Sage: What It Is, How It Works, and When to Use It
Sage (Salvia officinalis) is a grey-green, soft-leaved Mediterranean herb that sits in most British spice racks and has been used as a medicine for far longer than it has been used as a stuffing. It is traditionally used to support digestion, comfort during menopause and the mouth and throat. The research on it is modest and mostly small, which is a good reason to be precise about what it can and cannot do. It is one of the five herbs in the EarthWise MenoEase Day formula.
What it is
Sage belongs to the mint family (Lamiaceae) and is native to the northern Mediterranean. It grows as a woody, silvery shrub about half a metre tall, with wrinkled, velvety leaves and spikes of blue-purple flowers that bees love. It does well in a British garden and tends to come back year after year.
The genus name Salvia is usually traced to the Latin for being well or being safe, and the herb has carried that reputation through European folk medicine, monastery gardens and Elizabethan herbals. The part used is the leaf, picked before or around flowering and used fresh or dried.
A buyer's note worth reading. Look for the Latin name Salvia officinalis on the label. There are hundreds of Salvia species, and some sold as sage in other parts of the world are different plants with different chemistry. Common sage and Spanish sage (Salvia lavandulifolia) are also not interchangeable, because their essential oils differ. If a supplement does not name the species and the plant part, I would keep looking.
The active compounds
Sage leaf contains an essential oil, together with phenolic compounds, flavonoids and bitter diterpenes.
The essential oil. The oil is rich in terpenes, including 1,8-cineole and camphor, and in thujone. Thujone is the compound that matters most for safety, because it is a known convulsant at high doses. That is why the European monograph on sage sets an upper limit on daily thujone intake, and why sage essential oil is not something to swallow.
Phenolic acids and flavonoids. Rosmarinic acid and related compounds give sage much of its antioxidant activity in laboratory tests. Rosmarinic acid is also found in lemon balm and rosemary, which is part of why those herbs get compared.
Bitters. The bitter taste of sage leaf is part of its traditional logic for digestion, since bitter herbs are used to stimulate digestive secretions.
Most of what is known about these compounds comes from cell and animal studies. How closely that reflects what a tea or tincture does in a person is an open question.
How it is traditionally used
The EU herbal committee (HMPC) has a monograph on sage leaf, with a revision published in draft form in 2016. It recognises sage leaf as a traditional herbal medicine for several uses:
the symptomatic relief of mild digestive upset, such as bloating and wind
the relief of excessive sweating
the relief of minor inflammation in the mouth and throat
minor skin inflammation, as a topical use
It is a traditional-use monograph, which means it rests on long-standing use and not on clinical trials. The monograph gives a herbal tea amount of 1 to 2 g of sage leaf in boiling water, up to three times a day. It advises limiting use for digestive upset and sweating to a short course of about two weeks before seeing a doctor or qualified practitioner if symptoms continue, and it keeps total thujone intake below 6 mg a day. It is not recommended for anyone under 18, or in pregnancy or breastfeeding.
In Western herbal practice sage has a long association with the changes of menopause, particularly night sweats and hot flushes. That is the use behind its place in MenoEase Day, where it sits alongside Red Clover, Shatavari, Turmeric and Rosemary.
What the research shows
Sage has not been studied nearly as much as many of the herbs in this library. Here is how the evidence reads.
Traditional evidence: digestion, sweating, mouth and throat. This is the basis of the EU monograph. It is a legitimate foundation for a gentle supporting herb, and it is a weaker one than people often assume.
Early evidence: menopausal hot flushes. An open, uncontrolled study of 71 menopausal women (Bommer and colleagues, 2011) used a fresh sage leaf tablet daily for eight weeks. Hot flush scores fell by around 64% over that period. That is an encouraging number, but with no control group there is no way to tell how much came from sage and how much from the natural ups and downs of menopausal symptoms.
Evidence overall. The US National Center for Complementary and Integrative Health notes that only small amounts of research exist on sage for health conditions. I agree with that reading.
