By Dr. Nicole Sundene

Female Hormone Specialist

Semaglutide is the newest “Naturopathic” weight loss fad I am already sick of talking about because it is not natural and it is not Naturopathic. So I basically wrote this blog so that when patients with just 5-15 pounds to lose ask me if they should try Ozempic for weight loss, I can just text them: “NO!” with a link to my research that concludes we should take a “wait and see” approach unless it is for severe obesity.

Let’s review the current existing research and separate the facts from all the false marketing materials I am seeing my patients bring me about the shot. Much of what these weight loss centers, even the Naturopathic ones, are stating about this shot is grossly untrue. 


Semaglutide also known as Ozempic, Rybelsus, and Wegovy became approved in 2021 for obesity. These weekly shots or pills are  currently hitting every weight loss center near me, along with their marketing materials to my patients that are only 5-30 pounds overweight and are reading marketing materials that they are “natural” “thyroid boosting” “immune boosting” and “good for them.” So my “Norwegian Rant” today includes all the latest research on the safety and efficacy of these drugs to burst the Utopian bubble with the realities that the new “Skinny Shot” has REAL safety issues and potential long term consequences women should be educated on before remotely considering. 

The take home message if you don’t want to read my entire rant about semaglutide injections for weight loss is to wait and see unless you are severely obese and have tried everything natural with me including testing your hormones, balancing your hormones, improving your nutrition, counseling , exercise, and stress management


If you need the program I specifically designed to help balance female hormones, insulin, and weight naturally with herbal medicine and nutrition simply pick up my PGE-2 Diet program.  I should of course first disclose that I have my own hormone program and I think is much better for you and safer than taking a weekly diabetes shot before we get started.

I must also admit that I never participate in fads because I am a classic Bastyr trained Naturopathic Doctor and prefer to treat my patients at their “Root Cause.”  So let's go over this weight loss shot together and look at the pro’s and cons. 


I believe the safest option is to first do everything correctly to avoid taking weight loss medication. But that is just how I think and practice medicine and always use natural alternatives and herbal medicine before prescription drugs. 

I also must be honest and confess that I do sincerely believe that whether you are going to do semaglutide shot or not you will need my program. My patients following my program on the shot are doing really well and I am seeing their insulin numbers come down over time with their weight to the point they are planning to taper off the shots and use my hormone program for maintenance. 


Otherwise the most clear cut side effect is dependency with semaglutide. We may never be able to get you off the shot if you do not adhere to a proper clean Naturopathic nutrition and exercise program. 


YES! Anything that stimulates receptors in the hormone system will somewhat “mess up” hormones. Here is what you need to know to protect yourself from the latest marketing nonsense about a new drug with a fresh black box warning for thyroid cancer. 

Is it worth risking thyroid and hormone health as well as the other potential side effects of semaglutide medications? Let's separate the facts from the fiction so that women are fully informed up front of the potential side effects and risks of becoming dependent upon semaglutide therapy for the rest of their lives. 


Semaglutide is a synthetic peptide drug that is manufactured in a lab. Semaglutide is made of amino acids and is a man made chemical that is NOT natural in my opinion as it has two different amino acid changes from the actual natural or endogenous form and only mimics it by 94%. So anyone purporting that semaglutide is “natural” or calling it a “natural peptide” is either intentionally lying or very stupid when it comes to biochemistry. Most likely they making fraudulent claims which is morally and legally wrong. 

First off, calling semaglutide “natural” is like calling the thyroid hormone synthroid or levothyroxine “Natural” when it is chemically manufactured. Nor is synthroid derived from a “Natural source” so calling such a medication natural is a false statement and biochemical FRAUD. The synthetic thyroid hormone from the pharmacy does not come from a natural source like Armour thyroid, but instead comes from synthetic manufacturing. Synthetic manufacturing is also the case with semaglutide and thus is not actually “natural peptides.”

Semiglutide only mimics natural human GLP-1 by 94% and is not the same exact “natural peptide.” This is an annoying false claim that is inaccurate and misleading for women. I have zero respect for any Naturopathic Doctors that are purporting this as a “Natural Peptide” or “Natural and Safe” weight loss system. There are risks, we don’t know the long term consequences beyond a few years, and it's not 100% natural. So please consider these factors before deciding to shoot up with Semaglutide!

My gravest concern aside from cancer is the autoimmune research I found that we will discuss below. The fact that some patients are making antibodies to semaglutide and their own natural GLP-1 after receiving the shot is concerning and may result in some new form of an autoimmune disease at some point that doctors have never seen before. As a doctor with chronic pain from an autoimmune disease, I find this gravely concerning, because once the antibodies form, it is difficult to get them to stop. I know this very well because this is what many autoimmune patients seek me out to help with and it can take a solid 6-12 months to get Hashimoto's antibodies down if not longer.


Any Naturopathic Doctor, Endocrinologist,  or Weight Loss Clinic falsely labeling their semaglutide weight loss shot as “Natural” or “Natural peptides” should have their license revoked for either being stupid or a scam artist. Patients are not medically trained to know the difference between natural and synthetic man made chemicals. This is the #1 sign you are being lied to by an unethical doctor that is desperate for money and now hopping on the Semaglutide Gravy Train. 

Sorry if I sound rude but I am disgusted by the utter lack of ethics from some of the people in the medical industry that are capitalizing on something they have falsely led consumers to believe is natural. It only takes a few bad Naturopathic Doctors to make our entire profession look horrible to MD’s and the public. If someone wants to offer the shot to patients that is their professional choice, but they should at least be honest about the ingredients and side effects. 


Since early 2022 women are calling me, texting me and asking me daily thanks to misleading marketing scams in my profession about the latest weight loss shot or “Skinny Shot” semaglutide, or Ozempic I felt compelled to post the research of the “Other side” of the shot like Ozempic Face, Rebound Weight Gain, Dependency, Gallbladder Disease, Thyroid Cancer, Diabetic Retinopathy, Immune Response, Autoimmunity to endogenous GLP-1, Nausea, Vomiting, Diarrhea, GI Adverse side effects, loss of lean muscle, appetite control, eating behavior changes, intestinal obstruction, serious allergic reaction, anaphylaxis, increased heart rate, increased hospitalization for heart failure, potential kidney failure, unknown long term cardiac risk from stimulating the GLP-1 receptors in the heart and increasing heart rate over the long term, rats given semaglutide had increased thyroid and endocrine system cancer [1-13]. 

For most of my patients that is all they need to read and know that in my mind it’s a solid NO for the big O shot. For everyone else that wants to dig through these research studies that currently exist both bad and good I will break down each research study demonstrating side effects in detail. If you are going to choose to use semaglutide at least be properly informed and not a victim of marketing hype that is not true or supported by research, data, and facts we currently are lacking. 


Any patient that knows me well knows I hate most medications, especially all new medications. This is because I have been working in Family Medicine for over twenty five years on both the prescription and natural side and I have seen all the shiny new drugs that were once regularly used by patients recalled. I have also seen bad side effects from drugs, that I have never seen with herbal medicine and nutrition in Naturopathy. 

But dozens of times in my career have I sat at a “Drug Rep Lunch” with a fancy shiny new drug that sounds too good to be true, only for the FDA to recall it, or the company to recall it themselves just a few years later. 

I can go on and on about watching Vioxx, Accutane, Fen Phen, Baycal, Bextra, Premarin, Prempro, Zantac/Ranitidine, come and go but we will focus on semaglutide today.

Doctors that have been around a while are generally less Utopian about a new drug and instead a bit skeptical of anything new, as we should be. Patient safety should always come first, and doctor’s have taken an oath to “First, Do No Harm.”

So the truth about semaglutide at this point, is that if you are taking a new drug that has not been tested long term, you have essentially signed yourself up as a “Test Bunny” for the drug as nobody really knows its long term effects until the Test Bunny group of people all try it for twenty years. This is why many new drugs do not survive the five year mark because they are shown to cause serious adverse side effects within a few years. 

So we cannot just get sucked into the marketing as women, and we do not need to have unrealistic expectations of our perimenopausal and menopausal bodies and risk a potentially dangerous shot just to lose 5-10 pounds.  

 So today I will discuss the questions patients are most frequently asking about the weight loss shot semaglutide, what you should know about it’s risks and potential benefits. 

Ok #1 as a Naturopathic Doctor that has been around since Herbal Phen Fen, regular Phen Fen, the HCG diet, the HGH diet, Keto Diet, Celery Juice, etc…. I must disclose up front that I never participated in any of those other weight loss programs as I see them as scams, and not in a woman’s best interest for her long term health. 

I will admit I do have many patients on this weight loss shot right now, and they are doing it against my advice and we have just agreed to disagree about it. The one positive thing I do actually see happening to consider is that it does reduce hunger and cravings. A lot of my patients are using the appetite suppressant effect along with my hormone balancing diet program, The PGE-2 Diet ® knowing that the recipes are all designed to balance the female hormones and insulin resistance that naturally occurs with aging induced hormone imbalance in women. 

This way when we do finally decide to take the semaglutide shot away they are eating in a manner that is continuing to balance their hormones and are already on a system that they can sustain to prevent the rebound weight gain that is the main concern I have for many of my patients that are severely overweight.

I worry my obese patiuents cannot afford to gain more weight back after they discontinue the shot, and the research studies indicate that discontinuing the shot may be the problem. Once you start the shot you may not be able to stop, you may end up twice as overweight as you started if you do stop the shot. 


Getting people hooked on drugs for free is the ultimate drug dealer scam. So are the first month of semaglutide shots really “free?” If the shot is something you may have to be dependent on for the rest of your life to maintain your weight, it is a bait and switch scheme. 

This is the #1 bait and switch game that drug manufacturers play to get patients hooked on their medication, so they are stuck paying for it for the rest of their lives. At this point we don’t know how long you will need to take the semaglutide shot for, in order to maintain weight loss.  Since most research studies are conducted for two years this is not a quick fix but something you may need to pay >$1000.month for two years or longer! The problem is that most research finds discontinuing the shot results in going back to being obese [13]. You may need to afford to stay on this medication for two years or even longer [14-17]. 

If you are rich and famous and can afford to potentially be addicted to a shot for $1000/month then that is one thing. Most of my patients cannot afford that risk financially. In a New England Journal of Medicine 2021 research study, semaglutide was found to be the inferior choice for doctors to combine with metformin in diabetes, which makes me wonder if some of this new weight loss shot push is because the manufacturer is losing out on diabetes business they once had. 

Before starting this shot ask yourself if it is affordable for you to continue paying for it weekly for the rest of your life. If you can afford to be twice as overweight as you are right now should you experience “Rebound Weight Gain,” and if you can afford to risk the side effects that potentially include cancer


Semaglutide is being misrepresented in a very clever biochemical way by weight loss centers. First of all they are categorizing the benefits of all peptides into one entire group of benefits. We cannot just refer to “peptides” or “natural peptides” as just one thing. Peptides can be natural or synthetic and are represented by many different drugs. 

This is like me stating the benefit of all herbal medicines that have ever existed and say these benefits are for nettles. Just because nettles are an herbal medicine and other herbal medicines also have benefits does not mean that nettles share that same benefit for being in the same descriptive category. 

Peptides are a description of a type of medication or a class of medications doctors refer to as “Peptide Therapy.” 

Peptides are a category of drugs made from amino acids designed to treat MANY different conditions like Diabetes and  Multiple Sclerosis. Stating the benefits of all of these peptides as a whole when stating the benefit of using just one form of a peptide is fraudulent marketing and is happening at weight loss centers everywhere. Most women are not educated enough to understand they are being lied to.

While it is one thing for a weight loss center to honestly offer this shot, inform people it is synthetically manufactured and has a black box cancer warning with it but may be the only solution to stubborn weight loss… 

What truly disturbs me as a Naturopathic Doctor are the other Naturopathic weight loss clinics that are upright lying to women and telling them these are “Natural peptides” or “peptide therapy” that is “good for their thyroid and heart” when there is a clear black box warning for thyroid cancer, and demonstrated research I will discuss that causes an increased heart rate and potential increased risk for heart failure. 

Currently nobody knows the actual long term side effects of using semaglutide. So anyone purporting it as the safe and natural is crazy in my medical opinion. 

Any doctor or clinic that says semaglutide is “natural” and “good for you” and acting like they actually know what is going to happen to you twenty years from now from taking weekly semaglutide shots is a liar, and clearly lacking good ethics. 


Semaglutide is merely mimicking just ONE TYPE of peptide that occurs in the body. Many doctors and weight loss centers are using the word “Natural Peptide” incorrectly to mislead the patient into falling victim that this is 100% natural and safe. This is a chemically manufactured medication that does contain natural amino acids but they are manufactured in a lab into a protein sequence that is not “natural.” 

This is NOT like how we give women bioidentical hormones from yams or soy. This is not manufactured as the exact same chemical your body naturally makes. Semaglutide is only 94% similar to the natural form. I believe doctors using the word “Natural” for semaglutide products are making false statements and misleading patients. 


Whether you have chosen to avoid semaglutide or are choosing to go against my advice and do it anyway, I do recommend to my patients on the injections that they follow my PGE-2 Diet designed to help balance female hormones, insulin resistance, and weight gain. By eating my PGE-2 Diet you can lose weight without an expensive weekly injection and avoid its inevitable side effects. For those on the injections they need a solid nutrition program in place or they will not be able to ever stop the shot, and will likely have the same “Rebound Weight Gain” that I had to deal with when patients stopped their HCG Diets that I also told them not to lose and then we had to work to help them lose eighty pounds instead of forty. 

So this is why I approach this new shot with dread because ultimately patients may end up in the same metabolic mess after using HCG and diets that are too restrictive in calories!


Moral of the story. You cannot cheat the system. When you try to cheat the system and lose weight without a solid nutrition plan in place, you will fail and either gain double the weight back, or never be able to stop the semaglutide injections and need to pay for them for the rest of your life. For a drug that has only been approved since 2017 we are already seeing gallbladder disease and cancer as potential consequences. The majority of diabetes drugs already have class action lawsuits related to cancer, so before I even looked at the existing research on semaglutide I knew that it would have cancer listed as a potential side effect. 


The safer, more cost effective alternative to being an unpaid Lab Test Bunny for Semaglutide shots is using proper nutrition and herbal medicine for weight loss and hormone balancing. My PGE-2 Program has helped many women achieve hormone balance and optimal weight in my practice and I trust it works when patients properly follow it. Whether you are going to choose to risk it and try the shot or not, my program will help you achieve success and you will need a hormone balancing program that targets insulin like the shot in place in order to withdraw from the semaglutide shot without the risk of rebound weight gain. 

So I do have a handful of obese patients using the shot with my program and planning to taper off the shot towards just my program. I do hear that it is easier for them to adhere to the program because they have less hunger and cravings. So I am going to state the positive about the shot without overinflating it.


Proper nutrition and herbal medicine is the better natural alternative to risking dependency on semaglutide injections.  I truly believe my PGE-2 Diet program is a safer, better, anti-aging option that has me looking and feeling my best at forty-seven. You can watch my weight loss journey on my FREE CLASS page in my “Metabolism and Hormones” class. 

My journey involves struggling with postpartum depression, anxiety, weight gain from insulin resistance after the birth of my daughter. So I have been through it and know exactly how to test and treat hormonal weight gain. 

The best part about my PGE-2 Diet hormone program is the majority of my patients say it is super easy to follow, they are saving money on the recipes, they enjoy eating clean, and they look and feel amazing! Investing in nutrition is always the better alternative than prescription drugs. To follow my simple Mind/Body/Spirit Naturopathic program and improve your health and weight via nutrition and herbal medicine. 

To pick up your program visit:

If you need my help with your female hormones, insulin resistance, or weight loss I would be happy to help you!  Simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit. For those doctors and nurses, and researchers that want to review the existing semaglutide research, we will dive deeper into the existing peptide therapy research studies. 


In clinical trials, semaglutide led to an average weight loss of approximately 15% at 68 weeks among participants without type 2 diabetes, with sustained results observed at the two-year mark. That is 15-20 pounds for the average woman. I see women in my practice losing that much weight a lot faster than over two years. Occasionally I hear my patients telling me they lost thirty pounds in just one month and all their body pain is gone on my PGE-2 Diet! So if we can use an alternative to semaglutide then we should because the weight loss may not be as dramatic as women expect. 

