Why your "normal" labs aren’t actually normal

A patient came to see me last month carrying a stack of lab reports from her primary care visit. Every value was inside the reference range. Every value was marked, in green, as "normal." And yet she had been waking up exhausted, gaining weight despite eating less, losing her words mid-sentence, and trying not to cry at her own annual physical when the doctor told her, kindly, that her labs looked great.

She is not unusual. I see some version of her every week.

The gap she fell into is the same gap most patients fall into eventually. It is the difference between normal — the statistical average of a tested population — and optimal — the level at which a person actually feels well, functions clearly, and is biologically protected.

Most physicians are trained to look at the first number. I was trained to look at the second.

Where reference ranges actually come from

When your lab report says a value is "within normal limits," the lab is comparing your result to a reference range. That range is calculated by drawing blood from a large group of people, plotting the results, and drawing a line around the middle 95%.

Sounds reasonable. Until you ask: who is in that group?

The answer is, everyone who shows up to a lab. Which means it includes patients who are sick, patients who are stressed, patients on medications that distort results, patients in late perimenopause, patients with undiagnosed thyroid dysfunction, patients who don’t sleep, patients who haven’t eaten well in years. The reference range is the statistical norm of that population.

You are being compared to a group that is, on average, not particularly well.

What "optimal" actually means

The optimal range is something different. It is the level at which research has shown people feel their best — clear cognition, stable mood, durable energy, healthy body composition, low inflammation, lower long-term disease risk. It is consistently a narrower window than the reference range, and it sits in a different part of the curve.

A few examples I find myself explaining most often:

Vitamin D. Reference range: roughly 30 to 100 ng/mL. Optimal: closer to 60 to 70 ng/mL. The patient sitting at 32 ng/mL is told they’re fine. They are not fine. They are barely above the threshold the lab has decided to call "not deficient." Their immune function, mood regulation, and bone density are all measurably worse at 32 than at 65.

Vitamin B12. Reference range: 200 to 1100 pg/mL. Optimal: above 850 pg/mL. Patients with a B12 of 250 are routinely told they are normal. Most of them think and feel sharper once their level climbs above 850. The cognitive difference is not subtle.

Ferritin (iron stores). Reference range often starts at 11 or 13. Optimal in most patients: 60 to 200 ng/mL. A patient with ferritin in the 30s is statistically "normal" and clinically exhausted. Her hair is thinning. She is short of breath on the stairs. The number on the report is technically inside the line.

Free T3 (the active thyroid hormone). Standard panels usually only test TSH, which is a pituitary signal, not a thyroid output. When we run Free T3 directly, optimal is in the upper third of the range. Most patients are in the lower third — flagged as "normal" because they fall above the absolute floor, but functionally hypothyroid in the way that matters: fatigue, weight retention, cold hands, sluggish cognition.

Fasting insulin. Almost never tested on a standard panel. Optimal is below 7 µIU/mL. Patients with fasting insulin of 12 — not technically diabetic, not technically pre-diabetic — are insulin-resistant for years before glucose ever flags abnormal. By the time glucose moves, the metabolic damage has been compounding for a decade.

The pattern is the same across all of them. The reference range is wide enough to call most people normal. The optimal range is narrow enough to actually predict how someone will feel.

Why this matters

Most patients who come to me have already seen a competent physician. They are not failed by a bad doctor. They are failed by a framework that asks the wrong question — is this person sick? — instead of the right one — is this person well?

Being not-sick and being well are not the same thing. Most of medicine is organized around the first question. The Meliora Method is organized around the second.

When we interpret labs against optimal ranges, three things change. First, we find imbalances ten years earlier — when they are still easy to correct. Second, we connect symptoms that have been dismissed as "just stress" or "just aging" to a measurable physiological driver. Third, we give the patient a target. Not "your numbers are fine." A real target — what we are moving toward, what to expect, how long it takes, what changes first.

The honest answer

Is the reference range useless? No. It is genuinely valuable for ruling out frank disease. If your TSH is 12, you have hypothyroidism and the lab will tell you so. That work matters.

But the reference range was never designed to answer the question most patients are actually asking when they walk into a doctor’s office. They are not asking, am I sick? They are asking, why don’t I feel like myself?

For that question, the right tool is an optimal-range framework — applied alongside, not instead of, conventional medicine. And it is the foundation everything else at Meliora is built on. Hormone Rebalancing, Nutrient Repletion, Gut and Detox Optimization, Stress and Adrenal Regulation, Metabolic and Mitochondrial Support — every one of those pillars depends on reading labs against what is optimal for this patient, not what is statistically permissible across an unwell population.

If a doctor has ever told you your labs are normal, and you have walked out of the office wondering why you still feel terrible — you were not wrong, and you were not crazy. You were comparing yourself to a different standard than the one the lab was using.

That is the gap we close.

Dr. Rowena Chua is the founder of Meliora Integrative Medicine in Evanston, IL and is triple board-certified in Neurology, Integrative Medicine, and Obesity Medicine. A Northwestern University alum and longtime Evanston physician, she specializes in hormonal, metabolic, and neurological health.