Elderberry is the berry of the black elder tree, or Sambucus nigra, and contains a number of antioxidants. The black elder tree is native to Europe, but also grows in North America and parts of Asia and Africa. In folk medicine, elderberry has been used for centuries to support overall well-being. Today, elderberry is typically included in dietary supplements as an extract or juice concentrate of the whole fruit, and products with elderberry are primarily marketed to support immune health—from respiratory illnesses such as the common cold and influenza to, most recently, COVID-19.


Little research confirms any benefit of elderberry to support immune health. If not properly prepared, it could be toxic. Elderberry is not prohibited for use by Military Service Members.


Elderberry supplements come in a variety of formulations, including syrups, capsules, and lozenges. Many products are specifically marketed for children, especially in a chewable or gummy form. In addition, some products contain other parts of the black elder tree, most commonly elderflower, mixed with the berry. If elderberry isn’t prepared correctly, it could be toxic.

Can elderberry support immunity to respiratory illness?

Elderberry does not seem to prevent or reduce the risk of developing a respiratory illness. However, this evidence is based on only one study among healthy adults that examined the effects of a dietary supplement containing elderberry extract (600 mg per day). The study found no significant difference in the incidence of cold episodes among those taking the extract compared to those who did not.

Can elderberry help support recovery from respiratory illness?

A few small studies have investigated whether elderberry has an effect on cold and flu symptoms in adults and children. Some of the latest research shows that elderberry might reduce the duration and severity of upper respiratory symptoms. However, the largest study, which included both children and adults, showed no benefit of elderberry on either duration or severity of flu symptoms. More research is needed to understand whether elderberry has any benefit in the recovery from respiratory illness for adults and children.

Recently, elderberry has been fraudulently touted as a treatment and preventive agent for COVID-19. No research supports any of these claims. By FDA’s definition, a dietary supplement cannot be “promoted on its label…as treatment, mitigation, prevention, or cure for a specific disease or condition.” FDA has released warning letters to several companies found to be illegally marketing supplements as treatments for COVID-19.

Can elderberry supplements negatively affect your health?

Studies report no serious adverse effects from the use of elderberry. Complaints received by FDA during the last several years indicate that abdominal pain, nausea, and vomiting are among the most common adverse effects reported by consumers taking elderberry supplements. Some case reports of more severe adverse effects associated with elderberry, including acute pancreatitis, also exist.

Unripe elderberries, as well as the stems and leaves of the elder tree, contain cyanide-producing compounds that can be toxic if ingested. Cooking can remove these compounds, but many homemade elderberry recipes do not specify sufficient heat to fully evaporate all toxins, so these are more likely than commercial supplements to cause adverse effects.

Recently, reports of elderberry products adulterated with contaminants have increased.  If you’re considering an elderberry supplement, first consult your healthcare provider, and then make sure you’ve selected a product that has been third-party certified.

Are dietary supplements containing elderberry safe for children?

Limited scientific evidence supports the safety of elderberry in children. A few liquid elderberry extracts have been used in children ages 5–12 years for up to 5 days without adverse effects. Still, consumption of elderberry that hasn’t been cooked adequately is associated with nausea, vomiting, and diarrhea in children. In addition, a recent report described pancreatitis in a child given elderberry supplements.

The bottom line about elderberry

  • Research is inconclusive regarding the use of elderberry for immunity and illness recovery.
  • No dietary supplement can be legally marketed as a treatment, prevention, or cure for any disease or condition, including flu, cold, and COVID-19.
  • Elderberry is not prohibited for use by Military Service Members and will not cause a positive result on a routine military drug test.
  • Talk with a healthcare provider before using any supplement containing elderberry or before giving an elderberry supplement to a child.
  • Verify that the product you’ve chosen has been third-party certified.

 

Posted 19 July 2021

References

Adams, K. K., Baker, W. L., & Sobieraj, D. M. (2020). Myth busters: Dietary supplements and COVID-19. Annals of Pharmacotherapy, 54(8), 820–826. doi:10.1177/1060028020928052

Brendler, T., Al‐Harrasi, A., Bauer, R., Gafner, S., Hardy, M. L., Heinrich, M., . . . Williamson, E. M. (2020). Botanical drugs and supplements affecting the immune response in the time of COVID‐19: Implications for research and clinical practice. Phytotherapy Research, 35(6), 3013–3031. doi:10.1002/ptr.7008

FDA. (2019). Questions and answers on dietary supplements.   Retrieved 13 July 2021 from https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements

FDA. (2021). Fraudulent coronavirus disease 2019 (COVID-19) products.   Retrieved 13 July 2021 from https://www.fda.gov/consumers/health-fraud-scams/fraudulent-coronavirus-disease-2019-covid-19-products

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. Complementary Therapies in Medicine, 42, 361–365. doi:10.1016/j.ctim.2018.12.004

Macknin, M., Wolski, K., Negrey, J., & Mace, S. (2020). Elderberry extract outpatient influenza treatment for emergency room patients ages 5 and above: A randomized, double-blind, placebo-controlled trial. Journal of General Internal Medicine, 35(11), 3271–3277. doi:10.1007/s11606-020-06170-w

Mahboubi, M. (2020). Sambucus nigra (black elder) as alternative treatment for cold and flu. Advances in Traditional Medicine, online, 10 pp. doi:10.1007/s13596-020-00469-z

Porter, R. S., & Bode, R. F. (2017). A review of the antiviral properties of black elder (Sambucus nigra L.) products. Phytotherapy Research, 31(4), 533–554. doi:10.1002/ptr.5782

Tiralongo, E., Wee, S., & Lea, R. (2016). Elderberry supplementation reduces cold duration and symptoms in air-travellers: A randomized, double-blind placebo-controlled clinical trial. Nutrients, 8(4), article 182. doi:10.3390/nu8040182

Ulbricht, C., Basch, E., Cheung, L., Goldberg, H., Hammerness, P., Isaac, R., . . . Wortley, J. (2014). An evidence-based systematic review of elderberry and elderflower (Sambucus nigra) by the Natural Standard Research Collaboration. Journal of Dietary Supplements, 11(1), 80–120. doi:10.3109/19390211.2013.859852

Weissman, S., Lo, A., Patel, R., Mehta, T. I., Singh, V., Aziz, M., . . . Tabibian, J. H. (2019). An unusual culprit of drug-induced pancreatitis. Digestive Diseases and Sciences, 65(5), 1549–1552. doi:10.1007/s10620-019-05864-4

Wieland, L. S., Piechotta, V., Feinberg, T., Ludeman, E., Hutton, B., Kanji, S., . . . Garritty, C. (2021). Elderberry for prevention and treatment of viral respiratory illnesses: A systematic review. BMC Complementary Medicine and Therapies, 21(1), article 112. doi:10.1186/s12906-021-03283-5