Sugar or Stress (SOS): Which Is Worse?
Sometimes it takes very bad news to get people to make necessary changes in their lives. Someone diagnosed with lung cancer might finally give up the 2-pack-a-day habit they've had since high school. Someone who experiences a heart attack might finally cut some fats from their diet and increase their cardio workouts.
So what kinds of changes should myeloma patients be ready to make?
In April 2009, the International Myeloma Foundation's advocacy efforts led to FDA and Medicare approval of crucial myeloma diagnostic tests, including the use of PET scans for diagnosing myeloma. The reason PET scans are successful in diagnosing multiple myeloma is because myeloma cells love to "eat" sugar, a practice which becomes visible using PET scan technology.
So does that mean that by limiting sugar intake, one could essentially "starve" the myeloma cells? There are two crucial points to consider: first, the sugar pathways in the myeloma cells are not directly linked to the sugars that you eat. Second, any sugar you eat is immediately countered by insulin, which regulates, along with many other hormones, the uptake and use of sugar throughout your body.
The sugar/insulin balance is under very tight control in the body. One key point is to avoid what is called "glucose intolerance," when sugar and insulin levels are out of sync. Dexamethasone and other steroids push the body toward glucose intolerance. That is why patients taking dexamethasone need to track blood sugar and use medication such as metformin (Glucophage) to control insulin/sugar levels as needed. The relationship between sugar and insulin may be important and related to myeloma cell growth, since insulin has been shown to trigger sugar uptake and myeloma cell growth in laboratory experiments. A recent study aired as part of "60 Minutes" showed that breast cancer patients taking metformin to control diabetes had better outcomes from the breast cancer.This is in line with a recent laboratory study that showed metformin slowing cancer cell growth especially in tumors with the 17p (p53 deficient) chromosome pattern--just like high risk myeloma. So stay tuned for further updates on all of this.
A second key point is that regularly including high sugar items, such as soft drinks, in your diet is not a good idea. Recent research indicates that high intake is associated with increase risk of cancer as well as heart disease as well as, of course, obesity and sugar diabetes. Soft drinks contain not only sugar in the form of fructose, but also a variety of other chemicals such as glutamate, which may be additionally harmful.
What does this mean for the myeloma patient? It means that having a doughnut or an extra scoop of ice cream, while probably not the best choice for your overall health, will not have any significant impact on myeloma. However, it is very important to eat as well as possible, and Michael Pollan's "Food Rules: An Eater's Manual" provides an excellent guide. Eat "real food" and "don't eat anything your grandmother would not recognize." (Rule #1)
So what about stress? Stress can be a very destructive force when it comes to myeloma. Stress really disrupts the immune system and myeloma is a cancer of the immune system. In addition, the stress hormone noradrenaline (the "flight" hormone, versus adrenaline, the "fight" hormone) can actually trigger cancer cell growth directly. Although this has not been shown for myeloma cells, it has been for lung and other types of cancers. Hans Selye, a Hungarian scientist who worked in Montreal, Canada, showed that a chronic "alarm state" (anticipating problems requiring "flight") leads to an "exhaustion state" which depletes the immune system.
For a patient newly diagnosed with multiple myeloma, it might seem difficult to reduce stress, but that's where the IMF steps in to help. Our education and support programs are designed to help alleviate some stress by providing clear plans for myeloma management, thus reducing fear and alarm and providing hope to help you move forward in a constructive fashion.
So while it is extremely important to be cautious about your sugar intake for your overall health, it may be equally important to reduce your stress level in order to achieve the best results in myeloma treatment.
Dr. Brian G.M. Durie serves as Chairman of the International Myeloma Foundation and serves on its Scientific Advisory Board. Additionally, he is Chairman of the IMF's International Myeloma Working Group, a consortium of nearly 200 myeloma experts from around the world. Dr. Durie also leads the IMF’s Black Swan Research Initiative®.