Chronic Symptoms—and Nobody Can Tell You Why?
Your immune system and metabolism may be sending warning signals long before you have a diagnosis.
By Dr. Greg Fors, Board-certified Chiropractic Neurologist
Clinic Director, Pain and Brain Healing Center
Chief Science Officer, Biospec Nutritionals
Key Takeaways
- Disease often develops silently for years before it earns a name.
- Autoantibodies can appear years before a clinical diagnosis.
- A positive ANA does not mean you have an autoimmune disease, but it may be worth investigating in context.
- Genetics loads the gun. Environment pulls the trigger.
- Normal blood sugar can hide high insulin, so fasting insulin and HOMA-IR may matter.
- The goal is to improve the biological terrain early rather than wait for a diagnosis.
Millions of people struggle with fatigue, aching muscles and joints, brain fog, digestive problems, headaches, poor sleep, weight gain, and other symptoms that never seem to have a clear explanation.
They are told their laboratory tests are "normal." But are we looking deeply enough?
One of the things I have learned during more than 40 years of clinical practice is that disease often does not suddenly appear one morning. The body may be struggling for years before enough damage has occurred to finally give the problem a name. Autoimmune disease can work the same way. Research has shown that autoantibodies may be present for years before an autoimmune disease becomes clinically apparent.[1,2]
If You Feel Chronically Inflamed, Ask About an ANA Panel
If you have chronic inflammation or unexplained symptoms, particularly if autoimmune disease runs in your family, talk with your doctor about whether an ANA panel is appropriate.
ANA stands for antinuclear antibodies. These are antibodies directed against components of our own cells. A positive ANA does not mean you have an autoimmune disease. ANA can also be found in otherwise healthy people.[3] But research has also found associations between higher ANA levels and metabolic abnormalities, inflammation, and immune dysfunction.[4]
Here's why I pay attention to it: autoantibodies can sometimes be detected years before an autoimmune disease becomes obvious enough to diagnose.[1,2] In one remarkable study of people who eventually developed lupus, autoantibodies were detected as much as 9.4 years before diagnosis.[2]
For more than 20 years, I have included ANA testing in my evaluation of new patients. When I find an elevated ANA, I start asking questions.
Does autoimmune disease run in the family?
Does the patient feel chronically tired, achy or inflamed? Are other markers of inflammation elevated? Is there insulin resistance or other metabolic dysfunction?
I don't look at one laboratory number. I look at the whole biological picture. That is especially important when someone has a positive ANA and a family history of autoimmune disease.
Genetics can create susceptibility. Then diet, metabolic dysfunction, gut problems, chronic stress, poor sleep, environmental exposures and other inflammatory burdens may add additional logs to the fire. Modern research likewise describes autoimmune disease as developing through interactions between genetic susceptibility and environmental influences.[5]
Genetics loads the gun. Environment pulls the trigger.
Don't Just Measure Blood Sugar—Measure Insulin
One of the most important pieces of this puzzle may be hiding in plain sight: insulin resistance.
You can have "normal" blood sugar while your pancreas is pumping out far too much insulin to keep it there. That is why I don't want to see glucose alone. I want to know the fasting insulin.
I want to calculate HOMA-IR, which uses fasting glucose and fasting insulin to give us a better picture of insulin resistance.
I also look at triglycerides, HDL cholesterol, the triglyceride-to-HDL ratio, waist size and other signs of metabolic dysfunction. Research supports the triglyceride-to-HDL ratio as a simple, useful indirect marker associated with insulin resistance.[6]
Why does this matter?
Because excess body fat and metabolic dysfunction are tied to chronic inflammatory signaling. Fat tissue is not simply a storage tank. Dysfunctional fat tissue can produce inflammatory signals such as TNF-alpha and IL-6, and inflammation and insulin resistance can feed each other.
Think of it as a fire that keeps feeding itself.
Blood sugar is the smoke. Insulin is the fire.
Measure the Fire
If you have unexplained chronic symptoms, I want more information than "your basic blood work looks fine." My evaluation always includes:
- ANA panel — looking for evidence of autoantibodies
- hs-CRP — measuring systemic inflammation
- Sedimentation rate (ESR) — another marker of inflammation
- Fibrinogen — an inflammatory and clotting-related marker
- Fasting insulin
- Fasting glucose
- HOMA-IR
- Hemoglobin A1c
- Triglycerides and HDL
- Triglyceride-to-HDL ratio
- Additional testing based on the patient's symptoms, history and family history
No single test tells the whole story. The pattern is what matters.
