Multiple myeloma is a cancer affecting plasma cells, crucial for your immune system. In 2024, over 35,000 new cases are expected in the US, according to the American Cancer Society (ACS). This condition can impair kidney function, weaken immunity, and cause anemia. The emotional toll, including feelings of overwhelm, depression, and fear, can also affect your ability to eat. Therefore, maintaining good nutrition is paramount, especially during treatment.
Understanding Multiple Myeloma and Its Impact on Nutrition
Multiple myeloma (MM), the second most common hematologic malignancy, is characterized by neoplastic proliferation of plasma cells. Although MM remains incurable for the majority, treatments continue to improve longevity and a subset of patients may be cured. The Third Expert Report on diet, nutrition, physical activity, and cancer risk provides updated objective evidence for the role of diet and nutrition in cancer.
Anemia, a common complication, results from cancerous plasma cells crowding out healthy red blood cells. This can lead to fatigue, weakness, and feeling cold. Low iron levels can also contribute to anemia. If you’ve developed anemia because of multiple myeloma, your doctor may suggest that you eat more foods containing iron. A boost in iron levels can help you feel less tired and will also help your body make more healthy red blood cells.
Kidney disease is another potential complication. As cancerous cells multiply, bones may break down, releasing calcium into the bloodstream. Cancerous plasma cells can also produce a protein that further burdens the kidneys. This extra workload can damage the kidneys. Depending on how well your kidneys are functioning, you may need to adjust your diet to protect your kidneys. You might need to reduce the amount of salt, alcohol, protein, and potassium you eat. The amount of water and other fluids you drink may have to be restricted if your kidneys are severely damaged, you may need to restrict the amount of water and other fluids you drink. You may also need to eat less calcium if your blood calcium levels are already high due to the cancer breaking down bone, which releases calcium. Talking with your doctor before making any dietary changes due to kidney disease is important.
Treatment for multiple myeloma can weaken your immune system, increasing your risk of infection. Therefore, preventive measures, including dietary choices, are essential.
Read also: Understanding Myeloma-Related Weight Loss
General Dietary Guidelines for Multiple Myeloma
Guidelines on healthy eating for people with myeloma do not vary greatly from healthy eating guidelines for everyone else. Eating a nutritious, balanced 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 overall health during myeloma treatment. Several symptoms of myeloma and the side effects of myeloma treatments might require specific nutrition recommendations.
When creating a supportive eating plan, it’s important to limit highly processed snacks and sweets, which typically offer little or no nutritious value. Instead, fill your plate with fresh fruits and vegetables, lean proteins, and whole grains. A few diet tips and tricks can make it easier to eat well and nourish your body. Also, ask your doctor about working with a dietitian, who can help you choose the right foods.
You may find that it’s easier to eat a few small meals throughout the day instead of eating two or three large ones. It can keep up your energy and help you feel less nauseated. There may also be a certain time of day when you can handle food easier, like in the morning or at lunch. Try to keep snacks handy for when you get hungry. Think about meal replacement shakes as a way to get enough calories, too.
Foods to Incorporate into Your Diet
The right kinds of foods in your diet can give you the best balance of nutrients and help with your symptoms or the side effects of treatment. The findings presented in this review will provide a comprehensive guide on the evidence available to date of the impact of dietary and other lifestyle interventions on the gut microbiome and on MM incidence, outcomes, and quality of life.
Iron-Rich Foods
If you’ve developed anemia because of multiple myeloma, your doctor may suggest that you eat more foods containing iron. A boost in iron levels can help you feel less tired and will also help your body make more healthy red blood cells.
