Finding Resilience through Functional Medicine, Science, and Faith, with Dr. Jill Carnahan

In this episode, we discuss:

• Dr. Jill’s battle with breast cancer and Crohn’s disease: the driving passion behind her passion for Functional Medicine
• Dr. Jill’s experience with recovery and resilience after mold-related illness
• How to find meaning and purpose in the midst of your suffering or illness and allow it to transform you
• The power of turning to a more heart-based/intuitive way of living
• Forgiveness and other keys to healthy and thriving relationships and strategies for healing trauma
• Why safety and unconditional love are the most essential components of a healing journey 

Show notes:

Hey, everyone, Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week, I’m excited to welcome Dr. Jill Carnahan as my guest. She has a new book out called Unexpected: Finding Resilience Through Functional Medicine, Science and Faith.

Jill is a board-certified physician in the Functional Medicine space. She was diagnosed with aggressive breast cancer at age 25, and that really changed the trajectory of her life and her career. Later, [she] struggled with severe mold toxicity and illness and Crohn’s disease, which has brought her a unique perspective to treating a variety of complex and chronic illnesses, but also on how to respond to illness in your life, finding meaning and purpose in the midst of your suffering, the power in turning from a purely analytical mind to a more heart-based or intuitive way of living, the importance of forgiveness and grieving in the face of significant health challenges or other challenges, the addictive ways we use to escape pain and how to overcome them, finding support in your community, [and] strategies for healing trauma. These are a lot of the capacities we need to develop when we are struggling with any kind of complex chronic illness that’s not something that’s going to resolve quickly or easily or perhaps ever. Or, really, any significant challenge or long-term difficulty in life. And over the course of my career, I have come to believe that how we relate to ourselves in the process of healing is as important [as] or sometimes more important than what we do to heal. And that’s really the foundation of this conversation with Dr. Carnahan. I hope you enjoy it as much as I did. Let’s dive in.

Chris Kresser:  Jill, welcome to the show. It’s such a pleasure to have you on.

Jill Carnahan:  Thank you, Chris. It’s great to be here.

Chris Kresser:  I’ve been aware of you and your work for many years, [but] we haven’t had a lot of interaction. But after reading your book and learning a little bit more about you, I think we have a pretty similar story in some respects, as is the case for many people in our field, who come to it from their own health journey and background. And I know you’ve written an entire book on this, so I’m not going to ask you to rehash the entire book in this introduction. We’re going to talk a lot about the book in the course of the interview. But just as a brief overview for people who are not familiar with you, how did you come to this point in time [when] you wrote this book? What inspired you to do that?

Jill Carnahan:  Yeah, thank you, Chris. It’s interesting because I grew up on a farm in central Illinois and had a mother who was a nurse and retired after she had five children. So, I had a fairly holistic upbringing. I guess I didn’t know I was born a healer, like probably you and many of our colleagues, but in that journey, I knew I wanted to help people. I had no idea I would go into conventional medicine. But as I [made] that journey and the doors opened up, I realized that maybe the best way to actually make a change in our system was to infiltrate and actually go that route. Even though I grew up not really, I was very holistic-minded. My main contacts as a child were chiropractic and acupuncture and those kinds of healers. And I still went to the doctor. It wasn’t like we were anti-medical, but I knew that there [were] more holistic ways to heal. So, I went into medicine with a very different mindset. And then, as you know from the book and anyone who’s heard my story, at 25, I was diagnosed with aggressive cancer. And I had to kind of come to grips [with] what it was like to actually be the patient and to navigate that from the patient’s perspective. And the divine knew because what happened with that experience for me is it shaped everything that I do. It could have been the worst thing that ever happened. And it turned out to be the best thing that ever happened because it framed my experience as a patient, what I wanted to see in doctors, what I didn’t want to see in doctors, and even how to navigate all the information that comes at us. And [that was] 20-plus years ago; it’s only exponentially more that we’re dealing with.

Chris Kresser:  Right. Yeah. It’s a problem that is somewhat intractable, I think, unfortunately. My second book, Unconventional Medicine, was about this topic. And I’d be dishonest if I didn’t say that I’ve been disappointed in the lack of progress in many areas since I published that book in 2017. Of course, there have been bright spots, as well, in areas of progress and improvement. But it’s a 9-million-pound gorilla. It’s just very, very difficult to change that system when the incentives are so fundamentally misaligned. And to me, that’s the core of the problem is you still have a system that is incentivized to produce bad outcomes. And as long as those incentives continue to exist, it’s just human nature that that will be the direction of things. So we have to figure out a way to change those incentives.

That’s a totally different but related topic. I want to talk a little bit more about [that] you were diagnosed with breast cancer at a young age, 25. And that was a big wake-up call for you. So, talk a little bit about that and how that changed your trajectory.

