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Hawthorn
Overview

Hawthorn (Crataegus species) has been used to treat heart disease as far back as the 1st century. By the early 1800s, American doctors were using it to treat circulatory disorders and respiratory illnesses. Traditionally, the berries were used to treat heart problems ranging from irregular heartbeat, high blood pressure, chest pain, hardening of the arteries, and heart failure. Today, the leaves and flowers are used medicinally, and there is some research that suggests that hawthorn might be effective when used in the treatment of mild to moderate heart failure.

laboratory studies report hawthorn contains antioxidants, including oligomeric procyandins (OPCs, also found in grapes) and quercetin. Antioxidants are substances that destroy free radicals -- compounds in the body that damage cell membranes, tamper with DNA, and even cause cell death. Free radicals occur naturally in the body and grow in number as we age. Environmental toxins (including ultraviolet light, radiation, smoking, some medicines, and air pollution) can also increase the number of these damaging particles. Free radicals are believed to contribute to the aging process (such as wrinkling), as well as the development of a number of health problems, including cancer and heart disease. Antioxidants found in hawthorn may help stop some of the damage from free radicals, especially when it comes to heart disease.


What is Hawthorn ?
Hawthorn is a spiny bush or small tree. It has strong-smelling white flowers and bright red spherical fruit containing 1 to 3 nuts.

How it is made
The hawthorn leaf and flower are used to make liquid extracts, usually with water and alcohol. Dry extracts can be put into capsules and tablets.

Benefits / uses
Heart failure
Hawthorn has been studied in people with heart failure (a condition in which the heart is unable to pump enough blood to other organs in the body), but more studies are needed to understand how effective it may be. A number of studies conclude that hawthorn significantly improved heart function. Studies also suggest the herb can enhance a person's ability to exercise following heart failure. Participants in studies have reported that hawthorn significantly improved symptoms of the disease (such as shortness of breath and fatigue). One study found that hawthorn extract (900 mg/day) taken for 2 months was as effective as low doses of captopril (a prescription heart medication) in improving symptoms of heart failure.

A large study found that a standardized hawthorn supplement was effective in 952 patients with heart failure. The study compared conventional methods of treating heart failure (with different medications) with hawthorn alone and in addition to the drugs. After 2 years, the clinical symptoms of heart failure (palpitations, breathing problems, and fatigue) decreased significantly in the patients taking the hawthorn supplement. People taking hawthorn also took less medication for their condition.

Heart failure is a serious condition, and you should never try to self treat with hawthorn. Ask your doctor if hawthorn is right for you.


Chest pain (Angina)
Preliminary evidence suggests hawthorn may help combat chest pain (angina), which is caused by low blood flow to the heart. In one early study, 60 people with angina were given either 180 mg/day of hawthorn berry leaf flower extract or placebo for 3 weeks. Those who received hawthorn experienced improved blood flow to the heart and were also able to exercise for longer periods of time without suffering from chest pain. However, more studies are needed to say for sure whether hawthorn is effective.

High blood pressure
Although hawthorn has not been studied specifically in people with high blood pressure, some people think its benefits in treating heart disease may carry over to treating high blood pressure (hypertension). However, so far not enough research has been done to say whether hawthorn is effective at lowering blood pressure -- and if so, by how much.
In one study, hawthorn extract was found to be effective for hypertension in people with type 2 diabetes who were also taking prescribed medicines. Participants took 1,200 mg hawthorn extract daily or placebo for 16 weeks. Those taking hawthorn had lower blood pressure than those taking the placebo.
You should talk with your doctor before taking hawthorn if you have high blood pressure.

Best Form For Human Consumption
Hawthorn is available in non standardized and standardized capsules and liquid extracts, along with tinctures and solid extracts. A bitter tasting tea can also be made from dried hawthorn leaves, flowers, and berries.

Doses
Trials have evaluated dosages ranging from 160 to 1,800 mg/day standardized extracts (mostly WS 1442) in divided doses over 3 to 24 weeks. A minimum effective dose for adjunctive therapy in mild CHF is 300 mg of standardized extract daily, and maximum benefit appears after 6 to 8 weeks of therapy. Clinical trials conducted in patients with class II and III CHF found hawthorn extract 900 mg daily to be safe.

Possible Side effects / Precautions / Possible Interactions:
Hawthorn is considered safe for most adults when used for short periods of time. Side effects are rare and can include upset stomach, headache, and dizziness.

Although drug interactions with hawthorn have not been thoroughly studied, there is evidence to suggest that hawthorn may interact with a number of different drugs, including certain heart medications.


Possible Interactions:
If you are taking prescription or nonprescription medicines, talk to your health care provider before taking herbal supplements. If you are currently being treated with any of the following medications, you should not use hawthorn without first talking to your health care provider:

Digoxin -- Hawthorn may enhance the activity of digoxin, a medication used for irregular heart rhythms.
Beta-blockers -- These drugs are used to treat heart disease by lowering blood pressure and dilating blood vessels. Hawthorn can make the effects of these drugs stronger. They include:

Atenolol (Tenormin)
Metoprolol (Lopressor, Toprol-XL)
Propranolol (Inderal, Inderal LA)
Calcium channel blockers -- These drugs are used to treat high blood pressure and angina by dilating blood vessels. Hawthorn can make the effects of these drugs stronger. They include:
Norvasc (amlodipine)
Cardizem (diltiazem)
Procardia (nifedipine)

Phenylephrine -- In a laboratory study, an alcoholic extract of hawthorn fruit reduced the effects of phenylephrine, a medication that constricts blood vessels and is commonly found in nasal decongestant products. Natural remedies, including cat's claw, coenzyme Q10, fenugreek, fish oil, ginger, and other herbs.

