By Nnenna Udensi, MD
This review covers the recent literature regarding the effectiveness and safety of elderberry products in medicine. Its purpose is to discuss and update the findings in previous literature reviews like Ulbricht1Ulbricht C, Basch E, Cheung L, et al. An Evidence-Based Systematic Review of Elderberry and Elderflower (Sambucus nigra) by the Natural Standard Research Collaboration. Journal of Dietary Supplements. 2014;11(1):80-120. doi:10.3109/19390211.2013.859852. and Porter18Porter RS, Bode RF. A Review of the Antiviral Properties of Black Elder (Sambucus nigraL.) Products. Phytotherapy Research. 2017;31(4):533-554. doi:10.1002/ptr.5782. . The majority of the studies referenced will be from 2013-2018, although, older studies may be included as well for completeness. Publications not referenced directly in this article will still be incorporated in appendix charts and will contain the disease, lab results, and animal studies not addressed in this review. Including this information may hopefully serve to further the conversation surrounding elderberry use in medicine.
My review of elderberry studies since 2013, conducted using various databases (including Pubmed.org, herbmed.org, herbalgram.org) yielded 13 new studies on safety and effectiveness in humans, ten recent animal studies, and over 60 studies involving laboratory, chemical, and genetic studies of elderberry. This article will only address those studies related to our inquiry, a fraction of the available data, but the complete list of studies will be made available Appendix A. I refer to some studies older than 2013 in the article, but the charts will only include publications from 2013-2018 since earlier studies are referenced in other reviews.1Ulbricht C, Basch E, Cheung L, et al. An Evidence-Based Systematic Review of Elderberry and Elderflower (Sambucus nigra) by the Natural Standard Research Collaboration. Journal of Dietary Supplements. 2014;11(1):80-120. doi:10.3109/19390211.2013.859852. 18Porter RS, Bode RF. A Review of the Antiviral Properties of Black Elder (Sambucus nigraL.) Products. Phytotherapy Research. 2017;31(4):533-554. doi:10.1002/ptr.5782. I did not have access to the full texts of all the publications, so in those cases, I cited the abstract alone.
This article will focus on ten common ailments that the previous reviews1Ulbricht C, Basch E, Cheung L, et al. An Evidence-Based Systematic Review of Elderberry and Elderflower (Sambucus nigra) by the Natural Standard Research Collaboration. Journal of Dietary Supplements. 2014;11(1):80-120. doi:10.3109/19390211.2013.859852. 18Porter RS, Bode RF. A Review of the Antiviral Properties of Black Elder (Sambucus nigraL.) Products. Phytotherapy Research. 2017;31(4):533-554. doi:10.1002/ptr.5782. and studies suggest elderberry may affect. Although there are additional potential benefits that have been or are currently under investigation, the ones listed here are more likely to apply to the daily lives of average people. Elderberry has several useful medical applications, and the goal of this article is to present those medical uses and the evidence supporting them to you the reader.
What is Elderberry?
Sambucus nigra, more commonly known as elderberry, is a flowering plant found in subtropical regions worldwide. It produces large clusters of dark-colored berries. People consume the fruit and its products for a variety of reasons including dietary supplementation, remedies for various ailments, and regular consumption as food. Ripe, cooked elderberries are edible; however, raw fruit and other parts of the plant can be toxic in sufficient quantities.23Tejero J, Jiménez P, Quinto E, et al. Elderberries: A Source of Ribosome-Inactivating Proteins with Lectin Activity. Molecules. 2015;20(2):2364-2387. doi:10.3390/molecules20022364
While similar to other berries, in everyday use elderberry is unique in that it has a wealth of potential health and medical benefits and applications not often associated with different types of berries. Some of the benefits ascribed to elderberries include:
|Reduction in cold symptoms||Diuretic effect for urination|
|Bacterial sinusitis/ bronchitis||Hyperlipidemia|
|Anti-inflammatory and anti-microbial effect||Overall wellbeing|
The purported health benefits of elderberry have varying degrees of anecdotal, scientific, and clinical trial support. The purpose of my research effort was to review all scientific studies published between January 2013 and July 2018 that sought to investigate different medical aspects of elderberry. After reviewing each study, I found that some of the evidence shows clear health benefits, while other data is mixed. So, this article will discuss the merits of these and other claims about the effectiveness of elderberry as medicine. For simplicity’s sake, a rating system cited by Ulbricht1Ulbricht C, Basch E, Cheung L, et al. An Evidence-Based Systematic Review of Elderberry and Elderflower (Sambucus nigra) by the Natural Standard Research Collaboration. Journal of Dietary Supplements. 2014;11(1):80-120. doi:10.3109/19390211.2013.859852. will be used to describe elder’s effect for each disease.
