Hawthorn berries supplement research and health benefit for heart, Crataegus laevigata, oxyacantha and pinnatifida
February 1 2017 by Ray Sahelian, M.D.

In some European countries, hawthorn berries extract is considered a relatively safe and effective therapy for mild to moderate congestive heart failure. In congestive heart failure, the heart has a reduced ability to pump blood effectively, often due to a previous heart attack. Hawthorn berries may also be helpful in high blood pressure. Hawthorn leaves, flowers and berries are used by herbal practitioners in the UK to treat hypertension in conjunction with prescribed drugs. I have not seen enough studies yet on hawthorn to be completely convinced that hawthorn is effective for heart failure, and perhaps a couple of more rigorous trials that show good results would tip me over in the believer category.

What's in Hawthorn berries?
Hawthorn contains flavonoids, procyanidins and other active compounds.

How does Hawthorn work? Benefit
This herb acts as a vasodilator, increasing blood supply to the heart and improving circulation to the extremities by decreasing arterial resistance. Hawthorn also has positive inotropic and beta-blocking effects, along with antioxidant and anti-inflammatory benefits. One human study show hawthorn to be affective in lowering blood pressure in patients with diabetes.

What form of is best?
The methanol or alcohol extract of hawthorn berries seems to be more effective. Hawthorn is sold as the plain powder and various extract potencies including 10 percent flavones, hawthorn berry extract 2 percent vitexin, and hawthorn leaves extract 2 percent hyperosides.

Vitexin and isovitexin are active components of many traditional Chinese medicines, and are found in various medicinal plants. Vitexin (apigenin-8-C-glucoside) has a wide range of pharmacological effects, including but not limited to anti-oxidant, anti-cancer, anti-inflammatory, and neuroprotective effects. Isovitexin (apigenin-6-C-glucoside), an isomer of vitexin, generally purified together with vitexin, also exhibits diverse biological activities.

What is the dosage?
The recommended daily dose of hawthorn berries is 160-900 mg of a native water-ethanol extract of the leaves or flowers (equivalent to 30-169 mg of epicatechin or 3.5-19.8 mg of flavonoids) administered in two or three doses.

What about Hawthorn side effects?
At therapeutic dosages, hawthorn side effects may include a mild rash, headache, sweating, dizziness, palpitations, sleepiness, agitation, and gastrointestinal symptoms.

Interactions with drugs
Hawthorn may interact with vasodilating medications and may potentiate or inhibit the actions of drugs used for heart failure, hypertension, angina, and arrhythmias. Some studies have shown less benefit when this herb has been combined with heart medications.

Interactions with supplements
Q. Can I take magnesium, hawthorn and garlic at the same time?
   A. It is not easy to give any reliable information without examination since each person is totally unique in which diet, supplements, medications, hormones they may require and in which dosages. Also, many people may not need to take any supplements on a regular basis. So I can't tell without examining a patient and reviewing their total medical history and current symptoms.

Diabetes and blood sugar
Hawthorn evokes a potent anti-hyperglycemic capacity in streptozotocin-induced diabetic rats.
J Herb Pharmcotherapy. 2003.
The hypoglycemic effect of an aqueous extract of hawthorn leaves (Crataegus oxyacantha) was investigated in normal and streptozotocin (STZ) diabetic rats. After a single dose or 9 daily doses, oral administration of the aqueous hawthorn extract produced a significant and dose-dependent decrease on blood glucose levels in STZ diabetic rats, but had no effect on blood sugar levels in normal rats. No changes were observed in basal plasma insulin concentrations after treatment in normal or STZ diabetic rats. In addition, the acute toxicity study of the extract was investigated in mice. The results obtained showed that the aqueous hawthorn extract had a high LD50 value in mice. We conclude that an aqueous extract of hawthorn leaves exhibits a potent anti-hyperglycemic activity in STZ rats, but not in normal rats, without affecting basal plasma insulin concentrations.

Heart failure
Crataegus oxyacantha (Aubepine, Hawthorn), was used by European herbalist in the first century A. D. It went out fashion as a medicine until the 19th century for heart disease. The leaves, flowers, and berries of hawthorn contain a variety of bioflavonoid-like complexes that appear to be primarily responsible for the cardiac actions of the plant. Bioflavonoids found in C. oxyacantha include oligomeric procyanidins, vitexin, quercetin, and hyperoside. The action of these compounds on the cardiovascular system has led to the development of leaf and flower extracts. Hyperoside is the marker for quality control.

