Sage: extract trials in diabetes, and very little about the herb as food

A meta-analysis of 3 randomized trials in people with diabetes found that Salvia officinalis extract lowered fasting blood sugar by 31.15 mg/dL (95% CI -37.56 to -24.73) and HbA1c by 0.94 percentage points (95% CI -1.25 to -0.63). Three trials is a thin base, and the authors themselves ask for stronger ones. Every clinical result on this page comes from sage extract given to people who were already ill, at 330 to 1500 mg a day in the trials we could read, and none of it tested sage as a kitchen herb. In 100 people with type 2 diabetes and high cholesterol who were already taking glyburide, metformin and atorvastatin, 500 mg of sage leaf extract three times a day for 2 months lowered fasting glucose, HbA1c, LDL cholesterol and triglycerides and raised HDL compared with placebo. The abstract gives no size for any of these changes, so we cannot tell you how large they were. That dose is above the traditional doses in the EU herbal monograph for sage leaf, 320 mg of dry extract a day or 80 to 160 mg three times a day. The monograph requires daily thujone, a sage compound reported to be neurotoxic, to stay below 6.0 mg, and the trials did not report how much thujone their extracts carried.

The numbers, per 3.5 oz (100 g)

How much is actually in it

• UK composition data list dried ground sage at 1650 mg calcium and 28.1 mg iron per 3.5 oz (100 g), and fresh sage at 600 mg calcium. — CoFID 2021 Sage, fresh (13-853) and Sage, dried, ground (13-854) (n = 2 records) Evidence E source
  Per 100 g fresh vs dried: calcium 600 vs 1650 mg, manganese 9.10 vs 25.00 mg, carotene 1290 vs 3540 mcg, water 66.4 vs 8.0 g; USDA FDC 170935 ground: vitamin K 1714.5 mcg, iron 28.12 mg

What it does to your health

• In a meta-analysis of 3 randomized trials in people with diabetes, Salvia officinalis extract lowered fasting blood sugar by about 31 mg/dL and HbA1c by 0.94 points. — Patients with diabetes in 3 randomized trials (n = 3 trials) Evidence A source
  FBS MD -31.15 mg/dL (95% CI -37.56 to -24.73); HbA1c MD -0.94% (95% CI -1.25 to -0.63); LDL MD -19.23 mg/dL
• In a 2-month RCT in 100 statin-treated type 2 diabetics with high cholesterol, 1500 mg/day of sage leaf extract lowered fasting glucose, HbA1c, LDL and triglycerides versus placebo. — 100 patients with dyslipidemic type 2 diabetes on glyburide, metformin and atorvastatin, 500 mg extract three times a day for 2 months (n = 100) Evidence B source
  FG, 2hPPG, HbA1c, TC, LDL-C, TG lower and HDL-C higher vs placebo (P<0.05); sizes not given in abstract
• In an 8-week RCT in 70 women with polycystic ovary syndrome, 330 mg/day of sage extract lowered triglycerides by about 17 mg/dL versus placebo, with no difference in LDL or total cholesterol. — 70 Iranian women aged 15-40 with newly diagnosed PCOS, 330 mg extract daily for 8 weeks (n = 70) Evidence B source
  TG MD -17.25 mg/dL (95% CI -34.35 to -0.14); TC, HDL-C, LDL-C no difference

Safety, limits and interactions

• The European Medicines Agency limits thujone from sage leaf medicinal preparations to 5 mg per person a day for at most 2 weeks, later setting 6 mg a day as the limit of exposure from medicinal products. It concluded that the benefits of sage essential oil do not outweigh its risks. — adults using herbal medicinal products made from sage leaf or other thujone-containing plants Evidence E source
  Thujone from sage leaf preparations limited to 5 mg per person a day for at most 2 weeks; 6 mg a day as the limit of daily exposure from medicinal products; benefits of sage essential oil do not outweigh its risks
• The European Medicines Agency reports that overdoses of thujone-rich preparations or their essential oil can cause convulsions, unconsciousness and death, and that humans are at least as sensitive to thujone as lab animals. — humans exposed to thujone-rich essential oils or overdosed preparations Evidence E source
  CNS disturbances leading to convulsions, unconsciousness and death; humans at least as sensitive to thujone neurotoxicity as experimental animals
• The EU monograph reports no overdose from sage leaves, but sage oil equal to more than 15 g of leaf has been reported to cause a racing heart, vertigo and seizures, so low-thujone types are preferred. — people taking sage oil or high amounts of sage Evidence E source
  Sage oil equal to more than 15 g of sage leaf reported to cause heat, tachycardia, vertigo and seizures; no overdose from sage leaves reported
• A case report describes a 13-year-old boy who developed angioedema after drinking sage tea, confirmed by oral challenge with sage. — One 13-year-old boy (n = 1) Evidence D source
  Angioedema after sage tea; positive oral food challenge with sage

