Optimizing Resilience in a Toxic World with Jill Carnahan, MD

Episode 86:

Optimizing Resilience in a Toxic World with Dr. Jill Carnahan and Evan H. Hirsch, MD

Evan H. Hirsch, MD 00:08

Hey everybody, welcome back to the energy MD podcast where we're on a mission to

help a million people with chronic fatigue long COVID and M casts take their energy and

their health to the next level. So really excited about our guest today we're gonna be

talking with Dr. Joe Carnahan, and her new book, unexpected and we're going to kind of

dive into that and a number of the things that she's kind of been through and the things

that she's learned from that. So let's learn a little bit about her first. So Dr. Joe Carnahan

is your functional medicine expert, dually board certified in family medicine for 10 years

and an integrative holistic medicine. She is the founder and medical director of flatiron

functional medicine. As a survivor of breast cancer, Crohn's disease and toxic mold

illness. She brings a unique perspective to treating patients. She specializes in

searching for the underlying causes of illness through cutting edge lab testing and

personalized medicine protocols. She has been featured in People Magazine shape

parade, Forbes MindBodyGreen, first for women Townsend newsletter, and the

Huffington Post, as well as CNN NBC News and health segments with Joan Lunden. Her

YouTube channel and podcast features interviews with the healthcare world's most

respected names in medicine, science and functional medicine. She co authored the

personalized and precision integrative cardiovascular medicine textbook with Dr. Mark

Houston. Her new best selling book unexpectedly finding resilience through functional

medicine, science and faith, was released in March 2023. She is also an executive

producer and film writer and is featured in a new documentary about her journey

overcoming illness called Doctor slash patient. Dr. Joe, thanks so much for being with

me today.

01:53

Thank you, Dr. Evan, I'm so happy to be here with you. So

Evan H. Hirsch, MD 01:57

let's start at the very beginning. Or let's start with your story. Tell us a little bit about

where you're coming from and how you got here.

02:04

Yeah, so I grew up on a farm in central Illinois, I was one of five children. And you would

have thought it was the most ideal, like healthy Norman Rockwell lowest price place in

the world, right, like a lovely environment to grow up from lovely family. But

unbeknownst to me, these chemicals on the farm and some of the things I was exposed

to probably even in utero, so in my mother's womb, were affecting me. And I didn't know

that until I got into medical school. So I started pursuing my dream of becoming a

doctor was in my third year of medical school in Chicago, and I found a lump in my

breast. Now I'm literally 24 going on 25, the next week or so. And I didn't think anything

of it. 20 year olds don't get cancer, especially breast cancer. But I at this insistence on

my then husband, I went and had a biopsy, and a workup and ultrasound and all that

ended up, I get a call from the surgeon just a few days after my surgery. And she said

Jill, I don't know how to tell you this, but you've got aggressive breast cancer. And

ironically, I was at Loyola University School of Medicine in that medical arena, which is a

pretty major medical center. At that time, in 2001, I was the youngest woman they had

ever diagnosed with breast cancer. So statistically very significant. Now sadly, we're

since then, we've seen a lot more women in their 20s. And even like late teens with

breast cancer. And it's part of the bigger picture, which I alluded to in the beginning.

We're all swimming in toxic soup in our world is becoming more and more toxic. And I

think one of the biggest things I know you see this as well with fatigue, and all those

patients is the toxicity of our environment is really affecting us to a degree like never

before. And this was my first introduction as a student, you know, getting cancer to

realize that this toxic world was affecting me. And I don't know that there was one thing

that caused my cancer, but there's no doubt in my mind that those pesticides and

hormone disrupting chemicals that I was exposed to on the farm and that like I said,

probably even from my mother in utero, I think the same year I was born there was a

study out of Canada that showed the cord blood of baby infants born fresh into the

world was filled with 200 or more chemicals. So and that was 20 years ago. So often

says say our environmental toxic load became one of my biggest passionate topics of

discussion because I realized that it was responsible in some ways, for me getting

aggressive breast cancer at 25 years old.

Evan H. Hirsch, MD 04:26

Wow. And so you were obviously able to finish med school.

04:31

Yes, I took nine months off and did very aggressive three drug chemotherapy, pretty

much everything they could throw at me. And then radiation. I had a couple of surgeries

and about nine months later, I was considered in remission. But I was so sick from all

the chemotherapy. It's interesting that one little point for your listeners I think is so

important is when we're faced with a life threatening diagnosis or decision or as you

know, as you're crafting a treatment plan with patients. I think one of the most important

things we can do is that it's overwhelming. And even for me, I'm in medical school, I

have all the data at my fingertips, the libraries, the docs to help me. And it was still

overwhelming to make a decision. But one thing I did, Evan, was I looked at all the data

and made a decision. And I decided at that moment at 25 years old, I would never, ever

second guess my decision in the moment that I will just move forward without regrets.

And the truth is those chemotherapeutic agents, they probably saved my life, who

knows, but they also cause long term detriment to my body to my heart to my immune

system. And I've never ever regretted doing that. And I think that's an important lesson

because so often we're faced with these really complex decisions in our healthcare. And

the worst thing to do is live with regret. And so I think as we go forward, we tend to just

do the best thing we can at that time, and then move forward. And I've done that since

those years because I had some sequelae. Just shortly after my breast cancer after it

was in remission, I started having cyclical fevers, and I started having abdominal pain.

