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

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

Guest post by Dr. Nasha Winters

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.

<This video> will show you how to track lab values and customize ranges in your Heads Up profile.


Dr. Nasha Winters

Guest Lecture: Nutrition & CBC Blood Testing

New to Health Coaching?  The Best Health Coach Tools to Keep You  (& Your Clients) Thriving

New to Health Coaching? The Best Health Coach Tools to Keep You (& Your Clients) Thriving

The health and wellness market is absolutely exploding, now estimated at $4.2 trillion as of 2019. It wasn’t that long ago when being “healthy” meant hitting the gym and getting an occasional massage. Today, however, the wellness mindset is permeating the global consumer consciousness, so it’s no surprise that right along with it has come the explosive growth of health and wellness coaches for hire. 

If you’ve jumped into the health coaching game with gusto, then finding the best tools for your health coaching business is just as important as finding your first clients. That’s not only good for business, it’s great for your soon to be clients because once you get going, it’s easy to quickly get lost in the weeds. The good news is that there are some useful coaching tools to help you get organized while streamlining critical aspects of the business such as communicating with clients, scheduling, promoting, and tracking client progress. 

So you don’t get bogged down in tool reviews, here’s the low-down on the best we’ve tools we’ve found to fast-track your way to productivity, so you can spend more time focused on helping clients and less time in the admin details. 

Scheduling, Organizing & Communication Tools for Health Coaches


Evernote is a note-taking and task management app that gives you an easy way to take notes, share with clients, and keep an organized to-do list. One of the best features is the sync across devices, so you always have access, even when on the go. 

Cost: Free version; PRO upgrade option for added features

Acuity Scheduling. We’d probably all love it if email disappeared from our work lives, and although that may not quite be the case yet, Acuity Scheduling software lets your clients book appointments with you directly instead of doing the back and forth dance through email or SMS.

Cost: Free version for solo use; plans start at $15/month for added features.

Bookly is an appointment and scheduling plugin for WordPress websites which creates a form that you can easily add to your site to handle booking, cancellations, and re-scheduling, so it’s all automated. The system also handles online payments, notifications, and syncs with your Google calendar. 

Cost: $89 regular license with 6 months support included; WooCommerce integration; 12 languages

Practice Better is online coaching software specifically designed to help manage a variety of aspects of a health coaching business, including managing 1-on-1’s with clients and managing your online coaching. The free version lets you manage up to 3 clients, storage space, HIPAA and PIPEDA compliance, scheduling, billing and a client portal.

Cost: Free version up to 3 clients, storage, compliant iOS and Android apps and more; upgrade for additional features.

The Coaches Console

If you’re feeling overwhelmed by the number of tools you need to manage a coaching business, not to mention the costs, then consider The Coaches Console, an all-in-one platform for managing nearly every aspect of your new coaching business. 

Cost: Core system is $147/month; upgraded system is $247 per month.

Meeting with your clients regularly is obviously vital, but staying in touch with them via a video conferencing tool is a great way to stay connected more frequently without the travel time. Zoom is a user-friendly video conferencing tool that lets you and clients host and attend web conferencing easily on any device, including tablets and smartphones.

Cost: Free version for 1-on-1 calls for up to 40 minutes; upgrade plan options starting at $14.99/month.

Marketing & Social Media Tools for Health Coaches


Social media is essential for promoting your new business and being easily found, but it can take a lot of admin time. Tools like Buffer let you create posts and custom images and schedule them out over time, so you can crank out social media content like a pro, and look like you’re posting all week, even when you’ve spent just 30 minutes on it the week before. 

Cost: $15/month basic plan; upgrade plans available for more users, posts and social accounts.


Another social media automation tool, Edgar lets you create and schedule evergreen posts, as well as update your status in an automated way so you can control your brand reputation while looking like you’re on top of regular status updates.

Cost: One month free; plans starting at $25/month.


