SAMe

SAMe is a naturally occurring molecule that has been shown to be beneficial in the treatment of symptoms of mild depression, osteoarthritis, and even fibromyalgia.

Alternative Names     S-adenosyl methionine, adomethionine, SAM.

What is SAMe? 

            SAMe (pronounced sammy) is a naturally occurring chemical that is normally produced by and present in all human cells. SAMe was first discovered in Italy in the early 1950’s as a metabolite of methionine (an essential amino acid found in the diet). It is formed by the combination of methionine and ATP (an energy source for biochemical reactions).  In many European countries SAMe is available only as a prescription for the treatment of depression, however it has been available over the counter in America for nearly a decade. It was originally suggested as a treatment for depression because of the high concentration of natural SAMe in the brain. Trials of SAMe to improve depression and mood revealed that many patients on SAMe also reported an improvement in pain associated with arthritis. This led to an investigation regarding the efficacy of SAMe as an arthritis treatment. Recent evidence suggests that SAMe is an effective treatment for osteoarthritis and even fibromyalgia. Since this discovery it has been marketed heavily in America in pharmacies and health food stores. Since SAMe is degraded fairly rapidly, it is most commonly sold either as an enteric coated form of S-adenosyl methionine or as an inactive salt like S-adenosyl methionine 1, 4 butanedisulfonate, that is converted to an active form once ingested.  

How does it work?

            Normally SAMe functions as what is known as a methyl donor. It is involved in over 100 different reactions in the body, including those involved in the synthesis of polyamines, neurotransmitters, and adrenaline. While very much is known about what SAMe does in a normal system, our understanding of why SAMe does what it does in the treatment of disease is not totally understood yet.

            SAMe has been shown to help improve cartilage structure and function. Studies demonstrated that SAMe helped to stimulate the growth of cartilage. The inflammatory response that causes osteoarthritis involves several different inflammatory molecules including IL-1 and TNF-a. IL-1 and has been shown to inhibit the production of type-2 collagen, which provides strength for cartilage, and also aggrecan, which helps cartilage to cushion the stress and force applied to joints. SAMe helps to reverse this inhibition stimulating the production of proteoglycans (the precursors to aggrecan) and also collagen. TNF-a has been shown to inhibit the production of fibronectin which is another essential component of cartilage. SAMe is able to increase the production of fibronectin to stop this effect. The net effect is that SAMe may be able to counter some of the inflammatory damage associated with arthritis and return the joints to their pre-disease states.

            SAMe is also able to prevent the attack of inflammatory cells by protecting the proteoglycans like aggrecan from being attacked in the first place. As mentioned before, SAMe is a key component of the production of polyamines. Polyamines are able to stabilize proteoglycans and protect them from the enzymes that are released to break the proteoglycans down.

            At this time it is not understood how or why SAMe helps treat fibromyalgia but small scale studies have shown it to help improve back pain, joint pain, and stiffness associated with fibromyalgia. This may be due to the anti-inflammatory nature of SAMe.

How well does it work?

            Studies in over 22,000 people have shown that SAMe can help in the treatment of arthritis. Smaller scale studies pitted SAMe against Celecoxib (Celebrex) an anti-inflammatory drug (Cox-2 inhibitor) that is often used to treat arthritis. In this study, while SAMe took longer to become effective, by the second month of treatment it was just as effective as the competition without side effects. Because SAMe is a naturally occurring molecule few side effects are experienced even when the drug is taken for a long time. Some people experienced dry mouth, stomach upset, and insomnia. These cases were rare and similar to those experienced by people taking a placebo. In extremely high doses (those higher than commonly used for arthritis or fibromyalgia) SAMe can cause heartburn and diarrhea.

Dosage Information

* It is important to consult your doctor before starting any drug or natural* *supplement*

            Studies have used SAMe in dosages ranging from from 400 to 1200 mg per day, but the recommended dosage at the moment is as follows:

Arthritis: 400 mg two times a day for two weeks. After 14 days the dosage can be reduced to 200 mg two times a day as a maintenance dose. If no results are seen after 14 days the dosage can be increased to 400 mg three times a day.

Fibromyalgia: 400 – 600 mg two times per day.

SAMe should be taken on an empty stomach to improve absorption. Also, some people report a mild energy boost when taking SAMe so you it should not be taken late at night or close to bed time

Cautions

            The natural byproduct of SAMe is homocystein which has been shown to have implications in cardiovascular disease. In order to counter this effect a B-complex vitamin (a combination of all members of the vitamin B family) should be taken every day. A recommended dose of 100mg daily is suggested.

            Also SAMe should not be taken with certain anti-depressants called Monoamine Oxidase Inhibitors (MAO-I’s) like phenelzine sulfate and tranylcypromine sulfate.  Again, always speak with your physician before taking any new supplement.

Authors:  Peter Mazari, BA, Robert Wood Johnson Medical School, Piscataway, NJ       Grant Cooper, M.D., New York-Presbyterian Hospital, The University Hospital of Columbia and Cornell, New York, NY

References

-           Dellle Chiaie et al. “Efficacy and tolerability of oral and intramuscular S- adenosyl-L-methionine 1,4-butanedisulfonate (SAMe) in the treatment of major

            depression: comparison with imipramine in 2 multicenter studies”. American      Journal of Clinical Nutrition 76 (5): 1172

-           Bottiglieri Theodoro et al. “S-Adenosyl-L-methionine (SAMe): from the bench to           the bedside—molecular basis of a pleiotrophic molecule”. American Journal of            Clinical Nutrition 76 (5) 1151

-           Jacobsen S, Danneskiold-Samsoe B, Andersen RB. “Oral S-adenosylmethionine          in primary fibromyalgia: Double-blind clinical evaluation”. Scandinavian Journal           of Rheumatol   1991;20:294–302

-           WholehealthMD.com “SAMe S-adenosylmethionine”             http://www.wholehealthmd.com/refshelf/substances_view/1,1525,818,00.html