Is night shift making you sick, fat, and depressed?

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I used to think that night shift wasn’t that big of a deal. In fact, I had many “good reasons” for working late at the psychiatric hospital. It was calmer than the day-shift, I made extra money, and I liked the relaxed vibe I had with my co-workers. But many years later and quite a bit of reflection, I realized how damaging that time of my life was to my body and mind.

I ate cookies and cake during the night when I was bored, I was isolated from my friends who worked normal hours, I barely had the energy to workout (and consequently gained 15 pounds), and most importantly, I felt very unhappy. It wasn’t until I quit that job and started looking at the research, that I realized I was falling apart because of my unbalanced sleep schedule. Come to find out, night shift disrupts our natural circadian rhythm leading increased risk of disease, obesity, diabetes, fatigue, sleep disturbances, and overall well-being.

In this blog post, I’ll discuss the basics of circadian biology, the harmful effects of disrupted circadian rhythms, and possible remedies if you’re stuck in shift work.

How our Circadian System Works:

We have a central control unit in our brain that’s called our Master Circadian Clock (or the Suprachiasmatic Nucleus, SCN). The Master Circadian Clock has a direct connection to the organs of our body, our hormone system, and our autonomic nervous system (1). This Master Clock produces melatonin, which increases at night to tell us that it’s time to sleep. Our Master Clock is controlled by the day and night cycles, if we’re fasting or eating, and if we’re asleep or awake. This Master Clock also produces our circadian rhythms.

We also have other biological clocks in our peripheral organs and they receive signals from the Master Circadian Clock via neural, humoral, and temperature signals. This means, our organs, our brain chemicals, and even some products of metabolism have their own rhythms that are synced up to our Master Clock. These clocks run in parallel with our Master Clock.

And, we want these clocks (master clock and peripheral clocks) to be in alignment!!

When our peripheral clocks our misaligned (running too fast or too slow) they can disrupt our circadian rhythms, which is when all the problems occur.

Harmful Effects of Night Shift:

  • Night shift has been linked to cancer

    • In 2007, the International Agency for Research on Cancer (IARC) classified shift work with circadian disruption as a probable human carcinogen. One agent from IARC, stated that shift work was more worrisome than some carcinogenic chemicals!

  • Night shift is associated with depression and interferes with levels of brain chemicals

    • Researchers found that shift workers in all occupational groups had an increase risk of depression; however, there was a lack of statistical confirmation (3).

    • Brain monoamines (noradrenaline, dopamine, and serotonin) have been shown in rats to be off-balance with irregular light-dark cycle leading to anxious behavior. This highlights the possible connection between circadian disruption and anxious or depressed behavior influenced and controlled by the neurotransmitter systems. (4)

  • Night shift is associated with cardiovascular disease mortality and disrupts metabolites of metabolism

    • Night shift sleep patterns have been shown to impact digestive organs, the liver, and the pancreas. Because night shift worker’s circadian clocks are not aligned with the Master Circadian Clock, there is major disruption in metabolism. This insight leads to possible lifestyle changes that can benefit someone experiencing digestive problems such as stomach aches, indigestion, or irregular bowel movements. (5)

    • Researchers have found that nurses working night shift for 5 years had a moderate increase in all-cause and cardiovascular disease mortality, emphasizing the detrimental impact on the circulatory system. (6)

If you can’t change your schedule, what can you do?

Currently there isn’t enough research to determine a complete remedy for night shift work, but here are some suggestions that may be useful if you can’t change your circumstances.

  • Mindfully eating and drinking while at work.

    • Notice if you’re snacking when you’re bored at work. Are you grabbing for candy or treats because there’s not much else to do? Are you drinking sodas or caffeine to stay awake all night? Try switching your sodas for herbal teas to eliminate the extra sugar and empty calories.

  • Keep a consistent eating schedule.

    • Similar to the mindful eating practice, try to maintain an eating schedule on night shift, even if you’re used to eating all night. Try having your breakfast when you wake up in the afternoon (1-3PM), your lunch at 8-9PM, fast throughout your night shift, and then have  your “dinner” at the completion of your night shift. There aren’t many resources to support my hypothesis on this food timing schedule, but it makes sense that fasting through the night is the closest thing to a regular eating pattern that you can manage.

  • Wear blue-light blocking glasses.

    • In one research review, the suggestion for shift workers to block their eyes from the light spectrum was mentioned as a way of protecting their hormonal system (2). However, this may or may not have consequences on the worker’s attention and focus. This tip may not be possible for shift workers in the healthcare system, like nurses or doctors.

  • Find a therapist.

    • This may seem dramatic compared to the previous tips, but this is a serious issue.  It’s so serious that even German law gives shift workers free occupational medicine exams and counseling before starting shift work AND once every 3 years. This is due to the fact that depression is not uncommon amongst shift workers, and therapy can be of benefit to those feeling down.

