Hawthorn is the oldest European medicinal herb. Its flowers, leaves, and berries are highly valued, especially as heart disease remedies. This plant may offer added benefits to people with high cholesterol, diabetes, and anxiety. Read on to discover more about Hawthorn and how to safely use it.
What Is Hawthorn?
Hawthorns (Crataegus spp.) are thorny trees or bushes with white flowers and red berries. Although the name “Hawthorn” originally referred to the common hawthorn (C. monogyna), it’s now used for the whole genus and even for its relatives (Rhaphiolepis) [1+].
Hawthorns are native to Europe, North America, and Asia. They belong to the same family as roses and many edible fruits such as apples, pears, plums, and cherries (Rosaceae) .
Hawthorn is the oldest known medicinal plant in Europe and its use was first documented 2,000 years ago. In European and American folk medicine, it’s used for [3+, 4+, 2]:
- Heart disease
- Digestive issues
- Anxiety and insomnia
Similarly, Chinese hawthorn (C. pinnatifida) is a traditional remedy for :
- Blood circulation disorders
- Digestive issues
- High blood fat
The German Commission E approved hawthorn use for mild heart failure in the 1980s. Hawthorn extracts are mainly obtained from the common and English (C. laevigata) hawthorn, their hybrids, and other European species [3+].
Should You Use the Berries, Flowers, or Leaves?
The extracts used in Europe and America are obtained from the berries, leaves, and flowers. The berries must contain at least 1% procyanidins, while the leaves and flowers need a minimum flavonoid content of 1.5% [1+].
Two commercial extracts have been widely investigated in clinical trials [6+]:
- WS 1442: standardized to 18.75% oligomeric procyanidins
- LI 132: standardized to 2.2% flavonoids
In China, only the berries and leaves are used. There are no requirements for the berries, but leaves must contain at least 7% flavonoids and 0.05% hyperoside [1+].
The berries are also eaten fresh or used to make wine, jam, and candy in both China and Europe [1+].
The main active components of hawthorn are [7+, 8+, 9+]:
- Flavonoids: such as hyperoside, vitexin, rutin, and quercetin
- Oligomeric proanthocyanidins: such as catechin, epicatechin, and procyanidin B2
- Phenolic acids: chlorogenic and caffeic acid
- Pentacyclic triterpenes: crataegolic, ursolic, and oleanolic acid
Flavonoids are most concentrated in the flowers. Berries are also rich in them, but ripe ones less so. Leaves are higher in vitexin and oligomeric proanthocyanidins [10, 11+].
Health Benefits of Hawthorn
Although not approved by the FDA, hawthorn extract is commercially available as a supplement, especially for heart disease. Regulations set manufacturing standards for supplements but don’t guarantee that they are safe or effective. Talk to your doctor before using hawthorn supplements to avoid unexpected interactions.
Possibly Effective for:
1) Heart Failure
Although conventional therapies improve the symptoms and reduce death rates, people with heart failure often have a reduced quality of life. Hawthorn can be combined with drugs and implantable devices to improve heart failure .
Hawthorn extract (240-1,800 mg/day), both alone and as add-on therapy, improves mild heart failure according to two meta-analyses and 8 studies on over 4k people. It increased pumping force while reducing fatigue and shortness of breath [12, 13, 14, 15, 16, 17, 18, 19, 20, 21].
However, the extract didn’t improve heart failure symptoms in 2 studies on almost 3k people also taking conventional medicines; it only reduced the risk of sudden death. The dose might have been insufficient, though, since the majority of people included had moderate to severe heart failure [22, 23].
Homeopathic hawthorn remedies are also used, although these might not contain active compounds. In one trial on over 200 people, homeopathic hawthorn (10-20 drops, 3x/day) was as effective as conventional drugs. However, the study suffered from multiple flaws (lack of randomization and blinding, evaluating subjective parameters, and short follow-up) [24+].
Vein blood can stagnate in the legs in people with heart failure, leading to swelling. In 2 studies on over 1k people with heart failure, hawthorn extract (900 mg/day) reduced leg swelling [14, 15].
In mice and cells, the extract reduced blood leakage from the vessels by strengthening their inner lining [25, 26].
