Calculating the Neutrophil-Lymphocyte Ratio (NLR) as Immune and Inflammatory Markers

Calculating the Neutrophil-Lymphocyte Ratio (NLR) as Immune and Inflammatory Markers

Conventional vs. Functional Lab Testing Ranges And Markers

The Neutrophil-lymphocyte ratio is a blood marker calculation used in functional medicine, particularly in the fields of immunology and cancer.  Looking at conventional lab testing can be a great screening tool for diseases and disorders, but looking at them through a functional lens can provide insight into the health trend of a patient long before a disease is discovered.

Functional ranges and ratios can help a clinician to see the health trend of a patient long before a diagnosis is made, thereby improving the overall health, wellness, and longevity potential of a patient, lowering medical costs, and improving the quality of life.

What Is NLR?

The neutrophil-lymphocyte ratio (NLR) is a calculation that can be run off of a Complete Blood Count (CBC), which is a very low-cost, low barrier test picked up by most insurance companies or available through any direct to consumer lab testing. This marker  “may be an indicator of systemic inflammation, as neutrophils and lymphocytes are thought to be significant in tumour immunology and inflammation.

What Do Neutrophils And Lymphocytes Do?

Neutrophils are a white blood cell (WBC) and are part of the innate immune system, which is the branch of our immune system that we are born with and identifies potential threats as either self or not-self. They make up about 60-70% of WBCs, are made in the bone marrow, and are found mostly in the lymphatic system including the lymph nodes, spleen, and thymus.

Lymphocytes are another type of white blood cell, and are part of the adaptive or acquired immune system, making up about 20-25% of the WBCs and are more specific in their targets. They are what we acquire after exposure to a virus or pathogen and is the system that vaccines are based upon.

Together the neutrophils and lymphocytes work to protect the body from potential pathogens or threats, by increasing inflammation to bring nutrients to the site of injury or using inflammation to keep the infection or pathogen from spreading to other parts of the body easily.

How Can The Neutrophil-Lymphocyte Ratio Benefit Myself Or My Patients?

Looking at the ratio between neutrophils and lymphocytes can help to show if there is an increased likelihood of inflammation and other threats to the system that are working in the background against the body on a chronic or acute level.  This ratio is often used with functional doctors who work with cancer patients. One study found that preoperative breast cancer patients with a high NLR had worse outcomes than those with a lower NLR. Another study found that the NLR in conjunction with a CRP (C-Reactive Protein) could be a better predictor of outcome for gastric cancer patients utilizing a ratio known as COC-NLR.

NLR may help to reflect systemic inflammation in patients with cancer and their immunologic capacity to mount an attack against the malignant cells. An increasing number of recent reports suggest that NLR can be used as a prognostic marker in various malignancies”.  The NLR “has been shown to predict cardiac arrhythmias as well as short- and long-term mortality in patients with acute coronary syndromes”.

How Do I Calculate Neutrophil-Lymphocyte Ratio (NLR)?

To calculate the NLR marker, you simply need to divide the neutrophils into the lymphocytes based on your most recent CBC. Rather than manually calculating your patient’s NLRs, Heads Up is now calculating this measurement for you when you import or enter your lab values into our system.

Seeing the trends over time will provide an even deeper insight into the health trend of your patients and can be a warning sign that it’s time to take action with diet or lifestyle interventions or perhaps even consider further testing.

 

What Do The Numbers Mean?

I use a 2:1 or better ratio for neutrophils to leukocytes for the NLR when working with patients. For example, a ratio of 55-60:25-30 would be the highest/lowest I would want to see a neutrophil to lymphocyte ratio.

I also look at how big of a gap there is between neutrophils and lymphocytes, with a larger gap indicating a higher risk. Additionally, there is cause for concern if there is a relative ratio switch and the lymphocytes are elevated, and neutrophils lowered which could equate to blood dyscrasias, leukemias, lymphomas.

Consult with your health professional of choice if you have questions on these or any other lab values.

How can I track my NLR?

If you are using the Heads Up app to track lab values, you can either use the default ranges or enter your own custom ranges depending on your unique health objectives.

Click on the video below to see how you can track lab values and customize ranges in your Heads Up profile.

Ep 49 – Jim Howard – Biosense releases breakthrough ketone testing technology

Ep 49 – Jim Howard – Biosense releases breakthrough ketone testing technology

Biosense releases an at-home breath ketone testing device for both consumers and clinical settings after three years of extensive lab development and clinical trial. This device allows clients to self monitor their breath ketones at home, which in conjunction with food journaling, or other metrics can provide invaluable insight into what is contributing to weight gain, high blood sugar, metabolic syndrome, and more while utilizing a ketogenic diet.

