Elderberry: Benefits, Dosage, and Safety

What elderberry is

Elderberry (usually written as one word) is the ripe fruit of Sambucus nigra, a small deciduous tree also called European elder or black elder that grows in North America, Europe, Western Asia, and parts of Africa. The dried flowers (elder flower) and the cooked blue or black berries are used in teas, liquid extracts, syrups, gummies, and capsules. It is a botanical dietary supplement, not an essential nutrient, so it has no Dietary Reference Intake. Elderberry contains many compounds including anthocyanins, flavonols, and phenolic acids. Most human studies have used elderberry extracts rather than the whole berries.

What it does

• Contains anthocyanins, flavonols, and phenolic acids that laboratory studies suggest may have antioxidant activity
• Laboratory and animal research suggests its constituents might have anti-inflammatory effects
• Preliminary laboratory and animal research suggests constituents might inhibit some viruses from binding to host cells
• Laboratory research suggests possible immune-stimulating (immunostimulatory) activity
• Marketed and traditionally used for cold and flu symptoms, though clinical evidence remains uncertain

Intake and dosing

Elderberry is not an essential nutrient, so no Recommended Dietary Allowance or Tolerable Upper Intake Level has been set. Doses in studies vary widely. Because supplement doses are not standardised, discuss an appropriate amount with a clinician or pharmacist.

Deficiency and who is at risk

Not applicable. Elderberry is a botanical supplement, not an essential nutrient, so there is no deficiency state or established requirement.

Who may need more

• People interested in traditional or supplemental use for cold and flu symptoms, recognizing that the clinical evidence is uncertain
• There is no population with a nutritional requirement for elderberry, because it is not an essential nutrient

Food sources

Cooked ripe elderberries used in syrups, jams, and cordials; commercially processed elderberry products. Only the cooked blue or black ripe berries of Sambucus nigra are edible; raw or unripe berries and other plant parts are toxic.

Forms and absorption

Available as standardized berry extracts, syrups, lozenges, gummies, capsules, and teas; dried elder flower is also sold. Most clinical trials used elderberry extracts rather than whole berries, and products vary widely in concentration and standardization. ODS notes that recent analyses found some elderberry supplements have been adulterated, being highly diluted or containing a substitute such as black rice extract instead of elderberry, so product quality and authenticity vary. Only the cooked blue or black ripe berries are safe; raw or unripe berries are toxic.

Safety, excess and interactions

Too much

Raw or unripe elderberries and other parts of the elder tree (bark, leaves, seeds, and stems) contain a cyanogenic glycoside, a cyanide-producing substance that is potentially toxic. Consuming these uncooked or unripe parts can cause nausea, vomiting, severe diarrhea, dehydration due to diuresis, and cyanide poisoning. Large quantities of the toxin may cause serious illness. The heat from cooking destroys this toxin, so cooked elderberry fruit and properly processed commercial products do not pose this concern. No Tolerable Upper Intake Level has been established.

Interactions to know

• Immunosuppressant medications: due to its potential immunostimulatory activity, elderberry might reduce the effectiveness of medications that suppress the immune system (ODS COVID-19 fact sheet)
• Diabetes medications and blood glucose control: elderberry might affect insulin and glucose metabolism, so people with diabetes and those on glucose-lowering drugs should use it with caution (ODS)
• Diuretic drugs: because of elder flower's possible diuretic effects, use caution when taking it with drugs that increase urination (NCCIH European Elder fact sheet)

How status is measured

Not routinely measured. Elderberry is not an essential nutrient and there is no clinical laboratory marker for elderberry status or intake.

Regulated as a dietary supplement under DSHEA, not approved by the FDA before sale. Manufacturers are responsible for safety and labeling. The FDA and Federal Trade Commission have taken action against companies marketing elderberry products with unsubstantiated claims of effectiveness for COVID-19.

What the evidence supports

We grade the strength of evidence behind each common reason people take elderberry, mirroring how the NIH describes it.