Duty to Warn

Duty to warn is phrase used in medical care regarding an ethical duty to warn patients or research participants or anyone at risk of the potential harm. My own health and my experience helping others has made me appreciate wellness and sharing what has helped or what can be harmful are things I feel ethically it is my duty to warn or inform anyone who might be interested. We are one – your pain is my pain and the Earth needs more health. It is hurting too.

Empathy – feeling emotionally connected can also feel painful, a short article discusses the idea of the pain that may occur with feeling compassion for other’s suffering:

The Agony of Being Connected to Everything in the Universe, (andrewboyd.com)

The words sympathy, empathy and compassion are used somewhat interchangeably however they can refer to slightly different things. In medical settings the care of patients can be affected positively or negatively by how the caregiver provides help. Research with patients receiving cancer treatment found that patients felt that empathy and compassion were beneficial while sympathy was perceived more negatively. Compassion was felt to be most beneficial by the patients. What is the difference? Sympathy seems to be regarded as pity-based remarks or attitude about the chronic illness that was offered without having been asked, with less of a feeling of being understood. Empathy may be closer to feeling emotionally understood and compassion included feelings that the caregiver was acting with love and kindness out of a altruistic – giving mindset. (3) The risks of rudeness in a medical setting and possible value of kindness is discussed in a review of a research study on rudeness in a neonatal clinic setting: A Message to you Rudy, about Rudeness, SGEM#227.

Feeling like there is a physical problem and being told that it must be hypochondria or mental illness is not as helpful as being told that a reason for the symptoms are unknown at this time. Chronic itch, chronic pain and other vague symptoms of inflammation may be labeled as psychosomatic instead of unknown cause. Overactive TRP channels can be involved in chronic itch and chronic pain and the variety of possible substances and other reasons for a flair up in symptoms can make it very difficult to notice the pattern. I would rather be told we don’t know what is causing your symptoms than to be told to see a talk therapist or to be prescribed medications for mental illness that may cause additional symptoms due to side effects. The following chart is something I created after noticing a pattern, a very complex pattern, in my own symptoms and researching what the connection might be —- TRP channels. Not all substances or factors would cause symptoms for all of the conditions or for all people with a certain type of condition, however they may in larger amounts, or they may when the symptomatic condition is in a more severe state of inflammation. In reading about patients with some types of chronic itch symptoms I could feel their itchiness and mental hurt when treated as just difficult patients with anxiety problems – anxiety other extreme itchiness perhaps.

More about chronic itch and inflammatory stress conditions is available within a longer page/chapter I wrote about G3:Relaxation & StressG3.5: Negative stress chemicals may cause symptoms like itching, migraines, pain or IBS. (effectivecare.info) Preeclampsia is a prenatal condition that can become life threatening for the woman and expected infant and it affects a significant percentage of pregnancies – more information about TRP channels and a physical position that might help reduce internal pressure on the channels is available in the section on G5: Preeclampsia & TRP Channels. It is a yoga style position that was recommended to reduce risk of a breech birth during my own pregnancies and I found it relaxing. (effectivecare.info) I feel a duty to warn – a duty to inform other expectant mothers about a simple strategy that might protect their infant from a potentially life-threatening condition.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

  1. Shah SK, Hull SC, Spinner MA, et al. What Does the Duty to Warn Require? The American journal of bioethics : AJOB. 2013;13(10):62-63. doi:10.1080/15265161.2013.828528. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816221/
  2. Andrew Boyd, The Agony of Being Connected to Everything in the Universe, andrewboyd.com http://andrewboyd.com/the-agony-of-being-connected-to-everything-in-the-universe/
  3. Sinclair S, Beamer K, Hack TF, et al. Sympathy, empathy, and compassion: A grounded theory study of palliative care patients’ understandings, experiences, and preferences. Palliative Medicine. 2017;31(5):437-447. doi:10.1177/0269216316663499.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405806/
  4. Dr. Simon McCormick, SGEM #227: A Message to you Rudy, About Rudeness, Aug. 22, 2018, A Skeptic’s Guide to Emergency Medicine, http://thesgem.com/2018/09/sgem227-a-message-to-you-rudy-about-rudeness/

World Suicide Prevention Day

First, do no harm – I share information because I have been ill, physically and mentally and managed to get better for the most part. Not one hundred percent better though, prevention is the best medicine, or second only to laughter. Mental illness is treated as if it is separate from physical health and largely the two are very connected. I have improved but it has been with many lifestyle and dietary changes – every day, or at least most days of the week. Getting a genetic screening done and finding out more specifically what was different about me also was necessary.

