EASY Does It: Elderberry and COVID

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The EASY guide to deciding whether to try something for COVID

When you are choosing whether or not to do something for your health, take it EASY! All four factors - 1) Effects, 2) Access, 3) Safety, and 4) You – can help you make a decision.

Julie heard that taking the herb elderberry could help with COVID symptoms if she got sick.¹ But she also read that elderberry might increase inflammation during COVID so she was confused. She used the EASY guide to learn more and sort out some details:

Effects: Elderberry is the dark purple berry of the European or Black elder tree (Latin name Sambucus nigra). The ripe, cooked elder berries are often made into jams and pies and are also used as medicine. Traditionally, elderberry fruit extract has been used for the common cold and the flu.² Some studies in cells have found that elderberry was effective against a human coronavirus and that it seemed to work best early in an infection.^3,4 These results may not reflect what would happen in a person because they were done in cells, in one study the extract used was from stem, not berries and was a different species of elder (Formosana nakai) than is most commonly used (Nigra), and the viruses tested were similar, but different than COVID. A review of 4 small human studies with a total of 180 patients concluded that elderberry extract might shorten the length of having upper respiratory symptoms from the flu or a cold when started within the first 24 hours of having symptoms.⁵ Elderberry seemed to have a greater effect against symptoms of flu than the common cold. There is some concern that elderberry may cause increased inflammation during later stages of an infection.¹ The evidence for this is limited to studies in cells.^3,6 Since most research has tested the use of elderberry at the first signs of symptoms, it seems reasonable to start early and if symptoms worsen, discontinue use. As of this writing, there were no human studies on the use of elderberry and COVID.

Access: Elderberry extract is commonly available in many forms such as capsule, syrup, and alcoholic extract. Be sure that the label indicates that it contains Sambucus nigra fruit. Typical amounts recommended are based on limited evidence.⁷ When it is taken either as a preventative or during the early stages of experiencing cold or flu symptoms, suggested doses range from 650 to 1,500 mg per day, divided into 2-3 doses. A 30-day supply ranges from $5.00 to $15.00 depending on the brand and dose.

Safety: The berries of elderberry are the commonly used part, though elder flowers are also used traditionally. The berries contain a compound called cyanogenic glycoside that can become toxic in the GI tract.⁶ Cooking or heating can evaporate this compound, making the berries safe to consume in jams, pies, and medicinal preparations. Elderberry fruit extract has been consumed with apparent safety for 5 to 15 days and even up to 12 weeks.²

You: Julie is 43 years old and healthy. She knows that having a healthy lifestyle like eating lots of fruits and vegetables, exercising, and getting plenty of sleep does a lot to keep her healthy. She also likes to be prepared with dietary supplements and herbs that are safe and may help if she gets sick.

Julie knows now that elderberry should always be cooked, may help shorten her symptoms if she gets sick, and could increase inflammation if she takes it when her symptoms are really bad. She decides to have some on hand just in case.

NOTE: Dietary supplements are intended to supplement the diet. They are not medicines and are not intended to treat, diagnose, mitigate, prevent, or cure disease. In some cases, dietary supplements may have unwanted effects, especially if taken before surgery or with other dietary supplements or medicines, or if you have certain health conditions. Also, supplements are not regulated with the same degree of oversight as medications. Products vary greatly in terms of accuracy of labels, presence of contaminants, and the validity of claims on the label. Work with your health care provider to determine how best to achieve optimal health.

What we know about integrative health care has come to us thanks to the efforts, experiences, and collective wisdom of people from many cultures and backgrounds. We wish to acknowledge all the healers, researchers, patients, and peoples who have informed the content of this tool.

Author(s)

This handout was adapted for the Osher Center for Integrative Health at the University of Wisconsin-Madison from the original by Sara Arscott, PhD, and Adam Rindfleisch, MD.

Date Created: August 2020

References

1. Alschuler L, Weil A, Horwitz R, et al. Integrative considerations during the COVID-19 pandemic. Explore (New York, NY). Nov-Dec 2020;16(6):354-356.
2. Therapeutic Research Center (TRC). Elderberry. Accessed March 7, 2025. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=434
3. Weng JR, Lin CS, Lai HC, et al. Antiviral activity of Sambucus FormosanaNakai ethanol extract and related phenolic acid constituents against human coronavirus NL63. Virus Res. Nov 2019;273:197767.
4. Chen C, Zuckerman DM, Brantley S, et al. Sambucus nigra extracts inhibit infectious bronchitis virus at an early point during replication. BMC Vet Res. Jan 16 2014;10:24.
5. 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. Complementary therapies in medicine. Feb 2019;42:361-365. doi:10.1016/j.ctim.2018.12.004
6. Barak V, Halperin T, Kalickman I. The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. Eur Cytokine Netw. Apr-Jun 2001;12(2):290-6.
7. Tiralongo E, Wee SS, Lea RA. Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Nutrients. Mar 24 2016;8(4):182.