And one day I was in the ER taking a patient's blood pressure back on rotations after

cancer. And I passed out, and I ended up that night in surgery for an emergency

abscess, and I woke up to the surgeon telling me I had Crohn's disease. And this is

literally like months, probably four to six months after finishing the therapy for cancer.

So that was my second intro to autoimmunity and what that meant, and I'll never forget

the gastroenterologist, no telling what the diagnosis was saying, you're probably gonna

need lifelong immune modulating meds, you're gonna need steroids, you may need

surgeries for bowel resection, and this is incurable. So that was depressing. And then

right before I left, I said, Well, Doc, you know, I want to do my part, is there anything I can

do with my diet? And he did not even pause, and he said, she'll die has nothing to do

with this. And that was once again, lessons about intuition. There was this place deep

inside me that I didn't know what I was talking about. I had no nutritional training. But

deep inside me, I thought, That can't be true. How can a gut disease not have anything

to do with the external world and the environment and the foods that we eat? So I went

on a search, and I found the specific carbohydrate diet, and I started changing my diet

because I thought, What do I have to lose. And within two weeks, my fevers went away,

a lot of my gut symptoms improved. And it took me a couple years to really restore my

gut to full health. But that moment, when I saw the diet change didn't make a difference,

I realized diet does matter. And I'm considered now 20 years later, I don't have Crohn's

anymore. It's, it's what we call reversible autoimmunity.

Evan H. Hirsch, MD 07:30

Brilliant. And so it sounds like that kind of moved you at that point, you were still kind of

more conventional. But you were learning more about the the natural side of things with

the diet? When did you make a big pivot into integrative and functional medicine?

07:45

Well, the interesting thing is I grew up my mother was a retired nurse, and she raised her

children, and we had like a half acre garden. So I was kind of enmeshed in the principles

of more holistic, like food as medicine. And even though I wouldn't have called it that

growing up, we grown apples in an orchard and made our homemade cider. And like we

had a garden with tons of frozen and canned fruits and vegetables every year. So there

was a lot of emphasis on quality of soil quality of food, quality of life, and understanding

that the nature and the foods that we put into our bodies made a difference in our

health. And we were fairly healthy growing up. And it wasn't like we didn't go to the

doctor, but we'd never went to the doctor for first like my mother would do in herbal tea,

or, you know, something, and often we get well without having to go into the hospital. So

I have these principles ingrained. And I kind of knew I wanted to do a more holistic

model. And what I ended up doing is I went into medical school, but I kind of went with

the idea that what if I learned the currently best reimbursed system in the US. And

notice, I didn't say the best system, because really all reimbursement, right versus

insurance purposes, and really learn that system well, and then try to really shift and

change to how we do root cause like trying to find root cause and also trying to use the

most natural ways for healing. So I kind of went into medicine with that idea. But my my

face to face encounter with death, you know, mortality and possible death from cancer.

And then Crohn's really allowed me to go to where the rubber meets the road is like,

what am I going to do from my body? And I started doing I did some very conventional

things, but then I also learned the diet, you know, made a difference. And I also learned

that supplements made a difference in my cancer treatment. And it wasn't until after I

graduated from medical school that I first heard Dr. Jeffrey bland, you know, Father

functional medicine, and many of us have the story where it was an epiphany because

as he was talking and realized, oh, what I've always wanted to do is what he's talking

about I just didn't know I had a name. So then right through residency, I started doing

training and holistic medicine did my boards and started learning from the functional

medicine training but once I heard Dr. Jeffrey bland, I realized that there was a name for

this medicine called root cause and formally, holistic medicine is really just how do we

add in therapies and people that we know like an acupuncturist or massage or service

or physical therapist or these other modalities. But what I wanted to do probably like you

is what do I do in the clinic with a patient myself? Like, how am I looking at them? How

am I assessing and treating them. And that's where functional medicine came in,

because it really gave a landscaper protocol for going deep into root cause of why

someone might be suffering from chronic fatigue or migraine headaches, versus just

giving a label and a diagnosis, actually going into that deeper level. So once I found out

about functional medicine, I really fell in love. And I kind of I think it was one of those

things that I always wanted to do and didn't know it existed. And then I went and

pursued that. So pretty much right out of residency, I was starting to do integrative

functional assessments and plans. Excellent.

Evan H. Hirsch, MD 10:46

Yeah, I love the fact that you brought up the kind of the root cause versus diagnosis.

And I wonder if you can talk a little bit about that. Oftentimes, people you know, there's a

lot of security sometimes that people get with having a diagnosis. And oftentimes, I'm

telling them that that's very different than knowing what your causes are, can you kind

of speak to that distinction?

