Dr. Nicole Sundene, NMD

Scottsdale Naturopathic Doctor

Gallstones and gallbladder disease are very common women's health conditions best served by a Naturopathic Doctor unless surgery is required. Whether you are working to avoid having your gallbladder removed, or you have already had your gallbladder removed you will need to follow this gallbladder diet.

Patients with emergency clogged bile ducts must have their gallbladders removed as it is a true medical emergency. Whereas patients with gallstones their doctor is keeping an eye on are good candidates for this diet. When patients have their gallbladders removed they generally have chronic diarrhea without a pouch to collect their bile, and instead have bile constantly dripping into their intestines which triggers chronic diarrhea.

Signs of gallstones causing an emergency are sharp pain in the right lower rib cage, sharp pain in the right shoulder blader, fever, chills, and/or yellowing of the eyes or jaundice. Patients do not need to have all of these symptoms to need to go to the emergency room for surgery.

Your gallbladder is a “pouch” below the liver that stores a fat emulsifying liquid (bile) produced by the liver.

While a small amount of cholesterol in the bile is normal, bile acids and lecithin are necessary to keep the cholesterol soluble. When there is more cholesterol than the bile salts and lecithin can dissolve, gallstones begin to form. Gallstones can be a medical emergency requiring immediate removal of the gallbladder located within the liver, or they may be under "watchful waiting" with instructions to go to the ER for emergency surgery should they develop sudden sharp pain in their upper right shoulder blade, or pain under their right rib cage where the liver is located.

This type of gallstone, made primarily of cholesterol, occurs most frequently. There are also many types known as “mixed” because they contain varying amounts of calcium and bilirubin along with cholesterol.

Gallstones (cholelithiasis) and inflammation of the gallbladder (cholecystitis) are the two most common forms of gallbladder disease. Gallstones are usually present when there is an inflammatory process going on within the gallbladder, and there is a controversy as to which of these disorders occurs first.

What follows are dietary guidelines to decrease both the cholesterol saturation of the bile and the irritation and inflammation of the gallbladder. Since the two conditions are so closely related, the same dietary guidelines apply. If you feel any of them need to be modified for your unique situation, please ask your doctor.

Gallstones can be a medical emergency requiring immediate removal of the gallbladder located within the liver, or they may be under "watchful waiting" with instructions to go to the ER for emergency surgery should they develop sudden sharp pain in their upper right shoulder blade, or pain under their right rib cage where the liver is located.

Dr. Nicole Sundene

(480) 837-0900

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

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

By Dr. Nicole Sundene

Female Hormone Specialist

PMS symptoms can be debilitating to not just women, but also to their husbands. PMS and hormone imbalance can sadly destroy marriages when not properly addressed and treated as it almost happened to my patient Jenny and her husband.

Googling for PMS symptoms, doctors and treatments are what triggered Jenny’s husband to drive her from California to Scottsdale for Hormone Testing. This is when he kindly brought to my attention that “Dr. Sundene is the #1 BEST PMS Doctor in all of California and Arizona” which is why he now calls me the “PMS Queen of the Southwest” and thanks me for saving their marriage.  He began to notice a monthly cyclical pattern to their fighting, and after failed marriage counseling for a year, he began to lose hope until he started to research more about PMS symptoms.

While it is hilarious to me to find out I am #1 for PMS on his Google list…. it also makes sense since I am a Naturopathic Hormone Doctor. I know very well from my 8 years of working in regular Family Medicine how many of the conventional medications for PMS we will discuss today truly fail women. Medications to mask PMS symptoms can only get you so far with hormone imbalance which is why we need to treat hormone imbalance at the root cause.   Otherwise many women with PMS end up on antidepressants, anti-anxiety medications, and birth control pills while still not feeling quite right. Or even worse their doctor tells them that PMS is normal and to just learn to live with it.

Patients with PMS need a solid Naturopathic approach to balance their hormones and prevent PMS which can take at least 3 months or “3 cycles” as the eggs releasing imbalanced hormones that are being made today have not yet undergone treatment with a Naturopathic approach with herbs and nutrition and therefore will continue to release imbalanced hormones until we address the impaired egg quality with nutrition and impaired liver detox pathways from genetic mutations such as COMT and MTHFR causing estrogen dominance. This is why Naturopathic Medicine is by far superior to conventional medicines and also why PMS symptoms tend to worsen with age.  I often refer to Perimenopause as “Permanent PMS” to my patients in their 40’s while they nod their heads and agree, which is why intervening sooner than later with PMS can save a woman’s mental health

As much as I love to joke around about PMS it is truly no laughing matter as it affects around 90% of menstruating women and is the most common condition impacting a woman's menstrual cycle. Studies report that PMS affected around 47.8% of women worldwide. PMS is a set of medical symptoms, including physical, psychological, and behavioral symptoms that occur before the beginning of each menstrual cycle in women typically days 21-25 of the menstrual cycle. These symptoms often last for a few days to 2 weeks typically between days 14-28 . 

Severity of PMS

Did you know that 20% of women reported severe PMS symptoms that disrupted their daily life activities?  1 in 5 women are experiencing very disruptive symptoms to their physical and mental health. In comparison, the rest of the women showed mild to moderate symptoms. Epidemiological studies reported that the prevalence rate of PMS among university students is 80-90%. [1]

PMS Symptoms

PMS is characterized by the following symptoms that appear during the second half or luteal phase of the menstrual cycle. The severity of symptoms ranges from mild to moderate, disrupting the daily life activities and relationships with family, partner, coworkers and friends. The consumption of alcohol aggravates or increases the risk of developing PMS symptoms. [1, 2, 3] 

It is important to note that when PMS symptoms get severe and cause mental illnesses like depression and anxiety, it is called premenstrual dysphoric disorder (PMDD).

Diagnostic criteria for PMS

Diagnosis of PMS involves assessment of symptoms and patient history. The PMS diagnostic criteria are based on the presence of at least one physical (Somatic) and emotional (Affective) signs during the 05 days before a period in each of the three previous menstruations. [3, 7]

PMS Treatment

Different treatment interventions, including both pharmacological agents and non-pharmacological approaches, help the symptoms of PMS. However, hormonal medications are commonly prescribed in the treatment of PMS symptoms. Other medications include painkillers, anti-anxiety agents, antidepressants, and diuretics. 

Hormonal contraceptives: 

Oral contraceptives such as progestin drospirenone and estrogen can reduce PMS symptoms. Studies reported that these synthetic hormonal medications can decrease PMS symptoms, improve daily life activities, social communication, and help poor mood in women with PMS. Although some women experience worsening of their PMS and mood swings and cannot tolerate hormonal contraceptives. The possible side effects include breast tenderness, increased risk of blood clotting, gastrointestinal symptoms, and breakthrough bleeding. [2, 4]

Plus, hormonal contraceptives are contraindicated in case of pregnancy or women who want to conceive. Always consult with your physician first because there are limited research studies about the best and most effective hormonal contraceptive agents for PMS symptoms. [2, 4]

Antidepressants:

Antidepressants such as Selective serotonin reuptake inhibitors (SSRIs) can be useful for treating depression and anxiety associated with PMS. These are the first-line treatment options that increase the serotonin concentration in the brain and help women with psychological and behavioral symptoms. [2, 4]

SSRIs include Sertraline (Zoloft), paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa), and escitalopram (Lexapro).

