The photo above shows the Chinese caterpillar fungus Ophiocordyceps sinensis.(Photo: Prot - stock.adobe.com)The term “vital mushrooms” is exclusively a marketing term that is neither (legally) defined nor protected.It is used to market products that contain powdered, crushed mushrooms or mushroom extracts.These are usually mushrooms that are not used as edible mushrooms.The vast majority of these "vital mushrooms" come from Ayurvedic or traditional Chinese medicine, and the marketing mentions or at least suggests health effects.Table 1 gives an overview of commonly used mushrooms.While most of the "vital mushrooms" originally came from wild collections in China, Korea or Japan, the mushrooms used today are usually no longer collected but cultivated in mushroom farms.Many of these mushrooms are unsuitable for normal consumption simply because of their taste or consistency (e.g. caterpillar mushrooms, butterflies or polythene).In traditional Asian medicine, these mushrooms are put together individually and not taken in the form of application that is typical for food supplements - such as a capsule.Like all mushrooms, the "vital mushrooms" are rich in indigestible polysaccharides typical of mushrooms.These include various beta-, xylo- and heteroglycans, chitin-containing compounds and polysaccharide-protein complexes [Lo et al.2011].In addition, terpenoids and short-chain peptides are frequently represented [Lo et al.2011;Lam et al.2015].Individual types of fungi also contain specific ingredients, for example the so-called cordycepin in Ophiocordyceps sinensis or the enzyme laccase in Coriolus versicolor.There are no systematic studies or meaningful data on the toxicological profile of these compounds.Even the use of the marketing terms "vital", "medicinal" or "medicinal mushrooms" suggests the preventive and therapeutic effectiveness of a corresponding "mycotherapy".A preferred target group of this marketing are cancer patients.In addition, practically all diseases, including cardiovascular diseases, rheumatism, allergies and diabetes mellitus, can be found in the advertising statements about “vital mushrooms”.Disguised as alleged editorial contributions on the Internet, book reviews or via influencer marketing via Instagram, promises of healing and effectiveness are made.In their "Opinion on the classification of medicinal mushroom products", the joint expert commission of the Federal Institute for Drugs and Medical Devices (BfArM) and the Federal Office for Consumer Protection and Food Safety (BVL) determined after an Internet search that the "vital mushrooms" Chinese caterpillar fungus (Ophiocordyceps sinensis), buttercup (Coriolus versicolor) and Varnish polypore (Ganoderma lucidum) whether the claimed efficacy for rheumatism, impotence or depression would suggest a medical effect in the addressed consumers even without explicit information on the packaging (so-called presentation medicinal products) [statement on the classification of certain vital mushroom products.Joint Expert Commission 2014].In addition to the risks of questionable effectiveness and unknown undesirable effects, evaluations by consumer advice centers also show that "vital mushroom" products often contain mushrooms other than those declared and are contaminated with mold.There are numerous reports of allergic reactions to preparations containing shiitake [Stephany et al.2016].Over 100 different species of “medicinal mushrooms” are used in Asia.The most prominent representatives include Trametes versicolor (Butterfly Tramete), Ganodermum lucidum (Reishi) and Lentinus edodes (Shiitake).The indications of the therapeutic effects of "vital mushrooms" come largely from in vitro and animal studies [Jayachandran et al.2017].In addition, there are only a few randomized controlled studies with humans.This includes, for example, the use of powdered oyster and abalone mushrooms in type 2 diabetics, which reduced the postprandial rise in blood glucose concentration [Jayasuriya et al.2015].Similar effects have been found for preparations on almond fungus [Hsu et al.2007] and chaga mushroom base [Maenaka et al.2008].Apart from individual studies that are not very meaningful, the data on the various "vital mushrooms" is very sobering overall.The situation for the bestsellers Butterfly Tramete, Reihsi and Shiitake is presented below as an