One of the most interesting shifts in cardiology over the last decade is the growing recognition that the heart doesn’t operate in isolation from the gut. As a cardiologist who takes a root-cause approach, I find this genuinely exciting, because it opens up levers for heart health that live on your plate rather than in a pill bottle.
The clearest thread connecting the two is a compound called TMAO — trimethylamine-N-oxide. Here’s the sequence: certain gut bacteria feed on nutrients abundant in red meat, egg yolks, and full-fat dairy, and produce a substance that the liver converts into TMAO. Higher blood levels of TMAO have been associated in multiple studies with a greater risk of cardiovascular events. In other words, it’s not only what you eat — it’s what your particular community of gut microbes does with what you eat.
That reframes diet in a useful way. A gut populated by fiber-loving, beneficial bacteria behaves very differently from one shaped by a heavily processed, low-fiber diet. This is a large part of why plant-forward, fiber-rich eating patterns are so consistently good for the heart: they don’t just lower cholesterol, they cultivate a microbiome that produces fewer harmful metabolites and more beneficial ones, like the short-chain fatty acids that help calm inflammation and support healthy blood pressure.
So what actually helps? Feed the good bacteria with a wide variety of plants — vegetables, legumes, whole grains, nuts, and seeds — because fiber diversity drives microbial diversity. Include fermented foods like yogurt, kefir, and sauerkraut, which introduce beneficial organisms. Go easier on the red meat, fried foods, and heavily processed items that tilt the balance the wrong way. These are simple, unglamorous changes, but they work with your biology rather than against it.
The gut-heart axis is still an active area of research, and I’m careful not to overpromise — no single food is a cure, and this complements rather than replaces standard cardiac care and any medications your physician has prescribed. But the direction is clear and encouraging: tending your gut is one of the more powerful and pleasant ways to tend your heart.
This article is for general education and is not medical advice. Discuss dietary changes and any heart concerns with a qualified physician.
About the author
Andrew Rudin, MD is a cardiologist and board-certified cardiac electrophysiologist with more than 20 years of experience. He works as a consultant helping patients take a natural, root-cause approach to heart health — through diet, lifestyle, and supplements — and sees patients via telehealth through Natural Heart Doctor. His expert commentary has been featured in Medscape and Men’s Journal. Learn more at andrewrudin.com. Work with Dr. Rudin at Natural Heart Doctor →