#171 – Increase energy levels, decrease cravings, & improve blood sugar stability with Brigid Titgemeier

Episode introduction

Episode Transcript

Brigid Titgemeier (00:06):

Sometimes when people get stuck in their own mind where it’s like, “It’s too expensive to eat healthy, I don’t have enough time to eat healthy.” Those are limitations that you are creating for yourself because I guarantee you there is a person in the world that has a smaller budget and has less time and is working more hours or has other obligations that they’re fitting in, who’s finding a way to make it work. So much of it comes from stepping out of those barriers that you create for yourself, that narrative that you tell yourself, the mindset limitations that you unknowingly place on yourself and say, “Okay, how can I make this happen?”

Ben Grynol (00:45):

I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health and this is your front row seat to everything we do. This is A Whole New Level.

Ben Grynol (01:11):

Earlier in the year, Dr. Lauren Kelly-Chew, head of clinical product at Levels, she sat down with one of our friends at Levels, Brigid Titgemeier, who is a functional nutrition dietician. And the two of them discussed this idea around nutrition and metabolic health. How can people think about the different food that they consume? What works for some people doesn’t necessarily work for others. And so in 2021, Brigid started an initiative called the Blood Sugar Reset Program. We’ll fast forward to 2022. She’s now had over 7,000 people through the program due to its popular demand. And the idea is to give people insight and tools, things like recipes and meal plans that work with their schedule, things that are simple enough to recreate on an ongoing basis.

Ben Grynol (01:55):

It’s not just enough to give people the recipes and the ideas, but more so to help them understand how different food affects their health. Things like eating certain foods and the stable glucose responses that come along with them. And so there are a lot of lessons learned through things like community, the changes that people have seen with increased energy levels and decreased things like brain fog. And Brigid and Lauren also discuss things like the differences and the importance in understanding how food affects men and women differently based on hormonal changes at different phases of life. Anyways, no need to wait. Here’s Lauren.

Dr. Lauren Kelley-Chew (02:35):

Brigid, so excited to have you back on A Whole New Level. Brigid is a functional nutrition dietician who helps people find health through personalized nutrition. Brigid started her career as a nutritionist at the Cleveland Clinic Wellness Institute and later joined Dr. Mark Hyman to open the Cleveland Clinic Center for Functional Medicine. In addition to running Being Functional Nutrition, Brigid also co-created a grad level integrative and functional nutrition course at Case Western School of Medicine, where she’s taught for the last six years. So excited to have you back and welcome.

Brigid Titgemeier (03:06):

Thanks, Lauren. Thanks so much for having me again.

Dr. Lauren Kelley-Chew (03:10):

The first thing that I wanted to chat with you about is your Blood Sugar Reset Program. I know you recently completed one of these programs. And I would love if we could just start by you sharing with us what that is and how it works.

Brigid Titgemeier (03:24):

I’d love to. The Blood Sugar Reset is an incredibly popular 10-day nutrition program that is designed specifically to help people improve their blood sugar stability, increase their energy levels, and decrease their cravings. So essentially we provide 10 days of meal plans that have been strategically designed to support blood sugar and we ensure that all the recipes are low glycemic by tracking all of them on a Levels continuous glucose monitor. And it’s a program that I started in November of 2021 and it was wildly popular then, so we ran it again in May of 2022 and we’ve had 7,000 people go through the program. And it’s such a supportive and inspiring community of individuals that come together and are committed to improving their blood sugar support for 10 days.

Dr. Lauren Kelley-Chew (04:21):

It really is an amazing community. I came on as a guest speaker during the program and it was so inspiring just to hear people’s experiences with the program and how much change they felt was happening. Can you describe for people listening, what would be a common recipe and how did you formulate the recipes in general?

Brigid Titgemeier (04:42):

We loved having you as a guest. It was actually the highlight of the program. So many people said that they absolutely loved everything, all of the knowledge and the research and the science that you contributed to helping them understand why they were doing what they were doing.

Dr. Lauren Kelley-Chew (04:57):

I appreciate it.

Brigid Titgemeier (04:58):

Well, I felt that was definitely really fun. When we formulate the recipes, our recipes really focus on three principles that are the most essential aspects of nutrition in my mind. The first is keeping them low glycemic to ensure that you’re getting blood sugar support. The second is nutrient dense. So nutrient density, sometimes when people focus so much just on blood sugar stability, they forget about the importance of nutrient density, meaning where are those sources of micronutrients, and antioxidants, and phytonutrients coming from? How can you get the most bang for your buck calorically, even though we’re not big fans of counting calories rigidly, but if you have $1 to spend, where are you spending it and what are those nutrients that you’re getting in return to fill your body?

Brigid Titgemeier (05:45):

And then the third aspect is keeping it simple because we know that we can make super elaborate recipes that are beautiful in a cookbook, but the likelihood of someone actually being able to implement them when they have 20 minutes to figure out what their family’s eating for dinner that night is very low. So we want it to be really doable and that’s something that we spend a ton of time and energy on is how can we keep the ingredients as few as possible for the shopping list for the 10 days, and then how can we keep the recipes simple enough that people can go back to them as a default, quick dinner after they’re out of the program? So really those three components are low glycemic, nutrient dense, and then making them simple.

