By Dr. Nicole Sundene

Holistic Psychiatry & Hormone Specialist

Anxiety disorder in Women's Health is best managed by a Holistic Hormone Doctor that can work to evaluate the root cause of the anxiety. For women hormone imbalance such as PMS, PCOS, Perimenopause, Menopause, Adrenal Fatigue, Hypothyroidism, and Hashimoto's Thyroidtis are often the culprits behind what appears to be a generalized anxiety disorder. Especially when typical anti-depressants or anti-anxiety medications do not help.

While many of my patients are currently feeling anxious and can benefit from a natural anxiety treatment the real clue that the anxiety or depression is caused by hormone imbalance is when women experience fluctuating symptoms.

Anxiety that fluctuates monthly is absolutely hormonal. Women that suddenly develop anxiety later in life such as in their 40's or 50's that have never experienced anxiety before are most likely being triggered by peri-menopausal or menopausal hormone changes that can impact mood. Patients with a family history of thyroid disease that suddenly develop anxiety should also have their hormones checked by a female hormone expert.

While different herbs help patients with their anxiety the real issue with anxiety is that we work to discover the root cause. Some women are just more anxious than others but the real clue that there is an underlying hormone issue is when a woman that has never had anxiety before is suddenly feeling anxious, agitated, angry or impatient. Especially when nothing situational is actually going on to contribute to the anxiety.

As a Naturopathic Doctor I honestly don't really even care WHAT herb we use to treat your anxiety. That is pretty boring to me to just prescribe HERB X for SYMPTOM X. Dr. Google can do that for you....what my Detective brain always wants to know is what is the ROOT CAUSE? Until we understand the root cause the patient will just continue to perseverate with their symptoms and nothing will ever truly fix the problem or provide lasting results.

I have included a brief blurb so that you can get an idea of the herbs that I generally find safe for most women to try for their anxiety. Please always check with your Naturopathic Doctor before combining herbs with prescription drugs. Do not take sedative herbs during pregnancy or breastfeeding. More importantly treat yourself to a Naturopathic consultation to discover the root cause of your anxiety by popping over to my SCHEDULE page.

#1 Passionflower- The intricate purple flower pictured above was shown to be as effective as sedatives in the benzodiazepine (valium) family, the aerial parts of this herb are great for nervous tension and anxiety. In recent research, passion flower extract at 45 drops daily (tincture) was shown to be as effective as oxazepam (similar to valium). This nervine herb is also “antispasmodic” which makes it great for people with constant nervous twitching.

#2 Ashwaganda- This is probably one of my favorite herbs. Unlike most of the herbs on this list that are designed to be taken at night or at least late afternoon, both ashwaganda and schisandra (listed below) are terrific “adaptogenic” herbs that help us tolerate our stressful days that much better. You can make some tea, or grab some capsules of the organic root and take two capsules twice a day.

This herb is specifically intended for those that are exhausted and agitated or debilitated by stress. In ayurvedic medicine ashawganda is a renowned anti-aging and rejuvenating herb.

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#3 Schisandra- Referred to as “Chinese Prozac” this herb is commonly unappreciated and underutilized in American herbal practice. Schisandra is a terrific day time adaptogen herb and should be taken as is recommended with Ashwaganda, two capsules with breakfast and lunch, or a cup of tea in the morning and afternoon. The berries can be made in to a nice aperitif for those with a low libido.

#4 California Poppy- The bright orange flowers of the California poppy, leaves and other aerial parts are sedative, anti-spasmodic, and mild pain relievers. This is also a gentle herb used for colic and agitation in children. Do not use this herb or any other sedative herbs in pregnancy.

#5 Hops- No I am not recommending that you drink more beer to calm down. However, the herb commonly used to make beer bitter also works as a sedative. It is extremely bitter though so is best given a small part in your herbal tea formula for insomnia or stress. Do not combine with prescription sleep aids due to an additive effect.

#6 Kava Kava- A well known Polynesian psychotropic sedative, this herb is sedative and “spasmolytic” and thus helpful for chronic pain conditions. Several conflicting studies debate the safety of using this herb with alcohol. Liver damage is thought to occur if used in large doses in conjunction with alcohol. This research however was used to scare many people away from using kava kava for whatever reason.

People need to simply remember that herbs are medicines and that an herb with actions similar to prescription sleep aids and analgesics will of course pack the same side effects. A strong herb demands respect. When used ceremoniously, or occasionally this herb does not run the risks it runs when it is heavily abused.

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The best way to safely use kava kava is in an organic tea form. Look for a tea blend that includes kava, or make your own. This herb should not be used in large doses, and large doses should not be used over long term. Do not combine with alcohol, or use during pregnancy or nursing. Chronic abuse will result in a horrible scaly skin rash.

#7 Lavender- Try adding lavender to your favorite baked good recipe. Purple lavender flowers will offer a sophisticated herbal makeover to your favorite shortbread cookies, or white tea cakes.

Lavender is great in your herbal medicine blend, and can also be used to stuff pillows, or as an aromatherapy stress reliever throughout the day. Lavender should not be used in pregnancy due to it’s emmenagogue effect.

#8 Lemon Balm- Also known as “Melissa officinalis” this herbal sedative should not be used by those with hypothyroidism as it inhibits the thyroid and is used to treat hyperthyroidism, however for everyone else it is a common simple herb to grow in your garden and make in to your own calming sedative tincture each summer. Do not use this herb in pregnancy.

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I grow lemon balm in my garden and harvest it, rinse it, let it dry and then pack it in a jar with enough room for it to swim around in some vodka. Shake the jar once a day for two weeks. The vodka will extract the constituents and after a few weeks you can strain out the plant part leftovers and put a half a teaspoon of this liquid “anxiety medicine” in a little bit of water when you need something to calm you down.

#9 St. John’s Wort- Although we think depression the second we hear about St. J’s Wort, we also need to address that depression and anxiety tend to walk hand in hand and this herb is not just an anti-depressant it is a mild sedative as well. St. John’s Wort has also been shown to have a lower risk of side effects than conventional anti-depressants and is worth trying for those that don’t quite have severe enough depression to mandate the use of a prescription pharmaceutical, but instead need something to take the edge off and boost the mood a bit.

If you are suffering from anxiety that has a form of depression associated with it, then this would be a great herb to consider in your herbal sedative blend pending that you are not on any anti-depressants or anti-psychotic medications. The condition “serotonin syndrome” may occur from combing this herb with those classes of medications or other herbs and supplements that boost neurotransmitter levels.

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This herb should not be used by those on oral contraceptives, or any medications as it increases the cytochrome p450 enzyme system which results in a more rapid detoxification of drugs from the system. The drugs or birth control pills are then rendered useless. Standard dose of St. John’s Wort for those not on any other medications, is 300 mg three times daily of the 0.3% standardized extract.

#10 Red Clover- Not traditionally recognized as a sedative, but as a mineral source and blood thinner, this “cooling” herb calms the system and has a special affinity to the lungs, throat, and salivary glands.

This is a terrific balancing herb to include in your herbal sedative blend as the dried flower blossoms make for a beautiful addition to a glass teapot. Do not use in pregnancy, or if on blood thinning medications.

#11 Catnip- Not just for cats. Catnip is actually a gentle nervine herb for humans. No it won’t make you roll around on the carpet or chase after things (at least not to my current knowledge) but it is still a great mild sedative.

This herb should absolutely NOT be used during pregnancy, as most herbs should never be used during pregnancy without checking with your naturopathic midwife, however it can safely be used in children by making a very weak tea. Be sure to only give your children organic herbs and check with their pediatrician or naturopath prior to use.

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#12 Valerian- Definitely one of the more potent herbal sedatives, valerian is also a great pain killer for those with chronic pain. Some people prefer not to use this herb because it can cause quite the herbal hangover the next morning and most complain that it makes them feel really groggy, or desire to sleep through the day.

Look for a tea formula that includes a bit of valerian to avoid the hangover, and if you have severe anxiety, chronic pain, or insomnia talk to your naturopathic doctor about using this at a more therapeutic dose. Always use organic root.

#13 Motherwort- The perfect herb for fried and frazzled mothers; it strengthens a weak heart and is great for nervous palpitations. Motherwort is best taken over a prolonged period of time, and because it is a uterine stimulant, it should not be used in pregnancy.

#14 Skullcap- A bitter, cooling sedative herb that is best used for nervous fear, restless sleep, and is also thought to lower blood pressure. This herb is great for people with the inability to pay attention—huh what was that? And has been used effectively to calm down children with ADHD. Some kids concentrate better when they are sped up, and some do better when they are calmed down.

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#15 Chamomile- One of the most common kitchen herbs, chamomile is a great mild sedative and digestive bitter.

Be careful in using chamomile tea if you experience ragweed allergies, formally known as the “asteracea family” and previously recognized as “composite family.” If you have a history of seasonal allergies you should exercise caution.

If not, make your tea up strong, use a heaping tablespoon and not a teaspoon per 8 oz cup of water, and allow to steep 15 minutes covered. If you don’t cover your chamomile tea you will lose the calming essential oils to evaporation. Only elitist herbalists know to do that. Welcome to the club!

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Traditional Herbal Sedative Use: Establishing a nighttime or daytime tea ritual is a great way to reduce stress, avoid binge eating, and help those that fight insomnia get to sleep at a decent hour.

Directions: For most of these herbs simply make a tea with about 1 tsp (milder herbs use a tablespoon) to 8 oz cup of boiling water. Allow to steep covered 15 minutes. Or if you aren’t a tea drinker just look for a pre-made organic herbal formula to take in tincture or capsule form, and follow the manufacturer’s recommendations.

Please check with your Naturopathic Doctor before combining any herbal medicines with prescription medications or making any changes to your health care routine or simply treat yourself to a Naturopathic consultation with me by popping over to my SCHEDULE page. I am able to help patients that are not in Arizona via Telemedicine with their anxiety, we can conduct hormone testing and implement naturopathic medicine by phone consult.

Dr. Nicole Sundene

Female Hormone Expert

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for MenopauseThyroid, Hashimotos, PMS, PerimenopauseAutoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

By Dr. Nicole Sundene, NMD

Scottsdale Naturopathic Doctor

Anxiety anyone? Pretty much every patient I talk to lately is experiencing anxiety for one reason or another. Which is the inspiration behind my "ANTI-RAGE LATTE" recipe. So if you are feeling overwhelmed, stressed, drained, and hopeless please know that you are not alone. Life for many of us, has never been more stressful. So I am going to be writing a lot about anxiety, the adrenals glands, adrenal fatigue, and the importance of female hormone health with PMS, Perimenopause, "Hormone Rage," and Menopause until things can return to normal.

In the meantime, the Ruler of My Herbal Queendom shall be...Ashwagandha! While in Ayurvedic medicine they call it "King of All Herbs", in my women's health practice it of course shall be referred to as THE QUEEN OF HERBS! For many years my female patients have said things like "What is that ashwaghandadaddda thingy you put me on again? I need more of that immediately!"

One of my favorite anxiety disorder treatments for patients that are struggling from chronic fatigue and excess stress is Ashwagandha, formally known as Withania somnifera. With so many women feeling tired and stressed these days I am going to have to vote ashwagandha the #1 Best Herb to Help Women Cope! Which is why I put it in my "Invincible Mommy Tea." The best thing about Ashwagandha is it is gentle enough you can take it during the day while at work, it is tonifying so it helps restore you back to normal over time, and as I talk about in my "Anti-Rage Latte" Blog very much needed while everyone is extra angry, annoyed and agitated.

The root of this plant is best for those feeling very frazzled and in need of a nervous system reset. If you feel like you need to push the reboot button for your brain then this is the herb for you!

Ashwagandha is helpful especially for women that are extremely agitated. I love that it is also considered safe for women that are pregnant and breastfeeding (obviously check with your own OBgyn before starting any herbs.)

If you know someone that is annoying to be around you might want to sneak a 1/2 teaspoon in their coffee... (just kidding instead just anonymously email them this article, or print it, and leave it on their desk??)

