The tree and its products are quite popular in Europe, where it is known as elder, elderberry tree, or bour tree. Several species of Sambucus are well known, especially S. nigra, which is native to Europe, and S. canadensis from North America. The flowers, or cymes, are the parts that are most favored in herbal therapy; the berries, bark, and leaves are used less frequently.
Uses and Benefits:
In Europe, elder flowers have been popular for treating colds and fevers, and to help expectoration in bronchitis and asthma. Elder is commonly described as being a diaphoretic. It is often incorporated in herbal mixtures to treat influenza, sinusitis, and bronchitis. Other recommended uses include neuralgia, nervous conditions, inflammatory diseases, rheumatism, diabetes, and various infections. It is also employed as a laxative, a diuretic, for weight loss, and as a topical preparation for skin disorders. The blue or black berries are used as a food, in wine and other drinks, and in jams. Itspopularity today relates in large part to its importance in traditional European folklore, where it is credited with legendary properties.<.p>
The flowers are the source of an essential oil that has a buttery consistency because it contains palmitic and other fatty acids, and alkanes The leaves and seeds contain cyanidin glycosides. Over compounds have been extracted from elder, including triterpenes, glycosides (e.g., sambucin, sambucyanin, sambunigrin), various anthocyan ins, flavonoids, sterols, and lectins. The lectins have been shown to have antiviral and hemagglutinin properties in vitro.Laboratory studies suggest that elder flowers have anti-inflammatory effects, and animal models indicate that elder preparations may protect the liver against toxins. Clinical experience in Germany suggests elderberry (or elderberry-containing products) may have mulecretory properties.
The clinical value of elder flowers and fruits has been clearly demonstrated, and no individual component has shown to have specific clinical value. However, elder’s use in herbal mixtures has been evaluated in several controlled clinical. An elderberry combination product, Sinupret, elder flowers combined with gentian root, primrose flowers, sourdock, and very, has been evaluated for upper respiratory infections in several controlled clinical trials in Germany, and some benefit has been demonstrated in sinusitis and bronchitis. Sinupret was compared to placebo in four double-blind clinical trials for sinusitis of 1 to 2 week duration. Two small trials (n = 31 and 39) reported benefits in headache symptoms and sinus x-rays, and a larger study of patients also reported significant improvement in x-rays vs. placebo (87% vs. 70%) and in self-rating of symptoms (96% vs. 75%). However, a separate trial of patients with chronic sinusitis found little symptomatic difference between Sinupret and placebo.
In several studies, Sinupret has been compared to established mucokinetic drugs, including acetylcysteine and ambroxol (derived from the Ayuverdic herb, vasaka) for patients with acute bronchitis. Similar clinical benefits were shown, and there was equivalent improvement in mucociliary clearance In an observational study involving over 300 centers, 3187 patients with acute bronchitis or exacerbations of chronic bronchitis were evaluated. Similar symptomatic benefits were reported with Sinupret as were seen with the standard mucokinetic drugs.
These studies did not evaluate elderberry separately, and those for bronchitis did not evaluate Sinupret against a placebo. Since the beneficial effects of allopathic expectorants and mucolytics have not been adequately demonstrated, Sinupret and elder flowers cannot be regarded as having objectively proved their value.
Using a standardized black elderberry extract (Sambucol), a double-blind, placebo-controlled trial of 40 Israeli subjects was carried out during an influenza outbreak. Symptoms and fever improved significantly within 2 days in 93.3% of subjects in the treatment group, whereas the same degree of improvement was achieved by 91.7% of the controls at 6 days (P < 0.001). The preparation was also reported to increase hemagglutination inhibition titers to influenza B, and to inhibit replication of strains of influenza A. Although this surprisingly successful outcome has led to the promotion of Sambucol for influenza, the study has yet to be replicated.
There are no recognized adverse effects, although data is limited. It is suggested that a diuretic effect may result in hypokalemia, but this has not been objectively reported or studied.
Side Effects and Interactions:
There are no recognized drug interactions.
The stems, roots, unripe berries, and seeds may contain cyanide, and could cause vomiting and severe diarrhea if chewed or eaten uncooked. Ripe berries are safe when prepared for use in foods.
Preparations & Doses:
The flower preparations are usually administered as teas and alcoholic extracts, and are often found in composite herbal remedies. The traditional dose is 3-5 g of the flower, and this is typically administered 2-3 times a day. Topical cosmetic preparations are used for the skin and eyes. Sinupret contains 18 mg of powdered elder flower extract per dose in combination with other herbs, and Sambucol (a standardized elderberry extract) is marketed in the U.S. by both J.B. Harris and Nature’s Way.
Elder products including the flower and berry are pleasant traditional preparations, especially for use in mild sinus and bronchial infections. There is some evidence in support of using elder flower in combination with other herbs for these indications, but there aren’t enough well-designed clinical trials to determine its individual or synergistic value. Its potential value in influenza needs to be confirmed.