We often get asked how myeloma patients can have the best outcome. We believe the best outcome will be a result of proper treatment through a myeloma specialist, consistent fitness and movement, and a proper diet filled with nutrition for your body. 

We want to give our bodies and ourselves the best chance for survival and achieve the highest possible quality of life. That is part of why Dr. Urvi Shah has made it her mission to help myeloma patients discover which foods are best for them to include in their diets, and what modifiable factors in their life they can change to minimize their risk of progressing or relapsing myeloma. 

Dr. Urvi Shah is a faculty on the myeloma service division of hematologic malignancies at Memorial Sloan Kettering Cancer Center. Her research focuses on studying the role of diet, microbiome, and other lifestyle-related risk factors in plasma cell disorders as well as identifying interventions to improve outcomes for these patients. Being a lymphoma survivor herself, she is passionate about helping patients make wise nutritional and lifestyle choices as they face a plasma cell disorder diagnosis as well as raising awareness about healthy choices to prevent cancer. 

In her two-part series given to the Nutrition and Wellness for Myeloma Community Chapter, Dr. Shah first shared with us the metabolic and microbiome-related factors that when modified could affect the outcome of our myeloma, followed by a session in which she described diet and supplements could be beneficial to myeloma patients as they strive to be as possible. 

In this article, I will focus on Dr. Shah's thoughts and advice concerning the microbiome. However, I will include the videos from her sessions below so that you can learn from her expertise and learn at your own pace how we can modify several factors in our life to give our bodies the best fighting chance possible. 

Modifiable Risk Factors that Affect Myeloma Part 1: Obesity, Diabetes, and the Microbiome 

Modifiable Risk Factors that Affect Myeloma Part 2: Diet and Supplements 

Why is nutrition so important for a cancer patient? 

It's important to remember that proper nutrition is vital in all stages of cancer. It can be used as a preventive approach, reducing the risk of the development of cancer. If you find yourself already diagnosed with precursor or active myeloma, nutrition can serve as a type of treatment. It can keep you from developing comorbidities, which means fewer side effects, and the more likely chance you will qualify for all the treatment that you need to fight the myeloma. In the stages of survivorship, it can help patients decrease the likelihood of a relapse once completed with treatment and reduce the risk of other medical problems or secondary cancers. Today we hope to teach you about an integral part of your body and your health. By learning more about the microbiome and how to provide the proper nutrients for it, you are setting your health up for as much success as possible. 

What is the microbiome? 

According to Wikipedia, the human microbiome is the aggregate of all microbiota that reside on or within human tissues and biofluids along with the corresponding anatomical sites in which they reside, including the skin, mammary glands, seminal fluid, uterus, ovarian follicles, lung, saliva, oral mucosa, conjunctiva, biliary tract, and gastrointestinal tract. Types of human microbiota include bacteria, archaea, fungi, protists, and viruses. 

Why focus on the microbiome?

The microbiome is often referred to as the second mind. Your gut health (which makes up 95% of your microbiome) is essential to your overall health. 

To put things into perspective, we are more microbiome than human cells. We each have around 30 trillion human cells within our body, compared to the 100 trillion microbial cells that we contain within our body. We have around 23,000 human genes within our body, but we each have over 2 million microbial genes in that same space. So though we think of ourselves as skeletons with visible organs, the invisible microbiome plays an incredibly important factor in who we are and how healthy of an individual we are. As the genetic code is different in every person, so is the microbiome. 

Interesting Facts about the Microbiome

According to Biosite and Microbiome Ireland, here are some interesting facts about the microbiome (that shows how important of a factor it plays in our bodies!)

• 100 trillion microbes live in and on every person and make up the microbiota 
• The human body has more microbes than there are stars in the Milky Way 
• 95% of the microbiota is located in the GI tract 
• The surface area of your GI tract is the same size as two tennis courts 
• The gut microbiota can weigh up to 2 kilos 
• 90% of diseases can be linked in some way back to the gut and health of the microbiome 
• If positioned end to end, your body's microbes would circle the Earth 2.5 times

The Role of the Gut Microbiota In Health and Disease 

The microbiome truly plays a significant role in determining the health of a patient. If a myeloma patient is eating an adequate amount of fiber in their diet, as well as a healthy proportion of probiotic intake, then their microbiome will result positively with results such as: 

• increase of short-chain fatty acids
• increase of antioxidants
• lowered kidney toxins
• improved lipid metabolism
• low gut inflammation 
• insulin sensitivity and
• reduced risk of some infections 

On the other hand, mistreating your microbiome can cause significant damages as well. For example, if you are to eat large amounts of sugar (fructose), high amounts of animal protein, saturated fatty acids, or frequent antibiotics, then your gut health can result in: 

• decrease of short-chain fatty acids 
• increase of TMAO (increases risk of cardiovascular disease)
• gut inflammation 
• insulin resistance 
• increased risk of diarrhea 
• possible cognitive decline 

Probiotic vs. Prebiotic and Diversity  

We often hear of probiotics and prebiotics but aren't sure what they mean or what the difference between these two words is.

