Systemic lupus erythematosus (SLE) is "...an inflammatory connective tissue disorder of unknown etiology occurring predominantly in young women, but also in children: 90% of cases occur in women," so sayeth the Merck Manual. It is a very complex disease. It may start suddenly with fever, like an acute infection, or may come on slowly for months and years. Any organ can be affected. Most patients complain of joint symptoms from intermittent arthralgia to acute polyarthritis. Characteristic is a flush on the cheeks, a butterfly-shaped area of reddening, but other lesions may occur anywhere. There may be a general reddening of the skin and rashes of various types. Forty percent of patients are sensitive to sun. Other tissues involved include the brain (with mental changes), the kidneys, the lymph glands, the lungs, and others. Over the past 20 years, treatment has improved substantially. Over ten percent survive more than ten years. Treatment includes corticosteroids, nonsteroidal anti-inflammatory drugs, and antibiotics against infections.

I first became interested in the late 1970's, when I was asked to see a woman with severe lupus from which she was dying. Because of the prominence of joint pain, arthritis, and because I was, by then, familiar with the use of niacin for treating arthritis, I thought it might help her as well. I started her on niacin, I think about 500 mg t.i.d. I cannot remember what else I gave her, but since it has been my habit to always combine niacin with ascorbic acid, I probably also gave her the same amount of ascorbic acid.

To my amazement, she was normal in about a week. Her lesions healed, her arthritic pain eased, and her depression was less troublesome. I was convinced I had found an answer for this dreadful disease, then considered uniformly fatal. However, several months later, she was back in hospital, and this time she no longer responded to any vitamin regimen. Within a few weeks, she died. This showed me that there was to be no simple vitamin treatment to this very complicated disease or syndrome.

In 1972, Henrietta Aladjem published The Sun is My Enemy. Here is how this book is described on the cover. "When Henrietta Aladjem experienced her first symptoms of systemic lupus erythematosus in 1953, she did not know that the dizziness, headaches, and nausea were only the beginning of a grueling, 15-year battle with a mysterious disease." Lupus primarily strikes young women. There are 17 to 19 female cases of it for every male case. In Canada, 5,000 women die of lupus each year. Not only can it be a vicious disease, but also an elusive one. Twenty years ago, little was known about lupus. Ms. Aladjem, fortunate to have the resources of the Harvard Medical School near her home, consulted many doctors before lupus was diagnosed. These doctors subjected her to endless testing and a series of wonder drugs, which, often enough, worsened her condition. She even went to Switzerland in search of a cure. Nothing helped. Ms. Aladjem feared that she would succumb to an early, painful death, as some lupus victims do.

A few years later, by chance, she heard of a Bulgarian doctor who had been successful in treating lupus. She went to Bulgaria, located an old professor who had been using injections of nicotinic acid for this disease. She was started on the program and advised to continue it back in Boston. The doctors in Cambridge were skeptical – previously nicotinic acid had only been used to treat pellagra, and they doubted that it could have any effect on lupus. In fact, they equated the Bulgarian remedy with "any harmless potion." But at the same time, they realized that their own methods had failed and that any experiment was worth a try. Finally, Ms. Aladjem became the first lupus patient in the United States to be treated with nicotinic acid. In a few months, her symptoms disappeared, and she became strong enough to play tennis. Even her severe kidney damage began to repair itself. The doctors were totally surprised and are still by no means convinced that it was not a spontaneous remission!

The Sun Is My Enemy is the only published first-hand account of a case of lupus I have seen. This account is very important, not only to doctors and medical students. Its importance goes far beyond that. Ms. Aladjem's story makes each and every one of us a little stronger. We learn once again what the refusal to admit defeat can do for every individual under stress.

A few years after reading her book I had lunch with Ms. Aladjam in New York, and heard what had happened and her activities from then on. She had helped organize a lupus society in New York, and was actively promoting further research and newer treatments for lupus. Later, I was in contact with an organization in the Midwest, kept alive by the dedicated zeal of a victim of lupus who had also recovered on vitamins, including nicotinic acid. Unfortunately, the medical profession ignored these very important first leads, and even today, I doubt there are any internists who are familiar with the potential benefit from nicotinic acid in treating patients with lupus.

