Vitamins are magic. Especially when they’re injected. Roll up the sleeve, find a vein, insert a needle and watch that colourful concoction flow directly into the bloodstream. It may sound somewhat illicit, but that person infusing it is wearing a white coat, and you’re sitting in a chic clinic. There must be something to it, right? Intravenous vitamin injections are popular with celebrities and have even been described by Dr. Oz as “cutting edge”. Advocates claim vitamin injections can benefit serious conditions like cancer, Parkinson’s disease, macular degeneration, fibromyalgia, depression, and that modern-day obsession, “detoxification”. And vitamin infusions aren’t just for the ill. They’re also touted as helpful for preventing illness, too. A search for vitamin injections brings up millions of hits and dozens of advertisements. There is no question that vitamin injections are popular. But despite all the hype and all the endorsements, there is no credible evidence to suggest that routine vitamin infusions are necessary or offer any meaningful health benefit. Vitamin infusions are a marketing creation, giving the illusion you’re doing something for your health, but lacking any demonstrable efficacy. What’s more concerning, providers of vitamin therapies target their marketing at those fighting life-threatening illnesses like cancer, selling unproven treatments in the absence of good scientific evidence that they are beneficial.
The intravenous vitamin industry is a sideshow to science-based health care. Yes, there is an established medical role for injectable vitamins, though it’s no energy-boosting cure-all – they’re used to replace what we should obtain in our diet. As a hospital-based pharmacist I used to prepare sterile bags of total parenteral nutrition (TPN), a mixture of vitamins, carbohydrate, protein and fat that completely replaced the requirement to eat. TPN is effective, but not without risks, and far less preferable than getting your nutrients the old fashioned way – by eating them. There’s also the routine use of injectable vitamins like B12, or iron, all of which can be science-based when used to address true deficiencies, or to manage specific drug toxicities. IV vitamins (particularly thiamine) are also used in the emergency room, given to alcohol-dependent patients in order to prevent Wernicke’s encephalopathy. And there is the therapeutic use of high-dose minerals like intravenous magnesium for acute asthma attacks. But there is no medical justification to infuse vitamins into a vein when you can more appropriately obtain those nutrients in your diet.
So if they’re not necessary, where does the demand come from? A review in the Globe and Mail illustrates the hype and the promise:
Alison Dantas, chief executive officer of the Ontario Association of Naturopathic Doctors, says people’s fast-paced, frenetic lives are what is prompting more interest in naturopathic medicine and IVMT [intravenous micronutrient therapy]. While underscoring the difference between a recreational boost like caffeine and the injections, which must be given by trained professionals, she takes no issue with their trendy turn. “It raises awareness about complement therapies and medicines that assist people in staying healthy,” she says.
Of the 867 practising naturopaths in her province, Dantas says, 156 are intravenous-certified. She expects that number to increase. “We see a growing need because of the lifestyle of the population; it’s very effective in mitigating the risks of chronic disease but also managing chronic disease,” she says of Myers’ cocktail.
A 2011 survey by Caulfield and Rachul observed that that IV therapies are among the most popular services advertised by naturopaths. If it’s not “Myers’ cocktail”, (the intravenous version of a multivitamin pill), it’s high-dose vitamin C, which is explicitly marketed to cancer patients (One naturopath even recommends a video “Vitamin C better for cancer than chemo“.) Nothing subtle about it. Like Myers’ cocktail, vitamin C infusions are also touted as a panacea for the prevention or treatment of pretty much everything. As noted above, naturopathy organizations explicitly endorse the practice, and have even created a certification for the service. Given naturopaths argue that naturopathy is scientific and that the services they offer are science-based, I took a closer look at the scientific evidence supporting these services.
Blame Linus Pauling. Actually, to be fair, the idea of injectable vitamins precedes Pauling. But Pauling, with two Nobel Prizes, brought attention and interest to vitamin C far beyond what any evidence suggested. He seized on the observation that many species can produce their own vitamin C, while humans, apes and some other species lack this ability. Pauling surmised that some disease may be due to vitamin C deficiency, which could be addressed with massive supplements. Linus moved from vitamin C for colds and on to vitamin C for cancer, teaming up with surgeon Ewan Cameron to conduct a clinical “trial” which claimed efficacy, but was so poorly designed no conclusions could be drawn. He continued to tout the potential of vitamin C, wrote a few books on the subject, and founded the Linus Pauling Institute of Medicine, creating the foundation for the entire “orthomolecular” pseudoscience you see today. (Orac has more.) Unfortunately it seems Pauling was a victim of Nobel disease, where prize-winning scientists subsequently become enamored with scientifically unsound ideas. At the time of his death in 1994, Pauling’s vitamin C theories were considered quackery within the scientific community, but those ideas had gone on to be embraced and widely promoted by complementary and alternative medicine (CAM) purveyors.
