Root-Cause Naturopathic Assessment in Toronto
Patients often come into the clinic with symptoms impacting a variety of body systems. These can include fatigue, changes in weight and metabolism, brain fog, or shifts in sleep, mood or cycles. So many of these patients have gone to the doctor and asked for testing, but are told that everything looks normal. Yet, they don’t feel normal at all! Despite this, at the clinic we have found there is almost always an undiscovered root cause for these health issues, and in our experience, treating those root causes is what finally moves symptoms.
Unfortunately, normal lab results don’t mean much in situations where a variety of different factors are involved. Firstly, many lab reference ranges often consider only overt diseases, and can miss shifts in the normal range that impact overall health and wellbeing. Many lab normal ranges include precursors to disease, since many people in the population may show up in this part of the range. In addition, lab ranges don’t include clinical assessment correlation with the patient’s case or symptoms.
Using optimal, functional lab ranges along with a comprehensive assessment of all symptoms, timeline of health changes, medical history and a detailed review of underlying factors and causes can reveal so much more about your health.
Over the past 24 years, our clinic has focused on exactly this. We offer individual care that considers the entire body, with a comprehensive review of all health factors.
Awareness is the first step in healing.
When Labs Are Normal but Something Feels Wrong
A common example of this which we see often in our patients: exhaustion on a level never experienced before, weight gain without an obvious reason, along with brain fog. This patient has gone for assessment and had iron and thyroid levels tested, along with an assessment for diabetes. All of these tests came back normal and the patient was told their issues are just part of getting older.
On coming into the clinic, we review the patient’s overall health and learn that they have very heavy cycles and a family history of thyroid disease. We complete a full blood review and determine that their iron stores, ferritin, are at a level of 22 (which we consider to be low, despite this being in the “normal” range).
Their TSH, thyroid stimulating hormone, is out of the optimal functional range and their T3 thyroid hormone is low in the range. However, neither of these flagged as “abnormal” on blood testing.
Clearly, this patient is losing significant amounts of blood with their period, causing low iron. And since thyroid is related directly to iron status, these two factors begin to look like root causes for this patient.
With proper care and treatment in the right order, this patient’s iron stores replenish and their thyroid function improves, and with them the fatigue and brain fog that brought them in.
In addition, we work on the patient’s heavy periods with natural methods, correcting the underlying cause of iron deficiency.
This approach can improve health in a more systemic and long-term way. It is logical and considers all factors in health as interrelated.
How Root-Cause Assessment Differs From Standard Testing
Standard testing looks for overt diseases. Standard reference ranges often include levels which may cause symptoms. Standard lab ranges are based on the population, which in general may include a lot of patients with suboptimal health changes (for example insulin resistance, iron, or thyroid).
Testing for hormones such as estrogen and progesterone involves wide ranges, and a detailed understanding of hormones, and of how levels change over the cycle and at different ages, is needed to interpret these correctly.
It’s important to understand that levels near the top or bottom of the range may provide information for specific conditions. When we combine a comprehensive assessment with a detailed view of labs designed to understand the big picture, we are able to make sense of many conditions which have been left “undiagnosed.”
For example, insulin resistance is a common condition which causes weight gain, inflammation and long-term risk for diabetes. However, standard testing for glucose and diabetes often looks normal for decades before it starts to show signs.
We can order testing specifically for insulin resistance and look for its presence in a lipid panel, and with tests such as fasting insulin, HOMA-IR and the insulin glucose challenge. When combined with physical signs and symptoms and family history, the picture becomes clear and treatment can be planned accordingly.
Online Information Can Be Confusing
Our naturopathic approach is science-based and systematic. Social media and online information is confusing and noisy, often claiming that a simple solution will work for a variety of issues. We can help you sort through the noise, and get to the approach that actually fits your case. In complex conditions like PCOS for example, it’s rare that a single supplement will fix everything.
