The Rise of Intravenous Nutrition Products in Professional Team Athletes: Any Reasons for Concern?

Use of intravenous nutrition products in sport

The authors regularly interact with professional team sports players in European and American leagues and their multidisciplinary support teams, and we are aware of players regularly receiving intravenous nutrition (IVN) products. Additionally, this is often evident in blood biomarker profiles where specific nutrients exceed the clinical laboratory’s upper measurement limit. The precise prevalence of IVN use is not known, however, anecdotally, some players receive IVN as often as weekly as part of a pre-game or post-game routine. -match. So-called “drip bars” and concierge IVN services are readily available, although apparently lacking proper regulation.1 These offer an IVN menu containing nutrients such as B vitamins, amino acids, glutathione, vitamin C and electrolytes, claiming to improve health. and performance, restoring hydration, accelerating recovery, etc. Additionally, players may request parenteral administration of nutrients such as iron and vitamin B.12 of a team doctor unless otherwise specified. Typically, NIVs administered by a sports physician are reserved for clinical presentations such as anemia, significant impairments with symptoms or in race medicine (e.g. severe dehydration/collapse caused by racing ultramarathon in the desert)2. self-directed use of NIV described above, there is a crossover regarding potential risks and benefits.

Guidance for players and practitioners in the peer-reviewed sports medicine/sports science literature describing the evidence base and risks associated with IVNs is largely absent. IVNs are not mentioned in recent nutrition consensus statements, which is in line with the principle of reducing needle use in sport and the “diet first” approach taught in the courses. of sports nutrition around the world. A ban on the use of needles by athletes at the Olympic Games has been put in place for all recent Games, except for appropriate medical use and when a Therapeutic Use Exemption (TUE) is obtained. Similarly, the World Anti-Doping Agency prohibits intravenous infusions of more than 100ml (per 12 hours) unless a TUE is obtained; however, these checks are not reflected in all sports leagues.

Is there evidence of benefits for athletes beyond placebo?

IVN products are often used as a way to treat tiredness, fatigue, or recovery, but the evidence is sparse and poorly substantiated. We are aware of only two studies evaluating vitamin injections in otherwise healthy participants; neither produced an effect for the injection group. Tin May et al observed no effect of 1 mg of cyanocobalamin (synthetic B12) or placebo injections (3/week) for 6 weeks in a double-blind fashion, on various physical performance tests, or any difference from placebo.3 A cross-sectional study of elite Polish track and field athletes reported 34 % ( n=82) received vitamin B12 injections over a period of 6 years.4 Although a beneficial effect of vitamin B12 was observed on red blood cell parameters, there was no additional benefit when the athlete’s vitamin B12 the concentration was greater than 700 pg/mL. Moreover, when a B vitamin12 deficiency exists, one study found no additional benefit of an injection over oral supplementation.5

Risks

It is well known that the gut-liver axis actively protects humans against infection, from the acidity of bile to the complex immune pathways in the epithelial mucosa, and the dynamic role of gut microbiota providing protection against toxicity. (eg, heavy metals).6 Bypassing these mechanisms seems foolhardy unless there is significant clinical justification, and no studies have addressed the long-term impact. However, via biomarker profiling, we observed vitamin B6 and cobalamin (vitamin B12) often beyond the laboratory measurement range, in a subset of professional gamers. These observations may be the direct result of intravenous therapies, although accidental consumption via fortified foods and energy drinks may also be the cause. Although the long-term effects of high cobalamin are unknown, the long-term effects of vitamin B6 are classically associated with peripheral neuropathy.7 Athletes regularly receiving parenteral iron risk liver disease, and indeed elevated body stores (hepatic iron concentration) have been observed in road cyclists.8

Since the long-term effects of supratherapeutic doses of B vitamins and other nutrients are unknown in athletes, it doesn’t seem worth the risk, especially given the lack of evidence-based benefits. There are also direct risks associated with venous access, including infections and thromboembolic complications. More than that, there’s the reputational risk to sport if it’s normalized for athletes to regularly participate in self-directed IVN use with a disturbing shift from what “works” (by scientific standards) to which is not proven. Additionally, some athletes risk an anti-doping violation by participating in self-directed IVN use.

Future directions

A better understanding of the prevalence of regular IVN use among athletes needs to be established. A qualitative study can provide important information about the draw and motivating factors for athletes to seek IVN, perhaps illuminating alternative education and resource strategies to address nutritional and performance needs. At the same time, governing bodies and players’ associations in professional leagues should provide advice on the potential risks of using IVNs. The “food first” and “no needles” messages must be amplified with all athletes and multidisciplinary support teams to prevent what was once a “last resort” treatment from becoming normal without scientific evidence of profit.

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