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Multiple Myeloma Diet and Nutrition Tips

Posted on May 26, 2020
Article written by
Kimberly Mugler, RDN, LDN

Eating a nutritious diet is an important factor in the treatment of myeloma. Along with getting enough sleep and physical activity, a healthy diet can help you feel your best and support your body during myeloma treatment. Several symptoms of myeloma and the side effects of myeloma treatments might require specific nutrition recommendations.

Guidelines on healthy eating for people with myeloma do not vary greatly from healthy eating guidelines for everyone else. Some of the main aspects of a healthy diet for myeloma are discussed below. While these nutritional guidelines are safe for most people, you may have additional health concerns — such as food allergies or stomach conditions — that require special consideration. Always consult with your doctor or a dietitian before making major changes to your diet.

Make Plants the Focus

A good goal is a plant-based diet, which emphasizes plant foods but can include meat and dairy products in moderation. A plant-based diet often coincides with a Mediterannean diet. This is an eating pattern rich in fruits, vegetables, whole grains, low-fat dairy, lean meat and other proteins, and healthy fats. Unhealthy, saturated fats like those found in butter and fried foods should be limited to less than 10 percent of your total calorie intake for the day. One of the advantages of a plant-based diet is maximizing your antioxidant intake. Antioxidants such as vitamin A, vitamin C, vitamin E, beta-carotene, and lycopene fight free radicals and can help prevent cancer.

“Day 3 of plant-based diet,” wrote one MyMyelomaTeam member. “So far, so good. I was afraid I would be starving, but I am satisfied.” Another member neatly summed up the basics of the plant-based diet: “Eat everything in moderation. But more veggies, and yes, get enough protein.”

Plant Compounds That May Help Fight Cancer

Preliminary research suggests ursolic acid may decrease tumor growth by regulating mitochondrial function through metabolic pathways. Foods that contain ursolic acid include apples, basil, rosemary, and cranberries. Cooking with these ingredients or consuming these foods can’t hurt you, but taking supplements with these ingredients is not currently recommended.

Cruciferous vegetables contain compounds called glucosinolates, which may help with cancer prevention and recurrence. There is research proving this compound can help with lung, colon, breast, and prostate cancer. More research is needed to clarify relationships and evidence of the health effects of glucosinolates on other forms of cancer. Cruciferous vegetables include broccoli, Brussels sprouts, and cauliflower.

Curcumin, also known as turmeric, is a compound that has anticancer properties. The spice may target different cell-signaling pathways, including growth factors and cytokines, which may help with cancer prevention or recurrence. Curcumin has poor bioavailability, meaning it has low absorption rates and fast elimination from the body, but studies suggest that black pepper may enhance absorption. The research on this compound is preliminary, and further clinical trials are needed to assess its effectiveness.

One MyMyelomaTeam member enjoys finding delicious ways to incorporate turmeric. “I slice up sweet potatoes like fries and sprinkle turmeric, black pepper, garlic and onion powder with olive oil and bake at 400 for about 40 minutes. Don't know if it helps, but my daughter and I enjoy eating them.”

While curcumin, cruciferous vegetables, and ursolic acid may not have specific relationships with blood cancers, they contain healthful compounds for immune health. These may help fight infections — a common complication of myeloma and its treatment.

Fiber

Fiber is a neglected, yet crucial, component of healthy eating. Fiber comes from foods like vegetables, fruits, whole grains, beans, nuts, and seeds. Fiber stimulates proper digestion, aids in glycemic control, manages healthy lipids, and promotes a balanced gut microbiota. For optimal health, women need at least 25 grams of fiber per day, and men need at least 35 grams of fiber per day.

Fiber can help with some side effects of myeloma treatment. “My specialist told me to eat Kashi Go cereal — the one with 13 grams of fiber and a digestive probiotic,” wrote one MyMyelomaTeam member. “Really made a difference in my diarrhea.”

