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Safety Record of Lumbrokinase
The discovery of lumbrokinase in earthworms is not by accident but rather a targeted investigation into understanding traditional medical practices in Asian cultures. Earthworms have been used for many centuries (including present days) in traditional Asian medicine and are considered as a safe ingredient according to all ancient and modern medical writings and cumulative experiences.
Even though earthworms appear to be very safe, what about enzymes extracted from earthworms? Past experiences with the development of pharmaceuticals have taught us to be vigilant about the risk of bleeding with any agent that affects the coagulation system. Thus, bleeding risk is one of the most watched for side-effect in the early research and trials involving lumbrokinase. To date, virtually all of the researchers who have ever studied or published on lumbrokinase concluded that it is a well-tolerated and very safe fibrinolytic enzyme preparation.
The review paper by Wang et al estimated the overall adverse reaction rate to be about 3% with symptoms like mild headache, dizziness, constipation, and nausea; all the symptoms resolved spontaneously after stoppage of medicine and required no special treatment.38 Another review paper by Tang et al reached an even lower rate of adverse reactions – 0.7% – though the authors believed this number to be an under-estimation.39 The types of adverse reaction include nausea, vomiting, rash, skin itch, and dizziness; there are no bleeding issues nor damage to liver or kidney functions.
Experiences in pharmaceutical drug development have taught researchers that clinical trials are simply simulations, no matter how perfect the study designs are. Adverse reaction profile of any drug can only be truly realized, in time, after it has been put on the market and used in real life conditions. Currently there are many lumbrokinase-containing products on the market, with most of them being sold in Asian countries. Some of these products are considered as nutritional supplements, some as Traditional Chinese Medicine, and some as pharmaceutical products. Over the past 30 years, lumbrokinase and earthworm-derived products have maintained an excellent safety record with little to none adverse reaction reported.
Differences Between Lumbrokinase Products and Other Enzymes
Not all lumbrokinase products are made the same. Lumbrokinase is a mixture of enzymes from earthworms, thus products manufactured by different companies will have slightly different properties due to the differences in earthworm species used, extraction methods, and purification processes. As a result, some lumbrokinase products may affect lab tests like INR or aPTT and some may not. They may also differ in the type of capsules used, fillers, and the quality control processes. Despite the differences, good quality lumbrokinase products should provide similar clinical benefits when used properly. In addition to products with standardized enzymatic activities, there are also products that use ground-up earthworms or crudely extracted earthworm proteins, which may contain lumbrokinase but without having the enzymatic strength and total enzymatic activities assayed.
Then how does lumbrokinase compare to other proteolytic enzymes? There are many oral proteolytic enzymes currently on the market, including bromelain, pancreatic enzymes, serrapeptase, nattokinase, etc. In terms of safety, by nature of being a protein, oral proteolytic enzymes are considered very safe. In terms of enzymatic activity, many proteolytic enzymes have broad-spectrum enzyme activities that are not specific towards fibrin. Presently only serrapeptase and nattokinase are being promoted as possessing fibrinolytic activities, thus more similar and comparable to lumbrokinase.
Serrapeptase is an enzyme extracted from silkworms and has been shown to be an effective anti-inflammatory enzyme for pain and swelling reduction.40 However, it still lacks clinical research supporting its use in thromboembolic conditions. On a milligram to milligram basis, the fibrinolytic strength of lumbrokinase is about 300-fold stronger than serrapeptase (see Table 1 .pdf).
Nattokinase is an enzyme extracted from traditional Japanese fermented soybeans and has been shown to an effective enzyme in improving various hypercoagulation-associated parameters; it looks very promising as an oral enzyme in the treatment and prevention of cardiovascular diseases. However, the use of nattokinase in human clinical trials involving thromboembolic conditions is still limited.41 On a milligram to milligram basis, the fibrinolytic strength of lumbrokinase is about 30-fold stronger than nattokinase (see Table 1).
Therefore, serrapeptase is not considered a strong fibrinolytic enzyme and should primarily be used for inflammation and pain association with oral/facial surgeries, sinus infection, arthritis, or chronic airway diseases. Respectively, nattokinase and lumbrokinase would be more suited for patients with mild and severe hypercoagulation or for patients with low and high cardiovascular risks.
Current and Future Challenges for Lumbrokinase
The use of earthworms to achieve circulatory health in traditional medicine has come a long way. First there were dried earthworms used in traditional oriental herbal decoctions, and then there were ground-up earthworm powders. Later came crude extracts of earthworms, and now there is lumbrokinase -- a purified multiple-enzyme preparation extracted from earthworms. Just like omega-3 molecules from fish oil, polyphenols from green tea, and curcumin from turmeric root, in time lumbrokinase shall be known as the most valuable therapeutic ingredient from the humble earthworms.
Even though lumbrokinase is a well-researched and clinically proven enzyme preparation, outside of Asia it is still relatively unknown to most practitioners and consumers. This is likely due to three main factors: first, most of the available clinical data on lumbrokinase is in Chinese and not readily accessible or understood by non-Chinese clinicians or researchers; second, pharmaceutical grade lumbrokinase is expensive and hard to come by (primarily from China), thus only a few companies are selling and promoting its clinical benefits; third, major pharmaceutical companies (with their massive influence on the media) have not found a way to profit from this enzyme yet. However, works have begun in further selecting and isolating one single enzyme from lumbrokinase for the eventual patenting and manufacturing of that specific enzyme via recombinant DNA technology.42 Will a singular lumbrokinase, without the synergistic and balancing actions of other lumbrokinase sub-enzymes, still be as safe and effective as the whole lumbrokinase enzyme group? Only time can tell.
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Dr. Martin Kwok completed his Bachelor of Science degree from the University of British Columbia, BC, Canada. Then he went on to receive his Doctor of Naturopathic Medicine and Master of Science in Acupuncture & Oriental Medicine from Bastyr University in Washington State.
Dr. Kwok is dual-licensed as a naturopathic physician and a doctor of traditional Chinese medicine in BC, Canada, and has had an active practice at the Richmond Alternative Medical Clinic, Inc. (Richmond, BC, Canada) for over 20 years. Dr. Kwok has a general practice with focuses on cardiovascular conditions, cancer supportive care, and hyperthyroid issues.
Dr. Kwok currently holds positions as a board member at National Traditional Chinese Medicine Association of Canada, as the Editor-in-Chief at Dragon's Medical Bulletin (an e-newsletter for health care professionals), as the Vice-President at Canada RNA Biochemical Inc., and as an advisor for Vita Aid Professional Products.
Dr. Kwok can be contacted by email at email@example.com or via his website at