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Does Elderberry Syrup Really Work as an Immune Booster?

You feel a cold coming and, naturally, you reach for the elderberry syrup. But does that make any scientific sense? Here's what the studies say.

Flu season is here. Time to reach for the elderberry syrup to boost your immune system. But does that make any scientific sense? Here's what the studies say.

With cold and flu season just around the corner, you’ll take all the necessary precautions: get your family this season’s flu shot, stay hydrated, order the kids back to the sink to scrub those grubby hands with soap, and stock up on… elderberry syrup? While there’s ample scientific evidence for the rest of these precautions (go on, get your flu vaccine), the cult of elderberry syrup as cold and flu precaution is based more on fringe enthusiasm for a few cherry-picked studies. So where does the truth lie? As always, in the science.

Derived from the berries of European black elder trees, it’s usually sold as a syrup, but also comes in lozenges, capsules, or gummies. Elderberry has been used to fight upper-respiratory infections for centuries, and you’ll hear plenty of people rave about its ability to nip cold and flu symptoms in the bud.

As it turns out, elderberry benefits do have some solid science to back it. They’ve mostly been small studies, but they include a few high-quality, placebo-controlled human trials, the kind that is required for pharmaceuticals but rarely conducted for supplements. The research shows great promise in taking it at the onset of symptoms may lessen their severity and help you feel better faster. The caveat: It does not support taking daily spoonfuls of elderberry syrup to prevent colds and flus.

For example, in a 2004 study, researchers recruited 64 people who’d been experiencing flulike symptoms for 48 hours or less. For the next five days, the participants took 15 milliliters of either elderberry syrup or a placebo syrup four times a day, without knowing which one they’d been given. On average, those who took elderberry saw their symptoms clear up four days sooner than the people given the dummy syrup.

In another study published in 2016, Australian researchers showed that taking elderberry before an overseas flight may protect against the cold viruses that can wreak havoc in a plane’s tight quarters and stagnant air. Over the course of 20 months, they gave 312 international air travelers either 600 to 900 milligrams of elderberry extract capsules or a placebo starting 10 days before their trip. The participants kept taking elderberry (or the placebo) until four or five days after they returned home, and they tracked any cold symptoms they experienced during or after their trip. Sure enough, more people in the placebo group got sick, and they reported harsher and longer-lasting cold symptoms than those who’d taken elderberry extract.

A third trial had people experiencing flu-like symptoms take lozenges containing 175 milligrams of elderberry extract four times a day for two days. “After 24 hours, they reported less fever, nasal congestion, muscle pain, and headaches,” says Irina Todorov, M.D., an integrative physician at the Cleveland Clinic’s Center for Integrative and Lifestyle Medicine.

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Based on these studies, Todorov recommends elderberry to her patients when they feel a cold or flu coming on — or before a situation, such as an international flight, that will readily expose them to viruses. But she insists we shouldn’t take it daily on a long-term basis, as there just isn’t good evidence showing it’ll provide ongoing protection against colds and flus.

“I do not recommend using it regularly as prevention,” Todorov says. “It’s mostly just if you have cold or flu symptoms today, then it’s worth taking until your symptoms improve.” She also cautions women who are pregnant or nursing and anyone taking immunosuppressant drugs against using elderberry.

So how does elderberry work? As is the case with most herbs, the exact mechanisms haven’t been observed in human trials, but laboratory studies offer a few clues. Some research suggests elderberry may increase the production of specific cytokines, chemicals that tell the immune system to rev up and fight off an infection. Elderberries are also chockfull of antioxidants such as vitamin A and C and various flavonoids — botanical compounds that protect cells from oxidative damage — which may help keep colds and flus under control.

“Elderberry is antiviral as well,” Todorov says. “It loosens mucus, making it easier to cough and preventing [an upper-respiratory virus] from turning into pneumonia or bronchitis.”

When shopping for elderberry, Todorov suggests Sambucol, the proprietary extract that’s been studied the most. In line with the research, she suggests 15 milliliters of Sambucol syrup four times a day for adults and twice a day for children for up to five days. Or, if taking a Sambucol lozenge, she recommends 175 milligrams four times a day for adults and twice a day for kids for up to two days. If going with another brand, read the ingredients list and look for the botanical name (Sambucus nigra) along with the common name (elderberry) to ensure that it’s the right species of elderberry.

While elderberry is no substitute for a flu shot, and it won’t guarantee a cold-free winter, it may help your family get through the season with fewer sneezes and sick days.