Learning Outcomes
By the end of this section, you should be able to:
- 5.4.1 Discuss water-soluble and fat-soluble vitamins and their importance in the body.
- 5.4.2 Identify minerals to treat deficiencies.
- 5.4.3 Discuss chelating agents to remove excess copper, iron, and lead from the body.
- 5.4.4 Identify food source and deficiency conditions associated with vitamins and minerals.
- 5.4.5 Describe the use of common complementary and alternative therapies.
- 5.4.6 Explain how complementary and alternative therapies may potentiate, negate, or cause toxicity with prescribed drugs.
- 5.4.7 Discuss the nursing implications related to complementary and alternative therapies.
- 5.4.8 Explain the client education related to complementary and alternative therapies.
Vitamins and minerals are essential nutrients that the body requires for various physiological functions, including growth, development, and maintenance. Complementary and alternative therapies such as acupuncture, aromatherapy, and herbal supplements are becoming increasingly popular as nontraditional treatments for various medical conditions. This section of the chapter will discuss vitamins, minerals, and common complementary and alternative therapies.
Vitamins
Vitamins are essential organic compounds required for normal metabolic function, growth, and healing. The body requires only small amounts of vitamins daily, which are typically obtained through a well-balanced diet. Vitamins are usually prescribed for clients who have the inability to metabolize and absorb vitamins, such as with celiac disease; increased vitamin losses, such as with diarrhea and crash diets; and when there is an increased vitamin need, such as with pregnancy. There are two types of vitamins, water-soluble and fat-soluble, discussed in the following sections.
Water-Soluble
Water-soluble vitamins dissolve in water. They are excreted by the kidneys in urine and are minimally stored in the body. Water-soluble vitamins need to be consumed regularly in the diet or through supplements to maintain adequate levels in the body. They play a critical role in various bodily functions, such as energy, metabolism, nerve function, and collagen synthesis. Water-soluble vitamins, their functions, food sources, and deficiency conditions are also discussed in Table 5.2.
Fat-Soluble
Fat-soluble vitamins dissolve in fat and are stored in the body’s fat tissues and liver. They are absorbed along with dietary fat and can be stored in the body for extended periods. Excessive intake of fat-soluble vitamins can lead to toxicity because they are not readily excreted. Fat-soluble vitamins are essential to various bodily functions such as vision, immune function, blood clotting, and bone health. Fat-soluble vitamins, their functions, food sources, and deficiency conditions are also discussed in Table 5.2.
| Water-Soluble Vitamins | |||
| Vitamin | Function | Food Source | Deficit Conditions |
| B1 (Thiamine) | Promotes carbohydrate metabolism and nerve function | Whole-grain and enriched breads and cereals, nuts, liver, black beans, and meats such as fish (richest source), liver, and pork | Metabolic disorders, wet and dry beriberi, Wernicke’s encephalopathy, and Korsakoff’s psychosis |
| B2 (Riboflavin) | Promotes use of carbohydrates, fats, and proteins necessary for red blood cell function; biggest role is with protein to promote wound healing | Whole grains, enriched grains, organ meats, and dairy products | Angular stomatitis, cheilosis, glossitis, itchy dermatitis of scrotum or vulva, microcytic anemia, and alcohol substance use disorders |
| B3 (Niacin) | Essential for metabolism, glycogenolysis, and nerve function; participates in the synthesis of steroid hormones and fatty acids |
Fish, poultry, peanuts, mushrooms, and whole grains | Pellagra, hepatotoxicity, and anorexia |
| B9 (Folic acid) | Necessary for DNA and heme synthesis and intestinal functioning | Leafy vegetables such as spinach and broccoli, yellow vegetables such as squash, liver, dried beans, and peas | Megaloblastic anemias, intestinal disturbances, fetal neural tube defects (caused by deficiency during pregnancy) |
| B12 (Cobalamin) | Synthesis and maintenance of myelin; involved in protein synthesis and an essential factor in the synthesis of DNA; helps form red blood cells and assist in nerve function | Fish, poultry, liver, eggs, and dairy products | Poor growth, interruption or delay of nerve impulse transmission, and pernicious anemia |
| C (Ascorbic acid) | Essential for tissue repair and wound healing, necessary for formation of collagen; facilitates absorption of iron | Citrus fruits and juices, strawberries, kiwi, potatoes, tomatoes, and cantaloupe | Poor wound healing, bleeding gums, and scurvy |
| Fat-Soluble Vitamins | |||
| Vitamin | Function | Food Source | Deficit Conditions |
| A (Retinol and beta carotene) | Necessary for immune function and healthy eyes, skin, and hair | Carrots, potatoes, pumpkins, spinach, beef, and eggs | Night blindness, skin lesions, xerophthalmia, and brittle hair |