Especially, when the main concern with semaglutide use is the potential for dependency and affordability. In a trial extension, participants who withdrew from semaglutide treatment regained 11.6 percentage points of lost weight by week 120, resulting in a net loss of 5.6%. Cardiometabolic improvements observed with semaglutide reverted towards baseline at week 120, indicating that ongoing treatment might be necessary to maintain weight loss and health improvements [1].


Semaglutide is a newer drug that has only been FDA approved for diabetes since 2017. While semaglutide has shown promise in treating Type 2 Diabetes and obesity, there are several concerns to consider before using it for weight loss. The long-term safety of semaglutide is still uncertain, as there is no complete Phase IV clinical trial investigating its side effects, efficacy, and safety in the long run. Until more comprehensive studies are conducted, it is advisable to avoid the risk of a new medication until the long term studies have been conducted. For mild or moderate weight loss the shot is simply ludicrous and should not be used. 


Semaglutide carries a black box warning for thyroid C-cell tumors in the US, based on rodent studies. Though medullary thyroid carcinoma (MTC) is rare, regulatory authorities require additional monitoring of MTC incidence in the US for at least 15 years, with results expected by 2035-2037. Semaglutide is contraindicated in patients with a personal or family history of MTC and patients with multiple endocrine neoplasias (MEN) type 2 in the US [2].


In the SUSTAIN-6 trial, an increase in diabetic retinopathy complications (DRP) were reported for semaglutide compared to placebo. In PIONEER 6, unadjudicated diabetic retinopathy complications occurred in 5.8% of oral semaglutide-treated and 4.8% of placebo-treated patients [2]. 

Early worsening of pre-existing diabetic retinopathy complications was secondary to the initial and rapid improvement in glycemic control in SUSTAIN-6. A large trial is ongoing (FOCUS trial, NCT03811561) assessing the long-term effects of semaglutide on diabetic retinopathy complications in patients with Type 2 Diabetes. Until then, caution should be exercised when using semaglutide in patients with diabetic retinopathy complications [2].


Semaglutide can trigger an immune response, leading to the production of antibodies against the drug. In some cases, these antibodies may cross-react with endogenous GLP-1. Clinical trials revealed that 2.9% of patients treated with Wegovy, a semaglutide formulation, developed anti-semaglutide antibodies. Among these patients, 56% had antibodies that cross-reacted with endogenous GLP-1. The impact of anti-semaglutide antibodies on treatment efficacy and hypersensitivity reactions remains unknown and may potentially cause a new type of brand new unknown autoimmune disease, with unpredicatble symptoms [2].


Phase 3 trials have shown that oral and subcutaneous semaglutide can cause gastrointestinal disturbances, such as nausea, vomiting, and diarrhea. Higher doses of both formulations are often associated with more frequent stomach adverse effects. A dose escalation scheme is advised, starting with a low dose. Stomach complaints with semaglutide generally occur during dose escalation in the first 8-12 weeks of treatment and wane over time. Overall, the adverse effects are mild to moderate in severity and often self-limiting [2].


Although it is unclear exactly why, the patients in the research study receiving weekly injections of semaglutide had increased adverse gallbladder events. GLP-1RA treatment, including semaglutide, has increased the risk of gallbladder events. 

In the SUSTAIN program, 1.4% of patients treated with semaglutide developed a gallbladder event, mainly cholelithiasis. In the PIONEER program, cholelithiasis occurred more often in the semaglutide-treated group (0.6% vs. 0.1% with placebo). Gallbladder events have not been linked to mortality. The cause of these gallbladder events is unclear, with several potential mechanisms being suggested [2, 3].


Another concern is the potential loss of lean muscle mass in patients experiencing more than 15% weight loss with semaglutide. This issue can arise when patients consume too few calories to maintain adequate protein intake, leading to muscle loss. This is why Ozempic face happens, and skin can look droopy, losing it's elasticity as is common with menopause and hormone imbalance such as hypothyroidism.


Individuals taking semaglutide may observe a decrease in facial fullness, referred to as "Ozempic face," due to rapid and significant weight loss leading to facial fat loss, looser skin, and more prominent wrinkles. Coupled by the fact that most insulin resistant weight loss patients in my practice eat a high carb low protein diet, so without correcting the protein deficiency and continuing to eat carbs their facial skin will become very saggy. At minimum take a protein shake if choosing to risk taking this drug. Especially if you are in menopause and already have lost a lot of collagen and skin turgor and elasticity from it. 

Aggressive weight loss can also result in nutrient deficiencies, muscle loss, and collagen loss, which may contribute to the appearance of facial aging [6].


Importantly, semaglutide may impact appetite control by interacting with specific brain cells and chemicals, potentially leading to changes in eating habits or food intake behavior. This alteration in the brain's appetite-regulating pathways could cause nausea or contribute to the development of eating disorders [7].


Although no cases of gastric outlet obstruction have been reported with semaglutide, healthcare providers should be aware of potential risks and monitor patients closely for symptoms. A case of a 29-year-old male with type-1 diabetes experiencing symptoms of intestinal obstruction after a single injection of semaglutide highlights this concern [8].


Clinical trials have reported mental health issues such as suicidal behavior and ideation with weight management products, including semaglutide. Healthcare providers should closely monitor patients for signs of depression, suicidal thoughts, or unusual mood changes. Semaglutide should be avoided in patients with depression, or a history of suicidal behavior and discontinued in patients who develop depressed thoughts or suicidal ideation.


Severe allergic hypersensitivity reactions, such as anaphylaxis and angioedema, have been reported in patients using semaglutide. It is advised to avoid its use in patients with a history of reactions to semaglutide and exercise caution in those with a history of reactions to other GLP-1 analogs [2]. 


SUSTAIN 6 and PIONEER 6 trials showed no signals of pancreatic adverse events with semaglutide. A meta-analysis of available cardiovascular outcome trial data argues against any effect of GLP-1RA on pancreatitis and pancreatic cancer incidence. A subtle and asymptomatic increase in plasma lipase and amylase levels is consistently found but is not associated with pancreatic events. The FDA and EMA concluded that a causal association between incretin-based drugs and pancreatitis or pancreatic cancer is inconsistent with the current data [2].


Semaglutide, like all GLP-1RAs, increases heart rate, as reported in research studies. However, it did not lead to an increase in cardiovascular outcomes. The effect of GLP-1RAs on heart rate is important in patients with heart failure. While the semaglutide cardiovascular outcome trial did not show an increased incidence of hospitalization for heart failure, studies with other GLP-1Ras, like liraglutide, in heart failure patients showed an increased incidence of serious cardiac events. The underlying mechanisms for the GLP-1RA-induced heart rate increase remain unclear [9, 10].


Initial case reports suggested that GLP-1RA treatment could cause acute kidney injury (AKI) in some patients. In the SUSTAIN program, acute kidney failure was only reported in SUSTAIN 6, where its occurrence was similar between semaglutide and placebo. In the PIONEER program, acute kidney injury occurred in 2.0% of patients treated with oral semaglutide and 2.3% of placebo-treated patients [11, 12].


For women with under 100 pounds to lose, they likely do not need semaglutide and can lose the weight with diet, hormone, and nutrition changes.  My Mind/Body/Spirit Naturopathic Weight Loss Program, The PGE-2 Diet ® works to naturally help balance female hormones, insulin, and inflammation similar to the benefits purported with the semaglutide shot. So for those of you seeking natural alternatives to semaglutide or needing a program to maintain the benefits of semaglutide without rebound weight gain please use my hormone balancing diet program. 


Semaglutide, a peptide medication, is used for the long-term management of Type 2 Diabetes and Obesity. As a glucagon-like peptide-1 (GLP-1) receptor agonist, stimulates insulin production, slows gastric emptying, extends satiety, and suppresses appetite. While semaglutide has demonstrated efficacy in managing blood glucose levels and promoting weight loss, it is crucial to be aware of its potential risks before considering its use for weight loss purposes. Semaglutide is approved for treating type 2 diabetes since 2017, and weight loss in those with a BMI >30 since 2021. 

Nevertheless women that do not have much weight to lose are seeking to use it for mild to moderate weight loss. Many clinics now are helping some of these individuals engage in off-label use of the medication for weight loss, which can potentially harm their health in exchange for a quick way to drop a few pounds, which the research studies show will just return when you stop the shot.


Semaglutide is available in both injectable and oral forms. Ozempic, the injectable form, is administered weekly via injectable pens in doses ranging from 0.5 mg to 2 mg. Rybelsus, the oral form, comes in 7 mg or 14 mg tablets and is taken daily. Wegovy, another injectable form for weight management, is administered through a weekly pen injection at a higher dose of 2.4 mg.


Semaglutide has shown promise in managing type 2 diabetes and obesity, with significant weight loss results observed in clinical trials. However, it is essential to consider the potential risks associated with its use. The long-term safety of semaglutide remains uncertain,

and there are concerns about various side effects, including gastrointestinal disturbances, gallbladder events, diabetic retinopathy complications, and potential effects on the heart and kidneys.

Given these potential risks, patients and healthcare providers must carefully weigh the benefits and risks of semaglutide treatment. It is strongly advised to consult with a medical professional before considering semaglutide for weight loss or other purposes. As more research and long-term studies become available, we will gain a clearer understanding of the safety profile of this medication. Until then, it is essential to approach semaglutide treatment cautiously and stay informed of the latest research findings.


Of course I have to recommend my PGE-2 Diet designed specifically to help balance female hormones, manage weight, insulin resistance, and inflammation through my years of research and experience helping women with hormone imbalance. Proper nutrition and herbal medicine is the tried and true, time tested way to lose weight properly, healthfully, and maintain it over the long run. 

The eight weeks of recipes, meal plans, and grocery shopping lists put together by my nutritionist will ensure you have plenty of healthy ideas to help you reach your weight loss goals. If you need my help with your hormones or weight loss, simply visit my SCHEDULE page to treat yourself to a Naturopathic Hormone Consultation.  

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 MenopauseThyroidHashimotosPMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food AllergiesDigestion, 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 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 Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!


  1. Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, Lingvay I, McGowan BM, Oral TK, Rosenstock J, Wadden TA, Wharton S, Yokote K, Kushner RF; STEP 1 Study Group. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug;24(8):1553-1564. doi: 10.1111/dom.14725. Epub 2022 May 19. PMID: 35441470; PMCID: PMC9542252. 
  2. Smits MM, Van Raalte DH. Safety of Semaglutide. Front Endocrinol (Lausanne). 2021 Jul 7;12:645563. doi: 10.3389/fendo.2021.645563. Erratum in: Front Endocrinol (Lausanne). 2021 Nov 10;12:786732. PMID: 34305810; PMCID: PMC8294388. 
  3. Committee for Medicinal Products for Human Use (CHMP) . Assessment Report “Rybelsu” (EM/95374/2020) (2020). Available at: 
  4. Alabduljabbar, K., Al-Najim, W., & le Roux, C. W. (2022). The impact once-weekly semaglutide 2.4 mg will have on clinical practice: a focus on the STEP trials. Nutrients, 14(11), 2217. Ida, S., 
  5. Kaneko, R., Imataka, K., Okubo, K., Shirakura, Y., Azuma, K., ... & Murata, K. (2021). Effects of antidiabetic drugs on muscle mass in type 2 diabetes mellitus. Current diabetes reviews, 17(3), 293-303
  6. Tay JQ. Ozempic face: A new challenge for facial plastic surgeons. J Plast Reconstr Aesthet Surg. 2023 Apr 20;81:97-98. doi: 10.1016/j.bjps.2023.04.057. Epub ahead of print. PMID: 37126934
  7. Gabery S, Salinas CG, Paulsen SJ, Ahnfelt-Rønne J, Alanentalo T, Baquero AF, Buckley ST, Farkas E, Fekete C, Frederiksen KS, Helms HCC, Jeppesen JF, John LM, Pyke C, Nøhr J, Lu TT, Polex-Wolf J, Prevot V, Raun K, Simonsen L, Sun G, Szilvásy-Szabó A, Willenbrock H, Secher A, Knudsen LB, Hogendorf WFJ. Semaglutide lowers body weight in rodents via distributed neural pathways. JCI Insight. 2020 Mar 26;5(6):e133429. 
  8. Shemies, R. S., Abdalbary, M., Nasreldin, E. K., Fouda, A. Y., Abdel-Razik, A., Alsulaimani, A. A., & Abdelsalam, M. Semaglutide Induced Gastric Outlet Obstruction: A. 
  9. Seufert, J., Nauck, M., Rosenstock, J., Hansen, T., Vrazic, H., & Vilsboll, T. (2018). P2857 Increase in pulse rate with semaglutide did not result in increased adverse cardiac events in subjects with type 2 diabetes in the SUSTAIN 6 cardiovascular outcomes trial. European Heart Journal, 39(suppl_1), ehy565-P2857. 
  10. Hozawa A, Ohkubo T, Kikuya M, Ugajin T, Yamaguchi J, Asayama K, Metoki H, Ohmori K, Hoshi H, Hashimoto J, Satoh H, Tsuji I, Imai Y. Prognostic value of home heart rate for cardiovascular mortality in the general population: the Ohasama study. Am J Hypertens. 2004 Nov;17(11 Pt 1):1005-10. doi: 10.1016/j.amjhyper.2004.06.019. PMID: 15533725.
  11. Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, Lingvay I, Rosenstock J, Seufert J, Warren ML, Woo V, Hansen O, Holst AG, Pettersson J, Vilsbøll T; SUSTAIN-6 Investigators. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016 Nov 10;375(19):1834-1844. doi: 10.1056/NEJMoa1607141. Epub 2016 Sep 15. PMID: 27633186. 
  12. Husain M, Birkenfeld AL, Donsmark M, Dungan K, Eliaschewitz FG, Franco DR, Jeppesen OK, Lingvay I, Mosenzon O, Pedersen SD, Tack CJ, Thomsen M, Vilsbøll T, Warren ML, Bain SC; PIONEER 6 Investigators. Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2019 Aug 29;381(9):841-851. doi: 10.1056/NEJMoa1901118. Epub 2019 Jun 11. PMID: 31185157. 
  13. Wilding JPH, Batterham RL, Davies M, Van Gaal LF, Kandler K, Konakli K, Lingvay I, McGowan BM, Oral TK, Rosenstock J, Wadden TA, Wharton S, Yokote K, Kushner RF; STEP 1 Study Group. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022 Aug;24(8):1553-1564. doi: 10.1111/dom.14725. Epub 2022 May 19. PMID: 35441470; PMCID: PMC9542252.
  14. Garvey WT, Batterham RL, Bhatta M, Buscemi S, Christensen LN, Frias JP, Jódar E, Kandler K, Rigas G, Wadden TA, Wharton S; STEP 5 Study Group. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat Med. 2022 Oct;28(10):2083-2091. doi: 10.1038/s41591-022-02026-4. Epub 2022 Oct 10. PMID: 36216945; PMCID: PMC9556320.
  15.  Weghuber D, Barrett T, Barrientos-Pérez M, Gies I, Hesse D, Jeppesen OK, Kelly AS, Mastrandrea LD, Sørrig R, Arslanian S; STEP TEENS Investigators. Once-Weekly Semaglutide in Adolescents with Obesity. N Engl J Med. 2022 Dec 15;387(24):2245-2257. doi: 10.1056/NEJMoa2208601. Epub 2022 Nov 2. PMID: 36322838; PMCID: PMC9997064.
  16.  Heise T, Mari A, DeVries JH, Urva S, Li J, Pratt EJ, Coskun T, Thomas MK, Mather KJ, Haupt A, Milicevic Z. Effects of subcutaneous tirzepatide versus placebo or semaglutide on pancreatic islet function and insulin sensitivity in adults with type 2 diabetes: a multicentre, randomised, double-blind, parallel-arm, phase 1 clinical trial. Lancet Diabetes Endocrinol. 2022 Jun;10(6):418-429. doi: 10.1016/S2213-8587(22)00085-7. Epub 2022 Apr 22. PMID: 35468322.
  17. Ghusn W, De la Rosa A, Sacoto D, Cifuentes L, Campos A, Feris F, Hurtado MD, Acosta A. Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity. JAMA Netw Open. 2022 Sep 1;5(9):e2231982. doi: 10.1001/jamanetworkopen.2022.31982. PMID: 36121652; PMCID: PMC9486455.
  18. Strain WD, Frenkel O, James MA, Leiter LA, Rasmussen S, Rothwell PM, Sejersten Ripa M, Truelsen TC, Husain M. Effects of Semaglutide on Stroke Subtypes in Type 2 Diabetes: Post Hoc Analysis of the Randomized SUSTAIN 6 and PIONEER 6. Stroke. 2022 Sep;53(9):2749-2757. doi: 10.1161/STROKEAHA.121.037775. Epub 2022 May 18. PMID: 35582947; PMCID: PMC9389936.
  19. Yabe D, Deenadayalan S, Horio H, Kaneto H, Jensen TB, Terauchi Y, Yamada Y, Inagaki N. Efficacy and safety of oral semaglutide in Japanese patients with type 2 diabetes: A subgroup analysis by baseline variables in the PIONEER 9 and PIONEER 10 trials. J Diabetes Investig. 2022 Jun;13(6):975-985. doi: 10.1111/jdi.13764. Epub 2022 Mar 3. PMID: 35112504; PMCID: PMC9153832.
  20.  Wharton S, Batterham RL, Bhatta M, Buscemi S, Christensen LN, Frias JP, Jódar E, Kandler K, Rigas G, Wadden TA, Garvey WT. Two-year effect of semaglutide 2.4 mg on control of eating in adults with overweight/obesity: STEP 5. Obesity (Silver Spring). 2023 Mar;31(3):703-715. doi: 10.1002/oby.23673. Epub 2023 Jan 18. PMID: 36655300.
  21. Gullaksen S, Vernstrøm L, Sørensen SS, Ringgaard S, Laustsen C, Funck KL, Poulsen PL, Laugesen E. Separate and combined effects of semaglutide and empagliflozin on kidney oxygenation and perfusion in people with type 2 diabetes: a randomised trial. Diabetologia. 2023 May;66(5):813-825. doi: 10.1007/s00125-023-05876-w. Epub 2023 Feb 6. PMID: 36746803.

