Elderberry for Colds and Flu?

Cold and flu remedies will be in ample supply in the coming months as coughs, sneezes, and sniffles are expected to spread. However, elderberry products have been on the shelves season after season when it comes to natural treatments. Elderberry is a plant that has been used for centuries to treat colds, flu, fever and other illnesses. It’s also the main ingredient in many commercial cold remedies. But does it work? This article will explore the effectiveness of elderberry as a way to treat or prevent colds and flu.

What are elderberries?

Elderberry or Sambucus nigra is a shrub in the honeysuckle family that grows primarily throughout North America and Europe where it has been used since ancient times as both food and medicine. In fact, many sources attest to its use as far back as Biblical times by Egyptians, Greeks, Romans, Germans and others. The berries are dark blue with white spots when unripe and they turn black-red when ripe.

How is Elderberry used?

Elderberry can be used several ways. For example, the berries are cooked into jams and jellies or made into wines that produce a dark purple liquid with sweet-tart flavor. Elderberries can also be combined with other herbs to make teas; tinctures; syrups; extracts for candy, beverages and baking.

Supplements containing elderberries have been used to treat colds and flu, as well as:

Chronic fatigue syndrome
Hay fever
High cholesterol
Sinus infections
Upper respiratory infections

Does Elderberry work in clinical trials?

In a randomized, double-blind, placebo-controlled study during the influenza season of 1999-2000, 60 patients (aged 18-54 years) suffering from influenza-like symptoms for 48 h or less received 15 ml of elderberry or placebo syrup four times a day for 5 days, and recorded their symptoms using a visual analogue scale. Symptoms were relieved on average 4 days earlier and use of rescue medication was significantly less in those receiving elderberry extract compared with placebo.(1)

Additionally, a meta-analysis of elderberry performed in 2018 determined that supplementation with elderberry was found to substantially reduce upper respiratory symptoms. The quantitative synthesis of the effects yielded a large mean effect size.(2)

A meta-analysis by the way is an examination of data from a number of independent studies pertaining to the the same subject in order to identify overall trends.

This promising trend and the glowing reviews from people of all walks of life resulted in more than $100 million in sales of elderberry supplements in the US between January and March of 2018. Sales of herbal supplements overall grew by a record breaking 17.3% in 2020 with elderberry sales skyrocketing to $320 million.

Not so fast, though.

Michael Macknin, MD, professor emeritus of pediatrics at Cleveland Clinic Lerner College of Medicine, was lead investigator in a study conducted between January 2018 and April 2019 including 87 patients ages five and older who tested positive for influenza. A 5-day trial of elderberry extract or placebo was conducted in an emergency room setting. Alternatively, they could take oseltamivir (Tamiflu), which is an antiviral drug.

A placebo was given orally twice daily for five days to patients between 5 and 12. Elderberry extract was administered four times daily for five days to subjects over the age of 12. No difference was observed between the groups of Elderberry and placebo in the severity or duration of flu symptoms. It took two extra days for people in the elderberry group who did not take oseltamivir to feel better compared to people in the placebo group. Considering that earlier studies reported that elderberries shortened flu symptoms by four days, further studies are needed.

Likewise, the Federal Trade Commission and the Food and Drug Administration have taken action against firms marketing products with unconfirmed claims that Elderberry can prevent COVID-19.

In summary, there is evidence that elderberry can shorten the duration and severity of some viral respiratory infections and that elderberry is generally regarded as safe when taken as a supplement. There is, however, no magic bullet when it comes to COVID-19 and flu cases. The fundamentals of vaccination when appropriate, proper hygiene, nutrition, sleep habits and exercise all remain critical steps we can take to mitigate the risk of infection.


1) Zakay-Rones et al. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. Mar-Apr 2004;32(2):132-40.

2) Hawkins et al. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complement Ther Med 2019 Feb;42:361-365.

3) Macknin et al. Elderberry Extract Outpatient Influenza Treatment for Emergency Room Patients Ages 5 and Above: a Randomized, Double-Blind, Placebo-Controlled Trial Intern Med. 2020 Nov;35(11):3271-3277.

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