11:04

I'm so glad you said that. And you said it so eloquently. Because truly, diagnoses are just

the label. And a label gives us a reference. It's like a place on a map where he's like,

Okay, I want to go here. And this is where we know it is we know how far it is, from our

destination, how many miles it'll take how much gas we need. So it gives us kind of a

roadmap of where we're at, and what the label is of the description of, of set of

symptoms that we have. So it is helpful, because Doctor doctor like you and I talking, we

can talk about a diagnosis, and we know immediately what we're talking about. So it's

kind of a common language that doctors can talk amongst one another, or if there's

clinical research on a thing. We know what that means. But like you said, it doesn't say

anything about what happened in your life, we're always walking on a trajectory. And

we're always walking from point A to point B, and we're somewhere on that trajectory.

So you and I are looking at the patient as if they're on a journey. And we want to say

where are you at in your journey? And how did you get here from there? And if we map

that out and say, Oh, well, this happened in 1980. In the 1990, this happened in the 1992,

this happened. And we're seeing these points in the trajectory of where something

changed, or shifted in the patient's health, we can actually go back and say, Oh, well,

maybe that move to that water damage building, started the process of your chronic

fatigue, and then your brain fog, and then you got early onset dementia, I'm just making

this up. But there could be this trajectory of ever episodes of things that happened. And

when we do that, then we can go backwards and try to reverse some of those things. So

for example, autoimmunity, you can look at the gut, you can look at the immune system,

you can look at environmental insults, and you can look at what point did the immune

system start to shift and attack self. And like I said, with my Crohn's disease, we have

something now called reversible autoimmunity, which means if we go to root cause, I'm

sure like you I've seen cases over and over again, where someone who's told they have a

life threatening autoimmune disease that is incurable, gets cured or gets reversed

because we go to the root cause.

Evan H. Hirsch, MD 13:06

Yeah, and I just want to put a greater understanding around that where it really is, you

know, if you've got Hashimotos, or if you've got Crohn's or something like that, that that

isn't the cause. And oftentimes, there's multiple causes, you know, in the work that I do

for chronic fatigue, I, you know, I call them the big five or the toxic five and heavy metals,

chemicals, molds, infections and trauma. And I'm curious about like, what have you

seen in terms of causes of autoimmunity and causes of fatigue and the work that you

do? They same? Are they different, when which ones would you say like are most

prominent for you?

13:43

Oh, I love that five roadmap because it's so so true. Two things. Number one, if we look

at autoimmunity Dr. Fasano wrote a decade ago about the triad and we see this

common whether it's Ms. Hashimotos, lupus, Crohn's or colitis or any other even rare

autoimmune disease, if not common, we know that at the core, there's a genetic

component, there is a environmental insult, that could be something as simple as

gluten, or something as complex as heavy metals or mold or environmental inputs of

some insult that triggers the immune system. And the third thing is that gut immune

interface there's usually something wrong at that level, because the majority of our

immune system lines the gut. And so when we have an insult permeability, mast cell

activation, heavy metals, mold, and I could name 100, other parasite infections

dysbiosis. That in barrier from the gut lumen is impacted, and all of a sudden you have

dumping of the gut contents into the bloodstream which overwhelms the immune

system. And then immune system is there right on the barrier of the gut immune

interface to protect us because that's our, that's our, that's our interface with the

environment. But because that overload of the immune system happens there that's

usually ground zero for autoimmunity. So we have genetics we have environmental

insults, and we have the gut immune interface and we understand that triad. We can go

to each those pieces and do what we can to restore and reverse the things, the insults

that were causing it. So that's like autoimmune in a nutshell. And then on this side, you

said, Well, what do I really see? Mine is a little more simplistic, although I think yours

your five causes are actually way more accurate. I always think of it as toxic load plus

infectious burden, and the interface of those two creating immune inflammation,

dysfunction and autoimmunity. And really so usually my complex cases like chronic

fatigue or migraine headaches, or some nuance of autoimmunity or brain dysfunction,

at the core involve some combination of toxic load plus infectious burden.

Evan H. Hirsch, MD 15:40

And by toxic load, you mean like heavy metals, chemicals molds?

15:44

Yeah. So honestly, I'm just putting them in a bucket. But yes, that's exactly a big bucket

of toxic heavy metals, chemicals, all the things that we get exposed to PCA or PCBs, and

then PSAs are big now. You can name 100 things.

Evan H. Hirsch, MD 15:59

Yeah, and I really, something you said initially kind of speaks to this too, is this. A lot of

people think that illnesses that run in families are strictly genetic. But we know that so

much of this gets passed through the placenta, right? So so what do you say how much

of some of these things that we think are genetic or actually just environmental being

passed through?

16:24

I love that question, because so it's really like the nature nurture question, right. And the

truth is, whether it is someone who survived the Holocaust and had a baby in utero and

had an imprint, we have this data now to show the science that a baby in utero when the

mother goes through a very traumatic event, or a war or something difficult, actually,

imprints on the cortisol and the HPA axis of the babies. So they come out of the womb

with HPA Axis dysfunction, or proneness, to higher low cortisol. And that's literally

imprinted. And that's and we have things like, say, a nutritional deficiency, and a mother

can imprint on the epigenetics of a child. So this thing is yes, we pass on genes. But far

less often, it's a hardwired gene that can't be changed. And far more common. It's an

epigenetic imprint that's either nutritional X excess or deficiency, chemical excess, or

deficiency, or some sort of stressor that makes an imprint on the transcription of genes,

which means that the route you and I know this can actually be changed, because then

that next generation, we can do some things with methylation or with diet or nutrition or

decreasing chemical load, that actually changes the gene expression. So I love thinking

about that way, because it's so much more empowering to patients to know that

generally, even genetic expression can be changeable with the right inputs.

