Myeloproliferative Neoplasms (MPNs)

Myeloproliferative neoplasms (MPNs) are a collection of rare blood cancers that occur when bone marrow makes too many of a certain type of blood cell, such as platelets or red blood cells. MPNs are also a condition of chronic inflammation, and includes diagnoses such as:

• Essential thrombocythemia (ET)
• Myelofibrosis (MF)
• Polycythemia vera (PV)

How do I make the best food choices throughout cancer treatment?

When you are living with an MPN, nutrition can be an important part of managing your health. There isn’t one diet or specific food that can help increase or decrease the number of certain types of blood cells. Eating a well-balanced diet is recommended to improve your energy level, support your immune system, and maintain your strength. While there is still a lot for us to learn about nutrition for MPNs, we do know that nutrition can help to decrease inflammation, improve quality of life, and help to manage side effects from an MPN or treatments for MPNs.

Inflammation can impact symptoms and progression of an MPN. In addition to medical treatment, lifestyle approaches such as diet, not using tobacco products, physical activity, and managing stress through practices such as meditation and mindfulness may help to reduce inflammation and support overall health. Food is just one piece of the puzzle to decrease inflammation in your body. Foods that can be helpful to decrease inflammation:

• Fiber foods: Whole grains and whole grain products such as whole wheat tortillas and bread products, legumes, fruit, vegetables, nuts and seeds
• Omega-3 fatty acids: Fatty fish (such as salmon, sardines, mackerel), flax seeds, chia seeds, walnuts
• Monounsaturated fats: Olive oil, canola oil, avocados, nuts, seeds
• Polyphenols: Olive oil, black and green tea, dark chocolate, legumes, berries, onions, nuts, seeds, coffee
• Flavonoids: Onions, kale, lettuce, tomatoes, apples, bananas, peaches, pears, grapes, berries, citrus, soybeans, legumes
• Vitamin C: Citrus such as lime, bell peppers, kiwi, broccoli, strawberries, and Brussels sprouts
• Vitamin E: Wheat germ, sunflower oil, safflower oils, sunflower seeds, hazelnuts, peanut butter, peanuts
• Carotenoids: Pumpkin, spinach, sweet potato, carrots, winter squash, cantaloupe
• Prebiotics: asparagus, garlic, onion, Jerusalem artichoke, wheat, banana, barley, tomato, rye, soy, peas and beans
• Herbs and spices: Garlic, ginger, cilantro, rosemary, peppers, clove, basil, oregano, cumin, turmeric, paprika, cinnamon and thyme

Limit foods that may increase inflammation.

Consuming foods that may increase inflammation on occasion or in small quantities does not cause inflammation. The foods that you eat most often and make up most of your diet have the biggest impact on inflammation. Foods that may increase inflammation include:

• Saturated fat: Red and processed meats, poultry with the skin on, lard, cream, butter, palm oil, coconut oil, fried foods
• Added sugar: Soda and other sugar sweetened beverages, candy, sweet snacks, some processed foods
• (contains an ingredient(s) produced in a laboratory): Sugary cereals, packaged snack cakes, flavored chips, boxed meals such as macaroni and cheese
• Trans fats: often found in ultra processed or fried foods
• Alcohol: Consume alcohol in moderation, if at all. Limit or avoid alcohol.

Follow a plant-forward eating pattern.

There is not one specific eating pattern for MPNs. Several plant-forward eating patterns can be helpful to decrease inflammation and are appropriate for those living with an MPN, such as:

The New American Plate focuses on shifting the amount food on your plate; eating more plant-based foods and less animal-based foods.

• This eating pattern recommends your plate at meals to include:
  • 2/3 (or more) from foods that come from plants, such as grains, vegetables, fruits, and beans
  • 1/3 (or less) from foods such as lean proteins such as dairy, eggs, fish, poultry and meat
    • Red meat is encouraged to be limited to 12-18 oz per week or less, which includes pork, beef, and lamb. Include little, if any, processed meats, such as bacon, sausage, and hot dogs.

The Mediterranean Diet has been included frequently in nutrition research for MPNs, and includes the traditional foods, eating patterns and cultural practices of countries in the Mediterranean.

• Characteristics of the Mediterranean Diet includes:
  • Be physically active and enjoy meals with others.
  • Base every meal around fruits, vegetables, whole grains, legumes, beans, nuts, seeds, healthy oils, herbs, and spices.
  • Eat fish and seafood at least twice a week.
  • Consume moderate portions, daily to weekly, of poultry, eggs, cheese, and yogurt.
  • Eat meat and sweets less often.
  • Drink water liberally throughout the day.

Visit Oldways to explore traditional African, Asian, and Latin American eating patterns.

The DASH (Dietary Approaches to Stop Hypertension) Eating Plan was designed to lower blood pressure and improve LDL or ‘bad’ cholesterol. This can be helpful to manage cardiovascular risk factors when living with an MPN.

• An example 2,000 calorie diet following the DASH Eating Plan includes:
  • 6-8 servings of whole grains per day
  • 6 or less ounces of lean meats, fish, poultry, and eggs per day
  • 4-5 servings of vegetables per day
  • 4-5 servings of fruit per day
  • 2-3 servings of low-fat or fat-free dairy products per day
  • 2-3 servings of mostly unsaturated fats per day
  • 4-5 servings nuts, seeds, dry beans and peas per day
  • 5 or less servings of sweets each week
  • Limit sodium intake to less than 2,300 mg per day to manage blood pressure and no more than 1,500 mg of sodium per day is recommended for people with high blood pressure, heart disease, or other specific health risk.
  • Additionally limit fatty meats, full-fat dairy, and sugar-sweetened beverages.

