Sambucus nigra (elderberry) 

Highlights

• Parts of the plant used: flower, leaf, berry, bark and root 
• Actions depend on the part used; however, they have all been used with good effect. According to Buhner S.H. (2013): “The secret is in the preparation.” (1)
• Berry: diaphoretic (helps you sweat*), diuretic (increases urination), laxative (moves bowels) and antirheumatic (helps relieve pain & inflammation associated with rheumatic conditions) (2)
  *This helps lower fevers and is very useful during viral infections
• Actions based on earlier research: anti-viral (remains a research focus)
  • The aqueous elderberry extract Sambucol R may be useful for the treatment of  viral influenza infections; however, according to Vlachojannis, J. E. et al (2010): “These promising effects of elderberry fruit preparations from experimental and clinical studies should be backed by more rigorous studies before these preparations are recommended in the prevention of diseases and in treatment schedules.” (3) 
• More recent research: enhances immune responses (4)
  • A meta-analysis supports its benefit when administered during acute viral infections (5) 
• Action is not fully understood, since polyphenolic compounds have relatively low bioavailability (more research is needed on its bioavailable components) (6) 
• By nature of test tube research, in vitro studies on a herb can provide insight into a few specific aspects of immune function; however, any clinical relevance is potentially confounded by bioavailability, dosage issues and local tissue factors (6) 
  • Meaning, extrapolation of in vitro research on herbs needs to be done with great caution 
• Positive clinical data that it may support immunity:
  • Combination of elderberry and echinacea given as soon as possible for 10 days after symptoms developed was as effective as an antiviral drug with no harmful effects (included many patients with confirmed influenza A and/or B) (7) o 
  • Significant reduction of cold duration and severity in air travelers when elderberry was taken continuously from 10 days before travel until five days after arriving at travel destination. Also well tolerated, with no serious adverse events (8) 

Based on the research, you may consider adding elderberry to your diet/supplement regime for the following reasons/indications

1. As a preventative measure during cold and flu season 
2. Before and shortly after travel to prevent colds (especially if susceptible to this) 
3. During a cold to reduce severity and duration of symptoms

In terms of treatment, there is insufficient research to state that elderberry can treat viral infections 

How to Use Elderberry 

Usually what is used is a standardized liquid extract, standardized lozenge, or some other variation of the berry juice: expressed juice, syrups, a tea, or a juice decoction (1).

1. As a tea or herbal decoction using the raw dried* herb (loose or tea bag)

• Tea vs decoction: the boil time on a decoction is long, usually much longer than 30 minutes. You are essentially producing a very concentrated tea.

• General infusion instructions for a tea: Add 1 tbsp of herb per cup of boiling water and steep 20+ minutes.

• General decoction instructions: Add 1 tbsp of herb per cup of water and boil on low for 30-35 min. To make a really strong decoction, simmer overnight in a slow cooker.

• *dried elderberries: soak overnight in water and keep in the refrigerator 

2. As a supplement using standardized extracts of elderberry (Sambucol R) o Capsules

• Liquids
• Lozenges
• Berry Juice 

3. Through your healthcare provider as a custom botanical medicine prescription

• Liquids/tinctures: ethanol (alcohol) and glycerine extractions available 
  • available in different potencies and different formulations based on the individual

• Dried: to be taken as a tea or decoction
  • single herb or blended with other herbs based on the individual 

4. Fresh elderberries

• The berries are fine, but the seeds possess HCN and this is what makes some people vomit and feel nauseated.
• See “caution” below. Nearly all sources recommend cooking them first.
• Below is a recipe from Buhner S.H. (2013): 

Dosage 

• Elderberry syrup for colds and flus: as mentioned above (adult dosage) 
• Children: Appropriate dosage for children varies according to age, and a number of mathematical formulae have been developed to facilitate this (2). You can determine the dosages for children through one of three approaches as outlined by Buhner S.H (2013): 
  • Clark’s rule: Divide the weight in pounds by 150 to give an approximate fraction of an adult’s dose. For a 75-pound child, the dose would be 75 divided by 150 or 1/2 the adult dose. (This is the rule I find most useful.)
  • Cowling’s rule: The age of a child at his or her next birthday divided by 24. For a child coming 8 years of age, the dose would be 8 divided by 24 or 1/3 the adult dose.
  • Young’s rule: The child’s age divided by (12 + age of child). For a 3-year-old it would be 3 divided by (12 + 3; that is, 15) for a dose of 1/5 the adult dose. 
• Please follow your chosen product’s suggested use and directions, especially when using standardized products
• Reducing fever: usually a cup of the tea or a glass of the juice or a couple tablespoons of the syrup for influenzal infections (1) 

Caution: do not use this herb fresh and do not take more than recommended 

There is a misconception that this plant is poisonous or toxic. There are cyanogenic compounds, also known as hydrocyanic acid (HCN) in this plant that will make you feel nauseous and possibly cause vomiting if you take too much and if used fresh, and some people are especially sensitive to these compounds (there seems to be a wide range of sensitivity to the HCN in this plant). 

This is no different than cooking raw kidney beans. Unless soaked for several hours and cooked sufficiently in boiling water, raw kidney beans (and a few other beans) are also considered poisonous. 

“The cyanogenic compounds in elder, which are also strongly present in cherries and apples, for example, can poison you . . . if you take them as isolated compounds. But the “poisoning ” they are talking about here merely consists of nausea, weakness, dizziness, and vomiting — the usual things that happen when you eat something that disagrees with you.” (1) 

Boiling the plant (that is, the leaves, berries, bark, or root), beginning with cold water and raising the heat, for 30 minutes will reduce the cyanide content to nearly nothing. The longer the boil, the lower the cyanide compound content. Starting with cold water, not boiled water, also lowers the cyanide compound content. 

References 

1 Buhner, S. H. (2013). Herbal Antivirals: Natural Remedies for Emerging & Resistant Viral Infections. Storey Publishing, LLC. 

2 Hoffmann, D. (2003). Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts.
3 Vlachojannis, J. E., Cameron, M., & Chrubasik, S. (2010). A systematic review on the sambuci fructus effect and efficacy profiles. Phytother Res., 24(1), 1–8. doi: 10.1002/ptr.2729 PMID:19548290 

4 Golnoosh Torabian, Peter Valtchev, Qayyum Adil, Fariba Dehghani. (2019). Anti-influenza activity of elderberry (Sambucus nigra). Journal of Functional Foods 54: 353–360. doi. org/10.1016/j.jff.2019.01.031

5 Hawkins J, Baker C, Cherry L, Dunne E. (2019). Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complement Ther Med. 42:361-365. doi: 10.1016/j.ctim.2018.12.004. PMID: 30670267 

6 Bone, Kerry. (April 23, 2020). Part 1 of Virtual Masterclass Series: Herbs for Maintaining Immune and Respiratory Health Presented by Professor Kerry Bone [Virtual Masterclass Series]. Retrieved from www.mediherb.ca and www.promedics.ca 

7 Rauš K, Pleschka S, Klein P, Schoop R, Fisher P. (2015). Effect of an Echinacea-Based Hot Drink Versus Oseltamivir in Influenza Treatment: A Randomized, Double-Blind, Double- Dummy, Multicenter, Noninferiority Clinical Trial. Curr Ther Res Clin Exp. 77: 66-72. Doi: 10.1016/j.curtheres.2015.04.001. PMID: 26265958 

8 Tiralongo E, Wee SS, Lea RA. (2016). Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Nutrients. 8(4): 182. doi: 10.3390/nu8040182. PMID: 27023596