Inflammageing: What It Is, Why It Ages You, and What to Do About It

Inflammageing is the term given to the chronic, low-grade, systemic inflammation that develops progressively with age — even in the absence of infection or obvious disease. It is not the same as acute inflammation.
It produces no fever, no obvious swelling, and no clear symptoms. But it steadily damages tissue, accelerates biological ageing, and sits upstream of virtually every major age-related disease, from cardiovascular disease and type 2 diabetes to Alzheimer's, cancer, and sarcopenia.
Understanding inflammageing — what drives it, how to measure it, and what actually reduces it, is arguably one of the highest-leverage areas of applied longevity science.
What Is Inflammageing?
Inflammageing is a state of persistent, low-grade systemic inflammation associated with ageing, characterised by chronically elevated pro-inflammatory cytokines — particularly IL-6, TNF-α, and IL-1β — in the absence of acute infection or injury.

The term was coined in 2000 by Italian immunologist Claudio Franceschi, who identified that older adults consistently show elevated inflammatory markers compared to younger adults, and that this elevation predicts mortality and disease onset independently of other risk factors.
What makes inflammageing distinct from normal inflammation is its nature: acute inflammation is a rapid, targeted, self-resolving response to a specific threat. Inflammageing is chronic, diffuse, and — critically — fails to resolve. The body's inflammatory machinery is perpetually activated at low intensity, like an engine running slightly hot. Over years and decades, the cumulative damage this causes is substantial.
Why Does Inflammageing Develop? The Core Drivers
Several interconnected biological processes accumulate with age and converge to create a chronically pro-inflammatory state. The most important are:
1. Cellular Senescence and the SASP
Senescent cells are cells that have permanently stopped dividing but have not been cleared from the body. As they accumulate with age, they secrete a cocktail of pro-inflammatory cytokines, proteases, and chemokines collectively known as the senescence-associated secretory phenotype (SASP).

The SASP includes IL-6, IL-8, TNF-α, MMP-3, and MCP-1 — molecules that degrade surrounding tissue, recruit immune cells, and importantly, induce senescence in neighbouring healthy cells (a process called paracrine senescence). A relatively small number of senescent cells can therefore propagate an inflammatory signal far beyond their own immediate environment.
This is one of the most direct mechanistic links between cellular ageing and systemic inflammation. For more on senescent cells and how they are addressed, our article on senolytics and zombie cells covers the research in detail.
2. The cGAS-STING Pathway
As cells age, mitochondria and nuclei increasingly release DNA fragments into the cytoplasm — a location where DNA is not supposed to be. The cGAS-STING (cyclic GMP-AMP synthase — stimulator of interferon genes) pathway is the innate immune system's sensor for cytoplasmic DNA. When it detects these fragments, it activates NF-κB and type I interferon responses — triggering inflammation.
This pathway represents a direct mechanistic link between mitochondrial damage, genomic instability (both of which increase with age), and chronic systemic inflammation. It is one of the reasons that mitochondrial health is so central to the inflammageing picture — damaged mitochondria do not just produce less ATP, they actively signal the immune system to remain on alert.
3. NF-κB Pathway Dysregulation
NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) is the master transcription factor of the inflammatory response. It controls the expression of over 150 genes involved in immune activation, cytokine production, and cell survival.
In younger biology, NF-κB activation is tightly regulated — switched on acutely in response to pathogens or damage, then suppressed. With age, NF-κB becomes constitutively active in many tissues — remaining switched on at a low level even without an acute trigger. This basal NF-κB activity is a primary driver of the chronic cytokine elevation that characterises inflammageing.

Key activators of chronic NF-κB include: oxidative stress, elevated blood glucose, visceral adipose tissue, gut-derived lipopolysaccharide (LPS), and the SASP cytokines themselves — creating a self-reinforcing loop.
4. The NLRP3 Inflammasome
The NLRP3 inflammasome is a multiprotein complex of the innate immune system that, when activated, drives the production of IL-1β and IL-18 — two of the most potent pro-inflammatory cytokines involved in inflammageing.
NLRP3 is activated by a range of age-associated signals: cholesterol crystals, uric acid, mitochondrial reactive oxygen species (ROS), extracellular ATP, and misfolded proteins. Its chronic activation with age contributes to neuroinflammation (relevant to Alzheimer's disease pathology), atherosclerotic plaque instability, and insulin resistance.
NLRP3 inhibition is an active area of pharmaceutical research. Several natural compounds — including quercetin, resveratrol, and omega-3-derived resolvins — have demonstrated NLRP3 inhibitory activity in preclinical studies.
5. Gut Dysbiosis and Intestinal Permeability
The gut microbiome undergoes significant compositional changes with age — a shift termed dysbiosis — characterised by reduced microbial diversity, decline of anti-inflammatory species such as Bifidobacterium and Lactobacillus, and relative increases in pro-inflammatory Gram-negative bacteria.

