Enzyme in fermented soybean dish may help with blood clots
Q: I recently spoke with a doctor friend who is taking nattokinase on the advice of her physician. She believes nattokinase dissolved a pulmonary embolism a day after the clot was visible on a CT scan. My friend says this drug is not well-known in the U.S. because all of the research has been done in China. Are you aware of any benefits of nattokinase?
A: Chinese scientists have studied this enzyme, but researchers in other countries such as India, Japan, Korea and Thailand have also contributed to knowledge about it.
Nattokinase is an enzyme that breaks down fibrin, a component of blood clots along with blood platelets. It is produced by the bacteria that ferment soybeans to produce a traditional Japanese food, natto. In Japan, people eat natto regularly, but elsewhere, people who want the anticlotting effects of nattokinase take it as a dietary supplement. However, scientists are working on developing more potent, targeted forms of the enzyme (Molecular Pharmaceutics, January 2024). Nattokinase appears less likely to lead to adverse reactions than conventional anticoagulants (International Journal of Molecular Sciences, March 2017). Medical supervision is still appropriate.
Q: I read with interest your response to a reader who suffered adverse abdominal effects from taking red rice yeast to lower cholesterol. I had the same issue. I discovered that the supplement I was taking contained capsaicin to improve absorption. It caused tremendous gastric issues. To my dismay, I can no longer take any supplement that contains this one ingredient. However, I can take red yeast rice without it and get positive results with no problems.
A: Capsaicin, the compound that supplies the “heat” in hot peppers, can cause digestive tract irritation and diarrhea in some individuals (Molecular Medicine Reports, March 2024).
When the yeast Monascus purpureus acts on rice, the result is red yeast rice, or RYR. This product has been used in traditional Chinese medicine for centuries to improve circulation and restore balance (Frontiers in Pharmacology, Dec. 2, 2019).
Chemists have identified more than 100 constituents, including some that are identical to certain statin drugs. That probably explains why people take RYR to lower cholesterol (Frontiers in Pharmacology, Jan. 17, 2022).
An umbrella review of meta-analyses concluded that red yeast rice preparations are safe, by and large, although better studies are needed (Journal of Integrative Medicine, Feb. 2, 2024).
Q: I know that many people take the antihistamine diphenhydramine to help them sleep. Unlike them, I feel agitated, not drowsy, when I take it. This drug often gives me restless legs or leg cramps.
A: Researchers call your reaction to diphenhydramine (Benadryl) “paradoxical excitation.” Some have hypothesized that this could be explained by genetic differences in enzyme activity (CNS Spectrums, February 2008).
Other readers have also experienced restless leg syndrome, or RLS, after taking diphenhydramine. We find it disturbing that diphenhydramine is a component in most “PM” pain relievers. Using a sleep aid that might cause leg movements or agitation seems potentially counterproductive.