Can You Actually Reverse Arterial Plaque? A Closer Look at the Study Behind the Headlines

Nattokinase has been getting a lot of attention lately, and a big part of that stems from a conversation between David Sinclair -- a Harvard-trained geneticist known for his work on aging biology -- and Peter Diamandis, founder of the XPRIZE Foundation and a prominent voice in the field of exponential health technologies. Like most things that go viral, the nuance got left behind -- and what stuck was a single compelling idea: that arterial plaque might not be as permanent as we've been led to believe.

But the study they were referencing, published in Frontiers in Cardiovascular Medicine, tells a more nuanced story than the headlines suggest. Researchers followed 1,062 people over 12 months, tracking both blood lipid levels and physical changes in the carotid arteries via ultrasound. What makes this study worth paying attention to isn't just its size -- it's that it measured both the biochemistry and the actual anatomy before and after participants consistently took nattokinase.

The daily dose was 10,800 fibrinolytic units (FU), which is significantly higher than what you'll find in most off-the-shelf supplements. Researchers looked at triglycerides, total cholesterol, LDL, HDL, carotid artery wall thickness (CCA-IMT), and plaque size. Taken together, the numbers paint a picture of meaningful, multi-front improvement in cardiovascular risk markers.

What happened in the arteries themselves

Using Doppler ultrasound, the researchers observed measurable structural changes—not just better blood work, but also thinner arterial walls and smaller plaques.

On average, carotid wall thickness dropped from 1.33 mm to 1.04 mm, a reduction of about 21.7%. Plaque size shrank by roughly 36%. About 78% of participants saw improvement in arterial thickness, and two-thirds saw their plaque burden decrease.

That said, this wasn't a clean sweep. There was real variability from person to person. The pattern points more toward regression and stabilization than across-the-board plaque elimination.

Dose matters -- a lot

One of the most important details in this study is easy to miss. A subset of participants taking 3,600 FU per day -- which is much closer to the levels in most commercial nattokinase products -- didn't show statistically significant improvements in lipid levels or arterial measurements. The contrast with the high-dose group is hard to ignore, and it may explain why past studies using lower doses have yielded mixed results. There seems to be a threshold you need to cross before things start to shift.

How does nattokinase actually work?

Most people know nattokinase as a fibrinolytic enzyme -- it breaks down fibrin and plays a role in how the body handles clots. But the data from this study hints at something broader. The researchers describe a cluster of overlapping effects: clot modulation, lipid reduction, antioxidant activity, and influence on LDL oxidation and endothelial function.

That kind of multi-pathway activity isn't unusual for compounds that come from fermentation. Fermented foods tend to produce a web of biological effects rather than acting through one clean mechanism, and nattokinase fits that mold.

While nattokinase is most closely associated with natto (the Japanese fermented soybean dish), similar enzymatic activity can be produced by fermenting other substrates, such as chickpeas, with Bacillus subtilis. It's less a magic bullet and more a window into how fermentation creates biologically active compounds with wide-reaching effects.

In summary, in clinical settings, nattokinase is a powerful enzyme that helps reduce arterial plaque. I have seen patients whose arterial plaques decreased by as much as 90%!

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