> ## Content Index > Fetch the complete content index at: https://thatpaleochick.com/llms.txt > Use this file to discover other available public pages before exploring further. # The Labs Your Doctor Didn't Order (But You Should Be Asking For) - URL: https://thatpaleochick.com/labs-worth-asking-for-bloodwork-coaching/ - Published: 2026-11-14T18:04:28.000Z - Updated: 2026-11-14T18:04:28.000Z - Description: Your standard annual panel tells you almost nothing useful. Here are the specific labs a functional-medicine health coach actually wants to see, what they reveal, and exactly how to ask for them at your next appointment. - Author: Krista Wade - Tags: Health, Coach's Corner, Bloodwork, Functional Medicine, Labs, Thyroid, Insulin, Vitamin D, Iron, Inflammation, Real Food, Women's Health, Hormones, Metabolic Health, #toc Your annual bloodwork came back and your doctor said everything looks "normal." You felt anything but normal. That gap has a name, and it has a fix. ## Normal Is Not the Same as Optimal Most standard panels are designed to catch disease, not to map function. A result that lands inside the reference range gets stamped "normal" and filed away. But reference ranges are built from large population averages, and that population includes a lot of people who are metabolically unwell. So "normal" can mean you are not in the worst quartile. That is a pretty low bar. From a functional-medicine coaching lens, the question is not just whether a number clears the floor. The question is where it sits within the range, whether it is trending, and whether it tells a story alongside your other markers. A ferritin of 12 is technically in range at most labs. It is also functionally depleted for most people, especially women. Those are two very different things. This piece is not about diagnosing yourself or second-guessing your doctor. It is about knowing which questions to ask, because a lot of useful tests do not get ordered unless you ask for them. Your doctor has twelve minutes and a standard protocol. You have a body you live in every day. Those two things need to work together. *This article is for general informational purposes only and is not medical advice. Always consult a qualified healthcare professional before making changes to your diet or health routine.* ## The Standard Panel: What It Covers and Where It Stops A typical annual physical in the U.S. includes a complete blood count (CBC), a basic or comprehensive metabolic panel (BMP/CMP), and sometimes a lipid panel. That is it. Those are genuinely useful. A CBC can flag anemia, infection, or immune irregularities. A metabolic panel checks kidney and liver function, electrolytes, and fasting glucose. The lipid panel gives you total cholesterol, LDL, HDL, and triglycerides. But notice what is not there: no fasting insulin, no thyroid breakdown beyond maybe a single TSH, no inflammatory markers, no vitamin D level, no detailed iron panel, no HbA1c unless you are already diabetic or pre-diabetic by standard criteria. For someone trying to understand *why* they feel off, the standard panel is a rough sketch when you need a detailed map. ## Fasting Insulin: The One Most People Have Never Had Fasting glucose is on most standard panels. Fasting insulin is almost never ordered unless someone is already in trouble. That is backwards, because insulin rises years, sometimes a decade, before blood sugar does. By the time fasting glucose is elevated, insulin has often been chronically high for a long time, working harder and harder to do its job. Fasting insulin is one of the earliest, most actionable windows into metabolic health. [Research published in the journal *Diabetes Care*](https://diabetesjournals.org/care/article/32/7/1327/38756/Fasting-Insulin-and-the-Metabolic-Syndrome?ref=thatpaleochick.com) has linked elevated fasting insulin to metabolic syndrome components even in people with normal fasting glucose. The functional sweet spot most practitioners look for is roughly 2 to 6 uIU/mL fasting, though lab ranges vary. A result in the mid-teens or above is worth a real conversation. How to ask: "Can we add a fasting insulin to my metabolic panel? I'd like to get a fuller picture of my insulin sensitivity, not just my glucose." ## The Thyroid Panel Your Doctor Probably Skipped Half Of A TSH alone is a one-data-point view of a multi-step system. TSH tells you what the pituitary is signaling; it does not tell you how much active thyroid hormone your cells are actually using. For that you want