Jill Carnahan:  Yeah, so here I am going along in medical school. I decided to attend conventional medical school, go that way, and was thriving, doing great. And in my third year, just the beginning, it was literally when I was still 24 when I found a lump in my breast during a surgical rotation. And I really, at that moment, did not think anything of it. Most of us in our 20s think we’re invincible, and mortality isn’t really in the conversation. And this was no different for me. I would have probably ignored it. I was in intensive rotations with surgery, like 36-hour shifts, and crazy insane stresses on my physiology because of lack of sleep and all that. But at the insistence of my husband at the time, I went ahead and got it checked out. I’ll never forget, Chris, sitting with a radiologist. Because, as a medical student, what you do is you learn. Everywhere you’re at, you’re learning. So the radiologist took me back to look at my mammogram and ultrasound on the big screen, and [he looked] at it, [he] pointed out [the] calcifications, and he looked at me. And there was just this glint in his eye that I caught because I’m very intuitive. And I thought, “Oh, this is not good.”

And he kind of hid it well, and he said, “Jill, if [you were] 55 years old, this would be highly suspicious for cancer. But you’re 25.” And I caught it there, and that was the first moment that the reality of the fact that this could be serious hit me. And I think on an intuitive level, I knew at that moment. I knew I had cancer. But I went on to get a biopsy and actually determine the diagnosis. And then, the second call and experience with a doctor, colleague, [and] teacher in my medical school was the surgeon calling me, Dr. Smith. I’ll never forget her. She called me and said, “Jill, I don’t know how to tell you this, but you have aggressive, very aggressive [breast cancer]. These cells are some of the worst we’ve seen. And that’s pretty typical in a young person. It’s incredibly more aggressive, more life-threatening than someone who is 50, 60, [or] 70 years old.” So I knew I was in the battle of my life. But I’ll never forget the song on the radio, the color of the walls, that experience. And we all have those where our life shifts and changes in an instant. And it’s never the same. And that was one for me just a week after my 25th birthday. The call from the surgeon saying you have aggressive cancer; what are you going to do about it? She didn’t say it quite like that, but it was in my heart.

And that’s where I started to learn. Number one, I went to the library and started searching treatments. I started doing consults [and started] getting information. And that’s when I first realized I had an almost full medical education. I was nearing the end of my medical education. And it was so overwhelming, the complexity. It was not black and white like we expect. And that was my first a-ha [moment] of what we think medicine is. It’s like the doctor has the idea [that] this is the right thing to do, and this is the one way to do it. It is so far from the truth. And as I dove in, even to just the types of radiation, the types of chemotherapy, there was no black and white. And for sure, no black and white for the youngest person ever diagnosed at Loyola University Stritch School of Medicine, where I attended medical school. So it was really, the first a-ha [moment] was, “This is complex.” And I have a medical education. How much more complex is it for the average patient? Second, a-ha [moment] was [that] there is no standard of care. They make it sound like there is, but there isn’t. And that was my first incentive to [create] my own treatment plan. And I still, because of my aggressiveness of the cancer and my age, I went with a very aggressive regimen. And the third thing I learned was when I made that decision to go forward with chemotherapy, knowing that there [were] toxic effects that would probably affect me the rest of my life if I was cured, I decided to make a decision at that moment in time and never, ever in the 20 years later, or 30 years later, look back or second guess that decision. And I believe that’s one of the things that’s created resilience in my mind and body because I’ve never said, I still today, Chris, suffer from the effects of that chemotherapeutic regimen 20 plus years ago, but I’ve never once said, “What if I hadn’t done it? Or what if I did?” So, I’ve never had to wrestle with that because, in the moment, I did the best with what I had, and I never looked back.

Chris Kresser:  I would heartily endorse that as a general strategy in life. And in respect to our health and any other decision we make, we’re always just doing the best we can with the information we have and with our current capacities and abilities. I know you talk in the last chapter of your book a lot about this—unconditional love and self-acceptance. And we’ll, I’m sure, return to this throughout the interview. So, you recovered from cancer, finished medical school, went into the practice of medicine, and I imagine that initial cancer diagnosis really opened your eyes to some of the limitations of the conventional system. But what continued to draw you toward integrative and Functional Medicine?

Jill Carnahan:  Yeah, so the neat thing was I still had that [holistic] mentality. So, while I was in chemo and radiation, I had prayer meditation. I had friends and family surrounding me, [a] close network. I had a naturopath who did a supplement regimen that worked with the oncologist. So I had lots of alternative and integrative therapies during that, and then as soon as I was done with the aggressive treatments, I did everything I could to restore my gut. And one little piece I’ll mention here, and [then] we can move on, is six months after I got finished with the chemo and radiation, I was once again in the ER for [an] emergency. I’d passed out, found out I had an abscess, and was told that I had Crohn’s disease. So, all of a sudden, I was at another level. And again, that related to the chemotherapy, damaging my gut, creating this predisposition toward attacking self in this autoimmune disease and my gut lining, and then I had Crohn’s [disease]. So all that experience was really just, I think, confirming my desire to combine. And what I always wanted to do was say, “How do we take the good science of conventional medicine, and the good diagnostic skills, and the good clinical skills, and just open the minds and hearts of myself and those around me to what else is possible? What other therapies can we use and not just be so narrow in our scope?”

