Elderberry Syrup Concerns
There has been a lot of controversy about elderberry syrup that has been going around right now mainly because of some that have voiced their concerns about it based upon one article and it has spread from there.
I am in several integrative and functional medicine groups as well as a very large physician/advanced practitioner group focused on the coronavirus. This has been brought up many times with great discussions at length.
There is a study that a person is referencing the cytokine storm to elderberry which is not enough to really put a blanket statement that no one should be using elderberry syrup while coronavirus is going around. It was pointed out that it is the virus acting on the immune system (and those who have an already weakened system) that is increasing the cytokines causing the storm; not the elderberry that is doing that (or other herbals for that matter). The actions of most herbals are adaptogenic, stabilizing physiological processes based on what the body needs. The likelihood of elderberry syrup alone causing a cytokine storm is rather minimal.
It is all about context and the person. As we know, each person is unique in their biochemical makeup. What works for one person, may not work for another. There is also talk that elderberry should be avoided in those with autoimmune disease and those that are immunocompromised or in an immunosuppressed state. Again, most do fine with elderberry even with these conditions. I have autoimmunity and have not had any issues with elderberry. But again, this is not always the case and one needs to listen to one’s body to feel what may not be working for them. Of course, the best way to determine this is to do specific, detailed laboratory testing which includes a lengthy panel of inflammatory markers, but that is not always available to everyone.
I think elderberry syrup still may be good for proactive use for most people (not all). Some suggest that one should only use elderberry syrup when only symptomatic for the flu. With regards to coronavirus, some recommend taking it prophylactically, while also stating that one should stop once symptomatic.
I think it really depends on the person and how you feel and have responded to it before. And, if you are taking it and you come down with symptoms and do not see any improvements in the 1st 48 hours and actually see worsening of symptoms, then yes, I would recommend discontinuing use and seeking further guidance. Basically, if you are already in a cytokine storm, do not use it because you are already at a bad stage and it’s likely not going to help anyway. At this critical point, one would need emergent, intensive care by a team of healthcare providers.
Do focus on ways that you can optimize your health and wellness. Good nutrition, avoid toxins, restful sleep, reduce stress, keep moving, think positive thoughts and meditate on what we can be grateful for.
I have included further information below from other colleagues. Please do take the time to read and research. If you have a weakened immune system, then take caution. This information is for educational purposes only and is not to be considered medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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What is a cytokine storm and does elderberry make it more likely when you have influenza?
Dr. Song, MD states:
While it’s true that some people have sadly died from influenza and other infections due to a “cytokine storm,” please remember that this is a RARE occurrence and that the media highlights the few and very sad cases of people who die from influenza (some due to cytokine storm, some not).
Of course, they don’t highlight the many 1000s of people who get influenza every year and do not die, including the many more 1000s who have zero or very mild symptoms.
While we don’t understand the exact pathophysiology of the cytokine storm, we know it’s NOT just a problem of immune system OVERREACTION; it’s also a problem of immune system UNDERREACTION. The parts of the immune system that create inflammation are in overdrive, and the parts of the immune system that are supposed to REGULATE and bring this inflammation back to equilibrium is not active enough.
Remember – INFLAMMATION is NOT always bad. Inflammation is our body’s normal response to infection and stress. We need inflammation to heal.
It is inflammation that goes unregulated is the REAL problem.
The cytokine storm involves dysregulation between PRO-inflammatory cytokines, ANTI-inflammatory cytokines, and REGULATORY cytokines.
Do I think that elderberry can trigger or make a cytokine storm more likely when you have influenza?
I really don’t. The centuries of use of elderberry and data on its activity against the influenza virus, its immunoprotective and antioxidant effects leave me with very little concern that its “immunostimulatory effects” will cause your immune system to go haywire. Elderberry has been shown to increase BOTH PRO-inflammatory cytokines and ANTI-inflammatory cytokines, and REDUCE oxidative stress (oxidative stress = free radicals) and may help to REGULATE inflammatory disease like autoimmunity. There have not been case reports of elderberry-induced cytokine storms, and I have not stopped using elderberry for my kids or my patients, even with autoimmune disease. But as with anything, it's always best to check with your naturopathic or functional medicine doctor!”
Originally posted here:
https://www.facebook.com/DrElisaSongMD/posts/866774387001688
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One colleague wrote:
“Elderberry does not induce cytokine storm! The source of this rumor is from a 2001 study published in the European Cytokine Network. The study was double-blind, placebo controlled and randomized. It showed the Elderberry extracted reduced flu symptoms to 3-4 days. Convalescent phase serum showed a higher antibody level to influenza virus in the elderberry extract group, than in the control group. There was no mention of a cytokine storm but within the study there was reference to the enhancement of the pro-inflammatory cytokines after taking elderberry extract that led to the quick and very effective recovery and specifically the
antibody production. The study never mentioned a warning on elderberry, or caution needing to be used because of a concern of a cytokine storm being caused by elderberry.”