Dr. Nicole Sundene

Holistic Hormone Doctor

"When I get stressed out my heart skips a beat or races. Is there an herb for that?"

~Jen H. Scottsdale, Arizona

Motherwort was at least properly named to help point moms in the right direction for their stress.

Leonarus Cardiaca or “Motherwort” is one of my favorite gentle herbs to calm fried and frazzled mothers. There is no coincidence in my mind that “motherwort” rhymes with “worrywart”.

This herb may as well have been hand-designed for worried stressed mothers. For women with High Blood Pressure, Paliptations, and chronic anxiety from little children constantly screaming "MOM!" and burning out their mom's adrenal glands.

Motherwort is typically a “nervine” or anxiety herb that is recommended for those with the kind of anxiety that results in occasional heart palpitations. If you are suffering from disturbed sleep as a result of emotional or physical stress this herb might just be right for you.

Motherwort serves to strengthen the heart, and is also used in Naturopathic Medicine for PMS and menopause. This herbal medicine can additionally be used as a preventative agent for herpes zoster (shingles and chicken pox) as well as herpes simplex (traditional “herpes”).

This herb should NOT be used during pregnancy or breastfeeding. Always talk with your Naturopathic Doctor before starting any new herbal medicines.

Perhaps life does not grant you the relaxation time that you deserve as a mother, but you can still find a bit of calm amidst the storm by using an herbal medicine such as Motherwort to help reduce stress and your reaction to it.

Happy Mother's Day!

If you wish to treat yourself to a Naturopathic visit simple pop over to my SCHEDULE page. I would be happy to help!

Dr. Nicole Sundene

Naturopathic Medical Doctor

(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

Author of "The PGE-2 Diet Program" for Pain

“Arthritis in my hands and knees is making me miserable. What should I take for my painful knees, tennis elbow, and arthritis in my hands? Glucosamine, Chondroitin, MSM, Bone Broth, Collagen, or Hyaluronic Acid?” Helen S. Scottsdale, AZ

Arthritis can be treated and prevented by taking the right joint building agents. Chondroitin, Collagen, Glucosamine, Bone Broth, MSM, and Hyaluronic Acid are great for joint health. I often use these in combination with each other and seldom see patients having adverse reactions to these supplements. Lets review the best options, the cheapest and most expensive natural arthritis formulas, as well as the actual side effects I see from prescribing them as a Naturopathic Doctor. 


From painful knees, to tennis elbow, shoulder pain, arthritis in the hands, TMJ, Psoriatic Arthritis, Rheumatoid Arthritis, shoulder pain, and arthritis in the hip this is a MANDATORY natural treatment for my joint pain patients that they should not skip, and at the very least use the cheapest form I will discuss today.

Whenever my patients are severely suffering from arthritic bone on bone grinding I recommend they treat their joints to the very best option they can afford. Let’s start with the best and of course most expensive arthritis choice. 


Without a doubt in my mind as a doctor that relies on this for her own joint pain, as well as specializes in Autoimmunity and Natural Pain Management, the best joint support supplement for arthritis is Hyaluronic Acid. This is the #1 Cadillac choice that works the best and does the most “Extra Magic Tricks” for women. We are actually killing four birds with one stone. As we age our hair thins as does our skin, our nails become more brittle with hormone imbalance, aging, and menopause [1-3].

Hyaluronic Acid is not just for arthritis but also helps hair loss, skin, nails, facial sagging, skin sagging. Women actually pay a great deal of money in Scottsdale to shoot Hyaluronic Acid in their faces, knees, and arthritic joints. So taking Hyaluronic Acid internally can help not only with arthritis pain, and hair loss, but also thinning and sagging skin as we tend to lose the collagen behind our skin with the aging process and lack of female hormones, especially in menopause with lack of estrogen and testosterone.


Two caps twice daily of Hyaluronic Acid can be a game changer for arthritis and saggy skin [4, 5]. Once arthritis symptoms improve many of my patients taper the dose down to two caps once daily for cost reasons.

However, my female patients that can afford it like to stay on the 2 caps twice daily because their hair is suddenly growing like a weed. And for women it is all about their hair and skin! So this is my best anti-aging tip that is also good for your joint pain and arthritis. I personally buy the Pure Encapsulations brand in Fullscript. Be sure you are on a high quality form of this as cheap Hyaluronic Acid supplements are likely fake and therefore useless. When used correctly, I hear my patients telling me in 1-2 months their arthritis is improving or completely resolved.


After working four years in a health food store and over fifteen years as a Naturopathic Doctor I can pretty much tell you that I have heard it all when it comes to side effects. Rarely do I hear something new doing my job as a Naturopath. Since I prescribe these supplements to patients regularly I do hear occasional negative feedback about them, which means we need to switch to an alternative. 

Generally stomach ache is the main side effect of arthritis supplements. Allergic reaction is always a possibility as well. While it is possible to have a food sensitivity to different joint support, I will be reviewing my favorite options today that are less expensive than our Arthritis Cadillac… Hyaluronic Acid.

If glucosamine causes digestive upset you should take it in divided doses. Although many of my patients can stomach taking 1500mg of glucosamine all at once.

Worsening joint pain with collagen is a common side effect I hear from my Hashimotos and Autoimmune patients, because their bodies are already attacking collagen. They also describe it as "Feeling heavy, sick, and gross."

So with autoimmune arthritis, I proceed with caution using collagen, and forewarn my Autoimmune patients, which I have a ton of as a Naturopathic Doctor with an Autoimmune condition. If stomach upset is the side effect then take it with food. Never take supplements on an empty stomach unless specifically recommended by your Naturopathic Doctor.

Personally some forms of collagen make me very sick and flared up my autoimmune arthritis to a 10/10 level of pain. I have heard this tale from many other Lupus and RA patients. So when a non-autoimmune patient describes this type of reaction, I immediately think to test them for autoimmune conditions such as Hashimoto's Thyroiditis, Scleroderma, Rheumatoid Arthritis, Lupus, Sjogren's, MCTC, and so forth.

Oddly I feel great on the Vital Proteins grape gummies and snack on these as my dessert after dinner in addition to taking 2 caps of Hyaluronic Acid twice daily. That is just the arthritis system that works for my body, and keeps me away from candy and desserts! Collagen is derived from different animal sources such as beef, eggs, and fish, so one form may be okay and another may not if you have food allergies.

With that being said many of my Rheumatoid Arthritis and autoimmune disease patients feel perfectly amazing on collagen, and instantly note improvement as they build their joints back up from autoimmune attacks and inflammation. Everyone is so unique!

For whatever reason collagen tends to have the most adverse side effects reported about it so ultimately women should be using the joint support that they feel the best on. Today we will review the best available arthritis options and the appropriate dosing as not taking enough joint support is the primary reason I see joint support supplements failing.

Glucosamine theoretically may worsen blood sugar in diabetes, but I have never seen this occur in over fifteen years of using glucosamine for my arthritic diabetic patients. But it is important to be aware that it is a potential phenomena….yet that I have never seen in over fifteen years of seeing my diabetic patients on their glucosamine. 


Treating arthritis naturally is a marathon and not a sprint. We cannot expect to undo years of damage suddenly in a day. Most research studies cite improvement around 6-12 weeks of implementing an arthritis formula. This is also in alignment with what I generally hear from my patients. Younger women and those with mild arthritis generally feel better after three weeks of consistent use. It is important to note your pain level when you first start taking your arthritis supplement. Keep track of any changes, and make sure the number is going down and not up. We generally track patients on a scale of 0-10 with ten being the worst pain imaginable and zero being no pain at all. 


We need to be building the joints for arthritis and not further deteriorating them with OTC pain meds. While I do rely on some of these medications for my Lupus arthritis pain at times, as well as prescribe pain medication to my patients, they are not the best long term solution for chronic pain management. First of all, I don’t want to shame anyone that takes them, we all need them at times and I feel grateful to know they exist. For many years when I was bedridden as I tell the story in my own Autoimmune Arthritis journey, I required a lot of different types of prescription medications until I discovered the correct anti-inflammatory nutrition my body needed and began researching, creating, testing, and following my PGE-2 Diet.  

So, I would like to just start a brief tirade about the use of NSAIDS for Osteoarthritis, Rheumatoid Arthritis, and conditions with degenerative joints that chronic patients deserve to know. They need to know the truth: When used regularly  NSAIDS are actually deteriorating the joint, and doing the opposite of what joint building formulas are doing for arthritis. So if you have to take one of these OTC pain medications PLEASE also take the joint formula that you can afford and works the best for you. 

NSAIDS  (non-steroidal anti-inflammatory drugs) otherwise known as the common pain relievers that we use to treat temporary pain such as aspirin, ibuprofen, and naproxen should be taken for arthritis flare ups, and a solid Naturopathic Pain Management program using arthritis supplements, herbal medicine, and my PGE-2 Diet should be the foundation of treating arthritic pain. 

NSAIDS and heaven forbid cortisone injections (please only do this as a last resort as cortisone completely shuts down your joints ability to repair as does stress) are simply a quick fix for pain and not a great long term solution as they actually INHIBIT the synthesis of cartilage.


As I explain in my Adrenal blog further about cortisol being a destructive "catabolic" hormone that destroys our joints and muscles in exchange for brief bursts of energy for emergencies. So the more stress, and rage we have the worse our arthritis is. 

Isn’t that why we have arthritis in the first place? The meniscus (shock pad between joints) is made of cartilage right? As we age it gets worn down and our joint space naturally diminishes, loses lubrication and eventually as a result we are in severe pain because we have bone rubbing on bone. Ouch!

Now that everyone is hip to the fact that NSAIDS are not a great long term solution for joint pain, let’s talk about the things that are.

If Hyaluronic Acid is not within your budget, then some of the less expensive joint formulas may be the better choice. So which one is the best?

The answer to the question of “What is better glucosamine, bone broth, collage, chondroitin, or MSM?” is “all of the above”. A good student when in doubt always picks “all of the above” or “C."

Now you could effectively choose “C” for Chondroitin and that would not be a bad answer, but Chondroitin is also pretty pricey so most people buy it with Glucosamine and MSM. Glucosamine was shown to reduce arthritis symptoms in 80% of people after just three weeks at 1500mg daily. Now 80% is FANTASTIC for any drug in a research study. So you can’t go wrong with Glucosamine on its own.

Personally I am not convinced that Glucosamine is better than Chondroitin or vice versa. So in this case we can easily choose “all of the above” because great research studies support the efficacy and safety of all three. So why not use them all together for a nice synergistic effect? Especially a great option for those with severe arthritis. You want to make sure that you are constantly topping off these nutrients that help the joints regenerate [6-12].

MSM (methylsulfonylmethane) is typically the least helpful of the three in my experience, and this research study [13]. The good thing about MSM is that it is dirt cheap so if you take a high dose diligently over the long term you will see results. Most research studies do not allow enough time realistically for improvement, and conclude falsely that these supplements do not work. The truth is they take time.

So MSM is also super cheap so in a pinch is better than nothing, and it is great for irritable bladder and the skin.

This is why many of my patients like Naturopathic arthritis formulas that contain a blend of these ingredients. But if you tend to get stomach aches, skin problems, or food sensitivities I would recommend starting with just one at a time and watching for any side effects. 


Yes! I am a huge fan of these injections you can get at your local Orthopedic doctor or pain management doctor. My patients generally find these injections extremely helpful and notice immediate improvements. Also many insurance companies now cover these injections, so you may even be able to get a free “Jiffy Lube” or Hyaluronic Acid injection into your deteriorated joint [13].


Rebuilding arthritic joints takes patience! Most studies note improvement at three weeks, but I think patients should plan for three months before deciding the treatment will not work. Repairing painful deteriorated joints is truly something that is going to take time. We need to rebuild collagen that has been destroyed for decades in some of my patients so expecting it to improve in a few days is not in alignment with reality. These treatments also work to improve lubrication of the painful arthritic joints. I also always recommend my patients with arthritis take a high quality omega-3 fish oil to further aid lubrication of the joint and reduce inflammation as I discuss the science and why for arthritis on that blog.


Be sure to buy a Naturopathic Doctor approved brand like Thorne, Vital Nutrients, Douglas Labs, Pure Encapsulations, Jarrow, Twinlab, Enzymatic Therapy, etc in Fullscript. These are the brands I buy myself and prescribe regularly to my patients. There is some concern with poor quality brands using crab and shrimp sources of glucosamine and chondroitin that are contaminated with lead. Now something that arthritis patients take daily should not have lead in it! Remember that the FDA does not regulate supplements in America so if you want your natural substance to work you need to shop smart. Many chondroitin products do not contain nearly the amount of chondroitin that they purport on the label.

When I worked four years in a health food store in the 90’s my favorite brands were Jarrow, Twinlab, and Enzymatic Therapy if you need health food store options for your arthritis. Be sure to take the full dose by the manufacturer as many of my patients are taking 25-50% of the correct dose. Double check with your Naturopathic Doctor if you can take more. For collagen powders and bone broths I recommend adding these to your smoothies, lattes, and food at 1 scoop 2-3 times daily for the first month or two. Then once the joint pain has resolved continue one scoop daily for maintenance.


In addition to joint support, fish oil, and herbal medicine such as curcumin, pine, cinnamon, and ginger for arthritis, I also recommend a solid anti-inflammatory Naturopathic nutrition plan. My PGE-2 Diet is chock full of recipes to reduce pain and is perfect for women that want to treat their pain at the "Root Cause" as our nutrition can be the biggest source of inflammation in our bodies. A great deal of inflammatory molecules can come from digestion. My program is designed specifically for women in pain, or with autoimmune arthritis and provides, eight weeks of meal plans, recipes, and grocery shopping lists so women have access to exactly how I eat to manage my own autoimmune pain as I discuss in my autoimmune blog about my own battle with chronic pain.

Many of my arthritis patients also have food triggers and food sensitivities. By testing for arthritis pain trigger foods, removing them, and replacing them with the anti-inflammatory diet in my PGE-2 Diet program, we can halt inflammation driving arthritis forward, and at minimum slow the progression of the arthritis.

Women can pick up my complete Mind/Body/Spirit Naturopathic program that includes gentle yoga stretching exercises for women in pain, in addition to easy exercise videos to help improve mobility.

