Oral Versus Intravenous (IV) Vitamins: A Side-by-Side Comparison

Why should you go to the trouble and expense of doing IV nutrient therapy when you can buy over-the-counter oral supplements and take them in the comfort of your own home?

It's a question I get asked all the time.

I know it seems counter-intuitive to go into a clinic for IV therapy when supplements seem to be everywhere these days. But there are actually many sounds scientific reasons to do so.

Much of it comes down to one simple concept. Absorption.

The IV Route

An IV infusion delivers 100% of each vitamin directly into your blood stream. You can relax in a recliner while we flood your cells directly with abundant doses of nourishing vitamins and nutrients. Absorption is completely bypassed! That means your gut doesn't have to go to the work of breaking down food into its constituent vitamins, nutrients, minerals, and amino acids, your small intestine doesn't have to pass them through its walls, your cells don't have to seek out these molecules. Mega-doses of the nutrients you need to heal are delivered right where they need to go.

"An IV infusion delivers 100% of each vitamin directly into your blood stream. You can relax in a recliner while we flood your cells directly with abundant doses of nourishing vitamins and nutrients. Absorption is completely bypassed!"

I've said it before and I'll say it again: IV therapy is like the urgent care of Functional Medicine. It allows for an immediate effect.

The Oral Route

When you take a vitamin by mouth, your body has to do a lot of work to move that vitamin into the blood stream. The process is actually fairly complex and quite inefficient.

Water-soluble vitamins, for example, are large molecules. They can't just pass through from your intestines directly into the blood stream like IV vitamins can. Instead they have to cross your "enterocytes" or "colonocytes"—fancy terms for the layer of cells lining the entire intestinal tract. These cells have phospholipid cell membranes that are impenetrable to water soluble vitamins and nutrients.

Regular water soluble vitamins actually need special "transporters" to move each individual nutrient across the cells lining the intestinal tract.

One such transporter is called the Sodium-dependent Multi Vitamin Transporter (SMVT). Think of the SMVT (or any other multi-vitamin transporter) like the passport control station at the border between two countries. They allow certain individuals to get through while prohibiting others. In this case the "individuals" are vitamins trying to cross the border to get from the gut into your blood circulation.

Aside from being limited in capacity, the SMVT transporter regulates the absorption of several vitamins and nutrients: Biotin (vitamin B1) important in skin, hair, nails integrity and immune function, pantothenic Acid (vitamin B5) and alpha lipoic acid (ALA - a key antioxidant).

Because it is responsible for the transport of several nutrients this means each of them has to get in line waiting to cross the border into your blood circulation. This means oral vitamins compete with each other for access to the blood stream! 

There are of course other transporters for other vitamins that perform the same "passport control" function to get that vitamin from the gut into blood circulation.

Thiamine (vitamin B3)- a vitamin important in cardiovascular and neurologic function-uses transporters called Thiamine Transporter 1 and 2 (THTR1 and THTR2-these are shown in the diagram above). These transporters are abundant, but are easily influenced by what we eat and drink. Chronic alcohol consumption, for example, significantly inhibits absorption of vitamin B3 E. Coli infections also cause a significant inhibition of thiamine uptake as well.

Riboflavin (vitamin B2)-vital in the generation of energy (ATP) in mitochondria and for the activation of folate (vitamin B9) into its active form-uses the transporters RFVT-1 and RFVT-3 (also pictured in the diagram above). Chronic alcohol consumption, as well as some medications can significantly inhibit absorption of Vitamin B-2.

Oral supplementation is already challenging, because it's going to be hard for these vitamins to cross from your small intestine into your blood stream. This is further complicated by the "transport" stations that are like border crossing from your gut to your blood where vitamins have to line up and vie with one another for priority placement. On top of all this, the transporter molecules themselves can be impacted by a wide range of dietary and lifestyle factors that impact their abundance and, therefore, their usability.

Put simply oral supplements are not typically very efficient or bioavailable to your body. However, there is another route.

The Liposomal Route

Liposomal supplements offer a more efficient alternative to traditional oral supplements. Liposomes are tiny, spherical vesicles made from phospholipids, similar to the membranes that surround our cells. The active ingredients of a supplement are encapsulated within these liposomes, protecting them from breakdown in the digestive system and enhancing their absorption and bioavailability.

"Liposomal supplements offer a more efficient alternative to traditional oral supplements.... The active ingredients of a supplement are encapsulated within these liposomes, protecting them from breakdown in the digestive system and enhancing their absorption and bioavailability.

Unlike regular water-soluble vitamins, liposomal supplements can pass through the phospholipid cell membranes of the intestinal tract more easily, as they are wrapped in the same phospholipids that make up these membranes. This means they don't have to rely on the same transporters as traditional oral supplements, potentially increasing their absorption and efficacy.

Liposomal Vitamin C by Core Med Science is an excellent example.

Lifestyle and Illness Affect the Intestinal Lining

Aside from liposomal options, regular vitamins present other concerns. The cells lining the intestinal tract, which carry out the function of transporting vitamins and nutrients, have to be healthy and intact for proper absorption of vitamins to occur.

As pointed out above, the absorption of thiamine (B3), riboflavin (B3) and other vitamins is severely inhibited by chronic alcohol consumption. Alcohol is inflammatory and damaging to the cells lining the stomach and intestines where absorption of vitamins occurs. Other factors that influence the integrity and function of the intestinal lining include:

• Stress
• Medications - Ibuprofen and aspirin, for example
• Infections - like E.Coli, Pseudomonas, and Clostridium
• Inflammation - from diabetes, Crohn's disease, ulcerative colitis, and other conditions
• Leaky gut - A topic I will explore in future blogs
• Smoking

Anything that negatively impacts the lining of your intestine also negatively impacts your ability to absorb nutrients through that lining. Most people do not have perfect gut barrier function. This makes oral supplements even less efficient than they usually are.

"Anything that negatively impacts the lining of your intestine also negatively impacts your ability to absorb nutrients through that lining.... This makes oral supplements even less efficient than they usually are."

The Summary

I know that's a lot of information to consume in one sitting so here is the executive summary:

Oral vitamin supplementation is:

• Dependent on crossing the cells forming intestinal lining for absorption into the circulation
• Dependent on an intact intestinal lining which can be easily damaged by stress, alcohol, infections and medications
• Reliant on specific transporters for each vitamin which are sensitive to alcohol use and are "competitive" as several vitamins try to use the same transporter.
• Less expensive but also much less efficient compared to IV infusions

Intravenous (IV) supplements and vitamins:

• Bypass absorption completely making them immediately 100% bioavailable to you
• Deliver high concentrations of nourishing vitamins unattainable with the oral route
• Is almost painless with the use of a special freezing skin spray that we employ in our clinic
• Is more expensive but is typically worth it for those who have symptoms of vitamin deficiencies including fatigue, headaches, weight gain, frequent infections, dry blemished skin, brittle hair and nails, and more.
• Can have an immediate impact on your health-they are like the urgent care of functional medicine.

Liposomal supplements:

• Use a specialized delivery system that encapsulates vitamins and nutrients within tiny, spherical vesicles called liposomes
• Liposomes are made from phospholipids, similar to the membranes surrounding our cells, allowing for better absorption and bioavailability
• May bypass the need for specific transporters, as they can pass through the phospholipid cell membranes of the intestinal tract more easily
• Are generally more expensive than regular oral supplements but may provide better value for money if absorption is significantly improved
• May be a good option for those who have difficulty absorbing nutrients due to compromised gut health or other factors affecting the intestinal lining
• Provide a convenient, at-home alternative to IV therapy for those seeking higher bioavailability without the need for clinic visits

Oral supplements are not "bad." In fact, they can be a wonderful adjunct to treatment, especially if you use liposomal supplements. But they may not be a replacement for or the equivalent to IV therapy.

Sources

1. Said HM. Recent advances in transport of water-soluble vitamins in organs of the digestive system: a focus on the colon and the pancreas. American Journal of Physiology-Gastrointestinal and Liver Physiology, 305(9), G601-G610.
2. Gibson PR, Anderson RP, Mariadason JM, Wilson AJ. Protective role of the epithelium of the small intestine and colon. Inflammatory bowel diseases, 2(4), 279-302.