Gram-negative bacteria produce lipopolysaccharide (LPS) — a component of their outer membrane that is a potent activator of the TLR4 (Toll-like receptor 4) pathway and downstream NF-κB signalling. As gut barrier integrity declines with age (intestinal permeability increases), LPS translocates into systemic circulation — a phenomenon sometimes termed "leaky gut" — driving a continuous low-level inflammatory signal.
Data from the Human Microbiome Project and subsequent ageing cohort studies indicate that gut dysbiosis is consistently associated with elevated hs-CRP and IL-6, and that microbiome diversity correlates inversely with inflammageing markers in older adults.
6. Visceral Adipose Tissue as an Inflammatory Organ
Visceral fat — the fat depot surrounding abdominal organs, distinct from subcutaneous fat — is not metabolically inert. It functions as an active endocrine and immune tissue, secreting adipokines including leptin, resistin, and visfatin that directly activate NF-κB and promote macrophage infiltration.

Visceral adipose tissue (VAT) macrophages are polarised toward a pro-inflammatory M1 phenotype and continuously secrete TNF-α and IL-6. The well-documented relationship between abdominal obesity and systemic inflammation is therefore mechanistically grounded — excess VAT is, literally, an inflammatory organ embedded in the body's core.
7. Declining NAD+ and Sirtuin Activity
NAD+ — the coenzyme central to cellular energy metabolism — declines substantially with age, and this decline has direct consequences for inflammageing. SIRT1, one of the seven sirtuin proteins that depend on NAD+ for their activity, is a potent suppressor of NF-κB: it deacetylates the p65 subunit of NF-κB, reducing its transcriptional activity.

As NAD+ falls with age, SIRT1 activity declines, and NF-κB suppression is progressively lost — contributing directly to the chronic inflammatory state. This is one of the mechanistic reasons why NAD+ precursor supplementation (via NMN or NR) intersects with inflammageing: by restoring NAD+ availability, it supports SIRT1 activity and downstream NF-κB suppression.
Our article on how NMN slows ageing covers this mechanism alongside four others identified in a recent scientific review.
How Does Inflammageing Cause Disease?
The downstream consequences of chronic low-grade inflammation touch virtually every organ system. The most clinically significant are:
| Disease / Condition | Inflammageing Mechanism |
|---|---|
| Cardiovascular disease | IL-6 and TNF-α promote endothelial dysfunction; NLRP3 drives plaque instability |
| Type 2 diabetes | TNF-α and IL-1β impair insulin receptor signalling; NF-κB promotes insulin resistance |
| Alzheimer's disease | Neuroinflammation via microglial NLRP3 activation; IL-1β disrupts synaptic function |
| Sarcopenia | IL-6 and TNF-α promote muscle protein catabolism via NF-κB / ubiquitin-proteasome pathway |
| Osteoporosis | IL-1β and TNF-α activate osteoclasts, suppressing osteoblast activity |
| Cancer | NF-κB promotes tumour survival, angiogenesis, and immune evasion |
| Depression | IL-6 and TNF-α cross the blood-brain barrier and reduce serotonin synthesis |
| Frailty | Cumulative tissue damage from chronic cytokine exposure impairs regenerative capacity |
The landmark 2020 paper in Nature Reviews Immunology — which introduced the term "inflammaging" to a broad clinical audience — noted that IL-6 elevation alone independently predicts all-cause mortality in adults over 65, with each standard deviation increase in IL-6 associated with approximately a 39% increase in mortality risk. This is the scale of the problem.
How to Measure Inflammageing
The most accessible clinical proxy for inflammageing is high-sensitivity CRP (hs-CRP). Unlike standard CRP — which detects acute inflammation at clinical levels — hs-CRP detects the low-level chronic inflammation relevant to ageing. An hs-CRP below 0.5 mg/L is considered optimal; above 3.0 mg/L indicates high chronic inflammatory burden.

