Hawthorn's therapeutic uses
Hawthorn, a natural plant product known scientifically as *Crataegus*, has been utilized for centuries for its potential therapeutic benefits, primarily in heart-related conditions. Its most notable use is in the treatment of congestive heart failure (CHF), where studies suggest it may enhance the heart's pumping ability and stabilize heart rhythm without the toxicity associated with some conventional medications. While hawthorn shows promise in improving symptoms of mild to moderate CHF, it is essential to note that self-treatment is discouraged; patients should always consult healthcare providers before considering hawthorn as a treatment option.
In addition to CHF, hawthorn is also explored for its potential to address benign heart palpitations, high blood pressure, and digestive issues, though evidence supporting these uses is less robust. Safety assessments indicate that hawthorn is generally well-tolerated, with few side effects reported. However, the risk of complications from CHF necessitates cautious use, and individuals should avoid using hawthorn in place of proven heart medications. Overall, hawthorn exemplifies the intersection of herbal remedies and traditional medicine, reflecting historical practices while facing modern scientific scrutiny.
Hawthorn's therapeutic uses
- DEFINITION: Natural plant product used to treat specific health conditions.
- PRINCIPAL PROPOSED USE: Congestive heart failure
- OTHER PROPOSED USES: Benign heart palpitations, high blood pressure, orthostatic hypotension, atherosclerosis, high cholesterol, digestive issues, inflammation, anxiety
Overview
The name “hawthorn” is derived from “hedgethorn,” reflecting this spiny tree’s use as a type of living fence in much of Europe. Besides protecting estates from trespassers, hawthorn has also been used medicinally since ancient times. Roman physicians used hawthorn as a heart drug in the first century Common Era, but most of the literature from that period focuses on its symbolic use for religious rites and political ceremonies.
During the Middle Ages, hawthorn was used to treat dropsy, a condition now called congestive heart failure (CHF). It was also used for treating other heart ailments and for treating sore throat.
Therapeutic Dosages
The usual dosage of hawthorn is 300 to 600 milligrams (mg) three times daily of an extract standardized to contain about 2 to 3 percent flavonoids or 18 to 20 percent procyanidins. Studies indicate that full effects may take up to six months to develop, although some improvement should be apparent much sooner.
Therapeutic Uses
Meaningful evidence indicates that hawthorn is a safe and effective treatment for CHF. Like other treatments used for CHF, hawthorn improves the heart’s pumping ability. It also may offer some important advantages over certain conventional drugs used for this condition.
Digoxin, as well as other medications that increase the power of the heart, also make the heart more susceptible to dangerous irregularities of rhythm (arrhythmias). In contrast, preliminary evidence indicates that hawthorn may have the unusual property of both strengthening the heart and stabilizing it against arrhythmias.
It is thought to do so by lengthening what is called the refractory period: the short period following a heartbeat during which the heart cannot beat again. Many irregularities of heart rhythm begin with an early beat. Digoxin shortens the refractory period, making such a premature beat more likely, while hawthorn protects against such potentially dangerous breaks in the heart’s even rhythm.
Another advantage of hawthorn is its lower toxicity. With digoxin, the difference between the proper and the toxic dosages is dangerously small. Hawthorn has an enormous range of safe dosing.
However, keep in mind that digoxin is itself an outdated drug. There are a great many newer drugs for CHF, such as angiotensin-converting enzyme (ACE) inhibitors, that are much more effective than digoxin. Many of these have been proven to prolong life in people with advanced CHF. There is no reliable evidence that hawthorn offers the same benefit, although one large study found promising evidence. One small study concluded that it may be safe to combine hawthorn and digoxin, but whether hawthorn interacts safely with other heart drugs remains to be determined. The Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial, a rigorous double-blind, placebo-controlled study of hawthorn, failed to prove any benefits.
Finally, CHF is simply too dangerous a condition to rely solely on self-treatment. People who have CHF should not use hawthorn except under close physician supervision.
In addition to CHF, hawthorn is sometimes used to treat heart palpitations that have been thoroughly evaluated and found to be harmless. Common symptoms include occasional thumping, as well as episodes of racing heartbeat. These may occur without any identifiable cause and may not require any medical treatment except for purposes of comfort. However, there is no evidence that hawthorn is effective for this purpose. Furthermore, because there are many dangerous kinds of heart palpitations, it is absolutely necessary for individuals to get a thorough checkup first. It is only worth considering hawthorn as a treatment for palpitations if a doctor tells a patient that they have no medically significant heart problems.
Hawthorn is sometimes recommended for the treatment of high blood pressure, but its effects appear to be marginal at best. Furthermore, there is some evidence that a combination herbal treatment made from hawthorn and camphor can help prevent the sudden fall in blood pressure that may occur on standing up from a sitting or lying position (orthostatic hypotension). In these studies, the mixture acted to increase blood pressure.
Hawthorn has also been tried for other heart-related conditions, such as angina and atherosclerosis in general. Small studies have suggested hawthorn may be effective for improving digestion and reducing anxiety. However, there is no reliable evidence to support these uses.
Scientific Evidence
Several reasonable-quality, double-blind, placebo-controlled trials involving more than 750 participants have found hawthorn effective for the treatment of mild to moderate congestive heart failure. In one of the best of these studies, 209 people with relatively advanced congestive heart failure (technically, New York Heart Association [NYHA] class III) were given either 900 mg or 1,800 mg of standardized hawthorn extract or matching placebo. The results after sixteen weeks of therapy showed significant improvements in the hawthorn groups compared with the placebo groups. Benefits in the high-dose hawthorn group included a reduction in subjective symptoms, as well as an increase in exercise capacity. Subjective symptoms improved to a similar degree in the lower-dose hawthorn group, but there was no improvement in exercise capacity.
In an analysis that mathematically combined the results of ten controlled trials involving 855 patients, hawthorn extract was found to be significantly better than placebo for improving exercise tolerance, decreasing shortness of breath and fatigue, and enhancing the physiologic function of an ailing heart in mild to moderate CHF. In another study, however, researchers found that persons with mild-to-moderate CHF taking a special extract of hawthorn, 900 mg daily, were more likely to experience an initial worsening of their condition compared to those taking a placebo. By the end of six months, however, there was no difference in the two groups. In light of numerous other studies supporting the safety and effectiveness of hawthorn in CHF, the results of this special extract study need to be repeated before drawing any firm conclusions.
A comparative study suggests that hawthorn extract (900 mg) is about as effective as a low dose of the conventional drug captopril. However, while captopril and other standard drugs in the same family have been shown to help reduce hospitalizations and mortality associated with CHF, there is no similar evidence for hawthorn.
As previously mentioned, the Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial, one of the most rigorous clinical trials performed on hawthorn, failed to show measurable benefits.
Safety Issues
Hawthorn appears to be generally safe. Germany’s Commission E lists no known risks, contraindications, or drug interactions with hawthorn, and mice and rats have been given very large doses without showing significant toxicity. In clinical trials, reported side effects were relatively rare and nonspecific, consisting primarily of mild dizziness, stomach upset, headache, and occasional allergic reactions (skin rash).
Perhaps the biggest risk with hawthorn is that using it instead of conventional treatment might increase the risk of death or other complications of CHF. In addition, it is not known whether hawthorn can be safely combined with other drugs that affect the heart. Therefore, individuals should not self-treat CHF with hawthorn; a physician’s supervision is essential.
Safety in young children, pregnant or nursing women, or those with severe liver, heart, or kidney disease has not been established. Taking hawthorn could cause problems for people who are simultaneously using any medications that affect the heart.
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