A mushroom is a spore-bearing fruiting body of a fungus—a simple definition for a rather complex group of living organisms. Indeed, mushrooms and other fungi are considered neither plant nor animal—they comprise their very own self-named kingdom within the Eurkarya domain of the taxonomy of living things.1 In fact, recent studies indicate that fungi are actually more closely related to animals than to plants and play an essential role across the various ecosystems of the world.2 Unfortunately, describing what makes the over six million species of fungi worldwide different from plants and similar to animals, as well as how they impact nature as a whole, is well-beyond the scope of this article. So, you’ll just have to settle for this review article in which we focus on edible species of mushrooms and the roles they play in human diet and health. 

History of Mushroom Cultivation

Cultivation of mushrooms likely began with the Chinese—Tao Hongjing (456–536 CE) included a commentary on cultivating the mushroom Wolfiporia cocos in Bencao Jing Jinzhu, an extension of an extension of the Shennong Bencao Jing, the oldest surviving Chinese materia medica, which categorized medicinal uses of 365 herbs.³ In contrast, early cultivation of mushrooms in Europe was documented much later, during the mid-1600s, beginning in abandoned quarries and caves near Paris.⁴ Both Asian and European mushroom cultivation practices were subsequently introduced in the United States in the 1870s.⁵ Today, of about 2,000 species of mushrooms considered safe for consumption, 25 to 35 are widely eaten, and fewer than that are commercially cultivated.^6,7

Mushroom Nutrient Composition

While the primary mass of most mushroom fruitbodies is water, depending on the species—and even within the same genus—mushrooms contain varying percentages of carbohydrates (3–42% dry matter [DM]), protein (4–44%; maximum, 57.3% DM), and lipids (2–6% DM).⁸ Mushrooms are low in calories yet contain a variety of vitamins, polyphenols, carotenoids, macroelements, and other bioactive components.^8,9 In an analysis, the addition of an 84g serving of commonly consumed raw mushrooms (e.g., the white, brown/cremini, and portabella states of Agaricus bisporus) to United States (US) Department of Agriculture Food Patterns resulted in a 2- to 3-percent increase in fiber, an 8- to 12-percent increase in potassium, a 12- to 18-percent increase in riboflavin, an 11- to 26-percent increase in niacin, an 11- to 23-percent increase in selenium, and a 16- to 26-percent increase in copper depending upon the pattern type and calorie level but only one-percent or less increase in sodium, a one-percent increase in calories, and no effect on saturated fat or cholesterol.¹⁰ Adding a serving of raw specialty mushrooms (Pleurotus ostreatus) also increased dietary vitamin D by 8 to 11 percent and dietary choline by 10 to 16 percent.¹⁰

The nutrient profiles of mushrooms can also vary depending on the environment in which they grow; for example, a comparison of wild and commercial species of mushrooms revealed that the latter generally contained more fat, less protein, and more sugar. When considering types of vitamin E, higher levels of α-tocopherol but undetectable levels of γ-tocopherol were found in the wild species, and the wild species also contained lower concentrations of monounsaturated fatty acids but higher concentrations of polyunsaturated fatty acids as well as higher concentrations of phenols but a lower concentration of ascorbic acid compared to commercial mushrooms.¹¹ A separate study confirmed the greater phenol content and antioxidant capacity of wild mushrooms compared to commercial mushrooms.¹²

Mushrooms as Medicine

Views on the consumption of mushrooms varied across the ancient world; while leading Roman medical practitioners were wary of mushroom consumption due to numerous cases of accidental poisoning and excessive consumption of edible mushrooms leading to indigestion by the populace,¹³ Eastern populations, such as the Chinese, Japanese, and Indians, have long viewed mushrooms as medicinal aids.^14,15 Today, the health benefits of various mushrooms are known to include antioxidant, prebiotic, antihypertensive, anti-inflammatory, antiviral/antimicrobial, neuroprotective, hepatoprotective, and antitumor/anticancer effects, among others.^16–18

