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During treatment the aim is to eat enough, especially protein, and keep weight steady; this is not the time to cut calories unless the team advises it. Handle food safely, but a strict 'neutropenic diet' is not recommended. Ask about alcohol, which may need limiting when platelets are low, and about foods that interact with your tablets. Regular exercise is recommended.
ESPEN's practical guideline (2021) recommends checking intake, weight change and BMI regularly from diagnosis (strong, very low evidence), no diets that restrict energy in people who are malnourished or at risk (strong, low), vitamins and minerals at about the recommended daily allowance and no high-dose micronutrients without a deficiency (strong, low), and for survivors a healthy weight, physical activity and a diet low in saturated fat, red meat and alcohol (strong, low). It finds insufficient data for a low-bacterial diet more than 30 days after allogeneic transplant. ASCO (2022) recommends regular aerobic and resistance exercise during curative treatment, recommends against neutropenic diets to prevent infection, and finds evidence for other diets and for weight loss during treatment very limited. NCI's Eating Hints (2022) gives practical food safety (clean hands, separate boards, thorough cooking, pasteurised products) and a longer list of foods to avoid when treatment raises infection risk, which goes further than the trials support. Alcohol advice is about specific risks: NCI says to limit or avoid it if platelets are low, and Macmillan to avoid it with diarrhoea. ACS (2025) says some oral drugs interact with food.
Why: Weight and muscle loss are common and harder to reverse once advanced; early checks find them in time.
“To detect nutritional disturbances at an early stage, we recommend to regularly evaluate nutritional intake, weight change, and body mass index (BMI), beginning with cancer diagnosis and repeated depending on the stability of the clinical situation.”
ESPEN (Clinical Nutrition) 2021 · Recommendation B1-1: strength of recommendation strong, level of evidence very low, strong consensus
Why: Treatment is easier to get through and complete when strength and weight are kept up.
“We recommend not to use dietary provisions that restrict energy intake in patients with or at risk of malnutrition.”
ESPEN (Clinical Nutrition) 2021 · Recommendation B3-2: strength of recommendation strong, level of evidence low, strong consensus
Why: Some supplements change how cancer treatment works, and high doses have not been shown to help.
“Tell your doctor, nurse, or dietitian about any vitamin, mineral, dietary supplements, or herbs you are already taking or plan to take.”
National Cancer Institute (US) 2022 · Not graded (patient booklet); ESPEN B2-4 on high-dose micronutrients: strong, low evidence
Why: Some treatments make food poisoning more likely and more serious.
“Wash your hands, knives, and countertops before and after you prepare food.”
National Cancer Institute (US) 2022 · Not graded (patient booklet)
Why: Trials found that restricted neutropenic diets do not reduce infections, and they make eating harder.
“Neutropenic diets are not recommended to prevent infection in patients with cancer during active treatment.”
ASCO (Journal of Clinical Oncology) 2022 · ASCO guideline recommendation (strength not shown in the abstract)
Why: Alcohol adds to bleeding risk when platelets are low and can make diarrhoea and dehydration worse.
“You may also be advised to limit or avoid alcohol if your platelet count is low.”
National Cancer Institute (US) 2022 · Not graded (patient information)
Why: Some foods change how much of an oral drug is absorbed, making it weaker or more toxic.
“Sometimes there are food and drug interactions that can change how well the chemo works, making it less effective or causing additional side effects.”
American Cancer Society (with ASCO medical review) 2025 · Not graded (patient information)
Why: Exercise during treatment improves fitness, strength and fatigue.
“Oncology providers should recommend regular aerobic and resistance exercise during active treatment with curative intent and may recommend preoperative exercise for patients undergoing surgery for lung cancer.”
ASCO (Journal of Clinical Oncology) 2022 · ASCO guideline recommendation (strength not shown in the abstract)
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
ESPEN's practical guideline (2021) and ASCO's exercise, diet and weight guideline (2022) are the current graded standards. They agree on screening intake and weight from diagnosis, avoiding calorie restriction in people who are malnourished or at risk, not using high-dose supplements without a deficiency, and exercise during treatment. ASCO recommends against neutropenic diets to prevent infection; ESPEN finds insufficient data for a low-bacterial diet after allogeneic transplant. Both say evidence for specific diets and for intentional weight loss during treatment is limited. After treatment, ESPEN recommends a healthy weight and a diet low in saturated fat, red meat and alcohol (strong, low evidence). Alcohol during treatment has no graded recommendation; patient guidance ties it to specific risks (low platelets, diarrhoea).
ESPEN (Clinical Nutrition) 2021 · ASCO (Journal of Clinical Oncology) 2022
Where it differs: Beyond safe handling, advises avoiding produce that is hard to scrub such as berries and grapes, raw nuts, bulk bins, buffets and salad bars, mouldy cheeses, and leftover rice.
Evidence: Patient booklet, not graded. It goes further than ASCO 2022, which found that neutropenic diets did not decrease the risk of infection and recommends against them.
National Cancer Institute (US) 2022 · ASCO (Journal of Clinical Oncology) 2022
Where it differs: Some transplant units keep food restrictions for weeks after an allogeneic transplant.
Evidence: ESPEN 2021 recommendation C4-3: insufficient consistent clinical data to recommend a low-bacterial diet more than 30 days after allogeneic transplant (strength of recommendation none, low evidence); it cites a Cochrane review finding no evidence that low-bacterial diets prevent infection during neutropenia.
Where it differs: After treatment, aims for a healthy weight (BMI 18.5 to 25), physical activity, and a diet based on vegetables, fruits and whole grains, low in saturated fat, red meat and alcohol.
Evidence: ESPEN 2021 recommendation C5-2, strong, low evidence; the ACS 2022 survivor guideline covers the same ground (abstract read; its recommendations were not).
ESPEN (Clinical Nutrition) 2021 · American Cancer Society (CA: A Cancer Journal for Clinicians) 2022
| Recommendation | Grade, as printed | Source |
|---|---|---|
| Regular screening of intake, weight change and BMI from diagnosis | B1-1: strong, very low evidence, strong consensus | ESPEN (Clinical Nutrition) 2021 |
| No energy-restricting diets in people malnourished or at risk | B3-2: strong, low evidence, strong consensus | ESPEN (Clinical Nutrition) 2021 |
| Vitamins and minerals at about the recommended daily allowance; no high-dose micronutrients without a deficiency | B2-4: strong, low evidence, strong consensus | ESPEN (Clinical Nutrition) 2021 |
| Low-bacterial diet more than 30 days after allogeneic transplant | C4-3: strength of recommendation none, low evidence, strong consensus | ESPEN (Clinical Nutrition) 2021 |
| Survivors keep a healthy weight, stay active and eat a diet low in saturated fat, red meat and alcohol | C5-2: strong, low evidence, strong consensus | ESPEN (Clinical Nutrition) 2021 |
| Neutropenic diets did not decrease infection risk “Neutropenic diets did not decrease risk of infection during cancer treatment.” | Finding of the ASCO 2022 systematic review | ASCO (Journal of Clinical Oncology) 2022 |
| Evidence for other diets and weight loss during treatment “Evidence for other dietary and weight loss interventions during cancer treatment was very limited.” | Very limited (ASCO 2022) | ASCO (Journal of Clinical Oncology) 2022 |