Each review contains information about the ingredient’s clinical applications, formulations, dosing & administration, adverse effects, and pharmacokinetics. Learn more about our critical appraisal research or contact us for initial guidance and more information.

Reishi (Ganoderma lucidum/lingzhi)

Medicinal mushrooms of the Ganoderma genus are called the “Mushrooms of Immortality” for their uses to maintain general health and increase longevity. (1)(32) In Traditional Japanese medicine or Traditional Chinese Medicine (TCM), the mushrooms are called reishi, or lingzhi, respectively. (32)

The name Ganoderma lucidum has been broadly used to describe laccate mushrooms of this family. (23) However, on a global scale, species belonging to the Ganoderma genus have been widely misclassified as lucidum species, creating confusion and possible mislabelling of Ganoderma-based products available in the dietary supplement market today. (1)(22)(23)

Strictly based on chemical composition, Ganoderma lucidum is a mushroom native to Europe, whereas Ganoderma lingzhi is native to Asia. However, products labeled as Ganoderma lucidum are frequently of the lingzhi species, the type most often cited for its medicinal effects despite its bioactive constituents’ distinct chemical compositions, known as polysaccharides and triterpenes. (17)(23)(35) Polysaccharides act primarily through immunomodulation to provide anti-bacterial, anti-oxidative, and anti-tumorous properties, whereas triterpenoids have broader anti-angiogenic, anti-histaminic, anti-hypertensive, anti-tumorous, hepatoprotective, and hypocholesterolemic properties. (8)

Notwithstanding the taxonomic-based complications of reishi-containing products, the use of Ganoderma lucidum will refer to reishi from a broad sense rather than it’s biochemical identification in this review.

Main uses

Anti-oxidant
Chemotherapy and radiotherapy adjuvant
Immunomodulation
Sense of well-being
Symptoms related to cancer (emotional, cognitive, or physical)

Formulations

Formulation	Comparison
Whole mushroom	Whole mushroom By weight, G. lucidum is ~90% water and 10% other components, including polysaccharides and triterpenes (32) Polysaccharides make up ~0.5% of the weight of the fruiting body (3) Typical TCM doses range between 50-300 g per day (12)
Crude dried extract	Raw (unfractionated) extracts are not processed in a manner to isolate specific biochemical constituents. As 10% of the weight of G. lucidum are non-water constituents, crude dehydrated mushroom extracts are 10x more concentrated than the whole mushroom (e.g., 10 g of whole mushroom = 1 g crude extract) (32)
Water-soluble extracts	Primarily used to refine the polysaccharides of G. lucidum (32) Doses found in research (see below) most often range between 1,500-3,000 mg taken in divided doses
Ethanolic extracts	Mainly used to refine the triterpenes of G. lucidum (32) Doses found in research (see below) are much lower than water-soluble doses and listed at 6 mg per day
Ganopoly®	A water-soluble extract containing 25% weight per weight of G. lucidum polysaccharides; one capsule (600 mg) is equivalent to ~30 g of reishi fruiting body, where the total recommended daily dose (5400 mg) is equal to 270 g of whole mushroom fruiting body (12)
Ji 731 injection/ Jisheng injection/ Polysaccharidum of G. lucidum Karst Injection	Intramuscular medicine containing polysaccharides from G. lucidum spores. Approved by China’s FDA in 2000, it treats neurosis, polymyositis, dermatomyositis, atrophic myotonia, and muscular dystrophy, as well as conditions related to immunodeficiency (36)

Dosing & administration

Anti-oxidation and hepatoprotection
General outcomes from A-level evidence	No data currently available.
Dosing & administration	1,100-3,300 mg (as water-soluble G. lucidum extract) acutely, or 730 mg per day for up to 10 days to healthy Px
Outcomes	↑ plasma total anti-oxidative capacity by ~30% within three hours (peaking at 90 mins post-ingestion), and fasting ɑ-tocopherol & urinary anti-oxidative capacity after ten days with the lower dose (31)
Class of evidence	C
Dosing & administration	225 mg (as 7% triterpenoid-ganoderic acid and 6% polysaccharide peptides enriched G. lucidum) per day for six months to healthy adults with mild liver dysfunction
Outcomes	↑ total anti-oxidative capacity compared to placebo/baseline, & thiols and glutathione compared to baseline ↓TBARS and 8-OH-dG (biomarkers of oxidative stress), & glutamic oxaloacetic transaminase and glutamic pyruvic transaminase (hepatic markers) compared to placebo/baseline Px normalized from an initially mild fatty liver (5)
Class of evidence	C

Cardiovascular disease risk factors
General outcomes from A-level evidence	No data currently available.
Dosing & administration	720 mg (water-soluble G. lucidum extract) twice per day for 12 weeks to mildly hypertensive or hyperlipidemic adults
Outcomes	↑ HDL-C by 24% ↓ triglycerides by 8% compared to placebo (6)
Class of evidence	C

Chemotherapy and radiotherapy response
General outcomes from A-level evidence	May improve the chemotherapy response rates to treatments compared with chemotherapy alone by ~30-50%, but G. lucidum therapy alone does not induce the same regression as combined therapy (18)(41) May improve the percentage of CD3, CD4 and CD8 by 3.91%, 3.05%, & 2.02%, respectively (18)
Dosing & administration	1,200 mg (as G. lingzhi) per day starting with radiotherapy and for one month to patients with esophageal cancer
Outcomes	↑ rate of radiotherapy effectiveness, leukocyte and platelet counts, phagocytic activity, & survival time and rate compared with radiotherapy alone (20)
Class of evidence	C
Dosing & administration	1000 mg (as G. lucidum spore powder) three times per day for four weeks intra- or post-endocrine therapy to women with breast cancer who had previously received surgery, with or without chemotherapy or radiotherapy
Outcomes	↑ rticularly within the physical, emotional, functional, and fatigue subscores compared to placebo ↓ Hospital Anxiety and Depression scale compared to baseline, & IL-6 and TNF-ɑ inflammatory markers compared to placebo Improves EORTC QOL-C30 scores for physical, emotional, and cognitive functioning, & global QoL score compared to placebo (40)
Class of evidence	C

