Episode 18: Functional Medicine – Getting to the Root Cause of Illness

Cindy Kennedy, FNP, is joined by Dr. Jill Carnahan to discuss functional medicine and how she helps her patients to get to the root cause of their disease or illness. Dr. Carnahan also discusses the role that mold can play in chronic illness.

Dr. Jill Carnahan

Dr. Carnahan completed her residency at the University of Illinois Program in Family Medicine at Methodist Medical Center. In 2006 she was voted by faculty to receive the Resident Teacher of the Year award and elected to Central Illinois 40 Leaders Under 40. She received her medical degree from Loyola University Stritch School of Medicine in Chicago and her Bachelor of Science degree in Bio-Engineering at the University of Illinois in Champaign-Urbana. She is dually board-certified in Family Medicine and Integrative Holistic Medicine. In 2008, Dr. Carnahan’s vision for health and healing resulted in the creation of Methodist Center for Integrative Medicine in Peoria, Illinois, where she served as the Medical Director for two years. In 2010, she founded Flatiron Functional Medicine in Boulder, Colorado, where she practices functional medicine with medical partner, Dr. Robert Rountree, author and expert speaker.

Dr. Carnahan is also 10-year survivor of breast cancer and Crohn’s disease and passionate about teaching patients how to “live well” and thrive in the midst of complex and chronic illness. She is also committed to teaching other physicians how to address underlying cause of illness rather than just treating symptoms through the principles of functional medicine. She is a prolific writer, speaker, and loves to infuse others with her passion for health & healing!

If you would like to read more about Dr. Carnahan, visit www.drcarnahan.com.

Transcript of Episode 18: Functional Medicine

Cindy: Hi everybody, thanks for joining me on another episode of Living With Lyme, this is your host, Cindy Kennedy. I have the pleasure of having Dr. Jill Carnahan with me today. She’s both a medical doctor and a functional medicine doctor. Her practice is in Boulder, Colorado. She has an incredible resume, and she has been named one of the 50 best functional and integrative US doctors, and you have to see her website. She has a wonderful website and a blog that you can follow. It’s filled with information, and she puts this information out for people that subscribe to her site. It’s actually more than helpful, and certainly great for our listeners that have Lyme or any other illness that’s on a chronic basis. I am very excited to introduce to you, and here she is. Here’s Dr. Jill Carnahan, welcome Jill!

Jill: Good morning Cindy, what a delightful honor to be here, and thank you for the kind words, I so appreciate it.

Cindy: Oh, absolutely. When I wrote to you and we decided that we could coordinate our time to do this podcast, I said geez, you know, I don’t know much about the term functional medicine. I’m pretty familiar with homeopathy and naturepathic medicine, but the functional portion, can you give us some information on what that’s all about so then we can talk about your topic?

Jill: You bet. I’m a medical doctor, MD, but I have always wanted to go to wellness and preventing disease. Even with chronic illness and Lyme and some of these things we deal with, getting to the root cause and actually trying to reverse the processes in the body that are causing disease. Nowadays, conventional medicine, which I’m well trained in and has its place, just gives drugs or surgery a symptomatic solution, and there’s rarely a complete cure. Conventional medicine does a great job with trauma, so if you have a heart attack or you have a stroke or you get in a car accident, there’s no better place than a conventional medical hospital in the US. However, most of the diseases that we’re dealing with nowadays are chronic, so obesity, diabetes, chronic infections like Lyme, and other things, toxic exposures. These things accumulate over time and change metabolic and genetic function. My job as a functional medicine doctor is to look at root cause and try to actually intervene with nutritional, if possible, interventions, and change the course of disease or reverse it entirely.

Cindy: That’s similar to naturepathic medicine, but is there a different spin on the functional component?

Jill: Yeah, so basically naturepaths, chiropractors, medical doctors can all become functional medicine practitioners, so there’s a lot of us in different backgrounds. Naturepathics medicine just doesn’t use drugs or surgery and they use all natural, but there’s still, a naturepath could use natural remedies and not look at root cause, or if they’re looking at functional medicine, they might look at root cause. Yes, there’s lots of principles of naturepathic medicine that are used in functional medicine for sure.

Cindy: Functional medicine seems very specific. It sounds like you can tackle just about any problem. How do you gain your patients? Do you see them as you’re their primary care provider? Do you do this through insurance based or private pay? How does your practice work?