| D3 (Cholecalciferol) D2 (Ergocalciferol) |
Facilitates equilibrium of phosphorus and calcium, crucial for maintaining strong teeth and bones | Milk and other dairy products, such as yogurt and cheese | Rickets, osteomalacia, and osteoporosis |
| E (Alpha-tocopherol) | Promotes functioning of red blood cells, muscles, and tissues and is essential in anti-inflammatory processes, platelet aggregation, and immune response | Fortified cereals, whole grain products, vegetable oils, wheat germ, seeds, and nuts | Retinopathy, peripheral neuropathy, and ataxia |
| K (Phytonadione) | Necessary for blood clotting | Dark green leafy vegetables, turnips, and beets | Increased clotting time, bleeding, or hemorrhage |
Minerals
Minerals are inorganic substances that are essential for certain physiological functions. Minerals are necessary for the formation of strong bones and teeth, regulation of fluid balance, muscle function, and the production of hormones and enzymes. They aid in the transport of oxygen and nutrients throughout the body and support immune function. Table 5.3 lists the heavy metal minerals iron, copper, lead, and zinc and their functions, food sources, chelating agents for toxicity, and deficiency conditions. Table 5.4 lists the functions, food sources, and deficiency conditions for zinc, chromium, and selenium.
| Mineral | Function | Food Source | Chelating Agents for Toxicity | Deficiency Conditions |
|---|---|---|---|---|
| Iron | Component of hemoglobin, helps transport oxygen, supports immune function, and assists in the production of energy | Red meat, poultry, fish, beans, lentils, tofu, fortified cereals, spinach, and other leafy greens | Deferoxamine, deferasirox, and deferiprone bind to excess iron in the body, forming a complex that can then be excreted in the urine or feces. They are used to treat iron overload conditions such as hemochromatosis or thalassemia. | Iron deficiency anemia (microcytic, hypochromic), pregnancy (due to an increased need for RBCs as a result of increased blood volume and the fetus), gastrointestinal bleeding |
| Copper | Helps form red blood cells, supports immune function, and assists in the production of energy and collagen; required for melanin production | Shellfish, nuts, seeds, whole grains, beans, and dark leafy greens | Penicillamine and trientine bind to excess copper and form a complex that can be excreted in the urine. They are used to treat Wilson’s disease, a genetic disorder that causes copper to accumulate in the liver and brain. | Celiac disease, excessive zinc intake (which can interfere with copper absorption and utilization), and Menkes’ disease (a hereditary abnormality that blocks absorption of copper) |
| Lead | Is a toxic heavy metal and has no known essential functions within the body but through exposure can lead to a variety of health problems | Found in contaminated water and food supplies, especially in areas of high environmental pollution and in older homes with lead-based paint or pipes | Dimercaprol, EDTA, and succimer bind to lead in the body, forming a compound that is excreted in the urine or feces; they are used to treat lead poisoning and reduce the body burden of lead. | No deficiency conditions |
| Mineral | Function | Food Source | Deficiency Conditions |
|---|---|---|---|
| Zinc | Supports immune function, helps with wound healing, assists in the production of proteins and DNA synthesis, involved in taste acuity | Oysters, beef, pork, chicken, beans, nuts, seeds, and whole grains | Crohn’s disease, celiac disease, pregnancy, growth retardation, delayed sexual maturation, alopecia, loss of taste sensation, poor wound healing, impaired immunity |
| Chromium | Helps regulate blood sugar levels by potentiating the action of insulin; supports healthy metabolism | Broccoli, grape juice, whole grains, and nuts | Chromium deficiency is rare because the body requires only small amounts; however, severe deficiencies can cause glucose intolerance and weight loss. |
| Selenium | Acts as an antioxidant and helps protect cells from damage, supports immune function, necessary for iodine metabolism to assist in the production of thyroid hormones | Brazil nuts, seafood, poultry, beef, eggs, and whole grains | Malabsorption syndrome |
Complementary and Alternative Therapies
Complementary and alternative therapies, also known as complementary and alternative medicine (CAM), is a broad term used to describe health practices and treatments that are used in addition to or instead of conventional medical therapies. Examples of CAM include herbal supplements, acupuncture, chiropractic care, massage therapy, and mind-body practices such as meditation and yoga. Some people choose CAM therapies because they believe they are more natural or holistic than conventional medicine or because they have had negative experiences with conventional medicine (Jones et al., 2019; National Institutes of Health, n.d.-b). However, it is important to note that not all CAM therapies are safe and effective, and some may even be harmful.
