Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight podcast. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to today's episode of the Conquer Your Weight podcast. I have a guest with me today, Dr. Oraedu. She is an internal medicine physician working as a hospitalist and primarily as a nocturnists. So for those of you who don't know, a nocturnists is a hospitalist who works in the nighttime hours. And from that she has developed a coaching program where she helps people who are night shift workers to understand their health, how that can play a way of role in their weight. And so that as a conversation we are going to be having today. I'm so excited to have you here today, Dr. Redu, thank you for joining me. Dr. Chinyelu E. Oraedu: Thank you so much. Thank you for having me, Sarah. Thank you. Dr. Sarah Stombaugh: You're welcome. Dr. Chinyelu E. Oraedu: So my name is Dr. Oraedu. I mean most of you who meet me at the hospital, well record recognize me as Dr. Oraedu, but I also go by Dr. Yel'Ora. And Yel'Ora is actually a name that I created from Chinyelu Oraedu. It's the last four letters of my first name and the first three letters of my last name. And to me it signifies the night shift, the fact that I go to work at night and I just get home we hours in the morning time, not even wee hours, but so it's like a dusk to don because I also go by the DusktoDawnMD on social media. Dr. Sarah Stombaugh: Absolutely. Well, I love, we know that for people who work night shift that their schedules are not in line with a traditional circadian rhythm. And so that can really create a lot of issues, both of our health in general, but even just in general in work-life balance. So tell me a little bit about how as a night shift worker, what are the things people can do to create their work-life balance and their health and weight goals? Dr. Chinyelu E. Oraedu: I think the first thing about when you work a night shift is that you have to get your body into a routine and not just your body. It's like your whole family if you have children or a significant other because you need to align, try to get some semblance of aligning your natural circadian rhythm with your schedule so that you can thrive. And what I mean by that is that you have to, your sleep cycle, you have to know that sleep is essential, not just because you work at night, but for overall longevity and also in order for you to be able to control the metabolic processes that happen. So the first thing I just tell people who work night shift is routine. You have to get into a pattern of behavior so that you can rest, and then you can also be able to realign. And on the days you're off, you can at some point also reestablish and start to thrive again as a normal person because that's part of the suffering with night shift that you are out of sync with majority of people who work nine to five. But it's important to know that we have about 15 million people almost like, I mean the studies actually show that one in five people do shift work in the US. So that's really a significant amount of people. So my program does focus on helping them go beyond survival, but for them to thrive while the work the night shift. Dr. Sarah Stombaugh: Yeah. Oh, absolutely. Well, and I think you mentioned spouse, you mentioned family, and I think that's so important because a lot of times if a night shift worker is working while the rest of the family is sleeping, there has to be this really intentional creation of sleep for that night shift worker that may happen while the rest of the family or will happen while the rest of the family is awake. And so I think sometimes people really struggle to carve out an appropriate amount of time to be able to sleep because their family may have other expectations of them or like, Hey, you're home. Why are you not helping with the kids or doing chores? And so I imagine that that type of thing is something that probably comes up a bunch. Dr. Chinyelu E. Oraedu: Yeah, that's part of the problem with night shift. I tell people that it's like you work overnight and then when you get back home, people expect you to continue the rest of the world. 80% of the world who work regular shift and now it's left for you with some intentionality to really carve out that time and carry your family along that you need to rest. I need at least six, seven hours of rest before I can reintegrate with the family activities. And I think over time it becomes a source of stress and dissatisfaction for people who work nights, the people I work with, because you find out that you work nights so you can take care of your children, but when you get back, your children are home and they want to spend time with you now you want to go sleep. So it's almost like it's shooting yourself in your foot because you are not spending time with the people you are working nights in order to take care of. I don't know if you get it, but it's kind of where you worry. And like I said, dissatisfaction for some people that I work with. And at that point in time I tell people, what is your why story? Why do you work, right? If the people you care about the most, the people you love are suffering or you're just feeling very unhappy while working night, then it's time to stop. It's not working for you, it's not working for you because people work nights for a reason. I think that, and it was very shocking to me when I started doing this, looking at all the research, the pros and the cons of night shift work. And I'm like, oh wow, okay. So there's actually some benefits to working at night, but at this point in time, when the cons outweigh the pros, then I think you need to reevaluate you're doing it. And because family is first, right, especially with so many mothers who work