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The Get Healthy Tampa Bay Podcast
Bringing all things health and wellness to Tampa Bay, FL from your very own family and obesity medicine physician, Dr. Kerry Reller, MD, MS. We will discuss general medical topics, weight management, and local spots and events focusing on health, wellness, and nutrition in an interview and solo-cast format. Published weekly.
The Get Healthy Tampa Bay Podcast
E134: Dr. Katrina Coulter on Gut Health, Antibiotics, and How to Feed Your Microbiome Right
Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I am joined by Dr. Katrina Coulter, an infectious disease specialist with a passion for microbiome health. In this episode, we dive into the world of gut health—what the microbiome is, how it protects us, and what damages it. Dr. Coulter shares how antibiotics, processed foods, and modern farming impact our gut bacteria, and what you can do to protect and restore it. From fermented foods to fiber and movement, she offers science-backed strategies to build a resilient microbiome—before and after antibiotic use. Tune in to learn how to nourish your gut and improve your immune health from the inside out.
0:52 – What is the microbiome?
3:38 – How your gut bacteria act as a frontline defense
6:43 – What disrupts the microbiome and raises infection risk
9:05 – What your gut really wants: feeding the good bugs
11:34 – Cravings and the gut-brain connection
14:38 – Antibiotics: necessary but not harmless
20:23 – Lifestyle tips for chronic UTIs and sinusitis
28:26 – How to recover your gut after antibiotic use
34:58 – Soil health, farming, and food quality explained
45:17 – Dr. Coulter’s top 4 tips for microbiome health
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Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller. And today we have Dr. Coulter.
Katrina:Thank you. Thank you. I'm really excited to be here and have this conversation today.
Kerry:Me too. I'm everybody, you know, buckle up. Listen, this is gonna be a great one, a fun one to you know, go back and listen to, I think. So please, why don't you tell us a little bit about who you are and what you do.
Katrina:Yeah, so I am an infectious disease specialist. I did my residency in internal medicine and then a fellowship in infectious disease, and I've been in a pretty traditional practice for about a decade now where I'm about 50% in the hospital, about 50% in the clinic. And that's been a really, you know, interesting, fulfilling career path. But as evidence and science has changed, I have started focusing a lot more. On the microbiome and the health of my patient's microbiome. And this has been just kind of an evolution over the past 10 years of patients really asking me when they're on some of these prolonged antibiotic courses that are often needed with infectious conditions. They're asking about, well, what is this doing to my good gut bacteria? And should, you know, should I even be taking this antibiotic or should I be taking a probiotic with it? And as, as scientific evidence has evolved, the answer that I gave 10 years ago is not the same answer that I give now because we've had such an explosion in scientific research on what's kind of become a hot topic, the microbiome. So I'm pivoting a little bit now in my career and really recognizing if I can teach people about their microbiome. Before they get sick and before they need a course of antibiotics, their outcome is going to be a lot better than if we're we're trying to damage control on the backend.
Kerry:Mm-hmm. Yeah, it's definitely a hot topic. It's exciting and you know, all this new research has definitely come out during the journey of your career, so I think it's. Only appropriate, right, that you educate and, you know, do your continuing medical education so that you can learn more about what's going on with this. So, basics, basic questions. What is, what is the microbiome?
Katrina:The microbiome are the the millions or trillions of bacteria and fungi and viruses and protozoa that live on us and in us, but they're really not our own cells, so. I think of them as like our friendly crew that we absolutely need to be alive in this environment that help us out that we often don't think about. But hopefully after this, listening to this podcast, we'll have your listeners thinking about this a little bit more. So they live on our skin. They live in our mouth. They live in our GI tracts. One way you could think of it is the mouth and all the way to the anus is just an open tube in which kind of the outside environment transiently passes through us.
Kerry:Yeah, I've heard of that kind of thought and analogy before, and I think it's a good explanation that all these things are, you know, essentially living within us because those are the sources to the outside, like you said. Yeah. It's a, it's a good description. So how does it act as like a frontline defense against pathogens?
Katrina:So you can think of it a couple different ways. So one way that I often explain to my patients is we're covered in a bacterial shield essentially, and so on. Our skin is what I think of as our wimpy protective bacterial layer, and I call them wimpy because they're not aggressive and they don't cause problems for our skin. They're in a nice, happy balance. But when we have a cut or some sort of damage to our skin, which is our protective organ to the outside world, these bacteria are competing for resources and preventing a more aggressive bacteria, such as a strep from, from invading and creating a inflammation or an infection at that point. So that's how it kind of works on the outside. And then if you wanna think about it on the inside, we're ingesting lots of different things all day long. And so again, on the inside we have bacteria fungi who are living in residence. They're part of our, our happy, friendly colonies. And they are also competing for resources and helping determine what belongs and what doesn't belong and needs to just kind of move on through. So it's really amazing the amount of things that could potentially be harmful that we ingest on a day-to-day basis. And unbeknownst to us, our, our microbiome just deals with it and, and kind of pushes it out and, and moves it along and helps protect us and we just go on about our day to day without even knowing.
