Elder

Several species of Sambucus produce elderberries. Most research and publications refer to Sambucus nigra . Other species with similar chemical components 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 eder ( S. nigra ) are often discussed simultaneously in the literature since they have many of the same uses and contain common constituents.

European elder grows up to 30 feet tall, is native to Europe, but has been naturalized to the Americas. Historically, the flowers and leaves have been used for pain relief, swelling/inflammation, diuresis (urine production), and as a diaphoretic or expectorant. The leaves have been used externally for sitz baths. The bark, when aged, has been used as a diuretic, laxative, or emetic (to induce vomiting). The berries have been used traditionally in food as flavoring, and in the preparation of elderberry wine and pies.

The flowers and berries (blue/black only) are used most often medicinally. They contain flavonoids, which are found to possess a variety of actions, including antioxidant and immunologic properties. Although hypothesized to be beneficial, there is no definitive evidence from well-conducted human clinical trials currently available regarding the use of elder.

The bark, leaves, seeds and raw/unripe fruit contain the cyanogenic glycoside sambunigrin, which is potentially toxic.

Synonyms

Almindelig hyld, baccae, baises de sureau, battree, black berried alder, black elder, black elderberry, boor tree, bountry, boure tree, Busine (Russian), Caprifoliaceae (family), cyaniding-3-glucoside, cyaniding-3-sambubioside, devil's eye, elderberry, elderberry anthocyanins, elderberry bark agglutinin, elderberry juice, ellanwood, ellanwood, ellhorn, European alder, European elder, European elderberry, European elderflower, European elder fruit, frau holloe, German elder, Holunderblüten, Holunderbeeren, lady elder, nigrin b , peonidin 3-glucoside, peonidin monglucuronide, peonidin 3-sambubioside, old gal, old lady, pipe tree, Rubini® (elderberry extract), Sambreo, sambuco (Italian), Sambucus sieboldiana (Japanese), Sambucipunct Sambucus, Sambuci flos, Sauco (Spanish), Schwarzer holunder (German), sieboldin-b, stinking elder, Sureau noir (French), sweet elder, tree of doom, yakori bengestro.

Evidence

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.

Uses based on scientific evidence	Grade^*
Bacterial sinusitis Elder has been observed to reduce excessive sinus mucus secretion in laboratory studies. There is only limited research specifically using elder to treat sinusitis in humans. Combination products containing elder and other herbs (such as Sinupret®) have been reported to have beneficial effects when used with antibiotics to treat sinus infections, although the majority of this evidence is not high quality and requires confirmation with better research.	C
Bronchitis There is a small amount of research of the combination herbal product Sinupret® in patients with bronchitis. This formula contains elder flowers ( Sambucus nigra ) as well as gentian root, verbena, cowslip flower, and sorrel. Although benefits have been suggested, due to design problems with this research, no clear conclusion can be drawn either for Sinupret® or elder in the management of bronchitis.	C
High cholesterol There is no reliable human evidence currently available evaluating elder alone as a treatment for high cholesterol. Early study reports that elderberry juice may decrease in serum cholesterol concentrations and an increase in low-density lipoprotein (LDL) stability. Additional research is needed in this area before a firm conclusion can be reached. Elder should not be used in the place of other more proven therapies, and patients are advised to discuss with their primary healthcare provider before using elderberry for treatment of high cholesterol.	C
Influenza Human study reports that elderberry juice may improve flu-like symptoms, such as fever, fatigue, headache, sore throat, cough and aches, in less than half the time that it normally takes to get over the flu. However study designs are weak, therefore it remains unclear whether there is truly any benefit from elder for this condition. Additional research is needed in this area before a firm conclusion can be reached. Elder should not be used in the place of other more proven therapies, and patients are advised to discuss influenza vaccination with their primary healthcare provider. It should be noted that the berries must be cooked to prevent nausea or cyanide toxicity.	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 against this use;
F: Strong scientific evidence against this use.

Grading rationale

The below uses are based on tradition or scientific theories. 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.

