Elderberry and elder flower (Sambucas nigra L.)
Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
Almindelig hyld, baccae, baises de sureau, battree, black berried alder, black elder, black elderberry, boor tree, bountry, boure tree, Busine (Russian), Caprifoliaceae (family), cyaniding-3-glucoside, cyaniding-3-sambubioside, devil's eye, elderberry, elderberry anthocyanins, elderberry bark agglutinin, elderberry juice, ellanwood, ellhorn, European alder, European elder, European elderberry, European elderflower, European elder fruit, frau holloe, German elder, Holunderbeeren, Holunderblüten, lady elder, nigrin b, old gal, old lady, peonidin 3-glucoside, peonidin 3-sambubioside, peonidin monglucuronide, pipe tree, Rubini® (elderberry extract), sambreo (Italian), sambuco (Italian), Sambucus sieboldiana (Japanese), Sambucipunct Sambucus, Sambuci flos, Sauco (Spanish), Schwarzer holunder (German), sieboldin-b, stinking elder, Sureau noir (French), sweet elder, tree of doom, yakori bengestro.
Several species of Sambucus produce elderberries. Most research and publications refer to Sambucus nigra. Other species with similar chemical components include the American elder or common elder (Sambucus canadensis), antelope brush (Sambucus tridentata), blue elderberry (Sambucus caerulea), danewort (Sambucus ebulus), dwarf elder (Sambucus ebulus), red-fruited elder (Sambucus pubens, Sambucus racemosa), and Sambucus formosana. American elder (Sambucus canadensis) and European elder (Sambucus nigra) are often discussed simultaneously in the literature since they have many of the same uses and contain common constituents.
European elder grows up to 30 feet tall, is native to Europe, but has been naturalized to the Americas. Historically, the flowers and leaves have been used for pain relief, swelling/inflammation, diuresis (urine production), and as a diaphoretic or expectorant. The leaves have been used externally for sitz baths. The bark, when aged, has been used as a diuretic, laxative, or emetic (to induce vomiting). The berries have been used traditionally in food as flavoring and in the preparation of elderberry wine and pies.
The flowers and berries (blue/black only) are used most often medicinally. They contain flavonoids, which are found to possess a variety of actions, including antioxidant and immunologic properties. Although hypothesized to be beneficial, there is no definitive evidence from well-conducted human clinical trials currently available regarding the use of elder.
The bark, leaves, seeds, and raw/unripe fruit contain the cyanogenic glycoside sambunigrin, which is potentially toxic.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Elderberry juice may improve flu-like symptoms, such as fever, fatigue, headache, sore throat, cough, and aches, in less time than it normally takes to get over the flu. Additional research is needed in this area before a firm conclusion can be reached.
Elder has been observed to reduce excessive sinus mucus secretion in laboratory studies. There is only limited research specifically using elder to treat sinusitis in humans. Combination products containing elder and other herbs (such as Sinupret®) have been reported to have beneficial effects when used with antibiotics to treat sinus infections, although the majority of this evidence is not high quality and requires confirmation with better research.
There is a small amount of research on the combination herbal product Sinupret® in patients with bronchitis. This formula contains elder flowers (Sambucus nigra) as well as gentian root, verbena, cowslip flower, and sorrel. Although benefits have been suggested, due to design problems with this research, no clear conclusion can be drawn either for Sinupret® or elder in the management of bronchitis.
Reliable human evidence is currently unavailable evaluating elder alone as a treatment for high cholesterol. Early study reports that elderberry juice may decrease serum cholesterol concentrations and increase low-density lipoprotein (LDL or "bad" cholesterol) stability. Additional research is needed in this area before a firm conclusion can be reached. Elder should not be used in the place of other more proven therapies, and patients are advised to discuss with their primary healthcare provider before using elderberry for treatment of high cholesterol.
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.
Alzheimer's disease, angioprotectant, anti-inflammatory, antioxidant, antispasmodic, asthma, astringent, blood vessel disorders, burns, cancer, chafing, circulatory stimulant, cold sores, colds, colic, cough suppressant, dental plaque and gingivitis, diabetes, diuresis (urine production), edema, epilepsy, fever, flavoring, fragrance (perfume), gout, gut disorders, hair dye, hay fever, headache, herpes, HIV, immune stimulant, increased sweating, insomnia, joint swelling, kidney disease, laryngitis, laxative, liver disease, measles, migraines, mosquito repellant, nerve pain, osteoporosis, psoriasis, respiratory distress, sedative, skin infections, stomach ulcers, stress reduction, syphilis, toothache, ulcerative colitis, vomiting, weight loss.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
Patients were given 400 milligram spray-dried powder capsules containing 10% anthocyanes three times a day equivalent to 5 milliliters of elderberry juice for two weeks in one study for high cholesterol.
For treating influenza or flu-like symptoms, a dose of 4 tablespoons of elderberry extract taken daily by mouth for three days has been used.
Cream has been prepared by taking several handfuls of fresh elder flowers, mixing in liquefied petroleum jelly, simmering for 40 minutes, heating, filtering, and allowing the formula to solidify. This has been applied to the hands at bedtime.
For bacterial sinusitis, a dose of two tablets of Sinupret® taken by mouth three times daily with antibiotics has been used. Sinupret® contains elder and several other herbs.
15 milliliters of elderberry syrup has been taken four times a day for five days for influenza symptoms.
A dose of 3-5 grams of dried elder flowers steeped in one cup of boiling water for 10 to 15 minutes and three times daily has been taken by mouth. Be aware of possible toxicity.