So I came out, and then, of course, as many of us could say, I heard Jeff Bland. That was my a-ha to Functional Medicine because, in my heart, I knew I wanted to do Functional Medicine; I just didn’t know it had a name. And at the time, the common term was alternative and integrative. I never liked alternative medicine because I felt like I was relegating it to the side. So, I hated that term, integrative medicine.

Chris Kresser:  Yeah, I mean, if anything, conventional medicine is an alternative to the traditional systems we had for a long time, right? But yeah, I’m totally with you on that.

Jill Carnahan:  So I did not like that term, but the integrative was kind of the route I had chosen. And then, when I heard about Functional Medicine, which to me, the difference [is that with] integrative, you know all these wonderful therapists you can use and collaborate with. But Functional [Medicine] is what I do as a medical doctor in the clinic as a problem solver. Find a root cause. So when I heard Jeff first talk about that, I was like, “That’s it.” And again, I’m not unique. [There’s] a lot of people Jeff has inspired in that. So literally, I was just in my first year of residency in family medicine, and I started doing all the [Institute for Functional Medicine] (IFM) training. And I was among the very first class of graduates from IFM.

Chris Kresser:  Oh, I didn’t know that. That’s great. Yeah, I described the difference in a similar way. Functional [Medicine] is much more systematic in its approach and always looking at the root cause. You can still practice integrative medicine in an allopathic framework, right? Where you’re just like, “Oh, you have high cholesterol? I’m going to give you this herb or this nutrient to reduce your levels.” Or, “You have anxiety? I’m going to give you this thing to reduce that,” instead of looking at [whether] there [is] a common underlying cause that we can identify and address. And to me, that’s the key distinction [between] functional and integrative medicine.

Another thing we share in common is a history of our experience [with] mold illness and biotoxin exposure and also treating a number of patients with those conditions. And it’s tough, right? On both sides—experiencing that and treating patients with it. It’s one of the most tricky constellations, in my experience, to address because there [are] so many factors. Not just what’s happening internally with the patient, but finding the right indoor environmental professional to do the diagnosis of the house or environment, remediation, all that stuff. So let’s sort of fast forward in your timeline, where you were practicing, doing better, and then mold came into your life. Tell us what happened there and how that changed your trajectory again.

Jill Carnahan:  Yes, I always say I would have never chosen mold. Mold chose me.

Chris Kresser:  Yeah, I don’t know anyone who would.

Jill Carnahan:  I really think it’s (inaudible 13:52) mold. It is the most complex area of medicine because it affects all systems. And it’s very hidden. So often, after my mold exposure, which I’ll talk about in one second, I would be like, “I can’t. I want to be objective, I want to see what’s going on with [this] patient.” And not everybody has mold, right? Well, over and over and over again, it would come out. The mold was not 100 percent, but a very large percentage of people who are suffering [from] autoimmune [disease] or something else that doesn’t appear to be mold at first glance is actually mold at the root. So that awareness really, I’m sure, like [for] you, it changes everything. Because then you have this lens, and you understand, “Oh, that’s what I’m missing.” So, my experience was after the Boulder flood. I moved to Boulder in 2010 to start my functional consulting practice. It was thriving and doing well, and [I was] loving life in Colorado. And there was a flood in 2013, a massive epidemic flood.

Chris Kresser:  I remember that.

Jill Carnahan:  I mean, literally, I think it was almost a billion dollars of damage. So significant. And my office flooded. I had an older office anyway, so I think there might have been an issue before. Now, in hindsight, this is almost laughable. I had a second-story office that had been remodeled. The contractor threw on a brand new beautiful bamboo floor over [the] 20-year-old carpet like, duh, that’s not very good. So [it] was like soft bamboo, probably puffing that gross, moldy, whatever carpet every step that I took, number one. Number two, my office was right above a crawl space on the first floor. Totally unfinished, standing water, [I] had no idea. And then the bottom floor of the basement was also full of mold. And when that flood occurred, the basement got even more flooded, [and] the crawlspace got even worse. And within the next six months, I started having horrendous rashes, acne, itching, histamine symptoms, brain fog, congestion, [and] trouble breathing. I had a new diagnosis of asthma at the age of 40. That’s very unusual. So, these are the things that we see in adults. [If there’s a] new diagnosis of asthma, there’s something going on. If you’re 30, 40, somewhere in your later years, not later but later than teens, and you have a new diagnosis of asthma, that’s suspicious for some external environmental thing on the lung lining. So, all that to say, I was in denial for a while because I did have a suspicion mold was the cause. But as [with] many of our patients, [and] I’m sure you encountered this, it’s overwhelming. When you’re in mold, there’s actually a limbic activation that happens through the chemical inhalation, and I had both (inaudible 16:15) pituitary axis that triggers a limbic response, even if you’re healthy, well-adjusted, have great context, [and] you’ve done therapy. There is a trauma response just from the chemical inhalation.