Safety evidence. The main safety signal is thujone. Culinary amounts in food are widely regarded as safe, and long courses of concentrated products or oil are where the concern lies. That is the logic behind the monograph's thujone limit and its advice to keep medicinal courses short.
Sarah's clinical perspective
I use sage in MenoEase Day as a tincture alongside Red Clover, Shatavari, Turmeric and Rosemary. I put it in the daytime formula because of its long traditional association with comfort during menopause.
I am careful with anyone who has epilepsy or a seizure disorder, and I advise against sage at high doses or for long periods. I also advise anyone who is breastfeeding and wishes to keep up their milk supply to avoid it, because sage is traditionally used to reduce milk.
Practical guidance
Dose. There is no trial-tested tincture dose. The EU monograph gives a traditional amount of 1 to 2 g of leaf as a tea, up to three times a day, for adults. That is a traditional amount for a tea, and it is not a dosing instruction for any particular product.
Format. A tea is the traditional and simplest form. A tincture is more concentrated and easier to take consistently. Sage essential oil should not be swallowed.
Time to effect. There is no clinical timeline. The one small study I have described ran for eight weeks. The monograph limits its digestive and sweating uses to about two weeks before review.
Timing. Sage tea is traditionally taken warm, spread through the day.
What it does not replace. Sage does not replace medical advice about menopause, and it is not a substitute for HRT or other medical options. Heavy or unexpected bleeding, new symptoms after menopause, or symptoms that disrupt daily life need a GP.
For how to take the EarthWise tonic specifically, the dose and full safety information are on the product page.
Common questions
Is the sage in my kitchen the same as medicinal sage? Common culinary sage is Salvia officinalis, the same species. The amounts used in cooking are small, and medicinal courses are more concentrated.
Can sage stop night sweats? The evidence does not support a promise like that. There is an encouraging small open study and a traditional reputation, and no good controlled trial that I can point to.
Is sage safe to take every day? The monograph advises short courses, mainly because of thujone. If you want to use a sage product for longer than a couple of weeks, I would speak to a qualified practitioner first.
Can I drink sage tea while breastfeeding? Sage is traditionally used to reduce milk supply, so I would avoid it if you are breastfeeding and want to keep your supply.
Does sage interact with medication? I am not aware of a well-documented list. The EarthWise safety guidance for MenoEase asks anyone on HRT, anticoagulants, hormone-related medication or medicines the liver metabolises to check with a GP or pharmacist first.
Where sage appears in the EarthWise range
Sage is one of the five herbs in MenoEase Day, the daytime half of the MenoEase menopause support pair, where it sits with Red Clover, Shatavari, Turmeric and Rosemary.
If you are not sure which formula fits, the EarthWise health quiz is the best place to start. Full safety information is on each product page.
Related reading: Menopausal Weight Gain Explained and Herbs for Hormonal Balance: A Naturopath's Plain-English Guide.
When to seek professional support
Sage in food amounts is generally well tolerated. Concentrated products are where the cautions apply. Check with a practitioner first in these situations:
Epilepsy or a seizure disorder. Thujone can provoke seizures at high doses, so sage should be avoided.
Pregnancy and breastfeeding. Not recommended. Sage is also traditionally used to reduce milk supply.
Oestrogen-sensitive conditions. This applies to certain breast, uterine and ovarian conditions. The EarthWise MenoEase guidance asks for medical advice first, mainly because Red Clover in the same formula contains phyto-oestrogens.
HRT, anticoagulants, hormone-related medication or medicines metabolised by the liver. Check with your GP or pharmacist first.
Under 18. The monograph does not recommend use in children and adolescents.
Symptoms that continue beyond about two weeks. The monograph advises seeing a doctor or qualified practitioner.
Bleeding after menopause or any new, unexplained symptom. See your GP promptly.
Sarah Burt is a registered naturopath, medical herbalist and iridologist with 25+ years of clinical experience. All EarthWise tonics are formulated by Sarah based on her clinical protocols.
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This article is for informational purposes only and is not intended to diagnose, treat or cure any health condition. Always consult a qualified health practitioner before making changes to your health regimen.
