Inflammation is an undeniable key player in the pathogenesis of cardiovascular disease (CVD), involving activation and accumulation of immune cells and releasing inflammatory cytokines.

 

Impacts of a healthy gut

 

According to a Nutrients review, gut microbiota consist of micro-organisms in the intestinal tract that maintain internal stability.

Wang W, Zhu LJ, Leng YQ, et al. Inflammatory Response: A Crucial Way for Gut Microbes to Regulate Cardiovascular Diseases. Nutrients. 2023;15(3):607.

 

 

A healthy gut microbiome is anti-inflammatory—consider the following:

• Mesona chinensis Benth Polysaccharide (MBP) reduces serum, cardiac, and renal inflammation by altering gut microbiota through modulation of the TLR4/MAPK/NF-KB pathway.

• Probiotics alleviate colitis symptoms and normalize serum cytokine profiles by modulating host immunity and gut microbiota composition—a fall in pro-inflammatory Interleukin-1β (IL-1β), Interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), with upregulation of anti-inflammatory Interleukin-13 (IL-13).

• Paeonol and the Qige Huxin formula (QHF) restore gut microbiota balance, reducing inflammation and offering cardioprotective effects.

 

 

Health benefits of probiotics

 

Authors publishing in the International Journal of Molecular Sciences state that probiotics are “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.“

Hijová, E. Benefits of Biotics for Cardiovascular Diseases. Int. J. Mol. Sci. 2023;24:6292.

 

Probiotics combat enteric pathogens through antimicrobial bacteriocin production, competitive adhesion to the gut epithelium, mucosal improvement, and immune system modulation. They primarily consist of microbial strains of lactic acid bacteria like Lactobacillus, Lactococcus, Enterococcus, Streptococcus, Bifidobacterium, and yeasts such as Saccharomyces.

 

Lactobacillus rhamnosus administration may prevent cardiac remodeling after myocardial infarction by improving metabolic dysfunction and attenuating inflammation. At the same time, these strains improve atherogenic indexes and antioxidant markers in diabetic patients. 

 

Prebiotics

 

The Nature review authors state, "Prebiotics are a group of non-digestible carbohydrates that selectively alter microbial composition and activity.” Criteria for identifying prebiotics include resistance to upper intestinal digestion, fermentation by beneficial gut bacteria, beneficial effects on host health, and stability during the processing of food—which are fulfilled by oligosaccharides like fructans, galactans, human milk oligosaccharides (HMOs) and non-saccharides like polyphenols, according to the International Journal of Molecular Sciences authors.

 

Let's take a closer look at the results from three recent RCTs:

• In a 2020 study, a lacto-ovo-vegetarian diet (vegetarian diet with eggs and dairy products) led to improvement in CVD risk factors, such as reduced levels of oxidized LDL and total cholesterol, as well as a decrease in body weight (by 0.67 kg) and positively impacted gut microbiota in patients with ischemic heart disease.

  Djekic D, Shi L, Brolin H, et al. Effects of a Vegetarian Diet on Cardiometabolic Risk Factors, Gut Microbiota, and Plasma Metabolome in Subjects With Ischemic Heart Disease: A Randomized, Crossover Study. J Am Heart Assoc. 2020 Sep 15;9(18):e016518.

   

• A trial from China demonstrated that dietary fibers promoted certain short-chain fatty-acid (SCFA) producing strains, leading to improved HbA1c levels in T2DM patients due to increased production of GLP-1.

  Zhao L, Zhang F, Ding X, et al. Gut bacteria selectively promoted by dietary fibers alleviate type 2 diabetes. Science. 2018;359(6380):1151-1156.

   

• Dietary interventions with high fiber, plant protein, omega-3 fatty acids, and polyphenols reduced pathogenic Prevotella copri and increased SCFA-producing Faecalibacterium prausnitzii and Akkermansia muciniphila in T2DM patients.

  Medina-Vera I, Sanchez-Tapia M, Noriega-López L, et al. A dietary intervention with functional foods reduces metabolic endotoxaemia and attenuates biochemical abnormalities by modifying faecal microbiota in people with type 2 diabetes. Diabetes Metab. 2019;45(2):122-131.

  The intervention group saw improvements in glucose, cholesterol, triglycerides, and inflammation markers.

   

 

Postbiotics

 

Postbiotics are compounds released or generated through the metabolic processes of the gut bacteria and yeast, per the International Journal of Molecular Sciences report.

SCFAs, notably acetate, are extensively studied postbiotics with potential disease-modifying effects on cardiometabolic diseases. These include gut hormone modulation, reducing inflammation, and enhancing energy expenditure and fat oxidation.

 

Working together: Synbiotics

 

 

According to International Scientific Association for Probiotics and Prebiotics (ISAPP), synbiotics are defined as “a mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit.”

Swanson KS, Gibson GR, Hutkins R, et al. The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of synbiotics. Nat Rev Gastroenterol Hepatol. 2020;17:687-701.

 

 

 

Research demonstrates that synbiotic supplementation leads to the following:

• Reduction in inflammatory markers, including C-reactive protein, plasma nitric oxide, cholesterol, and malondialdehyde (MDA) in two separate studies

  Pavlidou E, Fasoulas A, Mantzorou M, Giaginis C. Clinical Evidence on the Potential Beneficial Effects of Probiotics and Prebiotics in Cardiovascular Disease. International Journal of Molecular Sciences. 2022; 23(24):15898.

   

• Reduced weight and plasma bile acid levels, altered gut microbiota composition, and improved obesity-related markers in obese and overweight patients

• Lowered BMI, lower fasting blood glucose, improved lipid profile, less insulin resistance, and increased GLP-1 and PYY levels in subjects with metabolic syndrome.

The WHO, FAO, and EFSA heavily regulate dietary biotics to ensure their safety (origin, absence of pathogenic association, and antibiotic resistance profiles) and functionality (survival in the intestinal tract and immunomodulation). Strains must maintain properties during production, storage, and distribution.