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/

And what do osmomechanical stress, changes of temperature, chili powder, curry powder, ginger, Benicar, hormone D, steroids, and cannabinoids have in common?

// 7/1/16 addition: This post is for people suffering from Irritable Bowel Syndrome (IBS) which is not well understood, easy to diagnose or treat, and can be life threatening when more severe symptoms continue long term. The condition can continue for years or be a life long issue that flairs up at times and is less severe at other times.

Dietary tips can be helpful but why some foods seem to trigger symptoms while others don’s has not been well understood either. The common factor underlying why some foods seem to be triggers for many people may be the TRP channels that are found in cells throughout the intestines and actually in most cells of most life forms. //

So what do osmo-mechanical stress, changes of temperature, chili powder, curry powder, ginger, Benicar, hormone D, steroids, and cannabinoids all have in common?

They all may be able to overstimulate Transient Receptor Potential channels (TRP channels) within the gastrointestinal system and cause severe diarrhea in susceptible individuals.

In many cases, the activation mechanism of TRP channels is unclear (Figure 1), but known activators include specific agonists such as mustard oil (TRPA1) and capsaicin (TRPV1), an increase in intracellular Ca2+ (TRPM4, 5), temperature (heat: TRPV1, 2, 3, 4, TRPM4, 5; cold: TRPM8, TRPA1), mechanical or osmotic stress (TRPV4, TRPCs?) and phospholipase C (PLC) activation. TRP channel activity can be further modulated by intracellular phosphatidylinositol phosphates, such as PI(4,5)P2 and membrane potential, but also by inflammatory mediators, cannabinoids and steroids (Nilius, 2007; Rohacs, 2007; Nilius and Voets, 2008).” [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012403/]

The TRP channels are a large group found in many species of life from yeast, to worms, fish and mammels. The agonists/activating chemicals for many of the types of TRP channels have not all been identified as of yet.

One type of TRP channels were formerly called Vanilloid Receptors, and are now called TRPV channels. Vanilloid Receptors were known to be activated by capsaicin found in hot peppers and chili powder. And more recent or less well known research has also found that they can be activated by cannabinoids and steroids, (see the link from the excerpt above), and osmomechanical stress.

Osmo-mechanical stress might be a precursor to edema, excess fluid in the extracellular space; if an organ or cell over fills with fluid it would mechanically be adding physical pressure to the organ or cell — and instead of popping like an overfull water balloon the TRP channels open in response to the physical pressure and let the excess fluid leak out into the extracellular space or into the area surrounding the heart for example. [http://www.ncbi.nlm.nih.gov/books/NBK92821/] Fibrotic heart disease would be adding mechanical stretching stress within the heart. TRP channels are being studied for possible use in preventing fibrotic heart disease. From that research article, we are told that changes in temperature may also activate them:

The activation mechanisms of TRP channel are highly diversified. Some TRP channels appear to be constitutively active, whereas others are activated by Gq-linked receptor activation, oxidative stress, changes of temperature, or an elevation of intracellular Ca2+ [126128]. All the TRP channels appear to be regulated by PIP2 [134137] .” [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874073/]

  • PIP2 = phosphoinositides = phosphatidylinositol phosphates (PIPs) = phosphorylated deriviatives of phosphatidylinositol (PI) [http://www.annualreviews.org/doi/abs/10.1146/annurev.cellbio.21.021704.102317]
  • PIP2 = phosphatidylinositol-4,5-bisphosphate and PI, and phospholipase C (PLC) from the first excerptare involved in cannabinoid metabolism within plasma membranes: [page 9 Kendall et. al., Behavioral Neurobiology of the Endocannabinoid System (Springer, 2009, New York)]

Steroids and hormone D function similarly. And Benicar and curcumin can function similarly to hormone D. And curcumin is a medically active extract from turmeric, a powdered spice that is a main ingredient in curry powder. Turmeric is made from the root of a plant that is biologically very similar to ginger,  which is also a root that is used as a dried spice or  may be used as a chopped vegetable in stir-fry dishes and other foods. Ginger has over 400 active phytochemicals, and one of them might be acting similarly to the curcumin — but that is speculation based on the similarity of symptoms of Irritable Bowel Syndrome that both ginger and curry powder stimulate.

Because — what else do osmomechanical stress, changes of temperature, chili powder, curry powder, ginger, Benicar, hormone D, steroids, and cannabinoids all have in common? — They all may irritate Irritable Bowel Syndrome, (IBS), for some people, along with emotional stress and other things like eating fructose in much quantity (example: from a piece of fruit or fruit juice) or gassy vegetables like cabbage and cruciferous vegetables and beans (gas would be adding mechanical pressure to those TRP channels which might be an over-active culprit in IBS patients).

  • The book, “Tell Me What to Eat If I Have Irritable Bowel Syndrome; Nutrition You Can Live With; Including Dozens of Healthful Mouth-Watering Recipes,” by Elaine Mager, M.P.H., R.D., includes dietary advice and other information about Irritable Bowel Syndrome (IBS). (Warning – most of the recipes contain gluten
  • Re corticosteroids and hormone D:  http://www.oapublishinglondon.com/article/1471

Other diseases that are not well understood but which involve edema and excess fluid entering the area between cells include Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF).

So a lack of adequate potassium or magnesium might be involved in allowing too much calcium to enter the interior of cells where it can act as a trigger to increase the flow across the TRP channels even more.

A summary:

/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./