Okay good evening everyone or good
afternoon I’m Robin Tuohy, senior director support groups of the International
Myeloma Foundation and it’s my pleasure to welcome you to tonight’s Living Well
webinar on Nutrition. Tonight’s program is part of the IMF’s Living Well with
Myeloma series which is designed to cover all the important and most
up-to-date information regarding myeloma to help you live well. I’d like to thank
our sponsors for their support of this program
Celgene, Janssen, and Takeda Oncology so it’s now my pleasure to introduce
tonight’s speaker Kylie Buchan. Kylie is a registered and licensed
dietitian and holds a certified specialist in oncology nutrition
designation. She currently works as an outpatient oncology dietician for Savor
Health, an oncology nutrition company providing nutrition consultations and
personalized meal delivery to customers nationwide. She received her Bachelors of
Science in Clinical Dietetics from the University of Oklahoma in 2008. Kylie is
passionate about educating oncology patients on the importance of nutrition
during cancer and assisting them during all phases of treatment as well as
survivorship. We’re very pleased to have Kylie present on our call this evening
and to also field your questions at the end of this presentation. Please remember
if you have a question type it in in the control box under questions. It’s now my
pleasure to turn the call over to Ms Buchan. All right well we’re going to
start first it a little bit late the first slide is just about the importance
the overview of what we’re doing. We’re going to talk about the importance of
nutrition, the management of treatment related side effects, food safety,
multiple myeloma complications, nutrition and survivorship and then we’ll
the question answer at the end. So starting with importance of nutrition
why is nutrition important? During treatment and after well 60 to 70
percent of cancer patients suffer from malnutrition one-third of all those all
the cancer deaths are from malnutrition. So it’s a very important aspect of it.
Importance of nutrition is good you maintain weight and body stores keeps
your body built up an immune system built up. Better tolerate your treatment
related side effects the nausea the diarrhea the constipation you do a lot
better with that when you’re fully when you’re fully hydrated and fully and
fully built up nutritionally. Lowers the risk of infection plus hospitalizations,
helps you heal and recover faster, and a better quality of life. You have better
intake, you have better quality of life. Research has shown that adequate
nutrition can reduce the delays and treatment as well as hospitalization, so
there’s a lot of benefit in that. Okay, so now we’re caught back up with the slides.
The nutrition goals during treatment maintain body weight. You lose weight,
therefore you lose muscle mass. You want to keep that body built up as much
as possible. Graduate loss say like 1 to 2 pounds per week in overweight or obese
individuals is okay as long as that patient is eating adequate calories and
protein. We just want to make sure our intake is is enough. Another goal during
treatment is adequate protein intake. So protein helps build that body up, helps
with healing, helps with the immune system. So your protein sources of course
are going to be your meats, your beans your nuts, your eggs, your dairy products,
soy, also those nutritional supplements say the protein bars, protein shakes,
those types of things. So the goal of getting protein every time you’re eating
that can help keep that body built up. Adequate hydration status so making sure
you’re fully hydrated. At least 64 fluid ounces of water is the goal or more if
you’re losing excess fluid with your diarrhea or vomiting or excess sweating.
Your fluid sources are going to be your water of course is the best
and then you’re 100% fruit juice, your tea, your vegetable juices, those types of
things anything hydrating it has caffeine you’re kind of losing fluids
through that. And then another goal through treatment remains the physically
active as possible you don’t want to overdo it you just want to remain as
active as you were before and so you can get through treatment a little bit easier with
that. So side-effect management you know those side effects can occur and a lot
of times they’re not adequately managed. It’s important to let you know the
transition know about those side effects and not just thinking oh well it’s just
treatment it’s just it’s just cancer this is just what happens. There’s
medications, there’s tips that you can use to help combat those
side effects. A lot of times these physical side effects can lead to a
delay in treatment or for dosage of your treatments so you want to make sure you
you stay on top of those. So the first one your decrease appetite that’s a lot
of times what people people associate with with going through treatment you
know your appetites that are really poor. One of the major goals and
you’ll hear a lot of times through this is eating small meals often. You don’t
want to sit down try to sit down two – three meals a day, two meals a day
even if that’s what you’ve done your whole life. You want to kind of switch
over to the grazing method eating every two to three hours, five to six times a
day and that way you can usually get in more nutrition than just trying to sit
down the three meals. Drink your fluids in between meals so you don’t want to
sit down to lunch and have a big glass of water and then you’re not hungry for
anything that has some calories. So try to go more on a food-drink, food-drink, food-drink schedule in order to try to get get the adequate calories and also stay
hydrated as well. Physical activity prior to a meal that
could just be you know walking around the block, going out and checking your
mail, go you know doing something a little bit more active can help
stimulate that appetite. Add extra calories to the food that
