Expanded Scope of Practice
Friday the 13th (I'm not very superstitious but some people are) - this marks the day I received great news! I passed both the oral and written portions of the prescribing exam! I will now be expanding my scope of practice in Embrun, Russell, and Ottawa!
What does this mean for the public? I can now prescribe high dose vitamin D, administer B12 injections, and prescribe natural desiccated thyroid (NDT) as well as bio-identical hormone replacement therapy (BHRT). I'll be eagerly learning about these new additions within the next few months!
If you'd like to schedule your Naturopathic appointment, you may reach out via the contact form or phone the clinic directly.
Yours in health,
Dr. Ashley Kowalski, ND
This blog post has been retrieved from my publication on the following website: naturopathiccurrents.com/index.php/hypothyroidism-what-is-it
What is it?
Hypothyroidism is a term used to describe an underactive thyroid gland. Hypothyroidism is further classified according to “type”: subclinical, primary, or secondary hypothyroidism. The main function of the thyroid gland is to regulate the metabolic processes essential for normal growth, development, and tissue differentiation. The thyroid gland can become “sluggish” for various reasons, as we will explore in more depth. Normally, the thyroid and peripheral tissues convert thyroxine (T4) into its more active form of triiodothyronine (T3). Thyroid hormone production is influenced by various factors, including: thyrotropin-stimulating hormone (TRH) from the hypothalamus; the levels of thyroid stimulating hormone (TSH) released from the pituitary gland; and the availability of iodine & tyrosine. TSH production is regulated via means of a feedback loop between the hypothalamus, pituitary gland, and thyroid.
Hypothyroidism results in a slower basal metabolic rate (BMR) which ultimately leads to weight gain. Other signs and symptoms of hypothyroidism include: irregular bowel movements (constipation); low energy; dry skin; hair loss; irritability; mental impairment; cold intolerance; joint/muscle pains; and delayed or absent reflexes, to name a few. Keep in mind that not every single one of these symptoms will necessarily be present with hypothyroidism.
What causes it?
A common cause of hypothyroidism is Hashimoto’s thyroiditis which affects an estimated 5% of the general population, making it one of the most prevalent autoimmune diseases. It is reported to occur in approximately 10-20% of all women, and less frequently in men. Hashimoto’s is regarded as a disorder of T-cell mediated immunity, with the infiltration of self-targeting T and B lymphocytes in the thyroid gland. Additional autoimmune conditions may be present in those who have a diagnosis of Hashimoto’s, and so it is important to evaluate for co-existing autoimmunity.
Stress can play a crucial role in thyroid dysregulation by triggering the release of noradrenaline, cortisol, and corticotropin-releasing hormone. These hormones have an inhibitory influence on TSH secretion and suppress enzymes involved in the conversion of T4 to T3.
Poor gastrointestinal (GI) health may also be responsible for autoimmune thyroiditis. Did you know that 70-80% of the immune system is found within the GI tract? Lifestyle factors such as stress, medication/antibiotic use, and poor diet directly impact the integrity and health of the GI tract. When the GI tract loses its integrity the immune system can ultimately become confused and the body makes mistakes! In the case of intestinal hyper-permeability, the immune system misidentifies normally harmless antigens (such as foods) as being foreign and mounts immune responses to them. The protein structure of certain foods resembles that of the thyroid, and cross-reactivity can occur as a result; the body can turn against itself causing an autoimmune reaction. Also, on a side note, poor GI health will also likely be evident as a result: bloating, gas, irregular bowel movements, heartburn, and abdominal cramps are possible but just some of the symptoms that correlate with poor GI health!
Your Naturopathic Doctor will screen for signs and symptoms of an underactive thyroid. She/he will likely order a thyroid panel (possibly including iodine via a 24-hour urinary excretion test) to determine the state of the thyroid gland and also perform a physical exam to assess for nodules or irregularities. An ultrasound may also be ordered to assess the thyroid when nodules are palpated. In hypothyroidism, TSH tends to be elevated with T4 and T3 being low. Elevated thyroid peroxidase (TPO) and thyroglobulin (TG) antibodies on lab results signify that the thyroid is being “attacked”.
