Dr. Nicole Sundene, NMD
PCOS hormone imbalance from insulin resistance can eventually lead to Type 2 Diabetes when not well managed. The good news is that early intervention with diet for PCOS and insulin resistance can work to prevent diabetes!
Over the years I have warned many of my PCOS patients with severe insulin resistance that they will become diabetic within 5 years if they do not get their insulin resistance under control. Many have worked hard with my natural recommendations and diet changes to prevent this often inevitable occurrence.
Not all PCOS patients are at risk for diabetes because there are over five types of PCOS as I discuss on my PCOS blog. My "Skinny PCOS" patients that have the lean type, or adrenal type of PCOS may not feel good on this recipe. As a PCOS specialist, I have seen many variations of PCOS over the years, and the poor patients with an adrenal type of PCOS where the hormone imbalance is coming from the adrenals and not insulin need a completely different treatment plan and are often misdiagnosed when they truly have Congenital Adrenal Hyperplasia and do not feel good on medications for PCOS such as Metformin.
So this recipe is for women with PCOS that have a high fasting insulin level of >6-20+ and should not be used for those with fasting insulin at <2-4 as it may cause hypoglycemic vomiting. Although other types of PCOS may benefit from this anti-inflammatory recipe, this recipe is specifically for PCOS caused by insulin resistance. Many research studies indicate PCOS is an inflammatory condition, therefore using powerful herbal medicine and functional foods can help reduce inflammation for all types of PCOS. To read about the research behind the herbal medicines used in the recipe visit my Insulin Resistance blog.
Did you know cinnamon is an amazing herb not just for my PCOS and diabetic patients but it also is an antiviral, antioxidant, and anti-inflammatory herb that also helps with pain and neuropathy?
So cinnamon is an excellent daily medicine to add to your regime so long as it is not giving you hot flashes! Cinnamon is a warming herb which is why I combine it with cooling apples, coconut, and aloe to help balance this functional medicine herbal smoothie recipe out.
As I discuss on my apple blog, apples actually help with weight loss for PCOS and Type 2 Diabetes by helping the pancreas work more effectively and modulate insulin production. If you are allergic to apples I believe you can effectively substitute the apples with pears, peaches, nectarines, or plums. But the most amount of research on fruits for diabetes I have been able to find was conducted on apples. I love that apples are a superfood because they are super inexpensive, delicious, and only have around 20g of carbs per medium sized apple. Because Apples are on the "Dirty Dozen" I buy mine organic.
Since I found this exciting apple weight loss research I have been having many of my female patients replace their bread with 1-2 apples per day.
Guess what? They are losing weight and getting their hormones balanced just with apples! Plus I love an Apple Pie flavored smoothie to break things up from my normal berry or banana chocolate smoothie I normally drink. If you need to gain weight add more nut butters or organic coconut milk.
To make the smoothie extra cold I recommend chopping the apples and freezing them. You can put the apples and ginger together in bags so most of the ingredients are ready to go and you just need to add nut milk, water, and ice. If you freeze aloe vera juice into ice cubes you can throw one or two ice cubes into the bag as well.
I love teaching my patients how to add more “Functional Foods” to their regimes. When I have a great health nut patient that likes recipes such as this, they get well faster and save so much money on herbal medicine when they choose to have food be their medicine.
Personally, I would rather buy organic herbal medicine powders to put in a smoothie than capsules as I know the cost-saving benefit is quite dramatic! The organic herbs I stock at my clinic come from either Mountain Rose Herbs or Starwest Botanicals. You can buy your own organic herbs directly from their websites. I do not trust random herbal powders on Amazon. Always buy organic and stick with trusted suppliers for your medicine.
By using foods and herbs researched to be effective for PCOS, inflammation, diabetes, and insulin resistance in a daily smoothie my patients can reduce their reliance on vitamins, expensive capsules, and medications. When I was putting the herbal medicine research together for my latest blog on insulin resistance, I realized how delicious it would be to make an apple pie flavored smoothie with all the herbs backed by research to effectively work against insulin resistance!
Let food be thy medicine!
Safety Tip: This recipe is designed to lower insulin and should not be used by Type 1 Diabetics. Please work with me or your own Naturopathic Doctor if you are using this smoothie recipe for medicinal purposes. It will work to lower blood sugar and insulin over time and I do not want any diabetics getting dangerous low blood sugar!! Hypoglycemia can occur if not using enough carbs or calories for those that do not have any issues with their blood sugar they may need to add some almond butter, agave syrup, or use more organic coconut milk so they do not lose weight.
Coconut milk contains MCT's or Medium Chained Triglycerides that work to balance blood sugar. Too much coconut fat can become a bad fat as there is a lot of saturated fat in coconut and I do see it occasionally being the reason behind my patient's high cholesterol so keep in mind that too much of any good thing may not be good! But coconut also has antiviral properties along with the cinnamon and ginger. Aloe vera helps heal the digestive tract which is important in hormone imbalance as we are often treating the gut in functional medicine to balance hormones.
PCOS Apple Pie Smoothie Recipe:
½ cup coconut milk or water
½ cup frozen apples
1 tsp cinnamon *Organic real cinnamon from Mountain Rose Herbs or Starwest Botanicals)
1 tsp-1 Tbl fresh ginger
½ tsp curcumin powder *Not turmeric but its more potent extract, get this from Starwest or Mountain Rose, I do not trust any yellow herbs otherwise as they may often have lead contaminants
1-3 packets of stevia to taste (1/4-1/2 tsp)
1 scoop pea protein powder (My favorite brand is by Sunwarrior on Amazon as it is sweetened with stevia and is low carb)
1 Tbl aloe vera juice or gel (When using fresh aloe rinse the yellow latex off the gel or diarrhea will occur. Start with one piece about the size of a cucumber slice) For premade my favorite brand is the "Lily of the Desert Brand" on Amazon, "Inner Fillet."
Blend all ingredients and add more nut milk, water or ice to reach desired consistency. Drink 1-3 shakes daily per your Naturopathic Doctor’s recommendation. You can use powdered ginger but fresh is much more potent, buy a pound of ginger root at your grocery store, peel and cut in dice-sized cubes so they can be frozen and easily popped into your smoothie every day.
All of these herbs combined are POWERFUL anti-inflammatories and blood sugar regulators. Be sure to track your fasting glucose, Hemoglobin A1c, and fasting insulin with your Naturopathic Doctor as these numbers will gradually come down over 3-6 months and I often need to adjust my patient's medications down as their herbal medicines begin to take effect. I have taken patients off their BP meds, diabetes meds, and high cholesterol meds using this recipe or the herbs in capsules but that happens over three to twelve months generally and is thus a long-term goal. Nobody should suddenly stop taking their medications!
Keep in mind that herbs don't work immediately. As someone that is super impatient and wants results NOW, I should forewarn you to stay committed to the healing process. Herbs work gradually over time.
If you would like my help with your PCOS, Insulin Resistance, or Diabetes I would be happy to help! Simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit.
