Accurate Education – Elderberry

Elderberry

Elderberry has been used for centuries and is currently one of the most-used medicinal plants worldwide, mostly to treat respiratory illnesses such as cold and flu. It is also believed that Elderberry may have anti-inflammatory, antiviral, and anticancer properties. The flowers and berries (blue and black only) are the plant parts used most often medicinally. They contain flavonoids, which have been found preclinically to possess a variety of biochemical and pharmacological actions, including antioxidant and immunologic properties.

Therapeutic Benefits of Elderberry

 Colds, Influenza and other Viral Infections

Elderberry has been used for centuries throughout the world, mostly to treat respiratory illnesses such as cold and flu. Evidence suggests that constituents in elder flower and berries may help reduce swelling in mucous membranes, such as the sinuses, and help relieve nasal congestion.

 A meta-analysis published in 2019 evaluating a total of 180 participants concluded that supplementation with elderberry was found to substantially reduce upper respiratory symptoms in routine cases of the common cold and influenza. While the extent of black Elderberry’s antiviral effects are not fully known, antiviral and antimicrobial properties have been found in Elderberry extracts.

An Israeli randomized, double-blind, placebo-controlled study of Sambucol in the treatment of influenza in 40 otherwise healthy individuals (children and adults) not previously vaccinated against the flu offers evidence of Sambucol’s benefit for influenza. In subjects who were analyzed, convalescent phase serologies demonstrated higher antibody titers to influenza B in the group treated with Sambucol, although statistically significant changes were lacking and only demonstrated a trend in favor of the treatment group. Follow-up of symptoms was adequately recorded over six days, and significant improvement in symptoms was observed in 93.3% of treated patients within two days, vs. the control group, in which it took six days to see improvement in 92.7% of patients. A complete cure was seen within 2–3 days in Sambucol-treated patients (90%), whereas six days were needed in the placebo group. Although randomization and blinding were adequately described, this study was limited by the small sample size, lack of intent-to-treat analysis, and use of influenza B rather than influenza A titer measurement.

Elderberry benefits with other corona viruses

Elderberry has been studied in other corona viruses including Human coronavirus NL63 (HCoV-NL63), one of the main circulating HCoVs in the fall and winter worldwide, causes respiratory tract illnesses like runny nose, cough, bronchiolitis and pneumonia and was responsible for a recent severe respiratory illness outbreak in a long-term care facility in Louisiana in winter 2017. Among the 20 cases aged from 66 to 96 in this outbreak, 6 patients developed pneumonia and had to be hospitalized and 3 patients died.

Product Variability

Elderberry Species and Cultivars – Why it Matters

Different elderberry products may vary widely in their quality based on their bioactive constituent content. Factors that come into play included the species variety, the source of extract, be it flower, stem or fruit, the conditions where it was grown and variables related to the product’s storage. It is important to keep these facts in mind when reviewing a publication reporting on elderberry’s therapeutic benefits or when selecting an elderberry product for consumption.

Elderberry Species

There are several species of elder, but Sambucus nigra, or European elder (also called black elder), is the one used most often for medicinal purposes. American elder or common elder (S. canadensis) and European elder (S. nigra) are often discussed simultaneously in the literature, since they have many of the same uses and contain common constituents. Other species with similar chemical components include antelope brush (Sambucus tridentata), blue elderberry (Sambucus caerulea), danewort (Sambucus ebulus), red-fruited elder (Sambucus pubens, Sambucus racemosa), and Sambucus formosana. Different species may have different constituents and different levels of constituents. Dwarf elder (Sambucus ebulus) should be avoided because it can be toxic. Additionally, raw or unripe fruit, as well as the leaves, seeds, and bark, contain a chemical related to cyanide, which is poisonous so one must use a trusted preparation of elder.

Elderberry Cultivars

A cultivar is a plant variety that has been cultivated by selective breeding in order to enhance certain properties of the plant such as size of fruit, resistance to freezing or pesticides or levels of specific chemical constituents. Elderberry shrubs grow in the wild, but there are also elderberry cultivars, the most popular of which are ”Sampo”, ”Samyl”, ”Alleso”,”Korsor”, and ”Haschberg.”  Elderberry is grown mainly for its fruit, which can be used to produce juices, soft and alcoholic beverages, marmalades, or colorants. Berries are rich in various bioactive compounds, the most important of which are polyphenols, including anthocyanins, and other phenolic compounds including caffeic acid, chlorogenic acid and quercetin derivatives. Compared with plants growing in the wild, cultivars bear more abundant c
rops of larger and heavier berries.

