Lion's Mane (Hericium erinaceus): Benefits, Mechanisms, Risks, and Dosing
Lion's mane mushroom lacks sufficient evidence to recommend for any medical condition, and should be discontinued 2 weeks before surgery due to potential bleeding and hypotensive effects. 1
What is Lion's Mane?
Lion's mane (Hericium erinaceus) is an edible medicinal mushroom containing bioactive polysaccharides, particularly erinacines from its mycelia and other compounds from its fruiting bodies. 2 It has been used historically in traditional Asian and European medicine for fighting infection and cancer. 3
Proposed Benefits and Mechanisms
Cognitive Function
- Preclinical evidence shows neuroprotective properties, anti-inflammatory effects, and promotion of neurite growth in cell and animal models. 3
- Bioactive compounds correlate with increased production of neurotrophic factors (pro-BDNF and BDNF), promoted hippocampal neurogenesis, and improved behavior in laboratory studies. 2
- Human evidence is extremely limited: One very small double-blind, placebo-controlled trial in patients with mild cognitive impairment showed temporary improvement in cognitive function, but this has never been replicated. 3 A pilot study in 41 healthy young adults showed faster performance on the Stroop task at 60 minutes post-dose. 4
- Contradictory findings: A 4-week study with 10g daily showed no impact on cognitive performance or metabolic flexibility in college-age participants. 5
Mood and Mental Health
- Limited evidence suggests potential reduction in subjective stress after 28 days (p = 0.051, not statistically significant). 4
- Laboratory studies indicate improved symptoms of depression, anxiety, binge eating, and sleep disorders through enhanced BDNF production. 2
Other Proposed Benefits
- Cancer: In vitro studies show isolated erinacine A inhibited invasiveness of gastric cancer cells and activated caspase pathways in leukemia cells. 2
- Gut health: Increased gut microbiota diversity and abundance of short-chain fatty acid-producing bacteria, reducing inflammation. 2
Risks and Side Effects
Perioperative Concerns
Lion's mane must be held 2 weeks before surgery due to multiple concerning mechanisms: 1
- May increase nitric oxide (NO) production leading to intraoperative hypotension
- Potential antiplatelet effects and increased bleeding risk
- Possible additive effects with anesthetics
Reported Adverse Effects
- Stomach discomfort 2
- Headache 2
- Anaphylaxis: One case report documented anaphylactic reaction after consuming fresh lion's mane mushroom. 3
- Allergic reactions 2
Regulatory Status
Lion's mane is not FDA-regulated, and like other herbal supplements, has undergone few controlled clinical trials with little evidence of efficacy to justify beneficial claims or safety. 1 Commercially available products are not standardized and vary in content of active ingredients. 1
Clinical Recommendation
Do not recommend lion's mane supplementation for any medical indication. The evidence parallels other dietary supplements and herbal products that lack convincing evidence for health benefits. 1 Current evidence does not support use of dietary supplements to duplicate cardioprotective or neuroprotective benefits of consuming healthful foods. 1
Specific Populations
- ALS patients: No studies exist in ALS cell models, animal models, or humans with ALS. There is insufficient information to support use for treating ALS. 3
- Dementia patients: Should NOT be offered supplements unless there is an indication of deficiency. 1 Available intervention studies do not support use to improve cognition or prevent cognitive decline in persons with mild to moderate dementia. 1
- Surgical patients: Must discontinue 2 weeks preoperatively. 1
If Patients Insist on Use
If patients choose to use lion's mane despite lack of evidence:
- Dosing studied: 1.8g daily 4 to 10g daily 5 in powder or capsule form
- Avoid fresh mushroom consumption due to anaphylaxis risk 3
- Monitor for stomach discomfort, headache, or allergic reactions 2
- Inform all healthcare providers, particularly before surgery 1
- Watch for herb-drug interactions 1
The priority remains that further research in larger clinical trials is needed before any recommendation can be made. 3, 6