C.M. Born 1930 - In September 1987, she complained of a variety of symptoms coming on for a long time but worse over the past four years. She had difficulty swallowing, had changes in her skin on her hands, fingers, legs, and ankles. She also suffered bowel spasms and constipation. At times, her hands and feet would turn white and purple and become very painful. She also suffered a lot of fatigue. Many years earlier, she had a right lobectomy, probably scarred from old tuberculosis. She had had three mastoid operations, had suffered pneumonia many times for which she was given antibiotics, and had suffered from frequent colds. One year before I saw her, she eliminated all dairy products and felt somewhat better after that. She was on penicillamine, which had decreased her zinc levels to the point her sense of taste was poor. Her blood copper was 133, her zinc was 87, giving her a high ratio of 1.5 She was then taking vitamin A 25,000 IU, B complex 50 1 OD, a calcium and magnesium preparation twice daily, vitamin E 1200 IU. I added to that ascorbic acid 12 g, vitamin K 5 mg, pyridoxine 250 mg b.i.d., niacin 500 mg t.i.d., and zinc sulfate 220 mg.

Two months later, she reported she had a flu shot early in November. This was followed by the development of ulcers in her mouth, cleared by mycostatin. Her lupus was quiescent. After four months, her toenails began to come back, she had no further hemorrhages in her skin, she had lost 25 pounds, and had had no colds. Her mood was good. April 1992: her nails were still healing, she still had difficulty swallowing, and had three small ulcers in her gastrointestinal tract. She decided to discontinue naprosyn. One month later, she was better, sleeping well, and swallowing easier. One year later, she still had good and bad days and had been in hospital four times. She had to have her esophagus stretched. She had been depressed in the fall, but this was alleviated by small doses of an antidepressant drug.

D.R. Born 1971 - Lupus was diagnosed in December 1987, and I saw her the following May 1988. As an infant, she suffered colic for several months. This was followed by constant colds and ear infections, and pneumonia when she was 2.5 years old. She suffered permanent hearing loss and has needed a hearing aid. At age five, she was found positive for nuclear antibody factor. On aspirin, she went into remission but two years later, required more. Her knee had become swollen. At age 12, both knees flared up. During the year before she saw me, she was very tired. In October, she developed pain in her fingers, elbows, shoulders, feet, and ankles and a churning feeling in her stomach. Eventually she ran a high fever for ten days and had to be admitted to hospital. She was started on prednisone 90 mg daily but needed only 10 mg when I saw her. Her kidney was involved, and her liver was enlarged. She also had the butterfly rash on her face. At times, she was depressed.

I advised her to eliminate sugar, dairy products, and the grains. To this, I added niacin 500 mg t.i.d., ascorbic acid 1 g t.i.d., evening primrose oil three capsules daily, in addition to the Centrum she had been taking before. One month later, she was better. She had not eliminated the grains. Her hair was not falling out as fast, and new hair was coming in. She still had her rash, but her mood was better. After two months, her rash was worse. She had had a flare-up and had to increase the prednisone to 20 mg. I doubled her niacin. All her hair was coming back.

After three months, her rash began to leave her, and she had more energy. She was now taking 30 mg prednisone. June 1993: she told me she had a kidney transplant in December 1991 and had been well since then. She was on prednisone 15 mg every second day. She was taking only Centrum daily. Her mood was good, and she stated she felt normal.

These two cases illustrate how the orthomolecular approach has been helpful but has to be combined with standard treatment, usually prednisone. Nutrition and supplements used alone have not gotten my patients well nor maintained them. They have been subject to recurrent episodes, often precipitated by virus infections such as the flu. However, the vitamins and diet have been helpful in alleviating depression and fatigue, and I think it has decreased the frequency of the episodes. Unfortunately, I have not seen the very early cases. I think this approach would work even better with them.

Correspondence:
A. Hoffer, MD, PhD, FRCP(C)
Suite 3 - 2727 Quadra Street
Victoria, British Columbia V8T 4E5
Canada
604-386-8756
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References
1. Aladjem H. The Sun is My Enemy. Englewood Cliffs, NJ: Prentice-Hall, Inc.; 1972.
2. These were cortisone and ACTH, introduced in the early 1950s with great fanfare and given to almost every disease then known. They were supposed to be very effective against the arthritides but eventually were shown to be no better than aspirin. The first recorded double-blind experiments were conducted in England testing these hormones against aspirin. Prednisone is a more modern derivative of the corticosteroids.