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
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.