Recently on his daily television show, Dr. Oz discussed IV nutrition therapy. I was very disappointed when Dr. Oz questioned the validity, benefit, and safety of this invaluable therapy. He had a guest physician on his show to defend IV therapies, but his guest talked in generalizations with no specifics and no scientific data. Dr. Oz’s conclusion at the end of the show, and I will paraphrase, was: “I guess if the Hollywood celebrity types are doing it, there must be some benefit.”
Wow! Now that’s scientific (insert sarcasm). We live in day where we have instant access to data and scientific research, and that is his closing statement?
As physicians, we often forget that we are scientists. Our testing and therapies should be based on science, not opinion. Yet, neither Dr. Oz nor his guest presented any scientific data to support their statements in favor or opposition. So, allow me to do the job that Dr. Oz and his guest did not.
Intravenous nutritional therapy has been around since IV vitamin C was first used for treatment of polio in 1949. Is it something everyone needs? Of course not. Should everyone take insulin? You get my point.
At Forum Health Knoxville, we evaluate a client’s needs based on symptoms. The symptoms lead us to extensive metabolic testing to determine the specific presence and severity of deficiencies of amino acids, fatty acids, vitamins, minerals, etc. Only then do we recommend IV nutritional therapies using the metabolic test results combined with the client’s symptoms. That is what medicine is all about – using the art and science of medicine for the patient’s benefit.
Another reason to use IV nutritional therapy is that for most Americans, our guts are a wreck (and that is putting it mildly). Absorption problems are a major concern for Americans. If you can’t absorb a vitamin or nutrient, it doesn’t matter how good the source or the dosage of therapy is, it just won’t be absorbed. If you are dealing with severe deficiencies, then you’ll never catch up.
How about an analogy to paint a clearer picture? A patient seeks help from a physician for severe dehydration. The patient just can’t keep anything down. Is the physician going to give the patient a pat on the back, tell them to just drink more water, and send them on their way? Of course not. The physician knows that the patient cannot tolerate oral therapy at that point. The deficiency is severe. The physician knows that he/she must catch the patient up, and then instruct the client to drink more water. And how does the physician “catch” the patient up? Well, IVs of course.
Does Dr. Oz question the safety, validity, and benefits of this therapy? Of course not. That is because it is standard practice. Standard practice is defined as: whatever everyone else is doing. I remember my mom often asking me, So…if everyone else jumps of a cliff, are you going to do that too?
And the testing to determine dehydration? Very limited. Usually, a urinalysis, complete blood count test (CBC), maybe a general chemistry, and of course a physical exam. From experience and training, I can tell you that the IV fluids are started based on the physical exam, before the test results get back. That is not how we approach IV nutritional therapy at Forum Health Knoxville. Dr Oz gave the impression that people just walk into a Doctor’s office to order IVs as one would a hamburger at a fast food drive-through. We customize therapy to specific needs and match it with their specific metabolic demand.
So, what does the science say about IV nutritional therapy? The science is overwhelmingly in favor of IV nutritional therapy.
The research below looks at surgical patients. It is well known that poor nutritional status of the patient undergoing surgery effects outcome. These studies showed that IV nutritional therapy improved outcomes. This is not total peripheral nutrition (TPN). TPN is therapy to replace all nutrition. Intravenous nutritional therapy is just to replace vitamins, minerals, and maybe some targeted macronutrients.
- Bellantone R, Doglietto G, Bossola M, Pacelli F, Negro F, Sofo L, Crucitti F. Preoperative parenteral nutrition of malnourished surgical patients. Acta Chir Scand. Apr 1988;154(4):249-51.
- Rham D. A guide to perioperative nutrition. Aesthetic Surgery Journal. July-August 2004;24)4):385-390.
- Xu J. Yunshi Z, Li R. Immunonutrition in Surgical Patients. Current Drug Targets. Aug 2009;10(8):771-777.
- Beier-Holgersen R, Boesby S. Influence of postoperative enteral nutrition on postsurgical infections. Gut. 1996;39:833-835.
So, what about the other benefits of IV nutritional therapy?
- Wolk RA, Rayburn WF. Parenteral nutrition in obstetric patients. Nutr Clin Pract. Aug 1990;5(4):139-52.
- Rayburn W, Wolk R, Mercer N, Roberts J. Parenteral nutrition in obstetrics and gynecology. Obstet Gynecol Surv. Apr 1986;41(4):200-14.
- Russo-Stieglitz KE, Levine AB, Wagner BA, Armenti VT. Pregnancy outcome in patients requiring parenteral nutrition. J Maternal Fetal Med. 199;8:164-7.
- Zibell-Frisk, Jen KL, Rick J. Use of parenteral Nutrition to maintain adequate nutritional status in hyperemesis gravidarum. J Perinatol. 1990;10:390-5.
First trimester miscarriage
- Acacio B et al. Pregnancy outcome after intralipid infusion among women experiencing recurrent pregnancy loss. Fertility & Sterility. Apr 2008;89(4):S11.
- Roussev RG et al. Duration of intralipid’s suppressive effect on NK cell’s functional activity. Am J Reprod Immunol. Sep 2008;60(3):258-63.
- Klenner FR. Massive doses of vitamin C and the virus diseases. J So Med & Surg. April 1951;113(4).