you’re eating. The goal is to maximize those small meals that you’re eating
you’re not eating a lot so you need to get pack as many calories as you can in
that small amount of volume. So adding high calorie foods and on to the things
you’re already eating so you got olive oil, avocado, full fat coconut milk, switch
to whole milk instead of skim milk, you make those making those little changes
can can make the difference in the calories that you’re intaking. Take
advantage of good days in time so say breakfast is always a good time for you
you’re feeling pretty good well eat a bigger breakfast or there’s just there’s
a week in between your chemo treatment that you’re feeling pretty good take
advantage of those good days and then try to just make up for it for the for
those times when you’re not feeling as good. And then medications to help
increase the appetite there are medications out there that you can talk
to your physician about if you feel like you’ve tried some of these things and
you’ve really worked on it and you know it’s not getting any better there’s some
medications that can that can help some of the lot of those medications they
have to be in your system for a while for them to work so you want to you want
to be on them for maybe a week almost a week and a half before they start really
kicking up your appetite the next next side-effect we talked about diarrhea
very common with certain chemotherapies other chemo therapies you don’t really
experience it just it just depends and kind of depends on how your body adjusts
to it major goal of diarrhea is adequate hydration so your water your bra sports
drinks Pedialyte is a good one that is given to children usually but it
actually has less sugar than your normal than your normal sports drinks so you’re
still getting those electrolytes the major electrolytes that are usually lost
or potassium magnesium so you want to make sure you’re getting those with some
sort of electrolyte drink following a low-fiber and bland diet you
don’t want to eat the high the high-fiber whole-wheat bread you want a
white bread pasta follow the BRAT diet if you’ve heard that bananas rice
applesauce toast that’s all your bland easy to tolerate easy to digest foods so
stick with stick with that type of food stay away from anything spicy fried or
creamy anything that can be too heavy for your digestive system avoid caffeine
our added sugar those things will both stimulate your guts get things moving
faster when when you have diarrhea you don’t need that so avoid the caffeine
also alcohol is another one to avoid as well because of that also with the added
sugars stay away from fruit juices some people think that’s good for the
diarrhea well that high amount of sugar will make the diarrhea worse and you can
speak with your physician regarding anti diarrheal medication regimens there’s
some that it moves up from these or over the counter but there are still some
better better prescription strengths and you have to stay on a pretty regimented
schedule in order for it to really get get a hold of it so you just kind of
have to stay on stay on top of that constipation swing on the other side it
can be caused from certain chemo therapies but a lot of times it’s caused
from other medications pain medications are a major one also can be caused from
dehydration so again adequate nutrition is one of
the big goals here doing those hydrating fluids like we talked about on this side
you want to increase the fiber intake so that whole wheat bread the brown rice
your fruits and vegetables all of those are going to help with the constipation
as long as you’re getting adequate fluids if you’re eating fiber and not
getting the adequate fluid it’s it’s not going to do any good for the
constipation physical activity as well so what more you’re moving the more it’s
going to help your help your balance move as well some foods that will help
constipation prunes or raisins also prune juice of course that you’ve heard
black cherry juice is another one that works as an aspirin juice but in my
experience tastes a little bit better that might be one to try sanity Sinha is
in a stool softeners only a stool softener form but certainties are made
that that senna leaf is in the tea bag and so that can help that can help
stimulate the digestive system and get things moving you can find Senna teas
and your normal your normal grocery stores just in the tea section and
another time speak with your physician regarding a bowel program there’s stool
softeners there’s laxatives there’s a lot of different options out there so
you just need to talk to your physician kind of get on a good a good schedule nausea and vomiting also also common
through any kind of cancer treatment that you’re having sometimes you’re
nauseous when your stomach is empty a lot of patients don’t realize that they
don’t they’re not just so they’re not eating it’s kind of a snowball effect
so aiming to eat every two hours or more can actually help prevent the nausea
from coming on but it also might settle the stomach as well so stick again with
your bland cold or room temperature foods you don’t want to do pop suits
when you’re when you’re nauseous tops food smell and a smell is a lot of times
what can trigger that nausea so the colder room-temperature foods don’t
smell so stick with those same with the bland foods
I said nothing fried nothing rich creamy anything like that trick with
loose-fitting clothing you don’t want anything on your on your stomach that
can that can make it worse foods that could help with the nausea
ginger is one there’s they they make ginger candies out there that have
better made for nausea and those can those can help quite a bit ginger ale
ginger tea is another good one that can kind of help settle the stomach saying
what peppermint tea or little peppermint candies might help do the job take your
anti medics as prescribed some people take them just when they get nauseous
well that that could be too late you can say on a schedule with them some you can
