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The intravenous use of vitamins, minerals, amino acids, essential fatty acids, and other important nutrients has a long and venerable history in American medicine. But while most physicians know about it, only a small number of us are making use of these beneficial therapies to help our patients.

This inexpensive, safe, and effective approach to nutrient repletion is underutilized in part because of a lack of controlled trials. But it also reflects a general lack of nutrition education in conventional medical training, which is largely centered on pharmaceuticals. Recently though, there seems to be a renewed interest in intravenous nutrition among clincians and researchers alike, and the number of physicians offering IV nutrition is on the rise.

It is fair to say that a large percentage of Americans are deficient in many important nutrients. Even among those who avoid fast foods and eat relatively well, deficiencies are common. Industrialized agriculture has certainly increased food yields, but it has done so at the cost of nutrient loss from the soil. The results have been vegetables and grains containing fewer nutrients. The use of antibiotics, hormones and commercialized feed for the livestock has also decreased the quality of our food supply. We’re eating larger quantities of nutrient-deficient foods, and this contributes to chronic lifestyle-related diseases.

Even conservative medical institutions now recognize the need for nutritional supplementation in addition to a balanced diet. And judging from the growth of the nutraceutical industry, the public is very interested in vitamins, minerals, fish oils and other dietary supplements.

Poor Digestion = Poor Nutrition

Oral supplementation is definitely convenient, but it has limitations and may not deliver the benefits we’d like to see. It is only as good as a patient’s digestion, and as we know, many people have significant digestive and absorptive problems. Many commonly used pharmaceuticals interfere with normal digestion and assimilation. Older patients taking multiple medications may be getting only a fraction of the benefits they hope to obtain from the vitamins and supplements they’re taking.

Jonathan Wright, MD, founder/director of the Tahoma Clinic, Renton, WA, and a long-time advocate of intravenous nutritional therapies, regularly tests his patients for low stomach acid. A healthy stomach has a pH of 2. Hydrochloric acid is essential for denaturing the quaternary, tertiary and secondary structures of protein; it is also needed for activation of pepsinogen to pepsin, which, at a pH less than 3.5 hydrolyzes peptide bonds in proteins and polypeptides. Without these actions the proper absorption of amino acids does not take place.

Decreased production of stomach acid, whether drug-induced or due to some sort of disease process, leads to poor digestion and diminished nutritional status. Dr. Wright has found hypochlorhydric patients are the most in need of and most likely to respond to IV nutrient infusions, which can lead to significant improvement in conditions such as macular degeneration, depression, fibromyalgia, chronic fatigue and other chronic illnesses. (Details of Dr. Wright’s protocols are available at his website, www.tahoma-clinic.com.) Any patient who is a chronic user of acid-suppressing drugs may benefit from IV nutrient therapy.

Micronutrient deficiencies are increasingly common these days, and they can have major adverse health impacts. Magnesium is a good example. It is important for over 300 different enzyme reactions, and plays a fundamental role in glycolysis, oxidative decarboxylation during the Krebs cycle, DNA synthesis and degradation, DNA and RNA transcription, amino acid activation, protein synthesis, cardiac and smooth muscle contractibility, vascular reactivity, and cyclic adenosine monophosphate formation.

Intravenous Magnesium

Magnesium deficiency is, unfortunately, all too common among our patients, and it contributes to a host of disease processes. Fortunately, many patients are very responsive to intravenous repletion.

Assessment of magnesium can be difficult because extracellular magnesium represents only about 1% of the total body magnesium, and appears to be homeostatically regulated so blood levels may not accurately reveal the actual metabolic situation. A patient may have normal serum levels despite severe intracellular deficit. A normal serum level does not rule out deficiency. However, when serum magnesium is below normal, it is almost certain that intracellular magnesium is inadequate.

Testing methods do exist for measuring intracellular magnesium, and it is a much more reliable indicator of total body magnesium levels than simple serum measures. But unless a patient has significant renal impairment, magnesium is so safe and inexpensive that I tend to err on the side of just giving it when I suspect a patient is deficient, rather than running tests, which can be expensive.

Symptoms of magnesium deficiency include fatigue, depression, anxiety, irritability, insomnia, hyperventilation, muscle spasms, chest tightness, confusion, and memory loss. Other conditions that should prompt you to think about magnesium deficiency include chronic fatigue, fibromyalgia, mitral valve prolapse, cardiovascular diseases (acute MI, arrhythmias, angina, CHF, cardiomyopathy, intermittent claudication), calcium-oxalate kidney stones, asthma, osteoporosis, migraine, premenstrual syndrome, urinary frequency, urge incontinence and nocturia caused by detrusor instability, diabetes, reactive hypoglycemia, COPD, preeclampsia, premature delivery, hypertension, sickle-cell disease, alcohol and narcotic withdrawal, restless legs syndrome, and acute spasm.

