In the back corner of Eucalyptus Wellness Company, there's a smoothie counter where they serve a drink called the "Immune Delight," a combination of ingredients including coconut milk, bananas, dates, ginger and the incredibly popular elderberry.
In fact, on a neighboring counter of the Mount Pleasant store, there's a shelf and table stacked with individual containers of elderberry syrup, a frequently referenced natural remedy for the cold and flu.
"We have people buying it by the pound," said Jennifer Emplit, the store's owner and a certified natural health professional.
With cold and flu season in full effect, it’s not uncommon for people to take preventive measures to protect their body. For some, that includes increased hand-washing and the daily use of multivitamins. And while medical professionals agree that the flu shot is one of the most highly recommended and common measures to prevent influenza, natural health enthusiasts claim other remedies such as elderberry syrup and essential oils can complement the vaccine.
"A lot of people are coming around," said Emplit, who sells an 8-ounce bottle of elderberry syrup for $19.99 at Eucalyptus. “Charleston actually has a huge natural health following.”
But as the popularity of elderberry syrup and other all-natural flu fighters have skyrocketed in recent years, some doctors and public health experts have expressed skepticism about their effectiveness and have called for more detailed scientific studies.
"That's probably the hesitancy," said John Fowler, manager of the in-patient pharmacy for Roper St. Francis.
Elderberry, derived from a tree commonly called the elder tree, is a fruit that's been used for centuries as a natural remedy. Today, it's incorporated into powders, syrups and teas.
The main reason some people believe it can ward off illness stems from the belief that elderberry has an anti-viral component that directly combats the influenza virus. Amber Hoover, a licensed dietitian, frequently takes elderberry syrup for this reason.
"You're getting these antiviral properties,"said Hoover, a frequent customer of Eucalyptus. “I make it (elderberry syrup) all the time in case I need it or some co-workers need it.”
Emplit explained a protein in the syrup prevents the flu virus from replicating in the body. Some studies seem to back this up. In a 2011 study published by the BMC Complementary and Alternative Medicine where they specifically looked at the impact of elderberry on infected cells, they found that Rubini elderberry liquid extract was effective against influenza viruses.
However, one of the main critiques and sources of apprehension surrounding the use of elderberry is the lack of increasingly detailed studies. According to the National Center for Complementary and Integrative Health, some of the products used in these studies tend to have other ingredients mixed in that could also play a role in combating flu symptoms.
Although some research indicates that elderberry may possibly relieve flu symptoms, there isn't enough strong evidence or data to support it's use, according to the center.
“The data is normally anecdotal," said Fowler, the Roper St. Francis pharmacist.
For example, in a 2017 review published by Phytotherapy Research, the authors highlighted the fact that there hasn't been enough research in comparing elderberry-based products to traditional antiviral medications. That makes detailed recommendations for use of the elderberry remedies impractical, they wrote.
Fowler said that this is the main reason why most doctors are apprehensive about speaking out in support of or even against natural health remedies like elderberry syrup.
“It’s not that anybody isn’t curious," he said. “I think there’s a lot of interest in the medical community.”
He said when it comes to medications and treatments, most doctors are going to go with Food and Drug Administration-approved drugs that have been highly studied and reviewed. Most arguments against natural remedies, he said, aren't necessarily attacking their effectiveness, but questioning the lack of certainty.
"It's not to say that it's not effective," he said. “Medicine’s roots are in these natural products."
Essential oils are another example of a debated natural remedy. And these oils aren't relegated to natural food stores. Vicks VapoRub, which features the essential oil derived from the eucalyptus plant, can be found on mainstream pharmacy shelves across the country.
Though some studies have shown essential oil blends may have a slight impact on the influenza virus, many, including Emplit, don't view them as being as effective as FDA-approved medications or elderberry syrup.
“Essential oils can’t do that much except help make you comfortable," Emplit said. "(They) are definitely more preventative.”
Fowler believes that a lot of the emerging curiosity surrounding natural remedies stems from people becoming more health conscious and wanting to mitigate increasing health care and drug costs. According to the national Blue Cross Blue Shield Association, prescription drug prices are expected to increase by more than 130 percent between 2010 and 2025.
Because of this, he said that he definitely sees more people looking at natural alternatives.
But he also highlights that because these are practices that are still in need of greater study, using them does come with a little bit of a gamble. Patients should routinely consult their doctor. “You are by some degree taking a chance," he said.
Emplit, to an extent, agreed.
“It’s a lot of self-education," she said. “Everyone needs to see their doctor when they’re sick.”