What You Need to Know about Sage

Common Name: Sage, Garden Sage, Common Sage

Scientific Name: Salvia officinalis L.

History and Origin

Sage or garden sage is a plant in the mint family Lamiaceae and genus Salvia. (Salvia is the largest genus of the Lamiaceae family,⁽¹⁾ containing around 700 to 900 species of shrubs, herbaceous perennials, and annuals. ⁽²⁾)

Garden sage is native to the Mediterranean region, though it has naturalized in many places throughout the world. ⁽³⁾ The generic name “Salvia” means “to cure”, and the species name “officinalis” means “medicinal”. So, it is clear that sage has a historical reputation of promoting health and treating ailments ⁽⁴⁾, and it has a long history of medicinal and culinary use. ⁽³⁾ It also finds a special place in today's foods ⁽²⁾, and it is widely used as a flavor ingredient in baked goods, meat and meat products, condiments and relishes, processed vegetables, soups, gravies, fats and oils, and others. ⁽⁵⁾

The medicinal parts are the fresh leaves and the fresh flowering aerial parts, the dried leaves, and the oils extracted from the flowers and stems. ⁽⁶⁾

Sage Plant Structure

Sage or garden sage is a perennial, evergreen shrub ⁽³⁾ that gets up to 60 cm tall. ⁽²⁾ The stems of this aromatic and medicinal plant are woody, ⁽³⁾ erect, square, multibranched, with hairy green branches. ⁽⁷⁾

The leaves are thick, gray-green, oval ⁽²⁾, aromatic, tangy, bitterly astringent ⁽⁶⁾, petiolate, opposite, simple, elongated, and have rugose surfaces ⁽⁷⁾ with white hairs on the lower leaf surface and greenish or greenish-grey on the upper surface. ⁽¹⁾

The flowers are blue, lilac or white, and borne in racemes. The seeds are dark brown, oval, and very small. ⁽²⁾

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Fig. 1 The photo of Salvia officinalis Fig. 2 The photo of sage flowers and leaves

Sage Health Benefits

1. Regulating Blood Pressure

In a 2009 study, six healthy women volunteers (aged 40-50) were taken sage tea (300 mL, twice a day) for four weeks. It was demonstrated that both systolic (SBP) and diastolic (DBP) blood pressure decreased to some extent in the subjects. ⁽⁸⁾

2. Regulating Blood Glucose Levels

In 2016, a study aimed to evaluate the effects of aqueous extracts of sage leaves on the levels of blood glucose in diabetic rats. The rats consumed aqueous sage extracts at a dosage of 300 mg/kg for five weeks. Administration of sage tea had no effect on normal rats. However, it significantly reduced the blood glucose levels of diabetic rats. Therefore, it can be concluded that sage has a potent hypoglycemic activity, which may be attributed to its antioxidant activities. ⁽⁹⁾

In a 2006 study, it was found that sage tea significantly lowered fasting plasma glucose concentration and had metformin-like effects on rats. ⁽¹⁰⁾ (Metformin is an oral anti-diabetic drug used for the treatment of type 2 diabetes, which acts by reducing liver glucose production as well as increasing the action of insulin. ⁽¹¹⁾)

In 2013, a clinical trial was carried out to investigate the effects of sage (150 mg extract) on 80 type 2 diabetic patients who had not reached the ideal control of the disease. The results showed that the 2-hour postprandial (2hpp) blood sugar levels were significantly decreased in the sage-treated patients compared to the control group. Therefore, it can be concluded that sage might be beneficial in diabetic patients to reduce 2hpp.

