# Nutrition in acute myeloid leukemia
Nutritional status and treatment outcomes
Nutritional status at the time of diagnosis and during treatment is related to how well patients manage their treatment journey.
ResearchediPositive results in clinical studies, not yet standard treatment
Research shows that poor nutritional status (low body weight, deficiencies in proteins and certain vitamins) is associated with more complications during chemotherapy and transplantation, and with slower recovery. This is especially true for children and adults undergoing intensive treatment.
Serum albumin (a protein in the blood) is therefore measured regularly, both before and after stem cell transplantation. A low albumin level is seen as a warning signal that extra attention to nutrition is needed. However, this is not a cause for panic: many patients restore their nutritional status as treatment works well and side effects decrease.
Side effects of treatment on eating and drinking
Chemotherapy and hypomethylating agents (certain replacement treatments for those not eligible for intensive chemotherapy) often cause gastrointestinal complaints.
ResearchediPositive results in clinical studies, not yet standard treatment
Gastrointestinal side effects such as nausea, altered taste, diarrhea, and reduced appetite are well documented and are related to changes in metabolism and nutrient absorption.
These complaints are usually temporary, but can mean that your body absorbs fewer nutrients. A dietitian or nutrition nurse can help with practical tips: smaller, more frequent meals, food that matches what you can tolerate at that time, and possible meal replacements.
Folic acid and vitamin balance
Folic acid (vitamin B11) plays a role in cell divisions and the formation of blood cells.
ResearchediPositive results in clinical studies, not yet standard treatment
A serious folic acid deficiency can (rarely) cause blood abnormalities that resemble AML or precursors to it. Conversely: in AML itself, normalization of folic acid is not the treatment, but a healthy folic acid status does support your body during chemotherapy.
Folic acid is found in green leafy vegetables, legumes, and certain grain products. Whether you need additional folic acid is determined by your doctor or dietitian based on blood values. Some chemotherapy drugs affect folic acid metabolism; it is best to discuss this with your treatment team.
Iron metabolism
Recent research points to a link between iron metabolism and certain genetic changes in AML cells.
ExperimentaliOngoing in study setting, outcome still unknown
This is still an area of research and does not yet lead to specific nutritional advice for patients.
What is important: if your blood is regularly transfused, your body can accumulate iron. Your doctor monitors this and may discuss medicines to excrete iron. A dietitian can help you with food choices that adjust iron uptake (iron-restricted eating pattern) if necessary.
NAD metabolism and cellular fuel
Research into NAD (nicotinamide-adenine-dinucleotide), a substance that helps cells generate energy, suggests that AML cells use their nutrition differently than healthy cells.
ExperimentaliOngoing in study setting, outcome still unknown
This opens possibilities for new therapies, but does not yet mean you need to change your diet differently. NAD is related to vitamin B3 (niacin), but taking additional niacin without medical reason is not useful and can cause interactions.
Nutrients and immune system
ResearchediPositive results in clinical studies, not yet standard treatment
Proteins, vitamin D, zinc, and certain antioxidants play roles in immune defense. In AML, especially after stem cell transplantation, a well-functioning immune system is crucial. This does not mean you need to take special 'immune boosters,' but it does mean that basic nutrition (sufficient protein, variety in vegetables and fruit, healthy fats) remains important.
This is also why infection prevention through food hygiene (properly washing vegetables, cold storage, avoiding certain raw foods) receives extra attention especially in periods of low immunity.
Supplements: caution advised
UnproveniNo scientific evidence that it works
Many alternative supplements (antioxidant pills, special herbal mixtures, megadoses of vitamins) have no proven benefit in AML and may interact with chemotherapy or immunosuppressive agents after transplantation.
Advised againstiProven ineffective or harmful, or dangerous in combination with your treatment
Very high doses of certain antioxidants can even conflict with how certain chemotherapies work (which specifically want to generate harmful radicals in cancer cells). Never start supplements on your own without discussing this first with your doctor or dietitian.
Nutrition and transplantation
After stem cell transplantation, nutrition plays an extra role because your body must recover from intensive treatment, while your immune system must be reformed.
ResearchediPositive results in clinical studies, not yet standard treatment
Good nutritional status around transplantation is associated with better short-term outcomes and fewer complications. Many transplantation centres have dietitians on their team who will support you through all phases.
Oral nutrition supplements and artificial support
If eating becomes difficult due to side effects or other reasons, liquid nutritional products (oral nutrition supplements) and sometimes artificial nutrition via a tube or intravenously may be needed.
ResearchediPositive results in clinical studies, not yet standard treatment
This is regularly applied in hospitals and can make a difference in how well you are able to get through treatment. A nutrition or support team will advise on this.
Practical approach
The most important thing is: eat what your body can handle and what you enjoy, without putting pressure on yourself for perfection. Water, tea and bread can be enough if more is not possible. Talk regularly with your dietitian at the hospital; they know your situation and can suggest adjustments. Your treating physician can also help with questions about nutritional interactions.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._