Nutrition for Myeloma

Overview
Everyone feels their best when they consistently eat a healthy, balanced diet. For people with myeloma, good nutrition can help you recover from treatment, reduce treatment side effects, support bone health, maintain a healthy weight, and avoid developing complications such as infections, diabetes, and heart disease. Knowing which foods to avoid can help prevent drug interactions and food-borne illness.

Some popular diets may contain toxic levels of some nutrients or dangerously low levels of others. Always consult your doctor before adding dietary supplements or making significant changes to your diet.

For nutrition guidance specific to your condition and treatments, ask your doctor for a referral to a registered dietician or nutritionist.

What does it involve?
For the most part, a nutritious diet for someone with myeloma is not very different from a healthy diet for other people. In general, focus your diet on fresh vegetables and fruit, whole grains, legumes, fish, low-fat dairy products, lean meats, and sources of healthy unsaturated fats such as nuts and olive oil. Always use food safety practices – wash all produce, check meat for doneness using a meat thermometer, and do not consume expired products.

While undergoing and recovering from myeloma treatments such as chemotherapy and radiation therapy, your immune system will be suppressed. Most people develop neutropenia, or low counts of white blood cells called neutrophils. During this time, your body is unable to fight off bacteria and other pathogens that may not affect healthy people. Some doctors recommend a neutropenic diet that limits exposure to any potentially harmful foods. For a neutropenic diet, meat and fish must be cooked thoroughly to kill any potential microorganisms. Avoid sushi, undercooked meat, soft cheeses, and any foods containing raw eggs. Make sure all beverages have been pasteurized. Skip cold-cut lunchmeats, dry-cured salami, and cold salads containing seafood or eggs, which are all potential sources of bacteria. When eating out, skip the buffet and salad bar and order all food well-cooked. Some doctors recommend those on a neutropenic diet avoid all raw fruit and vegetables and eat only cooked or canned produce. If your doctor okays raw produce, wash all fruit or vegetables first, even if you plan to peel them. Raw bean sprouts in particular should be avoided.

Some myeloma treatments can cause weight gain, while others can cause nausea, mouth sores, changes in taste, and loss of appetite that leads to weight loss. If you are concerned about weight gain, ask your doctor about safe ways to control your weight. If you are concerned about weight loss, try drinking high-calorie beverages such as juices or smoothies, increasing your intake of healthy fats such as avocados and nuts, or adding cream or gravy to meals. Frequent small meals throughout the day may be easier to eat than fewer, larger meals.

If your treatment regimen includes corticosteroids, you may develop high blood glucose (blood sugar) that can contribute to weight gain and mood swings or lead to the development of diabetes. Reducing your intake of carbohydrates such as fruit juices, sweets, white rice, white bread and other baked goods may help prevent blood glucose spikes, keep moods even, and prevent the development of diabetes.

If you develop anemia (low levels of red blood cells), eating foods high in iron and folate may help. Iron occurs naturally in foods such as lean meat, dried fruits, legumes such as beans and peas, and dark green leafy vegetables. Folate – also known as folic acid – is present in meat, eggs, dairy products, nuts, legumes, and dark green leafy vegetables. Cereals and other grain-based foods are often fortified with iron and folate during processing; check labels to be certain.

Healthy levels of vitamin D are vital to bone health and may help fight cancer. Vitamin D deficiency is common in people with myeloma. Vitamin D is found in egg yolks, cheese, beef liver, and many types of fish including salmon, mackerel, and some canned tuna and sardines. Vitamin D is also added to milk, many cereals, and other products such as soy milk and orange juice. Check labels to make sure products contain vitamin D.

Myeloma treatments and their side effects can increase the risk for dehydration, which contributes to dry mouth, headaches, nausea, constipation, and dizziness. Rather than drinking large amounts a few times a day, try sipping your favorite non-caffeinated beverages throughout the day.

Alcohol and caffeine can worsen the side effects of some myeloma treatments, lessen treatment effectiveness, and cause dehydration. Moderate your intake of beverages containing caffeine and alcohol and discuss specific limits with your doctor.

If you have trouble with nausea, eating bland foods and adding ginger or peppermint may help.

Ask your doctor if you are concerned that you may not be getting enough of certain nutrients. Your doctor may want to test your nutrient levels before recommending an effective nutritional supplement.

Intended outcomes
Eating a nutritious diet can help you feel your best, improve overall health, and ease recovery from myeloma treatments. A healthy diet can support strong bones and normal weight. A nutritious diet can also help reduce medication side effects and lower your risk for serious complications.

Results
A systematic review of studies examining the effectiveness of the neutropenic diet in cancer patients found insufficient evidence to support use of the diet.

Constraints
Side effects of some myeloma medications, which can include nausea, upset stomach, mouth sores, changes in how food tastes, fatigue, and dizziness, may make it difficult to eat regular meals or focus on a healthy diet.

Fatigue, weakness, depression, or physical disabilities may make it more difficult to find the energy to prepare fresh, healthy meals. Cooking large batches of food and freezing several portions for future meals can help conserve energy.

Depending on where you live, it may be harder to get to a grocery store with a good selection of produce and other nutritious foods.

For more details about this treatment, visit:

Food and Nutrition Facts – Leukemia & Lymphoma Society
http://www.lls.org/sites/default/files/file_ass...

Nutrition therapy for multiple myeloma – Cancer Treatment Centers of America
https://www.cancercenter.com/multiple-myeloma-c...

Vitamin D Levels Are Frequently below Normal in Multiple Myeloma Patients and Are Infrequently Assessed By Their Treating Physicians – Blood
http://www.bloodjournal.org/content/124/21/5769...

Iron – National Institutes of Health
http://ods.od.nih.gov/factsheets/Iron-HealthPro...

Folate – National Institutes of Health
https://ods.od.nih.gov/factsheets/Folate-Health...

Why Are Steroids Used in Conjunction With Myeloma Treatment? – Patient Power
https://www.patientpower.info/video/why-are-ste...

Treating Lupus with Steroids – Johns Hopkins Medicine
https://www.hopkinslupus.org/lupus-treatment/lu...

The effect of neutropenic diets on infection and mortality rates in cancer patients: An updated systematic review and meta- analysis. – Journal of Clinical Oncology
http://ascopubs.org/doi/abs/10.1200/JCO.2018.36...