Children (younger than 18 years)
There are no standard or well-studied doses of elder, and many different doses are used traditionally. There is not enough scientific information available to recommend the safe use of elder in children. Toxicity has been reported, and caution is recommended.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Avoid elder in patients with known allergy to plants in the Caprifoliaceae family (honeysuckle family). There are some reports of allergies in children playing with toys made from fresh elder stems.
Side Effects and Warnings
Elderberry products should be used under the direction of a qualified healthcare provider because of the possible risk of cyanide toxicity, especially from elder bark, root, or leaves.
There are reports of gastrointestinal distress, diarrhea, vomiting, abdominal cramps, and weakness after drinking elderberry juice made from crushed leaves, stems, and uncooked elderberries. Notably, the berries must be cooked to prevent nausea or cyanide toxicity.
Allergies are possible from fresh elder stems and may include rash, skin irritation, or difficulty breathing.
In theory, high doses or long-term use of elder flowers may have diuretic (urine-producing) effects. People taking diuretics or drugs that interact with diuretics should use caution when taking products containing elder.
Elder may also lower blood sugar levels. Additional blood tests may be necessary. Dizziness, headache, convulsions, and rapid heart rate have also been reported.
Pregnancy and Breastfeeding
Elder cannot be recommended during pregnancy or breastfeeding based on a theoretical risk of birth defects or spontaneous abortion. Gastrointestinal discomfort in pregnant women taking elderberry has been reported.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Elder may possess diuretic (urine producing) effects and should be used cautiously with drugs that increase urination. Elder may possess laxative effects, and should be used cautiously with other laxatives.
Elder may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. A qualified healthcare provider should monitor patients taking drugs for diabetes by mouth or insulin closely. Medication adjustments may be necessary.
The flavonoid quercetin, which is found in elder, has been reported to inhibit xanthine oxidase, and may affect caffeine and theophylline levels. Patients using theophylline should speak with their healthcare provider before using elder.
Elder may increase the effects and possible adverse effects of some cancer chemotherapies.
Based on preliminary research, increased benefits may be seen when elder is used in combination with antibiotics and decongestants, such as oxymetazoline (Afrin®). Elder flowers may possess anti-inflammatory properties and may add to the effects of some drugs that also decrease inflammation.
Interactions with Herbs and Dietary Supplements
Elder may possess diuretic (urine producing) effects and should be used cautiously with herbs that may increase urination, such as artichoke, dandelion, or horsetail.
Elder may possess laxative effects and should be used cautiously with herbs that may also have laxative effects, such as alder buckthorn, Dong quai, or psyllium.
Elder may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar such as aloe, burdock, fenugreek, maitake mushroom, or milk thistle. Blood glucose levels may require monitoring, and doses may need adjustment.
Increased effects may be seen when elder is used in combination with other antioxidants, such as vitamin C or flavonoids like quercetin.
Taking sucrose (a type of sugar) and elder together may decrease elimination of the anthocyanin component of elder.
Elder may also interact with herbs and supplements with anticancer, antibacterial, decongestant, and anti-inflammatory activities.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Barak V, Birkenfeld S, Halperin T, et al. The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines. Isr Med Assoc J 2002;4(11 Suppl):919-922. View Abstract
Bitsch I, Janssen M, Netzel M, et al. Bioavailability of anthocyanidin-3-glycosides following consumption of elderberry extract and blackcurrant juice. Int J Clin Pharmacol Ther 2004;42(5):293-300. View Abstract
Ernst E, Marz RW, Sieder C. [Acute bronchitis: effectiveness of Sinupret. Comparative study with common expectorants in 3,187 patients]. Fortschr Med 4-20-1997;115(11):52-53. View Abstract
Forster-Waldl E, Marchetti M, Scholl I, et al. Type I allergy to elderberry (Sambucus nigra) is elicited by a 33.2 kDa allergen with significant homology to ribosomal inactivating proteins. Clin Exp Allergy 2003;33(12):1703-1710. View Abstract
Guo CT, Takahashi N, Yagi H, et al. The quail and chicken intestine have sialyl-galactose sugar chains responsible for the binding of influenza A viruses to human type receptors. Glycobiology 2007 Jul;17(7):713-24. View Abstract
Gray AM, Abdel-Wahab YH, Flatt PR. The traditional plant treatment, Sambucus nigra (elder), exhibits insulin-like and insulin-releasing actions in vitro. J Nutr 2000;130(1):15-20. View Abstract
Hassid S, Choufani G, Nagy N, et al. Quantitative glycohistochemical characterization of normal nasal mucosa, and of single as opposed to massive nasal polyps. Ann Otol Rhinol Laryngol 1999;108(8):797-805. View Abstract
Jaber R. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Prim.Care 2002;29(2):231-261. View Abstract
Konlee M. A new triple combination therapy. Posit Health News 1998;(No 17):12-14. View Abstract
Milbury PE, Cao G, Prior RL, et al. Bioavailablility of elderberry anthocyanins. Mech Ageing Dev. 4-30-2002;123(8):997-1006. View Abstract
Neubauer N, März RW. Placebo-controlled, randomized double-blind clinical trial with Sinupret® sugar coated tablets on the basis of a therapy with antibiotics and decongestant nasal drops in acute sinusitis. Phytomedicine 1994;1:177-181.
Richstein A, Mann W. [Treatment of chronic sinusitis with Sinupret]. Ther Ggw 1980;119(9):1055-1060. View Abstract
Roy S, Khanna S, Alessio HM, et al. Anti-angiogenic property of edible berries. Free Radic Res. 2002;36(9):1023-1031. View Abstract
Wu X, Cao G, Prior RL. Absorption and metabolism of anthocyanins in elderly women after consumption of elderberry or blueberry. J.Nutr 2002;132(7):1865-1871. View Abstract
Zakay-Rones Z, Thom E, Wollan T, et al. 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. View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017