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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.

Click on the following links to learn tips for reducing sugar intake and stress levels.


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I was diagnosed stage II myeloma October 31, 2012. I began chemo and in June 2013 underwent an autologous stem cell transplant. After returning to work as manager at the local housing authority, I discovered that, confronted with my normal everyday stresses, I would lapse into a state of exhaustion that left me weak and would result in me having to leave work and go home to bed. After considering going on disability until I could handle the stress, my boss and I restructured my job duties so I could function. Unfortunately, I developed diarrhea at least 3 days a week, which leaves me pretty weak. So I am experimenting with eliminating different foods from my diet to determine which may be the culprits. In addition, I am on 15 mg of revlimid daily. But I am in remission and glad to be alive! Thanks for reporting about the noradrenaline "flight" because I was wondering what was wrong with me!

I found out just before christmas of 2012 that I have myeloma. I have only one tumor on my pelvic and I have take 25 radiation for it. I take dexamethasone, eight for four day and off for four days.After the radiation I had to start taking revlimid and for some reason I look very pale. I have no color in my face at all. Tomorrow will be my second dose of it. I have to take 25 mg. for twenty one days and off seven days. I am so leery of taking new meds, but they say that is is a good medicine along with the steroids. I just wish the steroids wouldn't make me feel so bad. I hate that they mess with my sugar. I have even been skipping meals because of it. I go to bed hungry because no matter what I eat it seems to raise my sugar. On the days that I am off of them my sugar is low and I can eat a little more then. I go back to the dr. on tuesday and I have a lot of questions for him. I hope we can get things straight.

Is there any reason Metformin (apparently "safe" and affordable) is not prescribed for Multiple Myeloma patients?

Well it is good to know that a dish of ice cream won't make the MM worse, although it seems to me that processed food and sugars should probably be avoided by everyone as much as possible. Boy I do love my sweets, sigh.

Stress on the other hand seems to be part and parcel of our modern life and the more modernized we become the more it seems to increase. We are pressed to always be doing more and more. Today, even simple things like exercise has to be scheduled and accounted for. We are bombarded by newscasts given by strident voices lamenting another crime, disaster or disease to worry about.

Each of us is an individual with our own methods of coping and our own stressful triggers. My husband reads the newspaper from cover to cover and never fails to listen to the news (usually twice a day). He seems to take it in stride. I don't do those things because I would be a basket case if I did. Obviously we have different stress triggers. He copes by playing golf, I do it through prayer, meditation and exercise. It has taken me a long time to learn to just be still. We are always learning aren't we?

Having fought back after Stage III MM, my skeleton took a lot of damage, especially my spine. I start the day with severe back pain and have to take medication in the morning and before going to bed. Fatigue is a major problem after a short hike, or even doing minor things around the house. I was taken off Zometa after three and a half years when ONJ appeared in my Jaw. Stress is a major problem in dealing with the disease, ONJ and finances. Helpful Hint: Never let your kids move back into your home if you are dealing with MM and stress.

we live in Italy, Bari
My mom only had asymptomatic myeloma from MGUS when she fell with rotator cuff rupture and traumatic brain injury has developed multiple myeloma, may have been the stress of the fall and fracture

mia mamma aveva solo mieloma asintomatico MGUS da quando � caduta con rottura cuffia rotatori e trauma cranico ha sviluppato mieloma multiplo, puo essere stato lo stress della caduta e frattura?

I have MM, diagnosed in 2005. Had a SCT in 2006. Although my MM is not gone it is down enough for them to put me in the category of partial completed remission. The treatments gave me diabetes so sugar and carbs are on my no no list. As far as stress, I have just retired at the age of 62. I want to enjoy what time I have left (which I hope is at least another 20 years). I cannot loose weight no matter how hard I try but I won't give up. I make most of my own meals from scratch. Fruit raises my blood sugar up very high so I've been told to stay away from them. Veggies come from the can or frozen since I've been told to stay away from the fresh fruit and veg. I also have been told to stay away from groups and especially kids since they carry so many germs. I currently am not on any maintenance drugs. I feel very fortunate to have the myeloma society keeping me informed. Bless you all.

Hi Susan,

Gee, who told you to stay away from fresh fruit and vegetables, was it you diabetes doctor? I feel very bad for you that there are so many can'ts and Don'ts in your life. Just to be extra sure that you are getting the best possible advice I think it might be helpful to get a second opinion. Good luck!

Thank you Dr. Durie for this very insightful blog on sugar and stress. I am glad to see that some sugar here and there isn't going to cause MM to go wild. There are some who advise against ANY sugar intake and I think that is going a bit overboard.

My dx of MM was in September 2001, 2 weeks after 9/11. I had been running a recruting firm focusing on hiring senior level (CEO, CFO, VP, etc.) executives for high tech firms. The dot-com bubble burst in late 2000 and I was paying salaries for a number of employees and generating next to no revenue. While I didn't recognize it at the time, the stress was enormous, and I believe it was so intense that my immune system couldn't fight off the onset of the myeloma. So yes, reducing stress plays a HUGE role in fending off myeloma or keeping it at bay.

Please keep up your wonderful blog, I look forward to the wisdom you have to share.

Dear William,
We are in awe of you. You should keep going! The writer of this response is your age, doesn't have myeloma, and couldn't do what you do. Clearly that 10 mg of Revlimid every other day is keeping your myeloma at bay without compromising your quality of life. Just be aware that you should be cautious about the health and safety of your skeleton; don't get out on the gridiron with your football players.
The IMF Hotline

As a myeloma patient and sugar addict, hearing these words led to incredible reduction in my stress level :) Thank you...

It is nice to know that the subcutaneous administration of Velcade has been approved by the FDA because that is how I have been getting it.

Being in a deep remission from myeloma, I sometimes forget that I have cancer and tend to over indulge in activities. At 58, I coach football, work 50 hours a week, care for two homes, fish,camp, and love to cook and eat. Should I consider slowing it down or keep going full tilt boogie? I can't retire for another 4 to 5 years. I underwent a tandem auto stem cell transplant in 2009. I take 10mgs of Revlimid every other day, no steroid(by personal choice). It seems to be working for me.

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