Dr. Laura Kostrzewski

Naturopathic 

HORMONES

Below, you'll find our overview of endocrine disorders and frequently asked questions about common conditions. To discuss your hormones with Dr. Kostrzewski click here for more booking information. 

 

ENDOCRINE DISORDERS

What are endocrine system disorders?

Endocrine system disorders involve dysfunction of the endocrine glands and hormones in the body. Hormones are responsible for regulating many of the body’s integral functions. 

 

What are some endocrine conditions and disorders?

Examples of endocrine disorders include Cushing’s disease, Addison's disease, Hashimoto’s, and Polycystic Ovarian Syndrome, among many others. 

 

Can endocrine problems cause anxiety?

Absolutely! Anxiety states frequently occur in association with adrenal dysfunction, but can be indicative of other hormone issues or imbalances in the body.

 

Which are some examples of hormones and their actions?

The parathyroid gland secretes parathyroid hormone which regulates blood calcium levels. Cortisol is produced by the adrenal gland and controls physical and psychological stress. Female hormones such as estrogen and progesterone play a role in fertility. There are so many more hormones with different jobs throughout the body. 

 

What are examples of things that can mess up hormones?

Poor diet, lack of sleep, too much caffeine, and stress can affect hormones. Many lifestyle factors influence our bodily hormones in some way. 

 

What are some of the problems associated with attempting to determine causation in a hormone behavior interaction?

Multiple hormones work together which makes determining causation challenging. The endocrine system is a complex network of signals and feedback loops, where many hormones interact with one another. It is often not just a simply linear relationship.

 

What are symptoms of hormone imbalance?

Some symptoms of hormone imbalance can include weight gain, unexplained and sometimes sudden weight loss, fatigue, muscle weakness, muscle aches, tenderness, and stiffness, pain, stiffness, or swelling in your joints, or increased or decreased heart rate.

 

Where are hormones produced in the body?

Hormones are produced in various places in the body, and secreted by either an endocrine or exocrine gland. For example, the thyroid gland produces and secretes thyroid hormone. 

 

How does the endocrine system transport hormones?

The endocrine system is a system of ductless glands that secretes hormones directly into the circulatory system to be carried long distances to other target organs regulating key body and organ functions.

 

What are the main types of hormones in the body?

There are three basic types of hormones: lipid-derived, amino acid-derived, and peptide.

 


 

HYPOTHYROIDISM

What is hypothyroidism and what are the symptoms?

Hypothyroidism means that someone has a low functioning thyroid and therefore insufficient thyroid hormone activity in the body. Symptoms may include fatigue, increased sensitivity to cold, constipation, dry skin, weight gain, puffy face, hoarseness, or muscle weakness.

 

Can you have mild thyroid problems?

It is possible to have mild thyroid problems, which might mean that you are trending toward having more severe thyroid problems, or that your thyroid is just a bit sluggish. Subclinical hypothyroidism is an early, mild form of hypothyroidism, a condition in which the body doesn't produce enough thyroid hormone.

 

What commonly causes hypothyroidism?

The most common causes of hypothyroidism include thyroiditis (inflammation of the thyroid), Hashimoto’s thyroiditis, postpartum thyroiditis, Iodine deficiency, or a non-functioning thyroid gland. 

 

How is hypothyroidism diagnosed?

Your doctor will likely run a serum TSH (thyroid stimulating hormone) to determine if it is elevated. This hormone comes from the anterior pituitary gland in the brain and tells the thyroid to secrete thyroid hormone. If serum TSH is high, it likely means that the thyroid is not secreting enough thyroid hormone. When enough thyroid hormone is secreted, it feeds back to the anterior pituitary to tell the brain there is enough thyroid hormone, which keeps TSH at a normal level. Your doctor might also look at your serum thyroid levels -- T4, T3 (the bioactive form), or both, to get a more accurate picture of what is going on.

 

What are the complications of hypothyroidism?

Complications of untreated hypothyroidism include goiter, heart problems, mental health issues, peripheral neuropathy, infertility, and birth defects. 

 

Who is more likely to develop hypothyroidism?

Women are much more likely than men to develop hypothyroidism. The disease is also more common among people older than age 60.

 

What happens if hypothyroidism goes untreated?

If untreated numerous health challenges can develop.

 

Can hypothyroidism cause erectile dysfunction?

