← Back
Nutrition and daily life

Sushi and raw fish: waiting it out during treatment

Sushi, sashimi, ceviche, tartare and lightly salted fish are made from raw or barely processed fish. They can carry bacteria (Listeria, Vibrio, Salmonella), viruses and parasites. Avoiding them is advised during neutropenia and after transplant.

Last updated: ~1 min read
Sushi on a dark table.
Figure 1.Sushi in shadow — Sushi and raw fish: waiting it out during treatment

01Short answer

During treatment avoid sushi with raw fish, sashimi, ceviche, poke, tartare, raw oysters, and cold-smoked or lightly salted fish (such as lightly cured salmon or herring). Freezing can kill parasites but not bacteria. Rolls with cooked fillings (cooked prawn, omelette, vegetables, canned tuna) freshly made at home are often fine. In restaurants the same knives and boards handle raw fish, so there is a cross-contamination risk; avoiding sushi restaurants is safer. Rice vinegar does not kill germs.

02Simple explanation

No raw fish.

Freezing does not kill bacteria.

Cooked fillings at home.

No sushi restaurants.

03Scientific explanation

FDA: people with weakened immunity should avoid raw and undercooked fish and shellfish.

WHO: foodborne illness is more severe in people with weakened immunity; the five keys are keep clean, separate, cook thoroughly, keep food at safe temperatures, and use safe water and raw materials.

04What happens in the body?

When again?

Your team will say once your counts and immunity recover.

Prawn, omelette and cucumber rolls.
Figure 2.Cooked fillings — Sushi and raw fish: waiting it out during treatment

An alternative

A rice bowl with grilled or steamed fish.

Fish on rice — Sushi and raw fish: waiting it out during treatment
Figure 3.Grilled fish — Sushi and raw fish: waiting it out during treatment

Neutropenia

When neutrophils are low, even ordinary germs can cause serious infection, which is why the rules are stricter.

General rules

This section is part of the general food-safety rules in “Handwashing: the simplest protection” and “Eggs and dairy: safe choices” and “Food safety: four simple rules”.

05Safety: four steps

Check, swap the risky, prepare properly, use in time.

Check — Date and condition.1CheckDate and condition.
Swap — A safe choice.2SwapA safe choice.
Prepare — Clean and thorough.3PrepareClean and thorough.
In time — No delay.4In timeNo delay.
CleanHands and surfaces.
CookGerms die.
ColdGrowth slows.

06Key points at a glance

TopicIn brief
When again?Your team will say once your counts and immunity recover.
An alternativeA rice bowl with grilled or steamed fish.
NeutropeniaWhen neutrophils are low, even ordinary germs can cause serious infection, which is why the rules are stricter.
General rulesThis section is part of the general food-safety rules in “Handwashing: the simplest protection” and “Eggs and dairy: safe choices” and “Food safety: four simple rules”.

07Key terms

Sashimi
Slices of raw fish.
Ceviche
Raw fish "cooked" in citrus juice; the germs are not killed.
Foodborne infection
An infection spread through food or water.
Neutropenia
Low neutrophils.

08Key points

  • Avoid raw fish.
  • Cooked fillings at home.
  • Avoid restaurants.
  • When in doubt, throw it out.
  • Call if you have a fever.

09Frequently asked questions

Is fish "cooked" in lemon safe?

No; acid does not reliably kill germs.

Is caviar OK?

Ask your team about pasteurised canned roe; avoid fresh roe.

Are these rules for ever?

No. They are usually relaxed as blood counts recover; your team will say.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

  1. Is fish "cooked" in lemon safe?

  2. Is caviar OK?

  3. Are these rules for ever?

My questions

12Sources

  1. World Health Organization. Five Keys to Safer Food manual
  2. World Health Organization. Food safety fact sheet
  3. U.S. Food and Drug Administration. Safe Food Handling
  4. National Cancer Institute. Eating Hints: Before, During, and After Cancer Treatment
  5. MedlinePlus. Herbal Medicine
  6. National Cancer Institute (NCI). Nausea and Vomiting and Cancer Treatment
  7. National Cancer Institute (NCI). Appetite Loss and Cancer Treatment
  8. American Cancer Society. Nutrition for People with Cancer
  9. World Health Organization (WHO). Healthy diet — fact sheet
  10. Clinical Nutrition, 2021. ESPEN practical guideline: Clinical Nutrition in cancer
Medical disclaimerThis information is for educational purposes only and does not replace medical advice.
Last updated: ← Back to the list

Open the interactive site →