Evid Based Complement Alternative Med. 2013. Effect of Crataegus Usage in Cardiovascular Disease Prevention: An Evidence-Based Approach. Hawthorn (Crataegus oxyacantha) is a widely used Chinese herb for treatment of gastrointestinal ailments and heart problems and consumed as food. In North America, the role of treatment for heart problems dates back to 1800. Currently, evidence is accumulating from various in vivo and in vitro studies that hawthorn extracts exert a wide range of cardiovascular pharmacological properties, including antioxidant activity, positive inotropic effect, anti-inflammatory effect, anticardiac remodeling effect, antiplatelet aggregation effect, vasodilating effect, endothelial protective effect, reduction of smooth muscle cell migration and proliferation, protective effect against ischemia/reperfusion injury, antiarrhythmic effect, lipid-lowering effect and decrease of arterial blood pressure effect. On the other hand, reviews of placebo-controlled trials have reported both subjective and objective improvement in patients with mild forms of heart failure (NYHA I-III), hypertension, and hyperlipidemia. This paper discussed the underlying pharmacology mechanisms in potential cardioprotective effects and elucidated the clinical applications of Crataegus and its various extracts.

Hawthorn leaf extract extended the lives of patients with congestive heart failure by about four months. These patients were already receiving medical treatment. Results of the 2,681-patient clinical trial that tested the hawthorn extract known as WS 1442 against a placebo. Dr. Christian Holubarsh, was lead investigator of the study that was sponsored by the Germany-based Dr. Willmar Schwabe Group. Hawthorn leaf extract is a natural antioxidant that has been used in parts of Europe to treat heart failure. Patients in the trial had severely impaired left ventricular function. The primary goal of the study was time to first cardiac event, defined as sudden cardiac death, death due to progressive heart failure, fatal and nonfatal heart attacks or hospitalization due to heart failure. Patients who received the hawthorn extract had a 20 percent reduction in cardiac-related deaths, which translated into four months of added survival time during the first 18 months of the study.

A randomised double blind placebo controlled clinical trial of a standardized extract of fresh Crataegus berries in the treatment of patients with congestive heart failure NYHA II.
Phytomedicine. 2003.
A placebo controlled, randomised, parallel group, multicentre trial conducted shows the efficacy and safety of a standardised extract of fresh berries of hawthorn in patients with cardiac failure. A total of 143 patients (72 men, 71 women) were recruited and treated with 3 times 30 drops of hawthorn extract or placebo for 8 weeks. The primary variable for the evaluation of efficacy was the change in exercise tolerance determined with bicycle exercise testing, secondary variables included the blood pressure-heart rate product (BHP). In the hawthorn population there was a significant increase in exercise tolerance in both groups between visit 1 and visit 3. The difference between the treatment groups was 8.3 watts in favour of the standardised extract of fresh hawthorn. Changes in BHP at 50 watts and at comparable maximum load were in favor of hawthorn extract but the results are not statistically significant. The subjective assessment of cardiac symptoms at rest and at higher levels of exertion did not change significantly and the patient and investigator overall assessment of efficacy were similar for the two groups. Hawthorn was well tolerated and had a high level of patient acceptability. The significant improvement, due to the fact that dyspnoea and fatigue do not occur until a significantly higher wattage has been reached in the bicycle exercise testing allows the conclusion that the recruited NYHA II patients may expect an improvement in their heart failure condition under long term therapy.

Heart rhythm disturbances
There have been reports that hawthorn herb may be helpful for arrhythmia control.

Last year I was diagnosed with PVC's (premature ventricular contractions). My doctor ran the necessary tests and thankfully they were all negative. He said that they were from stress. They lasted for approximately six months during the time of which I was doing extensive research on how to get rid of them. I found out that magnesium could help, so I started taking it and they went away, until recently. Approximately 3 weeks ago they started again. I'm afraid of having a heart attack. I read that Hawthorn herb may be able to help. I take a Centrum multivitamin along with a separate 250 mg magnesium supplement and separate 50mg zinc vitamin. Is taking the hawthorn supplement along with all these vitamins safe?
   Each person has a different response to the combination of supplements and I cannot say whether using a hawthorn supplement is safe or not in your case. You may consider reading this page on heart palpitations and perhaps some of the information would help you and you can discuss the info with your doctor. Sometimes even certain multivitamins could trigger heart rhythm disturbances in those who have a low threshold for arrhythmias.

