Sarah’s surgery

Dr Sarah Brewer, GP and expert in complementary medicine, answers your questions

Dr Brewer on the latest sugar fads and the risks of fizzy medication

Help for hay fever

Q What are the best natural approaches for preventing or treating hay fever? I’ve heard honey can help if taken early enough. A Locally produced honey is often recommended as it is believed to expose your immune system to small amounts of pollen to build up tolerance. One study did suggest that birch pollen honey reduced the need for antihistamines, but I feel uncomfortable advising anyone to deliberately eat something they know their body reacts against. My best advice is to wear wraparound sunglasses, and to apply a nasal barrier to reduce contact between allergens and the nasal lining, such as Haymax Balm (£6.99) or Prevalin Allergy Nasal Spray (£9.99, Holland & Barrett). Rinsing pollen from the nose with saline (such as Stérimar Stop & Protect sterile sea water spray, £8.99 for 100ml) has been shown to reduce the need for corticosteroid sprays, resulting in fewer side effects.

Parkinson’s risk

Q My father was recently diagnosed with Parkinson’s and I’m concerned that I’m at risk, too. Is the disease hereditary? A Some families have a high prevalence of Parkinson’s disease due to a mutation in a particular gene. But even if you inherit this mutation, it doesn’t necessarily mean you’ll develop symptoms, such as tremor and stiffness. Generally, about one in 10 cases appear to have a genetic link. Most cases occur spontaneously and what causes cells in a particular part of the brain to perish remains unknown. These brain cells produce a brain chemical called dopamine, and treatment revolves around replacing dopamine through medication. Recent studies have focused on immune links involving gut bacteria, but there is no firm evidence of a link. For information about living with Parkinson’s, or caring for someone with the condition, visit parkinsons.org.uk. If you would prefer to talk to someone, call the National Parkinson’s UK Helpline on 0808 800 0303.

Pelvic pain

Q My doctor suspects I have something called pelvic congestion syndrome due to varicose veins in the lower abdomen. How is this treated? A Pelvic congestion syndrome (PCS) causes unpleasant dragging sensations and persistent aching in the pelvis, which is typically made worse by standing and sitting and made better by lying down. PCS is also associated with an irritable bowel and bladder, painful intercourse and piles (which are a form of varicose veins, too). Latest research suggests that up to 40% of women with long-term pelvic pain have PCS. Common signs of PCS are vulval or vaginal varicose veins. Many women who develop these, particularly after pregnancy, are simply advised to wear tight pants. However, these can now be cured permanently. Treatment involves local anaesthetic, a thin catheter going into the varicose vein and a substance being injected that can be seen on

X-ray. As pelvic pain can be due to other conditions, such as adhesions from surgery and ovarian or womb problems, it’s important to have persistent symptoms properly checked out.

Which sugar is best?

Q Is brown sugar healthier than white? I’ve also seen coconut sugar, date sugar and agave nectar – which sweeteners are best? A Brown sugar sounds healthier than white but, despite providing a smattering of vitamins and minerals, it doesn’t contain enough to offer any meaningful nutritional benefit. Coconut sugar is crystallised sap from the flower buds of coconut palms. Similar to brown sugar – in that it consists of sucrose plus small amounts of glucose and fructose – it also provides small amounts of B vitamins, iron and magnesium, and is better for you than white sugar. But don’t have too much because it is still sugar. Date sugar is made from the sap of the palmyra or sugar date palm and provides iron, magnesium, calcium and vitamin B12. It’s better for you than white or brown, but you should still watch your intake. My favourite sweetener is the plantderived stevia.

Energy boost

Q Since turning 50, I’m lacking energy and finding myself flagging in the afternoons despite a healthy diet and exercise. A Sometimes a lack of energy at your age can be related to menopause, in which case hormone replacement therapy might help, especially if you are also experiencing hot flushes and mood swings. As we move into spring, energy levels tend to lift and you should start to feel better if you spend more time outdoors and work out in the fresh air. Exercise and a good intake of protein are key to maintaining muscle strength and combatting the loss of muscle bulk that occurs with age. While a persistent lack of energy is the result of a medical condition in one in 10 people, certain conditions need to be ruled out, such as anaemia and an underactive thyroid. If you are cutting back on food to lose weight, a multivitamin – for example, Seven Seas Cod Liver Oil plus Multivitamins (£9.85 for 90 tablets, Boots) – can safeguard against deficiencies linked to lack of energy.

Ditch the fizz!

Q My pharmacist recently suggested I stop taking fizzy paracetamol because it contains too much sodium and recommended I didn’t use effervescent vitamin C tablets either. Is this widely known? A Effervescent medication – and vitamin C supplements – can contain as much sodium as 1g of salt. Official NHS advice is to consider changing to a non-effervescent tablet, particularly if you have been advised to reduce your salt intake. This is especially important if you have high blood pressure, as salt promotes fluid retention and can contribute to hypertension. A study involving 1.29 million people over seven years found that those who used soluble or effervescent painkillers containing sodium were seven times more likely to have high blood pressure than those using non-fizzy tablets. Another study showed that when subjects switched from effervescent formulations to ordinary tablets, their blood pressure went down by an average of 13.1/2.5 mmhg after four weeks – a better effect than can be achieved from taking most prescribed blood pressure medication! If you want to take fizzy vitamin C tablets, choose one without sodium, such as the Ruby Breakfast Vitamin C Effervescent Tablets (£11.95 for 80, Healthspan) or get more fresh fruit and vegetables into your diet.