Do I still need to see my regular GP?

Yes. We work alongside your GP. Functional and integrative medicine is complementary — we don't replace your primary care relationship.

My results keep coming back normal. Can you actually help?

Yes. Standard blood tests typically look for overt disease. We run broader panels — reverse T3, fasting insulin, inflammatory markers, microbiome analysis, provoked urine testing for heavy metals — that pick up patterns standard testing misses.

Will I need a lot of testing?

It depends on your case. Your first appointment includes a thorough history. Testing is ordered based on what we find — never a panel-for-the-sake-of-a-panel approach.

How long until I feel better?

Complex chronic illness takes time to unpack. Most patients notice measurable shifts within 8-12 weeks of starting their individualised plan, with deeper changes over 6-12 months.

Where is Mojo Klinik located?

Suite 11, 40 Yeo Street, Neutral Bay NSW 2089, Sydney, Australia.

What are the clinic hours?

Monday to Friday, 9:00am to 5:00pm. Bookings are by appointment only.

Is parking available?

Yes. There is 2-hour free parking on Yeo Street and surrounding streets, plus public transport options including the Neutral Bay ferry wharf a 5-minute walk away.

Do you offer telehealth?

Yes. Telehealth follow-ups are available Australia-wide. The first appointment is strongly recommended in-person at our Neutral Bay clinic.

What kinds of conditions do you treat?

Chronic, complex, multi-system, often unexplained conditions — including hormonal, digestive, metabolic, fatigue, immune and toxicity-related presentations. We do not provide acute or emergency care.

Do you treat cancer, Alzheimer's or dementia?

No. We do not advertise treatment for cancer, Alzheimer's, dementia or serious neurodegenerative conditions per TGA prohibited representations.

How do I know which condition page to start with?

Most patients begin with the Mojo New Patient Appointment (one hour) which covers the full clinical picture. From there we identify which condition-specific testing is needed.

Can I see both doctors?

Yes. Many patients see both Dr Mackey and Dr Varipatis — typically Dr Mackey for hormonal, digestive and metabolic presentations and Dr Varipatis for environmental, heavy metal and chronic infection work.

Small Intestinal Bacterial Overgrowth (SIBO) is a condition where bacteria that normally live in the large intestine overgrow in the small intestine, causing bloating, gas, abdominal pain and altered bowel habits.

How is SIBO diagnosed?

We use a lactulose or glucose breath test that measures hydrogen and methane gas over 2-3 hours. This identifies bacterial overgrowth and the dominant gas pattern (hydrogen-dominant, methane-dominant, or hydrogen sulfide).

Is IBS the same as SIBO?

No, but they overlap. IBS is a functional diagnosis of digestive symptoms without identifiable disease. SIBO is one identifiable cause of IBS-like symptoms. Many IBS patients have underlying SIBO, but not all.

How long does treatment take?

Treatment duration depends on the case. A typical SIBO protocol involves 2-4 weeks of antimicrobial therapy followed by gut repair and prevention of recurrence. Underlying motility and digestive function must also be addressed.

Yes, SIBO has a moderate recurrence rate. We focus on identifying and treating the underlying causes (motility, structural issues, MMC function, diet) to reduce recurrence risk.

Do I need to stop my medications before testing?

Some medications (particularly antibiotics and probiotics) need to be stopped before breath testing. Your practitioner will advise specific preparation instructions at booking.

Will Medicare or private health insurance cover this?

The Mojo New Patient Appointment carries a Medicare rebate. Breath testing is privately billed. Private health fund rebates depend on your policy — check with your insurer.

What is perimenopause?

Perimenopause is the transition period leading up to menopause, typically lasting 4-10 years. Hormone levels fluctuate, causing symptoms that often begin years before periods stop.

At what age does perimenopause start?

Most women begin perimenopause in their mid-40s, but it can start earlier. Symptoms before age 40 may indicate primary ovarian insufficiency and warrant investigation.

Menopausal Hormone Therapy (formerly HRT) replaces the hormones that decline during perimenopause and menopause. Modern body-identical MHT is far safer than older synthetic versions.

