1
00:00:00,000 --> 00:00:01,000
Josh (02:23.102)
Dr. Jill Carnahan, welcome to Reversible.

2
00:00:01,000 --> 00:00:02,000
Dr. Jill Carnahan, MD (02:24.536)
Yeah.

3
00:00:02,000 --> 00:00:03,000
Dr. Jill Carnahan, MD (02:31.399)
Surf.

4
00:00:03,000 --> 00:00:04,000
Dr. Jill Carnahan, MD (02:40.165)
Thank you.

5
00:00:04,000 --> 00:00:05,000
Josh (02:41.59)
Well, I'm really excited to have you here, Dr. Jill, for many reasons. Obviously, you're a functional medicine physician and a huge advocate for holistic healthcare. And I know it's kind of a broad term. And frankly, you're also a pretty big deal. And so it is a pleasure having you here. However, I'm familiar with your work. And that's obviously why you're here, but not all of my listeners know you yet. So can you give us a little bit of a background early on who you are and sort of the villain origin story we'll call it onto what brought you here today?

6
00:00:05,000 --> 00:00:06,000
Dr. Jill Carnahan, MD (03:11.544)
You got it. So I grew up on a farm in central Illinois, one of five children and really a healthy, wonderful, idyllic kind of environment and wonderful parents and all of that. We had a half acre garden. So I grew up with a very like holistic minded idea of health and wellness and food as medicine. And what was unbeknownst to me was there was a lot of chemicals on the conventional farm, like pesticides and glyphosate and things. And I always say it was, it was

7
00:00:06,000 --> 00:00:07,000
starting to kill me because at the age of 25, in my third year of medical training, I suddenly found a lump in my breast, went to have that examined and biopsy and I got a call just not too long after that, that at the age of 25, just a week after my birthday, I was diagnosed with aggressive breast cancer. So that was my first awakening. And as you so well know from interviewing guests and even maybe your own history or whatever, we often have these stories of like I was born to

8
00:00:07,000 --> 00:00:08,000
Dr. Jill Carnahan, MD (04:08.036)
I have had many, many health obstacles, difficulties, suffering and illness myself. But what happens in each one of those, including my original story with the breast cancer is I really, really learned at a deep level some of the things that I could have never learned in medical training. So this was my first teacher and that breast cancer was a big deal. I did three drug chemotherapy. I did very, very aggressive treatment. Lost all my hair, got so sick. I took a nine month leave from medical school to get treatment.

9
00:00:08,000 --> 00:00:09,000
And I came out of that, you know, very malnourished, very sick, just barely surviving, but free of cancer. So I went right back into rotations. And as you know, we love to talk about the gut. That's your forte. Unbeknownst to me, the chemo had a dramatic effect on my gut and also unbeknownst to me, I had silent celiac. So I hadn't been yet diagnosed, but I had the gene and the high risk issue with gluten being a trigger. And one of these drugs from the chemotherapy creates a more permeable gut.

10
00:00:09,000 --> 00:00:10,000
It's actually one of the mechanisms of how it allows the immune system to fight the cancer. I didn't know any of this at the time, right? So basically with the chemo, I was taking an already probably damaged gut from the gluten and inducing a more permeable situation. I also had overgrowth of bacteria and yeast and all kinds of things. Again, didn't know any of this. And that load that happened after I did my chemotherapy caused some illness. So what was happening when I got back into my rotations, I was having nausea, weight loss, bleeding.

11
00:00:10,000 --> 00:00:11,000
pain, lots of symptoms, fatigue. And it took about four to six months, but there was one day I'm in the emergency room taking a patient's blood pressure, and I literally passed out cold on the floor, and all of a sudden I became the patient again. I was rushed into emergency surgery, I had an abscess that was drained, and the surgeon came in the next morning, I'm in the hospital, and he said, "'Jill, you have Crohn's disease.'" So that was my intro to the gut, and really what's going on. I didn't even know what Crohn's was. I was a third year medical student.

12
00:00:11,000 --> 00:00:12,000
Josh (06:00.302)
Mm-hmm.

13
00:00:12,000 --> 00:00:13,000
Dr. Jill Carnahan, MD (06:01.828)
And then again, you'll get this Josh, because we both have a passion for helping people with inflammatory bowel disease. I went to a followup with a gastroenterologist to get to know him and say, you know, what's Crohn's? What do I do? He gave me a long lecture and he said, Jill, this is lifelong. You're, you know, it's considered incurable. He said, you're probably gonna need immune modulating drugs. These are some pretty heavy duty drugs to control the symptoms. He said, right now I'll give you some steroids to calm the inflammation down. And he said, there's a likelihood over your lifetime you'll have part of your colon removed.

14
00:00:13,000 --> 00:00:14,000
Josh (06:15.426)
Mm-hmm.

15
00:00:14,000 --> 00:00:15,000
Dr. Jill Carnahan, MD (06:30.216)
And he gave me all these wonderful statistics, you know, and it was very depressing. And right before I left, I said, you know, Doc, I want to do whatever I can. And I didn't know a thing, but I did ask a question. I said, could I change my diet? Would diet have anything to do with this? And he did not even pause. He said, Jill, diet has nothing to do with Crohn's disease. But that window, and we can go into that next, was my doorway into saying, wait a second, this can't be true. How in the world could a gut disorder not have anything to do with a diet?

16
00:00:15,000 --> 00:00:16,000
So I went to the medical library, started researching, and the long story short is I found some things that started to change my symptoms very quickly with dietary changes, and I knew that diet did have something to do with it.

17
00:00:16,000 --> 00:00:17,000
Josh (07:11.142)
See that is a conversation I have all the time. You know my groups my Facebook groups You got you know 13,000 people in there right now, and we're just radically changing lives, which is incredible But there are people who come in they have this narrative that this is what I've been told therefore This is what is and anything else outside of that is seen as an attack It's very it's a very emotional place to be when your life is ruined. You're having 40 bowel movements a day

18
00:00:17,000 --> 00:00:18,000
Dr. Jill Carnahan, MD (07:26.469)
Yes.

19
00:00:18,000 --> 00:00:19,000
Josh (07:36.662)
There's blood, pain, mucus, you can't move, you're fatigued. It does get very personal. And I think it's crazy that in this hugely sensitive, personal, delicate situation, we'll have GI specialists, like you said, saying food has nothing to do with it. How can a gut disease have nothing to do with the things that you put into your gut?

20
00:00:19,000 --> 00:00:20,000
It's quite shocking. So take us on the next step here. You mentioned food, and I have so many questions we'll get into here. You mentioned food. What was that first step that you took for yourself? Was it just diet alone?

21
00:00:20,000 --> 00:00:21,000
Dr. Jill Carnahan, MD (08:10.396)
Sure. So, I love that you said that and I think the personal thing comes. I just want to mention this because we're all there and I'm a former Crohn's patient. So, I get it. I get it. I've been there. If you're listening, I've been there. I've been sick. I've been… But what happens is if diet or lifestyle could have something to do with it, that means we might have to do something hard.

22
00:00:21,000 --> 00:00:22,000
And I think that's where the rubber meets the road. It's much easier and I am not minimizing the suffering. So if you're out there and you've been told to take this drug or whatever and maybe you're stable, that's perfectly appropriate. I get people all the time that come into the clinic on a med. I don't change it, I don't touch it. I just work on the bottom line core issues to reverse that inflammation. And maybe someday they can get off the med, but that's not my job in the beginning. And I say that because if you're listening and you're maybe having trouble with that IDL, though if you've been around the podcast long enough, I'm sure you've heard this. The truth is there's this ownership

23
00:00:22,000 --> 00:00:23,000
right of our diet and our lifestyle. And if we have to own it, we can't be a victim and just say, give me a med, I don't want anything to do with this. It's like, it either happens to us or for us. And that's actually a real core principle to illness in general. And if it's happening to us, we have no control, right? We've lost ownership, we don't have it. Number one, we don't have to do anything about it because it just happened, what can we do about it? Number two, we don't have control. And one of the biggest stressors of loss of control is an acronym called NUTS, novelty, something new, unpredictability, something we don't know what's gonna.