There were no significant changes in glycosylated hemoglobin (HbA1c) and fasting blood sugar (FBS) between the two groups. However, higher doses might be needed to decrease fasting blood glucose and glycosylated hemoglobin. ⁽¹²⁾

Also, in a 2009 study on diabetic rats, it was found that extracts from this plant show a dose-dependent activity which is comparable to the antidiabetic drug glibenclamide. ⁽¹³⁾In this study, the sage extract increased plasma insulin in the diabetic rats. The elevation in plasma insulin levels in the sage extract treated diabetic rats could be due to substances present in the plant extract which protect pancreatic beta cells from further deterioration and stimulate insulin secretion. The extract contains rosmarinic acid, phenolic acids, carnosic compounds, and flavonoids or their derivatives. ⁽¹⁴⁾

3. Regulating Blood Fat Levels

In 2016, a study aimed to evaluate the effects of aqueous extracts of sage leaves on the levels of plasma lipids profiles such as triglycerides (TG), total cholesterol (TC), high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very-low-density lipoproteins (VLDL) in diabetic rats. The aqueous sage extracts were consumed at a dosage of 300 mg/kg for five weeks. It was demonstrated that sage tea significantly induced amelioration in lipid profile parameters. Therefore, it could be recommended that sage tea should be ingested to hypercholesterolemic patients beside the usual therapy. ⁽⁹⁾

Also, in 2009, a study with six healthy female volunteers (aged 40-50) was designed to evaluate the beneficial properties of sage tea consumption on total plasma cholesterol, LDL-C, and HDL-C levels in humans. The participants were taken sage tea (300 mL, twice a day) for four weeks.

It was observed that plasma LDL cholesterol and total cholesterol levels decreased and plasma HDL cholesterol levels increased during and two weeks after treatment. No hepatotoxic effects or other adverse effects were observed. ⁽⁸⁾

In 2016, a study was conducted to evaluate the efficacy and safety of sage extract combined with statin therapy to improve lipid profile (including triglyceride, total cholesterol (TC), LDL-C, HDL-C) in 50 hypercholesterolemic patients with type 2 diabetes. (Statins are a class of drugs that help lower cholesterol levels in the blood.)

It was found that the extract lowered TC, LDL-C, and triglyceride levels, but increased HDL-C level. In addition, the extract has substantial antioxidant activity, which may be beneficial for the prevention of the cardiovascular complications of dyslipidemia in type 2 diabetes. Moreover, addition of the extract to statin therapy is apparently safe and further improves lipid profile. ⁽¹⁵⁾

4. Improving Digestive System Function

Motility-related diarrhea is caused by the rapid movement of food through the intestines. If the food moves too quickly through the gastrointestinal tract, there is not enough time for sufficient nutrients and water to be absorbed. This type of diarrhea can be treated with an anti-motility agent like loperamide. ⁽¹⁶⁾Loperamide can modify intestinal motility to slow down the transit of intestinal contents. ⁽¹⁷⁾

In a 2011 study, the anti-motility-related diarrhea activity of sage tea was evaluated in laboratory mice. The activity of sage tea was compared with loperamide. According to the findings of this study, sage tea possesses a marked inhibitory action on motility-related diarrhea as compared to loperamide. ⁽¹⁶⁾

Also, a 2011 study demonstrated that the crude extract of sage provides protection against diarrhea through its inhibitory effect on gut motility by the presence of some gut relaxant components. The data of this study suggested the medicinal use of sage in hyperactive gut disorders such as diarrhea. ⁽¹¹⁾

5. Improving Liver Function

According to a study done in 2005, drinking sage infusion improves liver antioxidant status in animal models. In this study, the researchers evaluated the antioxidant potential of sage tea by quantification of plasma transaminase (AST and ALT) activities and liver glutathione-S-transferase (GST) and glutathione reductase (GR) enzyme activities. The findings revealed that drinking sage tea for 14 days did not induce liver toxicity. On the other hand, a significant increase in liver GST activity was observed. ⁽¹⁸⁾ (GST is an important ancillary enzyme of the antioxidant defense system.) ⁽¹⁹⁾

This study indicates that the compounds present in sage tea improve the liver antioxidant status. ⁽¹⁸⁾

In 2015, a study was conducted to investigate the effect of alcoholic extract of sage on increasing resistance of liver cells to oxidative stress.⁽²⁰⁾ (Oxidative stress is an imbalance between free radicals and antioxidants in your body.) ⁽²¹⁾The researchers fed the drinking water enriched with ethanolic extract of sage to experimental animals for two weeks. It was found that the extract of sage increases the resistance of liver cells to oxidative stress and the extract may be considered as a cheap nutritious or dietary supplement, that could have a beneficial impact on prevention of liver diseases as well as other diseases induced by oxidative stress. ⁽²⁰⁾

