The Fantasy of the One Thing

There is something incredibly satisfying about finding an abnormal lab result when you have felt like crap for a long time. I know that probably sounds strange. Nobody actually wants something to be wrong with them, but when you have been tired, cold, bloated, unable to lose weight, struggling with your mood, sleeping poorly, or simply feeling like something isn't right, there can be a weird sense of relief in finally seeing a number on a piece of paper that says, There it is. That's the problem.

I've done this myself. There have been times when I've been exhausted and cold all the time and thought, surely this is my thyroid. It makes perfect sense. Let's run the labs, find the problem, fix my thyroid and move on with my life. Except then my thyroid numbers came back looking perfectly fine. Good news, technically. Frustrating news when you're still standing there thinking, Okay, then why the hell am I so tired?

I see versions of this with patients and clients all the time. Someone struggling with weight wants to see hormones that are spectacularly out of whack because then there would be an explanation. Someone with digestive problems almost hopes the stool test finds a parasite—not because anybody actually wants a parasite, but because a parasite is wonderfully concrete. There. That's why my stomach has been a disaster. Get rid of that and we're done. Someone who's exhausted wants us to find the thyroid problem, the iron deficiency, the vitamin D deficiency, the reactivated Epstein-Barr virus, the missing nutrient, the single abnormal number that finally explains why they haven't felt like themselves.

I completely understand the desire because there is comfort in believing there is One Thing.

Maybe that's why, after talking about Hobbit Day and The Lord of the Rings this week, my brain ended up here. We want the health equivalent of the One Ring: one thing powerful enough to explain everything else. One diagnosis to rule them all. One lab value. One hormone. One deficiency. One supplement. One answer that allows the whole complicated mess to suddenly make sense.

Unfortunately, bodies tend to be considerably more complicated than Middle-earth.

Sometimes There Really Is a Thing

Before I go any further, I don't want to swing too far in the opposite direction and pretend that testing doesn't matter or that everything can be fixed by sleeping eight hours and eating your vegetables. Sometimes we actually do find something significant, and sometimes it changes everything.

I've experienced that side personally too. When my thyroid wasn't providing the satisfying explanation I wanted for my fatigue, further investigation eventually showed evidence consistent with Epstein-Barr reactivation. Suddenly there actually was something staring me in the face that could help explain why I was so profoundly tired. Addressing it wasn't a magical overnight fix, and treatment wasn't particularly simple, but it helped significantly.

I've also seen people who were told their “thyroid was normal” when the only thing that had been checked was a TSH. A more complete evaluation can sometimes reveal additional pieces of the picture, including thyroid hormone patterns or elevated thyroid antibodies that warrant attention. I've seen people with gastrointestinal symptoms where testing really did identify a parasite. I've seen vitamin D levels come back profoundly low, or a full iron evaluation reveal depleted iron stores that weren't obvious from simply looking at hemoglobin and hematocrit. Finding and addressing those things matters.

Sometimes you open the lab report and essentially think, Oh. Well, there it fucking is.

Those moments can be enormously validating, especially for someone who has known for months or years that something wasn't right. Appropriate testing, diagnosis and treatment matter. Conventional medical care matters. Looking more deeply when symptoms warrant it matters. I have no interest in replacing one oversimplification—“your basic labs are normal, so you're fine”—with another one—“labs don't matter, just improve your lifestyle.”

The problem is that even when we find The Thing, it rarely exists alone.

If someone's iron stores are depleted, replacing iron may be important, but I also want to know why they're depleted. Are they having heavy periods? Are they getting enough iron in their diet? Is there a gastrointestinal issue affecting absorption? Is there blood loss somewhere that requires medical evaluation? If someone's vitamin D is extremely low, getting that level back into a healthier range may help them feel considerably better, but adequate vitamin D doesn't automatically give them restorative sleep, nourishing food, movement, relationships, manageable stress and a life they enjoy.

The abnormal result can be real without being the entire story.

Sometimes There Is a Whole Damn Fellowship

The much less satisfying answer is that sometimes we look and there isn't one enormous abnormality waiting for us.

Maybe your hormones aren't perfect, but they aren't spectacularly abnormal either. Maybe your progesterone or testosterone is a little lower than we'd like, or estrogen is doing something worth paying attention to, but there isn't a giant flashing sign saying THIS IS WHY YOU CAN'T LOSE WEIGHT. Maybe your gut testing doesn't reveal the dramatic parasite you were half hoping to find, but your commensal bacteria could use some support. Maybe your thyroid looks good. Maybe your iron isn't terrible. Maybe there isn't one single result that explains why you feel terrible.

Instead, there may be six relatively unimpressive things happening at once.

You're sleeping six hours a night. Work has been brutal. You're skipping meals and then eating whatever is easiest because you're exhausted. Your iron stores aren't ideal. You haven't been moving very much because you don't have the energy. You're drinking more caffeine to compensate, which isn't helping your sleep. You're stressed about money. You haven't done anything purely because it brings you joy in months. Maybe your hormones are changing too. None of those things individually gives us the satisfying movie moment where the detective slams the evidence onto the table and announces that the case has been solved.

Together, though? You feel like shit.

There isn't One Ring.

There's a whole damn fellowship.

