Elderberry

Introduction

Elderberry, or elder, has been used for centuries to treat wounds (when applied to the skin) and for respiratory illnesses (when taken internally). In many countries, including Germany, elder flower is used to treat colds and flu. Some evidence suggests that chemicals in elder flower and berries may help reduce swelling in mucous membranes (such as the sinuses) and help relieve nasal congestion. Elder may have anti-inflammatory, antiviral and anticancer properties.

Elderberry also contains flavonoids, which have antioxidant properties and may help prevent damage to the body’s cells. However, very few studies have been done in humans, so the effectiveness of elder is not known.

There are several species of elder, but Sambucus nigra, or European elder (also called black elder), is the one used most often for medicinal purposes. Avoid dwarf elder (Sambucus ebulus), which can be toxic. It is important to use a trusted preparation of elder because raw or unripe fruit -- as well as the leaves, seeds, and bark -- of the plant contain a chemical related to cyanide, which is poisonous.

Alternative Names

Overview

Plant Description

European elder is a large shrub or small tree that grows up to 30 feet tall in wet or dry soil in a sunny location. It is native to Europe, Africa, and parts of Asia, but has become naturalized in the United States. Deciduous leaves grow in opposite pairs and have five to seven leaflets. Flowers are white and flat-topped with five primary rays. Berries are green, turning red and then black when ripe.

What's It Made Of?

Parts Used

The berries and flowers are used medicinally. Berries must be cooked before they are consumed. Raw berries contain a chemical similar to cyanide.

Medicinal Uses and Indications

Colds and Flu

Elderberry may help reduce the symptoms of colds and flu by reducing congestion and possibly making you sweat more. One study suggested that using a standardized elderberry extract, Sambucol, could shorten the duration of flu by about 3 days. Sambucol also contains other herbs plus vitamin C, so it isn’t known whether elderberry by itself would have the same effect. Another preliminary study found that a lozenge with elderberry extract (ViraBLOC) helped lessen flu symptoms when taken within 24 hours of initial symptoms. In the lab, one study suggested that elderberry could kill the H1N1 virus (“swine flu”) in test tubes, but it is not known whether it would be effective against H1N1 in people.

Bacterial Sinusitis (Sinus Infection)

One study examined the use of a proprietary product, Sinupret, to treat bacterial sinusitis along with an antibiotic (doxycycline or Vibramycin) and a decongestant. People who received the combination had significant improvement compared to those who did not take Sinupret. However, Sinupret contains other herbs in addition to elderberry, so it’s not possible to say whether taking elderberry alone would have the same effect.

Dosage and Administration

Available Forms

Elderberry is available as a liquid, syrup, tincture, capsules, and lozenges. Dried elder flower is usually standardized to at least 0.8% flavonoids. Sambucol is standardized to 38% elderberry extract for adults and 19% for children. Sinupret contains 18 mg of elder flower.

Possible Interactions

If you are being treated with any of the following medications, you should not use elder without first talking to your health care provider:

Diuretics (water pills) -- Diuretics help the body get rid of excess fluid and increase the amount of urine the body produces. Elderberry may also act as a diuretic, so taking it along with a diuretic could increase the effect of the drug and raise your risk of dehydration. Diuretics include:

• Hydrochlorothiazide
• Bumetanide (Burinex)
• Furosemide (Lasix)
• Amiloride (Midamor)
• Metolazone (Zaroxolyn)

Diabetes medications -- Elderberry may lower blood sugar levels. If you are also taking drugs for diabetes, taking elderberry may increase your risk of developing hypoglycemia (low blood sugar).

Chemotherapy -- Elderberry may interact with some chemotherapy drugs. Do not take elderberry or any herb or supplement while undergoing chemotherapy without first talking to your oncologist.

Laxatives -- Elderberry may have laxative properties and should not be taken at the same time as other laxatives.

Theophylline (TheoDur) -- Elderberry may reduce levels of theophylline, a drug taken for asthma and other respiratory conditions.

