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Influenza and Elderberry

January 1st, 2010

by Dr. Mary Bove

Elderberry, the dark blue/black fruit from the shrub Sambucus nigra has traditionally been used as a food made into wines, syrups, cordials, jams, and jellies as well as being a traditional medicine for the treatment of colds and flu during the winter season. Clinical trials conducted within the past 15 years have supported the traditional use of Elderberry for reducing the duration and severity of fever, headache, muscle ache, mucus production, and nasal congestion associated with colds and flu _. Recent placebo-controlled, double-blind studies, on Elderberry syrup found it to be an effective treatment for influenza by reducing hemagglutination and inhibiting replication of human influenza A and B viruses(2)_. Influenza virus particles have an envelope protein called hemagglutinin that binds to the cell. The virus also binds to red blood cells, causing the formation of a lattice. This is hemagglutination. Elderberry increases the hemagglutination inhibition titers in the body, blocking the virus from binding to the host. More recent in vitro studies have supported this mechanism by demonstrating that Elderberry extract acts to inhibit H1N1 viral infection in vitro by binding to H1N1 virions, blocking host cell entry and/or recognition, thus blocking replication of the virus, which must occur inside the cell_(2)_. A recent pilot clinical trial examined the effect of Elderberry in the treatment of flu-like symptoms and showed positive outcomes for decreasing fever, headache, and nasal congestion at 24 and 48 hours post starting Elderberry extract_(3)_. No adverse effects of Elderberry have been reported in any of the human clinical trials. Specific flavonoid compounds are major contributors to the immune-stimulating action of Elderberry. The flavonoids bind to specific proteins present on the surface of envelope viruses that are required for attachment and entry into host cells. By blocking the virus from attaching to the host cells,_ the Elderberry inhibits the virus’s ability to reproduce and flourish within the body. One specific affect of Elderberry is that it activates the healthy immune system by increasing inflammatory cytokine (IL-1 beta, TNF-alpha, IL-6, IL-8) production and anti-inflammatory cytokine IL-10.(4)_ This beneficial effect activates the immune system in healthy individuals or in patients with various diseases. Elderberry active compounds demonstrate immunoprotective and immunostimulatory effects_(4)_ correlating with the findings of recent clinical studies that showed that flu patients treated with Elderberry recovered significantly quicker than those patients not treated with the Elderberry. Elderberry anthocyanin compounds have shown significant protective effects against oxidative stress, exhibiting antioxidant activity. In vitro research using plasma membrane and endothelial cells enriched with Elderberry anthocyanins confer significant protective effects against oxidative stress along with exhibiting an oxygen radical absorption capacity (ORAC) similar to cranberry_(5)_ .
Using Elderberry syrup during the active stage of colds and flu, to minimize distress, appears to support immune function and offers a natural, safe, and effective option. The use of Elderberry as part of a daily wellness plan during cold and flu season for immune support, inhibition of oxidative stress, and as an antiviral makes sense for a healthy immune system.

References
1 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., 2004 March-Apr.; 32(2): 132-40.

2 Zichria Zakay-Rones, Noemi Varsano, Moshe Zlotnik, Orly Manor, Liora Regev, Miriam Schlesinger, Madeleine Mumcuoglu, Inhibition of Several Strains of Influenza Virus in Vitro and Reduction of Symptoms by an Elderberry Extract (Sambucus nigra L.) during an Outbreak of Influenza B Panama, The Journal of Alternative and Complementary Medicine. Winter 1995, 1(4): 361-369. doi:10.1089/acm.1995.1.361.

3 King H.F., Pilot clinical study on a proprietary elderberry extract: efficacy in addressing influenza symptoms, Online Journal of Pharmacology and Pharmacokinetics, 2009; 5: 32-43.

4 The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines, I. Inflammatory cytokines, Eur. Cytokine Netw., 2001 Apr.-June;12(2): 290-6.

5 The ABC Clinical Guide to Elderberry, American Botanical Council, 2004.