every eight hours some you can take every four to six hours and and then
that will take that’ll take care of it and actually prevent the nausea
yes I’m coming on so talk to your position about that different antiemetic
because there are a lot out there and they work in different ways so you can
actually take a couple out of time without without doing interfering or
anything taste issues sometimes it’s a metallic taste sometimes it’s a no taste
sometimes it’s just not a very pleasant taste you get all sorts of all sorts of
different things there if you have metallic taste use plastic where instead
of silverware don’t put anything metal up to your mouth so even trying to avoid
metal pots and pans is a good idea although it’s very tricky but using
glass ceramic whenever you can may help prevent that transfer of the metallic
taste tart foods and candies so lemon drops Jolly Ranchers anything kind of
tart can help set can kind of help get the salivary glands working and clean
the mouth out rinse your mouth out before meals sometimes just water with
lemon can help or you can do kind of a baking soda and salt swish and spit that
works pretty well balancing out the pH of the mouth makes make things taste a
little bit fresher the recipe for that if you don’t know it is one teaspoon of
baking soda 1/2 a teaspoon of salt and with a quart of water you can just mix
that up it stays it stays fresh for a long time so you can you can make a big
batch of it and just rinse your mouth out before eating just to make things
help things taste a little bit better adding distinct flavors and marinades
onto things so a lot of patients will tell me that spicy foods are really good
right now or I pickles are really good these really strong distinct flavors
where if you can’t pick up on any anything else any bland foods at least
you can pick up on pick up on these strong flavors marinating in some type
of vinegar base like a vinaigrette and sometimes help kind of boost that juice
that flavor a little bit so maintain the adequate nutrition
during treatment by eating small meals or snacks frequently I told you it would
be I’d be mentioning that a lot every two to three hours is the goal to kind
of keep that body keep that body built up and keep your mind getting hungry
you know triggering that turning that stomach to get hungry treating food like
medicine you take your medicine every day every every two hours three hours
four hours whatever it is you need to do the same with food it’s just changing
your mindset whereas you now you have to eat instead of instead of just wanting
to eat staying on top of those side effects really kind of get a get a grasp
on on any side effects that you’re having to really try to prevent any type
of of malnutrition asking for help from family friends in the community you know
there’s a lot of a lot of people want to help bring a meal or do grocery shopping
take advantage of that also too many resources go to your social worker at
your at your local hospital and there’s and she’ll probably have a good list of
different community resources that can help with meals or help with with a lot
of with transportation a lot of different things that that is needed for
for oncology patients and cooking in bulk when you’re feeling good so that
day after chemo a lot of times you’re still feeling still feeling pretty good
make a big pot of soup a big freezer lasagna something like that too to keep
on hand for when when you don’t have a lot of energy to cook those next few
days speaking of energy fatigue is is very common with chemo but also with
radiation again small frequent meals it’s kind of the theme eating more often
can help provide the body with energy so anytime you eat your body burns that
energy and you get some a little boost there reduce your intake of sweets and
sugar high sugar foods can actually cause more fatigue because because it
raises those blood sugars and then it and then it drops them so trying to eat
foods with more protein in them can help can help decrease the fatigue or help
kind of give you a little bit of more energy
the active small back south of activity can help can help kind of get you get
your body moving a little bit get your get your fatigue resolved get adequate
rest of course and then talk with your doctor about any any stress or feelings
of depression also that social worker might be a good a good resource for that
to low blood count so like the low blood counts are talking
about are the white blood cells the red blood cells the platelets those are
those are commonly can be low with multiple myeloma neutropenia is where
white white blood cells are low that’s very common also with the immunotherapy
as well one of the things for nutrition to do is just having a well-balanced
diet keeping you’re keeping adequate nutrition adequate intake adequate
protein intake as well like I said that’s very important for all treatments
but of course when your blood counts are low that can help boost boost you up a
little bit food safety is very important when you’re when you’re neutropenic when
you’re low we have low white blood cells or neutrophils when your neutropenic
here is a much higher risk of infection so you want to practice good food safety
skills in order to to prevent infections or hospitalizations so food safety wash
your hands as often as possible it’s the best way to prevent the spread of germs
and prevent infections you want to wash your hands when before and after eating
you want to do it after touching raw meat seafood eggs really anytime there’s
a question you need to wash your hands for those undergoing stem-cell
transplant there are more extensive guidelines that your local that your
loss about your hospital or clinic will give you everyone’s a little bit
different so it’s going to be it’s going to be somewhat strict just to make sure
that you that you’re playing it safe and since you’re at a much higher risk for
