An inflammation test is probably not the first thing you think of when it comes to measuring your health and wellness. More commonly used tests would be blood pressure, cholesterol or glucose, which are certainly important. However, in my clinical experience the most powerful marker of metabolic and cardiovascular disease is a biomarker known as the blood AA/EPA ratio.

Arachidonic acid (AA) is a fatty acid that initiates inflammatory responses in the body. Eicosapentaenoic acid (EPA) is a fatty acid that ‘turns off’ this inflammatory response. When the ratio of AA to EPA becomes unbalanced it leads to cellular inflammation. This isn’t an inflammation you really feel, it’s very low level. But the fact you don’t feel it is what makes it particularly insidious. Cellular inflammation underlies insulin dysfunction, vascular disease and even depression.

Below is  a table of AA/EPA ranges shown to be correlated with various health risk levels.

AA/EPA Ratio Cellular Inflammation Expected Wellness
1.5 to 3 Low Excellent
3 to 6 Moderate Good
7 to 15 Elevated Moderate
Over 15 High Poor

How to Improve Your AA/EPA Ratio

The AA/EPA ratio is highly controlled by diet. The #1 way to improve your ratio is by eating a non-inflammatory diet. The ideal diet is not high or low in protein, avoids highly processed grains and sugars and also limits Omega 6 and saturated fats. This will lower the AA portion of the ratio.

Eating more omega 3 fatty acid-rich fish and fish oil supplements will raise EPA. You should be taking steps to improve both sides of the ratio.

Now you can see why we start with this test as the foundation to an effective treatment and wellness protocol for all patients. Once you have your test reults, below is information on what it means and some more specific guidacne on diet.

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Understanding The Result of Your Inflammation Test

Arachidonic Acid (AA) and Eicosapentaenoic acid (EPA) are the two fatty acids most commonly made into eicosanoids. Eicosanoids control inflammation in the body. Pro-inflammatory eicosanoids come form AA. Too much AA leads to chronic disease.

Non-inflammatory eicosanoids come from EPA and inhibit the formation of AA. EPA also displaces AA in the cell membrane, resulting in less inflammatory response. Maintaining the right balance between these to fatty acids is paramount to health and longevity of the body.

Why Japanese Live Longer

Japan has the longest average lifespan and lowest rates of cardiovascular disease as well as lowest rates of depression. Coincidence? Hardly. The typical range of AA/EPA for the Japanese is 1.5 to 3. The average range of supposed healthy Americans is 12 or higher. You can look great in a bikini and still have an AA/EPA ratio in the 7 to 15 range. This means on the inside there’s a slow ‘metabolic fire’ in your cells and it’s only a matter of time before this shows up in your health.

With an ideal score of 2.2 for example, your AA levels would be at 9% and EPA levels at 4%.

In Americans with chronic disease it is common to see AA/EPA ratios in the 20’s! We are the most overweight AND inflamed population in the world. The two markers go hand in hand but the thing is you can lose weight and still be inflamed.

Is Too Low of an AA/EPA Dangerous?

Yes, there is definitely a floor to a healthy AA/EPA ratio. If it gets too low your body’s ability to defend against infection can be reduced. The inflammatory response is there for a reason, to defend ourselves from invaders and heal from injury. If we use the Japanese population as a model, the lower limit is around 1.5. From there, the higher it gets the more continuous inflammation you have and the faster your body is aging.

Dietary Guidance Based on Your Current Ratio

Arachidonic Acid (AA) Target Range 7-9%

If your AA level is over 9%, here are some dietary guidelines to lower to the ideal range. Limit your intake of fatty red meats, egg yolks and organ meats. Avoid sources of Omega 6 fatty acids such as common cooking oils (corn, sunflower, safflower, soybean). Focus your diet on fresh vegetables and fruits, lean proteins like fish and chicken plus sources of Omega 3 fatty acids such as fish, olive oil, avocados and nuts. Supplementing with a quality and certified form of fish oil can certainly be beneficial.

If it’s under 7%, you can raise it with occasional egg yolks.

Eicosapentaenoic Acid (EPA) Target Range Less than 4%

The primary source of EPA is fish and fish oil. EPA inhibits delta-5-desaturase, the enzyme that makes AA,, giving fish oil its anti-inflammatory effect.  Our general guidance is to supplement with 2.4 grams of EPA and DHA per day. Also be sure your fish oil is credentialed with appropriate purity standards.

AA/EPA Target Range 1.5 to 3

If your ratio is over 3, increase your intake of EPA and or decrease levels of AA in the diet.

It’s possible to get your ratio too low. If it’s under 1.5 you should decrease your intake of fish oil.

At our Wellness Institute, we help patients develop a customized and realistic plan to get their ratio into the optimal range with appropriate medical supervision. Each medical case is different and may require special considerations, please schedule an evaluation to learn more about your specific situation.

About Deepti Sadhwani, M.D.

deeptiprofilepicDr. Deepti Sadhwani is an Internal Medicine and Bariatric Medicine Board Certified physician with 15 years of experience. She is specialized in metabolic health, menopause and andropause management, weight loss and nutrition. At her practice in Sebastian and Vero Beach, FL, she treats all types of primary care conditions and offers a comprehensive preventive approach to achieving and maintaining your healthiest life.