Dr. Mariah, ND
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Registered Naturopathic Doctor ยท Woodstock & virtual across Ontario

How I approach common health concerns

This page is here so you know how I think before you book. It covers fertility and preconception, pregnancy and postpartum, periods and the menstrual cycle, PMOS, metabolic health, men's health, thyroid, perimenopause, digestion, fatigue, and stress and sleep. Each one follows the same walkthrough, from the first visit to how progress gets measured.

When appropriate, patients can ask their MD or NP whether medically indicated testing can be ordered through OHIP. Coverage varies by test and clinical situation. Tests ordered by a naturopathic doctor are paid privately.

How I approach Fertility & preconception

A lot of people booking for fertility have been tracking their cycles for months and still are not sure whether they are ovulating, when their fertile window actually is, or what should be looked at before they keep trying. Many have heard that everyone should wait a full year before anyone looks closer. The right timing depends on age and history. Irregular or absent cycles, suspected endometriosis, recurrent pregnancy loss, or a known sperm concern are all reasons to look sooner.

  1. What the first visit covers

    A first visit runs 60 to 75 minutes. We go through your cycle: length, regularity, flow, pain, spotting, and any ovulation signs you have noticed. Then how long you have been trying, previous pregnancies or losses, your contraception history, and everything you currently take, including your prenatal and folic acid. The foundations come next: protein, fibre, sleep, movement, alcohol, caffeine, and stress. If a medical condition should be stable before pregnancy, or your partner's health is part of the picture, we cover that too.

  2. What testing may look like

    Testing is chosen from your history, and only where the result would change what happens next. Depending on your situation, that may include reproductive hormones drawn at the right point in your cycle, TSH and free T4, prolactin, a CBC, ferritin, B12, vitamin D, or glucose and A1C. When confirming ovulation matters, progesterone is drawn about seven days before your expected period. A single value can support that ovulation happened recently; it cannot grade the whole second half of your cycle. A semen analysis is worth arranging early, and uterine or tubal assessment is referred out when your history points there.

  3. What a plan may include

    A plan usually starts with nutrition and preconception nutrients, including a review of your prenatal and folic acid. Then sleep, movement, and stress, along with alcohol, smoking, and cannabis where they apply. Supplementation is added where your labs support it, for example iron when ferritin is low. If you are already working with a fertility clinic or on medicated cycles, naturopathic care runs alongside that treatment.

  4. How progress is monitored

    Cycle and ovulation tracking stay in the plan while they are giving useful information, and come out when they are adding stress without adding answers. Markers that came back abnormal, or that affect the plan, are rechecked on a timeline that suits each one.

  5. When I refer or collaborate

    I refer for a fertility workup based on your age, how long you have been trying, your cycle history, recurrent loss, suspected tubal or uterine concerns, or a possible sperm factor. Your family physician, NP, midwife, obstetrician, or fertility clinic stays part of the team, and I collaborate with them.

Every plan is individualized, and no particular outcome can be promised.

Book an appointment Read the guide to naturopathic fertility care

How I approach Pregnancy & postpartum

Pregnancy and postpartum needs change from one month to the next. A lot of people booking at this stage are dealing with nausea, reflux, constipation, fatigue, questions about iron or blood sugar, broken sleep, feeding, or recovery after birth, and they are not sure which supplements are actually safe to take. Naturopathic care here works alongside your prenatal or postpartum team.

  1. What the first visit covers

    A first visit runs 60 to 75 minutes. We start with how far along you are or how long it has been since birth, who is on your prenatal care team, and your pregnancy and birth history. Then current symptoms, including any warning signs, and everything you take: medications, prenatal vitamins, herbs, and supplements. The foundations follow: nutrition, hydration, protein, fibre, what food you can tolerate right now, sleep, movement, mood, and how much support you have at home.

    Then for postpartum support, that means addressing concerns around feeding and lactation, bleeding, pain, pelvic floor symptoms, birth recovery, and whether your cycle has returned. This will often look like coordinated care with a lactation consultant, and/or a pelvic floor physiotherapist.