Fast forward to today, and not much has changed. Pauling’s theories on the efficacy of vitamin C have never been substantiated. Despite the lack of evidence, the routine use of vitamins has continued to expand in popularity over the years. With the growth in sales of vitamin pills, there seems to be a similar rise (though admittedly hard to quantify) of intravenous vitamin injections. The most popular seems to be Myers’ cocktail, an arbitrary concoction of vitamins and minerals including magnesium and calcium. It’s named after Baltimore physician Dr. John Myers who apparently administered injectable vitamins to his patients regularly. After he died in 1984, the practice was taken on by another physician, Dr. Alan Gaby. Gaby admits that he doesn’t know what was in the original Myers’ cocktail, so he made up his own recipe and took on the practice of offering multivitamin injections for the treatment of various maladies. The use of Myer’s cocktail seems to have gained more prominence after an article by Gaby appeared in Alternative Medicine Review which is essentially a collection of anecdotal claims of benefit for conditions that include asthma, migraine, fatigue, fibromyalgia, depression, cardiovascular disease, upper respiratory tract infections, allergies, urticaria, narcotic withdrawal, athletic performance and hyperthyroidism.
The advertisements you’ll find online above make it clear – it’s not what vitamins are good for – they’re clearly good for everyone. Infusions run from $50 to $250 for a few pennies worth of vitamins delivered intravenously. You’ll find no shortage of explanations from providers as to why intravenous injections are superior to dietary sources, from food sensitivities and “intolerance”, to greater demand by the body in times of disease or recovery. There are even claims the higher levels in the bloodstream “coax” vitamins into the cells and mitochondria, where presumably they’re beneficial. It sounds impressive, but these claims betray a profound ignorance of physiology and biochemistry. Strangely missing from these descriptions is an explanation why pushing megadoses of vitamins directly into a vein (and bypassing the liver’s first pass metabolism) is somehow still considered a “natural” treatment.
As expected, being a pharmacist, I’m blamed (along with other health professionals) with standing in the way of the widespread use of intravenous vitamins. Apparently it’s our bias against nutritional treatments of illness. Oh, and blame Big Pharma too – apparently you’ll never see research on a vitamin (unless you do) or on products you can’t patent (unless you do) or on cancer treatments that aren’t industry funded (unless you do). We love the prescription pad too much – but just for drugs, not for vitamins. (Never mind that it’s pharmaceutical companies manufacturing the injectable vitamins in question.) The fact that conspiracies are often cited should tell you all you need to know about the veracity of these statements. But I’ll risk the wrath of the Pharmaceutical-Industrial Complex™ and tell you the real reason science-based health professionals don’t recommend or use vitamin injections in routine practice. It’s because there’s no convincing evidence they are useful.
The Evidence Check
I looked in PubMed for evidence with injectable vitamins that would demonstrate a therapeutic or preventative effect. With respect to Myers’ cocktail, there is no published evidence to substantiate claims of efficacy for the prevention or treatment of any condition. The only paper in the medical literature is the review paper by Gaby (which collates impressive anecdotes, but no trials). Shrader published a study examining injectable vitamins for the use in asthma, but the study was unblinded with no placebo group. There is also a randomized trial by David Katz examining efficacy for fibromyalgia, which failed to show any efficacy. (Katz discusses this on Dr. Oz, and admits there’s a lack of efficacy). And that’s it for published evidence.
Looking specifically at vitamin C, there are hundreds of citations – there’s no question that vitamin C has been extensively studied. Advocates for vitamin C always find reasons to criticize the negative trials, so let’s look at the most positive trials only. Some of the “evidence” proponents of vitamin C like to cite includes the following papers:
- Pharmacologic ascorbic acid concentrations selectively kill cancer cells: Action as a pro-drug to deliver hydrogen peroxide to tissues. Discussed and critiqued here and here in detail. Preliminary data that hasn’t been substantiated in human studies.
- Phase I clinical trial of i.v. ascorbic acid in advanced malignancy. Discussed here. Showed high-dose injectable vitamin C can be well tolerated, but also showed a lack of any efficacy for advanced cancer.
- Intravenously administered vitamin C as cancer therapy: three cases. Discussed here. These are case studies, and even the authors acknowledge that these reports increase plausibility, but don’t provide conclusive evidence given other factors could have contributed to the positive observed effects. The accompanying commentary is appropriately cautious.
- Effect of high-dose intravenous vitamin C on inflammation in cancer patients. Unblinded. Doesn’t measure relevant clinical outcomes.