There are multiple fear-based theories around cortisol online without an understanding of how cortisol actually works. When we look at root causes and your case individually it allows us to create a clear plan for you, customized to your case, lifestyle and more. What works for one person won’t work for all, as each patient is unique. This is the strength of naturopathic medicine.
Naturopathic Medicine vs. Functional Medicine
The root-cause philosophy we use overlaps with what’s commonly called “functional medicine.” The two share the same investigative approach to health issues. The practical difference in Ontario is regulatory: a naturopathic doctor is licensed by the College of Naturopaths of Ontario, with defined laboratory-ordering and prescribing authority. “Functional medicine” isn’t a regulated health profession designation in this province, so there is no way to know what background or training someone has when they use this term.
Naturopathic medicine is a system of medicine which has been using a root-cause, individual approach to treatment since its beginning. Functional medicine is wonderful as it brings a naturopathic approach to conventional care — however it isn’t the same, as a naturopathic doctor has taken this type of training since day one of their education.
About Dr. Fiona McCulloch, ND
Medically reviewed by Dr. Fiona McCulloch, ND — June 18, 2026
Last reviewed: June 2026
Dr. Fiona McCulloch is a licensed naturopathic doctor, registered with the College of Naturopaths of Ontario. Her training began in science, with a BSc in molecular biology, and that grounding still shapes how she reads a case, down to which markers she weighs and how she interprets a result that sits inside the normal range. Dr. Fiona completed a fellowship through the American Board of Naturopathic Endocrinology, with advanced training in endocrine assessment and hormonal treatment. She served as a peer reviewer on the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome, and she wrote 8 Steps to Reverse Your PCOS, which has reached more than 50,000 readers. She has worked with patients on hormonal and metabolic health for over 25 years.
Dr. Alexandra Triendl-Dimitriu, ND is also a licensed naturopathic doctor registered with the College of Naturopaths of Ontario. She works within the same clinical approach, with a focus on hormonal and metabolic health, and you can read more on her profile page.
What This Assessment Is For, and When Other Care Comes First
Root-cause naturopathic assessment is built for chronic, complex presentations where multiple systems are involved, especially when a standard workup hasn’t explained the symptom picture. That’s where the investigative, integrative role we offer can provide long-sought answers.
Conditions such as persistent fatigue, thyroid symptoms, PCOS, chronic inflammation, perimenopause, and metabolic concerns all sit squarely in this territory, particularly when several symptoms look related but no single clear answer has been found yet.
Some situations call for conventional care first. Acute illness, anything that looks like an emergency, and conditions needing immediate pharmaceutical or surgical treatment belong with your family physician or an emergency department, and we always refer when needed. Naturopathic assessment complements that relationship, offering support for chronic health conditions that aren’t getting results from conventional approaches.
We work with evidence-based interventions alongside our clinical experience and individualized judgment. For example, not every natural medicine intervention carries the same weight of published evidence, and it’s important to understand what studies are relevant or high quality before starting a treatment. Honesty about what the research supports is part of our rigorous care approach.
Selected references
- Kraft JR. Detection of diabetes mellitus in situ (occult diabetes). Laboratory Medicine. 1975;6(2):10–22.
- Teede HJ, Tay CT, Laven J, et al. Recommendations from the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. European Journal of Endocrinology. 2023;189(2):G43–G64.
- Kalantaridou SN, Makrigiannakis A, Zoumakis E, Chrousos GP. Stress and the female reproductive system. Journal of Reproductive Immunology. 2004;62(1–2):61–68.
Questions About Root-Cause Assessment
What does "root cause" actually mean in naturopathic medicine, and is it just a marketing term?
It refers to a multi-signal, multi-system way of investigating symptoms rather than a single test or a single system looked at in isolation.
