IV Hydration: Science or Pseudoscience?

This article was originally published in the October/November 2025 issue of UltraRunning Magazine. Subscribe today for similar features on ultra training, racing and more.

Congratulations! You just finished an ultra and are deservedly stiff, sore and exhausted. A perky person at the finish line, acknowledging your post-race waddle, hands you a business card complete with a cute name and fun logo. You are directed to a tent (shade) with reclining chairs (rest) offering intravenous (IV) rehydration therapy. This tent is not the official medical tent of the race, providing treatment for sick runners, but a spa-like atmosphere which allows you to personalize your own “treatment plan” including a host of vitamin, electrolyte and supplement-infused cocktails guaranteed to enhance recovery (by boosting immunity, maximizing hydration, eliminating toxins, etc.). The typical cost for these “restorative” IV therapies ranges between $300-$600 (1), but on race day, they’re offering their services free for finishers.

If these intravenous magical elixirs sound “too good to be true,” it’s because they are. In short, the proposed health, wellness and recovery benefits largely represent overpriced placebo effects that offer more harm than good. As doctors and scientists, we aim to distinguish between science and pseudoscience, and we hope to persuade you to reject IV hydration and adopt a safer, more effective “food first” approach (2).

In the United States, wellness spas and clinics offering IV therapies are largely unregulated (1). Unlicensed and unqualified individuals can administer infusions in many states without additional regulatory standards for preparing these infusion products (1). This recently changed in Texas, where the Senate passed “Jenifer’s Law” (3) in response to the death of Jenifer Cleveland, who died after receiving intravenous therapy by an unlicensed individual without training or medical supervision (3). In Texas, “med spas” are now classified as medical practice settings with the same regulatory standards as traditional medical practices (3), including physician oversight and supervision of such treatment after a medical evaluation and written treatment plan. However, even with this physician oversight, we still strongly recommend against visiting these facilities. Often, the “medical director” isn’t onsite and only oversees the protocols. There is often no pre-IV lab testing being done to truly see if you are deficient in anything (which typically, you aren’t). Sadly, the goal of these facilities is to sell you something you don’t need.

The potential risks from IV therapy range from minor complications (from the invasive nature of needlesticks) to life-threatening emergencies (from fluid overload hyponatremia). Improper or dirty (unsterile) use of needlesticks carries risk of infection, thrombophlebitis, bleeding, hematoma, arterial puncture, soft tissue infiltration and/or air embolism (4). In a study looking at the National Football League (NFL), almost half of the teams that had given players IV fluids reported at least one complication (5). In an overhydrated individual, administration of IV fluids can worsen (6) the morbid consequences of water intoxication (dilutional hyponatremia), particularly if electrolytes are not measured before IV resuscitation. In rare instances, the administration of isotonic saline without prior knowledge of blood sodium concentrations has led to the tragic deaths of marathon runners competing in the Marine Corps (7), Boston (8) and London (9) Marathons. Thus, the risks of IV therapy (outside of medical care, directed by a physician with appropriate evaluation and testing) are not harmless and may even prove fatal.

There are medical indications for the administration of IV fluids, which primarily include athletes with documented cellular dehydration (hypernatremia) coupled with an inability to tolerate fluids by mouth (10) due to gastrointestinal distress. This treatment is usually rendered under the direct medical supervision of a physician (4), and only after electrolytes have been measured, before the facilitation of supportive IV resuscitation. With that said, there are no clear medical, recovery or performance advantages for IV fluid therapy over oral rehydration, especially since IV rehydration bypasses the immune-protective gut-liver axis (2) and oropharyngeal receptor modulation (11) of thirst perception and anti-diuretic hormone secretion.

Therefore, according to the current scientific evidence, IV infusions have been included within the World Anti-Doping Agency’s (WADA) prohibited substances list since 2018 (12). WADA has essentially banned these, not because they have health benefits, but because IV fluids dilute blood samples to elude drug testing. Additionally, the American College of Clinical Pharmacology (ACCP) released a position statement in 2024 (1) concluding that “there is little to no evidence that the benefits outweigh the risks for hydration and vitamin infusions.” Specific to sport, a 2022 editorial (2) promoted amplification of “food first” and “no needle” messaging, also concluding that IV therapy is “…without scientific evidence of benefit” (2).

Here is another question to consider: how is getting IV fluids considered “holistic or natural”? The idea of sticking a large needle into one’s arm for something with no scientific benefit is in no way natural. Humans have survived for thousands of years without IV hydration. Listening to your body and your thirst to determine when you should drink is still the best way to stay hydrated. Are you worried about your vitamins and minerals? Spend your money with a local farmer to eat more fresh fruits and vegetables instead of having some lab-formulated vitamin pumped into your arm. Frankly, as medical professionals, we’re shocked to see the proliferation of these IV spas popping up all over the country. We have several patients with serious medical conditions, including cancer, who, unfortunately, must go to infusion centers for their treatment. These people would do almost anything not to have to get an IV. Maybe it’s because of our experience with patients who have serious and life-threatening medical issues that the idea of people cavalierly signing up for this completely unnecessary and potentially harmful therapy seems so egregious.

Finally, if you are a race director or race organizer, we beg you: please do not allow these companies to sponsor your events and/or set up at the finish line. While we recognize that races don’t necessarily endorse all of their sponsors, hosting an IV spa at your race expo or finish line provides these companies with visibility and the opportunity to target unsuspecting athletes.

If you’re feeling overly stiff, sore and fatigued, and you’re looking for the best recovery strategy, consider saving that extra cash and splurging on real food and healthy beverages. There are zero scientifically validated medical, recovery or performance advantages for using IV (re)hydration over oral (re)hydration strategies and the potential harms of IV therapy clearly outweigh any benefit beyond a placebo effect. Be smart and save yourself some money and a poke in your arm.

References

IV Hydration: Science or Pseudoscience?

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