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"Clutching his chest, laboring to breathe, and sweating profusely, Woody Swanson pulls aside the oxygen mask, looks up at the doctor, and gasps, `What's happening to me?' as the paramedics unload his gurney from the ambulance and catapult it through the extra-wide doors of the Palm Gardens Hospital Emergency Room."
"Why, you're having a heart attack, Mr. Swanson."
"Are you sure, doc? My cholesterol is normal."
"No time to answer that now, but I'll tell you one thing: you're lucky to be alive!"
"Fast forward two weeks: Referred to me by a mutual friend, Woody's first question in my office is exactly the same: `Why me, doc? My cholesterol is normal.' "
"That's true, Woody, it is normal, but cholesterol is just one marker for heart disease, and not a great one at that. Has your C-Reactive Protein ever been checked?"
"How about homocysteine or fibrinogen?"
"I doubt it. My doctor always just tested my cholesterol, and it has always been normal, so he always says I am not at risk of a heart attack."
"I hope he didn't notice me rolling my eyes. `Let's get you tested.' "
"A couple of days later we sit down with the results."
"Woody, now that we have a picture of your biochemical landscape, we can answer your question about why you had a myocardial infarction."
"If your cholesterol is low, you may think your risk of having a heart attack is pretty low, but the fact is that a normal cholesterol only lowers your heart attack risk by about 30%. In fact, more than half of all heart attacks occur in people with normal cholesterol levels."
"I guess I'm in that half, huh?"
"That would appear to be the case."
"There should be a better way to predict heart attacks, doc."
"There is, Woody, but most doctors don't use it yet."
"That is unfortunate. You guys should be finding and treating and even preventing this disease."
"Amen. Two in three of us die prematurely of atherosclerotic disease. We do need to be more aggressive."
"So what is this `better way?' "
"We could prevent almost every single heart attack if family doctors and internists included five additional markers for cardiovascular disease - homocysteine, C-reactive protein, fibrinogen, fasting glucose, and LDL Particle Size - along with their cholesterol as an annual exam."
"Wow! It's amazing that most doctors don't do this. Are they pricey?"
"Not really, these tests are actually pretty inexpensive. Especially when you consider the cost of a heart attack."
"I don't know, Woody. These tests are readily available and the research literature on them is quite clear: taken together, they are remarkably accurate at predicting heart attacks. And these tests are not indirect markers or "innocent bystanders" - they represent the real root causes of heart disease. The CRP, for example - the marker that apparently caused your heart attack - has been shown to be three times as accurate as cholesterol."
"If I were a doctor, I'd test everybody."
"Problem is, Woody, the conventional medical establishment is somewhat schizophrenic on the subject of CRP testing. For example, the American Heart Association and Centers for Disease Control recently convened a panel of experts to study this question (published in the January 28, 2003 issue of Circulation: The Journal of the American Heart Association). The doctors summarized their conclusions as follows:
"So they acknowledge CRP is a risk factor, but see no need to test for it, except in people of `moderate risk.' "
"Doc, if atherosclerosis is going to kill two-thirds of us, aren't we all at `moderate risk'?"
"Wait a minute. Aren't we all at high risk? Shouldn't we all be tested?"
"Yes, of course! Their dilemma is obvious, isn't it? Pardon my cynicism, but they can't patent curcumin, red yeast rice extract, or vitamins E and C, so there's no profit in it. Why distract attention from the cholesterol-statin cash cow?"
"Point well taken, doc. You'd think identifying high risk patients and saving millions of lives would motivate them. I expected more. It's a real disappointment."
"Woody, I think many physicians are reluctant to order a CRP because they really aren't sure what to do if they see an abnormal result. It's one thing to tell a patient they are at great risk, but if the doctor can't give good advice about how to correct the situation, then he or she will be reluctant to do the test."
