Sage
Scientific Name(s): Salvia officinalis L. (Dalmatian sage), S. lavandulaefolia Vahl. (Spanish sage). 1 Family: Labiatae or Lamiaceae
Common Name(s): Garden sage , true sage , scarlet sage , meadow sage
Uses of Sage
Dried sage leaf is used as a culinary spice and as a source of sage oil. Medicinally, the plant has antispasmodic and carminative properties. Sage leaves, apart from their culinary uses, have been recommended for dyspepsia, excessive sweating, and as a gargle in coughs and colds.
Sage Dosing
Typical dosage is 4 to 6 g/day of the leaf. 2
Contraindications
Contraindications have not yet been identified.
Pregnancy/Lactation
Do not use during pregnancy and lactation because of the lack of clinical trials.
Sage Interactions
None well documented.
Sage Adverse Reactions
Cheilitis, stomatitis, dry mouth, and local irritation. Patients with preexisting hypertension should closely monitor systolic and diastolic blood pressure when using the herb.
Toxicology
No data.
Botany
This small, evergreen perennial plant can attain heights up to 1 m, and its short woody stems branch extensively. The plant is native to the Mediterranean region and grows throughout much of the world. Its violet-blue flowers bloom from June to September. This plant should not be confused with red sage or the brush sage of the desert. 1 , 3
History
The name salvia derives from the Latin salvere , meaning to cure. Traditionally, sage and its oil have been used for the treatment of a wide range of illnesses. Ethanolic tinctures and decoctions have been used to treat various inflammations of the oral cavity and gastrointestinal tract; sage has also been used as a tonic and antispasmodic. The plant has been employed topically as an antiseptic and astringent and has been used to manage excessive sweating. Sage has been used internally as a tea for the treatment of dysmenorrhea, diarrhea, gastritis, tonsillitis, and sore throat. The dried leaves have been smoked to treat asthma. 1 , 3 , 4 , 5 , 6 , 7
Dried sage leaf is used as a culinary spice and as a source of sage oil, which is obtained by steam distillation. The fragrance of the plant is said to suppress the unpleasant odor of fish. Sage oil is used as a fragrance in soaps and perfumes. It is a widely used food flavoring, and sage oleoresin is also used in the culinary industry.
Chemistry
S. officinalis contains essential oil 1% to 2.8%, flavones, phenolic acids, phenylpropanoid glycosides (such as martynoside), triterpenoids, and diterpenes, including phenolic, quinoidal, and rearranged abietane and apianane derivatives. Known compounds of the plant include salvigenin, lupeol, β-sitosterol, stigmasterol, physcion, carnosol, rosmadial, rosmanol, epirosmanol, isorosmanol, columbaridione, atuntzensin A, miltirone, carnosic acid, and 12-O-methyl carnosic acid. 3 , 8 , 9 , 10
Sage oil contains α- and β-thujones that account for about half of the composition of the oil. S. lavandulaefolia and S. officinalis have similar compositions except that S. officinalis has a much higher concentration of thujone, which is toxic in large doses. S. lavandulaefolia also contains variable amounts of camphor, cineol, limonene, camphene, and pinene. Sage oil is often adulterated by the addition of thujone derived from the leaves of Juniperus virginiana (red cedar). 3 , 4 , 6 , 11 , 12
Sage Uses and Pharmacology
Potential usesReview of the scientific literature reveals pharmacological studies on the use of sage as an antioxidant, anti-inflammatory, antibacterial, HIV-1 reverse transcriptase-inhibitor, and in treating patients with Alzheimer disease.
Antioxidant activityTertiary references document sage extracts as having strong antioxidative activities, with labiatic acid and carnosic acid reported to be the active compounds. 3
Antimicrobial activityTertiary references document the phenolic acid salvin and its monomethyl ether having strong antibacterial activity against Staphylococcus aureus . 3
Anti-inflammatory activityAnimal data
The chloroform extracts, in particular ursolic acid, of S. officinalis leaves showed strong anti-inflammatory properties after topical application. Ursolic acid exhibited dose-dependent inhibition of the croton oil-induced ear edema in mice. The anti-inflammatory effect of ursolic acid was 2-fold more potent than that of indomethacin. 13
Gastrointestinal activityAnimal data
There is some evidence that sage oil may exert a centrally mediated antisecretory action; the carminative effect is likely caused by the irritating effects of the volatile oil. 2 , 14
Alzheimer disease and memory enhancementClinical data
The present study did not involve Alzheimer patients and consisted of healthy adults in 2 consecutive trials. In the first trial, 20 participants received 50, 100, and 150 microliter of a standardized essential oil extract of S. lavandulaefolia and placebo. In the second trial, 24 participants received 25 and 50 microliter of a standardized essential oil extract of S. lavandulaefolia and placebo. Doses were separated by a 7-day washout period. The authors concluded that the 50 microliter dose of Salvia essential oil significantly ( P < 0.05) improved immediate word recall in both studies and thus may improve cognition in healthy young adults. 11
Another study involved patients with mild to moderate Alzheimer disease (between 65 to 80 years of age) in a placebo-controlled, 16-week clinical trial. Patients were randomized to receive either placebo or S. officinalis extract. Inclusion criteria consisted of scores of 12 or higher on the cognitive subscale of Alzheimer's Disease Assessment Scale (ADAS-cog) and 2 or higher on the Clinical Dementia Rating (CDR). Main efficacy measures were the change in the ADAS-cog and CDR scores compared with baseline. After 16 weeks, patients taking the S. officinalis extract had a significantly better outcome on cognitive functions than did those on placebo (ADAS-cog: P = 0.03; CDR-SB: P < 0.003). 15
Dosage
Sage leaves, apart from their culinary uses, have been recommended for dyspepsia, excessive sweating, and as a gargle in coughs and colds. Typical dosage is 4 to 6 g/day of the leaf. 2
Pregnancy/Lactation
Do not use during pregnancy and lactation because of the lack of clinical trials.
