Monday Health & Wellness: Is Elderberry Really The Best Flu Remedy?

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Right now, there is a lot of hype about how bad the flu season is.  I am not sure how true this is because I’ve seen very little data about the actual numbers of people are getting sick, and the only reported deaths (that I have seen) have been in the elderly.  But let’s suppose that this is a really bad flu season, like everyone’s saying.  There are two general camps right now:

If you’ve been around for any length of time, then you know I don’t think the flu shot is a good idea.   Elderberry has been hailed as a completely safe, natural, effective alternative remedy.  But…is it?

Natural Remedies Warrant Caution Too

Natural remedies aren’t without their drawbacks.  They are not necessarily safe just because they are “natural.”  Natural things can be poisonous, or can affect certain people adversely.  Natural remedies are potent and serious.  We must never make the mistake of thinking that natural remedies are safe simply because they are natural.

Some natural remedies are truly unsafe for certain people.  Alfalfa, for example, because it is high in vitamin K, can cause problems in people who have blood clotting disorders and even increase the likelihood of stroke or autoimmune conditions!  It must be used with caution in vulnerable populations, despite that it is beneficial to many.  (Yes, it’s in my pregnancy tea recipe…and for the average woman or especially those who are at risk of hemorrhage, it is a good idea.  For anyone who has lupus, autoimmune, or blood clots, it is not.)

Elderberry has been hailed as safe because, well, it’s a food.  We eat elderberry in pies!  Surely it can’t be dangerous if it is consumed this way?

Unfortunately, I’ve run across new evidence that elderberry’s effects are truly potent…and not necessarily beneficial to all people, in all cases.

 (You can buy elderberries here.)

Image by Girl Interrupted Eating

Taking a Closer Look at Elderberry

As it turns out, from my early research, elderberry is very potent.  This is both good and bad.  It’s good because, well, it works — it’s not some sort of “placebo effect” or wishful thinking.  It’s bad because of the way it affects people — at least some people.

Elderberry does have a strong effect on flu:

Sambucol was shown to be effective in vitro against 10 strains of influenza virus. In a double-blind, placebo-controlled, randomized study, Sambucol reduced the duration of flu symptoms to 3-4 days.

Other studies confirm this:

A significant improvement of the symptoms, including fever, was seen in 93.3% of the cases in the SAM-treated group within 2 days, whereas in the control group 91.7% of the patients showed an improvement within 6 days (p < 0.001). A complete cure was achieved within 2 to 3 days in nearly 90% of the SAM-treated group and within at least 6 days in the placebo group (p < 0.001).

This study also shows that elderberry is effective in preventing viral infections like flu.

However, elderberry was discovered to also have this:

We conclude from this study that, in addition to its antiviral properties, Sambucol Elderberry Extract and its formulations activate the healthy immune system by increasing inflammatory cytokine production.

Another study shows the same thing:

The Sambucol preparations increased the production of five cytokines (1.3-6.2 fold) compared to the control.

That is what concerns me.

Children who develop ASD (Autism Spectrum Disorders) were shown to have depressed immune systems and decreased cytokine production (at birth), including low TH-2 levels (newborns should be TH-2 dominant because this protects the mother from rejecting the baby as a foreign object).  However, later, after an official diagnosis, they were shown to have increased levels of cytokines, especially those with regressive autism.  In that second study, they specifically note this:

Moreover, when the ASD group was separated based on the onset of symptoms, it was noted that the increased cytokine levels were predominantly in ASD children who had a regressive form of ASD. In addition, increasing cytokine levels were associated with more impaired communication and aberrant behaviors.

Certain cytokine increases (there are several types) were associated with an increase in asthma, including severe attacks.  Disorders of cytokine regulation are also linked to autoimmune conditions.

Then there is this:

Severe influenza is characterized by cytokine storm and multiorgan failure with edema.

This study also shows that cytokine storm is associated with severe flu.

Plus this:

Principal-component analysis of the data reveals three clusters of similar cytokine responses: [TNF-α, IL1, IL10], [IFN-γ, IL2, IL4, IL8, and IL12], and [IL6]. IL1, IL6, IL10, and TNF-α have the highest degree of variability in response to uncertain initial conditions, exogenous effects, and parameter estimates.