Brigid Titgemeier (06:28):

And a few other things that we aim for with all of the recipes that I think is always just helpful to consider if you’re not doing the blood sugar reset, how you can try to create recipes that continue to support the blood sugar of yourself and maybe even your family. And that framework really is incorporating proteins, fats, non-starchy vegetables, and carbohydrates with each of the meals. Typically, some form of whole food carbohydrates, which is always optional depending on a person’s insulin sensitivity, at least five cups of non-starchy vegetables per day when we’re formulating each of the days.

Brigid Titgemeier (07:06):

We also incorporate smoothies for lunch, which is something that I’m a big proponent of because I like to chew my breakfast and I find a lot of clients that I work with like to chew their breakfast as well. But when it comes to lunchtime, when they’re really busy and they’re trying to fit in a scheduled lunch, that being able to drink a smoothie, get those nutrients in and help to support their afternoon energy levels is huge. So every day in the Blood Sugar Reset, we have a smoothie for lunch. And that really, I think helps with just making the meal plan overall simple.

Brigid Titgemeier (07:41):

And then the last thing is actually incorporating those forms of whole food carbohydrates. So you might be surprised that the recipes actually have 75 to 100 grams of real food carbohydrates each day, which might be higher than what some people might expect since it’s a blood sugar reset, you might expect it to be super low carbohydrate. But we really focus on trying to incorporate those fiber rich carbohydrate sources in the right portions that aren’t spiking blood sugar, which is where the Levels CGM can be so useful. Of course, everyone has their own individual response from a blood sugar standpoint to meals, but being able to modify the recipes as we’re creating them based on the Levels feedback is so valuable and helps us actually not have to overly limit carbohydrates so that people are getting those fiber sources for their microbiome.

Dr. Lauren Kelley-Chew (08:35):

It’s such a good point because I think people often think that if you’re trying to have stable blood sugar, you can’t eat carbs. And really what I think is so rarely discussed is the impact of fiber, what you’re describing, which is not all carbs are the same and carbs that come with a lot of dietary fiber, the net carbs, which is to say the amount of that carb that gets turned into blood sugar is dramatically less and in some cases is like one gram. You could have a food that’s nine grams of carbs per serving and seven of those grams are dietary fiber and you end up with a net of two. And I think people don’t think in those terms, so I really appreciate you bringing that up.

Dr. Lauren Kelley-Chew (09:12):

And also just, it sounds like your program really, it’s meant to be accessible, where it’s not overly crazy like you said. I think so often I’ve been to websites or blogs where there’s gorgeous recipes and everything is beautiful. And then you look and you need 12 different ingredients and eight of them you need a specialty store to find them and it’s like ground-fresh turmeric. Not that that isn’t a beautiful thing to have in your food, but if you’re living an active life, it’s hard to have every meal be this massive arts and crafts project. So I really appreciate your approach there.

Dr. Lauren Kelley-Chew (09:46):

In working with all these people who have done the program, what have been some of the major takeaways or insights?

Brigid Titgemeier (09:53):

Yeah, I would say that there’s probably three big takeaways that I’ve found from learning, from so many of the individuals that have been in the community because that’s of course where we learn the most is from the people that we work with. The first lesson from the Blood Sugar Reset is that improving blood sugar balance is one of the fastest and most effective ways to decrease fatigue and brain fog, to create a stable mood, to improve focus, to improve quality of sleep. And then also from a long-term standpoint, thinking about the easiest and most effective ways to support fertility and hormonal health, to support healthy aging and longevity, to support liver health, to support cardiovascular function. So many other things that last even longer than the immediate symptom improvements that people see.

Brigid Titgemeier (10:43):

And also one of the most effective ways to feel like you’re in control physiologically of the foods that you desire to eat, because we always say that your taste buds crave what you feed them. So if your taste buds crave what you feed them and you’re constantly feeding them foods that are higher in sugar and you also are physiologically having those blood sugar imbalances, it will feel like you are swimming upstream every single day of your life to eat healthy. So when you’re able to improve that, and even in a 10-day period, this is something that I’ve known for a long time is the importance of blood sugar balance, of course. This is something that Levels is constantly educating on the importance of, and something that I’ve been educating on the importance of for the last 10 years.

Brigid Titgemeier (11:29):

But it wasn’t until seeing in 10 days the impact that people can have on their continuous glucose monitors, and not everyone uses a continuous glucose monitor, there’s just some people who elect to do that. It is not a prerequisite to join the program, but in looking at some of the people’s data, it was astonishing to see the change that can happen in literally a 10-day period of time. I think sometimes people think that making changes is going to take so long that it might not be worth the effort to put in initially. And it’s like, “No, no, you can actually change your physiology after 10 days of changing the food that you’re putting on your plate every single day.” It’s so powerful.

