105: Can Nattokinase Improve Heart & Metabolic Health? with Dr. Ben Bikman

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In this Metabolic Classroom lecture, Dr. Bikman dives into the science behind nattokinase, an enzyme derived from natto—a fermented soybean staple in Japan. Nattokinase has gained attention for its cardiovascular benefits, especially its ability to dissolve blood clots. Ben explains the enzyme’s key role in degrading fibrin, the primary structural protein in clots, and how it stimulates the body’s own clot-dissolving pathway by activating plasminogen. He compares its action to pharmaceutical blood thinners like Warfarin but notes nattokinase may work without the same bleeding risks.

Beyond clot dissolution, Ben explores nattokinase’s effects on atherosclerosis. He shares clinical trial results where nattokinase reduced plaque size and arterial wall thickness, even outperforming statins in some metrics. The enzyme also appears to improve lipid profiles, including lowering triglycerides and slightly boosting HDL. Though Ben remains skeptical of LDL as a reliable heart disease predictor, these lipid changes are seen as beneficial.

The lecture also touches on how nattokinase might support metabolic health. Some human and animal studies suggest the enzyme improves insulin sensitivity, possibly by activating lipoprotein lipase and hormone-sensitive lipase, both involved in fat metabolism. Rodent studies also hint at a role in reducing lipid peroxidation, potentially decreasing levels of oxidized LDL, a strong predictor of heart disease. However, Ben notes more human research is needed to confirm these findings.

Dr. Bikman ends the lecture by acknowledging the limitations of current nattokinase research, such as small study sizes, inconsistent dosing, and questions around supplement bioavailability. Despite these gaps, he finds the cardiovascular evidence promising and suggests those interested might consider trying natto—the whole food source—rather than a supplement. While not a magic bullet, nattokinase offers compelling support for vascular health and metabolic resilience.

Show Notes/References:

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