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Low & High Sedimentation Rate + How to Lower Inflammation

Written by Joe Cohen, BS | Last updated:
Jonathan Ritter
Medically reviewed by
Jonathan Ritter, PharmD, PhD (Pharmacology) | Written by Joe Cohen, BS | Last updated:
Erythrocytes are red blood cells; Sed rate is their sedimentation rate

Erythrocyte sedimentation rate, short for sedimentation rate (or “sed rate”) is a blood test that checks for chronic inflammation. It is often called the “sickness index.” Read on to find out what low or high levels mean and which factors may help naturally reduce inflammation and ESR.

What Does High Sed Rate Mean?

Conditions Associated With High Sed Rate

The conditions we discuss here are commonly associated with high sedimentation rate test values, but this lab result is not enough for a diagnosis. Work with your doctor to discover what underlying condition might be causing your high values and to develop an appropriate plan to improve your health.

1) Polymyalgia Rheumatica

Polymyalgia rheumatica is an inflammatory condition that affects people over 50. It causes pain and stiffness in the neck, shoulders, upper arms, and hips, or pain all over the body [1, 2].

The ESR test is often used as a diagnostic tool for polymyalgia rheumatica, as high ESR levels show inflammation [3, 4].

In multiple studies on almost 900 people with polymyalgia rheumatica, most people had ESR above 30 mm/h. Only 6% to 22% of them had ESR lower than 30 mm/h [5, 6, 7, 8, 9, 10].

High ESR (> 30-40mm/h) may show polymyalgia rheumatica. Yet, normal ESR rates cannot exclude the condition and more tests should be done [7, 11, 12, 13].

2) Giant Cell/Temporal Arteritis

Temporal arteritis or giant cell arteritis is when there is inflammation of the blood vessels. It affects people over 50 and is more common among women. It can cause headaches, pain in the joints, fever, eye pain, blindness, and even stroke. It is often related to polymyalgia rheumatica [14, 15, 16, 17, 18].

One of the diagnostic criteria of temporal arteritis is when ESR is equal or higher than 50 mm/hr [16, 19, 15, 20, 21].

In multiple studies on almost 400 people with temporal arteritis, most people had ESR above 40 mm/h [22, 23, 24, 25, 26, 27].

High ESR (> 40-50mm/h) can show temporal arteritis, but ESR < 40mm/h cannot exclude the condition. Other tests, like C-reactive protein, are more sensitive in diagnosing the disease [22, 28].

A high sedimentation rate may point to various inflammatory disorders like polymyalgia rheumatica and temporal arteritis.

3) Heart Disease

In multiple studies with over 262,000 people, those with high ESR had higher chances of developing heart failure, heart attack or atherosclerosis (hardening of the arteries) compared to people with normal ESR levels [29, 30, 31, 32, 33, 34].

In multiple studies with almost 21,000 people, those with high ESR had increased risk of dying from heart disease or stroke [31, 32, 35, 36, 37].

In multiple studies with almost 500 heart disease or stroke patients, most patients had increased ESR levels [38, 39, 40].

In two studies on almost 1,000 patients who had heart surgery, people with ESR above 40 mm/h had longer periods of hospital stay and intensive unit care, and increased risk of adverse effects [41, 36].

Hig sed rates have been associated with heart disease, but further research should explore the clinical relevance of this link.

4) Cancer

In a study of almost 240,000 Swedish men, those with ESR above 15 mm/hr had a 63% higher risk of colorectal cancer compared to those with ESR of < 10 mm/hr [42].

In a study on 5,500 people, those with weight loss, anemia, and high ESR had a 50% chance of cancer. Patients with weight loss and high ESR, but not anemia, had a 33% chance of cancer [43].

In a study of almost 4,500 people, breast cancer patients had much higher ESR levels (> 35 mm/h) compared to healthy women and those with benign cancer [44].

In multiple studies with 1.2 million prostate cancer patients, those with ESR above 50 mm/h had lower survival rates and a higher risk of metastasis [45, 46, 47].

In two studies with almost 1,500 kidney cancer patients, high ESR increased the risk of death [48, 49].

In 854 Hodgkin disease patients, those with ESR above 30 mm/h had active disease and a higher risk of death [50, 51].

In 139 skin cancer patients, those with ESR higher than 22 mm/h had lower survival rates and a higher risk of metastasis [52].

In 97 patients with blood cancer (mycosis fungoides), those with high ESR levels had a 52.83% chance of surviving the disease [53].

In 220 patients with stomach cancer, men with ESR above 10mm/h and women with ESR above 20 mm/h had lower survival rates, more metastases and larger tumors [54].