6. Promoting Weight Loss

In 2015, the effects of sage infusion on a high-fructose-and-fat (HFF) diet-induced obesity was evaluated in rat model. The administration of HFF diet promotes an increase in body weight due to augmented fatty acid synthesis in the liver and triglyceride storage in adipose tissue, leading to an increase in fat mass. For this reason, the relative weight of the abdominal fat tissue was measured. Consumption of sage infusion prevented the increase in abdominal fat mass. The decrease in fat mass has been linked to a protective effect against metabolic alterations, such as dyslipidemia and cardiovascular risk. ⁽²²⁾

According to a 2004 study, the methanolic extract of sage leaves showed a significant inhibitory effect on serum triglyceride and inhibitory activity against pancreatic lipase, ⁽²³⁾ which is critical for the digestion and absorption of dietary fats, ⁽²⁴⁾ and eventually was effective to reduce body weight and obesity. Carnosic acid and carnosol in the extract substantially inhibited pancreatic lipase activity. Also, carnosic acid inhibited blood triglyceride elevation and reduced the gain of body weight. ⁽²³⁾

7. Improving Respiratory Tract Function

Inflammation in asthma and other allergic diseases is characterized by excessive production of immunoglobulin E (IgE) and the influx of leukocytes, especially eosinophils. Interleukin 4 (IL-4) and IL-5 are essential for IgE production and eosinophilia, respectively, and are produced by mast cells in allergic conditions. ⁽²⁵⁾

In 2012, anti-inflammatory, immune regulatory, and protective effects of sage water extract were investigated in asthmatic mice. The asthmatic mice exhibited a significant increase in total leukocytes count, IL-4 and IL-5 levels, and eosinophils count in lung tissue, in addition, to the serum total IgE level. However, consumption of sage water extract reduced significantly the number of inflammatory cells and IL-4 and IL-5 in lung tissue and the level of IgE, and also reduced the eosinophils infiltration in the lung tissue. These results suggest that sage extract via oral treatment may have anti-inflammatory and immune regulatory effects on bronchial allergic asthma. ⁽²⁶⁾

In 2015, the aqueous methanolic extract of the aerial parts of sage was studied to investigate its medicinal use in asthma in vivo. Sage (1-10 mg/kg) dose-dependently inhibited bronchospasm in anesthetized rats with three-fold greater potency than aminophylline. ⁽²⁷⁾ (Bronchospasm is a tightening of the muscles that line the airways (bronchi) in your lungs.) ⁽²⁸⁾

These results indicate that the crude extract of sage possesses bronchodilatory activity, and its medicinal use is useful in the treatment of asthma and cough. ⁽²⁷⁾ Bronchodilators are a class of medications that make breathing easier by relaxing the muscles in the lungs and widening the airways (bronchi). ⁽²⁹⁾

8. Improving Nervous System Function

In 2015, a study aimed to investigate the anti-amnesiac and antioxidant activity of aqueous extract of sage in mice. The results showed that the sage aqueous extract had high total phenolic contents and flavonoids. It exhibited an interesting antioxidant activity. Acetylcholinesterase (AChE) activity significantly decreased in mice treated with the extract of sage. ⁽³⁰⁾ (Treatment of Alzheimer's disease has been dominated by the use of acetylcholinesterase (AChE) inhibitors.) ⁽³¹⁾

These findings suggested that aqueous extract of sage leaves possess a mnemonic effect on adult male mice, confirming their use in traditional medicine for the treatment of memory disorders. ⁽³⁰⁾

In 2003, a study was carried out to assess the efficacy and safety of a fixed dose (60 drops/day) of alcoholic extract of sage in patients (aged 65-80) with mild to moderate Alzheimer’s disease over a 4-month period. The results showed that at 4 months, the sage extract produced a significantly better outcome on cognitive functions than placebo. Moreover, sage may reduce agitation in patients with Alzheimer’s disease. ⁽³²⁾

