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Lion's Mane mushroom

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    Lions Mane Hericium Erinaceus · 180 capsules

    GN Laboratories

    The so-called "lion's mane" is a mushroom that has recently become increasingly popular. This is because it is often associated with neuroprotectiv...

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    Lions Mane · 60 capsules

    Olimp Sport Nutrition

    Standardized product At least 125 mg beta-1,3/1,6-D-glucans per capsule! No psychoactive properties Does not affect perception in any way! Food su...

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Lions Mane / Yamabushitake / Hedgehog goatee / Lion's Mane

What is the Lions Mane mushroom?

The Lions Mane mushroom, also known as yamabushitake, hedgehog's goatee or lion's mane, is a large, white, shaggy mushroom that looks like a lion's mane (hence its name). This mushroom is used in Asian countries such as China, India, Japan and Korea for both culinary and medicinal purposes (14). Lions mane can be enjoyed raw, cooked, dried or as a tea. Extracts of the mushroom can also be found in dietary supplements. The taste of this mushroom is described by many as reminiscent of seafood such as crab or lobster (16). The Lions Mane mushroom contains a number of bioactive compounds that have positive effects on the body, particularly the brain, heart and digestive tract. Due to these effects, the Lions Mane mushroom is becoming increasingly popular in the field of health and athletic performance enhancement.

What makes the Lions Mane mushroom so special?

The Lions Mane mushroom contains large amounts of beta-glucan polysaccharides - a type of naturally occurring glucose polymers found in the cell walls of certain fungi and bacteria. In addition, this mushroom is also rich in lectins, proteins, lipids, hericenone, erinacin and terpenoids, which is basically everything an athlete needs for maximum performance.

Along with beta-glucan, these compounds are responsible for many of the health benefits such as reduced fatigue, improved cognitive function, reduction of inflammation, improved digestive health and better immune system function associated with Lions Mane mushroom (3).

What are the benefits of Lions Mane mushroom for athletes?

In addition to a number of other potential health benefits, which we will discuss in more detail in a moment, the Lions Mane mushroom is particularly interesting for athletes due to the following effects:

  • Reducing fatigue and increasing energy
  • Improving focus, concentration and general cognitive function
  • Reduction of inflammation
  • Reducing recovery time after training
  • Improving the health of the digestive tract
  • Improve the function of the immune system

Potential health benefits

Lions Mane can reduce fatigue and increase muscle energy

Physical fatigue is a foe that every athlete has to fight continuously. Rapid recovery after training or any other form of exercise is crucial for any athlete. Scientific research has shown that the Lions Mane mushroom can reduce physical fatigue (4). In a study conducted on mice, markers of physical exhaustion such as blood lactate levels, serum urea nitrogen and malondialdehyde levels were lower in the group of mice given Lions Mane. This study showed that Lions Mane could promote fatigue-reducing activity and enhance athletic performance. The same study also showed that Lions Mane could increase tissue glycogen levels, muscle energy storage and antioxidant activity (4).

What does all this mean for the athlete? Well, not only does Lions Mane appear to reduce fatigue, but it also has the potential to increase muscle energy.

Lions Mane can improve focus and concentration

Mental sharpness is just as important for athletes as physical performance. Improving focus and concentration can greatly enhance athletic performance. Lions Mane has been shown to improve cognitive function, particularly focus, concentration and memory (5). Some experts even consider Lions Mane to be the most effective "brain food", as this mushroom stimulates the production of the natural growth factor NGF. NGF is a protein that is crucial for the development, function and survival of the brain's neurons (5).

Other neurological benefits associated with ingredients found in Lions Mane include reduced irritability, improved neuron growth, better regeneration of damaged nerves and overall improvement in cognitive function (6, 7).

Lions Mane may reduce inflammation and oxidative stress and shorten recovery time Chronic inflammation and oxidative stress are thought to be causes of many modern diseases including heart disease, cancer and autoimmune diseases (18). Scientific research shows that Lion's Mane contains powerful anti-inflammatory and antioxidant compounds that may help reduce the effects of these diseases (18).

