dr_susan_beavenOur lives are all about the balance and integration of our many parts. The yin and yang, the building up (anabolic) and breaking down (catabolic), sympathetic and parasympathetic nervous systems are to name a couple. When we lose the balance in our bodies, it causes disease. When we experience a of combination of symptoms like fatigue, joint pain, muscle pain, headache, abdominal bloating and pain, it tells us that many systems in our body are out of balance. We need to find and treat the main imbalances and our body will start to rebalance itself and heal. Now more than ever in this age of specialization, we need our health care providers to look at our bodies and health as a whole and how each part affects the other.
A lovely quote from Jeff Bland PhD, the father of Functional Medicine, “Functional Medicine is the science of creating health. Disease goes away as a side effect”.

The highest balance/integration is the balance between the mind (emotional), body (physical), and spirit. Within the body, the neurological, endocrine, and immune systems must be balanced. Any disruption in any system causes the others to malfunction. Within the endocrine system three of the major systems, the thyroid, adrenal, and sex hormones must be balanced. Failure to do this is why some people do not feel quite right on sex hormone replacement alone. For instance, elevated levels of cortisol from the adrenal glands causes a change in the binding of the sex hormones and the amount of free hormones like estrogen available to perform their functions.

Hypothyroidism is a good example of the effects of different organs on another. Treating hypothyroidism is not just a matter of testing and TSH and finding it to be elevated and then giving the patient medication to fix it. It is necessary to ask the question ”why did this occur? ”. Then to find the root cause(s), begin the proper treatment(s) and balancing our bodies allowing them to heal. It is necessary to have the proper nutrients such as iron, iodine, tyrosine, zinc, selenium, vitamin E, B2, B3, B6, C and D to make thyroid hormones. So we must eat a healthy, nutrient dense diet, but that is not enough. We must digest and breakdown and absorb those foods-the proteins, fats and carbohydrates. So we can have the nutrients from those foods available to us to use in the many cellular reactions in our bodies and in this case to make thyroid hormone.

Here are examples of the gut-thyroid balances/interregulation. Medicines like the protein pump inhibitors, Prilosec, can interfere with the absorption of vital nutrients that can lead to disease states like hypothyroidism and osteoporosis. Surgeries like removal of the gallbladder, and stomach surgeries for weight loss and also alter the ability for digestion and absorption of our food. Celiac disease, an autoimmune disease, causes damage to the intestinal lining and problems with digestive enzyme production, absorption of foods. This damage to the lining gives loose connections between the cells (leaky gut) and allows foods to pass from the gut into the blood stream and body. This causes the body to react to these ‘foreign invaders’ and produce antibodies leading to autoimmune diseases like Hashimoto’s thyroiditis.
Hypothyroidism is known to cause elevation in the cortisol levels. It is felt to do this as it is causing metabolic stress on the cells. And elevated cortisol levels suppresses TSH and low cortisol levels cause a high TSH. This is an example of the thyroid axis and adrenal axis interplay.

Cholesterol metabolism is another example of complex interplays. High cholesterol
Is not a statin deficiency. It comes from a variety of causes. It can come from genetic, inflammation, hypothyroidism, insulin resistance, the foods we eat and stress. Just because our genes say we have inherited a particular genetic sequence, does not mean that we are doomed. Another of my favorite quotes by Dr. Bland is “Genetic expression=Our genes get messages from our interactions with the environment and with how we choose to behave. They translate those messages into cellular instructions. These instructions are then what control our health and disease patterns. Genetic inheritance is not fate. Your lifetime health was not predetermined at your conception. On the contrary you have the opportunity-and the power-to shape your own pattern of health and longevity. It’s what personalized health management is all about”.
Insulin resistance can come from high cortisol levels, problems with carbohydrate metabolism from excessive intake, and stress increases cortisol levels. Insulin resistance can cause high cholesterol levels. It is all really interrelated and interdependent. So when you get that high cholesterol level back, you can see why just putting you on a statin isn’t the answer. One of the reasons that statins have been shown to work in the studies is that they do decrease the inflammation which is one of the causes of high cholesterol. In Functional/Integrative Medicine, we have other ways to treat the inflammation. First we need to find the source. We need to look at the whole picture and decide on a treatment plan. We access genetic risk and then how our environment affects this causing those genes to express or not. Are we eating a diet that is balanced and giving us the proper nutrients? Are we eating too many carbohydrates and the wrong kind of fats?
Do we have in place a daily lifestyle plan that we use to modulate the stresses in our lives? Are we exercising and not excessively? Have we evaluated our thyroid and adrenal (cortisol and adrenaline) function? Have we identified any inflammation that could be causing the problem? So all these factors need to be taken into consideration when treating high cholesterol to treat it appropriately.

