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6 Elderberry Benefits (incl. Colds & Flu) + Side Effects

Written by Anastasia Naoum, MS (Health Informatics) | Last updated:
Jonathan Ritter
Puya Yazdi
Medically reviewed by
Jonathan Ritter, PharmD, PhD (Pharmacology), Puya Yazdi, MD | Written by Anastasia Naoum, MS (Health Informatics) | Last updated:

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Elderberry

Elderberry is among the most popular natural remedies for the common cold and flu symptoms. It helps fight other viral infections and may also protect the heart. However, some parts of the plant are toxic. Keep reading to learn elderberry benefits, side effects, and how to use it.

What is Elderberry?

Elderberries are glossy, tart, deep-purple fruits of the Sambucus tree. Among many varieties, the most common one is the European elder or black elderberry (Sambucus nigra) [1].

Native to Europe, black elderberry today grows across America, Asia, and North Africa. The tree is up to 30 feet tall, with a brownish-gray bark and fragrant white flowers. The fruits are small, dark-colored berries, sometimes appearing almost black [2].

Snapshot

Proponents:

  • Helps fight the cold and flu
  • Kills viruses & bacteria
  • Great nutritional value
  • Relieves gum inflammation
  • May protect the skin and heart

Skeptics:

  • Most benefits lack solid clinical evidence
  • Leaves, seeds, bark, and raw berries are potentially toxic
  • May not be safe for pregnant or breastfeeding women

Uses in Traditional Medicine

All parts of black elderberry are used in folk medicine. The flowers and leaves are natural remedies for reducing pain, swelling, and inflammation. Preparations from the bark are taken to stimulate urination and bowel movements. Fresh or dried berries are thought to relieve headaches, toothaches, low back pain, respiratory infections, as well as constipation [1, 3].

Modern Uses

Recent research voices the traditional wisdom. Flavonoids discovered in the flowers and fruits of elderberry trees have antiviral, anti-inflammatory, and antioxidant properties. People use it to combat flu, respiratory infections, and more [3].

Furthermore, Sambucus nigra has become popular in the food industry. The berries are often used to make refreshing, sweet-tart juices, jams, jellies, pies, punches, and wines. Elderflowers are boiled to prepare a soothing, creamy tea or syrup or added to the batter when baking [4, 5].

Black, Blue, and Red Elderberry – What’s the Difference?

Elderberry supplements – such as syrups, lozenges, capsules, tea, and powder – are all typically made from the European, black elderberry (Sambucus nigra) [6, 7].

The three other well-known elderberry varieties include the following [3, 8]:

  • American elderberry (Sambucus canadensis)
  • Blue elderberry (Sambucus cerulea), and
  • Red elderberry (Sambucus racemosa)

All elderberries are rich in anthocyanins, powerful antioxidants responsible for the red, blue, and purple berry color variations [1, 9].

Although both European and American elderberry abound in antioxidants, the European variety is higher in specific ones (phenolics and flavonoids). Anthocyanins deepen the color of plants, which explains the greater potency of black elderberry, especially compared to the red variety [10, 11, 2].

Red and blue elderberry, native to the North American continent, may offer distinct health benefits. Native people would collect these berries in the summer and store them in a safe place for medicinal use during the winter months. Research on their effects is limited, however, so this post will focus on the black variety.

Active Components

Black elderberry is rich in bioactive components, the most important ones being [12, 3, 13, 2]:.

Nutritional Profile

Elderberries are low-calorie fruits, high in nutrients and antioxidants. Their precise nutritional content depends on the ripeness of the fruit, environmental conditions, and the plant variety [6].

100 g of fresh elderberries contain only 73 calories and will provide 28% of your daily fiber requirement. Plus, the fruits are rich in vitamins – such as vitamin C and provitamin A (carotenoids) – and minerals – including iron, potassium, and phosphorus [6, 14].

