Why do we need to balance cholesterol in our body?

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.
Despite these breakthroughs, the killer continued to do its
deadly work completely under cover for the next forty years. To
be sure, heart trouble abounded in the Western world during this
period. But the major cause of coronary disease didn’t as yet
even have a name.
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.
In related development in 1856, one which was destined to
converge with cholesterol research about fifty years later,
Rudolf Virchow, a prominent German pathologist, kicked off the
study of atherosclerosis. Specifically, Virchow observed that
significant changes occur in artery walls during the “hardening”
process, as plaque builds up and clogging of the blood vessels
occurs.
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.
In 1905, a German graduate student named Wolf Windaus began
trying to determine the chemical structure of cholesterol.
Working at the Institute of Chemistry, at the University of
Freiburg in Germany, he made such tremendous strides in his
research that he was eventually awarded the Nobel Prize in 1928.
Unfortunately, later investigation showed that his description of
the structure of the cholesterol molecule was in error.
Scientists began to get the killer in their sights. Over a
period of nearly two centuries, they had identified it, named it,
and begun to get a record of its “fingerprints” and other
characteristics. But the connection between the cholesterol and
coronary heart disease had been tenuous at best.

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 in 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.
When this happens, either a heart attack or stroke
will occur, depending on where in the circulatory
system it happens.

• 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.

• The body produces and regulates its cholesterol levels

in the natural way. People must do something else to
ensure their body processes cholesterol properly. Diet
and exercise are the primary, safest, and most natural
way to lower cholesterol without the side effect of
drugs.

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 send a person to risk.
The study is limited with the straight truth about the
effects in our heart of coffee, alcohol, smoking, stress, oat
bran, olive oil, fiber, and fish oil (omega-3). It will clearly
state the different risk factors in men and women. How, when and
when not to use over-the-counter medications, some of which may
be quite effective in lowering cholesterol and what most people
don’t know about cholesterol and aerobic exercise program to help
control coronary disease. Examples and case histories of
cholesterol reversal in patients diagnosed as suffering from
coronary artery disease were included for us to know how to
balance the cholesterol inside our body.

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. They are made up of 20
percent cholesterol, surrounded by an Apo A lipoprotein blanket.
HDL is called “good” cholesterol because high levels in your
blood are associated with a lower risk of atherosclerosis and
coronary heart disease.

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.

