Every year, there’s a lot of hype about how bad the flu season is. They do this purposefully, even when they know the season is average, just to push flu shots. But let’s suppose that we have a nasty flu season, like they always say. There are two general sides:
- Get your flu shot!
- Take your elderberry!
If you’ve been following me for any length of time, then you know I don’t think the flu shot is a good idea. I feel so strongly about the flu shot that my team and I have written a guide, Should You Get A Flu Shot and Other Ways to Stay Healthy. Conversely, elderberry has been hailed as an entirely safe, natural, effective alternative remedy. But is it, and is there any caution that should be taken?
Natural Remedies Warrant Caution Too
Natural remedies aren’t necessarily safe because they are “natural.” They can be poisonous or affect some individuals. Natural remedies are potent and serious. We must never think that all natural remedies are safe for everyone just because they’re natural.
Some natural remedies can be 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 cautiously in vulnerable populations despite its benefits to many.
On the contrary, some natural remedies can be used one way but not another. For example, essential oils; drinking lemon juice is perfectly safe, but drinking lemon essential oil – not so much. Another example is oil of oregano and oregano essential oil, which we discuss in our blog, When & Why to Choose Oil of Oregano Vs. Oregano Essential Oil. Additionally, diffusing or using essential oils topically is perfectly safe for most but not certain ages or stages of life; it all depends on the essential oil.
Back to elderberry. Previously, I thought elderberry was not for anyone with lupus, autoimmune, or blood clots–that has since changed. Now, I know elderberry is safe for most people. Of course, we recommend caution for individuals with autoimmune diseases and those on blood thinners, but this does not mean these individuals cannot use elderberry. Check out our blog, My Personal Experience Taking Elderberry with an Autoimmune Disease, discussing Sarena-Rae’s testimony.
How Elderberry Works During Flu
As it turns out, from my early research, elderberry is very potent. But, it doesn’t work along the same lines as Western principles. When I first wrote this post in 2013, I thought that elderberry’s potent effects were enough to warn certain people away from it. I now have a better understanding of its total effects on the body.
First, look at what happens when it’s used during illness. For instance, elderberry has a strong effect on the flu. One study notes:
“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 (1).”
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) (2).”
Another study also shows elderberry prevents viral infections like flu (3).
“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 (4).”
A final study states:
“The Sambucol preparations increased the production of five cytokines (1.3-6.2 fold) compared to the control (5).”
But what about cytokine storms?
Elderberry and Cytokine Storms
Suppose you’ve read Earthley’s guide, What You Need to Know About Elderberries. In that case, you’d know “Cytokine storms” are poorly defined in the scientific literature. Still, they are dysregulated pro-inflammatory cytokines to the point where they can hurt or kill a person.
High cytokine production can lead to a so-called “cytokine storm,” where the body massively overproduces these pro-inflammatory cytokines, and the body essentially attacks and kills itself. That’s usually how young, healthy people die of the flu. One reason is that both ibuprofen and acetaminophen have been known to lead to a “rebound” inflammation effect after taking (6) – and many people use these to treat the flu.
Trying to “fight” the body doesn’t work out well for anyone (at a minimum, it can prolong symptoms). But supporting it with elderberry works exceptionally well and is much safer.
The general production of pro-inflammatory cytokines is normal during illness – it’s how the immune system activates to protect the body. In otherwise healthy people, pro-inflammatory cytokines are balanced by anti-inflammatory and other effects so that the body can clear the illness without causing harm to itself.
In the spring of 2020, many people became concerned that elderberry would likely cause or contribute to a cytokine storm, and this was especially possible with COVID-19 – leading to many recommending against taking elderberry at all, in case they might develop that illness.
Previously, I misunderstood elderberry’s actions and thought that elderberry would continue to boost cytokine production any time it was taken — even if the person wasn’t sick (many others believe this, too). But newer research shows that isn’t true, which mitigates many of the concerns surrounding it.
The evidence most often used to ‘prove’ elderberry can cause a cytokine storm is a 2001 study that looks at immune activation in healthy people. Researchers noted that, with regular consumption, pro-inflammatory cytokine production was increased. They concluded that elderberries could benefit several health issues (7).
This study does not conclude that the cytokine increase was problematic (quite the opposite!). Pro-inflammatory cytokines are standard in most cases – they activate the immune system and help fight acute and chronic illnesses. This is not evidence of dysfunction, nor that elderberry is causing or could cause a “cytokine storm.”
In fact, in one study, elderberry was used and other herbs for its anti-cytokine production. In most cases, it has more of a “balancing” effect than anything else (8). Another study confirms this, noting elderberry’s “inflammation-modulating” properties (9).
In over 4000 years of use, there have been no actual reported cases of a cytokine storm associated with elderberry use. It would be more than theoretical if this were a real risk.
Elderberry can increase the production of pro-inflammatory cytokines, which may be associated with a cytokine reaction and severe complications. However, elderberry has never explicitly been associated with a cytokine storm nor caused any problems with immune function.
How Elderberry Behaves When You’re Not Sick
First, we need to understand an important principle. Herbs, in general, do not work at all like Western medicine.
In Western medicine, drugs are a single chemical with just one action. They always do that one action, whether or not your body needs it. They’re usually designed to interrupt your body’s function to “correct” a problem (which is why they cause so many side effects).
But herbs are different. They don’t just have one action because they combine many other chemicals. These chemicals work with your body to support it and can work in opposing ways — depending on what your body needs. They usually don’t have side effects and are much safer!
