Sage (Salvia officinalis)
Summary
Sage leaf extract (Salvia officinalis) has small trials in memory, hot flushes, lipids and blood sugar. A 94-person trial and a 20-person crossover found memory and attention gains, and Iranian trials reported lower cholesterol and glucose. A hot-flush meta-analysis of 4 trials was inconclusive. Sage contains thujone, which can trigger seizures at high doses.
Key facts
- Leaf extract of garden sage (Salvia officinalis); some products also use Spanish sage (Salvia lavandulaefolia)[2][8]
- 94 healthy adults (600 mg/day for 29 days) and 20 adults over 65 (single doses) showed memory or attention gains[1][2]
- A meta-analysis of 4 trials (310 women) found a trend for fewer hot flushes; the confidence interval crossed zero[4]
- 500 mg three times daily lowered LDL and raised HDL in two Iranian trials (67 and 80 patients)[5][6]
- Sage contains thujone and camphor, which are neurotoxic at high doses; the EU monograph caps daily thujone exposure below 6 mg, and swallowed sage oil can cause seizures[8][9][10]
- 7 graded human outcomes on this page
- October 13, 2026
How it works
ProposedSage extracts inhibited cholinesterase in lab tests, the same enzyme targeted by some dementia drugs, which is the proposed basis for memory effects. Proposed lipid and glucose effects are based on lab and animal findings such as PPAR-gamma activity and pancreatic lipase inhibition.[1][5]
What the human research says
Human trials only, one row per outcome. The form column shows what each trial actually tested. Grades follow our evidence-grading policy.
At a glance: strongest evidence per outcome
| Outcome | Grade | Effect | Strongest evidence | Rows |
|---|---|---|---|---|
| Menopause | Grade C | Mixed | Meta-analysis · n = 310 · 2023 | 1 row |
| Memory | Grade C | Improved | RCT · n = 94 · 2021 | 3 rows |
| Blood sugar | Grade C | Improved | RCT · n = 80 · 2013 | 1 row |
| Cholesterol | Grade C | Improved | RCT · n = 67 · 2011 | 1 row |
| Insulin resistance | Grade D | Improved | RCT · n = 60 · 2020 | 1 row |
Every graded row
| Outcome | Effect | Grade | Best evidence | PMID |
|---|---|---|---|---|
| Frequency and severity of menopausal hot flushes | Mixed | Grade C | Meta-analysis · n = 310 · 2023 Postmenopausal women in 4 trials Form: Salvia officinalis preparations · Dose: Varied · Duration: Varied All 4 trials reported fewer and milder hot flushes, but the pooled effect on frequency had a confidence interval crossing zero (ES −1.12, 95% CI −2.37 to 0.14) and severity was not significant; the authors nonetheless called the frequency effect significant. | 37489230 (opens PubMed)Source [4] |
| Working memory and accuracy in healthy adults | Improved | Grade C | RCT · n = 94 · 2021 Healthy adults aged 30–60 Form: Combined extract of Salvia officinalis polyphenols and Salvia lavandulaefolia terpenoids (Cognivia) · Dose: 600 mg/day · Duration: 29 days Working memory and accuracy tasks (Corsi blocks, numeric working memory, name-to-face recall) improved versus placebo, both within test days and across the 29 days. | 33466627 (opens PubMed)Source [2] |
| Fasting glucose, HbA1c and lipids in type 2 diabetes with high lipids | Improved | Grade C | RCT · n = 80 · 2013 Adults with type 2 diabetes and hyperlipidaemia (Iran) Form: Sage leaf extract capsules · Dose: 500 mg three times daily (1,500 mg/day) · Duration: 3 months Fasting glucose, HbA1c, total cholesterol, triglycerides and LDL fell and HDL rose versus placebo; no adverse effects reported. | 24050577 (opens PubMed)Source [6] |
| Blood lipids in hyperlipidaemia | Improved | Grade C | RCT · n = 67 · 2011 Patients with high cholesterol and/or triglycerides Form: Sage leaf extract capsules · Dose: 500 mg every 8 hours (1,500 mg/day) · Duration: 2 months Total cholesterol, triglycerides, LDL and VLDL fell and HDL rose versus placebo, with no change in liver enzymes or creatinine. | 21506190 (opens PubMed)Source [5] |
