Intravenous (IV) delivery of nutraceutical agents is a growing area of medicine. So, what are the benefits? How does IV differ to oral delivery? What are the risks and what is the evidence telling us? We invited Dr Mark Donohoe back to FX Medicine to share all this and more, based on his own personal experience using IV Vitamin and Nutrient therapy.
Covered in this episode
[00:52] Welcoming back Dr Mark Donohoe
[01:26] Today's topic: IV Nutrients
[08:24] The Myer's Cocktail
[10:35] IV vs. Oral
[15:26] Utility in toxic shock and sepsis
[22:12] The rise of IV nutrient therapies
[25:46] What nutrients can be used?
[31:34] Nutritional medicine, not nutrition
[33:45] The costs of usage
[35:25] Risks to be aware of
[37:46] Learning from trial and error
[40:50] Final thank you to Dr Donohoe
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook, and joining me once again in the studio is Dr Mark Donohoe, who graduated in 1980 from Sydney Uni. Worked around the Central Coast, and this is where his interest in integrative medicine sparked, because patients just weren't fitting into the boxes of diagnoses and treatments. He's one of the 'kind uncles' of integrative medicine in Australia and has been a vanguard for patient health throughout his career. Welcome back, Mark. How are you?
Mark: It's a pleasure to be younger, an uncle, instead of a grandfather. It's great to be back.
Andrew: Now, Mark, today we're going to be discussing intravenous applications of nutrients. So, to start, where was...let's say IV Vitamin C because that would probably have been the first intravenous nutrient used, wouldn't it? What's its history?
Mark: Its history dates back to evolutionary biology. Somewhere along the line, we humans lost the ability to produce Vitamin C. Most mammals can. I think it's only guinea pigs are the other ones that can't.
Andrew: Yeah, there was a bird...
Mark: Was it?
Andrew: Yeah, some weird...
Mark: But under stress, most animals produce large amounts of ascorbate. They convert it very efficiently. We've lost the enzyme to do it. And so, it became apparent that we were able to get enough from the diet to meet most of our dietary needs. Unless we were on a ship traveling to some foreign land in the, you know, 17th, 18th century where we probably ran out of Vitamin C, developed scurvy, and there is a known disease state of deficiency. And most animals cannot get that. If they get their glucose, they make their own Vitamin C.
Mark: So, there was no animal model for it. It took a long time to work that out. And then, what we did discover later was that animals, under extreme stress, can make the equivalent, in human terms, of 20 grams or more of ascorbate per day. By diverting the kind of, sugar in the metabolic pathway. So, it became apparent to people that maybe what we could do in areas where say, adrenal stress was very high - and this becomes apparent later, you know, what we'll discuss about septic shock and stressors and the like. Maybe what happened to humans was that they would run out of ascorbate and there may be consequences for that.
And so, clever people got together, intravenous applications became easier to do as the giving sets and sepsis and those kind of things became easier to manage. And at least by the 1940s, '50s and '60s, intravenous Vitamin C was being used. And the applications were not always clear. It was done on the basis of, "Let's give this and it might fix the cold. It might fix infection. It might fix stress. It might fix just about anything." And it ran through what happens in medicine, which is, it did everything, and then the pendulum swings back the other way and it is complete rubbish.
And so, you have this kind of history of medicine that we try things out, they are claimed to have all good outcomes. Then the benefits are questioned, and you find that they were never that great. And it falls back the other side where things fall into disrepute. This happened to the vitamins, the whole concept of vitamins, that they were going to be the cure of everything for mankind. And then you see, even today, you find the skeptics that still say, "But we don't need vitamins." And of course, we do. The middle ground lies there.
What we found was that in different conditions, things like acute glandular fever for example, acute infections, acute viral and septic and bacterial infections, Vitamin C, for those who used it, worked a kind of magic. And I do remember my own history of this. My own history was I did the ACNEM education, I learned from Ian Brighthope about Vitamin C. Ian Dettman was there as well. These are grandfathers and great people in this whole area, and true grandfathers.
Andrew: Kind, great-uncles.
Mark: Yes, kind, great-uncles. But these were people that pushed us into saying, "Well, look, there's a therapeutic application of a molecule that is incredibly safe to administer, and we should be considering this in the following circumstances”.
