What is Elderberry?

Elderberry is a dark purple berry that grows on the European or black elder tree, also known as the Sambucus nigra plant. It is a rich source of antioxidants known as anthocyanins and is often used to support the immune system.

The ripe berry is tart and typically sweetened, similar to cranberries. One cup of elderberries provides 106 calories, 27 grams (g) of carbohydrates, 10 g of fiber, 52 milligrams (mg) of vitamin C, 2.3 mg of iron, and 406 mg of potassium.

Elderberry is not the same as American Elder, Elderflower, or Dwarf Elder, and these will not provide the same intended benefit as elderberry.

Elderberry is often touted for use against viral infections such as the common cold or the flu. It is marketed for several other conditions as well, but research is lacking.

This article will review the potential uses of elderberry, how to safely use it, and possible concerns with using elderberry.

Elderberry Benefits

Most proposed uses of elderberry have not been supported by research.

However, evidence does show that elderberry:

• May relieve symptoms of the flu or other respiratory infections
• Contains many nutrients, such as fiber, vitamin C, iron, and potassium
• Is an excellent source of antioxidants, which may promote health by reducing cell damage caused by free radicals

Uses of Elderberry

Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian, pharmacist, or healthcare provider. No supplement is intended to treat, cure, or prevent disease.

Reduce Symptoms of Common Colds or Flu

Elderberry juice syrup has been used for centuries as a home remedy for viral illnesses like the common cold and flu. Some research has suggested that the syrup shortens the duration of some illnesses and makes them less severe; however, study findings have varied.

The following are some of the findings from elderberry research:

• A systematic review from 2021 found that elderberry may be a safe option for reducing the severity and duration of respiratory infections like the common cold and flu. However, the researchers noted that further research is still needed.
• A 2020 study did not find black elderberry to improve symptoms or reduce the amount of time of illness. Some participants also took Tamiflu (oseltamivir), a common antiviral treatment. People who did not take Tamiflu but took black elderberry had a longer illness duration. Adults were given 3 teaspoons four times daily, and children were given 3 teaspoons twice daily.
• In a 2019 study on elderberry for cold and flu, elderberry appeared to reduce the duration of upper airway symptoms caused by the flu when taken at the onset of symptoms.
• A 2016 study on airline passengers suggested using elderberry extract for 10 days before and five days after a flight led to milder symptoms and 50% fewer sick days from cold illnesses. However, although it appeared to lower the duration and severity of the illness, it did not prevent infection. The elderberry group and placebo group had a similar infection rate.
• A 2004 study found symptom improvement four days sooner in those who were given 3 teaspoons of black elderberry four times daily.

When evaluating the limited research available to date, it is important to keep in mind that:

• Most of the trials done have been funded by the company that makes the supplement, possibly leading to bias in the results.
• There is no defined, standard dose of elderberry, so the amounts given differ among studies.
• The most tested product in research (Sambucol) is now sold in different formulations that are not consistent with the original form that was studied.

Elderberry is also promoted for treating high cholesterol, relieving pain, having anti-inflammatory properties, and more. However, there is not enough evidence to support these claims. Additionally, dietary supplements should not be used to treat a condition or disease.

What Are the Side Effects of Elderberry?

Ripe, cooked elderberry fruit is considered safe to eat in moderation. As with several other fruits, eating a lot of elderberry fruit can cause:

• Diarrhea
• Stomachache
• Abdominal cramping

Elderberries should always be cooked and processed before they’re consumed. Other parts of the plant should be avoided as they contain a naturally occurring chemical compound called cyanogenic glycoside, which releases the poison hydrogen cyanide. These include the:

• Leaves
• Roots
• Bark
• Stems

Unripened, raw elderberries can release cyanide into your body and make you sick. Even ripe berries can contain trace amounts, so elderberries must be cooked before you eat them.

Precautions

Elderberry use is considered safe for up to 12 weeks. However, some groups of people should avoid elderberry.

