Short answer
Black elderberry (Sambucus nigra) has been studied for colds and flu in several small randomized trials. Some found people recovered faster, such as symptoms relieved about four days earlier in a trial of 60 adults, and one of 312 air travelers had half the cold days. But a trial of 87 emergency-room flu patients found no benefit, and a systematic review rated the overall evidence uncertain. Raw or unripe berries and other plant parts should not be eaten uncooked. [1] [2] [3] [4]
Key takeaways
- Mixed evidence: a 2019 meta-analysis of trials with 180 people reported a large reduction in upper respiratory symptoms, while a 2021 systematic review of five trials concluded any benefit is uncertain. [5] [4]
- The best-known positive trials were small. 60 adults with flu in Norway recovered about four days sooner on syrup, and 312 travelers had fewer cold days. [1] [2]
- A 2020 emergency-room trial of 87 flu patients found no difference in days to recovery between elderberry and placebo. [3]
- Elderberry does not appear to reduce the chance of catching a cold. [4]
- Cook elderberries. Raw berries, unripe fruit, leaves, stems and seeds contain cyanogenic compounds. [6]
Elderberry became a household name during flu seasons, and US sales more than doubled in a single year, to over $100 million. [3] That popularity runs ahead of the evidence, which is more interesting and more mixed than any bottle label suggests.
We use elderberry in our Zapped In blend, so we have read the studies, including the ones that did not find a benefit.
What is elderberry?
Elderberry usually means the dark purple fruit of black elder, Sambucus nigra, a deciduous shrub or small tree in the Adoxaceae family native to Europe and widely grown elsewhere. The flowers (elderflower) are used separately. A review of elderberry's antiviral compounds notes the fruit has been known for thousands of years for nutritional and healing properties. [7] In cell studies, elderberry extracts reduced inflammatory signaling and protected cells from oxidative damage. [8]
What the clinical trials found
Positive trials
In a randomized, double-blind trial in Norway during the 1999 to 2000 flu season, 60 adults aged 18 to 54 with flu symptoms for less than 48 hours took 15 ml of elderberry syrup or placebo four times a day for five days. Symptoms were relieved on average four days earlier and less rescue medication was used in the elderberry group. The authors said it needed confirmation in a larger study. [1]
In a 2016 Australian trial, 312 economy-class passengers travelling overseas took a standardized elderberry extract or placebo. The number of people who caught a cold was not significantly different (12 versus 17, p = 0.4), but placebo participants had more cold days (117 versus 57, p = 0.02) and higher symptom scores. The authors concluded the data suggested shorter and milder colds and called for more research. [2]
A negative trial
A 2020 US trial enrolled 87 people over age four with PCR-confirmed influenza in emergency rooms. Participants took a 15 ml elderberry extract or placebo for five days, and some also took oseltamivir. The average time to mild or no symptoms was 5.3 days on elderberry and 4.9 on placebo (p = 0.57), and time to complete resolution was nearly identical (8.6 versus 8.7 days). The trial was powered to detect a two-day benefit and found no evidence that elderberry shortens or eases influenza. [3]
What the reviews conclude
A 2019 meta-analysis of randomized trials covering 180 participants reported a large mean effect on reducing upper respiratory symptoms. [5] A 2021 systematic review took a more cautious view: it screened 1,187 records and included five randomized trials, and concluded that elderberry may not reduce the risk of getting a cold, may reduce the duration and severity of colds but with uncertain evidence, and may reduce the duration of influenza but with uncertain evidence. It also found that an elderberry-containing product compared with oseltamivir was associated with a lower risk of complications and adverse events, based on one small study. [4]
The immune-system question
During the COVID-19 pandemic, some worried that elderberry might overstimulate the immune system and add to a cytokine storm. The 2021 systematic review found no studies linking elderberry to clinical inflammatory outcomes, but did find three studies measuring cytokine production ex vivo after ingestion, and evidence that elderberry has some effect on inflammatory markers that may decline with ongoing supplementation. [4] This is why people with autoimmune conditions or on immunosuppressants should ask a clinician first.
| Use | Evidence level | What we know |
|---|---|---|
| Shortening influenza | Mixed: two positive trials, one negative | 4 days sooner in 60 adults; no benefit in 87 ER patients. [1] [3] |
| Shortening colds | Small RCT plus review | Fewer cold days in air travelers; review says uncertain. [2] [4] |
| Preventing colds | Little to no support | Cold incidence not significantly different in the travel trial. [2] [4] |
| Reducing inflammation in the body | Lab and ex vivo data | No clinical inflammatory outcomes found. [4] |
| COVID-19 | Review only | A 2022 review says more research is needed, and that the cytokine-storm worry is not yet supported by evidence. [9] |
Elderberry safety: why you must cook it
The one hard safety rule with elderberry is to cook it. Stems, leaves, seeds and green berries of elder plants contain cyanogenic glycosides, compounds that can release hydrogen cyanide. A 2021 analysis of American elderberry found the highest cyanogenic potential in the stems and green berries, low levels in ripe fruit tissues and seeds, and no quantifiable trace in commercial juice, concluding the levels pose no threat in fresh and processed berry products. [6] That is why products use ripe, cooked, processed fruit, and why you should not eat raw elderberries, leaves or stems.
