The Myeloma Alphabet Soup Handbook

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Source: Stephen B. Strum M.D.
Practice of Internal Medicine, Medical Oncology & Hematology
9808 Venice Blvd. Suite #503
Culver City, California
Telephone 310-558-4562

In the last few years increasing numbers of reports have suggested that the use of Beta Carotene may act to prevent the development of various malignancies. Beta Carotene and other similar compounds have differentiating properties that appear to affect cell growth and maturation. Beta Carotene is not toxic to the liver even in high doses in contrast to Vitamin A. Large doses of Beta Carotene will increase the body's demands for Vitamin ;therefore, those of you on 50,000 to 100,000 units of beta carotene per day will need to also increase your vitamin E to 1,000 to 2,000 units per day. The definitive role of beta carotene/vitamin E is yet to be understood, but there is sufficient reason to use beta carotene in a dose of 50,000 units per day. There is no need to supplement this with carrot juice or vitamin A. Beta carotene, like vitamin A and E is stored in the liver. Current clinical trials in prevention of cervix cancer and cancer of the lung and breast are using beta carotene. This may also be helpful in the prevention of colon cancer and melanoma.

B Complexes

The B complexes are important membrane stabilizers. They are natural tranquilizers or anti-stress vitamins because of this property. They are important vitamins to help nerve function. The B complex vitamins contain PABA which is important in protecting the skin against the harmful effects of Ultra-violet radiation. PABA is an excellent UV screening agent and helps to protect against the development of skin cancer or sun-induced skin damage e.g. wrinkling and solar keratoses. Fair complexioned people should avoid sun exposure and should use sun-blockers with at least a 15 factor as well as use B complex orally. Such people are actinic or sun sensitive and are at a greater risk for the development of skin cancers of all types. People with red hair, blue or green eyes tend to be sun sensitive (actinic sensitive). Women using oral contraceptives increase their utilization of the B vitamins and need to supplement their diet with B complex. Patient under high stress should do the same. The B vitamins are water soluble. They are not stored in the body as are beta carotene and vitamin E. B complex must be taken with food already in the stomach. If taken on an empty stomach, pain and nausea are not uncommon. The use of B complex in a dose of 100 mg once to three times a day with meals is recommended per patient tolerance. If the B complex is being absorbed the urine will be bright yellow and have a pungent smell due to the riboflavonoids present. This is to be expected and should not cause alarm. If no change in urine color is noted then suspect that your brand of B complex is not being absorbed by your body- change brands.

Vitamin C

This vitamin is important for tissue healing. Patients with peptic ulcers will heal faster on vitamin C than those without extra vitamin C. As mentioned previously, vitamin C is an anti-oxidant. It is also water soluble as B complex. I advise that it be used in doses of 2,000 to 6,000 mg after each meal to take advantage of its anti-oxidant effects. I would start with 1,000 mg after each meal and increase slowly up to 6,000 mg after each meal. Side-effects of large doses include diarrhea and flatulence. Studies in Canada show a decrease number of colon polyps in patients taking high doses of vitamin C. Such polyps are precursors for colon cancer. If we can decrease polyp formation with vitamin C perhaps we can decrease colon cancer as well. The use of vitamin C in this capacity should accompany a very low fat diet that is high in dietary fiber. Smoking and alcohol consumption will increase the excretion of vitamin C. Alcohol will actually deplete all of the water soluble vitamins. Vitamin C has been touted by Pauling and Cameron to decrease cancer growth and cause remissions in cancer patients. I have not seen any evidence in all of the studies published to warrant that conclusion. The studies published by Pauling and Cameron were scientifically unsound and poorly controlled. Major trials using high dose I.V. vitamin C fail to confirm any anti- cancer effect of this vitamin in patients with established cancer.

High dose vitamin C may be a problem in patients with a tendency to kidney stone formation. Check with your physician if this is your situation.

In patients receiving iron supplements to help treat iron deficiency, the use of vitamin C taken at the same time as the iron medicine will greatly enhance the absorption of iron. Vitamin C will help with wound healing and healing of burns. It improves the strength of the walls of the blood vessels and may help decrease the easy bruising seen with some patients. Vitamin C in topical form to prevent sunburn and to absorb the ultraviolet rays will soon be available.

Vitamin C may help people with low back pain and arthritis due to its anti-oxidant effects. This and other vitamins need to be taken over long periods of time. These substances work over time -- be patient.

Dr. Durie recommends that Myeloma patients DO NOT take more than 1000 mgs of vitamin C per day.

Vitamin D

Its principal function is to maintain blood calcium in the normal range. It does that largely by telling the intestine to absorb more calcium from the food we eat. If you're not getting enough calcium from your diet, vitamin D removes calcium from your bones. The body will keep blood calcium normal at any expense because calcium is critically important to keep your mind, lungs, muscles, and heart functioning. When skin is exposed to sunlight, the highest energy ultraviolet light, called UV-B, penetrates into the skin. It converts a precursor into vitamin D, which is then activated, first in the liver and then in the kidneys. In Boston, you can't make any vitamin D from November through February because the angle of the sun markedly limits the amount of UV-B radiation that can reach the earth's suface. If you wear a sunscreen with SPF-8, it prevents 95 percent of your skin's production of vitamin D. When you get to SPF 30, production is almost zero. Do older people make less vitamin D? Yes there's about a three to four fold decrease in the precursor of vitamin D. My belief is that people over the age of 50 need 400 to 600 IU a day, and that for people over 70 it could be as high as 800 IU, Your body destroys any extra vitamin D it makes from exposure to sunlight. Should people get a blood test for vitamin D? Yes, especially adults over the age of 50. Vitamin D deficiency is silent. There's no way of detecting it without measuring 25-hydroxyvitamin D The only natural food sources are cod liver oil and some fatty fish, but unless you're eating them two or three times a week, you're not getting enough vitamin D. Eggs also have some, but not much. Some breads and cereals are now being fortified with vitamin D, but in small quantities.