In 410 patients with a type of bladder cancer (upper urinary tract urothelial carcinoma), ESR levels higher than 22 mm/h for men and 27 mm/h for women were associated with cancer progression and death [55].

Patients with skin disease (dermatomyositis) and ESR levels higher than 35 mm/h had higher chances of developing cancer [56].

In 94 patients with glioma (tumor in the brain or spinal cord), those with ESR above 15 mm/h had higher chances of dying [57].

In 42 patients with multiple myeloma, those with increased ESR had lower survival rates [58].

Patients with high ESR had lower chances of survival compared to patients with low ESR in a study on 189 lung cancer patients [59].

Several studies revealed a link between high sed rate, cancer risk, and poor cancer survival. However, the data are still inconclusive.

5) Rheumatoid Arthritis Progression

Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, stiffness, and swelling in joints. Increased ESR often suggests active RA or disease progression [60, 61, 62].

In a 25-year study on almost 1,900 rheumatoid arthritis patients, 64% of the patients had ESR levels higher than normal [63].

In multiple studies with 373 people with a 2-year study on 251 patients with rheumatoid arthritis, higher ESR levels showed worse disease status or lower treatment response [64, 65, 66].

But, in a 1-year study on 159 children with rheumatoid arthritis, the ESR levels did not relate to disease progression [67].

Evidence suggests that people with a higher sed rate are more likely to experience rheumatoid arthritis worsening, but the findings have been mixed.

6) Bone Infections & Inflammations

ESR levels higher than 70 mm/hr in adults and above 12 mm/h in children can suggest bone infections [68, 69, 70, 71].

People with diabetes and ESR above 70 mm/hr have an increased risk of developing diabetic foot osteomyelitis (bone infection) [68].

In 61 patients with an untreated foot infection, ESR levels higher than 67 mm/hr indicated osteomyelitis (bone infection) [69].

In bone inflammation (spondylodiscitis), more than 90% of the patients have ESR levels between 43 mm/h and 87 mm/hr [70].

In 259 children with limb pain, ESR above 12 mm/hr and C-reactive protein (CRP) above 7 mg/L were related to orthopedic infection [71].

In patients after hip replacement surgery, increased ESR may show joint infection [72].

In 285 patients with knee osteoarthritis, those with ESR above 20 mm/h had lower muscle strength compared to patients with normal ESR levels [73].

A decrease of ESR during treatment may show good treatment response and improvement in disease status [74].

A high sed rate may point to bone infections, but other tests are needed for diagnosis.

7) Systemic Lupus Erythematosus (SLE)

Systemic lupus erythematosus (SLE) is an autoimmune condition. It can affect joints, the nervous system, the kidneys, the skin, the heart, and the lungs. People with lupus have periods of health (remission) and periods of illness (flares) [75, 76].

In patients with active lupus, ESR is usually high. High ESR in lupus patients may indicate flares [77, 78].

In multiple studies with over 1,000 people with lupus, abnormally high ESR showed flares, infections, or disease progression [79, 80, 81, 82].

8) Sickle-Cell Disease

In two studies with 139 children with sickle-cell disease, their normal ESR levels were below 8 mm/h. ESR above 20 mm/h showed crisis or infection [83, 84].

If ESR is high (> 20 mm/h) in people with sickle-cell disease, it indicates infection or painful crisis [85, 83, 84].

9) Ulcerative Colitis

In a 7-year study on almost 241,000 healthy men, those with higher than normal ESR levels had a higher incidence of ulcerative colitis [29].

ESR above 15 mm/h may predict relapse in patients with ulcerative colitis [86].

10) Subacute Thyroiditis

Subacute thyroiditis is an inflammation of the thyroid. It causes pain and swelling of the thyroid, fever, and tiredness. In most patients with subacute thyroiditis, ESR levels are higher than 50 mm/h [87, 88, 89, 90, 91, 92, 93].

Ginger and iodine may cause subacute thyroiditis, which increases ESR [90, 93].

11) Reduced Cognitive Ability

In a study on almost 50,000 men, those with ESR above 7 mm/h had decreased cognitive abilities at age 18 – 20 [94].

In 368 stroke patients, increased ESR was related to reduced hippocampal volume (part of the brain responsible for memory) and lower cognitive abilities [95].

Higher ESR was associated with a lower IQ in a study of 638,000 men [96].

12) Schizophrenia

Higher ESR was also related to an increased risk for schizophrenia in the same study of 638,000 men [96].

Potential Benefits of High Sed Rate

1) May Increase Survival In Heart Failure

In a study of 242 people with chronic heart failure, those with high ESR levels had higher survival rates compared to patients with low or normal ESR levels [97].

