Gut microbiota–mediated cardiovascular effects of Gastrodia elata polysaccharides: resolving the bioavailability–efficacy paradox

Background Growing evidence suggests that many plant-derived polysaccharides exert systemic effects through gut microbiota–mediated mechanisms rather than direct absorption. Gastrodia elata polysaccharides (GEPs) represent a promising but mechanistically complex class of bioactive compounds with potential cardiovascular relevance. Objective This review aims to examine the role of gut microbiota in mediating the biological effects of GEPs, with particular focus on resolving the bioavailability–efficacy paradox through host–microbe interactions. Methods A narrative synthesis of recent literature was conducted, integrating data on microbiota–polysaccharide interactions, microbial fermentation processes, metabolite production, and downstream host signaling pathways. Results Due to limited systemic bioavailability, GEPs undergo extensive fermentation by gut microbiota, generating bioactive metabolites such as short-chain fatty acids and secondary bile acids. These metabolites modulate key host pathways including inflammation, oxidative stress, endothelial function, and lipid metabolism. Emerging evidence highlights the central role of the gut–heart axis in mediating these effects. Conclusion The biological activity of GEPs is best understood within a microbiota-centered framework. This perspective provides new insights into polysaccharide pharmacology and supports the development of microbiome-targeted therapeutic strategies.