What the Elderberry Record Shows, From Folk Use to Syrup
Elderberry has a folk record for colds and flu, a classical record that describes the tree but not a remedy, and a short run of trials. This history follows all three and ties each claim to its source.
The history of elderberry is a folk remedy for colds and flu with a short run of trials behind it. According to PubMed, [a 2004 trial](https://doi.org/10.1177/147323000403200205) described the berry as used in folk medicine for centuries to treat influenza, colds and sinusitis. The classical text checked here describes the tree, not a cure. ## What did Pliny say about the elder? Pliny the Elder's Natural History mentions the elder tree in three passages of Book 16, which covers trees, in the [Holland translation](http://penelope.uchicago.edu/holland/pliny16.html). Pliny says a person would hardly see elders on any hill. He lists the elder among trees that leaf out with the first and shed their leaves last. Among the wild trees, he writes, the elder flowers first and has more pith than any other. None of these passages gives a medicinal use. The Hippocratic attribution in modern accounts appears in no primary text checked, so this post leaves it out. ## How did the berry become a syrup? The [National Center for Complementary and Integrative Health](https://www.nccih.nih.gov/health/elderberry) says the dark purple berry of the European or black elder grows in Europe, North America, Western Asia and North Africa, and that it has been used in folk medicine. It is now promoted as a dietary supplement. A [2001 laboratory study](https://pubmed.ncbi.nlm.nih.gov/11399518/) describes Sambucol, a line of products based on a standardized black elderberry extract, and names a syrup among them. For a parallel path from folk remedy to a single compound, see [the turmeric history](/blog/history/history-of-turmeric-and-curcumin-from-ayurveda-to-isolation). ## What did the flu and cold trials test? The trial record is short. Three entries matter here. | Trial | Who was studied | What was given | What it measured | What it reported | |---|---|---|---|---| | [Zakay-Rones et al., 2004](https://doi.org/10.1177/147323000403200205) | 60 adults, aged 18 to 54, with flu-like symptoms for 48 hours or less | 15 ml of elderberry or placebo syrup four times a day for 5 days | Symptom relief and rescue medication use | Symptoms eased about 4 days earlier, with less rescue medication; the authors said the finding needs a larger study | | [Tiralongo et al., 2016](https://doi.org/10.3390/nu8040182) | 312 economy-class air travelers from Australia | Standardized elderberry extract or placebo | Cold episodes, their duration and symptom scores | Placebo participants had more cold-episode days (117 against 57, P = 0.02) and higher symptom scores; the difference in number of episodes was not significant | | [Hawkins et al., 2019](https://doi.org/10.1016/j.ctim.2018.12.004), meta-analysis | 180 participants across randomized, controlled trials | Black elderberry supplementation | Upper respiratory symptoms | Reported a substantial reduction in symptoms | According to PubMed, two of the three are randomized, placebo-controlled trials, and the third pools randomized trials. The [NCCIH's 2020 clinical digest](https://www.nccih.nih.gov/health/providers/digest/the-common-cold-and-complementary-health-approaches-science) still says conclusive evidence from high-quality trials is lacking. The two trials also used different preparations, a syrup in 2004 and a standardized extract in 2016, so their results should not be stacked as one. The vitamin C record has a similar cold-trial dispute, laid out in [the vitamin C history](/blog/history/history-of-vitamin-c-from-scurvy-to-ascorbic-acid). None of the three reports an immune measure, so readers with immune questions should start with the [immune health guide](/health/immune-health). ## What do the anthocyanins do in the research? Anthocyanins are the purple pigments in the berry. Their content varies with growing conditions: in a [2008 study of wild plants in Austria](https://doi.org/10.1021/jf801104e), berry anthocyanins fell as altitude rose. Elderberry extracts are used for food coloration, and a [2009 study](https://doi.org/10.1021/jf8034435) treated one extract to make its color more stable to light and heat. The trial abstracts do not report measuring anthocyanins, so no result can be tied to them. ## Why do raw elderberries need special handling? [NCCIH](https://www.nccih.nih.gov/health/elderberry) warns that raw or unripe elderberries, along with the leaves and stems of the elder tree, contain poisonous cyanide-producing substances. These can cause nausea, vomiting and severe diarrhea when eaten. Cooking eliminates the toxin. Large quantities of the toxin may cause serious illness. The agency also says little is known about whether elderberry is safe to use during pregnancy or breastfeeding. ## How do regulators treat elderberry? The [European Medicines Agency](https://www.ema.europa.eu/en/medicines/herbal/sambuci-fructus) reports that its herbal committee did not adopt a monograph for the fruit, Sambuci fructus, so no public summary was prepared. In the United States, [NCCIH](https://www.nccih.nih.gov/health/elderberry) notes that dietary supplements are not approved by the FDA before they are sold. The same fact sheet reports that the FDA and the Federal Trade Commission have taken action against companies that marketed elderberry products with unsubstantiated claims of effectiveness for COVID-19. ## Bottom line Treat elderberry as a folk remedy with a few trials behind it. The 2004 and 2016 trials are worth reading closely, but NCCIH's 2020 digest still says conclusive evidence from high-quality trials is lacking, and a label should say no more than that. In the passages checked here, Pliny's elder is a wild tree that flowers early, with no remedy attached. ## Frequently asked questions ### Which ancient writers mention the elder tree? Pliny the Elder's Natural History, Book 16, names the elder as a wild tree that flowers early and has much pith, with no medicinal use in the passages checked. The Hippocratic attribution does not appear in any primary text checked for this post. ### How did elderberry move from folk remedy to commercial syrup? NCCIH says the berry has been used in folk medicine, and it is now promoted as a dietary supplement. A 2001 laboratory study describes a line of products based on a standardized black elderberry extract, and names a syrup among them. ### What does the anthocyanin story look like in elderberry research? Anthocyanins are the purple pigments in the berry. Their content falls with altitude in wild plants, and elderberry extracts are used for food coloration. None of the trial abstracts cited here reports measuring them. ### Why do raw elderberries need special handling? Raw or unripe berries, and the leaves and stems, contain cyanide-producing substances that can cause nausea, vomiting and severe diarrhea. Cooking eliminates the toxin. NCCIH says large quantities of the toxin may cause serious illness. ### What did the early influenza and cold trials test? The 2004 trial compared elderberry syrup with placebo in adults with flu-like symptoms, and the 2016 trial tested a standardized extract against placebo in air travelers. They measured symptom relief, rescue medication use and cold episodes. The 2019 meta-analysis pooled 180 participants. ### How do European and US regulators treat elderberry products? The EU herbal committee did not adopt a monograph for the fruit, so no public summary exists. In the US, supplements are not approved by the FDA before sale. NCCIH reports that the FDA and the Federal Trade Commission have taken action against companies that marketed elderberry products with unsubstantiated claims of effectiveness for COVID-19. ### What do elderberry trials not yet show? NCCIH says conclusive evidence from high-quality clinical trials is lacking, and it describes only a small number of human studies for colds, flu and other upper respiratory infections. It also says there is no good evidence to support elderberry for COVID-19. ## Next reads - [Immune health guide](/health/immune-health): the pillar for immune questions. The trials above measured symptoms and cold episodes, not immune function. - [Who Found Vitamin C, and How Scurvy Became a Supplement Story](/blog/history/history-of-vitamin-c-from-scurvy-to-ascorbic-acid): the same cold-trial question for a nutrient, with the contested data laid out. ### Related reading - [the echinacea history](/blog/history/history-of-echinacea-from-plains-tribes-to-german-clinic) - [the garlic history](/blog/history/history-of-garlic-from-pyramid-workers-to-allicin)