Evan H. Hirsch, MD 17:50

Yeah, let's dive into resiliency, you know, which you talk a lot about in your book. And it's

so important, you know, especially if we're looking at this example, you know, where so

much of trauma can be inherited, you know, so we're already coming. And then we're

getting all these toxins through the placentas, we're already coming out of the womb,

into the world kind of behind the eight ball. And so and then we accumulate our own

toxins and our own trauma. And so, how does somebody create resiliency? How do they

increase their resiliency throughout their life?

18:25

Yes, so the idea of resiliency is so empowering, because what happens is, we all have

suffering and suffering is inevitable as a human being. And if we think I think what we

often do is we think we have control. I'm just gonna take a little side segue for a

moment with Hans Selleys work on stress and cortisol, he talks about the acronym nuts,

novelty, unpredictability, threat to ego or threat to health, and sense of control. Those are

the four things that are most common to trigger a stressor or stress response in our

body. And the reason I bring that up is because all of those things, we think that we have

control, we get health insurance and car insurance and health insurance, and we go to

the doctor and we do all the right things. And we try to eat the right things. And we still

could get like me at 25 I was voted in my senior yearbook, most healthy senior like

health conscious senior, like I was the one of all of my high school classmates that

rarely drank, didn't do drugs, ate really clean exercise every day. And guess what I was

the one who got cancer at 25. And I would have thought in my teens and even even early

20s I was doing all the right things. That was my insurance policy. But it didn't help right.

So that illusion of control. As soon as you've kind of break that down and realize, oh,

wait, suffering happens. And I know people listening and you know, from seeing

patients. Sometimes you have the most beautiful, wonderful family or person in your

office that just lost their you know, their dad or their son or their tragedy and suffering

happens. So back to resilience. When we think we have control over this. It actually

stresses us more because We're shocked when something bad happens, right. And the

truth is, we're either having just gone through something crisis crisis like or tragic or

difficult. We're in it right now. Or it's coming up around the bend. Like that's the only

three options. So the sooner we get really comfortable with suffering and the inevitable

difficulties of life, or even a difficult diagnosis or health issue, the sooner we can actually

become resilient. Because when we start to recognize this as inevitable suffering is

going to happen. Instead of resisting and trying to avoid it, we can't. And when we when

we try to avoid it, and then it happens. We're shocked. And it's terrifying. It's so

upsetting. But when we know it's going to happen, that's the part of resilience where we

can say, Okay, this happened, this is sucks, I hate that I got cancer. But what can I do in

the midst of the suffering in the midst of the difficulty in the midst of the new diagnosis

of the death of a loved one, to actually take this, the thing that I can't change and

transform it into something that actually creates a better, stronger person inside. And I

call that like transformation, right? So if we can take difficulty and allow it to transform

ourselves, mentally, physically, emotionally, otherwise. And this is really the real work

beyond trauma, because we all have trauma, big trauma, little trauma, I love that you

include that. And I feel like so often when we get stuck in trauma patterns, it's the thing

that keeps us from being resilient. And I am not saying that suffering is easy, or that we

shouldn't have deep compassion. I'm just saying if we expect it, and then we reframe it,

we can do a lot with how we reframe. And when we do that, and we we try to find the

pearls and the important pieces and the lessons, all of a sudden, what could have been

the most tragic thing in my life, my cancer at 25. Turns out now I can talk about it as the

greatest blessing because it truly transformed who I am and how I practice medicine.

Evan H. Hirsch, MD 21:51

I feel like I just got called out because I do like to control my life. You know?

21:57

It's so easy to

Evan H. Hirsch, MD 21:58

Yeah, yeah. In the hope that that uncover uncomfortable things are suffering isn't gonna

show up. Right? What is? What does Buddhism say all of life is suffering.

22:09

Yes, yes. Yeah. And some of the principles are really the ones that and what's funny is

instead of again, you think about it, I think like a car accident, and someone who's

maybe been drinking, and they're just kind of like, they never get hurt, because they're

not resisting. They're just flopping around, they're kind of half not sadly, you know, and

then the person who like sees it coming and braces and like their whole body stiffens,

they often get fractures and head injuries and significant trauma, because they're

resisting what they see coming. And that surrender to life is so powerful in how we can

become resilient. Because when we resist it, we actually do more damage to our minds

and our bodies.

Evan H. Hirsch, MD 22:48

Going with the flow? Yeah, I mean, there's definitely lessons in there and business, you

know, if the universe is showing you something, you know, you pivot your business in a

certain direction, or you or, or with your team, or, or certain things that you need to learn

at the right time. Very interesting. And so then other practices that you recommend, I

know you kind of go into some limbic system, retraining stuff in the book, what do you

what do you think are good ways to kind of practice going with the flow surrendering to

life being more resilient?

