Wise Mind Herbs

The information on this page has been prepared with reference to published scientific literature, not by a medically qualified expert. It is not medical advice. Any decision to use a supplement or herb-based product is your responsibility. Consult a suitably qualified medical professional, especially if you have underlying conditions. Remember, nothing is for everyone, and not everything sold is what it claims to be. Some things work for some people, some of the time.

Hawthorn - Crataegus

Hawthorn, belonging to the genus Crataegus in the Rosaceae family, has a long history of use in traditional medicine systems worldwide. Modern scientific research has increasingly validated several of its traditional applications, particularly in cardiovascular health. This review synthesizes findings from peer-reviewed scientific literature on hawthorn's health benefits, appropriate dosages, side effects, and therapeutic applications.

Botanical Information and Common Names

The genus Crataegus comprises approximately 280 species of shrubs and small trees native to temperate regions of the Northern Hemisphere. The most commonly studied species for medicinal purposes include:

• Crataegus monogyna (Common Hawthorn, One-seed Hawthorn, May)
• Crataegus laevigata (Midland Hawthorn, English Hawthorn)
• Crataegus oxyacantha (now considered synonymous with C. laevigata)
• Crataegus pinnatifida (Chinese Hawthorn, Shan Zha)
• Crataegus mexicana (Mexican Hawthorn, Tejocote)

Other common names include whitethorn, maybush, quickthorn, and thornapple. It's important to note that "thornapple" can also refer to Datura species, which are entirely different plants with toxic properties. Similarly, "haw" may sometimes refer to fruits of other plants, particularly in certain regional contexts.

Active Constituents

Hawthorn's therapeutic properties are attributed to its rich phytochemical profile, which includes:

• Flavonoids (particularly vitexin, hyperoside, rutin, and quercetin)
• Oligomeric procyanidins (OPCs)
• Triterpene acids (ursolic and oleanolic acids)
• Phenolic acids (chlorogenic acid, caffeic acid)
• Cardioactive amines

Standardized extracts are typically standardized to contain 1.8-2.2% vitexin-4'-rhamnoside or 18-22% oligomeric procyanidins.

Therapeutic Applications with Scientific Evidence

1. Cardiovascular Conditions

The strongest evidence supports hawthorn's use in cardiovascular health. A 2020 meta-analysis by Wang et al. examined 14 randomized controlled trials (RCTs) with 1,153 participants and found that hawthorn extract significantly improved exercise tolerance and reduced symptoms in patients with chronic heart failure, particularly New York Heart Association (NYHA) class II-III. The analysis demonstrated improvements in maximal workload, exercise duration, and pressure-heart rate product (indication of myocardial oxygen consumption).

• Chronic Heart Failure: Numerous clinical trials have shown hawthorn's ability to improve cardiac output, increase exercise tolerance, and reduce symptoms of mild to moderate heart failure.
• Hypertension: Several studies demonstrate modest hypotensive effects, with systolic blood pressure reductions of 3-8 mmHg.
• Angina Pectoris: Research suggests hawthorn may decrease the frequency and severity of angina attacks by improving coronary blood flow.
• Arrhythmias: Some studies indicate anti-arrhythmic properties, potentially stabilizing heart rhythm.
• Hyperlipidemia: Evidence from both animal and human studies suggests cholesterol-lowering effects.

2. Other Conditions with Moderate Evidence

• Anxiety: Several studies suggest mild anxiolytic effects, possibly related to flavonoid content.
• Digestive Issues: Traditional uses for digestive complaints have some preliminary support from modern research.
• Cognitive Function: Emerging research suggests neuroprotective effects and potential benefits for mild cognitive impairment.

3. Conditions with Preliminary Evidence

• Diabetes: Animal studies suggest potential for improving insulin sensitivity and glucose metabolism.
• Inflammatory Conditions: In vitro and animal studies demonstrate anti-inflammatory properties.
• Antioxidant Activity: Strong antioxidant properties have been demonstrated in laboratory studies.

Recommended Dosages

Based on clinical trials, the following dosages have been established as effective:

• Dried berries: 300-1000 mg, three times daily
• Liquid extract (1:1): 0.5-1 mL, three times daily
• Tincture (1:5): 1-2 mL, three times daily
• Standardized extract (18-22% oligomeric procyanidins or 1.8-2.2% vitexin-4'-rhamnoside): 160-900 mg daily, divided into 2-3 doses

For heart failure, the most commonly studied dosage in clinical trials has been 900 mg/day of standardized extract, divided into three doses. Most clinical benefits have been observed after 4-8 weeks of consistent use.

