5

votes

Super High ESR, Normal CRP - WTF?

Answered on August 19, 2014
Created July 25, 2011 at 1:43 PM

Hey all. Been paleo for a few years, strict for the past 8 months. I have ankylosing spondylitis and have been working with Cordain's (and others') autoimmune protocol. I feel like paleo + my awesome strength and conditioning coach have helped reduce pain and inflammation over the past year. I've been able to cut my AS meds (Celebrex) by 75% and am more comfortable and active than I've been in years.

Last week I had a few tests run through my cardiologist and found out that my CRP (c-reactive protein) levels are normal (yay!), but my ESR (erythrocyte sedimentation rate) was off the charts (boo...). I was very surprised. The upshot from my doctor's POV is that, regardless of lower superficial pain in my joints, this high level of systemic inflammation will burn out my heart, kidneys, lungs, eyes, etc, and needs to be treated aggressively in the short term to be put into remission. Although I'm fully on board with paleo and its anti-inflammatory powers, I have to admit that I'm a little worried by the test results.

How do you reconcile a seeming reduction in the outward expression of inflammation (pain, stiffness), with increasing internal markers?

Medium avatar

(3259)

on July 26, 2011
at 12:56 AM

Thanks for the interest. I'm doing Cordain's AI protocol, which is essentially no starch. I arrived at paleo through Carol Sinclair's Low Starch IBS Diet book. Can't claim to have eliminated all starch (some sneaks in), but am close. Mostly meat, fat, and green veg.

0faecc3397025eab246241f4dcd81f5e

(2361)

on July 25, 2011
at 10:55 PM

My AS client has no problem with sugars, only starches. It is the long poly-saccharide chains that feed the nasty gut bacteria that are the problem.

0faecc3397025eab246241f4dcd81f5e

(2361)

on July 25, 2011
at 10:51 PM

I don't think it is non-starch. It still uses starchy root veggies but not potatoes. It is grain, legume, sugar (but not fruit) nightshade, seeds, nuts and egg free.

9d43f6873107e17ca4d1a5055aa7a2ad

on July 25, 2011
at 10:30 PM

what are the specifics of your diet? What foods included/excluded? What macros?

9d43f6873107e17ca4d1a5055aa7a2ad

on July 25, 2011
at 10:29 PM

isn't Cordain's autoimmune protocol already non-starch?

3864f9a2af09b1b447c7963058650a34

(3703)

on July 25, 2011
at 10:25 PM

If one has difficulty digesting, it doesn't really matter the type of starch and chain bending/length. The duodenom only absorbs mono-saccharides (so straight ribose and glucose are ok) but FODMAPs are not and will ferment. If protein doesn't digest, then they'll putrify. Here are some signs/symptoms to look for (if one is in tune w/their body) (look at the answer box -- whoops too BIG)

6670b38baf0aae7f4d8ac2463ddc37c0

(3946)

on July 25, 2011
at 10:19 PM

Thanks for this info. I am curious as to the role of straight sugars as the author names starches as the main culprit here.

3864f9a2af09b1b447c7963058650a34

(3703)

on July 25, 2011
at 10:17 PM

Absolutely!!! Ebringer is no-starch. Right now I am going through metal toxicity (positive hair analysis post8wks chelation by oral) and gut still digests little food. When the microvilli are blunted, pancreas non-functional (from dysbiosis, strain, metals), and brush border enzymes are defunct/non-existent, supps (proteases, lipases, etc) help til lawn of villi grow back... WEED, SEED, WATER!! http://chemistry.gravitywaves.com/CHE452/06_Diges.%20%20Ab.%20Prot.%20&%20CHO.htm [digestion 101] Pottenger's work on digestive enzymes: http://www.regenerativenutrition.com/printer.asp?cId=54

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on July 25, 2011
at 09:31 PM

I agree fully with this.....anything that upregualtes insulin pathways increase issues with the joints

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on July 25, 2011
at 09:30 PM

I use high dose omega threes Rx grade only though. I also make my AS patient do bone broths with pasture animals four times a week push their D levels and most are on HRT because of the inflammatory damage to their HPA axis over time. Tough disease that HLA B27. I maximize the immunity side with HRT too......especially higher progesterone and lowered cortisol.

34a367e60db77270bd7096dc04270fdc

(4171)

on July 25, 2011
at 06:26 PM

Thank you Annie!

6670b38baf0aae7f4d8ac2463ddc37c0

(3946)

on July 25, 2011
at 05:53 PM

Heather, see below for the damage NSAID's can do.

