Dear Dr. Roach: I am a 52-year-old woman coming out the other side of menopause. I’ve had a smooth ride through it, with the exception of occasional mood swings. I’ve been taking SAM-e since I found out about it on the Internet. I did not want to take a prescription medicine, nor did I feel my mood swings were strong enough to warrant doing so. I just wanted to be a little more upbeat, positive and energetic. I have found it to be very helpful. Recently, I have had a few people tell me that SAM-e can cause various issues, most notably thyroid malfunctions and cancers. Can you please speak to both the efficacy and potential harm of SAM-e for women in my situation?

— J.A.

Dear J.A.: S-adenosyl methionine is a naturally occurring substance commonly used as a supplement in the U.S. for arthritis and depression. The evidence on SAM-e is mixed, but there are small studies that show SAM-e to be effective for depression, about as effective as some prescription drugs, but with fewer side effects.

However, larger studies were not as hopeful, and my opinion is that while it is a lot better than nothing, SAM-e is not as effective as the better-studied prescription drugs for depression. This may not be applicable to mood swings.

Since it does seem to be working for you, I can reassure you on one point: There is no reliable evidence that SAM-e increases risk of cancers or thyroid disease. The major side effects, which are rare, are upset stomach and dizziness. SAM-e may interact with other medications, so if you do start taking any, please discuss with your doctor or pharmacist.

Dear Dr. Roach: My husband is 72 and suffers from heart disease, kidney disease and diabetes. Almost daily he chokes, with extreme coughing and loss of breath, when eating or drinking. This is getting worse as time goes on. Is there a relationship between this constant choking and heart disease? Heart surgery is not possible because of his kidney disease. Is there anything we can do to keep him from choking?

— S.T.

Dear S.T.: The word “choking” is nonspecific. I can’t be sure what you mean exactly. However, in a 72-year-old person with medical issues, the most common problem that is described as choking while eating or drinking is a swallowing issue, the medical term for which is dysphagia, from the Greek roots meaning “bad eating.” This is separate from painful swallowing (odynophagia).

The underlying defects are generally broken down into two categories: problems in the mouth to pharynx and problems in the esophagus. When I hear “choking,” I tend to think more of problems in the mouth and pharynx.

There are many concerns for frequent choking, gagging and coughing, but the one that is most concerning to me is aspiration, when food or liquids go into the trachea and lungs instead of into the esophagus and stomach. This can lead to infection and damage to the lungs. Because of this, it’s very important to get him evaluated.

Evaluation of suspected aspiration is complicated and may require multiple professionals, including a radiologist, speech-language pathologist, ENT doctor and gastroenterologist. I don’t have enough room to discuss all the possible reasons for your husband’s symptoms. Treatment will depend on the findings of the workup, but it often includes swallowing rehabilitation and changes in food consistency.

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