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. 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. For
example, the increased narrowing of the blood vessels at those
high levels of blockage may take it more likely that a blood clot
or other obstruction will result in a complete stoppage of blood
flow. This would cause a heart attack, death of heart tissue, and
perhaps death of the individual. 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 initial tests
were conducted between 1973 and 1975 in eighteen cities in the
United States. 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. 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.
*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; the other half took a placebo. Finally, members
of both groups were also placed on a moderate cholesterol-
lowering diet and then were put randomly into one of the two
groups. Because cholestyramine has certain unpleasant side
effects such as constipation, nausea, or bloating, the men who
were chosen to take it didn’t always comply by taking the full
daily dose. Even so, after an average 7.4 years of follow up on
the study, the group that was being treated with drug developed
19 percent less coronary heart disease than did the untreated
group. In the 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
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. One-half of these men made no changes
in diet or lifestyle. The other half were placed in an
experimental program designed to help them reduce the cholesterol
and saturated fat in their diets and break their cigarette
habits. During the study, 25 percent of the men managed to quit
smoking; another 45 percent decreased to some extent the number
of cigarettes they smoked each day. The total cholesterol levels
of those in the experimental low-fat, nonsmoking group decreased
by 13 percent. Furthermore, 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.
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). It’s
always best to choose aerobic exercise over increased alcohol
consumption as a means to raise HDL levels. A report by Dr. G.
Harley Hartung in sports Medicine in 1984 noted that for people
who are already active aerobic exercises, alcohol has no effect
on HDL levels. It was only the inactive men in this study who
experienced an increased in HDL levels with an alcohol intake
equivalent to three beers a day. Exercise, then, is clearly
better than alcohol as a means to elevate HDL levels. In
addition, 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. 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.
Others, who ran as much as forty miles per week, experienced only
modest increases. 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. Among other things, as you lose
body weight during exercise, your total cholesterol decreases and
your HDL level increases. 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.
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 his team had
found a risk threshold at two and one-quarter cups of coffee per
day. To put this in other terms, the study analyses revealed that
concentrations of both Apo B and LDL cholesterol, the two major
villains in the atherosclerosis scenario are unrelated to
drinking up to two cups of coffee per day. 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. During the six years of the study, the average
coffee consumption was 3.4 cups per day and the average tea
consumption was 1.8 cups per day. 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.
There was no such relationship between cholesterol levels and tea
or cola consumption. There may be a link between coffee and
cardiovascular disease. 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. In a
Norwegian study, 9 female medical students experienced a 1/5
increase in their total cholesterol levels during important
examination. These young women, aged 22-30 years, were studied
during their most important preclinical exam, a test known to
impose considerable mental stress on most students. Blood samples
were drawn immediately after the exam; forty-eight hours later;
and finally two months later, during a time when there wasn’t any
particular academic pressure. The total cholesterol levels in all
the students were higher on the exam day by an astounding 20
percent than on either of the other two days. 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.
Women tend to have less problem than men with heart
disease, at least before they go through menopause. In more
concrete terms, a normal HDL level in men tends to be 45 or
higher, while in women it’s 55 or higher. In one of the studies
at the Aerobics Center, women aged 40-49 had an average total
cholesterol of 194 mg/dl and an HDL cholesterol count of 58, for
a ratio of 3.34. in contrast, men aged 40 to 49 had an average
total cholesterol of 210 and an HDL reading of 44, for a ratio of
4.77. Women who use birth control pills have at times been found
to have slightly elevated total cholesterol levels, marked
elevations in their triglycerides, slightly higher LDLs, and
lower levels of the good high-density lipoproteins (HDLs). In
other cases, however, the opposite occurs: the HDL cholesterol
increases and the LDL cholesterol decreases. The effect of birth
control pills on the serum cholesterol level is dependent on the
ratio of estrogen to progesterone. In women, it’s the estrogen
that increases the HDL level and reduces LDLs. In post coronary
men, however, supplemental estrogen has not been associated with
any decrease in mortality. As women age, their HDL levels usually
increase; as men age, their HDLs stay about the same. As men lose
weight, their ratios of total cholesterol/HDL cholesterol
generally improve; as women lose weight, their ratios stay about
the same.
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. But
despite this intake of fat, the levels of cholesterol, as well as
coronary disease, were relatively low. “The interesting thing
about olive oil is that it’s rich in oleic acid, which is
monounsaturated fatty acid,” Dr. Grundy said. Yet, olive oil is
also low in polyunsaturates. So, Dr. Grundy decided to conduct to
a study to see how well a diet rich in monounsaturated fatty
acids compared with a diet high in polyunsaturates or other types
of 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 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.
 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 underwent coronary arteriogram,
which showed they had 50 percent or greater narrowing of a major
coronary artery. Also, 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 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. Studies of rhesus monkeys by
Dr. Robert W. Wissler of the University of Chicago School of
Medicine have demonstrated reversal of atherosclerosis as well.
The monkeys were given a combination of cholestyramine and
probucol and they experienced major regressions in fatty deposits
in their blood vessels within one year.
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. So the Leiden team decided to explore this matter more
fully. 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 investigation focused
on the dietary habits and family histories of all the men and the
results tended to support the “fish interpretation” of the
Greenland Eskimos’ low death rates from coronary heart disease.
Specifically, 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.” This amounts to as little as 1 ounce of fish a
day or the equivalent of two or three fish meals per week.
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. Three diets
were tested on each patient. One was high in fish oil, mostly
from salmon. The second diet included equivalent amounts of
usually given to patients, such as those involved in the study,
who have an inherent problem metabolizing fat. The final results
were that when the participants where on the fish oil diet they
experienced drops in their total cholesterol levels ranging from
27 percent to 45 percent. Their triglycerides declined 64-79
percent. Both the other diets were considerably less effective
than the fish oil diet in achieving these results. 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.
 Research Paper

Submitted to:
Mr. Rosales

Group – IV

1. Leanne Erasga
2. Ronalyn Garbo
3. Marjorie Garcia
4. Leslie Domingo
5. Ma. Cherrie Diapolette
6. Joan Delos Santos
7. John Mark Tayoto
8. Michael George Sotero