So, increased cytokine levels — especially long-term — are not exactly beneficial.  And anything that might increase cytokine levels too much, especially the inflammatory cytokines, could contribute to various severe or long-term illnesses.  Some of the major cytokines associated with the dangerous cytokine storm (IL-6, IL-10, TNF) were increased by the use of elderberry!

 (You can buy elderberries here.)

Image by BLESS_PICTURES

Is Elderberry Good or Bad?

Well, all that confuses the issue.  Elderberry increases the production of pro-inflammatory cytokines, which may be associated with a cytokine reaction and severe complications.  But, elderberry has never been specifically associated with a cytokine storm, nor causing any problems with immune function.  It appears only to boost these cytokines at the time of illness in order to fight it off faster.  Based on what the studies show, in otherwise healthy individuals, the boosting of these cytokines may be what helps to fight off the infection more quickly.

Interestingly, elderberry has also been shown to have anti-bacterial properties, including against a couple of strains of strep bacteria (including Streptococcus pyogenes, which is responsible for many strep throat infections).  That study also notes that elderberry may be useful in preventing complications of viral illnesses, like bacterial pneumonia, and because its protection is “non-specific,” infections would not become resistant to it as they do to antibiotics.   (You can buy elderberries here.)

This study shows that chronic (daily) consumption of elderberry wasn’t effective at increasing overall health (by measures of liver and kidney function), but appeared to be safe.

Mixing lemon juice and elderberry appears to increase the shelf life as well as preserve vitamin C, another important nutrient in fighting off respiratory infections.

The bottom line of all of this?  Elderberry has many amazing properties and appears safe in all studied populations.  I would recommend, personally:

  • Taking elderberry in fairly large/frequent doses only at the onset of illness or upon exposure, but not all the time (up to 1 tsp. per hour for children under 6, and up to 1 tbsp. per hour for older children/adults).
  • Continuing use for 2 – 5 days as needed, then discontinuing
  • Caution is warranted in individuals with autoimmune conditions, who may be better off choosing a different remedy due to their disturbed cytokine production

These guidelines are a bit different from what most say, which is that a daily dose is a good idea.  Elderberry is so potent and powerful that it ought to be treated like medicine more than food.  It should be safe for pregnant and breastfeeding moms (whose immune systems may be lowered, especially in pregnancy, and could benefit from the boost) and there has been no report of any adverse effects from use in these cases.

Based on all of this research, I will post a new elderberry syrup recipe next week that incorporates the best combination of natural remedies.  This syrup may also be used for certain bacterial infections and I recommend using FCLO in larger doses along with it.  (You can buy elderberries here.)

Image by RobotSkirts

What Else Helps?

Fermented foods, especially true lactic-acid ferments (anaerobic ferments) have been shown to activate the TH-1 immune system and prevent viral infection.  Consuming fermented foods regularly may help to prevent illness.  Fermented milk products ( yogurt, kefir) containing lactic-acid bacteria were associated with a lower risk of allergies.  (More evidence.)  Kimchi is beneficial against food-borne illness.  Kombucha may repair damage caused by environmental irritants and help kidney function.

Ginger may be helpful with respiratory infections, and has been shown to have anti-inflammatory effects, including inhibiting the TNF-alpha   cytokine.  Fresh ginger (but not dried) was also shown to be beneficial in preventing/helping RSV.

Very early research shows that pomegranate juice may be effective against flu, stomach flu (norovirus), and other infections.  Pomegranate, actually, has also been shown to possibly prevent and even cure cancer of the breast, prostate, and colon.

Cod liver oil is especially beneficial.  It contains vitamins A and D, which have benefits in immune function.  It may also protect against or slow the development of heart disease.  It has anti-inflammatory properties as well.  It may decrease the risk of respiratory illness (more evidence).  It also affects the fat-soluble vitamin content of breastmilk.  It may play a protective role against cancer death, and help rheumatoid arthritis.  It may reduce the risk of type I diabetes (other vitamin D supplements didn’t show the same effect), also reduces risk when pregnant women take it (other vitamin D and multivitamin supplements didn’t show the same effect).  It’s beneficial for eye health and may decrease the risk of glaucoma and associated blindness.