infection infection at that point so with with food safety keep your raw
fruit raw food separate from your prepared foods that’s when shopping
storing using cutting boards use disposable paper towels for cleaning and
drying your hands which can help decrease exposure to bacteria always
stall or marinate your meats in their refrigerator not on the counter I always
get that from my grandma that she always left it on the counter refrigerate or
freeze leftovers within an hour and cook all your meat and eggs thoroughly and
that that’s specially like even with steak with eggs make sure everything is
well done during that time when your when your neutropenic women when your
neutropenic especially avoid these foods on here the the raw dairy products
unpasteurized dairy products moldy and soft cheeses unwashed fruits and
vegetables I recommend a vinegar wash that you can use for all your fruits and
vegetables it’s really just 1/2 a cup of white vinegar to a quart of water you
just fill your sink up let your fruits and vegetables soak for a few minutes
three to five minutes scrub them and then rinse them off that can get rid of
the molds force you can get rid of the pesticides the bacteria all of that all
that junk that’s on your that’s on your fruits and vegetables from from the
grocery store when you’re eating out however I would I would avoid raw fruits
and vegetables for that reason we don’t know how how they’re prepared how
they’re cooked when you’re at home raw fruits and vegetables are fine because
you know that you wash them well with that buffets salad bars and deli
counters there also wants to avoid just because we don’t know we don’t know
what’s going on in the back and or under the sneeze guard or anything like that
to play it stays safe we want to avoid any any extra exposure to that bacteria
and then you’re on that honey and all of these other raw foods much much higher
risk of bacteria so these multiple myeloma complications
these are not necessarily from treatment or treatment related they can occur in
patients from from needs from the actual disease and actual multiple myeloma the
first ones anemia there’s different types of anemia bone lost hypercalcemia
which is high amount of calcium in your blood renal issues so some kidney some
kidney insufficiency and then hyperglycemia which is high blood
Sugar’s so 4c anemia it’s caused by the multiple myeloma not not usually because
of a nutritional deficiency your physician will be able to tell you the
exact type of anemia and if there are there adjustments to your diet that you
can make that can that can make an impact with anemia usually some blood
transfusions come along with that so you want to be cautious with iron
supplements because they can cause an iron overload iron is given when you get
a blood transfusion so it could it could be too much for for your system if it is
iron deficiency anemia you can try to increase the iron in your diet the high
iron foods are kind of broken down into two different sections
there’s plant-based which is called non heme iron and there’s animal base which
is heme iron the animal-based are in your your meat products those are much
easily absorbed over your plant-based which are your leafy greens your nuts
your being some dried fruit a lot of your cereals are fortified with iron so
you’re going to get more iron out of the animal base than you will out of the
plant-based if you’re eating the plant-based foods to get the iron you
need to pair it with some vitamin C the vitamin C helps increase that absorption
so say you’re having a spinach salad you want to get that iron from it put some
tomatoes on it use some type of a vinaigrette or some form juice in the
dressing something like that to try to get to try to get that iron
out of there avoid calcium supplementation with with iron
deficiency anemia Kazee because the calcium can interfere with the iron
absorption also tea tea has something called pan ins in them and if you drink
tea with while you’re eating iron rich foods you won’t get that iron it will it
will interfere with the iron absorption so when so try to avoid those two things
tea is fine not with me but not but not during bone loss and bone pain is common
in patients with multiple myeloma for the nutrition side a well-balanced diet
your your whole grains your lean meats your fruits and vegetables your your
low-fat dairy those are all those are all good choices for that well-balanced
diet your calcium vitamin being magnesium and vitamin K those are all
vitamins and minerals that are needed to prevent further bone loss your high
magnesium foods are going to be your greens your nuts your beans your fish
same with your vitamin K it’s mostly those leafy green vegetables so getting
those getting those vitamins minerals from food is a good way good way to help
with that bone loss but this phosphonates those can help slow the
advancement of bone disease and reduce the risk of fractures and bone pain so
Zometa is one of those that that you may be familiar with you also want to make
sure that you are taking calcium and vitamin D supplementation while you’re
doing me while you’re on the Zil meta weight-bearing exercise isn’t it’s
helpful for bone loss can help strengthen your bones avoiding smoking
and alcohol that will exacerbate the bone loss and there’s also low-dose
radiation something to talk to your physician about and also may also help
reduce bone pain if it becomes if it becomes unbearable hypercalcemia so
multiple myeloma associated with bone breakdown which causes that excess
calcium in the blood so that’s why that hypercalcemia is
is pretty common in multiple myeloma so you have the bone loss so that calcium
is coming from the bone loss to the to the blood stream so your dietary calcium
intake doesn’t need to be restricted it doesn’t what you eat won’t affect the
amount of calcium in your blood supplements however can because if
you’re taking that a larger dose of them so any type of supplements also antacids
