Elderberry or S. nigra sbsp. nigra (L.) R. Bolli, is a genus plant of the Adoxecea family (Donoghue (2003) and a common plant in Europe (Bolli, 1994). The berries have gained popularity in recent times due to their purported antioxidant properties (Duymus, et al. 2014; Mandrone et. al. 2014), being anti-diabetic (Gray et. al. 2007) as well as possessing antiviral properties in vitro studies (Roschek et. al. 2009).  These properties have landed it into the category of foods that can help to boost the immune system and aid in one’s overall health and well-being.

As such, Elderberry is regarded as an excellent nutritional candidate that can be beneficial for respiratory and cardiovascular health as well as mental health (Tiralongo et al. 2016).  In this article, we’ll be discussing some of these notable benefits of elderberry, some of those that have made it a firm contender on the list of the world’s most famous elite berries.  Let’s discuss!

The Discussion

Elderberry has been getting quite a buzz these days due to its purported health benefits.  The berries, which are dark violet to black in colour are said to be a good source of protein, antioxidants and minerals (Sidor and Gramza-Michalowska, 2014).  Most of its nutritional properties have been attributed to its anthocyanins, the compound that gives the berries their colour.  Anthocyanins are phenolic compounds which along with flavonoids are found in abundance in elderberry and are active constituents of the fruit (Mikulic-Petkovsek, et. al. 2015).  Other nutrients of Elderberry include vitamin A, Thiamine (B1), Riboflavin (B2), Pyridoxine (B6), vitamin C, vitamin E, calcium, magnesium, zinc, and iron among others (Sidor and Gramza-Michalowska, 2014).

According to research, the berries are also a good source of protein and contain over Sixteen (16) amino acids, those that must be supplied to the human body via the diet (Akbulut et al. 2009; Kislichenko and Velma, 2006).  Its seeds are also said to have lipids which are largely of the unsaturated type.  These include linolenic acid, linoleic acid and oleic acid (Dulf et al. 2013).  Additionally, the fruit is also high in carbohydrates and fibre, which makes it beneficial for those on a weight loss journey.

While the berries’ popularity has recently gained momentum, its usage has long since boasted in particular societies, where it is lauded as a folk medicine for centuries and used for the treatment of many health conditions and ailments such as influenza, colds and sinusitis (Zakay-Rones et al. 2004).

However, there are different versions of the berries that are available and used which can be confusing depending on where you live – Eastern and Central North America or Europe. For example, the American Elder or what is often denoted as the common elder can be found in Eastern and Central North America (Small et. al. 2004) while the Black elder, is in Europe (Bolli, 1994).  The Black Elder is the berry that is famous in Europe and the one that had gained prominence both as a folklore medicine and in most of the commercial elderberry products you might see on the market (Charlebois, 2007).

Research suggests that the Black Elder has been consumed in Europe, North America and some parts of Asia since 1651 (Borchers et al. 2000) and has an established production and processing mechanism. In these regions, it was mostly used to treat fever and rheumatism (Moerman 1986).  On the other hand, the American Elder can be found in Nova Scotia (Canada), some parts of Florida as well as in the State of Texas (Small et al. 2004).  

However, the berry is reportedly largely unknown to the general public and industry leaders alike and such, less studied (Charlebois, 2007).  Elderberries are usually the constituents of many food and medicinal products for example, in food production; it can be found in pies, jams and wines etc. and in medicine, you can find it in supplement form, extracts and syrups etc (Charlebois, 2007).  Nonetheless, both types of berries are said to share similar properties, and as such, in research, the two are typically referenced interchangeably.

In this article, we will be exploring the research surrounding its cardiovascular disease benefits, Diabetes, antiviral, antibacterial and antifungal properties, anti-tumour activity and its overall effects on the immune system.