Read also: The Hoxsey Diet
Good sources of iron include:
- Lean red meat
- Raisins
- Bell peppers
- Kale
- Brussel sprouts
- Sweet potatoes
- Broccoli
- Tropical fruits, such as mango, papaya, pineapple, and guava
Fiber-Rich Foods
Some chemotherapy drugs can cause constipation. Increasing your fiber intake and drinking plenty of water are helpful. Foods that are high in fiber include:
- Whole grains, such as oatmeal and brown rice
- Dried fruits, such as raisins, figs, apricots, prunes
- Apples, pears, and oranges
- Berries
- Nuts, beans, and lentils
- Broccoli, carrots, and artichokes
Plant-Based Foods
MSK myeloma specialist Urvi Shah, MD, is currently researching the role that plant-based diets may play in slowing the progression of these conditions - or even preventing them altogether. Our NUTRIVENTION research in humans and additional studies in mice suggest that this may be possible in some cases with a high-fiber, plant-based diet although larger trials are needed to confirm this. There is existing evidence that a plant-based diet helps with weight loss, diabetes, cardiovascular disease, renal (kidney) disease, and possibly also autoimmune disease. So there are a lot of overall lifestyle benefits to a plant-based diet.
The diet we are researching is whole-food and plant-based. It’s basically vegan, with an additional emphasis on whole foods. We want patients to limit ultra-processed foods. People should try to get at least 80% to 90% of calories from unprocessed plant foods.
Fruits and vegetables are full of antioxidants that help your body rebuild itself. They also fight constipation which can be a side effect of pain medicine and some cancer treatments. Your doctor may want you to stick with cooked vegetables and fruit. Raw produce sometimes can increase your chance of having an infection, which is dangerous when multiple myeloma or its treatments have made your immune system weaker.
Read also: Walnut Keto Guide
Greens, contain several chemicals that may help prevent or fight cancer. Antioxidants are one of these. Antioxidants include vitamins A, C, and E, as well as beta-carotene and lycopene. A wide variety of fruits and vegetables contain antioxidants. Cruciferous vegetables are known to contain isothiocyanates, dithiothiones, glucobrassicin and indoles, as well as flavonoids which inhibit cancer development in laboratory animals. They also contain vitamin C, an antioxidant that reduces endogenous formation of oxygen-free radicals
Whole grains include the bran, endosperm and germ and thus have higher quantities of insoluble and soluble fiber, nutrients and micronutrients like zinc, magnesium, vitamin B6, niacin, antioxidants like vitamin E, phenolic acid and lignans like phytoestrogens when compared with refined grains. Whole grains also have a lower digestion rate and glycemic index with consequent lower rise in insulin and insulin-like growth factor-1 (IGF-1) levels. Both insulin and IGF-1 have been implicated in the pathogenesis of MM by promoting MM cell growth. Indigestible carbohydrate is a major substrate for microbes in the GI tract.
Fish
Most case control studies have shown an inverse association with MM risk and fish consumption. Fish and fish oils contain polyunsaturated omega-3 essential fatty acids (PUFAs) that are mainly responsible for the protective effect of fresh fish. They competitively inhibit arachidonic acid utilization in the production of eicosanoids, which have been implicated in tumor progression. They also limit cell growth in mouse MM cell lines in vitro. Additionally, fish oil suppresses T-and B- cell proliferation, enhances apoptosis and reduces IL-6 production (a promoter of MM cell growth). PUFAs have been shown to decrease ratio of Firmicutes/Bacteroidetes, and increase abundance of butyrate-producing bacterial genera such as Bifidobacterium, Lachnospira, Roseburia and Lactobacillus.
Bland Foods
Many people experience nausea and vomiting as a side effect of chemotherapy. If you’re dealing with diarrhea, your doctor may have you eat a low-fiber diet known as the BRAT diet:
- Bananas
- Rice
- Applesauce
- Toast
You’ll also want to drink broth and plenty of water to stay hydrated.
If you have mouth sores, try foods that are easy to swallow, such as pudding or mashed potatoes. Avoid spicy foods that might irritate your tongue and mouth.
Other Foods
If you’re losing weight, try to eat high-calorie, nutrient-dense foods. There are a lot of foods that qualify, for example, you can try:
- Nuts
- Nut butters
- Avocados
- Beans
- Chicken
- Fish
- Yogurt
Curcumin, a compound found in the spice turmeric, may reduce your risk of becoming resistant to certain chemotherapy drugs. This helps ensure chemotherapy drugs are an effective treatment option. Some older research in mice also suggests that curcumin may slow the growth of multiple myeloma cells. Many people experience nausea and vomiting as a side effect of chemotherapy. Bland foods may be easier on your stomach, but if you can handle meals with a little more spice, you might consider trying a curry made with turmeric. Mustard and some types of cheese also contain turmeric.
