Myeloproliferative neoplasms (MPNs) are chronic forms of cancer that develop in blood stem cells in the bone marrow. When first diagnosed with an MPN, many people are advised to “watch and wait” rather than beginning treatment right away. Whether you are currently treating your MPN or not, eating a nutritious diet is an important factor in helping you feel your best. Along with getting enough sleep and physical activity, a healthy diet can support your well-being in many ways. Several symptoms of MPNs and the side effects of MPN treatments might require specific nutrition recommendations.

Most guidelines on healthy eating for people with MPNs do not vary greatly from healthy eating guidelines for everyone else. Some of the main aspects of a healthy diet for MPNs are discussed below. While these nutritional guidelines are safe for most people, you may have additional health concerns — such as food allergies or bowel disorders — that require special consideration. Always consult with your doctor or a dietitian before making major changes to your diet.

What Is a Plant-Based Diet?

A plant-based diet does not necessarily mean eating vegetarian or vegan. In a plant-based diet, plants are the main focus, but you can also include meat and dairy products in moderation. For instance, the Mediterranean diet is considered one type of plant-based diet. This is a heart-healthy eating pattern rich in fruits, vegetables, whole grains, low-fat dairy, lean meat and other proteins, and healthy fats. Unhealthy, saturated fats like those found in butter and fried foods should be limited to less than 10 percent of your total calorie intake for the day.

Benefits of a Plant-Based Diet

Besides reducing your risk for cardiovascular diseases, such as heart attack and high blood pressure, a plant-based diet helps maximize your antioxidant intake. Antioxidants such as vitamin A, vitamin C, vitamin E, beta-carotene, and lycopene fight free radicals and can help prevent cancer. Getting antioxidants from foods has been shown in studies to provide benefits, while taking antioxidants as nutritional supplements has not. Researchers believe antioxidants may require the combination of other nutrients and plant chemicals, such as polyphenols, in order to be active in our bodies.

Foods High in Antioxidants

• Beta-carotene and Lycopene — found in apricots, carrots, pumpkin, sweet potatoes, and bell peppers
• Vitamin A — found in spinach, chard, carrots, squash, and sweet potatoes
• Vitamin C — found in broccoli, leafy greens such as turnip and mustard, cantaloupe, oranges, lemons, strawberries, tomatoes, and bell peppers
• Vitamin E (also called alpha-tocopherol) — found in avocado, peanuts, sunflower seeds, and boiled spinach

Cruciferous vegetables contain compounds called glucosinolates, which may help with cancer prevention and recurrence. There is research proving this compound can help with lung, colon, breast, and prostate cancer. More research is needed to clarify relationships and evidence of the health effects of glucosinolates on other forms of cancer. Cruciferous vegetables include broccoli, Brussels sprouts, and cauliflower.

Preliminary research suggests ursolic acid may decrease tumor growth by regulating mitochondrial function through metabolic pathways. Foods that contain ursolic acid include apples, basil, rosemary, and cranberries. Cooking with these ingredients or consuming these foods can’t hurt you, but taking supplements with these ingredients is not currently recommended.

Curcumin, also known as turmeric, is a compound that has anticancer properties. The spice may target different cell-signaling pathways, including growth factors and cytokines, which may help with cancer prevention or recurrence. Curcumin has poor bioavailability, meaning it has low absorption rates and fast elimination from the body, but studies suggest that black pepper may enhance absorption. The research on this compound is preliminary, and further clinical trials are needed to assess its effectiveness.

While curcumin, cruciferous vegetables, and ursolic acid may not have specific relationships with blood cancers, they contain healthful compounds for immune health. These may help fight infections — a common complication of myeloproliferative neoplasms and MPN treatments.

Dietary Fiber

Fiber is a neglected, yet crucial, component of healthy eating that comes from plant-based foods like vegetables, fruits, whole grains, beans, nuts, and seeds. Fiber stimulates proper digestion, aids in glycemic control, manages healthy lipids, and promotes a balanced gut microbiota. For optimal health, women need at least 25 grams of fiber per day, and men need at least 35 grams of fiber per day.