A Positive ANA Can Be a Window of Opportunity
This is where I want patients to change the way they think. Finding a positive ANA does not have to be frightening. It may be a window of opportunity.
If you have autoantibodies, inflammatory symptoms, metabolic dysfunction and a family history of autoimmune disease, why wait until enough tissue damage has occurred for somebody to finally give the condition a name?
This is when I want to improve the biological terrain. Remove ultra-processed food, added sugar and refined carbohydrates. Improve insulin sensitivity. Reduce excess visceral fat. Exercise. Build muscle. Improve sleep. Address gut dysfunction. Correct nutritional deficiencies. Reduce unnecessary environmental exposures. Manage chronic stress. And when appropriate, use targeted nutritional and botanical support for insulin resistance, oxidative stress and chronic inflammation.
This isn't about treating a laboratory number. It is about making the person healthier.
In my own clinical practice, I have followed patients with positive ANA results and family histories of autoimmune disease who did not yet have a diagnosable autoimmune disease. When we identified metabolic and inflammatory problems early and aggressively changed their lifestyle and physiology, I have seen remarkable improvements. Among the patients I have followed in this way, I have not observed this group progressing to a clinical autoimmune disease.
That is my clinical observation, not irrefutable proof. But after decades of caring for patients, it has profoundly influenced how I practice.
Don't Wait for the Diagnosis
Too much of medicine begins treatment after disease has already arrived. I would rather ask a different question: What can we change now?
If your immune system appears activated, inflammation is elevated, insulin is high, your metabolism is struggling, and autoimmune disease runs through your family, those findings deserve attention. You may not have an autoimmune disease yet. And the goal is to help keep it that way.
Need Help Finding the Root Causes?
At the Pain and Brain Healing Center, we use personalized functional medicine to investigate the metabolic, inflammatory, nutritional, gastrointestinal and lifestyle factors that may be contributing to chronic illness.
If you have unexplained fatigue, pain, brain fog, digestive problems, chronic inflammation, metabolic dysfunction, or a family history of autoimmune disease, we can help you look deeper.
Pain and Brain Healing Center
763-862-7100
painandbrainhealingcenter.com
Don't wait until your body has accumulated enough damage to finally earn a disease label. Find the fire—and start putting it out.
Scientific References
- Ma WT, Chang C, Gershwin ME, Lian ZX. Development of autoantibodies precedes clinical manifestations of autoimmune diseases: a comprehensive review. Journal of Autoimmunity. 2017;83:95–112. doi:10.1016/j.jaut.2017.07.003.
- Arbuckle MR, et al. Development of autoantibodies before the clinical onset of systemic lupus erythematosus. New England Journal of Medicine. 2003;349:1526–1533. doi:10.1056/NEJMoa021933.
- Tan EM, et al. Range of antinuclear antibodies in "healthy" individuals. Arthritis & Rheumatism. 1997;40:1601–1611. doi:10.1002/art.1780400909.
- Li X, et al. Antinuclear antibodies in healthy population: positive association with abnormal tissue metabolism, inflammation and immune dysfunction. International Immunopharmacology. 2022;113:109292. doi:10.1016/j.intimp.2022.109292.
- Pisetsky DS. Pathogenesis of autoimmune disease. Nature Reviews Nephrology. 2023. Review of genetic susceptibility, environmental factors, autoantibodies and preclinical autoimmunity.
- Scicali R, et al. The triglyceride/HDL ratio as a surrogate biomarker for insulin resistance. Biomedicines. 2024;12:1493. doi:10.3390/biomedicines12071493.
Dr. Greg Fors is Clinic Director of Pain and Brain Healing Center and Chief Science Officer of Biospec Nutritionals.
Related reading: Why Can't You Lose the Weight? Because Your Brain May Think You're Starving! · America's Metabolic Epidemic: Insulin Resistance Is Destroying Our Health One Meal at a Time · Why Your “Normal” Labs Don’t Explain Your Fatigue and Brain Fog, and What Tests Actually Help · Healthy Environment
Ready to look deeper instead of waiting for a diagnosis? Call 763-862-7100 or visit https://painandbrainhealingcenter.com/free-consultation-intake/ to explore a root-cause, functional medicine evaluation.
Educational only. This is not personal medical advice.
This article is for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment. Do not change medications or begin a new treatment program without speaking with a qualified healthcare professional.