In a 2017 Randomized Control Trial 300mg of Ashwagandha twice daily improved memory and cognition in just eight weeks. [1} Another study found it beneficial in suboptimal hypothyroidism. [2} A 2019 study found it decreased anxiety, decreased cortisol stress hormone, and increased testosterone levels in men with zero adverse side effects reported! [3] 2021 Randomized control trial found it improved sleep and was beneficial for insomnia patients! [4] 2019 research on schizophrenic patients administered 1000mg daily found it beneficial for improving their depression and anxiety. [5] In 2015 Ashwagandha was found to improve libido and lubrication in women. [6]

In 2015 ashwagandha was found to improve lean muscle mass at 300mg twice daily. [7] This is why we commonly prescribe this herbal medicine to weak patients with cachexia or muscle loss and wasting in cancer. When you are menopausal you lose your testosterone and muscle mass which causes your metabolism to slow down since the only thing really burning calories in your body is muscle! 2016 research found it beneficial to the reduction of OCD or obsessive-compulsive disorder symptoms. [8] 2021 research found it to enhance and improve cardiorespiratory performance in athletes. I have since been recommending it to my Long Hauler patients that need help getting their lungs and hearts back on track. [9] 2013 research found benefits with ashwagandha to bipolar patients. [10] A 2018 study found it helpful as an adjunctive treatment for Tuberculosis patients. [11] In 2019 it helped Covid-19 patients recover faster when used in conjunction with other herbal medicines so while we are sipping it for our mental health it should be considered as a potent antiviral for further research against Covid. [12]

Because the cinnamon in my "Anti-Rage Latte" Recipe is also antiviral I like to think that maybe we can treat our crappy moods and boost the immune system at the same time! Please let's get more research on Ashwagandha!

As I have been doing a lot of marriage counseling for my patients lately because they are simply spending too much time together, perhaps if men take ashwagandha to boost their testosterone and women take it to boost their libido and vaginal hydration we may have less fighting and more exercise at home!

Ashwagandha as an added bonus supports the immune system, is anti-inflammatory, anti-aging, and also helpful for those with impotence. It supports the woman that is feeling exhausted, deficient, and drained. If you are feeling somewhat like Scarlett O'hara's horse that is frothing at the mouth while she screams at it and beats it to keep going... then you probably should chat with your Naturopathic Doctor about starting some Ashwagandha or a similar adrenal adaptogen herb! As you need to work with an herbalist that knows what they are doing and some patients with Autoimmune disease such as myself do not feel good on certain immune-boosting herbs. Although I have thousands of autoimmune patients in my women's health practice and find this to be more of a myth as most adaptogen herbs are "Immune Modulating". This is why it is important to work with a Female Hormone Specialist such as myself if you have a chronic disease and are using herbs!

Otherwise, Ashwagandha is the REJUVENATOR that you need right now to pick your sad little stressed mess of life up and keep going if you have not been doing well. According to a 2011 Review article of Ashwagandha, it was found to be anti-tumor, protective to the adrenal glands, effective against tumors, fibroids, and neuro-regenerative for patients with Neuropathy, Parkinson's, Alzheimer's, Dementia, Huntington's, and children with ADHD and cognitive deficits. For children I divide their weight by an average adult weight of 150 pounds and that become their dose aka 1/2, 1/3 or 1/4 of a standard 500-1000mg adult dose twice daily is what I typically prescribe to my female hormone patients, as is also used in the majority of the above studies.

Ashwagandha was also found to help regenerate dendrites (the portion of the nerve cell that conducts electrical signals) which is amazing if you have neuropathy such as myself or a disease that causes nerve damage.

Studies show Ashwagandha improves energy, improves both Osteoarthritis and Rheumatoid arthritis, and is an anxiolytic that mimics GABA aka "Nature's Valium." This is why it is the leading herb in my "Anti-Rage Latte" recipe that you can watch me make on my Instagram page! Don't forget to follow me for my latest herbal recipes as I don't always have time to post the random herbal medicine videos I enjoy sharing on Instagram.

According to Naturopathic healing principles, women should notice the effects of their adrenal adaptogen herbs within three days, feel a restoration of their emotional and physical well-being after three weeks, and should no longer need to take the herb after three months. Hopefully once that three-month period is up, better coping mechanisms for stress management have been implemented! Such as breathing exercises, yoga, pilates, meditation, exercise, or my favorite is...crafting!

Are you beyond an "Anti-Rage Latte"? Is it time for you to start feeling your absolute best? Then treat yourself to a Naturopathic Hormone consultation with me by popping over to my SCHEDULE page so we can work together as a team to help you feel awesome! If you don't want to come into my clinic or are not in Arizona I am happy to help you by phone consult!

Dr. Nicole Sundene, NMD

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology, Acne, Psoriasis, Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

REFERENCES:

  1. Choudhary D, Bhattacharyya S, Bose S. Efficacy and Safety of Ashwagandha (Withania somnifera (L.) Dunal) Root Extract in Improving Memory and Cognitive Functions. J Diet Suppl. 2017 Nov 2;14(6):599-612. doi: 10.1080/19390211.2017.1284970. Epub 2017 Feb 21. PMID: 28471731.
  2. Sharma AK, Basu I, Singh S. Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. J Altern Complement Med. 2018 Mar;24(3):243-248. doi: 10.1089/acm.2017.0183. Epub 2017 Aug 22. PMID: 28829155.
  3. Lopresti AL, Smith SJ, Malvi H, Kodgule R. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study. Medicine (Baltimore). 2019 Sep;98(37):e17186. doi: 10.1097/MD.0000000000017186. PMID: 31517876; PMCID: PMC6750292.
  4. Langade D, Thakare V, Kanchi S, Kelgane S. Clinical evaluation of the pharmacological impact of ashwagandha root extract on sleep in healthy volunteers and insomnia patients: A double-blind, randomized, parallel-group, placebo-controlled study. J Ethnopharmacol. 2021 Jan 10;264:113276. doi: 10.1016/j.jep.2020.113276. Epub 2020 Aug 17. PMID: 32818573.
  5. Gannon JM, Brar J, Rai A, Chengappa KNR. Effects of a standardized extract of Withania somnifera (Ashwagandha) on depression and anxiety symptoms in persons with schizophrenia participating in a randomized, placebo-controlled clinical trial. Ann Clin Psychiatry. 2019 May;31(2):123-129. PMID: 31046033.
  6. Dongre S, Langade D, Bhattacharyya S. Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Improving Sexual Function in Women: A Pilot Study. Biomed Res Int. 2015;2015:284154. doi: 10.1155/2015/284154. Epub 2015 Oct 4. PMID: 26504795; PMCID: PMC4609357.
  7. Wankhede S, Langade D, Joshi K, Sinha SR, Bhattacharyya S. Examining the effect of Withania somnifera supplementation on muscle strength and recovery: a randomized controlled trial. J Int Soc Sports Nutr. 2015 Nov 25;12:43. doi: 10.1186/s12970-015-0104-9. PMID: 26609282; PMCID: PMC4658772.
  8. Jahanbakhsh SP, Manteghi AA, Emami SA, Mahyari S, Gholampour B, Mohammadpour AH, Sahebkar A. Evaluation of the efficacy of Withania somnifera (Ashwagandha) root extract in patients with obsessive-compulsive disorder: A randomized double-blind placebo-controlled trial. Complement Ther Med. 2016 Aug;27:25-9. doi: 10.1016/j.ctim.2016.03.018. Epub 2016 Apr 9. PMID: 27515872.
  9. Tiwari S, Gupta SK, Pathak AK. A double-blind, randomized, placebo-controlled trial on the effect of Ashwagandha (Withania somnifera dunal.) root extract in improving cardiorespiratory endurance and recovery in healthy athletic adults. J Ethnopharmacol. 2021 May 23;272:113929. doi: 10.1016/j.jep.2021.113929. Epub 2021 Feb 15. PMID: 33600918.
  10. Chengappa KN, Bowie CR, Schlicht PJ, Fleet D, Brar JS, Jindal R. Randomized placebo-controlled adjunctive study of an extract of withania somnifera for cognitive dysfunction in bipolar disorder. J Clin Psychiatry. 2013 Nov;74(11):1076-83. doi: 10.4088/JCP.13m08413. PMID: 24330893.
  11. Kumar R, Rai J, Kajal NC, Devi P. Comparative study of effect of Withania somnifera as an adjuvant to DOTS in patients of newly diagnosed sputum smear positive pulmonary tuberculosis. Indian J Tuberc. 2018 Jul;65(3):246-251. doi: 10.1016/j.ijtb.2017.05.005. Epub 2017 May 21. PMID: 29933868.
  12. Devpura G, Tomar BS, Nathiya D, Sharma A, Bhandari D, Haldar S, Balkrishna A, Varshney A. Randomized placebo-controlled pilot clinical trial on the efficacy of ayurvedic treatment regime on COVID-19 positive patients. Phytomedicine. 2021 Apr;84:153494. doi: 10.1016/j.phymed.2021.153494. Epub 2021 Feb 4. PMID: 33596494; PMCID: PMC7857981.

Dr. Nicole Sundene, NMD

Female Hormone Specialist

With Holistic Psychiatry, we are treating your mood disorder such as anxiety, depression, bipolar, ADHD, addictions, PTSD, OCD, and even schizophrenia with natural medicines. We also are more importantly using metrics such as hormone testing, and nutritional testing, to determine if there is a vitamin or mineral deficiency or a hormone imbalance. An easy indicator a woman’s moodiness is caused by hormone imbalance, is seeing fluctuations in the mood during the monthly cycle. You can test this yourself at no charge by downloading a free “Period Tracker App” and rating your mood every day for an entire cycle. 

If the mood is not good the 7 days prior to your period or the first few days of your period then we can work together to change that with Naturopathic Medicine!

Fear not, there IS HOPE! 

When women are generally happy in the first half of their cycle days 1-14, with day 1 being the first day you start bleeding, and then struggle with anger, agitations, depression, anxiety, hopelessness, rage, crying, and sadness during the PMS window or days 21-28 then you need hormone testing as there is likely a hormone imbalance going on that can be addressed with Naturopathic Medicine. 

Also if you have never experienced anxiety or depression until after having a baby or with your 40’s or 50’s and your mood suddenly shifts, this is a sign you are experiencing hormone imbalance. Common hormone imbalances in the following conditions can be improved for mental health patients with natural hormones or herbs such as Postpartum Depression, Hypothyroidism, Perimenopause, Menopause, or even Hashimotos impacting your mood. 

The #1 Sign that something physical is causing the mental health disorder is when nothing stressful or sad is actually going on yet the patient feels anxious or depressed. When women tell me “My life is great, I love my husband, my kids are great, I love my job...I just don’t know why I feel like this…” This is when I think there is a mental health mystery for me to solve!

As a Naturopathic Doctor and Female Hormone Specialist, I love helping patients with depression and anxiety. Especially since I have battled my own depression and anxiety for over 30 years, and it started in my teen years indicating a strong hormonal link. I was never depressed as a child. I had a very happy childhood and wonderful parents. But suddenly, in my teens my attitude rapidly changed, I was angry at my Mom all the time. I was grouchy, depressed, sad, cried a lot, and constantly had anxiety about everything. 

I had social anxiety, anxiety about my school work. I was an overachiever that would cry over an A- or a “Chinese F’ as they call it. First, my parents sent me to counseling to no avail, then I tried a lot of different antidepressant medications, I was even sent to a psychiatrist to try to medicate my mood. Many of the antidepressants they gave me just made my mood worse and caused me to gain weight or have an upset stomach, which made my mood even worse because now I was overweight and my stomach hurt!

HORMONE TESTING FOR WOMEN’S MENTAL HEALTH

Hormone testing is the most important thing we do for women with PMS like hormone imbalance. I like to conduct “Biphasic Labs'' which means we test your hormones while you are happy and feeling good during the first half of your cycle, and then, we test them in the PMS window days 21-25 when you are feeling at your worst, so we can capture the hormone imbalance. You can watch my Free Presentation on “Hormones, Metabolism and Weight Gain” to see my case study about Jenny, who was a crying mess while her husband called me frantically, not sure what to do with her. 

