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Sage (Salvia officinalis, Salvia lavandulaefolia, Salvia lavandulifolia)

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Also listed as: Salvia officinalis, Salvia lavandulaefolia, Salvia lavandulifolia
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • 1,8-Cineole, 1-O-(2,3,4-trihydroxy-3-methyl)butyl-6-O-feruloyl-beta-D-glucopyranoside, 1-O-caffeoyl-beta-D-apiofuranosyl-(1-->6)-beta-D-glucopyranoside, 1-O-p-hydroxybenzoyl-beta-D-apiofuranosyl-(1-->6)-beta-D-glucopyranoside, 3-carene, 3'-O-beta-D-glucuronide, 3-O-caffeoylquinic acid, 4-hydroxyacetophenone 4-O-[5-O-(3, 5-dimethoxy-4-hydroxybenzoyl)-beta-D-apiofrunosyl]-(1-->2)-beta-D- glucopyranoside, 4-hydroxyacetophenone 4-O-(6'-O-beta-D-apiofuranosyl)-beta-D-glucopyranoside, 5-methoxysalvigenin, 5-O-caffeoylquinic acid, 6-hydroxyluteolin 7-O-beta-D-glucoside, 6-O-caffeoyl-beta-D-fructofuranosyl-(2-->1)-alpha-D-glucopyranoside, 7-alpha-12-dihydroxy-8,12-abietadiene-11-14-dione (horminone), 7-alpha-acetoxy-12-hydroxy-8,12-abietadiene-11,14-dione (7-O-acetylhorminone), 7-O-beta-D-glucuronide, 7-O-glucuronide-6,8-di-C-beta-D-glucosylapigenin (vicenin-2), 12-hydroxy-8,12-abietadiene-11,14-dione (royleanone), 12-O-methyl carnosol, abietane diterpenes (7-methoxyrosmanol and galdosol), alpha-amyrin, alpha-cedrine, alpha-humulene, alpha-pinene, alpha-terpinene, alpha-terpineol, alpha-thujone, alpha-tocopherol, apigenin, aromadendrine, atuntzensin A, berggarten sage, beta-carotene, beta-caryophyllene, beta-myrcene, beta-pinene, beta-sitosterol, beta-sitosterol-D-glucoside,beta-thujone, beta-trans-ocymene, beta-ursolic acid, betulin, black sage, bornyl acetate, broad-leafed sage, caffeic acid, caffeoyl-coumarin conjugates, campesterol, camphene, camphor, carnosic acid, carnosol, carnosolic acid, caryophyllene, caryophyllene oxide, catechin, chlorogenic acid, chrysoeriol, cirsilineol, cirsiliol, cirsimaritin, cis-p-coumaric acid 4-O-(2'-O-beta-D-apiofuranosyl)-beta-D-glucopyranoside, citral, clary sage, columbaridione, common sage, cynaroside, Dalmatian sage, delta-cadinene, diosmetin, diterpene quinones, East Mediterranean sage, Edelsalbei (German), ellagic aid, epirosmanol, essential oil, ethyl beta-D-glucopyranosyl tuberonate, eucalyptol, farnesol, ferulic acid, feuilles de sauge (French), flavones, flavonoids, fumaric acid, gallic acid, gamma-terpinene, garden sage, Gartensalbei (German), genkwanin, geraniol, Greek sage, herba Salviae, hesperetin, hispidulin, (-)-hydroxyjasmonic acid, isocaryophyllene, isoferulic acid, isorosmanol, isothujone, Judean sage, kew gold, kitchen sage, Labiatae (former family name), labiatic acid, Lamiaceae (family), limonene, linalool, linalyl acetate, lupeol, luteolin, luteolin-7-glucoside, luteolin-7-O-beta-D-glucoside, malic acid, manool, maslinic acid, meadow sage, menthol, miltirone, monoterpene glycosides, monoterpene hydrocarbons, nepetin, Newe Ya'ar No. 4, nutmeg sage, oleanolic acid, oleoresin sage, ortho-dihydroquinones, oxygenated monoterpenes, oxygenated sesquiterpenes, oxytriterpenic acids, p-cymene, pentacyclic triterpenes, phenolic diterpenes, p-hydroxybenzoic acid, physcion, phytosterols, polysaccharides, pomolic acid, purpurascens, quinines, red sage, rosmadiol, rosmanol, rosmanol-9-ethyl ether, rosmarinic acid, rouleanone, royleanones, S. hypoleuca, S. reuterana, S. verticillata, S. virgata, sagecoumarin, Salbeiblatter (German), salicylic acid, Salvia acetabulosa, Salvia argentea, Salvia bertolonii, Salvia fruticosa, Salvia hispanorum Lag., salvia honey, Salvia judaica Boiss., Salvia lavadulifolia, Salvia lavandulaefolia, Salvia lavandulaefolia Vahl., Salvia lavandulifolia, Salvia lavandulifolia Vahl., Salvia libanotica, Salvia mellifera, Salvia miltiorrhiza, Salvia multicaulis, Salvia officinalis, Salvia officinalis L. "Desislava", Salvia officinalis subsp. auriculata, Salvia officinalis var. purpurea, Salvia officinalis x Salvia fruticosa, Salvia pratensis, Salvia reflexa Hornem., Salvia repens, Salvia rhytidea Benth., Salvia runcinata, Salvia sclarea, Salvia somalensis Vatke, Salvia splendens, Salvia stenophylla, Salvia triloba, salviatannin, salvigenin, salvin, sawge, scarlet sage, selenium, sesamol, sesquiterpene hydrocarbons, shell flower sage, silver sage, Spanish sage, stigmasterol, tannins, tanshinone IIA, terpinen-4-ol, terpineol, terpinolene, thujenone, thujone, thymol, trans-p-coumaric acid 4-O-(2'-O-beta-D-apiofuranosyl)-beta-D-glucopyranoside, tricolor, triterpenoids, true sage, ursolic acid, uvaol, vanillic acid, viridiflorol, water-soluble polysaccharide complex.
  • Note: This bottom line does not contain information on clary sage (Salvia sclarea), red or Chinese sage (danshen or Salvia miltiorrhiza), prairie sage (Artemisia ludoviciana), white sage (Salvia apiana), or Jerusalem sage (Phlomis fruticosa). This bottom line focuses on Salvia officinalis or Salvia lavandulaefolia (Salvia lavandulifolia).