• There is no data evaluating elderberry safety in people who are pregnant or breastfeeding.
• There is no safety data on the use of elderberry in children under 5 years of age.
• People with certain autoimmune diseases should avoid elderberry. Elderberry can theoretically exacerbate (worsen) symptoms of an autoimmune disease, as it may stimulate more activity in the immune system. Consult with your healthcare provider before taking elderberry.
  

Dosage: How Much Elderberry Should I Take?

There is no standard recommendation for dosing elderberry.

In some clinical trials, adults took 3 teaspoons (1 tablespoon) of elderberry extract in syrup form four times daily for five days. Since there is no standard dosage, however, consult your healthcare provider or pharmacist and read the dosage directions on the product label before taking it.

There are no standard recommended amounts for elderberry in gummies, tablets, or teas.

What Happens If I Take Too Much Elderberry?

Elderberry extract appears to be safe when taken in small doses. Taking amounts greater than recommended could be more likely to result in undesirable side effects.

Elderberries should always be cooked and processed before they’re consumed. Unripened, raw elderberries can release toxins into your body. Even ripe berries can contain trace amounts of cyanide, so you must cook elderberries before consumption.

Poisoning from elderberries is rarely life-threatening. But it may cause:

• Nausea
• Vomiting
• Abdominal cramps
• Weakness
• Dizziness

Get medical attention if you develop these symptoms after consuming elderberry.

Interactions

Elderberry may reduce the effectiveness of immune suppressants, which are common medications for people who have undergone organ transplant procedures. Immunosuppressants are also used for other conditions. Common ones include:

• CellCept (mycophenolate)
• Corticosteroid drugs like prednisone
• Enbrel (etanercept)
• Humira (adalimumab)
• Imuran (azathioprine)
• Methotrexate
• OKT3 (muromonab-CD3)
• Prograf (tacrolimus)
• Rapamune (sirolimus)
• Sandimmune (cyclosporine)
• Simulect (basiliximab)
• Zinbryta (daclizumab)

How to Store Elderberry

Keep elderberry in a cool, dry place. Supplements should always be stored out of reach of children and pets to prevent accidental consumption. Keep your supplements stored according to the instructions on the product label.

Fresh elderberries may last longer when refrigerated.

Sources of Elderberry & What to Look For

Elderberries have long been cultivated for food and to make natural medicines. Products are available in many forms, including:

• Syrups
• Teas
• Capsules
• Gummies
• Tonics
• Tinctures
• Topical ointments

In addition to the various forms, elderberry is available as a single supplement or in combination with other nutrients. For example, several forms are marketed for immune support that also contain vitamin C, zinc, vitamin A, or vitamin E.

One study evaluating elderberry products on the market found that many did not contain elderberry. Instead, they contained elderflower or were mixed with other ingredients, such as black rice extract or purple carrot extract.

Dietary supplements are not regulated like conventional food products or drugs in the United States. Look for products that have undergone third-party testing to confirm that the contents match what's on the label.

In 2021, the USP held a forum to discuss the need for standards in developing elderberry products. Once standards are available, supplement companies can be held accountable for the quality of the products they sell.

Food Sources of Elderberry

You can buy dried berries online and in health food stores.

If you want fresh berries, be sure you buy them from a reputable source. It’s never safe to eat unknown berries in nature, as they may have dangerous effects. If you have eaten an unknown berry and develop concerning symptoms, get immediate medical attention.

Summary

Elderberry is marketed mostly for immune support. Some research suggests it reduces the severity and duration of symptoms associated with the flu or common cold. However, it does not prevent infections or illnesses.

There is limited data on the uses of elderberry other than viral infection symptom management.

Unripe or unprocessed berries, as well as other parts of the plant, should not be consumed as they can be poisonous. However, elderberry extract in supplement form is generally safe to take in small doses.

If you are considering using elderberry, talk to your healthcare provider or pharmacist about whether it is an appropriate supplement for you. Since there is no recommended dosage, follow the instructions on the product label or ask your provider how much you should use.