Is Elderberry Safe Right Now?

If you are one of the many people that have sworn by elderberry as a helpful tool to get through the colds and flu season, you might be scratching your head at this question. Many people say that a spoonful taken at the first tickle in the throat, helps to nip a cold in the bud, and there is research to support it's use in the fight against cold and flu viruses, and certain bacteria.

But even if you are a elderberry devotee, please read this.

We are in some uncharted waters right now with the new novel Corona Virus (COVID-19). Every day - moment really - there is new information being discovered and disseminated. So it is important to stay informed. According to experts, this COVID-19 virus is not only novel (new), so we don't know really know what we are up against; it is also mutating - so it is basically a moving target. Experts are basically re-writing the "Rule Book" on the fly when it comes to this virus.

I wanted to alert you to some new information that has arisen about COVID-19, how it can potentially progress to more severe illness, and why we might want to perhaps be cautious about supplements that could be stimulating to the immune system. As Dr. Afrouz Demeri, ND - Director of Functional Medicine at the University of California Irvine's Integrative Health Institute says, "Things that may have been safe 3 weeks ago, may not be safe right now."

One severe complication of COVID-19 appears to be something called a "Cytokine Storm" - read this article to learn more.

What is a Cytokine Storm?

“Cytokines are inflammatory immunologic proteins that are there to fight off infections and ward off cancers,” explains Randy Cron, M.D., Ph.D., professor of pediatrics and medicine, and author of the textbook Cytokine Storm Syndrome (Springer, 2019). “But when they’re out of control they can make you very ill.”

Simply put, a Cytokine Storm is when the immune system goes into "severe overdrive" in response to an insult or infection (like a virus). So the inflammatory response - which is normally part of a healing process - switches into something that can be harmful, even lethal. According to Dr. Cron, up to 10% of the population could carry genes that make them more prone to this type of immune system issue.

While a Cytokine Storm is generally very rare with garden variety flu and colds, it appears to be one potential severe complication of COVID-19. Because of this, while experts don't believe elderberry "causes this," there is a concern that certain foods and supplements designed to activate and boost the immune system could potentially exacerbate this mechanism.

So Should We Avoid Elderberry Right Now?

According to this study, one of the ways that elderberry works to ward off colds and flu is that it stimulates cytokine production, which activates the immune response. "In addition to its antiviral properties, Sambucol Elderberry Extract and its formulations activate the healthy immune system by increasing inflammatory cytokine production. Sambucol might therefore be beneficial to the immune system activation and in the inflammatory process in healthy individuals or in patients with various diseases."

But because cytokine storms is one of the concerns for severe cases of COVID, I asked the question about it's safety to a network of doctors and natural health practitioners in March, and not everyone agreed at that time. The general consensus was that since we do not have the data yet, the best approach may be to proceed with caution. The safest, most conservative route would be to avoid elderberry during the COVID-19 outbreak, and other supplements, and interventions that could have the potential to overstimulate the immune system. Some doctors felt that it may be safe (for those without automimmune issues or other conditions) to take for prevention only, or at the first signs of a sore throat; but to stop taking if there is a fever, or lung involvement (this advice may also be a sensible approach during a regular flu and cold season as well).

What About Anti-inflammatories?

So if we are to avoid foods and substances that could promote inflammation, it would make sense that anti-inflammatories such as Advil are safe to take, right? Again - not so fast. According to this article, experts in France warned that anti-inflammatories like NSAIDs may not be helpful or safe with COVID-19. Then according to this article, experts were questioning that notion, saying that the hard data is not there to suggest that Ibuprofen is not safe or effective for treating COVID-19 symptoms. But then, the BMJ (a respected medical journal) published this report stating that NSAIDs should be avoided with COVID-19. The alternative recommendation is to use acetaminophen, but it is important to not exceed recommended doses, as high doses can be toxic to the liver. There are studies underway to look at the use of anti-inflammatories and anti-virals together, but the results are not in yet. We have to remember that one of the reasons our body gets a fever, is because a fever is part of the healing process and helps to make you a less hospitable host to a virus or bacteria. It is when fevers get really high, or we are extremely uncomfortable, that a fever reducer is important. As with all interventions, one must consider the risk/benefit ratio - please talk to your doctor to get his/her recommendations for your situation.