Nutrition and myeloma

Keeping up your food and fluid intake and enjoying a well-balanced diet is a vital part of living well with myeloma. 

Your body works best when you eat a balanced diet with a wide range of fresh, unprocessed foods, while limiting processed, salty and sugary foods. Both myeloma itself and its treatments can affect your appetite and your nutritional needs. This can make eating well and keeping up your fluids more challenging. It also means that doing your best to follow a healthy diet can have a big impact on how well you feel and your energy levels.

We have outlined some key information about nutrition and myeloma pain on this webpage. If you would like to read more, see infosheet below.

How good nutrition can help when you have myeloma

Eating well and including plenty of water can help you to:

• keep up your energy levels
• promote recovery after periods of treatment 
• maintain your muscle mass and strength 
• maintain bone strength and bone health 
• experience a greater sense of general wellbeing 
• better manage the side effects of some treatments 
• improve your mood 
• sleep better 
• maintain a healthy weight for you 
• improve your body’s ability to fight infection
• prevent or manage other health problems, like diabetes and heart disease. 

What are the building blocks for healthy eating?

A well-balanced diet is one that will supply your body with all the nutrients it needs to help you live as well as possible.

We’ve included some general nutritional guidelines, which you can adapt based on your dietary preferences (such as following a vegetarian, vegan or flexitarian diet, or a diet that’s traditional to your culture), and based on any food intolerances or allergies you may have.

Plant foods

Plant foods should make up a large part of your diet with wholegrain-based foods, vegetables, fruits and legumes making up more than half the foods you eat each day. 

Plant foods provide your body with carbohydrates for energy, and essential vitamins, minerals and antioxidants, which help strengthen bones, maintain healthy nerves, repair cells, heal wounds, and support your immune system. Plant foods are also a rich source of fibre, which you need for healthy digestion and to increase the diversity of your gut’s population of beneficial bacteria (called your gut microbiome). Legumes and wholegrains also provide protein, which is essential for preserving muscle mass, and for metabolism, strength, and immune function. 

• Eat a variety of different coloured vegetables.
• Choose wholegrain products, which are higher in nutrients, whenever you can. 
• Include the skin and seeds of vegetables and fruits whenever possible.
• Reduce highly-refined carbohydrates and sugary foods like cakes, biscuits, pastries, doughnuts, lollies and soft drinks.
• Include legumes such as chickpeas, cannellini, red kidney and black beans, split peas, and lentils.
• Talk to your treating team if you are having problems like constipation, diarrhoea, gastrointestinal pain or cramping.

I’ve started adding canned chickpeas, butterbeans and black beans to all types of meals: soups, salads, curries, taco fillings and more. It’s such a quick, easy and delicious way to add extra protein and many other nutrients.

– Cathryn, Victoria

Protein

Your body needs protein to help build new cells and replace old ones. Protein is an important building block for bones, muscles, hormones, immune factors and neurotransmitters. We need more protein as we get older, where it’s especially important to prevent muscle loss.

During myeloma treatment, your protein needs increase greatly. It’s often helpful to chat to a dietitian for recommendations on the ideal amount of protein for your needs and healthy ways to include this in your eating plan. 

• Good sources of protein include legumes, tofu, fish and seafood, unsalted raw nuts and seeds, poultry, lean red meat, and dairy products. 
• Try to reduce reliance on red meat as your main protein source and get more of your protein from plant sources, fish, and poultry. 
• Include canned or fresh fish a couple of times a week. Include oily fish varieties such as salmon, sardines, mackerel and tuna.

Canned sardines are my go-to emergency meal. I love them on wholegrain toast with some avocado and a squeeze of lemon – YUM!

– Jake, Tasmania

Dairy products and other calcium-rich foods

Dairy products include milk, yoghurt and cheese, which are a valuable source of calcium and other minerals needed as building blocks for bone. There are many non-dairy sources of calcium too.

• You need at least 2–3 serves of calcium-rich foods each day, and women over 51 need 4 serves a day. 
• There are many plant-based dairy alternatives — including oat, almond, macadamia, rice and coconut milk, yoghurt and cheese. It’s important to look for varieties that are calcium-fortified. 
• Green leafy vegetables from the brassica family are also very good sources of easily absorbable calcium. These include broccoli, kale, rocket, Brussels sprouts, cabbage, bok choy and other Asian greens. 
• Canned sardines and salmon that include the cooked (and edible) bones are another way to enjoy more calcium, and provide the added bonus of omega-3 fatty acids. 

