Circadian Rhythms & Their Impact On TTC

Kristen DeAngelis, RD, IFNCP, RYT

Thank you so, so much for having me here. excited to talk about this topic.

Carrie Jones, ND, FABNE, MPH

Fertility is your area of expertise, so I can’t think of anyone better. especially, like I said, having just had a baby. Let’s talk about your history and background. What got you here? What got you into fertility?

Kristen DeAngelis, RD, IFNCP, RYT

When I began as a dietitian, I was working with outpatient centers and working with women, but I was dealing with my health issues at the time. I had been experiencing amenorrhea, or loss of period, for over seven years. I had gone to multiple specialists and doctors, some of the best in the country, and no one could figure me out. I kept getting the same repeat, answer, shrug their shoulders. Everything looks fine when you want to get pregnant. One day, it will just give you hormones. I was like, there’s no other answer here. There’s not another root cause that I could look at. That’s when I got into going down the path of functional medicine and starting to work with nutrition dynamics. I’m now the director of health coaching today. We started working on the root cause, and I got my period back in three months. After seven years of unexplained infertility, I just wanted to dive all in. That kind of is what brought me to want to empower women to help them address, whether it’s their infertility, their reproductive issues, or their period problems. I was able to conceive naturally, and I’m four months postpartum. It’s been a wild journey, and I’m so blessed and honored to be in the position that I’m in to help other women today.

Carrie Jones, ND, FABNE, MPH

I  love that. As you and I were talking off-air, we were talking, of course, about whether we were night shift workers or swing shift workers. We love them. We need them. Our mamas who are up with their kids are either breastfeeding or up just because of kid health stuff. They are feeling it. When they feel it, a lot of it centers around cortisol and their circadian rhythms. I want to get into that a little bit. What is the circadian rhythm for everyone listening, and then how might that impact health? What would that do to maybe throw somebody off work? Their fertility could be at risk a little bit.

Kristen DeAngelis, RD, IFNCP, RYT

It comes back to the circadian system, which is based on our 24-hour biological rhythms and impacts everything in our body. It’s mostly coming back to our light and dark cycles. The light comes in through our eyes and retina, and there’s a light-sensing protein, melanopsin, that assesses this blue light. Is this telling me to wake up, be active, and turn things on, or is it assessing more of this like an amber, orange, or red light? Think of sunsets or campfires before we had all of the digital products we do today, and that would say it’s time to wind down. It’s time to turn down the digestive juices. It’s time to turn on melatonin. This is when cortisol should be the lowest. It is time to go to bed. so when we have a disrupted rhythm. For our shift workers, let’s say they’re going into their typical Monday through Friday, that’s one type of shift work.  They’re looking at the sunset as they’re driving in to start their day. They’re getting this confusing signal. What I like to kind of think of is whether we like these mini-factories or conveyor belts in every organ or gland in our body. Those are the clock genes. The master clock is up in our brains. It starts in our hypothalamus, the suprachiasmatic nucleus.

But it’s the master clock that dictates those rhythms. But there are rhythms in our thyroid, in our pancreas to tell insulin to release or not release in our gut, and in our digestive juices to say that there’s food coming down; we just woke up or we didn’t. even with hormone production. when we’re looking at estrogen and progesterone, testosterone production, and then, of course, what we can talk about today more in-depth is cortisol. We’re getting a typically normal response: when we wake up, we have the sleep cortisol rise. That’s our cortisol awakening response, the steepest rise we should get in the day. Then it starts to slow down, and it drops down during the day. It’s lowest at night, and that’s when melatonin turns on. But through several different cortisol tests, one of my favorites, the Dutch, I have to bring up with Dr. Carrie Jones. We can see that there can be many different rhythms. Why should that be the rhythm that happens in a normal circadian response? We can see someone who might have very low cortisol in the morning and it’s high at night. They might be feeling exhausted all day. But when it’s time to hit the pillow, they can’t fall asleep.

