Mushrooms and Stress
28.3% Fatigue Reduction
In a 132-person randomized controlled trial, Ganoderma lucidum polysaccharide extract reduced fatigue severity by 28.3% over 8 weeks, compared to 20.1% in the placebo group.
Tang et al., Journal of Medicinal Food, 2005
HPA Axis
primary stress response system
4.4% Cortisol Drop
mushroom blend, from baseline at 6 weeks
2 Species
reishi + cordyceps most studied
Tang et al., Journal of Medicinal Food, 2005
The term "adaptogen" describes a substance that helps the body resist physical, chemical, or biological stressors. Medicinal mushrooms, particularly reishi (Ganoderma lucidum) and cordyceps (Cordyceps militaris and C. sinensis), are marketed as adaptogens with stress-reducing properties. The evidence behind these claims varies from well-designed randomized trials to animal studies and in vitro experiments. For a broader overview of how mushrooms help the body cope with stress, the companion article covers the general framework.
Panossian and Wikman published the most cited review of adaptogen mechanisms in Current Clinical Pharmacology in 2009.[1] They established that true adaptogens work by modulating the hypothalamic-pituitary-adrenal (HPA) axis, the neuroendocrine system that governs cortisol release. This review focused primarily on plants (rhodiola, ashwagandha, eleuthero), but Panossian updated the adaptogen concept in a 2021 review in Medicinal Research Reviews, explicitly including medicinal mushrooms in the framework.[2]
Key Takeaways
- A 132-person RCT found reishi polysaccharide extract reduced fatigue severity by 28.3% and improved well-being by 38.7% over 8 weeks, versus 20.1% and 29.7% for placebo (Tang et al., Journal of Medicinal Food, 2005)
- A 2026 50-person RCT showed a five-mushroom blend (including reishi) reduced serum cortisol by 4.4% at 6 weeks and 5.5% at 12 weeks from baseline, versus reductions of just 0.7% and 0.8% on placebo (Hisamuddin et al., Brain and Behavior, 2026)
- The same trial measured ACTH, the pituitary hormone upstream of cortisol, and found it fell further than cortisol did (10.5% at 6 weeks) — a pattern that points to reduced central stress signalling rather than a suppressed adrenal gland (Hisamuddin et al., Brain and Behavior, 2026)
- That trial was funded by the company that makes the tested blend, and several authors work for it — the most-cited human cortisol result in this field is not independent
- Cordyceps sinensis extract directly stimulated corticosterone production in rat adrenal cells in a dose-dependent manner, suggesting direct adrenal gland modulation (Wang et al., J Cell Biochem, 1998)
- Cordyceps militaris water extract prevented anhedonia and hypoactivity in an unpredictable chronic mild stress rat model and reduced serotonin and dopamine turnover rates in the frontal cortex (Lin et al., J Ethnopharmacol, 2021)
- Reishi spore powder improved fatigue scores in 48 breast cancer patients undergoing endocrine therapy in a randomized trial (Zhao et al., eCAM, 2012)
- Cordyceps militaris fruit body extract delayed fatigue onset and increased ATP levels in mice, reducing lactic acid accumulation by a significant margin (Song et al., eCAM, 2015)
The HPA Axis: How Stress Works at the Molecular Level
The hypothalamic-pituitary-adrenal axis is a feedback loop between three structures: the hypothalamus in the brain, the pituitary gland at the base of the brain, and the adrenal glands on top of the kidneys. When the brain perceives a stressor, the hypothalamus releases corticotropin-releasing hormone (CRH). CRH signals the pituitary to release adrenocorticotropic hormone (ACTH). ACTH travels through the bloodstream to the adrenal glands, which respond by producing cortisol.
Cortisol is the primary stress hormone. In acute doses, it is beneficial: it mobilizes energy, sharpens focus, and suppresses inflammation. Chronically elevated cortisol, from sustained psychological or physical stress, damages the hippocampus, disrupts sleep, suppresses immune function, and promotes visceral fat storage.[1]
An adaptogen, by definition, modulates this axis: dampening cortisol release when it is chronically elevated and supporting it when the system is depleted. The question is whether reishi and cordyceps actually do this, and at what doses, in humans.