Reduction in Cold Symptoms
Flu symptoms relief is one of the more well-studied benefits of elderberry, and there is a lot of useful data to support it. The antiviral properties are well documented. One study2Zakay-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. Journal found that elderberry extract reduced the duration of symptoms (aches, pain, cough, congestion, sleep and mucus discharge) by about half, 3-4 days down from 7-8 days.
A similar study3Zakay-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 observed the effects of elderberry in the first 48 hours of confirmed influenza infection. It also showed marked improvement in shorter periods of time.
These and other studies4Guo R, Pittler MH, Ernst E. Complementary Medicine for Treating or Preventing Influenza or Influenza-like Illness. The American Journal of Medicine. 2007;120(11). doi:10.1016/j.amjmed.2007.06.031. suggest that if taken early in the infection, elderberry extract can safely be used to reduce the time and severity of flu symptoms.
Since 2013 four studies, including one clinical trial and three laboratory studies, were conducted and the results confirm these and Ulbricht1Ulbricht C, Basch E, Cheung L, et al. An Evidence-Based Systematic Review of Elderberry and Elderflower (Sambucus nigra) by the Natural Standard Research Collaboration. Journal of Dietary Supplements. 2014;11(1):80-120. doi:10.3109/19390211.2013.859852. findings.
Bacterial Sinusitis/ Bronchitis
Sinusitis is characterized by inflammation of the tissue that lines the sinus cavity. Likewise, bronchitis is characterized by inflammation of the bronchial lining in the lungs. The causes of the inflammation can include viruses, bacteria, and allergens among other things.
The symptoms often include pain, fever, drainage, cough, and fatigue. When tested8Krawitz C, Mraheil MA, Stein M, et al. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complementary against bacteria that commonly cause these conditions, elderberry was shown to have antimicrobial properties.
There were six studies during the five and half year review period and the results of these studies support the findings from previous reviews that show elderberries’ effectiveness against respiratory bacteria and viruses.
Allergic rhinitis is characterized by nasal congestion or drainage, sneezing, and itching of the nose, ears, or eyes. The causes include various allergens such as pollens, animal dander, dust, etc.
There’s very little new scientific support for this claim during the 2013 – 2018 period. While studies11Sayin I, Cingi C, Oghan F, Baykal B, Ulusoy S. Complementary Therapies in Allergic Rhinitis. ISRN Allergy. 2013;2013:1-9. doi:10.1155/2013/938751. show that elder appears in alternative treatments for allergic rhinitis, there are currently no studies that focus on the treatment of allergies with elderberry. Since the 2013 observational study falls within the review period, I felt it appropriate to address the claim.
Gingivitis is mild gum disease characterized by irritation, redness, and swelling of the gum around the base of teeth. Left untreated, it can lead to more severe disease.
Studies13Levine WZ, Samuels N, Sheshet MEB, Grbic JT. A Novel Treatment of Gingival Recession using a Botanical Topical Gingival Patch and Mouthrinse. The Journal of Contemporary Dental Practice. 2013;14:948-953. doi:10.5005/jp-journals-10024-1431. 14Harokopakis E, Albzreh MH, Haase EM, Scannapieco FA, Hajishengallis G. Inhibition of Proinflammatory Activities of Major Periodontal Pathogens by Aqueous Extracts From Elder Flower (Sambucus nigra). Journal of Periodontology. 2006;77(2):271-279. examining the anti-inflammatory effects of elder reveal useful anti-inflammatory properties. One paper suggests that these properties of elderberry are helpful for conditions like gingivitis that have inflammation as their cause and that elderberry is excellent for overall oral health. In fact, mouthwash containing an elderberry preparation is currently in clinical trials.22Evaluation and Comparison of Efficacy of PeriActive Mouthwash to Chlorhexidine 0.12% Mouth Rinse. Full Text View - ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02987634?term=Sambucus nigra&rank=3. Accessed August 6, 2018.
Hyperlipidemia refers to excess fat in the blood. There is some evidence15Dubey P, Jayasooriya AP, Cheema SK. Fish oil induced hyperlipidemia and oxidative stress in BioF1B hamsters is attenuated by elderberry extract. Applied Physiology, Nutrition, and Metabolism. 2012;37(3):472-479. doi:10.1139/h2012-030. from animal studies conducted during the review period that elderberry extract can reverse hyperlipidemia, but the research is limited in scope, and there is no evidence so far of this effect in humans. One study16Vauzour D, Tejera N, Oneill C, et al. Anthocyanins do not influence long-chain n-3 fatty acid status: studies in cells, rodents and humans. The Journal of Nutritional Biochemistry. 2015;26(3):211-218. doi:10.1016/j.jnutbio.2014.09.005. done on human cells saw no effect at all.
Obesity, generally regarded as excessive energy storage caused by increased calorie intake, has inspired new questions about its causes and effects. Research is starting to take a harder look at how things like inflammation affect obesity and chronic diseases associated with it.