Black elderberry’s nutrient profile and Recommended Daily Intake (RDI) based on a 2,000 calorie diet is listed below [7, 15, 16, 17]:

Amount/100 gRDI
Energy73 kcal4%
Proteins0.7 g1%
Fat0.5 g1%
Carbohydrates18.4 g6%
Dietary Fiber7.4 g28%
Vitamin C18 – 35 mg30 – 58%
Vitamin A600IU12%
Vitamin B60.25 mg11%
Folate17 mg8.50%
Vitamin B50.18 mg1%
Iron1.86 mg10%
Potassium288 – 305 mg9 – 10%
Phosphorus49 – 57 mg7 – 8%
Calcium28 mg3.50%
Copper0.14 mg3%
Zinc0.36 mg2.40%

The leaves, berries, and flowers are high in antioxidants (flavonoids, phenolics, and anthocyanins) that lower oxidative stress and balance the immune system. Elderberries have the highest amount of flavonoids compared to 28 different species of berries [4, 18, 19, 20, 21].

Some common preparation methods can lower certain nutrients and antioxidants, such as high extraction temperature, cooking, or juicing. Expectedly, elderberry teas, juices, jellies, and wines will be lower in active components than the fresh herb or its standardized extracts [22, 23, 6].

Health Benefits of Elderberry

Possibly Effective:

1) Cold & Flu

Flu Symptoms

Sambucol is a popular, widely-available brand of standardized elderberry extracts. In clinical studies with over 80 people with influenza A or B, taking Sambucol syrup for 5 days relieved flu symptoms 4 days faster than the placebo [24, 25, 26].

Elderberry lozenges (four times per day) reduced fever, headache, muscle pain, and nasal congestion within 48 hours in a clinical study on 64 people with the flu [27].

Elderberry syrup also decreased the duration of flu-like symptoms in chimpanzees [28].

Flavonoids in elderberry may prevent infection from the influenza A and B viruses, which are responsible for the yearly seasonal flu epidemics. In test tubes, elderberry could bind to both viruses and prevent them from entering cells and multiplying [29, 30, 31].

Cold Symptoms

Symptoms of the flu and the common cold often overlap, but colds are caused by different viruses and are usually milder

Frequent travelers are under stress – long flights and layovers put a strain on the immune and respiratory system. In one clinical study of 312 people traveling overseas from Australia, elderberry extract reduced the severity and duration of common cold symptoms, compared to the placebo [32].

Reducing Inflammation & Swelling

Non-steroidal anti-inflammatory drugs are common ingredients in cold and flu products (such as Advil); they reduce symptoms such as swelling, pain, and stuffiness. A combination of elderberry and other herbs (gentian root, cowslip flowers, sorrel, vervain wort) might work in a similar way: it lowered inflammatory enzymes COX-2 and messengers (PGE-2) in rats [33].

2) Other Bacterial and Viral Infections

In clinical studies with over 2,300 people with a bacterial sinus infection, a combination of elderberry and other herbs (gentian root, cowslip flowers, sorrel, vervain wort) reduced inflammation, headaches, and nasal discharge [34, 35, 36, 37, 38, 39].

In test tubes, elderberry extracts blocked the growth of bacteria that cause malaria and a myriad of other health problems (including Plasmodium falciparum, Streptococcus, Escherichia coli, Staphylococcus, Bacillus, Salmonella, and Helicobacter pylori) [40, 41, 42, 2].

It was also active against the herpes simplex virus, which causes cold sores [29, 30, 40].

3) Gum Inflammation

In several clinical studies with more than 200 people, an herbal mouth rinse containing elderberry and echinacea decreased gum inflammation (gingivitis), bleeding, and plaque size [43, 44, 45, 46, 47].

4) Constipation

In a clinical study of 20 people with constipation, a tea containing elderberry, anise, fennel, and Alexandrian senna increased the number of evacuations per day and improved bowel movements. It’s unclear to what extent elderberry helped since senna is a well-known laxative [48].

Insufficient Evidence:

No valid clinical evidence supports the use of elderberry for any of the conditions in this section. Below is a summary of up-to-date animal studies, cell-based research, or low-quality clinical trials which should spark further investigation. However, you shouldn’t interpret them as supportive of any health benefit.

5) Heart Disease

Flower and berry extracts, together with asparagus, reduced body weight, and improved blood pressure and quality of life in a clinical study on 80 people [49].

In another study on 34 healthy people, elderberry juice for 2 weeks slightly decreased cholesterol levels (by 9 mg/dL) and oxidative stress, compared to the placebo [50].

