Article written by
Kimberly Mugler, RDN, LDN
Along with getting enough sleep and exercise, nutrition is an important factor in the treatment of leukemia. Eating the right foods for a healthy body and immune system will help your body heal during and after leukemia treatment. Several side effects of leukemia and its treatments might warrant specific nutrition recommendations.
Guidelines on healthy eating for people with leukemia do not vary greatly from healthy eating guidelines for everyone else. Some of the main aspects of a healthy diet for leukemia are discussed below. While these nutritional guidelines are safe for most people, you may have additional health concerns — such as food allergies or gastrointestinal conditions — that require special consideration. Always consult with your doctor before making major changes to your diet.
Aim for a plant-based diet, which emphasizes plant foods but can include meat and dairy products in moderation. A plant-based diet often coincides with a Mediterranean diet. This is an 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. One of the advantages of a plant-based diet is maximizing your antioxidant intake. Antioxidants fight free radicals and can help prevent cancer.
“My oncologist told me to try to stay on a Mediterranean diet for overall health,” wrote one MyLeukemiaTeam member. “I eat mostly chicken, turkey, and fish,” shared another member. “I also eat fresh greens (kale, spinach, collards), brown rice, and snack on fruit during the day. Drink tea and water. Try eating plenty of vegetables.”
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.
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.
Curcumin is a compound that has anticancer properties. It 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 leukemia and its treatment.
Fiber is a neglected, yet crucial, component of healthy eating. Fiber comes from starchy foods like vegetables, fruits, whole grains, beans, nuts, and seeds. Fiber stimulates proper digestion, aids in glycemic control, manages healthy lipids, and promotes a healthy 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.
“I never get constipated because I tend to ‘overdose’ on high-fiber foods,” wrote one MyLeukemiaTeam member. “Alpen, Raisin Bran, whole wheat bread and pasta, and veggies.”
For some people living with leukemia, a high-fiber diet may irritate the stomach and worsen nausea. In these cases, your doctor may recommend a low-fiber diet instead.
The plate method can 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:
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.
As one MyLeukemiaTeam member put it, “Eat what you want in moderation. Live for today because we are not promised tomorrow.”
Maintaining a healthy weight is crucial for good overall health. You should consume enough calories to maintain an appropriate weight for your size or enough calories to gradually lose weight if you are overweight or obese.
It can be hard to maintain a healthy weight and prevent malnutrition if you are experiencing nausea, vomiting, diarrhea, loss of taste, or lack 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 during or after leukemia treatment, choose foods dense in both nutrients and calories. Some good options are:
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 help amplify health. 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.
Some MyLeukemiaTeam members reported losing excess body weight and feeling better after making changes to their diets. “I eliminated the sugar and processed food back in March,” shared one member. “I have felt much better since then and have dropped about 30 pounds, which I could stand to lose.” Another benefit of maintaining a healthy weight can be managing dangerous, weight-related health conditions. “I cut out carbs and sugar for four months. My extremely fatty liver healed itself, and my diabetes went away. My oncologist has been so proud of me,” another member said.
Individuals with leukemia 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 — 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.
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 acute myeloid leukemia and myelodysplastic syndromes. Below are lists of the top food sources containing vitamin B12 and folic acid.
Some people with leukemia experience kidney damage. If your lab results 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 what is causing your kidney problems. Your health care provider will monitor your blood test results to assess whether restriction of one or more of these nutrients is warranted. If so, you may be asked to limit:
Adequate hydration is important for nutrient transportation, joint health, blood pressure regularity, and so much more. Water is the best choice of hydration. Avoid sugary drinks like fruit juice, soda, and sweetened teas — or keep them to a minimum. If you don’t like the taste of water, try adding fresh fruit, fruit extract, or low-sugar sports drinks like G2 by Gatorade, Propel flavored electrolyte water, or Vitaminwater Zero. Alcohol should be limited to no more than one drink per day for women and two drinks per day for men. Time your intake of coffee and tea to avoid limiting your iron absorption, as mentioned above.
MyLeukemiaTeam members often discuss their preferred drinks. “I tell you, I quit drinking soda and stopped eating sweets and I feel amazing,” shared one member. Another member recommended their favorite pre-gym beverage: “I drink V8 +Energy tea before workouts and swim laps. Could be mental, but I feel it gives me the boost I need.” Another member chose high-protein drinks for extra nutrition: “For protein, I like the Core Power drink. There is one that has 42 grams of protein. I usually drink half a bottle at a time, once a day or so.”
Food safety is incredibly important for people living with leukemia, who often deal with a weakened immune system due to leukopenia (low white blood cell count). If you undergo a stem cell transplant, you will likely be more susceptible to foodborne illness than individuals who receive chemotherapy and radiation alone.
Follow these safe food handling do’s and don’ts to avoid foodborne illnesses.
It can be challenging to read health claims regarding nutrition supplements and cancer and try to decipher what is legitimate and what may be far-fetched marketing claims. There is little science-based evidence proving a specific nutrient or supplement to be 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 Bortezomib, which is used to treat multiple myeloma and mantle cell lymphoma.
Further nutrition recommendations must be individualized based on your specific response to leukemia treatment. The most common side effects of chemotherapy and radiation include loss of appetite, early satiety, nausea, vomiting, dry mouth, mouth sores, taste changes or loss of taste, difficulty swallowing, constipation, and diarrhea. Your doctor, a registered dietitian, or a nutritionist can provide recommendations on how to alleviate these side effects and maintain a healthy, nutritious diet that will help you feel your best.
Members of MyLeukemiaTeam often discuss their efforts to eat healthy and improve their diets. Here are a few examples of conversations about diet and nutrition:
Do you feel better when you eat a healthy diet? What steps do you take to maintain good nutrition while living with leukemia? Comment below or post on MyLeukemiaTeam.