This is one reason I talk so much about looking at the whole forest instead of becoming completely fixated on one unhappy tree. Our bodies don't exist as separate little departments. Sleep affects appetite, mood, pain, blood sugar, hormones and energy. Pain affects sleep and movement. Stress affects digestion and appetite. Nutrition affects energy and recovery. Hormonal changes can affect sleep, mood, temperature regulation and body composition. Financial stress can affect what food you can buy, how much you have to work and whether you have time to rest. Everything keeps bumping into everything else because that's what happens when you are a human being rather than a collection of independent organ systems.

That doesn't mean everything is connected to everything in some mystical way that allows us to explain every symptom with “inflammation” or “cortisol” or whatever happens to be popular on wellness Instagram this month. It means context matters.

The Most Basic Things Aren't Actually That Simple

This whole train of thought started because I saw a meme that essentially said everyone is looking for The Vitamin, but the vitamin is eight hours of sleep, eating nutritious food, exercise, sunlight, work-life balance and time with people you love.

And I agree with the spirit of that. I really do.

I also think calling those things “simple” can hide how profoundly difficult they can be.

“Get more sleep” sounds like the easiest recommendation imaginable until you're working two jobs, raising a baby, caring for an aging parent, living with chronic pain, dealing with insomnia, working nights, lying awake worrying about money, or—in my current situation—living with a puppy who believes 5:30 in the morning is an excellent time to begin conducting business.

“Eat nutritious food” sounds simple until we account for money, time, access, executive function, sensory issues, cooking skills, fatigue and the fact that somebody still has to plan, purchase, prepare and clean up after all of those nutritious meals.

“Exercise regularly” sounds simple until you're exhausted, injured, chronically ill, working twelve-hour shifts or don't have somewhere you feel comfortable exercising.

“Reduce your stress” might be one of the most useless pieces of health advice ever delivered without also asking what is creating the stress and whether any of it can realistically be changed.

Simple is not the same thing as easy.

At the same time, I think we've built a culture that often treats ignoring our basic needs as admirable. Sleep less. Work harder. Grind. Get another job. Optimize every minute. Turn your hobby into a side hustle. Be productive. If you're overwhelmed, somebody else is more overwhelmed, so stop complaining and keep going.

We even compete over who has earned the right to be tired. Someone without children says they're exhausted and gets told, “Just wait until you have kids.” Someone with one child gets told they don't understand what it's like to have three. Someone struggling with work hears that somebody else works two jobs. Someone with an invisible chronic illness may look perfectly capable from the outside while using an enormous amount of energy just to keep functioning.

Eventually, by that logic, only the single most exhausted human being alive is allowed to take a nap.

Your body doesn't care whether somebody else has a “better” reason to be tired.

We Have Also Made Wellness Weirdly Expensive

Then there is the other side of this. While one part of our culture glorifies running ourselves into the ground, another part has turned taking care of ourselves into an elaborate shopping experience.

Apparently wellness now requires the right wearable, red-light panel, sauna, cold plunge, grounding sheets, organic everything, twelve supplements, an elaborate morning routine and possibly a small room of your house dedicated entirely to biohacking.

I like tools. I recommend supplements. I use herbs, acupuncture, homeopathy, nutrition, functional testing and plenty of things that cost money in my own practice. Some expensive tools are genuinely useful for some people. This isn't an argument that none of those things matter.

But they aren't prerequisites for caring for yourself.

Sometimes taking care of yourself is remarkably boring. Going to bed. Eating an actual meal. Taking the medication you're supposed to take. Going outside. Moving your body in a way you don't hate. Drinking water. Going to the doctor's appointment you've been putting off. Doing your physical therapy exercises. Calling someone you love. Spending twenty minutes doing something that brings you joy and produces absolutely nothing useful.

And then doing those things again tomorrow.

There's not much money to be made selling the revolutionary concept of going to bed on time.

Maybe What We Really Want Is Certainty

The more I think about it, the less I think the fantasy of The One Thing is really about thyroid hormones or iron or gut testing or vitamins.

I think it's about certainty.

When you've felt bad for a long time, you want someone to tell you why. You want reassurance that what you're experiencing is real. You want a name for it. You want something you can point to. Most of all, you want someone to tell you what to do next.

Tell me why I feel this way. Tell me what I need to fix. Tell me this can get better.

Of course we want that.

And sometimes medicine can give us a beautifully clear answer. Sometimes the test comes back, the diagnosis fits, treatment works and we get to watch someone feel dramatically better.

Other times healing looks much less cinematic.

It's noticing that three or four things are each contributing a little bit. It's treating the deficiency while also figuring out why it happened. It's supporting hormones while acknowledging that hormones don't exist independently of the rest of your life. It's improving sleep slowly. It's eating breakfast more consistently. It's finding movement your body tolerates. It's treating the medical condition while also making room for joy. It's accepting that one supplement probably isn't going to undo five years of running yourself into the ground.

Looking at the whole forest also doesn't mean you need to fix every tree at once. That's another trap wellness culture is very good at creating. Suddenly someone who came in because they're tired leaves believing they need a new diet, twelve supplements, a sleep routine, meditation, strength training, a sauna, a gratitude practice and seventeen laboratory tests.

That's not particularly healing either.

Sometimes the most useful thing we can do is look at the whole forest, figure out which two or three things need attention first, and start there.

Maybe there is a One Thing hiding somewhere in your story.

Maybe there isn't.

Maybe there's a whole damn fellowship.

Either way, you don't have to solve all of Middle-earth before you can start feeling better.

Want to figure out whether you have One Thing—or a whole damn fellowship? That’s where I can help. Schedule a free discovery call and let’s see if we might be a good fit to work together.