example.Trametes versicolor (Butterfly Tramete) is used in traditional Chinese medicine to treat lung diseases.The polysaccharide K (PSK, krestin) obtained from the fungus is being researched in Japan in particular and has been tested in several human studies in the context of adjuvant cancer therapies since the 1970s.In the meantime, various meta-analyses of studies with several hundred patients have been published that show positive effects of adjuvant PSK supplementation in parallel with chemotherapy for gastric, colorectal and lung cancer, some with significant effects on disease-free and overall survival [Oba et al.2007;Sakamoto et al.2006;Fritz et al.2015].These data give rise to further research.No meaningful studies have been published for other indications [PDQ 2019].The butterfly tramete grows as a tree fungus on many deciduous trees and also on some conifers.It is not an edible mushroom and is considered inedible.Ganoderma lucidum (Lingzhi, Reishi).There are numerous species of Ganoderma, which are not declared separately in most products.In China, the mushroom has been used medicinally for at least 2000 years as the "mushroom of immortality", including to treat cancer, epilepsy, heart disease and diabetes [Wachtel-Galor et al.2011].In addition to powdered mushroom (G. lucidum mycelium), extracts containing a mixture of different triterpenoids, polysaccharides, lipids and proteins are also marketed.In a study of patients with coronary artery disease, taking Reishi extract for 12 weeks reduced blood pressure and blood triglyceride levels compared to placebo [Gao et al.2004].For oncological indications there are only mechanistic but no meaningful clinical studies [Gao et al.2005;Chen et al.2006, Jin et al.2018].Comprehensive Cochrane reviews also found no evidence of clinical efficacy for the other postulated indications [Jin et al.2018;Klupp et al.2015;PDQ 2019].The glossy lacquer polypore inhabits mainly deciduous woods, mostly oaks.The fruiting body is covered with a yellowish to reddish layer of resin.Lentinus edodes (Shiitake).The medicinal use of shiitake mushrooms has been documented in China since the 14th century.Traditionally, shiitake preparations have been used as a tonic, heart tonic and for cancer therapy - but without evidence-based evidence of any corresponding effects.While there are some in vitro data showing that lentinan (a β-1,3-D-glucan) isolated from shiitake has immunomodulatory effects [Zhang et al.2011;Ina et al.2013].In addition, individual pilot studies on humans provide indications of an adjuvant effectiveness of lentinan in the oncological therapy of gastric carcinoma [Ina et al.2013].So far, however, the validity of this data is extremely questionable.The Shiitake mushroom comes from Asia and is mainly cultivated in China and Japan.Overall, the data on the preventive and therapeutic effects of "vital mushrooms" as well as on their risk potential is extremely patchy and in no case meaningful [Money et al.2016].In accordance with the principle "primum nil nocere", corresponding products should not be used if there are effective, safe and comprehensively tested medicinal substances for the corresponding indication.In addition, the cliché frequently promoted by manufacturers should not be taken in by the belief that traditional Chinese medicine has herbal or fungal miracle cures for treating cancer or other serious illnesses, which is why this “natural medicine” is superior to western “orthodox medicine”.In China in particular, cancer mortality is comparatively high [Zhou et al.2016], and parallel to the increasing spread of "Western" medicine in China, life expectancy has improved significantly (1960: 43 years; 2017: 76 years [UN 2017]).