Another important interplay is between cholesterol and sex hormones and cortisol. Cortisol is the ‘mother’ substrate necessary for the production of adequate sex hormones like progesterone, estrogens, DHEA, testosterone, and cortisol. If we don’t
have enough cholesterol, we can’t make these hormones and have deficiency states. Driving cholesterol down too far with statin drugs becomes a problem for our hormone production and we become symptomatic. So the hot flashes, fatigue, insomnia symptoms that a woman is presenting with can be coming also from this very low cholesterol.
We all know that stress is necessary for our health and too much either of the right kind which gives us high cortisols initially or the wrong kind damages our bodies. Elevated levels are a tear me down situation, not a build up the body.
Too much exercise contributes to this problem also.

We need to balance our lives with proper foods, exercise, stress management, and attitudes. Be happy, generous, and most of all be yourself.
I am happy to help you on your journey to optimal health, happiness and well -being.

Dr. Susan Beaven, MD is a board certified Family Medicine physician and one of 215 internationally certified in Functional Medicine by the Institute of Functional Medicine. She is a Diplomate of the Academy of Integrative Health & Medicine. Her extensive training, qualifications and experience in allopathic Medicine and Functional/Integrative Medicine allow her to provide patients with exceptional care.
Dr. Beaven works at Hermann Wellness on 6387 Central Avenue, St Petersburg, FL.
Call 727-278-4992 for an appointment for a comprehensive evaluation and plan.
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Health Benefits of Fiber

Fiber is the part of plant foods that cannot be digested. It is divided into soluble and insoluble fiber.                                         The difference is solubleFibres examples fiber dissolves in water and turns into a gel like substance where insoluble fiber does not. Soluble fiber slows down digestion, helping us to feel full longer and has been associated with reducing cholesterol. Insoluble fiber adds bulk to the stool since it does not dissolve and helps food to move through the intestines more quickly maintaining a healthy intestinal tract.

Sources of fiber include: legumes, vegetables, fruit, and whole grains. Foods especially high in fiber include flax seed and psyllium. The FDA recommends on average of 20 to 30 grams of fiber in the diet; however, most Americans fail to reach this goal due to a diet high in refined grains. Refined grains have been milled to give grains a finer texture and to improve shelf life; however, in the process dietary fiber is also removed. Low fiber in the diet leads to constipation and the downstream effects from impaired elimination (removal of toxins from the body).

Bacteria that house our intestines feed on fiber and the by products are what keep our gut healthy. In particular, buytrate is a substance made by bacteria in the colon from fermentation of certain fibers and has anti-inflammatory and anti-oxidant effects. A study published in the American Journal of Clinical Nutrition suggests that the greater production of butyrate may explain why colon cancer is less common in native residents of Africa than African Americans. Although additional research is needed in this area, evidence is promising that butyrate made from fermentation of fiber may be protective against colon cancer.

At Hermann Wellness we over comprehensive stool analysis that includes butyrate testing. Our offices are located in Tampa and St. Petersburg. Please call the office at 813- 902-9559 for more information or to schedule an appointment.


Magnesium is one of the most abundant minerals found in the body. It is found in                                                                       bone, teeth, red blood cells and is vital for 3d Magnesium elementmany systems in the body including the cardiovascular, muscular, and nervous system. Magnesium deficiency can result from a variety of causes and can be divided into 2 main categories: inadequate dietary intake or increased loss either via the GI tract or kidneys. There are also many drugs that deplete magnesium levels such as medications for reflux (Prilosec, Zantac, Nexium), statins, and some blood pressure medications.

Common symptoms of low magnesium include muscle cramps, weakness, heart palpitations, constipation, insomnia, and headaches. Magnesium is found in many foods such as whole grains, nuts, and green vegetables; however, most people do not get enough from their diet.

