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Does elderberry cause diarrhea?

Written by the Full Measure editorial team, which sells supplements. Approved for publication by the Full Measure owners. Updated .

Drafted with AI assistance from the sources listed below. How we write these

Quick answer

Yes, when raw. NCCIH says raw or unripe elderberries and the leaves, stems, bark and seeds contain cyanide-producing substances that can cause nausea, vomiting and severe diarrhea, and that cooking eliminates them. In a 1983 outbreak, 11 of 25 people became ill after drinking juice from wild elderberries crushed with leaves and stems. Ask your doctor if symptoms last.1,2,3

Key facts

  • NCCIH says raw or unripe elderberries and other parts of the elder tree contain poisonous cyanide-producing substances that can cause nausea, vomiting and severe diarrhea, and that cooking eliminates the toxin.1
  • NIH's consumer sheet says cooked elderberry fruit and properly manufactured supplements do not have this concern, and that the poisoning can also cause dehydration.4
  • In 1983, 11 of 25 people at a gathering in California fell ill within 15 minutes of drinking juice made from wild elderberries crushed with their leaves and stems.2
  • Sambunigrin, the main substance in elder that can release cyanide, is highest in the leaves and lowest in unripe berries, and one study found none that could be measured in commercial elderberry juice.5
  • Trials of elderberry products have reported few side effects and none serious, but most did not check for them carefully.3

What do NCCIH and NIH say about diarrhea from elderberry?

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.1,6

NIH's fact sheet for health professionals names the same parts of the plant, bark, leaves, seeds and raw or unripe fruit, and the same effects, adding dehydration and cyanide poisoning to the list. It states that cooked elderberry fruit and properly processed commercial products do not pose the concern.6

LactMed, the NIH breastfeeding database, gives the same picture from a different angle: the fruit contains flavonoids, while the bark, leaves and root contain sambunigrin, and cooked berries do not carry the risk.7

What happened in the California juice outbreak?

In 1983, 11 of 25 people at a gathering in California fell ill within 15 minutes of drinking juice made from wild elderberries crushed with their leaves and stems. The eight most affected had nausea, vomiting, stomach cramps and weakness and were flown to hospital, and all recovered.2

Sambunigrin, the main substance in elder that can release cyanide, is highest in the leaves and lowest in unripe berries, and one study found none that could be measured in commercial elderberry juice.5

The outbreak is a reminder of what raw preparation can do and not a finding about supplements. It involved juice made from wild berries crushed with leaves and stems, and a laboratory study did not find measurable sambunigrin in commercial juice.2,5

Do trials of elderberry products report diarrhea?

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

The 2021 systematic review of five randomized trials, lasting 2 to 16 days, reported no serious adverse events. It also said the limited attention to adverse events means we are uncertain about minor ones, which is where diarrhea would sit, and its text does not mention diarrhea or any other stomach effect.3

In the largest trial of elderberry on its own, 3 people taking elderberry and 2 taking placebo reported an adverse event.3

Who should ask their doctor about diarrhea and elderberry?

  • Anyone with diarrhea or vomiting after making or drinking a home-made elderberry preparation from raw berries, leaves or stems should ask a doctor promptly, because NCCIH and NIH describe the cyanide-producing substances as poisonous.
  • Anyone whose diarrhea lasts, or comes with dehydration, should ask their doctor, because NIH lists dehydration among the effects of the raw plant.
  • Parents of children, and people who are pregnant or nursing, should ask their doctor before using elderberry at all, because no official source gives a safety statement for those groups.
  • Anyone who takes prescription medicines can ask their pharmacist, because NCCIH says some herbs and medicines interact in harmful ways.

Questions people ask

Does elderberry cause diarrhea?

Raw or unripe berries and other parts of the plant can, according to NCCIH, because they contain cyanide-producing substances. Cooking eliminates the toxin. Ask your doctor if diarrhea lasts.1

Does elderberry cause constipation?

No source we read lists constipation as an effect of elderberry. The documented stomach effects come from raw or unripe parts of the plant.1,6

Does elderberry cause gas or acid reflux?

The sources we read do not list gas or acid reflux. They list nausea, vomiting and severe diarrhea from raw parts, and say trials reported few side effects, none serious.1,3

Does cooked elderberry cause diarrhea?

NIH says cooked elderberry fruit and properly manufactured supplements do not have the cyanide concern. The sources do not rule out other individual reactions, including allergy.4

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Sources

  1. National Center for Complementary and Integrative Health. Elderberry. Last updated November 2024. Opened 2026-10-07.
  2. Centers for Disease Control (CDC). Poisoning from elderberry juice, California. MMWR Morb Mortal Wkly Rep. 1984;33(13):173-174. Opened 2026-10-07.
  3. Wieland LS, Piechotta V, Feinberg T, et al. Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complement Med Ther. 2021;21(1):112. Opened 2026-10-01.
  4. National Institutes of Health, Office of Dietary Supplements. Dietary Supplements for Immune Function and Infectious Diseases: Fact Sheet for Consumers. Updated March 10, 2025. Opened 2026-10-07.
  5. Osman AG, Avula B, Katragunta K, Ali Z, Chittiboyina AG, Khan IA. Elderberry Extracts: Characterization of the Polyphenolic Chemical Composition, Quality Consistency, Safety, Adulteration, and Attenuation of Oxidative Stress- and Inflammation-Induced Health Disorders. Molecules. 2023;28(7):3148. Opened 2026-10-07.
  6. National Institutes of Health, Office of Dietary Supplements. Dietary Supplements for Immune Function and Infectious Diseases: Fact Sheet for Health Professionals. Updated March 10, 2025. Opened 2026-10-07.
  7. Drugs and Lactation Database (LactMed). Elderberry. Bethesda (MD): National Institute of Child Health and Human Development; 2006 onward. Entry revised April 15, 2025. Opened 2026-10-11.

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