Story at-a-glance

• Elderberry supplements reduce upper respiratory and flu-like symptoms and could lessen the ability of viruses to replicate, even after a cell is infected
• Commercial preparations have consistently demonstrated antiviral properties effective against strains of coronavirus, among others
• Much of the antiviral activity may be attributed to the anthocyanidin compounds
• Some are concerned that elderberry increases the risk of a cytokine storm, but Chris Masterjohn, Ph.D., concludes this is not the case

The outbreak of SARS CoV-2 took the world by surprise. While it was only revealed in December 2019, by February 15, 2020, a Nature article recorded more than 80 clinical trials underway to test treatments.1 These ranged from studies involving such things as Traditional Chinese medicine, herbs, stem cells from menstrual blood, and HIV drugs and malaria medications.

The virus can trigger a wide range of symptoms that affect people differently. The acronym SARS stands for Severe Acute Respiratory Syndrome, as it often attacks lung cells.2 Symptoms can appear from two to 14 days after exposure and may include fever or chills, cough, shortness of breath, fatigue and muscle or body aches.3

The virus that triggers COVID-19 is not the same as those that cause the common cold or flu, yet many of the symptoms are similar. An upper respiratory tract infection causes irritation and swelling with cough and it’s one of the most common illnesses in children.4 Symptoms include headache, cough, congestion, fatigue and achy muscles and bones.

Flu is also a respiratory infection that generally affects up to 20% of those living in the United States each year.5 The symptoms are like the common cold, but they usually stick around longer and tend to be worse. Flu can lead to pneumonia, sinus infections and a worsening of other chronic medical conditions, such as asthma and diabetes.

Elderberry May Boost Ability to Combat Viral Infections

What each of these conditions has in common is a viral attack on lung tissue. Of course, each of the viruses use different pathways and cause varying degrees of severity. For instance, the CDC estimates that up to 50% with COVID-19 are asymptomatic, or don’t have any symptoms.6

Elderberries have been used for many years to help treat upper respiratory infections. They are the fruit of the sambucus tree, the most important of which is sambucus nigra.7 The plant is also called the black elderberry and European elder with documented origins dating back to 2000 BC in Switzerland.8

Hippocrates was among the first physicians known to use elderberries.9 Currently, the fruit is available in various supplement forms such as gummies, syrups, pills and lozenges.10

In one study, researchers found that elderberries directly inhibited the ability of flu viruses to enter cells and replicate.11 The same results have been found in past studies, but in this one scientists examined the exact mechanism using commercially cultivated elderberry.

Researchers from the University of Sydney were surprised to find that elderberry juice effectively inhibited replication of flu viruses after the cells had been infected.12 This is significant, since blocking the virus at different stages increases the potential for an intervention to help prevent infection.

Anthocyanidin compounds, which are phytonutrients responsible for the fruit’s intense color, were credited with reducing viral activity. The results of this study supported past research in which adults suffering flu-like symptoms took elderberry syrup and experienced an average four-day faster recovery.13

Elderberry Is a Powerful Antiviral

Research on treatments for COVID-19 were started using those interventions previously used with SARS, MERS and/or influenza. In a recent paper, scholars called for the testing of elderberry supplements against COVID-19 as it has been “effective in cold and influenza by randomized, double-blind, placebo-controlled study and meta-analysis.”14

The authors of this paper believe the use of products made from the fruit should be carefully guided, as “Elderberry supplements can be used in those with COVID-19 at an early course of disease, if you understand the previous efficacy of these and potential adverse effects.”15

In one investigation, researchers studied people traveling in airplanes as a test of the effectiveness that elderberries may have in infection rates and severity of the common cold.16 The clinical trial involved 312 economy-class travelers embarking on an international flight from Australia.

Data were collected on cold episodes, duration and symptoms. There was no statistically significant difference in infection rate between individuals taking elderberry syrup and those who didn't. However, participants who did not take elderberry had a significantly longer duration of cold days and severity of symptoms.

In a study published in late November 2019, researchers showed that elderberry syrup was effective against a strain of human coronavirus. They said, “Human coronavirus NL63 (HCoV-NL63), one of the main circulating HCoVs worldwide, causes respiratory tract illnesses like runny nose, cough, bronchiolitis and pneumonia.”17

Although not identical to COVID-19, the virus is a member of the same coronavirus family. In this study the researchers found that an ethanol extract of Sambucus Formosana Nakai had strong potential against HCoV-NL63.

In a separate study using sambucus nigra against infectious bronchitis virus, a pathogenic chicken coronavirus, a research team discovered that in cell culture, the extract can inhibit the virus at the point of infection.18

Dr. Irina Todorov, integrative medicine physician, was quoted in the Cleveland Clinic Health Essentials talking about elderberry syrup. She said:19

"If you have acid reflux, you drink chamomile tea. If you have abdominal bloating, you drink ginger or peppermint tea. One approach is to use specific products that have been studied in clinical research with positive effect.

