Series on COVID Therapy Studies – Elderberry
Normally, the natural therapy world works together in promoting most therapies. There are exceptions when arguments arise, but most agree on the big issues. The social media and internet world currently reverberate with one of those exceptions, elderberry in the treatment of COVID. Let’s examine the evidence further below.
With the onslaught by COVID and its coinciding onslaught of self-proclaimed experts with every opinion under the sun, I choose to respond with a series of research study reports so you can choose for yourself. Each edition will bring a few studies describing possible therapies for COVID under investigation or reported in past research. As my recent Facebook Live video noted, we do not know enough about this virus to be definite at this time. I am not claiming any of these are the preventive or curative answer for you or your family’s safety. I just want you to be aware of these studies and have knowledge so that you can grow in wisdom rather than stumble about in panic.
Who didn’t love elderberry prior to COVID 19? Oh yeah, mainstream medicine. Aside from them, it stood out as a hot therapy for all sorts of infections. You could buy it in the stores, from your local neighborhood home grown shop, or try to brew it up yourself.
Suddenly elderberry sends cold chills up the spine of the average crunchy mom or functional medicine aficionado. All this negative attention when someone suggests that it might trigger cytokine storm in COVID patients making them worse. Don’t get me wrong. COVID is serious business and therapies for it should not stir up more trouble for someone on their death bed.
Let’s start with clearing up some fear anxiety. As far as I know no documentation of exacerbating a cytokine storm in a COVID patient by elderberry has occurred. Theories have been promoted. Social media has echoed. Documentation, not so much as a sentence.
Let’s also explain what a cytokine storm means for a COVID patient. Cytokines are peptide messengers, short chains of amino acids, that our immune cells use to communicate with one another. Their absence or failure means the immune system does not coordinate its attack and lessens the chance of overcoming an invader. High levels would seem universally beneficial, but when the cytokine levels rise too high, the resulting inflammation does more damage than good to the patient. Sepsis, even death may result.
Now that we passed the initial hysteria and fed a few facts into our heads, we look to studies and extrapolations for answers. No study exists which tested COVID patients with and without elderberry to see what happened. That study design will never happen short of a miracle. We can only find studies examining the effects of elderberry on either viral infections or cytokines.
In terms of viral infections, a study by Weng et al in 2019 reported some activity of sambucus, the official name of elderberry, against a human coronavirus named NL63. Well that is promising but nothing to hand our hats on yet. A literature review by Porter and Bode in 2017 could not offer sufficient evidence to guide or support elderberry use in viral infections. On the other hand, a systematic review by Akram et al in 2018 suggested that sambucus and a few other compounds showed some anti-viral activity against HIV, HSV, influenza, hepatitis, and coxsackievirus. Hawkins etal in 2019 and . Tiralongao etal in 2016 also recommended it for treatment of colds. Kinoshita in 2012 also expressed support for its use in flu therapy. Together these studies plus a few more in the bibliography offer at least potential for elderberry in fighting viral infections, maybe even COVID.
In terms of cytokine responses several studies support claims that elderberry modulates cytokines in the body. Barak et al offered one study from 2001 and another from 2002 describing significant alterations in cytokine levels after elderberry administration. Waknine-Grinberg etal 2009 evaluated shifts in the immune response to parasite infections after elderberry. Putra and Muhaimin described in 2019 immune modulator effects of elderberry. So yes, elderberry acts as an immune modulator.
What can we piece together from all this? Elderberry appears to have some anti-viral effects on several viruses and may carry this out through modulating cytokines. That is about all we can say with certainty. From there, we are only guessing at whether elderberry will or will not help COVID patients. Some mechanisms suggest that harm is possible, but honestly, the likelihood of significant harm is low.
Elderberry presses the immune system in a particular direction, but does not act like pharmaceutical by pushing hard or turning something completely on or off. Botanicals usually work on several pathways at one, none to an extreme degree. This tendency suggests that elderberry is likely safe.
Am I taking it? No, it is not in my top list of therapies. But I am also not mortified by this virus. I believe it is real, but I am depending on a healthy low inflammatory diet, a healthy lifestyle, and God. I try to remember some vitamin D and some zinc lozenges, but that is as far as I am going. Are there therapies I would add if I cross paths with a COVID patient or come down with it myself? Yes. Would I add elderberry then? I am not sure. If it is the only therapy I can get my hands on, I would probably take it without worrying about cytokine storm.
Until next time, I pray your are moving towards the healthier more abundant life and avoiding COVID.
