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Will Elderberry Extract Help You Recover from Flu?

Elderberry extract has antiviral activity in laboratory tests, but there are too few good clinical trials to show if it works for the flu.
Will Elderberry Extract Help You Recover from Flu?
Branch of black elderberry. Elderberry is a medicinal plant

Natural approaches to healing are getting extra attention right now, as people try hard to stay out of doctors’ offices if they can. After all, if you don’t have COVID-19, you don’t want to go anywhere other people might have it and give it to you. Some readers have been asking about elderberry extract (Sambucus nigra or Sambucus canadensis) to help treat the flu. Here are reports from a few members of the community.

Will Elderberry Extract or Tea Help Sniffles?

Q. During cold season, I use elderberry seeds to make a tea as soon as I start to sniffle. It has stopped the cold in its tracks every time. My friend with COPD used to get pneumonia every fall but now takes elderberry daily and hasn’t had pneumonia in over ten years.

A. Traditionally, people have used the flowers or berries of elderberry bushes to treat coughs and colds. Although the extract has antiviral activity, a double-blind clinical trial did not show that it helps people recover more quickly from flu (Journal of General Internal Medicine, Nov. 2020).

Elderberry Extract for Influenza:

Q. Our daughter told us about taking elderberry extract. In fact, she brought us a bottle of the syrup. We’ve all been taking two tablespoons once per day.

She came down with the flu this winter and was running a fever of 100.3 degrees (F). Taking the elderberry extract, though, she recovered completely in just three days.

She doesn’t have insurance, so she didn’t see the doctor. But I had both Type A and Type B influenza last year myself, and it sure looked to us like she had the flu. We will all continue to take it on a daily basis, especially in these uncertain times.

What Is the Evidence on Elderberry?

A. Many readers have asked about elderberry extract to treat viral infections. Only a handful of clinical trials have examined its use for influenza or other viruses. One meta-analysis found that black elderberry extract can “substantially reduce upper respiratory symptoms” (Complementary Therapies in Medicine, Feb. 2019). In general, such upper respiratory symptoms are associated with colds or mild cases of the flu. Another study found that air travelers taking placebo had more colds and suffered longer with cold symptoms than those randomized to take elderberry extract (Nutrients, March 24, 2016).

Scientists examining the mechanism of action suggest that the anthocyanin compounds in elderberry have antiviral effects (Frontiers in Pharmacology, Nov. 8, 2019). However, a review found too few studies comparing elderberry extract to standard antiviral medications (Phytotherapy Resarch, April 2017).

According to The Medical Letter (Feb. 25, 2019),

“There is no acceptable evidence to date that elderberry is effective for prevention or treatment of influenza and its safety is unclear.”

A more recent review came to a similar conclusion:

“Elderberry may be a safe option for treating viral respiratory illness, and there is no evidence that it overstimulates the immune system. However, the evidence on both benefits and harms is uncertain and information from recent and ongoing studies is necessary to make firm conclusions.” (BMC Complementary Medicine and Therapies, April 7, 2021)

Coronavirus Questions:

Researchers in Taiwan found that the extract of Formosan elderberry is active against a common human coronavirus called NL63 (Virus Research, Nov. 2019). NL63 normally causes colds and other upper respiratory infections. Needless to say, no one has had a chance to study elderberry extract as a treatment for SARS-CoV-2, the coronavirus that causes COVID-19. Consequently, we do not know whether it would be helpful for a mild case.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
  • Macknin M et al, "Elderberry extract outpatient influenza treatment for emergency room patients ages 5 and above: A randomized, double-blind, placebo-controlled trial." Journal of General Internal Medicine, Nov. 2020. DOI: 10.1007/s11606-020-06170-w
  • Hawkins J et al, "Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials." Complementary Therapies in Medicine, Feb. 2019. DOI: 10.1016/j.ctim.2018.12.004
  • Tiralongo E et al, "Elderberry supplementation reduces cold duration and symptoms in air-travellers: A randomized, double-blind placebo-controlled clinical trial." Nutrients, March 24, 2016. DOI: 10.3390/nu8040182
  • Mohammadi Pour P et al, "The signaling pathways, and therapeutic targets of antiviral agents: Focusing on the antiviral approaches and clinical perspectives of anthocyanins in the management of viral diseases." Frontiers in Pharmacology, Nov. 8, 2019. DOI: 10.3389/fphar.2019.01207
  • Porter RS & Bode RF, "A review of the antiviral properties of black elder (Sambucus nigra L.) products." Phytotherapy Resarch, April 2017. DOI: 10.1002/ptr.5782
  • "Elderberry for Influenza." The Medical Letter, Feb. 25, 2019.
  • Wieland LS et al, "Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review." BMC Complementary Medicine and Therapies, April 7, 2021. DOI: 10.1186/s12906-021-03283-5
  • Weng JR et al, "Antiviral activity of Sambucus FormosanaNakai ethanol extract and related phenolic acid constituents against human coronavirus NL63." Virus Research, Nov. 2019. DOI: 10.1016/j.virusres.2019.197767
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