BETA - Are there any supplements that myeloma patients should avoid?

I think it has to be individualized to the patient, but I sometimes see patients because they're just not feeling well or things they'll have like a huge list of supplements that they're taking thinking that, you know, different things will help. But that actually might be a problem because there's a lot of drug interactions happening and so especially when they're starting treatments. So I think in those situations we should not be just blindly taking more supplements without speaking to either a pharmacist and integrated medicine expert or their oncologist to get the drug interactions at least checked. Another thing to note is the American Institute of Cancer Research has 10 cancer prevention guidelines and one of them is actually do not take supplements to prevent cancer and that is because of evidence with some of these fat soluble vitamins like beta-carotene, vitamin E, where it was thought that they might actually have anti-cancer properties and so large trials were done or like even population studies to see who is taking more of supplements, not dietary intake, but supplement intake and they saw that there's actually an increased signal of cancer in these patients of prostate cancer, lung cancer. So these supplements may not completely be benign and they may actually be harmful for some people and so I would not take it unless you think that there is truly a benefit and there's enough evidence for you. Another example is probiotics. So probiotics, there's one study I think where about 50% of myeloma patients take probiotics or up to 50%, but the thing is that we don't really know enough about it and there's a very large heterogeneity in probiotics where the strains of the bacteria being used in different probiotic supplements are going to be different, the doses are different and everybody's microbiome is different. So what it does and what there's not in myeloma but in melanoma, so a type of skin cancer, there's been a study looking at patients who took adequate dietary fiber with probiotic supplements and adequate dietary fiber without probiotic and this was just looking back at their chart so it wasn't an interventional study but just seeing what they did and they saw that patients who had adequate dietary fiber but without probiotics actually did better than those with probiotics in terms of progression free survivals on immune checkpoint inhibitors. So immune therapy may actually benefit from only certain supplements but not all of the certain probiotics but not all of them and in general the over-the-counter probiotics did not benefit and it may be something to do with the diversity of the microbiome when you're taking a few strains in a probiotic you might be affecting the diversity of the microbiome negatively instead of positively. What supplements should myeloma patients be particularly aware of? So there is a little bit of data around vitamin C and green tea affecting bortezomib efficacy or ability to work and so we do recommend that if a patient is on bortezomib therapy that we do not take vitamin C supplements or green tea and high doses and occasional green tea would be fine and I think that it doesn't mean you don't eat foods rich in vitamin C because that's different than the high doses that would be in a supplement but I think the supplements should be avoided in that situation. Another thing where I'm not talking about any one specific supplement but just herbal supplements that often patients may use can affect liver function and inhibit certain enzymes or compete in the degradation or metabolism of those herbal supplements with other drugs that are being used to treat the myeloma and that could enhance or increase risk of toxicity like liver function abnormalities so I think it's important as a patient to discuss the supplements you are taking with your doctor especially if you are on treatment because you don't what you don't want is additional liver toxicity unnecessarily developing.