6670b38baf0aae7f4d8ac2463ddc37c0

(3946)

on July 25, 2011
at 05:50 PM

http://www.emedicinehealth.com/understanding_rheumatoid_arthritis_medications/page9_em.htm

34a367e60db77270bd7096dc04270fdc

(4171)

on July 25, 2011
at 05:15 PM

Can one of you tell me what biologics is? I have Sjogren's Syndrome and my last blood work showed a sed rate of 72 and a CRP of 16.6. My doctor has given me an nsaid for moderate pain and a muscle relaxer to help me sleep but that is all. I told her I was concerned about the inflammation and asked what I could do to help get it down and she had no answers for me, just said people with autoimmune diseases just have high inflammation markers..

6670b38baf0aae7f4d8ac2463ddc37c0

(3946)

on July 25, 2011
at 04:49 PM

Great answer. This is something I did not know when I was taking all of those anti-inflammatories that didn't work.

6670b38baf0aae7f4d8ac2463ddc37c0

(3946)

on July 25, 2011
at 03:08 PM

I feel for you Riveted, as I have AS as well. I have been through several periods of increased inflammation, but it seems to wax and wane for me. And on an interesting note, none of the designer drugs they threw at me lowered inflammation. Unfortunately, diet has not cured me, but it is a definite improvement. I wish you well and hope you find the answers you are looking for.

Medium avatar

(3259)

on July 25, 2011
at 02:57 PM

Annie - thanks for that. I've been looking into them for the past few months and am (of course) very reluctant. I gave myself 6 mos of strict paleo to see what I could do on my own, and I feel I've done well (which is why I was shocked at the ESR). It ultimately comes down to weighing the drug risk against the damage chronic systemic inflammation can cause. Still not sure what I'll do, just know I can't stay inflamed given my super risky family history of heart disease.

6670b38baf0aae7f4d8ac2463ddc37c0

(3946)

on July 25, 2011
at 02:51 PM

Riveted, please do some serious research on the biologics before committing. Doctor's throw these drugs at us without telling us that they supress your entire immune system and can make you more susceptible to cancers such as leukemia. The percentage of increased risk is low, but real.

Medium avatar

(3259)

on July 25, 2011
at 02:30 PM

Thanks - will ask for those at next appointment.

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on July 25, 2011
at 02:26 PM

ESR. Is very non specific.......hs crp comes from acute phase reactants from liver and shows gut mediated inflammation. Your inflammation may not be gut mediated. I bet your TNF alpha is up too and your thyroid is down too.......get a salivary cortisol too. It will be altered I bet as well

Medium avatar

(3259)

on July 25, 2011
at 02:13 PM

Biologics - adalimumab. Not sure yet. He says we need to "hit it hard", put it hopefully in remission, then back off the biologics and maintain as usual (for him that means NSAIDS, for me paleo + exercise).

Aead76beb5fc7b762a6b4ddc234f6051

(15239)

on July 25, 2011
at 02:09 PM

what is it your doc wants to do- steroids? oral or infusion? for how long?

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3 Answers

3
3864f9a2af09b1b447c7963058650a34

(3703)

on July 25, 2011
at 03:34 PM

R--

Congrats with all the progress so far!

ALL health and health demise starts in the gut. You were on Celebrex and that drug like similar NSAIDs/COX2-I are disruptors of gut permeability and the microbiota. Have you had antibiotics? Any acid blockers to 'protect NSAID/celebrex induced risk' of peptic ulcers? These all cause gut dysbiosis allowing Klebsiella, a gut inhabitant, to cross into the blood stream and initiate an immune response and antibodies which are similiar to the proteins in spinal and joint proteins. Read: google 'Ebringer and HLA B27'.

Is your food digesting? Are you a hard gainer? Is the doc gonna repeat the ESR or rx based on an asymptomatic profile and just one lab test??

I would consider w/your doc 3 things first: (1) a focus on the gut, (2) removing immune complexes in circulation (takes 6-18 months -- using some enzymes e.g. seraptidase hastens) and (3) even consider evaluation of a heavy metal burden because even low levels of metals cause autoimmune disease and gut dysbiosis. Metals behave as metalloestrogens and the pathogenic bacteria and yeasts have estrogen receptors which can induce their growth.

I concur with Quilt -- the adrenals take a hit for multiple reasons. Get the adrenals in line.

