Intravenous Nutritional Therapy

Following last month’s Introducing IVNT article, Dr Jacques Otto and Dr Samantha Gammell discuss the benefits of IVNT ingredients and factors to be aware of when treating patients

Demand for intravenous nutritional therapy (IVNT) has increased in the UK since it became popular in 2014.1 However, despite this growing trend, IVNT is still considered by some as a controversial topic, perhaps because, often in medical school, there is little or no time spent learning about vitamins and nutrients in detail. As a result, many medical professionals remain uninformed about
the benefits of IV nutrition. This article will outline the importance of understanding the theoretical basis for IVNT, what IVNT ‘cocktails’ are composed of, how these differ, and the possible side effects to be aware of.

Theoretical basis for IVNT
Every day, our body produces skin, muscle and bone. It churns out rich red blood that carries nutrients and oxygen to remote outposts, and sends nerve signals skipping along thousands of miles of brain and body pathways. It also formulates chemical messengers that shuttle from one organ to another, issuing the instructions that help sustain your life. To do all this, our body requires raw materials. These include at least 30 vitamins, minerals, and amino acids that your body needs, but cannot manufacture on its own in sufficient amounts. Many believe that we should be able to get all nutrients we need through our diet, however, with increasingly busy lifestyles, the decreasing trend of cooking from scratch with fresh organic produce and the overwhelming increase in convenience food, fast food and takeaways, this is often not the case. Even for those who are conscious about what they eat, the nutrients in our food are simply not the same as they were in previous generations, and the main culprit of this disturbing nutritional trend is soil depletion. Studies published in the Journal of the American College of Nutrition (Dec 2004) and the British Food Journal show that today, modern intensive agricultural methods have stripped increasing amounts of nutrients from the soil and, in our attempts to grow climate adaptable, pest resistant crops which are bigger and grow more rapidly, nutrient uptake simply cannot keep pace. In addition, there are also numerous conditions and circumstances in which additional nutrients are required above and beyond the ‘recommended daily allowance’ such as poor digestion, food sensitivities, chronic inflammation, stress, exercise, alcohol or simply just the ageing process. A vicious cycle then ensues. When cells are not healthy or not functioning to their maximum capacity they are not as effective in transporting vitamins and minerals to where they are needed. This is because many cells require energy (obtained from these same nutrients) in order to transport nutrients. Unlike oral supplementation, IV administration of nutrients can bypass gastrointestinal absorption saturation and increased renal clearance, resulting in high serum not obtainable with oral or even intramuscular administration.2 This is important not only to allow cells to rapidly repair, regain strength and function normally again, but also because various nutrients only exert their pharmacological effects depending on the concentration of the nutrient. For example, an antiviral effect of vitamin C has been demonstrated at a concentration of 10-15 mg/dL,3 a level achievable with IV but not oral therapy. Similarly, oral magnesium supplementation results in little or no change in serum magnesium concentrations, whereas IV administration can double or triple the serum levels.4,5

Types of products
Just like all areas of medicine and aesthetics, the results, benefits and risks of any procedure depend largely on the quality of the products, the type and combination of products used and the knowledge and skill of the administering physician. Whilst adverse events are extremely rare, with IVNT it is of vital importance to understand what is in the ‘cocktail’ you are administering, what the osmolarity is of that cocktail and how fast the IV infusion should run. A short overview of the most widely used IVNT products are given below.

Minerals

1. Magnesium: Research has indicated that the mineral content of magnesium in food sources has decreased.6 As well as this, studies in the US have also indicated that an estimated 75% of people do not meet the recommended daily allowance of magnesium, which has raised concern about the health effects of magnesium deficiency.6 Magnesium is a cofactor for more than 300 metabolic reactions in the body7,8 and is essential for healthy bones, teeth, heart and brain tissue. It is also critical for energy production, relaxes muscle, lessens headaches, reduces stress and promotes restful sleep.9-12 Intravenous
   Nutritional Therapy
   Following last month’s Introducing IVNT article, Dr Jacques Otto and Dr Samantha Gammell discuss the benefits of IVNT ingredients and factors to be aware of when treating patients
   
2. Calcium: Calcium is required for healthy teeth and bones. It also helps trigger the clotting process by activating fibrin and together with magnesium, calcium helps in the regulation of heartbeat, muscle contraction, muscle tone and nerve conduction.13,14 Magnesium and calcium need to be in balance with each other to fully experience good health. Because vitamin C is a mild calcium chelator, IV calcium replacement is also used in our protocols for IVNT.
3. Zinc: Conservative estimates suggest that 25% of the world’s population is at risk of zinc deficiency15 and the World Health Organisation put the prevalence of zinc deficiency at 31%.16 Zinc plays an essential role in numerous biochemical pathways. Zinc is vital for the immune system; for good skin, hair and nails, it acts as a mood stabiliser, is vital for taste, smell and appetite; fertility and vision.17,18
4. Selenium: A decline in blood selenium levels in the UK and other European has raised concern about possible public health implications, particularly in relation to cancer and cardiovascular disease.19,20 Incorporated into protein to make selenoproteins, selenium has a huge range of health benefits, it is antiageing, boosts immunity, improves brain function, antiviral, improves fertility and regulates the thyroid.21

