Challenging workloads, staff shortages, missed breaks and shift work invariably impact the time nurses and midwives have to prepare and eat healthy meals.

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Dr Michelle Rogers is an Accredited Practising Dietitian (APD) from South Australia with a PhD in Nutrition.

She is currently part of a joint research team from the University of South Australia (UniSA) and Monash University in Victoria, undertaking a National Health and Medical Research Council (NHMRC) funded study investigating weight loss strategies for nightshift workers.

The study is exploring the impact of intermittent energy restriction, specifically the 5:2 diet, as a weight-loss strategy for nightshift workers. Under the diet, five days of the week are normal eating days, while the other two restrict calories to 500-600.

The study, which currently has about 150 active participants, including many nurses, involves a six-month weight loss phase, followed by 12-months of maintenance. Each individual is randomly placed on one of three diets and then works with dietitians to implement the strategy into their everyday life.

“We work with them to achieve the initial weight loss but also help set longer-term goals to keep that weight off,” Dr Rogers explains.

“We also discuss other issues they might be having at work. Lots of nurses and midwives say night shifts can be quite difficult, and they find themselves eating just because they are tired or just to stay awake. Other times it is the complete opposite; if it is a busy night, they’re not eating at all.”

Dr Rogers says the study’s objective, which began in 2018 and is still actively recruiting participants, is to improve the health and wellbeing of this important, yet vulnerable, cohort.

“We know that shift workers are at higher risk of having co-morbidities, so being overweight but also having diabetes, heart disease and other conditions. We also know shift work requires individuals to eat and sleep out of synchronisation with our traditional body clock, which says we eat during the day and sleep at night. Their routines are obviously difficult to keep and that can lead to disrupted eating and sleeping habits, with this circadian disruption resulting in metabolic consequences.”

Researchers are looking for people who work a minimum of two night shifts per week for the study.

Findings are years away, but so far, everyone who has taken part in the trial has lost weight.

“We know that even small decreases in weight improves metabolic responses. We want to help people achieve that, but we also want to help them sustain that behaviour change, especially in the shift work population, because routines are often difficult for this population to get into.”

Dr Rogers shares her top 5 ways nurses and midwives can eat healthier on night shift.

1  Food variety and preparation

A healthy diet should include foods from every food group each day. Ensuring a wide variety of different foods from every group increases your chances of taking in all the vitamins and minerals that your body needs for optimal nutrition and preventing lifestyle diseases and nutritional deficiencies.

Having a variety of food in your daily intake can be difficult, especially when on shift work: meal preparation can help you have nutritious food available even when you are on the run.

Menu/meal preparation does not have to be a time-consuming task – as little as 10 minutes a day can help.

Three key tips for being prepared; 1) Plan your week ahead of time with what meals and snacks you would like to take to work, 2) Pre-cut all fruit and vegetables at the start of the week and store in good quality air-tight containers – this will allow you to grab and go for some healthy snacks as well as form a base for salads or sandwich fillings, and 3) Keep it simple; this will keep the time needed and mental load for preparation to a minimum.

2  Focus on fibre

Consuming high fibre foods as part of your dietary intake can assist you in feeling fuller for longer, therefore helping to reduce the need to snack.

A diet high in fibre can also regulate glucose levels to keep them within a healthy range and reduce cholesterol levels.

There are two main types of fibre: soluble and insoluble. Insoluble fibre is found in wholegrain breads and cereals, wheat bran, wheat-based pasta and some vegetables. Soluble fibre is found in fruits, oats, barley, legumes and some vegetables. Trying to get a mix of fibre types in your diet will also help will regular bowel movements.

Tips for increasing fibre intake:

• Choose wholemeal or wholegrain breads.
• Eat wholemeal breakfast cereals. Weetbix, All-bran, muesli or porridge are excellent choices. You could make your own natural muesli using oats, nuts, seeds, dried fruits, other grains etc.
• Use brown rice and wholemeal noodles and pasta.
• In between meals, choose high fibre snacks such as fresh fruit, raw vegetables, wholegrain crackers, nuts, seeds and dried fruits.
• Eat plenty of fresh fruit and eat the whole fruit rather than drinking the juice – it has much the same nutrition but a lot more fibre.
• Try chopped raw vegetables eg. carrot, celery, capsicum, asparagus, snow peas to dip into salsa or hummus.
• Try for 5 serves of vegetables daily – in main meals, salads, soups, and added into baked goods if possible.

3  Snack vs meal

Will eating a meal while on night shift be the healthiest, or should you just have a snack? Or perhaps not eat at all? A recent clinical trial investigating the impact of eating a large meal, a snack or not eating during simulated nightshifts on hunger, gut reaction, sleepiness and mood found that a small snack during the night may protect shift workers from the increased sleepiness experienced after a large meal and the hunger experienced when not eating during the night.¹ Additional research has also shown that for optimal performance, shift workers should consider consuming main meals during the day and limit food consumption late at night.²

4  Look for low GI options

Eating a lower glycemic index (GI) diet can reduce average blood glucose levels and improve the body’s ability to use glucose for energy. Low GI foods also improve satiety (feeling of fullness), which can assist with weight management, reduce snacking behaviour, and provide a slow release of energy during the course of your night shift.

Low GI foods include wholegrain breads, pasta, some breakfast cereals, sweet potato, legumes, milks, yoghurt and temperate fruits (fruits grown in areas with mild to warm summers and cool to cold winters; such as apple, pear, apricot, plum, kiwifruit, strawberry, raspberry & blueberry).

Some examples of high GI foods include; cakes, white bread, white rice, white pasta, most packaged cereals, croissants, and confectionery. Only consume these types of foods in moderation.

5  Caffeine

Night shift work is typically associated with reduced sleep and increased sleepiness. Caffeine has typically been used as a compensatory behaviour, but how much should we be having?

Caffeine has positive effects on alertness and performance when consumed at low doses (3 mg/kg body weight/day; so for an individual weighing 60kg, this would be 180mg), and at moderate doses is considered an effective fatigue countermeasure. Research conducted in 2011,³ found that shift workers may be consuming more caffeine than would be useful for beneficial effects.

Typically, there is 60-80mg per 250ml of instant coffee and 60 – 120ml per 250ml for percolated coffee, so aiming for 1-2 cups of coffee per night will produce the most beneficial results for alertness and fatigue.

Large amounts of caffeine can also lead to increased urination- try to keep up non-caffeinated beverages such as water during the night shift to help keep you hydrated. Small sips frequently will help keep you hydrated.

If you would like to take part in the research study, click here

References

[1] Gupta CC, Centofanti S, Dorrian J, Coates AM, Stepien JM, Kennaway D, Wittert G, Heilbronn L, Catcheside P, Noakes M, Coro D, Chandrakumar D, Banks S. Subjective Hunger, Gastric Upset, and Sleepiness in Response to Altered Meal Timing during Simulated Shiftwork. Nutrients. 2019 Jun 15;11(6):1352. doi: 10.3390/nu11061352. PMID: 31208092; PMCID: PMC6628383.

[2] Charlotte C Gupta, Jill Dorrian, Crystal L Grant, Maja Pajcin, Alison M, Coates, David J Kennaway, Gary A Wittert, Leonie K Heilbronn, Chris B Della Vedova & Siobhan Banks (2016): It’s not just what you eat but when: The impact of eating a meal during simulated shift work on driving performance, Chronobiology International, DOI: 10.1080/07420528.2016.1237520.

[3] Dorrian, Jillian & Paterson, Jessica & Dawson, Drew & Pincombe, Jan & Grech, Carol & Rogers, Ann. (2011). Sleep, stress and compensatory behaviors in Australian nurses and midwives. Revista de saúde pública. 45. 922-30. 10.1590/S0034-89102011005000059.