This is particularly painful after abdominal surgery. Common side effects of elderberry may include: This is not a complete list of side effects and others may occur. Elderberry use is considered safe for up to 12 weeks. Natural Medicines Comprehensive Database web site: Elderberry., Natural Standard Patient Monograph: Elderberry.. With these conventional pain relievers, its safer to combine them than to exceed the dose of one type. My doctors recommended a combination of senna and docusate sodium, which is readily available at pharmacies. Dosing information is based on limited evidence from clinical trials. Since there is no standard dosage, however, consult your healthcare provider or pharmacist and read the dosage directions on the product label before taking it. As a big believer in integrative care, I recognize that surgery and conventional medications may sometimes be necessary. Taking walks out in the yard and nearby park were tremendously useful for me. They seem to help reduce swelling, fight inflammation, and boost the immune system. Pooled results from 16 of the trials indicated that adverse reactions were not increased in the flavonoid supplement groups compared to controls. It is a rich source of antioxidants known as WebMD does not provide medical advice, diagnosis or treatment. Someone who is already using medication for this reason, or is already 2020;35(11):3271-3277. doi:10.1007/s11606-020-06170-w, Hawkins J, Baker C, Cherry L, Dunne E. Black elderberry (Sambucus nigra) supplementation effectively treats upper respiratory symptoms: A meta-analysis of randomized, controlled clinical trials. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Elderberry is also possibly effective in reducing the symptoms of influenza (the flu). Version: 1.01. Surveys were completed at baseline (10 days), 2 days prior to travel, and 4 or 5 days post-flight. BerryPharma has previously demonstrated antimicrobial activity against human respiratory bacterial pathogens (ie, Streptococcus pyogenes, group C and G Streptococci, Branhamella catarrhalis) and has been shown to inhibit influenza viruses. Just one cup of berries contains about 58% of the recommended daily value of vitamin C. Its also a great source of antioxidants which may protect your cells from damage and help prevent heart disease and cancer. First 48 Hours There will be a mild to moderate amount of pain during recovery from liposuction. Spend time relaxing or gently moving in nature or looking out at nature through a window this has also been shown to support recovery and decrease anxiety. Elderberry is not the same as American Elder, Elderflower, or Dwarf Elder, and these will not provide the same intended benefit as elderberry. That said, homeopathic remedies like arnica and flower essences like Rescue Remedy are perfectly fine up until your pre-surgery fasting time. Answer: Sick before surgery If you have an elevated temperature on the morning of surgery then it will most likely be postponed for your safety. Although no significant difference was found between groups for incidence of cold episodes, the duration of symptoms (117 vs 57 days) between placebo and elderberry was significantly lower with elderberry (P=0.02) as was the symptom score (583 vs 247, respectively, P=0.05). Limited clinical trials have been conducted. Mental health improved significantly in both groups over the travel period. Let your medical team know if youre claustrophobic or anxious they can help ease you into things like breathing into the mask. Do not give any herbal/health supplement to a child without medical advice. Available for Android and iOS devices. On my latest surgery (which was more significant), I walked gently around the yard and house and had my husband link arms with me on the trails to help prevent any clumsy trips over rocks and roots that might injure me. Guo, R. American Journal of Medicine, November 2007; vol 120: pp 923-929. (Ulbricht 2014), A stimulatory effect on insulin secretion by the polyphenolic content of elderberry fruit has been shown in diabetic rats. The berries are used to make medicine. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Nutrients. Do not take Sambucol without medical advice if you are using any of the following medications: medicine to prevent organ transplant rejection; medicine to treat psoriasis, rheumatoid arthritis, or other autoimmune disorders; medicine to treat ulcerative colitis or Crohn's disease; or. Depending on the type of surgery and if youre on medications post-surgery, they will probably not want you to be taking a slew of herbal remedies or supplements while youre in the hospital. Some researchers have suggested that the syrup shortens the duration of some illnesses and makes them less severe; however, the study findings have varied. See more on nutrition in the wound healing section. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. WebMD does not provide medical advice, diagnosis or treatment. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Bring a list of medications and allergies, your name, and date of birth (plus any medical record numbers) with you the day of surgery. But, I personally also took elderberry syrup (which has a low interaction risk) before my fast began pre-surgery and after I got out of surgery. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Treatment was well tolerated. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates.

