SAM-e, or s-adenosyl l-methionine, found naturally in the body, was discovered in 1953. It is the only drug currently in use that works by promoting methylation pathways within the body. SAM-e is manufactured from adenosine triphosphate and methionine within the liver. Although it is commonly used for as a treatment for both depression and liver colestasis, it is best known as a treatment for arthritis pain, for which it gets a B rating from MayoClinic.com.
Painkilling Action
In Europe, SAM-e is a prescription-only drug known as Ademetionine. Despite its long history of use and its established efficacy, the way it works is not well understood. It is known that SAM-e is an essential precursor in three of the body's major chemical pathways. SAM-e's painkilling properties are thought to be produced in a different way than any other pharmaceutical painkiller. While most pain killers are COX inhibitors, SAM-e may work by helping the body produce spermine and spermidine, two of its own painkillers. The amino acid methionine is also recycled in this way to produce the glutathione, the most powerful antioxidant in the human body.
Protective Effects
SAM-e further increases antioxidant glutathione levels by rejuvenating its precursor, homocysteine. Increased levels of glutathione are thought to reduce tissue damage due to inflammation, improving the health of cartilage cells and potentially slowing the progression of rheumatoid arthritis. The Food and Drug Administration acknowledges that SAM-e may increase the production of joint cartilage and may increase the production of synovial fluid, the body's joint lubricant.
NSAID Alternative
Nonsteroidal anti-inflammatory drugs, or NSAIDs, are the most popular class of drug for treating the pain and inflammation associated with rheumatoid arthritis. Some patients can experience gastrointestinal upset, internal bleeding, liver damage or kidney failure as a result of taking some of these medications. These side-effects are especially common among elderly patients. For arthritis sufferers looking for nonopiate pain relievers, SAM-e may provide relief.
Side-Effects
SAM-e is not without side-effects. It should not be used by patients with bipolar disorder, as it can trigger episodes of mania. Its effects on the production of the neurotransmitters norepinephrine and dopamine can result in central nervous system stimulation, producing insomnia in some patients if taken in the evening. This may also cause loss of appetite in some patients, as well as lowered blood sugar. For this reason, it should be used with caution by people with blood sugar irregularities. Gastrointestinal upset is the most common side-effect, with a small number of patients experiencing ear flushing, vomiting, dry mouth, increased thirst or salivation, increased urination, anxiety, hostility, elevated mood, headache, suicidal ideation, hyperactivity, a reduced need for sleep or bursts of energy.
References
- Mayo Clinic; Osteoarthritis: Expert Answers; David P. Martin; July 2009
- MayoClinic.com; SAMe: Evidence; April 2011
- Sloan-Kettering; SAM-e; August 2006
- "Critical Reviews in Food Science and Nutrition"; Exploring the Mechanisms behind S-Adenosylmethionine (SAMe) in the Treatment of Osteoarthritis; Heather Joy Hosea Blewett; May 2008
- Food and Drug Administration; Memorandum on New Dietary Ingredient: S-Adenosylmethionine; Robert J. More, Ph.D; May 1998
- "Expert Opinion of Investigational Drugs"; Ademetionine (S-Adenosylmethionine) Neuropharmacology: Implications for Drug Therapies in Psychiatric and Neurological Disorders; Teodoro Bottiglieri; April 1997
