How to work out your neutrophil to lymphocyte ratio (NLR)

Your neutrophil-to-lymphocyte ratio (NLR) can tell you about inflammation in your body. This basic ratio can help you to monitor your long-term health, alongside other markers. 

We’ll review how to work out and improve your NLR, which may be useful if you’ve just had a Full Blood Count or Longevity Blood Test. 

• NLR: a marker of inflammation  
• Healthy NLR results 
• High NLR results 
• How to work out your NLR 
• Four ways to improve your NLR
• Blood tests for NLR

NLR: a marker of inflammation

What are neutrophils? 

Neutrophils are the most abundant type of white blood cell in your body. They are the first to help your body fight infection, and you can be more vulnerable to illness and infection when they are low. 

Neutrophils secrete inflammatory mediators that protect your body from infection and illness. However, excessive levels of inflammatory mediators can affect vascular wall integrity. 

What are lymphocytes? 

Lymphocytes are another type of white blood cell. They produce antibodies and memory cells to help prevent future infections. 

A low lymphocyte count can sometimes be an early marker of physiologic stress. That's because raised cortisol levels can reduce your levels of lymphocytes. 

NLR: a marker of inflammation  

Your NLR can be a helpful marker to indicate whether you: 

• Are overtraining 
• Have acute or chronic inflammation  
• Are at a greater risk of developing some diseases 

How does NLR link to overtraining? 

NLR increases after exercise, with high-intensity (HIIT) exercise causing the most significant spikes. So, you need to be mindful that you may get a high result if you take a test soon after a HIIT workout.  

A persistently high NLR, or high result when you aren't expecting one, may indicate that you are overtraining. If your body is under stress because of overtraining, you can be at an increased risk of infection or injury. 

In context with your other health markers, this is all pretty useful. However, NLR won’t be able to tell you about any tissue damage or repair processes. 

Healthy NLR results

What’s a normal NLR result? 

A normal NLR range is roughly between one and three. A low NLR result suggests you have lower levels of inflammation in your body.  

NLR result ranges [1]: 

NLR	Result
<0.7	Significantly low NLR (likely pathological)
07-1	Low-normal NLR
1-2	Normal NLR
2-3	Raised NLR
>3	Significantly raised NLR (likely pathological)

 

NLR results tend to be lower in:  

• People of African-Caribbean or black African origin 
• People who do vigorous activity 
• Women 

Occasionally, a viral infection may cause a low NLR. If you have recently been unwell, it’s worth checking when you are better to make sure your result has improved. 

High NLR results

Raised NLR indicates higher levels of inflammation. The inflammation could be acute (short-term) or chronic (long-term).  

Reasons for temporarily raised NLR:  

• Corticosteroid medications 
• Flare-ups of inflammatory conditions 
• Pregnancy  
• Recent illness (particularly bacterial infections) 
• Strenuous exercise 

A chronically raised NLR may put you at greater risk of developing some conditions linked to chronic inflammation, including: 

• Heart disease 
• High blood pressure 
• Diabetes 

You can reduce your risk of these conditions by making healthy lifestyle changes. Lowering your NLR may be particularly beneficial if you already have a chronic condition, such as diabetes or cancer. 

How to work out your NLR

Your NLR is as easy as dividing your neutrophil result by your lymphocyte result. Just make sure they are both in the same units.  

Alternatively, you could use a ready-made calculator like this one from MDCalc.  

What can affect my NLR result?  

NLR can vary depending on your ethnicity. Non-Hispanic black people tend to have a lower result than white people. A study showed black participants’ average NLR result was 1.76 compared to 2.24 among white participants2.  

Many studies don’t yet consider multi-ethnic cut-off points. This means that black people who fall into a normal NLR range may have a similar risk to white people with a higher NLR.   

Aside from ethnicity, some conditions that affect cell count may give a skewed result. These include conditions like HIV and blood cancers. 

Can I improve my NLR result? 

Healthy lifestyle changes that address your inflammation and cardiovascular risks can help to improve your NLR result.  

