Kitchen Remedies: Elderberry Syrup

One of my favorite fall rituals is preparing a large batch of elderberry syrup. It’s beneficial to keep on hand during cold season as a valuable herbal ally. Making a large amount is key, not just so the flavors of the ingredients taste richer, but because having extra on hand to offer loved ones is immensely fulfilling.

Elderberry (Sambucus nigra) has been used by healers for over 2000 years. Modern herbalists know how to process and use elderberries to effectively treat cold and flu viruses due to its long history of use in folk medicine. Additionally, there has been a fair amount of research investigating the use of elderberries to treat cold virus symptoms.

Elderberries are considered immune modulators that have shown antibacterial activity against Gram-negative and Gram-positive bacteria, and antiviral effects upon influenza [1, 2].

Medicinal constituents within elderberries include flavonoids, phenolic acids, lectins and vitamins [3]. Elderberry works by competitively inhibiting cold viruses from attaching to and entering cells, thereby, reducing the rate of viral replication inside the body [3].

One double-blind placebo trial found that elderberry reduces the severity and duration of cold virus respiratory symptoms [4]. This supports results from a previous randomized study showing that cold symptoms were relieved on average 4 days earlier by participants taking elderberry compared to those who weren’t [2].  

Elderberry has been shown to stimulate the immune system, such as stimulating macrophage response and production of cytokines [3]. It is important to note that there is no research or historical evidence that elderberry overstimulates the immune system leading to a Cytokine storm [5].

Elderberry syrup, when prepared and dosed correctly, is very safe. Used for centuries, herbalists have a good understanding of what to expect. It is important that only the ripe berries be processed into syrup as the unripe fruits, bark, leaves and seeds all contain a potential toxin, sambunigrin [6].

Ripe berries need to be cooked for at least 15 minutes before ingestion; typically, berries are cooked from 45 minutes to 2 hours when making elderberry syrup. A systematic review evaluating the effects of elderberry in the treatment of respiratory illness found no reported adverse effects in any of the studies evaluated; the authors therefore concluded that elderberry may be a safe option to treat cold virus respiratory symptoms [5]. Regarding safety, it is important not to give syrups containing honey to children under 12 months due to possible risk of infantile botulism.  

Just do a simple internet search and you can find many different recipes published illustrating the flexibility in what you can add to your syrup. This allows options in regards to creating a syrup that fits specific dietary restrictions and preferences. Basic ingredients include elderberries, water, and sugar. Examples of other potential ingredients include ginger, orange peels, cloves, cardamom, cinnamon, lemon, vanilla and even other immune enhancing herbs depending upon the desired effect. I encourage you to explore and research recipes yourself to determine how you like it best.  

In general, there is a 1 to 4 ratio by weight of herbs to water. Once decocted, you need to measure your final liquid volume and then add at least half of that in sugar. So, what this might look like is 2 cups dried elderberries and 4 cups water simmered together until the volume is reduced by half, then strain thru cheesecloth. If you are left with 2 cups decoction add at least 1 cup honey, label and store in the refrigerator. Make sure your decoction has cooled before adding honey so as not to denature the natural antimicrobial properties of honey itself [7]. Adding alcohol and increasing the proportion of sugar will help make your syrup shelf stable.  

Adding apple cider vinegar or an alcohol such as vodka or brandy to our basic recipe above can extend the life of your syrup. Syrups only using honey in our basic recipe can last for 2 months refrigerated. Adding vinegar can preserve your syrup for 4 months refrigerated; the addition of alcohol can extend your syrup to 6 months refrigerated before it spoils. Again, you can play around with what works best for you. For example, adding 1 cup brandy to our basic recipe and substituting maple syrup or agave syrup instead of honey can produce a vegan product that will last for 6 months if kept refrigerated.

The proportion of elderberries used in your starting herbal product along with added sugar and preservatives dictates the dosage, but in general 1 tsp to 1 tbsp is recommended. The example given earlier of a 1 to 4 dried herb to water ratio is a strong decoction, and 1 tsp is a sufficient dose. Weaker decoctions or those with more sugar or including alcohol may call for adults to take 1 tbsp per dose and kids 1 tsp. Recipes should provide a recommended dosage.

I strongly suggest using distilled or purified water and organic ingredients whenever possible. Homemade syrups will look watery compared to products you may purchase from large manufacturers, and this is due to the sugar content. 65%-70% of the syrup needs to be sugar to keep shelf stable for mass production, which is a lot of sugar! The option of making your own products with less sugar is a more palatable option. And don’t forget to label your product, including the date so you’ll know when it has expired.

I like to take elderberry syrup if I’m feeling that tickle in the back of my throat suggesting I could be coming down with something. I’ll also take a dose if I am exposed to someone with a cold, and before visiting crowded spaces or engaging with lots of people during flu season. I may take elderberry syrup every 3-4 hours if I am battling a cold virus, but for no more than a few days. I advise against taking it more frequently or more than 6 times a day.

Everyone is different, so it is always a good idea to check with your healthcare providers before starting a new herbal product. Elderberry is a diuretic and an immune modulator, so if you are taking any diuretic medications, laxatives, immunosuppressants, or chemotherapy you should most definitely check with your prescribing doctor first before taking elderberry. I cannot offer advice regarding whether elderberry is a good fit for you unless I am your provider. However, my hope with this article is to provide practical information to help ensure the safe and effective use of elderberry.

References:

[1] Krawitz, C. & Mraheil, M. A. & Stein, M. & Imirzalioglu, C. & Domann, E. & Pleschka, S. & Hain, T. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC complementary medicine and therapies. 2011, vol. 11:16. Available at: doi: 10.1186/1472-6882-11-16.  

[2] 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. The Journal of international medical research. 2004, vol. 32. P. 132-140. Available at: doi: 10.1177/147323000403200205.

[3] Mocanu, M. L. & Amariei, S. Elderberries – A source of bioactive compounds with antiviral action. Plants (Basel). 2022, vol. 11:6. P. 740. Available at: doi: 10.3390/plants11060740.

[4] Tiralongo, E. & Wee, S. S. & Lea, R. A. Elderberry supplementation reduces cold duration and symptoms in air-travellers: A randomized, double-blind placebo-controlled clinical trial. Nutrients. 2016, vol 8:4. P. 182. Available at: doi: 10.3390/nu8040182.  

[5] Wieland, L. S. & Piechotta, V. & Feinberg, T. & Ludeman, E. & Hutton, B. & Kanji, S. & Seely, D. & Garritty, C. Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC complementary medicine and therapies. 2021, vol. 21. P. 112. Available at: doi: 10.1186/s12906-021-03283-5. 

[6] Ulbricht, C. & Basch, E. & Cheung, L. & Goldberg, H. & Hammerness, P. & Isaac, R. & Purkh, K. & Khalsa, S. & Romm, A. & Rychlik, I. & Varghese, M. & Weissner, W. & Windsor, R. C. & Wortley, J. An Evidence-based systematic review of elderberry and elderflower (Sambucus nigra) by the natural standard research collaboration. Journal of dietary supplements. 2014, vol. 11:1. P. 80-120. Available at: doi: 10.3109/19390211.2013.859852. 

[7] Robinson, V. & Patrick, K. B. Effect of heat on the antibacterial activity of honey on bacterial isolates. European journal of pharmaceutical and medical research. 2019, vol. 6:11. P. 463-467.