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Derived from the cap and stem of the mushroom, Reishi mushroom is used as an immune stimulant by patients with HIV or cancer. The active constituents are thought to include both beta-glucan polysaccharides and triterpenes (1). Extracts of Reishi can stimulate macrophages and alter the levels of TNF and interleukins (2) (3) (4) (5). Reishi also inhibited platelet aggregation (11) (12) and improved lower urinary tract symptoms (LUTS) in men (9) (10). Studies done in rats have shown that Reishi extract may alleviate chemotherapy-induced nausea (13). In clinical studies, Reishi increased plasma antioxidant capacity (6) (7)and enhanced immune responses in advance-stage cancer patients (8).

Derived from the cap and stem of the mushroom. The active constituent is thought to be a beta-glucan polysaccharide. The whole mushroom is used primarily as a dietary element, but extracts and supplements are sold as immune stimulants for patients with HIV or cancer. While no adverse effects have been reported, some studies reveal a hypoglycemic effect following administration of maitake extract (9) (12). Maitake was shown to enhance bone marrow colony formation, reduce doxorubicin toxicity in vitro (11), and to inhibit tumor metastasis

Coriolus versicolor is a mushroom of the Basidiomycetes class. It was used initially in Traditional Chinese medicine as a tonic, but recent studies suggest that it has immunostimulant and anti-tumor properties. Polysaccharide-K (PSK), a proprietary product derived from Coriolus, was developed for cancer treatment in Japan. When used as an adjuvant, PSK appears to improve survival rates in patients with gastric (1) (2) and colorectal (3) (4) (5) cancers. Other Coriolus extracts, such as polysaccharide-peptide (PSP) and VPS, are available as dietary supplements. When used in conjunction with chemotherapy, PSP may benefit patients with advanced non-small cell lung cancer (7). Other clinical studies using Coriolus extract alone or in combination with other botanicals also suggest positive immunomodulatory effects (8) (9). However, studies on breast cancer (10), hepatocellular carcinoma (11), and leukemia (12) produced mixed results. A hot water extract of Coriolus, VPS, was found to enhance development of large intestinal tumors in mice (21). Coriolus extracts are generally well tolerated but minor adverse effects have been reported. Many over-the-counter Coriolus products are not standardized, making it difficult to compare potency between brands. It is also unclear if PSK, PSP and other Coriolus extracts have comparable effects.

Derived from the bulb or clove of the plant. Garlic is used as a spice and to treat hyperlipidemia, hypertension, atherosclerosis, cancer, and infections. Processing can have a substantial effect on the chemical content in garlic; the volatile oil components are sensitive to heat and certain enzymes are acid-labile. Several oral garlic formulations are available, and clinical studies have addressed a variety of the proposed claims. Placebo-controlled trials on the cholesterol lowering effect of garlic yielded mixed results (16) (17) (18) (21) (22) (26). Studies evaluating the antithrombotic effects repeatedly have shown modest reduction in platelet aggregation, but varying levels of fibrinolytic activity. Research shows mixed effects with regard to reductions in blood glucose, blood pressure, or risk of cardiovascular disease (23). Frequently reported adverse events include bad breath, headache, fatigue, GI upset, diarrhea, sweating, and possible hypoglycemia (9). Because garlic is known to decrease platelet aggregation and potentially elevate the INR, it should not be used with anticoagulants or in patients with platelet dysfunction (15). Garlic appears to induce cytochrome p450 3A4 and may enhance metabolism of many medications (e.g. cyclosporin and saquinavir) (12). An analysis of several case-control studies in Europe suggests an inverse association between garlic consumption and risk of common cancers (25).

Shiitake mushroom, native to East Asia, is cultivated worldwide for its purported health benefits. The fresh and dried forms of the mushroom are commonly used in East Asian cooking. It is also valued as an anticancer agent. Lentinan (1,3 Beta-D-glucan), a polysaccharide isolated from Shiitake, has been well studied and is thought responsible for its beneficial effects. It was shown to have anticancer effects in colon cancer cells (1), which may be due to its ability to suppress cytochrome P450 1A enzymes that are known to metabolize pro-carcinogens to active forms

The Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center was established in 1999 to complement mainstream medical care and address the emotional, social, and spiritual needs of patients and families. The Service includes: patient and outpatient clinical care research, and education and training. In addition, the Service provides unique access to otherwise unavailable information about over-the-counter products and unproven cancer treatments and their impact in the context of cancer care via our About Herbs database

A proprietary extract prepared from co-cultured mycelia of several species of Basidiomycete mushrooms, including shiitake (Lentinus edodes), active hexose correlated compound (AHCC) is extracted from mushrooms using hot water following an enzyme pretreatment, but specific mushroom source and preparation details have not been fully disclosed. Patients use this to prevent and treat cancer. Animal studies suggest that AHCC has antioxidant effects and may protect against disorders induced by oxidative stress (1) and may also enhance resistance against bacterial (2) (7)and viral infections (3). In healthy humans, AHCC increased dendritic cell number and function (4) In vitro and animal studies show that AHCC exhibits some anticancer activities, but the results of these studies are vague

Astragalus root is used in traditional medicine for its immunestimulating properties. Chinese studies suggest that astragalus, when used with angelica, has renal protective effects (6). In addition, astragalus decreases the proteinuria associated with idiopathic membranous nephropathy (7) as well as possesses natriuretic action (8). Astragalus may also suppress airway hyperreactivity associated with allergic asthma in vivo (9). An herbal formula using astragalus as a major ingredient has been shown to reduce fatigue in athletes (10). Furthermore, astragalus increases M-cholinergic receptor density in senile rats (11), which suggests that it may have a role in combating senility.