Nutrition Bytes

S-adenosylmethionine, more commonly known as SAMe, was released in the U.S. only a year ago, but has already become the fourth most popular individual supplement in drugstore chains and retail stores. On the other hand, SAMe, pronounced Sammy, has been in use in Europe for over 20 years as a prescription drug for treatment of depression and arthritis. The few clinical trials done indicate that SAMe has, equal if not greater, therapeutic effects on depression as tricyclic antidepressants but with a more rapid onset and virtually no adverse side effects. Similarly, the limited trials performed with arthritis patients suggest that SAMe has anti-inflammatory and pain relief properties comparable to those of non-steroidal anti-inflammatory drugs but with the added bonuses of joint cartilage repair and minimal adverse side effects. Surprisingly, SAMe is not an exotic chemical; it is an endogenous molecule in the body which serves as the most potent methyl donor known. Methyl donation, an essential biological process, has interestingly been linked to the monoamine neurotransmitter metabolic pathway in ways comparable to conventional anti-depressants. Despite existence of only preliminary scientific evidence for SAMe's alleged beneficial effects, this dietary supplement has almost instantly become a favorite among the public. Several books and web sites dedicated solely to disseminating information about SAMe have already been developed. The increasing popularity of SAMe in the U.S. is alarming since the unregulated marketing nature of SAMe may cause severely depressed individuals or patients suffering from arthritis to self- medicate or substitute SAMe for their current medication resulting in potentially devastating consequences.

The ketogenic diet is a high-fat, low-protein, low-carbohydrate diet developed in the 1920s for the treatment of children with difficult to control seizures. After the diet's renewed popularity several years ago, long-term and multicenter clinical trials are now available. These studies, along with recent animal models, provide evidence supporting the diet's efficacy when treating various types of epilepsy in both children and adults. Further evidence suggests that the classic 4:1 diet (fats to carbohydrates and protein) should be modified to an increased ratio, such as 6:1. Few serious complications are associated with the diet, and the side effects are considered tolerable as most patients remain on the diet at one year follow-up. The ketogenic diet may lead to a significant decrease in antiepileptic drug use and an accompanying decrease in daily medication costs. Although the mechanism of action is still uncertain, recent studies suggest that ketone bodies do not directly alter hippocampal synaptic transmission, however, they may increase glucose transport activity and provide an alternative energy source. Other research supports the inhibition of NMDA-type glutamate receptors in the presence of ketone bodies. The ketogenic diet has the potential to improve an epileptic patient's quality of life by decreasing seizure frequency, reducing the number of prescribed medications as well as daily medication costs, and by reducing the frequency of diet-medication interactions.

Androstenedione, a precursor to testosterone, is produced in the adrenal glands and gonads. Testosterone's effects in promoting skeletal muscle growth are well-known among athletes. By taking these anabolic steroids, however, they predispose themselves to dangerous side effects. An ingested plant form of androstenedione has recently gained popularity as a natural and safe alternative to conventional anabolic steroids. Unfortunately, until recently, there had been only one study that investigated the effect of oral androstenedione administration on blood testosterone levels. A flurry of recent experiments has attempted to confirm these initial findings, as well as analyze the effect of androstenedione supplementation on skeletal muscle anabolism. Contrary to popular belief, several studies have claimed that androstenedione does not increase serum testosterone concentrations, and has no effect on muscle strength and size. Other studies report that this conclusion is not entirely correct either. These experiments suggest that androstenedione can produce elevated testosterone levels when administered at high enough doses. Perhaps the most important finding, however, is that androstenedione may produce the same side effects as conventional anabolic steroids. Coupled with testosterone's side effects, increased estradiol levels from androstenedione aromatization may predispose subjects to gynecomastia, cardiovascular disease, breast cancer, and prostate cancer.

Saint John's wort (Hypericum perforatum) is an increasingly popular over-the-counter dietary supplement used to treat mild to moderate depression. It is generally considered safe and is reported to have a better side-effect profile than other commonly prescribed antidepressants. However, recent reports indicate the need to re-evaluate the issue of safety. Hypericum is suspected to increase cytochrome P-450 enzyme activity leading to lower plasma concentrations of prescription drugs metabolized by this system such as digoxin, cyclosporin, and indinavir. This emerging information underscores the need for physicians to exercise diligence in monitoring all medications and supplements being taken by their patients.

Over a million children have been infected with HIV as a result of vertical transmission and approximately 1600 are newly infected each day. The majority of these children and their families live in developing regions that have inadequate access to healthcare and cannot afford antiretroviral therapy. Finding inexpensive alternatives that decrease the incidence of HIV vertical transmission is of utmost importance to the public health of these regions. Micronutrients, particularly vitamin A, have been implicated in reducing the negative birth outcomes and vertical transmission of HIV in infected pregnancies in several trials. Possible mechanisms by which these micronutrients confer their positive effect include enhancing immune function in both mother and fetus/infant, decreasing viral shedding during delivery and decreasing viral shedding into breast milk during lactation. Each of these mechanisms functions to improve the birth outcomes and reduce the morbidity and mortality of infants born to HIV infected mothers. Reports on the efficacy of micronutrient supplementation on pregnancy outcomes and vertical transmission of HIV are inconclusive, but due to the clinical importance that such a finding would have, this subject merits further investigation and contemplation.