Nattokinase Supplements Review
Choose the Best Nattokinase Supplement. CL Tests Reveal Which Nattokinase Suppplements Provide
the Best Quality & Value.
Medically reviewed and
edited by Tod Cooperman, M.D. 
Initially Posted:
04/09/2016
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Table of Contents
Summary
·
Health benefits of nattokinase
supplements: Nattokinase supplements have
been promoted to reduce the risk of blood clots and reduce blood pressure.
However, the evidence for these effects in people remains preliminary: No study
has definitively shown a reduction in clots in people from using nattokinase, although a reduction in blood clotting factors
has been demonstrated, and nattokinase causes only a
small reduction blood pressure. (See "What It Does")
·
How to choose a nattokinase
supplement: When choosing a nattokinase
supplement, it is important to look for one which lists its enzyme activity,
which will be in FU (fibrin degradation or fibrinolytic units). Listing just
the amount of enzyme in milligrams doesn't tell you enough, since not all nattokinase is equally active. You'll want a product
providing at least 1,000 FU per pill or unit (see "What It Is"). Also, check that
ConsumerLab.com or another reputable independent 3rd party has verified the
enzyme activity, as not all products provide the activity they list (see "What CL Found").
·
Best value for nattokinase: Products which
ConsumerLab.com found to contain their listed nattokinase
enzyme activity are indicated as Approved in the 3rd column of the Results Table below. Among those, several
provide the best value (i.e., greatest enzyme activity at lowest cost) --
see Top Picks.
·
Nattokinase safety and side effects: Short term use of nattokinase supplements is generally well-tolerated but
people who are taking medications such as blood-thinners or blood-pressure
lowering medication should use them only with caution (See "Concerns and Cautions"). Nattokinase may also increase bleeding in the event of
trauma or during and after surgery. Many nattokinase
supplements contain soy and should not be used by people with an allergy to
soy. See the last column of the Results Table to find out which claim
soy.
What It Is:
Nattokinase is an enzyme with an anti-clotting effect --
it helps break down fibrin, a component of blood clots. It is derived from
natto, a traditional Japanese food created by fermenting soybeans with bacteria
(Bacillus subtilis). Nattokinase was identified and
extracted from natto in 1987 by Dr. Hiroyuki Sumi (Sumi, Experientia 1987).
Nattokinase is measured in enzyme activity units
called fibrin degradation (or fibrinolytic) units, or FU, which is a measure of
its ability to break down fibrin. Some supplement labels only provide amounts
(such as milligrams), however, the enzyme activity
level (FU) is needed in order to know the potency of the enzyme.
What It Does:
Nattokinase is often promoted for
reducing the risk of blood clots, due to its ability to breakdown fibrin. Nattokinase may also lower blood pressure. Consequently, it
is has been promoted for general cardiovascular
health. However, these uses are based largely on several small, preliminary
clinical studies, as described below. Larger, longer, and better controlled
studies are needed. Blood Clots/Thrombosis
Laboratory and animal research suggest nattokinase
may help to break down blood clots that can block blood flow in arteries (which
can cause heart attacks and stroke) (Sumi, Acta Haematol 1990; Fujita, Biol Farm Bull 1995). However,
evidence of this effect in people is limited to preliminary studies, none
of which show reduced risk of clots using only nattokinase.
One small study found that 4,000 FU of nattokinase
(from two enteric-coated capsules) taken daily for two months decreased levels
of blood-clotting factors (fibrinogen, factor VII, and factor VIII) by about 7%
to 19% in healthy people as well as those with cardiovascular risk factors or
undergoing dialysis. Blood pressure remained stable except for a slight decline
(-3.73 mm Hg) in systolic blood pressure (Hsia, Nutr Res 2009).
Similarly, a study in twelve men found that taking two enteric-coated capsules
three times per day (a total daily dose of 1, 950 mg nattokinase)
significantly increased measures of fibrin breakdown after eight days. (Sumi, Acta Haematol 1990).
The same study reported that that consuming 200 grams of natto itself
(which contains nattokinase) increased
fibrinolytic activity (fibrin breakdown) for 2 to 8 hours after ingestion. In
addition, a fairly recent study in 12 healthy men found that a single dose of nattokinase taken as a softgel
providing 2,000 FU (NSK-SD, Japan Bio Science Laboratory Co.)
significantly increased measures of fibrin breakdown and anti-thrombotic
factors in the blood 4 hours after ingestion compared to placebo (Kurosawa, Sci Rep 2015).