3) High Blood Pressure
High blood pressure is the most important risk factor for heart disease. Hawthorn extract (500-1,200 mg/day) lowered blood pressure in 4 clinical trials on almost 300 people [27+, 28, 29, 30, 18].
The extract also lowered blood pressure in rats and relaxed arteries in tissue studies [31, 32, 33, 34, 35].
Orthostatic hypotension (literally, “upright-standing low pressure”) is a condition causing sudden blood pressure drops after standing up quickly.
In Germany, a combination of hawthorn berries and camphor is commonly used to raise blood pressure in people who frequently suffer from orthostatic hypotension. This remedy (5-80 drops/day) worked in 6 clinical trials on over 500 people, but its fast action suggests camphor is responsible for the effect [36, 37, 38, 39, 40, 41].
Hawthorn is a time-tested natural remedy for mild heart issues, including heart failure and high blood pressure. It can be safely added to conventional drugs and interventions. However, it’s likely ineffective used short-term or as a stand-alone in people with more severe heart conditions.
Nevertheless, note that hawthorn is not approved by the FDA for heart disease. You may try this herb if you and your doctor determine that it could be appropriate for improving your arthritis. Remember that taking hawthorn should never be done in place of what your doctor recommends or prescribes.
Insufficient Evidence for:
1) Chest Pain (Angina)
Poor heart blood and oxygen supply can be caused by clogs in blood vessels that nourish the heart (coronary arteries). This ultimately causes chest pain or angina [42+].
Cholesterol buildup inside the arteries is the most common cause of chest pain. In a clinical trial on 80 people with chest pain, hawthorn extract (240 mg, 2x/day) combined with exercise prevented artery clogging .
Hawthorn tablets relieved chest pain in a Chinese clinical trial on 46 people. However, we couldn’t access the study specifics to analyze it [44+].
In animals and cells, hawthorn extract prevented high blood cholesterol, inflammation, LDL damage by free radicals, and artery wall thickening–all of which increase the risk of clogging [45, 46, 47, 48, 49, 50].
Coronary arteries can also be clogged by blood clots. Although hawthorn extract prevented platelets from clumping together in animals and test tubes, a high dose (2,400 mg/day) was ineffective in a trial on 16 people [51, 52, 53, 54, 55+].
The surgery to unclog vessels may damage their inner walls, which triggers vessel narrowing. In rats, hawthorn extract prevented this unwanted effect .
2) Lowering Cholesterol
In a trial on 49 people, hawthorn extract (400 mg, 3x/day) reduced blood cholesterol, both free and bound to LDL. Similarly, a complex with 129 mg hawthorn and other herbs (Asian water plantain, corn silk, Chinese knotweed, lingzhi mushroom, and mulberry) reduced LDL cholesterol in a trial on 42 people (4 capsules, 2x/day) [57, 58].
Plus, hawthorn reduced blood cholesterol levels in animals fed high-fat diets [45, 59, 60, 61, 62].
All in all, the existing evidence is insufficient to claim that hawthorn lowers blood cholesterol. Further clinical research is needed to confirm these preliminary findings.
In a clinical trial on over 250 people with anxiety disorders, a formulation with hawthorn, California poppy, and magnesium (2 tablets, 2x/day) reduced anxiety. Similarly, a formulation with hawthorn and other herbs (purple passionflower, valerian, black horehound, guarana, and kola nut) was effective in a trial on almost 200 people (2 tablets, 3x/day) [63, 64].
However, many of the natural compounds used in the formulations mentioned above have anti-anxiety properties. It’s hard to say if hawthorn contributed to the benefits.
Hawthorn extract alone also relaxed both stressed and non-stressed mice and increased their sleep [65+, 66].
Chronic stress and depression are tightly linked. Different extracts with Chinese but not common hawthorn reduced depression in stressed mice [67, 68, 69, 70].
Two clinical studies using hawthorn as part of herbal mixes and a few animal studies cannot be considered sufficient evidence. Additional clinical trials testing hawthorn alone should be conducted to find out if it has any anti-anxiety effects in humans.