Medications for male sexual dysfunction (Phosphodiesterase-5 inhibitors) -- When used together with Hawthorn, it may result in blood pressure dropping too low.

Nitrates -- These medications increase blood flow to the heart and taking Hawthorn together with them might increase the chance of dizziness or light headedness.


Research studies / References

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Leuchtgens H. Crataegus special extract (WS 1442) in cardiac insufficiency. Fortschr Med 1993;111:352–4.
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Schmidt U, Kuhn U, Ploch M, Hübner WD. Efficacy of the hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomed 1994;1:17–24.
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Pittler M, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev 2008 Jan 23;(1):CD005312.
arw
Maevers VW, Hensel H. Changes in local myocardial blood flow following oral administration of a Crataegus extract to non-anesthetized dogs. Arzneimittelforschung 1974;24:783–5.
arw
Weikl A, Noh HS. The influence of Crataegus on global cardiac insufficiency. Herz Gerfässe 1992; 11:516–24.
arw
Bahorun T, Trotin F, Pommery J, et al. Antioxidant activities of Crataegus monogyna extracts. Planta Med 1994; 60:323–8.
arw
Schmidt U, Albrecht H, Podzuweit M, et al. High-dose crataegus therapy in patients suffering from congestive heart failure NYHA class I and II. Z Phytotherapie 1998;19:22–30.
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Rietbrock N, Hamel M, Hempel B, et al. Actions of standardized extract of Crataegus berries on exercise tolerance and quality of life in patients with congestive heart failure [in German]. Arzneimittelforschung 2001;51:793–8.
arw
Hanack T, Bruckel MH. The treatment of mild stable forms of angina pectoris using Crataegutt® novo. Therapiewoche 1983;33:4331–3 [in German].
arw
Weikl A, Assmus KD, Neukum-Schmidt A, et al. Crataegus Special Extract WS 1442. Assessment of objective effectiveness in patients with heart failure. Fortschr Med 1996;114:291–6 [in German].
arw
Weihmayr T, Ernst E. Therapeutic effectiveness of Crataegus. Fortschr Med 1996;114:27–9 [in German].
arw
Leuchtgens H. Crataegus Special Extract WS 1442 in NYHA II heart failure. A placebo controlled randomized double-blind study. Fortschr Med 1993;111:352–4 [in German].
arw
Schmidt U, Kuhn U, Ploch M, Hübner WD. Efficacy of the hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomed 1994;1:17-24.
arw
Pittler M, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev 2008 Jan 23;CD005312.
arw
Schmidt U, Kuhn U, Ploch M, Hübner W-D. Efficacy of the hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomed 1994;1(1):17–24.
arw
Walker AF, Marakis G, Simpson E, et al. Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial. Br J Gen Pract 2006;56:437–43.
arw
Al Makdessi S, Sweidan H, Dietz K, Jacob R. Protective effect of Crataegus oxycantha against reperfusion arrhythmias after global no-flow ischemia in the rat heart. Basic Res Cardiol 1999;94:71–7.
arw
Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy. Sandy, OR: Eclectic, 1919, 217–20.
arw
Weikl A, Noh HS. The influence of Crataegus on global cardiac insufficiency. Herz Gefabe 1993;11:516–24.
arw
Loew D. Pharmacological and clinical results with Crataegus special extracts in cardiac insufficiency. ESCOP Phytotelegram 1994;6:20–6.
arw
Bahorun T, Trotin F, Pommery J, et al. Antioxidant activities of Crataegus monogyna extracts. Planta Med 1994;60:323–8.
arw
Weihmayr T, Ernst E. Therapeutic effectiveness of Crataegus. Fortschr Med 1996;114:27–9 [in German].
arw
Schmidt U, Kuhn U, Ploch M, Hübner W-D. Efficacy of the Hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. Phytomed 1994;1:17–24.
arw
Leuchtgens H. Crataegus special extract WS 1442 in heart failure, NYHA II. A placebo-controlled randomized double-blind study. Fortschr Med 1993;111:352–4.
arw
Weikl A, Assmus KD, Neukum-Schmidt A, et al. Crataegus special extract WS 1442: Objective proof of efficacy in patients withy cardiac insufficiency (NYHA II). Fortschr Med 1996;114:291–6.
arw
Tauchert M, Ploch M, Hübner W-D. Effectiveness of hawthorn extract LI 132 compared with the ACE inhibitor Captopril: Multicenter double-blind study with 132 patients NYHA stage II. Münch Med Wochenschr 1994;132(suppl):S27–33.
arw
Hanack T, Brückel M-H. The treatment of mild stable forms of angina pectoris using Crataegutt (R) Novo. Therapiewoche 1983;33:4331–3 [in German].
28. Brown DJ. Herbal Prescriptions for Better Health. Rocklin, CA: Prima Publishing, 1996, 139–44.