And I think that adds to the confusion because the overwhelm is present. The brain is literally short-circuiting because of this toxin. So there’s a piece I’ve seen [in] almost 100 percent of patients, and I was no different. I was a little overwhelmed, I didn’t know what was wrong, and I was in denial. But finally, I found a bulk mold of Stachybotrys in the basement, [and the] same type of toxins from that, trichothecene, in my urine. I couldn’t deny it anymore. And then I had to figure out how to heal.

Chris Kresser:  Yeah. So tell me about that process. Because I know from personal experience and from treating hundreds of patients with mold illness that [it] is, or can be, arduous, and certainly not linear. Two steps forward, one step back. Or sometimes, one step forward and five steps back, depending on how things go. So what was that like for you?

Jill Carnahan:  It was very difficult. In fact, I went through a divorce a year or so after, and I really think my ex-husband, we’re friends now, but he had Lyme [disease], and I had mold, and our brains were not working. And we both attribute our illnesses and [the] trauma of those events to our divorce. And it ended up good, but it was that big of a deal. And I want to say that because a lot of people in the midst of suffering and mold are struggling in their relationships. And it’s no wonder because it takes all the resources you can possibly muster to deal with that illness. For me, I barely held together the clinic and slept and ate, and that’s all I could do. I didn’t have a social life. I didn’t do anything outside of that. And to frame it, I really feel it took me about 18 months to get to a point where I was really starting to feel a little bit better. Now granted, I had the ups and downs like you mentioned, but I like to frame it like that because so many patients say, “How long will this take?” And they expect three months or six months. And some people do get better quickly. [But] it’s very common for it to be a year or over a year for you to really, really make that progress.

And as you mentioned, this was no different with me. I started doing binders and all this detox. I always say [that] there [are] two parts of getting rid of toxins: there’s mobilization and there’s excretion. Mobilization is getting it out of the tissues, like the mycotoxins that have settled in your fat. You need to mobilize them through sauna and all those things that move the toxins back into the bloodstream so that our liver, our kidney, our skin, our sweat, all those things can filter [it]. But if you mobilize too quickly and you’re not excreting—that other side of the equation—then you get stuck, and you get toxic. And I had hives, head to toe, for two months because I was pushing, mobilizing way too quickly and not excreting. And now I understand that, but that’s part of the reason why people get [stuck]. And then I had mast cell issues because all of [those] mycotoxins that [were] being mobilized were triggering my mast cells to produce prostaglandins and histamines, so I was incredibly sick. Literally, when I found out that my office was contaminated with mold, I didn’t set foot in the office again. I took my charts and left everything. I just literally walked away from all my medical school textbooks, my furniture, everything in the office, and I started over.

In this episode of Revolution Health Radio, Dr. Jill Carnahan provides listeners with strategies you can use to discover your path to profound transformational healing in the midst of illness and trauma. #chriskresser #resilience #recovery

Chris Kresser:  Yeah, and sometimes, that’s necessary for sure. I want to shift gears and talk a little bit about the emotional, psychological, psychospiritual aspects of struggling and working with a chronic illness. You’ve had multiple experiences of this in your life, [and] you’ve treated a lot of patients with chronic illness. And I, over the course of my career, have become increasingly interested in this as a topic because, from my perspective, there’s more to health than just the absence of symptoms. There are people who are symptom-free who I would describe as incredibly unhealthy, in terms of how they relate to themselves and other people and how they operate in the world—their ethics, maybe their attitude, their mood, all of those things. And then there are also people who still experience symptoms but live incredibly rich, meaningful, and rewarding lives.

I also have seen in my practice a distinction between people who are able to allow their illness to change them in positive ways and help them grow and evolve as people and people who are stuck in a kind of, and this is said with compassion and empathy, but a sort of like, “Poor me. Why is this happening to me? It’s not fair; this shouldn’t be happening,” in a kind of victim mentality. And look, I mean, I was in that mentality myself for a period of time. So, again, there’s no judgment or criticism there. But I think illness can be a powerful teacher, and you write about this eloquently in your book. So I’m just curious to hear a little bit more about your path, in terms of your relationship with chronic illness and what that has meant for you, and how that has helped you to grow and evolve as a person.