Dr. Nicole Sundene
(480) 837-0900
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is 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 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease.
She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!
Dr. Nicole Sundene, NMD
Breast Cancer prevention can be done via balancing hormones, weight loss, nutrition, weight loss, routine mammograms, and analysis of genetics related to breast cancer.
My heart has been very sad since the loss of Olivia Newton John along with my dear friend Brenda from High School also from Breast Cancer. So today, I am tearfully sharing my favorite Breast Cancer-preventing foods and lifestyle factors. I know Brenda would want women everywhere to be working hard to prevent breast cancer because she was tough, no-nonsense, and hard-working. She was a fighter and fought very hard against this terrible women's health disease. Prevention is critical.
Please share this important women's health research with the women you love!
Cruciferous vegetables contain chemicals such as sulforaphane that break down estrogen, this is important for women undergoing treatment for breast cancer taking estrogen blockers, as well as women that are overweight, family history of breast cancer, or have estrogen dominance and therefore high risk of breast cancer.
Researchers recently concluded, "We report that total cruciferous vegetable intake is associated with decreased cell proliferation in breast cancer tissue."
Less cell proliferation means fewer breast cancer cells are forming in the breast!
Breast Cancer Preventing Foods:
Check out my blog on "Best Green Foods for Women's Health," to learn more about why some of these made my list as a Women's Health Naturopath.
For breast health please drink your green tea and eat your brocolli! Either 1/2 cup raw or 1 cup lightly steamed of the above veggies should be eaten daily. Green tea can be decaffeinated and consumed iced throughout the day!
Along with discussing foods for prevention the #1 and #2 most important things women should do for breast cancer prevention are weight loss and mammograms! Women should generally do mammograms starting at forty, depending on family history, and not listen to the cost-cutting new guidelines from the government to start at fifty.
Women that are not taking hormones, and have a negative family history for breast cancer and reproductive cancers can generally go every other year for their mammograms. Patients with fibrocystic breasts and lumpy breasts should go annually and may need an ultrasound along with a mammogram to determine if the breast cysts are filled with fluid (benign) or solid (tumor.) We may follow up every six months with an ultrasound (no radiation) to check for changes.
While many women are scared of mammograms because of the radiation, women actually receive more radiation flying on an airplane than getting a mammogram! We are constantly exposed to radiation everywhere, so exposing yourself for something that can save your life and chemo-induced hair loss is important!
For many women, hair loss is one of the hardest part of breast cancer. I know it was for my friend Brenda that had amazing long beautiful blonde hair before she was treated.
Early detection of breast cancer is critical with this slow growing cancer. If you are like many of my patients and have neglected to do your annual exam and mammogram for the past few years….please get it booked!
Summer is the best time to get annual exams, pap smears, labs and imaging done as this is the slowest time of the year in Family Medicine. Plus patients are exposed to less germs planning their routine cancer screenings during the summer and not during cold and flu season.
When Should Women Do Self-Breast Exams?
Check your breasts at the beginning of every month, “Pay your bills and check your boobs,” is what I recommend to prevent forgetting this critical self-exam. Most women in my experience, find their own breast cancer this way. Breast cancer in early stages is easier to treat and may not have to result in hair loss.
Women with lumpy breasts should check them a few days after their period ends and talk to your Naturopathic Doctor about when to start doing mammograms. The decision should be made by your doctor, and not the government or the "US Taskforce" that suddenly dropped annual mammograms to every other year, and shifted the starting age from forty to fifty when the government became financially responsible for mammograms.
This also coincided with their "research" concluding that women only need to get pap smears done every two to five years, which I also completely disagree with.
Don't let blanket government recommendations smother the individual...doctors should be deciding what is best for their patients and not the government. Especially any US government-funded research that concludes that the US should pay less towards women's health issues!
Generally, a baseline mammogram is done for women in their forties or fifties. While the new government recommendation is to start at 50 and do it every other year, I find this utterly irresponsible as a women’s health doctor and some of my patients really need to get mammograms annually. I have seen women develop breast cancer in under two years that could have been picked up at an annual screening.
I also have had patients develop cervical cancer in less than two years so I do not agree with US Taskforce's "findings." Especially when the UK conducted its own study and concluded the exact opposite: "mortality from breast cancer is overall decreased when we begin to screen women at forty."
Mammogram is a simple test that is more accurate than breast thermography, as thermography often fails to pick up breast cancer. I shudder as a Naturopath when women ask me to order breast thermography rather than a mammogram, as I have personally seen breast cancer missed by thermography yet picked up on a mammogram. While it is technically a "safer" tool for breast cancer detection, it is also a worthless tool, plus anything worrisome that shows up is going to require a diagnostic mammogram anyways.
Breast cancer is mostly a hereditary condition in my experience as a women’s health doc that also prescribes a lot of bioidentical hormones. I do not believe that bioidentical hormones cause cancer because I have so many women on them getting annual mammograms and I just don't see it happening.
Let me tell you what I do see happening.... breast cancer happening in women with a family history of breast cancer, prostate cancer, and reproductive cancer. I also see breast cancer occurring in women with severe "estrogen dominance."
This is my #1 screening question, as I cannot in good ethics provide hormones to women that have had a mom, aunt, grandma, or sister with breast cancer. This is also why I prescribe hormones carefully, judiciously, and with frequent hormone lab testing as I know many MD's just give women bioidentical hormones and do not follow up on the levels which I find incredibly dangerous as a hormone doctor. Women uniquely process these hormones and eliminate them, therefore we cannot just slap every woman on the same tablet of estrogen and expect the same results. That is not safe, not smart, and pretty lazy when it is simple to follow up with some basic hormone labs.
Getting annual cancer screenings such as pap smears, pelvic exams, and mammograms performed while taking bioidentical hormones is also important for cancer prevention.
Let's please just stop this silly nonsense of being scared of mammograms yet ignoring the excessive radiation women are exposed to flying on an airplane!
While I personally don’t like to get radiation, I do get mammograms myself. Simply take vitamin C and bioflavonoids green tea or high antioxidants for the three days before and three days after any scheduled radiation exposure. Or alternatively, drink fresh veggie juice preferably with some of the above known cancer fighting foods to provide your body with the antioxidants needed to quench free radicals from radiation.
Although the radiation is very minimal, it is not as scary as some women are led to believe.
I am more scared for the women that refuse mammograms!!
Please share this important breast cancer message with the women you plan to grow stronger with! I don't want you to have to lose any friends to this horrible disease. Many women have not been doing their labs, imaging, or checkups in the past few years. We all need to get back on track with our cancer screenings. While nobody wants to get a pap smear, mammogram, or colonoscopy these are all VERY SLOW growing cancers that can be caught EARLY and treated early.
Please do not wait until it's too late!
Let's stay healthy and "Hopelessly Devoted to Kale" in honor of Olivia Newton John and the women we have all loved and lost to breast cancer.