Kerry:What do you mean competing with resources? Can you explain that a little bit further?
Katrina:Sure. So there's only so much real estate on both our skin and inside of our intestine. And so what we wanna do is promote the healthy colonies, the ones that are going to help us harvest our food correctly, send the right signals to the rest of our body, and we can get into that a little bit more. About all, all these different functions that they have, but at the very basic level, there's only so much space in there. There's only so much food. And so you want to colonize your GI tract with these healthier, favorable bacteria and fungi. So that when others do come along, there's not there's not a vast open land for them to, to take up residence and set up shop. Does that make sense?
Kerry:Yeah. Yeah. So what are some examples when like the microbiome is disrupted, which increases the infection risk? We might be jumping ahead, but.
Katrina:Yeah. So if you have not very healthy colonies in there, or you more specifically what I'm seeing happen is we're not feeding the healthy colonies, the foods that they want. And we should definitely dive into that a little more. Then when you are exposed to these other environmental, less favorable bacteria or, or as some people would like to think of it it might be simpler to think of it as just the bad bacteria. Then you might see something very, very basic like GI distress. So for example we are all exposed to some degree of, bacteria on our fruits and vegetables and we wash them. We try to get them cleaned up. But if you have, say there's a high load of an aggressive e coli on the fruit that you get and it doesn't completely wash off, and then you ingest that, you may get what we would typically call food poisoning. And so you know where you're vomiting, you're having diarrhea, you're miserable, you know, you ate something bad. And so that's going to be one of the very. Basic examples of what could happen. A less obvious example would be that you're just not feeding those good gut bacteria, the food that they want, and so you just kind of have a low level. This regulated uncomfortable GI tract where you know, you might feel fine some of the day, but then there are certain times of day where you feel very bloated or gassy or you suffer from constipation. Or you might not really have any of those symptoms. You might just, you know, say, well, I have normal-ish bowel function, so therefore my GI tract is fine. My microbiome is happy. But instead you're finding that you're excessively tired, your energy is low. You're, you're really grouchy during certain times of day. You just, you're not making the best decisions because you're, you are some version of hangry, but maybe not under fed, hangry. Maybe it's, it's what you're feeding just isn't what your body is needing.
Kerry:So how do you know, like what's good, what's bad, and what the gut really wants?
Katrina:Yeah, so we, we know from research what the gut bacteria and the favorable bacteria that we want in the gut that are going to help regulate the immune system with low levels of inflammation, the ones that are going to be kind of the anti-inflammatory that they want fiber, and that's something that we as Americans are definitely not getting enough of in our diet. So the more that we can add in fiber, the more we are going to nourish those colonies of the types of bacteria that we want and really promote the ones that we want. So often. People will start noticing or or recognizing once they start really paying attention to the foods they're eating and then kind of their mood and the way their body feels afterwards. You know, we've, we've probably all had an experience where maybe we were excited to go do a workout or some sort of exercise. Then maybe ate something that wasn't so healthy, and then afterwards you're like, yeah, no, I don't really feel like doing that. I think I'm just, I, I'd rather kind of just sit around and, and you know, relax and digest a little more. So it's really, it's starting to recognize how the food that you're putting in your mouth is then making affecting your mood, affecting your movement, affecting your sleep, affecting all the things.
Kerry:Yeah, I hadn't really thought about it with the mood comments as much like the hangry and different types of hangry. Right. That's
Katrina:Yeah. Absolutely. One thing I notice that always happens is if I have a really busy morning in the hospital, I even if I've eaten lunch and of course crave more calories for lunch, so then I, I will choose a heavier meal, and then in the afternoon I'm really craving sugar and you know, depending on what's available, which is usually like. M and ms or some, some sort of candy or not so healthy option, then I'll, I'll crave more of that. Like I'll, I'll want to go straight to that sugar where if I kind of stop and make those say, okay, no, I'm going to eat a piece of fruit instead, then I'll have a much better, much more energetic afternoon.
Kerry:Do you think that the gut is, you know, we talk about the gut brain axis a lot. Do you think the gut is dictating some of those cravings?