I emailed him a lab slip and said “Take her in NOW to get her hormones drawn.'' Of course, it was the last thing Jenny felt like doing while suffering from a migraine, depression, and anxiety but as a Female Hormone Specialist, I know how important it is to get the PMS labs drawn when the patients are at their worst for me to solve the hormone puzzle. The best thing about getting your labs checked when you are at your best mood is, we can set those aside in the event you need bioidentical hormones someday with menopause, and then I know exactly what numbers I need to have you at, to make you feel your "personal awesome!" For more information about hormone imbalance and the blood hormone testing I conduct via women’s insurance please visit my HORMONE THERAPY page. 

The state of Arizona does not allow Naturopathic Doctors to order labs for Medicaid or AHCCCS patients. But most decent insurance plans including Medicare, allow me to check your hormones per your insurance plan reimbursement. So long as you are at the correct lab which is either Labcorp or Sonora Quest. Be sure to call your insurance and find out which lab is contracted with your insurance, otherwise, the testing can be quite expensive! If you do not have insurance I have cash lab options, and the first panel should be around -$500 depending on what is going on, so please do not sign up to work with me if you cannot afford cash labs, or have Medicaid insurance. My ability to help you will be left with just guessing, and that is not how I work, I like to rely on metrics and numbers to ensure each woman is in an optimal range for their hormones and vitamins. 

Vitamin and Mineral Testing for Mental Health

Testing nutritional metrics is extremely important as many vitamins and minerals are the very cofactors, and coenzymes that form the neurotransmitters such as serotonin, dopamine, norepinephrine, and epinephrine that impact our mood. Most of this can easily be done via blood testing through your insurance, although I will say Medicare is the worst at reimbursing for vitamin testing. Basically, the government does not care what your vitamin levels are and they may or may not pay for this part of the testing if you have medicare. If you have a secondary insurance it may be picked up by that, but you still will get the “contracted price” which is generally $20-$50 per vitamin we test, so they usually cover the hormones and then send the patient a bill for the vitamins. Just because I think it is necessary does not always mean the government is going to agree with me. The good news with mental health testing is you are 

making a one time investment in understanding what your personal weak spots are and once we know what those are the follow up lab testing is never as expensive, as the first panel when I am on a Detective Mission to figure out the ROOT CAUSE of your mental health issue. 

Neurotransmitter Testing for Mental Health

Is neurotransmitter testing really necessary for mental health patients? 

Yes and No. 

This is why it is the 3rd step, I list in my simple 3 step process of addressing the physical causes that impact the mental health of patients with anxiety, depression, and mental health disorders. Because, oftentimes we can determine the cause of the mood disturbance via hormone testing and vitamin and mineral testing. This is the final step I resort to when the above testing is not helpful in revealing any physical causes of depression. 

For a small handful of my patients, I will admit that neurotransmitter testing has been a futile waste of their time and money. But for the majority of my patients that do not improve from balancing hormones and nutrition, the neurotransmitter and adrenal testing can unearth some very important neurotransmitter deficiencies or excesses that we can balance with “Amino Acid Therapy.” By using amino acids targeted to boost specific neurotransmitters that are low we can improve mood via a different pathway that an antidepressant works. 

For instance, low dopamine can be related to depression, low motivation, memory issues, ADHD, addiction,  impulse control disorders, dementia and even schizophrenia. Physical symptoms of low dopamine include Pain muscle cramps and stiffness, tremors, trouble swallowing, back pain, balance problems, and constipation, 

Symptoms of low serotonin include depression, crying, insomnia, carbohydrate cravings, weight gain, nausea, poor self-esteem, anxiety, and poor memory.  When serotonin is low then an anti-depressant is often useless for the patient because the way the antidepressant works is to recycle serotonin so if there are “no pop cans in the recycling program” then there is nothing to recycle. The patient gets no benefit from the antidepressant and gets side effects like dry mouth, sweating, weight gain, poor libido, erectile dysfunction or stomach ache. Neurotransmitter testing is also great for patients that have no triggers for their anxiety or depression yet feel flat, blah, anxious, or stressed and don’t know why. If it isn’t a hormone imbalance like what we often find via insurance-paid labs then we need to look at a neurotransmitter profile. This can be done via simple saliva and urine testing.  

So that is the simple 3 step system I used in my Mental Health Detective process to understand any physical causes that may be contributing to your depression, anxiety, and mental health disorders. 

WHAT PATIENTS ARE NOT SUCCESSFUL WITH HOLISTIC PSYCHIATRY?

After serving patients for 22 years, I know exactly the patients I can and cannot help so please read this section carefully and do not sign up for my service if any of the following scenarios apply to you. I cannot help mental health patients in the following scenarios: 

  1. If you are too depressed to take supplements, get your labs drawn, or make dietary changes, or you do not have a caregiver that can ensure the plan I prescribe is implemented, you will not be successful with my Holistic Psychiatry program, and I will not be able to help you. I only want patients that will be compliant with their instructions to enroll in my practice. If you cannot do it and you cannot appoint a family member of friend to ensure you make these changes it will not work.
  2. If you do not have insurance to pay for hormone and nutrition testing or do not have finances to pay for the cash lab pricing of this ~$500 depending on the patient’s symptoms, then I will not be able to help you. 
  3. If you are not friendly and coachable and cannot maintain good boundaries with our working relationship I will not be able to help you.
  4. If you are unwilling to take vitamins, supplements and make dietary changes to support your mental health. You have to be open to changing your diet to whatever I think you need to change it to.
  5. I generally do not provide counseling and recommend you use a therapist for additional emotional support. Think of me more as your “Holistic Psychiatrist” that helps you adjust your medications, supplements and vitamins and looks for the root cause of your mental health from a physical standpoint. 
  6. I will not prescribe antidepressants, anti-anxiety medications (valium or benzodiazepines) outside of a scheduled appointment. I refill your medication until you are legally due back in, and it is the patient’s responsibility to schedule their med checks. I cannot prescribe stimulant medications for patients with ADHD, only an MD psychiatrist can do this.
  7. Anyone expecting a “Quick Fix” will end up disappointed as Naturopathy is investing in long term solutions to health problems. My mental health patients generally take 3-6 months to improve. Please check my fee schedule to ensure it is affordable for your budget.
  8. If you are very angry and agitated and cannot control your emotions and lash out on others, I will not be able to accept you in to my practice.

WHAT PATIENTS ARE THE MOST SUCCESSFUL WITH HOLISTIC PSYCHIATRY?

  1. My favorite and always successful patients are the ones that show up with a pen and paper handy to take notes and want to be a student and learn everything they can about their mental health and how to improve it.
  2. Women that enjoy making herbal teas, taking capsules and vitamins, and prefer to support their body in this manner, I specialize in food as medicine. You are my perfect mental health patient!
  3. Women that want to make the diet changes to what I think their brain/body needs.
  4. Women that have a care team that will ensure they are following their plan if they are slipping. 
  5. Women that are also working in conjunction with a counselor or therapist on their issues will always have awesome results!
  6. Women with inquiring minds that also "Need to Know" what is causing their symptoms. I like patients that are just as involved in helping me solve the riddle as I am.

That is how I help my mental health patients as a Holistic Psychiatrist. If you think we would be a good fit working together, pop on over to my SCHEDULE page and book your new patient visit so we can get started helping you feel better immediately. You do not have to live in depression as I did for many years, you do not have to live with anxiety and panic attacks in terror like I did for many years, I am happy to help you with your anxiety or depression. I want to go through this detective process together so we can determine what your individual weak spots are when it comes to your personal mental health. 

Sincerely, 

Dr. Nicole Sundene, NMD

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for MenopauseThyroidHashimotosPMS, PerimenopauseAutoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter, and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

Dr. Nicole Sundene, NMD

Holistic Hormone Specialist

Menopause symptoms can be truly miserable between hot flashes, night sweats, insomnia, constipation, dry skin, and mood disturbances such as anxiety, depression, trouble concentrating, poor memory, ADHD, and generalized brain fog.

Many women experience hormonal anger from constantly feeling too hot.

Ladies, let food be thy medicine with this easy Menopause Milkshake recipe designed to help calm hot flashes and night sweats. This recipe is packed full of herbal medicines to help women stay cool.

Whether the heat is bothering us in Arizona, or we are having a hot flashes or night sweats the cooling properties of spearmint, red clover, and nettles combine nicely with blueberries and pears to help cool women down. In Herbal Medicine, every food has a "temperature" and it is either heating, neutral or cooling. We need to avoid the hot foods, and heating herbs if too hot as I explain in my blog about how I gave myself a hot flash from mixing them all together!

Nettles were found to help menopausal hot flashes after 8 weeks at 450mg daily. Spearmint is cooling and refreshing.

Red clover is a phytoestrogen herb that also works for anxiety as a mild sedative to help women sleep better. I also love Red Clover for gentle ongoing detox support as a clogged liver often causes imbalanced hormones.

By combining multiple cooling foods and phytoestrogens this is how many of my menopause patients manage their menopause symptoms with Bioidentical Hormones!

Menopause Milkshake Recipe:

1-2 cups of chilled “Hot Flash Iced Tea”= Spearmint, Red Clover, and Nettles Herbal Tea

1 cup frozen Blueberries

½ frozen Pear

½ cup of Kefir

1-3 Tbl freshly ground Flaxseed

1-2 Packets of Stevia to taste (optional)

1 Scoop of Protein Powder or Collagen

Mint to Garnish

Instructions:

Add chilled herbal tea, fruit, flaxseeds, kefir, protein, and stevia to blender. Mix well and garnish with mint. Drink 1-3 shakes per day for hot flashes and night sweats. 

To make your “Hot Flash Iced Tea,” combine 1 tsp each of nettles, red clover, and spearmint per 8 oz of water. 

Tea should be made fresh every 1-2 days and discarded after 48 hours in the refrigerator. 

To make 2 nights' worth of iced tea at once, you will need 3 cups of boiling water and 3 Tbl of each:

1) Nettles 2) Red Clover 3) Spearmint

Cover herbs with boiling water, stir, and let steep covered to preserve the mint essential oils for 15-45 minutes. Letting your tea steep a little longer helps absorb the minerals and phytoestrogens that mimic estrogen into your tea. Chill your tea before using it in my Menopause Milkshake. 

Women should drink their menopause shake 1 hour before bedtime for optimal, cool sleep.

Dr. Nicole Sundene

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause,  Thyroid,  Hashimotos,  PMS, PerimenopauseAutoimmunePostpartumChronic Fatigue, DepressionAnxiety, Food Allergies,  DigestionDermatology, AcnePsoriasis Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. 

She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!

Dr. Nicole Sundene

Female Hormone Specialist

Hormones actually picked me many years ago! Did you know I was serendipitously selected by life to become a Holistic Hormone Doctor 23 years ago? Be it God, kismet, fate or dumb Luck, my old neighbor in Issaquah, Washington chased me down one rainy morning when she saw I worked at our neighborhood medical clinic and offered me a job working for her Hormone Doctor. She said there was an immediate opening, better pay and it sounded much less stressful than the busy Family Medicine and Dermatology clinic I worked at  for 20 Docs rooming 100 + patients per day. Of course I took the job!

Little did I know  this would be the #1 experience that would shape my future career as a Women’s Health Doctor and I was put in very special training with a genius Female Hormone Specialist that was a Pharmacologist and Internist. Working for the Hormone Doctor every day was a wonderland of fun for me! I left the office giddy with joy every day! The biochemistry nerd in me really enjoyed the hormone and hormone lab lessons on her specialties of Menopause, Perimenopause, Osteoporosis and Chronic Pain. She also taught me everything I know about autoimmune testing and hormones. 

The Female Hormone Specialist also taught me a lot about chronic pain testing for women with Fibromyalgia. It is difficult to find a doctor to take you seriously when you are in severe pain, or struggling with bizarre autoimmune disease symptoms… but she did this with tremendous compassion, kindness and brilliant detective work. Fibro patients need a multitude of proper tests conducted to determine the cause of the pain which requires multiple specialists working together or someone with enough knowledge in Rheumatology, Endocrinology, Neurology, Nutrition and Infectious Disease such as Dr. Panitch.  

