What to do when your Labs are “normal,” but you still feel like trash
Have you ever waited weeks, or even months, to see your doc about your persistent, quality-of-life-reducing symptoms (like exhaustion, brain fog, PMS, heavy bleeding, digestion problems, or bad moods), only to get the old:
“Your labs look good. Try to reduce your stress. I can prescribe you the pill for your hormone symptoms.”
Buckle up! We’re getting into the topic that makes me the most rage-y of all!
When labs are “normal” but you still feel like shit.
This post comes with a hefty dose of NO, ACTUALLY, IT’S NOT NORMAL. And an action plan for how to get to the bottom of why you feel like roadkill.
Let’s dive in.
Why do your labs look normal but you definitely don’t *feel* normal? I see the same three reasons time and time again.
1. Your workup wasn’t thorough.
More often than not, my patients who go to their PCP or OBGYN with slightly vague but life-impacting symptoms are offered a couple of tests to rule stuff out. The lab list I usually see given in response to these symptoms is a CBC (Complete Blood Count) and a TSH (Thyroid Stimulating Hormone)—standard general health tests. The majority of the time these come back “fine” and that’s where the conversation ends. See ya next year.
The problem: That list is just so completely NOT thorough enough that it’s almost a joke. If you’re lucky, a few more are run—like an iron panel or a vitamin D test. These are heading in the right direction, for sure, but still not detailed enough to get a full picture.
2. Your labs actually aren’t optimal.
There’s a big difference between “you don’t have a diagnosable and treatable disease” and “you are the picture of health.”
The problem: Often the lab ranges are way too generous, and put results in the “normal” category when they aren't anywhere near optimal. Ferritin (the stored form of iron) is a great example here. A lab may call a result of 12 ng/mL normal, but *ideal* is over 50 ng/mL. I've worked with many women who are symptomatic with fatigue, hair loss, brain fog, and even depression and have "normal" levels of iron. Similar stories with thyroid labs and many other hormones.
3. Certain supplements, medications, or events happening in the body can alter labs.
For example, high-dose biotin can make thyroid labs go wild. Or, elevated inflammation can make iron labs look higher than they are.
The problem: If we just look at one tiny thing in isolation, we won't see the whole story. It’s all about the big picture and running enough labs so that we can read between the lines.
So, what to do?
First, I send my patients off with a big ass list of labs to request from their provider, as a general health screening. We also do functional lab kits that are sent straight to their homes (more on that in a moment).
Then we consider all of the results in context with their symptoms...we look at results that are abnormal and suboptimal results…and together, we come up with a plan.
I’m a fan of data. I’d rather have way too much info on you so I can connect the dots and make a thorough treatment plan, than not enough. The latter sets the stage for missing key information and for just shooting in the dark with treatment ideas. Lab results give us a blueprint of your body and what’s off balance. But only if we get enough info.
Sometimes multiple lab results are a bit “off” and the combination of them all tell a story. And other times, we find BIG things that are more medical in nature that need to be sent back to the doctor for further workups. I’ve found shockingly high inflammation rates, critically low levels of iron that needed transfusions, and blood in the stool that needed to be evaluated by gastroenterology. These were all really BFDs.
Often just showing up and asking your doctor for “the works” isn't quite clear enough. So, here’s the lab list I send all of my patients to their doctor with:
Full iron with ferritin
Full Thyroid Panel (TSH, Free T3, Free T4, rT3, thyroglobulin, TPO)
CBC
CMP (fasting)
hsCRP
A1c
B12
Vitamin D
Insulin (fasting)
Lipid panel (fasting)
(There may be more inflammatory or hormonal markers that I request as well, but that’s case by case.)
A lot of doctors have their hands tied with how insurance companies work, so sometimes, to get the whole list, you may need to be willing to pay out of pocket. From my experience though, this is 100% worth it to get answers on your health. If you have the budget for functional testing, this is also worth it. I do every single one of these tests on myself and some on my family every year!
Functional Tests I Love
I run a full nutrient panel for my patients—which is a home lab kit that gets sent directly to their homes and does not need to be ordered from their doctor. This test gives us huge insight into how the body is taking in, absorbing, and utilizing nutrients. If nutrient deficiencies are present, we need to patch those up as a first step.
A comprehensive hormone panel is great for those dealing with PMS, irregular cycles, period problems, acne, mood disorders, or really anything else that feels cyclical and related to hormones. The test analyzes sex hormones (like estrogen, progesterone, testosterone, etc), plus a full day’s worth of stress hormone ups and downs. It’s a urine test done at home at a specific time during your cycle.
If there are any GI symptoms, significant nutrient deficiencies, inflammation, immune issues, or signs of elevated estrogen, I like to include a stool test. Here we see signs of gut infection and inflammation, a microbiome assessment, maldigestion markers, hormonal detox enzyme activity, and a general “state of the gut” assessment. These tests are the most fun. :)
As you can see, thorough testing and data collection is my style!! Keep in mind, this work isn’t a "one and done" kind of situation. I generally work with someone for at least three months so we have time to uncover what’s going on in their unique body and allow time for our diet, supplement, and lifestyle plan to start kicking in.
My key message to you:
If you feel like sh*t all the time and haven’t gotten any answers, keep digging.
I’m here to help if this resonates and you’d like to explore working together.
