Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
10 Jan

How to Tell If You’re Inflamed: Objective and Subjective Inflammatory Markers

In the comments section of last week’s post on inflammation, many of you expressed a desire for a post explaining how to know if one is actually suffering from systemic, chronic inflammation. I thought that was a great idea and decided to put the other followups on hold so I could tackle this one. Obviously, it’s easy to tell if you’ve got some acute inflammation going on – swelling, pain, heat radiating from a part of your body that’s suddenly assumed a rosy hue, and throbbing open wounds are all blatant indicators of the inflammatory process at work – but tests for markers of inflammation are not yet standard across most medical practices. With that in mind, I’ll be giving info on both objective markers for which you can test, as well as on the subjective markers I use on myself that you can “test” and use to evaluate your own level of inflammation.

Let’s get to it.

CRP, or C-Reactive Protein

CRP is a protein that binds with phosphocholine on dead and dying cells and bacteria in order to clear them from the body. It can always be found (and measured) in the bloodstream, but levels spike when inflammation is at hand. During acute inflammation caused by infection, for example, CRP can spike by up to 50,000-fold. CRP spikes due to acute inflammation peak at around 48 hours and decline pretty quickly thereafter (post acute-phase inflammation CRP has a half life of 18 hours). Thus, if the incident causing the inflammation is resolved, CRP goes back to normal within a few days. If it persists, the infection/trauma/etc. probably persists as well.

CRP elevates in response to essentially anything that causes inflammation. It’s highly sensitive to many different kinds of stressors. This makes it valuable for determining that inflammation is occurring, but it makes it difficult to determine why that inflammation is occurring – because it could be almost anything. But if you’re looking for confirmation that you are chronically, systemically inflamed, an elevated CRP in absence of any acute infections, injuries, burns, or stressors is a useful barometer.

“Normal” CRP levels are supposedly 10 mg/L. Absent infection or acute stressors, however, ideal CRP levels are well under 1 mg/L. You want to stay well below 1; you don’t want “normal.” Between 10-40 mg/L (and perhaps even 1-9 mg/L, too) indicates systemic inflammation (or pregnancy), while anything above that is associated with real acute stuff. Note that exercise can elevate CRP.

IL-6, or Interleukin-6

T cells (type of white blood cell that plays a huge role in the immune response) and macrophages (cells that engulf and digest – also known as phagocytosing – stray tissue and pathogens) both secrete IL-6 as part of the inflammatory response, so elevated IL-6 can indicate systemic inflammation.

Tissue Omega-3 Content

This is a direct measurement of the omega-3 content of your bodily tissue. It’s not widely available, but it is very useful. Remember that anti-inflammatory eicosanoids draw upon the omega-3 fats in your tissues and that inflammatory eicosanoids draw upon the omega-6 fats. People having a higher proportion of omega-6 fats will thus produce more inflammatory eicosanoids. Now, we absolutely need both inflammatory and anti-inflammatory eicosanoids for proper inflammatory responses, but people with high omega-6 tissue levels make way too many inflammatory eicosanoids. Studies indicate that people with the highest omega-3 tissue levels suffer fewer inflammatory diseases (like coronary heart disease).

Research (highlighted and explicated here by Chris Kresser) suggests that omega-3 tissue concentrations of around 60% are ideal, which is a level commonly seen in Japan – seemingly paradoxical land of high blood pressure, heavy smoking, and low coronary heart disease rates.

Omega-3 Index

This measures the EPA and DHA, the two important omega-3 fatty acids, as a percentage of total fatty acids present in your red blood cells. It doesn’t correlate exactly to tissue amounts, but it’s pretty good and a powerful predictor of cardiovascular disease risk. The omega-3 index doesn’t measure omega-6 content, but those with a low omega-3 index are probably sporting excessive omega-6 in their red blood cells.

