‘First Study of its Kind’ Shows Diet Can Delay Progression of Cancer — Understanding Multiple Myeloma & The Diseases That Precede It

Thank you @MSKCancerCenter for featuring our nutrition research in MSK News summer edition! And also interviewing Will Wright about his experience on the NUTRIVENTION trial too @MSK_DeptOfMed #mmsm #nutrition #cancer #lymsm #leuksm https://t.co/ERc5m43XwL

— Urvi Shah (@UrviShahMD) July 6, 2023

Dr. Shah, who led the clinical trial, obtained her findings by using a food company to send high-fiber, plant-based food to 20 people, living with MGUS or SMM, for three months to see how their change in diet affected them, The clinical trial participants also received health coaching for six months.

“This is the first study of its kind to show that a high-fiber plant-based intervention may delay progression from MGUS or SMM to multiple myeloma,” Dr. Shah told MSK.

She explained further, “Our NUTRIVENTION research in humans and additional studies in mice suggest that this may be possible in some cases with a high-fiber, plant-based diet although larger trials are needed to confirm this. There is existing evidence that a plant-based diet helps with weight loss, diabetes, cardiovascular disease, renal (kidney) disease, and possibly also autoimmune disease. So there are a lot of overall lifestyle benefits to a plant-based diet.

“There are many reasons to think that plant-based diets may affect MGUS and smoldering myeloma progression. For example, we know that the risk of these conditions increases in people with an elevated BMI (body mass index). A person with an elevated BMI and MGUS or smoldering myeloma is twice as likely to progress to myeloma as a person with a normal BMI.

“Additionally, there are multiple studies showing that people who eat more plant-forward diets reduce their risk of myeloma and of cancer in general.”

RELATED: Alcohol Consumption Increases Cancer Risk. Less Booze Is Associated With Lower Cancer Risk, New Data Adds To The Case For Moderation

Overall, Dr. Shah’s research found that, after making dietary changes, in one year, participants had better quality of life, lost excess pounds, had an improvement in biomarkers that show how well one’s immune system is doing, and better cholesterol and insulin levels.

Dr. Shah further explained to MSK, “People should try to get at least 80% to 90% of calories from unprocessed plant foods. … One of the biggest challenges comes from social pressure and not planning ahead. Because we live in a world where eating a plant-based diet is not the norm, it can feel isolating.”

Additionally, when asked whether removing carbs from one’s diet will keep multiple myeloma away, by “starving” the cancer, Dr. Shah said, “This is a common misconception. People often think that eating carbohydrates will feed their cancer, so they try to cut them out of their diet completely. Yes, carbohydrates break down into glucose, which is the main sugar in your blood. Glucose is the source of energy for our cells and is needed for them to function. People avoiding carbohydrates still produce glucose when they eat protein and fat. So it’s a myth that avoiding carbohydrates will starve the cancer.

“However, it is important to know that not all carbohydrates are the same. They can be refined (simple) or complex. People should avoid refined carbohydrates such as cookies, cakes, and croissants. But they should not avoid complex carbohydrates such as whole grains, beans, fruits, and vegetables. They are associated with reduced cancer risk.”

Understanding Multiple Myeloma

Multiple myeloma is a rare type of blood cancer. When you have this cancer, white blood cells called plasma cells (the cells that make antibodies to fight infections) in your bone marrow grow out of proportion to healthy cells. Those abnormal cells leave less room for the healthy blood cells your body needs to fight infections. They can also spread to other parts of your body and cause problems with organs like your kidneys.

Hematologist and SurvivorNet advisor, Dr. Nina Shah, helps you understand this rare cancer

Certain factors increase your likelihood of getting multiple myeloma. Remember that this is a rare cancer overall, and just because you have any of these factors doesn’t mean you will get this cancer. Most likely, you won’t. Conversely, it’s possible to have no risk factors and still get multiple myeloma.

Here are a few factors that might increase your risk:

• Age. Most people with this cancer are diagnosed in their 60s, although it is possible to get multiple myeloma earlier in life.
• Family history. Having a sibling, parent, or other close relative with this cancer could increase your risk.
• Gender. Men are at slightly higher risk for this cancer than women.
• Race. African Americans tend to have higher rates of this disease, although it is still relatively rare. Asian Americans are least likely to get this cancer.
• Monoclonal gammopathy of undetermined significance (MGUS). This condition with the hard-to-pronounce name simply means that you have too much of an abnormal protein–called monoclonal protein–in your bone marrow and blood. MGUS is rare, and the risk that it will turn into multiple myeloma is only 1% each year.

Diseases that Precede Multiple Myeloma: MGUS

It’s important to understand that mMultiple myeloma can begin with conditions people have long before they ever have cancer. These conditions in the early phase are called precursor conditions.

One of them is called MGUS, or monoclonal gammopathy of undetermined significance. But having MGUS doesn’t mean you get cancer. “Over the age of 50, three percent of the population walking around have MGUS, but they don’t know about it,” says Dr. Irene Ghobrial, medical oncologist and multiple myeloma expert at Dana Farber Cancer Institute.

Precursurs To Multiple Myeloma

Although the current treatment for patients with MGUS is “watchful waiting,” researchers are currently working to find markers associated with patients’ MGUS that could indicate that they are at a high risk of progressing to active myeloma.

“The hope in the future is that we can define what is the best therapy for that individual patient, and then we give it to them,” Dr. Ghobrial says.

However, we’re delighted to see the recent promising clinical trial results from Dr. Shah suggesting how diet and lifestyle intervention can help in delaying progression in cancer.