Thankfully Dr. Panitch taught me a great deal about Menopause, Perimenopause and Osteoporosis, at the same time I also worked for 3 Dermatologists. While I loved helping them with their skin surgeries we would often see patients with chronic skin problems such as acne, psoriasis, eczema, dermatitis and MRSA struggle to get better. When I asked the Hormone Doctor about these patients she explained how a lot of chronic disease skin issues are actually hormone problems in disguise. Which makes a lot of sense when we see women get dry skin with menopause or thyroid disease, and oily skin with PCOS, Perimenopause and PMS. “Until we treat the cause of the Hormone Imbalance topical agents will continue to fail” is the take home message from my acne rant that prefaces the latest Natural Medicine research for Acne on my latest blog about “Hormonal Acne."

The #1 clue a symptom is related to hormone imbalance is fluctuation. Women who have fluctuating symptoms throughout the month or that begin with menopause, pregnancy or postpartum should be aware of how hormones can adversely impact their skin. There is way more to acne than just testosterone. Estrogen and progesterone are often to blame as well as many other hormones.

To properly balance hormones we need to use natural medicine to treat the root cause of the hormone imbalance. While we sometimes need bioidentical hormones or thyroid hormones, oftentimes from a Functional Medicine standpoint the cause of the hormone imbalance is something we address with herbs. Patients that like to drink tea, take herbal capsules, tinctures or supplements and improve their nutrition are perfect candidates for Naturopathy.

Patients that do not like those above things should stick with their MD's as it is difficult for me to help them as a Naturopath when they can't take herbs or make nutritional changes specific to what their body needs. Women are very unique as I discuss further in my Snowflake blog.

Today I wanted to share a picture of my favorite room, the "Herb Room" and remind you to drink more iced herbal tea to stay hydrated in the heat.

Teas are perfect for those of us in the Arizona heat that need to be taking in more water. I love to use ginger, mint and licorice which all contain powerful antioxidants and can help mask the flavor of herbs used for medicine. Patients can enjoy their herbal medicine tea iced for a refreshing change. Simply make your tea as normal, refrigerate and serve over ice!

If you need my help testing and balancing your hormones, or have not been feeling good and want to get to the "Root Cause," simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit!

Dr. Nicole Sundene, NMD

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Specialist  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

Dr. Nicole Sundene

Female Hormone Specialist

Estrogen dominance symptoms caused by high estrogen and/or low progesterone are various and therefore often missed in women’s health. Women with high estrogen are commonly treated with a medication to suppress each individual symptom without addressing the "Root Cause." Many doctors often fail to identify and properly diagnose the estrogen dominance. A skilled women’s health doctor can identify the cluster of symptoms relating to estrogen dominance and order the proper hormone testing to diagnose the estrogen dominance. 

ESTROGEN DOMINANCE SYMPTOMS

High estrogen symptoms include weight gain, bloating, fatigue, anger, agitation, rage, moodiness, dark mood, mood swings, anxiety, depression, panic attacksacne, cystic acne, oily skin, constipation, nausea, PMS, fluid retention, swelling, headaches, and a generalized feeling of unwellness. 

Women struggling with high estrogen levels often have heavy periods, painful menstrual cramps, light or absent periods, irregular periods, decreased sex drive, endometriosis, endometriosis pain, uterine polyps, adenomysosis, uterine fibroids, breast cysts, fibrocystic breasts, dense breasts, breast pain, and insulin resistance. Women with heavy bleeding from estrogen dominance often end up with anemia which worsens the fatigue and weight gain from high estrogen.

High estrogen levels tend to worsen if not cause many of these common women’s health conditions. Insulin resistance results from estrogen dominance and estrogen dominance then further worsens insulin resistance creating a vicious cycle of weight gain for PCOS and diabetic women with high estrogen levels.  It is nearly impossible for these women to lose weight when they are battling estrogen dominance and insulin resistance with herbal medicine and dietary changes.

With this many common women’s health conditions being adversely impacted by high estrogen levels it is imperative that women are educated about estrogen dominance for prevention and proper treatment. 

HIGH ESTROGEN LEVELS: LONG TERM DANGER

High estrogen symptoms or “estrogen dominance” when left untreated can result in high blood pressure, increased risk of stroke, heart attack, blood clots, ovarian cancer, and breast cancer. High estrogen levels will worsen patients prone to these conditions and increase their risk of developing them. Alternatively, having low estrogen can also increase a woman’s cardiac risk. So estrogen can be the hero or the villain in women’s health. It is all about the levels being at optimal levels and in proper balance with the other female hormones

HIGH ESTROGEN VS LOW ESTROGEN

Neither extreme high estrogen nor low estrogen is healthy for women. Low estrogen such as in menopause can cause a whole host of problems such as Osteoporosis, Hot Flashes, Insomnia, Anxiety, and Depression. We need to think of estrogen as if its water. Too much water can be just as dangerous as too little water. Just like with estrogen, women also need an individualized level of water as they metabolize it uniquely. Just like with water we need to hit “the sweet spot” with estrogen where the levels are not too high nor too low. Menopausal women suffer without any estrogen just as much as my estrogen dominant patients. Both high estrogen and low estrogen states cause insulin resistance causing weight gain so it is imperative women increase the fiber, good fat, and protein in their diets as otherwise the will gain weight when their estrogen level is not optimal.

ESTROGEN DOMINANCE DIAGNOSIS

Estrogen dominance diagnosis involves proper Hormone Testing with emphasis on the estradiol, progesterone, and total estrogen to determine if the estrogen to progesterone ratio is healthy. A healthy estrogen to progesterone ratio is under <60-100. When women have an estrogen ratio higher than this they are at high risk for disorders and diseases caused by estrogen dominance.

When the estrogen to progesterone ratio is above >60-100 women have estrogen dominance. This can be caused by a few different scenarios I will explain with the math I use to calculate the "E:P Ratio" or Estrogen to Progesterone Ratio:

Total Estrogen 600/ Progesterone 20= 30 Normal 

Total Estrogen 600/Progesterone 10=60 Normal

Total Estrogen 600/Progesterone 0.5=1200 High

Total Estrogen 300/Progesterone 0.5= 600 High

So we can see in the last calculation that the estrogen can be in the normal range yet if the progesterone is deficient then we can still have estrogen dominance despite a “normal estrogen level.” The first scenario is generally the progesterone level of a woman in their teens or twenties and as the progesterone level progressively deteriorates the high estrogen begins to cause symptoms. The last two calculations I commonly see in women in their 40's and 50's. Women that are overweight will maintain a high estrogen level at menopause produced by their body fat yet have very little progesterone to balance it out.

I hear every day from women how their doctor tested their hormones and said they were “normal,” yet often I receive incomplete labs that are not properly ordered. Many important hormone tests are missing, and there is a 99.99% failure rate their previous doctor calculated the ratios of the hormones to each other to ensure they are all in balance with each other.

ESTROGEN DOMINANCE TREATMENT

Treating estrogen dominance involves a multifactorial approach between eliminating xenoestrogens from beauty products, plastic water bottles, and environmental sources as well as helping the liver detoxify estrogen, in addition to understanding why the estrogen levels are so high in the first place. 

Often in a woman's 40's this is somewhat "normal" as women that are Perimenopausal are experiencing often permanent PMS symptoms from constant estrogen dominance. Rather than having a few days each month that they feel "PMSy" they are now feeling PMS symptoms every day of the month with a few breaks from it as their hormones begin to shift towards menopause. Around 35 years of age a woman's progesterone and testosterone levels begin to decline while estrogen remains high or becomes even more elevated.

Estrogen dominance can be corrected with a solid long term nutrition and herbal medicine approach. The good news with estrogen dominance is that it can be easily treated naturally by a women's health Naturopathic Doctor that specializes in bioidentical hormone therapy, nutrition, and herbal medicine. While bioidentical hormones are not always required to correct the estrogen dominance, they can be helpful for correcting a scenario of low progesterone that is out of balance with a high or normal estrogen level. 

WHY DO WOMEN HAVE ESTROGEN DOMINANCE? 

When women are in their teens and twenties their progesterone levels are generally around 20. Around 35 these levels begin to dwindle down to zero causing the symptoms of estrogen dominance to become more unbearable each year. The impact of this hormone imbalance can significantly impair the mental health of women and cause their psychiatric issues to worsen. Some women develop depression or anxiety during this time of severe hormone imbalance. 

When women suddenly develop mental health disorders in their 40's or 50's it is more likely related to their hormones impacting their neurotransmitter levels. Did you know that estrogen dominance, estrogen deficiency, testosterone deficiency, and progesterone deficiency can all impair a woman’s mental health? Around 35 most women begin to notice this decline in their natural hormones with various odd new symptoms they never experienced before. 

WHAT DISEASES ARE CAUSED BY ESTROGEN DOMINANCE?

Many women's health conditions cause high estrogen such as hypothyroidism, Hashimotos thyroiditis, obesityperimenopause, oral birth control, synthetic hormones, and bioidentical hormones. When bioidentical hormones are not properly tested to match a woman’s individual hormone metabolism they can also cause estrogen dominance. On rare occasions, tumors secreting estrogen on the ovaries and adrenal glands can also cause estrogen dominance. 

Alcoholism causes estrogen to pool in the system as the liver fails to detoxify both the estrogen and the alcohol. PCOS, excess body fat, liver problems and even stress all cause estrogen dominance. Stress lowers progesterone levels referred to as “The Progesterone Steal” in biochemistry, causing estrogen dominance symptoms to worsen when there is not sufficient progesterone to balance the high estrogen levels. 

Some women do not excrete or metabolize estrogen due to genetic mutations such as COMT, MAO, and MTHFR, and therefore will need estrogen metabolizers and liver support in addition to bioidentical hormones. Bioidentical hormones such as progesterone and testosterone can be helpful in balancing high estrogen levels. When women are younger all three hormones are high. With the aging process, the progesterone and testosterone decline and the estrogen remains high until menopause officially sets in.  

ESTROGEN DOMINANCE CAUSES  WEIGHT GAIN WHICH ELEVATES ESTROGEN

Estrogen dominance causes weight gain and weight gain then ironically causes more estrogen dominance as the higher a woman’s body fat level the higher their estrogen level. Body fat constantly secretes estrogen independently of the ovaries.

Conversely, the less body fat a woman has the lower their estrogen. When women are estrogen dominant and they are losing weight even more estrogen is being released from the fat cells and this can actually slow if not stop weight loss completely until properly addressed with the appropriate estrogen detox measures. 

Women with estrogen dominance often end up stuck in a vicious weight loss cycle where they cannot lose the weight because when they start to lose weight their estrogen dominance worsens and causes more weight gain. High estrogen levels also smother thyroid function and therefore lower and suppress the metabolism even further. It is important to work with a skilled hormone doctor that understands all the other hormones that need to be tested for to properly identify and treat the high estrogen levels, and treat the thyroid and estrogen.

Just treating one hormone in the “web” will not be effective when we do not address the other imbalanced hormones in the web impacted by estrogen.

ESTROGEN DOMINANCE AND LIVER DETOX

The liver is important in breaking estrogen down into an almost totally impotent form. It also converts estrogen into compounds that can be excreted from the body through urine and bile. The purpose of an estrogen lowering diet is to support the liver, to reduce sources of estrogen found in foods, and to support other glands such as the adrenal glands and the thyroid gland that influence estrogen. 

Women with Hashimotos Thyroiditis, Thyroid Disease, and Hypothyroidism will suffer from estrogen dominance until the thyroid levels are properly regulated. The thyroid is the "Mother of the Endocrine System," and in this case the estrogen dominance is caused by thyroid disease. A holistic women's health Naturopathic approach can work to balance the estrogen levels over time. 

HOW LONG DOES IT TAKE TO LOWER HIGH ESTROGEN LEVELS? 

Estrogen dominance requires patience and reasonable expectations. It generally can take three to six months for menstruating women to correct their estrogen dominance as the eggs that are being made today have not yet undergone Naturopathic hormone balancing treatment and will be released in three months. These unhealthy eggs will also then secrete imbalanced hormones along with them. 

Therefore it is important for women to understand this takes time, and it is important we never ignore estrogen dominance. Many of my estrogen-dominant patients that were unable to follow their estrogen lowering program and remember to take their supplements have ended up with breast cancer, uterine cancer, and ovarian cancer due to the high uncontrolled estrogen levels in their systems. Therefore working on your high estrogen levels for mood or weight loss now may save your life someday in the future!

The following estrogen dominance diet and lifestyle recommendations should be implemented as soon as possible to prevent stroke, blood clots, breast cancer, uterine, and ovarian cancer in estrogen-dominant women.

