OpenHealth Q&A

Understanding Chronic Inflammation and Stool Concerns: Seeking Insights

I’m a 24-year-old male weighing 120 kg. Over the last 14 months, I've gained approximately 15 kg but managed to shed around 5-6 kg in the past seven weeks. I do not smoke or consume alcohol. Currently, I'm on a proton pump inhibitor (PPI), specifically esomeprazole, while managing generalized anxiety disorder with a daily dose of 0.75 mg of Xanax. My experience with SNRIs was challenging, so I'm collaborating with my psychiatrist to explore alternative medications, alongside Covercard PLUS for blood pressure management. About 14 months ago, routine blood tests revealed mild elevation of my CRP at 10 mg/l; a follow-up test after ten months showed it had increased to 11.5 mg/l, accompanied by a low serum iron level of 8.5. In response, I began taking 7 mg of non-heme iron daily, which later normalized my iron levels. Dental and ENT examinations, including x-rays and CT scans, were unremarkable. A urologist confirmed normal results via ultrasound, and an abdominal ultrasound seven months ago did not reveal any issues. Several months back, I underwent five separate fecal occult blood tests (FOBT), all yielding negative results, while a calprotectin test indicated a level of 90. Food allergy tests showed no allergies, but I did have intolerances for mustard seed and lactose, which I ignored until about two months ago when I completely removed these from my diet. My initial calprotectin test coincided with an elevated CRP level of 17, even though my serum iron had normalized, and my TSH levels were also within the normal range. A lung x-ray came back completely normal. In January, a control blood test revealed my CRP had risen to 23, with a sedimentation rate (WE) of 38 mm/h (iron levels were not measured at this time). Just a week ago, I had another blood test, during which my CRP elevated further to 26, while my WE decreased to 20 mm/h. Throughout all blood tests, I have shown no signs of anemia, and my hematological profile has remained stable and normal. Blood lipid levels were slightly elevated, increasing gradually, and my glucose was noted at 5.7, with insulin levels at 45.5 uU/ml, giving a HOMA-IR of 11.5, although my Hemoglobin A1C level was normal. Tests for autoimmune conditions returned normal results, as did my morning cortisol levels. However, my serum iron level was again low at 6.8, despite consistently taking 7 mg of iron supplements daily, and no anemia manifested. My calprotectin, after dietary modifications (removing the aforementioned allergens for over six weeks), unexpectedly increased to 174. From a gastrointestinal perspective, my stools were initially loose, but improved to a more consistent form, now typically ranging between types 4 and 6 on the Bristol stool scale. Notably, I’ve never observed blood in my stool. Over the last 14 months, I’ve experienced only minor gastrointestinal symptoms like occasional mild discomfort and minimal fatigue, which has actually improved in recent months. There is no known family history of colorectal cancer, inflammatory bowel disease, or other significant gastrointestinal disorders. Consequently, my GI specialist has recommended a combination endoscopy and colonoscopy to investigate further, reassuring me that it is unlikely to be cancer. I acknowledge that my anxiety levels have been heightened due to my situation, often resulting in elevated blood pressure and a near-panic state. I regularly monitor my bowel movements and have noticed small black or brown “fragments” in my stool. This is not a new occurrence; I recall similar findings from four to five years ago. I attempted to dissolve these pieces in water, but they remained intact. I’ve raised this concern with my GI specialist but neglected to inquire about the potential cause. I suspect these might be undigested iron, especially as I have started a new supplement with a higher iron dosage, coinciding with an increase in these fragments’ appearance—prior to this when I was taking only 7 mg, their occurrence was less frequent. I have a couple of queries: - Do you believe that the gradual rise in CRP may be attributed to metabolic syndrome factors such as increased insulin levels and obesity? - Could the small particles I observe in my stool likely be related to the iron supplementation? I greatly appreciate any insights regarding my situation.

Answers (1)

3/23/2025, 5:20:54 PM

OpenHealth AI

Thank you for sharing such detailed information about your health concerns. You've made significant efforts to monitor and manage your condition, which is commendable. Let's break down your main queries:

Key Points

1. CRP Levels and Metabolic Syndrome: The gradual rise in your CRP may be linked to factors like obesity and elevated insulin levels, which are components of metabolic syndrome.
2. Stool Particles and Iron Supplementation: The small particles you see in your stool could be related to your iron supplementation, but further evaluation is necessary.

Explanation

• C-Reactive Protein (CRP): This protein increases in response to inflammation in the body. Factors such as obesity and insulin resistance can cause ongoing inflammation, potentially leading to elevated CRP levels. Your weight gain, alongside high insulin levels and blood lipid changes, suggests you may be experiencing elements of metabolic syndrome, which could be contributing to your rising CRP levels.

• Stool Fragments: The "small black or brown fragments" in your stool may very well be undigested or poorly absorbed iron supplements, especially since you noted an increase in their appearance after increasing your iron intake. It's common for some iron supplements to cause changes in stool color or consistency. Since you've had negative FOBT tests and no other alarming symptoms, it's less likely to indicate a serious issue, but it's worth further exploration.

Next Steps

1. Monitor Symptoms: Keep an eye on any changes in your stool patterns or any new symptoms, particularly digestive discomfort or changes in energy levels. Note the frequency and appearance of these stool fragments.

2. Consult Your GI Specialist: Before your upcoming endoscopy and colonoscopy, it would be beneficial to discuss the following:

   • The possibility of your stool particles being from iron supplementation.
   • Any recommendations for adjusting your iron intake based on your observations.

3. Review Lifestyle Factors:

   • Consider dietary modifications that can help manage your weight and insulin levels (e.g., balanced meals with whole foods, exercise).
   • Engage in stress-reducing practices to help manage your anxiety and its impact on your physical health, such as mindfulness or gentle exercise.

4. Follow-up on Blood Tests: Keep track of your follow-up blood tests, especially your CRP levels and insulin resistance indicators, for any significant changes over the coming months.

5. Seek Additional Support: Since you experience anxiety related to your health, continue working with your psychiatrist to find effective management strategies that contribute to your overall well-being.

I hope this helps clarify your situation. It’s essential to continue being proactive and informed about your health. If you have further questions or need more assistance, feel free to reach out.