Low magnesium levels are associated with endothelial (blood vessel) dysfunction, increased C-reactive protein (inflammation marker), and decreased insulin sensitivity. The World Organization reports “low magnesium is implicated in hypertension, coronary heart disease, type 2 diabetes and metabolic syndrome” confirming its significance in maintaining the body’s overall health. According to the National Health Institute the daily recommended intake of magnesium is 420mg for men and 320 mg for women. There are many forms of magnesium: chelate, citrate, and glycinate.

When checking magnesium levels it is important to check RBC magnesium. Serum blood levels do not accurately reflect levels because the body will maintain a steady supply to ensure adequate levels for the heart.

At Hermann Wellness we offer Nutrient testing to our patients including magnesium. Our offices are located in Tampa and St. Petersburg. Please call the office at 813-902-9559 for more information or to schedule an appointment.

What is LDN (low dose naltrexone)?

Naltrexone is a synthetic drug that blocks opiate receptors in the                                                                                                    central nervous system, which are responsible for the pillsensation of pleasure derived from narcotics.  Naltrexone is typically used for heroin addiction and is FDA approved at doses of 50mg. It is also used in alcohol and drug addiction.

In recent years, lower doses of naltrexone have been used to treat autoimmune conditions such as MS (multiple sclerosis), rheumatoid arthritis, ulcerative colitis and crohn’s disease. The lower dosing of naltrexone is commonly referred to as LDN (low dose naltrexone). The typical dose ranges from 3.5mg to 4mg and is recommended to be taken at bedtime. Low dose naltrexone is inexpensive and well-tolerated.

LDN was first used by a physician in 1985 who found that it boosted the immune system in AIDS patients. It is thought that by briefly blocking opioid receptors, LDN causes an increase in endorphins and enkephalins (our body’s natural pain killers). These natural opioids are believed to influence our immune system as we have opioid receptors on immune cells. In particular, blocking the opioid receptors at night is thought to cause a longer up regulation hence LDN is recommended to be taken at night.

At Hermann Wellness we offer Holistic Primary Care to our patients including Low Dose Naltrexone. Our offices are located in Tampa and St. Petersburg. Please call the office at 813-902-9559 for more information or to schedule an appointment.

How to Prepare for a Testosterone visit at Hermann Wellness

Feeling tired? Experiencing a low sex drive? Noticing a loss of muscle mass? You may be experiencing symptoms from low testosterone word in letterpresstestosterone levels. Testosterone is a hormone produced by the body that is responsible for stimulating sperm production, maintaining sex drive, and building muscle in males. Low testosterone is diagnosed when levels fall below 300ng/dl. The normal range is from 300-1000 ng/dl.

Your initial visit for low testosterone will include a prostate exam to assess the heath of your prostate and blood work to check baseline CBC (blood counts), PSA level (prostate level), and free/total testosterone. Testosterone therapy can affect the prostate so a yearly prostate exam is required while on treatment as well as periodic blood work to monitor PSA levels. Testosterone therapy can also affect the red blood cell counts (hematocrit) causing them to increase thus is monitored regularly. Estradiol (estrogen) levels may be checked after testosterone replacement and sometimes an aromatase inhibitor will be given to reduce levels if found to be elevated. Labs are monitored every 3 months. Options for testosterone therapy include clomid, which is an oral medication that helps kick start the body’s own natural production of testosterone. This is a good option for young males to prevent sterility and is often used for only 3 to 6 months. Other options of testosterone replacement include gel, bioidentical cream, patch and injection. The best option will be selected during your visit.

At Hermann Wellness we offer hormone testing and therapy. Our offices are located in Tampa and St. Petersburg. Please call the office at 813-902-9559 for more information or to schedule an appointment.

Hermann Wellness Approach to Fatigue

Hermann Wellness Approach to Fatigue Tampa and St Pete

Fatigue can be caused by many things.  We always perform a medical exam and make sure that the patient’s blood pressure, heart rate and temperature are normal.  If the exam in normal, then these are things that we consider:

Low Thyroid: we check both a T3 and T4 as well as the standard TSH that most primary care physicians check.  Often patients have a normal TSH but will feel fatigue with a low T3.

Anemia: Anemia means low blood count.  Most doctors will not check iron levels if a patient does not have a low blood count.  I will always check iron studies in a patient who complains of fatigue.   I have found low iron in a large number of patients who do not technically have anemia.