ESTROGEN DOMINANCE DIET

• Eliminate sugar, white flour, and refined foods. Sugar increases estrogen. Having insulin resistance or diabetes also increases estrogen. Body fat makes estrogen, therefore losing weight will also naturally lower estrogen levels. Keep in mind that while losing weight your estrogen levels may suddenly shoot up as I discussed above. However, over the long term fat loss will lower high estrogen naturally. 

• Eliminate alcohol and methyl xanthines that increase estrogen such as coffee, tea, chocolate, colas, and other foods or beverages that contain caffeine. The liver is too busy metabolizing these chemicals to eliminate high estrogen levels. 

• Eliminate red meat, lamb and pork. Organic chicken, turkey, and safe seafood such as Alaskan wild salmon, shrimp, and scallops (not Tuna or Swordfish) are acceptable alternatives. Many women eat Vegan to reduce estrogen consumption from meat. Most animal protein naturally contains some hormones. Non-organic meats are injected with estrogen to help increase the sale per pound of meat in the meat industry. If you suffer with estrogen dominance the first most important diet change you should make is to invest in high quality organic meats that are low fat. The saturated fat content in animal fats should be counted daily and women with estrogen dominance should be under <10g of saturated fat daily. This is why many Naturopathic Doctors recommend a Vegan diet for estrogen dominance. But eating low-fat meat choices free of hormones can also be helpful, especially for those with insulin resistance that need to be on a higher protein diet. 

• Decrease fats, especially animal fats and trans fats from fried foods. Use instead unsaturated fats such as those in cold-pressed vegetable oils raw nuts like walnuts, and flax or fish oil. Total fat consumption should be <50g of fat for estrogen-dominant women as fats increase estrogen in biochemistry pathways.

• Increase foods found in the cabbage family such as cabbage, Brussels sprouts, cauliflower, etc. As the sulforaphane and Indole-3 Carbinole helps aid in the detoxification of estrogen to a less active form. Increase fruits and veggies that aid liver support and liver detoxification in my Liver Foods blog. 

• Decrease dairy products such as milk, cheese, cream, etc. Saturated fat from dairy is a top contributor to female hormone imbalance. Only consume organic low-fat dairy if any. 

• Increase fiber from vegetables to naturally detoxify estrogen. Fiber binds estrogen for elimination in the digestive tract. Without sufficient fiber the estrogen continue to circulate and worsen the estrogen dominance. Women with estrogen dominance should consume at least 30g of fiber daily. I recommend using a macro tracker such as Myfitness pal to understand where the excess fat and carbs are coming from and to reach dietary fiber intake goals.

• Increase garlic and onions as sulfur is needed to detoxify estrogen.

• Be sure you are taking adequate amounts of selenium, iodine, beta-carotene, and vitamins A, C and E. Consult your Naturopathic Doctor to determine this.

ESTROGEN DOMINANCE LIFESTYLE FACTORS

Chemicals and Xenoestrogen or “estrogen mimickers” increase estrogen levels. Chemicals like pesticides and insecticides impede liver detox pathways causing elevated estrogen. Plastic and other chemicals such as BPA, phthalates, and parabens also contribute to high estrogen. 

#1 MOST IMPORTANT THING FOR WOMEN WITH HIGH ESTROGEN: BPA from plastic water bottles, and lining aluminum cans are a significant source of xenoestrogens or estrogen mimickers that contribute to the estrogen dominance when seen in the total estrogen pool. Do not eat canned food, do not use plastic water bottles, do not cook or freeze anything in plastic and work to eliminate as much plastic from your world as possible as it is the #1 issue causing hormone imbalance for women. 

There is no point in me prescribing expensive herbs and supplements to detoxify high estrogen when we are not paying attention to the front loading of synthetic estrogen poison entering a woman’s body in the form of plastics and BPA. This is why I buy food in glass jars and support companies that also are willing to pay a little extra for glass jars to save our environment from the loads of plastic poisoning women, sea creatures, and wildlife. This is not only a better choice for our health as women, but also the environment.  

#2 Eliminate all beauty products with parabens, fragrance and phthalates. Switch to clean beauty products as your beauty products run out. This is especially important for lotions, creams and moisturizers you regularly use as well as makeup that is regularly used. Most makeup is complete poison for women and causing their estrogen dominance. Any “natural fragrance” should be listed with the source, or should be assumed as toxic otherwise.  Perfume is 100% hormone poison and should be thrown straight into the garbage can if you have been diagnosed with estrogen dominance. 

#3 Decrease stress as it depletes progesterone. Stress causes cortisol our main stress hormone to be made from progesterone. This lowers our progesterone and raises our estrogen to progesterone ratio. Stress also tells the body it is “Running From a Bear” and  it is not a good time to reproduce and hence less progesterone that is needed to maintain a pregnancy is produced under stress. The body does not care about making a baby when it is running from a bear. Women with high estrogen and also low progesterone will feel the worst with their estrogen dominance symptoms. Read my blog on tips for Anxiety to learn more about managing your stress naturally.

If you need my help with diagnosing your estrogen dominance or treating high estrogen levels or the conditions related to estrogen dominance simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit. 

Dr. Nicole Sundene 

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause,  Thyroid,  Hashimotos,  PMS, PerimenopauseAutoimmunePostpartumChronic Fatigue, DepressionAnxiety, Food Allergies,  DigestionDermatology, AcnePsoriasis Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. 

She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!

By Dr. Nicole Sundene, NMD

Female Hormone Specialist

Hashimoto's thyroid treatment is extremely different than regular hypothyroidism in Naturopathic Medicine. In my mind, Hashimotos is very different from regular hypothyroidism and requires a different treatment plan. As a Female Hormone Specialist and Naturopathic Doctor.

Many of my patients have been treated for their thyroid for years without knowing what type of thyroid disease they have. Half the time most MD’s could care less what form of thyroid disease the patient has because it does not affect their thyroid treatment. The thyroid treatment is the same for an autoimmune Hashimotos as standard hypothyroidism. This makes little sense since we are comparing apples and oranges.  

Did you know with Hashimoto's the real problem is actually the immune system attacking the thyroid, and there is generally nothing actually wrong with the thyroid gland itself? I like to think of the thyroid in this situation as the poor little kid getting bullied in the schoolyard. He is constantly under attack, but otherwise would be completely fine. When we fail to address the immune system in this frustrating autoimmune disease, we fail to ever truly help the patient return their inflammation levels to normal, restore energy, and reduce arthritis, achy joints, swelling and traveling pain that is the hallmark for Hashimotos.

If you are a thyroid patient that has not been tested for Hashimoto's yet, you have constant traveling mysterious aches and pains that no doctor or physical therapist can diagnose…I will bet the farm that the diagnosis is Hashimoto's. 

As a thyroid doctor and Hashimoto's specialist, it is extremely important to me to understand my thyroid patient’s diagnosis, and if they have just a “Lazy Thyroid” as I have in regular hypothyroidism, or whether they have an autoimmune disease that is actually causing the hypothyroidism. 

Nutrients that most thyroid patients are deficient in can also cause severe adverse reactions for my Hashimotos patients. I have seen patients harm themselves from too much iodine, zinc, tyrosine, b-vitamins and thyroid cofactors that can throw the sluggish low thyroid into hyperdrive and cause an actually “Thyroid Storm” where the immune system is ferociously attacking the thyroid and as an immediate result of cell destruction.

During a thyroid stomr, the thyroid hormones are dumped into the bloodstream causing the heart to be immediately triggered, as T3 stimulates contractility and thus palpitations, tachycardia and anxiety can ensue from the hyperthyroid storm. 

When we work to address the autoimmune condition from a Naturopathic standpoint, we can calm these thyroid storm attacks down and lessen the rate of destruction the thyroid will endure. Once the thyroid has endured enough attacks, and as part of the natural aging process of our glands, most Hashimoto's patients eventually require thyroid replacement hormones. 

What is the best thyroid medication for Hashimotos? 

While it may have a higher likelihood of adverse reactions for those with autoimmune Hashimotos I do see Armour Thyroid work the best to control symptoms and improve fatigue and weight loss. Armour thyroid is a generic term for “Natural Dessicated Thyroid” because the pig gland is desiccated generally there is no reaction to the natural thyroid medication for the majority of my Hashimotos patients and therefore the "rule" that autoimmune patients should not be given Armour thyroid is simply untrue.

Around 95% of the Hashimotos patients in my hormone practice prefer Natural Dessicated Thyroid or Armour over levothyroxine or synthroid.

The other choice is synthroid or levothyroxine combined with T3. I do not recommend patients take T4 alone or “T4 Monotherapy” unless they are great converters to T3, the metabolically active thyroid hormone. Because most women struggle with this conversion, especially when in Menopause and Perimenopause as female hormones can impact the thyroid levels and smother them, reduce thyroid function, and cause the metabolism to slow down.

Therefore monitoring the thyroid for women in their forties and fifties is critical in Women's Health.  

Women with Hashimotos should find a seasoned Hashimotos Expert that specializes in Naturopathic Medicine, Herbs and Nutrition. Many other hormones can impact the Hashimotos patient such as adrenal hormones, estrogen, progesterone, and insulin. In my mind, there is no patient that needs a Naturopathic hormone doctor more than a Hashimotos patient!

Your naturopathic doctor should be providing hormone testing and treatment to the adrenals which are the underlying foundation of support for the thyroid, in addition to addressing gut health and the microbiome which are also triggering many women with this frustrating thyroid disease.

Treating Hashimotos properly is extremely complicated and requires a multifaceted approach to correct hormones, nutrition, inflammation, and most importantly balance the immune system, helping it to become less reactive and thus less likely to “bully” or attack the thyroid. 

If you would like my help with your thyroid condition simply visit my SCHEDULE page to set up your initial Naturopathic visit!

Dr. Nicole Sundene, NMD

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

Dr. Nicole Sundene, NMD

Scottsdale Naturopathic Pain Doctor

Chronic Pain: What is a Holistic Pain Specialist? 

As a Naturopathic Doctor that has survived fifteen years of varying levels of severe pain from an Autoimmune disease causing Fibromyalgia and Neuropathy the first and most important thing I will do is BELIEVE you, and provide you with empathy and compassion. I have been to too many doctors that thought I was a whiner, a hypochondriac, or just a bored depressed woman that had nothing better to do with her time but go from doctor to doctor, specialist to specialist, and simply needed an antidepressant to cure all that was ailing me. Please watch my 30 minute free presentation, “Hormones, Metabolism & Pain” on my free class page for the full story. 

Many chronic pain patients do improve from taking anti-depressants, simply because being in constant pain is depressing. As I tell the story of my own Fibromyalgia journey, I went from being an avid mountain biker that could mountain bike for eight hours a day and ride the STP- Seattle to Portland bike ride with my Dad to being completely bedridden. I lost connection with a lot of my friends because I was too sick to go to parties or social events. I was too tired to talk on the phone with anyone…and simply getting through a regular day of work or going to the grocery store was more exhausting to me than actually doing an actual Triathlon. As a former endurancd athlete, I was used to being in constant pain but it was “Good Pain.” My legs were weak and like Jell-O from riding my bike for 8 hours on the weekends. I loved that feeling. 

But when I developed Fibro, my legs burned and felt weak when I had done nothing. I could barely climb the 8 steps out of my condo and walk to my car. Nobody knew what was wrong with me and I wasted many years of my life not getting the right treatments. Because we NEED to know what the diagnosis is in order to provide the chronic pain patient the correct treatment. When I was in Naturopathic school at Bastyr University, I learned a pain protocol for Fibromyalgia: Magnesium, Vitamin D, and Malic Acid. I literally graduated from Naturopathic school thinking this was what Fibro patients need and that is all we needed to do for them. Very sad right? And precisely why pain patients need to hire an expert such as myself that specializes in pain management.