One study using a combination of nattokinase and Pycnogenol has shown a lower risk of clots in men and women
at high risk for deep vein thrombosis (DVT) who were not taking anticoagulant
or anti-thrombotic medication. None of those who took 300 mg of this
combination (amounts of each not stated) two hours before a long flight ( 7 — 8
hours) and again six hours after the first dose experienced a thrombotic event
(a clot), while seven of those who took a placebo had a thrombotic event (Cesarone, Angiology 2003). However, it should
be noted that four of the women who developed thrombosis had been taking oral
contraceptive drugs, which can increase the risk of blood clots. It's not
possible to draw conclusions from this study about the effect of nattokinase itself on the risk of blood clots. One product
in this review, Solgar Nattokinase Complex, contains both nattokinase
(2,000 FU) and Pycnogenol (5 mg).
Blood Pressure
Preliminary evidence suggest that natto may help lower blood pressure, possibly
due to inhibition of angiotensin converting enzyme (ACE) inhibition (Okamoto, Plant Foods Hum Nutr
1995). A study in men and women with untreated high systolic blood
pressure (130 to 159 mmHg) found that one capsule containing 2,000 FU nattokinase taken daily for 8 weeks reduced systolic and
diastolic blood pressure, by 5.55 mmHg and 2.84 mmHg, respectively, compared to
placebo (Kim, Hypertens
Res 2008). In another study, noted in the section above, taking
4,000 FU of nattokinase lead to a slight decline
(-3.73 mm Hg) in systolic blood pressure but not diastolic blood pressure (Hsia, Nutr Res 2009).
Alzheimer's Disease
Nattokinase has been shown in the laboratory to help
break down amyloid-beta fibrils (the accumulation of which, in the brain, is
associated with Alzheimer's disease) (Hsu, J Agric Food Chem).
However, there are no studies on the effects of nattokinase
supplementation in people with Alzheimer's disease, or studies on its effects
on cognitive function or memory.
See the Concerns and Cautions section for more
about the risk of bleeding and lowered blood pressure with nattokinase.
Quality Concerns and
Tests Performed:
Neither
the Food and Drug Administration (FDA) nor any other federal or state agency
routinely tests supplements for quality prior to sale. In order to help consumers identify products of better quality,
ConsumerLab.com purchased and tested nattokinase
supplements to determine whether they possessed their labeled amount of enzyme
activity. As the FDA only requires supplements to list the amounts of enzyme
ingredients, for products listing only amounts and not enzyme activity,
activity levels were determined by ConsumerLab.com. Tablets were tested for
their ability to properly break apart (disintegrate) in solution. See How Products Were Evaluated for more information
on testing.
What CL Found:
Out of 9 nattokinase supplements
selected for review by ConsumerLab.com, 7 contained their listed nattokinase activity. One product, The Vitamin
Shoppe Nattokinase with Rutin,
did not list its nattokinase activity, just its
amount of nattokinase (100 mg per capsule), but it
did possess significant nattokinase activity — 2,693
FU per capsule — a reasonable amount for 100 mg.
The one product which did not have its claimed nattokinase
activity was Healthy Origins Nattokinase
2,000 FU's, which provided only 1,397 FU per vegetarian capsule — just
69.9% of what was claimed. It was also the lowest priced product — at just 15
cents per capsule, while 2,000 FU capsules from other brands cost 27 cents to
65 cents.
Top Picks:
Nattokinase can be very expensive. In fact, the most
expensive product, Ortho Molecular Products Nattokinase,
costs $1.21 to get 2,000 FU (from 2 soft gel capsules). Among the nattokinase supplements Approved by ConsumerLab.com, the
following were lowest in cost, based on how much you have to pay to get an
equivalent amount of nattokinase enzyme activity
(FUs):
·
Lower dose (1,000 FU per pill): Puritan's Pride Nattokinase (31 cents per softgel)
·
Moderate dose (2,000 FU per pill): NOW Nattokinase (27 cents per vegetarian capsule)
·
High-dose (4,000 FU per pill): Arthur Andrew Medical Nattovéna (56 cents per capsule)
It is not clear whether
or not it is important that nattokinase be protected
from stomach acid, but if you are concerned, one product was enteric-coated
(and we tested it to be sure the coating worked properly). It is KAL Nattokinase 100 mg (2,000 FU per tablet) — each
tablet costs 44 cents.
Natto, from which nattokinase is often produced, is
naturally rich in vitamin K. Vitamin K is essential to proper blood clotting.
Since some people take nattokinase to reduce the risk
of blood clots, it has been suggested that it would be preferable to avoid
intake of vitamin K. Vitamin K can apparently be removed during the processing
of nattokinase. However, if you want a product
without vitamin K, the labels of two products indicate that they do not contain
vitamin K, Enzymedica Natto-K (49
cents per capsule, which claims 1,000 FU and includes several other enzymes)
made with NSK-SD, a proprietary form of nattokinase,
and NOW Nattokinase, which, as noted
above, costs only 27 cents for a 2,000 FU capsule.
