Herbal support for runners

In honor of last Sunday's marathon in Burlington, VT, I offer some of my favorite herbs for dealing with common complaints runners (and especially distance runners) mention.
Chamomile (Matricaria recutita, Anthemis nobilis) is an excellent antispasmodic for the stomach and intestines. A mild tea (2 TBS of flowers brewed in 1 quart of hot water) relieves the cramping, "stitches", spasming, and gas that can develop over the course of a long run. Carry some with you - no more than 8oz for every 13 miles is necessary - and take little sips every few miles to help control gastrointestinal symptoms. The tea can be taken cold, and has a pleasant and refreshing flavor. Mix with a little maple syrup if desired for an extra sugar boost.
Rhodiola (Rhodiola rosea) is perhaps my favorite performance enhancer, working very well in the short term, reducing fatigue and improving your muscle's utilization of glucose and oxygen. Try 120 drops (about 4ml) of a liquid extract 20-40 minutes before a race. Because it gives you a "little extra" (without the dangers of stimulants like Ephedra), I save it for races and don't use it during training. Eleuthero (Eleutherococcus senticosus) is good as well, but needs to be taken for a few weeks for optimal effect.

Recovery and injury treatment can be a long and difficult process. Muscles bounce back quickly - feed them with adequate sugars and a little good quality protein. Ligaments and tendons, on the other hand, take a lot more effort. I've experimented with a variety of internal and external treatments, and have come to prefer the following regimen:
First off, gentle movement (walking or slow jogging) is preferable to just resting. This allows all the sinews in your legs to warm up, making the next step more effective.
Secondly, stretching after running is crucial. There are a variety of techniques out there - do your research and find what works for you. I like to allow at least 15-20 minutes for stretching, even after a short 3-mile run.
Thirdly, ice is your friend. After stretching, apply ice to problem areas for 5 to 10 minutes, and follow with a warm shower or compress. You can then apply Arnica (Arnica montana) gel or oil if there is any inflammation with swelling.
St. John's Wort (Hypericum perforatum) oil is helpful if you have radiating nerve pain, like a pinched nerve in your shoulders, or sciatic nerve pain running down the back of your leg. Rub a liberal amount of the oil on the problem area(s).
For long-term support in the health of ligaments and tendons, I rely on two herbs in particular: Horse chestnut (Aesculus hippocastanum) and Gotu Kola (Centella asiatica). Both help improve circulation and reduce inflammation. They can be taken as liquid extracts (Gotu Kola must be prepared fresh, in my opinion, to be most effective), and Horse chestnut tincture can be applied topically as well to excellent effect. I have used and recommended these herbs in combination for conditions like IT band syndrome, achilles tendonitis, plantar fasciitis, and the general sprains and strains of running. They work quite well, along with ice and stretching, over the course of a few weeks.

As the summer season comes into full bloom, keep on running (or hiking, or walking, or swimming, or paddling, or simpy playing) and stay injury-free with herbs!

Northern Willow-herb

Also called "small-flowered", Epilobium parviflorum is a member of the Onagraceae, the same family to which Evening Primrose belongs. The genus is rich with many species that have extensive references in the literature, especially from the Eclectics, but this species seems to be a little less well-known. I've been dancing back and forth with this plant for a few years: first, pulling it as a weed. Then, appreciating its flavor on hot summer days. Drinking its tea. Preparing a tincture. Introducing it to some clients. It really is a helpful herb, though unassuming (funny how often these two qualities go hand in hand); and since Rebecca is hosting a blog party on less common botanicals, this one fit the bill, at least for me.
Its Latin name means "a small flower on the end of a tube", and that describes the inflorescence well (serving also as something of a signature, if you ask me). The flower itself is beautiful, small and delicate, with four deeply notched purple petals, revealing itself a bit later in the season (late June / early July) up here in Vermont.