such as tums can have a good amount of calcium in them and they can they can
cause a calcium overload so just tell your physician about any of those
over-the-counter meds that you’re that you’re taking adequate hydration you
want you want to be fully hydrated because it will help flush flush
everything out things that aren’t supposed to be in there if you’re
dehydrated that’ll cause the calcium in your blood to be even higher kidney
health that multiple myeloma will also could also cause problems with your
kidney function from that higher calcium levels in your blood so it’s all kind of
it’s all kind of connected the bone loss causes the hypercalcemia which could
then cause the the kidney problems calcium and the blood decreases is hard
for the kidneys to to filter so that’s where that comes from
so generally well balanced diet again those those lean meats the whole grains
the fruits and vegetables adequate fluids
again we want to make sure we’re hydrated so the kidneys can filter can
filter through that blood limit your sodium intake to a less than a two
thousand milligram per day which is a low which is a low sodium diet high
sodium intake can be difficult for the kidneys to tolerate so you want to you
want to make it as easy on your kidneys as possible since there’s some things
working against it protein needs or one that are variable based on the renal lab
based on the clinical picture sometimes of the higher protein sometimes you’ll
need lower so it just depend on just depend on kind of what’s going on and
that’s something to talk to your your physician or your local dietician about hyperglycaemia this is usually caused
from from the steroids that you would take the dexamethasone that you would
take with your treatments steroids are now too deep to increase that increase
those blood sugars so nutrition wine the goal achieve and maintain healthy body
weight when you when you have a when your body mass is higher your blood
sugar is higher it’s harder further your insulin to to bring your blood sugars
down so having a lower body weight can help decrease the blood sugars same with
your physical activity restrict your intake of sweetened beverages which is
which is pretty obvious stick mostly with your water decrease amount of of
those simple sugars complex carbohydrates those are going to be what
you want to choose with the hyperglycemia so again the whole wheat
the brown rice the whole wheat pasta those you’re going to get what those are
going to have fiber in them fiber can help decrease the blood sugars protein
as well will do the same so when you’re eating you want to do complex
carbohydrates with so being protein source and that can decrease those blood
sugars is best possible your fish your poultry your soy those are going to be
custom me you’re some of the best lean proteins so dietary supplements you
always want to check with your physician regarding any type of supplement use
some of them may interact with your treatment some will make your treatment
less effective so anything that you’re taking you definitely want to bring to
the attention to your medical oncologist one of the chemotherapy that’s pretty
common with multiple myeloma is Velcade and that can have an interaction with
both green tea and vitamin C with green tea you need to avoid green tea on the
day of treatment any other time you don’t want to you don’t want to drink a
lot of it but everyone smile some green tea is fine just not on the day of
treatment you want to however avoid any type of supplements of the green tea or
of the EGCG which is the compound in the green tea that’s
going to be a more concentrated dose and it will and it will affect that the
Velcade Zep because ii vitamin C also can interfere with the Velcade you don’t
need to reduce your intake from food but you don’t want it’s not recommended to
take a supplement either so that’s one – also to also keep notice so going to
survivorship patients diagnosed with multiple OMA are living longer with the
event with the advent of these new therapies following a well balanced diet
can help with the prevention of other medical issues you know heart disease
diabetes it can also help prevent certain types of cancer so the different
goals with that maintaining a healthy body weight there’s a lot of research
that says a higher body weight a higher body mass increase body mass index
excuse me is linked to all these things that I mentioned including different
types of cancer adopting a physically active lifestyle which will will help to
maintain that healthy body weight eat Whole Foods limit the processed foods so
your fruits and vegetables the goal is to eat five to nine per day and also
variety you don’t want to just eat apples and carrots you want to eat a
variety of different fruits and vegetables to get those variety of
different antioxidants whole grains so your whole wheat bread your your quinoa
your barley those whole grains are going to be a great source of protein but also
a good source of fiber limit your red meat your beef pork and lamb the goal is
less than 18 ounces per week that’s just because there’s a lot of there’s a lot
of strong link between red meat and certain types of cancer including
specifically colon cancer limit processed meats the same thing strong
link to to certain types of cancer with these it’s best to just avoid as much as
possible strive for at least two servings a week
of fatty fish so your salmon your tuna your mackerel those higher fat fishes
are going to get those omega-3s which are great for your heart great for to
prevent inflammation great to to help with brain function just a lot of
benefit with those Omega threes if you drink alcohol limit the consumption so
no more than one drink per day for women or two drinks per day for men so one of
the goals maybe is to follow a Mediterranean diet so that is that’s
more of your whole grains your fruits and vegetables nuts olive oil fatty fish