For example, a patient with abdominal weight gain might have normal fasting glucose labs while a post-challenge insulin pattern shows clear dysregulation indicating insulin resistance. A patient with hypothyroid symptoms might have a TSH at the very top of the normal range, with low active thyroid hormone levels and positive antibodies indicating an issue with the thyroid, but the TSH level was the only test done in the past. A cortisol pattern can explain ongoing fatigue without any one value falling outside the reference range. Root-cause work means reading those signals together with symptoms to see what individual tests, on their own, can miss.
I've seen naturopaths before and it didn't help. Why would this be different?
Sometimes a factor has been missed, or the right question hasn’t been asked yet. We have the time and attention to go through your case in detail, and if there’s an “unknown,” we can often help uncover it. We have a special focus on endocrine conditions and many years of experience. Conditions such as PCOS, fatigue, and cycle problems involve several interrelated contributors which we are familiar with.
How is a naturopathic doctor different from a functional medicine practitioner?
Both share the same investigative, root-cause philosophy. The difference is regulatory. In Ontario, a naturopathic doctor is licensed by the College of Naturopaths of Ontario, with lab-ordering authority and a defined, limited scope of prescribing authority. “Functional medicine” isn’t a regulated health profession designation in this province. In naturopathic medicine this approach is taught from the start in medical college and is woven all through practice.
What does the first visit actually involve, and what will I leave with?
The first visit is a 90-minute intake built around a full case review and a goal-setting conversation. No two cases present the same way, so while the structure is consistent, what comes out of it is entirely specific to your situation: the symptom timeline, what you’ve already tried, and what you’d like to understand or change. Some people arrive wanting a thorough investigation with targeted lab testing; others want to start with one or two questions and go from there. Both are fine.
You set the pace. You’ll leave with a treatment plan and/or lab testing based on what you’ve described and what you’d like to do. We put the options on the table and you decide which ones to take up.
Does OHIP cover naturopathic assessment? What does it cost?
OHIP doesn’t cover naturopathic visits, but most extended health benefit plans include naturopathic coverage. It’s worth checking your specific plan with your insurer before booking.
How many visits will I need? Is this an ongoing program I'm signing up for?
Book a 90-Minute Initial Intake
If you’d like to understand what’s driving your symptoms, the first visit is where we start. You set the pace and decide which options to take up.
For Telemedicine appointments, you must be in Ontario at the time of your visit.
Please do not book a telemedicine appointment if you are unable to do this.
Both practitioners offer naturopathic intakes for this kind of assessment. Dr. Alex has immediate availability, and Dr. Fiona typically has a 2 to 3 week wait. You'll find each practitioner's fees and booking link in the cards below.
Fees for Dr Fiona McCulloch, RAc, ND
Author of 8 Steps to Reverse Your PCOS. PCOS Advocacy and 20+ years clinical focus in PCOS, thousands of patients assessed.
| Time | Description | Price |
|---|---|---|
| Up to 90 min | Initial Naturopathic Consultation | $420 |
| 45m | Followup Naturopathic Consultation | $215 |
Click Links in description to see booking options. All new patents must start with
Insurance Coverage
Insurance is not provided by OHIP but is typically included on most extended insurance plans.
Prescribing note
Both practitioners are licensed naturopathic doctors in Ontario with prescribing authority for bioidentical hormones, cyclic progesterone and natural dessicated thyroid medication. Prescribed medications may be covered by your prescription drug insurance.
Fees for Dr Alexandra Triendl-Dimitriu, ND
For complex or challenging cases, Dr. Alex has direct access to Dr. Fiona's guidance — so you benefit from that depth of expertise regardless of which practitioner you see.
| Time | Description | Price |
|---|---|---|
| Up to 90 mins | Initial Naturopathic Consultation | $350 |
| 30m | Followup Naturopathic Consultation | $110 |
Insurance Coverage
Insurance is not provided by OHIP but is typically included on most extended insurance plans.
Prescribing note
Both practitioners are licensed naturopathic doctors in Ontario with prescribing authority for bioidentical hormones, cyclic progesterone and natural dessicated thyroid medication. Prescribed medications may be covered by your prescription drug insurance.