Additional blood markers worth tracking:
- IL-6 — the most directly relevant inflammageing cytokine; available privately
- TNF-α — less commonly tested but informative in high-risk individuals
- Fibrinogen — an acute-phase protein that correlates with chronic inflammation
- Homocysteine — an indirect inflammageing marker; elevated levels damage endothelium and activate NF-κB
- Ferritin — a marker of both iron status and inflammatory activity when elevated
- GGT (gamma-glutamyl transferase) — reflects oxidative stress burden and indirect inflammatory load
- White blood cell differential — neutrophil-to-lymphocyte ratio (NLR) is an emerging inflammageing index
Our complete guide to blood tests to ask your GP for covers how to request these markers on the NHS and what optimal ranges look like.
What to Do About Inflammageing: The Evidence
This is where most content on this topic becomes vague. The following is grounded in specific mechanisms and evidence quality, ranked broadly by the strength of the data.
Lifestyle Interventions
1. Zone 2 Aerobic Exercise

Regular moderate-intensity aerobic exercise — the kind that keeps you in a conversational pace — is the single most robustly evidenced intervention for reducing systemic inflammation. The mechanisms are multiple:
- Muscle contractions release anti-inflammatory myokines, including IL-10 and IL-1 receptor antagonist (IL-1Ra), that directly counter pro-inflammatory cytokines
- Regular aerobic training reduces visceral adipose tissue — removing a chronic inflammatory source
- Exercise activates AMPK, which suppresses NF-κB activity
- Physical conditioning reduces sympathetic nervous system tone, which itself drives NF-κB activation
A 2019 meta-analysis in Brain, Behaviour and Immunity found that regular aerobic exercise reduces circulating IL-6 by approximately 18% and TNF-α by approximately 15% in older adults. Effect sizes are modest but consistent — and cumulative over years.
For a structured approach to exercise and longevity, our complete exercise protocol for longevity is a practical starting point.
2. Dietary Pattern: Anti-Inflammatory Nutrition

No single food is meaningfully anti-inflammatory. Dietary pattern over time is what matters. The components with the strongest anti-inflammatory evidence:
- Omega-3 fatty acids (EPA and DHA): Serve as precursors to resolvins and protectins — specialised pro-resolving mediators (SPMs) that actively switch off inflammatory responses. The Omega-3 Index (the percentage of EPA+DHA in red blood cell membranes) is directly inversely correlated with hs-CRP in multiple cohort studies. Target above 8%.
- Polyphenols (particularly quercetin, luteolin, and EGCG): Inhibit NF-κB and NLRP3 in vitro and demonstrate anti-inflammatory effects in well-controlled human trials. Found in berries, green tea, onions, and dark leafy vegetables.
- Olive oil (oleocanthal): A natural COX inhibitor with ibuprofen-like anti-inflammatory properties at typical dietary doses.
- Fibre and resistant starch: Feed butyrate-producing bacteria in the colon; butyrate inhibits HDAC enzymes and NF-κB activation in intestinal epithelial cells, reducing gut-derived LPS translocation.
- Ultra-processed food reduction: Dietary emulsifiers (carboxymethylcellulose, polysorbate-80) disrupt gut barrier function and increase LPS translocation — a well-characterised pro-inflammageing mechanism.
Our article on the best foods for healthy ageing covers the dietary evidence in more depth.
3. Sleep Quality and Duration

Sleep is the body's primary window for inflammatory resolution. During slow-wave and REM sleep, glymphatic clearance removes inflammatory debris from the brain, cortisol falls (removing a chronic NF-κB activator), and the sympathetic-parasympathetic balance shifts toward the vagal anti-inflammatory state.
Chronic short sleep (below 6 hours) is associated with hs-CRP elevations of 25–40% compared to adequate sleepers in large epidemiological cohorts. A 2019 study in Sleep demonstrated that experimental sleep restriction to 6 hours for two weeks produced measurable increases in IL-6 and TNF-α that persisted even after recovery nights — indicating that sleep debt has a lasting inflammatory cost.
4. Caloric Restriction and Intermittent Fasting
Both caloric restriction and intermittent fasting (time-restricted eating) reduce systemic inflammation through several mechanisms: lowering visceral fat, activating AMPK (which suppresses NF-κB), and inducing autophagy (which clears the cellular debris — including damaged mitochondria — that activates the NLRP3 inflammasome and cGAS-STING pathway).
A 2022 study in Cell Metabolism demonstrated that Ramadan-style intermittent fasting produced significant reductions in NLRP3 inflammasome activity and circulating IL-1β — the first direct human evidence linking fasting to NLRP3 suppression specifically.
5. Stress Reduction and Vagal Tone

