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A Simple Berry Helps Fight The Flu
Elderberry is an ancient traditional remedy that also serves as food. Among the plants called by this name, Sambucus nigra is the one used in the treatment of the flu. This herb is one of the few herbs confirmed to possess specific antiviral effect against influenza A and influenza B viruses. So, how does elderberry work? How strong is the evidence to support its use? And how does it compare against prescription flu drugs? Read on to find out.
by Brad Chase
Elderberry is the name for the flowering plants, shrubs and trees of the Sambucus plant family. The most popular member of this family is Sambucus nigra, an elderberry plant with black berries and medicinal properties.
The flowers and oils of elderberry are used to prepare and flavor different drinks including soft drinks, wines and yogurt.
Besides its use as food, elderberry is also an important medicinal plant. In Chinese traditional medicine, the herb is dissolved in wine and used to treat arthritis and rheumatism. A homemade syrup is also commonly prepared by soaking the flowers in water.
Even though elderberry has been used in traditional medicine for centuries especially to treat wounds, studies into its medicinal effects have only recently begun. Scientists have determined that elderberry is useful for managing allergies, for improving respiratory health and for treating the flu.
Elderberry also has antioxidant, anti-inflammatory and anticancer properties.
While most species of the elderberry plant family contain toxic cyanide-based compounds, S. nigra is considered non-toxic. Even then it is recommended that the plant be cooked before it is used in food preparation.
Only a handful of studies have been done to investigate the benefits of elderberry extract in the treatment of the flu. However, almost all of these studies found some benefits.
In one study done during an influenza B virus outbreak, researchers found that elderberry cut down the duration of flu episodes to 2 days in 93% of the users. In contrast, those who were given placebo experienced 6 days of sickness.
Elderberry is not only effective against the slow-growing influenza B virus. Studies also confirm that it is effective against the more common and more virulent influenza A virus.
In a study that investigated the effectiveness of the herb in the treatment of flu caused by both influenza A and influenza B viruses, the results showed that elderberry extract reduced both the duration and severity of flu as long as it was taken within 48 hours of the first appearance of symptoms.
Some health experts believe elderberry is a suitable replacement for prescription flu drugs such as Tamiflu.
Elderberry is quite safe and produces none of the common side effects of flu drugs. For one, it does not cause drowsiness.
Common side effects of elderberry extracts include mild indigestion and hypersensitivity reactions.
However, the occurrence of side effects is rare and serious side effects are not associated with commercially available elderberry capsules, juices and syrups. The recommended form of this herb is elderberry extract and not the fresh leaves, bark, flower, unripe berries and roots of the plant.
Elderberry does not prevent the flu but it is conclusively proven to be effective for treating the disease.
Because elderberry syrup is easily prepared at home, care should be taken with the plant part used and the species of the plant used. While elderberry extracts are not toxic, freshly harvested plant parts may contain enough cyanide compounds to be lethal if consumed in significant quantities.
The only identified brand of elderberry extract used in most studies is Sambucol. This is a standardized elderberry preparation. Therefore, make sure the elderberry extract you choose is standardized by its main ingredient.
Elderberry extract can be used by both adults and children (2 years and above).
The recommended dosage of the extract for children is ½ tablespoon taken 4 times per day. Adults should take 1 – 2 tablespoons 4 times per day. Higher doses of the herb do not appear to be more effective but may cause side effects such as nausea, vomiting and diarrhea.
Although they taste pleasant, elderberry juice and syrup can still be mixed with hot water and honey to be taken in form of herbal tea.
Alternatively, they can mixed with water and served with ice for a refreshing drink.
The active compound in elderberry extract believed to be responsible for most its effectiveness in the treatment of the flu is known as Antivirin. This compound is found bound to proteins in elderberry.
Laboratory studies show that elderberry extract exhibits a total antiviral activity against influenza viruses.
Besides its antiviral properties, these studies also reveal that elderberry inhibits the growth of bacteria associated with upper respiratory tract infections. These bacteria usually worsen flu episodes and can cause flu-like symptoms too.
Researchers have demonstrated that elderberry can kill off 70 – 99% of the population of these bacteria depending on the concentration of the herbal extract used.
The exact mechanisms by which elderberry inhibits influenza viruses are still not clear but early results showed that active phytochemicals in the herb prevent flu viruses from docking to cells. By preventing them from adhering to cells, elderberry extract ensures that influenza viruses cannot infect cells and cause symptomatic disease.
In addition, elderberry prevents influenza viruses from gaining entry into respiratory tract and systemic circulation by preventing them from sticking to the soft tissues of the nose and throat.
To block the adhesion of the viruses to the tissues, elderberry extract prevents them from producing the enzyme (neuramididase) needed for this adhesion.
When exposed to elderberry extract, in vitro studies showed that the reproduction of influenza A virus was reduced by 30% while the growth of influenza B virus was inhibited by 25%.
To achieve these significant reductions in viral production, elderberry blocks essential growth factors that the viruses need to reproduce.
Besides the main antimicrobial compound in elderberry, the flavonoids and anthocyanins in elderberry are believed to help.
