There is so much beauty in the community opening to the idea of nature-based support during this uncharted health climate. Although, with the fast speed that information is posted / shared, there is much to decipher & much room for misinformation & theoretical extrapolation. Without giving any specific recommendations, my goal is to provide resources you can research further & ultimately make the decision that best suits you & your family regarding the cytokine response & elderberry use at various stages of COVID-19.
COVID-19 Prevention: From Commonsense to Natural Remedies (& Avoiding Nonsense!) - Aviva Romm, MD
“There’s an enormous amount of information and misinformation circulating on the internet about elderberry, COVID-19, and a phenomenon called ‘cytokine storm.’ The bottom line is that most of the evidence for elderberry is for the treatment of flu when taken during the first 72 hours of symptoms, not for the prevention of either colds or flu, though one study showed a reduced duration and severity of colds (upper respiratory infection) in air travelers compared to those who didn’t use it.
Cytokine Release Syndrome (CRS), or in its extreme, cytokine storm is an immunologic phenomenon that occurs in advanced states of infection, for example, in ARDS, as mentioned above, a potentially severe advanced COVID-19 complication, sepsis, also a possible severe COVID-19 complication, or with certain specific immunologic medications (i.e., monoclonal antibodies). It was considered a major cause of death in the Spanish Flu, SARS, and H1N1 Interleukin-6 is a term often dropped in these conversations because it is an immune mediator that acts as both a pro-inflammatory cytokine but, simultaneously it also acts as an anti-inflammatory.
The association with elderberry and cytokine storm is implausible; elderberry is not able to cause cytokine storm whether used for prevention or infection, or during infection. Were one to be experiencing cytokine storm, one would be far too sick for herbal therapies; this is an ICU/life support level crisis.
Bottom line: elderberry is unlikely, based on what we know at this time, particularly relevant for COVID-19 prevention or even treatment of mild-to moderate symptoms and if you’re concerned about cytokine release syndrome or cytokine storm as a result of this herb, don’t use it.”
Guido Masé's via BotanicWise: An Herbalist Perspective - below excerpt from corresponding slideshow
“There is conflicting, theoretical evidence that elderberry may increase cytokine release in some cases. Elderberry contains immune-active lectins, though more in its leaves. These ramp up immune function and may limit viral incursion into cells, theoretically impacting likelihood of first infection.
What does this mean? Taking elderberry once symptoms are present will not likely be as effective as some of the other measures discussed, and in folks with immune dysregulation or with severe symptoms, might (theoretically) be contraindicated. The likelihood that a hospitalized patient will be taking elderberry is low. Best rely on the medical system for severe cases.”
Seven Song explains the cytokine action further….
“There were some studies showing that Elder increases Interleukin 6 (IL-6), which is the cytokine thought to be one of the major players involved in the cascade of immune responses that create the cytokine storm. It should be pointed out that IL-6 also has anti-inflammatory (immune-modulating) action as well, but here, we will consider its pro-inflammatory status. So since Elder can increase IL-6, and since IL-6 is implicated in the cytokine storm, can Elder increase the chances of this event?”
Seven Song’s continues with his opinion:
“Reducing Elder to just its IL-6 activation is very limiting to what else Elder can do; it is simplifying a chemically complex plant. And having been around many people who have taken this plant in multiple preparations (tinctures, syrups, capsules, etc) and not having seen it create this condition, it seems relatively safe.”
Is Immune Health On Your Mind? - Dr. Bridget Somine, ND
Elderberry is well known for its use in influenza, with at least 3 randomized controlled trials demonstrating improvement in flu symptoms. Elderberries may inhibit the ACE2 receptor, which certain viruses use for cell entry in the lungs. Elderberry has been shown to increase cytokines in one small human study and there have been some concerns expressed about the potential that it could potentiate a cytokine storm in susceptible individuals. I have not seen or heard any case reports on elderberry contributing to a cytokine storm, despite its very broad use as an antiviral.
Furthermore, the impacts of elderberry on the immune system cannot be reduced to cytokine activity alone. Elderberry also acts as antioxidant and probably has a net anti-inflammatory effect. Of course, if you have a sense that elderberry is not right for you, don’t take it!
Herbs For Immunity – Rosalee de la Forêt
“I know of zero actual cases of elderberry stimulating a cytokine storm or CRS. I’m happy to revise my statements if a clear correlation is found; however, I’ve seen elderberry work too many times to now brush it aside because of a hypothesized risk.”
Elderberry: Is it Safe? - Rosalee de la Forêt presented by Learning Herbs
“Many many many things encourage cytokine production. Cytokines are a necessary part of our immune system. Elderberries are often attributed with having a modulating effect on inflammation…. There is absolutely no evidence that elderberries are contraindicated for the coronavirus.”
Plants are powerful & abundance of caution with use is always recommended. Please see this herbal monograph to learn about the elder & its many actions.
Extrapolating data & reducing this plant part to a single action is quite possibly a disservice to the immune modulating actions this berry holds.
Lastly, this article shows how the COVID-19 is presenting uniquely among patients & a multi-faceted Eastern medicine approach is being taken. I find it fascinating to learn how nature-based approaches are being applied at the front lines of care.
I hope this information is helpful for you & your family as we all work together to navigate this uncharted territory.
In health,
Carol
