Medically reviewed on September 15, 2017
Scientific Name(s): Sambucus nigra L. (European elder) and Sambucus nigra ssp canadensis (American elder). Family: Caprifoliaceae.
Common Name(s): Sweet elder , common elder , elderberry , sambucus , Sambucol
Limited clinical trials have been conducted. Elderberry extracts may have some value in the treatment of influenza and appear to have antioxidant potential.
The bioavailability of active constituents in elderberry extracts is considered to be poor. Trials are lacking to provide dosing information. For the treatment of influenza, 15 mL of syrup taken 4 times per day for 5 days has been used in clinical trials.
Contraindications have not been identified.
Information regarding safety and efficacy in pregnancy and lactation is lacking.
None well documented.
Consumption of uncooked berries may result in vomiting and diarrhea. Commercial preparations generally do not cause adverse reactions at the recommended dosage. Type 1 allergy to elderberry (positive skin prick tests) has been recorded.
Poisonous alkaloids, lectins, and cyanogenic glycosides are present in some plant parts. Short-term use of elderberry extract preparations appears to be relatively safe; however, long-term toxicological studies are lacking.
The American elder is a tall shrub that grows to 4 m, and is native to North America. The European elder grows to approximately 10 m and has been naturalized to the United States. The tree has light brown/grey bark and narrow, dark green leaves. Clusters of white-cream flowers have a particular fragrance and develop into dark purple-black berries. 1 , 2
Elder flowers and berries have been used in traditional medicine and as a flavoring for centuries. In folk medicine, the flowers have been used for their diuretic and laxative properties and as an astringent. Various parts of the elder have been used to treat cancer and many other unrelated disorders. Distilled elder flower water has been used as a scented vehicle for topical preparations, and extracts are used to flavor foods as well as alcoholic beverages. The fruits have been used to make elderberry wine. 3
European elder flowers contain approximately 0.3% of an essential oil composed of free fatty acids and alkanes. The triterpenes alpha- and beta-amyrin, ursolic acid, oleanic acid, betulin, betulic acid, and a variety of other minor components have been identified. 4 The elder leaf contains sambunigrin, a cyanogenic glucoside (0.042% by weight). 5 Leaves of S. nigra express 2 classes of thaumatin-like proteins. The fruit-specific, thaumatin-like proteins accumulate only during the final stages of fruit ripening. 6
The fruit of the elderberry contains phenolics, including quercetin, kaempferol, rutin, and phenolic acids and anthocyanins. High-performance liquid chromatography and mass spectrometry have been used to identify individual anthocyanins, which give the berry its color, and include cyanidin 3-sambubioside-5-diglucoside, cyanidin-3,5-diglucoside, cyanidin 3-sambubioside, and cyanidin 3-glucoside. 7 , 8 The total anthocyanin content varies during the growing season and by cultivar. Vitamins A and C are also present, and antioxidant capacity of the berry has been estimated to be similar to that of black raspberries, blackberries, and other dark-fleshed small fruit. 9 , 10
Uses and PharmacologyAntiviral effects
In vitro studies have shown that elderberry extracts exert activity against the influenza virus A (including H1N1) and B and the herpes simplex virus. Laboratory studies also suggest an inhibitory effect on the infectivity of the HIV virus. 12 , 13 , 14 , 15 , 16Animal data
Research reveals no animal data regarding the use of elderberry extracts for antiviral effects.Clinical data
Although in vitro data are promising, few clinical trials have been conducted examining the efficacy of elderberry extracts for the treatment of influenza. 15 , 16 When used within the first 48 hours of onset of symptoms, elderberry extracts reduced the duration of influenza versus placebo. 12 , 17 Anecdotal reports exist for elderberry use in HIV. 16Diabetes
A stimulatory effect on insulin secretion by the polyphenolic content of elderberry fruit has been shown in diabetic rats. 18 In vitro studies using rat abdominal muscle showed increased insulin secretion in response to flower extracts. 19 , 20Clinical data
Research reveals no animal data regarding the use of elderberry extracts for lipid-lowering effects.Clinical data
In a placebo-controlled study among healthy volunteers, there was only a small and statistically insignificant change in cholesterol in the elderberry-treated group compared with placebo. The dosage used in the study may have been too low (anthocyanin 10%). 23 No change was found in healthy volunteers consuming 500 mg of anthocyanins daily for 12 weeks in another study. 24Other effects
The compound sambuculin A and a mixture of alpha- and beta-amyrin palmitate demonstrated hepatoprotective properties against carbon tetrachloride-induced liver damage. 26
Antioxidant activity of elderberry extracts has been evaluated and is estimated to be similar to that of black raspberries, blackberries, and other dark-fleshed small fruit. 9 , 10 , 18 , 23 , 28 , 29
Induction of quinine reductase and cyclo-oxygenase-2 has been suggested to be responsible for anticancer effects in vitro. 30
Fruit syrups are commonly standardized to 30% to 38% elderberry extract. Powdered extracts are available as capsules and in liquid form.
Doses of 500 mg of anthocyanins per day were taken for 12 weeks in healthy volunteers, with no effect on cardiovascular disease biomarkers. 24Influenza
15 mL of syrup taken 4 times per day for 5 days has been used in clinical trials. 12
Information regarding safety and efficacy in pregnancy and lactation is lacking.
None well documented. Elderberry may potentiate the effects of insulin.
Consumption of uncooked berries may result in vomiting and diarrhea. Commercial preparations are generally considered relatively free from adverse effects at the recommended dosage. No adverse events were reported in a clinical trial evaluating the efficacy of elderberry extract in the treatment of influenza, 12 or in healthy volunteers consuming elderberry extract standardized to 500 mg of anthocyanins per day for 12 weeks. 24
Type 1 allergy to elderberry (positive skin prick tests) has been recorded. 16
Poisonous alkaloids, lectins, and cyanogenic glycosides are present in some plant parts. While elderberries are safe to consume, particularly when cooked, leaves and stems should not be crushed when making elderberry juice. Uncooked berries may produce nausea. A report of severe illness (nausea, vomiting, weakness, dizziness, numbness, and stupor) following the ingestion of juice prepared from elderberries exists. 16 , 33
Toxicity in children who used peashooters made from elderberry stems has been reported. 3
No effects were recorded on kidney and liver function markers in healthy volunteers consuming elderberry extract standardized to 500 mg of anthocyanins per day for 12 weeks. 24 Long-term toxicological studies are lacking. 16
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