Based on comments on my first article about nutritional supplements ^[1] that I wrote a couple of weeks ago, I was able to identify four important questions anyone should consider before deciding to take a nutritional supplement:

What benefits do you hope to achieve? Are the contents in the bottle what the label says they are? How much do they cost? Are there any risks to taking them?

All good questions. But I would like to stay focused on the first and last question: “What benefits do you hope to achieve?” and “Are there any risks to taking them?”

In my case, the first question is easier than it is for a relatively healthy person off the street. The vitamins and supplements I take are designed to either help my neuropathy or keep my blood counts up.

The second question about risks has to do with possible negative effects supplements may have on the effectiveness of the medications I take.

The two most obvious examples of this are (1) how certain foods and supplements may block the blood thinning properties of warfarin (Coumadin) that I take to prevent blood clots, and (2) the risk that supplements may interfere with the effectiveness of my oral chemotherapy, Revlimid ^[2] (lenalidomide).

I don't eat grapefruit or drink tea—both are known to interfere with the ability of warfarin to keep my blood thin and in an acceptable range. Vitamin K, which is found in green, leafy vegetables, is also thought to hamper warfarin's ability to work. But no way am I giving up eating lots of broccoli, spinach, or kale! I eat so many servings of fresh, green vegetables daily that my doctor has been able to adjust and increase my warfarin dose to compensate.

The only supplements I have been told to avoid while taking Revlimid are concentrated sources of antioxidants. My doctors aren't referring to natural food sources here—I can eat as many natural antioxidant foods as I like, such as blueberries, beans, spinach, and kale. They are referring to the new, highly concentrated potions made from mysterious leaves or tree roots found in the Amazon, or concentrated powders made from thousands of blueberries all in one bottle.

Why might this be a problem? Because antioxidants protect cells by preventing and repairing damage to the cell. This also applies to cancer cells. By taking high doses of antioxidant supplements, a patient risks strengthening the very cancer cells chemotherapy is designed to destroy.

So, I make sure to eat a handful or two of blueberries everyday, along with generous servings of broccoli, spinach, cauliflower, and/or asparagus. I also eat lots of raw nuts and home made juices, all designed to help keep my body strong and healthy enough to withstand my next round of chemo.

Next week I will cover some additional supplement options a multiple myeloma patient may want to consider. This list will include curcumin, a natural compound believed to contain anti-myeloma properties.

Until then, feel good and keep smiling! Pat