Katrina:Absolutely, absolutely. I think the gut is dictating those cravings and we know if you eat more of the m and ms and the Skittles and these kind of processed candies, you will select out for specific types of bacteria in your gut and then they will. As they proliferate, we'll send more signals up to your brain saying, Hey, this is what you want. This is what we want. This is now what you want. And so, so it absolutely is affecting the choices you're making in food by the, the types of bacterial colonies, you're nurturing
Kerry:So it's like a, you know, obviously a, like a kind of a feedback mechanism too, right? Like saying you, you eat this and it's gonna tell you, you keep wanting more of it. Mm-hmm.
Katrina:Yeah. So I'm glad you mentioned the gut-brain connection because that's, that's the piece that's really exploded in the past, you know, one to two decades. When I was in training, we were primarily looking at the microbiome as this is how you harvest energy and, you know, process waste in your body. And now we're recognizing that actually, the, a lot of signals are being sent from the gut up to the brain, through the vagus nerve. And so all of our neurotransmitters, or, or the majority of are being made in the GI tract. So our dopamine, our serotonin, our gaba, you know, it's all being manufactured in the GI tract and then sent up to the brain through the vagus nerve and on the flip side of that, the brain is sending signals down through the vagus nerve saying, okay, now it's time to relax and digest, or now it's time to make more of the dopamine. Or you know, we're in a stressed out state, let's divert blood away from the GI tract and let's let's divert it into the muscles instead.
Kerry:Not to get off topic, but with the, you know, the GLP one, craze two, with that gut-brain connection. I think it, people are understanding. And that a little bit more, right? The, the, you mentioned the neurotransmitters and everything of that, they're, they're not craving those foods as much because of that, how that me, you know, medication is working on the gut, but also in the brain with the same kind of, you know?
Katrina:Absolutely. The the GLP one is produced in the GI tract at the signal of the gut bacteria. To tell us, you know, Hey, we're full, we have enough along with some other satiety hormones that then go up to the brain and, and just like you said, tell the brain I don't need any more food. We're good. We've, we've had enough nutrition here. So yeah, I really, it's cool how those GLP wants have really kind of blown open the doors in our understanding of this connection.
Kerry:So what? So I mean, you're infectious disease and you give lots of antibiotics and things, right? That's what we normally think. I always find this ironic, I mean, maybe that's the wrong word now since we're having so much research on it, but how is that really playing a role in the whole microbiome?
Katrina:Yeah, so antibiotics in our explosion of antibiotics has definitely affected our microbiome in a negative way. And not to say that antibiotics are negative, they're lifesaving. And that's a conversation I often have to have is, this is our tool to treat this life-threatening condition. We know that there is going to be some innocent bystanders that are going to to be sacrificed in this process, so how can we minimize that damage? And what foods and what practices can you take on to try to minimize that? And then how can we keep this course as short as possible to, to mitigate that damage? and kind of think of it like that or even approaching a, an infection as is this truly a bacterial infection that requires antibiotics or is this actually a virus and the antibiotics aren't going to change the outcome, and we just need to give it time because I do feel we've with the advent of an antibiotics, we've also developed this society of we want the quick fix, we want the pill. I know it might be a virus, but just in case can I have that antibiotic doc? And really having those conversations and being a good steward of the antibiotics and saying, okay, in this condition we don't actually need this, or we don't need this broad of an antibiotic.
Kerry:Mm-hmm. I mean, I, in our practice. In any practice really. But we have, you know, the allergic patients who sometimes aren't sure if the allergy is causing a sinus infection and is a bacterial or viral and you know, most of the cases it's viral and they are so trained to just want an antibiotic and it's very hard to have this conversation. Right. But I think having our conversation today might educate them on the importance of really, you know, taking that pause and always asking for the antibiotic. Are there any, I guess, tips or tricks that can help them, I guess, be patient in that process? Or how do you approach the conversation?
