Sage (Salvia officinalis): Uses, Evidence and Safety

Safety first: thujone. NIH says common sage (Salvia officinalis) contains a component called thujone that can be toxic in large amounts, so sage may be unsafe in high doses or if used for long periods. [1] The EU herbal committee reports that intake of sage oil corresponding to more than 15 g of sage leaf has caused a sensation of heat, fast heartbeat, vertigo and seizures. [2] NIH also says sage may be unsafe in pregnancy because of thujone. [1] Do not swallow sage essential oil. For a suspected poisoning or seizure call 911 or Poison Help at 1-800-222-1222 (US).

Overview

NIH says the word "sage" refers to many plants in the genus Salvia, and that sage is also used as a cooking spice. [1] This page covers common sage. It does not cover white sage as used in smudging, which is a cultural practice with its own page: Smudging and White Sage. Clary sage is an essential-oil topic: Clary Sage Oil.

Scientific name, plant part and a name trap

Salvia officinalis L. is the accepted name in the GBIF plant database, in the family Lamiaceae. [3] The part used in the EU monograph is the leaf (folium). [2] NIH says common sage and Spanish sage (Salvia lavandulaefolia) are two different species that have both been used as traditional remedies, and some memory studies used one or both. [1] Check which species a study or product used.

Traditional use (not proof)

NIH says sage was traditionally used for digestive, respiratory and skin problems. [1] A trial report describes a long-standing reputation in European medical herbalism, including for memory. [4] The EU committee accepts sage leaf as a traditional herbal medicine for mild heartburn and bloating, excessive sweating, mouth and throat inflammation and minor skin inflammation, based "exclusively" on long-standing use. [2]

What research shows (research, not tradition)

NIH says only small amounts of research have been done, so definitive conclusions cannot be reached. [1]

See also Herbs for Menopause Symptoms and Black Cohosh vs Red Clover vs Sage.

Official limits on thujone

The EU monograph says thujone is reported to be neurotoxic, so low-thujone types should be preferred, the amount of thujone must be stated in a product, and daily exposure has to be below 6.0 mg. [2] (EMA, European Union, 2016.) A 2010 risk assessment concluded that short-term medicinal use of sage can be regarded as safe, and that existing limits were sufficiently protective; this is the authors' view. [6] NIH says larger amounts than found in foods were used safely for up to 8 weeks in research studies. [1]

Forms and why the form matters

The EU monograph lists herbal tea, extracts, tinctures, a gel and skin or mouth rinse preparations. [2] Thujone content depends on the type of plant and preparation, so one product is not equal to another. The memory study used a standardized extract. [4]

Safety and who should ask first

• Pregnancy and breastfeeding: NIH says sage may be unsafe in pregnancy and little is known about breastfeeding. [1] The EU committee does not recommend use in either. [2] See Pregnancy and Breastfeeding.
• Seizures: the EU monograph reports seizures after sage oil. [2] People with epilepsy should ask a clinician before any sage product.
• Children: use under 18 is not established because of lack of data. [2]
• Medicines: the EU monograph reports no interactions. [2] NIH advises talking to a provider if you take any medicine. [1]
• Duration: NIH says it may be unsafe for long periods. [1]
• Liver, kidney, bleeding, surgery, allergy: hypersensitivity to sage is a contraindication in the monograph. [2] The other points are not described in the sources we read. Tell the surgical team about every herb you use.