Smart marketers and entrepreneurs understand the power of growing your email database over time. SumoMe is a free email capture tool for adding simple pop up forms to a website. Ideally you offer your web visitors something of educational value or an ‘opt-in’ offer, and they ‘trade’ you their email for the offer. That gives you a captive audience of prospects to stay in contact with over time. 

Cost: Free basic plan; upgrade options to remove Sumo branding and customize more on your web forms.


Marketing automation is another important way to stay in front of clients and prospects, so once you’ve grown your email database with a tool like SumoMe, you can stay in touch regularly with contacts through newsletters, special offers, and more. 

Cost: Free plan; upgraded plans start at $9.99/month as your database and automation needs evolve.


Canva is an online design tool that expedites the custom image creation process with a do-it-yourself way to create custom images for everything from brochures and business cards to YouTube thumbnails, Facebook page graphics, social media ads, and more. Templates for every type of graphic are provided along with access to free stock images you can use. 

Cost: Free plan for individual users; Pro plan starts at $12.95/month for added features.

Boomerang for Gmail

Yes, we all wish email was a thing of the past, but frankly, it’s just not yet. So, this cool little tool for Gmail helps you better manage your inbox with read receipts, email scheduling, email reminders, and prompts. You can set follow up reminders so you never forget to circle back when you need to again.

Cost: Free basic version includes up to 10 email credits; upgrade plans available for unlimited starting at $4.99/month.

Client Progress Tracking & Measurement Tools for Health Coaches

As a new health coach, tracking client progress is mission-critical to demonstrating your value over time, and therefore, to maintaining a healthy pipeline of recurring revenue and a solid way to gain word-of-mouth referrals. Using the above-mentioned Coaches Console is certainly one way to do that all in one system, and there are a lot of health coaching practice apps on the market too.

Practice management apps have important features to streamline the business admin side of your practice, such as processing client intake forms, logging and sharing goals and meal plans, keeping client charts (securely), sending and processing invoices, email marketing and client scheduling. Take a look at several well-balanced tools that offer such features including Healthie, SimplePractice, MindBody, Trainerize and Cliniko.

And yes, all that’s required to build a successful coaching business, but what about tracking client’s health metrics so clients also have a clear view of how your efforts are helping them reach their goals? You could do everything else right, but if you’re clients don’t see real, measurable results from your work with them, it will be challenging to retain them over the long haul. Arguably, keeping tracking of their health metrics is the #1 thing you can and should be doing.

Try Heads Up (free for 30 days), a health metrics dashboard app designed to help users optimize their health. The system integrates with a wide variety of other niche health tracker apps and wearable devices so you can see all of your client’s health metrics in one place, via the web dashboard, or for quick views from the mobile app (for iOS and Android) that’s synced across devices.

Ready to Go?

Your new health coaching career will be off to the races with the right tools in place to help you more easily manage the day to day aspects of the business, and a few key tools to track client progress. All of that will be well worth it so you can clearly demonstrate your value over the short and long haul… which is precisely how you retain clients and secure positive referrals. 

The key to success will be finding ways to simplify and streamline your daily to-do list, and most importantly, finding ways that work with your style and comfort level with just how ‘teched-up’ you want and need to be. 

Health coaches can grab a 30-day free trial of Heads Up, and trials and/or free versions of many of the tools listed above. 

Happy Coaching My Friends, and Namaste!

?? Dave

How an Innovative Cryotherapy Center Uses Data to Personalize Client Recovery Programs

How an Innovative Cryotherapy Center Uses Data to Personalize Client Recovery Programs

Huemn is an innovative health and wellness cryotherapy center focused on providing clients with a non-invasive, drug-free, natural way of recovering from athletics, injuries, pain and inflammation. Using a variety of non-toxic, natural interventions that trigger the human body’s innate healing systems, such as cryotherapy, photobiomodulation, oxygen therapy, neurotherapy, and lymphatic drainage, the company’s value is in bringing advanced, all-natural remedies to clients at an affordable price.