Free T3 and Free T4 at minimum, and many functional-medicine practitioners also look at Reverse T3 and thyroid antibodies (TPO and TgAb). Free T3 is the metabolically active form your cells use for energy regulation, temperature, and mood. Reverse T3 is a kind of brake on that system; it can rise under chronic stress and caloric restriction, essentially blocking the active hormone from doing its job. Thyroid antibodies tell you whether there is an autoimmune process underway, sometimes years before TSH goes outside range. The [American Thyroid Association](https://www.thyroid.org/patient-thyroid-information/ct-for-patients/november-2018/vol-11-issue-11-p-10-11/?ref=thatpaleochick.com) acknowledges that some patients remain symptomatic with a normal TSH and may benefit from additional thyroid evaluation. That is not fringe thinking; it is in their own guidance. How to ask: "My TSH was normal last year but I'm still struggling with energy and cold hands. Can we run a full thyroid panel including Free T3, Free T4, and thyroid antibodies?" ## Vitamin D: Get the Number, Not Just the Yes/No A lot of doctors will order a vitamin D test if you ask. What they sometimes do not tell you is that the "sufficient" threshold used by conventional labs (20 ng/mL per many standard guidelines) is set to prevent deficiency diseases like rickets, not to support optimal immune function, mood regulation, or bone density. Many functional-medicine practitioners look for a serum 25(OH)D level closer to 40 to 60 ng/mL as a functional target, though that range is debated and individual context matters. [Research from the National Institutes of Health](https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/?ref=thatpaleochick.com) notes that while the science on optimal levels is still evolving, most people in the U.S. have insufficient sun exposure to maintain adequate vitamin D year-round without dietary or supplemental support. The actual number matters. If you come back at 22 and feel terrible, that is different from someone who feels fine at 22\. Get the number. Know where you are. How to ask: "Can you run a 25-hydroxyvitamin D test and give me the actual number? I want to track it over time." ## Iron Panel, Not Just Hemoglobin If you are female and fatigued, the standard response is to check hemoglobin or hematocrit for anemia. But you can be depleted in iron long before you are technically anemic. The marker that catches this earlier is ferritin, which reflects your stored iron. Serum iron and TIBC (total iron-binding capacity) round out the picture. Ferritin in particular sits in an interesting gray zone. The lab low end is often 10 or 12 ng/mL. Many practitioners who specialize in thyroid and metabolic health look for ferritin above 50 to 70 ng/mL to support optimal energy and thyroid hormone conversion. A [2008 study in the *Canadian Medical Association Journal*](https://www.cmaj.ca/content/179/4/373?ref=thatpaleochick.com) found that non-anemic women with low-normal ferritin and unexplained fatigue showed significant improvement in fatigue scores with iron supplementation. The study authors concluded that ferritin levels below 50 ng/mL may warrant clinical attention even when hemoglobin is normal. If you eat an animal-rich, real-food diet and still feel exhausted, ask for the full iron panel before you assume the food is the problem. How to ask: "Can we run a full iron panel, specifically serum iron, TIBC, and ferritin? I want to see if storage iron is a factor in my fatigue." ## hsCRP: The Inflammatory Signal in Your Blood High-sensitivity C-reactive protein (hsCRP) is a marker of systemic inflammation. It is not specific, meaning a high number does not tell you exactly what is inflamed, but it tells you that something is. And chronic low-grade inflammation is a thread that runs through a lot of the conditions people deal with day to day, from joint pain to brain fog to poor recovery from exercise. The standard CRP test is used to detect acute illness or infection. The high-sensitivity version is calibrated to detect the lower levels of chronic, smoldering inflammation. These are two different tests and you want the hsCRP specifically. The [American Heart Association and the CDC](https://www.ahajournals.org/doi/10.1161/01.cir.0000063337.52885.f7?ref=thatpaleochick.com) have published joint guidance recognizing hsCRP as a clinically useful marker for cardiovascular risk assessment, particularly when LDL is borderline. But from a coaching perspective, it