For individuals diagnosed with multiple myeloma, weight changes, especially weight loss, can be a significant concern. In many cases, unexplained weight loss is one of the initial indicators of the disease. While some individuals with myeloma may experience weight gain, the overall trend, particularly in the early stages or during certain treatments, leans toward weight loss. Understanding the causes of these weight fluctuations and strategies for maintaining a healthy weight is crucial for managing the condition effectively.
The Interplay of Myeloma and Weight Changes
Weight loss is a common symptom across various types of blood cancers, including myeloma. However, it's important to note that myeloma can lead to both weight loss and weight gain, depending on the disease stage and treatment approach. The unpredictable nature of these weight changes can make it challenging for individuals to maintain a stable and healthy weight.
Maintaining a healthy body weight is vital for overall well-being, especially when battling myeloma. Being underweight, characterized by a low body mass index (BMI), can weaken the body's ability to fight infections, increase fatigue, lead to muscle loss, and exacerbate treatment side effects. Conversely, being overweight, indicated by a high BMI, raises the risk of other health issues like diabetes and heart disease, while also hindering physical activity.
Decoding the Causes of Weight Changes in Myeloma Patients
Several factors can contribute to weight changes in individuals with myeloma. While emotional factors like depression, anxiety, and stress can influence appetite and eating habits, the primary drivers of weight changes are often the disease itself or the treatments used to combat it.
Causes of Weight Loss
Myeloma-Induced Metabolic Changes
Myeloma can disrupt the body's hormonal balance and metabolism, leading to appetite loss and nausea. The disease also triggers the breakdown of bone cells, releasing calcium into the bloodstream. Elevated blood calcium levels, known as hypercalcemia, can further suppress appetite.
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Cachexia: A Complex Syndrome
Cachexia, a common syndrome in cancer patients, affects a significant proportion of individuals with myeloma. This condition alters the body's metabolism, causing it to burn muscle and fat, resulting in unintentional weight loss.
Side Effects of Myeloma Treatment
Certain myeloma treatments, such as stem cell transplants, chemotherapy, and targeted medications, can diminish appetite or alter the sense of taste. Oral thrush, a yeast infection that can occur due to immune system suppression from stem cell transplants and steroids, can also cause a bad taste, further reducing food intake.
Causes of Weight Gain
Corticosteroids: A Double-Edged Sword
Treatment with corticosteroids, commonly known as steroids, is a major contributor to weight gain in myeloma patients. While steroids are crucial for treating the disease, enhancing the effectiveness of other medications, and managing chemotherapy-induced nausea, they can also trigger side effects that lead to weight gain. Steroids can increase appetite, cause water retention, and disrupt sleep patterns, all of which can contribute to weight gain.
Other Contributing Factors
Stem cell transplants can sometimes cause weight gain due to water retention. Additionally, an underactive thyroid (hypothyroidism), a potential side effect of Revlimid, can also lead to weight gain. Hormone changes caused by myeloma can affect how the body processes and stores fat. Bone pain associated with myeloma can reduce physical activity, further contributing to weight gain. Some individuals may overeat to prevent weight loss, inadvertently leading to weight gain.
Strategies for Maintaining a Healthy Weight
It is important to consult with an oncologist regarding any weight changes. They can determine the safest and most effective ways to balance your weight. They may also refer you to a dietitian or nutritionist.
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Addressing Weight Loss
Cachexia, a complex syndrome, is the subject of ongoing research aimed at developing better treatments. Current management strategies may involve a combination of approaches, including exercise to rebuild muscle mass and slow further muscle loss, medications to alleviate nausea and stimulate appetite, and nonsteroidal anti-inflammatory drugs to mitigate the effects of cachexia.
Preventing weight loss as a symptom or side effect is ideal, but it's challenging due to individual variations in how people respond to the illness and its treatments. Prophylactic antifungal medications may help prevent oral thrush. Some doctors recommend gaining weight before stem cell transplants to offset anticipated post-treatment weight loss.
Practical Tips for Managing Weight Loss
- Consider medications to stimulate appetite.
- Use a mouthwash (often called "magic mouthwash") to alleviate mouth sores.
- Consume meal-replacement or protein bars and shakes to increase calorie intake.
- If experiencing "metal mouth," use plastic silverware.
- Make a conscious effort to eat, even when not hungry or unable to taste food.
- Identify appealing foods and prioritize them. Avoid consuming favorite foods before chemotherapy sessions to prevent associating them with nausea.
Managing Weight Gain
Unfortunately, there are fewer options for addressing weight gain associated with myeloma treatment. Certain medications can help reduce hunger, regulate hormone imbalances, and alleviate water retention. However, the most effective approach involves careful attention to diet, focusing on proper nutrition rather than solely restricting calories.
