In their editorial, published online in the British Journal of Sports Medicine, experts urged the “food first” and “no needle” messages – that are taught in sports nutrition courses around the world – need to be amplified among all athletes and their support teams to “stop this trend in its tracks”.
The international group of authors, including experts from St Mary’s University, London; University College London; and University of Bath (England), who regularly interact with professional team players in European and American leagues and their support teams, said they have become increasingly aware of the practice.
Although it’s not known exactly how common the practice is, they pointed out that, anecdotally, some players are hooked up to intravenous nutrition drips as often as every week as part of a pre- or postgame routine.
‘Drip-bars’ easily accessible but devoid of regulation
Intravenous nutrition has traditionally been reserved for serious clinical conditions – such as anaemia – symptoms caused by nutrient deficiencies, or to correct severe dehydration caused by marathon running in, for example, a desert.
A ban on needle use by athletes at the Olympic Games has been in place for all recent Games except for appropriate medical use, and where a therapeutic use exemption is obtained, explained the authors.
However, “so-called ‘drip bars’ and concierge IV nutrition services are now easily accessible,” they said. These claim to boost health and performance, restore hydration, and speed up recovery, by offering a menu of B vitamins, amino acids, glutathione, vitamin C, and electrolytes, and potentially boosting levels beyond any therapeutic range.
However, they are “devoid of regulation” and for players or practitioners there is no official guidance on their use.
Physical and reputational risks
Bypassing the gut-liver axis risks nutrient toxicity warned the authors, and “appears foolhardy” unless there is a “significant clinical rationale.” They highlighted that they had noted vitamin B6 and vitamin B12 levels often “beyond the measurement range of the laboratory” in a subgroup of professional players. They pointed out how long-term effects of too much vitamin B6 include peripheral neuropathy, and that athletes regularly receiving parenteral iron “risk liver disease.”
“Given that the long-term effects of supratherapeutic doses of B vitamins and other nutrients are unknown in athletes, it does not appear to be worth the risk, especially given the lack of evidence-based benefits,” they said. They added that there is also the risk related to venous access, including “infection and thromboembolic complications.”
Additionally, a shift away from “what works” according to scientific standards to that which is “unproven” puts the reputation of sport at risk, and also puts athletes at risk of antidoping violation, they cautioned.
Figures on the prevalence of intravenous nutrition need to be gathered in tandem with governing bodies and players’ associations in the professional leagues providing guidance on the potential risks of intravenous nutrition use, recommended the authors.
The ‘food first’ and ‘no needle’ messages need to be amplified among all athletes and multidisciplinary support teams, they emphasised, to avoid what was previously a ‘last resort’ treatment becoming “normal without scientific evidence of benefit”.
A version of this article first appeared on Medscape UK.