Diet and Lifestyle

Core Conclusion

Evidence-based nutrition for myeloma emphasizes maintaining 1.2 to 1.5 grams of protein per kilogram daily, drinking 2,000 to 3,000 mL of fluids, and avoiding raw foods when absolute neutrophil counts drop below 1.0 × 10⁹/L.

Detailed Points

(1) General Nutritional Advice and Food Safety

• A Well-Balanced Diet: While there is no single "myeloma diet," a healthy approach emphasizes eating "real," whole foods. Your meals should be rich in fruits, vegetables, whole grains, fish, and other lean animal proteins, while avoiding processed foods, added sugars, and trans fats. High-dose treatments can sometimes reduce your appetite; if this happens, try eating small meals every few hours and keeping energy-dense, high-protein snacks (like nuts, eggs, and cheese) readily available to keep your strength up.
• Infection Prevention: Because myeloma and its treatments suppress your immune system, you must be careful to avoid infections. Wash your hands frequently, avoid crowds or sick people, and practice excellent food hygiene by thoroughly washing fruits and vegetables and ensuring all meats are fully cooked.

(2) The Importance of Staying Active and Exercising

• Fighting Fatigue: It might feel counterintuitive when you are tired, but gentle exercise is actually the only non-drug approach proven to reduce cancer-related fatigue. Activities like walking, swimming, stretching, or a personalized yoga program can significantly boost your energy, improve your mood, and even reduce the numbness and tingling (neuropathy) caused by your medications.
• Protecting Your Bones: Because myeloma often weakens bones and causes soft spots (lesions), you must exercise safely to prevent fractures. Always ask your doctor or a physical therapist to help you create a safe routine. You must strictly avoid contact sports, lifting heavy weights, sudden twisting movements, or "weight-bearing" activities like push-ups that put extra stress on vulnerable bones. Done correctly, safe exercises strengthen the muscles that support your skeleton and improve your balance, lowering your risk of falls.

(3) Hydration Needs for Kidney Protection

• Flushing the Kidneys: Multiple myeloma cells produce abnormal proteins (light chains) that can clog and damage your kidneys. To protect them, aggressive hydration is absolutely critical. Guidelines recommend drinking a high volume of fluids—at least 3 liters per day (or 2 L/m² per day)—to maintain a healthy urine output of 100 to 150 cc per hour.
• Avoiding Kidney Stressors: To further protect your kidneys, you must avoid nephrotoxic (kidney-damaging) drugs. Never take over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as Aleve (naproxen) or Advil/Motrin (ibuprofen) without your doctor's explicit permission.

(4) Avoidance of Certain Supplements

• The Danger of Unregulated Supplements: It is tempting to take dietary supplements to boost your health, but the U.S. FDA does not regulate them the same way it does prescription medicines. Even supplements labeled as "organic" or "natural" can dangerously interact with your myeloma therapies—either stopping the treatments from working or causing damage to your liver and kidneys.
• Vitamin C Warning: High-dose supplements can be particularly harmful. For example, taking Vitamin C in doses greater than 1,000 mg per day can actually be counter-productive for your myeloma and significantly increase your risk of kidney damage. Always bring your supplement bottles to your appointment and get your doctor's approval before taking any new herbs, vitamins, or minerals.

The above content is sourced from the following references

• Patient Handbook
• Staying Physically Active with Multiple Myeloma
• Dietary Supplements and Myeloma: What You Need to Know
• Management of multiple myeloma-related renal impairment: recommendations from the International Myeloma Working Group
• NCCN Guidelines for Patients® Multiple Myeloma
• NCCN Clinical Practice Guidelines in Oncology: Multiple Myeloma