These days as a locum doctor I tend to avoid night shift jobs. I noticed the impact that had in my decision-making in my personal life and the worrying risk that it might affect it at work too! And so I prefer to keep my body clock in check. I do however do the odd shift in a tiny private hospital where there are never more than 2 patients overnight and it is very realistic to sleep. The last shift was not quite as relaxed as usual: while the patient who was scheduled to stay was looking healthier than me after her tummy-tuck, there was another patient who was waiting to go to the local A&E to manage the ongoing bloody ooze since their nose job. Normally on these shifts I arrive at 8pm after a couple of hours commuting, I see a patient or two and then head off to bed at around 10pm. Assuming nothing goes wrong overnight, as is normally the case, I am not awoken until around 6.30am when I will check in with the patient before leaving at 8am. As far as night shift jobs go, it is perfect. But even that little difficulty last night had knock on effects. Today I travelled 2-3 hours on my commute back and found myself having a milky coffee on route even though I normally limit my dairy and caffeine intake. As I neared home the idea of having a KFC popped into my head and I couldn’t get it out. I even avoided mentioning it to a loved one over the phone to make sure nothing stopped me! Yes, it’s true - me, Dr Dil, Dilraj Kalsi, Lifestyle Doctor and Founder of Hippocrates’ Lounge had a KFC this week. I am ashamed but $% happens, how you and I can learn from it is more important now. I actively chose to harm myself with my eating with this decision. So is it just me, or is it night shift jobs that are the killer?
The real answer is both; but less is my fault than you might think. Our body relies on rhythm, there are many organs which have genes linked to rhythmic cycles but the ‘mothership’ is in the brain: the suprachiasmatic nucleus to be precise, which aligns our body to a roughly 24 hour cycle of light and dark. When workers on night shift jobs sleep at odd times, their circardian rhythm is thrown off and shift workers have been shown to have increased insulin levels leading to fat [triglyceride] storage and a 40% increased risk of heart disease. Not only that but workers on night shift jobs will choose more sugar, snacks and caffeine and less variety in food mostly due to convenience; as evidenced by my KFC and perpetuated by the ironic lack of health food in hospital vending machines
The long term effects are even more alarming. Shift work has been linked to: reduced alertness and cognition; mood disorders; heart disease; high blood pressure; diabetes; obesity; poor immunity; cancer; gastrointestinal disturbances; and possibly even rheumatoid arthritis and reproductive problems. That’s an exhaustive list. And one you wouldn’t ever think about when you’re just picking up shifts for that extra bit of cash. But this is the stuff that all adds up in the long run. So what can you do about it?
Our happy friends in Scandinavia, the happiest in the world, in fact, have a few tips. Nordic Nutrition recommends:
- Avoid eating between midnight and 6am
- Avoid large meals [meaning >20% of your daily intake] 1-2 hours before sleep
- Eat a variety of foods
- Eat breakfast before day sleep to avoid waking up hungry
- Stick to a normal day-night food intake pattern
- Avoid convenience and sugary, high-carb foods [soft drinks, sweets, breads, etc.]
- Choose vegetables, soups, salads, yoghurts, wholegrain sandwiches, cheese, fruits, boiled eggs, nuts
I have only come across these recently but in my own experience they make a lot of sense. If you wanted to be really disciplined you might minimise the grain, dairy and sugar intake but the broad principles here are sound. The only thing I consider adding is taking vitamin D supplements. During a stretch of night shifts you do not get any light exposure and I noticed a huge improvement in the quality of my sleep when I started taking them.
All in all, the simple answer to this question is yes, night shift jobs are killer. They alter our behaviours and offsets our rhythms in ways that ultimately affect our health. Obviously the most comprehensive approach to this problem would be to avoid shift work altogether but life doesn’t always work like that. The great news is that for those of you who can’t avoid it there are plenty of simple changes you can make to control your risk.
Dr Dilraj Kalsi uses Lifestyle Medicine and Digital Health to empower patients to reverse disease via his online clinic Hippocrates Lounge. He is a Lecturer in Digital Health at the University of Warwick and publishes regularly on patient empowerment with colleagues from Oxford University. For all his latest health tips straight to your inbox, sign up here!