Danielle Barron speaks to dietitian Diarmuid Duggan in advance of the 2022 Multiple Myeloma Ireland Patient Information Day
The Multiple Myeloma Ireland Patient & Carer Information Day 2022 will take place on May 27th at the Ashling Hotel in Dublin. As always, a wide range of clinicians and healthcare professionals involved in the care of patients with multiple myeloma will gather to offer expert advice and new insights into the condition and its management. As the first in-person Patient Day since 2019, it is highly anticipated.
Diarmuid Duggan is the Dietetic Manager in the Department of Nutrition & Dietetics at the Bon Secours Health System in Cork. He will present on multiple myeloma and diet, as this is a key concern for patients who are seeking to nourish themselves appropriately during treatment and beyond.
Nutritional requirements may change throughout a person’s multiple myeloma journey and their nutritional care plan should reflect this, Duggan explained in advance of the Patient Information Day.
“There may be times when the individual will need increased nutrition to meet the demands of treatment and its side effects. There may also be a time when the focus is on preventing the cancer from reoccurring, which may require a different focus.”
Being well-nourished through a person’s cancer journey can benefit the individual in many ways, Duggan says.
“It can help to reduce the toxicity of the treatment, and help with preserving their weight or in particular muscle which can in turn help with fatigue and increases their ability to engage more in everyday living.” Duggan recognises that trying to get the best advice about diet through treatment can be very confusing with the internet, social media and family and friends all having an opinion and wanting to help. He recommends the world cancer research funds website as a good place to start ( www.wcrf.org-uk). “They have some really good resources to support the individuals no matter what stage of the journey they might be on.”
For most patients, preserving lean body mass, in particular muscle mass, can be of benefit as they undergo treatment. “Preserving or enhancing muscle mass can lead to better treatment outcomes,” Duggan explained. “I tend to bring focus on specific foods and fluids that will help the individual meet their specific nutritional requirements. If the patient struggles with the traditional three meals a day, we recommend little and often.”
Yet it isn’t always up to the individual. Issues such as chemosensory dysfunction can occur where the individual’s sense of smell, taste and even the sight of food can be affected, as well as anticipatory nausea, Duggan said. This is where the dietitian is invaluable. “We help to explain these and offer some tricks of the trade to help patients cope.”
Rather than a strict menu of foods, balancing the diet is key, he noted. “It is about what your body needs at that moment, so we have to manipulate and personalise it for the individual.”
While the number of dietitians in the health service has increased in recent years, Duggan explains there is still a shortfall, especially in the oncology outpatient departments. This means that patients can turn to “Dr Google” and social media, meaning that dietary myths and misperceptions are common; for example, Duggan says that many patients will have read that “sugar feeds cancer”.
“Yet if a patient is going through treatment and losing weight then high energy foods will help keep your body mass up and give you a better outcome from treatment. So it’s really about timing and what foods your body needs in that moment.”
Many so-called “miracle” diets, from juice diets to ketogenic diets, are peddled to people with multiple myeloma and all forms of cancer. Duggan admits it can often be difficult to combat this type of misinformation, as most people are seeking to do whatever they can to help fight the disease.
“I always appreciate where the patient is coming from. They may have been given a very poor prognosis so of course they are going to explore these things. I gather the evidence and present it to the individual, tell them what the diets purport to do, and what can happen from a negative point of view if they do decide to proceed down this road. We always allow the patient to make up their own mind.” The reality is that there will be “a little bit of science behind everything”, he adds. “You will always find a small study that appears to support it. But when we go to extremes, and that’s what a lot of these diets are, you can do a lot of damage to your own treatment.”
For example, a few years ago, high doses of vitamins and minerals were one of the alternative “treatments” being recommended by some parties to cancer patients. Many patients began taking high doses of vitamin C in the belief that the antioxidants might protect them against the harmful effects of cancer. Duggan says it is now known that this can reduce the effectiveness of some forms of cancer treatment by up to 50 per cent. “It makes the treatment not fit for purpose. Again, it’s about educating the individual and a collaborative, informed decision-making process, rather than just us saying ‘no’.”
Duggan acknowledged that not everyone will have access to a dietitian as they progress through their treatment journey. On the day he will signpost attendees to the best evidence-based dietary research and advice – the World Cancer Research Fund is just one website he encourages patients to visit.
Dietary advice is just one part of an holistic treatment plan for multiple myeloma, with the overall goal being to keep the patient as well as possible. According to Duggan, it’s about treating the person, and not just the disease. “Some of the cancer centres are very good at doing this but unfortunately services can be patchy throughout the country. That’s where the charities come in, such as Multiple Myeloma Ireland. It’s about managing the person as a whole, and personalising everything for the individual.”
Eating is not just about nutrition, Duggan is keen to emphasise. “Food can be about love and socialisation too. Food is nourishment but it is also about sitting down with family or friends and that can be as good for the patient.”