Katrina:Yeah. And, and one subset of patients that I would imagine we share is the patients that have a lot of allergies to antibiotics. So often if that is the, the subset of patient. If you're somebody who you've had a lot of allergy reactions to. Foods, meds, antibiotics. That's kind of a starting point where I say, maybe your body is trying to tell us that that's not what it needs. That a another different class of antibiotics is actually not the answer. And let's, instead of approaching this in a way that could potentially do more harm by just trying yet another antibiotic, let's step back and see where can we change this process, you know? And so that, that is where I start kind of with diet. But it is a difficult conversation, especially I often get oh, well my PCP always gives me this when I have this. And from my area of expertise, it's a little bit, I, I have a little bit of a, privileged pedestal because I can say, well, okay, now they've sent you to me because that's clearly not working. And if I'm going down a road and I'm not getting to the destination I want to get to, I don't keep going down that same road. I stop and assess and say, okay, you've had three courses of Clindamycin now, and the problem hasn't been solved. You know, yes, I could probably name five other antibiotics immediately that we could try. Or maybe let's just step back and say, okay, let's, let's really look at this condition. And chronic sinusitis is one of the ones that is frequently, gets a lot of antibiotic exposure, which I'm sure is, is happening a lot in your world where maybe it's all just allergic, you know? And so no amount of antibiotics is going to solve that problem. Or chronic urinary tract infections are something a lot of my patients suffer with, especially as we are living longer now and we have so many active women, especially that are per and postmenopausal and they've got, they, we experience those changes to the vaginal microbiome that in, in turn put us at higher risk for. More urinary tract infections. So talking to those patients about lifestyle practices they can change such as drinking more water. So 50% increase in water intake will decrease urinary tract infections by 50%. And so just that simple lifestyle change, your body probably needs more water anyway. Make your skin look great and then you could avoid antibiotic horses.
Kerry:Yeah, I mean, those are very, very important comments like you said. I would. I mean, I feel like we can go many directions here. We can kind diving more into it. So, so we see a lot of, you know, the multi-drug resistant urinary tract infections and it is usually, you know, somebody later in life who probably had lots of different antibiotic exposures and then, you know, what do you do with them? And then that's how they find you, I'm sure. But so what other, I guess, lifestyle things can you use to treat one? The UTIs and the other one, or is it the same for like chronic sinusitis with maybe, you know, not having improvement with antibiotics.
Katrina:So urinary tract infections incomplete bladder emptying is a, a big issue. So we're all in a, a very busy go go go society. So just kind of counseling people, Hey, you've gotta spend a little bit more time. Or there's even a trick I call double voiding where, where if you're sitting down to urinate and then you stand up, you go wash your hands, you sit right back down and what you're doing is changing where in the bladder the, the leftover or the incomplete emptied urine is still at. And so the body will then say, oh yeah, there's some more left. And, and most people will say, yeah, I have noticed that I'll go to the bathroom 10 minutes later. I'm like, I have to go again. I just went And it's because you got up and moved around. And so just teaching little tricks like that. There's vaginal estrogen cream, which we're learning more and more about, but that is actually evidence-based proven to decrease urinary tract infections in peri and postmenopausal women. With the sinusitis sometimes the antihistamines are helpful and that's always a nice little trial. I'll sometimes have people do if we're not sure if it's bacterial or viral or if it's just allergic. There's also, I'm, I'm a fan of the nasal rinses with saline. I always absolutely counsel people, you need to use distilled water or it needs to be heated to boiling and then allowed to cool down because again, tap water is not sterile, and that's one of those things that we're, tap water is meant to be ingested through our GI tract, which then can handle whatever levels of low levels of bacteria or amoebas or whatever may be present. But then when you put it into your mucus membranes and render sinuses with it, you can actually introduce some harmful bacteria. So those are a couple practices that just I keep, trying to reiterate and, hearing it over and over helps people really, it kind of hit home and sometimes people just have to try it. Back to urinary tract infections also not testing, just every time somebody comes into the office if they don't have symptoms. And so a lot of the patients that come to me. With these multi-drug resistant infections. They're like, well, I, I felt fine, but my doctor said I had this. And so they gave me an antibiotic, and then they tested again and they said, I still have it. So then I got another antibiotic and I've never had any symptoms. But I guess I have this bacteria and recognizing that there is a condition called asymptomatic bacteruria, and it, it can absolutely be managed without antibiotics.
Kerry:Hmm. Yeah, that's an interesting point too. I feel like I don't typically do a urinalysis on every patient that walks in the door, and it's not really even part of my, you know, well visit workup unless. There is like a smoking history or something like that. I know oB will be doing that every time, but it's a little bit different case, I'm assuming when you're pregnant.
Katrina:Absolutely. Yeah, there, there are specialized conditions. Urology does a lot of them if they're going to do some instrumentation, but.
Kerry:sometimes they do them for pre-op and stuff, probably also for instrumentation, like if you're gonna have to need a catheter during your procedure and things like that.
Katrina:Absolutely, but like a test of cure is totally unnecessary. If the symptoms are gone, then let it be
Kerry:Mm-hmm. It makes, that's a really good point too. Yeah, and then I, we also recommend those nasal sinus rinses for chronic sinusitis. And I think it, it can make a big deal, especially if you know the patient is allergic, flushing out the allergens, especially at the end of the day before you go on a lay down. And then obviously, like you said, you wanna use the proper water so that you don't introduce those amoeba infections, but I never really thought of it in the way that you said it is that when you're drinking the tap water, they're gonna be, you know, the proper microbiome is going to basically take care of that. But when it's getting so close to the brain and everything like that, there's less microbiome there, I guess, to take care of those situations.
