How effective are flu shots, elderberries, echinacea, and cranberries?
Elderberry Benefits and Side Effects: Does It Help with Colds and the Flu?
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
The CDC recommends everyone over the age of six months get a routine annual flu shot every year––unless you have some sort of contraindication, such as an allergy to any of the components. They recommend trying to get it by the end of October, but it may be beneficial even in December or later.
How effective are flu vaccines? It depends on the year, but typically, it reduces the risk of getting the flu by about 40 to 50 percent. So, in healthy adults, we can say with moderate certainty we can decrease the risk of getting it from like 2 percent each year down to just under 1 percent. Among older adults, you may get a similar relative risk reduction, but the baseline risk is higher, and the consequences greater; so, the absolute benefits are greater, too. In kids, flu vaccines really shine—a high certainty of evidence of a substantial drop in risk. But even in this kind of best-case scenario, with vaccination, there’s still a risk, so what else can we do?
Each year, Americans experience millions of cases of influenza, and hundreds of millions of colds. What about elderberry supplements? In a test tube, elderberry extracts can inhibit pathogens, including the flu virus. In a petri dish, it can rev up the production of flu-fighting molecules from human immune system cells, like tumor necrosis factor, as much as nearly 45-fold. And elderberry juice can help mice fight off the flu. But what about actual people?
The first clinical trial was published back in the 90s: a double-blind, randomized, placebo-controlled trial to treat flu-like symptoms. And the odds for improvement before the fifth day in the treated group were more than 20 times the odds in the control group (p < 0.001). Two subsequent double-blind, randomized, placebo-controlled trials showed similar accelerated healing in the elderberry groups.
This is the study I was excited to see: elderberry supplementation for cold symptoms in air travelers, given my 200-city book tour. It was a randomized, double-blind, placebo-controlled clinical trial of 312 economy-class passengers. And while taking elderberry didn’t seem to prevent people from coming down with cold symptoms, the duration and severity of symptoms in those who did get a cold seemed to have been lessened, suffering an average of about five days instead of seven.
A similar study using the herb echinacea found a lessening of symptom scores that was of only borderline statistical significance. But if you compile all such studies together, even though most of the individual trials didn’t find statistically significant improvements, put them together, and there may be about a 20 percent decreased cold incidence (though there is a concern about selective reporting and publication bias, meaning a bunch of findings and entire studies seem to be MIA, suggesting maybe negative studies were quietly shelved). So, we’re really not sure about echinacea, but all the elderberry studies seemed to have positive results, suggesting elderberry supplementation provides an effective treatment option when more serious treatment isn’t needed. This conclusion came from someone with apparent conflicts of interests, though: each of the four elderberry studies were funded by the elderberry product companies themselves.
Any other berries that might help? A randomized, placebo-controlled interventional study funded, predictably, by Ocean Spray, found that the gamma-delta-T-cells of those drinking a low-calorie cranberry juice beverage for 10 weeks appeared to be proliferating at nearly five-fold the rate. These immune cells serve as like our first line of defense. Though they didn’t get fewer colds, they did seem to suffer less, but not enough to actually prevent days missed from work or an impairment of their activities.
But at least cranberries have never been reported to cause pancreatitis. Some guy taking an elderberry extract not only suffered an attack of acute pancreatitis––a sudden painful inflammation of the pancreas, it went away when he stopped it, and then re-appeared again years later when he tried taking it again, which suggests a cause-and-effect. Why take elderberry extracts, though, when you can just eat the elderberries themselves? Well, cooked are fine, but consuming raw elderberries can cause you to puke your guts out.
Oh, now you tell me! I found out the hard way, as I explained in an answer to the question “What was the worst day of my life?” in my How Not to Die “London Real” interview. It turns out elderberry fruit form cyanide, such that eight people had to be medevacked out after someone brought freshly squeezed elderberry juice to a gathering.
Please consider volunteering to help out on the site.
- Grohskopf LA, Alyanak E, Broder KR, Walter EB, Fry AM, Jernigan DB. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza Season. MMWR Recomm Rep 2019;68(No. RR-3):1–21.
- Centers for Disease Control and Prevention (CDC). Effectiveness of Seasonal Flu Vaccinesfrom the 2005 –2019 Flu Seasons. 2019.
- Demicheli V, Jefferson T, Ferroni E, Rivetti A, Di Pietrantonj C. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev. 2018;2(2):CD001269.
- Demicheli V, Jefferson T, Di Pietrantonj C, et al. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev. 2018;2(2):CD004876.
- Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev. 2018;2(2):CD004879.
- Hawkins J, Baker C, Cherry L, Dunne E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complement Ther Med. 2019;42:361-5.
- Krawitz C, Mraheil MA, Stein M, et al. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complement Altern Med. 2011;11:16.
- Barak V, Halperin T, Kalickman I. The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. Eur Cytokine Netw. 2001;12(2):290-6.
- Kinoshita E, Hayashi K, Katayama H, Hayashi T, Obata A. Anti-influenza virus effects of elderberry juice and its fractions. Biosci Biotechnol Biochem. 2012;76(9):1633-8.
