Essential thrombocythemia (ET) is a chronic myeloproliferative neoplasm (MPN) characterized by an overproduction of platelets in the bone marrow. While medical treatments like aspirin and chemotherapy are crucial, dietary modifications can play a supportive role in managing symptoms and promoting overall well-being. This article provides a detailed guide to dietary considerations for individuals with ET, drawing upon expert recommendations and available research.
Understanding Essential Thrombocythemia and Its Impact
Myeloproliferative neoplasms (MPNs) are chronic cancers arising from blood stem cells in the bone marrow. ET is one such MPN, primarily affecting megakaryocytes, the cells responsible for platelet production. This overproduction leads to thrombocytosis, an elevated platelet count in the blood. The exact reasons for ET development are not fully understood, but genetic mutations, such as the JAK2V617F mutation, are implicated in many cases.
The clinical manifestations of ET can vary significantly. Some individuals remain asymptomatic, while others experience symptoms like bone pain, night sweats, early satiety, dizziness, headaches, acrocyanosis, erythromelalgia, and hemorrhagic or thrombotic events.
The Role of Diet in Managing ET
While there is no specific diet that can cure ET, a well-planned nutritional approach can help manage symptoms, support the body during treatment, and improve overall quality of life. Many people with MPNs are advised to "watch and wait" initially, making a healthy diet even more critical during this period. The following sections outline key aspects of a diet suitable for individuals with ET.
General Healthy Eating Guidelines
Most dietary recommendations for people with MPNs align with general healthy eating principles. These include:
Read also: The Hoxsey Diet
- Plant-Based Focus: Prioritize plant-based foods like fruits, vegetables, whole grains, legumes, nuts, and seeds. A plant-based diet doesn't necessarily mean vegetarian or vegan; it simply emphasizes plant foods while allowing for moderate consumption of meat and dairy.
- Limit Unhealthy Fats: Reduce intake of saturated fats (found in butter and fried foods) to less than 10% of your total daily calorie intake.
- Adequate Fiber Intake: Aim for at least 25 grams of fiber per day for women and 35 grams for men. Fiber promotes healthy digestion, glycemic control, and a balanced gut microbiota.
- Balanced Meals: Utilize the "plate method" to ensure balanced meals: half the plate with vegetables, one-fourth with protein (chicken, fish, legumes), and one-fourth with healthy starches (brown rice, quinoa, sweet potato). Include healthy fats like olive oil, avocado, nuts, or seeds.
- Hydration: Drink plenty of water to support kidney function and overall health.
Specific Dietary Considerations for ET
Given the potential impact of ET and its treatments on the body, certain dietary considerations are particularly relevant:
Antioxidant-Rich Foods
A plant-based diet is rich in antioxidants, such as vitamin A, vitamin C, vitamin E, beta-carotene, and lycopene, which combat free radicals and may help prevent cancer. Studies have shown that obtaining antioxidants from foods is more beneficial than taking them as supplements.
- Beta-carotene and Lycopene: Apricots, carrots, pumpkin, sweet potatoes, bell peppers
- Vitamin A: Spinach, chard, carrots, squash, sweet potatoes
- Vitamin C: Broccoli, leafy greens (turnip, mustard), cantaloupe, oranges, lemons, strawberries, tomatoes, bell peppers
- Vitamin E: Avocado, peanuts, sunflower seeds, boiled spinach
Cruciferous Vegetables
These vegetables contain glucosinolates, compounds that may aid in cancer prevention and recurrence, particularly for lung, colon, breast, and prostate cancers.
- Broccoli
- Brussels sprouts
- Cauliflower
Ursolic Acid
Preliminary research suggests that ursolic acid may decrease tumor growth. Foods containing ursolic acid include:
- Apples
- Basil
- Rosemary
- Cranberries
Curcumin (Turmeric)
Curcumin has anticancer properties and may target cell-signaling pathways. Black pepper can enhance its absorption.
Read also: Walnut Keto Guide
Managing Anemia
Anemia, a deficiency of red blood cells or iron, is common in individuals with MPNs. Focus on iron intake, distinguishing between heme iron (animal sources like red meat, poultry, and fish, with about 15% absorption) and nonheme iron (plant-based sources like legumes, grains, and vegetables, with only 3% to 8% absorption).