You can pick up the program and watch my free webinar training on how it works to help women conquer their pain, hormones, and weight gain all right here:

If you need my help with treating your arthritis with herbal medicine, testing for trigger foods and learning how to manage your pain with natural medicine simply visit my SCHEDULE page. I would be happy to help! 

Dr. Nicole Sundene

Naturopathic Medical Doctor

(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 MenopauseThyroidHashimotosPMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food AllergiesDigestion, 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 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 Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!


  1. Oliviero F, Ramonda R, Hoxha A, Scanu A, Galozzi P, Favero M, Frallonardo P, Punzi L. Effect of an oral preparation containing hyaluronic acid, chondroitin sulfate, hydrolyzed collagen type II and hydrolyzed keratin on synovial fluid features and clinical indices in knee osteoarthritis. A pilot study. Reumatismo. 2020 Nov 19;72(3):125-130. doi: 10.4081/reumatismo.2020.1272. PMID: 33213125.
  2. Canciani E, Sirello R, Pellegrini G, Henin D, Perrotta M, Toma M, Khomchyna N, Dellavia C. Effects of Vitamin and Amino Acid-Enriched Hyaluronic Acid Gel on the Healing of Oral Mucosa: In Vivo and In Vitro Study. Medicina (Kaunas). 2021 Mar 18;57(3):285. doi: 10.3390/medicina57030285. PMID: 33803814; PMCID: PMC8003116.
  3. Wang SJ, Wang YH, Huang LC. The effect of oral low molecular weight liquid hyaluronic acid combination with glucosamine and chondroitin on knee osteoarthritis patients with mild knee pain: An 8-week randomized double-blind placebo-controlled trial. Medicine (Baltimore). 2021 Feb 5;100(5):e24252. doi: 10.1097/MD.0000000000024252. PMID: 33592868; PMCID: PMC7870173.
  4. Agha-Hosseini F, Atyabi F, Akbari K, Moosavi MS. Decreased recurrence of symptoms in oral lichen planus with intralesional injection of hyaluronic acid and triamcinolone. Int J Oral Maxillofac Surg. 2021 Dec;50(12):1643-1648. doi: 10.1016/j.ijom.2021.02.028. Epub 2021 Mar 23. PMID: 33741218.
  5. Michelotti A, Cestone E, De Ponti I, Pisati M, Sparta E, Tursi F. Oral intake of a new full-spectrum hyaluronan improves skin profilometry and ageing: a randomized, double-blind, placebo-controlled clinical trial. Eur J Dermatol. 2021 Dec 1;31(6):798-805. doi: 10.1684/ejd.2021.4176. PMID: 34933842.
  6. 6. Kalman DS, Hewlings S. The effect of oral hydrolyzed eggshell membrane on the appearance of hair, skin, and nails in healthy middle-aged adults: A randomized double-blind placebo-controlled clinical trial. J Cosmet Dermatol. 2020 Jun;19(6):1463-1472. doi: 10.1111/jocd.13275. Epub 2020 Jan 6. PMID: 31904175; PMCID: PMC7418556.
  7. Puigdellivol J, Comellas Berenger C, Pérez Fernández MÁ, Cowalinsky Millán JM, Carreras Vidal C, Gil Gil I, Martínez Pagán J, Ruiz Nieto B, Jiménez Gómez F, Comas Figuerola FX, Aguilar Hernández ME. Effectiveness of a Dietary Supplement Containing Hydrolyzed Collagen, Chondroitin Sulfate, and Glucosamine in Pain Reduction and Functional Capacity in Osteoarthritis Patients. J Diet Suppl. 2019;16(4):379-389. doi: 10.1080/19390211.2018.1461726. Epub 2018 Apr 27. PMID: 29701488.
  8. Wang SJ, Wang YH, Huang LC. The effect of oral low molecular weight liquid hyaluronic acid combination with glucosamine and chondroitin on knee osteoarthritis patients with mild knee pain: An 8-week randomized double-blind placebo-controlled trial. Medicine (Baltimore). 2021 Feb 5;100(5):e24252. doi: 10.1097/MD.0000000000024252. PMID: 33592868; PMCID: PMC7870173.
  9. Czajka A, Kania EM, Genovese L, Corbo A, Merone G, Luci C, Sibilla S. Daily oral supplementation with collagen peptides combined with vitamins and other bioactive compounds improves skin elasticity and has a beneficial effect on joint and general wellbeing. Nutr Res. 2018 Sep;57:97-108. doi: 10.1016/j.nutres.2018.06.001. Epub 2018 Jun 9. PMID: 30122200.
  10. Navarro SL, Herrero M, Martinez H, Zhang Y, Ladd J, Lo E, Shelley D, Randolph TW, Lampe JW, Lampe PD. Differences in Serum Biomarkers Between Combined Glucosamine and Chondroitin Versus Celecoxib in a Randomized, Double-blind Trial in Osteoarthritis Patients. Antiinflamm Antiallergy Agents Med Chem. 2020;19(2):190-201. doi: 10.2174/1871523018666190115094512. PMID: 30648524.
  11. Lomonte ABV, Gimenez E, da Silva AC, Radominski SC, Scheinberg MA, Ximenes AC, de Freitas Zerbini CA. Treatment of knee osteoarthritis with a new formulation of a fixed-dose combination of glucosamine sulfate and bovine chondroitin: a multicenter, randomized, single-blind, non-inferiority clinical trial. Adv Rheumatol. 2021 Jan 19;61(1):7. doi: 10.1186/s42358-021-00165-9. PMID: 33468249.
  12. Liu X, Robbins S, Eyles J, Fedorova T, Virk S, Deveza LA, McLachlan AJ, Hunter DJ. Efficacy and safety of a supplement combination on hand pain among people with symptomatic hand osteoarthritis an internet-based, randomised clinical trial the RADIANT study. Osteoarthritis Cartilage. 2021 May;29(5):667-677. doi: 10.1016/j.joca.2021.01.011. Epub 2021 Feb 19. PMID: 33617972.
  13. Hsieh RL, Lee WC. Effects of Intra-articular Coinjections of Hyaluronic Acid and Hypertonic Dextrose on Knee Osteoarthritis: A Prospective, Randomized, Double-Blind Trial. Arch Phys Med Rehabil. 2022 Aug;103(8):1505-1514. doi: 10.1016/j.apmr.2022.04.001. Epub 2022 Apr 16. PMID: 35439521.

Dr. Nicole Sundene author of “The PGE-2 Diet ®”

Female Hormone Specialist

Good news for women with anxiety! We can now treat your anxiety, libido, weight gain, diabetes, and loss of lean muscle all at once with schisandra thanks to the latest research! Menopausal women that took my favorite anxiety herb, schisandra,  had improved quadriceps muscle strength in a few recent research studies [1,2]

This is important because loss of female hormones with menopause causes Osteoporosis AND a loss of lean muscle. When women lose lean muscle they are essentially losing their metabolism, as your muscles are pretty much the only thing burning calories in your body. Therefore taking a super safe, gentle herb like schisandra or ashwaghanda is important to prevent that postmenopausal weight gain that tends to happen in perimenopause and menopause. It is all about prevention ladies!!

I should forewarn women that I prescribe schisandra not just for anxiety, but also for poor libido and liver support. So if you don’t want a libido then definitely proceed with caution as I certainly don’t want you getting into trouble for picking up a second husband!! 😉

I am certainly not a homewrecker!

Otherwise, most of my menopausal patients need the libido enhancing effects of schisandra and research also found it effective in treating menopausal symptoms so this is a game changer! [4]

Plus the best part is that it is a very safe, gentle herb, as it is just Chinese berries. Personally, I prefer capsules to the tea or tincture form which has a bit of a bitter, Christmas tree type of flavor. I have most women on about 2 capsules twice daily of Schisandra for anxiety, weight loss, libido, and menopausal support.

The flavonoids in schisandra or the red berry color were also shown via research to help with weight loss. Managing high blood sugar is likely the mechanism for weight loss, as in a recent research study schisandra was found effective at lowering both high fasting glucose and high insulin levels and is therefore safe, and effective for women with diabetes and insulin resistance. [3]

But the most cost effective way of getting schisandra in your system is via the tincture method in my Instagram video. I fill my bottle about half full of berries and continue to shake it every few days for about 4-6 weeks and be sure to ensure the vodka is always covering the berries. Then strain and take a full or half teaspoon twice daily or more for anxiety. 

The giant bottle of schisandra tincture I made in my Instagram video will last me for several years and is super inexpensive and fun to make! So if you are on a budget then the tincture is the way to go!

Be sure to only buy organic herbs from reputable brands trusted by your Naturopathic Doctor

Check out my latest Women’s Health Masterclass “Mental Health and Hormones” to learn more of my best tips for your mental health. This free women's masterclass is not something you will want to miss! Plus it is 100% FREE so there are no excuses getting yourself educated on how female hormones impact mental health:

If you want to treat yourself to a Naturopathic visit simply give us a call, or pop over to my SCHEDULE page. I would be happy to help you with your anxiety, or women's health!

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!


  1. Cho YH, Lee SY, Lee CH, Park JH, So YS. Effect of Schisandra chinensis Baillon extracts and regular low-intensity exercise on muscle strength and mass in older adults: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr. 2021 Jun 1;113(6):1440-1446. doi: 10.1093/ajcn/nqaa447. PMID: 33710261.
  2. Park J, Han S, Park H. Effect of Schisandra Chinensis Extract Supplementation on Quadriceps Muscle Strength and Fatigue in Adult Women: A Randomized, Double-Blind, Placebo-Controlled Trial. Int J Environ Res Public Health. 2020 Apr 4;17(7):2475. doi: 10.3390/ijerph17072475. PMID: 32260466; PMCID: PMC7177795.
  3. Kim DS, Baek HI, Ha KC, Cha YS, Park SJ. Efficacy and Safety of Omija (Schisandra chinensis) Extract Mixture on the Improvement of Hyperglycemia: A Randomized, Double-Blind, and Placebo-Controlled Clinical Trial. Nutrients. 2022 Jul 30;14(15):3159. doi: 10.3390/nu14153159. PMID: 35956334; PMCID: PMC9370295.
  4. Park JY, Kim KH. A randomized, double-blind, placebo-controlled trial of Schisandra chinensis for menopausal symptoms. Climacteric. 2016 Dec;19(6):574-580. doi: 10.1080/13697137.2016.1238453. Epub 2016 Oct 20. PMID: 27763802.

“What can I do naturally for my ADHD without Adderall?” ~Maddie H, Scottsdale, AZ

Dr. Nicole Sundene, NMD

Scottsdale Naturopathic Doctor

Adderall shortages have been challenging for doctors and patients. Because I have been getting this question regularly since the October Adderall shortage began, I thought I would talk about how I use Naturopathy, Herbal Medicine, Nutrition, and Hormones in my Holistic Hormone and Psychiatry practice. Conditions such as brain fog and ADHD are very common in Women’s Health. ADHD when left untreated can cause depression and anxiety from failing to execute tasks properly. 

This blog will go over the most important nutrition, herbs, and lifestyle factors I use to treat ADHD naturally without stimulant medication.

Is there actually an Adderall shortage? Yes.

Doctors have been forewarned about this for a year, but I was still shocked to see it actually begin to happen in October and more horrified to hear it is predicted to continue due to an increased demand coupled with blunted production. 

People cannot get the ADHD drug they rely on? WHAT?!? 

As the “OG Ritalin Child of the 90’s” I hate to admit I slightly panicked when I heard there was an Adderall shortage. Then I laughed and thought, “This does not pertain to you. You no longer need medication for your ADHD like you did back then.” 

Yet back in the 90’s if I was suddenly unable to get the medication I relied on for my ADHD it could have been devastating for my education. This is also a medication patients should not suddenly stop should they not be able to obtain it, and generally requires tapering especially when the patient has been on it for many years for their ADHD.  

Sadly this Adderall shortage is impacting many women and teens in my practice as well as their families, and I am being asked often for ADHD alternatives.  Of course Naturopathic Medicine is a bit more complicated than just popping a new natural pill for of course I had to write a blog about all the different factors that should be addressed between nutrition, herbs, supplements, and testing to find the "Root Cause."

Today, I wanted to share a bit of insight from my own journey of learning how to manage my ADHD symptoms naturally. As I shared in my story about ‘Why I Became a Naturopathic Doctor” I was going from different specialist to specialist all trying different medications out on me to see if it would help my symptoms. This specialist loop involved constantly going to a Psychiatrist every month for ADHD, Anxiety, and Depression

Back in the nineties as my ADHD worsened and I progressed through the different options, dosing, timed release vs instant released, I grew weary of taking ADHD medications, and the cost continued to sky rocket as my insurance did not pay for it. 

As time went on and that vicious stressful loop of doctor’s appointments failed me and I ended up at a Naturopathic Doctor’s office….I began to feel better on the nutrition changes and herbs, and gradually needed less and less Ritalin. 

Now keep in mind this was back in the 90’s before Adderall, Strattera, and Vyvance were prescribed. The doctor prescribed either brand named Ritalin or methylphenidate. It was like Dairy Queen for ADHD patients back then, and we only had two flavors, chocolate or vanilla. 

While I was grateful to finally have a diagnosis of my condition as a teenager, and a better understanding of how to cope with it, I frankly never liked the medication options. Thankfully now ADHD patients have other medication options they can try as well as pursuing my type of natural and nonstimulant Adderall alternatives I prescribe in my Naturopathic practice. 

Did you know I am actually allergic to Adderall? 

My doctor did try prescribing Adderall to me, but I had an allergic reaction to one of the food colorings used which is a common trigger or irritant in ADHD patients as I recommend avoiding ALL food colorings in my “ADHD Diet” that is 100% free for anyone to follow and use, and exactly what I do for myself, and my patients with ADHD. If you need further recipe ideas and eight weeks of meal plans, simply pick up my PGE-2 Diet program to implement easy recipes, meal plans, and weekly grocery shopping lists.  

The worst thing about my ADHD Diet is when I fall off of it over the weekend and indulge in bad foods and cannot concentrate well on Monday.  

So the Adderall shortage does not directly pertain to me, but it affects many ADHD patients as it is still one of the most commonly prescribed ADHD medications. Adderall became more commonly prescribed as I was tapering off Ritalin towards natural treatments for my ADHD. 

My Psychiatrist stopped the Adderall and returned me to Ritalin as we worked together to lower the dose. It took us a very long period of time to taper me off Ritalin as I was on a very high dose. So if you are wondering if Naturopathy can be helpful for severe ADHD cases, my answer is yes, and it certainly cannot hurt mood and concentration. But please read my comments at the end of this blog to ensure you will be successful with treating ADHD naturally. Natural treatments for ADHD still require a daily regime and discipline. 

The good news from my story about "How I Became a Naturopathic Doctor," is that I began to notice that when I followed the Food Trigger Elimination Diet my Naturopathic Doctor placed me on, my attention span was much better. Suddenly I had better energy,  I got tasks done efficiently, I was no longer procrastinating! My ADHD was no longer this giant obstacle in my day. Getting things accomplished in an orderly flow became easy, and the more I improved, the more I naturally wanted to adhere to the nutrition and lifestyle choices that helped my concentration and mood the best.

Suddenly my brain was crystal clear, and I was no longer experiencing annoying ADHD fumbles from forgetting things or locking my keys in my car!

I graduated from college as I continued to work on my ADHD with natural remedies. The concentration demands of studying were ending and it was time for me to get a job. I realized the medicine I had been relying on for many years to help me focus on accomplishing tedious school related tasks was no longer really necessary. I often did not take ADHD meds on the weekends and just relied on them when in class, studying, and going to the library. I did not need to take them to concentrate at my job at the health food store, and suspected I no longer needed them at all. I also didn’t like how it made me constantly sweaty with a dry mouth, so I began to research nutritional treatments for ADHD. It became my final Biochemistry Thesis project for graduation, and was my final grade for spring quarter. 

My final graduating Thesis was twenty eight pages about “Docosahexanoic Acid and Nerve Conduction.” I had compiled pages and pages of nutrition research studies on animals that demonstrated that the nervous system does not work well without this critical Omega-3 fatty acid. I broke down the biochemistry of how the fatty acid was needed to form healthy cellular membranes and concluded with my hypothesis that nerves in humans would likely not function as efficiently or effectively if deficient in this fatty acid. I worked extremely hard on the project and was very proud of my Thesis paper.

