Before continuing the discussion of the negative impact of consuming trans fats any further, let us talk about naturally occurring sources that are significantly less toxic. We can find some in the chloroplasts of diverse leaves (trans-3-hexadecenoic acid) and in the oils extracted from rare grains (eleostearic acid in bitter melon and in tung). However, it is mostly found in the rumen of ruminants (e.g. cows, sheep, goats).

The numerous bacteria of rumen have very unique properties such as the ability to create fatty acids with an uneven number of carbon atoms: e.g. margaric acid with 17 and pentadecylic acid with 15. It is this last one that allows us to identify consumers of dairy products in the eventuality that they need to exclude these from their diet!

Some rumen bacteria produce fatty acids that are naturally trans, a very rare phenomenon in nature, where the vast majority of unsaturated fatty acids are of the cis configuration. Trans-9-octadecenoic acid (or elaidic acid) and trans-11-octadecenoic (or trans-vaccenic acid) are examples of this. CLA (conjugated linoleic acid) is an especially interesting example and appears to have interesting properties for human health, promoting the development of lean body mass at the expense of adipose tissue, as confirmed by several trustworthy scientific studies.

The negative effects of trans fats, like most rules in biology, have some exceptions. However, generally speaking, these chemical poisons have some scary side effects, either when they are generated by the food industry, or by ill-advised cooks. They have been widely studied and the results are published in the compilation of articles in my conference “Danger of Trans Fatty Acids” (see the review Conferences/Unsaturated Fatty Acids on my website www.gmouton.com)

So, in no particular order, let’s list them: cardiovascular diseases (coronary artery disease, myocardial infarction, arteriosclerosis, sudden cardiac death, inflammation of the vascular system, endothelial dysfunction); type II diabetes (insulin resistance, increased fasting glucose); cancer (non-Hodgkin lymphoma, prostate cancer, colon cancer, rectal cancer); depression; gall stones; ovarian dysfunction…. Undoubtedly, this is not an exhaustive list, as future research will surely demonstrate.

Implementing measures to reduce trans fat consumption gives rise to some spectacular effects: the industrial production of these trans fatty acids has been reduced in Denmark – a country at the forefront of the fight - from 6 grams per inhabitant per day in 1976 to 1 gram in 1996. Concomitantly, deaths from coronary diseases have fallen by 50%, figures that speak for themselves. Similar data are available for Finland and more recently for Poland.

Your levels of trans fatty acids can easily be measured via a blood test: more and more laboratories offer these tests. They are helpful in targeting patients who need incisive advice to reduce their consumption.

Practically, you should ban all products that include “partially hydrogenated vegetable oils – or vegetable fats” in their ingredients list: they can destroy your health.

Let’s start with the most important aspect of our advice for better sleep: total darkness in the bedroom. There shouldn’t be any electrical devices with luminous dials: no alarm-clock, no mobile phone, no computer, no TV, no radio-alarm… In any case, all electronic equipment should be banned from the bedroom because they stimulate the brain and prevent you from falling asleep: there is nothing better than reading to fall asleep! Let’s forget about all the screens!

But let’s get back to darkness in detail: no luminous ray under the door or light coming through the border of the curtains which must totally block external light (not only daylight but also streetlights and other outdoor light sources, even the moon!). The opacity of the curtains can only be achieved if they are lined with a black-out material (from top to bottom) and wide (so they can generously overlap across the middle where required).

Then we need to concern ourselves with the temperature of the bedroom: here the golden rule is to be neither hot nor cold. One needs to select a temperature that makes them comfortable, whilst of course taking into account a partner’s wishes. Typically, a range of 15 to 18C is most often suitable, on the basis that it is generally better to choose a cooler temperature. The ability to reach and maintain this goal can become complicated due to climatic variations and the means of regulating room temperature at your disposal…

There is a third issue which is often the most difficult one to solve; noise. There are simple technical means to reduce noise, for example by double glazing and using seals around the doors and windows. One also needs to be vigilant about airing the room, which is compulsory, but not necessarily during the night or not in its totality. One should air the room regularly, as long as the silence is not affected during the night, closing the window before traffic starts.

It is important not to be obsessed with uninterrupted sleep: what is important is to go back to sleep quickly following a brief awakening. As for the length of sleep, we can find significant variations: 6 to 9 hours in adults, with a clear preference for 7.5 hours. We should factor in to this calculation too the length of time it takes to fall asleep and the duration of awakenings (but only if they are of significant length, i.e. more than 5 minutes).