What people believe that the data does not support

• A 2026 systematic review of 35 studies on hot flashes in men on androgen deprivation found dietary supplements, including Salvia officinalis, seem ineffective. — Men with prostate cancer on androgen deprivation therapy, 35 studies (n = 35 studies) Evidence C source
  Supplements ineffective; blinded drug reductions 21-84% vs placebo 19-30%

Who this works differently for

• The European Medicines Agency says no studies allow a reliable safety assessment of thujone in pregnant women or children, so thujone-containing herbal products such as sage preparations should be kept to a minimum in these groups. — pregnant women, children and other sensitive groups Evidence E source
  No preclinical or clinical data for sensitive groups; use of thujone-containing herbal products should be minimized
• The EU herbal monograph for sage leaf sets traditional doses of dry extract at 320 mg a day for indigestion or 80 to 160 mg three times a day for sweating. It requires daily thujone exposure below 6.0 mg and says use under 18 has not been established. — adults; children and adolescents under 18 Evidence E source
  Dry extract 320 mg a day for dyspepsia or 80 to 160 mg three times a day for sweating; daily thujone exposure below 6.0 mg; not established under 18
• The EU herbal monograph does not recommend sage leaf preparations during pregnancy or breastfeeding because safety is not established. It lists no reported drug interactions and no known side effects. — pregnant and breastfeeding women; users of other medicines Evidence E source
  Use in pregnancy and lactation not recommended; interactions none reported; undesirable effects none known
• In a 2-month RCT in 100 people with type 2 diabetes already on glyburide, metformin and atorvastatin, adding 1500 mg a day of sage leaf extract led to no reported adverse drug reactions. The trial did not report low blood sugar episodes separately. — 100 patients with dyslipidemic type 2 diabetes on 15 mg glyburide, 2000 mg metformin and 10 mg atorvastatin daily, sage leaf extract 500 mg every 8 h or placebo for 2 months (n = 100) Evidence B source
  No adverse drug reaction reported in either group; hypoglycemia not reported as a separate outcome
• NIH NCCIH says sage is likely safe in food amounts and larger amounts have been used safely for up to 8 weeks in research, but it may be unsafe in pregnancy because of its thujone content. — General public; pregnant and breastfeeding women Evidence E source
  Guidance; no effect size

What is still unknown

• The only meta-analysis of sage in diabetes pooled just 3 randomized trials, and its authors call for stronger trials. — 3 randomized trials in diabetic patients (n = 3 trials) Evidence A source
  Evidence base small

