Polycythemia vera (PV) is a myeloproliferative disorder, a type of cancer causing the body to overproduce red blood cells. This overproduction can lead to thickened blood, increasing the risk of blood clots and other complications. While there's no cure for PV, and dietary changes aren't a standalone treatment, a well-chosen diet can play a crucial role in managing the condition and minimizing risks. As many as 77 percent of people diagnosed with cancer take dietary supplements, according to the Leukemia & Lymphoma Society.
Understanding Polycythemia Vera and Its Complications
PV slowly worsens, usually over many years. The disease can be life-threatening if you don't get treatment, but the right care can help you live a long life. PV can cause a range of complications, including blood clots (thrombosis) that can lead to pulmonary embolism, stroke, or heart attack. Other potential issues include kidney stones, gout, stomach ulcers, bleeding, easy bruising, and an enlarged liver or spleen. These complications arise due to thickened blood and reduced blood flow. It is important to understand that PV is usually not inherited; however, parents can pass these affected genes to children. In rare cases, polycythemia vera risk may run in families.
The Role of Diet in Managing PV
While diet cannot cure PV, it is essential for managing weight, cholesterol, and blood pressure levels, which can help reduce the risk of complications. A well-balanced diet for PV can help lower a person’s risk of complications by helping manage cardiovascular risk factors such as diabetes, obesity, high blood pressure, and high cholesterol, which may help reduce the risk of blood clots, improving circulation, reducing inflammation in the body, and preventing the buildup of uric acid. The ongoing treatments for polycythemia vera (PV) can sometimes interfere with appetite. But if you’re getting regular blood withdrawals or undergoing chemotherapy, there’s no understating the importance of eating a healthy diet.
Dietary Recommendations for Individuals with PV
There is no single special diet for PV, but people with this condition should generally try to eat a well-balanced diet rich in fruits, vegetables, lean proteins, and whole grains. Incorporating more of the following foods into their diet may benefit many people with PV:
- Fruits such as apples, oranges, and bananas
- Vegetables such as leafy greens, red peppers, and broccoli
- Lean proteins such as poultry, eggs, nuts, and fish
- Whole grains such as quinoa, oats, millet, brown rice, and barley
- Low fat milk, yogurt, and cheese
Hydration
Since PV thickens the blood, drinking enough water is also essential to reduce the possibility of kidney stones and gout caused by a buildup of uric acid.
Read also: The Hoxsey Diet
Foods to Limit or Avoid
In general, people with PV can benefit from limiting or avoiding foods that can contribute to the development of high blood pressure, high cholesterol, diabetes, and obesity.
- Saturated fats such as butter, palm and coconut oils, cheese, heavy cream, and red meat
- Trans fats, which are sometimes found in highly processed foods
- Foods high in sodium, such as convenience foods, salty snacks, and processed meats
- Added sugars from sugary soft drinks, energy drinks, fruit juices, and desserts, as research suggests that high sugar intake is associated with an increased risk of PV
- Foods containing oxalates
- Foods containing purines
- Foods that can irritate a stomach ulcer, such as alcohol, caffeine, chocolate, and spicy foods
A person with PV should try to limit foods that are high in oxalates, as these can contribute to the development of kidney stones. Foods high in oxalates include: spinach, peanuts, almonds, rhubarb, beets, sweet potatoes, and soy products. People may also need to limit their intake of foods high in purines, as they can contribute to the development of gout. Foods high in purines include: red meat, organ meats such as liver, kidney, tongue, and sweetbreads, some seafood, including shellfish, anchovies, and sardines, and alcohol.
Smoking
Though not a dietary factor, smoking can also have a strong negative effect on PV because it damages blood vessels and can raise a person’s blood pressure. For people who smoke, quitting is crucial to help lower the risk of PV complications.
Specific Diet Plans for Heart and Circulatory Health
A specific diet plan for heart and circulatory health can be beneficial for those with PV. These diets provide guidelines to help incorporate healthy eating patterns into a person’s daily routine.
Mediterranean Diet
This eating plan includes foods traditionally consumed in countries bordering the Mediterranean Sea, such as France, Spain, Greece, and Italy. It is rich in fruits, vegetables, whole grains, nuts, seeds, legumes, and heart-healthy fats such as olive oil. The Mediterranean diet is generally low in animal products and meat but includes fish and seafood. Some research, including a small 2022 study, suggests that this type of diet has the potential to reduce symptoms in people with PV.
Read also: Walnut Keto Guide
Following a Mediterranean Style of Eating - rich in fish, fruits and vegetables, nuts, vegetable oils and whole grains - can help prevent heart disease. That makes it a particularly good choice for people with PV, because the cancer causes an overproduction of red blood cells. And that increases the risk of heart attack, stroke, or pulmonary embolism (a blood clot in the lungs). Even if you don’t follow a Mediterranean diet plan exactly, try eating plenty of fruits and vegetables, olive oil, and whole grains, while limiting added sugar, highly processed foods, and saturated fat.