The Bottom Line

Treat elderberry as the medication that it is, rather than “just a food.”  Consider using additional natural remedies or using some of the other remedies in its place, depending on your circumstances.

Yes, I had way too much fun doing all that research.  It took about 4 hours to do it all, but I feel like I’ve learned so much (you can read all the studies I did by clicking the links throughout the text).  I hope to bring you all more posts in the next few weeks based on all I have learned from writing this one!

 (You can buy elderberries here.)

Do you use elderberry?  Why or why not?

Comments

  1. Rebecca says

    Very well said. That is the same research I found when deciding if I should give this to my children. You need to treat it with respect, as with all herbal/natural remedies. I can’t stand when people are under the impression that because something is natural there is no harm. They are also like drugs (to me) and people can get in the habit of over doing the natural things too. Our bodies (according to one naturopath) need to fight things on our own too, and not become addicted to “natural” medicine too.

  2. Cassandra says

    Well done research! I’ve been making my own
    This winter- and all if these herbal and homeopathic
    Are fairly brand new to me. I do have a concern
    For myself though- I have lichen schlerosus and
    Psoriasis which are autoimmune conditions.
    Everything that I make for winter medicine has
    Elderberry or echinacea in the preparation. Any thoughts
    On this re- I don’t experience flares or problems
    When I ingest these things but I wonder if I’m
    Setting myself up for future problems.
    Thanks for all that you do and share!

  3. says

    I love this post. I will be referring back to it quite often! Thank you! When you post the recipe (which I am hugely looking forward to) can you please specify whether maple syrup is ok to make it with instead of honey? I have not seen a recipe that does, and I try to avoid honey for my son. Thanks Kate!

  4. says

    Thank you for this information. I think it’s very important to always delineate the risks involved with natural remedies in particular, since many people assume that just because it’s natural means it’s safe.

    I would add to the list turmeric milk. I just got over fighting off a nasty cold that would have turned into something worse back when I wasn’t doing all this weird stuff lol. I used a combination of elderberry, apple cider vinegar (for sore throat), green tea with ginger and honey, and turmeric milk 3 times a day. Gone in two days!!

    I’m gonna try the pomegranate juice next time. Thanks again and I enjoy your work!

  5. Stefanie says

    Great info to know. I still need to make this and haven’t done it yet. I was thinking of taking it everyday but now I will definitely reevaluate that decision. Thank you!!

  6. Lisa Wilson says

    I made elderberry jelly & know people who eat it lots .Lots of foods have different properties ,but it doesn’t make them bad to use as daily foods. The pioneers used them for main fruit in some places. Broccoli will cause blood to clot & your blood thinner not to work as well. Garlic will thin your blood & cause you to bleed to much , if taking blood thinners. I think in moderation they are all ok for foods, as they have important nutrients in them. Potatoes,mushrooms & soybeans pick up pesticides more than any other foods.There are lots of facts we can learn about all foods if do some research on them. God bless.

    • Kate Tietje says

      It is probably okay for most people to eat on occasion…but we do need to be careful, with anything. A good balanced diet is key. Food is medicine and we can’t forget that.

  7. says

    This was great information…I had read about the cytokine storms in younger folks during the Spanish flu of 1910 causing great problems. Also, as I have some autoimmune issues, I have tried to find things that may help or note what could hinder. (Like Echinacea is not great for folks with screwy immune systems–overstimulates) Never knew about alfalfa…thanks. But, I am confused–so you say the elderberry is OK for those of us with autoimmune (MS, Fibromyalgia, lupus, EBV type things) for short term use (as in treating the flu is more important) or is it better to try another route? (Like ginger, baking soda/water dosing,or ACV–things that alkylize the body) I realize this is just a discussion not medical advise–but your research is very good. Have you looked at that occillo stuff? Heard mixed things….Thanks. Lovely site :)

    • Kate Tietje says

      I probably would not use it in someone with an autoimmune condition…just in case. I would try the other remedies you noted first or similar approaches. I love ginger because it is such an inexpensive, versatile, and effective remedy. Garlic may also be beneficial. I am aware of the occillococcinum but have not researched it much so I can’t really say if that is a good option or not. I have *heard* that it mixes homeopathic remedies and a homeopath told me that is not a good idea…but that is all I know on it.