You can read more on some of the other notable and beneficial berries or immune-boosting nutrients in these articles:

• • Blueberries – They are more than just for Brain Health – Here are five (5) awesome benefits worth knowing!
  • Cranberries – The little red berries with some ‘Huge’ health benefits – Here are 5 worth knowing!
  • Quercetin – A Powerful Flavonoid and Immune System Defender

Five(5) ‘must know’ Health Benefits of Elderberry:

• Cardiovascular health.
• Anti-diabetic.
• Antiviral and antibacterial properties.
• Anti-tumour.
• Strengthening of the immune system.

Elderberry and Cardiovascular Health

According to the World Health Organization (WHO), cardiovascular diseases (CVDs) are the leading cause of death, globally, with an estimated 17.9 million people dying from the disease in 2019.  This figure represents Thirty-two (32%) per cent of all global death in that year (WHO-2021).

Cardiovascular diseases are a group of disorders of the heart and the blood vessels such as Coronary Heart Disease (a disease of the blood vessels supplying the heart muscles), rheumatic heart disease (damage to both the muscles of the heart and its valves) and congenital heart disease (a birth defects that impact the normal development as well as the functioning of the heart).  Rheumatic heart disease usually arises from rheumatic fever hence its name (WHO – 2021).

Apart from birth defects, an unhealthy diet has been noted to be the most important behavioural risk factor for heart disease and stroke.  An unhealthy diet may result in raised blood pressure, sugar levels and cholesterol, which can then lend itself to the development of these diseases.  However, elderberry is beneficial to the components of blood pressure and oxidative stress, factors that have been cited as risk factors for cardiovascular diseases (Ciocoiu et al 2012a; Badescu et al. 2012b).

Observational studies have shown that the intake of flavonoids such as anthocyanins which elderberry has in abundance, could significantly reduce the risk of cardiovascular diseases (Youdim et. al. 2000). Nonetheless, the results of these observational studies have been debatable (Wang et al. 2014). Additionally, another study by (Ogino and Wang, 2007) observed a decrease in total cholesterol and triacylglycerol contents as well as lipoproteins (LDL) with the consumption of elderberry.  However, the same results were not confirmed in healthy volunteers (Ciocoiu et al. 2012, 2012b).  Nevertheless, the daily intake of elderberry at amounts that are usually considered ‘established amounts’ for daily intake did not reveal any significant effect on the lipid profile of healthy rats (Frank et al. 2002).

Elderberry and Diabetes

Diabetes is a multiple metabolic disorder which causes chronic hyperglycemia and defects in the way the body produces and uses insulin (Alberti et al. 1998).  According to research, by the year 2030, over Three Hundred (300) million people will be affected by this disease (WHO – 2014; Ruhe and McDonald, 2001; Wild et. al. 2004). As such, increasing research is being encouraged to evaluate the effectiveness of some of the current interventions to both prevent and manage the condition.  One such is behavioural changes which involve the way we eat (our diet) and certain lifestyle practices.  Therefore, a diet rich in fruits and vegetables has been recommended not only for diabetes but for a healthy lifestyle.

Elderberry, the little violet-black berries from the era of the Hippocrates, has been used on its own or in other preparations to either prevent or control many different diseases (Sidor and Gramza-Michalowska, 2014). These include diabetes, where several studies have been conducted showing favourable results, at least in reducing diabetes complications (Ciocoiu et al. 2009; Badescu et al. 2012; Groza et. al. 2011; Badescu et. al. 2015).

Research has shown that elderberry could potentially reduce serum glycemic and lipidic levels (cholesterol and triacylglycerol).  It was also shown to reduce other inflammatory markers as well as oxidative markers, which are considered risks factors for the development of diabetes (Ciocoiu et al. 2009; Badescu et al. 2012; Groza et. al. 2011; Badescu et. al. 2015).

These studies were conducted with methanol elderberry extracts (28-70 mg/kg) body weight on induced Wistar diabetic rats over a Twelve (12) to Sixteen (16) week period. Another study by (Sasaki et. al. 2007) showed that Cyanidin 3-glucoside, one of the main anthocyanins in elderberry was found to promote the reduction of blood glucose levels as well as enhance insulin sensitivity in type 2 diabetic mice.  The study was conducted over a five (5) – week period where the cyaniding 3-glucoside constituted 0.2% of the diet of the mice.