Dietary Approaches to Stop Hypertension (DASH) Diet
The National Heart, Lung, and Blood Institute developed the DASH diet to help lower high blood pressure. The diet focuses on eating fruits, vegetables, and lean meats and limiting intake of sodium, fat, and alcohol. In general, this diet recommends consuming less than 2,300 milligrams of sodium per day.
Anti-Inflammatory Diet
This way of eating focuses on foods with the potential to reduce inflammation in the body. Since inflammation plays a key role in the development and progression of PV, incorporating foods that reduce inflammation in the body might help manage the condition. An anti-inflammatory diet incorporates fruits and vegetables, whole grains, low fat dairy, fatty fish, olive oil, nuts, dark chocolate, tea, legumes, and red wine (in moderation).
Managing Specific Symptoms Through Diet
Iron Intake
As many as 60 percent of people with PV have an iron deficiency, which can cause fatigue. But while many people with an iron deficiency can take an iron supplement or a multivitamin containing iron, people with PV can’t. “We generally try to avoid supplementing with iron, because that will cause you to make more red blood cells and add fuel to the fire,” says Jacqueline S. Garcia, MD, a medical oncologist at Dana-Farber Cancer Institute in Boston. You can get extra iron from food, such as beans, meat, and spinach. Just be sure not to eat too much of it. For example, Dr. Garcia suggests steering clear of any fad diet that features excessive amounts of red meat. “I don’t restrict the amount someone eats, but I recommend eating a regular amount within the daily requirements,” she says. (Also, be sure to eat plant-based, iron-rich foods along with a food or drink containing vitamin C, such as a glass of orange juice, to help with iron absorption.) For adults, the Recommended Dietary Allowance for iron is usually 8 milligrams per day, but women ages 19 to 50 need 18 milligrams.
Gastrointestinal Side Effects
Treatments such as chemotherapy may cause gastrointestinal side effects, including diarrhea and constipation. To address diarrhea, prioritize foods that contain soluble fiber. “Soluble fibers act like a gel and can help absorb water in the intestines, [which adds bulk to the stool]”.
Read also: Weight Loss with Low-FODMAP
Weight Loss
Some people with PV will lose weight from the disease, because the spleen has to work overtime to clear out the extra red blood cells, which can cause the organ to grow larger. That can then lead to abdominal pain, bloating, and feelings of fullness, even after you’ve only eaten a little bit. If you’re struggling with weight loss, try to eat nutritious, high-calorie foods, such as a nutritional supplement or protein-rich snack (think: peanut butter and a banana, full-fat yogurt with fruit and nuts, or cheese and crackers), whenever you’re able. You can also work with a registered dietitian experienced in both nutrition and oncology. Together, you can create a balanced eating plan that gives you the nutrition you need.
The impact of vegetable soup on blood viscosity
This randomized clinical trial was carried out during a 7-month period (year 2016) at Isar health clinics affiliated to Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran. The study was registered in the Iranian Registry of Clinical Trials (IRCT2015111024993N1). The study population comprised of male patients, who referred to the hematology clinic of Isar health clinics, and diagnosed with polycythemia without underlying diseases. Male patients with polycythemia (Hct ≥50) without underlying diseases such as renal, respiratory, cardiovascular and liver diseases, malignancies, hyperlipidemia and diabetes mellitus, aging 35 to 60 years old, not taking any medication during the last two weeks before entering the study, were enrolled into this trial. A diet regimen for 6 weeks and phlebotomy at baseline considered for intervention group. This diet was served as dinner and no other food was served within the next two hours. A significant influence of vegetable soup on blood viscosity at seconds 30 and 40 was found only in intervention group (p<0.001). After ingestion of vegetable soup, there was a statistically significant decrease in only intervention group in TC (p<0.001), LDL-cholesterol (p<0.001), VLDL-cholesterol (p<0.001), HDL-cholesterol (p<0.01), osmolarity (p<0.001), and FBS (p<0.001), whereas no significant changes were observed in the control group.
Supplements and Polycythemia Vera
While some supplements may improve polycythemia vera (PV) symptoms or reduce risks for complications, others have the potential to cause harm. Many dietary supplements containing vitamins, minerals, and herbs are available without a prescription. Some may be marketed as having benefits to prevent or treat cancer or reduce cancer treatment side effects. It’s very important to follow your doctor’s advice about which supplements to take and avoid - your doctor understands the details of your health condition best. Although some supplements may be helpful, you shouldn’t use them as a replacement for your usual PV treatment. Before you start taking any supplements, check with your doctor to make sure it’s safe for you.