24
00:00:23,000 --> 00:00:24,000
Josh (09:17.09)
Hmm.

25
00:00:24,000 --> 00:00:25,000
Dr. Jill Carnahan, MD (09:32.04)
and like threat to ego or threat to health, which is illness and sense of control. So when you're diagnosed with Crohn's or colitis, these all are there, it's new, it's unpredictable, it's a threat to your health and your sense of control. So I say that with deepest compassion, because I was there, but the truth is, we do have power to change this. It may not be easy. And I started to realize maybe diet did have something to do with it, went to study, and I came across Elaine Gottschall's

26
00:00:25,000 --> 00:00:26,000
specific carbohydrate diet, which was one of the, she's an RN whose daughter had colitis and worked with a, I think it was a gastrointestinal pediatrician or someone who knew enough about diet that gave her some insights and she was able to actually reverse her daughter's colitis through this diet. Now what this does is a principle that can be taken across other types of diets that are similar, but what the diet does is it eliminates certain food for the bacteria in the small bowel and many, many patients with Crohn's and colitis

27
00:00:26,000 --> 00:00:27,000
Josh (10:12.398)
Hmm.

28
00:00:27,000 --> 00:00:28,000
Dr. Jill Carnahan, MD (10:26.872)
especially Crohn's, maybe more so than colitis, have dysbiosis or abnormal overgrowth of bacteria or fungi in their small bowel. And again, I didn't know any of this. All I knew was like, oh gosh, diet. And my thought was, okay, drugs, heavy duty things that could cause immune issues long-term or even leukemias or cancers, or why not try a diet? I have nothing to lose, right? It's just my effort and that.

29
00:00:28,000 --> 00:00:29,000
And what happened before this was I didn't know it at 14. I was probably low stomach acid, low B12, low zinc. I became a vegetarian. And this is on like a steak and potatoes kind of farm, Midwestern, so I was the weirdo in the family. But I did it because my stomach didn't produce enough stomach acid, it didn't feel well to eat meat. But that was the precursor 10 years prior to my diagnosis of breast cancer and then Crohn's. And what had happened was I had gravitated towards an uneducated vegetarian diet, which is a carbiterian.

30
00:00:29,000 --> 00:00:30,000
where I'm eating processed soy and definitely gluten and things that were inflammatory. And so I was on the exact wrong diet for me when my diagnosis of breast cancer and Crohn's came along. So what happened is when I started making changes, first getting out gluten, getting out inflammatory foods, eventually going grain-free, but starting with specific carbohydrate, I noticed, Josh, in two weeks, my pain, my diarrhea, my bloating, almost all went away. Now I wasn't cured in two weeks, but it was so dramatic.

31
00:00:30,000 --> 00:00:31,000
Josh (11:49.973)
course.

32
00:00:31,000 --> 00:00:32,000
Dr. Jill Carnahan, MD (11:51.12)
that I was like, there is something to this, right?

33
00:00:32,000 --> 00:00:33,000
Josh (11:53.518)
Mm-hmm. That's amazing. It's so funny you bring this up because I tell people all the time and the first thing I can say is bullshit There's no way I had someone come to see me 16 years of severe IBD She was having ulcerative colitis all the drugs all the biological to the intibial and the Remicade still are other humera She did them all in three weeks She was down from 40 plus bowel movements a day down to five and eight by just managing food and stress and basics And so it can be so easy

34
00:00:33,000 --> 00:00:34,000
And I love how you break this down. So maybe this will illustrate for our listeners. I created a Venn diagram literally just last night. I'm trying to do some more illustrations for this thing. My argument, something I've been lecturing on actually at the functional medicine academy here is that I don't believe and disagree with me if you disagree with me, Dr. Jill, that not all cases of IBD, particularly UC are actually truly autoimmune.

35
00:00:34,000 --> 00:00:35,000
looking at instead the spectrum, more of a wear and tear inflammation, like you're wearing a pair of shoes without socks and you've got a blister, you just have to pull out the wear and tear. Like you said, it's mold or it's fungi or it's dysbiosis or some kind of SIBO. And so I created this Venn diagram to show the outside, this three ring diagram. So on the outside, you've got your main triggers for this thing being toxins, you have bacterial imbalances and then diet or nutrient deficiencies.

36
00:00:35,000 --> 00:00:36,000
The inside three on the overlap, which lead to more autoimmunity, are your triggers, like an antecedent of some kind. So your traumas, your intervention that caused this, genetic predisposition, and of course, leaky gut leading to autoimmunity, at the center is your Crohn's and colitis. Would you say that's a fair assessment, or would you break that apart in some way?

37
00:00:36,000 --> 00:00:37,000
Dr. Jill Carnahan, MD (13:32.392)
I could not agree more because, and I'll tell you, just me personally, I have the NOD2 gene which is what you all know is a high risk Crohn's. So here's my perfect storm and this will just be one illustration of an example. So I didn't know I had celiac, the undiagnosed type, it probably wasn't full blown but it's the high risk genetics for gluten is creating massive permeability. At 14 because I didn't like meat, I went on a vegetarian diet but what I did is mostly

38
00:00:37,000 --> 00:00:38,000
processed soy, like the wrong, exact wrong diet for me. And that was precluded by type A blood, which is low stomach acid producers. So we don't do great with a lot of high protein unless we supplement stomach acid. Because of that low stomach acid, I had low zinc, which also is critically important to heal the damaged gut. Like you have to have zinc. I was low deficient in zinc. I was incredibly deficient. I have all the genetic mutations possible, almost for B12 absorption. So I was very, very significantly.

39
00:00:38,000 --> 00:00:39,000
depleted in B12, so B12 deficiency, zinc deficiency, celiac that was silent, and then on a diet that was putting in things that were creating permeable gut. Then I get breast cancer, I get chemotherapy, I did three drugs, very aggressive chemotherapy. One of the drugs, cyclophosphamide, is literally known and written about in the literature for inducing leaky gut because what it does is it dumps the bacterial when you create leaky gut through this drug. And again, that's not the maybe…

40
00:00:39,000 --> 00:00:40,000
first mechanism they tried, but what happened is they realized that mechanism was underlying the success with cancer because it's dumping gut contents into the bloodstream. Immune system, of course, gets irritable. It's like poking a bear, right? It starts to activate and then starts to fight the cancer because it's so aggressively revved up. So it does its job, but the innocent bystander is your gut, which obviously has holes in it.

41
00:00:40,000 --> 00:00:41,000
Josh (15:08.59)
Of course.

42
00:00:41,000 --> 00:00:42,000
Dr. Jill Carnahan, MD (15:19.12)
because I had that NOD2 gene, which makes me very susceptible. I like to say it's an abnormally robust response to a normal microbiome when you have that gene, that's a Crohn's kind of gene. So all of a sudden, dumping of my gut contents into the bloodstream, my body's already genetically prone to revving up and trying to take care of this, trying to fight the cancer, but also activating based on that microbiome content in the bloodstream that should never be there. And then of course it starts to react and attack and cause.

43
00:00:42,000 --> 00:00:43,000
damaged the gut lining, which presented with me having an abscess and then Crohn's. To me, it makes so much sense, right? Then you go back and you deal with a B12 deficiency. You take out gluten. My diet started with specific carbohydrate, but right now I am mostly paleo gluten-free, grain-free. We can go into this, but I think one of the reasons why a grain-free diet works so well is the most highly contaminated food product with mold and mycotoxins is grains, at least in the US.

44
00:00:43,000 --> 00:00:44,000
So that was a whole nother thing I didn't know about. But it kind of starts to make sense, doesn't it?

45
00:00:44,000 --> 00:00:45,000
Josh (16:20.282)
It all adds, like you did, you had the perfect storm. You had nutrient deficiencies, you had genetics, you had toxins, you had the leaky gut, you had the suppressed immune system. It's a no brainer that you ended up with Crohn's disease. And I think really looking at the statistically, it's largely a preventable disease, both Crohn's and colitis. You know, we look at the stats, right? As per the CDC and my listeners have heard me scream the stat from the rooftop, especially those in my IBD Facebook groups, that we have...

