Elderberry: Benefits for Colds & Flu, Syrup Recipe and Dosage

Dr. Josh Axe Vitamin Advisor · 4–5 questions

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Elderberry helps your body clear colds and flu faster: started at the first sign of symptoms, elderberry syrup got people over the flu about 2 to 4 days sooner in placebo-controlled trials of 60 and 27 people, and in a placebo-controlled trial of 312 air travelers, those who caught a cold while taking elderberry recovered about 2 days sooner.3104 Take 1 tablespoon of elderberry syrup a day through cold and flu season, and at the first sign of symptoms, 1 tablespoon four times a day for 3 to 5 days.1

Colds and flu are viral infections, and how hard one hits you comes down to two things: how ready your defenses are when the virus arrives, and how fast you respond in the first few days. That's why I work upstream all season, with good sleep, time outdoors, vitamin D and zinc, and then hit an infection hard at the very first sign.11 Elderberry fits both halves of that plan, and elderberry syrup is the first thing in the cold and flu kit in my Top 50 Healing Herbs & Essential Oils protocol.1

Elder has been used for centuries for influenza, colds and sinus trouble, and in 1993, during an outbreak of influenza B in Israel, researchers put elderberry syrup to a placebo-controlled test.37

Did you know?

• Elderberries get their near-black color from anthocyanins, the purple plant pigments behind much of their antioxidant power.41

• The anthocyanin content of elderberries changes with the season: in one variety, it nearly doubled from one year's harvest to the next.5

• In lab tests, a standardized elderberry extract slowed the growth of the strep bacteria behind many sore throats, and of an H5N1 bird flu virus taken from a patient.12

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What is elderberry?

Sambucus, the plant's Latin name, covers several species; American elderberry, Sambucus nigra subspecies canadensis, is the North American cousin of the European black elder.14 Both the flowers and the fruit carry the same family of plant compounds, flavonoids such as quercetin along with anthocyanins.5 Most of the research on this page used extracts of Sambucus nigra berries.34

Elderberry is a fruit that serves as both food and medicine, and Scripture paints that picture: "He causeth the grass to grow for the cattle, and herb for the service of man: that he may bring forth food out of the earth" (Psalm 104:14).1

A short history of elderberry

In traditional medicine, both the flowers and the berries of the elder were used to bring on a sweat, lower fevers and increase urine, and the berries also served as a gentle laxative.5 Elder was also documented as a traditional treatment for diabetes.15

Modern medicine has caught up with that record. In 2018, the European Medicines Agency published its monograph recognizing elder flower, on the strength of its long-standing use, as a traditional remedy for the relief of early cold symptoms in adults and teens over 12.13

Elderberry nutrition facts

Calculated from USDA FoodData Central FDC ID 171727 (Elderberries, raw) at the record's 1-cup weight of 145 grams; daily values are the FDA's adult values.16

A cup of the fruit is a strong source of fiber and vitamin C. As medicine, though, elderberry is valued for its anthocyanins, and the syrups and extracts used in the trials concentrate them.4

What is elderberry good for?

How does elderberry work in your body?

Cold and flu viruses get into your body through the cells lining your nose, throat and lungs, and that's where your immune system meets them first. Elderberry works on the three fronts I teach: it blocks viral entry, tunes your immune response and protects your cells.1 Here's how, step by step:

Those immune messengers are cytokines, the chemical signals your body uses to coordinate its defenses, and elderberry helps modulate them.121 Your gut is the other front, and a week of elderberry juice raised beneficial gut bacteria in a placebo-controlled trial of 18 adults who each tried both drinks.18 The payoff is a cold or flu that clears faster.34

Elderberry benefits, ranked by evidence

I rank elderberry's top uses by the strength of the research: shortening the flu, shortening and easing colds when you travel and reducing upper respiratory symptoms.1 Growing research covers sinus relief, blood sugar, gut health and antioxidant and heart support.

When should you take elderberry for a cold or flu?