Or it could be the person. This would wear the shift work moms or someone who’s having sleep disruptions in the middle of the night, sleep apnea, or whatever it is they’re waking up in the middle of the night. What happens when we wake up? We have a cortisol rise. We have cortisol, which is a glucocorticoid, so our glucose rises. I was doing an interesting experiment on myself, but I had a CGM, and I had my Oura ring. I have all the biohacking data. I don’t know if it’s helpful or not as a new mom because I see how often I wake up. But what I saw is that throughout the night, the multiple times that I would wake up, at the same time I woke up, my cortisol spiked up. Or my glucose spiked up, and the glucose on my glucometer spiked up. I know the cortisol spiked up as a baby. How is that throwing off the rest of the day during normal hours? It’s impacting my insulin, my thyroid hormones, my steroid hormones, and everything else in every other organ of the body. When we’re looking at reproductive health and fertility, whether you’re trying to conceive or whether you’re trying to optimize your hormones postpartum, it’s looking at how we can use light and dark to help optimize those clock genes in every organ of the body, from our pancreas, our insulin, our gut health, our liver detoxification, our thyroid health, and of course, helping support our HPA function when it comes to cortisone and melatonin.

Carrie Jones, ND, FABNE, MPH

That’s the truth. I want to go back to the CGM. the Continuous Glucose Monitor for people who don’t know what that is. Will you briefly define that? Then I wanted to get into that further with cortisol and things like ovulation because that’s going to hit home for a lot of people. This particular talk on this summit is around cortisol, shift workers, hormones, etc., but this is going to hit home for those of you who are one of those women and you have PCOS or have metabolic issues, This is a good time to listen up. If you could talk about the CGM, that’d be great.

Kristen DeAngelis, RD, IFNCP, RYT

We use a CGM in all of our patients because of the nutrition dynamic, but we also use a CGM as a continuous glucose monitor. You can just put it on the back of your arm. It’s simple and seamless, and it assesses what your glucose is doing during the day. But if you don’t have access to CGM, you can also pick up a glucometer at your local pharmacy. Anyone can do this and have this data. What we’re looking at is particularly not only fasting, what your blood sugar is when you first wake up in the morning, but after you eat your two-hour postprandial response, so your blood sugar might spike up, but is it coming back down? 

Two things I’m looking for is I’m looking for stability. How big of a variance and my spiking up or dropping down? I want it to be in the mid-eighties throughout the day and the evening. mid-eighties is kind of our goal that we’re looking at. When we bring back the concept of looking at our sleep and our circadian rhythms, we know that five consecutive days of sleep disturbances impact our insulin sensitivity. It decreases insulin sensitivity by 20%. When we know that PCOS, for example, is our number one cause of infertility and the hallmark of PCOS is insulin resistance, we have to come back and look at, well, asking the question, How are your sleep and wake cycles? Are you waking up feeling refreshed? Are you waking up in the middle of the night? A third of PCOS patients have obstructive sleep apnea, and that is true. Sleep disturbances are twice as likely in PCOS patients as not, so it’s a big thing to consider. How are we supporting sleep hygiene and circadian rhythm?

Carrie Jones, ND, FABNE, MPH

As Kristen mentioned, one of the reasons that we wake up. whether it’s something that wakes you up, you’re listening for your baby, your dog, or your partner has sleep apnea. You have sleep apnea. As she said, your cortisol goes up, and then your cortisol will cause your glucose to go up. It is a natural response to protect you, except that you don’t necessarily need protection. It’s just your baby crying, or it’s just your dog barking, or your partner is snoring. and so you wake up and you get this blood sugar response. When you have a client who is a nurse, an EMT, or a night shift factory worker, do you use a continuous glucose monitor on them as well? Do you see these shifts in their blood sugar, or do you find that they can accommodate them over time depending on their schedule?

Kristen DeAngelis, RD, IFNCP, RYT

It depends on what their schedule is. For the nurse who has a Monday through Friday night schedule, and that’s just always their schedule, they’re on, and their glucose will typically start to even out, and it’s very much because they’re waking up and going to sleep at the same time. We can usually help assess and support them as they go to sleep and as they wake up some more, from a biotech standpoint. But it’s the people who have two days on, two days off, one week on, night shift, one week I’m day shift, or it’s for the shift work lifestyle. I have a client I spoke to yesterday, and she’s a musician, so she’s up at shows until three a.m. on Friday nights and Saturday nights, or she’s working her regular job Monday through Friday, waking up at seven a.m. and going to bed at 10 p.m. That’s the one. Just look at her CGM data, and I’m seeing huge variances. I’m also looking at HRV data. I use the ordering service. I like it because we can also look at the temperature. back to helping women look at their ovulation and helping them assess their fertility health. But back to HRV, I say, I bet you’re HRV. When you tell me all of these numbers, I bet they’re in their twenties and thirties on Sunday, Monday, and Tuesday. Then the higher numbers you’re seeing are Wednesday, Thursday, and Friday, which is like, how did that happen? It’s like you’re Genie. No, I just know that Friday through Monday, your body is trying to recover from this weird waking up at three a.m. and it’s just starting to get into the rhythm again, and then you change it. It’s that frequent change that throws things off when we think about the cortisol and glucose response.

Carrie Jones, ND, FABNE, MPH

If you’re somebody new to HRV, it’s Heart Rate Variability. The higher it is, the better, more resilient, and less stressed your body is. The easier it is to handle stress, the lower it is. It’s a good indicator that things have not been good. You should probably take care of yourself. Maybe you need to rest. I have no affiliation, but I also love the Oura ring. However, I know people listening have an Apple Phone, an Apple Watch, or a Whoop band. There are HeartMath, and there are other ways to assess HRV if that sounds intriguing to you as you’re listening. We have to go to ovulation. You were your night shift worker. Let’s say you’re the cortisol all over the place person. You’re shifting constantly, or you have a night shift-type lifestyle. How does that variation in your clock genes affect when your cortisol goes up or down, your melatonin does or doesn’t, and how does that affect something like ovulation?

Kristen DeAngelis, RD, IFNCP, RYT

When we think about it again, that light and dark cycle and how it’s perceived and coming in through the retina, as the suprachiasmatic nucleus, is the master clock that is going to activate and generate, which sends the signals of LH and FSH, and so that’s going to impact our production of estrogen, progesterone, and testosterone. There’s the clock rhythmicity; also in the ovary are the theca cells, the granuloma cells, and the helper cells that have to play all the role-playing and observations. When we’re looking at a mismatch, there can be a missed signal that is then sent. especially when we’re looking at, for example, PCOS, which has a missed signal, let’s say the LH in a surge to release an egg. That’s when we start to see that there can be quite a bit of improvement when we start to regulate our rhythm and try to regulate that activation and the signal that’s being sent.

Carrie Jones, ND, FABNE, MPH

I wonder how many people are listening or how many clients you are with where they are. Let’s say they’re tracking their LH, their luteinizing hormone, like an ovulation predictor kit or an LH strip or something, or they’re trying to track for ovulation with mucus or temperature. They’ll say this month, and nothing happened this month, and you’ll go, How’s it been? How’s that stress? How’s your sleep been? What’s your job like? And it’s been terrible. I’ve been traveling or even crossing time zones. We haven’t even mentioned that. But if you took a big trip where you’re like night and day got flipped, it’s the same; it falls under that night shift worker thing. How many times do they go? It’s terrible; it’s like the worst lately,  Unfortunately, that ties hand-in-hand.

Kristen DeAngelis, RD, IFNCP, RYT

When we have to think about it, It’s a stress on the body. I remember when I was looking at my ovulation data, and we have to remember, too, that it takes 90 days for a follicle to mature. We want to think about what was happening. Was there some major jet lag happening two months ago? There was a time when I went to Mexico. It was sunny. I was outside every day. I was, of course, getting used to the natural rhythms of waking up and falling asleep based on the sun. But when I went back to Chicago, it was snowing. It was a blizzard for, like, two weeks straight. Not only was there a major stressor on my body from climate change, but I was also not getting outside. I was inside, and I wasn’t getting exposed to the natural rhythms of that light and dark cycle. What happened was that you looked a month, two months, or even, sometimes, three months out. That light or dark cycle, how it activated or shifted that LH signal could then affect your emotions even up to three months down the line.

Carrie Jones, ND, FABNE, MPH

The big question, of course, is: What do we do? If somebody is listening who is like, this is completely me, either through the new mom or mom up at night. They’re just like your musician client, too. They have that night-shift lifestyle. They’re an actual night shift worker, thinking, This is me. I identify. Where do you start with them?

Kristen DeAngelis, RD, IFNCP, RYT

I want to think of, like, four buckets. There’s light. Is always going to be our biggest mover down the river. But then there’s also food, activity, and mood. How am I managing my stress? First, we’ll start with the light piece. Anything that you can do to try to set the tone: is it time to wind down or is it time to wake up? Let’s say that a musician, for example, who’s going to bed at 3 a.m. As soon as she can get home, I want her to put some type of amber-blue-blocking glasses on. I want her to shut off every single light, cut all of it out of the alarm clock as much as you can get it all out, and then try to wake up.

I try to advise her not to sleep until 1 p.m. The next day, try to get your alarm clock within if you can. Two hours from when your regular morning wake-up schedule is, and this comes back to when you said jet lag and going over time zones. Our bodies start to have problems when they go over time zones. Think about almost like that two hours. We don’t want to go past the two-hour time zone when we’re waking up on the weekends, sleeping in, or something of that nature. Now for the wake-up time. When we wake up, we want to be exposed to bright light within 30 minutes. Now I live in Vermont. It’s dark, and it’s cold. I’m waking up, and it’s still dark. I got one of those light boxes, and that thing is bright, but I swear it works so well for a lot of my clients, including myself, that it almost feels like a cup of coffee. But what that is, it’s cortisol; it’s that natural cortisol, weakening response.

Exposing yourself to that bright light first thing in the morning is the best way to set and reset the systems we’re trying to do. For the food and activity piece, I like to suggest asking yourself, When are you eating? When you first wake up and try to advise within the first two hours of waking to have your first big meal, that can be another way to kind of set the rhythms for the rest of your body the rest of the day. It’s also when we tend to be able to receive more food. There’s a little bit more of that insulin sensitivity in the morning. whether I’m calling it morning or not, when you wake up, whatever that time is for you, eat something within two hours of waking, have a full spectrum of light, and then try to eat a little bit lighter in the evening. That’s, again, to try to tell the body it’s time to wind down. It’s time to start preparing for bed and whatnot.

Carrie Jones, ND, FABNE, MPH

I’m glad you said that because if you’re a strict night shift worker, I want to point that out again. When Kristen says morning, she means your morning. If your morning is at 4 p.m., that’s when you wake up and get up at 4 p.m. to go to work at seven, then you’re going to get a bright light at 4 p.m. You’re going to eat your first big breakfast or big meal within two hours of waking. So that you can follow. When she says morning and night, she means to your schedule, whether you are on your day shift days or your night shift days; whatever your morning is your morning. I’m glad you said that. I just wanted to point that out because I know that can get confusing depending on what somebody might say, but I bet I wake up in the afternoon. That’s your morning. 

Kristen DeAngelis, RD, IFNCP, RYT

Keep staggering. 

Carrie Jones, ND, FABNE, MPH

Keep going. Keep going.

Kristen DeAngelis, RD, IFNCP, RYT

Just always go back to your schedule and think about light food, mood, and activity. We also know that those who are active end up sleeping better and having fewer sleep disturbances during the night. I typically recommend getting outside at least for a 20- or 30-minute walk every single day, and that can also help you to get the natural rhythm of what’s happening outside versus the fluorescent lights that we’re under all day or the blue screens that are in front of our faces If you can walk at night that way, you’re getting exposed to maybe the sunset or some of those red tones that are happening in the sky. When it comes to having some type of closure, that walk can be somewhat closer to our day. When you get back from the walk, what are the steps that you’re taking that allow you to not get in front of the computer, to not just jump back into blue screens? 

If you’re going to watch TV, let’s say you want to watch a show. Watch your show, but shut all of the other lights off. Don’t be on your phone or computer while you’re watching a show and all the lights are on. Shut off as many things as possible. Wear blue blocker glasses, and then try to clean up in the kitchen. You’re washing your face; you’re taking the shower after that show so that there’s a buffer before your head hits the pillow. I always ask people, What is the buffer between being on and hitting the pillow? What’s the closure for you? There might be some other things that you want to put in there. It could be some camomile tea, sleepy time tea, meditation, or again, just having soft, quiet music. You can set it. I know a lot of people have Siri, Alexa, or different apps and whatnot. You can set a timer for every day at 8 p.m., put on meditation music, or put on something so that it registers. It’s not something that you can just shut off from an app. It’s like a sound or the lights are dimming down. I know some of my clients have that in their house. Their lights were dimmed down at a certain time of day.

Carrie Jones, ND, FABNE, MPH

That is nice. With the walk, if somebody is again back on the night shift, do you change their walk at all? For example, let’s go back to the same example. They wake up at 3:04 p.m. to get ready for work., I’ll say go and take a walk. Go outside or in your house. You have a treadmill or whatever you do. Get some movement in before you get to work at that light exposure and get going. If somebody says, I don’t have time, my job, schedule, kids, what have you, I’d prefer to do it while I’m at work, whether I can walk around the building or walk outside. But it is the middle of the night, or I can do it when I get home at 7 a.m. Do you give different advice for that? If they say, I can’t walk, but it’s at one in the morning on my break, or I can walk, but it’s at 7 a.m.. When I get home, I do the walking part. You change anything in the walk part, or you’re like, No, movement is important; just get it right.

Kristen DeAngelis, RD, IFNCP, RYT

I would still say that movement is important to get the best you can. If we’re realistic, it’s a matter of, Where can we fit it in. It’s better to get it than not. Just try to utilize light to your advantage in the other areas that you can. If you’re going outside in the dark and it’s I don’t know when I am, I guess that you’re walking outside; just try to make sure that you’re having that full exposure when you’re getting back in. Then, when you’re getting off your shift. for a typical shift worker, and they’re getting off their shift, and it’s 7 a.m. and it’s bright. Have blue walker glasses as you drive home. When you leave the building, put something on so that it has that amber glow and you’re not getting confusing signals that it’s still bright out.

Carrie Jones, ND, FABNE, MPH

Then, at that point, if you get off, let’s say you’re getting off at 7 a.m., you do the same thing that Kristen just said. You’re going when you get home; even though it is everybody else’s morning, it’s your night. You’re going to start to wind things down. You’re going to turn the lights down and keep the blue light-blocking glasses on. You’re going to have the music or do the meditation or you take a bath, whatever you do to have that buffer before your head hits the pillow, and then sleep and complete darkness, even though it is other people’s day. Now, here’s a question. You mentioned the person who’s like two days on, two days off, or two days on, three days off, or what do you have them flip back and forth about this routine, especially if it’s irregular? Or do you try to keep them to one routine or the other, meaning, well, Kristen, I am the three days on, three days off person? Do I look at the light only in the morning? Do I look at my morning? Do I just flip it based on whether I’m on or off shift? How do I do that?

Kristen DeAngelis, RD, IFNCP, RYT

It’s such a toss-up, and sometimes what I try to do is try to assess, like, where does the client feel best? What I’ll try to do is just try to be strict on their nighttime, their bedtime, and their wake-up time, or try to be strict there between one week and the next and see how they feel. again, looking at biomarkers like, How is their HRV responding? How is their blood sugar responding? To be honest, it’s one of the hardest things that I will say to assess and help. I don’t like to always resort to a pill or take those, but I do find adaptogens supportive for those types of patients. What I will say is that we are always working towards the end goal to try to get it so that it’s even a week on and a week off rather than two days and two days. Try to work towards where we can have either an all-night shift or an all-day shift. because it’s just hard on the body when we continue to look back.

Carrie Jones, ND, FABNE, MPH

Our clients say that because they know it’s hard, they’re fully aware whether they’re given this shift to not have a choice for someone. Some people enjoy their night shift. That’s their preferred route, but they still know it’s hard on the body; they can feel it. Let’s talk about that final bucket of mood. because that can be done at any time, no matter what your shift is.

Kristen DeAngelis, RD, IFNCP, RYT

It’s one of the most important things that we say in the word mindset, and we don’t exactly know what that means to work on ourselves.  I could easily just say check off the box and tell me that you meditated or did a gratitude journal. But I’m talking about digging into that. understand what your triggers for your nervous system that put you into a fight or flight mode, or to help you rest and digest what pushes your buttons, what’s your coping style? A lot of women who have this people-pleasing attitude say, yes, a lack of boundaries like that might be the area that you need to work on. Even though we’re talking about mood, I still classify that in the mood bucket because it comes back to how you’re regulating your nervous system. Again, a walk or journaling could be your way to do that. It could be working with a coach or working with someone to dive deeper into how you experience the world and how you relate to your nervous system. Or it could be starting to get into yoga or spiritual practice, or again, anything that helps to support the nervous system from that, like somatic so many body visceral sensations, how to calm the body down, and learning what your body needs.

Carrie Jones, ND, FABNE, MPH

To finish this off, I do want to touch on the supplemental side. You mentioned adaptogens. If you can explain what that is, even though we all know that there’s no magic pill to cure them all, I do want to touch on a couple just of your favorites, especially with those swing shift, night shift, the moms who are up at night, like what could be supportive, like that’s kind of a go-to for you, so let’s get there.

