Get to the Root of Your Autoimmune Symptoms

Can Functional Medicine Help If My Labs Are "Normal" But I Still Feel Awful?

Autoimmune symptoms can show up years before antibody panels or inflammatory markers turn clearly abnormal. Dr. Lisa Gengo looks past a single "normal" lab to the whole immune picture—gut health, nutrient status, stress, and family history—often catching the shift early, while standard labs still look fine. The goal isn’t another restrictive diet. It’s finding what’s actually driving your immune system into overdrive, and building a plan around more good food, not less.

Why a Former Cardiac Surgery PA Takes Autoimmune Symptoms Seriously

Before training in functional medicine, Dr. Gengo spent years working in cardiac surgery, including as Chief Physician Assistant at NewYork-Presbyterian/Weill Cornell. There, she cared for patients whose autoimmune conditions—lupus, rheumatoid arthritis, and others—carried a higher risk of heart disease than their chart numbers alone suggested, and whose early symptoms had often been dismissed for years before a diagnosis finally stuck.

That experience shapes how she evaluates autoimmune symptoms today. She doesn’t wait for every antibody to turn positive before taking a patient seriously. She looks at the whole picture—inflammation, gut health, nutrient status, and family history—to find out what’s actually driving the immune system into overdrive, while there’s still room to change course.

Autoimmune Disease Doesn’t Start the Day You’re Diagnosed

According to the American Autoimmune Related Diseases Association, autoimmune disease affects an estimated 50 million Americans—and for many, it takes years and multiple doctors before symptoms add up to a diagnosis. The immune system doesn’t flip from healthy to attacking overnight.

Think of your immune system as a smoke detector. In autoimmune disease, it starts going off at things that aren’t actually a fire—your own joints, thyroid, skin, or gut lining. Early on, the alarms may be quiet enough that labs still look normal, even as the underlying inflammation builds underneath the surface.

Why Autoimmune Health Is a Whole-Body Issue

Autoimmune conditions rarely travel alone. Having one—Hashimoto’s, for example—raises your risk of developing another, and chronic inflammation is closely linked to metabolic health, gut function, and even heart disease risk.

After years working in cardiac surgery, Dr. Gengo doesn’t look at autoimmune symptoms as an isolated problem. Inflammation and immune function are connected to nearly every system in the body, which is why her evaluation looks well beyond a single antibody panel.

A Closer Look at Your Immune System

Conventional care often waits for antibody levels to cross a diagnostic threshold. Functional medicine asks an earlier question: why is your immune system attacking your own tissue, and what can we do about it now? Depending on your symptoms and history, evaluation may include:

• Comprehensive thyroid panel, including antibodies
• Inflammatory markers such as CRP and ESR
• Relevant autoimmune antibody panels
• Gut health and intestinal permeability markers
• Nutrient status, including vitamin D, B12, and iron
• Medications, sleep, and stress that may be contributing

The goal isn’t to order every test available. It’s to ask the right questions so we can choose the right ones.

More Good Food, Not Less

This isn’t about eliminating every food group at once. It’s about adding more of the foods that calm inflammation and support gut health: protein and fiber at every meal, colorful vegetables, healthy fats, and foods that work with your immune system instead of against it. Many people find their symptoms ease over time—not because they’re white-knuckling restriction, but because their body has more support.

Curious what this looks like day to day? Read more in Hashimoto’s Disease: Recognizing the Sneaky Symptoms.