See sidebar “Mushrooms and Beta–Glucans”

Cardiovascular and metabolic health. Research suggests that edible mushroom consumption may favorably alter metabolic markers (e.g. cholesterol, triglycerides) and reduce blood pressure,^19–21 although the effects can differ depending on the mushroom. For example, among spontaneously hypertensive rats (a common animal model of hypertension and cardiovascular disease) in one study, those fed maitake mushrooms (Grifola frondose) experienced a decrease in their total cholesterol level compared to the control group, while those fed shiitake mushrooms (Lentinus edodes) experienced a reduction in their free cholesterol level.²⁰ There was no difference in the plasma triglyceride or phospholipid levels between the experimental groups; however, shiitake consumption resulted in a decrease in both very-low-density lipoprotein (“bad”) cholesterol and high-density lipoprotein (“good”) cholesterol compared to the control group, while maitake consumption elicited a decrease in very-low-density lipoprotein (“bad”) cholesterol only.²⁰ Some of the same investigators reported in another study that the blood pressure of spontaneously hypertensive rats was significantly reduced following eight weeks of maitake mushroom consumption, but this effect was not true with shitake consumption. Moreover, although the investigators affirmed the reduction in plasma-free cholesterol levels and reported reductions in triglyceride and phospholipid levels with shiitake intake, they did not observe reductions in either total or free cholesterol levels or triglyceride and phospholipid levels with the consumption of maitake mushrooms.²¹ Keeping in mind all these findings and that free cholesterol has cytotoxic effects (which may be mitigated by high-density lipoprotein cholesterol),²² the intake of both mushrooms (ensuring variety) rather than either alone, in combination with other healthy foods (i.e., those that increase high-density lipoprotein cholesterol and phospholipid concentrations on their own), may lead to the best outcome.

Collectively, edible mushrooms appear to support glucose control by a variety of mechanisms, including inhibiting glucose absorption, protecting β-cells (which produce and release insulin in the pancreas) from damage, increasing insulin release, and regulating different relevant pathways in the body.²³ In Type 2 diabetic C57BL/6 mice (which carry a genetic predisposition to develop Type 2 diabetes), oral administration of 250 or 500mg/kg of chaga mushroom (Inonotus obliquus) extract significantly alleviated insulin resistance, with a dose–effect relationship noted within a certain range; indeed, the authors reported that the 500mg/kg dose of extract achieved an effect similar to that of the diabetes drug metformin.²⁴ Along these lines, oral administration of 900mg/kg of chaga mushroom in another study led to reductions in fasting blood glucose levels, an improved glucose-tolerance ability, an increased hepatic glycogen level (to better prevent high blood glucose levels), and ameliorated insulin resistance in a Type 2 diabetic mouse model induced by a high-fat diet and streptozotocin (a compound with preferential toxicity toward pancreatic β-cells) compared to diabetic control mice.²⁵ 

See sidebar “Mushrooms and the Central Nervous System”

Immune function. Research has attributed the beneficial effects of edible mushrooms on the immune system to their ability to modulate different cytokine responses. In cancer, maitake, Ganoderma lucidum (reishi), Cordyceps sinensis, and Trametes versicolor (turkey tail) may increase the production of T helper (Th)1 cytokines, such as interferon-γ, which activate death receptors on the surfaces of tumor cells to help Th1 cells locate and kill them.²⁶ Edible Agaricus, maitake, reishi, Cordyceps, and turkey tail mushrooms may also downregulate Th2 cytokines, which reduce Th1 cytokine concentrations, thus showing an additional benefit in treating cancer by maintaining higher concentrations of tumor-destroying Th1 cells.²⁶ 

