Background
This ruling forms part of a wider piece of work on advertising claims about the health benefits of intravenous nutritional therapy (IVNT), identified for investigation following complaints received and intelligence gathered by the ASA. See also related rulings published on 20 December 2023.
Ad description
The website for REVIV UK, www.revivme.com/london, seen 1 April 2019, stated on the main page for its London clinic “REVIV IV infusion therapies deliver hydration, vitamins, and antioxidants helping to optimise vital hydration balance and maximise your wellness & efficiency. Whether looking to boost your immune system […], REVIV offers a quick and efficient way to restore your body to a healthy balance”. Text underneath the heading “REVIV London Prices” listed the intravenous (IV) drips available and their prices: “Hydromax™ ¦ Hydration IV”; “Ultraviv® ¦ Recovery IV”; “Megaboost® ¦ Vitamin IV”; “Vitaglow® ¦ Glutathione IV”; “Royal Flush™ ¦ Deluxe IV”. The IV drip names were linked to individual pages which included additional claims about the health benefits of each of the drips.
Issue
The ASA challenged whether the claimed health benefits of the IV drips were misleading and could be substantiated.
Response
REVIV UK Ltd t/a REVIV said they gave a specific formulation for an IV drip for each of their clients after a consultation at one of their clinics with a medical or clinical practitioner, all of whom were registered healthcare providers such as doctors, nurses, midwives, paramedics or operating department practitioners. Their prices reflected the involvement of registered healthcare practitioners in the selection of their drips as well as their administration. They provided a wellness service, rather than just a product; the IV drips could not be directly purchased from the website. They were registered with the Care Quality Commission and had been rated by them as ‘Good’.
REVIV said the claim “REVIV IV infusion therapies deliver hydration, vitamins and antioxidants helping to optimise vital hydration balance and maximise your wellness & efficiency. […] REVIV offers a quick and efficient way to restore your body to a healthy balance”, which appeared on the main London clinic web page, simply stated what they did, rather than what they offered.
With regard to the claim on the London clinic home page that REVIV drips “boost your immune system” REVIV said that this was delivered primarily from their drips which contained vitamin C: the Ultraviv, Megaboost, Vitaglow and Royal Flush drips. In support of the claims they referred to two papers relating to vitamin C and the immune system. They highlighted that one, an abstract, stated that vitamin C was needed for some cells in the immune system to perform their tasks and therefore a deficiency in vitamin C resulted in reduced resistance against certain pathogens, while a higher supply enhanced several immune parameters. It stated that studies, including meta-analyses, underlined that the prophylactic intake of vitamin C might slightly reduce the duration of the common cold in healthy people, but that it did not affect the incidence or severity of the common cold. It also stated that vitamin C supplementation was most effective in cases of physical strain or insufficient intake of the vitamin. The second paper was a literature review. REVIV highlighted that it stated that vitamin C appeared to exert a multitude of beneficial effects on cellular functions of both the innate and adaptive immune system and that it was necessary for the immune system to mount and sustain an adequate response against pathogens.
Hydromax drip
In relation to the Hydromax drip, REVIV provided substantiation which they said supported the claims in the ad that related to its efficacy for dehydration, flushing out lactic acid, and detoxification. Three documents related to dehydration. The first paper related to a study of hydration levels in Chilean professional football players, of which only the abstract was in English. REVIV said the study was intended to assess the athletes’ normal hydration status and it found that 98% of them showed moderate to severe dehydration before regular training practices. The abstract stated that this might negatively affect an athlete’s performance and increase their risk of heat-related injuries. REVIV also provided a chapter on volume depletion (dehydration) from a medical textbook, highlighting that intravenous 0.9% saline was given when volume deficits were severe or oral fluid replacement was impractical. A further article from a medical journal relating to disorders of sodium and water balance stated that the first priority in patients with water and/or sodium imbalance was to correct dehydration and then reassess sodium balance and treat with an appropriate solution to correct sodium balance.
With regard to the claim that the Hydromax drip “Flushes Out Lactic Acid”, REVIV referred to a case report in a medical journal which summarised the clinical presentation of a patient with lactic acidosis (a medical condition in which the body overproduced or underutilised lactic acid, but was unable to adjust to those changes) and how it was treated. REVIV highlighted that the report stated that resuscitative efforts to support circulation and ventilation were the first steps in treating lactic acidosis, and that there were proponents of both saline and balanced salt solutions as the treatment for fluid resuscitation in such circumstances.
To support the claim that the Hydromax drip had a detoxifying effect, REVIV referred to a medical journal article about the medical condition rhabdomyolysis (the breakdown of damaged skeletal muscle), noting that the article stated that treatment of the condition was primarily directed at preserving kidney function, and that treatment was via intravenous saline.
Ultraviv drip
To support the claim that the Ultraviv drip delivered an “energy boost”, REVIV said that fatigue was a common condition which could result from factors including but not limited to malnutrition, dehydration, stress, illness and mood disorders. They said that the administration of fluid, replacement of nutrients and treatment of inflammation associated with illness could reduce fatigue and provide a boost of energy.
They referred to three papers. The first, a review article, looked at post-match fatigue and its treatment in professional footballers. It said post-match fatigue was multifactorial and mainly related to dehydration, glycogen depletion, muscle damage and mental fatigue, and that recovery strategies should be targeted against those major causes of fatigue. REVIV highlighted that the second document, a clinical review of fever-illnesses in athletes, stated that fever was correlated with an increase in insensible fluid losses, dehydration, metabolic demands, and dysregulation of body temperature. It could have detrimental effects on the musculoskeletal system, including decreasing strength and endurance, generalised muscle catabolism, and an increase in perceived fatigue. A further review article discussed vitamin B12 (cobalamin) deficiency, finding that it had been correlated negatively with cognitive functioning in healthy elderly subjects, with symptoms including slow mentation, memory impairment, attention deficits and dementia.
