Why Am I So Tired When My Blood Work Is Normal? What Standard Testing Misses — What tests would actually catch what is missed

The tests that detect the layer where chronic illness lives are not the standard panel. They include: For the gut layer: A comprehensive stool panel that measures microbial community composition (Akkermansia, Faecalibacterium, Bacteroides ratios), dysbiotic markers (calprotectin, beta-glucuronidase), and barrier markers (secretory IgA, zonulin if available). GI-MAP, Diagnostic Solutions, Doctor&rsquo;s Data, or comparable. An organic acids urine test (OAT, Mosaic Diagnostics or comparable) for mitochondrial markers, microbial metabolites, neurotransmitter precursors, and inflammation indicators. For the mitochondrial and metabolic layer: The OAT, again, particularly for citric acid cycle intermediates (succinic, fumaric, malic, citric), beta-oxidation markers (3-hydroxypropionic), and oxidative damage markers (8-OHdG). Specific consideration of mitochondrial cofactors (acetyl-CoA precursors, B-vitamin status with attention to functional rather than serum levels). For the autonomic layer: Heart rate variability assessment (consumer wearables like Oura or WHOOP are surprisingly informative). Active stand test or tilt-table test if POTS is suspected. Detailed history of symptom patterns relative to posture, exertion, and stress. For the inflammatory and immune layer: IL-6 and TNF-alpha if accessible. These are not always within standard panels but can be ordered. Detailed examinat