DEAR DR. DONOHUE: My wife chokes quite a lot when she eats or drinks. This started a few months ago. There are times I nearly start to do a Heimlich maneuver on her. It really scares me, and I know it does her, too. Could it be a nerve problem? — A.C.

ANSWER: People with a swallowing problem are not imagining the problem, and have little to no control over it. Rarely does it get better on its own.

Swallowing takes place almost automatically, with no thought given to it. However, it is a complicated process. First, the tongue has to push food to the back of the mouth. The swallowing muscles of the throat are then activated, and they propel food into the swallowing tube, the esophagus. It has a muscular wall that forces food down and into the stomach. Things can go wrong at any stage of this process.

Tumors can obstruct food and drink. Calcium spurs originating from the backbones can press on the throat and esophagus to put a halt to the downward progression of food. Webs of tissue can cause food to hang up. Nerves involved in controlling the swallowing muscles can go on the blink.

Your wife must see a doctor. The doctor can order a barium X-ray, taken when she swallows. Barium is an opaque material that outlines the throat and esophagus. Or the doctor can look directly into her throat and esophagus with a scope to find out what’s gone wrong.

I can make more guesses for your wife, but she doesn’t need guesses. She needs a definite diagnosis.

DEAR DR. DONOHUE: People on cholesterol-lowering medicines are warned to avoid ingesting grapefruit or its juice because of the danger that there might be a harmful increase in the effect of the medication.

Is it possible to use grapefruit to lower cholesterol sufficiently to stop or reduce the dosage of medication? — Anon.

ANSWER: Eating an entire grapefruit every day lowers cholesterol. It’s a significant drop, but not as great as the drop brought on by medicines. However, if you combine a daily grapefruit with a diet centered on vegetables, fruits and grains with little red meat and whole-fat dairy products, the drop will be greater. And if you engage in daily exercise, you might be able to attain a cholesterol level as low as you can attain with medicines.

Some statin drugs — the drugs most often prescribed for lowering cholesterol — should not be used along with grapefruit or grapefruit juice. Grapefruit can cause a rise in the blood levels of those drugs, and the dose might be too much. This effect of grapefruit lasts for 24 hours, so you can’t avoid it by eating grapefruit in the morning and taking the medicine at night. The involved statins are Mevacor (lovastatin), Zocor (simvastatin) and Lipitor (atorvastatin).

The cholesterol story is told in detail in the booklet on that topic. To obtain a copy, write: Dr. Donohue — No. 201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I’m writing regarding the young woman with no menstrual cycles. She should evaluate her diet. My daughter, at 14 1/2, went vegetarian. After several months, she stopped menstruating. She told me about this after five months of not having a period.

After testing for hormone production and getting ready to force menstruation with pills, my daughter made a connection with protein from her biology class. Her diet presented a challenge in obtaining enough protein. Once she started getting enough protein, her periods came back. The doctors never asked her about diet. — C.B.

ANSWER: Thanks for telling your daughter’s story.

A certain amount of body fat is necessary for normal menstrual periods. I am not familiar with the emphasis on a protein deficit only. Vegetarian diets are healthy diets, and most of the world’s population eats a vegetarian diet. People not used to such a diet can get into trouble if they don’t understand all the ramifications of it.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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