"A 2008 New England Journal of Medicine study named JUPITER (Justification for the Use of Statins in Prevention) received a big dose of media attention because it appeared to support the idea that statins could lower C-reactive protein and thus prevent heart attacks. Finally doctors had a prescription they to write. After the initial excitement died down, however, analysts took a closer look and found deep flaws. The statin benefit was marginal at best: you'd have to give expensive statins to 200 people for a year to prevent just one heart attack. Conflicts of interest further weakened the study's credibility: the lead researcher owned a patent on CRP testing and the drug company that funded the project peddled statins."
"So what the heck is a CRP, doc?"
"Well, technically, like cholesterol and LDL, CRP is a biochemical marker for atherosclerosis. Problem is, cholesterol's really not a very good marker. If your cholesterol is low, you may think your risk of having a heart attack is low, but half of all heart attacks occur in people, like you, whose normal cholesterol levels have lulled them and their doctor into a false sense of security."
"What about people with elevated cholesterol? Do they all get heart attacks?"
"No. Most people with elevated cholesterols never have a heart attack."
"But until recently, cholesterol was all you had, right?"
"Right. We knew it wasn't perfect, to say the least. But over the past decade we've developed newer better tests, tests that look directly at the various causes of atherosclerosis and heart attack. These `independent markers,' one of which is CRP, dramatically improve our predictive powers. So if we couple cholesterol with these new blood test markers, we can provide our patients with a much more precise risk assessment. The beauty of these markers goes far beyond just better testing and predicting, however."
"Simply put, as with cholesterol, fixing the marker removes the risk created by that marker. Each of the six markers (I discuss in this book) drives a pathological process that causes arterial disease. When we correct the abnormal markers we are curing or reversing or preventing the disease process associated with that marker. Bringing each marker back to normal lowers that person's risk (for that marker and only that marker) back to zero! And we can do it naturally, with herbs and vitamins and nutritional supplements that improve general health, rather than drugs, which, as you know, can be toxic."
"That's great. Wish I could have benefitted from all that information before I had a heart attack!"
"You still can, Woody! It's true that it would have been preferable if we had found your elevated CRP before you had that heart attack, because correcting the abnormal marker (assuming no other markers were elevated) would probably have averted the event. Researchers have found that an elevated CRP more accurately predicts heart disease in men and women like you whose cholesterol and LDL levels are in the normal range. Once we get your CRP marker back to normal, your risk goes down to what it would have been if it hadn't ever been elevated."
"Believe me, after what I've gone through this past week, I'm ready, Doctor Tim. But you haven't really answered my question. I get it that CRP is a `risk factor,' but what does it do in my body? What's the actual connection, the smoking gun, the cause and effect?"
"In a word," I said, "it's inflammation . Researchers now agree that inflammation is the most important single factor causing atherosclerotic hardening of the arteries. CRP is our single best marker for measuring inflammation. Known as an `acute phase' protein, CRP is the `fire alarm molecule' that alerts the entire body to injury, infection, and allergic reactions. It's our response to any and all inflammation. The more inflammation, the higher the CRP. But CRP also causes atherosclerosis, so the higher the CRP, the more atherosclerosis. A persistently high CRP, regardless of cause, indicates a state of systemic inflammation that damages the entire vascular system."
"So you would want to make sure your patients have a low CRP no matter what, right?"
"Right, Woody. It translates into optimum health on a multiplicity of levels."
"How does this inflammation damage arteries and lead to heart attacks and strokes?"
"Inflammation damages the endothelium, that single thin layer of cells that coats the insides of our arteries, and acts as a protective barrier to protect the rest of the artery. Once the endothelium is damaged, the barrier is breached and the nasty sequence leading to plaque formation (see Chapter 5 for details) is off and running. And inflammation also encourages coagulation, the formation of those blood clots that trigger a heart attack or stroke. Inflammation weakens the plaque deposits in atherosclerotic arteries, increasing the probability of rupture, hemorrhage, and thrombotic disease."
"I must have had a great deal of inflammation," says Woody, "but it wasn't showing up in the cholesterol levels my doc was ordering."
"Exactly! Cholesterol is not a measure of inflammation. CRP is."
"What causes the inflammation?"
"Another great question, Woody! Difficult to answer, however, because there are so many possible causes. Inflammation is the body's natural reaction to injury, allergy, or infection. Inflammation is obvious when it's on the outside - like the angry red swelling you see around a skin wound. When inflammation is on the inside - as with injured blood vessels - it's silent and invisible: we can't feel or see it. CRP is a biochemical way for us to be able to `see' the inflammation that would otherwise be invisible."
"So when something is causing inflammation inside of me, it is also driving up my CRP and causing atherosclerosis?"
"You got it, Woody. The three go together. Anything that can cause low grade chronic inflammation has the potential to cause both arterial damage and an elevated CRP. There's another twist: CRP is not just a marker; it's also an irritant. So once CRP is elevated, regardless of cause, its very presence adds to the fires of inflammation."
"If I get your drift, doc, you are saying that the trauma or toxin or infection - whatever it is - first causes irritation and inflammation which raises the CRP, and then both the original factor and the high CRP start working in cahoots to accelerate the atherosclerosis?"
"I'd call that a triple whammy."
"Does the elevated C-reactive protein molecule contribute to the damage that causes atherosclerosis, or is it just `along for the ride,' so to speak?"
"Another great question, Woody! When CRP's predictive powers were first discovered, the answer to that question was not clear. We did know that it was a large protein molecule produced in the liver as one of the body's responses to inflammation, and we did know that endothelial damage (damage to the inner lining of the artery) is the first step in atherogenesis, the arterial hardening process. For several years it was unclear whether the CRP molecule itself was adding to the arterial damage. Researchers linked an elevated CRP to several conditions that coexist with atherosclerosis. They showed that CRP elevations are seen with insulin resistance, obesity, and prior infection with three specific infectious microorganisms (all of which have been linked to subsequent heart disease: Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus). We also knew that CRP triggers the release of pro-inflammatory chemicals that trigger an inflammatory reaction (cytokines). So there were quite a few connections, but ... "
"Not until 2002, Woody, when researchers at the University of California, Davis Medical Center finally showed that C-reactive protein really does damage the endothelial lining, the first step in the sequence that leads to plaque formation. Earlier experiments by researchers at the University of Texas Health Sciences Center showed that CRP acts directly on the endothelial cells that make up the inner lining of blood vessels, making them stickier (we call this vascular adhesion), so that white blood cells and inflammatory molecules are more likely to attach themselves to the endothelial surface and start forming plaque. Other scientists have shown that CRP encourages macrophages to gobble up more LDL particles, which further accelerates plaque formation."
"So" I continued, "CRP truly is a bad guy, not just a hapless onlooker. Getting rid of it - lowering ones level - is a very good idea. This is an important breakthrough because doctors (and the insurance companies that often influence diagnostic decisions) deny coverage for CRP testing, arguing that a CRP elevation doesn't zero in on the heart and that it is just a general measure of inflammation somewhere - could be anywhere - in the body. The status of CRP has now shifted from "innocent bystander" to "causative agent". The recent research has proven that an elevated CRP damages the heart regardless of where it is coming from. Thus we need to test for it routinely, and when it is elevated, we can treat the inflammatory reaction generally with nutritional medicines and lifestyle measures (see CRP lowering program at end of this chapter). When possible, we also need to find and treat specific infectious, allergic, and/or toxic causes."
"This is all so logical and straightforward that I can't believe doctors don't routinely order a CRP. I have to ask you again: why is that?"
"Physicians are reluctant to check the CRP because if a patient's level is elevated they need to prescribe a treatment for it, but no drug lowers CRP. These docs are usually unaware that nutritional medicines and lifestyle (diet and exercise) are extremely effective agents. Mainstream doctors have been so conditioned by the pharmaceutical industry to look for a drug for every problem that when confronted with an elevated lab value and nothing to write a prescription for, they feel helpless. They don't like this feeling, and can avoid it by simply refusing to order the test."
"I'm glad that isn't my problem."
"Yes, Woody, but it is very real for the millions of Americans who have HMOs, and need the doctor to write the order so that the test will be covered by their insurance."