- Zakay-Rones Z, Varsano N, Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. 1995;1(4):361-9.
- Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. 2004;32(2):132-40.
- Kong F. Pilot clinical study on a proprietary elderberry extract: Efficacy in addressing influenza symptoms. OJPK. 2009;5:32-43.
- Tiralongo E, Wee SS, Lea RA. Elderberry supplementation reduces cold duration and symptoms in air-travellers: A randomized, double-blind placebo-controlled clinical trial. Nutrients. 2016;8:182.
- Tiralongo E, Lea RA, Wee SS, Hanna MM, Griffiths LR. Randomised, double blind, placebo-controlled trial of echinacea supplementation in air travellers. Evid Based Complement Alternat Med. 2012;2012:417267.
- David S, Cunningham R. Echinacea for the prevention and treatment of upper respiratory tract infections: A systematic review and meta-analysis. Complement Ther Med. 2019;44:18-26.
- Gramza-Michałowska A, Sidor A, Kulczyński B. Berries as a potential anti-influenza factor–A review. J Funct Foods. 2017;37:116-37.
- Nantz MP, Rowe CA, Muller C, Creasy R, Colee J, Khoo C, Percival SS. Consumption of cranberry polyphenols enhances human γδ-T cell proliferation and reduces the number of symptoms associated with colds and influenza: a randomized, placebo-controlled intervention study. Nutr J. 2013 Dec 13;12:161.
- Weissman S, Lo A, Patel R, et al. An Unusual Culprit of Drug-Induced Pancreatitis. Dig Dis Sci. 2020 May;65(5):1549-52.
- Elderberry for influenza. Med Lett Drugs Ther. 2019;61(1566):32.
- Pogorzelski E. Formation of cyanide as a product of decomposition of cyanogenic glucosides in the treatment of elderberry fruit (Sambucus nigra). J Sci Food Agric. 1982;33(5):496-8.
- Centers for Disease Control and Prevention (CDC). Poisoning from elderberry juice - California. April 6, 1984.
Video production by Glass Entertainment
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
The CDC recommends everyone over the age of six months get a routine annual flu shot every year––unless you have some sort of contraindication, such as an allergy to any of the components. They recommend trying to get it by the end of October, but it may be beneficial even in December or later.
How effective are flu vaccines? It depends on the year, but typically, it reduces the risk of getting the flu by about 40 to 50 percent. So, in healthy adults, we can say with moderate certainty we can decrease the risk of getting it from like 2 percent each year down to just under 1 percent. Among older adults, you may get a similar relative risk reduction, but the baseline risk is higher, and the consequences greater; so, the absolute benefits are greater, too. In kids, flu vaccines really shine—a high certainty of evidence of a substantial drop in risk. But even in this kind of best-case scenario, with vaccination, there’s still a risk, so what else can we do?
Each year, Americans experience millions of cases of influenza, and hundreds of millions of colds. What about elderberry supplements? In a test tube, elderberry extracts can inhibit pathogens, including the flu virus. In a petri dish, it can rev up the production of flu-fighting molecules from human immune system cells, like tumor necrosis factor, as much as nearly 45-fold. And elderberry juice can help mice fight off the flu. But what about actual people?
The first clinical trial was published back in the 90s: a double-blind, randomized, placebo-controlled trial to treat flu-like symptoms. And the odds for improvement before the fifth day in the treated group were more than 20 times the odds in the control group (p < 0.001). Two subsequent double-blind, randomized, placebo-controlled trials showed similar accelerated healing in the elderberry groups.
This is the study I was excited to see: elderberry supplementation for cold symptoms in air travelers, given my 200-city book tour. It was a randomized, double-blind, placebo-controlled clinical trial of 312 economy-class passengers. And while taking elderberry didn’t seem to prevent people from coming down with cold symptoms, the duration and severity of symptoms in those who did get a cold seemed to have been lessened, suffering an average of about five days instead of seven.
A similar study using the herb echinacea found a lessening of symptom scores that was of only borderline statistical significance. But if you compile all such studies together, even though most of the individual trials didn’t find statistically significant improvements, put them together, and there may be about a 20 percent decreased cold incidence (though there is a concern about selective reporting and publication bias, meaning a bunch of findings and entire studies seem to be MIA, suggesting maybe negative studies were quietly shelved). So, we’re really not sure about echinacea, but all the elderberry studies seemed to have positive results, suggesting elderberry supplementation provides an effective treatment option when more serious treatment isn’t needed. This conclusion came from someone with apparent conflicts of interests, though: each of the four elderberry studies were funded by the elderberry product companies themselves.
Any other berries that might help? A randomized, placebo-controlled interventional study funded, predictably, by Ocean Spray, found that the gamma-delta-T-cells of those drinking a low-calorie cranberry juice beverage for 10 weeks appeared to be proliferating at nearly five-fold the rate. These immune cells serve as like our first line of defense. Though they didn’t get fewer colds, they did seem to suffer less, but not enough to actually prevent days missed from work or an impairment of their activities.