2) May Increase Survival In Cancer

In a study on 300 people with prostate cancer, ESR levels between 40 – 50 mm/hr were associated with a lower risk of death [46].

Possible Causes of High Sed Rate & Inflammation

Causes shown here are commonly associated with a high sed rate (high ESR). Work with your doctor or other health care professional for an accurate diagnosis.

1) High Fibrinogen

High fibrinogen levels make the red blood cells to clot together and fall faster, thus increasing ESR levels [98].

Diets high in iron, sugar, and caffeine were related to increased fibrinogen levels in 206 people [99].

Protein, in particular, may be necessary for healthy levels of fibrinogen. Protein-deficient animals have low fibrinogen compared to their properly-nourished counterparts [100].

In a study on 16 people, a protein shake or a balanced-meal shake doubled fibrinogen levels [101].

High fibrinogen may increase sedimentation rate by making red blood cells clot together.

2) High Triglycerides (Association)

In 101 people with high cholesterol and triglycerides, most of them had higher ESR levels [102].

  • A low-fat, high-carbohydrate diet increased blood triglycerides in healthy adults [103, 104, 105, 106].
  • Low-fat, high-carbohydrate, sugar-rich diets increase the production of Very-Low-Density Lipoprotein (VLDL), and blood triglycerides [107, 108, 109].
  • Lack of exercise and sugar consumption, including fructose and glucose, can increase blood triglyceride levels [110, 111, 112].

3) Birth Control Pills

In 42 healthy women who were taking oral contraceptives, 45% of them had much higher than normal ESR levels [113].

A high sed rate has been associated with higher triglycerides and the use of birth control pills, but more studies are needed to verify these two links.

4) Alcohol Consumption

Chronic alcohol consumption can cause inflammation [114].

In a study on 250 people, people with alcoholic fatty liver disease and alcoholics had the highest ESR levels compared to the other groups [115].

Alcohol can also cause macrocytosis (large red blood cells), a condition that increases ESR [98, 116, 117].

5) Smoking

Smoking produces free radicals that increase inflammatory proteins, such as fibrinogen. This leads to increased ESR levels [118, 119].

In 550 arthritis patients, smokers had higher ESR levels and lower immunoglobulin levels, independent of their treatment or condition [120].

In 105 healthy men, smokers had higher ESR compared to non-smokers, but the number of cigarettes did not play any role in ESR [121].

Smoking and excessive alcohol drinking increase inflammation and ESR values.

6) Immunoglobins (IVIG)

High doses of immunoglobulin injections (IVIG) increased the ESR levels in 63 children with Kawasaki disease on a 7-day study [122].

In another 7-day study on 21 patients with an autoimmune disease, a high dose of immunoglobulin injections (IVIG) increased their ESR levels [123].

Factors that May Decrease Sed Rate & Inflammation

If your sedimentation rate is too high, the most important thing is to work with your doctor to find out what’s causing your high values and to treat any underlying conditions.

The additional lifestyle changes listed below are other strategies you may want to discuss with your doctor. None of them should ever be implemented in place of what your doctor recommends or prescribes!

1) Preventing Infections

Living a healthy and hygienic lifestyle can help protect the body against infections. People with infections can have a high sedimentation rate. Thus, preventing infections can help prevent increases in ESR [124, 125].

2) Exercise

Exercise can decrease inflammation [126, 127].

In two studies with over 1,000 people, light or moderate exercise decreased their ESR levels [128, 129].

In an animal study, ESR decreased more when the training intensity increased [130].

3) Diet and Nutrition

In a clinical trial on 27 people, a gluten-free vegan diet and a lacto-vegetarian diet decreased their ESR levels [131].

In another study on 23 people, a 7-day fast reduced ESR levels [132].

Fish oil decreased the ESR levels in 2 trials with 60 people [133, 134].

Vitamin A and vitamin E decreased ESR levels in rats [135].

4) Weight Loss

Losing weight can help decrease ESR [136].

Lifestyle changes that may help lower inflammation and ESR include getting regular exercise, living a healthy and hygienic lifestyle, losing weight if overweight, and eating nutritious foods.

5) Supplements

Supplements have not been approved by the FDA for medical use. Supplements generally lack solid clinical research. Regulations set manufacturing standards for them but don’t guarantee that they’re safe or effective. Speak with your doctor before supplementing.

6) Dental Hygiene

In 32 patients with gum disease, periodontal treatment decreased ESR levels after 2 months [145].

7) Drugs

In 64 patients who had surgery, their ESR levels decreased after they received propofol and thiopental (anesthetic drugs) [146].

