By Mary Pembleton
It’s touted as a “miracle” remedy for a variety of pesky winter bugs: colds, flu and yes, even recently, the coronavirus. Elderberry has garnered a cult following on social media in recent years, and has the sales numbers to show for it. According to a report published by the American Botanical Council in 2019, sales of elderberry supplements, which are made from the fruit of a flowering shrub, more than doubled in the United States between 2017 and 2018 to a total of nearly $51 million.
“In my own community, many of my friends dose their kids with elderberry in pretty much every iteration,” said Ashley Adams English, author of “Home Apothecary with Ashley English,” meaning they give their children elderberry in the form of homemade syrups, gummies and more.
Elderberry supplementation has long been used as a folk remedy for flu, but what does the science say? And is it safe? Here’s what to know.
What is elderberry?
The elderberry is a flowering plant native to Europe and North America. Its fruit — which ripen as berries in clusters and which can range in color from bright red to blue to dark purple or black — are often packaged into products like lozenges, syrups, gummies, capsules, tinctures and teas. You can find them in pharmacies, grocery stores, vitamin shops and on Amazon.
Dried berries are also available for purchase in bulk. Keep in mind, however, that the seeds of raw or dried elderberry fruit are toxic, so if you want to eat elderberries safely, you’ll need to cook them. The leaves, bark, and roots of the plant are also poisonous and should be avoided.
How has it been used historically?
For centuries, people have used elderberry fruit to make food products like jams, wines, pies and more. But it is perhaps best known as a traditional medicine. Elderberry fruits contain vitamin A, potassium, calcium, vitamin C and high levels antioxidants like anthocyanins, which give the fruit its color and may play a role in boosting overall health.
In 400 B.C., Hippocrates, the Greek physician who’s also known as “the Father of Medicine,” referred to the shrub as his “medicine chest.” Since then, the plant has been used around the world as a traditional remedy for not only colds and flu, but also a variety conditions such as constipation, toothaches, sprains, dislocations, hemorrhoids, burns, insect bites and rashes.
Is there any evidence that elderberry helps with the flu?
The available evidence on how elderberry might fight the flu is “spotty at best,” said Dr. Eric Ball, M.D., a pediatrician with CHOC. Children’s at Mission Hospital in Orange County, Calif.
A systematic review published in 2014, for instance, identified two small human studies which found that those who took elderberry extract while sick with the flu had less severe symptoms and were sick for a shorter amount of time than those who took a placebo, but concluded that large, well-designed clinical trials were needed to confirm this result. Another review, published in 2010, looked at 22 studies (the majority of which were on animals or in petri dishes) on how elderberry fruit might treat or prevent disease. The authors concluded that the elderberry fruit was only poorly or moderately effective based on those studies’ limited conclusions. None directly addressed elderberry’s safety.
“The data we have is extremely small, short-lived studies that looked at how people felt,” said Dr. Ball. “When we look at things that’ve been proven to be effective against influenza such as the flu shot, we do giant studies with lots of patients documenting outcomes like hospitalization and death.”
Stacey Gillespie, director of brand strategy at Gaia Herbs, a manufacturer of elderberry syrups, capsules and other supplements, said that the barrier to conducting the large clinical trials is funding. “Peer-reviewed, double-blind, placebo-controlled studies are often quite costly,” she said, which makes it challenging for industry and academics to carry them out.
Is it safe to try on my child?
If properly prepared, most experts consider elderberry safe for adults, but because available elderberry research has focused mainly on adults, it’s hard to say how safe it is for kids.
Supplements in general aren’t strictly regulated by the Food and Drug Administration, so while the F.D.A. puts forth safe manufacturing guidelines for the supplement industry, products can enter the market without any F.D.A. testing. It’s difficult, then, to know whether a given supplement contains what it says on the label, or if it’s free from contamination.
According to a review of 10 elderberry supplements by ConsumerLab.com, a company that hires independent labs to test supplements and publishes the results, some products may contain much less or much more elderberry extract than is advertised on a product’s label, making it hard to know how much elderberry a given supplement actually contains.
It’s also unclear what dose is appropriate or safe for a child. For these reasons, Dr. Ball advised that parents avoid giving their children supplements altogether, unless specifically prescribed by a doctor.
If you still decide to use it, Dr. Hilary McClafferty, M.D., past chair of the American Academy of Pediatrics Section on Integrative Medicine, said it’s important to use “a quality, well-established product with good manufacturing practices.”
One way to determine a product’s quality is to look up whether it’s been third-party tested or verified by trusted independent organizations like ConsumerLab.com, N.S.F. International or United States Pharmacopeia (USP), though it’s important to remember that doing so doesn’t guarantee a product’s safety.
Dr. Joy Weydert, M.D., chair of the A.A.P. Section on Integrative Medicine, advised parents who give their children elderberry to avoid products that also contain other herbs or vitamins, since they could potentially cause side effects. Never use lozenges or gummies with young children, she said, since they can pose a choking hazard, and avoid products containing alcohol.
What parents should never do, said Dr. David Cennimo, M.D., an assistant professor of medicine and pediatrics at Rutgers University, is substitute elderberry for medical intervention. “If you avoid medical treatment or a flu shot because you put your hope and faith into that supplement, that’s where it really becomes an issue,” he said.
If you do decide to try elderberry (or any supplement), always do so under the guidance of a licensed pediatrician. Supplement use should never override your pediatrician’s medical advice.
What should I do if my child gets the flu?
If your child does get sick, contact their pediatrician, keep them hydrated and look for signs of distressed breathing, which could signal an emergency. To help relieve their symptoms, Dr. Ball suggested “proven, effective, supportive treatments such as acetaminophen, saline nasal sprays and Grandma’s chicken soup.”
By far, the best thing you can do for your family is to make sure everyone aged 6 months or older gets their annual flu shot. It’s not 100 percent effective in preventing the flu, but even if your child does end up getting it, vaccination can significantly reduce their risk of developing severe, life-threatening complications. “What we are seeing is that those who had the flu vaccine this season seem to be tolerating the illness better overall with fewer hospitalizations and comorbidities, such as pneumonia or oxygen requirement,” Dr. McClafferty said.