23:25

Yeah, so some form of practice of spirituality, I believe we all and spirituality can be

anything to anyone, right? It doesn't have to be a certain religion. But the idea there is

when we have I love even going back to the research that Dan Buettner has done with

the blue zones. And he goes to all the places where there's centenarians the most

common high concentrations of people who are living over the age of 100. And so what

is unique about this culture, and there's things like good foods that are local and

sustainable and walking everywhere in movement, and connections with long term

lifelong friends, those are all great. But one of the other things he found across cultures

of all different places, Japan and Greece and Costa Rica and Loma Linda etc, was they

had a purpose and meaning they had this greater idea that their life was had a meaning

and purpose beyond just themselves. And when we have that greater purpose and

meaning, which again, can be a form of spirituality. It actually I think, invigorates us to

live in a different way to live with generosity and live with love and live with this, this

greater good for humanity. So that's one of those pieces, and then the personal

practices for me, it's like walking in nature, being connected to nature. breathwork can

be an avenue, I do prayer and meditation as well. So that kind of connection with

something greater than myself. And that's also where we can surrender and trust that

the universe is working out things for our good. And again, everybody has different

practices for me, it's literally walking in nature. breathwork being with people I love

pretty basic things

Evan H. Hirsch, MD 24:58

and they connect you to spirit connect To to something larger than yourself. Yeah, that's

great. Yeah. And so purpose in meaning. So, can you give? Can you give us some

examples of purpose and meaning? Yeah. Yeah. So

25:16

I'll just take myself for example. So I feel like it's really clear. I'm a healer, I'm a doctor.

But underneath that my real meaning every day is to glorify the divine and love people.

So my greater purpose and meaning is, how do I today in my interactions with my staff,

and my patient, my family, my friends? How do I show unconditional positive regard, or

we call it unconditional love to every single person I come in contact with. Because so

often, the healing starts this place where someone walks into my office and feels this.

Many of our elders go back to medical trauma. Medical gaslighting is so common. And

what happens again, I know you see this with your clients and patients as well. People

have been led to believe they can't trust themselves that when they don't feel well, that

Doc says Oh, everything's fine, your laps look normal. And they start to start to doubt

that their own intuitive body can give them information that's helpful, like, My chest

hurts a little, and it might be just they're angry, it might not be that they're just having a

heart attack, right. But when we start to lose contact with our somatic senses, and our

body and trauma does this too, then we start to not trust our intuition about what's right

for us as far as health and healing. And we start to relegate that to an expert, like a

doctor or a coach or someone else. And when we lose that connection to our body, it

was like when I went back to the doctor in the gastroenterology right for my cancer

diagnosis. And he told me, Jill diet has nothing to do with this, I could have done this

one thing would have, which would have been, he's a doctor, he's the guru, he knows

best. diet has nothing to do with it, even though my heart said that wasn't right. Or I

could have gone the other way, which is trusting my heart and mind and body saying, I

don't know much. But my intuition says that can't be true. I'm going to search and find

and see if this feels right for me. And then as I make changes in my diet, see if it's true,

and I did and I saw results. So that was trusting my body and heart. But for many, many

years, I kind of dissociated from the somatic experience of living, and I could do a lot I

suppressed pain, I have one of the highest pain tolerance of anyone I know because of

what I've been through. But by doing that we're subjugating our human body to say,

you're not valuable to give me information only can someone else outside of myself, tell

me what's true and right. And when we do that, we lose our ability to heal. So back to

unconditional love and greater purpose. If I'm creating space for someone to truly feel

seen, and to feel heard, and to feel known, all of a sudden, they start to be like, well,

maybe I do know something, maybe I do know what's wrong with me or I can help the

doctor get to the right answers or, or I can even be part of my plan. What if that were

true. And all of a sudden, we empower that patient to give them purpose and meaning.

So back to the greater purpose. For me, it's that love unconditional love at the core. And

it's that giving empowerment to the patients and purpose and meaning to so that they

can start to trust their bodies to give them information and data that will guide them and

lead them in a healing journey.

Evan H. Hirsch, MD 28:19

So well said. And so then you mentioned intuition. And trusting ourselves when it comes

to our health. Can you talk a little bit about how people can foster greater intuition with

themselves?

28:40

Yes, this is the heart of what I do in my book and the resiliency there because what I

learned in it, all of this comes from my personal experience. So almost everything that I

talked about is something I had to learn the hard way, or the difficult long way. And so so

much of it is just coming out of this wellspring of like oh, I've lived that I know what it's

like to not have intuition. And the important thing here is this. Let's take autoimmune for

a moment. We've talked a little bit about that. And I love Gabor Matta his work Peter