A study that examined the antioxidant effects of 14 different mushroom species found that Lion's Mane had the fourth highest antioxidant activity. The authors of the study therefore recommended Lions Mane as a good dietary source of antioxidants (19). Several animal studies found that Lions Mane extracts reduced markers of inflammation and oxidative stress and may be particularly helpful in controlling inflammatory bowel disease, liver damage and stroke (20, 21, 22, 23). Lions Mane may also help reduce some of the health risks associated with overweight and obesity, as this mushroom has been shown to reduce the levels of pro-inflammatory compounds secreted by adipose tissue (24).

Physical exhaustion can also cause inflammation and increase oxidative stress, which can lead to muscle tissue damage and impaired muscle contractility. Studies have shown that dietary antioxidant manipulation can accelerate recovery after exercise both by reducing muscle fatigue and by reducing the levels of reactive oxygen species that are harmful to the body (8). Lions Mane is rich in anti-inflammatory and antioxidant compounds and can therefore reduce reactive oxygen species and the time required for muscle recovery. Studies have also shown that Lions Mane contains natural ACE inhibitors, which can relax blood vessels, increase blood flow and reduce stress on the heart (9).

Lions Mane can improve fat metabolism

The two primary energy sources for metabolism are carbohydrates and fats. While the body's carbohydrate stores are limited, this is not the case for fat stores. For athletes, the ability to metabolize fat as an energy source is ideal for prolonged exercise to increase endurance. Scientific research has shown that Lions Mane extracts improve fat metabolism, which can be beneficial for endurance athletes (10). Another study found that administration of a Lion's Mane extract resulted in increased fat metabolism and reduced weight gain in mice despite a high-fat diet (11). These results suggest that Lions Mane could potentially improve fat metabolism in endurance athletes.

Lions Mane may improve digestive tract health and protect against digestive tract ulcers

Lions Mane has natural antibacterial properties that have been shown to protect against harmful bacteria such as H. Pylori - the leading cause of stomach ulcers. There is also evidence that Lion's Mane may also protect the stomach lining from other harmful substances (12). Peptic ulcers are often caused by two main factors: excessive growth of the H. pylori bacterium and damage to the stomach lining, which can often be attributed to long-term use of non-steroidal anti-inflammatory drugs (25). Lion's mane extracts may protect against gastric ulcers by inhibiting the growth of H. pylori bacteria and protecting the gastric mucosa from damage (26, 27). Several studies have shown that Lion's Mane can prevent the growth of H. pylori in the test tube, but no studies have been conducted on live test subjects (28, 29). However, a study conducted in animals concluded that Lion's Mane extract was more effective than traditional gastric acid blockers in preventing alcohol-induced gastric ulcers, with Lion's Mane showing no adverse side effects (30).

However, ulcers can develop not only in the stomach, but anywhere in the digestive tract including the colon and small intestine. Lions Mane may also reduce inflammation and prevent tissue damage in other areas of the digestive tract. Lions Mane may even help treat inflammatory bowel diseases such as ulcerative colitis and Crohn's disease (31, 32, 33). A study of ulcerative colitis patients found that taking a Lions Mane supplement containing 14% Lions Mane extract significantly reduced symptoms and improved quality of life after 3 weeks (34). However, when the same study was repeated with Crohn's disease patients, the benefits were no greater than with a placebo (35). It is important to note that herbal supplements used in these studies contained multiple types of mushrooms, making it difficult to draw conclusions about the specific effects of Lion's Mane. Overall, scientific research suggests that Lions Mane extracts may help prevent the development of ulcers, although further human studies are needed.

