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hs-CRP

This chapter discusses the laboratory values associated with silent inflammation, circulation and the regulation of cholesterol values in the blood. Each of these has an important role in the prevention of cardiovascular diseases.

HIGH-SENSITIVITY C-REACTIVE PROTEIN (HS-CRP)

The levels of C-reactive protein (CRP) in the blood increase during inflammation or infection, as well as cardiac arrest, surgery or trauma. C-reactive protein is formed throughout the body, especially in the immune system cells, the liver, and fat cells. By binding to other molecules, CRP participates in the production of cytokines and other inflammatory agents.


High-sensitivity C-reactive protein (hs-CRP) is an excellent marker for determining low-level inflammation (or “silent inflammation”). It plays a significant role, for example, in atherosclerosis and other inflammatory diseases. Elevated silent inflammation is also a contributing factor to practically all degenerative diseases.


NB! CRP may become elevated due to acute illness, tissue trauma, or infection (usually significantly higher than 10). It should not be used for risk assessment of cardiac diseases under these circumstances. Prolonged, very strenuous exercise may also cause slightly elevated CRP.


Elevated high-sensitivity CRP is an independent risk factor for mortality involving cardiovascular diseases in particular. A comprehensive meta-analysis published in 2017 found that the overall mortality risk of individuals with the highest hs-CRP levels was more than 75 % higher compared to the group with the lowest hs-CRP levels. Individuals of the high hs-CRP group had 2.03 times the risk of dying of cardiovascular diseases than individuals with low hs-CRP levels. Increased high-sensitivity CRP levels are linked to cancer mortality in men. This link was not found in women. The Moli-sani study published in 2016 (an Italian population of 20377 adults) found that the individuals with hs-CRP levels in the bottom quarter (0.72 mg/L) had a significantly lower mortality rate compared to the individuals with hs-CRP levels in the top quarter (2.75 mg/L).


Another comprehensive meta-analysis published in the same year studied the effect of the dietary inflammatory index on equivalent variables (overall mortality, cardiovascular disease mortality, and cancer mortality) in a European population. A link was found between the dietary inflammatory index (DII) and all the above-mentioned variables. In other words, the more inflammatory the diet, the higher the levels of silent inflammation in the body, as well as mortality. As such, consuming an anti-inflammatory diet (see below) appears to be one of the clearest dietary factors for health and longevity. A 2009 review found an inversely proportional link between DII and hs-CRP – the higher the DII (anti-inflammatory potential), the lower the hs-CRP. Body mass index (BMI) has also been found to correlate with hs-CRP (obesity linked with high hs-CRP).


Some DII definitions use a negative value for anti-inflammatory foods, i.e. the lower the DII, the more effective the anti-inflammatory potential, and conversely the higher the DII, the greater the inflammatory potential of the food.


All studies involving the dietary inflammatory index and silent inflammation have found one common denominator: the typical Western diet. This diet relies heavily on the consumption of inflammatory foods such as processed cereal, dairy and meat products, white sugar, and refined carbohydrates. The general finding has also been that the typical Mediterranean diet is associated with reduced silent inflammation. This diet relies heavily on the consumption of extra virgin olive oil, fish and seafood, vegetables, berries, fruits, and unprocessed wholegrain cereals (see a more detailed list below).


Foods that reduce silent inflammation include:

  • Cold-pressed virgin olive oil
  • Foods rich in omega-3 fatty acids, such as fish and seafood
  • Turmeric
  • Ginger
  • Rosemary

Polyphenols (incl. flavanols, flavonoids, anthocyanins, isoflavones, etc.):

  • Local berries (the darker the better, the wilder the better)
  • Green tea, black tea, coffee
  • Dark chocolate
  • Apples and citrus fruits
  • Onions and cabbages
  • Spices such as dill, lovage, thyme, parsley, peppers, and paprika
  • Legumes
  • Capers
  • Red grapes and red wine (be mindful of portion sizes - excessive portions increase inflammation)
  • Celery

Foods containing carotenoids: Carrot, sweet potato, spirulina, chlorella, kale and other dark green vegetables, seaweed, celery, rosehip

  • Lycopene (such as in tomatoes)
  • Garlic
  • Fiber (both soluble and insoluble)

Vitamins and minerals that reduce silent inflammation include:

  • Vitamin D
  • Vitamin C
  • Vitamin E
  • Zinc
  • Magnesium
  • Vitamin A
  • Vitamin B6
  • Selenium
  • Niacin (vitamin B3)
  • Folate (vitamin B9)

Ideally the intake of these vitamins and minerals should be guaranteed from nutrition – however, sometimes dietary supplements are necessary if the diet does not provide the amounts required for optimal intake.


Foods that increase silent inflammation include:

  • White sugar and carbohydrate-rich food (particularly processed and refined carbohydrates)
  • Processed vegetable oils and the excessive intake of omega-6 fatty acids
  • Trans fats (such as margarine and “junk food”)
  • Processed dairy products (particularly low-fat and highly refined products)
  • Processed meat products
  • Processed cereal products
  • Alcohol (excessive use)
  • Processed soy products
  • Artificial sweeteners, diet soda
  • Excessive saturated fat from processed foods

Other lifestyle choices that reduce silent inflammation include:

  • Stress management such as breathing exercises, meditation, mindfulness, etc.
  • Balanced physical activity (excessive stress increases inflammation, as does a sedentary lifestyle) [approx. 9 MET-hours / week, i.e. as per official guidelines]
  • Normal body weight
  • Avoiding chemicals and toxins found in the environment, as well as removing these from the body
  • Sufficient and high-quality sleep
  • Balanced blood sugar levels
  • Psychological and emotional balance
  • Regular fasting and/or intermittent fasting

Reference ranges (hs-CRP):
These values are determined based on the risk of cardiovascular disease:

  • Less than 1.0 mg/L = low (relative) risk
  • 1.0–3.0 mg/L = medium (relative) risk
  • More than 3.0 mg/L = high (relative) risk

The optimal hs-CRP value for men has been estimated to be less than 0.55 mg/L, and for women less than 1.0 mg/L. According to a Japanese demographic study, the optimal high-sensitivity CRP value to prevent metabolic syndrome is less than 0.65 mg/L.