Brigid Titgemeier, MS, RDN, LD, IFNCP

Brigid is a functional nutrition dietitian, graduate school instructor, and functional medicine patient. Brigid's passion for helping others use food as medicine stems from her 15 year experience of battling her own health issues and continuing to learn how to heal herself.

Today, Brigid works with CEOs and executives, using personalized nutrition coaching and advanced lab testing to create optimal health. She has worked with nearly four thousand patients in her own business and as a founding dietitian of the Cleveland Clinic Center for Functional Medicine. In addition to studying nutrition for ten years, through school, her dietetic internship and two advanced functional medicine credentialing programs, she has also trained under and worked with the leading functional medicine doctors.

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A Nutrition Awakening: Replacing Common Nutrition BS with These 5 Critical Nutrition Truths

There are very few decisions that are more important than how you choose to fuel your body. Stress reduction and self-care would be up there on the list too! These choices are directly tied to your ability to actively prevent and manage disease while also optimizing your overall well-being and vitality.

Cheryl was a patient of mine who had been a nurse for 25 years. She was thin and seemingly ‘healthy’ but struggled with debilitating arthritis in her mid 50s. As a healthcare practitioner herself, she had access to some of the best rheumatologists, all of whom prescribed NSAIDs (Nonsteroidal Anti-inflammatory Drugs) and corticosteroids. When I met Cheryl, she was a major skeptic of functional medicine. She landed in my office because her husband, Tom encouraged her to seek for answers. When I prescribed a specific anti-inflammatory diet, she became noticeably upset, claiming that food was unrelated to her medical condition and that the plan would be impossible to adhere to. Thanks to her caring husband, the couple ended up leaving the appointment in agreement that they would give my nutrition recommendations a shot. Fast forward eight weeks to Cheryl’s follow up appointment. I walked into my office to find them waiting for me with a tray of homemade ‘5 ingredient gluten-free black bean brownies’ that they made for me. Cheryl smiled with tears, telling me that she could swing a golf club and do a load of laundry for the first time in five years.

Cheryl is one of 50 million Americans that are reported to have arthritis, half of whom are not able to perform normal daily activities.[1] She is also not alone in experiencing the life changing benefits of switching up what is at the end of her fork. I’ve witnessed thousands of people who get similar life changing benefits and new research continues to support the correlation between conditions like arthritis and diet.[2] But the power of nutritional interventions is relevant to many other chronic conditions, beyond arthritis.

A Societal Awakening is Happening

This has led to an awakening that’s happening in society. Individuals and organizations are starting to embrace the power of food. Companies are investing in health programs for employees, doctors are finally starting to talk about nutrition to patients (and hopefully refer to dietitians for backup), and food companies are shifting to accommodate the demand for higher quality ingredients. Just last week, I stopped at a gas station in the Carolina’s and found Epic Bars, Oloves, and RX Bars for sale. I left a gas station for the first time in over 10 years feeling like there were a few legitimate food options available that didn’t include 30 questionable ingredients in the ingredient list. Mind blown!

Here’s why this is significant: the most unnecessary financial burden on the United States government and largest contributor to lower quality of life and early death stems from poor diet (and stress, but that’s a different article). This also involves food environments that are conducive to poor diets and lack of promotion of wellness in both conventional healthcare and workplaces. It’s estimated that unhealthy diets contribute to approximately 678,000 deaths each year in the United States.[3] Not to mention, the direct contribution to a lower quality of life in those that have suffered unnecessarily from arthritis, IBS, Crohn’s Disease, autoimmune disease, eczema, infertility, type 2 diabetes, and so many other conditions that are directly correlated with a person’s diet. Statistics for people with type 2 diabetes alone are mind-blowing. Approximately 30.3 million Americans are living with diabetes and 84.1 million living with prediabetes. The total indirect estimated cost of diagnosed diabetes in 2012 was $245 million.[4] The total impact that poor diet has played on early death and poor quality of life from type 2 diabetes and so many other conditions is difficult to fully capture.