- Vitamin C reduces fatigue in breast cancer. Unrandomized and unblinded. Is it any surprise the patients who accepted vitamin C felt better subjectively?
On balance, the data supporting the use of vitamin C are unimpressive – it’s no wonder that few scientists are advocating for more use or even more research. An optimistic review article from 2009 reluctantly admitted that the evidence supporting efficacy is still lacking despite 50 years of research. When we look at current clinical trials, it’s equally unimpressive. Notably, two trials (NCT00441207 and NCT00626444) have concluded in the past few years but have still not reported any results, suggesting the results were negative.
Overall, the evidence for vitamin C seems to suggest that if there really is an anticancer effect, it is so modest that it’s not detectable in clinical trials. While there are lots of anecdotes claiming benefit, there are also ones claiming it’s useless:
Celebrated physicist Sir Paul Callaghan has ended his experimental intravenous vitamin-C treatment for cancer, saying there is “absolutely no evidence” it worked. He is concerned that alternative medicine advocates are now using his “unusual experiment” to promote the controversial treatment in a misleading way. The New Zealander of the Year, who has terminal colon cancer, began receiving high-dose intravenous infusions of vitamin C in June last year, along with several alternative herbal remedies. The 64-year-old began the treatment during a six-month break from chemotherapy, tracking its effectiveness through a blood test for protein carcinoembryonic antigen (CEA), which indicates cancer levels. Yesterday, he told The Dominion Post he had ended his experiment after analysing data from six months of blood test results. “I have, as a result, learned enough to say that there is absolutely no evidence of any beneficial effect of high-dose intravenous vitamin C in my case.”
(Callaghan died in 2012.)
Given the lack of efficacy, my take on the efficacy of vitamin C for cancer is along the lines of what the American Cancer Society recommends – get your vitamin C from your food. When it comes to the use of injectable vitamin C for other conditions, no obvious benefit has been shown. There is no evidence to support the use vitamin C infusions for the prevention of disease, or for general “wellness.” In light of the lack of documented benefit, vitamin C infusions should really only be offered (or accepted) as part of a research study, and only in situations where its use is not expect to delay the use of more effective treatments. For any other conditions, the science-based approach would be the same: maximize the consumption of vitamin C-containing foods like fruits and vegetables, rather than relying on supplements – injectable or otherwise.
If you trust the sterile technique of vitamin infusion purveyors, and are willing to chance the small risk of infection, then the risks associated with the different vitamin infusions appear to be quite low. You generally don’t get adverse effects when there’s no effect, which may be why these products are well tolerated. While good data have not been compiled, there are also few case reports that document harms. Based on the ingredients themselves, that’s what we’d expect. Vitamin C infusions are generally well tolerated though the osmotic load (fluid shifts) from huge doses may be problematic. There are also case reports of kidney stones from intravenous infusions, an association also seen with vitamin C oral supplements. There are also harms to consumers with glucose 6-phosphate dehydrogenase deficiency – the risk of blood cells bursting (hemolysis) which can be life-threatening. Of course there are the cases compiled at What’s the Harm?, but reassuringly, most of the documented harms seem to be the result of avoiding appropriate treatments, rather than due directly to IV vitamin therapy. There is some evidence suggesting high dose vitamin C may reduce the effectiveness of chemotherapy (reviewed in detail here). There are also specific concerns about concurrent use with bortezomib (Velcade). Given there is no demonstrable benefit to vitamin C infusions for cancer, it’s probably safest for cancer patients to avoid vitamin C infusions entirely.
The Bottom Line
With so many purveyors of vitamin infusions, one would hope the practice was grounded in good science. But it isn’t, and that shouldn’t be a surprise. Despite the lack of good evidence, there is a near-obsessive devotion to touting the benefits of intravenous vitamins while railing against the mysterious entities which are blocking The Truth. But the reality is more mundane. In the absence of a deficiency, vitamin infusions don’t do much of anything. To the worried well, intravenous vitamins are going to be a harmless panacea that just succeed in enriching the revenues of the purveyor. Just as That Mitchell and Web Look said of the homeopath, “Bottle of basically just water in one hand, and a huge invoice in the other.” So if you value health theater over health care, and don’t mind paying mightily for the illusion, vitamin infusions may be your thing.
I have a much different opinion when these products are promoted to patients fighting for their lives, particularly with illnesses like cancer. There is good evidence to show that delaying treatment or substituting CAM for established cancer treatments dramatically worsens outcomes. Touting unproven treatments and then profiting from their administration is appallingly opportunistic. Real diseases require real treatments, not fake ones. They may look sciencey, but the reality is that intravenous vitamin injections are modern-day snake oil.