all these things that I mentioned up here a less amount of meat so you’re
going to get get a lot more antioxidants more benefit from that so this is the
what is what is called a new American plate it comes from a ICR which stands
for the American Institute for cancer research their goal actually who they
are is their have a government entity that all they study is nutrition and
cancer I on the end of this end of my presentation there’s a reference guide
it has their website on there they recommend to follow a diet of two-thirds
plant-based one-third animal base so this is kind of an example of how a
plate could look on that with the new American plate you have your your
plant-based foods with that small amount of animal base you don’t have to go
completely vegetarian but you’re getting more of the good the good Bennett from
the plant-based your plant-based proteins are essential in this so your
beans your nuts you’re nuts but errs like your peanut butter all in butter
and soy so that’s a good way to get protein without getting the the
animal-based protein so in this into practice how do you do this
first of all make half of make happier plate non starchy vegetables going back
to that new American plate that’s a good way to measure you don’t you don’t have
to you don’t have to count anything you can just look at your plate and in that
tab that’s a good way a good starting point shop on the perimeter of the
grocery store so that’s mostly where your produce your lean meats your low
fat dairy all your less processed foods your real Whole Foods are going to be in
that area include one colorful fruit or vegetable in each meal daily and try
different fruits and vegetables there’s so many benefits to to a variety of
fruits and vegetables so having more variety is is the goal there eliminate
one sweetened beverage and replace it with water or and the goal eventually is
to replace all your sweetened beverages with water as much as possible strive to
keep meat portions to 1/4 of your plate going back to that new American plate
it’s an easy way easy way to look at it you don’t have to measure it’s just a
good a good eyeball try new whole grain there’s so many whole grains out there
that most people don’t don’t know about there’s quinoa there’s barley there’s
farro wheat berries there’s all different types of whole grains that
will give you more variety more fiber and give you some some plant-based
protein and try to make one vegetarian dinner per week it’s a good goal to have
a meatless Monday to really tread it to get more of those plant-based proteins
in so a physical activity also very important for the for the survivorship
it can help like I said with the diet it can also help prevent heart disease
diabetes and those and some other other malignancies just just like healthy diet
would so discuss with discuss it with your physician make sure it’s an okay
time okay time to increase your physical activity strive for 30 minutes at least
5 days a week don’t go out too strong you know start
if you’re starting from scratch start with
five minutes ten minutes and go from there there’s actually research that
says breaking up your your exercise into ten minute increments a few times a day
can help you burn more calories and get more energy than just doing a whole one
thirty minute stint at one time so that’s always an option to break it up
throughout the day in two times per week aim for paying for the stretching and
the strength training strength training of course is very important for your for
your bone health so putting it into practice find an exercise buddy for that
accountability that’s what’s very important to keep to keep you motivated
find a friend there’s there’s apps nowadays that have a lot of a lot of
different ways to motivate you so look for something like that to really kind
of get you get you excited and get you motivated if you’re sitting down for an
hour try to walk for ten minutes every hour so that way you know you’re being
active in doing what you can to to help keep that body moving and burn some
calories find a fun physical activity you enjoy pretty self-explanatory you
want to do something that you like doing instead of just making yourself do
something that you won’t stick with if you’re limited or confined to a bed talk
to your physician about doing physical therapy there’s so much benefit to
physical therapy to increase the strength increase your immune system
less hospitalizations so that’s really that’s really an important aspect for
for everyone and here’s kind of a here’s a smoothie recipe it comes from one of
from our cookbook that was released last year smoothies are great a great option
for those undergoing treatments because there’s a lot of ways to add add those
extra calories in but also it’s good is good for survivorship as long as it’s
Whole Foods as long as you’re having getting some fruits and vegetables and
protein you’re getting some you’re getting benefit from it so with this one
having having your both fruits and vegetables in a smoothie is important to
shitcan you can they pack in the nutrition there you get
a good source of protein with the dates in there you can’t really even taste the
dough there but do you get an extra amount of fiber potassium magnesium
those electrolytes that aren’t very important during treatment and after so
some references the first one forces the International myeloma foundation they
have a lot of very interesting nutrition articles and videos to look at I found
them very informative so something too something to check out
the American Institute for cancer research I mentioned that with the new
American plate they have a lot of recipes and anytime there’s new research
that comes out regarding nutrition and cancer it’s it’s on there and of course
the American Cancer Society and then here’s just some general information the
NCI National Cancer Institute the Academy and nutrition Dietetics that’s
the that’s the dietitians group have a lot of a lot of good articles on there