I recently began taking this supplement for hypertension. I purchased Nature's Way Hawthorn Berries (not STANDARDIZED) 510 mg per capsule. I followed the dosage recommendation on the label which is 3 capsules 3 times a day. After 3 weeks I began to have severe heart palpitations. After doing some research online I found that most studies indicated that the maximum daily dosage should not exceed 1500 mg. I was taking almost 5 grams a day by following the instructions provided by Nature's Way. I stopped taking Hawthorn about 10 days ago but I still have some palpitations. I have used a variety of Nature's Way supplements over the years and I have always felt they were a reputable company and have been very happy with their products. I contacted Nature's Way inquiring why their daily dosage was so much higher than studies suggested as well as the suggested dosage of other companies' Hawthorn supplements. I was told that they based their recommendations on a variety of studies to determine the best dosage for safety and efficacy. However I have been unable to find any studies myself to confirm that this is a safe and effective dose. I actually came across your website while researching this and thought you might be able to shed some light on this for me. What do you think about the dosage I was taking? Should I still be having an adverse reaction 10 days after discontinuing the supplement?
   A. There has been very little research done with hawthorn supplements in humans therefore it is difficult to know at this time the full benefits and side effects. The dosage recommendations on labels of various natural herbal products on the market vary significantly between different companies since there are few accepted guidelines. Most side effects will go away within a week or two.

High blood pressure benefit
Hypertension, blood pressure study
Hypotensive effects of hawthorn berries for patients with diabetes taking prescription drugs: a randomised controlled trial.
Br J Gen Pract. 2006.
To investigate the effects of hawthorn berries for hypertension in patients with type 2 diabetes taking prescribed drugs. Patients with type 2 diabetes were randomised to daily 1200 mg hawthorn extract or placebo for 16 weeks. Hypotensive drugs were used by 71% of the study population with a mean intake of 4.4 hypoglycaemic and/or hypotensive drugs. This is the first randomised controlled trial to demonstrate a blood pressure lowering effect of hawthorn in patients with diabetes taking medication.

Hawthorn Research and review
Molecules. 2014. Crataegus pinnatifida: Chemical Constituents, Pharmacology, and Potential Applications. Crataegus pinnatifida (Hawthorn) is widely distributed in China and has a long history of use as a traditional medicine. The fruit of hawthorn has been used for the treatment of cardiodynia, hernia, dyspepsia, postpartum blood stasis, and hemafecia and thus increasing interest in this plant has emerged in recent years. Between 1966 and 2013, numerous articles have been published on the chemical constituents, pharmacology or pharmacologic effects and toxicology of C. pinnatifida. To review the pharmacologic advances and to discuss the potential perspective for future investigation, we have summarized the main literature findings of these publications. So far, over 150 compounds including flavonoids, triterpenoids, steroids, monoterpenoids, sesquiterpenoids, lignans, hydroxycinnamic acids, organic acids and nitrogen-containing compounds have been isolated and identified from C. pinnatifida. It has been found that these constituents and extracts of C. pinnatifida have broad pharmacological effects with low toxicity on, for example, the cardiovascular, digestive, and endocrine systems, and pathogenic microorganisms, supporting the view that C. pinnatifida has favorable therapeutic effects. Thus, although hawthorn herb has already been widely used as pharmacological therapy, due to its various active compounds, further research is warranted to develop new drugs.

Hawthorn: pharmacology and therapeutic uses.
Am J Health Syst Pharm 2002.
Hawthorn uses have included the treatment of digestive ailments, dyspnea, kidney stones, and cardiovascular disorders. Today, hawthorn is used primarily for various cardiovascular conditions. The cardiovascular effects are believed to be the result of positive inotropic activity, ability to increase the integrity of the blood vessel wall and improve coronary blood flow, and positive effects on oxygen utilization. Flavonoids are postulated to account for these effects. Hawthorn has shown promise in the treatment of New York Heart Association functional class II congestive heart failure (CHF) in both uncontrolled and controlled clinical trials. There are also suggestions of a beneficial effect on blood lipids. Trials to establish an anti-arrhythmic effect in humans have not been conducted. The recommended daily dose of hawthorn is 160-900 mg of a native water-ethanol extract of the leaves or flowers (equivalent to 30-169 mg of epicatechin or 3-19 mg of flavonoids) administered in two or three doses. At therapeutic dosages, hawthorn may cause a mild rash, headache, sweating, dizziness, palpitations, sleepiness, agitation, and gastrointestinal symptoms. Hawthorn may interact with vasodilating medications and may potentiate or inhibit the actions of drugs used for heart failure, hypertension, angina, and arrhythmias. The limited data about hawthorn suggest that it may be useful in the treatment of NYHA functional class II CHF.

