Powerful Inflammation Marker
– Using Routine CBC –

Dr. Al Danenberg Nutritional Periodontist

March 6, 2022 [printfriendly]


We all have heard that chronic inflammation is the bad guy in our body. We also have heard that there are many medical tests that can monitor inflammation in your body. Some are complex and expensive – some are too generalized.

Here is a powerful inflammation blood marker that is getting quite a bit of press lately. It’s what I trust for myself, and it’s what I recommend for you.

The powerful inflammation blood marker is the NLR – the Neutrophil Lymphocyte Ratio. It is an easy and inexpensive blood test to run because it is part of the routine CBC (Complete Blood Count).

As you continue to read, you will learn …

  • The predictive power of this inflammation blood marker
  • The research reported in numerous peer-reviewed medical studies where the NLR is being investigated
  • How to calculate your NLR and understand its ranges
  • Methods to improve your NLR
  • How you can benefit personally by monitoring this blood test

As a unique marker, it can be used to assess risk and severity of systemic infections, autoimmune diseases, cardiovascular disease, gum infection, many types of cancer, and a whole lot more.

And being armed with this knowledge, you could integrate methods to record and monitor this biomarker as you take specific steps to reduce systemic inflammation in your body.

You’ll be on top of your game.


Predictive Power of the NLR

Neutrophils and lymphocytes are white blood cells. They can be identified and counted in the popular CBC blood test. Specifically, they are immune cells and work together to defend the body against foreign substances and diseases, such as bacteria, viruses, and cancer cells.

Neutrophils are the first responders as part of innate immunity. They patrol for signs of microbial infections in cells and quickly trap and kill the invading pathogens. After neutrophils fulfill their purpose, they are eliminated by macrophages. In addition, they actively participate in several diseases including cancer and have a role in innate immune memory.

Lymphocytes have a slower but critical response to inflammation and tend to arrive after neutrophils. Certain lymphocytes are part of the generalized response of the innate immune system. These natural killer cells (NK Cells) deliver an immediate response to viral attack. NK cells can also distinguish cells that are cancerous or have infections caused by microbes. The NK cells target and destroy these cells in the same way they eliminate cells with viral infections.

Other lymphocytes act against specific pathogens or infected cells and are part of the adaptive immune response. They include T cells and B cells. Both types are produced in the bone marrow; however, B cells mature in the marrow while T cells migrate to the thymus to mature. Both B cells and T cells have the capacity to remember antigens for a stronger and quicker response when the antigen is encountered in the future.

Together, neutrophils and lymphocytes reflect the balance between the innate and adaptive immune system. The NLR helps to create a “relationship” between them. As the NLR increases, more systemic inflammation is coursing throughout the body affecting all organ systems. Over the last few years, the neutrophil lymphocyte ratio (NLR) has helped to identify inflammation that correlates to the severity of many chronic as well as acute diseases.


The Research

I searched PubMed on 3/4/22 and uncovered 11,625 peer-reviewed papers describing how the NLR has proved itself useful in the prognosis of specific diseases. Here is just a smattering of papers regarding specific disease manifestations …


Calculation of the NLR and its Ranges

It’s easy to calculate the NLR. The CBC blood test will identify:

  • Neutrophil # (Absolute neutrophil count)
  • Lymphocyte #

The NLR is the Neutrophil # divided by the Lymphocyte #.

A normal NLR will generally fall between a level of 1:1 to 2:1[1], though this value may vary from person to person.

An NLR level above 4:1 seems to be an indicator of increasingly more severe inflammation. In extremely severe illness, the NLR may go as high as 100:1!


Methods to Improve NLR

Different “diseases” appear to have different cutoff points for the predictive significance of the NLR. But the trend and direction in which this biomarker is moving can be a telling measurement about your success or lack of success in improving your immune system and reducing chronic inflammation in your body.

Proactively, your goal would be to decrease systemic inflammation throughout your body. And you could monitor this biomarker, which will slowly improve as you succeed. Here are some steps you can employ to get your numbers right:

  • Identify and remove any infection or inflammation in your mouth (Example: read Shoddy Dentistry & Mouth Splinters)
  • Increase the diversity of your gut microbiome (Example: consume spore-based probiotics like MegasporeBiotic and Terra Flora Deep Immune)
  • Heal a leaky gut to prevent leakage into the general circulation of lipopolysaccharides, which are highly toxic (Examples: use Colostrum-6 to bind to LPS in the gut and repair the gut lining; avoid anti-nutrients in the diet)
  • Remove all possible irritants that can damage the gut microbiome and the epithelial barrier (Example: remove and avoid environmental toxic elements)
  • Consume the foods that provide bioavailable nutrients in their proper ratios to your body for absorption (Example: follow my Better Belly Blueprint way of eating)
  • Enhance the production of ATP by your mitochondria and allow seamless channeling of nutrients and waste material crossing the cell membranes (Examples: fasting, dietary ketosis, high-intensity interval training, Pulsed Electromagnetic Field Therapy)
  • Neutralize excessive and damaging free radicals which can destroy cell membranes, DNA, lipids, enzymes, and mitochondria (Examples: Molecular Hydrogen, stress reduction, restorative sleep)


Monitoring Success

Although a specific value of the NLR may have predictive value, monitoring the trend of the ratio may be the most important function of this biomarker. If the ratio is moving to a higher number, that would suggest more severe and aggressive systemic inflammation and an increase in morbidity and mortality for life-threatening diseases. If the ratio is moving lower, that would suggest a decrease in the severity of systemic inflammation.

Personally, I am keeping a journal of all my lymphocyte and neutrophil numbers from my CBC blood tests since my diagnosis of multiple myeloma in September 2018. I might be able to identify trends as my overall healing improved as well as those times when I had serious setbacks. This is purely informational for me, but it does help to confirm my success or failure over time. If my NLR is trending toward more inflammation, I can investigate additional steps to reduce the inflammation in my body and enhance the efficient and effective response of my immune system.


[1] https://pubmed.ncbi.nlm.nih.gov/28057051/


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  1. Dr. Al,
    Does a neutrophil/Lymphocyte ratio of .88 mean anything? The individual numbers were marked as “low” on my bloodwork. Can it be too low?

    • Many medical investigators are evaluating the meaning and the predictive qualities of the NLR. I cited several medical papers that discuss the ranges of the NLR in by Blog. It is understood that as the NLR increases, more systemic inflammation is present. Here is a paper that discusses the NLR as it relates to mortality in the general US population: https://www.nature.com/articles/s41598-020-79431-7

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