The ad also included claims about the Ultraviv drip’s efficacy in restoring hydration. REVIV referred to the same evidence referenced above in relation to such claims.
Megaboost drip
REVIV said that the claim “Antioxidant Therapy”, which was made in relation to the Megaboost drip, could also be attributed to the drip’s vitamin C content. They provided an article which reviewed evidence relating to vitamin C’s role as an antioxidant in humans. They highlighted that the article stated that epidemiological studies showed that diets high in fruit and vegetables were associated with lower risk of cardiovascular disease, stroke and cancer, and with increased longevity, but that it was not known whether those protective effects could be attributed to vitamin C, and that intervention studies using vitamin C had not shown any change in markers of oxidation or clinical benefit. An additional article, in which the author summarised relevant published clinical research and described his own use of the ‘Myers’ Cocktail’ (an IV infusion developed by a US physician) as a treatment, stated that the Myers’ Cocktail had been found to be effective in a wide range of medical conditions and disorders.
REVIV also referred to the documents provided in support of the claims to boost the immune system, and to the document provided in relation to Hydromax’s detoxifying effect.Vitaglow dripREVIV said the Vitaglow drip contained saline, vitamin C, glutathione and n-acetyl-l-cysteine (NAC). They provided four documents relating to glutathione and to NAC, to support claims that the Vitaglow drip “Prevents & Reverses Effects of Free Radicals”.
The first, a review article, reviewed literature relating to the antioxidant role of glutathione and NAC supplements. It said that an increase in exercise intensity was one of the ways in which oxidative stress and free radical production increased in human cells, which in turn could be related to some conditions such as Parkinson’s and Alzheimer’s diseases. It was therefore possible that a decrease in the amount of oxidative stress a cell was exposed to could increase health and performance. The article stated that glutathione and NAC were antioxidants which could minimise oxidative stress and highlighted that supplements with those substances were popular. The second paper, an abstract, summarised the antioxidant and chemopreventive properties of glutathione and NAC and referred to a large study investigating the long-term daily usage of NAC supplementation in high-risk individuals to prevent a second occurrence of primary lung cancer.
A third article summarised the role of glutathione in the body, and stated that glutathione deficiency contributed to oxidative stress, which played a key role in ageing and the pathogenesis of many diseases. It stated that new knowledge of the nutritional regulation of glutathione metabolism was critical for the development of effective strategies to improve health and treat such diseases. The fourth paper, published in 1997, described a randomised controlled trial (RCT) which investigated whether glutathione delivered intravenously would enhance the feasibility of giving six cycles of chemotherapy to women with ovarian cancer, without dose reduction due to toxicity. The study found that glutathione allowed more cycles of chemotherapy to be administered because less toxicity was observed and patient quality of life was improved.
In support of the claims that the Vitaglow drip improved the appearance of skin and resulted in “glowing” skin, REVIV provided one abstract of a study and one full study relating to the role of glutathione as a skin lightening agent. The abstract described a study which investigated the effects of glutathione supplementation on the lightness of the skin of 30 Filipino women, concluding that it was safe and effective. The full study related to a double-blind and placebo-controlled trial investigating the effects of a topical glutathione preparation on skin whiteness, skin moisture content, smoothness, wrinkle formation and elasticity. The study concluded there was increased moisture, suppression of wrinkle formation, improvement in skin smoothness and that the preparation effectively whitened skin.
Royal Flush drip
REVIV said that the Royal Flush drip incorporated all the elements of the Megaboost, Vitaglow and Ultraviv drips, referring to the evidence provided in relation to each of those three drips.
Assessment
Upheld
The ad described five IV drips offered by REVIV, including on individual web pages a range of claims about the health benefits provided by each drip. In the descriptions of the drips, the ad also included some claims about the role that some of the specific substances in the drips played in the body, and the health benefits they provided. The ASA considered that consumers would therefore understand that the health benefits associated with those specific substances would be provided by the described drip.
We considered that the average consumer who viewed the web pages relating to the advertiser’s IV drips, and to whom the claims were clearly addressed, would be generally healthy but interested in products which might support or enhance specific aspects of their health and wellbeing, or support their preparation for or recovery from specific events, including intensive exercise. We considered those consumers would have some understanding that the body required certain levels of vitamins, minerals and other substances to support its normal functioning.
We noted that the London clinic web page included the claim “[…] whether its[sic] work or play that’s taking its toll, REVIV provides a quick and efficient way to rehydrate and re-energize via IV infusions […] helping to optimise vital hydration balance and maximise your wellness & efficiency […] REVIV offers a quick and efficient way to restore your body to healthy balance”.
IV drips were delivered via an invasive method which we considered consumers would generally associate with medical uses, and single drips were offered by IV clinics in the UK at prices generally ranging from around £100 to around £400; at the time the ads were viewed, REVIV’s prices ranged from £99 to £349 for a single drip. In that context, and in the context of the claims referenced above, we considered consumers were likely to expect that an IV drip was an instantaneous, and therefore more effective, or superior way, of delivering essential nutrients to normally healthy people than other methods (such as through diet or regular oral supplementation) and therefore would also provide superior health benefits more quickly than the same nutrients administered through other methods.