In 2006 God gifted me with the Fibromyalgia label by a well-meaning doctor that tried to help me but simply did not know enough to order the correct tests, and my understanding of chronic pain shifted dramatically. As I graduated from school I was gifted this "Internship" by Life in Fibromyalgia and although I have felt very angry and frustrated with my body over the years.... Fibromyalgia has been my #1 Biggest Teacher. When the correct women in constant pain find my practice and finally feel heard and understood I get goose bumps and tears well up in my eyes because I realize that although Fibromyalgia was a brutal teacher... it taught me very well. Fibromyalgia has taught me many lessons that are important I share with my patients and the medical community so that we can shift how we perceive Fibromyalgia and we can stop failing all of our Fibromyalgia patients.

First of all, I tell my patients with Fibromyalgia to stop using the “F Word,” and I don’t mean the actual F word because I know people in pain often can ONLY say the F word, because they are hurting so badly that they really DO need to use that word. However, the F word I want them to stop using is Fibromyalgia. The reason for this is that as a Fibromyalgia Doctor with Fibromyalgia I believe with my whole heart that it is an utterly useless diagnosis that means nothing and allows your pain specialist or family doctor to continue to doctor you in a somewhat lazy way because it sounds like you finally have a diagnosis right? I remember calling my Mom in 2006 and saying in a state of shock, "They said I have Fibromyalgia!" And that is when my journey down the Fibromyalgia rabbit hole first began. That is why I hate and detest the word Fibromyalgia and that is why I encourage my patients to use more descriptive words like burning, stabbing, aching and so forth so that we are focused on the actual problem. Treating patients with Fibromyalgia is a lot like looking at snowflakes, while they may look similar from a distance there is quite a difference between the hundreds of Fibromyalgia patients in my practice. Should you be happy to be diagnosed with Fibromyalgia? Does this help you as a patient get the correct "Fibromyalgia" treatment or care? Fibromyalgia actually means something, doesn't it?

NO THAT IS 100% WRONG

Fibromyalgia means you have pain aka “myalgia” in your “Fibro” which is your joints and muscles. What good does this diagnosis do for you as a chronic pain patient? While I understand some patients are very attached to their Fibro label and I know thousands of Fibro Warriors between my Fibro practice and the online groups I participate in....personally as a Fibromyalgia Doctor I would encourage you to work to get your label undone. Personally, because I have a caregiver's heart and care about people, especially those also in pain, I want you to hate the word Fibromyalgia as much as I do as a chronic pain specialist for women. Mainly because the word Fibromyalgia tells me ZERO about what is actually wrong with you, and it provides the doctor ZERO help to provide you with the correct treatment plan. 

I feel for some over-booked busy doctors and pain specialists, using the label Fibromyalgia allows them to take off their thinking caps and stop working to determine the ROOT CAUSE of your pain. My job as a chronic pain specialist is to ask the following questions like a detective, to look to find the actual cause of your chronic pain. Fibromyalgia is a description and not a diagnosis!

What is the cause of the patient's fibromyalgia or chronic pain?

  1. Is the pain hormonal? 
  2. Is the pain a vitamin or nutrient deficiency and nutritional?
  3. Is the pain caused by your diet?
  4. Is the pain caused by an autoimmune condition?
  5. Is the pain caused by an infection? 
  6. Is the pain Neurological and you actually have Neuropathy throughout your entire body like I do and need a Neurologist to test your nerves with an EMG and nerve biopsy?
  7. Is your pain psychological? I am not calling you crazy when I ask this, I am simply wondering if too much stress could be impacting your adrenal glands and causing a common condition my chronic pain patients have called “Adrenal Fatigue.” 

When the adrenal glands burn out as I discuss in my Adrenal Gland Blogs: 1) “Adrenal Hormones: Are you Running from the Bear?” 2) “Adrenal Fatigue: Fight, Flight, and Fright?” When these adrenal glands become depleted, the patient feels exhausted, depressed, and has pain in their joints and lower back, with joints that are constantly cracking or popping. This is a picture of the adrenal fatigue patient. Constant stress and anxiety about a condition with no known cause and no known cure can cause adrenal fatigue and living with constant pain while people have unrealistic expectations because they may look completely healthy on the outside, as I do, yet are miserable and struggling with serious pain on the inside. 

Your adrenals will likely need some treatment, which only exists in herbal medicine and naturopathic medicine, because other than prescribing a beta-blocker medication and telling you to take a vacation or do yoga, your MD has little to offer you for your adrenals, that are under constant stress from being in constant pain. 

You can probably see there are already a bunch of tests that you likely have not been offered as a Fibromyalgia or Autoimmune patient. It is imperative you commit yourself to this process of working with me as a team so that we can unearth the cause or the causes of your pain. Often it is a combination of a few things on my list above. Seldom am I unable to help patients with their chronic pain. I may not be able to make it go away completely, but I can take the level of pain down once we target the correct herbs and nutrition to the correct chronic pain diagnosis.   

Aside from listening and providing compassion, the second and more important thing we will do together as a team when you treat yourself to a Naturopathic pain consult with me, is to rely on lab metrics to determine the cause of your pain. Together we will order the proper labs to determine the cause of your pain. If you have decent insurance then your labs are covered per your insurance plan. There may be a few Naturopathic Specialty tests I will need to do for your pain, but I prefer to start with the testing that insurance will cover (Naturopathic Doctors cannot order labs in Arizona for patients on Medicaid or AHCCSS) but can order tests via most insurance plans such as Cigna, BCBS, Aetna, Ambetter, United Healthcare and so forth. Medicare labs are only covered if you go to Labcorp and some tests will simply not be paid for as the government could seriously care less about your vitamin levels although hormone testing for women is covered and patients with good secondary insurance generally receive a final bill under $100 for thousands of dollars worth of chronic pain testing. It is not realistic to expect 100% of anything to be covered by your insurance. But the initial Lab detective work is critical to the chronic pain patient's diagnosis and prognosis. Patients with Fibromyalgia that lack a diagnosis generally will have a worse prognosis because we are just throwing spaghetti noodles on the wall for your pain management plan and not targeting it towards an actual solid diagnosis. It is critical that you know what lab is contracted with your insurance plan for Fibromyalgia testing as it is the insurance’s preference of Labcorp vs Sonora quest that is more important than the ordering doctor. 

More times than not, my fibromyalgia and autoimmune patients have not had the proper battery of tests that should be conducted. While hormone imbalance is not always the cause of chronic pain in my women’s health practice it is more commonly the problem, which is exactly why more women have fibromyalgia than men. Rarely if never do I receive adequate hormone testing or chronic pain testing done by a previous doctor. Many patients think they have had their hormones checked and I get one piece of paper with a TSH and progesterone level.

Often my new pain patient thinks they have been tested for autoimmune disease and just an ANA with reflex test was conducted with a CBC. I cannot help any pain patient that does not let me do my detective process properly and my #1 pet peeve is having someone's primary care doctor or another specialist that does not know what I know mess up my lab tests. Keep in mind I worked in regular Family Medicine for eight years and processed the lab letters for 20 doctors, so I already know what your Family Doctor is going to do for you, and since hormone testing is super complicated 9/10 times another doctor just screws it up and your valuable lab dollars are wasted and my hands are tied because the wrong doctor ordered the wrong tests and now we have to wait 6 weeks before your insurance will allow me to re-conduct the testing I need to help you. So please take your labslip directly down to the lab that is contracted with your insurance plan if we are working together so your time and money are not wasted.

Even if your pain is not caused by hormone imbalance, we will need to cross the hormone testing off your “Chronic Pain Bucket List.” As your holistic pain specialist, I will look at the big picture of your nutrition, stress, exercise, hormones, and blood tests. 

My skills as a Female Hormone Specialist are extremely important to my chronic pain patients because oftentimes pain for women is related to hormone imbalance. If you notice fluctuations in your pain with your monthly cycle and get migraines or pain flares with PMS then there is likely a hormonal component to your pain. For women that have always been healthy and develop pain when they become menopausal, this is a very important reason to work with a holistic pain specialist. When estrogen levels decline inflammation goes up and that can cause women to have more pain in their hips, hands, and joints. 

Too much estrogen such as in perimenopause, PCOS, and PMS can also cause joint pain and inflammation. So working with a doctor that understands optimal ranges for estrogen is extremely important. Estrogen is like water, and too much causes pain, inflammation, and weight gain, and too little causes joint pain, thyroid issues and inflammation. 

The third most important thing I do for you as your integrated chronic pain specialist is prescribe medications, herbs and supplements to help you with your pain. I cannot do this properly and can only guess at what you need until we have gone through the process of testing your pain labs and hormones. There is no magical herb from the rainforest that will cure all of your fibromyalgia symptoms. If there was, I would be on it!

The treatments I provide as a naturopathic doctor will fail if we are not targeting the correct diagnosis. 

I want to always treat the root cause, and while I am knowledgeable from working 8 years in conventional Family Medicine and know how to prescribe these meds, I am comfortable doing this for you. Prescribing pain meds is somewhat boring to me. Pretty much anyone can slap you on a bunch of vicodin, gabapentin, amitriptyline, gabapentin, Naproxen, and cyclobenzaprine and then quarterly test your liver and kidneys to ensure they do not fail.

If that is the route you prefer for your chronic pain then I am not the right doctor for you. I prefer to only prescribe pain medications for the purpose of tapering you down from them, which saves the pain patient from going to multiple specialists, as I personally know how exhausting that is. My goal is to taper you down from these meds that can be toxic to your liver and kidneys once your Naturopathic protocol begins to take effect. 

As a chronic pain patient with Neuropathy, when I finally received that diagnosis, the supplements I used to treat the neuropathy were a huge game-changer for me. I was now targeting my treatment plan to heal and repair nerve damage, whereas before I was taking herbs and supplements for muscle pain. This is why it is critical to me that I know what the diagnosis is as a pain specialist otherwise I cannot get a good result for my patient and then I don’t get the “Joy of fixing you,” which is what puts a smile on my face every day as a doctor knowing that my patient is better and that the riddle of their Fibromyalgia has been solved. 

Many chronic pain patients cry in my office because they realize quickly that my own horrific experience as an autoimmune patient has gifted me with a vast set of skills they could never find anywhere else prior to working with me. I am not trying to sound arrogant but unless you have lived severe pain you simply do not understand what it is like. I admit that I worked with autoimmune and fibro patients for eight years without fully understanding.

Due to my own medical mysteries causing my pain I have a lot of experience in specialties that are necessary to help chronic pain patients: Endocrinology, Pain Management, Gynecology, Urology, Family Medicine, and even Psychiatry. Because at one point I fell victim to a Psychiatrist actually convincing me that everything that was wrong with me was all in my head and I took five psychiatric meds that just made me and my chronic pain much much worse. So I know a lot about antidepressants and anti-anxiety medications as a result. I understand the anxiety and depression related to chronic pain too well and can easily help you with that.

Finally and maybe even the most important, what I can promise you as your holistic chronic pain specialist, is to oversee the big picture of your chronic pain treatment plan. This includes your referrals to Neurology, Rheumatology, or Infectious Disease, to make sure what we are doing for you is helping and not making you worse. Often my pain patients have bounced around from specialist to specialist and nobody is talking to each other. What I promise to do as your personal nerdy little detective, is to look at all your tests and make sure we have left no stone unturned. 

This way, we have you at the RIGHT specialists and we are not wasting your precious energy on being a “Professional Patient.” Which I have wasted much of my time doing, and know exactly how emotionally exhausting these appointments can be. I understand how frustrating it is to keep telling your story to a new doctor over and over again, and what it feels like to be judged, criticized, and sadly I know also what it feels like to be yelled at by some MD’s. 

WHICH PATIENTS ARE NOT GOOD CANDIDATES TO WORK WITH A HOLISTIC PAIN SPECIALIST?

