Which blood tests for inflammation are worth testing to improve your health and performance?
Quick Summary: Inflammation is another "bad thing" buzzword in the medical and fitness worlds. And when unchecked, inflammation can harm our health - usually cardiovascular - but inflammation is also needed for survival. So, how do we measure it? We can test CRP and hs-CRP; more functionally, we can look at homocysteine, ferritin, and omega-3 index. This is not a comprehensive list of inflammatory markers. Your doctor may order more/less depending on your specific condition.
Inflammation
We won't do a deep dive into the mechanisms of inflammation here. The punchline is this: too much inflammation for too long can result in tissue damage and destruction (if these tissues are your blood vessels, we're looking at CVD complications).
Now the other punchline is this: most people could quench most of their inflammation by:
"Eat food, not too much, mostly plants." - Michael Pollan
Minimize refined/processed carbohydrate intake.
Minimize the intake of fried/trans fats.
Consume 2-3L of water or non-diuretic herbal tea daily.
Have at least one complete bowel movement per day.
Sleep 7-8 hours each night, waking and going to bed at consistent times.
Now, that's only possible for some. Life, work, family, and socioeconomic circumstances can impact people's lives in a way that affects their physiology. So, how would we measure these inflammation levels to monitor the success of your lifestyle and treatment recommendations?
C-Reactive Protein (CRP)
CRP is a protein made by the liver in response to inflammatory conditions. When CRP is elevated, we can assume that something inflammatory is occurring. However, this metric is wildly unspecific to any condition. It's so unspecific that it's nearly pointless for your doctor to run without a specific disease or other specific markers being assessed (e.g., fibrinogen, serum amyloid A protein, etc.).
High Sensitivity C-Reactive Protein (hs-CRP)
This is similar to the CRP we discussed above, but its sensitivity is to the heart/cardiovascular system. When hs-CRP is elevated, we can assume something has happened or may happen to the cardiovascular system (e.g., heart attack, coronary artery disease, etc.).
Homocysteine (Hcy)
Homocysteine is an amino acid intermediate that helps produce methionine and cysteine, two other amino acids used in the body's inflammation management, protein production, and immune health. When homocysteine levels are too high, we see a correlation with CVD risk.
Image Source Linus Pauling Institute
Note: Another place you may have heard about homocysteine is the popularity of single nucleotide polymorphisms (SNPs; “snips”) - most notably, the MTHFR gene involved in the methylation cycle. Homocysteine depends on riboflavin, folate, B12, B6, and choline. Poor methylation genetics (e.g., homozygous MTHFR SNP) and poor nutrient intake make it possible to see a build-up of homocysteine.
Ferritin
Ferritin is an iron-storage protein produced by your liver. Usually, a (good, thorough) doctor will order your ferritin as a part of an iron panel and CBC to asses for iron-deficiency anemia. In this case, we may see low ferritin levels (sometimes even before we see low iron levels). However, ferritin is also an "acute phase reactant protein," meaning your liver will produce ferritin in response to inflammation. Thus, non-specifically, we may see elevated ferritin in inflammatory and immune conditions.
Omega-3 Index
This is the metric I like to use for my athletes and otherwise "healthy" individuals as an "inflammation preview test" because it's so tightly tied to your diet and lifestyle. For example, you may have good omega-3 levels because you supplement fish oil. Still, your index may be less than ideal or poor because your fast food intake outpaces your two fish oil pills each morning.
When measuring a red blood cell's "membrane content," we'd like to see that 8-11% of the fat that makes up the membrane is EPA or DHA. I talk more about EPA, DHA, and the omega-3 index here.
Wrap up and summary.
With this post, I hope to show you that most folks do not need inflammation markers tacked on to their labs. Unless you have a specific condition or risk factor (e.g., hypertension, dyslipidemia, long-COVID, immune deficiency, etc.), the tests are too non-specific to be helpful. Where I will start with most folks is an omega-3 index because the values do correlate with inflammation and cardiovascular risk, and the lab gives us a concrete look at dietary factors that we can change to mitigate this risk. Whereas a CRP tells us there's inflammation, an omega-3 reveals that the inflammation may be related to too many potato chips (e.g., omega-6 fats).
In my practice, we work together to make you make you resilient before or after injuries. I offer in-person care here in Arizona and virtual concussion/PCS programs for folks outside the state and abroad. Over the course of our visits, we dive deeply into autonomic, metabolic, visual/vestibular, cervical, and psychological assessment and screening. By completing this comprehensive assessment in a matter of 2-3 weeks, patients are provided with a comprehensive rehab plan that can shave months off their recovery times.
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