Studying the Relationship Between Myeloma Progression and Diet with Dr. Urvi Shah

How Can I Stop My Myeloma From Progressing? 

Many times, people living with myeloma ask the question, "What lies in my power to stop my myeloma from progressing?"

While we aren't aware of any single golden answer to this question, researchers and myeloma specialists alike believe that both physical activity and diet play a role in myeloma progression. Dr. Urvi Shah, a myeloma specialist from Memorial Sloan Kettering, has made it her life mission to understand this relationship and guide patients toward a healthier, active myeloma lifestyle. 

She joined HealthTree for Multiple Myeloma on January 25th to share what we know so far on this subject and what studies will be conducted in the future in order to research more on this subject. 

Why Does What I Eat Matter? 

Why would a change of diet matter in the progression of myeloma? 

We know that obesity increases the risk of:

• Developing MGUS 
• MGUS progression to active myeloma 
• Active myeloma development 
• Death from multiple myeloma 
• Worse survival after a stem cell transplant 

Therefore, taking care of what we put into our body will affect how our body will be able to fight off cancer in conjunction with the different treatment regimens that are administered to us. 

So what kind of diet (or, in better words, a lifestyle change) would Dr. Shah recommend? 

Plant-based diets have proven to be a way of eating that is least associated with cancer, according to three major studies conducted in the United States (Tantamango-Bartley, Cancer Epidemiol Biomarker Prev 2013), the U.K. (Key, Am J Clin Nutr 2014), and France (Kane-Diallo Int J Cancer 2018). On the contrary, the typical inflammatory Western diet was associated in each of these studies with higher death rates after a cancer diagnosis. The study in the U.K. even went far enough to study the effects of a plant-based diet on multiple myeloma and found that vegans and vegetarians had 77% less multiple myeloma than meat eaters.

What is a Plant-Based Diet? 

Plant-based diets are feasible and effective weight-loss strategies, often showing a 10-15% reduction in body mass index (BMI) within six months. Wright et al. Nutr Diab 2017, Kahleova et al. JAMA Network Open 2020, Wilding et al. NEJM 2021.

The diets themselves can be of different varieties.  

1. Vegans usually refrain from eating animal products, citing ethical or environmental reasons for their change in diet. The foods they choose don't necessarily have to be healthy; french fries are considered vegan and would fit into the diet classifications.

2. Vegetarians will consume some animal products but usually refrain from meat and fish. This might be for ethical or religious reasons. Food choices here don't necessarily have to be healthy; many vegetarians will still choose to eat ice cream. 

3. Whole food plant-based diet followers will focus on whole foods, less processed foods and more of a plant-based diet. These include minimal animal products and are usually followed for health reasons. Therefore, vegetarians and vegans can also choose to be healthy eaters by following a whole-food, plant-based diet. 

What Does a Whole Food Plant-Based Diet Look Like? 

This diet focuses on quality versus quantity. Diets restricting calorie or carbohydrate intake can be harmful and usually unsustainable. On a whole food plant-based diet, you want to focus on foods that aren't processed, fried, or high in added sugars. You want to include plants in every meal that you eat. 

Here's a more detailed look. 

Carbohydrates

• Increase the number of whole grains you eat daily - strive for three servings of whole grains a day. (examples of whole grains are barley, brown rice, buckwheat, whole wheat bread, and old-fashioned oatmeal, to name a few) 
• Decrease the number of refined carbohydrates that you consume. Limit white bread, rice, or pasta
• Avoid sugary foods and drinks

Fiber 

• Increase your vegetables and fruits to 5-6 servings a day
• Eat various plant foods because the more diverse your plant choice, the healthier your microbiome (or gut bacteria) and the stronger your immune system will be!
• Try to eat 30 different types of plant foods in one week

Protein 

• Plant protein has been proven to be associated with less cancer and less mortality/death than animal protein, so choosing plants as your protein source is always a good choice
• Plant-based sources of protein can be beans, tofu, tempeh, chickpeas, quinoa, and peanut butter, to name a few
• If you do choose to eat animal protein, avoid red meats and processed meats, as nitrates in these meats have been closely linked to cancer

Fats 

• Choose foods that are high in unsaturated fats, such as avocados, almonds, and pumpkin seeds
• Olive oil is an excellent example of unsaturated fats in a whole food plant-based diet, although some people on the diet choose to restrict all oils
• Decrease the number of fried foods, dairy, and cheese that you consume
• Make sure that you are getting the proper amount of omega-3 fatty acids (often found in fish like salmon, flaxseeds or chia seeds), and Vitamin D (recommended >30 ng/mL)

Studies for MGUS, SMM, and NDMM Patients

The four studies that Dr. Shah mentioned in her presentation are below. You can see all of HealthTree's active research projects here.

NUTRIVENTION Study

Who: MGUS and Smoldering myeloma patients 
What: Plant-based diet & nutrition counseling (partnered with Plantable)
Where: Memorial Sloan Kettering

NUTRIVENTION-2 Study

Who: SMM Patients
What: Four arms: Whole Food Plant-Based Diet, Curcumin, Omega-3, and Probiotics, testing levels of butyrate levels after two weeks of each of the previously-mentioned trial arms 
Where: Virtually with HealthTree Foundation

NUTRIVENTION-3 Study

Who: MGUS or SMM patients (m-spike >0.5 or involved light chain >10) 
What: Three arms: Whole Food Plant-Based Diet (followed by nutrition counseling), Supplement (followed by whole food plant-based diet and supplement), or Placebo (followed by a whole food plant-based diet + placebo)

NUTRIVENTION-4 Study 

Who: Newly Diagnosed Multiple Myeloma (≥ VGPR after Induction therapy with or without an ASCT)
What: 2 arms: lenalidomide maintenance and daratumumab maintenance, both followed by optional assignment of whole food plant-based diet for 12 weeks
Where: Memorial Sloan Kettering Cancer Center 

Other Fun Facts and Studies Shared by Dr. Shah

You can learn more about what Dr. Shah taught during her presentation through this video. Highlighted below are more facts and studies that Dr. Shah shared in her presentation that you can access: 

• COVID-19 and plant-based diets (1:54)
• If/how diabetes and myeloma are linked (8:28)
• HealthTree Foundation study of diet (10:05)
• Diet rapidly and reproducibly alters gut microbiome (17:10)
• Nitrogen-recycling bacteria accelerate myeloma progression (21:06)
• MRD and diverse microbiome study (24:45)
• The Fiber Gap (34:40)
• William's Story (Patient Testimonial, 40:37)
• Q&A (1:02:45)

A thank you to our community event sponsors, with whom this event would not have been possible.