Dear doctor

Desperate to detoxify

Q I am feeling very sluggish and want to feel perkier before winter sets in. I've read about detox diets in magazines - can you recommend one?

A Advocates say that chemicals, bugs, alcohol and antibiotics can make the gut more permeable so that instead of passing straight through and out, toxins are diverted to the liver. The liver is the in-house detoxifier, but some say we overburden it so that a high load of toxins circulates in the blood, causing all manner of ills.

These include all the conditions for which conventional medicine offers so few solutions, including headaches, excessive mucus, rashes, aches and pains. Add to these lethargy, bad breath, indigestion and weight gain, and that more or less covers all of us. Apparently, some people detoxify well, some sluggishly and some hardly at all. Any diet high in fruit and veg and low in caffeine, alcohol, fats and processed foods probably offers the same benefits as some of the complicated regimes described in the many, often contradictory, books. The Total Detox Plan by Dr Sarah Brewer seems sensible if you need something to tell you to exercise, eat properly and drink water.

Flu fighters

Q I work in advertising, am in my mid-40s, quite fit, but prone to stress and overwork. The last thing I need this winter is flu. Do you recommend flu jabs and are there reasons for not having one?

A Cut down on the work and stress and leave your immune system to fight off flu. There is no epidemic forecast this year. The best way to avoid flu is to urge any colleagues who think they have it to stay at home until they have recovered. The jab is fairly benign, but can cause the rare and potentially dangerous neurological condition Guillain-Barré syndrome, which can cause paralysis. It's really only worth having the jab if the risks of flu outweigh any potential danger from the jab. For a healthy 40-year-old, flu is a nuisance for a week. The people most likely to develop complications from flu, such as pneumonia, are over-75s, anyone in a residential home and those with diabetes, long-standing chest, heart or kidney diseases or lowered immunity due to chemotherapy or steroids. They should all have the jab.

Vein hopes

Q I get recurrent varicose ulcers in my legs. They are slow to heal and painful when knocked, which often happens when my grandchildren visit. The nurse at my GP's surgery dresses each one and they do eventually heal. But I would like to prevent any further ones developing. Any ideas?

A Keep your skin as moisturised as possible using E45. Graduated support stockings, for which you need to be measured by a pharmacist, encourage the blood to flow back up towards the heart and protect against minor scrapes and cuts, which can lead to ulcers. Cuddling grandchildren is fine, but take their shoes off if they are clambering over your legs, and keep your legs out of harm's way while they ride bikes and scooters. You will need antibiotics if your ulcers fail to heal. New medications containing growth factor give hope for the future but are not yet widely available.

The homeopathic remedy Cargo Veg 6c is sometimes recommended for elderly people with varicose ulcers. Surgery to correct varicose veins does not always prevent ulcers but is often advised as a preventive measure.

• These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.

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