Background: Active polysaccharides are a class of important active ingredients extracted from natural substances, which are used in the fields of food, medicine and health care. As a natural intestinal microecological regulator, active polysaccharides are widely used to regulate intestinal microecology, intestinal tumors, and intestinal inflammation due to their abundant availability, stable efficacy, and few side effects. With the increasing use of active polysaccharides in therapeutic studies for a variety of gut-related diseases, it is increasingly important to explore their effects on gut and organismal health. Scope and approach: This review focuses on the effects of the monosaccharide composition of polysaccharides, the type of glycosidic bonding, and molecular weight size on organisms, providing a theoretical basis for food and drug development. The modulatory effects of active polysaccharides on the gut microbiota, mechanical barriers, immune barriers, and mucus barriers are summarized, and the mechanisms of action of active polysaccharides in the host are discussed. In addition, this review describes the effects of active polysaccharides on the health of the body, including enhancement of antioxidant and immune system function, antitumor and inflammation-reducing effects, and blood glucose and lipid level regulation. Key founds and conclusion: Active polysaccharides have a broad application prospect in the food and drug field, so this review provides new ideas for food and drug development by presenting the latest research in the field of active polysaccharides use to maintain intestinal health and their protective effect on the overall health of the organism.