Kristen DeAngelis, RD, IFNCP, RYT

It”s always a bucket that can just be helpful and supportive. One of my favorites, of course, is magnesium. I know I’ve talked to you about this quite a bit. I feel like it’s just a staple that I have in almost everyone’s protocol to support sleep, specifically magnesium l-theanine, which can be wonderful, but adaptogens, and we’re looking at adaptogens, means it’s helping the body to adapt. Whether you need help having more energy or you need help winding down, think of it as a natural balance. Ashwagandha is one of our well-known favorites when it comes to this space. Ashwagandha is a wonderful one that I like to utilize. There’s another one too, Rhodiola, Albuterol. We can also utilize some more traditional Chinese herbal medicine.

It could be, jujube, schisandra, or again some of these that are helping to adapt the body, wind it down at night, or you might need something to again kind of raise that in the morning. There are a couple of other things that I like to use sometimes, too. Cordyceps mushrooms can be great for the immune system, but they also have a natural energy component. Sometimes I’ll put that for the it’s time to wake up to aspects. I like using adaptogens for the typical night shift person rather than glandular. sometimes when we get a cortisol test back and we see that cortisol is low we think, again, there’s a time and a place, and I love granular, but when I’m working with a shift worker, I’m usually opting more for the adaptogenic supportive supplements than a glandular, bovine adrenal glandular for helping with their cortisol. 

Carrie Jones, ND, FABNE, MPH

Can you explain glandular loss for people who are new to this?

Kristen DeAngelis, RD, IFNCP, RYT

A glandular is taking our actual tissue from an animal that is from the organ that we’re trying to support. When it comes to the adrenal glandular, adrenals are what produce cortisol. If someone has low cortisol, we may want to supplement with that glandular or that tissue of the organ itself to help naturally revive our cortisol production.

Carrie Jones, ND, FABNE, MPH

Perfect.

Kristen DeAngelis, RD, IFNCP, RYT

I will say that glandular is not just for cortisol. There can be glandular for anything. 

Carrie Jones, ND, FABNE, MPH

That is very true. Also remember, as Kristen said earlier, that she mentioned things like chamomile tea, tea, and sleepy time tea, which also have good wind-down herbs in them. Adaptogens. My other favorite is Holy Basil, or Tulsi tea to you else. Why, that’s another favorite of mine. Again, that goes in the wind down whatever part of the day that is for your bucket, and you can even take camomile as a supplement or tincture. You can take Tulsi as a supplement or a tincture if you’re not exactly a tea person. But making tea is sometimes that nice buffer, as she talked about before your head hits the pillow, just to signal to your body like Pavlov’s dog. It’s my camomile time. I know. I’m going to go to bed soon. Let’s start shutting the systems down and not having high cortisol. It’s like not being on an adrenaline-fight or flight. Let’s start winding down. I love that you said that earlier.

Kristen DeAngelis, RD, IFNCP, RYT

That’s a great point, too, that just when we think about Pavlov’s response, it’s the action of creating the tea, but it’s also the smell. If you can think about scent and also sound, like the sound of coming music or the smell of camomile tea, you could also use essential oils. I like using something like a stress blend or lavender for the evening, whereas you might use something like peppermint or eucalyptus in the morning. Scents can be helpful as well.

Carrie Jones, ND, FABNE, MPH

Perfect. That’s such a good point. I love that. Thank you so much for being at the summit today. Tell everyone where they can find you and about the free e-book that we have for them as well.

Kristen DeAngelis, RD, IFNCP, RYT

Thank you again for having me on. You can find me on Instagram, @kdwellness. You can also find our company, our health coaching company. We do one-on-one services. If you’re interested in my Trying to Conceive program or some of my period health programs, that’s through Nutrition Dynamic. nutritiondynamic.com, or Instagram, we’ll be having the first chapter from the Trying to Conceive e-book that we’ll be giving away with this summit.

Carrie Jones, ND, FABNE, MPH

Kristen, I always love seeing you. I always love talking with you. This topic is not talked about that much. As much as we need and love our night shift workers, they get forgotten about, and they are struggling just as much. I’m happy. We had to have you in to talk about this topic. Thank you so much.

Kristen DeAngelis, RD, IFNCP, RYT

Yes, thank you. Thank you for having me.