Brigid Titgemeier (12:11):

And then we’ve heard from so many of the Blood Sugar Reset people, they’ve said, “I’m having better sleep and less joint pain. I’m astonished that I’m not having any cravings and that my sleeping is so much better. I can’t believe how much energy I have throughout the day. I’m not having any crashes mid afternoon. And I feel so much more motivated to do things, and I feel less bloated, and my mood swings, and my crazy fatigue seem like they’ve mostly vanished, and my cravings are under control.” These are testaments that we’re hearing from individuals who have done this for 10 days of their life and are seeing the reward and the benefit so soon after making the investment. So it really reinforces the fact that blood sugar balance is one of the fastest and most effective ways to improve nearly every physiological state in your body and in how you’re functioning on a daily basis.

Brigid Titgemeier (13:07):

The second takeaway is that people heal in community, not in isolation. So the recipes and the meal plans are of course we strategically design them, we reiterate, and reiterate, and reiterate depending on the impact, the feedback that we’re getting from the Levels CGM. But it’s like another aspect of the success is the wonderful people that are in the community that are striving for more in their lives. And I feel like when you surround yourself with people who are striving for more in their life, who are dedicated to consistency in their diet, who are taking their health into their own hands, who are showing up and not trying to be perfect, but just being vulnerable enough to say, “I know that I’m capable of more,” it’s so contagious and it provides an opportunity for you to see possibility in other people that then you can bring back to yourself, where it’s that idea that like, “If it’s possible for one other person on this planet or one other person in this Facebook group, it’s possible for me too. If they can do it, why can’t I?”

Brigid Titgemeier (14:19):

And so I think that it goes to the fact that for so long, medicine has been dictated by a one-on-one doctor’s office appointment. And when you see the impact in 10 days of what coming together as a community and choosing low-glycemic, nutrient-dense foods and meals that are simple, the impact that that can have on people’s health in such a massive way, it becomes so clear. People heal in community, not in isolation, and we really need others on our journey with us.

Brigid Titgemeier (14:51):

And then my last takeaway would really be that in order to create or make consistent change in your life, feeling hopeful and optimistic and like you are capable is such a crucial element. And that really speaks to the mindset that you’re embracing on your journey and the confidence that you allow yourself to hold. You have to believe that you can change your health in order for you to be convinced to take action and then to continue to take that action on an ongoing basis. And I can’t tell you the feedback that we’ve gotten, can’t tell you how much feedback we’ve gotten from people who are like, “This program just made me feel so hopeful for the first time in a very long time.” And unfortunately that’s also an element that’s missing in our conventional medicine system where it doesn’t always feel empowering, hopeful, optimistic. And those are really critical elements of people being able to pursue the healthiest version of themselves.

Dr. Lauren Kelley-Chew (15:56):

It’s so powerful what you do and I so appreciate it because like I said, I think one of the big themes here is accessibility. It’s what you said, you’re giving people the evidence of their own behavior that they can make a change and that it’s possible. And I think we don’t talk enough about the psychology behind these things and the fact that it’s not like people are choosing to eat unhealthy foods or choosing… I mean, yes, there’s an element of choice, but I think so often we create this idea that, well, if someone had more discipline or if someone had more willpower, if they just decided to do something differently that then they would do it.

Dr. Lauren Kelley-Chew (16:34):

And the reality is that behavior is so much more complex than that and mindset is so interwoven into that along with all these other circumstances and constraints that exist in real life with real people. And I love how your program honors that and says, “This is something that you can really do and achieve.” And that that’s the stepping stone to the next thing. I’m curious when the program ends, how do people stay connected to this amazing community that’s been created during the program itself?

Brigid Titgemeier (17:05):

So we’re still working on elements of that, how to continue the engagement after the fact. So we still have the Facebook group that people can engage with and they do continue to engage throughout. I would say that the other way that they engage would be feedback that we’ve gotten is in their day-to-day life with their family members where they’re like, “This was what I needed to get me on the right track. And now my family is using these recipes as templates that we’re using for dinner and we’re taking some of these concepts that we’ve learned from the recipes, and we’re integrating them into our day-to-day norm.” We get messages from people months after they’ve done their first Blood Sugar Reset saying, “That was when I needed to get started. And I just went to the doctor and they’re taking me off of my statin drug, or they’re taking me off of my blood pressure medication, or they’re taking me off of my metformin. And it’s because I’ve been able to continue to embrace 80% of what I learned or 80% of what I was doing in the Blood Sugar Reset.”

Brigid Titgemeier (18:09):

And I think that’s important too, is that it doesn’t need to be 100% in order to see those results. Even if you take 50% away from the program, you’re going to be a lot better off. And even people that are really educated, because that’s something that we run into a lot is people who listen to a lot of podcasts and read a lot of blogs, and they’re constantly looking for more and more information. And so often it’s like you don’t actually need to put as much energy always into more information as you do into taking action. You listening to more podcasts about nutrition isn’t getting dinner made for you on a Sunday night. So how can you, and maybe you’re listening to a podcast and getting information because it inspires you while you’re making dinner, that’s even better, but I think there’s so much emphasis on information in this information content age that people miss the importance of just staying consistent with their day-to-day actions.