In 2 meta-analysis studies, statin therapy decreased ESR levels in patients with rheumatoid arthritis [147, 148].

Drugs that fight inflammation and infection may also decrease ESR levels. These include:

  • Tocilizumab [149, 150]
  • Levamisole [151]
  • NSAIDs (non-steroidal anti-inflammatory drugs) [116, 152]
  • Cortisone [116, 152]

These drugs may help you lower your ESR value if you are already taking them for some other health condition, but never start taking them or increase your dose for this reason. Always follow the treatment plan prescribed by your doctor.

Diseases Associated With Low Sed Rate

The conditions we discuss here are commonly associated with low ESR test values, but this single symptom is not enough for a diagnosis. Work with your doctor to discover what underlying condition might be causing your unusually low value in this test and to develop an appropriate plan to improve your health.

1) Sickle-Cell Anemia

Sickle-cell anemia is a genetic blood disorder. People with sickle-cell anemia have abnormal hemoglobin (sickle hemoglobin), making their red blood cells crescent-shaped. These cells block blood flow in the vessels and die faster than normal red blood cells, which causes low hematocrit levels [153].

The deformed sickle cells fall down more slowly. Hence, people with sickle-cell anemia usually have low ESR levels (< 5 mm/hr) [154, 155, 156, 83].

In a study on 44 children with sickle-cell disease, their average ESR levels were 7.9 mm/hr when they were healthy [84].

2) Red Blood Cells Abnormalities

Red blood cells that have different shapes or sizes decrease the sedimentation (falling) rate. These conditions include [98, 116, 152, 157]:

  • Spherocytosis (red blood cells are shaped like circles)
  • Polycythemia (increased production of red blood cells)
  • Acanthocytosis (red blood cells with spikes)
  • Anisocytosis (red blood cells of unequal size)
  • Microcytosis (very small red blood cells)

3) Extreme Leukocytosis

Leukocytosis is a condition in which the body produces a high amount of white blood cells, which decreases the ESR [158, 98, 116, 152, 157].

4) Low Fibrinogen

High fibrinogen levels make the red blood cells clot together and fall faster, which increases ESR levels [98].

In hypofibrinogenemia, on the other hand, the body produces less fibrinogen than normal, which decreases ESR [98, 116, 152, 157].

Various blood cell disorders, including sickle cell anemia, may decrease sed rate. Work with your doctor for an accurate diagnosis.

Potential Benefits of Low Sed Rate

May Predict Cancer Survival

In a study on 220 people with stomach cancer, men with ESR lower than 10mm/hr and women with ESR lower than 20 mm/hr had higher survival rates [54].

Limitations and Caveats

While there are many studies examining sedimentation rate, almost all of them are population-based, which means they can associate high or low values with certain conditions but not establish them as their cause. Additional limitations of some of these studies include being based on older data or only conducted with men.

More clinical trials investigating sedimentation rate should be undertaken.


The erythrocyte sedimentation rate (ESR) test or “sed rate test” is a blood test that mainly checks for chronic inflammation. High levels may be used to diagnose or screen for specific conditions.

However, this test is not sensitive or specific. It is often ordered along with other labs.

A high sed rate may point to various inflammatory disorders like polymyalgia rheumatica, temporal arteritis, and others.

Factors that may help lower inflammation and ESR include engaging in regular exercise, living a healthy and hygienic lifestyle, losing weight if overweight, and eating nutritious foods.

A low sedimentation rate is often normal. In some cases, it may point to blood cell disorders. The most important step is to see your doctor to get adequate diagnosis and treatment.

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About the Author

Joe Cohen, BS

Joe Cohen, BS

Joe Cohen flipped the script on conventional and alternative medicine… and it worked. Growing up, he suffered from inflammation, brain fog, fatigue, digestive problems, insomnia, anxiety, and other issues that were poorly understood in traditional healthcare. Frustrated by the lack of good information and tools, Joe decided to embark on a learning journey to decode his DNA and track his biomarkers in search of better health. Through this personalized approach, he discovered his genetic weaknesses and was able to optimize his health 10X better than he ever thought was possible. Based on his own health success, he went on to found SelfDecode, the world’s first direct-to-consumer DNA analyzer & precision health tool that utilizes AI-driven polygenic risk scoring to produce accurate insights and health recommendations. Today, SelfDecode has helped over 100,000 people understand how to get healthier using their DNA and labs.
Joe is a thriving entrepreneur, with a mission is to empower people to take advantage of the precision health revolution and uncover insights from their DNA and biomarkers so that we can all feel great all of the time. 


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