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December 20, 2012

How Do I Know If I Have Silent Inflammation?

have silent inflammationDo You Have Silent Inflammation?

In Silent Inflammation And Chronic Disease and How To Treat Silent Inflammation we discussed what silent inflammation is, what causes it, and how to treat it.

But, how do you know if you have silent inflammation? Today we are going to answer that question. Laboratory tests and your responses to certain questions can help determine if you have silent inflammation.

First, for the questions you should ask yourself. These questions are modified from  The Anti-Inflammation Zone, by Barry Sears, PhD. “Yes” to three or more questions increases the chances you have silent inflammation.

You Might Have Silent Inflammation If You…

  • Are overweight
  • Crave carbohydrates
  • Are constantly hungry
  • Are tired especially after exercise
  • Have brittle finger nails and limp hair
  • Need a lot of sleep
  • Are constipated
  • Are groggy when first you wake up
  • Lack mental concentration
  • Have headaches
  • Have dry skin
  • Are a red-neck (couldn’t resist)

Blood Markers for Silent Inflammation

Silent Inflammation Profile (AA:EPA Ratio)

The best test, but one that is not easy to obtain, is simply called the Silent Inflammation Profile (SIP). If you ask your physician about it, he or she may not know what you are talking about. SIP measures the ratio of the pro-inflammatory eicosanoids versus the anti-inflammatory eicosanoids. This is done indirectly as eicosanoids are fleeting hormones that last a few seconds making them challenging to measure.

But, arachidonic acid (AA) is the source of pro-inflammatory eicosanoids and can be measured. EPA (eicosapentaenoic acid) is an anti-inflammatory omega-3 fatty acid and is a source for the anti-inflammatory eicosanoids. EPA can also be easily measured in the blood. So SIP is the arachidonic acid: EPA ratio. That ratio for many Americans is 20:1. Ideal is 1.5:1 and less than 3:1 is good.

Your physician may have the ability it to order it as the AA:EPA ratio. Plus, a Google search will take you to specialized clinical labs that offer the test. Some of them can send you a blood test kit that you can do yourself and send back to them, or direct you to a laboratory blood draw center and have your blood sample sent to them for analysis.

There are other more indirect biomarkers of silent inflammation that physicians routinely obtain for reasons other than gauging silent inflammation. These include:

  • Fasting insulin levels
  • Triglyceride (TG) to HDL ratio
  • High sensitivity C-reactive protein (hs-CRP)
  • Percent body fat
  • Waist size

Fasting Insulin Levels

From the previous posts we discussed that insulin is pro-inflammatory. We need insulin to drive glucose from the blood into the cells for energy. But, you want the least amount of insulin to successfully do this.

Ideally, you want fasting insulin levels below 5 uIU/ml. This is far lower than the 12 uIU/ml that is considered normal. The risk of developing chronic disease does not bottom out until levels of 5 uIU/ml are reached. Levels of 12 uIU/ml simply put you at average risk. Below 5 uIU/ml puts you at optimal risk.

TG/HDL Ratio

This can be calculated easily from your lipid or cholesterol panel as both are measured. Levels above 2:1 indicate you have some silent inflammation. The TG/HDL ratio coincides with insulin levels. The average American has a ratio of 3.3. The higher your TG/HDL ratio the more bad LDL cholesterol (small and dense) particles you make. Fish oil is great for lowering triglycerides.


High sensitivity C-reactive protein is another inflammation marker. There is a less sensitive CRP which is not sensitive enough to be clinically useful, but it’s the one insurance companies will pay for.  Many will not pay for hs-CRP (consider paying for it out-of-pocket if necessary). A high sensitivity CRP level less than 2 mg/L is good, but under 1 mg/L is optimal. The non-sensitive CRP only tells you if you’re above or below 5 mg/L. Again, this is the difference between being at average risk or optimal risk for heart disease and other chronic diseases.

Percent Body Fat and Waist Size

These are weaker indicators of silent inflammation but easy to obtain. Waist size can be measured with a tape measure and is measured either at the level of your belly button or the half way point between your lower rib and the tip of your hip bone (iliac crest). For men a waist size less than 40 inches is good, but less than 35 inches is optimal. For women, less than 35 inches is good and less than 30 inches is optimal.

There are various ways to determine percent body fat. See What’s The Best Way To Measure Body Fat? For men, less than 15% is good and less than 12% is optimal. For women, under 22% is good and less than 20% is optimal.

Silence is not Golden When it Comes to Inflammation

If you have symptoms or biomarkers to suggest silent inflammation it doesn’t mean you’re destined to always have it. Silent inflammation is very much under your control. Go back and read How To Treat Silent Inflammation. Reducing silent inflammation is most likely the single best act you can do to improve your health. Sometimes silence isn’t so golden.

See related articles.

How To Treat Silent Inflammation

Silent Inflammation And Chronic Disease








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Dr. Joe Jacko

Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio at Grandview Primary Care. Read more about Dr. Joe Jacko

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