Background
  • Sage has been used in Europe for centuries as a spice and a medicine. Salvia officinalis and Salvia lavandulifolia (Salvia lavandulaefolia) are two of the most common types of sage.
  • Sage is a popular European treatment for inflammation of the mouth and throat, upset stomach (dyspepsia), and excessive sweating, in addition to other uses.
  • Evidence supporting the use of sage for any condition is limited and all findings remain inconclusive. Further research is necessary before a strong assessment can be made.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Based on early human study, Salvia lavandulaefolia essential oil may be useful in the treatment of Alzheimer's disease. Also, a product containing an extract of sage prevented memory worsening. Additional study is needed in this area.

C


Early study has shown that sage extracts may prevent the ability of the herpes virus to affect cells. In human study, a product containing sage leaf and other ingredients helped reduce side effects on the skin normally associated with herpes. Additional study is needed in this area.

C


Salvia officinalis L leaf extract improved blood levels of total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL or "good cholesterol") in people with newly discovered high cholesterol. Further research is needed before conclusions can be made.

C


Although there is a lack of human study, sage used daily as a spice in foods has been associated with a lower risk of lung cancer in the Mediterranean diet. Additional study is needed in this area.

C


Sage is traditionally used to improve memory and cognition. Early human study suggests that sage (Salvia lavandulaefolia essential oil or Salvia officinalis leaf as capsules) may aid memory, even in stressful situations. Additional study is needed in this area.

C


Sage may contain compounds that act like the hormone estrogen. In theory, these compounds may decrease symptoms of menopause. Sage has been tested against menopausal symptoms with promising results. Additional study is needed in this area.