Dr. Lauren Kelley-Chew (19:06):

I agree. And I think it’s such a good point that bringing what they learned and the energy of being in the bigger community into the family unit can be such an amazing way to continue progress and to just keep that ball rolling. And like you said, it doesn’t have to be 100%, it can be 80%.

Brigid Titgemeier (19:23):


Dr. Lauren Kelley-Chew (19:24):

Even if it’s only 50%, it’s still an improvement over what it was before.

Brigid Titgemeier (19:29):

Exactly. And I think too, what you’re hitting on with the mindset piece and the community support being one of the most critical elements, this was something that when I worked for Dr. Hyman and I was at the Cleveland Clinic, Dr. Hyman is really the person who initially opened my eyes to the power of community because that’s a huge part of the mission that he’s rolled out in his career. And he created what’s called The Daniel Plan, with Rick Warren and Dr. Daniel Aman, where they essentially took the community support from churches and they went into churches and had people make changes to their diet and lifestyle. They followed The Daniel Plan that they created that was based on Daniel from the Bible and it was a 40-day program.

Brigid Titgemeier (20:14):

We took that on as a philanthropy initiative when I was at the Cleveland Clinic and we did that in inner-city churches throughout the Cleveland area. And it was the first time that I realized there is so much research, I got my master’s in public health nutrition, there is so much research and so much of the core essence of public health is how can we increase resources financially? People don’t have enough time, there’s food deserts, there’s all of these limiting factors. But I was not really taught of the limitations of mindset that are largely, I would argue in my experience, one of the biggest barriers for people regardless of socioeconomic status and backgrounds, because we went into these churches of low socioeconomic status and gave them the nutrition plans, gave them the encouragement. They had small groups in their community of people who were just like them, who were sharing crock-pot recipes and that sort of thing, and strategies that they were using if they were working two jobs or trying to get their kids from place to place.

Brigid Titgemeier (21:22):

We had nurses go in and do the pre and post biometric screenings. And the improvements that we saw in weight, blood pressure, and blood sugar in a 40-day period of time with no doctors, no medication, no real medical intervention, just a food plan that was budget friendly and encouragement, support, and mindset shifts to say this is possible, is giving me actually full body chills right now because the results were so transformative. And I think that sometimes when people get stuck in their own mind, where it’s like, “It’s too expensive to eat healthy, I don’t have enough time to eat healthy.” Those are limitations that you are creating for yourself because I guarantee you there’s a person in the world that has a smaller budget, and has less time, and is working more hours, or has other obligations that they’re fitting in, who’s finding a way to make it work. So, so much of it comes from stepping out of those barriers that you create for yourself, that narrative that you tell yourself, the mindset limitations that you unknowingly place on yourself and say, “Okay, how can I make this happen?”

Dr. Lauren Kelley-Chew (22:30):

Thank you first of all for doing such impactful work. I know that our audience appreciates it, but I just feel like it’s worth saying over and over is this is the kind of work in the community, with groups of people, whether that community’s virtual or in-person, across all different kinds of socioeconomic background, different cultural and racial groups, different gender, different ages, all of these things. I think having people who are out there impacting all these communities is so, so powerful and I really appreciate all the work that you have done and are doing in that regard. And I think what you’re saying is so important also to recognize, which is first of all, there are ways that we can impact every community regardless of constraints. And also that encouragement and a little bit even of resourcing can make a world of difference.

Dr. Lauren Kelley-Chew (23:22):

I always kind of think about it as people are always saying, “Well, where is the new drug coming from? What’s the miracle drug going to be for weight loss or for getting… When is the artificial pancreas really going to come into existence?” And there’s amazing science and research being done. And also, in many ways the magical pill, we already know what it is, we have it and it’s behavior change and it’s creating ways. And that’s not to say behavior change is easy. I think it’s almost the hardest problem out there to solve right now. This is an enormous challenge and I wouldn’t say that I’ve figured it out even for myself all the time. I’m constantly trying to understand my own psychology, but it’s there. We know the behaviors and the changes that will create health.

Dr. Lauren Kelley-Chew (24:03):

And so having people like you going out there and really applying that and problem solving and saying, “Okay, well this is how this person lives. They have two or three jobs, they have this budget, this is where they spend their time, these are the pain points and the constraints.” And then saying, “Okay, how do we make it work within that?” It’s such important work. So thank you.

Dr. Lauren Kelley-Chew (24:21):

Switching gears a little bit, I think so much of the diet and nutrition advice that’s out there doesn’t really distinguish between women and men or let’s say male and female physiology, despite the fact that our bodies are very different. I think as many people say, “Women are not just small men, women are not just men with breasts.” There’s intricate hormonal balancing happening for both males and females. How do you approach this difference in your work?

Brigid Titgemeier (24:51):

It’s a good point. And I think that the lack of recognition between the needs of males and females stems largely from the lack of research that has been conducted in women of reproductive years who are still menstruating, because for a long time they were left out of the research because when you’re dealing with hormonal fluctuations throughout the month, it adds another input that research typically doesn’t like because you’re trying to control as many factors as you can. So since there has been, the NIH has changed to say, “Yes, we need more research conducted in females of reproductive years and we’ll include them in more studies,” thank the Lord, we see that I think there’s more recognition around the fact that there are differences physiologically in males and females, which means that there are different needs that they have as well, especially when it comes to nutrition.

Brigid Titgemeier (25:46):

And typically we work with all categories, and by categories I mean people who are, I’m going to say people that are born a specific gender just for simplicity’s sake over the nutrition factors, but as far as males and the hormone impact that has, females that are postmenopausal and then females of reproductive years that are still having a menstrual cycle because postmenopausal females and males typically are more similar because the postmenopausal females, after you go through menopause, you don’t have the hormonal fluctuations on a monthly basis like women of reproductive years have. So it’s really this category of women who are still menstruating who have different needs than the rest of the population.

Brigid Titgemeier (26:38):

And this is something that has been very eye opening in working with Levels clients that are in this category because the number of people that have come to me saying, “I’m following the slow-carbohydrate diet, I’m intermittent fasting, I’m doing high-intensity interval training, I’m doing all of the things. I’m checking all the boxes from all of the things that I’ve read about the benefits of intermittent fasting because there are a ton of benefits to intermittent fasting when you think about improvements in insulin sensitivity, and decreases in blood pressure, and improved weight loss, and supportive metabolism, and improved cognition, longevity.” I mean, the list is fairly extensive, but when you are a woman that is still menstruating and having those hormonal fluctuations, you actually could be doing more harm than good by not dosing those hormetic stressors appropriately.

Brigid Titgemeier (27:35):

And that is something that I see all the time in these women that are frustrated with their Levels CGM data, where they think that they’re doing everything that they’ve been taught from the research done in males or postmenopausal females and they don’t understand how it actually… Because it’s hard to think when I say, “I think the solution is to increase your carbohydrates in your diet,” they look at me like, “No way.” Or when I say, “I think that the solution might be to decrease the window of fasting that you’re doing because 16 hours might just be too hard on your hormones, it might be creating issues with your estrogen levels, which we know can actually impact your ability to lose weight, and it can also impact and increase cortisol levels, it can tell your body that you’re not safe to get pregnant, so you might be having more issues with ovulation. Those increases in cortisol can also impair thyroid health, which then can negatively impact your metabolism since the thyroid is such a regulator of metabolism.”

Brigid Titgemeier (28:40):

So it’s much more intricate and not so black and white as you would think when it comes to, should people fast? Do intermittent fasting, or should they not? Is 16 hours the right amount or is it not? Because there’s this whole category of people who are having different levels of hormones throughout their menstrual cycle every single month that need to account for those in order to support their physiology and to support those fasting glucose levels going down, and everything that’s involved with that. And I would say too that we see fasting glucose levels being a concern for several Levels users that will start working with me because they want to work on lowering their fasting glucose, they’re not having a lot of spikes after their meals, but it’s this fasting glucose that’s really difficult to come down.

Brigid Titgemeier (29:31):

And if they go to a traditional endocrinologist and show their endocrinologist the data, the endocrinologist will say, “Oh, this is likely just a dawn phenomenon. This is a normal thing that happens to people, you’re doing everything right since you’re being proactive with your diet and your lifestyle.” And it actually appears in my experience that women in their reproductive years that aren’t eating enough carbohydrates or that are fasting for too long may be having elevated fasting glucose levels because their cortisol levels in the morning are either way too high or flat lines completely, because they are just burning off of cortisol all day long. And that’s negatively impacting their thyroid function and then that can actually impact and decrease a woman’s ability to ovulate, so you might see disruptions in the regularity of your cycle or difficulty getting pregnant.

Brigid Titgemeier (30:19):

And it’s not all chopped up to the dawn phenomenon in my opinion and in my experience of working with some of these women, helping them to decrease their hours of fasting or increase some of those sources of carbohydrates or even just to ensure that they’re getting enough calories in their diet because undereating calories can do the same thing. And that’s where I think that it becomes much more nuanced than just what works for men works for women too.

Dr. Lauren Kelley-Chew (30:47):

That makes so much sense. For the women listening, especially of the reproductive years, are there certain times during the menstrual cycle when it’s easier or harder to, say fast, do keto, or make other diet changes? Is there a way that women can optimize around their cycle phases?

Brigid Titgemeier (31:07):

I do believe yes. So there’s going to be different times of the month that your body will do best with different fuel sources and fasting windows that don’t create as much stress and don’t impact hormones as much. Let’s say that you have a regular 28-day cycle. A regular 28-day cycle will include your menstrual cycle as day one, so the first day of the bleed is also the first day of your cycle. And that is part of your follicular phase. So the first half of the month essentially is your follicular phase, and then you move into ovulation. And then after ovulation you move into the luteal phase, and then you shed that lining after the luteal phase that starts to build up throughout the luteal phase that then takes you back to day one of your cycle. So when you think about times of the month that are easier to fast, that would typically be in that follicular phase.

