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Elderberry and elderflower (Sambucus nigra)

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Also listed as: Sambucus nigra
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Almindelig hyld, alpha-amyrenone, alpha-amyrin, anthocyanins, baccae, baises de sureau, battree, beta-sitosterol, betulin, black berried alder, black elder, black elderberry, boor tree, bountry, boure tree, Busine (Russian), Caprifoliaceae (family), cyaniding-3-glucoside, cyanidin-3-glucoside monoglucuronide, cyanidin-3-sambubioside, devil's eye, elderberry, elderberry anthocyanins, elderberry bark agglutinin , elderberry juice, ellanwood, ellhorn, European alder, European elder, European elder fruit, European elderberry, European elderflower, frau holloe, German elder, Holunderbeeren, Holunderblüten, hyperoside, inking elder, lady elder, mucilage, nigrin b, N-phenylpropenoyl-L-amino acid amides, old gal, old lady, oleanolic acid, peonidin 3-glucoside, peonidin 3-sambubioside, peonidin monoglucuronide, pipe tree, plastocyanin, quercetin, Rubini® (elderberry extract), rutin, Sambreo, Sambuci flos, Sambuci fructus, Sambucipunct Sambucus, sambuco (Italian), Sambucus sieboldiana (Japanese), Schwarzer holunder (German), sambunigrin, sieboldin-b, suco (Spanish), sureau noir (French), sweet elder, tannins, tetrameric, tree of doom, yakori bengestro.
  • Selected combination products: OptiBerry IH141 (contains wild blueberry, strawberry, cranberry, wild bilberry, elderberry, raspberry extracts), Sinupret® (contains Sambucus nigra flowers, gentian root, verbena, cowslip flower, and sorrel), Sambucol® Active Defense (contains elderberry extract, vitamin c, zinc Echinacea angustifolia, Echinacea purpurea, and propolis), Sambucol® Immune System (contains elderberry, Echinacea angustifolia root, Echinacea purpurea, propolis, vitamin C, zinc), Sambucol® for Kids (contains elderberry, Echinacea purpurea, Echinacea angustifolia root, propolis). A phytotherapic compound contained Pimpinella anisum, Foeniculum vulgare, Sambucus nigra, and Cassia augustifolia.
  • Note: Several species of Sambucus produce elderberries. Most evidence refers to Sambucus nigra. Other species with similar chemical parts include the American elder or common elder (Sambucus canadensis), antelope brush (Sambucus tridentata), blue elderberry (Sambucus caerulea), danewort (Sambucus ebulus), dwarf elder (Sambucus ebulus), red-fruited elder (Sambucus pubens, Sambucus racemosa), and Sambucus formosana. American elder (S. canadensis) and European elder (S. nigra) have often been studied together, since they have similar parts and uses.

Background
  • Several species of Sambucus produce elderberries. Most evidence refers to Sambucus nigra. American elder and European elder have often been studied together, since they have similar parts and uses.
  • European elder may grow up to 30 feet tall. It is native to Europe, but has been brought to the Americas. The flowers and leaves have been used to reduce pain, swelling, and inflammation. They also been used to improve mucus and urine production. The leaves have been used in baths. The bark has been used to improve urine flow or bowel movements, as well as to induce vomiting. The berries have been used as food.
  • The flowers and blue or black berries are most often used as medicine. They contain compounds that may help treat the flu, sinus infections, or bronchitis. However, more evidence is needed. Information is lacking on the possible benefits of elder used alone.
  • The bark, leaves, seeds and raw fruit contain sambunigrin, a compound that may be toxic.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Early research suggests that elder may have antiviral benefits. One study found that elderberry juice may improve flu symptoms such as fever, fatigue, headache, sore throat, cough, and aches, in less than half the usual recovery time of the flu. However, the study was small, and it should be noted that the berries must be cooked to prevent nausea or poisoning. In another study, elderberry appeared to improve cough, fever, headache, mucus discharge, muscle aches, and nasal congestion. More research is needed before firm conclusions can be made.

B


Evidence on the use of elder alone for bronchitis is lacking. The combination product Sinupret®, which contains elder, has been used to treat acute bronchitis and sinus infection. There is some evidence that Sinupret® may have benefits for this condition compared to other medications. More information is needed.

C


Early study suggests that a combination product containing elder may help treat chronic constipation in as little as two days. More research is needed before firm conclusions can be made.

C


Elder has been used in combination with other products to reduce gum disease and inflammation. Significant results were seen four days after treatment. A combination mouthwash containing elder significantly decreased gum disease when used three times daily for 14 days. Further study is needed on the possible effects of elder alone.

C


Early study suggests that long-term elderberry use may lack heart health benefits in postmenopausal women. More research is needed in this area.

C


Evidence on the use of elder alone as a treatment for high cholesterol is lacking. One study reports that elder may have benefits for people with this condition. However, more research is needed in this area.