Interactions
None well documented.
Adverse Reactions
Reported side effects from the ingestion of sage include cheilitis, stomatitis, dry mouth, or local irritation. Cheilitis and stomatitis have been reported in some cases following the ingestion of sage tea. 6 Ingestion of large amounts of the plant extract may cause dry mouth or local irritation according to some reports.
Toxicology
There were no significant side effects reported by healthy patients in 2 clinical trials. 11 , 15 However, in a pilot, open-label study involving oral administration of S. lavandulaefolia essential oil to patients with Alzheimer disease, a significant increase in diastolic and systolic blood pressure was observed in 2 patients with preexisting hypertension. 16 Although sage oil contains thujone, the oil does not have a reputation for toxicity. The oil has been found to be nonirritating and nonsensitizing when applied topically to human skin in diluted concentrations. Spanish sage oil was also nonphototoxic when applied to mice and pigs. 3
Bibliography
1. Chevallier A. The Encyclopedia of Medicinal Plants . New York, NY: DK Publishing Inc; 1996.2. Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs . Newton, MA: Integrative Medicine Communications; 2000.
3. Leung AY. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics . New York, NY: J. Wiley and Sons; 1980.
4. Dobelis IN, ed. Magic and Medicine of Plants . Pleasantville, NY: Reader's Digest Association, Inc; 1986.
5. Simon JE. Herbs: An Indexed Bibliography, 1971-1980 . Hamden, CT: Shoe String Press; 1984.
6. Duke, JA. CRC Handbook of Medicinal Herbs . Boca Raton, FL: CRC Press; 1985.
7. Capek P, Hribalova V, Svandova E, Ebringergova A, Sasinkova V, Masarova J. Characterization of immunomodulatory polysaccharides from Salvia officinalis L. Int J Biol Macromol . 2003;33:113-119.
8. Hohmann J, Redei D, Mathe I, Blunden G. Phenylpropanoid glycosides and diterpenoids from Salvia officinalis . Biochem Syst Ecol . 2003;31:427-429.
9. Miura K, Kikuzaki H, Nakatani N. Apianane terpenoids from Salvia officinalis . Phytochemistry . 2001;58:1171-1175.
10. Ninomiya K, Matsuda H, Shimoda H, et al. Carnosic acid, a new class of lipid absorption inhibitor from sage. Bioorg Med Chem Lett . 2004;14:1943-1946.
11. Tildesley NT, Kennedy DO, Perry EK, et al. Salvia lavandulaefolia (Spanish sage) enhances memory in healthy young volunteers. Pharmacol Biochem Behav . 2003;75:669-674.
12. Savelev S, Okello E, Perry NS, Wilkins RM, Perry EK. Synergistic and antagonistic interactions of anticholinesterase terpenoids in Salvia lavandulaefolia essential oil. Pharmacol Biochem Behav . 2003;75:661-668.
13. Baricevic D, Sosa S, Della Loggia R, et al. Topical anti-inflammatory activity of Salvia officinalis L. leaves: the relevance of ursolic acid. J Ethnopharmacol . 2001;75:125-132.
14. Spoerke DG, Jr. Herbal Medications . Santa Barbara, CA: Woodbridge Press; 1980.
15. Akhondzadeh S, Noroozian M, Mohammadi M, Ohadinia S, Jamshidi A, Khani M. Salvia officinalis extract in the treatment of patients with mild to moderate Alzheimer's disease: a double blind, randomized and placebo-controlled trial. J Clin Pharm Ther . 2003;28:53-59.
16. Perry NS, Bollen C, Perry EK, Ballard C. Salvia for dementia therapy: review of pharmacological activity and pilot tolerability clinical trial. Pharmacol Biochem Behav . 2003;75:651-659.
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