Other Vitamin Deficiencies:  We check B12, Folate and consider checking MTHFR which is a gene mutation that prevents us from using our B vitamins properly.  We also check Vitamin D and we offer comprehensive panels of all the vitamin levels if we feel that the patient is not absorbing nutrients properly.

Hormones:  Low testosterone in men and women will cause fatigue.  I often check this on the initial visit if a patient complains of fatigue.  Imbalances of estrogen and progesterone can also contribute to fatigue and I will order these if the patient has signs of hormone imbalance.

Sleep Apnea:  If a patient does not get enough sleep, then of course, they will be tired.  I always consider a sleep study in patients who snore or report frequent night time wakenings.

Adrenal Fatigue:  This is the concept that the adrenal gland stops making adrenalin in a healthy pattern.  We are supposed to make adrenalin in the am and less in the evening. Sometimes we live with so much stress, that the adrenal gland gets tired of pumping out adrenalin all day.  Without our usual am “shot” of adrenalin, we often feel tired.  I test for this with saliva samples

Infection:  I consider chronic infections such as HIV, hepatitis, Epstien Barr Virus, Chronic Lyme and chronic yeast overgrowth in tired patients.  Most of these can be checked with bloodwork.

Allergies:  I often consider food allergies in patients who complain of fatigue and have gastrointestinal symptoms, such as gas and bloating.  I also consider allergies if the patient has rashes or chronic sinus drainage.

Autoimmune disease:  Most people with autoimmune disease feel very tired.  I will often screen for autoimmune disorders such as Rheumatoid arthritis, sjogrens, or Lupus in a fatigued patient.

Depression:  Mood disorders often cause fatigue and must be considered.

Medications:  We always make sure that there is no medication that might cause sleepiness.

To discuss if you might suffer from one of these conditions that causes chronic fatigue, please contact:

Hermann Wellness St. Petersburg or Tampa:  (813) 902-9559











What you need to know about Bioidentical Hormone therapy

Many women and men, feel the changes of hormones as early as their mid-thirties.  The most common symptoms are depression, weight gain, poor libido, skin changes and vaginal dryness (in women).  Women, may experience these symptoms even if they are still getting their monthly cycles.

The first step in figuring out whether your symptoms are related to hormone changes is to have hormone levels tested.  I usually recommend checking some basic bloodwork and thyroid levels in addition to estrogen, progesterone, testosterone and DHEA levels.  Normal hormone levels do not rule out a hormone problem.  Some people with low-normal hormone levels, my develop symptoms of hormone deficiency.

We check hormone levels with bloodwork or saliva tests.  I often start with bloodwork as that is more likely to be covered by insurance.  If the hormone levels are low, I offer patients several alternatives.

Men can use a medication, called Clomid, to increase their testosterone levels.  Clomid is especially useful in young men because it does not reduce sperm count the way testosterone therapy does.  If men choose to start testosterone therapy, I explain the pros and cons of testosterone injections, creams, patches and pellets.  Men choose which of those are best based on their preference.

In women, I recommend bioidentical hormone replacement therapy when natural therapies do not alieve menopausal symptoms.  Bioidentical hormones differ from standard, synthetic hormones because they are the same molecular structure as the hormones your ovaries make.  Bioidentical hormones, have less side effects and less risk of blood clots and stroke than standard hormones.  Less risk does not mean no risk, and I always discuss these pros and cons with my patients prior to prescribing.

Anne Hermann, MD is a board Internal Medicine physician who trained at Columbia University in New York.  She was first author in the study that demonstrated that the bioidentical progesterone cream is absorbed as well as progesterone pills. Over-the-counter progesterone cream produces significant drug exposure compared to a food and drug administration-approved oral progesterone product.  Hermann AC, Nafziger AN, Victory J, Kulawy R, Rocci ML Jr, Bertino JS Jr.J Clin Pharmacol. 2005 Jun;45(6):614-9.

As a research pioneer on bioidentical hormone therapy, Dr. Hermann has been treating men and women for 12 years in Tampa Bay.  For additional information on hormone therapy, please call the office at 813-902-9559.


What is Fosteum?

Fosteum is a medical food that contains cholecalciferol, genistein, and zinc.  It is used to manage bone loss, primarily in post-menopausal women.  A medical food are foods that are specifically designed with nutrients intended to treat a specific disease that cannot be met by the diet alone.  Genistein is the main active ingredient and is a natural isoflavone derived from soybean. Isoflavones have some estrogen activity and help in reversing bone effects of estrogen loss in Fresh Soy Beanspostmenopausal women. Genistein has been clinically proven to reduce bone resorption and increase bone formation.

