Arbeitsgemeinschaft Multiples Myelom

Arbeitsgemeinschaft Multiples Myelom (Plasmozytom, Morbus Kahler)
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In tiefer Trauer nehmen wir Abschied von Joseph Seil-Rommes,
der nach einem langen Kampf gegen das Multiple Myelom von uns gegangen ist.
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VITAMIN D ..............Builds Bones And Much More

Antwort auf VITAMIN D ..............Builds Bones And Much More
24 Sep 2010 21:51
  • joseph
  • josephs Avatar
  • 4701 Beiträge seit
    22. Okt 2009

Hi Sergio

Hängt ja von der Zeit ab, wann und wo du hinfliegen möchtest

Dengue gibts auf jeder Karibikinsel, nur in der Regenzeit extrem aggresiv dieses Jahr

Martinique war noch nie so stark betroffen und im März, wenn wir normalerweise da sind, ist ja Sommerzeit, also quasi Null Stechmücken.

Ich wollt halt ein vorwinterliches Vitamin D Bad nehmen, aber mal schauen, was draus wird

Wo fliegst du hin, wenn ..............

Liebe Grüsse

Joseph

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Antwort auf VITAMIN D ..............Builds Bones And Much More
24 Sep 2010 22:13
  • sergio
  • 479 Beiträge seit
    27. Okt 2009
Joseph,
vor vielen Jahren...(bin ich schon so alt?!) war ich auch auf martinique und nebenan auf St. Lucia, wirklich schoen im Winter8),
aber mit 2 kl. Kindern wuerde es jetzt auf Hotel oder Cluburlaub hinauslaufen, vielleicht Dom. Republik, Barbados, oder weiter suedlich??? Aber der Winter scheint noch so weit weg...

Sergio

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Antwort auf VITAMIN D ..............Builds Bones And Much More
24 Sep 2010 23:28
  • joseph
  • josephs Avatar
  • 4701 Beiträge seit
    22. Okt 2009
INFO
.............

Text ist urheberrechtlich geschützt, es handelt sich um eine Kopie

......................

Guide To Nutrition In Multiple Myeloma – Part 2: Supplements
by Francie Diep

Published: Sep 2, 2010 3:48 pm

Guide To Nutrition In Multiple Myeloma – Part 2: Supplements

This article is the second in a two-part series about nutrition for multiple myeloma patients. The first article provides an introduction to nutrition for cancer patients as well as tips for getting the right nutrition. The second article describes sources and amounts of nutrients that are important for myeloma patients.

Taking nutritional supplements is common among multiple myeloma patients and other cancer patients. These supplements, including vitamins, minerals, and various plant compounds, may be important to keep the body healthy, aid in the treatment of myeloma, or to reduce negative side effects of treatment.

However, supplements, even those found naturally in foods, have the potential to interact poorly with chemotherapy or other treatments. Physicians typically agree that eating a balanced and nutritional diet is important, but they are often hesitant to recommend the use of certain supplements, since there may be little to no research to show that they are effective and safe in myeloma patients (see a related Beacon forum discussion). So, please discuss all supplements with your doctor before taking any.

If you and your doctor decide that certain supplements may be right for you, there are several important things to keep in mind. In general, supplements should be taken with food, unless otherwise indicated. If you are being treated with Velcade (bortezomib), avoid taking supplements on the days you receive Velcade, as they can diminish the efficacy of Velcade. If your doctor approves a supplement regimen, ask your doctor to provide specific instructions on when and how to take the supplements.

In order to help you decide which supplements you may want to discuss with your doctor, this article will provide for each nutrient: information on its potential purpose in multiple myeloma treatment, where to find it in your normal diet, and the suggested doses for myeloma patients.

Acetyl-L Carnitine

Some small studies suggest supplementing with acetyl-L carnitine, a nutrient normally made in sufficient amounts by the body, can help reduce the symptoms of peripheral neuropathy (nerve damage to arms and legs that is a common side effect of myeloma treatment). Acetyl-L carnitine may also protect heart cells from damage from Doxil (doxorubicin liposomal) treatment.

Acetyl-L carnitine is found in beef, pork, and milk. As a supplement for peripheral neuropathy, patients can try 500 milligrams twice a day with food. Up to 2 grams a day is safe, but over 5 grams a day can cause diarrhea, appetite changes, body odor, and rash.