I never want to enroll a patient into my practice that I cannot help. I don’t want to waste anyone’s time with fibromyalgia, chronic pain, or autoimmune that I cannot help. While I have a great success rate improving my patient’s chronic pain and my pain patients are constantly referring me new pain patients it is always important to me that the correct patient matches up with the correct doctor

Below are the patients I 100% CANNOT help as a holistic pain specialist. Please do not sign up to work with me if you match any of the following scenarios: 

  1. If you are someone that does not want to go through the above testing I have just described, if you don’t have the right insurance or money to afford the proper testing then it is a waste of your time and money to enroll in my practice. I rely on lab tests and metrics and blood work. I cannot help you if you cannot afford this. 
  2. Pain Victims: I am a pain victim too but I choose to fight the pain and not let it take me over. I choose to work hard against my pain and not just lay in bed and eat Fast Food and chug a bottle of wine while I whine to my friends about my pain and be a victim of pain. Do you want to continue on the rest of your life as a victim of your pain or do you want to be a victor of your pain? I work really hard every day to battle my own chronic pain, and I cannot take your supplements for you. I cannot shove them down your throat and stroke it like I give my pet supplements. I cannot drive to your house and take away the foods you shouldn't be eating, and I can’t make you do the gentle yoga and exercise I recommend. Frankly I just don't have time for patients like this. If you want to wallow in your pain and live as a victim of it I will not be able to help you. In 2008 I was there myself and began drinking, eating fast food and even smoking cigarettes because I felt SO CRAPPY it seemed that nothing I did even mattered. I felt like I was 100 years old and was going to die. I actually wanted to die. But people with this lifestyle cannot be helped by Naturopathy. I cannot prescribe enough supplements to “Out supplement your crappy diet.” I just can’t. Please skip me as your holistic pain doctor if you refuse to change your diet to whatever we determine your body needs. 
  3. Patients with pre-conceived notions as to what their diet and supplements should be. If you were a Fibromyalgia genius that already had everything fixed and wrapped up with a bow I doubt you would need my help. When patients don’t let me have control over their diet and treatment plan I just can’t help them. "Well I am an expert with nutrition and I believe...X,Y,Z" Yes I have heard it all. I don't care what you think is the right diet in your head. What I care about is what the right diet is for YOUR BODY. That is the diet we will work to discover together and that is the diet I will need you to follow. Every single time the patient decides they are in charge of their nutritional situation, the situation fails and therefore is a waste of everyone’s time. I have many doctors and nurses that trust me to take care of them and hire me as “their expert.” Nearly every day there is a doctor or nurse on my schedule because they respect what I know as a holistic pain doctor. So if you can’t trust that I am the expert and not you on this then we will not be able to get you better. I am not an arrogant doctor I am just efficient and no nonsense. And I am driven by results. I can't get the result when you won't let me be in charge of your nutritional plan.
  4. I cannot help patients that do not take their supplements or follow their treatment plan. Whether you are being lazy or not taking it seriously, or argue with me about what the treatment plan should be. Patients that argue do not get better. Sometimes I think they actually don't want to get better. My old office manager said “It is so funny, the patients that follow your directions are better in a few weeks or a month, and the patients that don’t follow your directions seem to NEVER FEEL BETTER!” She would tell patients with extreme confidence, "Just get off Google and stop watching Dr. Oz, and do what Dr. Sundene says to do!” After fourteen years of treating pain patients I could not agree with her more.  And while I am the opposite of bossy I always fail patients when I let them be the boss. If you want to drive your "Chronic Pain Bus" around you will simply steer it in to a ditch and then blame me you didn't feel better. So decide now if you are willing to let me take my 22 years of clinical experience and fifteen years as a Fibro Warrior and Autoimmune patient to offer you the very best I have to offer. 
  5. If you are someone with trust issues, please know, I am going to work as hard as I can with you to help you feel better, using EVERYTHING I know from both Naturopathic and Prescription medicine with over 22 years of experience. My least favorite Fibromyalgia patient is super paranoid and refuses to do anything I say. I usually see this on the first visit and immediately know I cannot help. Why is that? You cannot be your own doctor. I have my own doctors, and I trust them, and follow their advice. I realize at times patients cannot see the forest for the trees, and can get stuck on googling things and listening to other Naturopathic Doctor’s Podcasts etc. and not following my instructions. The patients that do not get better in my practice have "Naturopathic Medicine ADD" and are all over the place with doing too many different things at once. It is my expectation that you will be taking the supplements I prescribe and the nutritional plan I prescribe the best you can at all times unless you have an adverse reaction. For adverse reactions it is my expectation that you contact me to request a substitute. If you have a lot of allergies and food intolerances like I do that is not the problem and sometimes it is helpful information to know if you are not responding well to a specific herb or supplement. Otherwise the herbs don’t work when they are sitting in a bottle and I need patients to stop giving me excuses and start giving me the real reasons they are not taking care of themselves. For many it is a lack of self love and we cannot heal a body that you hate. If you are not capable of making healthy food decisions and taking supplements I recommend you work with a counselor or therapist first to determine why you don't love yourself, before signing up to work with me. Otherwise I simply cannot help you and I do take pride in my work and providing each patient with a successful outcome. When you hire me to help you, I am on your team. But I cannot be the only person on the team doing the work. Health is actually a four letter word...its called WORK and never shall the doctor be working harder on the patient than the patient is working. Please get out of your funk and choose to fight for your health back like Kathy Bates in "Fried Green Tomatoes," I need you determined and sick of feeling sick to get better.
  1. If you are too sick to follow the diet and supplement plan I put together for your pain, or you don’t have a caregiver to implement it for you, then I cannot help you. Please know, I am permanently physically disabled. I can realistically only work part time in the office as a result of it.  Many people with my same physical disability don’t work at all but I am a busy body and cannot just sit at home and do nothing. I need to do something productive with myself and when I can use what I have learned from my own suffering to save another patient, to intervene BEFORE they have permanent damage like I do…. Then that gives me the sense of purpose I need to feel happy and not depressed about being physically disabled. I need you to get better for me. If you don't want to do it for you, at least do it for me, because I know my methods work. They just don't work when the patient does not do them.
  2.  Something else to think about...if you feel you are too depressed or too sick to follow my instructions, the brutal truth is, I won’t be able to help you at all, and you'll just waste your time and money signing up with me. 
  3. Are you coachable and friendly? Please be kind when you interact with me and my small office as I am simply not able to tolerate patients that are rude or verbally abusive to my employees or myself. When I worked as a nurse the doctor’s I worked for did not care if the patients screamed at me or grabbed me or treated me inappropriately. Now that I am the boss I do not tolerate abusive patients like this. I know it is hard to be in a good mood when you are in pain which is why I will only work with patients that can be respectful to my own mental and physical health needs. In a small office when you yell at my assistant you are also yelling at me because I have to hear about it….then I just fire you and you have wasted your money because I will not tolerate unacceptable behavior. If your caregiver or family member yells at me or my staff that will be the end of our relationship. I have dilligently put on my scrubs to kindly serve patients with a smile on my face since 1999. I expect and deserve respect for showing up to a tough job for that many years, especially while disabled, as does every other health care worker with a care giver’s heart. When I don’t like you I cannot pour my blood sweat and tears in to your case and you likely will not receive a good result. 
  4. Patients that are unable to pay me for my time. I know the last thing I ever want to do is pay my dentist, but I do need to be compensated for my time and I believe my pricing is affordable and very fair for the amount of time you receive, my level of expertise and training. I have actually been told by multiple other Naturopathic doctors that are also my patients that for my level of expertise I should be charging double what you see on my fee schedule. But I prefer to always stay busy helping people and deliver a reliable service at an affordable price.  Please do not sign up to work for me if you expect me to feel sorry for you and take you on as a "Charity Case" after one appointment. I am already physically disabled and therefore a "Charity Case" myself. The Charity Case cannot take on any Charity Cases in her free time. I am also a single Mom so the time that I am working is time that is taken away from my child. I would rather just be at home with my child then working for people for free.  Therefore if you do not have a few hundred dollars to compensate me for the generous amount of time and attention I provide at each individualized appointment,  I do not want you to sign up to work with me as I do not expect anyone to work for me for free and I only want to work with people that are respectful, have integrity and also always expect to pay their service providers. I have met one too many entitled spoiled brats for one life time and have zero tolerance for this. Too many times I have been burned badly by dishonest patients saying they cannot afford to pay me only to see them at fine dining or off to a cruise the following month. I believe my fees are very reasonable and fair and that you are investing in a long term solution to your pain. You are paying me for a process that you must go through and not a prescription. This will require you to pay for 3-6 appointments for the average chronic pain patient. Please determine first before you sign up to work with me if this is something you can afford.
  5. If you are not mentally capable of following complex instructions then Naturopathic medicine is generally very difficult for both the patient and the doctor. The majority of my patients take their treatment plan and run with it, if you struggle with directions on how to make a tea or how to track your macronutrients on an app then this may simply be too complicated for you. While I see these things as simple and easy, I understand that some patients are truly so sick that they cannot follow basic instructions. At one point I was so sick I could not fill out my own paperwork and I would have needed to have my Mom do this for me, so I get that, but someone HAS to do it and not waste a ton of my time asking me the same question five times a day. There is nothing more frustrating for me to have to clarify my instructions repeatedly to the same patient. This is not a healthy doctor patient relationship I will be able to tolerate. If you cannot appoint a friend or family member to ensure you are correctly facilitating your naturopathic plan please do not sign up to work with me. 

WHAT PATIENTS ARE THE MOST SUCCESSFUL WORKING WITH THE HOLISTIC PAIN SPECIALIST? 

  1. My #1 most successful naturopathic pain patients show up to learn with a pad of paper and pen and are actively taking notes and writing down the things I say. These patients always get better because they are showing up as my student. Every master was once a disaster and I am now the master that helps your disaster. These patients want to learn everything I know about hormones, naturopathy,  and pain.  They are the kind of patients that help me help them,  and they want to make sure they understand all of my different instructions. They pay precise attention to the time of day or the time in their menstrual cycle that they should have their hormones tested and ensure the testing is done properly and while on consistent dosing of their hormones without any lapses. Please keep in mind I am NOT some narcissist that enjoys having people follow them around with a pad of paper and pen but when I see patients doing this I can tell they are taking their chronic pain treatment very seriously and even though I type each patient a written instruction plan I think taking your own notes helps you remember and learn your new way of taking care of this broken body that is sick and in pain. When I meet a new patient like this... they always get better!
  2. Patients that are able to follow up monthly until they are better usually have the most successful outcomes. I will usually need to see you for a first appointment to order labs, then a follow up appointment a month later to go over the labs. Then we will meet either monthly or quarterly thereafter. My most successful patients are able to afford to do this financially and also with their time. If your job or life is too busy to dedicate to calling in to my office once a month for a telemed visit then you will not be my next success story as we will need to constantly fine tune your plan until your symptoms have resolved or you are at least as improved as we can expect you can be despite an autoimmune condition, painful joint, surgery disaster, motor vehicle accident, or so forth. 
  3. Patients that truly enjoy using herbal medicines as teas and foods are always my best most successful patients. I prefer to avoid the use of relying on capsules by teaching you how to incorporate herbs in to your drinks, smoothies and foods. I am doing a "Happy Dance" when I hear you like the tea recipe I gave you and that you are doing it regularly because we are saving you money using bulk herbs and you aren't relying on a bunch of expensive capsules.
  4. Patients that are willing to change their diet to whatever I say they need to eat will always be a success. I understand some people struggle to make changes and need to do so in steps… I am that type of patient myself but in order to truly be successful you have to trust that I know what I am talking about after working for chronic pain patients and being one myself for fifteen years. I know exactly what works best, and I know what absolutely does not work. I am also looking for what specific foods triggers that flare your pain and sometimes they are your favorite foods and sometimes they are foods you think you should be eating to be healthy that are making you worse. I don't make the rules I just teach you how to follow them.

To learn more about my Naturopathic process treating pain, inflammation, and hormones you are invited to watch my free presentation, “Metabolism, Hormones & Pain” on my Free Class page. There is no charge to watch the presentation and the purpose of it is to educate you on the exact simple three-step Naturopathic Process I have used to help hundreds of women achieve relief from their chronic pain. If you already KNOW that I am the right doctor for you and that you are the PERFECT Naturopathic Patient then simply pop on over to my SCHEDULE page and treat yourself to a Naturopathic Consult immediately. We need to get to work on you before you have permanent damage to your body like I have. I found out my diagnosis ten years too late. I could have had answers sooner. I don't ever want anyone to suffer like I did when I just didn't have the right testing done. I was frustrated, my parents were frustrated and we simply lacked the proper blueprint to follow that could have saved me years of misery.