C


Limited study has looked at elder for sinus infection in humans. Combination products containing elder (such as Sinupret®) have been reported to have benefits when used with antibiotics. Research suggests that such products may help improve swelling, drainage, headache, and nasal congestion. More evidence is needed on the possible benefits of elder alone.

C


Elderberry has been studied for possible weight loss benefits. A significant difference has been seen in body weight, blood pressure, and quality of life. However, further study is needed before conclusions may be made.

C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Alzheimer's disease, angiogenesis (anti-, prevents blood vessel formation), anti-inflammatory, antioxidant, antispasmodic (prevents muscle spasms), asthma, astringent, blood pressure control, blood vessel disorders, burns, cancer, circulation, colds, colic, cough, diabetes, diaphoretic (promote sweating), epilepsy, fever, flavoring, fragrance, gout, hair dye, hay fever, headache, , herpes simplex virus, HIV, immune enhancer, improving urine flow, insomnia, joint swelling, kidney disease, laryngitis, liver disease, measles, migraines, mosquito repellant, nerve pain, osteoporosis, psoriasis, respiratory distress, sedative, skin infections, skin irritation (chafing), stomach disorders, stress reduction, swelling, syphilis, toothache, ulcerative colitis, vomiting.

Dosing

Adults (18 years and older)

  • Dried elder flowers (3-5 grams steeped in boiling water for 10-15 minutes) have been taken by mouth three times daily. There may be a risk of poisoning.
  • For heart disease prevention, two elderberry extract capsules (500 milligrams, containing anthocyanin levels equivalent to those in 25 grams elderberries, 140 grams blackberries, and 100 grams blueberries) have been taken by mouth twice daily (in the morning and at night) for 12 weeks.
  • To treat high cholesterol, 400 milligram spray-dried powder capsules containing 10 percent anthocyanes have been taken by mouth three times daily (equivalent to five milliliters of elderberry juice for two weeks). Spray-dried elderberry juice containing 120-4,000 milligrams of anthocyanins have been taken by mouth daily for two to three weeks.
  • To treat the flu, elderberry extract lozenges (175 milligrams) have been taken by mouth four times daily for two days. A dose of 15 milliliters of elderberry syrup has been taken by mouth four times a day for five days.
  • A cream (made from fresh elder flowers mixed with petroleum jelly and simmered for 40 minutes, filtered, then solidified) has been applied to the skin.

Children (under 18 years old)

  • There is no proven safe or effective dose for elder in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in people with a known allergy or sensitivity to elder or plants in the Caprifoliaceae (honeysuckle) family.

Side Effects and Warnings

  • Elder is likely safe when used as cooked berries in amounts found in foods. Short-term use of elder flowers is believed to be safe. Combination products containing elder, such as Sinupret®, are likely safe.
  • Use elderberry products with caution and under a healthcare provider's care, due to the risk of poisoning from elder bark, root, leaves, or juice. The berries must be cooked well to avoid nausea or vomiting.
  • Use cautiously in people who have abnormal heart rhythms or heart disease. Elder may cause changes in heart rate.
  • Elder may cause low blood pressure. Caution is advised in people taking drugs or herbs and supplements that lower blood pressure.
  • Use cautiously in people who are taking chemotherapy agents, due to the risk of increased side effects.
  • Use cautiously in people who have central nervous system disorders. Elder may cause central nervous system changes.
  • Use cautiously in people who have skin disorders. Elder may cause allergic skin reactions.
  • Elder may affect insulin and blood sugar levels. Caution is advised in people with diabetes or low blood sugar, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood sugar levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.
  • Use cautiously in people who have diarrhea or conditions that cause diarrhea. Elder may have laxative effects.
  • Use cautiously in people who are taking agents that improve urine flow. Elder may promote urination.
  • Use cautiously in people who have eating disorders or are underweight. Elder may decrease body mass or cause anorexia.
  • Use cautiously in women. Elder may cause painful menstrual periods.
  • Use cautiously in people who have stomach disorders. Elder may cause indigestion, nausea, stomach cramps, stomach upset, and vomiting.
  • Use cautiously in people who have abnormal potassium levels. Elder may decrease potassium levels.
  • Use cautiously in people who have migraines. Elder may cause headache.
  • Use cautiously in people who have muscle pain. Elder may cause backaches.
  • Use cautiously in people who have breathing disorders. Elder may cause breathing problems or coughing.
  • Use cautiously in people who are taking theophylline. Elder may affect theophylline levels.
  • Avoid if allergic or sensitive to elder or plants in the Caprifoliaceae (honeysuckle) family. Avoid consuming the bark, roots, leaves, and unripe berries, due to the risk of poisoning.
  • Elder may also cause a bad taste, mouth sensitivity, sore throat, teeth staining, and weakness.

