Being gluten free is certainly more popular than in previous decades, but is it just a trendy fad?

I would categorise patients into three groups: coeliac, gluten intolerant, and gluten vulnerable. The first group offers no controversy. Coeliac disease is an auto-immune disease where there are antibodies created to the protein component of wheat,barley, oats and rye. This causes severe damage to the small intestine and demands a lifetime of strict avoidance of all products containing gluten even if the amounts are tiny.

Gluten intolerant patients have negative tests for coeliac disease but suffer from bloating, abdominal pain and bowel disturbance ( diarrhoea or constipation) when they eat gluten containing food. Because gluten is a protein which is quite dense and hard to digest, these people develop symptoms when eating variable amounts of such foods  A therapeutic trial of strict gluten avoidance will provide relief from symptoms within two weeks, and I frequently suggest such a trial since this will inform future food choices.

I am in the third group. I did not suffer from any gut symptoms when I ate gluten but over the years have become convinced that my health and longevity demands avoidance of gluten. We now know that gluten increases the amount of an intestinal cell  regulator called zonulin. Zonulin increases the permeability of the lining of the gut and allows diffusion of various particles across into the gut, where there is a large collection of immune tissue. Over time these particles may look similar to part of a cell in the body, such as the thyroid cell. The immune system may then be activated to create antibodies to the particle which attacks native cells or proteins in the body. This is very new research and I find it quite convincing. For me, it is a  very small compromise to avoid gluten!!

The current play at the Griffin, Five Properties of Chainmale, is excellent, and explores some foibles of modern middle aged man. It reveals vanity, self doubt, cowardice and dishonesty in five very funny and utterly convincing vignettes. The staging is extremely clever in that the different male characters are played by all three men, and feelings are sometimes narrated so that we have an excellent view of both the interior and exterior of the characters. The sets are equally imaginative and flexible to set up the various stories.

The acting by Jeremy Waters , Briony Williams, Dominic McDonald and Alan Lovell is wonderful and they affect a variety of accents effortlessly as well as portraying a wide range of emotions . These are seasoned stage actors whose performances I have enjoyed in plays such as Four Places and Scenes from an Execution.

The biggest credit must go to Nicholas Hope another great Australian actor who wrote and directed this play. Some of the lines are quite delicious and the play flows seamlessly.

I have read some unfavourable reviews of this play which is disappointing. It is not a preachy play and therefore does not draw a final conclusion. It shows us who we are, and if we are honest, both men and women could not help but relate to the behaviours depicted.

There are several important uses for intravenous therapy in integrative general practice. Vitamin C and other nutrients are presented as vials and bottles and are added to small bags of warmed normal saline. The doses are dependent upon the condition being treated. Vitamin C, vitamin B groups, Glutathione, ALA, Magnesium and Zinc are all common nutrients used in intravenous therapy. Vitamin C is the most versatile of all, as a strong antioxidant and boost to the immune system. It is used either once or twice per week for two to three weeks to help recovery from viral illnesses. It is particularly helpful for shingles, the adult form of chicken pox ,in reducing the duration of nerve pain ( neuralgia) from the shingles. It is also helpful for Epstein Barr Virus, (glandular fever,) and other acute viral infections. It can be mixed with glutathione for this indication. Some of my patients have heavy metal toxicity symptoms, and vitamin C is used with other chelation agents such as ALA in particular regimens to help remove these from the body. Mercury is one example where intravenous therapy is useful, and radioactive materials is another, where magnesium is added to help chelation. Cancer support is another area where intravenous therapy is very helpful. Higher doses of vitamin C are required. It supports the patient and also has chemotherapeutic activity. It is used weekly or twice weekly before chemotherapy. My patients have experienced a gratifying stability in their white cell counts during chemotherapy enabling the chemotherapy regimen to be completed more quickly and reducing side effects- particularly the extreme fatigue. Some patients utilise Vitamin C as an energiser after international travel or a particularly hectic schedule. It is popular overseas in this context.

My patients often come to see me armed with blood tests ordered by their local G.P. The blood tests have been reported as ‘normal’ but my patient does not feel well…how can this be explained? There are a few reasons why this can happen. Firstly, ‘ordinary’ G.Ps are taught that all numbers in a range are ‘equally good’. The reference ranges are taken from patient results and out of one hundred results, the top five and bottom five are excluded, leaving a reference range of ninety percent. But this does not represent good or optimal, particularly when you realise that the blood tests to achieve this reference range are performed on unwell people!!

For example, if the range of ferritin ( iron stores) is 15-200, then any result between these two figures is acceptable….this is nonsense.!!

A level of 15 is inadequate and a person with such low iron will undoubtedly feel tired. I do infusions of iron in my surgery and the improvement in energy when someone has an iron less than 50 is remarkable. Similarly, the range for Vitamin D is 51-140.. but at 50 the patient is at risk of rickets, so just being slightly over the lowest number in the range cannot be optimal. Always question your doctor about what would be OPTIMAL rather than whether something is just ‘in the range.’

