"Is a Neutropenic Diet Necessary for Cancer Patients?"
Back in the 1960s, a patient isolator unit
was developed for cancer patients undergoing chemotherapy.
Because our immune system cells were often caught in the friendly fire,
up to 50% of cancer patients died of infections
before they even completed the chemo,
because their immune systems had become so compromised.
So they developed this bubble boy like contraption where they shave you,
dip you in disinfectant, rinse you off with alcohol, antibiotic ointment in every orifice,
and a rotating regimen of a dozen of the most powerful antibiotics we had.
Procedures were performed through plastic sleeves
and everything in and out had to be sterilized and passed through airlocks,
and so of no fresh fruits and vegetables.
People went crazy cooped up in these things,
with 38% of people starting to hallucinate.
Fifteen years later the results were in: it simply didn't work.
People were dying at the same rates,
so the whole thing was scrapped, except the diet.
The air locks and alcohol baths were abandoned,
but they continued to make sure no one got to eat a salad.
Neutrophils are our front line of defense white blood cells,
and so when we're immunocompromised, when we don't have enough neutrophils
we're called neutropenic, so patients
are put on a neutropenic diet: no fresh fruits and vegetables.
The only thing is that there's a striking lack of evidence
that such a diet actually helps.
Ironically, the neutropenic diet is the one component that's still practiced,
yet has the least evidence supporting its use.
The rationale was like, look, there's bacteria on salads,
bacteria cause infections, and so, look, immunocompromised patients
are at increased risk for infections and so no salad for you.
And frankly, we're glad there's no studies on it
because it could be way too risky to give a cancer patient a salad.
So its continued use seemed to be based
on a "better safe than sorry" philosophy. OK.
The problem is, look, kids diagnosed with cancer
come in already low in dietary antioxidants.
The last thing you'd think you'd want to say is no fresh fruit.
So in addition to the lack of clinical evidence for this diet,
there may be some drawbacks -- maybe restriction of fruits and vegetables
may increase the risk of infection, compromise their nutritional status.
So are neutropenic diets for cancer patients
reasonable prudence or clinical superstition?
A resurgence of research started during the 90s,
when the need to support clinical practice with --- wait for it:
evidence became increasingly important. What a concept!
In other words, you don't know until you put it to the test.
Three randomized controlled trials were published,
and none supported the neutropenic diet.
This was the biggest: an all-cooked diet
versus one that allowed raw fruit and vegetables,
and there was no difference in infection and death rates.
As a result of the study, the principal investigator at the MD Anderson
Cancer Center described how their practice has changed
and now everyone is allowed to eat their vegetables ---
a far cry from the "please don't eat the salads" 31 years earlier.
Today, neither the FDA nor the CDC support the neutropenic diet
nor does the American Cancer Society.
The real dangers are the pathologic food poisoning bacteria:
Campylobacter, salmonella, E. coli.
So you still have to keep people away from risky foods
like undercooked eggs, meat, dairy, and sprouts.
At this point there really shouldn't even by a debate,
yet many institutions continue to tell cancer patients
they shouldn't eat fresh fruits and veggies.
According to the latest survey, more than half of pediatric cancer doctors
continue to prescribe these diets,
though it's quite variable even among those at the same institution.
Why are doctor still reluctant to move away from the neutropenic diet?
Well, there are several reasons why doctors may be hesitant
to incorporate evidence-based medicine into their practice.
They have limited time to review the literature.
They'd like to dig deep into studies
but they simply don't have the time to look at the evidence.
That's what NutritionFacts.org is for.
Bone marrow transplants are the final frontier.
Sometimes it's our immune system itself that is cancerous --
leukemia, lymphoma -- and so the immune system is wiped out
on purpose to rebuild from scratch,
and so inherent in the procedure is a profound immunodeficiency
for which a neutropenic diet is often recommended,
but had never been tested, until now.
Not only did it not work,
a strict neutropenic diet was actually associated
with an increased risk for infection,
maybe because you didn't have all the good bugs from fruits and veggies
crowding out the bad guys in the gut.
Not only was the neutropenic diet not beneficial
but there was a suggestion that it could be potentially harmful.
It would not be the first time
that an intervention strategy made good theoretical sense,
but ultimately was ineffective when put to the test.