Healthy gut, healthy heart?

Healthy gut, healthy heart? – Harvard Health – June 2018

If you ask most medical experts about the hottest trends in health research, chances are they’ll mention the microbiome. The term refers to the trillions of microbes living inside our bodies, known as the human microbiota.

The vast majority of these bacteria, viruses, and fungi dwell deep within our intestines.

These microbes

  • help with digestion,
  • make certain nutrients, and
  • release substances that have wide-ranging health effects. 

“There’s a complex interplay between the microbes in our intestines and most of the systems in our bodies,” says Dr. JoAnn Manson, professor of medicine at Harvard Medical School

Microbe metabolites

As you’d expect, what we eat plays a major role in the composition of our gut microbiota.

And we’re learning more about how the substances gut microbes churn out (called metabolites) influence our risk for many chronic diseases, including diabetes, heart disease, and cancer, says Dr. Manson.

So it’s not just these microbial organisms themselves, but their chemical output that influences our health.

This adds two more layers of complexity to add on top of all the chemistry involved in our diet.

One of the best known of these gut metabolites, called trimethylamine (TMA), forms when gut microbes feed on choline, a nutrient found in red meat, fish, poultry, and eggs.

In the liver, TMA is converted to trimethylamine N-oxide (TMAO), a substance strongly connected with the formation of artery-clogging plaque (atherosclerosis).

A 2017 study in the Journal of the American Heart Association by Dr. Manson and colleagues pooled findings from 19 studies looking at the connection between blood levels of TMAO and serious cardiovascular problems (mainly heart attacks and strokes).

People with the highest TMAO levels were 62% more likely to experience serious cardiovascular problems than those with the lowest levels. High TMAO levels were also linked to higher mortality rates.

What’s more, these connections were independent of traditional risk factors, such as diabetes, obesity, and kidney problems. This suggests that TMAO could be a novel target for prevention or treatment strategies.

Gut microbe metabolites are also known to influence other factors closely tied to cardiovascular risk, such as diabetes, high blood pressure, and inflammation.

For example, a high-fiber diet may encourage the growth of gut bacteria that produce short-chain fatty acids. A gut that includes these microbes seems to help people with diabetes better control their blood sugar and body weight, according to one small study.

Blood pressure benefits

Other preliminary findings discussed in the review include

  • how high dietary sodium levels change the composition of gut microbe populations
  • how toxins released from microbes may influence kidney function, a key player in blood pressure regulation
  • how microbes that live in the mouth interact with nitrates from vegetables to form nitrites and nitric oxide, which relaxes blood vessels.

The promise of probiotics

What about probiotics, the live bacteria found in yogurt, other fermented foods, and dietary supplements? While they potentially improve diarrhea caused by infections or antibiotics and may ease symptoms of irritable bowel syndrome, so far the evidence of any definitive benefit is limited.

It’s far too early to recommend probiotics routinely for preventing or treating most chronic diseases, says Dr. Manson. “We often don’t know if the probiotics are actually getting to the right place and changing microbial flora,” she says.

Metabolomics — the study of metabolites — has been called a missing link that connects the microbiome with human health.

However, we are only beginning to understand how what we eat and what our microbiota make of it affects our health, so simply adding a bunch of “probiotic” supplements isn’t a solution:

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