Your doctor or dietitian may suggest that you take a daily supplement to make sure you get enough nutrients to stay healthy. These may include:
- Iron
- Vitamin D
- Fish oil
- Folate
Foods to Avoid
Since multiple myeloma makes your immune system weaker, you’ll need to steer clear of any foods that could make you sick, including:
- Raw meat or fish
- Runny eggs
- Unpasteurized drinks
- Sushi
- Unwashed fruits and vegetables
In one study, people who ate a lot of foods that cause inflammation were more likely to develop multiple myeloma and more likely to have negative outcomes from the disease. A lot of foods that are common in a Western diet fall into this category, including:
- Commercially produced baked goods
- Fried foods
- Sugar-sweetened beverages
- Processed meats
- Red meat
- Foods with a lot of added sugar
- Foods made with white flour
- Trans fats
Foods That Raise Your Insulin, include:
- Pastries and baked goods
- Candy
- Bagels
- Potatoes
- White rice
The Importance of Gut Health
Dietary nutrient absorption and metabolism are facilitated by the gut microbiota. Our understanding of this ecosystem of >1013 microorganisms in health and disease has been significantly improved with the availability of next-generation sequencing approaches evaluating conserved 16 S rRNA regions to profile the microbial composition and shotgun metagenomics to study its function. The microbiome plays key roles in absorption and energy utilization from soluble fiber, fats, proteins, and vitamins. Nutritional intake, in turn, directly impacts the human microbiome. In addition to participating in the absorption of nutrients, the microbiota also serves a role in immunologic stimuli and regulation of cytokine secretion in intestinal epithelial cells by activation of signal transduction pathways.
Plant-based diets are high in soluble fiber with higher levels of bacteria from Bacteroidetes, Lactobacilli, Bifidobacteria and Clostridium clusters XIVa and IV. The latter groups contain Eubacterium, Roseburia, Faecalibacterium, which degrade fiber and produce short-chain fatty acids (SCFAs), such as butyrate, acetate, and propionate. Western diets are lower in soluble fiber resulting in less SCFA production. SCFAs have important roles in the immune response, preventing inflammatory disease states, and are associated with improved MM outcomes.
Specific Dietary Considerations and Research Findings
Diet is a major modifiable risk factor for cancer and several studies have assessed the association between diet and MM.
Plant-Based Diets and Myeloma Risk
A pooled analysis of two large prospective studies (EPIC-Oxford and Oxford-Vegetarian), categorized participants into meat eaters, fish eaters, vegetarians, and vegans based on a food-frequency questionnaire. The analysis demonstrated significantly lower risk for cancer overall in fish eaters (Relative Risk, RR 0.88, 95% Confidence Interval, CI: 0.80-0.97), vegetarians (RR 0.89, 95% CI: 0.83-0.96) and vegans (RR 0.81, 95% CI: 0.66-0.98) compared to meat eaters. This difference was even more pronounced for MM in vegetarians and vegans (RR 0.23, 95% CI: 0.09-0.59) and in fish eaters (RR 0.80, 95% CI: 0.34-1.76) as compared to meat eaters.
A pooled prospective survival analyses of 423 MM patients from the NHS and HPFS cohorts (345 total deaths, 295 MM related deaths) demonstrated 15-24% lower MM-specific mortality for presumed healthy pre-diagnosis plant based dietary patterns (HR range 0.76-0.85 per 1-SD increase in scores). Simultaneously they also saw a 16-24% higher MM-specific mortality in unhealthy pre-diagnosis dietary patterns (HR range 1.16-1.24, per 1-SD increase in scores). These findings suggest that pre-diagnosis high insulinemic or inflammatory diets are associated with higher MM risk and increased risk of MM related death whereas plant-based dietary habits may reduce risk of development of MM and risk of death once MM develops.
Fruit and Vegetable Consumption
In the AGES-Reykjavik prospective cohort study, fruit consumption (≥3 times per week during the adolescent period) was associated with reduced risk of MGUS (Odds Ratio, OR 0.62, 95% CI: 0.41-0.95). Additionally, fruit consumption during late life was associated with lower risk of progression of MGUS to MM (HR 0.34, 95% CI: 0.13-0.89).
