Do You Have Silent Inflammation?

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

But, how can you tell if you have silent inflammation since it is silent? Laboratory tests and your answers to specific questions can determine if you have silent inflammation.

Below are signs and symptoms of silent inflammation that are modified from  The Anti-Inflammation Zone, written Barry Sears, PhD. If you have three or more of the following you likely have silent inflammation.

  • are overweight
  • crave carbohydrates
  • are constantly hungry
  • are tired especially after exercise
  • have brittle finger nails and limp hair
  • need more sleep
  • are constipated
  • are tired when first you wake up
  • lack mental concentration
  • have headaches
  • have dry skin


Blood Markers for Silent Inflammation

Silent Inflammation Profile (AA:EPA Ratio)

The best test for silent inflammation  is simply called the Silent Inflammation Profile (SIP). Beware your physician may have never heard of SIP.  SIP measures the ratio of the pro-inflammatory eicosanoids versus the anti-inflammatory eicosanoids. This test is performed indirectly as eicosanoids are fleeting hormones that last a few seconds making them challenging to measure.

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 and can be measured in the blood. SIP is simply the arachidonic acid:EPA ratio. That ratio for many Americans is 20:1. The ideal ratio is 1.5:1 and less than 3:1 is good. Most Americans, however, have a arachidonic acid:EPA ratio greater than 20:1.

Ask your physician to obtain the AA:EPA ratio. An internet search will take you to specialized clinical labs that offer the test if your physician is unable to order it. Some of labs will send you a blood test kit that you can do yourself and send back to them. Or, you can go directly to a laboratory blood draw center and have your blood sample sent to a lab that offers the test for analysis.

Silent inflammation can be gauged by other indirect tests that physicians routinely obtain for reasons. 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

Insulin is pro-inflammatory hormone that regulates sugar metabolism. Insulin drives glucose from the blood into the cells for energy. The less insulin needed the better.

Ideally, fasting insulin levels should be below 5 uIU/ml. This is far lower than the 17 uIU/ml that is usually considered normal. The risk of developing chronic disease does not bottom out until insulin levels of 5 uIU/ml are reached. Levels of 17 uIU/ml simply put you at average risk. Below 5 uIU/ml puts you at optimal risk.

TG/HDL Ratio

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


High sensitivity C-reactive protein is inflammation marker more specific to heart disease. Some insurance companies 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 and under 0.5 mg/L is even better.

Percent Body Fat and Waist Size

Percent body fat and waist size are weaker indicators of silent inflammation but very easy to obtain. Waist size is 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 acceptable, but less than 35 inches is optimal. For women, less than 35 inches is acceptable 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, a body fat of less than 15% is good and less than 12% is optimal. For women, a body fat less than 22% is good and less than 20% is optimal.

Silent Inflammation Summary

If you have biomarkers consistent with silent inflammation it doesn’t mean you’re destined to always have it. You control whether or not you have silent inflammation. Read How To Treat Silent Inflammation. Reducing silent inflammation may be the most important step you take to improve your health.  Silence is not always golden.

Dr. Joe JackoDr. Joe is Joseph G. Jacko M.D.

He is board certified in internal and sports medicine and his main practice interest is helping patients achieve optimal health through hormone replacement therapy (men and women) and exercise and nutrition.

He is a certified fitness trainer through ISSA (International Sports Sciences Association).

Dr. Joe has given numerous talks on sports medicine, exercise, nutrition, and hormones. He has two chapters published in Hughston Orthopaedic Clinic: Sports Medicine Book and is in the process of writing his first book based on the content he has written for his personal website Live Long Stay Young.


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