Considering that elderberry extract and its major components have been found to be potentially beneficial in the prevention of diabetes complications, then this is seemingly a good place to continue the research on this fruit’s anti-diabetic effect, especially with the alarming estimations for 2030.

Elderberry and Antiviral and Antibacterial Benefits

Elderberry has been used for centuries as a folk medicine in the treatment of influenza, colds and even sinusitis (Zakay-rones et al. 2004).  As such, the plant has been known to have antiviral and antibacterial properties (Kong, 2009).  An elderberry flower extract with a concentration of 252 µg/mL was found to inhibit the influenza A virus (H1N1) (Roscheck et al. 2009). 

The mechanism of its antiviral activity is that of its polyphenolic compounds that were found to directly bind the H1N1 virus, which then prevents the virus from penetrating the cells and thus inhibiting infections in vitro. Therefore, research contends that elderberry portrays a protective role in the body as well as has the potential to stimulate the body’s immune system response (Kinoshita et al. 2012).

Its antiviral potential was also observed in a double-blind, randomized, placebo-controlled study with sixty (60) volunteers between the ages of Eighteen (18) to Fifty-four (54) years.  These patients were all suffering from influenza-like symptoms for Forty-eight (48) hours or less. The patients were given an oral elderberry syrup or a placebo, four (4) times a day over a five (5) day period.  The patients consuming the elderberry syrup experienced relief in symptoms at least 4 days earlier compared to the placebo group (Zakay-Rones et al. 2004).  The researchers concluded that elderberry could be considered a safe and cost-effective treatment for influenza. Nonetheless, more studies are still recommended particularly using larger groups.

Elderberry was also shown to have antibacterial effects with certain bacterial strains that can cause one to experience frequent infections such as gram-positive straptococ-cus pyogenes, streptococcus group G (Kravitz et al. 2011).  As such, extract concentrations have been found to inhibit the effect of bacterial growth.

Elderberry and Anti-tumor Activities

While the studies of elderberry anti-cancer properties have been controversial or not confirmed any significant effect, research has shown that the fruit and leaf extract could moderately inhibit the growth of tumours in potato disk tumour (Pehlivan et al. 2012) as well as leukaemia (Goun et al. 2002).

The compound in elderberry that has been found to be responsible for its anti-tumour activity includes its polyphenols such as quercetin and proanthocyanidins (Thol et. al. 2006).

Elderberry and the Immune System

Research has shown that elderberry may potentially increase the body’s defence mechanism in both healthy people as well as those suffering from diseases (Barak et al.2002).  Its immune system potential can be observed in some of the other benefits that have been listed above, particularly as it relates to its antiviral and antibacterial activities.

Therefore, the research found that elderberry extract could stimulate both pro-inflammatory cytokines (IL-1β, IL-6, IL-8 and TNF-alpha (tumour necrosis factor) as well as anti-inflammatory cytokines (IL-10). The type of cytokines it produces though will be depended on the type of extract, for example, whether the extract is derived from its leaf, flower or some type of solvent (Barak et al.2002; Halperin, & Kalickman, 2002; Yesilada et al. 1997). Cytokines are small secreted proteins that are released by the body’s cells which foster interactions and communication between the cells (Zhang et al. 2007).  Cytokines can be both pro-inflammatory and anti-inflammatory. As such, cytokines are regulators of how the body responds to infection, inflammation and trauma (Dinarello, 2000).

Pro-inflammatory cytokines may worsen a disease, while anti-inflammatory cytokines reduce inflammation and promote the body’s healing (Dinarello, 2000). As such, persons that suffer from autoimmune conditions (i.e. lupus, multiple sclerosis etc.) are particularly advised to avoid its consumption as it could cause the immune system to become more active which could worsen the condition. If being used, it should be done under the strict supervision of a medical doctor.

Are there any side effects in consuming Elderberry?