We considered consumers would understand that the nutrients delivered via a single IV drip would result in a one-off increase in the availability of those nutrients to be utilised by the body, whereas diet and oral supplementation provided a daily regular, ongoing source of those nutrients. However, consumers would be unlikely to have knowledge of how long the various nutrients administered via a single IV drip would be available for utilisation by the body or how long the claimed health benefit might therefore last. As a result they were likely to base their understanding of how long the health benefit might last on information in the ad, where relevant information was included. This could include, for example, references to a ‘course’ of drips or recommended frequency of administration, the overall impression created by the claims, the name of the drip or other elements of the ad.
We understood that human nutritional needs were complex, requiring different amounts of different nutrients at differing frequencies to ensure normal functioning of the body, and these needs varied from person to person depending on a range of factors such as biological sex, age, levels of physical activity and so on. Human nutritional needs were answered through diet and, in the case of vitamin D, exposure to the sun.
We took expert advice on what type and standard of evidence would be relevant to claims about the health benefits of IVNT drips.
The expert firstly referenced evidence for advertising claims about the health benefits of IVNT drips which did not include that IVNT would provide superior health benefits compared to diet or oral supplementation. For such claims, they advised that evidence relating to the health benefits of oral supplementation could be relevant to support claims relating to IVNT. Such evidence would, however, have to provide robust evidence of the correlation between a particular dose of a nutrient (i.e. the quantity provided, frequency of provision and duration of provision) and a particular health benefit. The IVNT drip would have to be of the same or greater dose than the oral supplement. The advertiser would have to demonstrate that the particular formulation of the drip did not include other nutrients or components which could adversely affect the effectiveness of the key nutrient (e.g. amino acids that bound to zinc or copper). They would also have to demonstrate that interaction with the gut microbiome was not necessary to achieve the health benefit, which may be the case for some nutrients such as polyphenols and glucosinolates.
The expert secondly referenced evidence for advertising claims that IVNT would provide superior health benefits compared to other methods of administration of the same nutrients, such as through diet or oral supplementation. IV administration would achieve peak plasma concentrations of a substance more quickly than oral administration, although the speed at which this was achieved would vary between nutrients. It also achieved 100% bioavailability under the pharmacological definition (the fraction of the administered drug that reached the systemic circulation), but there was a lack of consensus as to the definition of bioavailability in relation to nutrients. Consequently, they considered there was not sufficient evidence to support assertions that IVNT offered superior bioavailability compared to oral administration for all nutrients.
For claims that IVNT would provide superior health benefits to other methods of administration, they advised that evidence would need to relate to the immediate and superior efficacy of the specific drips the advertiser sold, or substances contained in them. Such evidence would ideally consist of appropriately designed RCTs comparing the health benefit effects of IVNT with a placebo drip and with oral supplementation with the same formulation and at the same dose. Alternatively, such evidence could consist of appropriately designed observational studies comparing reported or measured health end-points of users of IVNT with individuals who routinely took the same nutrients in a different form, at similar doses. Those studies would also have to be adequately controlled in terms of inclusion criteria and other likely mitigating variables. Such evidence should have clinically significant outcomes that were directly relevant to the health benefits claimed in the advertising. Evidence relating to the health benefits of regular oral supplementation would not be sufficient, but evidence relating to intramuscular injection could be, as its mode of delivery was similar to IV drip.
The expert further advised that evidence relating to the effects of nutrients on individuals suffering from a deficiency of that nutrient would not be relevant to claims about the health benefits of IVNT in normally healthy individuals, regardless of the method by which the nutrient was administered. Evidence relating to the effects of nutrients on individuals suffering from a medical condition that was not a nutrient deficiency could be adequate to support claims about the health effects of IVNT, whichever method of administration was used. However, such evidence would have to show that the provision of the nutrient led to improvements in a measure that was not related to the medical condition or to symptoms caused by side effects of any ongoing medical treatment. The expert understood that such evidence was likely to be scant.
The ASA understood that IV administration delivered 100% of a nutrient to the systemic circulation and achieved peak plasma concentrations more swiftly than via oral supplementation. However, we understood that the speed at which peak plasma concentration would be achieved varied between nutrients, and that a range of other factors, including the composition of the particular IV drip formulation, could affect the body’s use of those nutrients and the delivery of any health benefits.
We considered the type and standard of evidence we would expect to see, taking into account the context of how consumers would interpret the advertising claims as outlined above: that IVNT would provide a superior way of delivering essential nutrients than other methods to normally healthy people and therefore would also provide superior health benefits more quickly than the same nutrients administered through other methods.We therefore expected to see evidence which related to the immediate and superior efficacy of the specific drips sold by the advertiser, or drips with the same formulation and dosage as referenced in the ad (including regularity of administration), preferably in humans who were normally healthy. Evidence relating to people with a clinical nutrient deficiency or which examined the effects of a nutrient as a treatment for a medical condition would not be relevant to advertising claims directed at generally healthy consumers. Evidence relating to people with a medical condition would only be relevant if it clearly established that the measures by which health benefits were assessed were unrelated to either the medical condition or to symptoms caused by associated medical treatments. We expected all evidence, whether consisting of RCTs or observational studies, to be methodologically robust with clinically significant outcomes that were directly relevant to the health benefits claimed in the advertising.In addition to documentation provided by REVIV in support of their advertising, we also reviewed other evidence we had seen which related to the claims in their advertising.