is useful far beyond heart health. It is a broad signal of how your body is managing its inflammatory load. If your hsCRP is elevated and you are eating a real-food diet, sleeping reasonably well, and not under extreme stress, that result is worth investigating further with your doctor. If you are not doing those things, it is a pretty clear message. How to ask: "Can we add an hsCRP to my panel? The high-sensitivity version, not the standard one." ## HbA1c: Blood Sugar Over Time, Not Just Today Fasting glucose is a snapshot. HbA1c gives you a three-month average by measuring what percentage of your hemoglobin has glucose attached. It is a much better picture of how your blood sugar is behaving over time, and it is worth having even if your fasting glucose looks fine. The conventional pre-diabetic threshold is 5.7% and above. Many functional practitioners start paying close attention in the 5.4 to 5.6% range, particularly in combination with elevated fasting insulin or triglycerides. It is a useful trend marker, too. Watching it move up slowly over three to four years, even staying in "normal" territory, is information worth having. The [CDC estimates](https://www.cdc.gov/diabetes/data/statistics-report/index.html?ref=thatpaleochick.com) that over one-third of American adults have pre-diabetes, and the vast majority don't know it. HbA1c is one of the most accessible tools for catching this drift early. How to ask: "I'd like an HbA1c added to my bloodwork even though my fasting glucose is normal. I want to track average blood sugar over time." ## A Word on Omega-3 Index and Oily Fish This one is less commonly known but worth mentioning. The omega-3 index measures the percentage of EPA and DHA in your red blood cell membranes. It is not standard, it is often out of pocket, and you may need to order it through a direct-to-consumer lab. But it is one of the more direct ways to assess whether the omega-3s you are eating are actually getting incorporated into your tissues. Most Americans sit at an omega-3 index of 4 to 5%. A [review in the journal *Prostaglandins, Leukotrienes and Essential Fatty Acids*](https://pubmed.ncbi.nlm.nih.gov/18561128/?ref=thatpaleochick.com) found that an index of 8% or above is associated with more favorable cardiovascular and inflammatory profiles compared to lower levels. If you eat oily fish like mackerel, sardines, or herring two to three times a week, your index is probably where you want it. If you have been relying mostly on plant-based omega-3 sources like flaxseed, the conversion to EPA and DHA is limited enough that you may not be getting what you think. The omega-3 index tells you what is actually in your cells, not just what you are eating. Talk to your doctor or a functional-medicine practitioner about whether this test makes sense for you. ## How to Have This Conversation Without Your Doctor Rolling Their Eyes The goal here is not to show up with a printed list and demand a twelve-tube draw. That approach is not going to serve you. The approach that works is coming in with one or two specific questions, a clear reason rooted in your symptoms, and a willingness to hear your doctor's perspective. "I've been dealing with low energy for about six months. I'm eating well, sleeping okay, and I'd like to look at ferritin and fasting insulin alongside the standard panel to get a fuller picture." That is a reasonable ask. Most doctors will work with you on it. If you get pushback, ask what it would take for them to feel comfortable ordering the test. Sometimes it is a symptom threshold, sometimes it is a waiting period. Know where the line is so you can come back if things progress. And if you are consistently feeling dismissed and your concerns are not being heard, you are allowed to get a second opinion. You are allowed to find a doctor who practices differently. That is not disloyalty; that is stewardship of the body you were given to take care of. One more thing worth saying: labs are clues, not verdicts. A single elevated marker in isolation is rarely the whole story. The goal is to use these numbers alongside how you feel, how you sleep, how you recover, what you are eating, and what your life looks like right now. The number on the page is a data point. You are the whole picture. ## Key Takeaways - Standard annual panels are designed to detect disease, not to map function. Normal does not automatically mean optimal. - Fasting insulin is one of the most useful early metabolic markers and is almost never included