The Biosense testing device is non-invasive allowing clients to test without poking their fingers for a blood sample, increasing testing compliance. Increased compliance provides your client and you with better data to evaluate and customize a plan for their goals. It’s also incredibly small so that you can take it with you anywhere, and requires no calibration before use.

Measuring deep lung air and eliminates contamination from ambient air, providing the user with highly accurate, dependable results, requiring no testing strips to purchase or worry about running out of.

Join Heads Up founder Dave Korsunsky as he discusses the Biosense meter with Jim Howard, and how it’s use can revolutionize your keto compliance and results with your clients, especially when combined with other data tracking through Heads Up.

This podcast is brought to you by Heads Up, a web app designed to help you centrally track all of your vital health data. Instantly synchronize your medical records, connect your favorite health devices and apps and use your data to optimize your health!

Click on the button below to start your free 30-day trial. Or, read on for more information about our latest podcast episode!

In this podcast you’ll learn:

  • About the consistency of measurement with Biosense, which provides a 24-hour graph in-app to see your progression throughout the day [8:00]
  • How the Biosense device is providing agency to allow people to decide for themselves by seeing feedback throughout the day to know what the consequences of their actions are and act accordingly for their goals [8:25]
  • Jim Howard educates how Biosense technology testing differs from acetone testing due to Biosense using a deep lung air sample with a closed flow cell so it’s not sampling ambient air [9:18]
  • This device can fit in your pocket and only weighs a couple of ounces so it can be utilized anywhere and is the only device out there backed by a clinical trial [10:15]
  • Biosense can be purchased as a consumer or clinic use and is involved in 4 upcoming trials as a non-invasive testing device [11:00]
  • How much higher compliance is for use due to the non-invasive testing [12:20]
  • How clinics and coaches can see the data from their patients throughout the day and correlate it with the food, insulin and other metrics they have to see how compliant patients are and how effective their protocol is [12:30]
  • That testing can show more visibility of how compliant a client is throughout the day, rather than just once a day testing [13:10]
  • About a clinic in Washington State that was able to adapt to virtual visits early and roll out the program seamlessly while having patients track their breath ketones at home easily as well as other metrics that is using Biosense technology [14:13]
  • Looking at adherence to the program as the patients are able to give feedback, knowing that they are going to test throughout the day [15:25]
  • About the coach-client compliance and improved results as clients can start to make their own connections between diet, sleep, exercise and ketones [17:00]
  • About the effects of being home due to COVID-19 and how rebuilding your immune system and metabolic health will be key to returning to the world and how to utilize Heads Up and Biosense as a strategy[18:20]
  • How COVID is shifting health responsibility back to the patient or client and that can be empowering if they choose [19:10]
  • That half of the population will be obese in the US by 2030 if we do not course correct with our diets and metabolic health [21:30]
  • How we may see more health plans and other organizations utilize these tools [24:50]
  • Biosense works with clinics for Alzheimer’s, diabetes, obesity, and oncology that are utilizing their device for ketogenic diet support [25:50]
  • How the device can easily be utilized while out running errands or at home increasing compliance [26:50]
  • The device is firmware updatable [27:20]
  • The device is available in the USA currently, just released in Canada, and coming to Europe estimated by the end of the year. [28:10]
  • The Biosense device gives you feedback that the test was performed correctly, with consistent accurate readings, and does not require calibration. [28:25]
  • Biosense offers a much more accurate reading as it’s measuring deep lung air, rather than just providing a red yellow green reading for example. [29:30]
  • Biosense is targeted to the consumer to use on a regular basis and expected to last at least 2 years before estimating that it will need to be recalibrated or tuned up. [30:30]

About Heads Up

Heads Up is a website designed to empower individuals who want to take a self-directed approach to managing their health. Instantly centralize your medical records, connect your favorite devices and apps (e.g., Oura, MyFitnessPal, Keto-Mojo, FitBit, Apple Health, MyMacros+, Withings and many more) and use your data to optimize your health.

Click on the button below to start your free 30-day trial now!