Hydromax drip
The description for the Hydromax drip stated “BENEFITS – Restores Hydration – Rebalances Body Salts – Flushes Out Lactic Acid – Detoxification. BEST FOR – Optimal Athletic Performance – Recovery from Exhausting Activity – Dehydration. REVIV’s Hydromax IV therapy is used by athletes to hydrate before exhausting athletic activity and also post activity to properly rehydrate. Hydromax is also best for correcting general dehydration. Sport & fitness activity such as a marathon, triathlon, or MMA/cross-fit training, generates lactic acid build up in your muscles and depletes your body’s hydration. Besides restoring hydration, Hydromax IV therapy also delivers minerals, antioxidants and electrolytes to detoxify your body and reenergize you after exercise or general dehydration.”Given the context referenced above, we considered consumers would understand from the ad that hydrating via the Hydromax drip provided benefits over and above those provided through oral fluid intake (i.e. drinking water or electrolyte drinks) in ensuring adequate hydration in generally healthy people, particularly if it was administered shortly before or after undertaking strenuous physical activity. We considered consumers were likely to expect that these benefits would include achieving greater and more effective levels of hydration, more quickly, than could be achieved through oral fluid intake. In combination with the references to rebalancing body salts, flushing lactic acid and detoxifying the body, we considered consumers would also understand those benefits to include improved performance during sporting activity and generally quicker and more effective recovery from post-exercise fatigue than could be achieved through drinking water or electrolyte drinks, including reduced muscle pain and soreness over a shorter time period than they would otherwise have experienced.
REVIV had identified five documents in support of the claims for the Hydromax drip. We also reviewed additional documents they had provided, and other documents we had seen that we considered related to the claims as consumers would understand them and which related to the substances in the drip: saline, magnesium and NAC.
The medical manual chapter on volume depletion provided an overview of the condition and recommended that IV saline be given to patients with severe dehydration or when oral fluid replacement was impractical. A journal article provided an overview of the conditions hypernatremia and hyponatremia (abnormally high and low sodium levels) and recommended IV infusion as a treatment. The two articles referred to by REVIV in relation to the claims to flush lactic acid and detoxify the body described the conditions lactic acidosis and rhabdomyolysis and recommended IV saline as a treatment. A clinical review of febrile illnesses in athletes highlighted that fever could affect physical performance, was correlated with dehydration, and that participating in strenuous exercise with a fever could exacerbate dehydration. The journal article relating to the Myers’ Cocktail, provided by REVIV, included a reference to the IV infusion providing an “energy boost” for an athlete, but this was in the context of the drip being administered as treatment for a flu-like illness. Those documents focused on the use of saline as a treatment for medical conditions and therefore were not relevant to advertising claims aimed at generally healthy people experiencing normal levels of water and sodium loss, fatigue, muscle pain and soreness following strenuous physical activity.
A further study examined the impact of food intake on the gastrointestinal absorption and effectiveness of an anti-diuretic medicine. Saline IV drips were used to hydrate the healthy participants in a study design which, for the purpose of accurate measurement, required that participants did not drink anything (or eat anything other than specific meals) during the trial. We considered the study demonstrated the use of saline IV drips as a method of hydration by researchers but noted that IV administration was used rather than oral rehydration in order to make precise measurements relevant to the outcome measures of the study rather than having outcome measures relevant to the advertising claims.
A series of four articles described levels of dehydration in professional football players in Chile, how dehydration was thought to affect performance in training and matches, and strategies for recovery, although we had not been provided with full copies, in English, of two of those documents. A further article provided a general overview of research on hydration and health. The articles did not relate to hydration via IV drip and did not comment on whether there was greater value in IV drips over drinking water or electrolyte drinks for ensuring adequate hydration, including in the context of strenuous physical exercise.
REVIV had also provided a review article which looked at the role of NAC (and glutathione) on exercise-induced oxidative stress. The reviewed studies were largely conducted using IV administration of the substance, but the article did not contain sufficient information for us to evaluate their methodological robustness or relevance to the claims made in relation to the Hydromax drip.
An RCT investigating the effect of oral magnesium supplementation on physical performance in healthy elderly women involved in a weekly exercise programme over a three-month period did not blind participants. The key outcome measure saw a significant effect in the treatment group versus the control group, but because the study was not blinded, involved only elderly women and was based on oral supplementation, we considered it was not adequate to support advertising claims for an IV drip. We had also seen an RCT examining whether dietary zinc magnesium aspartate (ZMA) supplementation in resistance-trained men, administered during training, affected zinc and magnesium status, anabolic and catabolic hormone profiles and/or training adaptations. While we understood that ZMA contained zinc and vitamin B6 as well as magnesium aspartate, we nonetheless reviewed its relevance to the claims made in relation to the Hydromax drip. However, the RCT involved only a small number of participants, showed no significant differences in the results of its three outcome measures and related to a dietary supplement. We concluded it therefore was not adequate evidence to support advertising claims made in relation to an IV drip.
We considered the evidence demonstrated that maintaining adequate levels of hydration was important to the normal functioning of the body, but that it did not demonstrate that IV drips provided benefits over and above oral fluid intake in maintaining (or restoring) adequate levels of hydration in normally healthy people undertaking either normal levels of physical activity or particularly strenuous activity. Nor did the evidence demonstrate that administering the Hydromax drip shortly before or after strenuous exercise would deliver improved performance or quicker and more effective recovery, including reduced muscle pain and soreness.
Ultraviv drip
The description of the Ultraviv drip stated “BENEFITS – Restores Hydration […] Delivers an Energy Boost. BEST FOR […] – REVIV’s Ultraviv Recovery IV therapy is formulated to replenish hydration […]. The elements of life can leave you susceptible to feeling run down. While Ultraviv replenishes your body’s hydration level it also adds vital minerals, antioxidants, electrolytes and vitamins […] Ultraviv provides an energy boost that will return you to feeling like your former self. FAST RECOVERY”. We considered consumers would understand from those claims that the drip would provide an increase in levels of energy for people who were generally healthy but who were feeling tired and rundown due to their lifestyle. In the context of the refences to a “boost”, “feeling run down” and “FAST RECOVERY”, we considered consumers were likely to expect those benefits to last a few days to a short number of weeks.
