IV Therapies: Use and Utility

Intravenous nutrient therapy (IVNT) has been a growing trend over the last several years. “IV lounges” are abundant across the city, no doctor’s visit required, where anyone can receive a bolus dose of nutrients like vitamin C and B vitamins. Despite the rise in access, this is not a novel offering. IVNT has been part of the naturopathic practice for decades but this tool is now often exploited for profit. Naturopathic doctors are the only medical providers with education in the use of IVNT as part of their training. Conventional medicine may recognize overt nutrient deficiencies, such as B12 or carnitine, and prescribe intramuscular or intravenous supplementation in severe cases, but this is of negligible mention in the standard medical education and does not even begin to broach the full scope of IVNT.

As a longstanding part of our therapeutic repertoire, the California Board of Naturopathic Medicine recognizes the implications of this tool as a medical therapy, and one with potential for serious consequence if not used appropriately. As such, we are required to have a specialty license to be able to provide this treatment reflecting our competence in it. The training to obtain this license covers nutrient formulation (some products can be ineffective or, worse, harmful, if not formulated properly), appropriate use and administration, contraindications to treatment, sterile procedures, and medical emergency triage. My MD and DO counterparts do not have this license or training requirement. Nurses can receive specialty training in IV therapy but it is for administration purposes and not for formulation or for evaluation/management for appropriate need. While I hope all providers involved in IVNT receive adequate training to apply it effectively and safely, there is not a lot of oversight in the operation of walk-in IV facilities to ensure this (see this recent article on the unfortunate outcome of a grossly mismanaged “IV lounge”. Please note that this is an incredibly rare event for these treatments, but showcases the severity of consequences when not administered with competence or appropriate protocols in place). Truthfully, many of these establishments are “plug and play” setups – basic formulations are copied and shared amongst these facilities with little understanding of their biochemical actions on the body or intended medical use, and instead touted as hangover cures, energy enhancers, immune boosters, and beauty drips. These are far from their true therapeutic value and can have serious consequences if not administered competently.

When I initially learned IV nutrient therapy in medical school I had little interest in it. My thoughts at that time aligned with many staunch skeptics of the practice: it just ends up as expensive urine. With inappropriate application of IV therapy this can be true, but with further education and seeing these treatments in practice for those that truly needed it, I now see the value in it. In my practice I use it for suspected nutrient deficiencies (especially in those with compromised GI function where oral dosing may not be sufficient) and I am most often using it in patients with suspected mitochondrial deficits that can occur from long-term illness, chronic fatigue, Long Covid, fibromyalgia, mold toxicity, heavy metal burden, use of certain pharmaceuticals, and more. In patients where the cost of this therapy is not out of reach I often front load treatment with weekly IVs x 4-6 weeks to restore foundational aspects of biochemistry that often need support before other therapies can even work effectively; IVNT is often the fastest way to accomplish this.

Below I cover various proposed applications of IVNT and my thoughts on them.

HANGOVERS

When it comes to hangover cures, the benefit of IVNT is dependent on your individual biochemistry and needs. With alcohol consumption comes dehydration, a greater need for B vitamins, and oxidative stress. Theoretically, these IVs should help but they don’t usually do so in a noticeable way unless medications have been added to the formula. Many hangover formulas add anti-nausea medication and, at times, steroid or pain medications; any immediate hangover relief is most often due to these additions and overall hydration, not the nutrients themselves. The formulas also have to be osmotically balanced to adequately hydrate you and this isn’t always the case. Some nutrient formulations can actually be dehydrating depending on their concentration; a hyperosmolar formula will displace water from your cells and cause you to lose water. Make sure the establishment you are using understands this, or ask for an extra hydration bag in addition to the nutrients you receive to make sure your treatment is not going to dehydrate you further. 

NUTRIENT DEPLETION

I find it hard to accept the prevailing notion that we are universally suffering from nutrient depletion solely because modern produce is less nutritious (due to issues of soil quality and industrial farming practices). While this may hold some truth, a more fundamental concern lies in the inadequate consumption of nutrient-rich foods and the suboptimal condition of our digestive systems. Various factors have contributed to the compromise of our digestive health including lack of fiber, medication use, food additives, over-sanitization, stress, environmental toxins, and more. Nutrient depletion also happens more readily with a high oxidative load which occurs with inflammation, acute or chronic illness, environmental toxicities including pollution (hello city life!), alcohol use, certain medication use, emotional stress, etc. Water-soluble vitamins and minerals such as B vitamins, vitamin C, magnesium, and zinc, are particularly susceptible to depletion since they are not readily stored in excess like fat-soluble vitamins (e.g., vitamin A, E, D). These water-soluble nutrients are frequently found in intravenous (IV) formulations because of this. While intravenous nutrient therapy (IVNT) can be beneficial for some, it may not provide substantial benefits to those who are generally healthy, maintain a diverse diet, and possess sound digestive health, and in these cases you are likely ending up with that expensive urine. In such cases, oral supplementation is often adequate, if necessary.

A note on iron:

Iron is a nutrient often depleted in my female patients, individuals with long-standing GI disorders, and those with low red-meat diets. Depending on the state of anemia, iron IVs are the quickest route to repleting iron stores and feeling better. Unfortunately, conventional medicine has fostered concerns regarding iron infusions, primarily due to historical anaphylaxis risks associated with older iron formulations like iron dextran. Consequently, IV iron therapy is not often readily considered. Iron sucrose, a far safer alternative with a track record spanning over two decades, carries little anaphylaxis risk, rendering the perpetuation of fear surrounding infusions unwarranted. Shockingly (to me) some hospitals are more inclined to resort to blood transfusions rather than opt for an iron IV. Conventional medical approaches also tend to overlook the potential benefits of IV iron until patients reach a severe state of anemia. Yet, it is a valuable option to quickly replenish low iron stores before a patient gets to this desperate state, especially if absorption is compromised due to gastrointestinal issues. Iron IVs should be delivered with care, however, and are most gently given combined with nutrient cofactors to help the body appropriately utilize a high dose of this nutrient. There is no consideration for this support (or understanding of its benefits) in conventional settings.

