Aspirin vs Nattokinase for Clogged Arteries (Which One Wins?)
In a Nutshell
Aspirin has far stronger evidence for preventing actual heart attacks and strokes in people with arterial plaque, while nattokinase shows plaque reversal in only one short study and lacks outcome data. Low-dose aspirin is recommended for those with confirmed plaque if they can tolerate it, with nattokinase as a reasonable second option for those who can't. Neither should be combined with other blood thinners, and both require proper artery imaging (calcium score or CIMT) to determine actual risk before use.
These notes were generated by AI and may contain inaccuracies.
Nattokinase has become one of the most popular dietary supplements online because research indicates its ability to remove plaque from arteries within a few months. If patients would rather not add another prescription to their pile of medications, reading about this sounds appealing. The channel is one of the strongest channels in terms of reversing plaque buildup, because it actually happens.
Sixty years ago, doctors prescribed aspirin to anyone over the age of fifty or sixty. The recommendation regarding aspirin has changed completely. Initially it was suitable for everyone based on age, then the U.S. Preventive Services Task Force said it should no longer be prescribed based on age. But then it changed its tune again, saying that if you have arterial plaque and are high risk, then maybe you should take aspirin. The speaker has been saying this for a few years as well.
The comparison between aspirin and nattokinase seems settled before the day even began, as if all you had to do was eat natto and nattokinase and you'd be fine, and do not take aspirin. The study of the plaques that everyone quotes is not the study that should settle this matter. There is one result that determines whether aspirin will protect you or harm you. That result is not your cholesterol level, and it is not any number from the tests your doctor performed last spring. If you miscalculate in either direction, you could end up having a heart attack even though your lab results appeared normal. Or on the other hand, you may end up with serious bleeding from something you thought wouldn't hurt you.
The speaker will explain what nattokinase and aspirin actually do to the body, and the advantages and disadvantages of each, so that patients know what to choose if the need arises. Once patients know what they're choosing, they won't have to listen to their doctor, their nurse, the speaker, or anyone else online. Patients make their own decision, which is seen as the most effective, appropriate, and best way to do it. The speaker is not saying this for reasons of freedom or for liberal political reasons, but because the medical evidence and research are very clear.
If patients are involved in their healthcare, they will be in a much better position, especially with chronic diseases which represent 80% of illnesses. All that is being discussed here are chronic diseases and vascular diseases. Therefore, it is best for patients to participate in making their own decisions. If patients know which of these things might cause them a heart attack or help them avoid one, this is what they should be able to do by the end of the video.
The speaker will give their direct answer about what they recommend and when, and will tell what they personally are eating at the moment. This may surprise some after hearing the rest of the opinions on this subject.
Nattokinase is an enzyme extracted from natto. Natto is a dish made from fermented soybeans. It is a traditional breakfast food in Japan and has been around for a thousand years. The speaker worked for Toyota for about a decade, went to Japan several times, and tried natto, or what they used to call rotten soybeans. It's a taste that needs to be gotten used to; unless you eat it a few times and get used to it, it will taste very bad.
The enzyme itself does three things worth understanding. The first one is direct: when the body builds a clot, it lays down a mesh to hold that clot together. That network stabilizes the platelets, which will be discussed later when talking about aspirin. Nattokinase works to break down that network.
The second thing is indirect, and more interesting. The body already has a special system for dissolving blood clots, and this system works in the presence of a brake. Nattokinase removes that inhibitor. Therefore, it becomes easier for the body to dissolve the clots.
The third thing is that nattokinase works by reducing the raw materials in the blood that it uses to build a clot in the first place.
Nattokinase is not a vitamin. It is an enzyme. It is a real substance that has effects similar to some drugs, namely blood thinners. What are known as blood thinners. Some of them are antiplatelet drugs, and some of them are drugs for anticoagulation mechanisms. These are sold as dietary supplements. Nattokinase is one of them, and most of the other types discussed are prescription drugs. You can measure the effect of nattokinase in the blood a few hours after taking a single dose of it. The enthusiasm surrounding nattokinase did not come from nowhere. It is effective.
Aspirin works on a completely different part of the clotting system. However, this difference matters more than most people realize. Think of platelets as cells, although they are not cells in the technical sense, they are merely parts of cells. They clump together. This blockage prevents any leakage. Before they can coalesce, one of them must send a signal to the others telling them they have found a leak and must come and join to fill the gap by gathering together. Aspirin stops that signal. It permanently stops every platelet it touches. Therefore, once aspirin stops the aggregation signal in a blood platelet, that will not change for the next few days. Its life will simply end. Other platelets will have to be replaced. Therefore, a single dose of aspirin will not be able to repair the damage or create a replacement for that assembly mechanism. You just need to produce new platelets.
