Cholesterol problems, Mostly for the nocturnists

[suckstobeme]

Friends:
I've been doing the nocturnist thing for almost three years now. Mostly I love it and would really not be excited about having to go back to days.
About myself, full time nocturnist, love my job, late 30s, about 10-15 lbs overweight but certainly not obese, used to be OK at the gym but family life has made exercise sporadic at best. No other health problems, great BP, etc. I do 14-15 9hr shifts per month, almost all nights, just a few swing shifts here and there to help out when needed.
So recently I had my cholesterol checked and it was kinda crazy bad. Total 270, LDL 202, borderline triglycerides, sucky HDL. So full disclosure, I can't blame all of it on being on nights all the time. A few years ago, when I was only doing like 4-6 nights a month, I had life insurance exam, and although i never got the actual numbers, they did not give me the 20yr policy I wanted at the rate I wanted because of my lipid panel, so I got a 10yr policy with the idea that I would work on it and get tested in a year or so for the preferred rate. I never really did anything with that because my job increased the coverage for me on the policy I get from them.
Anyhow, although I can't blame it all on nights, I think it's part of the problem.
So questions:
1) do any of the other nocturnists have any similar experiences with health problems you think may be related to nights? If so how did you respond? Anyone cut back on nights and get an improvement? Lifestyle? Meds?
2) any diet suggestions that have worked for you guys? I admire eat a lot of carbs and probably too many trans fats. I don't eat fried fast food or sugary drinks much but do often stop at Panera for a very bready sandwich and a creamy soup prior to a shift. More than my share of pizza, too. Thinking about keto but seems too hard. Thinking about Mediterranean as a happy medium. My last ditch effort to avoid lipitor.
3) have you ever considered the compensation for the deleterious health effects of nights? So, I get a good differential (40), but I always considered that compensation for the inconveniences of nights, and I never really took into account the health impact. It ends up being about 60k/yr though probably a bit less since my RVUs go up if I work in the midday when it's busy. What number is worth it to you guys?

Sorry for the rambling message.

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[bravotwozero]

They could pay me $800/hr and I still wouldn’t do a nocturnist gig..


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[VA Hopeful Dr]

LDL of 202 isn't lifestyle, that's genetic and likely a familial hypercholesterolemia.

 

[goodoldalky]

I would take the statin and forget about anything drastic. Yeah, try to live a little healthier, maybe cut back to the minimum nights, but statins are basically wonderdrugs, and you probably aren’t fixing your lipid panel without one.

 

[BAM!]

not sure we're supposed to give health advise on this forum. but if we were, you may find better answers under the family medicine forum

 

[VA Hopeful Dr]

not sure we're supposed to give health advise on this forum. but if we were, you may find better answers under the family medicine forum

See, sometimes it pays to have a nosy FP hanging around the cool kids' forum

 

[suckstobeme]

Fwiw, not looking for medical advice as much as job/lifestyle advice and other people's experiences. Considering leaving nights but a bit reluctant to do so. Some of my nocturnist colleagues have stopped nights bc of some health concerns.

 

[engineeredout]

Try getting back into a regular workout routine. Join a gym (Orange Theory Fitness is awesome). Schedule it prior to your shifts after you wake up. If you get yourself into a routine, you'll not only see physical benefits, but mental ones as well.

 

[shookwell]

I wouldn't take a statin for primary prevention.

 

[VA Hopeful Dr]

I wouldn't take a statin for primary prevention.

In this case it's not primary prevention it's (most likely) treating familial hypercholesterolemia

 

[bravotwozero]

the thing I don't like about statins is that type 2 diabetes is a known side effect of statin therapy. So if you're trying to minimize one cardiac risk factor, only to replace with one infinitely more worse, that's pretty counterproductive....

 

[Janders]

Who knows the precise effects of night shifts on your cholesterol (vs diet, exercise, genetics).

I also wonder the difference between full time nocturnist, and a "normal" ED doc who does, say, 3-4 overnights a month and in addition 8 shifts that end in the neighborhood of midnight...

