Wise Mind Herbs

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Sage - Salvia officinalis

Salvia officinalis, commonly known as common sage, garden sage, or culinary sage, is a perennial, evergreen subshrub native to the Mediterranean region. It belongs to the Lamiaceae family and has been traditionally used for centuries for its medicinal properties. This review examines the current scientific understanding of sage's health benefits, applications, dosages, and potential side effects based on peer-reviewed literature.

Image source and license: https://commons.wikimedia.org/wiki/File:Salvia_officinalis_Habitus_DehesaBoyalPuertollano.jpg.
Modified by Peter Jorgensen.

Common and Botanical Names

The primary botanical name for sage is Salvia officinalis. Common names include garden sage, common sage, culinary sage, and Dalmatian sage. It's important to distinguish this species from other Salvia species that may be called "sage" but have different properties, such as:

• Salvia sclarea (Clary sage) - Used primarily for essential oil
• Salvia divinorum - Has psychoactive properties
• Salvia miltiorrhiza (Chinese sage or Danshen) - Used in Traditional Chinese Medicine
• Salvia hispanica (Chia) - Used as a food source
• Artemisia species (Sagebrush) - Not true sage despite the name

Active Compounds

The therapeutic properties of Salvia officinalis are attributed to various bioactive compounds, including:

• Essential oils (1-2.5%): α-thujone, β-thujone, 1,8-cineole, camphor
• Phenolic compounds: rosmarinic acid, carnosic acid, carnosol
• Flavonoids: luteolin, apigenin, quercetin
• Diterpenes, triterpenes, and tannins

Therapeutic Applications and Evidence

Recent research has demonstrated several potential therapeutic applications for Salvia officinalis:

• Cognitive Function: Multiple randomized controlled trials have shown sage extracts improve memory and cognitive function in both healthy adults and those with mild cognitive impairment.
• Menopausal Symptoms: Clinical trials have demonstrated efficacy in reducing hot flashes and night sweats, with one study showing a 50% decrease in hot flash frequency after 8 weeks.
• Antimicrobial Activity: In vitro studies consistently show antibacterial and antifungal properties against various pathogens, including Staphylococcus aureus and Candida albicans.
• Anti-inflammatory Effects: Several animal and in vitro studies demonstrate anti-inflammatory properties, primarily attributed to rosmarinic acid and carnosol.
• Antioxidant Activity: Sage exhibits strong antioxidant properties that may help prevent oxidative stress-related diseases.
• Glycemic Control: Some clinical trials suggest sage may improve glycemic control and insulin sensitivity in patients with type 2 diabetes.
• Hyperlipidemia: Evidence suggests sage extracts may reduce total cholesterol and LDL levels while increasing HDL levels.
• Oral Health: Studies show efficacy in reducing dental plaque, gingivitis, and oral pathogens when used in mouthwash formulations.

Recommended Dosages

Dosage recommendations vary based on preparation and intended use:

• Dried Leaf Preparations: 1-4 g daily, typically as tea (infusion), using 1-2 g per 150 ml of hot water, steeped for 5-10 minutes, up to three times daily.
• Liquid Extract (1:1 in 45% ethanol): 1-4 ml, three times daily.
• Tincture (1:5 in 45% ethanol): 2-6 ml, three times daily.
• Standardized Extract (2.5-7.5% rosmarinic acid): 300-600 mg daily, divided into 2-3 doses.
• Essential Oil: Not recommended for internal use due to thujone content. Topical applications should be diluted to 1-2% in carrier oil.
• For Cognitive Function: 300-600 mg of extract standardized to contain 5-10 mg of essential oil or 15-60 mg of rosmarinic acid daily.
• For Menopausal Symptoms: 280-300 mg of standardized extract daily.

Side Effects and Safety Concerns

Salvia officinalis is generally recognized as safe when consumed in normal culinary amounts, but medicinal doses may pose risks:

• Thujone Toxicity: The essential oil contains thujone, which in high doses can cause neurological symptoms including seizures. This is primarily a concern with essential oil or high-dose leaf preparations.
• Hypoglycemic Effects: May potentiate the effects of antidiabetic medications, leading to hypoglycemia.
• Potential Drug Interactions: May interact with anticonvulsants, central nervous system depressants, and medications metabolized by CYP enzymes.
• Pregnancy and Lactation: Not recommended due to potential uterine-stimulating effects and unknown effects on the fetus or infant.
• Allergic Reactions: Members of the Lamiaceae family can cause allergic reactions in sensitive individuals.
• Hormone-Sensitive Conditions: May have estrogenic effects that could impact hormone-sensitive conditions.

