•Hyperemesis

•Rheumatoid arthritis

•Psoriatic arthritis

•Gout

•Psoriasis

•Lupus

•Dermatomyositis

•Ankylosing spondylitis

•Iron deficiency anemia

•Primary immune deficiency diseases (PIDDs)

•Inflammatory bowel disease

•Magnesium deficiency

•Multiple sclerosis

•Opioid and alcohol dependence

•Post-operative hydration

•Others

Main Results

The treatment group had a lower mean weight loss, postural change in systolic blood pressure, and serum creatinine concentration than the control group.

Commentary

Preparing the bowel for surgery can increase risk of fluid and electrolyte imbalance, which, if uncorrected, can lead to hypotension during anaesthesia. Successful strategies to ensure that patients having colorectal surgery are adequately hydrated are therefore imperative. Encouraging patients to increase their oral fluid intake during bowel preparation is currently the most common strategy used by nurses to minimize dehydration before fasting for surgery.

IV Therapy for Pre- and Post-Op

PRE AND POST OPERATIVE NUTRITIONAL IV THERAPY SPEEDS YOUR HEALING & PREVENTS COMPLICATIONS FOR YOUR SURGERY by Les Cole, MD

Why should you get IV nutritional therapy if you are having surgery? Insufficient nutrition impairs wound healing and leaves surgical patients more susceptible to post-operative complications. By providing optimal IV nutritional supplementation before and after surgery we can positively influence your surgical outcome. The risk of complications also increases from other medical conditions, which increases the importance of optimal perioperative nutrition. Patients who are poorly nourished, overweight, and/or have diabetes or other health problems are particularly prone to surgery-related complications; including wound infection and poor healing.

Most Americans consume diets too high in calories and deficient in essential nutrients. We are known as a malnourished and overfed population. More than 70% of American adults do not even get two thirds of the RDA for 1 or more nutrients and the RDA is only enough to prevent a deficiency disease (i.e. Rickets, Beriberi, Scurvy) but not enough for your optimal healing. The Standard American Diet (SAD) is notably poor in consumption of fruits and vegetables – foods with high micronutrient density. American meals, loaded with packaged, processed, nutrient-poor foods, contribute to nutrient deficiencies that result in a shortage of micronutrients and antioxidants – particularly important to surgical patients undergoing anesthesia, trauma, and wound healing.

Deficits in micronutrients such as zinc, selenium, vitamin B6 & D (to name a few) have a negative influence on the immune response. Perioperative IV supplementation can have a significant and measurable effect on your surgical outcome by favorably affecting 4 primary mechanisms: reduction of oxidation generated by surgery and anesthetic agents, enhancement of immunity, reduction of bruising, swelling, and inflammation and promotion of wound healing. Beneficial antioxidants can deactivate unstable free radicals resulting from trauma or surgery, thereby playing an important role in the prevention of further damage. Vitamins, minerals and nutrients such as carotenoids, vitamin A and C, selenium, bioflavonoids and glutathione act as antioxidants. Specific amino acids are needed for tissue building and others actually increase healing. Specific nutrients stimulate anabolic (“building”) hormones and reduce catabolic (“breaking down”) hormones. Zinc, selenium, vitamin B6 & D and other nutrients mobilize and improve immune function while decreasing inflammation.

This is important because during surgery it has been documented that the blood and tissue levels of nutrients decreases while the body’s requirement for them increases. What are you often told to do before surgery? Fast (i.e. nothing to eat for up to 8 hours before surgery) – so you are nutrient depleting an already nutrient deficient body and brain. In addition, you are also told to stop all vitamins and supplements 2 weeks before surgery. In an effort to prevent bleeding, you are being even more nutritionally compromised. Yes, there are certain nutrients you do not want to take before surgery since they can increase bleeding risks, but many others are essential to healing.

IV pre and post-operative nutrition is the solution to optimal perioperative nutrition and can decrease bruising, swelling, inflammation, pain, scarring, and infection rates. It will also significantly improve wound healing and recovery time. If you have or plan any of the following you owe it to yourself to come get IV nutritional supplementation:

IV Therapy for Pre- and Post-Op

Bariatric Surgery – very important in your case because it is likely your diet has been high in macronutrients and low in micronutrients – i.e. foods that don’t support healing Gastric Band Gastric Bypass Sleeve Gastrectomy

Cosmetic Procedure – for cosmetic purposes, you want the best healing, least scarring you can achieve

Gastrointestinal Surgery – very important because you are likely to have poor digestion and absorption from your gastorointestinal tract before and after surgery

IV Therapy for Bariatric Patient Care

Bariatric surgery is the only long-term successful treatment for morbid obesity. As a result, about 196,000 bariatric surgeries are performed annually in the United States.[1] Laparoscopic sleeve gastrectomy (LSG) is the most commonly procedure performed, followed by laparoscopic Roux-en-Y gastric bypass (RYGB).[1] Outcomes of RYGB and LSG promise perioperative complications rates of less than one percent, and excess weight loss at 69 to 76 percent excess weight loss (EWL).[2] On the contrary, long-term complication rates can be quite high and frequently go undiagnosed. These long-term complications are often related to nutritional deficiencies that mostly occur from malabsorption secondary to bypassing segments of gastrointestinal tract, where the various nutrients are absorbed. Common deficiencies seen include inadequacies in cobalamin (B12), thiamine, folate, zinc, iron, magnesium, selenium, copper, calcium, vitamin D, and protein. As a result of these deficiencies, complications might ensue, including generalized weakness, alopecia, psychiatric disorders, cognitive dysfunction, fatigue, irritability, osteoporosis, Wernicke encephalopathy, iron-deficient and megaloblastic anemias, cardiomegaly, and peripheral neuropathy.[3,4]

Bariatric surgeons are aware of these deficiencies, and most patients are placed on oral supplementation immediately after surgery. However, the oral absorption of nutrients is altered significantly after bariatric surgery, and there is a wide variation in the use of supplementation and the performance of diagnostic laboratory tests. Patients are required to take oral supplementation for the rest of their lives but often become nonadherent. Physicians may become less diligent about monitoring patients for nutritional deficiencies.[5] Currently, there are no accepted universal guidelines for supplementation or monitoring after bariatric surgery. As such, nutritional deficiencies often go undiagnosed and untreated. One study found that three years after bypass surgery, even with supplementation, as many as 50 percent of patients had iron deficiency and nearly 30 percent had cobalamin deficiency.[6] Intravenous (IV) micronutrient therapy (IMNT) for bypass patients is well researched but underutilized.[7,8] IMNT has its origin in the management of cancer-related issues and fibromyalgia, but is being considered more and more as a prophylactic and therapeutic option for bariatric patients. IV infusion of micronutrients is safe, feasible, reliable, and relatively inexpensive. A basic supplementation regimen of United States Department of Agriculture (USDA) recommended doses of magnesium, calcium, cobalamin, thiamine, iron, and vitamin C on a bi-weekly or monthly basis might serve as an adjunct therapy to a daily oral supplementation regimen. Specific IV infusions for documented deficiencies are also well tolerated and more effective than oral supplementation because of superior absorption via the IV route.[10]

With the number of bariatric surgery patients in the United States approaching 10 million, bariatric surgeons and primary care physicians will encounter nutrient deficiencies and associated complications at an increasing rate. The use of IMNT as a prophylactic and therapeutic management tool to prevent and treat these deficiencies should be considered for this patient population.

Intravenous iron replacement for persistent iron deficiency anemia after Roux-en-Y gastric bypass

Background: Iron deficiency is a major postoperative complication of Roux-en-Y gastric bypass surgery. Oral replacement can fail to correct the deficiency. Thus, recourse to parenteral iron administration might be necessary. Our objective was to evaluate the effectiveness and safety of a standardized 2 g intravenous iron dextran infusion in the treatment of iron deficiency after Roux-en-Y gastric bypass surgery. The setting was a university-affiliated community hospital in the United States.

Methods: We reviewed the medical records of 23 patients at our institution who had received 2 g of iron dextran intravenously for recalcitrant iron deficiency after Roux-en-Y gastric bypass surgery. We obtained the demographic data and the complete blood count and serum iron studies obtained before treatment and at outpatient visits after infusion.

Results: Before treatment, all 23 patients were iron deficient (average ferritin 6 ng/mL) and anemic (average hemoglobin 9.4 g/dL). By 3 months, the average ferritin and hemoglobin had increased to 269 ng/mL and 12.3 g/dL, respectively. The hemoglobin levels remained stable throughout the follow-up period. The iron stores were adequately replaced in most patients. Four patients required a repeat infusion by 1 year, because the ferritin levels had decreased to <15 ng/mL. The probability of remaining in an iron replete state was 84.6% (95% confidence interval 78-91.2%). One patient required warm compresses for superficial phlebitis. No other significant adverse events were reported.