Colorectal adenomas
General outcomes from A-level evidence	No data currently available.
Dosing & administration	750 mg (water-soluble G. lucidum mycelia extract) twice per day for 12 months
Outcomes	↓ the number and size of adenomas compared with no treatment (26)
Class of evidence	C

Coronary heart disease
General outcomes from A-level evidence	No data currently available.
Dosing & administration	1,800 mg (as Ganopoly®) three times per day for 12 weeks
Outcomes	↓ prevalence of chest pain, palpitation, angina, shortness of breath, abnormal ECGs, & blood pressure compared to placebo, and lower serum cholesterol compared to baseline (14)
Class of evidence	B

Fibromyalgia-related physical capacity
General outcomes from A-level evidence	No data currently available.
Dosing & administration	3,000 mg (as G. lucidum) twice per day with meals for six weeks to women with fibromyalgia
Outcomes	↑ aerobic endurance, lower-body flexibility, & walking speed compared with Ceratonia siliqua (Carob plant) (7)
Class of evidence	C

Hepatitis B
General outcomes from A-level evidence	No data currently available.
Dosing & administration	1,800 mg (as Ganopoly®) three times per day for 12 weeks
Outcomes	↑ proportion of Px with reduced HBeAg viral proteins & hepatitis B viral DNA compared to placebo, especially in Px with baseline AST > 100U/L ↑ rate of normalized ALT levels in treatment group (11)
Class of evidence	B

Immunomodulation
General outcomes from A-level evidence	No data currently available.
Dosing & administration	350 mg (as beta-glucan polysaccharides derived from G. lucidum) per day in yogurt for 12 weeks to children
Outcomes	total lymphocytes, CD3+, CD4+ , & CD8+ T cells compared to placebo (16)
Class of evidence	B
Dosing & administration	2,500-5,000 mg (as water-soluble G. lucidum extract) per day for four weeks to athletes subject to high altitude sleeping conditions
Outcomes	↑ CD3+ T cells (high dose) Attenuates reductions in CD4:CD8 lymphocytic ratio caused by high altitudes (either dose) (39)
Class of evidence	C

Lower urinary tract symptoms
General outcomes from A-level evidence	No data currently available.
Dosing & administration	6 mg (as ethanolic G. lucidum extract) per day for 4-12 weeks to men
Outcomes	Improves International Prostate Symptom scores & QoL scores (24)(25)
Class of evidence	B

Advanced lung cancer
General outcomes from A-level evidence	No data currently available.
Dosing & administration	600 mg (as Ganopoly®) three times per day for 12 weeks
Outcomes	↑ the proportion of Px with stable disease after 12 weeks compared to placebo, the percent of patients with positively impacted Karnofsky performance score (well-being and activity), relief from cancer-related symptoms of fever, cough, weakness, sweating, and insomnia, & immune parameters of lymphocyte mitogenic reactivity to concanavalin A, CD3 percentage, and natural killer cell activity (9)
Class of evidence	B

Neurasthenia
General outcomes from A-level evidence	No data currently available.
Dosing & administration	1,800 mg (as Ganopoly®) three times per day for eight weeks
Outcomes	↓ clinical global impression & fatigue scores ↑ sense of well-being (28)
Class of evidence	B

Type II diabetes
General outcomes from A-level evidence	Note: no effect was observed on cardiovascular risk factors including HbA1C, total cholesterol, LDL-C, or BMI in studies using 1,400-3,000 mg G. lucidum per day for 12-16 weeks (21)
Dosing & administration	1,800 mg (as Ganopoly®) three times per day for 12 weeks
Outcomes	↓ HBA1C, fasting and postprandial glucose, insulin, & C-peptide (10)
Class of evidence	B

Adverse effects

G. lucidum is generally considered safe and without clinically significant adverse effects or greater prevalence of side effects than placebo. Reported possible adverse effects include mild gastrointestinal distress (e.g., nausea, diarrhea, constipation), dizziness, headache, rhinorrhea, sore throat, dry mouth, insomnia, and rash. (6)(18)(21)(24)(25)(40) G. lucidum may also induce respiratory allergy. (27)

Pharmacokinetics

Absorption

Two G. lucidum triterpenes, Ganoderic acid A (GAA) and Ganoderic acid F (GAF), are rapidly absorbed in the gastrointestinal tract and detectable in blood within 5-10 minutes, with max concentrations reached within 30 minutes, as shown in humans. (29)(30)
As shown in humans, GAA was better absorbed in a fasted state compared to in a fed state, but absolute bioavailability is low. This is consistent with rat studies demonstrating GAA, GAF, and ganoderic acid D absolute oral bioavailabilities of 10-22%. (4)(13)(19)(28)(30)

Distribution

Ganoderic acids are widely distributed. (33)(37)

Metabolism

GAA is primarily metabolized by the liver to ganoderic acid C2 via phase I reduction, oxidation, oxidoreduction, and hydroxylation, as well as phase II glucuronidation and sulfation, as shown in rats and in vitro. (2)(37)
GAA was reduced by CYP3A, as shown in vitro. (2)

Excretion

Triterpene acids, including GAA metabolites, are primarily excreted in bile, but can also be found in urine, as shown in rats and in vitro. (2)(15)(34)(37)
GAF and GAA half-lives can range between 30-40 minutes, respectively, as shown in humans. (29)(30)