You can catch Brigid Titgemeier, MS, RDN, LD, IFNCP on the Levels Nutritionist Marketplace giving out one-on-one nutrition coaching to members who want to dive deeper into how they can optimize their metabolic health, gut health, and more.
Board-certified in integrative and functional nutrition, Brigid also completed the advanced practitioner training through the Institute of Functional Medicine. She was part of Dr. Mark Hyman’s team at the Cleveland Clinic’s Center for Functional Medicine.
Here, she talks about her journey in the medical system as a teenager diagnosed with a neurological autoimmune condition and how diet played a significant role in helping her reclaim her life. Plus, why she thinks a CGM is extremely valuable for most of her clients, the top three health concerns of Levels members, and how the pursuit of a completely flat glucose line may backfire.
What drew you into practicing nutrition?
My journey started 16 years ago as a teenage patient. I had been having a lot of terrible symptoms—primarily falling asleep every second of every day. That included not only every class, but in the three minutes between cross-country 800-meter repeats, I’d fall asleep in the grass.
I was also having 30 mini seizures a day, called cataplexies. I was diagnosed with narcolepsy with cataplexies, which is now known as a neurological autoimmune disease.
When I went to see a traditional neurologist, he prescribed me medication. My parents were concerned because it was a very new drug to the market, and there were no long-term studies on its safety. In my parents’ search to find other options, they found a functional medicine doctor (although they didn’t call it functional medicine then). I started with nutrition and supplement interventions that changed my day-to-day functionality. Within a month, I stopped having my mini seizures.
Excited, we went back to see my neurologist to tell him about my success. He stared at his computer screen and said, “Nutrition has nothing to do with your condition. There is absolutely no scientific evidence to show us that this is even a route to go down.”
He denied my personal, lived experience. When I was 15, I said to my mom, “There have to be a million other people who have doctors telling them that nutrition has nothing to do with their condition. I’m going to help those people.” That’s when I decided I would become a dietitian to help people use food as medicine.
How has your experience played a role in how you work with clients?
Sometimes people in the functional medicine field are anti-medication or believe that you can do everything with nutrition. For a lot of people, that’s not the case. I take medication four days a week, but I take a low dose of the drug and have a much higher functionality than many with my disease. Combining nutrition and lifestyle interventions with conventional medicine is the ultimate patient experience that yields the greatest outcomes.
We focus so much on disease treatment and not nearly enough on health creation and disease reversal and prevention. I have helped thousands of people reverse health conditions and resolve adverse symptoms such as fatigue, migraines, congestion, joint pain, bloating, and many others directly related to the way we fuel our bodies.
Food is one of our most powerful and underutilized interventions, yet it is largely left out of the healthcare conversation. Some practitioners will argue that a functional medicine approach is not evidence-based. Back when I was initially being treated for my narcolepsy, my doctor justified that it was somehow okay for me to take a new drug with limited research but using food as medicine was not okay?
My personal experience plays a role in how I work with clients every day. Especially with clients who have doctors telling them that nutrition doesn’t play a role in their situation. Then after the patient works with me, the same doctor is able to reduce or eliminate the patient’s medications. I love when these same physicians reach out to me to ask what I did to help their patients and recommend their other patients to me.
You have a functional nutrition business, BeingBrigid, where you and your team work with individuals, groups, and corporations. When do you recommend a CGM?
Our programs lead to remarkable health transformations because we focus on blood sugar and inflammation from day one. It’s often mindblowing when we see clients who have worked with various physicians for decades and just increased their medications and experience worsening symptoms. Then they work with us to personalize their nutrition, and things start to improve dramatically. We recommend CGMs to our clients who have poor metabolic health, prediabetes, polycystic ovary syndrome (PCOS), and women trying to get pregnant or who are pregnant and experiencing blood sugar imbalances.
Most women and men we work with who are thinking about having a baby receive zero education from their doctor about the importance of the preconception window. This is a three-month period before trying to conceive that you can impact the lifelong health of your child and grandchild. In other words, optimal health now can improve the health of three generations. Better metabolic health, nutrient status, and inflammation levels in both mom and dad significantly increase the health of the egg and sperm and impact epigenetics to improve the health of the baby. One woman who wanted to prep her body for pregnancy wore a CGM for three months before trying and decreased her glucose levels significantly and lost 10 lbs, setting her up for a healthier pregnancy and passing on better metabolic health for her baby.
Separately, for our clients who have high blood pressure and high cholesterol, using a CGM and our guidance helps them change their diet and exercise habits so that their doctors can get them off many medications. This is the power of using food as medicine, blood sugar balance, personalized nutrition, coaching, and having a supportive community.
Others in our programs often use CGMs to understand better how food affects their metabolic health and energy production. We let our clients know this is something they can benefit from, assuming that they aren’t struggling with disordered eating tendencies.
It’s not uncommon for us to hear that after seeing some of the data from the CGM, a member feels as if they ate something “bad.” How do you counsel clients about the emotions surrounding CGM readings?
This is something I’m highly conscious of. I recently spoke to a client whose doctor told her that she could never eat foods like bananas, potatoes, or alcohol again. It sets the stage for disordered eating, and it’s a slippery slope. Having a healthy relationship with food is an integral part of having health.
There are a lot of downsides I’ve seen over the years when people are too obsessive. With the CGM, is the goal always to have a flat glucose line? Is that healthy? A better focus may be how you can create a relationship with food that supports your health goals and doesn’t take away from them but also makes you informed about your habits to make the best choices for yourself.
What’s critical is being able to meet people where they’re at, as well as setting realistic goals, so they don’t feel like they have to go from zero to 100. If you’re trying to get an A+ for six months out of the year, which causes you to get F’s for the second half because you’re burnt out, you have a C average by the end of the year. But if your approach is less rigid, your outcome may not only be the same level of success as that of a person who initially got A+s and then dropped down to Fs, but it’s also more sustainable and, therefore, in my experience, more likely to drive longer-term change throughout a lifespan, which truly is the goal.
You connect with members through the Levels app. What are the top concerns people come to you with?
The top three concerns I see from Levels members are lowering their A1C or fasting glucose, weight loss, and improving their heart health, specifically cholesterol, triglycerides, and blood pressure levels.
When I speak with a client, we set up three to five actionable goals they can work on until we talk next. Many times, people upload their labs for me to review. If they’re low in a particular nutrient, I’ll talk to them about food sources of that nutrient and how to incorporate it into their diet. In addition, we go through their glucose data together, and that’s when I can point out some of the trends I see—not just specific foods, but also timing or pairing of foods.
We also work on non-food goals. For instance, a client I spoke with works from home and is having difficulty getting her steps in, even though she exercises regularly. So, we made it a goal that she walks to get coffee every morning. That adds 4,000 steps every day. What’s more, for many people, it’s not food that’s affecting their blood sugar so much as it’s poor sleep. If I can get my clients sleeping better at night, that will improve glucose without putting additional effort into changing their diet.
Is there room for improvement even when someone feels otherwise healthy?
Absolutely. I’ll give you an example. There was one man in one of our corporate programs who said he had no health issues and no typical symptoms, like joint pain or problems with sleep or digestion. But after our program, his blood pressure came down 10 points, and he lost eight pounds. He said he had more energy and mental clarity. It just goes to show you that you normalize how you feel. Even when people think they’re healthy and doing great, there’s often still opportunity for improvements in labs, symptoms, and their relationship with health and food.