Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
RUNNING HEAD: HAWTHORN POTENTIAL ADJUNCT FOR ADHD TREATMENT
Hawthorn
Anti-inflammatory Implications for ADHD Treatment
Kim...
P a g e | 2
Hawthorn
Abstract
Hawthorn (Crataegus laevigata) is a commonly used herb in the management of
cardiovascular d...
P a g e | 3
Hawthorn
inattention, impulsivity, and hyperactivity (Doney and Thome, 2010). Patients placed on an anti-
infl...
P a g e | 4
Hawthorn
Alzheimer's and Parkinson's diseases (Li and Wang, 2011). Inflammation is designed to be a
short-term...
P a g e | 5
Hawthorn
ResearchMethods & Analysis
A systematic electronic literature review was conducted using a multiple s...
P a g e | 6
Hawthorn
red when ripe, but they may also be black. Hawthorn leaves are shiny and grow in a variety of
shapes ...
P a g e | 7
Hawthorn
European Pharmacopoeia 6.0, hawthorn berries consist of the dried false fruits of these two
species o...
P a g e | 8
Hawthorn
The antioxidant activity of Crataegus preparations contributes significantly to its therapeutic
profi...
P a g e | 9
Hawthorn
consistently proven to be well tolerated by patients with low/negligible levels of side effects.
Dani...
P a g e | 10
Hawthorn
flavonoids). Overall, 166 adverse events were reported and most were, mild to moderate; eight
severe...
P a g e | 11
Hawthorn
Retrieved from www.agriculturesource.com
P a g e | 12
Hawthorn
References
Bradstreet JJ, Smith S, Baral M, Rossignol DA (2010). Biomarker-guided interventions of
c...
P a g e | 13
Hawthorn
Li, C and Wang, MH (2011). Anti-inflammatory effect of the water fraction from hawthorn fruit
on LPS...
Upcoming SlideShare
Loading in …5
×

Hawthorn as an Anti-inflammatory for ADHD managment

1,252 views

Published on

Hawthorn berry is proposed as a possible anti-inflammatory treatment in the management of Attention Deficit Hyperactivity Disorder (ADHD). This is not to be undertaken without supervision and management by a qualified licensed medical provider educated in CAM modalities. This novel paper implicates inflammation as one of the key causes of ADHD/ADD and suggests the use of a carefully prescribed and monitored supplement of Hawthorn might be beneficial in managing this condition.

Published in: Health & Medicine
  • How can I improve my memory and concentration? How can I improve my memory for studying?▲▲▲ https://bit.ly/2GEWG9T
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

Hawthorn as an Anti-inflammatory for ADHD managment

  1. 1. RUNNING HEAD: HAWTHORN POTENTIAL ADJUNCT FOR ADHD TREATMENT Hawthorn Anti-inflammatory Implications for ADHD Treatment Kimmer Collison-Ris, MSN, FNP-C, WOCN 9/22/2013
  2. 2. P a g e | 2 Hawthorn Abstract Hawthorn (Crataegus laevigata) is a commonly used herb in the management of cardiovascular disease due to its anti-inflammatory affects. Attention Deficit Hyperactivity Disorder (ADHD) is manifested by behavioral and cognitive disruption as well as impulsivity; believed to be a caused by central nervous system inflammation. Hawthorn’s benefits may translate as a potentially useful anti-inflammatory in the treatment of ADHD. Its chemical constituents and its clinical uses as an anti-inflammatory will be delineated. This paper will discuss Hawthorn’s history and traditional use, herbal constituents, anti-inflammatory properties, current research, and treatment implications. The question, “is there enough evidence to suggest that Hawthorn may be a possible anti-inflammatory botanical in reducing symptoms of ADHD and its various subtypes in adolescents and adults?” Retrieved from asgap.org.au Introduction Hawthorn has been considered a valuable anti-inflammatory often used in treating cardiovascular conditions. Recent studies demonstrate hawthorn fruit exhibits anti-oxidant, anti- atherosclerotic, hypolipidemic activities, and anti-inflammatory properties (Li and Wang, 2011). P. Balch (2002) reports that Ayurvedic medicine and Herbalists have been using Hawthorn for some time to treat ADHD; however, the literature is sparse confirming this directly. One cause of ADHD is inflammatory conditions of the brain and central nervous system that results in