In simple terms, probiotics actually contain the healthy bacteria, that when entering the gut, creates more healthy bacteria in the intestines. These are not degraded by our host enzymes. You can increase the number of healthy bacteria in your gut but consuming probiotics such as fermented foods (kombucha, sauerkraut, etc.)

Prebiotics, on the other hand, are the food for this bacteria. The amount of natural fiber that you include in your diet, or prebiotic supplements, provides the food on which your healthy gut bacteria thrives. 

Another important thing to note about the microbiome is that in order to thrive, it needs diversity. You want many different kinds of microbial bacteria within your gut in order to achieve a healthy microbiome. 

MGUS vs Smoldering Myeloma and the Microbiome 

We are receiving very early data from humans (after testing significantly on mice), but here are some trends that are being seen in current trials and studies: 

• There is some change in the microbiome in patients with MGUS and myeloma, and it progressively gets more imbalanced as the disease progresses into the different stages
• Patients who had myeloma were less likely to have short-chain fatty acid-producing bacteria (good bacteria for your gut) and more likely to have nitrogen recycling bacteria, which when put into mice accelerates myeloma progression significantly 
• Myeloma patients have lower diversity within their gut microbiome, this signifies its a less healthy microbiome than those who have more diversity in their gut bacteria 
• Lower diversity within your microbiome can lead to increased diarrhea and more toxicity in your gastro health

Microbiome in Myeloma Post-Induction 

A study at Memorial Sloan Kettering in New York tested the state of a myeloma patient's microbiome after induction therapy. After the induction therapy (and perhaps a transplant), a small number of myeloma patients were tested for minimal residual disease. Then, their microbiome was evaluated. The study's findings showed that the MRD-positive patients had less short-chain fatty acid bacteria-producing bacteria, while those with MRD negativity had an increase of short-chain fatty acid-producing bacteria (healthy bacteria for your gut). 

How can I expand my gut diversity and increase the good bacteria in my microbiome? 

Studies continue to show that plant-based foods provide short-chain fatty acid-producing bacteria in your gut. By eating healthy plant foods that have antioxidants, fiber, and other nutrients that feed the microbiome, you are providing foods that increase the good bacteria in your microbiome. 

Ask yourself this question: How many types of plant foods do I eat in a week? 

This question is not asking the frequency or even the serving size of the plant-based foods that you have in your diet but rather is meant to serve as self-reflection for the diversity of plant-based foods that you are consuming. Are you eating several different types of vegetables? Are you eating different kinds of whole grains? As we introduce diverse and healthy plant-based foods into our diet, we are serving our gut and allowing the healthy bacteria to grow that is directly connected with our overall health.

Make it a goal to include 30 different types of plant-based foods in your diet every week. 

Conclusions 

• Though most of this data is still very preliminary, we see through the trend of many cases that myeloma directly affects the microbiome and decreases its diversity. 
• We know to keep an eye and ear out for more myeloma microbiome-related studies and data that are to be published within the next few years. 
• We can increase the number of good bacteria within our microbiome and expand our microbe diversity but eating a variety of probiotic fermented foods and prebiotic fiber-filled plant-based foods. 

Need a recipe to get you started? Start with a recipe that gets you up to 8 diverse plant-based foods in one meal! 

Mexican Quinoa Stuffed Sweet Potatoes

Thank you to Alyssa at Simply Quinoa for sharing her recipe. 

This Blood Cancer Awareness Month we focus on becoming the healthiest we can be through movement and proper diet. Keep moving to honor this special month and share this article with some of your friends and family to increase awareness about the microbiome. 

Thanks to our sponsors for making this event possible: 

And a big thank you to our Muscles for Myeloma sponsors for making our Muscles for Myeloma 30-Day Challenge possible during Blood Cancer Awareness Month.