  2. What testing may look like

    Routine prenatal screening and obstetric testing stay with your prenatal team. What I can do is review the results you already have and help you put together questions to bring back to your MD, NP, midwife, or obstetrician. Any additional testing is driven by your history and stays within my scope. Postpartum, depending on your symptoms, that may include a CBC, ferritin, B12, vitamin D, thyroid markers, or a glucose assessment.

  3. What a plan may include

    A plan may include meal strategies for your trimester or postpartum phase, with attention to protein, fibre, hydration, and what you can keep down. Your prenatal and every other supplement get reviewed for safety at this stage. Nutrients are added where labs support them. Support for nausea, reflux, constipation, fatigue, and postpartum recovery stays within scope and is coordinated with your prenatal or postpartum care team.

  4. How progress is monitored

    We follow your symptoms, how well you are tolerating food, the lab markers that were relevant, and how recovery is going, and the plan shifts as your stage changes.

  5. When I refer or collaborate

    Urgent or obstetric concerns go straight to your prenatal provider, urgent care, or the emergency department. That includes significant bleeding, severe abdominal pain, a severe headache or changes in vision, chest pain, shortness of breath, fever, reduced fetal movement later in pregnancy, or a mental health crisis. Postpartum, concerning bleeding, severe pain, wound concerns, signs of infection, breastfeeding complications that need medical or lactation care, and significant mood symptoms get a prompt referral.

Every plan is individualized, and no particular outcome can be promised.

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How I approach Periods, hormones & menstrual cycle concerns

A lot of women booking for their periods have already been told their blood work is normal and that this is just what periods are like. Heavy bleeding, cramps that take a day out of the month, spotting between periods, PMS that starts two weeks early, cycles that are irregular or have stopped altogether. Normal blood work does not make disruptive symptoms normal, and it does not rule out every possible cause. Each of these points somewhere different, so each gets worked up on its own terms.

  1. What the first visit covers

    A first visit runs 60 to 75 minutes. We go through your cycle in detail: length and how much it varies, how heavy the bleeding is, flooding, clots, spotting or bleeding between periods, where the pain sits and how bad it gets, and when PMS starts. Then ovulation signs where they matter, your history with hormonal contraception, whether pregnancy is possible, and any signs of higher androgens like acne or unwanted hair growth. We look at recent changes in food intake, exercise, weight, sleep, or stress, and at personal or family history of bleeding disorders, fibroids, endometriosis, adenomyosis, thyroid disease, or PMOS.

  2. What testing may look like

    Testing follows the presentation, because a heavy period and a missing one raise different questions. Depending on your history, that may include a pregnancy test, a CBC and ferritin for heavy or prolonged bleeding, TSH when thyroid dysfunction is possible, prolactin for certain cycle patterns, and FSH, LH, estradiol, or progesterone drawn at the right point in your cycle when the result would answer a specific question. Androgens are checked when the picture calls for it. Pelvic imaging or a gynecology assessment may be the next step: ultrasound can find fibroids, adenomyosis, endometriomas, or deep endometriosis, though a normal scan does not completely exclude endometriosis.

  3. What a plan may include

    Foundations first: nutrition, sleep, and a training load your body can recover from. Iron comes in only where ferritin or your bleeding pattern supports it, and other supplements are chosen for the symptom and the labs in front of us. If hormonal contraception or another medical treatment is the right tool for you, naturopathic care is coordinated with it.

  4. How progress is monitored

    We track your cycles, bleeding, and pain in writing, and recheck the markers that were off at intervals that suit them, so changes show up on paper instead of relying on memory of a bad month.

  5. When I refer or collaborate

    Suspected fibroids, endometriosis, or adenomyosis need imaging and often a gynecologist. Very heavy bleeding, bleeding with dizziness or fainting, or severe pain that is new or getting worse needs urgent assessment. If your history points anywhere else outside my scope, I refer out or collaborate with your MD.

Every plan is individualized, and no particular outcome can be promised.

