By Dr Chun Tang — MBChB (Manchester), MRCGP, MBA · Practising NHS & Private GP · Founder, Little Ox

Dr Tang in the Press: King Charles's Swollen Fingers — What They Tell Us About Inflammation and Ageing

Over the past two years, I've been quoted multiple times — in the Daily Mail, The Mirror, Grazia, Yahoo News UK and several international outlets — on what many people have come to call King Charles's "sausage fingers": the visibly swollen, puffy digits that have been a topic of public curiosity since his coronation and continue to attract attention.

I want to use this as an opportunity to explain something clinically important that these press pieces rarely have space for: what chronic low-grade inflammation actually is, why it accelerates with age, and what you can do about it.

What I Said About King Charles

My medical explanation, as quoted in the Daily Mail and reproduced in multiple outlets: puffy fingers are typically a symptom of fluid retention, which can arise from numerous causes — inflammation being the most common underlying mechanism. Inflammatory conditions including arthritis, certain infections, and autoimmune conditions can all cause fluid to accumulate in the soft tissues of the hands.

Other causes I mentioned include high salt intake (which causes sodium-driven fluid retention), allergic reactions, medication side effects, injury, and various autoimmune conditions. Without examining a patient directly, you cannot determine the specific cause — and I was careful not to speculate about the King's specific diagnosis. What I could say is that the medical explanations for finger swelling are well-understood.

The Bigger Picture: Inflammaging

The reason I find this topic more broadly relevant is that it's a visible illustration of something that happens internally in all of us as we age: what researchers call "inflammaging" — the chronic, low-grade inflammatory state that develops progressively from our 40s onwards, even in the absence of specific disease.

Inflammaging is driven by several mechanisms that converge with age: declining NAD+ levels reduce the efficiency of sirtuin proteins (particularly SIRT1 and SIRT3) that regulate inflammatory pathways; accumulation of senescent cells releases pro-inflammatory cytokines; and mitochondrial dysfunction generates inflammatory signals at the cellular level.

The clinical consequences of unchecked inflammaging are significant. Chronic low-grade inflammation is a driver of cardiovascular disease, type 2 diabetes, cognitive decline, joint deterioration, skin ageing, and cancer risk. It's not a disease state itself — it's a background condition that makes you more susceptible to all of these outcomes.

How NAD+ Addresses Inflammation at Its Root

This is precisely where NAD+ supplementation through NMN Pure and NMN Plus has its most important and least appreciated benefit. The NAD+/sirtuin pathway is one of the primary regulators of inflammatory gene expression. SIRT1 and SIRT6, which require NAD+ as a substrate, directly suppress NF-κB — the master transcription factor that drives inflammatory cytokine production.

When NAD+ is depleted, sirtuin activity falls, NF-κB goes unchecked, and chronic inflammation escalates. Restoring NAD+ through NMN supplementation supports sirtuin function and, through it, inflammatory regulation — addressing inflammaging at its molecular root rather than masking the downstream symptoms.

Trans-Resveratrol — present in our NMN Plus formula and our Collagen Complex 5-in-1 — is a potent SIRT1 activator in its own right, and also a direct inhibitor of several pro-inflammatory enzymes including COX-2. The combination of NMN and Resveratrol addresses both sides of the equation: NAD+ supply and sirtuin activation.

Visible swelling in a public figure is a reminder that ageing has a biology — and that biology is increasingly well-understood and addressable.

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