Later, in August, the long ovaries open to reveal seeds that float off on fine down, much more delicate than that of milkweed but similar in behavior. It spreads quite easily, but behaves well: its root is divided, and easy to pull if you're so inclined.
I've been using the leaves for medicine, and my feeling is that they are most potent right now, before the flower heads start forming. They are opposite, a finely toothed and almost glossy, with deep veins and a slightly maroon color at the base, where they clasp the stem tightly. As the plant ages, the leaves spread out a little bit, and become smaller as they grow up the stem. Straight off the plant, the leaves taste sour and are a bit astringent, but have a roundness and "butteriness" that balances out the tannins well. As an infusion, the flavor becomes a bit more complex and bitter, but retains the round fullness I've come to associate with more aromatic plants. Hmm.
The tincture of the fresh leaves, prepared at about 60% alcohol b/v, is less astringent than the infusion and more bitter. I've come to favor it for medicinal use, as I believe the sterols it contains are better extracted by this method.
The whole plant contains polyphenolic compounds in the broad family of tannins, related somewhat to the catechins found in tea or the more widely distributed flavonoid polyphenols. Specifically, a compound called oenothein has been identified and linked to some of its medicinal action (at least, on enzyme models in a petri dish). Additionally, plant sterols (such as beta-sitosterol specifically) are present in appreciable quantities. Part of its "round" flavor may also be related to the good amount of mucilage it contains.

Historically, the whole genus is used for gastrointestinal complaints, mostly characterized by bloating and inflammation (I definitely consider this a cooling herb). Colitis and "irritable bowel" might be good modern names for what goes on in a gut that could benefit from the willow-herbs: too fast, too sour, crampy and stressed. Generally, a loose stool (though I suppose it would help in either loose or dry stools if the constitutional profile fit). Modern research seems to agree that Epilobium would make a great medicine for mice with stressed out intestines. I can see how a gently astringent, mucilage-rich plant would help slow the GI tract down a bit, thereby improving digestion and absorption. To this end, a tea would be best (you're not really after the sterols), combined perhaps with agrimony or chamomile.
But Epilobium parviflorum specifically, due to its rich phytosterol content as well as the oenothein, has found a place in my apothecary for helping men who are having prostate problems: swelling of this gland results in obstructed urine flow, which causes much discomfort and a dribbly, unsatisfying urine stream. The research on oenothein seems to suggest that this compound has an effect of the enzyme 5-alpha-reductase, responsible for converting testosterone to DHT (dehydrotestosterone, a reduced form of the hormone) which has pretty conclusively been implicated in prostatic inflammation. Additional research shows that the whole plant has broad-spectrum anti-inflammatory effect, which certainly helps. I suspect that its name may have come from this ability to control swelling and inflammation, much like the willow tree does. Regardless, I combine it to good effect with cleavers and yarrow for treating prostatic inflammation and hypertrophy - and I'm excited to move away from using the non-bioregional saw palmetto for this purpose! It seems to work better, anyway.

General info on other Epilobiums from Maude.
Research on non-proliferative effect of various Epilobiums.
Some say Epilobium species have antifungal effects, systemically and topically.
Science says: bumblebees love it! (especially its most symmetrical flowers)

A collection of late spring ephemerals

This seems to be a season of airy, white flowers. We caught a few in between some May rain showers, gracing the woodlands and pleasing the pollinators...


Foamflower (Tiarella cordifolia) is rich in tannins and other astringent compounds, but as is often the case with medicinal herbs, is also mucilaginous and soothing. Generally, the root and leaves are used, brewed into an astringent and tonic preparation for digestive complaints (indigestion, gallbladder colic) and urinary inflammation (including kidney stones).






Goldthread (Coptis canadensis) is a beautiful Ranunculus family plant (notice the multiple green carpels, each leading to a single seed later in the season). Its root is like a bright yellow string cris-crossing the humus, and is used as a "damp-heat" clearer (digestive torpor with inflammation, mostly) with similar qualities to goldenseal (another Ranunculus) and a similar chemical profile.















