Scientific Name(s): Salvia officinalis L. Family: Lamiaceae (mint)
Common Name(s): Sage , culinary sage , Dalmatian sage , garden sage , kitchen sage , true sage , meadow sage
Uses of Sage
Dried sage leaf is used as a culinary spice and as a source of sage oil. Sage extracts are being investigated for their potential in memory enhancement and Alzheimer disease; however, clinical trials are lacking. Anti-inflammatory and antimicrobial properties have been identified, as well as potential effects in diabetes and gastric ulcers.
Dried sage leaf has been investigated in memory studies at doses of 300 and 600 mg. Ethanolic extract 333 mg has been studied in Alzheimer disease. Typical dosage has been described as 4 to 6 g/day of the leaf.
Contraindications have not been identified.
Information regarding safety and efficacy in pregnancy and lactation is lacking.
None well documented.
Sage Adverse Reactions
There were no clinically important adverse reactions reported by healthy patients in 2 clinical trials; however, effects were similar to those reported with cholinesterase inhibitors. Cheilitis, stomatitis, dry mouth, and local irritation have been reported.
Data are limited. Thujone and camphor constituents are toxic.
At least 95 species and many varieties exist within the sage genus Salvia . This small, evergreen perennial plant can grow 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 through September. This plant should not be confused with red sage or desert brush sage, which are unrelated. 1 , 2 , 3 , 4
The name Salvia derives from the Latin salvere , meaning to cure . Traditionally, sage and its oil have been used to treat a wide range of illnesses. Ethanolic tinctures and decoctions have been used to treat inflammation of the oral cavity and GI tract; sage has been used as a tonic and antispasmodic.
The plant has been used topically as an antiseptic and astringent and to manage excessive sweating. Sage tea has been ingested for the treatment of dysmenorrhea, diarrhea, gastritis, tonsillitis, and sore throat. The dried leaves have been smoked to treat asthma.
Dried sage leaf is used as a culinary spice and as a source of sage oil, which is obtained by steam distillation. Sage oil is used as a fragrance in soaps and perfumes. Sage is used as a food flavoring, and its aroma is said to suppress the odor of fish. Sage oleoresin is also used in the culinary industry. 2 , 4 , 5
S. officinalis contains 1% to 2.8% essential oil, along with flavones, phenolic acids, phenylpropanoid glycosides (eg, martynoside), triterpenoids, and diterpenes, including phenolic, quinoidal, and rearranged abietane and apianane derivatives. The plant's compounds include salvigenin, lupeol, beta-sitosterol, stigmasterol, physcion, carnosol, rosmadial, rosmanol, epirosmanol, isorosmanol, columbaridione, atuntzensin A, miltirone, carnosic acid, and 12-O-methyl carnosic acid. 4 , 6 , 7 , 8 , 9
Monoturpenes have been identified using gas chromatography and other techniques, with alpha- and beta-thujones accounting for about one-half of the oil's composition. 10 , 11 , 12 Capillary electrophoresis has been used to identify the polyphenols, 13 , 14 while high performance liquid chromatography and nuclear magnetic resonance techniques have been applied to cold water extracts in identifying polysaccharides. 15 , 16
Salvia lavandulaefolia (Spanish sage) and S. officinalis have similar compositions except that S. officinalis has a much higher concentration of thujone, which is toxic in large doses. 17 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). 4 , 12 , 18 , 19
Sage Uses and Pharmacology
Trials in human subjects are limited.CNS effects
Improved memory retention has been demonstrated in animal studies, 20 as well as in clinical studies. In 1 study, mood and cognitive performance were improved in young healthy volunteers given 300 and 600 mg of dried S. officinalis leaf. An anxiolytic effect was also observed. 21 In another study, ethanolic leaf extract increased memory and attention in older healthy volunteers (mean, 72.95 years of age) at lower dosages (333 mg extract), but had no effect at higher dosages. 22 Adverse reactions were similar to those reported with cholinesterase inhibitors. 23
Limited studies have evaluated the efficacy of sage extracts in Alzheimer disease. 17 , 23 , 24 While the results are promising, some methodological issues remain, and larger, long-term trials are needed before a definitive role for sage in the management of Alzheimer disease can be seen. 17 Similar results have been obtained in studies using other Salvia species, including S. lavandulaefolia and Salvia miltiorrhiza , as well as rosmarinic acid alone. 17 , 18 , 25 , 26 , 27 , 28 , 29Other effects
Proinflammatory cytokines were suppressed in in vitro experiments with human leukocytes 30 and in induced colitis in mice. 31 No histological changes were apparent. 31 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 croton oil-induced ear edema in mice. The anti-inflammatory effect of ursolic acid was 2-fold more potent than that of indomethacin. 26 , 32Antimicrobial activity
In vitro antimicrobial activity has been demonstrated by both the aqueous extracts of sage leaves and the essential oil. A wide antibacterial spectrum has been suggested, while activity against fungi is uncertain. 11 , 33 , 34 , 35 Interest centers on activity against vancomycin-resistant enterococci, 36 herpes simplex and corona viruses, 10 , 37 and HIV. 38 , 39Antioxidant activity
Aqueous extracts of sage, sage tea, and volatile and phenolic sage compounds have been used in experiments demonstrating the antioxidant potential of sage and other related species. Oxygen radical absorbance capacity assay and electron spin resonance techniques have been used in assay and in vitro experiments. In vivo markers, such as glutathione levels, have been used in rats. Inhibition of lipid peroxidation and increasing food oil stability have been demonstrated, but clinical applications are lacking. 11 , 28 , 30 , 40 , 41 , 42 , 43 , 44 , 45 , 46Cancer
Sage essential oil and its constituent monoterpenes were effective in protecting against ultraviolet-induced mutations in bacterial studies. 47Diabetes
Studies in animals have shown effects of methanol leaf extracts and sage tea on fasting plasma glucose levels, but not on glucose tolerance tests or insulin. 48 , 49 Sage essential oil had no effect on serum glucose. 48 Other Salvia species have also been evaluated for effects on serum glucose. 50GI activity
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. 3 A hydroethanolic extract was protective against ethanol-induced gastric lesions in rats. 51
Dried sage leaf has been investigated in memory studies at doses of 300 and 600 mg. 17 Ethanolic extract 333 mg has been studied in Alzheimer disease. 22 , 24 Typical dosage has been described as 4 to 6 g/day of the leaf.
Information regarding safety and efficacy in pregnancy and lactation is lacking.
Reported adverse reactions from the ingestion of sage include cheilitis, stomatitis, dry mouth, and local irritation. 5 There were no clinically important adverse reactions reported by healthy patients in 2 clinical trials 18 , 24 ; however, effects were similar to those reported with cholinesterase inhibitors. 23 Increases in blood pressure were reported in a trial evaluating S. lavandulaefolia essential oil in 2 patients with preexisting hypertension. 29
Doses of more than 200 nL/mL essential oil are hepatotoxic, 40 and at concentrations of 120 mcg/mL, decreased cell viability was found. 43 The intraperitoneal lethal dose in rats of a methanolic extract of sage leaves was calculated at 4,000 mg/kg. 20 Constituents thujone and camphor are recognized as neurotoxic, 40 while rosmarinic acid, carnosic acid, and carnosol were not genotoxic at dosages used in experiments. 27 , 30
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