Reishi (Ganoderma lucidum) and Stress
The Neurasthenia Trial
The most directly relevant clinical trial was conducted by Tang and colleagues, published in the Journal of Medicinal Food in 2005.[3] They enrolled 132 Chinese patients diagnosed with neurasthenia, a condition characterized by persistent fatigue, irritability, and difficulty concentrating. In a randomized, double-blind, placebo-controlled design, participants received either 1,800 mg of Ganoderma lucidum polysaccharide extract (Ganopoly) three times daily or placebo for 8 weeks.
Results were statistically significant in favor of reishi. Fatigue severity scores dropped 28.3% in the treatment group versus 20.1% with placebo. The Clinical Global Impression severity score improved by 15.5% versus 4.9%. Well-being scores increased by 38.7% versus 29.7%. Over half the treatment group (51.6%, 32 of 62 participants) rated themselves as more than minimally improved, compared to 24.6% (15 of 61) in the placebo group.
The magnitude of these effects is modest. The absolute difference in fatigue reduction between groups was 8.2 percentage points. This is not a dramatic clinical effect. It does suggest a real signal above placebo for subjective fatigue and well-being in a stressed population.
Tang et al. (2005) · Journal of Medicinal Food
- Population
- 132 Chinese adults diagnosed with neurasthenia (persistent fatigue, irritability, poor concentration); 123 assessable at endpoint
- Intervention
- Ganoderma lucidum polysaccharide extract (Ganopoly), 1,800 mg three times daily (5,400 mg/day) for 8 weeks
- Comparator
- Matched placebo, randomized and double-blind
- Finding
- Fatigue severity fell 28.3% from baseline versus 20.1% on placebo; well-being rose 38.7% versus 29.7%; 51.6% (32/62) of the reishi group rated themselves more than minimally improved versus 24.6% (15/61) on placebo (p = 0.002).
positive Statistically significant on every prespecified subjective measure, but all outcomes were self-reported and no stress hormone was measured. The between-group gap in fatigue was 8.2 percentage points.
Tang et al., Journal of Medicinal Food, 2005 (ref 3)
Cancer-Related Fatigue
Zhao and colleagues tested reishi spore powder in a different stress context: cancer-related fatigue.[4] Their pilot clinical trial enrolled 48 breast cancer patients undergoing endocrine therapy who reported significant fatigue. After 4 weeks of reishi spore powder supplementation, fatigue scores on the FACT-F scale improved, and patients also showed improvements in quality of life measures. The trial was a pilot with limitations (small sample, no blinding details), but it aligns with the Tang neurasthenia data: reishi appears to have a modest, consistent effect on subjective fatigue.
Reishi, Mood, and Fibromyalgia
Pazzi and colleagues examined reishi's effects on mood and health-related quality of life in women with fibromyalgia in a 2020 study.[5] Fibromyalgia involves chronic pain, fatigue, and psychological distress. The reishi group showed improvements in mood dimensions compared to controls, though the study was exploratory and the sample size was small. What this adds to the picture is that reishi's effects appear to extend beyond fatigue to broader psychological well-being.
Reishi and Sleep
Yao and colleagues demonstrated in 2021 that Ganoderma lucidum promotes sleep in mice through a gut microbiota-dependent and serotonin-involved pathway.[6] The acidic polysaccharide fraction of reishi increased serotonin levels in the brainstem through modulation of gut bacteria. Sleep quality is intimately connected to stress: poor sleep elevates cortisol, and elevated cortisol disrupts sleep. If reishi improves sleep through serotonergic pathways, this could partly explain its fatigue-reducing effects in clinical trials. For a deeper look at reishi's mechanisms, see the pharmacology of Ganoderma lucidum. The reishi for stress research review covers species-specific evidence.
Safety Profile
Wicks and colleagues conducted a double-blind, randomized, placebo-controlled safety trial of Ganoderma lucidum in 16 healthy subjects in 2007.[7] Participants took 2 g of extract twice daily (4 g/day total) for 10 consecutive days. Reishi was well tolerated with no significant adverse effects across questionnaire, ECG, blood-count, blood chemistry, urinalysis, and immune-cell measures versus placebo.