Flavonoids and anthocyanins are responsible for the antioxidant properties of elderberry. Studies show that the measured ORAC value of elderberry is similar to that of cranberry.
ORAC or oxygen radical absorption capacity is a measure of antioxidant power. The high ORAC value of elderberry means that it can reduce oxidative stress and effectively mop up reactive oxygen species and free radicals.
The antioxidant flavonoids are also known to stimulate the cells of the immune system.
Specifically, flavonoids enhance the activities of monocytes. Along with anthocyanins, they block the release of pro-inflammatory cytokines.
By stimulating the “attack” arm of the immune system while blocking the “inflammatory” arm, these bioactive compounds of elderberry relieve the pain, ache and fever associated with the flu. It is no wonder then that elderberry significantly reduces the number of sick days caused by flu.
One of the earliest studies to demonstrate the efficacy of elderberry in the treatment of flu was published in the Journal of Alternative and Complementary Medicine in 1995.
The researchers first recounted multiple successful treatments of influenza A virus with Sambucol. For their own study, they recruited the citizens of an agricultural community during an outbreak of influenza B virus in Panama in 1993.
The results of their study showed that
The researchers concluded that given the fact there is no satisfactory drug to successfully treat flu caused by influenza A and B viruses, elderberry extract (Sambucol) made an excellent flu remedy because of its efficacy, its low cost and absence of side effects.
A 2004 study published in The Journal of International Medical Research also investigated the efficacy and safety of elderberry extract for treating influenza A and B infections.
For this study, the researchers used an oral elderberry syrup and recruited 60 patients within 48 hours of appearance of their first flu symptoms. These patients were given either placebo or 15 ml of elderberry syrup 4 times daily for 5 days.
The results of the study showed that those who received elderberry experienced relief from flu 4 days earlier than the placebo group. In addition, they also used significantly less flu medications.
In their conclusions, the researchers also praised elderberry for its efficacy, safety and cost-effectiveness in the treatment of influenza.
In 2010, a systematic review of past studies done to investigate the therapeutic benefits of elderberry in the treatment of the flu was published in the journal, Phytotherapy Research.
The authors of the review recognized that recent studies had indicated that elderberry extract (Sambucol) had a clear clinical benefit for flu sufferers. They identified evidences for the antiviral, antibacterial, antioxidant and anti-inflammatory properties of the herb from several in vitro, animal and human studies.
While they recommended more well-designed and larger studies, the authors concluded that all evidence suggests that elderberry aqueous extract is both safe and effective in the treatment of the flu.
A 2009 study published in the Online Journal of Pharmacology and Pharmacokinetics detailed a pilot study investigating the efficacy of a proprietary formulation of elderberry extract in the treatment of the flu.
The proprietary elderberry extract used was a slowly dissolving lozenge.
The researchers recruited 64 patients with at least 3 flu symptoms that had appeared in less than 24 hours. Some of these volunteers were given the elderberry lozenges while the others got placebo. The dose of the elderberry given was 175 mg of elderberry extract taken 4 times daily for 2 days.
At the end of the treatment period, the result of the study showed that the elderberry group experienced significant improvements while the placebo group barely improved and worsened in some symptoms.
After 48 hours, 28% of the elderberry group was completely cured while 60% reported significant relief.
In contrast, none of the placebo group was completely cured after 48 hours and only 16% of them were relieved of one or two symptoms. For the rest of this group, symptoms remained the same or worsened.
No side effects were reported by both groups during this study.
The researchers, therefore, concluded that the elderberry extract was safe and effective for treating flu.
A 2001 study published in the journal, European Cytokine Network, investigated the effect of elderberry extract on the healthy immune system.
First, the researchers noted that elderberry extract (Sambucol) had been proven effective in vitro against at least 10 strains of influenza virus and that human studies have found that it can reduce the duration of flu symptoms to 3 – 4 days.
Their focus was to determine how elderberry affected the release and activities of proinflammatory cytokines in a healthy immune system.
For this study, they recruited 12 healthy donors to donate blood. Then they separated the monocytes (a kind of white blood cells) from the donors’ sera and incubated them with different Sambucol products (Sambucol for Kids, Sambucol Immune System, Sambucol Black Elderberry Syrup and Sambucol Elderberry Extract).
The results of this study showed that all Sambucol preparations stimulated the production of inflammatory cytokines such as the interleukins (IL-6, IL-8 and IL-1b) as well as tissue necrosis factor (TNF-alpha).
The best stimulatory action was obtained from Sambucol Black Elderberry Syrup and the highest increase was from TNF-alpha.
The researchers, therefore, concluded that Sambucol elderberry products can activate the immune system by boosting the production of inflammatory cytokines.
This immunostimulatory effect can be useful not only in the treatment of influenza infections but possibly in the management of cancer and AIDS.
While it may seem like elderberry promotes inflammation, it should be noted that these cytokines are not necessarily pro-inflammatory. Their effects on the immune system depends on the prevailing condition. In fact, previous studies have also indicated that elderberry promotes the production of anti-inflammatory cytokines as well as major white blood cells.
Therefore, the conclusion to derive from this study is that elderberry boosts the immune system.
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