Evaluating the Impact of Dietary Fiber Supplementation in Patients with Heart Failure

Growing evidence suggests that the gut microbiome plays an important role in understanding the origins and development of heart failure (HF). It is also thought that fermentable dietary fiber (FDF) could have a direct impact on the gut microbiome; however, no adequately controlled studies have previously measured the effect of FDF in patients with HF.

The Need for Fiber Addition in Symptomatic Heart Failure (FEAST-HF) trial, recently published in CJC Open, evaluated the feasibility of recruitment and supplementation with FDF in HF patients and sought to determine whether FDF acacia gum reduced the level of N-terminal pro–b-type natriuretic peptide (NT-proBNP, a protein produced by the heart and blood vessels) and growth stimulation expressed gene 2 (ST2, a biological marker for cardiovascular disease), and had a direct impact on the gut microbiome, when compared to placebo.

Study participants, recruited from 3 heart function clinics in Alberta, were 18 years of age or older, had chronic HF, and, at the time, were receiving optimally tolerated medical therapy. Between September 2018 and December 2021, 51 patients were randomly assigned to either one of two intervention arms (5g or 10 g per day of acacia gum) or the control arm.

Study results showed that a dietary supplementation of FDF acacia gum was safe, easy to administer, and well tolerated; however, it did not have an impact on the gut microbiome, NT-proBNP or ST2 levels, or quality of life in ambulatory patients with HF. The study authors recommend further study of FDF in future trials, which could potentially include extended follow-up and either a higher dose or different combination of FDF.

“Food as medicine is an important concept endorsed by organizations such as the American Heart Association,” says Dr. Justin Ezekowitz, CVC Co-Director and Principal Investigator for the study. “While the intervention here disappointingly did not change outcomes for this group of patients, we’ll regroup with our scientific colleagues for next steps, knowing that the CVC can deliver research in many fields.”  

Trial design and operations for FEAST-HF were led by the CVC. This publication was co-authored by the CVC’s Drs. Justin Ezekowitz, Finlay McAlister, and Wendim Alemayehu, along with their colleagues Dr. Eloisa Colin-Ramirez (Universidad Anáhuac México), Dr. Jonathan Howlett (University of Calgary), and Drs. Benjamin Willing, Andrew Forgie, Karen Madsen, and Jason Dyck (University of Alberta).