Elderberry extract and similar fruits have been shown to be effective at reducing inflammation in several studies20Chrubasik C, Maier T, Dawid C, et al. An observational study and quantification of the actives in a supplement withSambucus nigraandAsparagus officinalisused for weight reduction. Phytotherapy Research. 2008;22(7):913-918. doi:10.1002/ptr.2415. conducted from 2013 to 2018. So, given the links between obesity and inflammation; and inflammation and elderberry, one study sought to examine potential connections between elderberry and obesity directly. The conclusions17Lee Y-M, Yoon Y, Yoon H, Park H-M, Song S, Yeum K-J. Dietary Anthocyanins against Obesity and Inflammation. Nutrients. 2017;9(10):1089. doi:10.3390/nu9101089. drawn by the scientists were limited, but they noted the fact that elderberry seemed to attenuate obesity driven inflammation.
So even if elderberry doesn’t directly cause weight reduction, if it reduces potential side effects of obesity it could be invaluable in a health maintenance capacity.
Inflammation is one of the body’s defense mechanisms. The inflammatory process combats irritants and pathogens while allowing the body to begin healing.
However, when inflammation is chronic, it can go from being part of the solution to being the problem. Conditions like COPD, arthritis, Crohn’s disease, and obesity all have inflammation at the core of the disease process.
While there is no evidence supporting elderberry treatment in some of these more serious diseases, there are seven studies in the last five years that look at several less complicated conditions, some discussed in this paper, that have inflammatory disease processes that maybe benefit from elderberry therapies and its reductive effect on inflammation.17Lee Y-M, Yoon Y, Yoon H, Park H-M, Song S, Yeum K-J. Dietary Anthocyanins against Obesity and Inflammation. Nutrients. 2017;9(10):1089. doi:10.3390/nu9101089.
The overall consensus of these studies is that elderberry can reduce inflammation. Future studies will likely address questions about whether this effect is enough to change the course of chronic inflammatory diseases. As of now, it is still unclear.
Loosely defined, constipation is infrequent or difficult bowel movements. Causes include other disease, medications, or various factors such as lifestyle or diet.
Fortunately, in addition to the range of conventional medical therapies to treat constipation, there is evidence7PD, Picon RV, Costa AF, et al. Randomized clinical trial of a phytotherapic compound containing Pimpinella anisum, Foeniculum vulgare, Sambucus nigra, and Cassia augustifolia for chronic constipation. BMC Complementary and that elderberry is useful as a laxative. When served as a tea, a study showed a significant decrease in constipation symptoms.
As is common with other laxatives, one of the side effects noted in the study is cramping. However, when combined with other herbs such as fennel, the study suggested that cramping caused by elderberry can be reduced or eliminated.7PD, Picon RV, Costa AF, et al. Randomized clinical trial of a phytotherapic compound containing Pimpinella anisum, Foeniculum vulgare, Sambucus nigra, and Cassia augustifolia for chronic constipation. BMC Complementary and
Diuresis is defined as increased or excessive production of urine. Factors include things as benign as drinking too much water, to more severe conditions such as chronic disease. Substances or medications that cause this are called diuretics.
A healthy person would not typically need to induce diuresis, but people with conditions like hypertension may benefit from diuresis. There are older more traditional forms of medicine that use elder in this way. However, there is very little to no scientific evidence to back up this claim, and there appear to be no recent efforts to study this effect.
This review is not, by any means an exhaustive list of the health benefits of elderberry; more so an overview of the more tangible effects that have at least some scientific backing. Traditional medicine and historical anecdotes extol the virtues of elder in a variety of home remedies for a multitude of ailments. Modern medicine, while seemingly slow to catch up, is increasingly finding elder useful as an alternative or complementary medicine. It’s shown to be safe for consumption in a variety of different ways. So long as one does not eat the plant raw, ingesting elderberry is not toxic. One caveat, people who have allergies to plants similar to elder such as honeysuckle, may have allergic reactions to elderberry products.
In a study of participants seeking a healthy lifestyle and weight changes, the addition of elderberry to their new regimen significantly improved their emotional well being and quality of life20Chrubasik C, Maier T, Dawid C, et al. An observational study and quantification of the actives in a supplement withSambucus nigraandAsparagus officinalisused for weight reduction. Phytotherapy Research. 2008;22(7):913-918. doi:10.1002/ptr.2415. 21Shahsavandi S, Ebrahimi MM, Hasaninejad Farahani A. Interfering With Lipid Raft Association: A Mechanism to Control Influenza Virus Infection By Sambucus Nigra. Iranian Journal of Pharmaceutical Research : IJPR. 2017;16(3):1147-1154. In addition, well documented anti-oxidant properties can make elderberry useful overall as part of a healthy diet and lifestyle.20Chrubasik C, Maier T, Dawid C, et al. An observational study and quantification of the actives in a supplement withSambucus nigraandAsparagus officinalisused for weight reduction. Phytotherapy Research. 2008;22(7):913-918. doi:10.1002/ptr.2415. 21Shahsavandi S, Ebrahimi MM, Hasaninejad Farahani A. Interfering With Lipid Raft Association: A Mechanism to Control Influenza Virus Infection By Sambucus Nigra. Iranian Journal of Pharmaceutical Research : IJPR. 2017;16(3):1147-1154.