I was excited to find over a dozen dwarf ginsengs (Panax trifolium) in flower by a marshy, rocky spot off the main trail. This plant is a close relative to the more prized American ginseng, but is much tinier (4" tall) and its leaves are less rounded. Traditionally, it provided an important source of nourishing food (it's also called "groundnut" due to its tuberous root) that has the same sort of sweet /round flavor other that other members of the Panax genus have. Its medicinal qualities are very similar to American ginseng, though weaker: tonic, adaptogenic, enhancing energy and endurance without being overstimulating. A beautiful, classic Aralia flower: they always remind me of fireworks. An interesting fact about the dwarf ginseng: individuals can be male or hermaphroditic (this one appears to have only male flowers) and can change from season to season, or within the short flowering season itself, depending on needs.



Toothwort (Dentaria diphylla) is delicious. A spicy woodland Brassica, it was used as a circulatory warmer and "antispasmodic nervine" (as described by Cook). Smart spider is waiting.













A beautiful painted trillium (T. undulatum), though a bit past its prime and not exactly ephemeral (its flowers have appeared on woods walks for a few weeks now), certainly deserves a little attention... The root was traditionally employed, as a parturient and nervine.



Finally, a shot of some Solomon's seal (Polygonatum multiflorum) arching over Canada mayflowers (Maianthemum canadense) in a rocky crack.

Milk Thistle and mushroom poisoning

Milk thistle (Silybum marianum) has a long history of use in liver disease. A report in the current issue of HerbalGram highlights its effectiveness in one of the worst, most acute cases of liver damage: that which occurs from ingesting the deathcap mushroom, Amanita phalloides. A proprietary intravenous administration of milk thistle has been approved and used in Europe for some time as an effective antidote to this poisoning; in the United States, such approval is lacking and thus no effective antidote exists.
As the Santa Cruz Sentinel reports, six people who ate deathcap mushrooms over New Years 2007 were rushed to the local hospital, where the doctors, in a desperate search for something that could help reverse the rapid destruction of their patient's livers and thus save their lives, came across milk thistle as a proven antidote. Unfortunately, the herbal medicine was unapproved by the FDA. Not willing to give up, the doctors petitioned the FDA for an emergency IND (Investigational New Drug) status for the milk thistle extract, and in the interim gave the patients oral silymarin from a natural foods store. The FDA granted the request, and the IV extract was immediately shipped from Europe. Five of the six patients had a complete reversal of symptoms, their lives saved. The sixth, a woman 83 years old, succumbed to kidney failure. Even still, Dr. Mitchell (the attending physician) commented that "...her liver function was improving because of her treatment, and unfortunately factors other than her liver resulted in the final complications".
This simple remedy does not need to be administered intravenously except in the most dire circumstances, as in this case. For most diseases involving liver damage and inflammation, the oral intake of crushed milk thistle seed (1 to 3 TBS daily) is more than adequate for hepatic protection.

Paul Stamets and mycoremediation

Reality Sandwich, a new online venture started by Daniel Pinchbeck and others (quite interesting in its own right), reminds us of the power of mushrooms and their mycelia by discussing the work of Paul Stamets (Fungi Perfecti). Beyond their use as powerful medicines, mushrooms have the ability to decontaminate sites polluted with hydrocarbons and other toxins. For a more complete discussion, and if you have an hour to spare, check out this fascinating lecture Paul gave in 1999.

Sweet Violets

Spring advances, and flowers are blooming everywhere! Herbalists' lawns tend to look a bit messier than average this time of year (I'm still letting the dandelion greens grow, too) - but how can you mow down these beauties??

Trumpet tree

A couple of years ago, when I was in Belize with Anne hiking around the rainforest, exploring Mayan power sites, and talking to a range of different plant people, two main species came up over and over: the cockspur acacia (A. cookii, A. cornigera) and the trumpet tree (Cecropia spp). The former was always touted as a remedy for snakebite, and the presence of cardioactive glycosides in its bark may be potentially related to this traditional use (slowing the heart rate and perhaps decreasing the circulation of poison). "It won't cure it", one gentleman told me, "but it will give you time to get to help, even if you have to walk a long distance". Seemed like a useful tip.
The latter, a middle canopy plant known as the trumpet tree, seemed to have a special place in the hearts of nearly everyone I spoke with who knew anything about the jungle. "It's the toucan's favorite". "The stems, which are hollow, can be used as a trumpet". "We use it to communicate with the spirits" (hollow stemmed plants often have this power, as with the Elder tree). "It makes high blood pressure go away". "It helps with men's issues". Fresh research now points to the power of this plant in treating hypertension and the bronchiospasm of asthma. Though these studies are from animal models, I feel more confident about their conclusions (the authors speculate a Ca-channel blocking activity) given the wealth of traditional information that is available.
From Phytomedicine:
Antihypertensive effect
Antispasmodic effect in bronchial asthma

