With “flu season” upon us and the nightly news reporting frightening data about the novel coronavirus outbreak, we tend to look for information to comfort and reassure us. For me, the wealth of knowledge found in our herbal heritage offers both comfort and intriguing research topics. Sometimes the way to move forward is to come full circle and appreciate our past. We live life to the fullest when we are open to new research and discoveries, while not despising the natural heritage and wisdom offered to us by our ancestors.

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Although savored in many culinary delicacies, the heritage of herbs and spices are not limited to food. The usefulness of these plants extends to many other areas, including quite an impressive historical reputation for health and medicinal use. When thinking of viral-based diseases like the various coronavirus diseases and Influenza A and B, one plant in particular comes to mind. One of the most widely used medicinal plants in the world today, it is found in both jam and wine recipes as well as syrups, home remedies, and commercial herbal preparations.

Elder, called ala·sék by our elders, is a truly amazing species! It has an impressive list of traditional uses among my people both in the culinary and medicinal areas. Worldwide, the elder plant has a long history of use. From Native peoples to the ancient Greeks, 1600’s political author and diarist John Evelyn to 1800’s pharmacopoeias, Elderberry’s reputation as an herbal friend is well known. From arthritis to skin conditions and allergies to internal complaints, elder is proclaimed to help a wide range of issues. Elderberry is best known for its help when people are dealing with fever and sinus or respiratory infections caused by viral-based diseases. It is mentioned historically in the treatment of influenza, measles, mumps and herpes in addition to many other viral invaders. Elderberry was also believed to be an effective remedy for colds, bronchitis and diphtheria.

As an anti-viral, elder inhibits viral replication and binds influenza viruses making it difficult for them to infect host cells. It also suppresses the ability of the viruses to mature, in addition to being directly virucidal. The peak presence of elderberry in the body is 30 to 60 minutes after ingestion with a half-life of about two hours. There is one interesting contradiction worth noting. If you have malaria do not take elderberry preparations as it’s potential as a Th1 activator could lead to a worsening of symptoms.

Thankfully, elder’s offer of friendship was not limited to our ancestors, modern research is again documenting this amazing plant. European Black Elder (Sambucus nigra) is the variety most often researched in scientific journals, although several other varieties of elder are reportedly used for remedies around the world with beneficial results. While there are many fascinating peer-reviewed journal articles on elderberry and its potential uses, I have selected the following studies to provide a sample of current medical research on the topic.

A sixty patient randomized study conducted in Norway during the winter of 1999-2000 compared the effectiveness of elderberry syrup on Influenza A and B. The study participants took 15ml of either elderberry syrup or a placebo four times a day for 5 days. The authors’ concluded, “Symptoms were relieved on average 4 days earlier and use of rescue medication was significantly less in those receiving elderberry extract compared with placebo. Elderberry extract seems to offer an efficient, safe and cost-effective treatment for influenza.” (1)

A double-blind placebo-control study in Panama, conducted in 1993, studied the effectiveness of elderberry against Influenza A types H1N1, H3N2 and Influenza B. “A significant improvement of symptoms” was noted in over 93% of cases taking the elderberry in just two days, while only just under 92% of the placebo group showed improvement after six days! They concluded, “Considering the efficacy of the extract in vitro on all strains of influenza virus tested, the clinical results, its low cost, and absence of side-effects, this preparation could offer a possibility for safe treatment for influenza A and B.” (2)

Laboratory tests conducted in 2011 on the H5N1 Influenza virus and Influenza B cultures, as well as common bacterial co-infections, concluded the following: “[Brand name removed] elderberry liquid extract is active against human pathogenic bacteria as well as influenza viruses.” (3) Another journal reports that the anti-viral action of elderberries against the H1N1 virus has been shown to “compare favorably” to that of popular prescription anti-viral treatments. (4)

An analysis of available research on elderberry published in 2019 concluded “These findings present an alternative to antibiotic misuse for upper respiratory symptoms due to viral infections, and a potentially safer alternative to prescription drugs for routine cases of the common cold and influenza.” (5)

In the case of influenza, I think the above data speaks for itself. But what about the coronavirus, you ask? Coronaviruses are a family of viruses which cause respiratory tract illnesses in humans. They range from the coronaviruses HCoV-OC43 and HCoV-229E which are responsible for some of the common winter-time colds, to the SARS-CoV that causes severe respiratory distress. The new novel coronavirus named 2019-nCoV has caused multiple cases of severe or even fatal pneumonia. While the seasonal flu has a fatality rate of .1%, SARS-CoV has a death rate of around 10%, and the 2019-nCoV as of the date of writing had a 2% fatality rate. This 2% is equivalent of the 1918 Spanish Flu pandemic. But if all the unreported cases which are believed to exist are factored in, the fatality rate drops to around 1% categorizing it as just a “really bad flu season.” (6) Although there are exceptions, typically the better a virus becomes at spreading, the lower its mortality rate becomes. While the current novel virus is too new for much published research, we can compare the effectiveness of elderberry on other coronavirus family members.

