#Middlebury
DEAR DR. ROACH: Please tell me about the supplement SAMe. I am a woman, 58, who suffers from osteoarthritis from my exercise routine, which is three days of heavy lifting with free weights and 15 miles of jogging each week. I love the workouts but not the pain it causes in my hands, knees and lower back.
I get relief from ibuprofen and the like, but these can cause problems with long-term use. I have checked with several doctors and pharmacists concerning this supplement, but they know nothing about it. Doctors in Europe have been prescribing it since the 1970s. Can you give me your opinion of this supplement? – K.Z.
ANSWER: S-adenosyl methionine, usually referred to as SAMe, is a naturally occurring substance found in the body, and it has been used as a supplement in people with depression and those with osteoarthritis. It appears to have effectiveness in both cases. Regular readers of this column know that I seldom recommend supplements, but SAMe is one of the few that has good data backing it up.
In a meta-analysis of 11 trials, SAMe was found to be about as effective at improving function and pain as ibuprofen-like drugs but with fewer adverse effects. It may take two full months to reach peak effectiveness, based on a 2004 study.
As always, I have to warn that supplements are not FDA-regulated. SAMe is also relatively expensive (about $40 for 60 tablets at a U.S. warehouse store). Very inexpensive products are a warning that the product may not be of high quality or even contain what it is supposed to. This supplement is generally considered safe, but it is always best to speak with your doctor before taking any supplement.
DEAR DR. ROACH: I have noticed that my 22-year-old granddaughter’s eyes are bulging more than in the past. She has not had a recent thyroid test. Can you help me understand the cause of this? She is addicted to table salt, using an extreme amount with every meal. What problems will this overuse of salt cause her? Are the two conditions linked in any way? – L.M.
ANSWER: Exophthalmos, the bulging appearance of the eye, is a classic sign of Grave’s disease, an autoimmune stimulation of the thyroid gland, where antibodies bind to receptors in the thyroid, stimulating it to produce more hormone. The bulging is not a result of thyroid excess, but rather a cross-reaction of the antibody to fat cells behind the eye, causing the eye to bulge out. Treatment for excess thyroid hormone doesn’t reverse this, because the antibodies are still present. Your granddaughter needs to be tested for Grave’s disease.
I have seen people whose eyes just appear to bulge. They have sometimes had dozens of thyroid tests, as every doctor they see checks their levels. Other conditions that can simulate exophthalmos include obesity, Cushing’s syndrome, inflammation of the eye muscles and other inflammatory diseases.
Excess salt may increase blood pressure, and may even increase stroke risk in people with normal blood pressure, but I can’t think how it could be related to the appearance of her eyes.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com.
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