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Elderberry and the Immune System

In part four of this series about the immune system, we are going to discuss the herb elderberry and the benefits it has on the immune system. In future weeks we will further explore other herbs that can help with boosting the immune system.

Elderberries scientific name is Sambucus nigra. Sambucus or Elder are flowering shrubs that produce elderberries. Elderberries were first found in Europe but can now be found across the globe including here in the United States (1). They have been used since the middle ages for both medicinal and food purposes (2). The elderberry was considered a holy tree that had the ability to restore health, maintain health, and to help people live longer (2). The fruit of the elderberry plant is often used to make jams, syrups, and wine. In addition to food and drinks, the flowers and fruit of the plant are used as therapies to lessen cold and flu symptoms, reduce inflammation, treat respiratory diseases, and as a laxative for helping with constipation (1). Elderberries can also help to prevent heart disease, lower cholesterol, act as a diuretic, and prevent/treat HIV/AIDS (1).

Regarding the immune system, many studies have shown that elderberries have antiviral, antibacterial, antidiabetic, immunomodulatory, antioxidant, anti-inflammatory, and chemopreventive properties (1).

In one study, elderberry and elderflower extracts were studied for their effects on the complement system and nitric oxide production (3). Adjustment of the complement immune activity and inhibition of nitric oxide production by macrophages and dendritic cells may have medicinal value when treating inflammatory diseases (3). The complement system plays a critical role in the immune system and acts as a first-line of defense against infections. The complement system also holds important effector functions as part of the innate and the adaptive immune system (3). The results showed that elderberry did indeed have inflammatory altering properties. This was due to the phenolic compounds that are found in elderberries and in elderflowers (3). The researchers concluded that taking elderberry and elderflower may help with the regulation of inflammatory diseases.

Another study looked at the benefits of oral elderberry syrup in the treatment of influenza A and B infections (4). Study subjects were given 15 ml of either elderberry or placebo syrup four times a day for 5 days. The subjects recorded their symptoms over the 5 days. The results showed that the “symptoms were relieved on average 4 days earlier and use of rescue medication was significantly less in those receiving elderberry extract compared with placebo” (4).

Elderberries have a minimal number of infrequently seen side effects including GI distress and type 1 allergies (1).

Use Caution

  • Raw or unripe elderberries must be adequately cooked to avoid cyanide toxicity because they contain cyanogenic glycosides (1)

  • The leaves and stems of the elderberry plant also contain cyanogenic glycosides; therefore, they should not be consumed as well (1)

  • Caution needs to be taken with elderberry bark, leaves and raw elderberries due to the risk of poisoning (1)


  • Avoid elderberries during pregnancy and during lactation (1)

  • Avoid use if you have an autoimmune condition since elderberries have the capability of strengthening or modulating the immune system (1)

Herb and Drug Interactions

  • Antidiabetic drugs: Elderberry can have additive effects with antidiabetic medications due to their abilities to both lower blood glucose (1)

  • Diuretics: Elderberry may have additive effects with diuretics since they both promote urination (1)

  • Laxatives: Elderberry may have additive effects as they both work to produce bowel movements (1)

  • Cytochrome P4503A4 substrates: Elderberry should be used with caution with CYP3A4 substrates (1)

If you have an acute or chronic health condition or take medications, you should consult with your health care provider before taking any new herbs.

About the Author: Leanne DiMaio earned her Master’s degree in Applied Clinical Nutrition from New York Chiropractic College in December 2017. She is currently working on her Doctorate degree in Clinical Nutrition at Maryland University of Integrative Health. Leanne is passionate about helping others achieve their optimal state of health and wellness. She is currently earning clinical hours toward the Certified Nutrition Specialist (CNS) credential under Kim Ross's supervision.


1. Memorial Sloan Kettering Cancer Center. Elderberry. Published 2018. Accessed August 25, 2018.

2. U.S. Department of Agriculture. COMMON ELDERBERRY. Published 2003. Accessed August 25, 2018.

3. Ho GTT, Wangensteen H, Barsett H. Elderberry and Elderflower Extracts, Phenolic Compounds, and Metabolites and Their Effect on Complement, RAW 264.7 Macrophages and Dendritic Cells. Andrade P, Valentão P, eds. International Journal of Molecular Sciences. 2017;18(3):584. doi:10.3390/ijms18030584.

4. Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized Study of the Efficacy and Safety of Oral Elderberry Extract in the Treatment of Influenza A and B Virus Infections. Journal of International Medical Research. 2004;32(2):132-140. doi:10.1177/147323000403200205

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