Homeopathic Same

SAMe carries one of the most specific warnings on Australia's ingredient list, so the questions our naturopaths ask in store start with your medicines, not your goals.

A good fit if

• You want to support healthy liver function and you don't take any antidepressant
• You're comfortable with evidence that's promising in places and mixed in others
• You'll check the SAMe dose per tablet, not just the salt name on the front
• Your doctor knows what else you take and is happy for you to try it

Check with us first if

• You're pregnant or breastfeeding. The only pregnancy data used SAMe through a drip in hospital, which tells us nothing about a tablet in a healthy pregnancy.
• It's for a child. There's no age limit on the label, but there's no safety data for children either.
• You take any other prescription medicine. Interactions beyond antidepressants haven't been studied, so no one can tell you either way.
• You plan to take it for months on end. Long-term safety hasn't been studied.
• You've been diagnosed with a liver condition. Talk to your doctor, as existing treatments did better than SAMe in the research.
• If you take prescription medicine, check with your doctor, pharmacist or our naturopaths before you start.

• Tosylate salts (disulfate tosylate, tetratosylate dihydrate and similar). Best known for: The stabilised salts named on Australia's ingredient list, and the ones used in the oral trials. Absorption: No study has compared how well one SAMe salt is absorbed against another. Typical use: Most SAMe on shelves. Every one must carry the antidepressant and bipolar warning.
• Sulfate salts (tetrasulfate, pentasulfate, hexasulfate dihydrate and similar). Best known for: Other stabilised salts, each listed as its own Schedule 1 item. Absorption: Not compared with the tosylate salts in any study we found. Typical use: Same warning, same rules. Choose on the SAMe dose per tablet, not the salt name.
• Mixed sulfate/tosylate salts. Best known for: The exact chemistry the label warning rule is written around. Absorption: Not studied separately. Typical use: Treat it like any other SAMe product. The warning applies in full.
• Enteric-coated tablets. Best known for: The common format for SAMe products. Absorption: None of our sources measures whether the coating changes absorption. Typical use: A format choice rather than a different ingredient, and not covered by the Australian ingredient rules.
• Intravenous SAMe. Best known for: The hospital route, used at 1,000 mg a day in one trial of a liver condition in pregnancy. Absorption: Not comparable to anything taken by mouth. Typical use: Prescription setting only. In that trial, an existing oral medicine did better on three of four measures.
• Methionine. Best known for: The amino acid from food that your body turns into SAMe. It's a separate ingredient, not a form of SAMe. Absorption: Not relevant. It's a different ingredient with its own evidence. Typical use: Allowed in Australia with no conditions and no warning. Don't apply SAMe research to it.

Reference values. There aren't any. Your body makes SAMe from methionine and ATP, so it isn't an essential nutrient and there's no reference intake.

Typical supplemental range. The liver studies most often used 1,000 or 1,200 mg a day. Across other pooled trials, doses ranged from 200 to 3,200 mg a day over two to twelve weeks. That sixteen-fold spread is one reason the authors said their results should be read with caution. The one well-run 8-week trial that found no effect used 800 mg a day.

Upper level. No Australian daily cap applies to any of the 20 permitted SAMe ingredients, and there's no limit on how it's taken. There's no long-term safety data either, as the most recent liver review pointed out.

Worth knowing. SAMe tablets are labelled by salt, so check how much actual SAMe each one gives you before comparing products. Nobody has compared one salt with another. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• No food supplies SAMe in meaningful amounts: your body makes it. Its building block, methionine, comes from protein foods, but no source we hold shows that eating more methionine raises your SAMe

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• You take prescription antidepressants. The required label warning says not to use it unless a healthcare practitioner is supervising.
• You have bipolar depression. It's named in the same required warning.
• Serotonin syndrome-like symptoms. One case was reported in a 107-patient trial where SAMe was added to an antidepressant.
• You're pregnant or breastfeeding. There's no data on oral supplements; the only data is from intravenous use in hospital for a diagnosed condition.
• Children. There's no age restriction, but there's no supplement safety data in children.
• You take other medicines. Our evidence has no interaction data beyond antidepressants.
• You plan to take it long term. There's no long-term safety data.
• Your gut is sensitive. Mild, short-lived gut upsets were the main side effect in liver studies.
• Product quality. A 2008 review named product quality problems as a limit on its use.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before you start.