C


Sage is traditionally used to improve mood. Early human study suggests that sage (Salvia lavandulaefolia essential oil or Salvia officinalis leaf as capsules) may aid mood, even in stressful situations. Additional study is needed in this area.

C


Sage mouthwashes and gargles have been approved in Germany by the German Commission E for many years for use against sore throat. Good clinical evidence exists for the use of sage for pharyngitis.

C


Preliminary evidence in humans suggests that Salvia officinalis may be an inferior treatment for postoperative pain compared to benzydamine hydrochloride. Additional study is needed in this area.

C


Sage mouthwashes and gargles have been approved in Germany by the German Commission E for many years for use against sore throat. Also, an echinacea/sage spray for three days may result in a decrease in sore throat symptoms. Additional study is needed in this area.

C


Based on early study, a sage extract, applied to the skin, may prevent ultraviolet light-induced skin swelling (erythema) in healthy subjects. Additional study is needed in this area.

C


Based on early study in humans, a sage extract may reduce vaginal pH levels and improve symptoms of vaginal infection. Additional study is needed in this area.

C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Abdominal pain, acne, acute alcohol withdrawal, aging, amenorrhea (lack of menstrual period), antibacterial, antifungal, anti-inflammatory, antioxidant, antiseptic, antitumor, antiviral, anxiety/stress, appetite stimulant, bad breath, baldness, bloating, blood clotting disorders, bone loss, breast feeding (decrease), bronchitis, carbuncles (a type of skin infection), colds/flu, dental conditions, diabetes, eczema (type of skin inflammation), estrogen-like activity, fever, food uses, gallstones, headaches, infection, hemorrhoids, HIV/AIDS, high blood pressure, immune system regulation, indigestion, insect bites, insecticide, liver protection, malaria, menstrual cramps, mouth sores, muscle relaxant, neuroprotection (nerve protection), pain (general), parasites, Parkinson's disease, respiratory disorders, seizures, sexually transmitted disease, sleep aid, stomach disorders, sweating (excessive), swelling (limbs), urinary tract infection, withdrawal from narcotics, wound healing.

Dosing

Adults (18 years and older)

  • For Alzheimer's disease, 60 drops of Salvia officinalis extract has been taken by mouth daily for four months.
  • For menopause, a tablet containing fresh sage leaves has been taken by mouth once daily for eight weeks.
  • As a memory aid, single doses of Salvia lavandulaefolia essential oil (25-150 microliters) and 167-1332 milligrams of a standardized extract have been taken by mouth. Salviaofficinalis or Salvia lavandulaefolia aromas have been inhaled by adding five drops of the oil from either type of sage and 5 milliliters of water onto a stone that provided a constant warming temperature; the liquid was allowed to spread through air for five minutes prior to having people enter the room.
  • For high cholesterol, one 500 milligram sage (Salvia officinalis) capsule has been taken by mouth every eight hours for two months.
  • For mood enhancement, 300 or 600 milligrams of dried sage leaf has been taken by mouth in single daily doses, and 50 microliters of an essential oil of S. lavandulaefolia has been taken by mouth as a single dose. Salviaofficinalis or Salvia lavandulaefolia aromas have been inhaled by adding five drops of the oil from either type of sage and 5 milliliters of water onto a stone that provided a constant warming temperature; the liquid was allowed to spread through air for five minutes prior to having people enter the room.
  • For pain after surgery, Salvia officinalis has been taken by mouth along with pain medications.
  • For pharyngitis (throat inflammation), a 15% spray containing 140 microliters of Salvia officinalis extract per dose has been applied to the back of the throat 6-9 times daily for three days.
  • For vaginal infections (bacterial vaginosis), an extract of Salvia officinalis has been applied to the affected area once or twice daily for four weeks.
  • For sunburn prevention, a 2% sage extract in an ointment, has been applied to the skin as a single application.
  • For herpes, a cream containing 23 milligrams per gram of dried sage extract has been applied to the skin daily.

Children (younger than 18 years)

  • There is no proven safe or effective dose for sage in children. Sage has been used as a spice in food for centuries.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in people with known allergy or sensitivity to types of sage, their parts, or members of the Lamiaceae family. A life-threatening allergic reaction is possible. Dust from sage plants may contain microorganisms that may cause allergic reactions. Other allergic reactions include skin reactions and difficulty breathing.

