Ronald B. Keys, JD, PhD
Free Initial Consultation Call: (954) 448-1515 E-mail: email@rkeysphd.com |
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Free Initial Consultation - Call Now (954) 448-1515 WHAT IS A BASIC VITAMIN DRIP? By Ronald B. Keys, JD, PhD Former Co-Director, American Aging Association Former Scientific Director, Life Extension Foundation May 1st, 2006 What is a basic vitamin drip? It can be disheartening but challenging at the same time when we encounter in our practice an ill or possibly elderly person shuffling in front of a walker who has had a prolonged history of conventional care on common pharmaceutical drugs under our usual palliative care clinical medicine model, finally turning to functional, integrative medicine. He or she would be searching for that magic pill, potion or formula, not understanding or grasping yet, the complexity of already, heavily sustained, cumulative free radical damage to his/her frame and internal organs that has reached such a threshold to cause a "malabsorption syndrome" for any initial or early use of more standard, over-the-counter vitamins. It would be extreme naivete to think that a few bottles of vitamins at this stage would make any subtstantial difference concerning outcome, improvements in range of function and quality of life. What can we do with patients like this, who out of prolonged and even benign neglect under conventional care, have developed " multiple, uptake load blocks" due primarily to impaired absorption and utilization pathways? They literally starve to death, though they be served meals, prepared in with kindness and love even fit for a king or queen. Significant weight loss and shifts in loss of lean body mass and conversion to fat mass may be a major indicator on top of their sheer visual impact and obvious declines in gait, mobility and general activities of daily living. It is our job to see that these folks get some real help in order to earn their respect and trust. Does your doctor have all of his oars in the water (does he know and understand) concerning possibly rapid IV nutrient replacement IN TWO MONTHS in an evidence-based, MEASURED DEPLETION, MEASURED REPLETION EMPIRICAL MODEL? While a two month, customized IV nutrient protocol is more expensive than oral vitamins, it may fix someone in two months what might take an entire year on oral vitamins. In directing and advising people with nutritional inquiries, what is the clinical context for assessing and implementing a "vitamin drip" for a patient? There are five (5) pathways involved in treating a patient that are assessed in patient interviews along with a detailed, physical examination and possible laboratory testing of blood and urine. This includes the following; 1. Ingestion 2. Digestion 3. Absorption 4. Utilization 5. Elimination The major issues are described; 1. What does the patient need? 2. How much does he/she need? 3. And what is the appropriate route of administration for this particular patient? Put another way; 1. How does the patient look? 2. How does the patient feel 3. And what are the numbers on his/her blood chemistry to guide clinical judgement? Where "uptake load blocks" may be present in this special class of patients, physician-directed IVs may be needed to "jumpstart" absorption and utilization of nutrients before regular oral nutrition is introduced. When nutrients are injected intravenously or intramuscularly, they bypass these roadblocks and go straight into the bloodstream where they can be delivered immediately to the tissues or organs that need them. While it may be true that some of them are promptly excreted by the kidneys and liver, the body knows what it is doing so if it really needs something specific in the drip (nutritional IV), the body will hang on or retain them to a larger proportion. A classic multivitamin/mineral infusion may contain 10-30 grams of vitamin C, B-Complex in the 100 mg range, with vitamin B12 and folic acid in the 1 mg and 5-10 mg range, respectively, with a trace of element mix, magnesium and calcium in the 600 to 2000 mg range may be infused in 30 to 90 minutes, depending upon the fluid volume. They are very safe and often help provide added sources of energy, especially after surgery or hospitalization. These kinds of infusions also have benefit in muscle cramp and spasm types of complaints. Adjusting magnesium and calcium up to 3 grams per infusion may be done safely in essentially healthy individuals. The elderly need more monitoring and lower magnesium doses. Sometimes, we don't know what biochemical component was normalized by an infusion or series of infusions. Constituents of a particular "drip" for a specific patient is always a "medical decision" by the properly trained physician in functional and nutritional medicine. Doctors may be trained to do this as well as to learn to manage related issues like protein malabsorption due to hypochlorhydria (low stomach acid). Is the doctor ready to learn about downregulated gene clusters no longer doing DNA replication for the body's own production of hydrochloric acid and still other digestive juices no longer being produced? Or does the doctor still state naievely, without clinical genetics knowledge, that a patient just refuses to eat and there is nothing to be done? Is the doctor ready to learn how to re-activate and stimulate gene cluster production (of digestive juices needed) through advanced cell signalling apparatus enhancements or just tell the family of the patient that there is nothing to be done? There are dozens of potential pathways that lead to a gene cluster that manages DNA replication of digestive juices in all people. There is nothing accidental, random or unavoidable why the appropriate gene clusters stop DNA replication of these digestive juices. Consider and attempt to restore the signalling pathways that govern the operation of a gene cluster that may regulate digestive juice production (hydrochloric acid, etc.)in basic DNA replication. This is besides and in addition to giving a fast two month IV nutrient replacement program. Programs may be developed to accomplish this. Or, you can accept the statement of an untrained physician that there is nothing to be done because the patient just refuses to eat and the patient has a bad attitude. Without knowledge of clinical genetics and considerations of activation of gene cluster regulating precursor protein gene systems, Some even say that it is God's will when a patient refuses to eat! More Doctors are finally converting to more nutritional applications (evidence-based clinical nutritional pharmacology) in their medical practices because of public pressure by their patients and the increased recognition of the problems of side effects from medications (toximolecular medicine and ADR or adverse drug reactions). Using a two month program of aggressive IV nutritional supplementation, it may be possible to restore a person to normal ranges in his chemistries based upon a MEASURED DEPLETION-MEASURED REPLETION EMPIRICAL MODEL. Here, the patient is his own control; numbers on his/her reference ranges are compared before and after IV treatment Recognizing that nutritional intervention may exist on multiple levels, we owe it to our clients/patients to provide the best possible clinical care and direction. There is almost always a place later in the treatment picture, usually only several weeks down the road, for these types of patients for regular, oral nutritional support after we have earned their trust, support and their loyalty. GETTING YOU TO THINK: (And thank you, pub med) When you review these abstracts below, tell me.....why are nutritional IVs still largely limited to a reactive, disease-based model such as in severe burn cases such as noted below ?? Why isn't this used, daily, routinely for the severely impaired, grossly ill or generally weakened patient instead of solely, showering them with pharmaceuticals from each of the specialty practices? Why aren't nutritional IVs used routinely across the board, menued from the patient's own, originating biochemistry before the IV is applied? Matching the depetions shown through competent biochemistry with a specialized drip, responsive to those depletions, may be part of the recovery solution. What do you think? Nutr Clin Pract. 2006 Oct;21(5):438-49. Antioxidant micronutrients in major trauma and burns: evidence and practice.Berger MM. Department of Intensive Care Medicine and Burns Center, CHUV-BH08.660, CH-1011 Lausanne, Switzerland. Mette.Berger@chuv. There has been a growing interest in micronutrients as a result of their essential role in endogenous antioxidant defense mechanisms and immunity. Critically ill burn and trauma patients are characterized by an increased free radical production, which is proportional to the severity of the injury. In addition, they are at high risk of negative trace element balances, which contribute to the imbalance in endogenous antioxidant capacity and the extension of primary lesions. Although selenium, zinc, and vitamin C and E status are altered in all injured patients, patients with major burns are unique for having copper deficiency. In major burns, high-dose ascorbic acid for 24 hours achieves reduction of resuscitation fluid requirements by endothelial antioxidant mechanisms both in animal models and in 1 human trial. Supplementation trials in trauma and burns including selenium and zinc have shown that early provision of micronutrients improves recovery. Vitamin supplementation trials without selenium have not achieved definitive effects. The human studies show that reinforcing antioxidant defenses early in the course of major injury is rational and that substituting the large initial micronutrient losses of selenium and zinc is safe in trauma, as is the addition of copper in burns. The IV route seems the only way to deliver the doses required to obtain a clinical effect. Am J Clin Nutr. 2007 May;85(5):1293-300. Trace element supplementation after major burns modulates antioxidant status and clinical course by way of increased tissue trace element concentrations.Berger MM, Baines M, Raffoul W, Benathan M, Chiolero RL, Reeves C, Revelly JP, Cayeux MC, Sénéchaud I, Shenkin A. Department of Adult Intensive Care Medicine & Burns Center, Lausanne, Switzerland. mette.berger@chuv.ch BACKGROUND: After major burns, patients can develop nutritional deficiencies including trace element (TE) deficiencies. Various complications, such as infections and delayed wound healing, influence the clinical course of such patients. OBJECTIVES: We aimed to investigate the effects of large, intravenous doses of TE supplements on circulating and cutaneous TE tissue concentrations, on antioxidant status, and on clinical outcome after major burns. DESIGN: This was a prospective, randomized, placebo-controlled trial in 21 patients aged 35 +/- 11 y (x +/- SD) with burns on 45 +/- 21% of their body surface area. Intravenous copper, selenium, and zinc (TE group) or vehicle (V group) was given with a saline solution for 14-21 d. Blood and urine samples were collected until day 20, and skin biopsy specimens were collected on days 3, 10, and 20. RESULTS: The age of the patients and the severity of their burns did not differ significantly between the groups. Plasma TE concentrations were significantly higher in the TE group. In burned areas, skin contents of both selenium (P=0.05) and zinc (P=0.04) increased significantly by day 20. Plasma and tissue antioxidant status was improved by supplementation. The number of infections in the first 30 d was significantly lower in the TE group (P=0.015), with a median number of 2 versus 4 infections per patient in the TE and V groups, respectively, as a result of a reduction in pulmonary infections (P=0.03). Wound healing was improved in the TE group, with lower requirements for regrafting (P=0.02). CONCLUSIONS: TE supplementation was associated with higher circulating plasma and skin tissue contents of selenium and zinc and improved antioxidant status. These changes were associated with improved clinical outcome, including fewer pulmonary infections and better wound healing. Free Initial Consultation - Call Now (954) 448-1515 RONALD B. KEYS, JD, PhD CLINICAL & OPERATIONS DIRECTOR Ronald B. Keys, JD, PhD 2402 N. 28th Avenue Hollywood, Florida, 33020-1814 USA 954-448-1515 primary email: email@rkeysphd.com secondary email: rkeysphd@brainlink.com secondary email: rkeysphd@yahoo.com by pre-arrangements for voice/text chat: Mostly, Dr. Keys works as a Consulting PhD Doctor, usually from a distance, with and through a proper local anchor physician to order blood work. Advanced treatment protocols may develop from the advanced blood chemistries he requests. If you have no local doctor, Dr. Keys finds one through an affiliate physician network. His work is global, oftetimes involving patients from other countries as well as all over the continental USA. There are many tests and treatments to help people; Oftentimes, anchor physicians are not familiar or comfortable with them. Dr. Keys teaches and helps to direct individual patients AND their physicians with laboratory-work for these treatment options. This is measured work and clinical biochemistry. Opinion evidence standards are not employed here since this is a measured and laboratory-based or empirical study of the patient. Numbers are sought from the results of these tests that, usually, "...jump up and grab you..." that dictate what is needed and how much. Patient-advocacy is frequently involved to get advanced and necessary clinical biochemistries ordered and to help interpret them in filed reports..Chat room capabilities in voice or text, besides email, may be employed. This may include conference calls online. In a perfect world, if your physician knew everything, people like Dr. Keys would not exist. Physicians themselves are caught frequently in the traps of their own standards of care that may be very limited in many cases. Methods used by Dr. Keys are rational, scientific and disciplined. Designed by Fencl Web Design.Com DISCLAIMER: Ronald B. Keys, JD, PhD is not a physican. He acts here, when hired, only as a consulting PhD doctor. Any information offered on this site is intended for prevention and education. It is the responsibility of your anchor doctor or chosen physician to diagnose and treat diseases through their medical licenses. By using this web site you agree that you will seek professional medical advice from your doctor before using any of the information presented on this web site. All tests are ordered through your physician, only, and not Dr. Keys. Most jurisdictions require that an attending physician is required by law to take patient and family history, conduct a physical examination of the patient and to order tests appropriate and necessary. As an online consultant, he cannot do these things required together, as a whole, as a practice of medicine. Any emergencies should only be handled in a hospital emergency room or by your physician. |