Diet and fluid intake

There is no evidence to suggest that patients with myeloma require a specific diet. Many patients will already be aware of the importance of eating a healthy, balanced diet.

However, it is important to discuss the benefits of a healthy diet with patients so that they understand that it will help increase energy levels and maintain muscle strength in order to carry out day-to-day activities. A healthy balanced diet may also aid recovery after treatment and help the immune system to function more effectively.

A healthy diet includes a variety of foods including: plenty of fruit and vegetables; high fibre wholewheat breads, cereals, rice and pasta; lean meat and fish or a well-balanced vegetarian diet, with less red or processed meat, fatty or fried food, and limited amounts of salt and sugar.

Some patients, especially if they are receiving treatment, may feel fatigued, sick or nauseous, have diarrhoea or constipation, or have a sore mouth. This may cause them to lose their appetite or find it difficult to eat. For such cases, nurses, dieticians and others involved in supportive care should:

• Recommend patients eat small amounts regularly throughout the day
• Ensure patients with a sore mouth are using any prescribed treatments to clean and maintain good oral hygiene
• Encourage patients to do gentle exercise (e.g. walking) to stimulate their appetite
• Advise those patients who need to gain weight to add extra calories to their diet e.g. using full-fat instead of skimmed or semi-skimmed milk, adding butter to sandwiches etc, or include nutritional shakes/drinks to supplement their diet
• Identify those patients whose diets may be lacking in essential vitamins and minerals and recommend they take dietary supplements, although it is best to avoid any that are aimed at boosting the immune system (e.g. echinacea) as it is not known whether they affect the progression of the myeloma

It is also important to emphasise the need for patients to maintain their fluid intake and drink the recommended daily amount of 2-3 litres (3-5 pints) per day to promote good kidney function, unless there is a medical reason to limit fluid intake. Tea, coffee and alcohol, should be consumed in moderation as this can exacerbate dehydration.

Nurses have a responsibility for identifying patients who are dehydrated or who are not eating enough. For patients on wards, this would include charting their fluid and food in-take but for patients attending outpatients or day units, being aware of changes in weight and asking appropriate questions to better understand how a person’s diet may have changed is important. Patients who continue to have problems with their diet or digestion, or who have lost weight, should be referred to a dietician.

It may, from time to time, be necessary for patients to alter their diet if they are neutropenic. This is especially so for patients recovering from high-dose therapy and stem cell transplantation. Patients may be advised to avoid certain foods until their white blood count returns to normal, including:

• Raw or undercooked eggs or meat
• Soft or blue cheeses
• Live yoghurts e.g. probiotic yoghurts
• Shell-fish
• Pate
• Unpasteurised dairy products e.g. certain soft ice creams

Watch this video in which complementary therapist Melissa Tyers explains how diet and nutrition are important and provides information about how myeloma patients should be eating: