Research

Paper
Submitted to:
Mr. Rosales

Group-IV
Leanne Erasga
Ronalyn Garbo
Joan Delos Santos
Leslie Domingo
John Mark Tayoto
Marjorie Garcia
Michael George Sotero
Ma. Cherrie Diapolette
Chapter-I

Introduction

Like many mass killers, cholesterol was born into the world under rather
innocent, unpretentious circumstances. The earliest known scientific
investigation into this substance, which would later be identified as one of the
deadliest forces in our bodies, dates back to 1733. In that year, a French
scientist by the name of Antonio Vallisniere discovered that gallstones were
soluble in alcohol. It shouldn’t be particularly surprising that this researcher
was fascinated by gallstones. These hard, rock like sources of pain which are
produced by gall bladder and may vary in size from a little seed to a hefty plum
were popular playthings at many of the social functions of eighteenth-century
French aristocrats. What we know today as cholesterol is a major component of
most gallstones. Still, like mischievous child whose criminal nature has not yet
covered up for decades, secreted behind the protective skirts of the gallstone.
It wasn’t until 1769 that cholesterol was actually extracted from
gallstones in the form of powdery white flakes. The chemist who achieved this
feat was another Frenchman, Poulletier de la Salle.De la Salle conducted his
experiments in the political climate that preceded the mass killings of the
French Revolution. But as he prepared the first pure cholesterol by crystallizing
a gallstone in an alcohol solution, the researcher was unaware that he was
confronting a lethal force in his own laboratory. Still, the orderly processes of
research continued as another scientist confirmed de la Salle’s findings in
1775.
Then, Michael Chevreul, a French chemist, took some crucial steps,
beginning in 1815, to lift the shroud of secrecy. First, he succeeded in
differentiating the white flakes from other waxes. Specifically, he discovered
that the gallstone-related substance was “unsaponfiable” or incapable of being
transformed, as are many other fats, into soap. Chevreul, who apparently didn’t
have inkling about the connection between his research and heart disease,
continued with his investigations throughout the next decade. By 1824, he had
discovered the fascinating white substance in both human and animal bile, the
yellow fluid produced by the liver, which helps with digestion of fatty foods in
the intestine. Perhaps just as important, at the beginning of this period of
fruitful discovery Chevreul gave the great enemy of the healthy heart a name:
“cholesterine”. Appropriately enough, the word was derived from the Greek
chole, meaning bile and stereos, meaning solid.
During the next 25 years, scientist from many nations identified
cholesterine in brain tissue, the human blood, tumors, and hen’s eggs. Also, as
part of this discovery process, researchers showed that cholesterines from eggs,
gallstones, and bile were identical. Most significant of all, the substance was
found in arteries which had been ravaged by atherosclerosis. As yet, however,
this process of fatty build up in the arteries was not called atherosclerosis.
As the nineteenth century moved on and scientific techniques improved,
scientists discovered that cholesterine contained alcohol like molecules. So, the
name of the substance was changed to “cholesterol”. The great killer had finally
been given its true name.
Statement of the Problem

To help us fight diseases caused by cholesterol, we should know the

important information about the substance. We can use the problem below to
find out how cholesterol affects our health and how we can fight against it.

Why do we need to balance cholesterol inside our body?

Hypothesis

 When blood cholesterol is too high, it can become sticky and adhere to the
walls of the blood vessels. This can cause them to become clogged and
narrowed to the point where the blood cannot freely pass through. As a
result, either heart attack or stroke will occur.

 It is important to lower cholesterol and avoid stroke because a stroke can

lead to so many other permanent conditions. There can be paralysis,
memory loss, speech problems, and issues with other motor skills. It all
depends on which part of the brain is impacted by the stroke.

 Cholesterol often performs essential work in our bodies. For example, it

promotes synthesis of the cell’s vital membranes and is a component of
many of the key hormones produced in the body. It also aids digestion as an
ingredient in the bile acids.

 Lowering cholesterol too much may increase the risk of cancer. Good
cholesterol levels are needed as additional cancer protection.

Significance of the Study

A very important part of preventing heart disease like heart attack is

controlling our cholesterol and not eliminating it altogether. Cholesterol is
essential to life. Without it, we couldn’t function as a normal healthy human
being. On the other hand, if too much of it is present in our blood, we’re looking
down the barrel of a cocked and loaded weapon which is pointed directly at our
heart.
Our first objective should be to understand exactly what’s going on with
the cholesterol in our blood and arteries. Next, we should become aware of how
we can improve the condition of our blood vessels through changes in our diet
and lifestyle. Then, will be much more likely to take constructive steps to
improve our health and possibly save our life. It is important to study
cholesterol to have sufficient knowledge about the deadly work of the substance
and the means and motivation to act on that knowledge. In other words, we
first must know something about the problem and about practical way to apply
your knowledge.
Scope and Delimitation

The study scopes the great principle of balancing cholesterol. This will
explain many things of how the deadly cholesterol work and how it sends a
person to risk. . The fact that aerobic exercise which increases good cholesterol
inside our body, was a big help to lower high cholesterol level and to avoid the
risk of coronary heart disease.
This research is limited with the straight truth about the effects in our
heart of coffee, alcohol, smoking, and stress. Also, a useful knowledge about
olive oil and fish oil will be stated clearly. These factors are related in lowering
and balancing cholesterol in the body. In addition, examples and case histories
of cholesterol reversal in patients diagnosed as suffering from coronary artery
disease were included.

Definition of Terms

LDL (low density lipoprotein) cholesterol – perform functions that are important
to the continuation of life in the body’s tissues. But sometimes, when the cells’
receptors don’t pick up them, LDLs get lost, almost like molecular orphans, in
the bloodstream. When this happens, instead of doing good work in the body,
the cholesterol of LDL, guided by the villain Apo B, becomes a menacing
presence, one that can ultimately terminate life.

HDL (high density lipoprotein) cholesterol – these cholesterol-carrying

lipoproteins probably are produced in the liver, intestines, or other parts of the
body. HDL is called “good” cholesterol because high levels in your blood are
associated with a lower risk of atherosclerosis and coronary heart disease.

Triglycerides - a form of fat in the bloodstream. People with high triglycerides

often have high total cholesterol, high LDL (bad) cholesterol and a low HDL
(good) cholesterol level. Many people with heart disease also have high
triglyceride levels.

Atherosclerosis (arteriosclerosis) – infiltration of fats into artery walls which

causes a build up of plaque in the circulatory system. Also mean the hardening
of arteries.

Bile acids (bile salts) - serve the purpose of breaking down fats.
Chapter-II

Review of Related Literature and Studies

One group of findings has emerged from Framingham Heart Study, a

project begun in Framingham, Massachusetts, in 1948. These suggest that for
the average adult, there may be a relatively safe “threshold” level of cholesterol,
ranging from 200-220 mg/dl. Specifically, the Framingham Study and a
number of other investigations indicate that the rates of coronary heart disease
remain relatively constant for cholesterol levels up 200-220 range. But as
cholesterol levels rise above this threshold, the risk for coronary disease and
atherosclerosis accelerates. So, if your cholesterol goes up from 200-250, your
risk of heart disease doubles. Then, if it goes up from 250-300, your risk
doubles again. Findings by another long-term study, the Multiple Risk Factor
Intervention Trial (MRFIT), also suggest that it may indeed be a good idea to get
your cholesterol below 200. The MRFIT Study measured cholesterol levels
approximately 360,000 men, from ages 35-57. The participants were followed
for six years, and the researchers recorded deaths in the group from coronary
disease. Among other things this study showed the risk of heart disease
definitely was lower for people with cholesterol levels below 200 mg/dl. So, it’s
certainly advisable not to allow your cholesterol to rise above 200-220 range.
According to Dr. Scott M. Grundy, Director of the Center for Human Nutrition
at the University of Texas Health Science Center at Dallas and one of the
world’s foremost authorities on cholesterol, there may be a critical phase in the
process of vessel-clogging. This point may be reached when about 60 percent of
the surface of your coronary arteries is covered with plaque from LDL
cholesterol and its “partner” Apo B. At that level of blockage in your arteries,
you may begin to experience a substantially increased risk of coronary heart
disease.
The Framingham Heart Study, an investigation of more than 2,000
women and nearly 2,000 men between 20 and 49 years of age, revealed a lower
level of HDLs among smokers. In this investigation, a key factor is the number
of cigarettes smoked per day, not the number of years a person had been
smoking or whether filtered cigarettes were used. Also, the Framingham Study
revealed that quitting smoking seemed to reverse the effect of the HDLs.
Although it took many months for this reversal to occur. Specifically, former
smokers who had stayed away from cigarettes for more than a year had the
same HDL levels as those who had never smoked. Apparently, it takes a year for
beneficial effect to emerge. A group of 73 people who had stopped smoking for
less than a year had lower HDL levels, which were similar to those of current
smokers.
A change in diet and lifestyle can also balance cholesterol, sometimes
more dramatically than drugs. In a study begun in Oslo, Norway, in 1973,
researchers followed more than 1,200 men, from ages 40-49, for more than five
years. They were selected for the study because they had cholesterol levels
between 290 and 380 mg/dl, and they were smoking at least one pack of
cigarettes per day. After the five-year program had been completed, the subjects
who were on the diet-and-lifestyle program were healthier. They showed a 47
percent lower rate of heart attacks and sudden death than those who had made
no changes in their lifestyles.
Very moderate exercise may result in a significant increase in HDL levels.
In one thirteen-week program of moderate exercise, consisting mainly of
walking and slow jogging, 32 sedentary, middle-aged men with coronary artery
disease increased their HDLs. They exercised twenty-thirty minutes per session,
for an average of three sessions per week, and their average HDL levels went up
from 35.8 mg/dl to 39. 3 mg/dl. Similarly, in a study reported by Dr. G. Harley
Hartung, of the Baylor College of Medicine in Houston, some, men who jogged
eleven miles per week experienced dramatic increases in their HDLs.
Apparently; such moderate exercise may be enough. Dr. Hartung concluded
that his findings clearly show that the effect of endurance running on changes
in HDL is limited, at least in certain men. As you increase the intensity and
duration of your exercise, very complex interactions changes begin to take place
in your body. Also, the pace at which these changes take place depends on a
number of factors, such as the levels at which you begin exercise, your age, and
the length and intensity of your training. It’s always best to choose aerobic
exercise over increased alcohol consumption as a means to raise HDL levels.
Exercise tends to use up calories and a lower percentage of body fat is
associated with lower levels of the bad LDL cholesterol. Alcohol, in contrast,
may raise the levels of good HDL cholesterol. But it also tends to put on weight
through increased in calories.
For many people, the dangers of alcohol consumption far outweigh any
possible benefits. As one researcher in this area, Dr. Kenneth W. Heaton of the
University of Bristol in England, has said, “Heavy alcohol intake causes serious
damage to the brain, liver, pancreas, stomach, nerves, and even the heart. It
shortens or blights the life of millions” (Executive Health Report, vol. XXI, no.
11, August 1985). A study of 234 alcoholics in Pittsburgh beginning in 1983
showed that “alcohol consumption is associated with an increase in HDL
cholesterol concentrations.” Furthermore, this study established that the
increase in HDL cholesterol was a “combination of an increase in both HDL-2
and HDL-3 cholesterol subclasses, mainly HDL-2 cholesterol.” HDL-2
cholesterol is the most protective subclass of HDL in combating cardiovascular
disease. Others, however, have questioned whether moderate consumption of
alcohol would really elevate the HDL-2, which is thought to be protective
against atherosclerosis and coronary heart disease (Journal of the American
Medical Association, vol. 242, December 21, 1979, p. 2,746). A Harvard Medical
School Study showed that moderate consumption of beer, wine or liquor
(“moderate” being 2 ounces of alcohol per day) is “inversely correlated with
death from coronary heart disease” (Journal of the American Medical
Association, vol. 242, December 21, 1979, pp. 1,973-74).
The Lipid Research Clinics Coronary Primary Prevention Trial (LRC-
CPPT) study has demonstrated that drugs can help put your cholesterol in
better balance. The researchers in this investigation screened more than
480,000 men, ranging from 39-59 years of age. One-half of these men were
placed on the drug cholestyramine. They developed 19 percent less coronary
heart disease than the other half which was the untreated group. In this drug
treated group, the cholestyramine lowered cholesterol levels by an average of
13.4 percent. In contrast, the nondrug group, which was only on a moderate
cholesterol lowering diet, showed a more modest 4.9 percent decrease in their
total cholesterol levels.
The Thomso Heart Study conducted the study about the relationship
between coffee consumption and higher levels of cholesterol at the University of
Thomso in Norway and reported in the June 16, 1983, issue of the New
England Journal of Medicine. The Thomso researchers found that drinking
boiled coffee was associated with higher total cholesterol levels and higher
triglyceride levels in people of both sexes. Also, the coffee consumption was
associated with lower levels of HDL cholesterol levels tended to go up as those
participating in the study consumed additional cups of coffee. A study at the
Stanford University Medical School has suggested that sedentary and mildly
active middle-aged men who drink more than two cups of coffee a day are more
likely to have high levels of cholesterol. One statistician who helped conduct the
study said that drinking up to two cups of coffee per day are unrelated in the
increase of LDL cholesterol. In another study, involving Japanese men in
Hawaii, researchers at the Honolulu Heart Program determined that there was a
significant relationship between coffee consumption and higher levels of total
cholesterol. Those consuming no coffee had an average of cholesterol level of
210 mg/dl, while those who drank 9 or more cups of coffee per day had levels of
220 mg/dl. A recent report from Johns Hopkins Medical School, in which 1,130
male medical students were followed for nineteen to thirty-five years, found that
a person who drinks five or more cups of coffee per day is almost three times as
likely to develop heart disease as is the person who drinks no coffee at all.
A number of studies have shown that cholesterol values rise during
different types of emotional stress. These include academic examinations,
occupational problems, job loss, difficulties in underwater demolition training,
surgery, difficult childbirth and other stressful activities. Cholesterol levels of
men who lost their jobs went up, but then dropped later when they found new
job. These were the findings of a longitudinal study, conducted at the University
of Michigan, on the cholesterol levels of 200 married men with stable
occupational histories. They had all lost their jobs because of a plant shutdown.
Those in the study, which was reported in the Journal of the American Medical
Association in November 1968, were evaluated over a period of two years.
During this time, the researchers also discovered that depression levels of the
men correlated directly with their total cholesterol counts.
In the past, attempts to lower cholesterol in the diet have centered on
foods which contain polyunsaturated fats, such as various vegetable oil. But
more recent research, much of which has been conducted by Dr. Scott M.
Grundy, has shown that monounsaturated fats, such as olive oil, may be a
better alternative. Dr. Grundy had noted that in the Mediterranean basin and
particularly in Greece, Crete, and southern Italy, tended to be low rates of
coronary heart disease. Furthermore, the traditional diet in those areas was
high in olive oil, which contains relatively large quantities of monounsaturated
fats. In one study, Dr. Grundy and Dr. Fred H. Mattson, of the Department of
Medicine of the University of California at San Diego, formulated three liquid
diets, which differed from one another only in the kinds of fats they contained:
one contained saturated fats, monounsaturated fats and the third contained
polyunsaturated fats. As everyone expected, when the patients were on the
saturated fat diet, their total cholesterol levels tended to be highest. When they
were on polyunsaturated fat diet, their total cholesterol levels dropped, and that
included both their “bad” LDLs and their “good” HDLs. As for the
monounsaturated fat diet, the researchers found that this regimen lowered the
total cholesterol and the LDLs as effectively as the polyunsaturated fat diet had
done. But the mono-fat diet didn’t lower the HDLs as often. In effect the mono-
fat diet tended to target the LDLs for reduction, but not the HDLs.
The possibility of reversal has been established in recent reports in the
Lournal of the American Medical Association (June 19, 1987), by Dr. David H.
Blankenhorn and several colleagues at the University of Southern California
School of Medicine in Los Angeles. Their Cholesterol-Lowering Atherosclerosis
Study (CLAS) involved 162 nonsmoking men, aged 40 to 59 years, who all had
undergone coronary by-pass surgery. The men, who were treated with colestipol
hydrochloride and niacin over two years, experienced an average 26 percent
reduction in their total cholesterol ; a 43 percent drop in their LDLs; and a 37
percent increase in their HDLs. Dr. David T. Nash of the University of New York
Upstate Medical Center in Syracuse has reported stopping cholesterol deposits
in humans and even reversing them in some cases. In his two year study of 17
patients, he put 9 on drug and diet therapy for two years. He used the other 8
as “controls’ for purposes of comparison. All the patients had total cholesterol
levels above 250 mg/dl. Of the 9 who were on therapy, 8 showed no changes in
their fatty-cholesterol deposits: their disease was halted. One patient
experienced some reversal of his blocked arteries. Moreover, these patients on
therapy experienced a drop of 23 percent in their cholesterol levels, from 270
mg/dl to 209mg/dl. Of the 8 “controls”, 1 went on a diet and exercise program
on his own, dropped his cholesterol level, and experienced a regression in his
disease. Five of the other “controls” experienced progression of their cholesterol
deposits, and 2 experienced no change. Obviously this was a small study but it
stands as a contribution to the growing body of evidence that atherosclerosis is
reversible.
The Dutch Study. Researchers from the Institute of Social Medicine at the
University of Leiden in the Netherlands noted that a low death rate from
coronary heart disease exist among Greenland Eskimos. The researchers
acknowledged that this low rate has been attributed to the Eskimos’ high
consumption of fish. After choosing the town of Zutphen in the Netherlands,
they selected 852 middle-aged men with coronary heart disease as participants.
Over the twenty-year period of the study, 78 of the men died from coronary
heart disease. The researchers found that deaths from coronary heart disease
were more than 50 percent lower among those who consumed at least 30 grams
of fish per day, than among those who did not eat fish. Furthermore, those
doing the study concluded that the consumption of as little as one or two fish
dishes per week may be of preventive value in relation to coronary heart
disease.
The Oregon Study. Another research team, from Oregon Health Sciences
University, studied a group of people who had a genetic inability to metabolize
fat. They discovered that those who ate a diet rich in fish oils had much lower
levels of cholesterol and triglycerides than did those who ate vegetable oils.
According to the test done, the patients who were on fish oil diet experienced
drops in their total cholesterol levels ranging from twenty-seven percent to
forty-five percent. Their triglycerides declined 64-79 percent. It’s interesting that
both fish which tend to be high in fat, such as salmon and tuna, and those low
in fat, such as cod and flounder, were equally effective.