Chronic psychological stress activates the HPA (hypothalamic-pituitary-adrenal) axis and sympathetic nervous system, both of which drive NF-κB through catecholamine and glucocorticoid receptor signalling. High cortisol chronically — paradoxically — desensitises the inflammatory response rather than suppressing it, leading to the glucocorticoid resistance observed in stressed and depressed individuals.
High vagal tone (reflected in heart rate variability — HRV) is anti-inflammatory: vagal efferent fibres directly suppress macrophage TNF-α production via the nicotinic acetylcholine receptor pathway — a mechanism termed the "inflammatory reflex." Practices that increase HRV — including slow diaphragmatic breathing, cold exposure, and regular aerobic exercise — therefore have mechanistically grounded anti-inflammatory effects beyond their general health benefits.
When I started tracking HRV consistently, the thing that struck me was how directly lifestyle inputs showed up in the data — poor sleep, high stress days, and skipped exercise all registered within 24–48 hours. What I hadn't fully appreciated before is that those same inputs are also the direct drivers of your inflammatory state. HRV is, in part, a proxy for your inflammageing burden. — Mat Stuckey, Founder, Longevity Formulas
Supplement Interventions for Inflammageing

The following have the most mechanistically grounded and clinically supported evidence for reducing inflammageing-relevant markers. This is not a comprehensive list of "anti-inflammatory supplements" — it is specifically those with evidence relevant to the chronic, low-grade inflammatory state of ageing.
Omega-3 (EPA and DHA)
The most evidence-backed supplement intervention for systemic inflammation. EPA and DHA are enzymatically converted to resolvins (E-series from EPA; D-series from DHA) and protectins — specialised pro-resolving mediators that actively terminate inflammatory signalling rather than simply suppressing it. This distinction matters: most anti-inflammatory agents (including NSAIDs) block the initiation of inflammation; omega-3-derived SPMs resolve it — a fundamentally different and more physiologically appropriate mechanism.

Clinical trials consistently show that omega-3 supplementation at doses of 2–4g EPA+DHA per day reduces hs-CRP, IL-6, and TNF-α in adults with elevated baseline inflammation. The REDUCE-IT trial (8,179 participants) demonstrated a 25% reduction in major cardiovascular events with icosapentaenoic acid supplementation — an outcome mediated substantially through anti-inflammatory mechanisms.
Krill oil provides EPA and DHA in phospholipid form — a structure that is absorbed more efficiently into red blood cell membranes than the triglyceride form found in most standard fish oils, potentially improving the Omega-3 Index more effectively at equivalent doses.
Resveratrol

Resveratrol is a polyphenol found in grape skins, berries, and Japanese knotweed that acts as a SIRT1 activator and direct NF-κB inhibitor. It also inhibits COX-1 and COX-2 (the enzymes targeted by NSAIDs) and demonstrates NLRP3 inflammasome suppression in preclinical models.
Human trial data is more mixed than preclinical evidence suggests, partly due to poor oral bioavailability of standard resveratrol formulations. Trans-resveratrol (the biologically active isomer) at doses of 150–500 mg/day has shown statistically significant reductions in hs-CRP and TNF-α in meta-analyses of randomised controlled trials, particularly in individuals with metabolic dysfunction or elevated baseline inflammation.
The combination of resveratrol with NMN is mechanistically coherent: NMN raises NAD+ levels, providing the substrate SIRT1 requires to function; resveratrol activates SIRT1 directly. Together, they address both the substrate and the activator sides of the sirtuin-mediated NF-κB suppression pathway — which is covered in detail in our article on NMN and resveratrol together.
NMN (Nicotinamide Mononucleotide)

