From the Guidelines
Cancer patients undergoing chemotherapy should avoid eating raw or undercooked sushi due to their compromised immune system, and instead opt for fully cooked sushi options or practice strict food safety guidelines, as recommended by recent guidelines 1. When considering the consumption of sushi by cancer patients undergoing chemotherapy, it is essential to prioritize their immune system's vulnerability to foodborne illnesses. Chemotherapy reduces white blood cell counts, making patients more susceptible to infections. Raw fish may contain harmful bacteria, parasites, or other pathogens that a healthy immune system could fight off but could cause serious infections in immunocompromised individuals. Some key points to consider:
- The ESPEN guidelines on nutrition in cancer patients suggest that there is no evidence to support a low bacterial diet for patients more than 30 days after allogeneic transplantation, but emphasize the importance of food safety guidelines 1.
- A recent Cochrane database review found no evidence to support the use of a low bacterial diet for the prevention of infection and related outcomes in patients undergoing chemotherapy-induced neutropenia 1.
- The American Cancer Society recommends that cancer survivors receiving chemotherapy or radiotherapy avoid exceeding the tolerable upper limits of the Dietary Reference Intakes for antioxidant vitamins such as vitamins C and E during the treatment phase 1. In terms of specific dietary recommendations, cancer patients should:
- Opt for fully cooked sushi options like California rolls with cooked crab, shrimp tempura rolls, or vegetable sushi.
- Ask for the fish to be cooked thoroughly if they crave traditional sushi.
- Always practice good food safety by ensuring food is fresh, properly stored, and prepared in clean conditions. It is crucial to discuss specific dietary restrictions with an oncologist, as recommendations may vary based on the treatment regimen, cancer type, and current blood counts. Some patients may be able to consume certain types of sushi during periods when their blood counts are higher, but it's best to err on the side of caution during active treatment.
From the Research
Food Safety Considerations for Chemo Patients
- Chemo patients are more susceptible to foodborne illnesses due to their compromised immune systems 2
- Common causes of foodborne illnesses include viruses, bacteria, and parasites, which can be found in undercooked or raw foods, including sushi 2
Chemotherapy-Induced Nausea and Vomiting
- Chemotherapy-induced nausea and vomiting (CINV) are common side effects of cancer treatment that can be managed with antiemetic regimens 3, 4, 5
- Dietary strategies, such as CINV-specific education and support with a personalized meal plan, may help reduce the severity of CINV 6
- Some studies suggest that certain foods, such as ginger, may have a positive effect on CINV severity, but the evidence is not conclusive 6
Dietary Recommendations for Chemo Patients
- There is limited evidence to suggest that chemo patients should avoid specific foods, including sushi, but it is recommended to follow proper food safety guidelines to minimize the risk of foodborne illnesses 2
- A balanced diet that includes adequate energy and macronutrient intakes, particularly protein, may help manage CINV 6
- It is essential for chemo patients to consult with their healthcare provider or a registered dietitian to develop a personalized meal plan that meets their nutritional needs and minimizes the risk of foodborne illnesses 6