C Reactive Protein level reduction with natural foods, diet, vitamins, herbs, omega-3 fatty acids, and supplements by Ray Sahelian, M.D.
Role in heart disease and testing of blood levels
. See prior issues here newsletter 2008.

C-reactive protein (CRP) is an inflammatory biomarker. Based on the results of several prospective epidemiologic studies, it has emerged as one of the most powerful predictors of cardiovascular disease. This marker provides valuable information to clinicians in various clinical settings, ranging from overt cardiovascular disease, stable angina, presenting acute coronary syndromes and peripheral vascular disease, to the metabolic syndrome. Furthermore, elevated C-reactive protein levels are a marker to all stages of atherogenesis (hardening of the arteries), endothelial dysfunction, atherosclerotic-plaque formation, plaque maturation, plaque destabilization and eventual rupture. High levels of this compound may be a sign of a future risk for heart attacks, stroke and cancer, though it does not seem to be a direct cause. Those with depression are often found to have higher levels.
   Levels of C-reactive protein can be decreased by increasing consumption of fruits and vegetables and by taking certain supplements such as vitamin C.

How to Lower elevated C Reactive Protein level with diet and supplements
Eating more fresh fruits and vegetables is a safe and reliable way to decrease levels. Foods high in fiber lower C reactive protein. Higher intake of n–3 polyunsaturated fatty acids from marine or fish is inversely associated with serum C-reactive protein (CRP) concentrations. Therefore, eating more fish or perhaps taking fish oil capsules can reduce C reactive protein levels. Taking certain antioxidants, such as vitamin C, lowers CRP levels.
   Consuming dark chocolate can reduce c reactive protein levels. Taking a cacao supplement will likely have a similar effect. See cacao for more information. Vitamin C can help lower levels of C reactive protein.

Research study, diet and food
A 4-wk intervention with high intake of carotenoid-rich vegetables and fruit reduces high C-reactive protein in healthy, nonsmoking men.
American Journal of Clinical Nutrition 2005
We investigated the effects of low, medium, and high intakes of vegetables and fruit on markers of immune functions, including nonspecific markers of inflammation. In a randomized controlled trial, nonsmoking men consumed a diet that included ?2 servings/d of vegetables and fruit for 4 wk. The subjects were then randomly assigned to 1 of 3 groups to consume 2 servings/d, 5 servings/d, or 8 servings/d of carotenoid-rich vegetables and fruit for another 4-wk period. Plasma concentrations of vitamins C and E and carotenoids were measured. The assessment of immunologic and inflammatory markers included the number and activity of natural killer cells, secretion of cytokines, lymphocyte proliferation, and plasma C-reactive protein concentrations.  The high intake (8 servings/d) of vegetables and fruit significantly increased total carotenoid concentrations in plasma compared with the low intake (2 servings/d; week 4 compared with week 8), whereas concentrations of vitamins C and E did not differ between week 4 and week 8. Immunologic markers were not significantly modulated. In contrast, C-reactive protein was significantly reduced at week 8 in the subjects who consumed 8 servings/d of vegetables and fruit compared with those who consumed 2 servings/d. In healthy, well-nourished, nonsmoking men, 4 wk of low or high intakes of carotenoid-rich vegetables and fruit did not affect markers of immune function. However, a high intake of vegetables and fruit may reduce inflammatory processes, as indicated by the reduction of plasma C-reactive protein.

Fruit and vegetable intakes, C-reactive protein, and the metabolic syndrome1,2,3
American Journal of Clinical Nutrition 2006. Ahmad Esmaillzadeh, Masoud Kimiagar, Leila Azadbakht. 1 From the Department of Human Nutrition, School of Nutrition and Food Science (AE, MK, and LA), and the School of Public Health (YM), Shaheed Beheshti University of Medical Sciences, Tehran, Iran, and the Departments of Nutrition (AE, LA, FBH, and WCW) and Epidemiology (FBH and WCW), Harvard School of Public Health, Boston, MA
We evaluated the relation between fruit and vegetable intakes and C-reactive protein (CRP) concentrations and the prevalence of the metabolic syndrome. Our findings indicate higher intakes of fruit and vegetables are associated with a lower risk of the metabolic syndrome; the lower risk may be the result of lower CRP concentrations. These findings support current dietary recommendations to increase daily intakes of fruit and vegetables as a primary preventive measure against cardiovascular disease.

Fiber and C Reactive Protein
In a study of 524 healthy adults, investigators found that those with the highest fiber intake had lower blood levels of C-reactive protein CRP than those who ate the least fiber. The findings support the general recommendation that adults get 20 to 35 grams of fiber per day in the form of fruits, vegetables, beans and whole grains. It's not clear why fiber may reduce inflammation, but it may lower cholesterol and blood sugar, both of which can contribute to inflammation. Both of the main forms of fiber, soluble and insoluble, were related to lower CRP levels. Soluble fiber is found in foods like oatmeal, beans, berries and apples, while whole grains and many vegetables are good sources of insoluble fiber. American Journal of Clinical Nutrition, 2006.

Flavonoids
intake of dietary flavonoids is inversely associated with serum c reactive protein concentrations in U.S. adults. Intake of flavonoid-rich foods reduces inflammation-mediated chronic diseases.

C Reactive Protein and Mediterranean Diet
Sticking to a Mediterranean diet, high in fruits and vegetables and low in saturated fats, lowers levels of inflammation as reflected by lower levels of C-reactive protein. This effect should, in turn, lead to a lower risk of cardiovascular disease that has been associated with this type of diet.

Healthy bacteria
Ann Nutr Metab. 2013. Effect of Multispecies Probiotic Supplements on Metabolic Profiles, hs-CRP, and Oxidative Stress in Patients with Type 2 Diabetes. Multispecies probiotic supplementation, compared with placebo, for 8 weeks in diabetic patients prevented a rise in FPG fasting blood glucose and resulted in a decrease in serum hs-CRP and an increase in plasma total GSH.

Lower C Reactive Protein with vitamin C supplements
Vitamin C treatment reduces elevated C-reactive protein.
Free Radic Biol Med. 2008. Block G, Jensen CD, Dalvi TB, Norkus EP. University of California, Berkeley, CA, USA.
We investigated whether vitamin C or E could reduce CRP. Healthy nonsmokers were randomized to three groups, 1000 mg/day vitamin C, 800 IU/day vitamin E, or placebo, for 2 months. Median baseline CRP was low, 0.85 mg/L. No treatment effect was seen when all participants were included. However, a significant interaction was found, indicating that treatment effect depends on baseline CRP concentration. Among participants with CRP indicative of elevated cardiovascular risk (>/=1.0 mg/L), vitamin C reduced the median CRP by 25% vs placebo. These effects are similar to those of statins. The vitamin E effect was not significant. In summary, treatment with vitamin C but not vitamin E significantly reduced CRP among individuals with CRP >/=1.0 mg/L. Among the obese, 75% had CRP >/=1.0 mg/L.

Omega-3 fatty acids, fish oils
An inverse relationship between plasma n-3 fatty acids and C-reactive protein in healthy individuals.
European Journal of Clinical Nutrition 2009. Nutraceuticals Research Group, School of Biomedical Sciences, The University of Newcastle, Callaghan, New South Wales, Australia.
High sensitivity C-reactive protein (hs-CRP) is a marker of low-grade sustained inflammation. Omega-3 (n-3) fatty acids have anti-inflammatory properties and are associated with reduced cardiovascular disease risk. The aim of this study was to investigate whether plasma n-3 fatty acid concentration is related to hs-CRP concentration. A total of 124 free-living adults, were divided into tertiles of plasma hs-CRP. Plasma hs-CRP concentration was negatively correlated with total n-3 fatty acids, eicosapentaenoic acid (EPA) and docosapentaenoic acid (DPA). The highest hs-CRP tertile had significantly lower concentrations of total n-3 fatty acids, EPA and DPA, when compared with the other tertiles. This study provides evidence that in healthy individuals, plasma n-3 fatty acid concentration is inversely related to hs-CRP concentration, a surrogate marker of CVD risk.

Eating Fish
Effect of a sardine supplement on C-reactive protein in patients receiving hemodialysis.
J Ren Nutr. 2007. Dietetics-Higher School of Health Technologies, Lisbon, Portugal.
The study evaluated the effect of a canned sardine supplement in C-reactive protein in patients on hemodialysis (HD) and the compliance and adherence to this supplement.  This was a quasi-experimental study: Participants with a serum CRP of 5 mg/dL or less volunteered to consume a sardine supplement or were maintained on the usual cheese ham sandwich supplement. The study comprised 63 patients receiving maintenance HD three times per week for at least 6 months and an initial CRP concentration of 5 mg/dL or less. After a 4-week washout period, the nutritional intervention included a canned sardine sandwich for the case group (n = 31) and a cheese or ham sandwich for the control group (n = 32), to be ingested during each routine HD session, 3 times per week, for 8 weeks. Only 65 patients from the invited 186 patients met the inclusion criteria and agreed to eat the sardine sandwich supplement three times per week and were involved in the study. A significant proportion of 48% consumed the sardine sandwich supplement three times per week for 8 weeks, fulfilling the requirements and completing the study. The present investigation showed that a sardine sandwich supplement had no effect on CRP levels among patients on HD. However, when participants were stratified according to tertiles of CRP distribution values at baseline, a reduction in CRP levels was found for those in the higher tertile, being higher for the case group. Although diabetic patients were excluded from the analysis (eight in the sardine supplementation group and seven in the control group) a significant CRP reduction was found. Although a supplement of low-dose n-3 long-chain polyunsaturated fatty acids had no effect on the plasma high-sensitivity CRP of the supplemented group, a reduction in CRP levels was found when patients were stratified for tertiles of CRP (for the upper tertile) and diabetic status (for nondiabetic patients).
   Comments: The study may have provided clearer results if the sardine was consumed daily in larger amounts and without white bread. The study does not mention whether the sardine was packed in oil or mustard or tomato paste.