Conclusion: Intravenous administration of 2g of iron dextran corrects the anemia and repletes the iron stores for ≥1 year in most patients. This therapy is safe, tolerable, efficient, and effective.

The Benefits of IV Drip Treatments for Oncology Patients

IV Therapy for Oncology

IVC Protocol Vitamin C Research: The Riordan IVC Protocol for Adjunctive Cancer Care Intravenous Ascorbate as a Chemotherapeutic and Biological Response Modifying Agent

Cameron and Pauling observed fourfold survival times in terminal cancer patients treated with intravenous ascorbate infusions followed by oral supplementation (Cameron & Pauling, 1976). However, two randomized clinical trials with oral ascorbate alone conducted by the Mayo clinic showed no benefit (Creagan, et al., 1979; Moertel, et al., 1985). Most research from that point on focused on intravenous ascorbate.

Cancer patients tend to be depleted of vitamin C: fourteen out of twenty-two terminal cancer patients in a phase I study we depleted of vitamin C, with ten of those having zero detectable ascorbate in their plasma (Riordan, et al., 2005). This is shown in Figure 2. In a study of cancer patients in hospice care, Mayland and coworkers found that thirty percent of the subjects were deficiency in vitamin C (Mayland, et al., 2005). Deficiency (below 10 μM) was correlated with elevated CRP (c-reactive protein, an inflammation marker) levels and shorter survival times. Given the role of vitamin C in collagen production, immune system functioning, and antioxidant protection, it is not surprising that subjects depleted of ascorbate would fare poorly in mounting defenses against cancer. This also suggests that supplementation to replenish vitamin C stores might serve as adjunctive therapy for these patients.

When vitamin C is given by intravenous infusion, peak concentrations over 10 mM can be attained (Casciari, et al., 2001; Padayatty, et al., 2004) without significant adverse effects to the recipient. Figure 3 shows plasma ascorbate concentrations attained via IVC infusion at the Riordan Clinic, while Figure 4 shows pharmacokinetic data for two subjects given eighty minute IVC infusions. These peak plasma concentrations are two orders of magnitude above what is observed with oral supplementation. This suggests that IVC may be more effective than oral supplementation in restoring depleted ascorbate stores in cancer patients. Physicians at the Riordan Clinic have observed that (a) peak plasma concentrations attained after IVC infusions tend to be lower in cancer patients than in healthy volunteers, suggesting their depleted tissues act as a “sink” for the vitamin; and (b) in cancer patients given multiple IVC treatments, baseline plasma ascorbate concentrations tend to increase to normal levels slowly over time as reserves are restored with adequate IVC dosing.

In addition to providing ascorbate replenishment, IVC may allow oncologists to exploit some interesting anti-cancer properties, including high dose IVC’s ability to induce tumor cell apoptosis, inhibit angiogenesis, and reduce inflammation. In vitro and in vivo data supporting these potential mechanisms of action, discussed below, suggest that they may be relevant at ascorbate concentrations on the order of 2 mM. As shown in Figures 3 and 4, these concentrations are attainable in plasma using progressive dosing of IVC. A 2-compartment model can be used to predict peak and “average” (over 24 hours) plasma ascorbate concentrations for an average sized adult at a given IVC dose. This calculation suggests that a 50 gram, 1 hr. infusion would yield a peak plasma concentration of roughly 18 mM and an integral average of roughly 2.6 mM, a reasonable target for producing anti-cancer effects.

Peroxide-based Cytotoxicity Vitamin C, at normal physiological concentrations (0.1 mM), is a major watersoluble antioxidant (Geeraert, 2012). At concentrations on the order of 1 mM, however, continuous perfusion of ascorbate at doses that trigger “redox cycling” can cause a build-up of hydrogen peroxide, which is preferentially toxic toward tumor cells (Benade, et al., 1969; Riordan, et al., 1995; Casciari, et al., 2001; Chen, et al., 2005; Frei & Lawson, 2008), often leading to autophagy or apoptosis. To examine this cytotoxic effect in a three dimensional model, the RCRI employed hollow-fiber in vitro solid tumors (HFST). Figure 6 shows a histological section of colon cancer cells growing in this configuration. Dual staining annexin V and propidium iodide flow cytometry showed as significant increase in apoptosis, along with decreased surviving fractions, at ascorbate concentrations in the 1 mM to 10 mM range. Ascorbate concentrations required for toxicity in the HFST model (LC50 = 20 mM), with only two days incubation, were much higher than those typically observed in cell monolayers. The cytotoxic threshold could be reduced significantly (LC50 = 4 mM) by using ascorbate in combination with alpha-lipoic acid. Other reports suggest that ascorbate cytotoxicity against cancer cells can be increased by using it in combination with menadione (Verrax, et al., 2004) or copper containing compounds (Gonzalez, et al., 2002).

Inflammation Modulation

Analysis of clinical data from the Riordan Clinic suggests that inflammation is an issue for cancer patients, and that it can be lessened during IVC therapy (Mikirova, et al., 2012). C-reactive protein was used as a marker of inflammation, as reports in the literature indicate that elevated CRP is correlated with poor patient prognosis (St. Sauver, et al., 2009). Over sixty percent of analyzed Riordan Clinic cancer patients had CRP levels above 10 mg/L prior to IVC therapy. In 76 ± 13% of these subjects, IVC reduced CRP levels. This improvement was more prevalent, 86 ± 13%, in subjects with elevated (above 10 mg/L) CRP. Comparisons of individual values before and after treatments are shown in Figure 10A. Since many of the subjects in this database were prostate cancer patients, we examined prostate specific antigen (PSA) levels before and after therapy. This is shown in Figure 10B. Most of the prostate cancer patients showed reductions in PSA levels during the course of their IVC therapy. This was not true with other markers, as shown in Figure 10C. In some subjects, both tumor marker and CRP data were available both before and after IVC therapy. In those cases, there was a strong correlation (r2 = 0.62) between the change in tumor marker and the change in CRP during IVC therapy. This is consistent with observations from the literature showing a correlation between CRP levels and PSA levels in prostate cancer patients (Lin, et al., 2010).

The potential effect of IVC in reducing inflammation is also supported by cytokine data: serum concentrations of the pro-inflammatory cytokines IL-1α, IFN-γ, IL-8, IL-2, TNF-α and eotaxin were acutely reduced after a fifty gram ascorbate infusion, and in the case of the last three cytokines listed, reductions were maintained throughout the course of IVC therapy (Mikirova, et al., 2012).

A variety of laboratory studies suggest that, at high concentrations, ascorbate does not interfere with chemotherapy or irradiation and may enhance efficacy in some situations (Fujita, et al., 1982; Okunieff & Suit, 1987; Kurbacher, et al., 1996; Taper, et al., 1996; Fromberg, et al., 2011; Shinozaki, et al., 2011; Espey, et al., 2011). This is supported by meta-analyses of clinical studies involving cancer and vitamins; these studies conclude that antioxidant supplementation does not interfere with the toxicity of chemotherapeutic regiments (Simone, et al., 2007; Block, et al., 2008).

Case Studies

The situation with intravenous ascorbate therapy is different from that with new chemotherapeutic agents in that FDA approval was not strictly required in order for physicians to administer IVC. As a result, clinical investigations tended to run concurrently with laboratory research. Two early studies indicated that intravenous ascorbate therapy could increase survival times beyond expectations in cancer patients (Cameron & Pauling, 1976; Murata, et al., 1982). There have been several case studies published by the Riordan Clinic team (Jackson, et al., 1995; Riordan, et al., 1998; Riordan, et al., 1996) and collaborators (Padayatti, et al., 2006; Drisko, et al., 2003). While these case studies do not represent conclusive evidence in the same way that a well-designed Phase III study would, they are nonetheless of interest for comparing methodologies and motivating future research, in addition to being of monumental importance to the individuals who were their subjects.

•A 49 year old male with a bladder tumor (invasive grade 3/3 papillary transitional cell carcinoma) and multiple satellite tumors declined chemotherapy and instead chose to receive intravenous ascorbate. He received 30 grams twice weekly for three months, followed by 30 grams monthly for four years. Patient supplementation included botanical extract, chondroitin sulfate, chromium picolinate, flax oil, glucosamine sulfate, alpha-lipoic acid, lactobacillus acidophilus, L. rhamnosus, and selenium. Nine years after the onset of therapy, patient is in good health with no signs of recurrence or metastasis (Padayatti, et al., 2006).