It is recommended to take SSRIs for at least three months to become effective during the second half of the cycle. Most treatments for PMS will require long term dedication. The side effects of SSRIs include nausea, weight gain, dry mouth, sleep disturbances, and low libido. [2, 4]

NSAIDs:

NSAID medications such as  aspirin and ibuprofen can provide anti-inflammatory and analgesic effects. This class of drugs can relieve inflammation and pain associated with PMS. They help with headaches, body aches, muscle aches, backaches, period pain, and other physical symptoms of PMS. The side effects associated with NSAIDs include gastrointestinal distress, ulcers and drowsiness. [2, 4]

Diuretics: 

Diuretics can help with edema swelling and swollen breasts during PMS. Diuretics whether natural or prescription work to increase water release from the body and help edema. The side effects associated with diuretic drugs include nausea and headaches. [2, 4]

Gonadotropin-releasing hormone agonists:

Gonadotropin-releasing hormone (GnRH) analogs are rarely prescribed for the management of severe PMS symptoms. They interfere with hormone production in the ovaries. Side effects with GnRH agonists include hot flashes, insomnia, and depressed mood. These agents are not recommended for more than six months and are contraindicated in women who want to become pregnant. It is important to mention that there are minimal studies about their clinical effectiveness. [2, 4]

Progesterone

Progesterone can be beneficial during PMS when used correctly and can help balance the “Estrogen Dominance” occurring when estrogen is too high and progesterone is too low during PMS. Research studies however have shown no significant effect of progesterone on PMS symptoms compared to placebo. Plus, they can impair regular periods when not used cyclically as a withdrawal from hormones . Progesterone gel in Germany is approved to use for premenstrual breast tenderness. [2, 4]

Herbal and Dietary supplements

In addition to the medication, certain herbs and dietary supplements also help PMS symptoms. Naturopathic Doctors use nutrients like magnesium, pyridoxine (vitamin B6), calcium, turmeric, chaste tree extracts, evening primrose oil, St. John's wort, peppermint, angelica root, tangerine leaf, and Ginkgo biloba to ease their patient’s PMS symptoms. However, minimal data currently suggest the use of these herbs and nutrients in the management of PMS symptoms. While natural medicines for PMS do not have significant research their side effects are generally minimal and well tolerated to help women manage their symptoms. [2, 4] Many natural remedies and counseling can also be beneficial for women struggling with PMS. There is no solid research evidence about the use of cognitive-behavioral therapy (CBT), homeopathic medicines like Pulsatilla or Sepia, acupuncture, and reflexology massages to manage PMS symptoms. [2, 4]

Lifestyle modifications

Research suggests certain lifestyle modifications such as intake of high fluid, regular exercise, and meditation, the addition of nutrients, taking enough sleep, and avoiding high sugar, salts, caffeine, and alcohol may help PMS symptoms. Keeping a period tracker app to plan for expected mood swings and shift in energy can also help women minimize their symptoms and target their natural remedies for PMS to the appropriate time in their menstrual cycle when PMS symptoms will be expected to be at their worst. [1]

If you would like my help with your PMS simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit! Remember that the medicine I provide to women is in the form of nutritional changes, taking herbs and supplements in capsules, tinctures, or teas. So if that type of thing does not work for you please do not sign up to work with me as I will not be able to help you. Otherwise, if you are open to using Naturopathy and herbal medicine I would be happy to help!

Dr. Nicole Sundene, NMD

(480) 837-0900

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

References

  1. Gudipally PR, Sharma GK. Premenstrual Syndrome. [Updated 2020 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
  2. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Premenstrual syndrome: Overview. [Updated 2017 Jun 15].
  3. Hofmeister, S., & Bodden, S. (2016). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American family physician, 94(3), 236–240.
  4. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Premenstrual syndrome: Treatment for PMS. [Updated 2017 Jun 14].
  5. Dickerson, L. M., Mazyck, P. J., & Hunter, M. H. (2003). Premenstrual syndrome. American family physician, 67(8), 1743–1752.
  6. Yonkers, K. A., O'Brien, P. M., & Eriksson, E. (2008). Premenstrual syndrome. Lancet (London, England), 371(9619), 1200–1210. https://doi.org/10.1016/S0140-6736(08)60527-9
  7. Kwan, I., & Onwude, J. L. (2015). Premenstrual syndrome. BMJ clinical evidence, 2015, 0806.
  8. American College of Obstetricians and Gynecologists. Guidelines for Women's Health Care: A Resource Manual. 4th ed. Washington, DC: American College of Obstetricians and Gynecologists; 2014:608.

Hormone Testing for patients with hormone imbalance such as menopause, perimenopause, hypothyroidism, Hashimoto’s, PCOS, Insulin Resistance, cystic acne, and hormonal acne is extremely complicated, and should therefore only be conducted only by a Naturopathic Doctor specializing in hormones and never should the labs be ordered by an MD, otherwise, the labs receive are incorrect and the patient will then need multiple appointments to review the labs that are incorrectly ordered. 

Our clinic works hard to ensure that insurance covers hormone testing which would otherwise cost $800-$2000 if not paid by insurance for an initial hormone panel to determine the type of hormone imbalance. Please read the following information carefully to ensure we can process your labs accurately via your insurance. 

Patients with standard insurance plans such as Cigna, BCBS, United Healthcare, Aetna, etc should call their insurance provider to determine which lab is contracted with their plan. It will be either Labcorp (preferred) or Sonora Quest (more errors, greater wait time.) For these plans, it does not matter who the ordering doctor is. It matters that the doctor has the correct diagnosis codes to match the labs that are being ordered and that the patient is at the correct lab that is contracted with their plan. If your PPO plan does not care what lab you go to we recommend Labcorp as less likely to cause errors at this time. 

Patients should be fasting and go to the lab around 8am with no caffeine or AM hormones taken the day of their blood draw. If you get to the lab and realize you have taken hormones, your lab tests will be inaccurate and need to be repeated. It is best to leave and not waste your insurance opportunity on incorrect labs. Please take any AM hormones after your blood has been drawn to avoid false elevations of thyroid and bioidentical hormones. If you take PM hormones such as BHRT, Bioidentical Hormones such as estrogen, progesterone or testosterone, please take these as you normally do before bed. Patients should not have a lapse in their medication the two weeks prior to their blood draw or their labs will be incorrect. Any caffeine the day of your labs will interfere with your hormone labs, as will any biotin taken the 2 weeks prior to testing. Biotin interferes especially with thyroid tests. 

Menstruating women: Should have their blood drawn days 21-25 of their menstrual cycle with day 1 being the first day that they start to bleed. 

Non-menstruating women: Can have their blood drawn at any point in the month

Cash Pay Patients: For patients without insurance, we recommend cash labs at Sonora Quest as the most cost-effective option. The first panel is generally $500-$800 to determine the diagnosis of hormone imbalance, then follow-up spot checking of the imbalanced hormones is generally around $200. Patients receive the cash pay discount by paying at the time of their blood draw. 

Please be advised that no MD is trained in Naturopathy and Hormones and therefore no MD should be ordering Dr. Sundene’s labs. The only exception we make to this rule is for patients with AHCCSS or Medicaid Arizona state insurance as Naturopathic Doctors are not able to order labs for these patients. Patients requiring the use of AHCCSS for their labs should always first submit the lab report from their MD to Dr. Sundene by faxing the report to 480-409-2644 prior to booking their visit so she can review that the labs were correctly ordered. There are multiple variations of thyroid and hormone tests, and MD’s including Family Doctors, Internists, OBgyns, and Endocrinologists 100% of the time do not understand the complex hormone labs needed. When patients erroneously think the MD will do a more comprehensive job ordering their labs we end up with half the information we need. It is the patient’s responsibility to ensure they are not causing lab errors by having an MD order the wrong labs. The patient is then financially responsible for multiple follow-up visits. 

Patients with Medicare MUST be at Labcorp or they are 100% financially responsible for their hormone labs. Vitamin testing is not generally paid by Medicare, nor is Hemoglobin A1c. While Medicare does not deem the  Hemoglobin A1c necessary, it is necessary for the hormone doctor to properly help you and you will need to pay the medicare contracted price of $40. Patients with a secondary insurance generally have this covered. The patient may also receive an additional bill of $20-$40 for each vitamin test that is not covered. Patients with Medicare should have a PCP via their Medicare to order any imaging they require as imaging is not covered when ordered by a Naturopathic Doctor such as Mammograms, X-rays, DEXA, Ultrasound, and so forth. 

For more questions about Bioidentical Hormones, or information about hormone testing for Psychiatry and mental health, please visit our page on Bioidentical Hormones.  

To set up your new patient visit to receive a lab order, please visit our SCHEDULE page.

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

Has something destroyed your house, life, job, family, or soul? Licorice shall restore you!

The brilliant thing about herbal medicine is that it has restorative adrenal adaptogen herbs to repair weary tattered souls. When I worked in regular family medicine antidepressants were really all we had to offer patients suffering from too much stress. Sleeping pills for insomnia, ADHD medications for fatigue, and valium for anxiety.

What I have learned later on from practicing Naturopathy is that many of these depressed, blue, sad, exhausted, and blah feeling patients simply needed a solid adrenal adaptogen such as licorice root!

I love licorice as an adrenal adaptogen herb because it is also a potent antiviral. This root is one of our most powerful anti-inflammatory herbs. When we need to cut inflammation and revive patients that are weak, dilapidated, running LOW with low immunity, low blood pressure, low mood, and low cortisol adrenal hormone levels... licorice is the perfect herb!

Especially when there are any digestive issues going on such as heartburn, ulcers, acid reflux, constipation, IBS, liver disease, hepatitis, and cirrhosis licorice root is the perfect herb. Licorice is safe to use as a demulcent healing herb similar to the slippery nature of aloe vera. It helps heal and soothe irritated membranes in the digestive and respiratory tracts.