C Reactive Protein and Hypertension
For young adults in their 30s, the blood test for C-reactive protein (CRP), which is linked to inflammation, is unlikely to predict the future risk of high blood pressure. There is increasing evidence that inflammation is related to high blood pressure, and the presence of CRP often indicates low-level ongoing inflammation. In a previous study of women in their 50s, raised CRP levels, as a marker of inflammation, predicted the development of high blood pressure, independent of other risk factors such as obesity. But it appears that in a younger group of individuals, mainly black and white people in their 30s, would C-reactive protein does not independently predict hypertension. Therefore, CRP blood test is not necessary to do in one's 30s solely to determine future blood pressure risk.

Rhematoid arthritis and CRP
Increased blood levels of C-reactive protein (CRP), a marker for inflammation, are seen long before symptoms of rheumatoid arthritis appear.

Pregnancy
Women who have very high levels of the inflammatory marker C-reactive protein early in pregnancy run the risk of delivering before term.

C reactive protein blood test
A simple blood test for C-reactive protein CRP can be done at the same time as a cholesterol screening. The high-sensitivity C-reactive protein (hs-CRP) test, helps determine heart disease risk and is widely available. It is important to remember that the usefulness of knowing hs-CRP levels in a particular individual is still unknown. For the time being, The American Heart Association recommends C-reactive protein testing as part of routine screening for those who are at intermediate risk for heart disease. HS-CRP results in that risk group can help the physician determine additional testing and treatment. The American Heart Association adds that patients at low risk probably do not need their C-reactive protein tested and those at high risk should be treated aggressively regardless of their CRP test results.
   Measuring C-reactive protein helps identify people with heart disease, but there is no reason to think that elevated levels of the substance itself cause heart problems.
 

Questions
Q. Do CoQ10 and Lipoic acid supplements reduce c reactive protein levels?
     A. I am not sure, I have not seen such as alpha lipoic acid studies yet but vitamin C does appear to reduce C reactive protein levels, so does cacao.

Q. Hello, I was wondering if Dr. Sahelian knew of any supplement that managed C-reactive proteins levels in the body. From what I understand C-reactive proteins are strong contributors to heart attacks and strokes.
   A. Rather than focusing on one blood study such as c reactive protein, cholesterol, homocysteine, and others, it is important to take a more comprehensive approach. There are many inflammatory substances in the body that influence heart disease and a comprehensive dietary and supplement approach, along with exercise, will lead to better prevention and healing. See the link for heart disease at the top of the page.

Q. The Crestor study in 2008 showed benefit in those with elevated c-reactive protein. Aspirin is also especially effective in that group, as I understand it. One thing that should be discussed is why this study did not include an arm taking 81 or 162 mg a day aspirin and no Crestor. The study might then have shown an equivalent or greater reduction in cardiac / stroke events in the aspirin arm. (There also could have been a Crestor plus aspirin arm.) Of course, natural products could be tested in the same way.

Q. Can you tell me about resolvins and how they interact with CRP.
   A. See resolvins for more information.

A recent test showed a high level of c reactive protein. Are there supplements that would lower it?
    Rather than focusing on specific supplements that lower it, one should try to lower overall inflammation through several lifestyle and diet changes. Supplements are used when all other methods do not show an adequate response.

Can you recommend anything I can take in a natural substance that would lower my C - Reactive Protein level. In my recent blood test I had a reading of 11.7 mg/L, the range is 0.00 - 3.00 mg/L and its been that way for the past several test. The blood test I got were through Life Extention and blood draw from Lab Corp. Any help you can offer will be very much appreciated as I have confidence in your recommendation and the product you sell.
    It is often a good idea to have a test done at a different lab to confirm. The information on this website may be of benefit to you.

I truly enjoy reading your material and agree fully with your advise and direction. Can you perhaps advise as to how can one reduce the lpa and C- Reactive. Your thoughts would be much appreciated.
    The best option is to eat a low inflammatory diet consisting of fish, whole grains, lots of vegetables, and some fruit. Fish oils are helpful.

Your article on high levels of CRP is extremely informing and I sincerely thank you for putting this on line. We have been monitoring my CRP for over a year. It was initially 45, then in the 20s, then 17. I have been taking fish oil and Vitamin C and am anxious to see if it has gone down (blood was taken today for HS-CRP). Your article provides food for thought, and I need that information, since my primary care physician doesn’t seem too concerned. Update: I had another HS-CRP test done in March 2010 and the result is 1.2! From what I have read, that is normal and almost puts me in the low risk category. Apparently my daily dose of 1000 mg fish oil and 2000 mg Vitamin C has made a difference. Too bad the doctor didn’t recommend that; I had to read it on line!