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Tuesday, February 23, 2016

SAM-e (S-adenosylmethionine)

Emotional health is affected not only by our experiences, but also by our physical health. You don’t have to always be the life of the party, but if your mood is feeling a little low or just too unpredictable, it could be as simple as decreased levels of SAM-e.

SAM-e (S-adenosylmethionine) is a naturally occurring molecule in our bodies. It works to promote overall healthy brain functions, helping to balance our emotions by acting as a mood stabilizer. As we age, SAM-e levels decrease. Poor diet also contributes to its decline. But there’s good news for good moods – taking a SAM-e supplement as a mood enhancer may reverse the effects of diminished levels in as little as 7-14 days when taken daily.

SAM-e has also been shown to promote joint health by improving the structure and function of joint cartilage, and may assist cells in producing glutathione, which are essential to the liver. And that’s something else to feel good about.


If the world needs a better antidepressant, it could also use a better arthritis remedy. Nearly a third of the 40 million Americans with chronic joint pain use drugs like aspirin and ibuprofen. In arthritis-strength doses, these so-called NSAIDs, or nonsteroidal anti-inflammatory drugs, can have devastating gastric side effects. Some 103,000 Americans are hospitalized annually for NSAID- induced ulcers, and 16,500 die. Even when NSAIDs don't destroy the digestive tract, they may ultimately worsen people's joint problems, for they slow the production of collagen and proteoglycans, the tissues that make cartilage an effective shock absorber.

Could SAMe provide an alternative? In a dozen clinical trials involving more than 22,000 patients, researchers have found SAMe as effective as pharmaceutical treatments for pain and inflammation. But unlike the NSAIDs, SAMe shows no sign of damaging the digestive tract. And instead of speeding the breakdown of cartilage, SAMe may help restore it. You'll recall that after giving up its methyl group, SAMe becomes homocysteine, which can be broken down to form glutathione (the antioxidant) or remethylated to form methionine (the precursor to SAMe). As luck would have it, the reactions that produce glutathione also yield molecules called sulfate groups, which help generate those joint-sparing proteoglycans.

What does this mean for patients? The Arthritis Foundation, a mainstream advocacy group, recently said its medical experts were satisfied that SAMe "provides pain relief" but not that it "contributes to joint health." The evidence that SAMe can repair cartilage is admittedly preliminary, but it's intriguing. When German researchers gave 21 patients either SAMe or a placebo for three months, using MRI scans to monitor the cartilage in their hands, the SAMe recipients showed measurable improvements. That wouldn't surprise Inge Kracke of Cologne. She was an active 48-year-old when a 1996 auto accident mangled her left knee and left her hobbling on a cane. Dr. Peter Billigmann of the University of Landau prescribed a regimen that combined SAMe (1,200 mg a day for three months) with injections of hyaluronic acid, a cartilage component. Cartilage injuries don't normally heal, but a year later Kracke's knee looked better on X-rays. She now plays golf three times a week.

SAMe may have other benefits as well. Studies suggest it can help normalize liver function in patients with cirrhosis, hepatitis and cholestasis (blockage of the bile ducts). SAMe has also been found to prevent or reverse liver damage caused by certain drugs. As patients hear more about this supplement, they may try treating themselves for all these conditions and others. But many of them will be disappointed—either because they expect miracles that SAMe can't deliver, or because they take the wrong dose or form.

The first challenge is to buy full-strength SAMe. "Some companies are very reliable manufacturers," says Dr. Paul Packman of Washington University in St. Louis. "But some aren't. You can't always tell from the label on the bottle how much active ingredient is actually in it." Pharmaceutical-grade SAMe comes in two forms, one called tosylate and a newer, more stable form called butanedisulfonate. Only Nature Made and GNC sell the new butanedisulfonate version, but several U.S. retailers import reliable tosylate products. And because SAMe is absorbed mainly through the intestine, it's best taken in "enteric coated" tablets that pass through the stomach intact. None of the products comes cheap. The price of a 400-mg dose ranges from $2.50 (Nature Made) up to $18.56 for an uncoated Natrol product called SAM sulfate.

Assuming you buy full-strength SAMe, the second challenge is to use it effectively. Experts advise taking it twice a day on an empty stomach, but different people may require different amounts. Though studies suggest that 400 mg a day is an effective dose for arthritis, the daily doses used in depression trials have ranged as high as 1,600 mg. Clinicians generally start people with mood problems at 400 and ratchet up as necessary.