Katrina:Yeah, a different microbiome. So our nasal passages. And our oral cavity is totally lined with bacteria and fungi, but it's not the same that's going to exist all throughout the GI tract. So each little area in our body has kind of like its own little specialized microbiome, which is cool. I mean, even your armpits have their own, their own crew in there
Kerry:Yeah. What, so tell me more about like what are the antibiotics overuse doing to our specifically with the gut?
Katrina:Yeah, so they're directly killing. It's kind of interesting how I started to really think about this. So I, about five years ago, bought a ranch and it was this kind of overgrazed overused land that I wanted to rehabilitate. So I started learning about soil health and regenerative ranching and like no-till agriculture and all these important microbes in the soil. And I recognized all of them because I was like, oh, I know, you know, this antibiotic kills that and this antibiotic kills that. And really flipped my thinking to what I'm also doing to our human microbiome. So antibiotics that you're taking systemically, whether you're taking them orally or through an injection they are going to kill some of the gut microbiome and a lot of the infections I treat, especially urinary tract infections, those are all caused by GI bacteria. I treat a lot of intraabdominal infections. I treat a lot of diverticulitis with abscesses, and those are all gut bacteria, so I'm directly targeting gut bacteria. So there is no way for me to give you a pill or an injection and say, this is gonna only kill the abscess, but not the, the good guys that are hanging out where they're supposed to. So these effects can be lasting even after, you know, say you take a course of antibiotics for a week. The effects on your microbiome in your gut and also on your skin, by the way I mean, they're being affected too. That may last for up to three months. Some studies show that it may last for up to two years. So there's absolutely this downstream effect. And then if you wanna go back to agriculture, we are using a lot of antibiotics in industrialized agriculture, and that's actually driving our MDRs or multi-drug resistant organisms at a much faster pace than even just our human antibiotic use. So we're giving antibiotics to animals. One because their living conditions are not hygienic, they're being concentrated into these concentrated animal feeding operations or feedlots where it's unsanitary, unhygienic, the animals get sick because they don't have enough exposure to pasture or sunlight or fresh air, or they're, they're waiting in their own wastes. So we are heavily using antibiotics to keep them alive and also because it makes the animals gain weight. And so that's something we don't talk about a ton in humans, but it does the same for humans especially early in life. Antibiotic exposure has been shown to disrupt the human microbiome early in life in such a way that obesity and weight gain can be a problem throughout the rest of life.
Kerry:So how Does one recover from having to use antibiotics when they actually need it?
Katrina:Yeah, that's the million dollar question, right? So the first thing I would say is the best recovery is going to occur if your microbiome was healthy to begin with. So don't start after the fact. And if, if you can avoid that, I mean, that does happen. But instead, you wanna start thinking about that before you need a course of antibiotics, because chances are in the next 10 years, everybody listening to this is going to need some sort of course of antibiotics for something. And so really feeding that gut. And trying to promote those healthy colonies both before the antibiotic exposure and afterwards is crucial. So that is fiber. So right now I challenge everyone to take a look at their diet and see how many grams of fiber they're really getting in a day. The recommendation is 25 to 35 grams, and most of us are probably getting about seven to 10. So one is the fiber. Eating lots of fiber, fruits, vegetables nuts, seeds, whole grains and making sure you're adequate on that. A second thing that you can do is try to introduce probiotic foods into your diet. And so these are going to be fermented foods or, dairy, a lot of dairy products if you eat dairy, so things like yogurt. cottage cheese, buttermilk cream cheese, you can all find as probiotic foods. They contain live active bacterias. Also sauerkraut, kombucha, kimchi. Sourdough bread is a food made from probiotics. It's a fermented food, although once you cook it, you kill the bacteria. So getting the right food in your diet is crucial. And then we're learning lots of different things. Other things are affecting our diet, such as our movement. So the more you move and exercise, the more diverse the gut bacteria are. Your sleep and your circadian rhythm affects your gut microbiome. And so making sure you have adequate sleep, sleep and you're well rested, and then of course you're well hydrated.
Kerry:So you recommend, obviously, the fiber is insoluble or soluble. Does it really matter?
Katrina:So the gut bacteria really like the non-digestible or the insoluble fiber, but getting a nice mix of both is crucial. So I don't counsel people to choose one versus another. In most conditions when they're recovering, it's more just getting those whole foods in.
