Elder (Sambucas nigra L.)

Elder (Sambucas nigra L.)

Background

Several species of Sambucus produce elderberries. Most research and publications refer to Sambucus nigra . Other species with similar chemical components include the American elder or common elder ( Sambucus canadensis ), antelope brush ( Sambucus tridentata ), blue elderberry ( Sambucus caerulea ), danewort ( Sambucus ebulus ), dwarf elder ( Sambucus ebulus ), red-fruited elder ( Sambucus pubens, Sambucus racemosa ), and Sambucus formosana . American elder ( S. canadensis ) and European Elder ( S. nigra ) are often discussed simultaneously in the literature since they have many of the same uses and contain common constituents.

European elder grows up to 30 feet tall, is native to Europe, but has been naturalized to the Americas. Historically, the flowers and leaves have been used for pain relief, swelling/inflammation, diuresis (urine production), and as a diaphoretic or expectorant. The leaves have been used externally for sitz baths. The bark, when aged, has been used as a diuretic, laxative, or emetic (to induce vomiting). The berries have been used traditionally in food as flavoring, and in the preparation of elderberry wine and pies.

The flowers and berries (blue/black only) are used most often medicinally. They contain flavonoids, which are found to possess a variety of biochemical and pharmacological actions, including antioxidant and immunologic properties. Although hypothesized to be beneficial, there is no definitive evidence from well-conducted human clinical trials regarding the use of elder.

The bark, leaves, seeds and raw/unripe fruit contain the cyanogenic glycoside sambunigrin, which is potentially toxic.

Synonyms

Almindelig hyld, baccae, baises de sureau, battree, black berried alder, black elder, black elderberry, boor tree, bountry, boure tree, Busine (Russian), Caprifoliaceae (family) , devil's eye, elderberry, ellanwood, ellanwood, ellhorn, European alder, European elder, European elderberry, European elderflower, European elder fruit, frau holloe, German elder , Holunderblüten, Holunderbeeren, lady elder, old gal, old lady, pipe tree, Rubini® (elderberry extract), Sambreo, sambuco (Italian), Sambucus sieboldiana (Japanese), Sambucipunct Sambucus , Sambuci flos , Sauco (Spanish), Schwarzer holunder (German), stinking elder, S ureau noir (French), sweet elder, tree of doom, yakori bengestro.

Selected combination products which include Sambucus nigra : Sinupret® (contains Sambucus nigra flowers, gentian root, verbena, cowslip flower, and sorrel ), Sambucol® Active Defense (contains elderberry extract, vitamin c, zinc Echinacea angustifolia , Echinacea purpurea , and propolis ).

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidenceGrade*Bacterial sinusitis
Elder has been observed to reduce excessive sinus mucus secretion in laboratory studies. There is only limited research specifically using elder to treat sinusitis in humans. Combination products containing elder and other herbs (such as Sinupret®) have been reported to have beneficial effects when used with antibiotics to treat sinus infections, although the majority of this evidence is not high quality and requires confirmation with better research. Some of these studies suggest that herbal preparations containing elder result in less swelling of mucus membranes, better drainage, milder headache, and decreased nasal congestion. There is no evidence regarding the effects of elder when used alone for treatment of this condition.

C

Influenza
Some laboratory studies suggest that elder may reduce mucus production and possess anti-inflammatory and antiviral effects. One study reports that elderberry juice may improve flu-like symptoms, such as fever, fatigue, headache, sore throat, cough and aches, in less than half the time that it normally takes to get over the flu. However, this study was small with design flaws, and it should be noted that the berries must be cooked to prevent nausea or cyanide toxicity. It remains unclear whether there is any benefit from elder for this condition. Additional research is needed in this area before a firm conclusion can be reached. Elder should not be used in the place of other more proven therapies, and patients are advised to discuss influenza vaccination with their primary healthcare provider.

C

Bronchitis
There is a small amount of research of the combination herbal product Sinupret® in patients with bronchitis. This formula contains elder flowers ( Sambucus nigra ) as well as gentian root, verbena, cowslip flower, and sorrel. Although benefits have been suggested, due to design problems with this research, no clear conclusion can be drawn either for Sinupret® or elder in the management of bronchitis.

C

* Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Alzheimer's disease, anti-inflammatory, antioxidant, antispasmodic, asthma, astringent, blood vessel disorders, burns, cancer, chafing, circulatory stimulant, cold sores, colds, colic, cough suppressant, diabetes, diuresis (urine production), edema, epilepsy, fever, flavoring, gut disorders, hair dye, hay fever, headache, herpes, HIV, immune stimulant, increased sweating, insomnia, joint swelling, kidney disease, laryngitis, laxative, liver disease, measles, migraines, mosquito repellant, nerve pain, psoriasis, respiratory distress, sedative, stress reduction, syphilis, toothache, ulcerative colitis, vomiting, weight loss.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Standardization:

There are no standard or well-studied doses of elder, and many different doses are used traditionally.

