Nattokinase is one of the most hyped supplements in cardiovascular health — claimed to lower blood pressure, shrink arterial plaque by 36%, and drop LDL cholesterol without a statin. I put a patient on it. Then I looked closer at the data. Now I've stopped.

In this video, I break down what the evidence actually shows:

✅ Blood pressure: Real, but modest. A 2023 meta-analysis of 6 RCTs found just 3.45 mmHg systolic reduction — roughly half the effect of a low-dose ACE inhibitor.

❌ Plaque reduction: The headline 36% plaque reduction comes from a single retrospective chart review (Chen 2022) with no control group, no randomization, co-administered confounders, and 5 of 10 authors employed by the supplement manufacturer. Meanwhile, the rigorous double-blind NAPS trial (Hodis 2021, n=265) found zero effect on carotid plaque.

❌ Lipid lowering: In randomized trials (Yang 2009, Hsia 2009), nattokinase alone doesn't move lipids. The signal only appears in non-randomized studies — often confounded by red yeast rice, which contains monacolin K (chemically identical to lovastatin).

📉 The case study: I put "Susan" on high-dose nattokinase for a year. Her arterial age went from 64 to 73. We stopped.

The lesson: Test. Don't guess. Never start a supplement without a plan to stop it if the numbers don't move.

⏱️ Chapters
0:00 Why I stopped using nattokinase
0:21 Meet Susan
1:46 What nattokinase actually is
2:14 How nattokinase works
5:00 Does it survive digestion?
6:14 The real signal: blood pressure
8:34 The plaque-regression claim
9:59 Problems with the 2022 study
13:09 The 2017 plaque study
14:50 The 36% plaque reduction problem
16:30 Does it lower ApoB or LDL?
19:31 Why plaque ultrasound is tricky
22:56 Safety and bleeding concerns
25:57 What’s actually in the bottle?
27:24 The NAPS trial
28:48 Was the dose too low?
30:29 Susan’s one-year follow-up
32:51 What if you take it anyway?
33:42 Final take: test, don’t guess

⚠️ This video is for education only and is not personal medical advice. Please talk with your own physician before starting or stopping any supplement or medication — especially if you take aspirin, clopidogrel, warfarin, Eliquis, Xarelto, Pradaxa, or any other blood thinner.

— PRODUCT POTENCY TESTING —
Natural Informant (Danny Curtin). "Nattokinase: We Tested Them All… Which Products Can You Trust?" https://youtu.be/K1l_g6-vdC4?si=h4oOnGEw_Vvh51cx

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🧬 About Dr. Lily Johnston

Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease.

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