Lab testing for low energy: conventional vs functional medicine

Have you ever had the experience of feeling exhausted, going to see your doctor, and being told that all your bloodwork was “normal”? Maybe your doctor even said that being exhausted was part of aging. Or, maybe you were told you were depressed and left his office with the antidepressant prescription. Well, at some point in my life it was me. I’m here to tell you that being exhausted is not normal.

I want to go over the differences between conventional medicine and functional medicine lab testing so we can uncover the blind spots and see what additional information functional medicine labs provide.


1) Complete Blood Count, Ferritin, Vitamin B12/Folate

·  The first condition your doctor is most likely to rule out if you present with low energy is anemia. Complete Blood Count will show if you have enough red blood cells or hemoglobin (protein that carries oxygen). The top three reasons for anemia among many others are:

1) Low iron

2) Low vitamin B12

3) Low folate (vitamin B9).

·  Iron. Most of the iron in the body is found in hemoglobin. The function of iron is to carry oxygen so your cells can breathe and produce energy!

·  Ferritin. Because iron fluctuates daily your doctor might want to order ferritin. Ferritin reflects iron storage level and is a much more accurate indicator of how much iron is in your body. It should not be low or too high. Low levels strongly suggest iron deficiency. Ferritin levels > 200 ng/ml are abnormal and toxic to the cells. Ferritin increases with inflammation and insulin resistance.

·  Vitamin B12. Like iron, Vitamin B12 is required to make red blood cells. Vitamin B12 deficiency usually takes years to develop since your body can store large amounts in the liver. People who are eating vegan or vegetarian diets are more likely to develop Vitamin B12 deficiency because Vit B12 is only found in animal derived foods.

·  Folate (Vitamin B9).  Folate is another key vitamin that is needed to make red blood cells. Folate deficiency is rare. It happens to people who don’t eat enough fruits and leafy green vegetables. It also can happen in people who consume large amounts of alcohol.

2) Comprehensive Metabolic Panel (CMP)

·  CMP will give your doctor the information about your kidney function, liver function, electrolyte and hydration status.

·  Liver is responsible for detoxifying your body and plays a crucial role in maintaining your energy levels.

3) Vitamin D deficiency.

·  Vitamin D is called a “sunshine “vitamin for a reason. It is produced in your skin under sun exposure. Many people spend very little time in the sun and therefore are deficient in Vitamin D.  It’s a key factor for regulating dozens of reactions in your body including upregulation of serotonin, insulin receptors and assimilation of nutrients. Correcting Vitamin D deficiency improves fatigue in both healthy people and people with chronic diseases.

·  The 25 – hydroxyvitamin D test is the best measure of your vitamin D stores. Optimal level is between 60-80 ng/ml.

4) Magnesium.

·  Magnesium is a mineral that is also called “the miracle cure”. It impacts nearly all of your body systems. It’s key in energy production.

·  Magnesium deficiency is extremely common due to the lack of green leafy vegetables in most diets!

·  Serum Magnesium is most often used but is rarely helpful. Red blood cell magnesium is more accurate.

·  Even if your lab tests show your levels are normal, taking supplemental magnesium will exert many positive effects. I prescribe Magnesium for all of my patients as part of a multivitamin that includes minerals, vitamins and antioxidants.

5) THYROID PANEL: TSH, Total T4, Free T4, Free T3, Reverse T3, Antibodies: thyroid peroxidase and thyroglobulin Ab.

·  Poor thyroid function will slow down your metabolism and decrease energy production. This is why thyroid testing is another value most likely run by your conventional doctor.

·  Most doctors diagnose thyroid problems by testing your TSH levels and sometimes your free T4 level.

·  If you receive only TSH level without other six markers you could be missing out on some valuable information about your thyroid health.

·  To get a complete picture it’s worth looking at free T4 and free T3 which are the inactive and active hormones; T3 is a gasoline that fuels your cellular energy.

·  Many people have autoimmunity against their thyroid with increased thyroid peroxidase and thyroglobulin antibodies. Most conventional doctors do not test this UNLESS the TSH is high.

·  With every lab test, I’m looking for “optimal ranges” versus “normal ranges”.  When it comes to thyroid function it becomes even more important. Normal TSH ranges according to conventional reference are from 0.11-4.5 mIU/L. However, the optimal level is considered to be from 1 to 2.5 mIU/L. When TSH rises over 2.5, your health can start to change.

6) Metabolic markers: HbA1c, fasting glucose & Insulin

·  Unstable blood sugar, high fasting glucose and high insulin levels all contribute to low energy.

·  When your blood sugar is riding a roller coaster, the excess sugar is very oxidizing to your mitochondria (the engine in your cells that produces energy) and thus diminishes production of energy.