Edible mushrooms may also increase the therapeutic efficacy of mainstay treatments for cancer.²⁶ During chemotherapy, chemotherapeutic agents penetrate and accumulate in tumor cells to induce cell cycle arrest and apoptosis; as such, some edible mushrooms, such as Agaricus spp., may help drugs such as doxorubicin to accumulate intracellularly at greater doses, increasing their therapeutic efficacy.²⁷ Other edible mushrooms, when combined with such drugs, may help to inhibit tumor growth; one study concluded that administering an extract of Cordyceps sinensis in combination with cisplatin could inhibit tumor growth,²⁸ and another determined that the combination of polysaccharide K (a derivative of turkey tail mushrooms) and trastuzumab reduced cell growth in colorectal tumors by 96 percent.²⁹ Mushrooms may also minimize associated undesirable side effects of chemotherapy and radiation therapy, such as nausea, bone marrow suppression, anemia, and insomnia.³⁰

Other research has examined mushroom intake for managing inflammatory conditions. According to a literature search, the various bioactive molecules found in mushrooms, including peptides, polysaccharides, terpenes, sterols, fatty acids, and phenols, may inhibit major proinflammatory biomarkers and associated pathways, thus exerting anti-inflammatory effects.³¹ Mushrooms such as chaga,³⁴ maitake,³⁵ and reishi³⁶ also seem to have antiallergic effects by inhibiting the process of mast cell degranulation (during which mast cells release mediators, such as histamine). 

Certain edible mushrooms may also combat viral infection by preventing viral entry or replication and stimulating immune cell responses. Polysaccharides from Agaricus blazei Murrill, for example, were found to reduce the cytopathic effects of Western equine encephalitis virus, herpes simplex virus (HSV), and poliovirus in Vero cells (a lineage of cells derived from kidney epithelial cells extracted from an African green monkey).³⁷ A sulfated derivative of a polysaccharide from Agaricus brasiliensis Fr. suppressed HSV-1 and HSV-2 cell attachment, cell penetration, and intracellular spread in vitro.³⁸ Interestingly, the sulfated derivative in question also displayed a synergistic antiviral effect against HSV when combined with the antiviral drug acyclovir, suggesting the potential of combining edible mushrooms with antiviral medications to improve treatment effects.³⁸

See sidebar “Poisonous Mushrooms and Medicine”

Neuroprotection and neuroregeneration. According to investigators, edible mushrooms could play a role in the prevention³⁹ and treatment^40,41 of dementia, with various mushroom species displaying the potential to reduce or inhibit the production of beta-amyloid and phosphorylated tau.⁴² However, mushroom consumption may also help to limit or prevent more general cognitive decline: among 663 participants 60 years of age or older in the Diet and Healthy Aging study in Singapore, those who consumed greater than two portions (>300g) of mushrooms per week had reduced odds of having mild cognitive impairment independent of age, sex, education, cigarette smoking, alcohol consumption, hypertension, diabetes, heart disease, stroke, physical activities, and social activities.⁴³ Similarly, greater mushroom intake was associated with better scores on certain cognitive performance tests among adults 60 years of age or older from the 2011–2014 U.S. National Health and Nutrition Examination Survey.⁴⁴ Along these lines, a study from western Norway that recruited elderly participants (70–74 years) from the general population confirmed a linear increase in the dose–response association between mushroom consumption and cognitive test performance.⁴⁵

The neuroprotective effects of edible mushrooms may be attributable to the amino acid ergothioneine, which the human body cannot synthesize itself but can source from certain foods, including mushrooms. Notably, however, whole-blood concentrations of ergothioneine were found to decline significantly after 60 years of age,⁴⁶ and ergothioneine levels were lower in individuals with mild cognitive impairment (plasma)⁴⁶ or Parkinson’s disease (serum)⁴⁷ compared to age-matched healthy individuals. Some edible mushrooms, such as Hericium erinaceus (lion’s mane), contain compounds that may also boost hippocampal memory by encouraging nerve growth.⁴⁸ The antioxidants in mushrooms may also help to control oxidative stress levels and maintain antioxidant defenses to prevent age-related neurodegeneration.⁵³