File another one under the "Science plays catch-up" tab.

Phytoestrogens and phthalates

A recent (end of January) case report generated a lot of furor in the herbal community by implying that certain soaps and body care products containing lavender and tea tree oil were causing abnormal breast growth in young boys. There are numerous reasons why this conclusion is suspect (to say the least); check out the herbsandinfluenza blog for a quick recap.
What I was immediately concerned about was the lack of investigation on the effects of common plasticizers and parabens that are present in many of these skin care products. Phthalates are a common, dangerous, and highly estrogenic class of chemicals that are part of this mix. A new report published in the journal Environmental Health Perspectives analyzes the urine of prepubescent girls for estrogenic compounds. The conclusions: enterolactones (byproduct of plant lignans such as those contained in flax) and phthalates were the most common urinary metabolites found in these girls. And while plant lignans have been consumed since we've existed as a species, phthalates are very new - and generally much more potent in the physiology.
In light of this new information, I believe that the original report on breast growth in young boys should be taken more seriously: not as a warning sign that lavender will disrupt everyone's endocrine system, but that artificial compounds present everywhere in our consumer products and sporting a very long half-life are skewing the hormonal balance not only of our species, but probably of the entire environment. Perhaps some follow-up research will come out of this, and plastic packaging will be reconsidered (don't hold your breath).

Bloodroot

Bloodroot (Sanguinaria canadensis) flowers glistening in the spring sun.

Medicine: evidence based vs. observational

A 2003 report from the British Medical Journal serves as a good commentary on medicine's current obsession with evidence-based knowledge: an attitude that dismisses "traditional", "empirical", and "observational" reports and analyses as somehow inadequate for determining the safety and efficacy of treatments.
The authors make an interesting case. Especially if you're gravitationally challenged.

Ginkgo extract and colitis inflammation

A well-crafted study from China examined the role that Ginkgo biloba extract (GBE, the good-ol'-24% flavoglycosides stuff) can play in the guts of rats poisoned with a substance that induces severe inflammation and remodeling of the GI-tract lining. Pretty weird conditions for a plant to work under, and a fairly concentrated, drug-like preparation of the plant itself: nevertheless, the study shows that inflammation is substantially reduced and tissue is healed. There are some interesting microscopic images of the epithelium of the rats' large bowels, and the changes induced by the GBE are clearly visible. There are also detailed analyses of the various types of inflammatory markers (NF-κB, TNF-α, IL-1β, IL-6) presented both histologically and as Western Blot data.

My opinion: this animal study isn't enough to draw any conclusion about how a Ginkgo extract might affect humans with ulcerative colitis or Crohn's disease. What it does show me is that a flavo-glycoside (the joining of a flavonoid and a sugar) has anti-inflammatory activity even after passing through a digestive process (granted, a rat's belly works very differently from mine). This continues the trend that flavonoid research has been showing: cellular processes can be altered towards healthier expression, longer life, and a reduction of both extra- and intra- cellular markers of inflammation (the interleukins, and NF-κB, TNF-α, for example). But you don't necessarily need GBE to accomplish this: there are plenty of flavonoids and flavo-glycosides in almost all colorful fruits and vegetables.

Happy May Day!

Enjoy the gorgeous day, greening of the fields and hedges, and full moon tonight!
Here are some pictures of the advancing Spring.



Coltsfoot (Tussilago farfara) flowering. These fresh yellow flowers make a great brew for those stubborn, dry coughs that come up at the end of Winter...









