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Memorandum from Linus Pauling to Paul Wolf, August 25, 1972.
Pauling writes to discuss a suggested orthomolecular regimen for preventing sickle-cell crises. Pauling proposes that a series of studies be conducted to measure the impact of vitamin C, vitamin E, niacin and pyridoxine intake on sickle cell patients. Pauling also suggests that patients eliminate sucrose from their diets.


Date: 25 August 1972

To: Professor Paul Wolf

From: Professor Linus Pauling

Subject: Efforts to prevent sickle-cell anemia crises

In accordance with our discussion today, I am writing to make some suggestions about a study that might be made of patients with sickle-cell anemia to see whether a change in the amounts of certain nutritional substances could decrease the incidence of crises of the disease.

The original proposal was that vitamin E be used. Vitamin E is the fat-soluble antioxidant and Vitamin C the water-soluble antioxidant, among the vitamins. It is my feeling that both of them are needed, and I suggest accordingly that vitamin E be included in the regime.

In orthomolecular therapy for schizophrenia it has been a common practice for subjects to be put on a diet largely free of sucrose, and in addition to receive four grams per day of ascorbic acid, four grams or more per day of either niacin or niacinamide, and about 600 or 600 milligrams per day of pyridoxine. About 10,000 subjects have been observed over a year or more on such a regime, with no serious side effects. Niacin and niacinamide seem to have special value in schizophrenia. I think that niacin, but not niacinamide, might be valuable also for controlling sickle-cell anemia, because of its vasodilating power.

I suggest the following regimen:

1. Subjects to eliminate sucrose from the diet, to as great an extent as can be done practically: no sugar added to coffee, tea, or other drink or to breakfast cereal or fruit. No breakfast cereals or other foods with incorporated sugar to be eaten. Sweet desserts not to be eaten. Soft drinks not to be drunk, except diet drinks.

2. Four milligrams of ascorbic acid to be taken per day—two 500 milligram tablets with each meal and at bedtime.

3. 400 milligrams of pyridoxine to be taken: one 100-mg tablet at each meal and at bedtime.

4. 800 milligrams of vitamin E per day; one 200-mg capsule at each meal and at bedtime.

5. 2,000 milligrams of niacin to be taken per day, by those subjects who are willing to do so—two 500-mg tablets with each meal and at bedtime.

6. The niacin produces a flushing reaction, which some people find unpleasant. If niacin is taken regularly in amounts greater than 250 mg per day, however, the flushing reaction usually does not occur. I suggest that the effort be made to get the subjects to take niacin, but that they be kept on the regimen without niacin if they are unwilling to take niacin.

We should like to get urine samples from the subjects in the usual way, and also to run a 6-hour vitamin loading test on each of them.

Linus Pauling

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