Jill Carnahan:  Yes. When you first experience suffering, and we all either have just gone through it, we’re in it right now, or it’s coming up. There [are] only three possibilities because life is life, and life has surprises. And my first experience that was a major suffering and trauma was the cancer, of course. And I remember being a little bit shocked by the diagnosis, but it wasn’t too long after [when] I heard a message on the radio that said, it was a pastor, “The sickness will not end in death, but is for the glory of God.” And whether you believe in God or not, the idea for me was that there was some greater purpose and meaning. And I remember hearing that and immediately grabbing on to that, and, in my soul, to me, it was actually a little promise that I would survive. And from that moment on, I never once again doubted that I would survive. But it doesn’t take away the suffering. It doesn’t take away the difficulty, like when [I was] sitting cramped up from the chemo and wanting to die because my stomach hurt so bad, my mouth [was] ulcerated, and I had no hair. I mean, there [were] some really, really difficult things that I still had to go through. And that was just the first experience because then, there [was] Crohn’s [disease], and there [was] mold, and there [are] all these things that come.

But if we can, when that happens, believe, not to negate the suffering, like you said, I don’t want to minimize and be like a Pollyanna and say, “Oh, it’s all great.” Because it’s not. It hurts. It’s painful; it can be devastating. But in the midst of the suffering, and I learned this from my heroes, Viktor Frankl[’s] Man’s Search for Meaning and Edith Eger[’s] The Gift. And these are people who have suffered far more than I can ever imagine in the Holocaust, so I can’t even compare to their suffering. But what they’ve done is teach us how to find purpose and meaning in the midst of the deepest suffering because if we have, number one, a purpose and meaning that’s greater than our physical selves, like a mission, a plan. For me, it was, “I want to be a healer, I want to be a great doctor, [and] I want to learn through this.” So I had this motive that was outside of the suffering that I could grab on to and look to in that experience that would help me accomplish that greater purpose. And then, the second thing is knowing that deep inside, no matter how much suffering, what man takes away from you, what relationships do to you, what the financial ruin is, all those things that we can deal with outside of ourselves, no one can take away our choice, our mindset, our self, our faith, our beliefs, all these kinds of things we own. And there’s not one type of suffering that can actually steal that from us unless we allow it to. And by knowing that, we can really, really own.

I recently heard someone who framed it, and I’ve always thought this way, but I didn’t have the frame to say it this clearly, and what she said was, “It’s all about safety.” Where do we find safety? If we find safety in our bank account, and all of a sudden, the markets go crazy, and we lose all the money in the bank, we’re terrified. Our limbic system gets activated, and we’re in trauma. If we have faith in our relationship, our marriage, our spouse, our partner, our children, our parents, and all of a sudden, we lose them due to an unexplained event or something terrible happens, or divorce happens, again, this sense of safety is blown apart. If we have a sense of safety in our physical bodies, that we are beautiful or healthy or that our heart works or that we don’t have cancer, and our physical health gets disrupted, that sense of safety is blown apart. And [in] every single one of those situations, our limbic system is activated, and that activation puts us in a state of trauma where we can’t heal. However, if we take something outside of ourselves, [like] our vision for our legacy, “What do we want to leave in this world? What is [the] meaning and purpose of why I’m here?” For me, it’s existential, my belief in a higher power. And for whatever piece that is for you. If there’s something that’s outside of [myself], no one can take away my purpose. No one can take away my vision, my legacy. No one can take away my belief in God and a higher power and the meaning and purpose there. No matter what happens, that sense of safety will never, ever be shaken. And that’s the kind of thing that will help us pull out of the difficulties because everything else is fallible.

Chris Kresser:  Absolutely, and I’m a big Viktor Frankl fan, as well. I think he can speak with authority on how to use mindset to overcome adversity, having been through what he [has], for those who are not familiar with his background, [as] a concentration camp survivor in World War II. And Man’s Search for Meaning was a kind of Bible to me at one point in my life in the most difficult moments.

Let’s talk a little bit more about the tools and resources you drew on when you were in the most difficult places. You mentioned in your book forgiveness as a key to this process for you. I imagine that’s forgiveness of self and forgiveness of others. It’s not something that really gets talked about very much in Functional Medicine generally, even in the recovery from illness. But I think it’s an important factor. Because without that, we can really get stuck in these sort of repetitive loops of self-judgment, or judging other people, or, again, judging what has happened. “Why did this happen to me?” And that, in my experience, can really interfere with getting well, in the broadest sense. So tell me more about your perspective on that.

