DEPRESSION and INFLAMMATION - Research and Differential Diagnosis

CRP C-reactive protein is an acute phase protein that is part of the inflammatory process. Many studies show that an elevated CRP is linked to depression in a wide range of patients. It also seems to be an effective biomarker for predicting both morbidity and mortality in a number of conditions.

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I have been recommending CRP testing for over 21 years as an important biomarker of silent inflammation and am surprised that it has not been more readily embraced in this country. Many Doctors explained their reluctance due to its lack of specificity. Interpreting an elevated CRP, in relationship to CBC, ESR, screens for infection. Albumin has traditionally been considered a marker of malnutrition, yet when globulins are fairly normal it is a biomarker for inflammation. Low albumin levels in relation to globulins along with an elevated CRP, seems to be a strong predictor of morbidity and mortality in a number of conditions.

Also, in patients with kidney problems HCO3 levels can help to interpret CRP and the risk of future adverse events. These biomarkers provide a prognostic capability independent of GFR to refine the analysis of risk in kidney patients.

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A number of papers identify that obesity, smoking and various dietary patterns upregulate CRP independently of other factors. Poor dietary choices increase obesity and inflammation. Diet alone can initiate the inflammatory cascade that leads to atherosclerosis. Initially, this low level inflammation causes a sympathetic increase in systolic pressure and over time, an increase in diastolic pressure.

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Removing the dietary and lifestyle causes of an elevated CRP is critical. Restricting: arachidonic acid (animal fats), trans fats, omega 6 oils, along with a diet high in phytonutrients (fruits and vegetables) and omega 3 oils seems to be valuable in reducing CRP levels. Also, natural anti-inflammatories like curcumin and proanthocyanidins have shown benefit.

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• http://jop.sagepub.com/content/26/12/1512.abstract

The initial presentation of a dietary induced upregulation of CRP is lethargy, malaise or depression. The compensatory increase in cortisol increases abdominal fat and contributes to insulin insensitivity. So even if your patient is just overweight, tired and depressed get a CRP.

Dr. Fleming was on 20/20 and has a great video link that I put on my twitter feed to show doctors the importance of CRP testing in cardiovascular disease.

https://twitter.com/GilBatio