Elderberry – effective treatment for Swine Flu

On Sunday night I contracted the H1N1 “Swine” flu that is pandemic in my city; on Monday morning I had severe symptoms, headache, chills, nasusea - today, Wednesday morning, I am over it, and yesterday I was well enough to go for a long walk. I haven’t taken Tamiflu or any toxic drug (Tamiflu must be detoxified by the liver before it becomes effective, and according to the FDA causes neurological symptoms in a significant percentage of users, compared to the incidence of those symptoms in ‘flu sufferers who do not take Tamiflu; evidence is summarized in Wikipedia’s Tamiflu entry). Instead I have used an extract of Elderberry juice; a few grams of berry juice, amounting to two tablespoons of berries, is enough to stop the symptoms of, and speed recovery from any influenza virus, including the H1N1 “swine” flu (because there are other H1N1 flus, it is actually appropriate to use the term swine flu to define the current pandemic, in the absence of a less stigmatizing designation).

Standardised elderberry extracts are sold as Sambucol, the brand used for most scientific testing and therefore the gold standard of Elderberry extracts, which is an attractive syrup (Sambucus is the New Zealand brand name of the equivalent product), and as Elderberry Biocomplex, a less palatable tablet comprising 2.33g elderberry juice, 120mg ascorbic acid, and 12mg zinc (as gluconate) per tablet. To achieve the same intake of elderberry as used in tests with Sambucol it is necessary to take slightly more than the two Elderberry Biocomplex tablets twice a day recommended, but because the tablets were less expensive (twice as many doses for the same price) I went with them. Sambucus make a pure elderberry syrup, a sugar free syrup, a syrup with added zinc, ascorbic acid and echinacea (about which more later), and a children’s strength syrup.

Elderberry flowers, elderberries, elderberry juice, and elderberry wine should all be considered effective if available, but because their anthocyanin strength is not standardised it would be wise to use larger amounts. There is no toxicity from taking too much elderberry – it is just a berry (however, see the "Side Effects and Toxicity" advice below about the advisability of cooking the berries and juice if using them straight off the tree). However, the tree was sacred to the Druids, which suggests its medical properties have been well appreciated from prehistoric times.

Elderberry has three main modes of action, but what is unique is its ability to neutralize the "hemagglutinin" spikes which influenza viruses use to attack and infect new cells. This is how antibodies defeat the flu; however, it takes 2 or three days for your body to produce enough antibodies to stop a new virus, by which time it has spread throughout the body. Elderberry extract is like having instant antibodies against ‘flu – as good as, or better than, a ‘flu vaccine. But it is important to start taking elderberry within 48 hours of the first flu symptoms. The less the virus spreads, the less it affects you, and after 48 hours your own antibodies will have kicked in, so the benefit from Elderberry will be less noticeable. Nonetheless Elderberry is still valuable for people who find it hard to recover, or are suffering badly – Elderberry too late is still better than no Elderberry at all.

Elderberry, at about 12g per day, not only cured my flu within a day, when I took it less than a day after becoming ill, it has also caused my daughter to recover; she was sicker for longer, but probably got it within the 48 hour window of greatest opportunity. The next day she was able to eat and her flushed face had regained a healthy complexion; her compulsive coughing and sneezing had almost completely stopped.

As well as blocking the flu virus’ spikes, elderberry slightly but significantly elevates immune function (macrophage activity and cytokines) and acts as an antioxidant, becoming incorporated into cell membranes and protecting them from the free radicals generated by immune activity, viral replication and cell death.

This last factor is important; though Elderberry stimulates white blood cells somewhat, it also helps protect the body from the consequences, and reduces the need for immune response by hobbling the virus. It is unwise to use herbs that strongly stimulate immunity during the acute phase of an illness; Ginseng is, speaking from experience, particularly unpleasant, Echinacea is not recommended, and even the gentle herb Astragalus is not to be used during an acute illness in the Chinese Traditional Medicine system. But all antioxidants stimulate white blood cell activity to some extent, and as long as this immune enhancement is a secondary function of a potent antioxidant it is good and indeed a desirable effect. The danger exists where the antioxidant potential of a herb is inferior to its immune stimulating effect; then there may be a net increase in free radicals.

The damage and death caused by influenza and other infections, including meningitis, is due to free radicals, pro-inflammatory prostaglandins, and the unrestrained proliferation of cytokines. Antioxidants (specifically vitamin E, selenium, NAC, and vitamin C) and anti-inflammatories (Vitamin D, so often deficient in winter, and increasingly now in summer due to ill-informed “cover up” policies, fish oils, and herbs such as ginger) reduce the extent of suffering and the likelyhood of death or damage due to influenza and other infections and auto-immune conditions. Because Paracetamol (acetaminophen) actually depletes antioxidants it is a very unwise NSAID to use during such an illness, especially when appetite is absent. Ibuprofen is more suitable for children and aspirin, with fish oil (which makes aspirin far more potently anti-inflammatory), for adults. But if you follow this advice no-one will be asking for painkillers or suffering from high fevers.