•A 66 year old woman with diffuse Stage III large B-cell lymphoma with a brisk mitotic rate and large left paraspinal mass (3.5 – 7 cm transverse and 11 cm craniocaudal) showing evidence of bone invasion agreed to a five-week course of radiation therapy, but refused chemotherapy and instead chose to receive intravenous ascorbate concurrent with radiation. She received 15 grams twice weekly for two months, once per week for seven months, and then once every twothree months for one year. Patient supplementation included coenzyme Q10, magnesium, betacarotene, parasidal, vitamin B and C supplements, Parex and n-acetylcysteine. The original mass remained palpable after radiation therapy and a new mass appeared. Vitamin C therapy continued. Six weeks later, masses were not palpable. A new lymph mass was detected after four months, but the patient showed no clinical signs of lymphoma after one year. Ten years diagnosis, the patient remained in normal health (Padayatti, et al., 2006)

•A 55 year old woman with stage IIIC papillary adenocarcinoma of the ovary and an initial CA-125 of 999 underwent surgery followed by six cycles of chemotherapy (paclitaxel, carboplatin) combined with oral and parenteral ascorbate. Ascorbate infusion began at 15 grams twice weekly and increased to 60 grams twice weekly. Plasma ascorbate levels above 200 mg/dL were achieved during infusion. After six weeks, ascorbate treatment continued for one year, after which patient reduced infusions to once every two weeks. The patient also supplemented with vitamin E, coenzyme Q10, vitamin C, beta-carotene, and vitamin A. At the time of publication, she was over 40 months from initial diagnosis and remained on ascorbate infusions. All CT and PET scans were negative for disease, and her CA-125 levels remained normal (Drisko, et al., 2003).

•A 60 year old woman with stage IIIC adenocarcinoma of the ovary and an initial CA-125 of 81 underwent surgery followed by six cycles of chemotherapy (paclitaxel, carboplatin) with oral antioxidants. After six cycles of chemotherapy, patient began parenteral ascorbate infusions. Ascorbate infusion began at 15 grams once weekly and increased to 60 grams twice weekly. Plasma ascorbate levels above 200 mg/dL were achieved during infusion. Treatment continued to date of publication. The patient supplemented with vitamin E, coenzyme Q10, vitamin C, betacarotene, and vitamin A. Her CA-125 levels normalized after one course of chemotherapy. After the first cycle of chemotherapy, the patient was noted to have residual disease in the pelvis. At this point, she opted for intravenous ascorbate. Thirty months later, patient showed no evidence of recurrent disease and her CA-125 levels remained normal.

Note that these case studies involve a variety of cancer types, sometimes involve the use of IVC in conjunction with chemotherapy or irradiation, and usually involve the use of other nutritional supplements by the subject.

CONCLUSIONS

There are several potential benefits to giving IVC to cancer patients that make it an ideal adjunctive care choice:
• Cancer patients are often depleted of vitamin C, and IVC provides an efficient means of restoring tissue stores.
• IVC has been shown to improve quality of life in cancer patients by a variety of metrics.
• IVC reduces inflammation (as measured by c-reactive protein levels) and reduces the production of proinflammatory cytokines.
• At high concentrations, ascorbate is preferentially toxic to tumor cells and is an angiogenesis inhibitor.

The role of vitamin C in the treatment of pain: new insights

The vitamin C deficiency disease scurvy is characterised by musculoskeletal pain and recent epidemiological evidence has indicated an association between suboptimal vitamin C status and spinal pain. Furthermore, accumulating evidence indicates that vitamin C administration can exhibit analgesic properties in some clinical conditions. The prevalence of hypovitaminosis C and vitamin C deficiency is high in various patient groups, such as surgical/trauma, infectious diseases and cancer patients. A number of recent clinical studies have shown that vitamin C administration to patients with chronic regional pain syndrome decreases their symptoms. Acute herpetic and postherpetic neuralgia is also diminished with high dose vitamin C administration. Furthermore, cancer-related pain is decreased with high dose vitamin C, contributing to enhanced patient quality of life. A number of mechanisms have been proposed for vitamin C's analgesic properties. Herein we propose a novel analgesic mechanism for vitamin C; as a cofactor for the biosynthesis of amidated opioid peptides. It is well established that vitamin C participates in the amidation of peptides, through acting as a cofactor for peptidyl-glycine α-amidating monooxygenase, the only enzyme known to amidate the carboxy terminal residue of neuropeptides and peptide hormones. Support for our proposed mechanism comes from studies which show a decreased requirement for opioid analgesics in surgical and cancer patients administered high dose vitamin C. Overall, vitamin C appears to be a safe and effective adjunctive therapy for acute and chronic pain relief in specific patient groups.

Recent epidemiological evidence has indicated an association between spinal pain and suboptimal vitamin C status [6]. Musculoskeletal pain is also a symptom of the vitamin C deficiency disease scurvy [7]. Furthermore, accumulating evidence indicates that vitamin C administration can exhibit analgesic properties in some clinical conditions. In this review we focus on human studies investigating the role of vitamin C in orthopedic, virus-associated, cancer-related, and postsurgical pain.

Vitamin C has a number of important functions in the body, primarily through acting as a cofactor for a family of biosynthetic and regulatory metallo-enzymes. These functions include synthesis of neurotransmitters and peptide hormones, and regulation of transcription factors and gene expression [9, 10]. We cover the potential analgesic mechanisms of vitamin C and propose a novel analgesic mechanism involving the biosynthesis of amidated opioid peptides.

Vitamin C deficiency and scurvy has been reported to occur in elderly hospitalized patients [25, 26], critically ill patients [18, 27, 28], and cancer patients [29]. Hospitalized patients, in general, are more likely to present with hypovitaminosis C (defined as plasma vitamin C concentrations <23 μmol/L), and a higher proportion of hospital patients exhibit deficiency compared with the general population [20, 21]. Trauma and surgery are known to significantly deplete vitamin C concentrations [22], and patients with severe infections and sepsis also have significant depletion of vitamin C [23]. Cancer patients typically have lower vitamin C status than healthy controls [30, 31], with a large proportion of them presenting with hypovitaminosis C and outright deficiency.

Vitamin C deficiency has been associated with spinal pain, primarily neck, lower back and arthritis/rheumatism [6]. The vitamin has been shown to exert a number of regulatory effects on cells of the skeletal system, including osteogenic, chondrogenic and osteoblastogenic [42]. A number of randomized controlled trials have investigated the effect of vitamin C supplementation on the incidence of CRPS in wrist and ankle surgery patients (Table 1) [43–47]. Doses of vitamin C used in these studies ranged from 0.2 to 1.5 g/day for 45– 50 days post-surgery. All studies, but one [43], showed a decreased incidence of CRPS in the patients receiving vitamin C, with vitamin C doses ≥0.5 g/day being the most efficacious [44]. Previous research has indicated that surgical patients have high vitamin C requirements and supplementation with >0.5 g/day vitamin C is required to restore normal vitamin C status in these patients [22]. The results of these studies have been pooled in various combinations in a number of recent meta-analyses [48–52] and all, but one [50], concluded that the evidence indicates that daily administration of vitamin C can decrease the incidence of CRPS following distal fracture surgery. We have shown a complete decrease in pain in a patient with rheumatoid arthritis following administration of twice weekly infusions of high-dose vitamin C [56]. This data suggests that vitamin C may be more effective for the pain associated with rheumatoid arthritis than osteoarthritis, or that intravenous administration of the vitamin may be more effective than oral administration in patients with arthritis. It is noteworthy that the average vitamin C status of patients with rheumatoid arthritis is less than half that of healthy controls (i.e. 27 ± 13 versus 70 ± 21 μmol/L, respectively) [57]. Paget’s disease of bone is a chronic disorder caused by the excessive breakdown and formation of bone and disorganized bone remodeling which results in bone weakening, misshapen bones, fractures, arthritis, and pain. An early study in 16 patients with Paget’s disease of bone showed that oral doses of 3 g/day vitamin C for 2 weeks decreased pain in 50% of the patients and resulted in a complete elimination of pain in 20% of the patients [58].

Vitamin C and virus-associated pain

Infection with viral pathogens is commonly associated with myalgia, arthralgia or neuralgia [60]. Herpes zoster infection (shingles) results in a painful skin rash which generally lasts 2–4 weeks. However, some people develop ongoing nerve pain, a condition known as postherpetic neuralgia, which may last for months or years and is due to nerve damage or alterations caused by the virus in discrete dermatomes. Pain can be mild to extreme in the affected dermatome, and can include sensations of burning pain, itching, hyperesthesia (oversensitivity), or paresthesia (tingling, pricking, or numbness, ‘pins and needles’) [61, 62]. Analysis of the nutrient status of 50 patients with postherpetic neuralgia indicated significantly lower circulating concentrations of vitamin C compared with 50 healthy controls (i.e. 30 ± 21 versus 76 ± 31 μmol/L, respectively) [63]. More than 50% of the patients had hypovitaminosis C (i.e. <23 μmol/L) and vitamin C concentrations ≤45 μmol/L were found to independently increase the risk of post-herpetic neuralgia (adjusted OR 21; 95% CI 6, 76; P < 0.001). A number of case studies have indicated that both acute and postherpetic neuralgia can be dramatically decreased following intravenous vitamin C infusions (2.5–15 g daily or every other day for 5–14 days) [64–67]. In an uncontrolled follow-up study, Schencking et al. recruited 64 patients with Herpes Zoster who were subsequently administered 7.5 g intravenous vitamin C two to four times a week for a total of 2 weeks [68]. Baseline pain was reported to be 58% (as determined by VAS), which decreased to 22% within 2 weeks and this had decreased to 6% at 12 week follow-up. Overall, there was a decrease in pain for 92% of the patients. The lack of a control group is a major limitation of this study.