Although some studies indicate that elderberry extract may relieve cold and flu symptoms, more research on a large scale is needed to support these findings. Meanwhile, I will continue to enjoy herbal tea made from elderflower and jam from elderberry as part of my diet.”

A meta-analysis was conducted in 2018 to examine the effects of elderberry supplementation in individuals with upper respiratory symptoms; the study team considered vaccination status in their evaluation.20 Supplementation significantly reduced participants’ upper respiratory symptoms, with the authors noting that their findings:21

“… present an alternative to antibiotic misuse for upper respiratory symptoms due to viral infections, and a potentially safer alternative to prescription drugs for routine cases of the common cold and influenza.”

Elderberry Promotes a Balanced Immune System

One concern expressed by some experts is that elderberries could promote a cytokine storm. Cytokines are protein molecules produced by the body during an immune response. In some with COVID-19, this response is as destructive as the viral infection.

It's sometimes described as a runaway reaction triggered by a feedback loop that ultimately can result in death. Blocking the hyperinflammatory immune response is one pathway researchers are investigating to reduce the damage done by the body's reaction to the virus.22

The impact of a cytokine storm on individuals who are suffering from viral infection is a significant reason for COVID-19 deaths. The question of cytokine storms related to botanical nutraceuticals was first raised in 2009 during the H5N1 flu pandemic.23

However, it has become apparent that there is an incomplete understanding of cytokine behavior. Paul Bergner, director of the North American Institute of Medical Herbalism, commented to a New Hope Network reporter that:24

“In the lab dish, both echinacea and sambucus (elderberry) have been shown to stimulate immune-regulatory cytokines, making the inflammatory response more moderate, as well as inflammatory ones—with a net noninflammatory effect.”

Chris Masterjohn, Ph.D. believes he found the source of the first claim that elderberry could increase the risk of a cytokine storm. He traced it to a blog that is run by a retired U.S. Army intelligence officer, whose post was distributed through the internet through Reddit.25

Masterjohn writes that in 2009, there was one randomized, placebo-controlled trial in which researchers tested the concept in humans who took 500 mg of elderberry extract every day for 12 weeks.26 In this study, the participants showed no difference in their inflammatory markers.

This suggests that elderberries do not raise levels of inflammatory cytokines or contribute to a cytokine storm with flu or COVID-19. However, the participants were healthy and without infection, so Masterjohn dove deeper into other lab and animal experiments.

He reported that cytokine storms also happen to individuals with a severe case of flu. However, in two randomized control trials in people with flu who were using elderberry, cytokine storms did not occur. After a methodical review of the published literature, Masterjohn concluded:27

“Elderberry has a good chance at providing the antiviral defense, with at best a very, very weak case it could contribute to a cytokine storm. In fact, the evidence suggests that if the cell studies have any relevance, elderberry would have an anti-inflammatory effect in the macrophages of the lung that could perhaps blunt a cytokine storm. So, the verdict: not guilty. And quite possibly a hero to be discovered.”

Nutrient Power in Elderberries

One of the reasons elderberries may have so many health benefits is that they are packed with nutrients. Fresh elderberries have about 36 mg of vitamin C for every 100 grams of fruit.28 Although oranges have about 15 grams more per 96 gram serving, the little purple power-packed fruit has less sugar.29,30

Elderberries also have 12% of the recommended daily value of vitamin A and 11% of vitamin B6. They are a good source of flavanols, including quercetin,31 which is known to have zinc ionophore activity.32 Another of the biologically active components of elderberries is phenolic acid.33 These are known to have anticarcinogenic and antimutagenic qualities.34

Anthocyanins are antioxidants that give the fruit its characteristic purple color and have strong anti-inflammatory effects.35 Based on human and animal studies, researchers have found that anthocyanins induce anti-inflammatory effects and have anticarcinogenic activity.36 Antioxidants, including those found in elderberries, can help prevent chronic disease.37

Some Precautions With Fresh Elderberries

Elderberry extract has shown promising potential benefits, which you can read more about in “Elderberry Confirmed as Immunity Booster.” However, it's wise to take heed that the bark, seeds and unripe berries contain small amounts of lectin.38 As I’ve written about before, lectins have been linked to autoimmune reactions and inflammation.

Additionally, in some instances the elderberry plants can release cyanide.39 Symptoms of eating uncooked berries, leaves and roots are nausea, vomiting and diarrhea.40

Cooked berries and commercial elderberry syrup and supplements do not contain harmful substances. However, there is not enough data to establish safety for women who are pregnant or breastfeeding. Safety for pregnant women and nursing mothers has not been established. It is always important to speak with your practitioner before taking any medication while pregnant or breastfeeding.