Brigid Titgemeier (32:03):

Now, some women are going to have a difficult time doing that when they actually are bleeding or when they’re in the menstrual phase, so you’ll want to potentially bump that out to just that window of time that you’re in the follicular phase before you ovulate. And that can be a time that you may do better because your hormones are a little less complex. It’s typically in the second half of your cycle, which also happens to be the time actually that women are more insulin resistant, where you’ll see potentially changes in your CGM data we see all the time. Then in the first half of the cycle, women can eat more carbohydrates without seeing an increase in blood sugar. And then the second half of the cycle you’ll see changes in your ability to process the same amount of carbohydrates at the exact same times of day compared to the first half.

Brigid Titgemeier (32:53):

So thinking about the ways that you can support that would really be paying attention to how you feel at different phases of your cycle, starting with 12 hours of fasting overnight and then trying to just slowly work your way up instead of thinking, “Let me throw in 16 hours of overnight fasting because I’ve read about all the benefits of improving insulin sensitivity,” and that sort of thing, so that you’re not jumping into the deep end too quickly where then you’re noticing more anxiety in the afternoon or more cravings mid-afternoon where you’re just overeating and that sort of thing, or impaired sleep or other symptoms that can happen.

Brigid Titgemeier (33:32):

And then the other thing that I would say is make sure that you’re tracking your cycle. I can’t emphasize the importance of that enough. I wish I had learned about that sooner, even with me being in the functional nutrition space for the last 10 years, I feel like I didn’t understand the importance of that until probably halfway through the time that I’ve been working in functional nutrition because you really want to be having a period every single month so that you’re shedding that uterine lining that decreases your risk of future cancers and really helps to support your overall metabolic health and your decreasing risk of chronic disease.

Brigid Titgemeier (34:08):

And in addition to that, making sure that the changes that you’re making to your diet, like if you’re decreasing your carbohydrates, that that’s not causing a delay in your ovulation or in dysregulating your cycle altogether.

Dr. Lauren Kelley-Chew (34:23):

And I think actually many healthcare providers think of the menstrual cycle as another vital sign, and unfortunately this is an entire other conversation, I think the way that society has treated the menstrual cycle in general is the opposite of that, in the sense that it’s almost like women feel the need to hide it. I mean, it’s rarely discussed even in groups of women, it kind of is, but it’s really only recently that I think even conversations about hormones, this vague term, but that’s so important, has even felt acceptable in public. And of course in certain medical communities and other communities, these things have been discussed much more openly for a longer time, but just colloquially and kind of in the communities, I think.

Dr. Lauren Kelley-Chew (35:03):

A friend of mine recently shared that it’s only recently that she realized that the period and the bleeding portion is just one part of the overall menstrual cycle. That the menstrual cycle actually refers to the whole month. And I think this is a common belief. It’s like you’re either on your period or nothing’s happening. And of course everything is happening all the time. And I guess just to give a little bit of attention to women who are outside of their reproductive years, is there anything that you especially recommend or keep in mind for women either going through menopause or post-menopause, or I guess in menopause is how we would say it?

Brigid Titgemeier (35:40):

So when you’re going through menopause or you have gone through menopause, typically you’ll see a decline in insulin sensitivity. So after you you experience those changes hormonally, insulin sensitivity unfortunately goes down to some extent. So you may not be able to get away with eating the same amount of carbohydrates as you were able to in your reproductive years. You may actually benefit from doing a little bit more intermittent fasting, pushing that window a little bit longer. Of course, depending on the individual, it’s not going to be the same for everyone but paying attention to the amount of carbohydrates that you’re getting, increasing your protein because for every decade that you live, you unfortunately lose lean body mass, muscle mass, which helps to improve insulin sensitivity unless you’re doing two things. Unless you are eating enough protein in your diet and doing some form of strength training or resistance training at least two days a week.

Brigid Titgemeier (36:39):

So thinking about those two things as helping to support your lean body mass so that you can continue to have the highest level of insulin sensitivity possible. And then also in that phase, paying attention to symptoms that you’re experiencing as well as clues and signs of what could be happening. So if you’re experiencing a lot of hot flashes, or mood imbalances, or a significant decline in sex drive or energy levels, really trying to figure out ideally with some kind of a practitioner, what is causing those changes because that’s not just something that you should accept as a normal part of going through menopause. There’s a lot of factors that can be optimized to decrease those types of symptoms. Sometimes it just comes down to some adaptogenic herbs like maca, that has been clinically studied and found to improve hot flashes and other symptoms that are associated with menopause. Or it could be decreasing the amount of carbohydrates that you’re eating, eating more protein with your meals so that you can increase your lean body mass.