NMN's anti-inflammageing action is primarily indirect but mechanistically important. By restoring NAD+ levels, NMN supports SIRT1 activity — and SIRT1-mediated deacetylation of NF-κB p65 is one of the primary endogenous brakes on chronic inflammation. Additionally, NAD+ is required for PARP-1 (DNA repair), CD38 (immune cell regulation), and sirtuins 3 and 6 — all of which play roles in maintaining the cellular environment that prevents inflammageing signals from accumulating.
Human trial data on NMN and inflammatory markers is early but directionally consistent with the mechanistic model. A 2023 study in GeroScience demonstrated that NMN supplementation in older adults reduced inflammatory gene expression profiles in peripheral blood mononuclear cells — a molecular signal consistent with reduced NF-κB activity.
NAC (N-Acetyl Cysteine)

NAC's anti-inflammageing mechanism operates through two routes: first, by restoring glutathione (the primary intracellular antioxidant), it reduces the oxidative stress that is a primary upstream activator of NF-κB. Second, by directly scavenging reactive oxygen species, it reduces the mitochondrial damage-associated molecular patterns (DAMPs) that activate the NLRP3 inflammasome and cGAS-STING pathway.
In clinical trials, NAC supplementation has reduced circulating hs-CRP and IL-6 in populations with elevated baseline inflammation. Its role as an upstream antioxidant — reducing the oxidative fuel that feeds chronic inflammation — makes it a logical foundational supplement in an anti-inflammageing protocol. Our dedicated article on NAC and longevity covers the full mechanistic picture.
Magnesium

Magnesium deficiency — which is common in the UK, estimated to affect 10–30% of adults depending on the threshold used — is an underappreciated driver of inflammageing. Magnesium is a cofactor for over 300 enzymatic reactions and is required for the activity of NF-κB inhibitory proteins. Low intracellular magnesium increases NF-κB activation and elevates circulating CRP and IL-6.
Meta-analyses of magnesium supplementation trials consistently show reductions in hs-CRP (effect size approximately −0.5 mg/L in deficient populations), and population studies demonstrate an inverse relationship between dietary magnesium intake and all-cause mortality. This is covered in depth in our article on magnesium and longevity.
Vitamin D3

Vitamin D receptors (VDRs) are expressed on virtually every immune cell type, and activated VDRs directly suppress NF-κB activity and reduce the transcription of IL-6, TNF-α, and IL-1β. Deficiency — prevalent in the UK — is consistently associated with elevated inflammatory markers and higher all-cause mortality.
Supplementation in deficient individuals reliably reduces hs-CRP. The effect is attenuated in those who are already replete, which underscores the importance of testing before supplementing and using the result to guide dosing.
The supplements I return to most often when thinking about inflammageing are not the most exotic ones — they are the ones that address the fundamental upstream drivers: oxidative stress, NAD+ decline, omega-3 deficiency, and magnesium insufficiency. Getting these right is less dramatic than talking about senolytics, but it is probably where most people will see the most return.
Pharmaceuticals and Emerging Interventions

