In March 2024, Myeloma Specialist and Hematologist-Oncologist Dr. Urvi A. Shah (Memorial Sloan Kettering Cancer Center-New York, NY) hosted a Live Q&A on Myeloma and Nutrition as part of Myeloma Action Month as well as National Nutrition Month. 

Dr. Shah spearheads research that is aimed at developing dietary guidelines for hematological malignancies such as multiple myeloma. 

“How do obesity, diabetes, diet nutrition, the microbiome, all these factors affect the immune system and cancer development and progression? Is there something we could do? Small changes in our life that may help with improving outcomes once we have cancer or preventing cancer if we’re at a precursor state?” asked Dr. Shah, as she introduced the topic to the live Q&A’s audience.  

Here are some of the top questions and answers we gathered from Dr. Shah’s informative and insightful Facebook LIVE session (EDITOR’S NOTE: Dr. Shah’s responses have been edited for conciseness and clarity): 

1. What is your opinion on the assurance, purity, and strength of supplements in light of less regulation? 

I know that we all want an easy fix, or something that can take care of the cancer, one that is natural and doesn't have many side effects.  

Unfortunately, the supplement industry is not as tightly regulated as the drug industry. Often, there can be supplements that can have side effects, or they haven't been studied exactly, so we don't know the doses, or if drug interactions can take place. It is important, especially if you're on therapy, to be discussing supplements with your doctor and maybe the pharmacist to make sure there aren't any drug interactions. 

It is crucial for us to learn more about each supplement to better understand why we can’t just take them across the board.  

2. What about the gut microbiome?  

I think we are really in the very early stages of understanding the gut microbiome. In the last few years, we have seen a lot of research, but in the next decade, we are going to see a lot more around this.  

Some things to think about when you are looking at the gut microbiome is to understand what all these studies are showing. What is the general pattern? If we try to focus on one species, it can get overwhelming.  

One of the healthier patterns we have seen in most studies is the concept of “gut microbiome diversity.” Gut microbiome is bacteria; there are more gut microbial cells than human cells. We are about 38 trillion bacterial or microbial cells and only 30 trillion human cells. It is important to feed these gut microbial cells and fiber is their basic food. 

The more diverse the gut microbiome, the healthier we are. Think about the rainforest, with so many different species of animals and plant life it is a healthier environment as compared to a plantation where there is less diversity—making it unhealthy and unsustainable in the long term. 

It is important to have an overall healthy and diverse microbiome. How do we keep it diverse? That involves a lot of ongoing research, with more studies looking into microbiome as it relates to cancer. Is having a diverse gut microbiome associated with progression-free survival (PFS)?  

We actually see a consistent connection—whether for myeloma, lymphoma, or other cancers. Higher gut microbiome diversity is associated with longer PFS and overall survival (OS). 

3. What is the NUTRIVENTION pilot study?  

In the completed NUTRIVENTION pilot study, we helped patients eat more fiber-rich, plant-based foods and what we found out is that gut microbiome diversity greatly improved. We did this intervention for three months, and then even a year out because they have made changes gradually and now are sustaining them—we are seeing higher diversity. 

One study of over 10,000 healthy individuals looked at whose gut microbiome is healthier. They found out that people who eat more than 30 types of plant-based foods per week have a healthier gut microbiome than if they eat less than 10 types. 

The NUTRIVENTION-2 and NUTRIVENTION-3 trials are currently enrolling at MSK and will be doing a deep dive into understanding the effects of turmeric on the microbiome in myeloma and smoldering MM, as well as other inflammation markers and the immune system. 

4. What are the best anti-inflammatory foods to incorporate in one’s diet? 

Based on the results of the NUTRIVENTION study, a high-fiber diet reduces inflammation. It is important to get enough fiber in your diet because fiber-rich diets have been linked to more gut microbiome diversity and less inflammation. 

A study from Stanford looked into including fermented foods in patients’ diets. They discovered that eating more fermented foods reduces inflammation as well. 

There was also one study in Australia which looked into using turmeric for smoldering myeloma. In theory, turmeric has anti-inflammatory properties as evidenced in cases of arthritis. Some case reports suggested that patients who took turmeric for a significant length of time had stabilization, even a decrease in M spike trajectory. However, these are only a small number of cases. 

5. How bad is sugar, really?  

We know that most of the U.S. and world population are taking in way more sugar than what is recommended. The average sugar intake for the U.S. population is about 17 to 19 teaspoons a day—with one teaspoon containing about 3-4 grams of sugar. A can of cola has about 8-10 teaspoons of sugar and can significantly raise one’s sugar intake.  

In terms of carbohydrates, there are refined carbohydrates and complex carbohydrates. Complex carbohydrates include whole grains which contain fiber, vitamins, minerals, protein, etc., and are considered very healthy. 
 
Whole grains have been associated with lowering cancer risk based on multiple population studies. Three servings of whole grains a day is recommended. 
On the other hand, refined carbohydrates (or sugar) consist of white flour, sugar, sweetened beverages, candy, cakes, cookies and all that. They do not contain fiber and can raise blood sugar levels. High blood sugar can lead to insulin spikes, and high insulin levels are associated with cancer risk and progression.  

Cutting out unnecessary sugar intake is preferable. But you can have a little bit of sugar in a day—maybe limit your sugar intake to 7-9 teaspoons a day, as per recommended guidelines. 

6. What about sugar substitutes? 

There is a bit of mixed data around sugar substitutes. The International Agency for Research on Cancer said that some artificial sweeteners are associated with increased cancer risk. When we studied this for monoclonal gammopathy of undetermined significance (MGUS), we did see an increased risk of MGUS development with sugar substitutes and artificially sweetened beverages. In general, I would not say that sugar substitutes are much healthier and limiting intake is preferable.  

7. How do you avoid heme iron to starve cancer? 

Heme iron typically comes from red meat and animal-based foods. Plant-based foods have non-heme iron, which is considered to be less inflammatory. However, there is not much data around this. If you prefer, you can shift your protein intake to beans, nuts, and seeds to get non-heme iron. 

These are only some of the highlights of Dr. Urvi A. Shah’s Live Q&A. Other questions about recommended daily allowances, vital protein, the ketogenic vs plant-based vegan diet, diets for those with kidney disease, intermittent fasting, and much more were also addressed during the live Q&A. 

Find out more by watching the entire video.