Berries : The berries must be cooked to prevent nausea or cyanide toxicity.

Dried elderflower : Dried elderflower may be standardized to contain at least 0.8% total flavonoids calculated as isoquercitin. The dried flower may contain at least 25% water-soluble extract.

Sambucol® : The elderberry product Sambucol® Active Defense consists of a 38% standardized black elderberry extract plus vitamin c, zinc Echinacea angustifolia , Echinacea purpurea , and propolis .

Sinupret® : The combination product Sinupret ® (formerly marketed in the United States as "Quantera ® Sinus Defense") , is an herbal mixture containing elder flowers as well as gentian root ( Radix Gentianae luteae ), verbena, cowslip flower ( Flos Primulae veris cum calycibus ), and sorrel ( Rumex acetosa ) ).

Rubini® : Rubini®, an elderberry extract of bioflavonoides is produced only from elderberries, with no additives from animals, no colorings, and no preservatives. Rubini® BioFlavonoides are produced with "organic certified fruits" (Zertifikationsnr: IT-CDX 5987).

Adults (18 years and older):

Tea : A dose of three to five grams of dried elder flowers steeped in one cup of boiling water for 10 to 15 minutes and taken by mouth three times daily has been used. Be aware of possible toxicity.

Sinupret® tablets : For bacterial sinusitis, a dose of two tablets of Sinupret® taken by mouth three times daily with antibiotics has been used. Sinupret® contains elder and several other herbs.

Extract : For treating influenza or flu-like symptoms, a dose of four tablespoons of elderberry extract taken daily by mouth for three days has been used.

Hand cream : Cream has been prepared by taking several handfuls of fresh elder flowers, mixing in liquefied petroleum jelly, simmering for 40 minutes, heating, filtering, and allowing the formula to solidify. This has been applied to the hands at bedtime.

Children (younger than 18 years):

There are no standard or well-studied doses of elder, and many different doses are used traditionally. For influenza or flu-like symptoms, a dose of one teaspoon of elderberry juice containing extract syrup taken twice daily has been suggested. However, there is not enough scientific information available to recommend the safe use of elder in children. Toxicity has been reported, and caution is recommended.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid elder in patients with known allergy to plants in the Caprifoliaceae family (honeysuckle family). There are some reports of allergies in children playing with toys made from fresh elder stems.

Side Effects and Warnings

Elderberry products should be used under the direction of a qualified healthcare provider because of the possible risk of cyanide toxicity, especially from elder bark, root, or leaves.

There are reports of gastrointestinal distress, diarrhea, vomiting, abdominal cramps, and weakness after drinking elderberry juice made from crushed leaves, stems and uncooked elderberries. Notably, the berries must be cooked to prevent nausea or cyanide toxicity.

Allergies are possible from fresh elder stems and may include rash, skin irritation, or difficulty breathing.

In theory, high doses or long-term use of elder flowers may have diuretic (urine-producing) effects. People taking diuretics or drugs that interact with diuretics should use caution when taking products containing elder.

Pregnancy and Breastfeeding

Elder cannot be recommended during pregnancy or breast-feeding based on a theoretical risk of birth defects or spontaneous abortion.

References

1. Dellagreca M, Fiorentino A, Monaco P, Previtera L, Temussi F, Zarrelli A. Synthesis of degraded cyanogenic glycosides from Sambucus nigra. Nat Prod Res. 2003 Jun;17(3):177-81.

2. Ernst E, Marz RW, Sieder C. [Acute bronchitis: effectiveness of Sinupret. Comparative study with common expectorants in 3,187 patients]. Fortschr Med. 1997 Apr 20;115 (11) :52-3. [Article in German]

3. Gray AM, Abdel-Wahab YH, Flatt PR. The traditional plant treatment, Sambucus nigra (elder), exhibits insulin-like and insulin-releasing actions in vitro. J Nutr. 2000 Jan;130(1):15-20.

4. Kunitz S, Melton RJ, Updyke T, et al. Poisoning from elderberry juice. MMWR 1984;33(13):173-174.

5. Neubauer N, März RW. Placebo-controlled, randomized double-blind clinical trial with Sinupret sugar coated tablets on the basis of a therapy with antibiotics and decongestant nasal drops in acute sinusitis. Phytomed 1994;1:177-181.

6. Richstein A, Mann W. [Treatment of chronic sinusitis with Sinupret]. Ther Ggw. 1980 Sep;119(9):1055-60. [Article in German]

7. Zakay-Rones Z, Varsano N, Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract ( L.) during an outbreak of influenza B Panama. J Altern Complement Med 1995;1(4):361-369.

April 01, 2004