By Termeh Feinberg, PhD, MPH
Affecting more than one in three U.S. adults(1), almost all of us have a friend or loved one who has faced the prospect of troubling and potentially life-threatening heart issues. When it comes to heart health, consistent efforts in prevention may go a long way. Clearly, a healthy lifestyle including exercise and a Mind-Body balance are beneficial for preventing and often treating a variety of chronic conditions, and a recent review of twelve studies found that adding a Mind-body component reduced the occurrence of cardiac events, atherosclerosis, and lowered systolic blood pressure(2). Additionally, consumption of antioxidant and anti-inflammatory pigments (such as resveratrol, anthocyanins, and pigment precursors part of broad classes of flavonols and flavonoids) found in red-blue-purple foods likely prevent heart disease and other, related chronic conditions(3-5); colorful fruits and vegetables(6), as well as the DASH(7) and Mediterranean(8 9) diets, could potentially maintain heart health over time. However, existing research on phytonutrient-dense foods, including herbs, remains relatively sparse.
While many herbs with a widely-established history of culinary use (e.g., rosemary, oregano) are usually available in grocery stores, lesser-known herbs are also available at health food stores, online (one of my favorite sources for sustainably-harvested and often-organic herbs is The Herbiary), and simply found in nature for your own harvest. There is little comparative joy than preparing your own herbal remedies for consumption, if you are not taking other medications and do a little digging (pun intended!) to ensure you have identified the herb properly (many field guides exist but I happen to really like Steve Brill and Evelyn Dean’s guide, and that your herb of choice is considered safe and free of pesticides. It is important to note that, although there are a few exceptions, herbs are generally not best for acute conditions but are better for affecting changes slowly, and over a longer period of time. I think of them as a type of special food; many herbs have benefits that western herbalists have known about through the decades, with mixed knowledge-bases arising from a combination of medical systems (i.e., Ayurveda, Traditional Chinese Medicine), the mish-mash of European and Native American herbal traditions arising from our country’s official founding, and anecdotal evidence from those who grow, harvest, prepare, and use herbs regularly. While there is no licensing regarding the use of herbal medicine in the U.S., the scientific evidence-base is slowly (and finally) catching up with many traditional uses. Although many herbal supplements (usually in pill form) carry the risk of adulteration (scary stuff!), there are many high-quality herbal supplements on the market, including tinctures made from only a few ingredients.
Hawthorn (Crataegus monogyna, C. oxyacantha) is a tree found widely throughout North America with beautiful red berries appearing in the fall (harvested after the first frost), and long thorns usually appear on branches (thorns and size of berries depend on species hybridization). Hawthorn directly affects the cells of the cardiac muscles, enhancing both activity and nutrition(10). Traditional herbalists use hawthorn to relax and tone blood vessel lining and strengthen heart muscles(11-12). In fact, an older trial demonstrated that hawthorn may be possibly effective for angina(13), while most 14-20 but not all studies(21-23) showed hawthorn may result in positive outcomes for congestive heart failure. In many of these studies, it only took 6-12 weeks for maximum effects to occur(14-19)!
While the amount of active constituents within hawthorn varies by species (and there are many!), this edible berry is generally regarded as safe for adults (studies have assessed up to 16 weeks(14 15 17 20 21) although the traditional herbalism view regards this herb as generally safe for long-term use(10)) not taking medications, particularly blood pressure medication or digoxin. Hawthorn has coronary vasodilating and antiarrhythmic effects and thus may potentially reduce the toxicity of some cardioactive drugs (thus, also reduce the dosage needed to achieve the desired effect)(10). As always, remember that people metabolize things in different ways. If you (and your physician) feel hawthorn is appropriate for you, it could be a wonderful addition to your diet for its plethora of phytonutrients and potential benefit for heart health.
Herbal teas are a fantastic way to stay hydrated throughout the day, and consuming 6-8 cups daily is a great way to supplement herbs as part of your overall, heart-healthy diet. You can create a tasty tea by simmering denser plant material such as hawthorn berries and cacao nibs (dark chocolate works in a pinch but contains less of the active constituents which are likely beneficial for heart health(11)) for 10-20 minutes in a covered pot, and mixing in other herbs rich in antioxidants such as green tea, rooibos, or hibiscus during the final few minutes (1tsp-1tbsp total plant material per cup of water, depending on your ideal flavor/strength). Additionally, hawthorn leaves and linden flowers (harvested in the spring, when flowers are still quite young and fresh), in addition to rose (petals) may be added to teas - herbalists have long used these (safe) herbs to relax the heart, as some have nervine qualities(11). When I drink this tea, I immediately feel a sense of calm settle into me, followed by a small but noticeable sense of strength emerge from within. Placebo? Perhaps…but maybe not, and I like it. I hope you enjoy it, too!
In addition, hawthorn berries may be made into a jam (their high pectin content helps!). In a pinch, you can soften and plump dried berries in a bit of water, for a few minutes (and sweetener, if desired, which will create a syrup) on the stovetop, then pop out the inner seeds (you don’t want to eat these). Place all of your edible fruit pieces into a jar with some chia seeds and mix it up into a fresh, protein-rich jam for oatmeal, waffles, etc. In fact, you can take any berry (even frozen) and make a chia jam for your daily-dose of health-protective polyphenols! Just remember to refrigerate and use within a week. I like to make a blueberry/hawthorn combination so I’m not stuck pitting the hawthorn for a long time.
