Cytokine Storm & Elderberry —Putting the Myth to Bed

Is elderberry really going to make a so-called “cytokine storm” worse? —Or is it all a bunch of convoluted misinformation and fear tactics? 

To be honest, a few herbalists and aromatherapists in positions of authority haven’t really taken the time to do the work and really dig into the facts and figures, and are basically just saying, “if you are concerned, avoid it.” 

But we assure you. 

The truth is out there…

And we are bringing it to you. 

So, let’s begin with a few questions. 

What on earth does elderberry and echinacea have to do with cytokine storm?

Well, to begin with, elderberry is sort of a generic term for the entire elder bush.

Elder is the common name, and sambucus is the botanical name.

Elderberry syrup is made from the berries of the plant, which develop towards the end of summer in the northern hemisphere, after the plant flowers in spring.

Medicine can be made from the flower, the berries, the leaves, as well as the bark.

Most herbalists however, avoid use of the bark and leaves because it’s much more powerful of an antiviral than the berries and flowers —but if not prepared properly, ie., ‘decocted’ (boiled), then it may cause vomiting in some. However, once ‘cooked’, is generally safe.

When made into a medicinne, sambucus acts as what is known as an immunomodulator, which just brings more questions.

What is an immunomodulator?

To simplify, elderberry, and antivirals like echinacea, help increase and support immune activity for viral infections. Now that you know what elderberry (sambucus) and echinacea do —let’s talk about cytokines. 

What are cytokines?

And what exactly IS a cytokine storm, anyway? 

This would be the first question to answer, because it’s being thrown around like crazy, isn’t it? 

Well cytokine storm is an extreme case of normal cytokine activity in the body.

We will talk more about “cytokine storm” in a bit —but first let’s define “normal” cytokine activity. 

Normal Cytokine Activity 

Cytokines comprise a multitude of different kinds of messenger-type protein molecules found in the body that are generally known to increase when we are fighting an infection of some kind. 

‘Cytokine’ is more of a ‘generic’ term that actually comprises a large group of both anti and pro-inflammatory agents meant to help heal the body. There are also ambivalent cytokines. 

In short, “The naturally occurring anti-inflammatory side of cytokine activity facilitates viral clearance and promotes tissue repair, and regulates the severity of virally-induced storms,” according to Paul Bergner. 

Who knew?

Do you like technical stuff? If so keep reading. If your answer was ‘not so much’, then feel free to skip to the next section.

Cytokines affect nearly every biological process; these include embryonic development, disease pathogenesis, non-specific response to infection, specific response to antigen, changes in cognitive functions and progression of the degenerative processes of aging.”

“Cytokines may be ‘‘good’’ when stimulating the immune system to fight a foreign pathogen or attack tumors. Other ‘‘good’’ cytokine effects include reduction of an immune response, for example interferon b reduction of neuron inflammation in patients with multiple sclerosis. They may be ‘‘bad’’ when their expression causes inflammatory diseases, such as the role of tumor necrosis factor a in rheumatoid arthritis or asthma and Crohn’s disease. Therapeutic modulation of cytokine expression can help the ‘‘good’’ cytokines to generate or quench the immune system and block the ‘‘bad’’ cytokines to prevent damaging inflammatory events,” according to ‘Cytokines: The Good, The Bad, & The Ugly’.

Kind of Cytokines

Some different types include IFN-gamma, CXCL10, 1L-1b, TNF-a, RANTES, MCP, IL-8, and IL-6. —We could go on, but I think you get the picture. 

“Clearly in some contexts (specific cytokines and specific receptors) cytokines can be broadly pro- or anti-inflammatory but it is more complex than this: cytokines can elicit different highly specialised events in different cell types.  In some respects it is useful to categorise cytokines as broadly pro-or anti-inflammatory, after all TNF overexpression has a profound effect in driving rheumatoid arthritis and other inflammatory diseases and IL-10 knockout mice spontaneously deliver colitis but bear in mind that even in the case of TNF it has two different receptors (TNFR1(p55) and TNFR2(p75)) and while TNFR1 signals pro-inflammatory events, TNFR2 is now thought to signal anti-inflammatory events.”

