Protective Effects of Nattokinase against Strokes

This article discusses how nattokinase can protect the brain from the destructive effects of strokes.

Nattokinase (NK) is an enzyme derived from natto, a fermented Japanese food. It has been consumed for over a thousand years.

Stroke

Strokes or ischemic cerebrovascular accidents (CVA) cause cerebral ischemia. A condition where blood and oxygen supply to the brain tissues are lost. If not reperfused, neurons die, and a body part’s function is lost.

Typically, the offending clot can come from the heart if there is atrial fibrillation (AF). In AF, the left atrium, one of the heart’s upper chambers, quivers instead of pumping. The shivering starts blood clotting.

That is why people with AF are typically on blood thinners like warfarin or apixaban (Eliquis) and dabigatran (Pradaxa).

Another common cause is a piece of atherosclerosis or clot that broke off from an atherosclerotic plaque from the carotid artery.

Brain tissue damage from stroke

Cerebral ischemia releases calcium in the arteries in the brain and causes them to constrict to compromise the blood flow further. Apoptosis or programmed cell death can also happen to neurons that don’t have enough oxygen (hypoxic).

Typically, the body uses its tissue plasminogen activator (TPA) to form plasmin that dissolves the fibrin in the blood clots with its fibrinolytic effect. However, it is not predictable how fast that can happen.

TPA

That’s why hospitals specializing in strokes (stroke centers) use big pharma-formulated recombinant TPA to dissolve the blood clots. Careful monitoring happens next since intracranial bleeding may occur after. If it happens, it will be a disaster because the bleeding will be inoperable for several hours due to the presence of blood thinners.

Ischemia-reperfusion injury can also happen once the blockage is removed. The resumption of blood flow can trigger inflammation and damage more tissues. It can occur in stroke, myocardial infarction, and limb ischemia.

With that brief background, here is how NK could be helpful in cerebral ischemia.

Neuroprotective Effects of Nattokinase on Strokes

Prevention

Anti-atherosclerosis

NK protects against strokes by preventing glucose spikes and insulin resistance, which are the root causes of atherosclerosis.

Insulin Resistance and Atherosclerosis and the Nattokinase Solution

But if atherosclerosis is already present, NK can still help. Nattokinase has been shown to decrease atherosclerosis in two human studies. I discussed those at:

Anticoagulant

Nattokinase is an effective anticoagulant as it prevents blood clots from forming. One way is by blocking platelet clumping that starts a clot. Typically aspirin is initiated in some patients to avoid clots. However, between 8 % and 45% of patients are aspirin resistant.[2]

Moreover, some patients cannot take aspirin for one reason or another. One study from Bulgaria shows how NK may be of help.

Nattokinase vs. Aspirin and Clopidogrel

A study by Maslarov and Drenska studied two groups. One took nattokinase (NK) (160 mg, 3,000 FU) n=96. Another took aspirin (325 mg) and clopidogrel (Plavix 75 mg daily) n=95. All were followed for six months.

The NK group consisted of those who could not take aspirin. They are the following:

Moderate and high risk of gastrointestinal bleeding (62.5%)
A history of cerebral hemorrhage (6.3%)
Rare episodes of atrial fibrillation/flutter (12.5%)
Individual intolerance or unwillingness for treatment with antithrombotic drugs (18.7%).
17.7% of patients have cancer compared to 12.6% of the control group.

The results showed no statistical difference between the NK versus the aspirin and Plavix groups in the number of ministrokes or Transient ischemic Attacks (TIA), strokes, and heart attacks after six months of follow-up.[2]

The image below compares the number of cardiovascular diseases, TIA, and strokes in the gray nattokinase and red aspirin, and Plavix groups. m=months.

Source: Maslarov D, Drenska D. Use of Nattokinase in patients with ischemic stroke and transient ischemic attacks. Neurol Neurosci. 2020; 1(2):1-5.

More importantly, the number of adverse reactions in both groups was also statistically insignificant.[2]

Therapeutic

Dissolves Fibrin

Platelets and red blood cells adhere to a scaffold of fibrin bridges. NK has fibrinolytic properties that can dissolve the fibrin bridges and allow blood flow to resume. It is interesting to note that TPA and NK are both serine proteases. Proteases are enzymes that can cleave peptide bonds in proteins.

Ahn et al. showed that NK prevented the formation of a blood clot and hastened the dissolution of blood clots in an experimental stroke in animals resulting in improved blood flow in all brain regions.[1]

Ultimately, the volume of the infarcted brain was smaller in those that received nattokinase compared to the control.[1]

Wang et al. also demonstrated a 54-68% reduction in infarct volumes in both low and high-dose NK doses in gerbils. A low dose (4mg/day) of NK was also shown to decrease inflammation following strokes. [4]

Mechanisms of Cerebral Protection

Ji et al. examined the intricate pathways on how NK can protect the brain. They found the following.[3]

NK has antiplatelet activity.
NK has anti-apoptosis activity and could prevent brain cell death.
NK can relax smooth muscles by releasing nitric oxide in blood vessels and increasing blood flow.
NK increases fibrinolytic activity and facilitates spontaneous thrombolysis.

In summary, nattokinase prevents strokes by preventing and decreasing atherosclerosis. It can inhibit and dissolve blood clots and protects brain cells from injuries due to low oxygen levels.

Talk to your doctor before starting any supplements. The following contains affiliate links.

Doctor’s Best Nattokinase – 2,000 FU of Enzyme – this formulation is NSK-SD with no vitamin K2. Vitamin K2 counters the effect of warfarin.
Best Naturals Nattokinase, 2000 FU, 100 Mg, 90 Vegetarian Capsules – This has vitamin K2 that is good for cardiovascular and bone health.

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References:

Ahn Y et al. Neuroprotective Effect of Nattokinase Mediated by Inhibition of Platelet Aggregation and Thrombosis in Photothrombotic Stroke. Stroke. 2015;46:AWP262. 9 Feb 2015. https://doi.org/10.1161/str.46.suppl_1.wp262
Maslarov D, Drenska D. Use of Nattokinase in patients with ischemic stroke and transient ischemic attacks. Neurol Neurosci. 2020; 1(2):1-5.
Ji H, Yu L, Liu K, Yu Z, Zhang Q, Zou F, Liu B. Mechanisms of Nattokinase in protection of cerebral ischemia. Eur J Pharmacol. 2014 Dec 15;745:144-51. doi: 10.1016/j.ejphar.2014.10.024. Epub 2014 Oct 27. PMID: 25446567.
Wang JM, Chen HY, Cheng SM, et al. Nattokinase reduces brain infarction, fibrinogen and activated partial thromboplastin time against cerebral ischemia-reperfusion injury. J Food Drug Anal. 2012; 3: 686-91.
Chen H, McGowan EM, Ren N, et al. Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases. Biomark Insights 2018; 13: 1177271918785130.
Pham PT, Han B, Hoang BX. Nattospes as Effective and Safe Functional Supplements in Management of Stroke. J Med Food. 2020 Aug;23(8):879-885. doi: 10.1089/jmf.2019.0183. Epub 2020 Jan 14. PMID: 31934821; PMCID: PMC7415874.

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