• The review encompassed a wide range of participants — They ranged from individuals diagnosed with CAD to adults managing Type 2 diabetes, high cholesterol, obesity, or hypertension — groups most at risk for future cardiac events.

• The researchers focused on 10 key human studies — These consisted of seven randomized controlled trials (RCTs) and three meta-analyses. Each of these studies involved human participants with CAD or its major risk factors.

• One of the standout strengths of the methodology is the diversity of the data used — Trials came from countries including the U.S., Iran, China, Thailand, Greece, and Japan. That means the findings are not tied to one ethnicity or geographic population — they represent a much wider pool of data, which makes the conclusions more likely to apply across different lifestyles and genetic backgrounds.

• The research consistently showed that probiotics were associated with measurable changes in heart disease triggers — These include blood pressure, cholesterol, blood sugar, weight management, and inflammation.* According to the researchers:

“There are several risk factors for the development of CAD, which are hyperlipidemia, hyperglycemia, hypertension, inflammation, and oxidative stress, which increase patients' risk of atherosclerosis and, in turn, lead to CAD.

In recent years, growing evidence has established the beneficial effect of the gut microbiota in influencing these cardiovascular risk factors. This microbial ecosystem plays a significant role in metabolic regulation, immune function, and systemic inflammation, all of which are significant to the development and progression of CAD.”³

• The study highlighted bacteria strains that provide significant benefits — For example, they noted that Lactobacillus acidophilus has a more significant effect on cholesterol levels compared to other strains, while Bifidobacteria has protective effects against atherosclerosis, especially if partnered with a lipid-lowering treatment. Bacteroides vulgatus and Bacteroides dorei helped prevent formation of atherosclerotic plaque.*

• Helping reduce inflammation by supporting the gut barrier — The paper emphasized that dysbiosis harms your gut lining, allowing endotoxins like lipopolysaccharides (LPS) to escape into the bloodstream. This may trigger inflammation that contributes to endothelial dysfunction and atherosclerosis.

The trials found that the probiotic strain Lactobacillus rhamnosus reduced LPS levels and inflammatory cytokines like IL-1β, which may help lower cardiovascular strain.

• Shifting short-chain fatty acid (SCFA) balance toward heart-protective molecules — SCFAs are byproducts of bacterial fermentation, and they have a significant impact on your metabolic health. The study found that probiotics promote the production of propionate — a SCFA that has been linked to reduced vascular inflammation and less fat accumulation in the liver. At the same time, it limits acetate, which may contribute to fat storage and cholesterol synthesis in excessive amounts.

Acetate is generally beneficial, as it supports mucus production. But if there’s too much of it, it could cause adverse effects, which is why balance is key. This shift supports healthy blood lipid levels and lowers the burden on your cardiovascular system.

• Reducing trimethylamine N-oxide (TMAO) production from gut microbes — TMAO is a compound created when certain gut bacteria break down foods like red meat and eggs, and having high levels is associated with arterial plaque buildup and heart attacks.

The study found that certain probiotics like Lactobacillus plantarum modulate bile acid metabolism and suppress TMAO-producing bacteria, which may help lower this risk. A separate analysis⁴ found that having high blood levels of TMAO increased the risk of dying from any cause fourfold in the next five years.

• Balancing blood pressure via nitric oxide and ACE pathways — Specific strains like Lactobacillus helveticus may help regulate blood pressure by influencing nitric oxide (NO), a molecule that relaxes blood vessels, and inhibiting angiotensin-converting enzyme (ACE) activity, which raises blood pressure.

A meta-analysis included in the review found that probiotic doses of 10¹⁰ colony-forming units (CFU) or more reduced both systolic (the top number in a reading) and diastolic (the bottom number) blood pressure, especially in older adults with hypertension.

• Improving cholesterol metabolism — Certain probiotics influence how your body processes cholesterol. For example, Ruminococcus helps convert cholesterol into bile acids that are excreted, while other strains incorporate cholesterol into their own membranes or convert it into non-absorbable forms like coprostanol. These actions may help reduce circulating low-density lipoprotein (LDL) levels and slow plaque formation.

• Supporting blood sugar and insulin sensitivity — Probiotics such as Bifidobacterium species may help increase GLP-1, a hormone that boosts insulin secretion and slows gastric emptying — both important for stable blood sugar. They may also help reduce oxidative stress and improve how cells respond to insulin, which may lower the risk of Type 2 diabetes.

• Those who regularly took probiotics have lower blood pressure levels compared to those who did not — On average, their systolic blood pressure was 3.6 millimeters of mercury (mm Hg) lower, while their diastolic blood pressure was 2.4 mm Hg lower. The most significant benefit appeared to be among those whose blood pressure was higher than 130/85, and probiotics that contained a variety of bacteria lowered blood pressure to a greater degree than those containing just one type of bacteria.*

• Kefir demonstrated antihypertensive effects and more — In a 2018 study published in the FASEB journal⁶ researchers conducted an experiment on three groups of rats — one group had hypertension and was given kefir, the other had hypertension, but was not treated, and the third had normal blood pressure and was not treated. They found that rats fed kefir not only appeared to have lower blood pressure levels, but also had:*

“Our data suggest that kefir antihypertensive-associated mechanisms involve gut microbiota-brain axis communication during hypertension,” the researchers concluded.