Kerry:Mm-hmm. And so somebody reading a label of a yogurt or anything and they tell you all the bugs in there, what are the best ones?
Katrina:So it's not really so much one best one because when you're getting an antibiotic course, it's probably going to take out multiple different strains. So it's actually getting the diversity in. So if you read a, a yogurt label you're gonna see about five or six on there. If you read a probiotic pill label, you're usually gonna see one or two. And so I really try to, to encourage people to get more of the probiotic foods because they will get that diversity in addition if you're eating something like sauerkraut, you are going to get the, the prebiotic fiber with it. So it's like you're getting the whole package, you're getting the, the fiber that the bacteria likes. You're getting the bacteria. Then you're getting the, their post biotic, their breakdown products, which are the signaling molecules, which do all the great things in our body. So you're going to get more of a diversity and the more diverse types of fiber you eat, the more you're going to nourish a diverse community in your microbiome.
Kerry:Would that include like a diverse type of vegetable?
Katrina:absolutely. So I know some people it's easier just to eat the same thing for lunch every day, and the same thing for breakfast. And I'm, I'm not that person. I can't. I would be so bored. But yeah, just trying to mix it up. Maybe try to get 30 different plants and vegetables a week. I'll sometimes play a game with my family where we'll have a little contest to see who can get the most diverse fruits and vegetables in their diet.
Kerry:Yeah, tell my kids that I keep trying to, you know, rotate it and things like that and they're, you know, they want their specific ones.
Katrina:It's tough with kids'cause they do, they'll, they'll kind of get stuck on something and they'll want that every day. But I'll find, you know, it'll be great for a, a few weeks and then they don't want it anymore. So they keep me on my toes.
Kerry:what about, uh, is it, Do you recommend using like free range? I don't know, getting free range chicken and the ones that say on the packages, you know, no antibiotics and things like that.
Katrina:I do, if you can source food that is local and that is pasture raised. You're going to get a much healthier, especially animal product than you are if you're just buying kind of the generic factory farmed Tyson chickens that are also going to be the cheapest. But the cost is your health. we may save a few dollars in the bank account, but you are gonna pay for it with a chronic disease if you eat large amounts of that over time, so absolutely. We do have scientific evidence that grass fed beef has a much better Omega-3 to omega six profile compared to grain fed. It's got more micronutrients, it's got higher concentrations of antioxidants and so absolutely. And it's the living conditions are going to be much more favorable. It's gonna be better for the planet. It's gonna be a healthier animal that's going to be a healthier product for you to consume.
Kerry:Yeah, it is. It is difficult'cause it is more expensive, right? Yeah, absolutely.
Katrina:It is, but I, I am suspecting we're gonna see these prices level out with current conditions due to tariffs and imported food. And also as we become more environmentally focused and recognize what some of these practices are doing to our planet.
Kerry:Mm-hmm. Yeah.
Katrina:cost is going to even out.
Kerry:You mentioned tilling. I don't know much about farming, but I was just in Missouri in the farmland. But what, what is that? How is that negatively affecting things?
Katrina:So the soil kind of like our microbiome has a whole structure. It's called soil tilt, and it's, it is kind of these layers within the soil that, have basically little pockets where the microbes live. So you've got, again, so sort of similar stuff to what's in our GI tract. And then there's the decaying root systems from the crops that have been there, that are nourishing these and these pockets that contain water. And when we till the soil every single year, what it does is it'll bring nutrients up to the surface. So the first year you till a soil you're gonna have a, a bumper crop because if a soil's not been disturbed for many years, all of a sudden all these nutrients are released to the surface. You plant your seed, it grows really big. But unfortunately that soil compacts down because now you've destroyed these pockets. And so the next year the soil will be depleted of nutrients. It'll be more compacted. The microbes can't, can't grow as well, and can't contain water as well. So year after year after year of tilling, the soil just destroys it. So then to, to replenish it, we add fertilizer. And that fertilizer also destroys the microbes. So the fertilizer provides some macronutrients, but we don't provide micronutrients. Those are provided by these microbes. So then, the fertilizer further kills it. And then as you might have seen in your recent trip, we like to plant monoculture. So all the same type of plant because our machines are designed to harvest, you know, rows and rows of corn. But the pests, the insects also will find, you know, their whole buffet of the same kind of of food. And so then we need to apply pesticides to the monoculture, which then further kills the soil. So it's just kind of this really negative feedback loop that we've been using for about thepast 50 to 70 years to mass produce food and we're seeing loss of soil diversity, loss of micronutrients in our food and, and now loss of diversity in our microbiomes.