But let’s just emphasize, that during times of infection, cytokine activity is a normal, required part of the healing process and a sign of healthy immune reaction. 

—It occurs when the body needs to fight off something.

So why do elderberry and other herbs, like echinacea come into question… ? 

Where Did This Concern Arise? 

Back in 2009, during the emergence of SARS, herbalists asked the same thing about Echinacea as they are asking about Sambucus, now —is it going to exacerbate cytokine storms and contribute to fatal outcomes?

 People near death have higher than normal cytokine activity, also known as Cytokine Release Syndrome. The concern is that these herbs will add to and exacerbate CRS and contribute to cytokine storm related deaths. 

Now, let’s take a look at the studies. 

The following study says it increased inflammatory cytokines —even so, you will notice that it is still considered to activate the healthy immune system.

“Sambucol was shown to be effective in vitro against 10 strains of influenza virus. In a double-blind, placebo-controlled, randomized study, Sambucol reduced the duration of flu symptoms to 3-4 days… The production of inflammatory cytokines was tested using blood – derived monocytes from 12 healthy human donors… Production of inflammatory cytokines (IL-1 beta, TNF-alpha, IL-6, IL-8) was significantly increased, mostly by the Sambucol Black Elderberry Extract (2-45 fold)… We conclude from this study that, 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,” according to the National Center for Biotechnology Information (NCBI).

In the study below, however, it says sambucus INHIBITED inflammatory cytokine production —notice the above study used elderberry extract, and the below one uses leaf and bark.

I personally would like to see more studies comparing the two forms of elder to see if the effects on the production or inhibition of inflammatory cytokine activity can be replicated —and if it is specific to the form of elder used.  

In another study, “The anti-inflammatory activity of ethanol extracts of the leaf and bark of S. australis (1-100 μg/mL) were studied… Solely the leaf extract showed significant inhibition of (certain inflammatory cytokines)… The results indicate that the ethanol leaf extract of S. australis exhibit prominent anti-inflammatory effects,” which you can read more about here.

The last study we will look at actually says elder is best used after a flu has begun —whereas I always advise using echinacea proactively before exposure. So now we have an official endorsement of what to use before and after viral infection.

“Elderberry extract is effective in treatment of flu… Elderberry showed mild inhibitory effect at the early stages of the influenza virus cycle, with considerably stronger effect in the post-infection phase. Our data further support both direct effects of elderberry extract by blocking viral glycoproteins… In conclusion, elderberry exhibits multiple modes of therapeutic action against influenza infection,” this according to Science Direct.

Ok, ok… Now you know a bit more about sambucus and how it supports the immune system… Let’s take a brief detour to look at how a few other cultures have used (and continue to use) elder. 

Sambucus nigra

“Black elderberry (Sambucus nigra L.) has traditionally been used by Native Americans to treat rheumatism and fever.”

Sambucus Ebulus

“The leaves of Sambucus ebulus L. (Adoxaceae) are widely used in Turkish folk medicine particularly against inflammatory disorders. The fresh leaves after wilted over fire or the poultices prepared are directly applied externally to heal burns, edema, eczema, urticarial and abscess.”

“Both Echinacea and Sambucus have been shown to stimulate immunoregulatory cytokines with a net, non-inflammatory effect.”

This essentially means that these herbs actually dampen the proverbial ‘storm’ or ‘fire’ in the body —adding only to the GOOD cytokines, which supports healing. Yes, there are some exceptions to the rule but overall sambucus appears to be safe, as does echinacea. 

So What Is All the Alarm About? 

A study was published in The Lancet on January 2, 2020 41 early patients with Covid-19 were assessed. 

Of the 41, 22 had shortness of breath within 6 days of the virus taking a foothold. Of the 41, 13 went to ICU, aka the intensive care unit of a hospital. Of the 13, about half died, or 6 or 7. —Those in ICU did have elevated levels of cytokine activity, which is referred to as cytokine storm. 

