Probiotics have long been used in functional foods and supplements to restore the gut’s ideal microbial balance and address gastrointestinal (GI) issues. Advances in our understanding of the human microbiome (the collection of trillions of microbes that live in our intestine), however, are rapidly unveiling probiotics’ potential to promote and support heart health. Life sciences companies are harnessing this power to develop non-pharmaceutical solutions for health problems, including high cholesterol and high blood pressure, which is driving exciting innovation in the natural products sector.
Cardiovascular disease and public health
Cardiovascular disease (CVD) is the leading global cause of death, claiming almost 20 million lives each year, according to the World Health Organization (WHO). More people die from CVD than from any other cause.
The condition has been linked to risk factors including abnormal blood lipid levels (high total cholesterol), triglycerides (fat in the blood) and low-density lipoprotein (LDL) and/or low levels of high-density lipoprotein (HDL) cholesterol; all of which increase the likelihood of heart disease and stroke.
High blood pressure is likewise a major public health issue and the single biggest risk factor for stroke, as well as playing a significant role in heart attacks; so much so that lowering blood pressure reduces the risk of heart attack by 20 to 25%, stroke by 35 to 40% and heart failure by 50%.1
The combination of high blood pressure and high cholesterol may lead to the chronic inflammation and hardening of blood vessel walls (arteriosclerosis), which increases the probability of cardiovascular events. The European Society of Cardiology stated that a reduction of both LDL and blood pressure largely eliminates the lifetime risk of cardiovascular disease, with a reduction of up to 90%.
The microbiome and heart health
However, CVD risk depends on many additional factors and much research has been devoted in recent years to examining these. While great advances have been made in genetic research, one of the most promising fields in cardiovascular science is the role that the gut microbiome has been found to play in heart health and disease.
Our intestinal bacteria work with our liver in a continuous, two-way relationship through what is known as the microbiome-liver axis. The liver produces bile salts to help digestion, which some microbes can modify to produce certain chemicals to aid our well-being. This is important for heart health, as research shows that the gut microbiome can affect blood pressure and lipids metabolism via this microbiome-liver pathway and other complex mechanisms that are only starting to be understood.2
Most cardiovascular risk factors can be prevented with first-line lifestyle and dietary changes, from not smoking to maintaining moderate exercise and a healthy diet. Nevertheless, lifestyle changes are not sufficient in many cases, so medications such as statins are required. While usually effective, drugs are not exempt from adverse side effects, especially after long-term treatments, so complementary approaches to heart health are in high demand from the industry, clinicians and the public.
Probiotics are increasingly emerging as one of these strategies, thanks to the tremendous advances being made in microbiome research. A growing body of evidence suggests food microbes can have a beneficial impact on blood lipid levels and blood pressure, with studies showing at least some probiotic strains can impact all the main biomarkers of CVD risk at once.3
This is an enormous advantage over non-probiotic functional food ingredients and drugs, which tend to have narrow therapeutic targets and therefore deliver more specific physiological effects. As live, metabolically active organisms, probiotics can harbor complex and diverse mechanisms of action for a natural, holistic and non-pharmaceutical approach to cardiovascular health.
How does this work?
Approximately one-third of the cholesterol we absorb through the intestine comes from food, and gut microbes are sometimes exposed to it in advance of our intestinal cells. Microbes can reduce the absorption of dietary cholesterol in three main ways. First, some cholesterol is absorbed into the surface of intestinal bacteria.4 Second, some bacteria can break down and assimilate cholesterol for nutrition.4 Third, some microorganisms can transform cholesterol into a chemical called coprostanol, which cannot be absorbed and is thus excreted, lowering the body’s cholesterol levels.5
Probiotics stimulate microbial growth, supporting their beneficial activities. By modulating the human microbiome activity with probiotic support, science is increasingly able to harness its power to reduce cholesterol and blood pressure.
Harnessing the microbiome with functional ingredients
As we learn more about the role of the gut microbiome in cardiovascular health and disease, selected probiotics with specific and complex mechanisms of action will increasingly become firm candidates to aid in the prevention and management of CVD. Probiotics can be incorporated into functional food and supplement products—a popular consumer approach to managing health and diet with optimal convenience.
When it comes to hypertension, probiotic-fermented foods have shown promising results in blood pressure reduction thanks to their chemical content.6 However, recently selected probiotic strains have also been found to lower blood pressure without previous fermentation processes.7 There is therefore great scope for making the benefits of microbiome modulation available to wider markets.
Luis Gosalbez is the director of business development at OptiBiotix Health Plc. in the U.K. Previously, he held different positions in the biotechnology industry and in pharmaceutical consulting in Spain and Germany. His scientific career was developed between Universidad Complutense de Madrid, Centro de Biología Molecular Severo Ochoa-CSIC (both in Spain) and the Korea Advanced Institute of Science and Technology (KAIST, South Korea). His research has always been focused on microbiology, the human microbiome and the development of antimicrobials and antivirals.
1 Antonakoudis G et al. “Blood pressure control and cardiovascular risk reduction.” Hippokratia 2007;11:114–119.
2 Fu J et al. “The Gut Microbiome Contributes to a Substantial Proportion of the Variation in Blood Lipids.” Circ Res. 2015;117:817 LP-824.
3 Costabile A. et al. “An in vivo assessment of the cholesterol-lowering efficacy of Lactobacillus plantarum ECGC 13110402 in normal to mildly hypercholesterolaemic adults.” PLoS One. 2017;12:e0187964.
4 Vaquero M et al. “Properties, structure, and applications of microbial sterol esterases.” Appl Microbiol Biotechnol. 2016;100:2047–2061.
5 Koppel N et al. “Chemical transformation of xenobiotics by the human gut microbiota.” 2017;:356(6344).
6 Khalesi Set al. “Effect of Probiotics on Blood Pressure.” 2014;Oct;64(4):897-903. DOI: 10.1161/HYPERTENSIONAHA.114.03469.
7 Costabile A et al. “An in vivo assessment of the cholesterol-lowering efficacy of Lactobacillus plantarum ECGC 13110402 in normal to mildly hypercholesterolaemic adults.” PLoS One. 2017;12:e0187964.