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:
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
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Key Takeaways
- A high sedimentation rate is a valuable indicator of inflammation in the body, necessitating further investigation to determine its cause.
- Through a combination of laboratory tests and clinical evaluation, healthcare providers can diagnose and treat the underlying conditions contributing to elevated sed rates.
- Managing a high sed rate involves a multifaceted approach, including dietary changes, lifestyle modifications, supplements, and medications.
- Consulting with healthcare professionals is essential for personalized care and effective management of conditions that can cause high sedimentation rates. Understanding and addressing the root causes of inflammation lowers the sed rate and improves overall health.
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