Whether you need to get your annual exam and mammogram ordered or need a custom preventative breast cancer plan and hormone testing, simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit!
Dr. Nicole Sundene
(480) 837-0900
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, 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 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease.
She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy
References:
Dr. Nicole Sundene, NMD
Hashimoto's & Hypothyroidism Specialist
Hypothyroidism patients everywhere have been freaking out from Scottsdale, to Phoenix, to Tempe, Mesa, Chandler, Fountain Hills, Flagstaff, Sedona, and even Payson ever since their favorite thyroid medication, Naturethroid went on backorder, so today we will be discussing natural thyroid hormone alternatives to Naturethroid, which are Armour thyroid, and NDT or compounded "Naturally Dessicated Thyroid," and why it is better than synthroid, tyrosine or levothyroxine.
The purpose of this thyroid article is to guide you through the pros and cons of the current thyroid hormone options available, if you are not happy on the thyroid hormones you are currently taking, or your previous thyroid hormone has suddenly been discontinued.
When thyroid dose is not correct patients can become depressed, anxious, gain weight and experience worse pain and chronic fatigue. The majority of my thyroid patients in my Holistic Hormone practice feel better on Armour Thyroid (90%) than Levothyroxine (10%).
The reason for this is that the active hormone that boosts energy, boosts mood, and aids weight loss must be converted from inert synthetic T4 in levothyroxine to active T3 that actually burns fat. Most patients that seek me out struggle with this conversion and either need a little bit of cytomel (T3) to assist with this or prefer Armour Thyroid. Women that are menopausal make moire binding hormones that bind up their Free T3, causing weight gain and insulin resistance.
Patients that are Vegan are not comfortable taking hormones from a pig gland or "Porcine Thyroid" and therefore will need to use synthetic hormones if they do not use animal products for spiritual reasons. The synthetic hormones lack the other magical thyroid chemicals that thyroid patients are generally deficient in and I never see my thyroid patients respond as well to synthetic hormones as natural hormones.
The main issue with pig gland thyroid is that pigs have a higher ratio of T3 to T4 than humans generally have and for some patients, the T3 is overstimulating for them and can cause palpitations, hot flashes, chest pain, headaches, diarrhea and increased sweating.
While many patients are completely fine on Armour, many of my patients with food intolerances, food allergies, and sensitivities to excipients and fillers are struggling with this change. Today I will review all of the current thyroid hormone options available to patients so they can determine what their best option is without Naturethroid returning anytime soon.
Naturethroid was recalled due to the medication not being at the correct 100% dose and most doses are coming through at about 75%. If you are feeling fine then you can continue to take the same dose and contact your Naturopathic Doctor for testing immediately to determine if the dose is working for you or not.
If you are having symptoms of hypothyroidism: Fatigue, weight gain, cold intolerance, constipation, dry skin, depression, or anxiety then we need to check your labs and adjust your medicine accordingly.
Simultaneously NP Thyroid was also recalled as it was measuring at higher doses than the label which explained to me why so many of my patients HATE NP Thyroid. I personally and professionally completely detest NP Thyroid because it is bound with mineral oil which is not safe to consume.
While they did a good job making NP Thyroid gluten-free, it is pretty ironic that they are instead putting poison in my poor thyroid patient's medication! This is by far the worst choice, I now refuse to prescribe NP Thyroid since women notoriously call with adverse side effects, which is literally the last thing my poor thyroid patients need! Please check your prescription when you pick it up and make sure your pharmacist has not changed your Armour prescription to NP Thyroid poison without asking if you want it.
This is an important instance where generic is better than name brand.
This is the #1 reason my Hashimtotos patients that were previously doing well on Naturethorid or Armour Thyroid suddenly feel sick. Being switched over to something with chemicals in it without being told.
If a patient is chemically sensitive they absolutely should NOT take NP Thyroid. I have so many of my thyroid and Hashimotos patients having horrific side effects of hair loss, joint pain, anxiety, palpitations, and autoimmune flares. NP Thyroid now goes on the list of garbage that I hate.
Amour thyroid is the #1 best alternative at the regular pharmacy in my opinion as a Thyroid Doctor that also takes thyroid medicine and specializes in Hashimotos. While it is not my favorite choice it is my #1 substitue. If your pharmacist asks you if you want brand name and you say yes then they are going to give you this horrific NP Thyroid crap, so just tell them you want generic. If your insurance only pays for NP Thyroid you will end up paying more in side effects than if you just pay for the Armour Thyroid up front.
If you have a corn allergy or other issues with the excipients in Armour then the only other alternative is for me to call in a compounded "Natural Desiccated Thyroid" (NDT) or a combination of Levothyroxine/Cytomel (T4/T3) to your regular pharmacy or to a compounding pharmacy. The prescription is not covered by insurance at a compounding pharmacy but the combination is overall less expensive if you do not have insurance at $1/capsule for the compounding pharmacy to make you NDT or T4/T3.
The only issue with T4/T3 is when the dose is not correct, and then the patient spent money on something they cannot take. Follow-up lab testing is advised at 6-8 weeks of making any dose changes with thyroid hormones to ensure the levels are accurate for the long run.
"Should I take Tirosint?"
Tirosint questions and side effects are very common lately. Tirosint is just a brand name for Levothyroxine and shares the same shortcomings as Levothyroxine as discussed above. If you have food allergies you should stick with brand name Synthroid or Tirosint as generic levothyroxine may be purchased from different manufacturers each month and therefore my food allergy patients do not do well with constant change and should eliminate as many variables from their diet as possible including ever-changing binders and fillers in their medications.
If you need help with your Hypothyroidism or Hashimoto's simply pop on over to my appointment SCHEDULE page and book a visit, would be happy to help. As a hormone doctor with a thyroid problem myself, I know how important it is that we get your thyroid medication correct.
Why is it SO IMPORTANT? Because thyroid hormone turns every cell in your body on. So when your dose is not correct then nothing in your body is working properly. Nothing.
Thank you for mailing your Naturopathic Women's Health questions to me on a postcard. I love to get something in the mail that is not a bill. Remember, if it cannot fit on a postcard then you need to schedule a visit with me!
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, Perimenopause, Autoimmune, Postpartum Depression, 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 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 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!
By Dr. Nicole Sundene
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.
So I am not quite sure if being labeled the "#1 PMS Doctor" is a good thing or a bad thing 😉
However, this family asked me to share their story about how PMS almost destroyed their marriage in the event other families are dealing with debilitating PMS symptoms interfering with the happiness of their relationship. So today we are talking about hormones and how they can impact relationships.
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 “Best PMS Queen of the Southwest” and thanks me for saving their marriage.
On our initial phone consults his wife was not even present because she was on the floor crying. He booked a phone consult with me and explained he thought she needed me to test her hormones and figure out what was wrong with her after doing many hours of research all night on the internet. He was not sure if I could help and said if I could he would drive her straight there as soon as I had my next opening.
