Q. My family has switched almost entirely to using sea salt in cooking. Are we now at greater risk of developing a goiter because we’re not using iodized salt?
A. You are correct that sea salt contains minimal iodine. If you don’t get iodine from other sources, you might develop a goiter ... an enlarged thyroid gland that is working overtime to produce thyroid hormone.
The Recommended Dietary Allowance of iodine is 150 micrograms per day for an adult. You can get adequate amounts by eating fish (cod, haddock, perch, shrimp, etc.), dairy products or baked potato. Kelp (seaweed) is highest in iodine, but this is an acquired taste. Many multivitamins contain iodine.
Q. The generic form of Xanax, alprazolam, does not work for me. It is at best 50 percent effective.
A few years ago, I was given alprazolam in place of Xanax. My panic attacks came back with a vengeance. I kept thinking I had missed a dose. After three refills over three months and a visit to my doctor, I asked him if other people had complained. He said yes and wrote the prescription for Xanax only. It made a noticeable difference.
My insurance company recently stopped allowing this, and now I can only afford alprazolam. My anxiety is back. What’s going on?
A. Whenever a benzodiazepine drug like alprazolam, clonazepam, diazepam or lorazepam is stopped suddenly, the patient can experience withdrawal symptoms. These include anxiety, panic, insomnia, muscle spasms, shocklike sensations, dizziness and headache.
It seems as though you may have had a withdrawal reaction when you switched to the generic alprazolam. That suggests that the generic is not truly equivalent for you.
Perhaps your doctor can intervene with the insurance company on your behalf.
Q. I am incensed about your response to the woman who wrote asking about differences in libido. She reported they only have sex three times a month “if she is lucky.” Her partner’s excuse was stress from work. She asked how to slow down her own sex drive.
After suggesting blood work “to rule out low testosterone” in the male partner, you told her to consider an antidepressant to lower her own libido. Are you nuts or drug-company stooges?
Hormone levels drop as we age, and this man obviously needs some kind of supplement. Perhaps he has hypothyroidism, which could cause depression and low libido.
A. Stress can have a negative impact on sex drive. So can an imbalance of hormones such as testosterone or thyroid. Even so, that couple should not have to give up sex. He could find ways to satisfy her other than intercourse.
This woman specifically asked about a way to dampen her desire. There are no Food and Drug Administration-approved treatments for this purpose. Progesterone and antidepressants can cause low libido as a side effect, as does the herb vitex (chaste tree berry).