Can gut bacteria cause heart failure
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All diseases begin in the gut. – Hippocrates1

Despite all the research and drug development on heart failure, it still continues to be the leading cause of death worldwide.2 The need for new modes of treatment has induced researchers to explore the role of microorganisms inside the gut in the development of heart failure.

The microorganisms present in the gut are collectively called gut microbiota.1 Recent studies suggest that a change in gut bacteria influences heart disease and overall health to a great degree.2

Let’s understand gut microbiota first!

There are more than 2000 species of microorganisms, mostly bacteria, living within our body, a majority of which are found in the gut. You will be surprised to know that approximately 100 trillion bacteria live within the gut of a healthy human adult.

These gut bacteria are not present naturally since our birth; they are acquired from the environment. A new-born may acquire different microorganisms during delivery and subsequently from their diet and the environment they are exposed to.1

Gut microbiota has formed a symbiotic relationship with humankind which has evolved over thousands of years.3 The normal function of the gut microbiota is vital for our health as it plays many significant roles in the functioning of our body, such as:

  • Digesting nutrients that our body cannot digest naturally
  • Developing our immune system
  • Producing hormones and vitamins
  • Preventing the colonisation of bacteria that cause infection or release toxins2

How gut bacteria might aggravate heart failure?

Gut microbiota feeds on certain dietary nutrients present in high-fat dairy products, egg yolks and red meat. During this process, they release a substance called trimethylamine (TMA). The liver subsequently breaks down TMA into trimethylamine-N-oxide (TMAO), which is responsible for the development of many heart-related diseases.4

A change in your gut microbiota composition, called dysbiosis, results in increased levels of TMAO and the generation of other toxins.5 TMAO causes a build-up of cholesterol on the inner walls of your blood vessels. The presence of high levels of TMAO in your blood over a prolonged period doubles the chances of heart-related diseases and death. TMAO levels in the blood can be used as an indicator of the risk of heart ailments.4

Various studies have also observed that the composition of gut microbiota is disturbed in individuals with chronic kidney disease (CKD). In CKD, increased TMAO and the leakage of gut bacterial DNA and gut-derived toxins (uremic toxins) into blood circulation can lead to malfunctioning of various organs, bacterial infection and shock.5,6 Uremic toxins are shown to be responsible for accelerating the progression of heart failure.5

A study conducted on about 617 middle-aged women found that low diversity of the gut bacteria may be responsible for the hardening of arteries, which can result in a heart attack. Researchers speculate that gut bacteria may be responsible for cases of heart-related ailments seen in young men and women that cannot be explained by obesity or smoking.7

Thus, we can see that changes in gut dysbiosis can be a significant concern for heart failure.

How can I regulate my gut microbiota?

The techniques most often used to modulate gut dysbiosis are diet modification and the use of prebiotics and probiotics.5

  • Dietary modification: Dietary habits have an impact on the composition of the gut microbiota. A diet consisting of a substantial amount of carbohydrates from unrefined grains, nuts, legumes, fruits, olive oil, and fish and a low consumption of dairy products and red meat is recommended to regulate gut microbiota.5
  • Probiotics and prebiotics: Probiotics are live bacteria that are found to be beneficial in restoring the gut microbiota balance. Administration of a commonly used probiotic lactobacillus was found to be beneficial for the gut as it significantly reduces toxins in patients with CKD.5 Prebiotics are substances that promote the growth of good bacteria. The bacteria utilize the prebiotics to make substances that can lower your blood pressure.8

A recent study found that a high-fibre diet shows reduced gut dysbiosis, decreased blood pressure and improvement in the function of the heart in individuals with hypertension-induced heart failure.2

Given all the ways that the disturbance of gut microbiota can lead to heart failure, we suggest you keep your gut healthy, primarily by making healthy food choices and making prebiotics and probiotics a permanent part of your diet. Keeping your gut microbiota healthy may eliminate at least one factor responsible for probable heart ailments.


  1. Harikrishnan S. Diet, the gut microbiome and heart failure. Card Fail Rev. 2019 May 24;5(2):119-122. doi: 10.15420/cfr.2018.39.2.
  2. Branchereau M, Burcelin R, Heymes C. The gut microbiome and heart failure: A better gut for a better heart. Rev Endocr Metab Disord. 2019 Nov 9. doi: 10.1007/s11154-019-09519-7. [Epub ahead of print].
  3. Thursby E, Juge N. Introduction to the human gut microbiota. Biochem J. 2017 May 16;474(11):1823-1836. doi: 10.1042/BCJ20160510.
  4. Cleveland Clinic. How gut bacteria may help curb your heart disease [Internet]. [updated 2015 Dec 31; cited 2019 Nov 22]. Available from:
  5. Kitai T, Kirsop J, Tang WH. Exploring the microbiome in heart failure. Curr Heart Fail Rep. 2016 Apr;13(2):103-9. doi: 10.1007/s11897-016-0285-9.
  6. National Cancer Institute. Systemic inflammatory response syndrome [Internet]. [cited 2019 Nov 22]. Available from:
  7. European Society of Cardiology. New link between gut microbiome and artery hardening discovered [Internet]. [updated 2018 May 10; cited 2019 Nov 22]. Available from:
  8. John Hopkins Medicine. The power of gut bacteria and probiotics for heart health [Internet]. [cited 2019 Nov 22]. Available from:

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