Extracellular Matrix, Interstitium, and Adrenal Fatigue

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM; Dorine Lam, RDN, MS, MPH

Read Part 1 Now!

Nutritional Supplementation and Medication Considerations

Adrenal Fatigue and InterstitiumFrom a nutritional supplementation perspective, a comprehensive approach should be detailed in accordance to the level of congestion present before starting a body cleansing detoxification. Supplements that may be good for liver and adrenal function is usually not well tolerated when the interstitium is congested. Sensitivities to vitamin C, B, herbs, and glandular compounds as well as medications are common. It may be necessary to temporarily reduce nutritional supplementation load carefully so as not to send the body into a crash or a state of withdraw.

Draining the ECM of pollutants therefore should be the primary focus, or else the release of toxins from micronutrients’ action on the cell (including vitamins, enzymes, minerals, etc.) will stimulate negative symptoms, such as skin eruptions, anxiety, aches and pain, fatigue, fever, malaise and skin rashes. Most of these are the result of inflammation.

Because most sufferers need some form of nutritional support, abrupt cessation is not recommended and should be avoided. Providing a gentle delivery system of nutrients with easy assimilation and cellular absorption without over stimulating and over burdening the liver workload should be the guiding principles. For example, gel caps or liquids and encapsulated powders should be considered for better absorption.

A thorough review of supplementation should be undertaken. In severe congestion, even relatively harmless compounds such as digestive enzymes and probiotics may be too much for the body to handle. Selected supplements can be considered, provided they are given at the right time, along with the proper delivery system and dosage. Slow drip delivery is preferred to bolus. The right nutrient at the wrong time or wrong dose will easily backfire given a fragile body with limited reserve.

Avoid traditional detoxification approaches such as liver flushes, body cleansing detoxification, and enemas, vegetable juicing, and fasting. These approaches can generate a significant amount of toxins that can overwhelm the liver and pollute the ECM. In other words, they can be “too strong” for the ECM. Intensive exercise can lead to excessive oxidative stress that can damage the ECM as well. Both should be avoided until the body is well healed and stable.

Avoid medications as much as possible because invariably they all have to be metabolized by the liver. This includes all steroidal hormones such as cortisol, testosterone, estrogen, and progesterone. Those who already on such medications should not discontinue abruptly. Antibiotics can be insulting to hepatic cells, and statin drugs commonly prescribed for lipid abnormality can damage the cytochrome P450 detoxification pathways over time, leading to sub-optimal liver function. Exposure to environmental toxins including fumes and chemicals should be curtailed. These toxins accumulate within the interstitium over time. Live in a clean and unpolluted environment with plenty of sunshine, fresh air, and clean water are sound principals to be adhered to whenever possible.

Which Tool to Use?

A woman with a lot of questions on interstitiumOne should always exercise prudence in choosing any alternative methodology. Remember in this discussion, we are dealing with an extremely weak and fragile body at a time when extensive medical workup and laboratory tests are normal. Clinically, the picture is convoluted and defies conventional medical logic. Symptoms include fatigue, insomnia, heart palpitation, anxiety, food and supplement sensitivity, low blood pressure, dizziness, and hypoglycemia, just to mention a few. With the lack of understanding of the root cause of Adrenal Fatigue Syndrome (AFS) to start, and not knowing the underlying mechanism of action of these tools, it comes as no surprise that these techniques, though clinically proven useful when properly deployed to the right subject, are universally rejected by conventional medicine. Once the stimulatory approach of conventional medicine, using tools such as hydrocortisone, testosterone, estrogen, thyroid replacement, anti-depressant, and sleeping pills has run its course, sufferers are abandoned. Sufferers at this point should not be discouraged, but instead should get educated and start “thinking out of the box”. Remember that modern medicine of the past 150 years does not hold a monopoly to the collective medical knowledge of 5000 years of civilization.

Not one tool mentioned above is superior to another because all are designed, when properly used, to perform a body cleansing detoxification for the interstitium in the background, subtly and slowly. The body is in control of how fast this can go. Our job is to facilitate that process by providing the body the necessary tools for self-healing. For best results, a personalized program using multiple tools to harness the collective synergistic effect is recommended. Proper design of such a program requires the clinician to thoroughly understand not only AFS but also each of these tools in detail as to their pros and cons. Some trial and error is necessary, even in the best of hands.

Gentle Detoxification of the Interstitium

Normal detoxification processes can do more harm than good when the interstitium is compromised. A more natural approach may help rid the body of harmful substances.

