Blood Tests While Taking Ademetionine (SAMe)
Ademetionine is usually taken for a reason connected with the liver or mood, and in both cases the right blood tests help judge whether it is needed, whether it is safe and whether anything is changing. The editorial team explains which tests are relevant before and during use, how often they are typically repeated and what can distort results in people who train.
Why testing matters with ademetionine
Ademetionine (S-adenosylmethionine, SAMe) is licensed as a medicine in several European countries for intrahepatic cholestasis and is sold as a supplement in the UK. Regardless of its status, it is typically used when there is a suspected problem: abnormal liver blood tests, cholestasis or low mood. Testing helps confirm that the problem is real and track its course.
There is also a safety dimension. SAMe is part of the methionine cycle, which is linked to homocysteine, vitamin B12 and folate. In people with deficiencies of these vitamins or with inherited defects of the cycle, SAMe may not be processed normally, and homocysteine can rise.
Perhaps most importantly, abnormal liver tests have many causes, some of them serious. Taking a supplement without investigating why the liver tests are abnormal risks delaying the diagnosis of fatty liver disease, viral hepatitis, autoimmune conditions, gallstones or drug-induced liver injury.
For these reasons, the editorial team considers baseline tests before starting and follow-up tests during use to be good practice, ideally organised through a GP.
Baseline tests before starting
A sensible baseline includes a standard liver function panel and a few additional markers that relate specifically to the methionine cycle. The table below outlines the tests most commonly considered.
| Test | What it shows | Why it matters for SAMe |
|---|---|---|
| ALT, AST | Liver cell injury (AST also from muscle) | Main markers to track liver changes |
| ALP, GGT | Bile flow and cholestasis | Key markers when SAMe is used for cholestasis |
| Bilirubin (total and conjugated) | Bile processing and excretion | Itching and jaundice in cholestasis |
| Albumin, INR | Liver synthetic function | Signals more advanced liver disease |
| Vitamin B12 and folate | Cofactors of the methionine cycle | Deficiency is a contraindication until corrected |
| Homocysteine | Methionine cycle function | Baseline for comparison if concerns arise |
| Full blood count | Anaemia, platelets | Low platelets may suggest advanced liver disease |
| Creatine kinase (CK) | Muscle damage | Helps interpret raised AST/ALT in athletes |
Depending on the clinical picture, a GP may also check hepatitis B and C serology, a lipid profile, HbA1c for diabetes, thyroid function, ferritin and an ultrasound scan of the liver. These help identify the underlying cause rather than simply measuring its effects.
If SAMe is being considered for low mood, the more relevant baseline is a mental health assessment, including screening for bipolar disorder, since SAMe can trigger hypomania in susceptible people.
Tests during and after use
There is no single official monitoring schedule for SAMe as a supplement in the UK. In countries where it is a medicine, monitoring is guided by the underlying liver condition. A practical approach often used by clinicians is to repeat liver tests after about four to eight weeks, then according to the clinical situation.
- 4–8 weeks: repeat ALT, AST, ALP, GGT and bilirubin to see whether there is a trend.
- Every 3 months during longer use: liver panel plus full blood count as advised.
- If B12 or folate were low: recheck after correction and before relying on SAMe.
- If symptoms change: test promptly rather than waiting for the planned date.
- After stopping: a final panel helps show whether improvements persist.
Homocysteine does not usually need regular repeat testing in people with normal B12 and folate, but it can be useful if there are concerns about the methionine cycle or a family history of hyperhomocysteinaemia.
An improvement in liver enzymes during SAMe use does not automatically prove that SAMe caused it. Changes in alcohol intake, weight loss, stopping a medication or simply the natural course of a condition can all lower enzymes over the same period.
How exercise and lifestyle affect liver tests
For active people, one of the most common pitfalls is interpreting liver tests after heavy training. Strength training and long endurance sessions damage muscle fibres, releasing AST, ALT and CK into the blood. AST is particularly affected, but ALT can also rise significantly.
Studies in weightlifters have shown that ALT and AST can remain elevated for a week or more after an intense session, especially when unaccustomed exercise is involved. Without a CK result, this can easily be misread as liver injury.
To reduce misinterpretation, many sports physicians recommend avoiding intense exercise for about 48–72 hours, or longer after very heavy sessions, before liver blood tests. Telling the doctor about recent training is equally important.
Other influences include alcohol in the days before testing, recent illness, certain medicines (including paracetamol, some antibiotics and statins) and supplements such as green tea extract, which has been linked to liver injury. Fasting status mostly matters for glucose and lipids, but labs may give specific instructions.
When results need urgent attention
Most mild elevations in liver enzymes are not emergencies, but some results and symptoms require prompt medical review. These include yellowing of the skin or eyes, dark urine with pale stools, severe abdominal pain, confusion, easy bruising or bleeding, and marked fatigue.
In blood tests, significant concern arises with very high ALT or AST (for example, several times the upper limit of normal), rising bilirubin, a falling albumin or a prolonged INR. These suggest more serious liver involvement and require specialist assessment rather than supplement use.
For people using SAMe alongside substances known to harm the liver, such as oral anabolic steroids, the priority is to stop the harmful substance and seek medical care. SAMe is not a proven protection against such injury, and continuing the cause while "covering" it with a supplement is unsafe.
If tests show raised homocysteine together with low B12 or folate, these deficiencies should be treated first. A GP can arrange treatment and further investigations, such as tests for pernicious anaemia.
Conclusions of the editorial team
Before taking ademetionine, a liver function panel, full blood count, vitamin B12, folate and, ideally, homocysteine and CK provide a useful baseline.
Repeating liver tests after four to eight weeks, then periodically during longer use, helps track trends. Improvement does not necessarily prove that SAMe was responsible.
Active people should avoid intense training before tests and tell their doctor about recent exercise, because muscle damage can mimic liver injury.
Related reading from the editorial team: ademetionine side effects and contraindications, interpreting creatine kinase after training, and understanding a liver function test report.
References
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- Pettersson J, Hindorf U, Persson P, et al. Muscular exercise can cause highly pathological liver function tests in healthy men. Br J Clin Pharmacol. 2008;65(2):253–259.
- Newsome PN, Cramb R, Davison SM, et al. Guidelines on the management of abnormal liver blood tests. Gut. 2018;67(1):6–19.
- Frezza M, Surrenti C, Manzillo G, et al. Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis: a double-blind, placebo-controlled study. Gastroenterology. 1990;99(1):211–215.
- Rambaldi A, Gluud C. S-adenosyl-L-methionine for alcoholic liver diseases. Cochrane Database Syst Rev. 2006;(2):CD002235.
- 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.