However, my biochemistry professor was a "Know it all" very grouchy bossy nerve conduction Kinesiologist that angrily scribbled across my paper “UTTER RUBBISH! What you eat has NOTHING to do with your nerve function! This is not a potential treatment for ADHD, depression, anxiety, dementia, Alzheimers, MS, or cognition. Animal studies are utter nonsense and cannot be extrapolated to human data….” Which went on for several pages in angry blue sharpie with a giant B- next to it!  I was horrified to receive a B- and not the expected A+ for all my hard work compiling research studies, also knowing I had gone far beyond my other classmates and was hoping to get the special recognition he would give to his favorite papers.

Mainly though I was just really excited to share all of my ADHD research with my professor, and instead of him being glad.... I made the nerve conduction professor mad!

Considering we spent two full quarters just going over how a nerve makes an "action potential" or conducts energy, I should have known he would not be open to my nutrition research.  But in that same time period we discussed the anatomy and physiology of nerve cell membranes and they were made up of these very fatty acids that were needed to make proper action potentials or in regular language “thoughts and movements.” The cellular membrane lacking Omega-3 is akin to a frayed electrical cord that cannot efficiently send electrical signals.

So I laugh about this twenty five years later as there are now a plethora of research studies cited on my blog about “Flax vs Fish: Omega-3” proving my crotchety angry biochemistry professor wrong. My ADHD nutrition theories were not so radical after all back in the nineties! 

In 1999, after compiling all this research on fish oil as a fish hating Scandinavian woman with ADHD, I began experimenting with high doses of a particular extract of fish oil called DHA or docosahexanoic acid. Every day I took between 2000-10,000mg of DHA. On longer study or test days I needed the full 10,000mg. 

For most children with ADHD I now start them at 1000mg, there are great chewable “DHA Juniors” that taste good and make it easy to give to children. This is the most important nutrient for patients with ADHD in my opinion. 

My biggest pet peeve in Naturopathic Medicine is that I am seen as the “Crazy Witch Doctor” for using nutrition, herbs and fish oil for children with ADHD, when other doctors are giving children with ADHD stimulant medications known to stunt their growth as the main side effect, and somehow I am the irresponsible doctor here?  If you or your child needs medication, that is okay, I get it, but we have our system in how we treat ADHD patients set up backwards, and in order to "First, Do No Harm," as the oath every doctor is required to take, we should look at these nutritional interventions as the start of treating ADHD, and not as the only remaining option when medications fail ADHD.

Lets use this Adderall shortage as an opportunity to turn DHA fish oil into first line treatment for ADHD in children. Especially children that are growing! Adults over fifty on stimulants are also risking their heart health, therefore natural medicine that is effective is clearly the best choice in ADHD.

While my ADHD methods are alternative, and not mainstream, I am confident they are effective because I rely on them myself, and also see the children with ADHD in my practice improving after just 1-2 appointments, to the point they do not even need to get to the Naturopathic lab stage of us working together. They are improved enough with just DHA and a probiotic that their parents text me that they don’t need to come back as their psychiatrist has already tapered them off their ADHD meds. So I am confident that my methods work. I know from experience that the only time they don't work is with an ADHD patient or parent that is too disorganized to implement them and adhere to them as a new daily routine.


DHA or docosahexanoic acid is the precise extract of fish oil I recommend for ADHD, TBI: Traumatic Brain Injury, and for pregnant women to take with their prenatal vitamins to ensure their baby has the highest IQ possible per the latest women’s health research studies. Be sure to use only the finest brands free of heavy metals and parabens.

VERY IMPORTANT: Please just do me a BIG FAVOR and stop the Omega 3,6,9 nonsense if you have ADHD and ONLY use the DHA concentrate of an Omega-3 as a supplement. Read my full Omega-3 blog to find out more about the science behind the why. Otherwise most women are already getting plenty of Omega-6 and Omega-9 from diet.

Research studies demonstrate that too many Omega-6 and Omega-9's from nuts and grains can actually become inflammatory in excess especially during Omega-3 deficiency and essentially “clog” the brain and worsen ADHD symptoms similar to inflammatory trans fats and saturated fats. Not all patients can burn these types of fats for fuel and the ADHD patient needs way more Omega-3 than the average bear! This is why inflammation can persist even when vegetarian or vegan.

If you need a nutrition program with recipes that are chock full of Omega-3 rich foods, and lower in inflammation driving foods you can pick up my mind/body/spirit PGE-2 Diet program. There is a vegan version, and a meat containing version. There are eight weeks of meal plans, grocery shopping lists, and dozens of healthy recipes that follow the rules of my ADHD Diet. The yoga and aromatherapy meditations are also critical for learning to better control a hyperactive mind.

VERY IMPORTANT: Only use my trusted brands of DHA: Carlson, Arctic Omega, Nordic Naturals, Thorne, and Pure Encapsulations in Fullscript. Most other fish oil brands patients show me I find poor quality if not disgusting spoiled rancid fish oil full of mercury, lead, and arsenic that I would not even feed to my dog! If you are burping up bad smelling fish oil that means it is rancid and you should throw it away and get an above Naturopathic Doctor trusted brand.

Be careful with this supplement, as a poor quality one may cause more inflammatory damage to your brain, than be helpful. Inflammation is a huge trigger for ADHD symptoms which is why I recommend my anti-inflammatory PGE-2 Diet with all common trigger foods removed for my ADHD patients until they have been tested for triggers.

Please stick with a good quality brand especially if pregnant or using this as medication for ADHD. 

In America anything can be put in a bottle and labeled DHA and sold for a high amount. This is perfectly legal, and why patients should stick with prescription grade supplements recommended by their Naturopathic Doctor to avoid falling victim to poor quality or fake products.

Oftentimes people state that Natural Medicine didn't work for them, when really they were not using the correct dose of the natural medicine, or a high quality enough form of the medicine.

Quality of DHA is especially important when looking at replacing stimulant medications with natural alternatives.

For me and many of my ADHD patients, taking this form of DHA fish oil in high doses is like watering a dying brain! Worst thing about fish oil is it causes blood thinning. So those on blood thinners need to check with their doctors as with anything otherwise a slight blood thinning effect is protective against “The Virus.”

Back in the nineties, the beauty of adding the high dose DHA omega-3’s in was that I began to actually need less and less DHA and Ritalin. My body did not become "tolerant" to the dose of the DHA and need it to be raised like Ritalin, instead I needed a higher amount in the beginning to extinguish the "ADHD fire in my brain", and now I just take 2000mg daily for maintenance.

The opposite happened when I was on Ritalin though and I needed to keep increasing the dose or it stopped working. When I first began taking Ritalin I only took 10mg. Then eventually I was on 20mg. Then 20mg twice a day. Then 30 mg three times a day. As I exceeded 100mg of Ritalin my brain was working right but my heart did not feel good, I had a racing pulse at times, I had drenching armpit stains that were embarrassing, and I feared I would get high blood pressure. Yet my concentration required that high of a dose. 

So my brain was about 80% improved on DHA and Naturopathic Nutrition, but not quite at 100%, perfect, so I continued researching the herbs and vitamins in the health food store I worked in and began adding different well known memory herbs in for concentration. I recommend reading about my favorite ones: Ginkgo biloba and Rosemary.  Check out my Rosemary Salmon recipe to treat your ADHD brain! Of course discuss with your Naturopathic Doctor before implementing anything new I will be reviewing today.


Certain mild sedative herbs such as California poppy, Passionflower, and Hibiscus…. can also help ADHD patients concentrate and focus as I discuss along with my ADHD Tea recipe on my “Hibiscus Tea” and “ADHD Tea” blogs. 

Ashwaghanda is safe and effective for agitated women and angry children and teens with ADHD. Ashwaghanda is generally considered safe even in pregnancy but please always check with your Naturopathic Doctor when pregnant!

Curcumin helps with those suffering from postviral, Lyme, Long Covid, or Mold Exposure brain fog. Be sure to use curcumin for ADHD and not Turmeric as it is not nearly as potent. When tapering someone off stimulants, or treating ADHD naturally I am using the strongest version of the plant, in this case use curcumin. 

Liposomal Glutathione is also great for those with toxic, or post-immune brain fog, shortness of breath, asthma, and in need of detox support, I like the Pure Encapsulations brand available via Fullscript.

Be sure to work with a skilled Naturopathic Doctor or Herbalist when treating ADHD. Many adverse consequences to improperly managed ADHD can occur such as depression, anxiety, insomnia, poor self esteem, and school or work disruptions. It is important to work with someone that is experienced and skilled and not just randomly throw your child or self on the above list of supplements I am discussing today. 

In addition to supplements and herbs for ADHD treating “The Root Cause,” is also especially important. It varies between patients and there is never one unique cause otherwise I would just create an exact treatment plan everyone with ADHD should follow and post it here. 

But the Root Cause of my ADHD is different from many of my patient’s ADHD, and we are all a little bit like snowflakes. The symptoms look similar, but the pattern overall is different. 

As a female hormone specialist I am first looking to see if the mental health cause is physical such as hormonal or nutritional. Things like anemiamenopause, perimenopause, PMS, hypothyroidism, and Hashitmoto’s thyroid disease can often cause brain fog and trouble concentrating in women. 

If no insurance based lab testing is helpful we may conduct specialty testing such as food sensitivities, organic acid testing, neurotransmitter testing, stool testing, and infectious disease testing….all dependent on each patient with ADHD’s symptoms, story, health and travel history.


No. Naturopathy unfortunately cannot help teens, children or women with ADHD in the following circumstances. I want every patient that enrolls in my practice to be a success story, so I do not recommend signing up to work with any Naturopathic Doctor if the patient is: 

  1. Unable to make nutrition changes, even small goals one at a time
  2. Unable to take or remember to take supplements or herbs in a tea, tincture, or capsule form
  3. Unable to have insurance based or self pay hormone and nutritional testing conducted
  4. Unable to dig for the root cause of ADHD with Naturopathic specialty testing 
  5. Unable to remember to attend appointments or take natural treatments

I understand the forgetful nature and chaos of ADHD. I have it myself, but I also follow through on my plans and appointments by following a very strict nutrition, herbal medicine, hormone, and lifestyle program which includes my top ten most important lifestyle tips for ADHD patients:  


#1 Always plan to show up for appointments early to compensate for any ADHD forgetful fumbles. Bring magazines, books, or something to do once arrived early. 

#2 Make checklists for things you regularly need to remember when you leave the house, head to work, school, sports, or activities. Laminate the checklist so you or your child can check off things as you prepare for your day, then wipe it clean for the next day. Make one side for work/school and the other side for sports/activities.

#3 Bring a small notebook with you everywhere you go with your list of appointments and daily tasks for each day, as well as an ongoing “To Do” list for random tasks that you do not want to forget. Writing tasks with a bold marker and placing the list somewhere easily visible will help stay focused on the tasks in need of accomplishing, as well as the order to work on them.

#4 Text message yourself anything you need to accomplish quickly or don't want to forget. This is important when you are away from your ADD notebook. Then add the task to your "To Do" notebook and calendar. If the task is extremely important I leave it as an unread text message to myself so I continue to see the alert until the task is completed.

#5 Have an accountability partner to help hold you accountable to the tasks you need to complete, especially the ones you do not want to do. This can be someone else with ADHD that also needs to be held accountable or a friend or family member that is part of your mental health care team.

#6 Every night organize the things you are your child need to have a good day. I call this "Setting my tomorrow self up for a great day." Adults with ADHD or their children should stay committed every evening to creating an easy morning by laying out their clothes, packing their lunch, and organizing all their office or homework. This way in the morning it is all organized and ready to go. The sunglasses, keys, purse, and phone are all together and will not be a Stressy Scavenger Hunt. By creating this simple evening routine a lot of drama can be prevented each day. Especially for the ADHD patients and parents that are not morning people!

#7 Avoid "ADHD Overwhelm" by committing to completing at least three tasks each day you don't want to do. I like to always start with the easiest ones to get them over with. But by scheduling tasks, and remaining committed to keeping up with a busy schedule, ADHD patients can avoid the overwhelming anxiety and depression that can result from ADHD inactivity. 

#8 Keep "ADD Stations" in each room that is a dish, or catch all tray that you commit to only setting your important items like keys, phone, jewelry, watch, wallet, or purse on.

#9 Invest in multiple sets of sunglasses, reader glasses, pens, notepads, and items ADHD patients frequently lose, and just keep them in every room in your "ADD Station." Consider adding tracking devices to important items like keys.

#10 Work on only one project at a time. Set an amount of time for the project and only work on that project. In college I kept a pretty canopy above my desk and would set a timer for an hour when I could get out of my "Study Cocoon" and take a break. Otherwise I would be up baking cookies, answering the phone, and washing dishes. By utilizing strong visual reminders, and keeping projects separate from each other, this is how we prevent the ADHD fumbles that annoy ourselves, friends, and family.

While treating ADHD from a holistic standpoint requires more work on the patient's end, the results are far more rewarding. Many of my ADHD patients state, “I am so happy to be off Adderall. I feel so much better physically without stimulants, and my brain is working better than ever.” So not being able to obtain a medication may also be an opportunity to explore Naturopathic Medicine!

Most of my adult ADHD patients are able to function completely without stimulants over a 6-12 month period of working together. While some of my severe cases are able to function 95% of the time without stimulants, yet reserve a small emergency supply for difficult adulting tasks like doing taxes or boring paperwork.

I hope you learned today that nutrition is the most important place to start with ADHD. The first thing I need my patients doing to improve their ADHD symptoms naturally is changing to a clean, Naturopathic diet. Proper nutrition is the foundation for a successful ADHD nonstimulant treatment plan.

The very best natural ADHD treatment is my "ADHD Diet" which involves eating a clean, anti-inflammatory diet free of food coloring and rich in Omega-3’s for proper brain health as I provide the recipes and grocery shopping lists in my PGE-2 Diet program if you need a full program.

My simple nutrition program is the exact recipe for success I follow myself! Remember my #1 Naturopathic Rule: Taking bottles of supplements without making nutrition changes is like throwing water bottles on a burning building. The bottles alone are not going to be strong enough by themselves! We must activate your "Inner healing power of nature" that every patient has inside of them via colorful and clean nutrition and herbal medicine.

If you need my expert help testing for your root cause of ADHD, improving your memory, concentration, or mood simply pop over to my SCHEDULE page. I would be happy to help!

Dr. Nicole Sundene, NMD

(480) 837-0900

Naturopathic Medical Doctor

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, NMD

Scottsdale Naturopathic Doctor

Did you know pine needles are a rich source of vitamin C, beta carotene and antioxidants? Sometimes Naturopathy indeed sounds crazy but I thought I would share one of my favorite anti-aging rejuvenating herbs today with everyone feeling blah after a long winter.

A delicious way for women to get more anti-aging antioxidants is with a simple cup of pine needle tea! Pine needles are a year round readily available nutrition source. 

I have learned from prescribing pine needles to my patients over the years that it is an either “LOVE IT or HATE IT” type of flavor. Either you love it like me or wrinkle up your nose and feel like you are drinking floor cleaner....I get it! So warning this is not for everyone just like a lot of other strong flavors such as cinnamon, ginger, star anise, and licorice.

Personally I love the aroma of pine, as it reminds me of mountain biking or skiing on a clear sunny day. That smell of sunshine on pine is a perfect mental health afternoon pick-me-up for a healthy  “Happy Hour.” 

I like to make my pine needle tea in a big cup with one bag of organic pine needles, one bag of organic cinnamon and 2-3 packets of stevia. It is the perfect cozy cocktail for a rainy day. 

If my sinuses are blocked I will inhale the steam from my tea to help clear them. 

Naturopathic Doctors use pine needles for pain and to treat sinus infections, colds and flus. So I bring up this simple pine needle tea today as many patients are complaining of post-viral fatigue,  stuffiness, cough, phlegm, and that annoying post nasal drip after sickness that keeps lingering.

Pine essential oil can help clear the sinuses for Seasonal Allergies. So I thought I would remind everyone of the benefit from my favorite anti-aging decongestant! Between the pollen and all the germs flying around we need some new healthy tea rituals. Don't forget the nettles for allergies!

