By Christopher Piercecchi, MD
Physician and Wellness Manager, Founder, The Men’s Clinic for Wellness & Vitality
SITREP Disclaimer: SITREP is an evidence-review briefing for patients and colleagues of The Men’s Clinic for Wellness & Vitality. It is educational and does not constitute individualized medical advice.
A note before you read this: This is not a piece defending statins. If you have strong feelings about statin therapy, one way or the other, that debate is not the point here, and you do not need to agree with me about statins specifically to get something out of what follows. What I am unwilling to compromise on is the evidence that lowering LDL cholesterol in people whose cardiovascular risk warrants treatment reduces the risk of heart attack and stroke. How you get there is a separate question. Statins are one tool. Ezetimibe, bempedoic acid, and PCSK9-directed therapies are others. I am an advocate for appropriate lipid lowering, not for the idea that everyone needs to take a statin.
Every once in a while, I come across a video that makes me stop and raise an eyebrow. This week it was a YouTube video titled “Statins Are Being Replaced by This Miracle Enzyme.” The miracle enzyme is nattokinase, and the person making the argument is Stephen Cabral. I had never heard of him, so naturally I looked him up. His own website identifies him as a “Board Certified Doctor of Naturopathy,” not an MD, and lists among his credentials and specialties Ayurveda, iridology, live and dried blood microscopy, hair mineral analysis, homotoxicology, cupping, and various other alternative practices.[1] In this context, “alternative” is doing a great deal of work: many of these practices sit well outside evidence-based medicine, and some of the diagnostic methods on that list have failed scientific validation.[2]
Cabral’s nattokinase argument gives us a remarkably clean example of exactly what I mean. He says there is “very strong research,” calls nattokinase a “miracle enzyme,” and writes that “nature has a better remedy than the pharmaceutical industry.” He then claims that a large randomized controlled study of more than 1,000 people compared nattokinase head-to-head against statins.[3] That description is factually wrong. His own article makes that claim, but the study of 1,062 people was retrospective and did not randomly compare nattokinase with statins.[4] Oh, and by the way, he’s trying to sell you the nattokinase supplement. His video directs viewers to a nattokinase formula and provides the discount code HEART15 to purchase it.[5]
Pro tip: If someone on social media is using medical or health credentials to promote a supplement, device, therapy, or other product they also happen to sell, move on. They are not just giving you information. They have a financial interest in convincing you to believe it.
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