Recommendations for a Healthy Lifestyle: One Doctor’s Advice for Cancer Survivors

To be clear: the experts we have spoken with have all made it clear that there is no “cancer diet,” meaning there are no guidelines that are recommended for every person with cancer.

The general recommendations for a healthy lifestyle are the same whether you have cancer or not. But Dr. Ken Miller, the Director of Outpatient Oncology at the University of Maryland Greenebaum Cancer Center, has some guidelines for cancer survivors who are concerned about a recurrence:

1. Exercise at least two hours a week — and walking counts.

2. Eat a low-fat diet. The Women’s Intervention Nutrition Study, which looked at early stage breast cancer patients, found that a low-fat diet was associated with reduced risk for cancer recurrence, particularly in those with estrogen receptor-negative cancers. Other studies have found that foods with a high glycemic index that are digested quickly and cause a spike in blood sugar may lead to tumor growth in lung cancer patients.

3. Eat a colorful diet with lots of fruits and vegetables. The American Cancer Society recommends aiming for two to three cups of vibrant vegetables and fruits each day.

4. Maintain a healthy weight. Studies have shown that being obese can increase your risk for several types of cancer.

What to Know About Diet and Exercise if You Have Cancer

Dr. Andrea Tufano-Sugarman of NYU Langone Health explained to SurvivorNet the benefits of losing weight.

“While all cancers cannot be prevented,” she said, “losing weight is a great way to reduce one’s risk.”

Dr. Tufano-Sugarman said that this is especially true for women; they lower their risk of developing breast cancer and endometrial cancer when they lose weight and keep it of.

How Can Diet Affect My Cancer Risk?

Even without losing weight, adopting a more nutritious diet can help.

“Food choices, independent of weight loss, may also help to reduce risk,” Dr. Tufano-Sugarman said.

“Research has shown that the Mediterranean diet (rich in fruits, vegetables, nuts and legumes, fish and olive oil) is associated with a decreased risk of cancer. Whereas diets rich in red meat may be associated with an increased risk of colorectal and prostate cancer.”

Additional research published in “Cancers” last year noted that “Physical activity has been shown to reduce the side effects of treatment and fatigue in cancer patients.”

WATCH: Exercising and Cancer

“Lack of exercise actually begets fatigue,” Dr. Marleen Meyers, a medical oncologist and Director of the Cancer Survivorship Program at NYU Perlmutter Cancer Center, told SurvivorNet in a previous conversation about how to deal with some of chemo’s most challenging side effects.

“So the best treatment for fatigue is exercise. And what we have to do is get people over the hump, to get initial exercise going.” Dr. Meyers treats patients with breast cancer, but she said her advice applies to many other cancers as well.

Linking Alcohol Consumption to Cancer

According to the American Cancer Society, alcohol consumption can increase your risk for many different types of cancer. Considering cancers of the mouth, throat, voice box and esophagus, for example, alcohol “clearly” increases risk. That being said, the ACS notes that drinking and smoking together puts you at a much higher risk for these cancers than drinking or smoking alone.

“This might be because alcohol can help harmful chemicals in tobacco get inside the cells that line the mouth, throat, and esophagus,” the ACS website states. “Alcohol may also limit how these cells can repair damage to their DNA caused by the chemicals in tobacco.”

RELATED: Alcohol Can Cause Cancer So Why Don’t Beer, Wine, Whiskey and Other Booze Labels Warn Us?

When it comes to liver cancer, “long-term alcohol use has been linked to an increased risk.” When you regularly drink a lot of alcohol, liver damage can occur and lead to inflammation and scarring a possible explanation for the increased risk.

We also know there’s a clear link between breast cancer and alcohol consumption. In November 2017, the American Society of Clinical Oncology published a statement citing evidence that links alcohol to multiple cancers and calling for reduced alcohol consumption as a way to cut people’s cancer risk. But many women said they had been drinking more during the pandemic, and 70 percent weren’t aware of the resulting increased cancer risk, according to SurvivorNet survey in February 2021.

Alcohol Can Increase the Risk of Developing Breast Cancer

As per a more recent study, published in August in the JAMA Network Open, people who “increased their alcohol consumption had a higher risk for alcohol-related cancers and all cancers compared with those who had sustained levels of drinking” and people “who reduced their alcohol consumption had a lower risk.”

In addition, researchers also found that people had “an increased risk ” temporarily after quitting drinking, but there was no increase found “when quitting was sustained.” What this means is that changing your drinking behavior may positively affect your cancer risk. Therefore, the researchers concluded that “alcohol cessation (discontinuance) and reduction should be reinforced for the prevention of cancer.”

For colon and rectal cancer, the ACS reports that alcohol use has been linked with a higher risk of cancers of the colon and rectum with stronger evidence for this in men than in women, though studies have found the link in both sexes.

Does Alcohol Impact the Risks for Colon and Other Cancers?

Dr. Heather Yeo, a colorectal cancer surgeon at New York Presbyterian/Weill Cornell Medical Center, said she believes alcohol increases risk for certain cancers but acknowledged that the data was mixed, especially for colon cancer.

“I do think that high levels of alcohol certainly predispose to a certain number of cancers, including pancreatic and liver cancer, and may predispose to colon cancer,” she said. “But there’s also some data that shows that low levels of alcohol, or a glass of wine here and there, may actually lower your risk of colon cancer.”

Perhaps ‘In Moderation’ Is the Motto

It’s important to note that alcohol consumption may increase the risk of developing these cancers, but it doesn’t necessarily cause these cancers. That being said, it’s hard to know what to do if you’re concerned about your alcohol intake increasing your risk of various cancers.

Contributing: SurvivorNet Staff

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