      • says

        Thanks Kate… I used ginger –Love the flavor, but have heard that it can affect blood clotting (thinning blood) if used in larger ammounts??…guess there is no “perfect” answer. Garlic is great as well (Yumm) and versatile–I was told it can be used topically or in carrier oil for things as well, but not applied directly/raw as it might burn. Nature is a wonderful pharmacy! Thanks again…

      • says

        We have used Boiron’s Oscillococcinum multiple times and I love it! In fact, I kicked the flu just last month by using elderberry and Oscillococcinum– woke up with aches and all the flu symptoms, took those two remedies like crazy, and the symptoms disappeared by the next day, leaving me with nothing worse than a mild cold.

        After eight years of having it on hand and using it at least every other winter, I think Oscillococcinum really works. :)

  8. LBR says

    thanks for the good information. as for oscillococcinum, there are different schools of thought when it comes to homeopathy and while some homeopaths adhere to the single remedy practice, there are many homeopaths who regularly and successfully treat with combination remedies. for the flu, muccococcinum (similar to oscillococcinum) is a good choice as a preventive (and treatment) taken once every other week during flu season.

  9. says

    Interesting info. I would be interested in knowing who backed those studies about elderberry. Natural or conventional researchers? I really hope people aren’t scared away from using elderberry because it really is a wonderful remedy. We take it daily during cold and flu season (with breaks here and there) and swear by it.

  10. Liz says

    Hi, thanks for this information although I am still confused. My family and I all get asthma on occasion….so should we use elderberry or not? What about elderflower, could we substitute that – would it have a milder effect?

    Once again, thanks for posting this.

    Liz xx

  11. Kathie says

    Though I completely agree with being as cautious with “natural remedies” as with medicines…I am confused by an apparent contradiction in your post. You say because elderberry increases the cytokines that it should not be taken daily, but then you say that it only increases the cytokines during illness…so why not take it daily during flu season?

    Thanks in advance for clarification.

    • Kate Tietje says

      Hi Kathie,

      Elderberry can increase cytokines whenever it is taken, but that’s not something we want unless there is illness. Continuous increase can be related autoimmune disorders.

  12. says

    I was curious if you and anyone had heard of or experienced a heightened immune response when using elderberry. I mean really heightened: I am fighting some kind of upper respiratory infection that has cough and fever but nothing else, and my fevers have been very high, like 103-104+ especially if I bundle up. I have been using my elderberry syrup that I made a couple weeks ago for my hubby who had it as a really nasty cold. I’m just wondering if all I’m doing, the elderberry, thieves oil, vit D and cod liver oil is putting my immune system into overdrive.

  13. Brandy Mills says

    I just came across this article while researching ways to get children to take FCLO. Elderberry syrup came up a few times and I was wondering if it was a good idea to have them taking a dose everyday. I really appreciate the way you presented your information. Thank you! Still looking for ways to get my children to take FCLO since we are a little late in the game…

  14. says

    Thanks for the work, but I think your warning is unwarranted based on your admittedly limited research. In any case, following your advice one would limit the possible effectiveness of elderberry. From the experience of two cold-and-flu-prone people, taking several tablespoons of tea brewed from elderberry berries two to four times a day for four years, it entirely (for us) prevents colds, flu and bacterial infections, seemingly curing annoying chronic bacterial and viral problems of many years duration — curing in the sense that these conditions have simply disappeared. Isn’t it better — much better — to eliminate/prevent these conditions then to treat them after they break out, when, for example, according to research, elderberry only lessens flu symptoms and shortens the duration of flu attacks? Moreover, according to new research, elderberry prevents cancer — at least prostate cancer! — in mice and apparently other conditions as well. According to researchers in Jerusalem who have studied elderberry, it seems safe. So perhaps you are jumping the gun. — Jared Israel

    • Jennifer Harper says

      According to other medical sites elderberry extract does come with some warnings. Elderberry is potent and that’s why it may not be a good thing for all people / in all cases. Usually something that works always comes with warnings. I would hardly call caution with a potent substance “jumping the gun.”

      “Precautions

      The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should should herbs only under the supervision of a health care provider.

      Do not use unripe or uncooked elderberries. They may be poisonous.

      Elderberry appears to have few side effects when used properly for short periods of time (up to 5 days).