That trial is reassuring but narrow, and its own authors said so, concluding that a longer-term safety and tolerability study was still warranted. Sixteen people dosed for ten days cannot characterise the risk of taking reishi daily for months, which is what the stress-supplement market actually asks people to do. The case-report literature fills in what the trial could not: Wanmuang and colleagues documented a fatal fulminant hepatitis associated with Ganoderma lucidum powder in 2007,[14] and Guedikian and colleagues reported reishi-induced acute liver injury in a patient who had also been drinking alcohol in 2023.[15]
Hepatotoxicity
CriticalReishi powder has been linked to serious liver injury, including one death
Concern
Wanmuang and colleagues reported a fatal case of fulminant hepatitis in a patient taking Ganoderma lucidum (Lingzhi) powder, following an earlier non-fatal Hong Kong case. Notably, both patients had taken traditionally boiled Lingzhi for extended periods without toxicity, and the hepatotoxic episodes began only 1 to 2 months after switching to the powdered form. Guedikian and colleagues later reported acute hepatitis with significant transaminitis in a 47-year-old man who consumed reishi powder alongside alcohol; he recovered with supportive care.
What the research says
These are individual case reports, not controlled trial data, and they cannot establish how often reishi causes liver injury. They do establish that it can. The preparation-specific pattern (powder implicated, decoction tolerated) and the alcohol co-ingestion case are both consistent with the broader picture of unregulated supplements varying widely in composition.
Particularly relevant for: Anyone using reishi powder daily, and especially people who drink alcohol regularly, take hepatotoxic medications, or have existing liver disease
What to do
Treat reishi powder as a substance with a real, documented hepatic signal. Do not combine it with heavy alcohol use, and seek medical evaluation for abdominal pain, dark urine, or jaundice.
Wanmuang et al., J Med Assoc Thai, 2007 (ref 14); Guedikian et al., Cureus, 2023 (ref 15)
There is also an interaction question that matters specifically for the cancer-related fatigue use case discussed above. Lam and colleagues systematically reviewed herb-drug interactions between Lingzhi (reishi), Yunzhi, and cytotoxic anticancer drugs in 2020, identifying 213 studies including 77 clinical reports.[16] Reishi was most often combined with cisplatin, 5-fluorouracil, and paclitaxel. The review found only two clinical pharmacokinetic studies available, and most of the clinical literature was of modest methodological quality — meaning the interaction profile is under-characterised rather than established as safe.
None of this is a reason to treat reishi as dangerous in ordinary culinary or short-term use. It is a reason to reject the "it's a mushroom, so it's harmless" framing that dominates the adaptogen marketing category. This article is not medical advice; anyone considering supplementation while on prescription medication or undergoing cancer treatment should discuss it with their physician.
Cordyceps and Stress
Direct Adrenal Effects
Wang and colleagues investigated whether Cordyceps sinensis acts directly on adrenal glands in a 1998 study published in the Journal of Cellular Biochemistry.[8] They cultured rat adrenocortical cells with a water-soluble extract of Cordyceps sinensis and measured corticosterone production. The extract stimulated corticosterone production in a dose-dependent manner. The stimulating effect appeared within 1 hour of treatment and was maintained for 24 hours. This indicates that cordyceps has a direct effect on the adrenal glands, not only an indirect effect through the hypothalamus or pituitary. The implication is that cordyceps may modulate cortisol production at the end organ level, which distinguishes it from plant adaptogens that primarily work through central nervous system pathways.
It is worth being explicit about an awkward detail here, because it is usually glossed over in marketing summaries: the extract raised corticosterone, the rodent equivalent of cortisol. That is the opposite direction from the cortisol reduction people typically want from an anti-stress supplement. The finding is best read as evidence that cordyceps is pharmacologically active at the adrenal gland, not as evidence that it lowers stress hormones. Whether that activity translates into dampening a chronically overactive axis, stimulating a depleted one, or neither, is not answered by a dish of cultured cells.