In contrast, three case-control studies did not show significant associations. A trend was noted between fruit consumption 4-7 times/week and MM risk (OR 0.6, 95% CI: 0.3-1.1). These three case control studies outlined above showed reduced MM risk with increased consumption of vegetables. One study showed reduced MM risk with cruciferous vegetables (>2 times/week vs <1/week) (OR 0.5, 95% CI: 0.3-0.8, Ptrend =0.01) and tomatoes (>2 times/week vs 2-3 times/month) (OR 0.2, 95% CI: 0.1-0.6, Ptrend = 0.002).
Whole Grains
The AGES-Reykjavik prospective cohort study also demonstrated that midlife intake of whole wheat bread ≥5 times per week was associated with lower risk of MGUS (OR 0.75, 95% CI: 0.57-0.99). The NHANES study similarly showed that low intake of whole grains and high intake of refined sugars and sugar sweetened beverages was associated with the risk of MGUS. An integrated case control study in Northern Italy showed that higher frequency of whole grain food intake (>3 days/week) is associated with reduced MM risk (OR 0.5, 95% CI: 0.2-1.1).
Fish Consumption
Most case control studies have shown an inverse association with MM risk and fish consumption. In the Connecticut women’s study, fresh fish intake >4 times/month (OR 0.4, 95% CI: 0.2-0.7, Ptrend < 0.001) and shellfish intake >3 times/month (OR 0.5, 95% CI: 0.3-0.9, Ptrend = 0.05) were inversely associated with MM risk. A similar protective effect of fish consumption for MM risk was observed (OR 0.7, 95% CI 0.5-0.9; Ptrend 0.012 for high vs low tertile of fish consumption) in the above-mentioned case control study.
Addressing Common Misconceptions
People often think that eating carbohydrates will feed their cancer, so they try to cut them out of their diet completely. Yes, carbohydrates break down into glucose, which is the main sugar in your blood. Glucose is the source of energy for our cells and is needed for them to function. People avoiding carbohydrates still produce glucose when they eat protein and fat. So it’s a myth that avoiding carbohydrates will starve the cancer.
However, it is important to know that not all carbohydrates are the same. They can be refined (simple) or complex. People should avoid refined carbohydrates such as cookies, cakes, and croissants. But they should not avoid complex carbohydrates such as whole grains, beans, fruits, and vegetables. They are associated with reduced cancer risk.
People will sometimes say, “A plant-based diet is not for me because I am not satisfied.” Or, “I won’t get enough protein.” However, contrary to popular belief, dietary fiber is associated with people feeling more satiated.
Practical Tips for Implementing Dietary Changes
We understand that this is a big transition for people, and to commit 100% may not be feasible for everyone. It’s more important that the changes are gradual and sustainable. One of the biggest challenges comes from social pressure and not planning ahead. Because we live in a world where eating a plant-based diet is not the norm, it can feel isolating.
Patients also wonder what exactly it means to eat whole-food, plant-based. Some people go vegan for ethical and environmental reasons, because they don’t want to hurt animals and know about the increased global-warming potential of animal-based foods. Vegetarians are often motivated by ethical or religious reasons.
They should consider making small substitutions. For example, instead of adding chicken, maybe swap it out for tofu. Often, people will say they don’t like the taste of tofu, but that’s because it hasn’t been marinated well. Tofu is inherently tasteless like chicken, and it takes on the flavor of the way it’s prepared.
The Role of Dietitians and Oncology Teams
Our oncology nutrition specialists are part of your health care team. They are registered dietitians dedicated to helping you eat well throughout the course of your cancer treatment and beyond. They should be able to give you guidelines about what to eat and what not to eat. If they aren’t comfortable doing that or if you want additional help, they can refer you to a registered dietitian who has experience working with multiple myeloma and other types of cancer. They may also refer you if you have additional dietary restrictions or needs. If you have gastrointestinal issues or food allergies, for instance, a dietitian can help you come up with a meal plan that meets your needs and won’t make those problems worse.
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