Antioxidation. Mushrooms contain both primary and secondary antioxidants as well as compounds with antioxidant properties that act as cell signals and/or inducers, leading to alterations in gene expression that activate enzymes to eliminate reactive oxygen species.⁵⁰ Certain mushrooms also inhibit lipid peroxidation, a process in which reactive oxygen species trigger the oxidative deterioration of lipids.⁵⁵ One study determined that mushrooms contain unusually high amounts of ergothioneine and another antioxidant, glutathione, although the levels vary between species: among 13 species tested, maitake (2.41mg/g of dry weight) and Agrocybe aegerita (1.92mg/g of dry weight) mushrooms contained the most glutathione, and Boletus edulis (7.27mg/g of dry weight) and Pleurotus citrinopileatus (3.94mg/g of dry weight) mushrooms contained the most ergothioneine.⁵² 

Mushrooms also contain different amounts of other antioxidants, including phenolics, flavonoids, glycosides, polysaccharides, tocopherols, carotenoids, vitamins, minerals, and ascorbic acid.⁵⁰ In a study from Ethiopia, testing of two cultivated (Pleurotus ostreatus and shitake) and five wild (Laetiporus sulphureus, Agaricus campestris, Termitomyces clypeatus, Termitomyces microcarpus, and Tapura letestui) mushroom species indicated that, among them, Agaricus campestris exhibited significant antioxidant potential due to having the highest levels of multiple phenolic compounds, including ferulic acid, gallic acid, and p-hydroxybenzoic acid.⁵³ In another study investigating hot water extracts of Agaricus, Antrodia, Auricularia, Coprinus, Cordyceps, Hericium, Grifola, Ganoderma, Lentinus, Phellinus, and Trametes mushrooms, researchers reported concentrations of polyphenolic compounds and polysaccharides to be responsible for their high antioxidant potential, with Ganoderma mushrooms exhibiting the greatest antioxidant potential.⁵⁴ In another study, among 16 of the most popular edible species of wild-growing mushrooms, Boletus chrysenteron and Boletus edulis had high polyphenol contents and antioxidant activity.⁵⁵ 

Supplementing with Mushrooms

As an alternative to consuming mushrooms during meals, mushroom supplements are available and often combine multiple mushrooms that are heat-treated and milled to disrupt the chitinous cell wall matrix and increase the surface area for digestion and absorption.⁵⁶ When choosing a mushroom supplement, however, one may need to consider whether the mushroom mycelium (a web of fibers found underground) or the fruiting body (the cap and stalk) provides better nutrition, as different supplement companies opt to include one, the other, or both.⁵⁶ Ultimately, to secure one’s preferred nutrient profile, the choice between a mycelium or fruiting body supplement may depend on the mushroom: one study comparing the antioxidant properties of commonly cultivated mushrooms between in-vivo (fruiting body) and in-vitro (mycelium) samples determined that the mushroom species with the greatest antioxidant potential was the brown Agaricus bispous, while, among the mycelium samples, shiitake mushrooms showed the highest antioxidant activity.⁵⁷ Similarly, other studies reported that the mycelium of Pleurotus ostreatus had greater concentrations of ergosterol and phenolic compounds than the corresponding fruiting body,⁵⁸ while fruiting bodies of Agaricus bisporus, when compared to both farm (old mycelium) and in-vitro (young) mycelium, contained higher levels of different phenols and ergothioneine.⁵⁹ In other cases, both parts of the same mushroom may contain unique nutrients: take, for example, lion’s mane, where hericenones were isolated from the fruiting body but erinacines were isolated from the mycelium.⁶⁰ 