      Pregnant and breastfeeding women should not take elderberry.

      If you have an autoimmune disease, such as rheumatoid arthritis or lupus, you should ask your doctor before taking elderberry, as it may stimulate the immune system.

      Possible Interactions

      If you are being treated with any of the following medications, you should talk to your health care provider before taking elderberry:

      Diuretics (water pills) — Diuretics help the body get rid of excess fluid and increase the amount of urine your body makes. Elderberry may also act as a diuretic, so taking it along with a diuretic could make that drug stronger and raise your risk of dehydration. Diuretics include:

      Hydrochlorothiazide
      Bumetanide (Burinex)
      Furosemide (Lasix)
      Amiloride (Midamor)
      Metolazone (Zaroxolyn)
      Diabetes medications — Elderberry may lower blood sugar levels. If you are also taking drugs for diabetes, taking elderberry may increase your risk of developing hypoglycemia, or low blood sugar.

      Chemotherapy — Elderberry may interact with some chemotherapy drugs. If you are undergoing chemotherapy, ask your oncologist before taking any herb or supplement.

      Laxatives — Elderberry may act like a laxative and should not be taken at the same time as other laxatives.

      Theophylline (TheoDur) — Elderberry may reduce levels of theophylline, a drug taken for asthma and other respiratory conditions. That could make the drug not work as well.

      Drugs that suppress the immune system — Because elderberry may stimulate the immune system, it could interfere with medications taken to suppress the immune system. These medications include corticosteroids (prednisone) and medications used to treat autoimmune diseases. People with organ transplants should also avoid elderberry.”

      Source: Elderberry | University of Maryland Medical Center http://umm.edu/health/medical/altmed/herb/elderberry#ixzz34fChO7AF
      University of Maryland Medical Center
      Follow us: @UMMC on Twitter | MedCenter on Facebook

  15. says

    Thanks for the info! I love that you share your research and conclusions with us freely. I appreciate that there are others who have the time, patience, whatever to do all this. Especially for people like me who are trying to play ‘catch up’ a bit with these topics :)

  16. Tammy says

    Well, I’m thoroughly confused now. I am 33 weeks pregnant and yesterday I took 4 doses of elderberry syrup due to flu symptoms. You say, this is give my unborn child chances of autism?

    • says

      Hi Tammy,

      That’s extremely unlikely. There’s a tiny chance if a child already has chronic inflammation that elderberry could cause problems, but it would have to be in high doses over a long period. The average person will do just fine with it.

  17. Jennifer says

    My 4 month old and I have the flu. The elderberry syrup I got said not for lactation or pregnancy, and for 2 years and older. Would you give this to your baby?