Vitamins

1. Vitamins B5, B6, B12 and vitamin B complex
   Whilst many B vitamins work in tandem, each B vitamin is chemically distinct and has its own specific benefits from converting food into energy, cell metabolism, promoting cell growth and division, forming red blood cells, enhancing the immune system, maintaining healthy skin and muscle tone and easing stress and improving mood.22
2. Vitamin C (ascorbic acid)
   Although humans cannot synthesise vitamin C, every tissue and cell in the body needs it for healthy growth and repair. Vitamin C is beneficial for the skin, enhances wound healing, helps lower cholesterol, improves blood flow, regulates sugar levels in diabetics, improves asthma symptoms and reduces risk of cataracts.23
   Glutathione
   In our opinion, glutathione (GSH) is the superhero of all antioxidants. If you are sick or elderly or are just not in peak shape, you are likely to have glutathione deficiency. In fact, a leading British medical journal, The Lancet, found the highest glutathione levels in healthy young people, lower levels in healthy elderly, lower still in sick elderly and the lowest of all in the hospitalised elderly.24
   Amino acids
   Approximately 24 known amino acids are needed by the body to form more than 50,000 unique proteins it requires. Listed below are a few of the main amino acids, however other amino acids such as choline and lysine are also commercially available for IVNT.
3. Arginine: Arginine performs many vital functions within the body, largely due to its formation of nitric oxide. Arginine improves cardiovascular health, strengthens the immune system, improves insulin resistance; supports production of collagen; improves burning of excess fat and minimises stress.25-29
4. Carnitine: Hugely popular with athletes, carnitine enhances fat burning, supports the immune system, reduces stress, increases vitality, protects against degenerative neurological disease and boosts male fertility.30-33
5. Cysteine: Known as the antiageing amino acid, cysteine has many qualities that prevent or help reverse the ageing process. In fact it has been suggested that ageing may actually be a deficiency in cysteine.34-35
6. Glutamine: Glutamine is integral to a whole host of systems in the body. It helps build and maintain muscle mass, helps against stress, anxiety and depression, improves cerebral performance and counteracts fat storage.36-38
7. Taurine: Made popular by the energy drink Red Bull, taurine reduces anxiety
   and stress, burns fat, improves insulin sensitivity, acts as an antioxidant,
   improves training performance and reduces recovery time, reduces
   fatigue and improves brain function.39-42
8. Methionine: Helps to process and eliminate fat, boosts athletic performance, essential for healthy collagen formation, helps the body eliminate toxins.43-44
9. Ornithine: Promotes release of growth hormone that promotes the metabolism of excess fat necessary for immune system and liver function, reduces stress and improves sleep.45
10. Phenylalanine: Phenylalanine is used to produce tyrosine, a precursor of dopamine, adrenaline and noradrenaline, which are important for maintaining a sense of wellbeing and energy. Phenylalanine also directly affects mood, helps with fatigue, depression, food cravings and chronic pain.46

Administering IVNT ‘cocktails’
As briefly outlined above, vitamins, minerals and amino acids are active products and even though they are considered as basic nutrients, they still require in-depth training in order to be administered in a safe and effective manner. It is important that the practitioner knows the mechanism of action of each nutrient and which products together are complementary and which are antagonistic. Companies that train, manufacture and supply IV products also provide physicians with IV protocols that they can start using in their clinics immediately. The benefits of using such protocols is that the osmolarity of each protocol/cocktail will have been calculated for you and this in turn will determine how quickly the cocktail can be administered. Whenever any IV is given, it is imperative that the osmolarity of the final solution is known to avoid any unwanted side effects and complications.

Reactions and side effects
As with any treatment, safety comes from understanding and thus avoiding any risks and potential side effects. Allergic reactions from IVNT are now extremely rare if preservative-free products are used. However, knowledge of minor details such as calcium gluconate being derived from shellfish is imperative if one is to avoid complications in patients with a shellfish allergy. Other precautions such as pre-treatment blood pressure checks should also be done to avoid any transient hypotension in susceptible patients when administering IV magnesium. The most common issues we see in our practice is nausea if the infusions are given too quickly or a patient hasn’t eaten for several hours, or possibly a vasovagal incidence, which is typically due to poor cannulation technique in needle-phobic patients.

Conclusion
It is quoted that nutrient deficiencies are common in the US population, with research from the 2010 Dietary Guidelines Advisory Committee’s report citing 90% of Americans are nutrient deficient due to poor diet.47 With the UK following similar trends and lifestyles to those in the US it is not surprising that IVNT in the UK is growing at an exponential rate. IVNT is a very safe and beneficial treatment to the large majority of patients. However it is imperative that practitioners are adequately trained and that proper high quality nutrients are used in the IV cocktails. It is unfortunate that already we have seen clinics offering bags of saline mixed with anti-emetics and anti-inflammatories, and still labelling this as ‘nutrition therapy’. Anti-emetics and anti-inflammatories are not by definition ‘nutrients’ (a substance that provides nourishment essential for the maintenance of life and for growth), they have nothing to do with nutrients and have been used purely to treat hangovers. Hopefully, with correct training and the medical technicalities required to administer IVNT we can prevent IVNT falling into rogue, untrained hands, as occurs too often with many aesthetic treatments. In 2014, Dr Samantha Gammell and Dr Jacques Otto, together with aesthetic distributor Mr Vernon Otto, founded IntraVita Ltd. They now manufacture and supply IV products and teach and train other medical practitioners in the use of IVNT

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