Every flu trial on this page started elderberry within 48 hours of the first symptoms, and the placebo-controlled 1993 outbreak trial enrolled people within 24 hours.3710 That's how I handle it myself. If you want to shorten a cold or flu, the most important time to take a supplement or make a change is on the front end.26 When I can tell I'm starting to fight something, I get a nutrient IV with vitamin C, lysine and glutathione and start taking my elderberry, echinacea and vitamin D right away, and the last time I did that, I hardly had any symptoms at all.26

Pair it with the rest of the plan: ginger and thyme tea, a pot of chicken bone broth and plenty of rest, and our guide to natural cold remedies covers the rest of your toolkit.11

Prevention comes first. Get good sleep, exercise, spend a lot of time outdoors, and take some preventive supplements ahead of time: vitamin C and zinc, your vitamin D, especially in the fall and winter months, and herbs such as elderberry, reishi mushroom and astragalus.11

The holidays are when this matters most, with full houses and long flights. If people in your house are sick, go ahead and start doing those remedies right now.11 For a trip, the placebo-controlled air-traveler trial's schedule is a good model: start elderberry 10 days before you fly and keep taking it until a few days after you arrive.4

How does elderberry compare with flu medicine?

A hot drink of echinacea with elderberry juice held its own against the antiviral drug oseltamivir in a large trial.27 The trial enrolled 473 people ages 12 to 70, nearly all of them adults, in the Czech Republic within 48 hours of their first flu symptoms. One group took the drink, 5 mL of syrup stirred into hot water five times a day for 3 days and then three times a day for 7 days, and the other took oseltamivir for 5 days; neither the people nor the researchers knew who got what.27 Among the 420 who completed the trial as planned, 50.2% of the drink group had recovered by day 5, against 48.8% on oseltamivir, and 90.1% by day 10, against 84.8%.27 Complications ran 2.46% on the drink and 6.45% on the drug, a difference too small to be statistically certain, and the drink caused fewer side effects, especially nausea and vomiting.27 The drug helped a few more people recover by the end of day 1, 4.1% against 1.5%.27

Elderberry in Traditional Chinese Medicine

In Traditional Chinese Medicine, the herb has to fit the pattern. I teach that colds and flu come in different types. Ancient practitioners knew that sometimes you have a heat pattern, sometimes a cold pattern and sometimes more of a bacterial or viral pattern, and different herbs suit each one.11

Elderberry is cooling, with a sweet and sour flavor, and it goes to the lungs. It's best for hot-type colds, with fever, sore throat, sweating and body aches, and its flowers are used to open the pores and break a fever.1 That puts elderberry among the cooling foods and herbs, and it matches elder's European reputation as a sweat-inducing, fever-lowering remedy.5 In the placebo-controlled 1993 outbreak trial, fever was among the symptoms that eased within 2 days on elderberry syrup.7

If you run cold instead, with chilled hands and feet, warming ginger is the better match, and at the very start of a cold, a cup of ginger tea goes right beside your elderberry, as it does in my first 3 days.111 Matching an herb's warming or cooling nature, and who it fits best, is often what makes an herb work for you.1

How to use elderberry: syrup, gummies, tea and capsules

The rest of my cold and flu kit is echinacea tincture, eucalyptus oil for steam, oregano oil capsules and holy basil tea.1 Here are the forms and the amounts behind them:

• Syrup: 1 tablespoon a day through the season; at the first symptoms, 1 tablespoon four times a day for 3 to 5 days.1 The placebo-controlled flu trials gave 1 tablespoon up to four times a day.37

• Lozenges: 175 mg of elderberry extract, up to four times a day, the amount tested in a placebo-controlled trial of 64 adults with flu symptoms.110

• Capsules: 300 to 600 mg of a standardized extract a day; the placebo-controlled air-traveler trial used 600 to 900 mg.14

• Gummies: syrup set with gelatin, an easy way to get elderberry into kids; the recipe below makes each gummy about 1 tablespoon of syrup.

• Tea: dried berries simmered in water, or dried elderflowers steeped; recipes below.13

• Juice: 100% elderberry juice; the placebo-controlled blood sugar trial used about 12 ounces a day, split into two servings.18

• Tincture: an extract of the berries, taken in a little water as the label directs.