Pine needles have amazing expectorant properties that actually help patients cough OUT the sickness so it leaves quickly, rather than in traditional medicine we instead suppress the cough and keep the sickness IN with a codeine cough syrup for instance. Which is when sickness can tend to linger longer from too much suppression. The body is naturally ridding itself of sickness by coughing it out.  A cough longer than two weeks is not normal which is when you should contact your Naturopathic Doctor.

Rejuvenating herbs such as pine needles are very important to include in the diet after a long dreary winter. Especially those feeling sluggish and phlegmy with a lingering cough will benefit from the alpha and beta-pinenes, that help make pine a natural decongestant!

Pine needles internally and topically can also be soothing for pain. Remember anything that is an antioxidant will generally be helpful for chronic pain and autoimmune disease.

For more tips on how to add herbal medicine to your diet and lifestyle pick up my complete Naturopathic program here: 

In my Mind-Body-Spirit Naturopathic program I teach how you how to cook with herbal medicine so you can get more plants in your body for antioxidants, anti-aging, pain relief, balanced female hormones, and energizing fuel, as well as review the best choices of aromatherapy for meditation and yoga.

There are easy fitness classes designed for women. And the Body Pump is MANDATORY for preventing and treating Osteoporosis! So there are no excuses your bones will thank you someday!

The best part of my Naturopathic Diet program is women say it is an easy program to follow, their families will eat the most of the meals with them,  and they feel and look amazing eating my Naturopathic diet chock full of my favorite herbs and superfoods all designed to balance female hormones!

Need my help feeling your best? Simply visit my schedule page to set up your Naturopathic visit or give us a call (480) 837-0900. I would be happy to help!

Dr. Nicole Sundene, NMD

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

Why is cinnamon one of my favorite herbs as a Naturopathic Hormone Doctor you ask? Cinnamon is not only super effective, but most women find it a delicious herb to incorporate in their daily diet. Today I will go over the latest women’s health research on cinnamon, and how to use cinnamon as a tea and in foods. 

The most important condition I think of using cinnamon for is PCOS. As cinnamon is one of the most helpful herbs for PCOS, especially when it is the insulin resistant or “metabolic type” as I discuss on my PCOS blog. 

Exciting new research shows diabetes and peripheral neuropathy pain improve with cinnamon! Cinnamon actually helps regenerate nerve damage [11].


Cinnamon research demonstrates benefit in Type 2 Diabetes, PCOS, Migraines, Cramps, improved nerve damage in Peripheral Neuropathy, and improved pain [1-11]. Cinnamon aromatherapy actually helped newborns in the ICU go home an average of 3-4 days sooner [12]. 

Diabetes: Researchers found that only 500mg of daily cinnamon was needed to improve Type 1 Diabetes [1, 7]. This is fantastic because I have most of my diabetics taking 2 x 500mg capsules of cinnamon twice daily with meals and see this dose helping lower the need for Metformin. Some can’t handle taking that much as I discuss in the contraindication section further, so it is amazing to know that even one capsule daily provides benefits!

Most capsules of herbal medicine are 500mg. Most of the research studies cited here were done with 500mg capsules. Make sure you check the product you are using so you know the dose and then always stick with the same brand to avoid dose variations especially for those with diabetes and high blood pressure relying on cinnamon as medicine. You don't want to unwittingly increase or decrease your dose of cinnamon. Check out my Diabetes Diet for more tips. 

I immediately prescribe 1000mg of cinnamon twice daily with meals to all of my diabetic patients and ask them to take as much as they can tolerate with food. Cinnamon is nature’s metformin and it works beautifully to support the pancreas and help stabilize blood sugar. With stable blood sugar my diabetics can mentally make healthier choices and have less episodes of low blood sugar causing them to crave carbs and fall off their diet. 

PCOS: Three x 500mg capsules of cinnamon daily were beneficial for both PCOS and Insulin Resistance [2]. In another study, 1500mg of cinnamon not only improved PCOS symptoms but also lowered insulin and cholesterol [17].

An herbal formula containing 1) Cinnamon 2) Licorice 3) Flaxseed 4) Vitex was found beneficial for improving menstrual flow in PCOS patients better than metformin [10].

Migraines: Cinnamon is commonly used to treat pain. Researchers studied fifty patients with migraine headaches given cinnamon, and found cinnamon to be beneficial for migraines [3].

Cramps: Hooray! Researchers found that “cinnamon can reduce the intensity of primary dysmenorrhea” or painful cramps. Cinnamon was given at onset of cycle for 72 hours for 2 cycles and found helpful [5].

Peripheral Neuropathy Pain: Cinnamon improved nerve damage in peripheral nerves [11]. Research demonstrated that cinnamon positively affects peripheral nerve restoration! Another study demonstrated it's ability to heal the sciatic nerve after crush injury [16]. This is amazing news for those with peripheral neuropathy from diabetes, long covid, or other causes. Unlike the central nervous system, the peripheral nervous system can actually heal and repair when we add herbal medicine and remove the “Obstacles to Cure” and address the “Root Cause."

Thrush: Cinnamon was found beneficial as a treatment against thrush and yeast species [4].

Nasal Spray: I fear to discuss this cinnamon nasal spray research and pray children on social media will not change the “Cinnamon Challenge” from eating cinnamon to snorting cinnamon! But,  since the research found cinnamon beneficial I will share that intranasal cinnamon solution improved seasonal allergies [6].  Keep in mind this was a nasal solution of cinnamon and nobody was snorting straight cinnamon!

Because cinnamon is anti-inflammatory, antiviral, and antifungal I would be excited to see a commercially available cinnamon nasal spray to help prevent and treat chronic sinusitis. Especially for allergy sufferers as oftentimes seasonal allergies inflame the tissues and thus increase risk of infection. 

Bladder Pain: Cinnamon applied over the bladder as a patch was found beneficial for reducing bladder pain in those with "Overactive Bladder" [13].

Lip Plumper: Cinnamon when combined with menthol and capsaicin was found to be a safe and effective lip plumper [14].

Mouth Ulcers: Cinnamon was an effective topical agent for mouth ulcers or apthous stomatitis [15].

Cinnamon Safety Research: Cinnamon was found to be extremely safe by researchers that concluded they found no significant side effects or toxicity with cinnamon including “hepatoxoxicity or anti-coagulation properties” [8] Meaning cinnamon is non-toxic, and does not actually interfere with blood thinning medications.  Cinnamon was also found not to cause electrical changes to the heart via ECG [17].

Researchers also concluded no side effects for cinnamon at doses that also “demonstrated anti-hyperlipidemic and blood pressure lowering effects among healthy adults” [9] 

So cinnamon is generally safe and non-toxic at therapeutic doses, while working to lower both cholesterol and blood pressure. Considering how effective cinnamon is for diabetes it should be considered as a first line treatment doctors can trust when treating diabetes, cramps, high cholesterol, seasonal allergies, thrush, and peripheral neuropathy. Especially in a mild range where diet and exercise may be sufficient to control the pre-diabetes or diabetes. 

I have personally reversed many diabetics A1c levels with cinnamon from 6.5-7% into the normal or just prediabetic range with cinnamon, carb counting, and exercise! 


The most dangerous thing about using cinnamon as an herbal medicine is when patients buy grocery store garbage cinnamon. This is generally not real cinnamon just like how most vanilla extract is synthetic chemicals and not actual vanilla… which is why real vanilla is more expensive as is real cinnamon. To counteract this simply buy real cinnamon as I buy from either Mountain Rose Herbs or Starwest botanicals, or at the very least buy organic cinnamon at the grocery store from a reputable brand. 

Otherwise the worst side effects I generally see with cinnamon are nausea from its tannins. Tannins stop up the intestines. This is why cinnamon is a helpful antiviral herb against diarrhea and stomach flu symptoms. 

When implementing therapeutic levels many of my PCOS and Insulin Resistant patients become nauseated from the tannins. This tends to be alleviated by cutting the dose in half and slightly increasing carbs in the diet until the stomach has adapted to the treatment plan after a few weeks. Your stomach can get adjusted to the tannins, I promise. Rarely is it a long term side effect.

Suddenly dropping carbs and/or adding in high amounts of blood sugar herbs will cause side effects. These drastic sudden changes to blood sugar can cause nausea, vomiting, dizziness, and fatigue and thus it is best to implement the dose gradually. 

Patients on medicines for heart disease, diabetes, and high blood pressure should work with their Naturopathic Doctor to determine if cinnamon is a good choice. Often the interaction effect with cinnamon is improving these conditions as it provides a synergistic benefit, and therefore medications need to be monitored with labs and vitals and adjusted down over time as the herb begins to help.  

Do not use cinnamon at therapeutic levels if you are already overheated, having hot flashes or night sweats as it is a heating herb and it may make you feel warmer. As one of my diabetics on 2 capsules of cinnamon three times a day once described, “I can stand out in the snow with just shorts and a tank top on and feel warm. This much cinnamon gives me superhero powers against cold!”

While some women appreciate the gentle warming effect, and not all of my overheated patients are made worse by cinnamon, not every herb is the best fit for every woman as we have unique hormone patterns and constitutions like snowflakes. 


Cinnamon pairs really well with berries, bananas, oats, apples, peaches, and chocolate for those that prefer to use it as “food as medicine.”

Cinnamon can be made as an herbal tea, added to smoothies, added to high fiber oat muffins, sprinkled over smoothie bowls, stirred into melted dark chocolate with stevia and walnuts for a lower carb therapeutic treat, or stirred into ¼ cup of applesauce. 

When using cinnamon therapeutically the typical dose is around 1 tsp of real organic cinnamon twice daily with meals. I recommend starting with ½ tsp and working up to that.  Do not take cinnamon on an empty stomach as it will cause vomiting from its blood sugar lowering properties and tannins effects on the stomach. This herb must be taken with food especially at high doses. 

Check out my Gingerberry Blaster, Elderberry Syrup, and Apple Bottomed Smoothie recipes to learn more ideas about how I like to use cinnamon in my daily diet. 

Need my help with your Women’s Health or hormone condition? Simply visit my SCHEDULE page to treat yourself to a Naturopathic visit. I would be happy to help.

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!


  1. Zare R, Nadjarzadeh A, Zarshenas MM, Shams M, Heydari M. Efficacy of cinnamon in patients with type II diabetes mellitus: A randomized controlled clinical trial. Clin Nutr. 2019 Apr;38(2):549-556. doi: 10.1016/j.clnu.2018.03.003. Epub 2018 Mar 11. PMID: 29605574.
  2. Borzoei A, Rafraf M, Asghari-Jafarabadi M. Cinnamon improves metabolic factors without detectable effects on adiponectin in women with polycystic ovary syndrome. Asia Pac J Clin Nutr. 2018;27(3):556-563. doi: 10.6133/apjcn.062017.13. PMID: 29737802.
  3. Zareie A, Sahebkar A, Khorvash F, Bagherniya M, Hasanzadeh A, Askari G. Effect of cinnamon on migraine attacks and inflammatory markers: A randomized double-blind placebo-controlled trial. Phytother Res. 2020 Nov;34(11):2945-2952. doi: 10.1002/ptr.6721. Epub 2020 Jul 7. PMID: 32638445.
  4. de Araújo MRC, Maciel PP, Castellano LRC, Bonan PRF, Alves DDN, de Medeiros ACD, de Castro RD. Efficacy of essential oil of cinnamon for the treatment of oral candidiasis: A randomized trial. Spec Care Dentist. 2021 May;41(3):349-357. doi: 10.1111/scd.12570. Epub 2021 Jan 21. PMID: 33475184.
  5. Jahangirifar M, Taebi M, Dolatian M. The effect of Cinnamon on primary dysmenorrhea: A randomized, double-blind clinical trial. Complement Ther Clin Pract. 2018 Nov;33:56-60. doi: 10.1016/j.ctcp.2018.08.001. Epub 2018 Aug 15. PMID: 30396627.
  6. Steels E, Steels E, Deshpande P, Thakurdesai P, Dighe S, Collet T. A randomized, double-blind placebo-controlled study of intranasal standardized cinnamon bark extract for seasonal allergic rhinitis. Complement Ther Med. 2019 Dec;47:102198. doi: 10.1016/j.ctim.2019.102198. Epub 2019 Sep 24. PMID: 31780001.
  7. Lira Neto JCG, Damasceno MMC, Ciol MA, de Freitas RWJF, de Araújo MFM, Teixeira CRS, Carvalho GCN, Lisboa KWSC, Marques RLL, Alencar AMPG, Zanetti ML. Efficacy of Cinnamon as an Adjuvant in Reducing the Glycemic Biomarkers of Type 2 Diabetes Mellitus: A Three-Month, Randomized, Triple-Blind, Placebo-Controlled Clinical Trial. J Am Nutr Assoc. 2022 Mar-Apr;41(3):266-274. doi: 10.1080/07315724.2021.1878967. Epub 2021 Feb 19. PMID: 33605836.
  8. Ranasinghe P, Jayawardena R, Pigera S, Wathurapatha WS, Weeratunga HD, Premakumara GAS, Katulanda P, Constantine GR, Galappaththy P. Evaluation of pharmacodynamic properties and safety of Cinnamomum zeylanicum (Ceylon cinnamon) in healthy adults: a phase I clinical trial. BMC Complement Altern Med. 2017 Dec 28;17(1):550. doi: 10.1186/s12906-017-2067-7. PMID: 29282046; PMCID: PMC5745724.
  9. Ranasinghe P, Jayawardena R, Pigera S, Wathurapatha WS, Weeratunga HD, Premakumara GAS, Katulanda P, Constantine GR, Galappaththy P. Evaluation of pharmacodynamic properties and safety of Cinnamomum zeylanicum (Ceylon cinnamon) in healthy adults: a phase I clinical trial. BMC Complement Altern Med. 2017 Dec 28;17(1):550. doi: 10.1186/s12906-017-2067-7. PMID: 29282046; PMCID: PMC5745724.
  10. Hameed L, Farooq AD, Qureshi T. Analysis of Unani coded formulation on the hormonal parameters of patients with polycystic ovarian syndrome. Pak J Pharm Sci. 2021 May;34(3):899-907. PMID: 34602412.
  11. The current research demonstrated that Cin positively affects peripheral nerve restoration. Therefore, Cin therapy could be considered as a potential treatment method for peripheral nerve regeneration and its functional recovery. 
  12. Cao Van H, Guinand N, Damis E, Mansbach AL, Poncet A, Hummel T, Landis BN. Olfactory stimulation may promote oral feeding in immature newborn: a randomized controlled trial. Eur Arch Otorhinolaryngol. 2018 Jan;275(1):125-129. doi: 10.1007/s00405-017-4796-0. Epub 2017 Nov 8. PMID: 29119319.
  13. Chen LL, Shen YC, Ke CC, Imtiyaz Z, Chen HI, Chang CH, Lee MH. Efficacy of cinnamon patch treatment for alleviating symptoms of overactive bladder: A double-blind, randomized, placebo-controlled trial. Phytomedicine. 2021 Jan;80:153380. doi: 10.1016/j.phymed.2020.153380. Epub 2020 Oct 12. PMID: 33091856.
  14. Boen M, Alhaddad M, Guiha I, Wu DP, Goldman MP. A Single Site, Open Label Clinical Trial, Evaluating the Duration, Efficacy, and Safety of a Novel Lip Plumper. J Drugs Dermatol. 2018 Sep 1;17(9):999-1004. PMID: 30235388.
  15. Molania T, Malekzadeh Shafaroudi A, Saeedi M, Moosazadeh M, Valipour F, Rostamkalaei SS, Salehabadi N, Salehi M. Evaluation of cinnamaldehyde mucoadhesive patches on minor recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled clinical trial. BMC Oral Health. 2022 Jun 14;22(1):235. doi: 10.1186/s12903-022-02248-5. PMID: 35701773; PMCID: PMC9199160.
  16. Jahromi Z, Mohammadghasemi F, Moharrami Kasmaie F, Zaminy A. Cinnamaldehyde Enhanced Functional Recovery after Sciatic Nerve Crush Injury in Rats. Cells Tissues Organs. 2020;209(1):43-53. doi: 10.1159/000507016. Epub 2020 May 11. PMID: 32392570.
  17. Pender DN, Crawford PF, Clark JM, Crawford AJ, Prats AA, Shah SA. Effect of water-soluble cinnamon extract on electrocardiographic parameters: An analysis of the CiNNaMON trial. Complement Ther Med. 2018 Dec;41:302-305. doi: 10.1016/j.ctim.2018.10.009. Epub 2018 Oct 21. PMID: 30477858.
  18. Hajimonfarednejad M, Nimrouzi M, Heydari M, Zarshenas MM, Raee MJ, Jahromi BN. Insulin resistance improvement by cinnamon powder in polycystic ovary syndrome: A randomized double-blind placebo controlled clinical trial. Phytother Res. 2018 Feb;32(2):276-283. doi: 10.1002/ptr.5970. Epub 2017 Dec 18. PMID: 29250843.