Current evidence shows body-identical MHT is safe for most women when started within 10 years of menopause onset. Individual risk assessment is essential — your family history, personal history and current symptoms all inform the decision.

What is DUTCH testing?

DUTCH (Dried Urine Test for Comprehensive Hormones) measures hormones and their metabolites over 24 hours, giving a fuller picture than a single blood draw. It's particularly useful for perimenopause where hormone levels fluctuate.

Do I need blood tests or urine tests?

Both. We typically run a full blood panel (thyroid, sex hormones, metabolic markers, vitamins) plus DUTCH for detailed hormone metabolite analysis. The combination gives the clearest clinical picture.

Can I take MHT if I've had breast cancer?

This requires careful specialist input. Non-hormonal options are usually preferred. Decisions are made in consultation with your oncology team.

What is heavy metal toxicity?

Accumulation of toxic metals (mercury, lead, arsenic, cadmium, aluminium) in body tissues beyond levels the body can safely excrete. Sources include dental amalgams, contaminated fish, occupational exposure, old plumbing and some traditional medicines.

How do you test for heavy metal burden?

We use provoked urine testing — a chelating agent is administered to mobilise stored metals, then urine is collected over 6 hours. This reveals what's actually stored in tissues, not just recent exposure. Blood tests only show recent exposure.

Is chelation therapy safe?

When medically supervised, chelation is safe and well-tolerated. The Heavy Metal Initial Appointment assesses kidney function, mineral status and overall suitability before any chelation is undertaken. Treatment is individualised.

Do I need to see a specific doctor?

Both Dr Mackey and Dr Varipatis offer Heavy Metal Initial Appointments. For chelation therapy specifically, both doctors prescribe — Dr Varipatis has the longer clinical history with chelation, Dr Mackey integrates it with broader hormonal and metabolic work.

Will my insurance cover this?

The Heavy Metal Initial Appointment does not carry a Medicare rebate. Private health fund coverage depends on your policy. Itemised receipts are provided for you to submit.

How long does treatment take?

A typical chelation programme runs 6-12 months depending on the metal burden identified. Repeat provoked urine testing guides treatment duration.

What's the difference between you and a naturopath?

Dr Mackey and Dr Varipatis are AHPRA-registered medical doctors. Provoked urine testing, chelation therapy and pharmaceutical prescribing are medical acts not available to naturopaths. Your treatment is medically supervised throughout.

Clinically termed 'increased intestinal permeability' — the gut lining becomes more porous than it should, allowing partially digested food particles, bacterial fragments and toxins to enter the bloodstream, driving systemic inflammation.

What causes bloating?

Common drivers: SIBO, food intolerances (FODMAP sensitivity, histamine, lactose), microbiome imbalance, low stomach acid, sluggish motility, and increased intestinal permeability.

How do you diagnose it?

We use a combination of detailed symptom analysis, breath testing (SIBO), stool microbiome analysis, intestinal permeability markers (zonulin, lactulose/mannitol test), and food intolerance panels where indicated.

Is bloating always related to food?

Not always. Bloating can also be driven by HPA axis dysfunction, hormonal fluctuations, stress, structural issues, and microbiome imbalance independent of specific foods.

How long does treatment take?

Most patients see significant improvement within 8-12 weeks. Full gut repair typically takes 6-12 months depending on the underlying cause and how long the issue has been present.

Should I do an elimination diet?

Elimination diets can help identify triggers short-term, but they're not a long-term solution. We use targeted testing where possible to identify specific drivers, then individualise dietary advice.

Sometimes, but not always. The wrong probiotic for your specific microbiome imbalance can worsen symptoms. We test first, then prescribe specific strains based on your results.

Can stress cause bloating?

Yes. Chronic stress alters gut motility, microbiome composition, digestive enzyme secretion, and intestinal permeability. We address the stress component alongside the physical drivers.

Hashimoto's thyroiditis is an autoimmune condition where the immune system attacks the thyroid gland, gradually reducing its function. It's the most common cause of hypothyroidism in Australia.

Why is my TSH 'normal' but I still have symptoms?