if you’re looking for a CSO which is a certified specialist in oncology which
is a dietitian that has gone through training has been has taken a test is on
through a certain amount hours you can look on on this website the oncology
nutrition org and find a CSO in your area and then save your health that’s
who that’s who we work with and we do we do custom meal planning meal delivery
for oncology patients I think we’re time ready for questions so thank you ty
Lee’s not I found very very informative and helpful and I’ve been monitoring the
questions that have been coming in and they’ve been very very good right before
we go into those I just wanted to answer a general
question that had been coming in quite often some people are looking how they
can access and download the slides so if you go to myeloma org
ye L o ma l RG and you scroll down a little bit till you get to the section
where you see news ne WS on the lower left of the homepage click on news where
you see Kylie’s photo and the nutrition information and then right there is
where you’ll be able to download the slides for tonight’s call and also some
of you were wondering if we’re recording this call and the answer is yes we are
and so that recall and replay will be available early next week so again just
go to myeloma org and you can replay this so now I’d like to go on to some of
your questions that have been coming in and we did have a couple questions
saying Kylie would you please let us know what the measurements were again
when you were talking about washing the fruits and vegetables with that vinegar
mixture what was the measurement between of the water to the vinegar it is half a
cup of white vinegar to a quart of water okay I do it in my sink so it’s easy
just to fill it up in the sinker and a big you know big tub and get up in the
grocery store and throw it all in there just let it soak for a couple minutes
don’t soak it too long because it can some of the fruits and vegetables it can
it can kind of turn a mushy but scrub one rinse them off and that can kind of
help get rid of some of that extra bacteria in there
yeah that’s that’s a great tip especially for those patients with low
immune systems or after transplant or depending on the treatment they’re on or
actually the myeloma itself so that’s a great tip so now I’ve had another
question from Edina and Adina’s asking what about people with kidney damage but
not on dialysis who are trying not to eat a lot of protein she says she’s been
told that protein can put a strain on the kidneys yes yes that is very true
and you want to do some protein you don’t want to
without protein but that’s maybe wearing doing more of your plant-based proteins
so your nuts your beans peanut butter you’re getting some protein in there but
you’re not getting too much where it will stress out your kidneys some people
some people need extra protein with their with their renal issues some
people like you need less so it’s just talking to your physician about about
that goal and what and what your what your needs are but the more plant-based
proteins you can still eat protein but it just won’t be as as hard on your
kidneys okay great okay the next question is from Ellen Miller and she’s
saying when taking steroid medication how do you balance diabetes as it raises
blood sugar that’s the best that is tough it’s very tough
eating often can actually can help eating often and eating protein at all
of your all of your little meals can help kind of stabilize your blood
Sugar’s not kind of it’ll prevent the ups the strong ups and down so still
eating some carbohydrates that protein every time you’re eating and often can
help keep you keep you stabilized fluids too making sure you’re hydrated can help
kind of decrease those blood sugars a little bit as well okay great and then
you know of course always discussing that too with making sure all of your
doctors know if you’re myeloma treatment includes steroids like dexamethasone
then all of your doctors should know that you are now on this so so they
understand how to best treat each patient okay next question comes from
Fred and he asks have you ever found that a low or gluten-free diet helps
with bowel issues you know and I haven’t heard that I guess I would have I guess
if you have some type of gluten insufficiency or gluten
tolerance then that would definitely be the case
every gluten is hard on your digestive system so I could see that you know be
less it would be less fiber which which sometimes it’s easier on your digestive
system but I think that all depends on it depends on you and how your body
reacts to reacts to gluten so just mine fortunately is one of those that
everyone’s different is with with that right yeah it’s getting more and more
common I guess so next question is from Sam and he’s asking is Holi usually
better than nine-grain as long as it’s as long as it is whole-wheat it is about
it’s the same as a nine-grain is great it really is up to personal preference
as long as you’re getting a whole product with the with the whole grain in
it including the nine grain if it just says a wheat bread that doesn’t really
tell us anything so any of those that are whole wheat whole grain nine grain
all those are going to be that have a lot of protein and have a lot of that
fiber in it so any of those will work out just just as well so Kylie I’m
getting a question here to please go back to the reference slides again
people want to bring that information down and also folks these slides again
if you go on your computer and you go to myeloma that org scroll down under news
until you see the information on the nutrition webinar once you click on that
you’ll see a red button that says click here to download the slides so you’ll
then be able to have all these slides written right out for you you can print
them download them and hold on to that and of course like I just mentioned we
will have the replay of that’s available probably by next week okay so I have a