But at least cranberries have never been reported to cause pancreatitis. Some guy taking an elderberry extract not only suffered an attack of acute pancreatitis––a sudden painful inflammation of the pancreas, it went away when he stopped it, and then re-appeared again years later when he tried taking it again, which suggests a cause-and-effect. Why take elderberry extracts, though, when you can just eat the elderberries themselves? Well, cooked are fine, but consuming raw elderberries can cause you to puke your guts out.
Oh, now you tell me! I found out the hard way, as I explained in an answer to the question “What was the worst day of my life?” in my How Not to Die “London Real” interview. It turns out elderberry fruit form cyanide, such that eight people had to be medevacked out after someone brought freshly squeezed elderberry juice to a gathering.
Please consider volunteering to help out on the site.
- Grohskopf LA, Alyanak E, Broder KR, Walter EB, Fry AM, Jernigan DB. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza Season. MMWR Recomm Rep 2019;68(No. RR-3):1–21.
- Centers for Disease Control and Prevention (CDC). Effectiveness of Seasonal Flu Vaccinesfrom the 2005 –2019 Flu Seasons. 2019.
- Demicheli V, Jefferson T, Ferroni E, Rivetti A, Di Pietrantonj C. Vaccines for preventing influenza in healthy adults. Cochrane Database Syst Rev. 2018;2(2):CD001269.
- Demicheli V, Jefferson T, Di Pietrantonj C, et al. Vaccines for preventing influenza in the elderly. Cochrane Database Syst Rev. 2018;2(2):CD004876.
- Jefferson T, Rivetti A, Di Pietrantonj C, Demicheli V. Vaccines for preventing influenza in healthy children. Cochrane Database Syst Rev. 2018;2(2):CD004879.
- Hawkins J, Baker C, Cherry L, Dunne E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complement Ther Med. 2019;42:361-5.
- Krawitz C, Mraheil MA, Stein M, et al. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complement Altern Med. 2011;11:16.
- Barak V, Halperin T, Kalickman I. The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. Eur Cytokine Netw. 2001;12(2):290-6.
- Kinoshita E, Hayashi K, Katayama H, Hayashi T, Obata A. Anti-influenza virus effects of elderberry juice and its fractions. Biosci Biotechnol Biochem. 2012;76(9):1633-8.
- Zakay-Rones Z, Varsano N, Zlotnik M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. 1995;1(4):361-9.
- Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. 2004;32(2):132-40.
- Kong F. Pilot clinical study on a proprietary elderberry extract: Efficacy in addressing influenza symptoms. OJPK. 2009;5:32-43.
- Tiralongo E, Wee SS, Lea RA. Elderberry supplementation reduces cold duration and symptoms in air-travellers: A randomized, double-blind placebo-controlled clinical trial. Nutrients. 2016;8:182.
- Tiralongo E, Lea RA, Wee SS, Hanna MM, Griffiths LR. Randomised, double blind, placebo-controlled trial of echinacea supplementation in air travellers. Evid Based Complement Alternat Med. 2012;2012:417267.
- David S, Cunningham R. Echinacea for the prevention and treatment of upper respiratory tract infections: A systematic review and meta-analysis. Complement Ther Med. 2019;44:18-26.
- Gramza-Michałowska A, Sidor A, Kulczyński B. Berries as a potential anti-influenza factor–A review. J Funct Foods. 2017;37:116-37.
- Nantz MP, Rowe CA, Muller C, Creasy R, Colee J, Khoo C, Percival SS. Consumption of cranberry polyphenols enhances human γδ-T cell proliferation and reduces the number of symptoms associated with colds and influenza: a randomized, placebo-controlled intervention study. Nutr J. 2013 Dec 13;12:161.
- Weissman S, Lo A, Patel R, et al. An Unusual Culprit of Drug-Induced Pancreatitis. Dig Dis Sci. 2020 May;65(5):1549-52.
- Elderberry for influenza. Med Lett Drugs Ther. 2019;61(1566):32.
- Pogorzelski E. Formation of cyanide as a product of decomposition of cyanogenic glucosides in the treatment of elderberry fruit (Sambucus nigra). J Sci Food Agric. 1982;33(5):496-8.
- Centers for Disease Control and Prevention (CDC). Poisoning from elderberry juice - California. April 6, 1984.
Video production by Glass Entertainment
Motion graphics by Avo Media
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Title
Elderberry Benefits and Side Effects: Does It Help with Colds and the Flu?
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
What else can we do for the common cold? Check out:
- Can Gargling Prevent the Common Cold?
- Preventing the Common Cold with Probiotics?
- Kiwifruit for the Common Cold
- Preserving Athlete Immunity with Chlorella
- Using the Produce Aisle to Boost Immune Function
- Best Food to Counter Stress-Induced Immune Suppression
- Benefits of Garlic for Fighting Cancer and the Common Cold
Speaking of cranberries, Can Cranberry Juice Treat Bladder Infections?
And, here’s the London Real interview I mentioned.
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