(This blog was originally published on February 29, 2012, with information updated for the benefit of our readers.)

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.

What kind of changes should myeloma patients be ready to make?

In April 2009, the International Myeloma Foundation's advocacy efforts led to the 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 monitoring multiple myeloma is because myeloma cells love to "eat" sugar—a practice which becomes visible using PET scan technology. 

Does this 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 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 fructose intake is associated with increased risk of cancer as well as heart disease as well as, of course, obesity and sugar diabetes. 

A 2020 study on how fructose contributes to the Warburg effect for cancer growth states that “recently, fructose has emerged as a driving force to develop obesity and metabolic syndrome.” 

“Clinical and experimental evidence showed that fructose intake was associated with cancer growth and that fructose transporters are upregulated in various malignant tumors. Interestingly, fructose metabolism can be driven under low oxygen conditions, accelerates glucose utilization, and exhibits distinct effects as compared to glucose, including production of uric acid and lactate as major byproducts. Fructose promotes the Warburg effect to preferentially downregulate mitochondrial respiration and increases aerobic glycolysis that may aid metastases that initially have low oxygen supply,” according to the study.

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 healthily as possible. I recommend reading my most recent blog on Blue Zones. 

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 in myeloma cells, it was observed in 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.

In one of my blogs, I discussed stress reduction and the importance of touch. In a 2022 KCRW podcast interview with Tiffany Field (a researcher at the University of Miami School of Medicine), she relates how she and her students discovered through a survey “that touch deprivation was highly correlated, highly related to anxiety symptoms, to depression symptoms, to sleep problems, to PTSD symptoms, to boredom, to loneliness.” 

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.

The IMF has a Mind, Body, and Wellness program that contains accessible and wellness resources for myeloma patients and caregivers. Here you will find wellness education, movement, exercise, and mindfulness practices tailored for patients and caregivers.  

In conclusion, while it is extremely important to be cautious about your sugar intake for your overall health, it may be just as equally important to reduce your stress level in order to achieve the best results from your myeloma treatment.

Learn more about stress levels from additional IMF resources. 

Image of Dr. Brian G.M. DurieProfessor of Medicine, Hematologist/Oncologist, and Honoree MD at the University of Brussels, Dr. Brian G.M. Durie is Chairman Emeritus and Chief Scientific Officer of the IMF. Dr. Durie is also the Chairman of the International Myeloma Working Group (IMWG)—a consortium of more than 250 myeloma experts from around the world—and leads the IMF’s Black Swan Research Initiative® (BSRI). 


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