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A Review Of Elderberry: Health Benefits, Risks, Uses, Effectiveness

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Elderberry is a deciduous multi-stemmed shrub with brittle branches that easily bent under the weight of its fruit clusters. Suckering from the roots and branching from the base of the main stems force the plant to form dense thickets. It can reach up to 9 m in height in the southern part of its distribution area but less than 4 min the southern part of Canada (Small et al. 2004). Aging of the shrub is accompanied by the death of old branches, a process preventing the plant from reaching extreme heights. S. nigra. or black elder is a plant native to Europe, America, Northern Africa, and Western- and Central Asia. Sambucus is a genus of flowering plants in the family Adoxaceae (formerly Caprifoliaceae) that grows on sunlight-exposed places.

While there are a number of Elderberry species native to the US and Canada, it is Sambucus canadensis that is most common in the central and eastern parts. In fact, this one is often considered a woody weed in fencerows, along ditches, and around farmsteads. In many instances, only the local birds take much notice of this medium to large shrub. Large (5–15 cm long) opposite pinnately compound leaves contain from 5 to 11 leaflets with sharply serrated margins. American elder is among the first shrubs to flush in early spring in Canada. In the northern part of its distribution range, it blooms at the end of June independently of heat accumulation (Guilmette 2006). Blooming is synchronous for numerous cultivars of interest for the industry. Creamy-white flowers gather into large terminal clusters up to 35 cm across. Wind rather than insects are the main vector for pollen distribution (unpubl. data).

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Fruit ripening happens over a 2-month period in northern latitudes. At maturity, small (5–9 mm in diameter) deep purple almost blackberries (Fig. 1) hang upside down as the stem often bent under the weight. A single cluster can contain as many as 2000 berries. American elder should not be confused with a red-berried elder (S. racemosa Michx. or S. pubens Michx. ) which partly shares the same territory but blooms earlier and produces bright red berries.


The Sambucus nigra plant is a member of the Caprifoliaceae or honeysuckle family and can be found growing in shady, moist areas in Europe, Asia, North Africa, and North America. It tolerates relatively poor soil conditions and is often found growing as part of the underbrush in forests. The naturalized plant in North America is known as Sambucus nigra ssp Canadensis, Sambucus canadensis, or North American elderberry. The tree-like shrub has light brown or gray stippled bark and narrow, dark green, serrated leaves. In early summer, Sambucus nigra blooms with large clusters of small, fragrant, creamy-white flowers that develop into shiny, purplish-black berries by late summer and early fall. 1,2 Historically, the leaves, bark, flowers, and berries have all been used medicinally, but most of the clinical studies have been conducted on the therapeutic uses and properties of the elderberry.

Active Constituents

The fruit of Sambucus nigra (elderberries) contains several constituents responsible for the pharmacological activity. Among these are the flavonoids quercetin and rutin, anthocyanins identified as cyanidin-3-glucoside and cyanidin-3-sambubioside,3 the hemagglutinin protein Sambucus nigra agglutinin III (SNA-III),4 cyanogenic glycosides including sambunigrin,5,6 viburnic acid, and vitamins A and C.


Due to limited research, the pharmacokinetics of many constituents of Sambucus nigra is not completely understood. Available research has focused on the absorption and urinary excretion of the anthocyanin constituents. Historically, researchers were uncertain whether anthocyanins were absorbed unless they were first hydrolyzed in the gastrointestinal tract. Recently, however, several small pharmacokinetic studies of elderberry extract in healthy volunteers demonstrated elderberry anthocyanins are indeed absorbed and excreted in an intact form. Within four hours of consuming 12 g elderberry extract containing 720 mg total anthocyanins, the two major anthocyanins in elderberry extract were identified in the urine of four elderly women. 3 One study investigated the absorption of elderberry anthocyanins in a single male subject given 25 g elderberry extract (1. 5 g total anthocyanins); high-performance liquid chromatography (HPLC) analysis detected two anthocyanin peaks in plasma collected 30 minutes post-dose.

Mechanism Of Action Antiviral

There are several mechanisms responsible for the beneficial effects of Sambucus nigra and extracts of its berries, perhaps the most important and best studied are the antiviral effects. Mumcuoglu, an Israeli virologist, was the first to discover elderberry constituents neutralize the activity of the hemagglutinin spikes found on the surface of several viruses. Numerous studies using the Sambucol preparation have shown it to neutralize and reduce the infectivity of influenza viruses A and B,12,13 HIV strains and clinical isolates,14 and Herpes simplex virus type 1 (HSV-1) strains and clinical isolates.