nights, the more I do this, my coaching and read around it, and even families that work overlapping shifts, there's almost like 7% of families that do overlapping shifts. What it means is that maybe the father or one person works day shift, the other person works at night so that they have continuous childcare. You find out that that's another level of stress on the family because personal relationships would be disrupted and of course communication, family life and it's just a dissatisfier. And you just have to know that when your wife story is not really working for your family and the people you love, you have to stop. You just have to stop. It doesn't make sense to continue. So that's kind of the focus of the program that the more I read around it, I just see that we haven't really addressed how can we really help people thrive? How can we meet people who work nights at their greatest point of need? Does it meet people at their point of need? That's when you can help them. Dr. Sarah Stombaugh: Absolutely. Well, and tell me about that, because I imagine there's a lot of people who they desire to work nights, they know that moving forward that will continue to be part of their plan, but they definitely need help with optimizing that in terms of their sleep schedule and their eating schedule. And of course there's going to be really some different answers here, but give me some examples of someone who is working night shift and how they might choose some example schedules of what their hours are and how they might choose to eat, how they might choose to sleep, what are some general recommendations there? Dr. Chinyelu E. Oraedu: So when it comes to night shift, that is part of the reason why I'm not just fascinated, but I'm very invested and I just do a lot of reading around the research around shift work. So for the most part, the recommendation is when you work overnight, when you get home in the morning, you should eat a light breakfast. People are encouraged light breakfast and eat the heaviest meal before you go to work at night. And most people will recommend that you should eat, try to eat before midnight, try to just, I mean the body naturally, the natural metabolic pathway of the body is that we don't eat all the time as human beings at night, we eat, which is why we fast overnight. So when you work at night, you have to simulate the same physiologic process. You are encouraged actually, if you can support the physiologic process whereby you minimize high caloric eating in the middle of the night that you can actually, I mean, they've been kind of limited studies that showed that you can control your blood sugar, you can control your body weight. As a matter of fact, I think it was the study said 6.4% reduction in diabetes for people who minimize high caloric eating in the middle of the night. But that doesn't mean that you're not going to snack, which is why there's recommendation to eat more protein because of satiety. It makes you feel full. And of course hydration, a lot of hydration, a lot of healthy nuts and healthy snacks and low fat yogurt. There are ways you can eat without ingesting a lot of calories, which is part of the problem. Nighttime eating, which is prevalent shift workers. Dr. Sarah Stombaugh: Absolutely. So if you're saying so when you go to bed, so right before going to bed, maybe having a light meal, and then I assume having a meal maybe upon awakening, and then if you're going to have another meal though, just really being intentional if that is before midnight, is that right? Dr. Chinyelu E. Oraedu: Absolutely. Yeah. The heaviest meal should be eaten after you have when you get to work or just before you go to work. Like dinner doesn't mean you have you go to work at 7:00 PM that you should eat it around that time rather than delaying the late meal at midnight, which just try to discourage people from eating very late because it's just physiologic. Your body doesn't work that way. And of course, that's part of the reason why some people who work nights do have a lot of gastrointestinal problems because of the natural security rhythm. When it's nighttime, the system starts to slow down the metabolism. So that's part of the reason why you don't want to be eating heavy in the middle of the night. And I find out that people who follow that pattern, and that was kind of the changes I went through when I started to be more intentional about working the night shift. And I just saw that my energy level was better. I was able to regulate my weight and intentionality with sleep without, it's almost impossible to control your weight if you don't sleep. Dr. Sarah Stombaugh: Yes, absolutely. Dr. Chinyelu E. Oraedu: Yeah. Your appetite is going to just be ravaging. You just will not be able to control your appetite and you're going to, of course, your body's going to crave all the bad food, the high fat, the high salt, the high sugar and all that. But I know as healthcare workers, professionals, we always advise and recommend that our patients should follow the guidelines, but I also know that it's working at night. Part of the reason people eat a lot is that they're trying to stay awake, not necessarily hungry. It's not the hunger, it's just a way of, so that's why hydration is very big at my job. I'm very excited when you come in, there's so many water bottles, it's like everybody hydrate. So we like the biggest water bottle because it just, that sense of fullness, and it kind of regulates your appetite with the gastric extension and then the feedback and you just able to minimize having the urge to go to the vending machines. So it's a process. I mean, nights are hard. It's hard. Dr. Sarah Stombaugh: Well, and one thing I say often, and this is true, whether for someone who