Levine all these I know, you know, some of the trauma experts, somatic healing experts,

and they will talk about autoimmune, metaphorically is attack of self right. It's this

body's immune system has turned on itself and whether it's the thyroid, or the nerve

cells or the muscles or whatever organ, your body is attacking self. So metaphorically,

there's something against self self hatred, self loathing parts of ourselves, we don't like

or acknowledge or any number of things that is against self. And what I learned in my

journey is okay, we can talk about self love, let's start loving ourselves. Let's start being

compassionate and kind to ourselves, which is part of the route of healing. But what I

learned along the journey is you cannot really love yourself and your cells into healing

until you trust yourself in your cells to give you the right information. So if I say I don't

believe any signals that come from my neck down, it's all here and it mice stomach

hurts I ignore it, I suppress it, it's fine, I'm fine. That's all this like denial of self, and denial

of my own intuitive, innate healing potential in my body. But when I started tapping and

listening and say, Oh, my heart feels heavy today, and I'm sad, and I let that feeling flow

through me. And that's part of the trusting myself, because then I get information that

allows me to heal and move on. And I just learned in the journey, I hope this is making

sense. But at the core, if we don't trust our intuition, our innate a healing ability, and our

innate ability to know what's right and wrong, and what's might even be, you know, on a

cellular level going wrong in our bodies, we cannot really love ourselves. So it starts with

trust, and then we love and then when we truly, truly accept ourselves, just how we are

without wanting to change it, even in the suffering, because so often is, you know, when

people say I have chronic fatigue, or I am sick, they become that identity, can't really

change or transform until you start to love those parts yourselves and realize that

change is possible. And I think the intuition comes first. So trusting ourselves, loving

ourselves, and then and only then can true healing take place.

Evan H. Hirsch, MD 31:13

And so how do you recommend that people reconcile or hold those different

components of, of diagnosis? Or cause or, okay, I know I have chronic fatigue, and I have

to work on it. And they don't want to identify with it. How do you rectify those?

31:29

Yeah, cuz you have to have the diet, whatever the diagnosis is in the beginning, right?

You still need these labels that kind of guide and direct the past. So you get Okay, I need

this kind of a protocol or plan. But what happens is, and I love that you have trauma in

your milieu of what do we treat, because this all relates to that. So often, when someone

is in my office, and they've had chronic fatigue, or fibromyalgia or some certain illness

for 20 years, or 30 years, there's some piece of that, that they might be stuck with.

Because there's, again, this is gonna sound really harsh, and I promise you it's not. But

often, there's a piece of ourselves that either identifies with the illness, or that has a

benefit from the illness. Let me tell you my example. I was 21 years old, when I got

married, I'm divorced now. And I immediately got married and have three children. One

of them had disabled totally Down syndrome and autism and needed full time care. I

was in medical school, 60 8100 hours per week, raising three children, new marriage, it

was way, way, way more than I should have been able to do. But what I did is I

suppressed my body. I was strong, I was tough. I grew up on a farm, don't complain, pull

by the bootstraps, all those mentality things, right? And I was like, I'm going to show up,

I'm going to do this and I with the mental fortitude, I pushed through that I got through

and guess what, third year medical school. Cancer comes. Now we talked about the

chemicals and all of these other pieces of the puzzle, and those were part of it. But

guess what else was part of it part of it was me suppressing my true nature, which was

actually highly sensitive, empathetic person who needed rest, who needed nourishment,

who needed to not work herself to the bone. And now I think that was part of my body

actually saying, Hello, Jill. If you're not going to listen to our subtle signals that you are

not well and that you're pushing yourself way too hard. We're gonna come up and show

you and again, metaphorically, I think the cancer and the autoimmunity was a wake up

call saying my body was like choke, please, will you please be kind to us? Will you please

be kind to me. And I was just like, shut up and behave. I'm going to push through this. I

remember when I got my diagnosis in medical school, and I thought, I'm not going to

take any time off. No one will even have to know I have cancer. I'm just gonna work. I

won't tell anyone. Well, the first chemo treatment put me on my back and I was so sick. I

realized real quickly there was no way I was going to continue medicine while I was

doing chemo, but in the beginning, I thought, oh, Bodhi, you can just take a backseat, I'm

just going to treat you with the drugs. And we'll get through this but I had no self

compassion. And so back to the meaning and purpose. Sometimes these things come

to our into our lives, to transform us and to shake us out of our reality and to get our

attention. And sometimes it's the best gift in the world. When an illness comes so often

as awful as cancer and autoimmunity are or chronic fatigue. They are a Hello, are you

there because your body and mind and spirit need transformation in order for you to get

to the next level. And if we listen to that message, it can be transformational. But they're

hard. And so again, if we ask ourselves, Is there a reason this is here? And often there is.

Evan H. Hirsch, MD 34:44

Yeah, and you find that people do better in your programs when they do have that

acceptance?

34:49

Yes, yes, absolutely. Because all of a sudden there becomes it's really kind of like deep

trauma work, which I'm sure I'd love to hear more about how you address that because I

think there's multiple ways but When we deal with those, because often again, there's an

identity with that illness where there's a purpose with that, and we kind of get to that

root and pull it out by the root, all of a sudden, it becomes unnecessary for us to be ill

anymore.