Vitamin C and cancer-related pain

Pain is one of the most common symptoms reported by cancer patients, and can seriously affect their quality of life [76]. Pain associated with cancer can be related to the primary tumour, cancer treatment, associated procedures and as a consequences of disease progression and metastasis. Furthermore, cancer pain may include several types of pain and pain features occurring concurrently as mixed pain, such as nociceptive, neuropathic, and bone pain [3]. Cancer-associated pain resulting from metastasis to bone is a severe and complex condition comprising neuropathic, nociceptive and inflammatory pain [77, 78]. As mentioned above, cancer patients typically have depleted vitamin C status [30–32] as well as higher requirements than healthy controls [37], which could potentially be exacerbated by anti-cancer therapies [38–40]. High dose oral and intravenous vitamin C has been administered to cancer patients for many decades as a complementary and alternative therapy [79]. Although the efficacy of vitamin C as a cancer treatment is questionable, recent research has indicated a positive impact of high dose vitamin C on cancer- and chemotherapy-related quality of life, including pain [80]. Early studies of high dose vitamin C in patients with advanced cancer indicated that many patients experienced some improvement in subjective symptoms, including decreased pain and the need for analgesics [81, 82]. Cameron and Campbell [81] reported a number of cases of dramatic to complete amelioration of bone pain in patients with severe cancer-related pain given both high dose oral and intravenous vitamin C (Table 3). Retrospective studies of patients with bone metastases receiving 2.5 g intravenous vitamin C once weekly or during intensifying pain reported a range of responses, including 0–100% decreases in pain [83, 84]. These, and the earlier case studies [81], indicate that vitamin C can potentially provide dramatic improvements in pain relief in cancer patients with bone metastases. Two prospective studies of patients with advanced cancer who were administered intravenous vitamin C at doses of 10–100 g vitamin C (twice a week) have shown 30–44% decreases in pain using the EORTC pain scale within 1–4 weeks. Yeom et al. [88] recruited 39 patients with terminal cancer who subsequently received 10 g intravenous vitamin C twice weekly for 1 week, followed by 4 g/day oral vitamin C for 1 week. Patients exhibited 30% pain at baseline (as measured by the EORTC-QLQ) and this decreased by onethird following vitamin C infusion (P = 0.013). Takahashi et al. [89] recruited 60 patients with advanced cancer who received 25–100 g intravenous vitamin C twice weekly for 4 weeks. Baseline pain in this cohort was 18% and this decreased by 44% following vitamin C infusion.

Cancer-related pain is typically managed with opioids [92]. In the early 1970s Cameron and Pauling [93] described dramatic decreases in opiate dependence in five patients with advanced cancer following high dose vitamin C administration. These patients were in considerable pain due to skeletal metastases and were receiving large regular doses of opiate analgesics (morphine or diamorphine). Within five to seven days of commencing vitamin C, four of the five patients became completely free from pain, and the fifth required only mild analgesics [81]. Several of these cases are summarized in Table 4. Interestingly, none of the patients experienced any withdrawal symptoms despite having received opiate analgesia for periods of weeks or months, nor did they request that their opiate regime be continued. It is interesting to note that vitamin C (at a dose of 300 mg/kg body weight/day for 4 weeks) has been shown to dramatically decrease the major withdrawal symptoms of heroin addicts compared with a control group who were treated with conventional medication only [94]. A complete decrease in morphine requirement was also observed in a patient with terminal cancer undergoing 30 g/day vitamin C infusion for palliative care [95]. Murata et al. [82] reported a dose-dependent decrease in opioid requirement in patients with terminal cancer who received vitamin C. In those who received 0.5–3 g/day vitamin C, 50% of the patients required opioid drugs, whereas only 17% of those who received 5–30 g/day vitamin C required opioids, compared with 79% in the control group (Table 4). A recent study failed to confirm a decrease in opioid requirement in 17 patients with a range of malignancies [96], however, the study lasted for only 3 days and the vitamin C dose was lower than in studies that reported positive findings (Table 4). Three recent placebo-controlled trials have been carried out to investigate the effect of vitamin C on opioid requirement for postoperative pain, two using intravenous vitamin C [97, 98] and one using oral vitamin C [99]. In the most recent, 97 patients undergoing laparoscopic colectomy for colon cancer were randomized to receive intravenously 50 mg vitamin C per kg body weight or placebo infused immediately after induction of anaesthesia (Table 4). A decrease in postoperative morphine consumption was observed at 2 h (P < 0.05) in the vitamin C group, as well as a decreased frequency of rescue analgesia (P < 0.01), and decreased pain at 2, 6 and 24 h post-surgery as assessed by the numeric pain rating scale (P < 0.05). In the other study, 40 patients undergoing uvulopalatopharyngoplasty with tonsillectomy, which is normally associated with intense postoperative pain, were randomized to receive intravenously either 3 g vitamin C or placebo 30 min into the surgery (Table 4). A decrease in post-operative pethidine dose was recorded for the vitamin C group compared with the placebo group (5 vs 46 mg, P = 0.0001), as well as a delay in the time of first dose of pethidine use (12 vs 3 h, P = 0.003), and a decline in the total number of times pethidine requested was requested (0.2 vs 1.3 times, P = 0.001). Visual analogue scale scores were also lower in the vitamin C group at all time points assessed (recovery, 6, 12, 24 h, P = 0.001). Opioid-based analgesics are typically used for postoperative analgesia, however these may complicate care by causing excessive sedation and respiratory depression. In contrast, no side effects were observed with the vitamin C treatment.

In an earlier study, a single oral dose of 2 g vitamin C or placebo was given to 80 randomised cholecystectomy patients 1 h prior to anesthesia (Table 4). Postoperative morphine consumption and verbal numerical rating scale scores for incisional pain were recorded for 24 h. Morphine consumption was lower in the vitamin C group versus the placebo group (16 vs 23 mg, P = 0.02) and, despite the lower opioid usage in the vitamin C group, there was no difference in reported pain intensity or side effects between the two groups [99].Vitamin C is a potent antioxidant [108] which can scavenge a wide range of reactive oxygen species and, thus, is capable of protecting cells and tissues from oxidative damage [109]. Vitamin C also exhibits anti-inflammatory properties, providing marked decreases in markers of inflammation such as C-reactive protein and pro-inflammatory cytokines, e.g. tumor necrosis factor, interferon, and interleukins [110]. Depletion of vitamin C during acute or chronic disease or trauma could contribute to pain symptoms due to sub-optimal biosynthesis of analgesic neurotransmitters and neuropeptide hormones. The observation that vitamin C administration significantly decreases the requirement for opioid analgesics (Table 4) lends support to this hypothesis.

IN CONCLUSION

Acute and chronic pain can be debilitating for patients, particularly if not adequately managed by conventional analgesics. Accumulating evidence indicates that vitamin C can exhibit analgesic properties in some clinical conditions, thus potentially mitigating suffering and improving patient quality of life. Pain is costly because it requires medical treatment, complicates treatment of other conditions and results in lost productivity. In the USA the annual cost of pain was greater than the annual costs of heart disease, cancer, and diabetes [132]. Vitamin C is cost effective and appears to be a safe and effective adjunctive therapy for specific pain relief.

Intravenous High-Dose Vitamin C in Cancer Therapy
NATIONAL CANCER INSTITUTE

The discovery and isolation of vitamin C was one of the most important advances in improving human nutrition. Scurvy, a severe vitamin C deficiency disease characterized by weakness, lethargy, easy bruising and bleeding, was particularly problematic for sailors on long voyages during the 16th century, where access to fresh fruits and vegetables was limited. In fact, scurvy was the leading cause of naval deaths between the 16th and 18th centuries, killing more sailors than all battles, storms and other diseases combined. It wasn’t until 1747 that Scottish naval physician James LindExit Disclaimer demonstrated that consuming oranges and lemons cured and prevented scurvy. However, it took scientists nearly two more centuries to identify the nature of the curative substance contained in citrus fruits, now commonly known as vitamin C. The search for this elusive substance ended in 1932 when Albert Szent-GyorgyiExit Disclaimer, a Hungarian biochemist, isolated and identified a 6-carbon carbohydrate, hexuronic acid, as the anti-scurvy factor. Shortly thereafter, Szent-Gyorgyi renamed it “a-scorbic acid”, a reference to its anti-scorbutic properties, and later went on to receive the Nobel Prize in Physiology and Medicine in 1937 for his discoveries.

However, it is worth noting that a significant number of people even in developed countries are still vitamin C deficient. For example, approximately 7% of the US population has a plasma vitamin C concentration of less than 11 μM, that is considered scurvy. Vitamin C has many essential functions in our body in addition to its wellknown role as an antioxidant. Thus, prolonged periods of sub-optimal vitamin C exposure could have adverse health effects, including an increased susceptibility to a plethora of diseases.

Nearly 60 years ago Toronto physician William McCormick observed that cancer patients often presented with severely low levels of vitamin C in their blood and featured scurvy-like symptoms, leading him to postulate that vitamin C might protect against cancer by increasing collagen synthesis. In 1972, extending this theory, Ewan Cameron, a Scottish surgeon, hypothesized that ascorbate could suppress cancer development by inhibiting hyaluronidase, which otherwise weakens the extracellular matrix and enables cancer to metastasize. He began treating terminally ill cancer patients and published a case report of 50 patients in which some of the treated patients benefited from high dose vitamin C.

Nearly 60 years ago Toronto physician William McCormick observed that cancer patients often presented with severely low levels of vitamin C in their blood and featured scurvy-like symptoms, leading him to postulate that vitamin C might protect against cancer by increasing collagen synthesis. In 1972, extending this theory, Ewan Cameron, a Scottish surgeon, hypothesized that ascorbate could suppress cancer development by inhibiting hyaluronidase, which otherwise weakens the extracellular matrix and enables cancer to metastasize. He began treating terminally ill cancer patients and published a case report of 50 patients in which some of the treated patients benefited from high dose vitamin C. In 1976, they published a study of 100 patients with terminal cancer treated with ascorbate. Their disease progression and survival rates were compared to 1000 retrospective control patients who were matched with the vitamin C-treated patients regarding age, sex, type of cancer and clinical stage and who were treated by the same physicians in the same hospital, and in the same way except that they did not receive vitamin C.

The results demonstrated that patients treated with vitamin C had improved quality of life and a four-fold increase in their mean survival time. In a follow up study, Cameron and Pauling reported that 22% of vitamin C-treated cancer patients survived for more than one year compared to only 0.4% of control patients. A clinical trial in Japan independently showed a similar result.

Virtually all studies show improved quality of life for cancer patients by minimizing pain and protecting normal tissues from toxicity caused by chemotherapy. Additionally, vitamin C showed synergistic effects when combined with radiation and standard chemotherapies.

GLUT1 not only transports glucose but also transports dehydroascorbic acid (DHA), the oxidized form of vitamin C. Subsequently, we observed that CRC cells harboring KRAS or BRAF mutations uniquely increased uptake of DHA via GLUT1 when treated with vitamin C. The increased DHA uptake in mutant cells produced oxidative stress, increasing the level of reactive oxygen species (ROS) in cells because intracellular DHA was rapidly reduced back to vitamin C at the expense of glutathione (GSH), a master antioxidant in cells. In turn, we found that elevated ROS activated poly (ADPribose) polymerase (PARP), a DNA repair enzyme, consuming large amounts of cellular NAD+ as its cofactor. The depletion of NAD+ resulted in the inactivation of glyceraldehyde 3-phosphate dehydrogenase (GAPDH) because GAPDH requires NAD+ as a cofactor. Inhibiting GAPDH in highly glycolytic KRAS or BRAF mutant cells ultimately led to an energy crisis and cell death not seen in their KRAS and BRAF wild-type counterparts. Finally, we showed that high-dose vitamin C therapy reduced both the number and size of tumors in KRAS or BRAF mutant mice as compared to mice without these mutations, confirming that vitamin C selectively targets KRAS or BRAF mutant tumors in mouse models of colon tumors. In short, ascorbate functions as a “Trojan horse” through its conversion to DHA, and insidiously enters cancer cells via GLUT1 to promote the generation of intracellular ROS, which ultimately kills the cancer cell.

Vitamin C may be benefit other types of tumors. For example, 90% of pancreatic cancers and approximately 30% of lung cancers have KRAS mutations. These KRAS mutant tumors also have high GLUT1 expression and are linked to altered glucose metabolism similar to CRC. Therefore, high dose vitamin C may benefit other types of tumors harboring KRAS/BRAF mutations. Based on these results, Weill Cornell Medicine is currently conducting a Phase II clinical trial to examine the effects of intravenous high dose vitamin C in the treatment of KRAS-mutant cancers, and Sun Yat-sen University Cancer Center in China are conducting placebo-controlled, randomized Phase III clinical trials in colorectal cancer patients in combination of chemotherapy.

Now a growing number of preclinical studies are showing how high-dose vitamin C might benefit cancer patients. Importantly, these preclinical studies provide a clear rationale and potential biomarkers that may help personalize the therapeutic approach and identify patient populations that are likely to respond to high-dose vitamin C therapy. Since the mechanisms of action of vitamin C are becoming better defined, we can propose vitamin C combinations in a more rational, hypothesis-driven manner. In addition, given the current high financial cost of new cancer drugs, it seems rational to improve the effectiveness of current therapies by studying their clinical interactions with vitamin C. In our view, the implementation of this treatment paradigm could provide benefit to many cancer patients.

This work was supported by the US National Institutes of Health (NIH) grant (R35 CA197588), Stand Up to Cancer–American Association for Cancer Research grant (SU2C-AACR-DT22-17), and the Damon Runyon Cancer Research Foundation. Lewis Cantley is a founder and member of the senior advisory boards of Agios Pharmaceuticals and Petra Pharmaceuticals, which are developing novel therapies for cancer. The Cantley laboratory also receives financial support from Petra Pharmaceuticals.

The Benefits of IV Drip Treatments for

Gastrointestinal Health

Until recently, the gastrointestinal tract was largely ignored by Western medicine. It was thought it was simply the place where nutrients were digested. However, recent research has shown that maintaining a healthy gut is essential to overall health. In fact, the intestinal tract plays a key role in so many biological process it’s hard to list them all. Here are but a few examples:

1. Digestion of food into small particles

2. Absorption of critical nutrients like amino acids, carbohydrates, fats and minerals

3. Elimination of waste products such as heavy metals via bile

4. Immune function—the intestinal tract is the LARGEST immune organ.

5. Barrier function—keeping out bacteria, viruses and fungi as well as other toxic substances from being absorbed. This is compromised in conditions such as IBD, IBS and “leaky gut.”

6. Inflammation—due to it’s intimate relationship in immune function and it’s regulation of foreign substances from crossing into our blood stream, the gut plays perhaps THE key role in inflammation.

Put simply, if your gut is out of balance, you cannot achieve optimal health.

Zinc and L-glutamine both reduce intestinal permeability (“leaky gut”) closing the tight-junctions between intestinal cells and thus protecting us from over-activating our immune systems and setting off inflammation. LArginine is included in this IV because it raises the levels of IGF-1 (the active form of Growth Hormone) a critical component in maintaining “Occludin” integrity, a protein which “seals” the space between intestinal cells preventing “leaky gut.” The other ingredients are antioxidants like vitamin C and glutathione which are important protectors of the mucous layer and cells of the intestinal tract, shielding against the damage done from intestinal inflammation.

Our IV was designed to enhance the proper function of the intestinal tract by adding elements like L-glutamine which is an important source of energy for the cells of the intestinal tract. Zinc and L-glutamine both reduce intestinal permeability (“leaky gut”) closing the tight-junctions between intestinal cells and thus protecting us from overactivating our immune systems and setting off inflammation. Antioxidants like vitamin C and glutathione are important protectors of the mucosa and cells of the intestinal tract shielding against the damage done from intestinal inflammation. All of these vitamins and minerals are brought together in one IV to help kick start the healing process for your gut.

After our skin, the intestinal tract is the major interface between us as human beings and the outside environment. Starting at the mouth and ending at the rectum and anus, the intestinal tract is a “tube” than runs through our bodies and helps us break down food, absorb nutrients like amino acids, fats, carbohydrates, vitamins and minerals, and eliminate waste.

The intestinal tract also houses billions of bacteria, viruses and fungi (collectively known as the gut microbiome) which need to be kept separate from “us” otherwise they would cause certain death. This barrier function of the gastrointestinal (GI) tract is just as important as its other functions. In fact, the GI tract happens to be the largest, most important part of our immune system.

The first layer of cells in the GI tract form the “mucosa”. These cells sit very close one another forming “tight junctions” to prevent foreign organisms or substances from entering our bodies. They also secrete a protective mucous layer and IgA’s which are protective antibodies for the same purpose.

Deeper within the wall of the intestines the immune system is housed in the form of lymph nodes in what is called the Gut Associated Lymphatic Tissue (GALT). The deeper levels of the intestinal walls also content the Enteric Nervous System (ENS) which is a nervous system dedicated to the gut itself and is only partially controlled by Central Nervous System (CNS).

Many factors can affect the integrity of this intestinal barrier, wear down the mucous protection, decrease IgA production and finally break down the “tight junctions” between the cells of the intestinal tract making them permeable to substances. When this happens even whole bacteria and viruses can “leak” through the gut lining into your blood stream which is not desirable. This phenomenon is called “increased intestinal permeability”, and it is commonly referred to as “leaky gut”.

When you have a leaky gut, your immune system is exposed to foreign materials, toxins and organisms which triggers the immune system to attack using powerful inflammatory compounds. This can set off a tragic downward spiral where the gut becomes more permeable, systemic inflammation takes off like a fire in a forest, and your “leaky gut” gets worse.

Re-establishing a healthy gut mucosa is integral to health, nutrient absorption and a normally functioning immune system. The ingredients in this IV have been shown to help in this process.

L-glutamine is an important energy source for the cells of the intestinal mucosa and is conditionally essential for normal mucosal structure and function. Glutamine appears to be required for normal production of secretory immunoglobulin A (IgA) in the intestines. Secretory IgA is the most abundant immunoglobulin in external secretions and is central to the normal function of the intestinal mucosa as an immune barrier. Glutamine also seems to help maintain gut mass and protect intestinal barrier function against bacteria and may be essential to survival during critical illness in humans.

Research has shown that the addition of Lglutamine to total parenteral nutrition TPN (IV nutrition for the critically ill) prevents pathologic increase in intestinal permeability in humans. A 1993 controlled study in 20 randomly assigned hospital inpatients compared the effects of standard total parenteral nutrition (STPN) to glutamine-enriched total parenteral nutrition (Gln-TPN). Investigators concluded that supplementation of TPN with glutamine prevented deterioration of gut permeability and preserved mucosal structure.

Glutamine-enriched TPN also preserves Gut Associated Lymphoid Tissue (GALT) function and intestinal IgA levels in animal studies. A 2005 controlled animal study showed that glutamine added to the diet led to a significant reduction of increased intestinal permeability and bacterial translocation in experimental biliary obstruction. In a 2015 study glutamine was also shown to restore the tight junction proteins between intestinal cells in diarrhea dominant IBS (1-8).

Zinc—also included in this IV—is a mineral with many important functions in metabolism. For example, it seems to help control intestinal permeability. In a 2015 study of children admitted to the hospital with gastroenteritis (diarrhea) those given hydration fortified with zinc had greatly improved intestinal permeability (9)

It is likely that in mucosal damage and inflammation the cells of the intestine are faced with increased oxidative stress and antioxidant depletion, making antioxidants such as vitamin C and glutathione useful in treatment. A 1995 study in patients with IBD showed significantly decreased levels of vitamin C in mucosal tissues compared to non-IBD controls. (10). Studies have also shown that the intestinal layer of patients with active Ulcerative Colitis (UC) were low in trace minerals like zinc, iron and selenium as well as in glutathione peroxidase signifying a tissue antioxidant deficiency versus those with inactive UC (11).

Supporting the Treatment of GI Disease with IV Therapy

The current Merck Manual lists 14 main gastrointestinal disorders, with up to 14 subdivisions within each of the principle groupings (Beers, 2006). Add to this the finding that many other disease states affect the gastrointestinal tract significantly, and both give us a strong reminder that our gut has a major influence on our health. Intravenous (IV) therapy can be a useful adjunct to the oral treatment of gastrointestinal diseases.

By the time symptoms of disease have made their appearance, it is sometimes too late for oral vitamins and minerals to make much difference. Nevertheless, these same vitamins and minerals, given intramuscularly (IM) or intravenously, can benefit many diseases.

We know that the health of the GI tract affects the overall health of all body functions and the well being of every individual. We approach the problem of disease as a problem of the cell. What the cell needs to be maximally healthy is always found in nature. However, to be effective, these nutrients must be admitted into the cell.

When given in high concentration, IV or IM nutrients enter the cell by sheer force of numbers. Administering nutrients in a concentration great enough to force those nutrients into the cell by means of a high-concentration gradient and the ability of the cell wall to absorb without expending its energy on active transport is highly beneficial. Highly concentrated on the outside, the semipermeable cell membrane admits the nutrients into the cell due to the high-concentration gradient that has been created.

The only way to obtain this high concentration is by IV or IM administration. With the GI cells, we observe that the transport and absorption cannot occur fast enough to have a high-concentration gradient for the remainder of the body. The IV route is especially useful for this purpose, because little time is required for absorption from an injection site as within a muscle. When oral absorption is not effective, the parenteral route proves most beneficial.

Case Study #1

A 59-year-old female presented with an acute flare-up of chronic diverticulitis. She was first diagnosed nine years ago and typically had acute flare-ups every 4-6 months, but recently the recurrences had been more frequent. She was hospitalized in 2002 for a particularly severe episode. Her last doctor visit was two weeks prior to this visit and she was prescribed antibiotics for 10 days, during which time probiotics were taken between antibiotic doses.

Physical examination revealed moderate tenderness in her LLQ. Vital signs were within normal limits.

Prevention and treatment rationale: IV therapy to treat current infection. A whole-food, high-fiber diet with sufficient water intake helps prevent the occurrence of diverticulosis. Exercise is also a valuable preventive. The frequency of diverticulitis episodes can be lessened by avoiding substances that contribute to bowel inflammation, such as processed foods or foods one is sensitive to, and by eating foods and taking supplements that are soothing and anti-inflammatory to the gut.

IV therapy to help eliminate infection was administered in-clinic. The protocol used included 15g ascorbic acid, 10mg zinc sulfate, 400μg selenium, 1000mg calcium as 10mL calcium gluconate, 1000mg magnesium sulfate and 1mL B-complex; the nutrients were added to a 500mL bag of 0.45% saline and administered over two hours.

Oral treatment was started immediately using the following supplements:

• A fortifying supplement to support overall GI function, 1 scoop 2- 3 times daily until symptoms resolve. Product includes fiber and herbs that are soothing and healing for the bowel (psyllium powder, flax seed powder, L-glutamine, DGL, marshmallow root, unripe plantain, slippery elm and fruit extracts).

• Cod liver oil, 2Tbsp daily until asymptomatic, 1Tbsp daily as maintenance. Cod liver oil is an anti-inflammatory and facilitates healing.

• Ginger tea, 2-3 cups daily. Either grate fresh ginger into a cup of hot water or use commercially available ginger tea bags. Ginger is anti-inflammatory and improves digestion.

A follow-up phone call was made two days later, and the patient stated that she felt 70% better and had cancelled her appointment with the gastroenterologist.

She came in the following day for a follow-up IV therapy infusion using the same protocol. After two weeks she was experiencing no symptoms. Over the following three months she felt well and used the fortifying supplement whenever mild symptoms returned. The patient was then put on a maintenance program with preventive measures.

Case Study #2

A 27-year-old female presented with ulcerative colitis and extreme fatigue of two years’ duration. Symptoms came on abruptly while in daily swim practice in 2005. Previous to illness, the patient was pursuing law school and swimming up to five hours a day. In the past two years, she had been to four gastroenterologists and had undergone upper and lower GI studies with biopsy, which revealed marked inflammation and colitis in the large intestine and inflammation of the esophagus consistent with reflux; final comment, “However, infectious etiologies should be excluded.” Medications of mesalamine, bupropion hydrochloride, escitalopram oxalate and prednisone were initiated two months prior to her visit in our clinic. At a previous visit with an ND, GI health and thyroid panels were done. She was referred for EAV testing to assess food intolerances and IV therapy to address fatigue. Patient was receiving acupuncture for pain in the LUQ of the abdomen and reported the therapy to be “very helpful.” Upon presentation to us, the patient was obviously quite fatigued; lethargic; very pale; and exhibiting slight, uncontrollable muscle tetany, which she reported as a new symptom. Other symptoms included bloating, episodes of bloody diarrhea, excessive sleeping, night sweats, activities of daily living significantly affected by fatigue, anxiety, depression and recurrent UTIs. She also reported a fever of 100 degrees Fahrenheit (F) for the past year. She was unable to work, continue her education or be physically active, and ultimately had to move in with her mother to be cared for. Her past medical history included cholecystectomy for unknown reasons. IV therapy to address fatigue, malnutrition and lack of absorption was administered. The protocol included 500mg dexpanthenol, 200mg pyridoxine, 10mg hydroxocobalamin, 200mg B-complex, 1g vitamin C, 100mg calcium gluconate, 800mg magnesium chloride, 149mg (2mEq) potassium chloride, 400μg selenium, 200mg germanium, 10mg zinc and 20mg folate. All nutrients were added to 500mL of 0.45% saline and administered over two hours. The patient’s fatigue decreased moderately with weekly IV therapy. Adrenal insufficiency was suspected, and an Adrenal Stress Index (ASI) was ordered. Previously ordered blood work showed a normal TSH, normal free T4 and slightly lowered free T3 – presumably from the two years of illness. Ferritin was also low. The patient was placed on the following supplements per previous doctor: Iron citrate 25mg bid and glandular thyroid replacement (1/4grain before food in the morning), which she discontinued after some weeks, as she felt no improvement. She also began eliminating offending foods determined by EAV testing from her diet. Within three weeks, the ASI showed normal to elevated adrenal function. However, the GI panel showed significant infection and dysbiosis. Organisms included light Candida albicans growth; moderate yeast on stool culture; moderate Enterococcus species; positive toxoplasma Ab (SIgA); borderline H. pylori Ab (SIgA); detected levels of Ascaris lumbricoides andT. solium; lowered total intestinal SIgA (stool); elevated intestinal lysozyme; significantly elevated alpha anti-chymotrypsin; lowered chymotrypsin; and positive antibodies for milk, soy and gliadin. The patient continued weekly IV therapy and was immediately started on the following oral supplements: 1. A product that includes berberine, gentian root, black walnut hull extract, sweet wormwood and other botanicals, 2 caps tid between meals. This is proven to exhibit activity against many intestinal organisms. 2. Lipotropic product, 2 caps tid with meals. It includes liver supportive herbs, nutrients and bile salts to assist the body in dealing with any die-off reactions and to support the body in further detoxification. 3. Product containing plant enzymes, 2 caps with meals. This product assists with decreased pancreatic output. 4. Intestinal repair powder, 2 tsp tid with meals. Comprised of mucilaginous herbs, amino acids and enzymes, it supports intestinal healing, decreases inflammation and restores GI structure. 5. A hydrolyzed fish protein concentrate, 2 caps tid between meals. This concentrate is for intestinal health. At a follow-up appointment one week later, the patient was feeling significantly better. Her pallor was diminished, her lethargy was markedly decreased and she stated that she felt her life had been given back to her. Within three weeks she was no longer exhibiting GI symptoms. Other than waves of flu-like symptoms as Herxheimer reactions occurred, she reported feeling better than she had in years. “It’s like death and life.” Bloating was absent; sleep hours had regulated; ulcerative colitis episodes had not occurred “in weeks”; and bowel movements were well formed and had increased to 2-3/day (up from one episode of diarrhea daily). The patient had begun light exercise and was able to participate in activities of daily living once again. Recent lab work showed a lowered serum 25,OH vitamin D of 43ng/mL initiating emulsified vitamin D, dosed at 10,000 IU/day for 1 month as well as a multi-vitamin, 2 caps tid. At a follow-up appointment one month later: serum lab testing to assess ferritin, serum vitamin D, CBC, CMP, thyroid function and GI health panel.

The Benefits of IV Drip Treatments for Arthritis, Chronic Joint Pain, & Inflammation

IV Therapy for Arthritis

Our knowledgeable team employs IV therapy and other non-surgical, state-of-the-art holistic treatments to ease pain and improve overall quality of life. IV therapy delivers nutrients the body needs to help heal arthritis pain. Options include:

1. Nutrients to enhance healing and reduce pain.

2. Decrease inflammation.

Benefits of IV Therapy

IV therapy can slow the disease’s progression. You may notice less pain and fatigue after just a few sessions. Our doctors also use IV therapy to build up your immune system, increase energy, and reduce stress.

IV therapy offers an array of health benefits, as it delivers nutrients and electrolytes straight into your bloodstream much faster than oral supplements. Nutrients can be absorbed quickly without concern for low stomach acid or lack of digestive enzymes, which can reduce the absorption of oral supplements.

In addition to pain relief, IV therapy may enhance your overall health. It can help:

- Strengthen your immune system

- Increase energy and lessen fatigue

- Improve athletic performance

- Reduce stress

- Improve your skin quality

- Assist weight loss

- Speed healing following an injury or surgery

Rheumatoid arthritis (RA) is a major inflammatory joint disease that causes cartilage destruction, bone erosions, and joint destruction. In severe cases, it can also lead to rheumatoid nodules, vasculitis, heart disease, long disease, anemia, and peripheral neuropathy.

The Riordian clinic has long been interested in the use of ascorbic acid (Vitamin C) at millimolar concentrations to treat illnesses associated with inflammation, including cancer, atherosclerosis, and viral infections. At high doses, vitamin C has been shown to reduce the production of proinflammatory cytokines. Ascorbic acid has other properties that suggest it may be useful in treating rheumatoid arthritis: it is an antioxidant that scavenges ROS and it supports collagen formation and enhances extracellular matric protein synthesis. RA patients tend to be vitamin C deficient and require high supplementation doses required to maintain plasma ascorbic acid levels.

“Based on the properties of ascorbic acid to reduce oxidative stress, decrease production of proinflammatory cytokines, and suppress the activation of pro-inflammatory nuclear factors, we analyzed the effect of intravenous millimolar concentration of ascorbic acid in RA treatment. The rheumatoid arthritis patients in this study were characterized by moderate to high levels of the inflammation marker CRP accompanying moderate to severe discomfort levels. The effect of intravenous vitamin C (IVC) treatment on subjects with RA demonstrated that IVC therapy with dosages of 7.5 g-50g can reduce inflammation and the pain levels. The inflammation as measured by Creactive protein levels was decreased on average by 44 %. The average CRP level before treatment was 9.4 +/- 4.6 mg/L, while the average after IVC therapy was 6.4 +/- 4.6 mg/L. Examining those subjects who showed a net CRP decrease, we found that the effect of treatment is IVC frequency dependent. Based on this pilot study, it is hypothesized that IVC therapy is a useful strategy in treating RA.” "Effect of high-dose intravenous ascorbic acid on the level of inflammation in patients with rheumatoid arthritis." Journal of Modern Research in Inflammation; Dr. Nina Mikirova, Dr. Joseph Casciari, Andrea Rogers and Paul Taylor

IV Therapy for Osteoporosis

Osteoporosis is defined by weakening of bones, which in turn increases risk of fracture and effects about 10 million adults over age 50. The elderly are the most prone to this disease and the hip and spine are the most common sites of injury.

IV Therapy for Chronic Joint Pain

IV Therapy for Suppression of Inflammation

“Chronic inflammation is thought to be involved in the progression of several sustained illnesses, including rheumatoid arthritis, asthma, irritable bowel syndrome, atherosclerosis, diabetes, and cancer…Inflammation plays a key role in tumor development, affecting tumor proliferation, angiogenesis, metastasis, and resistance to therapy.

• IVC therapy was associated with decreases in cancer markers as well as decreases in CRP and in proinflammatory cytokines (interleukins 1, 2, and 8, as well as interferon-gamma). Since inflammation is associated with poor cancer prognosis, this was an important finding.

• Our clinical data supported the hypothesis that high dose intravenous ascorbate treatments may reduce inflammation in cancer patients.

• We published our results in a peer-reviewed journal: Effect of high-dose intravenous vitamin C on inflammation in cancer patients Mikirova NA, Casciari JJ, Taylor PR and Rogers AM Journal of Translational Medicine, 2012, 10:189 (Sep 2012)

• Intravenous ascorbic acid to prevent and treat cancerassociated sepsis. Ichim TE, Minev B, Braciak T, Luna B, Hunninghake R, Mikirova NA, Jackson JA, et al. Journal of Translational Medicine 2011, 9:25”

The Benefits of IV Drip Treatments for

Athletic Endurance and Weight Loss

Athletes are always seeking that next record and that next goal, pushing their bodies to the limit to succeed. Intensive training is very demanding on the body, requiring more nutrients and vitamins to maintain peak performance.

IV Therapy for Endurance & Energy Boost

Workouts are not only tiring on muscles, but exercise also leads to the gradual buildup of free radicals. IV infusions for athletes are designed to flush out free radicals, promote healing, provide fast and thorough rehydration, and maintain muscle and tissues. These IV drips also contain amino acids, the building blocks of proteins that help the body during the recovery and muscle building process.

IV drips for energy & performance can:

• Provide fast and effective hydration

• Improve athletic performance

• Reduce recovery time

• Support muscle recovery

• Maintain healthy muscle and tissue

• Flush out free radicals naturally produced by exercise

• Act as a pre-exercise endurance boost

• Act as part of a recovery plan after a competition or workout

The powerful combination of rehydration and essential nutrients helps the body prepare for a challenging workout or competition and recover more quickly after crossing the finish line.

IV Therapy for Athletic Performance

• Quickly and thoroughly rehydration after intensive workout routines

• Quickly replaces electrolytes and nutrients naturally lost during workouts

• Helps keep competitive athletes at top physical performance

• Reduces post-workout fatigue

• Reduces recovery time

• Boosts overall performance by helping your body maintain optimal levels of vital nutrients

• Maintains muscle structure and integrity

• Helps quickly remove free radicals and toxins naturally produced by your body during workouts

• Increases endurance and capacity for exercise

IV Therapy for Weight Loss

Our Weight Loss IV treatment is formulated with a unique blend of vitamins and fluids that offer an appetite suppressant and give you an energy boost, helping your body break down fat naturally and help you burn calories faster. However, this therapy is not a weight loss solution on its own. Our Weight Loss IV is most effective when used in conjunction with healthy eating and regular exercise. Our Weight Loss IV also includes an MIC injection which speeds up the fat burning process of the body.

The Benefits of IV Drip Treatments for Hair, Skin, Nails and Anti-Aging

Our anti-aging IVs are formulated with a special blend of vitamins, nutrients, and antioxidants that improve the health and strength of your skin, hair, and nails. Our formula is designed to detoxify your body and rejuvenate your appearance from the inside out.

IV Therapy for Beauty

Unlike topical creams and oral supplements, IV therapy contains antioxidants to target and remove free radicals, which are molecules that contribute to aging and tissue damage. IV infusions contain ingredients such as biotin and glutathione to naturally reduce the appearance of wrinkles, repair UV damage, and help your body remove toxins.

IV drip therapy can help you look your best by working to:

• Prevent the damaging effects of free radicals

• Slow the aging process

• Strengthen hair, nails, skin, and eyes

• Brighten skin

• Improve blemishes

• Reduce the appearance of wrinkles

Regular treatments of our anti-aging IVs can slow the natural aging process and help keep your skin, hair, and nails looking radiant and healthy.

IV Therapy for Anti-Aging

Anti-aging treatments are most effective over time, meaning regular appointments. Zen Infusion brings appointments to you, saving you the time and hassle of frequent trips to your local clinic.

Treatments detoxify your body from free radicals that cause cell age and cell damage which may, in turn, lead to chronic disease.

Protect your skin from UV damage, wrinkles, toxins, and dryness with essential fluids and age-defying antioxidants as well as other nutrients to nourish the body from the inside out.

The Benefits of IV Drip Treatments for Hangover, Immunity, & Migraines

Vitamin IV therapy allows various intravenous fluids to be delivered to your body immediately. Since the IV drip allows the nutrients, fluids, and medication to bypass your digestive system – going directly into your bloodstream – it speeds up your recovery time.

IV Therapy for Hangovers

Alcohol is a diuretic, meaning that it dehydrates and removes nutrients from your body. Tissues in your body shrink, especially in the brain, which leads to headaches and muscle aches. At the same time, your liver produces toxins that can lead to body-wide discomfort. Excessive alcohol consumption – especially when fluids are not being replaced – dehydrates the body more quickly and leads to the symptoms of a hangover. Symptoms of hangovers include:
• Headaches
• Fatigue

• Nausea, vomiting

• Stomach pain

• Dizziness

• Increased heart rate

• Muscle aches

• Sensitivity to light and sound

• Changes in mood

The symptoms of hangovers start when the blood alcohol level dips near zero and can last up to 24 hours. Staying hydrated is the best way to prevent a hangover, but if you’ve already woken up with a pounding headache and a sour stomach, you’ll most likely be looking for a way to relieve symptoms quickly.

IV Therapy for Illness & Immunity

For Illnesses:

• Direct-to-customer delivery is ideal when illness leaves you housebound

• Allows you to rest and recuperate instead of having to expend energy on travel to visit a doctor

• Home therapy allows you to avoid exposure to sick people and other illnesses at a clinic, ER, or urgent care

• When you’re hungover, you likely don’t want to leave the house – Zen Infusion brings the treatment directly to you

• Powerful antioxidants and vitamins boost your immune system to help fight off your ailment

• Reduces recovery time

IV Therapy for Migraines

A growing body of research has supported intravenous vitamin therapy as an effective treatment for migraine relief. Infusing critical vitamins and medicines directly into the bloodstream can stop acute migraines in their tracks, offering patients nearimmediate relief from their symptoms. Chronic or frequent sufferers are also finding relief in ongoing treatments plans.

Our Migraine IV contains a blend of vitamins, minerals and medicines designed to curb symptoms and relieve pain. Among the most effective nutrients are magnesium and riboflavin, which have both proven to alleviate migraines in clinical trials.

Magnesium

It’s long been known that migraine patients tend to have lower levels of magnesium. But just within the last two decades, a number of clinical trials have demonstrated that supplementing magnesium reduces the frequency and severity of headaches. In one study, over the course of 9–12 weeks patients who took oral magnesium supplements saw their attack frequency reduced by 41.6 percent, as opposed to 15.8 percent in the placebo group compared to the baseline – a significant difference.

Riboflavin (Vitamin B2)

A 1998 trial studied the effects of riboflavin supplementation on 55 migraine patients, ultimately discovering that 59% of participants who supplemented for three months improved by at least 50%, as compared with 15% who improved as much among the placebo group. They observed reductions in migraine frequency and duration in the riboflavin group.

While migraine sufferers continue to work to find the best path forward, IV therapy is a new and promising option for more headache free days in the future.

Migraine Treatment: Intravenous Micronutrient Therapy (IVMT)

IVMT is the therapeutic, regular and frequent infusion of micronutrients directly into the body. These nutrients include vitamins, minerals, amino acids and antioxidants. The purpose is to create levels within the body that normally wouldn’t be possible any other way than intravenously. Some doctors think that particular patients have an inborn inability to process some of these nutrients properly and this can result in physiological problems with some of our systems including our immune system which controls inflammation. Sometimes patients can’t tolerate the nutrients orally and may have absorption or other problems that make them deficient. When it does work, it often results in significant results that can keep the patient off more serious and potentially harmful medicines. Regular infusions of magnesium are sometimes helpful for their Migraines. Riboflavin (B2) is used by headache and Migraine specialists as a preventive for Migraine. Niacin is used by some patients to help their Migraines. The combination of B3, B6, magnesium and tryptophan are building blocks in the production of serotonin and are used to treat serotonin deficiency. Serotonin is known to play a role in Migraine pathogenesis. B12 is necessary for hundreds of chemical reactions in the body, and influences our metabolism. It’s also necessary for neurological health and maintenance of our nerves. Low B12 levels can result in increased homocysteine levels which are found more frequently in Migraine patients than non-Migraineurs.

Boost Your Hydration

Dehydration is one of the main culprits for migraines. When you’re dehydrated, your brain can temporarily shrink and cause intense head pain. However, getting an adequate amount of water daily is often easier said than done. The average woman should consume 11.5 cups of water, and men should drink 15.5. IV vitamin infusion therapy can boost your hydration levels more than drinking water alone. Each IV therapy contains a combination of vitamins, saline, and electrolytes. By hydrating your body faster and more efficiently than drinking water, your body will distribute the hydration to the parts you need it most. Having optimal hydration levels not only improves your migraine symptoms, but also keeps your energy.

Replenish Vitamin Levels

If you’re like most Americans, you probably don’t get the vitamins and nutrients you need. Recent studies show that almost everyone falls short of the proper vitamin D and vitamin E levels, and nearly half the population doesn’t get enough vitamin C. Migraines may occur as a result of vitamin deficiency. Vitamin IV therapy involves restoring your body with the essential vitamins without using the digestive system. Zen Infusion administers an IV in your arm to help you get your vitamin levels back on track quicker and better than any oral supplement or food. In approximately 30 minutes, you’ll kickstart your health with IV therapy, which offers a 100% absorption rate. Most patients feel better immediately following their treatment and notice the effects of IV therapy last for days and even weeks after.

Packed with Electrolytes

Electrolytes are minerals that have an electrical charge. Your body needs electrolytes to aid in energy production and muscle function. A migraine can be triggered if you don’t have enough electrolytes. IV therapy involves an electrolyte-packed solution that can help alleviate your migraine while preventing new ones from happening. When you boost your electrolyte level, you also regulate your blood pressure and help muscles, like your heart, to contract.

Get Better Sleep Quality

You might have noticed migraines occur when you don’t get good sleep. Research shows a direct link between lack of sleep and migraines. Sometimes it might be hard to fall asleep. Other times you may wake up, but feel unrested. IV therapy can improve your REM sleep to make you feel more rested. By restoring your body’s hydration and vitamin levels, you’ll notice you reach a deeper state of sleep. We even have drips with magnesium that can help improve your relaxation levels and keep stress at bay — two ingredients that are known to help sleep.

The Natural Way is the Best Way

Triptans are one of the kinds of medications prescribed for migraines. Although triptans offer some people relief, they also come with side effects like nausea and fatigue. Taking triptans too much can also create a rebound headache, causing you to get more migraines than you previously did.

IV therapy is a natural way to treat your migraines without the harmful chemicals and side effects that come with medication. When you get nutritional IV therapy, you also get other health benefits like boosted energy, mood regulation, and anxiety relief.