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Should retailers recommend elderberry for coronavirus?

Controversy around the “cytokine storm” can finally be put to rest.

Retailers are selling immune support supplements at a record pace in the midst of the COVID-19 pandemic. A number of specific supplement ingredients are typically being sold, including zinc, vitamins C, vitamin D and elderberry.

With elderberry in particular, concern has arisen that the top-selling botanical might be actually bad news for COVID-19 patients because it is alleged to create a “cytokine storm.”

Cytokines are proteins secreted by the immune response within the body. They are known to be pro-inflammatory agents. The cytokine storm is an excessive immune response that may occur in late-stage severe illness, typically occurring when patients reach intensive care. The cell senses it’s being attacked and so unleashes a cytokine storm so the infection invasion does not spread to other cells.

It is known to occur in autoimmune diseases, and can also strike with infections like the flu. And with the COVID-19 disease, it worsens outcomes for patients as it is a primary reason for multiple-organ failure and the acute respiratory distress that is what all those respirators are about.

Simply put, the impact of the cytokine storm is a major reason COVID-19 patients die.

As it relates to botanicals, the cytokine storm first arose in 2009 during the H5N1 flu pandemic. At that time, echinacea and elderberry were talked about as possible herbs that could incite a cytokine storm. But that’s because of an incomplete understanding of cytokines.

“In the lab dish,” said Paul Bergner, director of the North American Institute of Medical Herbalism, “both echinacea and sambucus (elderberry) have been shown to stimulate immune-regulatory cytokines, making the inflammatory response more moderate, as well as inflammatory ones—with a net noninflammatory effect.”

It is this incomplete understanding of the spectrum of cytokine behavior that has led to the confusion around elderberry. That is, elderberry does stimulate cytokines—but cytokines are not all bad, and on the whole are actually good despite their bad-boy reputation.

The elderberry cytokine storm thing,” said herbalist Chris Kilham, known as the Medicine Hunter, “it reported an increase of pro-inflammatory cytokines but what it didn’t report was the corresponding increase in anti-inflammatory cytokines, which is just plain irresponsible. I’m very suspicious that a safe wholesome fruit that’s been consumed by tens of millions of human beings over time would potentially be inflammatory. It makes no sense.”

So recommending elderberry remains a positive notion to tell customers. They can help support a healthy immune response, and that could help a person’s overall immune health constitution.

A 2018 meta-analysis of 180 patients found elderberry supplements could “substantially reduce upper respiratory symptoms.” The study authors suggested black elderberry (Sambucus nigra) could be an effective alternative to antibiotic misuse for upper respiratory symptoms born of viral infections, and could also be safer than the typical pharmaceuticals used for colds and flu.

“I’m not worried about the cytokine storm with elderberry,” said Jacob Teitelbaum, MD, author of "From Fatigued to Fantastic" and a consultant to the Terry Naturally supplements line. “The main thing to prevent a cytokine storm is to give your body a leg up on the virus so you don’t get to that point. I would be giving elderberry. By the time they’re in the hospital you can be sure doctors aren’t giving patients elderberry anyway.”

The conclusion is now clear: Elderberry supplements are positive immune support supplements to recommend, without any fear of a backlash particular to those customers worried about the COVID-19 virus.

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