May 2019 Issue

Ask the Expert: Elderberries
By Toby Amidor, MS, RD, CDN
Today’s Dietitian
Vol. 21, No. 5, P. 8

Q: My clients have been asking about elderberries and elderberry products; what does the research say about their potential health benefits?

A: Elderberries and their products are touted to have anti-inflammatory, antioxidant, cardioprotective, diuretic, laxative, and antiviral properties, as well as the ability to improve blood pressure, lower lipids, promote insulin secretion, and stimulate weight loss. There’s some evidence for elderberry’s immune-supporting properties, but research on this is limited and scant or nonexistent for other conditions.

What Is Elderberry?
The elderberry (Sambucus nigra), is a dark purple berry grown on the European elder tree. The exact composition of the berry depends on a variety of factors including variety, degree of ripeness, and environmental conditions and climate. Elderberries comprise about 2.4% to 3.3% protein, depending on the part of the plant.1 The seeds contain unsaturated fatty acids, and the berries are about 18.4% carbohydrates, of which 7.4% is fiber and 6.8% to 11.5% is sugar. Vitamins include B vitamins and vitamins A, E, and C. What sets the elderberry apart from other foods is its high biological activity from flavanols, phenolic acids, proanthocyanidins, and anthocyanins.

Elderberry is found in a variety of foods and supplements. In food form, it can be found as whole berries and in jelly, teas, syrup, juice, and wine. As a supplement, it can be found in the form of gummies, capsules, drops, and syrup.

The Research
Elderberry products are most commonly advertised for their immune-supporting properties and their ability to combat cold and flu symptoms, as well as their cardioprotective aspects, so these are the areas of study Today’s Dietitian addresses here. Few studies have been conducted on humans, but several animal and cell studies are available. In one study of blood samples from 12 healthy donors, one brand of elderberry extract was found to stimulate the production of numerous pro- and anti-inflammatory cytokines, potentially supporting the immune system.2 In another study, 60 subjects with flulike symptoms were administered 15 mL elderberry syrup or placebo four times per day for five days; those in the elderberry group noted self-recorded symptom relief an average of four days earlier than controls.3

The evidence is more limited for cardiovascular benefits. In a 2011 study, rat chow containing polyphenols from elderberries resulted in higher antioxidant activity and more favorable lipid profiles in hypertensive rats, but this effect wasn’t seen in healthy rats.4 Another study showed no significant benefit of dietary elderberry anthocyanins on rats’ cholesterol or lipid levels.5

Recommendations for Clients
Elderberries contain a diverse portfolio of phytonutrients and have a high amount of antioxidant activity. However, as with many popular bioactive compounds, more research on elderberries is needed to understand the various components and how they may or may not benefit health.

Consumption of elderberries in any form is contraindicated for clients on antidiabetes drugs, morphine, phenobarbital, diuretics, and immunoactive drugs.1 In addition, as there’s a lack of data on its toxicity, pregnant and lactating women, and children and adolescents younger than 18 are recommended to avoid consumption.

— Toby Amidor, MS, RD, CDN, is the founder of Toby Amidor Nutrition ( and a Wall Street Journal best-selling author. Her four cookbooks are Smart Meal Prep for Beginners, The Easy 5-Ingredient Healthy Cookbook, The Healthy Meal Prep Cookbook, and The Greek Yogurt Kitchen. She’s a nutrition expert for and a contributor to U.S. News Eat + Run, Muscle&, and

1. Sidor A, Gramza-Michałowska A. Advanced research on the antioxidant and health benefit of elderberry (Sambucus nigra) in food — a review. J Funct Foods. 2015;18(B):941-958.

2. Barak V, Birkenfeld S, Halperin T, Kalickman I. The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines. Isr Med Assoc J. 2002;4(11 Suppl):919-922.

3. 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. J Int Med Res. 2004;32(2):132-140.

4. Moroşanu AI, Ciocoiu M, Bădescu L, Bădescu M. Antioxidant effects of aronia versus sambucus on murine model with or without arterial hypertension. Ann Rom Soc Cell Biol. 2011;16(1): 222-227.

5. Frank J, Kamal-Eldin A, Lundh T, Määttä K, Törrönen R, Vessby B. Effects of dietary anthocyanins on tocopherols and lipids in rats. J Agric Food Chem. 2002;50(25):7226-7230.