4) Menopausal Symptoms
A traditional Chinese medicine with hawthorn, goji berry, safflower, kombu, and mulberry extracts (Menoprogren, 4x/day) reduced menopausal symptoms such as hot flashes, and mood changes in a trial on 83 women. It also improved low sex hormone levels (estradiol and progesterone) .
Menoprogren also prevented sex hormone drops in menopausal rats by protecting their ovarian follicles [72, 73, 74, 75].
Larger, more robust clinical trials should confirm the benefits of hawthorn on menopausal symptoms.
5) Improving Skin Appearance
In a clinical trial on 20 women, a mixture of hawthorn and ginseng extracts on the eyelids reduced wrinkles while increasing skin elasticity, moisture, and luminance .
UV radiation accelerates skin aging by reducing its collagen content. In UV-exposed mice and skin cells, hawthorn extract increased collagen buildup and reduced cell death [77, 76, 78].
Interestingly, hawthorn extract also promoted hair growth in mice by reducing the death of hair follicle cells .
Hyperpigmentation is a harmless condition in which the skin pigment melanin builds up, causing dark skin spots or patches. Hawthorn may prevent this condition since it blocked melanin production in skin cells [80, 81].
On the downside, the cosmetic use of hawthorn may be limited by the low penetration of its active components into the skin .
The potential benefits of hawthorn on skin appearance should be confirmed by carrying out more clinical trials.
Animal and Cell Research (Lack of Evidence):
Researchers are investigating other potential health benefits of hawthorn. Because the studies have only been conducted in animals and cells, there is no evidence that these effects may be observed in humans as well.
Heart attacks occur when the blood flow to the heart is interrupted. The lack of oxygen increases the production of free radicals and triggers inflammation, damaging the heart muscle tissue [83+].
Hawthorn protected rats from heart attacks by reducing inflammation, oxidative damage, and the production of vessel-narrowing hormones [84, 85, 86, 87].
When blood flow is restored after a heart attack, the new blood entering the heart may damage the vulnerable tissue – this is called ischemia-reperfusion injury. Hawthorn extract reduced its severity in rats and dogs by lowering inflammation and oxidative damage [88, 89, 90, 91, 92].
Ischemia-reperfusion injury often disturbs the heart rate. Although hawthorn extract restored the heart rate in rats with heart damage, a 160-mg dose had no effect in 20 healthy people [93, 94, 95, 96].
Protecting the Brain
Hawthorn extract and camphor (25 drops/day), used to increase low blood pressure, improved logical thinking, visual-motor speed, and attention in almost 150 adults. It might work by increasing blood flow and energy use in the brain, which is especially important in the elderly. As previously discussed, camphor rather than hawthorn may account for this effect [37, 39].
The same formulation had no effect in a trial on 200 teenagers. Possibly, the hawthorn-camphor combo offers benefits only to people with poor circulation .
Hawthorn extract preserved brain cell function, learning capacity, and memory in rats with diabetes or those exposed to brain toxins [97, 98, 99, 100].
Its component vitexin reduced movement problems in mice with Parkinson’s disease and prevented this condition in brain cells [101, 102].
Several hawthorn compounds blocked key processes that trigger Alzheimer’s disease. These might be valuable phytochemicals for disease prevention [103, 104].
Recovery after a Stroke
Hawthorn extract protected animal brains, reducing oxidative damage and inflammation after a stroke. This suggests it might help with recovery [105, 106, 107, 108, 109+].
Hawthorn reduced inflammation in rats and mice with conditions such as asthma, arthritis, and gum disease. In both animals and immune cells (macrophages), its components lowered the production and activation of pro-inflammatory:
- Cytokines: such as TNF-alpha, IL-1beta, and IL-6 [106, 110, 111]
- Messengers: prostaglandins, NO [112, 113, 114]
- Pathways: NF-kB, p38, ERK1/2, JNK [111, 113]
- Enzymes: phospholipase A2, COX-2, iNOX, MMP-9 [115, 112, 116]
- Cells: Th2, CD3+, CD8+ [106, 117, 118]
The main antioxidant compounds of hawthorn are its:
- Flavonoids [119+, 120+]
- Oligomeric proanthocyanidins [121, 122+]
- Phenolic acids [123, 119+]
- Lignans [124, 125]
Hawthorn extracts broke down free radicals and protected important fatty molecules from these chemicals in test tubes [119+, 126+, 127, 128+].