One study compared the mineral content and bioactive properties of flowers and fruit coming from wild elderberry plants with those of flowers and fruit harvested from elderberry cultivars grown in an orchard. Fruit showed significantly higher antioxidant activity than flowers, whereas the total phenolic content varied depending on the growing location or cultivar. The material obtained from selected cultivars growing in an orchard had higher antioxidant activity and polyphenol and anthocyanin content than the material obtained from wild plants. Fruit of the ”Haschberg” cultivar and flowers of the ”Sampo” cultivar had the best bioactive properties of the studied samples.

Elderberry Product Storage

Elderberry Storage is another variable that influences the quality of an eldeberry product. There can be a significant decline in bioactive content from three months to six months, and also from six months to nine months of frozen storage. As much as 80% bioactivity can be lost in 9 months of frozen storage.

For an excellent resource, see:

An Evidence-Based Systematic Review of Elderberry and Elderflower (Sambucus Nigra) by the Natural Standard Research Collaboration – PubMed – 2014

Available Products

“Sambucol” (Razei Bar Industries, Jerusalem, Israel) This standardized elderberry product is a syrup containing elderberry juice, raspberry extract, glucose, citric acid, and honey), is a 38% standardized black elderberry extract containing three flavonoids.

“Sambucol Active Defense” contains a 38% standardized black elderberry extract, plus vitamin C, zinc, propolis, and a proprietary blend of Echinacea angustifolia and Echinacea purpurea.

Rubini BioFlavonoides Elderberry Extract (Zertifikationsnr: IT-CDX 5987) is a monotherapy derived from elderberries, with no additives from animals or col- orings, and no preservatives

Sinupret (Quanterra Sinus Defense) is an herbal mixture of 18 mg of flos Sambucus nigra (elderflower), 18 mg of herba Verbenae off. (vervain wort), 6 mg of radix Gentianae luteae (gentian root), 18 mg of flos Primulae veris cum

Dose

Per IFM: 500 mg per day (of USP standard of 17% anthocyanosides)

Sambucol:

1 tbsp (15ml) four times daily for treatment of influenza symptoms

2 tsp (10ml) once a day for preventative management

With natural products it is often not clear what the optimal doses are to balance effectiveness and safety. Preparation of products may vary from manufacturer to manufacturer, and from batch to batch within one manufacturer. Because it is often not clear what the active component(s) of a product is, standardization may not be possible, and the clinical effects of different brands may not be comparable. Therefore, along with the notes above outlining the variability amongst elderberry plants and plant parts, caution is advised in the choice of product and it is recommended to use only standardized products such as Sambucol.

Mechanism of Action

A placebo controlled, double-blind study of Sambucol documented a rapid recovery from influenza and associated with the inhibition of replications of multiple strains of the flu virus. In this study the mechanism of action is believed to be rendering viruses nonfunctional by staining and coating them.

Elderberry modulate cellular defense and repair mechanisms and viral-induced pathological cellular processes. Caffeic acid significantly inhibited the replication of HCoV-NL63 and specifically blocked virus attachment.  Caffeic acid has also been reported to possess antiviral activity against hepatitis B and C viruses, influenza A virus, and herpes simplex virus. Other phenolic acid constituents found in elderberry, chlorogenic acid and gallic acid, have also been demonstrated to suppress replication of influenza A virus, enterovirus 71 and hepatitis B and C viruses.

Quercetin, also present in elderberry, promotes viral eradication or inactivation by inhibiting viral replication and reduces viral-induced pathological cellular processes. Quercetin functions as both an antioxidant and an anti-inflammatory as well a NRF2 activator. NRF2 (Nuclear factor erythroid 2-related factor 2) is a protein that regulates the expression of antioxidants that protect against oxidative damage triggered by injury and inflammation. NRF2 activation has been reported to suppress the NLRP3 inflammasome, leading to decreased production of IL-1𝛽, the master regulatory cytokine that activates other cells to produce other inflammatory cytokines.

(see Quercetin and NRF2 Activators)

Pharmacology

The flowers and leaves contain flavonoids, including quercetin (up to 3%), rutin, hyperoside and anthocyanins, as well as essential oils that are responsible for the muscat aroma characteristic of elder flowers. In the elderberry stems a pre-clinical study evaluating six phenolic acid constituents in a Sambucus FormosanaNakai stem ethanol extract, caffeic acid, chlorogenic acid and gallic acid sustained anti-HCoV-NL63 activity that was ranked in the following order of virus yield reduction: caffeic acid > chlorogenic acid > coumaric acid. The results revealed that Sambucus FormosanaNakai stem ethanol extract displayed strong anti- HCoV-NL63 potential and the caffeic acid had the highest anti-HCoV-NL63 potency and could be the vital component with anti-HCoV-NL63 activity.

Risk of Harm

Mild; caution w/autoimmune disease; uncooked/unripe plant parts toxic; USDA rated as Generally Recognized As Safe (GRAS)