Uncovering hidden inflammation that conventional analysis often misses
The introduction is also posted on Spotify as a podcast by “Gerry at The Health Equation”
You can search Spotify for “Gerry at The Health Equation”
Or use the link below
https://podcasters.spotify.com/pod/show/gerrygaj
Below is the specific link
Gerry Gajadharsingh writes:
“Dr Dicken Weatherby, a Naturopath Based in Canada, is probably the leading light in the functional interpretation of blood tests. I’ve recommended his book to the delegates on many of my courses over the years and continue to use his software to produce functional blood analysis reports for many of my patients. Functional ranges are narrower than the usual standard medical reference ranges used in the interpretation of blood test results. Using these ranges can help to give much more detailed advice to patients to be proactive about their health rather than just using blood test results to pick up pathology.
https://www.thehealthequation.co.uk/private-health-screen/
See the section on Functional Blood Analysis
Inflammation underlies most disease processes. So being able to measure the level of inflammation in patients is important. ESR (erythrocyte sedimentation rate), is one of the common blood parameters used as well as CRP (C reactive protein), elevated as an acute response to inflammation. However, there are a whole host of other inflammatory markers, such as IL6 (interleukin 6), often raised in rheumatological problems but expensive to test.
Silent inflammation, also known as low-grade chronic inflammation, is a long-term, persistent immune response that occurs in the body sometimes without obvious symptoms like pain, redness, or swelling. Unlike acute inflammation (which is the body’s immediate response to injury or infection), silent inflammation where ESR and CRP are usually normal (partly because the reference ranges are wide and include a majority of the so-called normal population), can go unnoticed for years but contributes to the development of chronic diseases such as:
Cardiovascular diseases (e.g., heart disease, high blood pressure)
Type 2 diabetes
Osteoarthritis and rheumatoid arthritis
Neurodegenerative diseases (e.g., Alzheimer’s, Parkinson’s)
Cancer
Osteoporosis
Causes of Silent Inflammation
Several factors contribute to silent inflammation, including:
Chronic stress
Poor diet (processed foods, sugar, unhealthy fats)
Lack of exercise
Obesity (fat tissue releases inflammatory molecules)
Gut dysbiosis (imbalanced gut bacteria)
Environmental toxins (pollution, smoking)
Given that the commonly used inflammatory markers ESR and CRP can be normal in silent inflammation and that specialised inflammatory markers can be expensive, it’s good to know that parameters included in many basic blood panels can be used in combination to measure silent inflammation.
Atherogenic Index of Plasma (AIP)
The AIP (calculated as log[TG/HDL-C]) serves as a critical indicator of both cardiovascular risk and systemic inflammation. As a logarithmically transformed ratio, it provides enhanced sensitivity to metabolic disturbances that drive inflammatory processes throughout the body.
Clinical relevance: An AIP value above 0.21 strongly correlates with increased inflammatory cytokine activity and oxidative stress, even when conventional lipid values appear normal. Research has linked elevated AIP with insulin resistance, metabolic syndrome, and chronic low-grade inflammation that precedes clinical disease by years.
Example:
Male Patient
Triglycerides 0.8 mmol/L (<2.3)
HDL 2 mmol/L (0.9-1.5)
AIP=log(0.8/2)
AIP= -0.4
A negative AIP (below 0.21) is considered low risk for cardiometabolic disease i.e. low inflammation.
Ferritin
While commonly viewed as simply an iron storage marker, ferritin is actually an acute phase reactant that can provide valuable insights into inflammatory status.
Clinical relevance: When ferritin is elevated without corresponding iron markers, investigate underlying inflammation in the digestive tract, joints, or vascular system. This pattern often appears in conditions like rheumatological problems, inflammatory bowel disease, and metabolic syndrome well before other clinical signs develop.
Example:
Male Patient
Serum iron 16.9 umol/L (10.6-28.3)
TIBC 44 umol/L (41-77)
Transferrin Saturation 38% (20-55)
Ferritin 450 ug/L (30-400)
Normal iron markers but elevated Ferritin, probably inflammation.
Absolute Neutrophil-to-Lymphocyte Ratio (NLR)
This simple calculation derived from a complete blood count offers remarkable sensitivity for systemic inflammation.
Clinical relevance: While conventional ranges consider an NLR below 3.0 normal, functional evaluation suggests that values above 2.0 warrant attention. Research has linked elevated NLR with cardiovascular disease, insulin resistance, and even cancer progression—making it a valuable early warning system.
Example
Male Patient
Neutrophils 5.34 *10 to 9/L (2-7.5)
Lymphocytes 1.58 *10 to 9/L (1.2-3.5)
NLR= 3.38 (>2 = possible inflammation)
Platelets
Platelets do far more than participate in clotting; they play an active role in immune function and inflammation.
Clinical relevance: Pay particular attention to platelets above 300,000/μL (300*10 to 9/L, especially when accompanied by an increased mean platelet volume (MPV). This combination suggests active platelet production and release of pro-inflammatory mediators that contribute to disease progression.
Example
Male Patient
Platelets 400 X10 to 9/L (150-400)
MPV 14 fl (7-13)
Possible Inflammation
RDW (Red Cell Distribution Width)
This measurement of red blood cell size variability appears on every CBC but is frequently ignored unless anaemia is present.
