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A Message From Dr. Will Cole: "Your Labs Are Normal" Is Not the Same as "Your Tank Is Full"
If you have ever left a physical with perfect numbers and a nap schedule, this article is for you.
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There is a particular conversation I have heard hundreds of times in my career. It goes like this.
A woman in her late 60s sits down. She is tired in a way she was not five years ago. Her calves cramp at two in the morning.
Words she has known her whole life have started hiding from her mid-sentence. She has raised this with her doctor, responsibly, more than once. The labs come back.
And she hears the four words that are supposed to be good news and somehow land like a door closing: "Your labs are normal."
She believes her doctor. She should, the labs ARE normal. And so, with nothing left to blame, she blames the calendar. It must just be age.
She adjusts her expectations of herself downward, quietly, the way millions of people do every year.
Normal labs mean no disease was detected. They do not mean your tank is full.
What the Standard Panel Actually Checks
The panel at your annual physical is built to find disease:
blood sugar for diabetes, a metabolic panel for your kidneys and liver, a blood count for anemia and infection, cholesterol for cardiovascular risk. It is good at that job.
| Blood sugar, metabolic panel, blood count, cholesterol | Usually included |
| Vitamin B12 level | Not unless ordered |
| Magnesium level | Not unless ordered |
| CoQ10 level | Essentially never measured |
The three nutrients most involved in steady energy, calm muscles, and clear thinking are, for most people, simply not on the report that declared them normal.
And even when they are ordered, there are two honest problems with the word normal:
The Magnesium Problem
Less than 1% of your body's magnesium is in your blood at all. The NIH states plainly that serum levels correlate poorly with total body stores.
Your serum magnesium can read normal while your reserves run low. [1]
The B12 Problem
Normal ranges for B12 are wide and the cutoffs are debated. A reading can sit inside the range while sitting well below where you feel your best. [2]
Low-normal is normal on paper. It does not always feel normal at 3 p.m.
Now Add the Drain
For adults over 60 on daily medications, this measurement gap collides with a second, well-documented fact:
some of the most prescribed drugs in America gradually deplete these exact nutrients.
- Heartburn pills: Linked to malabsorption of vitamin B12 and magnesium, connected to muscle weakness, poor balance, and falls, per the Cleveland Clinic. [3]
- Metformin: One in five long-term users had low or borderline-low B12 in the Diabetes Prevention Program follow-up. [4]
- Statins: Work by blocking the same pathway your body uses to make CoQ10. [5]
- Water pills: Flush magnesium in the same water they were prescribed to remove. [1]
A person can be genuinely healthy by every measured standard, and genuinely running on a low tank, at the same time. Both things are true.
That is the whole mystery of "normal labs, tired anyway," and it never required the calendar to explain it.
What I Tell My Own Patients
Take the word normal as the beginning of a conversation, not the end of one.
The next sentence to say in the exam room: "Could we look at my B12 specifically? I'd also like to talk about magnesium, given my medications."
Compare backward, not just against the range. The most useful question is not "am I inside the normal range?" but "how do I feel against my own baseline from a year ago?"
Mind the forms. Most drugstore B12 must be converted before your body can use it and that conversion slows with age [2], and most drugstore magnesium is the oxide form, poorly absorbed.
Methylated B12 and peptide-bound magnesium exist precisely because the standard forms fail the people who need them most.
Introducing The Medicine Cabinet Refill
Steady in 90 nights. Two formulas, four capsules, one job: put back what your prescriptions use up.
That is the entire protocol. It fits the two moments you already own: breakfast, and lights-out. No new pills at lunch, nothing to remember at odd hours. And this matters: most people notice the nights change first, often within the first week. That is the magnesium. The morning half works quieter and slower, and we will show you exactly what to expect and when.
LongevityRx built the Refill for exactly the people on this page. MitoMultiply is methylated, pre-activated B vitamins built for how absorption works after 60, two capsules with breakfast. Mag18 is peptide-bound magnesium for the muscles that have been waking you at 2 a.m., two capsules before bed. Most people notice the nights change first, often within the first week.
Your order includes $212 in practical tools, free:
Your Order Includes:
BONUS First Three Chapters of Heal Your Cells, by Dr. Will Cole & Dr. Josh Axe
About the Author
Dr. Will Cole, MD
Functional Medicine Practitioner
Dr. Will Cole is a leading functional medicine practitioner who works to find the root cause of fatigue, inflammation, and hormone imbalance. After reviewing thousands of genetic profiles in his clinic, he formulated MitoMultiply for Longevity Rx to give the body the methylated nutrients it can actually use.