Dietary Supplement and Health Education Act
The Dietary Supplement and Health Education Act (DSHEA) of 1994 is a federal law that regulates the manufacturing and labeling of dietary supplements. Under DSHEA, dietary supplements are classified as a food, not a drug, and are not subject to the same strict regulations as drugs. However, DSHEA does require that manufacturers of dietary supplements meet certain labeling requirements and notify the Food and Drug Administration (FDA) of any new ingredients they plan to use. DSHEA also allows manufacturers to make certain health claims about their products as long as they are truthful and not misleading (National Institutes of Health, n.d.-a).
Good Manufacturing Practices
Good Manufacturing Practices (GMPs) are a set of guidelines established by the FDA that ensures quality, purity, and strength of dietary supplements. GMPs require manufacturers to use standardized manufacturing processes, perform regular testing of raw materials and finished products, and maintain detailed records of all production and testing. GMPs also require manufacturers to have a system in place for handling complaints and reporting adverse events (National Institutes of Health, n.d.-a).
Commonly Used Herbal Remedies
There are numerous herbal remedies that are used by the general public. Table 5.5 presents common herbal remedies, their use, and special considerations.
| Herbal Remedy | Use | Special Considerations |
|---|---|---|
| Astragalus | To increase stamina and energy and to improve immune function | May increase effects of anti-hypertensive drugs (Han et al., 2019); caution should be used when administering if the client has a fever because it can mask infection |
| Chamomile | Used topically to treat wounds and conjunctivitis; used orally for migraines and anxiety | Clients should not take if pregnant or breastfeeding because it can harm the fetus/infant, can interact with anticoagulants and increase bleeding times, and may cause depression |
| Echinacea | To enhance the immune system and treat colds and influenza; suppresses inflammation | Usage for longer than 12 weeks may cause liver toxicity; do not use with antifungals or hepatotoxic drugs; usage in immunocompromised clients is discouraged |
| Garlic | To treat colds; for cardiovascular health (reduces levels of triglycerides and LDL and raises levels of HDL); helps to reduce blood pressure and suppress platelet aggregation and lower blood glucose levels | Has anticoagulant effects and should be used cautiously in clients on anticoagulants; lowers blood glucose levels and may cause hypoglycemia in clients already taking medications for their diabetes; reduces triglycerides and LDL and increases HDL levels—may need a dosage adjustment if client is taking medications for lipids |
| Ginger | To treat nausea, motion sickness, and postoperative nausea; also has anti-inflammatory and analgesic properties | Affects blood clotting and is contraindicated for clients on anticoagulants |
| Ginseng | To treat hypertension; also is a mood elevator and decreases cholesterol levels | May cause irritability if taken with caffeine; may cause interactions with phenelzine and monoamine oxidase inhibitors (MAOIs); may interfere with the effectiveness of digoxin |
| Hawthorn | To treat blood pressure problems and lower cholesterol levels | Use cautiously with digoxin, ACE inhibitors, and central nervous system (CNS) depressants because it may potentiate their effects |
| Licorice root | To treat cough and stomach ulcers | Contraindicated with renal or liver disease, hypertension, coronary artery disease, and pregnancy and in clients who are taking digoxin and thyroid drugs |
| Milk thistle | To treat fatty liver and hepatitis | Can potentiate antihypertensive drugs and immunosuppressant drugs |
| Saw palmetto | To treat urinary symptoms related to prostate issues | May cause orthostatic hypotension; do not use with finasteride because toxicity may occur (Mount Sinai, n.d.) |