Elderberry contains anthocyanins, quercetin, citric acid, tannins, and lots more! Each has its own actions, which is why elderberry can do so many different things in the body.
Some parts of elderberry are pro-inflammatory and responsible for the immune system modulation during illness. Other features are anti-inflammatory, which can calm the immune system and promote overall health when you’re not sick.
One study shows that elderberries and elderflowers regulate the immune system (10). Another study shows that elderberries and astragalus root upregulate the immune system when you’re sick but otherwise do not (11). A final study shows that the flavonoids in elderberry inhibit an excessive immune response (12). But wait, there’s more! Elderberries also help protect liver and heart health and have anti-cancer properties (13,14)!
Elderberry has also been shown to have anti-bacterial properties, including against some strains of strep bacteria, including Streptococcus pyogenes, responsible for many strep throat infections (15). That study also notes that elderberry may help prevent complications of viral illnesses like bacterial pneumonia. Because its protection is “non-specific,” infections would not become resistant to it as they do to antibiotics.
The bottom line of all of this? Elderberry has many exceptional properties and appears safe in all studied populations. Personally, I would recommend:
- Taking elderberry daily, in small amounts, unless you have a negative reaction to it (not all herbs are for all people!)
- Use from August – to March, during the majority of flu season, especially if symptoms develop or you have been exposed.
- Caution is warranted in individuals with autoimmune conditions. Generally, I recommend trying for immune support elderberry when not sick to see how you’ll react to it. Don’t try it for the first time when sick. If you find you respond negatively to elderberry, astragalus root may be a better option.
This is a bit of a reversal of what I thought back in 2013, but after reading more studies and having more experience with elderberry, I feel differently about it now. Previously, I recommended only using elderberry during symptoms and for a short time. I have witnessed so many people find it beneficial for daily use and avoiding illness that I needed to update my recommendations. Personally, I had used it through the winter months and did not get sick when others around me did.
Based on all this research, we created an ultimate elderberry collection incorporating the best combination of natural remedies. These syrups may also be used for certain bacterial infections, and I recommend using cod liver oil in moderate doses.
If you’re looking to make your own elderberry syrup but don’t have the time to gather ingredients, find you’re overbuying herbs, or spend too much time researching the best recipe. Simply boil in water and add honey, syrup, or a sweetener with these DIY Elderberry Syrup Kits.
Earthley’s Elderberry Elixir may be a good fit if you are not a DIYer or are tired of making syrup only to waste half of it. This is a tincture I formulated. It’s shelf-stable, very concentrated, and more cost-effective than syrups. It’s also free of allergens, preservatives, colors, flavors, and added sugars.
What Else Helps?
To start, nourishing your body is vital. Look for herbs that will replenish the nutrients you’ll lose during illness. Herbs like nettle leaf and alfalfa are excellent for this, both brimming with vitamins and minerals (16,17). Look at this herbal multivitamin formulated to provide the body with safe and effective levels of vitamins and minerals it can absorb properly.
Fermented foods, especially true lactic acid ferments (anaerobic ferments), have been shown to activate the TH-1 immune system and prevent viral infection (18). 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 (19,20). Kimchi is beneficial against food-borne illnesses (21). Kombucha may repair damage caused by environmental irritants and help kidney function (22).
Ginger may be helpful with respiratory infections (23) and has been shown to have anti-inflammatory effects, including inhibiting the TNF-alpha cytokine (24). (Ginger is found in our Elderberry Elixir for this reason.) Fresh ginger (but not dried) was also shown to be beneficial in preventing/helping RSV (25).
Very early research shows that pomegranate juice may be effective against flu, stomach flu (norovirus), and other infections (26). Pomegranate has also been shown to possibly prevent and even kill cancer of the breast, prostate, and colon (27,28,29,30).
Cod liver oil (CLO) is incredibly beneficial. If you read our blog, Everything You Need To Know About Cod Liver Oil, you know it contains vitamins A and D, which benefit immune function. CLO may also protect against or slow the development of heart disease (31). It has anti-inflammatory properties as well (32). It may decrease the risk of respiratory illness (33,34). It also affects the fat-soluble vitamin content of breast milk (35). It may protect against cancer death (36) and help rheumatoid arthritis (37). It may reduce the risk of type I diabetes (other vitamin D supplements didn’t show the same effect) (38). Cod liver oil also reduces the risk of diabetes when pregnant women take it (additional vitamin D and multivitamin supplements didn’t show the same effect) (39). It benefits eye health and may decrease the risk of glaucoma and associated blindness (40).
Vitamin C is also important. If you read our blog, What You Need to Know About Vitamin C Supplements, you know we should be avoiding the ascorbic acid found in the store and opt for whole foods vitamin C instead. Acerola berry and camu camu are two great sources of vitamin C (41) (that’s why it’s in our Immune-Aid Vitamin C). Acerola berry is not only high in vitamin C, but it also has antioxidant and anti-aging properties (42).
The Bottom Line
Elderberry has a long history of use as both food and “medicine” and benefits health in many ways, above and beyond flu treatment. It’s a worthwhile herb to include in your diet regularly. Including other herbs, like ginger or mullein, is a good idea, too!
Yes, I had way too much fun doing all that research. It took many years of experience and hours of reading, but I’ve learned so much (you can read all the studies I did by clicking the links throughout the text).
Disclaimer: This post is not intended as medical advice. These statements have not been evaluated by the FDA, and nothing in this post is intended to diagnose, treat, or cure anything. If you have questions, please do your own research or seek advice from a health professional.