Herb of the Month: Sage

Sage (Salvia offinicalis)

The wonderful thing about herbal medicine is that it is all around us – even if you don’t know much about it, you probably know more than you think.

Culinary herbs are a great example – many common ones (Thyme, Rosemary, Sage, Peppermint, Lemon Balm) grow everywhere like clever little weeds, sprouting up just where we need them.

Sage is a wise old herb and ancient medicine in the East and West, and it was added to rich meals to aid digestion as much as to impart flavour. The Latin name for Sage, Salvia officinalis, is derived from salvere, to be saved – referring to the curative properties of the herb.

Traditional uses

Sage tea is traditionally used as a gargle to soothe sore throats, mouth ulcers and inflamed gums & tonsils, and is taken internally as a nervous system and memory ‘tonic’.

It is thought of as an inwardly-acting herb, helping to conserve strength and prevent dispersal of forces in the body – giving some traditional background to its modern use in hot flushes & night sweats as an anti-hydrotic (anti-sweating) medicine. It is also oestrogenic; a practical explanation for its use during the menopause.

Sage depicted in the legendary Nicholas Culpeper's (1616-54) book, The English Physician

Sage depicted in the legendary Nicholas Culpeper’s (1616-54) book, The English Physician

These traditional actions of sage – anti-microbial, memory-enhancing, anti-hydrotic & oestrogenic – have been investigated in both laboratory experiments and human clinical trails, and I will be discussing these over the next few paragraphs. I’ll also be touching on the chemistry of Sage and finishing off with some easy home remedies.

Anti-microbial

The prefix ‘anti-‘ to describe a herbal action is not entirely suitable, as herbs do not really kill organisms like bacteria in the same way that conventional drugs do. Generally speaking, they prompt the body’s own immune system to do the killing instead. Or they employ complex, synergistic means to get rid of the invading organisms in their own cunning ways.

However, modern medical parlance does reflect the uniqueness of herbs as complex medicines by calling them anti-microbials rather than anti-bacterials or anti-fungals– their non-specific nature means they have an effect on all types of organisms.

Culinary herbs come from the botanical family Lamiaceae, and share many similar chemicals and properties. The powerful antioxidant called rosmarinic acid (named after Rosemary) – has shown strong anti-viral activity against both Herpes simplex and HIV infection in laboratory studies.

Thujone, a monoterpene found in varying amounts (9-44% of sage essential oil), is a strong anti-microbial but toxic at high levels. This was the compound once blamed for the psychotropic effects of absinthe, as the bitter herb Wormwood used in absinthe also contains thujone. It was later confirmed that adulteration and high alcohol content were the main culprits!

Carnosol, a diterpene also found in Rosemary is a potent anti-inflammatory.

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Herpes simplex (cold sores)

Various trials have investigated sage’s diverse anti-microbial effects. In a double-blind, comparative, randomised trial of 149 patients with herpes simplex (cold sores), creams containing either 2.3% sage or a mixture of 2.3% sage and 2.3% rhubarb were compared to conventional Zovirax cream. The time taken for cold sores to heal in each group was worked out as an average of 7.6 days for the sage cream, 6.7 days for sage & rhubarb and 6.5 days for Zovirax. Apart from showing that the sage & rhubarb were just as effective as the Zovirax, this trial is another nice example of herbal synergy – sage & rhubarb together worked better than sage alone.

Viral pharyngitis

Another double-blind, placebo-controlled study of 286 patients compared the efficacy of Sage throat spray against a placebo for acute viral pharyngitis. A 15% sage spray was found to be more effective than placebo in relieving throat pain, with relief occurring 2 hours after application. Mild side effects of dryness and burning were reported. Other herbs could be added to a homemade throat spray or gargle to counteract this dryness. See ‘Sage Old Remedies’ at the end of this post!

Helicobacter pylori

Sage was also among the most active herbal extracts in inhibiting the growth of Helicobacter pylori, a bacteria that plays a big part in the development of stomach ulcers and stomach cancer. Sage is a good digestive remedy not only for its anti-microbial effects, but also because it is a demulcent – soothing to the mucous membranes of the gastrointestinal tract.

Sage for old age

Herbalists of old cannot be criticised for holding back when describing the curative wonders of Sage.

John Gerard remarked in the 16th century – “It is singularly good for the head and brain and quickeneth the nerves and memory”, while Sir John Hill said in 1756 – “Sage will retard that rapid process of decay that threads upon our heels so fast in latter years of life, will preserve faculty and memory more valuable to the rational mind than life itself.”

