Carusos Sage

With sage, our naturopaths spend more time on the label than the dose, because several different plants share the name and only some of them fall under the thujone rule. These are the questions they ask in store.

A good fit if

• Memory is what you're after, and you've found a product that matches the two-species blend the trial used
• You're buying an Australian listed medicine, so the thujone in it has been measured against the 4% limit
• You enjoy the tea and the ritual, and you're not expecting a cup to match a trial dose
• You read botanical names, so you know whether you have common sage, Spanish sage or clary sage
• You want the evidence explained plainly, including where it runs out

Check with us first if

• You're pregnant. Australia's ingredient rules have no warning statement for sage, and we found no pregnancy data either. Because sage has a required limit on a compound that acts on the nervous system, treat that silence as unknown rather than reassuring.
• You're breastfeeding. There's the same lack of data, plus a question we couldn't answer. Australia permits a traditional claim for reducing breast milk production, and sage has a folk reputation for this. Nothing in the research we've reviewed confirms the link either way, so ask before you start.
• You take prescription medicine. We couldn't find any interaction data for sage, which means we can't tell you it's clear, only that no one we can cite has looked.
• It's for a child. There's no age limit on the sage products you swallow, and no data in children either way.
• You've bought sage from overseas, or you brew it strong and often. A listed Australian product has had its thujone measured, but an unregulated import or a home brew hasn't.
• You're buying it for hot flushes or sweating. Those are the uses sage is best known for, and the ones we couldn't find a trial for. It's worth a chat about what else is available.
• If you take prescription medicine, check with your doctor, pharmacist or our naturopaths before you start.

• Sage leaf dry, loose leaf and tea bags (Schedule 1 item 4415 SAGE LEAF DRY). Best known for: The traditional preparation, and what most people picture when they hear the word sage. Absorption: Hot water draws out the water-soluble parts and only some of the volatile oil. Typical use: Not standardised. No research we reviewed measures what a cup delivers, so a tea can't be compared with a trial dose.
• Sage leaf powder in capsules (item 4416 SAGE LEAF POWDER). Best known for: The whole leaf, ground and measured into a capsule. Absorption: Delivers everything in the leaf, including the thujone that a water infusion partly leaves behind. Typical use: Allowed as an active or homoeopathic ingredient (purpose codes A and H) only, not as a non-active ingredient. We found no trial of sage leaf powder.
• Salvia officinalis extract (item 4434 SALVIA OFFICINALIS). Best known for: Concentrated common sage, and one half of the blend in the memory trial. Absorption: Standardisation varies between products, so two extracts can't be swapped weight for weight. Typical use: We found no trial of common sage on its own. The thujone condition applies to this item.
• Spanish sage, Salvia lavandulaefolia (item 4432). Best known for: A different species, and the other half of the blend in the memory trial. Absorption: We have no absorption data, and there's no standardisation marker in common use. Typical use: Australia attaches no conditions at all to this item, including no thujone limit. Whether the plant really is lower in thujone isn't something we could confirm.
• The two-species blend: Salvia officinalis polyphenols with Salvia lavandulaefolia terpenoids. Best known for: The only sage product with a positive randomised memory trial behind it. Absorption: Not reported in the trial. Typical use: 600 mg a day in 94 healthy adults aged 30 to 60, measured 2 and 4 hours after a dose and again at 29 days. It combines a Schedule 1 item that has conditions with one that has none.
• Sage oil dalmatian (item 4417). Best known for: The essential oil of common sage, and the most concentrated form of everything in the leaf. Absorption: Carries the volatile oils rather than the polyphenols. Typical use: An aromatherapy oil, not a supplement. Above 10% in a container of 15 mL or less it must have a restricted flow insert, a child-resistant cap, “Keep out of reach of children” and “Not to be taken”.
• Clary sage oil (item 4435 SALVIA SCLAREA) and sage oil Spanish (item 4418). Best known for: Aromatherapy species sold next to common sage and often confused with it. Absorption: Not established in any research we reviewed. Typical use: Both are allowed with no conditions recorded. We found no clinical trial of either, and none of the memory evidence applies to them.
• Danshen, Salvia miltiorrhiza (item 4433) and chia, Salvia hispanica (item 4431). Best known for: Two plants that share the genus name and nothing else. Absorption: Separate products with separate evidence. Typical use: Danshen is a Chinese heart and circulation herb; chia is a seed sold as food. Neither is culinary sage, and research on them tells you nothing about this page.

Reference values. There's no reference intake for sage, and there can't be one. It's a herb, not a nutrient, so there's no RDI, deficiency or upper level. Any percentage-of-daily-intake figure on a sage pack doesn't mean anything.

Typical supplemental range. Only one dose in the research we've reviewed comes from a trial: 600 mg a day of the two-species blend, taken by 94 healthy adults for 29 days. The second memory trial didn't state its dose in the record we have. For hot flushes, sweating and gargling, the three things sage is mostly bought for in Australia, we couldn't find a dose anywhere in the research, so we won't publish one. Follow the label of the product you've bought, because sage products can't be swapped gram for gram.

Upper level. No sage ingredient has a maximum daily dose in Australia's permitted ingredients list (Schedule 1). Instead, Australian law caps one compound: thujone, at no more than 4% of the medicine, for Salvia officinalis, sage leaf dry, sage leaf powder and sage oil dalmatian. Having no dose cap doesn't mean any dose is fine. A company still has to hold evidence for the dose it uses.

Worth knowing. How long you take it matters as much as the dose. The one positive trial ran for 29 days, and it measured performance on tasks rather than how anyone felt. What you need depends on your age, diet and health, so talk to one of our naturopaths.

Food first, where the diet allows it.

• Fresh or dried sage leaf, used in cooking: an everyday kitchen herb, used by the pinch rather than the spoonful. No source we hold quantifies the thujone or the active content of a culinary serve
• Sage tea, infused from the dried leaf: the traditional preparation and a common way Australians take sage. Nobody we can cite has measured what a cup delivers, so we can't tell you how it compares to a capsule
• Other mint-family kitchen herbs: rosemary, thyme, oregano, mint, basil: same botanical family as sage, eaten in the same small amounts. A 20-trial meta-analysis pooled the family as a whole, which is exactly why its results can't be attributed to sage

If any of these sound like you, talk to one of our naturopaths or your doctor before you start.

• You're pregnant. There's no Schedule 1 warning and no human data either way, for an ingredient with a mandatory thujone limit. This is unresolved, so see a practitioner.
• You're breastfeeding. The same lack of data, plus an open question about reducing milk supply: Part 10 item 37 allows a traditional indication about reducing breast milk production. See a practitioner.
• Babies and children. There's no age restriction on the oral items and no data in children. Sage oil dalmatian above the set strength must carry “Keep out of reach of children”.
• You take prescription medicine. We found no interaction data for sage. That's a lack of data, not a clean safety record, so check with your prescriber.
• You'd be taking concentrated dalmatian sage oil by mouth. Above 10% in containers of 15 mL or less it's labelled “Not to be taken”. Never swallow it.
• You're using unregulated imports or strong home-brewed sage tea. The 4% thujone limit applies to Australian listed medicines, and nothing else has been measured against it.
• You're looking to sage as an established treatment for menopause symptoms. The only evidence we found is one narrative review with no effect sizes.
• Thujone in general. We found no toxicology source, so this page records the regulatory limit and makes no statement about what thujone does.
• You're reassured because sage doesn't show up in herbal side-effect reviews. An overview of 50 systematic reviews doesn't list sage, which means there were none on sage to include.
• If you take prescription medicines, check with your doctor, pharmacist or our naturopaths before starting.