What kinds of heart-healthy foods do you like to make?
1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017 doi: 10.1161/CIR.0000000000000485
2. Cramer H, Lauche R, Paul A, et al. Mind-Body Medicine in the Secondary Prevention of Coronary Heart Disease. Dtsch Arztebl Int 2015;112(45):759-67. doi: 10.3238/arztebl.2015.0759
3. Markoski MM, Garavaglia J, Oliveira A, et al. Molecular Properties of Red Wine Compounds and Cardiometabolic Benefits. Nutr Metab Insights 2016;9:51-7. doi: 10.4137/NMI.S32909
4. Juturu V. Capsaicinoids Modulating Cardiometabolic Syndrome Risk Factors: Current Perspectives. J Nutr Metab 2016;2016:4986937. doi: 10.1155/2016/4986937
5. Auger C, Said A, Nguyen PN, et al. Potential of Food and Natural Products to Promote Endothelial and Vascular Health. J Cardiovasc Pharmacol 2016;68(1):11-8. doi: 10.1097/FJC.0000000000000382
6. Association AH. About Fruits and Vegetables Dallas, TX American Heart Association; 2016 [Available from: http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/About-Fruits-and-Vegetables_UCM_302057_Article.jsp#.WIujOFMrIkI accessed January 27 2017.
7. Siervo M, Lara J, Chowdhury S, et al. Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis. Br J Nutr 2015;113(1):1-15. doi: 10.1017/S0007114514003341
8. Grosso G, Marventano S, Yang J, et al. A Comprehensive Meta-analysis on Evidence of Mediterranean Diet and Cardiovascular Disease: Are Individual Components Equal? Crit Rev Food Sci Nutr 2015:0. doi: 10.1080/10408398.2015.1107021
9. Liyanage T, Ninomiya T, Wang A, et al. Effects of the Mediterranean Diet on Cardiovascular Outcomes-A Systematic Review and Meta-Analysis. PLoS One 2016;11(8):e0159252. doi: 10.1371/journal.pone.0159252
10. Hoffmann D. Medical Herbalism: The Science and Practice of Herbal Medicine. Rochester, VT: Healing Arts Press 2003.
11. Groves MNl. Body into balance : an herbal guide to holistic self-care. North Adams, MA: Storey Publishing 2016.
12. Winston D. Herbal Therapeutics: Specific Indications for Herbs and Herbal Formulas. 2 ed. Broadway, NJ: Herbal Therapeutics Research Library 2009.
13. Weng Wl Fau - Zhang WQ, Zhang Wq Fau - Liu FZ, Liu Fz Fau - Yu XC, et al. Therapeutic effect of Crataegus pinnatifida on 46 cases of angina pectoris--a double blind study. (0255-2922 (Print))
14. Schmidt U Fau - Kuhn U, Kuhn U Fau - Ploch M, Ploch M Fau - Hubner WD, et al. Efficacy of the Hawthorn (Crataegus) preparation LI 132 in 78 patients with chronic congestive heart failure defined as NYHA functional class II. (0944-7113 (Print))
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17. Pittler MH, Schmidt K Fau - Ernst E, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. (0002-9343 (Print))
18. Weikl A, Assmus KD, Neukum-Schmidt A, et al. [Crataegus Special Extract WS 1442. Assessment of objective effectiveness in patients with heart failure (NYHA II)]. Fortschr Med 1996;114(24):291-6.
19. Leuchtgens H. [Crataegus Special Extract WS 1442 in NYHA II heart failure. A placebo controlled randomized double-blind study]. Fortschr Med 1993;111(20-21):352-4.
20. Tauchert M. Efficacy and safety of crataegus extract WS 1442 in comparison with placebo in patients with chronic stable New York Heart Association class-III heart failure. (1097-6744 (Electronic))
21. Holubarsch CJ, Colucci Ws Fau - Meinertz T, Meinertz T Fau - Gaus W, et al. The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial. (1388-9842 (Print))
22. Zick SM, Vautaw Bm Fau - Gillespie B, Gillespie B Fau - Aaronson KD, et al. Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial. (1879-0844 (Electronic)) doi: D - NLM: PMC2754502
23. Zick SM, Gillespie B Fau - Aaronson KD, Aaronson KD. The effect of Crataegus oxycantha Special Extract WS 1442 on clinical progression in patients with mild to moderate symptoms of heart failure. (1388-9842 (Print)) doi: D - NLM: NIHMS57226
About the Author: Termeh Feinberg, PhD, MPH
Dr. Feinberg is an epidemiologist with community herbalism training and postdoctoral fellow at the Center for Integrative Medicine, where she contributes to trial protocols and conducts analyses on micronutrients, plants, and nutraceuticals using national datasets. She has also worked in an herbal apothecary, for the U.S. Census Bureau, and as project coordinator for a multi-site study assessing herbal use for pain. Additionally, she has presented on herbal topics at international, national, and regional conferences. When she isn’t conducting analyses, she can be found in the woods.
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