Question explored with the scientific record
Conversation so far
- 1 Do statins increase life expectancy and by how much?
- 2 Do statins reduce strokes
- 3 What are the best strategies to lower ldl
- 4 Does Repatha actually reduce arterial plaque
- 5 What about using nattokinase for plaque reduction
Answered on this page ↓
What about using nattokinase for plaque reduction
The short version: the best trial we have found no plaque reduction from nattokinase, and the weaker studies that claim it are too small to trust.
The strongest evidence is a double-blind, randomized, placebo-controlled trial in 265 healthy older adults given 2000 fibrinolytic units of nattokinase daily for about three years [3]. It found no reduction in carotid intima-media thickness (CIMT) progression: the nattokinase group progressed at 0.013 mm per year versus 0.011 mm in the placebo group, a difference that was not statistically significant (p = 0.31) [3]. Arterial stiffness, blood pressure, and all measured coagulation and lipid biomarkers also showed no benefit [3]. This trial was not funded by a supplement manufacturer and used a true placebo group, which makes it the most reliable piece of evidence in the retrieval.
The claims for plaque reduction come from smaller, shorter, and weaker studies. One study of 30 adults with carotid thickening reported that adding nattokinase (1500 FU/day) to standard lipid-lowering drugs for 90 days reduced plaque size by about 36% [2]. A retrospective study of 1062 people taking a very high dose (10,800 FU/day) for a year reported a 36% reduction in plaque area and a 21.7% reduction in IMT [2]. Both are observational or uncontrolled, meaning they cannot separate the supplement's effect from regression to the mean, concurrent medication changes, or lifestyle shifts. The retrospective study had no true control group at all [2].
| Study | Design | N | Duration | Plaque/IMT result |
|---|---|---|---|---|
| RCT [3] | Double-blind, placebo-controlled | 265 | ~3 years | No reduction in CIMT progression (p=0.31) |
| Small trial [2] | Add-on to standard therapy, no blinding stated | 30 | 90 days | 36% plaque area reduction |
| Retrospective [2] | No control group | 1062 | 1 year | 36% plaque area reduction |
The rat study from 2003 showed that a natto-derived protein enhanced thrombolysis and lowered fibrinogen [1], but that is a mechanism in animals, not evidence of plaque reduction in humans. A separate review noted that nattokinase lowered fibrinogen by 7-10% in small human groups [4], but lower fibrinogen does not equal plaque shrinkage.
My call: the only rigorous human trial found no plaque reduction from nattokinase. The positive claims come from small, uncontrolled studies that cannot be trusted. Confidence: low for any plaque-reduction benefit.
Sources used 4
-
The Effect of Dietary Bacillus Natto Productive Protein on in vivo Endogenous Thrombolysis
In rats, 14 weeks of dietary Bacillus natto productive protein (BNPP) enhanced endogenous thrombolysis dose-dependently; 1% BNPP matched 0.2 mg/kg i.v. t-PA and lowered plasma fibrinogen, while argatroban was not additive.
DOI: 10.1159/000077822 -
Research Progress of Nattokinase in Reducing Blood Lipid
This review synthesizes current knowledge on nattokinase (NK) — a natto-derived serine protease — detailing its sources, structure, lipid-lowering mechanisms, clinical evidence, safety, and potential combinations with conventional therapies, while outlining future research direc…
DOI: 10.3390/nu17111784 -
Nattokinase atherothrombotic prevention study: A randomized controlled trial
A double-blind, randomized controlled trial in healthy older adults found that daily nattokinase (2000 fibrinolytic units) over about 3 years did not reduce subclinical atherosclerosis progression (carotid intima-media thickness and arterial stiffness) or improve cardiovascular …
DOI: 10.3233/CH-211147 -
Natural Remedies Lower Elevated Fibrinogen Levels in the Prevention of Atherosclerosis
This study reviews evidence that elevated plasma fibrinogen levels are both a consequence and predictor of cardiovascular disease (CVD), and discusses various natural remedies that can effectively lower these levels to prevent CVD.
DOI: 10.4172/2573-4555.1000247