I went back to my own practice, as you said, in the Central Coast. I had accumulated a group of complicated people. I'd done the allergy management, I'd done the diet. I'd done everything that I could think of to work with these people, and they didn't get better. And I remember ringing up Ian Brighthope and talking about how do we do the intravenous Vitamin C, and we came to this conclusion; Ok, the 30 gram doses, you put the IV bag up, just what we were doing in the hospital a few years before, and we were using antibiotics and drugs, and we ran this into my patients. My recollection of that time is that it was magic. For about a six-month period there, people who had not got better through two or three years of my treatment - I was a young doctor at the time - through two or three years of that treatment, were just getting better like magic. They would get up, they would walk, they would feel better within four hours. And they'd be up walking. They were getting over their infections, back to work on their farms. I actually misinterpreted it as all this time I had been doing nutritional, environmental, I've been looking at other forms of medicine, all I ever needed to do was give intravenous Vitamin C. And so, like every enthusiastic doctor, I said, "Okay, I'm going to do that first from now on."
Mark: And when you do it first, it doesn't work. You cannot just give everybody intravenous Vitamin C. It's no panacea. It's nothing of the way it seemed. And it took me years to realize what I had done was I had done everything I could do. These people were at the point where they only needed one final push to get well. But if I thought that final push was the only push, it was incorrect.
Andrew: Yes, the salient points of treatment.
Mark: Yeah. So, I was trying to get out of doing all the hard work of managing all the rest of their health and lives. And what I really found was, most people respond without needing Vitamin C. But when you need it, when you need it for that final push for the person that just can't get over their chronic relapsing viral infections, it worked like magic.
Andrew: I mean, this is the same sort of issue that I've seen even in my wife that used to get this post-viral cough during winter. This tickly cough. I'll do a shout-out to Dr Alan Hadley who we used to see for treatment, and it was the only thing. But as you say, we'd done everything else. But it was the only thing that was able to hold Lea and get rid of the cough. And I remember, I think it was like, you know, maybe two, possibly three years of each winter going in for treatment, and that was it. And for years, over a decade, she had never had this cough afterwards. Recently, it's resurfaced, probably due to her work and possibly due to other work failing, you know, the prerequisite work not being done by me.
Mark: Well, we all fail at times, right? And that opens the gate, and that opens the gate for illnesses to relapse and to, you know, make their impact with symptoms.
And so, in retrospect, we can always look back and say, "Oh, that's probably my failure to do “X”. I was too stressed. I missed sleep. I did something." They are all normal parts of life and normally we beat along and we get through those things. Sometimes certain people get stuck with, say, those chronic infections and it relapses, and like your wife, it'll come back over and over. So, it is true that the Vitamin C, which I’m guessing you're moving to, did something?
Andrew: Well, there was a whole cocktail. It wasn't just Vitamin C. There was nutrients, minerals. I guess where I want to go, though, is the history of Vitamin C, intravenous application of vitamins. Now, I think...was it Myers?
Mark: Yeah. The Myers' Cocktail.
Andrew: Everybody talks about Linus Pauling and his use with cardiovascular disease, his claims of them having an anticancer effect. But there's a few issues there. Firstly, I think it wasn't Linus Pauling. It was Myers, correct? What was his applications?
Mark: Yeah, it was, I believe. I was not there.
Andrew: I hope not.
Mark: I was not there. But the Myers' Cocktail is still used to this day.
Andrew: Right. What does that consist of?
Mark: Well, it's a combination of B vitamins. It's a very specific formulation. You can order it from intravenous suppliers. But the Myers' Cocktail, to this day, has a nice impact. It's a kind of horse serum type kick that when you've got a person who you really need to just push back into a stable state of health, the Myers' Cocktail, the multi B's in a particular formulation. Now, you must remember, the formulations that are made are a combination that could've been made a million different ways. So, somebody comes to…
Andrew: …Well, they're not personalized either.
Mark: Yes, that's true. And the same goes for Vitamin C. You can mix Vitamin C with other things, you can have varying doses. We are just now discovering, now that Vitamin C, intravenous Vitamin C, is back in the mainstream for very specific medical purposes, we are doing the drug work that is really required. And we need to know a little bit more about what combinations work, rather than just have historical people who have said, "Okay, I use this combination." What do we do? We're all lazy and we copy it. The trouble with nutrients is, you can put hundreds of nutrients in an almost infinite variety of doses in there, and we haven't even started the discovery path for that yet. So we use the Myers' Cocktail or we use, say, even intravenous glutathione.
