SAM-e (S-Adenosyl methionine) is a chemical that naturally occurs throughout the entire body. It was first discovered by a researcher in Italy in 1952 and commercial use dates back to the 1970s. SAM-e is made of the essential sulfur-containing amino acid methionine, a component of most proteins in the body, and the energy-producing compound adenosine triphosphate (ATP), found in all cells in the body. Sam-e has proven anti-inflammatory and analgesic properties and is commonly used as a supplement to treat musculoskeletal disorders and other health conditions, including heart disease, infertility, mental health conditions including depression, and premenstrual disorders.
As with all supplements, whether vitamins, minerals, herbal or chemical products, consult with your doctor before you start taking SAM-e. There may be health risks associated with use of SAM-e, including interactions with medications that you are taking and negative effects associated with health conditions you may have. Your doctor is in the best position to determine the proper and safe dosage for any supplement.
What evidence do we have that SAM-e is effective in arthritis?
SAM-e has been studied most extensively in osteoarthritis and depression. In osteoarthritis, a number of randomized, controlled trials involving thousands of patients have shown SAM-e to be effective in reducing arthritis pain. A US Agency for Healthcare Research and Quality (AHRQ) meta-analysis of 102 studies evaluating the analgesic effects of SAM-e in osteoarthritis found that SAM-e (given at oral doses of 600 to 1,200 mg per day) was significantly more effective than placebo in relieving pain and comparable to non-steroidal anti-inflammatory drugs (NSAIDs), without the gastrointestinal side effects associated with these drugs.1
While SAM-e appears to provide benefits to individuals with osteoarthritis, there have been few studies evaluating its effects in RA. One small randomized, controlled trial conducted in patients with fibromyalgia secondary to autoimmune conditions including RA, found that SAM-e (400 mg given intravenously) resulted in significant reduction in pain and tenderness and a significant improvement in depression compared with placebo. Results from this study may be of interest to individuals with RA because fibromyalgia is a common comorbidity with RA. Further well-designed studies are needed to determine whether SAM-e may provide benefits for patients with RA or certain subgroups of patients.1
Supplement dosing and brands
As an oral supplement in studies in osteoarthritis, SAM-e has been given a doses ranging from 600 to 1,200 mg per day in 1-3 divided doses. A typical dose for SAM-e supplementation is 400 mg 3 times per day. SAM-e oral supplements are available in a several brands, including AdoMet, Sammy, and Samyr. The General Nutrition Center product Triflex with SAMe is a combination supplement that contains chondroitin, glucosamine, MSM, and SAM-e.
Both folic acid (vitamin B9) and vitamin B12 are considered co-nutrients that aid in the metabolism of SAM-e. Therefore, if you are considering taking SAM-e, you should also make sure that you are getting adequate amounts of both vitamins B9 and B12.1
Side effects with SAM-e
SAM-e has been well tolerated in the majority of clinical trials reported. The most common side effects associated with SAM-e supplementation include gastrointestinal effects, including nausea (most frequent), vomiting, and diarrhea, and skin rashes. At higher doses SAM-e can cause headaches.
Since it crosses the placenta, SAM-e is not recommended during the first trimester of pregnancy. In studies conducted in pregnant women, no adverse effects were observed in newborns. It is not known whether SAM-e passes into breast milk or whether it poses a risk to the nursing infant. Therefore, SAM-e should not be taken while nursing.1