Heat stress is a major problem for dairy cows in hot climates, thus coping strategies are essential. This study evaluated the effects of increasing diet fermentability on intake, total tract digestibility, ruminal pH and volatile fatty acids (VFA) profile, blood metabolite profile and milk production and composition of lactating dairy cows managed under conditions of ambient heat stress. Nine multiparous cows (650 ± 56 kg BW; mean ± SD) averaging 102 ± 13 days in milk and producing 54 ± 6 kg/day were randomly assigned to a triplicate 3 × 3 Latin square. During each 21-day period, cows were offered one of three total mixed rations that varied in diet fermentability. The three levels of diet fermentability were achieved by increasing the proportion of pellets containing ground wheat and barley in the dietary DM from 11.7% (low), to 23.3% (moderate), and 35.0% (high) by replacing ground corn grain. Each period had 14 day of adaptation and 7 day of sampling. The ambient temperature–humidity index ( ≥ 72) indicated that the cows were in heat stress almost the entire duration of the study. Also, rectal temperature of cows was elevated at 39.2°C, another indication of heat stress. Increasing diet fermentability linearly decreased dry matter intake (22.8, 22.5, 21.8 kg/day for low, moderate and high, respectively; P ≤ 0.05) but increased non-fibre carbohydrate digestibility (P ≤ 0.05) and tended to increase digestibility of DM (P = 0.10) and crude protein (P = 0.06). As a result, the intake of digestible DM was not affected by the treatments. The production of 3.5% fat corrected milk (32.6, 33.7, and 31.5 kg/day) was quadratically (P ≤ 0.05) affected by diet fermentability with lower production for the high diet compared with the other two, which were similar. Rumen pH (ruminocentesis) and proportions of butyrate and isovalerate linearly decreased whereas propionate proportion linearly increased with increasing diet fermentability (P ≤ 0.05). The rumen concentration of NH3-N (11.0, 9.0, and 8.7 mg/dL) and blood concentration of urea linearly decreased with increasing diet fermentability (P ≤ 0.05). The activity of alkaline phosphatase increased (65.1, 83.2, and 84.9 U/l) and concentration of malondialdehyde decreased (2.39, 1.90 and 1.87 µmol/l) linearly with increasing diet fermentability (P ≤ 0.05), which indicated possible attenuation of the effects of oxidative stress with increasing diet fermentability. Overall, a modest increase of diet fermentability improved nitrogen metabolism, milk protein production and oxidative stress of heat-stressed dairy cows, but a further increase in diet fermentability decreased milk yield.