Echinacea (Echinacea purpurea) has been one of the most commonly used herbs as the first-line of defense for preventing influenza. But another herb gaining a lot of attention--and for all the right reasons--is black elderberry.
Black elderberry (Sambucus nigra L.) has been used for centuries and is another excellent supportive agent against common cold- and flu-like symptoms (Roxas & Jurenka, 2007). In fact, in combination with herb and root extract of echinacea, elderberry has been found to be as effective as oseltamivir (brand name Tamiflu, the conventional antiviral medication), for the early treatment and prevention of influenza A and influenza B (flu) (Rauš et al., 2015).
Due to the volume of scientific literature on elderberry’s clinical findings, it has gained popularity in health spheres because of the added antioxidant (Netzel et al., 2005), antidiabetic (Gray et al., 2000), anti-inflammatory and immune-modulating (Badescu et al., 2015), and antidepressant (Mahmoudi et al., 2014) properties.
Elderberries are dark violet, almost black-appearing stone fruits that grow in clusters in temperate to subtropical regions of the earth. Their rich color is due to anthocyanins—a class of phenolic compounds. Among flavonoids, anthocyanins are highly concentrated in elderberries and are thought to be the active constituents of the fruit (Mikulic-Petkovsek et al., 2015). Elderberries also contain a host of vitamins (A, B1, B2, B6, B9, C, and E), minerals (potassium, calcium, and magnesium), trace elements (copper, zinc, and iron), and phytochemicals (carotenoids, phytosterols, and polyphenols) (Tiralongo, Wee, & Lea, 2016).
In a randomized, double-blind, placebo-controlled clinical trial, Tiralongo and colleagues (2016) investigated whether or not a standardized elderberry extract could provide beneficial effects on respiratory and mental health.
To do this, they sampled 312 passengers flying from Australia to an overseas destination. Ten days prior to travel, 2 elderberry capsules or placebo (300mg) were administered, and all participants filled out surveys assessing upper respiratory symptoms (e.g. if they had cold episodes, what was the duration and symptoms) and quality of life. The surveys were given again 4 days after their flight.
In this study, black elderberry (Sambucus nigra L.; Haschberg variety from the Steiermark region in Austria) was chosen because it was previously found to demonstrate antimicrobial activity against human respiratory pathogens (gram-positive bacteria of Streptococcus pyogenes, groups C and G Streptococci, and gram-negative bacterium Branhamella catarrhalis), and be an inhibitor of the propagation of human pathogenic influenza viruses (Krawitz et al., 2011).
The exact extract was produced by Iprona AG, Lana (BZ), Italy (under the brand name BerryPharma), and contained 300mg of elderberry extract: 22% polyphenols (quercetin and its glycosides, rutin), 15% anthocyanins (cyanidin and pelargonidin glycosides), 150mg of rice flour, and several mineral, trace elements, and vitamins.
At the end of this study, there were more colds in the placebo group (17 vs 12), but the difference was not statistically significant (p=0.4). However, placebo participants did have a significantly longer duration of cold episode days (117 vs 57; p=0.02), compared to the group receiving the elderberry extract. Furthermore, the average symptom score over the 4 days was significantly higher among the placebo group (583 vs 247; p=0.05).
This suggests a noteworthy reduction of cold duration and severity in air travelers. Considering these constituents and aforementioned bioactivities, elderberries may be beneficial for nutritional/medical supplementation, not only for the common cold/flu, but for cardiovascular and mental health--all of which can be affected when traveling. Further research is needed to assess the range of elderberry's effect on cold duration and severity and mental health proposed benefits.
One of the distinctions of the Tiralongo et al. study that conducted an RCT of a standardized, proprietary preparation of elderberry is that the researchers took the time not only to standardize the dose (300mg of elderberry per dose) but also to standardize the polyphenol and anthocyanin content (22% and 15%, respectively).
This does not necessarily mean that a different preparation of 300mg of elderberry extract does not contain anthocyanins and polyphenols or would not be as effective, but it does suggest that using the proprietary product would give the consumer a lab-verified and researched dose of anthocyanins and polyphenols that was shown to have a documented, statistically significant clinical effect.
Treatment with elderberry fruit extracts is very well-tolerated. No adverse events related to elderberry have been reported in clinical trials in children or adults using specific extracts, including BerryPharma, Iprona AG, Sambucol, Nature's Way, and ViraBLOC, Herbal Science. (Zakay-Rones et al., 1995; Zakay-Rones, Thom, Wollan, & Wadstein, 2004; Kong, 2009; Tiralongo, Wee, & Lea, 2016).