| St. John’s wort | To treat depression | Take on an empty stomach to enhance absorption; may interact with other antidepressants as well as theophylline, digoxin, hormonal contraceptives, and certain anticancer drugs; client should not take if pregnant or breastfeeding because it may affect the fetus/infant |
| Turmeric | To treat inflammation | May cause gastrointestinal upset and may increase bleeding times if used with oral anticoagulants |
| Valerian | To treat insomnia and anxiety | May cause severe liver damage; should not be used with CNS depressants because it may cause severe sedation |
Common Complementary Therapies
Complementary therapies are used to promote overall health and well-being. They are often used to alleviate symptoms and side effects associated with medical conditions and treatments, but they are not intended to replace or serve as a substitute for traditional medical care. Table 5.6 describes common complementary therapies, their uses, and special considerations.
Special Considerations
Asian Americans and CAM
Asian Americans are more likely to use complementary and alternative medicine (CAM) as compared to other races or ethnicities. Many continue cultural traditions of using Eastern alternatives such as acupuncture, Ayurveda, and yoga.
(Source: Felicilda-Reynaldo et al., 2020.)
Trending Today
Cannabis and Health Care
Cannabis has been used for centuries as a natural remedy to alleviate symptoms of various health conditions, such as chronic pain, anxiety, and insomnia. Medical cannabis is a new trend that is legal in many states and countries, allowing clients access to cannabis-based treatments under the supervision of licensed health care providers. With the increasing use of medical cannabis, there is a growing need for health care professionals to be trained in its use and to be able to provide accurate information to clients. Dr. Josh Axe, DNM, DC, CNS, is a doctor of natural medicine, chiropractor, and clinical nutritionist. In the video podcast “Medicinal Benefits of Cannabis Compounds,” Dr. Axe interviews Dr. Bonni Goldstein, MD, who speaks about the different types of cannabis and its medicinal benefits.
| Complementary Therapy | Definition | Use | Special Considerations |
|---|---|---|---|
| Acupuncture | A traditional Chinese medical practice that involves inserting thin needles into specific points on the body to promote healing and pain relief | Treatment of chronic pain, headaches, and musculoskeletal problems | Risk for infection and injury from the needles; not appropriate for people who are taking immunosuppressant or anticoagulant drugs; contraindicated in clients who have diabetes, stroke, or other neurological conditions |
| Aromatherapy | The use of essential oils to promote physical and emotional well-being | Stress reduction, improvement of mood, and promoting relaxation | May cause skin irritation or an allergic reaction |
| Ayurveda | A traditional Indian medical practice that seeks to balance the body, mind, and spirit through diet, lifestyle changes, and herbal remedies | Treatment of digestive disorders, anxiety, and skin problems | Herbal remedies may interact with prescription drugs and should not be used without speaking to the health care provider; some products may contain heavy metals or other toxins |
| Cannabis (marijuana) | A plant that contains compounds that have psychoactive effects | Treatment of chronic pain, muscle spasms, seizures, and nausea and vomiting associated with chemotherapy, and to increase appetite | May cause impaired coordination and memory, increased heart rate, and temporary cognitive impairment; may be addictive |
| Touch therapy | A form of healing that involves the use of touch to promote relaxation and reduce stress | Treatment of anxiety, depression, and chronic pain | Contraindicated in skin conditions where touch therapy may exacerbate the condition, areas of recent injuries or surgery, or areas where cancer treatment such as radiation therapy is being administered |