In England, summer is said to begin when the elderberry tree blooms and ends when its fruit ripens.
Elderberry Sambucus nigra L. has been used for thousands of years and remains a popular natural remedy for coughs, colds, and flu. As a general health aid, its been highly regarded by English herbalists, and in the 17th century, John Evelyn said, “If the medicinal properties of its leaves, bark, and berries were fully known, I cannot tell what our countryman could ail for which he might not fetch a remedy from every hedge, either for sickness or wounds.”
Sales of elderberry products have skyrocketed since the 2020’s and though this article may be longish, its well worth the read – it could even be said to prove John Evelyn quite right.
Historical Use
Elder was used to ward off evil influences, witches, spirits, and death in England and Russia, the Serbs considered elder to be good luck, and elder twig knots were carried as charms to protect from rheumatism in England. Historically the cross on which Jesus was hanged was said to be made of elder. The word Sambucus originates from an ancient Asiatic stringed instrument that was made from the wood of elder.
Ancient Egyptians used elder flowers to improve complexion and heal burns, and Native Americans used elder for infections, coughs, and skin conditions. The flowers and leaves have been used for pain relief, swelling, inflammation, and diuresis (urine production), and as an expectorant and to induce sweating. The leaves have been used externally to relieve pain and in sitz baths (a warm bath covering the hips and buttocks) to relieve pain in the lower body; the word “sitz” comes from the German word sitzen, to sit. The bark, when aged, was used as a diuretic, laxative, and emetic (to induce vomiting).
Sambucus nigra has long been gathered in the UK, Poland, Italy and other parts of the world for its food and medical uses. The berries have been used traditionally in food as flavouring and in the preparation of elderberry wine, jellies and jams, and when mixed with sage, lemon juice, vinegar, and honey, elderberry as been used as a gargle for coughs, head colds, laryngitis, flu-like symptoms, and shortness of breath.
At a glance
Elderberry, the fruit of the black elder tree, has diverse health promoting properties making it a valuable preventative medicine. Its science-backed effects include antioxidant, anti-inflammatory, antimicrobial and anti-influenza, as well as anticancer, antidiabetic, cardioprotective and neuroprotective.
Elderberries antiviral effects have been studied most. Upper respiratory symptoms are often treated with over-the-counter drugs, antibiotics, and antivirals. However, concerns over safety, effectiveness, and resistance to these medications have led to a demand for alternative solutions. A meta-analysis of controlled trials indicates that elderberry supplementation significantly reduces upper respiratory symptoms, and is efficacious in reducing the severity and the duration of influenza and the common cold. It is deemed a safe, cost-effective treatment for colds and flu, a potential alternative to antibiotic mis-use for viral infections, and a safer option than prescription drugs for the common cold and flu.
More scientific research is required to determine elderberry’s full mechanisms of action, and the effects and bioavailability of different extracts.
The Plant
Elderberry Sambucus nigra L. is in the Adoxaceae plant family – characterised by opposite toothed leaves, small 4 or 5-petalled flowers in cymose (where the the first flower forms at the top of the stalk) inflorescences, and the fruit being a drupe. It is a small, fast-growing tree (9m/30 feet), featuring creamy white fragrant flowers, and shiny purple-black berries.
Native to Europe and North America, it also grows in Western and Central Asia and North Africa. There are several species of Sambucus that produce elderberries. Most research is on Sambucus nigra. Other species with similar chemical components include the American elder or common elder (Sambucus canadensis), blue elderberry (Sambucus caerulea), danewort (Sambucus ebulus), antelope brush (Sambucus tridentata), red-fruited elder (Sambucus pubens, Sambucus racemosa), Sambucus formosana. and dwarf elder (Sambucus ebulus),. American elder (S. canadensis) and European elder (S. nigra) have many of the same uses and contain common constituents. The name Sambucus is derived from an ancient Greek musical instrument made from the wood of this tree.
Bioactive Compounds
Every part of the tree has been used medicinally. Factors such as cultivar, location, ripening stage, and environmental conditions influence the chemical composition. The wood, bark and leaf are not used for health today as they can be poisonous – they contain compounds that metabolise into cyanide in the body.