Interestingly, it is in animals that the coronavirus family has their most devastating effects, leading to the majority of coronavirus research being in the field of veterinary medicine. While cross-species research definitely has its limitations, the data is still quite informative. One laboratory study tested 33 plant substances against SARS-CoV and FIPV (a feline coronavirus). They found that 15 of the plant lectins studied “showed antiviral properties against both SARS-CoV and FIPV.” (7) Elderberry and garlic were listed among the plants containing these anti-viral lectins. Other veterinary studies have shown the effectiveness of elderberry against IBV a poultry coronavirus. “These results demonstrate that S. nigra extract can inhibit IBV at an early point in infection, probably by rendering the virus non-infectious.” (8)

Now that your head is swimming with data, your next question is probably, “How do I make this historical home remedy?” As with any ancient recipe, variations abound. A brief search of the web will produce an assortment of elderberry syrup recipes with wide ranging differences. One thing that is important to keep in mind is that while cooking with herbs and spices is an art, the medicinal use of herbs and spices is a science. Art allows one the freedom of expression, fluid rules and an “if you like it—go with it” easy-going attitude. Science on the other hand is more structured with a definite knowledge base. You need to understand how the world works. The biology of the plant in question, the impact of its growing conditions, and whether or not a modification to the recipe will change the chemistry of the product, can all be important factors! You have to really know and respect the plant, not just start throwing a bunch of items reported to be good for a certain aliment together and hope it all turns out!

The first difference to consider is whether or not to soak the berries. I saw recipes that used 12-48 hour cold soaks, boiling water infusion followed by a 48 hour soak and others that just dumped the dried berries into a pot with the water and started cooking! The question becomes, “What is your goal?” Herbal tea connoisseurs know that the water-solubility of plant based nutrients is temperature dependent. Tea made from the very same plant material will contain different nutrients and flavors if steeped in cold water verses hot water. I cannot be dogmatic, but I believed the overnight cold water soak is the traditional method for preparing the dried berries. On the other hand, I would not recommend the no-soak option.

1. You are trying to incorporate the nutrients the plant has to offer into your remedy, not merely soften and cook the berries. This takes patients and forethought.

2. In every recipe I know that uses dried fruits or berries, the flavor and texture of the final product is improved by first soaking them. I don’t see how this recipe is any different.

The next major difference is the ratio of water to berries. Here again is the question, “What is your goal?” Is the strength of the remedy based on the amount of plant material you started with like cinnamon bread or the length of time you cooked it like maple syrup? I saw quantities of water from ¼ cup to eight cups. This is where knowledge of the plant becomes vital.

Interestingly, the elder plant, including the fresh berries, contains hydrocyanic acid (HCN). An individual’s tolerance to this substance may vary greatly from one person to the next, resulting in a wide range of experiences with this impressive plant. One person may eat the fresh raw berries by the handful with no side effects while another experiences it’s emetic and purgative effects after only a few berries! (This same cyanogenic compound is also found in apples and cherries, thus explaining why pigging out on too much of these fresh fruits can also cause the same results.) On the other hand, HCN breaks down with heat exposure. So recipes that involve cooking like jams or syrups do not contain noticeable amounts of HCN. Thus a word of common sense, unless you are trying to make a substitute for syrup of ipecac, it is best for a beginner to herbal remedies to stick to thoroughly cooked elderberry recipes.

When reducing the HCN content of elderberry, starting with cold water is necessary as starting with hot water has been found to not reduce the HCN as effectively. Bringing the mixture to a boil and cooking for 30 minutes is sufficient, although continued cooking will lower the by-this-time-minuscule content even further.

Armed with this knowledge, it is obvious that the larger amounts of water contained in some recipes are to allow for this lengthy period of cooking. Small amounts of water may permit you to reach the correct consistency quicker, but may not allow sufficient time for all the necessary chemical reactions to take place.

The next topic of wide variation is the sweetener content of the syrup. On the low end, recipes contained a 25% sugar/honey to water ratio while at the high end I found two and a half times (250%) more sugar than water! Even here the same question applies. If your goal is sweetening the mixture to your taste preference then the 25% or even less is fine, but this is not the historical reason for adding sugar/honey to the remedy. To prevent bacterial growth in the elderberry preparation, it is traditionally preserved with either sugar or alcohol. Both of these natural substances create an environment that is inhospitable to bacteria. At moderate sugar levels many types of bacteria live with flourish, but at super-sweet levels the majority of bacteria find themselves unable to survive. Another clue is in the name, a syrup by definition is a highly concentrated sugar solution.

