Why Am I So Tired When My Blood Work Is Normal? What Standard Testing Misses — Why standard labs produce this result

The blood tests included in a standard panel were designed to detect acute disease, frank deficiency, and organ failure. CBC catches acute infection, frank anemia, and significant blood loss. Comprehensive metabolic panel catches kidney failure, liver failure, and electrolyte derangements. TSH catches frank hypothyroidism. Hemoglobin A1c catches established diabetes. Lipid panel catches established dyslipidemia. Each test was validated against frank disease and the reference ranges were set to distinguish frank disease from no disease. The patient with chronic illness is rarely in either state. They are not acutely diseased. They are not organ-failing. They are in a third state: chronic functional compromise where cells are not dying but are operating at substantially reduced capacity. The standard panel was not designed to detect this state. The reference ranges were not validated against this state. When the test runs on a patient in this state, the result is usually within range because the analytes the test measures are not the analytes that change first when cellular function falls. This is not a failure of the laboratory. It is a category error in what the test is being asked to do. A panel designed to detect organ failure does not detect functional compromise. Asking the panel to do something it was not designed to do, and then concluding from the negative result that th