Licorice is an amazing cough syrup which is why I had to preserve the licorice I used in my Herbal Gingerbread house we destroyed on Instagram, and turn it into an herbal syrup. Since I use Stevia to sweeten my syrup and keep them low carb, I freeze them instead of preserving them in sugar.

First I let the syrup cool and then freeze it in ice cube trays. Once you make your licorice ice cubes you can store them for a rainy day in the freezer. To use simply pop a couple cubes into your hot tea or coffee to boost it with nature's best steroid. Licorice is often akin to giving patients a Medrol dose pack. So if you do not feel well on steroids you should discuss the use of licorice with me or your own Naturopathic Doctor.

As an Autoimmune specialist, I use licorice for many of my patients to help naturally reduce their inflammation. For autoimmune hormone conditions like Hashimotos, it can also be very balancing and supportive to the immune system. Immune support herbs are "immune modulating" so in a hyper autoimmune state such as what I have, Lupus, or other autoimmune diseases I commonly treat like scleroderma, MCTD, Sjogren's, Hashimoto's, and Rheumatoid Arthritis this herb can really be helpful. Although we should always monitor our autoimmune patients when implementing new treatments to ensure they are working properly and not causing "Paradoxical Reactions" as many of us often have strange reactions to foods and medications.

For patients that are exhausted with prolonged coughs from asthma, bronchitis, or pneumonia this is an excellent restorative herb for their lungs and energy levels. But this powerful medicine is not without side effects and should not be used by patients with high blood pressure or on any medications. I also generally do not recommend using licorice with any medications unless you are working with a skilled Naturopathic Doctor trained in Integrative Medicine. Because licorice is a powerful medicine it has more herb-drug interactions than most herbs.  

Licorice is also contraindicated for patients that have overactive adrenal glands such as in Congenital Adrenal Hyperplasia (CAH), PCOS, and stage 1 adrenal fatigue. Please do not take licorice if in adrenal excess, you instead need a calming adrenal adaptogen herb for your type of hormone imbalance such as ashwagandha.

Licorice may be overstimulating for patients with PTSD, although many of my PTSD patients report improvements by taking small amounts in the morning. Do not take licorice at bedtime or it will cause insomnia. You want to use herbal medicines that boost the adrenal glands in the morning when the glands are the most active and need the most support. At bedtime, a calming sedative tea is generally better to quiet the mind.

If you have been feeling depressed, fatigued, or blue and need help getting your energy, mood, and attitude back on track simply pop over to the SCHEDULE page of my website to treat yourself to a Naturopathic visit. We can easily rely on modern insurance-based lab metrics to test your hormones, adrenals, thyroid, and vitamins so we can put together a custom herbal medicine plan based on your specific constitution, symptoms, and lab numbers.  

Dr. Nicole Sundene, NMD

(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. Swab the tops of your bottles with rubbing alcohol. 
  2. Put the large needle “Draw needle” on your syringe and fill your syringe with the appropriate amount of each medication. 
  3. Fill the same syringe with all the vitamins as long as the total quantity is under 3cc. While they need to stay separate for storage, they can be mixed together in the syringe.
  4. Tap the syringe to remove any extra bubbles.
  5. Push the plunger up slowly to release any bubbles at the tip of the syringe.  
  6. Inject the upper outer quadrant of the gluteus maximus or “butt cheek.”
  7. Refer to a Youtube video or schedule an appointment with your Naturopathic Doctor for proper location instruction if you require additional support.
  8. To visualize the proper location cut the gluteus in to 4 quadrants by visualizing a plus sign over the gluteux maximus, and inject the upper outer quadrant. 
  9. Avoid the midline of the gluteus as it contains the sciatic nerve. 
  10. Alternative injection sites are the deltoid muscle <1.5 cc max solution, the top of the thigh or side of the thigh <2cc max solution
  11. Dispose of your sharps in a sharps container.
  12. You can unscrew the needle and place that in to the sharps container and then throw the syringe in regular trash to eliminate waste with your sharps containers. 
  13. Dispose of your sharps in accordance with your state law. In Arizona patients can use a sturdy plastic bottle like a gatorade bottle ( not a plastic water bottle) and repearedly duct tape it closed. It can then be disposed in regular trash.
  14. Many pharmacies also provide a sharps removal service.
  15. Check with your local pharmacist for the correct way to properly dispose of your sharps in your state. 
  16. Please Note: B-complex can slightly sting and burn. This is normal. Slow the rate of the injection down to your comfort level. Apply a warm pack if too uncomfortable. If the injection is severely painful you have hit a nerve. Make mental notes when you find a less painful location for your shot. If adminstering the shot yourself it helps to turn and look in to a bathroom mirror. Or make sure your shot is loaded up properly and have someone administer it for you. 
  17. Any redness, heat, swelling, or streaking is a sign of an infection from lack of sterile technique that requires antibiotics.
  18. Discard your injectable vitamins as instructed by the compounding pharmacist, or per the expiration date. Do not inject expired vitamins, or vitamins that have not been properly refrigerated as this will cause a fungal or bacterial infection.
  19. When you need refills of your vitamin injections please contact the compounding pharmacy as we call in refills for a year for each patient.
  20. When your refills have run out you are legally due for a visit or we cannot prescribe you any medication.

For further assistance administering your injection please visit the SCHEDULE page and book an injection training visit.

Dr. Nicole Sundene

(480) 837-0900

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

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

Dr. Nicole Sundene, NMD

Scottsdale Naturopathic Doctor

Mercury filling removal can stir up toxins in the process, so it is imperative that women considering this do it properly. I get this question asked nearly every day as a Naturopathic Doctor, so I would like to take the time to explain the Do's and Don'ts of this potentially dangerous process when not done properly.

I would like to take a moment to just briefly summarize the basics of safe mercury amalgam removal, as well as how to support the natural elimination of mercury from your body.

I tend to be very conservative in my thinking as a naturopathic doctor, and hope that women go about having their mercury amalgams replaced sensibly, and slowly over time. The rationale for this, is that you are likely exposed to much more mercury in the removal process than what is released from chewing your food or grinding your teeth.

Below are key points to ensure your fillings are safely removed, followed by tips to help safely eliminate mercury from your system.

Safety Considerations for the removal of mercury amalgams:

Natural ways to aid detoxification of mercury from the body:

Remember, it is not an “emergency” that these fillings are removed. However, I have suspected for quite some time that at some point the ADA will be forced to change its position on mercury amalgams. Doing so, will be a huge financial burden on the American “sick care” system, and thus will take a great deal of time and literature for a safer stance to finally be made official on mercury.

As a biochemist and Naturopathic Doctor, I say why bother to wait around for the “old boys club” to make their decisions on how to deal with the politics surrounding this widely recognized mercury problem. If it is not good for children or pregnant women, then it is not good for anyone else either!

Don't get mercury fillings put in your mouth. Only work with a dentist that offers composite fillings. Be sure you understand what materials are being used before they are somewhat permanently placed in your mouth.

It is important to find a Naturopathic or Holistic Dentist that specializes in this!

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

Scottsdale Naturopathic Doctor

Happy St. Patrick's Day! I thought I would share my favorite Naturopathic green foods for women today. As a Women's Health Doctor and hormone specialist, it is imperative that women eat healthy and incorporate hormone balancing herbs and nutrition into their daily diets. By relying on food as medicine women can work to avoid using prescription drugs, or at least keep them to a minimal level.

#1 Cabbage: Of course, since we are celebrating St. Patties Day we MUST celebrate cabbage! Recently I went to an Irish Pub and ordered corned beef and cabbage, and was horrified to find out that the beef is “corned” because it is brined with corn sized pieces of salt! No wonder it was too salty for me to eat.

Hold the corned beef, but keep the cabbage because it is a powerful cancer fighter thanks to the indole-3-carbinol content. This is also a great breast cancer preventative for women as it decreases estrone the “bad estrogen” while maintaining healthy levels of estradiol or the “good estrogen.” Cabbage is also full of sulforaphane which also prevents cancer via this estrogen detox mechanism and other anti-cancer properties. As a Women's Health Naturopath, I always have to remind women of what an important superfood cabbage is, and how important eating daily cruciferous vegetables are to protect their breasts, uterus, and ovaries from cancer.

When estrogen pools and is not detoxified it remains high as bad estrogen or estrone which increases breast cancer risk. Estrogen is like water. Too much is just as bad as not enough. Being overweight causes an increase in bad estrogen which then furthers insulin resistance which causes more weight gain. That is the estrogen dominant loop many women get stuck in when they cannot lose weight.