Metabolism is a fancy word for the body’s many chemical reactions that burn energy and use it to combine nutrients from the diet and oxygen from the air for the purpose of building and repairing cells. Most cells other than brain cells are regenerated on a regular basis. Old ones are dismantled and new ones replace them on a time cycle that varies with the type of body part. If our individual genetic coding has differences sometimes we need more or less of some nutrients and possibly additional types of chemicals that in normal health could be manufactured within normal metabolic pathways. Mental illness including depression and suicidal urges can have to do with emotional issues or history of trauma but there can also be nutrient deficiencies causing too much or too little of some types of brain neurotransmitters/messenger chemicals.

Twenty percent of adults in the U.S. have a mental illness and twenty-two percent of young adults. Magnesium deficiency can be a cause of anxiety and depression. (Magnesium: an Essential Supplement for Psychiatric Patients, PsychiatryAdvisor) Magnesium is commonly low in people with chronic pain or migraines, diabetes, and other chronic conditions too. (Dietary Magnesium Intake in a Nationals Sample of U.S. Adults, The Journal of Nutrition) Topical creams or a soak in Epsom salt may be better absorbed for people with a digestive malabsorption problem — if there is magnesium in the diet but the digestive system isn’t absorbing it then there still may be symptoms such as muscle cramps, pain, or anxiety and depression. (See previous post on magnesium)

Crisis line: Suicide Prevention Lifeline at (800) 273-8255 for confidential support 24/7, for Veterans or their families, press 1 to then reach the Veterans Crisis Line.

Other resources for LGBTQ support: see link.

Crisis lines for a variety of nations other than the U.S.: see link.

Support can be meant well but hurtful to the person in mental anguish – some commonly used statements that may make a person with suicidal thoughts or actions feel worse: themighty.com.

What to say – some helpful brief tips: see link.

Symptoms or other lifestyle changes in a person that may indicate risk for suicidal thoughts or actions: see link

I have no affiliation with Epsom salt companies – it just really works well.

/Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

Brain cells and aging

Within the majority of the brain the type of brain cells that send nerve signals generally do not get replaced, however they also generally don’t lose function. Dementia – loss of memory and other cognitive skills – is not a normal part of healthy aging. Age related forgetfulness has to do with loss of the connections between brain cells but the brain cells remain functional – so continuing to take part in learning and social activities may help prevent dementia and forgetfulness by helping to maintain current connections between brain cells and add new connections formed during learning or socializing. 

And yet Alzheimer’s dementia now “afflicts 5% to 10% of the U.S. population over the age of 65 and as much as 45% of the population over 85.” (page 694, Neuroscience, 6th. edition, 1)

Research for medications for Alzheimer’s treatment have focused on reducing the levels of certain types of protein that collect in the damaged areas of the brain of a patient with the condition, however even if successful at reducing the amount of the protein the medications have not been found very helpful for restoring the patient’s cognitive health. (previous post) People with normal brain function also can have excess of the protein and it is also found in the brains of people with autism disorder – confusing, yes. Adequate quality sleep may help the brain waste removal system keep the levels of excess protein from building up to damaging amounts. (previous post on sleep and the glymphatic system)

Things that may increase risk include chronic stress and the excess cortisol and inflammatory oxidative stress chemicals production. Moderate exercise may help reduce stress and promote detoxification of inflammatory chemicals. Staying socially and mentally active also may be protective of brain function. Prevention is the best medicine for conditions that cause irreversible degenerative changes such as the damage in Alzheimer’s Disease. Learning about new foods and recipes and then making healthy meals to share with others can be a way to combine physical and mental activity and gain from nutrients that help detoxify inflammatory oxidative stress chemicals. (previous post, Foods for beneficial T-cells) – (Nrf2 promoting foods)

T cells are a type of blood cell with immune system functions. Beneficial T cells can help clear excess protein found in Alzheimer’s (2) while other types can increase inflammation and the types can transform based on the level of oxidative stress chemicals that are present so having antioxidants and other phytonutrients in daily meals can help signal the T-cells to take the beneficial forms instead of the inflammatory forms. (The non euphoria producing endogenous cannabinoid 2-AG (acts at the CB2 receptor, somewhat similar to CBD) may also help signal T cells towards the less inflammatory type, and reduce migration of them. page 96)

Nrf2 is a gene and protein that help promote the more beneficial types of T cells and help the immune system in other ways and also promote our own production of antioxidants for reducing the oxidative stress chemicals that are a natural waste product left from energy metabolism – when blood sugar is turned into a usable form of energy.

