Myeloma and Sarcopenia

Fit people doing deadlift exercise in gym. Horizontal indoors shot

Multiple myeloma and sarcopenia are inextricably linked. According to the research below, sarcopenia is a sort of sleeper side effect. I say this because:

The average MM survivor is 70 years of age-
MM symptoms may cause patient inactivity- even before a diagnosis of MM-
Active therapy causes a host of side effects that contribute to to inactivity-

The average MM patient is prone to sarcopenia. A diagnosis and treatment of MM speeds this average MM patient on the way to sarcopenia.

To be fair, we MM patients are focused on killing our MM. Or possible symptoms such as fatigue, nausea or peripheral neuropathy. The last thing on our minds is muscle loss.

Yet muscle loss can reduce our OS aks overall survival!

What is sarcopenia?

What are therapies to prevent sarcopenia?

1. Resistance Training

Strength Exercises: Weightlifting, resistance bands, and bodyweight exercises (e.g., squats, lunges, push-ups) are essential. These exercises increase muscle mass and improve bone density.
Progressive Overload: Gradually increasing weights or resistance levels helps stimulate muscle growth over time.

2. Aerobic Exercise

Low to Moderate Intensity: Brisk walking, cycling, and swimming can improve overall fitness, support cardiovascular health, and improve stamina, which helps prevent sarcopenia.
Combining Cardio and Resistance: Combining both types of exercise has been shown to be particularly effective for muscle maintenance in older adults.

3. High-Protein Diet

Adequate Protein Intake: Aiming for about 1.2–2.0 grams of protein per kilogram of body weight per day (depending on activity level) can help maintain muscle mass.
Quality Protein Sources: Lean meats, fish, eggs, dairy, legumes, and plant-based proteins (like tofu and quinoa) provide essential amino acids for muscle repair.
Protein Timing: Distributing protein intake throughout the day (in meals and snacks) is often more effective than consuming a large amount at once.

4. Vitamin D and Calcium Supplementation

Vitamin D: Low vitamin D levels are associated with muscle weakness and can accelerate sarcopenia. Supplementing with vitamin D (if levels are low) helps maintain muscle and bone health.
Calcium: Important for muscle contraction and bone health. Maintaining adequate levels through diet or supplementation supports muscular and skeletal health.

5. Creatine Supplementation

Muscle Mass and Strength: Creatine is commonly used by athletes for muscle gain, but studies show it may also help preserve muscle mass in older adults.
Usage: Consult with a healthcare provider before starting creatine, as it may not be suitable for all, particularly those with certain kidney issues.

6. Hormone Replacement Therapy (HRT)

Testosterone Replacement in Men: Testosterone levels decline with age, and low levels are associated with muscle loss. HRT may benefit men with clinically low testosterone levels.
Estrogen Therapy in Women: Estrogen loss during menopause can contribute to muscle weakness; HRT in postmenopausal women has shown benefits, though risks and benefits must be carefully weighed with a physician.

7. Anti-Inflammatory Diet

Omega-3 Fatty Acids: Found in fatty fish, flaxseeds, and walnuts, omega-3s may help reduce inflammation, which is associated with muscle loss.
Antioxidant-Rich Foods: Fruits and vegetables high in antioxidants, like berries, leafy greens, and nuts, help reduce oxidative stress that can contribute to sarcopenia.

8. Neuromuscular Stimulation

Electrical Stimulation: This therapy can help maintain muscle tone, especially for individuals unable to engage in traditional resistance training. Physical therapists can guide its use safely.

9. Adequate Rest and Recovery

Sleep: High-quality sleep (7–8 hours per night) is essential for muscle repair and hormone regulation, especially growth hormone.
Recovery Time: Allowing muscles to recover between intense workouts is crucial to prevent overuse injuries and encourage muscle growth.

As is often the case, research advocates evidence-based non-conventional therapies such as:

Nutrition
Supplementation
Exercise and
Sleep

I am a long-term MM survivor who researched and posts about MM. I wish I had a nickel for every time I included those therapies in a post about MM.

Email me with at David.PeopleBeatingCancer@gmail.com with your questions about myeloma and sarcopenia.

Thank you,

David Emerson

MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

Chemotherapy-Induced Sarcopenia

“Sarcopenia is being consistently recognized as a condition not only associated with the presence of a malignancy but also induced by the oncologic therapies. Due to its negative impact on tolerance to chemotherapy and final outcome in both medical and surgical cancer patients, sarcopenia should be always considered and prevented, and, if recognized, should be appropriately treated.

A CT scan at the level of the third lumbar vertebra, using an appropriate software, is the more common and easily available way to diagnose sarcopenia. It is now acknowledged that mechanisms involved in iatrogenic sarcopenia are several and depending on the type of molecule included in the regimen of chemotherapy, different pharmacologic antidotes will be required in the future.

However, progression of the disease and the associated malnutrition per se are able to progressively erode the muscle mass and since sarcopenia is the hallmark of cachexia, the therapeutic approach to chemotherapy-induced sarcopenia parallels that of cachexia.

This approach mainly relies on those strategies which are able to increase the lean body mass and include the use of anabolic/anti-inflammatory agents, nutritional interventions, physical exercise and, even better, a combination of different therapies…”

Prevalence and Significance of Sarcopenia in Multiple Myeloma Patients Undergoing Autologous Hematopoietic Cell Transplantation

“MM patients undergo rigorous treatment regimens including chemotherapy with steroids, autoHCT, as well as post-transplant continuous maintenance therapy. These interventions, though life prolonging, are likely to affect body composition. It is well known that steroids increase body fat as well as contribute to muscle atrophy, weakness, and fatigue.²⁴

Recent literature identifies chemotherapy itself as a direct contributor to sarcopenia. Proposed mechanisms include:

1) impaired food intake with reduction in vitamin D, omega 3 fatty acids and protein,
2) reduced physical activity secondary to fatigue,
3) the direct effect of chemotherapy or targeted agents on muscle, and 4) malabsorption secondary to mucositis or treatment related pancreatic insufficiency.²⁵

Lifestyle interventions can modify sarcopenia.^26–29 The goals of these interventions are to decrease fat mass, improve fat-associated dysregulation of metabolism and inflammation, increase muscle mass, and improve muscle strength and physical function.²⁷

Studies show that low-calorie, high-protein diets in conjunction with physical activity with a focus on aerobic exercise resistance training are well-established interventions that have significantly improved muscle strength and composition and also decrease fat mass.^26–28

Other novel therapies under investigation include pharmacologic therapies such as myostatin inhibitors and testosterone, among others.^{26, 28} Ongoing studies are needed to see if pharmacological therapies also have a role in the treatment of sarcopenia.²⁶ Although various studies have identified ways to modify sarcopenia, interventions aimed at modifying sarcopenia in patients with MM have not been explored.^27…”

myeloma and sarcopenia myeloma and sarcopenia

Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission