Dr Rupy: Today's episode is for anyone whose life doesn't align with the nine-to-five routine, whether you are a night shift worker, a new parent, a student, a frequent flyer. Basically all of us at some point are going to have broken sleep, jet lag, etc. So this episode is going to be about how to shift your body clock and use lifestyle and dietary strategies to support your health.
Dr Rupy: Hi, I'm Dr Rupy. I'm a medical doctor and nutritionist. And when I suffered a heart condition years ago, I was able to reverse it with diet and lifestyle. This opened up my eyes to the world of food as medicine to improve our health. On this podcast, I discuss ways in which you can use nutrition and lifestyle to improve your own wellbeing every day. I speak with expert guests and we lean into the science, but whilst making it as practical and as easy as possible so you can take steps to change your life today. Welcome to the Doctor's Kitchen podcast.
Dr Rupy: Hey, it's Dr Rupy. I'm going to be doing a solo episode today where I'm going to be talking about my personal experience doing night shifts and how I developed strategies to shift my body clock and support my health out of pure need. And like I said at the top of this, this episode is for not just people who do shift work. I believe a lot of us are out of sync with our natural rhythms, our circadian rhythms. So today I'm going to dive into how circadian rhythms work, why they affect everything from digestion to brain health. We're going to dive into artificial light, late meals and inconsistent sleep, as well as simple practical tips for not only shift workers, and I will be telling most of the story through shift workers, but I hope you'll be able to read between the lines and see how this could apply to you and your lifestyle, whether you are someone with an irregular shift pattern or you are a new parent or you do have a lot of travel as part of your work or routine. So these are going to be nutritional strategies and lifestyle strategies to support your internal clock. I really think this is going to be a great one to share as well. So if you have someone in your life that does have irregular schedules, maybe this is one to copy and paste the link to and send across. That really does help with the Doctor's Kitchen podcast as well. So if you find this useful, please do share on your own platforms as well.
Dr Rupy: As a doctor, I've worked hundreds of night shifts and I know the pain of staring at a vending machine and having to buy Snickers just to get through a shift because I didn't pack my tupperware. My gut felt horrible, it worsened my sleep and so I had to adapt if I wanted to look after my health. And after 15 years of working as a doctor, this is going to be a collection of my night shift strategies as well as an explainer for anyone suffering symptoms as a result of shift work, jet lag or simply irregular eating and sleeping patterns. Maybe you're a newborn parent like myself. So hopefully this is going to be really helpful for a broad range of people. And with demand for 24-hour services growing across industries, around 15 to 29% of people in countries like the UK, US and Australia work night shifts. That means millions of people are regularly eating, sleeping and living out of sync with their internal body clock. And this does not come without a cost. Shift work or any work that involves out of hours is a very unnatural way of eating and living. It is outside of our circadian rhythm. So the first part of this pod is going to be about some scary facts and it might be a hard listen for anyone who has an irregular shift pattern or travels frequently, but I do think it's possible to reduce these risks with a few simple evidence-based strategies grounded in circadian biology, I'm going to unpack that a little bit later, and lifestyle medicine. So we're going to talk about what shift work and jet lag actually do to your body, how disruption to this internal body clock affects your health and practical tips to reduce the risks before, during and after your shift, what to eat, when to eat and other supplements and other strategies that may have less evidence but I think hold promise. So let's first discuss the health effects of shift work. So looking at outcomes in large studies compared to day workers, these are the unfortunate facts. There is a raised risk of type two diabetes. Shift workers have about 10% higher risk of developing this compared to people who work regular daytime hours and that holds true across different types of shift work. You're more likely to be overweight. You have a 25% increased risk of obesity. You're more likely to have high blood pressure, also known as hypertension. There is a 30% increased risk with night shifts. Also, if you're female, there is a higher risk of menstrual disruption, a disruption to your cycle. Shift workers have significantly higher rates of irregular periods, dysmenorrhea, which is painful periods, and earlier menopause as well. There's also a link with mental health issues like depression and anxiety. In fact, in a study of more than 175,000 people, researchers found shift work to be associated with a higher risk of developing depression and anxiety. And lifestyle factors partially mediated these associations. So if you didn't smoke, if you're physically active, if you didn't consume that much alcohol, if your diet was good, but there is still a higher risk nonetheless. And then interestingly, all these different factors will predispose to a higher risk of coronary heart disease and give you a higher risk of something like a heart attack. And in a study published in JAMA, looking at the Nurses' Health Study, which is a big study looking at nurses, even after controlling for risk factors such as smoking, poor diet and lack of physical activity, these researchers saw a 15 to 18% increased risk of coronary heart disease in women who work more than 10 years doing three or more night shifts per month. So this is a really big issue. Now, it doesn't necessarily mean that shift work causes these health issues or affects everyone in the same way, but it does mean that compared to working in the day, the chances are a bit higher that you're going to suffer these conditions. And over time, across thousands of people, that adds up and it shows us that something real is going on. So the natural question now is, why? What is going on in the body that potentially raises your risk of all these different conditions? The short answer is that your body is completely out of sync with the external environment. See, we're designed to follow a rough 24-hour internal cycle called the circadian rhythm. It governs almost everything, when we feel sleepy, how we digest food, when hormones are released, how our immune system responds. And at the centre of this system is a tiny part of the brain called the suprachiasmatic nucleus or SCN for short. And this is also referred to as your master clock. And it's set by light, especially bright, high intensity morning sunlight. And your organs, like your liver cells, gut cells, pancreas, heart cells, they all have their own local clocks, but they all take cues from this SCN. So when you're exposed to light, as well as when you eat and move, all these things can affect clocks, but light is one of the biggest triggers, or it is the biggest cue. So when you work nights or you have an irregular sleep schedule, these clocks get mixed messages. So your brain is saying it's time to be awake, but your pancreas or gut still thinks it's nighttime or it's just not on the same wavelength as the rest of your body. And this mismatch between your central clock and your peripheral clocks, so your central clock being the one in your brain, peripheral ones being in your gut, your liver, etc, is what we call circadian misalignment or what researchers call circadian disruption. And over time, this sort of internal confusion puts stress on your body and it can be a recipe for ill health. So some of the things that we can observe are disruptions to hormones, things like cortisol, which is really important for your immune system, melatonin, which is colloquially known as the sleepy hormone, but it actually has a powerful antioxidant role, it has a role in anti-cancer as well. Leptin and ghrelin, which are hunger hormones and satiation hormones, these can be disrupted. And this can all increase your stress, your hunger levels, reduce energy regulation, it can impact your sleep as well. So hormone disruption as a result of this internal confusion is a real big issue. Another thing that we observe is impaired blood sugar control. So insulin, which is a hormone that is released from your pancreas in response to sugar going into your bloodstream after you've eaten something, the sensitivity to this hormone drops. And insulin plays a really important role. It is signalling to your cells, like your liver cells, your fat cells, your muscle cells, to take the sugar from your bloodstream into those cells where it can be utilized for storage or energy generation. If your sensitivity to insulin drops, your body doesn't really know what to do with the sugars that you're getting from your food. So essentially, your blood sugar raises as well. And this is something that we observe in people who are just simply sleep deprived outside of people who are eating during a night shift, for example. Your calories are essentially counting more. Another thing is increased inflammation. So if you've listened to any of our podcasts, you know that inflammation and the chronic low-grade inflammation over time is something that can predispose to a host of different conditions, everything from mental health issues, even things like dementia, as well as obesity. This chronic misalignment is linked to low-grade inflammation, which plays a huge role. You also see disruption to gut health. Your digestion slows overnight. Your microbes are essentially sleeping. Eating during this window can potentially affect things like your gut motility, hormone release and possibly impact your gut microbes negatively as well. We obviously see worse sleep, but your daytime sleep, so let's say you're doing a night shift and you're like, oh, I can actually fall asleep quite well during the day, eight hours, nine hours, but the quality of that sleep is usually less restorative. You have less deep sleep, you have less REM sleep, and this all affects your brain function, your mood, etc. Another thing that we witness is an indirect mechanism, but doing night shift or having an irregular shift pattern is linked to unhealthy eating behaviours such as high energy intake from snacking, imbalanced diets, so meals with less protein but more saturated fat, a decreased intake of fibre from fruits and vegetables. There might even be a link with a higher alcohol intake and a higher propensity to smoke, but these are indirect mechanisms. So all in all, there is an absolute cacophony, a real sort of blend of unhealthy hormonal shifts, unhealthy behaviours, all predisposing potentially to some of those associations that we mentioned earlier with type two diabetes, obesity and other chronic illnesses. And I just want to labour this point, it's not just shift workers that are at higher risk. We are all jet-lagged and circadian disrupted in some way or other because of our modern lifestyles and exposing ourselves to things like artificial light at night and irregular sleep schedules, which is a risk factor in itself. In fact, researchers have examined satellite images of city lights at night and they combined this information with obesity prevalence rates reported by the WHO. And even after adjusting for things like income and other factors, artificial light at night, also known as ALAN, Allen, it emerged as a statistically significant and positive predictor of being overweight and suffering obesity. There's also a small study looking at just how three hours of exposure to bright light at night, like you might get doing a night shift or staring at screens, can disrupt your body's metabolism. So they actually took 10 healthy young men. It was an elegant study actually, and they were tested in a special sleep lab and they had their metabolic markers rigorously measured. And what they did was they were exposed to either dim light, so that's less than 50 lux, about a candle light, and then another intervention with super bright light, 10,000 lux. So that's something to going outside on a partially sunny day. And they were exposed between the hours of 9:00 p.m. and 12:00 a.m., so midnight. And then they were allowed to sleep for seven hours. And what they discovered was that their bodies burned less fat and more carbohydrates while they slept. So essentially, what this light exposure did was disrupt the individual's metabolic flexibility. Metabolic flexibility is your body's ability to switch really easily from burning fat and carbs, which is a marker of good metabolic health. You want to be able to burn fat when you don't have carbohydrates and burn carbohydrates when you've got carbohydrates on board, and you want to be able to switch really, really easily. And so essentially what they demonstrated was it made that switch harder. Essentially what they demonstrated was that it made this switch harder and exposure to bright light alone could make it easier to gain weight and predispose to things like type two diabetes if this exposure became a regular habit. So just artificial light alone, I mean, it was quite strong artificial light. This isn't similar to what you get from a laptop, more so if you're going into a hospital environment or you've got all the lights on in your house and they're quite strong, it's still something that we should all be aware of. But in the context of someone who's got no other choice, you know, you've got to do your night shifts, you've got to do shift works, I believe it is possible to reduce these risks. So I'm going to go through my top strategies for reducing the effects of shift work and jet lag. And I'm going to talk about what you can do before a shift, during a shift and after night shifts. And this should be applicable to anyone who is travelling long haul and trying to adjust when they reach their destination. Okay, after years of experimentation, this is what I would do before a shift. You want to try and change your sleep patterns to do something called phase shift or phase shifting. And so a question I get quite often is whether it's actually truly possible to adapt to night shifts. And the answer is yes, but not perfectly and it's not necessarily ideal for everyone. But we can observe partial adaptation to this new circadian rhythm in the body by adjusting the internal clock. So circadian adaptation is the process by which your natural rhythms shift to align with a new external schedule, like a different time zone when you're travelling or working a night shift. Like I said, this is also known as phase shifting, something I personally try and do whenever I'm now travelling across multiple time zones because I no longer do night shifts. And it involves a combination of light exposure, eating schedule changes and exercise. So I'm going to give you an example of how I, someone who normally sleeps between 10:00 p.m. and 6:00 a.m., could phase shift over three days to prepare for a night shift that goes between 8:00 p.m. and 8:00 a.m. Okay. So three days before, I'm going to be trying to phase shift. So instead of waking up at 6:00 a.m., I'm going to allow myself a bit of a lie in to 8:00 a.m. And when I get up at 8:00 a.m., that's when I want to seek bright light exposure on waking. This is entraining my internal body clock that I'm not getting the early exposure at 6:00 a.m., I'm getting it at 8:00 a.m. And so now this is giving cues to my SCN, so the little part of my brain that is then sending that signal to the rest of my body, my pancreas, my gut, etc, etc. Now it's not going to have an effect straight away, but this is the phase shifting process. The other thing I'm going to do as well as delaying my light exposure is delaying my meal times by an hour or two compared to my normal routine. I may also, this is sort of buyer beware territory here, nap. I might take a nap, an hour nap in the early evening around 5:00 to 6:00 p.m. and then I'm going to try and go to bed a lot later, two hours later at midnight. That for me, just thinking about going to bed at midnight is quite anxiety provoking because I tend to try and get myself as early as I can to bed, right, at 9:00 p.m., 9:30 in the anticipation I'll probably fall asleep at 10:00. But that's that's sort of day one, three days before a night shift. Day two is I'm going to wake up later. I'm going to wake up at 10:00 a.m. I'm going to try and get my light exposure at 10:00 a.m. This is all assuming that we're not working during this time as well because I'm acutely aware that sometimes you're landed with a night shift with less than three days notice and this is quite common practice particularly in the NHS, but let's assume that you've got three days notice. So on this day two, I'm going to try and get my light exposure between 10:00 a.m. and 2:00 p.m. So again, I'm getting that exposure, getting that signal to my brain, my brain is going to communicate that to the rest of my body and hopefully they're going to follow suit as well. I'm going to continue to shift my meal slightly later as well. I'm going to have another nap in the evening about 60 minutes around 7:00 p.m. I'm going to try and go to bed at 2:00 a.m. I'm really going to push myself to get to bed at 2:00 a.m. And the day before, I'm going to wake up even later, 12:00 p.m. Get my daytime light exposure between 12:00 p.m. and 4:00 p.m. My meal is going to be aligned to this new schedule and I'm going to have a nap in the evening around 9:00 p.m. and then go to bed at 4:00 a.m. So on the day of my shift, I'm going to be waking up at 2:00 p.m. So this is super late to align with this new night schedule. I'm going to get light exposure almost immediately. This is where it's up to you as to whether you want to take a little nap before your shift. This is kind of very dangerous territory because you don't want to have a nap and then suddenly find yourself four hours later like, oh my god, I missed my shift. This is something that sort of takes a bit of practice. It's more of an art than a science at this point. But you're going to be really fastidious if you want to take this nap. And then I'm going to get up around 4:00 or 5:00 p.m. in anticipation of my shift, expose myself to light via a light box if you can get one, or just turning the lights on and doing a little bit of exercise to get my body moving. And then I'm going to be using caffeine strategically at this point, the first part of my shift and avoiding caffeine after 2:00 a.m. So I'm going to use it to sort of pump myself up to get ready for that shift. My my meals are going to be shifted further. So dinner becomes my breakfast and then I'm going to fast overnight, we'll talk about that a little bit later, and then I'm going to have breakfast, it's going to be my dinner. And after my routine, I'll talk about that a little bit later. So that's the general sort of thinking, the theory. It's phase shifting is very different for different people because it can take anywhere between three to five days to shift six to eight hours and everyone is just an individual. So you really got to try this out and just figure out what works for you. So remember the key strategies we're using here to phase shift are light exposure, so bright light during your new day, meal timing, so eating meals aligned to your new sleep-wake cycle, naps, buyer beware, and this consistent routine once you've started your night shift. You are going to feel groggy on day one and day two of your night shift. There is no two ways about it. Very rarely have I come across anyone that loves night shifts and can adapt very easily. Usually it's the younger generation, so when you're 20s, you're probably a little bit more adaptable, but certainly me, like I'm 40 this year, this is something that I find harder and harder as we go along. So if you were to try this, are there actually any benefits that are evidence-based? Well, there was a small study that followed real-world night workers through a series of shifts and they monitored their recovery sleep in a lab. And they found that some people partially adapted, meaning that their rhythms started to shift to better match their their new routine. And compared to the unadapted group, the partially adapted group got around 29 minutes more REM sleep, which is critical for brain and emotional health, a particular stage of sleep. They slept longer in the days before their shifts and they had more stable sleep timing as well. So while adaptation isn't automatic and it's different for anyone, for everyone, the body can begin to adjust with this consistency and this is where the right habits come in. And because night shifts are generally over a few consecutive days and then back to less extreme shift patterns, we constantly have to adapt to ensure that our health is protected. So I do think it's worth the investment. So that is my best advice of what to do before a night shift in preparation. You know, doing all the simple things like having a Mediterranean style diet, making sure that you're not having too much sugar, making sure that you're not having alcohol as well, that will disrupt your sleep. These are all things to prepare your body and potentially even shift it so you're better adapted for the night shift itself. Okay, what do you do during a night shift? What are the things that you can do to ensure that you're having the best possible outcome given the stressor that you know you're going into? Well, the first thing is strategic light exposure. So using this bright light first in the first half of your shift to stay alert is super important. And I would personally invest in a light box. A light box is a special type of box that you can buy online and it can deliver anywhere up to 10,000 lux, which is like a partially sunny day outside. Direct sunlight is anywhere between 30,000 and 100,000 plus lux. So 10,000 lux is giving you a really good dose of light that can entrain your circadian rhythm. We also use it in seasonal affective disorder and other disorders as well. I think it's a really good investment to have if you are a regular shift worker. The other thing, as well as strategic light exposure, it's about strategic light avoidance as well. So wearing blue light blocking glasses towards the end of your shift or trying to dim lights, which is impossible if you're working in the NHS and in A&E or ITU, I get that. But if you can use anything to block the light towards the end of your shift, that is going to help you get to sleep and improve the quality of your sleep when you're trying to get rest during the day. There was a really intriguing small study published in 2023 involving 50 nurses working full-time rapidly rotating shift schedules who utilized some of these light strategies. So the experimental intervention in the study was light exposure before night shifts with a light box, like I mentioned, at home before their shift started. So this is something that they're using to sort of like amp up their body, make sure everything's aligned. And the aim of this was to, you know, improve this circadian alignment. And they also used light avoidance at the end of the shift. Compared to the baseline observation period, the intervention, this light stuff, reduced errors by 67%, which is wild. I think that was super, super interesting. Again, small study, lots of issues with the design, but this reduction was partially mediated by improvements in fatigue. And these experimental participants reported less fatigue on work days than the control participants. So having some of these strategies, utilizing light, given that we know it's such a strong cue to the rest of our body, is for me, a great investment as it pertains to the quality of your work, regardless of whether you work in medicine or not. These are things that can actually improve our cognitive functioning and even improve our sleep as well. I actually recently reached out to our Instagram community and asked them for their suggestions and we have, you know, loads of nurses, doctors, shift workers across the number of people that follow Doctor's Kitchen. And one of whom reached out is new consultant Dr. Anita Mitra, who utilizes strategic light avoidance in the at the end of her shift. So she wears her sunnies on the way back from coming from hospital to get herself in that sleepy state and actually improve her sleep during the day. So lots of people have suggested sunglasses at the end of their shift. It's super important, particularly during summertime in the UK because it's so bright in the mornings. So yeah, trying to minimize that exposure towards the second half of your shift is something that a lot of people do swear by. Another strategy for during your shift is what I call too mad. Now, I know everyone's very mad about being a night shift worker. I was mad about it. You don't want to get too mad, you want to use too mad. Too mad is two meals a day. So your dinner becomes breakfast and your breakfast becomes dinner. So your main meal before your shift is something that is quite substantial, but not carb heavy. You want something that has good amounts of protein, good amounts of vegetables and quality fats. This is going to prevent cravings in the middle of the night, hopefully. This is going to keep your energy levels steady. This isn't going to cause glucose spikes and then corresponding crashes that a lot of people will recognize as that sort of energy droop that you get, you know, regardless of whether you're working a shift or not, in the middle of the morning, a regular morning, this is what a lot of people report, particularly if you've had a refined carb heavy breakfast. So this is definitely something you want to avoid. And after doing years of experimentation with what I eat at the start of my meal, a suggestion for me is having leftovers. So literally, my dinner becomes my breakfast. I'm a big fan of leftovers regardless. So what I might be having is a chicken curry with peas and coconut milk with a side salad or like a small portion of whole grains, not too much on the carbohydrate front, but I'm getting enough protein, enough really good quality fats. It could be something simple. It could be a chicken salad with a tahini dressing. You're getting protein from the chicken, you're getting good quality fats from the tahini, you're getting your green vegetables, you can put some pumpkin seeds on top as well for a little bit of texture, extra protein, fibre and a little bit more of those fats as well. These are steadying for your energy levels and these are great examples of what to consume before a night shift. So really think about dinner becoming your breakfast as well. Now, if you do need to snack during the shift, and trust me, I am a snacker. I try not to snack during the middle of my shift. We'll get into that a little bit later. Essentially, it's because you're asking your microbes to do some work in the middle of the night when they shouldn't really be up. And this is a lot of what people report as bloating. There may be something that we can mitigate against that. We'll talk about that a little bit later. But you want to have a very light snack during the shift. So this is something that is a little bit of yogurt, fruit, a handful of nuts, maybe a soup. You definitely do not want to be having Domino's, Pizza Express, Pizza Hut, whatever's open, unfortunately, in the middle of the night. You know, no judgment. I've been in those scenarios myself where you just have incredible cravings in the middle of the night. You just need some energy, you just need something quick and the only options available to us are the fast food deliveries. So this is exactly what you do not want to be eating because high saturated fat, high refined carbohydrates, your microbes don't know what to do with them. Your body is not releasing insulin to the same degree as it does during the day. These calories count more, your sugar level will be higher and your ability to utilize this as energy falls. So you're more likely to put this on as weight and it can lead to a whole bunch of different metabolic issues further down the line. And doing this repeatedly, you know, one-off is probably fine, but if you do this repeatedly, which a lot of people find themselves in the pattern of doing, this, I feel, is in part related to what we see in those big outcome studies that we discussed right at the start of this podcast. Higher rates of type two diabetes, higher rates of obesity, higher rates of cardiovascular disease. So please be aware of anything that you eat in that window between the start of your shift and the end of your shift. A lot of people recognize this themselves. Again, when we looked at our Instagram community, loads of people fast during that period between the start of their shift and the end of their shift because they just feel better as well. A lot more better in terms of digestion and a lot more better a lot better in terms of energy levels as well. And then at the end of your shift, you want to have your breakfast. And your breakfast is actually going to be something that's relatively light because you don't want to be disrupting those sleep signals that you ideally want to have at the end of your shift to get you good quality sleep so you're rested for the following night shift the next day. So having a light breakfast, again, I would choose savoury, I would choose low refined carbohydrates. It would be something very similar to my dinner but just smaller in quantity. A light salad, something with a little bit of protein, good quality fats, nothing that's going to cause a slump and certainly nothing that's going to be so heavy that you're still digesting it when you're trying to go to sleep. Regardless of anything that you eat within these first couple of night shifts, unfortunately, you're probably going to get some digestive discomfort just purely because of the fact that you are eating outside the normal window when your body is expecting food. Looking at some research, although not directly examining night shifts, there was a study examining whether shift workers benefit from TRE, which is time-restricted eating. And in a randomized control trial involving around 130 shift workers, these were firefighters aged between 23 and 60, they followed either a 10-hour time-restricted eating regimen, which is basically, you know, if you start eating between 8:00 a.m. and you finish eating at 6:00 p.m., or eating without any restriction whatsoever. And they followed them for 12 weeks. And what they found was that when both of these groups were advised to consume the same sort of diet, Mediterranean style, that the participants in the time-restricted eating group decreased their daily feeding window by about three hours from a control of 14. So if you were in the control, you were eating around 14 hours, and if you were in the TRE, you were eating around 10 hours. And there were some benefits in both of the groups, probably because they were told to, you know, A, you're in a study and B, you need to eat Mediterranean, so it probably shifted the behaviours of both groups. But they found significant extra benefits in the TRE group. What they found is that their weight reduced, their insulin sensitivity increased, their fasting blood glucose went down, their average blood glucose over the preceding couple of months went down, their sleep disturbances went down, their inflammation levels went down. There are lots of different benefits. Now, we know that there are benefits of time-restricted eating. This has been shown before in other studies, but not specifically in shift-working cohorts. And I think this was interesting because this could be a strategy that is useful during shifts as well as potentially during night shifts as well. And I believe from some of the potential mechanisms of time-restricted eating that these are applicable to when you're doing night shifts. So if you can keep that feeding window just dinner and just a breakfast, I think there are lots of benefits to to be gained and if anything, mitigating some of the ill effects of having to do night shifts and eating outside of those windows. So if we're just focusing now on the during night shift, we've talked about strategic light exposure and avoidance, too mad. Team prep ahead. This is something that I think has benefits beyond the actual consumption of food. So a team prep ahead is something that I've tried to do a bunch of times in different A&E departments that I've worked in over the last 15 years. And it's where you as a collective are all working with the same night shift team. This generally happens that same nurses come on, same doctors come on. There is a little bit of overlap, but it can be easy to organize with a WhatsApp group. And it's where everyone brings in one particular ingredient and you have like a mini feast at the start of your shift. So everyone comes in about 30 minutes earlier, brings in all the food, and then you sort of mix and match. It's like creating your own sort of like mini healthy Chipotle or, you know, healthy salad bar, like a sweet greens or a salad green or whatever you want to call them. So someone will bring in sweet corn, someone will bring in cooked chicken, someone will bring in roasted sweet potatoes, someone will bring in like a mixture of greens, and then you take turns as to whoever's bringing what. And you try and keep it as healthy as possible. I know people love to, I've worked in so many different departments, they bring in like, you know, cheese boards and crackers and stuff. And it's look, it's great. I love that because you kind of feel like you want to eat something that gives you joy and comfort, but trust me, like there's a time for that and it's not going to be a night shifts without sounding puritanical. We want to be looking after our health as much as possible. So when we did this, like everyone brought this different ingredient and then you get a plate or a bowl that you bring in and you just mix and match. And that way you've got a delicious, easy diversity bowl with all those different ingredients, all offering those anti-inflammatory benefits, those high fats, the good quality fats, those good amounts of protein, choosing your proteins, all that kind of stuff. And it's a great communal way of eating and sort of developing some camaraderie about the night shift that you're just about to go on. So it's a lovely thing to do if you can, team prep ahead. Another thing that I've tried to instigate without much success actually is a pre-shift exercise. Everyone thought it was a bit wild for trying to do hit training before a night shift. But actually, we know that exercise can improve alertness and help with circadian shifting as well. So regular physical exercise is obviously something that we should all be doing. And this can generally help mitigate some of the negative effects of shift work outside of doing the night shift. But even when you're doing night shifts, exercising before the start of your night shift can boost alertness and light exercise after a night shift can potentially help wind down and prepare for sleep. So the kind of exercises that I was doing before night shifts were hit training, not a massive amount of hit training, just 10 to 15 minutes, maybe a quick Tabata, maybe star jumps, that kind of thing, before I had my shower and got ready and light exposure, all the rest of it. And at the end of my shift, it would be something like Hatha yoga or Yin yoga, which I've recently discovered even more actually. I didn't realize I was doing Yin, but it's a beautiful restorative type of yoga that focuses on breath work and slow movement and keeping a particular position for a long period of time that isn't too strenuous. And that's a great way to prepare for sleep as well. There was a nature paper that argued that strategically timed physical activity could help shift workers adapt their circadian rhythms to night shift work by eliciting this phase delay. So it's another way of developing a cue to your body in the same way light or strategic light exposure can be. Exercise is another one of those cues. So it increases alertness and mood. It can increase neurotransmitters like dopamine and serotonin. Like I said, this circadian cue is it's not as strong as light, but it's a non-photic time cue that can shift your internal clock. So it can signal to your brain that it's time to be alert and it can push your other cells and signals to your other cells, making it easier to stay alert during the other during the night shift as well. There is an interesting potential mechanism of it causing pupils to dilate. So if you've got dilated pupils as a result of doing some exercise, it could allow more light into the eyes and indirectly enhance the effect of the light cue as a circadian cue. So that was quite an interesting hypothesis. And I think more generally, just the habit of exercise is almost like a buffer to the body's stress response that is going to be heightened, unfortunately, as a result of doing shift work or just having irregular shift patterns as well. It's one of the most powerful tools that we have to prevent chronic illness. So I didn't want to remove that exposure during night shifts, particularly when I was doing night shifts so often working in A&E and ITU. So if you can combine carefully timed exercise with light exposure, it's almost like this combination can work together to help your body clock adjust to night shifts and it's even more valuable if you're in a job where light is not controllable like in a hospital environment, for example. Again, during your night shift, using caffeine strategically and wisely. So a dose early in your shift can increase alertness. It's essentially blocking the adenosine receptor, which is responsible for that increased alertness. If you're sensitive to caffeine and you're not used to having caffeine, you may experience a caffeine