Alpha Lipoic Acid

Alpha lipoic acid is an antioxidant that is commonly used in supportive therapy for peripheral neuropathy in people treated for multiple myeloma. It is an antioxidant that is normally made in the body, but people can also take extra alpha lipoic acid through supplements. Myeloma patients with peripheral neuropathy can take 300 milligrams to 1 gram daily, with 600 milligrams often recommended for up to four weeks.

Patients should be aware that one study done in myeloma cells in a lab found that alpha lipoic acid may reduce the effectiveness of Velcade treatment.

Calcium

People with multiple myeloma may take calcium along with vitamin D to help support their bones. However, bone breakdown during multiple myeloma also releases unhealthy amounts of calcium in the blood, so patients should consult their doctors before considering calcium supplements.

Curcumin

Curcumin, a compound found in the spice turmeric, may work to kill myeloma cells and prevent them from multiplying. For those who have the pre-cancer conditions monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma, curcumin may slow progression to active multiple myeloma, but this has not yet been supported by clinical research.

At the same time, patients should beware that curcumin can also suppress the immune system, which can be dangerous for people with multiple myeloma, smoldering multiple myeloma, or MGUS. For more information, please see the related Beacon news and discussion.

There is no standard established dose for curcumin in multiple myeloma. In the few small studies available on curcumin as a myeloma therapy, patients usually take about 4 grams daily spread out over many doses throughout the day. In India, where turmeric is popular in cooking, the average daily consumption is much less—60 milligrams to 200 milligrams through diet.

Enzymes

A mixture of the enzymes papain, trypsin, and chymotrypsin may weaken myeloma cells and increase the likelihood of responding to conventional chemotherapy. Anecdotal evidence suggests drinking papaya juice, which is rich in papain, may also be helpful in cancer therapy (see related Beacon news).

Eating papaya or drinking papaya juice generally poses little risk, though people who are pregnant, are allergic to kiwi fruits or figs, or have problems with blood clotting should avoid papain. Also, raw papain can irritate the skin.

There is little data on the effectiveness of this type of therapy or how much enzyme supplement to take for multiple myeloma. An ongoing Phase 3 trial is studying three daily doses of a product called Wobe Mugos E, which contains 100 milligrams of papain, 40 milligrams of trypsin, and 40 milligrams of chymotrypsin. Side effects of papain supplements, such as Wobe Mugos E, include throat and stomach irritation.

Fish Oils

Fish oils commonly contain plenty of omega-3 fatty acids, which may boost peripheral nerve health. For this reason doctors sometimes recommend them for peripheral neuropathy. Omega-3 fatty acids may also work against cancers by reducing inflammation.

Omega-3 fatty acids perform many important functions in the body and are an essential part of a healthy diet. Healthy patients are recommended to take 1.1 grams of omega-3 fatty acids a day for women and 1.6 grams a day for men. No recommendations specifically for myeloma patients were found. Patients should be careful not to take more than 3 grams a day without medical supervision because of an increased risk of bleeding.

The science on the effects of omega-3 fatty acids on multiple myeloma is still preliminary—two studies from the 1990s showed certain omega-3s kill myeloma cells in mice. For those interested in trying fish oils in a clinical trial, a trial is recruiting volunteers who have MGUS or smoldering multiple myeloma for a study on whether omega-3 supplements will delay or prevent the progression of these diseases to symptomatic multiple myeloma. The trial is starting patients on 1.25 milligrams three times a day, and the dosage will be increased for patients who can tolerate it.

Ginger

Ginger is a well-known home therapy for nausea. The latest science supports using ginger alongside prescribed nausea medication to reduce nausea from chemotherapy (see related Beacon news). The study showed that 0.5 gram to 1 gram of ginger daily for three days before chemotherapy and the first three days of chemotherapy significantly reduced nausea.

Glutamine

Supplements of the amino acid glutamine may help with several major side effects of high dose-chemotherapy and bone marrow transplantation. Small studies have shown it may reduce peripheral neuropathy, mouth sores and mouth ulcers, and infections.

Patients can take 15 grams of a pure L-glutamine powder twice daily for a total of 30 grams.