works night shift or someone who doesn't, someone who's following a traditional schedule, but when we don't have enough sleep, our body when it needs energy, the right place may have been to get that energy from sleep. But if we haven't gotten that, then our body starts looking for other ways that we can get it, which is where sometimes those highly processed snacks and treats and sweets come in. And that has to be a really intentional decision as you're saying. I mean, I haven't done much shift work. In residency, we did a lot of 24 hour calls and that type of thing, for example, and I always really struggled in that middle of the night. I'd be so tired and I'd find myself in the hospital break room eating the graham crackers and peanut butter and the other sort of highly processed foods because that was what was available. But it definitely, eating those type of foods or sometimes even worse options can create a lot of issues in terms of your health and your weight. So tell me a little bit, I of course assume that we see higher rates of obesity and night shift workers, but I actually don't know some of the statistics on that. So tell me a little bit about weight is impacted for people who work that overnight shift. Dr. Chinyelu E. Oraedu: So pretty much first of all, part of the problem with night shift is the disruption in your natural security rhythm. That is the primary problem. So with that, all the hormonal processes get disrupted and there's an imbalance in your hormones. And that imbalance, whether it's your melatonin, whether it's your cortisol level, promote fat deposition for cortisol, you start to get the midsection or the posity. So the primary issue is, like I said, the circadian rhythm disruption, which as a coach, I cannot reverse that because at this time I don't think there's any science that can reverse it. And interestingly, that's why we, there's a lot of focus on chronotypes now. There's a lot of focus on chronotypes. What is your nature of chronotype and does it really align with night shift and the people who are going to be able to work nights and not get sick, right? If genetically you chronotype aligns with night shift work, probably you're going to do it for a long time and you just would not be part of the cohort who are going to have the cardiometabolic syndrome, who are going to be at risk for breast cancer, prostate cancer, these are the two cancers that are most studied in night shift workers, especially in nurses. There's been tons of studies, a gamut of studies on nurses and night shift work, not even physicians. I mean, I would think hospitalists should be studied, but I guess we're not there yet. But like I said, the disruption is the problem. But the way you can work around that I always tell people is first of all, with intentionality, your body tells you when you need to stop working nights, you have to rest. You have to go for your annual follow up and check if somebody who worked night there has to be a heightened alert for you to be in tune and take care of your health, I think is really very important because studies have shown that people who work nights have three times the risk. And they have three times actually, not just any type of obesity, but the midsection, the centrality, which puts you at risk for cardiometabolic syndrome. There is cardiovascular disease, high risk of strokes, sleep apnea and all that. And of course, type two diabetes because obesity and diabetes almost go hand in hand due to the abnormalities that occur as a result, the metabolic derangement. So the studies have shown that there's high risk of obesity because of disruption in the hormonal cycle. But I guess the follow up is that what are we doing about it? Because we have 15 million people who work at night and of course at risk for ill health. So how do we help them? There have been studies that showed that we shouldn't. I mean, this was in 2007 then again in 2019, and this is an international committee, I think it's IARC, International Association of, I mean they do monitor cancer. It's an international agency that monitors human cancer, and they actually proposed that knife shift work to human beings. Oh, wow. That's so interesting. Exposed to animals. Yeah, it was on the CDC website. I mean, they had to be reiterated again in 2019 because in experimental animals they had cancer, especially breast cancer and prostate cancer. Dr. Sarah Stombaugh: That's interesting. Oh, go ahead. Sorry. Dr. Chinyelu E. Oraedu: So they were proposing that in order to help people who do shift work, that people should do less shift, that you shouldn't do more than three shifts, three nights in a row, you should do less than 12 hours shift. You shouldn't do anything more than 12 hour shifts at one standing. People should do kind of forward rotation. When you do your night shift, you should be like a clockwise rotation, meaning that you should go from maybe a swing to night to morning rather than just going from working morning and then next day you're working night, you should do a forward rotation, which is with more in line with your natural circadian rhythm. So they've been some guidelines that are out there that will benefit whether it's residents, whether it's people who do night shift work on a permanent basis, because we have people that do rotating night shift, they do days and then they do nights, and then we have people that are permanent. I do permanent and permanent is actually better for your body system compared to rotating day and night shape. And it kind of makes sense because the constant switching could be a little bit misalignment with the constant switching seems to be more than when your body is already aligned that you work nights all the time. Dr. Sarah Stombaugh: Well, it's interesting that the constant switching. I'm curious though, so for someone like yourself who works as a hospitalist on your off days, do you follow the same schedule or tell me what are the recommendations for someone who's full-time always in that night shift role? Should they maintain that on their off days or how should that be handled? Dr. Chinyelu E. Oraedu: Most send to tell you on your last night, I worked last night and I got home that you should try to stretch it out and go to bed at a normal time with everybody else. So that way you start to regulate going back to a normal night schedule and a normal regular schedule like everybody else, or that if you need to rest that you should rest for a little bit, but don't sleep 12 hours at a stretch, get some few hours of sleep and then wake up and so that you'll be able to go to bed at night with everybody else. So that's really what is recommended so that way you can reset back to a normal schedule with the rest of your family. But you just find out that I think because people work such long hours, it may not really be feasible for you to sleep four hours and get up and then hang out with your family and go to bed again at night. Some people may just sleep much longer and just wake up. Just when it comes to recommendation for night shift, since I started doing my coaching program, I just find out that it's so personalized. We have guidelines, but it is so personalized because people try to find a normalcy that works for them and their families because you live with your family, you have other people that you interact with, so you just poorly have to sleep and wake up and interact and then go back to bed at a time that is okay for yourself and your other family members. So it is part of the personalized part of what I do because everybody is so different and everybody works nights for different reasons. That's the thing about, I mean, I tell people that going to work daytime is normal. If you don't go to school or you're not infirmed, you're not sick and you're not elderly or retired, you go to work in the morning. But when you go to work at night, there's usually a reason you want to go back to school to get a higher education. You want to take care of your children who are young. You want to participate in raising your kids because I started working nights, I had twins just by the time I started residency. Yeah, now they're like 18. So I don't even do that much nights anymore because the reason no longer exists as far as, so you find out that people will tell you why they work at night and then Dr. Sarah Stombaugh: That making a plan part I think is so important, right? Because I think a lot of times we sort of just allow life to happen to us rather than making an intentional plan of let me see what works and let me have a intentional plan of I need 6, 7, 8 hours of sleep, for example, or I'm going to make sure that I'm eating it this time, this time and this time. I think sometimes we just sort of drift along with life allowing things to happen and regardless of whatever the recommendations are, we don't even have our own plan. We're sort of doing whatever. And so whether it is in line with recommendations or whether it is just your plan for you that you're going to try that out for a period of time before deciding, okay, is this working or do I need to make some shifts here or there? Is that what I hear you saying in terms of understanding that underlying why and then make some intentionality there? Dr. Chinyelu E. Oraedu: Absolutely. Because when you think about exercise, I get this question all the time, should I exercise after nights? Some of my clients, they ask me that question, I'm like, I don't think it's a question I can answer for you. Because first of all, you have to know the level of physicality of your job, how intense, how much work do you do? You don't want to exercise when you're tired. Everybody tells you that you're going to hurt yourself. Of course, if you have other medical problems, you take medications that could make you hypoglycemic or something, you just don't want to exercise after working 12 hours at night if you are very tired. So it's one of those recommendations that you take on a case by case basis because sometimes you feel strong enough, maybe you can put in intense. I like to work out what I get back from night shift. I like to work, I mean, doesn't work. Some people tell you say you shouldn't, but I like to because I know my body and I know when I'm very tired. When I'm very tired, I rest and I workout before I go to work. But when I feel like my night wasn't too busy, I can still put in 20 minutes because for me, exercise is just what kind of keeps me grounded. And I like those end of things. Some people, like I said, it's different for night shift is so the variation and how people handle it is so different, which is why the chronotypes is going to give more insight into how people thrive as night shift workers where somebody else works nights and is totally ready to go, gets home, eats, works out, comes in, sleeps the whole day. Some people don't work, can't sleep when they get home, especially. Dr. Sarah Stombaugh: The chronotypes. Yeah, I mean I think a lot of, I hadn't even heard that word until the last couple of years actually. So for those who don't know what it is, it's about are you an early bird? Are you a night owl? What are you sort of naturally predisposed to? And we know that there are people who love waking up at four o'clock in the morning and there's other people who are probably still awake from the day before at four o'clock in the morning. And so yeah, when you can use that to then determine whether it is night shift or day shift, I think so many of these things, people should