Thyroid problems can create a hormonal imbalance, causing men to have trouble getting or keeping an erection.

 

What is Hashimoto’s disease?

Hashimoto’s is an autoimmune condition in which the body produces antibodies to the enzyme that produces thyroid hormone. These antibodies are called anti-thyroid peroxidase antibodies. If someone has elevated TSH, and low thyroid hormone in labs, these antibodies might be checked to see if there is Hashimoto’s disease. 


How is hypothyroidism treated?

Hypothyroidism is most commonly managed with replacement thyroid hormone. There are various options for thyroid medication, including synthetic and natural options. There are also natural options for treatment, including various herbs and nutrients that promote healthy thyroid function. Certain diets can also be effective at managing hypothyroidism.

 

 


 

HYPERTHYROIDISM

What is hyperthyroidism and what causes it?

Hyperthyroidism means that there is excess thyroid hormone activity in the body. Labs will indicate low TSH and high thyroid hormones. Symptoms include jitteriness, anxiety, weight loss, rapid heart rate, and many more symptoms. Conditions that can cause hyperthyroidism include graves' disease, Nodules, Thyroiditis, or Excessive iodine

 

What is Grave’s disease?

Grave’s disease is an autoimmune condition causing hyper, or excess thyroid hormone in the body. Labs will indicate low TSH, high thyroid hormone, and the presence of the antibody TSI (thyroid stimulating immunoglobulin). 

 

 


 

CALCIUM HOMEOSTASIS DISORDERS

What happens to patients with calcium metabolism disorders?

Patients with calcium metabolism disorders can have elevated or decreased blood calcium levels.

 

What diseases are caused by changes in calcium levels?

Too much calcium in the blood can weaken bones, create kidney stones, and interfere with how your heart and brain work. Calcium is monitored in diseases such as osteoporosis and in patients that have kidney stones. Your doctor might also look at a calcium score in heart disease to see how much calcium has been deposited in artery walls. 

 

Which hormones are involved in calcium homeostasis?

Several hormones are involved in regulating calcium and its activity including parathyroid hormone (PTH), vitamin D, and estrogen. Calcium and phosphate levels are tightly regulated in the blood to maintain homeostasis, or stability between these interdependent nutrients. 



 

POLYCYSTIC OVARIAN SYNDROME - (PCOS)

What are the signs of PCOS?

The signs of Polycystic ovary syndrome (pcos) include irregular periods, difficulty getting pregnant, excessive hair growth (hirsutism), weight gain, thinning hair and hair loss from the head, oily skin, and hormonal acne.

 

How can you manage PCOS naturally?

Possible ways to manage symptoms include maintaining a healthy weight, limiting carbohydrates, increasing healthy fat consumption, and staying active. There are also many herbal and nutrient supplements that may help manage PCOS.

 

How do you check if you have PCOS?

There's no test to definitively diagnose PCOS . Your doctor is likely to start with a discussion of your medical history. They will ask you about any menstrual cycle irregularity, any unwanted hair growth, weight gain, and acne. They may do imaging to check for cysts in the ovaries, look at your blood sugars or insulin levels, and check your testosterone levels.

 

 


 

MENOPAUSE

At what age do women's hormones change?

Most women experience menopause between the ages of 45 and 55.

 

What are the symptoms of menopause? 

Women will often experience hot flashes, mood changes, night sweats, changes in libido, changes in energy, other vasomotor symptoms, and genitourinary changes. These generally include pain with sex (often due to some vaginal atrophy), increased vaginal dryness, and increased susceptibility to urinary tract infections (UTI).

 

What can too many hormones do to a woman?

Too many hormones can cause bloating, fatigue, irritability, hair loss, palpitations, mood swings, problems with blood sugar, trouble concentrating, and infertility.

 

What hormones are affected by menopause?

Estrogen and progesterone are the most prevalent hormones affected by menopause. Testosterone levels can also be affected.

 

Can hormones help with menopause?

Yes hormones can help with the symptoms of menopause. There are multiple options for delivery of estrogen, progesterone, and testosterone including transdermal, vaginal, and oral applications. Often used in naturopathic medicine are topical Bi-Est and oral micronized progesterone. 

 

How much estrogen should I take for menopause?