Brigid Titgemeier (37:40):

Being able to figure out what works best for you is really important in making sure that you’re not just accepting the symptoms because society tells us that that’s the normal experience for a menopausal woman to experience. Similar to, for a woman that’s still menstruating, it’s not normal to have excessive cramping, and extreme bleeding, and having a difficult time going to work every time that you have your cycle. Those are all signs that something is off balance, not that you just need to accept because the norm of our society is that women should be in pain in that time of the month.

Dr. Lauren Kelley-Chew (38:19):

It’s such an important thing to point out and I think it applies, there’s so many examples of this where we’ve come to believe that something is normal when in fact it’s actually the symptom or reflection of underlying dysfunction. Dysfunction that oftentimes is created and can be reversed by lifestyle, so thank you for saying that.

Dr. Lauren Kelley-Chew (38:40):

Going back now to the other side of the spectrum of the female life cycle, for so many women and men, fertility is top of mind. I’ve heard a lot of conversations recently on this topic. You’re on the Medical Advisory Board and helped to formulate WeNatal, and I know that fertility is one of your areas of focus. I know that we don’t have a lot of time, but I would just love to hear how you got into this space.

Brigid Titgemeier (39:07):

Yes. So I’ve always been fascinated by fertility and nutrition specifically just in the research that’s been out for the last 20 years, showing that a simple nutrient like folate can actually significantly decrease risk of neural tube defect. Talk about food as medicine when you think about the power of nutrients in that period of life and those being the building blocks for forming future life, I find to be incredibly fascinating. In the last two years, I’ve really developed an interest in fertility because one, statistics show that one and eight couples are infertile, which is absolutely astonishing. And then also in my own experience with fertility, my husband and I were nine weeks pregnant about a year and a half ago, and we went into our check-in appointments and our practitioner, who was so lovely, she was so enthusiastic talking to us about the plan for working together for the next seven months, and she started conducting the ultrasound and her face just went blank.

Brigid Titgemeier (40:14):

And she said, “I’m so sorry, but I’m not detecting a heartbeat. And based on the baby’s growth, it looks like we lost it about two days ago.” So that was obviously devastating, especially because I felt like I had been checking off so many boxes that I was eating so well and doing all the things that are just incorporated into my lifestyle as a product of the field that I work in and all the different factors. But it was really the most devastating when I was at a follow-up appointment with a different OB-GYN who actually had conducted a D&C because I had waited a month to miscarry and I actually didn’t miscarry, which I didn’t know was a thing. Even though I had worked in healthcare for a long time, I didn’t know that it’s fairly common for women to not miscarry and to lose the heartbeat and then not miscarry right away.

Brigid Titgemeier (41:14):

So I had a D&C and then the follow-up appointment with the OB-GYN and I said, “I’d like to check my hormones since drops in progesterone in the first trimester can be a contributing factor to increased risk of miscarriage. And also I’d like to get my thyroid checked because that also contributes to loss.” And she said, “No, we don’t do that until after you’ve miscarried twice.” I said, “Excuse me? The panel, I know for a fact, is less than $200 out of pocket if insurance isn’t involved since insurance inflates the cost of labs. You’re not going to run a hormone panel and a thyroid panel and try to just make sure that everything is right before we try again and then potentially lose a baby again? Then you’ll take a more proactive approach to supporting my hormonal journey?”

Brigid Titgemeier (42:10):

So I mean, I’ve been working in functional nutrition, like I said, for 10 years. We work with CEOs and executives that have concierge medicine doctors. I’m used to us running more advanced labs on clients and helping their doctor be able to work them off of medications that they’ve been placed on through diet and lifestyle changes. Like, I’m used to those deficiencies in the medical system, but I was astonished that this is the standard of care that we have for females who are going through such a vulnerable, emotional phase of their life of trying to start a family and accepting loss without looking into anything further.

Brigid Titgemeier (42:50):

And of course, miscarriages happen with no explanation even though you’re doing everything right and all of your labs look great, but in order to prevent women from enduring the physical and the emotional pain that’s associated with the miscarriage in addition to their spouse, because of course the spouse grieves the loss as well, it’s so important for us to be proactive about these things, to be checking hormones, to be checking thyroid imbalances that can contribute to miscarriages, to be checking for nutrient deficiencies like B vitamins, and we’ll be looking at blood sugar and fasting insulin because we know that poor metabolic health is a driving factor of not only miscarriage, but also poor birth outcomes and birth defects.

Brigid Titgemeier (43:35):

And even looking at genetics so that if you’re possibly susceptible genetically to nutrient deficiencies, like if you have an MTHFR snip and need additional methylation support, how that isn’t a factor in the whole picture was shocking to me. And it has really lit a fire under me to say women deserve better, families deserve better, because it’s the couples that are going through the experience. And how can we ensure that couples can feel confident that they are checking as many boxes as possible going into pregnancy? And I really believe that the formula that we’ve created for WeNatal helps to at least check that box to know that you are getting the optimal dose of nutrients in the most bioavailable forms.