Natural approaches to treatment:
ii) Increase protein intake: this is important as protein is a precursor to both tyrosine and stress hormone production (ie. catecholamines).
Hypothyroidism can result from an autoimmune attack, poor digestive health, nutritional deficiencies, as well as adrenal fatigue. Common approaches to treatment include: eliminating food sensitivities and healing the GI tract; modulating the immune system and decreasing inflammation (in the case of Hashimoto’s); nutritionally providing the precursors necessary for thyroid function; and supporting the adrenal glands to reduce the impact of stress on the endocrine system. Naturopathic medicine addresses thyroid issues with diet, nutritional supplementation, and herbal medicines. **Consult with your Naturopathic Doctor before self-diagnosing and initiating treatment for thyroid issues.**
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My article below has been published and retrieved from the Naturopathic Currents website:
What is the Digestive System?The gastrointestinal (digestive) system is complex. The process of digestion follows sequential steps and must function properly in order for the body to get the nutrients it requires for optimal health. Digestion begins in the mouth: Salivary enzymes help degrade food, and teeth aid with the mechanical breakdown. The food bolus then passes down a muscular tube called the esophagus, which transports food from the oral cavity to the stomach. Here, various enzymes and secretions such as hydrochloric acid break down food particles even further. As soon as food leaves the stomach, it enters the small intestine. Most nutrient absorption takes place in the small intestine, whereas waste is formed and stored in the large intestine. The pancreas also plays an important role in secreting digestive juices and enzymes into the small intestine in order to help break down food into smaller molecules that can be absorbed. The digestive system is not only responsible for the digestion and absorption of nutrients from food, but there are many other health benefits noted for having a healthy, functional digestive system.
The Digestive System and Overall Health/WellbeingDid you know that approximately 70% of the immune system is located in the gut? The importance of the gastrointestinal system is testified by the huge amount of immune cells that reside within it. Gut-associated lymphoid tissue (GALT) is the prominent part of mucosal-associated lymphoid tissue (MALT) and represents almost 70% of the entire immune system; in the lamina propria, there are about 80% of all plasma cells responsible for IgA antibody production. The gastrointestinal system therefore plays a central role in immune system homeostasis. It is therefore important that the gut is healthy and functional in order to defend against invaders.
Meanwhile, the digestive system produces approximately 95% of the body’s serotonin. Serotonin is involved in mood regulation. People who have compromised digestion may therefore also complain of irritability or display signs and symptoms of anxiety/depression.
Causes of Poor Digestive HealthMultiple factors contribute to poor digestive health. Physicians must consider physical health, but also look at possible mental/emotional causes as well.
Poor Diet: Unhealthy eating habits can contribute to symptoms of gas, bloating, abdominal discomfort/pains, and change in frequency and/or consistency of bowel movements. An unhealthy diet is also a significant contributor to a variety of health conditions we see today, including but not limited to diabetes, metabolic syndrome, and hypertension. Processed, refined foods contribute to inflammatory processes within the body. What we put into our bodies is important—foods can affect mood as well as immune health.
Stress: The state of our emotional/mental health powerfully influences gut function and flora—the mind/body connection is important. The relationship between environmental or psychological stress and gastrointestinal distress is complex and bidirectional: stress can trigger and worsen gastrointestinal pain and other symptoms, and vice versa. The digestive system has an enteric nervous system which controls peristalsis—the movement of materials through the colon. Under constant stress, blood is diverted away from the digestive tract; as a result, food is not digested, and we do not assimilate nutrients properly. Lack of blood flow affects gut motility, gastric secretions, and mucosal permeability. We often recognize the mind-gut connection as a “gut feeling” which ranges in presentation from butterflies in the stomach to anxiety-induced nausea.
