A Practitioner's Guide to Probiotics: Cardiovascular and Metabolic Conditions

Probiotic supplements contain live beneficial microorganisms, similar to those found in the human gastrointestinal tract (195). When ingested, these microorganisms confer a number of health benefits to the host, particularly by modifying gut composition (48). With respect to cardiometabolic health, the microbiota can modulate weight and nutrient use by extracting energy from the diet through saccharolytic or proteolytic fermentation. Saccharolytic fermentation produces short-chain fatty acids (SCFA), while proteolytic fermentation produces amines and ammonia. Furthermore, the microbiota can reduce the inflammatory environment that may develop in obesity or with a chronic intake of high-fat diets (196). 

Imbalances in the intestinal microbiota are believed to be involved in the development of chronic metabolic and inflammatory disorders (67). Low microbial diversity has been linked with higher systemic inflammation, insulin resistance, adiposity, and dyslipidemia (108). The microbiotic signaling from the GI system can lead to the release of hormones, as well as immune and inflammatory factors that modulate glucose and fat metabolic pathways (20). 

Probiotics supplements can provide a safeguard to cardiometabolic processes through a number of mechanisms, including (127, 165, 196):

  • Protecting against endotoxins 
  • Suppressing the innate immune system to reduce pro-inflammatory cytokines
  • Reducing hepatic recirculation of cholesterol through bile acid and SCFA synthesis from complex carbohydrates
  • Producing SCFAs that bind to receptors that regulate energy expenditure, increase peptides involved in heightening insulin sensitivity, and alter renin secretion to modulate blood pressure
  • Modulating the presence of trimethylamine N-oxide (TMAO), which may lead to atherosclerotic events and vascular inflammation

While probiotics are now commonly prescribed therapeutically and clinical research examining the relationship between the gut microbiome and cardiovascular and metabolic disorders is becoming increasingly available (165), clear guidelines for clinical application have yet to be established. This is particularly important as the effectiveness of probiotic supplementation may be dependent on the condition, strain, dosing, and duration of therapy (125). 

This guide provides an overview of the available research for the clinical application of probiotics in cardiovascular and metabolic conditions, including dosing and administration for single-strain and multi-strain probiotics.

Download the full guide to probiotics in cardiovascular and metabolic conditions.

Safety Considerations & Contraindications

While probiotics are considered safe, rare short term side effects, such as gas and bloating, may occur (30). Isolated cases of bacteremia or fungemia have been associated with probiotics, though population data also indicates that there is no widespread risk of these complications (174). 

There is some limited evidence that probiotics should not be administered in critically ill or immunocompromised patients, as demonstrated by an increased risk of mesenteric ischemia and mortality in a trial of patients with predicted severe acute pancreatitis (23).

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