By Dr. Steven Long, DO, MHA, CPT
Beyond Health | Precision Medicine for High-Performance Living

Inflammation: Friend and Foe

Inflammation is a double-edged sword. In the short term, it’s a protective response—your immune system mobilizing against infection or injury. But when inflammation lingers, it becomes a silent driver of chronic disease, accelerating atherosclerosis, diabetes, cancer, neurodegeneration, and frailty. Understanding and measuring inflammatory markers allows us to quantify that silent risk and intervene before disease manifests.
At Beyond Health, we use evidence-based tools to evaluate inflammation and help patients move toward longevity, performance, and resilience. Five key biomarkers stand out: C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Each reflects a different dimension of the body’s immune response.

C-Reactive Protein (CRP) and hs-CRP

• What it is: CRP is produced by the liver in response to inflammatory cytokines, particularly IL-6. It rises in infection, trauma, and systemic inflammation.
• Why it matters: Elevated CRP has been strongly linked with cardiovascular risk, independent of cholesterol levels . The high-sensitivity version (hs-CRP) detects low-grade inflammation associated with atherosclerosis and metabolic disease.
• How to improve: Weight loss, regular exercise, smoking cessation, and diets rich in omega-3 fatty acids and polyphenols reduce hs-CRP . Statins and GLP-1 receptor agonists also lower hs-CRP beyond their metabolic benefits .

Erythrocyte Sedimentation Rate (ESR)

• What it is: ESR measures how quickly red blood cells settle in a tube. Faster rates suggest higher levels of circulating proteins (like fibrinogen) that reflect systemic inflammation.
• Why it matters: ESR is less specific than CRP but useful in chronic inflammatory conditions such as autoimmune disease or infections like endocarditis .
• How to improve: ESR falls when underlying inflammatory diseases are treated (e.g., rheumatoid arthritis with biologics) and with general anti-inflammatory lifestyle strategies—exercise, sleep optimization, and Mediterranean-style diets.

Interleukin-6 (IL-6)

• What it is: IL-6 is a cytokine secreted by immune cells, fat tissue, and muscle during inflammation. It stimulates CRP production in the liver.
• Why it matters: Chronically elevated IL-6 is associated with insulin resistance, sarcopenia, cognitive decline, and increased mortality . Interestingly, IL-6 also rises acutely with exercise but in a beneficial, transient way—mobilizing glucose and stimulating anti-inflammatory mediators.
• How to improve: Resistance training and aerobic exercise reduce chronic IL-6 signaling . Adequate sleep, visceral fat reduction, and omega-3 supplementation also lower baseline IL-6 levels.

Tumor Necrosis Factor-Alpha (TNF-α)

• What it is: TNF-α is one of the body’s most potent pro-inflammatory cytokines, produced by macrophages and fat tissue.
• Why it matters: TNF-α contributes to insulin resistance, endothelial dysfunction, and progression of autoimmune diseases . High TNF-α is strongly implicated in frailty, sarcopenia, and cardiovascular risk.
• How to improve: Exercise and dietary interventions lower TNF-α over time. Pharmacologically, TNF-α inhibitors have revolutionized the treatment of autoimmune diseases, though they are not used preventively in otherwise healthy populations.

Practical Implementation at Beyond Health

1. Baseline testing: hs-CRP, IL-6, and TNF-α for systemic inflammation; ESR when autoimmune disease is suspected.
2. Lifestyle prescription: Structured resistance and Zone 2 training, Mediterranean-style nutrition, sleep optimization, and body composition targeting (especially visceral fat reduction).
3. Medical optimization: Consider statins, GLP-1 receptor agonists, SGLT2 inhibitors, or biologics when appropriate.
4. Monitoring: Regular retesting allows us to quantify progress, ensuring that interventions are not just theoretical but measurable.

The Big Picture

No single marker tells the whole story. CRP is fast but nonspecific, ESR is blunt, IL-6 is upstream, and TNF-α represents deep systemic inflammation. Used together, they provide a window into the inflammatory state that underlies many of the diseases we fear most. The good news: inflammation is modifiable. With precision medicine, we can dampen unnecessary inflammation while keeping the immune system strong, resilient, and ready when needed.

References

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4. Ridker PM et al. "Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein." N Engl J Med. 2008;359:2195-2207.
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