It depends on the specific person and route of administration! Everyone experiences menopause slightly differently, and similarly everyone responds differently to treatment. Many women are adequately managed on a daily topical estrogen and oral progesterone. 

 

What are the side effects of hormone therapy for menopause?

Side effects can include bloating, breast swelling or tenderness, headaches, mood changes, nausea, or vaginal bleeding. 

 

What about cancer and hormones?

Because many cancers are hormone responsive, there is a concern for increased cancer risk with taking hormones. Specifically, breast cancer risk is the most discussed. However, most of the research studies horse-urine derived estrogen and synthetic progesterone in determining this increased risk. There is less evidence supporting increased cancer risk with bio-identical hormone replacement therapy (BHRT). However, your doctor should do an assessment of your specific risks in the determination if hormone replacement therapy is right for you.

 

Can a woman manage menopause naturally?

Many women can manage their menopause symptoms naturally through diet, lifestyle, and supplementation.

 

Which hormone helps with hot flashes?

Estrogen is the primary hormone used to reduce hot flashes.

 

What does a hormonal hot flash feel like?

A hot flash is the sudden feeling of warmth in the upper body, which is usually most intense over the face, neck and chest. Your skin might redden, as if you're blushing. A hot flash can also cause sweating. 

 

What triggers a hot flash?

Hot flashes may be precipitated by hot weather, smoking, caffeine, spicy foods, alcohol, tight clothing, heat and stress. They can also come unexpectedly with hormone fluctuations, such as menopause or with menstruation.

 

Can too much estrogen cause hot flashes?

Hot flashes and night sweats can also be signs of estrogen dominance, or too much estrogen activity in comparison with progesterone. 

 

Can menopause cause joint pains (arthralgia), muscle aches, stiffness and creaky joints?

Aches, stiffness and swelling around the joint and sometimes heat are typical symptoms of menopausal joint pain. 


 

PERIMENOPAUSE

What are the signs of perimenopause?

Signs of perimenopause include irregular periods, hot flashes, sleep problems, and mood changes. This is the time of transition from menstruation into menopause. 

 

Can you test for perimenopause?

Perimenopause is a process — a gradual transition. No one test or sign is enough to determine if you've entered perimenopause. However, it is often clinically determined by the symptoms you are experiencing and when you had your last cycle. Menopause is defined as 1 full year without a menstrual cycle. 

 

How do you know if you're starting perimenopause?

A persistent change of seven days or more in the length of the menstrual cycle is an early sign of perimenopause. 

 

How can you regulate your hormones during perimenopause?

Hormones can often be regulated through diet, exercise, supplementation, and other lifestyle interventions. You can also speak to your doctor about initiating hormone therapy to support the transition into menopause.

 

 

 



 

PREGNANCY

When are you most likely to get pregnant?

A woman is most fertile at the time of ovulation (when an egg is released from the ovaries), which usually occurs 12 to 14 days before your next period starts. 

 

What hormones are released in early pregnancy?

Progesterone, estrogen, and human chorionic gonadotropin is released in early pregnancy. Urine pregnancy tests are testing for the presence of human chorionic gonadotropin (hCG). 

 

What's happening to your hormones in early pregnancy?

When someone first becomes pregnant, progesterone and estrogen, hormones that are a part of the normal menstrual cycle, rise dramatically, and a new hormone, called human chorionic gonadotropin, begins to be produced. 

 

What hormones cause early pregnancy symptoms?

The rapid increase in estrogen levels during the first trimester may cause some of the nausea associated with pregnancy. Increased progesterone may cause headaches, and increased hCG is most often associated with the nausea that comes with many pregnancies. Most bothersome pregnancy symptoms are a result of some mix of this massive increase in hormones. 

 

 



 

PRECONCEPTION

What is done at a preconception visit?

At this visit, your doctor will ask many questions about your history, family history, and lifestyle. The doctor may perform a physical exam, including a pelvic exam and Pap smear. They also may order tests to screen for sexually transmitted diseases or other conditions, such as anemia.

 

What preconception tests might I need?

Tests for sexually transmitted diseases, a pelvic exam, and a pap smear. Your doctor will also run blood tests depending on your clinical history to look at your blood count, thyroid function, possible anemia, diabetes markers, and vitamin D. 

 

What should you do if you think you have a STI?

Go to your doctor or a STI clinic, as some untreated STIs can have consequences of infertility. 