A Note of Caution

Like other foods, edible mushrooms should be consumed after being properly prepared. Cutaneous reactions (e.g., shitake dermatitis^61,62) have been documented following the ingestion of raw or undercooked mushrooms. Raw Agaricus mushrooms also contain agaritine,^63,64 a hydrazine-derivative mycotoxin with carcinogenic properties in which concentrations may be reduced—although not removed entirely—by exposing the mushrooms to heat.⁶³ Similarly, Agaricus bisporus and another edible mushroom, Gyromitra esculenta, contain hydrazine analogs, which were found in an animal study following administration in drinking water continuously for life to directly or indirectly (by way of their derivatives) to cause tumors in various tissues in Swiss mice and Syrian (golden) hamsters.⁶⁵ Of course, serious anaphylactic reactions can occur in susceptible individuals following the consumption of even the most commonly eaten edible mushrooms.⁶⁶ Finally, mushroom supplementation should be monitored in individuals with more complex health conditions; for example, authors of a case series report of three Japanese patients with cancer suggested a causal relationship between the patients’ severe hepatic damage and their use of Agaricus blazei extract as alternative medicine.⁶⁷

Editor’s note. Please discuss the consumption of mushrooms or mushroom supplements with your primary care practitioner.

Sources

1. Canadian Forest Service website. Forest mushrooms. What is a mushroom? https://www.for.gov.bc.ca/hfp/publications/00029/mushwhat.htm. Accessed 16 May 2023.
2. Lovett B. Three reasons fungi are not plants. 6 Jan 2021. American Society for Microbiology website. https://asm.org/Articles/2021/January/Three-Reasons-Fungi-Are-Not-Plants#:~:text=This%20is%20our%20final%20reason,related%20to%20animals%20than%20plants.Accessed 16 May 2023.
3. Lu D. Ancient Chinese people’s knowledge of macrofungi as medicinal material during the period from 581 to 979 AD. Int J Med Mushrooms. 2014;16(2):189–204. 
4. Bertelsen, C.D. Mushroom: A Global History; Reaktion Books: London, UK, 2013
5. Bunyard, B. A History of Mushroom Cultivation in America Timeline; FUNGI: Basel, Switzerland, 2021; pp. 24–25
6. Valverde ME, Hernández-Pérez T, Paredes-López O. Edible mushrooms: improving human health and promoting quality life. Int J Microbiol. 2015;2015:376387.
7. Bhambri A, Srivastava M, Mahale VG, Mahale S, Karn SK. Mushrooms as potential sources of active metabolites and medicines. Front Microbiol. 2022;13:837266.
8. Malinowski R, Sotek Z, Stasińska M, Malinowska K, Radke P, Malinowska A. Bioaccumulation of macronutrients in edible mushrooms in various habitat conditions of NW Poland—role in the human diet. Int J Environ Res Public Health. 2021;18(16):8881.
9. Kumar K, Mehra R, Guiné RPF, et al. Edible mushrooms: a comprehensive review on bioactive compounds with health benefits and processing aspects. Foods. 2021;10(12):2996.
10. Agarwal S, Fulgoni III VL. Nutritional impact of adding a serving of mushrooms to USDA Food Patterns – a dietary modeling analysis. Food Nutr Res. 2021;65:10.29219/fnr.v65.5618.
11. Barros L, Cruz T, Baptista P, Estevinho LM, Ferreira ICFR. Wild and commercial mushrooms as source of nutrients and nutraceuticals. Food Chem Toxicol. 2008;46(8):2742–2747.
12. Alvarez-Parrilla E, de la Rosa LA, Martínez NR, Aguilar González GA. Total phenols and antioxidant activity of commercial and wild mushrooms from Chihuahua, Mexico. Cienc Tecnol Aliment. 2007;5(5):329–334.