Standard TSH testing misses many thyroid issues. We test the full panel — TSH, free T3, free T4, reverse T3, and thyroid antibodies (TPO and TG). Patterns of suboptimal T3 conversion, elevated reverse T3, or positive antibodies explain persistent symptoms.

Do you prescribe thyroid medication?

Yes. As AHPRA-registered medical doctors, we prescribe all forms of thyroid medication including T4 (Oroxine), T3 (Cytomel/Tertroxin), and combination T4/T3 therapy. Decisions are based on the full panel and your symptoms.

What's reverse T3 and why does it matter?

Reverse T3 is an inactive form of T3 that blocks thyroid receptors. Elevated reverse T3 (from chronic stress, calorie restriction, illness, or low iron) causes hypothyroid symptoms even when TSH and free T4 look 'normal'.

How long until I feel better on thyroid treatment?

Most patients notice meaningful improvement within 4-8 weeks of starting treatment, with full stabilisation over 3-6 months. Repeat testing at 6-8 weeks guides dose adjustment.

Will my GP continue to manage my thyroid?

We work alongside your GP. Once stable, we can transition thyroid monitoring back to your GP with a clear management plan. Many GPs prefer this collaborative approach for complex thyroid cases.

How do you test hormones?

We use a combination of blood tests (for thyroid, sex hormones, metabolic markers) and DUTCH (Dried Urine Test for Comprehensive Hormones) for detailed hormone metabolite analysis. The combination reveals patterns a single blood draw misses.

Do I need to test on a specific day of my cycle?

Yes for blood tests — typically day 21 for progesterone, day 2-3 for baseline hormones. DUTCH can be done any day and is more forgiving.

Can hormones cause weight gain?

Hormonal drivers of weight gain include thyroid dysfunction, cortisol dysregulation, insulin resistance, oestrogen dominance, and perimenopausal changes. We test for these before any weight management advice.

What about testosterone in women?

Testosterone in women is essential for energy, libido, muscle mass and motivation. We test and address both deficiency and excess (PCOS-related).

Chronic Fatigue & ME/CFS | Mojo Klinik

Mojo Klinik / Conditions / Fatigue & recovery / Chronic Fatigue Syndrome and ME/CFS

DR MARIA MACKEY

Mojo Klinik · Neutral Bay Sydney

Chronic fatigue syndrome and ME/CFS.

Tired in a way sleep does not fix.

Three months. Six months. Years.

Standard tests come back fine.

You cannot function the way you used to.

SOUND FAMILIAR?

You will recognise yourself in some of these.

Most patients arrive carrying one or more of these.

You are exhausted in a way that sleep does not fix
You crash after physical or mental exertion (post-exertional malaise)
You have been told your bloods are fine but you cannot function the way you used to
Your fatigue has lasted 3 or more months and is interfering with daily life
You have brain fog, unrefreshing sleep, muscle and joint pain, or sensitivity to light and sound
You suspect ME/CFS, post-viral fatigue, or chronic exhaustion but no one has investigated properly
You have already been to multiple doctors and have a thick file of normal results
You want a structured biological investigation, not encouragement to give it more time

There is almost always a clinical explanation. Pulling on the thread is what we do.

WHAT CHRONIC FATIGUE AND ME / CFS ACTUALLY ARE

Chronic fatigue is persistent, unexplained exhaustion lasting more than three months that does not resolve with rest.

ME/CFS (myalgic encephalomyelitis / chronic fatigue syndrome) is a specific diagnostic entity within that broader category, defined by postexertional malaise as the cardinal feature alongside cognitive

impairment, unrefreshing sleep, and other clinical criteria. A chronic fatigue specialist Sydney approach investigates the biological drivers behind the fatigue rather than treating it as a psychological or motivational problem. The biology is real, the markers are measurable, and the treatment plan follows from what the testing shows.

"Chronic fatigue patients often arrive with a thick file. What they have rarely been offered is a structured biological investigation of why they are this tired. That is what we do. The tests are not exotic. They are different from the standard panel, and they almost always find something."

Dr Maria Mackey, MBChB. FRACGP. FAARM. Mojo Klinik Founder

A DRIVER MAP

The three most common drivers we find.

Almost no CFS case sits just here. The drivers overlap.

