Ask the Doctors

Dear Doctor: I am a 62-year-old woman diagnosed last year with a myelodysplastic syndrome. I have blood work done every three months, but my white count keeps dropping. Most days, I feel fine, but I retired from teaching because of fatigue. What foods and drinks should I avoid? Should I eat only organic produce?

Dear Reader: To bring other readers up to speed, let's explain the basics of myelodysplastic syndrome, a bone marrow disorder. For starters, bone marrow contains a type of stem cell that produces the body's red blood cells, white blood cells and platelets. When these stem cells acquire multiple mutations, which can happen with various cancers, their ability to produce the other cells is compromised.

In myelodysplastic syndrome (MDS), a slowly developing form of cancer that can devolve into acute leukemia, abnormal stem cells reproduce within the bone marrow, where they die prematurely -- decreasing their ability to produce red and white blood cells and platelets. As you're aware, MDS often causes fatigue (caused by anemia) and a drop in white blood cells, putting people at greater risk of infection.

To answer your question about dietary changes, we might want to consider what exposures have been linked to MDS. A study in Greece compared the dietary habits and work exposures of 126 people with MDS with those of 102 people without the disease. The authors found that general pesticide exposure was linked to a 2.5 times greater risk of MDS. The association was even greater for people specifically exposed to insecticides and even greater for those exposed to the herbicide paraquat.

As for diet, those who ate meat more than five days per week had three times the odds of developing the disease compared to those who ate it less frequently, while those who ate more than two eggs a week had twice the odds compared to those who ate fewer eggs. Second, eating fruits more than five days per week decreased the likelihood of illness by nearly half. Lastly, drinking more than 15 alcoholic drinks nearly doubled the odds of developing MDS.

Of course, this was a small and retrospective study, meaning it relied on participants to recall their chemical exposure and dietary habits. A stronger prospective study in 2009 followed 471,799 men and women ages 50 to 71, and after about six years, found no association between meat, fruit or vegetable intake and MDS. The researchers did, however, find an association between obesity and smoking and MDS. Although that study didn't assess pesticide exposure, a 2014 analysis of 11 studies did. It found that exposure generally doubled the odds of MDS, although the connection was lower in the United States than Europe and Asia.

While I would like to provide dietary guidance, there simply are no studies specifically about diet for MDS patients. That said, you might want to consider organic food in order to avoid pesticides that could increase the risk of future stem cell mutations. If you smoke, obviously, you should stop, and if you have more than two drinks per day, you should decrease your intake. Increasing your fruit intake may also be helpful, as might weight loss and exercise.

Overall, take the best possible care of yourself. Your questions suggest you're already doing so.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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