What Your “Normal” Labs Aren’t Telling You — And How to Read Between the Lines

Erin Botticelli
Apr 17
5 min read

You’ve probably been there (or had a client tell you this):"My doctor said my labs are normal… but I still feel off."

Fatigue. Weight that won’t budge. Bloating. Crashes after meals. Low mood.But when you ask for help? The answer is often vague at best: “Everything looks fine.”

As a functional nutrition practitioner, I’m here to tell you: “Normal” does not equal optimal.And your blood work holds way more answers than you’ve likely been told.

In my practice and in my Backyard Health podcast, I use a functional blood chemistry lens to interpret common labs like CBCs, CMPs, lipid panels, and hormone markers in a way that connects your symptoms to the systems of your body — and gives you a personalized game plan.

So let’s break down the top areas your labs might be quietly waving red flags 👇

🔥 1. Blood Sugar & Insulin Resistance (Even When A1c Looks Fine)

You can have normal glucose and A1c… while still being on the path to insulin resistance.

Markers like fasting insulin, triglyceride:HDL ratio, and ALT:AST help reveal early-stage metabolic dysfunction. If you’re holding onto belly fat, craving carbs, or hitting energy dips after meals, this is one place to look deeper.

What’s typically missed:Your fasting glucose might be 85, and your A1c might be 5.4% — but that doesn’t mean you’re metabolically healthy. Most traditional reviews stop there. But in functional medicine, we look at insulin resistance much earlier.

What we look at functionally:

Fasting Insulin — high even with normal glucose = early insulin resistance
Hemoglobin A1c — we aim for <5.2–5.4%, not just “<5.7”
Triglyceride:HDL ratio — >1.5 may signal poor glucose utilization
ALT:AST ratio — elevated ALT with low AST can reflect fatty liver
C-Peptide or Fructosamine — additional clues if insulin is unclear

💧 2. Hydration, Electrolytes & Hidden Cellular Stress

Your sodium:potassium ratio, chloride, CO2, and BUN:creatinine don’t just tell us about hydration. They point to adrenal capacity, acid-base balance, and your ability to recover from stress.

Low potassium? It could signal more than a banana deficiency — it might reflect burnout or mineral depletion from chronic stress.

What’s typically missed:Most doctors only flag electrolytes when they’re critically low or high. But suboptimal levels, or imbalanced ratios, can point to deeper issues like adrenal stress, chronic dehydration, or even hidden kidney strain.

What we look at functionally:

Sodium & Potassium — especially the Sodium:Potassium ratio
Chloride & CO2 (bicarbonate) — reflect acid-base pH and HCl status
BUN:Creatinine ratio — often used to catch hidden dehydration
Anion Gap — can suggest thiamine deficiency or underlying acidosis
Magnesium (RBC) — often overlooked but essential for stress recovery

🔬 3. Inflammation That’s Blocking Fat Loss

Inflammation isn’t always loud.Sometimes it shows up as fatigue, stubborn weight, or hormonal resistance.

Labs like hs-CRP, ferritin, homocysteine, and uric acid are underrated goldmines. They tell the story of oxidative stress, poor recovery, and blocked metabolic flexibility.

If you’re “doing everything right” and still not seeing results — this is where we often find the missing piece.

What’s typically missed:Low-grade inflammation doesn’t always show up with pain. It’s often a “silent disruptor” of metabolism, hormone function, and fat loss. hs-CRP might not be on a basic lab panel, but it should be.

What we look at functionally:

hs-CRP — ideally <1.0 for systemic inflammation
Ferritin — high levels often missed as an inflammation signal
Homocysteine — high = poor methylation & cardiovascular risk
Fibrinogen, Uric Acid — signs of oxidative stress and metabolic strain
Albumin/Globulin ratios — reflect oxidative stress & detox capacity

💪 4. Muscle Mass, Protein Status & Metabolic Efficiency

Your muscle isn’t just about aesthetics — it’s your metabolic engine.

Markers like creatinine, BUN, CPK, and protein levels can tell us how well you’re building and preserving lean tissue. Low levels may point to catabolism, nutrient insufficiency, or poor protein utilization (often linked to low stomach acid or gut dysfunction).

This is a huge factor in perimenopause, men with abdominal weight gain, or anyone with fatigue and blood sugar crashes.

What’s typically missed:Low creatinine or total protein is often dismissed unless it's dangerously low — but it can point to muscle loss, poor protein digestion, or catabolic metabolism. This is huge for anyone trying to lose fat, build muscle, or recover from burnout.

What we look at functionally:

Creatinine & BUN — low = possible muscle breakdown or protein deficiency
CPK (Creatine Kinase) — elevated with intense training or slow recovery
Total Protein, Albumin, Globulin — reflect digestion & amino acid status
Magnesium & Zinc — key minerals for protein synthesis and repair
ALT/AST/GGT — can show liver’s ability to handle nitrogen waste from protein

🧠 5. Thyroid & Adrenal Dysfunction

The classic “TSH is normal” dismissal is one of the most frustrating things I hear.

Functional thyroid assessment includes looking at Free T3, Free T4, Reverse T3, and cortisol or DHEA-S alongside symptoms. The story isn’t just about under- or over-active thyroid — it’s about how your brain, adrenals, and metabolism are adapting to stress and demand.

What’s typically missed: A “normal” TSH doesn’t mean your thyroid is working optimally. We often miss hypothyroid conversion patterns (where T4 doesn’t convert to T3), or chronic adrenal strain that suppresses thyroid function altogether.

What we look at functionally:

TSH — optimal range is tighter (0.5–2.5)
Free T3 & Free T4 — T3 is the active hormone; low = sluggish metabolism
Reverse T3 — high = stress is blocking thyroid hormone use
DHEA-S & Cortisol — show your resilience or burnout status
Free T3:RT3 ratio — helps identify conversion blocks

🧬 6. Micronutrient Status (That Tells More Than Your Multivitamin)

You don’t just absorb what you eat — you absorb what you digest and assimilate. That’s why labs like Vitamin D, B12, magnesium (RBC), and zinc tell a story.

Low B12 with fatigue? It may not just be diet — it could reflect low stomach acid, gut dysfunction, or methylation issues. We connect the dots.

What’s typically missed: You could be eating a great diet — and still be deficient. Most providers only check Vitamin D and maybe B12. But deeper analysis reveals functional shortfalls that impact energy, sleep, cravings, mood, and immunity.

What we look at functionally:

Vitamin D (25-OH) — optimal 50–70 for immune & metabolic health
B12 & Folate (serum + RBC) — essential for nervous system & energy
Magnesium (RBC) — blood serum is often falsely normal
Zinc, Selenium, Copper — key in thyroid, immune, and hormone balance
MMA (methylmalonic acid) — checks for intracellular B12 use

Ready to Finally Understand Your Labs?

If you’re nodding your head thinking, “Why has no one explained this to me like this before?” — this is exactly why I created my Integrative Nutrition Intensives.

Inside this 1:1 lab-based experience, we’ll:

✅ Review your recent labs through a functional lens

✅ Uncover the hidden patterns sabotaging your energy, metabolism, or mood

✅ Build a personalized nutrition and supplement protocol

✅ Map a clear path forward — no guesswork, no overwhelm

➡️ Already have labs from your doctor? Great. We can start with those

.➡️ Don’t have labs? I’ll help you order what’s actually useful (not $3,000 worth of fluff).

📩 Want to get started? Click here to learn more or apply, or send me a DM on Instagram with the word "labs" and I’ll send you my Metabolic Map PDF that outlines every lab I use, what they mean, and how to ask your provider for them.