9. Anti-Inflammatory

In 2010, a study was carried out to evaluate the antinociceptive and anti-inflammatory potential of the leaf aqueous and alcoholic (butanol) extracts of sage in an animal model. According to the results, the sage leaf aqueous and butanol extracts have analgesic and anti-inflammatory effects, and both extracts are effective in relieving inflammation-induced pain. The study is confirming the traditional use of this plant for pain alleviation. ⁽³³⁾

According to a 2012 study, essential oil of dried aerial parts of sage also has anti-inflammatory activity. ⁽³⁴⁾ It is reported that among different extracts of sage, the chloroform one shows more anti-inflammatory action, while the methanolic extract and essential oil demonstrate low action. Flavonoids and terpenes are the compounds that most likely contribute to the anti-inflammatory and antinociceptive actions of the herb. Manool, carnosol, and ursolic acid are of the terpenes/terpenoids with anti-inflammatory potential. The anti-inflammatory action of ursolic acid is twofold more potent than that of indomethacin (a potent anti-inflammatory drug). ⁽³⁵⁾

10. Relieving Menopause Symptoms

The most common type of osteoporosis is the bone loss associated with ovarian hormone deficiency at menopause. Sage plant, which contains flavonoid phytoestrogens, has been used to reduce menopausal symptoms. Evidence suggests that flavonoid-rich foods and beverages may benefit bone health.

In 2010, a study was conducted to evaluate the protective effect of sage tea on the progression of bone loss occurred in menopausal female rats. At the end of the treatment period (2 months), bone minerals density (BMD), as well as serum calcium (Ca), phosphorus (P), estradiol (a female hormone, estrogen, used to help reduce symptoms of menopause) and alkaline phosphatase (ALP) were examined.

(Elevated serum ALP levels may reduce bone mineral density in postmenopausal females.)

It was observed that consumption of sage tea significantly decreased the decline in BMD, prevented the rise of serum ALP levels, and increased serum Ca, P, and estradiol levels. These findings suggest that sage tea is effective in reducing bone loss occurred in menopausal women. ⁽³⁶⁾

In a clinical trial done in 2011, 71 menopausal women (with at least five flushes daily) were treated with a once-daily tablet of fresh sage leaves for 8 weeks. It was demonstrated that the mean total number of hot flushes per day decreased significantly each week from week 1 to 8. Therefore, fresh sage is effective in the treatment of hot flushes and associated menopausal symptoms. ⁽³⁷⁾

11. Anti-cancer

Colorectal cancer draws a lot of scientific interest because of its strikingly high correlation with diet. Sage infusion has been found to prevent colorectal cancer in rats. In addition, it has cytotoxic effects on cancer cell lines and diminishes the negative effects of radiotherapy used for cancer treatment.⁽¹⁾

In 2007, the anticancer activity of sage essential oil was evaluated in tumor cells in vitro. It was observed that the α-humulene and trans-caryophyllene extracted from sage essential oil inhibit tumor cell growth. ⁽³⁸⁾

What Are Sage Side Effects?

1. When Taken by Mouth: Sage is LIKELY SAFE in amounts typically used in foods. It is POSSIBLY SAFE when taken by mouth in medicinal amounts for up to 4 months. But it is POSSIBLY UNSAFE when taken by mouth in high doses or for a long time. Sage (Salvia officinalis) contains a chemical called thujone, which can be poisonous if you take too much and can cause seizures and damage the liver and nervous system. The amount of thujone varies with the species of sage, the time of harvest, growing conditions, and other factors.

2. When Applied to the Skin: Sage is POSSIBLY SAFE when applied to the skin for up to one week.

3. When Inhaled: Sage essential oil is POSSIBLY SAFE when inhaled as aromatherapy.

4. Pregnancy and Breast-Feeding: Taking sage during pregnancy is LIKELY UNSAFE because of the possibility of consuming thujone. Thujone can bring on a woman's menstrual period, and this could cause a miscarriage.

