NATTOKINASE
Updated: 2 hours ago
I've used nattokinase as part of different combination enzyme formulas over the years. Because it comes from a fermented food, I've always been cautious with it because of my MCAS, and I noticed I was having more reactions when I used it. My doctor and I decided I should avoid it since I tend to react. I do great on the enzymes I take now. Boluoke is still my favorite, and my Lyme doctor, who I trust with my life, has me take it alongside a serrapeptase blend.
Nattokinase is one of the fibrin-breaking enzymes that come up often in Lyme protocols, so here is what Lyme-literate doctors and the research say about it.
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WHAT IS NATTOKINASE?
- Nattokinase is an enzyme from natto, a traditional Japanese food made by fermenting soybeans with a bacteria called Bacillus subtilis (Memorial Sloan Kettering).
- It is a protein-breaking enzyme (2026 review). Its best-known job is breaking down fibrin, the sticky protein that holds blood clots together (lab studies, Memorial Sloan Kettering).
- It seems to work in more than one way. Besides breaking down fibrin directly, it boosts tPA, the body's own clot-dissolving signal, and blocks PAI-1, a protein that slows clot breakdown (2025 review).
- Natto the food is high in vitamin K, which can get in the way of the blood thinner warfarin (Memorial Sloan Kettering). Nattokinase supplements like the ones below are made free of vitamin K.
NATTOKINASE OPTIONS
Allergy Research Group Nattokinase (softgels)
Klaire Labs Nattokinase NSK-SD (vegetarian capsules)
WHY LYME DOCTORS USE IT
- Biofilms: well-known Lyme-literate doctors explain that fibrin helps hold together the protective layer (biofilm) where Lyme germs can hide. One way to break it up is with fibrin-breaking enzymes like lumbrokinase, other proteases or nattokinase.
BIOFILMS - POSSIBLE SOLUTIONS
- Babesia "nests": some well-known Lyme-literate doctors share that some people with chronic Babesia need enzymes to break up clumps of Babesia and fibrin that form in small blood vessels. These nests can slow blood flow and make it harder for treatment and the immune system to reach the germs. Nattokinase is listed as one option.
- Microclots: in a Long COVID guide (2024), a well-known Lyme-literate doctor notes that lumbrokinase or nattokinase may help break up tiny clots (microclots) in the blood vessels.
- Thick, sticky blood (hypercoagulation): Dr. Todd Maderis (2020) explains that inflammation from infections, mold and MCAS can lead to extra fibrin, and he calls fibrin-breaking enzymes the main treatment for it.
HYPERCOAGULATION
HOW IT COMPARES WITH LUMBROKINASE AND SERRAPEPTASE
- Lumbrokinase comes from earthworms. Some well-known Lyme-literate doctors find it much stronger at breaking down fibrin, and have not found nattokinase as effective for biofilms. For Babesia nests, lumbrokinase is described as very effective, with nattokinase and serrapeptase as much weaker options. No study has compared them head to head in people yet.
LUMBROKINASE (BOLUOKE)
- Serrapeptase is an enzyme first found in bacteria living in silkworms.
SERRAPEPTASE
- Soy: nattokinase is made from soy. Lumbrokinase is suggested as the alternative for people with a soy allergy.
- My Enzymes post explains which enzyme does what.
ENZYMES
WHAT THE RESEARCH SAYS
- I couldn't find any published studies yet that test nattokinase on Lyme bacteria or Lyme biofilms. For Lyme, what we have so far comes from doctors' experience.
- Blood pressure (human studies): a 2023 review of 6 randomized trials with 546 people found nattokinase lowered the top blood pressure number (systolic) by about 3.5 points. It did not improve cholesterol. No notable side effects were reported.
- Heart and arteries (human study): a University of Southern California trial (2021) gave 265 healthy older adults 2,000 FU a day or a placebo for a median of 3 years. There was no difference in artery thickening or stiffness, blood pressure, or any lab test, including clotting tests. The people in this trial were at low risk for heart disease.
- Brain (human study): in a 2026 trial, 120 people with narrowed brain or neck arteries but no symptoms took nattokinase or a placebo for 6 months. Overall thinking scores didn't improve, though an extra analysis hinted at less decline in visual and spatial skills.
- Newer research: a 2024 review notes growing research on nattokinase calming inflammation and oxidative stress, along with its clot-related effects. A 2026 review adds that clinical evidence in people is still limited and products aren't yet standardized.
HOW TO TAKE IT
- When enzymes are used to break down fibrin, Lyme-literate doctors suggest an empty stomach. Dr. Maderis suggests at least 30 minutes before a meal or 2 hours after. One Long COVID guide suggests no food, medicines or supplements from 1 hour before until 1 hour after (water is fine).
- Your doctor can guide you on the right amount.