13. Buller AHR. The fungus lore of the Greeks and Romans. Trans Br Mycol Soc. 1914–1916;5:21–66. 
14. Varghese R, Dalvi YB, Lamrood PY, Shinde BP, Nair CCK. Historical and current perspectives on therapeutic potential of higher basidiomycetes: an overview. 3 Biotech. 2019;9(10):362.
15. Lee K-H, Morris-Natschke SL, Yang X, et al. Recent progress of research on medicinal mushrooms, foods, and other herbal products used in traditional Chinese medicine. J Tradit Complement Med. 2012;2(2):84–95.
16. Jayachandran M, Xiao J, Xu B. A critical review on health promoting benefits of edible mushrooms through gut microbiota. Int J Mol Sci. 2017;18(9):1934.
17. Zhang J-J, Li Y, Zhou T, et al. Bioactivities and health benefits of mushrooms mainly from China. Molecules. 2016;21(7):938.
18. Bhambri A, Srivastava M, Mahale VG, Mahale S, Karn SK. Mushrooms as potential sources of active metabolites and medicines. Front Microbiol. 2022;13:837266.
19. Krittanawong C, Isath A, Hahn J, et al. Mushroom consumption and cardiovascular health: a systematic review. Am J Med. 2021;134(5):637–642.e2.
20. Kabir Y, Yamaguchi M, Kumura S. Effect of shiitake (Lentinus edodes) and maitake (Grifola frondosa) mushrooms on blood pressure and plasma lipids of spontaneously hypertensive rats. J Nutr Sci Vitaminol (Tokyo). 1987;33(5):341–346.
21. Kabir Y, Kumura S. Dietary mushrooms reduce blood pressure in spontaneously hypertensive rats (SHR). J Nutr Sci Vitaminol (Tokyo). 1989;35(1):91–94.
22. Kellner-Weibel G, Luke SJ, Rothblat GH. Cytotoxic cellular cholesterol is selectively removed by apoA-I via ABCA1. Atherosclerosis. 2003;171(2):235–243.
23. Lo H-C, Wasser SP. Medicinal mushrooms for glycemic control in diabetes mellitus: history, current status, future perspectives, and unsolved problems (review). Int J Med Mushrooms . 2011;13(5):401-26.
24. Zhang Z, Liang X, Tong L, et al. Effect of Inonotus obliquus (Fr.) Pilat extract on the regulation of glycolipid metabolism via PI3K/Akt and AMPK/ACC pathways in mice. J Ethnopharmacol. 2021;273:113963.
25. Wang J, Wang c, Li S, et al. Anti-diabetic effects of Inonotus obliquus polysaccharides in streptozotocin-induced type 2 diabetic mice and potential mechanism via PI3K-Akt signal pathway. Biomed Pharmacother. 2017;95:1669–1677.
26. Guggenheim AG, Wright KM, Zwickey HL. Immune modulation from five major mushrooms: application to integrative oncology. Integr Med (Encinitas). 2014;13(1):32–44.
27. Lee JS, Hong EK. Agaricus blazei Murill enhances doxorubicin-induced apoptosis in human hepatocellular carcinoma cells by NFκB-mediated increase of intracellular doxorubicin accumulation. Int J Oncol. 2011;38(2):401–408.
28. Ji N-F, Yao L-S, Li Y, He W, Yi K-S, Huang M. Polysaccharide of Cordyceps sinensis enhances cisplatin cytotoxicity in non-small cell lung cancer H157 cell line. Integr Cancer Ther. 2011;10(4):359–367.
29. Ohwada S, Ogawa T, Makita F, et al. Beneficial effects of protein-bound polysaccharide K plus tegafur/uracil in patients with stage II or III colorectal cancer: analysis of immunological parameters. Oncol Rep. 2006;15(4):861–868.
30. Park H-J. Current uses of mushrooms in cancer treatment and their anticancer mechanisms. Int J Mol Sci. 2022;23(18):10502.
31. Rowaiye A, Wilfred OI, Onuh OA, et al. Modulatory Effects of mushrooms on the inflammatory signaling pathways and pro-inflammatory mediators. Clin Complement Med Pharmacol. 2022;2(4):100037.