So we can do things that bypass problems that we have with the gastrointestinal tract, absorption, and the availability. But more importantly, intravenous works in an entirely different way.
Andrew: Now, this is really important. Not just the point of dose, the appropriate dose that you can ingest or, forgive me, that you can administer. But also the aspects of how it works within the body.
Mark: Yes. You'll probably remember more than most, the problem with Vitamin C is you just can't get enough in orally before you cause diarrhoea. And if you've got diarrhoea, what's all that you're saying is that's bowel tolerance.
Andrew: Yeah, that's right.
Mark: The typical healthy person can absorb maybe 8 to 12 grams a day, and that's even pushing it. Many people get diarrhoea at just seven or eight grams a day.
I remember HIV positive people taking orally, 200 grams a day, for you know, basically four grams every 20 or 30 minutes, never getting diarrhea. So there is an upregulation of the gut…
Andrew: There would have been some wind there, though.
Mark: There was.
Andrew: Rather sulfurous.
Mark: There was plenty of wind. But what's impressive is, the sicker the person, the higher the gastrointestinal uptake, the less the diarrhea that they had.
Mark: And so, it was known as, you know, oral Vitamin C to bowel tolerance, a well-known naturopath William Vayda was out there. William would always test the limits of just how far they could go, and I was working around the Darlinghurst area where HIV was relatively common. It was impressive that Hep B, HIV, really serious life-threatening infections, the body may not have been able to produce it, but boy, could it take it up at a rate that was quite impressive.
But no matter what you did with oral Vitamin C, you could never reach the peak levels that you can do with administering intravenous Vitamin C. So, there is alterations of the nutrient as it goes through the gut. It's got to make it through the stomach, it's got to be absorbed through the upper part of the small intestine. And the peak levels are maybe one-twentieth of what you can achieve with intravenous administration.
Andrew: Did it have similar actions, though?
Mark: It did not. A good example of one that I can think of straight off is, oral Vitamin C, when a person has glandular fever, has a bit of an impact. It's pretty bold no matter what dose you use. But acute glandular fever, the kid that turns up HSC year, big nodes, sore throat, classic glandular fever. Intravenous Vitamin C can take that out in 72 hours. And so, using doses as high as, say, 45 grams at a time over those 72 hours, I've seen over and over through my career, people that you would predict are going to be sick for weeks, coming right through it. And it does come back to that concept of if every mammal under acute infection, under acute stress like in HSC, if they can produce almost unlimited ascorbate, what we should be doing is trying to emulate that by the use of intravenous. And the results are spectacular.
I really, I mean, over and over, my colleagues and I, when we've seen it, we keep on saying, "If only we can kind of get this into the medical mainstream." We integrative doctors often see people late. We're not the standard GP. But if GPs got used to this idea that intravenous Vitamin C, for every kid in the HSC year who turns up with glandular fever, you put them on three days of 45 grams per day, we could stop a lot of what I see later on, which is, "I was in the HSC. I got stressed. I got glandular fever. I couldn't sit my exams. I'm still sick five years later." And so, when it comes to these post-viral syndromes, my feeling is that intravenous Vitamin C would make them almost irrelevant.
Andrew: What I don't understand is when doctors are faced with a patient that, A, is not responding, B, there is no further medical management, and it's not working and you've got devastating diseases like necrotizing fasciitis, the flesh-eating disease, where it gallops along in between the fascia. It's very hard to stop with normal...with throwing everything medical at it. Why is there this refusal to say, "Let's try something"?
Mark: Yes. I have been through this many times, over the years, asking hospital doctors to do intravenous Vitamin C. For a start, they don't have it in their dispensary. Crazy. To my mind, you've got $10,000 drugs there dripping all over the place, and the simple cheap, effective Vitamin C.
But there is a philosophical thing as well. In my generation, there had been a generation before where vitamins were going to cure everything. Then vitamins were going to do nothing, and they were effectively a hallmark of a charlatan. And now, I do see hope because in the last five years, six years probably, we are seeing that desperate conditions, just as you are saying, are now coming back with people trying intravenous Vitamin C and finding dramatic survival rate increases.
Andrew: What are we talking about here?