in a standard panel. Ask for it by name. - A TSH alone does not tell you how well your thyroid is functioning at the cellular level. Free T3, Free T4, and antibodies fill in the gaps. - Ferritin can be functionally depleted while hemoglobin is still normal. Ask for the full iron panel, not just a CBC. - hsCRP (high-sensitivity, not standard) gives you a signal of chronic low-grade inflammation even when nothing acute is going on. - HbA1c is worth tracking even before blood sugar looks problematic. It shows you the trend, not just today's number. - Come to your appointment with one or two specific asks and a symptom-based reason. You are more likely to get the labs if you are specific. ## Frequently Asked Questions ### What labs should I ask my doctor for at my annual physical? Beyond the standard CBC and metabolic panel, consider asking for fasting insulin, a full thyroid panel (Free T3, Free T4, and thyroid antibodies rather than TSH alone), ferritin (as part of a full iron panel), high-sensitivity CRP (hsCRP), HbA1c, and a 25-hydroxyvitamin D level. These are not exotic tests, they just fall outside the default annual order. Come to your appointment with a specific symptom-based reason for each request and your doctor is more likely to work with you. ### What is the difference between fasting glucose and fasting insulin? Fasting glucose measures how much sugar is circulating in your blood at the moment of the test. Fasting insulin measures how much insulin your body is producing to manage that sugar. Insulin can be chronically elevated, with the body working harder than it should to keep glucose in a normal range, years before fasting glucose moves out of range. Fasting insulin is an earlier signal of metabolic stress and is almost never included in a standard panel. ### What is a good ferritin level for women? Lab reference ranges vary, but many functional-medicine practitioners look for ferritin above 50 to 70 ng/mL to support optimal energy and thyroid hormone conversion, even though the low end of most lab ranges is around 10 to 12 ng/mL. If you are fatigued and your ferritin is technically in range but on the low end, it is worth a conversation with your doctor. Always discuss your specific results and symptoms with a qualified healthcare professional before making any changes. ### What is hsCRP and why is it different from a standard CRP test? Standard CRP is calibrated to detect the high levels of inflammation associated with acute illness or infection. High-sensitivity CRP (hsCRP) is calibrated at a much lower level and can detect the chronic, low-grade inflammation that simmers in the background without obvious symptoms. The American Heart Association and CDC have recognized hsCRP as a useful clinical marker, particularly for cardiovascular risk assessment. If you want this test, ask specifically for the high-sensitivity version. ## Sources - [Diabetes Care (American Diabetes Association): Fasting Insulin and the Metabolic Syndrome](https://diabetesjournals.org/care/article/32/7/1327/38756/Fasting-Insulin-and-the-Metabolic-Syndrome?ref=thatpaleochick.com) - [American Thyroid Association: Clinical Thyroidology for the Public, November 2018](https://www.thyroid.org/patient-thyroid-information/ct-for-patients/november-2018/vol-11-issue-11-p-10-11/?ref=thatpaleochick.com) - [National Institutes of Health, Office of Dietary Supplements: Vitamin D, Health Professional Fact Sheet](https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/?ref=thatpaleochick.com) - [Canadian Medical Association Journal: Iron supplementation for unexplained fatigue in non-anemic women: randomised double blind placebo controlled trial](https://www.cmaj.ca/content/179/4/373?ref=thatpaleochick.com) - [American Heart Association / CDC Joint Statement, Circulation: Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice](https://www.ahajournals.org/doi/10.1161/01.cir.0000063337.52885.f7?ref=thatpaleochick.com) - [CDC, National Diabetes Statistics Report: National Diabetes Statistics Report](https://www.cdc.gov/diabetes/data/statistics-report/index.html?ref=thatpaleochick.com) - [Prostaglandins, Leukotrienes and Essential Fatty Acids (PubMed): The omega-3 index as a risk factor for cardiovascular disease](https://pubmed.ncbi.nlm.nih.gov/18561128/?ref=thatpaleochick.com) --- *This article is for general informational purposes only and is not medical advice. Always consult a qualified healthcare professional before making changes to your diet or health routine.*