A panacea for cold and flu symptoms or an overhyped health trend?
Black elderberry (Sambucus nigra) is one of the highest grossing dietary supplements in recent years. It is available as a syrup, in gummies, as lollipops, lozenges, capsules, and just about any other preparation imaginable.
Manufacturers, both large-scale and at your local farmer's market, tout it as a heal-all for everything that ails you. From cold and flu symptoms to ear infections to general immune support, the berry is marketed for seemingly anything and everything.
But does elderberry actually work? Ultimately, that's what matters. Can taking elderberry actually reduce the severity and/or duration of cold and flu symptoms? Here are the facts.
Is there scientific research on elderberry?
There are multiple scientific studies evaluating the effects of elderberry for cold and flu symptoms (1-4). The strongest available evidence was published by our research team in early 2019 (4). In this study, the FHRF research team found that elderberry is highly effective against cold symptoms and has a powerful reduction effect on both the duration and the severity of the flu.
This study reflects a total of 180 patients. Our team looked at effects on cold symptoms as compared to flu symptoms. We also looked at whether the syrup worked differently in patients who had received the flu vaccine as compared to those who did not.
In this study, elderberry was found to dramatically reduce symptoms of both the common cold and the flu. It was much stronger at reducing the total duration of the flu as compared to the common cold. Whether or not a patient had been vaccinated against the flu had no effect on the strength of elderberry supplementation.
At a Glance
Botanical: Sambucus nigra
Dose: standardized product
Duration: 3-4 times per day
Effect: dramatic reduction in cold and flu symptoms
Is elderberry an evidence-based approach?
Elderberry makes a great treatment for upper respiratory symptoms. A reduction in total symptoms should also produce a reduction in total complications, which has the potential to save lives.
In the study conducted in early 2019, the total effect size for flu symptoms was 2.074. This means that roughly 98% of people who take elderberry for the flu will improve faster than the average person with the flu who does not take elderberry. Similarly, 41% of people who take elderberry for the common cold will improve faster than the average person who does not take elderberry.
While the total body of research is rather small, the effect size of elderberry is substantial. Given the overall safety of the supplement, it provides a useful approach to these winter viruses.
What does this mean for me?
If you are stocking a winter medicine chest, elderberry is a great tool to include. However, the effects found in this research are not applicable to all elderberry syrups on the market. With the recent increase in elderberry supplementation, many cottage businesses have begun manufacturing their own syrups, unaware that it can pose significant health risks.
Elderberries contain chemicals known as cyanogenic glycosides, which convert to hydrogen cyanide in the gastrointestinal tract (6). The quantity of these glycosides varies according to the type of elderberry. The cyanogenic glycoside content in the berries can even vary by growing conditions (7). This means the average consumer and manufacturer is unable to identify the exact content of these poisonous compounds in their homemade products.
If not removed, they can result in gastric complaints and even poisoning. While there are documented cases of poisoning from homemade elderberry products that were not sufficiently cooked, most exposures cause milder symptoms, including nausea, vomiting, and diarrhea (8). The risk is particularly noteworthy in children (9).
Fortunately, it is easy to remove these chemicals as they are volatile and evaporate with heat (10). As a result, we do not recommend homemade syrups unless prepared according to a strict formula. You can find the recipe our research team uses here.
Zakay-Rones, Z., Varsano, N., Zlotnik, M., Manor, O., Regev, L., Schlesinger, M., & Mumcuoglu, M. (1995). Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. The Journal of Alternative and Complementary Medicine, 1(4), 361-369. doi: 10.1089/acm.1995.1.361
Zakay-Rones, Z., Thom, E., Wollan, T., & Wadstein, J. (2004). Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. Journal of International Medical Research, 32(2), 132-140.
Tiralongo, E., Wee, S. S., & Lea, R. A. (2016). Elderberry supplementation reduces cold duration and symptoms in air-travellers: A randomized, double-blind placebo-controlled clinical trial. Nutrients, 8(4), 182. doi: doi.org/10.3390/nu8040182
Kong, F. K. (2009). Pilot clinical study on a proprietary elderberry extract: efficacy in addressing influenza symptoms. Online Journal of Pharmacology and Pharmacokinetics, 5, 32-43.
- Hawkins, J., Baker, C., Cherry, L., & Dunne, E. (2019). Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complementary therapies in medicine, 42, 361-365.
Vlachojannis, J. E., Cameron, M., & Chrubasik, S. (2010). A systematic review on the sambuci fructus effect and efficacy profiles. Phytotherapy Research: An International Journal Devoted to Pharmacological and Toxicological Evaluation of Natural Product Derivatives, 24(1), 1-8. doi: 10.1002/ptr.2729
- Senica, M., Stampar, F., Veberic, R., & Mikulic‐Petkovsek, M. (2017). The higher the better? Differences in phenolics and cyanogenic glycosides in Sambucus nigra leaves, flowers and berries from different altitudes. Journal of the Science of Food and Agriculture, 97(8), 2623-2632. doi: 10.1002/jsfa.8085
Centers for Disease Control (CDC. (1984). Poisoning from elderberry juice--California. MMWR. Morbidity and mortality weekly report, 33(13), 173.
Knudsen, B. F., & Kaack, K. V. (2013, June). A review of human health and disease claims for elderberry (sambucus nigra) fruit. In I International Symposium on Elderberry 1061 (pp. 121-131). doi: 10.17660/ActaHortic.2015.1061.12
Pogorzelski, E. (1982). Formation of cyanide as a product of decomposition of cyanogenic glucosides in the treatment of elderberry fruit (Sambucus nigra). Journal of the Science of Food and Agriculture, 33(5), 496-498.
Meet Dr Hawkins
Dr. Hawkins brings 20 years of expertise in the integrative health field to her role as Executive Director of the Franklin School of Integrative Health Sciences and the leader of our clinical research team.
She holds a Bachelor’s Degree in Environmental Health from Union Institute and University, a Master’s Degree in Health Education & Promotion from the University of Alabama, a post-graduate certificate in epidemiology from the London School of Hygiene and Tropical Medicine, a PhD in Health Research from Middle Tennessee State University, and is completing the post-doctoral Global Scholars Research Training Program at Harvard Medical School. She also holds certifications in numerous natural health fields including aromatherapy, aromatic medicine, herbalism, childbirth education, and labor support.