Brigid Titgemeier (44:20):

Not only for you, but also for your partner because we know that males contribute to about 50% of infertility and to miscarriage. And I was astonished when I was pregnant and I went into two separate appointments at my four week and eight week appointment and was asked, “Are you taking a prenatal?” And I responded, “Yes.” And they said, “Good.” And I asked, “Do you want to know what prenatal I’m taking?” And the answer both times from both practitioners was, “No, we’re happy that you’re taking a prenatal.” That was also absolutely mind blowing to me because there are so many prenatals on the market and some of them are so absolutely horrible that they are not supporting the health of the future child. How can that be thought of as everything being, every prenatal being the same and not offering any additional education on nutrition and lifestyle when you’re forming the building blocks of a future child?

Dr. Lauren Kelley-Chew (45:20):

Well, first thank you so much for your openness in sharing your own story. I think often we don’t talk a lot about miscarriage and other aspects of fertility and infertility, and so thank you for being open about that. And the story, there’s so many aspects of it that are disappointing in relation to the relationship with the provider and then all these other things that you’re mentioning. And I think one that really stands out is that when you ask to have tests done, regardless of what her response would’ve been in terms of saying yes or no, the hope is that every person is encouraged to be proactive in their health like you are, to be curious about their health, to try to understand their body, to really be their own doctor in that way.

Dr. Lauren Kelley-Chew (46:05):

And that’s not to say that doctors don’t have a lot of expertise, and I have a lot of respect for my practicing physician colleagues. And also, no one is going to care about your body and your health more than you. No one knows your body and your health more than you. No one will advocate for your health more than you will. And 99.9% of the time, we’re not sitting in the doctor’s office. And so what I think is really disappointing among the things that you mentioned on that encounter is that you came in with the exact mindset and approach to your body and your health and your kind of life that we would hope all patients are empowered to feel and you were completely turned down. And actually if anything, were made to feel or I think the intent was to make you feel that you had done something wrong or that somehow you were saying something crazy.

Dr. Lauren Kelley-Chew (46:54):

And I really hope that that changes in the medical field because the mindset that you went in with is exactly how change is created, so that’s really disappointing. And similarly, this question of what prenatal vitamin you’re on, I think there’s so many aspects of this in terms of the way that physicians practice, but the lack of interest in what is actually happening to patients’ bodies and what’s actually going into their bodies and informing, like you said, the creation of the baby and also the maintenance of the mother’s body because the mother’s going through these massive fundamental changes in her nutritional needs and in everything. So, so much work I think is required to improve on those metrics.

Dr. Lauren Kelley-Chew (47:39):

Is there anything else? We’re basically out of time, but we’ve touched on so many topics of women’s health, fertility, menopause, blood sugar in general for both men and women. Is there anything that we haven’t talked about that you want to make sure that we touch on?

Brigid Titgemeier (47:55):

I think we covered it. I would just say from a fertility standpoint that I’m trying to always educate for people that we work with that are past the fertility age, the importance of blood sugar support for longevity and cardiovascular health, but not to lose sight of the fact that if you are in your 20s, or your 30s, or your 40s, and you’re thinking about having a family, balancing your blood sugar is one of the most important things that you can do to decrease your risk of infertility, to decrease your risk of miscarriage, to decrease your risk of birth defects and malformations that happen in the heart, kidney, and brain to children that are born to women that have higher blood sugar levels. And not to mention the female’s experience going through pregnancy and being able to decrease risk of preeclampsia and gestational diabetes.

Brigid Titgemeier (48:49):

We see that people that have imbalances in blood sugar going into pregnancy, that it is only worsened or exacerbated by pregnancy and puts them at a greater risk of gestational diabetes. So some of the leading contributors to infertility today are blood sugar imbalances and oxidative stress. And those cited in the research are driven by poor diet, nutrient deficiencies, tobacco use, alcohol use, sedentary behavior, and substance abuse. And so thinking about it just from a creation standpoint, how we can serve not only ourselves, but also future generations? Taking care of yourself, balancing your blood sugar, increasing the nutrient density in your foods are one of the most critical ways that you can do that.

Dr. Lauren Kelley-Chew (49:39):

Absolutely. And of course, having gestational diabetes then also increases your risk of developing diabetes. So all of these things are linked. And to your point, I think the sooner that you’re able to control your blood sugar, the more you’re able to reduce the risk of each condition at each chapter in your life and just overall as you move through the different chapters of your life.

Dr. Lauren Kelley-Chew (50:01):

If people are interested in learning more about your work and joining the next Blood Sugar Reset and engaging with your community, what’s the best way for them to find you?

Brigid Titgemeier (50:12):

So you can follow me on social media @beingbrigid, B-E-I-N-G-B-R-I-G-I-D. That would be one place to find me. And then our next Blood Sugar Reset, our Blood Sugar Reset Program is free and it’ll be November 7th through the 16th of 2022. So you can go to my social media and then put the link to sign up. We hope that you’ll join us because the community in the program is really exceptional.