hs-CRP Results and Inflammation Questions Follow-up

Hello,

I had posted some old hs-CRP results some time ago trying to decipher if there was any link to my pain sensitivity issues, and possibly to try and mitigate possible future health concerns.

Long story short, 10 years or so ago I was tested for RA and hs-CRP was in there (flagged at 8.2mg/L, wasn’t sick and no acute injury). Doctor at the time said it was probably just from having worked out less than 24h prior (I don’t believe this is correct, but I could be wrong). Since then I eliminated dairy (which seemed to mostly prevent random eczema flare-ups), and wheat.

Was re-tested a few months ago – no acute viral infection, no particular injury – results attached. hs-CRP is >2.0mg/L, and I’m not sure how much of a risk factor this truly is for chronic illness independent of other factors. I’m not really concerned about apo-B as even when I was eating an ill-informed higher-sat fat diet with coconut oil and the like (about 23% of daily cal), my apo-B was only at 87, so it’s likely safe to assume it’s dropped significantly since changing that to <10%/day.

My main concern is trying to deal with pain symptoms. It’s not the obvious debilitating chronic pain or obvious inflammation people with severe arthritis experience, but it’s a constant and frustrating process of evaluating many activities participated in alongside potential for pain, whether having to do a short period of chainsaw work alongside workouts (after a back re-injury two years prior), or trying to play instruments for an hour while having to do some menial PC work. If I had to describe it it would seem like a poor ability to recover and a subpar resilience. It’s not constant and always present, but when it arises it seems to linger for longer than normal periods of time.

As an example, I had to sand down quite a few doors in the cold for a reno with a friend, and while I’m in significantly better overall health than he is, I ended up with what feels like tendonitis in my hands that has persisted on and off for months, reducing my ability to play piano or guitar to very short amounts of time and usually not days in a row. His hands were sore for a short period, but with zero lasting effects despite continuing to work with his hands (I also work with my hands 4 days a week doing similar work).

My lifts have frequently been disappointing given my training age, and training to reasonable RPEs is frequently mitigated by considerations for a weak link of some sort (i.e. my lower back for deadlifts, knee for squats, etc), even under the direction of superior (to myself) strength coaches in the past. I’ve also generally find it difficult to lose abdominal fat, though not sure if that’s related. I lost 10 lbs (going from 203 to 193) but lost a mere half inch on my waist, despite my protein being around 0.8g/lb bodyweight and continuing lifting and biking. Could be genetics.

Sorry for the long post, but I don’t know what route to investigate here and am starting to feel somewhat desperate. I should note I’m in Canada and it’s not only difficult to find a doctor, but also to get one to follow up and take non-catastrophic flags seriously.

Some info:
Age: 33
Weight: 192
Waist: 35.5"
BF estimate (Navy): 19%
Diet: Lean protein (quite a bit of red meat, mostly due to cost and availability, but lean overall), 5-7 servings F/V, no dairy/oats/wheat (due to sensitivity suspicions), processed food is mainly wholegrain rice cereal, 30-35g fiber/day, carbs from basmatic rice or potatoes.
Workouts: Stuck on beginner prescription phase 1 until I can get my knee stable enough to try and progress more rapidly

I should note I’ve had these issues on a variety of workout programs, on a variety of diets, at lower BF %s, and it’s been the overall “rule” for as long as I can remember. Any tips would be greatly appreciated. Not sure if inflammatory markers are related to this experience, but 2.5mg/L is considered “moderately elevated” or sufficient for “chronic” by almost any standard I can find online.

Sorry to hear about this, it certainly sounds very frustrating. As you have likely learned, hs-CRP is a very non-specific marker for inflammation. A level in the range of 2-3 is mildly elevated, but not super helpful diagnostically, nor can we assume that it is related to what you are experiencing either. It remains possible that you have some sort of rheumatic condition, as there are many others besides RA (and even RA can be “seronegative”, i.e., with negative RF/anti-CCP, although the symptoms need to be pretty classic for that diagnosis – which yours are not), although this CRP level is trivially elevated for an overt autoimmune/inflammatory disease.

Ultimately, this sort of evaluation requires an in-person physical examination, potentially X-ray imaging of affected joints, and other lab testing, typically via a Rheumatologist. And it is possible (likely, even) that all of this evaluation may come back negative/normal, raising questions about more of a fibromyalgia-type syndrome, among other things.

Given your interest in this subject I will PM you a review on CRP levels and their interpretation/application.

Also to say, in-depth questions like this are likely best handled via consultation. We are happy to try and field general questions that span medical and exercise topics, but I think very specific questions like this should start as a request for consultation. RVR, feel free to email us at support@barbellmedicine.com to schedule a consultation should you require additional discussion.

@Jordan_Feigenbaum Apologies, I was concerned it would be a bit of an obnoxious question and was hesitant about posting. Am happy to speak in generalities here, and would absolutely consider a consultation, just wanting to see if there are any obvious areas I can attempt to pursue via covered medical locally before I go the out-of-pocket route. Also just trying to understand this stuff better; the article on APRs was really informative and helpful for conceptualizing these markers as correlational rather than “causative”, per se.

@Austin_Baraki Thanks for the article link, that was quite informative. Far easier to conceptualize these markers (including vitamin D) as a result. Caution with concluding that my hs-CRP levels are specifically related to pain sounds wise, I just thought they might be worth investigating in tandem, considering some medical bodies (locally anyway) consider chronic levels of >2.0mg/L as a risk factor for heart disease. Specific to hs-CRP, I imagine the best levers to pull are to continue trying to improve overall health goals, namely figuring out consistent/adequate sleep (seems to happen somewhat infrequently) and decreasing a 19% bodyfat level.

Specific to pain, I have actually had x-rays done years ago on some joints (mid-20s), as well as an MRI on my knee when I was 17, but no abnormalities have ever come up in screening. I’ll try to pursue more covered help here if I can, and will otherwise consider a consult if I get stuck. In the meantime, I’ve heard secondhand that some of the BBM staff recommend “Curable” as an approach to helping mitigate pain, especially given the potential for some sort of somatosensory issue. Is it something you guys would recommend?

Thanks again for your generosity with your time and the resources you guys put out!

PS: In lieu of making another thread, is there a template you’d recommend that includes a solid degree of movement variability? I recall you (Austin) mentioning increase movement variability to help your own aches and pains. I’ve been stuck on the Beginner Prescription for a while due to the aforementioned issues, but am not sure what the other phases of the beginner program look like (perhaps they include this already).

It’s been a while since I’ve looked into that resource; I did mention it to a few patients when it first came out, basically as a tool that delivers pain-related education and cognitive behavioral therapy-type strategies. You may find it helpful, but if you are already very “up” on our pain-related content, it may not add a ton. Again, I don’t know the current state of that service though, it’s been a few years.

Many of the templates, including the beginner template, have user-selectable exercises, i.e., you can pick among a set of exercises for each slot.