Does Elderberry Really Work?

The days are getting shorter, the air has that crisp edge, and if your house is anything like mine, someone has already started sniffling.

This is the season when I start pulling jars off my home apothecary shelf a little more often. So for the rest of November, we’re going to spend some time with the immune system. Each week, I’ll share an Herb of the Week, plus a second piece on how your immune system actually works and what helps it do its job.
We’re starting with the herb that probably comes to mind first this time of year: elderberry. What do centuries of tradition and a handful of studies tell us about this beloved herb?

Meet Elderberry

Botanical name: Sambucus nigra (European elder) and Sambucus canadensis (American elder)
Parts used: the cooked ripe berries and the flowers

Elder is a shrub or small tree that grows along field edges and creek banks across mostly Europe and North America. It has a lacy cluster of flat, creamy white flowers by early summer, and later in the summer, those flowers become heavy clusters of tiny, deep purple berries.

I love the different stories passed along with herbal folklore, and even its name tells a story. “Elder” is thought to come from an old Anglo-Saxon word for fire, because people blew through the hollow young branches to coax a fire to life. Sambucus comes from the sambuke, an ancient Greek instrument made from those very hollow stems. And nigra simply means black, for the berries. People have been eating elderberries for a very long time. Elder seeds have even turned up at prehistoric sites in Europe. (Herbal Academy)

Elder has been part of folk medicine for centuries. It’s often called “the medicine chest of the country people,” because nearly every part of the plant was put to use. In many European traditions, elder served as a sacred, protective plant. Legends tell of a wise woman, the Elder Mother or Hylde-Moer, who lives in the tree and watches over it. Before harvesting, people asked her permission and thanked her for her gifts. (There’s my dash of woo for the week.)

That deep purple color comes from anthocyanins, the same family of plant pigments found in blueberries and blackberries. These compounds are a big part of why researchers have been interested in elderberry.

Getting to Know the Whole Plant

When most of us hear “elderberry,” we picture a bottle of purple syrup. But herbalists have worked with nearly every part of the elder for centuries. Today, we focus on just two, and it helps to know why.

Part: Berries (ripe, dark purple, always cooked)
How it’s used: Syrups, teas, and jams for immune support during colds and flu
Beginner friendly?- Yes, this is where to start

Part: Flowers (creamy white, early summer)
How it’s used: A gentle tea that helps the body “sweat out” a fever, supports stuffy, congested sinuses, and makes a cooling wash for the skin
Beginner-friendly: Yes

Part: Leaves
How it’s used: Historically used only on the skin, in salves for bruises and sprains. Never take them internally.

Part: Bark and roots
How it’s used: Traditionally used as a strong laxative and to cause vomiting, but toxic if prepared incorrectly.
Beginner friendly: No, leave these to an experienced herbalist

Part: Stems and unripe green berries
Not used as medicine
No, remove every bit of stem before cooking

Part: The berries and the flowers: a closer look

The Berries and Flowers

The berries are the part most of us know. They’re the immune supporters, best taken at the very first sign of a cold. They taste tart and a little earthy, which is why syrups pair them with honey and warming spices. Many herbalists prefer small, frequent doses at the start of a cold rather than one big dose. For example, 1 teaspoon to 1 tablespoon of syrup about every hour when feeling something brewing. (Herbal Academy)

The flowers are elder’s quieter gift, but I think they deserve more attention. Herbalists call elderflower a relaxing diaphoretic. In plain words, a hot cup of elderflower tea helps open the pores and lets the body release heat when experiencing a fever, rather than fighting it. It’s an old remedy for the restless, feverish first night of a cold. Elderflower blends beautifully with peppermint and yarrow in a classic cold and flu tea, and herbalists find the three work better together than on their own. Elderflower also helps calm swollen, congested sinus tissue so mucus can drain. It’s also considered a gentle, relaxing nervine that soothes tense nerves. Herbalist and physician Aviva Romm regards both the flowers and the berries as safe for children. (Herbal Academy)

How elder feels in the body

Herbalists often describe herbs by their energetics, meaning how they tend to feel in the body. Elder is considered cooling and drying. That makes it a good match for hot, feverish, congested states, like a stuffy nose and a warm forehead. The berries taste sour, and the flowers taste slightly bitter and sweet. (LearningHerbs)

If you forage

Elder grows wild in much of North America, and foraging it can be exciting, but please be sure of your plant:
• Elder is a woody shrub with flat-topped, umbrella-shaped clusters of flowers and berries. Its leaves grow in opposite pairs, with 5 to 11 toothed leaflets on each leaf.
• Water hemlock, one of the most poisonous plants in North America, also has white, umbrella-shaped flower clusters. But it isn’t woody, and it grows from the ground like a tall weed. If the plant has no woody stems, walk away.
• Pokeweed berries are also dark purple, but they hang in long, drooping strands rather than flat clusters.
• Red elderberry (Sambucus racemosa) has red berries in cone-shaped clusters. It’s more toxic, so it’s best to skip it.