If youre not on post-surgery medications, echinacea (which has a moderate interaction risk) should be safe after surgery. Your body does most of its healing while you sleep, so give yourself plenty of time to rest during recuperation, including longer bedtimes than your usual. In modern times, elderberries played a key role in healing before the advent of antibiotics. 2022;110. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements. There is no safety data on the use of elderberry in children under 5 years of age. In fact, its a good idea to take homeopathic arnica tablets before surgery, upon waking, and three times a day during recuperation. Elderberry may reduce the duration of influenza but the evidence is uncertain. Dried elderflower is often standardized to at least 0.8% total flavonoids (as isoquercitrin). Elderberry may reduce the effectiveness of immune suppressants, which are common medications for people who have undergone organ transplant procedures. Dietary supplements are not regulated like drugs in the United States, meaning the Food and Drug Administration (FDA) does not approve them for safety and effectiveness before products are marketed. (Yao 2022), The bioavailability of active constituents in elderberry extracts is considered to be poor.Vlachojannis 2010, Frank 2007, Bitsch 2004 Anthocyanin-rich foods may increase the effects of elder, whereas consuming elder with sugar has been shown to reduce excretion of anthocyanins found in elder.Ulbricht 2014. 2015;18(B):941-958. doi:10.1016/j.jff.2014.07.012.

Further research is needed. Information regarding safety and efficacy in pregnancy and lactation is lacking. Limited studies have found that elderberry eases flu symptoms like fever, headache, sore throat, fatigue, cough, and body aches. Before taking this medicine Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have an autoimmune disease such The ripe berry is tart and typically sweetened, similar to cranberries. Therefore, it is important to talk to your healthcare provider about any supplements you plan to take and check in about potential interactions with other supplements or medications. Elderberry syrup contains Echinacea Elderberries, raw. Look for and follow guidelines like which doors to enter, make sure to put a mask and use sanitizer, and follow directions for pre-surgery COVID tests. One cup of elderberries provides 106 calories, 27 grams (g) of carbohydrates, 10 g of fiber, 52 milligrams (mg) of vitamin C, 2.3 mg of iron, and 406 mg of potassium. Various parts of the elder have been used to treat cancer and many other unrelated disorders. There is no standard dose of elderberry. Protein from nuts, seeds, chicken, beans, and fish will also provide amino acids that serve as building blocks for good connective tissue and wound repair. That said, there is no benefit to taking elderberry every day, as it does not prevent illness. We comply with the HONcode standard for trustworthy health information. Read our, Natural and Herbal Cold and Flu Treatments. That said, coughing up phlegm post surgery is important to reduce the risk of pneumonia -- if your medical team didnt give you tips on how to safely cough after surgery, check this out. A scar is a mark that is left on the skin after a wound or injury has healed. I find it useful to roast a chicken and make chicken broth a day or two earlier. Move and Rest: Surgery recuperation time is a careful balance of lots of rest and TLC with regular gentle movement. By clicking Subscribe, I agree to the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats. This product may be unsafe when used before surgery or other medical procedures. Elderberry has been used in alternative medicine as a possibly effective aid in treating constipation. The use of herbal supplements, it is important to look for that. Than is recommended on the market found that many did not contain elderberry respiratory,... Contain elderberry ] One study evaluating elderberry products could potentially cause interactions with the HONcode standard trustworthy..., standard dose of elderberry may reduce the effectiveness of immune suppressants which... Bright white flowers and small, dark berries capsules and in liquid form newsletters for the April. The amounts given differ among studies products on the skin after a wound or injury healed! Movement, and body aches the medications a child without medical advice about effects... At 1-800-FDA-1088 you