Medication/Antibiotic Use: Some prescription and OTC drugs negatively impact the population of beneficial bacteria in the gut. The intestinal tract has a relative ratio of good and “bad” bacteria—medications (such as antibiotics) can wipe out the population of good bacteria. This leads to a predominant population of “bad” bacteria which increases the risk of infection, toxin buildup, inflammation, and allergies. The bacterial flora is disrupted by antibiotics, infection, chemotherapy, and radiation. This disruption has profound effects on the protective barrier and results in overgrowth of pathogens and the invasion of toxins.
Low Stomach Acid: Hydrochloric-acid production tends to decline with age. Hydrochloric acid is important for digestion to occur in the stomach. Insufficient levels of stomach acid can contribute to symptoms associated with digestive upset, such as bloating, gas, indigestion, belching/flatulence, a sensation of fullness after eating, acne, and rosacea.
Intestinal Hyperpermeability: When the epithelial barrier of the intestine is breached, food particles and other substances “leak” through and enter the bloodstream, triggering immune responses and possibly contributing to the development of autoimmune disease. When someone presents with an autoimmune condition, it is important to assess digestive health. Many factors such as gastrointestinal infections and stress appear to increase intestinal permeability. Symptoms of intestinal hyperpermeability include abdominal pain, joint pains, brain fog, gas, indigestion, mood swings, skin conditions, and changes in bowel frequency/consistency.
Food Intolerances/Allergies: These are highly individualized and vary from one person to the next. These foods cause inflammation in the intestinal lining and compromise the integrity of the mucosa. Food allergies are generally more severe and involve IgE-mediated antibody responses. On the other hand, food intolerances are IgG-mediated and cause delayed symptoms. Talk to your naturopathic doctor about ways you can assess for food sensitivities and about how you can heal the intestinal tract. Signs and symptoms of food intolerances include, but are not limited to, bowel changes/irregularities, skin conditions (e.g. eczema), headaches/migraines, fatigue, irritability, brain fog, and joint pains.
Natural Treatments to Optimize Digestion:Probiotics/Fermented Foods: These replenish the population of beneficial bacteria in the digestive system, providing optimal defense against pathogens/toxins that contribute to inflammation and infection. The vast majority of the immune system is located in the gut, and beneficial bacteria are crucial for proper immune function. There are many different strains of probiotics, and research suggests that each unique strain comes with its own set of unique health benefits. Fermented foods also contain probiotics; these foods include yogurt, sauerkraut, tempeh, kombucha tea, kefir, and miso soup. Speak with your naturopathic doctor to determine which probiotic is indicated for you.
Oligoantigenic/Anti-Inflammatory Diet: Aim for nutrient-dense foods such as fruits and vegetables; whole, gluten-free grains; and lean hormone-free meats. Avoid refined sugars and simple carbohydrates (white bread, white rice, baked goods…). This diet includes foods that are hypoallergenic in nature. It eliminates adverse food reactions and allows the intestinal tract time to heal. Speak to your naturopathic physician for complete information and to find out ways you can implement this diet into your lifestyle.
Omega‑3s: Omega‑3 fatty acids are known for decreasing inflammation in the gut; they also suppress proinflammatory cytokine production. Cytokines are chemical messengers that coordinate the whole immune system. Omega‑3 fatty acids have been shown to delay the onset and improve the progression of autoimmune diseases by upregulating protective antioxidant pathways.
Glutamine: It downregulates inflammatory mediators in the gastrointestinal system by stimulating the protective stress response in gut cells. Glutamine also helps increase integrity of tight junctions in the small intestine, increases mucosal thickness, decreases permeability, and decreases bacterial adherence and translocation.
Common Digestive ConcernsConstipation--Infrequent bowel movements resulting from slow intestinal motility. When stools move slowly, more water is absorbed from the stools, and this causes them to become dry and hard. People will often experience pain in the rectum during bowel movements, and abdominal pains and/or bloating as the quantity of stool increases.
