A few weeks ago I shared how I’m supporting my family’s immune system during this pandemic, and I’ve received a lot of questions about whether or not I’m still making elderberry tea like I mentioned. Like many of you, I’ve come across several articles stating that elderberry should be avoided right now because it might cause cytokine storms.
If you’ve ever read one of my herbal profiles, you know that I always include the Botanical Safety Handbook’s usage guidelines if it’s available, plus any other safety data I come across in books like Medical Herbalism and The Modern Herbal Dispensatory. That’s because safety is my top priority when using herbs, and this is definitely a topic that I felt I needed to become informed about.
With that in mind, in this article we’ll dive into:
- What a cytokine storm is
- What research says about elderberry and cytokine production
- What clinicians and herbalists say about elderberry safety
- What I’m doing personally
As always, I want to mention that none of these statements have been evaluated by the FDA, this article is not medical advice, and it is not meant to diagnose or treat any condition. As always, please talk with your healthcare provider about any herbs you are considering. Now that we’ve got that out of the way, let’s dive in.
Elderberry & The Immune System
Travel through any European country in wintertime, and you’ll find a variety of elder products lining pharmacy shelves.” – Rosemary Gladstar, Medicinal Herbs: A Beginner’s Guide
Black elderberry (Sambucus nigra) has long been used to support the immune system during cold and flu season. Among its many benefits, it’s thought to have a positive impact on:
- General Immune Function – Studies done in Norway, Australia and Israel found that participants experiencing cold and flu symptoms felt better sooner (and had milder symptoms) when they received elderberry extract.
- Vitamin C absorption – This is important because Vitamin C is essential for immune function. (1)
- Respiratory Health – According to The Herbal Apothecary, “Elder is supportive to the respiratory system, with its ability to open the body, induce mild sweating (flower and leaves), reduce fever” and support the body’s natural clearance of phlegm.
Unlike medicines with one or two active ingredients, herbs like elderberry offer support by supplying a wide variety of constituents that work synergistically. Together, they are thought to influence our production of cytokines.
What are cytokines?
“Cytokines are cellular communication molecules that the immune system uses to communicate with itself and mobilize the healing response. They are used for local communication between immune cells and local tissues.” (2)
Cytokines are often lumped into one category, but actually there are both pro-inflammatory cytokines and anti-inflammatory cytokines.
According to herbalist Rosalee de la Foret, author of Alchemy of Herbs and Wild Remedies:
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.” (3)
So, what is a cytokine storm?
Cytokine release syndrome (CRS), also known as a cytokine storm, is when the immune system becomes over-activated and releases a “storm” of pro-inflammatory cytokines. According to Paul Bergner, who is the director of the North American Institute of Medical Herbalism:
A cytokine storm is experienced in the advanced stages of infection, such as sepsis or acute respiratory distress syndrome (ARDS), when there is already a significant amount of damage to the tissues in the body. The body sends an overwhelming number of messages to try and mobilize the healing response and activate immune cells, but the messages end up jamming the system, and spilling over into systemic circulation. The resulting influx of too many activated immune cells ends up causing additional damage to the tissues.” (4)
Although therapies are currently being explored, cytokine storms are very serious and potentially fatal.
Does elderberry cause cytokine storms?
Concerns raised about elderberry stem from a 2001 study in which healthy participants took a popular elderberry product, Sambucol®. In that study, the participants experienced a rise in cytokines, which caused the researchers to conclude that “Sambucol might therefore be beneficial to the immune system activation and in the inflammatory process in healthy individuals.” (5)
Although not mentioned by the researchers, a theoretical concern was drawn from this study that since elderberry enhanced cytokine production, it might upregulate inflammatory cytokines and trigger a cytokine storm.
However, it’s important to remember that herbs don’t have one mechanism of action, but rather a diverse blend of compounds that have complex interactions with our bodies.
Elderberry has been found to support cytokine production in some cases, while having the opposite effect in others. Regarding the initial 2001 study, Gaia Herbs notes that:
The key take-away from this study is that Elderberry supported cytokine production during a healthy inflammatory process related to optimal immune function that was beneficial in this situation. However, the research did not suggest it would stimulate a cytokine storm in patients that have an underlying condition that may tax the immune system.
More recently, a 2016 study showed that a formula based on Elderberry inhibited cytokines in people who had atherosclerosis.3 The take-away from this study is that the cytokines were not helpful to the overall situation, and Elderberry did not stimulate cytokine production. ” (2)”
The Institute for Functional Medicine, which is currently recommending elderberry for immune support, has this to say:
One in-vitro study reported an increase in TNF-alpha levels related to a specific commercial preparation of elderberry leading some to caution that its use could initiate a ‘cytokine storm.’ However, these data were not confirmed when the same group performed similar studies, which were published in 2002. Therefore, these data suggest it is highly implausible that consumption of properly prepared elderberry products (from berries or flowers) would contribute to an adverse outcome related to overproduction of cytokines or lead to an adverse response in someone infected with COVID-19.” (6)
They also note that although no studies have been done on elderberry and coronavirus specifically, there’s strong evidence for elderberries benefit in supporting immune function against other viruses. Only one other supplement was listed as having strong evidence – vitamin C.
Paul Bergner, whom as I mentioned earlier is the director of the North American Institute of Medical Herbalism, has this to say:
. . . herbalists cannot take an isolated experiment showing the effect of an herb or its constituents on a single cytokine, and extrapolate that to the net effect of the plant on the whole spectrum of cytokines. In fact both Echinacea and Sambucus have been shown to stimulate immunoregulatory cytokines, with a net non-inflammatory effect. Elderberry extracts were shown to enhance both inflammatory and anti-inflammatory cytokines in human cells in lab experiments (Barak et al.). In another lab study, an extract of Sambucus flowers inhibited all pro-inflammatory cytokines measured (Harokopakis et al.) Another yet another showed regulation through partial inhibition of inflammatory cytokines (Yesilada et al).” (4)
That said, I agree with Rosalee de la Foret, who writes that “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.” She is currently suggesting elderberry as an herb to consider for immune support right now, but also lists some other ones you can consider alongside (or instead of) here.
What about autoimmune diseases?
According to de la Foret, “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.” (3)
Am I still using elderberry?
So back to the original question – am I still making elderberry syrup, tea, etc.? After reviewing the available research and recommendations from clinicians and herbalists I respect, the answer is yes. I have a lot of elderberry on hand, and there’s strong evidence of its general immune supportive properties, so I’m continuing to use it.
However, I also honor my family members’ intuitive sense of what is or is not right for them. I have two kids that love the astragalus and elderberry tea I make several times per week, and one that simply doesn’t feel drawn to it. That child skips it and I’m just fine with that. We’re doing lots of other things to keep our immune systems strong.
1. Jones, E and Hughes, R.E. (1984) The influence of bioflavonoids on the absorption of vitamin C
2. Gaia Herbs (2020) The Facts on Black Elderberry and COVID-19
3. de la Foret, Rosalee (2020) Elderberry Side Effects
4. Bergner, Paul (2020) Herbal Medicines and Cytokine Storm in Respiratory Infection
5. Barak, V et. al. (2001) The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines.
6. Institute for Functional Medicine (2020) The Functional Medicine Approach to COVID-19: Virus-Specific Nutraceutical and Botanical Agents