How to Track Inflammation in ME/CFS, Fibro, and Long COVID

Fibromyalgia, chronic fatigue syndrome (ME/CFS), and long-haul COVID are increasingly recognized as inflammatory conditions. Research shows they involve a chronic imbalance of pro-inflammatory cytokines, immune activation, and oxidative stress (Maes & Twisk, 2010; Komaroff & Lipkin, 2021; Peluso et al., 2022). In general, the more severe the illness, the greater the inflammatory burden appears to be.

Reducing this persistent inflammation through diet, supplements, or medications may help improve symptoms. But how do you track whether these interventions are actually working?

While some studies focus on neuroinflammation (inflammation in the brain), which requires advanced imaging equipment like PET scans, something far out of reach for most patients. Fortunately, there are blood-based markers that can provide insight into systemic inflammation and immune activity.

These tests aren’t perfect. But they’re widely available, and when used over time, they can help monitor the inflammatory trends of people living with ME/CFS, fibromyalgia, or long COVID.

Blood Tests to Track Inflammation

You or your healthcare provider can order these lab tests to check your baseline status and again after any anti-inflammatory intervention, such as:

• Starting an anti-inflammatory diet

• Taking supplements like quercetin or curcumin

• Beginning immune-modulating medications, like LDN

Some of these tests are available through patient-direct labs in the U.S.

Core Inflammation Markers

• hsCRP (High-Sensitivity C-Reactive Protein)

A widely used marker of low-grade inflammation, hsCRP has been found elevated in some individuals with ME/CFS (Fletcher et al., 2009) and may be useful to track over time, even if levels are only modestly increased.

• ESR (Erythrocyte Sedimentation Rate)

A more traditional test that can increase in systemic inflammation. While often normal in fibromyalgia, ESR may be elevated in certain postviral cases (Maes & Twisk, 2010).

• GlycA (Glycoprotein Acetylation)

This newer marker reflects chronic immune activation and is more stable than CRP (Otvos et al., 2015). It’s not available everywhere but can be a sensitive indicator when accessible.

Oxidative Stress and Immune Activation

• Homocysteine

Elevated in ME/CFS and linked to neuroinflammatory symptoms (Blomberg et al., 2018). Homocysteine also reflects methylation status and B-vitamin sufficiency.

• LDH (Lactate Dehydrogenase)

Often underutilized, LDH can reflect tissue stress and mitochondrial dysfunction, especially in fibromyalgia (Sánchez-Morla et al., 2018).

• Uric Acid

High levels are associated with oxidative stress and have been linked to metabolic dysfunction in postviral syndromes (Sánchez-Morla et al., 2018).

Nutritional and Immune-Related Inflammation Markers

• Ferritin

Often elevated during inflammation as it is an acute phase reactant. Ferritin may also rise in long COVID, potentially masking iron deficiency (Zhang et al., 2022).

• Vitamin D (25-OH D)

Low vitamin D status is common in ME/CFS and contributes to immune dysregulation and chronic inflammation (Fukuda et al., 2019).

• Albumin and A/G Ratio

Albumin tends to fall in systemic inflammation, while the albumin-to-globulin (A/G) ratio may be reduced in chronic immune activation (McPherson & Pincus, 2016).

Cardiometabolic Inflammation Markers

• Omega-3 Index or AA/EPA Ratio

The omega-3 index provides insight into dietary inflammation and has been used in studies examining fatigue and mitochondrial support (Otvos et al., 2015). A higher ratio of EPA to AA is associated with lower inflammatory activity.

• Fibrinogen

This coagulation factor is also a marker of systemic inflammation and may be involved in microclotting or hypercoagulability in long COVID (Zhang et al., 2022).

• HbA1c

Chronic high blood sugar increases glycation and inflammation. HbA1c is often overlooked in fatigue-related conditions but may correlate with worsening oxidative stress (McPherson & Pincus, 2016).

• Triglycerides

Frequently elevated in inflammatory metabolic states, triglycerides can improve with anti-inflammatory diets, omega-3 intake, and improved mitochondrial health.

White Blood Cell Count with Differential

WBC patterns may reflect immune dysregulation, such as low neutrophils, elevated monocytes, or lymphocyte shifts common in postviral or chronic immune conditions (Komaroff & Lipkin, 2021).

Monitoring Progress Over Time

Inflammation in fibromyalgia and postviral illness is complex and systemic. No single lab test will give you the full picture, but tracking a few key markers can help show whether your treatments are moving the needle.

Retesting after 8 to 12 weeks of any new intervention (diet, supplement, or medication) can help you and your provider evaluate what’s working and what’s not.

Final Thoughts

Many people with ME/CFS, fibromyalgia, or long COVID are told their labs are “normal,” even while experiencing severe symptoms. But standard panels often miss the subtle, low-grade inflammation that defines these conditions.

When interpreted in context, these advanced inflammatory markers offer valuable insight into your current health status and response to treatment. They’re not just data points—they’re tools to help guide your recovery.

References

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Komaroff AL, Lipkin WI. Insights from myalgic encephalomyelitis/chronic fatigue syndrome. JAMA. 2021;325(14):1344–1345. PMID: 33787847

Peluso MJ, Deeks SG, Mustapic M, et al. SARS-CoV-2 and mitochondrial health: persistent inflammation and cytokine changes in long COVID. Nat Commun. 2022;13(1):4829. PMID: 35940420

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Blomberg J, et al. Infection elicited autoimmunity and ME/CFS: an explanatory model. Front Immunol. 2018;9:229. PMID: 29541048

Otvos JD, et al. GlycA: A composite NMR biomarker of systemic inflammation. Clin Chem. 2015;61(5):714–723. PMID: 25647771

Sánchez-Morla EM, et al. Oxidative stress and mitochondrial dysfunction in fibromyalgia. Neurochem Res. 2018;43(1):76–84. PMID: 28956258

Zhang X, et al. Ferritin as a risk factor in post-acute COVID-19 syndrome. Front Med. 2022;9:826345. PMID: 35371139

Fukuda N, et al. Association between serum 25-hydroxyvitamin D and fatigue in patients with chronic fatigue syndrome. BMJ Open. 2019;9:e032723. PMID: 31857346

McPherson RA, Pincus MR. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. Elsevier; 2016.