SAM-e old, same old? - effectiveness of S-adenosylmethionine supplements for depression and arthritis - Brief Article

Running & FitNews, Dec, 1999

You've probably heard of it. It seems to be everywhere. SAM-e, pronounced "Sammy"--short for S-adenosylmethionine, is enjoying a variety of incredible claims, which may turn out to be exactly that--incredible--as in "not believable." SAM-e is touted for depression with claims that it is as effective as prescription anti-depressants without any of their notorious side effects. It is also marketed for the treatment of osteoarthritis. Not only do proponents say that SAM-e treats joint pain as effectively as anti-inflammatory medications, but that it will possibly cure your arthritis by re-growing cartilage.

Those are very compelling claims. Anyone (and there are plenty of runners in this category) who suffers pain from degenerative joint disease and struggles with the use of approved treatments could have a hard time resisting the advertisers' claims. And, anyone who has sifted through the side effects associated with prescription anti-depressants in search of relief might be sold without another word. But before you reach for a bottle, take some time to evaluate. If nothing else, your budget may thank you.

SAM-e is a chemical found in every living cell. It is extremely important to virtually everything that goes on in the cellular life of humans. Your body needs SAM-e as a source of methyl groups for methylation (methylation is important in many different processes going on in your body from brain chemistry to your genetic code). In the process of methylation, SAM-e produces an evil offspring, homocysteine. Homocysteine has been associated with heart disease, stroke, and birth defects, but if B-vitamins are present (especially folic acid),it is converted quickly and SAM-e is recycled for another round of methylation.

European doctors have been using SAM-e for years (by prescription only) with a good bit of European research behind it. The bulk of published research is from the 1980's--much of it using animal subjects instead of human. Other studies are too short term, or use too few subjects, or are too flawed in other ways to supply the burden of proof necessary to satisfy American standards. But laws passed in 1994 allow substances that are naturally occurring in the body to be sold without Food and Drug Administration approval, so SAM-e sits on shelves with vitamins and other supplements for you to try.

Skepticism could creep into the most impressionable among us when claims cover such a wide variety of cures (depression and arthritis), accomplish what was previously impossible (curing arthritis), and all without any side effects. If it seems too good to be true, it just might be. But, on the other hand, some respectable American authorities are convinced that SAM-e has promise. The Arthritis Foundation in a public statement said, "there is sufficient information to support the claim that SAM-e provides pain relief" but not cartilage regeneration.

So should you try it? There are several reasons against it. First, doctors worry that patients will forego proven treatments in favor of unproven alternatives. In the case of depression, the consequences can be serious. Second, long-term effects are not known. Taking SAM-e now without long-term studies demonstrating safety can put you at risk. You only need to recall recent experience with Fen-Phen to know what that can mean. Third, daily doses of SAM-e can be very expensive ranging from 400 mg to 1,600 mg, at more than two dollars a day. And fourth, as is always the case with pharmaceutically active dietary substances that are not regulated by the government, you have no guarantee of purity. Despite these problems, if you decide to see for yourself, be sure to let your doctor know so that symptoms and progress can be monitored. Maybe SAM-e will turn out to be the exception to the usual "miracle drug without merit," and not just the same old story.