The erythrocyte sedimentation rate, commonly called ESR, is one of the oldest blood tests still used to track inflammation in the body. It often appears in lab reports for people with polymyalgia rheumatica, rheumatoid arthritis, infections, and other inflammatory conditions.
Because ESR is frequently monitored, many people naturally ask how to reduce it. The more useful question is what ESR actually reflects, why it rises, and which changes tend to move it over time in a meaningful way. ESR itself is not something to treat directly. It is a signal, not a target.
This article explains what ESR measures, the many reasons it can be elevated, and what reliably influences it over weeks and months. The aim is understanding and context, not chasing a number.
What ESR Measures and What It Does Not
ESR measures how quickly red blood cells settle to the bottom of a test tube over a fixed period of time. When inflammation is present, certain proteins in the blood increase and cause red blood cells to clump together and sink more rapidly. The faster they fall, the higher the ESR reading.
Because this process is indirect, ESR is considered a nonspecific marker. It does not point to a single disease, and it cannot diagnose a condition on its own. Some people with active inflammatory disease have normal ESR values, while others without serious illness may have mildly elevated results.
For clinicians, ESR is one piece of a larger picture that includes symptoms, physical findings, and other tests.
Common Reasons ESR Is Elevated
Inflammation is the most common reason ESR rises, particularly in autoimmune conditions such as polymyalgia rheumatica or rheumatoid arthritis. Infections, whether acute or chronic, can also drive elevations, as can certain cancers and inflammatory injuries.
Non-inflammatory factors play an important role as well. Anemia, especially iron-deficiency anemia, can raise ESR because changes in red blood cell number and shape affect how sedimentation appears. Pregnancy, older age, and female sex are all associated with higher baseline ESR values.
Long-standing metabolic stress, including obesity, may contribute to low-grade inflammation that nudges ESR upward over time. Medications do not correct ESR directly, but drugs that suppress inflammation often lower ESR as a secondary effect.
Why Lowering ESR Directly Is Not the Goal
ESR reflects what is happening in the body rather than causing it. Trying to lower ESR without addressing the underlying reason rarely leads to lasting improvement.
In inflammatory diseases, ESR falls when inflammation settles. In infections, it improves as the infection resolves. In anemia, it often normalizes once blood counts recover. Treating ESR itself, rather than the cause, usually leads to frustration and unnecessary concern over lab numbers.
For this reason, clinicians focus on symptoms and function first, using ESR to support — not override — clinical judgment.
What Actually Influences ESR Over Time
ESR changes slowly compared with some other inflammatory markers. Understanding what tends to influence it helps set realistic expectations.
Treating the Underlying Condition
The most reliable way ESR decreases is when the condition driving inflammation comes under control. In PMR, this usually means symptoms improve and stiffness lessens as treatment takes effect. ESR often follows this trend, though it may lag behind symptom relief.
If symptoms are improving but ESR remains mildly elevated, clinicians often monitor trends rather than reacting to a single value. Stability over time can be just as informative as a return to the reference range.
Lifestyle Factors That Shape Inflammatory Tone
Lifestyle factors do not override inflammatory disease, but they influence background inflammatory signaling. Poor sleep, chronic stress, and prolonged inactivity are associated with higher inflammatory markers in population studies.
Regular, moderate movement, consistent sleep routines, and stress-regulation practices can support overall immune balance. These changes tend to work gradually and subtly, shaping long-term trends rather than producing rapid drops in ESR.
Eating Patterns and Blood Health
No specific food or diet reliably lowers ESR on its own. However, eating patterns that support cardiovascular and metabolic health are often associated with lower inflammatory markers overall.
Balanced, plant-forward diets with adequate protein support both immune regulation and muscle preservation. Blood health is particularly important: when anemia is present, correcting iron, vitamin B12, or folate deficiencies can indirectly normalize ESR by restoring normal red blood cell behavior.
Dental, Gut, and Infection-Related Factors
Chronic low-grade infections can sustain elevated ESR without obvious symptoms. Periodontal disease, untreated dental infections, or ongoing gastrointestinal inflammation may quietly contribute to persistent elevation.
In these cases, ESR improves only when the underlying issue is identified and addressed. Routine dental care and reporting ongoing digestive symptoms can therefore be more relevant to ESR trends than many people realize.
Supplements and ESR: What to Expect
Supplements such as fish oil, turmeric, and vitamin D are often discussed in relation to inflammation. Some studies suggest modest effects on inflammatory markers in certain populations, but results are inconsistent and usually small.
Supplements do not replace medical treatment, and their effects on ESR are unpredictable. Because they can interact with medications or affect bleeding risk, they are best viewed as optional, supportive considerations rather than tools for lowering ESR.
ESR and CRP: Why Both Are Followed
CRP (C-reactive protein) responds more quickly to changes in inflammation, while ESR changes more slowly and reflects longer-term shifts. In PMR, CRP may normalize before ESR, or ESR may remain mildly elevated even as symptoms improve.
Clinicians interpret both values alongside how a person feels and functions. Lab results inform decisions, but they do not replace symptom-based assessment.
Why Trends Matter More Than Single Numbers
A single ESR value rarely tells a complete story. Day-to-day variation, lab timing, and unrelated health changes can all influence results.
Patterns over time are far more meaningful. Many people find reassurance in tracking how symptoms align with lab dates, rather than focusing on whether a single number is “normal.”
Bottom Line
ESR is a useful indicator of inflammation, but it is not something to lower directly. The most reliable way ESR improves is when the condition driving inflammation is brought under control. Lifestyle factors, blood health, and infection status can influence ESR modestly, but they work in support of — not instead of — medical care.
Understanding what ESR reflects, and what it does not, can make lab results less stressful and more useful as part of a broader picture.
My younger brother began developing PMR symptoms shortly after getting the #2 shot for the Pfizer vaccine. He was severely disabled, lost 63 pounds and almost died. The local physicians were all but useless, failing to perform any tests outside of COVID related tests ,saying that he did not fit their protocols. Finally his personal physician intervened, and got him admitted to a local hospital, where, just by chance he was diagnosed and treated for PMS. That was last year. Shift to present, he still has the (worsening) symptoms of PMS, and now has a diagnosis of lymphoma or leukemia (depends on whether or not its in the blood stream now). I, as his older brother, am worried that I may have some of the preliminary signs of PMR, and several other troubling medical issues. I would like to get an evaluation as to our conditions, as several of my siblings had testicular cancer and my sister had cervical cancer at age 18.