Kerry:Wow, it's such a difficult balance. I mean, I was literally running, you know, in the corn fields, which apparently weren't for corn consumption, but the feed corn, right for the animals. And then I always am paying attention to learning. They rotate between the corn and the soybeans and I don't know what the other ones are wheat, like through a season. So it's clearly, you know, corn, corn, corn, corn, corn, and then soybeans and then, you know, for whatever, like you said, oh, the big mass crop produced and then they change it every year, but I don't know how to fix the system.
Katrina:Yeah, it, it's, I think it has to start as a recognition of there, there are other ways to do it and it's challenging to do that on a mass scale, but maybe even just as you mentioned that corn wasn't grown for us to eat, that corn was grown for animals in a feedlot, and that's not their natural diet. And so we're changing the microbiome of the cattle, you know, we're selecting out multi-drug resistant organisms. So, so there, there needs to be more recognition of maybe we should focus more on growing crops for humans and letting the animals graze the pasture. That's not suitable for, for growing crops because, you know, a lot of I wanna say like 40% or something of agricultural lands are, are considered graze lands, like not, not even suitable for growing crops. And so kind of introducing the animals back into the farm, which they've, you know, it's now been separated and it's become more of this, this is a farm that grows crops. This is a ranch that raises animals and really traditionally was combined together because the animals, you know, they provide fertilizer, lots of fertilizer for the soil and, and reintroduce the microbes as it passes through them.
Kerry:Mm-hmm.
Katrina:So nature has these systems and we just have stepped in and and kind of modified them in the vein of nutrition and health. But. At some point industry came along and profit and we, I think we've lost a little bit of focus on what we're doing with the food industry. It's not just about nutrition now, it's about. Profits and selling products. And something we haven't even touched on, but I will mention here is ultra processed foods. And so those are something that's really taken over our diet. They contain very little fiber. They contain a lot of sugar. A lot of other additives, you know, flavoring, coloring, emulsifiers, shelf stabilizers, and these are terrible for our microbiome. The microbiome doesn't eat these. It's like sawdust coming in. And they may be actually destroying our microbiome as well. And so you know, we went maybe from a time when we needed to fortify cereals because of vitamin deficiencies now to, we're just making these flavor profiles that kids will eat an entire box of and not feel full. And then, you know, throw a tantrum in the grocery store to have their parent buy another box of.
Kerry:No, no. Yeah, yeah. Well, I mean, to be fair, we didn't know these things right when we were starting with agriculture. But as you learn and we research more, you know, we gotta figure out how to make things better. So, but yeah, the finances and those kind of things make it more difficult, especially when we're trying for convenience and mass production and things like that. So on a smaller scale, how can the microbiome be more like used for personalized medicine or individualized care, or what, what have we learned about it with regard to those kind of things?
Katrina:So we're still really early. In that that avenue. And so I think over the next 10 years we're going to see stool analyses being used to help determine which foods will help your blood sugar stay low versus will send your blood sugar through the roof because it's individualized, right? We, we all have our unique microbiomes and they're, they tend to be pretty similar amongst people that live together and in certain regions, especially if you're, you are outdoors a lot and you're eating locally, you're going to have a very region specific microbiome. And so one type of food that might be favorable for me might not be favorable for you. And so I, I do think there'll be a future where we're looking more closely and we understand that as to, okay, you should avoid. Nightshades, but I can eat them or, or something along those lines, but we're not there yet. So I caution people, you know, there's all these stools you can, you can mail off your poop and get your stool analyzed. And that sounds cool. And I love data and I'm tempted to do it, but I'm also like, we, we at this point don't know exactly what that means. And I would especially caution people to avoid like, oh, now I need to take mega doses of this probiotic in response to this finding on this stool analysis. Because it's just not, the evidence isn't there yet. I do think it will be there, there's a lot of people in this field doing this. But it's just, it's not ready for primetime yet.
Kerry:Yeah. Yeah. A couple things you mentioned. So you said someone may have a different response to specific the food than somebody else. Right. So I know that sometimes we get a lot of information of that with using like the continuous glucometers and things like that. So some people may have a huge reaction to grapes and some people may not have as much. So using these, you know, more personalized tools to be able to do that is sometimes a fun activity, but not. Necessarily necessary. But I thought that was an interesting comment, like you mentioned, and then you mentioned weight gain and obesity earlier. And I remember when I was doing my boards for obesity medicine, you know, there's specific I guess some bug in the gut that is associated with obesity. Do you know what that is off the top of your head?