crash in the middle of the night, which is not what you want. And this is what leads to a lot of people overconsuming caffeine during the night and that has a knock-on effect on their sleep quality during the day. So if you are sensitive to it, it might be something to avoid, but if you can use it strategically, like I do, at the start of the shift and make sure you're not having it after midnight or 1:00 a.m. It sounds really strange for me to even say that, but you shouldn't be having caffeine around that time because generally it has a half-life of 8 to 12 hours. So if you're having a cup of coffee at that time, half of that is going to be potentially in your system when you're trying to go to bed and that's not what you want. Another thing on the subject of liquids is staying hydrated. So one of the things that can lead to an idea of craving is actually not being hydrated well enough. So ensuring that you're drinking plenty of water, this might be an option where I think electrolytes could have a role. I haven't come across many studies looking at electrolyte replacement during night shifts, but staying hydrated appropriately, ensuring that your cells are getting the necessary hydration, potassium, magnesium, those sort of blends that you find in very cheap and accessible electrolyte drink powders that you can buy online or in pharmacies. These might be an option and it could help with your your microbes as well. Sometimes that dehydration in the middle of the night may lead to digestive discomfort as well. So making sure you're staying hydrated appropriately, you're constantly drinking water and not diuretic drinks. So caffeine, particularly in the middle of the night as well, because that can dehydrate you. We've talked about how you can prepare for your night shift, what you can do during your night shift, food and light avoidance and light exposure, etc. What do you do after your night shift? How can you use this period of time to optimize your energy levels, your concentration levels, so you're bringing your best on your night shift and winding down after the night shift set is over? Sleep cave. So you want to block out all light with curtains or an eye mask and you want to keep your room cool. Use ear plugs or white noise if needed. I used white noise actually. I found it amazing because it blocked out everything. Um, because I obviously I was when I was doing night shifts, particularly when I was working in Australia, I had folks who were working from home and just working around and it can be really, really disrupting. Um, making sure you put a sign on the front door like, do not press this button. Uh, ear plugs, I think were really, really helpful for me as well. But you want to essentially create this sleep cave. Block out the light, keep the room cool, make sure it's well ventilated, use ear plugs, white noise if needed. Create this cave because whatever ounce of REM sleep you can get, deep sleep you can get is going to pay dividends on your night shifts and afterwards as well. It's going to mitigate against all those different issues that we've just described. So make sure you've created that cave and everyone in your household respects that because this is about your health at the end of the day. It's not just about you, you know, feeling energetic, it's actually about your long-term wellbeing. Avoid alcohol after nights, during and afterwards. So I remember when I did my first night shift, uh, set of night shifts, and uh, it was almost like a tradition for the registrar, who's our senior, to take us out for a brunch where you have like a mimosa or like, you know, um, a bloody Mary, uh, to sort of like, you know, celebrate popping your cherry, doing the first night shift. It's it's really, uh, it's a moment for celebration because you survived it. And I get that. And I think, you know, if you're doing that in your 20s, it makes complete sense. I don't, like I said throughout this whole thing, I don't want to sound puritanical. After you've done a few night shifts, you don't want to be doing this anymore. Uh, because this is probably the worst thing you can do after a set of nights. Not only are you exposing yourself to an additional toxin that is going to be bad for your gut and your circadian rhythm as well. Um, it's just not something that you want to compound the insult that you've already experienced. And it can affect the speed at which you get back to normal and go back to your rhythm. So you're going to be phase shifting the opposite direction now. You're going to be training your body to get back onto a normal 9 to 5 or whatever your normal schedule is. So please, please, please avoid alcohol after nights. You might find that a glass of alcohol in the morning helps you get to sleep during the day, but the quality of said sleep is going to be really, really poor. I think Matt Walker said this really aptly when he described the use of benzodiazepines and alcohol as equating to someone being hit over the head with a baseball bat until they're knocked out. You wouldn't say that the person passed out on the floor as a result of being knocked on the head is having good quality sleep. And this is essentially what some of these substances can do. They can disrupt the normal sleep architecture, such that you're not really getting sleep, you're just getting unconsciousness. And so I really, really recommend people avoid alcohol after nights and even over the following nights as well, because you're still trying to get your body to adapt during this time period. It's really, really important to avoid this, which is why I'm being quite blunt about it. Avoid alcohol after night shifts. We've talked about blue blocking glasses and sunnies on your way home. I would also use relaxation techniques. Now, if you struggle to sleep, which is perhaps why you're having a glass of wine or a bit of alcohol to get you to go to sleep, try instead 10 to 20 minutes of yoga nidra or a body scan or box breathing. So yoga nidra is a very well-studied and well-regarded breathing technique that comes from the Ayurvedic tradition, where you breathe in through your nostrils alternately and breathing out, and it can be very, very relaxing. It changes the frequency of your brain waves and it can improve not only the subjective feeling of relaxation, but the literal change, or it can literally change your your brain waves to get you in that state of relaxation. A body scan is something that I personally do, where closing my eyes, either cross-legged, sat up or lying on the floor, I concentrate on my toes, and then my ankle, and then my knee, and I work my way up my body, trying to shift my attention and essentially that focuses my brain and instead of it being scattered across all these different questions or different experiences that I had the night before or like from whatever I'm thinking about, whatever I've seen on my phone, I'm focusing my attention on my body and that again can help you get into a deeper state of relaxation and switch off. And then box breathing is where you breathe in for four seconds, hold for four, breathe out for four, hold for four, etc, etc. Doing that 10 to 20 times can reduce cortisol and support recovery as well. So getting every element of your physiology into a more relaxed state is something that you want to try and a better way than substances is using some of these relaxation techniques. Those are the core techniques to survive night shifts before, during and after. Let's talk about some fun things now, some extras. These have got less evidence, but I've certainly used some of these and I think they work for me, but everyone's