Diarrhea--Frequent, loose stools as a result of increased intestinal motility. People may experience an urge to defecate, as well as abdominal pain/cramping as pressure builds within. Nutrients are not absorbed properly when transit time is increased, and this can result in malabsorption. Malabsorption over a period of time can lead to weight loss and fatigue. Dehydration is possible after experiencing bouts of diarrhea.
Dyspepsia--An umbrella term for a subset of symptoms. These symptoms include heartburn, abdominal bloating, nausea, early satiety, and/or excess burping/belching.
ConclusionThe digestive system is complex. If any of the organs involved are compromised, digestion becomes impaired. The gastrointestinal system does more than just digest food; it is also involved in mood as well as immune health. There are ways to be proactive when it comes to the health of the digestive system: proper diet, stress reduction, avoidance of medication (if possible), and supplementation all impact the health and function of the digestive system.
It is the year 2017 yet there remain many people who scratch their head or shrug when hearing the term ‘Naturopathic medicine’. What if I told you that modern concepts and principles of Naturopathic Medicine actually date back to over 2000 years ago? My goal here is to help the general population better understand the ways in which Naturopathic Medicine can help people like you, live a better life.
Naturopathic Medicine takes on a holistic approach to patient care in an attempt to determine the cause of your concern(s); there is more to assess than just the aches and pains, heartburn, bloating, or fatigue you may be experiencing right now. Don’t get me wrong, physical health is important; but it is equally important to consider the mental, emotional, and spiritual aspects of health as well. This holistic approach likely varies from the one used by your general practitioner or family doctor. You can expect a Naturopathic Doctor to spend anywhere from an hour to an hour and a half with you to assess overall health and identify any obstacles to cure. In brief, it’s time to share your life story and disclose relevant case information. Don’t worry though; your Naturopathic Doctor will prompt you with relevant questions.
Naturopathic Medicine has many tools at its disposal to help patients. This means that, for instance, if one person is not very responsive to acupuncture treatments then there are other modalities that may be used in conjunction with, or instead of the acupuncture. Modalities that Naturopathic Doctors use in practice include: diet and lifestyle, acupuncture, nutrition, botanical medicine, hydrotherapy, and homeopathy.
Naturopathic Doctors order and interpret blood work, just like your general practitioner does! Naturopathic Medicine is a form of preventative medicine, and as such, Naturopathic Doctors interpret laboratory values differently. Reference ranges can be quite broad to begin with; Naturopathic Doctors detect deficiencies or excesses in blood work early enough to help you restore your health to an optimal state before conditions deteriorate.
So if you’re looking for a well-rounded approach to healthcare, take the time to invest in your health! Book an appointment with a Naturopathic Doctor today.
Happy New Year! If you’re like most people, then you probably want this year to be brighter, happier, and healthier than the last. In order to be happier and healthier, you need to feel good about yourself.
How can a Naturopathic Doctor help you feel good about yourself?
Why should you start seeing a Naturopathic Doctor today?
Most healthcare benefit plans renew at the beginning of the New Year! Check with your healthcare insurance plan to verify how much coverage you have for Naturopathic Medicine and book your appointment today. Invest in your health - cheers to a happier, healthier you in 2017!
Used to be hyper, but now you’re feeling hypo? You might have a sluggish thyroid gland…
Did you know that an under-functioning thyroid gland can make you feel tired while negatively affecting metabolism – leading to weight gain? Some common signs and symptoms of hypothyroidism include: fatigue, weight gain, low mood, poor memory, constipation, cold intolerance, dry skin, hoarse voice, and hair loss/thinning. It is important to make note that many hypothyroid cases will present with some, but not all, of the latter symptoms.