Dr. Nicole Sundene

Scottsdale Naturopathic Doctor

Did you know the best health habits bloom one at a time just like the Barrel cactus? 

While the Barrel cactus normally has a gorgeous crown of flowers…that crown did not arrive overnight!

Instead each flower in my picture actually bloomed one flower at a time over several months from April to May.

This beautiful crown reminds me of my most successful Naturopathic hormone patients.  Women that are the most successful reaching their goals are working on small goals one at a time to improve, and not expecting to do it all at once. 

They understand many pieces of the picture need to be addressed and they work through perfecting simple steps one at a time.

Many New Year’s Resolutions fail because women become too overwhelmed to be successful. Most women lack the energy, time, direction, organization, and focus to make it all happen at once. 

That's when I see women totally give up!

Expecting yourself to do everything perfectly all at once is just as unrealistic as expecting this Barrel cactus to suddenly pop out its majestic crown overnight. Building long term healthy habits takes patience and fortitude. 

Think of each bloom as one single habit. What will you look like after working on one habit at a time such as exercise, proper hydration, eating vegetables, increasing lean protein, getting 10,000 steps in per day, getting outside for natural light, eliminating sugar, quitting smoking, decreasing alcohol, meditating, yoga, and eating clean?

What if we stopped these annual New Year’s Resolutions and instead focused  on Monthly Resolutions? Wouldn’t that feel so much less overwhelming and easy to accomplish?

They say it takes 28 days to make or break a habit.  

Each month of the year lets work on a new self improvement!

When my patients see and feel success from their efforts they are all the more excited to tackle the next goal. Building that self efficacy and knowing you receive great benefits from investing time and effort into your body will motivate you to achieve more and more.

After fifteen years of helping women feel and look their best, I have learned that women are much happier once they are fit and eating clean because they feel confident in their own skin. They are happy with their weight, their complexion is glowing, and their friends and family are shocked by their “sudden transformation.” Something I know isn’t magic because I watched it happen gradually over several months as their Naturopathic Doctor.

But for the friend that has not seen them in a while it appears to be as magical as the beautiful bright flower crown from the Barrel cactus.

Most people succeed by focusing on one small goal at a time. 

“Inch by inch is a cinch. Yard by yard is hard.”

Instead of making one big giant overwhelming resolution this year and giving up by Valentine’s Day, think about setting twelve mini health goals this year and work through them in steps! Go grab a pen and write them on your calendar now.

Stay committed to the process to succeed!

Need help deciding what to work on first? Visit my SCHEDULE page to treat yourself to a Naturopathic visit! I would be happy to help.

Wishing you the best health, happiness, and energy for 2023!

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, NMD

Female Hormone Specialist

Weight loss programs that fail to address female hormones in women often fail women!

Oftentimes in Women's Health the "Root Cause" of weight gain is hormone imbalance. We need to first diagnose and treat the hormone imbalance as well as implement my basic Naturopathic hormone balancing weight loss program that is 100% free for women to start below.

One thing that always brings me joy as a Naturopathic Hormone Doctor is helping women identify the specific weaknesses in their hormones and metabolism so we can target the exact nutrition program, macros, and hormone balancing supplements to aid weight loss.

Getting to see women transform to their fittest most beautiful version of themselves is such an amazing reward for doing this job! I often receive new patient referrals from my weight loss success stories as their friends and family have always seen them challenged by being overweight and suddenly like magic change right before their eyes.

The truth though is that it is not magic... it is hormone balancing with a splash of hard work.

When we don't understand women's complex female hormones, thyroid, and adrenal profile, expecting weight loss to happen is somewhat like vacuuming in the dark. While vacuuming in the dark will be somewhat helpful, we are missing things, it is inefficient, time consuming, lacks results, and is frustrating. Vacuuming just like hormone balancing becomes a lot easier when we "flip the lights on" and know exactly the obstacles we are dealing with as well as the areas of greatest concern!

By running a full panel of Naturopathic Hormone Labs women can target their nutrition to their own metabolism and understand exactly what ratio of fats, protein, and carbs will works the best for their specific constitution.

This is when I see "the lights come on" for my hormone weight loss patients and everything becomes much easier and efficient. Hacking macros and hormones with labs makes everything so much easier and my women are no longer "bumbling around in the dark" lacking a clear direction of how to best target their efforts.

Bumbling around in the dark is oftentimes why women fail with their weight loss program because they are busy trying different fad diets, and not gathering the specific information that helps optimize their personal metabolic challenges.

Naturopathy can work very well for weight loss when we can take the time to analyze nutrition, metabolism, hormones, and vitamins that can impact weight.

Female hormones are complex and precisely why weight loss for women can be very tricky when complex hormone imbalance is present. To further confuse matters, women experience hormone imbalance and constantly fluctuating hormones every month with PMS. As well as in their forties and fifties with perimenopause and menopause. Therefore it is important we rule out hormonal causes of weight gain with women first and foremost as this is impacting women monthly, and also in midlife when perimenopausal weight gain begins around forty.

When women cannot lose weight with diet and exercise I recommend we conduct hormone and macronutrient testing to determine the correct macro profile of carbs, fats, protein, and fiber needed. Looking at a full set of female hormones, thyroid, and adrenal tests can diagnose the particular hormone imbalance or imbalances impeding the metabolism.

As a thyroid specialist, I often see thyroid disease causing weight gain, and weight loss, but in women we MUST address all of the other hormones in the "hormone spider web" for a woman to feel properly balanced, healthy, and fit.

If we have a weakness in one part of the web it will impact the stability of the rest of the web.

The impact of estrogen deficiency that suddenly occurs in Menopause, can impact the rest of the hormone web and cause weakness in the thyroid, which is why it is imperative for women to have their thyroids checked when they are perimenopausal and menopausal in their forties and fifties. Some women will naturally start perimenopause earlier in their thirties.

The average age of menopause is 51, and perimenopause generally starts the ten years prior to menopause. Women that enter menopause at 45 will generally exhibit signs of hormone imbalance earlier, in their thirties. Premature Ovarian Failure occurs when women become menopausal sooner than age forty. POF is common in women with anorexia and low body fat as body fat levels directly increase estrogen levels whether too much body fat or not enough.

Menopause can also impact the adrenal glands in our spider web model. When the ovaries cease to produce estrogen, progesterone and testosterone, the adrenal glands become the sole source of hormone production. The hormones DHEA, and cortisol can begin to become deficient in menopause or sooner if there is "Chronic Stress."

Symptoms of adrenal fatigue can cause insomnia, joint pain, stiffness, moodiness, anxiety, depression, and a general blah unmotivated feeling where my patient has become flat and lost their zest for life.

The adrenals and the thyroid also interact with each other and when the adrenals become fatigued and cease to produce hormones that can impact the thyroid gland and tax it further. And vice versa. This is what is going on behind the scenes with many of my weight gain patient's labs.

It is not just always about the Thyroid! We must address our entire "Metabolic Web of Hormones" as I explain in my video about "Hormones and Metabolism" on my free class page.

Hypothyroidism, Hashimoto's, Insulin Resistance, and Adrenal Fatigue can also cause women to gain weight.

Testosterone deficiency occurs for most women around the age of 35, this is why our metabolisms slow down when we lose our lean muscle mass with menopause. Each year our metabolism goes down further as we lose our female hormones. Transitioning through perimenopause and menopause also causes the body to become more inflamed and Insulin Resistant. Insulin is the "Weight Gain Hormone," that causes women to gain weight despite following the same diet and exercise regime in their 20's.

"I am doing everything the same, I am not cheating." I commonly hear women complain as they continue to gain weight and cannot figure out why. Most women that are over-weight have insulin resistance and need supplements to address and correct this blood sugar disorder that is common in women with PCOS.

Sluggish liver can also impact the metabolism, as can inflammation from Food Sensitivities and Food Allergies.

Chronic Fatigue and Chronic Pain can cause women to exercise less resulting in less calories burned on the same diet.

The good news is that by addressing female hormone imbalance, and implementing the following Naturopathic weight loss program I will review today, I do see many cases of stubborn hormonal weight gain finally release!

Usually I treat the hormone imbalance with herbs and supplements. Herbal medicine takes time to work, most women only can lose one pound per week and need to be patient. If you have fifty pounds to lose as a woman, that is a year of hard work you need to mentally commit to doing for long term success to keep the weight off.

With menopause, generally Bioidentical Hormones are needed to reduce the inflammation spike causing weight gain. Women under fifty generally do not need hormones and instead have weight gain issues from excessive amounts of hormones as I discuss more in my "Estrogen Dominance" blog. Much of what I do for women and weight loss does involve making dietary changes and taking supplements.

In order to lose weight, one must follow the basic laws of physiology that you must consume fewer calories than you burn each day. This is especially important to follow if you have a thyroid condition, insulin resistance, or estrogen dominance! Expecting your twenty year old metabolism to burn a ton of calories is not realistic without first fine tuning your hormones and then creating a calorie deficit every day.

You must burn more calories from exercise than you consume. If you are inactive and not exercising this is why it is impossible to lose weight especially when lack of exercise is compounded by hormone imbalance.

Addressing the underlying causes behind poor eating and lifestyle habits with regular weekly counseling is the ONLY way to ensure a healthy and long-term approach to weight loss. Food should be fuel and not a treat. The treat is feeling and looking good from perfect fueling!

I know this very well based on how I used to look and feel before I went to Naturopathic school and how I look and feel now. Many people say I look better today than I did in college! That is because I am on the right fuel for my metabolism and hormones!

Eating wrong and not properly fueling your body is the hard way after living both options!

The best approach to weight loss emphasizes lifestyle changes that incorporate whole foods and activity. Many simple sustainable Naturopathic changes in diet and activity can lead to maintainable, long-term weight loss success.

Physical activity guidelines are recommended to complement the nutrition counseling and make this process easier and more productive.

If you are struggling with Seasonal Depression, or post holiday exhaustion it is imperative you get outside for an hour to get 10,000 lux of natural light every day to ensure your energy, metabolism and mood are optimal for weight loss. Especially for women that crave carbs! Lack of light puts us in a fatigued dormant state that is not conducive to fat burning.

Many of my weight loss patients have underlying mental health issues such as depression, anxiety, and PTSD and are using food for comfort instead of fuel. This can create a vicious mental health loop when choices for emotional reasons are worsening physical health, appearance, and self confidence which then drives more unhealthy food choices as "rewards."

Patients constantly seek instant gratification for emotional reasons to treat their poor mood. These poor fuel choices then cause them to feel more fatigued, lethargic, hopeless and depressed.

Depression, sadness, hopelessness and anger trigger more unhealthy food reward behavior and the vicious cycle continues as a woman continues to gain more and more weight.

By using Naturopathy and hormone balancing we can also treat these underlying mental health issues naturally and work to use new rewards such as jewelry, makeup, concerts, events, and fun trips rather than cookies, cake, and candy.

The interesting thing about women's health is that each woman generally has different hormonal metabolic challenges to address. It is not a one sized fit all program, although I generally need my patients following the basics below.

Please do not sign up for hormone balancing work with me if you are not willing to make at least some baby step changes with your diet. Occasionally I get new patients that seem to think all their problems will be fixed with popping a hormone or applying a cream. This is not realistic and we are working to balance the hormones so your metabolism is running optimally and you are receiving benefits from your efforts with diet and exercise.

Hormone testing is important in women's health since many women with hormone imbalance are starving themselves to death to compensate for their sluggish metabolism. Sadly, I see this happening often, and is why I am writing this blog so women know there is a better way than living on 800 calories a day in starvation!

Once I diagnose the metabolic problem and fine tune their hormones they are then able to eat a normal amount of food each day without gaining weight.

While each woman's metabolism is unique like a snowflake and will require labs to develop a custom tailored dietary macro program, I would like to share the basics for hormone balancing that generally work for most women with hormone imbalance. The best diet for balanced hormones is:

• HIGH in fiber-dense carbohydrates found in whole grains, beans, fresh fruits, and vegetables. Also, it is important to drink plenty of water= 60-80oz daily + 8 oz per "vice" of alcohol or caffeine and more water if you are exercising.

 MODERATE in fish and organic lean meats such as chicken and turkey.

 LOW in red meat, animal fats, hydrogenated oils, full-fat dairy products, pre-packaged, processed, and refined foods, sugar, alcohol, and caffeine.

General Tips
• Set a realistic weight loss goal, usually 1 to 2 pounds per week is recommended.
• Balance food intake with activity. The most successful weight loss programs combine increased activity with decreased caloric intake.

Tips to Increase the Amount of Physical Activity in a Day:
• Try some group activity classes at the local gym, fitness center, or swimming pool.
• Work out with family, friends, or neighbors. Motivation is increased with partners.
• Take a walk at lunchtime.
• Use a bike to run local errands and go for pleasure rides.
• Use the stairs instead of the elevator.
• Walk to the bus stop or work
• Park the car a few blocks away and walk.
• Dance to some favorite music at home or sign-up for a series of classes.

Tips to Reduce the Quantity of Food Eaten:
• Plan and prepare meals ahead of time.
• Identify foods that are often over consumed and set limits, or avoid.
• Identify and limit problem foods.
• Eat small, frequent meals and healthful snacks.
• Eat slowly and savor each mouthful. Allow 20-30 minutes for each meal, rest, set the fork down, and/or converse between bites. Chew the food well.
• Wait 10-15 minutes before taking a second helping.
• Serve food on a smaller plate.
• Drink two glasses of water or a cup of hot tea 30 minutes before meals to reduce appetite.
• Postpone a desired snack for at least 10 minutes. It may be helpful to take a walk, get some fresh air, drink a cup of water or tea, or take a short nap during this time.
• At restaurants eat half of the portion and take the rest home. Prepackage the food to go before starting the meal.
• Nurture with nonfood related activities, such as a hot bubble bath or a massage, developing a hobby, relaxing with a good book, or listening to some music.

Tips to Eliminate Eating Cues that Promote Overeating:
• Designate a specific place in the home to eat, preferably the kitchen or dining room. Eat snacks and meals only when sitting down at this place.
• Avoid watching TV, talking on the phone, reading, or driving while eating. This will help increase the awareness of fullness.
• Do the grocery shopping on a full stomach to decrease impulse buys.
• Create a schedule for eating. Plan meals and snacks at regular intervals, including the types of food to be eaten.
• Carry food to work or when going out, to eliminate long periods without eating.
• To prevent visual food distractions, keep all food stored in the kitchen cupboards or refrigerator, rather than out on the counter.
• Read or listen to motivational books, join a support group, or consider seeing a therapist to help with any emotional issues involving food, eating, and/or weight loss.

Diet, activity, and emotional work can provide feelings of health and wellness, which establish new patterns that support and nurture the body. Food should be eaten for fuel and not just for fun.

When we are on the best fuel we have the best energy and mental health.

Think well! Eat well! Be well!

If you need my help diagnosing and treating your personal hormone imbalance to determine your personalized weight loss plan, I would be happy to help!

Simply visit my SCHEDULE page to treat yourself to a Naturopathic hormone visit in my Scottsdale clinic or by telemedicine for all fifty states!

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!

“Hi Dr. Nicole, Thank you for your great blog! I love your recipes. My depression is much worse this time of year.  Why am I more depressed in the winter? What do you recommend?”

Tara M. Scottsdale

Prescription: Vitamin L 10,000 Lux

"Vitamin L" or Light in the form of "Lux" is very important in seasonal depression. Depression patients need to schedule their outdoor time when the sun is out or invest in a lightbox.

