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Where to look next when your bloodwork is normal but you still don’t feel well

Updated: Apr 26, 2021

Whether you’re just feeling a little off, or are feeling outright unwell, there is nothing more frustrating than reaching out for help and being told that everything is normal and that you’re fine. I’m a strong advocate of optimizing your health, not living in the zone of lab tests that are just good enough, or not bad enough to be diagnosed with a clear disease or disorder.

Here are some of the more common reasons for feeling unwell, when your first assessment with labs look fine, based on principles of naturopathic and functional medicine:

1) You are at the low end of the reference range

This is one of the most common issues where your labs are not low enough to flag as abnormal, but are right at the bottom of the reference range. This applies especially to markers like Ferritin, Vitamin B12 and TSH. For example most people feel very tired with a ferritin under 20 ug/L, a vitamin B12 under 250 pmol/L, or a TSH above 3.5 mIU/L, and yet none of these would flag on your bloodwork. Remember that a reference range is an average distribution of results, and doesn’t necessarily indicate your optimal range.

2) You have a hormone imbalance

Hormone imbalances can impact your life in so many ways – causing mood swings, energy fluctuations, digestive upset, nausea, skin flare-ups, and general inflammation. With low progesterone, estrogen dominance, high androgens, or during perimenopause and menopause, you might simply feel unwell most of the time. Measuring hormones is somewhat of an art – the reference ranges are huge, and it is extremely important that you test at the correct points in your cycle. The good news is that once we determine which hormones are imbalanced, there are many tools to help you feel better.

3) Stress is impacting your health

Although I rarely say that stress is the cause of illness, it certainly turns up the volume on anything else that is going on. For example if you have a mild thyroid disorder, high stress can make it much worse; if you have joint pains from arthritis, your pain will be worse with ongoing stress; if you have a sleep disturbance, it will also worsen with stress. We can get an indicator of whether your stress hormones are out of balance by testing cortisol and DHEA levels, because these values indicate whether you are in an excess or deficient state.

4) You have ‘subclinical hypothyroidism’

Many people feel unwell before their thyroid hormones go completely out of balance, with symptoms like fatigue, feeling cold, difficulty losing weight, dry skin, constipation and hair loss. This is referred to as subclinical hypothyroidism, where the TSH is a little high, and the free T4 and or free T3 are at the low end of the reference range. In this case, it is important to test the thyroid thoroughly, including TSH, free T4, free T3, reverse T3 and thyroid antibodies to know how to support thyroid function best. In some cases this is related to prolonged high stress, others it is autoimmune, and also can be from deficiencies of nutrients like iodine, selenium and zinc.

5) You gut needs support

In recent years, countless studies have linked gut health to almost every chronic health condition. It turns out that the state of your digestive tract – including digestive function, the balance of the microbiome, and the state of your gut lining all impact your health, especially with inflammatory conditions. This includes skin conditions (rosacea, eczema, psoriasis), autoimmune diseases, but also includes mood and behaviour problems, hormone balance, nutrient absorption, joint pains, and more. As the old naturopathic adage states “if in doubt, start with the gut.”

6) There are hidden infections

The new wave in chronic illness is diagnosing and treating hidden infections. These infections are associated with chronic fatigue syndrome, fibromyalgia, POTS (Postural orthostatic tachycardia syndrome), autoimmune conditions, digestive dysfunction, and more. These infections include Epstein Barr virus, Lyme disease, H. pylori, small intestine bacteria overgrowth, and many more. Some of these infections are quite simple to test for, and others are more complex. Testing usually depends on symptoms and a thorough review of your health history and timeline, looking for patterns that match. Addressing the infection, and most importantly your immune system function can have a profound effect on your health and inflammation.

7) You have mycotoxin illness

Mycotoxin illness refers to illness after mold exposure. Not everyone is sensitive to illness from water-damaged buildings, but some people get quite ill because they have an immune and neurological response. Symptoms can include muscle cramps, chronic sinus congestion, joint pain, brain fog, increased anxiety, neurological symptoms (ex. neuralgias or neuropathic pain). In some cases it presents like atypical multiple sclerosis with a normal brain MRI. I have written about mycotoxin illness here:, where you can learn more about assessment and treatment.

8) Heavy metals or other toxins are affecting your health

The reality is that toxins surround us, and we are exposed to heavy metals, hormone mimicking chemicals, oxidative stress and volatile organic compounds every day. Some people have the genetics to clear and eliminate toxins better than others, which is why this can be so difficult to diagnose. For example, I have seen several cases now of fairly low exposure to mercury through fish, causing very high blood levels of mercury leading to neurological symptoms over time. The ability to clear toxins clearly varies from person to person. Testing for toxins that are stored in the body can be complex, so we first assess through a detailed history and “Toxin Exposure Timeline” ( to see which types are more likely in your personal health picture. Exposure to toxins can affect every system in the body, with symptoms ranging from neurological to multiple chemical sensitivity, to respiratory issues, and even cancer.

9) Mitochondria dysfunction

Mitochondria are the energy centres of your cells, and we have over 100,000 trillion in our body to make ATP (adenosine triphosphate), our major fuel that supports every body function. When mitochondria are functioning poorly, fatigue is the most common symptom, followed by brain fog (or difficult concentration), and chronic pain. If you’re feeling exhausted and all of your labs truly do check out normally, this may be the next place to look. Mitochondria are damaged by many medications, chronic stress, poor nutrition (nutrient deficiencies), and you can also have a genetic susceptibility. Learn more about mitochondria function and health here:

10) Emotional health or trauma is impacting your physical health

We are very complex and integrated beings, and our emotional health can affect physical symptom in many ways. For example, it is not uncommon to be fatigued and get sick with a respiratory illness with grief, and it is very difficult to distinguish the fatigue from depression from that of a more physical cause (although it could be debated that they are always linked). Trauma adds another layer of complexity, in that it impacts the body’s ability to tolerate stress and feel safe. This means there can be fatigue, racing heart, anxiety, insomnia and muscle pain related to past trauma, and the chronically activated stress response prevents to the body from healing and recovering. If health issues have started after an emotional event, loss or trauma, it is important to address both sides – the emotional and physiological together.

What’s Next?

This article is my current top 10 list of areas to investigate after the basic lab tests check out normally. What is important to recognize is that every single case is different. This is why mapping out a health timeline, and going through a very thorough health history are important – we often find clues to what is currently happening in the body along the way. If this article rings true with you, and you want to investigate more deeply what is causing your health struggles, or simply why you don’t currently feel your best, please book in for an appointment where we will take a deep dive look and do the detective work together.


Please note that content on this website is intended for informational purposes only, and is not intended as a substitute for the advice provided by your physician or other healthcare professional, not is it meant to diagnose or treat a health problem, symptom or disease. Always speak with your physician or other healthcare professional before taking any medication or nutritional supplement, or using any treatment for a health problem. If you have or suspect that you have a medical problem, contact your health care provider promptly. Do not disregard professional medical advice or delay in seeking professional advice because of something you have read on this website. Information provided on this website DOES NOT create a doctor-patient relationship between you and any doctor affiliated with our website.

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