For completeness, the most significant pharmaceutical approaches to inflammageing currently under clinical investigation include:
- Metformin: Activates AMPK, suppresses NF-κB and mTOR, reduces circulating IL-6. The TAME (Targeting Ageing with Metformin) trial is specifically investigating its effects on ageing biology.
- Low-dose aspirin: COX inhibitor; evidence for long-term use in primary prevention has weakened due to bleeding risk but the anti-inflammatory rationale remains.
- Senolytics (dasatinib + quercetin, fisetin): Clear SASP-generating senescent cells — addressing one of the root causes of inflammageing rather than suppressing the downstream signal. See our senolytics article for the current state of the evidence.
- JAK inhibitors (e.g., ruxolitinib): Suppress the JAK-STAT signalling pathway downstream of IL-6 receptors; showing promise in ageing cohorts but require medical supervision.
These are not recommendations — they are presented for contextual completeness. Any pharmaceutical intervention requires GP or specialist involvement.
A Practical Anti-Inflammageing Protocol
Translating the above into a daily framework:
Non-negotiables (lifestyle foundation):
- 150+ minutes of moderate aerobic exercise per week, prioritising Zone 2 (conversational) intensity
- 7–9 hours of quality sleep; treat sleep as a biological necessity, not a lifestyle preference
- Dietary pattern emphasising whole food, adequate omega-3 intake (oily fish 3× per week or supplementation), and minimising ultra-processed food
- Visceral fat reduction if relevant — this alone meaningfully reduces the chronic inflammatory load
Supplement foundation:
- Omega-3 (EPA+DHA): 2–3g daily; krill oil for superior phospholipid absorption
- Magnesium: 300–400mg daily (glycinate or malate forms for best bioavailability)
- Vitamin D3+K2: Supplement to maintain 25-OH-D above 75 nmol/L — test to confirm dose
- NAC: 600mg daily for glutathione support and upstream oxidative stress control
Advanced layer:
- NMN: For NAD+/SIRT1 restoration and downstream NF-κB suppression
- Resveratrol: As a SIRT1 activator and direct NF-κB inhibitor — particularly relevant when combined with NMN
Track it:
- Annual hs-CRP testing as the primary inflammageing biomarker
- Monitor trend over 12–24 months against the interventions above
- Add IL-6 and homocysteine if hs-CRP is persistently above 1.0 mg/L
For a comprehensive view of how supplements stack together in a longevity protocol, our longevity supplement tier list ranks compounds by evidence quality and practical impact.
Inflammageing: Frequently Asked Questions
What is inflammageing? Inflammageing is chronic, low-grade, systemic inflammation that develops progressively with age, even in healthy individuals. It is characterised by persistently elevated pro-inflammatory cytokines — particularly IL-6, TNF-α, and IL-1β — and is a major driver of age-related disease and accelerated biological ageing.
What causes inflammageing? The primary drivers are: accumulation of senescent cells secreting SASP cytokines, cGAS-STING pathway activation by cytoplasmic DNA from damaged mitochondria and nuclei, constitutive NF-κB activation, NLRP3 inflammasome activity, gut dysbiosis and intestinal permeability, visceral adipose tissue, and declining NAD+/SIRT1-mediated NF-κB suppression.
How do you test for inflammageing? The most accessible marker is hs-CRP (high-sensitivity C-reactive protein), available on the NHS with a specific request. Optimal is below 0.5 mg/L. IL-6 is more directly relevant but requires private testing. A full panel including homocysteine, ferritin, and GGT provides additional context.
Can inflammageing be reversed? The evidence suggests it can be significantly reduced and its progression slowed, though complete reversal is not established in humans. The interventions with the strongest evidence are regular aerobic exercise, dietary omega-3, sleep optimisation, visceral fat reduction, and targeted supplementation. Senolytic therapies — which remove the senescent cells that generate SASP — represent the most direct approach to addressing a root cause.
What is the difference between acute inflammation and inflammageing? Acute inflammation is a rapid, targeted, self-resolving immune response to a specific threat (infection, injury). Inflammageing is chronic, systemic, low-intensity, and fails to resolve. Acute inflammation is protective; inflammageing is damaging. They share some molecular machinery (NF-κB, cytokines) but are fundamentally different in their causes, duration, and consequences.
Is omega-3 anti-inflammatory? Yes, but through a specific mechanism: EPA and DHA are precursors to specialised pro-resolving mediators (SPMs) including resolvins and protectins, which actively terminate inflammatory signalling. This is a resolution mechanism, not merely a suppression mechanism — and it is more physiologically appropriate than simply blocking inflammation initiation.
Does NMN reduce inflammation? NMN supports SIRT1 activity by restoring NAD+ availability. SIRT1 suppresses NF-κB through deacetylation of its p65 subunit — reducing transcription of pro-inflammatory genes. This is an indirect but mechanistically grounded anti-inflammatory pathway. Human trial data on NMN and inflammatory markers is directionally consistent with the preclinical evidence.
What foods cause inflammageing? The dietary components most consistently associated with elevated inflammatory markers are: ultra-processed foods (particularly those containing emulsifiers), high fructose corn syrup, refined carbohydrates driving glycaemic variability, trans fats, and excess omega-6 relative to omega-3 (which skews arachidonic acid metabolism toward pro-inflammatory eicosanoids rather than resolvins).
This article is for informational purposes and does not constitute medical advice. If you have concerns about chronic inflammation or any related health condition, consult a qualified healthcare professional.