Leaves, flowers and fruit are rich in dietary phytochemicals like terpenoids, flavonoids, alkaloids and phenolic acids. Active alkaloids such as hydrocyanic acid and sambucine are associated with inducing nausea and are found in the unripe berries, leaves, bark, and seeds and should therefore not included in a medicinal preparation.
Fruit/ berries contain high concentrations of polyphenols such as anthocyanins (giving the berries their dark hue) compared with other fruit (approximately 80% of the polyphenol content), including cyanidin-3-glucoside and cyanidin-3-sambubioside. Berries are also rich in other polyphenols such as flavanols, phenolic acids like gallic acid, and procyanidins. These polyphenols contribute to the high antioxidant and anti-inflammatory capacities and the health benefits of elderberry fruit extract.
Leaves and especially flowers are abundant in flavonoids, including quercetin (up to 3%), rutin, hyperoside, and anthocyanins, as well as a terpene rich essential oil (giving the characteristic aroma of elder flowers), mucilage, tannins (3%), organic acids, glycoside and sambunigrin and high amounts of amino acid amides.
Bark contains betulin, oleanolic acid, alpha-amyrenone, alpha-amyrin, and beta-sitosterol, as well as nigrin b, a lectin similar to ricin, and other type-2 ribosome inactivating proteins that are less toxic to cells and animals.
Protein, carbohydrates, vitamins and minerals: Elder berries also contain sixteen amino acids, seven being essential (i.e., not synthesised by the body), and they are rich in unsaturated essential fatty acids like linoleic and α-linolenic acids (mainly located in the seeds, with an estimated oil content of 22%; note raw seeds can be toxic if ingested in large quantities). Elderberries contain 18% carbohydrates of which 7.4% is dietary fibre, including pectin and other polysaccharides. Elderberries are high in B-group vitamins, vitamin A, and vitamin C – a 100g serving of fresh (raw) berries provides 660 mg protein, 38 mg calcium, 1.6mg iron, 0.07 mg vitamin B1, 0.06 mg vitamin B2, 0.5mg vitamin B3, 0.14 mg vitamin B5, 0.23 mg vitamin B6, 17 mg vitamin B9, 36 mg vitamin C, and many minerals.
How Elderberry Works
Elderberry possesses many health benefits verified by science in either laboratory or clinical studies, including antioxidant, anti-inflammatory, anticancer, anti-influenza, antimicrobial, antidiabetic and cardioprotective and neuroprotective actions.
Anti-inflammatory: In laboratory studies, S. nigra extracts are anti-inflammatory through several actions, lowering inflammatory processes involved in diseases such as rheumatoid arthritis, Crohn’s disease, and ulcerative colitis. It lowers the expression of pro-inflammatory genes and the production of inflammatory mediators (such as IL-1α, IL-6, IL-1β, IL-6, TNF-α, and COX-2, PGE2, nitric oxide and histamine). It alters the function of human neutrophils and inhibits macrophage release of proinflammatory cytokines. Clinically a trial supports the anti-inflammatory effects, where a cream improved skin lesions in humans.
Antioxidant: elderberries contain flavonoids and anthocyanins which possess antioxidant activity and protect against several different oxidative stressors.
Anticancer: Laboratory studies report elderberry extract and its active compounds (flavonoids, anthocyanins, agglutinin, and triterpenoids), to be anticancer in various cell lines: human breast carcinoma and adenocarcinoma, ovarian carcinoma, liver carcinoma, lung adenocarcinoma, colon and bladder carcinoma – the latter studies suggesting elderberry flower extracts are toxic to cancer cells but safe to normal cells. The anticancer mechanisms involved are regulation of cell membrane structure, expression of cell cycle checkpoint proteins, inhibition of nuclear protein transport in neuroblastoma cells, affecting proapoptotic (cell death) proteins, autophagy and DNA damage.
For influenza: Elderberry exhibit anti-influenza activity both in laboratory and human studies. Elderberry works by directly attacking viruses, by stimulating the immune system and by its anti-inflammatory (reducing inflammation in blood cells and brain cells), potent antioxidant, as well as analgesic properties.