"I get it that CRP is obviously better than cholesterol at predicting heart attacks. How much better is it?"
"Many researchers believe it is two or three times as good, but remember, cholesterol and CRP are different and additive. By which I mean that if you have an elevated cholesterol, you need to bring it down regardless of whether the CRP is elevated. Same is true of CRP: if it is elevated, you need to lower it, regardless of the status of cholesterol. Either can cause a heart attack.
"A leading CRP researcher, Dr. Paul Ridker of Boston's Brigham and Women's Hospital, estimates that between 25 to 35 million healthy middle-aged Americans are just like you, Woody - they have normal cholesterol but above-average CRP's, putting them at unusually high risk of heart attacks and strokes. A recent study published in the New England Journal of Medicine found that men whose CRP was in the top 25% had three times the incidence of heart attack and twice the frequency of stroke."
"Doc," says Woody, "it boggles my mind that this resource is available and most doctors don't use it."
"Yes, mine too. Dr. Ridker went on to add that, by testing for CRP, `We could prevent many heart attacks, stroke, bypass surgeries, angioplasties and save a lot of lives. To me that's a good thing.'
"The research evidence very clearly supports the importance of CRP testing," I continued. "Even so, in medicine, there is often a lag time between the appearance of new data and its acceptance by the medical community. I encourage all physicians to make CRP testing (and the other new markers I discuss in this book) a routine part of their regular blood testing profile. Many lives could be saved if they got on the bandwagon sooner, rather than later. At the very least a CRP, homocysteine, and fibrinogen should be done along with the usual fasting glucose and lipid panel. There is an epidemic of cardiovascular disease out there and we doctors need to start taking responsibility for finding it."
Risk starts at 0.56 mg/dL, and significant risk begins at about 0.8. In the 22,000 man Physicans' Health Study, CRP scores were divided into four quartiles:
A CRP level like Woody's (3.8 mg/dL) put him at more than four times baseline risk of future stroke or heart attack than if his CRP had been normal, i.e., below 0.8.
So, when people ask me what is the normal range, I say the lower the better, but shoot for a level that is at or below 0.8 mg/L. Between 1.0 and 2.0 there is significantly increased risk, and above 2.0 risk is high. Ideal would be 0.56 or less.
To be sure your CRP-lowering program is working, repeat the CRP (along with any other markers that were abnormal) after two months. If you are moving in the right direction - even though you may not have yet reached your goal - stay on your program. (Remember, it may take 6-12 months or more to lower your CRP to normal, so at two months we are just looking for a trend in the right direction.) If, on the other hand, you don't see (at least) modest lowering of your CRP at two months, you will need take another look at the program options and make appropriate alterations.
Lower your CRP to the ideal level of 0.8 mg/dL or less.
Red yeast rice extract - one to two 600 mg. capsules twice daily
Coenzyme QH - one to two 50 mg. capsules daily
A daily high quality Multivitamin-mineral
Curcumin (a component of the spice turmeric) - 2-8 500 mg. phytosome capsules twice daily, or use turmeric liberally in cooking
Fish oil - one to two 1000 mg capsules once or twice daily
Flaxseed oil - 4-6 1000 mg capsules daily or one tablespoon of liquid (Barlean's brand recommended)
Vitamin E (as "mixed tocopherols") - one to three 400 IU capsules daily
Phytonutrient Complex - one or two capsules twice daily
The active ingredient in the spice, turmeric, curcumin lowers CRP. Preferable products combine generous amounts of curcumin with other anti-inflammatory herbs such as rosemary, holy basil, barberry root, green tea, ginger, Chinese goldenthread, skullcap, and Protykin. Make sure your curcumin product contains the research-proven proprietary complex of curcumin with soy phosphatidylcholine (Meriva®). (Inflammation Control, Renewal Research; 1-4 capsules twice daily.)
Red yeast rice extract - the original Chinese herb from which statin drugs were purified - provides a natural alternative to statin drugs that sidesteps toxicity by retaining the natural spectrum of ingredients. (For more about statins, see Chapter 7: Lipoproteins and The Lipid Panel,)
Even though red yeast rice extract has "yeast" in its name, it does not contain yeast or any fungus.
