Elderberries: cook the berries, and hold the cold remedy loosely

The cold remedy claim for elderberry rests on small trials of commercial extracts. By a meta-analysis of randomized trials in 180 people with cold or flu symptoms, black elderberry supplements substantially reduced upper respiratory symptoms, and the abstract calls the effect large without giving the number. A systematic review of 5 randomized trials, graded with GRADE, reads the evidence more cautiously. Elderberry may not reduce the risk of catching a cold, and any shorter or milder cold or flu is uncertain. In 312 air travellers, a membrane-filtered extract left the number of colds statistically unchanged at 12 against 17, and cut cold days to 57 against 117 on placebo. The berry itself needs cooking. According to NCCIH, raw or unripe elderberries, the leaves and the stems contain cyanide-producing substances that can cause nausea, vomiting and severe diarrhea, and cooking eliminates the toxin.

The numbers, per 3.5 oz (100 g)

How much is actually in it

• Whole elderberries in UK data carry 35 calories, 7.4 g sugars, 1.6 mg iron and 290 mg potassium per 3.5 oz (100 g). — CoFID 2021 Elderberries, whole fruit (14-089) (n = 1 record) Evidence E source
  35 calories, carbohydrate 7.4 g, total sugars 7.4 g, protein 0.7 g, iron 1.60 mg, potassium 290 mg, calcium 37 mg, carotene 360 ug per 3.5 oz (100 g)
• Raw elderberries in US data carry 36 mg vitamin C and 7 g fiber per 3.5 oz (100 g), about 40 and 25 percent of the Daily Value. — USDA SR Legacy Elderberries, raw (FDC 171727) (n = 1 record) Evidence E source
  Vitamin C 36 mg (40% DV), fiber 7 g (25% DV), vitamin B6 0.23 mg per 3.5 oz (100 g)

What your body absorbs

• In postmenopausal women taking 500 mg of elderberry anthocyanins a day, blood carried breakdown products at up to 1237 nM but intact anthocyanins at only 34 nM. — Healthy postmenopausal women in a 12-week elderberry extract trial, 500 mg anthocyanins per day Evidence B source
  Phenolic metabolites peak 1237 nM versus anthocyanin conjugates 34 nM in plasma

What cooking and storage change

• According to NCCIH, raw or unripe elderberries and the leaves and stems contain cyanide-producing substances, and cooking eliminates this toxin. — Anyone eating elderberries or elder plant parts Evidence E source
  Nausea, vomiting and severe diarrhea from raw or unripe berries

What it does to your health

• By a meta-analysis of randomized trials in 180 people, black elderberry supplements substantially reduced upper respiratory symptoms. — 180 participants with cold or flu symptoms in randomized controlled trials of Sambucus nigra supplements (n = 180) Evidence A source
  Large mean effect size, numeric value not given in abstract
• In a randomized trial of 312 air travellers, an elderberry extract did not cut the number of colds but halved cold days (57 versus 117 with placebo). — 312 economy class passengers flying from Australia overseas (n = 312) Evidence B source
  Cold episodes 12 vs 17 (p = 0.4); cold days 57 vs 117 (p = 0.02); symptom score 247 vs 583 (p = 0.05)
• In a crossover trial in 18 overweight adults, one week of elderberry juice twice daily lowered blood glucose after a test meal compared with placebo. — 18 overweight or obese adults without chronic illness, two 1-week periods with controlled feeding (n = 18) Evidence B source
  Lower post-meal blood glucose and higher fat oxidation versus placebo, magnitude not in abstract
• In an earlier pilot of 9 overweight adults, one week of elderberry juice changed fuel use after a meal but did not change glucose or insulin. — 9 analyzed overweight and obese adults, two 1-week periods of twice-daily juice or sugar-matched placebo (n = 9) Evidence B source
  Carbohydrate oxidation 3.38 vs 2.88 g per interval (p = 0.0113); glucose and insulin response no difference