Anything above 8% corresponds to a “low risk,” but levels of 12-15% are ideal and roughly correspond to the 60% tissue content mentioned by Chris’ article. 4% and below is higher risk and can be viewed as a proxy for increased inflammation (or at least the risk of harmful systemic inflammation developing from normal inflammation).

Systemic Inflammatory Response Syndrome Score

There’s the systemic inflammatory response syndrome, which is incredibly serious and has four criteria. If you have two or more of them at once, congratulations: you qualify – and should probably see a health professional immediately. This isn’t relevant for low-grade systemic inflammation, like the kind associated with obesity or autoimmune disease.

  • Body temperature less than 96.8 F (36 C) or greater than 100.4 F (38 C).
  • Heart rate above 90 beats per minute.
  • High respiratory rate, 20 breaths per minute or higher.
  • White blood cell count fewer than 4000 cells/mm³ or greater than 12,000 cells/mm³.

Of these objective markers to test, I’d lean toward CRP and one of the omega-3 tests. CRP is pretty comprehensive, and, while omega-3 tissue or blood cell content doesn’t necessarily indicate the existence of systemic inflammation in your body, it does indicate the severity of the inflammatory response you can expect your body to have. Taken together, both tests will give you an idea of where you stand.

And now, some subjective markers that I’ve picked up on over the years. These are a few signs and symptoms to watch out for. They may be harmless artifacts, but they may indicate that something systemic is going on.

Flare-up of Autoimmune Conditions You Haven’t Heard from in Ages

Sore joints, dry, patchy, and/or red skin, and anything else that indicates a flare-up. For me, this is usually mild arthritis.

Water Retention

As we discussed last time, acute inflammation is often characterized by swelling at the site of injury. The same effect seems to occur in states of systemic inflammation, although they aren’t localized, but rather generalized.

Stress Load

If you feel stressed, you’re probably inflamed. I’m talking about the kind that has you rubbing your temples, face palming, sighing every couple minutes, and pinching the space between your eyes very, very hard.

Persistent But Unexplained Nasal Congestion

Could be allergies, sure, but I’ve always noticed that when I’m under a lot of stress and generally in an inflamed state, my nose gets clogged. Certain foods will trigger this, too, and I think it can all be linked to a persistent but subtle state of inflammation.

Overtraining

If you fit the bill for the eight signs of overtraining listed in this post, you’re probably inflamed.

Ultimately, though? It comes down to the simple question you must ask yourself: how do you feel?

I mean, this seems like an obvious marker, but a lot of people ignore it in pursuit of numbers. If you feel run down, lethargic, unhappy, your workouts are suffering, you struggle to get out of bed, you’re putting on a little extra weight around the waist, sex isn’t as interesting, etc., etc., etc., you may be suffering from some manner of systemic, low-grade inflammation. Conversely, if you’re full of energy, generally pleased and/or content with life, killing it in the gym, bounding out of bed, lean as ever or on your way there, and your sex drive is powerful and age appropriate, you’re probably good.

And really, isn’t that the most important health marker of all?

Anyway, I hope this was helpful. Systemic inflammation is a pretty nebulous state, and pinning it down can be tough, even with the help of actual objective lab markers. And because inflammation and all the maladies associated with it are so intertwined and feed off each other and have so many different effects, we often feel helpless. Well, try not to pile too much on your shoulders. Get some markers tested if you can, but ultimately it’s going to come down to eating better, moving better, sleeping better, relaxing better, and avoiding too much stress. And if you feel great, I wouldn’t really worry. Don’t be the guy or gal who chases “inflammation,” and don’t go looking for a drug that reduces the liver’s production of CRP. Instead, be the one who eliminates the ultimate cause, or causes (because there are always more than one) of the chronic inflammation. Revisit the list from the end of the last inflammation post and make sure you’re not omitting anything that you should be including or including anything that you should be omitting.

Take care and be sure to leave a comment! How do you tell if you’re in a state of low-grade inflammation?

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I took some bloodtests some months ago and they were fairly comprehensive, but one of the figures that was elevated was C reactive protein, as well as elevated levels of white blood cells. I haven’t felt well in some time and im currently working with Laurent Bannock and might use Chris Kresser as well.

    Jared wrote on January 25th, 2012
  2. Hi Mark,

    Great article but I noticed you do not mention Sedimentation Rate. Can you please explain why not? I am of the understanding that elevated sed rate is a major marker of inflammation.

    Thanks

    Caroline wrote on February 3rd, 2012
  3. I’ve been going primal for about 44 days so far. Today I feel kind of hot, I’m breathing about 30 breathes per minute and my heart rate is about 70 bpm.

    I’m not sure what is wrong with me but I ate for the first time today around 6pm and fasted for most of the day. I kind of had a big meal so I think it might have something do with it.

    Anybody have any advice?

    Chris wrote on October 17th, 2012
  4. i had blood taken this week every thing came back ok but one that i had inflamation what is wrong thanks

    wyn wrote on February 17th, 2013
  5. Just for a note on acne, while eating plenty of pasta/bread/carbs for the last 10 years, I tried dairy/no dairy and it didn’t really make much of a difference that I saw. For the past 3 months I’ve been doing paleo and have had lots of full fat cheese and yogurt, and lots of whole fat milk & cream (organic/grass fed as much as possible).

    Have not had major (or minor, really) acne problems over the last 3 months.

    Peter wrote on April 6th, 2013
  6. 50 yrs old. History of MRSE Osteomyelitis, spine after multiple spine fusion surgeries/hardware. Horrible back pain continuese. Chronic Elevated sed rate and crp. WBC low-norm. Chronic chills, sweats, severe fatigue. Feel exhausted all of time. Skin color worsening pale to pasty color. Recently diagnosed with Rheum. Arthritis (neg rhem factor). Just recovered from adrenal crisis. Have hypothyroidism. Baseline vital signs: BP 90-100/60-70, HR 90-100, RR 20-24 (SOB frequently), temp always low 96.0-96.8. Docs missing something. I feel horrible; cannot function seriously. No one individual should feel this bad nor be brushed off by the medical community for help. I am a Registered Nurse. Help me doctors. Kentucky.

    Cynthia M. wrote on October 17th, 2013
  7. Speaking of inflammatory responses and such. I’m just starting out with paleo, 53 years old, very overweight at 260. I’m also a former jock, and jumped into some high intensity intervals with perhaps too much enthusiasm. BP was great at annual physical, about four weeks into program, at 115/68. My HDL is up ten points. But my liver enzymes were seriously elevated, about five times normal, ditto for C-reactive protein. My doctor is scratching his head, but I reckon it’s a normal response to a new, stringent diet that’s knocking off fat cells, along with some muscle probably, and perhaps too much exercise to start off with. Anyway, I’m not worrying, and I bet we are on the way back to normal when we recheck. I’m putting on muscle in spite of it all and losing fat like a demon. So grok on!

    Andy R. wrote on November 25th, 2013
  8. i would like to know if there is any device which could detect inflammation ….theres a person i know who died in a accident ,he was taken to a hospital doctors could not find out the tissue which has inflammed inside the body can anyone atleast help me out in designing such a device so that it could be helpful for others

    ramsam wrote on December 30th, 2013
  9. The comments about inflammation and eye issues are interesting. I am self – diagnosed gluten intolerant (doctors have been next to useless in my quest for improving my chappy health) and the past couple days I’ve made bread for my family. I didn’t eat any but just kneading it caused a huge flare up in inflammatory response- swollen &crusty eyes and extreme fatigue. Also certain eye makeups will do the same thing.

    Sierra wrote on January 9th, 2014
  10. Dear Mark,
    I have been on a quest since the age of 13 to better health through diet. I gave up soda and red meat. While in college, I became a full vegetarian and only ate veggie burgers, veggie chicken, etc as a protein source . Then I found almond milk and restricted a lot of dairy. I’m from a very rural town and low fat diet was always preached to me. I began a going to the gym about 5 or 6 nights a week. After grad school. I obtained a job and after starting work, maintaining vegetarian diet, and workout devotion I was diagnosed with an autoimmune disease at 26. It was the most horrific news and I know that’s somewhat selfish but it’s true. Through reading your posts and other resources, I understand how my vegetarian diet contributed to my current state. I began the paleo diet in July 2013 and after that time still have a lot of problems. So being incredibly stubborn, I did more research discovering the autoimmune Paleo diet. Again my brain is buzzing with food I have to eliminate, replace. Not having dark chocolate breaks my heart. Can you offer any guidance to help me on this journey, avoid traps, etc.
    Thank you

    stew wrote on January 10th, 2014
  11. I can tell within minutes if what i have eaten has triggered inflammation in my body. Swelling in my hand and ankles, and if i go over board on the sugar/grains (even whole grains) my face will even swell.. I can lose 2 inches over the course of a few days simply by cutting the sugar and the grains from my diet. I also notice increased pain in my knees. I control my these issues, using my own diet on diymydiet.com but mostly just cutting the carbs. in all forms. The effect they have on your body is amazing!

    Sara wrote on April 6th, 2014
  12. Have you heard any correlation between BP MEDICATION, Ramipril as the cause of chronic Inflamation? I suffered devastating side effects from this medication – where I could not even get of of bed by pushing myself to a sitting position. Next came a flare up of Inflamation which caused muscle weakness, muscle soreness, loss of muscle strength, and joint stiffness. It has gotten progressively worse. I stopped that BP MEDICATION 3 months ago. I lost 20 lbs and now have good BP AND DO NOT NEED IT!
    Now I have been dealing with constant flare-ups which involve my legs and keep me from walking, climbing stairs, or even simply exercising every day!
    I also get leg flare ups for two days, then upper body flare up, and in between I only feel moderately normal, until it starts all over again.
    My CRP LEVEL Is 15 and my Dr said it s/b below 8
    No RA or Lupus
    No joint problems noted in X-Ray of shoulders, hips, and knees.
    No tendon or ligament problems.
    Not sure if I have arthritis, but doubts that.
    I’m not taking any pain MEDS until I see a Rheumatologist.
    What can I do that will help me out of this Inflamation cycle?

    Before this happened I exercised every day and never once had any pain in my life. I just turned 66, and I’m a grandmother.

    Kathleen wrote on December 31st, 2014
  13. Seen a few of your posts, I’m not sure if I have it or not… I’m taking tablets for my eyes that reduce inflammation and promote blood circulation, that and fish oil (omega 3 only). I was suppose to be clear by 3 months, it’s now like 10…. It’s now a pain, every time I contact them they aren’t helpful as much. At first I had orange skin due to beta-carotene, I drink water/soft drinks/herbal teas… eventually went down, my eyes are still dry and red. Could I ask for this test and to see if i’m consuming omega 3? I’m getting acupuncture done to. Going to do it every 2 weeks possibly to see if it helps, with eye exercises, I go to college 2 and a half days, I have a normal diet: I love trying to eat healthier thought… I do eat chocolate and crisps… I am suffering from a bit of stress… when I asked my gp about the chest pains it was told it was just panic attacks. My acupuncturist disagreed, (I agreed with what they said). They treated my upper eye brows, and legs aiming for the liver, due to me being tired which to them was described as not getting what I need from the food. I’m at a loss, I’ve seen acupuncture cure some people, and a healthy diet for others… (Doubt I’m lucky enough). I just wanna be able to get this under control. The redness makes me very unhappy about my eyes, as I use to like them. I suspect my periods by about 90%, I use computers but this has never happened… (never experienced dryness once…) Any advice would be helpful! I emailed (the person I mentioned about diet) they recommended a nutritionist. Thanks a lot!

    Natalie wrote on February 10th, 2016

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