Immunosuppressants (drugs that suppress the immune system) -- Because elderberry may stimulate the immune system, it could interfere with medications taken to suppress the immune system. These medications include corticosteroids (prednisone) and medications used to treat autoimmune diseases and people with organ transplants.

Interactions and Depletions

Supporting Research

Battelli MG, Citores L, Buonamici L, et al. Toxicity and cytotoxicity of nigrin b, a two-chain ribosome- inactivating protein from Sambucus nigra: comparison with ricin. Arch Toxicol. 1997;71(6):360-364.

Chang WS, Lee YJ, Lu FJ, et al. Inhibitory effects of flavonoids on xanthine oxidase. Anticancer Res. 1993;13:2165-2170.

Ernst E, Marz RW, Sieder C. Acute bronchitis: effectiveness of Sinupret. Comparative study with common expectorants in 3,187 patients. Fortschr Med. 1997;115(11):52-53.

Gray AM, Abdel-Wahab YH, Flatt PR. The traditional plant treatment, Sambucus nigra (elder), exhibits insulin-like and insulin-releasing actions in vitro. J Nutr. 2000;130(1):15-20.

Kong F. Pilot clinical study on a proprietary elderberry extract: efficacy in addressing influenza symptoms. Online Journal of Pharmacology and Pharmacokinetics. 2009;5:32-43.

Kunitz S, Melton RJ, Updyke T, et al. Poisoning from elderberry juice. MMWR. 1984;33(13):173-174.

Middleton E Jr, Kandaswami C. Effects of flavonoids on immune and inflammatory cell functions. Biochem Pharmacol. 1992;43(6):1167-1179.

Neubauer N, März RW. Placebo-controlled, randomized double-blind clinical trial with Sinupret sugar coated tablets on the basis of a therapy with antibiotics and decongestant nasal drops in acute sinusitis. Phytomedicine. 1994;1:177-181.

Newall CA, Anderson LA, Philpson JD. Herbal Medicine: A Guide for Healthcare Professionals. London, UK: The Pharmaceutical Press, 1996.

Roschek B, Fink RC, McMichael MD, et al. Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry. 2009;70:1255-61.

Roxas M, Jurenka J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Altern Med Rev. 2007 Mar;12(1):25-48. Review.

Swanston-Flatt SK, Day C, Flatt PR, et al. Glycaemic effects of traditional European plant treatments for diabetes. Studies in normal and streptozotocin diabetic mice. Diabetes Res. 1989;10(2):69-73.

Ueno K, Wang ZH, Hanamure Y, et al. Reduced sialylation of glycoproteins in nasal glands of patients with chronic sinusitis. Acta Otolaryngol. 1997;117(3):420-423.

Uncini Manganelli RE, Zaccaro L, Tomei PE. Antiviral activity in vitro of Urtica dioica L., Parietaria diffusa M. et K. and Sambucus nigra L. J Ethnopharmacol. 2005 Apr 26;98(3):323-7.

Wright CI, Van-Buren L, Kroner CI, Koning MM. Herbal medicines as diuretics: A review of the scientific evidence. J Ethnopharmacol. 2007 Oct 8;114(1):1-31.

Zakay-Rones Z, Thom E, Wollan T, Wadstein J. 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. 2004;32:132-40.

Zakay-Rones Z, Varsano N, Zlotnik M, et al. 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. J Altern Complement Med. 1995;1:361-9.

How to Take It

Pediatric

Do not give elderberry or any product containing elder to a child without first talking to your pediatrician.

Adult

• Sinupret: 2 tablets taken three times a day for bacterial sinusitis
• Sambucol: 4 tbsp. a day for three days for colds and flu
• Tea: Steep 3 - 5 g dried elder flower in 1 cup boiling water for 10 - 15 minutes. Strain and drink three times per day.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider.

Do not use unripe or uncooked elderberries. They may be poisonous.

Elderberry appears to have few side effects when used properly for short periods of time (up to 5 days).

Pregnant and breast-feeding women should not take elderberry.