‘Tis the season for influenza ……….can elderberry really help?

Unfortunately one of my very dear friends is seriously unwell, so I started writing this from the 9th floor of St Thomas’s hospital.  There are hand wash points all over the place in a bid to prevent the spread of infection.  Any hint of a sniffle and I would not be allowed to set foot onto the ward.  So, I am doing my very best to keep my immune system strong! 

In the past I have written about the prevention and treatment of colds and coughs and generally about the immune system and how to keep it strong.  It is the time of year when the cold and flu virus sis rife and people are very interested in how they can escape the infections that seem to be surrounding them.  Earlier this week I was made aware of the potential benefits of Black Elderberry extract (brand name Sambucol®) for the prevention and alleviation of the influenza virus.  I wanted to delve into the scientific research to discover if there is fact behind the hype.

Black Elderberry (sambucus nigra), a member of the honeysuckle family, is a tree-like shrub.  Traditionally various parts of the plant, including the leaves, bark, flowers and berries, have been used in medicine.  The health giving properties have been documented as far back as the 5th century.  Currently much of the interest and research has focussed on extract from the berries.  Research(1) suggests that elderberry has antiviral properties, especially against the influenza virus, and also seems to activate and boost the immune system as well as acting as an antioxidant.

The berries contain various bioactive plant compounds, known as flavonoids, as well as certain vitamins (C, A and various B vitamins), that appear to be responsible for the positive effects on the immune system and our health.

Sambucol® is a supplement that contains 38% standardised extract of black elderberry.  Research(2,3) suggests that elderberry extract appears to boost and activate the immune system in individuals who are healthy as well as those who are already suffering from a viral infection.

Two small well planned studies (randomised, placebo-controlled, double-blind studies 4,5) found that Sambucol® effectively inhibited the influenza A and B virus strains when given orally to patients in the first 48 hours of flu symptoms developing.  The earlier preliminary study (4) was very small, involving only 27 patients, but demonstrated the ability of elderberry (4 tablespoons of Sambucol® syrup per day) to reduce influenza symptoms in 20% of influenza patients within 24 hours and to reduce influenza symptoms in 75% of patients within 48 hours.  After three days of elderberry use, 90% of influenza patients experienced a total alleviation of symptoms. 

The most recent study (5) involved 60 patients aged 18-54 years who had just began (48 hours or less) to suffer from flu-like symptoms.  Participants received 15 ml of elderberry or placebo syrup four times a day for 5 days, and recorded their symptoms using a special scale.  In the participants receiving the elderberry syrup the symptoms were relieved, on average, 4 days earlier and use of rescue medication was significantly less compared those receiving placebo.  The study was small but very encouraging, the findings need to be confirmed in a larger study.

The underlying mechanism (1) for elderberry’s effectiveness in the treatment of influenza virus was discovered by an Isreili virologist, Dr Mumcuoglu.  The berry seems to be able to prevent and inhibit the replication of the influenza virus.  The active compounds within the elderberry seem to ‘coat’ or neutralise the spike-like projections that are found on the surface of several viruses, including the influenza viruses.  When these spikes are deactivated the virus is prevented from piercing the human cells, so the virus does not enter our cells and is prevented from replicating.  Unlike bacteria, a virus cannot replicate on its own, it must attack living cells in order to survive.  If the virus is prevented from entering our cells it will be unable to survive and cause us to suffer health problems.

I mentioned earlier that elderberries also possess antioxidant properties.  Antioxidants protect our cells from the damaging effects of highly reactive molecules called free radicals, which cause oxidative stress in the body.  There is mounting evidence that these destructive molecules, together with lowered antioxidant defences, play a significant role in the development and aggravation of many diseases (including cardiovascular disease and cancer to name but a few).  The body does produce its own antioxidants but also relies on vitamins, mineral and phytochemicals (bioactive plant chemical) from the diet, especially from colourful vegetables and fruits, for additional valuable supplies.

The elderberry extract, Sambucol®, is widely available in the UK as a liquid or lozenge.  The products can be taken as a preventative or at the first signs of cold or flu-like symptoms.  A healthy diet (rich in fruit and vegetables) is obviously the most important way to keep the immune system strong, healthy and effective.  However, if you are surrounded by people with colds, or worried about the ‘flu-season’ taking an elderberry extract may well give your immune system an extra boost and help you to fight off invading infections. 

(1) Sambucus nigra – monograph.  2005.  Altern Med Rev.  10(1):51-54.
(2) Barak V et al.  2001.  The effect of Sambucol® , a black elderberry-based, natural product, on the production of human cytokines:I.  Inflammatory cytokines.  Eur Cytokine Netw.  12:290-296
(3) Barak V et al.  2002.  The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines.  Isr Med Assoc J.  4:S919-S922
(4) Zakay-Rones Z et al.  1995.  Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra) during an outbreak of influenza in Panama.  Journal of Alternative and Complementary Medicine.  1(4):361-369.
(5) Zakay-Rones, Z et al.  2004.  Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections.  J Int Med Res.  32(2):132-140.

Written Ani Kowal