Safety, limits and interactions

• A case report describes grade 3 liver injury in a woman taking the cancer drug pazopanib together with a long-term supplement made from elder. — One middle-aged woman with soft-tissue sarcoma on pazopanib 800 mg daily (n = 1) Evidence C source
  Fivefold rise in liver enzymes, normal within 4 weeks after stopping all medicines
• A case report classifies acute pancreatitis in a 75-year-old woman taking daily black elderberry extract as possibly linked to the supplement. — One 75-year-old woman with hypertension and hyperlipidemia on daily black elderberry extract (n = 1) Evidence C source
  Lipase 3016 U/L, recovered after stopping elderberry

What people believe that the data does not support

• By a systematic review of 5 randomized trials graded with GRADE, elderberry may not prevent colds, and any shortening of colds or flu is uncertain. — People in 5 randomized trials of elderberry for prevention or treatment of viral respiratory illness (n = 5 trials) Evidence A source
  No reduction in cold risk; possible shorter duration of colds and influenza, low certainty
• By a systematic review of 39 randomized trials of immune supplements including elderberry, evidence gaps prevent firm claims that they protect healthy people. — Children, adults and seniors under stressors such as air travel or intense exercise, in 39 randomized trials (n = 39 trials) Evidence A source
  No firm conclusion on benefit
• In a randomized trial of 34 young adults, 2 weeks of elderberry extract did not significantly lower cholesterol (199 to 190 mg/dl versus 192 to 196 mg/dl on placebo). — 34 young healthy volunteers taking 400 mg spray-dried elderberry powder three times daily for 2 weeks (n = 34) Evidence B source
  Total cholesterol 199 to 190 mg/dl versus 192 to 196 mg/dl, not significant

Who this works differently for

• In a pilot randomized trial in 24 older adults with mild cognitive impairment, 1 tsp (5 mL) of elderberry juice three times a day for 6 months was well tolerated with only a trend on problem solving. — 24 patients with mild cognitive impairment, mean age 76.3 years, 6 months (n = 24) Evidence B source
  Visuospatial problem solving trend p = 0.09; attrition 18% versus 15% placebo

The bottom line

As fruit, 3.5 oz (100 g) of whole elderberries carries 35 calories and 7.4 g of sugars in UK tables. US data give raw berries 36 mg of vitamin C and 7 g of fiber per 3.5 oz (100 g), about 40 and 25 percent of the Daily Value, from a single record, and the UK figure for vitamin C is 27 mg. In postmenopausal women taking 500 mg of elderberry anthocyanins a day as an extract, the blood carried breakdown products at up to 1237 nM and intact anthocyanins at only 34 nM, and the abstract does not say how many women took part. The metabolic results disagree with each other. In 18 overweight adults, a week of elderberry juice twice a day lowered blood glucose after a test meal against placebo, with no size given in the abstract. An earlier pilot, with 9 of 22 overweight adults analyzed, found no difference in glucose or insulin after a week, only a shift in carbohydrate oxidation (3.38 against 2.88 g per interval). In 34 young adults, 400 mg of elderberry powder three times a day for 2 weeks moved cholesterol from 199 to 190 mg/dl, against 192 to 196 on placebo, a change that did not reach significance. In 24 older adults with mild cognitive impairment, 1 tsp (5 mL) of juice three times a day for 6 months was tolerated about as well as placebo, with only a trend on problem solving (p = 0.09). A review of 39 randomized trials of immune supplements, elderberry among eight ingredients, found gaps that prevent firm claims of protection for healthy people. Beyond the raw plant, the cautions come from supplements, in two single case reports. A woman on the cancer drug pazopanib who also took long-term elder supplements developed grade 3 liver injury with a fivefold rise in liver enzymes, and causation was not established. A 75-year-old woman on daily black elderberry extract had acute pancreatitis that the authors classed only as possibly linked, because biliary disease and her other medicines could not be excluded. If you take a prescription drug, a daily elderberry supplement is worth mentioning to whoever prescribes it. We found no card on elderberry in pregnancy or in children.

