Elderberry Syrup

📜 Historical Use

Elderberry is Sambucus nigra, known as elderberry, black elderberry, European elder and common elder. NCCIH describes it as the dark purple berry of the European or black elder tree, which grows in Europe, North America, Western Asia and North Africa, and records that elderberry has been used in folk medicine to treat colds and flu. That is the whole of the traditional record NCCIH reports, and it is unusually short. Two things follow from its brevity. First, the continuity between the folk use and the modern product is closer than for almost any other remedy catalogued on this site: colds and flu then, colds and flu now, with NCCIH noting that elderberry is promoted today as a dietary supplement for colds, flu and other conditions. There is no discarded list of older indications to explain away, as there is for echinacea or willow bark. Second, that continuity is not evidence, and it is easy to mistake one for the other. The same fact sheet that records the folk use also says only a small number of studies have evaluated elderberry, that what exists is preliminary, and that there is not enough information to show whether it helps with anything else. The newest addition to the list makes the point plainly: elderberry was promoted for COVID-19, and NCCIH states there is no good evidence to support that use.

📊 What the Research Shows

Two federal sources were read for this page and they do not quite agree, which is itself the most useful finding. NCCIH's elderberry fact sheet, last updated November 2024, says that a small number of studies have evaluated elderberry for colds, flu and other upper respiratory infections, and that some preliminary research suggests elderberry may relieve symptoms of flu, colds or other upper respiratory infections. That is a real signal, but a deliberately hedged one: preliminary, symptom relief, a small number of studies. NCCIH's broader review of complementary approaches for colds and flu is blunter. It states that no complementary health approach has been shown to be helpful for the flu, and that none has been shown to prevent the flu or relieve flu symptoms. Elderberry appears there in the list of approaches studied for flu for which there is not enough evidence to show whether the approach is helpful, alongside echinacea, green tea and American ginseng. Elderberry does not appear at all in that review's list of approaches showing some promise for colds, which names oral zinc, saline nasal irrigation, honey for children's nighttime cough, vitamin C under severe physical stress, probiotics and meditation. Beyond respiratory infection, NCCIH says little research has been done in people and there is not enough information to show whether elderberry helps with anything else. On COVID-19 it is unambiguous: there is no good evidence to support its use, and the FDA and the Federal Trade Commission have taken action against companies that marketed elderberry products with unsubstantiated claims of effectiveness for COVID-19.

Take 1 tbsp elderberry syrup daily for prevention, or every 2-3 hours when sick.

Never eat raw elderberries. Avoid with autoimmune conditions.

⚠️ What happens if taken in excess:

RAW elderberries, leaves, bark, and stems contain cyanogenic glycosides (sambunigrin) that release hydrogen cyanide when ingested — causing severe nausea, vomiting, and diarrhea. Large amounts of raw elderberry can cause cyanide poisoning with symptoms including weakness, dizziness, and seizures. Excessive supplementation may overstimulate the immune system (cytokine storm risk), which is why it should be avoided during active autoimmune flares. Cooked/processed elderberry products are safe at recommended doses.

This section cannot do what the rest of this file does, and the reason is worth more than a filler paragraph would be. Neither federal source read for this page names a single drug, drug class, cytochrome P450 enzyme or drug transporter that interacts with elderberry specifically. (The 2016 colds and flu review does name interactions for other substances - garlic with anticoagulants, zinc with antibiotics and penicillamine - which makes the silence on elderberry a gap in the evidence rather than an omission in the document.) NCCIH's fact sheet offers only the generic instruction that if you take any type of medicine you should talk with your health care provider before using elderberry or other herbal products, because some herbs and medicines interact in harmful ways. No specific pairing is documented anywhere in it. That absence should be read as an absence of study rather than as a clean bill of health, since an interaction nobody has looked for has not been ruled out. One clinically important conflict is documented, even though it is behavioural rather than pharmacological, and during flu season it is the one that actually costs people something. NCCIH states that complementary health approaches should never be used as a substitute for flu vaccination, that vaccination is the best protection against getting the flu and is recommended annually for everyone over the age of 6 months, and that prescription antiviral drugs are the second line of defence and work best if they are used early in the illness. The realistic harm from elderberry is therefore delay: taking syrup instead of being vaccinated, or instead of calling a clinician promptly while antivirals would still work.

1. Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers — Tiralongo E, Wee SS, Lea RA Nutrients (MDPI) (2016)[doi ↗]
2. A randomized study of efficacy of oral elderberry extract in influenza A and B virus infections — Zakay-Rones Z et al J Int Med Res (SAGE) (2004)[doi ↗]
3. The effect of Sambucol on flu-like symptoms in chimpanzees — Mumcuoglu KY et al Isr Med Assoc J (1995)[PubMed ↗]