Jill Carnahan:  I’m going to frame it in an acronym because I think that’s always memorable for those listening. And it’s BLT, like the sandwich. And that came from [when] I was writing a book in the midst of COVID, [in] 2021, [I was] sitting in a chair, home alone, of course, isolated, and I thought, “You know what? People are turning from books to screens, and everybody I know is watching these serial Netflix [shows] and things. If I really want to influence and inspire, I need to be on screens.” But Chris, I don’t know what I’m doing. But I had this idea, and then I started talking to friends. And within a week, I had a producer, director, [and] an idea for a documentary. I’m like, “Oh my god.” All that to say, I ended up in the last two years producing a documentary, and it was based on the story that we look to, like my journey and my patients’ journey in this whole thing of life, and how we overcome. And I promise I’ll get back to forgiveness. But as we sat in the car talking about what this movie [is] going to really mean to people, we said BLT. And BLT means this. Number one, believe. Believe in yourself. And that’s part of the forgiveness. You can’t really love yourself until you believe and trust in yourself. And you can’t really trust and believe in yourself until you’ve forgiven the places you consider flawed or not enough, all those lies we tell ourselves. So, the B is for belief.

The L is for love. And once again, unconditional love is one of the foundations of healing that I know you and I both believe in. But you can’t really truly extend unconditional love to someone else until you do that to yourself. And what I realized is I couldn’t really love myself until I trusted my body’s signs and symptoms and my own physiology. And how that works is, if you have had trauma in your life, which we all have in some form or another, and I certainly am no different, often, what I did before the age of 40 is I learned to dissociate from my body because I felt like it had started to betray me in my 20s with cancer and stuff. So I was all here in my head, and I could [analyze] anything that I experienced and just suppress and shut down my body’s anger, my fear, my sadness, and my pain. And I was really, really, really good at dissociating from all of that. And I always say I was, like, superhuman. I could do anything, and it didn’t affect me. I didn’t cry. I didn’t have a lot of sadness. I didn’t feel a lot of anger. I told my therapist [at] the first visit, I don’t get angry. Well, she laughed at me. And then, of course, I realized I had totally repressed that emotion. But what we do when we do that is we are suppressing our [intuition] and the body’s ability to tell us signs and signals of what’s wrong. And autoimmune in general (I experienced Crohn’s and Hashimoto’s) is metaphorically, as Gabor Maté would say, [an] attack of self or self-hatred or self-loathing. So before you can extend this healing love to the world and the forgiveness that we’re coming back to, you must first address those parts of yourself that you’ve denied, suppressed, hated, [and] loathed. All those pieces that we’ve dissociated from, you have to reintegrate in your whole self and start to love those pieces of yourself.

And instead of saying, “Oh, that was stupid, you idiot. Why did you do that?” You say, “Oh, sweetheart, you’re doing a great job. Let’s try that again.” That’s a way to show that [we’re] passionate to ourselves. And you know what? When I started talking to myself, like the chatter in our head, with the sweetest, kindest words like I would to a dear friend, that was probably the most transformative thing in my health and my autoimmune disease and my mindset, of any of the therapies I’d done prior to that. And that’s why I think what you’re onto here is so important, Chris. Because I took a lot of supplements; I did a lot of IVs. I did a lot of things. And the most powerful transformations came from believing in myself, loving myself, every part of myself unconditionally, and then extending that to the world to everybody I met.

And then the T is trust. Trusting your intuition, trusting your body’s signals. When I close my eyes and touch into how I [am] feeling today, my body tells me everything I need to know. But for 40 years, I had suppressed those signals. I didn’t have any contact with my body, and it was screaming out with cancer and Crohn’s [disease] to say, “Please give me some love and attention. And I promise you, I’ll show up for you.”

Chris Kresser:  That’s beautiful. And I agree. It goes, in part, back to safety, what you were talking about before. When we’re criticizing and judging ourselves, we don’t feel safe. And forgiveness is something that helps create that sense of safety, self-acceptance, [and] self-love. And from that place, we can escape those continuous loops that we often get stuck in, that interfere with making good choices, treating ourselves with kindness, and doing the things that we actually need to do to get well. I think a lot of people end up getting stuck in cycles of self-flagellation, sort of alternating back and forth between making progress and then beating themselves up and then making progress and beating themselves up. And forgiveness and self-acceptance can go a long way toward breaking that cycle and just creating a lot more space for a more appropriate response to emerge.

Another aspect of that for me, and I’m curious how this has been for you, is actually taking the time to grieve. I think in our culture, grief is almost disdained. There’s certainly not much space created for it. It’s not something that is typically recognized as being important. There’s often a lot of judgment around it; it’s weak. But if you look at most traditional cultures, they all had grief rituals and considered it to be very important to leave time and space for grieving. Not just [the] death of a family member or friend or something like that, or a relationship that didn’t go well. But anything that really resulted in sadness or loss, like loss on a big scale. Like being diagnosed with cancer, for example. Or having to face a serious mold illness and potentially not being able to be in your office, or your livelihood being threatened, or having to leave your home or completely gut your home and rebuild it from scratch, as people often have to do. So I’m curious how you’ve related to that on your journey.