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 Women's Health Naturopathic Hormone Doctor. I know very well from my eight 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
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
Dr. Nicole Sundene, NMD
Holistic Psychiatry & Hormones
This diet is not just for those with ADHD.
Whether you have ADHD, think you have ADHD, are told by others that you are completely ADD, are worried about age-related memory loss, have chronic brain fog, or simply cannot focus; a few simple diet changes can help improve your concentration abilities. Check out my blogs on Rosemary and Ginkgo biloba to help your concentration using simple and safe herbal medicines along with diet.
Eating smart and healthy should also improve your overall productivity.
Let’s face it, we all could benefit from being more focused and cognitive. If this list is overwhelming, then you will most likely REALLY benefit from changing your eating habits. Please don’t be overwhelmed though, adopting a new eating plan takes time and effort at first. When I first began to research "Alternatives to Ritalin," for my own purposes back in 1994, I had terrible eating habits and was binging on a lot of fast food and candy that greatly impacted my ADD. Since I spent all my time studying or working and I lived in a dorm my diet was terrible and my ADHD worsened. It took a lot of time and effort to get my eating on track and I struggled to make immediate changes. However, I can now live Ritalin free and stay focused without having to deal with all the yucky side effects of taking that medication that would make me feel sweaty, shaky, nervous, and would occasionally cause my heart to race.
So if I can do it... then anyone can do it. You just need to focus on one thing at a time if you struggle with dietary changes. Start adding in the easiest things on my list and you will notice improvements that will help you stay motivated to tackle the next steps. Simply try making one change at a time until you have it down. They say it takes 28 days to make a new habit. To overcome a bad case of the “I cants” simply find one thing that you CAN do at a time and work on that!
Let’s quickly review the dietary Do and Dont’s of eating for ADHD, ADD, and better concentration…
Do:
Don’t:
I hope that helps get you started in the right direction. Anyone with ADHD, poor concentration, or memory problems should see improvement within a week or so with this eating plan. Overall improvement will be noted after a month of following this eating plan for better concentration and memory. Many women with concentration issues are actually struggling with hormone imbalance from menopausal hormone changes, perimenopause, as well as hypothyroidism can also cause brain fog, insomnia, and difficulty concentrating.
Thank you for your Women's Health and Herbal Medicine questions. Please send them to me on a postcard to the address below as I love to get something in the mail that is not a bill. Remember if your question cannot fit on a postcard then you need to treat yourself to a Naturopathic visit with me. Simply pop over to my SCHEDULE page to get set up. I love helping women with their ADHD, memory, hormones, and chronic fatigue.
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. PMID: 7247635 Effects of artificial food colrings in children with hyperactive symptoms. A critical review and results of a controlled study. Arch Gen Psychiatry
2. PMID: 3395307 Synthetic food colorings and behavior: a dose-response effect in a double-blind placebo-controlled, repeated-measure study. J Pediatr.
3. PMID: 349320 Hyperkinesis and diet: a double-blind crossover trial with tartrazine challenge.
4. PMID: 8257176 Effects of a few food diets in attention deficit disorder. Arch Dis Child.
5. PMID: 2857900 Controlled trial of oligoantigenic diet in the treatment of hyperkinetic syndrome. Lancet.
6. PMID: 9257090 Does oligoantigenic diet influence hyperactive/conduct disordered children. A controlled trial. Eur Child Adolesc Psych.
7. PMID: 8277950 Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. N Engl J Med.
8. PMID: 3674234 Effects of sugar and aspartame on aggression and activity in children. Am J Psychiatry.
9. PMID: 194563 Effects of sugar on aggressive and inattentive behavior in children with attention deficit disorder with hyperactivity and normal children. Pediatrics.
10. PMID: 16314082 Supplementation with flax oil and vitamin C improves the outcome of ADHD. Essential Fatty Acids 2006.
11. PMID: 15741051 The effect of fish oil on physical aggression in school children a randomized, double-blind, placebo-controlled trial. J Nutr. Biochem.
12. PMID: 14985685 Effect of docosahexaenoic adic-containing food administration on symptoms of attention-deficit/hyperactivity disorder- a placebo-controlled double-blind study. Eur J Clin Nutr.
13. PMID: 2539203 Gamma linolenic acid for attention deficit hyperactivity disorder; placebo-controlled comparison to D-amphetamine. Biol Psychiatry.
14. PMID: 12873849 Consumption of fish and n-3 fatty acids and risk of incident of Alzheimer disease. Arch Neurol.
15. PMID: 12580703 Dietary fats and the risk of incident of Alzheimer's disease. Arch Neurol.
16. PMID: 12380746 Similarities and differences between Alzheimer's disease and vascular dementia from the viewpoint of nutrition. Ann NY Acad Sci.
By Dr. Nicole Sundene
PCOS or Polycystic ovarian syndrome is a common Women's Health Hormone condition that is improved best by working with a Naturopathic Doctor in my humble opinion after twenty three years of experience working in both prescription and natural Women's Health.
My treatment for PCOS patients as a Holistic Hormone Doctor almost never require medications or birth control pills. There are alternatives to birth control pills and medications for PCOS patients that we will discuss today as well as the risks vs the benefits of many common medications prescribed for PCOS.