Antiviral laboratory studies: S. nigra inhibits influenza virus types A and B, SARS-CoV2, avian influenza virus and the herpes simplex-1 virus. The antiviral actions comes from its ability to decrease the spread and total amount of virus, interacting with the replication of the virus (reducing the synthesis of viral glycoproteins at the stage of attachment and penetration into host cells), and inhibiting the release of infectious virion particles from infected cells. Caffeic acid from the plant has shown anti-coronavirus activity by disrupting spike proteins’ binding to ACE2 receptors.
Antiviral effects are also related to elderberry’s ability to reduce viral hemagglutination of red blood cells, and to increase the content of specific neutralising antibodies such as IgA. Elderberry also stimulates other immune cells: water-based elderberry extracts, rich in polysaccharides, stimulate dendritic cells (which initiate immune responses), unlike ethanol-based extracts. Water extracts have also been shown to regulate the expression of pro-inflammatory cytokines (such as IL-6, TNF-α, IFN-γ), proteins that manage and strengthen the immune inflammatory response to viruses. Elderberry increases cytokine production at the early stages of infection, helping to combat the virus. Research to date suggest it is safe in treating viral respiratory infections without overstimulating the immune system. Other botanicals, like echinacea, also trigger an early cytokine response and then downregulate it during later stages of illness. It is both polysaccharides and anthocyanins that are thought to contribute to elderberry’s strong immune-modulatory properties., and compared to oseltamivir, elderberry products may be associated with fewer complications and adverse effects from the flu.
Antiviral clinical studies: While there is disparity due to different forms of elderberry extracts being tested, which is an important factor in assessing and comparing results in plant medicine, elderberry has been shown in a number of gold standard (controlled) studies to clinically reduce the duration and the symptoms of colds and flu.
In a meta-analysis, which included 180 participants, evaluating factors like vaccination status and the cause of upper respiratory symptoms, elderberry supplementation significantly reduced symptoms, offering a potential alternative to antibiotic misuse for viral infections and a safer option than prescription medications for routine colds and flu.
In one study, 312 healthy adults traveling on long-haul flights were given 600 mg/day of elderberry for 10 days before travel, followed by 900 mg/day for five days (from one day before departure to four days after arrival). Those who developed cold symptoms while taking elderberry experienced a 2-day reduction in the duration of symptoms (4.75 days vs. 6.88 days) and lower symptom severity (mean score of 21 vs. 34) compared to the placebo group.
Studies also report elderberry juice improves flu-like symptoms in less than half the time it normally takes to recover from the flu. Patients taking elderberry for 48 hours had a significant eradication of all symptoms such as cough, fever, headache, mucus discharge, muscle aches, or nasal congestion. A case report exisis of an HIV-positive woman, taking no HIV drugs, who experienced a viral load drop from 17,000 to 4,000 after ingestion of Sambucol® with olive leaf extract. Gold-standard trials of Sambucol® are associated with a rapid recovery from influenza.
Antimicrobial: In laboratory studies elderberry inhibits the growth of Gram-positive bacteria (e.g. Streptococcus pyogenes and groups C and G Streptococcus) and Gram-negative bacterium such as Branhamella catarrhalis, Escherichia coli, Vibrio anguillarum, V. ordalii, Flavobacterium psychrophilum, and Aeromonas salmonicida, Antibacterial mechanisms involve disrupting bacterial membranes, and may be associated with the levels of phenolic acids and flavonoids in the extracts, such as apigenin, kaempferol, ferulic acid, protocatechuic acid, and p-coumarin acid. Cranberry and elderberry extract successfully treated urinary tract infection in a clinical trial with 55 patients.
Antidiabetic: From laboratory studies, elderberry and its bioactive compounds or metabolites show potential use as co-adjuvants in diabetes management. Antidiabetic action is related to constituents naringenin, phenolic extracts, anthocyanins, procyanidins, and their metabolites. They regulate glucose metabolism by increasing the uptake of glucose, reducing the level of blood glucose and inhibiting carbohydrate-hydrolysing enzymes. Polar extract have been shown to modulate glucose metabolism by correcting hyperglycemia, while the lipophilic extract lowered insulin secretion. Both extracts lowered insulin resistance. Extracts also lower hyperglycemia-induced inflammation, lowering pain of the peripheral nerve and lower oxidative stress, enhancing the antioxidant defence system.