When you do eat it is important to avoid the allergenic proteins; wheat, milk, maize will produce symptoms of sensitivity during an acute viral infection in many people who usually tolerate them. Soy, beef may also deserve caution.

The Science – from the Alternative Medicine Review, Volume 10, number 1, 2005. Full text available online http://www.thorne.com/media/mono_sambucus10-1.pdf

While there are several mechanisms respon­sible for the beneficial effects of Sambucus nigra and extracts of its berries, perhaps the most important and best studied are the antiviral effects. Mumcuoglu, an Israeli virologist, was the first to discover elderberry constituents neutralize the activity of the hemagglu­tinin spikes found on the surface of several viruses. When these hemagglutinin spikes are deactivated the viruses can no longer pierce cell walls or enter the cell and replicate.11 Based on these findings, Sambucol®, a syrup containing 38-percent standardized extract of black elderberry, was developed. Numerous studies using the Sambucol preparation have shown it to neu­tralize and reduce the infectivity of influenza viruses A and B,12,13 HIV strains and clinical isolates,14 and Herpes simplex virus type 1 (HSV-1) strains and clin­ical isolates.15 It probably does so in the same man­ner as with influenza viruses, via neutralization of the virus resulting in reduced infectivity.

Immune Modulation via Cytokine Production

Elderberry extracts also have immune-modu­lating activity in healthy individuals as well as in those with viral infections or other diseases characterized by immunosuppression. Production of certain cyto­kines leads to activation of phagocytes and facilitates their movement to inflamed tissues.16 Two studies using blood-derived monocytes from healthy donors demonstrated the ability of several Sambucol extracts to significantly increase cytokine production. Cyto­kines tested were tumor necrosis factor-alpha (TNF-α), and interleukins (IL) -1β, -6, and -8.17 A second similar study also measured monocyte production of IL-10 when exposed to various Sambucol prepara­tions and confirmed the results of the first study. A 1.3- to 6.2-fold increase in cytokine production was observed compared to control. A 2.3-fold increase in IL-10 was also observed.18

Antioxidant

Elderberries contain several anthocyanin flavonoids known to possess significant antioxidant properties. Research has demonstrated low-level concentrations (4 mcg/mL) of elderberry anthocya­nins can efficiently regenerate alpha-tocopherol from alpha-tocopheroxyl radicals in models of copper-me­diated LDL oxidation.19 Since it has been observed that anthocyanin glycosides are indeed absorbed in humans,3,7-10 it is likely that supplementing with el­derberry extracts containing anthocyanins provides significant antioxidant benefit.

It has been established that endothelial cell dysfunction results in changes in the redox status of cells.20 Based on this premise and previous research on elderberry’s antioxidant potential, Youdin et al demonstrated elderberry anthocyanin incorporation into endothelial cells confers increased protection against oxidative stress. Human aortic endothelial cells incorporated elderberry anthocyanins into both the membrane and cytosol, affording significantly enhanced resistance to damage from reactive oxygen species. The most pronounced affect was seen with protection against H2O2-induced loss in cell viabil­ity.21

Clinical Indications

Viral Infections

Influenza

Two randomized, placebo-controlled, dou­ble-blind studies demonstrated the elderberry ex­tract, Sambucol, effectively inhibited both influenza A and B strains when given orally to patients in the first 48 hours of influenza symptoms. In the earlier study, 27 individuals experiencing typical early flu symptoms were given Sambucol or placebo daily for three days – 2 tablespoons (children) or four table­spoons (adults). Patients were followed for six days and symptoms monitored. Serum from all subjects was analyzed for antibodies to influenza A and B at the initial dose and during the convalescent phase. In the treatment group, significant improvement in flu symptoms was observed in 93.3 percent of subjects within two days after initial dosing, while 91.7 per­cent of the control group demonstrated improvement after six days. A complete resolution was achieved in the treatment group in 90 percent of patients after 2-3 days, while the placebo group yielded similar results after six days. Of these 27 patients, 23 had laboratory confirmation of influenza B.12

In a second study, 60 patients (ages 18-54 years) experiencing early influenza symptoms were given 15 mL of Sambucol or placebo syrup four times daily for five days. Symptoms were monitored for eight days. In the treatment group, the majority of patients reported “pronounced improvement” after an average of 3-4 days, while the placebo group required 7-8 days to reach the same level.13