• An earlier animal study found that probiotics help prevent hypertension from a high-salt diet — Published in the Nature journal, the researchers reported that the Lactobacillus Murinus bacteria was shown to help prevent salt-sensitive hypertension by modulating T helper 17 (TH17) cells in this animal model.* When the mice subjects were given this probiotic strain, it helped protect them from the adverse effects of excessive salt intake.

“Our results connect high salt intake to the gut-immune axis and highlight the gut microbiome as a potential therapeutic target to counteract salt-sensitive conditions," the researchers concluded.⁷

• Those who have metabolic disorders and chronic inflammation may have seen some of the greatest benefits — In individuals with obesity, Type 2 diabetes, cardiovascular issues, or inflammatory bowel conditions, gut dysbiosis is a common denominator. Combining targeted probiotics and plant-derived bioactives helped reduce systemic inflammation, strengthen gut barrier function, and rebalance microbial diversity.

• Specific strains showed unique effects — For example, Lactobacillus rhamnosus and Lactobacillus plantarum boosted production of mucin, a slippery protein that forms protective mucus, helping make the gut lining stronger. Meanwhile, Bifidobacterium longum and Bifidobacterium breve work efficiently in breaking down fiber into SCFAs.

• Certain plant compounds improved probiotic performance — Polyphenols found in tea, berries, and cocoa supported the growth of beneficial bacteria while slowing the spread of harmful ones.

1. Fix your gut microbiome before feeding it — Although fiber is essential for gut health, consuming too much if your gut health is imbalanced will only end up feeding the unhealthy microbes, triggering gas, bloating and toxic byproducts like endotoxins. This is called the fiber paradox — The very substance that promotes a healthy microbiome in the long term worsens symptoms in the short term if introduced too early.

If you're dealing with inflammation or bacterial overgrowth, start by healing your gut. Remove ultraprocessed foods and focus on easy-to-digest carbohydrates like fruit and white rice until your symptoms stabilize. Afterward, you can add in small amounts of more fibrous carbs like root veggies.

Once your gut health is healed, expand your diet by adding non-starchy vegetables, starchy options (sweet potato or squash), beans, legumes, and eventually whole grains with minimal processing.

2. Prioritize bacteria that produce butyrate — Butyrate is an SCFA and is one of the most powerful healing compounds your body makes. It fuels the cells lining your gut, calms immune overactivation, and reduces whole-body inflammation.

Specific gut microbes are needed to produce butyrate, particularly Faecalibacterium prausnitzii, Roseburia, and Eubacterium. They thrive on fermentable fibers found in foods like cooked-and-cooled potatoes, green bananas, lentils, Jerusalem artichokes, and oats. Once your gut lining begins to heal, feeding these bacteria becomes a top priority.

3. Feed Akkermansia correctly — While not a butyrate producer itself, Akkermansia plays a supportive role by maintaining and thickening your gut's mucus layer, creating an ideal environment for butyrate-producing microbes to thrive.

Having higher levels of Akkermansia is strongly associated with improved blood sugar control, lower inflammation, stronger gut barrier function, and even reduced body fat. Think of it as a gatekeeper that improves the terrain, while Faecalibacterium and others generate the fuel. Together, they create a microbiome that's stable, anti-inflammatory and metabolically protective.

Polyphenol-rich foods like pomegranate, red grapes, cranberries, and green tea may help promote Akkermansia growth. So do inulin-containing plants like garlic, leeks, chicory root, and asparagus. Start with small amounts and build as tolerated.

Once your gut symptoms have stabilized — minimal bloating, consistent stool form for at least a week, and improving fiber tolerance — consider starting with a pasteurized Akkermansia postbiotic formula that uses enteric coating or microencapsulation, which helps more of it survive stomach acid and reach your colon. Live Akkermansia may be introduced later, once that tolerance is firmly established.

4. Support gut health at the cellular level — Beyond just adding fiber, you need to remove factors that actively damage your gut environment. One major culprit is excessive linoleic acid (LA) from vegetable oils, which disrupt your mitochondrial function, decreasing your cellular energy production and wrecking your gut environment. Switch to healthier fats like butter, ghee, or tallow instead.

Also, minimize exposure to endocrine-disrupting chemicals and electromagnetic fields (EMFs), as these further impair cellular energy and negatively impact the oxygen-free gut environment that beneficial bacteria like Akkermansia need to thrive.

5. Rebuild daily habits that reinforce microbial balance — Eating at regular times, getting early morning sunlight, sleeping deeply, getting enough daily exercise, and managing stress all shape your gut flora and contribute to your overall health.