exercise in the morning, should exercise in the evening. I don't know what works for you are. I have patients who exercise at nine o'clock at night and then get straight in bed. And I know if I did that I would be totally wired and I'd have a horrible night's sleep. But they love it and it works for them. So great. Dr. Chinyelu E. Oraedu: That's an exciting thing about the whole chronotype shift. And I mean, I talk about shift work because the best time to exercise varies. Sometimes morning time, that's when you get the maximum energy expenditure. And then I mean, some studies will say, oh, it's in the evening time and I think it's based on your chronotype probably. Dr. Sarah Stombaugh: Yeah. Dr. Chinyelu E. Oraedu: If you align your exercise the hour of the day with your natural chronotype, that's when you get the best benefit from your exercise routine. So I think we have a lot of exciting times coming with all the research's going to emerge. Dr. Sarah Stombaugh: And it seems like as you're describing, yeah, there's a lot of things that we're starting to understand more and talking about more and more about how we can best support and individualize our treatments or recommendations at least. I love that. Well, let me ask you, Dr. Oraedu, as we are wrapping up here. Is there anything we haven't talked about yet that you're like, oh my gosh, your listeners need to hear this? Dr. Chinyelu E. Oraedu: I just want to just talk about mental health since we are in May, and this is mental health awareness month. Because one thing that I realized with some people, even myself sometimes, not just that night shift work, we know that it disrupts your natural sacred rhythm. We know that part of the reason night shift workers suffer is because of the suppression in melatonin. When you work at night and you're up all night, you don't secrete melatonin. And melatonin has a lot of qualities, properties that are good for humans, both the anti-inflammatory, it's good, it helps to regulate with your blood sugar and also anti-cancer an amazing hormone. But night shift workers studies have shown that they have decreased levels when tested in the urine. So is that part of the reason why people who work nights may be predisposed to a lot of depression? There've been studies that show that mental health, because I mean, the sun is the center of life. So when you get into a work schedule where you always have to be out at night, it may over time start to affect your mood and affect your body system. So I just want to create the awareness if people work night and they feel like their personality may be changing and not just that it affects even your intimate relationship. If you have a significant order, it can affect it because you working in opposite schedules because nights is good for almost everything. Passion, the beauty of the night, human interaction parties or just hanging out with people. So you find out over time when you talk to some people that work nights, they start to feel like their social lives is totally doesn't even exist, and it could make some people sad. So I just want to bring that to the surface that if you work nights and you having changes in personality or you feel like you need to talk to somebody, that you should seek mental help and support. Dr. Sarah Stombaugh: Yeah, I appreciate you saying that because I think a lot of times we don't necessarily have that we're not paying attention to. And so just this awareness that this is something I should be on the lookout for, there may need to be an intentional creation of morning coffee dates and other things that are going to supplement your social life if you're finding, oh, I'm left out from activities because I'm at work while they're happening. So I appreciate you bringing that awareness. Well, this was really wonderful. Thank you for coming on the podcast today. If people are interested in learning more about you, maybe working with you, where can they find more about you? Dr. Chinyelu E. Oraedu: So you can find, I mean, my website is dryelora is D-R-Y-E-L-O-R-A.com. So I have a lot of information on my website. You can reach me through my website or email. My email is hello@dryeloracoaching.com. But most importantly, I have actually, I have a radio show here in Connecticut. I live in Fairfield County, so I'm actually going to do the show this evening. So I have a weekly Tuesday, every Tuesday at 7:30 PM So it's the night shift lifestyle show with Dr. Yel’Ora, and you can stream it online. It's life. And tonight I'm going to have a speaker, she's pretty renowned psychiatrist, and we're going to dig into everything, mental health. And most importantly, I'm kind of very concerned about not just the rising number and crisis of mental health in young people country, but also what will be the impact of recreation and marijuana on young people. So I have all those question for my guests today. So my radio show is, like I say, I address everything night shift and more, and I'm always looking for people who want to call in and we can have phone conversation. And so it's every Tuesday. So that is kind of my best resource now and opportunity to interact and people can call in. So it's The Night Shift Lifestyle Show on WICC. Yeah, WICC 600 am 107.3 FM in Connecticut. Dr. Sarah Stombaugh: Okay, cool. Well, thank you for sharing that. That's a great resource for people. And like you said, whether you're in Connecticut area or if you want to live stream it, that's a cool way for people to maybe get some of their questions answered. And so thank you for sharing that with my audience. Well, thank you so much, doctor or Redu for coming on today. This was really a pleasure. Dr. Chinyelu E. Oraedu: Same here. Thank you. Thank you so much for having me. Thanks.