My colleagues and I have been fielding a lot of questions in the past few weeks about “the elderberry controversy”. There have been several warnings circulating about the potential catastrophic effects of taking elderberry extracts with COVID-19. The concern is that elderberry extracts may cause a fatal “cytokine storm” in patients affected by COVID-19.
Before I really dig in, I think it is important to point out that there are no scientific articles addressing this, because, well, COVID-19 is brand new. However, we do know how this new virus works, and we do know how elderberry extracts work. This post is intended to shed light on the theories, and share my own opinion based on the literature I have read, and explanations from my teachers and colleagues.
What is a cytokine storm?
Our immune system is like a team made up of a lot of different specialists. There are more than a dozen different types of immune cells, each one in charge of different aspects of immune function. They communicate using molecules called cytokines. There are LOTS of different cytokines (think letters in the alphabet that are used to make words or phrases). When we get a virus, a specific set of cytokines are released and they tell the viral-killing specialist cells to mobilize and swing into action. In most circumstances, this is how our body wins the battle against a virus, so an increase in those cytokines is usually a very good thing.
If the infection is severe, sometimes this cytokine signal gets stuck in a self-perpetuating loop. It keeps increasing, causing more and more immune response. If the immune response gets out of control, it can cause damage to our own healthy cells, sometimes on a large and dangerous scale. This is called a cytokine storm.
In the case of COVID-19, when people develop difficulty breathing and fluid build-up in the lungs, that is due to a cytokine storm. The huge excess of cytokines make the virus-killing cells too aggressive, and they end up damaging lung cells in addition to killing the virus. This can be fatal in some people (this is how COVID-19 kills). Just to clarify, the cytokines that can cause this deadly storm are the SAME cytokines that are essential for us to have an immune response to the virus at all.
So, some “antiviral” cytokine signal = good
Way too much of that same cytokine signal = bad
How does this relate to elderberry extract?
Elderberry extract produces a small increase in the exact same anti-viral cytokines that we need to fight off things like colds, flus, SARS and COVID-19.
So is elderberry safe or not?
It really is a matter of scale. Elderberry extract can produce a 2-6x increase in these cytokines. For the sake of perspective, running a marathon can produce a 100x increase in these same cytokines. A cytokine storm produced by a virus that is severe enough to start causing dangerous respiratory distress is more like a 1000x increase. When we consider this, the elderberry is not really the problem in this scenario. For prevention, mild illness, or early stages of illness in an otherwise healthy person, elderberry is theoretically a safe and effective choice. BUT once a viral-induced cytokine storm has started, adding elderberry would not be helpful, and could add a tiny bit to the already growing storm.
In summary
Elderberry by itself does not cause cytokine storms.
In otherwise healthy people, elderberry extract should be a safe and effective choice for prevention of viral infections, as well as immune support for mild, moderate, and early stages of viral infections (there is research to support this).
In people with underlying health conditions, who already have immune imbalances or lung issues (autoimmune, COPD, pneumonia), then elderberry might not be the best choice. (I have not done exhaustive research here, but I think this is a theoretical concern, as opposed to a data driven one.)
If you become infected with COVID and develop lung symptoms, you should head for the hospital because it is time for higher level intervention (we will keep hoping for permission to offer integrative care to folks). Elderberry is no longer useful in this scenario, and there is some theoretical concern that it might add to the problem.
There are many other herbs and nutrients that can be used to optimize and balance immune function. Elderberry is not our only, or even our best option. But for most people it can be helpful and safe addition to your immune boosting arsenal.
Closing notes for herb geeks
Different parts of the plant have different functions: Traditionally elder leaf and elder flower were also used as immune supporting remedies. These act on different parts of the immune system than the berry, and do not have the same concern for increasing the cytokine group that we were discussing here.
The Doctrine of Signatures: There is a lovely folk medicine tradition of associating the use of a medicinal plant with its physical appearance. I chose the picture above because it shows off the beautiful branching pattern of the elderberry stems, ending in the lovely round fruits. If you also happen to be an anatomy geek like me, these branching stems ending in round balls looks very much like the structure of the lungs. Hmmm.
Be well!
Dr. B