Why Athletes Take Ademetionine (SAMe): Evidence and Limits
Ademetionine, better known in the United States as SAMe (S-adenosyl-L-methionine), is sold here as a dietary supplement, while in parts of Europe it is a prescription drug for liver conditions. Athletes often hear about it as a "liver protector." But what does the evidence actually show, and is there a sensible place for it in sport?
What SAMe is
SAMe is a molecule the body makes from the amino acid methionine and ATP. It is the main methyl donor in the body, involved in creating and modifying DNA, neurotransmitters, phospholipids and many other compounds.
It also participates in the transsulfuration pathway that leads to glutathione, one of the liver's main antioxidants. This is the biochemical basis for interest in SAMe for liver health.
Bottiglieri (2002) reviewed the molecular roles of SAMe and highlighted its importance for the liver, brain and joints.
In chronic liver disease, SAMe production can fall, which led researchers to test supplementation.
Liver: the main reason athletes ask about it
The most cited clinical trial is by Mato et al. (1999), which studied patients with alcoholic liver cirrhosis. SAMe did not significantly reduce overall mortality or liver transplantation in the whole group, but a subgroup with less advanced cirrhosis appeared to benefit. These results have not been firmly confirmed.
An AHRQ evidence report (2002) concluded that SAMe may improve some symptoms of cholestasis (reduced bile flow) but that evidence for liver disease was limited.
Athletes, particularly those using oral anabolic steroids, sometimes take SAMe hoping to protect their liver. Oral 17-alpha-alkylated steroids are associated with cholestasis, liver tumors and other hepatic damage (Solimini et al., 2017).
There is no clinical evidence that SAMe prevents liver damage from anabolic steroids. Relying on it as "protection" may create a false sense of safety.
Joints and mood
SAMe has been studied for osteoarthritis. Najm et al. (2004) compared SAMe with celecoxib and found similar pain relief after the second month, though SAMe acted more slowly.
For depression, SAMe has been studied as a standalone and add-on treatment. Papakostas et al. (2010) found that adding SAMe to SSRIs improved response in patients who had not responded to SSRIs alone. A review by Sharma et al. (2017) summarized the overall evidence as promising but limited.
For athletes, joint benefits might be relevant, though most data come from people with osteoarthritis, not healthy athletes.
There is no evidence that SAMe improves strength, endurance or recovery directly.
Doses in research and safety
| Use studied | Daily doses used in studies |
|---|---|
| Osteoarthritis | About 600–1200 mg |
| Depression | About 800–1600 mg |
| Liver disease | Often 1200 mg orally or IV in European protocols |
These are doses reported in studies, not personal recommendations. SAMe is unstable, so quality varies; look for enteric-coated tablets in blister packs and third-party testing.
Common side effects include nausea, gastrointestinal upset, insomnia and anxiety.
Key cautions:
- People with bipolar disorder: SAMe may trigger mania;
- Those on antidepressants: risk of serotonin syndrome;
- People with Parkinson's disease taking levodopa;
- Pregnant or breastfeeding women, due to insufficient safety data.
Regulatory status and sport
In the US, SAMe is sold as a dietary supplement. In several European countries, ademetionine is a prescription medicine for intrahepatic cholestasis.
SAMe is not on the WADA Prohibited List, but supplements can be contaminated, so competitive athletes should choose certified products.
If an athlete has abnormal liver tests, the answer is medical evaluation, not self-treatment.
Elevated ALT and AST after hard training may reflect muscle damage rather than liver disease; a doctor can distinguish these.
Conclusions from the editorial team
SAMe is a biologically important molecule with some evidence for osteoarthritis, depression and certain liver conditions, but it is not a proven "liver shield" for athletes.
It does not counteract the hepatotoxicity of oral anabolic steroids, and believing it does can be dangerous.
Anyone considering SAMe, especially those taking antidepressants or with mood disorders, should consult a doctor.
Related reading: lab tests on rosuvastatin, hematocrit for athletes, and testicular atrophy.
References
- Bottiglieri T. S-Adenosyl-L-methionine (SAMe): from the bench to the bedside—molecular basis of a pleiotrophic molecule. Am J Clin Nutr. 2002;76(5):1151S–1157S.
- Mato JM, Cámara J, Fernández de Paz J, et al. S-adenosylmethionine in alcoholic liver cirrhosis: a randomized, placebo-controlled, double-blind, multicenter clinical trial. J Hepatol. 1999;30(6):1081–1089.
- Agency for Healthcare Research and Quality. S-Adenosyl-L-Methionine for Treatment of Depression, Osteoarthritis, and Liver Disease. Evidence Report/Technology Assessment No. 64. Rockville (MD): AHRQ; 2002.
- Najm WI, Reinsch S, Hoehler F, et al. S-adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: a double-blind cross-over trial. BMC Musculoskelet Disord. 2004;5:6.
- Papakostas GI, Mischoulon D, Shyu I, et al. S-adenosyl methionine (SAMe) augmentation of serotonin reuptake inhibitors for antidepressant nonresponders with major depressive disorder: a double-blind, randomized clinical trial. Am J Psychiatry. 2010;167(8):942–948.
- Sharma A, Gerbarg P, Bottiglieri T, et al. S-Adenosylmethionine (SAMe) for neuropsychiatric disorders: a clinician-oriented review of research. J Clin Psychiatry. 2017;78(6):e656–e667.
- Solimini R, Rotolo MC, Mastrobattista L, et al. Hepatotoxicity associated with illicit use of anabolic androgenic steroids in doping. Eur Rev Med Pharmacol Sci. 2017;21(1 Suppl):7–16.
