Energy IV

Full ingredient list

Exact amounts delivered in each size. Formulas are compounded per patient and can be adjusted by your provider.

Supporting studies

• 1

  L-carnitine is the molecule that physically carries long-chain fats across the mitochondrial membrane — without it, cells cannot burn fat for energy.

  This peer-reviewed review details how carnitine is essential for transferring long-chain fatty acids across the inner mitochondrial membrane so they can undergo beta-oxidation and generate ATP. Carnitine enters cells through the high-affinity OCTN2 transporter; when that transporter is defective, intracellular carnitine falls and fatty acid oxidation is impaired, producing low blood sugar without ketones, muscle weakness and cardiomyopathy. The review also notes that at higher supplemental doses carnitine can enter cells through alternative lower-affinity transporters. This is the mechanistic basis for using carnitine as an energy and fat-metabolism nutrient.

  Mechanistic review Longo N, Frigeni M, Pasquali M Carnitine transport and fatty acid oxidation. Biochimica et Biophysica Acta - Molecular Cell Research. 2016. PMID 26828774 ↗

• 2

  In randomized placebo-controlled trials, intravenous L-carnitine raised plasma carnitine and significantly reduced fatigue in dialysis patients at both 12 and 24 weeks.

  Brass and colleagues report two randomized, placebo-controlled trials of intravenous L-carnitine (20 mg/kg, and a dose-ranging arm of 10, 20 or 40 mg/kg) given after hemodialysis sessions for 24 weeks. IV L-carnitine raised plasma carnitine concentrations and significantly improved the fatigue domain of the Kidney Disease Questionnaire versus placebo at 12 weeks (P = 0.01) and 24 weeks (P = 0.03). A secondary analysis also showed less deterioration in peak oxygen consumption in carnitine-treated patients. This is direct human evidence for intravenously administered carnitine improving fatigue.

  Randomized controlled trial Brass EP, et al. Intravenous L-carnitine increases plasma carnitine, reduces fatigue, and may preserve exercise capacity in hemodialysis patients. American Journal of Kidney Diseases. 2001. PMID 11325685 ↗

• 3

  A meta-analysis of randomized trials found L-carnitine significantly reduced muscle soreness after exercise at every time point measured, from immediately after through 96 hours.

  This systematic review and meta-analysis pooled seven randomized clinical trials of L-carnitine supplementation and markers of exercise-induced muscle damage in healthy adults. L-carnitine significantly reduced muscle soreness at 0, 24, 48, 72 and 96 hours post-exercise, and lowered the muscle-damage markers creatine kinase, myoglobin and lactate dehydrogenase at 24 hours. Benefits were most apparent in resistance-training and untrained populations. Trials used oral supplementation.

  Systematic review and meta-analysis Yarizadh H, et al. The Effect of L-Carnitine Supplementation on Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Journal of the American College of Nutrition. 2020. PMID 32154768 ↗

• 4

  Vitamin C is a required cofactor for building carnitine, the molecule that shuttles fat into cells to be burned for energy.

  This review documents that ascorbate serves as a cofactor for two alpha-ketoglutarate-dependent dioxygenase reactions in the carnitine biosynthesis pathway: epsilon-N-trimethyllysine hydroxylase and gamma-butyrobetaine hydroxylase. Because carnitine is required for cells to generate metabolic energy from fat, the author notes this link has been proposed to explain the fatigue and weakness that characterize vitamin C deficiency. Evidence from enzyme preparations, perfused liver, and in vivo animal models is described as compelling support for ascorbic acid's participation in carnitine synthesis.

  Mechanistic review with enzyme and preclinical data Rebouche CJ Ascorbic acid and carnitine biosynthesis. The American Journal of Clinical Nutrition. 1991. PMID 1962562 ↗

• 5

  A B-complex increased exercise endurance by 26% and lowered the blood lactate and ammonia that drive the feeling of fatigue.

  In a randomized, double-blind crossover trial, 32 healthy non-athlete adults aged 20-30 took a daily B-complex tablet (B1 33.6 mg, B2 10 mg, B6 50 mg, B12 750 mcg, plus vitamin E, inositol and taurine) or placebo for 28 days, with a 14-day washout between arms. Running time to exhaustion increased 1.26-fold versus placebo (p < 0.0001), and blood lactate and blood ammonia concentrations during exercise were significantly lower (p < 0.05). No adverse effects were reported. Route was oral.

  Randomized controlled trial (double-blind crossover) Lee MC, et al. A functional evaluation of anti-fatigue and exercise performance improvement following vitamin B complex supplementation in healthy humans, a randomized double-blind trial. International Journal of Medical Sciences. 2023. PMID 37786445 ↗

• 6

  A high-dose B-complex improved vigor, reduced mental tiredness and lowered stress ratings in 215 working adults.

  This randomized, placebo-controlled, double-blind trial enrolled 215 healthy men aged 30-55 in full-time employment and gave them a high-dose B-vitamin complex with vitamin C and minerals, or placebo, for 33 days. The supplemented group showed significantly improved ratings of stress, better mental health scores, and greater vigor, along with improved Serial 3s subtraction performance and reduced mental tiredness both before and after cognitive testing. The authors concluded that 'healthy members of the general population may benefit from augmented levels of vitamins/minerals.' Route was oral.