PCOS causes hormonal imbalance such as the disruption of estrogen, testosterone, DHEA, cortisol, and progesterone levels. As a result, various clinical symptoms develop, including PMS, Estrogen Dominance, abnormal heavy periods, irregular periods, no period or amenorrhea, anemia, infertility, and a high risk for cancer of the breast, uterus and ovaries when the hormone imbalance is left untreated.[1, 4, 7]
PCOS is common among women of childbearing years, between 15 to 44 years of age. PCOS is affecting 6% to 12% of US women aged between 15–49 years. A research study estimated the worldwide prevalence of PCOS between 6% and 26%. Women with a family history of PCOS or who have diabetes, insulin resistance, or obesity are at higher risk of developing PCOS. [1, 2]
Symptoms of PCOS
PCOS symptoms vary from mild to severe and mostly appear in the late teens or early 20s. It involves a few or many of the below symptoms. [1, 3, 7, 8]
Types of PCOS
Research studies categorized PCOS into many types based on the clinical symptoms and causes responsible for the development and progression. While mainstream prescription medicine manages all PCOS patients with oral birth control pills, metformin and spironolactone, these treatments often fail when we do not have the correct treatment for the correct type of PCOS. Determining which category of PCOS the patient falls in should be done first and foremost prior to implementing any PCOS treatments. The main PCOS types include: [8, 9]
New research on PCOS presented the following subgroups of PCOS patients based on genetic markers. [8, 9]
PCOS Diagnosis and its Criteria
Diagnosis of PCOS should begin with the patient's questioning, family history, physical examination, and checking the other endocrine parameters. As PCOS is a complex disease, so research studies devised criteria for its diagnosis; based on the presence of hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. The presences of any two clinical symptoms in the patient among the hyperandrogenism, ovulatory dysfunction, and polycystic ovaries are necessary for PCOS diagnosis. [2, 3]
The clinician should consider the menstrual history, weight gain or loss, and cutaneous findings such as excessive hair, acne, alopecia, and dark patches for hyperandrogenism confirmation. Plus, ask and evaluate the presence of ovulatory dysfunction via oligomenorrhea and amenorrhea. Also, check for the other medical complications associated with PCOS. [3]
Other lab approaches to assist the diagnostic criteria to include; [2, 3]
Medical Complications of PCOS
Women with PCOS are at high risk of developing certain medical complications. These include type 2 diabetes, gestational diabetes, heart disease, hypertension, depression, sleep disorders, eating disorders, anxiety, plaque formation, and stroke. [6]
PCOS Treatment Guidelines
Although there is no definite cure for PCOS; however certain kinds of treatment interventions are recommended for resolving PCOS symptoms and complications. These interventions include both pharmacological and non-pharmacological approaches that treat symptoms and regulate normal physiological function. While I do not recommend or prescribe pharmaceuticals for PCOS and do not personally find them effective for managing this condition as a female hormone specialist, I will still discuss the risks and benefits of medications for PCOS. [1, 2, 5]
Non-Pharmacological approach
Non-pharmacological approaches involve applying electrolysis that passes electric current into the hair follicles, damage them, and arrests hirsutism. [3]
Weight loss
Weight loss is considered a gold standard for managing PCOS symptoms as weight loss improves insulin sensitivity, particularly in obese PCOS women. Also, obesity increases the risk of metabolic and reproductive abnormalities associated with PCOS. Weight loss is recommended as the first line of treatment for infertility in obese women with PCOS. Unfortunately, there is no approach for permanent weight loss, and weight decrease relapsed in around 90-95% of patients. However, bariatric surgery significantly sustains and reduces weight in obese individuals. Moreover, a hypocaloric diet also helps weight reduction in women with PCOS. But there is no clear evidence of the positive impact of weight reduction on PCOS symptoms. [2, 3]
Natural Diet & Lifestyle For PCOS Symptoms
PCOS Medication Treatment
Different classes of medicines are used for the treatment of PCOS complaints. These include;
Metformin: It is an oral anti-diabetic medication that improves insulin resistance and decreases insulin concentration. Mostly, it is recommended as a second-line drug of choice after clomiphene that induces ovulation, lowers serum androgen, and helps menstrual frequency. Moreover, it showed the best results in combination with clomiphene in obese women with PCOS. Side effects associated with the use of metformin include lactic acidosis and gastrointestinal symptoms such as diarrhea, nausea, vomiting, abdominal bloating, flatulence, and anorexia. [1-3, 5]
Oral contraceptives: Oral contraceptives such as estrogen and progestin therapy help treat PCOS symptoms via inhibition of Luteinizing and androgen hormone secretion, increasing the Sex hormone-binding globulin level, and also act as steroids receptors blocker. The side effects of oral contraceptives include a high risk of thromboembolic events, developing type 2 diabetes, elevated cholesterol and triglyceride level, and may impair insulin sensitivity. Therefore a low dose of oral contraceptives is recommended as the above adverse events are high dose-dependent in high-risk women with PCOS. [1-3, 5]
Progesterone therapy: Natural progesterone and synthetic progesterone such as Cyproterone acetate and drospirenone provide anti-androgenic properties. Some women with PCOS may need a combination or natural progesterone with an oral contraceptive to treat PCOS. The side effects of progesterone therapy include mood elevation or depression, weight gain, and abnormal periods, heavy bleeding, cramping, and spotting. [1-3, 5]
Spironolactone: It helps the treatment of excessive hair and acne. However, there are limited studies about its effectiveness. It is advised to use it with caution in women with renal impairment as it aggravates hyperkalemia as a side effect. Also, it is not recommended during pregnancy due to teratogenicity (congenital disabilities). [1-3, 5]
Please Note: If you do not want to take medications for PCOS and prefer a nutrition and herbal medicine approach then you will be a perfect fit for treating your PCOS. Otherwise, the medicine I use to treat PCOS is nutrition changes, supplements and herbs so there is no point in signing up to work with me if you or your teenager are not willing to make dietary changes. I understand they are hard to do and struggle with them myself, but we at least need to be comitted to making these changes gradually over time to be successful with Naturopathy when treating PCOS symptoms.
If you think you will be able to use Naturopathy and need help diagnosing or treating your PCOS symptoms simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit!
Dr. Nicole Sundene, NMD
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, 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
Dr. Nicole Sundene, NMD
"I can't sleep. Why can't I sleep? Is it my hormones? What is the best natural cure for insomnia in women? Why is my husband snoring away and sleeping more soundly than me?"
Tracy M, Scottsdale, AZ
Insomnia for women is often related to hormone imbalance. Conditions such as menopause, perimenopause, hypothyroidism, adrenal fatigue, anxiety, depression and postpartum depression can all trigger sleepless nights. In menopause estrogen deficiency is the primary trigger for sleepless nights. In perimenopause, it is generally progesterone causing the patient to wake up at 3am and not be able to fall back asleep. Especially when women feel over-heated. If you are suddenly waking up at 1-3am and then unable to get back to sleep, you need to contact me for hormone testing!
Your husband is sleeping just fine while you toss and turn all night because men have a ton of testosterone in their tanks which converts to estrogen naturally as it is being detoxified by the body so they generally have at least 40 points of estrogen in their system. When women develop menopause their levels generally go lower than that and trigger insomnia, hot flashes, anxiety, negative mental health, and brain fog.
While I can certainly prescribe a bunch of bioidentical hormones, herbs, and supplements for insomnia, the best way to get a solid night's sleep for most of my female patients is to eat a properly balanced bedtime snack with lots of flaxseeds!
Flaxseeds especially can help when women need something natural and non-hormonal to help them sleep during menopause. A proper bedtime snack as I will discuss today along with proper hormone testing and balancing via herbal medicine and nutrition often is all women need to help them get a restful night's sleep.
Many of my menopause patients don't need much more than that. We do have to dose the flaxseeds to match the severity of symptoms. If a woman has severe hot flashes and thinks 1 tsp of flaxseeds will be sufficient that is the equivalent of taking a click of estrogen cream once a month and is simply not realistic.
Flaxseeds fail when not dosed high enough. Most patients need 1-2 Tbl per day but some will need 3-6 Tbl per day and other supporting herbs. Be sure to check in with your doctor around menopause and have your blood pressure, cholesterol and thyroid checked. While it is not always necessary for women to be on hormones for menopause they should still not neglect other basic blood chemistry that can be impaired by menopausal or perimenopausal changes.
While everyone always assumes I am going to give them an herb or hormone as a Hormone Doctor to help them sleep that will not always be effective if we are not addressing the Root Cause of the insomnia. While it is normal for women to occasionally have a night of missed sleep, many days in a row can trigger chronic fatigue, chronic pain, inability to concentrate, brain fog, anxiety, and depression.