Side Effects and Warnings

  • Sage is likely safe for food use as a spice or seasoning, and in the United States, it appears on the FDA list of substances generally recognized as safe (GRAS). Sage is likely safe in the preparation of foods as a spice for upset stomach, and when applied to the skin as a cream to treat herpes infections.
  • Sage is possibly safe when used as a mouthwash or gargle for sore throat, and when taken by mouth as medicine in small amounts for memory, mood, menopause, and Alzheimer's disease.
  • Sage may cause agitation, airway irritation, changes in estrogen effects, chapped lips, dizziness, dry mouth, increased seizure risk, kidney damage, nausea, rapid heart rate, restlessness, skin irritation (burning or pain), tremors, vomiting, and wheezing.
  • Sage may affect blood pressure. Caution is advised in using amounts greater than those commonly found in the diet and in people taking agents that affect blood pressure.
  • Sage may increase the risk of bleeding. Caution is advised in people with bleeding disorders or those taking agents that may increase the risk of bleeding. Dosing adjustments may be necessary.
  • Sage may lower blood sugar levels. Caution is advised in people with diabetes or low blood sugar and those taking agents, herbs, or supplements that affect blood sugar. Blood sugar levels may need to be monitored by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Drowsiness or sedation may occur. Use caution if driving or operating heavy machinery or if taking certain sedatives or antidepressants.
  • Sage may interfere with the way the body processes certain agents using the liver's cytochrome P450 enzyme system.
  • Because sage contains estrogen-like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.
  • Use cautiously in people with epilepsy or seizure disorders.
  • Use cautiously when applying sage to the skin.
  • Only sterile preparations of sage should be used in the eye.
  • Avoid in people with known allergy or sensitivity to types of sage, their parts, or members of the Lamiaceae family.
  • Avoid amounts of sage greater than those commonly found in the diet in children or during pregnancy or breastfeeding.

Pregnancy and Breastfeeding

  • There is a lack of scientific evidence on the use of sage during pregnancy or breastfeeding. Avoid amounts greater than those found in the diet in pregnant or breastfeeding women, due to the risk of abortion or reduced breast milk.

Interactions

Interactions with Drugs

  • Sage may affect blood pressure. Caution is advised in people taking agents that affect blood pressure.
  • Sage may increase the risk of bleeding when taken with agents that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
  • Sage may lower blood sugar levels. Caution is advised when using agents that may also lower blood sugar. People taking insulin or drugs for diabetes by mouth should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Sage may interfere with the way the body processes certain agents using the liver's cytochrome P450 enzyme system. As a result, the levels of these agents may be increased in the blood and may cause increased effects or potentially serious adverse reactions. People using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
  • Because sage contains estrogen-like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.
  • Sage may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, sedatives, and alcohol. Caution is advised while driving or operating machinery.
  • Sage may also interact with agents that affect seizure risk or treat seizures, agents that harm the liver, agents that treat skin conditions, agents that treat stomach and intestine conditions, agents used for osteoporosis, Alzheimer's agents, androgen-deprivation agents, antianxiety agents, antibiotics, anticancer agents, anticholinergics, antifungals, anti-inflammatory agents, antiprotozoals, antivirals, benzodiazepines, cholesterol-lowering agents, immune system altering agents, lung agents, nervous system agents, non-steroidal anti-inflammatories (NSAIDs), and thyroid hormones.