Katrina:Yeah, so there's it's actually a ratio, so it's all a complex biological system. Which is why just the hack of like, oh, I just, I'll just take this one pill or one supplement doesn't really work. But there's a ratio of two big classes of bacteria, the firmicutes and bacteroidetes. And we find that not universally, but in general people that are leaner tend to have a different ratio than people that are more obese. And that's because they have more of the bacteria that are better at extracting energy from food. What we're finding in our modern society, and I suspect due to a lot of this, these things we've talked about, ultra processed foods, you know, all these things we're doing in, in the environment is we're finding that for whatever reason, people that tend to be more overweight or obese, they're, they're not getting the signal from the, the gut bacteria going to the brain saying, I'm full. We have enough calories you can stop eating. And it's almost like we have an overnutrition, but an undern nourishment problem. That is, is being a lot driven by these ultra processed foods. So you're getting the calories in, but you're maybe not getting the fat content or the right combination of signals. That's saying that's enough calories. We can run on this. The body is fed.
Kerry:Yeah. What, well, I have a million more questions, but I feel like I'm taking your whole time up. But so what, I guess let's just wrap up with like, what are your. Are top tips to help keep your microbiome healthy and if you have to use antibiotics, you know, what would, what are the top tips, I guess?
Katrina:Yeah, so top tip number one, I've already said it, but I'll say it a hundred thousand more times, is eat more fiber. So just really start paying attention to how much fiber you're getting and try. Try to find a spot in your breakfast, lunch, dinner, snacks where you can sneak a little bit more fiber in. So instead of the potato chips, grab an apple or dried fruit or something, or a trail mix so you know something that's going to contain fiber instead of these empty calories. So that's number one. Number two is the ultra processed foods. Just really being aware of them. Look at the labels. If you don't recognize an ingredient on the label, it's probably ultra processed. Or another thing that I heard somebody say, which I like, is if your grandparents wouldn't recognize it as food, probably don't eat it. So you really need these whole foods. So, so more fiber, so more fiber, more whole foods, less ultra processed foods. If you can get fermented foods into your diet, that helps replant the garden a little bit every day. So pickled things, sauerkraut, kombucha, yogurt, things like that. Even soy sauce, vinegar, those are all fermented foods. And then the last one is movement. I don't think we're talking about this. As much as we need to, but we've become a very sedentary society. And movement does affect the microbiome. It affects your digestion, move the actual physical movement and muscles in your core tell your intestines to move. And so they keep those colonies happy. So those would be my top four things when it comes to antibiotic. I empower every single one of your listeners to question an antibiotic prescription. And if your doc gets offended too bad. You know, I never am upset I, if somebody questions, do I really need this antibiotic? I love that because then I'm like, okay, this really opens the door for a big conversation about risks and benefits and, duration of treatment and expected outcome. And so I, I love an empowered, educated patients. I feel like they're, they're going to be more compliant if they understand why we're doing what we're doing. So it's okay to ask questions and maybe not go straight to the antibiotic if there's other options. And sometimes that, that's what you need.
Kerry:yeah, those are, I mean, I knew what you're gonna say for half of those, but, what, what is your favorite over the counter probiotic to recommend to patients who would need to use the antibiotic?
Katrina:don't have one. But I do, if you're going to use one and. If you're on an antibiotic, it might be helpful to take it every day. If you're not, you really don't need to plant your garden every single day. You wouldn't put seeds in your garden every single day. You would plant a seed and watch it grow. So what I recommend is try to find one that has six or more different species on it.
Kerry:Mm-hmm.
Katrina:And it does tend to, the ones that tend to be refrigerated, do tend to be a little bit more robust and diverse. So I wouldn't, I wouldn't waste your money on one or two different different species because you don't, you don't even know if that's what you need to replace.
Kerry:Mm-hmm. Okay. Yeah, I would love to ask you more questions about the immune system and everything else, but I think we will have to have you back
Katrina:Yeah, we'll have to do a follow up episode. So listeners, let us know what, what you liked and what you wanna know more about, and we can absolutely do that.
Kerry:Awesome. So where can people find you if they wanna work with you or follow you or anything like that?
Katrina:Yeah, I I have a YouTube channel that's been asleep for a couple months, but it's gonna wake back up here shortly. It is Katrina Coulter, md. I also have a website, katrina coulter md.com, and I will have some coaching opportunities available coming up in the next month. So the website's under construction, if it's down when you get to it, just check back in a week or so and we should have that all up and running. And I really had a lot of fun. Thank you so much for having me.
Kerry:Yeah. Thank you so much for coming on. This was a great discussion. Like I said, I could, you know, probably talk hours with this, but gotta end some point, right. So thank you. I appreciate it. And maybe we'll have you back and everybody stay tuned for next week's episode. Thank you.