Jill Carnahan:  Oh, you’re hitting so many important points, Chris. And grief is definitely one of those big ones for me because I grew up in a culture that was pretty conservative [and] fundamental. So when we’re optimistic, happy, helpful, considerate, not complaining, not too sad, never angry, like just stereotypes that kind of were ingrained in me. So after my divorce, which was one of my wake up calls—Who am I? What am I doing here? What’s my identity after divorce? I started doing neuro-linguistic programming. And I did a lot of other therapies besides that, but that was the first one that kind of opened the door for me to go down to the somatic self and feel again. And as I did that, I started really understanding that I had suppressed sadness and anger for 40 years. And when I first started allowing that emotion to come back, I remember the first two weeks after [those] first few sessions of neuro-linguistic programming, I had so much sadness. It felt like a wave, like a tsunami that was going to drown me. And I literally thought I was going to die because I’d always held it back and suppressed it. And finally, I was allowing it. Now, the truth is that you’re not going to die, and it comes in a wave, just like a wave or tsunami. It’s a very good metaphor because it comes and washes over you. And then, as it washes over, you actually feel better. You feel relieved; you feel like you’ve allowed yourself to feel. But in the beginning, those first two weeks, I thought, “This must be what depression is like.” I’d never experienced that in my life. And it was so hard and so overwhelming, I could barely work those first few weeks. But then, gently, as I allowed myself to feel little by little by little, I became more normal. And I recognized all of a sudden, my hands were clenched. And before, I told you, I thought I was never angry. But like, “Oh, I think I’m a little upset, I’m a little angry.” I would let myself feel those things and allow them to flow through. And it wasn’t so bad.

And it’s interesting, I always equate [addictions] in this realm, right? Because addictions are just ways of suppressing or numbing our ability to feel. And I remember sitting in a room with a famous health entrepreneur who was talking to a group of us, and he said addiction. And I just totally tuned out because I was like, “I don’t do drugs [and] I don’t smoke. I don’t drink alcohol.” So I thought I was clear. Of course not. But he started looking and pointing in the room. He said, “All of you in this room are addicts, and your addiction is a socially acceptable addiction [to] work.” And I started to pay attention because I was like, “What are you talking about?” But as he proceeded, I realized he was right. Because what happened for me is [that] I love my work, and [there’s] nothing else I’d rather do, probably like you. I love to learn, I love to help people. But it’s still, for me, a way of keeping busy on that treadmill and not sitting with my feelings and being quiet. I was so busy that it was just one more way of suppressing that feeling. So I had to really, as we just talked before we got on here, I had to create, since that time, a lot more space in my life to actually be with myself, to be with my emotions [and] to allow them in.

And this is another thing where it’s forgiveness and compassion. You have to have a lot of kindness to yourself in this process because it’s messy. And it’s up and down and up and down. I always think, “Oh, I’ve done all this work.” Well, there’s still more to do. It’s a process that we continue to grow through. But I think that feeling is so critical to healing.

Chris Kresser:  Absolutely. And again, very much underrated in our culture in general, and I think in the medical field. Of course, there are a lot of people, Gabor Maté talks about this, Bernie Siegel, lots of pioneers who have discussed the importance of this over time. I mean, there’s even this idea, which I’m sure you’ve come across, and I don’t like generalities and labels, but the Type C personality. For the listeners, you’ve all heard of Type A personalities, people who are very driven to succeed and be accomplished in the world. This idea of the Type C personality is generally thought [to be] more oriented around people who hold feelings inside. Do you think there’s anything to that? Was there anything to that for you, do you think, in your experience?

Jill Carnahan:  Yes, absolutely. Yes, I think that’s suppression. And this is, again, where Maté talks about it and I think also Peter Levine and some of our favorite trauma experts, who I’m sure you’ve read, as well.

Chris Kresser:  Yeah, my wife is actually a [Somatic Experiencing] (SE) practitioner. So I’m quite familiar with Peter’s work.

Jill Carnahan:  Amazing. So you know this very well. He shows the data on the incidences of cancer with a Type C [personality] and [amyotrophic lateral sclerosis] (ALS) especially. He talked in his most recent book, The Myth of Normal, about ALS and how ALS is very, very commonly associated with the suppression of motion. And it’s kind of a conscientious personality. It’s a very kind of like people pleasing, not complaining, not asking for needs to be met, compassionate. It’s not a bad kind of person to be, but the truth is with ALS, cancer, and certain other diseases like autoimmunity, there’s a much higher prevalence of these diseases with this personality.