Fats

Fats provide your body with a valuable source of energy and are needed to transport some vitamins around the body.

• Choose healthier fats from oily fish, unsalted raw nuts and seeds, avocados and olive oil 
• Limit saturated and trans fats found in meat, and processed foods like cakes, biscuits, ice-cream and chocolate.

Keeping up your fluids

Fluids are essential to keep you well-hydrated and to keep your kidneys functioning well so they can eliminate waste products. Keeping up your fluids is especially important during and immediately after the days you have your treatment. For most people, 2-3 litres of fluid a day is best. 

If you have kidney impairment you may be on fluid restriction. Please check with your doctor if this might apply to you. 

Water is the best fluid to choose most of the time, and you should do your best to limit:

• alcohol, which can contribute to dehydration and has many other risks 
• sugary soft drinks and juices, especially when you’re on steroids, which can increase blood sugar levels. 

Note that coffee and tea contain caffeine, which acts as a diuretic, causing the body to actually get rid of fluid, and so shouldn’t be counted towards your fluid intake.

I fill up a 2-litre water bottle every morning and drink from it throughout the day to make sure I’m getting enough fluids. It’s really motivating to see the water level go down as the day goes on. – Anh, Queensland

What can make a well-balanced diet difficult?

Myeloma itself and many of its treatments can cause side effects that make eating and drinking more difficult at certain times. Some of the problems you may experience include:

• reduced appetite and enjoyment of food 
• changes in taste and smell, including a metallic taste after treatment and a decreased sense of smell 
• a sore, dry mouth, especially after high-dose chemotherapy 
• nausea and vomiting 
• tiredness or fatigue 
• diarrhoea or constipation 
• anxiety and depression 
• acid reflux and heartburn 
• increased appetite that can lead to weight gain and digestive issues — caused by steroids.

Tips to make healthy eating easier

When you don’t feel like eating, these tips can help you to get the nutrients and energy you need:

• Eat small amounts regularly throughout the day. 
• Light, gentle exercise like walking can help to stimulate your appetite, improve fatigue, and keep your bowel moving. 
• If the smell of hot food is off-putting, try cold or room temperature meals instead. 
• You may find that softer, cooler or frozen foods are more appealing. 
• Try squeezing lemon juice on food to help bring out the flavour. 
• When you’re feeling well and less fatigued, try cooking a bigger batch of a favourite recipe and freezing some for another day. 
• Ask friends and family to help with food shopping and cooking. 
• Stock up on simple, nutritious snacks, so that when you feel like eating, there’s something within easy reach. 
• When you don’t feel like eating much, it’s important to still drink enough fluids. Keep a water bottle nearby and take regular sips. 
• If you’re experiencing a sore mouth or taste changes, ask your treating team about topical treatments that can help.
•  Some myeloma treatments can give you a metallic taste in your mouth. Try using wooden, silicone or plastic cutlery to help minimise this at mealtimes. 
• Help keep your mouth fresh and clean by using a non-alcohol-based mouthwash. 
• If you’re struggling to eat well, ask to see a dietitian who can give you extra information and tools to help make sure you’re getting all the nutrients you need. 

Sometimes I don’t have the energy to prepare healthy meals. This is when my friends and family step in. I really appreciate their help, and they feel good about being able to help me too.

– Svetlana, New South Wales

Should I see a dietitian?

A dietitian can help you to sift through and understand the large amount of nutrition information that’s available. They can help you to sort facts from fiction, and tailor recommendations that are unique to your diagnosis, food preferences, medicines, and treatment goals.

You may be able to see a dietitian at your treating hospital or in their private practice. There are Accredited Practicing Dietitians (APDs) who specialise in cancer, called oncology dietitians. Sometimes, there may not be any specialised oncology dietitians in your area, and so a general dietitian can help you instead. 

To search for a dietitian in your area, visit Dietitian’s Australia Find a Dietitian page. Under the ‘Help me with’ option, choose ‘Cancer’ to search for dietitians in your area who have experience with cancer. 

I thought I knew quite a bit about healthy eating, but when I was diagnosed with myeloma, I had so many new questions. Seeing a dietitian at different stages of my treatment has been so helpful. I’ve learnt how to keep up my food and fluids even when I don’t feel hungry or thirsty, how to include extra veggies, legumes and protein in every meal, as well as some quick, healthy recipes.’

– Shiva, South Australia