For some people living with myeloma, a high-fiber diet may irritate the stomach and worsen nausea. In these cases, your doctor may recommend a low-fiber diet instead.

Using the Plate Method

The plate method is a simple visual technique to help you accomplish a balanced diet and aid in portion control. Too much of even a good thing can be a bad thing, which makes portion control and distribution important. To use the plate method:

  • Half of your plate should include vegetables — the more colors, the better.
  • One-fourth of your plate should contain protein, such as chicken, fish, or legumes.
  • One-fourth should contain a healthy starch, such as brown rice, quinoa, or sweet potato.

The plate method helps you quickly and visually understand the ratio of the foods you are eating. “I know that I feel so much better when I eat more veggies than starches,” shared one MyMyelomaTeam member. This goal is easy to achieve using the plate method.

Your meal should also contain a healthy fat like olive oil, avocado, nuts, or seeds. Fruit can be enjoyed with a meal or as a snack, along with a source of protein or fiber to help control blood glucose and feel “full.” For instance, pair an apple and almond butter, grapes and string cheese, or bell pepper strips and hummus.

Part of a healthy meal distribution includes treating yourself to foods you crave — in moderation. It is healthier to have a small serving of your sweet of choice than to restrict yourself and possibly end up overdoing it later.

One MyMyelomaTeam member shared how they watch their sugar intake: “You will want to watch anything that spikes your glucose, so refined sugar should be off the menu. But agave syrup is OK as long as you stick to one teaspoon a day.”

Aim for a Healthy Weight

Maintaining a healthy weight is crucial for good overall health. You should consume enough calories to maintain an appropriate weight for your size or enough calories to gradually lose weight if you are overweight or obese.

It can be hard to maintain a healthy weight and prevent malnutrition if you are experiencing nausea, vomiting, diarrhea, loss of taste, or loss of appetite. During these times, prioritizing nutrient-dense, high-calorie foods is a must. Maintaining your weight with calories and preserving your lean muscle mass with protein are of equally high priority.

If you or your doctor is worried about weight loss during or after myeloma treatment, choose foods dense in both nutrients and calories. Some good options are:

  • Nuts
  • Nut butters
  • Avocados
  • Beans
  • Chicken
  • Fish
  • Yogurt

Making smoothies and soups are popular ways to load up on healthy foods if you don’t feel like eating solid foods. Soups and smoothies are easy, versatile dishes to disguise nutritious foods like flaxseed meal, chia seeds, nut butters, beans, and vegetables to help amplify health. Increasing your meal frequency, or eating small snacks throughout the day rather than large meals, can help you obtain adequate calories as well. Maintaining physical activity can also produce a healthy appetite.

Taking corticosteroids, such as Dexamethasone, can contribute to weight gain in people with myeloma. One MyMyelomaTeam member asked, “How does everyone deal with the weight gain from taking steroids? Are there foods to eat to help with this?” Another responded, “The good news is that it comes off again quickly when you go off of [the corticosteroid]. You can eat foods that purge your body of excess liquid, such as cucumbers, ginger, blueberries, artichokes, and watermelon.”

Managing Anemia

Individuals with myeloma often experience anemia — a condition caused by a deficiency of red blood cells or iron. Anemia causes fatigue and can often be managed with nutrition. Individuals with anemia will need to pay attention to their iron intake. There are two forms of iron — heme iron and nonheme iron. Heme iron includes animal sources — meat, poultry, and fish — and is about 15 percent absorbable by the body. Nonheme iron includes plant-based sources — legumes, grains, and vegetables — and is only 3 percent to 8 percent absorbable. There are several things that can help increase or decrease iron absorption. It is worth noting that taking excess iron can lead to nausea, vomiting, and liver damage.

A helpful guideline is to include a dietary source of vitamin C at every meal, especially meals with a source of iron. Vitamin C enhances the absorption of iron in the body. Dietary sources of vitamin C include citrus fruits, bell peppers, cruciferous vegetables, and tomatoes. It is important to note that coffee and tea can significantly decrease iron absorption. These beverages should not be included with meals that contain iron-rich foods.

