Studies on elderberries show they fight flu
Studies on elderberries show they fight flu

By Sarah Crawford, PhD

Introduction

Anti-viral medications such as Tamiflu (oseltamivir) are popular remedies that have been shown to decrease the duration of the illness as well as the severity of the symptoms. On the other hand, natural products from berries also possess important flu-fighting capabilities. So- what’s the best berry? What’s the best product to fight the flu? How do we know? Read on…….

Berry v berry: how do they stack up when it comes to the flu?

Elderberries have the highest levels of anti-oxidants of almost all other berries.1United States Department of Agriculture Oxygen Radical Absorbance Capacity (ORAC) of Selected Foods – 2007   Why is this important? Plant components with high levels of anti-oxidant activity, such as flavonoids, destroy free radicals that damage and destroy infected cells.  Among berries we commonly consume, the elderberry contains almost five times as much anti-oxidant power as strawberries; more than three times as much as raspberries, almost three times as much as blackberries and more than twice as much as blueberries.1United States Department of Agriculture Oxygen Radical Absorbance Capacity (ORAC) of Selected Foods – 2007 Researchers think that these flavonoids also help to stimulate the immune system to fight infections caused by flu and other viruses.2Barak, Vivian, Tal Halperin, and Inna Kalickman. "The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines." Eur Cytokine Netw 12.2 (2001): Moreover, the anti-inflammatory effects of the anthocyanins in elderberry provide an excellent antidote to the fever, aches, and pains that usually accompany the flu.2Barak, Vivian, Tal Halperin, and Inna Kalickman. "The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines." Eur Cytokine Netw 12.2 (2001):   Because the levels of these phytochemicals are significantly higher in elderberry than in almost all other edible berry species, this makes the elderberry the head of its class in flu-fighting ingredients.

Elderberry v flu medications: how do they work?

Tamiflu (Oseltamivir)

Oseltamivir (Tamiflu) is a very popular, although somewhat controversial anti-flu medication.  It was the first oral medication approved for the treatment of the flu. The FDA approved oseltamivir in 1999 for the treatment of the flu based on positive results in ten patient clinical trials.3 Kim, C. U. "Discovery and development of (oseltamivir, tamiflu): Rationally designed carbocyclic influenza neuraminidase inhibitor." ABSTRACTS OF PAPERS OF THE AMERICAN CHEMICAL SOCIETY. Vol. 219. 1155 16TH ST, NW, Medically, it is classified as a neuraminidase inhibitor. It is a chemical synthesized from shikimic acid derived from Chinese star anise.3 Kim, C. U. "Discovery and development of (oseltamivir, tamiflu): Rationally designed carbocyclic influenza neuraminidase inhibitor." ABSTRACTS OF PAPERS OF THE AMERICAN CHEMICAL SOCIETY. Vol. 219. 1155 16TH ST, NW,

Despite the popularity of Tamiflu, there have been some problems associated with its use.  For example, certain common strains of flu virus (H1N1, for example) have been shown to become resistant to its anti-viral effects.4Lackenby, A., et al. "Emergence of resistance to oseltamivir among influenza A (H1N1) viruses in Europe." Eurosurveillance13.5 (2008): 3-4. In addition, its use has been linked to some unpleasant side effects such as nausea, vomiting, and effects on kidney function in some individuals.5Fuyuno, Ichiko. "Tamiflu side effects come under scrutiny." (2007): 358-359.

Elderberry

A compound called ‘antivirin’ identified in the black elderberry binds to flu virus particles and prevents them from entering epithelial cells of the respiratory tract to cause infection.6Varshney, Jonish, et al. "VARIOUS REMEDIES FOR SWINE FLU."Pharmacologyonline 2: 36-47 (2010). In vitro studies have shown elderberry extracts to be directly effective against ten different strains of flu virus; moreover, unlike Tamiflu, viral resistance does not appear to be a problem with elderberry’s use.7Krawitz, Christian, 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 and alternative medicine 11.1 Elderberry extracts have also been shown to increase immune system responses to infections such as flu; this dual mechanism of action is a very important attribute of the elderberry.2Barak, Vivian, Tal Halperin, and Inna Kalickman. "The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines." Eur Cytokine Netw 12.2 (2001):   By both blocking the virus AND stimulating the immune system to fight the flu, there is less chance that flu virus resistance will develop as compared to drugs such as Tamiflu that attack the virus-infected cells only. Patient clinical trials have shown that elderberry’s regular use commencing at early stages of the flu shortens its duration by up to 4 days and decreases the severity of its symptoms.  Antibody levels were higher in patients taking this elderberry extract demonstrating its effects on immune system activity.8Zakay-Rones, Z., et al. "Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections." Journal of International Medical Research32.2   The documented effects of elderberry on immune system function provide evidence that its long-term use may have a preventive effect against infectious disease.

Elderberry v Tamiflu: which is better?

Unfortunately, there have not been nearly enough clinical research studies comparing the effects of elderberry extracts and Tamiflu. One notable exception is a clinical research trial in the Czech Republic that compared the effects of Tamiflu, with an elderberry/echinacea9Rauš, Karel, et al. "Effect of an Echinacea-based hot drink versus oseltamivir in influenza treatment: a randomized, double-blind, double-dummy, multicenter, noninferiority clinical trial." Current Therapeutic Research 77 (2015): 66-72.   prepared as a concentrated extract of approximately 50% of each of these plant components to maximize the effects of two plant species with documented anti-flu properties.  Patients who received this preparation recovered faster with fewer side effects than those who received comparable treatment with Tamiflu.

