Elderberry benefits: it did not prevent colds

Key benefits

1. 01Early research

   Prevention failed, and the shortening stayed "uncertain"

   2021, BMC Complementary Medicine and Therapies. The authors searched six databases, four trial registers and two preprint servers, screened 1,187 records and included five randomised trials. Two reviewers independently extracted data, assessed risk of bias with Cochrane tools and certainty with GRADE.

   The results:

   • Risk of developing a cold — it may not reduce it. No preventive effect was established
   • Duration and severity of colds — may be reduced, but the evidence is uncertain
   • Duration of influenza — may be reduced, also uncertain
   • Compared with oseltamivir (Tamiflu), an elderberry-containing product may have carried a lower risk of influenza complications and adverse events

   Another study that gets quoted constantly needs to sit next to this one.

   A 2019 meta-analysis in Complementary Therapies in Medicine reported that elderberry supplementation "substantially reduced upper respiratory symptoms" with "a large mean effect size". Search for elderberry online and this is almost always what comes back.

   That analysis included 180 participants in total.

   One hundred and eighty is a small number for a condition as common and as variable as a cold. A cold resolves in about a week whether or not you do anything. Measuring an effect against that background takes a far larger sample. The authors' affiliation is a wellness institute rather than a university or hospital.

   The two look like they disagree, but they do not really conflict. One says the effect was large; the other says there may be an effect, but the evidence is not good enough to be confident of it. The one that graded certainty is the second.

   The honest summary: elderberry will not keep you from catching a cold. It may shorten one you already have, and the evidence for that possibility is weak.

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2. 02Nutrition data

   7 g of fibre per 100 g — but how much survives in a spoonful of syrup?

   Per 100 g of raw elderberries:

   • 73 kcal, protein 0.66 g, fat 0.5 g
   • Of 18.4 g of carbohydrate, 7.0 g is fibre
   • Vitamin C 36.0 mg — 40% of the requirement
   • Potassium 280 mg, calcium 38 mg, iron 1.6 mg
   • Vitamin B6 0.23 mg, vitamin A 30 µg, phosphorus 39 mg

   7.0 g of fibre is high even among fruit — close to three times blueberry's 2.4 g. The 36 mg of vitamin C is below orange (53 mg) and far above blueberry (9.7 mg).

   But almost nobody eats that table.

   Elderberry reaches you by three routes.

   First, syrup. The berries are boiled, strained, and reduced with sugar or honey. Most of the fibre leaves at the strainer. Vitamin C is heat-sensitive and falls during the boil. What remains is anthocyanin and sugar.

   Second, jelly and jam. Same as syrup, with more sugar.

   Third, capsules and extracts. This is closest to what the trials above used — though concentration and specification differ by product.

   So separate two things:

   • If you want the nutrients — syrup will not deliver them. For 7 g of fibre you would need the cooked whole fruit, and other fruit may serve better anyway
   • If you want the effect the trials looked at — those trials used standardised extracts, not a spoonful of syrup

   One more thing — the colour is intense. That is the anthocyanin, and it stains clothes and cutting boards.

3. 03Not established

   "Boosts immunity" — no evidence was found for that sentence

   This entry sorts through a claim that is not established.

   The phrase attached most often to elderberry products is "boosts immunity", frequently with talk of "modulating cytokines".

   The 2021 review took this on directly, because concern had been raised during the COVID pandemic that elderberry might overstimulate immunity and increase the risk of a cytokine storm. The authors searched for evidence in both directions.

   What they found:

   • No studies linking elderberry to clinical inflammatory outcomes. No clinical evidence either for benefit or for harm
   • Three studies measured cytokine production ex vivo. There was some effect on inflammatory markers, but that effect may decline with ongoing supplementation
   • In one small study comparing it with diclofenac (an anti-inflammatory drug), elderberry was as effective or less effective than diclofenac at reducing cytokines over time

   Three points follow.

   First, "immunity" has no unit of measurement. Human immunity is not a dial you turn up. It can only be judged by outcomes — did you get infected less, were you less ill — and the evidence on those outcomes is entry one above, where prevention failed.

   Second, an ex vivo marker is not a human outcome. Cytokines moving in cells is a different order of claim from a person being less ill.

   Third, anyone with an autoimmune condition or on immunosuppressants should be especially careful. If the "stimulates immunity" claim were true, that would be a risk rather than a benefit for them. And there is no clinical evidence in that direction either.

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