Elderberry, derived from the berries of the Sambucus tree, has been used for centuries in traditional medicine for its purported health benefits, particularly in fighting cold and flu symptoms. However, a closer look reveals several important risks and downsides that consumers need to understand before incorporating it into their routine. These considerations, including toxicity and drug interactions, are crucial for safe use.
Toxicity of Raw and Unripe Berries
One of the most significant dangers associated with elderberry is the natural toxicity present in parts of the plant. The leaves, stems, seeds, bark, and especially the raw, unripe berries contain cyanogenic glycosides, compounds that can produce hydrogen cyanide in the body when ingested. Consumption of these raw parts can lead to serious illness.
Potential symptoms of elderberry poisoning include:
- Nausea and vomiting
- Severe diarrhea
- Stomach cramps
- Weakness and dizziness
- Numbness
- Confusion
It is critical that all elderberry, except for the flowers, is cooked thoroughly before consumption, as this process effectively eliminates the toxic compounds. While commercially prepared supplements are generally considered safe because they use processed berries, homemade remedies carry a higher risk if not prepared correctly.
Gastrointestinal Side Effects
Even when properly prepared, consuming elderberry can lead to gastrointestinal side effects for some people, especially with excessive intake. The berries are a rich source of dietary fiber, and overconsumption can result in an upset stomach, bloating, and diarrhea. For individuals with sensitive digestive systems, a high intake of elderberry can cause irritation. Some case reports also exist of more severe adverse effects, including acute pancreatitis.
Potential for Drug Interactions
Elderberry can interact with several types of medication, making it unsafe for individuals with certain health conditions or those on specific prescriptions. It is vital to consult a healthcare provider before taking elderberry supplements, particularly if you are on any of the following:
- Diuretics (Water Pills): Elderberry has natural diuretic properties, which can cause dehydration and compound the effects of prescription diuretics.
- Immunosuppressants: Elderberry is thought to stimulate the immune system. For people taking immunosuppressant drugs (e.g., for organ transplants or autoimmune diseases), this can counteract the medication's intended effect.
- Diabetes Medication: Some evidence suggests elderberry can affect blood sugar levels, potentially interacting with medications used to manage diabetes.
- Pazopanib (Votrient): A specific case report suggests that combining elderberry with pazopanib, a chemotherapy drug, might increase the risk of liver injury.
Contraindications for Specific Populations
Certain groups of people should avoid elderberry due to insufficient safety data or the potential for adverse effects:
- Pregnant and Breastfeeding Individuals: There is not enough reliable research to determine if elderberry is safe for pregnant or breastfeeding women. Healthcare providers generally recommend avoiding it out of caution.
- Children: Limited data exists on the safety of elderberry in young children. Some experts recommend avoiding it in children under five, and caution is advised for all children due to potential gastrointestinal issues.
- People with Autoimmune Diseases: As elderberry can stimulate the immune system, it is not recommended for individuals with autoimmune conditions like rheumatoid arthritis, multiple sclerosis, or lupus, as it could worsen symptoms.
Lack of Strong Efficacy Evidence
While often marketed as an immune booster or cold and flu remedy, the scientific evidence for elderberry's effectiveness is limited and, in some cases, inconclusive. Many studies are small or show modest effects, and some larger trials have found no significant benefit. The FDA has also issued warning letters to companies for making unsubstantiated claims, particularly regarding COVID-19. Consumers should be wary of overblown claims and not rely on elderberry as a replacement for proven medical treatments.
Supplement Quality and Adulteration Issues
Unlike prescription medications, dietary supplements are not strictly regulated by the FDA. This can lead to significant variations in product quality and purity. Some studies have revealed instances of elderberry supplements being adulterated with other, less expensive substances, such as black rice extract or synthetic coloring. To mitigate this risk, consumers should look for third-party certifications from reputable organizations like NSF or USP.
Elderberry vs. Reputable Medical Treatments
| Aspect | Elderberry Supplements | Proven Medical Treatments | Comparison Notes |
|---|---|---|---|
| Toxicity | Risk of cyanide poisoning if improperly prepared or consumed raw. | Risk of known side effects, clearly documented and tested. | Medical treatments are rigorously tested for safety and dosing. |
| Efficacy | Limited scientific evidence; some studies show modest benefits, others none. | Efficacy proven through large-scale, controlled clinical trials. | Reliability is significantly higher for proven medical treatments. |
| Regulation | Not FDA-approved; quality and purity can vary widely. | FDA-approved; manufactured and regulated to specific standards. | Medical treatments are held to a higher standard of safety and quality. |
| Drug Interactions | Potential interactions with diuretics, immunosuppressants, and other drugs. | Extensive research on known interactions, documented and monitored. | Risks are better understood and managed with medical treatments. |
Conclusion
While elderberry has a place in traditional medicine and can be a safe ingredient when correctly processed, it is far from a harmless cure-all. Consumers must be aware of the serious risks, including toxicity from raw or improperly prepared forms, common gastrointestinal side effects, and potentially dangerous interactions with prescription medications. For sensitive populations, such as those who are pregnant, breastfeeding, immunocompromised, or with autoimmune diseases, caution or avoidance is warranted. The limited and often inconclusive scientific evidence regarding its effectiveness also means it should not be relied upon as a primary medical treatment. When considering any elderberry product, it is essential to prioritize proper preparation and consult a healthcare professional to ensure safety and avoid potential harm.
For additional information on dietary supplements and safety, consult the National Center for Complementary and Integrative Health (NCCIH).