 

What is good preconception care?

Generally, during preconception you should follow a diet rich in vegetables, healthy fats, and protein. It is wise to start taking a prenatal with folic acid as early as 3 months before conception. Other considerations include a supplement regimen of vitamin D, omega 3s, and choline. See your doctor for preconception counseling to develop the plan that is right for you.

 

How is pregnancy diagnosed?

A woman will often take an at home pregnancy test on the first day of her missed period. Some pregnancy tests are sensitive to a few days earlier than that. Your doctor can then order an ultrasound to confirm the pregnancy or do a serum hCG test. 



 

INFERTILITY

What are the types of infertility?

Primary infertility refers to couples who have not become pregnant after at least 1 year of having sex without using birth control methods. Secondary infertility refers to couples who have been able to get pregnant at least once, but now are unable. Both females and males can have issues that lead to difficulties conceiving. 

 

How will I know that I am fertile?

Signs of ovulation include a positive result on an ovulation test, fertile cervical mucus, increased sexual desire, basal body temperature increase, change in cervical position, breast tenderness, saliva ferning pattern, or ovulation pain. There are many phone apps or other tools you can use to track some of these changes each month to give an idea about your fertility. 

 

Who should perform the infertility evaluation?

An obstetrician-gynecologist. This doctor will likely order tests to examine the cause for your infertility.

 

How can you treat infertility?

There are natural ways to improve fertility through diet, lifestyle, and supplementation. Many patients benefit from stress management to allow for healthy hormone function. Higher-order interventions include things such as in vitro fertilization, which many use in order to carry a successful pregnancy. 



 

MENSTRUATION

How do hormones change during the menstrual cycle?

The pituitary gland produces a hormone called follicle-stimulating hormone (FSH) which tells the ovaries to prepare an egg for ovulation. When estrogen levels are high enough, they signal to the brain causing a dramatic increase in luteinizing hormone (LH) which causes ovulation. If pregnancy does not occur, the corpus luteum stops producing estrogen and progesterone which causes the tissue of the endometrium to break down. The shedding of this tissue when the egg is not fertilized is your period.

 

What are the stages of the menstrual cycle?

The ovarian cycle consists of the follicular phase, ovulation, and the luteal phase, while the uterine cycle consists of menstruation, proliferative phase, and secretory phase.

 

What about OCPs?

Oral contraceptive pills (OCP) are hormonal contraceptives that will prevent the release of the egg to be fertilized, thus preventing pregnancy. The delivery of progesterone or estrogen and progesterone will prevent brain signals from telling your ovaries to prepare for pregnancy. 

 

How is premenstrual syndrome treated?

Lifestyle changes and medications may reduce symptoms including mood changes, menstrual cramps, heavy bleeding, and other symptoms. Some women experience severe symptoms, which may or may not be diagnosed as Premenstrual dysphoric disorder (PMDD), and this often requires more intervention. Again, there are many natural treatment options. Conventionally, women have often been prescribed birth control pills and are sometimes prescribed anti-depressants depending on the severity. 

 

Which hormone is responsible for periods? How is your period affected by hormones?

The key hormones involved in menstruation are estrogen, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) produced by the pituitary gland, under the influence of hormones secreted by the hypothalamus. Your period is dependent on these hormones cycling in a certain proportion to each other, in order to make very specific changes in the body.

 

What are the symptoms of high estrogen?

Symptoms of high estrogen include bloating, swelling and tenderness in your breasts, fibrocystic lumps in your breasts, decreased sex drive, irregular menstrual periods, increased symptoms of premenstrual syndrome (PMS), mood swings, and headaches.

 

How can you balance your hormones during your period?

You can balance hormones through diet, exercise, and good sleep habits. One very popular natural intervention for balancing female hormones is seed cycling, which incorporates adding different seeds into the diet throughout the cycle in order to help healthy hormone metabolism. 

 

How do the hormones affect your mood?

For women, estrogen acts everywhere in the body, including the parts of the brain that control emotion and can increase serotonin, and the number of serotonin receptors in the brain. This means that estrogen has a huge impact on mood. Progesterone also has a calming effect and influences mood. 

 

Why study the effects of surging pubertal hormones?