46
00:00:45,000 --> 00:00:46,000
Dr. Jill Carnahan, MD (16:27.664)
Mm-hmm. Yeah.

47
00:00:46,000 --> 00:00:47,000
Dr. Jill Carnahan, MD (16:36.018)
Yes.

48
00:00:47,000 --> 00:00:48,000
Josh (16:46.462)
In the last 30 years from 1990, there was about one and a half million global cases of IBD around the world, as per the CDC. Today, it's seven million. So in 30 years, we five X'd our cases. North America is 5% or less, about 4.7% of the global population, but they have more than 50% of all of those diseases. And so when we look at this, it's clearly a North American problem, like hands down. And it's often called the rich white lady's disease.

49
00:00:48,000 --> 00:00:49,000
Dr. Jill Carnahan, MD (16:54.833)
Ugh.

50
00:00:49,000 --> 00:00:50,000
Josh (17:13.774)
right? Because that just seems to be who happens to get it, the more affluent communities of white females. So you being a white female, you obviously had the genetics, you had all these things that lined up, you just also happen to be a white female. But walk me through this, Joe. What you mentioned, we had all these different triggers. But let's talk about the general population because I don't think

51
00:00:50,000 --> 00:00:51,000
Dr. Jill Carnahan, MD (17:26.246)
Yeah.

52
00:00:51,000 --> 00:00:52,000
Josh (17:34.014)
everybody listening has gone through cancer and chemo and all this. So one of the most common triggers you're seeing in your practice that leads to such inflammation, and I extend this to everyone, not just those with IBD, but those who are on the road of gut inflammation on the level of severity that maybe will get one day to IBD. We want to prevent that. So what are our big triggers, our big toxins and things that general population really needs to look for?

53
00:00:52,000 --> 00:00:53,000
Dr. Jill Carnahan, MD (17:56.584)
Got it. So the first thing is the wrong foods are important and usually that alone doesn't cause Crohn's or colitis but it will perpetuate. So kind of like you went mediators and things that cause it to keep going. And.

54
00:00:53,000 --> 00:00:54,000
because of say the standard American diet, which is white flour, white sugar, trans fats, all these not good things, there's a very high likelihood of nutrient depletion. Now I grew on a farm with a pretty healthy diet, so it wasn't really that, but I had genetically some real significant issues with zinc and B12 and some core nutrients. So the standard patient is gonna have some sort of nutritional deficiencies, either as a cause contributing to the Crohn's colitis or as a result of.

55
00:00:54,000 --> 00:00:55,000
malnutrition and malabsorption. Either way, that's a big deal because for me to help someone heal completely from Crohn's or colitis, I've got to address the nutritional piece. For example, even me today, free of Crohn's almost 20 years later, I still have to take very high doses of minerals because I don't absorb them very well. So if I told you the amount of calcium, magnesium, and zinc and all the minerals, I take very high doses because I want to basically...

56
00:00:55,000 --> 00:00:56,000
push those absorptions higher because I don't absorb well. B12 as well, I do B12 injections in half for 20 years. So that nutritional piece. Okay, number two. Once again, in our society, super common to see SIBO and CIFO. SIBO is small intestinal bacterial overgrowth. CIFO is small intestinal fungal overgrowth. Years ago, docs didn't even acknowledge it. Now they're starting to test. And there are breath tests that will determine hydrogen, methane, which instead of being...

57
00:00:56,000 --> 00:00:57,000
small intestinal methanogen overgrowth, it's now IMO, intestinal methanogen overgrowth, or there's a new kid on the block called hydrogen sulfide SIBO, which I think is the toughest, most difficult to treat. And those can be tested through a breath test. Sometimes we can see reflections on stool testing and organic acids in the urine, but we're looking at that. So if I see someone coming in, I'm doing organic acids, I'm doing stool, and I'm doing breath tests to really determine what is the content of the microbiome.

58
00:00:57,000 --> 00:00:58,000
Dr. Jill Carnahan, MD (19:52.568)
Now, sometimes we see things like mycoplasm and atypical bacteria that can grow in the gut as well or systemically. I see correlations at times with tick-borne infections that can cause significant impairment in gastric motility or overgrowth. A lot of times those infections will impair the migrating motor complex, which is our main small bowel. I think of it like as the, it's a peristalsis between meals that allows the bowels to move in the small bowel. It's actually very different from the colonic.

59
00:00:58,000 --> 00:00:59,000
motility because you could have diarrhea and a paralyzed migrating motor complex. So really important to differentiate because a lot of your patients, Crohn's and colitis are going to have loose bowel movements, but they might have a migrating motor complex in the small bowel that is not working at all. And I always like to think about this, like if you go watch a hockey game between the periods, there's a Zamboni that clears the ice. It makes it really beautiful in between periods. The Zamboni is your migrating motor complex. So it clears out the small bowel. If that's paralyzed from...

60
00:00:59,000 --> 00:01:00,000
diabetes, blood sugar abnormalities, tick-borne infections, gastroparesis, autonomic dysfunction, neuropathies, I could name 101 things, radiation. There's many, many things that cause that to not work well. And then you get stagnation. Stagnation allows the bacteria to overgrow. And we're supposed to have our bacteria in the colon. That's where it's meant to be the large bowel. But it can migrate up through either a problem with the valve, the ileocecal valve, it goes backwards into the small bowel.

61
00:01:00,000 --> 00:01:01,000
If you don't have enough stomach acid like I did or you don't have digestive enzymes, you can get it from the top down and get overgrowth of bacteria there from poor diet. And I could name 101 different things, but it's very common to have some of these things impaired either stomach acid, pancreatic enzymes, migraine motor complex due to infection or ileocecal insufficiency or other things and get this overgrowth. This is a core cause and it's why the SCD diet is so effective because the SCD diet

62
00:01:01,000 --> 00:01:02,000
starves those small bowel microbes. Now, the other thing that isn't talked about as much, but I think as important, maybe more so, is small intestinal fungal overgrowth. Docs for years and years ignored, and unless it was systemic candidiasis, which was rare, and usually only occurred in the ICU and septic cases, people, doctors ignored that candida could be an invasive organism in the gut, and in many cases it is.

63
00:01:02,000 --> 00:01:03,000
Dr. Jill Carnahan, MD (22:13.072)
Now again, you know this well, Josh, but one of the things I found fascinating when I really started to study was there's an inflammatory bowel disease panel that we order through LabCorp Quest or any major lab. And what it does is it checks antibodies to certain yeast and carbohydrates that are related to yeast. And I have found a high correlation. First of all, it is literally predictive of the severity of Crohn's, not as much colitis, but it's basically antibodies to yeast.

64
00:01:03,000 --> 00:01:04,000
So I would say clinically 80 to 85% of my patients with Crohn's have a fungal overgrowth that's never been diagnosed. And think about this, if we try to treat the SIBO with herbs that are specific for bacteria or antibiotics, you make that fungal worse.

65
00:01:04,000 --> 00:01:05,000
Josh (22:54.91)
Way worse. Oh, and that's something important for our listeners. So many people come in taking antibiotics and they wonder what they have recurrent C. diff infections or why they may become up clear of C. diff, but they're having more issues. And that's what we call those opportunistic bacterium or fungi or whatever. Long story short, imagine you have gangs running wild in the city and if the police are gone, the gangs have the opportunity to overgrow.

66
00:01:05,000 --> 00:01:06,000
Those good bacteria police the bad, so to speak. And so that's just kind of a summary for you guys. But this correlation is huge. I mean, the top two things that I see in my practice for sure, Dr. Jill, is fungus and mold. Those are the two primary drivers. Is that something you're seeing as well?

67
00:01:06,000 --> 00:01:07,000
Dr. Jill Carnahan, MD (23:32.676)
Yeah. Yes.

68
00:01:07,000 --> 00:01:08,000
Dr. Jill Carnahan, MD (23:37.124)
100% and it's so funny because even now, even 2024 as we're recording, docs are not taught to look for fungus or mold as an issue and it's so, so prevalent. Yeah.