Warm water

Drinking plenty of warm water is one such natural, effective, yet gentle method. Warm water induces sweating, a method whereby toxins are eliminated, and aids the liver in flushing out these toxins via the urine. Added to this, warm water increases your metabolism, thereby aiding the digestive process while helping the body maintain its electrolyte balance.

More benefits of water include keeping you hydrated, counteracting fatigue, calming your mind, and keeping your skin looking clear and fresh.

Warm water, lemon, and ginger

Lemon water and interstitiumPractitioners of Ayurvedic medicine have long used a tea made of warm water, lemon, and ginger to flush the system. Each of these three components has their own specific benefits.

Along with the benefits of warm water, ginger kick starts your digestive system and improves the circulation of nutrients throughout your system. It also helps in the elimination of toxins. Ginger may also have oxidative and anti-inflammatory properties, and can help with the following ailments:

  • It may help reduce the effects of motion sickness.
  • It may help reduce pregnancy-related vomiting and nausea.
  • It may help reduce nausea associated with chemotherapy treatment.
  • It may help reduce the pain and inflammation resulting from severe osteoarthritis.
  • It may help reduce the causes of heart disease or reduce your chances of getting a stroke. This is because it negates blood clotting and may help reduce cholesterol.
  • It may help control blood sugar levels.

Lemons are a great source of vitamin C, a powerful antioxidant that helps protect your interstitium from the damage of free radicals. It may also reduce your risk of developing heart disease or getting a stroke and may help lower blood pressure.

Furthermore, lemon has other great benefits:

  • It may improve the quality of your skin due to the antioxidant properties of vitamin C.
  • It aids the digestive process by improving your metabolism and acting as a mild laxative (helping to prevent toxic buildup).
  • It may support weight loss and improve insulin resistance.

Steamed vegetables and thick soups

Steamed vegetables and thick soups have a wealth of nutritional and health benefits. One of their greatest benefits is that they fight inflammation and promotes digestive health. During the cooking process, many of the complex compounds in vegetables are broken down into simpler forms, making nutritional absorption easier.

An added benefit is that they may help prevent kidney stones as the cooking process removes up to 87% of the oxalates that are present in foods. Oxalates are one of the contributors to kidney stone formation.

Avoid Castor Oil

While castor oil is rich in ricinoleic acid, which may have healing properties, and it has detoxification and mild laxative properties, it’s not a great choice for those with ECM issues.

Unfortunately, our clinical experience has found that it is generally too strong for most by the time the ECM is congested. Use of castor oil may actually make matters worse and trigger adrenal crashes. The weaker the body, the greater the risk. Too much oral castor oil can also cause diarrhea and dehydration. Transdermal applications carry similar risks and should also be avoided.

Tools To Avoid

Tui na therapy and interstitiumWhen an ECM body cleansing detoxification is being contemplated, it is important to remember that not all alternative tools and techniques are suitable for those in advanced AFS, especially when the body is very fragile. They should be avoided unless conducted under close supervision by an experienced clinician. These include skin brushing, moxibustion, ice therapy, tui na therapy, body manipulation, certain forms of yoga and breathing exercise, lymphatic massage, ultra violet light therapy, deep tissue massage, far infrared therapy, rifle therapy, hyperbaric oxygen therapy, hyperthermia, and ozone therapy. Needless to say, traditional detoxification techniques such as fasting, enemas, castor oil packs and flushes should be avoided during interstitium optimization because they are difficult to titrate when the body is fragile and can decompensate quickly.

Summary for a Body Cleansing Detoxification

The extracellular matrix is part of the internal milieu that bathes our cells. It provides the proper scaffolding for cells to thrive within our body. Pullulated and congested ECM is evident in advanced stages of AFS, where concurrent liver congestion and hypersensitivity to supplementation is common. The task of optimizing interstitium function should be considers as foundational priority in preparing the body for AFS recovery. Indiscriminate use of natural compounds to enhance energy and reduce fatigue without optimizing the ECM first is a common clinical mistake in the recovery process of those in late stage AFS. Multiple tools are available, though most lack evidence based data in the conventional medical model. Fortunately, they do provide positive clinical outcomes with no negative effects when properly supervised.

Read Part 1 Now!

© Copyright 2014 Michael Lam, M.D. All Rights Reserved.


5 - "Hello."
Hello. Thank you very much for posting and maintaining this site; I find it a veritable mine of gems.