I am able to help you in my clinic and by telemedicine phone consultation. If you do not live in Arizona I can still help relieve your pain by doing the detective process work of diagnosing your pain, I simply cannot prescribe medications for you if you live out of state. Many Family Doctors and Pain Doctors are happy to work with me remotely in the event you need hormones or medications so if you do not live in the Phoenix area but have a supportive doctor that is open to Naturopathy we can still work together to help you feel better with your Chronic Pain, Fibromyalgia or Autoimmune Disease. Did you know I have patients in ALL 50 states? A lot of what I do is easy to help you with via telemedicine!

I look forward to helping you get back on track and feeling awesome again!

Dr. Nicole Sundene, NMD

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for MenopauseThyroid, HashimotosPMS, PerimenopauseAutoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

Dr. Nicole Sundene

Female Hormone Specialist

Nasturtium flowers are an edible, powerful, delicious "food as medicine" natural remedy for Women's Health and Hormones! Did you know the Nasturtium is actually part of the cabbage family and therefore has many similar magical powers along with a few of its own?

Today we will discuss the latest Nasturtium research I didn't even know about in the works such as potentially benefiting pulmonary fibrosis and lung damage!

I love to decorate my food with fresh edible flowers because it makes it indulgent and pretty without the calories. The best thing about nasturtiums is they grow easily on a drip line, need little maintenance, and look indulgent so your inner child will be happy eating less junk food and more pretty flowers!

Whenever I feel blah and tired I love to pick some fresh nasturtium flowers and leaves and eat them for an instant energy boost. 

The rich orange pigment in the flowers and greens has a mild peppery flavor that pairs well with most salads and dinner dishes or serves as beautiful edible decor to make teas, drinks, and desserts fun and beautiful.  Indulging in beautiful flowers is healthy and disease and inflammation reducing per my recent research we will discuss today. 

Nasturtium is not only nutritious food but a rich source of glucosinolates which become the estrogen-lowering molecule sulforaphane once chewed. Eating as many plants as possible that reduce estrogen is important for women with estrogen-dominant conditions such as PMS, PCOS, Hashimoto's, Thyroid disease, and Perimenopause. 

Herbalists have traditionally used Nasturtium officinale or “watercress” as we commonly know it to treat high blood pressure, diabetes, liver detox, and kidney disease. 

The research studies below demonstrate that nasturtium is a cruciferous vegetable with potent antioxidant and anti-inflammatory benefits similar to the rest of the cabbage family. The phenylpropanoids are most concentrated in the flowers, second to the leaves, and least in the stems. 

No wonder I always feel so amazing when I eat some fresh nasturtium flowers as their magical healing components are in a higher concentration in the flowers, although the leaves are delicious in salads and an easy green leafy veggie to grow!

The anti-inflammatory benefits of nasturtium are shown to be beneficial when applied topically and taken internally. 

Nasturtium contains flavonoids, anthocyanins, glutathione, SOD (super oxide dismutase), and isoflavones that are also helpful for women against breast cancer, weight loss, chronic bladder problems, and anti-aging.

Scientists are currently studying how some of the properties of Nasturtium may have neuroprotective and anti-inflammatory properties that are specifically helpful to the nervous system and brain. The antioxidant properties in nasturtiums may be protective towards the liver and helpful against decreasing high LDL or “bad cholesterol” that causes heart disease as well as helpful for reducing post exercise induced inflammation in athletes. 

Preliminary studies show the antioxidants in nasturtium improved collagen deposits in the lung condition pulmonary fibrosis, and while more studies are warranted to understand the mechanism and dosing it is generally a safe and harmless “food as medicine,” for patients with pulmonary fibrosis. Since many efficacious treatments are lacking for pulmonary fibrosis this warrants a full randomized control trial to determine dose, safety, and efficacy. 

Patients that are physically disabled benefited from taking nasturtium in a research study and consumption resulted in fewer markers of inflammation including oxidative stress and c-reactive protein. Therefore nasturtium may also be beneficial for chronic pain via blocking COX pathways and demonstrates also antimicrobial properties against gram-positive bacteria in vitro.  The isothiocyanates in nasturtium have been shown to be beneficial against UTI- Urinary Track Infections. 

Nasturtium was found to be protective against gentamycin induced kidney damage and may have a future role in how we treat cancer patients undergoing chemotherapy. 

While cancer patients and kidney patients deserve more research on nasturtium to understand the most efficacious dose, since nasturtium is essentially a food it should be fine to add more to the diet but as with any new herbal medicine always check with your Naturopathic Doctor!

If you need my help with your nutrition, hormones, women's health, or any of the aforementioned conditions simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit.  

Dr. Nicole Sundene

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause,  Thyroid,  Hashimotos,  PMS, PerimenopauseAutoimmunePostpartumChronic Fatigue, DepressionAnxiety, Food Allergies,  DigestionDermatology, AcnePsoriasis Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. 

She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!

References: 

  1. Clemente M, Miguel MD, Felipe KB, Gribner C, F Moura P, R Rigoni AA, B Parisotto E, T Piltz M, Valdameri G, Henneberg R, B Schonhofen C, S Carvalho JL, Fernandes LC, G Miguel O. Biomarkers of oxidative stress and inflammation in people witha physical disability treated with a standardized extract of Nasturtium officinale: A randomized, double-blind, and placebo-controlled trial. Phytother Res. 2020 Oct;34(10):2756-2765. doi: 10.1002/ptr.6718. Epub 2020 Jun 8. PMID: 32510696.
  2. Clemente M, Miguel MD, Felipe KB, Gribner C, Moura PF, Rigoni AAR, Parisotto EB, Henneberg R, Dias JFG, Piltz MT, Clemente EF, Schonhofen CB, Carvalho JLS, Fernandes LC, Miguel OG. Effect of watercress extract supplementation on lipid profile and oxidative stress markers in overweight people with physical disability: A randomized, double-blind, and placebo-controlled trial. Phytother Res. 2021 Apr;35(4):2211-2219. doi: 10.1002/ptr.6979. Epub 2021 Jan 28. PMID: 33507592.
  3. Shokraei S, Khandouzi N, Sina Z, Nasrollahzadeh J. The acute effect of incorporating lettuce or watercress into a moderately high-fat meal on postprandial lipid, glycemic response, and plasma inflammatory cytokines in healthy young men: a randomized crossover trial. Lipids Health Dis. 2021 Jul 15;20(1):66. doi: 10.1186/s12944-021-01487-9. PMID: 34261489; PMCID: PMC8281573.
  4. Fogarty MC, Hughes CM, Burke G, Brown JC, Davison GW. Acute and chronic watercress supplementation attenuates exercise-induced peripheral mononuclear cell DNA damage and lipid peroxidation. Br J Nutr. 2013 Jan 28;109(2):293-301. doi: 10.1017/S0007114512000992. Epub 2012 Apr 5. PMID: 22475430.
  5. Jakubczyk K, Janda K, Watychowicz K, Łukasiak J, Wolska J. Garden nasturtium (Tropaeolum majus L.) - a source of mineral elements and bioactive compounds. Rocz Panstw Zakl Hig. 2018;69(2):119-126. PMID: 29766690.
  6. Klimek-Szczykutowicz M, Szopa A, Ekiert H. Chemical composition, traditional and professional use in medicine, application in environmental protection, position in food and cosmetics industries, and biotechnological studies of Nasturtium officinale (watercress) - a review. Fitoterapia. 2018 Sep;129:283-292. doi: 10.1016/j.fitote.2018.05.031. Epub 2018 May 28. PMID: 29852261.
  7. Camponogara C, Silva CR, Brusco I, Piana M, Faccin H, de Carvalho LM, Schuch A, Trevisan G, Oliveira SM. Nasturtium officinale R. Br. effectively reduces the skin inflammation induced by croton oil via glucocorticoid receptor-dependent and NF-κB pathways without causing toxicological effects in mice. J Ethnopharmacol. 2019 Jan 30;229:190-204. doi: 10.1016/j.jep.2018.10.011. Epub 2018 Oct 17. PMID: 30339978.
  8. Tran HT, Márton MR, Herz C, Maul R, Baldermann S, Schreiner M, Lamy E. Nasturtium (Indian cress, Tropaeolum majus nanum) dually blocks the COX and LOX pathway in primary human immune cells. Phytomedicine. 2016 Jun 1;23(6):611-20. doi: 10.1016/j.phymed.2016.02.025. Epub 2016 Mar 18. PMID: 27161402.
  9. Clemente M, Miguel MD, Felipe KB, Gribner C, F Moura P, R Rigoni AA, B Parisotto E, T Piltz M, Valdameri G, Henneberg R, B Schonhofen C, S Carvalho JL, Fernandes LC, G Miguel O. Biomarkers of oxidative stress and inflammation in people witha physical disability treated with a standardized extract of Nasturtium officinale: A randomized, double-blind, and placebo-controlled trial. Phytother Res. 2020 Oct;34(10):2756-2765. doi: 10.1002/ptr.6718. Epub 2020 Jun 8. PMID: 32510696.
  10. Clemente M, Miguel MD, Felipe KB, Gribner C, Moura PF, Rigoni AAR, Parisotto EB, Henneberg R, Dias JFG, Piltz MT, Clemente EF, Schonhofen CB, Carvalho JLS, Fernandes LC, Miguel OG. Effect of watercress extract supplementation on lipid profile and oxidative stress markers in overweight people with physical disability: A randomized, double-blind, and placebo-controlled trial. Phytother Res. 2021 Apr;35(4):2211-2219. doi: 10.1002/ptr.6979. Epub 2021 Jan 28. PMID: 33507592.
  11. Fogarty MC, Hughes CM, Burke G, Brown JC, Davison GW. Acute and chronic watercress supplementation attenuates exercise-induced peripheral mononuclear cell DNA damage and lipid peroxidation. Br J Nutr. 2013 Jan 28;109(2):293-301. doi: 10.1017/S0007114512000992. Epub 2012 Apr 5. PMID: 22475430.
  12. Freitas E, Aires A, de Santos Rosa EA, Saavedra MJ. Antibacterial activity and synergistic effect between watercress extracts, 2-phenylethyl isothiocyanate and antibiotics against 11 isolates of Escherichia coli from clinical and animal source. Lett Appl Microbiol. 2013 Oct;57(4):266-73. doi: 10.1111/lam.12105. Epub 2013 Jun 20. PMID: 23682789.

By Dr. Nicole Sundene

Hashimotos Thyroid Specialist

Depression caused by thyroid disease such as Hypothyroidism and Hashimotos Thyroiditis feels like a dead plant in need of water. Often patients will feel flat, blah, lifeless and disinterested in participating in activities when their thyroid level is low.  Many patients are also experiencing extreme emotional symptoms while their levels are hovering at the bottom of the normal range. More often than not this chronic thyroid deficiency is going on despite being told  their thyroid level is normal. T3 the most active thyroid hormone helps the brain make serotonin. When the thyroid is deficient less serotonin is made. This is why patients with hormonally triggered depression do not improve as expected on antidepressants.

TSH is generally the only test conducted by their doctor to evaluate it. TSH is only accurate 1 in 5 times at diagnosing hypothyroidism. Free T3 and Free T4 levels should always be checked when we suspect a thyroid problem. Just checking TSH is “90’s Medicine” in my opinion that should be stopped. I would never measure just measure your FSH to try to understand your estrogen levels. I would simply check your actual estrogen levels. FSH is also a message the brain is sending down in a feedback loop with estrogen and is elevated in severe states of estrogen deficiency such as menopause. Yet time and time again patients ask for their thyroid to be checked and it is only a TSH checked which tells us only about what your brain is telling your thyroid to do for it and tells us very little about how much hormone your thyroid is or isn’t making.

Depression or anxiety coupled with thyroid symptoms such as fatigue, weight gain, swelling, cold intolerance, constipation, dry skin, hair loss, arthritis and joint pain should be worked up by a doctor that specializes in hormones. Doctors that specialize in fine tuning hormones can help you understand the complex web of hormones and ensure each hormone pathway is optimal and not just “In the normal range.”

I have heard this TSH story nearly every single day of my career for the past 13 years! Let's put an end to the mental health problems caused by hormone imbalance. There are enough depressing things going on right now and we don’t need hormone imbalance causing moodiness.

Please share this important message on Thyroid Depression as many patients are silently suffering and don’t know why they do not respond to the typical antidepressants.

If you need help with your hormones I am always happy to help. Simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit!

Dr. Nicole Sundene

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

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