Test Results by Product:
Listed
below are the test results for 11 nattokinase
supplements. Nine products were selected by ConsumerLab.com and two (denoted
with a CL flask) are included for having passed the same evaluation through ConsumerLab.com's voluntary Quality Certification Program. Also listed is
one product similar one which passed testing but is sold under a different
brand name. The products are listed alphabetically.
Shown for each product is the labeled amount of nattokinase,
the claimed amount of activity units (FU) or weight of nattokinase
per suggested daily serving, and activity found. Products listed as
"Approved" contained their claimed amounts of enzyme activity and met
ConsumerLab.com's other criteria for quality (see
Passing Score). The full list of ingredients is available for each product by
clicking on the word "Ingredients" in the first column, although some
notable features are listed in the last column, as well as price and cost
comparisons.
|
RESULTS OF CONSUMERLAB.COM TESTING OF NATTOKINASE SUPPLEMENTS |
||||||
|
Product Name (Labeled
Amount of Nattokinase Per Unit, Serving Size, and
Suggested Daily Serving on Label |
Nattokinase Claimed Per Daily Serving |
--TEST RESULTS-- |
Cost for Daily
Suggested Serving on Label |
|||
|
OVERALL RESULTS: |
Contained Claimed
Amount of Nattokinase |
Disintegrated
Properly |
||||
|
|
8,000 FU to 24,000 FU
(400 mg to 1,200 mg) Nattovena™ |
APPROVED |
|
NA |
$0.56-$1.67 |
|
|
|
2,000 FU |
APPROVED |
|
NA |
$1.00 |
|
|
|
3,000 FU |
APPROVED |
|
NA |
$1.47 |
|
|
|
2,000 FU to 4,000 FU |
NOT |
Found only 1,397 FU to
2,794 FU per daily serving (69.9% of listed amount) |
NA |
$0.15-$0.30 |
|
|
|
2,000 FU to 6,000 FU |
APPROVED |
|
|
$0.44-$1.33 |
|
|
|
2,000 FU to 4,000 FU |
APPROVED |
|
NA |
$0.35-$0.70 |
|
|
|
2,000 FU to 4,000 FU |
APPROVED |
|
NA |
$0.27-$0.53 |
|
|
|
2,000 FU to 4,000 FU |
APPROVED |
|
NA |
$1.21-$2.41 |
|
|
|
2,000 FU to 3,000 FU |
APPROVED |
|
NA |
$0.31-$0.47 |
|
|
|
2,000 FU |
APPROVED |
|
NA |
$0.65 |
|
|
|
No amount of FU listed |
NA5 |
Found 2,692.8 FU per
daily serving |
NA |
$0.58 |
|
|
Similar to Approved Products*: |
||||||
|
Vitamin World Nattokinase
(1,000 FU per softgel; 1 softgel,
twice daily) |
Similar to Puritan's
Pride® Nattokinase. |
$1.17 |
||||
|
|
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|
Unless otherwise noted, information about the products
listed above is based on the samples purchased by ConsumerLab.com (CL) for
this Product Review. Manufacturers may change ingredients and label
information at any time, so be sure to check labels carefully when evaluating
the products you use or buy. If a product's
ingredients differ from what is listed above, it may not necessarily be of
the same quality as what was tested. |
||||||
|
Copyright ConsumerLab.com, LLC, 2016. All rights reserved.
Not to be reproduced, excerpted, or cited in any fashion without the express
written permission of ConsumerLab.com LLC. |
||||||
ConsumerTips™:
Dosage
Daily doses between 2,000 FU and 4,000 FU (and 100 mg and 650 mg) have been
used in clinical studies. Due to a lack of clinical evidence, it is not clear,
what dose, if any, is best for reducing the risk of
blood clots or lowering blood pressure.
It has sometimes been recommended nattokinase be
taken after dinner or before bedtime, although the reason for this is not
clear. This recommendation may be based, in part, on the fact that fibrinolytic
activity decreases over the nighttime hours, and is lowest in the morning,
which may increase the risk of blood clots and heart attacks early in the
morning (Urano, Thrombosis Res 1990).
Getting nattokinase from natto
You can get a fair amount of nattokinase from natto
itself. Natto, which has a sticky, slippery consistency and a pungent,
cheese-like odor (and may be an acquired taste for some), is estimated to
provide between 1,400 - 2,000 FU activity in a 50 gram
serving, but this may decrease depending on how natto is cooked or prepared
(Japan Food Science, 2000).
Vitamin K
Interestingly, natto is also rich in vitamin K — which is necessary for proper
clotting. In fact, a typical single-serving package of natto of about 40 grams
was found to provide 350 mcg of vitamin K2 (MK-7) (Ikeda, J Nutr 2006).
