Over the years, many ANP Commenters have mentioned issues with cholesterol, high blood pressure, and stroke. Recently, ANP Commenter Big Moe sent me an article about nattokinaseindicating that previous dosage recommendations were entirely too low to have an effect on arterial plaque or to improve lipid profiles. Of course, I was interested in learning more, and I will share what I have learned in this article.
But first, the disclaimer(since we're talking about our health):
The information provided in this article is for educational and informational purposes only and solely as a self-help tool for your own use. I am not, nor am I holding myself out to be a doctor/physician, nurse, physician's assistant, advanced practice nurse, or any other medical professional ("Medical Provider"), psychiatrist, psychologist, therapist, counselor, or social worker ("Mental Health Provider"), registered dietician or licensed nutritionist, or member of the clergy. I am not providing health care, medical or nutritional therapy services, or attempting to diagnose, treat, prevent, or cure any physical, mental, or emotional issue, disease, or condition. The information provided in this article pertaining to parasites is not intended to be a substitute for the professional medical advice, diagnosis, or treatment provided by your own Medical Provider or Mental Health Provider. Always seek the advice of your own Medical Provider and/or Mental Health Provider regarding any questions or concerns you have prior to implementing any recommendations or suggestions from this article. Do not disregard medical advice or delay seeking medical advice because of information you have read in this article. Do not stop or start taking any medications without consulting your Medical Provider or Mental Health Provider. The information contained in this article has not been evaluated by the Food and Drug Administration. This article is for educational and informational purposes only, does not constitute medical advice, and does not establish any kind of patient-client relationship by your access of this article. Although I strive to provide accurate information, the information presented here is not a substitute for any kind of professional advice. Always consult a professional in the area for your particular needs and circumstances prior to making any professional, legal, medical, financial, or tax-related decisions.
Nattokinase is an enzyme found in a Japanese culinary dish called natto. In Japanese culture,natto is a traditional food made from whole soybeans that are fermented with Bacillus subtilis.It is a traditionally salt-free dish. Origins of culinary natto are unknown but there are stories of Prince Shotoku (574-622) discovering natto as well as samurai Minamoto no Yoshiie (1039-1106) also discovering natto both using straw to ferment boiled soybeans. In Nepal they called it kinema and in Thailand, they called it thuanao. The Chinese had a similar dish of fermented black soybeans called shi chi or douchi but it was made with salt.
Natto does have a distinct odor which some find unpleasant but others find delicious. Some people discovered if they dried the natto or fried it, the smell is reduced. Natto tends to be very sticky and is usually eaten cold.
Bacillus subtilis is a Gram-positive bacterium named by Ferdinand Cohn in 1872. It can form an endospore enabling it to survive extreme temperatures and desiccation (drying). The European Food Safety Authority has granted "Qualified Presumption of Safety" for this bacterium. It was approved for US drug manufacturing in 1968, for animal drugs in 1990, and as a dietary additive in 1996. Bacillus subtilis natto has 5 functions:
Increase of beneficial bacteria
Inhibition of harmful intestinal bacteria
Producing a proper balance of intestinal flora by the functions above
Producing strong protein degradation enzymes and starch degradation enzymes
A fibrinolytic unit is a standardized unit of measurement where 2,000 FU is equivalent to 100 mg.
When choosing a supplement, look for products independently tested or certified by organizations such as the National Sanitation Foundation (NSF), United States Pharmacopeia (USP), or ConsumerLab. For personalized guidance, consult your healthcare provider, registered dietitian nutritionist (RD or RDN), or pharmacist.
Many of these studies did not use very large doses of nattokinase (dosages were usually about 2,000 FUs per day), they did not do a full empirical research study (treatment group vs placebo group), or they usedmostly healthy people in their study. In the 2022 clinical study a group of researchers from various areas in China coordinated to investigate nattokinase and its effect on atherosclerosis (hardened arteries) and hyperlipidemia (high cholesterol) involving 1,062 ill people. While this study compared large doses (10,800 FU) to small doses (3,800 FU) in people who were ill with the conditions being studied, it was not a blind study with two treatment(s) groups and no control group.
Wei C, Cai R, Song Y, Liu X, Xu HL. Research Progress of Nattokinase in Reducing Blood Lipid. Nutrients. 2025 May 24;17(11):1784 compared with traditional lipid-lowering drugs (e.g., statins and fibrates), nattokinase has a multifaceted lipid-lowering mechanism and lower risk of side effects, which makes it suitable for patients intolerant of traditional drugs; when combined with natural products such as statins, fibrates, red yeast, and lifestyle interventions, it can play a synergistic role and further reduce the risk of cardiovascular disease.
3. May Prevent Blood Clots (which can prevent strokes)
Natto is safe to ingest as a food (contraindications and drug interactions as listed below); the longest nattokinase study was 3 years of daily intake with no side effects.
Contraindications - check with your medical professional if any of the following apply to you:
Blood clotting disorders
Chronic Kidney Disease eGFR below 59
Women who are pregnant
Children
Allergy to natto (fermented soybeans)
Drug Interactions- check with your medical professional if you take any of the following
Blood thinners or other drugs that reduce clotting (aspirin or ibuprofen) and could cause excess bleeding and bruising.
Cholesterol medications (statins).
Blood pressure medications - could lead to to very low blood pressure.
It is recommended to stop taking nattokinase at least 1 week (but 2 is better) before any surgery to avoid excessive bleeding.
Bottom line?
Check with your health professional and remember that a nattokinase dose of over 10,000 FU daily is not likely to cause any issues in most people and may provide faster results in treating symptoms, provided you do not have any contraindications.
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