LINKS
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. 2019;273:197767. doi:10.1016/j.virusres.2019.
Porter, Randall S, and Robert F Bode. “A Review of the Antiviral Properties of Black Elder (Sambucus nigra L.) Products.” Phytotherapy research : PTR vol. 31,4 (2017): 533-554. doi:10.1002/ptr.5782
Akram, Muhammad et al. “Antiviral potential of medicinal plants against HIV, HSV, influenza, hepatitis, and coxsackievirus: A systematic review.” Phytotherapy research : PTR vol. 32,5 (2018): 811-822. doi:10.1002/ptr.6024
Hawkins, Jessie et al. “Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials.” Complementary therapies in medicine vol. 42 (2019): 361-365. doi:10.1016/j.ctim.2018.12.004
Tiralongo, Evelin et al. “Elderberry Supplementation Reduces Cold Duration and Symptoms in Air Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial.” Nutrients vol. 8,4 182. 24 Mar. 2016, doi:10.3390/nu8040182
Putra, Wira Eka, and Muhaimin Rifa’i. “Immunomodulatory Activities of Sambucus javanica Extracts in DMBA-Exposed BALB/c Mouse.” Advanced pharmaceutical bulletin vol. 9,4 (2019): 619-623. doi:10.15171/apb.2019.071
Tejero, Jesús et al. “Elderberries: a source of ribosome-inactivating proteins with lectin activity.” Molecules (Basel, Switzerland) vol. 20,2 2364-87. 30 Jan. 2015, doi:10.3390/molecules20022364
Badescu, Magda et al. “Effects of Sambucus nigra and Aronia melanocarpa extracts on immune system disorders within diabetes mellitus.” Pharmaceutical biology vol. 53,4 (2015): 533-9. doi:10.3109/13880209.2014.
Shahsavandi S, Ebrahimi MM, Hasaninejad Farahani A. Interfering With Lipid Raft Association: A Mechanism to Control Influenza Virus Infection By Sambucus Nigra. Iran J Pharm Res. 2017;16(3):1147–1154.
Kinoshita, Emiko et al. “Anti-influenza virus effects of elderberry juice and its fractions.” Bioscience, biotechnology, and biochemistry vol. 76,9 (2012): 1633-8. doi:10.1271/bbb.120112
Roxas M, Jurenka J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Altern Med Rev. 2007;12(1):25–48.
Roschek, Bill Jr et al. “Elderberry flavonoids bind to and prevent H1N1 infection in vitro.” Phytochemistry vol. 70,10 (2009): 1255-61. doi:10.1016/j.phytochem.2009.
Krawitz, Christian et al. “Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses.” BMC complementary and alternative medicine vol. 11 16. 25 Feb. 2011, doi:10.1186/1472-6882-11-16
Zakay-Rones, Z et al. “Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections.” The Journal of international medical research vol. 32,2 (2004): 132-40. doi:10.1177/147323000403200205
Barak, V et al. “The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines.” European cytokine network vol. 12,2 (2001): 290-6.
Barak, Vivian et al. “The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines.” The Israel Medical Association journal : IMAJ vol. 4,11 Suppl (2002): 919-22.
Waknine-Grinberg, Judith Hannah et al. “The immunomodulatory effect of Sambucol on leishmanial and malarial infections.” Planta medica vol. 75,6 (2009): 581-6. doi:10.1055/s-0029-1185357
https://www.uptodate.com/
Waknine-Grinberg, Judith Hannah et al. “The immunomodulatory effect of Sambucol on leishmanial and malarial infections.” Planta medica vol. 75,6 (2009): 581-6. doi:10.1055/s-0029-1185357
One huge challenge in identifying effective therapies for COVID lies in the novelty of it all. Research requires time, something of which we have little in an emerging pandemic. We don’t have the luxury of studying 100 years of research or 10,000 past experiments. This battle requires a great deal of extrapolation. Extrapolation means that we take the little information we do have and attempt to use it in predicting what we don’t know. This process takes place every time an experiment proceeds in science, but the urgency in this case makes it more frustrating than usual. As we walk through a different possible therapy each post, keep this paragraph in mind.
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.
Wonderful !! I had suggested y’all do an article on this – so glad y’all did . My daughter takes Elderberry gummies daily . In your opinion, should you only take them when sick with like cold or flu ?
I advise patients to use elderberry as needed.
That may include when symptoms of infection arise OR when infectious exposures occurs.
Dr. Potter