Elderberry

What It Does

The berries are rich in anthocyanins, mainly cyanidin-3-glucoside and cyanidin-3-sambubioside. In cell studies, elderberry extracts block influenza virus attachment and replication, and an elderberry syrup increased production of inflammatory cytokines by immune cells (Barak 2001).

The human trials are small. In 60 Norwegian adults with influenza, elderberry syrup 15 mL four times daily relieved symptoms about four days sooner than placebo (Zakay-Rones 2004). In 312 air travelers, elderberry capsules did not prevent colds, but colds in the elderberry group were shorter and milder (Tiralongo 2016). A 2019 meta-analysis of four trials with 180 participants found a substantial reduction in upper respiratory symptoms (Hawkins 2019); the pooled trials were small, and some involved the product's manufacturer. Then the largest independent trial, in 87 emergency room patients with confirmed influenza, found that elderberry for five days did not shorten symptoms or viral shedding, and it was stopped early for futility (Macknin 2020).

During the COVID-19 pandemic, the cell-study cytokine data prompted warnings that elderberry might worsen a "cytokine storm." That concern was theoretical. No clinical report has documented it. The same data are the reason some clinicians avoid elderberry in autoimmune disease and with immunosuppressant drugs.

Raw berries, leaves, stems, and unripe fruit contain cyanogenic glycosides. A group in California became ill with nausea, vomiting, and weakness after drinking juice pressed from raw berries along with leaves and stems (CDC 1984). Commercial products are heat-treated.

Forms and Bioavailability

Absorption ratings are broad tiers. Head-to-head human trials rarely support a finer ranking among well-absorbed forms.

Labels column: number of labels named as elderberry products that list this form. A product can list more than one form, and some labels do not state a form at all.

Syrups and liquid extracts were used in the influenza trials; capsules were used in the travel trial. Gummies carry small amounts of extract in a sugar base, and few state anthocyanin content. American elder (Sambucus canadensis) is a related species without the same trial data.

Typical Dosing

Influenza trials used standardized syrup, 15 mL four times daily for 3-5 days from symptom onset. A travel trial used 600 mg of extract daily before the flight and 900 mg during symptoms.

What to Look For

Start within the first day or two of symptoms and use it for three to five days, not continuously; outside the air-travel trial there is no evidence for daily prevention. Syrups carry significant sugar, which matters for people with diabetes. Look for Sambucus nigra on the label and a stated extract amount or anthocyanin content.

Do not make elderberry preparations from raw or unripe berries, or from leaves or stems. Safety in pregnancy has not been established.

Red flags: gummies sold for year-round "immune support," homemade syrups from uncooked berries, and products that do not name the species. Green flags: Sambucus nigra named, extract quantity or anthocyanin content stated, and a dosing schedule measured in days.

Products on Titrate

1,826 of the 214,745 labels in the NIH Dietary Supplement Label Database list elderberry as an active ingredient (1,008 on market). 1,037 are sold as elderberry products by name.

Top on-market labels, ranked by label completeness and simplicity:

1. Europen Elderberry + PureWay-C + Zinc Emerald Labs · 500 mg as extract
2. Europen Elderberry + PureWay-C + Zinc Emerald Labs · 500 mg as extract
3. Sambucus Elderberry BioSchwartz · 500 mg
4. Black Elderberry Triquetra · 400 mg as extract
5. Elderberry Woodstock Herbal Products · 435 mg as extract

Open supplement search

Elderberry does not have its own search category yet. Each product above links to its full label in the NIH database.

Related Tools

• Elderberry Extract vs Elderberry Syrup
• Elderberry Extract vs Elderberry Gummies
• Elderberry Gummies vs Elderberry Syrup
• All elderberry form comparisons
• All supplement guides

References

National Center for Complementary and Integrative Health. European Elder.

Centers for Disease Control (CDC). Poisoning from elderberry juice: California. MMWR Morb Mortal Wkly Rep. 1984;33(13):173-174.

Barak V, Halperin T, Kalickman I. The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. Eur Cytokine Netw. 2001;12(2):290-296.

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-travellers: 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.

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.