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What to Know About the Heart and Gut Health Connection

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Different factors can increase your chance of developing heart disease, like age, family history, high cholesterol, and high blood pressure, among others. And now, evidence suggests that gut health may also belong on the list of heart disease risk factors.

There are trillions of bacteria, fungi, and other small, microscopic organisms called microbes housed in your digestive system. They are collectively referred to as the gut microbiome. In recent years, researchers have found that the gut microbiome affects more than your digestive health alone. Heart disease is one of several health conditions that may be at least partially fueled by an unhealthy balance of gut bacteria.

The good news? This is a heart disease risk factor you definitely have control over. Here’s what to know about the link between heart health and gut health, including steps you can take to maintain a balanced gut microbiome.

Metabolites and your cardiovascular system

During the digestive process, microbes produce substances called metabolites. One of these substances in particular, trimethylamine (TMA), is linked to your risk for cardiovascular disease and other chronic health conditions like diabetes.

TMA forms when the bacteria and other organisms within the gut microbiome consume choline, a nutrient contained in red meat, fish, poultry, and eggs. The liver then converts TMA into a substance called trimethylamine N-oxide (TMAO). 

The medical community has identified a connection between high levels of TMAO in your blood and deposits of cholesterol, blood-clotting material, and other substances in your arteries. These substances are collectively referred to as plaque, and its accumulation in your arteries is referred to as atherosclerosis, a leading cause of cardiovascular disease, heart attacks, and strokes.

A 2017 analysis of several studies on the connection between TMAO blood levels and cardiovascular health found a correlation between elevated TMAO levels and serious cardiovascular issues. In the studies, researchers looked at people from different categories of health conditions in multiple countries, like individuals with and without diabetes, and individuals with and without chronic heart failure. 

Each group included individuals with various TMAO levels. The results showed that people with the highest levels of TMAO were 62% more likely to experience serious cardiovascular issues like heart attacks and strokes. The link appeared to be independent of other key risk factors for heart disease like diabetes and obesity.

The impact of inflammation

In addition to the findings about TMAO, researchers have also identified a link between gut health and inflammation (redness, warmth, and swelling around tissues and joints). Inflammation is part of the body’s natural response to an injury, but when it persists after the healing process and becomes chronic inflammation, it can lead to an ongoing high white blood cell count.  

Over time, this elevated level of white blood cells can affect other organs including your heart, lungs, and kidneys, which may influence your risk for heart disease and other chronic conditions like diabetes.

The majority of the body’s inflammatory cells are stored in tissues in your gut, and researchers have found that an inflamed gut can trigger inflammation elsewhere in your body. Certain gut bacteria produce substances that enter your bloodstream and create inflammation in every part of the body that they travel through. This inflammation in the walls of your blood vessels can eventually lead to atherosclerosis.

How to maintain a healthy gut

Researchers are still learning about the gut microbiome’s influence on your risk for various health conditions. One thing they do know for sure is that a healthy gut microbiome is an important component of your overall health, and there are simple steps you can take to maintain a balanced digestive system.


A balanced diet is a great starting point for better gut health. Start by limiting foods that are processed or high in sugar or fat — particularly cookies, sugary drinks, salty snacks, and frozen foods — as these can lead to increased inflammation. Opt for fiber-rich foods like beans, peas, bananas, and asparagus; fermented foods like kimchi, yogurt, miso, and kefir; and collagen-rich or collagen-boosting foods like salmon, mushrooms, and egg whites.

Lifestyle habits

Staying physically active and avoiding unhealthy habits like smoking and heavy alcohol consumption can also improve your gut health. Looking for a fitness routine that fits your schedule and health needs? Aim for about 150 minutes a week or 30 minutes per day. Explore different activities until you find the one that’s right for you — whether virtually or in person.

Stress management

Over the long term, stress can lead to many physical and mental health problems, including digestive issues. Staying physically active reduces stress, so you’re already tackling this risk factor simply by working out regularly.

Beyond exercise, check out Insight Timer, an app that offers free guided meditations or Moodfit, a free mood-tracking app. And since there’s an established link between stress and high blood pressure, heart disease, and stroke, these small actions can benefit several aspects of your health at once!

Your partner in health

At Alto, we’re committed to making it as simple as possible to protect your heart health and stay on top of cholesterol-lowering or blood pressure management medications.  We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly

Reach out any time by in-app secure messaging or phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.