Lions Mane promotes the function of the immune system

A strong immune system protects the body from bacteria, viruses and other disease-causing pathogens. A weak immune system, on the other hand, increases the risk of infectious diseases. In this respect, it should be interesting for athletes that a strong immune system supports the body's regeneration. For athletes who regularly push their bodies to their limits, a healthy immune system is essential to protect the body from all kinds of pathogens. There are a number of scientific studies that suggest that Lions Mane can improve the function of the immune system. Several studies suggest that Lion's Mane increases the activity of the immune system, thereby protecting the body from pathogens that enter the digestive tract through the mouth or nose (13). These effects may be at least partially related to beneficial changes in gut bacteria that stimulate the immune system (36). In addition, another study showed that fungal proteins contained in Lion's Mane improve the function of the immune system and can be used as a so-called "functional food" for immunotherapy (14). One study even came to the conclusion that daily supplementation with a Lions Mane extract could quadruple the lifespan of mice injected with a lethal dose of Salmonella (37). Although further research is needed, the immune system stimulating effects of Lion's Mane are very promising.

Lions Mane could protect against dementia

The brain's ability to grow and make new connections between neurons decreases with age, which could explain why mental function declines in many older adults (38). Studies have found that Lions Mane contains two specific compounds that can stimulate the growth of brain cells: Hericenone and Erinacines (39). In addition, animal studies have shown that Lion's Mane may help protect against Alzheimer's disease, a degenerative brain disease that causes progressive memory loss. Lions Mane and extracts of this mushroom have been shown to both reduce symptoms of memory loss in mice and prevent the formation of amyloid-beta plaques, which accumulate in the brain and cause neuronal damage in Alzheimer's disease (40, 41, 42, 43). While there are no human studies that have directly investigated the benefits of Lions Mane for Alzheimer's disease in humans, there is evidence that Lions Mane may improve mental function. A study of older adults suffering from mild cognitive impairment found that daily consumption of 3 grams of Lions Mane powder over a 4-month period significantly improved mental function, with these benefits disappearing when supplementation was discontinued (44). Lions Mane's ability to promote nerve growth and protect the brain from Alzheimer's-related damage may explain some of the positive effects on brain health.

Lions Mane may help alleviate mild symptoms of depression and anxiety

Up to a third of the population of countries in the Western world suffer from symptoms of anxiety and depression (45). While there are many causes of anxiety disorders and depression, chronic inflammation may be an important contributing factor. Recent animal studies have found that Lion's Mane extracts have anti-inflammatory effects that could alleviate symptoms of anxiety and depression in mice (46, 47). Other animal studies have found that Lion's Mane extracts can also help regenerate brain cells and improve the function of the hippocampus - a region of the brain responsible for processing memories and emotional responses (48, 49). Scientists believe that improved hippocampal function may explain the reduction in anxiety and depression observed in mice given Lion's Mane extracts. A study conducted with menopausal women also showed that daily consumption of cookies containing Lions Mane extract over a one-month period helped to reduce feelings of irritability and anxiety (50). Lions Mane may speed healing after injury to the nervous system The nervous system is made up of the brain, spinal cord and other nerves that run through the body. These three components work together to transmit signals that control nearly every bodily function. Injuries to the brain or spinal cord can have devastating consequences. They often cause paralysis or loss of mental function and can take a long time to heal. However, scientific research has found that Lions Mane extracts can accelerate healing in these types of injuries by speeding up the growth and repair of nerve cells (51, 52, 52). Lions mane extract has been shown to reduce the time required for healing by 23 to 41% in rats with nervous system injuries (54). Lions mane extracts may also help to reduce the severity of damage after a stroke. In one study, a Lion's Mane extract given to rats immediately after a stroke helped reduce inflammation and the amount of brain damage caused by the stroke (55).

Lions Mane could reduce the risk of heart disease

Primary risk factors for heart disease include obesity, high triglyceride levels, high levels of oxodized cholesterol and an increased tendency to develop blood clots. Scientific research shows that Lion's Mane can influence some of these factors and reduce the risk of heart disease. Studies in rats and mice have found that Lion's Mane extracts can improve lipid metabolism and reduce triglyceride levels (56). In one study, rats were fed a high-fat diet and received a daily dose of Lion's Mane extract. These rats had 27% lower triglyceride levels and 42% less weight gain after 28 days (57). Since overweight/obesity and high triglyceride levels are both considered risk factors for heart disease, this is one way in which Lions Mane may contribute to heart health. Test tube studies have also found that Lion's Mane extract can help reduce oxidation of cholesterol in the bloodstream (58). Oxidized cholesterol molecules tend to adhere to the walls of the arteries, increasing the risk of heart attack and stroke. For this reason, reducing this oxidation is beneficial for heart health. In addition, Lions Mane contains a compound called hericenone B, which may reduce the rate of blood clotting and reduce the risk of heart attack and stroke (59). In summary, Lions Mane appears to have positive effects on cardiovascular health through multiple pathways.