Four ways to improve your NLR

 

1. Eat a varied diet rich in anti-inflammatory foods  

The Mediterranean diet is a good plan to follow to get more natural, whole foods into your diet. This can improve your gut biodiversity, which may lower your NLR. [3]  

The Mediterranean diet focuses on eating: 

• Seasonal fruits and vegetables 
• Nuts and seeds 
• Olive oil 
• Quality lean meat, fish, and dairy (if you eat them)  

An anti-inflammatory diet may also reduce NLR. We list how to follow this diet on our foods to control inflammation blog.  

2. Start regular HIIT  

In the long term, high-intensity training (HIIT) can significantly reduce NLR. People who took part in a three-week study saw up to a 95% improvement in their result. In comparison, moderate continuous training only slightly reduced NLR [4]. Note, that taking a blood test shortly after a HIIT workout is likely to produce a raised result, due to the short-term inflammation that follows intense exercise. It’s best to wait until you’ve fully recovered, and any inflammation has settled.  

Learn more about HIIT and how to get started in our AMRAP, EMOM, WOD, and TABATA blog.  

3. Quit smoking  

Smoking can increase inflammation and your risk of many diseases like heart disease, metabolic disease, and cancer.  

On the plus side, NLR can significantly reduce after just three months of quitting smoking. [5]  

4. Take your vitamin D  

Vitamin D is crucial for helping control infections and reduce inflammation. One study found that taking high-dose vitamin D for three months can significantly decrease NLR [6].   

 

Is NLR accurate?  

NLR can help build an overall picture of your health, but you shouldn’t look at it in isolation.  

For instance, NLR rises during pregnancy and peaks during the second trimester [7]. Recent illnesses, blood disorders, and even exogenous corticosteroids can affect your results. A chronic inflammatory condition like rheumatoid arthritis or diabetes mellitus can also raise your result. 

Overall, NLR can be a good tool in your box of resources to help maximise your longevity and healthspan.  

 

Blood tests for NLR

You can get all the information from a Full Blood Count Blood Test to work out your NLR. Or any test that measures your white blood cell count. 

Our Optimal Health Blood Test is our most comprehensive home blood test for healthspan and lifespan. You can measure your overall health and long-term disease risk, including working out your NLR. Remember to fill in your health and lifestyle information so that our doctors can accurately report on your results. 

 

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References 

1. Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy. 2021;122(7):474-488. doi: 10.4149/BLL_2021_078. PMID: 34161115.
2. Azab B, Camacho-Rivera M, Taioli E. (2014). Average Values and Racial Differences of Neutrophil Lymphocyte Ratio among a Nationally Representative Sample of United States Subjects. *PLoS One*, 9(11), e112361. [PubMed]
3. Yoon HY, Kim HN, Lee SH, Kim SJ, Chang Y, Ryu S, et al. (2018). Association between Neutrophil-to-Lymphocyte Ratio and Gut Microbiota in a Large Population: a Retrospective Cross-Sectional Study. *Sci Rep*, 8(1), 16031. [PubMed]
4. Joisten N, Proschinger S, Rademacher A, Schenk A, Bloch W, Warnke C, et al. (2021). High-intensity interval training reduces neutrophil-to-lymphocyte ratio in persons with multiple sclerosis during inpatient rehabilitation. *Mult Scler*, 27(7), 1136–9. [PubMed]
5. Komiyama M, Ozaki Y, Miyazaki Y, Katanasaka Y, Sunagawa Y, Funamoto M, et al. (2021). Neutrophil/lymphocyte ratio is correlated with levels of inflammatory markers and is significantly reduced by smoking cessation. *J Int Med Res*, 49(6), 03000605211019223. [PubMed]
6. Tabatabaeizadeh SA, Avan A, Bahrami A, Khodashenas E, Esmaeili H, Ferns GA, et al. (2017). High Dose Supplementation of Vitamin D Affects Measures of Systemic Inflammation: Reductions in High Sensitivity C-Reactive Protein Level and Neutrophil to Lymphocyte Ratio (NLR) Distribution. *Journal of Cellular Biochemistry*, 118(12), 4317–22. [PubMed]
7. Hershko Klement A, Hadi E, Asali A, Shavit T, Wiser A, Haikin E, et al. (2018). Neutrophils to lymphocytes ratio and platelets to lymphocytes ratio in pregnancy: A population study. *PLoS One*, 13(5), e0196706. [PubMed]