 RAYNA MCCANN, M.S., RDN, CSO, CDN

Althought it is sometimes overlooked, nutrition is a pivotal factor in a patient’s medical plan. 

Receiving adequate nutrition before, during and after treatment can help with side effects, quality of life, strength, fatigue, healing, treatment toxicities and so much more. 

Depending on the cancer diagnosis and treatment plan, nutrition recommendations may change. Common symptoms of multiple myeloma may directly affect nutrition, both before diagnosis and after.

Approximately one in three people with cancer has high calcium levels, known as hypercalcemia. High calcium levels are common in patients with multiple myeloma. The high levels usually are not due to consuming large amounts of milk or calcium-rich foods but instead are the effect of the cancer on the bone. If the calcium level is high, a patient may be told to not consume a lot of dairy products. At the same time, it’s important to take in enough fluids to help the kidneys remove excess calcium from your body.

Multiple myeloma also may affect renal or kidney function. Kidney damage is common in patients with multiple myeloma, and it can lead to elevated potassium and/or phosphorus levels. Patients should communicate with their medical team to stay aware of potassium and phosphorus levels when their blood work is taken. 

If laboratory results show elevated levels, a patient may need to cut back on foods that are high in potassium and/or phosphorus. In the ingredients list, look for words such as "dicalcium phosphate," "disodium phosphate" and others to identify additives. 

Foods that are high in potassium include bananas, oranges, cantaloupe, apricots, prunes, raisins, dates, potatoes and avocados. Foods that are high in phosphorus include dark colas and dairy products such as milk, ice cream and pudding.

Nausea is common during cancer treatment, but there are steps that patients can take to mitigate the side effect.

During treatments, a patient may experience a wide range of side effects that affect nutrition, such as nausea, constipation, loss of appetite, fatigue, weight loss and excessive thirst. These may affect daily life, but there are some ways to combat these.

Having nausea can greatly affect nutrition status. Identifying patterns may help to guide treatment, so patients should keep their medical team informed. For example, if a patient experiences nausea every night before treatment, it may be caused by anxiety, as opposed to nausea following treatment, which may be caused by the medication.

Constipation can also be a sign of high calcium level, along with dehydration, thirst, confusion and worsening of underlying bone pain — so this should be pointed out. Fiber, or roughage, can help prevent constipation, but that’s only part of the story. Eating high-fiber foods such as spinach, whole grains and beans can help with bulk, but adequate hydration is also vital. Consuming enough fluids helps move bulk throughout the body and rid the body of waste. Drinking warm fluids in the morning may help ease constipation. A patient should tell their medical team how often they have bowel movements, in case a bowel regimen is needed.

More often than not, the number on the scale does not tell the full story. If a patient gets fatigued during daily activities, such as opening a jar or walking to the mailbox, they may be showing signs of muscle wasting. Patients should tell their medical team if they feel they have lost muscle mass and/or have lost weight without trying. A registered dietitian can show how to add nutrient-dense foods to the diet and explain ways to rebuild or preserve muscle mass, such as strength training and adequate protein intake.

Neutropenia is a term used to describe low neutrophils, a type of white blood cell. Having neutropenia may increase the risk for infection. Because of this risk, a medical team may discuss specific diet guidelines to avoid harmful organisms from foods and beverages. Safe food handling is especially important if a patient is receiving chemotherapy or radiation, or has had a stem cell transplant.

Patients should bring a notebook to appointments. Their medical team may 

Here are five tips for safer eating practices during (and after) cancer treatment.

mention certain foods or beverages that need to be avoided with medication, such as grapefruit or green tea. They also may give instructions about taking medication on an empty stomach or with food. All of this information may feel overwhelming. It can help to bring a support partner for a second set of ears or to take notes. 

Nutrition should be part of a patient's treatment plan, and it should be tailored to their specific laboratory results, medications and condition. Ask to speak with a registered dietitian for guidance on how to best fuel the body. 

For more news on cancer updates, research and education, don’t forget to 

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RAYNA MCCANN, M.S., RDN, CSO, CDN

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