Antifatigue Effects
Song and colleagues tested Cordyceps militaris fruit body extract in a mouse fatigue model published in Evidence-Based Complementary and Alternative Medicine in 2015.[9] Two weeks of cordyceps administration delayed fatigue onset in the forced swimming test, rotating rod test, and forced running test. The treated mice showed increased ATP levels and antioxidant enzyme activity. Lactic acid, lactic dehydrogenase, malondialdehyde, and reactive oxygen species levels all decreased. These are markers of physical stress: the cordyceps extract appeared to improve energy metabolism and reduce oxidative damage under physical load.
Antidepressant Effects in Chronic Stress
Lin and colleagues took this further in a 2021 study published in the Journal of Ethnopharmacology.[10] They subjected rats to an unpredictable chronic mild stress protocol (a validated model of depression) and administered Cordyceps militaris water extract at 125, 250, and 500 mg/kg body weight for 35 consecutive days. The stressed rats showed anhedonia and hypoactivity. All doses of the extract prevented those abnormal behaviors; the low-dose group reduced 5-HT (serotonin) turnover rate in the frontal cortex and all doses reduced dopamine turnover, with mechanism work pointing to modulation of the ROCK2/PTEN/Akt signaling pathway. The phrasing matters here — Lin et al. measured neurotransmitter turnover dynamics, not absolute "restored levels," so the paper supports normalized serotonergic and dopaminergic dynamics rather than direct level rescue.
The relevance to human stress is indirect but specific: chronic stress disrupts monoamine neurotransmission and HPA axis regulation, and cordyceps appears to normalize both in an animal model. Whether this translates to human doses and human physiology remains unproven. For best mushroom species for stress relief, the companion article compares species head to head.
The 2026 Mushroom Blend RCT
The most recent trial with direct HPA-axis measurements was published by Hisamuddin and colleagues in Brain and Behavior in 2026.[11] This randomized, double-blind, placebo-controlled trial enrolled 50 participants in Selangor, Malaysia, who received either 500 mg/day of a proprietary blend called Restake or placebo for 12 weeks. The blend contains five species: Hericium erinaceus (lion's mane), Cordyceps militaris, Ganoderma lucidum (reishi), Lentinula edodes (shiitake), and Grifola frondosa (maitake).
The results showed measurable effects on the HPA axis. Serum cortisol in the intervention group fell 4.4% from baseline by week 6 and 5.5% by week 12. The placebo group also declined, but far less — 0.7% and 0.8% at the same timepoints — and the between-group difference was significant at both (p < 0.001). Anxiety on the STAI-S scale fell 8.7% by week 12 versus 4.9% on placebo (p = 0.011), with a larger separation on the clinician-rated HAM-A (33.5% versus 13.1%).
The more informative result is one step upstream. The trial also measured adrenocorticotropic hormone (ACTH), the pituitary signal that tells the adrenal glands to make cortisol. ACTH fell 10.5% at 6 weeks and 8.1% at 12 weeks in the intervention group, while the placebo group barely moved (+0.3% at 6 weeks, −0.2% at 12 weeks; p < 0.001 for the between-group difference).
Two Levels of the HPA Axis
ACTH fell further than cortisol did
Percentage change from baseline, 50-participant randomized trial of a five-species mushroom blend at 500 mg/day versus placebo.
p < 0.001 at both timepoints
Week 6
Week 12
p < 0.001 at both timepoints
Week 6
Week 12
Why the direction matters
A falling cortisol level on its own is ambiguous — it can mean the stress signal has quietened, or that the adrenal gland has stopped responding. Those two states are told apart by ACTH. If the adrenals were being suppressed, ACTH would climb as the pituitary compensated. Here ACTH fell more steeply than cortisol, which is the signature of reduced drive from above rather than a blunted organ below.
Source: Hisamuddin et al., Brain and Behavior, 2026 (ref 11). Values are percentage change from baseline as reported by the authors. The trial was funded by the manufacturer of the tested blend, and the blend contained five mushroom species, so no result here can be attributed to any single species.
Two caveats sit on top of this result, and they are substantial. The first is attribution: the blend contained five species, so no part of the hormonal effect can be assigned to reishi, to cordyceps, or to any other single mushroom. This trial cannot tell you that reishi lowers cortisol. It tells you that a specific five-species commercial product, at 500 mg/day, moved two stress hormones in a 50-person sample.