One low-dose aspirin tablet takes that part of the platelet out of service for the rest of that platelet's lifespan. Platelet age ranges from about a week to ten days. This is part of the reason why the dose of aspirin is so small. You don't want to eliminate the function of all your platelets at once. That would be extremely dangerous. You hear a lot about blood thinners, and the speaker has used that term. We don't dilute anything, actually. You are simply reducing your blood's tendency to clump and form a clot in the first place. Keep this in mind as we move forward, because it is the whole reason why these two things cannot be considered one thing or interchangeable.
Nattokinase works on the clot that has already begun to form. Aspirin works on platelets, those tiny cells or cell fragments that would have started the clot in the first place. We have two different substances that perform two completely different functions, both of which lead to thinning the blood or reducing clotting. The question is, what has been proven to actually do each of them in the real human body.
The enthusiasm for nattokinase comes from one study that lasted about 6 months on patients who already had plaques in their carotid arteries. The area of the plaques decreased by approximately one-third. The artery wall became noticeably thinner. It outperformed the statin drug it was compared to. This is a good study, it lasted 6 months, the number of participants was large, and it was compared to statins, which is what most people in the medical community look at today, and it outperformed statins. In this study, nattokinase outperformed statins in reversing plaque growth. It's an amazing result.
There is a second experiment, and hardly anyone quotes this second experiment because it is disappointing. This experiment lasted 3 years instead of 6 months, and hundreds of people participated. None of the participants knew who was taking the real capsule and who was taking the placebo. In other words, it was a well-designed, randomized, double-blind clinical trial. They examined the neck arteries every 6 months for two years, and the result was nothing. Nothing at all. The scans found nothing. No change in the artery wall, no change in stiffness, and nothing in blood pressure.
The experiment that found nothing used a lower dose than the one that found results. The dosage might have been the key. We simply don't know yet. It is likely that it was not a sufficient dose, and that there is a limiting level here. This is a real limitation on the evidence we currently have before us. However, every part of this enthusiasm is built on the image of an artery. We are talking about an image of an artery. We don't talk about what happened to the people. Did they actually have a heart attack?
No one has ever conducted a study asking whether aspirin shrinks plaques. So, on that scoreboard, the plaque reduction scoreboard, aspirin has nothing to show. There is a tremendous amount of excitement surrounding nattokinase because nattokinase has actually reversed some plaques, at least in one study. There is very little interest in the ordinary old aspirin. It's old. It's boring. It's not really interesting. But what aspirin has instead is 60 years of counting the things you actually care about, so why would you want to reverse the plaques? Because you don't want to have a heart attack. Well, aspirin has 60 years of evidence regarding heart attacks.
For example, in men who had already had a heart attack, aspirin reduced the chances of having a second attack by about 20%, or one-fifth. This means fewer men in the emergency room due to a heart attack. And those studies are not small. These are not studies on 100 or 200 people. It's big. It is long-lasting. This has been repeated for decades in different countries by different research teams. We are talking about real evidence here. There are mountains of evidence here on aspirin at low doses.
Aspirin has mountains of evidence compared to the hills or perhaps small bumps of evidence for nattokinase. And mountains of evidence about cases prevented, heart attacks averted, and heart attacks and strokes reduced thanks to aspirin compared to far less evidence for nattokinase. This is the difference between the two sets of evidence. One of them is the reversal of plaque buildup, which may also mean a reduced risk of cardiovascular disease and a reduced risk of heart attack. But the other is a reduction in actual heart attacks, even if no one has conducted a study measuring the reversal of plaque buildup with regard to aspirin.
Doctors have been promoting aspirin for 60 years to prevent heart attacks and strokes. Then it seemed as if they had stopped doing that about 8 years ago. They were looking at three large experiments that dealt with this specific issue. Three research groups, healthy individuals, and then all of that was reviewed. What they found was that in men and women who do not have heart disease, the protection is real, but minimal. It is so small that the bleeding caused by aspirin negated most of what it prevented in terms of damage. So, they changed their recommendation after that. The U.S. Preventive Services Task Force came out and said they no longer recommend aspirin based on age alone. For men over 60, or over 50, and for women over 60, or any other age, they did not recommend starting it at all.
The speaker does not agree with giving aspirin based on age alone. In fact, the speaker was ahead of the curve in this matter and stopped recommending that more than a decade ago. The speaker was not saying that except to boast, and that is not the purpose of this talk. It's about what you actually need to do right now.
These trials included men who were screened for the study by a risk calculator, and we need to talk about the risk calculator for a minute, such as Framingham. Framingham is a town located about an hour north of Boston, and there is a huge research program on cardiovascular risks taking place there. Hundreds of studies have been published about this program. It has been going on for almost a hundred years. There are many risk calculators. Most of them had an origin in, or were at least influenced by, Framingham. No one in these studies was asked the one question that would have changed the answer. The question was about what is in your arteries.