Women often seek me out as a Hormone Doctor because they think they have hypothyroidism or Hashimotos causing weight gain, but oftentimes it is this elevated bad estrogen situation happening.

In the meat industry, they give shots of estrogen to cattle to fatten them up so they can sell the meat for more dollars per pound. So having high levels of estrogen is the last thing women want to have if they are overweight and cannot figure out why.

While lack of estrogen is a problem in menopause, estrogen dominant conditions such as PMS, PCOS, Insulin Resistance, Weight Gain, will improve with cabbage.

#2 Olive Oil: I cannot speak highly enough for the virtues of using olive oil as your primary cooking oil in your kitchen. My basic cooking rule of thumb as a Naturopathic Doctor and Biochemist is to simply use olive oil when cooking for ALL recipes unless the flavor will not work. That is only when I deviate to a different oil because olive oil is true antioxidant magic at its finest! Otherwise, olive oil is a RICH antioxidant source as I stated in my article, “Olive Oil Prevents DNA Damage.” If olive oil is NOT green, is yellow, and has no flavor or tastes bitter….it is...FAKE!

There are many fake olive oils out there, be sure to purchase organic olive oil that is certified from a reputable source or you may be getting overpriced canola oil with food coloring!

#3 Kale: Just like cabbage, kale falls in the cruciferous vegetable category, and all these veggies are super cancer fighters. In addition, kale is rich in magnesium, and trace minerals. To wilt kale, chop it finely, heat a pan to medium heat, add some olive oil and garlic, and when the garlic is soft add the kale, cover, stir occasionally until tender.

#4 Spinach: Whether served up in a salad, soup, or tucked away in an omelet, spinach is one of the most versatile and easy to hide green foods. I always keep a bag of organic frozen spinach in my freezer. This is the easiest way to pump up your recipes with the least amount of effort. Some patients react to the oxalates in spinach which is why you should eat your spinach slightly wilted as I instruct above with Kale.

#5 Chlorella: This blue green algae is great for chelating heavy metals such as lead, mercury, cadmium, and so forth. Chlorella is a rich protein and magnesium source. Start with a small quantity and work your way up to the manufacturer’s recommendation if you are using it for detox.  ALWAYS buy a certified organic brand when it comes to this chlorella or spirulina.

#6 Celery: The dieter’s best friend, celery is an excellent snack that also lowers High Blood Pressure. If you have hypertension try bringing a snack of celery with you every day. My favorite dip for celery is raw almond butter. Although high in fat, it is high in the good fats.

Good Fat + Fiber=Appetite Control=Weight Loss.

#7 Cilantro: An imperative part of salsa, cilantro also chelates heavy metals out of our system, as I discuss in my article "How to Detox After Mercury Fillings." This herb should definitely be included in your herb garden. I mix it in with fajita’s, salsa, guacamole, and stir fry.

#8 Mint: A wonderful cooling, uplifting herb that is highly versatile. You can chew a sprig from your garden, make my ADHD Tea, or make Mojito’s. Mint helps clear your sinuses, lifts depression, soothes migraine headaches when applied to the the temples, and is a powerful antioxidant that will preserve women against aging. There is Chocolate Mint, Pineapple Mint, Spearmint and many forms of mint so you can pop over to your favorite nursery and sample the flavor of each one!

#9 Basil: Basil is an antioxidant, anti-inflammatory, anti-cancer, anti-aging herb of the mint family traditionally used for headaches, arthritis, reducing stress and fevers, as well as making Pesto delicious! The mixture of raw pine nuts, basil, olive oil, and cheese make for a fabulous “superfood feast.” Pesto is a high fat food, but usually used in small quantities. I make mine in the summertime when the basil is on sale. Mass-produce pesto, and freeze in silicone containers, or ice cube trays. Then just add the frozen pesto cubes to hot gluten free noodles and wait for the magic to happen.

#10 Fennel: Did you know you can chew on fennel seeds to help release painful gas and bloating? This is a common traditional herbal remedy. Women don't need Gas-X for bloating, they can just munch on whole fennel seeds! No need to even make them into a tea. While the seeds are a fabulous carminative for gas, the fennel bulb is delicious alone or in salads.

#11 Nasturtiums: I love growing these in my garden because they grow like CRAZY on a dripline in Arizona and thus make me feel like an awesome gardener. There is no happier feeling than watching their beautiful orange, yellow and red blooms pop up while I have done little work to help.

Nasturtium leaves add spice to your salad, and the flowers provide a beautiful garnish. You can buy several types of nasturtiums and let them hang down a wall in a sunny location if you are in a moist environment. If in Scottsdale desert I would keep them low to the ground on a dripline and add extra water when you remember. The tendrils love to dangle down. Harvest simply by pinching back the latest leaves. They help with liver detox, and anger, moodiness, anxiety, and rage with PMS.

#12 Nettles: Seasonal Allergies happen TWICE a year in Phoenix, which is why you really need to make best friends with Stingle Nettles as I discuss in my Nettles blog. Nettles are so fabulous they also made it on my list of "Favorite Naturopathic Herbs for Women." What medication helps your allergies AND helps with Female Hair Loss? If you want thick, long, shiny hair you need to read my articles on how to use nettles!

Women can easily cook with nettles, make tea with nettles or take capsules of the leaves to reduce histamine levels, puffy, itchy watery eyes. I can't have any of my beautiful patients going around with puffy eyes and dark circles under their eyes from allergies. That is the last thing women need right now! Life has been challenging enough! New research recently found nettles to be helpful for night sweats, and hot flashes in menopause which is why they are in my "Menopause Milkshake Recipe." I love to have a cup of nettles tea before bed.

#13 Rosemary: One of my favorite herbs because it has so many different herbal talents. Ultimately rosemary is an amazing antioxidant, great for menopause, circulation and mental functioning. Read: “Rosemary for Memory & ADHD” and “Rosemary Salmon Recipe.”

As you can see in my above photo I like to pick a little sprig of rosemary off my plant and nibble on it as I drive to work in the morning. The essential oil of rosemary is uplifting, helps with depression, ADHD, brain fog, and concentration as I discuss in my ADHD Diet.

#14 Green Apple: Great for the “sour” flavor we are often missing in the Basic American Diet (BAD.) According to Chinese Medicine, we need all five flavors: Salty, Sour, Sweet, Bitter, and Pungent. In America we are out of balance because we eat mainly only salty and sweet. Did you know apples are protective against diabetes, insulin resistance, and a host of other health issues and can help women lose weight? Check out my article on Apples for more info!

#15 Honeydew: I LOVE HONEYDEW! It is nature’s Gatorade and perfect for an outdoor outing where you need electrolyte replacement. Pack some along next time you go hiking, skiing, rock climbing, mountain biking, etc.  Honeydew also quenches the thirst better than most drinks. Honeydew is great for cancer patients suffering from “radiation burn” to the throat. Singers, public speakers, and those prone to laryngitis can also benefit from using Honeydew as herbal medicine.

#16 Alfalfa: Alfalfa sprouts, along with other sprouted foods contain vital nutrients and enzymes that should make women feel amazing and youthful. Sprouts contain the enzyme Superoxide Dismutase which is anti-aging and helps protect joints from painful arthritis and autoimmune attacks for those women with chronic pain.

#17 Dandelion Leaves: Spring is the perfect time to harvest dandelion leaves and flowers. Use only the baby leaves in salads as the larger ones are too tough and bitter. The leaves in large quantities have been shown to reduce blood pressure through a diuretic mechanism, and the root detoxifies the liver. The root should be harvested in autumn. Be sure your dandelions are pesticide and herbicide free! Read: “Dandelions: Detox Your Liver”

Green foods are GREAT because they aid with detoxification.  Anytime we see a green food we know it is rich in chlorophyll.  The cholophyll molecule is very similar in structure to the hemoglobin in our blood, except it contains magnesium in the center instead of iron like hemoglobin. This is why we refer to green veggies and herbs as "Blood Building" in Naturopathic medicine, and why your Natuorpathic Doctor is prescribing greens to boost patients with anemia, chronic fatigue, and weakness.

Magnesium is responsible for over 400+ biochemical pathways in the body, and since most Americans don’t eat enough greens, the top nutrient deficiency in America is likely magnesium. 

If you need a Naturopathic Doctor to help you with your nutrition, hormones, or Women's Health issues simply pop over to my SCHEDULE page and treat yourself to a Naturopathic visit. I would be happy to help you feel awesome!

