When most people think about heart health, they think about cholesterol, blood pressure, exercise, and diet. But growing research suggests that another important influence may begin much farther down in the body: the gut.
The trillions of microorganisms living in the digestive system form the gut microbiome. These bacteria help process nutrients and produce compounds that may affect far more than digestion, including inflammation, metabolism, and cardiovascular health.
This relationship is often described as the gut-heart axis. Researchers are studying how an imbalanced microbiome may contribute to the production of certain metabolites, including trimethylamine N-oxide, or TMAO.
Elevated TMAO levels have been associated with processes involved in inflammation and arterial plaque formation. At the same time, scientists are continuing to explore ways to support healthy circulation, including enzymes such as nattokinase.
The connection is not as simple as blaming one food, one bacterium, or one compound for heart disease. Instead, the gut-heart axis offers a broader look at how different systems in the body may work together to influence cardiovascular wellness.
Learn how the Heartstrong Enzyme Formula Extra Strength is designed to support healthy circulation and explore whether it may fit into your broader heart-health routine.
What Is the Gut-Heart Axis?
How Your Gut Microbiome Communicates With the Rest of Your Body
The gut microbiome is made up of trillions of microorganisms living primarily in the digestive tract. These organisms interact with the food you eat and help produce a wide range of metabolites and signaling molecules.
Those signals can extend beyond the digestive system. Researchers are studying how the microbiome may interact with the immune system, metabolism, inflammation, and blood vessel function, potentially influencing cardiovascular health.
This is why gut health is increasingly being discussed as part of whole-body health. The composition and activity of the microbiome may influence processes that reach far beyond the intestines.
Why Microbiome Balance Matters for Heart Health
A balanced and diverse microbiome may support normal metabolic and immune function. When the microbial environment becomes disrupted, it may alter how certain nutrients are processed.
These changes may also affect the types and amounts of metabolites produced by gut bacteria. Some of these metabolites are now being studied for their possible effects on cardiovascular health.
The gut microbiome is not the only factor that influences the heart. However, it may be an important piece of the larger cardiovascular picture.
The Gut-Heart Connection Is More Than Digestion
The gut and heart are connected through multiple pathways involving the immune system, metabolism, and compounds produced by gut bacteria that can circulate throughout the body.
Inflammatory signals and microbial metabolites can enter the bloodstream and potentially influence processes throughout the body. This has made the gut-heart axis an important area of cardiovascular research.
One metabolite that has received significant scientific attention is TMAO. Understanding how it is produced helps explain why the composition of the gut microbiome may matter for arterial health.
How Gut Bacteria Contribute to TMAO Production
The Role of Choline and L-Carnitine
Certain foods contain nutrients such as choline and L-carnitine. Depending on the bacteria present in the gut, these nutrients can be processed into a compound called trimethylamine, or TMA.
Foods such as red meat and eggs contain nutrients like L-carnitine and choline that can serve as precursors for TMA production. However, TMA production varies between individuals and depends in part on the composition of their gut microbiome.
This means TMAO production is more complex than simply labeling one food as “good” or “bad” for the heart.
From Trimethylamine to TMAO
After gut bacteria produce TMA, it travels to the liver. The liver then converts it into trimethylamine N-oxide, commonly known as TMAO.
The liver primarily converts TMA into TMAO through an enzyme called flavin-containing monooxygenase 3, or FMO3.
Once TMAO enters circulation, it becomes part of a growing area of research focused on cardiovascular and metabolic health.
Scientists are continuing to investigate why some individuals may produce higher levels than others and how those differences may relate to overall cardiovascular risk.
Why TMAO Has Drawn Attention From Heart Researchers
Research has associated elevated TMAO levels with several processes relevant to cardiovascular health. These include inflammation, changes in cholesterol metabolism, and mechanisms involved in arterial plaque development.
However, association does not mean that TMAO alone causes cardiovascular disease. Heart disease is influenced by many interacting factors, including blood pressure, cholesterol, smoking, diabetes, genetics, and lifestyle.
TMAO may help researchers better understand how gut microbial activity and metabolism can influence the cardiovascular environment.
TMAO, Inflammation, and Arterial Plaque
How Inflammation Can Affect the Arteries
Inflammation is part of the body's normal defense system. But when inflammatory activity becomes persistent, it may contribute to processes that affect tissues and blood vessels over time.
Chronic inflammation is considered an important factor in cardiovascular disease. It can contribute to changes in the arterial environment and interact with other risk factors involved in atherosclerosis.
Researchers are studying whether metabolites produced through interactions between diet and gut bacteria may influence these inflammatory processes and contribute to cardiovascular risk.
The Connection Between TMAO and Arterial Plaque Formation
Arterial plaque develops through a complex process involving cholesterol, immune activity, inflammation, and changes in the walls of the arteries.
Elevated TMAO levels have been associated with mechanisms that may contribute to atherosclerosis. Researchers continue to investigate how these processes interact and which individuals may be most affected.
It is important to remember that TMAO is one possible piece of a much larger puzzle. No single metabolite can fully explain why arterial plaque develops.
Factors That May Work Together to Affect Arterial Health
The gut microbiome and TMAO exist within a much larger network of cardiovascular influences. Long-term arterial health can be affected by several interconnected factors, including:
- High LDL cholesterol and other lipid abnormalities
- High blood pressure
- Chronic inflammation
- Smoking
- Diabetes and metabolic dysfunction
- Poor dietary patterns
- Low physical activity
- Genetic and family history factors
Looking at these factors together provides a more realistic understanding of cardiovascular health than focusing on a single marker alone.