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Another wrote:
“Critically important studies emerging from China suggest that for many patients who die of COVID-19, it may be their own immune system, rather than the virus itself, that deals the fatal blow. This is called a cytokine storm.
During a cytokine storm, an excessive immune response ravages healthy lung tissue, leading to acute respiratory distress and leads to frequently fatal multi-organ dysfunction syndrome (MODS).
https://www.vox.com/.../coronavirus-covid-19-deaths-china…”
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Another wrote:
“I keep getting emails and facebook messages about how elder can increase cytokine storm, it raise TNF-a. This is completely untrue in the way those are spreading it around. WHAT IS TRUE is that elder is a CYTOKINE MODULATOR. It modulates inflammation. If too high, it lowers it, if too low it raises it. It is fine to use for viral infection of whatever sort.”
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Another wrote:
“I think there is not a single answer to this situation. It depends on the patient. The reason elderberry can be potentially good against the Corona Virus as some people have suggested, is the increased inflammatory response which is the initial stage of our immune system killing pathogens. It calls in all the many components of the immune system to the site of infection to kill the bug. In some people, taking this may be helpful.
But as the study suggested, the potential danger is the increased IL-6 (interleukin-6) production. If you increase IL-6 in a patient with already high TGFb, (transforming growth factor beta), you will activate and increase the number of Th9 cells. Th9 cells produce massive amounts of IL-9 (interleukin 9) and the effect of this is massive mucus production. Think of Th2 cells which are the drivers of allergies and asthma on steroids. In a respiratory illness, increasing mucus production will not be a good thing.
As we all know, those who are at risk for flu in general and this in particular, are the elderly, the immune compromised (cancer, HIV, immunosuppressive drugs) and typically the young, although they seem to be spared with the corona virus. I would add to this list those who are already suffering from respiratory illness like COPD, asthma, etc. In addition, I think people who run high IL-6 levels should avoid Elderberry. Who is that? Anybody with an elevated CRP. IL-6 also drives CRP.
But IL-6 alone will not raise Th9 levels and activity. You also need elevated TGFb. This also can be tested for and should be when possible if you are thinking to use Elderberry. TGFb when high is made from MDSCs (myeloid derived suppressor cells). MDSC’s rise when the immune system is being inefficient and having trouble clearing infections, resulting in chronic elevated inflammatory levels. It is commonly seen in autoimmune disease. I would add AI patients to those who should not take Elderberry to be on the safe side.
One final thought, no matter how well you treat somebody, some people who get the flu die. Thought should be made to potential liability issues when using a product were a reasonable caution against it can be established in the research. Even if that product has nothing to do with their death.”
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Another wrote:
“Echinacea works best at the beginning of an infection and is adaptogenic. Echinacea induces inflammatory cytokines at the beginning of infection and help with resolution post infection. There’s also a meta-analysis showing that it reduces upper-respiratory infections, especially in those susceptible to them.11,12
Elderberry is also adaptogenic – increasing cytokines in some situations and decreasing them in others. The reason I include it is that it’s anti-viral. There’s research showing it blocks viral uptake. Again, so much research on this that there’s a meta-analysis.13
Do these therapies increase cytokines? Yes. But NOT to the level of cytokine storm. You have to work hard to trigger a cytokine storm. I have not yet seen a situation where an herb can trigger a cytokine storm. We see cytokine storms with super-antigens like staph enterotoxin A, or TSST-1. And in fact, the scientific literature suggests that herbs (including Echinacea) actually decrease cytokine storms.12,16
So yes, wash hands, don’t touch your face, and sneeze/cough into your elbow. And if you want to use herbs, use what you already know. There is evidence.”
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Additional resources:
http://blog.indieherbalist.com/elderberry-and-the-immune-system/
https://avivaromm.com/covid-19-natural-prevention/
https://wintergreenbotanicals.com/2020/03/18/elder/
https://lindseyelmore.com/cytokine-storm-what-causes-immune-system-overdrive/
https://www.naturalmedicinejournal.com/sites/default/files/media/nmj_covid_update_zwickey.mp3
https://c1c17220-5aa6-46c5-a11f-1b9d7595d5fa.filesusr.com/ugd/ee530d_76f64605a3d74bd99dc924a48e341ee7.pdf?fbclid=IwAR0uAvYtBlA5YChrBJo9wgfq_R17UUX1ted0C9c45AplrfUARgz6W6HXYaU
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Image taken from:
https://www.healthline.com/nutrition/elderberry
Posted here: https://www.facebook.com/284412958991231/posts/670633910369132/