Practical Tips for Managing Weight Gain
- Limit carbohydrate intake, especially sweets.
- Eat healthy snacks to curb cravings.
- Establish and adhere to a consistent meal schedule.
- Engage in appropriate exercises, such as walking or swimming, after consulting with the cancer care team.
- Consume diuretic foods like cucumbers to help reduce water retention.
- Drink plenty of water.
- Monitor salt intake.
The Role of Obesity in Myeloma Development and Progression
Obesity has emerged as a significant risk factor for both the development and progression of multiple myeloma. Studies have shown a positive association between increased body mass index (BMI) and the risk of developing monoclonal gammopathy of undetermined significance (MGUS), a precursor condition to multiple myeloma. Obesity is considered the only known modifiable risk factor for multiple myeloma.
Epidemiological Evidence
Epidemiological studies have consistently demonstrated a link between obesity and an increased risk of developing multiple myeloma. A meta-analysis of multiple studies revealed a significantly increased risk ratio for myeloma incidence in both men and women with higher body weight. The Age Gene/Environment Susceptibility-Reykjavik Study (AGES-RS) found that a high midlife BMI is associated with an increased risk of progression from MGUS to multiple myeloma and other lymphoproliferative diseases. A retrospective study from the US Veterans Health Administration also showed that weight status and obesity are associated with an increased risk of transformation of MGUS to multiple myeloma. Data from the Nurses' Health Study (NHS), Health Professionals Follow-Up Study (HPFS), and Women's Health Study (WHS) revealed a positive association between cumulative average adult BMI and young adult BMI with multiple myeloma risk.
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The "Obesity Paradox"
While obesity is generally associated with increased mortality in many cancers, some studies have surprisingly suggested that obesity may have a protective effect in multiple myeloma. This phenomenon, known as the "obesity paradox," has been observed in other types of cancer as well.
Possible explanations for the "obesity paradox" include protection from cachexia, a wasting syndrome that can occur in cancer patients, and advantages of increased body weight during aging. However, methodological factors such as residual confounding, reverse causality, and selection bias may also contribute to this observation. It is important to note that these observations should not be interpreted as evidence that high BMI reduces the risk of death or cachexia for cancer patients, or that gaining weight could be beneficial.
The Link Between Diabetes and Myeloma
Type 2 diabetes mellitus (T2DM) has been suggested as a potential risk factor for developing multiple myeloma or causing worse clinical outcomes. Some studies have found that patients with MGUS, multiple myeloma, and other lymphoproliferative disorders are more likely to have a preceding diabetes mellitus diagnosis compared to matched controls.
However, the relationship between diabetes and myeloma is complex. Some studies have not found an increased risk of progression from MGUS to multiple myeloma in patients with diabetes. The use of hypoglycemic drugs, such as metformin, may explain why these patients do not have an increased risk of myeloma.
Therapeutic Interventions Targeting Obesity in Myeloma
Given the association between obesity and multiple myeloma, therapeutic interventions targeting obesity are being explored as potential strategies for preventing or managing the disease.
Metformin
Metformin, a drug commonly used in diabetic patients, has shown promising anti-myeloma effects in epidemiological data. Some studies have reported a significant reduction in myeloma risk for patients with MGUS and cumulative metformin exposure. Metformin has also exhibited anti-myeloma effects in vitro and in immunocompromised xenograft models.
Statins
Statins, or HMG-CoA reductase inhibitors, are another class of lipid-lowering medications that hold promise in multiple myeloma.
Lifestyle Changes
Lifestyle changes promoting lower BMI, such as diet and exercise, are also being investigated as potential strategies for reducing multiple myeloma risk.
Talquetamab and its Impact on Weight and Taste
Talquetamab, an approved therapy for relapsed multiple myeloma, has been associated with dysgeusia (taste disturbances) and weight loss. Studies have shown that dysgeusia is prevalent in patients undergoing talquetamab treatment, and patients may experience significant weight loss during treatment.
Weight loss and dysgeusia are important adverse events to consider while on talquetamab treatment. Monitoring and addressing these side effects can help prevent additional complications and improve patient comfort.
Navigating the Challenges of Weight Changes in Myeloma
Living with myeloma presents numerous challenges, and weight changes can add to the complexity. Open communication with the healthcare team, including the oncologist and a registered dietitian or nutritionist, is essential for developing a personalized plan to manage weight effectively.
Seeking emotional support for anxiety or depression can also play a vital role in weight management and overall quality of life. Online communities and support groups, such as MyMyelomaTeam, can provide a platform for individuals with myeloma to connect with others, share experiences, and access valuable information.