Chris Kresser:  Absolutely. Yeah, and just to be clear, I think it’s overly simplistic to suggest, and I don’t think you’re doing this, Jill, but I see this happen sometimes, that everyone who has cancer is responsible for their own cancer diagnosis because they didn’t adequately express their feelings. That’s, I think, a simplistic view of it and probably not accurate. The way I like to think about it is as a process of inquiry. If I am diagnosed with cancer, is this a useful perspective? Is there anything useful to learn from this idea of a Type C personality? Is that true for me? Is it something that I can use as a springboard for learning more about myself and growing and evolving as a person? Because I think the danger, of course, is that then it becomes the whole guilt, blame, shame game, right? “I did this; it’s my fault that I got cancer. There’s something wrong with me. And if I could just be a better person, then I wouldn’t have gotten cancer.” And something that I think easily dispels that idea is the fact that young children, even babies, are sometimes diagnosed with cancer and die of cancer. And I think it would be pretty ridiculous to suggest that the toddler who’s diagnosed with cancer got it because they didn’t adequately vent or express their feelings, right? So it’s tricky. It’s nuanced, as most things of any kind of depth are.

Jill Carnahan:  For autoimmune and everything we’re talking about here, I couldn’t agree more, Chris. I want to be clear, too, that the deal is [that] when something happens, if we can just say, ”Okay, what can I learn from this?” It’s like, okay, well, now that we’re here, what is there that could possibly help us to be better?

Chris Kresser:  That’s right. The other perspective is a rather egocentric view, that we’re in so much control that we cause all of these things to happen. The perspective you’re talking about is [that] we have a choice in how we respond to what happens. We’re not necessarily controlling everything, but we do have, like you said before, one of the only sources of control that no one can take away from us is how we respond to what happens to us. Which can either be terrifying or liberating, depending on how you look at it. I think it’s liberating. But it does require acknowledging that we are not in as much control over the circumstances of our lives as we often think we are.

Jill Carnahan:  Yeah.

Chris Kresser:  So we’re getting to the end of our time here, and I just want to conclude the way that you concluded your book, which was with a discussion of the importance of unconditional love, as it applies to our healing journey. I think that’s a great way to end the book and the podcast because, for me, there’s nothing more powerful than that, both in terms of how my relationship with myself has evolved over the course of my life and with my family, with my patients, just with, hopefully, everybody I interact with. So, talk a little bit about your journey toward unconditional love.

Jill Carnahan:  Yeah, so this is absolutely the secret sauce. And it’s funny because I have a wonderful clinic. I love what I do. And I feel like I like the diagnostics and all the depth of the work. It’s very similar to what you do. But at the core, I feel like the secret to any success that I could claim is this concept of when the patient walks in the door, do they feel safe, and do they feel unconditional love? Because I feel like that walking in. Literally. I’ve said this before, but my staff will get a wine glass, and I’ll give them a glass of water. That starts there. That little tiny thing, it’s no big deal. It doesn’t cost us any more. But what it does [is] it just symbolizes the tiniest little thing of you are special, you’re important, you’re valuable, [and] you’re worthy of the most unconditional love possible. And I believe that literally offering them a glass of water in something a little more special than a normal glass is the start of the healing process.

And then all the way through my staff and hopefully myself, that love that’s extended is really, really core to the healing. Because like we talked about earlier, safety, I think a person can only truly relax in themselves or in the presence of another human being when they feel completely at ease and accepted and loved, without masks, without stipulation, without having to perform or having to do anything at all. Just being that human in front of me. And I feel like that is truly the magic. The hidden secret to any success that I have is [that] I really, really truly love the patients I get to see. And I’m so grateful for those opportunities. And it’s always a work in progress. But it started with the stuff we talked about earlier. It’s really, truly loving myself and then being able to extend that to the patient who walks in the door.

Chris Kresser:  Absolutely. Jill, tell everybody who’s listening where they can find out more about your book and pick up a copy.

Jill Carnahan:  Yes, you can go to ReadUnexpected.com, and there [are] all kinds of free bonuses there you can get, as well. And my regular website is just JillCarnahan.com.

Chris Kresser:  Great. Well, thank you so much. And thank you for your book. It’s a really important contribution to the field. I love seeing this book out there because, as I’ve said, there are lots of great books on Functional Medicine and the tools and techniques and things we need to be thinking about from that perspective, which your book also includes. But as I have continued to progress in my own career and just zoom out and get a broader perspective, I think a lot of what we’ve talked about in this interview is what people need most. So I’m really glad you wrote this book.

Jill Carnahan:  Thank you, Chris. And thank you for the work that you do in the world. And thank you for having me on. I’m so grateful.

Chris Kresser:  It’s been a pleasure. Thanks, everyone, for listening. Keep sending your questions to ChrisKresser.com/podcastquestion. We’ll see you next time.

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