Green Tea

A compound found in green tea, called epigallocatechin-3-gallate (EGCG), may aid in killing myeloma cells and prevent myeloma cells from multiplying. However, it may also block the anti-cancer activity of Velcade, leading researchers to advise people with multiple myeloma undergoing Velcade therapy to avoid green tea products and EGCG supplements (see related Beacon news).

For people with MGUS or smoldering multiple myeloma, the compounds in green tea may slow down or prevent their pre-cancer conditions from progressing to multiple myeloma. Since most MGUS and smoldering myeloma patients are not actively treated, there is no worry of interference with chemotherapy. One Phase 2 clinical trial is studying the effects of a daily green tea extract on people with MGUS and smoldering myeloma. The trial is recruiting participants in Detroit.

Iron

Anemia (low red blood cell counts) is a symptom of multiple myeloma and is also a common side effect of many myeloma treatments. Iron supplements may help certain people with their anemia. Anemia is often treated with a prescription hormone called erythropoietin that stimulates red blood cell production. In severe cases, blood transfusions may be necessary.

For those whose anemia therapy would get a boost from iron, doctors may recommend an oral iron supplement or, if that is not enough, intravenous iron. In addition, patients can try including iron-rich foods in their diet such as dried beans, fortified cereal, beef, and eggs.

At the same time, people with multiple myeloma who get blood transfusions are at risk for having too much iron in their bodies, so iron supplements are not right for all myeloma patients. Doctors can tell patients how much iron is needed, depending on their condition.

Magnesium

Magnesium may help with peripheral neuropathy. It also helps regulate calcium levels and can help strengthen bone. Green leafy vegetables, almonds, cashews, and halibut are all good sources of this essential mineral.

People with multiple myeloma can also take 250 milligrams of magnesium twice daily through an over-the-counter supplement, or they might get a prescription for a daily 400-milligram supplement, depending on how much magnesium their doctors find in blood tests. Patients should beware that too much magnesium can cause diarrhea.

Potassium

Doctors may recommend potassium for people getting treated for multiple myeloma to help with peripheral neuropathy. Patients can get potassium from food sources such as sweet potatoes, bananas, citrus fruits, peas, red meat, and chicken, or their doctor may recommend potassium supplements.

There are no documented cases of people getting too much potassium from food, but supplements can cause hyperkalemia, a dangerous condition than can lead to sudden cardiac arrest. Since the kidneys work to remove extra potassium from the body, people with multiple myeloma, which often reduces kidney function, might be especially vulnerable. Multiple myeloma patients should be especially careful to take potassium supplements only under direction from their doctors.

Resveratrol

Resveratrol, a compound abundant in grape skins, may kill myeloma cells, prevent myeloma cells from multiplying, and enhance the effects of some common chemotherapy drugs (see related Beacon news).

Those interested in including more resveratrol in their diet can enjoy grapes, purple grape juice, red wine, peanuts, blueberries, and cranberries.

There are also many resveratrol supplements available on the market. However, because there have not been any completed clinical trials on resveratrol in multiple myeloma therapy, there is no established dosage. A Phase 2 clinical trial was studying the effects of 5 grams daily of a formulation of resveratrol in multiple myeloma patients. However, the trial was suspended earlier this year after several patients developed kidney failure (see related Beacon news).

Vitamin B

B vitamins, including vitamin B-1 (thiamine), vitamin B-2 (riboflavin), vitamin B-6, vitamin B-12, and folic acid, are important for the formation of red blood cells, enhance the immune and nervous systems, and more. People with multiple myeloma often have low red blood cells counts and can suffer from peripheral neuropathy, so getting enough B vitamins may be especially important for those with multiple myeloma.

Good food sources of B vitamins include fortified breakfast cereal; other fortified grain products; animal products such as fish, poultry, meat, and dairy; vegetables such as carrots, peas, and leafy greens; fruits such as avocadoes, grapes, and dates; and beans.

Vitamin B-1 and vitamin B-12 are so common in foods, people rarely need to take supplements for them. For the other B vitamins, supplements commonly come in a B-vitamin complex formula that includes many or all of the B vitamins in one pill.

Recommended amounts for multiple myeloma patients with peripheral neuropathy include 50 milligrams of vitamin B-6 daily (but not more than 100 milligrams a day) and 1 gram of folic acid daily.