The Challenge

Although the popularity of natural healing therapies is on the rise as many people seek alternatives to surgery and medication, it’s not uncommon for such health trends to come and go quickly. The Huemn team knew that in order to build a successful, long-term business, however, they needed an easy and predictable way to monitor the positive impact that their therapies were providing their clients. Such a solution would not only demonstrate the value of the client’s investment, but it would also allow them to cross-reference the benefits of their healing modalities with other health metrics such as sleep quality, inflammation levels and heart rate variability (HRV).

The Solution

Huemn found Heads Up, a personal health platform that makes it super easy to track and analyze health data for actionable insights on therapies and lifestyle changes that most positively impact one’s health. The goal of the project was to design a customized solution for Huemn that made it possible to track and validate their cutting-edge proprietary programs and protocols at the aggregate group and individual levels. The solution comprised of two components: a backend system  that enabled the Huemn team to customize their protocols and track client sessions; and a frontend interface for their clients to be able to easily add their favorite health apps and devices, view their health data in one single dashboard and track their improvements over time using Huemn’s healing programs.

Data-driven Programs & Protocols

One of the core principles of Huemn’s approach to recovery is supporting the body’s natural systems wholistically and synergistically. To achieve this, Huemn provides personalized programs for clients based on regular sessions of cryotherapy, oxygen therapy, neurotherapy and photobiomodulation, to name a few.

To validate the effectiveness of these four cutting-edge protocols, Heads Up built custom modules that made it easy to input data for each client session and track the progress they made toward achieving their recovery goals. With this data in hand, Huemn’s team of wellness experts are able to analyze the data for key patterns and trends on the particular lifestyle interventions that are having the most positive impact on a client’s ability to become fully recovered and rejuvenated.

Click on the images below to view customized recovery modules in detail.


With Huemn’s core protocols and input modules in place, it became much easier for practitioners to store client session data and track their progress over time on each protocol. For more advanced analysis, Heads Up team developed an analytics tool that made it super easy to analyze the impact each of Huemn’s protocols were having on their client’s physiology and recovery status.

Client Engagement Tools For Better Outcomes

With practitioner tools in place, the Heads Up team designed a beautifully simple end-to-end experience. The goal was to leverage user data to drive client retention and accountability for better health outomes. This comprised of personalized dashboards that displayed Huemn’s core recovery protocols, and weekly progress reports to drive client engagement and intrinsic motivation.


Client dashboards were meticuosly designed to visually present a user’s health data in the most easy to understand way possible. It included singular scores as well as trends across historical timelines. In conjuction with the dashboards, a personalized weekly progress report automatically gets send out regualarly. These reports help keep clients motivated and engaged knowing that they are making progress toward their health goals.

The entire user journey from sign in to sign out was custom designed according to Huemn’s modern brand aesthetics. 

Click on the images below to view how we customized Huemn’s onboarding process for a highly pesonalized user experience.

Moverover, the platform was architechted so that both practitioners and clients would have a seamless experience across desktop, mobile and tablet.

Click on the images below to view Huemn’s custom designed light and dark themes.

Stay tuned as we dive deeper into Huemn’s story. In part 2, we will provide a comprehensive analysis of the metrics Huemn used to quantify their cutting-edge protocols and the outcomes they were able to achieve with clients that completed their recovery programs.

About Heads Up

Heads Up is a web and mobile platform for next-gen healthcare professionals who want to take a personalized and preventive approach to optimizing the health and wellness of their clients using science and data. Get a complete picture of your client’s health story by combing lifestyle data with clinical outcomes. Instantly centralize all client medical records, connect popular devices and apps (e.g., Oura, MyFitnessPal, Keto-Mojo, FitBit, Apple Health, MyMacros+, Withings and many more) and use data to optimize your client’s health.

To learn more about how Heads Up can help you grow your health and wellness business or to schedule a call with a success agent, visit