Symptom guide · Energy & fatigue
The sentence we hear most often is that everything looked fine on the tests. That is usually true — and at the same time insufficient. Routine tests are built to detect disease, not to explain why energy production is failing.
Clinical assessment by a licensed physician. Patients across Sweden and internationally.
4.87 ★★★★★ Highest rated in Sweden Verified patient reviews · Reco.se Reco.seVerifiedShort answer: fatigue with normal routine tests rarely has a single cause. The most common explanations are insufficient cofactors for cellular energy production, a disrupted circadian rhythm in the stress system, low-grade inflammation, borderline thyroid dysfunction, or sleep that is long enough but not restorative.
Mitochondria need B vitamins, magnesium, iron, CoQ10 and carnitine to convert food into energy. A normal blood level does not mean the process inside the cell is working — serum reflects transport, not function.
Cortisol should be high in the morning and low in the evening. After prolonged strain the curve flattens or shifts. Typical pattern: difficulty getting going, a dip mid-afternoon, paradoxically alert late at night.
Chronic immune activation consumes energy and affects the brain directly. It need not show as elevated CRP.
A TSH within the reference range does not exclude a thyroid contribution, particularly if antibodies are present or conversion from T4 to T3 is insufficient.
Eight hours in bed is not eight hours of recovery. Sleep apnoea and nocturnal stress activation produce normal sleep duration with absent recovery.
Ferritin in the lower part of the reference range often produces symptoms long before haemoglobin is affected, particularly in menstruating women.
The following should be assessed within conventional healthcare before any extended investigation. They are best excluded early and cost nothing to check.
No functional analysis replaces conventional medical assessment for these symptoms.
Several of the causes above can be investigated objectively. The table shows which measurement answers which question — which is warranted in your case depends on the symptom pattern, not on how comprehensive the panel is.
| Possible cause | What is measured | Analysis |
|---|---|---|
| Cellular energy production | Organic acids, amino acids, mitochondrial markers | NutrEval® FMV |
| Metabolic bottleneck without a blood draw | Organic acids via a urine sample at home | Metabolomix+ |
| The stress system's daily curve | Cortisol at several time points plus DHEA | Adrenocortex Stress Profile |
| Inflammatory baseline | Omega-3 index and omega-6/omega-3 ratio | Fatty Acid Analysis |
| Hormonal cause in women | Sex hormones, cortisol and melatonin over time | Women's Health+ |
MediBalans is the official Swedish distributor for Genova Diagnostics. Analyses are ordered after clinical assessment, sampling is usually done at home, and results are interpreted by a licensed physician alongside your history.
Full blood count, ferritin, B12, folate, TSH, glucose and CRP. It is free, fast and necessary before anything more advanced is meaningful. Ask to see the actual numbers, not just the message that everything was normal.
Rate your energy three times daily. The pattern is diagnostic: uniformly low energy points somewhere different from energy that is low in the morning and rises at night.
It is common, underdiagnosed and treatable. No nutritional analysis compensates for fragmented sleep.
Without measurement it is guesswork, and some supplements at high doses can shift other systems.
Why am I tired when all my tests are normal?
Routine tests are constructed to detect disease, not to describe function. They measure the concentration of a handful of substances in blood, not whether the biochemical processes requiring them are working inside the cell. A normal serum level can therefore coexist with a bottleneck in cellular energy production.
Which tests can show why I am tired?
Beyond the basic work-up, cellular energy production can be assessed via organic acids and amino acids, the stress system's daily curve via cortisol at several time points, and fatty acid status. NutrEval FMV costs SEK 12,200, Metabolomix+ SEK 8,100 and the Adrenocortex Stress Profile SEK 2,100 through MediBalans.
What is the difference between ordinary tiredness and burnout?
Ordinary tiredness improves with rest and sleep. In burnout, rest does not produce the same recovery, and fatigue is often accompanied by cognitive symptoms, disturbed sleep and reduced stress tolerance. If rest does not help, that is a reason to investigate further.
Can fatigue originate in the gut?
It can. Impaired nutrient absorption, low-grade gut inflammation and immune reactivity to foods can all contribute. If you have both digestive symptoms and fatigue, investigating the gut first is often reasonable.
An initial consultation gives a clinical assessment of your situation and a clear next step — which investigation is warranted, and which is not.
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