Medicine Switches Bacteria On, and It Also Fixes the Neighbourhood They Live In

When herbal medicine and gut bacteria come up, it usually runs in this direction. Bacteria switch the medicine on. The story that a compound locked behind an attached sugar has to be opened by bacteria before it becomes medicine at all. (The same remedy works differently when the gut is different)

That is correct. But the arrow has only been drawn one way.

Today I want to describe the opposite direction.

Bacteria live in a neighbourhood

The inside of the gut is a neighbourhood. It has an acidity, it has food, it has a set amount of oxygen, and it has a mucosa in some state of repair. The bacteria live on top of those conditions.

Change the neighbourhood and the residents change. Some strains increase, some decrease. Obvious enough, and yet something follows from it here.

Change the neighbourhood and the make-up of residents changes; change the residents and what they produce changes too.

Bacteria feed the mucosa

The cells of the gut mucosa are a little unusual. They do not take their meals from the blood alone.

Certain bacteria living in the gut eat fibre and put out something called short-chain fatty acids. That substance becomes food for the mucosal cells. The mucosa eats what the bacteria have made for it.

It is not a side dish. Measured on human large-bowel cells taken out and tested, about three quarters of the energy they used was coming from this substance. Not from what the blood brings, but from what the bacteria in the gut have made.

So when the neighbourhood falls apart, the mucosa goes hungry. When the residents change and the strains making that substance decline, the meal reaching the mucosal cells is reduced. The mucosa thins and loosens.

There is a background like this behind why the gut does not heal easily in someone whose diarrhoea has gone on a long time, or who has been on antibiotics a long time.

So there is one more thing medicine does

Coming this far, what medicine can do splits in two.

One is getting itself switched on through bacteria. The road where a locked compound is opened and enters the body.

The other is working on the neighbourhood the bacteria live in. Changing the acidity, changing the state of the mucosa, changing the make-up of the food — making the residents come out different. This is not the medicine going to a target and pressing on something. The medicine only changes the environment; the actual work is done by the residents.

And these two push each other along. As the neighbourhood improves, the strains that switch medicine on increase as well. Then the next medicine you take gets switched on better. This has actually been observed in animals — when the same medicine was given over four weeks, the active compound entering the body increased as it went on. The medicine had made, by itself, the neighbourhood in which it would work well.

Why this is a different story

Two things are different.

The speed is different. Medicine being switched on and entering takes hours. The neighbourhood changing takes days, weeks. So medicine that works on the gut comes late. Not feeling it right after taking it does not mean it is not working.

What happens after you stop is different. A compound that was switched on and came in is gone once it leaves. The neighbourhood is another matter — stopping the medicine does not send it back to how it was; from that point on, what you eat decides the neighbourhood.

So I do not regard changing the neighbourhood with medicine as the end of it. What the medicine has made room for, food has to take over. If you only stop the medicine and go back to eating as before, the neighbourhood goes back too. This is the reason behind my reducing the medicine while working on daily life alongside it. (The illness that returns when you stop the medicine)

So in the clinic

When the gut has broken down, I look at the gut before the medicine. Put a good medicine into a neighbourhood in disarray and there are no residents to switch it on and the mucosa that would take it in is worn through.

I say in advance how long it will take. Medicine going in this direction does not change dramatically within a few days. Taken without knowing that, people judge that it is not working and stop.

I look at what you eat, alongside. The food of the neighbourhood is decided more by meals than by medicine. Change only the medicine and leave the rest as it is, and the neighbourhood stays as it is too.

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Bacteria switch medicine on — that is correct. It is just that the arrow does not run in only one direction.

Medicine fixes the neighbourhood, the neighbourhood changes the residents, the residents feed the mucosa, and that mucosa receives the next medicine differently. A circle turns. Here too lies a reason why what herbal medicine does cannot be drawn as a single line. (What herbal medicine does)

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References

• A study measuring that human large-bowel cells get most of the energy they use from a substance made by the bacteria in the gut — Gut, 1980
• A survey gathering the studies on herbal medicine changing the make-up of the human gut microbiota — Nutrients, 2023
• Giving the same medicine over four weeks produced more of the active compound as it went on — Pharmacology Research & Perspectives, 2016 (animal)

Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)