Lions Mane may help control diabetes symptoms

Diabetes is a disease that occurs when the body loses the ability to control its blood sugar levels. As a result, these remain continuously elevated. Chronically elevated blood sugar levels eventually cause complications such as kidney disease, nerve damage in the hands and legs, and vision loss. Lions Mane may be useful for controlling diabetes, as this mushroom can improve blood sugar control and reduce some of the side effects of diabetes. Several animal studies have shown that Lions Mane can significantly reduce blood glucose levels in healthy and diabetic mice at doses as low as 6 mg per kilogram of body weight (60, 61). One way in which Lion's Mane may lower blood glucose levels is through the activity of the enzyme alpha-glucosidase, which breaks down carbohydrates in the small intestine (62). When this enzyme is blocked, the body is no longer able to digest carbohydrates effectively, resulting in lower blood glucose levels. In addition to reducing blood sugar levels, Lions Mane extracts may reduce diabetic nerve pain in the hands and feet. In mice with diabetic nerve damage, six weeks of treatment with a Lions Mane extract resulted in reduced pain and lower blood glucose levels, and also increased antioxidant levels (63).

Lions Mane may have anti-cancer effects

Cancer occurs when the DNA of cells is damaged, resulting in uncontrolled cell division and growth. Some research suggests that Lion's Mane may have anti-cancer properties due to some of its unique compounds (64, 65). When a Lion's Mane extract is added to human cancer cells in a test tube, it causes a faster rate of cell death in the cancer cells. This has been demonstrated with different types of cancer cells including liver cancer cells, colon cancer cells, stomach cancer cells and blood cancer cells (66, 67, 68). However, at least one study did not observe any effects of this type, so further research is needed (69). In addition, it has been observed that Lion Mane extracts are able to slow down the spread of cancer. A study of mice with colon cancer found that taking a Lion's Mane extract reduced the spread of cancer to the lungs by 69% (70). Another study found that a Lion's Mane extract was more effective than traditional cancer drugs in slowing tumor growth in mice, with fewer side effects (67).

However, these are preliminary results, which means that Lion's Mane should by no means be considered a substitute for traditional cancer treatment!

Safety and side effects

No human studies have yet investigated the side effects of Lions Mane or its extracts, but Lions Mane still appears to be very safe. In rats, no adverse side effects were observed even at high doses in the range of 5 grams of Lions Mane per kilogram of body weight per day for 3 months or lower doses for 3 months (71, 72, 73). However, people who are allergic or sensitive to mushrooms should avoid Lions Mane, as this plant is also a fungus. There are documented cases of people complaining of respiratory problems or skin rashes after contact with Lions Mane, presumably related to allergies (74, 75).

Conclusion

Lions Mane continues to grow in popularity due to its numerous health benefits, and the potential benefits for athletes make this mushroom a unique addition to any sports diet. New studies continue to show positive effects of Lions Mane on physical and mental performance. Lions Mane can be incorporated into the diet in a variety of ways, which include consuming the whole mushroom or using extracts and supplements. Athletes who want to further enhance their performance should use Lions Mane on a daily basis in the form of supplements.