Frequently Asked Questions
Why isn't B12 checked at a normal physical?+
The standard panel is built to catch disease markers your doctor is watching for at night, like your A1c, blood pressure, and kidney function. B12 is not part of that default panel. The American Diabetes Association's own Standards of Care say measurement should be considered for people on long-term metformin, but "considered" is easy to lose inside an eleven-minute visit unless someone asks for it directly.[1]
How common is B12 deficiency in people on metformin?+
In the Diabetes Prevention Program Outcomes Study, 19.1% of long-term metformin users had low or borderline-low B12 at five years, compared with 9.5% on placebo. By year thirteen, it was 20.3%, roughly one in five. Each additional year of use raised the odds of deficiency by 13%.[2]
What does low B12 actually feel like?+
It tends to show up slowly, which is part of the problem. Tiredness that gets filed under age. Tingling feet that get filed under diabetes. Foggy thinking that gets filed under getting older. These symptoms look exactly like what people already expect to feel in their 60s and 70s, which is why a test matters more than a guess.
Should I stop taking metformin?+
No. Metformin has decades of evidence behind it and has helped protect many people from the consequences of uncontrolled blood sugar. Nothing here suggests stopping or changing it. The point of this page is the nutrient it can quietly use up over time, not the medication's value. Never stop or change a prescription medication without consulting your healthcare provider.
What should I actually say to my doctor?+
Something as direct as: "I've been on metformin for years. Could we check my B12?" This is already inside the ADA's own published Standards of Care, so it is not an unusual request. Bringing a printed summary with citations can help keep the conversation short and specific.
Why does the form of B12 matter?+
Most drugstore B12 is cyanocobalamin, a form your body has to convert before it can use it, and that conversion slows with age. Methylated B12 arrives already in the active form, which is why it's used instead of cyanocobalamin in formulations built for this stage of life.[3]
What if my B12 test comes back normal?+
That's a genuinely good outcome, and the honest majority result: about four out of five long-term metformin users are not in the low range. A normal result means one less thing to wonder about. The point of testing is finding out which group you're in rather than guessing.
You Have Two Options From Here
Keep doing what you have been doing. Your metformin keeps working exactly as it should. The B12 test the ADA's own Standards of Care say should be considered stays unordered, and the tiredness, the tingling feet, or the foggy thinking that might actually be telling you something keep getting filed under age, diabetes, or just getting older instead.
Start tonight, and give your body back what your metformin has been quietly using up. Methylated B12 in the morning, peptide-bound magnesium at night, two capsules each. That's the whole routine. Most people notice their nights change first, often within the first week. Score yourself tonight, score yourself again in 90 nights, and if nothing has moved, the 90-Night Guarantee means every dollar comes back.
This offer is available for a limited time.
The Medicine Cabinet Refill
Steady in 90 nights. Two formulas, four capsules, one job: put back what your prescriptions use up.
That is the entire protocol. It fits the two moments you already own: breakfast, and lights-out. No new pills at lunch, nothing to remember at odd hours. And this matters: most people notice the nights change first, often within the first week. That is the magnesium. The morning half works quieter and slower, and we will show you exactly what to expect and when.
LongevityRx built the Refill for exactly the people on this page. MitoMultiply is methylated, pre-activated B vitamins built for how absorption works after 60, two capsules with breakfast. Mag18 is peptide-bound magnesium for the muscles that have been waking you at 2 a.m., two capsules before bed. Most people notice the nights change first, often within the first week.
Your order includes $212 in practical tools, free:
Your Order Includes:
References
- [1] NIH Office of Dietary Supplements. Magnesium Fact Sheet for Health Professionals. ods.od.nih.gov.
- [2] NIH Office of Dietary Supplements. Vitamin B12 Fact Sheet for Health Professionals. ods.od.nih.gov.
- [3] Cleveland Clinic. Sarcopenia (Age-Related Muscle Loss).
- [4] Aroda VR, et al. Long-term Metformin Use and Vitamin B12 Deficiency in the DPPOS. J Clin Endocrinol Metab. 2016;101(4):1754-1761.
- [5] Qu H, et al. Effects of Coenzyme Q10 on Statin-Induced Myopathy. J Am Heart Assoc. 2018;7(19):e009835.
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Never stop or change a prescription medication without consulting your healthcare provider.