The bottom line

In 70 Iranian women aged 15 to 40 with newly diagnosed polycystic ovary syndrome, 330 mg of extract a day for 8 weeks lowered triglycerides by 17.25 mg/dL compared with placebo, with a 95% confidence interval of -34.35 to -0.14 that almost touches zero. Total, LDL and HDL cholesterol did not differ. For hot flashes, the one review we have is in men. A 2026 systematic review of 35 studies in men on androgen deprivation therapy for prostate cancer found that dietary supplements, Salvia officinalis among them, seem ineffective. It did not pool the data and did not include women in menopause. By weight, dried ground sage is mineral dense. UK data give 1650 mg calcium and 28.1 mg iron per 3.5 oz (100 g), and US data give 1714.5 micrograms of vitamin K per 3.5 oz (100 g). Fresh sage has 600 mg calcium per 3.5 oz (100 g). A spice is used in far smaller amounts than 100 g, and we have no portion data for sage, so these figures say little about what a pinch adds to a meal. We found no study on how drying, cooking or brewing changes sage, or on how much of its compounds the body absorbs. The NIH National Center for Complementary and Integrative Health says sage is likely safe in the amounts found in food and that larger amounts have been used safely for up to 8 weeks in research. It also says sage may be unsafe in pregnancy, because its component thujone may have harmful effects. One case report describes a 13-year-old boy who developed angioedema after drinking sage tea, confirmed by an oral challenge with sage. That is a single case. Concentrated sage is a different matter from the herb. The European Medicines Agency limits thujone from sage leaf medicines to 5 mg a day for at most 2 weeks, and later set 6 mg a day as the limit from medicinal products. It concluded that the benefits of sage essential oil do not outweigh its risks. Overdoses of thujone-rich preparations or essential oil can cause convulsions, unconsciousness and death, and sage oil equal to more than 15 g of leaf has been reported to cause a racing heart, vertigo and seizures. No overdose from sage leaves has been reported. The EU monograph does not recommend sage leaf preparations in pregnancy or breastfeeding and says use under 18 has not been established, and the agency says thujone products should be kept to a minimum in pregnant women and children. In the 100-person diabetes trial, people on glyburide, metformin and atorvastatin who added 1500 mg a day of extract for 2 months reported no adverse drug reactions. The trial did not count low blood sugar episodes separately, and the EU monograph lists no reported drug interactions but does not address glucose-lowering drugs, so this does not show the combination is safe for everyone. Anyone on those drugs should raise a sage extract with the doctor treating them.