In closing, elderberry possesses both immune-system stimulating and antiviral properties. The constituents in elderberry that may be primarily responsible for its therapeutic effects are the anthocyanins and polyphenols (as well as the health-promoting properties of its vitamin and mineral content.) And it’s completely safe. Elderberry syrup could be a common travel partner during the winter months, when these viruses are rampant, but I like black elderberry tea much better because of the lower sugar content.
Even if elderberry doesn't prevent symptoms altogether, it is important that it reduces symptom duration, which even for those not traveling, has a major impact on activities of daily living (especially work!). Many people cannot afford to take time off work, even when they are sick, so being able to use elderberry can be beneficial for them.
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Badescu, M., Badulescu, O., Badescu, L., & Ciocoiu, M. (2015). Effects of Sambucus nigra and Aronia melanocarpa extracts on immune system disorders within diabetes mellitus. Pharmaceutical biology, 53(4), 533-539. Retrieved from: https://www.tandfonline.com/doi/full/10.3109/13880209.2014.931441
Gray, A. M., Abdel-Wahab, Y. H., & Flatt, P. R. (2000). The traditional plant treatment, Sambucus nigra (elder), exhibits insulin-like and insulin-releasing actions in vitro. The Journal of nutrition, 130(1), 15-20. Retrieved from: https://uws.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=10613759&site=eds-live&scope=site
Kong, F. K. (2009). Pilot clinical study on a proprietary elderberry extract: efficacy in addressing influenza symptoms. Online Journal of Pharmacology and Pharmacokinetics, 5, 32-43. Retrieved from: omicron-pharma.com/pdfs/ElderberryClinicalOJPK_Published.pdf
Krawitz, C., Mraheil, M. A., Stein, M., Imirzalioglu, C., Domann, E., Pleschka, S., & Hain, T. (2011). Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC complementary and alternative medicine, 11(1), 16. Retrieved from: https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-11-16
Mahmoudi, M., Ebrahimzadeh, M. A., Dooshan, A., Arimi, A., Ghasemi, N., & Fathiazad, F. (2014). Antidepressant activities of Sambucus ebulus and Sambucus nigra. European review for medical and pharmacological sciences, 18(22), 3350-3353. Retrieved from: www.europeanreview.org/wp/wp-content/uploads/3350-3353.pdf
Mikulic-Petkovsek, M., Ivancic, A., Todorovic, B., Veberic, R., & Stampar, F. (2015). Fruit phenolic composition of different elderberry species and hybrids. Journal of food science, 80(10), C2180-C2190. Retrieved from: https://uws.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=26409176&site=eds-live&scope=site
Netzel, M., Strass, G., Herbst, M., Dietrich, H., Bitsch, R., Bitsch, I., & Frank, T. (2005). The excretion and biological antioxidant activity of elderberry antioxidants in healthy humans. Food Research International, 38(8-9), 905-910. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0963996905000943
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. Current Therapeutic Research, 77, 66-72. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0011393X15000053
Roxas, M., & Jurenka, J. (2007). Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Alternative Medicine Review, 12(1). Retrieved from: https://uws.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edsgao&AN=edsgcl.163199250&site=eds-live&scope=site
Tiralongo, E., Wee, S. S., & Lea, R. A. (2016). Elderberry supplementation reduces cold duration and symptoms in air-travellers: A randomized, double-blind placebo-controlled clinical trial. Nutrients, 8(4), 182. Retrieved from: https://www.mdpi.com/2072-6643/8/4/182
Zakay-Rones, Z., Thom, E., Wollan, T., & Wadstein, J. (2004). Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. Journal of International Medical Research, 32(2), 132-140. Retrieved from: https://journals.sagepub.com/doi/pdf/10.1177/147323000403200205
Zakay-Rones, Z., Varsano, N., Zlotnik, M., Manor, O., Regev, L., Schlesinger, M., & Mumcuoglu, M. (1995). Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. The Journal of Alternative and Complementary Medicine, 1(4), 361-369. Retrieved from: https://www.semanticscholar.org/paper/Inhibition-of-several-strains-of-influenza-virus-in-Zakay-Rones-Varsano/20459f1db0c5903844884c23e3dcee8f409c962f