Used in Chinese Traditional Medicine for over a thousand years, red yeast rice extract (Hong Qu) is the original herbal statin drug. This medicinal herb is just as effective as its modern drug knockoffs, but isn't plagued by the host of dangerous side effects that accompany the use of statin drugs. Because it is a food and not a drug, red yeast rice extract displays none of the harsh, toxic effects of statin drugs.
As described in the ancient Chinese pharmacopoeia, Ben Cao Gang Mu-Dan Shi Bu Yi, published during the Ming Dynasty (1368-1644), the use of red yeast rice in China to cure heart disease and circulatory disorders was first documented in the Tang Dynasty (800 A.D.) and has been used ever since.
Red yeast rice is made by fermenting rice with Monascus purpureus, a type of red yeast (it does not contain yeast, however). In the 1950s modern drug researchers, recognizing the potential medical importance of red yeast rice extract, but realizing they couldn't make a profit selling an non-patentable Chinese herb, stripped out the single most effective molecule (discarding the crucial supporting components), and then synthesized it. The result was the orginal statin drug: lovastatin (Mevacor). Unlike the Chinese herb, the synthesized drug causes severe musculoskeletal symptoms and brain damage.
Plant medicinals (herbs) contain a spectrum of active ingredients. Isolating and purifying one patentable molecule, while tossing out the rest of the family of beneficial compounds causes the widespread and well-documented side effects and toxicity that drug medicines are famous for. Statins are no exception. Statins, the drug version of red yeast rice extract, commonly cause severe musculoskeletal symptoms including muscle cramping, rhabdomyolysis (breakdown of muscle tissue), myositis (inflammation in the muscle), and myalgia (pain in muscles). These symptoms are usually missed by the prescribing physician, who chalks them up to muscular misuse or old age. These adverse reactions are not seen in patients using red yeast rice extract.
The most ominous adverse reaction, however, is statin-associated dementia. This syndrome has been documented by several research reports in the scientific literature, and thousands of anecdotal reports. The "statin effect study," where patients on statins self-report side effects, tells us that 48% of patients on statin drugs report some degree of mental impairment. Statin-associated memory loss, difficulty concentrating, cognitive impairment, and global and partial amnesia are the dark side of statins. One might reasonably wonder are these problems ignored? The docs are thrilled to see their patients' cholesterol come down, and the pharmaceutical companies love the cash cow.
The story of Millie, one of my patients, comes to mind. MIllie had been misplacing her keys, losing track of what she was doing, getting disoriented, easily confused, and depressed. I told her about statin-associated dementia, and suggested she try going off her statin for a while. Within a week her brain started functioning again and all her symptoms went away, But then she had a cardiology appointment and when she told him what she had done and why, he fussed and fumed, called it balderdash and horsefeathers, and told her to get back on the drug. She did, but within a week, her cognitive and memory problems had returned in full force. Millie quit again, this time for good.
Take Renewal Research: 600 mg capsules. Take 1-2 capsules twice daily)
These include proanthocyanidins, flavones and polyphenols-fancy names for the plant-derived anti-inflammatory biochemicals - the medicine in food. For more information, read chapter 25, "The Phytochemical Revolution," in my book, Renewal: The Anti-Aging Revolution (Rodale Press and St. Martin's Press). Examples include pycnogenol, red grape extract (proanthocyanidins), bilberry extract (anthrocyanosides and flavonoids), green tea (polyphenols), ginkgo biloba, milk thistle, and citrus bioflavonoid complex. Phytonutrients collectively exert powerful restorative effects on blood vessels, protect the delicate endothelium from inflammatory damage, and lower CRP. Focus on products that combine numerous phytonutrients in one capsule. (e.g., Phytonutrient Complex, Renewal Research; 1-2 capsules once or twice daily).