Avoid sage if you are breastfeeding too. There is some evidence that thujone might reduce the supply of mother's milk.

5. Diabetes: Sage might lower blood sugar levels in people with diabetes. So, watch for signs of low blood sugar (hypoglycemia) and monitor your blood sugar carefully if you have diabetes. The dose of your diabetes medications may need to be adjusted by your healthcare provider.

6. Hormone-Sensitive Condition such as Breast Cancer, Uterine Cancer, Ovarian Cancer, Endometriosis, or Uterine Fibroids: Sage might have the same effects as the female hormone estrogen. If you have any condition that might be made worse by exposure to estrogen, don't use sage.

7. Low Blood Pressure: Common sage (Salvia officinalis) might lower blood pressure in people with blood pressure that is already low. Be sure to monitor your blood pressure.

8. Seizure Disorders: Common sage (Salvia officinalis) might contain significant amounts of thujone, a chemical that can trigger seizures. So, if you have a seizure disorder, don't take sage in amounts higher than those typically found in food.

9. Surgery: Common sage might affect blood sugar levels. There is a concern that it might interfere with blood sugar control during and after surgery. So, stop using common sage as a medicine at least 2 weeks before a scheduled surgery. ⁽³⁹⁾

Generally, every person may be allergic to certain herbs and spices. This sensitivity must be first diagnosed by the person and secondarily by the physician. However, these allergic reactions do not cause chronic or acute side effects, and after identifying the allergenic plant and removing it from diet, allergy-related complications will be eliminated.

No company or product can be aware of the allergic reactions of different bodies in advance. The body's incompatibility with one or more specific herbs rarely occurs, but consumers may encounter it anyway.

Nutritional Information

Sage herbal tea contains vitamin C, phenolic compounds such as flavonoids and flavanols, and minerals (such as K, Na, Mg, Ca, and Fe). ⁽⁴⁰⁾

Sage Daily Dosage

The average daily internal dose is 4 to 6 g of leaves. ⁽⁶⁾

Also, according to a study, consumption of 3 - 6 cups of sage leaves tea (1.5 g /150 ml) per day is safe. ⁽⁴¹⁾

Bioactive Compounds

- Volatile oil: chief constituents include alpha-thujone and beta-thujone, 1,8-cineole, camphor, borneol, isobutyl acetate, camphene, linalool, alpha and beta-pinene, viridiflorol, alpha- and beta-caryophyllene (humulene).

- Caffeic acid derivatives: rosmarinic acid, chlorogenic acid.

- Diterpenes: chief components include carnosolic acid (picrosalvin), rosmanol, safficinolide.

- Flavonoids: including apigenin- and luteolin-7-glucosides, numerous methoxylated aglycones, including genkwanin, genkwanin-6-methyl ether.

- Triterpenes: chief components includes ursolic acid. ⁽⁶⁾

Best Time to Consume

1-2 hours before or after meals.

Possible Drug Interactions

1. Medications for Diabetes: Sage might decrease blood sugar. Diabetes medications are also used to lower blood sugar. Taking sage along with diabetes medications might cause your blood sugar to go too low. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed. Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.

2. Medications used to Prevent Seizures (Anticonvulsants): Medications used to prevent seizures affect chemicals in the brain. Sage may also affect chemicals in the brain. Therefore, it may decrease the effectiveness of these medications. Some medications used to prevent seizures include phenobarbital, primidone (Mysoline), valproic acid (Depakene), gabapentin (Neurontin), carbamazepine (Tegretol), phenytoin (Dilantin), and others. ⁽³⁹⁾

3. Sedative Medications (CNS Depressants ⁽³⁹⁾/ Benzodiazepines ⁽⁴²⁾): Sage might cause sleepiness and drowsiness. Sedatives cause sleepiness too. So, taking sage along with these medications might cause too much sleepiness. Some sedative medications include clonazepam (Klonopin), lorazepam (Ativan), phenobarbital (Donnatal), zolpidem (Ambien), ⁽³⁹⁾ diazepam (Valium) and others. ⁽⁴²⁾

4. Anticholinergic Drugs: Common sage might increase levels of certain chemicals that work in the brain, heart, and elsewhere. Anticholinergic drugs can also affect these chemicals. So, sage might decrease the effects of anticholinergic drugs. Some of these anticholinergic drugs include atropine, scopolamine, some medications used for allergies (antihistamines), and some medications used for depression (antidepressants).