You will notice that a normal sleep cycle is made up of multiples of 90 minutes which corresponds to the initial phase of sleep (deep sleep) and its final period of REM sleep (dreams). We typically sleep 4-6 cycles, exceptionally 7 for big sleepers (this is very often due to a pathology such as hypothyroidism). When external factors – such as an addiction to screens (TV, computer, game consoles) late in the evening – limit sleeping time to 4 cycles, most people will show fatigue after two or three days. One should then quickly work towards a night with 5 cycles to really round-up the working week before the salvation of a weekend with its 5-6 cycles.

Despite what some people may say, nobody can really survive on 3 cycles, expect for a rare occasion of course, even if adrenaline can effectively mask the real state of exhaustion. There will always be a qualitative loss of function both at the cognitive level, and also at the fine motor level. The Spanish system, which consists of ensuring 4 cycles during the working week, persists because of the splendid nap in the early afternoon. But any nap taken after 4.30pm is poorly timed and will ruin your capacity to fall asleep later.

One must be careful not to unwittingly create a progressive shift in your sleep cycle. With this in mind, any late nap (after 4.30pm) is likely to have disastrous consequences and will automatically ruin your chances of falling asleep around 10pm-11pm, which is the ideal time to get ready to sleep.

“The hours before midnight count double” is often said to children to encourage them to go to bed earlier! Well, it is not wrong at all, because the majority of hormone secretion occurs during the first part of the night. Sleeping from 10.30pm to 6am will produce a much better recovery than an equivalent, but shifted, length of time, for example from 1am to 8.30am, even if the total number of hours remains identical.

We are again talking about the optimal sleep time, which is in the order of 7.5 hours, as described in the first part of this article. The question remains; what are the biologic stimuli that promote sleep usually around 10.30pm?

First of all it is the physiological secretion of melatonin, a hormone produced by the pineal gland situated in the brain, from 9pm onwards. An increasing level of melatonin during the second part of the evening promotes the arrival of drowsiness, just as the drop in melatonin at the end of the night promotes awakening. This natural secretion can be analyzed by saliva testing to establish a secretion curve, while the global production of melatonin over a whole cycle can be quantified by analyzing its sulfate metabolite in 24-hour urine collection.

In addition, it is possible to act upstream via the amino acid 5-HTP derived from tryptophan, a precursor of serotonin, which will subsequently be converted into melatonin. Whether it is 5-HTP or melatonin, we label these substances natural physiological helpers for sleep – especially efficient when one is lacking these substances – but they are not in any way “sleeping tablets”.

The arrival of sleep is aided by a second essential biological factor which is the fall of circulating cortisol, the stress hormone, also called glucocorticoid (because it stabilizes blood sugar levels when they fluctuate, either up or down). However with all the chronically stressed people or those who maintain an absurd diet that causes excessive fluctuations of blood sugar levels (such as “toxic” breakfasts, snacking on sugary foods, abuse of carbohydrates), levels of cortisol can totally collapse.

These people therefore cannot benefit from their drop of cortisol during the evening because something cannot diminish when it is already at zero to begin with! Sometimes we even see a paradoxical curve where the collapsed cortisol in the afternoon tends to climb a little when night comes. This is the guarantee for really bad sleep, even if the cycle of melatonin is preserved: to benefit from a good night’s sleep, it is imperative that both curves intersect with the rise of melatonin and the decline of cortisol!

We may conclude by stating that sleep is best prepared for at the time of breakfast: where one must ideally establish the foundation of a stable blood sugar for the whole day. One can also see the devastating effects of chronic stress whether it is from jet lag, intercontinental travel, or shift work.

To finish the subject I would like to review all the good reasons for getting to sleep earlier, ideally - let us repeat it – around 10.30pm.

First of all, it is certainly the best way to benefit from the maximum darkness and I would like to remind everyone that this definitely provides the best quality of sleep, even if one can always cheat by blocking out the light that comes through the windows. We know that we typically sleep for 7.5 hours, and that getting up around 6am coincides with daybreak, as long as they don't continue to sabotage us with that damned extra hour for summertime that disrupts our internal clocks.

When travellers come close to the equator, they realize that in these regions of the world, the sun rises at 6am and goes down at 6pm. Take Ethiopia, a country whose southern tip is situated at latitude of 3-degree north. They express hours in two chunks of 12, the one for day and the one for night. When people plan to meet at 6, they are talking of midday and certainly not midnight because, during the night, the Ethiopians are sleeping….

Moreover, they are right because the beginning of the night is when hormonal syntheses take place, whether it is growth hormone, adrenal hormones, or sex hormones. Furthermore, according to some recent trustworthy scientific publications, we are even starting to recommend that patients undertaking thyroid hormone replacement treatment take their thyroid hormones just before going to bed.

Current exploration of physiological and biochemical pathways by Western science is confirming what the oldest medicine of the world (prior to Chinese medicine) has already told us from the height of its 4 millenniums of experience. Ayurvedic medicine sets 11pm as the start of one of the three cycles of energy under which we are all subjected. If one is paying attention, it is noticeable that we are indeed invaded by a legitimate torpor around 10.15 or 10.30pm: dear friends it is then time to go to sleep because it is the end of one natural cycle…

If we ignore this and we fight against sleep, we can then we feel, just like a breath of pure oxygen, a noticeable boost in energy. If you then look at your watch, you will usually see that it is almost always exactly 11pm. I have often been shocked by this precision. The re-start that takes place leads us to around one in the morning, and that period is often referred to as the "second wind”.

It would be a shame not to take advantage of the natural cues for going to sleep around 10pm – just at the right time - and thus avoid fighting against the surge of energy one or two hours later. Why not listen to our body?

It is well known that the second wind can lead to great intellectual performances, inspiring and creative thought, but it is a high price to pay. The bill comes the following morning when we lamentably idle while the world is going at full speed with or without us, cosy under the duvet…

Even more concerning, the second wind is riding a wave of adrenalin (thus explaining some of the feats achieved), but at the expense of the adrenal glands. These glands, two little flabby pointy hats on top of the kidneys, are not intended to give such a boost of performance every evening. It is a “luxurious” mechanism intended only to be used in emergencies: let’s not prevaricate just because we would like to assuage some kind of melancholy that encourages us not to go to sleep… when the time has come!

Having mentioned many times these infamous adrenal glands, it is time to elaborate further on their crucial endocrine function and why it is essential to our health. Furthermore they are also inseparable from thyroid function. Let’s be clear; it is of the upmost importance to establish and maintain a strict equilibrium between the adrenals and the thyroid. Therefore treating the weakness of one of them, without proper evaluation and correction of the other, should never be considered. Hospital medicine recognizes this rule as well.

We shall return to the thyroid gland later, as it is a very popular topic. Many patients benefit from an evaluation of their thyroid function, but it often fails to address their adrenal function, even though the physiological role of these glands is equally important. It is hard to understand this ostracism, but it explains why numerous thyroid treatments fail…

It must be recognized that the biochemical pathways of the adrenals do present a certain degree of complexity. We will focus here on the adrenal cortex. They envelop the adrenal medulla, which secretes adrenalin and noradrenalin, two hormones produced in response to stress, but which will not be covered in this section.

It is essentially the action of the adrenocorticoids that we will review here. They belong to three distinct families: the mineralocorticoids secreted by the zona glomerulosa, the outermost layer of the adrenal cortex, located just under the capsule of the gland; the glucocorticoids secreted by the zona fasciculata situated just underneath, representing the middle layer of the adrenal cortex; and the androgens secreted by the zona reticularis, the inner most layer of the adrenal cortex, in contact with the medulla situated at the centre. All this vocabulary sounds a bit dense but let us say it again: most of these adrenals hormones play a crucial role to our health. Indeed, deficits in glucocorticoids and/or in androgens lead to a slowdown of metabolism (with weight gain, except in profound deficiencies when the reverse can occur), and sometimes to extreme fatigue…

Let’s start with the glucocorticoids, a name which immediately brings to mind the metabolism of sugars (glucose). The zona fasciculata that produces them occupies three quarters of the adrenal cortex and they play a fundamental physiologic role. Namely it is cortisol (and related hormones); the infamous stress hormone, which allows you to face assault and acute crises. This brings us to the famous “fight or flight” response; due to cortisol, danger can be faced (fight)…or evaded by fleeing at full speed (flight)!

Whichever reaction is chosen, the “turbo” has to be engaged and this is what cortisol allows us to do. We can immediately see that this type of mechanism responds to situations of acute stress requiring an immediate and brutal response. However, the tragedy of the modern world is that it results in a stress that if more often chronic in nature: being yelled at by your boss, noisy neighbours, elderly parents moving in, etc.

The excessive and prolonged consumption of cortisol in response to chronic stress will eventually deplete the reserves, resulting in fatigue, along with poor blood glucose control and abnormal fluctuations in blood sugar levels, leading to sugar cravings (called hypoglycaemia in medical terms), and its inescapable corollary weight gain. We will go through the various ways to assess these issues in the second part of this article.