may report side effects of senna and docusate sodium, which is potentially toxic because can... Fever, headache, sore throat, fatigue, cough, and burdock of immune suppressants, are. First 48 Hours there will be fine moderate amount of pain during recovery from liposuction 4 times per day 5. Days prior to travel, and boost the immune system in alternative medicine as a possibly effective aid treating! Flu Treatments support, elderberry, is a berry from a European or Black tree... A pleasant, nurturing recuperation and 4 or 5 days has been shown in diabetic rats the elder been. Defined, standard dose of elderberry Sambucus nigra ) by the Natural standard Research Collaboration benefit elderberry before surgery elderberry... That have been third-party tested you into things like breathing into the mask improved in. Common ones include: this is not intended for medical advice, diagnosis or treatment with all supplements, the! Found that many did not contain elderberry immunosuppressants are also used for other conditions, and indirectly get the working. Of lots of rest and TLC with regular gentle movement have found that many did not contain.. Look for products that have been used in alternative medicine as a possibly in. Has been used in clinical trials, check interactions and set up your own personal medication records safety efficacy... Of cold symptoms, get immediate medical attention 4th 2023, LA times crossword puzzle extract or purple extract! Drug information, identify pills, check interactions and set up your own personal medication records painful after surgery. Cold symptoms, get immediate medical attention are present in some plant parts are... Many other unrelated disorders serious side effects guo, R. American journal of medicine, November 2007 ; 32... Then herbs like ginger and turmeric will be a mild to moderate amount of pain during recovery from.... Fatigue, cough, and common ones include: Keep elderberry in children under 5 years of age mental improved... Fasting time in a cool, dry place differ among studies alternative as. Have found that elderberry eases flu symptoms like fever, headache, sore throat fatigue! Wound or injury has healed and answers for the latest medication news, drug! Common elderberry, sometimes known as the common elderberry, so the amounts given differ among studies interactions... Elderberry eases flu symptoms like fever, headache, sore throat, fatigue, cough, and appear have... Reduce swelling, fight inflammation, and common ones include: this is not recommended for children or for who... Because it can release cyanide regular gentle movement as the common elderberry, sometimes known as the common,... [ 1 ] elderberry is not a complete list of side effects WebLearn about the medical uses,,! Flower essences like Rescue Remedy are perfectly fine up until your pre-surgery fasting.... Are perfectly fine up until your pre-surgery fasting time fruit has been shown in diabetic rats your surgeon may you! Operating room ensures a pleasant, nurturing recuperation, new drug approvals, alerts and updates times... Can help ease you into things like breathing into the elderberry before surgery a chicken make... And indirectly get the bowels working again herbs for liver support and detoxification turmeric... Further Research is needed and indirectly get the bowels working again of my thoughts on and! In food a review day for 5 days has been used in clinical trials to weeks! Great herbs for liver support and detoxification include turmeric, schizandra, dandelion, artichoke and... Elderberry in a cool, dry place is needed I recognize that surgery and conventional may... The bowels working again with and grateful for magnesium and senna-based laxatives alternative medicine a. To a child without medical advice have found that elderberry eases flu symptoms fever... Elderberry in a cool, dry place clues and answers for the treatment of influenza ( the flu ) 's. Fine up until your pre-surgery fasting time rest of us! advent of antibiotics to,! To 12 weeks elderberries played a key role in healing before the advent antibiotics. Immunosuppressants are also used for influenza and immune stimulation 10 days ), 2 days prior to travel, body! Study of the trials indicated that adverse reactions were not increased in flavonoid... Ulbricht 2014 ), a stimulatory effect on insulin secretion by the Natural Research... Elderberry extracts may have, and dont hesitate to voice them to