Jill: Oh, great question, because everybody’s different. In 2009, I was in a hospital system, and I was director of a integrative medical center there, and practiced medicine in the hospital system. Then I decided to move in 2009 to Colorado and actually start my own practice. When I moved, I did a few things. What I wanted to do is be able to speak and write and learn and have balance in my own life, because I know that I can’t really give and pour out into my patients’ lives unless I’m living well and practicing the things I preach. What I did is I moved out here, started a brand-new practice, it is cash based only. I do bill labs and things through patients’ insurance if possible, but we don’t bill insurance at all. What that does is it takes out the middleman, because nowadays in medicine, when you are billing through insurance, insurance gets to dictate what you order, what you do, what you prescribe. The truth is, they have their hands in the business where they never should have their hands in the business, and they dictate what patients should get, what they shouldn’t get, what tests should be covered.
By taking them out, I’m actually giving the patient 100 percent of my attention. Nobody interferes, I do what’s best for them, and there’s nobody else telling me what’s right for my patients. I protect them, I’m like mama bear, so to me, it’s actually an advantage. The other thing I found that I didn’t expect is those patients invest in themselves. They are ready to change and they’re invested in their own health. There’s power in the dollars as far as putting a little bit down towards your health and investing in that, and that frees me to give them 90 minutes, 120 minutes, 60 minutes, whatever it takes, but a long time where I have face-to-face time with them, and I can really get to know them and intervene. Nowadays in primary care, I think seven or eight minutes average on a visit, so it’s a really different feel when they see me, because they’re spending usually an hour and a half in my office on the first visit, and then another hour and a half with my staff. Sometimes up to three hours with us here.
As far as the primary care, I did family medicine, I delivered babies, I can do all the primary care. I treat all ages, however when I went to this practice, I’m a consultant. What that means is all of my patients current should or are advised to have a primary care doc, because I don’t take call on the weekends. I’m not an emergency type of physician, but I’m there, I respond by email. I’m really quite available to my patients, because obviously they have unique needs and they’re trusting in me, but technically I’m a consultant. I still treat them like I would if they were my primary patient, but it works out well for everybody that way.

Cindy: Yeah, it sounds that anytime people have skin in the game, they’re using their dollars, then they’re more likely to participate in a broader scope, or really listen to what you say. My patients, someone comes in and they’ve got an issue. Now, they’ve come to me with the issue, and I know via what should be done, what shouldn’t be done, and I suggest such as, an ultrasound, or I really want to check their bone status, because they’ve recently fractured an ankle. They’ll actually say to me, oh gosh, I’ve got such a large deductible, I’m not going to do that. I’m like, geez Louise, why are you coming in? It’s a very difficult thing, and I love this story, real quick.
A patient came in, post-menopausal bleeding. I do gynecology. Post-menopausal bleeding, we have to go for the worst thing, uterine cancer, she needs a biopsy. I send her out with some methods to soften the cervix so I can get in. She doesn’t make the appointment, we call her. Okay, I’ll take that under consideration. Doesn’t make the appointment, call her again, letter, I call her again and I explain to her, this is important, and under our practice we can’t continue her care if she doesn’t participate in her care. She still doesn’t make an appointment, she gets a letter saying she has to find care elsewhere. She came in with a letter and it said that she’s requesting her medical records because Cindy Kennedy is a bully. It just, I had to laugh. I mean, it’s so infuriating, but now would you consult a person over the phone?

Jill: Yes, so I do typically, legally in the state of Colorado it’s ideal that I see them in person on the first visit, so I do whatever I can to make that happen, but I have people with MS or can’t travel, and I try to make exceptions. As long as they fly in and see me for the first visit, I do most of the follow-ups by phone or Skype. Most of my days, anywhere from half to three-quarter of my days is phones.

Cindy: Oh, okay, that’s really good to know. I have had a lot of guests from a variety of backgrounds, and you are my first functional lady. I said geez, what topic are you interested in, and you told me mold. I don’t know, really, much about mold. I know that if I see it or find it, I don’t like it. I’m coming to you, I’ve had chronic illness, I’ve had Lyme, and you’re going to ask me a bunch of questions because you’re considering there’s some mold issue. Give me some background on what mold is. I understand it’s ubiquitous, it’s everywhere. How does it affect us, and what are you looking at and thinking about?

Jill: You bet. You know what, you are not alone, even many of my colleagues in functional medicine, nurse practitioners, doctors, all of the above, they have not heard of it or they have no idea about mold. It’s kind of the new kid on the block, and it’s pretty crazy. It’s like once you know about it, you can’t un-know about it and you start to see it more places. Just know you are in good company, even among integrative and functional doctors and naturepaths, so that’s normal.

Cindy: Excellent.

Jill: Very normal. Second of all, what is the deal? First thing first, this is a genetic issue. What that means is if you don’t susceptible genetics, you probably won’t get severely ill from mold. Why that’s important is because the same genetics that can cause chronic Lyme to be an issue are the same genetics that can cause mold to be an issue. What we see very frequently is that these two things are co-related in one patient with Lyme. That’s why it’s so relevant to your population and your interest group, because many, many patients with Lyme, first of all, it’s about 24 percent of the population that has the gene, and if they have a higher-risk gene, they have more trouble clearing biotoxins, which is living toxins from things like mold, algae, Lyme disease, [inaudible 00:10:13], and they have just more trouble with tolerating the toxins that those things produce, and that’s why it’s related. What I see very, very frequently is patients that are chronically ill, they have fatigue, they have brain fog, they have joint pain. They might have neuropathy, they might have sleep issues, insomnia. They may have gut issues, which are very common in Lyme and mold. This correlation with chronic fatigue and fibromyalgia and chronic pain and all of these things we see in Lyme can also be related to mold.
When I see this picture of someone chronically ill, I’m always looking at, is it toxin or is it infection, or is it both? I look at labs and things, and the reason this is so correlated to Lyme is very frequently, someone will have, they were a Boy Scout when they were young, they camped in the woods all summer and they got bit by ticks. They actually have [barellia 00:11:01] in their bloodstream, in their body, but they aren’t really, really sick from it. They don’t even know that they have it. Then that person at 21 years old is in a dormitory that had massive flooding and water damage, and it has mold, gross, and they go downhill. All of a sudden this Lyme starts to activate and become a problem. They have joint pain, they have brain fog, they have massive fatigue, they can’t finish their senior year. Why this is correlated is that mold is such a harmful thing for the immune system that it drops the reservoir, it drops the protection effect of the immune system, and that patient’s tick-borne illness pops up. Very frequently, I see a situation where a change in work or living environment into a moldy home or environment is the trigger for someone to have active Lyme disease, and it could cause problems.

Cindy: Wow. You know, it’s an unfortunate, and I use the term, it’s a perfect storm. Is that what we’re talking about here?

Jill: Exactly, and even my job as a medical detective is trying to find the layers in which we treat first. Say someone’s in a moldy home, and it’s pretty severe, there’s massive [inaudible 00:12:06], which is a nasty black toxic mold. Their Lyme will never get under control until you get them out of that environment of multiple layers. They may need treatment for Lyme, and they may need things, herbal treatments or medications, but until you get them out of that environment, they probably won’t get well.

Cindy: What’s the difference between indoor and outdoor fungal components? We see when it gets warm and moist, we see these little pop-ups of mushrooms everywhere. We’ve done an emergency visit with one of my dogs who got terribly sick.

Jill: Oh no.

Cindy: Chomping, oh yeah. It’s like, I go, oh my god, here comes at least a $500 bill.

Jill: This is actually a, once again, great question from you, because what happens is, think about this. The axiom for toxicity is, dilution is the solution to pollution. What that means is if you’re outdoors and there’s mold outdoors, where there’s tons of them, it’s diluted, because the air flow and there’s lots and lots of ability to dilute that toxic effect. Usually outdoor molds, even if they’re toxic, nasty molds, are not a huge, big deal. Now, the exceptions are after something like Hurricane Katrina or recently in Texas, the air can be pretty saturated with mold. There’s a lot of buildings and of course materials are saturated in water, then that mold growth can overcome the environment. We’ve seen places like that have outdoor spore counts in the hundreds of thousands, so that’s the exception. What happens is inside a home, nowadays everything is so efficient and air-tight it’s actually a problem for mold and for air exchange, so if there’s mold behind a certain wall, it actually is very, very concentrated in that home.
Ever since the 1970s, when they started putting fungicides into paints to prevent mold growth, we’re creating superbugs, just like we are with antibiotic resistance, we’re creating superbugs with mold, and those fungicides are killing off the more benign molds. Now when we have a mold problem in a home, it’s usually a pretty toxic mold that’s excreting lots of toxic VOCs and toxins that harm humans. Because it’s indoors, it becomes concentrated and becomes much more of a problem.

Cindy: Okay, okay. You just said that paints have fungicides.

Jill: Yes.

Cindy: Really? How do we know that? Is it on the can or is this one of yet the things that do not have to be reported or labeled?

