Q&A. Why Do I Still Have Inflammation When My CRP & ESR Are Normal?

If your blood tests are “normal”… why do you still feel inflamed?

In this Q&A Clarity Session of The Histamine Well Podcast, Joanne answers a deeply important and often overlooked question: why symptoms of inflammation can persist even when CRP and ESR markers come back normal.

Many people are told everything is “fine” based on standard blood work—yet continue to experience fatigue, brain fog, skin issues, gut dysfunction, and hormonal imbalances. This episode explains why that disconnect happens and what may actually be driving your symptoms.

CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) are commonly used markers for inflammation—but they primarily detect acute, systemic inflammation, not the chronic low-grade inflammation seen in many complex health conditions. 

In this episode, you’ll learn:

•  Why CRP and ESR can be normal despite ongoing symptoms 
•  The difference between acute vs chronic low-grade inflammation 
•  Common drivers of hidden inflammation (gut issues, histamine, mold, blood sugar imbalance, stress) 
•  How inflammation can show up as skin, neurological, hormonal, and digestive symptoms 
•  Why patients are often dismissed despite real underlying issues 

If you’ve ever been told “your labs are normal” but still don’t feel well, this episode will give you the clarity and validation you’ve been looking for.

This is essential listening for anyone dealing with:

•  Histamine intolerance 
•  Chronic inflammation 
•  Gut health issues (SIBO, candida, dysbiosis) 
•  Hormonal imbalances 
•  Unexplained symptoms despite normal blood tests 

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Transcript

0:00

Hi everyone. Today's question is, why do I still have inflammation if my CRP and ESR in blood work are normal? This is such an important question because this is where a lot of people get dismissed. Or they start doubting themselves. Because they're told your labs are normal, so everything must be fine. But their body is telling them something very different. So let's break this down. CRP and ESR are what we call inflammatory markers, that they're primarily markers of acute, systemic inflammation. So they're really good at picking up things like infections, injuries, or acute autoimmune flares. If those markers are elevated, it tells us something more obvious is going on. But here's the key. They're not very sensitive to low grade chronic inflammation. And that's the type of inflammation that most naturopaths, nutritionists, integrative doctors are seeing in clinic. It's these people with chronic low grade inflammation that have a myriad of different symptoms. It can be neurological headaches, migraines. It can actually be insomnia, brain fog. It can be skin issues, itchy skin, psoriasis, acne, eczema. It can be chronic gut issues. It can be chronic blood sugar instability. It can be things like hormonal dysregulation that show up as symptoms of inflammation. So it can be coming from gut dysfunction. Things like digestive enzyme insufficiency, gluten intolerance, other food intolerances, sibo, candida, large bowel dysbiosis. It can come from mold mycotoxins, it can come from oxalates, blood sugar instability, chronic stress and nervous system dysregulation. People don't realize that it's driving up your inflammation markers. Poor sleep can do it as well. So we often see CRP and ESR normal in our patients. And the doctors are saying You don't have inflammation. Everything is fine, but they're a bucket of inflammation and a bucket of histamine. So essentially CRP and ESR do not rule out inflammation. They just rule out a certain type of inflammation, such as acute bacterial overload or a virus. Any kind of infection or an injury or an autoimmune flare. So these are not chronic low grade inflammation, which is what our patients present with in clinic every day. So thank you for joining me. I hope you found this episode beneficial. Be sure to subscribe to the histamine well so you don't miss an episode. Leave a review and you can also share this episode with someone who could benefit. If you have any questions you'd like answered or have a topic you'd like me to discuss, please go to my website, joanne kennedy naturopathy.com, where you can provide us with that information. Until next time, take care and be well.