Exploring the rabbit hole of wellness trends
Everyone is recommending the stuff on Twitter, so we looked into the research to see if the hype is backed by science
I was raised by pragmatic parents whose cure for a cold was rest and time, and I remember rarely going to the doctor as a child. My family medicine cabinet in rural Norway had bandages, petroleum jelly, cough medicine, and ibuprofen—nothing strong, nothing alternative. Once I entered adulthood, for years I handled my colds the same way: stoically.
But about three years ago, I was sick in bed and scrolling through Twitter where a conversation was unfolding between three people I’d never met. They were discussing elderberry syrup as a game-changing remedy for colds. One woman even claimed not to have been sick for two years because the stuff had nipped everything in the bud. I was skeptical. I’d always figured that if the ride had started, there’s no getting off until it’s over. But there’s nothing like being miserably sick to make you a believer, so I went out and found the product: a small brown bottle of tangy syrup, with a picture of purple berries on the label.
Elderberry (scientific name: Sambucus nigra) is an old folk remedy mentioned in the writings of Hippocrates, and it’s something your grandma might have given to you when you were sick as a child. But around the same time as the remedy reached me via the internet grapevine, an Australian study found that elderberry may be genuinely helpful against colds and the flu. The randomized, double-blind, placebo-controlled clinical trial found that people in the placebo group were sick for several days longer and reported worse symptoms than those who took 600 milligrams to 900 milligrams per day of the real deal. This backs up findings of a smaller study from 2004 conducted in Norway, which suggested that taking elderberry reduced the duration of flu in participants.
Twitter’s favorite cult cure, it seems, is actually backed by some science. There are a lot of unsubstantiated claims around what elderberry can and cannot cure, such as heart disease (unlikely), constipation (maybe?), or high cholesterol (probably not). But the research does suggest that it may potentially be a sound way to reduce the duration and severity of a cold.
Pharmacies and health-food shops are full of things for people who want to believe, and the fact that studies back up elderberry as a potentially efficient remedy is important to many who recommend it. “Once you get into it, you get a bit evangelical about it and want to tell everyone,” Claire Oldman, a writer living in London, tells me. (She’s the one I first saw recommending elderberry on Twitter.) Oldman says she initially heard about Sambucol, the market-leading elderberry brand in the U.S., five years ago from a friend, who also credits it with keeping her illness-free for entire winters. I’ve passed on the gospel myself: after I mentioned it to Karima Adi, a CrossFit coach in London, she now brings it up whenever someone complains to her about getting sick.
Increased research into echinacea and other plants has boosted appetites for natural remedies; U.S. elderberry sales were already estimated at $6.8 million in 2010, and a report from market-research company Technavio estimates the global elderberry market will grow by 7 percent each year through 2022. And as cures that might previously be shared between families and friends are now passed on via the internet, they can travel farther and faster. Some (like honey) have merit, while others (like celery juice) do not, but many traditional medicines are derived from plants: a key ingredient in Tamiflu, the flu-fighting antiviral drug, is star anise, for example. So the fact that elderberry might be an efficient remedy isn’t an inherently far-fetched concept.
Still, the companies selling elderberry have to be careful about how they market it: Federal Trade Commission regulations mean it cannot be promoted as a pharmaceutical product. Sambucol is sold as a dietary supplement that the company claims “arms you with some of the best protection nature has to offer,” by being “rich in immune-supporting flavonoids.” Art Rowe-Cerveny, vice president of marketing at PharmaCare U.S., which sells Sambucol in about 60 countries worldwide, uses similar language: “People recommend Sambucol for lots of things, but in essence it is an immune support product,” he says. “When taken at the first sign of cold and flu, it can help in letting the body heal itself.”
Elderberry’s increased popularity in recent years has also coincided with global flu epidemics getting worse—the 2009 swine flu and the aggressive 2014 strain were reflected in Sambucol’s sales. (Sambucol declined to give me any specific numbers.) And while the brand does spend on Instagram influencer marketing, organic social mentions on Twitter and Facebook are plentiful. In a private women’s Facebook group where I’m a member, elderberry comes up every time someone posts desperately about feeling sick ahead of a big event. Sometimes, even seemingly random mentions end up going viral: in January of last year, a Tennessee woman named Sandi Ashby Flippo was surprised to see her non-sponsored Facebook post accumulate nearly a million shares.
There are a number of brands making elderberry syrups, pastilles, and gummies, including Frontier, Gaia, Nature’s Way, and Norm’s Farms. There’s no such thing as a “standardized extract” of elderberry; individual company decide what goes in their product. The Sambucol brand dates back to the 1980s, when Israeli virologist Madeleine Mumcuoglu established the formula based on her research into the anecdotal evidence surrounding elderberry. (It’s also possible to make your own elderberry syrup at home, although the raw berries are mildly toxic and require proper, careful preparation to ensure the final syrup is safe.)
Kevin Curran, the former head of medical-plants research at the University of San Diego, says it’s still unclear exactly how elderberry works in the body. “Like with most plant research, there’s a scarcity of human clinical trials, especially in terms of mechanism,” he tells me over the phone. Laboratory studies show that elderberry shifts the activity of certain cytokines, the body’s signaling molecules for the immune system to ramp up and down, which may explain how the plant can cause a boost to the body’s natural defenses. Elderberry is also high in antioxidant flavonoids, which can inhibit free radicals—which can damage cells and cause illness—in the body. But Curran points out that these antioxidants have low bioavailability, meaning little is absorbed by the body when you eat them. “It hasn’t been demonstrated exactly what the antioxidants are doing. It’s only been demonstrated that the plant itself has high antioxidant levels. You have to be careful when interpreting research. But that doesn’t mean they’re not doing anything,” says Curran.
Conducting large, authoritative studies is expensive, so it can be challenging to confirm or refute the enthusiastic anecdotes about natural remedies like elderberry. And just because a small-scale study fails to determine something doesn’t rule it out. (For example, the Australian study did not find that elderberry can stop a cold from developing, while anecdotal evidence is rich to the contrary.) “You have to take these smaller studies with a grain of salt, but don’t ignore them. It’s interesting when they find something and it corroborates with the anecdotal information,” says Curran. He adds that no matter how promising something seems, never take anything that doesn’t have a record of safety and nontoxicity.
So does elderberry work? In the years since I discovered elderberry on Twitter, I’ve taken it sporadically when I’ve felt something coming on. But I also get my flu shot. I’m still that same pragmatist my parents raised, and I’ll follow the scientific evidence. While researching this story, I started coming down with a cold. It was the kind of stuffy head and body ache that usually means being knocked out for three days. But I took my elderberry diligently, and I got away with taking only one day off. Maybe I got lucky, or maybe it worked. It’s hard to say. But the next time someone complains about their cold symptoms, I’ll probably spread the word.