·  Hemoglobin A1C measures the average of blood sugar levels over the last 90day period of time. Abnormal level is > 5.5% of total hemoglobin.

·  Fasting blood sugar should be less than 80mg/dl

·  Fasting insulin should be between 2IU/dl and 5

7) Inflammation markers: Homocysteine, Hs- CRP

·  It’s no surprise that inflammation can create chaos in your body, damage mitochondria and reduce energy production.

·  Homocysteine is a marker of vascular inflammation. It’s an amino acid that is created during your body’s methylation cycle. Adding or subtracting a methyl group to your vitamins, hormones, neurotransmitters is how your body turns them on and off. This process is called methylation and is tightly related to your MTHFR gene.

·  High Homocysteine level can indicate folate, Vitamin B12 and B6 deficiency.

·  Ideally the homocysteine level should be around 7 micromoles/liter that reflects a good balance of your B vitamins which are the cornerstone for your energy and stamina.

·  High sensitivity C reactive protein is a marker of inflammation. It could be influenced by many factors like toxicity, injuries, autoimmune conditions or irritable bowel syndrome. It’s abnormal > 1.0g/liter

These are all tests that you might’ve had from your conventional doctor and you might’ve also been told that all your tests were “normal”. But falling into the category of normal range does not necessarily translate into feeling your best.

In Functional medicine it’s important to look at the optimal levels instead of numbers that fall into normal conventional reference. A great example could be Vitamin D and TSH hormone which we discussed above.

This is one of the big ways functional medicine is different is that we are looking at the optimal range in order to keep you in your best health.

Now let’s look at the Functional Medicine labs testing.


1) Adrenal stress test

2) GI test

3) Organic acid test

4) ION panel

1) Adrenal stress test  

·  Functional Adrenal tests are very different from conventional medical testing.

·  Blood test and is used in conventional medicine to diagnose adrenal insufficiency (Addison’s disease) or Cushing’s syndrome.

·  Saliva adrenal stress test is utilized by functional medicine to map out how much stress you’ve been under and how stress is impacting you. It reveals adrenal burnout/ exhaustion/ fatigue.

·  Some common symptoms of adrenal burnout are fatigue, insomnia, depression, anxiety, weight gain or inability to lose weight, low blood sugar, low blood pressure, decrease sex drive.

·  Because of a long term period of stress, your cortisol level becomes depleted. Consider cortisol as units of energy.  When cortisol is depleted, energy is depleted too.

·  Cortisol regulates immune cells that line your digestive tract. If cortisol is out of balance you become prone to develop digestive symptoms like bloating, heartburn, constipation or diarrhea.

·  Cortisol is made from progesterone, so every molecule of cortisol you produce when you are under stress depletes your progesterone level.

·  Prolonged stress not only causes adrenal exhaustion and deplete progesterone but also with time can result in deficiency of other key hormones such as thyroid, estrogen and testosterone.

2) Stool testing for Optimal gastrointestinal Health

·  All health begins in the gut – the famous saying attributed to Hippocrates, the founder of modern medicine. It has a lot of truth to it. Now we know that many chronic and autoimmune conditions start in the gut.

·  The test looks at:

1. microbiome (opportunistic organisms, normal flora, overgrowth of bacteria)

2. GI organ function

3. GI pathogens:  parasites, fungi and viruses.

·  Your intestinal tract has a specific number of “good” bacteria and potential pathogenic and bad bacteria. It’s all about balance. For healthy balance about 85% of a human’s microbiome should be beneficial and 15% potential pathogenic.

·  When bacteria become unbalanced it can lead to a condition called dysbiosis. Gut dysbiosis also affects your body’s ability to absorb and digest food and nutrients. You could be taking all the right foods and taking the right supplements but if your body is not utilizing these nutrients it will lead to fatigue and overtime to nutrient deficiency with various chronic diseases.

·  Good bacteria help you digest the food, produce vitamins, help excrete toxins, regulate hormones and metabolism. Bad microbes like parasites, yeast, and bad bacteria produce nasty toxins that damage your gut lining and create “leaky gut”. Partially digested foods and bug toxins leak across the gut lining which triggers immune response to these foreign” substances that drive chronic low-level cellular inflammation, fatigue, insulin resistance, weight gain and other serious health problems.

·  There is a profound gut/brain connection, meaning much brain fatigue, brain fog, poor concentration, anxiety, depression stems from chronic GI issues. 

·  Pathogens are often present with no digestive symptoms and instead will manifest as fatigue, weight gain, depression, joint pain. This is why I consider this test a key part of the work up even if you don’t experience any digestive symptoms.

3)   Organic Acid Test

·  Urinary Organic acid testing looks at your metabolism in depth to analyze function in four main areas:

1. Energy production:

–   Mitochondrial energy production. It looks at your fat burning capacity in your mitochondria. Poor fat burning leads to poor energy production leaving you tired and exhausted.

