Elderberry for Flu Prevention, Safety in Pregnancy, Drug Interactions, and More…

I am excited to be able to introduce an elderberry supplement into the Sunshine Nutraceutical product line.  Elderberry is a purple berry produced by the European elder tree, a shrub which grows up to ten meters tall.  Elder flowers and berries have been used as medicines and flavorings for centuries and are especially popular as potent cold and flu remedies.  These common ailments have few treatments and can be annoying and even deadly in certain individuals.  Elderberries have been utilized to treat various health conditions including diabetes, gingivitis, inflammation, acne, and more. This post will concentrate on the evidence available for the use of elderberries as a nutraceutical agent.

Elderberry for Colds, Flu and Bacterial Infections

Probably the most common use for elderberry is as a treatment for upper respiratory infections.  Colds and influenza are prevalent especially during the winter months and are often treated with over-the-counter medications to combat symptoms and at times antibiotics are prescribed.  Both colds and the flu are caused by viruses.   Antibiotics are ineffective in the treatment of viral infections.  Taking antibiotics unnecessarily can lead to resistant bacteria so it is important to use antibiotics only when they are indicated.  No antibiotic is 100% effective and, if a resistant bacterial strain begins to multiply, it can be difficult to treat the infection.

The real question is whether elderberry will help with upper respiratory symptoms.  I know plenty of individuals who swear it works.  Before adding the elderberry product to my line, I did some research.  I located a meta-analysis published in February of 2019.  I have mentioned in previous posts that I like meta-analyses because they have a larger sample size and are generally more accurate than single studies. 

This meta-analysis showed that elderberry supplements, when taken at the onset of respiratory symptoms, substantially reduced symptom duration compared to a control group.  The investigators concluded that elderberry supplementation reduced influenza virus symptoms substantially more effectively than the upper respiratory symptoms caused by the common cold.  It should be noted that this meta-analysis included only one study on elderberry supplementation for the common cold.1

Elderberries neutralize hemagglutinin spikes found on the surfaces of some viruses.  This prevents the viruses from piercing cell walls or entering the cell to replicate.  If the viruses are unable to replicate, they cannot spread.2

Elderberries can also increase the antibodies produced by our bodies against the influenza virus.  This indicates elderberries may actually be able to prevent the flu from occurring.3

A study published in the BMC Complementary & Alternative Medicine Journal in 2011 concluded that elderberry liquid extract was effective against human pathogenic bacteria and influenza viruses.  Many patients develop bacterial infections when ill with the influenza virus.  Elderberry may prove to be helpful in fighting both the influenza virus as well as bacterial infections during outbreaks.4

Elderberry for Treatment and Prevention of Cancer

A study published in 2007 found extracts of the fruits of both the European elderberry (Sambucus nigra) and American elderberry (Sambucus Canadensis), demonstrated anti-initiation and anti-promotion properties.  This may prove to be useful in fighting cancer in the future.  However, more studies need to be conducted on this subject 5



Elderberry as an Antioxidant

Elderberry may act to protect the body against oxidative stress.  Elderberry has been proven to be an antioxidant and free radical scavenger in vitro (outside the body).  It has antioxidant activity comparable to other highly antioxidant fruits such as blueberry and chokeberry.6

Elderberry Effect on Obesity, Diabetes and Inflammation

Obesity is the result of excessive adipose tissue growth.  This can happen through two different mechanisms; Hypertrophy, which is the expansion of existing fat cells, and hyperplasia, which is the addition of new fat cells. 

The oxidative stress caused by an increase in fat tissue leads to obesity-related comorbidities including insulin resistance, diabetes, cancer and heart disease.7

The accumulation of fat in hypertropic adipose tissue associated with obesity leads to oxidative stress and chronic inflammation.8

A recent study found an extract of the elderberry fruit (EDB) was able to decrease reactive oxygen species (ROS) in hypertrophic adipocytes suggesting an antioxidant action.  This may be a potential protective mechanism against obesity risk factors such as insulin resistance and chronic inflammation. 

This study also suggested that the anti-obesity and anti-diabetic effect of EDB may be due to inhibition of dietary sugar and fat absorption from the GI tract.9

Some evidence suggests polyphenols from several berry fruits can inhibit digestive enzymes which are responsible for the hydrolysis necessary for absorption of dietary lipids and carbohydrates.10

Zielinska-Wasielica et al. cited the following in their study published in August of 2019:

Results of the study indicate that Sambucus nigra fruit extract may offer substantial preventive and therapeutic potential for the treatment of obesity and obesity-related disorders, accompanied by oxidative stress, inflammation and insulin resistance. Moreover, the extract can inhibit digestive enzyme activity, and consequently, significantly reduce the intestinal absorption of dietary lipids and carbohydrates, which is an effective strategy for the prevention and treatment of obesity and metabolic comorbidities.11


No contraindications to elderberry have been identified.

Side Effects

Consuming uncooked leaves, stems, or berries can lead to cyanide toxicity, which may cause vomiting and diarrhea. Commercial preparations generally do not cause adverse effects at prescribed dosages.

Pregnancy and Lactation

I do not recommend taking an elderberry supplement if you are pregnant or breast feeding as there are not enough studies confirming safety in infants and small children. For this reason, I recommend reserving the use of elderberry supplements to those over the age of eighteen.

