Thread by @organichemusic

NEW STUDY on NATTOKINASE!🧵

With further evidence of microclots in #LongCovid emerging, this NK study is timely.

Typical NK dose is 2,000 FU qd, but is that high enough in Long Covid? And is NK safe w/ aspirin? Read ahead for answers, details and Q&A.

ncbi.nlm.nih.gov/pmc/articles/P…

1st, quick rundown of study:

Retrospective analysis from 1,062 pts examined safety & efficacy of nattokinase *10,800 FU* in the treatment of atherosclerosis progression & hyperlipidemia.

No, this wasn't a Covid-related study, but we can still glean relevant info from the data.

RESULTS:

After *12 months* on daily nattokinase 10,800 FU, lipid profiles improved significantly. Size of carotid artery plaques (CPS) and thickness of the intima-media of the common carotid artery significantly decreased as well.

SAFETY

Authors proclaimed 10,800 FU/day was "safe & well-tolerated"✅

"No noticeable adverse effects associated with the use of NK were recorded.”

Note this was a study based on medical records, so authors didn't interview patients or gather detailed info on adverse effects.

NK + ASPIRIN

96 pts took NK 10,800 FU + aspirin 100 mg daily.

Q: Did co-administration of low-dose aspirin with nattokinase result in a different clinical outcome?

A: Yes, aspirin + NK showed a synergistic effect, further improving outcomes, with no recorded adverse events.✅

DOSING

NK at 3,600 FU dose was NOT effective.

Authors argue effective dose of NK for atherosclerosis and hyperlipidemia = 6,000 to 12,000 FU daily.

It stands to reason that doses in this range (or higher?) might be reasonable in #LongCovid too.🤔

Tl;dr

1) New study found high-dose nattokinase +/- aspirin 100 mg was safe & effective in those w/ mild CVD.

2) Patients were older (63 to 85 yrs) & likely at higher risk for bleeding, yet no adverse events were recorded.

3) Dose was 10,800 FU daily

4) Duration was 12 months.

Q&A

Q: What dose is best in Long Covid?

A: Depends on individual, but it's safe to say that 2,000 FU is likely not going to cut it for most. A good starting dose may be 4000 FU once daily x 1 week to test for tolerability, then increase to 4000 FU twice daily (empty stomach).

Q&A

Q: I can't take on empty stomach twice daily. Which is better, 8,000 FU once daily on empty stomach or 4,000 FU twice daily but with food during 2nd dose?

A: 8,000 FU once daily on an empty stomach would probably be more effective.

Q&A

Q: So is NK safe with aspirin?
A: Based on this study, it appears safe, but consider your own medical history, medications & supplements.

Q: How long should I take NK for Long Covid?
A: Depending on individual history, 12 weeks to 1 year

DISCLAIMER:
This doesn't mean high-dose NK + aspirin will be safe for everyone. The risk of bleeding with NK while likely low is not zero & studies have suggested it may prolong time to clot. Consider individual risk factors, meds, medical & family history before choosing dose.

For example, if you have a personal or significant family history of ICH (brain bleed) or GI bleed, adding aspirin to nattokinase is not recommended, and a lower dose of nattokinase (if any) would also be prudent.

Note this case study:
-52-yo woman w/ recent stroke & underlying cerebral microangiopathy w/ ⬆️ risk of ICH
-Family history of brain bleed (father, paternal uncle died)
-Daily aspirin 100 mg
-7 days after adding NK 400 mg, diagnosed w/ cerebral hemorrhage
jstage.jst.go.jp/article/intern…