The cover of John Gerard's 1597 'The Herball, or Generall Historie of Plants'

The cover of John Gerard’s 1597 ‘The Herball, or Generall Historie of Plants’

Even so, sage’s reputation as a cure for old age led a team of British & American scientists to investigate its properties. In a randomised, double-blind, placebo-controlled trial, the effect of a single dose of sage on memory was compared to placebo in 20 healthy elderly volunteers over a 6-hour period. A dose of 2.5g significantly enhanced secondary memory – longer-term memory where recently supplied information is processed – compared to placebo. It also increased accuracy of attention and was shown to inhibit cholinesterase (an enzyme that breaks down acetylcholine, an important neurotransmitter involved in memory & brain function) in an in vitro experiment. The authors conclude it could be a safe and effective way to temporarily reverse the deterioration of secondary memory that comes with normal ageing.

It’s also been shown to have a mood and cognition-enhancing effect in healthy young volunteers, too! In a laboratory setting, both 300mg and 600mg of sage led to improved mood ratings in 30 volunteers compared to placebo, with the lower dose reducing anxiety and the higher dose increasing ‘alertness’, ‘calmness’ and ‘contentedness’. See here for details of the study.

Alzheimer’s

One trial in patients with established Alzheimer’s disease has also been conducted. In the trial, 60 drops of sage were given to 42 patients with mild-moderate Alzheimer’s, daily for 4 months. At 4 months a significantly better outcome than placebo was seen with no side effects. Sage may also reduce agitation in Alzheimer’s patients, which was more frequent in the placebo group, but this was purely speculation. No further trials on Salvia officinalis have been done, to my knowledge, in Alzheimer’s patients. Dementia in all forms seems to be on the rise and the biggest challenge facing the current NHS is dealing with increasing numbers of elderly patients, many of whom have dementia-related special needs. Herbs and herbalists could help relieve this burden, and more research should be done.

Hot flushes

As hormone-replacement therapy (HRT) has been shown to increase the risk of certain cancers as well as heart disease, herbal medicine can provide a safe alternative to women having a bad time with the menopause. Menopausal symptoms like hot flushes occur due to naturally declining levels of oestrogen in the body – an important hormone in body temperature regulation, among other things. Sage is traditionally said to be oestrogenic, and one experiment did show possible oestrogenic activity in the essential oil of a Spanish species, Salvia lavandulaefolia.

An Italian study from 1998 involved 30 women with menopausal hot flushes & night sweats. An extract of Sage and Alfalfa (Medicago sativa) was given and symptoms disappeared in 20 women, with the remaining 10 also showing some improvement. A larger, open trial was conducted in 2011 over 8 practices in Switzerland – 71 patients were given a tablet of fresh sage daily for 8 weeks, and the average total number of hot flushes decreased by 50% after 4 weeks and 64% after 8 weeks. Average numbers of mild, moderate, severe, and very severe hot flushes decreased by 46%, 62%, 79%, and 100% over the 8 weeks, respectively. While the evidence is scanty, this is clearly a case for further investigations, and sage is a remedy often employed by herbalists in the treatment of hot flushes with good results. The great thing about it is that it is easy to grow and prepare at home – just pick one of the recipes below!

SAGE OLD REMEDIES

Hot flushes

This simple home remedy is given by Ruth Trickey in her herbal bible entitled ‘Women, Hormones & the Menstrual Cycle’: “Chop about 6 fresh sage leaves and soak overnight in lemon juice. In the morning, strain & drink the juice. Seven to ten days of the mixture will usually control flushing & sweating, and also improve digestion & concentration. It should not be continued for longer than two weeks without a break.”

Sore throat

Mix an equal amount of Echinacea, Propolis & Sage tincture, label & keep in an amber glass bottle away from direct sunlight. Whenever you have a sore throat, add 2mls of this mix to 10mls of water, gargle and swallow. Repeat this up to 3 times a day. This, along with an internal remedy, has been reported to cure a chronic case of sore throat after 8 weeks of treatment (Bone & Mills, 2013).

The quality of tinctures is very important. You can always make your own!

The quality of tinctures is very important. You can always make your own!

Old age

Sadly, there is no cure! But sage tea can help you grow older with grace and wisdom, and maybe even improve your memory. Fresh sage is best – take 3-4 leaves (depending on size), bruise but don’t cut, add a cup of boiling water and infuse for 15 minutes. Strain and sip, sip, sip. Drink when cold for hot flushes, hyperhidrosis or night sweats.

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References

Bone & Mills (2013) Principles & Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone. Ganora (2009) Herbal constituents: Foundations of Phytochemistry. CO, USA. Trickey (2003) Women, Hormones & the Menstrual Cycle. Allen & Unwin, Australia.

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