|We thank attorney Prof. Dr.Alfred Hagen Meyer, Munich, for his support.Akagi J, Baba H. PSK may suppress CD57(+) T cells to improve survival of advanced gastric cancer patients.Int J Clin Oncol 2010;15(2):145-152Association for Food Law and Food Science e.V. (BLL).Vitamin C and magnesium are the most popular dietary supplements.Information from the German Food Association of November 4, 2016, www.lebensmittelverband.de/de/presse/pressemitteilungen/pm-20161104-marktdaten-nemChen X et al.Monitoring of immune responses to a herbal immunomodulator in patients with advanced colorectal cancer.Int Immunopharmacol 2006;6(3):499-508Fritz H et al.Polysaccharide K and Coriolus versicolor extracts for lung cancer: a systematic review.Integr Cancer Ther 2015;14(3):201-211Gao Y et al.A phase I/II study of ling zhi mushroom Ganoderma lucidum (W.Curt.:Fr.) Lloyd (Aphyllophoromycetideae) extract in patients with coronary heart disease.Int J Med Mushrooms 2004;6:327-334Gao Y et al.Effects of water-soluble Ganoderma lucidum polysaccharides on the immune functions of patients with advanced lung cancer.J Med Food 2005;8(2):159-168Statement on the classification of certain vital mushroom products.Joint Expert Commission of the Federal Office for Consumer Protection and Food Safety (BVL) and the Federal Institute for Drugs and Medical Devices (BfArM) 2014;1Hsu CH et al.The mushroom Agaricus Blazei Murill in combination with metformin and gliclazide improves insulin resistance in type 2 diabetes: a randomized, double-blind, and placebo-controlled clinical trial.J Altern Complement Med 2007;13:97-102Ina K et al.The use of lentinan for treating gastric cancer.Anticancer Agents Med Chem 2013;13(5):681-688Jayasuriya WJ et al.Hypoglycaemic activity of culinary Pleurotus ostreatus and P. cystidiosus mushrooms in healthy volunteers and type 2 diabetic patients on diet control and the possible mechanisms of action.Phytother Res 2015;29:303-309Jayachandran M. A Critical Review on Health Promoting Benefits of Edible Mushrooms through Gut Microbiota.Int J Mol Sci 2017;18(9):E1934, doi:10.3390/ijms18091934Jin X et al.Ganoderma lucidum (Reishi mushroom) for cancer treatment.Cochrane Database System Rev 2016:CD007731Klupp NL et al.Ganoderma lucidum mushroom for the treatment of cardiovascular risk factors.Cochrane Database System Rev 2015:CD007259Lam YS, Okello EJ.Determination of lovastatin, beta-glucan, total polyphenols, and antioxidant activity in raw and processed Oyster culinary-medicinal mushroom, Pleurotus ostreatus (higher basidiomycetes).Int J Med Mushrooms 2015;17:117-128Lo HC, water SP.Medical mushrooms for glycemic control in diabetes mellitus: history, current status, future perspectives, and unsolved problems (review).Int J Med Mushrooms 2011;13:401-426Maenaka T et al.Effects of Fuscoporia obliqua on postprandial glucose excursion and endothelial dysfunction in type 2 diabetic patients.J Traditional Chin Med 2008;28:49-57Money NP et al.Are mushrooms medicinal?Fungal Biol 2016;120(4):449-453Dietary Supplements Ordinance of May 24, 2004 (Federal Law Gazette I p. 1011), which was last amended by Art. 11 V of July 5, 2017Oba K et al.Efficacy of adjuvant immunochemotherapy with polysaccharide K for patients with curative resections of gastric cancer.Cancer Immunol Immunother 2007;56(6):905-911PDQ Integrative, Alternative, and Complementary Therapies Editorial Board.Medicinal Mushrooms (PDQ®): Health Professional Version.PDQ Cancer Information Summaries [Internet].Bethesda (MD): National Cancer Institute (US) 2002-2019Directive 2002/46/EC of the European Parliament and of the Council of June 10, 2002 on the harmonization of the laws of the Member States relating to food supplements (NemRL)Sakamoto J et al.Efficacy of adjuvant immunochemotherapy with polysaccharide K for patients with curatively resected colorectal cancer: a meta-analysis of centrally randomized controlled clinical trials.Cancer Immunol Immunother 2006;55(4):404-411Stephany MP et al.Shiitake Mushroom Dermatitis: A Review.Am J Clin Dermatol 2016;5:485-489United Nations Population Division.World Population Prospects: 2017 Revision.United Nations (UN), https://data.worldbank.org/indicator/SP.DYN.LE00.IN?locations=CNWachtel-Galor S et al.Ganoderma lucidum (Lingzhi or Reishi): a medicinal mushroom.In: Benzie IF, Wachtel-Galor S (eds.), Herbal Medicine: biomolecular and clinical aspects.2nd Edition 2011, CRC Press, Boca RatonZhang Y et al.Advances in lentinan: isolation, structure, chain conformation and bioactivities.Food Hydrocolloids 2011;25:196-206Zhou M et al.Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet 2016;387(10015):251-272Prof. Dr.re.of courseMartin Smollich, pharmacist specializing in clinical pharmacy, member of the Drug Commission of the German Medical Association (AkdÄ);Head of the Pharmakonutrition working group at the Institute for Nutritional Medicine, Schleswig-Holstein University Hospital, Lübeck Campus;Publisher of the specialist blog Ernaehrungsmedizin.blog