69
00:01:08,000 --> 00:01:09,000
Josh (23:49.782)
It's frustrating. So here's the question that all our listeners, I'm sure are gonna be just chomping at the bit. Why the hell not? Why aren't doctors looking for this stuff? Is it the lens? Is it the treatment? Are their hands tied? Like what is keeping them from really digging into the roots like you do?

70
00:01:09,000 --> 00:01:10,000
Dr. Jill Carnahan, MD (24:04.828)
So it's very interesting. I really had that aha when I started looking at, first of all, the diet and the changes with even, I talked about gluten-free, grain-free, some of those things, but probably the most important I didn't say yet, and that was sugar-free, carb-free, a very, very low glycemic diet initially. Now that I'm healthy, I've been able to expand. I can definitely eat fruit and things like that, even dried fruit sometimes. But in the beginning, I was almost free of fruit. Temporarily, I was completely free of dried fruit. Fruit juice is all forms of sugar.

71
00:01:10,000 --> 00:01:11,000
because yeast love this. And I love that you said, this is something I wanna emphasize, yeast is opportunistic. What does that mean? That means it takes advantage of a weakened system. So we all have some yeast in our body. It's not that it's abnormal, but and that's I think why docs don't really recognize it is, oh, well, everybody has some yeast, right, Jill? What I have seen is I will do three different things to determine if there's yeast in the body. And if the story fits, I may not even, like I may not even have the lab values, but there's three tests that I use.

72
00:01:11,000 --> 00:01:12,000
One is organic acids. This is a urinary test for metabolites that might be happening in your gut or your body or your sinuses. And there's about, on the test, I used nine or 10 different fungal and mold metabolites. Sometimes that's the only way I'll find it. Number two is Candida IgA, IgG, IgM. And again, docs are like, oh, that's there for everyone. No, I see this very, very correlated to the degree of Candida invasiveness. And think about this.

73
00:01:12,000 --> 00:01:13,000
you cannot develop an IgG systemic antibody unless you have crossover from the gut lumen into the bloodstream. So if you have Candida IgA, that Candida has been in the blood at some point for you to make an antibody to it, which means it had to crossover, it has to be an issue. And I have actually seen clinical, this is very controversial, but I see clinical correlation to treating and bringing that down and those antibodies actually normalizing. So that's number two. Number three is stool. Now,

74
00:01:13,000 --> 00:01:14,000
We would think just stool would show it, but we're looking at colonic bacteria and yeast. And many times these bacteria and fungi reside in the small bowel and they will not show up on the stool test. And because of that stool is very, sometimes it'll be negative. In fact, many times I'd say 80, 90% of the time there's no yeast growing in the stool. And if the doc is only looking at, and even if they're integrative and kind of progressive, if they see no yeast in the stool, they're like, oh, you're fine, you don't have yeast. But that's just not true in my...

75
00:01:14,000 --> 00:01:15,000
Dr. Jill Carnahan, MD (26:22.952)
clinical experience.

76
00:01:15,000 --> 00:01:16,000
Josh (26:24.746)
I 100% agree. When I do the organic acid test, we'll see, I imagine somebody comes in, there are rhabinosis, that's for our listeners, that's a mold, or one of the fungal markers typically associated with Candida. I'll see that one four times over the normal range of the elevated value, but they don't show up in the stool test. They go, well, how do I know I have fungus? It's not in my stool. And this, it's really hard sometimes not to sit here and go, I told you so. You know, but it's so good for our listeners to hear this from somebody other than myself, because I harp and harp.

77
00:01:16,000 --> 00:01:17,000
Dr. Jill Carnahan, MD (26:32.913)
Yep.

78
00:01:17,000 --> 00:01:18,000
Dr. Jill Carnahan, MD (26:48.117)
Right.

79
00:01:18,000 --> 00:01:19,000
Josh (26:54.6)
and harp on the stuff but just a different lens is so awesome to hear and so we've gone over a few things here Dr. Jill we've talked about sort of how this comes about the most common cause even tests we can look at and the parts and pieces so it really brings us to our next one and really the biggest one is talking about reversal and so I have one question as a leading question I'm gonna kind of bait I'm just curious what you say

80
00:01:19,000 --> 00:01:20,000
Do you believe that IBD is just reversible into remission or do you believe it can be cured?

81
00:01:20,000 --> 00:01:21,000
Dr. Jill Carnahan, MD (27:27.928)
See, I love this and I love the title of your podcast and your whole platform, Josh, because I have been saying for years and you and I know sometimes we get hate mail for this, but 100% it is reversible. And I believe 100% I do not have Crohn's anymore. It's not in remission. It's not. And you can define it how you want, but I have no evidence. I have not had any evidence for 20 years, maybe 19.

82
00:01:21,000 --> 00:01:22,000
Josh (27:32.27)
Thank you.

83
00:01:22,000 --> 00:01:23,000
Josh (27:52.963)
Well, that's the question I like to ask because it's in remission. So I'm using air quotes for listeners, big bunny ears on my fingers. It's quote in remission. It's been in remission for 20, 25 years. There's no sign of it coming back. Is it really in remission or is it actually cured? So what's your take on that? How are you defining this?

84
00:01:23,000 --> 00:01:24,000
Dr. Jill Carnahan, MD (28:10.888)
And that's really, I guess we could get semantical and if remission just means you had it once and you don't have it now, then technically we could call it that. But I know the deeper stuff, like I have in my own health been the detective to the nth degree and gone, and literally even today I do tests like organic acids almost yearly to make sure, and I just continue to tweak those little things. And I know my own predisposition. So if I was working with a patient, it'd be the same thing I'd know if you're prone, like for me.

85
00:01:24,000 --> 00:01:25,000
I'm prone to yeast. I've got a weak immune system in that area. And so I will never eat a high carb diet and I'll never eat certain things that will, like gluten, never touch it. So those kinds of things could, we could say keep me in remission, but I believe with all of my heart, and I have evidence to prove it, that I do not have that disease process anymore.

86
00:01:25,000 --> 00:01:26,000
And because I've dealt with the root causes, even if I ate gluten for a week, or even if I started eating a little more sugar for a while, I don't believe I would go backwards and get Crohn's again.

87
00:01:26,000 --> 00:01:27,000
Josh (29:13.842)
maybe just a little blow to irritation or somewhere on the low end of the severity spectrum, not full blown, 10 out of 10 crumbs. Love it. So your approach to this, and I want to get into sort of some steps people can start to take and all that. So are you an advocate for purely functional holistic medicine? Are you an advocate for integrative medicine where we use both holistic plants and herbs and pharmaceuticals? What's your typical approach with patients when they come to see you?

88
00:01:27,000 --> 00:01:28,000
Dr. Jill Carnahan, MD (29:15.816)
Correct. Yeah. Correct.

89
00:01:28,000 --> 00:01:29,000
Dr. Jill Carnahan, MD (29:39.164)
So I'm functional, mess and trained, but I'm an MD. And so I would say integrative might be the best description because I will absolutely, number one, I mentioned this beginning, but I think it's so important. If you're on a biologic or you're on a med and you come to see me, I won't touch that because that's keeping you stable. And that's like a crutch with a broken leg. And say you have this crutch and you've just broke your leg. You need eight weeks, 12 weeks, a year, whatever kind of therapy and healing you need. So I'm not gonna touch that.

90
00:01:29,000 --> 00:01:30,000
and I'm gonna actually support you stay on that med because it's keeping you stable while I have the opportunity to work under the hood of the car and fix the root problem. And even at that point, say 12 weeks or six months later, I let that be a decision with the patient and their gastroenterologist because I don't wanna be the one that interferes with that. But usually what'll happen is either the patient is like, Dr. Jill, can I go off my med?

91
00:01:30,000 --> 00:01:31,000
And as long as I have evidence, and I literally do inflammatory markers, I might have them do a colonoscopy like I'm making sure medically that it's very safe. And then I let the patient make that decision with information, of course, but I rarely, I can't think of the last time I ever told someone to go off their biologics. And in a way, it gets in the other example, say someone comes in really inflamed and very, very sick and malnourished and not able to keep anything down or they're losing weight and they're in severe condition.