Eating a Balanced Diet

The plate method is a simple visual technique to help you accomplish a balanced diet and aid in portion control. Too much of even a good thing can be a bad thing, which makes portion control and distribution important. To use the plate method:

• Half of your plate should include vegetables — the more colors, the better.
• One-fourth of your plate should contain protein, such as chicken, fish, or legumes.
• One-fourth should contain a healthy starch, such as brown rice, quinoa, or sweet potato.

The plate method helps you quickly and visually understand the ratio of the foods you are eating. Your meal should also contain a healthy fat like olive oil, avocado, nuts, or seeds. Fruit can be enjoyed with a meal or as a snack, along with a source of protein or fiber to help control blood glucose and feel “full.” For instance, pair an apple and almond butter, grapes and string cheese, or bell pepper strips and hummus.

Part of a healthy meal distribution includes treating yourself to foods you crave — in moderation. It is healthier to have a small serving of your sweet of choice than to restrict yourself and possibly end up overdoing it later.

Weight Changes

How best to maintain a healthy weight may depend on which type of myeloproliferative neoplasm you are living with. People with myelofibrosis often experience unintended weight loss, which may be significant enough to negatively impact survival. On the other hand, those with essential thrombocythemia and polycythemia vera are more likely to be overweight, which can contribute to inflammation.

When It’s Difficult to Eat Enough

Several common symptoms of MPNs can make it difficult to eat enough to maintain a healthy weight. If you experience splenomegaly (enlarged spleen), you may have abdominal discomfort and feel full after only a few bites. Nausea may also lead to loss of appetite. During these times, prioritizing nutrient-dense, high-calorie foods is a must. Maintaining your weight with calories and preserving your lean muscle mass with protein are of equally high priority.

If you or your doctor is worried about weight loss due to your MPN, choose foods dense in both nutrients and calories. Some good options are:

• Nuts
• Nut butters
• Avocados
• Beans
• Chicken
• Fish
• Yogurt

Making smoothies and soups are popular ways to load up on healthy foods if you don’t feel like eating solid foods. Soups and smoothies are easy, versatile dishes to disguise nutritious foods like flaxseed meal, chia seeds, nut butters, beans, and vegetables to amplify wellness. Increasing your meal frequency, or eating small snacks throughout the day rather than large meals, can help you obtain adequate calories as well. Maintaining physical activity can also produce a healthy appetite.

Losing Excess Weight

If you are overweight or obese, adopting an anti-inflammatory diet such as the Mediterranean diet discussed earlier may help you lose weight and reduce inflammation. Lower inflammation also may improve your quality of life and even reduce the risk for dangerous blood clots. Talk to your doctor if you are concerned about your weight or curious whether losing weight may benefit your overall health.

Managing Anemia

Individuals living with myeloproliferative neoplasms often experience anemia, a condition caused by a deficiency of red blood cells or iron. Anemia causes fatigue and can often be managed with nutrition. Individuals with anemia will need to pay attention to their iron intake. There are two forms of iron — heme iron and nonheme iron. Heme iron includes animal sources — red meat, poultry, and fish — and is about 15 percent absorbable by the body. Nonheme iron includes plant-based sources — legumes, grains, and vegetables — and is only 3 percent to 8 percent absorbable. There are several things that can help increase or decrease iron absorption. It is worth noting that taking excess iron supplements can lead to nausea, vomiting, and liver damage.

A helpful guideline is to include a dietary source of vitamin C at every meal, especially meals with a source of iron. Vitamin C enhances the absorption of iron in the body. Dietary sources of vitamin C include citrus fruits, bell peppers, cruciferous vegetables, and tomatoes. It is important to note that coffee and tea can significantly decrease iron absorption. These beverages should not be included with meals that contain iron-rich foods.

A rare form of anemia, called megaloblastic anemia, may be caused by a deficiency in vitamin B12 and folic acid. Megaloblastic anemia may occur in people with some types of blood cancer. Below are lists of the top food sources containing vitamin B12 and folic acid.

Foods With Vitamin B12

• Clams
• Fortified cereal
• Tuna
• Nonfat plain Greek yogurt
• Salmon
• Beef
• Chicken
• Eggs
• Nutritional yeast

Foods With Folic Acid

• Spinach
• Fortified cereal
• Black-eyed peas
• Asparagus
• Brussels sprouts
• Broccoli
• Avocado

Hydration for Healthy Kidneys

Drinking enough fluids is important for nutrient transportation, joint health, blood pressure regularity, and so much more. Staying well-hydrated also supports kidney function, an important concern in people with myeloproliferative disorders. Studies have found that chronic kidney disease is prevalent in people with the three “classic” MPNs — myelofibrosis, essential thrombocythemia, and polycythemia vera. In addition, some people with MPNs develop kidney stones due to a buildup of uric acid.

If the results of your blood and urine tests show signs of kidney damage, your doctor may give you specific dietary recommendations. Limiting foods high in potassium, sodium, and phosphorus may be necessary, depending on the specific nature of your kidney problems. Your health care provider will monitor your blood test results to assess whether restriction of one or more of these nutrients could help prevent further damage.

If so, you may be asked to limit:

• Foods high in potassium, such as oranges, bananas, spinach, zucchini, and peaches
• Foods high in phosphorus, such as cheese, wheat bread, peanut butter, nuts, and seeds
• Foods high in sodium, such as processed foods, packaged snacks, condiments, salad dressings, sauces, and restaurant or takeout foods

Water is your best choice for staying hydrated. Avoid or limit sugary drinks like fruit juice, soda, and sweetened teas. If you don’t enjoy drinking water, try adding fresh fruit, fruit extract, or low-sugar sports drinks like G2 by Gatorade, Propel flavored electrolyte water, or Vitaminwater Zero.

Food Safety Tips

Food safety is incredibly important for people living with MPNs, who often deal with a weakened immune system due to cancer itself or MPN treatments. For instance, Revlimid (Lenalidomide) can cause leukopenia — low white blood cell count. If your cancer or the treatment you take for it leave you immunosuppressed, you will likely be more susceptible to foodborne illness.

Follow these safe food handling do’s and don’ts to avoid foodborne illnesses.

Food Safety Do’s

• Cook all meat and fish thoroughly.
• Cook eggs thoroughly — not runny or sunny-side up.
• Wash produce well before you peel it. Consider soaking fruits and vegetables in a solution of apple cider vinegar and water to kill bacteria.
• Refrigerate deli meats, even dry-cured sausages.

Food Safety Don’ts

• Eat products containing raw eggs, such as cookie dough or homemade mayonnaise.
• Drink unpasteurized milk or juice.
• Eat soft cheese such as brie, blue cheese, or Gorgonzola.
• Eat from salad bars and buffets, since food sits longer and is more likely to become contaminated.
• Eat alfalfa sprouts or other raw sprouts.
• Drink well water, unless it has been boiled for one minute or filtered.

Nutrition and Supplement Claims: Check Your Facts

Many companies make health claims regarding nutritional supplements and cancer. It can be challenging to decipher what is legitimate and what may be far-fetched marketing copy. There is little science-based evidence proving a specific nutrient or supplement is effective in the treatment of cancer.

It is important to always consult with your doctor before trying any supplement or herb. It may have a negative impact on your cancer treatment. For instance, the popular herbal supplement St. John's wort is known to reduce the effectiveness of Gleevec (Imatinib), a drug used to treat chronic myeloid leukemia and Philadelphia-positive acute lymphoblastic leukemia. Similarly, green tea supplements can interfere with the effectiveness of Velcade (Bortezomib), which is used to treat multiple myeloma and mantle cell lymphoma.

Keep in mind these facts about nutritional supplements from the Office of Dietary Supplements at the National Institutes of Health:

• Dietary supplements do not have to be proven effective before they are marketed.
• Just because a product is natural does not mean it is safe.
• Since some nutrients are already supplemented in foods you eat, you may wind up accidentally taking an unsafe amount.
• You are more likely to experience side effects from supplements if you take them in high doses, if you take them instead of prescribed medications, or if you combine several types of supplements.

You Are Not Alone

Changing eating habits can be hard. Eating healthier requires learning how to plan meals, choose healthy foods, and perhaps try new ways of cooking. It can become even more complicated when family members are not on board. When you join myMPNteam, you gain a support network of people living with MPNs who understand the challenge of trying to adopt a nutritious diet.

Do you feel better when you eat a healthy diet? What steps do you take to maintain good nutrition while living with an MPN? Comment below or post on myMPNteam.