Elder : Scientific and Traditional Uses

by MedlinePlus

Several species of Sambucus produce elderberries. Most research and publications refer to Sambucus nigra . Other species with similar chemical components include the American elder or common elder ( Sambucus canadensis ), antelope brush ( Sambucus tridentata ), blue elderberry ( Sambucus caerulea ), danewort ( Sambucus ebulus ), dwarf elder ( Sambucus ebulus ), red-fruited elder ( Sambucus pubens, Sambucus racemosa ), and Sambucus formosana . American elder ( S. canadensis ) and European Elder ( S. nigra ) are often discussed simultaneously in the literature since they have many of the same uses and contain common constituents.

European elder grows up to 30 feet tall, is native to Europe, but has been naturalized to the Americas. Historically, the flowers and leaves have been used for pain relief, swelling/inflammation, diuresis (urine production), and as a diaphoretic or expectorant. The leaves have been used externally for sitz baths. The bark, when aged, has been used as a diuretic, laxative, or emetic (to induce vomiting). The berries have been used traditionally in food as flavoring, and in the preparation of elderberry wine and pies.

The flowers and berries (blue/black only) are used most often medicinally. They contain flavonoids, which are found to possess a variety of biochemical and pharmacological actions, including antioxidant and immunologic properties. Although hypothesized to be beneficial, there is no definitive evidence from well-conducted human clinical trials regarding the use of elder.

The bark, leaves, seeds and raw/unripe fruit contain the cyanogenic glycoside sambunigrin, which is potentially toxic.

Uses based on scientific evidence

Bacterial sinusitis

Elder has been observed to reduce excessive sinus mucus secretion in laboratory studies. There is only limited research specifically using elder to treat sinusitis in humans. Combination products containing elder and other herbs (such as Sinupret®) have been reported to have beneficial effects when used with antibiotics to treat sinus infections, although the majority of this evidence is not high quality and requires confirmation with better research. Some of these studies suggest that herbal preparations containing elder result in less swelling of mucus membranes, better drainage, milder headache, and decreased nasal congestion. There is no evidence regarding the effects of elder when used alone for treatment of this condition.

Bronchitis

There is a small amount of research of the combination herbal product Sinupret® in patients with bronchitis. This formula contains elder flowers ( Sambucus nigra ) as well as gentian root, verbena, cowslip flower, and sorrel. Although benefits have been suggested, due to design problems with this research, no clear conclusion can be drawn either for Sinupret® or elder in the management of bronchitis.

High cholesterol

There is no reliable human evidence evaluating elder alone as a treatment for high cholesterol. Early study reports that elderberry juice may decrease in serum cholesterol concentrations and an increase in low-density lipoprotein (LDL) stability. However, this study was a pilot design of small sample population. It remains unclear whether there is any benefit from elder for this condition. Additional research is needed in this area before a firm conclusion can be reached. Elder should not be used in the place of other more proven therapies, and patients are advised to discuss with their primary healthcare provider before using elderberry for treatment of high cholesterol.

Influenza

Some laboratory studies suggest that elder may reduce mucus production and possess anti-inflammatory and antiviral effects. Human study reports that elderberry juice may improve flu-like symptoms, such as fever, fatigue, headache, sore throat, cough and aches, in less than half the time that it normally takes to get over the flu. However study designs are weak, therefore it remains unclear whether there is truly any benefit from elder for this condition. Additional research is needed in this area before a firm conclusion can be reached. Elder should not be used in the place of other more proven therapies, and patients are advised to discuss influenza vaccination with their primary healthcare provider. It should be noted that the berries must be cooked to prevent nausea or cyanide toxicity.

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Alzheimer's disease, anti-inflammatory, antioxidant, antispasmodic, asthma, astringent, blood vessel disorders, burns, cancer, chafing, circulatory stimulant, cold sores, colds, colic, cough suppressant, diabetes, diuresis (urine production), edema, epilepsy, fever, flavoring, gut disorders, hair dye, hay fever, headache, herpes, HIV, immune stimulant, increased sweating, insomnia, joint swelling, kidney disease, laryngitis, laxative, liver disease, measles, migraines, mosquito repellant, nerve pain, psoriasis, respiratory distress, sedative, stress reduction, syphilis, toothache, ulcerative colitis, vomiting, weight loss.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Standardization:

There are no standard or well-studied doses of elder, and many different doses are used traditionally.

Berries: The berries must be cooked to prevent nausea or cyanide toxicity.

Dried elderflower: Dried elderflower may be standardized to contain at least 0.8% total flavonoids calculated as isoquercitin. The dried flower may contain at least 25% water-soluble extract.

Sambucol®: The elderberry product Sambucol® Active Defense consists of a 38% standardized black elderberry extract plus vitamin c, zinc Echinacea angustifolia,Echinacea purpurea , andpropolis.

Sinupret®: The combination product Sinupret®(formerly marketed in the United States as "Quantera®Sinus Defense"), is an herbal mixture containing elder flowers as well as gentian root ( Radix Gentianae luteae ), verbena, cowslip flower ( Flos Primulae veris cum calycibus ), andsorrel (Rumex acetosa)).

Rubini®: Rubini®, an elderberry extract of bioflavonoides is produced only from elderberries, with no additives from animals, no colorings, and no preservatives. Rubini® BioFlavonoides are produced with "organic certified fruits" (Zertifikationsnr: IT-CDX 5987).

Adults (18 years and older):

Tea: A dose of three to five grams of dried elder flowers steeped in one cup of boiling water for 10 to 15 minutes and taken by mouth three times daily has been used. Be aware of possible toxicity.

Sinupret® tablets: For bacterial sinusitis, a dose of two tablets of Sinupret® taken by mouth three times daily with antibiotics has been used. Sinupret® contains elder and several other herbs.

Syrup: 15 milliliters of elderberry syrup has been taken four times a day for five days for influenza symptoms.

Capsules/juice: Patients were given 400mg spray-dried powder capsules containing 10% anthocyanes three times a day equivalent to 5 milliliters of elderberry juice for 2 weeks in one study for high cholesterol.

Extract: For treating influenza or flu-like symptoms, a dose of four tablespoons of elderberry extract taken daily by mouth for three days has been used.

Hand cream: Cream has been prepared by taking several handfuls of fresh elder flowers, mixing in liquefied petroleum jelly, simmering for 40 minutes, heating, filtering, and allowing the formula to solidify. This has been applied to the hands at bedtime.

Children (younger than 18 years):

There are no standard or well-studied doses of elder, and many different doses are used traditionally. For influenza or flu-like symptoms, a dose of one teaspoon of elderberry juice containing extract syrup taken twice daily has been suggested. However, there is not enough scientific information available to recommend the safe use of elder in children. Toxicity has been reported, and caution is recommended.

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