Mark: Well, toxic shock. Basically, the whole concept of shock. The body going into a level of, say, gram negative sepsis. Gram-negative sepsis, it can be a fatal disease, highly toxic. The blood pressure drops to nothing. We tend to give adrenaline, cortisone, and we hope that people get better. And in those circumstances, untreated, there's an almost 100% mortality. But even treated, with the best treatment, there's nearly 40% mortality. Some clever doctors have gone back to their roots and said, "How about we add intravenous Vitamin C?"
Andrew: They're adding it. They're not replacing it.
Mark: Yeah. The original studies which what about Vitamin C instead? Didn't work. The capacity of hydrocortisone to do the job didn't work. But intravenous Vitamin C, plus the hydrocortisone, plus interestingly, one little tip of the hat to biochemistry, putting in Vitamin B1 so that oxalates are not formed, so you don't give a person kidney stones. Because doctors were always fearful of kidney stones being formed. Probably an unrealistic fear. But it's still used that way. But that changes 40% mortality to around about 10% or even 5% mortality. And doctors are very impressed by things that don't let people die.
So, the only entry point for vitamins is to do something so dramatic, a five to tenfold decrease in mortality rate, for people that turn up to hospital with reasonable regularity has been the reentry point. The other entry point has been people using this for people who are going to die either of their cancer or chemotherapy, to diminish the toxicity of the chemotherapy without inhibiting the cancer response rate. And there's even some good studies now that apoptosis can be induced. That those peak levels of ascorbate are not what we were thinking. We'd always said we'll give you a high dose antioxidant. And it was this whole concept of everything that's oxidant, bad. Antioxidant, good. And we had good and evil and we had this fight going on, and it was always a case of electron transfer, of the ability to have a pro-oxidant effect where it's obviously needed, to win the battles against microbes. To produce the superoxides, to do the stuff that we need to get on with beating our microbes up.
And then the recovery phase, as the intravenous drops away and the tissue levels drop, it has a mopping up operation to do on the other side of it. And it's probably nothing to do with oxidant, antioxidants. Although there is the kind of...this concept of a flash pro-oxidant. High dose Vitamin C really kicked the immune system to a very aggressive ability to make life miserable for the microbes. It's probably much more to do with signaling. That the intravenous Vitamin C is part of a normal mammalian response to an extreme stress and it brings in all of the cohort of the adrenaline, the adrenal response, the cortisone secondary response, and the whole endocrine system being organized around it.
Andrew: So it's more of the rescue wake up call?
Mark: It is. The mechanisms are still unclear because something that works for septic shock and works for cancer chemotherapy reduction in toxicity and works with cancer apoptosis, that's a really interesting molecule. And as you and I have talked about many times, nature is ridiculously capable of using the one molecule for multiple purposes. It's very, very efficient in raising, lowering, and changing the metabolic state, and the endocrine state, and the neuronal response to stress by just manipulating the one molecule. And I think what we're doing with the intravenous Vitamin C right now is we're coming to a view of it as if it were a drug. And I suppose we have to think of it that way. I tend to think of it more as there's a mammalian response that we are trying to kick back in in humans. Do we really need it? Most of us don't 99% of the time. But medicine deals with the 1% or the 0.5% or the things that are on the edge where you're trying to flick a switch back in a different direction.
And it is really worthwhile. Almost every time you use intravenous Vitamin C, there's a clear biological effect. This is not, you know, you have to do 12 double blind trials. When you've got a reduction mortality from 40% to maybe 5%. It is so bloody obvious that everybody who watches it says, "We will do our trials, but that's in the future." Like, right now, we have the lives to save of the people who come in here, and the fact that its adoption has been now so high and so active means that if I have septic shock, I want to have that. I want that to be part of the regimen.
Andrew: That's right.
Mark: Am I going to have that alone? No, because the evidence is if that's all I get, I still die. The evidence is, if I only get my hydrocortisone and I get a bit of adrenaline, I am likely to die as well. But when you put the pair of those together, when medicine matches up with intravenous nutrients, there's a powerful new player in that field and it's not the same as taking a multi-B vitamin. Doctors keep on confusing those two things of "We know multivitamins don't work." They don't even pay attention to the trials. But we know "They don't work" is the kind of recurrent theme, and this is one that definitely does work.
