The Health Benefits of Elderberry

This age-old cold and flu remedy may also have other benefits


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Elderberries are the dark purple fruit of the elderberry shrub. A rich source of antioxidants known as anthocyanins, elderberry is reputed by some to be effective in treating the common cold, flu, constipation, hay fever, and sinus infections. Others contend that it may be useful in treating toothache, sciatica, and burns, among other things, but some of these claims are better supported by research than others.

The European elder (black elderberry, Sambucus nigra) is the species most often used in supplements, although other elder species also produce anthocyanin-rich berries. There are several elderberry supplement options and preparations, such as gummies, lozenges, syrups, teas, and more.

Health Benefits

Many of elderberry's health benefits can be attributed to anthocyanin. As an antioxidant, anthocyanin works by clearing the body of free radicals that damage cells at the DNA level. It also has antiviral properties that may prevent or reduce the severity of certain common infections.

Elderberry also exerts anti-inflammatory effects, reducing swelling and pain by tempering the body's immune response.

Colds and Flu

Elderberry juice syrup has been used for centuries as a home remedy to treat the cold and flu, both of which are caused by a virus. The syrup is believed to reduce the severity and duration of the infection if taken within 48 hours of the first symptoms. There is some clinical evidence to support this claim.

A 2016 study from Australia reported that, among 312 long-haul airline passengers, those who used elderberry extract 10 days before and five days after their flight had 50 percent fewer sick days resulting from a cold than those who didn't. In addition, passengers who used elderberry had less severe colds based on a scoring of upper respiratory tract symptoms.

What elderberry did not appear to do was reduce the risk of getting a cold; both the elderberry group and placebo group had more or less the same number of infections.

Similarly, in a 2011 study published in BMC Complementary and Alternative Medicine, researchers found that people with the flu who used elderberry syrup for five days (15 ml, four times daily) saw their symptoms resolve four days earlier than those given a placebo. As with a cold, there was no suggestion that elderberry could actually prevent the flu from happening.


Drinking tea made from dried elderberry may aid in the treatment of constipation. This laxative effect is attributed to a compound in elderberry known as anthraquinone. Also found in rhubarb and senna, anthraquinone inhibits the absorption of water in the intestines. This increases the intestinal pressure, stimulating muscles contractions (peristalsis) to promote clearance of the bowel.

Although there is little medical literature related to elderberry's laxative properties, it is generally accepted that the effects are mild and safe when used to treat occasional, uncomplicated constipation.

Pain Relief

Anthocyanins are known to reduced inflammation. Those in elderberry do so by inhibiting the production of nitrous oxide by the body's immune cells. Nitrous oxide serves as a signaling molecule that triggers inflammation in response to injury or disease. By tempering this response, pain and swelling may be relieved.

Topical elderberry tinctures and salves have long been used in folk medicine to treat dental pain, cuts, bruises, and burns. There are even some who claim that elderberry syrup can treat sciatica and other forms of neuropathic pain.

Unfortunately, there have been few studies investigating elderberry's anti-inflammatory or analgesic (pain-relieving) benefits in humans.

Disease Prevention

Alternative practitioners have long touted elderberry's antioxidant effects, asserting that they can reduce the risk of cancer and heart disease. While it is true that antioxidant-rich diets may offer such benefit, there is nothing to suggest that elderberries play an exceptional role.

A 2009 study in the Journal of Nutrition concluded that a 12-week course of elderberry extract (500 milligrams daily) did nothing to alter the risk or cardiovascular disease in 52 postmenopausal women.

Possible Side Effects

Ripe elderberry fruit is considered safe if consumed in moderation. The overconsumption of elderberries may cause diarrhea, stomach ache, and abdominal cramping due to their laxative effects. If elderberry is used for medicine, only ripe or dried berries should be used.

Certain parts of the elderberry plant (including the leaves, root, bark, and stems) contain a type of poison known as cyanogenic glycoside. Even unripe berries contain trace amounts of this, which, if chewed, can release cyanide into the body.

Poisoning from elderberries is rarely life-threatening but may cause nausea, vomiting, diarrhea, dizziness, numbness, abdominal distention, and difficulty breathing. Call your doctor if you experience any of these symptoms after consuming an elderberry extract or unripe fruit.

Elderberry is not recommended for children, pregnant women, or nursing mothers. While no adverse events have been reported in these groups, there is not enough data to confirm that it is safe over the long term.

Drug Interactions

Elderberry extracts may interact with drugs designed to suppress the immune system, undermining their efficacy. These include:

  • CellCept (mycophenolate)
  • Corticosteroid drugs like prednisone
  • Imuran (azathioprine)
  • OKT3 (muromonab-CD3)
  • Prograf (tacrolimus)
  • Rapamune (sirolimus)
  • Sandimmune (cyclosporine)
  • Simulect (basiliximab)
  • Zenapax (daclizumab)

Due to their effect on the immune system, the prolonged use of elderberry medications should be avoided in people with autoimmune disorders without guidance from a doctor.

Dosage and Preparation

Elderberries have long been cultivated for food and to make natural medicines. The latter are available in many forms, including syrups, teas, capsules, gummies, tonics, tinctures, and topical ointments. The ripe berry is tart and typically sweetened (like cranberries).

Treatment should start no later than 48 hours of the first appearance of symptoms. However, there are no universal recommendations as to the appropriate dosage to treat specific medical conditions.

As a general rule, an elderberry product manufacturer's recommended dosage should not be exceeded. Many commercial syrup manufacturers recommend 1 tablespoon (15 ml) of elderberry syrup taken four times daily to treat cold or flu symptoms. Elderberry lozenges (175 mg) can be taken twice daily.

Keep in mind that elderberry should never be used as a substitute for standard care. Self-treating a condition and delaying the standard care of treatment may have serious consequences.

What to Look For

Elderberry-based medications are classified as dietary supplements by the U.S. Food and Drug Administration (FDA). Under this classification, they are not meant to be sold or marketed as a treatment for any medical condition. Because supplements are not required to undergo rigorous research or testing, they can vary significantly in quality.

To ensure quality and safety, only buy supplements that have certified by an independent certifying body, such as the U.S. Pharmacopeia (USP), NSF International, or ConsumerLab.

Other Questions

How do you make elderberry syrup?

Elderberry syrup can be made with dried elderberries, available for purchase online and in specialty health food stores. To make the syrup:

  1. Combined 100 grams of dried elderberries with 2 quarts of distilled water and 1½ cups of honey or brown rice syrup in a heavy saucepan.
  2. Allow the berries to soak for one hour.
  3. Bring the saucepan to a simmer and cook uncovered for 35 to 45 minutes, stirring regularly.
  4. Remove from the heat and strain into a large measuring cup. There should be 2 cups of raw extract. If there is less, swirl in enough distilled water to make 2 cups.
  5. Pour the extract back into a fresh saucepan along with another 1½ cups of honey or brown rice syrup.
  6. Simmer on a medium-high heat for 10 to 30 minutes until thick.
  7. Allow the syrup to cool, then pour it into a sterilized container.
  8. Seal and store in the refrigerator for up to three months.

How should I store fresh elderberries?

Elderberries are best stored in the refrigerator if not consumed immediately.

Disclaimer: It is important that when consuming fresh berries, you purchase these from a reputable source. It is never safe to consume unknown berries in nature, as you don't know the potentially dangerous effects of a wild fruit. If you have consumed an unknown berry and are experiencing adverse side effects, be sure to contact a healthcare professional immediately.

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