I am of the opinion, however, that taking these herbs, perhaps in conjunction with ICU and before ICU is a wonderful way to mitigate and prevent the need for ICU, or help people get out of it alive. 

If these patients had been exposed to these herbal protocols sooner, perhaps they could have avoided these outcomes.

According to Red Moon Herbs, “Much of the information coming from traditional Chinese medicine (TCM) practitioners out of China is testifying to doctors using both acupuncture and herbal medicine to deal with the virus. One CNN article referenced a clinical trial in which those being treated ‘holistically’ with herbal medicine were having a 33% higher recovery rate as opposed to those who were not given herbs.”

Stay with us as we finish with one important, final note on elder and cytokines with commentary from world pioneering herbalist, Stephen Harrod Buhner.

Exploring Elder More Deeply

Elderberry products are widely available, so use them if you see fit. However, see below where we discuss the bark and leaves of elderberry as an alternative. ⁠

If you live where the trees grow, the bark is accessible now (in winter), and soon the leaves will bud —after that the flowers, then the berries.

Despite sambuca (elder) getting a nasty reputation by “adversary medical activists,” who, according to Stephen Harrod Buhner, “spread rumors that the plant was poison”, it simply wasn’t true.⁠ It must, however, be prepared properly.

Elderberry is prolific, which tells me we should all be using it all the time, like dandelion.⁠

It is, however, powerful at differing degrees. ⁠

In order of strength: Bark > Leaves > Flower > Berries ⁠

Stephen Harrod Buhner says specifically of elder, “The leaves and bark are far more potent antivirals than the berries or flowers. I would not suggest the berries for use in treating this pathogen (referring to SARS-Cov-2 which causes the Covid-19 infection); they are not, in my opinion, strong enough.” ⁠

Additionally, Stephen provides instructions for making your own elder leaf or bark extract. You can find that here. ⁠

He explains the purpose of decoction (boiling) an herb —specifically elder or elderberry, to deactivate the compounds that normally would cause vomiting.

Cytokine Storm aka CRS (Cytokine Release Syndrome)

So let’s get back to the subject of cytokine storms.

Here are some final thoughts with Stephen Harrod Buhner. 

We discussed how some cytokine activity is normal, but if the body is not successful in shutting the infection down, then what Stephen Harrod Buhner calls an ever-worsening inflammatory cascade occurs. When this happens, the immune system can go into hyperreactivity —or cytokine storm. 

This excess cytokine activity of the body working super duper hard to fight off this particularly strong viral pathogen can cause severe damage to the lungs, potentially taking someone years to recover. 

In the weaker among us, it can and does cause death because cytokine storms can spread throughout the body via the blood, sometimes resulting in sepsis or septic shock A VERY SERIOUS ISSUE. 

Those who survive septic shock are at higher risk of getting it again —and may suffer long term consequences. Organ failure is common when the cytokine storm is out of control. 

So while some cytokines are anti-inflammatory, others are proinflammatory. 

Some particularly dangerous cytokines during a Covid-19 infection include IL-1b, TGF, and HMGB1. 

Overall Cytokine Adaptogen (normalized cytokine dysfunction)
Common Name Latin or Botanical Name
Dan shen, red sage Salvia miltiorrhiza 
TGF Lowering Herbal Allies 
Common Name Latin or Botanical Name
dong quai, female ginseng Angelica sinnensis
Milkvetch Astragalus spp
HMGB1 Lowering Herbal Allies
Common Name Latin or Botanical Name
Dan shen, red sage Salvia miltiorrhiza 
IL-1b Lowering Herbal Allies
Common Name Latin or Botanical Name
Japanese knotweed  Polygonum cuspidatum 
Chinese skullcap  Scutellaria baicalensis 
caterpillar fungus, yartsa gunbu Cordyceps spp
kudzu Pueraria 
boneset Eupatorium perfoliatum 

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