High Sed (Sedimentation) Rate Explained: Lab Tests, Biomarkers, and Lowering Strategies

The erythrocyte sedimentation rate (ESR), commonly known more simply as the sedimentation rate or sed rate, is a simple, non-specific marker of inflammation in the body. This test has been used for over a century to detect inflammatory conditions and monitor the effectiveness of treatments. Chronic inflammatory diseases are a leading cause of mortality worldwide, affecting nearly 60 million people in the United States alone. There is a growing need for early intervention to improve public health outcomes. Tools like the ESR test help meet this goal.

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What Is Sed Rate?

The sed rate measures the rate at which red blood cells (erythrocytes) settle at the bottom of a test tube containing anticoagulated blood over one hour. The sed rate is influenced by the presence of acute phase reactants, such as fibrinogen and C-reactive protein (CRP), which are proteins that increase in response to inflammation. When inflammation is present, these proteins cause red blood cells to clump together into chains resembling stacks of coins and settle more quickly, resulting in a higher sed rate. (40)

ESR is a nonspecific test, meaning it can indicate the presence of inflammation but cannot pinpoint the exact location or cause. Therefore, it cannot confirm or rule out a specific diagnosis on its own and should be used with other tests to do so.

Understanding High Sed Rate

Normal sed rate values vary depending on age, sex assigned at birth, and specific laboratory methods. General reference ranges are listed below:

Males younger than 50: < 15 millimeters per hour (mm/hr)
Males older than 50: < 20 mm/hr
Females younger than 50: < 20 mm/hr
Females older than 50: < 30 mm/hr
Newborns: 0-2 mm/hr
Preadolescent children: 3-13 mm/hr

A high sed rate (a value over the upper limit of normal) indicates the presence of inflammation somewhere in the body. Common causes of high sed rate include:

Autoimmune diseases
Cancer
Infections
Inflammatory arthritis, such as rheumatoid arthritis (RA)
Inflammatory bowel disease (IBD)
Vasculitis (inflammation of the blood vessels)

While the sed rate itself does not cause symptoms, the underlying condition resulting in an elevated sed rate often does. Common symptoms associated with conditions leading to a high sed rate (and reasons for which a doctor might order the test) include:

Fever
Fatigue
Weight loss
Joint pain
Muscle aches
Headache (21, 34)

Lab Tests for Sed Rate

The sed rate is a simple blood test that requires a non-fasting blood draw performed by a healthcare professional, such as a phlebotomist (21). The blood sample will be sent to a lab for analysis.

There are various methods to measure ESR. The Westergren method, developed by Swedish physician Robert Westergren in 1921, is the most commonly utilized. It involves mixing 2 milliliters (mL) of whole blood with 0.5 mL of sodium citrate solution (an anticoagulant that prevents blood clotting). This mixture is used to fill a 200 mm tube, which is positioned vertically for one hour, during which the rate at which the red blood cells settle to the bottom is measured. (31, 40)

The modified Westergren method is an adaptation of the original technique that uses ethylenediaminetetraacetic acid (EDTA) instead of sodium citrate (31).

Order ESR through Rupa Health with one of these labs:

Sedimentation Rate (ESR) by Access Med Labs
Sedimentation Rate (ESR) by Access Labcorp Draw

It is important to interpret ESR results in the context of clinical symptoms and other diagnostic tests. Factors that can falsely elevate ESR levels include:

Old age
Female sex
Pregnancy
Macrocytosis (larger-than-normal red blood cells)
Obesity
Technical factors and lab error

Elevations in ESR can also be observed in patients with kidney disease, thyroid disease, and anemia (34).

Elevations of ESR less than 100 mm/hr are classified as mild-to-moderate (5). In asymptomatic patients with mild-to-moderately elevated ESR, a conservative approach that entails remeasuring ESR in several months is reasonable. If ESR levels are still elevated upon remeasuring, consider the following diagnoses:

Rheumatoid arthritis
Anemia
Thyroid disease
Kidney disease
Infection

ESR levels higher than 100 mm/hr are considered extremely elevated and associated with serious underlying diseases, including:

Temporal arteritis (a type of vasculitis that predominantly affects the arteries of the head)
Polymyalgia rheumatica (an inflammatory disorder that causes muscle pain and stiffness, primarily in the shoulders and hips, in adults over 50)
Cancer

Additional Testing and Biomarkers

When a high sed rate is detected, additional tests are often necessary to determine the underlying cause. Complementary tests that usually are sufficient in determining the cause of disease include:

CRP: another marker of inflammation, and often elevated alongside the sed rate
Complete blood count (CBC) to check for anemia, infection, and other blood cell abnormalities.
Comprehensive metabolic panel (CMP) to assess liver and kidney function
Autoantibody tests, such as antinuclear antibody (ANA) and rheumatoid factor (RF), are used to detect autoimmune conditions.
PPD (purified protein derivative) test to screen for latent tuberculosis
Chest x-ray
Urinalysis
Serum and urine protein electrophoresis
Fecal occult blood testing (FOBT)

How to Lower Sed Rate

Lowering a high sed rate involves addressing the underlying cause of inflammation. Treatment plans should be disease-specific, but here are several practical steps and interventions that can be applied to generally reduce the inflammatory load:

Eat an Anti-Inflammatory Diet

An anti-inflammatory diet focuses on reducing inflammation in the body through nutrient-rich foods while avoiding those that can trigger inflammatory responses. Key components of this diet include consuming plenty of fruits and vegetables, whole grains, legumes, and healthy fats. Evidence suggests that adherence to the Mediterranean diet, the most well-studied anti-inflammatory diet, is associated with reduced inflammation scores and long-term risk of chronic inflammatory diseases.

Incorporating these foods into your diet can ease the transition to an anti-inflammatory way of eating:

Berries
Green leafy vegetables
Fatty fish
Extra virgin olive oil
Nuts
Seeds
Herbs and spices

Simultaneously, you should avoid eating these pro-inflammatory foods and ingredients:

Refined sugars
Artificial sweeteners
Fried foods and baked goods, which are high in trans fats
Refined carbohydrates
Processed meats
Alcohol

Lifestyle Modifications

The following lifestyle modifications have been shown to reduce chronic inflammation:

Exercise regularly
Maintain a consistent sleep schedule
Manage stress
Quit smoking
Avoid common environmental toxins found in personal care products, cleaning products, and plastic reusable containers

Supplements and Medications

Depending on the underlying condition, your doctor may prescribe anti-inflammatory supplements and medications to lower inflammation, relieve symptoms, and prevent inflammatory-mediated tissue damage. These may be disease-specific, and patients are always encouraged to consult with a healthcare provider before making any changes to their medication and/or supplement regimen. Examples include:

Nonsteroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids
Disease-modifying antirheumatic drugs (DMARDs)
Fish oil
Vitamin D
Curcumin
Boswellia