Enhance Iron Absorption: Include a dietary source of vitamin C at every meal, such as citrus fruits, bell peppers, cruciferous vegetables, and tomatoes.
Avoid Inhibitors: Limit coffee and tea with meals, as they can decrease iron absorption.
Vitamin B12 and Folic Acid: Ensure adequate intake of vitamin B12 and folic acid to prevent megaloblastic anemia.
- Vitamin B12 Sources: Clams, fortified cereal, tuna, nonfat plain Greek yogurt, salmon, beef, chicken, eggs, nutritional yeast
- Folic Acid Sources: Spinach, fortified cereal, black-eyed peas, asparagus, Brussels sprouts, broccoli, avocado
Maintaining a Healthy Weight
Weight management is crucial, as individuals with myelofibrosis often experience unintended weight loss, while those with ET and polycythemia vera are more prone to being overweight.
Read also: Weight Loss with Low-FODMAP
- Weight Loss: If experiencing weight loss due to splenomegaly or nausea, prioritize nutrient-dense, high-calorie foods like nuts, nut butters, avocados, beans, chicken, fish, and yogurt. Consider smoothies and soups to disguise nutritious foods. Increase meal frequency with small snacks throughout the day.
- Excess Weight: If overweight or obese, adopt an anti-inflammatory diet like the Mediterranean diet to lose weight and reduce inflammation, potentially lowering the risk of blood clots.
Addressing Specific Symptoms
Nutritional interventions should be tailored to address specific symptoms:
- Early Satiety: Increase meal frequency, reduce meal volume, concentrate calories in small volumes, avoid drinking during meals, limit fatty preparations and carbonated drinks.
- Anorexia: Emphasize the importance of eating, increase meal frequency, reduce volume, concentrate calories and protein, encourage eating during periods of hunger, and keep snacks readily available.
- Diarrhea: Increase meal frequency, reduce meal volume, evaluate the need for lactose, sucrose, and gluten restriction, consider prebiotics, probiotics, or symbiotics, ensure adequate hydration (at least 3 liters), avoid flatulent, hyperosmolar, and fatty foods, decrease insoluble fiber, increase soluble fiber, and consume isotonic drinks between meals.
- Constipation: Maintain regular meal intervals, ingest fiber-rich foods with laxative properties, ensure normal fluid intake, and engage in appropriate exercise.
Food Safety
Individuals with MPNs often have weakened immune systems, making food safety paramount.
- Do's: Cook meat and fish thoroughly, cook eggs thoroughly, wash produce well (consider soaking in apple cider vinegar and water), and refrigerate deli meats.
- Don'ts: Avoid raw eggs, unpasteurized milk or juice, soft cheeses, salad bars and buffets, alfalfa sprouts, and unfiltered well water.
Managing Kidney Health
Chronic kidney disease and kidney stones are prevalent in people with MPNs. If blood and urine tests indicate kidney damage, your doctor may recommend limiting:
- Potassium: Oranges, bananas, spinach, zucchini, peaches
- Phosphorus: Cheese, wheat bread, peanut butter, nuts, seeds
- Sodium: Processed foods, packaged snacks, condiments, salad dressings, sauces, restaurant/takeout foods
Foods to Include and Limit with ITP
Eat: Fresh Fruits and Vegetables
- Folate is a nutrient that may support platelet production and function. Leafy green vegetables are a great source.
- The Mediterranean diet, which is high in fruits and vegetables, was shown to decrease the risk of thrombocytopenia in older participants in one study.
Avoid: Concentrated Foods That May Interfere With Clotting
- Certain foods, including red grapes, blueberries, garlic, onions, and ginger, may interfere with clotting when eaten in large quantities.
- Talk to your doctor about any foods you should be avoiding because of your ITP.
Eat: Foods That Contain Healthy Fats
- Healthy fats include nuts and nut butters, seeds, and avocados, which provide not just unsaturated fat but a wide range of other helpful nutrients.
- Focus on getting enough calories to help with the fatigue that at least half of the people who have ITP experience.
Avoid: Foods High in Saturated and Trans Fats
- People who receive corticosteroid treatment could be at an increased risk for high blood pressure, so heart-healthy foods are recommended.