Interactions with Herbs and Dietary Supplements

  • Sage may affect blood pressure. Caution is advised in people taking herbs or supplements that affect blood pressure.
  • Sage may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
  • Sage may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Sage may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.
  • Because sage contains estrogen-like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.
  • Sage may increase the amount of drowsiness caused by some herbs or supplements such as some sedatives or antidepressants.
  • Sage may also interact with alfalfa, antianxiety herbs and supplements, antibacterial herbs and supplements, anti-cancer herbs and supplements, anticholinergic herbs and supplements, antifungal herbs and supplements, anti-inflammatory herbs and supplements, antioxidants, antiparasitic herbs and supplements, antiviral herbs and supplements, cholesterol-lowering herbs and supplements, herbs and supplements that affect the immune system, herbs and supplements that affect seizure risk or treat seizures, herbs and supplements that contain perillyl alcohol, herbs and supplements that harm the liver, herbs and supplements used for Alzheimer's disease, herbs and supplements used for osteoporosis, herbs and supplements used for the lungs, herbs and supplements used for the nervous system, herbs and supplements used for skin disorders, herbs and supplements used for the stomach and intestines, rhubarb, sumac, and thyroid herbs and supplements.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Bommer S, Klein P, and Suter A. First time proof of sage's tolerability and efficacy in menopausal women with hot flushes. Adv.Ther. 2011;28(6):490-500.
  2. Dos Santos-Neto LL, Vilhena Toledo MA, Medeiros-Souza P, et al. The use of herbal medicine in Alzheimer's disease-a systematic review. Evid.Based.Complement Alternat.Med 2006;3(4):441-445.
  3. Guaschino S and Benvenuti C. SOPHY project: an observational study of vaginal pH, lifestyle and correct intimate hygiene in women of different ages and in different physiopathological conditions. Part II. Minerva Ginecol 2008;60(5):353-362.
  4. Kennedy DO, Dodd FL, Robertson BC, et al. Monoterpenoid extract of sage (Salvia lavandulaefolia) with cholinesterase inhibiting properties improves cognitive performance and mood in healthy adults. J.Psychopharmacol. 2011;25(8):1088-1100.
  5. Kennedy DO, Pace S, Haskell C, et al. Effects of cholinesterase inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery. Neuropsychopharmacology 2006;31(4):845-852.
  6. Kianbakht S, Abasi B, Perham M, and Hashem DF. Antihyperlipidemic effects of Salvia officinalis L. leaf extract in people with hyperlipidemia: a randomized double-blind placebo-controlled clinical trial. Phytother.Res. 2011;25(12):1849-1853.
  7. Moss L, Rouse M, Wesnes KA, and Moss M. Differential effects of the aromas of Salvia species on memory and mood. Hum.Psychopharmacol. 2010;25(5):388-396.
  8. Rakover Y, Ben Arye E, and Goldstein LH. [The treatment of respiratory ailments with essential oils of some aromatic medicinal plants]. Harefuah 2008;147(10):783-8, 838.
  9. Reuter J, Jocher A, Hornstein S, et al. Sage extract rich in phenolic diterpenes inhibits ultraviolet-induced erythema in vivo. Planta Med 2007;73(11):1190-1191.
  10. Sa CM, Ramos AA, Azevedo MF, Lima CF, Fernandes-Ferreira M, and Pereira-Wilson C. Sage tea drinking improves lipid profile and antioxidant defences in humans. Int J Mol.Sci. 2009;10(9):3937-3950.
  11. Schapowal A, Berger D, Klein P, et al. Echinacea/sage or chlorhexidine/lidocaine for treating acute sore throats: a randomized double-blind trial. Eur.J Med Res 9-1-2009;14(9):406-412.
  12. Scholey AB, Tildesley NT, Ballard CG, et al. An extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers. Psychopharmacology (Berl) 2008;198(1):127-139.
  13. Steinmann D, Eilers V, Beynenson D, Buhck H, and Fink M. Effect of Traumeel S on pain and discomfort in radiation-induced oral mucositis: a preliminary observational study. Altern.Ther.Health Med. 2012;18(4):12-18.
  14. Taheri JB, Azimi S, Rafieian N, and Zanjani HA. Herbs in dentistry. Int.Dent.J. 2011;61(6):287-296.
  15. Vandecasteele K, Ost P, Oosterlinck W, Fonteyne V, Neve WD, and Meerleer GD. Evaluation of the efficacy and safety of Salvia officinalis in controlling hot flashes in prostate cancer people treated with androgen deprivation. Phytother.Res. 2012;26(2):208-213.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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