Pollinators already hard at work...












Fresh green Nettles feel warm even with your hand a few inches from the leaves.












Lungwort (Pulmonaria officinalis).

FDA herbal regulation update

I'd written a few weeks ago about the FDA's shift in perspective regarding herb and supplement regulation. It seems now that the comment period for their new position has been extended until the end of May.
Links:
FDA docket.
Comment page.

Farms, Food and Obesity

"You are what you eat" (or, for many herbalists, "You are what you assimilate"): important adages, helping to bring the idea of good, whole food up from the nether reaches of our consciousness. Michael Pollan, whom I believe to be a pretty observant plant person, has given this age-old wisdom a bit of a twist in a New York Times Magazine article entitled "You are what you grow". The general idea is that part of the problem with the modern "obesity epidemic" are the basic ingredients of the modern American diet: cheap, industrialized corn, wheat, and soy (sugar, starch and oil - with a little food coloring, salt, and some hydrogenation, you can make almost anything you want), and the government subsidies that keep it all flowing. There are some interesting socioeconomic observations in this article as well. All in all, a fascinating take on the roots of cultural wellness, and our often self-defacing relationship with food.

An update from Vermont

Well, it's the third time this spring that I've seen the snow melt from the gardens, and I'm hoping this time it's for good! A remarkable April has given the daffodils a bit of pause - but I know they're hardy and a little white stuff won't hurt them at all. Up here, the woods and fields know better than to burst into flower at the first signs of warmth -- so we are a bit luckier than folks in the rest of the country who have seen damaging frosts and snows that virtually eliminated crops of almonds, peaches, apples, pears and other fruits that rely on early spring blossoms.
In the warmth of my greenhouse, the last few days have been the perfect time to start a second round of herb seeds for the beds that were under cover-crop last season. Some highlights: Ashwagandha, Stevia, Arnica chamissonis, Spilanthes, Tulsi, various Datura species, Belladonna. These will hopefully find happy homes alongside the standbys like Echinacea and Calendula. Many others (mostly self-seeders like the poppies) are already beginning to grow stronger as the sun hits the garden beds. And last night, a beautiful and meditative end to the day, as the moon's new crescent reaffirmed the tide of growth that is sweeping over these ancient hills. Winter's great -- but so is Spring! Green growth, here we come!

Soy, broccoli and breast cancer

Researchers at UCLA just reported some interesting results at a recent meeting of the American Association for Cancer Research. It involves a flavone from soy, genistein, and a secondary metabolite of cruciferous vegetables (broccoli, kale, etc...). Both of these compounds were tested in vitro on human breast cancer cell lines, and the results seem to indicate that, in controlled lab conditions, these botanical constituents inhibit the cancer cells' ability to metastasize, or spread to other areas. This is important in cancer therapy, since it is the spread of the disease to vital organs such as the lungs, liver, or kidneys that ultimately proves fatal.
The flavones and diindolymethane confound the cancer cells' ability to recognize cellular surface receptors from other tissues, lessening their ability to latch on to new surfaces and thus preventing their spread. And while this report provides interesting and encouraging evidence, it should be taken with a grain of salt: so far, the data is very preliminary and come from cells cultured in a petri dish. Nevertheless, it shouldn't surprise herbalists that flavones have cancer-protective effects: this broad family of plants has been shown to protect us from cellular mutations, DNA damage, oxidative stress, and metastasis time and time again.

The FDA's regulatory plans...

Last December, the FDA issued a comprehensive position paper on "complementary and alternative medicine" (CAM), offering an opinion that deviates pretty radically from current practice. In the United States, there is still a large degree of freedom in choosing herbal medicines, dietary supplements, massage and other somatic therapies, and "functional foods" (like juices) as part of a comprehensive treatment plan. This most recent position paper proposes to bring all of the above under FDA regulation, which (in a worst-case scenario) might even lead to the criminalization of gardeners who grow medicinal herbs. While I can't see how this would be enforced, it does seem to add another voice to the growing governmental chorus that has been pushing against health freedom and the DSHEA (Dietary supplement, health and education act) under which we've been operating for over ten years now.
Here is a link to the FDA recommendations; additionally, please note that the comment period is still open. It is important to offer our opinions on this matter, as there is some historical precedent for the government listening to public comment (as occurred with the organic foods standards in the U.S.). I know, I'm an optimist, but it certainly can't hurt to make our voices heard. Here is the FDA comment page for this paper. Please tell your friends. Someone has to push back.

What were they thinking?

Here's further proof that if you spend enough time away from the forest and fields, whole foods, and our plant allies, your brain eventually turns to mush.
Researchers at Northwestern University published a new method for generating flavonoids in a laboratory. Previous efforts by organic chemists had resulted in failure, primarily because flavonoids are chiral molecules that have a single "handedness" in nature, and all the lab processes to date have generated an equal mix of both left and right handed molecules, which greatly limits their usefulness while also increasing their toxicity. Well, using a catalyst from Cinchona (Peruvian bark - quinine), these folks managed to synthesize flavonoids that are all identical to those found in nature. They started by replicating the constituents found in milk thistle and soy. The hope: new drugs to treat cancer.
Ok. The goal is admirable, and I respect the chemists' desire to find new therapies for cancer. But flavonoids are one of the most abundant and bioavailable of all plant constituents, being responsible for color (other than green) in plants. They are found in coffee, chocolate, peppers, corn, berries, flowers ... the list could go on forever. So why spend all this time on trying to find synthetic ones? Karl Scheidt, one of the researchers, says he wants "... to get selectivity and specificity using chemistry. A naturally occurring flavonoid may not have all the characteristics you want -- it may not be potent enough, for example -- but with chemistry you can go in and modify that structure, imbuing the molecule with more desirable traits, such as binding more effectively to a protein of interest or being less toxic to normal cells."
Ok. I can understand this goal as well. But here, in my opinion, is the bottom line (and the reason why you can really see that the chemists' brains are a bit disconnected): we have evolved on this planet side-by-side with plants. The way our DNA expresses, the way the cellular machinery works, the way cancer is (or isn't) controlled, are all intimately tied to the environment in which we evolved. Plant flavonoids have profound effects on all of those processes, and by definition they are eminently compatible with our physiologies (we are really part of the same being). The effects of a modified flavonoid not found in nature are wholly unknown in vivo. However, the benefits of a colorful, plant-rich, whole-foods diet are well researched and obvious to any herbalist. Why are we wasting time trying to develop weird unnatural therapies that are only used after the fact (i.e. after cancer has become detectable)? Why are we not devoting huge chunks of our governmental infrastructure to developing community gardens, promoting whole, fresh plant foods, and using natural flavonoids to prevent cancer in the first place?
I appreciate the intention behind this research. But I do feel that pursuing such strategies long-term will only lead to further disconnection from Nature, and thus further disease.

Can Coleus help in stubborn urinary infections?

Coleus forskholii, a tropical member of the Mint family, has been used in Ayurveda for thousands of years. Recent research points to its role in increasing levels of intracellular cAMP (cyclic adenosine mono-phosphate), a secondary messenger involved in a variety of biochemical processes. Increasing levels of cAMP has numerous, system-wide effects that mostly relate to "yin"-like changes: reduced inflammation, blood pressure, anxiety, irritability; and increased activation of GABA neurons (here is a useful summary of the research and biochemistry of Coleus).
Now, in a study that is receiving lots of media attention, scientists have found that Coleus extracts are useful in chronic urinary tract infections (UTIs) by reducing the adherence and number of bacterial colonies that hide in the folds of the bladder. Coupled with antibiotics, the study reports, these extracts lead to a more complete and long-lasting remission from UTIs.
Some problems with this research: first, it was done on an animal model (mice). And while cells lining the inside of the mouse bladders did "kick out" bacteria when exposed to Coleus, the plant extract was injected directly into the bladder and bladder tissue. This method is not too practical for us herbalists, and the study reveals nothing about the pharmacodynamics of orally-administered Coleus. So, interesting information. But despite the media attention, not incredibly useful... Hopefully this will spur additional research.

Hawthorn in congestive heart failure

The cardiologists met last month in New Orleans to review new strategies, therapies, and research related to cardiovascular health. Among the presentations, a new European study on hawthorn (Crategus species) leaves gave some interesting evidence that this herb, traditionally used for a range of cardiovascular ailments, has a positive effect on congestive heart failure, reducing mortality and improving quality of life. While the study is controversial (some argue that it shows no benefit for hawthorn over placebo), there are some undeniable positive results which, when coupled with the wealth of traditional use, keeps me coming back to my bottle of Vermont hawthorn tincture.
Traditionally, herbalists use the ripe red berries of this storied tree. Modern research has identified a spectrum of flavonoid-family chemicals in all parts of the plant (well, except the bark...), and research has therefore expanded into analyzing the therapeutic effects of leaf and flower, too - and the results, as this recent research shows, have been positive.
Some details:

• A total of 2,681 patients with markedly impaired left ventricular function - indicating advanced congestive heart failure - were randomized to hawthorn extract or placebo for a duration of two years.
• All patients were already receiving pharmacological therapy with ACE-inhibitors (83 %), beta-blockers (64 %), glycosides (57 %), spironolactone (39 %) and diuretics (85 %).
• Researchers saw a 20 percent reduction in cardiac-related deaths among patients on hawthorn extract, extending patients' lives by four months during the first 18 months of the study. The safety of the compound was confirmed by a lower number of adverse events among the study group than those on placebo.
• Patients taking hawthorn showed significant relative-risk reductions in the secondary end point of cardiac mortality after six months (by 41%, p=0.009) and 18 months (by 20%, p=0.046) but not at the 12-month or 24-month follow-ups (by 18% and 10%, respectively).
• The protection was significantly stronger among the 70% of patients with ischemic disease. Researchers hypothesized the hawthorn extract is protective probably by being anti-ischemic.

The hawthorn extract "... is safe in patients with more severe congestive heart failure and left ventricular ejection fraction lower than 35 percent," said Dr. Holubarsch of Median Kliniken Hospitals in Bad Krozingen, Germany, and lead study author. "It postpones death of cardiac cause after 18 months and sudden cardiac death in an important subgroup of patients."

Another piece of evidence indicating the general life-promoting quality of colorful, flavonoid-rich plant foods! Additionally, continued reinforcement of hawthorn's beneficial effect on the cardiovascular system. My only complaint: as usual, this study uses a proprietary brand-name hawthorn preparation code-named WS 1442 (a standardized extract, 5:1, of hawthorn leaves and flowers produced by the Dr. Wilmar Schwabe Co. of Karlsruhe, Germany, standardized to contain 18.75% oligomeric procyanidins, a sub-class of the flavonoid family of phytochemicals). Sure, this makes the little pill easier to to take and consistent in dosage. But I bet study participants would have enjoyed a good hawthorn berry jam and/or delicious infusions of the spring leaves and flowers, maybe blended with a little linden flower (Tilia species) and lemon balm (Melissa officinalis).

Hawthorn Berry and Black Currant* Jam, from moonwiseherbs.com

-2 quarts Hawthorn berries
-1 quart Black Currants
-1-cup honey (or to taste)
-water to cover

(*Black Currants are high in pectin and make a great addition to thicken any jam or jelly.)

1. Place berries in a pot.
2. Cover with water (2 inches above the berries)
3. Add honey
4. Simmer until mixture thickens, (most of the liquid will be evaporated and the jam will thicken quickly when on a spoon that has been removed from the heat)
5. Run the mixture through a food mill, to remove seeds and stems.
6. Place back in the pot add a quart of water and simmer again until mixture is quite thick.

To can:

-Simmer canning jar lids
-Place mixture in clean canning jars
-Place lids on top
-Place jars in a canning kettle, cover with water (2 inches above the jar)
-Bring to a boil and boil for the appropriate time frame for the jar size: ½ pint 10 minutes, pints 15 minutes, quarts 20 minutes.