32. Mishra SK, Kang J-H, Kim D-K, Oh SH, Kim MK. Orally administered aqueous extract of Inonotus obliquus ameliorates acute inflammation in dextran sulfate sodium (DSS)-induced colitis in mice. J Ethnopharmacol. 2012;143(2):524–532.
33. Um MY, Park JH, Gwon SY, Ahn J, Jung CH, Ha TY. Agaricus bisporus attenuates dextran sulfate sodium-induced colitis. J Med Food. 2014;17(12):1383–1385.
34. Nguyet TMN, Lomunova M, Le BV, et al. The mast cell stabilizing activity of Chaga mushroom critical for its therapeutic effect on food allergy is derived from inotodiol. Int Immunopharmacol. 2018;54:286–295.
35. Kawai J, Mori K, Hirasawa N. Grifola frondosa extract and ergosterol reduce allergic reactions in an allergy mouse model by suppressing the degranulation of mast cells. Biosci Biotechnol Biochem. 2019;83(12):2280–2287.
36. Tasaka K, Akagi M, Miyoshi K, Mio M, Makino T. Anti-allergic constituents in the culture medium of Ganoderma lucidum. (I). Inhibitory effect of oleic acid on histamine release. Agents Actions. 1988;23(3–4):153–156.
37. Sorimachi K, Ikehara Y, Maezato G, et al. Inhibition by Agaricus blazei Murill fractions of cytopathic effect induced by western equine encephalitis (WEE) virus on VERO cells in vitro. Biosci Biotechnol Biochem. 2001;65(7):1645–647.
38. de Sousa Cardozo FTG, Camelini CM, Mascarello A, et al. Antiherpetic activity of a sulfated polysaccharide from Agaricus brasiliensis mycelia. Antiviral Res. 2011;92(1):108–114.
39. Zhang S, Tomata Y, Sugiyama K, Sugawara Y, Tsuji I. Mushroom consumption and incident dementia in elderly Japanese: the Ohsaki Cohort 2006 study. J Am Geriatr Soc. 2017;65(7):1462–1469.
40. Li I-C, Chang H-H, Lin C-H, et al. Prevention of early Alzheimer’s disease by erinacine A–enriched Hericium erinaceus mycelia pilot double-blind placebo-controlled study. Front Aging Neurosci. 2020;12:155.
41. Yanshree, Yu WS, Fung ML, Lee CW, Lim LW, Wong KH. The monkey head mushroom and memory enhancement in Alzheimer’s disease. Cells. 2022;11(15):2284. 
42. Phan CW, David P, Naidu M, Wong K-H, Sabaratnam V. Therapeutic potential of culinary-medicinal mushrooms for the management of neurodegenerative diseases: diversity, metabolite, and mechanism. Crit Rev Biotechnol. 2015;35(3):355¬368.
43. Feng L, Cheah IK-M, Ng MM-X, et al. The association between mushroom consumption and mild cognitive impairment: a community-based cross-sectional study in Singapore. J Alzheimer’s Dis. 2019;68(1):197–203.
44. Ba DM, Gao X, Al-Shaar L, et al. Mushroom intake and cognitive performance among US older adults: the National Health and Nutrition Examination Survey, 2011-2014. Br J Nutr. 2022;128(11):2241–2248.
45. Nurk E, Refsum H, Drevon CA, et al. Cognitive performance among the elderly in relation to the intake of plant foods. the Hordaland Health study. Br J Nutr. 2010;104(8):1190–1201.
46. Cheah IK, Feng L, Tang RMY, Lim KHC, Halliwell B. Ergothioneine levels in an elderly population decrease with age and incidence of cognitive decline; a risk factor for neurodegeneration?. Biochem Biophys Res Commun. 2016;478(1):162–167.
47. Hatano T, Saiki S, Okuzumi A, Mohney RP, Hattori N. Identification of novel biomarkers for Parkinson’s disease by metabolomic technologies. J Neurol Neurosurg Psychiatry. 2016;87(3):295–301.
48. Martínez-Mármol R, Chai Y, Conroy JN, et al. Hericerin derivatives activates a pan-neurotrophic pathway in central hippocampal neurons converging to ERK1/2 signaling enhancing spatial memory [online ahead of print January 20, 2023). J Neurochem. 