“I know when I kind of cheat from my normally healthy diet to keep my red blood cells, white blood cells, and platelets up, I totally feel the difference,” wrote one MyMyelomaTeam member. “I feel sluggish.” When another member asked for advice on how to combat anemia, he was advised: “Leafy green vegetables, lean red meat, iron supplements if OK with your doctor. I take a B12 supplement under my tongue.”

A rare form of anemia, called megaloblastic anemia, may be caused by a deficiency in vitamin B12 and folic acid. Megaloblastic anemia may occur in people with some types of blood cancer. Below are lists of the top food sources containing vitamin B12 and folic acid.

Good Sources of Vitamin B12:

  • Clams
  • Fortified cereal
  • Tuna
  • Nonfat plain Greek yogurt
  • Salmon
  • Beef
  • Chicken
  • Eggs
  • Nutritional yeast

Good Sources of Folic Acid:

  • Spinach
  • Fortified cereal
  • Black-eyed peas
  • Asparagus
  • Brussels sprouts
  • Broccoli
  • Avocado

Diet and Kidney Damage

Between 20 percent and 40 percent of people living with myeloma will develop kidney failure to some degree. If the results of your blood and urine tests show signs of kidney damage, your doctor may give you specific dietary recommendations. Limiting foods high in potassium, sodium, and phosphorus may be necessary, depending on the specific nature of your kidney problems. Your health care provider will monitor your blood test results to assess whether restriction of one or more of these nutrients could help prevent further damage.

If so, you may be asked to limit:

  • Foods high in potassium, such as oranges, bananas, spinach, zucchini, and peaches
  • Foods high in phosphorus, such as cheese, wheat bread, peanut butter, nuts, and seeds
  • Foods high in sodium, such as processed foods, packaged snacks, condiments, salad dressings, sauces, and restaurant or takeout foods

Staying Hydrated

Drinking enough fluids is important for nutrient transportation, joint health, blood pressure regularity, and so much more. Staying well-hydrated also supports kidney function, an important concern in people with myeloma. Water is your best choice for staying hydrated. Avoid or limit sugary drinks like fruit juice, soda, and sweetened teas. If you don’t enjoy drinking water, try adding fresh fruit, fruit extract, or low-sugar sports drinks like G2 by Gatorade, Propel flavored electrolyte water, or Vitaminwater Zero.

MyMyelomaTeam members are very aware of the importance of hydration. “Stay hydrated!” is a common reminder between members on the social network. “Everyone have a mentally sharp, physically comfortable, and hydrated day,” wished one member.

Limit alcohol to no more than one drink per day for women and two drinks per day for men. Time your intake of coffee and tea to avoid limiting your iron absorption, as mentioned above. Alcohol and caffeine can also make it harder to stay hydrated. “Caffeinated beverages and alcohol are dehydrating, so they don't count 😇,” said one MyMyelomaTeam member.

Do’s and Don’ts of Food Safety With Myeloma

Food safety is incredibly important for people living with myeloma, who often deal with a weakened immune system. For instance, Revlimid (Lenalidomide) can cause leukopenia — low white blood cell count. If you undergo a stem cell transplant, you will likely be more susceptible to foodborne illness than individuals who receive other treatments for myeloma.

Follow these safe food handling do’s and don’ts to avoid foodborne illnesses.

Food Safety Do’s:

  • Cook all meat and fish thoroughly.
  • Cook eggs thoroughly — not runny or sunny-side up.
  • Wash produce well before you peel it. Consider soaking fruits and vegetables in a solution of apple cider vinegar and water to kill bacteria.
  • Refrigerate deli meats, even dry-cured sausages.