When you use nutrients intravenously...and again, I would refer people back to Ian Dettman who's accumulated an enormous amount of information, of wealth and a library here that is available to any doctor, any hospital, anyone who wants to listen. He has carried the flag for the last 30 years. All of my medical life, he's carried this along to say, "Here's the applications that we know." And he's beat his head against a brick wall with doctors just refusing to listen.
Now we're listening. We're coming up with ideas. Okay, not just vitamins. The vitamins and Myers' Cocktail play their part. What about intravenous amino acids? What about minerals? What about high dose glutathione? So, you know, the oligopeptides. There are things that we can do that are highly, extremely safe. In other words, unlike drugs where you occasionally administer it and kill people, these things do not. These are molecules of life. These are molecules that the body is used to handling. Not necessarily at these doses, but these are really worth exploring.
Glutathione is a great example. We have the kind of standard treatment for giving N-acetylcysteine for paracetamol poisoning. Intravenous glutathione works better, is far safer, and it does not rely on us trying to adjust all kinds of doses, hoping that the glutathione and the tripeptide is made from just providing the N-acetylcysteine.
Andrew: Nor indeed, towards the end stage about the patient being conscious.
Mark: Yes. Yeah. So we have a lot of exploration to do with intravenous therapies. My experience has primarily been with the intravenous Vitamin C. And I've got to say, these days I'm not so active in that area because a person who's required, say, three months before they can get to see me, I'm pretty useless for an acute infection. By that time, I would have hoped that they would have been elsewhere.
But right now, in Sydney, we have these intravenous administration units turning up, the detox units and the like, and they are now providing intravenous Vitamin C on the request of medical practitioners. And the results are equally good. They're agnostic about what they're injecting. They're just providing the facility to put a doctor's prescription into a vein. And so, the opportunity there is now for doctors to do something about, say, acute glandular fever, acute viral infections, bacterial infections, the pneumonias and the like, and to do something that is very, very helpful and may reduce the use of long-term antibiotics and antivirals.
Andrew: Which of course is an emergent medical issue that is really going to strain the resources of treatment for so many conditions.
Mark: Yeah. Yeah. And we have failing antibiotics. We have antivirals which for, especially glandular fever, don't work very well. I mean, we do use Valacyclovir. But to do anything to inhibit Epstein-Barr virus, you've got to really go to quadruple the dose that you have for the other Herpes viruses. Epstein-Barr is a ring shaped virus which sits outside the normal DNA. It's not like the other Herpes viruses. So it doesn't copy itself in a way that we can use drugs for.
And so, my gut feeling is, this is returning. The risk is that we pay such attention to, okay, it can reduce mortality, and we forget its common day-to-day use that when we're thinking of a glandular fever case in the HSC year, we think, "Oh God, I hope this doesn't turn bad. What can I do about it?" This becomes a therapeutic intervention which once a doctor has used it a half a dozen times, there's no turning back. You cannot not notice it anymore.
And as I said, the problem is, people go to their naturopaths, their integrative medicine doctors, the groups that know about this, months after because all the ones that were going to get better from the glandular fever did. The ones that didn't get better drag on and on with doctors messing around, saying, "Oh what can you do? It must be in your mind. Maybe phsychological… maybe you're under stress." Of course they're under stress.
Virus plus extreme stress. The opening is, the extreme stress of the HSC, it's one of the commonest stories in my practice. When I go back, I was sitting the HSC. Mid winter, I caught glandular fever and I've never been well from that day. And so, if there was something that we could just have as a take-home message, that that dosage, even at just a simple push of 15 grams, a doctor in their own surgery can get 15 grams and push it in over a period, very short period of time, and their nurse can manage that. Or, refer them to an intravenous clinic where you can run the 30 to 45 grams in per day. If you give the Vitamin B1 with it, then you've covered any of those concerns you may have about the oxalate production and whether you're doing harm to the kidneys.
But over thousands of uses of Vitamin C, that has never been the problem. Vitamin C is self-managing when it comes to acidity of the urine. And it's very, very rare for there to be oxalate stones occurring as a result of it.
Andrew: So we've spoken about Vitamin C and you've mentioned adrenal stress, but of course we've got to be mindful that stress affects the volume of the mind of the hippocampus, not the adrenals. We're not plumping up the adrenals with Vitamin C. It's the mind. So, where I'm going here is, what other nutrients given IV are very useful in relieving the stressed patient and helping their cortisol response, and therefore, you know, possibly even neuroplasticity, decreasing NMDA receptor activity, hyperstimulation of nerves from NMDA receptors by utilizing say, IV magnesium, B vitamins?
