When Your Doctor Says Your Labs are “Normal” but You Still Feel Sick - Lakeside Natural Medicine

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When Your Doctor Says Your Labs are “Normal” but You Still Feel Sick

BySarah Axtell, ND June 19, 2014

Conventional lab ranges are based on the average of what is found in the general public, not necessarily healthy individuals. We all know that the average American is overweight, sick and tired. It is not optimal to simply be “in range.”

As a naturopathic doctor, my goal is to optimize the health of my patients. Labs are one tool that can assess underlying imbalances. When values are compared to the “optimal range,” we can strive to achieve a higher level of wellness. Comparing values to “optimal range” can also reveal trends in a person’s health and thus prevent disease.

Here are 6 common labs that can provide a lot of insight and their associated target ranges:

1. Vitamin D

Conventional range: 32-100

Optimal range: 60-100

The following Vitamin D levels are associated with the following health benefits:

20- Institute of Medicine- bone only beneficial

22- where colon cancer begins to decline

32- where breast cancer begins to decline

34- colon cancer rates would be cut in half

40- where most reach max bone density

52- where breast cancer rates would likely to be cut in half

60-auto-immune patients begin to improve

>150- toxicity

2. Thyroid

Unfortunately, most MD’s just check TSH. But this is an indirect , inadequate marker for thyroid status. To truly assess thyroid function, you must have your Free T3, Free T4 and Reverse T3 checked.


Conventional range: 0.450-4.500

Optimal range: 1.0-2.0

Free T3*

Conventional range: 2.0-4.4

Optimal range: 3.0-4.0

*Low Free T3 will present as FATIGUE!

Free T4*

Conventional range: 0.82-1.77

Optimal range: 1.24-1.66

*Often times, I see normal Free T4 and low Free T3. This is indicative of hypothyroidism, but of course we have to ask WHY? Normal T4 and low T3 indicate there is likely an underlying adrenal issue. Cortisol, the stress hormone produced by the adrenal glands, inhibits the conversion of T4 to T3 (thus resulting in low Free T3 and then fatigue).

Reverse T3*

Conventional range: 9-27

Optimal range: 10-20

*Elevated Reverse T3 is indicative of stress or adrenal dysfunction.

3. Vitamin B12

There are several markers of B12 status. A serum B12 can provide a rough estimate of B12 status, but there are many other indicators of B12 status:

Vitamin B12 (serum)*

Conventional range: 200-800

Optimal range: 500-1000

*It is well-established in the literature that people with B12 levels between 200-350 have distinct B12 deficiency symptoms:

  • Alzheimer’s, dementia or memory loss
  • Depression, anxiety, bipolar, psychosis
  • Fatigue
  • Numbness or tingling
  • Nerve pain

Methylmalonic acid (MMA)– this is a very sensitive test and will reveal a true B12 deficiency if high. If your serum B12 was “normal” but you still have signs of B-12 deficiency, ask your doctor to order the MMA test


MCV is a measure of the average volume of your red blood cells. When MCV is high, this is indicative of B12 or folate deficiency. When MCV is low, this is indicative of Iron deficiency. This is part of a routine CBC test.

Conventional range: 80-100

Optimal range: 83-90

4. Cholesterol- NMR test

Total Cholesterol

There is a happy medium with cholesterol levels. You don’t want your levels too high, but you also don’t want your levels too low. Low cholesterol (less than 150) can result in memory loss, anxiety and depression.

Conventional range: 90-200

Optimal range: 150-200

Simply looking at total cholesterol is inadequate. We must take into account your lipid particle size in addition to the standard lipid panel (cholesterol, HDL, LDL, etc). A comprehensive cholesterol test that will include these markers, such as particle size, is the NMR test. For more comprehensive info on cholesterol, see this post.

5. Blood sugar

Like cholesterol, there is also a happy medium with blood sugar. Elevated blood sugar can cause a whole host of symptoms/conditions- weight loss resistance, obesity, diabetes, heart disease. Low blood sugar, or hypoglycemia, can also be problematic, causing irritability, anxiety, palpitations, fatigue, headache and hunger.

Fasting blood sugar

Conventional range: 65-99

Optimal range: 80-99

Hemoglobin A1C

This is an average of blood sugar control over 3 months.

Conventional range: 4.5-6

Optimal range: 4.5-5.5

Fasting Insulin

Insulin regulates blood sugar. High blood sugar stimulates the release of insulin, whereas low blood sugar levels prevents insulin release. The most common abnormality with insulin is insulin resistance, in which the cells no longer respond to insulin. Elevated insulin increases your risk of diabetes, high cholesterol, breast cancer, PCOS, obesity, hypertension, and heart disease.  Insulin is a storage hormone, primarily promoting fat storage.

Conventional range: <5

Optimal range: <3

6. Ferritin

In addition to assessing one’s serum iron status, red blood cell status, hemoglobin, and hematocrit (as part of a routine CBC), I always check ferritin if I suspect iron deficiency anemia. Iron deficiency anemia is a common problem among women and children.

Signs of Iron deficiency anemia include:

  • Fatigue
  • Pale skin
  • Weakness
  • Irritability
  • Brittle nails
  • Dizziness
  • Leg pain
  • Restless legs
  • Headaches
  • Poor memory

Ferritin is the storage form of iron. It is low with iron deficiency anemia, which is common among menstruating women. Ladies, if you are tired, ask your doctor to order ferritin!

There is a happy medium with iron though. Iron in excess is inflammatory and can be an underlying cause of chronic disease.

Conventional range: 11-200

Optimal range: 30-80

Know your labs! Ask your ND to analyze your labs on a functional level. This means identifying trends to optimize your health and ultimately prevent disease.

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.

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