Book an appointment Read the guide to hormonal imbalance

How I approach PMOS (formerly PCOS)

A lot of women booking for PMOS (polyendocrine metabolic ovarian syndrome, formerly PCOS) have already had the diagnosis for years. They were told to come back when they want to get pregnant, or handed birth control as the only option, and nobody walked them through what is actually going on with their insulin, androgens, and cycles. The name changed in 2026; the diagnosis and the criteria did not.

  1. What the first visit covers

    A first visit runs 60 to 75 minutes. Before anything else, we go through the foundations: what your meals look like, protein and fibre intake, sleep, stress, movement, and your full cycle history.

  2. What testing may look like

    Testing starts with blood work, not expensive functional panels. Depending on your history, that may include fasting insulin and glucose, free and total testosterone, DHEAS, a thyroid panel, iron, B12, and vitamin D. Test, do not guess.

  3. What a plan may include

    A plan usually starts with foundations: nutrition targets, strength training, and sleep. From there it may layer in targeted supplements where your labs support them. If pharmaceuticals like metformin or hormonal birth control are the right tool for you, naturopathic care works alongside them, never against them.

  4. How progress is monitored

    Progress gets measured, not guessed at. We retest the same markers at defined intervals and track your cycles, so both of us can see what is changing on paper.

  5. When I refer or collaborate

    If something sits outside my scope, I refer out or collaborate with your MD.

Every plan is individualized, and no particular outcome can be promised.

Book an appointment Read the guide to naturopathic care for PMOS

How I approach Metabolic health & insulin resistance

A lot of people booking for metabolic health have been told everything looks fine, often on the strength of a normal fasting glucose. They still crash after meals, crave sugar in the afternoon, feel hungry again an hour after eating, or have a strong family history of type 2 diabetes. Those symptoms do not diagnose insulin resistance by themselves. They are a reason to look at the fuller picture, since metabolic changes can build for years before diabetes shows up on a lab report.

  1. What the first visit covers

    First visits run 60 to 75 minutes. We go through what your meals look like, including protein, fibre, carbohydrates, fats, and added sugar, and how hunger, fullness, cravings, and energy behave after you eat. Then movement, strength training, and how much of the day is spent sitting. Sleep gets real attention, including snoring and other signs of sleep apnea. We also cover stress, alcohol, smoking, medications, blood pressure history, and family history of diabetes, heart disease, and high cholesterol, along with PMOS or blood sugar concerns during a past pregnancy. Weight and waist changes come up only when they are clinically useful, and without judgment.

  2. What testing may look like

    Testing depends on your history. That may include fasting glucose, A1C, a lipid profile, a blood pressure reading, and liver enzymes or other metabolic markers. A 75-g oral glucose tolerance test may make sense in some cases, coordinated with your MD or NP. Glucose and A1C describe your blood sugar status; fasting insulin is a separate measurement. In selected cases it adds a data point, but one fasting insulin value cannot establish or rule out insulin resistance, and it is not a screening test for everyone.

  3. What a plan may include

    A plan starts with nutrition targets built around your meals. For a lot of people the Rule of 30 is a practical frame: about 30 grams of protein at each meal, 30 grams of fibre a day, added sugar under 30 grams, and 30 minutes of movement. Resistance training and regular movement carry a lot of the weight, and sleep comes next, with a sleep apnea follow-up where it is indicated. Supplementation is added where your labs support it. If metformin, a GLP-1 medication, lipid treatment, or diabetes management is part of your care, naturopathic care is coordinated with your MD or NP.

  4. How progress is monitored

    We track the markers that were actually abnormal or relevant for you, on a schedule that suits each one, along with energy, hunger, and how meals are sitting. The goal is a change in those markers and in how you feel day to day; weight loss is never the promised outcome.

  5. When I refer or collaborate

    Diabetes, very high blood sugar, concerning blood pressure, significant liver abnormalities, suspected sleep apnea, and anything that needs medication management go to your MD or NP. I refer out or collaborate.

Every plan is individualized, and no particular outcome can be promised.