There was one study that did that, but it did it in reverse. Instead of using a calculator, it ranked the men by a scan that counted the calcium in their hearts. This is called the calcium score. Then it posed the only question that matters here. How many men would you have to treat to prevent a single heart attack? How many patients do you have to treat to cause one severe hemorrhage? Because that is what the question really boils down to.
For men with a large amount of calcium in their arteries, the number of heart attacks prevented far exceeded the number of resulting hemorrhages. So, we are now starting to get an answer. If we go back to the top, here is the answer. If you have plaque, and if you know what's in your arteries, you should take a low dose of aspirin. For men with zero calcium levels, things went in the exact opposite direction. More bleeding episodes caused problems compared to the heart attacks that were prevented. Therefore, for these men and women with a calcium score of zero, the survey not only fails to support aspirin use, but completely rules it out.
The calcium score only accounts for one type of plaque. Calcium is the old, healed type. It is actually more stable than the other two types. Therefore, it was quite clear, if you thought more deeply about the plaques, that the presence of old, healed calcium was a vital indicator that these individuals also still had young, unstable plaques. Soft, uncalcified, and unstable plaques are dangerous. It is the one that tears and causes a blood clot.
Calcium levels are not the only picture that answers this question. The CIMT test is an ultrasound scan that starts out as a normal scan, but uses an additional technique to measure the thickness of the artery wall in your neck, rather than just measuring blood flow as a normal scan does. Why do we resort to this test and why is it important? Because stress tests require a decrease in blood flow of more than 50% to give a positive result. Therefore, people think they passed the stress test and they're fine. No, you are not. Two-thirds of heart attacks occur in people who have less than 50% of their blood flow blocked. That's why we go beyond simply measuring the flow provided by a normal inspection. We must uncover the plaques themselves. And that's exactly what the CIMT test does. The CIMT test actually detects soft plaques that calcium tests completely miss.
Here is the speaker's stance on this matter. The speaker will tell frankly about their reading of the available evidence. It is not a final consensus. The speaker is not part of the consensus group regarding aspirin. You can argue about that. Obviously, the speaker is not part of the consensus group regarding plaques, bad cholesterol (LDL), statins, and other things.
Here is the speaker's interpretation of the situation. Once a plaque is present, you are no longer sick in the prevention phase, and most people agree with that. But they simply aren't looking for plaques. You have the disease if you have plaques. You are no longer sick in the primary prevention phase. The disease has not yet manifested itself by an attack. So, this is the path the speaker would put you on if you have plaques, and it fundamentally changes the debate about aspirin.
That's why the speaker always comes back to this point. Your wife, your husband, your grandchildren, and the people in your church or company who depend on you to be present and accountable, need you to be present and active, not helpless or dead. They don't want your situation to be managed; they want you to be the one in control.
There is a second thing that aspirin does for men or women who already have plaques. Aspirin alters the state of the artery lining to stop inflammation. It slows down the inflammation that is the primary driver of all this. In animals given low doses of aspirin, the shape of the plaque itself changed. The number of swollen immune cells filled with fat inside decreased, and the covering over them became thicker and stronger, making them harder. In other words, less inflammation, and greater stability of the plaques. Well, that's in animals. In humans, however, inflammation markers decrease alongside all of that. Therefore, we can test and see that a low dose of aspirin actually reduces inflammation as well. So, what you are seeing there is the transformation of soft plaques into stable plaques. This means the healing and stabilization of the wall, which is different from cleaning or removing anything. This is exactly what you would want to happen in an artery if it is already suffering from disease or plaque.
Aspirin has outcome data to support it. But there is still an argument that the dietary supplement, nattokinase, cannot harm you, can it? Both of them actually carry a real risk of bleeding. Not just aspirin, but nattokinase as well. Only one of these two substances can tell you how much risk it involves. The risk of bleeding from aspirin has been calculated, the dose in the tablet is fixed, and there is a manufacturing process that supports all of that. Nattokinase, however, possesses none of that. We do not know exactly to what extent it will reduce clotting. We do not know exactly how important the dosage is based on the batch number or manufacturer. There are many things about nattokinase that are not well calibrated, standardized, or even known.
There is an interaction between these new drugs and nattokinase, and we simply do not understand the extent of its effect. Case reports already exist. We know there is a reaction. Bleeding in the back of the brain of a man taking nattokinase with aspirin, bleeding in the abdomen of an elderly woman also taking it with aspirin, and further bleeding with the drugs Xarelto and Eliquis. It starts with getting into case reports, and who wants to hear about case reports alone? It doesn't really give us actual rates.