During these dark times, we are exposed to less light. Light is needed by the brain to produce serotonin. Serotonin is needed for a happy calm mood without depression, anxiety, panic, or worrying. Deficient serotonin can lead to loss of sleep at night. The next day you wake up tired and even more depressed and the Vitamin L deficient cycle continues on and on progressively getting worse with each winter month. With less light, most depression patients already low in serotonin feel much worse. You should ensure you are getting at least 1 hour of time outside if you battle seasonal depression or "Seasonal Affective Disorder" aka SAD.

Ideally, for my depression patients, I want them outside walking or doing something active one hour twice a day to optimize their neurotransmitter production. If you are depressed and also struggle with chronic pain or an autoimmune condition like I have and can't always exercise, at least plan to sit outside twice a day in a sunny patch in your yard or drive to a park. Chronic pain patients that cannot exercise still need to get outside and get fresh air and sunshine.

Whether you have depression just during the winter months, or whether you struggle with depression all year round that is exacerbated by the low light conditions of winter; having a solid plan in place to better cope with the realities of winter depression is an important preventative measure.

My last name SUNDENE serves as the perfect mnemonic to help remember how to take care of yourself throughout the winter months. These are the basics to be doing for patients with seasonal depression along with connecting with their counselor or therapist by zoom or in person. Most decent insurance plans cover counseling so please enroll in counseling and have someone help you manage your depression if I am not your personal "Holistic Psychiatrist."

If you live in Arizona like I do it is easy for me to get plenty of "Vitamin L" and take a walk outside or schedule reading and other activities like phone calls and zoom meetings outdoors. If you live in a low light Northern Latitude like I did in Seattle you will find that using a lightbox twice daily can be enough to boost your mood like a medium to low level anti-depressant so that you feel happy on less medicine.

Let's make light a mandatory part of every depressed patient's mental health program!

The Sundene Protocol for Seasonal Affective Disorder

“Sun” – We need 10,000 lux of light every day in order to produce enough serotonin to feel happy. This can be achieved by 15 minutes outside on a BRIGHT BLUE sky sunny day, or 1 hour outside when it is overcast. You may wonder “What in the world is a lux?” A lux is the light equivalent put off by one candle. So you can light 10,000 candles in your home to cheer yourself up (a bit of an expensive fire hazard!) or you can just invest in a lightbox on Amazon or at a local sun shop. When I first bought a lightbox I bought the least expensive one that only put off 5000 Lux per hour and quickly realized it was very time consuming for me to spend so much time in front of a lightbox. However to save money, if you sit at an office desk all day this IS a feesable option.

A lightbox is an excellent idea for those with seasonal depression and is best used for twenty to forty minutes in the morning and afternoon depending on the manufacturer’s recommendations to achieve the 10,000 lux equivalent. What I did not understand when I first purchased one is that the Lux is generally per hour. So most that emit 10,000 Lux require you to use them for one hour. Therefore to get 10,000 Lux from the 5000 Lux Lightbox

If you are unable to afford a lightbox you can simply try full spectrum light bulbs as these often provide enough light for those with mild to moderate seasonal depression. Keep your windows open and move your desk or work station to natural light or a lightbox if you are depressed and aim for twice a day so your body can optimally make serotonin.

Don't use your lightbox before bed or it will keep you up as serotonin needs to be converted to melatonin which happens as our natural light goes down in the evening. Using a lightbox right before bed may upset your sleep and throw off your 24 Hour Circadian Rhythm resulting in hormone imbalance. So I don't recommend using a lightbox for depression right before bed.

The best winter options are near water or snow in beautiful settings in order to visit during the gloomy months of winter as the light is intensified as it is reflected back up to our eyes. If you are concerned about protecting your eyes from UV radiation, you can buy sunglasses with a clear or light lens, but that still provide UV filtration as it is the actual photons of light that our brains use and not UV radiation to produce serotonin.

Those struggling with seasonal depression need to make an appointment with the sun or the sun’s substitute via a lightbox every single day. Topping off your serotonin levels by day means that more of this neurotransmitter will be available for conversion to melatonin (the hormone that keeps us asleep at night). Using light as medicine should easily improve your sleep, leaving you more energetic for the following day.

“D” -Vitamin D is no longer considered a vitamin, but a “pro-hormone." Vitamin D is produced in our bodies when UV light touches our skin. Most people living in the northern latitudes are easily vitamin D deficient if they do not spend 20 minutes outside each day. Vitamin D is an important mental health vitamin we can test with lab metrics to ensure your dose is optimal. Some patients need more than 2000 iu and some patients may have toxicity at higher doses.

Elderly people are more at risk for depression because they have thinner skin, and thus produce less vitamin D, they also absorb less dietarily. If you struggle with depression, it only makes sense to be sure that you are at least not deficient in vitamin D. If you care for a senior in a care facility make sure they are wheeled outside twice a day in the morning and afternoon so they can receive natural light that is important for their bones and mood.

The RDA of Vitamin D for women is 800 IU. Food sources of vitamin D are milk, fish, and yeast. I typically recommend 2000 IU of vitamin D for my patients struggling with depression as a cheap and easy insurance policy that they are not deficient in vitamin D since it is also important to boost the immune system.

If you would like to have your levels checked be sure that your physician orders the “25-OH-D” as that is the most reliable indicator of vitamin D stores. Do not ever exceed 5000 IU of vitamin D daily unless under the care of your Naturopathic Doctor. Dangerous side effects such as hypercalcemia can occur. Be sure to have your vitamin D levels tested every 6 months so you are in an optimal range between 50-80. Levels above 100 are considered vitamin D toxicity. Too much Vitamin D can cause high calcium in the blood and can be dangerous. Please do not overdose with vitamin D as I am seeing a lot of toxic levels come through right now. It is critical the vitamin is dosed properly.

“E” -Exercise- is the drug of choice for anyone that is depressed. It is a tough medication to take though when depressed because as best summed up by Newton’s laws of motion: “An object at rest stays at rest until acted upon by another force.”

I know as someone that has personally struggled with depression that when you are down in that dark depressing hole it is tough to get exercising, but stagnation is just going to perpetuate your problem. I tell my depressed self that refuses the concept of the walk, "You can be in just as bad of a mood on your walk," and usually going on the walk results in a lifting of my mood. Worst case scenario you are in just as bad as a mood when you started. Rarely does exercise not help lift my patient's moods. Too much time indoors right now is affecting people mentally and physically so please get outside and walk, bike, hike, play tennis, swim, play basketball, ski, snowboard... if you are depressed it is your job to figure out which TWO sports you are going to be doing for fun, fitness, and light. I will let you pick! Rotate the two sports every other day and give yourself one rest day per week if you need it. By planning to exercise every day patients are more likely to achieve the 5 days of exercise a week that is optimal for mental and physical health.

Countless studies support the efficacy of exercise for depression. If you struggle with seasonal depression be sure to try to exercise outside EVERY SINGLE TIME the sun is out! Find a walking, running, or cycling buddy and take turns pushing each other out there. Put your exercise equipment in your backyard as a temporary gym and exercise outside in the light.

Whatever you do…just keep moving! Being cramped up indoors during the winter months is the problem and not the solution. Your brain needs to go on a walk every day. The best way to be successful with exercise is to schedule it and plan to walk or bike at the same time every day. I like to walk my Golden Retrievers first thing in the morning while I sip my tea, and mountain bike after work. I plan my exercise at the same time every day, twice a day, and follow the routine even when in a bad mood because as a Naturopathic Doctor I know that exercise is the best medicine for my brain. Plus it is free and when you look fit and healthy you also feel happier. If you are having trouble making decisions because your depression is that severe following your mental health daily schedule is very important. Some of my depression patients are so depressed they cannot decide where, when and what to do for their exercise that is why following a daily and weekly fitness schedule is imperative for depression patients.

“N” –Nutrition is fundamental for anyone struggling with depression. When the body does not feel good the mind is soon to follow. Depressed thinking often results in poor dietary choices.When we are depressed and in a low light setting we crave carbohydrates so that the body can produce more serotonin.

However, sugar is exactly what the body does not need in the long term for healing from depression. The best diet for those with depression, anxiety, and bi-polar to follow is my PGE-2 Diet as it is high in the Omega-3's mental health patients need, is high in protein for amino acids and also improves inflammation. You will also receive yoga and mediation videos that are only 10-15 minutes to do and easy to reset your brain and adrenals. Did you know multiple studies show a link between depression, anxiety and inflammation? When I started seeing my PGE-2 Diet improve my patient's moods, I realized how important this inflammation link is!

Protein is mandatory for depression patients. Female depression patients, in my experience as a naturopathic doctor are generally all eating very low protein causing their brains to be starved of the necessary amino acids needed to form hormones and neurotransmitters that help us feel happy such as tryptophan, taurine, and tyrosine. The thyroid needs tyrosine to make hormones and T3 is needed to make serotonin in your brain so not eating enough tyrosine foods can cause depression. Serotonin is formed from tryptophan which is why we give patients 5-HTP as an amino acid therapy precursor to boost serotonin levels. Eating a diet of all carbs is very common for my depression patients. We crave carbs because carbs give us a quick boost of serotonin, but then that goes away and is not sustainable when we lack a constant supply of amino acids needed for mental health.

Balancing your blood sugar will also help keep the mood at an even keel throughout the day. Be sure to eat protein and fiber with every meal to prevent low blood sugar crashes that can trigger depression, anxiety, and panic attacks. Especially focus on eating foods high in tryptophan such as turkey, cottage cheese, peanuts, fish, eggs, oatmeal, avocados, and bananas. Patients with Bipolar Depression may boost mania by eating some of those foods so please work with a Naturopathic Doctor experienced in these matters such as myself!

A high quality multi-vitamin will cover all the bases and ensure that you are not deficient in any of the B vitamins that are coenzymes for producing the neurotransmitters that make us feel happy. Be sure the b-vitamins are ACTIVE and not SYNTHETIC GARBAGE like Centrum or Flintstones vitamins. Synthetic vitamins will only make it worse. Invest in quality for your brain. Taking a high quality multivitamin is a simple and inexpensive thing to do that is especially important in Women's Health as low iron levels are the #1 thing I find causing anxiety, depression, sadness and chronic fatigue in women. Because women are losing blood every month it is important they replete iron stores sufficiently for anxiety, depression, and mental health.

My depression patients are also often deficient in Omega-3 Fatty acids from fish oil, flaxseeds, walnuts, chia seeds, or algae. That is it. There are essentially no other sources of Omega-3's and any other nuts or oils are full of omega-6 and omega-9 that can increase inflammation. Since there is a link between increased inflammation and depression and anxiety it is imperative that patients take a supplement of Omega-3's if they don't like the food sources. When I learned about this I realized that my severe aversion to fish is part of why I am prone to depression and simply taking a high dose fish oil every day was a huge game-changer for me. Those are the only sources of Omega 3's. Unless you are allergic to fish the active form of Omega-3's in fish oil will be more beneficial to your mood than vegan sources as the vegan source has to be converted to the active form which is a biochemical step that some people genetically lack the genes to make this conversion such as Scandinavians like myself.

“E” -For Everything Else please work with a doctor on your individualized care plan. There are many treatment options for depression. I could go on and on about amino acid therapy, herbal medicine, genetics and nutrition related to depression but it is important you work with someone overlooking your big picture. My most successful mental health patients in my practice work with me closely for 3-4 months checking their hormones, vitamins and amino acids related to their depression. They keep me updated with what is working and what is not working at monthly appointments until we have an effective treatment plan. As a Naturopathic Doctor I have helped many patients off of their anti-depressants but it is a process that requires we add in all of the correct nutrition and natural medicines first and then after a few months we gradually wean down the anti-depressant. Depression patients should never suddenly stop taking their anti-depressants. As a Naturopathic Doctor I really don't have a problem with anti-depressants. They are not a drug I see causing long-term effects that I find dangerous. The real problem with them is when they simply do not work because something is wrong with the patient and they don't make enough serotonin for instance to be recycled by the anti-depressant. By working closely together for a few months we can study your personal weak spots and target nutrition directly towards the weak spots to strengthen your mental health. Eventually I work my way out of a job when my mental health patients improve and they no longer need me.

Stay tuned for my blog on Neurotransmitter Testing as this was very helpful for me. Knowing that my body struggles to make serotonin and other neurotransmitters that calm the brain was a relief to know!

Please do not give up hope, I am providing an overview of what I do for depression patients so you do not ever give up hope. Rarely can I not help patients. The only patients I cannot help are the ones too depressed to follow their care plan. If you are in this boat you need someone to help you facilitate the plan for it to be effective and I reccomend bringing your Mom or Husband to your appointments, or have them listen in on your Telemedicine calls so they understand what you need to do. Be sure to implement the basics for your seasonal depression above and work with your doctor or book a visit with me below.

Counseling, herbs, amino acids, and of course anti-depressants when needed will help keep you out of that dark “hole." Naturopathic treatments for depression often take time as they are addressing the whole person and the long term.

As a physician, I give every depression treatment plan 2 to 4 weeks to determine its efficacy. Natural medicines take time to work. This is why I recommend monthly visits for mental health patients. Even a prescription antidepressant takes 2 weeks to work. If you are not experiencing improvement you may want to consider other treatment options but please don't throw away the depression treatment too soon. Too many of my depression patients have tried something for ONE DAY and then felt depressed and hopeless that the natural medicine did not work. We need to have realistic expectations for mental health. The same rules for Naturopathic Medicine apply to medications and you need to try something for at least a few weeks to give it a chance.

Various counseling and therapy techniques are also available to teach you how to cope and self-soothe, if you find you are not making progress with your therapist, consider a new referral for a different type of therapy such as EMDR or tapping. Sometimes talking about your problems can only get you so far and we need to focus on coping tools.

Remember that aside from physical and mental components, there is also a social component to seasonal depression. Much time spent inside, or repeatedly with the same people inside can contribute to a poor mood. Schedule weekly activities to get you out of the house and interact with others. If your relationship is struggling schedule yourself away to give everyone a break. Absence makes the heart grow fonder!

Did you know I have had to provide a lot of marriage counseling during the Pandemic for my patients? Everyone is struggling with too much time spent together. I promise you are not the only one!

If you live alone, the winter months can feel especially isolating. Find an elderly person that also lives alone to check in on, it will do you both a world of good. Many of my seniors are struggling with loneliness and it would be great if you could check on them for me. They need their neighbors to chat with them. It is okay to not feel your best right now. We have all been through a lot. It is very normal to feel down and depressed. After 22 years of working in Family Medicine, I have never seen people more sad, angry, frustrated, distressed, and depressed.

IF you need help looking at your hormones and nutrition related to your anxiety, depression or mental health challenges pop over to my appointment SCHEDULE page and book a visit. A lot of what I do is diagnostic if you are not in Arizona, we can still use Telemedicine to order your labs and work together to determine if your female hormones, thyroid, adrenals, and nutrition are all properly balanced or not. Herbs and supplements can still be prescribed to those out of state.

Ladies, as a Female Hormone Specialist I can assure you that female hormone imbalance is often the root cause of your mental health issues. Please remember mental health challenges like anxiety, anger, and depression in women that fluctuate monthly indicate high estrogen levels as seen with PMS. Feeling blah, depressed, lifeless and in a constant tired fog can be from imbalanced adrenal hormones or thyroid disease. Mental health challenges in women that start in the 30-40's can start because of low progesterone, perimenopause or pre-menopause. Sudden depression or anxiety that occurs with loss of estrogen in menopause can be treated with herbal medicine or bio-identical hormones. It is important if your body is changing with age that we get answers.

Thank you for your great Naturopathic Women's Health questions! Please continue to send them to my clinic address below on a postcard! I love to get something in the mail that is not a bill. Remember if your question can't fit on a postcard you need to schedule an appointment with me HERE.

Dr. Nicole Sundene, NMD

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, PerimenopauseAutoimmune, Postpartum DepressionChronic 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!

Location: 14300 N Northsight 
Blvd Ste 124
Scottsdale, AZ 85260
Ph: 480-837-0900
Fax: 480-409-2644
© Copyright 2023 | Scottsdale Naturopathic Hormones 
map-markersmartphone linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram