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Home / What we treat / Gut & fatigue
Gut, fatigue & root-cause workup
Tired isn’t a diagnosis. We dig until it is one.
The comprehensive functional medicine workup for the symptoms your primary care doctor said were normal. Gut, fatigue, brain fog, hormone shifts, mood, sleep, recovery. The full diagnostic deep-dive most clinics don’t order.
Who it’s for
The “everything’s normal” patient.
Most of the people who book a comprehensive workup with us have already seen 3 to 7 doctors. They’ve been told it’s anxiety, IBS, “just aging,” or that their labs look fine. Sound familiar?
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Chronic fatigue
Tired even after sleep. Tired despite normal labs. Crashed by mid-afternoon, can’t recover from exercise, can’t think clearly. Conventional workup found nothing.
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Persistent gut symptoms
Bloating, irregular bowels, food reactions, reflux, abdominal discomfort. Years of trying probiotics, elimination diets, prescription PPIs. Still not right.
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Brain fog & cognitive changes
Memory slips, can’t focus, words don’t come, mental fatigue that started recently or worsened gradually. Neuro workup came back clean.
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Sleep that doesn’t restore
Falling asleep fine but waking at 2 to 4am. Sleeping 8 hours and feeling unrested. Vivid dreams, night sweats, cortisol-pattern wake-ups.
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Recovery and resilience loss
Workouts that used to be easy now wipe you out for days. Recovering slowly from minor illnesses. Tolerance for stress dropping.
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Mood, anxiety, irritability changes
Mood shifts that don’t feel like “just psychology.” New anxiety, irritability, or low mood that tracks with cycles, sleep, or food, suggesting a physiological driver beneath.
What we actually test
The labs your primary care probably won’t order.
Not a 4-marker basic panel. We look at the systems that drive how you feel.
Comprehensive thyroid
TSH, free T3, free T4, reverse T3, TPO and Tg antibodies. Functional reference ranges. Most PCPs run only TSH and call it done.
Full hormone cascade
Total + free testosterone, SHBG, sensitive estradiol, progesterone (cycle-timed when relevant), DHEA-S, cortisol patterns (4-point salivary or DUTCH when warranted), pregnenolone.
Functional gut testing
GI-MAP or GI Effects comprehensive stool analysis: pathogens, dysbiosis, beneficial flora, digestive function (elastase), inflammation (calprotectin), zonulin (intestinal permeability marker), opportunistic overgrowth.
Inflammation & metabolic
High-sensitivity CRP, homocysteine, fasting insulin, HbA1c, fasting glucose, advanced lipid (NMR or LipoProfile), uric acid, ferritin, full iron panel.
Nutrient & micronutrient
Vitamin D (25-OH), B12, folate (RBC and serum), magnesium (RBC), zinc, copper, full electrolyte panel. Methylation markers when MTHFR or homocysteine flag concern.
Targeted specialty (when indicated)
Organic acids (Genova, Mosaic), DUTCH hormone metabolites, mycotoxin urine panels, viral PCRs, food allergy panels (IgE only by default), heavy metal challenge tests when clinically appropriate.
We don’t order everything on everyone. Specialty testing is selected based on your specific symptoms and history. We’ll explain why we’re ordering each test before we order it.
How we work
Test broadly, treat sequentially.
The mistake most functional medicine practices make is throwing every supplement at every problem. We don’t. We start by understanding what’s actually driving your symptoms, then we treat the most active contributors first, in sequence, not all at once.
Common patterns we see and address: gut dysbiosis driving systemic inflammation and fatigue. Subclinical thyroid dysfunction with normal TSH but suboptimal free T3 and high reverse T3. HPA-axis dysregulation causing wired-tired patterns and disrupted sleep. Hormone declines in perimenopause/andropause that don’t meet conventional treatment thresholds but are clinically meaningful. Mitochondrial fatigue from chronic infection, stress, or environmental load.
We’ll lay out everything we find at the review visit, prioritize what’s most likely driving your symptoms, and treat in phases. We retest at 3 to 6 month intervals to track what’s changing.
Pricing
What’s included.
Free
initial visit
See if a comprehensive workup is the right next step. No commitment.
Comprehensive workup intake
$450
- • 60-minute video intake
- • Comprehensive lab orders sent to LabCorp/Quest near you
- • Specialty lab orders (GI-MAP, DUTCH, etc.) when indicated
- • 60-minute review visit when results return
- • Prioritized initial protocol with reasoning
Monthly protocol management
$175 /month
- • 30-minute video visit (monthly initially, then every 6 to 8 weeks once stable)
- • Protocol adjustments based on response
- • Direct provider messaging
- • Re-labs at 3 months and beyond as appropriate
Specialty labs (GI-MAP, DUTCH, mycotoxins, etc.) typically run $400 to 1,200 at intake, billed separately. Most patients budget $300 to 500/month during active treatment for targeted supplements and medications. Some labs may be insurance-billable starting Q3 2026 once credentialing completes.