Mark: Yes. Yeah. Putting the magnesium… So, at the moment, this is a little bit of the Wild West. Every doctor makes their own judgments on "Is this person stressed?" I think the important...another important message is, stress does not cause any disease at all. It uncovers every weak point that you have, and exposes it. And so, stress will cause say, heart attack in one person, may cause depression in another person. Everybody has their weak spots. Stress exposes those weak spots.
Chronic stress is an entirely different thing to short-term stress. And so, what I was talking about with septic shock, that's acute stress. Adrenaline, cortisol, everything has gone crazy. That's not a game for GPs. I'm not suggesting for a second that you take a septic shock patient and say, "I'll try some Vitamin C here before we send you off to a hospital for your resuscitation."
But the chronic stress, the kind of stress that you see in the students, again, HSC, chronic work stress where people are cutting their hours of sleep and working longer to try and make ends meet. Those kind of stressors play out in an entirely different way. The entirely different way is that the body is well adapted to the kind of credit card of stress. That you can put something on your credit card short-term, but you are going to have to pay it off and there’s interest. If you keep on putting stuff on your credit card, the long-term impact of stress is that the organs that are adapting eventually cannot adapt any further. And so, as you said, the hippocampus, the pituitary, the parts of the brain, the limbic system where the stress response is probably playing out initially, the quality of people's amygdala responses, these are all the unknowns until stress is applied to the person, and then you see the breakdown in a particular area.
And what we can do is take the lessons that we learn in oral treatment and say, "Okay, magnesium is good for sleep, neuromuscular control. It is a good anti-neuroinflammatory agent." But we can never get the amount of magnesium in. Why? You would know the answer to this better than most. Magnesium, at the doses you need, goes out the other end.
Andrew: Similar to the Vitamin C.
Mark: It does. And so, there are limits to what we can do orally. And so, a very good example is, you put a couple of the B vitamins in there at moderate doses. Now I'm talking about, say, 50 to 100 milligrams as the total dose, not the multi-gram doses that we're using for Vitamin C.
You can cover some of those stresses, especially the hepatic and gastrointestinal ones, with glutathione, and the glutathione is also neuroprotective as well. And then you can use magnesium. And putting the magnesium in, it is incredible how a person can settle with say, an infusion over four hours of 500 to 600 milligrams, or even 2.5 grams. You can put a lot of magnesium in and force the person into a settled...neurologically settled and stress-settled state.
Andrew: Indeed. There are some interesting reactions, particularly amongst females, that I learned about the high dose intravenous magnesium. There's whimsically, flippantly, glibly I will say, that there seems to be these two reactions from many women, and one of them is either "Oh," or another one is, "Ooh." And that's because of the vasculature of the sex organs.
Mark: Yeah, well, men get the same but they don't tell you.
Andrew: Thanks, Mark.
Mark: You've got to be very careful about this vasculature, and embryology suggests that we're fairly similar to each other. Men don't say much, women may. But the receptivity to this...I mean, the same happens when you give Iodine injections for a contrast media. There is a sense of wetting yourself and there is a sense of vascular dilatation. And so, those symptoms are probably things that we have to ignore.
The benefit that I see with the intravenous magnesium and the B vitamins and the Vitamin C is, you're taking a response that animals are capable of doing and we are emulating that for saving the acute stress situation. When we're talking about getting viruses in post-viral syndrome to get better. Then we're talking about many, many doses over a period of time. The logistics of that are difficult, the cost of that is difficult, and the people tend to balk at that.
But what I would be saying is, every doctor should be exploring what part Vitamin C, intravenous B vitamins, glutathione, magnesium, the minerals.
Mark: The zinc, fabulous idea.
Mark: You can struggle, as I do, with really good zinc supplements orally and never see the zinc rise. You can get magnesium in vast amounts, to the point that people are getting diarrhea, and still not see the intracellular magnesium rise. And so, some nutrients are really, really hard to push back in the ways that we would like to see them therapeutically. And once you've administered them intravenously and you see the rapid response, it's very impressive for a doctor.