Alzheimer's disease, anti-inflammatory, antioxidant, antispasmodic, asthma, astringent, blood vessel disorders, burns, cancer, chafing, circulatory stimulant, cold sores, colds, colic, cough suppressant, diabetes, diuresis (urine production), edema, epilepsy, fever, flavoring, gut disorders, hair dye, hay fever, headache, herpes, HIV, immune stimulant, increased sweating, insomnia, joint swelling, kidney disease, laryngitis, laxative, liver disease, measles, migraines, mosquito repellant, nerve pain, psoriasis, respiratory distress, sedative, stress reduction, syphilis, toothache, ulcerative colitis, vomiting, weight loss.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older):

Patients were given 400 milligram spray-dried powder capsules containing 10% anthocyanes three times a day equivalent to 5 milliliters of elderberry juice for two weeks in one study for high cholesterol.

For treating influenza or flu-like symptoms, a dose of 4 tablespoons of elderberry extract taken daily by mouth for three days has been used.

Cream has been prepared by taking several handfuls of fresh elder flowers, mixing in liquefied petroleum jelly, simmering for 40 minutes, heating, filtering, and allowing the formula to solidify. This has been applied to the hands at bedtime.

For bacterial sinusitis, a dose of two tablets of Sinupret® taken by mouth three times daily with antibiotics has been used. Sinupret® contains elder and several other herbs.

15 milliliters of elderberry syrup has been taken four times a day for five days for influenza symptoms.

A dose of 3-5 grams of dried elder flowers steeped in one cup of boiling water for 10 to 15 minutes and taken by mouth three times daily has been used. Be aware of possible toxicity.

Children (younger than 18 years):

There are no standard or well-studied doses of elder, and many different doses are used traditionally. There is not enough scientific information available to recommend the safe use of elder in children. Toxicity has been reported, and caution is recommended.

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.

Avoid elder in patients with known allergy to plants in the Caprifoliaceae family (honeysuckle family). There are some reports of allergies in children playing with toys made from fresh elder stems.

Side Effects and Warnings

Elderberry products should be used under the direction of a qualified healthcare provider because of the possible risk of cyanide toxicity, especially from elder bark, root, or leaves.

There are reports of gastrointestinal distress, diarrhea, vomiting, abdominal cramps, and weakness after drinking elderberry juice made from crushed leaves, stems and uncooked elderberries. Notably, the berries must be cooked to prevent nausea or cyanide toxicity.

Allergies are possible from fresh elder stems and may include rash, skin irritation, or difficulty breathing.

In theory, high doses or long-term use of elder flowers may have diuretic (urine-producing) effects. People taking diuretics or drugs that interact with diuretics should use caution when taking products containing elder.

Pregnancy and Breastfeeding

Elder cannot be recommended during pregnancy or breast-feeding based on a theoretical risk of birth defects or spontaneous abortion.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. 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.

Interactions with Drugs

Elder may possess diuretic (urine producing) effects, and should be used cautiously with drugs that increase urination. Elder may possess laxative effects, and should be used cautiously with other laxatives.

Elder may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. A qualified healthcare provider should monitor patients taking drugs for diabetes by mouth or insulin closely. Medication adjustments may be necessary.

The flavonoid quercetin, which is found in elder, has been reported to inhibit xanthine oxidase, and may affect caffeine and theophylline levels. Patients using theophylline should speak with their healthcare provider before using elder.

Elder may increase the effects and possible adverse effects of some cancer chemotherapies.

Based on preliminary research, increased benefits may be seen when elder is used in combination with antibiotics and decongestants, such as oxymetazoline (Afrin®). Elder flowers may possess anti-inflammatory properties and may add to the effects of some drugs that also decrease inflammation.

Interactions with Herbs and Dietary Supplements

Elder may possess diuretic (urine producing) effects, and should be used cautiously with herbs that may increase urination, such as artichoke, dandelion, or horsetail.

Elder may possess laxative effects, and should be used cautiously with herbs that may also have laxative effects, such as alder buckthorn, dong quai, or orpsyllium.

Elder may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar such as burdock, maitake mushroom, or milk thistle. Blood glucose levels may require monitoring, and doses may need adjustment.

Elder (Sambucas nigra L.)

Background

Synonyms

Evidence

Dosing

Safety

Interactions