Supplements With Potential Benefits
If you’re living with PV, you may have symptoms linked to increased inflammation such as itching, joint pain and swelling, and fatigue. Currently, there aren’t any clinical trials specifically investigating how certain supplements may help people with PV. However, some supplements with effects on red blood cell (RBC) production, and those with anti-inflammatory properties have shown potential benefit for some people with PV. In a 2017 survey from the Mayo Clinic Survey Research Center of more than 1,300 people with myeloproliferative neoplasms (MPNs), 72 percent of people reported using an over-the-counter (OTC) supplement.
- Vitamin D: Vitamin D deficiency may be even more common in people with PV. A 2020 study found that two-thirds of people with the condition had a vitamin D deficiency. Researchers think that vitamin D may help reduce the production of excess RBCs in people with PV. Studies in mice have found that vitamin D can block one of the processes that cause excess RBCs - the Janus kinase/signal transducers and activators of the transcription (JAK/STAT) signaling pathway. A mutation in JAK2 can make developing blood cells extra sensitive to growth factors, resulting in an overproduction of many blood cells. More studies are needed to find out whether the same is true in humans. However, vitamin D supplements may have other health benefits, including preventing osteoporosis (bone thinning) and possibly reducing the risk of dying from some cancers.
- Omega-3 Fatty Acids: If you have PV, too many RBCs can increase your risk of blood clots, heart attack, and stroke. Some studies have found that taking an omega-3 supplement may lower your risk of blood clots, heart disease, and death from heart disease. While there haven’t been any clinical trials in humans, a study in mice in Lipids in Health and Disease found that omega-3 fatty acids can affect how blood cells develop. More studies are needed to see how this supplement may be used to treat PV and other blood disorders.
- Curcumin: In addition to its anti-inflammatory properties, curcumin may prevent the production of excess blood cells. A 2019 laboratory study using cells with a JAK2 mutation found that curcumin blocked the JAK/STAT pathway. These results are promising, but clinical trials are needed to see if curcumin has the potential to treat PV. Curcumin is generally recognized as safe by the United States Food and Drug Administration (FDA) and is usually well-tolerated by most people who take it.
- Green Tea: A study in rats from the European Journal of Nutrition found that green tea was associated with a lower amount of iron and a lower percentage of RBCs. Aluminum found in green tea may be responsible for the decrease in iron levels. This is because aluminum can compete with iron during the production of RBCs. Clinical trials are needed to find out if green tea may be helpful for people with PV.
- N-Acetylcysteine: A study in mice in the journal Blood found that NAC may help prevent blood clots in people with PV. While these results are promising, clinical trials in humans are needed to find out if NAC can improve PV symptoms.
Supplements With Potential Dangers
If you have PV, your doctor may ask you to avoid some common vitamins and minerals because they can encourage the production of RBCs. Before you take any supplement, check with your doctor to make sure it doesn’t contain an ingredient you should avoid.
- Iron: However, iron deficiency may actually be the goal of some treatments for people with PV because it limits how many RBCs your body can make. Iron is available in many different kinds of supplements - including many multivitamins. Make sure you check the label of your vitamins and supplements to see if they contain iron.
- Vitamin C: If you take a vitamin C supplement or eat foods high in vitamin C along with iron-rich foods, you can increase the amount of iron your body absorbs. Talk to your doctor about how much vitamin C you should consume each day.
- B Vitamins: If you take a supplement with vitamin B12 or folic acid, it may cause increased RBC production.
Medical Treatments for Polycythemia Vera
You should never use supplements to replace your doctor-recommended PV treatment. Only FDA-approved medications and treatments for PV are evaluated for safety and effectiveness. Dietary supplements don’t have the same strict requirements as approved treatments. Additionally, there aren’t any clinical trials that show any supplement is safe or effective for PV.
FDA-approved treatment options for PV and its symptoms include:
- Phlebotomy: Regular blood withdrawals can reduce your blood volume and excess blood cells.
- Low-dose aspirin: This can lower your risk of blood clots.
- Medications to reduce RBCs: These include hydroxyurea (Droxia, Hydrea, Siklos), interferon alpha, ruxolitinib (Jakafi), and busulfan (Myleran).
- Drugs to reduce itching: These include antihistamines like loratadine (Claritin) and antidepressants like fluoxetine (Prozac).
- Bone marrow transplant: This procedure involves replacing your bone marrow with healthy cells from your own body or a donor.
Before you start taking any new supplement, you should talk to your doctor about the possible benefits, side effects, and drug interactions with your current treatment. Make sure your doctor has an up-to-date list of everything you take, both OTC and prescription, on file.
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