MITOCHONDRIAL

Cellular energy production. Why exercise hurts. Why recovery is delayed.

HPA AXIS

Cortisol pattern is flat. Sleep is broken. The system is stuck on.

VIRAL REACTIVATION

EBV, CMV, and others reactivate. Low-grade chronic inflammation persists.

Treatment is paced to the dominant driver in your specific picture, not a one-size protocol.

OUR THREE – PHASE APPROACH

Foundational care first. Targeted treatment second. Capacity rebuilding third.

Investigation, reset, restoration.

Phase 1

Investigate

Weeks 1 to 4

Detailed history. Comprehensive functional pathology matched to your specific picture: mitochondrial markers, HPA axis, thyroid, gut, viral, inflammation, nutritional status. Review of any previous testing.

Phase 2

Foundation

Months 1 to 3

Pacing, sleep, nutrition. Removing the biggest stressors where life will let you. Resisting the well meaning instinct to push through with stimulants the depleted system cannot use. Foundational work first because pacing is non-negotiable.

Phase 3

Rebuild

Months 3 to 12

Targeted treatment matched to what your testing shows. Mitochondrial support, HPA axis work, viral or immune intervention where indicated. Capacity rebuilt slowly, with monitoring at each step.

THE THREE MOST COMMON DRIVERS WE FIND

These rarely sit alone.

Most patients with chronic fatigue have two or more drivers active at once.

Mitochondrial dysfunction

HPA axis dysfunction

Persistent viral reactivation

Testing matched to your specific picture, not a default panel. The cost of any privately billed test is explained before you agree to it. Mitochondrial markers (organic acids, oxidative stress markers, CoQ10, carnitine). 4-point urinary hormone testing for HPA axis function. Full thyroid panel including Free T3, Reverse T3, antibodies. Comprehensive gut microbiome and intestinal permeability where indicated. Viral reactivation panel (EBV, CMV, HHV-6) where the picture supports it. Inflammatory markers (hs-CRP, ferritin, ESR, immune cytokines where indicated). Nutritional status (iron studies, B12, folate, vitamin D, zinc, magnesium).

IS MOJO KLINIK RIGHT FOR YOU?

Is this approach right for you?

IT'S A FIT IF

Your fatigue has lasted 3 or more months without explanation
You have a thick file of normal standard tests
You have post-exertional malaise (you crash after exertion)
You want a doctor who will look at mitochondrial, HPA, viral, and gut drivers together
You are willing to pace recovery rather than push through

NOT A FIT IF

HOW TO START

Two ways to start with us.

Both options are 1-hour Mojo New Patient Appointments. The 45- minute fast-track is not the right entry point for chronic fatigue: the history alone takes 30 minutes done properly, and the condition spans multiple systems.

OPTION 1

Mojo New Patient Appointment with Dr Maria Mackey

Medicare rebate available for in-person initial consultations

A comprehensive deep dive across mitochondrial, HPA axis, gut, thyroid, viral, and nutritional contributors. Best when the fatigue picture is layered with hormonal, gut, or thyroid concerns.

OPTION 2

Mojo New Patient Appointment with Dr Emmanuel Varipatis

Medicare rebate available for in-person initial consultations

Best when the fatigue picture is layered with chronic infection, environmental exposure, or complex multi-system contributors. Dr Varipatis brings 40+ years of experience in complex chronic illness.

For full pricing, see Consultation Fees. For Long COVID and post-viral fatigue, see Post-Viral Fatigue and Long COVID. Telehealth available Australia-wide for follow-ups. Medicare rebates apply for in-person initial consultations (except Heavy Metal Initial Appointment). For your first appointment, in-person at our Neutral Bay clinic is strongly recommended.

FAQ

Frequently Asked Questions.

How much does a chronic fatigue consultation cost at Mojo Klinik?

The Mojo New Patient Appointment is the right entry point: 1 hour, $490
with Dr Mackey or $480 with Dr Varipatis (in-person), $510 or $500 by Zoom,
with a Medicare rebate available for in-person initial consultations.
Comprehensive functional pathology (mitochondrial markers, urinary
hormone testing, viral panels) is billed separately by the testing lab.