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

Scottsdale Naturopathic Doctor

Wow! Olive oil prevents DNA damage, how exciting.

Why should we care about this?

Because DNA damage is caused by inflammation, it is essentially the biochemical mother of all diseases.

Anti-oxidants prevent DNA damage and therefore women do not rapidly age. We can slow down a woman's aging process with the right antioxidants! Anti-aging nutrition is easy to do when you know the Best Naturopathic Women's Health Foods and Best Women's Health Herbs

Researchers have concluded that olive oil likely prevents cancer and aging by protecting DNA from damage.

The “phenolic compounds” in olive oil were studied and determined to inhibit the initial stages of cancer formation caused by “oxidative stress” (unstable molecules in our bodies that destroy healthy tissues resulting in inflammation and disease.)

Damage to our DNA is exactly what causes both cancer AND aging, along with a myriad of other chronic conditions. The phenolic compounds in olive oil are shown to have a protective effect in vitro to our DNA. The more antioxidants we can include in our diet, the more we can PREVENT disease.

The good news about this “in vitro” or test tube study is that researchers believe that the amount of olive oil needed to prevent cancer is easily achievable in “in vivo” or real-life doses!

Researchers concluded that “Overall, these results suggest that [phenolic compounds] may efficiently prevent the initiation step of carcinogenesis in vivo, because the concentrations effective against the oxidative DNA damage could be easily reached with normal intake of olive oil.”

Hooray! What a wonderful, delicious anti-aging, cancer-fighting treat for us to include in our diets. We already know that olive oil in the diet is important for preventing cardiovascular disease such as High Blood Pressure and inflammation, now we have yet another reason to make olive oil a major source of fat in our diet.

So how can you get more olive oil in your diet?

First of all, I always recommend buying extra virgin olive oil, the greener the better.

Next, keep in mind that olive oil is not good for baking as much as it is good for drizzling on already cooked foods such as gluten free bread, steamed veggies, salads, soups, and popcorn (yes it is delicious with organic sea salt and nutritional yeast).

To achieve the maximum anti-cancer and anti-aging benefits be sure to keep the temp below it’s smoking point of 350F. Best yet, avoid cooking it when at all possible if you want it to be super potent to freeze your aging process now.

You know I expect my patients to be the healthiest and most beautiful women out there on the inside and out, so its time to throw the butter in the garbage and fill a pretty jar with olive oil with a pour spout.

Women ask me every day which oil they should cook with. I primarily use olive oil for most things with medium and no heat. Coconut oil has fats that some women do not burn well and I often see them pooling in the LDL "bad cholesterol" and total cholesterol. Therefore olive oil or avocado oil are what I primarily use. I do like to coat baking pans with coconut oil. Sesame oil that is cold-pressed is great for Asian recipes. Otherwise a giant jug of organic extra virgin olive oil sits on my counter and that is what I cook most dinner items with. Which is also why everyone always tells me "You look too young to be my doctor!"

It's the olive oil!

Now simply drizzle olive oil on your bread and veggies instead of butter. Always make your own salad dressing with olive oil and lemon or balsamic vinegar. Add herbs, garlic salt, and pepper. Remember that olive oil is good for you but it is not free of calories and you will need to limit how much you use or it can cause weight gain.

Instead of fattening salads loaded with ranch to drain your energy and clog your arteries.... let's get you on some steamed veggies drizzled with a little bit of olive oil and garlic salt. I promise you will thank me for this! Olive oil is the fuel you can burn more efficiently especially if you struggle with chronic fatigue, you are likely not burning fats well for energy and need to avoid bad fats and switch to good fats for better energy and concentration.

If you need a Naturopathic Doctor to help you with your nutrition and anti-aging program simply pop over to 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!

Reference: 

“Oxidative DNA Damage Is Prevented by Extracts of Olive Oil, Hydroxytyrosol, and Other Olive Phenolic Compounds in Human Blood Mononuclear Cells and HL60 Cells” J. Nutr. 138:1411-1416, August 2008.

Dr. Nicole Sundene, NMD

Female Hormone Specialist

“Insulin Resistance? Nobody cares about Insulin Resistance” was what one of my patients with severe insulin resistance told me she was told by her anesthesiologist when he asked if she was diabetic. She laughed as she told me that her Cardiologist was just as dumbfounded by these statements as I was! Her Cardiologist actually agreed with me on the insulin resistance causing her high blood pressure. 

I asked my patient… “Is it okay that I am about to now go on an Insulin Resistance blogging  rampage and tell this story?” She told me to go for it so please enjoy today’s rant about why doctors and patients need to stop ignoring insulin resistance! We must screen routinely for insulin resistance and implement the appropriate diet and supplements so patients can be successful with getting their “Fat Storage” hormone under control.

Because until they do the insulin resistance will cause them to just continue to gain more and more weight until they are type 2 diabetic and have high blood pressure.

Ignorance around Insulin Resistance is EXACTLY what is wrong with everyone in America! I have worked in women’s health for 23 years now and I am finding patients with severe insulin resistance in my practice every single day. Because I specialize in PCOS and hormone imbalance, I test for insulin on all of my routine hormone panels…and guess what? 

It is actually the #1 most common cause that women to gain weight. While everyone is hiring me to figure out if they have a thyroid condition causing their metabolism to slow down, what I find more often than not in this scenario is that insulin resistance is causing them to gain weight and gumming up their metabolism. Insulin is the evil enemy that grabs every carb and fat you eat and slaps it into fat storage. Leaving my insulin-resistant patients with chronic fatigue because they are not able to burn carbs or fat properly for energy and are then left with protein as their main source of fuel.   

Doctors should be checking every American’s insulin numbers to prevent diabetes, hypertension, weight gain, and PCOS the leading cause of hormone imbalance in women. 

I am so SICK of the SICK care system that fails to focus on prevention, and instead just waits until you have a stroke from high blood pressure caused by insulin resistance and only then will insurance pay for you to have expensive physical therapy to teach you how to walk and talk again… yet it doesn’t care about screening for insulin resistance. Frankly, I don’t even know why we are so obsessed with cholesterol numbers while totally failing to test insulin levels, when the majority of my hormone patients are challenged more by the inflammation from insulin causing them high LDL, high triglycerides, high blood pressure, hormone imbalance, mood swings, headaches, and PCOS. 

Patients with a fasting insulin number greater than 8 are on the fast track for diabetes, high cholesterol, high blood pressure and obesity. I see my patients with a fasting insulin >20 become Type 2 Diabetic within 5 years. Sometimes sooner. Oftentimes it is not possible for patients to get their insulin numbers under control merely with a low carb diet alone because wildly swinging blood sugar numbers trigger hypoglycemia which generally causes my patients to binge eat when they get too hungry. 

I find every single day of my career that patients with fasting insulin above >10 are completely unable to lose weight until the insulin numbers are corrected with herbs and supplements. This process generally takes 6-12 months of diligent work. Most of my patients with insulin resistance cannot adhere to the reality that there is no quick fix to their weight gain, and also need to be in counseling about their disordered eating patterns because there is generally an emotional component and physical component impacting the patient’s eating pattern. 

Instead of setting patients with weight gain and insulin resistance up for failure by telling them to simply follow a low to moderate carb diet that is low in saturated fat, we also must implement counseling along with herbs and supplements that help stabilize the blood sugar and improve sensitivity to insulin. 

In a country full of obesity we do not have time for doctors that are ignorant about insulin and do not care about insulin resistance. Especially with viruses circling around us that are more likely to cause long-term effects and increased mortality in those with impaired immune systems from Type 2 Diabetes as one of the leading factors of death and long hauler symptoms!

In order to properly address insulin resistance, we must understand what it is, and why it is occurring. 

What is Insulin Resistance?

Insulin resistance is an impaired body response to normal insulin levels in the body resulting in metabolic complications. The body cells fail to respond to insulin hormone stimulation, specifically in the muscles, adipose tissues, and liver.

Initially, the pancreas increases insulin hormone production and secretion, but eventually, pancreatic beta cells wear out, and insulin resistance worsens. The insulin no longer works efficiently, the insulin levels increase resulting in hyperinsulinemia.  High cholesterol, high LDL, high triglycerides occur as the metabolism of saturated fats, lipids and glucose get disrupted [1]. Today we will discuss diet prevention and treatment of insulin resistance. It is important patients are under the care of a doctor that specializes in insulin resistance as low blood sugar can potentially be dangerous. 