- Schencking M, Vollbracht C, Weiss G, Lebert J, Biller A, Goyvaerts B, Kraft K. Intravenous vitamin C in the treatment of shingles: results of a multicenter prospective cohort study. Med Sci Monit. Apr 2012;18(4):CR215-24.
- Gorton HC, Jarvis K. The effectiveness of vitamin C in preventing and relieving the symptoms of virus-induced respiratory infections. J Manipulative Physiol Ther. Oct 1999;22(8):530-3.
- Tanaka H, Takayoshi M et al. Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration. Arch Surg 2000;135.326-331.
- Crimi E et al. The beneficial effects of antioxidant supplementation in enteral feeding in critically ill patients: a prospective, randomized, double, blind, placebo- controlled trial. A & A. Sept 2004;99(3):857-863.
- Dentico P et al. Glutathione in the treatment of chronic fatty liver disease. Recnti Prog Med. Jul-Aug 1995;86(7):7-8):290-3.
- Smith SW, Howland MA, Hoffman RS, Nelson LS. Acetaminophen overdose with altered acetaminophen pharmacokinetics and hepatotoxicity associated with premature cessation of intravenous N-acetylcysteine therapy. Ann Pharmacother. Sep 2008;42(9):1333-1339.
- Mitchell JR et al. Acetaminophen-induced hepatic necrosis. IV protective role of glutathione. JPET. Oct 1973;187(1):211-217.
- Chen JY, Chu CC, So EC, Hsing CH, Hu ML. Treatment of postherpectic neuralgia with intravenous administration of vitamin C. Anesth Analg. 2006;103:1616-1617.
- Schencking M, Sandholzer H, Frese T. Intravenous administration of vitamin C in the treatment of herpetic neuralgia: two case reports. Med Sci Monit. 2010;16:58-61.
- Chen JY, Chang CY, Feng PH, Chu CC, So EC, Hu ML. Plasma vitamin C is lower in postherpetic neuralgia patients and administration of vitamin C reduces spontaneous pain but not brush-evoked pain. Clin J Pain. Sep 2009;25(7):562-9.
- Riordan HD et al. A pilot clinical study of continuous intravenous ascorbate in terminal cancer patients. P R Health Sci J. Dec 2005;24(4):269-76.
- Mikirova N, Casciari J, Rogers A, Taylor P. Effect of high-dose intravenous vitamin C on inflammation in cancer patients
- Ohno S, Ohno Y, Suzuki N, Soma G, Inouse M. High-dose vitamin C (ascorbic acid) therapy in the treatment of patients with advanced cancer. Anticancer Research. Mar 2009;29(3):809-815.
- Chen Q et al. Pharmacologic ascorbic acid concentrations selectively kill cancer cells: Action as a pro-drug to deliver hydrogen peroxide to tissues. PNAS. Sept 20 2005;102(38):13604-13609.
- Juraschek SP, Guallar E, Appel LJ, Miller ER III. Effects of vitamin C supplementation on blood pressure: a meta-analysis of randomized controlled trials. Am J Clin Nutr. May 2012;95(5):1079-1088.
- Schneider MP et al. Superoxide scavenging effects of N-actylcysteine and vitamin C in subjects with essential hypertension. Am J Hypertens. 2005;18:1111-1117.
- Mikirova N, Rogers A, Casciari J, Taylor P, Effect of high dose intravenous ascorbic acid on the level of inflammation in patients with rheumatoid. Modern Research in Inflammation. 2012;1(2):26-32.
- Sechi G et al. Reduced intravenous glutathione in the treatment of early parkinson’s disease. Progress in Neuro-Psychopharmacology and Biological Psychiatry. Oct 1996;20(7):1159-1170.
- Hauser RA, Lyons KE, McClain T, Carter S, Perlmutter D. Randomized, double- blind, pilot evaluation of intravenous glutathione in Parkinson’s disease. Mov Disord. May 15 2009;24(7):979-83.
- Kuwabara S et al. Intravenous methylcobalamin treatment for uremic and diabetic neuropathy in chronic hemodialysis patients. Intern Med. Jun 1999;38(6):472-5.
- Ziegler D et al. Alpha-lipoic acid in the treatment of diabetic polyneuropathy in Germany: current evidence from clinical trials. Exp Clin Endocrinol Diabetes. 1999;107(7):421-30.
As you can see, the benefits of IV nutritional therapy are abound. That is not my opinion, but scientific fact.
How safe is IV nutritional therapy? The studies below showed the safety of IV nutritional therapies in all states of health, including pregnancy.
- Greenspoon JS, Rosen DJ, Ault M. Use of peripherally inserted central catheter for parenteral nutrition during pregnancy. Obstet Gynecol. May 1993;81(f (Pt2)):831-4.
- Valencia E, Hardy G. Practicalities of glutathione supplementation in nutritional support. Current Opinion in Clinical Nutrition & Metabolic Care. May 2002;5(3): 321-326.
- Padayatty SJ et al. Vitamin C: Intravenous use by complementary and alternative medicine practitioners and adverse effects. PLos ONE 5(7):e11414.
Just because Dr. Oz (the great and powerful, Dr. Oz) says it is so doesn’t make it so. I hope I’ve helped pull back the curtain and expose the real science supporting IV nutritional therapy.
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