The Nutrition Debate #187: Chronic Systemic Inflammation and C-reactive protein (hsCRP)

This is a primer for the layman on the narrowly defined subject of “Chronic Systemic Inflammation.” Chronic means “persistent, long-standing, long term,” in contrast, “acute” means “with a rapid onset and/or a short course.” Systemic means “throughout the body,” as in when you have a fever. Inflammation is the body’s response to an “injury.” I put injury in quotes because, while we understand the outward manifestation of the body’s “acute” inflammatory response to stubbing a toe (pain, swelling, etc.), we are often unaware of the presence and dire consequences of “chronic, systemic inflammation.” It is a continuing “injury” that is often undetected, and the consequences can be very serious.

First, to be clear, our body’s response to an acute injury, which we perceive as pain and swelling, is actually a good thing. It means the body’s immune system has swung into high gear to defend itself against the “injury.” The processes are too technical to describe in detail but suffice it to say they involve a temporary mobilization of “hormone-like” proteins such as cytokines and macrophages. But enough of that; my own eyes glaze over when I write about those little buggers. The point is: when the body has completed a repair to the injury, the inflammation goes away and everything returns to normal.

Chronic systemic inflammation is a whole other thing and is mostly unrecognized. So, why should we care? Dr. Art Ayers, a PhD biomedical researcher with a special interest in inflammation and disease, puts it this way: “Inflammation is the foundation for cancer and degenerative/autoimmune diseases. Small changes in diet and exercise, e.g. omega-3 oils, vitamin D, low starch, and maintaining muscle mass, can dramatically alter predisposition to disease and aging, and minimize the negative impact of genetic risks. His blog, “Cooling Inflammation,” is on my personal Blogger “reading list.”

I’m not sure I agree with his characterization of the changes in diet and lifestyle being “small”, but I do agree that they can make a big difference. One of the most common and inexpensive markers of chronic systemic inflammation is the high-sensitivity C-reactive protein (hs CRP) blood test. When I started eating Very Low Carb in September 2002, my doctor didn’t test my CRP (and it had never been tested since the time I first began keeping copies of lab reports in 1974.) Results in the range of 3.1 to 10mg/L are considered “Higher Relative Cardiovascular Risk;” 1.0 to 3.0 “Average Relative Cardiovascular Risk;” and <1.0 “Lower Relative Cardiovascular Risk.” Here are my hs CRP scores for the last 11 years:

3/03	10/03	12/06	4/09	4/10	7/10	4/11	8/12	11/12	4/13	10/13		1/14
6.4	5.8	2.5	1.8	1.5	0.7	1.5	<0.3	0.1	1.3	2.9	1.2

Note that my then doctor, a cardiologist/internist, tested my CRP twice in the first year, both times with a “Higher Risk” (6.4 & 5.8mg/L) result. I guess he wasn’t surprised with that result (See Note 2 below), or maybe he didn’t have a pill to prescribe to lower it. Anyway, he didn’t test me again for 3 years and by this time my CRP-based risk had dropped to “Average” (2.5mg/L). The next test, 3 years later, it had dropped further to 1.8mg/L. After that, he tested my hs CRP once or twice a year. I guess my doctor had noticed the kind of “big difference” that Dr. Ayers mentions on his blog. The next 6 tests results were all lower yet, three of them <1.0 (0.7, <0.3 and 0.1). Then my doctor died, and I had to find a new doctor.

Now I have to ask for a high sensitivity CRP test. The first was 2.9mg/L (“Average” according to the AHA/CDC guidelines), so my new doctor said nothing. But I was concerned with the spike, so this winter in Florida I saw another doctor and asked him to help me monitor and control my Chronic Systemic Inflammation. He agreed and ordered a series of tests from the Cleveland Heart Lab. My “PLAC” test (Lp-PLA₂) was “in-range” (192ng/mL) or “low risk;” however, my hs CRP was 1.2mg/L (out of range), or “moderate risk.” Interesting, I thought. It had dropped from 2.9 to 1.2 but the risk went from “Average” (in range) to “Moderate” (out of range). Well, I don’t disagree. I want my hs CRP to be <1.0, and I am working to make it so.

How do I do that? Well, there are two ways you can find out. You can read my two previous blog posts, “Your Diet is Very Restrictive” here and “Your Diet is Very Restrictive Part 2” here, or you can read the 3 related posts on Dr. Ayers’s “Cooling Inflammation” here. Actually, you should do both. Dr. Ayers, of course, speaks with a lot more authority than I (to put it mildly), but he also comes at the issue from a totally different perspective: a healthy gut biota. I learned a lot from reading his rejoinders to a recent Dr. Oz broadcast, and from his “Anti-Inflammatory Diet and Lifestyle.” I think you will too.

Note: A common cause of Chronic Systemic Inflammation is periodontitis, an inflammatory disease affecting the tissues that surround and support the teeth. Periodontitis is caused by microorganisms on the tooth's surfaces, along with an overly aggressive immune response by pro-inflammatory cytokines, lymphocytes & macrophages against these microorganisms.

Note 2: The Google heading “Inflammation” includes the following: “Chronic inflammation is widely observed in obesity.”[31] The obese commonly have many elevated markers of inflammation, including: CRP (C-reactive protein)[34][35]”; “Waist circumference correlates significantly with systemic inflammatory response,[37]” and “C-reactive protein (CRP) is generated at a higher level in obese people. Mild elevation in CRP increases risk of heart attacks, strokes…and high blood pressure.”

Read up; there’s more to come on this topic.