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Symptoms, Treatment and Diet for POEMS Syndrome

Mar 7, 2021

Highlights

When it comes to managing a rare type of blood disorder called POEMS Syndrome, taking the right foods and supplements as part of the diet matters. Foods such as Parsnip, Caraway and Fennel are recommended to be included as part of diet when undergoing treatment with Melphalan for POEMS Syndrome, however, lauric acid rich foods such as Margarine should be avoided. Also, dietary Mint Supplements should be avoided from the diet while undergoing treatment with Thalidomide/Dexamethasone for this disease. Additionally, taking Lions Mane Mushroom by patients with POEMS Syndrome undergoing palliative treatment may not be helpful. Hence, following a personalized nutrition/diet plan customized for the specific disease type and treatment is essential to stay safe, reduce symptoms and obtain maximum nutritional benefits while undergoing treatment for any disease including POEMS Syndrome.



What is POEMS Syndrome?

POEMS Syndrome is a rare type of blood/plasma cell disorder and a paraneoplastic disorder where the effects of systemic malignancies/cancers can lead to nerve damage and affect multiple systems in the body. It is a chronic disorder with an average survival time ranging between 8 and 14 years. The term “POEMS” was coined based on the signs and symptoms associated with this disease.

  • Polyneuropathy – nerve damage resulting in numbness and weakness in the legs and hands; shortness of breath
  • Organomegaly –  abnormal enlargement of organs such as spleen, liver or lymph nodes.
  • Endocrinopathy – a disease of the endocrine gland resulting in abnormal hormone levels which can lead to hypothyroidism, diabetes, metabolic problems, improper functioning of the reproductive system and can affect many other biological functions.
  • Monoclonal gammopathy – abnormal growth of plasma cells in the bones/bone marrow cells that produce a protein called monoclonal protein that can be detected in blood or urine tests. 
  • Skin changes – darkened skin colour, red spots/ small cherry like growths and thicker skin; clubbed or white fingernails

Symptoms, Treatment and Diet for POEMS Syndrome

POEMS Syndrome is commonly diagnosed in people who are about 40-50 years of age, however, it can occur in people of any age. It is more commonly found in men than women.

POEMS Syndrome has prevalence of certain genetic changes. Some of the genes such as KLHL6, LTB, EHD1, EML4, HEPHL1, HIPK1, and PCDH10 are known to have genetic abnormalities in this disease resulting in a change of function, which is not common in Multiple myeloma. Additionally, angiogenic factors (which can help form new blood vessels) such as VEGF, and inflammatory cytokines like IL6 and TNF are higher in the patients with POEMS Syndrome.

The genetic abnormalities found in POEMS Syndrome can influence specific biochemical pathways to drive the disease and survive ongoing treatment.  In addition, lifestyle conditions or habits like smoking, alcohol consumption and BMI (Body Mass Index) may have a big influence on the response to your physician prescribed treatments for POEMS Syndrome. Numerous studies have consistently shown that your nutrition/diet – both food and nutritional supplements can adversely affect the treatment or be supportive or play no role. Hence, the triangulation of POEMS Syndrome genomics, planned or ongoing therapies and lifestyle need to be thoroughly considered to make decisions on what foods and supplements to consider and avoid while designing diet/nutrition plan. Also, it is important to note that when any of these conditions change, like treatment or lifestyle – it may impact the nutrition and the POEMS Syndrome nutrition plan may have to be redesigned. 

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What are the Signs and Symptoms of POEMS Syndrome?

Since the signs and symptoms of POEMS Syndrome mimic those of other health disorders, POEMS syndrome may be misdiagnosed. The signs and symptoms of POEMS Syndrome may vary greatly depending on the location of the body the disorder affects.

Following are the signs and symptoms that may be caused by POEMS Syndrome.

  • Numbness and weakness in legs and arms
  • Breathing difficulty
  • Edema or fluid retention in different parts of the body
  • Pain
  • improper functioning of the reproductive system
  • Vision problems
  • Fatigue
  • Hypothyroidism
  • Metabolic problems
  • Diabetes
  • Loss of muscle
  • Darkened skin color
  • White or clubbed nails

Though many of these symptoms may also be caused by various other health conditions, consult your doctor if you experience these symptoms to rule out the possible chances of POEMS Syndrome.

What are the Treatment Options for POEMS Syndrome?