The second is independence. The study was funded by NexusWise Sdn Bhd, and several of the authors — including the corresponding author — are affiliated with the company's research and development department. Restake is the company's own product. Manufacturer-funded trials are not automatically wrong, and this one was ethics-approved, registered against validated instruments, and reported in reasonable detail. But the single most-cited human cortisol finding in the adaptogenic-mushroom literature is a manufacturer evaluating its own supplement, and independent replication has not yet happened. The HPA axis regulation article covers this mechanism in depth.
Reishi's Psychological Stress Study
Mitra and colleagues published a 2024 study examining reishi supplementation in female college students experiencing psychological stress in West Bengal, India.[12] Ganoderma lucidum supplementation improved psychological stress markers and selective fitness parameters. While this study adds to the evidence that reishi has measurable effects on stressed populations, the specific mechanisms (whether through HPA axis modulation, anti-inflammatory effects, or serotonergic pathways) were not measured.
Limitations and Open Questions
The evidence for adaptogenic mushrooms and stress follows a pattern: strong animal data, plausible mechanisms, and a handful of human trials with modest effect sizes. Several limitations deserve explicit acknowledgment.
First, no human trial has measured the full HPA axis response after mushroom supplementation. The Hisamuddin trial got two of the three levels — cortisol and ACTH — which is what allows the adrenal-suppression reading to be ruled out with some confidence. What is still missing is corticotropin-releasing hormone (CRH), the hypothalamic signal at the top of the cascade. Without it, the question of whether these effects originate in the brain or at the pituitary remains open. It is worth being precise about how thin this evidence base is: exactly one human trial in this literature has measured any stress hormone at all, and it was funded by the manufacturer of the product it tested. Every other human result discussed here rests on questionnaires.
Second, dose standardization varies enormously between trials. Tang used 5,400 mg/day of polysaccharide extract. Hisamuddin used 500 mg/day of a proprietary five-species blend — more than a tenfold difference in dose, on a different preparation, in a different population. Wu and colleagues showed in 2017 that Ganoderma lucidum supplements varied enormously in polysaccharide and triterpene content, with only 26.3% of tested products matching their labels.[13] This means that even where a trial result is real, a consumer buying a different product at a different dose has limited grounds for expecting the same outcome.
Third, the term "adaptogen" itself is not a regulatory category recognized by the FDA, EMA, or any major drug regulatory agency. No mushroom product has been approved by any regulatory body as a treatment for stress disorders, anxiety, or HPA axis dysfunction. The clinical trials show modest benefits on subjective measures (fatigue, well-being, anxiety scores) and small cortisol changes. These effects are consistent across multiple studies and statistically significant, but they are also small in absolute terms. A 5.5% cortisol reduction and an 8.2 percentage point improvement in fatigue over placebo are not transformative outcomes. They suggest a real biological signal that may complement, but cannot replace, behavioral stress management strategies. For readers interested in lion's mane and anxiety, that species has its own distinct evidence base.
The Bottom Line
Reishi and cordyceps both show measurable effects on stress-related markers in human trials and animal models. Reishi reduced fatigue by 28.3% versus 20.1% placebo in a 132-person RCT. A 2026 five-species blend trial showed a 5.5% cortisol reduction over 12 weeks alongside a larger drop in ACTH, a pattern that argues for reduced central stress signalling rather than adrenal suppression — but that trial was funded by the blend's manufacturer and tested no species in isolation. Cordyceps directly stimulates adrenal steroidogenesis in cultured cells and prevents depression-like behaviour in chronically stressed animals. The effects are consistent and statistically significant but modest in magnitude. No human trial has mapped the complete HPA axis response, and reishi powder carries a documented, if rare, liver-injury signal.
