"It is singularly good for the head and brain and quickeneth the nerves and memory."
– 16th Century Pharmacopoeia


"It also heals the memory, warming and quickening the senses."
– 17th Century Pharmacopoeia

Sometimes language and culture cross paths in strange ways. Whether by intelligent design, coincidence, or plain dumb luck, their juxtaposition has to make us sit up and wonder whether someone is playing a cosmic joke on us.

Consider the English word "sage." Sage has two familiar meanings:

Sage is used to describe a man respected for possessing the wisdom and calm judgment that come only with age and experience. A sage is a person whose intellect has only grown keener and sharper with age; one who has used the years as a sharp blade to pare life to its essence. A sage is a respected elder who has learned the answers to life’s important questions by living and learning and keeping his cognitive abilities long into old age, so he can pass his "sage advice" on to those who follow him. The word sage, as used here, is derived from the Latin word, sapere, for wise. The name of our species homo sapiens – literally knowing, or wise man – comes from this root.

Sage is also the name of an herb, usually either salvia officinalis or salvia lavandulaefolia. A member of the mint family, commonly used in cooking, sage is a key ingredient in Thanksgiving turkey stuffing recipes, among many others. Plants of the sage family have also been used since ancient times by Greek, Roman, Indian (Ayurvedic), Chinese, and American Indian medical systems. Its uses have included enhancing "head and brain" functioning, improving memory, quickening the senses, and delaying age-related cognitive decline. This form of the word sage is descended from the Latin salvia or salvius, meaning healthy.

Although there is absolutely no connection between the two forms of the word "sage," it nevertheless appears quite possible that ingesting the herb sage will go a long way toward helping a person become a sage.

While herbalists have understood the medicinal value of sage for centuries, Western medical science, which demands more than anecdote and folklore, is just starting to get a handle on it. The most recent scientific study, from researchers in the United Kingdom, evaluated the activity of Spanish sage (salvia lavandulaefolia) in healthy young adults. Confirming some of the findings of earlier studies,1, 2 the results showed consistent improvements in memory as well as enhanced "alertness," "calmness," and "contentedness."3

In this placebo-controlled, double-blind study, the participants included 24 healthy undergraduates, aged 18 to 37 years. They each received single doses of either placebo or 25 µL or 50 µL of an essential oil derived from Spanish sage. Their cognitive performance and mood were assessed using standardized measures immediately before treatment and again at 1, 2.5, 4, and 6 hours. The cognitive tasks measured included word recall, simple reaction time, digit vigilance, choice reaction, spatial memory, numeric working memory, delayed word recall, delayed word recognition, and delayed picture recognition. Mood variables included alertness, calmness, and contentedness.

Improved Memory

Compared to placebo, both doses of Spanish sage oil improved performance on memory tasks (Fig. 1). Specific improvements were seen in "Quality of Memory," a combination of word recall, spatial memory, numeric working memory, delayed word recall, delayed word recognition, and delayed picture recognition tasks; "Secondary Memory," a measure that reflects elements of learning, consolidation, and retrieval of information; and "Speed of Memory," which measures efficiency of memory retrieval.





Figure 1. Percent change from baseline in three measures of memory following treatment with essential oil of Spanish sage (25 µL or 50 µL) or placebo. * P <0.05. Adapted from Tildesley et al, 2005.1


Enhanced Mood

Even more striking were the improvements in mood associated with Spanish sage oil (Fig. 2). The 50-µL dose was most effective, producing significantly greater enhancement than placebo on all three mood factors tested at 2.5 and 4 hours after treatment.





Figure 2. Percent change from baseline in three measures of mood following treatment with essential oil of Spanish sage (25 µL or 50 µL) or placebo. * P <0.05. Adapted from Tildesley et al, 2005.1


How Does Sage Work?

The essential oil of Salvia lavandulaefolia has a complex composition that appears to offer several possible modes of action in enhancing memory and mood. These include the following effects:

  • Anticholinesterase4
  • Antioxidant5
  • Anti-inflammatory6
  • Estrogenic7

Of these, the one that has received most attention has been its anticholinesterase activity. Memory function in the brain relies to a large extent on the ability of the neurotransmitter acetylcholine (ACh) to carry messages across synaptic junctions from one neuron (nerve cell) to another. The brain modulates the levels of ACh by releasing the enzyme acetylcholinesterase (AChE), which quickly inactivates ACh molecules soon after they are released. By inhibiting AChE, sage effectively prolongs the lifespan of ACh molecules, especially in two areas of the brain, the striatum and hippocampus,4 which are closely involved in memory function.

So important is this function for memory enhancement, that AChE inhibitors have been shown to improve memory function in both young and elderly people and are especially valuable in Alzheimer’s disease (AD), where all the drugs currently approved for treating cognitive dysfunction in AD are AChE inhibitors. Spanish sage has a distinct advantage over these drugs in that they all have serious, dose-limiting adverse effects, whereas sage has been used for hundreds, if not thousands of years with no reports of negative effects. Most recently, a trial in healthy young adults confirmed Salvia lavandulaefolia to be safe and tolerable.

The fact that it has antioxidant and anti-inflammatory activity also places sage in a different class from conventional anticholinesterase drugs. While its AChE inhibition may improve age-related memory deficits, sage’s other activities may actually help prevent the Alzheimer’s disease from ever getting a foothold in the brain, especially when we start using it at a relatively young age. Moreover, sage’s ability to enhance mood as well as memory also helps set it apart, making it a valuable treatment for both young and old people who want to improve their memory and their mood, preserve their cognitive function into old age – and maybe live on to have both the mental function and the serenity to be recognized as a sage.

References
  1. Tildesley NT, Kennedy DO, Perry EK, et al. Salvia lavandulaefolia (Spanish sage) enhances memory in healthy young volunteers. Pharmacol Biochem Behav. 2003;75:669-674.
  2. Perry NS, Bollen C, Perry EK, Ballard C. Salvia for dementia therapy: review of pharmacological activity and pilot tolerability clinical trial. Pharmacol Biochem Behav. 2003;75:651-659.
  3. Tildesley NT, Kennedy DO, Perry EK, Ballard CG, Wesnes KA, Scholey AB. Positive modulation of mood and cognitive performance following administration of acute doses of Salvia lavandulaefolia essential oil to healthy young volunteers. Physiol Behav. 2005;83:699-709.
  4. Perry NS, Houghton PJ, Jenner P, Keith A, Perry EK. Salvia lavandulaefolia essential oil inhibits cholinesterase in vivo. Phytomedicine. 2002;9:48-51.
  5. Zupko I, Hohmann J, Redei D, Falkay G, Janicsak G, Mathe I. Antioxidant activity of leaves of Salvia species in enzyme-dependent and enzyme-independent systems of lipid peroxidation and their phenolic constituents. Planta Med. 2001;67:366-368.
  6. Bingol L, Sener B. A review of terrestrial plants and marine organisms having anti-inflammatory activity. Int J Pharmacogn. 1995;33:81-97.
  7. Perry NS, Houghton PJ, Sampson J, et al. In-vitro activity of S. lavandulaefolia (Spanish sage) relevant to treatment of Alzheimer's disease.J Pharm Pharmacol. 2001;53:1347-1356.

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