Generally I see this daytime fatigue pattern results in my patient reporting they "Feel like a Zombie" and no longer having the energy to exercise which is critical for proper sleep, and the pattern just worsens due to lack of physical and mental exercise the brain needs each day to feel tired enough to sleep.
Often retired patients struggle with this because they are no longer working and while they may have the time to exercise, they are deficient in enough brain exercises to "wear out their brains for sleep" and need to do some crossword puzzles, Jeopardy, reading, or Sudoku to give their brain a work out.
While I don't recommend eating a big meal right before bed, I do recommend some of the following healthy bedtime snacks for better sleep.
Only 200-300 calories for your snack is required. Otherwise, food just “sits there” and doesn’t optimally digest when we are inactive, as the peristaltic contractions of our gut are enhanced by exercise and movement. Still some people insist they can’t sleep without a bedtime snack. I actually might argue that some people might NEED a bedtime snack. Those that struggle with low blood sugar issues or “hypoglycemia” typically wake up in the middle of the night because of it.
Once awake, they can’t get back to sleep, and can’t figure out why.
I see insomnia as three different tedious breeds. There is the insomnia typically caused by stress when you can’t fall asleep (Adrenal Fatigue.) The insomnia when you wake up in the middle of the night and can’t get back to sleep (Estrogen and Thyroid Deficiency), and the insomnia that wakes you up much earlier than the actual time you care to start your day such as in Progesterone Deficiency.
You can also be amongst the “lucky ones” and have a combo pack of the three. This unlucky triad is typically the result of high stress, daytime inactivity, alcohol, too bright of a bedroom, and low blood sugar.
The best bedtime snacks are high in protein, fiber, complex carbs, minerals, and the amino acid tryptophan. To ensure a good night’s sleep, be sure to eat a light snack about 90 minutes before your anticipated bedtime. Shoot for 8:30pm if you typically go to bed around ten.
In the presence of carbohydrates, the amino acid tryptophan is able to pass the blood brain barrier, where it is then made into serotonin (the neurotransmitter that makes us happy) and in a dark atmosphere serotonin then converts to melatonin (the hormone that makes us sleepy). Boosting serotonin levels is also beneficial for those with anxiety or depression.
The WORST bedtime snacks for women are: #1 Alcohol #2 Sugar/Candy/Carbs #3 Toast
Remember that alcohol especially red wine causes women to have hot flashes which interfere with sleep as well as impact blood sugar which also interferes with sleep. Hypoglycemia is the enemy and that is exactly why women need a healthy bedtime snack designed to balance their blood sugar, neurotransmitters, and hormones.
If you have menopausal hot flashes keeping you up at night you might especially benefit from the ground flaxseeds as the lignans have a phyto-estrogenic effect, and the omega-3 oils are very important for ensuring hormonal imbalance as I disscuss more in my "Naturopathic Favorite Things" blog.
If you are going nuts from insomnia, nuts just might be the answer as they are high in protein, fiber, and minerals. Eat RAW nuts and raw nut butters to avoid the rancid fats that develop in the roasting process. Roasting turns the biochemistry of nuts into nasty rancid fat that pack on pounds, trigger hormonal acne, and clog our arteries. Raw nuts such as peanuts and cashews in moderate quantities are a great treat to keep on hand.
The healthiest foods highest in tryptophan are: Cottage cheese, peanuts, salmon, cashews, halibut, shrimp, granola, oatmeal, avocado, turkey, cheese, milk, wheat germ, eggs, collard greens, raisins, chicken, yogurt, sweet potatoes, and spinach.
Try giving up dessert for a week or two, and see if that helps. Substitute one of the health bedtime snacks below. Most night-time waking in my patients I find is caused by low blood sugar, because Americans commonly eat a sugary evening dessert that jacks their sugar up super high right before bed. As we sleep the sugar then comes crashing back down. The body always wakes us up to alert us of these kinds of imbalances.
Keep in mind that excess fluids before bed also wakes us up, so ultimately it is best to not have any food or drink at least 90 minutes before bed. The older you are, the more you may need to restrict your evening fluids to ensure you don’t need a night-time trip to the restroom. Just be sure you drink up upon waking and stay hydrated throughout the rest of the day.
The ultimate recipe for success is pairing light proteins such as vegetable proteins, turkey, and white cheeses with a high fiber friend such as a fruit, vegetable, or a whole grain choice. These foods also are typically rich in calcium and magnesium, minerals that serve to relax the nervous system and alleviate muscle tension.
THE FORMULA FOR SUCCESS:
Protein + Fiber + Good Fat + Good Carbs + Minerals= Perfect Sleep!
Using these basic rules of biochemistry, I have craftily put together a list of snacks that should induce relaxation as well as ensure proper blood sugar. The last one is what I personally have for my bedtime snack every night. Enjoy!
The Best Bedtime Snacks for Female Insomnia:
Additional Sleep Tips for Women:
Thank you for the great Naturopathic Women's Health questions. Please continue to send them to me on a postcard to my address below. Remember if your Naturopathic question can't fit on a postcard then you need to BOOK A VISIT!
Dr. Nicole Sundene, NMD
(480) 837-0900
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology, Acne, Psoriasis, Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!
Dr. Nicole Sundene, NMD
Hormone doctoring affords me more generous appointment times with each patient so that I am able to solve the health problem at the root cause...and it doesn’t always have to be a hormone problem!
Today I figured out that a patient's high blood pressure that had been going on for 6 months was simply caused by a medication interaction from her GI doctor's office. They started her on a medication for her IBS, and it interfered with her high blood pressure causing it to no longer work. Mystery solved!
Sometimes, I don't even need to use hormones or herbs. Just the fact I have enough time to review the patient's diet, supplements, medications, and emotional state to figure out what has suddenly changed causing the new symptoms is all that is truly needed.
I wanted to share this story today because a lot of patients are feeling very frustrated by the current state of shambles the health care system is in and it is important that you decide not to become a victim of it.
With lab and pharmacy delays due to the Pandemic, come more inconveniences and stressors on every doctor's plate. Your doctor's time, patience, and attention span have never been shorter or more taxed than right now while patients are trying to get care at clinics and hospitals everywhere.
It is important people know this and not just assume their doctor has it all figured out as they are brushing off symptoms and rushing them out the door with a prescription of something that may actually have a dangerous drug interaction with other medications.
This is called "Iatrogenic Error" and I see it happening more often than normal right now.
Here is how to keep yourself safe and protected from Iatrogenic error.
My #1 tip: Doctors fail patients because they simply don't have enough time to understand what is going on. Before I became a Naturopathic Doctor, I worked in regular Family Medicine for eight years. While the urgent care was great if you had a broken bone, strep throat or needed stitches...often we would fail patients with chronic disease such as High Blood Pressure, Diabetes, Hypothyroidism, and Autoimmunity mainly because each doctor only had about 1-5 minutes to actually spend with each patient.
