We have been fielding a lot of questions throughout the COVID-19 pandemic about “the elderberry controversy.” There have been several warnings circulating about the potential catastrophic effects of taking elderberry extracts with COVID-19. The concern is that elderberry extracts may cause a fatal “cytokine storm” in patients affected by COVID-19.

What is a cytokine storm?

The immune system is like a team made up of a lot of different specialists. There are more than a dozen different types of immune cells, each one in charge of different aspects of immune function. They communicate using molecules called cytokines. There are LOTS of different cytokines (think: letters in the alphabet that are used to make words or phrases). When we contract a virus, a specific set of cytokines are released and they tell the virus-killing specialist cells to mobilize and swing into action. In most circumstances, this is how our body wins the battle against a virus, so an increase in those cytokines is usually a very good thing.

If the infection is severe, sometimes this cytokine signal gets stuck in a self-perpetuating loop. It keeps increasing, causing more and more of an immune response. If the immune response gets out of control, it can cause damage to our own healthy cells, sometimes on a large and dangerous scale. This is called a cytokine storm.

In the case of COVID-19, when people develop difficulty breathing and fluid build up, it is due to a cytokine storm. The huge excess of cytokines make the virus-killing cells too aggressive, and they end up damaging lung cells in addition to killing the virus. This can be fatal in some people. Just to clarify, the cytokines that can cause this deadly storm are the SAME cytokines** that are essential for us to have an immune response to the virus at all.

So, some “antiviral” cytokine signal = good
Way too much of that same cytokine signal = bad

How does this relate to elderberry extract?

Elderberry extract produces a small increase in the exact same antiviral cytokines* that we need to fight off things like respiratory viruses.

So, is elderberry safe or not?

It really is a matter of scale. Elderberry extract can produce a 2-6x increase in these cytokines. For the sake of perspective, running a marathon can produce a 100x increase in these same cytokines. A cytokine storm produced by a virus that is severe enough to start causing dangerous respiratory distress is more like a 1000x increase. Taking this into consideration, the elderberry is not really the problem in this scenario.

For mild illness or early stages of illness in an otherwise healthy person, elderberry is theoretically a safe and effective choice for immune support. BUT once a virus-induced cytokine storm has started, adding elderberry would not be helpful, and could add to the already growing storm.

In summary

Elderberry by itself does not cause cytokine storms.

In otherwise healthy people, elderberry extract should be a safe and effective choice for immune support.

In people with underlying health conditions who already have immune imbalances or lung issues (autoimmune, COPD, pneumonia), elderberry might not be the best choice.

If you become infected with COVID-19 and develop lung symptoms, you should immediately STOP taking elderberry for immune support, and contact your healthcare provider.

There are many other herbs and nutrients that can be used to optimize and balance immune function. Elderberry is not our only option!

You can schedule a telehealth appointment with me by calling the Peoples Wellness Center at 512-219-8600. I, as well as the other Peoples Naturopathic Doctors, am also offering discounted mini consultations focusing specifically on immune support. Appointments can be over the phone or via video conference, and all appointments are safe and confidential.
**The cytokines that start the immune response and are also increased by elderberry, echinacea, and beta-glucan concentrates are: Interleukin-1b, TNF-alpha, Interleukin-6, and Interleukin-8.
Becky Andrews, ND*, L.Ac. received her Doctorate of Naturopathic Medicine and Masters in Acupuncture at Bastyr University. She specializes in complex, chronic and “difficult” cases, especially relating to digestive health, fatigue, mood and detoxification. She works extensively with MTHFr and genetic challenges. In addition to seeing patients in Austin, she is faculty at AOMA School of Integrative Medicine.
*Naturopathic Doctors are not currently licensed in the state of Texas.
Consult your healthcare practitioner before changing your medicine regimen in any way.

If you have comments and/or questions about this blog, email us at blog@peoplesrx.com.