B25022 I By M. Faisal Hossain, BPharm, MPharm, PhD
Elderberry (Sambucus nigra) is a dark purple berry traditionally used in Europe and North America as a home remedy for cold and flu. Known for its rich antioxidant profile, elderberry has been historically prepared as syrups, teas, and tinctures to support immune function and relieve congestion. In recent decades, scientific studies have examined its potential to reduce the severity and duration of upper respiratory tract infections (URTIs), including influenza and the common cold.
What the Science Says
Several clinical studies and reviews support elderberry’s antiviral and immune-modulating properties. However, more recent clinical data have introduced conflicting results.
Clinical and Meta-Analysis Evidence
Key Takeaways from the New Evidence
- Earlier studies (2004–2019) suggested elderberry shortens influenza and cold symptom duration by up to four days.
- The 2020 Macknin trial, conducted in three U.S. emergency rooms, found no difference in symptom duration or severity between elderberry and placebo. This suggests elderberry may not be as effective for confirmed influenza as previously thought, highlighting the need for further large-scale studies.
Natural Source & Active Components
Elderberry grows on the Sambucus nigra tree, primarily native to Europe. The berries are rich in:
- Anthocyanins (delphinidin, cyanidin) – antioxidant and antiviral properties
- Flavonoids & phenolic acids – immune modulation
- Vitamin C & dietary fiber – overall wellness support
Mechanism of Action: Elderberry anthocyanins can bind to viral surface proteins, preventing viral entry into cells, and may enhance cytokine production to support immune defense.
Available Supplements
Elderberry is widely available in:
- Syrups (commonly used for cold/flu support)
- Capsules and tablets (standardized extracts)
- Gummies and lozenges
- Teas and powders (for smoothies and hot drinks)
Consumers should check labels for standardized extract content
Possible Side Effects / Cautions
- Unripe or raw elderberries may contain cyanogenic glycosides that can cause nausea, vomiting, or diarrhea.
- Pregnant or breastfeeding individuals should consult a healthcare provider before use.
- Patients on immunosuppressants or with autoimmune diseases should use elderberry cautiously due to its immune-stimulating potential.
Conclusion
Elderberry remains one of the most popular natural remedies for cold and flu support. Earlier studies and meta-analyses suggested it may reduce symptom severity and shorten illness duration when taken early. However, a more recent randomized controlled trial (Macknin et al., 2020) found no measurable benefit in confirmed influenza cases and even suggested a possible worse outcome when taken without antiviral therapy.
Bottom Line: Elderberry may support immune health and symptom management for mild cold-like illnesses, but its role in confirmed influenza is still uncertain. It should not replace vaccination or antiviral therapy, and further research is warranted to clarify its true clinical value.
References
- Zakay-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. J Int Med Res. 2004;32(2):132-140.
- Tiralongo E, Wee SS, Lea RA. Elderberry supplementation reduces cold duration and symptoms in air-travelers: a randomized, double-blind placebo-controlled clinical trial. Nutrients. 2016;8(4):182.
- Hawkins J, Baker C, Cherry L, Dunne E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: a meta-analysis of randomized, controlled clinical trials. Complement Ther Med. 2019;42:361–365.
- Porter RS, Bode RF. A review of the antiviral properties of black elderberry (Sambucus nigra L.) products. Phytochemistry. 2017;36:84–93.
- Macknin M, Wolski K, Negrey J, Mace S. Elderberry Extract Outpatient Influenza Treatment for Emergency Room Patients Ages 5 and Above: a Randomized, Double-Blind, Placebo-Controlled Trial. J Gen Intern Med. 2020;35(11):3271–3277. doi:10.1007/s11606-020-06170-w.
Acknowledgment:
This blog was prepared with assistance from ChatGPT by OpenAI. The featured image was also created with the help of AI tools.
Note:
This content is for informational purposes only and is not intended as medical advice. Always consult your healthcare provider before starting any supplement.
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