Herpes simplex

Mumcuoglu et al examined the effects of Sambucol against HSV-1 in human diploid fibro­blasts. Four strains of HSV-1 were utilized – a ref­erence strain, two acyclovir-resistant strains, and a strain isolated from a patient. Viral replication was completely inhibited in all four strains, whether the cells were pre-incubated with the extract, simulta­neously incubated with extract, or the extract was added 30 minutes after viral adsorption to cells. The complete inhibition of four strains of HSV-1 in vitro by elderberry extract warrants further clinical trials in humans.15 A formula of Sambucus nigra (flower extract) in combination with Hypericum perforatum and Saponaria officinalis was also found to inhibit the replication of HSV-1 in vitro.22

HIV

Sambucol was studied for the potential to inhibit the infectivity of HIV isolates in CD4+ cell lines, peripheral blood lymphocytes, and laboratory HIV strains. The elderberry extract at two different dilutions was pre-incubated with HIV virus prior to addition of the cells. A significant reduction was ob­served in the infectivity of all HIV strains. In patient isolates treated with the extract, no HIV antigen was detected at either five or nine days post-incubation.14

Anecdotal evidence (six case studies) reports a combination of elderberry extract and a thymus ex­tract resulted in a reduction in viral load in people with HIV.23

Conditions Associated with Oxidative Stress

Numerous disease states are characterized by oxidative stress, including cardiovascular dis­ease, cancer, neurodegenerative disease, peripheral vascular disease, autoimmune diseases, and multiple sclerosis. The ability of elderberry extract to pro­vide antioxidant protection via inhibition of LDL-oxidation and scavenging of free radicals makes it a potentially valuable tool in the treatment of disease resulting from oxidative stress.19 Elderberry’s ability to incorporate into endothelial cells and potentially improve endothelial function may also indicate a role in prevention of vascular disease of various kinds.21

Effect on Blood Lipids

A randomized, placebo-controlled study of 34 healthy subjects examined the effectiveness of low-dose, powdered elderberry juice (10% anthocya­nins) versus placebo on lipid parameters. Elderberry was dosed at 400 mg capsuled powder (equal to 5 mL elderberry juice) three times daily for two weeks; patients were instructed to follow a diet containing 35-percent fat. Serum was obtained at baseline and at the end of the two-week period. Analysis of re­sults showed a slight, but statistically insignificant, decrease at two weeks in all lipid parameters of the low-dose elderberry extract group compared to base­line. Total cholesterol was 199 mg/dL at baseline versus 190 mg/dL at the end of the two-week period. Slight reductions were also reported in triglycerides, and HDL- and LDL-cholesterol.24 Although improve­ments in lipid values were statistically insignificant, the dosage of elderberry extract was low and it is pos­sible higher dosages might produce a more signifi­cant benefit. In addition, using subjects with normal lipid levels may not be as likely to produce significant results since the lipids are already within the normal range. Further study on patients with elevated lipid levels is warranted.

Diabetes

In folk medicine, Sambucus nigra flower was traditionally suggested as a remedy for diabe­tes.25 Researchers in Northern Ireland conducted an in vitro study to evaluate the effect on blood sugar. In the two-armed study, aqueous extract of elder flower significantly increased glucose uptake, glucose oxi­dation, and glycogenesis in rat abdominal muscle. El­der flower extract incubated with rat pancreatic cells also had a dose-dependent stimulatory effect on insu­lin secretion. The researchers concluded elder flowers contain water-soluble constituents capable of direct stimulation of insulin secretion and glucose metab­olism.26 Further clinical study is warranted before Sambucus can be recommended for use in diabetes.

Drug-Botanical Interactions

There are no confirmed drug interactions with elderberry extract. However, due to the ability of Sambucus flower extracts to potentiate insulin release in vitro,26 patients with diabetes should be advised to monitor blood sugar closely when using flower ex­tracts.

Side Effects and Toxicity

Elderberry extracts are generally without side effects when taken in the suggested dosages.12 Berries should be cooked, as the consumption of uncooked berries or juice can result in vomiting and diarrhea.1 Certain constituents of the leaves, stems, flowers, and roots contain poisonous alkaloids.27 It has also been reported that small percentages of the general popula­tion have a type-1 allergy to Sambucus nigra as evi­denced by positive-skin prick or RAST test.28

Dosage

Elderberry fruit syrups are often standard­ized to 30-38 percent elderberry. Powdered extracts are dosed at 500 mg (capsule) 2-3 times daily for 3-4 days, or if in liquid form, dosed at one tablespoonful (15 mL) three times daily. In the case of acute viral infections, course of treatment is generally at least three days.29