Improving HRV, the Stress Response and PTSD with Apollo Neuro – Dr. Dave Rabin

Improving HRV, the Stress Response and PTSD with Apollo Neuro – Dr. Dave Rabin

Dr. Dave Rabin of Apollo Neuro is a psychiatrist and neuroscientist specializing in disorders of chronic stress, who has utilized MDMA and ketamine in the treatment of PTSD and depression to calm the nervous systems stress response.  After running clinical trials at the University of Pittsburgh and finding that the fight or flight system could also be calmed through the use of a wearable device, he set out to bring a device to the market that helps towards improving HRV. This allows individuals suffering from PTSD, ADD, anxiety, and even high-level executives and elite athletes with high stress response, to use the sensation of touch to recreate a feeling of safety, changing the response the body creates to a stimulus. 

Measuring HRV can give a quantifiable measure of how effective the device is in altering the stress response and allows individuals to improve conditions they’ve been told they must just live with. Dr. Dave Rabin gives a great explanation of HRV and how it differs from Heart Rate and why HRV is an important indicator of recovery and the ability to slow down the nervous system from stimuli. 

Listen in as Heads Up Founder Dave Korsunsky talks with Dr. Dave Rabin of Apollo Neuroscience on his own experience with the Apollo wearable device and how it actually feels to use it. It is Dr. Dave Rabin’s belief that as recovery is enhanced, improving HRV, people will begin to understand and reach their fullest potentials.

Listen in iTunes!

This podcast is brought to you by Heads Up, a web app designed to help you centrally track all of your vital health data. Instantly synchronize your medical records, connect your favorite health devices and apps, and use your data to optimize your health!

Click on the button below to start your free 30-day trial. Or, read on for more information about our latest podcast episode!

START TRACKING!

In this podcast you’ll learn:

  • How stress makes chronic disease and mental health worse, especially chronic stress that happens multiple times a day [3:05]
  • Dr. Dave Rabin works with high-level executives with high stress, as well as people with PTSD, chronic depression/anxiety and substance abuse disorders and notices that commonality between these disorders [3:55]
  • That Apollo Neuro came out of his work at the University of Pittsburgh, where they were trying to develop new strategies to help improve recovery and balance in the nervous system [6:00]
  • How Dr. Dave Rabin looks at stress holistically, as a clinical psychotherapist and psychiatric neuroscientist, to help modulate the central nervous system from high-performance athletes to people with mental health disorders [6:15]
  • That Dr. Dave Rabin is trained to use MDMA for PTSD which is in phase 3 trials with the FDA and ketamine for the treatment of depression which can induce dramatic radical change within a single session that is likely to be measurable with things like HRV [7:20]
  • That metrics that can be tracked while utilizing alternative therapies such as MDMA and ketamine, as people with these chronic conditions of stress have chronically low HRV [8:40]
  • That those with PTSD will have some of the lowest HRV as they are always in a state of hypervigilance – high fight or flight, low recovery state, but when they are shown compassion or touch from loved ones, meditation, etc, they feel better and HRV goes up [10:03]
  • Apollo was created to allow people to recreate the feeling of safety allowing the body to come out of the fight or flight pattern and into a recovery pattern at home and not just while in therapy [11:30]
  • Apollo is not a substitution for meditation, but it can be used more as a tool to guide people through the stressors and understand that you can do it on your own and people seem to be able to train to it over time [14:10]
  • What is Heart Rate Variability (HRV) vs Heart Rate (HR) [15:35]
  • About how the Apollo wrist or ankle worn device brings awareness to the body when the heart rate changes to allow the brain to evaluate if the perceived stress is useful or not [19:10]
  • Apollo was tested in double-blind randomized placebo clinical trial studies at the University of Pittsburgh and found that Apollo was improving HRV within 3 minutes under stress [20:15]
  • Dave describes the sensation of what it feels like to wear the Apollo device [21:00]
  • Why Dr. Dave Rabin started Apollo Neuro to bring the technology to the market himself [24:16]
  • Dave Korsunsky’s seal of approval on the Apollo device and where you can find and purchase the device [28:40]

References

www.apolloneuro.com

Follow Dr. Dave Rabin on Twitter

Follow Apollo Neuro on Instagram

Apollo Blog Post Together All The Time, How to Make it Work

Apollo Blog Post Strengthening Your Immune System

Apollo Neuro Blog

About Heads Up 

Heads Up is a website designed to empower individuals who want to take a self-directed approach to managing their health. Instantly centralize your medical records, connect your favorite devices and apps (e.g., Oura, MyFitnessPal, Keto-Mojo, FitBit, Apple Health, MyMacros+, Withings and many more) and use your data to optimize your health.

Click on the button below to start your free 30-day trial now!

START TRACKING!