Surging pubertal hormones play a central role within a larger set of biological changes in the process of achieving reproductive maturity, which include rapid physical growth, sexually dimorphic alterations in facial structure, voice, and body characteristics, metabolic changes, the activation of new drives. 

 

How do you naturally balance your hormones?

Hormones can be balanced through a healthy diet, reducing stress, getting exercise, and getting proper amounts of sleep. There are plenty of herbal and nutritional supplements that can also be used to support healthy hormone levels and appropriate detoxification. 

 

Can probiotics help balance hormones?

Yes, probiotics can help balance hormones. We are still learning about the microbiome, but its healthy function supports the nervous system and endocrine function throughout the body.


 

AMENORRHEA

What is amenorrhea?

Amenorrhea means that an individual is not menstruating at all. Amenorrhea can be diagnosed as primary amenorrhea or secondary amenorrhea. 

 

Who is at risk for amenorrhea?

The risk factors for amenorrhea include: excessive exercise, obesity or eating disorders, such as anorexia nervosa. 

 

What are the complications of amenorrhea?

Complications of amenorrhea may include: Infertility. Patients that experience amenorrhea may also have mental-emotional issues tied to their lack of menstruation. 

 

How can you prevent amenorrhea?

To prevent amenorrhea maintain a healthy weight and eat a healthy diet, be aware of your menstrual cycle (so you'll know if you miss a period), get regular gynecological appointments, including having a pelvic exam and pap test, and get regular and adequate sleep.

 

 



 

MENSTRUAL IRREGULARITIES

What are menstrual problems or irregularities?

Menstrual irregularities are problems with a woman’s normal monthly period and can include  missing periods, having them too frequently, having painful periods, or having excessively heavy flow.

 

What causes menstrual cycle irregularities?

Menstrual irregularities can have a variety of causes, including pregnancy, hormonal imbalances, infections, diseases, trauma, and certain medications. 

 

When is a menstrual period considered irregular?

An irregular cycle is a menstrual cycle that continually falls outside of “regular” ranges for an unexpected reason. A regular menstrual cycle ranges from 24-32 days, so about once per month.

 

What are the symptoms of estrogen dominance?

Symptoms include irregular menses and heavy bleeding, weight gain, especially in your hips, thighs and midsection, fibroids/endometriosis, fibrocystic breasts and gynecomastia in men.

Insomnia, depression, anxiety, irritability, low libido, and fatigue can also be present. 

 

How do healthcare providers diagnose menstrual irregularities?

Health care providers often use medical history, physical examination, blood tests, ultrasound examination, and other medical tests to diagnose menstrual irregularities.



 

HORMONES FOR MEN

What are the male hormones and their functions?

The primary hormones involved in the male reproductive system are follicle-stimulating hormone, luteinizing hormone, and testosterone. However, males also have estrogen and progesterone working in their bodies, just at much lower levels than females do.

 

What do female hormones do to a man?

High estrogen levels can slow down sperm production and can cause more breast tissue to develop than normal. Aromatization is the conversion of testosterone to estrogen. Some doctors will prescribe an aromatase inhibitor to prevent this from happening in the male body.

 

Why would a man be prescribed hormones?

With a low testosterone level, a man might be prescribed testosterone replacement therapy (TRT). 

 

Why is it important to measure male hormones?

Measurements of hormones can be used to estimate the body’s own hormone production as a baseline test as well as to monitor levels of hormones during and after hormone treatment.

 

What happens when you have altered steroid hormone levels?

Individuals that frequently used high-strength steroid creams have significantly lower baseline cortisol levels, a sign of impaired cortisol function


 

HORMONES FOR TRANSGENDER

What hormones are used for transgender?

For female to male individuals, testosterone is used. For male to female individuals, estrogen is used. These hormones help create the changes that we associate with each gender. 

 

What is transgender top surgery?

Top surgery is the removal of breast tissue when transitioning from female to male or the creation of breast tissue when transitioning from male to female.

 

How does hormone therapy affect heart health in transgender people?

In trans men, testosterone therapy consistently increases systolic blood pressure and may increase diastolic blood pressure. For lipids, hormone therapy may increase triglycerides in both trans women and men. In trans men, testosterone therapy also may increase LDL-cholesterol and decrease HDL-cholesterol. All of these should be discussed with your doctor when transitioning.

 



 

OTHER HORMONE RELATED ISSUES

 

WEIGHT GAIN

What hormones make you gain weight?