5. Various Medications used for Glaucoma, Alzheimer's Disease, and Other Conditions (Cholinergic Drugs): Common sage might increase certain chemicals in the brain, heart, and elsewhere. Some medications used for glaucoma, Alzheimer's disease, and other conditions also affect these chemicals. Taking sage with these medications might increase the chance of side effects. Some of these medications used for glaucoma, Alzheimer's disease, and other conditions include pilocarpine (Pilocar and others), donepezil (Aricept), tacrine (Cognex), and others.

6. Medications for High Blood Pressure (Antihypertensive Drugs): Common sage seems to lower blood pressure. Taking common sage along with medications for high blood pressure might cause your blood pressure to go too low. Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), Amlodipine (Norvasc), hydrochlorothiazide (HydroDIURIL), furosemide (Lasix), and many others.

7. Medications Changed by the Liver: Some medications are changed and broken down by the liver. Sage might decrease/increase how quickly the liver breaks down some medications. Taking sage along with some of these medications might increase/decrease the effects and side effects of these medications. If you take any medications that are changed by the liver, talk to your healthcare provider before taking sage. ⁽⁴²⁾

Traditional Use

Sage is one of the oldest medicinal plants; it has been used in folk medicine as medication against fever, rheumatism, perspiration ⁽⁴³⁾ (e.g., night sweats ⁽⁵⁾), sexual debility, and in the treatment of chronic bronchitis, as well as mental and nervous ⁽⁴³⁾ (e.g., trembling, depression, and vertigo ⁽⁵⁾) diseases.

It is used to stop the flow of milk, dysmenorrhea, diarrhea, gastritis, sore throat, insect bites, and so on, usually in the form of a tea or infusion. Sage has been reported useful for cancer treatment. ⁽⁵⁾

In Iranian folk medicine, the leaves of sage are used for their digestive, carminative, antispasmodic, sedative, analgesic, tonic, diuretic effects, and also for treating functional gastrointestinal disorders. ⁽³⁾

Some Questions about Sage

Does sage help with excessive sweating?

Sage has been approved for excessive perspiration by the German regulatory agency of medicinal supplements, Commission E. ⁽⁶⁾

Is sage tea good for the flu?

According to studies, common sage extracts have some specific anti-viral and antimicrobial activity. ⁽⁴⁴⁾ Sage is good for the first tickle of a sore throat and is known to tone irritated tissues and kill bacteria. You can combine it with thyme, which is a good expectorant. ⁽⁴⁵⁾

Is sage good for the lungs?

According to Ayurvedic practitioner Vikrama, writing at Dr. Vikrama's friendly holistic herbalist, sage is an expectorant helping expel mucous from the respiratory tract. Sage tea is effective even in the severe case of hemoptysis or hemorrhaging from the lungs brought on by respiratory infection, Dr. Vikrama reports.

Salvia officinalis has antibacterial, astringent, and antiseptic properties, advises the Georgetown University Medical Center. These properties may account for sage's usefulness in treating lung disorders. ⁽⁴⁶⁾

Does sage tea help you lose weight?

According to a 2015 study, consumption of sage infusion can prevent the increase in abdominal fat mass. The decrease in fat mass has been linked to a protective effect against metabolic alterations, such as dyslipidemia and cardiovascular risk. ⁽²²⁾

Can I drink sage tea every day?

Some species of sage, including common sage (Salvia officinalis), contain a constituent called thujone that can cause seizures in experimental animals and may also do so in people. So, high-dose or long-term use of sage may not be safe. ⁽⁴⁷⁾

Yet, according to a study, we can consume on average 3 to 6 cups of sage tea a day without reaching toxicological thresholds. The researchers used 1.5 g of herbal tea material per cup (in 150 mL of hot water). ⁽⁴¹⁾