Book an appointment Get the Rule of 30 printable

How I approach Men's health, hormones & fertility

A lot of men book because something has been off for a while and no one has looked closely. Energy is flat, training is not producing what it used to, sleep is broken, libido has changed, or they are planning a pregnancy with a partner and want to know what their side of the picture looks like. In-person appointments are at either Woodstock location, and virtual visits are available anywhere in Ontario.

  1. What the first visit covers

    A first visit runs 60 to 75 minutes. We start with energy, sleep, snoring, stress, and recovery. Then nutrition and protein intake, alcohol, smoking, cannabis, and any other substances, and what your training actually looks like right now. Where it is relevant we cover libido, erections, and other sexual symptoms, plus fertility goals and reproductive history. We review every medication and supplement, including any past or current testosterone or anabolic steroid use, along with your heart and metabolic health and your family history.

  2. What testing may look like

    Testosterone is tested when your symptoms fit, starting with a total testosterone drawn in the morning. Free testosterone, SHBG, LH, FSH, or prolactin are added when the clinical picture calls for them. When fertility is a goal, a semen analysis belongs early in the process, since blood work says very little about sperm. Other markers are chosen for you rather than run as a set: thyroid, glucose or A1C, lipids, a CBC, ferritin, B12, or vitamin D, depending on your history.

  3. What a plan may include

    A plan usually starts with protein and overall nutrition, strength training, and recovery. Sleep comes next, including a sleep apnea assessment when snoring or daytime fatigue points that way. When fertility is a goal we look at alcohol, smoking, cannabis, heat exposure like hot tubs and saunas, and other exposures that affect sperm. Supplementation is added where your labs support it. If you are trying to conceive, testosterone therapy needs a careful conversation first, because testosterone taken from outside the body can suppress sperm production.

  4. How progress is monitored

    Symptoms get tracked, and only the markers that need follow-up are repeated, on a schedule that fits each one.

  5. When I refer or collaborate

    Persistently low testosterone, abnormal LH, FSH, or prolactin, a testicular lump or change, sexual symptoms that need a medical workup, an abnormal semen analysis, prostate concerns, severe high blood pressure, and diabetes management go to your MD, and sometimes on to a urologist, endocrinologist, or fertility clinic. I refer out or collaborate.

Every plan is individualized, and no particular outcome can be promised.

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How I approach Thyroid health

A lot of women booking for thyroid concerns have had a TSH run once, been told it was in range, and left it there. Fatigue, cold hands, hair thinning, constipation, a flat mood, body composition that will not shift. A single number from two years ago is not a thyroid workup.

  1. What the first visit covers

    A first visit runs 60 to 75 minutes. We go through your symptom history and timeline, any family history of thyroid disease, and any previous results you can bring. Then the foundations: meals, protein and fibre, sleep, stress, and movement.

  2. What testing may look like

    Testing starts with blood work, and a thyroid workup can mean more than a TSH. Depending on your history that may include TSH, free T4, free T3, and TPO antibodies, plus ferritin, B12, vitamin D, and a CBC, because low iron and low B12 produce a lot of the same symptoms.

  3. What a plan may include

    In an underactive thyroid or Hashimoto's, levothyroxine is often necessary, and it is the right starting point rather than something to work around. Once that is stable, a plan may layer in selenium, zinc, iron, and vitamin D where your labs support them, alongside the foundations.

  4. How progress is monitored

    Progress gets measured, not guessed at. Thyroid markers get rechecked on a defined schedule, generally some weeks after any change rather than immediately, so we are reading something real instead of noise.

  5. When I refer or collaborate

    A nodule, a goitre, or anything that needs imaging goes to your MD, and sometimes to an endocrinologist. Thyroid medication dosing sits with your MD, and I collaborate rather than work around it.

Every plan is individualized, and no particular outcome can be promised.

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How I approach Perimenopause & menopause

A lot of women in their forties are told they are too young for this. Cycles get shorter, or longer, or unpredictable. Sleep breaks in the middle of the night, mood shifts, and body composition changes even though nothing about the routine did. Perimenopause can start years before the last period, and the majority of women are not told that.

