Elderberry

• Immune support
• Antiviral activity
• Antioxidant protection

• Respiratory health
• Reduced cold and flu duration
• Anti-inflammatory effects
• Cardiovascular support
• Blood sugar regulation

Elderberry (Sambucus nigra) exerts its biological effects through multiple mechanisms primarily attributed to its rich phytochemical profile, which includes anthocyanins, flavonoids, phenolic acids, proanthocyanidins, and other polyphenols. The antiviral activity of elderberry, which is one of its most well-documented effects, operates through several pathways. Elderberry compounds, particularly flavonoids, can bind to viral envelope proteins, preventing viral attachment and entry into host cells. This has been demonstrated with influenza viruses, where elderberry constituents bind to H1N1 virions, inhibiting their ability to infect cells.

Additionally, elderberry extracts can inhibit viral neuraminidase, an enzyme essential for viral replication and release from infected cells. This dual mechanism of preventing viral entry and inhibiting viral replication makes elderberry particularly effective against respiratory viruses. The immune-modulating properties of elderberry involve both innate and adaptive immune responses. Elderberry enhances cytokine production, particularly of inflammatory cytokines like IL-1β, TNF-α, and IL-6, which are crucial for initial immune responses.

It also activates macrophages and increases phagocytosis, enhancing the body’s ability to clear pathogens. Furthermore, elderberry polyphenols can modulate T-cell and B-cell responses, potentially enhancing antibody production. The potent antioxidant activity of elderberry is primarily due to its high content of anthocyanins and other polyphenols, which can neutralize free radicals and reduce oxidative stress. This antioxidant effect contributes to its anti-inflammatory properties by reducing oxidative damage and modulating inflammatory signaling pathways like NF-κB.

Elderberry also exhibits vascular protective effects by improving endothelial function, reducing lipid peroxidation, and potentially inhibiting platelet aggregation. These cardiovascular benefits are likely mediated through both antioxidant mechanisms and direct effects on vascular signaling pathways. In metabolic regulation, elderberry has shown potential to improve insulin sensitivity and glucose metabolism. Studies suggest that elderberry extracts can stimulate insulin-like and insulin-releasing actions, potentially beneficial for blood sugar regulation.

The anthocyanins in elderberry may also influence lipid metabolism and adipokine production. The anti-inflammatory effects of elderberry extend beyond immune modulation, as its compounds can inhibit pro-inflammatory enzymes like cyclooxygenase-2 (COX-2) and reduce the production of inflammatory mediators. This broad-spectrum anti-inflammatory activity contributes to elderberry’s potential benefits for respiratory conditions, joint health, and overall systemic inflammation. The diverse mechanisms of action of elderberry explain its wide range of traditional uses and potential therapeutic applications, particularly for respiratory infections, immune support, and inflammatory conditions.

The optimal dosage of elderberry varies depending on the form and concentration of the supplement, as well as the intended use. For standardized extracts, 150-300 mg taken 2-4 times daily is commonly recommended. For elderberry syrup, 1-2 tablespoons (15-30 mL) taken 2-4 times daily is typical. Elderberry lozenges typically contain 175 mg of extract per lozenge, with 4 lozenges daily being a common recommendation.

Moderate, with significant variability depending on the preparation method and individual factors. Anthocyanins, the primary active compounds in elderberry, typically have a bioavailability of 1-5% when consumed orally. However, metabolites of these compounds may have higher bioavailability and contribute to the overall effects.

Consuming with a small amount of healthy fat may enhance absorption of fat-soluble components, Liquid extracts and syrups typically have higher bioavailability than capsules or tablets, Standardized extracts with verified anthocyanin content provide more consistent bioavailability, Liposomal formulations can significantly increase bioavailability by protecting compounds from degradation in the digestive tract, Combining with vitamin C may enhance absorption and effectiveness due to synergistic antioxidant effects, Consuming with quercetin-rich foods may enhance bioavailability and effectiveness, Fermented elderberry preparations may increase bioavailability of certain compounds

For immune support and cold/flu prevention, elderberry is best taken consistently at regular intervals throughout the day. For acute conditions like active cold or flu, more frequent dosing (every 2-3 hours in the first 24-48 hours) may be beneficial, followed by regular dosing 3-4 times daily until symptoms resolve. Taking elderberry with meals may improve absorption of some compounds, though it can be taken between meals as well. For travel-related immune support, begin supplementation 10 days before travel and continue until 4-5 days after arrival at the destination.