For those who find tons of sugar repulsive, or cannot use a syrup due to other preexisting health issues, two options are possible. You can simply use the elderberry decoction (the boiled down berries and water mixture) by keeping it in the refrigerator and using it up in a few days. This option is my preferred method, our family also really enjoys making Elderberry Popsicles, and Elderberry Finger Jello with the decoction.

Or you can add alcohol as a preservative to the decoction to inhibit bacteria and mold growth. What good is a remedy if it has mold growing in it when you need it? To preserve a water-based solution you will need enough alcohol so that the finished extract is 20%-30% ethanol. Pure alcohol, or ethanol, is sold as a culinary solvent and labeled 200 proof. (To determine the amount of alcohol/ethanol in a given bottle of liquor, divide the proof by 2. Example: 200 proof is 100% ethanol while 80 proof is 40% ethanol.) Most recipes using alcohol as a preservative are assuming 120 proof or higher with 190 proof appearing most frequently. For the 20%-30% ethanol range on a cup of elderberry decoction, approximately ¼-½ cup of 190 proof alcohol is needed. The liquor is 95% alcohol, but the finished extract is only 20% alcohol when using a quarter cup. To reach the minimum of 20% ethanol content with 1 cup (8 fl oz) of finished elderberry decoction using an 80 proof liquor you must add 1 cup of alcohol. This is because 80 proof liquor is 40% ethanol and 60% water. Anytime you change the proof of the liquor or the amount of decoction to be preserved, the measurement of liquor will change as well. Please remember that alcohol preserved extracts are not beverages; they were traditionally intended to be taken by the teaspoon or sometimes even just a few drops at a time.

Our last topic is the additions frequently seen in elderberry syrup recipes. Some of the flavors are historical, like hot elderberry wine was often served with cinnamon and others are medicinal- based, like the properties of ginger working symbiotically with elderberry. Another reason may simply be that elderberry has a very unusual and unique smell that is quite difficult to describe. But in any case, due to the chemistry involved, adding other herbs or spices to the mix is not a simple one-size fits all option. Unless you are well versed in this area, it’s best to leave the syrup/extract alone. Instead, add other beneficial spices to your meals or have a glass of hot herbal tea. Fresh ginger tea would be a prime example! Adding oils to your syrup/extract, like essential oils is not a good idea, given the basic chemistry principal that oil and water do not mix! (Mixing them would require a solubizing agent and a bit more chemistry as well as other concerns.)

If you are looking for a classic 1800’s elderberry syrup recipe, I would suggest this scaled down version of a recipe from Stephen Harrod Buhner, the author of Herbal Antivirals.

½ cup dried elderberries OR 1 cup fresh elderberries
4 cups water
10 cups sugar (for syrup)
¼ cup of 190 proof OR 1 cup of 80 proof alcohol (for extract)

Place elderberries and cold water in a small sauce pan or covered container. Soak the berries overnight in the refrigerator. While a counter will work for a short time, I have seen these berries grow mold if left to soak on a counter for 24 hours.Next, place your pan on the stove and bring the contents to a boil. Once boiling, reduce heat and simmer for 30 minutes, stirring as needed. Do not skim anything off the pot. Remember you want your heat low enough that you don’t reduce you liquid to fast, to insure you hit that 30 min cooking mark.

Remove from heat and allow mixture to cool sufficiently to safely strain the liquid. One word of caution is beneficial before beginning the straining process- Elderberries will dye your hands, cheesecloth, towels, apron, etc. Food-service gloves are also a good idea since they prevent your hands from being dyed red and you from being the brunt of good-natured jokes from family and friends. (Like getting caught red-handed! 🙂

I use a hand potato masher to smash the berries while still in the pan. Then I strain them through cheesecloth, wringing the pulp to remove all possible liquid. You should have approximately a cup of liquid. The resulting berry pulp can be placed in the compost. (At this point you have an elderberry decoction. If you intend to refrigerate and use promptly, simply let the liquid cool and place in the refrigerator.) The flavor of the unsweetened decoction is reminiscent of a slightly funky and highly watered down bitter tasting grape juice. It is OK as is, and works well added to smoothies or even a glass of grape juice.

For those making an alcohol preserved extract, let the decoction cool. Measure and add the appropriate amount of alcohol. (Remember to consider volume of finished decoction and ethanol content of your chosen alcohol.)

