Quick answer

Elderberry is the dark purple fruit of the black elder tree. The trials NIH reviews gave extracts for 2 to 16 days, mostly to people who were already unwell, and found mixed results. In healthy people, small trials of 2 and 12 weeks found no change in the blood markers measured. No benefit is claimed here.^1,2,3,4,5

Key facts

Raw or unripe elderberries, and the leaves and stems, can cause nausea and vomiting unless cooked.¹
In a small study, less than 0.4% of the anthocyanins in an elderberry extract passed unchanged into urine within 7 hours.⁶
In one analysis of 31 supplements, more than 60% of those sold as European elderberry did not match real elderberry.⁷
NIH says elderberry might reduce the effect of medicines that suppress the immune system.²

What elderberry is

Elderberry is the dark purple berry of the European or black elder tree, Sambucus nigra, which grows in Europe, North America, Western Asia and North Africa.¹

Elderberry contains anthocyanins, flavonols and phenolic acids. Anthocyanins make up about 80% of its polyphenols.^2,7

Ripe elderberries and elder flowers appear safe to eat, and the cooked berries are used in pies and jams. Raw or unripe berries are not safe to eat.^2,8

Supplements are made from the berries, usually as extracts, syrups or capsules. This page is about the berry, not the flowers, which are a separate ingredient.²

What the research shows

No benefit claim for elderberry passes our evidence rules. The trials are few and mostly short, many were in people who were already unwell, and they used different products at different strengths. This site makes no claims about illness.^2,3

A 2021 systematic review found five randomized trials of elderberry, lasting 2 to 16 days, four of them in people who were already unwell. Results were mixed, and the reviewers rated the evidence uncertain.^2,3

A separate 5-day trial in 2020, in 87 people who were already unwell, found no effect on how long or how badly they were ill.²

In 52 healthy postmenopausal women, an elderberry extract supplying 500 mg of anthocyanins a day for 12 weeks did not change the heart-related blood markers or the immune signalling proteins measured, compared with placebo.^3,5

In 34 healthy young adults, capsules of spray-dried elderberry juice three times a day for 2 weeks did not significantly change blood fats compared with placebo.⁴

NCCIH says little research has been done in people on other uses of elderberry, and there is not enough information to show whether it helps any other health purpose.¹

Laboratory results on elderberry's pigments do not show what a capsule does in a person. A grade needs trials in people that measure an outcome they would care about, and for elderberry those are missing. Some small trials looked at other outcomes this site does not cover.^1,2

How much is absorbed

Only a small share of elderberry anthocyanins is absorbed intact. In four older women given 720 mg of them in an extract, 0.077% appeared in urine within 4 hours.⁹

After elderberry, breakdown products of anthocyanins reached blood levels about 36 times higher than the anthocyanins themselves, and 12 weeks of intake did not change this pattern.¹⁰

So most of what circulates after a dose is not the pigment named on a label but compounds the body makes from it. Whether those compounds do anything in people is not known.¹⁰

Amounts used in studies

In a trial of 312 air travellers, people took capsules of 300 mg of elderberry extract: 600 mg a day for 10 days before flying, then 900 mg a day until 4 to 5 days after arriving.^2,3

The longest trial in healthy people that we found gave an elderberry extract supplying 500 mg of anthocyanins a day, as two capsules twice a day, for 12 weeks.⁵

Neither NIH nor NCCIH gives a recommended daily amount of elderberry, and the trials used different products, strengths and schedules.^1,2,3

The dosage guide lists every amount tried, including syrups, lozenges and tea.

Products differ, and some are not what they say

Products differ in strength. In two small studies, 30 mL of a commercial elderberry extract supplied 147 mg of anthocyanins in one case and 278 mg in the other.^6,11

NIH notes that some elderberry supplements are highly diluted or adulterated with a cheaper ingredient such as black rice extract. In one analysis of 31 supplements, more than 60% of those sold as European elderberry had pigment profiles that did not match real elderberry.^2,7

The FDA and the Federal Trade Commission have acted against companies that marketed elderberry products with claims that were not backed by evidence.¹

What's in ours

What’s in ours

Immune Support: Elderberry Extract, 500 mg per serving, from the label

Our label lists the elderberry extract shown above but not its strength or anthocyanin content, so it cannot be matched to a trial. The product it is in makes no claim for elderberry.

Side effects, medicines and who should ask first

Raw or unripe elderberries, and the leaves, stems, bark and seeds, contain substances that can release cyanide and cause nausea, vomiting and severe diarrhea. Cooking destroys them, so cooked fruit and properly processed products do not carry this concern.^1,2

Trials have reported few side effects and none serious, but most did not check for them carefully, so how often minor effects happen is uncertain.³

Allergic reactions to elderberry products are rare. Elderberry contains a known allergen, Sam n1.^7,12

Ask your pharmacist or doctor first

Because elderberry may stimulate the immune system, NIH says it might reduce the effect of medicines that suppress the immune system.^2,13

Expected from how the two work, not shown in studies

No upper limit has been set for elderberry. The longest trial in healthy people that we found gave an extract supplying 500 mg of anthocyanins a day for 12 weeks, and most others lasted 2 to 16 days.^2,5

Do not take elderberry supplements if you are pregnant. Their safety is unknown, and experts advise against them.²
Ask first if you are breastfeeding. There are no data on elderberry for nursing mothers or infants.¹²
Ask first if you have diabetes or take medicine that lowers blood sugar.²
Ask a pediatrician before giving elderberry to a child.
Ask your pharmacist if you take any prescription medicine.¹

Questions people ask

What does elderberry do for your immune system?

In laboratory studies its compounds act on immune cells. In people, three small studies measured immune signalling proteins after elderberry and found short-term changes but none after 12 weeks. That is not evidence of a benefit, so this site makes no immune claim for elderberry.^2,3

Is elderberry good for your skin?

We found no trial of elderberry taken by mouth for skin in people.

Is it safe to eat elderberries?

Ripe berries are eaten cooked, in pies and jams. Raw or unripe berries, and the leaves, stems and bark, can cause nausea, vomiting and severe diarrhea, so never eat them raw.^1,8

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Sources

This page is information, not medical advice. Talk to your doctor or pharmacist about your own situation.