be peeled were on the no no food list when my counts were zero w/ chemo. i know they are part of living in my world and this spring and summer were horrid diet wise. not only did nothing taste good but the choices were horrid. chocolate still does not taste right. i know, unbelievable.

  2. @Ehzu--not quite sure what you're getting at there, I'm afraid.

    Sure thing, Momster. This was more directed to the semi-compromised lupus patients, but I will definitely add fresh raspberries when I have time to edit the post. Such a travesty not to be able to eat them!

  3. Finally remembered to add it in, Momster!