Quick answer: Chronic inflammation often has no obvious symptoms, but blood tests can reveal it. High-sensitivity CRP (hs-CRP) is the most common marker, and homocysteine, oxidized LDL, myeloperoxidase (MPO) and Lp-PLA2 add detail about blood vessel inflammation. Common drivers include sugar, poor sleep, stress, gut imbalance and hidden infections, and food, movement and sleep help bring markers down.
Key takeaways
Chronic inflammation often has no obvious symptoms, but blood tests can reveal it.
High-sensitivity CRP is the most common marker, while homocysteine, oxidized LDL, MPO and Lp-PLA2 add detail about blood vessels.
Sugar, poor sleep, stress, gut imbalance and hidden infections are common drivers, and food, movement and sleep help bring markers down.
Key inflammation markers
- hs-CRP: a sensitive marker of whole-body inflammation
- Homocysteine: an amino acid that can damage blood vessels when high; often linked with low B vitamins (see methylfolate)
- Oxidized LDL: LDL that has been damaged by oxidation
- Myeloperoxidase (MPO): an enzyme from white blood cells linked with plaque inflammation
- Lp-PLA2: an enzyme associated with vascular inflammation
Your provider interprets results against the lab’s reference range and your overall picture; I do not recommend chasing a single number. Functional labs are optional. They can be helpful in more complex cases.
What drives inflammation up
Inflammation is driven up by added sugar and refined carbs, poor sleep and chronic stress, and gut imbalance or a leaky gut. Hidden infections, including gum disease, excess visceral fat, smoking and environmental exposures add to it.
Food-first ways to lower inflammation
Eat plenty of colorful vegetables and berries, use olive oil and eat fatty fish, and add turmeric, ginger and green tea. Move daily, and prioritize sleep and stress care.
For a deeper look, see inflammaging.
What does the research show about inflammation markers?
The Emerging Risk Factors Collaboration analyzed individual data on 160,309 people without vascular disease from 54 long-term studies. Each three-fold higher CRP level was linked with a 37% higher risk of coronary heart disease after adjusting for usual risk factors (risk ratio 1.37), and with higher risk of stroke and of death from non-vascular causes. Because CRP rose with many other risk factors, the authors could not show that CRP itself causes heart disease. (Emerging et al., 2010)
The CANTOS trial randomly assigned 10,061 people with a previous heart attack and hs-CRP of 2 mg/L or higher to an injected anti-inflammatory antibody at one of three doses or placebo, with a median follow-up of 3.7 years. The 150 mg dose lowered hs-CRP and reduced major heart events by about 15% (hazard ratio 0.85) without changing cholesterol, but it also increased fatal infections. The trial studied a drug in people who already had heart disease, so it shows that inflammation matters, not that lifestyle changes in CRP would have the same effect. (Ridker et al., 2017)
The Homocysteine Studies Collaboration combined data from 30 studies with 5,073 heart disease events and 1,113 strokes. In prospective studies of healthy people, a 25% lower homocysteine level, about 3 micromol/L, was linked with an 11% lower risk of ischemic heart disease and a 19% lower risk of stroke. The authors described homocysteine as at most a modest predictor, and these were observational data. (Homocysteine et al., 2002)
Taken together, inflammation markers add information about risk, but they are most meaningful when read with cholesterol, blood pressure, blood sugar and how a person feels.
Inflammation and healthy aging
Chronic low-grade inflammation (inflammaging) is closely linked with aging. It is associated with senescent cells, gut dysbiosis and stressed mitochondria, and it can disrupt communication between cells. Tracking hs-CRP is a simple way to monitor it. Related: hs-CRP explained.
When to see a naturopathic doctor
It may be time to see a naturopathic doctor if your hs-CRP or homocysteine is elevated, or if you have aches, fatigue or brain fog without a clear cause. The same is true if you have a family history of heart disease, or if you want a personalized anti-inflammatory plan.
See a medical provider promptly for chest pain, fever with severe pain, or sudden swelling.
Questions to bring to your clinician
These questions can help you get the most out of your next visit.
Which inflammation markers, such as hs-CRP or homocysteine, would be useful for me?
How should I read my inflammation markers alongside the rest of my labs and my symptoms?
How often would it make sense to recheck my inflammation markers in my situation?
Which daily habits or medications could be influencing my inflammation markers before we retest?
Frequently asked questions
What is the best blood test for inflammation?
hs-CRP is the most widely used marker of chronic inflammation.
What causes high homocysteine?
Low B12, folate or B6, genetics (such as MTHFR variants), kidney issues and some medications.
Can diet lower CRP?
Yes. Anti-inflammatory eating, weight loss, exercise and sleep can lower CRP.
Do I need advanced inflammation tests?
Not usually. They can add detail for people with higher heart risk.
Sources
- Emerging Risk Factors Collaboration, et al. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet 2010. PMID: 20031199. https://pubmed.ncbi.nlm.nih.gov/20031199/
- Franceschi C, et al. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci 2014. PMID: 24833586. https://pubmed.ncbi.nlm.nih.gov/24833586/
- Homocysteine Studies Collaboration. Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. JAMA 2002. PMID: 12387654. https://pubmed.ncbi.nlm.nih.gov/12387654/
- Huang F, et al. Lipoprotein-associated phospholipase A2: The story continues. Med Res Rev 2020. PMID: 31140638. https://pubmed.ncbi.nlm.nih.gov/31140638/
- Podrez EA, et al. Myeloperoxidase-generated oxidants and atherosclerosis. Free Radic Biol Med 2000. PMID: 10946213. https://pubmed.ncbi.nlm.nih.gov/10946213/
- Ridker PM, et al. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med 2017. PMID: 28845751. https://pubmed.ncbi.nlm.nih.gov/28845751/
- Ridker PM, et al. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000. PMID: 10733371. https://pubmed.ncbi.nlm.nih.gov/10733371/
- Smith AD, et al. Homocysteine, B Vitamins, and Cognitive Impairment. Annu Rev Nutr 2016. PMID: 27431367. https://pubmed.ncbi.nlm.nih.gov/27431367/
- MedlinePlus: C-Reactive Protein (CRP) Test
- MedlinePlus: Homocysteine Test
This article is for educational purposes only and is not medical advice. It does not replace an individual evaluation. Talk with your healthcare provider before starting supplements or changing medications, especially if you are pregnant, nursing, or managing a health condition.
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