| Insulin resistance markers in PCOS | Improved | Grade D | RCT · n = 60 · 2020 Women with polycystic ovary syndrome and normal blood sugar (Iran) Form: Sage extract capsules · Dose: 330 mg/day · Duration: 8 weeks Insulin and HOMA-IR fell and QUICKI rose versus placebo; BMI fell; systolic blood pressure did not differ. | 31987228 (opens PubMed)Source [7] |
| Cognition (ADAS-cog, CDR-SB) in mild to moderate Alzheimer's disease | Improved | Grade D | RCT · n = 42 · 2003 Adults aged 65–80 with mild to moderate Alzheimer's disease (Iran) Form: Salvia officinalis extract (drops) · Dose: 60 drops/day · Duration: 16 weeks Cognition scores were better than placebo at 4 months (ADAS-cog p=0.03; CDR-SB p<0.003). | 12605619 (opens PubMed)Source [3] |
| Secondary memory and attention in older adults | Improved | Grade D | Crossover RCT · n = 20 · 2008 Healthy volunteers over 65 (mean age 73) Form: Standardised Salvia officinalis extract · Dose: Single doses of 167, 333, 666 and 1,332 mg · Duration: Single doses, 7-day washouts The 333 mg dose improved secondary memory at every test time and accuracy of attention versus placebo; other doses helped less. | 18350281 (opens PubMed)Source [1] |
Forms
| Form | Elemental % | Absorption (human data) | GI tolerance | Studied for |
|---|---|---|---|---|
| Sage leaf extract (capsules, drops) | Varies[1][2][5][6][7] | No human absorption data for the extracts used in trials.[1][5] | No adverse effects were reported in the lipid and diabetes trials at 1,500 mg/day for up to 3 months. Occasional nausea, vomiting, abdominal pain, dizziness, agitation and wheezing are described for sage generally.[5][6][8] | Memory, Alzheimer's, lipid, diabetes and PCOS trials (330–1,500 mg/day) |
| Sage essential oil | Varies[9] | Not studied as an oral supplement.[9] | Internal use of sage essential oil can cause seizures because of thujone and camphor.[9] | Not studied for benefit; a seizure risk when swallowed |
Studied doses
Doses studied in human trials ranged from single doses of 167–1,332 mg (memory) to 330 mg/day (PCOS, 8 weeks), 600 mg/day (memory, 29 days) and 1,500 mg/day given as 500 mg three times daily (lipids and diabetes, 2–3 months). An Alzheimer's trial used 60 drops/day for 16 weeks.[1][2][3][5][6][7]
Interactions
Published interactions only: each row cites a source. No row means none was found in our sources, not that a combination is safe.
Medicines
- Diabetes medicinesRCTSage extract lowered fasting glucose and HbA1c in people with type 2 diabetes, so it could add to the glucose-lowering effect of their medicines.[6]
- Seizure medicinesReviewThujone and camphor in sage, especially in the essential oil, can lower the seizure threshold; no formal interaction studies exist.[9]
Who should be careful
- Epilepsy
- Sage essential oil taken internally can trigger seizures, and thujone and camphor are neurotoxic at high doses; the EU monograph reports that sage oil equal to more than 15 g of leaf caused rapid heartbeat, vertigo and seizures.[8][9][10]
- Breastfeeding
- Sage is traditionally used to reduce milk supply; no studies have tested this and no safety data exist for nursing mothers or infants.[8]
- Pregnancy, breastfeeding and under-18s
- The EU monograph does not recommend sage leaf in pregnancy or breastfeeding because safety is not established, and says use under 18 has not been established. The trials enrolled adults only.[10][2][5][6]
- Diabetes treatment
- People on glucose-lowering drugs should be aware that sage lowered blood sugar in a trial in type 2 diabetes.[6]
Talk to your pharmacist or clinician before starting a supplement, especially if you take prescription medicines.
