Dietary Strategies for Shift Workers to Improve Heart Health
Dietary Strategies for Shift Workers to Improve Heart Health
Cardiovascular disease remains the leading cause of death in the US.1 Following a cardio-protective diet is important for anyone and may be especially important if you’re a shift worker. A large meta-analysis including more than 2 million shift workers found that shift work is associated with a 24% increase in cardiovascular disease.2 Shift work is also associated with significantly higher amounts of low-grade inflammation among both male3 and female4 workers. Chronic, low-grade inflammation is recognized as a contributing cause of cardiovascular disease5 and may partly explain the higher prevalence of cardiovascular disease among shift workers.6,7
Targeted interventions to reduce inflammation have been shown to prevent cardiovascular disease.8 Likewise, an anti-inflammatory diet is associated with a lower incidence of cardiovascular disease.9 While a healthy diet is an important part of your cardioprotective strategy, other lifestyle changes or medical interventions may also be required. Metabolic effects of circadian misalignment,10, 11, 12 poor sleep quality,13, 14 and lack of physical activity15 may all increase your cardiovascular disease risk. Speak with your doctor to determine your personal risk and develop an approach that’s right for you.
Below are key diet strategies to reduce low-grade systemic inflammation and improve cardiovascular health:
5-10 servings of fruits and vegetables daily.
Adequate fruit and vegetable intake is the most well-supported anti-inflammatory diet strategy.16 While some studies have found a maximum benefit from as few as 4 servings daily,17 others suggest as many as 9 may be required for maximum benefit, especially among those with an increased risk of cardiovascular disease.18 A vitamin and mineral supplement does not appear to be an adequate replacement for the anti-inflammatory effects of fruits and vegetables.19
30 g fiber daily.
Among a group of individuals with low fiber intake, increasing dietary fiber to 30 g daily significantly reduced markers of inflammation. A fiber supplement appears to provide an equivalent effect to dietary fiber from whole foods like whole grains, fruit, vegetables, beans, and nuts.20
5 or more servings of nuts and seeds weekly.
Higher intake of nuts and seeds is associated with reductions in markers of inflammation.21 Nuts and seeds are high in polyunsaturated fats, fiber, vitamins, minerals, and other phytonutrients thought to be protective against cardiovascular disease. While whole peanuts have been shown to be protective, peanut butter has not.22
2 servings of fish weekly.
Observational studies support the anti-inflammatory benefit of fish,23 with 10 oz weekly associated with a 33% decrease in markers of inflammation compared with no fish consumption.24 Fish oil supplements may provide a similar anti-inflammatory benefit,25 though some robust studies have found little benefit.26
If tolerated, eat dairy daily, especially fermented dairy.
In a robust review, all dairy, including high-fat dairy, was associated with reduced markers of inflammation. Among individuals with gastrointestinal disease or dairy sensitivity, however, dairy was often associated with increases in inflammatory markers. Probiotic-rich dairy—such as yogurt and kefir—especially may be beneficial.27 Probiotic supplements alone have been shown to reduce inflammation.28
Choose healthy oils.
While a high fat intake is generally associated with increases in inflammation, the effects may vary depending on the type of oil and cooking technique used.29 Olive oil, in particular, has been shown to provide anti-inflammatory benefits in numerous studies.30 Other oils that may be a healthy choice but lack robust evidence include grapeseed, avocado, walnut, and canola.
Maintain a healthy weight.
Adipose tissue itself produces inflammatory mediators contributing to total systemic inflammation.31 Studies have consistently shown that weight loss, regardless of the means, results in decreases in markers of inflammation.32
Limit processed meats, sugars, and salty snacks.
In a large multi-ethnic study of more than 5,000 people, a diet high in processed meats (hot dogs, lunch meats, sausages, bacon), sugars (soda, ice cream, desserts, candy), and salty snacks (fries, chips, popcorn, crackers) was associated with a 33% increase in markers of inflammation compared with diets that were lower in these foods.33
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Vyas MV, Garg AX, Iansavichus AV, et al. Shift work and vascular events: systematic review and meta-analysis. BMJ. 2012 Jul 26;345:e4800.
Kim SW, Jang EC, Kwon SC, et al. Night shift work and inflammatory markers in male workers aged 20-39 in a display manufacturing company. Ann Occup Environ Med. 2016 Sep 20;28:48. doi: 10.1186/s40557-016-0135-y.
Nikpour M, Tirgar A, Hajiahmadi M, et al. A cross-sectional study on serum high-sensitivity C-reactive protein level and shift work among reproductive-age women. Caspian J Intern Med. 2019 Fall;10(4):402-410. doi: 10.22088/cjim.10.4.402.
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Wirth MD, Burch J, Shivappa N, et al. Dietary inflammatory index scores differ by shift work status: NHANES 2005 to 2010. J Occup Environ Med. 2014 Feb;56(2):145-8. doi: 10.1097/JOM.0000000000000088.
Ridker PM, MacFadyen JG, Everett BM, et al. Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: a secondary analysis from the CANTOS randomised controlled trial. Lancet. 2018 Jan 27;391(10118):319-328. doi: 10.1016/S0140-6736(17)32814-3.
Shivappa N, Steck SE, Hussey JR, et al. Inflammatory potential of diet and all-cause, cardiovascular, and cancer mortality in National Health and Nutrition Examination Survey III Study. Eur J Nutr. 2017 Mar;56(2):683-692. doi: 10.1007/s00394-015-1112-x.
Morris CJ, Purvis TE, Hu K, Scheer FA. Circadian misalignment increases cardiovascular disease risk factors in humans. Proc Natl Acad Sci U S A. 2016 Mar 8;113(10):E1402-11. doi: 10.1073/pnas.1516953113.
Burgueño A, Gemma C, Gianotti TF, et al. Increased levels of resistin in rotating shift workers: a potential mediator of cardiovascular risk associated with circadian misalignment. Atherosclerosis. 2010 Jun;210(2):625-9. doi: 10.1016/j.atherosclerosis.2009.12.032.
Castanon-Cervantes O, Wu M, Ehlen JC, et al. Dysregulation of inflammatory responses by chronic circadian disruption. J Immunol. 2010 Nov 15;185(10):5796-805. doi: 10.4049/jimmunol.1001026.
Kervezee L, Kosmadopoulos A, Boivin DB. Metabolic and cardiovascular consequences of shift work: The role of circadian disruption and sleep disturbances. Eur J Neurosci. 2020 Jan;51(1):396-412. doi: 10.1111/ejn.14216.
Meier-Ewert HK, Ridker PM, Rifai N, et al. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol. 2004 Feb 18;43(4):678-83.
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Miller V, Mente A, Dehghan M, et al. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet. 2017;390(10107):2037–2049. doi:10.1016/S0140-6736(17)32253-5.
Buil-Cosiales P, Toledo E, Salas-Salvadó J, et al. Association between dietary fibre intake and fruit, vegetable or whole-grain consumption and the risk of CVD: results from the PREvención con DIeta MEDiterránea (PREDIMED) trial. Br J Nutr. 2016;116(3):534–546. doi:10.1017/S0007114516002099.
Sun CH, Li Y, Zhang YB, Wang F, Zhou XL, Wang F. The effect of vitamin-mineral supplementation on CRP and IL-6: a systemic review and meta-analysis of randomised controlled trials. Nutr Metab Cardiovasc Dis. 2011;21(8):576–583. doi:10.1016/j.numecd.2009.12.014.
King DE, Egan BM, Woolson RF, et al. Effect of a high-fiber diet vs a fiber-supplemented diet on C-reactive protein level. Arch Intern Med. 2007;167(5):502–506. doi:10.1001/archinte.167.5.502.
Jiang R, Jacobs DR Jr, Mayer-Davis E, et al. Nut and seed consumption and inflammatory markers in the multi-ethnic study of atherosclerosis. Am J Epidemiol. 2006 Feb 1;163(3):222-31.
Guasch-Ferré M, Liu X, Malik VS, et al. Nut consumption and risk of cardiovascular disease. J Am Coll Cardiol. 2017 Nov 14;70(20):2519-2532. doi: 10.1016/j.jacc.2017.09.035.
He K, Liu K, Daviglus ML, et al. Associations of dietary long-chain n-3 polyunsaturated fatty acids and fish with biomarkers of inflammation and endothelial activation (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol. 2009;103(9):1238–1243. doi:10.1016/j.amjcard.2009.01.016.
Zampelas A, Panagiotakos DB, Pitsavos C, et al. Fish consumption among healthy adults is associated with decreased levels of inflammatory markers related to cardiovascular disease: the ATTICA study. J Am Coll Cardiol. 2005;46(1):120–124. doi:10.1016/j.jacc.2005.03.048.
Li K, Huang T, Zheng J, Wu K, Li D. Effect of marine-derived n-3 polyunsaturated fatty acids on C-reactive protein, interleukin 6 and tumor necrosis factor α: a meta-analysis. PLoS One. 2014;9(2):e88103. Published 2014 Feb 5. doi:10.1371/journal.pone.0088103.
Muldoon MF, Laderian B, Kuan DC, Sereika SM, Marsland AL, Manuck SB. Fish oil supplementation does not lower C-reactive protein or interleukin-6 levels in healthy adults. J Intern Med. 2016;279(1):98–109. doi:10.1111/joim.12442.
Bordoni A, Danesi F, Dardevet D, et al. Dairy products and inflammation: A review of the clinical evidence. Crit Rev Food Sci Nutr. 2017;57(12):2497–2525. doi:10.1080/10408398.2014.967385.
Mazidi M, Rezaie P, Ferns GA, Vatanparast H. Impact of probiotic administration on serum C-reactive protein concentrations: Systematic review and meta-analysis of randomized control trials. Nutrients. 2017;9(1):20. Published 2017 Jan 3. doi:10.3390/nu9010020.
Teng KT, Chang CY, Chang LF, Nesaretnam K. Modulation of obesity-induced inflammation by dietary fats: mechanisms and clinical evidence. Nutr J. 2014;13:12. Published 2014 Jan 29. doi:10.1186/1475-2891-13-12.
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Ellulu MS, Patimah I, Khaza’ai H, Rahmat A, Abed Y. Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci. 2017 Jun;13(4):851-863. doi: 10.5114/aoms.2016.58928.
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Nettleton JA, Steffen LM, Mayer-Davis EJ, et al. Dietary patterns are associated with biochemical markers of inflammation and endothelial activation in the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr. 2006 Jun;83(6):1369-79.
Sureda A, Bibiloni MDM, Julibert A, et al. Adherence to the Mediterranean diet and inflammatory markers. Nutrients. 2018;10(1):62. doi:10.3390/nu10010062.
Ron Beckstrom is a registered dietitian, exercise physiologist, and writer. As a retail dietitian, Ron advises on and writes about the latest food trends and products and has been featured on numerous local news outlets. Ron has worked in various settings as a health professional including hospitals, corporate wellness, and nutritional supplement R&D. Ron is also a member of the Utah National Guard where he serves as an operations officer.