Consume a variety of plant foods that you tolerate.

Reducing inflammation is not the only reason plant-forward eating patterns can be helpful for patients diagnosed with an MPN. Plant foods include a wide variety of vitamins and minerals to support your health. Only plant foods contain fiber, helping to meet fiber goals of about 30 gm per day. Additional benefits of consuming more plant foods include:

Phytochemicals:

• Phytochemicals are compounds only found in plants which perform many helpful actions within our bodies.
• Plant foods all contain different phytochemicals.
• Phytochemicals help support the immune system, reduce inflammation, prevent DNA damage, protect healthy cells, may inhibit cancer cell growth, longevity, protect against heart disease, and other benefits.

Improve gut health:

• Aim to consume 30+ different plant foods each week to increase the variety of the good bacteria in your gut for the greatest impact.
• This can help to reduce inflammation and support your immune system.
• Diversity in gut bacteria can also reduce chronic illnesses, strengthen your gut lining, aid in digestion, and improve many other health conditions.
• Before and after a stem cell transplant, consuming 30+ different plant foods per week may reduce the likelihood and severity of developing graft vs host disease,
  • Make sure to wash your produce well. You may need to avoid high-risk foods to prevent foodborne infections. These include bruised produce, pre-packaged cut fresh produce, alfalfa sprouts, and unpasteurized juice.

Explore new ways to eat more plant foods. 

Plan to make foods that can be easier to include a variety of plant foods in, such as oatmeal, smoothies, salad, stir-fry, and soup. For example: a bowl of oatmeal could include oats, chia seeds, walnuts, and a frozen mixed fruit blend of strawberries, blueberries and blackberries for a total of 6 different plant foods in one meal!

Find easy-to-prepare plant foods you enjoy.

Think of these as “convenience” foods. If you are experiencing fatigue, are on the go, or just want easy ways to add more anti-inflammatory foods to your day, these snacks or small meals can help make eating healthy more convenient:

• Popcorn, ideally made with corn and oil, seasonings optional
• Trail mix: include a variety of nuts, dried fruit with no sugar added, and a few dark chocolate chips if you prefer
• Whole grain cereal and low-fat dairy or plant-based milk: look for cereals that provide at least 5 gm fiber, such as shredded wheat
• Avocado slices on whole wheat toast: top with tomato slices, greens, and/or seeds
• Hummus and variety of raw vegetables to dip
• Celery pieces with peanut butter and raisins
• Find additional quick and easy snack ideas here!

Manage side effects.

MPNs and treatment for MPNs may cause side effects that can impact your nutrition. Common side effects can include fatigue, feeling full quickly, nausea, diarrhea, constipation, bloating, and gas. Visit the side effect page for tips and strategies to manage each. It is important for you to tell your healthcare team about any changes in the side effects that you are experiencing. Changes in your diet or medications may be necessary to manage these side effects.

Maintain a healthy weight.

Aim to maintain a healthy body weight. If you are receiving treatment, avoid losing or gaining too much weight. Strict dieting is not recommended during cancer treatment. Losing weight can lower your energy level and decrease your body’s ability to fight infection. 

Eat small, frequent meals throughout the day.

Eating frequent small meals will ensure your body is getting enough calories, protein, and nutrients to support a healthy body weight and tolerate treatment. Smaller meals may also help to reduce treatment-related side effects such as fatigue, nausea, diarrhea, and constipation. Try eating 5-6 small meals or “mini” meals about every three hours. 

Stay hydrated.

Drinking enough is important to prevent blood from thickening, to manage fatigue, and to maintain regular bowel function. Aim to drink 64 ounces of fluid daily. For people living with PV, adequate hydration can also help to prevent kidney stones and gout. Fluids to help with hydration include:

• Water
• Unsweetened tea
• Milk
• 100% fruit juice
• Low-sodium vegetable juice
• Broth
• Sports drinks

Foods with higher water content, such as yogurt, gelatin, soup, including fruits and vegetables such as cucumber or watermelon can help with hydration as well.

Practice good food safety.

Wash your hands often while preparing food. Use different knives and cutting boards for raw meat and raw vegetables. Be sure to cook all foods to their proper temperature, wash fresh produce well with running water, and refrigerate leftovers right away. Read more about food safety.

Talk to your healthcare team before taking any vitamins or supplements.

Some medications and cancer treatments may interact with vitamins and supplements. Choose food first as the main source for nutrients.

Try healthy recipes. 

Check out these organizations for new ideas to include more plant and anti-inflammatory foods in your diet:

• Blood Cancer United
• Oldways
• Cook for Your Life
• Meatless Monday
• American Institute for Cancer Research
• Have a Plant

Most importantly, know that your cancer journey is unique to you and your treatment.

You may experience side effects that affect your ability to follow these suggestions. If you are struggling with any side effects, such as loss of appetite, nausea, diarrhea, vomiting, or any other nutrition concerns, your needs may be different. Schedule a time to talk to our registered dietitians.