Frequently Asked Questions
Sources & References
- 1RTHM-00168·Panossian, Alexander et al. (2009). “Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity..” Current clinical pharmacology.Study breakdown →PubMed →↩
- 2RTHM-00711·Panossian, Alexander G et al. (2021). “Evolution of the adaptogenic concept from traditional use to medical systems: Pharmacology of stress- and aging-related diseases..” Medicinal research reviews.Study breakdown →PubMed →↩
- 3RTHM-00088·Tang, Wenbo et al. (2005). “A randomized, double-blind and placebo-controlled study of a Ganoderma lucidum polysaccharide extract in neurasthenia..” Journal of medicinal food.Study breakdown →PubMed →↩
- 4RTHM-00276·Zhao, Hong et al. (2012). “Spore Powder of Ganoderma lucidum Improves Cancer-Related Fatigue in Breast Cancer Patients Undergoing Endocrine Therapy: A Pilot Clinical Trial..” Evidence-based complementary and alternative medicine : eCAM.Study breakdown →PubMed →↩
- 5RTHM-00648·Pazzi, Francesco et al. (2020). “Ganoderma lucidum Effects on Mood and Health-Related Quality of Life in Women with Fibromyalgia..” Healthcare (Basel.Study breakdown →PubMed →↩
- 6RTHM-00731·Yao, Chunyan et al. (2021). “Ganoderma lucidum promotes sleep through a gut microbiota-dependent and serotonin-involved pathway in mice..” Scientific reports.Study breakdown →PubMed →↩
- 7RTHM-00123·Wicks, Sheila M et al. (2007). “Safety and tolerability of Ganoderma lucidum in healthy subjects: a double-blind randomized placebo-controlled trial..” The American journal of Chinese medicine.Study breakdown →PubMed →↩
- 8RTHM-00027·Wang, S M et al. (1998). “Effects of a water-soluble extract of Cordyceps sinensis on steroidogenesis and capsular morphology of lipid droplets in cultured rat adrenocortical cells..” Journal of cellular biochemistry.Study breakdown →PubMed →↩
- 9RTHM-00401·Song, Jingjing et al. (2015). “Studies on the Antifatigue Activities of Cordyceps militaris Fruit Body Extract in Mouse Model..” Evidence-based complementary and alternative medicine : eCAM.Study breakdown →PubMed →↩
- 10RTHM-00700·Lin, Yu-En et al. (2021). “Antidepressant-like effects of water extract of Cordyceps militaris (Linn.) Link by modulation of ROCK2/PTEN/Akt signaling in an unpredictable chronic mild stress-induced animal model..” Journal of ethnopharmacology.Study breakdown →PubMed →↩
- 11RTHM-00959·Hisamuddin, Ahmad Safiyyu'd-Din et al. (2026). “Adaptogenic Effects of Mushroom Blend Supplementation on Stress, Fatigue, and Sleep: A Randomised, Double-Blind, and Placebo-Controlled Trial..” Brain and behavior.Study breakdown →PubMed →↩
- 12RTHM-00895·Mitra, Sudeep et al. (2024). “Efficacy of Lingzhi or Reishi Medicinal Mushroom Ganoderma lucidum (Agaricomycetes) Supplementation on Psychological Stress and Selective Fitness Profile Parameters in Female College Students in West Bengal, India..” International journal of medicinal mushrooms.Study breakdown →PubMed →↩
- 13RTHM-00499·Wu, Ding-Tao et al. (2017). “Evaluation on quality consistency of Ganoderma lucidum dietary supplements collected in the United States..” Scientific reports.Study breakdown →PubMed →↩
- 14RTHM-00122·Wanmuang, Harirak et al. (2007). “Fatal fulminant hepatitis associated with Ganoderma lucidum (Lingzhi) mushroom powder..” Journal of the Medical Association of Thailand = Chotmaihet thangphaet.Study breakdown →PubMed →↩
- 15RTHM-00826·Guedikian, Roupen et al. (2023). “Ganoderma lingzhi (Reishi Mushroom)-Induced Acute Liver Injury in the Setting of Alcohol Use: A Case Report and Review of the Literature..” Cureus.Study breakdown →PubMed →↩
- 16RTHM-01225·Lam, Chun Sing et al. (2020). “Herb-drug interactions between the medicinal mushrooms Lingzhi and Yunzhi and cytotoxic anticancer drugs: a systematic review..” Chinese medicine.Study breakdown →PubMed →↩