For everyday immune support, Dr. Will Cole and I list elderberry among the top herbs for immune health in Heal Your Cells, at 300 to 600 mg a day of a standardized extract or 1 to 2 teaspoons of syrup; through cold and flu season, I recommend a tablespoon of syrup a day.281 Elderberry is also one of the easiest herbs to get kids to take.1

How to choose an elderberry supplement

Check the label for the Latin name, Sambucus nigra, and the plant part, and choose a standardized extract that matches the studied dose.1 The capsules in the placebo-controlled air-traveler trial, for example, were standardized to 15% anthocyanins, and the placebo-controlled flu trials used a standardized black elderberry syrup.43 For a syrup, look for one made from black elderberry, and use it at the tablespoon amounts above.

Homemade elderberry syrup and other elderberry recipes

Elderberry syrup is simple to make from dried berries, and a batch made before the holidays keeps your family covered when the season hits. Cooking is the key step: it eliminates the compounds in raw berries that upset the stomach.829 Sweeten it with raw local honey or Manuka honey, stirred in once the syrup has cooled so you don't cook the honey.

Ceylon cinnamon, ginger and cloves add warmth and flavor, so you can swap the spices to your taste. For a honey-based syrup aimed at coughs, see our homemade cough syrup.

Beef gelatin from grass-fed cattle sets the gummies and adds a little protein, and one gummy gives you the daily tablespoon of syrup.

Elderberry side effects and who should be careful

Prepared elderberry is well tolerated. In the placebo-controlled trial of 312 air travelers, side effects were uncommon and none could be tied to elderberry, and in a placebo-controlled trial of 52 women, 500 mg a day of elderberry anthocyanins for 12 weeks left liver and kidney function in normal ranges.419

Raw berries, leaves and stems. Raw or unripe elderberries and the leaves and stems contain cyanide-producing compounds that can cause nausea, vomiting and severe diarrhea; cooking eliminates this toxin.8 In 1983, 11 of 25 people at a gathering in California developed nausea and vomiting within 15 minutes of drinking juice pressed from raw wild elderberries crushed with their leaves and branches; 8 were flown to a hospital, and all recovered quickly.9 In American elderberry, these compounds run highest in the stems and green berries, and commercial juice tested had none in measurable amounts.14 Never eat raw berries, leaves or stems; use cooked or prepared elderberry only.1 If you make syrup from fresh berries, use only ripe, dark berries, strip off every stem and cook them well. Vomiting, dizziness or numbness after a homemade preparation means stop and get medical care.9

Autoimmune disease. With autoimmune disease, I recommend asking your practitioner first, because elderberry raises immune messengers in lab studies.121

Pregnancy and breastfeeding. Little is known about elderberry's safety in pregnancy, and no data exist on its use while nursing.829 During pregnancy and nursing, avoid most concentrated herbs, elderberry syrups and extracts included, unless your practitioner approves.1

Babies and allergies. Never give syrup or gummies made with honey to a baby under 12 months. Allergic reactions to elderberry preparations are rare; stop at any hives, swelling or wheezing.29