The hospital I worked for kept doctors on a very harsh schedule that would burn them out after having to see 40-60 patients each day.
God forbid the patient spends their 5 minutes talking about their vacation, literally nothing would be done other than the doctor handing the patient their best guess on what prescription will stop their symptoms and then walk out of the room after 1-5 minutes. A long appointment was 15 minutes. Rarely could the doctors afford the luxury of spending 30 minutes with a patient.
#2 Did what your doctor do actually work? If it did, good. If it did not help then you need to get a second opinion.
#3 Did your doctor ACTUALLY "Check all your hormones?" Everyday I am told this and a great deal of time out of my patient's appointment is wasted while they attempt to pull up previous labs on their phone. When I look at their "Full hormone panel," it is often just 1-2 tests! A TSH and an estrogen level is not a full hormone panel. My lab panels when you get blood work done are no shorter than 5 pages, so if all your labs fit on one page then you are likely a victim of The Sickcare System.
I mean no disrespect to my MD friends, because I know how hard the past few years have been on me, and I don't run even half of the schedule of patients they run every day. I actually have a lot of respect for MD's and I know firsthand how hard they work. Yet our health care system is officially broken, and patients need to learn to take responsibility for their own symptoms when they don't get the right answers they seek. Women with chronic disease symptoms such as menopause, hypothyroidism, weight gain, postpartum depression, anxiety, and high blood pressure can easily get lost in this vicious cycle!
Five minutes is not enough time for me to help you or do my job. The doctor does not have enough time to establish a root cause of symptoms, to educate the patient about symptoms, or to even take a proper history to determine if the symptoms are being caused by a new medication or supplement the patient started.
I can't tell you how many times as a Naturopathic Doctor I have figured out that a patient is just having a side effect from a new medication they recently started. If I did not have time to take a proper history I would have never solved it and instead piled a bunch of useless supplements and herbs on top of the medication error instead of addressing it.
While I personally choose not to be a victim of this "Sick Care System," and have my own Naturopathic Doctors I go to, many women do not know anything other than going to the doctor to get a prescription for what ails them.
When I first moved to Arizona I realized that there are very few MD's doing primary care and most providers covered by my insurance were PA's that did not know what to do for any of my symptoms and instead sent me to multiple specialists.
If you have a busy job like I do, you really just don't have time to keep going to different doctors and specialists and you need someone that can manage all your symptoms in one which is why Naturopathy excels. We treat the whole person and the whole set of symptoms!
Many patients that perceive Naturopathy as unaffordable really should look at it from a cost benefit analysis because constant appointments also means constant missed work. Lack of permanent lasting solutions means more sick days from disease, and more hospitalizations.
I have treated many patients in my career that had symptoms so severe they kept ending up in the hospital and spending thousands of dollars even with insurance. So sometimes the Sick Care System actually costs the patient more money overall, more time, and more misery.
Many of my patients that have been through hospitalizations before they received natural solutions from me see me as someone that saves them money every year AND keeps them out of the hospital!
When was the last time someone sat down with you for an hour and went through each and every symptom that you have to try to connect the dots and find the underlying cause?
My #1 pet peeve in Women’s Health is when women get bounced around from specialist to specialist without any answers yet they continue to feel poorly and nobody knows why. Each specialist prescribes a drug for their symptoms and eventually, they are on 5-6 prescription drugs to maintain all the symptoms. Sometimes the prescriptions don’t even help, and the patient feels even more frustrated and hopeless that nobody can actually help them.
Often this model of medicine will completely fail women because nobody is connecting the dots between their symptoms and their female hormones. Women with hypothyroidism, menopause, perimenopause, and PMS experience a cluster of symptoms that when ignored will result in the patient being on multiple medications when really they just need their hormone imbalance addressed.
We need to listen to the symptoms and understand them before we try to shut the symptoms up with medications. Doctors need to take a proper history of the symptoms and need time to do that. Oftentimes just the mere fact I am not rushed at my 45 minute visits with women is why we are able to sort out the cause.
“Tolle Causam” means “Treat the Cause” in Naturopathic Medicine, the cause is the #1 most important principle in Naturopathy. Treating the cause requires proper investigative work. I always rely on metrics such as labs for hormones, vitamins, minerals, liver, kidney, glucose and blood count.
While I love making teas with my jars of herbs, many of us know that when they are not used to “Treat the Cause” we are prescribing them in the same way we prescribe drugs. This is how patients can end up on 20 bottles of supplements.
In the 90’s I practiced ‘Health Food Store Medicine” when I worked at a GNC nutrition center for 4 years. Every day I said: “For stomach aches people use Marshmallow root, for headaches Feverfew, for anxiety Chamomile, for trouble sleeping Valerian, for hot flashes Black Cohosh, for hip pain Arnica, for weight gain Garcinia. for depression St. John’s Wort, for immunity Echinacea, for bladder infections Cranberry, and for vaginal dryness Aloe.”
But what if a woman has ALL of the symptoms listed above, at once?
If you are wise, you know that I just described the typical symptoms of a menopausal woman. Doctors need time to take a detailed history and evaluate their patient with proper hormone labs and blood chemistry.
If you need my help with your chronic disease symptoms, simply pop over to my SCHEDULE page and treat yourself to a Naturopathic visit! I will 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, Perimenopause, Autoimmune, Postpartum Depression, 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 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 and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!
Dr. Nicole Sundene, NMD
Scottsdale Naturopathic Doctor
Bladder Pain, frequency and urgency for women can feel very frustrating as there are not many prescription medications for long-term bladder pain. Ironically, women with bladder pain are shucking corn as we speak and throwing the important Women's Health herb corn silk in the garbage can!
This must stop! Today's PSA for women will be on chronic bladder pain for women and how I work to manage it naturally!
The MD's I used to work for would inevitably ask me what herbs worked for bladder pain, since it was such a frustrating symptom for women to complain about. They knew they did not have much to help their symptoms. I taught them about corn silk tea, and how to properly make it to heal and calm an irritated bladder and they would often report back how much better their patients were with cornsilk tea.
If you have to plan all your day errands and trips around where you can find a bathroom every 30 minutes, then something is seriously not right and you may benefit from some cornsilk tea!
Corn silk tea is a fabulous soothing treat for an irritated bladder. Whether you are using corn sik tea for preventing a bladder infection or calming the irritation of interstitial cystitis a form of chronic irritable bladder it generally works well for most women, and is a trusted Women's Health herb that is cheap and effective.
Horsetail and marshmallow root can also be safe and calming to the lining of the bladder. The demulcent properties of these teas are great for preventing bladder infections because the slippery "mucilaginous" nature of the glycosaminoglycans prevent bacteria from adhering to the bladder wall. Another example of a demulcent herb everyone knows that is mucilaginous is Aloe vera.
To make corn silk tea it is best to add 1 Tbl of heaping herb per 8 oz cup of room temperature water into a mason jar. Shake well and let sit overnight as a "cold infusion." The demulcent or mucilaginous properties of corn silk actually extract best in room temperature water than a typical hot tea infusion.