Side Effects and Safety

Hawthorn is generally well-tolerated when used at recommended dosages. Reported side effects are typically mild and may include:

• Gastrointestinal discomfort (nausea, digestive upset)
• Headache
• Dizziness or vertigo
• Palpitations (rare)
• Sedation or drowsiness
• Hypotension (in sensitive individuals)

More serious concerns include potential interactions with cardiovascular medications, particularly digoxin, beta-blockers, calcium channel blockers, and phosphodiesterase-5 inhibitors. These interactions may potentiate the effects of these medications. Hawthorn may also interact with CNS depressants and enhance their effects.

High-Dose Studies and Knowledge Gaps

Studies examining doses above the established therapeutic range (>1000 mg/day of standardized extract) are limited. Doses up to 1800 mg/day for 12 weeks have been found to provide no additional therapeutic benefit compared to standard doses, though no significant increase in adverse events was noted. A knowledge gap exists regarding the long-term safety and efficacy of high-dose hawthorn supplementation, particularly beyond 6 months of use. Animal toxicity studies suggest a large safety margin, but comprehensive human studies at very high doses are lacking.

Commercial Pharmaceutical Products

Several standardized hawthorn extracts are available as registered pharmaceutical products in European countries:

• Crataegutt®: Standardized extract of fresh hawthorn berries, licensed in Germany for mild heart failure.
• Cardiplant®: Standardized extract used for NYHA class II heart failure.
• WS 1442 (Crataegus Special Extract): Used in numerous clinical trials, this highly standardized extract is marketed under different brand names in various European countries.

In the United States, hawthorn products are primarily available as dietary supplements rather than pharmaceuticals, and thus not subject to the same regulatory oversight.

Conclusion

The scientific evidence most strongly supports hawthorn's use for mild to moderate heart failure (NYHA class I-III), with promising but less definitive evidence for hypertension, hyperlipidemia, and angina. The herb appears to have a good safety profile at recommended dosages but should be used with caution in patients taking cardiovascular medications. As with many herbal medicines, standardization of products remains a challenge for consistent therapeutic outcomes, and patients with serious cardiovascular conditions should not substitute hawthorn for conventional medical care without professional guidance.

References

Edwards, J. E., Brown, P. N., Talent, N., Dickinson, T. A., & Shipley, P. R. (2012). A review of the chemistry of the genus Crataegus. Phytochemistry, 79, 5-26.

Holubarsch, C. J., Colucci, W. S., & Eha, J. (2018). Benefit-risk assessment of Crataegus extract WS 1442: An evidence-based review. American Journal of Cardiovascular Drugs, 18, 25-36.

Koch, E., & Malek, F. A. (2011). Standardized extracts from hawthorn leaves and flowers in the treatment of cardiovascular disorders–preclinical and clinical studies. Planta Medica, 77(11), 1123-1128.

Lu, M., Zhang, L., Pan, J., Shi, H., Zhang, M., & Li, C. (2023). Advances in the study of the vascular protective effects and molecular mechanisms of hawthorn (Crataegus anamesa Sarg.) extracts in cardiovascular diseases. Food & Function, 14(13), 5870-5890.

Martinelli, F., Perrone, A., Yousefi, S., Papini, A., Castiglione, S., Guarino, F., ... & Salami, S. A. (2021). Botanical, phytochemical, anti-microbial and pharmaceutical characteristics of hawthorn (Crataegus monogyna Jacq.), Rosaceae. Molecules, 26(23), 7266.

Tassell, M.C., Kingston, R., Gilroy, D., Lehane, M. and Furey, A., 2010. Hawthorn (Crataegus spp.) in the treatment of cardiovascular disease. Pharmacognosy reviews, 4(7), p.32.

Wang, J., Xiong, X., & Feng, B. (2013). Effect of crataegus usage in cardiovascular disease prevention: an evidence‐based approach. Evidence‐Based Complementary and Alternative Medicine, 2013(1), 149363.

Zick, S. M., Vautaw, B. M., Gillespie, B., & Aaronson, K. D. (2009). Hawthorn extract randomized blinded chronic heart failure (HERB CHF) trial. European journal of heart failure, 11(10), 990-999.