REVIV had referenced seven documents in relation to energy boosting and hydration in support of the advertising claims. We also reviewed other documents we had seen which related to the substances included in the drip (vitamin B12, vitamin C, magnesium and NAC) and which related to the claims in the ad as consumers would understand them.
We assessed the same evidence relating to hydration that we reviewed in relation to the claims for the Hydromax drip to determine whether it supported claims that the Ultraviv drip would provide increased energy. This included two of the documents REVIV had provided specifically to support claims that the Ultraviv drip could provide an energy boost. While, as referenced above, we considered the evidence demonstrated that maintaining adequate levels of hydration was important to the normal functioning of the body, including in maintaining normal energy levels, it did not demonstrate that IV drips improved energy levels in normally healthy people.
The additional document provided by REVIV specifically in relation to the ‘energy boost’ claim was a review article relating to vitamin B12. We had also seen a further three review articles in relation to vitamin B12. The articles summarised the causes and health implications of vitamin B12 deficiency and confirmed its importance for the normal functioning of the body, particularly the nervous system and blood cell formation. They also highlighted the need to maintain adequate levels in the body, particularly for vegans and vegetarians who were more likely to have inadequate levels of vitamin B12 in the body as it was primarily found in animal products. However, the articles did not support claims that an IV infusion of vitamin B12 could increase energy levels in generally healthy people.
We had seen three documents relating to the effects of vitamin C on energy/fatigue levels. An article examined data from a largescale observational study (20,000 participants) in the UK to identify risk factors for vitamin C deficiency and found a correlation between low vitamin C levels and self-reported poorer physical health. Risk factors were: being older, male, of lower socioeconomic status and educational attainment, no alcohol intake, being a smoker, and having low levels of physical activity. The authors reported that the findings suggested that vitamin C supplementation was likely to only have an impact on those with the lowest levels of vitamin C and we considered that many of the risk factors they identified for low vitamin C levels were less likely to be present in the audience for the ad. A further study assessed the effects of 6g of oral vitamin C on fatigue in normally healthy office workers over a period of two weeks, but because it was not controlled or blinded and did not relate to IV administered vitamin C it was not adequate evidence for advertising claims relating to IV vitamin C.
Finally, an RCT examined the effects of an IV drip containing 10mg of vitamin C on fatigue and oxidative stress in normally healthy office workers in the Republic of Korea. The RCT was randomised, placebo-controlled and double-blinded: 73 were in the treatment group and 74 in the control group, who were administered IV saline only. Participants were aged between 20 and 49 years and had no vitamin supplement intake in the two days before enrolment in the study. Each participant was administered one drip. The primary outcome measures were the differences in self-reported fatigue score at two hours and at one day after the intervention, comparing between the groups. Secondary outcome measures were between-group comparisons of oxidative stress levels at two hours and at one day after the intervention, and a between-group comparison of plasma vitamin C concentration at two hours after intervention. The authors reported that fatigue score was significantly decreased in the vitamin C group compared to the placebo group at both two hours and one day after intervention, although this was evident in subjects with a lower vitamin C level at baseline, but not for those with a higher level. However, the fatigue score was reported on a zero to ten scale and the difference between mean score for the groups was, even specifically for those with lower vitamin C levels at baseline, only 0.43 at two hours after intervention and 1.14 one day after intervention. We considered the study did not demonstrate that such differences on a ten-point scale constituted a clinically significant difference. The authors also reported that oxidative stress was lower in the treatment group at two hours compared to the placebo group, but not at one day. They concluded that there was no significant relationship between fatigue and oxidative stress. While the RCT was well-designed, we considered its findings did not constitute adequate evidence that a vitamin C IV drip of any dose improved energy levels or decreased fatigue.
We had also seen a journal article which described the Myers’ Cocktail (which included vitamin C) providing an energy boost to an athlete with a flu-like illness. We had seen one RCT relating to magnesium and one RCT relating to ZMA (which contained magnesium), and a review article relating to NAC which had some relevance to claims about energy levels. As referenced in our review of those documents in relation to the Hydromax drip, those documents were not adequate to support such advertising claims.
We concluded the evidence was not adequate to support claims that the Ultraviv drip would provide, over any period of time, increased levels of energy for people who were generally healthy, but who were feeling tired and rundown because of their lifestyle.
Megaboost drip
The description of the Megaboost drip included the claims “BENEFITS – Restores Hydration – Replenishes Essential Minerals & Vitamins – Delivers A High Dose Of Vitamin C – Antioxidant Therapy – Boosts Immune System – Detoxifies Your Body – Adds an Energy Boost. BEST FOR – Maintain Good Health & Wellness – Strengthen Your Immune System – Increase Vitality […] This hydrating vitamin and nutrient IV contains an extra high dose of Vitamin C coupled with minerals, antioxidants and electrolytes aimed to boost the immune system, detoxify the body and increase strength and energy. Megaboost is an enhanced Myers’ Cocktail formulated as a comprehensive IV therapy for maintaining good health & wellness […] and boosting the immune system […]”.We considered many consumers would be aware that vitamin C contributed to the normal functioning of the immune system, and of its purported benefits in preventing or helping to treat illnesses, particularly viral illnesses such as colds and flu. In that context we considered they would understand from the references to the drip containing a “high dose” of vitamin C, in conjunction with the references to the drip ‘boosting’ and ‘strengthening’ the immune system, that a single drip would provide an improvement in the functioning of their immune system. We considered there was nothing in the ad that indicated how long those benefits may last, and consumer expectations of the longevity of the benefits would therefore likely range from days to weeks.
We considered consumers would also understand from the ad that a single drip would provide better hydration above other methods of hydrating (i.e. drinking water), that it would provide a short-term improvement in the body’s ability to remove toxins, in the body’s ability to combat oxidative stress, and that it would provide a short-term increase in energy levels and strength.
We further considered that consumers would understand from the claim that the drip was “formulated as a comprehensive IV therapy for maintaining good health & wellness…” that regular administration of the drip would ensure that the various claimed health benefits would be maintained over time.
REVIV had referred to two documents in support of the claim “Antioxidant Therapy”, two in relation to the claims to boost the immune system, and one in relation to the drip’s claimed detoxifying effect. We also reviewed other documents we had seen which related to substances included in the Megaboost drip (vitamin B12, vitamin C, NAC, and vitamins B6, B3, B1 and B2) which related to the claims made in the ad.
We had already reviewed documents relating to advertising claims that substances in REVIV’s drips would provide better hydration above other methods of hydrating, improve the body’s ability to remove toxins and provide an increase in energy levels. For the reasons already stated, we concluded that evidence was not adequate to support such claims for IV drips. For the same reasons those documents also did not support claims that an IV drip could increase strength, and we had not seen other relevant evidence relating to strength.
In relation to the role of vitamin C in the immune system, REVIV referred to the abstract of a journal article and a literature review. We had seen a further five literature reviews relating to vitamin C and its role in immune function (two of which also discussed the role of certain B vitamins in immunity, referenced below). We had also seen four documents relating to the role of vitamin C in medical conditions: a literature review which described the chemical and biochemical processes by which high dose IV vitamin C might have an impact as a cancer treatment; a study that examined the action of ascorbate on cells infected with HIV; an article about the role of vitamin C in the prevention and treatment of Covid-19; and a small, prospective study on the effects on quality of life in cancer patients of IV vitamin C. A further study examined whether high-dose vitamin C oral supplementation impacted on the steady-state concentration of a drug used to treat HIV. We considered that the literature reviews together confirmed that research had established that vitamin C was important to the normal functioning of the immune system due to its role in protecting cells against oxidative stress, and one stated that epidemiological studies had shown that eating fruit and vegetables could help to protect against some diseases although that could not be directly attributed to vitamin C. However, neither the reviews nor the documents relating to the role of vitamin C in the treatment or prevention of medical conditions were sufficient evidence that vitamin C IV infusions could help improve the functioning of the immune system in normally healthy people. The abstract did not provide sufficient information for us to assess its relevance.In relation to the B vitamins in the drip and their role in the functioning of the immune system, we had seen a textbook chapter about vitamin B2 deficiency, and four articles and a literature review which variously provided information about the immune-related functions of vitamins B1, B2, B3, B5, B6 and B12 (as well as vitamin C and other vitamins and minerals not included in the Megaboost drip). We had also seen four other documents relating to the causes and health implications of vitamin B12 deficiency, as described above in relation to the Ultraviv drip. Additionally, the article referenced above about the role of vitamin C in the prevention and treatment of Covid-19 also discussed the role of vitamins B1, B2, B3 and B6 in the prevention and treatment of that disease. We considered those documents confirmed that B vitamins played a role in immune function, but they were not sufficient or relevant evidence that an IV drip containing those nutrients improved the functioning of the immune system in normally healthy people. We had not seen any evidence relating to the role of NAC in immunity.
With regard to the claim that the Megaboost drip improved the body’s ability to combat oxidative stress, we reviewed the literature review and journal article referred to by REVIV as well as other documents we had seen that related to oxidative stress and substances which were included in the drip. This included the two documents relating to the effects of NAC referenced above, the RCT referenced above in relation to the Ultraviv drip, which examined the effects of a vitamin C IV drip on fatigue and oxidative stress, and two literature reviews relating to the role of vitamin C in ageing and Alzheimer’s disease.
The journal article featured anecdotal accounts of a doctor’s experience of using the Myers’ Cocktail in their treatment of patients with a range of medical conditions, the study abstract related to participants who were using NAC and who had a high risk of a second occurrence of primary lung cancer, and the literature reviews focused on the possible role of oxidative stress in the development of Alzheimer’s disease. Because those documents related to the role of substances in the Megaboost drip in the treatment or prevention of medical conditions rather than to health benefits in generally healthy people we considered they were not relevant to support the claims in the ad.
As referenced above in relation to the Hydromax drip, the review article which looked at the role of NAC (and glutathione) on exercise-induced oxidative stress did not provide sufficient information for us to evaluate the methodological robustness of the referenced trials or their relevance to the claims made in relation to the Megaboost drip. It noted that one study which administered vitamin C and NAC together via oral supplementation saw negative effects on oxidative stress. The literature review provided by REVIV was one of those we had also reviewed in relation to vitamin C’s role in immune function, and while the RCT showed a decrease in oxidative stress in the treatment group at two hours compared to the placebo group, this was not maintained at one day. The effect therefore could not be confirmed as having anything other than a very temporary effect and the paper included only a limited amount of analysis about this secondary outcome measure. We considered the evidence confirmed the role of vitamin C in protecting against oxidative stress, but did not demonstrate that IV infusion of vitamin C improved the body’s ability to combat oxidative stress.
We concluded the evidence was not adequate to support claims that the Megaboost drip could provide better hydration above other methods of hydrating. We concluded the evidence also was not adequate to support claims that the Megaboost drip would, over any time period, improve the body’s ability to remove toxins and combat oxidative stress, provide an increase in energy levels and strength, or improve the functioning of the immune system and therefore provide greater protection against infection and disease.
Vitaglow drip
The description for the Vitaglow drip stated “REVIV’s Vitaglow Anti-Aging IV therapy contains a high dose of the master antioxidant Glutathione as well as Vitamin C to help detoxify the body from damaging free radicals and improve the appearance of hair, skin and nails. The ageing process is inevitable and associated with various metabolic changes like declining Glutathione levels your body [sic]. Glutathione acts as the master antioxidant which detoxifies your body and promotes cellular repair. This rejuvenating infusion is typically delivered in 10 minutes or less, giving your body and skin a quick refreshment to help stop time in it’s [sic] tracks” and “SKIN GLOWING”. It also featured bullet points which made similar claims in relation to the drip’s detoxification, antioxidant and anti-ageing benefits, and its benefits for skin, hair and nails.
We considered consumers would understand from those claims that the drip would have a general anti-ageing effect on the body and specifically that the appearance of hair, skin and nails would improve as a result of the drip’s antioxidant and detoxifying effects that were delivered particularly by the glutathione and vitamin C in the drip. We considered there was nothing in the ad that indicated how long those benefits may last, and consumer expectations of the longevity of the benefits would therefore likely range from days to weeks.
In addition to the claims on the Vitaglow web page relating to the appearance of skin, at the bottom of the web pages for the Hydromax and Royal Flush drips there was an image of an East Asian woman accompanied by the linked text “GLUTATHIONE THERAPY […] Glutathione is an anti-oxidant commonly used for skin lightening. IV Glutathione is used as therapy by some and for detoxification”. We understood that many consumers interested in IV drips advertised for skin health would be aware that glutathione was purported to have skin lightening properties. In that context we considered consumers would understand that REVIV’s drip which included glutathione (Vitaglow) could, in the short-term, lighten skin pigmentation.
We reviewed the evidence firstly in relation to whether it supported claims that the Vitaglow drip had an anti-ageing effect, particularly by improving the appearance of skin, hair and nails, and secondly in relation to whether it supported claims that the Vitaglow drip could change skin pigmentation. We understood that the drip contained only saline, vitamin C, glutathione and NAC so we considered only evidence which related to the effects of those substances.
REVIV had provided six documents with regard to the effects of glutathione but the majority did not specifically relate to general anti-ageing effects on the body or more specifically to the appearance of hair, skin and nails. The review article they provided which summarised the role of glutathione in the body, described how it was produced by the body from other, ingested, substances. We considered it established the importance of glutathione in the normal functioning of the body, including that it had a role in protecting cells from oxidative stress. It noted that the rate at which glutathione was produced and used by the body meant that in healthy adults, glutathione was used less than two days after it was produced. A further article we had seen also gave an overview of the antioxidative protective roles, measurement and biosynthesis of glutathione, including noting some of its therapeutic uses. However, neither article provided information about the usefulness of direct glutathione supplementation by IV infusion and whether, if increased levels were delivered by such methods, it would have any additional benefits to health, such as having an anti-ageing effect and improving the appearance of hair, skin or nails. They also did not comment on whether there was evidence that glutathione had an effect on skin pigmentation.
A one-month trial in which 12 participants aged between 50 and 80 years were given oral glutathione, measured whether it increased levels of glutathione in the body and its effects on oxidative stress and immune function markers. Another study made in vitro assessments of the stability and bioavailability of different formulations of oral glutathione supplements, with an assessment of the glutathione levels achieved in rats following oral administration of those supplements. Those studies were not relevant to the health effects of IV-administered glutathione.We further noted that the review article REVIV provided, which looked at the roles of glutathione and NAC on exercise-induced oxidative stress, did not relate to those substances’ anti-ageing effects, efficacy in improving the appearance of nails, hair or skin or in changing skin pigmentation. It also stated that oral supplementation was an ineffective way of providing glutathione and that one study which administered vitamin C and NAC together via oral supplementation saw negative effects on oxidative stress. An abstract stated that glutathione played a crucial role in the detoxification of xenobiotics, but provided no further detail and referred to a large study investigating the long-term daily usage of NAC supplementation in high-risk individuals to prevent a second occurrence of primary lung cancer. Another document related to the use of glutathione in treating ovarian cancer. The abstract was not adequate to support advertising claims, and both documents related to the roles of those substances in the prevention or treatment of cancer and therefore were not relevant in supporting anti-ageing claims and claims about the appearance of skin, hair and nails in normally healthy people.
We had seen five documents which related to the effects of glutathione on skin appearance and condition, and/or its skin lightening effects, two of which were provided by REVIV. The first related to glutathione oral supplementation and skin lightening and was provided in abstract form only. The second related to the topical application of glutathione for skin condition and skin whitening. A literature review, published in 2016, stated that there were no RCTs that looked at the skin lightening effects of IV glutathione despite its common use for that purpose, and that there were only two RCTs relating to its efficacy for skin lightening via oral supplementation (one of which was the abstract provided by REVIV), and one relating to its topical application (as provided by REVIV). Two further RCTs on the antimelanogenic and anti-ageing effects of oral glutathione supplementation post-dated the review. We considered that evidence relating to oral supplementation and topical application of glutathione were not adequate to support advertising claims for glutathione IV drips.