"For chronic fatigue the full hour is non-negotiable. The history alone takes thirty minutes done properly. The condition involves multiple systems. The testing plan is built from the picture. There is no fast-track that does the job."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

Approximately 25% of Australians report persistent fatigue lasting more than 6 months, with
around 0.7 to 3.3% meeting full criteria for ME/CFS. Emerge Australia, 2024 position paper.

Is chronic fatigue the same as ME/CFS?

ME/CFS is a specific diagnosis with defined criteria, including post-exertional
malaise as a cardinal feature. Chronic fatigue is a broader term covering persistent unexplained fatigue. Many patients meet criteria for ME/CFS without ever being formally diagnosed. We use the diagnostic framework that fits each patient.

"Many chronic fatigue patients meet criteria for ME/CFS but have never been formally diagnosed because the diagnostic process in standard care is inconsistent. Label or no label, the clinical approach to post-exertional malaise is the same. Pace. Do not push."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

Up to 90% of ME/CFS cases worldwide are estimated to be undiagnosed or misdiagnosed.
International ME/CFS data review, BMJ Open, 2023.

Should I push through and exercise?

For most chronic fatigue patients, the answer is no, at least not in the early
stages. Graded activity must be carefully calibrated. Pushing too hard, too
early, frequently triggers crashes that set recovery back. This is particularly
true in patients with post-exertional malaise.

"The instinct in chronic fatigue is to push back. The biology punishes that. Recovery is built on pacing, not willpower. The patients who recover best are the ones who learn to respect what the body is telling them and work within those limits while we address the drivers underneath."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

A 2024 Lancet review of post-exertional malaise documented measurable physiological
deterioration in ME/CFS and Long COVID patients following standard exercise tests, supporting pacing as the appropriate clinical approach.

Can recovery from chronic fatigue happen?

Yes. Recovery is real but rarely quick. The patients who do best are those who have a structured plan, pace themselves through it, and address the biological drivers rather than just the symptoms. Time-frames vary, but most patients see meaningful improvement within 6 months of starting a comprehensive integrative approach. It can take longer for those patients who have predisposing factors and have had this for a long time.

"Recovery from chronic fatigue is achievable. It is a marathon, not a sprint. The patients who fully recover are the ones who took it seriously, paced themselves through the work, and stayed the course for six to twelve months. And didn’t push themselves too hard too soon."

Dr Maria Mackey, MBChB FRACGP Dip Hom FAARM

A 2023 longitudinal study of integrative chronic fatigue programmes in Integrative Medicine: A
Clinician’s Journal documented significant functional improvement in approximately 60% of
patients at 12 months.

What is the difference between chronic fatigue and Long COVID?

We treat them as related but distinct conditions. The biology overlaps
(mitochondrial, autonomic, immune) but specific drivers differ. Long
COVID has additional features like microclot pathology and a defined viral
trigger. See the dedicated Post-Viral Fatigue and Long COVID page for
that approach.

"Long COVID and ME/CFS share enough biology that the foundational treatment overlaps significantly. The differences matter clinically, particularly around microclot pathology and autonomic involvement, which I look at differently in a Long COVID patient than in someone with longstanding ME/CFS."

Dr Emmanuel Varipatis, MBBS FACNEM FASLM

A 2024 study in the Journal of Infection found 51% of Long COVID patients meet diagnostic
criteria for ME/CFS at 6 months, confirming significant overlap between the two presentations.

What testing will I need?

A typical chronic fatigue investigation includes mitochondrial markers (organic acids, oxidative stress markers), HPA axis testing (4-point urinary hormone testing), comprehensive thyroid panel, gut microbiome and intestinal permeability assessment, viral reactivation panel (EBV, CMV, HHV6), and inflammatory markers. The specific panel is decided at consultation based on your history.

AN INVITATION

Ready to be properly investigated?

One hour. Your full history. The right tests. A real plan. Book your
first appointment online, or call reception on 02 9133 8500.

WHERE
Suite 11, 40 Yeo Street
Neutral Bay NSW 2089

HOURS
Mon – Fri 8:30am – 5:00pm
Selected Saturdays by arrangement