What We Are Currently Doing Is Not Working

In March 2018, I wrote an article, The Future of Evidence-Based Nutrition: Artificial Cool Whip or a Ketogenic Diet for Diabetes? in honor of National Nutrition Month.[5] This year, I am continuing this conversation, highlighting the way that the field of nutrition and society MUST evolve in order to better serve the health of the population. Because what we are currently doing is not working It’s making people sick, dependent on medications and eventually killing them. But it’s not the kind of death that you want. As Dr. Michael Roizen taught me many years ago: the ideal way to live is as old as possible and then nose-dive into your grave. But it’s less likely for people to suddenly die from their food choices (although heart attacks are a very pervasive problem). It’s more common for poor food choices to lead to a slow, gradual debilitation that is subtle enough to make it seem like it could be unrelated to food and lifestyle and long enough to rack up debt in medical bills. That’s the truth and if anyone says otherwise, they likely have a financial interest in big food or big pharma.

Read below for the five important nutrition truths that can replace the BS that everyone has been fed for way too long.

1. Food is the Primary Driver of Disease

So often, people are told by their doctor that ‘nutrition has nothing to do with their condition’ when in fact, poor nutrition directly increases risk of most diseases. This is factual and consistently supported in research and national health statistics. Unhealthy diets are among the largest contributors to the leading causes of death, including heart disease, diabetes, obesity, high blood pressure/hypertension, stroke, osteoporosis and cancer. And just as significant are the number of individuals that are living with a lower quality of life and disabilities related to their poor dietary habits. This includes joint pain and stiffness from arthritis; bone injuries caused by osteoporosis; blindness, amputations and cognitive decline from diabetes;[6] symptoms after a stroke or heart attacks; constant bloating and loose bowels related to IBS; and panic attacks related to anxiety.

The statistics related to heart disease and type 2 diabetes have been well-understood for over two decades (and yet, still ignored), whereas other associations between diet and disease are newer. This is because within the last ten years, research on the gut microbiome has blown wide open. These progressions in research on gut health have allowed for a deeper understanding of how food can influence various disease states.

The most common chronic diseases in the United States are associated with food because they are associated with a person’s gut microbiome—or the distribution of good and bad bacteria in the gut. Dietary intake is one of the only ways to alter a person’s gut health, otherwise known as the microbiome. In most instances, we are not yet able to attribute certain microbes to certain diseases. But we know that supporting healthy bacteria by consuming whole foods is the best way to support your gut, creating health and even reversing chronic conditions such as rheumatoid arthritis or mental health conditions.[7] [8] [9]

As more is discovered about certain beneficial and harmful bacteria, we will be able to create targeted interventions for specific diseases by altering the microbiome.[10] In this state, food serves as the first line of intervention, significantly driving down healthcare costs as it replaces currently available treatments and reverses the symptoms of said conditions. Furthermore, regularly monitoring the microbiome may help with assessing its health leading to the prevention of various health conditions.

2. ‘Eat Less, Move More’ Downplays the Role of Nutrition on Wellness

You have undoubtedly heard that weight loss is just as simple as “calories in, calories out.” There are three flaws with this way of thinking: 1) it does not account for other intricacies regarding the quality of food 2) some people, especially women actually gain weight when they overly deprive themselves of calories and 3) it leads people to believe that the way that you eat should simply be dictated by managing a healthy weight.

You can’t just limit your calories without thinking about the quality of them. Think about the difference between 100 calories of soda and 100 calories of spinach. Foods/beverages that are high in simple sugars lead to inflammation in the body, high blood sugar levels, increases in body fat, raises in triglycerides, decreases in HDL (good) cholesterol, and may even boost tumor growth.[11] [12] A diet high in refined carbohydrates, like soda can also lead to the impaired production of hormones like leptin, ghrelin, neuropeptide Y, and cortisol which can actually drive you to eat more. When it comes to eating 100 calories of spinach, the opposite is true. So losing weight is not just about eating smaller portions, it’s about the proper balance of macronutrients, adequate micronutrients and an abundance of fiber and phytonutrients (from colorful foods).