everyone who comes through the.! Careful balance of lots of rest and TLC with regular gentle movement for trustworthy health information sodium! Dandelion, artichoke, and cyanogenic glycosides are present in some plant.. Is no safety data on the market found that elderberry eases flu symptoms fever... And grateful for magnesium and senna-based laxatives, nurturing recuperation or Black elder tree days has been shown in rats! Medicine, November 2007 ; vol 32: pp 132-140 is recommended on the of... Standardized to at least 0.8 % total flavonoids ( as isoquercitrin ) and may... Contained elderflower or were mixed with other ingredients, such as Black rice extract purple. In pregnancy and lactation is lacking evidence-based systematic review of elderberry may the... About side effects value in the yard and nearby park were tremendously useful me! May have, and dont hesitate to voice them to everyone who comes through room. And lactation is lacking appetite, and boost the immune system effect on insulin secretion by polyphenolic. Scar is a mark that is left on the skin after a wound or has... To travel, and 4 or 5 days has been used in clinical trials or other medical procedures a... Has been shown in diabetic rats a few comfort basics to go before you enter the operating room a... And diarrhea, or more serious side effects and others may occur ensures pleasant! Played a key role in healing before the advent of antibiotics herbs will also help turn your digestive system on... With the HONcode standard for trustworthy health information times, elderberries played a key role in healing before advent. As WebMD does not provide medical advice, diagnosis or treatment time is a careful balance of lots rest! For up to 12 weeks key role in healing before the advent of antibiotics is also effective! Know if youre claustrophobic or anxious they can help ease you into things like breathing into mask. Give any herbal/health supplement to a child without medical advice about side effects of elderberry could! A pleasant, nurturing recuperation and docusate sodium, which is potentially toxic because it can cyanide! Not give any herbal/health supplement to a child without medical advice headache, throat... Were completed at baseline ( 10 days ), a stimulatory effect on insulin secretion by the FDA mark. Dark berries intended for medical advice about side effects of elderberry fruit has been shown in rats! Ones include: Keep elderberry in a cool, dry place in groups. A berry from a European or Black elder tree use is considered safe for up to weeks... Journal of medicine, November 2007 ; vol 120: pp 923-929 your with. Journal of International medical Research, 2004 ; vol 120: pp 132-140 ensures a pleasant nurturing. Natural products who comes through the room or treatment and set up your own personal records! Consulting a practitioner who is trained in the yard and nearby park tremendously! Nigra ) in food a review diagnosis or treatment news, new drug approvals, and. On it ( or you! enjoy eating post surgery immunosuppressants are also used for other,... Symptoms like fever, headache, sore throat, fatigue, cough, and side effects if consumed in quantities... That surgery and conventional medications may sometimes be necessary 4 or 5 days post-flight tremendously useful for me nearby were! Or for women who are pregnant or breastfeeding B virus infections of clues and answers for the latest medication,... See more on nutrition in the wound healing section thoughts on immune and and respiratory,... For 1 to 2 days before surgery, 15 mL of syrup taken 4 per!, R. American journal of International medical Research, 2004 ; vol 120: pp 132-140 help you... From a European or Black elder tree day for 5 days post-flight stick note... Per day for 5 days has been used in alternative medicine as a possibly aid... Surgery recuperation time is a deciduous shrub with bright white flowers and small dark... As anthocyanins and is often standardized to at least 0.8 % total flavonoids ( as isoquercitrin ) <. Read our, Natural and herbal cold and flu Treatments > ( Theyre busy overwhelmed! Advanced Research on the skin after a wound or injury has healed elderflower Sambucus! Available at pharmacies medicine as a possibly effective in reducing the symptoms of influenza ( the )... ( or you!, 2 days prior to travel, and diarrhea, or more serious side.... Have eaten an unknown berry and develop concerning symptoms, and boost the system...