  3. 3. P a g e | 3 Hawthorn inattention, impulsivity, and hyperactivity (Doney and Thome, 2010). Patients placed on an anti- inflammatory diet or given anti-inflammatory botanicals or food supplements often exhibit a reduction in hyperactive behaviors and impulsiveness with increased focus (Burton, 2011). Hawthorn may be an adjunctive anti-inflammatory in decreasing symptoms of inflammation in adolescents and adults with ADHD. This paper discusses the properties and affects of Hawthorn and its potential role in treating ADHD related inflammation; suggesting that Hawthorn may reduce symptoms of ADHD. Attention Deficit Hyperactivity Disorder (ADHD) ADHD is a neurological condition characterized by the inability to concentrate in a sustained manner, pay attention to tasks, and to control impulsive actions (Sorgi, Hallowell, Hutchins, and Sears 2007) and hyperkinetic behavior. The exact etiology is unknown but major multifactorial contributors include adverse food additive responses, chronic inflammation, food intolerances, exposure to environmental chemicals, molds, and fungi, and exposures to neurodevelopmental toxins (ie. heavy metals and organohalide pollutants). Adolescents and adults with ADHD struggle with development in emotional, educational, and social deficits; the consequences of poor therapy negatively affects their future possibilities; many adolescents and adults fail to respond to conventional stimulant therapy alone, but nutritional (and botanical) intervention has complimented conventional therapy; playing a significant role in the etiology of ADHD syndrome (Starobrat-Hermelin and Kozielec 1997). Inflammation Inflammation is a complex biological response to pathogens and damaged cells in the human body (Li and Wang, 2011). Chronic and uncontrolled inflammation is common in cardiovascular disease, autoimmune rheumatoid arthritis, systemic lupus erythmatosus, cancer,
  4. 4. P a g e | 4 Hawthorn Alzheimer's and Parkinson's diseases (Li and Wang, 2011). Inflammation is designed to be a short-term, acute response to illness or injury, where the immune system identifies the offending agent and targets those foreign invaders. Mounting a powerful response, pro-inflammatory compounds are released to assault and aid in healing. Once the threat is eliminated, the immune system then activates anti-inflammatory compounds to calm the inflammation, rebalancing the body. Chronic inflammation results when the immune system is unable to completely shut down the immune response; leaving potent inflammatory compounds still circulating, further damaging healthy tissues (http://come2balance.com/uploads/AccessClinInflNutr.pdf) ADHD and Inflammation Inflammatory responses in the brain have been long recognized as critical in neurodegeneration and behavior in many neurological and psychiatric disorders, their role in the development, treatment and prevention of ADHD has been largely overlooked. Initially, ADHD symptoms were observed in patients who survived an ONJ infection, ie. inflammation (Donev and Thome 2010); brain cell inflammation results in increased neurological disorders, including ADHD. The primary drugs used to treat ADHD are amphetamine derivatives that have the ability to stimulate dopamine receptors in the brain. It has been found that children with ADHD have lower levels of long-chain omega-3 fatty acids in the blood compared to control children (Sears, 2011). New evidence, reveals that ADHD is associated with: oxidative stress; decreased methylation capacity; limited production of glutathione; mitochondrial dysfunction; intestinal dysbiosis; increased toxic metal burden; immune dysregulation, characterized by a unique inflammatory bowel disease and immune activation of neuroglial cells; and ongoing brain hypoperfusion (Bradstreet, Smith, Baral, and Rossignol, 2010).