Studies on Higher Dosages

Research on doses exceeding the recommended ranges is limited. A few toxicological studies have investigated the safety profile of higher doses:

• Animal studies suggest that very high doses (equivalent to >15g dried herb/day in humans) may cause liver damage and increased seizure risk, likely due to thujone content.
• No consistent additional therapeutic benefits have been documented at doses exceeding those recommended above.
• A significant knowledge gap exists regarding long-term safety and efficacy of high-dose sage supplementation in humans.

The European Medicines Agency has established a maximum daily intake of thujone at 6 mg/day, which limits the safe upper dosage of some sage preparations.

Commercial Pharmaceutical Products

Several pharmaceutical products containing standardized sage extracts are available, particularly in Europe:

• Menopause:
  • Menoforce® - Sage tablet for hot flashes
• Cognitive Function:
  • Cognivia™ (Nexira) - Proprietary sage extract for cognitive performance
• Oral Health:
  • Salviathymol N®- Sage and thyme combination for throat and oral conditions

Note that many of these products are classified as herbal medicinal products in Europe rather than conventional pharmaceuticals, though they undergo standardization and quality control.

Conclusion

Scientific evidence supports several traditional uses of Salvia officinalis, particularly for cognitive function, menopausal symptoms, and oral health. However, the quality of evidence varies considerably across indications. While generally safe when used appropriately, potential risks exist with high doses or in certain populations. Standardization of products and adherence to recommended dosages are important considerations for therapeutic use.

References

Abdollahi, A., Adelibahram, F., Ghassab-Abdollahi, N., Araj-Khodaei, M., Parsian, Z., & Mirghafourvand, M. (2023). The effect of Salvia officinalis on blood glycemic indexes and blood lipid profile in diabetic patients: a systematic review and meta-analysis. Journal of Complementary and Integrative Medicine, 20(3), 521-529.

Assaggaf, H. M., Naceiri Mrabti, H., Rajab, B. S., Attar, A. A., Alyamani, R. A., Hamed, M., ... & Bouyahya, A. (2022). Chemical analysis and investigation of biological effects of Salvia officinalis essential oils at three phenological stages. Molecules, 27(16), 5157.

Kačániová, M., Galovičová, L., Valková, V., Ďuranová, H., Borotová, P., Štefániková, J., ... & Grinshpan, D. (2021). Chemical composition and biological activity of Salvia officinalis essential oil. Acta Hortic. Regiotect, 24, 81-88.

Margetts, G., Kleidonas, S., Zaibi, N. S., Zaibi, M. S., & Edwards, K. D. (2022). Evidence for anti-inflammatory effects and modulation of neurotransmitter metabolism by Salvia officinalis L. BMC Complementary Medicine and Therapies, 22(1), 131.

Sadeghi, S., Esfahanian, V., & Damavandi, M. (2023). Comparing the effectiveness of Salvia officinalis herbal mouthwash and chlorhexidine in reducing plaque and inflammation: A clinical trial. Contemporary Orofacial Sciences, 2(2), 0.

Tavares, W. R., Seca, A. M., & Barreto, M. C. (2025). Exploring the Therapeutic Potential of Artemisia and Salvia Genera in Cancer, Diabetes, and Cardiovascular Diseases: A Short Review of Clinical Evidence. Journal of Clinical Medicine, 14(3), 1028.

Uysal, I., Koçer, O., Mohammed, F. S., Lekesiz, Ö., Doğan, M., Şabik, A. E., ... & Sevindik, M. (2023). Pharmacological and nutritional properties: Genus Salvia. Advances in Pharmacology and Pharmacy, 11(2), 140-155.

Wilfried, D., Nina, C. D. G., & Silvia, B. (2021). Effectiveness of Menosan® Salvia officinalis in the treatment of a wide spectrum of menopausal complaints. A double-blind, randomized, placebo-controlled, clinical trial. Heliyon, 7(2).