Oral magnesium supplementation, at doses of 400 to 600 per day, are sometimes effective in correcting deficiencies. At the high end of that range, however, patients may experience loose bowels, which should prompt them to cut back the dose. Magnesium can be taken as a one-time dose, which, if taken at bedtime, can induce melatonin secretion and aid sleep. It can be used as a muscle relaxant, at doses of 100 to 300 mg every 4 to 6 hours.

However, oral supplementation cannot achieve the high serum concentrations one can obtain with IV infusions. In treating chronically deficient patients, very high levels are necessary, in part because deficiency states impair the function of the cell membrane, making it more difficult to get nutrients into the cells.

The high concentrations obtained with IV nutrient infusions can overcome cell membrane transport impairments. This is why IV therapy can produce results not seen with oral supplements, and why IV nutrition can be so useful in treating many illnesses not responsive to other therapies.

When using IV magnesium, I generally give 2 to 4 grams. I’ve used it in the emergency room for acute conditions like asthma, migraines, and muscle spasm, which I treat by running the 4 grams, as tolerated, over 10 to 20 minutes. I like to have the patient feel warm all over but not to the point where they are too uncomfortable. So I try to stay at or near the bedside and titrate the dose accordingly.

IV magnesium preparations come premixed in 100 ml bags of sterile water containing 4 grams MgSO₄. Alternatively, one can draw up the 4 gram dose in a syringe and inject it through a 25-gauge butterfly; this small gauge prevents giving it too rapidly. Infusing into a large vein such as the antecubital will prevent local irritant effects.

Since magnesium tends to drive potassium into cells, IV infusion of magnesium may precipitate symptomatic hypokalemia, especially those patients who are already low owing to diuretics and beta agonists. You can prevent this by giving oral potassium before and after the IV magnesium infusion.

The Myers’ Cocktail

The “Myers’ Cocktail” is probably the most well-known form of intravenous nutrient repletion. The formula includes magnesium chloride, calcium gluconate, thiamine, vitamins B6, B12, calcium pantothenate, vitamin B complex, vitamin C and dilute hydrochloric acid drawn up in a syringe and given slowly intravenously. The concept was orignially developed by Dr. John Myers, of Baltimore in the 1960s. Dr. Meyers used intravenous infusions of dilute HCl and mega doses of vitamins effectively and safely to treat chronic fatigue, exhaustion, depression and chest pain until his death in 1984. His work was revived and expanded by modern practitioners like Alan Gaby, MD, who has used an augmented version of Myers’ formula in literally thousands of patients.

There are now many variants of the Myers’ Cocktail, incorporating various additional nutrients not used by Dr. Myers. The infusions are quite safe and relatively inexpensive, and they have been used successfully to treat CHF, asthma, chronic pain, migraines, fibromyalgia, chronic fatigue, chronic depression, acute narcotic withdrawal. Tailored protocols have been developed for specific illnesses such as acute viral illness, acute hepatitis, macular degeneration, glaucoma, and cachexia.

The high nutrient concentrations achieved by IV infusions enable the cells to uptake these needed nutrients, and the general consensus among practitioners who use Myers’ Cocktails is that the faster the infusion rate the better. Of course, the rate will depend on the patient’s tolerance and the size of the vein. A tolerable feeling of heat is the goal I use to guide the rate of infusion.

From personal experience, I have found the modified Myers’ Cocktail quite effective in resolving the symptoms and fatigue associated with the common cold or flu-like illness. They’ve been a big help when my performance needed to be optimal for a 12-hour emergency room shift. I could envision this therapy being used to enhance performance of athletes, performers, or any one whose occupation puts high demands on their physiology for prolonged time. It is certainly safer than a lot of the other things people choose to use to keep their energy up.

Rare adverse reactions include pain and burning of the extremity from the injection site, drop in blood pressure, nausea, diffuse feeling of heat and chemical phlebitis. Simply slowing the infusion rate and/or using a larger vein easily averts any ill effects. Careful attention to the osmolar load will reduce the local irritant effect. Most suppliers of IV nutraceuticals can supply an osmolarity table for their products. Ideal osmolarity is in the physiologic range of 280 to 300 milliosmoles per liter, but most patients can tolerate 500 to 600, if given at a slow rate of infusion.

Using a large caliber vein allows a faster rate of infusion, with less local irritant effects. I once personally experienced a chemical phlebitis when running an infusion “wide-open” on myself. This resolved without treatment in one week. Careful attention to the osmolar load reduces the local irritant effect.