Can an Unbalanced Microbiome Influence Cardiovascular Risk?
Microbiome Imbalance and Systemic Inflammation
An imbalanced microbiome may affect the way nutrients are processed and influence the production of compounds that interact with the immune system.
Researchers are exploring how changes in the gut environment may contribute to inflammatory signaling that extends beyond the digestive tract.
These processes may contribute to systemic inflammation, which can affect multiple parts of the body, including the cardiovascular system.
Why the Same Foods May Affect People Differently
Two people can eat similar foods and still have different metabolic responses. One possible reason is that their gut microbiomes may differ in composition and activity.
The bacteria present in the digestive tract can influence how certain nutrients are processed and which metabolites are produced.
This helps explain why researchers are becoming increasingly interested in personalized approaches to nutrition and cardiovascular risk.
Supporting the Gut-Heart Axis Through Daily Habits
There is no single perfect microbiome or one lifestyle habit that guarantees heart health. A more useful approach is to support overall health through consistent habits.
A heart-conscious lifestyle may include eating a varied, fiber-rich diet that supports a diverse gut microbiome, staying physically active, managing stress, and getting adequate sleep.
These habits can support multiple systems at the same time, including metabolism, inflammation, digestive health, and cardiovascular wellness.
A varied diet rich in fiber from vegetables, fruits, legumes, whole grains, nuts, and seeds can help provide nutrients that support a diverse gut microbiome.
Where Does Nattokinase Fit Into the Gut-Heart Conversation?
Nattokinase Is Not a TMAO Treatment
Nattokinase should not be described as a treatment that removes TMAO from the body or directly restores an imbalanced gut microbiome.
Its role in this conversation is different. Nattokinase is an enzyme that has attracted scientific interest because of its fibrinolytic activity and its potential role in supporting healthy circulation.
This distinction is important because the gut-heart axis involves many interconnected processes, and no single enzyme can address every aspect of cardiovascular health.
Understanding Nattokinase and Fibrinolytic Activity
Nattokinase is derived from natto, a traditional Japanese food made from fermented soybeans. It has been studied for its ability to interact with fibrin and processes involved in the body's natural clotting and circulatory systems.
Fibrin is a protein involved in normal blood clotting. Because of nattokinase's fibrinolytic activity, researchers have explored its potential role in supporting healthy circulation.
Research is still evolving, and nattokinase should not replace prescribed medical treatment or individualized cardiovascular care.
The available clinical evidence is still developing, so its potential cardiovascular benefits should be interpreted with caution.
A Broader Approach to Healthy Circulation
The gut-heart axis highlights how interconnected the body can be. Gut bacteria may influence metabolite production, metabolites may interact with inflammatory processes, and inflammation can affect the cardiovascular environment.
Nattokinase fits into this broader conversation as an enzyme being studied for its potential role in supporting healthy circulation. It does not directly address microbiome imbalance or eliminate TMAO.
Instead, it may be considered as part of a comprehensive approach that also includes healthy lifestyle habits and attention to established cardiovascular risk factors.
FAQs
Frequently Asked Questions About the Gut-Heart Axis, TMAO, and Nattokinase
What is the gut-heart axis?
The gut-heart axis refers to the relationship between the gut microbiome and cardiovascular health. Researchers are studying how gut bacteria, microbial metabolites, inflammation, and metabolic processes may influence the heart and blood vessels.
What is TMAO and why is it important?
TMAO, or trimethylamine N-oxide, is a metabolite produced through interactions between certain dietary nutrients, gut bacteria, and the liver. Elevated levels have been associated with cardiovascular processes involving inflammation and arterial plaque.
Does an unhealthy gut microbiome cause arterial plaque?
An unhealthy or imbalanced microbiome should not be considered the sole cause of arterial plaque. Atherosclerosis develops through multiple factors, including cholesterol, blood pressure, inflammation, genetics, smoking, and metabolic health.
The gut microbiome may be one additional factor that influences the overall cardiovascular environment.
Can nattokinase lower TMAO levels?
Nattokinase should not be presented as a supplement that lowers TMAO or directly corrects the gut microbiome. Its scientific interest is primarily related to fibrinolytic activity and its potential role in supporting healthy circulation. If you take anticoagulant or antiplatelet medications, talk to your healthcare professional before using nattokinase.
Ready to take a more comprehensive approach to cardiovascular wellness? Explore the Heartstrong Enzyme Formula Extra Strength and discover how nattokinase and serrapeptase are incorporated into Heartstrong's approach to healthy circulation.
AUTHOR:
Mike Woods is the founder of Heartstrong and has over three decades of experience in the nutritional supplement industry. For more than 30 years, he has been involved in educating consumers about cardiovascular wellness, circulation support, healthy aging, and evidence-based nutritional strategies that promote long-term health.
Through Heartstrong, Mike focuses on translating complex scientific and health information into accessible resources that help readers better understand topics such as arterial health, inflammation, calcium buildup, circulation, and preventive wellness. His work is centered on empowering individuals to take a proactive approach to their health through education, lifestyle modifications, and informed wellness choices.
Mike regularly researches emerging developments in cardiovascular health and nutritional science and is committed to providing educational content that supports healthier aging and overall well-being.
Connect on LinkedIn.
DISCLAIMER:
Disclaimer: According to federal guidelines customer testimonials must be indicative of typical results. Obviously, we do not have, nor do we collect, our customers private health records so we cannot make claims about “typical” results. These testimonials were shared with us by confirmed clients, but we cannot say whether these results are typical or not. We share them in good faith.