four months. After four months, themean serum 25-hydroxyvitamin Dconcentrations in the daily, weekly,and monthly groups were 69.9, 67,2,and 53.1 nmol/L, respectively. Themean increase in 25(OH)D level overbaseline was significantly greater inthe daily group than in the weeklyand monthly groups.

Comment: The results of this studyindicate that daily administration ofvitamin D improves vitamin D statusmore effectively than giving seventimes the daily dose once a weekor 30 times the daily dose once amonth. While that finding wouldseem obvious in the case of water-soluble vitamins, some practitionershave assumed that because fat-soluble nutrients are stored inthe body, they can be effectivelyadministered on a weekly or monthlybasis. The difference in vitamin Dstatus resulting from daily vs. weeklyadministration was relatively small,but monthly dosing appears to muchless effective than the other modes ofadministration.Chel V. el al. Efficacy of different doses and timeintervals of oral vitamin D supplementation with orwithout calcium in elderly nursing home residents.Osieoporos Inl. 2008;T9;663-671.

A spoonful of honey makes themucositis go down

Forty patients with head and neckcancer requiring radiation to theoropharyngeal mucosa were randomlyassigned to receive, in single-blindfashion (examiner blind) honey or nohoney during radiation therapy. Thepatients were instructed to take 20 mlof honey 15 minutes before radiationtherapy and again at intervals of 15minutes and six hours after radiation.The honey was rinsed in the mouthand then swallowed gradually inorder to coat the oral and pharyngealmucosa. The control group rinsedwith 20 ml of saline before and afterradiation. Patients were evaluatedweekly for progression of mucositisusing the Oral Mucositis AssessingScale. Throughout the six-weekstudy, the mucositis score was at least75% lower (indicating less severemucositis) in the honey group than inthe control group. ^

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Gaby's Literature Review

Comment: Oral mucositis is a common side effect ofchemotherapy and radiation. It is characterized by painfulinflammation and ulcération of the mucous membranesof the mouth and, in some cases, elsewhere in thegastrointestinal tract. Patients with mucositis have difficultyeating because of the pain. In addition, the inflamed andulcerated mucous membranes can be portals of entry formicroorganisms. Previous studies have shown that topicalvitamin E (mouth rinses) and oral supplementation withglutamine or zinc may reduce the severity of mucositis.The present study adds topical honey to the list of effectivelow-cost interventions for preventing and treating thiscondition.Motallebnejad M, el al. The effect of topical application of pure tioney on radiation-induced mucositis; A randomized clinicdl trial. / Contemp Deni Pract. 2008;9(3):40-47.

Glutathione inhalation for cystic fibrosisThirteen patients (aged 1-27 years) with cystic fibrosis

who were receiving a combination of oral and inhaledglutathione were followed for 5.5 months. The dosageregimen in most cases was 40 mg per kg of body weightperday orally and 1,800 mg per day by inhalation. Inhaledglutathione was given at a starting dose of 30 mg twice aday; this was increased progressively over a 45<lay periodto 900 mg twice a day. Inhaled glutathione was bufferedto produce a relatively neutral pH. The mean forcedexpiratory volume in one second (FEV,) percent predictedimproved by 5.8 percentage points (p < 0.0001), meanweight percentile increased by 8.6 points (p < 0.001),and mean body mass index percentile increased by 1.22points (p<0.001). All patients showed improvements inEEV, and body mass index; 12 of 13 improved in weightpercentile. The number of positive sputum culturesdeclined from 13 to 5 (p < 0.03), with sputum culturesof Pseudomonas aeruginosa becoming negative in four offive patients previously culturing positive, including two ofthree patients chronically infected with Pseudomonas.

Comment: The mutation that causes cystic fibrosis alsocauses systemic deficiency of glutathione, which maycontribute to the pathophysiology of the disease. The resultsof the present study suggest that treatment with glutathionecan improve lung function, increase body weight, anddecrease the frequency of pulmonary infections. Thebeneficial effects were probably due mainly to the inhaledglutathione, because orally administered glutathioneappears to be poorly absorbed. Orally administeredN-acetylcysteine in combination with L-glutamine may alsoincrease systemic glutathione levels. However, inhalationof glutathione via a nebulizer may be the preferred methodof administration in patients with chronic lung disease,such as those with cystic fibrosis.Visca A, et al. Improvement in clinical markers in CF patients using a reducedglulathJone regimen: An uncontrolled, observational study. I Cyst Floras. 200Ö;7:433-436.

Lithium for amyotrophic lateral sclerosisForty-four patients (mean age, 69 years) with

amyotrophic lateral sclerosis (ALS) for less than five yearswere randomly assigned to receive, in single-blind fashion,lithium carbonate plus riluzole (50 mg twice a day) (n = 16)or riluzole alone (control group; n = 28) for 15 months.The dosage of lithium was adjusted to maintain a plasmalevel of 0.4-0.8 mEq/L and was typically 300-450 mg/day.The mortality rate was 0% in the lithium group and 297o inthe control group (p < 0.05). The mean decline in globalfunctioning (as assessed by the normalized Norris ALS score)was 10.67o in the lithium group and 46.1% in the controlgroup (p < 0.05 for the difference in the change betweengroups). In a parallel study on a genetic ALS animal model,the G93A mouse, daily intraperitoneal administration oflithium carbonate (1 mEq per kg of body weight) delayeddisease onset, improved neurological function, slowed therate of neuronal death, and increased life span.

Comment: Lithium has demonstrated neuroprotectiveeffects both in animals and/nv/iro. Long-term administrationof lithium to rats markedly increased the levels of the majorneuroprotective protein, bcl-2, in several areas of the brain.In addition, lithium increased the concentration of bcl-2in cells of human neuronal origin in vitro. Increasing theconcentration of this protein has been shown to protectneurons against diverse insults, to promote regeneration ofaxons in mammalian central nervous system, and to prolongsurvival and slow motor neuron degeneration in an animalmodel of ALS. The results of the present study indicate thattreatment with lithium carbonate at a dose approximatelyone-half to one-third that used to treat bipolar disordercan slow the rate of functional deterioration and decreasethe mortality rate in patients with ALS who are receivingconventional therapy with riluzole.Fomdi F, et al. Lithium delays progression of amyotrophic lateral sclerosis. Proc NatiAcadSei. 2008;]05:2052-2057.

Conflict of interest in medical journalsThe authors of this study reviewed one year of the

issues of 11 major medical journals for advertising andcontent about dietary supplements. The journals wereAmerican Family Physician, British Medical Journal,Canadian Medical Association Journal, Journal of theAmerican Medical Association (JAMA), New EnglandJournal of Medicine, Annals of Internal Medicine, Archivesof Internal Medicine, Pediatrics, Archives of Pediatricsand Adolescent Medicine, and Pédiatrie Research. Thejournals were arbitrarily grouped into those with fewerthan ten pharmaceutical ads in an average issue (the fewestpharmaceutical ads group); those with more than 40 pagesof pharmaceutical ads per issue (the most pharmaceuticalads group); and those with 10-39 pages per issue (themiddle ads group). Articles were considered to be aboutdietary supplements if they discussed vitamins, minerals,herbs, or similar products. Articles were classified as major(e.g., clinical trials, cohort studies, editorials, and reviews)or other (e.g., case reports, letters, or news), journals withthe most pharmaceutical ads published significantly fewer

46 TOWNSEND LETTER - JANUARY 2009