- Raw elderberries and other plant parts: avoid. Heat and ripeness reduce the risk.
- Digestive upset: possible, especially with raw or large amounts.
- Autoimmune disease and immunosuppressants: ask a clinician first. [4]
- Pregnancy and breastfeeding: not enough data. Ask your clinician.
- Children: syrups used in trials were studied in patients as young as 5. Talk to a pediatrician before giving herbs to a child. [3]
How to use elderberry
The trials used standardized syrups or extracts, for example 15 ml (about 5.7 g of extract) four times a day for five days. [3] [1] A simmered tea of dried berries is a different preparation, and we cannot say it matches a trial dose. We simmer elderberry for 30 minutes in our blends, which also cooks the berries, as in our Zapped In directions: bring 2 cups of water to a boil, add 1 heaping tablespoon, reduce to low, cover, simmer 30 minutes, strain and drink warm. See our tea preparation guide for more.
How to buy elderberry well
- Species: Sambucus nigra (black elderberry) on the label.
- Ripe, dried fruit: deep purple-black berries, not green or mixed with stems.
- Standardized extracts for trial-like doses: if you want what the studies used, look for the same type of product and talk to your clinician.
- Honest claims: be wary of anything promising to prevent or cure flu.
Elderberry is one of the four botanicals in Zapped In, alongside guayusa, chuchuhuasi and ginger.
Frequently asked questions
Does elderberry help with colds and flu?
Can elderberry prevent a cold?
Is elderberry safe?
Cooked ripe elderberry products are generally considered safe. Raw berries, green berries, leaves, stems and seeds contain cyanogenic compounds and should not be eaten uncooked. [6]
Who should avoid elderberry?
People with autoimmune conditions or on immunosuppressants should ask a clinician first, and pregnant or breastfeeding people should check as well. [4]
How do you make elderberry tea?
Simmer dried berries in water, which also cooks them. For our Zapped In blend: 2 cups of water to a boil, 1 heaping tablespoon, reduce to low, cover and simmer 30 minutes, strain and drink warm.
How much elderberry should I take?
Does elderberry cause a cytokine storm?
A systematic review found no studies linking elderberry to clinical inflammatory harm, but noted effects on inflammatory markers ex vivo. People with immune conditions should ask a clinician. [4]
Where can I buy elderberry blends in the USA?
Kawsaypac's Zapped In blend includes elderberry with guayusa, chuchuhuasi and ginger, shipped across the USA: view Zapped In.
References
- Zakay-Rones Z, Thom E, Wollan T, et al. (2004). Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. PubMed 15080016 · DOI
- Tiralongo E, Wee SS, Lea RA (2016). Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Nutrients. PubMed 27023596 · DOI
- Macknin M, Wolski K, Negrey J, et al. (2020). Elderberry Extract Outpatient Influenza Treatment for Emergency Room Patients Ages 5 and Above: a Randomized, Double-Blind, Placebo-Controlled Trial. J Gen Intern Med. PubMed 32929634 · DOI
- Wieland LS, Piechotta V, Feinberg T, et al. (2021). Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complement Med Ther. PubMed 33827515 · DOI
- Hawkins J, Baker C, Cherry L, et al. (2019). Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complement Ther Med. PubMed 30670267 · DOI
- Appenteng MK, Krueger R, Johnson MC, et al. (2021). Cyanogenic Glycoside Analysis in American Elderberry. Molecules. PubMed 33806603 · DOI
- Mocanu ML, Amariei S (2022). Elderberries-A Source of Bioactive Compounds with Antiviral Action. Plants (Basel). PubMed 35336621 · DOI
- Ferreira SS, Martins-Gomes C, Nunes FM, et al. (2022). Elderberry (Sambucus nigra L.) extracts promote anti-inflammatory and cellular antioxidant activity. Food Chem X. PubMed 36211754 · DOI
- Asgary S, Pouramini A (2022). The Pros and Cons of Using Elderberry (Sambucus nigra) for Prevention and Treatment of COVID-19. Adv Biomed Res. PubMed 36518861 · DOI