Note: Bill’s Question for Sarah — Do research findings say that Relenza (zanamivir) and Rapivab (peramivir) suffer from the same limitations and side effects as Tamiflu?

Sarah’s Response — No, they are different; there are more restrictions on their use.

Conclusion

So-which is better-Tamiflu or elderberry extract? This is how the two therapies compare in some important areas:

Mode of action

Anti-flu treatments must be initiated at the early stages of the flu; this is directly related to their modes of action. Tamiflu works by binding to virally infected cells and preventing the virus from escaping and spreading infection. Elderberry also blocks flu virus infection, but it does so by preventing the virus from entering the cell to cause infection.6Varshney, Jonish, et al. "VARIOUS REMEDIES FOR SWINE FLU."Pharmacologyonline 2: 36-47 (2010). 10Roschek, Bill, et al. "Elderberry flavonoids bind to and prevent H1N1 infection in vitro." Phytochemistry 7010 (2009): 1255-1261. Both treatment modalities have shown broad-spectrum flu strain inhibition.

Side effects

Whereas no significant side effects have been associated with the use of elderberry preparations, reported side effects of Tamiflu include vomiting, diarrhea, headache and sleep issues.  Rare accounts of kidney problems, seizures, and psychiatric episodes have also been reported.

Drug resistance

Resistance to flu virus strain H1N1 has been documented in Tamiflu and is a current cause of concern as this trend may spread to other flu strains treated with this product.  In contrast, flu virus resistance has not been associated with the use of elderberry preparations.

Prevention

An oft-repeated proverb says “an ounce of prevention is worth a pound of cure”. So true! When it comes to the elderberry, its beneficial effects on the immune system may help to prevent colds and flu.  On the other hand, there are no documented effects of Tamiflu on enhancing immune system function.  Moreover, in 2017 the Centers for Disease Control stated that it does not recommend the use of Tamiflu to prevent the flu since its long-term use may cause flu virus to become resistant to its anti-flu effects.

Cost

At recommended dosages (see Table), elderberry extract use for approximately ten days costs about $15. Tamiflu is available in a generic version; in the U.S. the course of treatment costs approximately $140 in 2016.11NADAC 12-7-2016.

Table. Comparison of Anti-flu Virus Remedies: Tamiflu V Elderberry juice

Assessment Category

Tamiflu (oseltamivir)

Elderberry juice*

Active ingredient

Chemical derivative of shikimic acid

Flavonoids, antivirin

Mode of action

Neuraminidase inhibitor blocks flu infection

Blocks flu infection, stimulates the immune system, attacks free radicals

Therapeutic effect

Decrease severity/

duration illness 3-4d

Decrease severity/

duration illness 3-4d

Common Side effects

Nausea, vomiting, headache

None reported

Viral resistance

Flu strain H1N1

None reported

administration

oral

oral

mg/dose

150mg/day

2tsp/0.34oz/day*

Spectrum of virus strain activity

Broad spectrum

Broad spectrum

Prevention use

Not recommended

Yes, immune system activation

Approx. cost per 10 day treatment

$138*

$60***

  • *100% juice preparation; approx. 20g berry/oz. 8Zakay-Rones, Z., et al. "Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections." Journal of International Medical Research32.2 12Vlachojannis, J. E., Melainie Cameron, and Sigrun Chrubasik. "A systematic review on the sambuci fructus effect and efficacy profiles." Phytotherapy Research 24.1 (2010): 1-8.
  • **U.S. cost, NADAC 2016
  • *** River Hills Harvest elderberry juice
1 United States Department of Agriculture Oxygen Radical Absorbance Capacity (ORAC) of Selected Foods – 2007
2 Barak, Vivian, Tal Halperin, and Inna Kalickman. "The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines." Eur Cytokine Netw 12.2 (2001): 290-296.
3 Kim, C. U. "Discovery and development of (oseltamivir, tamiflu): Rationally designed carbocyclic influenza neuraminidase inhibitor." ABSTRACTS OF PAPERS OF THE AMERICAN CHEMICAL SOCIETY. Vol. 219. 1155 16TH ST, NW, WASHINGTON, DC 20036 USA: AMER CHEMICAL SOC, 2000.
4 Lackenby, A., et al. "Emergence of resistance to oseltamivir among influenza A (H1N1) viruses in Europe." Eurosurveillance13.5 (2008): 3-4.
5 Fuyuno, Ichiko. "Tamiflu side effects come under scrutiny." (2007): 358-359.
6 Varshney, Jonish, et al. "VARIOUS REMEDIES FOR SWINE FLU."Pharmacologyonline 2: 36-47 (2010).
7 Krawitz, Christian, 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 and alternative medicine 11.1 (2011): 16.
8 Zakay-Rones, Z., et al. "Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections." Journal of International Medical Research32.2 (2004): 132-140.
9 Rauš, Karel, et al. "Effect of an Echinacea-based hot drink versus oseltamivir in influenza treatment: a randomized, double-blind, double-dummy, multicenter, noninferiority clinical trial." Current Therapeutic Research 77 (2015): 66-72.
10 Roschek, Bill, et al. "Elderberry flavonoids bind to and prevent H1N1 infection in vitro." Phytochemistry 7010 (2009): 1255-1261.
11 NADAC 12-7-2016.
12 Vlachojannis, J. E., Melainie Cameron, and Sigrun Chrubasik. "A systematic review on the sambuci fructus effect and efficacy profiles." Phytotherapy Research 24.1 (2010): 1-8.