If making a syrup, return pan with liquid to the stove on medium heat. Add sugar and stir until completely dissolved. Let cool.

Buhner recommends an adult dosage of 2-4 tablespoons every 2-4 hours at the start of flu symptoms. Traditionally dosage would have been based on weight and reduced accordingly for those family members who are smaller and lighter. Assuming a “standard” adult weight as 150lbs, this comes out to 1 teaspoon per 12 ½lbs to 25 lbs.

Please NOTE: I am NOT a chemist or a medical doctor. This post is not intended as medical advice. I am simply sharing a love of plants and the historical legacy of their rich history and the friendship/symbiotic relationships they offer us.

I hope you have enjoyed this historical look at a truly amazing herbal friend. Looking to the wisdom of nature and past generations may once again inspire us and ensure a brighter future! Keep on learning!

Wishing you good health this flu season, The Homesteading Hen

Editor’s Note: Some people have expressed concern over Elder in relation to cytokines, (cytokine storm) citing the abstract of a single study on a commercial Elderberry product. As is often the case, the one foundational concept that people new to herbal preparations often have difficulty comprehending is the regulating behavior of plants. The same plant can increase or decrease a particular response in the body depending on a person’s needs. Nature seeks balance. Those who use a plant’s gifts, must also respect and trust the plant’s wisdom.

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Notes

1. Zakay-Rones, Z. et al. “Randomized Study of the Efficacy and Safety of Oral Elderberry Extract in the Treatment of Influenza A and B Virus Infections.” The Journal of International Medical Research 32.2 (Mar-Apr 2004): 132-40 <https://pubmed.ncbi.nlm.nih.gov/15080016-randomized-study-of-the-efficacy-and-safety-of-oral-elderberry-extract-in-the-treatment-of-influenza-a-and-b-virus-infections/>

2. Zakay-Rones, Z. et al. “Inhibition of Several Strains of Influenza Virus in Vitro and Reduction of Symptoms by an Elderberry Extract (Sambucus Nigra L.) During an Outbreak of Influenza B Panama”
The Journal of Alternative and Complimentary Medicine (New York) 1.4 (Winter 1995): 361-69
<https://pubmed.ncbi.nlm.nih.gov/9395631-inhibition-of-several-strains-of-influenza-virus-in-vitro-and-reduction-of-symptoms-by-an-elderberry-extract-sambucus-nigra-l-during-an-outbreak-of-influenza-b-panama/>

3. Krawitz, Christian et al. “Inhibitory Activity of a Standardized Elderberry Liquid Extract Against Clinically-Relevant Human Respiratory Bacterial Pathogens and Influenza A and B Viruses”
BMC Complimentary and Alternative Medicine 11.16 (Feb 25, 2011): <https://pubmed.ncbi.nlm.nih.gov/21352539-inhibitory-activity-of-a-standardized-elderberry-liquid-extract-against-clinically-relevant-human-respiratory-bacterial-pathogens-and-influenza-a-and-b-viruses/>

4. Roschek, B. Jr. et al. “Elderberry Flavonoids Bind to and Prevent H1N1 Infection in Vitro.”
Phytochemistry 70.10 (Jul 2009):1255-61. <https://www.ncbi.nlm.nih.gov/pubmed/19682714/>

5. Hawkins, Jessie et al. “Black Elderberry (Sambucus Nigra) Supplementation Effectively Treats Upper Respiratory Symptoms: A Meta-Analysis of Randomized, Controlled Clinical Trials”
Complimentary Therapies in Medicine 42 (Feb 2019): 361-365
<https://pubmed.ncbi.nlm.nih.gov/30670267-black-elderberry-sambucus-nigra-supplementation-effectively-treats-upper-respiratory-symptoms-a-meta-analysis-of-randomized-controlled-clinical-trials/>

6. Fauci, Anthony S. YouTube podcast. “ 2019 Novel Coronavirus (2019-nCoV) Update” <https://www.youtube.com/watch?v=wg5PjvbVioA>

7. Keyaerts, Els et al. “Plant Lectins are Potent Inhibitors of Coronaviruses by Interfering with Two Targets in the Viral Replication Cycle.” Antiviral Research 75.3 (Sept 2007): 179-87 <https://www.sciencedirect.com/science/article/pii/S0166354207002380>

8. Chen, C. et al. “Sambucus Nigra Extracts Inhibit Infectious bronchitis virus at an early point during replication.” BMC Veterinary Research 10.24 (Jan 16, 2014) <https://www.ncbi.nlm.nih.gov/pubmed/24433341>