Pregnancy and Breastfeeding

  • There is a lack of scientific evidence on the use of elder during pregnancy or breastfeeding.

Interactions

Interactions with Drugs

  • Elder may affect insulin and blood sugar levels. Caution is advised when using medications that may also affect blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Elder may cause low blood pressure. Caution is advised in people taking drugs that lower blood pressure.
  • Elder may also interact with agents that may affect electrolyte levels, agents that may promote urination, agents that may treat heart disorders, antibiotics, anticancer agents, anti-inflammatories, antivirals, caffeine, cholesterol-lowering agents, decongestants, dental agents, HIV agents, laxatives, methylxanthines, nervous system agents, stomach agents, vascular endothelial growth factor (VEGF) inhibitors, and weight loss agents.

Interactions with Herbs and Dietary Supplements

  • Elder may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Elder may cause low blood pressure. Caution is advised in people taking herbs or supplements that lower blood pressure.
  • Elder may also interact with antibacterials, anticancer herbs and supplements, anti-inflammatory herbs and supplements, antioxidants, antivirals, caffeine, cholesterol-lowering herbs and supplements, decongestants, dental herbs and supplements, herbs and supplements that may affect electrolyte levels, herbs and supplements that may promote urination, herbs and supplements that may treat heart disorders, herbs and supplements that may treat nervous system disorders, herbs and supplements that may treat stomach disorders, laxatives, and weight loss herbs and supplements.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Bagchi D, Sen CK, Bagchi M, et al. Anti-angiogenic, antioxidant, and anti-carcinogenic properties of a novel anthocyanin-rich berry extract formula. Biochemistry (Mosc.) 2004;69(1):75-80, 1.
  2. Chrubasik C, Maier T, Dawid C, et al. An observational study and quantification of the actives in a supplement with Sambucus nigra and Asparagus officinalis used for weight reduction. Phytother.Res. 2008;22(7):913-918.
  3. Curtis PJ, Kroon PA, Hollands WJ, et al. Cardiovascular disease risk biomarkers and liver and kidney function are not altered in postmenopausal women after ingesting an elderberry extract rich in anthocyanins for 12 weeks. J.Nutr. 2009;139(12):2266-2271.
  4. di Tizio A, Luczaj LJ, Quave CL, et al. Traditional food and herbal uses of wild plants in the ancient South-Slavic diaspora of Mundimitar/Montemitro (Southern Italy). J.Ethnobiol.Ethnomed. 2012;8:21.
  5. Grbic J, Wexler I, Celenti R, et al. A phase II trial of a transmucosal herbal patch for the treatment of gingivitis. J.Am.Dent.Assoc. 2011;142(10):1168-1175.
  6. Harokopakis E, Albzreh MH, Haase EM, et al. Inhibition of proinflammatory activities of major periodontal pathogens by aqueous extracts from elder flower (Sambucus nigra). J Periodontol. 2006;77(2):271-279.
  7. Hasani-Ranjbar S, Nayebi N, Larijani B, et al. A systematic review of the efficacy and safety of herbal medicines used in the treatment of obesity. World J.Gastroenterol. 7-7-2009;15(25):3073-3085.
  8. Kong F. Pilot clinical study on a proprietary elderberry extract: efficacy in addressing influenza symptoms. Online Journal of Pharmacology and Pharmacokinetics 2009;5:32-43.
  9. Melzer J, Saller R, Schapowal A, et al. Systematic review of clinical data with BNO-101 (Sinupret) in the treatment of sinusitis. Forsch Komplement.Med (2006.) 2006;13(2):78-87.
  10. Murkovic M, Abuja PM, Bergmann AR, et al. Effects of elderberry juice on fasting and postprandial serum lipids and low-density lipoprotein oxidation in healthy volunteers: a randomized, double-blind, placebo-controlled study. Eur.J.Clin.Nutr. 2004;58(2):244-249.
  11. Picon PD, Picon RV, Costa AF, et al. Randomized clinical trial of a phytotherapic compound containing Pimpinella anisum, Foeniculum vulgare, Sambucus nigra, and Cassia augustifolia for chronic constipation. BMC.Complement Altern.Med. 2010;10:17.
  12. Samuels N, Grbic JT, Saffer AJ, et al. Effect of an herbal mouth rinse in preventing periodontal inflammation in an experimental gingivitis model: a pilot study. Compend.Contin.Educ.Dent. 2012;33(3):204-211.
  13. Samuels N, Saffer A, Wexler ID, et al. Localized reduction of gingival inflammation using site-specific therapy with a topical gingival patch. J.Clin.Dent. 2012;23(2):64-67.
  14. Vlachojannis JE, Cameron M, and Chrubasik S. A systematic review on the sambuci fructus effect and efficacy profiles. Phytother.Res. 2010;24(1):1-8.
  15. Zakay-Rones Z, Thom E, Wollan T, 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. 2004;32(2):132-140.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


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