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

Bikman’s default recommendation is to favor whole foods over supplements. He emphasized that natto, while pungent and sticky, has been a dietary staple in Japan for centuries and is associated with lower heart disease rates. A small serving provides nattokinase naturally, along with other beneficial components from the fermentation process. He suggested this might make the enzyme work better or offer broader benefits than the isolated pill. He did not give a specific daily intake but implied that regular consumption in the context of a whole-food diet could replicate the low-heart-disease pattern seen in Japan. This advice aligns with his philosophy of using food as the first line of defense, with supplements as a secondary option.

Bikman explained that oxidized LDL is rapidly engulfed by macrophages, turning them into pro-inflammatory foam cells that build plaque. He noted that rodent studies have shown natto extracts reduce lipid peroxidation, thereby potentially lowering oxidized LDL. This fits neatly with his ‘indifference’ to unoxidized LDL; he emphasized that oxidized LDL tracks heart disease risk much better than total LDL. The human data are missing, but the theory is compelling: if nattokinase prevents the peroxidation of fat molecules on LDL, it would directly short-circuit one of the earliest steps in atherosclerosis. He presented this as part of the enzyme’s complementary mechanisms alongside lowering triglycerides and activating plasmin, though he cautioned that pure nattokinase—not just the whole natto extract—needs testing in humans for this effect.

Bikman flagged a recent (2025) publication showing that nattokinase is significantly degraded during digestion, with roughly 25% bioavailability. This means a large portion of the ingested enzyme might never reach the bloodstream intact. He noted that this could explain variability in study results and consumer experiences. He mentioned that emerging technologies, like creating small bioactive peptides from the enzyme, might circumvent the digestion problem, but for now the quality of the supplement matters enormously—cheap, unprotected formulations may deliver far less activity than the label suggests. He did not cite brand-specific data but stressed that consumers should be aware that the actual dose reaching the blood may be much lower than listed.