Sources

1. eldb-daily-r6-13 · food composition dataset
   Elderberries, whole fruit (14-089): Energy 35 kcal | Carbohydrate 7.4 g | Total sugars 7.4 g | Protein 0.7 g | Iron 1.60 mg | Potassium 290 mg | Calcium 37 mg | Carotene 360 ug
   CoFID 2021 (Public Health England, OGL v3.0), code 14-089 Elderberries, whole fruit · checked 2026-09-29
2. eldb-daily-r6-14 · food composition dataset
   Elderberries, raw, FDC 171727: Vitamin C 36 mg | Fiber 7 g | Vitamin B6 0.23 mg per 100 g
   USDA FoodData Central SR Legacy (April 2018), Elderberries, raw, FDC 171727 · checked 2026-09-29
3. eldb-daily-r6-05 · randomized controlled trial, metabolite analysis
   Phenolic metabolites reached peak concentrations of 1237 nM in plasma, while anthocyanin conjugates only reached concentrations of 34 nM.
   Mol Nutr Food Res, 2014 · checked 2026-09-29
4. eldb-daily-r6-10 · agency guidance
   Raw or unripe elderberries and other parts of the elder tree, such as the leaves and stem, contain poisonous cyanide-producing substances that can cause nausea, vomiting, and severe diarrhea; cooking eliminates this toxin.
   NCCIH, Elderberry: Usefulness and Safety (last updated November 2024) · checked 2026-09-29
5. eldb-daily-r6-01 · meta-analysis
   Supplementation with elderberry was found to substantially reduce upper respiratory symptoms. The quantitative synthesis of the effects yielded a large mean effect size.
   Complement Ther Med, 2019 · checked 2026-09-29
6. eldb-daily-r6-04 · randomized controlled trial
   Most cold episodes occurred in the placebo group (17 vs. 12), however the difference was not significant (p = 0.4). Placebo group participants had a significantly longer duration of cold episode days (117 vs. 57, p = 0.02)
   Nutrients, 2016 · checked 2026-09-29
7. eldb-daily-r6-07 · randomized crossover trial
   Supporting the changes to the microbiota, the EBJ treatment significantly reduced blood glucose following the MTT.
   Nutrients, 2024 · checked 2026-09-29
8. eldb-daily-r6-08 · randomized crossover trial
   There was no difference in serum glucose or insulin response between treatments.
   Nutrients, 2023 · checked 2026-09-29
9. eldb-daily-r6-11 · case report
   By the fourth week on pazopanib, laboratory tests showed grade 3 liver injury, as demonstrated by a fivefold rise in liver enzymes along with severe nausea and loose stools.
   Mol Clin Oncol, 2024 · checked 2026-09-29
10. eldb-daily-r6-12 · case report
    Because occult biliary disease and medication co-exposure could not be definitively excluded, causality was conservatively classified as possible black elderberry-associated acute pancreatitis.
    Cureus, 2026 · checked 2026-09-29
11. eldb-daily-r6-02 · systematic review
    Elderberry may not reduce the risk of developing the common cold; it may reduce the duration and severity of colds, but the evidence is uncertain. Elderberry may reduce the duration of influenza but the evidence is uncertain.
    BMC Complement Med Ther, 2021 · checked 2026-09-29
12. eldb-daily-r6-03 · systematic review
    Whereas some studies may point to evidence for benefit, specific gaps preclude the authors from making firm statements with regard to the overall evidence-base for these products and ingredients and in answering the research questions.
    Nutrients, 2022 · checked 2026-09-29
13. eldb-daily-r6-09 · randomized controlled trial
    In the placebo-controlled study, there was only a small, statistically not significant change in cholesterol concentrations in the elderberry group (from 199 to 190 mg/dl) compared to the placebo group (from 192 to 196 mg/dl).
    Eur J Clin Nutr, 2004 · checked 2026-09-29
14. eldb-daily-r6-06 · randomized controlled trial
    Elderberry (not placebo) trended (p = 0.09) towards faster visuospatial problem solving performance from baseline to 6 months.
    Int J Mol Sci, 2024 · checked 2026-09-29