The bottom line

Elderberry: frequently asked questions

References

1. Axe J. Top 50 Healing Herbs & Essential Oils. DrAxe.com protocol; 2026 (A Letter From Dr. Axe; Elderberry, Herb 05 of 30, p. 11: Best for, Top 5 Uses, How to Take It, How It Works, Traditional Chinese Medicine Profile, Use Caution; Ginger, p. 7, Traditional Chinese Medicine Profile; Your Natural Medicine Cabinet, cold & flu kit; Safety & interactions, pregnancy and nursing; Scripture & God's pharmacy, Psalm 104:14).
2. Roschek B Jr, Fink RC, McMichael MD, Li D, Alberte RS. Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry. 2009;70(10):1255-61. doi:10.1016/j.phytochem.2009.06.003. PMID:19682714
3. 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. J Int Med Res. 2004;32(2):132-40. doi:10.1177/147323000403200205. PMID:15080016
4. Tiralongo E, Wee SS, Lea RA. Elderberry Supplementation Reduces Cold Duration and Symptoms in Air-Travellers: A Randomized, Double-Blind Placebo-Controlled Clinical Trial. Nutrients. 2016;8(4):182. doi:10.3390/nu8040182. PMID:27023596 (PMC4848651)
5. Młynarczyk K, Walkowiak-Tomczak D, Łysiak GP. Bioactive properties of Sambucus nigra L. as a functional ingredient for food and pharmaceutical industry. J Funct Foods. 2018;40:377-390. doi:10.1016/j.jff.2017.11.025. PMID:32362939 (PMC7185606)
6. Hawkins J, Baker C, Cherry L, Dunne E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. Complement Ther Med. 2019;42:361-365. doi:10.1016/j.ctim.2018.12.004. PMID:30670267
7. Zakay-Rones Z, Varsano N, Zlotnik M, Manor O, Regev L, Schlesinger M, et al. Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. 1995;1(4):361-9. doi:10.1089/acm.1995.1.361. PMID:9395631
8. National Center for Complementary and Integrative Health. European Elder (Elderberry). NCCIH; accessed October 26, 2026.
9. Centers for Disease Control (CDC). Poisoning from elderberry juice--California. MMWR Morb Mortal Wkly Rep. 1984;33(13):173-4. PMID:6422238
10. Wieland LS, Piechotta V, Feinberg T, Ludeman E, Hutton B, Kanji S, et al. Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC Complement Med Ther. 2021;21(1):112. doi:10.1186/s12906-021-03283-5. PMID:33827515 (PMC8026097)
11. Axe J. How to Prevent & Heal Cold & Flu Naturally (Foods, Supplements, & Herbs for Rapid Recovery). The Dr. Josh Axe Show. 2024 (heat and cold patterns of cold and flu, at 02:24; elderberry against viral infections, with echinacea, at 14:09; the first 3 days, at 27:45; chicken bone broth when sick, at 28:12; prevention with sleep, the outdoors, vitamin C, zinc, vitamin D, elderberry, reishi and astragalus, at 33:41; fighting it fast and starting remedies when people in your house are sick, at 34:09; YouTube: https://www.youtube.com/watch?v=jw-cciZ5TTY).
12. Krawitz C, Mraheil MA, Stein M, Imirzalioglu C, Domann E, Pleschka S, et al. Inhibitory activity of a standardized elderberry liquid extract against clinically-relevant human respiratory bacterial pathogens and influenza A and B viruses. BMC Complement Altern Med. 2011;11:16. doi:10.1186/1472-6882-11-16. PMID:21352539 (PMC3056848)
13. European Medicines Agency, Committee on Herbal Medicinal Products. Sambuci flos (elder flower): EU herbal monograph, Revision 1 (2018); traditional use for relief of early symptoms of common cold.
14. Appenteng MK, Krueger R, Johnson MC, Ingold H, Bell R, Thomas AL, et al. Cyanogenic Glycoside Analysis in American Elderberry. Molecules. 2021;26(5):1384. doi:10.3390/molecules26051384. PMID:33806603 (PMC7961730)
15. Gray AM, Abdel-Wahab YH, Flatt PR. The traditional plant treatment, Sambucus nigra (elder), exhibits insulin-like and insulin-releasing actions in vitro. J Nutr. 2000;130(1):15-20. doi:10.1093/jn/130.1.15. PMID:10613759
16. U.S. Department of Agriculture, Agricultural Research Service. Elderberries, raw. FoodData Central, SR Legacy, FDC ID 171727 (NDB 9088; 1 cup = 145 g). Accessed October 26, 2026.