different. Creatine. So there is a suggestion that creatine can help with sleep deprivation. Creatine, just as a refresher, is a naturally occurring compound that helps regenerate ATP, which is the main energy currency in the body. And whilst it's widely known for improving strength and muscle performance, which is why it's so commonly used in the bodybuilding community and the gym fitness community, there are some recent studies that suggest that creatine can also support brain function and reduce fatigue because creatine helps buffer ATP levels in the brain. So these ATP levels can easily become depleted when you're sleep deprived. So anything that can maintain or buffer these ATP levels in the brain could be a good thing. And this buffering effect can help reduce the perception of fatigue, maybe improve mental clarity during night shifts, but this is still hotly debated. There are some examples of research. There was a 2006 study that found that creatine, 5 grams per day for seven days, improved reaction time and cognitive performance in sleep-deprived participants compared to placebo. There was another small study that showed that creatine reduced mental fatigue and improved mood after 24 hours of sleep deprivation. Most of these studies, as you've probably gathered, have focused on short-term sleep deprivation, you know, 24 to 36 hours, not chronic night shift work. So while creatine may help in the short term, there is less evidence on the long-term benefits for ongoing night shifts. But look, as a safe supplement and for someone who tolerates it well, there are individual differences, like not everyone responds the same to creatine and some may see more cognitive benefits than others. But speaking personally now, as someone who can tolerate creatine, doesn't have any GI side effects, has experienced some strength benefits from using it in a fitness capacity, I think it's worth the trial. And as a dad to a newborn, seven months who's still all over his sleep and, you know, waking up in the middle of the night, I'm hedging my bets. I'm taking a bit of creatine around 5 grams. There may be extra benefits at 10 grams and 15 grams, but I'm just going 5 grams for now. So I think it's relatively safe and it's worth a shot, but it's completely up to you. Another thing is I reduce my caffeine intake the week before. Why do I do this? Well, I don't want to be consuming more than two to three cups of coffee during my night shift because unless I'm having those two or three cups right at the start, I'm going to end up spacing it throughout the whole night shift and I don't want to be having it too close to my new bedtime. So I reduce my caffeine intake from two to three cups to like one cup, not so much that I experience maybe some headaches or some withdrawal effects, but enough that I can just tolerate one cup at the start of my shift. It gives me the energy that I want. I'm using it strategically and I'm not going to suffer any ill effects of having too much caffeine and thus it affecting my sleep during the day. So I want to be really strategic about caffeine and I feel reducing my caffeine in the week before my night shift is something that I've experimented with and it works for me. Probiotics. This is a really interesting one. So a common complaint, and we spoke to a few of our Instagram community members, a common complaint with people doing night shifts is bloating. Now, the reason why, the obvious reason why is because of the circadian disruption, your brain is out of sync with your pancreas, which is out of sync with your microbes, which is out of sync with your liver cells, etc, etc. Your microbes are just not going to know what to do. And so when you start eating food in the middle of the night when they are sleeping, it's almost like you're waking them up and you've like tried to get them to do some work. And obviously they're going to be a bit groggy, they're not going to be as efficient, they're going to produce a bit more gas potentially. These are all things that lead to some of these symptoms that people have regardless of what they eat in the middle of the night. So there was a study published in Frontiers in Immunology in January 2021, examining the effects of probiotics on night shift workers. Small study, and they tested two probiotic strains, Lactobacillus acidophilus and Bifidobacterium animalis, and they enrolled around 80 participants with an average age of 41, and they were performing routine night shifts. And the intervention was around two weeks, during which the participants took this daily probiotic supplement. They did some tests, they found that the supplements, the probiotic strains were actually alive in the digestive tract. It definitely was present. And what they found is that these probiotics helped moderate some changes in immune markers associated with stress before night shifts. There was a suggestion that it improved some digestive discomfort as well. And anecdotally, a lot of people have suggested that taking probiotics has helped them as well. Whether or not this is placebo, what strain is going to be beneficial for night shift workers, these are all questions I do not have answers for. I think probiotics generally are not harmful and if you are having some symptoms, as long as you've excluded other causes, it may be worth a shot. I don't think there would be anything wrong with trying a bit of like a lactobacillus or a bifidobacterium probiotic, but the specific strain that could be beneficial, I've got no idea about. There isn't any evidence to suggest that there are specific strains that are useful for circadian rhythm disruption, at least not from what I've seen. You may benefit from having a bit more probiotics in your diet as well. So you can get that from kimchi and sauerkraut and fermented yogurts. These may or kefirs, these may be beneficial, but again, I haven't seen much evidence for them as well. So again, one of these things, worth a shot. Would I do it? Probably. Have I done it before? I probably didn't know too much about probiotic strains back then, so I haven't tried it personally, but there are some studies that show some immune benefits. Talking of other supplements that again, I can't speak with much confidence about, but I personally have used them in the past, melatonin. Now, melatonin in the UK is only prescribable, whereas in other countries like the US, you can buy it over the counter like smarties. And I personally think that's wrong. I think melatonin as an endogenous hormone is something that we should be quite careful of. Melatonin is generally well tolerated, but still, I don't think just because it's well tolerated means that everyone should have access to it. And the dosages that are available in some pharmacies are huge, 10 milligrams, given that the body produces this in picograms, which is very, very small, taking milligrams of this stuff, which is a far higher amount, may not be a good thing. So melatonin is, like I said, a hormone, it's actually involved in instigating puberty. There are a number of other effects of melatonin other than creating sleepiness. It's actually an antioxidant, it's got lots of anti-cancer benefits. I have used melatonin in the past to get me back into rhythm after my night shifts. So taking 0.5 milligrams of melatonin a few hours before bed has helped me shift my circadian rhythm back into a normal rhythm. And that's helped me get a higher quality sleep that I've measured using a sleep tracker. So melatonin for me has been useful. I do not use melatonin regularly and I don't advise people taking melatonin regularly. When I've used melatonin simply to get myself back into