Currently, there is no standard treatment which can cure POEMS Syndrome. The treatments used for this disease are mostly aimed at managing and improving the symptoms and not curing the disease completely. The management of POEMS Syndrome depends on the underlying plasma cell disorder and the treatment options for this condition may include:

  • Chemotherapy
  • Radiotherapy
  • Stem cell transplantation
  • Medications like Steroids, diuretics etc to relieve swelling
  • Physiotherapy for numbness and mobility issues due to neuropathy

Association of Different Foods and Supplements with POEMS Syndrome

In POEMS Syndrome, the activation or inhibition of some of the biochemical pathways including  PI3K-AKT-MTOR Signaling, MAPK Signaling, DNA Repair and Oxidative Stress plays a key role in driving the disease. Melphalan, and Thalidomide with Dexamethasone are examples of some commonly used treatment regimens for managing symptoms associated with POEMS Syndrome.

All food and nutritional supplements contain active ingredients which have a specific molecular action on different biochemical pathways. Hence, while the intake of certain food and nutritional supplements may support a specific treatment for improving symptoms associated with POEMS Syndrome, eating few other foods and supplements may lead to adverse interactions with the treatment or may worsen the disease conditions.

1. Intake of Foods Rich in Myristicin may be beneficial when taking Melphalan treatment

Myristicin is one of the key active ingredients in foods such as Parsnip, Nutmeg, Caraway and Fennel.  Intake of Myristicin along with Melphalan treatment for POEMS Syndrome may be beneficial as it decreases DNA Repair. Hence, foods like Parsnip, Caraway and Fennel are recommended to be included as part of the diet when undergoing treatment with Melphalan to alleviate symptoms associated with this disease. (Célia Martins et al, Chem Biol Interact., 2014;  Pritesh Rajni Patel MB, Biol Blood Marrow Transplant 26; (2020)- S96S255)

2. Intake of Margarine should be avoided when taking Melphalan treatment

Foods such as margarine contain active ingredients including Lauric Acid, Palmitic Acid, and others. Lauric Acid may interfere with the impact of melphalan treatment by enhancing MAPK and PI3K-AKT-MTOR signaling. Hence, margarine should be avoided from the diet while undergoing treatment with Melphalan for POEMS Syndrome. (Rocha, D. M. et al, Atherosclerosis, 2016; Heping Zhou et al, J Inflamm Res. 2020; Mariko Ishibashi et al, Cancer Immunol Res., 2016)

3. Intake of Dietary Mint Supplements should be avoided when undergoing treatment with Thalidomide/Dexamethasone

Mint Supplements contain active ingredients such as caffeic acid, apigenin and others which have reported CYP2C19, CYP2C9 and CYP3A4 (drug metabolizing enzymes) interactions with the Thalidomide and Dexamethasone treatment. Hence, mint supplements should be avoided as these may interfere with the impact of Thalidomide/Dexamethasone treatment on symptoms associated with POEMS Syndrome. (Maryvonne Steuck et al, J Agric Food Chem., 2016; Yuichi Ando et al, Clin Cancer Res., 2002; Loai Basheer et al, Oxid Med Cell Longev., 2015; Himanshu Rastogi et al, Phytother Res., 2014)

4. Intake of Lions Mane Mushroom Supplements may not be beneficial for Patients with POEMS Syndrome undergoing Supportive Care Treatment

Lions Mane Mushroom Supplements contain active ingredients such as erinacine, which may increase disease progression because of inhibition of Oxidative Stress. Oxidative stress is known to induce cell death/apoptosis in cancer cells. Hence, the intake of dietary supplements of Lions Mane Mushroom may not be beneficial for patients with POEMS Syndrome undergoing Supportive Care Treatment. (Naufal Kushairi et al, Antioxidants (Basel)., 2019)

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Conclusion

While foods such as Parsnip, Caraway and Fennel are recommended to be included as part of diet when undergoing treatment with Melphalan for POEMS Syndrome,  Margarine should be avoided. Also, intake of Mint supplements and Lions Mane Mushroom supplements may not be beneficial for patients undergoing treatment with Thalidomide/Dexamethasone and palliative care treatment, respectively. Additionally, allergies should also be considered when mapping these lists of foods and nutritional supplements to come up with a diet plan for any disease including POEMS Syndrome. 

“What should I eat?” is the most frequently asked question to cancer dieticians and physicians. The right answer depends upon cancer type, underlying genomics, current treatments, any allergies, lifestyle information, and factors like BMI.

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Top 10 Foods and Supplements to Avoid for Cancer

Go beyond same nutrition guidelines for everyone and make personalized decisions with confidence.


Cancer patients often have to deal with different chemotherapy side effects which affect their quality of life and look out for alternative therapies for cancer. Taking the right nutrition and supplements based on scientific considerations (avoiding guesswork and random selection) is the best natural remedy for cancer and treatment related side-effects.