# Nutrition in multiple myeloma
Nutrition plays a supportive role in multiple myeloma, both for overall health during treatment and for managing side effects. Because patients with myeloma often undergo prolonged treatment and may struggle with eating problems, digestive issues and altered taste perceptions, good nutritional practices are an important aspect of self-care. This tab describes what research and experience teach about nutrition in this disease.
Energy and protein needs
In multiple myeloma, adequate protein intake is important because the disease and treatment both affect muscle mass and the immune system. Many patients experience weight loss or reduced muscle gain, especially during or after intensive treatment.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Adequate protein intake contributes to maintaining muscle mass and supports immune system recovery. For patients undergoing treatment, a protein intake is generally recommended that is higher than for healthy individuals, but the exact amount varies per person and phase of treatment.
Energy needs can increase due to the disease itself, but can also decrease due to side effects such as nausea or fatigue. A dietitian can help determine the right amount of nutrition for your individual situation.
Taste changes and eating problems
A common side effect of chemotherapy and targeted immunotherapies is dysgeusia – an altered or reduced taste perception. This can lead to loss of appetite and malnutrition.
ResearchediPositive results in clinical studies, not yet standard treatment
Recent research points to the importance of microbiome-friendly food choices and natural taste modulators (such as certain herbal extracts) to support patients who experience taste changes from immunotherapy. This helps some patients restore their appetite, but the effect varies greatly from person to person.
Practical tips that many patients find helpful:
- Cold food may taste different than warm food
- Metallic taste sometimes decreases with different dinnerware
- Spices and lemon juice can help rediscover taste
- Small, regular portions work better than three large meals
Discuss with your dietitian or healthcare provider which dietary changes are most likely to help your situation.
Kidney function and calcium needs
Multiple myeloma can affect the kidneys and the calcium-phosphate balance in the body. Some patients develop calcium disturbances or have kidney problems.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Normal calcium and phosphate intake is important; too much calcium can be harmful in certain situations. The kidneys play a crucial role, and if your kidney function is reduced, dietary composition may need to be adjusted (for example, less potassium or phosphate in certain phases).
This requires personal guidance based on blood values. Your doctor or dietitian can help you determine which foods are appropriate for your case.
Nutrition and medication use
Many medications for myeloma, including corticosteroids (for symptom management or as part of chemotherapy) and targeted agents, can affect nutritional metabolism.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Corticosteroids can increase hunger and increase the risk of weight gain. They can also affect bone strength, making calcium and vitamin intake more relevant. Nutrition alone cannot prevent this effect, but healthy weight stabilization does contribute to overall health.
Certain foods may have interactions with medications (for example, grapefruit with some targeted agents). Ask your pharmacy or doctor about possible nutritional interactions with your specific medication regimen.
Malnutrition and supplementation
Many patients lose weight or struggle to eat enough due to nausea, taste changes or fatigue. Malnutrition weakens the immune system and can slow recovery.
ResearchediPositive results in clinical studies, not yet standard treatment
Research shows that nutritional screening (assessment of risk of malnutrition) and early nutritional intervention help prevent complications and improve quality of life. This can consist of adjustments to normal food, nutritional drinks or in severe cases artificial nutrition.
Supplement drinks (such as nutritional drinks with less sugar or protein-enriched drinks) can be useful as snacks or meal replacements, but should always be tailored to your nutritional status and treatment phase. A dietitian can determine whether you need them and what type is best.
Immune status and nutrition
Because myeloma and its treatment affect the immune system, it stands to reason that good nutritional habits support your defenses. However: nutrition cannot 'cure' immune disease.
ResearchediPositive results in clinical studies, not yet standard treatment
Certain nutritional components (such as adequate amounts of vitamin D, zinc and selenium) play a role in immune function. However, there is no evidence that specific dietary choices or supplements can change the disease course or prevent relapse. The importance of nutrition lies mainly in supporting overall health and resilience.
Vitamin supplementation can be worthwhile if there are deficiencies, but 'megadoses' of vitamins or minerals are not proven to be necessary or safe. This requires individual discussion with your doctor.
Physical training and nutrition
Exercise contributes to maintaining muscle strength and bone health, especially in myeloma, but requires adequate nutritional support.
ResearchediPositive results in clinical studies, not yet standard treatment
Patients who combine nutrition and exercise generally better maintain their muscle mass and report better quality of life. Adequate protein intake becomes essential if you are or want to be physically active.
Alcohol and smoking
Alcohol and smoking have no direct support for nutrition, but can affect wellbeing and side effects.
ProveniIncluded in official guidelines, or approved by EMA or FDA
Alcohol can interact with certain medications and can worsen nausea. Smoking often worsens appetite and immune function. It is advisable to avoid these as much as possible, but this is a personal choice you can discuss with your doctor.
When to consult a dietitian?
Nutrition in myeloma is complex and very personal. A specialized dietitian – preferably one with experience in cancer patients – can help you:
- Prevent or correct malnutrition
- Cope with taste changes
- Understand drug interactions
- Adapt nutritional plans to your treatment phase
- Solve eating problems or digestive complaints
This is certainly valuable in the first months of treatment and after intensive therapy.
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_This information never replaces the judgment of a doctor. Always discuss your nutrition and possible supplementation with your own healthcare provider or dietitian._