Thanks for reading. If you have any questions or would like more information on ways to improve your nutrition or lifestyle as a night shift worker or someone dealing with disrupted sleep, email me and let’s talk!

References:

(1)Buijs RM, van Eden CG, Goncharuk VD, Kalsbeek A. The biological clock tunes the organs of the body: timing by hormones and the autonomic nervous system. The Journal Of Endocrinology. 2003;177(1):17-26. https://uws.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=12697033&site=eds-live&scope=site. Accessed April 1, 2019.

(2)Erren TC, Falaturi P, Morfeld P, Knauth P, Reiter RJ, Piekarski C. Shift work and cancer: the evidence and the challenge. Dtsch Arztebl Int. 2010;107(38):657–662. doi:10.3238/arztebl.2010.0657

(3)Angerer P, Schmook R, Elfantel I, Li J. Night Work and the Risk of Depression. Dtsch Arztebl Int. 2017;114(24):404–411. doi:10.3238/arztebl.2017.0404

(4)Matsumura T, Nakagawa H, Suzuki K, Ninomiya C, Ishiwata T. Influence of circadian disruption on neurotransmitter levels, physiological indexes, and behaviour in rats. Chronobiology International: The Journal of Biological & Medical Rhythm Research. 2015;32(10):1449-1457. https://uws.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=111870548&site=eds-live&scope=site. Accessed April 1, 2019.

(5) Skene DJ, Skomyakov E, Chowdhury NR, et al. Separation of circadian- and behavior-driven metabolite rhythms in humans provides a window on peripheral oscillators and metabolism. Proceedings of the National Academy of Sciences of the United States. 2018;(30):7825. doi:10.1073/pnas.1801183115.

(6)Fangyi Gu MD, ScD, Jiali Han, PhD, Francine Laden, ScD, An Pan, PhD, Neil E. Caporaso, MD, Meir J. Stampfer, MD, DrPH, Ichiro Kawachi, MD, PhD, Kathryn M. Rexrode, MD, MPH, Walter C. Willett, MD, DrPH, Susan E. Hankinson, ScD, Frank Speizer, MD, and Eva S. Schernhammer, MD, DrPH. Total and Cause-Specific Mortality of U.S. Nurses Working Rotating Night Shifts. American Journal of Preventive Medicine, March 2015 DOI: 10.1016/j.amepre.2014.10.018

Microbiota 101

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The importance of a healthy gut has been gaining more attention in healthcare due to the growing body of research emphasizing diseases and conditions affected by the gut microbiota. A dysfunctional gut has been associated with chronic inflammation leading to conditions such as obesity, metabolic syndrome, depression, anxiety, and Alzheimer’s disease. In the functional medicine sphere, I am constantly hearing about the next “7 Day Gut Healing Protocol” or "Bone Broths for Gut Healing". Although, I don’t believe in the false promises of these marketing schemes, I do believe there is truth to supporting and loving our gut bugs. This post only scratches the surface on one of the newest topics in science—the microbiota.

WHAT IS THE ‘MICROBIOTA'?

Our gut, or gastrointestinal tract, is filled with bacteria, collectively called the microbiota. In fact, the total amount of gut bugs is estimated to be more than 10^14 bacterial cells—10 times the number of human cells in our body! Caring for these gut bugs is of utmost importance, because they impact our health in massive ways. 

In a recent podcast, I heard Dr. Amy Proal, a PhD. in microbiology, use the following analogy to explain the relationship between our gut bugs and our immune system. I have paraphrased her beautiful explanation here: Imagine a classroom full of students. In this group, there is a mixture of dedicated students and rebellious students—or the “bad" students. The students, good and bad, are similar to our gut bugs, each one with their own agenda. The teacher in the classroom is like our immune system, patrolling the students and keeping everyone on task and in-line. However, things can go haywire when the teacher leaves the classroom. Suddenly, the “bad” students can convince the good students to misbehave too. And eventually the whole classroom is full of disruptive students.

Our gut bugs have their own agenda and without a strong immune system to keep them in check, they can become disruptive, multiply, form alliances, and create havoc. 

But we must remember that these gut bugs are beneficial to us too. There wouldn’t be a classroom without students in the first place!

So, how do these gut bugs help us? First, our gut bugs aid in the digestion of food, especially fiber that cannot be broken down by our own digestive enzymes. Secondly, our gut bugs help with the production of vitamins, like B & K, which are crucial for blood clotting and cell metabolism. To add to the list, our gut bacteria metabolize toxins, pollutants, and other xenobiotics, play a role in weight management, and contribute to our overall mood!

SUPPORTING THE STUDENTS & THE TEACHER

Supplementing with prebiotic foods and probiotics can improve the diversity of the gut microbiota significantly. Prebiotics and probiotics benefit the immune system and provide anti-inflammatory effects on the body.

There is an important difference between PREbiotics and PRObiotics.

Prebiotics are non-digestible foods that benefit our whole body by selectively stimulating the growth of one or a small number of bacteria in the colon. When we ingest a prebiotic food, it travels to the colon where it is fermented by certain bacteria, consequently improving the microbiota composition.

The health benefits of prebiotics are associated with the process of fermentation and production of short chain fatty acids (SCFA). Some touted health benefits include energy source for the intestinal lining, inhibition of pathogenic organisms, resilient immune system, and decreased inflammation.

The most commonly available and best researched prebiotics include Fructooligosaccharides (FOS), lactulose, and glactooligosaccharides (GOS). Prebiotics can be taken in supplemental form (be sure to start with small doses at first because it can initially cause adverse GI reactions aka gas, bloating or diarrhea) or prebiotic foods can be eaten. Some food sources of prebiotic compounds include garlic, onion, chicory root, beetroot, human milk, Jerusalem artichokes, and oats.

On the other hand, probiotics are supplements that contain live bacteria that support the existing microflora and can be used to treat a wide variety of conditions depending on the strain of bacteria used.

Essentially, PREbiotics feed the PRObiotics.

Traditionally, probiotics have been used for conditions such as intestinal permeability, dysbiosis, gastrointestinal tract infections, IBD, IBS, lactose intolerance, vaginal candidiasis, and post antibiotics. However, more novel uses of probiotics include endometriosis, hypercholesterolemia, prevention of postpartum obesity, mastitis, and poor immune function. Probiotics work by competing with potentially pathogenic bacteria and fungi in our gastrointestinal tract, interacting with immune cells, providing anti-inflammatory activity, strengthening the intestinal barrier, and producing beneficial compounds in the gut (short chain fatty acids like butyrate).

By working with your practitioner, you can find the correct probiotic strain specific for your clinical problem--this means, do not ingest any probiotic off the shelf or one that someone tells you is really good. Do your research first, or find someone that has done the research for you.

STRAIN MATTERS!! 

Because each probiotic strain is unique, you should make sure you know which strain is in each supplement, if that strain is right for YOU and your condition, and if it exhibits efficacy/well-researched.

**If you’d like to learn more about this, check out Probiotic Advisor—a database with science-based evidence regarding each strain.

I hope this post clears some things up for you regarding probiotics and prebiotics and the role of the microbiota in our health. Feel free to comment with any questions, as I’d love to hear from you.  


References

Ahrne, S. and M. L. Hagslatt (2011). "Effect of lactobacilli on paracellular permeability in the gut." Nutrients 3(1): 104-117.

Ho, J. K., Chan, G. F., & Li, J. B. (2015). Systemic effects of gut microbiota and its relationship with disease and modulation.BMC Immunology, 1621. doi:10.1186/s12865-015-0083-2

Peluso, I., Romanelli, L., & Palmery, M. (2014). Interactions between prebiotics, probiotics, polyunsaturated fatty acids and polyphenols: diet or supplementation for metabolic syndrome prevention?. International Journal Of Food Sciences And Nutrition, 65(3), 259-267. doi:10.3109/09637486.2014.880670

The Food & Mood Connection: Part 1, Gut Dysbiosis & Neurotransmitters

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It may be easy for a patient to understand that an unhealthy diet negatively impacts their health and can lead to outcomes such as gastrointestinal dysfunction, metabolic syndrome, cardiovascular disease, and obesity. However, its less likely for patients to associate their mood, cognition, and neurological function to the food they eat. Perhaps, part of this is due to lack of awareness of the body or the disconnected relationship to food altogether. Unfortunately, this disconnection is only made worse by our culture's tendency to rush through meals and eat on the go. In fact, Americans spend the LEAST amount of time eating and drinking compared to other developed countries. 

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This brings me to a quote by Thích Nhất Hạnh, "Haste is a form of violence."

You might be wondering, how does this quote relate to food & mood? Well, when we hurry, we mindlessly speed through the present moment. Violence is intentionally or unintentionally causing harm. When we eat quickly, without care or concern for the food we are ingesting, it's possible that we are harming our body by feeding it with food devoid of nutrients and without even noticing the reaction our body has to that food! Slowing down and truly tasting the food on our plate, can help us digest and assimilate properly and notice the body's response to individual foods.

Now, back to the biology. Gut dysbiosis (or imbalance of bacteria in your gastrointestinal tract) and inflammation, commonly attributed to a diet filled with processed, sugary, and refined foods, may directly influence brain function and behavior by disrupting the bidirectional gut-brain axis.  Gut function is almost entirely influenced by the nervous system, including the vagal and spinal afferents, sympathetic and parasympathetic efferents, and the ENS (deemed the gut’s brain)—all this is to say, a dysfunctional gut impairs our brain function (Daulatzai, 2014).  Since the gut microbiota modulates excitatory and inhibitory neurotransmitters such as serotonin, an altered pathogenic microbiota can directly effect the production and release of these neurotransmitters. For example, 95% of serotonin production occurs in the intestines; however, with stress and increased intestinal permeability, a patient may begin to produce less serotonin because of systemic inflammation. This was made clear in athletes subjected to chronic exercise stress, ultimately impacting their gut and brain (Clark & Mach, 2016).

Other factors besides diet also play a role in decreased serotonin synthesis, one being continuous exercise-induced stress as seen in athletes. This gut-brain axis dysfunction provoked by gastrointestinal inflammation and altered microbiota may possibly explain depression or loss of motivation in athletes.

The takeaway from this post is this: Patients may not be aware of the "mind-body" connection or how food affects their mood. Creating more awareness around food and its effect on mood is important. The gut plays a major role in the formation of neurotransmitters and neurotransmitter transmission; thus, eating a healthy diet and maintaining a healthy gut lining is crucial to  proper psychological functioning. 


References:

Clark, A., & Mach, N. (2016). Exercise-induced stress behavior, gut-microbiota-brain axis and diet: a systematic review for athletes. Journal Of The International Society Of Sports Nutrition, 131-21

Daulatzai, M. A. (2014). Chronic functional bowel syndrome enhances gut-brain axis dysfunction, neuroinflammation, cognitive impairment, and vulnerability to dementia. Neurochemical Research, 39(4), 624-644. doi:10.1007/s11064-014-1266-6

 

farm finds: tatsoi

Photo by simple.human.bean

Photo by simple.human.bean

A few weeks ago, I began volunteering at Agua Dulce (http://aguadulceaustin.com/), a sustainable urban organic farm that utilizes an aquaponic system to grow much of their produce. Right when you walk into the greenhouse at the farm, you are overwhelmed by the vast shades of green. I never thought lettuce and herbs could be so beautiful.

I added “farmer girl” to my resume to get more in touch with the earth and my food. Agua Dulce is run by a few dedicated guys who truly believe in their mission--providing local healthy food to the community while reducing the carbon footprint and growing in an environmentally conscious way. Each Monday, I work with one of the owner’s of the farm as he directs a few of us to harvest the greenhouse lettuces with care and precision. My hands are covered in dirt as I gently cut the stems from each lettuce head almost as if I’m pruning large green roses.

When I’ve completed my work at the farm, I am gifted with fresh vegetables and lettuces for the time I’ve spent working there (seems like I got the better deal!). The farm is a treasure trove of delectable edible finds and lucky for me, I leave with vegetables that I’ve never seen before!

This week I received Tatsoi, aka mustard spinach, spoon mustard, or rosette bok choy, an Asian green packed with vitamins, minerals, phytonutrients, and antioxidants. Tatsoi is in the Brassicaceae or Cruciferae family (mustard/cabbage family), specifically in the species Brassica rapa. Cruciferous vegetables contain a naturally occurring phytochemical called sulphoraphane, an inducer of antioxidant and detoxification enzymes which aid in cancer prevention, protects against oxidative stress and tissue damage, inhibits the formation of advanced glycation end products (AGEs) in vitro, and may be a possible therapeutic tool to protect against vascular damage in diabetes (part of this is due to its ability to suppress TNFalpha induced expression of adhesion molecules). Beyond sulphoraphane, Tatsoi has more vitamin C than an orange and it’s calcium content rivals milk. I can’t think of a much better veggie...a pretty amazing plant all around.

So how did I eat this nutritious plant? Well, because it tastes a lot like spinach, I lightly sauted it with cabbage and onions in olive oil. It has a mild mustard flavor, but the bitterness is negligible. I also added some leaves to my salad with sardines on top for some extra omega-3s.

I hope I’ve convinced you to go outside your comfort zone, and grab some of these guys at the grocery store or farmer’s market. WORTH IT.


References

Colonna, E., Rouphael, Y., Barbieri, G., & De Pascale, S. (2016). Nutritional quality of ten leafy vegetables harvested at two light intensities. Food Chemistry, 199702-710. doi:10.1016/j.foodchem.2015.12.068

USDA. Nutrient database for standard reference. Available from: <ww.nal.usda.gov/fnic/foodcomp> Accessed 13.02.18.

Yamagishi, S., & Matsui, T. (2016). Protective role of sulphoraphane against vascular complications in diabetes. Pharmaceutical Biology, 54(10), 2329-2339.