December 3, 2019
Does this story feel familiar? You have a busy week ahead of you without a minute to spare. You have planned it all out – the errands you are going to handle, the school activity you are volunteering for, the project you have to finish for work, the dinners you are cooking, and the playroom organization you’ve been putting off for far too long…. then you see that your child’s cheeks are looking flushed and her nose is running. She doesn’t want to eat lunch and instead of sleeping at naptime, just starts crying without stopping. You go in her room to pick her up, and she feels HOT. You take her temperature and it’s over 103º.
Your heart sinks as you remember the three kids at daycare who came down with the influenza last week, and you realize that your little one might have the flu. In despair you call a fellow mom to vent and to ask advice while you are getting ready to walk out the door for a trip to your kid’s healthcare provider, and she tells you that she gave her child elderberry syrup for the flu a few weeks ago. The elderberry syrup worked wonders. Her child is now happy and healthy.
At the medical office your kid’s flu test comes back positive. Her medical provider writes a prescription for Tamiflu, instructs you to give Tylenol as needed for the discomfort associated with high fevers, and explains how important it is to ensure your child receives plenty of fluids. The next day your kid is still miserable, and you wonder if you should go out and buy elderberry syrup for her, but how do you decide if elderberry is the right treatment for influenza? With plenty of anecdotal stories out there, let’s take a look at the evidence.
The first question you might have is, “What is elderberry syrup?” First off, no matter where it is located in the pharmacy section of your grocery store, or what form of elderberry you buy, elderberry is not a medication but is classified as a dietary supplement.
The European Elder is a tree that can grow to 30 feet, and its berries, leaves, bark, and flowers have been used for thousands of years in an attempt to relieve a variety of symptoms, some of which are flu symptoms. Elderberry syrup is made from the extracts of the berries of the European Elder tree.
Elderberries are known to be very high in something called flavonoids. Flavonoids are a part of what make fruits and vegetables so healthy. They are also partially responsible for giving flowers and fruit their color and smell; however, they can be found in other parts of plants, as well. Flavonoids have been shown to have strong antioxidant properties and might help decrease inflammation and help in fighting a variety of diseases. It is thought that the flavonoids in elderberries may also be effective in combating viruses. Elderberry supplements extract the flavonoid-rich contents of the European Elder tree and condense it into syrups, pills, teas, and lozenges that people can ingest.
Because elderberry is so well known and has been used for so many years, it must be safe and work well, right? Not necessarily. It is important to know that elderberry bark, leaves, seeds, and unripe fruit contain a form of cyanide that can be toxic to your child.
When I am evaluating any herbal remedies for children, I ask three questions:
Let’s start by looking at the safety of elderberry supplements. As mentioned above, it is known that the bark, leaves, seeds, and unripe fruit of the European elder are filled with a form of cyanide that can cause nausea, vomiting, diarrhea and/or cyanide toxicity. You should only ever use ripe, cooked berries, and avoid using any other part of the plant. When choosing a type of elderberry syrup or an elderberry supplement, make sure that they have only used extracts of the ripe berries. Avoid teas and capsules that contain other parts of the plant.
Another thing to keep in mind is that elderberry is not an FDA approved medication. It is a dietary supplement, and there are currently no laws that require supplements to be tested to show that they are safe or that they do what they say they do. Dietary substitutes are also not required to be “standardized,” which is a term referring to how you know if there is the same amount/concentration of a supplement in each bottle. In 2007, the FDA issued some recommendations and requirements called the Good Manufacturing Practices (GMP) that are meant to help ensure the safe production, storage, purity, and honesty in the labeling of supplements among other things. At the end of the day, however, we depend on the honesty of the manufacturers as testing is not required.
It is important to remember that just because something comes from a plant or other substance found in nature, it does NOT mean it is safe and can have no risk. There are plenty of poisonous plants in nature, and without testing, we do not know what other side effects those “natural” substances are having.
Now, let’s look at the efficacy of elderberry supplements. Do elderberry supplements do what manufactures say they will do, and do the benefits of taking them outweigh the harm?
Fortunately, elderberry supplement testing has begun, and in the few studies done on adults, minimal to no adverse effects were reported. This tells us that in adults, elderberry syrup may be a safe supplement to ingest.
A review of the current research regarding elderberry use as a treatment for influenza found three studies that showed some benefit in the use of elderberries for reducing the duration of symptoms:
In summary, there is some evidence that elderberry may be safe and effective in alleviating symptoms and shortening the duration of the dreaded flu virus in adults if it is started within 24-48 hours of when the symptoms start. Only one study, however, included a few children along with adults (and with only 27 total people included, was a very small study). With adults reporting no adverse effects of taking elderberry syrup, we can see that it most likely is safe for adults, but we can only guess if it is also safe for children.
There is an exciting study being conducted currently on children ages 5-12 to see if elderberry syrup is safe and effective in shortening the duration of the flu. It should be completed sometime in 2020, and will be the first study to truly study the effects of elderberries on children. Hopefully this new study will shed some more light on the matter.
One thing we have not looked at yet is how to give elderberry. The only information we have to go on in regards to the dosing of elderberry comes from the manufacturers and the limited studies conducted. If you choose to use an elderberry supplement, follow the dosage written on the bottle. Know that concentrations and preparations vary depending on the manufacturer, especially as there is no true standardization for supplements.
Personally, if you do decide to buy this supplement for your child, I would use a main manufacturer of pediatric-friendly products and go with Zarbees. Remember to avoid any product that uses parts of the plant besides the berries such as elderberry flower tea and capsules that contain other parts of the plant.
Be wary of inflated claims of the effectiveness of elderberry (especially on social media!), and know that stories of a supplement’s effectiveness is not a substitute for good, rigorous study. Good studies look to see if there are other things that may impact the person’s recovery, and they control for this to make sure that they are only looking at the effects of the substance being tested. Be sure to talk to your medical provider if you have questions or concerns or want more information about elderberry supplements.
STOP giving the supplement to your child if she develops signs of an allergic reaction such as hives or difficulty breathing. Also stop if you notice your child develops nausea, diarrhea, or vomiting after ingestion. Speak to your medical provider before administering elderberry supplements to any child with diabetes
Elderberries will probably not harm your child, but we also don’t know how much they will help. We will be certain to keep an eye on the new research coming out. But, if you want to give elderberry supplements a try, it is most likely not a problem. Please, however, do not view elderberry as a wonder-syrup. It has potential, but it is not a substitute for good medical care (including protecting your family with flu shots annually), returning to your medical office if symptoms are worsening, lots of fluids, rest, and plenty of TLC from mom and dad.
If you are interested in other supplements, here is an article about herbal remedies for children: what science says works and what doesn’t that covers six popular natural and herbal remedies.
Author: Dani Stringer, MSN, CPNP, PMHS