92
00:01:31,000 --> 00:01:32,000
and they're like, Dr. Jill, should I go on a medication? Usually the answer is yes, because what we want is the types of things that I'm doing are slow, they're powerful. They're the most powerful things we could do, changing your diet, treating the SIBO CIFO, treating the dysbiosis, down regulating inflammation, getting the nutrients back, but none of those things are gonna be overnight or quick. And I would say the minimum of six months. For my journey, it took me a good 18 months to get stability. Now my big symptoms were gone quickly.

93
00:01:32,000 --> 00:01:33,000
But as far as really, really feeling like I was in remission or a cure, I'd say it started around 18 to 24 months after I made the changes.

94
00:01:33,000 --> 00:01:34,000
Josh (31:33.43)
I feel like we should get DNA tests because I'm pretty sure you and I are related. I say the exact word for word. I tell my clients, I'm like, imagine you have a broken leg. It's in a cast. We have to pressure test. We can't just get out. We have to be healing time. I use the exact same analogy. I say, yes, right. It's a little weird. I tell them the same thing. I say, I can't talk to you about your drugs, but when you feel like you're ready, talk to your doctor, get some testing and see if we can extend the length of dose between

95
00:01:34,000 --> 00:01:35,000
Dr. Jill Carnahan, MD (31:49.412)
Wow.

96
00:01:35,000 --> 00:01:36,000
Dr. Jill Carnahan, MD (31:58.469)
Yes.

97
00:01:36,000 --> 00:01:37,000
Josh (32:03.344)
the dosage a little bit, whatever it is. And same, yes to meds. Let's stabilize you until you can feel better, you get your quality of life back, and then this entire process not only becomes more manageable, but also enjoyable and frankly doable. Like the things you want to eat, the supplements you might want to take. You can't get them in if you're running them out in a 10-minute transit time.

98
00:01:37,000 --> 00:01:38,000
Dr. Jill Carnahan, MD (32:03.943)
Yes.

99
00:01:38,000 --> 00:01:39,000
Dr. Jill Carnahan, MD (32:22.912)
Right, right. And it's actually really hard if someone's in really severe flair. It is I would actually recommend meds. I would prescribe have prescribed them on occasion, not frequently, but because there's nothing wrong with these. There are amazing. I just think of them sledgehammers, right? For a problem that maybe at the time needs something like a sledgehammer. In fact, I've even tested TNF alpha, which there's TNF alpha blockers. And if I see that's your issue, well, why not temporarily stave off that inflammation? And then we'll work on the problem.

100
00:01:39,000 --> 00:01:40,000
Josh (32:40.311)
Yes.

101
00:01:40,000 --> 00:01:41,000
Dr. Jill Carnahan, MD (32:50.91)
I love that Josh, you and I are so aligned.

102
00:01:41,000 --> 00:01:42,000
Josh (32:52.938)
Yeah, twinsies. So there's really interesting, I'm just gonna maybe you've stumbled across this in your practice. Obviously, everyone's body is different. I don't just I don't have the numbers yet in the hard enough data. And unfortunately, a lot of GI specialists won't really engage with me on these conversations. But I'm trying to figure out to see if there's a correlation that we're finding between the root causes.

103
00:01:42,000 --> 00:01:43,000
what part of someone's immune pathways are being stimulated and therefore which drugs they're taking that seem to work. So someone's on Remicade or Stelar or Humira, is there a correlation with a large enough p-value or large enough percentage of people coming in that if they're on Humira, it's typically say CFO. If they're on Remicade, it's typically Candida or whatever it might be. And that's something I'm trying to figure out to see if we can maybe simplify things down a little bit to help the general population start to look somewhere.

104
00:01:43,000 --> 00:01:44,000
Dr. Jill Carnahan, MD (33:20.028)
Mm-hmm.

105
00:01:44,000 --> 00:01:45,000
Dr. Jill Carnahan, MD (33:44.332)
Ooh, I think we're really close, Josh. I know this from my work with Long COVID because what we're doing there through machine learning and AI is actually they're analyzing these patterns which they can do with millions of pieces of data and saying what does this marker like CCL4 or Rontase or VEGF.

106
00:01:45,000 --> 00:01:46,000
does that correlate with fatigue or brain fog or what symptom? And I'm assuming, again, if we have the data of someone who tested positive for a rabinus in the urine and then we saw TNF-alpha elevated. And I mean, we can look, I teach this a lot and a lot of times there are very specific cytokines like TNF-alpha or IL-2 or IL-6 that are more related to fungal or bacteria triggers. So I think that we're close because what we could do is if we just had the data, we could start to put it into.

107
00:01:46,000 --> 00:01:47,000
machines that we could throw out. This is the most statistically significant correlation. I think we're, the problem is I think we'd need to get those tests for everybody, which isn't affordable at this point. I don't know. But you can now test cytokines in any major lab.

108
00:01:47,000 --> 00:01:48,000
Josh (34:38.896)
very expensive to do.

109
00:01:48,000 --> 00:01:49,000
Yeah, well that's something I'll tell you what, we'll make sure we hook up later. I got a hundred different people on a list I can go through and pull all their stuff and get it to you for data. That'd be rad.

110
00:01:49,000 --> 00:01:50,000
Dr. Jill Carnahan, MD (34:49.416)
Awesome. I would love to work with you on that.

111
00:01:50,000 --> 00:01:51,000
Josh (34:52.026)
Very cool. So we're diving in. I want to get back to the reversal conversation. We talked about kind of that integrative medicine approach where there is a place for pharmaceuticals. And people often say we are holistic, therefore, you're anti pharmaceutical and we've well established that neither of us are. I dig that. So let's talk about getting to these roots. You mentioned you do some testing. And so what is the first step? Often, a lot of people will be apprehensive to want to see somebody functional holistic because frankly, there's a lot of people in the industry who may be

112
00:01:51,000 --> 00:01:52,000
as targeted or dialed in or even specialized, it's they kind of spray and pray. They sort of shotgun different tests. They start to guess and people are 10 grand in and they've gotten nowhere. So what is your first step? Is it a history? Is it a story? Is it testing? What's the first thing you do with patients when they come to see you?

113
00:01:52,000 --> 00:01:53,000
Dr. Jill Carnahan, MD (35:27.821)
Yes.

114
00:01:53,000 --> 00:01:54,000
Dr. Jill Carnahan, MD (35:31.812)
Yeah.

115
00:01:54,000 --> 00:01:55,000
Dr. Jill Carnahan, MD (35:39.332)
Oh, I love this because I think you're right. I mean, we might read, oh, berberine is great. Well, berberine can bother some patients and it's not my first choice at all, but that would be the classical functional approach, give them some berberine. And if they're inflamed, not gonna help. So I love that. So what I do is people who come to see me have been suffering for a while, they've been to other doctors often and that. So usually they're ready to look at a deep dive and look at all things. Diet's huge. And even though there's no one size fits all, I do still feel like gaps in SCD

116
00:01:55,000 --> 00:01:56,000
Josh (35:46.21)
Mm-hmm.

117
00:01:56,000 --> 00:01:57,000
Josh (35:51.483)
Yes.

118
00:01:57,000 --> 00:01:58,000
Dr. Jill Carnahan, MD (36:08.268)
are probably the best initial kinds of protocols. SED has been made famous by Elaine Gottschall. She takes out those specific carbohydrates that can trigger SIBO. It's not quite as great for SIBO, but decent for both. GAPS is a diet that is a lot of homemade food. I think the autistic community really made that famous, and I think it's the hardest one to follow, but it's also really, really good. So I have had patients come in, and I've had so many patients who have read online or their mother, if they're in their teens or whatever,

119
00:01:58,000 --> 00:01:59,000
has helped them with the diet and the diet can really, really stabilize. So while we're doing the workout, the diet's huge. Now I have found personally, and now more patients, I think the paleo or the autoimmune paleo might be a little easier. And with some caveats, I personalize every diet. So there's never a one size fits all. So then what do I do? History is huge because we wanna know when does this start? Were there any triggers? Were there any moves? Was there any environmental exposures? Was there any chemicals? Was there any infection? Was there a tick bite? Was there a spider bite? Was there a...