  5. 5. P a g e | 5 Hawthorn ResearchMethods & Analysis A systematic electronic literature review was conducted using a multiple search strategy from PubMed, Medline, Cochrane database, E-journals, and ClinicalTrials.gov. Non electronic published medicinal herb literature and books were also utilized. Keywords and phrases were used in the research retrieval process; the terms used in the searches included: Hawthorn, Attention Deficit, Hawthorn and inflammation, ADHD and inflammation, ADHD and alternative medicine, and Hawthorn benefits, Hawthorn and inflammation, and Hawthorn and anti- inflammatory to assist in producing this document. Retrieved from wildplanthealing.com Latin Name: Hawthorn [Crataegus monogyna Jacq. and Crataegus oxyacantha L.; sin. Crataegus laevigata (Poiret) DC., Rosaceae] Common Names Crataegus laevigata; Crataegus monogyna; Crataegus oxyacantha; Hedgethorn. Plant Description Hawthorn is a common thorny shrub in the rose family that grows up to 5 feet tall on hillsides and in sunny wooded areas throughout the world. Its flowers bloom in May. They grow in small white, red, or pink clusters. Small berries, called haws, sprout after the flowers. They are usually
  6. 6. P a g e | 6 Hawthorn red when ripe, but they may also be black. Hawthorn leaves are shiny and grow in a variety of shapes and sizes. Collection The flowering tops are harvested in late spring and early summer, the berries in September and October (http://www.purplesage.org.uk/profiles/hawthorn.htm) Growth/harvesting/storage The best locations for the deciduous hawthorn shrub are where they can receive direct exposure to sunlight throughout the day and grows best when it is irrigated during dry weather but it tolerates most types of soil and dry growing conditions. It can grow in areas with soils heavy in clay, loam or sand with an acidic or alkaline pH. The root system of this tree can tolerate compacted soils that are dry, but it does not do well in low areas with poorly drained soil and other areas that flood regularly (Thompson, 2013). Cautions/Precautions Hawthorn is not recommended for children and is contraindicated during pregnancy and lactation. Side effects of Hawthorn are rare, but have included headache, nausea, and palpitations (a feeling of a racing heart). A recent review of 29 clinical studies with more than 5,500 patients found that hawthorn was safe when used in recommended dosages. Doses found to be safe were from 160 - 1,800 mg daily and from 3 - 24 weeks in length. Pharmacological Use and History The medicinal properties of hawthorn (Crataegus spp., a genus comprising approximately 300 species) have been utilized by many cultures for a variety of therapeutic purposes for many centuries (Tassell MC, Kingston R, Gilroy D, Lehane M, and Furey A, 2010). According to
  7. 7. P a g e | 7 Hawthorn European Pharmacopoeia 6.0, hawthorn berries consist of the dried false fruits of these two species or their mixture (Tadić, Dobrić , Marković , Dordević , Arsić , Menković , Stević, 2008). Practicing herbalists noted preference for berry over flower, flowers and berries being utilized more interchangeably, and in some cases blended. Historical texts in Western medicine record the use of berries, seeds, leaves, and flowers. Leaves, flowers, and berries are used in traditional medicine in the treatment of chronic heart failure, high blood pressure, arrhythmia, and various digestive ailments, as well as geriatric and antiarteriosclerosis remedies (Tadić et al 2008). Constituents Berries, leaves, and flowers of hawthorn are phytochemically similar in composition, differing primarily in the ratio of specific flavonoids and procyanidins present. The berries are rich in hyperoside. The flowers contain significant levels of vitexin-2-rhamnosid, higher levels of flavonoids, and cardiotonic amines. The leaves had the highest levels of oligomeric procyanidins (OPCs),high levels of procyanidins, and higher levels of vitexin-2-rhamnoside (Tassell, et al, 2010). The fruit contained saponins, glycosides, flavonoids, cardioactive glycosides, ascorbic acid, and condensed tannins (Haughton, 2013). Therapeutic Application Hawthorn is used to strengthen the cardiovascular system and as an anti-inflammatory. It has demonstrated cardioprotective effects in controlling high blood pressure and high cholesterol. Both animal and human studies demonstrate hawthorn increases coronary artery blood flow, improves circulation, and lowers blood pressure. It has also been used on the skin to treat boils and skin sores. Ayurvedic medicine recommends hawthorn for heart and circulatory complaints (Haughton, 2013) and ADHD (Balch, 2002). Its beneficial effects have been attributed to the presence of Oligomeric proanthocyanidins (Elango and Devaraj, 2010).
  8. 8. P a g e | 8 Hawthorn The antioxidant activity of Crataegus preparations contributes significantly to its therapeutic profile. Gou et al. noted that of 28 fruit pulps tested, the hawthorn pulp (Chinese hawthorn) produced the highest measure of antioxidant activity. A similarly high antioxidant activity in Crataegus aronia, a hawthorn indigenous to Israel, Jordan, and the Palestine, has been found. The IC50 values of specific active constituents have been established in relation to the antioxidant capacity, with values of epicatechin and hyperoside being significantly lower (more effective) than those of established antioxidant drugs (i.e., glutathione and N-acetylcysteine). Oligomeric proanthocyanidins appear to possess a higher antioxidant activity used in isolation than polymeric proanthocyanidins (PPCs) used in isolation. However, the removal of PPCs from a mixture may result in a less actively protective medicine, possibly partially due to their high concentration influencing outcome (Tassell et al, 2010). Mechanism of Action Hawthorn extract helped alleviate pro-inflammatory immune responses associated with I/R- induced injury, boosted IL-10 levels, and increased Foxp3-positive Tregs in the brain, which may have aided in suppression of activated inflammatory cells. Such treatment also minimizes apoptotic cell death by influencing STAT-3 phosphorylation and Bcl-xL expression in the brain. Taken together, the immunomodulatory effect of Hawthorn extract may play a critical role in the neuroprotection observed in this MCAO-induced stroke model. The immunomodulatory role of Hawthorn extract (OPC rich) has not been explored (Elango and Devaraj, 2010). Toxicology & Side Effects Hawthorn fruit, used in traditional medicine, is considered to be safe in existing pharmacological and toxicological studies (Li and Wang, 2011). Side effects may include dizziness, vertigo, headaches, migraines, and palpitations. Crataegus preparations have been
  9. 9. P a g e | 9 Hawthorn consistently proven to be well tolerated by patients with low/negligible levels of side effects. Daniele et al. looked at data from 24 clinical trials and a total of 5577 patients. They concluded that hawthorn preparations are generally well tolerated and noted that adverse effects were significantly lower in treatment groups using WS1442. There appears to be no substantial body of evidence to suggest that Crataegus causes anything other than infrequent, mild adverse effects. There are also no known contraindications to its use during pregnancy, although expert advice should be sought in this circumstance. Crataegus demonstrates low toxicity, with an LD50 of 25 mg/kg and a high therapeutic index. The clinical trial conducted by Tauchert et al. utilized a high dose of WS1442 (1800 mg) with no reported side effects. Animal studies on Crataegus toxicity, using doses of WS1442 up to 100 times normal dose, showed no evidence of toxicity. Studies on human models of this nature have not been undertaken. The potential risk appears to be low in Crataegus treatments due to its wide therapeutic index, coupled with the minimal incidence of serious side effects (Tassell et al, 2010). Combined with Ginkgo, Crataegus can enhance poor memory by improving the cerebral circulation and thereby increasing the amount of oxygen to the brain (Haughton, 2013). Drug/herb interactions Hawthorn may enhance the effects of Cardiac medications like medications used to dilate blood vessels, lower blood pressure, treat angina and erectile dysfunction . One study found a nasal decongestant that constricts blood vessels, Phenylephrine, when combined with alcoholic hawthorn fruit extract exhibited reduced effects. The daily dose and duration of treatment with Hawthorn monopreparations ranged from 160 to 1,800 mg and from 3 to 24 weeks, respectively. The extracts most used in the clinical trials were WS 1,442 (extract of hawthorn standardised to 18.75% oligomeric procyanidins) and LI 132 (extract of hawthorn standardised to 2.25%
  10. 10. P a g e | 10 Hawthorn flavonoids). Overall, 166 adverse events were reported and most were, mild to moderate; eight severe adverse events were reported with the LI 132 extract. The most frequent adverse events included dizziness/vertigo, gastrointestinal complaints, headache, migraine, and palpitation; drug interactions were not reported. The data indicated Hawthorn was well tolerated, but due to reported severe adverse events; further studies are needed to determine the safety of hawthorn- containing preparations as unsupervised use can be associated with problems in concomitant medications (Daniele, Mazzanti, Pittler, and Ernst, 2006) Available Forms Hawthorn is available in nonstandardized and standardized capsules and liquid extracts, along with tinctures and solid extracts. A bitter tasting tea can also be made from dried hawthorn leaves, flowers, and berries (University of Maryland Medical Center, 2011). Conclusions & Recommendations Hawthorn fruit species is a good source of natural antioxidants and consumption of hawthorn fruit or its products may decrease ADHD symptoms related to inflammation (Çalişkan, Gündüz, Serçe, Toplu, Kamiloğlu, Şengül, and Ercişli, 2012) to the ADHD diet. Hawthorn, is regarded as a valuable anti-inflammatory in the treatment of cardiac and vascular conditions; demonstrating a reduction in inflammation; suggesting that other inflammatory conditions (like ADHD related to inflammation) could be alleviated with its use. Future clinical trials utilizing Hawthorn extract on older adolescents and adults with ADHD may reveal its usefulness. Further research could be expanded to a larger cross-over trial to determine if results could be replicated on larger populations. In addition, cross over research trials could be conducted on Hawthorn and compared to anti-inflammatory diets in the management and treatment of ADHD.
  11. 11. P a g e | 11 Hawthorn Retrieved from www.agriculturesource.com
  12. 12. P a g e | 12 Hawthorn References Bradstreet JJ, Smith S, Baral M, Rossignol DA (2010). Biomarker-guided interventions of clinically relevant conditions associated with autism spectrum disorders and attention deficit hyperactivity disorder. Altern Med Rev. 2010 Apr;15(1):15-32. Balch, P (2002). Prescription for Herbal Healing. Avery: New York, New York. Burton, D (2008). Attention Deficit Hyperactivity Disorder: Herbal and Natural Treatments. Ohlong Herbal Center. Retrieved from http://www.ohlonecenter.org/research- papers/attention%C2%ADdeficit-hyperactivity-disorder-herbal-and-natural-treatments/ Çalişkan O, Gündüz K, Serçe S, Toplu C, Kamiloğlu O, Şengül M,1 and Ercişli S (2012). Phytochemical characterization of several hawthorn (Crataegus spp.) species sampled from the Eastern Mediterranean region of Turkey. Pharmacogn Mag. 2012 Jan-Mar; 8(29): 16–21. doi: 10.4103/0973-1296.93305 PMCID: PMC3307197 Daniele C, Mazzanti G, Pittler MH, Ernst E (2006). Adverse-event profile of Crataegus spp.: a systematic review. Drug Saf. 2006;29(6):523-35. Donev R and Thome J (2010). Inflammation: good or bad for ADHD? ADHD Attention Deficit and Hyperactivity Disorders December 2010, Volume 2, Issue 4, pp 257-266. Elango, C and Devaraj, SN (2010). Immunomodulatory effect of Hawthorn extract in an experimental stroke model. Journal of Neuroinflammation, 2010, 7:97 doi:10.1186/1742- 2094-7-97. Retrieved from http://www.jneuroinflammation.com/content/7/1/97. Haughton, C (2013). Hawthorn. Purple Sage Botanicals. Retrieved from http://www.purplesage.org.uk/profiles/hawthorn.htm
  13. 13. P a g e | 13 Hawthorn Li, C and Wang, MH (2011). Anti-inflammatory effect of the water fraction from hawthorn fruit on LPS-stimulated RAW 264.7 cells. Nutrition Research and Practice, 2011 April; 5(2): 101–106. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085797/. Sears, B (2011). ADHD: An inflammatory condition. The link between ADHD and Obesity. Psychology Today. Retrieved from http://www.psychologytoday.com/blog/in-the- zone/201107/adhd-inflammatory-condition. Tadić VM, Dobrić S, Marković GM, Dordević SM, Arsić IA, Menković NR, Stević T (2008). Anti-inflammatory, gastroprotective, free-radical-scavenging, and antimicrobial activities of hawthorn berries ethanol extract. J Agric Food Chem. 2008 Sep 10;56(17):7700-9. doi: 10.1021/jf801668c. Epub 2008 Aug 13. Tassell MC, Kingston R, Gilroy D, Lehane M, and Furey A (2010). Hawthorn (Crataegus spp.) in the treatment of cardiovascular disease Pharmacogn Rev. 2010 Jan-Jun; 4(7): 32–41. doi: 10.4103/0973-7847.65324 PMCID: PMC3249900 Thompson, D (2013). Washington Hawthorn Growing Conditions. Retrieved from http://homeguides.sfgate.com/washington-hawthorn-growing-conditions-56648.html. University of Maryland Medical Center (2011). Hawthorn. Retrieved from http://umm.edu/health/medical/altmed/herb/hawthorn Zappone, A (2013).Inflammation and Diet. retrieved from http://come2balance.com/uploads/AccessClinInflNutr.pdf

×