Jill: That’s a great question, because I’ve not looked at cans. I have an environmental ecologist here in Boulder that I work with with patients, and she’s told me that, and not to name names, but I will, Sherman-Williams does have fungicides in them, and something like Benjamin Moore does not, or at least not to the extent. I think you talk with someone who knows. I use her to find out materials in homes and things that’s safe, because I’m not an environmental expert, and I have no idea about materials. Yeah.

Cindy: You know what, it goes both ways. It’s like okay, all right, we don’t want to spend so much on our power or our resources to heat our homes or to keep them cool, etc., but again, like you’re saying, now we’re closed all up, and now we can’t have that flow. We can’t get, we need to, but what if we have, here we are in New England right now, we have a tremendous amount of leaves on the ground. We’ve had saturating rains. I’m very sensitive. I think I can actually, if I’m near piles of leaves, I can actually smell that mold. Is that true, am I really able to smell that mold?

Jill: Oh, absolutely. Musty smell, whether it’s in the home or under a pile of leaves is actually VOCs, or volatile organic solvents, that are put off by molds. We always think about the spores, because if someone’s coming in and checking air quality, they’re checking for spore counts, but the spores are really not the most toxic part of the mold for someone who’s susceptible. For someone who’s susceptible, it’s these tiny VOCs and micro-toxins and very, very small sub-atomic types of particles that are damaging to the immune system. It can be those VOCs. That’s why air filters in a home can do great things for someone who has sensitivity, because they take out the VOCs in the air.

Cindy: Okay, so let’s say someone comes to you. You’re considering that this might be a problem. What medical steps are you going to take to document that this is an issue? Do you go right to the person? Do you look at their home? What if their work situations have been, there’s cause for alarm. What do you do? I’m coming to you, you’re thinking geez Louise, this might be an underlying mold issue, what do you do?

Jill: Again, you have these great questions. Basically if I’m concerned about Lyme or mold or whatever, there’s a couple ways to do this. The first thing I’ll do that’s free and easy is I have a symptom checklist, and it includes about 100 different symptoms. They range from sinus congestion, respiratory, wheezing, difficulty, abdominal pain, diarrhea, heartburn, brain fog, poor focus concentration, memory, numbness or tingling, leg cramps, exercise intolerance, static shocks or breaking electronics. Yeah, if someone’s breaking watches and electronics, that’s actually a sign that the antidiuretic hormone is off. When that’s off, basically they create a human battery. They sweat salt on their skin and create a gradient that causes them to have lots of shocking potential.

Cindy: Are you kidding me?

Jill: No.

Cindy: I thought I had supernatural powers.

Jill: Yeah, so you might want to check the antidiuretic hormone in your body.

Cindy: Okay, I’m only joking, I’m only joking.

Jill: It’s crazy, isn’t it? I will do a symptom checklist, and then in the office, we can do a visual contrast study that checks retinal acuity. The reason this is effective is this was studied 20 years ago for biotoxin warfare in our armed forces, and what they found is the retina is very, very sensitive to toxic exposure. All of a sudden, you’ll have trouble differentiating these black and gray and white lines from your vision. If you fail that test, that test and the symptom checklist tell me if I need to go further, because those are free, they’re screening. After that, I’ll do lab tests. There’s a lot of blood work labs that look at the immune system and the immune reaction to mold. That’s very complex, it could be a whole ‘nother show, but things like TGF Beta, MSH, MMP-9, Veg-F, VIP, ADH [inaudible 00:18:27], we check all of those.
Then some other things we can do is environmental, we can give them a test kit for dust sampling in their home to check for DNA of mold and see the history of the mold that might have been in their home. I can look at that and tell pretty quickly if it’s a likely danger or if it’s not. We do the home testing, sometimes we’ll have an inspection person come in who’s an environmental expert. Then we do blood work, and then we can do urinary micro-toxin testing to check for micro-toxins in the body. There’s lots of things you can do, and sadly there’s no one test that tells you for sure.

Cindy: Wow, so you know what, I have a little granddaughter, and I was over giving her a bath. I was telling my daughter, you know what, some of her tub toys I see have mold in it. Is that a bad mold?

Jill: Well, no mold is good mold. Certainly some are much more toxic. I would clean those out, soak them in a diluted borax solution, but yeah, especially because little kiddos put those in their mouths. There’s actually a lot of evidence of microtoxins in food, so peanut butter or [inaudible 00:19:29] causing gut damage in humans. I would say get rid of it. It’s probably not life-threatening, but …

Cindy: Right, right. We find it everywhere. Underneath our shampoo caps, we find it, I’ve seen it in these little felt areas that line our windows, because of course, we’re trying to keep out any of the outdoors, of course. This is so much to think about. It’s impressive that it is, it’s almost like a sub-specialty.