Hormones that play a role in weight gain and loss include: thyroid, leptin, insulin, estrogen, cortisol, progesterone, ghrelin, testosterone, melatonin, and glucocorticoids.

 

Does weight gain increase estrogen?

Yes weight gain can lead to an increase in estrogen. 

 

What are the signs and symptoms of hormonal weight gain?

Symptoms can include unexpected weight gain and difficulty losing weight despite dietary or exercise changes. 

 

Do estrogen pills make your hips wider?

Yes estrogen pills may make hips appear wider.



 

AUTOIMMUNE DISEASES

What is an autoimmune disease?

An autoimmune disease is a condition in which the immune system mistakenly attacks the body. Examples include Hashimoto’s, Grave’s, and Rheumatoid Arthritis, among many others. 

 

How do you know if you have an autoimmune disease?

Symptoms like fatigue, muscle aches, swelling, and redness could be signs of an autoimmune disease. Your doctor can perform an assessment based on your clinical history and any appropriate labs or imaging to make a diagnosis. 

 

What is an example of systemic autoimmune disease?

Systemic autoimmune diseases are a group of common diseases, including rheumatoid arthritis, systemic lupus erythematosus, spondyloarthropathy, Sjogren's syndrome, polymyositis, and dermatomyositis that affect the entire body system. 

 

How do you find out if you have an autoimmune disease?

There's usually no single test to diagnose autoimmune disease and a diagnosis is based on having certain symptoms combined with specific blood markers and in some cases,  a tissue biopsy. 

 

 


 

HAIR GROWTH

Which hormone is responsible for hair growth?

Androgen hormones like testosterone, DHEA, and estrogen are the major hormones that dictate hair growth. In women, the ovaries and adrenals are responsible for producing these hormones from cholesterol. After a pregnant woman has a baby, she will often experience some hair loss due to the rapid decrease in estrogen. Women with PCOS will often have hair growth in a male pattern, such as along the jaw line on the face, due to excess testosterone. In men, excessive conversion of testosterone to DHT, another form of testosterone, will often play a role in male pattern baldness. 

 

What is lanugo and what causes this hair to grow?

Lanugo protects the skin and body, people who are malnourished may grow this hair on their face and body later in life. This occurs in eating disorders such as anorexia nervosa or bulimia. 

 

Which hormones are responsible for boosting hair growth and preventing hair fall?

The gonadotropins are responsible for boosting hair growth, as they produce the FSH (Follicle Stimulating Hormones) and the Luteinizing hormones. These in turn cause increases in estrogen and testosterone, which play a role in growing and keeping hair. Low thyroid hormones may also result in hair loss.

 



 

JOINT PAINS

Can hormone imbalance cause joint and muscle pain?

Hormonal imbalances may also contribute to joint pains. Many women experience joint pains during menopause due to these hormonal changes. 

 

What if your joint pain is severe?

Get medical help right away if the pain gets intense, the joint suddenly becomes inflamed or deformed, or the joint can not be used at all.

 

What does it mean if every joint in your body aches?

Acute pain in multiple joints is most often due to inflammation, gout, or the beginning or flare up of a chronic joint disorder.


 

HORMONE MANAGEMENT

What is bioidentical hormone therapy and what are its benefits?

Bioidentical hormone therapy involves bioidentical hormones which act in the body just like the natural hormones produced. Bioidentical hormone therapy is often called "natural hormone therapy." 

 

Is there a natural estrogen supplement?

Soybeans and flaxseed both have constituents that work on estrogen receptors in the body. For some, these may be effective at mitigating symptoms related to changes in estrogen. Maca is also a popular product for regulating hormones.

 

Can a naturopathic doctor help with hormones?

Hormonal concerns are an area where naturopathic medicine excels. Naturopathic doctors are trained in assessing risk for taking hormones and effectively prescribing to manage symptoms. 

 

Which bio-identical hormones should you take?

Common hormones that are matched are estrogen, progesterone and testosterone. These are then used as treatment for men and women whose own hormones are low or out of balance.

 

What are the side effects of hormone therapy?

Side effects can include bloating, breast swelling or tenderness, headaches, mood changes, nausea, or vaginal bleeding.

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

© 2020 by Dr. Laura Kostrzewski Naturopathic.