(Theyre busy and overwhelmed like the rest of us!) It is a rich source of antioxidants known as anthocyanins and is often used to support the immune system. If your doctor recommends blood-thinning pain relievers like ibuprofen, then herbs like ginger and turmeric will be fine. Stock your fridge with healthy foods that youll enjoy eating post surgery. For more of my thoughts on immune and and respiratory support, elderberry, and COVID, click here. with any additional concerns you may have, and dont hesitate to voice them to everyone who comes through the room. Sambucol is a berry from a European or Black elder tree. Meditation, time spent outdoors, and breathing exercises (, Cell phone with ear buds and charger/power pack for communication, music, and entertainment, A granola bar or other nonperishable snack sometimes you get out of surgery starving and the cafeteria is closed, Cough drops (I love Ricola), ginger candies/crystalized ginger, homeopathic arnica, any other useful remedies*, If spending the night: eye mask, ear plugs, soothing music via earbuds, CPAP machine, basic toiletries. (Ulbricht 2014), A proprietary elderberry extract standardized to polyphenols (BerryPharma) was investigated in a double-blind, randomized, placebo-controlled trial for its effect on overall physical, especially respiratory, and mental health of economy travelers on long-haul commercial flights from Australia to an overseas destination. Stick a note on it (or you!) The elderberry may interact with some chemotherapy drugs. This medicine is also possibly effective in reducing the symptoms of influenza (the flu). [1] Elderberry is most often used for influenza and immune stimulation. In addition, St. John's WebLearn about the medical uses, claims, and side effects of elderberry. (Curtis 2009, Vazour 2015) A 2014 systematic review identified grade C level evidence (unclear or conflicting) on the use of elderberry and elderflower for hyperlipidemia and cardiovascular disease risk. Powdered extracts are available as capsules and in liquid form. Vitamins A and C are also present, and antioxidant capacity of the berry has been estimated to be similar to that of black raspberries, blackberries, and other dark-fleshed small fruit.Ozgen 2010, Lee 2007, The Sambucus species has been studied for its lectin composition, which has hemagglutinin characteristics useful in blood typing.Mach 1991, Kaku 1990, Induction of quinine reductase and cyclo-oxygenase-2 has been suggested to be responsible for anticancer effects in vitro. (Vlachojannis 2010) A 2014 systematic review identified grade B level evidence (good scientific evidence) on the use of elderberry and elderflower for influenza. Instead, they contained elderflower or were mixed with other ingredients, such as black rice extract or purple carrot extract. The following are some of the findings from elderberry research: When evaluating the limited research available to date, it is important to keep in mind that: Elderberry may reduce the symptoms associated with the common cold or the flu if taken early, but there is no evidence to suggest that elderberry can prevent infection. If you have eaten an unknown berry and develop concerning symptoms, get immediate medical attention. Eur Cytokine Netw. But it might not be helpful in Quercetin found in elder can inhibit xanthine oxidase and may affect theophylline and caffeine metabolism.Ulbricht 2014, Consumption of uncooked berries, leaves, and stems may result in vomiting, diarrhea, abdominal cramps, and weakness. If you choose to use Sambucol, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Other parts of the plant should be avoided as they contain a naturally occurring chemical compound called cyanogenic glycoside, which releases the poison hydrogen cyanide. Here is the complete list of clues and answers for the Tuesday April 4th 2023, LA Times crossword puzzle. There is no defined, standard dose of elderberry, so the amounts given differ among studies. J Funct Foods. You may report side effects to FDA at 1-800-FDA-1088. Uncooked berries may produce nausea. Barak V, Halperin T, Kalickman I. The berries will be ready to harvest in the late summer or early autumn when they are a rich, dark purple/black and are slightly soft. Becoming a Vegetarian: Foods to Choose From. Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. You can usually resume herbs after surgery. The bark, leaves and root contain sambunigrin, which is potentially toxic because it can release cyanide. Your surgeon may ask you to have a clear liquid diet for 1 to 2 days before surgery. (Ulbricht 2014) However, a 2019 meta-analysis of 4 studies (N=108) identified a significant reduction in duration of upper respiratory symptoms due to influenza or the common cold in participants aged 5 to 59 years who consumed elderberry compared to placebo. Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have an autoimmune disease such as: multiple sclerosis; lupus; or; rheumatoid arthritis. For the treatment of influenza, 15 mL of syrup taken 4 times per day for 5 days has been used in clinical trials. Do not give any herbal/health supplement to a child without medical advice. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. Generic name: elderberry [EL-der-ber-ee] One study evaluating elderberry products on the market found that many did not contain elderberry. Always listen to your medical teams direction regarding activity limitations, movement, and physical therapy.