  1. What the first visit covers

    A first visit runs 60 to 75 minutes. We map your cycle history and how it has changed, your symptoms and when they started, and your family history. Then the foundations: protein, fibre, sleep, alcohol, stress, and strength training, which matters more in this window than at any point before it.

  2. What testing may look like

    This is the one place where I usually recommend less testing rather than more. Perimenopause is a clinical diagnosis, made on your history and your cycles. Hormones swing week to week here, so a one-time estradiol or FSH rarely changes the plan. What is worth running: a thyroid panel, ferritin, B12, vitamin D, fasting glucose and A1C, and a lipid panel, because cardiovascular and bone health become the real story in this decade.

  3. What a plan may include

    Foundations first, with protein and resistance training doing the heavy lifting for muscle and bone. From there a plan may layer in targeted supplementation where your labs support it. If hormone therapy is the right tool for you, that is a conversation with your MD, and naturopathic care works alongside it rather than in place of it.

  4. How progress is monitored

    Progress gets measured, not guessed at. We track symptoms and cycles over time and recheck the metabolic and nutrient markers at defined intervals.

  5. When I refer or collaborate

    Bleeding after menopause, or any bleeding pattern that concerns me, goes to your MD promptly. Hormone therapy prescribing and bone density imaging sit with your MD, and I collaborate with them.

Every plan is individualized, and no particular outcome can be promised.

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How I approach Digestion & gut health

A lot of women booking for digestion have already cut out gluten, dairy, and half of what they used to eat, and they are still bloated. Somewhere along the way the food list got shorter and the answers did not get better.

  1. What the first visit covers

    A first visit runs 60 to 75 minutes. We go through the full history: what the symptoms actually are, when they show up relative to meals, bowel habits, what has already been removed from your diet and what happened when it was. Then the foundations: fibre, protein, hydration, meal timing, sleep, and stress, which affects digestion more directly than most people expect.

  2. What testing may look like

    Blood work comes first: ferritin, B12, a CBC, a thyroid panel, and celiac screening. Celiac screening has to happen before you remove gluten, because gluten needs to be in your diet for the test to mean anything. For suspected SIBO, I would start with a two-week empirical protocol while we assess diet and lifestyle, rather than sending you for a $400 breath test up front. If you feel improvements, that is a strong signal to continue with the full protocol, and it saves about $400 in testing that was not going to change the plan. I do not use stool tests or food sensitivity testing as first-line; they are expensive substitutes for clinical thinking.

  3. What a plan may include

    Foundations first: fibre, protein, meal structure, and sleep. From there a plan may layer in targeted supplementation where it is indicated, and where food has already been restricted, a structured plan for adding things back rather than leaving the list short indefinitely.

  4. How progress is monitored

    Progress gets measured, not guessed at. Symptoms get tracked in a structured way rather than by memory, and any markers that came back low get rechecked at defined intervals.

  5. When I refer or collaborate

    Blood in your stool, unexplained weight loss, anemia, a family history of inflammatory bowel disease or colon cancer, or new symptoms after 50 go to your MD, and often to a gastroenterologist. Those are not naturopathic-first situations, and I refer out.

Every plan is individualized, and no particular outcome can be promised.

Book an appointment Read the guide to digestion and gut health

How I approach Energy & fatigue

A lot of women booking for fatigue arrive with a supplement shelf built around adrenal fatigue. Adrenal fatigue is a trendy topic, however from a clinical and diagnostic standpoint it is not a real condition. Real cortisol conditions do exist. They are called Cushing's and Addison's, and these are more rare to be diagnosed with. What most people are calling a cortisol problem is usually something else, and it is usually something we can see on standard blood work.

  1. What the first visit covers

    A first visit runs 60 to 75 minutes. We go through what the fatigue actually looks like: when it hit, whether sleep restores anything, and what else came with it. Brain fog, shortness of breath, heavy periods, hair loss, dark circles. Then the foundations: meals and their timing, protein, fibre, healthy fats and carbs, light exposure, screens before bed.

