Alcohol Extract vs. Hot Water Extract
For two millennia, health supporting mushrooms have been mainstream in Asia. Now, America is taking notice and interest is rapidly "mushrooming." With the sprouting of this new industry follows issues of ethical quality claims between competing brands.
All species of health supporting mushrooms appear haunted by this issue. Particularly so, it seems, is red reishi (Ganoderma lucidum), the oldest health supporting mushroom in Traditional Chinese Health. Please note, however, that the information in this article applies generally to all health supporting mushroom species.
An obvious caution is to stay away from cheap, mass-produced reishi. It may be merely dried and pulverized. In order to promote health, the mushroom cell-wall has to be broken down. Mass-produced reishi may be mostly inert and ineffective.
There are many real therapeutic brands on the market, though. But even among them, there are significant differences. They all claim to be the best, naturally, because they all want sell their particular brand. So let's sift the data, get the facts straight, and clear up misleading information that is out there.
There are primarily three ways to extract the health promoting compounds from red reishi. Each method pulls out different compounds, all of which have been proven by scientific research to be therapeutically important.
Polysaccharides have been shown to possess powerful anti-tumor qualities through enhancing the immune system and by inhibiting blood profusion through tumors. They are also strong antioxidants. 
Triterpenoids include a large number of related health promoting compounds whose proven effects include stabilization of blood pressure, cholesterol, and blood clotting. But most importantly, the triterpenoids are the anti-inflammatory compounds of reishi.  Inflammation is a serious component in asthma, allergies, arthritis and many more conditions.
Less researched are the "secondary metabolites" that come from fermenting reishi. "Secondary" because they result when the original health promoting compounds get broken down by bacteria. These new compounds have been shown to possess therapeutic properties that are unique, including immune enhancement, anti-tumor and blood-sugar regulation. 
This article is intended to give general guidelines to help you choose an effective reishi product, not to recommend any particular brand. But there are at least two reishi companies on the market which both state only hot water extract is useful while alcohol extracts are of no value.
Naturally, the reason they say so is because they want to sell their own brand. However, those statements are scientifically untrue. Hot water and alcohol extractions both contain critical compounds.
To determine if a brand of reishi (or Ganoderma) contains all the important health promoting compounds from the mushroom, find out if it utilizes both alcohol and hot water extraction. An additional plus would be if it also includes fermented reishi.
As a last point, when you look for the best reishi extract, one thing to look at is the form it comes in. For example, any reishi extract that fully dissolves in a water-based liquid such as coffee probably only contains hot water extracted reishi. So while reishi/ganoderma coffee certainly makes for a superbly delicious and healthy cup loaded with polysaccharides, it won't include the important anti-inflammatory triterpenoids.
Alcohol tinctures, on the other hand, are well worth considering because they may be a blend of water and alcohol extracts. The way to tell is if the tincture is cloudy. When water-soluble polysaccharides get mixed with alcohol, they fall out of solution. Cloudiness in an alcohol tincture indicates high polysaccharide content. Just shake before taking. Tablets and capsules can contain hot water extract, alcohol extract or both. You need to find out from the manufacturer.
 Boh B, Berovic M, Zhang J, Zhi-Bin L. "Ganoderma lucidum and its pharmaceutically active compounds." Biotechnology Annual Review 2007;13:265-301.
 Tang YJ, Zhang W, Zhong JJ. "Performance analyses of a pH-shift and DOT-shift integrated fed-batch fermentation process for the production of ganoderic acid and Ganoderma polysaccharides by medicinal mushroom Ganoderma lucidum." Bioresource Technology 2009 Mar;100(5):1852-9.
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