“Your Bloods Are Fine” — The Difference Between Normal and Optimal (and what I’m looking for as your chinese medicine practitioner)
If you’ve ever been told “your blood tests are normal” but you still feel exhausted, flat, anxious, bloated, gaining weight or struggling with your hormones — this one’s for you.
Because “normal” doesn’t always mean “well.”
And for many women — especially those on fertility journeys, post-burnout, or in perimenopause — this gap matters more than we’re often led to believe (or told to even think twice about).
What “Normal” Actually Means
When blood test results are reviewed, they’re compared against a lab reference range. These ranges are created by testing large populations and statistically excluding extreme outliers. If your result falls within that middle range, it’s labelled normal.
What’s often missed is that these ranges include people who are chronically stressed, inflamed, nutrient deficient, sleep deprived and hormonally dysregulated. In other words, normal reflects what’s common — not what’s ideal.
From a medical perspective, ‘normal’ typically means there is no clear disease state or pathology that requires immediate intervention. It doesn’t necessarily mean your body is functioning well, resiliently, or in a way that supports energy, mood and hormonal balance.
This is especially relevant for women, whose physiology is far more dynamic and influenced by stress, life stage and hormonal fluctuation than a static reference range can capture.
What “Optimal” Means (Especially for Women)
Optimal levels aim to reflect where the body functions best, not just where it avoids diagnosis. These ranges are narrower and consider how nutrients, hormones and metabolic markers support real-life outcomes like stable energy, emotional regulation, cycle health and stress resilience.
For women, this distinction becomes crucial during times of increased physiological demand such as menstruation, pregnancy, postpartum, perimenopause and periods of chronic stress or burnout. A value that is technically ‘normal’ may still be insufficient to support these demands.
Research increasingly acknowledges that subclinical deficiencies, particularly in iron, B12 and thyroid function, can significantly impact wellbeing even when results fall within laboratory reference ranges.
Common Bloods That Are “Normal”… But Not Optimal
Iron & Ferritin
Ferritin is a marker of iron storage, and while many labs list values as low as 15–20 µg/L as normal, studies show that women often experience fatigue, hair loss and poor exercise tolerance at levels well above this. Research suggests ferritin levels closer to 50–100 µg/L may be more supportive for symptom-free functioning in menstruating women. When you’re coming to clinic with me, I want to see you at 80-100, especially if you’re struggling with fatigue, or trying to conceive.
Thyroid Markers
TSH alone is often used to screen thyroid health, yet it doesn’t always reflect how thyroid hormone is converted or utilised at a tissue level. Stress, inflammation and nutrient deficiencies can all impair conversion of T4 to active T3, leading to symptoms despite those ‘normal’ results. Many women with persistent symptoms fall into this grey zone of subclinical or functional hypothyroidism. I also like to check your reverse T3 and T4 levels as this can make a world of difference.
Vitamin B12
Low–normal B12 levels have been associated with fatigue, cognitive changes and mood symptoms, particularly in women with gut dysfunction or high stress loads. Functional deficiency can occur well before levels fall below your generic lab cut-offs.
Why Symptoms Matter More Than Numbers Alone
100% blood tests are valuable tools, but they are not standalone answers. Two people can have identical results and experience completely different levels of wellbeing. This is because symptoms reflect how the body is actually functioning day to day, not just what appears on a single snapshot in time.
Persistent fatigue, emotional overwhelm, sleep disruption, cycle changes or weight gain are signs that the body is under strain. Research supports that patient-reported symptoms often precede biochemical abnormalities and can indicate early dysfunction long before disease thresholds are crossed. Ignoring symptoms simply because results are ‘normal’ risks missing the window for early, preventative care - and if there’s one thing we love in Chinese medicine, it’s preventative, balanced care.
A TCM Perspective (Because the Body Is a System)
From a Traditional Chinese Medicine perspective, pathology may not yet be present even though the system is clearly struggling. Patterns such as Blood deficiency, Qi depletion, Liver stagnation or Kidney depletion can exist well before they appear on conventional testing.
This is often why women feel deeply validated when their experience is assessed through a whole-body lens in clinic. TCM focuses on patterns, relationships and trends over time, rather than isolated numbers, which aligns closely with modern functional and integrative medicine approaches.
Finally…
As a mould and CFS warrior, the amount of testing I’ve done that is ‘normal’ (but out of control via functional and integrative care providers) is wild. I see you!!
And if you’ve been told “everything looks normal” but your body feels anything but, you’re not being dramatic or imagining it. And indeed, you may well be functioning at normal; but farrrrr from optimal.
And you deserve better than just coping.
References
Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015.
Favrat B et al. Evaluation of iron deficiency without anemia. Blood. 2014.
Greenhalgh T et al. Evidence based medicine: a movement in crisis? BMJ. 2014.
Kaptchuk TJ. The Web That Has No Weaver. McGraw-Hill.
Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician. 2016.
Peeters RP. Subclinical hypothyroidism. Lancet. 2017.
Taylor PN et al. Guidelines for thyroid function testing. Clin Endocrinol. 2018.
Turner MR et al. Reference ranges and clinical decision-making. BMJ. 2018.