When in doubt, buy your dried berries from a trusted source, or use my syrup kit here.

What the Research Says

I love elderberry, and I also believe you deserve the scientific picture. For me, the use of an herb that has worked for centuries and passed down from generation to generation is enough, but as a healthcare provider, I understand the need for people to know; however, I always tell people that studies have limitations, so here’s what we actually know.

The most cited review is a 2019 meta-analysis that pooled four small clinical trials. People who took elderberry at the start of cold or flu symptoms had shorter and less severe symptoms than those who took a placebo. The effect looked stronger for flu than for the common cold. (Hawkins et al., 2019)

That’s encouraging, but it does come with some limits:
• Only 180 people were studied across all four trials.
• Three of the four trials were funded by elderberry supplement companies.
• Most studies used a standardized commercial extract, not homemade syrup.

The National Center for Complementary and Integrative Health calls the evidence preliminary: elderberry may relieve flu and cold symptoms, but we need larger studies. It also cautions against relying on elderberry for COVID-19, since there isn’t enough evidence that it helps. (NCCIH)

One of the earliest studies, from 1995, found that most people with flu who took an elderberry syrup felt significantly better within 2 days, while most people taking a placebo took about 6 days. Lab studies also suggest that compounds in elderberry can latch onto flu viruses and block them from entering our cells. (Herbal Academy)

My take as a nurse and herbalist: elderberry is a gentle, food-like herb with a long history and some promising early science. It’s a lovely support at the first sign of a cold. It isn’t a shield, and it doesn’t replace rest, fluids, good food, or a phone call to your doctor when you really need one.

How to Use Elderberry

First, the most important rule: always cook elderberries. Raw or unripe berries, along with the leaves, stems, and bark, can cause nausea, vomiting, and diarrhea. Simmering the berries makes them safe. (More on that in the Nurse’s Note below.)

Here are the most common ways to bring elderberry into your home:
• Syrup: dried berries simmered with water and warming spices like cinnamon, ginger, and clove, then strained and sweetened with raw honey. This is my favorite, and it’s the one most families reach for.
• Tea: simmer dried berries for 15 to 20 minutes rather than steeping them like a regular tea. Elderberry blends beautifully with ginger, rose hips, or a little cinnamon.
• Store-bought syrups, gummies, and lozenges: handy, but read labels carefully. Many are mostly sugar, and quality varies.

When to take it: most people start elderberry at the very first sign of a scratchy throat or that run-down feeling, and some take a small amount through the cold months. Follow the directions on your product or kit.

Make Your Own
If you’d like to make syrup at home, my Elderberry Syrup Kit includes everything you need: organic dried elderberries, a warming spice blend, and step-by-step instructions. Just add water and honey. It’s one of my favorite things to make on a cold afternoon, and your kitchen will smell wonderful.

A Nurse’s Note 🩺

Elderberry is gentle for most healthy adults, but gentle doesn’t mean right for everyone. Here’s what I’d want you to know if you were sitting across from me:
Always cook it. Raw or unripe elderberries, and the leaves, stems, seeds, and bark, contain compounds that can release cyanide and cause nausea, vomiting, and diarrhea. Cooking removes this risk. Only use ripe, dark berries, and never eat red elderberries. (NCCIH)

Talk to your doctor first if you:

• Take immunosuppressants (for a transplant or an autoimmune condition, including prednisone, methotrexate, tacrolimus, or cyclosporine).
  Why it matters? Elderberry may stimulate the immune system, which could work against these medications.

• Have an autoimmune condition
  Why it matters? For the same reason, it could, in theory, stir up an already overactive immune response.

• Take diabetes medications or insulin. Why this matters? Elderberry may lower blood sugar, which could add to your medication’s effect.

• Use caution when taking diuretics (water pills) or laxatives
  Why this matters? Elderberry may have mild diuretic and laxative effects.

• Are you going through chemotherapy? Always check with your oncology team before adding any herb
  Are you pregnant or breastfeeding? There isn’t enough safety research yet

• For little ones: if your syrup is made with honey, it’s not safe for babies under 1 year old because of the risk of infant botulism. For older children, ask your pediatrician about the right amount.

In Summary

Something about a pot of elderberries simmering on the stove feels cozy to me as the weather turns cold. It’s one of those small, old rituals that reminds us we can care for our bodies through changing seasons.
In fact, last week I asked: is it really “cold and flu season,” or is it the season when we’re most open to germs? You can read about what changes in us when the weather turns, and what’s within our reach. Next week’s Herb of the Week is Astragalus.

What’s your family’s go-to when someone starts sniffling? Let me know; I love hearing what’s on your shelves.