A note from me: this list doesn't cover everything. Nattokinase may offer more benefits than I've included here. I'm sharing the uses that are best known or most studied as of today, from sources I trust. Research keeps growing, and one post can only cover so much.
BEFORE YOU START
- Read the warning on each bottle.
- Bleeding risk: taken alongside blood thinners, nattokinase may make bleeding more likely. Memorial Sloan Kettering advises not taking it if you have a clotting disorder, take a blood thinner, or take aspirin every day. The Allergy Research Group label says to use it only under medical supervision if you take blood thinners.
- Never use it in place of a prescribed blood thinner. Memorial Sloan Kettering describes a person who swapped warfarin for nattokinase and developed a clot that needed a repeat heart valve surgery.
- Past blood clots: Memorial Sloan Kettering notes that, in theory, it could loosen an existing clot, and advises anyone who has had a deep vein clot (DVT) to avoid it.
- Surgery and dental work: since it affects clotting, tell your surgeon or dentist you take it, and ask when to stop it beforehand and when it's okay to restart.
- Lab tests: it may change clotting test results like PT, PTT and INR (Memorial Sloan Kettering). Let your doctor know before blood work.
- Soy allergy: it's made from soy, and severe allergic reactions have been reported in people allergic to natto (Memorial Sloan Kettering).
- MCAS and histamine: because nattokinase comes from a fermented food, some people with MCAS choose to avoid it, as I do. Natto is a fermented food. Fermented foods are likely to contain histamine, so they are left out of low-histamine diets (2020 review). Supplements are a purified enzyme, and I couldn't find any studies of nattokinase in people with MCAS. Dr. Lawrence Afrin, a leading mast cell expert, explains that any supplement can trigger a flare in one MCAS patient or another, and that people with MCAS react to medicine products more often than others (2024). In people allergic to natto, a 2023 study found the trigger can be a sticky substance made during fermentation (PGA) or, in some people, nattokinase itself. If you have MCAS, ask your doctor first.
- Blood pressure: since it may lower blood pressure a little, check with your doctor if you take blood pressure medicine or your blood pressure runs low.
- Always ask your doctor before adding anything new.
Let us know if you use nattokinase and your experience.
RELATED POSTS
BIOFILMS EDUCATION
SUPPLEMENT / HERBAL DIRECTORY
SOURCES
Dr. Marty Ross, Biofilm Gated Communities, Lyme disease biofilms guide (2025)
Dr. Marty Ross, Kills Babesia: A Brief Guide (2024)
Dr. Marty Ross, Solving the Puzzle: The Ross Long COVID Management Guide (2024)
Dr. Lawrence Afrin, AIM Center for Personalized Medicine, Treatment of Mast Cell Activation Syndrome, Clinicians' Roundtable (2024)
Dr. Todd Maderis, Hypercoagulation in Lyme Disease (2020, older source, still worth reading)
Memorial Sloan Kettering Cancer Center, About Herbs: Nattokinase (updated 2022)
Dobre and others, Carol Davila University of Medicine and Pharmacy, Navigating the effects of anti-atherosclerotic supplements and acknowledging associated bleeding risks, International Journal of Molecular Sciences (2025)
Li and others, Nattokinase supplementation and cardiovascular risk factors: a systematic review and meta-analysis of randomized controlled trials, Reviews in Cardiovascular Medicine (2023)
Hodis and others, University of Southern California, Nattokinase atherothrombotic prevention study: a randomized controlled trial, Clinical Hemorheology and Microcirculation (2021)
Zhang and others, Zhejiang University, Nattokinase supplementation for cognitive enhancement in asymptomatic intracranial/carotid stenosis: a randomized controlled trial, Journal of Stroke and Cerebrovascular Diseases (2026)
Granito and others, Nattokinase as an adjuvant therapeutic strategy for non-communicable diseases: a review of fibrinolytic, antithrombotic, anti-inflammatory, and antioxidant effects, Expert Review of Cardiovascular Therapy (2024)
Ma and others, Xinjiang University, Nattokinase: a multifunctional food-derived enzyme for thrombophilia management, Life Sciences (2026)
Comas-Basté and others, University of Barcelona, Histamine Intolerance: The Current State of the Art, Biomolecules (2020, older source, still worth reading)
Suzuki and others, Fujita Health University, Nattokinase (Bac s 1), a subtilisin family serine protease, is a novel allergen contained in the traditional Japanese fermented food natto, Allergology International (2023)
Drugs.com, Nattokinase (medically reviewed, updated January 2026)
Product labels on Fullscript (2026): Allergy Research Group Nattokinase, Klaire Labs Nattokinase NSK-SD
Disclaimer: Rise Above Lyme makes no claims about any possible benefit of using any product mentioned within this site. Always consult with your doctor before adding anything. The information shared is based on personal experience, years of accumulated researched resources from Lyme Literate doctors and polls conducted within Lyme groups from actual patient experience using these solution ideas.
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