The speaker will tell what they saw in their clinic, because that matters as much as the research papers. The speaker has had men and women who have been taking a low dose of aspirin for 15 and 20 years without any problems whatsoever. Those who cannot tolerate that low dose of aspirin usually find out very quickly, then stop and find something else. Men and women who took nattokinase alone were generally fine as well. The risk of bleeding that you see with nattokinase at least usually involves using it with something else. There has been bleeding in the eye, in several places, and we have already seen it in our clinic. Therefore, we do not recommend combining them. There is really no experience anywhere that shows that combining the two, nattokinase and aspirin, gives you any benefit worth the risk.
Which one should you choose? The speaker will tell what they're eating. This might surprise some later, but let's talk about what the speaker recommends. If the images show plaques and there is nothing preventing you, such as an active ulcer, risk of severe bleeding, uncontrolled blood pressure, allergies, prescribed blood thinning medications, or impending surgery, then the speaker recommends a low dose of aspirin under your doctor's supervision. Herein lies the strongest scientific evidence. These are indications related to preventing seizures, not removing plaques. This is much stronger evidence, to a considerable degree. Manufacturing standards in this field are also much stricter.
But if you cannot tolerate aspirin and you have plaques, which is the case for many people, nattokinase is a reasonable second option. And again, here the speaker thinks many will criticize and say they don't trust aspirin and will take nattokinase instead. That's okay. There is something you may not have heard, perhaps you have heard the speaker say a lot about the evidence for aspirin being stronger, and perhaps the speaker would recommend it before nattokinase? Yes, you heard correctly. But the speaker has many people who take nattokinase instead of aspirin, and is completely fine with that. The speaker completely agrees with that.
With some patients occasionally saying they hear the speaker but won't comply, or they hear the speaker but they're going to make a different choice. Because, unlike many doctors, the speaker doesn't believe the most important thing is for the patient to do exactly what the speaker asks them to do. The speaker simply doesn't believe that. And the speaker thinks the evidence on this matter is very clear as well. The speaker thinks it is much more important for the doctor to show you what he knows and what he does not know, and try to explain it to you, and to tell you what he personally will do and will not do, and then support you in making your choice.
This is not just a personal opinion. This is what the evidence suggests. If you are involved and make your own decisions about your health, especially in preventing chronic diseases, you are in a much better position. You will get much better results. So, the speaker's role is not to tell you that you should take the speaker's opinion into account. The speaker's role is to say here are the options available.
The speaker emphasizes being careful when taking aspirin and nattokinase at the same time. The same caution applies when combining Xarelto, Eliquis, or other newer blood thinners with clopidogrel. These combinations should not be taken with nattokinase either, unless there has been a clear discussion with full understanding of the risks, because these blood thinners interact with each other very strongly.
Neither aspirin nor nattokinase caused the plaque buildup in the first place. Refined carbohydrates and insulin resistance, and the combination of refined carbohydrates and insulin resistance, are what caused the problem. This is a diagnosis that most of the time never makes it onto the medical record. The probability of going to a doctor in the United States with prediabetes, diabetes, or metabolic diseases and having them diagnosed, treated, and recorded in the medical record is 5%. Therefore, one cannot rely on their doctor to diagnose this. Diabetes damages arteries, but doctors cannot be relied upon to diagnose it, so individuals need to learn more about this and take care of their health themselves.
Even if a doctor is consulted and they miss the diagnosis of diabetes or prediabetes, there may be a slight elevation in cholesterol, and the risk will typically be linked to cholesterol. Blood thinners may help in treating the problem but they certainly do not replace a radical solution. The aspirin decision, the nattokinase decision, and whether anything is taken at all comes back to getting an oral glucose tolerance test (OGTT), finding out the insulin response, looking at the plaque in the arteries (or lack thereof), and understanding the cholesterol breakdown, because these things help identify hidden diseases and the actual risk of plaque in the arteries. Having an annual cholesterol test does not help much in this regard.
The speaker does not take either nattokinase or aspirin. They were taking aspirin until they discovered they had atrial fibrillation. When someone has atrial fibrillation, their risk of having a stroke increases by about six to eight times. Aspirin does not help prevent the risk of stroke caused by atrial fibrillation - a different type of blood thinner is needed. The speaker started with the drug Eliquis, and now, for reasons related to Medicare insurance coverage, they are taking Xarelto. They do not take nattokinase with Xarelto, and previously took it with baby aspirin but no longer do that. They strongly advise their patients not to do it.
The first step is to get tested, not to guess. Take a picture of your arteries and see if you have plaques. Then you will be in a different position to make the decision regarding aspirin versus nattokinase. Secondly, focus on prevention by reducing intake of carbohydrates with a high glycemic index. Simply assume you have prediabetes or diabetes and start doing the things that would keep you healthy if you actually had it. Reduce intake of carbohydrates with a high glycemic index, exercise intensely, get rid of obstacles such as sleep problems or stress, then start thinking about supplements and medications.
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