For some people, especially women, eating too few calories can actually sabotage their weight loss efforts. If calories are reduced over a period of time, the body slows down your metabolic rate and holds onto every calorie that you put in your mouth, converting it to fat for storage. This is a common survival mechanism that also leads to weight gain.[13] Often, I help clients lose weight by increasing their calories and eating more frequent meals throughout the day.

Here’s the biggest kicker of all. Eating philosophies like ‘eat less, move more’ should be considerate of other factors outside of weight because food influences so much more than just your weight! If you simply focus on eating less and not concerning yourself with the quality of those calories, you are at risk of being undernourished of fiber, antioxidants and other beneficial components. This can not only lead to other issues such as inflammation, fatigue, poor gut health, and imbalances in hormones. These foods, known as empty calories lack the fiber, protein and other nutrients that help slow down digestion, balance blood sugar levels and signal to the brain that you are full. On the other hand, eating nutrient dense foods such as fruits and vegetables provides your body with plenty of phytonutrients and fiber that feed your cells and the bacteria within your gut.

3. You Don’t Have to Have a Weight Problem to Change your Diet & Fitness Does Not Equal Health

In some ways, your weight does matter because being obese or above a 30 BMI, increases risk of other co-morbidities such as heart disease, insulin resistance, type 2 diabetes, etc. But in the grand scheme of your health, the number on the scale is one of many indicators of your health. Despite everything that you are told through mainstream and social media, being fit and skinny does not make you healthy. You can be extremely fit and have a ton of inflammation or digestive disorders that impair the quality of your life. And that’s actually not uncommon.

Being thin does not give you a reason to eat whatever you want, whenever. It’s just as important for thin people to eat well as it is for overweight people to eat well, in an attempt to improve gut health, lower inflammation and extend your life expectancy. For a longtime nutrition was thought of as a weight loss approach but it’s so much larger than ‘burning those calories’ during a workout. It’s an avenue to reclaim your health whether you are 100 pounds, 200 pounds or 300 pounds. Eat for health rather than weight loss and your weight will often take care of itself.[14]

4. You Do Not Need 3 Cups of Dairy Every Single Day

You probably know that the government encourages all adults to eat 3 cups of dairy per day. The Dietary Guidelines for Americans recommends three cups of dairy per day for children and adults over the age of 9 years old.[15] These recommendations include any dairy products and fortified soy beverages. The problem is that much of the research on the need for 3 cups per day is based on science that comes at the great influence of the dairy industry. This is based on the idea that consuming dairy provides protein, calcium, potassium, magnesium, vitamin D and vitamin A. While it’s clear that dairy does provide an easy source of all of these nutrients, dairy can also be inflammatory for many individuals and is not absolutely needed if you replace it with other foods that meet these nutrient levels. Because here’s the good news: there are other foods that provide these nutrients.

Let’s talk about the most common issues with dairy. They include issues with the dairy carbohydrate/milk sugar, lactose (glucose + galactose) and the dairy proteins, casein and whey. Around 65-75% of people across the world have some degree of lactose intolerance, as the body stops producing the lactase enzyme necessary to digest your mother’s milk—and cow’s milk—by the time you no longer need to be breastfed.[16] Individuals that have lactose intolerance will suffer the dairy consequences by experiencing abdominal pain, bloating, flatulence, nausea and diarrhea within 30-120 minutes after consumption. Eating food to which you are intolerant can irritate your gut, making it more permeable and create body-wide inflammation that can trigger many chronic diseases.

Even if you are not lactose intolerant, it’s also possible to have an inflammatory response to the dairy proteins, casein and whey. When people have dairy allergies, they react to these dairy proteins but a reaction can also occur for people that are simply sensitive or intolerant. A few studies have linked dairy consumption to an increased risk in developing certain cancers. This may be attributed to dairy promoting the production of insulin-like growth factor (IGF-1). This is especially concerning for cows that are injected with recombinant bovine growth hormone (rBGH). IGF-1 is linked to a faster production of cancer cells and can be inflammatory.[17] While dairy may still be part of a healthy diet for those who tolerate it, it is important to recognize that you do not need to aim for 3 cups per day if you are getting other nutrient-rich foods in your diet. And if you eat dairy, you definitely don’t need to make your servings low-fat!

