2 ingredients you need to survive flu season

woman holding cup of tea during cold and flu season

By Dr. Sarika Arora, MD

If you’re like a lot of my patients, you’ve used over-the-counter cold remedies and cough syrups and found they just don’t work. Maybe you’ll get temporary relief of your congestion or cough for a few hours. But often you feel “dopey” and lethargic. And if it’s the flu, rather than a cold, you may not even get that much relief.

This cold and flu season might be a good time to explore two natural remedies — elderberry and manuka honey. Both help reduce symptoms while supporting your natural immune defenses — and they don’t create brain fog.

What are elderberries — and how do they help with colds and flu?

Elderberry is a family of flowering trees that produce red, blue or black berries in the fall. They have been used to make medicines for thousands of years in Europe and North America.

Modern pharmacology has found that black elderberry contains a natural product, sambucol, that:

  • prevents infection with several strains of influenza, including H1N1 (swine flu)
  • reduces the duration of colds (as well as decreasing the overall symptoms)
  • fights viral infections as effectively as the well-studied antiviral medication Tamiflu.

You can find elderberry extract in natural food stores, but be sure to look for a reputable source. You can boil down dried or fresh, ripe elderberries to make your own. But be careful when making your own: unripe berries can be toxic.

elderberries and elderberry tea on a platter

Although elderberry extract by itself helps fight flu symptoms, I recommend pairing it with manuka honey for extra power against colds and flu.

How manuka honey helps with cold and flu

Honey derived from the manuka shrub native to Australia and New Zealand is special. Unlike honey from clover or wildflowers, manuka honey contains a compound called methylglyoxal (MGO) that appears to increase its ability to inhibit bacterial and viral reproduction. In effect, we’re letting the bees extract the active ingredient for us.

One study that focused on the influenza virus shows that not only did manuka honey inhibit viral replication by itself, it also had a synergistic effect when used with an antiviral medication. Meaning, the two together were considerably more effective than either one by itself.

Combining elderberry with manuka honey offers a much greater effect on cold and flu viruses than either one by itself. All without the dizziness and lethargy that many standard over-the-counter cold remedies produce.

It takes a little extra effort to get the healing benefits of manuka and elderberries — but here’s how

You can find a lot of elderberry-and-honey syrups from online sellers, but finding one made with manuka honey can be challenging. Manuka is native only to Australia and New Zealand, so a lot of “manuka” honey sold on the world market has little or no actual manuka in it — and therefore very little or no MGO. Because the supply is so limited, it’s easy to see why you may have to beware of phony manuka honey.

This means that if you want the power of manuka honey combined with elderberry extract, you may have to make your own.

manuka honey in a bottle

Genuine, unadulterated manuka honey comes from several companies that pack and label their products in New Zealand, where manuka is a dominant species. Look for the “Unique Manuka Factor” or UMF certification on the label and verify that the company is out of New Zealand to ensure you’re getting the real thing. Manuka comes in several grades ranging from 5 to 20, based on the amount of MGO in the honey. Grade 20 manuka has the most MGO, and grade 5 has the least. As you might expect, the higher-grade honey is more expensive.

To make a concentrated decoction of elderberries for cold and flu symptoms, try the following recipe:

Elderberry syrup and manuka honey recipe


  • 1 oz dried elderberries
  • Pinch of cayenne
  • 3 C cold water
  • Manuka honey
  • Juice of 1 lemon


1. Combine elderberries and cayenne with water.
2. Bring to a boil, then reduce heat and simmer, uncovered, until liquid is reduced by half.
3. Let cool enough that you can work with it.
4. Strain liquid and press elderberries to remove as much liquid as possible.
5. Add manuka honey to taste.
6. Add juice of one lemon.
7. Store in refrigerator.
8. Take 1 Tbsp or more as often as needed at the onset of sore throat or upper respiratory infection.

Adapted from:
Buhner, SH, Herbal Antivirals: Natural Remedies for Emerging and Resistant viral Infections. North Adams, MA: Storey Publishing, 2013

Get more tips with our article 6 natural remedies for cold and flu season.

Barak V, Halperin T, Kalickman I.

The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. Eur Cytokine Netw. 2001 Apr-Jun;12(2):290-6.

Buhner, SH, Herbal Antivirals: Natural Remedies for Emerging and Resistant Viral Infections. North Adams, MA: Storey Publishing, 2013.

Carter DA, Blair SE, Cokcetin NN, et al. Therapeutic manuka honey: no longer so alternative. Front Microbiol. 2016;7:569. doi: 10.3389/fmicb.2016.00569

“Counterfeit manuka honey causing legal headaches in the US.” New Zealand Herald (28 August 2018). https://www.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=12114712

Duke JA, “Sambucus: American and European elderberry: Family Adoxaceae.” In The Herb Society of America’s Essential Guide to Elderberry, Kirtland, OH: The Herb Society of America, 2013.

Kavasch E. B., “Ethnobotany of elderberry: Some American Indian elderberry uses.” In The Herb Society of America’s Essential Guide to Elderberry, Kirtland, OH: The Herb Society of America, 2013.

Roschek B, Fink RC, McMichael MD, Li D, Alberte RS. Elderberry flavonoids bind to and prevent H1N1 infection in vitro. Phytochemistry. 2009;70:1255-1261.

Tiralongo E, Wee SS, Lea RA. Elderberry supplementation reduces cold duration and symptoms in air-travelers: a randomized, double-blind placebo-controlled clinical trial. Nutrients. 2016;8(4):182.

Watanabe K1, Rahmasari R1, Matsunaga A1, Haruyama T2, Kobayashi N3. Anti-influenza viral effects of honey in vitro: potent high activity of manuka honey. Arch Med Res. 2014 Jul;45(5):359-65. doi: 10.1016/j.arcmed.2014.05.006. Epub 2014 May 29.

Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of Influenza A and B virus infections.” J Int Med Res. 2004;32(2):132-40.