Evan H. Hirsch, MD 35:12

And health can or the journey for better health can become a spiritual path. Yeah. So

one of the things that we do is we complement the work that we're doing with some

trauma programs out there are there specific trauma or limbic system retraining

programs that you find to be especially helpful for folks? Yes,

35:31

and again, you're probably the expert here, the things I've obviously DNRs, the Gupta

protocol, primal trust, any sort of somatic experiencing therapy, and even if someone

wants to do I find that a lot of these you are type A, and they're already like overloaded

with their to do list, or their OCD in nature, because of the histamine issues or whatever

else is going on. And so some of these people don't need one more to do. And some of

these programs are like an hour a day, this many times, very protocolized. So those

programs are great for someone who needs structure, and you can there most of them

online, or you could work with a therapist weekly, that does somatic behavioral therapy,

those are all great. But then there's the other side that some you will like myself, and

med school just needed someone to take care of them. So then I recommend like

massage therapy, cranial sacral therapy via neural beats, thought field therapy,

something where someone is actually helping them to take some of the burden off. So

it's either someone needs more structure, and then the programs or best DNRs, Gupta

program, primal trust, et cetera, or someone needs actually someone to help and

nurture them in their soul. And then it might be massage therapy, or cranial sacral or

neuro linguistic. But in that realm, there's 101 different things that they can do. And

really, it's just how do you get most awareness of your body and get back embodied in

your body so that you can feel what's happening, and learn to make the changes based

on the signals that your body innately will give you?

Evan H. Hirsch, MD 36:56

Well said, so, I want to touch on journaling a little bit and kind of the therapy of writing.

My wife leads program that we have, where it's like a four day journaling workshop for

expressive writing. And you talk about something in the book about a letter to your Dad,

can you talk a little bit about this? Oh,

37:23

sure. He had to the heart. This part of the book was probably the hardest to write. And I

wrote about something that was really difficult and beautiful my life. So I have a

wonderful family and wonderful parents and I didn't have any big treat big T horrible

trauma. But I definitely had little T traumas in my childhood that I started to realize. And

one of them again, my dad showed up the hard working farm kind of mentality is work

hard, don't complain. All the stuff I just talked to you about. My dad was no different.

And they weren't very expressive, this kind of the German Swiss, so there wasn't a ton of

like, you know, really coddling the youngsters. And because of that, I grew up in this

family I happened to unbeknownst to me at the time, I learned this in my 30s I was an

empath. And I was a highly sensitive person. And what that means is I feel emotions

and energy of everything in the room, I could walk into a room and tell you exactly what

happened before because I can feel the anger, the fear that heaviness whatever, as soon

as my patients part of the gift now is I can really, really tap into what they're feeling and

kind of understand them on that intuitive level. But growing up in my farm family, I didn't

know this about myself. I just thought it was a freaky sensitive girl that was totally an

alien like I didn't fit in. So all that to say with my father who wasn't super demonstrative

but so loving. And in my youth in my seven, eight years old, I thought, am I lovable? Am I

worthy? Am I special? All those things we asked ourselves and I started seeing after my

divorce I was dating some really not healthy character some really bad. I told you some

of the stories I have a whole nother book in me about I have already titled it's the unicorn

wide on how to not date psychopaths. Because I literally dated a, you know, 18 of 20

criteria for psychopathy, ex felon. So that's my story. So that got me to say okay, why am

I choosing these men who are not healthy, not good, not kind, not nurturing to me. And

what I realized was, I had to really believe this is also the self work that I was lovable

worthy that I was special. And my dad, I knew he loved me we have a great relationship.

But what I realized was I actually needed to go as a 40 something year old woman to my

70 something year old dad and say daddy, and I never called him daddy. We don't do

that on the farms dad. I said, Daddy, my seven year old little girl needs to hear from you.

That back then I was special. Have one of your five children that I matter. So I wrote this

in a letter and bawled my eyes out in the coffee shop for hours as I wrote it out. And

again, I knew my dad is so loving and so generous. I knew he'd be over To hear this and

actually helped me, because for me it was healing that seven year old because what

was happening was all these really bad relationship choices. Were coming from that

seven year old girl who needed this reassurance, and she would choose men that gave

her this false reassurance. But it wasn't real and it wasn't healthy. So I literally wrote a

letter to my dad, I send it to him by email. And of course, being the man that he is within

about 48 hours, he wrote me back, and he said someone that was beautiful things. And

one of the most precious things that he said was, first of all, I love you, you are so

special, you're the most incredible daughter I could have ever wanted. And then second

of all, he said, that year when you're talking about whatever year it was, when I was

seven years old, he said, I almost lost the farm. And because he's a stoic farmer, he was

mortgaged up to here, and the crop wasn't income, and he thought he would lose

everything and loses everything that provided family. So night after night or night, he

wouldn't be able to sleep, and I could as the empath in the family, I sense that my daddy

was upset. And I sensed that he wasn't okay. And they thought it was my fault. It wasn't

and he never did anything other than love me, right. And my sensitive little Empath soul

at seven, somehow integrated this idea that my dad was distressed, and it was my fault,

because kids are very self centric, and they don't know any better than just soon was

their fault. And so in me at 40, some years old writing that letter, say Daddy, can you help

heal that will seven year old, and for him telling me, Jill, we almost lost everything that

year, has, Oh, Daddy, I felt like we and again, we had this beautiful relationship, there was

no fracture at all. But it went to another level when I wrote in that letter, and I got his

response. And you know what else happened? I never again, my relationships aren't

perfect. But that moment was a turning point as an adult self of how I dated, because all

of a sudden, I was worthy of love. And I chose men that treated me like that. And I never

get had this awful crazy experience with men because I knew I was worthy and valuable.