Diet-control: Elderberry fruit extracts in human research decreased mean body weight, and in laboratory studies elderberry decreases intestinal absorption of dietary lipids and carbohydrates, by inhibiting carbohydrate-hydrolysing enzymes and digestive enzymes, such as α-amylase, α-glucosidase and pancreatic lipase, and increasing the uptake of glucose and oleic acid.
Laxative: S. nigra-containing products decreased colonic transition time and increased daily evacuations in patients with chronic constipation.
Cardiovascular protective: Elderberry has a cardio-protective effects in laboratory studies, through increasing endothelial nitric oxide synthase (an enzyme that produces the signalling molecule nitric oxide) that regulates many functions in the body, including blood flow and circulatory changes, platelet aggregation and vascular tone. Anthocyanin-rich elderberry extract reduced postprandial lipid levels, lowering triglycerides and cholesterol, and changing the expression of cholesterol and HDL function-associated genes. Phenolic extracts decreased systolic and diastolic blood pressure and S. nigra flowers have diuretic effects.
Neuroprotection: Elderberry has potential neuroprotective effects in laboratory studies. Terpenoid rich extract increased the memory signal acetylcholine and regulate mitochondrial function, as well as lower oxidative markers and enhance antioxidant enzymes – where mitochondrial dysfunction and oxidative stress are related to neurodegenerative diseases. Extracts of elderberry bark, fruit, and leaf have anticonvulsant activities and in a model of Huntington’s disease elderberry fruit extract could recover motor disorders and muscle incoordination, and could also promote the survival of neurons.
Other health functions: Elderberry also shows potential for other health functions in the laboratory, such as liver and kidney protection, male reproductive protection and protection of the skin.
How to Take Elderberry
Elderberry is typically available in extract form—either as a tincture or juice concentrate. Recommended doses vary, according to the products, current medical conditions and efficacy in different individuals. Up to 50ml of syrup (equivalent to 20g of berries or flowers) daily is common. Elderberry fruit extracts are typically used in doses up to 1200 mg daily for two weeks or 500 mg daily for up to six months in adults. No upper limit for elderberry intake has been established.
Elderberries can also be taken as a preventative medicine in cordials, jellies, jams and wine, and elderflower champagne is a popular preparation. Teas made from the flowers or berries are delicious with honey. Elderberry syrup or rob, a sweetened and spiced berry juice concentrate, is a child-friendly remedy.
Bioavailability: the bioavailability of elderberry beneficial compounds should be taken into account – the presence and competition of gut bacterial strains are key factors in interindividual variability of anthocyanin bioavailability and polyphenolics can be degraded by gut microbiota, while gut microbial populations can also be regulated by polyphenolics and their metabolites. Studies on the mechanisms of action of (different) elder berry or flower extracts are limited.
Caution: While elderberry is generally well-tolerated, consuming raw or unripe berries, stems, or leaves may cause nausea, vomiting, dizziness, or stupor due to the cyanide-inducing glycoside, sambucine. These effects can be avoided by removing all stems and properly cooking the berries, which neutralizes the toxins. Caution in certain medical conditions and with certain medications: arrhythmia or cardiovascular disease, with blood pressure medications (due to potential blood pressure lowering), with diuretics (due to diuretic properties), in chemotherapy, in diabetes (due stimulation of glucose metabolism and promotion of insulin secretion), in diarrhea (due to laxative effects), in hypokalemia (due to potential to decrease potassium), in migraines (due to potential for headache),and when taking theophylline.
Conclusion
Long regarded as a protective plant against evil, elderberry, when taken at a medicinal level in cooked tinctures and juice, is scientifically validated as an effective preventative treatment and remedy for colds and flu, and has potential in treating chronic disease.
Widely already used in the food industry, being a natural food colorant and antioxidant, elderberry also has great prospect as a functional food or nutraceutical for preventing chronic disease. Its fruit and flowers offer a wide variety of uses in flavourful, syrups, jams, wines and desserts, providing a natural and pleasant way to support health.
