Play It, Sam(e)!

S-adenosylmethionine is of fundamental importance in a number of biochemical reactions and has been trialled previously in the treatment of FM. It is quite a mouthful, isn’t it? The abbreviation SAMe (pronounced samm-ee) is much easier to say. Its chemical structure and name are derived from two materials you may (or may not) have heard about already: methionine, a sulfur-containing amino acid; and adenosine triphosphate (ATP), the body’s main energy molecule.

Depression

The evidence for SAMe for the treatment of depression is provocative but far from definitive. Several double-blind, placebo-controlled studies have found it effective in relieving depression, but most were small and poorly reported, and many used an injected form of the supplement.

Fibromyalgia

Four double-blind trials have studied the use of SAMe for FM, three of them finding it to be helpful. Unfortunately, most of these studies used SAMe given either intravenously or as an injection into the muscles, sometimes in combination with oral doses. The effects, when taken in this manner, can be quite different from when you take it orally. For that reason, these studies are of questionable relevance to most of us.

Nonetheless, the one double-blind study that used only oral SAMe did find positive results. In this trial, 44 people with FM took 800 mg of SAMe or placebo for 6 weeks. Compared to the group taking placebo, those taking SAMe had improvements in disease activity, pain at rest, fatigue, and morning stiffness, and in one measurement of mood. In other respects, such as the amount of tenderness in their tender points, the group taking SAMe did no better than those taking the placebo.

However, it isn’t clear whether SAMe is helping FM through its antidepressant effects, or by some other mechanism.

The body makes all the SAMe it needs, so there is no dietary requirement. However, deficiencies in methionine, folate, or vitamin B12 can reduce SAMe levels. SAMe is not found in appreciable quantities in foods, so it must be taken as a supplement.

It has been suggested that the supplement trimethylglycine (TMG) might indirectly increase SAMe levels; however, this is yet to be proven.

sam eA typical full dosage of SAMe is 400 mg taken 3 to 4 times per day (which can be quite expensive). If this dosage works for you, take it for a few weeks and then try reducing the dosage. As little as 200 mg twice daily may suffice to keep you feeling better once the full dosage has “broken through” the symptoms.

However, some people develop mild stomach distress (just what people who suffer with IBS want to hear!) if they start full dosages of SAMe at once. To get around this, you may need to start low and work up to the full dosage gradually.

samE sideSome labelling suggests a dosage of 200 mg twice daily. This dosage makes SAMe appear more affordable (if you’re only taking 400 mg per day, you’ll spend only about a third or a fourth of what you’d pay for the proper dosage), but it is unlikely that SAMe will actually work when taken at such a low dosage.

Safety Issues

  • SAMe appears to be quite safe, according to both human and animal studies. The most common side effect is mild digestive distress. However, SAMe does not actually damage the stomach.
  • Like other substances with antidepressant activity, SAMe might trigger a manic episode in those with bipolar disease (manic-depressive illness).
  • Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease has not been established.
  • SAMe might interfere with the action of the Parkinson’s drug levodopa. In addition, there may also be risks involved in combining SAMe with standard antidepressants. For this reason, you shouldn’t try either combination except under physician supervision.

 

If you’d like to see iHerb’s selection of SAM-e products, click here. Use Coupon Code LHJ194 to get $10 off any first time order over $40 or $5 off any first time order under $40.

Int Fibro

Play It Again, SAM (-e)!

Do you know about ClinicalTrials.gov? ClinicalTrials.gov is a registry and results database of publicly and privately supported clinical studies of human participants conducted around the world. As of today, ClinicalTrials.gov currently lists 134,739 studies with locations in 180 countries. (You might want to keep an eye on this site!)

Aside 1: I love to learn new things and research

Aside 2: I started SAM-E (at 400mg) this week (not feeling any better – in fact, this week has been my worst week in as long as I can remember!)

I’ve had AUSTRALIA and FIBROMYALGIA bookmarked with ClinicalTrials.gov for quite a while but nothing much is happening here.

However, one thing I noticed was a Double-Blind, Placebo-Controlled Trial of the Impact of S-Adenosyl-L-Methionine (SAM-e) on the Mood and Other Symptoms in Fibromyalgia.1 The phase 2 trial was completed in March 2007 but there were no results published – zip, nada!

Well, that was not particularly helpful. BUT I am an alumnus of the university where the study was run. So, one email later, I had the draft report in my grubby little hands (or inbox).

Available from iHerb.com

Quick background: SAM-e is of fundamental importance in a number of biochemical reactions and has been trialled previously in the treatment of FM. This study aimed to examine the clinical impact of SAMe-B-ForteTM – a complex containing 400mg of SAM-e – in the treatment of fibromyalgia in the light of possible melatonin (MLT) mediated circadian enhancing properties (basically, sleep).

Statistics: FM is the third most common disorder in rheumatologic practice after rheumatoid arthritis and osteoarthritis and its prevalence in the general population has been estimated to be between 1% and 4%.2,3,4 The prevalence of FM in primary care settings (at GP level) is much higher, where it is estimated to be between 5% and 20%.3,5 Studies examining the outcome in FM patients suggest that the probability of complete recovery in the short-term is low.6

As we know, no treatment (medical or psychological/behavioral) has been demonstrated to be clearly and reliably effective (or we all would have shared it by now!)

Patients were randomly allocated into two groups (placebo and active treatment). The SAMe-B-ForteTM group received capsules containing SAM-e 400mg, over an 8 week period.  The placebo group received capsules that were of identical appearance. All participants were instructed to take one of the capsules in the morning with food (the directions on my box of SAM-e state to take it without food?) Only 49 patients completed the trial.

It appears that the 4th week was the breakthrough week – SAM-e was effective in reducing global symptoms, sleep onset insomnia, and bowel dysregulation. While the results failed to support previous findings that SAM-e could aid depression, the dose given (400mg) and the short time period may not have allowed for optimal antidepressant action of SAM-e and future trials would be required, including a range of doses, in order to better examine dose-response data.

Conclusion: The SAMe-B-ForteTM complex tested shows promise in alleviating symptoms in FM. The promising results confirm there is a potential benefit of SAM-e administration in FM but also that this finding needs further exploration.

Well, I don’t want to wait (really sick of waiting – and it’s taken 5 years for researchers to produce a draft report!) so, as I said earlier, I am giving it a try. Hopefully, the next few weeks will be better than this one.

 

  1. Luke Xantidis, Gregory Tooley, Daniel Lewis and Laurence Lacey
  2. Doron Y, Peleg R, Peleg A, Neumann L, Buskila D: The clinical and economic burden of fibromyalgia compared with diabetes mellitus and hypertension among Bedouin women in the Negev. Fam Pract 2004, 21(4):415-419.
  3. Kirmayer LJ, Young A, Hayton BC: The cultural context of anxiety disorders. Psychiatr Clin North Am 1995, 18(3):503-521.
  4. Staud R, Domingo M: Evidence for abnormal pain processing in fibromyalgia syndrome. Pain Med 2001, 2(3):208-215.
  5. Al-Allaf AW, Dunbar KL, Hallum NS, Nosratzadeh B, Templeton KD, Pullar T: A case-control study examining the role of physical trauma in the onset of fibromyalgia syndrome. Rheumatology (Oxford) 2002, 41(4):450-453.
  6. Dobkin PL, De Civita M, Bernatsky S, Kang H, Baron M: Does psychological vulnerability determine health-care utilization in fibromyalgia? Rheumatology (Oxford) 2003, 42(11):1324-1331.