Page 1, 2
Dr. Miller's Caveats
A major caveat: I never advocate abruptly stopping conventional anticoagulant routines. You need experienced medical supervision to start and monitor your progress. This anticoagulant routine requires special knowledge of potency, dosing and the value of these natural sources. Dosages will vary depending on your laboratory tests. I have treated thousands of cases over the past 20 years. This is time- tested. It is effective. But this regimen has not been "validated" through conventional guidelines or task force committees. It is not the "standard of care." For this reason, your internist, cardiologist or family practitioner will have little understanding of the rationale or efficacy of this routine. Do not self-treat.
Nattokinase is a well-known fibrinolytic agent.28 As you may recall our goal is to prevent fibrinogen from converting to fibrin. A 2009, open label study involved three groups of patients: healthy volunteers, patients at risk for cardiovascular disease, and patients undergoing dialysis. Two months of nattokinase reduced fibrinogen, as well as two clotting factors known as factor VII and factor VIII.41 And a 2014 study in Nature found that a single oral dose of nattokinase improved fibrinolysis and blood flow.29
Studies have consistently shown that nattokinase possesses strong fibrinolytic activity.30,31 Nattokinase reduces plasminogen activator inhibitor I (PAI-1), which as you may recall, is important in the clotting cascade.32 Nattokinase also stimulates the conversion of plasminogen to plasmin.33 Nattokinase shows thrombolytic (clot dissolving) activity.45 The thrombolytic power of nattokinase may be stronger than plasmin.43
I have treated thousands of cases with nattokinase to help prevent recurrent thrombophlebitis, strokes, and heart attacks. It is essential that you source NSK-SD ® nattolinase, which is proven highly effective and standardized.
There are alternatives to nattokinase. Lumbrokinase is a similar fibrinolytic derived from the earthworm. By the manufacturer's claims, it is even more potent. Serrapeptase, an enzyme derived from silkworms, has similar but not identical properties and is often used to combat inflammation and swelling.34,35 I do use serrapeptase to treat arterial plaques.
Ginkgo biloba is a time-honored and venerated Chinese herb with many potent constituents, including flavonol and flavone glycosides, lactone derivatives (ginkgolides), and bilobalide.36,37 I use a standardized 26% ginkgo extract.
Ginkgo biloba exerts its action primarily as an anti-platelet and anticoagulant. It inhibits platelet aggregating factor.38 Ginkgo has many other uses. It is an antioxidant, may have vasodilatory effects, and has been used for cognitive enhancement. I find it much more effective as a cardiac protective herb.
Ginkgo is potent. A high dose can cause excess blood thinning and bleeding. Because of its action, Ginkgo biloba should not be combined with aspirin or non-steroidal anti-inflammatory drugs (NSAIDs). It will have an unwanted synergistic effect.
High Potency Fish Oils
High-dose fish oils have a "rheological" effect. That is, they prevent aggregation of red blood cells, which as you may recall, is part of the coagulation cascade.39,40 An image I find effective in describing fish oils to my patients is that they act like Teflon to prevent this aggregating effect. The dose that I recommend in my protocol is aggressive: one tablespoon daily. You will rarely achieve these doses with oral capsules. I rely on fish oils in liquid form.
Fish oils contain EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). One tablespoon of high potency fish oil will yield this high dose of 4300 mg EPA, approximately 3000 mg of DHA, and 1000 mg of other omega-3s. You will not achieve these doses with fish oil capsules.
Fish oils, in addition to their anticoagulant effect, may have multiple ancillary benefits:
- Enhance brain function – cognitive enhancement,41
- Prevent cardiovascular events,42
- Improve skin elasticity,44
- Lower blood pressure.45
Vitamin E Isomers
Like fish oil, vitamin E has rheological properties. It prevents red blood cell aggregation and lowers blood viscosity, or stickiness.46 Vitamin E exists as a family of tocopherols and tocotrienols, and I recommend mixed tocopherols, an isomeric mix of natural tocopherols including the alpha, beta, gamma and delta forms of vitamin E. There is a difference between "natural" vitamin E and "synthetic" natural vitamin E. Synthetic vitamin E is a tocopheryl not tocopherol.
Water, Elixir of Life
And last but not least, hydration. Keep well hydrated. Hydration will also prevent red blood cell and platelet aggregation.47 It will improve skin elasticity. I recommend filtered water in glass bottles, not plastic bottles. We all should avoid plasticizers. The softer the plastic bottle, the higher the plasticizer content.
Focus: When a patient comes to you seeking an anticoagulation protocol, what do you do?
Miller: I run a series of tests. First, I look at typical lab work – a complete blood count (CBC), chemistries (liver and kidney function), lipids, vitamin D, thyroid and adrenal. I also look at inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fibrinogen levels. With more sophisticated testing, we can test arachidonic acid/EPA ratios. These are obtained through one of a number of specialty labs.
I routinely measure fibrinogen levels on every one of my patients. I am aggressive about reducing fibrinogen levels. If levels are above 350 mg/dl, I recommend nattokinase, despite most labs using an upper level for high fibrinogen >450 mg/dl. I look at the patient's clinical picture: age, risk factors such as hypertension, cardiovascular issues, and family history. It's always a combination of lab values, family history, and the clinical picture.
I find that my recommended regimen, when fully implemented, treats all pathways of coagulation. Empirically and rationally, there is good evidence this approach has the ability to effectively prevent heart attacks, strokes, and recurrent thrombophlebitis. It is a comprehensive approach to anticoagulant therapy that, for my patients and me, has stood the test of time.
Page 1, 2
Dr. Philip Lee Miller, MD is the Founder, Medical Director, and CEO of California Age Management Institute. located in Monterey, CA. He has been in medical practice for over 45 years. He graduated from UC Berkeley in 1968 (Centennial) with a degree in biochemistry. In 1972, he graduated from the School of Medicine at UC San Diego with an MD degree -- the school's first (charter) graduating class. There was further training in neurology at UC Davis. He was ABEM Board Certified in Emergency and is currently a Diplomat of the American Board on AntiAging Medicine (ABAAM).
Dr. Miller is an internationally recognized leader in anti-aging, age management and integrative medicine. This started with a past association with Dr. Julian Whitaker of the Whitaker Wellness Institute in Newport Beach, California. Dr. Miller is the lead co-author of one of the classics in the anti-aging medicine literature: The LEF Revolution: The New Science of Growing Older Without Aging, first released on May 17, 2005. He regularly pens topical blogs at blog.antiaging.com on subjects with a critical view and additional blogs on Huffington Post. You can easily find him on www.antiaging.com.