Hawthorn Berries Laboratory Studies
Investigation of the pharmaceutical and pharmacological equivalence of different Hawthorn extracts.
Phytomedicine 2003.
Seven Hawthorn extracts were tested in isolated guinea pig aorta rings. The effect on noradrenaline-induced contraction was investigated. The aqueous-alcoholic extracts displayed similar spectra of constituents. They were characterised by similar procyanidin, flavonoid, total vitexin and total phenols content and by similar TLC fingerprint chromatograms. The aqueous extract, however, showed a different fingerprint and a noticeably lower concentration of procyanidins, flavonoids and total phenols but a similar total vitexin content. All 7 extracts had a relaxant effect on the aorta precontracted by noradrenaline and led to relaxations to 44 until 29% of the initial values. The EC50 values of the aqueous-alcoholic extracts varied between 4 and 9 mg/l. The aqueous extract produced a similarly strong maximal relaxation as the other extracts,. The results show that Hawthorn extracts with comparable quality profiles were obtained by using aqueous-alcoholic extraction solvents. The hawthorn extracts exerted comparable pharmacological effects. When using water as the extraction solvent, both, the spectrum of constituents and the pharmacological effect, deviated remarkably. It is thus possible to obtain bioequivalent extracts with comparable effect profiles by using 40 to 70% ethanol or methanol as the extraction solvent.

I have heart failure, but I'm very healthy otherwise. I've take herbs for over 30 years, but the high blood pressure finally made my heart succumb. I have been taking a Hawthorn combination with myrrh and motherwort from Pure Herbs. Will this affect the drugs they have me on to help control my blood pressure?
    It is not possible to easily predict the interactions between herbs and medications. Much depends on the dosage used of the herbs and medications, and the individual physiology and metabolism of the person.

Q. The extracts are standardized to 1.8% or so vitexin but how much is in just the plant? how much vitexin is in a gram of berries? they talk about the plant and the products but then brag on the extracts. So how potent is the extract?
   A. We don't have all the answers, but perhaps this study can shed some light. J Chromatogr B Analyt Technol Biomed Life Sci. 2015. Separation of vitexin-4″-O-glucoside and vitexin-2″-O-rhamnoside from hawthorn leaves extracts using macroporous resins. Vitexin-4″-O-glucoside and vitexin-2″-O-rhamnoside are the major flavonoids of hawthorn leaves. In this work, the adsorption and desorption characteristics of vitexin-4″-O-glucoside and vitexin-2″-O-rhamnoside on seven macroporous resins were evaluated. Among the tested resins, the HPD-400 resin showed the best adsorption and desorption capacities. After one run treatment with the HPD-400 resin, the contents of vitexin-4″-O-glucoside and vitexin-2″-O-rhamnoside in the product were increased 8-fold. These results show that the developed method is a promising basis for the large-scale purification of vitexin-4″-O-glucoside and vitexin-2″-O-rhamnoside from hawthorn leaves and other plant materials.

Products on the market
Hawthorn Berry extract 2.0% Vitexin
Leaves extract 2% Hyperosides

buy Hawthorn Berries supplement, 510 mg, 180 Capsules - Nature's Way
Hawthorn (Crataegus oxyacantha) berries of this European species have been used since ancient times for well-being and as a cardiovascular tonic.

Supplement Facts:
Serving Size: 3 Capsules
Servings Per Container: 60

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Supplement Facts Nature's Way, Hawthorn Berries
Serving Size: 3 Capsules
Servings Per Container: 60
  Amount Per Serving % Daily Value
Calories 5  
Total Carbohydrate 1 g <1%†
Dietary Fiber less than 1 gram 2%†
Sugars <1 g **
Hawthorn (berry) 1.53 g (1,530 mg) **
†Percent Daily Values are based on a 2,000 calorie diet.
**Daily Value not established.

Amount per Serving
Hawthorn (berry) 1,530 mg per 3 pills

Recommendation: Take 1 or 2 hawthorn capsules 1 or 2  times daily or as recommended by your doctor.

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