Elderberries contain several anthocyanin flavonoids known to possess significant antioxidant properties. Research has demonstrated low-level concentrations (4 mcg/mL) of elderberry anthocyanins can efficiently regenerate alpha-tocopherol from alpha-tocopheroxyl radicals in models of copper-mediated LDL oxidation.

Since it has been observed that anthocyanin glycosides are indeed absorbed in humans,3,7-10 it is likely that supplementing with elderberry extracts containing anthocyanins provides significant antioxidant benefit. Based on this premise and previous research on elderberryʼs antioxidant potential, Youdin et al demonstrated elderberry anthocyanin incorporation into endothelial cells confers increased protection against oxidative stress. Human aortic endothelial cells incorporated elderberry anthocyanins into both the membrane and cytosol, affording significantly enhanced resistance to damage from reactive oxygen species. The most pronounced effect was seen with protection against H2O2-induced loss in cell viability.

Culinary Uses

Elderberries are easy to like. They’re user-friendly. Jam, jelly, pies, syrup, schnapps, brandy, and wine can be made from them. pick and freeze clusters, to make removal from the stems easier and cleaner. The berries have more Vitamin C per unit weight than either oranges or tomatoes. They also contain more phosphorus and potassium than any other temperate fruit crop, and a good amount of Vitamin A. The flowers are also edible and can be used in pancakes and muffins, or just dipped in batter and fried. They also make a nice tea or a refreshing “Elder Blow Champagne,” which is a pale wine resembling champagne. Elderflower water is also used in perfumes and sweets. Flowers are used to producing elderflower cordial.

The French, Austrians, and Central Europeans produce elderflower syrup, commonly made from an extract of elderflower blossoms, which is added to pancake mixes instead of blueberries. People from Central, Eastern, and South-eastern Europe us a similar method to make a syrup which is diluted with water and used as a drink. In the US, the French elderflower syrup is used to make elderflower marshmallows. St. Germaine, a French liqueur, is made from elderflowers; and Hallands Flader, a Swedish aquavit, is flavored with elderflowers. Tart, deep purple berries are used in jams, jellies, chutneys, preserves, and wine. The dried blossoms are used in tea blends. There is one early recommendation that young elderberry shoots can be cooked like asparagus and eaten. No modern backup has been found for this one. MEdicinal valuEsElderberry fruits are an excellent source of anthocyanin’s, vitamins A and C and a good source of calcium, iron and vitamin B6.

They also contain sterols, tannins, and essential oils (Anon. 2005) and can readily be considered a healthy food. But more evidence is needed to really sustain any claim relative to their medicinal value. Folk Medicine In folk medicine, elderberries have been used for their diaphoretic, laxative and diuretic properties (Uncini Manganelli et al. 2005; Merica et al. 2006) and to treat various illnesses such as stomach ache, sinus congestion, constipation, diarrhea, sore throat, common cold, and rheumatism (Novelli 2003; Uncini Manganelli et al. 2005). The flowers are said to have diaphoretic, anti-catarrhal, expectorant, circulatory stimulant, diuretic, and topical anti-inflammatory actions (Merica et al. 2006). Some of these properties seem justified since elderberry fruits contain tannins and viburnic acid, both known to have a positive effect on diarrhea, nasal congestion, and to improve respiration (Novelli 2003).

Leaves and inner bark have also been used for their purgative, emetic, diuretic, laxative, topical emollient, expectorant, and diaphoretic action (Merica et al. 2006). Indirect Evidence for Health Benefits Elderberry medicinal potential comes from its antioxidant potential, a property shared by numerous phytochemicals. The human body is constantly under attack and uses free radicals to protect itself. Such a mechanism can, however, lead to cascade effects that can be detrimental to the cells and even lead to cancer. Our body uses antioxidants from plant origins to neutralize harmful free radicals and elderberry total antioxidant capacity is one of the highest of all the small fruits.