And I write in the book because I looked across my sphere of women successful and

men. And I saw so many women and men, and I'll talk about women, because I'm one of

them in the world successful in business successful and career having it all together.

And yet their relationships are falling apart. And I thought, I'm not the only one who

needs to heal with their daddy or mommy, like we often have. And this is that trauma, it's

a little tease, because I really had great parents. But even with little tease like this little

thing as a seven year old, it was my illusion that really affected my whole life. And so it

was powerful in doing that work in the healing. And to go one step further the writing, I

feel like it's so therapeutic. The secret about writing a book, you probably know this as

well, is this almost like therapy, because you have to understand yourself really well to

talk about experiences and patients and things. And so as you're writing, you really have

to work through any issues that are unclear in order to make it clear to your reader.

Evan H. Hirsch, MD 43:01

Yeah, you know, I think, yeah, it's such a great story and such a great reminder. And I

hope that everybody listening to this takes to heart, the that that idea, and hopefully it

goes and writes a letter to their parents writes a letter to their dad writes a letter to their

mom, and and hears back the words, you know, that's part of it, too, is that you could

potentially even write your own letter back to you probably, if you didn't think you were

gonna get the response that you wanted. And, and, and shift that relationship. I know,

for me, I actually got really upset with my father, when I went in, when I went to college, I

would call him up and, and yell at him and tell him that he didn't love me, because he

was a stoic German. Yes. And I know that there was a lot of stress, a lot of financial

stress and other stress that he had when we were growing up. And I'm sure that I felt it,

I'm sure I felt it. And I was like, you know, and he would show up at all my baseball

games and my sports games and coach on my teams. But that's not the way that you

know, I felt like I wanted to be loved or I needed to be loved. And so consequently, we

had, we had that rub for a while, until I was able to accept him and understand who he

was. And what you've just said, just now gives me even more insight and makes me

want to deepen that relationship with him. So thank

44:19

you. And thanks for sharing because it I think all of us like right, who has perfect

parents, and again, I had really good parents, and yet I still have these wounds. And

when we heal those wounds, then we can show up fully with all ourselves. And that's

part of the physical healing to

Evan H. Hirsch, MD 44:36

Amen. So we got a couple minutes left here, and so I know that you have a free gift for

our listeners and our watchers on YouTube. It's a chapter from your book, right? Yeah,

44:49

yeah. So if you're not sure you want to read it. You can just read the first chapter for free

and see if you like it or not. It's just read unexpected.com backslash free chapter. So

worried unexpected.com backslash free chapter. Yeah,

Evan H. Hirsch, MD 45:03

we will definitely drop that link below. And then where can people go and learn more

about the amazing work you're doing in the world? Thank

45:11

you. My main website is just Joe Carnahan, my name j, i, ll car and H A n.com. And there

is blogs from decades, podcasts, all kinds of free resources there. And you can also

follow me on Instagram at Dr. Jill carnian. Brilliant,

Evan H. Hirsch, MD 45:27

and we'll drop those links below as well. Anything that you want to say about the book,

Jill, that I haven't said already?

45:35

Well, no, just thank you for going to some of the deep places. And there's all these how

tos out there. And they're beautiful. And hopefully mine is a how to as well. But I think so

often, I'm not unique in my story. And everybody listening has a story. And when we start

to tell our story, it's connective tissue to the world and to our friends and our family, in

our patients, or even our doctors if you're a patient. And I love the idea of story as

healing. So if you have a story, like you mentioned earlier, go and start writing in your

journal, because we I'm not unique, that I have a book, you can do the same. And you

can start by just writing down these experiences. Because as we journal and write and

process them, often they give us insight into ourselves into our history, into our families

and even into our own healing journey.

Evan H. Hirsch, MD 46:19

Yeah, and I think it's, you know, picking one of those spiritual paths that speaks to you

most like, if you're not into prayer, or meditation or, or walking in the woods, or whatever

it is, maybe writing is for you, you know, so we get to know ourselves better and, and the

better we get to know ourselves, the better we can connect with, with everything and the

better we can heal ourselves.

46:40

Yeah, thank you. Thank you for the work that you do. I'm so grateful to be here with you.

Evan H. Hirsch, MD 46:44

Thanks so much for coming on. Joe, I appreciate you. You're welcome. I hope you

learned something on today's podcast. If you did, please share it with your friends and

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information out to more people who desperately need it. Sharing all the experts I know

in love, and the powerful tips I have is one of my absolute favorite things to do. Thanks

for being part of my community. Just a reminder, this podcast is for educational

purposes only, and is not a substitute for professional care by a doctor or other qualified

medical professional. It is provided with the understanding that it does not constitute

medical or other professional advice or services. Thanks for listening, and have an

amazing day.