Take the full daily recommended dose of a high quality multivitamin. The December 15, 2003 issue of The American Journal of Medicine published an article by Timothy S. Church, M.D. entitled "Reduction of C-Reactive Protein Levels Through Use of a Multivitamin." A high quality multivitamin supplement (we are not talking about the kind you get from drugstores, big box stores, and pharmacies here!) given to research subjects lowered their CRP by an average of 32%. The greatest reductions were observed in those with the highest CRP elevations.
According to a recent study published in the Journal of the American College of Nutrition, vitamin C reduces C-reactive protein levels. Researchers at the University of California, Berkeley saw a 24 percent drop in C-reactive protein (CRP) levels in participants who took 1-6 grams a day of vitamin C for two months. (Use buffered vitamin C or Ester-C - 2000-6000 mg a day.)
Researchers at Southwest Medical Center in Dallas found that vitamin E, at 1200 IU daily, reduced CRP levels by 30% in three months. When the E was discontinued, CRP rose back up to previous levels in two months. Be sure to get the "mixed tocopherols" type of vitamin E, the only kind that contains the CRP-lowering gamma-tocopherol fraction. The label should say "natural vitamin E". If the label doesn't contain the words "gamma tocopherol" (the isomer that must be present for a vitamin E product to be effective), don't purchase it. (Take three 400 IU capsules daily.)
All fish oils are not created equal! Our planet's seven seas are contaminated with evenly-distributed methylmercury; no fish or seafood escapes exposure. All fish oil products must therefore be treated to remove this mercury. Many manufacturers do not do this. Make sure your fish oil product is certified "mercury free".
Many large scale studies, including a report published in the July, 2006 issue of the American Journal of Clinical Nutrition, have confirmed the correlation between a higher intake of omega-3 fatty acids and a reduction in C-reactive protein.
Dose: Marine Lipids, Renewal Research; 1-2 - 1000 mg capsules once or twice daily.
The alpha-linolenic acid in flaxseed oil provides the raw material for our bodies to synthesize inflammation fighting prostaglandins (Barlean's brand; one tablespoon or six 1000 mg caps daily).
An important free radical scavenger and mitochondrial energy production molecule, coenzyme Q-10 protects us from the free radicals that generate CRP. Our bodies make Coenzyme Q-10 when we are young, but production drops off dramatically after age 35. Need for this important molecule increases with age, however, so supplementation is recommended at middle age and beyond. In addition, patients taking statins - including the safe statin, red yeast rice extract - are at risk of coenzyme Q-10 depletion and should take 50-100 mg daily. Use the more bioactive reduced form, Coenzyme QH. (Renewal Research; 1-2 - 50 mg capsules once or twice daily.
Low blood levels of vitamin D have been linked with high concentrations of CRP (Take 1000-5000 IU daily. It is important to test 25-hydroxyvitamin D levels to make sure you are not getting too little or too much. Ideal range is 50-100 ng/ml.)
A Harvard/Brigham and Women's Hospital examination of 11,686 women participating in the large-scale Women's Health Study showed that high magnesium intake correlates with significantly lower C-reactive protein levels. Take 400-1000 mg/day. (Magnesium may cause loose stools in some individuals.)
Studies have shown that a shortfall of this important B-complex vitamin will drive up C-reactive protein levels. P-5-P supplementation lowers CRP.
The more you exercise, the lower your CRP will be. Shoot for one hour every day. There is no way around the fact that exercise is essential if you want a healthy heart. The Centers for Disease Control and Prevention published the results of a study of 14,000 people in the journal Epidemiology in September, 2002 (Vol. 13 No. 5) showing that a vigorous daily exercise program lowers CRP. The study examined various levels of activity, and showed that leisure-time physical activity was inversely associated with C-reactive protein concentration in a dose-response manner. That means the more you exercise, the more you lower your CRP. Combine strength with aerobic training. Vary what you do. Dr. Kenneth Cooper, founder of the world-renowned Cooper Aerobic Center in Dallas, has demonstrated - in numerous research publications and in a presentation of his research results to Congress - that vigorous exercise lowers CRP.