Sources

1. sage-daily-r2-08 · food composition dataset
   Sage, fresh (CoFID 13-853): energy 119 kcal, water 66.4 g, calcium 600 mg, manganese 9.10 mg, carotene 1290 µg per 100 g; Sage, dried, ground (CoFID 13-854): energy 315 kcal, water 8.0 g, calcium 1650 mg, iron 28.10 mg, manganese 25.00 mg, carotene 3540 µg per 100 g; USDA FDC 170935 Spices, sage, ground (sr_legacy): vitamin K 1714.5 µg, vitamin B6 2.69 mg, iron 28.12 mg per 100 g
   CoFID 2021 (Public Health England, OGL v3.0), codes 13-853 and 13-854 Sage · checked 2026-09-29
2. sage-daily-r2-01 · meta-analysis of RCTs
   The results of meta-analysis showed that S. officinalis reduced fasting blood sugar (FBS) (mg/dL) (MD: -31.15; 95% CI: -37.56 to -24.73; p<0.00001). It also reduced HbA1c (%) (MD: -0.94; 95% CI: -1.25 to -0.63; p<0.00001)
   Abdollahi A et al., J Complement Integr Med, 2023 · checked 2026-09-29
3. sage-daily-r2-03 · RCT
   The extract lowered FG, 2hPPG, HbA1c, TC, LDL-C and triglyceride levels, but increased HDL-C level compared to the placebo at the endpoint (P<0.05). The extract did not affect the other parameters significantly and no adverse effect was reported.
   Kianbakht S et al., Int J Mol Cell Med, 2016 · checked 2026-09-29
4. sage-daily-r2-04 · RCT
   Among the lipid profile outcomes just TG (mg/dl) found a statistically significant difference compared with placebo after eight weeks of taking S. officinalis extract (MD = −17.25, 95% CI: −34.35 to −0.14; P = 0.048). TC (mg/d), HDL-C (mg/d), LDL-C (mg/d) and other ratios were identical between two groups after intervention.
   BMC Complement Med Ther, 2025 (PMC11938573) · checked 2026-09-29
5. hf2-sage-1 · agency position
   Difficulties culminated in the determination of maximum limit of daily intakes of thujone, which in the case of Absinthii herba was set at 3 mg/person and in the case of sage leaf preparations 5 mg/person, both for a maximum duration of 2 weeks. Furthermore, the HMPC has concluded that the benefits of sage essential oil do not outweigh its risks ... However, for the upper limit of the additional intake from medicinal products, the highest safe amount was reduced by the possible intake by food, to give 6 mg as a limit of daily exposure.
   EMA Committee on Herbal Medicinal Products, Public statement on the use of herbal medicinal products containing thujone, EMA/HMPC/732886/2010 Rev.1, 22 May 2012 · checked 2026-10-08
6. hf2-sage-3 · agency position
   Overdosage of alcoholic Absinthii herba preparations or the use of the essential oil may cause CNS disturbances which can lead to convulsions and ultimately to unconsciousness and death ... Although it is difficult to determine exposing doses in these cases, SCF (2002) concluded that humans are at least as sensitive to thujone neurotoxicity as experimental animals.
   EMA Committee on Herbal Medicinal Products, Public statement on the use of herbal medicinal products containing thujone, EMA/HMPC/732886/2010 Rev.1, 22 May 2012 · checked 2026-10-08
7. hf2-sage-6 · agency monograph
   No case of overdose from sage leaves has been reported. Intake of sage oil corresponding to more than 15 g of sage leaf is reported to cause sensation of heat, tachycardia, vertigo and epileptiform convulsions (seizures). ... Thujone is reported to be neurotoxic, hence chemotypes with low content of thujone should be preferred.
   EMA Committee on Herbal Medicinal Products, European Union herbal monograph on Salvia officinalis L., folium, EMA/HMPC/277152/2015 Rev.1, 20 September 2016 · checked 2026-10-08
8. sage-daily-r2-06 · case report
   3 weeks later, the patient was admitted with angioedema after drinking sage tea. OFC with sage was applied and angioedema was observed.
   Iran J Allergy Asthma Immunol, 2018 · checked 2026-09-29
9. sage-daily-r2-07 · systematic review
   Non-pharmacological options like acupuncture and CBT may offer some benefit, while dietary supplements seem to be ineffective.
   Prostate, 2026 · checked 2026-09-29
10. hf2-sage-2 · agency position
    There are no preclinical or clinical studies which would permit reliable scientific assessment of potential consequences regarding exposure of sensitive groups (i.e. pregnant women, children etc). Thus the use of thujone-containing herbal medicinal products in these groups should be minimised.
    EMA Committee on Herbal Medicinal Products, Public statement on the use of herbal medicinal products containing thujone, EMA/HMPC/732886/2010 Rev.1, 22 May 2012 · checked 2026-10-08
11. hf2-sage-4 · agency monograph
    c) Dry extract (DER 4-7:1) 320 mg daily divided in 3-4 doses ... c) Dry extract (DER 4-7:1) 80-160 mg 3 times daily ... The use in children and adolescents under 18 years of age has not been established due to lack of adequate data. ... The amount of thujone has to be specified in the given product. The daily exposure has to be below 6.0 mg.
    EMA Committee on Herbal Medicinal Products, European Union herbal monograph on Salvia officinalis L., folium, EMA/HMPC/277152/2015 Rev.1, 20 September 2016 · checked 2026-10-08
12. hf2-sage-5 · agency monograph
    None reported ... Safety during pregnancy and lactation has not been established. In the absence of sufficient data, the use during pregnancy and lactation is ... not recommended. ... None known
    EMA Committee on Herbal Medicinal Products, European Union herbal monograph on Salvia officinalis L., folium, EMA/HMPC/277152/2015 Rev.1, 20 September 2016 · checked 2026-10-08
13. hf2-sage-7 · RCT
    The patients were requested to report any adverse drug reaction. ... The patients did not report any adverse drug reaction.
    Kianbakht S et al., Int J Mol Cell Med, 2016 · checked 2026-10-08
14. sage-daily-r2-05 · agency guidance
    Sage is likely safe in the amounts commonly found in foods, and larger amounts have been used safely for up to 8 weeks in research studies. ... It may be unsafe to use sage during pregnancy because its component thujone may have harmful effects.
    NIH NCCIH, Sage: Usefulness and Safety · checked 2026-09-29
15. sage-daily-r2-02 · meta-analysis of RCTs
    However, due to the small number of included articles, it is recommended that stronger clinical trials be conducted in this field.
    Abdollahi A et al., J Complement Integr Med, 2023 · checked 2026-09-29