Nutrient and/or mineral deficiencies, as well as autoimmune disorders, can also cause your thyroid gland to under-function. In practice, I order lab tests to rule-out the possibility of autoimmune attack against the thyroid. Hashimoto’s thyroiditis is one such autoimmune condition that results in the production of antibodies against the thyroid gland, causing it to under-function. Blood tests are warranted to evaluate the function of the thyroid gland.
A clear correlation exists between autoimmune disease and intestinal permeability. “Leaky gut” is a commonly used term for intestinal permeability. Leaky gut results from repetitive “trauma” to the intestinal tract and from the consumption of food intolerances & allergies. Factors such as stress, medication use, and poor food choices (aka “The Western diet”) negatively contribute to the health and function of the intestinal tract resulting in loosening of intestinal tight junctions, inflammation, and a disruption in the relative population of beneficial bacteria. The majority of the immune system lies within the gut; if gut integrity is compromised, the chances of immune dysfunction (and hence autoimmune disease) are increased.
It is important to look at the whole picture. Hypothyroidism can result from nutrient/mineral deficiencies and/or Hashimoto’s thyroiditis. Assessing and treating gut health is important if antibodies are detected against the thyroid gland.
If you have a thyroid condition and would like to manage it naturally, book your appointment with Dr. Ashley today:
Mondays: Restore Chiropractic (Westboro, Ottawa)
Tuesdays, Fridays, and Saturdays: The Hampton Wellness Centre (Westboro, Ottawa)
Thursdays: Stella's Touch Health Spa (Russell) and the Embrun Holistic Wellness Centre (Embrun)
I am dedicating this week’s blog to my dear father who left his family suddenly on October 11, 2016. It is difficult to accept the death of a loved one. I’ve been asking questions like, “why now? He was too young!” and I still have not been able to understand nor digest what has happened. My father was healthy and physically active; he would bicycle during the summer months and ice skate in the winter. He was a very easy-going man who would crack a joke out of nowhere. He could always cheer people up and make them laugh.
My father lived in a small northern Ontario community. I wish I could have seen him more often. We spoke regularly on the phone, and we would send each other text messages now and then. In hindsight, I am glad we had a chance to communicate in the days leading up to his passing.
If you’ve ever suffered the loss of a loved one, you know that these circumstances are without a doubt difficult for the entire family. I would like to share what is helping me get through this difficult time:
My religion has helped me deal with the passing of my father. I’ve watched movies like Heaven is for Real and I’ve started to read books to help me understand what happens after life on Earth. Practicing my faith has allowed me to find some peace in knowing that my father’s soul and spirit will live on. I believe he is watching over me, although he may not be here physically. My father will know if I am happy or sad, & he will know about my future accomplishments.
Grieving and crying. Self-expression is important and HEALTHY! Do not keep emotions bottled up inside! You have to work through the feelings – feel the pain for as long as you have to. It’s okay. Time will heal, but you have to go through the grieving process. I’ve taken homeopathic remedies to help me go through the grieving process.
I talk to my father before I go to bed through prayer. I tell my dad how my day went, I express my feelings, and I ask him for advice when needed. What would my father say? What would he do? I still feel so close to him!
Knowing that in the future I will be with my father. I believe our souls transcend to a different dimension, one that most human beings are not physically or mentally able to be a part of. I am rest assured that we will be together again someday.
My father wants me to be happy. My father would understand that there is a time to grieve, but he would also want me to resume my life. I know my father would want me to be smile, laugh often, and to continue to work at building my practice.
My friends and family have been so supportive during this difficult time. They’ve offered shoulders to cry on, and have also given their time if I needed anything. It truly is a blessing to have such wonderful people around.
All the memories my father and I shared together. These are found in family photos, television shows, movies, and through songs we used to listen to together. Sports were also an important part of our lives.
How do you cope with the death of a loved one? Please share what has worked for you.
Ashley Kowalski is a licensed Naturopathic Doctor in Embrun, Russell, and Ottawa. She is currently accepting new patients.