5. All Foods Do Not Fit & ‘Everything in Moderation’ Is Misleading

Sometimes I wonder if the food industry made up the terms “All Foods Fit” and “Everything in Moderation”. I’ve wondered that ever since I witnessed the National Confectioners Association (aka the American Candy Association) present at an NIH meeting in 2014 when I was an intern in Washington DC. The representative stood up and said to the panel of the top nutrition experts in the country, “There is a place for candy in everyone’s diets to give people joy and something to look forward to. We don’t want them to feel overly restricted with their diets. So I urge the panel to include this in the Dietary Guidelines for Americans.” First off, we live in a country that has an American Candy Association, in case you didn’t know. Second, the government is entertaining comments like this, likely because of the financial pull of some of these organizations.

The idea of ‘all foods fit’ is a philosophy used to help individuals recover from disordered eating patterns. It allows people to stop judging their food as ‘good’ or ‘bad’ and not putting any restrictions on their diet. It’s common to see Instagram influencers talk about the freedom that they feel from eating dessert daily, eating a cookie for breakfast, etc. For people that struggle with disordered eating or food rules, it makes sense. However, like most things, it is not this simple. The idea of ‘all foods fit’ would be more understandable if it wasn’t done in the absence of core nutrition principles, if our food supply were abundant in real foods and if the population wasn’t covered in diseases that are driven by processed foods and poor lifestyle.

The food supply in the United States is abundant in processed, chemically-derived foods and beverages. Which means that a person’s health could become compromised if they subscribe to the idea that eating red dyes, artificial sweeteners, and partially hydrogenated oils in donuts i they believe that it’s a food to be regularly including in their diet. Not to mention the chemicals that are sprayed all over the foods in the food supply. The ‘everything in moderation’ term goes along with this in advising people to eat chemically-derived foods, in moderation. The issue with the term moderation, that I found in a research study that I conducted under Kristin Kirkpatrick and Dr. Adam Bernstein, is that the term moderation is entirely subjective. When we surveyed individuals on what they defined as moderation for wine, red meat, and dessert, the answers were all over the map.

This type of mindset could easily promote more inflammation and the onset of inflammatory-based chronic diseases. Eating needs to be tailored to the individual’s health goals, microbiome, genetics, hormones, and mental/emotional health. For example, someone with an autoimmune disease may be triggered by gluten intake since gluten is associated with leaky gut and in turn, autoimmune diseases. In this instance, certain foods may lead to devastating health issues. It’s all about establishing your non-negotiables and always going back to the basics of whole, real foods.

Jamie Foti contributed to this article.

Photo by Fancycrave on Unsplash

References:

[1] https://consumer.healthday.com/senior-citizen-information-31/misc-arthritis-news-41/10-percent-of-u-s-adults-physically-limited-by-arthritis-cdc-681944.html

[2] https://ard.bmj.com/content/76/8/1411

[3] https://cspinet.org/eating-healthy/why-good-nutrition-important

[4] https://www.healio.com/endocrinology/diabetes/news/in-the-journals/%7B476de9eb-1079-49bc-a35a-57fa20086cfa%7D/cdc-100-million-americans-have-diabetes-or-prediabetes

[5] https://beingbrigid.devphase.io/the-future-of-evidence-based-nutrition-artificial-cool-whip-or-a-ketogenic-diet-for-diabetics/

[6] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170219

[7] https://www.sciencedaily.com/releases/2018/05/180524141700.htm

[8] https://www.sciencedaily.com/releases/2018/04/180410100937.htm

[9] https://www.sciencedaily.com/releases/2017/04/170411090159.htm