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The Truth About Vitamin Drips and IV Therapy

01dragonslayer

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Placebo or Panacea?​

Getting vitamins and electrolytes through IV infusion is all the rage. But is it actually beneficial? Let's look at the real science.

Joe Rogan is a fan of getting certain micronutrients and other anti-oxidative agents intravenously. He’s not alone. IV therapy clinics have popped up all over the country. Some will even come to your house. These products are touted as having near-miraculous effects, but the scientific evaluation is scant, and what little does exist isn’t very promising.

The basic idea behind vitamin drips stems from the notion that oral administration isn’t as effective as intravenous. Consequently, proponents argue, you can achieve concentrations that could never be reached orally.

Let’s Start With What’s True​

  • Oral bioavailability (the amount reaching the bloodstream) for most micronutrients isn’t going to be 100%. This may be due to limited/poor absorption or extensive metabolism, referred to as the “first-pass effect” by the liver and/or GI tract.
  • IV administration allows 100% of the administered dose to reach the bloodstream (bypassing the issues above) and allows for high concentrations that could never be reached with tablets and powders.
  • IV administration allows for a much more rapid rise in concentrations of a given micronutrient than oral.

But Wait, Does Any of That Matter?​

At facilities outside these IV clinics, like hospitals, IV administration is rarely used in situations where severe vitamin/mineral deficiencies are likely and where it may make sense to provide for a rapid and large micronutrient increase.
Even in these situations, if at all possible, oral administration is the preferred method once a patient is discharged.

Yes, IV administration provides for higher plasma concentrations, but the difference between 40-60% and 100% reaching your bloodstream is negligible when it comes to physiological effects (1,2). Furthermore, IV administration won’t provide a superior pharmacokinetic profile, so daily or at least weekly administration would still be required.

This leaves only the potential for achieving much higher concentrations in the bloodstream with IV versus oral administration as a potential advantage. However, IV administration is really only effective if you’re attempting to bypass an area responsible for a first-pass effect (the liver or GI tract).

IV administration doesn’t solve issues with other pharmacokinetic variables. For example, it doesn’t solve issues with rapid elimination from plasma (at least not inherently), and it doesn’t solve poor distribution and penetration issues to target tissues or high protein binding once it reaches the bloodstream.

Take testosterone, for example. Oral administration has very low bioavailability, but intravenous administration doesn’t solve the issue of rapid elimination. You’d have to walk around with an IV bag every day.

Who Really Needs the Needle?​

In rare cases where you’re dealing with someone who’s extremely deficient in a micronutrient, rapidly hitting higher plasma concentrations makes sense, at least initially. However, it’s not a long-term solution unless you’re planning on daily or weekly IVs.

Also, we’re not talking about your friend Billy, who has a poor diet and doesn’t work out. We’re talking about people living in developing nations who haven’t eaten in a week, and what little they did eat consisted of tree bark. Or it may be someone who’s missing a substantial portion of their intestines.

Alternatively, IV drips make sense for people who are critically ill, septic, have intestinal cancer, or are unable to ingest anything (3). IV administration of micronutrients is called for in those circumstances. Otherwise, it’s effectively a waste for a normal, healthy adult.


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But What About Hitting Those Magic Levels?​

Proponents argue that there’s a physiological range for various micronutrients and other agents that serves basic functions. But to really experience downright amazing benefits, you must get those concentrations into a “pharmacological” range.

This concept is nothing new, and there’s no evidence that anything worthwhile occurs. Even if a high concentration of a given micronutrient is able to hit a given molecular target (albeit transiently), what actual benefit would you see unless you’re doing this constantly, every single day? Probably not much, and even then, it’s questionable.

Take vitamin C for example. It’s touted as a panacea for everything from infections to cancer. However, randomized controlled trials failed to show a consistent and significant effect. Well, proponents argue, that’s because you need really high concentrations to get the benefit, and those concentrations can only be reached via IV administration.

That’s a reasonable enough argument, yet studies administering large doses of vitamin C intravenously still failed to find these benefits, producing either no results or actually having a detrimental effect (4-7).

Even moderate doses of oral vitamin C can diminish the adaptational effects of resistance exercise (8,9). While lower concentrations of vitamin C have an anti-oxidative effect, higher concentrations actually produce a pro-oxidative effect.

The former is what exercise enthusiasts have long thought would be beneficial to counteract the pro-oxidative effects of exercise. As it turns out, the opposite may be true (8-10).

For the latter, some argue that pro-oxidative effects are beneficial in certain conditions (to kill foreign pathogenic organisms or cancer cells), but again, the studies evaluating these effects are disappointing (4-7).

What About Hangovers?​

Much of the popularity of these IV solutions is owed to their claimed ability to help with hangovers (3). The hypothetical reason? Alcohol consumption causes dehydration and vitamin/electrolyte deficiencies, leading to hangover symptoms.

But again, there’s no good evidence that acute alcohol consumption leads to severe dehydration or vitamin/electrolyte deficiencies, nor are they the cause of hangovers (11-14).

“It Worked for Me!” – Placebo Pete​

Most of the alleged benefits from IV solutions are probably due to a strong placebo effect (15). The fact that you’re paying good money to have a trusted healthcare provider inject you with something they claim provides benefits produces a pretty powerful psychological effect.

In fact, there’s evidence suggesting that the physical procedure of receiving an injection, even with nothing in the syringe, provides significant pain relief due to a placebo effect (16,17). That’s not to say the placebo effect itself isn’t beneficial; the question is if these treatments do as they claim. The answer is probably not.

The Risks​

Since these formulations are administered intravenously, they cross over from being food (or dietary supplements) into regulated prescription drugs. While trained clinicians are supposed to administer them, and their production is supposed to be closely regulated, you’re putting a lot of faith in a clinic and its personnel. That’s saying a lot. Remember, excessive electrolyte administration, for example, can be fatal.

Additionally, while established products obtained from large manufacturers are likely safe, compounded products aren’t always produced under the best conditions (conditions you wouldn’t want to eat in, let alone produce sterile drug products in). The federal government primarily leaves enforcement up to the states.

Some people have had serious infections from IV vitamin bags (18). I’m not sure about you, but injecting a product that could be contaminated directly into my bloodstream is something I consider risky.

The Verdict​

There’s no good evidence that IV-based micronutrient/hydration products are necessary or even helpful in most cases. At best, you’re spending money to get something you could probably get with regular pills or powders. At worst, you’re taking an unnecessary risk.
 
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