Jill: Yes, it really is. The more I learn, the more I’m like, wow. I know from, I won’t tell you my whole story, but in 2014, my office ended up having mold, and I got very, very sick. I recovered from it, but I had to learn this [crosstalk 00:20:17].

Cindy: The hard way. Oh, that is so awful. I listened to a, I believe she’s a naturepathic doc, and she was talking about, she ended up getting a lot more Lyme patients. Her feeling is, and I’ve read this before, that treating Lyme is like peeling back an onion. You get surface stuff, but once you peel that back, you get other stuff. You get deeper and deeper and deeper, and I guess with all of these extrinsic things that can affect us, we probably, if people just treat this correct, if our medical society would just get on board, then we could probably make a big difference. This is really unfortunately because the guidelines are very different. You see one set of doctors and they’re all about antibiotics, and we know awful things that occur after prolonged antibiotic exposure.
I would love, only to educate as many people as would listen to me, but I would love centers to pop up that have a variety of different sub-specialties. I’m not talking about surgery and cardiac and weight loss clinics and all this, I’m talking about the different branches of how we look at things. You know, I don’t know. Maybe in my lifetime, but I hope that if it’s not in my lifetime, it’ll be in my children’s lifetime. I can only hope so. This information is, I have some really close friends that are listening just because they support me, and I have gotten some great feedback via email from some of my listeners, but everybody says that each and every podcast, they have a big takeaway message. I guess, what is your takeaway? Well, no, no, you don’t have the takeaway, we don’t have the takeaway? Give us …

Jill: Yeah, what is the takeaway?

Cindy: Yeah, what is it?

Jill: Well, I think the key, again, this is how I run my practice and how I see patients is, if you’re not getting better, keep looking. My job is to always ask the question what else, what else, what else? What happens with a portion of patients with Lyme is they are not getting better, they’re getting worse. If they’re on a treatment protocol that should work, they need to ask what else. I can’t tell you the number of patients I’m treating with Lyme aren’t getting better, end up being in a moldy environment. For someone with Lyme, that’s such a correlation to their genetics and how they handle that toxin, that it’s very possible that they could even have both. What else is the takeaway, ask what else if you’re not getting better.

Cindy: I think that’s great. Now, before we end, I have a couple questions for you. The first question is real simple. What ticks you off?

Jill: That’s a hard one.

Cindy: Come on, come on. No one has asked me what ticks me off, so I’ll give you a couple of seconds to think while I tell the listeners, what ticks me off is when you allow a car to pass in front of you or people to cross in front of your path while they’re walking on their bike, and they just don’t raise their hand, or if they’re carrying something, look at you and nod at you or something to say thank you. That just really irks me. Now that you’ve had time to think, what ticks you off?

Jill: It’s very similar to yours, because it’s people who have no gratitude [crosstalk 00:23:53].

Cindy: I see. Second question before we end is, in life there’s a lot of times you get thrown a lemon, even a bunch of lemons. You can choose to be sour, or you can make lemonade, and my lemonade is meeting people like you and teaching people and that being that [facilitor 00:24:17], ooh, sorry. That facilitator. I’m like that go-between person, and I feel fortunate. I really do in that respect. What’s your lemonade?

Jill: Oh, I am overcome, I was born to overcome. I overcome all obstacles, I outlast all adversity, and things are always turning in my favor. The reason, I’ve beat breast cancer, I’ve beat Crohn’s disease, I’ve beat mold illness, and I am just bound and determined to use these kinds of lemons, which I’ve had many, to learn and to help others. When you have that attitude, nothing that comes your way doesn’t have a good learning experience and doesn’t have value.

Cindy: Wow. I know what, I guess we’re all labeled as fighters. We are fighters, and people, if I run into somebody that’s laying down and dying, I really try to pick them up and help them to find something better. Look, Dr. Jill, this has been Dr. Jill Carnahan, and I thank you so much. I so appreciate your information and I’m sure this podcast is going to get great reviews.

Jill: Thank you Cindy. Such a delight to talk to you, and maybe we can do it again sometime in the future.

Cindy: I would love to. Well everybody, this has been yet another episode of Living With Lyme, and you’ve been listening to me, Cindy Kennedy, and you’ve been listening to Dr. Jill Carnahan, all the way from Colorado. Tune in again, subscribe to the podcast, and stay connected. Till then my friends, ta-ta. Bye now.