BEAUTY AND FAT LOSS   

I have much frustration in IV beauty and fat loss claims. Oxidative stress takes a toll on appearance and one can argue antioxidant rich IV treatments like vitamin C and glutathione help reverse this, but these are long term processes at play. A one-off IV is not going to magically enhance the skin. The same for fat loss. IVs targeted toward fat loss include methionine, inositol, and choline (also known as “MIC”). Each of the MIC components may play a small roll in metabolism and energy efficiency but unless you are using these consistently and in conjunction with diet, lifestyle, and other supportive measures, this is not going to be effective on its own. Even then it is those more foundational factors that will carry most of the fat-loss and beautification, not the injections themselves. All this said, if you personally feel it’s helping you or gives you peace of mind, go for it! But from my perspective using IVNT for these specific claims are a waste of money.

IMMUNE HEALTH

Nutrient IVs are often touted as immune boosters. There is validity here but how much depends on individual needs and appropriate application. In nutrient deficient states production of immune cells can become compromised and lower our defenses against illness. Nutrient deficiencies can also slow recovery from illness. That said, if we are living a generally healthy lifestyle most of us do not need this extra support, or oral support would work just as well. If you are recovering from a prolonged illness or suffered GI distress during your illness, IVNT could aid in recovery as illness itself can cause us to rapidly cycle through nutrient stores, and this would be the faster way to restore them.

Doses of vitamin C not achieved orally (high oral doses are likely to cause GI upset) have antiviral, antibacterial, and immune-modulating activity and can help fight related illness if used early and often enough. But is a one-off vitamin C IV going to impart an impactful benefit in this sense? Not likely. When used for disease-fighting effect as demonstrated in hospital settings for Covid, vitamin C was infused continuously throughout the day. In an outpatient setting, daily IV infusions would be the next best thing along with diligent oral dosing.

Lastly, targeted IVNT is used in the integrative oncology world to manipulate immune function against cancer cells. This includes high dose vitamin C (25g, 50g, even 100g doses), mistletoe, artemisinin, among others. These therapies should not be used or offered to anyone unless done by a FABNO or other licensed health professional properly trained in their use and administration for integrative oncology purposes.

OXIDATIVE STRESS/MITOCHONDRIAL SUPPORT

As mentioned prior, mitochondrial support is the primary utility I find for IV therapy. Many chronic illness states are due to compromised mitochondrial function, the organelle responsible for all cellular function; when the mitochondria are not working optimally the body is not able to function or recover as it should. To repair the mitochondria we often need to flood the system with antioxidant-rich nutrients and this is difficult to achieve with oral supplementation, especially if GI health is compromised as is the case for most patients, even in the absence of overt GI symptoms.  Targeted IVNT tailored to the individual is prescribed in these instances at 2-3x per week for 4-6 weeks. Thereafter oral support can be relied on.

PSYCHIATRIC MEDICATION WEANING

Not a commonly known use for IVNT but I will use specific IV formulations for patients that desire to discontinue their stimulant, anti-anxiety, or antidepressant medications but experience withdrawal symptoms in the process. Using IVNT to support the nervous system, neurotransmitter activity, and mitochondrial health during this time in conjunction with other therapeutics can offer great support for this goal.

Final Note: Why is IV therapy so expensive?!

I acknowledge that IV therapy is very expensive, especially in California. The cost encompasses various factors, including the time required to deliver the IV, the materials and supplies used, and the challenging cost of doing business in California. During the supply chain disruptions caused by the pandemic, materials became especially costly, and these inflated prices have persisted. Additionally, pharmacy regulations mandate that products have limited usability once opened, typically ranging from a few hours to 21 days (not due to actual medication expiration but based on quite arbitrary United States Pharmacopeia guidelines). This results in a considerable amount of product waste if there isn’t sufficient demand to use the entire supply. In California, there is the added challenge of an overzealous pharmacy board that often acts against the IV industry in a manner that is, arguably, beyond their scope (more on this in time). This has made it particularly tough for medical providers in California to access certain products that were once available and have been instrumental in improving health outcomes for many. This scarcity further drives up product prices. In California, the base cost of a standard nutrient IV now is over 2x as much as it was in 2020, and with far fewer ingredients. As far as time, most IV therapies should take up to an hour to deliver and in the case of certain treatments, such as NAD, an IV can take upward of three hours. That’s three hours unavailable to serve other paying customers. Thus, turning a profit either takes a higher product cost or administering multiple IVs at once. Compliance, malpractice considerations, rent, higher hourly wages in the LA area, and the general cost of doing business in California also carry over into product price. We all wish it were more affordable but there simply is not a lot of room when operating out of California.

Last note: the FDA has placed a large target on the back of these outpatient IV therapies, which is a shame, but the result of how much these therapies have become available without oversight. It is frustrating that an overreaction from the FDA could potentially lead to the eventual demise of IV therapy, especially as these actions by the FDA are mostly motivated by financial considerations and power dynamics over overt concerns for consumer safety. IVNT has a long history of safe usage spanning decades, with very few adverse outcomes, particularly when compared to some commonplace medications like acetaminophen.

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photography: courtneypaigeray.com