Would be interesting to see how CPK fits into this and perhaps the lag between elevated levels of this and any depression like feelings. You would think that endurance athletes doing hard x long training would be more susceptible to this type of scenario (then again, power athletes would be too). I'd think that cortisol levels would have a greater link to depression type feelings?

Not something I specifically look at very much, but generally when I've seen studies talking about these sorts of things it's C-reactive Protein that is used.

Interesting. A few years ago wasn't C-reactive Protein supposed to be a new miracle predictor of heart attacks?

Interesting question. Not sure if this is helpful but I found it interesting...

http://www.alzforum.org/news/conference-coverage/systemic-inflammation-driver-neurodegenerative-disease

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Coach at KonaCoach Multisport

I'm not as familiar with the alzheimers and depression literature but I know a little about aging and inflammation. A lot of these studies in people use circulating markers of inflammation, CRP, TNFalpha, IL-6 etc. This makes sense of course because its harder to do invasive studies in people. In my mind the big question is the role of local (ie in the brain or blood vessel or muscle or whatever) vs. systemic (whole body) inflammation. Also an important question is the contributions of inflammatory signals from tissues that recruit immune cells vs. the inflammatory immune cells themselves. Another interesting question is the role of exercise, exercise is a short term inflammatory stimulus but in the long term appears to reduce inflammation. This is something I spend a fair amount of time thinking about. I realize I didn't give you too many solid answers and mostly just hand waved. To tell the truth, the more you dive into the mechanisms behind established autoimmune (inflammatory) diseases for example type 1 diabetes or rheumatoid arthritis we know a lot but we still don't know what really causes the immune system to go haywire.

My knowledge is somewhat limited (infectious disease) as I only use CRP or ESR in my practice to track inflammatory process due to infection. CRP and ESR are the most commonly tested. There's also hs-CRP, which is more cardiac specific and used during situations like with a heart attack. CPK is used to detect muscle break down and not so much inflammation.

There are many inflammatory/pro-inflammatory markers beyond the ones mentioned above. Here's one paper on alzheimer's and another on depression and the multiple markers they used.

Thanks. Those links are great.

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"Non est ad astra mollis e terris via." - Seneca | rappstar.com | FB - Rappstar Racing | IG - @jordanrapp

Yes, good links.

As a cardiologist, I'll focus on the way I use 'inflammatory' markers in my practice. (And I almost never cite papers, as they are usually over my patient's head and I try to talk to them like I was talking to family). I won't comment on depression or alzheimer's ds. Thde CRP data is old and has been known for quite a while.

HR-CRP is used to help decide if someone was on the verge of needing drug therapy for an elevated cholesterol. We really use a lot of risk markers and 10 and 20 yr scores of risk, to determine how aggressive we should treat certain numbers like LDL cholesterol numbers that are a bit high and not at goal. BP is pretty easy to measure and decide on treatment, but lipids...well, that always causes some ire with some, especially those who believe in drug company conspiracy theories. (I'll stay off the pedestal and not quote studies on lipid treatment and it's usefulness overall in lowering the incidence of heart disease for years now).

http://www.ncbi.nlm.nih.gov/pubmed/22010105

These markers are not useful when the body is actively fighting inflammation of some sort. So, a elevated HR-CRP may be so high that it can't be used as a marker for heart related risk, just a sign of infection/inflammation happening. But if only slightly elevated (to numbers that are indicated by the lab) and someone has a few risk factors for heart disease and a somewhat elevated long term cardiac risk, it may sway a doctor to advising drug Rx for the borderline high LDL. CRP is not used as a marker of a heart attack, just a marker of possible elevated cardiac risk.

CK, as noted, is a measure of muscle enzyme and is not helpful in determining long term heart risk. It was used in the past to diagnose acute MI (heart attacks) but we now have much more sensitive biomarkers like troponin.

As always, talk to your doctor, Rappstar. You should know your numbers and what they mean to you in terms of risk (BP, cholesterol-especially LDL, weight (HA-like triathlete's don't know their weight/BMI!), and blood sugar).

Good luck.
Dale (aka D. Toce MD FACC)

Inflammation increases with long and/or hard workouts. Cortisol, histamine release etc..... This is where good hydration and rest/recovery after these workouts helps. During extreme workouts and races free radicals can do damage to tissues. I eat tons of fruits and veggies during my hardest blocks of training and this seems to help control inflammation to some extent. In particular watermelon. I put one in the fridge and after a hard workout, I'll chug down 20 oz. of chocolate milk then eat half a watermelon. In the watermelon I'm getting tons of water, natural sugars, and lots of antioxidants ( has more lycopene than tomatoes)

Oh and yes CK is a measure ....a marker of damage to muscles. Not specific to cardiac. Troponin is a measure specific to cardiac tissue damage. You do not want this level going up over .04.

Total CK is not specific to cardiac, correct. However, CK has three specific isozymes - CK-MM which is specific to muscle, CK-MB which is specific for the heart, and CK-BB which is specific for the brain. As DToce pointed out, despite being relatively simple (i.e. assay after blood draw) and inexpensive, the measure of total CK is no longer considered sensitive enough for use in assessing cardiac damage as other more sensitive proteins are now used. The CK-MB isozyme, while highly specific for cardiac tissue, requires a longer and more expensive test (e.g. electorphoresis / Western blotting).

As others have mentioned, CK is not an accurate marker of inflammation but total CK is often used as a 'catch all' for indirectly assessing skeletal muscle damage, despite several caveats.

Rapp,

Why are you asking? Are you wondering about the effects of exercise on inflammation and then the inflammation setting an individual up for the outcomes? It is important to realize that measurements of inflammation are not patient centered outcomes.

The association of exercise with patient centered outcomes have almost all been beneficial. For example exercise reduces depression, exercise reduces alzheimer's and exercise reduces cardiovascular risk IN SPITE of the fact that exercise may increase inflammation. Here's the catch though it is quite possible (I would argue definitive) that exercise does not have a linear relationship with positive health outcomes. It probably has an inverted u relationship something like below as opposed to the dashed line.



Here is where things become an issue. Most of the population does not and will never exercise as the participants on this forum. Most of the participants on this forum will not exercise as much as you, Rapp. So what are the effects of the amount of exercise going to be on you? The answer is that there is no answer.

Can you see this? http://www.sciencedirect.com/...ii/S1474442215700165 (Heneka MT, Carson MJ, Khoury J El, et al. Neuroinflammation in Alzheimer’s disease. Lancet Neurol. 2015;14:388–405). Seems like a recent thorough review.

I am asking not for me in any specific way. Just trying to understand the larger picture of what it means to be "healthy," simply because I'm interested...

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"Non est ad astra mollis e terris via." - Seneca | rappstar.com | FB - Rappstar Racing | IG - @jordanrapp