In general, elderberry is not considered a toxic plant. However, its leaves, stems, barks, roots, flowers and unripe fruits contain a toxic substance known as Cyanogenic Glycosides, which when ingested is converted into hydrogen cyanide (Jensen and Nielsen, 1997). Hydrogen cyanide is a colourless, bitter-like substance that can be in either liquid or gas format. When consumed, it interferes with how the body uses its oxygen supply, which can cause damage to the brain, lungs and even the blood vessels. As such, its consumption or exposure can be fatal (Center for Disease Control –CDC-2021).  On the other hand, cooked, ripe berries are safe for consumption (European Medicine Agency, 2014).

Additionally, the consumption of high volumes of unripe fruits or immature fruits can cause nausea, vomiting and diarrhoea.  However, some of these side effects may not occur with products available on the market, as these products are usually produced and consumed in processed form.  As such, the consumption of its fruits that have gone through some heating process is said to not cause any symptoms of poisoning (Williamson et. al. 2009).

As per interaction with other medicinal plants, there is reportedly, no known interaction. Nonetheless, because medicinal plants can act in the same fashion as conventional medicines at times or counteract their activities, it is recommended that they are not consumed with Elderberry without the guidance of a medical professional. This is because they may not be considered completely safe for combination and warrant research in this area. This is especially crucial for diabetes and immunoreactive drugs (Barnes et al. 2007; NCCAM, 2012).

Elderberry consumption is also not recommended for pregnant and lactating women as well as children and adolescents under the age of Eighteen (18) years.   As such, persons in these categories or age groups are advised to avoid consumption.  This is due to the lack of research on its level of toxicity (EMA/HMPC European Medicines Agency, 2012). Additionally, persons suffering from autoimmune conditions (i.e. Lupus, Rheumatoid Arthritis, Multiple sclerosis) are advised to refrain from consuming it, as elderberry can cause the immune system to become more active, which would not be beneficial for these conditions.

To this extent, the toxicity effects of the anthocyanin mixture have been determined to be 25g/kg in mice and 20g/kg of body weight in rats. This was observed in experimental animal studies. However, anthocyanins were found to not cause toxicity in certain doses such as those at 1.5, 3 or 9g/kg taken on a monthly or daily basis (EFSA, 2013; Pourrat et. al. 1967).  As such, 1 tablespoon or 15ml or less is the usual recommendation, especially for commercial products.

Illustrative Summary

Here is a summary of the Five (5) must-know health Benefits of ELDERBERRY.

Let’s Sum Up!

Every fruit and vegetable has nutritional value and benefits to the human body, some more than others.  Hence the recommendation to consume them on a daily basis, elderberry is no exception. 

This fruit has been shown to have both antioxidant, antiviral and antibacterial effects on the body.  These are some of the reasons it has been revered as a folklore medicine to combat the common cold and influenza.  Other purported benefits of Elderberry include its effects on the cardiovascular system, diabetes and its overall potential in regulating and bolstering the immune system.

However, its consumption must be taken with all precautions, especially for pregnant and lactating women as well as children and adolescents of a particular age.  Additionally, it is cautioned that persons do not consume this fruit in its unripe or immature state, as that can cause toxicity which can lead to serious reactions including death.  Further, persons on medication especially diabetes and immunoreactive drugs should not consume this fruit unless under the guidance of a medical professional.

Therefore, not because a food may have potential benefits to enhance health, we should still consume same in modest proportion or not at all if you suffer from particular illnesses. So, while the research has shown that this fruit may have many positive benefits to the body, more research is required to further explore its full potential.  So, have you consumed elderberry or any related products before? How was it? Share it with us nuh!

You can read more on some other famous and beneficial berries or immune-boosting nutrients in these articles:

• • • Blueberries – They are more than just for Brain Health – Here are five (5) awesome benefits worth knowing!
    • Cranberries – The little red berries with some ‘Huge’ health benefits – Here are 5 worth knowing!
    • Quercetin – A Powerful Flavonoid and Immune System Defender
    • Wheatgrass Juice Powder – A Chlorophyll Powerhouse – Here are Three (3) Main Reasons Why you Should Add it to your Wellness Regimen!
•