How to read the label
- Extract vs essential oilThe trials used leaf extracts. Sage essential oil is a concentrated source of thujone and camphor and carries a seizure risk if swallowed.[9]
- Species mattersSome memory products blend Salvia officinalis with Spanish sage (Salvia lavandulaefolia), which contains less thujone; sage is also often misidentified or adulterated.[2][8]
- Thujone contentThe EU monograph says sage products should state their thujone content, keep daily thujone exposure below 6 mg and prefer low-thujone chemotypes. Most supplement labels do not list thujone.[10]
Cost per studied dose, without the sales pitch
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Cost per studied dose
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Frequently asked questions
Does sage improve memory?
Small trials suggest it might. 600 mg/day of a sage blend improved working memory in 94 healthy adults, and a single 333 mg dose improved memory in 20 older adults.[1][2]
Does sage help with hot flushes?
Possibly, but the evidence is inconclusive. Four small trials all reported benefit, yet the pooled result for frequency was not clearly different from placebo.[4]
Can sage lower cholesterol?
Two Iranian trials found 1,500 mg/day lowered LDL and raised HDL over 2–3 months; they come from one research group.[5][6]
Sources
- [1]An extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers.. Psychopharmacology (Berl), 2008. crossover-RCT
- [2]The Acute and Chronic Cognitive Effects of a Sage Extract: A Randomized, Placebo Controlled Study in Healthy Humans.. Nutrients, 2021. RCT
- [3]Salvia officinalis extract in the treatment of patients with mild to moderate Alzheimer's disease: a double blind, randomized and placebo-controlled trial.. J Clin Pharm Ther, 2003. RCT
- [4]The Effect of Salvia Officinalis on Hot Flashes in Postmenopausal Women: A Systematic Review and Meta-Analysis.. Int J Community Based Nurs Midwifery, 2023. meta-analysis
- [5]Antihyperlipidemic effects of Salvia officinalis L. leaf extract in patients with hyperlipidemia: a randomized double-blind placebo-controlled clinical trial.. Phytother Res, 2011. RCT
- [6]Improved glycemic control and lipid profile in hyperlipidemic type 2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomized placebo. Controlled clinical trial.. Complement Ther Med, 2013. RCT
- [7]Efficacy of Salvia officinalis extract on the prevention of insulin resistance in euglycemic patients with polycystic ovary syndrome: A double-blinded placebo-controlled clinical trial.. Complement Ther Med, 2020. RCT
- [8]Sage., 2006. database
- [9]The Effects of Various Essential Oils on Epilepsy and Acute Seizure: A Systematic Review.. Evid Based Complement Alternat Med, 2019. review
- [10]European Union herbal monograph on Salvia officinalis L., folium (Revision 1). European Medicines Agency (HMPC), 2016. guideline
What changed
- Independent adversarial review: added the EU (EMA/HMPC 2016) sage leaf monograph: daily thujone exposure below 6 mg, sage oil above 15 g leaf-equivalent linked to seizures, and use in pregnancy and breastfeeding not recommended (previously described only as unknown). All 9 PMIDs re-verified (title, year, no retraction) and every evidence row re-read against its abstract; no numeric errors found.
- Adversarial second pass: every PMID re-checked against NCBI esummary (title, year, no retraction, erratum or expression-of-concern flags) and every number in each evidence row re-read against its PubMed abstract (PMC full text where the abstract lacked dose or duration). Countries and funding notes kept only where the abstract or full text states them; interactions listed only where a source supports them, otherwise stated as unstudied.
- First draft. Every PMID checked against NCBI E-utilities esummary (title and year taken from the record) and abstracts read for the cited rows.