That's a lot of vitamin K, considering that an adequate adult daily intake of
vitamin K is 120 mcg for adult men and 90 mcg for adult women. (See the Vitamin K Supplements Review for
more information).
Since many people use nattokinase with the belief
that it will reduce clotting, the presence of vitamin K has been raised as a
potential concern. However, during the processing of nattokinase
it is apparently possible to remove or reduce much of the vitamin K (Health Canada "Notice to
Stakeholders on Nattokinase, 2012). A
proprietary form of nattokinase, NSK-SD, is claimed
to be vitamin K free (Japan Bio Science Laboratory
website). If you wish to avoid potential intake of vitamin K from nattokinase, look for supplements which explicitly claim
not to contain vitamin K (see the last column of the Results Table to find products which make
this claim).
Enteric-coating
Nattokinase appears to be absorbed in the intestine,
and some researchers recommend an enteric coating to help protect the enzyme
from stomach acid, before it reaches the intestine (Fujita, Biol Pharm Bull 1995; Milner, Altern Complement Ther 2002). Absorption of nattokinase
in the blood from an oral dose of nattokinase in softgel form has been confirmed, however, it is not clear
whether the softgels were enteric-coated (Kazuya,
Prog Med 2006; Ero, Altern Ther Health Med 2013). Only one of the
products in the current Review is enteric-coated — KAL Nattokinase 100 mg (2,000 FU per tablet).
Concerns and Cautions:
Nattokinase appears to be generally well-tolerated, and
serious adverse events have not been reported in short-term clinical studies.
Mild adverse effects including diarrhea, common cold, constipation, stomach
pain, menstrual cramps and headache, and one case of an abnormal liver function
test have been reported (Kazuya, Prog Med 2006; JBSL Study Report 2004).
However, long-term safety studies are needed. One safety study in eleven men
and women found 5 capsules of a branded nattokinase
supplement (NSK-SD) taken three times per day with breakfast, lunch and dinner
(a total daily dose of 552 mg/day) for four weeks was well-tolerated, with just
one episode of constipation reported; in the women there was a small but
significant decrease in systolic, but not diastolic blood pressure (Lampe, Food Chem Tox 2016).
This decrease in systolic blood pressure has been seen in other studies, with a
-3.73 mm Hg average decrease seen in a study using 4,000 FU of nattokinase daily (Hsia, Nutr Res 2009)
and in a study of people with untreated high systolic blood pressure given
2,000 FU of nattokinase daily (systolic blood
pressure decreased 5.55 mmHg and there was also a 2.84 mmHg in diastolic blood
pressure compared to placebo) (Kim, Hypertens
Res 2008). Therefore, nattokinase should
be used with caution in people with low blood pressure or people taking blood
pressure lowering medications (Kim, Hypertens
Res 2008).
Risk of bleeding
Nattokinase has anti-thrombotic and blood-thinning
effects which could increase the risk of bruising or bleeding if taken with
other blood-thinning supplements or medications. This also poses a potential
risk to any individual undergoing surgery or who may suffer trauma injury. For
a healthy individual, this potential for increased bleeding from accidental
trauma may outweigh any potential benefits of taking nattokinase.
Bleeding in the brain has been reported in one woman with high blood pressure
who took 400 mg of nattokinase daily for one week, in
addition to taking blood-pressure lowering medication and low-dose aspirin (Chang, Inter Med 2008).
Theoretically, nattokinase could potentially loosen
an existing blood clot from an extremity, such as a limb, allowing the clot to
travel to a potentially more dangerous location, such as the heart or lungs (Milner, Altern Complement Ther 2002).
Soy allergy
Nattokinase supplements may contain soy and should
not be taken by people with an allergy to soy. Nattokinase
supplements which claim to be free of soy (made by a process not involving soy)
are available.
Thyroid effect
People with impaired thyroid function should be aware of a theoretical concern
that soy can increase required the dose of thyroid hormone and this concern may
also apply to taking nattokinase made from soy,
although this has not been demonstrated (Messina, Thyroid 2006).
To further assist consumers, ConsumerLab.com licenses its flask-shaped CL Seal
of Approved Quality (see The CL Seal) to manufacturers for use on
labels of products that have passed its testing. ConsumerLab.com will
periodically re-evaluate these products to ensure their compliance with ConsumerLab.com's standards.
Information on this site
is provided for informational purposes only. It is not an endorsement of any
product nor is it meant to substitute for the advice provided by physicians or
other healthcare professionals. The information contained herein should not be
used for diagnosing or treating a health problem or disease. Consumers should
inform their healthcare providers of the dietary supplements they take.
Related CL Answers (4)