It is important to note that insulin resistance leads to prediabetes, non-alcoholic fatty liver disease (NAFLD), and type 2 diabetes mellitus. Plus, other consequences of insulin resistance include metabolic complications such as high cholesterol, high uric acid level, endothelial dysfunction, visceral adiposity, and high blood pressure. However, there are many preventive and treatment strategies to overcome insulin resistance and reduce the risk of prediabetes and type 2 diabetes mellitus [1].

What Causes Insulin Resistance?

Like other endocrine dysfunctions, the common causes of insulin resistance include poor diet (such as a diet high in carbs), physical inactivity, family history, and obesity. Other risk factors of insulin resistance are smoking, gestational diabetes, high cholesterol level, ethnicity, high blood pressure, hormonal disorders (Cushing syndrome, etc.), autoimmune disease, age, prediabetes symptoms, sleep problems, and certain drugs such as steroids, HIV medications, and antipsychotics. Note that African, Latino, or Native American and older individuals (>45 Yrs.) are at high risk of insulin resistance [1, 2, 15].

Insulin Resistance Symptoms

Common skin and Dermatology signs of insulin resistance are hormonal acne, skin tags (small skin growth) and acanthosis nigricans (darkened skin in the neck, back, groin, and armpits) significantly indicate insulin resistance. Patients with insulin resistance commonly complain of headaches, fatigue, joint pain, and weight gain. 

Lab Tests Indicating Insulin Resistance: 

The following blood markers help determine the diagnosis of insulin resistance. These include: 

  1. Blood pressure higher than 130/80 mm of Hg, 
  2. Fasting blood glucose level of more than 100mg/dl
  3. Fasting triglyceride levels of greater than 150 mg/dl
  4. HDL cholesterol levels less than 50 mg/dL and 40 mg/dL in women and men, respectively.
  5. Waist of more than 40 inches (for men) and >35 inches (for women) 
  6. Fasting insulin level above 8 indicates insulin resistance. Optimal insulin is <3

Patients with the above symptoms and findings almost always have insulin resistance and are therefore at extremely high risk of requiring medication for Type 2 Diabetes if they are not already on it.  [1, 2, 3].

Insulin Resistance Mechanisms

Insulin resistance is attributed to many factors and biochemical pathways. These include: hormonal disturbances (including the ratio of insulin to glucagon hormone, excess of catecholamines and glucocorticoid secretion), defects in insulin signaling at a cellular level, down-regulation of insulin, disturbed GLUT4 function, and also genetic polymorphism of insulin receptors [1, 2].

Insulin Resistance and Syndromes

Insulin resistance is highly associated with metabolic, clinical, and insulin resistance syndromes. Note that syndrome means a cluster of abnormalities that worsen the current condition and favors other chronic medical complications. The metabolic syndrome associated with insulin resistance involves high blood pressure, obesity, high fasting glucose level, and abnormal triglyceride and HDL cholesterol levels. 

Metabolic syndrome associated with insulin resistance increases the risk of various clinical complications, including type 2 diabetes mellitus, stroke, cardiovascular dysfunction, PCOS, sleep apnea, liver disease, and “essential hypertension” aka high blood pressure.

 Insulin resistance includes elevated pro-inflammatory markers, abnormal uric acid metabolism, endothelial dysfunction, glucose intolerance, and an increased testosterone secretion by the ovaries [2, 3].

Insulin Resistance and Type 2 Diabetes Mellitus (T2DM)

The most common medical consequence of uncontrolled Insulin resistance is Type 2 diabetes. Medical research studies reported that insulin resistance precedes T2DM development by 10-15 years. Initially, during insulin resistance, the pancreas increases insulin production and compensates for the tolerance to insulin. As a result, the pancreas elevates the insulin level that potentiates weight gain, aggravating insulin resistance condition. 

This compensatory cycle can negatively affect or even destroy the pancreatic beta-cell function (insulin production) with time. Thus, the insulin level does not meet the body requirement resulting in an abnormal glucose level in the blood and eventually Type 2 diabetes mellitus [2, 15].

Insulin Resistance and Polycystic Ovary Syndrome (PCOS) 

In addition to T2DM, insulin resistance is significantly associated with the development of PCOS in women. Medical research studies reported a relationship between insulin resistance, the severity of genetic defects in insulin sensitivity, and PCOS pathogenesis (the most common endocrine dysfunction in women). Studies reported that PCOS, obesity, and growth spurts in adolescents also damage insulin sensitivity. During insulin resistance, the high insulin level (hyperinsulinemia) in the body increases luteinizing hormone (LH) secretion and androgen production by the pituitary gland that causes ovarian dysfunction.

Insulin resistance combined with obesity increases estrogen production that further disrupt the hypothalamic-pituitary-gonadal axis. Further, the high insulin level suppresses sex hormone-binding globulin by the liver and increases the free androgen level in the body. As a result, the free androgen level further impacts insulin resistance and aggravates PCOS. Insulin resistance management can help ovarian function and improve PCOS symptoms [2].

Insulin Resistance and Hypertension

Essential hypertension or High blood pressure with no secondary causes is highly associated with insulin resistance. Medical research studies reported that hyperinsulinemia (during insulin resistance) increases sodium retention in the kidney and potentiates sympathetic nervous system activity causing high blood pressure. The further development of endothelial dysfunction due to insulin resistance and high blood pressure then cause a further elevation of blood pressure [2].

Insulin Resistance and Non-Alcoholic Fatty Liver Disease (NAFLD)

In insulin resistance, the muscle and adipose tissue enhance the free fatty acid delivery to the liver. In the liver, the synthesis of triglycerides increases except for the very-low-density lipoprotein (VLDL) triglycerides. High insulin increases the transport of VLDL triglycerides from the liver. As a result, insulin resistance increases the fat accumulation in the liver and significantly precedes NAFLD- Nonalcoholic fatty liver disease, or liver failure that is caused by consuming too much sugar and saturated fat. NAFLD generally progresses to various liver failure conditions, including steatohepatitis, cirrhosis, and non-alcoholic steatohepatitis [2].

Insulin resistance and Migraines/Headache

There is a common association between insulin resistance, diabetes, and migraine. Guldiken et al. in 2009 reported a high prevalence of migraine in individuals with diabetes mellitus (DM), greater waist circumference, and high body mass index (BMI). As blood sugar drops because insulin take the sugar and puts it in to fat cell storage, the patient then gets a migraine or headache from the sudden drop in blood sugar. The higher the insulin the worse the headaches become. 

Insulin resistance and High Cholesterol

Insulin resistance significantly affects and alters lipid metabolism resulting in dyslipidemia or lipid abnormalities. During insulin resistance, the level of plasma triglycerides and very-low-density lipoproteins (VLDL) increases, while the high-density lipoproteins level decreases and small dense LDL appears. As a result, combined with any endothelial dysfunction, the lipid abnormalities associated with insulin resistance potentially increase the risk of cardiovascular events [2, 4, 15].

Insulin Resistance Treatment

Insulin Resistance Lifestyle Modification Treatments

Lifestyle interventions play a significant role in the management of insulin resistance treatment. The most important lifestyle interventions are proper diet and regular physical activities. Diet must be optimized accordingly, as discussed in the Insulin Resistance Diet section. Regular exercise and  physical activity  improves calorie expenditure and insulin sensitivity. Patients should attend seminars, education programs, and anti-diabetic campaigns [1, 15].

Insulin Resistance Treatment Medications

In addition to lifestyle interventions, different type-2 diabetes mellitus medications also help insulin resistance management. However, note that they are not FDA-approved treatment options for insulin resistance. These therapeutic options include Metformin, Glucagon-like peptide-1 agonists, Sodium-glucose cotransporters-2 inhibitors, Thiazolidinediones, Dipeptidyl peptidase-4 inhibitors, and Insulin therapy [1].

Side effects of these medications for insulin resistance most commonly include: Weight gain, fatigue, headaches, diarrhea, nausea, vomiting, abdominal pain, constipation, stomach upset, cough, hoarseness, fever, chills, general feeling of discomfort, lower back or side pain, muscle pain, muscle cramping, eye twitching, and painful bladder or urination. Because many patients experience these side effects they often seek a Naturopathic treatment plan for insulin resistance. 

When using Naturopathic medicine for Insulin resistance we work with diet and supplements first to lower insulin, and then taper the patient off their medications gradually over a 3-12 month process. Patients with insulin resistance and type 2 diabetes should never suddenly stop taking their medications for insulin resistance as this can be dangerous and result in death. 

It is imperative to work with an experienced Naturopathic Hormone Doctor to reduce the need for medications for insulin resistance. 