Evening dosing may be particularly beneficial for the immune system, as many immune functions are enhanced during sleep.

• Gastrointestinal discomfort (rare)
• Mild nausea (rare)
• Diarrhea (rare, usually with excessive consumption)
• Allergic reactions (very rare, more common in individuals with plant allergies)
• Potential diuretic effect (mild)

• Pregnancy and breastfeeding (insufficient safety data, though limited evidence suggests no adverse effects)
• Autoimmune disorders (theoretical concern due to immune-stimulating effects, though clinical evidence is lacking)
• Known allergy to plants in the Caprifoliaceae family
• Unripe or raw elderberries should never be consumed as they contain cyanogenic glycosides that can cause nausea, vomiting, and diarrhea

• Immunosuppressants (theoretical concern due to immune-stimulating effects)
• Diuretics (potential additive effect)
• Diabetes medications (may enhance blood sugar-lowering effects)
• Laxatives (potential additive effect)
• Chemotherapy drugs (theoretical concern, consult oncologist before use)

No established upper limit for properly prepared elderberry products. Clinical studies have used up to 60 mL of elderberry syrup (equivalent to approximately 38% extract) daily for 5-6 days without significant adverse effects. For standardized extracts, up to 1200 mg daily has been used in research without reported adverse effects. However, long-term safety data beyond 12 weeks is limited.

In the United States, elderberry is regulated as a dietary supplement under the Dietary Supplement Health and Education Act (DSHEA) of 1994. It is not approved as a drug for the treatment of any medical condition. Manufacturers cannot make specific disease claims but can make general structure/function claims such as ‘supports immune health’ or ‘supports respiratory function.’ The FDA recognizes elderberry as Generally Recognized as Safe (GRAS) for use in food products.

Eu: In the European Union, elderberry is included in the European Medicines Agency’s (EMA) Community Herbal Monographs as a traditional herbal medicinal product. It can be marketed as a traditional herbal medicine for cold symptoms based on long-standing use. Elderberry is also approved for use in food products and supplements. The European Food Safety Authority (EFSA) has evaluated health claims related to elderberry anthocyanins but has not approved specific health claims due to insufficient evidence.

Canada: In Canada, elderberry is regulated as a Natural Health Product (NHP). Health Canada has approved several elderberry products with claims related to supporting immune function and providing antioxidants. It has been granted several product licenses for use as a traditional medicine to help relieve symptoms of colds and flu.

Australia: In Australia, elderberry is regulated by the Therapeutic Goods Administration (TGA) as a listed complementary medicine. It is included in the Australian Register of Therapeutic Goods (ARTG) for various traditional uses, particularly for immune support and relief of cold and flu symptoms.

Uk: In the United Kingdom, elderberry is regulated similarly to the EU approach, with recognition as a traditional herbal medicinal product for cold symptoms. It is also widely available as a food supplement.

Japan: In Japan, elderberry is regulated as a non-pharmaceutical health food and is not approved for medicinal use, though it is increasingly popular as a functional food ingredient.

China: In China, elderberry is not included in the traditional Chinese medicine pharmacopeia but is increasingly used in health products as an imported ingredient.

Medium

$0.50-$3.00 per day for standardized extracts; $1.00-$4.00 per day for high-quality syrups; $0.30-$1.50 per day for capsules or tablets

Elderberry offers good value for its cost when used for reducing the duration and severity of cold and flu symptoms, where clinical evidence supports its efficacy. A typical course of elderberry for an acute cold or flu (5-7 days) costs approximately $10-$25, which compares favorably to over-the-counter cold and flu medications that may only mask symptoms rather than potentially reducing illness duration. For preventive use during cold and flu season or for travel, the cost increases due to longer-term use, but may still provide value if it successfully prevents or reduces the severity of illness. The cost-effectiveness varies significantly based on the quality and standardization of the product.