The long story is complicated, the short story remains,

  • include moderate exercise most days of the week,
  • have adequate sleep, 6-8 hours/night, ideally with complete darkness, blackout curtains and cover the light from an electric bedside alarm clock (put it in a nearby drawer or cover it with something),
  • get some natural sunshine or full spectrum light during the day if possible (may help with vitamin D, bioactive sulfate, and circadian rhythm metabolism within the body which includes production of melatonin,
  • stay mentally and socially active,
  • reduce stress when possible and/or practice relaxation techniques,
  • drink adequate water and regularly eat a good variety of colorful fresh produce, whole grains, nuts, beans, seeds, and include omega 3 fatty acid sources on a daily or weekly basis.
  • Clean air quality is also important. Formaldehyde (from secondhand smoke or even excessive use of decorative candles), and other air pollutants (released by plastics or new carpeting/flooring for example) can collect in poorly ventilated buildings. See this post for more information about formaldehyde sources and ways to reduce it: Formaldehyde: Health Risks, and Environmental and Dietary Sources.(effectiveselfcare.info)
  • Adequate water, not getting dehydrated regularly, is important enough to repeat because dehydration allows toxins within the body, including formaldehyde, to collect, instead of being removed by the glymphatic/lymphatic and vascular system, and to then be excreted by the kidneys. Brain Formaldehyde is Related to Water Intake Behavior, Ting Li, et al, 2016, (PubMed) A discussion of how much water is typically needed for health each day, and how much protein to eat for basic needs without being too much for long term kidney health, is available in a previous post: Make Every Day Kidney Appreciation Day. (effectiveselfcare.info)

More of the long story – the Cannabinoid Receptor Type 2 is also activated by a phytonutrient called beta-caryophyllene (BCP) which is found in many aromatic herbs and spices including: oregano, cinnamon,  clove , rosemary,  thyme, black pepper, (4), and copaiba oil. (5) Benefits may include reducing inflammation and pain, anti-anxiety, anti-cancer, (4), and protection of the brain by helping reduce increased activity after brain trauma which can lead to scar like tissue walling off the area of trauma instead healing.(5)

The problem in Alzheimer’s may not be the protein itself but instead the cells that over-actively making it in response to inflammatory signals so the solution would be not trying to remove excess protein but to stop the production of excess protein by signaling the overactive cells that all is well again, stop walling off the supposed injury. Formalin, a more dilute buffered form of formaldehyde was the toxin used to create inflammation in an animal based study of the potential benefits of beta-caryophyllene. A dose of 5 mg/Kg purified beta-caryophyllene essential oil given by mouth (rather than by an injection) was found to help reduce inflammatory pain from the formalin. (4) For a 75 kilogram adult that would be a capsule with 375 milligrams of the purified oil.

The herb rosemary is pine needle like plant that has been used as a pain killer in traditional folk medicine for arthritis pain and was thought of a s a memory aid. Studies more recently have found the essential oil beneficial for improving memory. (6)  **Use care when purchasing essential oils, some are intended only for external use either on the skin when diluted in a small amount of milder oil such as almond oil for massage or topical pain relief, or as an aromatic for scent (example, put a few drops on a cotton ball that is attached to a fan or on the outlet of a humidifier to circulate the aroma through a room).

/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

  1.  Neuroscience, 6th Edition, Editors D. Purves, G.J. Augustine, D. Fitzpatrick, W.C. Hall, A.S. LaMantia, R.D. Mooney, ML. Platt, L.E. White, (Sinauer Associates, Oxford University Press, 2018, New York) (Barnes&Noble)
  2. Anna Mietelska-Porowska and Urszula Wojda, “T Lymphocytes and Inflammatory Mediators in the Interplay between Brain and Blood in Alzheimer’s Disease: Potential Pools of New Biomarkers,” Journal of Immunology Research, vol. 2017, Article ID 4626540, 17 pages, 2017. https://doi.org/10.1155/2017/4626540. https://www.hindawi.com/journals/jir/2017/4626540/
  3. edited by Karsten Sauer, Klaus Okkenhaug, Lipid Signaling in T Cell Development and Function, Frontiers Media SA, Nov 12, 2015 page 96
  4. A.-L.Klauke, I.Racz, B.Pradier, et al., The cannabinoid CB2 receptor-selective phytocannabinoid beta-caryophyllene exerts analgesic effects in mouse models of inflammatory and neuropathic pain. European Neuropsychopharmacology, Vol. 24, Issue 4, April 2014, Pages 608-620, https://www.sciencedirect.com/science/article/pii/S0924977X13003027
  5. Guimarães-Santos A, Santos DS, Santos IR, et al. Copaiba Oil-Resin Treatment Is Neuroprotective and Reduces Neutrophil Recruitment and Microglia Activation after Motor Cortex Excitotoxic Injury. Evidence-based Complementary and Alternative Medicine : eCAM. 2012;2012:918174. doi:10.1155/2012/918174. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291111/
  6. Rachel Hosie, Surge in Rosemary Sales as Aromatic Herb Found to Boost Memory, May 19, 2017, independent.co.uk,  https://www.independent.co.uk/life-style/health-and-families/rosemary-sales-surge-herb-boost-memory-holland-barrett-a7745231.html