Insulin Resistance Diet

Insulin resistance patients will not improve on the Keto Diet. When I tell patients to eat a low carb diet they often interpret this as, “I am going to go Keto,” only to gain more weight and return with worsened insulin numbers. Absolutely under no circumstance should this diet be implemented for insulin resistance. The problem with Keto is that it contains way too much saturated fat which also worsens insulin resistance so it is imperative that patients use a low glycemic index diet of low to moderate carbs and HIGH PROTEIN, paired with HIGH FIBER! Good fats are allowed in moderation, but Saturated fat consumption should be <10g daily for the insulin resistant patient to be able to lose weight. Most patients report to me they are actually  consuming 50-100g of saturated fat daily when they begin to track their macros. Sometimes even more than this which! Failing to track macros will result in failure with insulin resistance as this is the equivalent of writing as many checks from your checkbook as you want, simply because you have 100’s of checks. We must take into account the spending budget for insulin resistance patients. 

Please do not sign up to work with me as your Naturopathic doctor if you are not willing to track your macros for insulin resistance. It will just be a waste of everyone’s time and I will not be able to help you at all. 

Diet plays an important role in the prevention and management of various health complications. The same is true for endocrine disorders, including diabetes, prediabetes, and insulin resistance. It is important to note that there is no specific diet plan or single fit diet approach for insulin resistance management. However, research studies recommend using certain nutrients that help improve insulin resistance and reduce or delay the risk of insulin resistance complications. 

Studies reported the beneficial effects of complex, low-glycemic-index carbohydrates consumption in insulin resistance [7-9]. Also, American Diabetes Association does not recommend using a high-fat and low carbohydrate diet as it worsens the insulin resistance condition.

Insulin resistance patients should add a fiber-rich diet (beans, peas, and lentils, whole grains, raw fruit (be careful with portions= ½ cup of fruit generally is one serving), and non-starchy vegetables to their diet. Further, research studies confirmed the benefits of using a high-energy and low-glycemic-index breakfast in patients as such a diet plan increases calorific intake in the first half of the day. Additionally, after a proper diet plan, a slow and mindful eating approach significantly benefits insulin resistance patients [7, 8]. 

Insulin resistance and PCOS are inflammatory conditions worsened by inflammatory foods. Please don’t use processed foods, minimize foods containing high sugar (such as sugary sweets), avoid high salt, don’t consume artificial Trans fats, use olive oil, consume more fibers, add non-starchy vegetables instead of refined grains or starchy vegetables and reduce calorie intake coming from carbohydrates. 

Also, don’t eat starchy vegetables (unless used as a complex carb source), snacks, alcohol, beverages, dairy products, fried foods, chocolate, butter, and other items rich in saturated fats. Additionally, take certain nutrients, including magnesium, potassium, and calcium, to improve blood sugar levels [7-9].

Certain foods improve insulin resistance including dark leafy greens, vegetables, tomatoes, beans, peppers, citrus fruits, whole grains, broccoli, fish, soy, spinach, collards, asparagus, cabbage, carrots, kale, lean meats, omega-3s rich content, nuts, berries, and sweet potatoes. These healthy foods are demonstrated in research to improve insulin sensitivity and help insulin resistance patient [8, 9].

Natural Treatments for Insulin resistance: Medicinal Herbs, and Supplements

Various clinical trials are conducted on the beneficial effect of different herbs and supplements on insulin resistance. These trials reported positive effects of Cinnamon, Green Coffee Extract, Curcumin, Ginger, Berberine, Jinlida, Sancai Powder, Artemisia, Chamomile tea, Nigella sativa, Soybean leaf extracts (SLEs), Gymnema Sylvestre, Aloe Vera gel complex, and Fresh yellow onion [12].

Studies reported that Cinnamon significantly improves blood sugar level, total cholesterol, and triglyceride levels, helps liver enzymes, and decreases fasting blood glucose levels. Thus, cinnamon consumption helps insulin resistance and reduces the risk of NAFLD [10]. Additionally, Cinnamon contains flavonoids, terpenoids, coumarins, anthraquinones, glycosides, and tannins. Animal studies showed that optimal consumption of Cinnamon significantly suppresses post-meal blood glucose spikes and reduces the risk of diabetic complications. Besides, Cinnamon also helps reduce insulin levels in women and improve PCOS or reduce the aggravation of symptoms.

Regular use of ginger, curcumin, green coffee bean extract, and green tea extract reduces the fasting blood glucose level, helps abdominal obesity, decreases HbA1c, prevents atherogenic risks, and improves insulin resistance in type 2 diabetic patients. 

The beneficial properties of these herbs not only help insulin resistance but also reduce the risk of metabolic and clinical syndromes linked with insulin resistance [12]. Animal studies showed that various extracts of medicinal herbs, including Nettles (Urtica dioica), Anacardium occidentale, Symplocos cochinchinesis, and Helicterus Angustifolia, can improve insulin resistance and reduce plasma glucose levels. Also, other herbs like Pleurotus Ostreatus, Afzelia Africana, and Uvaria chamae consumption may help insulin sensitivity, improve fasting blood glucose level, and support regeneration of Islet of Langerhans in the pancreas [13]. 

Taking chromium can also be beneficial, but mainly in deficiency. Well-controlled trials are lacking about the use of Chromium for insulin resistance. Those in favor are considered insufficient due to poor methodology and low-quality research. However, animal studies reported that Chromium improves insulin resistance, relieves lipid abnormalities, and helps glycemia in diabetic patients[14]. Since farmers are not required to replete our soil with chromium it does not hurt an insulin-resistant patient to take 500mcg of chromium picolinate twice daily with food. Never take any supplements or treatments for blood sugar away from food as it will cause nausea and vomiting from low blood sugar!

If you would like my help with your insulin resistance, PCOS, or Type 2 Diabetes, I would be happy to help. I cannot help any patients with Naturopathic Medicine that are not open to making diet changes and taking supplements. I understand if you need to make diet changes in steps and struggle with them as I do, but realistically I will not be able to help you at all if you are not willing to remain committed to achieving a long term plan towards managing your insulin resistance, as this is one of the most challenging hormone conditions that I treat as a hormone doctor. To set up your new patient visit simply pop over to the SCHEDULE page.

Dr. Nicole Sundene

(480) 837-0900

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

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

References

  1. Freeman AM, Pennings N. Insulin Resistance. [Updated 2021 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
  2. Wilcox G. (2005). Insulin and insulin resistance. The Clinical biochemist. Reviews, 26(2), 19–39.
  3. Reaven, G. M. (2005). THE INSULIN RESISTANCE SYNDROME: Definition and Dietary Approaches to Treatment. Annual Review of Nutrition, 25(1), 391–406. doi:10.1146/annurev.nutr.24.012003.132155
  4. Ighbariya, A., & Weiss, R. (2017). Insulin Resistance, Prediabetes, Metabolic Syndrome: What Should Every Pediatrician Know?. Journal of clinical research in pediatric endocrinology, 9(Suppl 2), 49–57.
  5. Özcan, R. K., & Özmen, S. G. (2019). The Association Between Migraine, Metabolic Syndrome, Insulin Resistance, and Obesity in Women: A Case-Control Study. Sisli Etfal Hastanesi tip bulteni, 53(4), 395–402.
  6. Fava, A., Pirritano, D., Consoli, D., Plastino, M., Casalinuovo, F., Cristofaro, S., Colica, C., Ermio, C., De Bartolo, M., Opipari, C., Lanzo, R., Consoli, A., & Bosco, D. (2014). Chronic migraine in women is associated with insulin resistance: a cross-sectional study. European journal of neurology, 21(2), 267–272.
  7. Gołąbek, K. D., & Regulska-Ilow, B. (2019). Dietary support in insulin resistance: An overview of current scientific reports. Advances in clinical and experimental medicine : official organ Wroclaw Medical University, 28(11), 1577–1585.
  8. Weickert M. O. (2012). Nutritional modulation of insulin resistance. Scientifica, 2012, 424780.
  9. Weickert M. O. (2012). What dietary modification best improves insulin sensitivity and why?. Clinical endocrinology, 77(4), 508–512.
  10. Askari, F., Rashidkhani, B., & Hekmatdoost, A. (2014). Cinnamon may have therapeutic benefits on lipid profile, liver enzymes, insulin resistance, and high-sensitivity C-reactive protein in nonalcoholic fatty liver disease patients. Nutrition research (New York, N.Y.), 34(2), 143–148.
  11. Chuengsamarn, S., Rattanamongkolgul, S., Phonrat, B., Tungtrongchitr, R., & Jirawatnotai, S. (2014). Reduction of atherogenic risk in patients with type 2 diabetes by curcuminoid extract: a randomized controlled trial. The Journal of nutritional biochemistry, 25(2), 144–150.
  12. Li, J., Bai, L., Wei, F., Zhao, J., Wang, D., Xiao, Y., Yan, W., & Wei, J. (2019). Therapeutic Mechanisms of Herbal Medicines Against Insulin Resistance: A Review. Frontiers in pharmacology, 10, 661.
  13. Choudhury, H., Pandey, M., Hua, C. K., Mun, C. S., Jing, J. K., Kong, L., Ern, L. Y., Ashraf, N. A., Kit, S. W., Yee, T. S., Pichika, M. R., Gorain, B., & Kesharwani, P. (2017). An update on natural compounds in the remedy of diabetes mellitus: A systematic review. Journal of traditional and complementary medicine, 8(3), 361–376.
  14. Hua, Y., Clark, S., Ren, J., & Sreejayan, N. (2012). Molecular mechanisms of chromium in alleviating insulin resistance. The Journal of nutritional biochemistry, 23(4), 313–319.
  15. Ndisang, J. F., Vannacci, A., & Rastogi, S. (2017). Insulin Resistance, Type 1 and Type 2 Diabetes, and Related Complications 2017. Journal of diabetes research, 2017, 1478294.