We also assessed whether documents REVIV had provided in relation to vitamin C was relevant to the claims made about the Vitaglow drip, as well as other documents we had seen which related to the effects of vitamin C for anti-ageing and the appearance of skin, hair and nails. We had assessed evidence relating to the antioxidant effects of vitamin C in relation to the Megaboost drip. Three documents REVIV provided in relation to the effects of vitamin C all related to its role in the immune system so were not relevant to claims for the Vitaglow drip. The journal article they provided, which was about the Myers’ Cocktail (a key component of which was vitamin C) did not relate to anti-ageing or its efficacy in improving the appearance of hair, skin or nails. We had also seen a review of literature surrounding the roles of vitamin C in skin health. It compared the efficacy of oral supplementation to that of topical application, but did not refer to any research into the efficacy of IV vitamin C, and it summarised that there was little evidence concerning a relationship between vitamin C and general skin ageing although there was some evidence that general good nutrition led to better skin condition.
We had not seen adequate evidence that glutathione, NAC and vitamin C – alone or in combination – had, over any time period, an anti-ageing effect on the body, could improve the appearance of skin, hair or nails, or have an effect on skin pigmentation. We concluded that such claims in the ad for the Vitaglow drip had not been substantiated and were misleading.
Royal Flush drip
The description for the Royal Flush drip included the claims “BENEFITS – Restores Hydration – Replenishes Essential Minerals & Vitamins – Boost Your Immune System […] – Delivers Energy Boost – Detoxifies Your Body – Cleanses Vital Organs”. Claims also included that the drip combined “the benefits of Ultraviv, Megaboost and Vitaglow”, delivered “additional wellness” and was the “top choice for […] anyone that is completely worn out and exhausted.”
We considered that consumers would understand from the ad that the particular formulation of the Royal Flush drip would provide the health benefits of better hydration above other methods of hydrating, improvements in the functioning of the immune system, an increase in energy and an improvement in the body’s ability to remove toxins. We considered there was nothing in the ad that indicated how long those benefits may last, and consumer expectations of the longevity of the benefits would therefore likely range from days to weeks.
The ad also referred to “the benefits of Ultraviv, Megaboost and Vitaglow”. We considered consumers would therefore also understand that the drip would deliver the same health benefits as described in the web pages relating to the Ultraviv, Megaboost and Vitaglow drips, as laid out above, as associated with the particular substances in those drips which were also included in the Royal Flush drip. We considered consumers would further understand from the ad that because the Royal Flush combined the benefits of those drips, and because it delivered “additional wellness” it provided a greater overall general benefit to health than the other drips on their own.
We understood the Royal Flush drip included all the substances which were used in REVIV’s other drips in various combinations: saline, vitamins B1, B2, B3, B6, B12 and C, magnesium, NAC and glutathione.
We had already reviewed evidence relating to the claimed benefits of certain substances included in REVIV’s other drips. However, we had not yet reviewed evidence relating to the effects of vitamins B1, B2, B3, B6, B12 and C on hydration, the effects of magnesium and glutathione on immune function, the effects of glutathione on energy or the effects of vitamins B1, B2, B3, B6, B12 and C and magnesium and glutathione on the removal of toxins from the body.
We had not seen evidence relevant to claims that vitamins B1, B2, B3, B6, B12 and C improved the body’s ability to remove toxins (other than that reviewed above in relation to the role of those vitamins in the immune system and their effects on oxidative stress). We also had not seen evidence relating to the role of those vitamins in providing better hydration above other methods of hydrating.
We had reviewed seven documents relating to the role of glutathione as an antioxidant in relation to the Vitaglow drip, which were also of some relevance to claims about immune function and the removal of toxins from the body. However, the documents provided were not adequate to support claims that IV-administered glutathione could improve the functioning of the immune system or improve the body’s ability to remove toxins. We had not seen any evidence that IV-administered glutathione increased energy levels.
With regard to the role of IV-administered magnesium in immune function and the removal of toxins, we had not seen any evidence relating to the latter. We had seen a literature review relating to the role of various micronutrients, including magnesium, in immune function and an article relating to the role of various vitamins and minerals, including magnesium, in the prevention and treatment of Covid-19. The documents confirmed that those vitamins and minerals played a role in immune function, but they were not sufficient or relevant evidence that an IV drip containing those nutrients improved the functioning of the immune system in normally healthy people.
As discussed above, we also had not seen adequate evidence that the Ultraviv, Megaboost and Vitaglow drips delivered any of the health benefits described in descriptions for those drips, nor had we seen evidence that the Royal Flush drip delivered a greater overall benefit than those drips on their own. We concluded we had not seen sufficient evidence to support the claims for the Royal Flush drip.
Because we had not seen evidence which was adequate to support the advertised health benefits of the IV drips, or the substances in them when delivered by IV infusion, we concluded that the claims were misleading and breached the Code.
The ad breached CAP Code (Edition 12) rules 3.1 (Misleading advertising), 3.7 (Substantiation) and 12.1 (Medicines, medical devices, health-related products and beauty products).
Action
The ad must not appear again in the form complained of.
We told REVIV UK Ltd not to make any claims, explicit or implied, that their IV drips or the substances in them could provide any health benefits, over any period of time, until such time as they held evidence relating to the use of IV drips in normally healthy humans that was adequate to support such claims. This included, for example, stated and implied claims that the drips or the substances in them could: increase energy levels and physical performance; provide quicker and more effective recovery from strenuous exercise; provide better hydration than other methods in normally healthy people; improve the body’s ability to remove toxins and combat oxidative stress; improve the functioning of the immune system; improve the appearance and health of skin, hair and nails; have an anti-ageing effect; or change skin pigmentation.