Vitamin C

As an antioxidant, vitamin C helps protect cells from environmental damage that may lead to cancer. It also functions in protecting the immune system. The best protective benefits seem to result from obtaining vitamin C through fruits and vegetables, but the vitamin is still one of the most popular supplements for people with cancer.

Myeloma patients who are interested in vitamin C supplements should be aware that taking antioxidants on the same day as Velcade treatment reduces Velcade’s therapeutic effects (see related Beacon news). However, patients can still enjoy fruits and vegetables that are naturally high in vitamin C, such as red peppers, citrus fruits, kiwi, and broccoli.

Vitamin D

Vitamin D works with calcium to build bone, and recent research suggests it might be important in reducing some signs and symptoms of multiple myeloma. Supplements may help people with multiple myeloma deal with chronic bone pain, weakness, fatigue, and peripheral neuropathy. Meanwhile, vitamin D deficiency may be associated with poorer multiple myeloma prognoses (see related Beacon news).


Patients should aim to get 800 international units (IU) to 1,200 IU of vitamin D daily. Getting out in the sun every day for 15 minutes can go a long way toward keeping vitamin D levels up. Including fortified cereal and fortified milk, cheese, and other milk products in the diet can also prove beneficial. For those who cannot eat or drink dairy products, most alternatives, such as soy milk, rice milk, and almond milk, are fortified as much as cow’s milk. Vitamin D is also present naturally in fatty fish, such as salmon or tuna.

Many people do not get enough vitamin D through sun exposure and their diet, however. A daily supplement with 400 IU to 800 IU of vitamin D2 (ergocalciferol) or D3 (cholecalciferol) can help.

Vitamin E

For those suffering from peripheral neuropathy, vitamin E supplements may help. This antioxidant vitamin may protect nerves during therapy, especially with Velcade or thalidomide.

Additionally, Vitamin E may help heal mouth sores caused by chemotherapy. In a 2003 entry, multiple myeloma blogger Jon Siegel wrote about applying the contents of a vitamin E capsule to his mouth sores. He found he had “a relatively easy time of it compared to other folks” who had gone through chemotherapy.

For food sources of vitamin E, look to almonds, sunflower seeds and oil, peanut butter, and safflower oil. If taking a supplement, 400 IU daily is recommended.

For more information about nutrition for myeloma patients, see Part 1 in the series. Feel free to post as a comment any recommendations your physicians made about these or additional supplements, and please remember to always consult with your doctors before taking any new supplements.
www.myelomabeacon.com/resources/2008/10/15/velcade/
Photo by bradley j on Flickr -- some rights reserved.
Tags: Calcium, Curcumin, Dietary Supplement, Ginger, Green Tea, Multiple Myeloma, Nutrition, Papain, Papaya, Resources On Nutrition, Resveratrol, Vitamin C, Vitamin D

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Antwort auf VITAMIN D ..............Builds Bones And Much More
24 Sep 2010 23:33
  • joseph
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  • 4701 Beiträge seit
    22. Okt 2009
Noch was Kurzes

..........................

Based on the known functions of vitamin D, researchers have speculated that vitamin D deficiency may contribute to both skeletal complications and to the progression of multiple myeloma. In order to further examine the association between vitamin D levels and multiple myeloma, the current study tracked the vitamin D levels of 148 patients with newly diagnosed myeloma for five years. A vitamin D deficiency was defined by a serum vitamin D concentration of less than 50 nmol/L.

.........................

Mit freundlichen Grüssen

Joseph

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Antwort auf VITAMIN D ..............Builds Bones And Much More
29 Sep 2010 19:46
  • Caro
  • 683 Beiträge seit
    23. Okt 2009
Hallo,

mein LG hat gerade vom Endokrinologen gesagt bekommen, dass sein Vitamin D sehr gut sei (154) und er das Dekristol 20.000 I.E. nur noch alle vier Wochen nehmen soll, zwecks Erhaltung. Und das bei dem Sommer hier in Deutschland und obwohl es ihm bis in den Juli so schlecht ging, dass er kaum draußen war.

Scheint in dem Fall doch so zu sein, dass auch die Einnahme direkt hilft. Würde ja auch lieber nach Martinique oder noch lieber Thailand - können wir uns aber leider nicht leisten.

Viele Grüße in die Runde

Caro

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Antwort auf VITAMIN D ..............Builds Bones And Much More
07 Okt 2010 12:55
  • joseph
  • josephs Avatar
  • 4701 Beiträge seit
    22. Okt 2009
Zur Info
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Vitamin D Deficiency Rampant in Patients Undergoing Orthopedic Surgery, Damaging Patient Recovery

ScienceDaily (Oct. 6, 2010) — Almost 50 percent of patients undergoing orthopedic surgery have vitamin D deficiency that should be corrected before surgery to improve patient outcomes, according to a study by researchers at Hospital for Special Surgery (HSS) in New York City. Vitamin D is essential for bone healing and muscle function and is critical for a patient's recovery.

The study appears in the October issue of The Journal of Bone and Joint Surgery.

"In the perfect world, test levels, fix and then operate," said Joseph Lane, M.D., professor of Orthopedic Surgery and chief of the Metabolic Bone Disease Service at HSS, who led the study. "If you put people on 2,000-4,000 [milligrams] of vitamin D based on what their deficient value was, you can usually get them corrected in four to six weeks, which is when you are really going to need the vitamin D. If you are really aggressive right before surgery, you can correct deficient levels quickly, but you have to correct it, measure it, and then act on it."

According to Dr. Lane, bone remodeling or bone tissue formation, a part of the healing process, occurs about two to four weeks after surgery. This is the critical stage when your body needs vitamin D.

For their study, investigators conducted a retrospective chart review of 723 patients who were scheduled for orthopedic surgery between January 2007 and March 2008 at HSS. They examined the vitamin D levels, which had been measured in all patients before their surgery, and found that 43 percent had insufficient vitamin D and 40 percent had deficient levels.

Vitamin D inadequacy was defined as <32 ng/mL, vitamin D insufficiency was defined as 20 to <32 ng/mL, and vitamin D deficiency was defined at <20 ng/mL. Problems were more prevalent in younger patients, men and individuals with dark skin -- blacks and Hispanic.

The highest levels of deficiency were seen in patients in the trauma service, where 66 percent of patients had insufficient levels and 52 percent had deficient levels. Of the patients undergoing foot and ankle surgery, 34 percent had inadequate levels and of patients undergoing hand surgery, 40 percent had insufficient levels.

In the Sports Medicine Service, 52.3 percent had insufficient levels and of these, one-third of these or 17 percent of the total had deficient levels. "We frequently see stress fractures in the Sports Medicine Service and if you want to heal, you have to fix the calcium and vitamin D," Dr. Lane said.

In the Arthroplasty Service, which conducts hip and knee replacements, 38 percent had inadequate levels and 48 percent had deficient levels. "With arthroplasty, there is a certain number of patients that when you put in the prothesis, it breaks the bone adjacent to the protheses, which can really debilitate patients." This could be prevented or minimized by rectifying vitamin D levels. Dr. Lane also explained that they now perform procedures where they grow a bone into a prosthesis without using cement. "In those people, it would be an advantage to have adequate vitamin D, because it matures the bone as it grows in, it is really healing into the prosthesis," he said.

"The take home message is that low vitamin D has an implication in terms of muscle and fracture healing, it occurs in about 50 percent of people coming in for orthopedic surgery, and it is eminently correctable," Dr. Lane said. "We recommend that people undergoing a procedure that involves the bone or the muscle should correct their vitamin D if they want to have an earlier faster, better, result. What we are saying is 'wake up guys, smell the coffee; half of your patients have a problem, measure it, and if they are low, then fix it.'"

In recent years, vitamin D deficiency has been recognized as a common phenomenon and is caused by many factors. It is difficult to get from foods, except, for example, cod liver oil and fish. Until recently, the recommended daily allowance was set too low so foods were not supplemented with adequate doses. And third, while people can absorb vitamin D from sunlight, people these days often work long hours and often use sunscreen that impedes vitamin D intake.

The study was funded, in part, by the Charles Cohn Foundation of Rockville Centre, N.Y..

Other authors of the study, all from Hospital of Special Surgery, are Ljiljana Bogunovic, M.D., Abraham D. Kim, B.A., Brandon S. Beamer, B.A., and Joseph Nguyen, MPH.

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MFG

Seil Joseph

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