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
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.