Standardized extracts with verified levels of anthocyanins typically cost more but may provide more consistent benefits, potentially offering better value despite the higher price. Liquid formulations (syrups and extracts) tend to be more expensive than capsules or tablets but may offer better bioavailability and faster onset of action, particularly for acute conditions. Homemade elderberry syrup can be significantly more cost-effective (approximately $0.20-$0.50 per dose) for those willing to prepare it, though standardization and shelf life may be concerns. When compared to prescription antiviral medications for influenza (which can cost $50-$100 for a course of treatment), elderberry may offer substantial cost savings, though direct comparative efficacy studies are limited.

For general immune support and antioxidant benefits, less expensive basic preparations may provide adequate value, while for specific therapeutic applications during active illness, investing in higher-quality standardized extracts is likely more cost-effective. Considering the potential reduction in sick days, productivity loss, and additional healthcare costs associated with respiratory infections, elderberry supplementation may offer good overall economic value, particularly for individuals prone to frequent colds or those in high-exposure environments.

Properly stored dried elderberry products typically have a shelf life of 2-3 years. Liquid extracts and syrups generally have a shelf life of 1-2 years when unopened, and 3-6 months after opening if refrigerated. Freeze-dried elderberry powder typically maintains potency for 2-3 years when stored properly.

Store elderberry products in cool, dry places away from direct sunlight and heat. Capsules, tablets, and dried berries should be kept in airtight containers to prevent moisture absorption. Liquid extracts and syrups should be tightly sealed after use and refrigerated after opening to extend shelf life. Freeze-dried powders are particularly sensitive to moisture and should be stored with desiccant packets in airtight containers.

Exposure to light, particularly UV light, can rapidly degrade anthocyanins and other active compounds, Heat accelerates the breakdown of most bioactive compounds, particularly anthocyanins, Oxygen exposure leads to oxidation of polyphenols and other antioxidants, Moisture can promote microbial growth and enzymatic degradation, pH extremes can affect stability of anthocyanins, which are most stable in acidic conditions, Enzymatic activity can degrade active compounds if products are not properly processed, Microbial contamination can occur if stored improperly, particularly in liquid formulations

Synthesis Methods

Natural Sources

Quality Considerations

Elderberry (Sambucus nigra) has a rich history of traditional use spanning thousands of years across multiple cultures. Native Americans used elderberry for infections, coughs, and skin conditions, while European folk medicine employed it as a remedy for colds, flu, and fever. The elder tree itself was often considered sacred or magical in European folklore, believed to ward off evil spirits and bring good fortune. Hippocrates, the ancient Greek physician often called the ‘father of medicine,’ referred to the elder tree as his ‘medicine chest’ due to its diverse therapeutic applications.

In medieval Europe, elderberry was a staple in monastery gardens, where monks cultivated it for medicinal use. The 17th-century physician Martin Blochwich dedicated an entire book to the medicinal uses of elder, titled ‘The Anatomy of the Elder,’ documenting its applications for treating everything from toothaches to plague. Traditional preparations included elderberry wine, syrup, tinctures, and teas made from the flowers, berries, bark, and leaves, though modern usage focuses primarily on the berries due to safety concerns with other plant parts. Historically, elderberry was used not only for respiratory conditions but also for digestive complaints, skin conditions, pain relief, and as a diuretic and laxative.

In traditional European medicine, elderberry was often combined with honey and spices like cinnamon, cloves, and ginger to create medicinal syrups for winter ailments. Native American tribes, including the Cherokee, Iroquois, and Seminole, used elderberry for treating fevers and joint pain, and some tribes considered it an important ceremonial plant. In folk medicine, elderberry was often used as a ‘blood purifier’ and general tonic for overall health. The flowers were used in traditional cosmetic preparations for skin health and to lighten freckles.

During the 1918 influenza pandemic, elderberry preparations were reportedly used as a folk remedy, though formal documentation is limited. The resurgence of interest in elderberry as a medicinal plant began in the late 20th century, particularly after Israeli researcher Dr. Madeleine Mumcuoglu developed Sambucol®, one of the first standardized elderberry extracts, in the 1980s. Today, elderberry continues to be one of the most popular herbal remedies for immune support and respiratory health, with modern research beginning to validate many of its traditional uses.

Hawkins J, Baker C, Cherry L, Dunne E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complement Ther Med. 2019;42:361-365., Vlachojannis JE, Cameron M, Chrubasik S. A systematic review on the sambuci fructus effect and efficacy profiles. Phytother Res. 2010;24(1):1-8.

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