Cholecalciferol is Vitamin D3, the natural form of Vitamin D that is produced when the skin is exposed to sunlight. Vitamin D is important for reducing fracture risk and for enhancing the absorption of calcium from the intestines.  Zinc is a naturally occurring mineral and is important for mineralization (hardening and strengthening) of bones. The special combination of these ingredients results in a slowing of the metabolic processes the cause bone loss and ultimately osteoporosis in women. Overtime this improves bone mineral density and reduces the risk of fracture.

Fosteum is not for everyone and should be avoided in individuals with a history of breast or reproductive organ cancer.

At Hermann Wellness we offer Holistic Primary care to our patients. Our offices are located in Tampa and St. Petersburg. Please call the office at 813-902-9559 for more information or to schedule an appointment.

Health Benefits of Black Rice

Health Benefits of Black Ricegrains of rice

Carbohydrates in the diet provide a source of energy for our body and are found in food sources such as fruits, vegetables, and grains. Our body uses these foods to provide glucose (the body’s main energy source) to vital organs such the brain. It is important to remember that not all carbohydrates are created equal. The best carbohydrates are those containing a high amount of fiber, which provide the most amount of nutrients and takes longer to break down into glucose. Refined carbohydrates have been processed to remove the beneficial fiber resulting in a rapid spike in blood sugar levels in the blood. Black rice is among one of the healthy carbohydrate options and has been linked to many health benefits. It turns to a beautiful, deep purple color when cooked and has a sticky appearance with a nutty flavor. It is also known as “Forbidden Rice” as historically it was cultivated in small quantities only for the consumption by the Emperor of China.

Scientists at the 240th National Meeting of the America Chemical Society reported that “a spoonful of black rice bran contains more health promoting anthocyanin antioxidants than are found in a spoonful of blueberries, but with less sugar and more fiber and vitamin E antioxidants”.  Black rice is also a rich source of iron.

Considering the different options for rice, it is well known that brown rice is a healthy alternative to white rice. White rice is stripped of bran which is full of vitamins, minerals and anti-oxidants. Similar to brown rice, black rice is high in nutrients; however, contains even more antioxidants and protein. Black rice can be used in cold salads and is a great substitute for white rice and noodles.

At Hermann Wellness we offer Holistic Primary care to our patients. Our offices are located in Tampa and St. Petersburg. Please call the office at 813-902-9559 for more information or to schedule an appointment.

How Can B Complex Vitamins Help Me?

b vitamin 2B vitamins are a family of water-soluble vitamins that play critical roles in metabolism and biochemistry.  They represent the most common vitamins utilized by the body as cofactors for facilitating enzymatic function.  Our modern refined diet has lead to lower levels of B vitamins.  High levels of stress and many medications may lower B vitamin levels.  These vitamins have therapeutic power when taken together – their various functions are outlined below.

Thiamin (vitamin B1) is needed for energy production, nervous system functioning and heart health.

Riboflavin (vitamin B2) helps the body turn food into energy.  It is also a powerful antioxidant.

Niacin (vitamin B3) aids the body in metabolizing food (proteins, fats, carbohydrates) into energy.  It is also a powerful antioxidant.

Vitamin B6 plays important roles in amino acid metabolism, hemoglobin production, helps modulate blood sugar and aids in efficient functioning of the nervous and immune systems.

Folate is essential in carbon metabolism and deficiency can be associated with neural tube defects, certain cancers and hyperhomocysteinemia.

Vitamin B12 has been found useful in the treatment of asthma, depression and mental wellness.  Vegetarian are particularly susceptible to low B 12, as it is found exclusively in animal products.

Biotin can strengthen nails, lower blood sugar and insulin and support weight loss.  It may also aid in alleviating diabetic neuropathy.

Pantothenic acid (previously known as vitamin B5) helps with immune function, energy generation, and the production of stress hormones.

Hermann Wellness, a holistic internal medicine practice, offers comprehensive vitamin and mineral testing.  Locations are maintained in Tampa and Saint Petersburg, Florida.  Please contact the office at 813-902-9559 for more information or to schedule an appointment.