The process
What to expect.
Intake (90 min) + labs.
Full clinical history, symptom mapping, comprehensive lab orders. Specialty testing when warranted. You draw locally; results take 1 to 3 weeks depending on the panel.
Review (60 min) + protocol.
We walk through every result. Prioritized initial protocol. Then monthly follow-ups to adjust based on how you respond.
An honest note
We can’t promise a single answer.
Chronic fatigue and gut symptoms usually have multiple contributors, not one neat diagnosis. Our goal is to identify the most active drivers and treat them in sequence. Sometimes we find a clear primary cause; often we find a layered picture that takes phased treatment to resolve.
We’ll be honest if we’re not finding what we hoped to find. We won’t invent diagnoses or push protocols that don’t fit. If the workup suggests you need a specialist we’re not (rheumatology, GI, endocrinology), we’ll tell you and refer.
Initial visit · $250 targeted or $450 comprehensive
Tell us a few things.
We’ll text you within one business day to confirm care path and pricing tier. Then we send your detailed intake form and, after your provider reviews it, a lab order. You draw labs, then we meet for your initial visit (paid at booking) where we cover your story, review your labs, and build your protocol in one go.
Common questions about the workup
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I’ve had labs run before. Why would your labs be different? +
Conventional primary care typically orders a basic metabolic panel, a CBC, maybe a TSH, and calls it “comprehensive.” A functional medicine workup looks at functional thyroid (free T3, free T4, reverse T3, antibodies), full hormone cascade (sex hormones plus DHEA, cortisol patterns), comprehensive gut testing (GI-MAP or GI Effects: pathogens, dysbiosis, inflammation markers, digestive function), nutrient status, inflammation panel (hs-CRP, homocysteine, fasting insulin, HbA1c), and often organic acids or methylation panels. We see things conventional labs miss because we order tests conventional labs don’t order. -
Will I leave with a diagnosis? +
Sometimes yes, often we leave with a clearer picture rather than a single diagnosis. Chronic fatigue and gut symptoms usually have multiple contributors, not one neat answer. Our goal is to identify the most active drivers (e.g., gut dysbiosis + thyroid dysfunction + suboptimal sleep + low-grade inflammation) and treat those in sequence. We’ll be honest if we don’t find a clear cause. -
How is this different from a Parsley Health or Function Health membership? +
Parsley and Function are subscription-model annual memberships at $200 to 500/month, primarily focused on prevention and optimization for already-relatively-healthy people. We’re structured for patients with active, persistent symptoms who need targeted diagnostic work and treatment, not a quarterly health-check membership. We’re a clinical practice. They’re a wellness subscription. Both have a place; ours is built for people who actually feel sick. -
What about food sensitivity testing? +
We’re cautious here. IgE allergy testing is well-established. IgG “food sensitivity” testing has weaker evidence and frequently produces false positives that lead to unnecessary food restriction. We use elimination diets (the gold standard for identifying food triggers) more often than IgG panels. If you specifically want IgG testing, we’ll discuss the limitations honestly before ordering. -
Do you treat SIBO, leaky gut, candida? +
Yes, when there’s clinical and lab evidence supporting the diagnosis. SIBO has reasonable diagnostic testing (lactulose breath test) and treatment protocols. Intestinal permeability (“leaky gut”) is a real phenomenon with evolving research and treatable contributors. Candida overgrowth is over-diagnosed in functional medicine but can be a real driver in some patients. We test before we treat, we don’t put everyone on the same anti-candida or anti-SIBO protocol. -
Do you do heavy metal testing? +
When clinically indicated. Provoked urine challenges (DMSA, EDTA) are controversial in the conventional medicine world but commonly used in functional protocols when heavy metal toxicity is suspected. We use them selectively, not as part of a routine workup. Hair mineral analysis can be useful for chronic exposure patterns. We’ll discuss what testing makes sense for your specific situation. -
How much does this cost? +
Comprehensive Functional Workup Intake: $450 (60-minute video, includes pre-visit intake review, comprehensive functional labs, initial protocol design). Specialty labs typically run $400 to 1,200 at intake depending on what we order. Ongoing monthly protocol management: $175/month. Most patients budget $300 to 500/month during active treatment for medications, targeted supplements, and follow-up labs. Some labs may be insurance-billable starting Q3 2026 once credentialing completes. -
How long until I feel better? +
Depends on what we find and how layered it is. Patients with primarily gut dysbiosis often see meaningful changes in 6 to 12 weeks. Hormone-driven fatigue typically improves within 2 to 3 months of starting an optimized protocol. Complex cases with multiple contributors take longer, often 6 to 12 months for substantial recovery. We’ll be honest about what we’re seeing and what the realistic timeline looks like for your case.
Stop being told it’s nothing.
Comprehensive Functional Medicine Intake ($450, 60 minutes). We’ll listen to what’s actually happening and tell you whether a comprehensive workup is the right next step.