Elderberry: The Fact Sheet

Elderberry refers to the fruit of either Sambucus nigra (European elderberry) or Sambucus canadensis (American elderberry)[3]. Elderberry has long been used as a remedy in traditional medicine across many indigenous cultures[3]. The supplement market has grown substantially; elderberry supplement sales reached $320 million in 2020[3].

Evidence is mixed. A high-quality 2016 randomized, double-blinded, placebo-controlled trial found that among travelers who experienced cold-like symptoms, those taking elderberry felt sick for an average of 4.75 days versus 6.88 days in the placebo group[2]. However, the overall rate of illness between groups was not statistically significantly different (12 vs. 17 cases)[2]. Older studies using liquid elderberry extract showed reduction in influenza symptoms[1], but overall the evidence strength remains modest.

A 2016 Australian randomized, double-blinded, placebo-controlled trial involved 312 economy class travelers[2]. Participants took 600 mg elderberry extract for 10 days before travel and 900 mg daily during travel and 5 days after arrival[2]. Key findings: fewer participants in the supplement group became ill (12 vs. 17), but this wasn't statistically significant; among those who did get sick, symptoms lasted 4.75 days in the elderberry group versus 6.88 days in placebo[2]; physical health remained stable in the elderberry group during travel while declining in placebo (p=0.005)[1].

Elderberry contains polyphenolic compounds, particularly anthocyanins[3]. The anthocyanin content varies significantly based on genotype, harvesting year, and environmental conditions[3]. Cultivated elderberries have higher anthocyanin content than wild-collected fruit[3]. These polyphenolic compounds are believed to underlie the supplement's purported immune-enhancing and anti-inflammatory effects[3].

Limited explicit safety data exist in the search results. A clinical trial with 312 participants reported good tolerability, with over 90% of participants maintaining compliance with 90% or better adherence to their study medication[1]. No significant adverse effects were mentioned. However, the search results do not comprehensively detail potential side effects, contraindications, or drug interactions. Individuals with diabetes should consult healthcare providers, as cell studies suggest elderberry may affect blood sugar control[2].

Sambucus nigra (European elderberry) and Sambucus canadensis (American elderberry) are two species used for supplements[3]. European elderberry is more commonly cultivated and marketed[3]. Research indicates cultivated European elderberry plants have higher anthocyanin content than wild-collected varieties[3]. American elderberry is less popular in the supplement market[3].

Quality control is a significant concern. In a recent analysis of 31 dietary supplements, more than 60% claiming to contain European elderberry displayed anthocyanin profiles significantly different from authentic elderberry, indicating adulteration with black rice, purple carrot, and S. nigra flowers[3]. Additionally, polyphenolic content varies vastly across cultivars and harvesting years[3], meaning health benefits may be inconsistent between products.

The 2016 traveler study used 600 mg of elderberry extract daily for 10 days before travel, then increased to 900 mg daily during travel and continuing for 5 days after arrival[2]. The total trial period ranged from 15 to 16 days depending on individual travel duration[1]. The search results do not establish whether this is optimal dosing for other populations or purposes.

Possibly, but evidence is limited. Two clinical trials using liquid elderberry extract (Sambucol) showed a reduction in influenza infection symptoms and duration[1]. However, a more recent high-quality 2016 study on travelers found WURSS-21 quality-of-life symptom scores did not differ significantly between elderberry and placebo groups at any timepoint (p=0.18)[1]. Overall strength of evidence remains modest.

Yes, possibly. A 2016 trial with 312 economy-class travelers found that among those who developed cold-like symptoms, the elderberry group felt sick for 4.75 days compared to 6.88 days in placebo[2]. Additionally, physical health remained stable in the elderberry group during travel (when arriving in different climates and time zones) while declining significantly in the placebo group (p=0.005)[1].

Research suggests potential benefits beyond cold symptoms. Elderberry has demonstrated potential anti-inflammatory properties[3] and immune-stimulating effects[3]. Cell-culture and animal studies show elderberry may help control blood sugar, assist with depression, and have anti-depressive, chemo-preventive, and cardiovascular protective (atheroprotective) effects[3]. However, human clinical evidence for these applications remains limited. A 2023 test tube study found that antioxidants in fermented elderberry extract may reduce inflammation and protect skin cells from damage[4].

Compliance was high. Only 60% of participants took 100% of their trial medication, but more than 90% of participants maintained over 90% compliance, meaning 90% of trial participants missed no more than three elderberry capsules throughout the entire trial period[1]. No significant differences in medication compliance were observed between the elderberry and placebo groups (92% vs. 92.5%, p=0.6)[1].

Yes. To confirm blinding effectiveness, participants were asked to speculate whether they received elderberry or placebo. 80 participants (52%) correctly identified themselves in the placebo group and 73 (46%) in the elderberry group[1]. There was an even distribution of mismatches between groups (p=0.5), providing evidence of effective randomization and blinding[1].

Mental health improved significantly in both groups during travel, suggesting the improvement was not due to elderberry supplementation. From travel to post-travel, mental health improved in the placebo group (p=0.004) and in the elderberry group (p=0.03)[1]. This indicates that mental health is strongly positively affected by travel itself, regardless of whether participants took elderberry[1].

Evidence assessments are cautious. The University of Rochester Medical Center notes that a few small studies suggest elderberry may slightly improve flu symptoms, but the evidence wasn't strong[6]. Cleveland Clinic similarly provides a balanced perspective on what elderberries can and cannot do for health[4]. The overall scientific consensus reflects modest efficacy with need for additional high-quality research.

Elderberry supplement sales reached $320 million over the year 2020, according to an American Botanical Council report[3]. This substantial market growth is attributable to the purported immune-enhancing effects of elderberry[3].