Elderberry Side Effects

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Elderberry is an herb commonly used to address viral infections. It has a long history of use, as well as several studies in humans showing the benefits of using elderberry.

However, concerns about elderberry side effects for the cytokine storms have been widely shared. I’ve seen everything from negative social media posts to warnings sent to patients from doctor’s offices.

For example, I’ve seen claims that…

• elderberry side effects can cause a cytokine storm
• elderberry side effects will make you more sick
• elderberry side effects will make viral infections last longer
• elderberry should only be taken if you aren’t sick

Why is elderberry suddenly under fire?

Before I address these concerns, some background information is necessary. Let’s pause a bit to explore elderberry, elderberry side effects, cytokines and the concept of a cytokine storm.

What is Elderberry?

Elderberries come from the elder shrub, which commonly grows in temperate climates. The most commonly studied and used species is black elderberry (Sambucus nigra), a subspecies of which grows throughout the eastern half of North America. Many herbalists, myself included, use blue elderberry (S. cerulea), a species that is native to western North America. See my full monograph on the benefits of elderberry here.

(Note that red elderberry, S. racemosa, is not used in the same way as black and blue elderberry.)

What Are Cytokines?

Cytokines are a complex group of proteins that are used in cell signaling by many parts of the body, including the immune system. One of their jobs is to regulate inflammation, which is the natural process by which the body brings healing attention to itself when needed.

A common confusion I see right now is that people think that cytokines are bad. This is not accurate. Cytokines are a very necessary part of your immune system, acting to balance and modulate the immune response needed to address various threats.

I can’t sum up cytokines with just a couple of sentences. More in-depth information can be found in this extensive article.

What is a Cytokine Storm?

A cytokine storm, also called cytokine release syndrome (CRS), is a fairly rare and severe syndrome that is a complication of some diseases or even a side effect of some pharmaceutical drugs. Cytokine storms happen when the immune system becomes over-activated and releases a “storm” of cytokines, causing a snowball effect of inflammation in the body. This is seen in the last stages of an infection and can be fatal.

SARS, and MERS can all lead to cytokine storms in more critical cases.

Again, there is a lot more information about cytokine storms readily available in this article.

Do Elderberry Side Effects Cause Cytokine Storms?

In short, we have absolutely no evidence that elderberry – or any herb for that matter – causes or promotes cytokine storms.

Basically, the information you see circulating right now is oversimplified and often flat out wrong.

If we don’t have any evidence that elderberry causes cytokine storms, then what is the basis for all these claims?

In 2001, a study performed on healthy volunteers found that elderberry (in the product Sambucol) increased beneficial cytokines. The conclusion of that study was: “Sambucol might therefore be beneficial to the immune system activation and in the inflammatory process in healthy individuals or in patients with various diseases.”¹

I can’t count the times I have now seen that study referenced or linked with someone claiming that it’s proof that elderberry side effects cause cytokine storms. Again, that is absolutely not true. The study did not conclude anything regarding elderberry side effects and cytokine storms.

Let’s dig a little deeper.

The information we can glean from that particular study is that elderberry specifically promotes several cytokines of the immune system in healthy people, including IL-1 beta, TNF-alpha, IL-6, and IL-8.

The caution or concern is that certain viral infections may also promote some of those same cytokines.

The resulting assumption is that, because elderberry has been shown to increase certain cytokines and because certain viruses may increase those same cytokines, a combination of the two could cascade into a cytokine storm.

Here’s a way to illustrate this. Let’s say you have a glass that is half full. You then take something (in this case, elderberry) to fill it up. Then, something else comes along (in this case, a virus) and adds another half-glass of liquid, which completely overfills the glass and causes a big mess.

It makes sense that someone might make this assumption.

But the problem with this assumption is that it is reductionist thinking that completely oversimplifies the actions of elderberry, cytokines, and viruses that can contribute to cytokine storms.

I’ll keep repeating it: There is no direct evidence that elderberry side effects promote cytokine storms.

In fact, there is a lot of evidence that elderberry decreases inflammation.

Instead of simply doing one thing, elderberry modulates inflammation and regulates the activity of the immune system. It’s not uncommon for herbs to have this type of balancing effect (often called modulation). In a review of botanical medicines and cytokine expressions, the authors summarize, “The in vitro and in vivo research suggests that the reviewed botanical medicines modulate cytokines, and that such modulation may provide the mechanism of action for many of their therapeutic effects.”²  The review points out that Ashwagandha (Withania somnifera) has been shown to both increase TNF expression as well as decrease it.

We have evidence that this may also be the case for elderberry. For example, a 2016 study showed that a formula based on elderberry inhibited harmful cytokines in people who had atherosclerosis.³ So in this case, elderberry was modulating the inflammatory response and decreasing cytokines.

Does this prove that elderberries are always safe? No. It simply shows that they work in complex ways, like many herbs.

Can I Use Elderberry Safely?

I am an herbalist and I love elderberry. I’ve used elderberries countless times to ward off upper respiratory infections.

However, I want to be clear: there aren’t any studies regarding in vivo use of elderberries in viral infections that also cause cytokine storms.  

As much as I love elderberry, I can’t tell you that it is completely safe.

But I can tell you there is presently no evidence of harm from using elderberry. And I can tell you that elderberry is currently extensively used for upper respiratory infections with positive results. I just can’t promise anything beyond that.

Elderberry Benefits Against Upper Respiratory Viruses

Many studies have shown that elderberry can prevent and reduce the symptoms of upper respiratory viruses. One way we know it works is by inhibiting viral replication.^4,5 We don’t know that it specifically inhibits all upper respiratory viruses, but it has been shown to inhibit many upper respiratory viruses, including  forms of coronavirus,⁶ (but no tests have been done on the current novel strain).

One study followed 312 airline passengers flying overseas from Australia. Half were given an elderberry preparation and the other half got a placebo. Those taking the placebo had slightly more occurrences of a cold or influenza during their trip than did those taking the elderberry.

More significantly, those taking the elderberry who did get a cold reported a marked reduction of cold duration and severity compared with those taking the placebo.⁷

In a randomized, double-blind, placebo-controlled study in Norway, researchers gave 60 patients with influenza-like symptoms of less than 48-hour duration either 15 mL of elderberry syrup four times a day or a placebo syrup. On average, those receiving the elderberry syrup reported that their symptoms were relieved four days sooner than those taking the placebo. As an additional benefit, those taking the elderberry syrup reported using significantly less over-the-counter medication to relieve their symptoms.⁸

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Elderberry Side Effects in People with Autoimmune Diseases

Elderberry is safe for many people with autoimmune diseases. However, there are personal accounts and case studies from herbal clinicians showing that elderberry may adversely affect some people with autoimmunity, possibly causing a flare-up of autoimmune symptoms.

Unfortunately, at this stage it’s impossible to know for certain how taking elderberry will affect someone with an autoimmune condition. For most people it seems okay. For some it’s not. This is a case where it is important to proceed cautiously in trying elderberry, starting with a low dose and increasing gradually to assess the effects.

Will Elderberry Stop the all Virus Infections in their Tracks?

Elderberry is not an infallible miracle cure. We do know from many scientific studies that it can be beneficial for people with some strains of viral upper respiratory infections. 

The best defenses against getting any upper respiratory infection at this point are keeping a safe distance, washing your hands, and staying home if you are sick. In my opinion it is also important to build your immune system with a healthy lifestyle (i.e., appropriate sleep, nutrient-dense diet, movement), healthy levels of Vitamin D, and – yes – herbs!

In the second part of this article, I'll talk about Elderberry Uses against upper respiratory infections in general here.

Citations for Elderberry Side Effects

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