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Food for Thought

Right diet helps nurses keep minds stable throughout busy shifts

Sunday June 6, 2010
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The biggest problem with the eating habits of nurses during work hours is usually not that they eat too much — it’s that they don’t eat enough, nutrition experts say.

“It’s when you skip meals that your stress level gets crazier than it might otherwise,” says Kerry Neville, MS, RD, a Washington-based nutrition consultant and national spokeswoman for the American Dietetic Association. “You end up eating fewer calories during the day, but then (when you get home) you are starving and end up eating everything in sight.”

When many nurses grab a bite during a busy shift, it’s likely to be something high in simple carbohydrates — a candy bar, a bag of pretzels, a bagel. Such foods are quickly absorbed into the system and raise glucose levels, nutrition experts say. But the burst of energy they provide fades quickly, leaving the person even hungrier an hour later, and often tired and cranky as well. Over time, studies suggest, this up-and-down glucose pattern encourages the body to store fat and affects the brain’s natural signal to feel full, which can contribute to overeating, obesity and diabetes.

Unhealthy eating patterns are common in many busy people. But exacerbating the situation for nurses is that they tend to put everyone else first and themselves last, says Gary Scholar, BS, MEd, a Chicago-based health and wellness consultant to employees of the American Hospital Association, and author of “Fit Nurse: Your Total Plan for Getting Fit and Living Well” published by Sigma Theta Tau International. “They often overperform in their jobs and underperform in their own self-care and wellness,” he said. A 2009 study of nurses in Ohio showed those who reported high levels of job stress were at higher risk for eating disorders.

Nurses also deal with long shifts at work, followed by a “second shift” at home; vending machines and hospital cafeterias stocked with foods high in simple carbohydrates; and a constant supply of sugary treats brought in by well-meaning patient families and colleagues, Scholar says. He compares the energy nurses expend to that of runners in a marathon, “except they don’t train for it and they aren’t supported for it. One day just goes into the next and there’s no time for them to re-energize.”

Studies have shown low glucose levels affect concentration, short-term memory, and the ability to retain information, which can affect performance at work, says Kristen E. D’Anci, PhD, a researcher in the department of psychology and nutrition and neurocognition laboratory at Tufts University in Massachusetts. “If you’re not able to pay attention, you’re going to miss things, and it’s critical for nurses not to miss things,” she says. Hunger also has an effect on mood, making people irritable and less equipped to handle stressful situations, she says.

For optimal performance, busy people need to eat regular, small, balanced meals and snacks that provide energy throughout the day, nutrition experts say. They recommend eating every two-to-four hours during a busy shift. Shawn M. Talbott, PhD, LDN, FAIS, FACSM, is a nutritional biochemist, consultant, and author in Utah who frequently has worked with athletes, whom he says face many of the same constant energy demands faced by nurses. He suggests nurses think of eating as an IV bag with a constant drip of nutrients and energy to keep body and brain on an even keel. With a constant supply of energy, the brain is less likely to send out cravings for sweets and other simple carbohydrates.

This way of eating usually prevents weight gain, Talbott says, though it doesn’t necessarily promote weight loss unless nurses specifically choose foods lower in calories. But a steady supply of slower-burning energy should make nurses feel more alert, improve their ability to deal with stress, and level out mood swings caused by glucose spikes. Most nurses probably know this, says Christine Gerbstadt, MD, RD, a spokeswoman for the American Dietetic Association. “But they may not know how to do it or how to do it in their lives,” she says.

Here are some of the nutrition experts’ suggestions for successful “energy eating” on the job:

1. Keep a stash of nutrient-dense snacks in your purse, pocket, car, drawer or locker. Cans of tuna, string cheese, packets of whole-grain crackers, trail mix, fresh and dried fruit, and containers of yogurt provide portable servings of sustained energy to help keep the body and mind going strong throughout the day (see the box at right for some portable “super-food” suggestions). But constant grazing can easily lead to overeating, Gerbstadt warns. Measure out snacks and keep track of what you eat — snacks should be between 100 and 200 calories, nutritionists say. Neville suggests packing a lunch or dinner with various foods that add up to a certain number of calories and eating it at intervals throughout the shift.

2. Try to always balance carbohydrates with protein and a little fat. Imagine a saw-tooth, Talbott says, a sharp spike followed by an equally sharp drop. That’s your glucose level on simple carbohydrates. Nutritionists like to see a small bump — a more gradual rise followed by a gradual decline, produced by combining carbs, which provide energy, with protein, which helps sustain energy, promotes fullness and boosts neurotransmitters that increase alertness. Snacks from home would ideally include whole grains, fruits and vegetables — peanut butter on whole grain bread, or an apple and a cheese stick. But even a candy machine can provide some balance in a pinch, some nutrition experts say. Choose candy with peanuts — Snickers or peanut M&Ms — over healthier-sounding foods such as fruit roll-ups or pretzels, which will only make you hungry.

3. To balance meals, Scholar suggests buying or imagining a divided “energy” plate, with two small sections and one large one. Each small section should contain a portion of whole grains and one of protein. The half-plate section should be filled with fruits and vegetables. “If you’re still hungry, you can go back for more fruits and vegetables,” he says. The entire meal will be between 400 and 500 calories. Talbott suggests using your hand as a guide. Carbohydrates should be the size of the fist, protein the size of the palm. Fats should fit into the “O” of the thumb and forefinger in an OK sign, and fruits and vegetables should be the length of thumb to pinkie of an outstretched hand. This method works anywhere, he says, even at a fast food restaurant where you can have a burger with a bun the size of your fist and a meat patty the size of your palm, preferably accompanied by a salad or fruit cup. The fat can be cheese on the burger or dressing on the salad. The meal works out to between 400 and 600 calories, he says.

4. Eat breakfast, the most important meal of the day. After 10 or 12 hours without food, the body needs energy. No matter how little time people may have in the morning, it’s important to eat something, D’Anci says, even a power bar in the car or a fast-food burger from a drive-through. For a more sustained and healthful energy boost, choose cereal or oatmeal with fruit and milk, yogurt and berries with granola, or eggs with whole-wheat toast.

5. Don’t be afraid of calories — even if you’re trying to lose weight. Active people — including bedside nurses — need about 2,000 calories, nutritionists say. The problem is when people eat about three-quarters of their calories at the end of the day, Talbott says. Since they don’t need the energy, it gets stored as fat. Nutritionists recommend eating more during the day, when energy can be used immediately, and less at night. “Really watch the portion size at dinner,” Neville says.

6. Reaching for a cookie or chocolate after a stressful episode reflects the body’s need to boost serotonin levels. “We’re not actually hungry, we’re looking for something to make us feel good,” D’Anci says. But the best antidote to stress is usually exercise, she adds. “If it’s at all possible and you have 10 minutes, take a walk around the block or around the hallways.”

7. Stay hydrated with plenty of water or unsweetened tea throughout the shift. But keep away from soft drinks. Sugar in liquid form not only spikes glucose levels and provides empty calories, it doesn’t fill you up, not even for a short time, Talbott says. Although nutrition experts generally agree caffeine in limited amounts — one or two cups of coffee — is OK, it is easily abused, especially on the night shift.

8. Night shift workers should follow the same pattern as their daytime colleagues, eating small, balanced meals and snacks throughout the shift. But since most cafeterias and restaurants are closed at night, bringing food from home or coordinating a “healthy” pot-luck are their best — often their only — choices. Night shift workers also should try to cut off caffeine early and eat a small meal of sleep-inducing carbohydrates before bedtime, nutritionists say.

9. Consider working together to make sure everyone is eating for optimal energy. Rather than hold a weight-loss competition, co-workers can remind each other to eat during the day; ask colleagues if they’ve had breakfast; take turns stocking a cupboard with nutritious snacks; and agree to bring in healthful treats such as fruit baskets, limiting the days they bring in sugary foods, or pitching in for a massage therapist to give neck rubs instead of a takeout food feast.

10. Think long-term as well as short-term. The occasional burger or nut bar is fine, Neville says, but you will do your body and brain a huge favor by planning and eating meals full of vitamins, antioxidants, fiber and omega-3 fatty acids, provided by foods such fatty fish, berries, fruits, whole grains, certain nuts, beans and vegetables. Though research is still ongoing about the benefits these foods have regarding long-term cognition and preventing dementia, many studies have shown positive affects of these on cardiovascular function, which in turn affects brain function. “If you eat in a way that supports your heart,” D’Anci says, “that’s going to be good for your brain as well.”


Cathryn Domrose is a staff writer for Nurse.com.Send a letter to editorNTL@gannetthg.com or post a comment below.
Five Super Foods to Bring to Work

1. Fresh fruits and vegetables. Apples, bananas, berries, baby carrots, snow peas and bags of pre-washed greens — nutrition experts can’t say enough about the benefits of these. High in fiber, antioxidants, vitamins, complex carbohydrates, they are the foundation of healthy eating.

2. Fatty fish, including tuna and salmon. These contain omega-3 fatty acids, which have multiple health benefits, and can be added to a salad or eaten on crackers.

3. Sweet potatoes. These can either be cooked in a microwave, or oven-baked at home and eaten cold or reheated. They are filling, satisfying, and contain a dense packet of fiber and nutrients.

4. Yogurt. Easy to pack, easy to eat and high in protein, “yogurt could be the nurse’s best friend,” says Kristen E. D’Anci, PhD, a researcher in the department of psychology and nutrition and neurocognition laboratory at Tufts University in Massachusetts.

5. Avocados. These are high in calories (a medium one has more than 300) but their nutritional benefits make them an ideal portable energy food, says Gary Scholar, BS, MEd, a Chicago-based health and wellness consultant to employees of the American Hospital Association, and author of “Fit Nurse: Your Total Plan for Getting Fit and Living Well.” They are high in fiber, potassium and monosaturated fats, the kind that help bolster HDL cholesterol. Cut one in half before you pack it, and scoop out the creamy center with whole wheat pita bread, tortilla chips or vegetables.