Another problem with ‘ordinary’ G.P. blood tests is that tests may not probe deeply enough to give enough information. Thyroid tests are a good example, where ordering ‘thyroid function tests’ will provide the G.P. with just thyroid stimulating hormone, which is a pituitary hormone, not secreted by the thyroid gland at all. Thyroxine, and certainly free T3 and reverse T3 are vital to make an accurate assessment, and the G.P. has to specifically request them.

The third challenge that G.Ps have is acquiring adequate knowledge of available tests. There are many blood , saliva and urine tests which I utilise in my practice which medical centre G.P. are unfamiliar with.They provide valuable and sometimes vital information and inform treatment protocols. The internet can provide alot of information about available tests so that patients can arm themselves before visiting their G.Ps.

Remember..when it comes to blood tests…’in the range’ does not mean Optimum health!!!

The Old Fitz is currently my favourite independent theatre venue in Sydney..every show this year has been a winner. The latest , a play written , directed by and starring a talented and experienced member of Sydney stage royalty-Marshall Napier -is dazzling.

It is a true thriller, set on a stormy night in a dusty old home. I felt worried for the insurance salesman-played beautifully by Ben O’Toole- from the moment he entered the lair…just as one should. The tension was modulated by moments of wonderful comedy, enabling me to wonder whether I was just being neurotic!. The mild mannered home owner played by Napier was brilliant- menacing in every gesture and comment. This performance was enhanced by the fact that Napier himself had recently broken his leg and was using crutches and a frame- the dichotomy worked very well indeed. The third character played by the exquisite Anna Bamford was delightful as the mysterious Myra.

This play is fantastic entertainment. Combining the show with a meal at The Old Fitz ( the restaurant has recently reopened with two clever French Chefs who serve authentic cuisine) is a marvelous way to have a champagne evening for the price of beer!

The Griffin theatre is a lovely little theatre tucked away on the other side of the road from the  iconic coca-cola sign of Kings Cross. This theatre has been running for many decades and has been dedicated to the task of bringing new Australian plays to Sydney- a really tremendous feat.

The current play Caress/Ache is an Australian ( World) premiere and is very very creative and intricate play. I really love plays which have several threads that eventually tie in together. The acting is stunning as well, with all of the cast members playing more than one role effortlessly. The most poignant story in this play, which explores the theme of human touch , relates to a man about to be hung in Singapore for a drug crime…of course this resonates with audiences at the moment.

I highly recommend this play, which is running until early April. it is completely absorbing  and very moving. As an aside, I don’t usually read reviews until after I have seen a play. In this case I was horrified by the negative reviews which did not seem to capture the nuances of this play. Talking casually to audience members afterwards also reflected a great deal of enthusiasm for this show..so perhaps the critics get too bogged down with the joys of tearing a performance apart!

Ticket prices are so reasonable- only $35.00 for under thirty year olds.

There is an amazing array of nutritional supplements on the shelves of chemists, health food stores and even supermarkets. It is very difficult for consumers to know which are the most important, which are useful and which are unnecessary.

Integrative doctors aim to optimise nutritional elements rather than assume that ‘you’ll get what you need in an ordinary diet.’ We will focus on particular nutrients for particular symptoms- for example, people who suffer from muscle aches need high doses of magnesium. I jog daily, and used to accept that my legs ached. By increasing my magnesium supplement those aches disappeared and I have been more comfortable running than years ago- which is a pleasant surprise for a woman in her mid fifties!

For people who feel generally well, I would suggest three supplements- fish oils, Vitamin D and Vitamin C.

Fish oils are miraculous- antioxidant, cardio and joint protective! Eating enough fish/seafood to deliver optimal fish oils would expose us to excessive mercury, which is a sad commentary on our modern environment. It is important that the fish oil container is labelled in relation to its lack of mercury. An alternative is krill oil, since krill are very low in mercury. The capsule can also be opened into a liquid, such as a vegetable juice.

Vitamin D is also very versatile. Vitamin D is vital for bone strength, muscle strength, cardiovascular function and our immune system. We obtain it from the sun, but of course in protecting ourselves from skin cancer we have covered ourselves with UV protection, and hence our absorption of Vitamin D has plummeted. In my surgery, almost half of my patients are deficient when I do a blood test, so having your levels measured is vital. The optimal level is 100 nmol/l- but in Australia, the reference range is 50-140. Many people might therfore be told by doctors that they have enough vitamin D when their levels are  in fact suboptimal. There are two supplement options. Because Vitamin D is a fat soluble vitamin, it can be given as a once yearly injection. It can also be taken as an oral supplement- daily, weekly or even monthly depending on the formulation. I really recommend being tested!

Vitamin C is the most powerful nutritional supplement of all. It is a strong antioxidant, which reduces cell damage. It is vital for our immune system- both to prevent autoimmune disease AND ensure optimal surveillance against infection and cancer. It is also a great anti inflammatory agent, and helps to prevent arthritic conditions. A healthy person will benefit from 2gm daily, but to ward off infection during times of stress, 4gm is optimal. The only possible side effect is diarrhoea- which may happen if the dose is increased above 6gm daily.

These three supplements will have profound long term benefits on your health!