49. Liuzzi GM, Petraglia T, Latronico T, Crescenzi A, Rossano R. Antioxidant compounds from edible mushrooms as potential candidates for treating age-related neurodegenerative diseases. Nutrients. 2023;15(8):1913.
50. Kozarski M, Klaus A, Jakovljevic D, et al. Antioxidants of edible mushrooms. Molecules. 2015;20(10):19489–19525.
51. 55Cheung LM, Cheung PCK. Mushroom extracts with antioxidant activity against lipid peroxidation. Food Chem. 2005;89(3):403–409.
52. Martínez-Mármol R, Chai YJ, Conroy JN, et al. Hericerin derivatives activates a pan-neurotrophic pathway in central hippocampal neurons converging to ERK1/2 signaling enhancing spatial memory (online ahead of print January 20, 2023). J Neurochem.
53. Woldegiorgis AZ, Abate D, Haki GD, Ziegler GR. Antioxidant property of edible mushrooms collected from Ethiopia. Food Chem. 2014;157:30–36.
54. Song W, van Griensven LJ, Pro- and antioxidative properties of medicinal mushroom extracts. Int J Med Mushrooms. 2008;10:315–324.
55. Witkowska AM, Zujko ME, Mirończuk-Chodakowska I. Comparative study of wild edible mushrooms as sources of antioxidants. Int J Med Mushrooms. 2011;13(4):335–341.
56. Om. Mycelium vs. fruiting body: the power of the whole mushroom. Available at: https://ommushrooms.com/pages/mycelium-vs-fruiting-body-m2. Accessed April 26, 2023.
57. Reis FS, Martins A, Barros L, Ferreira ICFR. Antioxidant properties and phenolic profile of the most widely appreciated cultivated mushrooms: a comparative study between in vivo and in vitro samples. Food Chem Toxicol. 2012;50(5):1201–1207.
58. Cardoso RVC , Fernandes A, Beatriz M, Oliveira PP. Development of nutraceutical formulations based on the mycelium of Pleurotus ostreatus and Agaricus bisporus. Food Funct. 2017;8(6):2155–2164.
59. Ghahremani-Majd H, Dashti F. Chemical composition and antioxidant properties of cultivated button mushrooms (Agaricus bisporus). Hortic Environ Biotechnol. 2015;56:376–382.
60. Ma B-J. Hericenones and erinacines: stimulators of nerve growth factor (NGF) biosynthesis in Hericium erinaceus. Mycology. 2010;1(2):92–98.
61. Heer RS, Patel NB, Mandal AKJ, Lewis F, Missouris CG. Not a fungi to be with: shiitake mushroom flagellate dermatitis. Am J Emerg Med. 2020;38(2):412.e1–412.e2.
62. de Mendonça CN, Chaves e Silva PM, Avelleira JCR, Nishimori FS, de Freire Cassia F. Shiitake dermatitis. An Bras Dermatol. 2015;90(2):276–278.
63. Hashida C, Hayashi K, Jie L, Haga S, Sakurai M, Shimizu H. [Quantities of agaritine in mushrooms (Agaricus bisporus) and the carcinogenicity of mushroom methanol extracts on the mouse bladder epithelium]. Nihon Koshu Eisei Zasshi. 1990;37(6):400–405. In Japanese.
64. Toth B, Erickson J. Cancer induction in mice by feeding of the uncooked cultivated mushroom of commerce Agaricus bisporus. Cancer Res. 1986;46(8):4007–4011.
65. .Toth B. Hepatocarcinogenesis by hydrazine mycotoxins of edible mushrooms. J Toxicol Environ Health. 1979;5(2-3):193–202.
66. Gabriel MF, González-Delgado P, Postigo I, et al. From respiratory sensitization to food allergy: anaphylactic reaction after ingestion of mushrooms (Agaricus bisporus). Med Mycol Case Rep. 2015;8:14–16.
67. Mukai H, Watanabe T, Ando M, Katsumata N. An alternative medicine, Agaricus blazei, may have induced severe hepatic dysfunction in cancer patients. Jpn J Clin Oncol. 2006;36(12):808.