Strain your infusion and drink 2-3 cups at least per day to calm a very irritated bladder.
Patients with Food Allergies or Sensitivites to corn should not use cornsilk tea as they will likely react adversely to it which is an occasional side effect with any herbal medicine. Although I rarely see this!
Bladder pain for women can often accompany hormone imbalance with perimenopause and menopause.
I often find many food triggers from spicy foods, tannins, acidic foods, citrus, and Food Allergies and Sensitivities irritating my patient's bladders. This is why it is very important to work with a skilled Women's Health Doctor that knows how to address both nutrition and hormone imbalance that are often the root cause of bladder pain.
With menopause comes hormonal changes that can alter the friendly flora in the vagina and cause pathogenic organisms to take over such as a Yeast Infection. If you have already been to a Urologist, and have received no improvement then you are a perfect candidate for Naturopathic Medicine and hormone balancing!
Antibiotic use without enough probiotics to restore the microbiome are also often to blame for chronic female bladder pain. The bladder often becomes inflamed after a course of antibiotics and it is important that women rely on probioitic capsules for a month after one course of broad spectrum antibiotics and not just rely on yogurt. You basically need to drink a gallon of yogurt a day to fix your microbiome after taking harsh antibiotics and if there is underlying hormone imbalance causing pH changes it can create the perfect storm for bladder inflammation which triggers constant pain.
If you have already been worked up by a Urologist, and nobody has been able to help you then Naturopathic Medicine will be a perfect fit for you to try to heal from chronic bladder pain.
We ultimately need to figure out what is wrong with YOUR bladder, and the triggers and herbs it needs to be healed will be very individualized for each woman. But rest assured, you should not have to live in constant misery and pain with your bladder. This is one problem that is better off served with Naturopathy, Bioidentical Hormones, and herbs as there are not many medications that help for bladder pain.
If you need my help with your bladder pain simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit. I would be happy to help with this very common yet frustrating women's health issue!
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, Perimenopause, Autoimmune, Postpartum Depression, 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 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 and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!
Dr. Nicole Sundene
Bladder problems are a common and frustrating Women's Health condition that can be a sign of Hormone Imbalance and Poor Immunity. Women often complain to me about their ongoing bladder problems that have not been solved by visiting a Urologist.
As someone that used to assist a Urologist many years ago I know that Urology is great for severe issues such as prostate cancer and bladder cancer, yet it often fails the patients with chronic bladder problems and chronic bladder pain because there are few medications that can help the annoying and irritating bladder symptoms. that they have to use the bathroom urgently, have bladder pain, frequent infections.
If you have a bladder problem occasionally it is not a big deal and is considered normal, but women that constantly are experiencing bladder problems are better served by working with a Naturoapathic Doctor as Herbal Medicine can help to improve immunity and also soothe the bladder.
Many herbal medicines can provide immediate relief for bladder problems unlike in conventional medicine there are limited options to help women with their chronic bladder pain.
The symptoms of interstitial cystitis and irritable bladder can often improve from avoiding certain foods thought to specifically aggravate this condition.
Be sure to see your Women's Health Naturopathic Doctor if you are suffering with chronic bladder problems such as: chronic urgency, frequency, and burning pain involved in these conditions. While the list of foods below can help relieve chronic bladder pain, bladder pain can be a concerning symptom that can indicate greater issues with the patient's Immune System, Hormones and Muscle Tone of the Pelvic Floor.
1. For rapid relief of discomfort, take 1 teaspoon of baking soda dissolved in one cup of water. This helps to prevent urine acids from interacting with damaged tissue. This is not an adequate long term solution though as it can interfere with absorption of iron, magnesium, calcium, and minerals.
2. Drink plenty of water to dilute urine.
3. Ice packs or heating pads may help to ease pain.
4. Kegels: TEN Squeezes of the pelvic floor muscles used to stop the flow of urine should be done 3 times daily. Attach your Kegels to an activity you are constantly bored with such as 1) Waiting at a stop sign 2) Standing in line at the store 3) Waiting on hold on the phone. Women cannot do too many Kegels but failure to exercise the muscles that support the bladder will only make bladder problems worse as a woman ages because gravity will eventually win and the bladder as it continues to sag down through weak pelvic floor muscles will only become more painful, problematic and incontinent. The future of female patients with bladder problems that do not do their Kegels is grim as they may even need surgery or a "Bladder Sling" to support the prolapsing bladder. This can all be prevented by staying committed to doing Kegels three times daily.
5. Avoid foods that tend to cause bladder problems for two to three months or until the bladder pain has diminished. I have found that it is best for my patients to continue eliminating the irritants well past symptom resolution to insure the bladder pain does not return.
6. Add healing demulcent herbs or mucilaginouis herbs to your regime such as my "Cornsilk Tea Recipe" for bladder pain.
The patient can then test each food by eating high amounts of it three times daily for three days to determine if the food is specifically irritating their bladder. Not all foods on the list will irritate the bladder. Women occasionally will eat a combination of the wrong foods for the bladder and find their symptoms are worse. Avoid eating a combination of these foods at any one meal or in any given day to keep your bladder problems at a minimal level.
While many of the foods on the list are healthy foods my patients do not want to avoid, I recommend focusing on the elimination of: Spicy foods, Caffeine, Citrus, Peppers, Onions, Garlic, Gluten, Dairy, Chocolate, Tomatoes and Nightshades as the most common offenders my female patients complain of being the cause of their bladder problems.
By simply avoiding caffeine, tomatoes and spicy foods many women have their bladder problems immediately under control. If this is not the case please schedule an appointment with me or your Naturopathic Doctor immediately so we can analyze your bladder problems and address them at the ROOT CAUSE. The foods listed below contain amino acids and/or other acids which contribute to bladder destruction and discomfort.
Some foods may be more irritating for certain individuals than others. Avoid all foods listed below the best you can until symptoms have resolved before challenging them to determine if they are the cause of the bladder problems. You should be off each food for a minimum of two weeks before challenging.
The challenge phase involves reintroducing a food you want to eat again three times daily for three days while watching if your bladder symptoms flare. If not you can eat them moderately. Some spicy and acidic foods are best to just avoid completely in my humble opinion as a Women's Health Naturopath.
FOODS TO AVOID FOR BLADDER PROBLEMS
Please schedule an appointment to resolve your bladder problems at the ROOT CAUSE. If you need a Naturopathic Doctor that is a Female Hormone Specialist to assist you with your bladder problems or ongoing Female Urology complaints I would be delighted to help you as I have a very high success rate helping women with their bladder problems for over fourteen years and nothing brings me more joy than to help women gain control of their bladder and not have to live a constant victim of their bladder problems and worry they will not be able to find a restroom fast enough due to urgency, incontinence and other bladder symptoms.
Chronic bladder problems are best served by a Naturopathic Doctor!
Dr. Nicole Sundene
(480) 837-0900
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Specialist in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!
