Almost every chronic disease I read in my practice has an inflammatory layer. Cardiovascular disease is an inflammatory disease. Type 2 diabetes is an inflammatory disease. Autoimmunity, mood disorders, and cognitive decline all have inflammatory components.
The strange part: most patients have never had inflammation measured. They have had cholesterol checked, thyroid checked, maybe a basic metabolic panel run. The inflammation question gets skipped because there is no symptom code for low-grade chronic inflammation and most physicians are not in the habit of looking for it.
I look for it on every patient. The pattern usually changes the plan.
What I read
Five inflammation markers do most of the work.
- hsCRP (high-sensitivity C-reactive protein). The most common screen. Optimal is under 1.0 mg/L. Most adults I test run between 1 and 5, which is the chronic low-grade range. Above 3 is genuinely elevated and warrants a workup. Above 10 suggests an acute process and a different evaluation.
- Homocysteine. An indirect inflammation marker that also reads methylation status. Optimal is under 7 to 8 micromol/L. Elevated values predict cardiovascular and cognitive risk independently of cholesterol.
- IL-6. A cytokine driver of the inflammatory cascade. Useful when hsCRP is elevated and the source is unclear.
- Fibrinogen. An acute-phase reactant. Elevated values point to a chronic inflammatory load that is hardening clotting risk.
- Oxidative stress markers (8-OHdG, F2-isoprostanes). The downstream signature of cellular damage from inflammation. Surface them on a metabolomics panel.
A single elevated marker is a clue. A pattern across three or four of them is a case.
Why standard panels miss this
Standard panels measure structural damage after it has happened. Cholesterol shows a problem in the lipid system. ALT and AST show liver damage. Glucose shows pancreatic strain. Inflammation markers show the system that produces the damage, which is upstream.
The implication is practical: if you wait for structural markers to move, you have waited for years of inflammatory drive to do its work. The earlier window is where the disease is most modifiable, and that window is opened by reading inflammation directly.
What drives chronic low-grade inflammation
Most chronic inflammation in modern adults is downstream of a handful of inputs:
- Visceral fat. Active hormonal tissue that produces inflammatory cytokines continuously. Body composition matters here, not BMI.
- Insulin resistance. Coupled with inflammation in a vicious cycle. Each makes the other worse.
- Gut dysbiosis. A leaky or inflamed gut leaks bacterial fragments into circulation that the immune system reads as foreign. The result is systemic inflammation with no obvious source.
- Poor sleep. Sleep is when the inflammatory load resets. Sleep debt drives baseline inflammation up measurably.
- Chronic stress. Cortisol dysregulation drives a specific inflammatory pattern.
- Diet. Ultra-processed food, refined seed oils, and excess alcohol drive inflammation. A Mediterranean-style pattern reduces it.
- Environmental load. Smoking, air pollution, certain pesticides, mold exposure. The exposome shows up in the inflammation panel.
What moves the markers
The inflammation panel is responsive. Most patients who make the underlying changes see hsCRP fall by 30 to 50 percent in eight to twelve weeks.
The biggest single levers are sleep, strength training, addressing visceral fat, and reducing ultra-processed food. When those are in place and the markers are still elevated, the case usually has a gut, hormonal, or environmental layer that needs a deeper workup.
When I bring this into a plan
I bring inflammation reading into every new patient. The pattern tells me whether the case is primarily metabolic, primarily gut, primarily exposomic, or primarily lifestyle-driven. The next panel I order depends on which.
If you have done the lifestyle work and feel like something is still smoldering, the inflammation layer is often where the answer is. The path in is the Precision Call. I will tell you what I see and what I would test next.