  2. What testing may look like

    Blood work first, because most fatigue has a visible cause. Depending on your history that may include B12, an iron panel including ferritin, vitamin D, a thyroid panel, fasting glucose and A1C, a lipid panel, and a CBC. If someone came to me on only ashwagandha and a salt cocktail, I would let them know we are missing a lot of information about what could actually be driving the fatigue.

  3. What a plan may include

    Foundations first: meals with enough protein, sleep, light exposure in the morning, screens at night, and a movement load that fits what you have available. From there a plan may layer in targeted supplementation where your labs support it. I do not blanket-recommend iron, B12, or vitamin D without testing your levels first.

  4. How progress is monitored

    Progress gets measured, not guessed at. Any marker that came back low gets rechecked at defined intervals, so we can see on paper whether what we changed is doing anything.

  5. When I refer or collaborate

    If your history or your labs point toward something that needs medical workup, including a genuine suspicion of Cushing's or Addison's, that goes to your MD. I refer out.

Every plan is individualized, and no particular outcome can be promised.

Book an appointment Read the guide to fatigue and low energy

How I approach Stress, sleep & resilience

A lot of people booking for stress are functioning fine on paper and running on very little underneath it. Sleep is short or broken, meals happen when there is time, the fuse is shorter than it used to be, and a hard week takes longer to recover from. The advice they have already been given is to relax more, which is not a plan. Stress is rarely one thing, so the assessment looks at load, sleep, mood, capacity, and physical contributors together.

  1. What the first visit covers

    A first visit runs 60 to 75 minutes. We go through what the load actually is right now: work, caregiving, and how much support you have. Then sleep in detail: how long, what time, how often you wake, snoring, and whether you wake up rested. Meals, caffeine, alcohol, cannabis, and medications come next, along with what movement is realistic. We also talk about anxiety, low mood, trauma history where it is relevant, how much any of it affects your day, and what you have already tried. If there are safety concerns, those come first.

  2. What testing may look like

    There is no blood test that diagnoses stress. Testing is used to look for other contributors with overlapping symptoms, since low iron, low B12, thyroid changes, and blood sugar problems can also cause fatigue, poor sleep, low mood, and trouble concentrating. Depending on your history, that may mean a CBC, ferritin, B12, TSH, glucose, or other targeted tests. I would not run a cortisol panel to confirm that someone feels stressed. Cortisol and adrenal testing are reserved for presentations that genuinely suggest an endocrine disorder, like Cushing's or Addison's.

  3. What a plan may include

    Foundations first: consistent sleep timing and a sleep environment that works, regular meals with enough protein and energy, a look at caffeine and alcohol, morning light, and movement that fits your capacity. Where possible, some of the load comes off the plate. Changes happen one at a time, paced to what you can actually carry; you do not need to overhaul everything at once. Supplements or botanical medicine come in only when they are appropriate and safe for you. When psychotherapy or other mental health support fits the need better, that becomes part of the plan.

  4. How progress is monitored

    Sleep, symptoms, and how you are functioning day to day get tracked in a structured way, using validated screening questionnaires where they help. Any lab marker that came back abnormal is rechecked at a sensible interval.

  5. When I refer or collaborate

    Mental health care is a collaboration with your MD and often a psychotherapist, and it can be part of the plan from the start. Suicidal thoughts or risk of self-harm, psychosis, mania, a significant drop in your ability to function, significant eating disorder risk, substance use concerns, or symptoms that need medical or psychiatric assessment go to the right care promptly. If you are in crisis, call or text 988 or go to your nearest emergency department.

Every plan is individualized, and no particular outcome can be promised.

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Not sure where your symptoms fit?

Several of these often overlap, and sorting that out is what a first visit is for. Appointments are in person in Woodstock or virtual anywhere in Ontario (you need to be in Ontario at the time of the visit), and first visits run 60 to 75 minutes.

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