References

  1. Mudge, K. (2017, April 09). Lion's Mane: A new candidate for profitable forest mushroom cultivation. Retrieved October 28, 2018, from http://smallfarms.cornell.edu/2015/04/06/lions-mane/
  2. Akramienė, D., Kondrotas, A., Didžiapetrienė, J., & Kėvelaitis, E. (2007). Effects of ß-glucans on the immune system. Medicina, 43(8), 597. doi:10.3390/medicina43080076
  3. Khan, M. A., Tania, M., Liu, R., & Rahman, M. M. (2013). Hericium erinaceus: An edible mushroom with medicinal values. Journal of Complementary and Integrative Medicine, 10(1). doi:10.1515/jcim-2013-0001
  4. Liu, J., Du, C., Wang, Y., & Yu, Z. (2014). Anti-fatigue activities of polysaccharides extracted from Hericium erinaceus. Experimental and Therapeutic Medicine, 9(2), 483-487. doi:10.3892/etm.2014.2139
  5. Brandalise, F., Cesaroni, V., Gregori, A., Repetti, M., Romano, C., Orrù, G., . . Rossi, P. (2017). Dietary Supplementation ofHericium erinaceusIncreases Mossy Fiber-CA3 Hippocampal Neurotransmission and Recognition Memory in Wild-Type Mice. Evidence-Based Complementary and Alternative Medicine, 2017, 1-13. doi:10.1155/2017/3864340
  6. Mori, K., Inatomi, S., Ouchi, K., Azumi, Y., & Tuchida, T. (2009). Improving effects of the mushroom Yamabushitake (Hericium erinaceus) on mild cognitive impairment: A double-blind placebo-controlled clinical trial. Phytotherapy Research, 23(3), 367-372. doi:10.1002/ptr.2634
  7. Nagano, M., Shimizu, K., Kondo, R., Hayashi, C., Sato, D., Kitagawa, K., & Ohnuki, K. (2010). Reduction of depression and anxiety by 4 weeks Hericium erinaceus intake. Biomedical Research,31(4), 231-237. doi:10.2220/biomedres.31.231
  8. He, F., Li, J., Liu, Z., Chuang, C., Yang, W., & Zuo, L. (2016). Redox Mechanism of Reactive Oxygen Species in Exercise. Frontiers in Physiology, 7. doi:10.3389/fphys.2016.00486
  9. Abdullah, N., Ismail, S. M., Aminudin, N., Shuib, A. S., & Lau, B. F. (2012). Evaluation of Selected Culinary-Medicinal Mushrooms for Antioxidant and ACE Inhibitory Activities. Evidence-Based Complementary and Alternative Medicine, 2012, 1-12. doi:10.1155/2012/464238
  10. Choi, W., Kim, Y., Park, B., Kim, J., & Lee, S. (2013). Hypolipidaemic Effect of Hericium erinaceum Grown in Artemisia capillaris on Obese Rats. Mycobiology, 41(2), 94-99. doi:10.5941/myco.2013.41.2.94
  11. Hiwatashi, K., Kosaka, Y., Suzuki, N., Hata, K., Mukaiyama, T., Sakamoto, K., . . Komai, M. (2010). Yamabushitake Mushroom (Hericium erinaceus) Improved Lipid Metabolism in Mice Fed a High-Fat Diet. Bioscience, Biotechnology, and Biochemistry, 74(7), 1447-1451. doi:10.1271/bbb.100130
  12. Wang, M., Konishi, T., Gao, Y., Xu, D., & Gao, Q. (2015). Anti-Gastric Ulcer Activity of Polysaccharide Fraction Isolated from Mycelium Culture of Lions Mane Medicinal Mushroom, Hericium erinaceus (Higher Basidiomycetes). International Journal of Medicinal Mushrooms,17(11), 1055-1060. doi:10.1615/intjmedmushrooms.v17.i11.50
  13. Sheng, X., Yan, J., Meng, Y., Kang, Y., Han, Z., Tai, G., . . Cheng, H. (2017). Immunomodulatory effects of Hericium erinaceus derived polysaccharides are mediated by intestinal immunology. Food & Function, 8(3), 1020-1027. doi:10.1039/c7fo00071e
  14. Diling, C., Chaoqun, Z., Jian, Y., Jian, L., Jiyan, S., Yizhen, X., & Guoxiao, L. (2017). Immunomodulatory Activities of a Fungal Protein Extracted from Hericium erinaceus through Regulating the Gut Microbiota. Frontiers in Immunology,8. doi:10.3389/fimmu.2017.00666