In one study including the black elder, this species came third for its antioxidant capacity as measured with the FRAP method (Halvorsen et al. 2002). Using the ORAC technique to measure the antioxidant potential of various small fruits, Wu et al. (2004a,b) showed that the American elder had a much higher potential than cranberry and blueberry, two fruits praised for their high antioxidant capacity. Such a high antioxidant potential in American elderberries has been confirmed in our laboratory (unpubl. data). Direct Evidence for Health BenefitsIt is only recently that direct evidence has been provided showing that anthocyanins can be absorbed by humans (Cao and Prior 1999). These authors showed that after oral administration of elderberry extract, cyanidins are absorbed in their glycosidic forms. Despite these results, the exact form under which elderberry anthocyanins are absorbed by humans is still a matter of debate. More evidence showed that they are probably absorbed in their glycosidic forms (Cao et al. 2001; Murkovic et al. 2001; Milbury et al. 2002). The sugar moieties can alter their apparent absorption and metabolism (Wu et al. 2005). Absorption and excretion of anthocyanins were reported to be lower than other flavonoids (Wu et al. 2002). More evidence is available concerning anthocyanins absorption, including cyanidin 3-glucoside, by mammals (Talavéra et al. 2003, 2004; Felgines et al. 2006). Probably the most interesting properties of elderberry extracts were reported by Zakay-Rones et al. (1995).

Following earlier work done by Konlee (1998), these authors reported that a mixture containing elderberry extract had an inhibitory effect on haemagglutinin found in mycovirus. More work done by Barak et al. (2001, 2002) have shown that such a mixture could inhibit the replication of 11 strains of the influenza virus and increase cytokines production. Clinical IndicationsViral Infections InfluenzaTwo randomized, placebo-controlled, double-blind studies demonstrated the elderberry extract, Sambucol, effectively inhibited both influenza A and B strains when given orally to patients in the first 48 hours of influenza symptoms.

Herpes simplex

The complete inhibition of four strains of HSV-1 in vitro by elderberry extract warrants further clinical trials in humans. A formula of Sambucus nigra (flower extract) in combination with Hypericum perforatum and Saponaria officinalis was also found to inhibit the replication of HSV-1 in vitro.

Drug – Botanical Interaction

There are no confirmed drug interactions with elderberry extract. However, due to the ability of Sambucus flower extracts to potentiate insulin release in vitro,26 patients with diabetes should be advised to monitor blood sugar closely when using flower extracts.

Side Effects and Toxicity

Elderberry extracts are generally without side effects when taken in the suggested dosages. 12 Berries should be cooked, as the consumption of uncooked berries or juice can result in vomiting and diarrhea.

Certain constituents of the leaves, stems, flowers, and roots contain poisonous alkaloids. 27 It has also been reported that small percentages of the general population have a type-1 allergy to Sambucus nigra as evidenced by positive-skin prick or RAST test.

Dosage Elderberry fruit syrups are often standardized to 30-38 percent elderberry. Powdered extracts are dosed at 500 mg (capsule) 2-3 times daily for 3-4 days, or if in liquid form, dosed at one tablespoonful (15 mL) three times daily. In the case of acute viral infections, the course of treatment is generally at least three days. Considering the market potential of American elder and the stability of its anthocyanins, that is superior to that of black elder pigments, it is difficult to understand why its production is so low in North America. In fact, both the flowers and the berries are quite suitable for processing and close to 100 different products, mostly made from the black elder, are proposed on the Internet. These products can be divided into two main categories: food and beverages, and health products.

Food and Beverages

They can be used to prepare jam, jelly, pie, salad dressing, sauce, snack, juice, soft drink, cordial, wine, port, and beer. A very stable food colorant can be extracted from the berries and used in the food industry. Fresh and dried berries can be found in breakfast cereals, yogurt, and ice cream. To a lesser extent, elderberry flower can also serve to prepare fritters, wine, beer, and liquors. No information is available about fresh elder berries shelf life. The rather small size of these fruits probably makes them less appealing to consumers. This would explain why they are almost exclusively available as processed food.

Health Products

The high polyphenol content, including anthocyanins, of elderberry fruits, has been recognized and exploited by the pharmaceutical and natural products industries. Shampoos and body lotions are proposed to consumers.There is also a full array of products including lozenges, syrups, herbal teas, extracts, and supplements, all capitalizing on various health benefits associated with specific components found in elderberry fruits or flowers.


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