Clinical relevance: When RDW exceeds 13.5%, especially with normal haemoglobin and MCV, investigate underlying inflammation. Research has linked elevated RDW with inflammatory bowel disease, metabolic syndrome, and cardiovascular disease risk—making it valuable for early intervention.
Example
Male Patient
Hb 132 g/L (130-170)
MCV (mean cell volume) 86.6fl (80-99)
RDW 13.3% (11.5-15)
Borderline Inflammation
How to Reduce Silent Inflammation
Anti-inflammatory diet – rich in omega-3s (fish, flaxseeds), fruits, vegetables, whole grains, and nuts and managing glucose and insulin by not snacking in between meals.
Regular exercise
Good sleep hygiene
Stress management (meditation, breathing exercises)
Maintaining a healthy weight
Avoiding processed foods, sugar, and trans fats”
ODX Research
Dr Dicken Weatherby
Chronic inflammation lies at the root of many modern health challenges. While practitioners commonly look to ESR and CRP or hsCRP as the gold standard for measuring inflammation, standard blood work contains several other powerful indicators that often go unnoticed or underutilized in clinical practice.
These overlooked markers can provide critical insights into a patient’s inflammatory status—even when conventional markers appear normal. Here are five inflammatory markers hiding in plain sight on standard blood panels that deserve your clinical attention:
- Atherogenic Index of Plasma (AIP)
This powerful logarithmic ratio of triglycerides to HDL cholesterol offers insights that standard lipid panels miss, yet can be easily calculated from values present on every lipid profile.
What it reveals: The AIP (calculated as log[TG/HDL-C]) serves as a critical indicator of both cardiovascular risk and systemic inflammation. As a logarithmically transformed ratio, it provides enhanced sensitivity to metabolic disturbances that drive inflammatory processes throughout the body.
Clinical relevance: An AIP value above 0.21 strongly correlates with increased inflammatory cytokine activity and oxidative stress, even when conventional lipid values appear normal. Research has linked elevated AIP with insulin resistance, metabolic syndrome, and chronic low-grade inflammation that precedes clinical disease by years.
- Ferritin
While commonly viewed as simply an iron storage marker, ferritin is actually an acute phase reactant that can provide valuable insights into inflammatory status.
What it reveals: Elevated ferritin, particularly when serum iron and transferrin saturation are normal or low, strongly suggests an inflammatory process rather than iron overload. This pattern is frequently observed in chronic inflammatory conditions such as Rheumatological conditions.
Clinical relevance: When ferritin is elevated without corresponding iron markers, investigate underlying inflammation in the digestive tract, joints, or vascular system. This pattern often appears in conditions like rheumatoid arthritis, inflammatory bowel disease, and metabolic syndrome well before other clinical signs develop.
- Absolute Neutrophil-to-Lymphocyte Ratio (NLR)
This simple calculation derived from a complete blood count offers remarkable sensitivity for systemic inflammation.
What it reveals: The NLR (calculated by dividing the absolute neutrophil count by the absolute lymphocyte count) provides a window into the balance between innate and adaptive immune responses. An elevated ratio indicates active inflammation and has been associated with numerous chronic conditions.
Clinical relevance: While conventional ranges consider an NLR below 3.0 normal, functional evaluation suggests that values above 2.0 warrant attention. Research has linked elevated NLR with cardiovascular disease, insulin resistance, and even cancer progression—making it a valuable early warning system.
- Platelets
Platelets do far more than participate in clotting; they play an active role in immune function and inflammation.
What it reveals: Platelet counts trending upward, even within the conventional “normal” range, can signal ongoing inflammatory processes. Elevations in the upper quadrant of the reference range correlate with increased risk of cardiovascular events and chronic inflammatory conditions.
Clinical relevance: Pay particular attention to platelets above 300,000/μL, especially when accompanied by an increased mean platelet volume (MPV). This combination suggests active platelet production and release of pro-inflammatory mediators that contribute to disease progression.
- RDW (Red Cell Distribution Width)
This measurement of red blood cell size variability appears on every CBC but is frequently ignored unless anaemia is present.
What it reveals: Elevated RDW reflects increased heterogeneity in red blood cell size and correlates strongly with inflammatory cytokine activity. It serves as an excellent marker for oxidative stress, which drives chronic inflammation.
Clinical relevance: When RDW exceeds 13.5%, especially with normal haemoglobin and MCV, investigate underlying inflammation. Research has linked elevated RDW with inflammatory bowel disease, metabolic syndrome, and cardiovascular disease risk—making it valuable for early intervention.
Putting It All Together: The Inflammatory Pattern
The true power of these markers emerges when viewed collectively. Look for patterns rather than isolated abnormalities:
- Early inflammatory pattern: Subtle shifts in AIP and NLR with normal hsCRP
- Active inflammatory pattern: Elevated ferritin with normal iron studies, increased platelets, and rising RDW
- Chronic inflammatory pattern: Abnormalities across multiple markers with corresponding elevations in conventional inflammatory markers
By recognizing these patterns early, you can implement targeted interventions before inflammation manifests as diagnosable disease.
Beyond Identification: Clinical Application
Identifying hidden inflammation is only the first step. Effective intervention requires:
- Comprehensive assessment to identify contributing factors (gut dysfunction, environmental exposures, nutrient deficiencies)
- Targeted protocols addressing specific inflammatory pathways
- Sequential monitoring to track intervention effectiveness
Understanding these overlooked inflammatory markers transforms your clinical approach from reactive to proactive allowing you to address underlying dysfunction before disease processes advance.