  Randomized controlled trial Kennedy DO, et al. Effects of high-dose B vitamin complex with vitamin C and minerals on subjective mood and performance in healthy males. Psychopharmacology (Berl). 2010. PMID 20454891 ↗

• 7

  Thiamine (B1) is the cofactor that lets your cells convert fuel into usable energy — and repletion is fast, safe and can be dramatic.

  This clinical review describes thiamine as 'an essential nutrient critical for energy metabolism,' explaining that thiamine diphosphate is the required cofactor for pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase and transketolase — the enzymes that carry glucose into the Krebs cycle and generate ATP. The authors note that deficiency can appear in many non-alcohol settings including gastrointestinal disorders, bariatric surgery and hyperemesis, that it is frequently unrecognized, and that it is easily treatable, with prompt repletion capable of being life-saving. Parenteral thiamine is the standard route in acute repletion.

  Clinical review Schostak T, San Millan I, Jani A, Johnson RJ Thiamine deficiency: a commonly unrecognised but easily treatable condition. Postgraduate Medical Journal. 2023. PMID 37125640 ↗

• 8

  Thiamine supplementation significantly improved heart pumping function in a double-blind, placebo-controlled crossover trial.

  Nine patients with symptomatic chronic heart failure on long-term diuretics (baseline ejection fraction under 40%) were randomized in double-blind, placebo-controlled crossover fashion to 300 mg/day of thiamine or placebo for 28 days each, separated by a 6-week washout. Left ventricular ejection fraction rose to 32.8% on thiamine versus 28.8% on placebo — an absolute 3.9-point improvement (p = 0.024) from an identical 29.5% baseline. The authors concluded that subclinical thiamine deficiency is underrecognized in diuretic-treated patients and that repletion benefits cardiac function. Route was oral.

  Randomized controlled trial (double-blind, placebo-controlled crossover) Schoenenberger AW, et al. Thiamine supplementation in symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled, cross-over pilot study. Clinical Research in Cardiology. 2012. PMID 22057652 ↗

• 9

  Niacin (B3) raised blood NAD+ up to eight-fold and increased muscle strength in a human clinical trial.

  In this clinical trial published in Cell Metabolism, adults with adult-onset mitochondrial myopathy and matched healthy controls took escalating niacin doses of 750-1000 mg/day (10 months for patients, 4 months for controls). Blood NAD+ rose up to 8-fold, muscle NAD+ in patients normalized to control levels, and muscle strength and mitochondrial biogenesis increased in all subjects. Muscle metabolite profiles shifted toward the healthy control pattern and liver fat decreased. This is direct human evidence that niacin is the working precursor that refills the NAD+ pool driving cellular energy production. Route was oral.

  Clinical trial (human interventional, with mechanistic analyses) Pirinen E, et al. Niacin Cures Systemic NAD+ Deficiency and Improves Muscle Performance in Adult-Onset Mitochondrial Myopathy. Cell Metabolism. 2020. PMID 32386566 ↗

• 10

  Magnesium is a required cofactor for more than 600 enzyme reactions, including the ones that produce and use cellular energy.

  This comprehensive physiology review in Physiological Reviews describes magnesium as the second most abundant intracellular cation and an ion 'essential to the human body,' involved in over 600 enzymatic reactions including energy metabolism and protein synthesis. It maps how magnesium is absorbed, stored in bone and muscle, and regulated by the kidney, and why adequate magnesium status underpins normal nerve, muscle and metabolic function. This is the standard reference for magnesium's foundational biochemical role.

  Comprehensive physiological review (mechanistic) de Baaij JHF, Hoenderop JGJ, Bindels RJM Magnesium in man: implications for health and disease. Physiological Reviews. 2015. PMID 25540137 ↗

• 11

  A double-blind randomized trial in 141 healthy adults found a single 10-gram IV vitamin C infusion measurably reduced fatigue within two hours — and the effect lasted a full day.

  Healthy office workers aged 20 to 49 were randomized double-blind to receive either 10 grams of vitamin C in saline intravenously or saline alone. Fatigue scores dropped significantly in the vitamin C group at two hours and remained lower at one day (p = 0.004). The infusion also raised plasma vitamin C levels and lowered markers of oxidative stress compared with placebo (both p < 0.001). Benefits were most pronounced in participants who started with lower baseline vitamin C. The authors concluded that high-dose intravenous vitamin C was safe and effectively reduced fatigue in this population. (Route: intravenous.)

  Double-blind randomized controlled trial Suh SY, Bae WK, Ahn HY, Choi SE, Jung GC, Yeom CH Intravenous vitamin C administration reduces fatigue in office workers: a double-blind randomized controlled trial. Nutrition Journal. 2012. PMID 22264303 ↗

• 12

  Vitamin C drives the conversion of dopamine into norepinephrine, boosting production of this key alertness and stress-response neurotransmitter several-fold.