a better rhythm or just improve the quality of my sleep, I have a hangover effect the next day. So I definitely feel grogginess, I feel less alert. So this is why I've only used it during night shifts where I'm trying to get back into a rhythm. So I think for me, there are probably different responders to melatonin. For me, taking a very, very small amount of melatonin to phase shift back into a normal working routine has been useful, but it's horses for courses, it could be very, very different for you. Another thing that again is very different for different people, a magnesium supplements. Personally, I think magnesium supplements are beneficial. They can be useful for sleep quality, given that a lot of us are magnesium deficient. Magnesium wouldn't be a bad thing to try. And certainly if you're getting back into a rhythm after a night shift, taking anywhere between 200 and 400 milligrams of magnesium, whether that's magnesium citrate, magnesium glycinate or bisglycinate, these are all various forms that work fairly similarly. These could be useful for you as well, just getting yourself back into that that normal routine. The speed at which someone can shift their circadian rhythm actually does also depend on several other factors, including the individual's natural chronotype. So we're all different in terms of whether we're more likely to be morning people or night people. I think this is shiftable, but there is like an inherent natural type. And also how consistent they are with their adjustment strategies as well, as well as any other stressors. We haven't even talked about stress, psychological stress. You know, aside from things like alcohol, poor diet, or lack of movement, or how often we use our phones, the other things that can distract our minds, these are all things that can disrupt or affect the speed of circadian rhythm misalignment or alignment, depending on which way you're going. And everyone's very different. You know, remember, these are guides and suggestions, not the rules. So we've talked about what to do before to help prepare your body for the stressor, what to do during and what to do afterwards. And I also wanted to just to share some of our community's suggestions as well, because there've been some really lovely suggestions. In addition to Dr. Anita's, you know, sunnies on the way home before bed, dinner and coffee pre-shift, light snacks during and brekkie before having the first sleep, and then a nap just before. I think that was really, really good advice and very similar to what I do myself. Um, interesting, uh, having light snacks during because I think particularly, you know, Dr. Anita's a surgeon, so you're likely going to be going into surgery in the middle of the night, and if you're going to be doing a prolonged surgery or an emergency surgery or a surgery you just don't know how long you're going to be in there for, actually having some energy on board is really, really important. So again, remember, everything that I've said is a guide, not the rule. Um, I've had a nutritionist talk about how for her night shift nutrition clients, she gives them the main meal right before the shift, and then something low carb and sustaining. It could be cottage cheese, avocado, basil, mint, pumpkin seeds. These are really, really good suggestions. Another lady I've got, keep meals the same, dinner before and little breakfast at 6:00 to 7:00, and then a meal pre-sleep. I think that's really, really good advice. Uh, eating a good meal before going to bed, otherwise you'll wake up in the middle of the day hungry. That's I I've had that experience myself. So that's really good advice, making sure that you're having a light meal, but not so light that you're going to wake up hungry. You want to be able to sustain that sleep throughout the day as much as you can. Another suggestion from Michelle was very similar to mine. So eating a main meal before work, fasting overnight and only drinking herbal tea at work. I think herbal teas are underrated. Uh, herbal teas are great. They have a digestive properties. If you're having something like, uh, peppermint, licorice, uh, chamomile, these are all, uh, great for your for your gut as well. So these could have extra benefits. So I think herbal tea, decaffeinated teas, uh, could could be, uh, worth the investment. And remember, if you're going to be having herbal teas or any teas for that matter, try and go for natural bags, not the, uh, plastic bags. They're they're usually, um, uh, white and quite, I mean, plasticky when you feel them, because these are leaching microplastics into your tea. Um, you want to be having the natural bags that are like brown and, uh, they'll say natural unbleached bags on the packaging as well. Chef Chris Baber says easy to digest foods with plenty of water. I think that's really good advice. I personally have whole grains, uh, pure lentils, these are really easy to digest for me. So using whatever is whole, largely plant-based, uh, and easy to digest for you is a really, really good suggestion. A lot of people are saying drinking coffee at the start of the shift, but then only drinking water after that. I think this is really, really good, uh, advice. And drinking lots of water in general will just, you know, help you feel better, uh, the next day as well. Elise says, uh, she works in theatre and she focuses on protein and energy rich foods pre-show and magnesium afterwards. I think that's great advice. And yeah, as a magnesium advocate myself, I think that's great. Avoiding sugar at night. Uh, I think this is probably something I didn't harbor enough on, but trying to remove the Haribo, the chocolates, the sweets, the little quick energy releases, uh, of sugar, you know, as tempting as it is in the middle of the night, these are things that you want to avoid as much as possible. Again, I'm not trying to be puritanical, but when it becomes a habit, your gut runs into problems. So trying to avoid eating sugar at night, I think is really, really good advice. A lot of people saying simply crying, uh, because you're doing night shifts, but yeah, I know I get the jokes. There's, uh, there's a lot of shared angst. I really hope this is sound advice for not only shift workers and night shift workers, but people who have irregular schedules. And if you are looking to change your circadian rhythm to meet a destination, particularly if you're going across time zones where you're travelling across the globe rather than up or down, where you're just going to have the sort of travel fatigue and not the circadian disruption. Uh, these are all going to be sound tips for you as well. So in training yourself with light, using exercise as an additional cue, and then also mimicking your meals around your destination time zone. These are all things that I think are going to be useful as well. If there's anything I've missed, let me know in the comments. I'd love to read them.
Dr Rupy: Thanks so much for listening to this episode of the Doctor's Kitchen podcast. Remember, you can support the pod by rating on Apple, follow along by hitting the subscribe button on Spotify, and you can catch all of our podcasts on YouTube if you enjoy seeing our smiley faces. Review show notes on the doctorskitchen.com website and sign up to our free weekly newsletters where we do deep dives into ingredients, the latest nutrition news, and of course, lots of recipes by subscribing to the Eat, Listen, Read newsletter by going to the doctorskitchen.com/newsletter. And if you're looking to take your health further, why not download the Doctor's Kitchen app for free from the App Store. I will see you here next time.