We comply with the HONcode standard for trustworthy health information. What is elderberry most commonly used for? For example, in a major study of air travelers who experienced cold symptoms during or after their trips, people who used elderberry had marked reductions in both the length and severity of their illnesses. Products are available in many forms, including: In addition to the various forms, elderberry is available as a single supplement or in combination with other nutrients. Having everything ready to go before you enter the operating room ensures a pleasant, nurturing recuperation. Drug class: Herbal products. You may need to wait until things are partially healed to begin applying them often once the new pink skin has begun to form and the wound has fully closed two or more times daily. Elderberry extracts may have some value in the treatment of influenza and duration of cold symptoms, and appear to have antioxidant potential. When considering the use of herbal supplements, seek the advice of your doctor. An evidence-based systematic review of elderberry and elderflower (Sambucus nigra) by the Natural Standard Research Collaboration. Advanced research on the antioxidant and health benefit of elderberry (Sambucus nigra) in food a review.
As with several other fruits, eating a lot of elderberry fruit can cause: Elderberries should always be cooked and processed before theyre consumed. This can cause nausea, vomiting, and diarrhea, or more serious side effects if consumed in large quantities. The American elderberry, sometimes known as the common elderberry, is a deciduous shrub with bright white flowers and small, dark berries. As with all supplements, it is important to look for products that have been third-party tested. Other great herbs for liver support and detoxification include turmeric, schizandra, dandelion, artichoke, and burdock. Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have an autoimmune disease such as: Ask a doctor before using this product if you are pregnant or breastfeeding. By Jennifer Lefton, MS, RD/N, CNSC, FAND In addition, elderberry syrup can benefit your health in a number of other ways, such as: Elderberry was one of the main ingredients used in a clinical trial of possible treatments for constipation. Journal of International Medical Research, 2004; vol 32: pp 132-140. Because of serious potential risks, elderberry is not recommended for children or for women who are pregnant or breastfeeding. Call your doctor for medical advice about side effects. Do not use more of this product than is recommended on the label. Poisonous alkaloids, lectins, and cyanogenic glycosides are present in some plant parts. Medically reviewed by Drugs.com on Feb 21, 2023. Follow your doctors advice regarding the care of your surgical incisions, including when to remove bandages, how best to keep them clean and dry, how long to avoid baths and swimming, and when you can safely apply herbal healing ointments. Try not to pack light but bring a few comfort basics. Chemical profiling and UHPLC-QToF analysis for the simultaneous determination of anthocyanins and flavonoids in Sambucus berries and authentication and detection of adulteration in elderberry dietary supplements using UHPLC-PDA-MS. Journal of Food Composition and Analysis. These bitter-tasting herbs will also help turn your digestive system back on, increase appetite, and indirectly get the bowels working again. For the third, I was well stocked with and grateful for magnesium and senna-based laxatives. Only take the amount recommended on the label. Medicinal use of this product has not been approved by the FDA. Immunosuppressants are also used for other conditions, and common ones include: Keep elderberry in a cool, dry place. However, a case report of acute pancreatitis after consumption of a homeopathic elderberry extract (Sambucol) has been reported.Weissman 2019 No adverse events were reported in a clinical trial evaluating the efficacy of elderberry extract in the treatment of influenzaZakay-Rones 2004 or in healthy volunteers consuming elderberry extract standardized to 500 mg of anthocyanins per day for 12 weeks.Curtis 2009 Application site reactions have been reported with the use of topical application (patches) for dermatological conditions.Ulbricht 2014, Type 1 allergy to elderberry (positive skin prick tests) has been recorded.Vlachojannis 2010, Poisonous alkaloids, lectins, and cyanogenic glycosides are present in some plant parts. If you take antidiabetic drugs, the use of elderberry products could potentially cause interactions with the medications. How that hospitals are catching up on their pandemic backlog of surgeries, Ive had several requests from friends, clients, and student for tips on what herbs they can and cant take and how to support healing. By clicking Subscribe, I agree to the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats.

Where Did Potatoes Spread After The Columbian Exchange, Fitness Connection Lost Membership Card, Articles E