question here from John and he’s asking are there fruits and fruits and
vegetables our rich in calcium your your leafy
greens will be high in calcium broccoli is another one so any those are kind of
your main ones a lot of a lot of your like your cruciferous like your broccoli
cauliflower cabbage those are going to have some calcium in there and those
leafy greens so those are the best ones for you with the calcium okay great
this is an interesting one and I have heard this a little bit more mentioned
Perry is asking the question about bone marrow shoot there’s been a lot about
that lately do you have any thoughts on that piling I don’t I don’t know much
about bone marrow soup do we know what’s what is it – he’ll just I guess to help
build up the bone marrow bone marrow is that what the you know I’m not really
sure so I think the best thing to do is call the IMF info line and that’s one
eight hundred four five two two eight seven three and they could research that
a little bit for you I’m sure they’d be happy to look into that another question
that has come up a couple of times now I’ve seen a few questions on this is the
ketogenic diet I guess many doctors are recommending this versus those driving
on a higher carb diet versus the Mediterranean diet any thoughts on that
um yeah I think that a ketogenic diet still gives you that good amount of
protein very low carb it is higher in fat though than some of your some of the
other ones there’s some research out there that can go both ways that there’s
some there’s some benefits the ketogenic diet for certain diagnosis and some
downfall to be to the other but it’s it’s pretty
similar to the meta to not really to the Mediterranean in the in the meat wise
but doing more your whole foods less processed it’s similar in
that in that area but the ketogenic is like I said a lot more protein and very
high in fat which is appropriate for some but also so may not be appropriate
for other people with have maybe some some heart issues or diabetes or
anything like that that could affect that as well so just kind of like
myeloma it’s very individual so how important is it that we continue to have
good conversations with our own doctors and nurses so we know individually what
might be best for us okay another one of course is related to steroids with
myeloma patients it’s always the good the bad the ugly of steroids and best
methods own so this question comes from Kim and she’s wondering if you have any
suggestions for dealing with steroid related weight gain or puffiness that is
that is tough because it is very it is very common watch your sodium intake
because that can cause fluid retention for some of that puffiness with the with
the steroid induced weight gain may be following kind of like we talked about
that the new American plate you’re still getting protein in there but you’re
getting more of the the fruits and vegetables that have love less calories
eating more often like I talked about many many times the more often you eat
it burned it helps help your metabolism burn a little bit better so sticking
with more of a plant-based diet more of your fruits and vegetables you would get
you would stay full but get less calories that would probably be the best
the best route to go and then the dallisa sodium for the for some of the
fluid retention the puffiness there okay all right I see that it’s 8 o’clock and
I want to be conscientious and respectful to everyone’s time so I think
we’ll do one more question and then we’ll wrap this up and thank everyone so
I have a question from Bonnie and she’s wanting to talk about what is known
based on empirical evidence about curcumin and then she asks about type
and don’ts any thoughts on that home with the with the curcumin it is it
shown to be very good very healthy low it helps helps with inflammation and
it’s very high in antioxidants dosage wise that would be something to to talk
to your physician about because it is so high in antioxidants you don’t want to
interfere with any new treatment of medications that you’re on but adding it
into food into the foods you’re eating same with tumeric is another one that’s
that’s really really important same family as the curcumin you can make a
tea out of it so you’re getting getting some of that some of that benefit would
be supplement wise I would definitely err on the side of safety and speak with
your physician about the appropriateness with with treatment in that all right
that’s absolutely good advice so for those of you that have additional
questions that we did not have time to address tonight I highly encourage you
to call the ims info line call Judy and Missy are more than happy to talk with
you and research your questions the info line phone number is eight hundred four
five two two eight seven three and they are available to take your calls Monday
through Thursday from 9 a.m. to 4 p.m. Pacific and on Friday it’s 9 a.m. to 2
p.m. Pacific so Thank You Kylie so much for taking your time this evening to
help us better understand nutrition and I’d also like to give everyone a few
reminders about some important things you might want to mark on your calendars
there are three regional community workshops happening in June a Dinah
Minnesota is June 10th Buffalo New York is on June 17 Dearborn mission
again is on June 24 and these regional community workshops are free programs
bringing in myeloma experts and a member of the IMF nurse leadership board in to
talk with the community about all the updates you need to know about myeloma
and I think that we also want to always be very thankful of our sponsors for
tonight’s call and again that’s Janssen Celgene and jete de Oncology and most
importantly thanks to all of you tonight on the call I hope this was helpful to
you and Kylie we really thank you for all your additional information and care
for the myeloma community I hope they’ll all have a wonderful evening that
concludes our program for tonight thank you