  18. Katie Machek says

    I would like to begin by saying that I also firmly believe that herbal preparations and natural medicines in general need to be treated with respect, and one should do ample research or seek the advice of a professional herbalist or natural healer before implementing the long-term use of any herb or natural remedy. Also, of any blog on the web that discusses natural medicine and herbal healing methods as a means of leading a healthy lifestyle, this by far has the most extensive research I’ve seen. As a scientist myself, I appreciate that very much. I did, however, find your article lacking in a general understanding of how scientific studies are meant to be interpreted. The scientific studies you have quoted here are carried out independently from one another. To draw any type of relationship between them as a means to demonstrate- or imply, as you have done here- some kind of causal relationship is a fallacy. More specifically, you seem to imply a causal relationship between the increase in cytokine production associated with Sambucol and the increased cytokine levels associated with ASD/severe influenza/asthma/autoimmune disorders. In order to scientifically produce some kind of causal relationship between the use of Sambucus preparations and the types of cytokine storms that are related to ASD/severe influenza/asthma/autoimmune disorders, one would have to conduct separate experimental research studies on each variable in relation to the use of Sambucol. The mechanism involved with cytokine production and immune function is too intricate and delicate a process to simply surmise Sambucol’s effect on its function and regulation without proper scientific experimentation. Your article would make an excellent discussion section of such a study, but to draw such relationships based on opinion and rhetoric alone is misleading, and misinformative. I am an advocate for the daily use of Sambucus preparations during cold and flu season in healthy individuals. I think that this article instills an unnecessary amount of fear into people who are seeking a healthy alternative to western medicine and OTC options to treat cold and flu symptoms or as a preventative measure to prevent such illnesses. I can see where one with an autoimmune disorder may want to operate from the precautionary principle when considering whether or not to take elderberry, and for that I appreciate the inclusion of this consideration in your article. I have a problem, however, with the inclusion of the ASD study, which seemed to me to be irrelevant to your main argument, seeing as how later in the article you state that “ It should be safe for pregnant and breastfeeding moms (whose immune systems may be lowered, especially in pregnancy, and could benefit from the boost) and there has been no report of any adverse effects from use in these cases.” Were you including the ASD study specifically to address a word of caution to the use of Sambucol in infants/toddlers/children? If so, I would have specifically said so. If not, I’m not sure why the study is included, aside from the fact that it may have been an opposing opinion to the “elderberry is safe,” mantra for you to work with in this article. Even then, though, the ASD study did not have anything specifically to do with Sambucol and it’s relation to ASD, so it provides no supporting or opposing evidence whatsoever to the “is elderberry safe,” debate. On a more personal note, as a mom (one who is expecting kiddo number two, at that) I pay very close attention to any article or study that suggests a relationship between any environmental factor and autism, since the rate of autism in this country is so astoundingly high and the scientific community is still trying to pinpoint exactly what factor (or factors) cause autism. I personally would not even bring up the issue of autism unless there was a solid and statistically sound study that provided evidence to support my argument. I understand that it is necessary and important to do rigorous scientific research when adopting alternative medicine into ones lifestyle- a step that most people do not do, either because they feel overwhelmed or because they do not know how to properly analyze scientific papers- however one must weed through the evidence tactfully in order to reach sound conclusions.

  19. Glenda says

    Thanks for your hard work/research. Stephen H. Buhner in his book Herbal Antivirals does an outstanding job as well explaining cytokine cascades/storms and Elderberry usage. He is one of the few Master Herbalists I trust. We know Elderberry works from personal experience with flu. However, fantastic alternatives to consider are Boneset and Lomatium Dissectum and Baikal Skullcap. I agree with all here that herbal medicine must be respected and used with great care and caution. Blessings to all and God blessl.

  20. Phranque says

    Thank You for doing all of this ” footwork ” and letting us all know about the possible side effects. I love this stuff ! I am a firm believer but I also need to know what I might be getting in to ………. I have found conflicting info on other sites about H5N1 virus strain efficacy. One site said that it was 99% effective ……. another site said to stay away from ELDERBERRY because it increases TNFa and IL-6 . WOW …. polar opposites ! …… THANKS AGAIN SO MUCH !!!!!!!!!!!! ……. ya might wanna put a picture of elderberry up though , your picture shows privet berries as of now ……..

  21. Jennifer Harper says

    Thank you for the info. I personally am a believer in taking Sambucol. I haven’t ventured into making an extract for myself. In any case, I think caution is a good thing and I love reading information about the health effects of herbs and plant extracts.

  22. Talisha says

    Kate, it’s always so refreshing to see a site that includes so much research. I know that takes loads of time, so thank you for doing it.

    Question: I noticed you suggested taking elderberries along with FCLO. I’ve read so many good things about it, but I’m currently pregnant and my doctor is concerned that taking it along with my prenatals could be a risk because of vitamins A and D being in both the prenatals and FLCO. I know that FLCO has natural vitamin A and D, and that most CLO has synthethic A and D. Have you seen any research on the safety of taking FLCO or CLO along with prenatals? I am currently taking prenatals from Metagenics called Wellness Essentials. I was also wondering about the safety of it if I took FLCO or CLO along with prenatals while breastfeeding.

    • says

      Hi Talisha,

      There is honestly not much research out there on FCLO at all. But the research I’ve seen into natural vit A shows it’s really hard to overdose or hurt the baby. Many women (including me) took FCLO throughout pregnancy with no issue. http://www.westonaprice.org also has an article on it.

  23. says

    Interesting article! I have an inflammatory inner ear condition that causes chronic dizziness and the day after taking home made elderberry syrup w/honey (at 1 TBPS every 2 hours), I had bad vertigo. I’m wondering now if the inflammatory response from elderberry made my inner ear condition worse? The good news is that it stopped my cold dead in its tracks.

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