Sugary and high carb foods dramatically increase the amount of inflammatory activity in your body and drive up your CRP. Foods with a high glycemic index will rapidly raise your blood sugar levels. These include most breads and baked goods, corn, potatoes, rice, most cold cereals, and all foods made with refined flour or added sweeteners. Avoid all sugars and sweets. Make antioxidant-rich fruit and vegetables your top food choices.
Low glycemic index foods include: all vegetables, lean meats, soy foods and tofu, beans, whole grain pasta, oatmeal, sprouted grains, whole rye bread, whole wheat pita bread, and corn tortillas. Even though you are limiting your intake to low glycemic index foods, always also try to combine equal amounts of protein and carbohydrate in any given meal. (See Chapter 11: Blood Sugar, Insulin Resistance, and The Metabolic Syndrome for information about low carb diets.)
All fatty foods, and especially saturated animal fats, cause inflammation and push up your CRP. Reduce or eliminate fatty meat consumption. Choose only the very leanest cuts of meat. Skin-free organic chicken or turkey are low fat choices. Use nonfat or low fat dairy products. Avoid fried foods.
If you are overweight, shedding some pounds will lower your CRP. Obesity is accompanied by low-grade inflammation that is linked - via higher CRP levels - to accelerated atherosclerosis and the metabolic syndrome.
Poor oral hygiene and periodontitis are associated with increased risk of cardiovascular disease. According to Paraskevas et al in a 2008 issue of the Journal of Periodontology: "There is strong evidence that plasma CRP in periodontitis is elevated compared with controls."
According to the Dean of Dentistry and Head of the School of Dental Sciences, Newcastle University (as quoted in the British Dental Journal) "There is increasing evidence that reducing the inflammatory component in the periodontal tissues does have potential systemic effects. This has been shown to improve hyperglycaemic control in diabetics ... and may be of benefit in patients suffering from coronary heart disease."
Chronic low grade periodontal infections leak bacteria into the bloodstream. This drives up your CRP and can cause infections in the coronary arteries.
The bacterium Chlamydia is frequently found in infected gums, so if you have gum disease and an elevated CRP, have your doctor test you for anti-Chlamydia antibodies (IgG, IgA, IgM). If present, this bug responds to antibiotics.
Brush after every meal, floss daily and have your teeth cleaned by a professional every three months.
DHEA is an adrenal hormone that plays a critical role in regulation of inflammation. Optimum DHEA-S (we measure the sulfate form of DHEA on testing) levels are crucial for heart health and for keeping CRP low. The only way to know if your DHEA level is low is to test your blood for DHEA-S. If levels are below normal, take a DHEA supplement. DHEA is also an important anti-aging hormone. For a thorough discussion of the importance of DHEA for slowing the aging process, please read chapter 33, "DHEA and Pregnenolone: The Anti-Aging Superhormones," in my book Renewal: The Anti-Aging Revolution (Rodale Press; St. Martin's Press). Note: the normal range for DHEA-S is 500-800 mcg/dL in men and 300-500 in women. If you are below this range, supplement with 25 mg once or twice daily and retest in two or three months to make sure your level has come up into the normal range.
Inflammation (as measured by a CRP elevation) is intimately connected to - and often seen with - fasting blood sugar elevation and the metabolic syndrome. This is because high blood sugar generates a variety of unwanted chemicals and hormones that cause inflammation.
A low carb diet and one hour of daily exercise are necessary to control insulin resistance and to reverse the metabolic syndrome.
Excess iron - beyond that needed to make adequate hemoglobin - is a free radical looking for a place to do some damage. Iron causes oxidative stress (e.g., it can oxidize LDL particles) and that raises your CRP level. High iron levels are associated with increased risk of cancer and heart disease. Test for serum iron, ferritin, and TIBC (total iron binding capacity) to determine whether you have an iron overload. Results should be within standard normal range. You can lower your elevated iron by simply donating a unit of blood.
Inflammation and/or infection anywhere in the body will raise CRP and heart disease risk. The most common places for infections are the gastrointestinal tract, urinary tract, respiratory system, skin, and gums.
* I don't recommend taking these; they are included for informational purposes only.