December 2023

Talking to Patients About Top-Seller Elderberry

Elderberry continues to be in high demand for both the flu and COVID-19. It was the top-selling herbal supplement in the US mainstream market in 2021, with sales reaching over $273 million. It’s also maintained a seat on Amazon’s Best Selling supplement list throughout the past year. Make sure you’re prepared to talk about elderberry.

Elderberry extract is thought to have immune stimulating effects and may stop the replication of several strains of influenza viruses – this is the basis for a lot of marketing claims and online buzz. While these claims are supported by in vitro evidence, most clinical studies evaluating elderberry for flu have been relatively small and limited to otherwise healthy adults. They show that taking elderberry extract syrup (Sambucol, Nature's Way) 15 mL four times daily for 5 days improves symptoms such as aches and pains, cough, and nasal congestion. It seems to be safe for most people when used short-term.

But not all clinical data is supportive. A more recent clinical study in adults and children with or without other high-risk conditions like asthma shows that elderberry doesn’t reduce the duration of flu symptoms. It’s worth noting that this study evaluated the effect of elderberry on the duration of symptoms while earlier clinical studies evaluated whether it improved symptoms – this could help explain the conflicting findings. It might also be that elderberry is less likely to benefit people with high-risk conditions.

If patients ask you about elderberry, tell them that it might offer some benefits in otherwise healthy adults when taken within 48 hours of flu symptoms starting. But there isn’t any good evidence supporting its use in children. And despite claims to the contrary, there’s no good evidence supporting the use of elderberry for COVID-19. 

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