In animals, elderberry extracts lowered blood pressure, liver cholesterol, blood triglycerides, and fat buildup – all of which increase the risk of heart disease. Plus, they increased glutathione, one of the most important antioxidant enzymes in the body [51, 52, 53, 54, 55, 56].

However, elderberry extract had no effect on inflammatory biomarkers, blood fat or sugar levels in a clinical study on 52 healthy postmenopausal women, given over 12 weeks [57].

Elderberry may protect the heart by reducing blood pressure and cholesterol, but the evidence is inconclusive.

6) Skin Health

Elderberry is rich in flavonoids, phenolics, and vitamin C, and provitamin A, which decrease oxidative stress, prevent skin damage, improve skin elasticity, and lessen wrinkles [7, 58, 59, 4].

A formula containing elderberry, common hawthorn, and dwarf everlast extracts had a sun protection factor (SPF) of almost 10, meaning that these herbs can naturally protect from UV rays [60].

Animal and Cellular Research (Lacking Evidence)

Immunity

Elderberry extract acts as an immuno-modulator: it can calm an overactive immune system or activate an overly-suppressed one [61, 62, 63, 1].

Enhancing Immune Defense

In studies on human cells, elderberry syrup (Sambucol) increased the production of inflammatory cytokines (IL-1b, TNF-alpha, IL-6, IL-8) needed to activate immune cells. Elderberry syrup also increased the anti-inflammatory cytokine IL-10, which might help restrict the immune response and prevent it from getting out of hand [61, 62, 64].

Elderberry extracts stimulated the production of white blood cells (T-helper cells, macrophages), which increase overall immune defense [65, 66].

Preventing Immune Overactivity

Elderberry and elderflower extracts may balance an overactive immune system by blocking nitric oxide production in cells. Overproduction of nitric oxide has been linked to inflammatory autoimmune diseases [67, 68, 69].

Elderberry may balance the immune system, but clinical studies are lacking to draw any conclusions.

Diabetes

Elderberry extracts prevented insulin spikes and insulin resistance in mice fed a high-fat diet [55, 70].

Based on test-tubes experiments, they might work by [71, 72, 2, 73, 74]:

  • Promoting insulin production
  • Transferring sugar from the blood into cells and tissues
  • Breaking down sugar in cells
  • Blocking the enzymes (α-glucosidase and α-amylase) that digest carbs, which helps lower blood sugar spikes after meals

Other

According to limited animal studies, elderberry may help:

Clinical studies are lacking to back up these benefits.

Limitations and Caveats

Some potential benefits of elderberry are limited to animal and cell-based studies.

Some clinical trials had a small number of participants, and some of their findings are debatable. The benefits and contribution of elderberry are unclear in studies using multi-herbal formulas.

Elderberry Side Effects & Safety

When used in adequate amounts, elderberry tea, extracts, and other products are generally safe and well-tolerated. However, there are important safety precautions to consider when it comes to this herb.

Poisoning

The bark, leaves, roots, as well as raw or unripe berries, contain a toxic compound (sambunigrin) which can lead to cyanide poisoning. Consumption of raw elder products may cause nausea, vomiting, diarrhea, and even lead to hospitalization [3, 77, 26].

In 1984, 8 people became sick after drinking juice from fresh berries, leaves, and branches of Sambucus Mexicana tree. They suffered from nausea, vomiting, weakness, dizziness, stomach pain, numbness, and impaired consciousness [78].

The levels of the toxic compounds in raw berries are not extremely high but may still cause serious health problems. Cooked berries and standardized extracts are safe to consume [79, 80].

Fresh elderberries contain lectins, which may also cause a reaction in sensitive people. Cooking the berries reduces their lectin content [80].

Allergy

Some people are allergic to elderberry and will experience typical symptoms: runny nose, itchy or red eyes, and difficulty breathing [81, 82, 83].

However, elderberry allergies affect only 0.6% of the general population, according to a study of over 3.5K randomly tested people [81].

Pregnancy and Breastfeeding

Pregnant and breastfeeding women should avoid elderberry supplements due to the lack of safety data [1, 84, 85].