In rats with liver damage, hawthorn preserved the levels of glutathione and several other antioxidant enzymes. In cells, it activated a detox pathway that produces an antioxidant enzyme (NQO1) [129, 130].
In animals fed high-fat diets, different hawthorn extracts reduced body weight and fat buildup in the blood, liver, and fatty tissues. They also prevented fat cell development and fat buildup [131, 132, 133, 61, 134].
A complex sugar from hawthorn berries promoted the growth of obesity-fighting gut bacteria (Bacteroides), suggesting its potential as a weight-loss prebiotic [135, 136].
In mice and rats with colitis, hawthorn extract reduced diarrhea, excessive weight loss, bowel inflammation, and death rates. The extract also protected rats from stomach ulcers [137, 138, 139].
In studies in rat bowels, hawthorn berry extract blocked muscle contractions linked to diarrhea. Conversely, the leaf extract promoted their contractions, suggesting its laxative action [140, 141].
Kidney and Liver Support
In diabetic rats, hawthorn extract reduced cell damage in the kidneys by lowering inflammation. Its antioxidant activity also prevented kidney damage caused by toxins and the lack of oxygen [142, 143, 144].
Diets high in unhealthy fats raise blood fat levels, eventually causing their buildup in the liver (fatty liver disease). In rats and mice fed high-fat diets, hawthorn prevented this condition and reduced liver damage [145, 146, 147, 148].
Hawthorn extracts also protected rats and mice from liver damage caused by:
- Drugs and toxins [129, 149]
- Alcohol 
- High-sugar diets 
- Heart attacks 
- Partial liver removal 
- Tissue scarring 
In animals with diabetes or in those fed high-sugar diets, hawthorn extracts lowered blood sugar, increased blood insulin, and reduced insulin resistance. Plus, they improved pancreatic function [155, 156, 157, 158, 159].
What’s more, hawthorn may help prevent diabetic complications. In diabetic mice and rats, it protected the blood vessels, heart, and kidneys from diabetes-triggered inflammation [160, 161, 142].
In test tubes, hawthorn extract blocked the enzymes that increase blood sugar levels (alpha-glucosidase) and insulin resistance (PTP1B), similar to how some anti-diabetes drugs work. It also lowered the byproducts of sugar breakdown linked to diabetic complications .
In test tubes, hawthorn extract inhibited the viruses that cause AIDS, oral herpes, and infections in people with weak immune systems. However, a liquid Chinese formulation with ~4% hawthorn and other extracts (ginseng, magnolia berry, jujube, mungbean, soybean, and baker’s yeast) didn’t reduce HIV levels in a trial on 18 people [163, 164, 122, 165, 166].
Three hawthorn catechins enhanced the effects of antibiotics on a well-known hospital superbug (MRSA) in test tubes and infected mice .
Hawthorn extracts in test tubes blocked the bacteria causing:
- Food poisoning (E. coli, Staphylococcus aureus, Listeria monocytogenes, Shigella spp., Salmonella typhimurium) [168+, 169+, 170, 171+]
- Antibiotic-resistant infections (Pseudomonas aeruginosa, MRSA, Enterococcus faecalis) [172, 171+]
- Pneumonia (Klebsiella pneumoniae) 
Further research should determine if hawthorn is effective against infections caused by these organisms in normal doses.
Hawthorn Side Effects & Safety
In clinical trials, the adverse effects were generally mild, rare, and similarly frequent in the hawthorn and the placebo group. The most common ones were [174+, 22+, 175]:
- Dizziness and vertigo
- Nausea and digestive issues
- Fatigue and sleepiness
One woman developed an allergy to hawthorn fruits and leaves. She experienced eye-watering and eyelid swelling from working with the plant in her garden [176+].
A man who ate hawthorn branches and drank tea made from its leaves developed a hypersensitivity reaction with liver and kidney failure, increased heart rate, and blood anomalies [177+].
Hawthorn extract increased genetic mutations in bacteria, human cells, and mice. Although the doses were extremely high, these studies suggest caution when using hawthorn [178, 179].
Children and pregnant or breastfeeding women should consult their doctor before taking hawthorn, since safety data is lacking [4+, 180].
Hawthorn is mostly used for heart failure and high blood pressure. These are serious conditions that require medical supervision. Consult a doctor instead of self-medicating with hawthorn.
To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. Talk to your healthcare provider to find out how hawthorn might interact with something else you are taking.
Theoretically, hawthorn may enhance the effects of drugs for heart failure, high blood pressure, and male sexual dysfunction, such as [4+]:
- ACE inhibitors
- Angiotensin receptor blockers
- Calcium channel blockers
- PDE5 inhibitors
This could cause irregular heart rate, low blood pressure, and more frequent adverse effects. However, hawthorn was used together with these drugs in many clinical trials without interactions [12+, 13+, 21+, 22+, 181].
Hawthorn flavonoids can activate the protein that removes digoxin from cells and may thus reduce its blood levels. Hawthorn extract restored normal heart rate in rats poisoned with digoxin but didn’t alter digoxin levels in a trial on 8 people (at 450 mg, 2x/day) [95, 182].
Although hawthorn seems safe, consult a doctor first to avoid any drug interactions. Then, start with a trial period of 4–8 weeks and monitor its benefits and adverse effects.
How to Use Hawthorn
Supplements & Tea
Hawthorn can be taken by mouth in different forms:
- Dried leaves and flowers (used to make tea)
- Fresh berries (also used to make tea)
- Powdered berries, leaves, or flowers
- Capsules or tablets
- Liquid extract
- Solid extract, syrup, and jelly
Because hawthorn is not approved by the FDA for any conditions, there is no official dose. Users and supplement manufacturers have established unofficial doses based on their experience.
In clinical trials for heart failure, high blood pressure, and high cholesterol, the dose of standardized extracts was 160-1,800 mg/day taken 2x-3x/day [12, 13, 29, 30, 57].
The doses recommended by the European Medicines Agency are :
- Tea: 1-3 cups/day
- Powder: 300-1,000 mg (berries) or 200-500 mg (leaves and flowers), 3x/day
- Tincture: 20-30 drops in a glass of water, 2x-3x/day
- Liquid extract: 0.5-1mL, 3x/day
- Dry extract: 240-1,000 mg/day
Aside from these, the syrup is usually taken as 1 teaspoon, 2x-3x/day.
How Long Does It Take for Hawthorn to Work?
Hawthorn is a slow-acting herb and benefits before 3-6 weeks are unlikely. In clinical trials for heart failure and high blood pressure, it was used over 8-16 weeks [2, 12+, 13+, 18, 29].
Hawthorn Berry Recipes
- Tea: add 4-5 g dried berries or 1-2 g dried flowers or leaves to one cup of boiling water and steep for 20 minutes.
- Tincture: place 500 g of fresh berries and 1 L vodka in a jar and blend together. Cover and store in a cool, dark place for 6 weeks, shaking every 2-3 days.
Limitations and Caveats
The effects of hawthorn on chest pain, blood clots, high cholesterol, skin aging, and AIDS were tested in clinical trials with small populations (below 50 people). The research on most other conditions (except heart disease and blood pressure) is limited to animals and cells. High-quality, large-scale studies are needed to confirm the results.
Hawthorn was used in combination with other herbal extracts in many studies, making its contribution to the effects observed difficult to estimate.
Some studies investigating commercial formulations were funded or carried out by the companies selling them (Robugen Pharmaceuticals, Laboratoire Innotech, Laboratoires Soekami-Lefrancq) [37+, 38+, 39+, 40+, 41+, 63+, 64+].
Hawthorn is a time-tested herbal remedy for heart issues, including mild heart failure and high blood pressure. It also provides antioxidants that may protect your blood vessels from damage in the long run.
Don’t expect results overnight, though. You may need to use it daily for at least 6 weeks to see any improvement. Talk to your doctor before supplementing if you take prescription medication.