Now, the one proviso I'll put in here, is these are drug-like effects of nutrients. This is not nutritional supplementation, for deficiency. And so, you're using nutritional medicine, not nutrition. This is not an alternative to eating well. It isn't a kind of supplement for the diet. These are goals that can be achieved. So, magnesium, CoQ10, there are some things that you can do that will improve metabolic functioning, increase ATP availability, stabilize a nervous system. There are some things with glutathione that you can do which are neuroprotective, hepatically protective, and tissue protective right throughout the body. There's Vitamin C where you can have flash pro-oxidant effect for an antiviral, antibacterial, antifungal effect, and then a protective effect on the runoff of that Vitamin C. And we should be at the...you know, in the mid-life of these things' use.
And because of a bad name that was given to them in medicine maybe 30 years ago, in my youth of medicine, before I became an uncle or grandfather. Because of the bad name there, we've shooed them. We have just said, "No, they are worthless." Now the rediscovery is done by a new generation of doctors who say, "Hey, did you know this?" And so, you have the grandfathers in the world. You know, Linus Pauling is coming back into vogue. Ian Brighthope took a lot of hits in Australia for the use of the intravenous clinics. It worked like magic, but it was still beaten up because it was not part of orthodox thinking.
Andrew: Yeah, that's right.
Mark: And now it's returning to orthodox thinking. I think what'll happen is, we go from the septic shock and say, "That's impressive. What other applications are there for intravenous nutrients?" And I think we're at that point where nutritional medicine, the likes of Ian Dettman with the library of knowledge. That that should spread back out into the medical profession. I would dearly love it if there was a referral centre for GPs everywhere to just say, "Get to this clinic in the next 24 hours. Get the intravenous Vitamin C and just watch you being able to cope again with the stressors of the glandular fever in the middle of your HSC year."
Andrew: So we've spoken about that application of the intravenous nutrients given after or with adequate therapy. What about as a load prior to oral therapy to...
Mark: To bring them up to scratch?
Mark: Yeah. So, one of the hardest things...
Andrew: Where is it ethically with that? With overtreatment versus appropriate treatment? Do you wait until...
Mark: It's also expensive treatment.
Andrew: Yeah, that's very true.
Mark: So, you've got to have the IV in the clinic. And so, typically, one of these intravenouses can be, you know, a cost of somewhere between $90 and maybe $150, $180. The cost of the nutrients is high, the administration costs are high, and it has to be in a specialized clinic or you have to be set up for it.
And so, what used to be more common...I mean, I ran my practice back in the early 1980s. I think I would struggle with that same thing now. We had the IVs just set up in one room. It was a carpeted room. The sterility of it would probably be laughed at these days. So the regulation around it...which is worthwhile, I'm not suggesting go back to the old days. But the regulation, the training of the nurses and the like creates a very high barrier to entry. And that barrier to entry is something that we have the obligation to try and reduce.
Ian Dettman again, has provided an ever decreasing cost over time as the technology gets better. And there comes a point where the cost and utility cross over to the point that it's a doable thing, and I think we're at that point right now.
Andrew: I have to ask a point here about, in your experience, obviously there's a risk with this sort of treatment. There's phlebitis as an adverse thing. And that's one of the, I think, the practical applications that I've heard of and sort of learned, is try and warm the Vitamin C. So even coiling the given set and having a heated wheat pack on the arm just before the cannula.
Mark: Having the blood flow coming through so that it does not cool, chill, and get stuck in that area.
Andrew: Giving enough saline with it so that it doesn't have too caustic an effect.
Mark: It is hypotonic. Almost all the forms of Vitamin C that we see are hypotonic. Some, you know, extremely so. So if you're using 45 grams or the like, you have to really put a litre in it and run it in slowly. Good blood flow through there is...that's true.
But medicine, as you know, the value of the treatment is balanced against the risks each time. And so, when we're doing intravenouses, it's not a trivial choice. You don't do it because you haven't got any better nutrient to give the person. You're saying the benefit that we're going for is worth the risk of what we're about to do. And what you can do to minimize those risks is to, you know, appropriately deliver the dose, warmed, exactly as you say, and to make sure that the person... So, even a good example is, you don't want G6PD deficiency.
Andrew: I was just about to mention it, thank you.
Mark: You should check for G6PD deficiency because that does increase the risk for the person, and you do not give intravenous Vitamin C to the people who have that particular deficiency.
Andrew: Renal disease.