Source: Nutrition Action Health Letter Oct. 1997

Vitamin E

Please read the above. Vitamin E is an important anti-oxidant. It acts as a free radical scavenger to prevent the byproducts of chemical-cell interaction to cause cell damage. Free radicals are likely responsible for all or most of the degenerative diseases e.g. arthritis, heart disease, cancer, senility etc. The absorption or scavenging of free radicals would protect our cells from this type of injury. Other free radical scavengers include zinc, vitamin C, and selenium.

Studies have reported vitamin E to protect against some of the toxicities of ionizing radiation. Vitamin E may help to decrease the toxicity of certain chemotherapy drugs. Adriamycin is an important anti-cancer drug with potential major toxicity to the heart. The use of 1000 to 2,000 units of vitamin E per day may help to decrease this toxicity. Vitamin E may decrease some of the harmful effects of solar radiation on the skin. As cited above it works well in conjunction with beta carotene. Vitamin E appears to have stabilizing effect on the vascular system and is useful in decreasing menopausal and premenstrual symptoms. It is useful in decreasing leg cramps occurring especially at night. Vitamin E can be used in lotions or creams to protect the skin or to treat for burns. It is also helpful to treat burns secondary to radiation therapy. I have also used it with good results in patients with dermatitis resulting from poor blood circulation i.e. stasis dermatitis. It is commonly prescribed for topical use in pregnant women to prevent stretch marks on the abdomen. More recently it has been used to prevent or treat mucositis resulting from chemotherapy. I advise patients to bite into a 1000 unit capsule and swish the vitamin E around the mouth and over the mucous membranes lining the cheeks. This is done three to four times a day. You can also use liquid vitamin E to do this.


This is an anti-oxidant with activity as a free radical scavenger. Populations with high blood selenium levels are found to have lower death rates due to cancer. Mormons have high selenium blood levels perhaps related to their diet. Cancer patients have low selenium blood levels. Selenium works in harmony with vitamin E. Selenium toxicity can occur and the dose of selenium should be close to 100 MICROGRAMS (not milligrams) per day.


Calcium is deficient in most of our diets. This deficiency is most prevalent in women who have had children and have never supplemented their own diets with calcium. Calcium consumption along with exercise is the best means to prevent calcium deficiency. Once calcium is lost and signs of osteopenia develop the medical problem may be hard to reverse. Collapse of bone and fractures commonly of the pelvis may occur in such individuals. When people "shrink" with age it is due to vertebral compression fractures caused by osteopenia, commonly referred to as osteoporosis. Bone density studies will detect patients having osteopenia. Calcium, like B complex acts as a membrane stabilizer and natural tranquilizer as does magnesium and potassium. Calcium and magnesium should be taken together in a ratio of 2:1. A daily intake of Calcium of 1,000 to 1,500 mg is reasonable. Calcium/magnesium may be taken at bedtime to promote sleep. Magnesium in the form of magnesium oxide in combination with vitamin B-6 has been shown to dissolve certain types of kidney stones (calcium oxalate stones). This preparation is called Beelith and is taken twice a day. It is also helpful in patients with chronic constipation since magnesium salts act as cathartics. Patients with potassium deficiency should always be checked for magnesium deficiency. In the presence of magnesium depletion, it is very difficult to replete potassium stores. I have used a calcium citrate source containing vitamin D to enhance calcium absorption. This is an effervescent formulation and it is taken as two tablets dissolved in a glass of cold water per day. Calcium citrate is better absorbed and utilized than calcium carbonate. The use of fluoride in a liquid formulation (potassium fluoride 180 mg/cc) help bind calcium in the bones. Fluoride drops are taken as 1 drop in juice or water three times per day. This is a prescription item and must be made up by the pharmacist. The dose can be slowly increased per the physician. Fluoride in this concentration can irritate the gastric lining. Slow increases in dose are important to prevent this side-effect.


This element is important in wound healing. It also functions as antioxidant. It is helpful in the treatment of acne. It hastens healing of peptic ulcer disease and burns. The recommended dose is 100 mg per day. Chelated zinc will not cause the gastrointestinal distress the inorganic zinc will. Therefore, request a chelated zinc rather than zinc sulfate.

Coenzyme Q10

Coenzyme Q 10 (Co-Q-10) is an coenzyme involved in energy production within all the cells of the body. Co-Q-10 promotes electron transport for the most common form of body energy, oxidative phosphorylation. The electron transport system utilizes the enzyme succinate dehydrogenase-co-Q-10 reductase. This biochemical reaction pumps protons across the mitochondrial membrane which helps in the formation of ATP. ATP is the basic energy unit of the cell and accounts for approximately 95% of the total energy needs of the body. Although co-Q-10 can be synthesized within the body, deficiencies have been reported in hypertension, cardiovascular disease and in periodontal disease. In animal studies, decline in Co- Q-10 levels occur with advancing age and appear to be correlated with deterioration of the immune system.

Stephen B. Strum M.D.
September 1994
Recommendations: Vitamins, Minerals & Trace Elements
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