17. Jund R, Mondigler M, Steindl H, Stammer H, Stierna P, Bachert C, et al. Clinical efficacy of a dry extract of five herbal drugs in acute viral rhinosinusitis. Rhinology. 2012;50(4):417-26. doi:10.4193/Rhino.12.015. PMID:23193534
18. Teets C, Ghanem N, Ma G, Minj J, Perkins-Veazie P, Johnson SA, et al. A One-Week Elderberry Juice Intervention Augments the Fecal Microbiota and Suggests Improvement in Glucose Tolerance and Fat Oxidation in a Randomized Controlled Trial. Nutrients. 2024;16(20):3555. doi:10.3390/nu16203555. PMID:39458549 (PMC11510622)
19. Curtis PJ, Kroon PA, Hollands WJ, Walls R, Jenkins G, Kay CD, et al. Cardiovascular disease risk biomarkers and liver and kidney function are not altered in postmenopausal women after ingesting an elderberry extract rich in anthocyanins for 12 weeks. J Nutr. 2009;139(12):2266-71. doi:10.3945/jn.109.113126. PMID:19793846
20. Murkovic M, Abuja PM, Bergmann AR, Zirngast A, Adam U, Winklhofer-Roob BM, et al. Effects of elderberry juice on fasting and postprandial serum lipids and low-density lipoprotein oxidation in healthy volunteers: a randomized, double-blind, placebo-controlled study. Eur J Clin Nutr. 2004;58(2):244-9. doi:10.1038/sj.ejcn.1601773. PMID:14749743
21. Barak V, Halperin T, Kalickman I. The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. Eur Cytokine Netw. 2001;12(2):290-6. PMID:11399518
22. Macknin M, Wolski K, Negrey J, Mace S. Elderberry Extract Outpatient Influenza Treatment for Emergency Room Patients Ages 5 and Above: a Randomized, Double-Blind, Placebo-Controlled Trial. J Gen Intern Med. 2020;35(11):3271-3277. doi:10.1007/s11606-020-06170-w. PMID:32929634 (PMC7661609)
23. Aghajafari F, Choi B, Bhatt D, Maltoni S, Thomas ET, Rosca EC, et al. Benefits and Harms of Herbal Medicines for Preventing and Treating Acute Respiratory Infections: An Overview of Systematic Reviews. Phytother Res. 2026 (online ahead of print, Oct 6). doi:10.1002/ptr.70464. PMID:42839197
24. Jund R, Mondigler M, Stammer H, Stierna P, Bachert C. Herbal drug BNO 1016 is safe and effective in the treatment of acute viral rhinosinusitis. Acta Otolaryngol. 2015;135(1):42-50. doi:10.3109/00016489.2014.952047. PMID:25496178 (PMC4487568)
25. Rust BM, Riordan JO, Carbonero FG, Solverson PM. One-Week Elderberry Juice Treatment Increases Carbohydrate Oxidation after a Meal Tolerance Test and Is Well Tolerated in Adults: A Randomized Controlled Pilot Study. Nutrients. 2023;15(9):2072. doi:10.3390/nu15092072. PMID:37432227 (PMC10180883)
26. Axe J. The SHOCKING Science of Daily Red Light and Sauna Use. The Dr. Josh Axe Show. 2025 (the front end of a cold or flu as the most important time to act, at 40:54; a nutrient IV, then elderberry, echinacea and vitamin D, and hardly any symptoms, at 41:25; YouTube: https://www.youtube.com/watch?v=pt2mxcJYBEM).
27. Rauš K, Pleschka S, Klein P, Schoop R, Fisher P. Effect of an Echinacea-Based Hot Drink Versus Oseltamivir in Influenza Treatment: A Randomized, Double-Blind, Double-Dummy, Multicenter, Noninferiority Clinical Trial. Curr Ther Res Clin Exp. 2015;77:66-72. doi:10.1016/j.curtheres.2015.04.001. PMID:26265958 (PMC4528044)
28. Axe J, Cole W. Heal Your Cells. 2026 (Reversing Immune Age: Top Supplements and Herbs for Immune Health, #5 Elderberry, p. 327).
29. Drugs and Lactation Database (LactMed). Elderberry. National Institute of Child Health and Human Development; updated 2025 Apr 15. PMID:30000895

Dr. Josh Axe, DC, DNM, CNS

Doctor of Natural Medicine · Founder, DrAxe.com

Dr. Axe is a certified doctor of natural medicine, clinical nutritionist, and multiple New York Times bestselling author. He has spent 20+ years in clinical practice helping people heal at the root cause and founded one of the most-visited natural-health platforms in the world.

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