Dr. Nicole Sundene, NMD

Holistic Psychiatry & Hormones

Neurotransmitter Testing is very important for women with anxiety, depression, panic attacks, ADHD, PTSD, adrenal fatigue, chronic pain, chronic fatigue, and chronic mental health conditions. 

With neurotransmitter testing, we can pinpoint the patient’s individualized mental health weak spots.  

The problem with antidepressants and anti-anxiety medicine is that they are both a “One size fits all” treatment that assumes women with depression have low serotonin or norepinephrine deficiency, and women with anxiety have low GABA. As I discuss in my blog "Thyroid Depression," there are many causes of mood disorders with some being hormonal, emotional, and chemically caused by neurotransmitter imbalance.

While these are the #1 neurotransmitter deficiencies commonly impacting women’s mental health there are many variations to this picture and other neurotransmitters that can be individual weak spots such as low dopamine causing depression and chronic pain. Also, elevated histamine from Food Sensitivities and Food Allergies, can cause anxiety as histamine is an excitatory neurotransmitter. Elevated histamine then causes anxiety, and with anxious thoughts the patient experiences further elevation of epinephrine and norepinephrine which then cause shakiness, jitteriness, and even more anxiety. 

Low melatonin levels can cause insomnia and depression and are also tested for as shown below.

The great news is we have Neurotransmitter Testing that can be conducted via a simple urine test at 4 points throughout the day to determine which neurotransmitters are out of whack in my mental health patient so I can target “Amino Acid Therapy” to correct the problem. 

With amino acid therapy we are using the amino acids needed to make the deficient neurotransmitters in conjunction with vitamin and mineral cofactors to boost production. A classic example of amino acid therapy is using 5-HTP or tryptophan to boost serotonin levels. 

Women with depression and anxiety that do not respond well to typical mood medications are perfect candidates for Neurotransmitter Testing. Once the testing is completed, and I have received the results back then I can custom tailor the natural treatment plan that will specifically work to improve mood deficits. When we couple this test with mental health hormone testing for women we can vastly improve mental health without antidepressants!

Neurotransmitter Testing is one of my favorite parts of practicing Holistic Psychiatry because I get the opportunity to identify the underlying issue and improve the patient’s mood when not much else has been helpful previously. 

I personally found Neurotransmitter Testing helpful for my own mood as I have always struggled with anxiety and depression and seeing that my body simply makes zero serotonin explained a lot and helped me target my treatment to this specific neurotransmitter using amino acid therapy, diet changes, hormone balancing, vitamins and minerals that all boost serotonin production. 

It also explains why antidepressants did not work for me because I had ZERO serotonin for them to recycle. This is exactly why I experienced weight gain, dry mouth, stomach aches, and all of the side effects of antidepressants with ZERO benefits. I actually became in a WORSE mood because being thirty pounds overweight made me feel even more depressed.

Therefore I find neurotransmitter testing for patients with chronic anxiety, depression, and ADHD an important investment in their future mental health. This test can be life-saving for some mental health patients challenged with suicidal depression, as we can work quickly to target the specific problem that is individual for each patient. Otherwise, the doctor is basically randomly picking antidepressants and when they don't work, continue to switch the patient to a different antidepressant.

When we couple neurotransmitter testing with hormone testing we almost always can improve the patient's mood naturally! For women that rely on antidepressants and mental health medications it also helps us understand which medications will be the most useful.

How to collect your Neurotransmitter Test: 

  1. Schedule the date of your collection at least two days out, and when you are not on your menstrual cycle. Any blood in your urine will interfere with the test. 
  2. The day prior to collection avoid: bananas, pineapple, avocado, nuts, nut butters, protein powders, protein shakes, amino acid supplements, alcohol, and nicotine. This step must be followed.
  3. Refrain from drinking more than 8 oz of water in the HOUR before each dried urine strip collection to allow your urine to concentrate. Alternately do not avoid hydration as this may also cause the test to be inaccurate. Avoid hydration only the hour prior to each test strip. Don’t drink water upon waking, collect that urine instead and then set alarms in your phone for the hour prior to each collection time to remind you to stop drinking water, as well as alarms to remind you when you need to conduct the next test. 
  4. Don’t eat, drink anything but water, take vitamins or supplements or take medications (except what is considered mandatory by your doctor) until after the second urine collection. In general avoid excessive use of herbs, vitamins,  and supplements before and during this test to get the best results. Basically only take the things you will die without taking such as high blood pressure medications, and needed medications. You can generally skip your vitamins, herbs and supplements for one day prior.  

Collection Times: 

  1. Upon waking
  2. 2 Hours after waking
  3. Before dinner
  4. Before bed

How to Collect Urine: 

  1. Save the bag the collection card is in. 
  2. Write your name, date and time of collection on the card prior to collecting the sample. 
  3. Open the cover on the collection card. Fold it back and away from the filter paper. 
  4. Dip the filter paper directly into a clean cup or urinate directly on it up to the top of the black dash line. 
  5. Hang the card up to dry on a towel rack, ensuring that the urine-saturated filter paper does not touch anything. 
  6. Allow to dry completely. Once dry, refold the collection card and place the sample back into the baggie and seal. Make sure the absorbent pouch is still inside. 
  7. Repeat this process at the next three collection times. 

Finishing Steps: 

  1. Complete all paperwork. Ensure all sections are filled out and your form is signed. 
  2. Place the paperwork and samples back into the collection box. Snap the test kit lid shut. 
  3. Place the test kit in the shipping package and affix the prepaid label. 
  4. Allow 2-3 weeks for the lab to process your sampe. We will always call you when your test results are final. I do not practice "no news is good news." If greater than three weeks have gone by since the date you mailed your test please notify us immediately so we can contact the lab. 

This test generally just needs to be completed one time to identify the patient's individual mental health weak spots. Some of my patients with chronic pain, chronic fatigue, and severe depression or anxiety do prefer to repeat the test several months after they have started their treatment plan to ensure their amino acid treatment is working properly.

If you or your child would like my help improving your mental health with Naturopathy, I would be happy to help! Please keep in mind my service is not for everyone. Please do not sign your child or self up to work with me if not capable of taking supplements and making dietary changes as that is the type of medicine I practice. I want all my patients to always be a Naturopathic success story, and I will not be able to help anyone that cannot be committed to making these changes.

While I do provide integrated health services from my background of working in prescription Family Medicine for eight years, prescribing medications is truly boring for me and this is not what I prefer to do. There are many doctors that can treat you 100% with medications. I am comfortable working with a patient that is on medications and gradually taper them off the medication after a few months of using natural medicines. I always work to improve mental health first with natural medicines before tapering down medications.

I completely understand if you struggle with diet changes, and need to make them gradually. I am the same way, but realistically I cannot help anyone that is not on board with Naturopathy and nutrition. If diet changes are a challenge, you need to be able to at least take supplements regularly like medications as we work through the food and self love issues that accompany these challenges.

With the findings of neurotransmitter testing I then prescribe food as medicine that is rich in the amino acids you need to correct your neurotransmitter imbalance and/or you will need to take supplements. If you think you will be a good fit simply pop over to my SCHEDULE page to get your new patient visit set up. I would be happy to help you with your depression or anxiety!

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!

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