  Using cultured human neuronal cells, researchers showed that cells supplied with dopamine generated intracellular norepinephrine at rates stimulated several-fold by intracellular ascorbate, which serves as the electron donor for the enzyme dopamine beta-hydroxylase. The effect was half-maximal at intracellular ascorbate concentrations of 0.2-0.5 mM, matching the known kinetics of the enzyme, and these levels were reached from extracellular concentrations under 25 micromol/L because the cells actively concentrate vitamin C. Ascorbate loading also prevented the rise in cellular superoxide caused by dopamine, showing it both fuels the enzyme and protects the cell.

  Mechanistic/preclinical cell study May JM, Qu ZC, Nazarewicz R, Dikalov S Ascorbic acid efficiently enhances neuronal synthesis of norepinephrine from dopamine. Brain Research Bulletin. 2013. PMID 23022576 ↗

• 13

  Even mild dehydration — barely over 1% of body weight — is enough to dull concentration and drive up fatigue, which is why hydration status matters for how you feel day to day.

  In this controlled crossover study of 26 healthy young men, mild dehydration of about 1.6% body mass produced significant adverse changes in vigilance and working memory, increased tension/anxiety and fatigue, and raised ratings of task difficulty and concentration effort. The authors concluded that degraded mood, increased perception of task difficulty, lower concentration and headache symptoms result from mild dehydration in healthy young men — establishing how small a fluid deficit it takes to affect performance.

  Randomized crossover clinical study Ganio MS, et al. Mild dehydration impairs cognitive performance and mood of men. British Journal of Nutrition. 2011. PMID 21736786 ↗

• 14

  Rehydrating a dehydrated person measurably improves mental processing speed, working memory, mood and fatigue.

  This randomized controlled trial in young adults first induced mild dehydration through 36 hours of water restriction, then randomized participants to different rehydration volumes. Rehydration improved processing speed, working memory and mood, with 1,000 mL identified as the optimum volume; the two largest rehydration doses significantly improved fatigue scores, total mood disturbance and cognitive test performance. This is direct evidence that restoring fluid — not merely avoiding dehydration — makes people think and feel better. (Route: oral rehydration.)

  Randomized controlled trial Zhang J, et al. Effects of Water Restriction and Supplementation on Cognitive Performances and Mood among Young Adults in Baoding, China: A Randomized Controlled Trial (RCT). Nutrients. 2021. PMID 34684650 ↗

References

• 1Longo N, Frigeni M, Pasquali M. Carnitine transport and fatty acid oxidation. Biochimica et Biophysica Acta - Molecular Cell Research. 2016. PMID 26828774 ↗
• 2Brass EP, et al. Intravenous L-carnitine increases plasma carnitine, reduces fatigue, and may preserve exercise capacity in hemodialysis patients. American Journal of Kidney Diseases. 2001. PMID 11325685 ↗
• 3Yarizadh H, et al. The Effect of L-Carnitine Supplementation on Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Journal of the American College of Nutrition. 2020. PMID 32154768 ↗
• 4Rebouche CJ. Ascorbic acid and carnitine biosynthesis. The American Journal of Clinical Nutrition. 1991. PMID 1962562 ↗
• 5Lee MC, et al. A functional evaluation of anti-fatigue and exercise performance improvement following vitamin B complex supplementation in healthy humans, a randomized double-blind trial. International Journal of Medical Sciences. 2023. PMID 37786445 ↗
• 6Kennedy DO, et al. Effects of high-dose B vitamin complex with vitamin C and minerals on subjective mood and performance in healthy males. Psychopharmacology (Berl). 2010. PMID 20454891 ↗
• 7Schostak T, San Millan I, Jani A, Johnson RJ. Thiamine deficiency: a commonly unrecognised but easily treatable condition. Postgraduate Medical Journal. 2023. PMID 37125640 ↗
• 8Schoenenberger AW, et al. Thiamine supplementation in symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled, cross-over pilot study. Clinical Research in Cardiology. 2012. PMID 22057652 ↗
• 9Pirinen E, et al. Niacin Cures Systemic NAD+ Deficiency and Improves Muscle Performance in Adult-Onset Mitochondrial Myopathy. Cell Metabolism. 2020. PMID 32386566 ↗
• 10de Baaij JHF, Hoenderop JGJ, Bindels RJM. Magnesium in man: implications for health and disease. Physiological Reviews. 2015. PMID 25540137 ↗
• 11Suh SY, Bae WK, Ahn HY, Choi SE, Jung GC, Yeom CH. Intravenous vitamin C administration reduces fatigue in office workers: a double-blind randomized controlled trial. Nutrition Journal. 2012. PMID 22264303 ↗
• 12May JM, Qu ZC, Nazarewicz R, Dikalov S. Ascorbic acid efficiently enhances neuronal synthesis of norepinephrine from dopamine. Brain Research Bulletin. 2013. PMID 23022576 ↗
• 13Ganio MS, et al. Mild dehydration impairs cognitive performance and mood of men. British Journal of Nutrition. 2011. PMID 21736786 ↗
• 14Zhang J, et al. Effects of Water Restriction and Supplementation on Cognitive Performances and Mood among Young Adults in Baoding, China: A Randomized Controlled Trial (RCT). Nutrients. 2021. PMID 34684650 ↗