Anyway, I'm a huge believer in both keto and intermittent fasting. I like exercise a lot too... both cardio and weights... but I really think diet is the major player here. My lipid panel looked sorta insanely amazing after being largely keto / fasting for a few months. I found it helped my energy at work, etc. My suspicion is that just doing a week of keto per month, or a true intermittent fasting, you MAY get the same benefits. Now who knows if this ACTUALLY means you lower the risk of MI, but it does make your numbers look pretty :-D

My opinion is half of the benefit is if you are keto, suddenly 95% of the crap that the nurses, techs, and other docs bring to share suddenly becomes "i can't eat that". Keeps you from mindlessly stress eating 2k calories of chips and brownies during a tough overnight!

The key is to come prepared with lots of keto / fasting friendly snacks. Coffee with MCT / coconut oil / cream. Miso soup. "bone broth". Stacks of green tea bags....

 

[suckstobeme]

I have done intermittent fasting in the past and didn't mind it, so maybe I'll try that more regularly.

I like the idea of keto 1 wk a month, but I thought keto didn't work like that. Like you need 3 days just to get to ketosis. I thought it was effective if it was a more long term change.

 

[VA Hopeful Dr]

the thing I don't like about statins is that type 2 diabetes is a known side effect of statin therapy. So if you're trying to minimize one cardiac risk factor, only to replace with one infinitely more worse, that's pretty counterproductive....

For people with known cardiovascular disease, the risk of developing diabetes is much less than the benefits from MI and stroke prevention. It's a lot trickier in primary prevention which is why CV risk calculators are so popular these days.

 

[Brigade4Radiant]

Intermitant fasting and cutting down the carbs. Try to get 10000 steps a day. I would put some serious thought before just taking a statin. I just don’t eat on my night shifts even if have 4 in a row. You could try a pure keto diet during your nights. You can’t continue your regular diet stuff on nights.

 

[miacomet]

Who knows the precise effects of night shifts on your cholesterol (vs diet, exercise, genetics).

I also wonder the difference between full time nocturnist, and a "normal" ED doc who does, say, 3-4 overnights a month and in addition 8 shifts that end in the neighborhood of midnight...

Anyway, I'm a huge believer in both keto and intermittent fasting. I like exercise a lot too... both cardio and weights... but I really think diet is the major player here. My lipid panel looked sorta insanely amazing after being largely keto / fasting for a few months. I found it helped my energy at work, etc. My suspicion is that just doing a week of keto per month, or a true intermittent fasting, you MAY get the same benefits. Now who knows if this ACTUALLY means you lower the risk of MI, but it does make your numbers look pretty :-D

My opinion is half of the benefit is if you are keto, suddenly 95% of the crap that the nurses, techs, and other docs bring to share suddenly becomes "i can't eat that". Keeps you from mindlessly stress eating 2k calories of chips and brownies during a tough overnight!

The key is to come prepared with lots of keto / fasting friendly snacks. Coffee with MCT / coconut oil / cream. Miso soup. "bone broth". Stacks of green tea bags....

Nuts, lots of unsalted nuts, cherries, agreed on tea of various types, and my secret weapon is chugging tons of sparkling water to fill me up. Cycling to work is a bonus, too. But the night shift is rough. very rough on your body. Even though I only work a few a month, I'm thinking of UC when I hit 50 for the obvious health benefits of the day shift.

 

[d2305]

I never sleep right in the daytime. I take a statin which normalized my lipids.

 

[Tenk]

So I’ve been a night owl my whole life and did great in residency moonlighting nights. I decided I’d try it full time as an attending. It was terrible. I became grumpy, tired, and annoyed by everything. When I went back to days everything was better. Now I dread working nights but still prefer to stay up late when I’m off. Weird.

 

[The White Coat Investor]

Working nights is considered a cardiac risk factor. Dropping my night shifts is the best thing I've ever spent money on.

I never really liked them, but I didn't mind them so much. The way I felt about them at 40 was much different than how I felt at 30 though.