Recent Studies and Clinical Trials
Other studies25Kaptan E, Sancar-Bas S, Sancakli A, Bektas S, Bolkent S. The effect of plant lectins on the survival and malignant behaviors of thyroid cancer cells. J Cell Biochem. 2018 Jul;119(7):6274-6287. doi: 10.1002/jcb.26875. 26Jarić S, Kostić O, Mataruga Z, Pavlović D, Pavlović M, Mitrović M, Pavlović P. Traditional wound-healing plants used in the Balkan region (Southeast Europe). J Ethnopharmacol. 2018 Jan 30;211:311-328. doi: 10.1016/j.jep.2017.09.018. Epub 27Nilsson A, Salo I, Plaza M, Björck I. Effects of a mixed berry beverage on cognitive functions and cardiometabolic risk markers; A randomized cross-over study in healthy older adults. PLoS One. 2017 28Gleńsk M, Czapińska E, Woźniak M, Ceremuga I, Włodarczyk M, Terlecki G, Ziółkowski P, Seweryn E. Triterpenoid Acids as Important Antiproliferative Constituents of European Elderberry Fruits. Nutr Cancer. 2017 May-Jun;69(4):643-651. doi: 10.1080/01635581.2017.1295085. 29Salvador ÂC, Król E, Lemos VC, Santos SA, Bento FP, Costa CP, Almeida A, Szczepankiewicz D, Kulczyński B, Krejpcio Z, Silvestre AJ, Rocha SM. Effect of Elderberry (Sambucus nigra L.) Extract 30Kirichenko TV, Sobenin IA, Nikolic D, Rizzo M, Orekhov AN. Anti-cytokine therapy for prevention of atherosclerosis. Phytomedicine. 2016 Oct 15;23(11):1198-210. doi: 10.1016/j.phymed.2015.12.002. Epub 2015 Dec 19. Review. PubMed PMID: 26781385. 31Schröder L, Richter DU, Piechulla B, Chrobak M, Kuhn C, Schulze S, Abarzua S, Jeschke U, Weissenbacher T. Effects of Phytoestrogen Extracts Isolated from Elder Flower on Hormone Production and Receptor 32Farrell N, Norris G, Lee SG, Chun OK, Blesso CN. Anthocyanin-rich black elderberry extract improves markers of HDL function and reduces aortic cholesterol in hyperlipidemic mice. Food Funct. 2015 Apr;6(4):1278-87. doi: 10.1039/c4fo01036a. 33El-Houri RB, Kotowska D, Olsen LC, Bhattacharya S, Christensen LP, Grevsen K, Oksbjerg N, Færgeman N, Kristiansen K, Christensen KB. Screening for bioactive metabolites in plant extracts modulating glucose uptake and conducted during the review period 2013-2018 have shown positive effects involving cholesterol and LDL, atherosclerosis, wound care, anti-cancer activities and more! These were not covered in this review because they either have conflicting or inconclusive data, or they have not been replicated or peer-reviewed. The benefit of corroborating data for claims like these allows for more intelligent questions and decisions when it comes to science and healthcare. These claims are too recent to have a lot of corroborating data for them yet, but they are intriguing findings and are likely to be studied in the future.
So although more studies are needed, the possibilities are exciting! There are currently three active studies, registered in the clinicaltrails.gov database, involving elderberry and influenza, a mouthwash, and human immunity.
I included two conditions – constipation and diuresis – with studies older than 2013;. I found the documented laxative effects for constipation to be more robust than the view espoused in the Ulbricht paper. Diuresis was not addressed by Ulbricht so I addressed it here.
In this article, I cited but did not refer to the views expressed in the Ulbricht paper specifically. I chose to present the data for the 2013 – 2018 period as a whole. Only a few of my conclusions contrasted with those of the Ulbricht review. I noted these few differences in the chart that makes up most of Appendix A.
I did not see where Ulbricht made any claims either way about allergies and treatment with elderberry except to mention potential allergic reactions to elderberry itself. I didn’t see anything specific in the citations either. Independently, the only study referencing allergies that I found was the 2013 study that I cited in this article. If you have other scientific data about treating this condition with elderberry, please email me at firstname.lastname@example.org so I can add it to the review.