These Amazonian miners have elevated inflammatory markers incl ANA and cytokines (no ESR measured) due to low level exposure of metal from seafood and mining exposures. If metals are positive for you, then for optimal health and 100% remission of AS, the consideration for oral, gentle and safe chelation cannot be exempted. http://iah.iec.pa.gov.br/iah/fulltext/pc/artigos/2010/environres2010v110n4p345-354.pdf http://www.sc.edu/news/newsarticle.php?nid=1470 http://www.sciencedirect.com/science/article/pii/S0041008X05003248

G

6670b38baf0aae7f4d8ac2463ddc37c0

(3946)

on July 25, 2011
at 04:49 PM

Great answer. This is something I did not know when I was taking all of those anti-inflammatories that didn't work.

2
0faecc3397025eab246241f4dcd81f5e

(2361)

on July 25, 2011
at 08:46 PM

Are you doing the starch free version of auto-immune paleo for AS?

I've had great success with one client http://paleozonenutrition.wordpress.com/2011/02/12/auto-immune-disease-hla-b27-pain-free-on-no-starch-paleo-diet/

0faecc3397025eab246241f4dcd81f5e

(2361)

on July 25, 2011
at 10:51 PM

I don't think it is non-starch. It still uses starchy root veggies but not potatoes. It is grain, legume, sugar (but not fruit) nightshade, seeds, nuts and egg free.

3864f9a2af09b1b447c7963058650a34

(3703)

on July 25, 2011
at 10:17 PM

Absolutely!!! Ebringer is no-starch. Right now I am going through metal toxicity (positive hair analysis post8wks chelation by oral) and gut still digests little food. When the microvilli are blunted, pancreas non-functional (from dysbiosis, strain, metals), and brush border enzymes are defunct/non-existent, supps (proteases, lipases, etc) help til lawn of villi grow back... WEED, SEED, WATER!! http://chemistry.gravitywaves.com/CHE452/06_Diges.%20%20Ab.%20Prot.%20&%20CHO.htm [digestion 101] Pottenger's work on digestive enzymes: http://www.regenerativenutrition.com/printer.asp?cId=54

Ed71ab1c75c6a9bd217a599db0a3e117

(25477)

on July 25, 2011
at 09:31 PM

I agree fully with this.....anything that upregualtes insulin pathways increase issues with the joints

Medium avatar

(3259)

on July 26, 2011
at 12:56 AM

Thanks for the interest. I'm doing Cordain's AI protocol, which is essentially no starch. I arrived at paleo through Carol Sinclair's Low Starch IBS Diet book. Can't claim to have eliminated all starch (some sneaks in), but am close. Mostly meat, fat, and green veg.

6670b38baf0aae7f4d8ac2463ddc37c0

(3946)

on July 25, 2011
at 10:19 PM

Thanks for this info. I am curious as to the role of straight sugars as the author names starches as the main culprit here.

3864f9a2af09b1b447c7963058650a34

(3703)

on July 25, 2011
at 10:25 PM

If one has difficulty digesting, it doesn't really matter the type of starch and chain bending/length. The duodenom only absorbs mono-saccharides (so straight ribose and glucose are ok) but FODMAPs are not and will ferment. If protein doesn't digest, then they'll putrify. Here are some signs/symptoms to look for (if one is in tune w/their body) (look at the answer box -- whoops too BIG)

9d43f6873107e17ca4d1a5055aa7a2ad

on July 25, 2011
at 10:29 PM

isn't Cordain's autoimmune protocol already non-starch?

0faecc3397025eab246241f4dcd81f5e

(2361)

on July 25, 2011
at 10:55 PM

My AS client has no problem with sugars, only starches. It is the long poly-saccharide chains that feed the nasty gut bacteria that are the problem.

1
3864f9a2af09b1b447c7963058650a34

(3703)

on July 25, 2011
at 10:26 PM

From the Pottenger link:

Symptoms of mineral and vitamin deficiencies occur relatively quickly. They are recognised to cause specific illness. Enzyme deficiencies, outside of genetic or birth defects, take longer periods to be noticed and have only begun to be recognised in some circles of the medical community. What, then, are typical signs and symptoms of the more common enzyme deficiencies?

. If you have problems digesting carbohydrates, you may experience airborne sourced allergies, diarrhoea, fibromyalgia or attention deficit disorder (ADD or ADHD).

. If you cannot digest fats, you may experience constipation, gallbladder problems, heart disease or hormone imbalances.

. If you cannot adequately digest protein, you may experience constipation, arthritis or other inflammatory conditions, anxiety or panic attacks, premenstrual syndrome or immune system disorders.

. If you are unable to break down plant fibre, you may experience constipation, eczema or other skin-related problems, recurrent yeast/fungal infestations or excessive weight gain.

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