Depending on the condition being treated, the infusions can be given as a single treatment or as a series of 2 to 4 per week. In treating longstanding chronic illnesses like chronic fatigue, longstanding depression, fibromyalgia, macular degeneration, hypertension, chronic migraines, uterine cramps, chronic urticaria and congestive heart failure, it is not unusual to see no improvement until the third or fourth infusion. With each subsequent infusion the symptoms tend to improve to a point where no further improvement can be obtained, and one can discontinue treatment. If symptoms return, as they often do, you can begin another course of infusions. Gradually, through a process of trial and error, you can find for each patient an optimal treatment schedule that maintains the benefits with the fewest possible infusions.

There are many disease-specific approaches to IV nutrient therapy, which are based on infusing specific nutrients with known effects in managing particular disorders. For example, one can treat macular degeneration with intravenous zinc sulfate and selenium; hypertension with magnesium, B6 and L-arginine; diabetes using chromium and other trace minerals.

Be careful when using calcium and zinc intravenously, as they can induce arrhythmias when given too rapidly. On the contrary, selenium, manganese, magnesium, taurine and copper can be used in treatment of arrhythmias.

Intravenous Vitamin C

Nutritional medicine pioneer Linus Pauling proposed IV vitamin C for treatment of cancer and reported improvement in symptoms and prolongation of life. It is difficult to achieve very high vitamin C concentrations with oral administration, as there is a limit to intestinal absorption and bowel tolerance. IV infusions can give concentrations 25 times that of equivalent oral doses. This may be the reason studies of high-dose oral vitamin C have failed to achieve significant positive results in cancer therapy.

However, there are recent in vitro studies showing that high concentrations of vitamin C cause death to cancer cells at levels non-toxic to normal cells Increased production of H₂O₂ directly related to elevated vitamin C concentrations appeared to be the mechanism. The authors caution that IV vitamin C should not be used for people with glucose-6-phosphate dehydrogenase deficiency, as they have impaired ability to remove H₂O₂, and the buildup can cause intravascular hemolysis.

In summary the use of intravenous nutrients is safe, inexpensive, and effective for a whole host of illnesses many of which are not effectively treated by conventional means. With the pendulum now swinging from reliance on high-tech and patentable pharmaceuticals to more natural and physiologic treatments the time is ripe for IV nutritional therapy.

Recommended Reading

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Cameron E. Protocol for the use of vitamin C in the treatment of cancer. Med Hypotheses 1991; 36(3): 190–194.

Gaby A. Intravenous nutrient therapy: The “Myers’ Cocktail.” Altern Med Review 2002; 7(5): 403.

Gaby AR, Wright JV. Nutritional Therapy in Medical Practice. 1994, 1996, 1998, 2003.

Groff JL, Gropper SS, Hunt SM. Advanced Nutrition and Human Metabolism, 2nd edition. Thomson Learning, 1995.

Huntsman WR. Three Years of HCl Therapy. Philadelphia, 1935. Reprint by The Arthritis Trust of America available at http://www.arthritistrust.org/Books.htm.

Naidu KA. Vitamin C in human health and disease is still a mystery? An overview. Nutrition Journal 2003 Aug; 2(7): 1–10.

Padayatty SJ, Levine M. New insights into the physiology and pharmacology of vitamin C. CMAJ 2001; 164: 353–355.

Padayatty SJ, Sun H, Wang Y, et al. Vitamin C pharmacokinetics: Implications for oral and intravenous use. Ann Intern Med 2004; 140: 533–537.

Rask MR. Colchicine use in 6000 patients with disk disease & other related resistantly-painful spinal disorders. The Journal of Neurological & Orthopaedic Medicine & Surgery 1989; 10(4): 291–298.

Riordan HD, Jackson JA, Riordan NH, et al. High-dose intravenous vitamin C in the treatment of a patient with renal cell carcinoma of the kidney. J Orthomol Med 1998; 13: 72–73.

Riordan HD, Riordan NH, Jackson JA, et al. Intravenous vitamin C as a chemotherapy agent: A report on clinical cases. P R Health Sci J 2004; 23: 115–118.

Riordan NH, Riordan HD, Casciari JJ. Clinical and experimental experiences with intravenous vitamin C. J Orthomol Med 2000; 15: 201–203.

Kenneth W. Cartaxo, MD, is a family physician with a longstanding interest in nutritional medicine. He currently pratices emergency medicine part-time at Newton Memorial Hospital, Newton, NJ, while he develops Urgent Care House Calls, a house-call based practice that will incorporate nutritional therapies.