Andrew: Can't get rid of minerals.
Mark: Yeah. And if people have had oxalate stones in the past, I think that that's a really good wake-up call to say, don't give it to a person, especially if you don't know what they've had in renal stones. A surprising number of people pass renal stones. Almost none of them know whether it's calcium oxalate or urate or what it is.
Andrew: So that whole thing about Vitamin C causing kidney stones was debunked, wasn't it?
Mark: Yes, it has been over and over. I remember one of our renal physicians many, many years ago saying, "It's the one cause of them." And then, eventually years later, he came down and said, "Okay, so it doesn't cause it, but it can contribute." But a person who's an oxalate producer, you do pay attention to those ones, and you measure the oxalates before you go and do anything with the intravenous Vitamin C. Very simple test to do.
Andrew: The last point I just wanted to ask was regarding negative trials. For instance, there was the ISIS-4 that showed that giving intravenous magnesium didn't help acute coronary syndrome patients, heart attack. But when the authors of the LIMIT 1 and 2, which was positive, the authors of those trials commented, they actually said, "No, we advised the ISIS-4 authors, researchers, not to do it the way that they were doing it." And apparently what they did is the ISIS-4 gave it too late, too high and not frequently enough. So, its improper use, its improper knowledge, or ignorance – is the word? Asking something to do a job without appropriate preparation.
Mark: That's true.
Andrew: And I think this is the big salient point. If you're going to be using this stuff, you need to be adequately trained.
Mark: And you also need trials that cover the spectrum of dosages and timing. Negative trials are important, what didn't work and what was it about that that didn't work.
Andrew: So that we know not to do it, yes. Rather than saying it doesn’t work..
Mark: You hear this all the time on the radio: fish oils work. They don't work. They do work. They don't work. It depends what you mean by working and what you are trying to achieve.
One small anecdote, 1981, Lidcombe Hospital. We had the code blues which was basically a heart attack. And a lot of the people there were near the end of life anyway. One of those heart attacks, most impressively, we turned up...we gave the Lignocaine. We did all the things that were meant to be done. We were losing this person, obviously. And one guy who went on to become a cardiologist said, "Why don't we use intravenous magnesium?" And there was a kind of silence for a few moments of going, "We've just used all the good stuff. Why would you use the bad stuff? You know, why would you do that?"
The IV magnesium ran in, the heart rate stabilized. Part of it was Lignocaine toxicity that was being counteracted there. The guy came back. Within a period of, say, 15 minutes we'd lost him. And the intravenous magnesium, that ability for magnesium to stabilize and to settle the nervous system, to settle cardiac responses and settle neuromuscular responses, was the first time I'd ever seen the magic of a single nutrient used in a way that could be lifesaving on the spot. So that was in-fact the very first time I'd ever seen an intravenous nutrient used that way. Yes, we use saline all the time. They're intravenous nutrients. The sodium and the chloride and the Hartmann’s solution with potassium. But this was the first time a deadly event was just reversed by use of magnesium.
And we've got to rediscover that. That's what we're doing and that's why we're talking about it today. Doctors need to be able to use the tool appropriate to the job. When things are important, powerful, life-defining medical events, all the tools should be open to us. And the ones that are safest are in fact the nutrients and the molecules of life. When we use the drugs, they're the ones that we're hoping the body can cope with and eliminate the metabolic products. But it's a hell of a lot safer to use something that the body's used to.
Andrew: Dr. Mark Donohoe, thank you so much for taking us through the responsible application of intravenous nutrients. I think we leaned towards IV Vitamin C a little bit too much maybe? But it's a big topic.
Mark: It's a good start. If you get used to Vitamin C, you start to introduce the other IV nutrients. You learn a lot along the way. And so, IVC has got a powerful effect and it's falling into the mainstream. The reason we focused on it is, it's now okay to use it. There was a time when you took a risk just by being an IVC user.
Andrew: Yes. I thank you so much for taking us through the responsible application of these nutrients.
Mark: No one has ever called me responsible before in my entire medical career, so thank you.
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.
|Dr Mark Donohoe|
|ACNEM: The Australian College of Nutritional and Environmental Medicine|
|Prof Ian Brighthope|
|Dr Ian Dettman|
|Alternative Medicine Review: Intravenous Nutrient Therapy: the “Myers’ Cocktail”|
Other podcasts with Mark include: