Elderberry

What is elderberry?

Elderberry (Sambucus spp; S. nigra is one of the more commonly used species in research) is a shrub, formerly classed in the Caprifoliaceae family but now recognized to be in the Adoxaceae. Species of Sambucus are known to grow on most continents, with the exception of Oceania and Antarctica. Both elderflowers and elderberries are consumed for food and traditional medical purposes. Since elderberry shrubs have become naturalized in so many locations, they have traditional uses across many cultures. Two of the more popular uses for elderberries have been in the prevention of flu or colds and in immune stimulation. The berries themselves are known to contain relatively high amounts of anti-inflammatory and antioxidant compounds such as anthocyanins and flavonols. Elderberries also contain nutrients such as B vitamins, ascorbic acid, folic acid, potassium, and fructose.

What are the known traditional, historical, and cultural uses of elderberry?

Shrubs in the Sambucus genus are found globally, and their traditional use has been documented in the Americas, Africa, Europe, and the Middle East, including treatments for infections, ophthalmological issues, benign prostatic hyperplasia, and a broad range of other conditions. Indigenous peoples of the Americas have also been known to use elderberry leaves for medicinal purposes. More than 60 different Indigenous peoples of the Americas, notably the Iroquois, Cherokee, Paiute, Thompson/Ntlakyapamuk, and Kawaiisu tribes, have used elderberry as a traditional treatment for a total of nearly 50 recorded conditions and ailments. The most common uses for elderberry by First Nations include as an emetic, dermatological aid, gastrointestinal aid, fever reducer, laxative, pain reliever, gynecological aid, and cold remedy.

What are elderberry’s main benefits?

Current meta-analyses support elderberry’s use for the prevention and/or treatment of respiratory infections (mainly those caused by respiratory viruses, such as COVID-19 and influenza), and elderberry’s capacity to strengthen immune response under stressful circumstances, such as air travel, exercise, or exposure to extreme environments. Clinical trials have also studied elderberry for cardiovascular disease, topical treatment of eczema, gingivitis prevention, lipid or carbohydrate oxidation, and influenza treatment.

Does elderberry prevent or treat viral infections?

Thus far, the evidence is mixed. The strongest evidence to date is for reduction of cold/respiratory illness symptom severity and duration (in doses of 175–600 mg/day over 2-16 days). However, there is no strong evidence to suggest that elderberry can reduce the risk of contracting a cold or viral infection. In terms of cold prevention under stressful circumstances, a single RCT compared elderberry extract to a placebo when taken at 600 to 900 mg/day for 10 days prior to air travel and 4 to 5 days after. While elderberry was not significantly better than placebo at preventing colds, the elderberry group did experience milder symptoms and shorter colds. However, when elderberry was taken by both children and adults as a syrup extract (30 mL/day for people aged 12 or younger, 60 mL/day for people over 12 years over 5 days), no reduction in the duration or severity of influenza symptoms was found.

Does elderberry affect immune health?

Elderberry is often touted for preservation and protection of the immune system in general. Some researchers believe that elderberry’s capacity for immunoregulation occurs through modulation of cytokine release and activity; indeed, three clinical studies have demonstrated that certain preparations containing elderberry extract may stimulate a healthy immune response through cytokine release and activity in healthy individuals. It should be noted, however, that these were all industry-sponsored studies of proprietary blends.

Does elderberry impact cardiometabolic health?

Another area where the benefits of elderberry are of interest is in support of cardiometabolic health outcomes. One study found that people with overweight or obesity who drank elderberry juice had higher carbohydrate and fat oxidation than those who took placebo; however, there were no differences in energy expenditure or glucose/insulin response. An observational, non-placebo-controlled study of a combination therapy of elderberry and asparagus extracts noted a decrease in mean weight and improvements in blood pressure among its participants, but since all participants took the supplement and additionally fasted for several days, it is difficult to know whether to attribute these results to the supplementation.

What are elderberry’s main drawbacks?

Elderberry leaves, stems, and unripe or uncooked fruit contain a toxin, sambunagrin, which causes nausea, vomiting, and diarrhea, especially when taken in larger quantities. Because elderberry may act on the immune system, people who are immunocompromised or who have autoimmune conditions should not consume elderberry medicinally without a physician’s supervision. There have been case reports connecting consumption of elderberry extract with acute pancreatitis, processing of elderberries with repeat-exposure-induced allergies, and consumption of raw fruit, stems and leaves with symptoms consistent with poisoning (nausea, vomiting, dizziness, numbness, and stomach cramps).