  15. https://www.ncbi.nlm.nih.gov/pubmed/26244378
  16. https://www.ncbi.nlm.nih.gov/pubmed/25070597
  17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492709/
  18. https://www.ncbi.nlm.nih.gov/pubmed/25529054
  19. https://www.ncbi.nlm.nih.gov/m/pubmed/21716693/
  20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200813/
  21. https://www.ncbi.nlm.nih.gov/pubmed/27481156
  22. https://www.ncbi.nlm.nih.gov/pubmed/23000690
  23. https://www.ncbi.nlm.nih.gov/pubmed/25960751
  24. https://www.ncbi.nlm.nih.gov/pubmed/26559695
  25. https://www.ncbi.nlm.nih.gov/pubmed/25532720
  26. https://www.ncbi.nlm.nih.gov/pubmed/25070597
  27. https://www.ncbi.nlm.nih.gov/pubmed/26853960
  28. https://www.ncbi.nlm.nih.gov/pubmed/26364939
  29. https://www.ncbi.nlm.nih.gov/pubmed/23557368
  30. https://www.ncbi.nlm.nih.gov/pubmed/24302966
  31. https://www.ncbi.nlm.nih.gov/pubmed/27481156
  32. https://www.ncbi.nlm.nih.gov/pubmed/29156761
  33. https://www.ncbi.nlm.nih.gov/pubmed/29677563
  34. https://www.ncbi.nlm.nih.gov/pubmed/26933886
  35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4944955/
  36. https://www.ncbi.nlm.nih.gov/pubmed/28713364
  37. https://www.ncbi.nlm.nih.gov/pubmed/22624604
  38. https://www.ncbi.nlm.nih.gov/pubmed/16371948
  39. https://www.ncbi.nlm.nih.gov/pubmed/24266378
  40. https://www.ncbi.nlm.nih.gov/pubmed/21383512
  41. https://www.ncbi.nlm.nih.gov/pubmed/27350344
  42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5133811/
  43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895996/
  44. https://www.ncbi.nlm.nih.gov/pubmed/18844328
  45. https://www.ncbi.nlm.nih.gov/pubmed/25739893
  46. https://www.ncbi.nlm.nih.gov/pubmed/26150007
  47. https://www.ncbi.nlm.nih.gov/pubmed/29364170
  48. https://www.ncbi.nlm.nih.gov/pubmed/29091526
  49. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5237458/
  50. https://www.ncbi.nlm.nih.gov/pubmed/20834180
  51. https://www.ncbi.nlm.nih.gov/pubmed/26853959
  52. https://www.ncbi.nlm.nih.gov/pubmed/12675022
  53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3449638/
  54. https://www.ncbi.nlm.nih.gov/pubmed/21941586
  55. https://www.ncbi.nlm.nih.gov/pubmed/25167134
  56. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3714447/
  57. https://www.ncbi.nlm.nih.gov/pubmed/20622452
  58. https://www.ncbi.nlm.nih.gov/pubmed/24959591
  59. https://www.ncbi.nlm.nih.gov/pubmed/20637576
  60. https://www.ncbi.nlm.nih.gov/pubmed/28087447
  61. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3852124/
  62. https://www.ncbi.nlm.nih.gov/pubmed/25746618
  63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415746/
  64. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2896861/
  65. https://www.ncbi.nlm.nih.gov/pubmed/26547693
  66. https://www.ncbi.nlm.nih.gov/pubmed/21779573
  67. https://www.ncbi.nlm.nih.gov/pubmed/24631140
  68. https://www.ncbi.nlm.nih.gov/pubmed/25306354
  69. https://www.ncbi.nlm.nih.gov/pubmed/15737684
  70. https://www.ncbi.nlm.nih.gov/pubmed/23668749
  71. https://www.ncbi.nlm.nih.gov/pubmed/27816657
  72. https://www.ncbi.nlm.nih.gov/pubmed/20633464
  73. http://www.ncbi.nlm.nih.gov/pubmed/24810469
  74. https://www.ncbi.nlm.nih.gov/pubmed/14714963
  75. https://www.ncbi.nlm.nih.gov/pubmed/10344494