–   It examines carbohydrate metabolism. By testing carbohydrate markers, we can determine how stable your blood sugar is and if you’re at risk of developing problems with hormone insulin. Poor insulin handling leads to classic deep drop in energy in the afternoon and sleeping poorly.

–   It looks at protein metabolism and levels of B vitamins. Low B vitamins can trigger sugar craving, poor oxygen utilization, meaning you get tired and overweight. Low B vitamins also lead to poor quality skin, hair and nails.

–   Vitamin B6, B12 and folate are very accurately measured on organic acids to give you understanding of your methylation capacity and overall functioning of the genes related to MTHFR.

–   It can reveal a condition recently described by Dr. Richard Lord as hypometabolic state or mitochondrial retraction. A condition where your body doesn’t even have enough mitochondria to produce all the markers and therefore enough energy.

2. Detoxification capacity

–   The test accurately measures all major detox pathways so a highly personalized program can be created for you based on your test results so your body can be cleaned quickly.

–   Detoxification is critical for the removal of environmental toxins we all are exposed to on a daily basis. If toxins are not metabolized by your liver and excreted by your kidneys, then they build up and damage your tissues including mitochondria which ultimately leads to poor energy production.

–   It looks at the level of oxidative stress. Poor antioxidant protection leads to fatigue, heart disease, diabetes and cancer down the road.

3. Neurotransmitters 

–   It looks at the production of the key brain chemicals that determine how you feel from dopamine to serotonin.

–   It includes analysis of inflammation in the brain that can be the cause of brain fatigue, brain fog, memory issues, sleep problems.

–   Neurotransmitter imbalance can stem from three major areas: nutrient deficits, brain injury either physical or chemical and genetic factors.

4. Digestive Health

–   It analyzes bacterial growth patterns that represent the health of your microbiome.

–   It can reveal presence of yeast or fungal overgrowth

–   It can show if you’re eating enough vegetables and fruits

4)   ION Panel

·  ION panel includes two main parts: Urinary and Blood.

                            1) Urinary Organic Acids that we discussed above.  

                            2) Blood portion that looks at the following markers.

–   Amino Acids. It shows if your body breaks down and utilizes amino acids. If amino acids are just floating around and your body and your body can’t use them, it will lead to all sorts of inflammatory reactions, detoxification and energy production problems.

–   Fatty Acids. It can reveal if your body has enough of the right fats which are crucial for brain health, inflammatory response, immune regulation, hormone and energy production.

–   Mineral levels and Toxic metals.

–   Antioxidants in the serum

–   Vitamin D marker

Using Functional Medicine tests, we strive to uncover the root cause of a cellular or organ dysfunction prior to the development of a full-blown critical situation or onset of a serious disease.

Conventional medical labs are designed for other purposes. They are mostly focused on uncovering a disease once it progresses fully from a “dysfunction” of a body system to a “pathology” or a life-threatening problem.

Of course, we need both systems in place to handle the range of health challenges. One doesn’t replace the other.

Functional Medicine offers so many leading solutions for health concerns you might have including low energy.

Consider the following:

·  Fatigue and fatigue related symptoms are almost never from a single cause

·  Don’t accept low energy/ fatigue as a normal part of aging.

·  Go to the root cause of your low energy. It could be an early sign of a bigger issue.

·  Avoid guessing and spend money on the supplements you may not need.

·  Consult an expert.

If you desire to reclaim  your health, increase energy and are ready for a different approach to your health learn about True Health, P.C. programs here.

Larisa Gaitour, MD, DO, IFMCP

Graduate of

• The Institute for Functional Medicine

• Kalish Institute of Functional Medicine

Residency training in

• Cardiology, Moscow, Russia

• Physical Medicine & Rehabilitation at Rusk/NYU Langone Medical Center

She earned her

• Medical Degree from the

• Institute of Medicine In Chisinau, Moldova

• Doctor of Osteopathy from

Dr. Larisa has been helping patients regain their function
after they’ve experienced significant functional decline
in their health regardless of the diagnosis.

She is passionate about helping people regain health and get to the root cause of their issues.

Larisa Gaitour, MD, DO, IFMCP

Graduate of

• The Institute for Functional Medicine

• Kalish Institute of Functional Medicine

Residency training in

• Cardiology, Moscow, Russia

• Physical Medicine & Rehabilitation
at Rusk/NYU Langone Medical Center

She earned her

• Medical Degree from the

• Institute of Medicine In Chisinau, Moldova

• Doctor of Osteopathy from

Dr. Larisa has been helping patients regain their function after they’ve experienced significant functional decline in their health regardless of the diagnosis.

She is passionate about helping people regain health and get to the root cause of their issues.