- The PDSA advises people with ITP to avoid hydrogenated, partially hydrogenated, or trans fats as much as possible.
Eat: Lean Sources of Protein
- Quality sources of lean protein to include in your diet are poultry, fish, beans and lentils, nuts and seeds, and soy products.
- The Cleveland Clinic has compiled a list of 52 foods that are high in iron.
Avoid: Fatty and Processed Meat
- Too much saturated fat and salt can be a concern for your heart health. So be sure to stay away from items like bacon, sausage, and deli meat.
Eat: Whole Grains
- Some options include oats, whole-wheat bread and pasta, quinoa, and other grains. These foods are also often a good source of B vitamins.
- The survey found that 40 percent of patients reported improvements after following a macrobiotic diet.
Avoid: Refined Grains and Added Sugars
- Added sugars are especially important to limit, says Hultin, to ensure that your blood sugar and energy levels remain stable.
Drink: Water and Other Fluids
- Consuming enough water can help you fight fatigue and may help improve digestion.
Avoid: Alcoholic Beverages
- Alcohol damages the bone marrow, which produces platelets.
- Some people wonât be able to drink much, if at all. And they definitely need to be talking to their doctor about that.
Maybe Eat: Dairy Products
- Dairy is âa good source of calories and protein, itâs a natural source of B12, and itâs a bone builder â thereâs phosphorus and calcium,â she says.
- Hultin, who generally recommends low-fat dairy products.
Maybe Avoid: Coffee
- Coffee âcan be a mild anticoagulant,â says Hultin.
Lifestyle Tips
- Breathe: Take 20 minutes a day to just breathe slowly and deeply.
- Avoid Toxins: Take the natural approach with products including natural cleaning products, natural pesticides, low volatile paints and organic fertilizers.
- Avoid Plastic Containers: Store food in ceramic or glass dishes and containers.
- Reduce Stress: Look at the people and situations that create stress in your life and try to find ways to reduce the stress, which have been shown to aggravate many diseases.
- Think Positive: Replace any negative thoughts with positive ones
- Connect to a Higher Power: Pray or seek other spiritual guidance consistent with your beliefs.
- Consider Energy Therapy: Reiki, Qi-gong, and other subtle energy therapies can activate a healing response.
- Exercise: Find an exercise program you like and that fits your health situation.
- Breathe Clean Air: Avoid smoky (and smoking), musty, dank, dusty environments.
- Avoid Mercury: If you need a tooth filled, avoid mercury fillings.
- Listen to your body: Stay in touch with your inner self and follow your bodyâs suggestions for what your health needs.
- Be with People who Enliven You: Choose to be with people who brighten your spirits.
- Take Time for your Favorite Things: Bring as much joy into your life as possible.
- Reduce Negative Input: Reduce the amount of time you spend watching the news, reading scary stories and watching TV shows with violent themes.
- Live in a Positive Space: Remove clutter from your environment. Clean and organize your things. Fix anything thatâs broken.
- Get Your Sleep: Try to get at least seven to nine hours of sleep each night.
- Avoid Allergic Triggers: Find out if you have allergies to foods or other sources, then eliminate or avoid them, if possible.
- Do Fun Things: Create opportunities to smile and laugh.
- Avoid Drugs That Can Interfere with Platelets: Medical literature is filled with accounts of prescription products that can reduce platelet counts or inhibit their action.
- Get Help and Hugs: Find others who will listen. Talk about your feelings.
The Impact of Inflammation
Chronic inflammation is a hallmark of MPNs and can contribute to burdensome symptoms. Anti-inflammatory foods can play a role in managing this process.
- Anti-Inflammatory Foods: Whole-plant foods (fruits, vegetables), omega-3 fatty acids, certain spices, and green tea.
Cautions Regarding Supplements
Be cautious about health claims regarding nutritional supplements and cancer. Consult with your doctor before trying any supplement or herb, as it may negatively impact your cancer treatment. Keep in mind:
- 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.
- You may accidentally take an unsafe amount due to supplementation in foods.
- You are more likely to experience side effects from supplements if you take them in high doses, instead of prescribed medications, or combine several types.
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