120
00:01:59,000 --> 00:02:00,000
So I want to ask all the family history, those kinds of things. If everybody in their family had Crohn's, well, we know we're dealing with a big genetic issue. So history is huge. The second thing is I do usually make a pretty intervention of diet at the beginning to kind of calm inflammation. And sometimes it needs to be – this is why I like gaps in some of those where you're doing broths and cooked foods. Because when your digestion is so inflamed, you can't eat lettuce salads or these – you can't do any of that. So you have to get very nourishing.

121
00:02:00,000 --> 00:02:01,000
Josh (37:28.722)
No.

122
00:02:01,000 --> 00:02:02,000
Dr. Jill Carnahan, MD (37:32.104)
One thing I'll mention here, I'm sure you talked to patients, in the extreme cases, there is really good evidence for elemental diets. And before we just had Nestle making their kind of garbage product of processed corn syrups and things. Yeah. Nowadays, we actually have formulas that are made by the integrated companies that are pretty clean, these elemental diets. And what they do is it almost gives – I think of it as like the baby that had allergy to formula and needs to be on Neutramigen, which is like an elemental formula to rest their gut.

123
00:02:02,000 --> 00:02:03,000
Josh (37:43.761)
It's a garbage company.

124
00:02:03,000 --> 00:02:04,000
Dr. Jill Carnahan, MD (38:00.688)
Same thing for adults, you're giving the gut a rest because it's broken down fatty acids, it's broken down sugars to the simplest form and broken down proteins to amino acids. So your body does not have to do any work of digestion. And because those are in the simplest form, they don't feed the bacteria that's usually part of the overgrowth. Now, again, the caveat is if someone is truly just a fungal overgrowth or massive fungal issues, there's sugars in these elemental diets and some of those people with severe fungal overgrowth

125
00:02:04,000 --> 00:02:05,000
don't do great on an elemental diet because there's no product that doesn't have sugar because it's broken down into those, you know, lactose and sucrose and all the basic sugars, glucose. So for that, that would be kind of like how I'd start. And then what I'm doing is casting a net by doing stool testing, organic acid testing, ruling out other infections. So I'll do blood work to check for viruses, tick-borne infections, other kinds of mycoplasma triggers.

126
00:02:05,000 --> 00:02:06,000
I'll check their immune system and see do they have a selective IgA deficiency because some of these people have a mucosal immune system issue that I know they're going to have issues with bacterial overgrowth. And then we can test intestinal permeability but nowadays I assume everybody with Crohn's and colitis has leaky gut so I don't even need to test and I don't typically do that.

127
00:02:06,000 --> 00:02:07,000
So then we go into what are we doing? So diet number one, history number two, these basic tests, and I wanna get an idea of what is the main triggers for them, is it a bacteria, is it a fungal overgrowth, is it an inflammation, is it genetics? And then what I'll do is I'll put together a plan. Typically in that plan is some kinds of probiotics, but what I find is if there's SIBO or CFO, often the traditional probiotics don't work very well. So I'm using very targeted either low histamine probiotics or spore probiotics or something really simple.

128
00:02:07,000 --> 00:02:08,000
My story is interesting because 20 years ago when we didn't know what a spore was, I found this one product called bacillus coagulans and it was the only probiotic when I was severely inflamed with Crohn's that worked. It was really helpful. I didn't know a thing about spores. Now I look back and that was one of the first spores that they made into a probiotic and even today the kind of probiotics I take, bacillus subtilis or these bacillus, they work the best for me. Now some people have histamine issues. I definitely had that and that would be a low histamine diet and maybe a low histamine

129
00:02:08,000 --> 00:02:09,000
Dr. Jill Carnahan, MD (40:13.988)
like lactobacillus casei is actually high histamine and can make the problem worse. So you kind of got to look around into probiotics. I often use things that are going to be gut healing, anything from whitefish protein to butyric acid to glutamines old school and nice, but I feel like it's not as powerful as some of these newer agents. And some people can convert that to glutamic acid. So there are a few cases where it's not the best thing to start with, but typically butyric acid, zinc carnosine,

130
00:02:09,000 --> 00:02:10,000
curcumin in some cases, although there are people that react to even curcumin, Boswellia, anti-inflammatory herbs. And then again, if I find the bacterial overgrowth, the fungal overgrowth, I'm going to treat that. And it's interesting because herbs are great, but I find sometimes in these cases when it's very severe, the herbs, people react to them because they're having permeable gut. So there are times when I use things like rifaximin and fluconazole, antibiotics and antifungals, because I find I get a quicker response for someone who's in a severe flare.

131
00:02:10,000 --> 00:02:11,000
Josh (41:12.474)
It's interesting you say that. I just had some clients literally just, again, what's it, Tuesday we're recording, so last night I do a lot of my check-ins on Mondays and I told her, I said, go ask your doctor about flacanazole because you've clearly got a fungal issue. And so would you say in a lot of those cases you typically would rely on something like an antifungal pharmaceutical as a quick easy boom get it done? Or are there things you'll find those are big contraindications and people really should be careful if they have IBD?

132
00:02:11,000 --> 00:02:12,000
Dr. Jill Carnahan, MD (41:40.108)
No, I would say, I'll just tell you my story. Part of my healing is antifungals, absolutely 100% because I had a weakened system. I had overgrowth of yeast. I was post-cancer and I used fluconazole for years.

133
00:02:12,000 --> 00:02:13,000
off and on to get control. I don't use it anymore, but during the time it was a game changer. So let's talk about antifungals. We've got fluconazole, atriconazole, which is also sporinox, boriconazole, ketoconazole. These are all azole drugs. They do go through the liver. So the contraindications would be any liver inflammation, any elevation of liver enzymes, which can happen in Crohn's and colitis. So you wanna make sure liver is okay. If I give them, I always give them with milk thistle, which protects the liver. And in my 20 years of practice, I have rarely had

134
00:02:13,000 --> 00:02:14,000
anyone have elevation of liver enzymes from those meds, even with daily use, as long as I use milk thistle to protect the liver. But again, I'm screening my patients and making sure they're appropriate. They are powerful, but they're so, so effective for these invasive fungal cases. And those are the only systemic antifungals that treat if it's going through the gut wall into the systemic circulation, or you have antibodies in the blood or even antigens in the blood. Nystatin is another favorite. Nystatin is not systemically absorbed.

135
00:02:14,000 --> 00:02:15,000
It's so safe, we can use it in newborn infants with thrush. So it's really, really safe. It heals the gut lining. But because that lining is where the overgrowth happens, if you treat that, often you'll get systemic antifungal effects. So I actually find nystatin to be incredibly powerful, probably a little safer because it's not gonna cross over and go into the liver. And I use pretty high doses, but I get really good results. And in some cases, temporarily, I'll even combine them for different reasons.

136
00:02:15,000 --> 00:02:16,000
A typical doctor is taught to give fluconazole for a yeast infection one dose and then another a week later. I'm not dosing like that. Again, this is under your doctor's supervision but I'm dosing daily with protection of the liver sometimes 30, 60, 90 days. And my typical treatment of yeast whether it's starting with drugs and getting it under control and then doing herbs is minimum six months because it takes a lot to get this under control.

137
00:02:16,000 --> 00:02:17,000
Josh (43:30.222)
Wow.

138
00:02:17,000 --> 00:02:18,000
Josh (43:39.49)
It's very interesting you say that. So I've got a little girl I'm working with right now. She's just turning 13 years old and I did get an OAT test from her and she did have elevated arabinose, not as high. Again, for our listeners, that's a marker we get in urine to detect fungal overgrowth in the body, typically associated with Candida. And like we talked about, it's more in the small intestine, not the large intestine. And so I got this marker back and I sent her to her doctor. I said, hey, I was meeting with her mom. I said, take her into the doctor, see if they'll give you flucanazole or something else. And the doctor said, no.

139
00:02:18,000 --> 00:02:19,000
Dr. Jill Carnahan, MD (43:49.201)
Mm-hmm.