Elderberry Drug Interactions

Although drug interactions with elderberry are not well-documented, exercise caution when taking the following:

  •  Insulin
  •  Blood pressure lowering   medications  Chemotherapeutic agents
  •  Laxatives
  •  Theophylline
  •  Caffeine (Elderberry may   inhibit the enzyme that   metabolizes theophylline   and   caffeine). 12
Get Elderberry Now by Clicking Our Product Above

Our Elderberry Product

Sunshine Nutraceuticals has a brand-new elderberry product that contains 600 mg of elderberry extract per capsule. This supplement is designed to be taken twice daily 20-30 minutes prior to a meal with eight ounces of water. I DO NOT recommend taking this product if you are pregnant, breast feeding or under eighteen years of age. If you have a known medical condition, consult your physician or pharmacist prior to taking supplements containing elderberry.

Michael Brown pictured with Final Thought written

I expected to find a lot of information on elderberry for the treatment of colds and flu. After all, this is why many utilize this supplement and praise its effectiveness. What I didn’t expect was that elderberry has positive effects on diabetes, insulin resistance, and inflammation. We all know about the positive effects of blueberries as an antioxidant. It appears elderberries are not just good as a flavoring agent

and food source, but also possess medicinal properties beyond treatment of upper respiratory tract infections. As with all nutraceuticals, more studies are needed to determine the exact mechanism of action of the benefits of the elderberry. In the future, we may be able to isolate the active compounds from this plant, and use it not only to treat colds and the flu, but to prevent cancer, help fight insulin resistance, and more.

I firmly believe that, as a society, we under-utilize the natural substances provided to us in favor of chemicals which may help treat diseases but not without serious side effects. If we eat right, exercise, and spend time concentrating on our health, we may be able to avoid ingesting harmful chemicals. I know this sounds odd coming from a pharmacist, but this is the conclusion I have come to. Prescription drugs are absolutely necessary in some circumstances, but with the right lifestyle, we can limit our exposure to them.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


  1. Hawkins J, Baker C, Cherry L, Dunne E. 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. doi: 10.1016/j.ctim.2018.12.004. Epub 2018 Dec 18. PubMed PMID: 30670267.

  2. Monograph. Sambucus nigra (elderberry). Altern Med Rev. 2005 Mar;10(1):51-4. PubMed PMID: 15771563.

  3. Roschek B Jr, Fink RC, McMichael MD, Li D, Alberte RS. Elderberry flavonoids bind to and prevent H1N1 infection in vitro.Phytochemistry.2009Jul;70(10):125561.doi:10.1016/j.phytochem.2009.06.003. Epub 2009 Aug 12.PubMed PMID: 19682714.

  4. Krawitz C, Mraheil MA, Stein M, Imirzalioglu C, Domann E, Pleschka S, Hain T. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complement Altern Med. 2011 Feb25; 11:16. doi:10.1186/1472-6882-11-16. PubMed PMID: 21352539

  5. Thole JM, Kraft TF, Sueiro LA, Kang YH, Gills JJ, Cuendet M, Pezzuto JM, Seigler DS, Lila MA. A comparative evaluation of the anticancer properties of European and American elderberry fruits. J Med Food. 2006 Winter;9(4):498-504. PubMed PMID: 17201636.

  6. Tester J. Reviews of articles on medicinal herbs. Australian Journal of Herbal Medicine. 2015;27(2):73. http://search.ebscohost.com/login.aspx direct=true&AuthType=shib&db=edo&AN=103624136&site=eds-live&scope=site. Accessed December 21, 2019.

  7. Manna, P.; Jain, S.K. Obesity, Oxidative Stress, Adipose Tissue Dysfunction, and the Associated Health Risks: Causes and Therapeutic Strategies. Metab. Syndr. Relat. Disord. 2015, 13, 423–444.

  8. Bays, H.E.; González-Campoy, J.M.; Bray, G.A.; Kitabchi, A.E.; Bergman, D.A.; Schorr, A.B.; Rodbard, H.W.; Henry, R.R. Pathogenic potential of adipose tissue and metabolic consequences of adipocyte hypertrophy and increased visceral adiposity. Expert Rev. Cardiovasc. Ther. 2008, 6, 343–368.

  9. Zielińska-Wasielica J, Olejnik A, Kowalska K, Olkowicz M, Dembczyński R. Elderberry (Sambucus nigra L.) Fruit Extract Alleviates Oxidative Stress, Insulin Resistance, and Inflammation in Hypertrophied 3T3-L1 Adipocytes and Activated RAW 264.7 Macrophages. Foods. 2019 Aug 8;8(8). pii: E326. doi: 10.3390/foods8080326. PubMed PMID: 31398785; PubMed Central PMCID: PMC6724042.

  10. Pods ˛edek, A.; Majewska, I.; Redzynia, M.; Sosnowska, D.; Koziołkiewicz, M. In vitro inhibitory effect on digestive enzymes and antioxidant potential of commonly consumed fruits. J. Agric. Food Chem. 2014, 62, 4610–4617.

  11. Zielińska-Wasielica J, Olejnik A, Kowalska K, Olkowicz M, Dembczyński R. Elderberry (Sambucus nigra L.) Fruit Extract Alleviates Oxidative Stress, Insulin Resistance, and Inflammation in Hypertrophied 3T3-L1 Adipocytes and Activated RAW 264.7 Macrophages. Foods. 2019 Aug 8;8(8). pii: E326. doi: 10.3390/foods8080326. PubMed PMID: 31398785; PubMed Central PMCID: PMC6724042.

  12. Ulbricht C, Basch E, Cheung L, Goldberg H, Hammerness P, Isaac R, Khalsa KP, Romm A, Rychlik I, Varghese M, Weissner W, Windsor RC, Wortley J. An evidence-based systematic review of elderberry and elderflower (Sambucus nigra)by the Natural Standard Research Collaboration. J Diet Suppl. 2014 Mar;11(1):80-120. doi: 10.3109/19390211.2013.859852. Epub 2014 Jan 10. Review.PubMed PMID: 24409980.