Food Safety Don’ts:

  • Eat products containing raw eggs, such as cookie dough or homemade mayonnaise.
  • Drink unpasteurized milk or juice.
  • Eat soft cheese such as brie, blue cheese, or Gorgonzola.
  • Eat from salad bars and buffets, since food sits longer and is more likely to become contaminated.
  • Eat alfalfa sprouts or other raw sprouts.
  • Drink well water, unless it has been boiled for one minute or filtered.

Check Your Facts: Nutrition and Supplement Claims

It can be challenging to read health claims regarding nutrition supplements and cancer and try to decipher what is legitimate and what may be far-fetched marketing claims. There is little science-based evidence proving a specific nutrient or supplement to be effective in the treatment of cancer.

It is important to always consult with your doctor before trying any supplement or herb. It may have a negative impact on your cancer treatment. For instance, green tea supplements can interfere with the effectiveness of Velcade (Bortezomib), which is used to treat multiple myeloma and mantle cell lymphoma. Similarly, the popular herbal supplement St. John's wort is known to reduce the effectiveness of Gleevec (Imatinib), a drug used to treat chronic myeloid leukemia and Philadelphia-positive acute lymphoblastic leukemia.

Here are some facts about nutritional supplements from the Office of Dietary Supplements at the National Institutes of Health:

  • Dietary supplements do not have to be proven effective before they are marketed.
  • Just because a product is natural does not mean it is safe.
  • Since some nutrients are already supplemented in foods you eat, you may wind up accidentally taking an unsafe amount.
  • You are more likely to experience side effects from supplements if you take them in high doses, if you take them instead of prescribed medications, or if you combine several types of supplements.

It’s a Challenge, but You’re Not Alone

Many MyMyelomaTeam members are inspired to make healthy changes like improving their diet when they are first diagnosed. But changing eating habits can be hard, especially when they impact so many aspects of our life. As one MyMyelomaTeam member wrote, “I'm trying to do a better job of eating whole foods. It's not easy when you have eaten a poor diet all your life.”

Eating healthier requires learning how to plan meals, choose healthy foods, and perhaps try new ways of cooking. It can become even more complicated when family members are not on board. When you join MyMyelomaTeam, you gain a support network of more than 6,000 people living with myeloma who understand the challenge of trying to adopt a nutritious diet.

Members of MyMyelomaTeam often share recipes and discuss their efforts to eat healthy and improve their diets. Here are a few examples of conversations about diet and nutrition:

Do you feel better when you eat a healthy diet? What steps do you take to maintain good nutrition while living with myeloma? Comment below or post on MyMyelomaTeam.

References

  1. Antioxidants and Cancer Prevention — National Cancer Institute
  2. Anticancer effect of ursolic acid via mitochondria-dependent pathways (Review) — Oncology Letters
  3. Cruciferous Vegetables and Human Cancer Risk: Epidemiologic Evidence and Mechanistic Basis — Pharmacological Research
  4. Curcumin and Cancer — Nutrients
  5. Fiber: High or Low? — Rogel Cancer Center
  6. Meal Planning with the Plate Method — Drugs.com
  7. Anemia — Cancer.net
  8. Dietary Supplements: What You Need to Know — National Institutes of Health
  9. Anemia, Megaloblastic — National Organization for Rare Disorders
  10. Vitamin B12 — Health Professional Fact Sheet — National Institutes of Health
  11. Folate – Health Professional Fact Sheet — National Institutes of Health
  12. Myeloma Kidney — UNC Kidney Center
  13. Lenalidomide (Revlimid) — Oncolink
  14. Diet Guidelines For Immunosuppressed Patients — Leukemia & Lymphoma Society
  15. Potential Herb-Drug Interactions for Commonly Used Herbs — MediHerb
  16. Bortezomib — Drugs.com

Kimberly is a Philadelphia-based registered and licensed dietitian who specializes in weight management and behavioral change. Learn more about her here.

A MyMyelomaTeam Member said:

Really appreciate revisiting this list~> ANd all along been tuned into diet. Meeting with nutritionist at the cancer center often was helpful to me.… read more

posted 1 day ago

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