140
00:02:19,000 --> 00:02:20,000
Josh (44:08.786)
I said, okay, back to the drawing board. What about Nystatin? Doctor said no. And so we keep running into these roadblocks and if there are things, again, these are relatively considered safe provided everybody's liver is healthy. What advice would you give to somebody who's in this space where they're hearing this podcast to say, well, I thought this was an issue. I talked to my doctor about this or maybe they're dealing with mold and they asked for like a well-called prescription or something else. And they've asked their doctor who said no.

141
00:02:20,000 --> 00:02:21,000
Dr. Jill Carnahan, MD (44:09.296)
Mm-hmm. Yeah. Oh.

142
00:02:21,000 --> 00:02:22,000
Dr. Jill Carnahan, MD (44:21.189)
Mm-hmm. Yeah.

143
00:02:22,000 --> 00:02:23,000
Josh (44:36.366)
Do you go to a different doctor? Like, what do you do?

144
00:02:23,000 --> 00:02:24,000
Dr. Jill Carnahan, MD (44:39.492)
Yeah, you know, I think you need to find an advocate who really understands it because it's even in the integrative space and even the pharmacist, I can't tell you the number of times where I get, I'm not gonna mention doses because I don't want people to treat themselves, but I get pretty high doses of nystatin and pretty high doses of gluconazole. And I do it and monitor and it's very safe and literally 20 plus years of experience, I have not had any.

145
00:02:24,000 --> 00:02:25,000
Josh (44:51.406)
show.

146
00:02:25,000 --> 00:02:26,000
Dr. Jill Carnahan, MD (45:00.88)
side effects or issues. But having said that, sometimes the pharmacy will be like, oh, this is a really high dose. Are you sure your doctor wants you to stay on this after month three? I get that frequently. So I think it's just uneducation of the physicians and the pharmacies of the safety and the efficacy of this. And I can actually, because I teach doctors, I'll pull studies on safety and efficacy because they're out there. So I suppose we could start, you and I, maybe put together some of the studies and research because it is out there and it's safe.

147
00:02:26,000 --> 00:02:27,000
If your doctor really doesn't understand, obviously you need prescription, I would try to find someone who does and who's willing to work with you. You could say, if you're the patient, it shouldn't be on your shoulders, but what I do, if there's any question of the pharmacist and another doctor or the patient themselves, is I'm going to do labs before you start checking liver, checking inflammatory markers. We can even look at things like platelets for inflammation in the gut, sometimes that will go up. There's many other things, CRP or calprotectin. I'm actually watching markers.

148
00:02:27,000 --> 00:02:28,000
And what we can do is say, okay, well, why don't we try this? In one month, let's check your liver. Let's make sure everything looks good. So even if your doctor's, if they're open-minded, then just check your labs, and then that doctor will feel safer doing this for you because they're gonna know that they're monitoring you.

149
00:02:28,000 --> 00:02:29,000
Josh (46:12.814)
I love

150
00:02:29,000 --> 00:02:30,000
Josh (46:42.448)
which is where we get this sick building syndrome and all kinds of just crazy shit happening to people. So let's touch on molt. Where are you seeing it? Is there particular age groups you're seeing it? Demographics, geographics, what's going on with that?

151
00:02:30,000 --> 00:02:31,000
Dr. Jill Carnahan, MD (46:56.86)
So mold is huge and many people, because it's invisible behind walls, may not even have a scent or musty smell. Often it is contributing to inflammation, to inflammatory bowel disease, but also autoimmunity, cognitive decline, immune deficiencies, you name it, it's so toxic.

152
00:02:31,000 --> 00:02:32,000
And it's kind of hidden. So this is one thing in the history. I often will ask about when did you first start feeling ill and say, well, what happened right before that? Was it a stress or was it a death of a loved one? Was it a move in home? And sometimes I'll get a story where we moved to a new home or moved to a new location or I started a new job and there's an environmental component that's very clear.

153
00:02:32,000 --> 00:02:33,000
And especially if it's not just them, but someone else in the family was sick as well because of that move. And it could be new home, new job, new location. And one of the things that's crazy is the most common places we're finding mold are new builds. We think new homes are immune and it's not the case because of poor construction, porous materials, water intrusion during the construction process, improperly installed.

154
00:02:33,000 --> 00:02:34,000
like grout in the shower or you name it. Or you can have leaking of a fridge line in the wall. Someone puts a cabinet in and puts a nail through the plumbing. And again, I could name 101 of the things that are really common, sadly. And unbeknownst to them, there's a leak in the wall and there's mold growth and then people are sick. So a location history is huge. So if you find out that someone has something that got worse or they just got a diagnosis when they moved or have a new location, that's a clue.

155
00:02:34,000 --> 00:02:35,000
Cognition is really common with this. And of course, with inflammatory bowel, it can affect the brain as well. But if you're having brain fog, word finding, difficulty concentrating memory, and you're young and healthy and shouldn't be having Alzheimer's types of symptoms, that's a big clue that mold might be involved. Nuance at autoimmunity. I mentioned histamine. That's a whole nother topic, but very common with inflammatory bowel disease for there to be a histamine or mast cell component. And mold is the number one trigger of mast cell activation. Mast cells.

156
00:02:35,000 --> 00:02:36,000
Dr. Jill Carnahan, MD (48:51.528)
throughout histamine, they throw out prostaglandins, and these are some of the mediators that create a leaky gut. So that's one way that it's connected. So those are just a few of the clues. Typically, history is number one for me. Usually in the history, I have a pretty good idea of what's going on, but I'll do urinary mycotoxins as well to kind of confirm that.

157
00:02:36,000 --> 00:02:37,000
Josh (49:08.51)
Yeah, it's really interesting. And just for our listeners to connect the dots, and as a clinician, I'll do the same thing. I'll sit in, we'll do a history. And great example, I had a fella come in, 22 years old, and he came in and his doctor, he was just recently diagnosed with ulcerative colitis. And so he started a new job in HVAC, two months in, he got diagnosed with IBS. Six months after that, he was diagnosed with IBD. He went to his doctor, he said, well, it's ulcerative colitis, it's genetic, you're Jewish, your family's Jewish, Jewish people get it more.

158
00:02:37,000 --> 00:02:38,000
So I don't know and here's some drugs. He put them on misalamine four pills a day. And that was it. End of conversation. And it took us 15 minutes, Joe, to go through a conversation to get this new job. I said, okay, were you wearing, sorry. I said, were you wearing your PPE?

159
00:02:38,000 --> 00:02:39,000
Dr. Jill Carnahan, MD (49:40.036)
Yeah. Oh, wow.

160
00:02:39,000 --> 00:02:40,000
Dr. Jill Carnahan, MD (49:50.074)
Thanks.

161
00:02:40,000 --> 00:02:41,000
Josh (49:53.93)
when you were working this HVAC, he goes, no, I said, great. It's probably that you have a mold infection, got a urine test and he's loaded with okra toxin A. And there it was, now we are 10 weeks later, bing, bang, boom, it's gone. He's got no problems, no symptoms. He's going in for a new colonoscopy and we're expecting nothing. And so it can be so easy from the history.

162
00:02:41,000 --> 00:02:42,000
Dr. Jill Carnahan, MD (50:10.67)
Yeah.

163
00:02:42,000 --> 00:02:43,000
Josh (50:14.054)
And I think for our listeners, just hearing this, like Jill said, if you are dealing with histamine issues, so spinach, canned foods, fermented foods, fried foods are causing problems, that's a histamine issue, maybe consider mold. Like she said, it's not just old homes, we often associate old homes, maybe it's new builds. I think that's just brilliant and just so simple for people to go, histamines, mold, let's check, right? What's it gonna harm to check? And some doctors.

164
00:02:43,000 --> 00:02:44,000
Dr. Jill Carnahan, MD (50:14.115)
Yeah.

165
00:02:44,000 --> 00:02:45,000
Dr. Jill Carnahan, MD (50:22.266)
Mm-hmm.

166
00:02:45,000 --> 00:02:46,000
Dr. Jill Carnahan, MD (50:28.488)
Mm-hmm. Yes.