Drug Interactions

Herb-drug interactions can be dangerous and, in rare cases, even life-threatening. Always consult your doctor before supplementing and let them know about all drugs and supplements you are using or considering.

Based on its possible benefits, elderberry may, in theory, interact with the following drugs:

Elderberry Supplements & How to Use

Supplements are made from elderberry fruits or flowers. They are available as powder, syrup, tablets, capsules, and lozenges [3, 1].

You can also purchase raw, frozen or dried berries, as well as elderberry juice or tea [22, 23, 6].

Sambucol

Sambucol is a clinically-tested standardized elderberry extract, available as syrup, gummies, capsules, and chewable tablets.

The syrup contains 38% of the standardized elderberry extract. The same potency is used in adults and kids (called Anti-Viral Flu Care), only the dosage differs.

The other formulation for kids called Cold & Flu contains 47mg of the extract per tablet, along with vitamin C, zinc, and Echinacea. Aside from these, the Cold & Flu softgel formulation for adults also contains white willow.

Tip: Watch out for Sambucol homeopathic formulations (such as “Cold and Flu Relief Homeopathic” and “Cold & Flu Sinus Relief”). These don’t contain the standardized elderberry extract but homeopathic dilutions with trace amounts of active compounds. The efficacy of such products is unproven.

Syrup Recipe

To make your own syrup, you will need:

  • 3½ cups water
  • 2/3 cup dried elderberries (or 1 1/3 cups fresh or frozen)
  • 1 cup of raw honey or brown rice syrup

Instructions:

  1. Put the berries and water in a saucepan (you can also add other herbs, such as ginger, cinnamon, and cloves)
  2. Place over medium heat and gradually bring to a boil. Then decrease to simmer for around 45 minutes, stirring often
  3. Once about half of the liquid evaporated, remove from heat and let it cool to room temperature
  4. Mash the berries carefully and pour through a strainer into a bowl
  5. Add the honey or brown rice syrup and place the mix in a saucepan again
  6. Bring to a boil and continue to cook for 10-30 minutes until the mixture thickens
  7. Take the mixture off the stove and allow it to cool
  8. Transfer to a glass jar
  9. Store your syrup in the refrigerator

Dosage

The below doses may not apply to you personally. If your doctor suggests using elderberry, work with them to find the optimal dosage according to your health condition and other factors.

For flu or cold, 15ml elderberry syrup (Sambucol) four times a day for five days is recommended. Alternatively, take a 175 mg elderberry lozenge four times a day, for two days. Since various formulations exist, it’s best to follow the instructions on the label [27, 86].

For bacterial sinus infections, 2 tablets of a multi-ingredient herbal Sinupret (elderberry flowers, gentian root, verbena, cowslip flower, and sorrel) three times a day, for up to 2 weeks [3, 34].

For lowering blood fats, 400 mg elderberry powder or 5ml elderberry juice (containing 10% anthocyanins) three times a day, for at least 2 weeks [50].

For gum inflammation, 15 ml of a multi-herbal rinse (with elderberry, Centella, and Echinacea) for 60 seconds twice a day for adults and children older than 12 is recommended. For younger children, a 10 ml rinse twice a day is advised [3].

Takeaway

Clinical studies support the traditional use of black elderberry for reducing flu and cold symptoms, other infections, and gum inflammation. It may also protect the heart and skin, but more research is needed.

Standardized extracts and cooked berries are safe for a general population. Children, pregnant and breastfeeding women should avoid them, while others should consult their doctor before supplementing. Stem, bark, leaves, and raw berries can be toxic.

About the Author

Anastasia Naoum

Anastasia Naoum

MS (Health Informatics)
Anastasia holds an MSc in Health Informatics from the Sheffield University, an MSc in Health Economics from the Erasmus University of Rotterdam and a BSc in Economics from the University of Macedonia.
Anastasia grew up in a medical environment, as both her parents are doctors and developed from a young age a passion for medicine and health. She has worked in several institutions and associations which promoted healthy living and sustainable healthcare systems. Currently, she is leading a green life, sailing with her boyfriend across Europe, living in their sailboat with the help of solar and wind power, minimizing CO2 production.

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