167
00:02:46,000 --> 00:02:47,000
Dr. Jill Carnahan, MD (50:33.219)
Mm-hmm.

168
00:02:47,000 --> 00:02:48,000
Dr. Jill Carnahan, MD (50:37.45)
Yeah.

169
00:02:48,000 --> 00:02:49,000
Josh (50:41.074)
most offices can even just run a quick urine test and check for basic toxins.

170
00:02:49,000 --> 00:02:50,000
Dr. Jill Carnahan, MD (50:44.056)
Yes, yes, totally agree with you. I think it's a real big important part, especially like you said with the statistic you mentioned 80%, I used to say like one in four homes, I think it is more like 70, 80%. And I would say autoimmune cognitive issues, inflammatory bowel issues, maybe 50 to 60 to 70% are mold related.

171
00:02:50,000 --> 00:02:51,000
Josh (50:56.642)
Oof.

172
00:02:51,000 --> 00:02:52,000
Josh (51:06.358)
That's wild. And it's so easy sometimes. Now I do want to put caution to the listener. Dr. Jill, do you feel like it is extremely dangerous for people to take on mold by themselves and mold detoxing?

173
00:02:52,000 --> 00:02:53,000
Dr. Jill Carnahan, MD (51:19.696)
So first of all, as I just told before, suffering, that I wanna empower anyone that they can out there. And the first thing that you can do on your own is get out of this situation if possible, right? That's safe and easy. But I love that you said that because it is complex and you can get way sicker before you get better. And if you don't know what you're doing and you're mobilizing toxins and you're not excreting, whether it's Crohn's or mold or any of these things, you can get pretty darn sick. So I do think it's best to really have someone who's helping you along the way, if at all possible.

174
00:02:53,000 --> 00:02:54,000
Josh (51:24.034)
Yes.

175
00:02:54,000 --> 00:02:55,000
Josh (51:46.946)
I'm glad you agree with that. I've had some people go, well, I did some Googling and I found that I can use XYZ. I said, please don't. The level of severity of sickness, it creates for our listeners something called a Herxheimer reaction is one of them. Like Jill said, you're just moving toxins around the body. You can create severe liver, kidney damage long-term, all kinds of stuff. So please be careful and consult a professional. But I wanna start putting a nice tidy bowl around this one, Dr. Jill. Our kind of primary leading causes, like we talked about fungus,

176
00:02:55,000 --> 00:02:56,000
Dr. Jill Carnahan, MD (51:52.016)
Yeah. No. Good.

177
00:02:56,000 --> 00:02:57,000
Josh (52:16.66)
mold. Of course, there are insults to the gut bacteria. I suppose this is where I find two types of ways that people acquire IBD. The first one being more instantaneous, right? More acute, where it's an insult, like you said, Lyme disease or heavy antibiotic dosage or something that happened versus a slow wear and tear like the heel and a shoe without socks. And so I see things like Lyme disease, COVID, motility disorders, heavy metals, parasites.

178
00:02:57,000 --> 00:02:58,000
mold toxins, antibiotics, fungus, or like overgrowth. Is there anything else on the list that you put as a very common cause or root, so to speak of somebody's IBD?

179
00:02:58,000 --> 00:02:59,000
Dr. Jill Carnahan, MD (52:54.816)
Thank you.

180
00:02:59,000 --> 00:03:00,000
Dr. Jill Carnahan, MD (52:58.26)
Often, like you said, the gut, so like you said, the dysbiosis, the sepo, the sepo, the parasites, the bacterial overgrowth, the mycoplasma, but there can be systemic things like you said mold and then you go to the mold or the tick-borne infections or other kind of greater issues there. Diet itself can be a big trigger, but usually diet alone is not the cause.

181
00:03:00,000 --> 00:03:01,000
Like that's what I actually want to say that really loud and clear. Diet alone can really contribute or perpetuate the inflammation, but it's been very rare that diet alone, unless there was a toxic chemical or toxic exposure in the diet, has caused Crohn's or colitis.

182
00:03:01,000 --> 00:03:02,000
Josh (53:36.094)
Yeah, love that. That's so good. So Dr. Jule, I wanna respect your time. I know we're kind of winding down to the end of our interview together. This has been just brilliant. I'm very much looking forward to getting it out to our listeners as well. So before we do wrap this up officially, is there anything that we haven't really talked about yet or anything we haven't gone over that you'd like to say to our listeners? Open mic, open table, the floor is yours.

183
00:03:02,000 --> 00:03:03,000
Dr. Jill Carnahan, MD (53:59.596)
Well, it's interesting, we haven't talked about this, but I think there's such a core of self-compassion and the healing. And it's kind of like why we started about, there's no, I don't want people to feel like a victim, but I also don't want them to feel like they're lacking empowerment. And somewhere in between there, this kindness to ourself, but also empowerment, where we actually have some control over this, I think is part of the most powerful healing. Because when we feel totally disempowered, all we can do is drugs, that's not good. When we feel like it's all our fault and we're doing everything wrong, that's not good. And somewhere between there is this love

184
00:03:03,000 --> 00:03:04,000
to ourselves that we're dealing with a chronic illness but that we do have choices and that we do have empowerment and on that note I'll just end with this when you have a habit say you're like oh my gosh I got to get gluten on my diet how am I going to do that the most empowering thing I found is when you make it your identity because when it's like I don't eat gluten that's who I am

185
00:03:04,000 --> 00:03:05,000
It's very easy because you don't ever have to think about a decision. Do I have gluten now or not this time? It's like, if you say I can't or I won't or no, you're 80% less empowered than if you should just say, I don't eat gluten. So it's actually, it's semantics, it's neuro-linguistic programming, but there's a power to having an identity around. And for me, I am healthy, which means that everything I do.

186
00:03:05,000 --> 00:03:06,000
has to go in that direction because I know at the core, I am healthy. And I think that's part of the identity of someone who recovers is changing that messaging.

187
00:03:06,000 --> 00:03:07,000
Josh (55:19.278)
I think that's fantastic. And it's so true. The power is in your hands. And there's something to be said for self empowerment for like you said, the neuro linguistic programming and self advocacy, not only within yourself in your own mind, but also with your doctor, just because your doctor says, well, you're stuck with this, it doesn't mean you are. And that can really put people in these positions where they are sort of victims to their circumstance. And like you said, it's happening to you, not for you. And that's a very, very different approach. Well, Dr. Jill.

188
00:03:07,000 --> 00:03:08,000
Dr. Jill Carnahan, MD (55:43.856)
Yes.

189
00:03:08,000 --> 00:03:09,000
Dr. Jill Carnahan, MD (55:47.111)
Yeah.

190
00:03:09,000 --> 00:03:10,000
Josh (55:48.982)
there's going to be so many follow up questions. I've got a group of almost 13,000 people with IBD who I'm going to share this with and I'm sure they're going to want to have some follow up. So if they were to do that, how can they reach out? How can they connect and learn more?

191
00:03:10,000 --> 00:03:11,000
Dr. Jill Carnahan, MD (55:58.631)
Yes.

192
00:03:11,000 --> 00:03:12,000
You got it. Well, I have a 10 years of blogs, podcasts, all kinds of information on my website, a lot of it on inflammatory bowel. It's just my name, jillcarnehan.com. So come by, send me a note, however you want to visit. And for your listeners, Josh, my book came out this year and it's called Unexpected. And if you want a free chapter there to just kind of get a little idea on how to empower yourself, you can go to readunexpected.com slash free chapter and download it for free. No obligation for your listeners.

193
00:03:12,000 --> 00:03:13,000
Josh (56:30.606)
I love that. And I've actually got a copy of the book and it's just brilliant. I think it's just really going to shift the landscape for people. So thank you so much for that. It's my pleasure and likewise.

194
00:03:13,000 --> 00:03:14,000
Dr. Jill Carnahan, MD (56:31.785)
Thank you.

195
00:03:14,000 --> 00:03:15,000
Dr. Jill Carnahan, MD (56:38.896)
You're welcome. Thank you for the great work you're doing as well.