1–3 g/day of extract.
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Cordyceps is a genus of parasitic fungi that in nature infects insects (the most famous species, Cordyceps sinensis, parasitizes caterpillars in the high regions of Tibet and Nepal); traditional Chinese medicine has used it for centuries as a tonic for fatigue, libido, and longevity, and the last twenty years of pharmacological research have documented a profile of activity on physical performance, immune function, and energy metabolism that justifies its moderate clinical use.
The cultivated form of true Cordyceps sinensis is extremely scarce and very expensive (when sold wild, its price exceeds that of gold per gram), so most supplements on the market use Cordyceps militaris, a different species that can be cultivated industrially, or mycelial strains (CS-4) that reproduce part of the profile of the wild fungus but are not identical; human clinical studies have mostly been done with CS-4 or with C. militaris, not with wild Tibetan Cordyceps.
The most studied indication is improved performance in submaximal aerobic exercise: several randomized trials have shown modest improvements in VO2 max, ventilatory threshold, and time to exhaustion with doses of 1-4 grams daily of Cordyceps militaris or CS-4 extract for 3-6 weeks in untrained adults; in elite athletes the effects are harder to detect, but some studies suggest benefits for energy economy.
The most plausible mechanism combines improved mitochondrial efficiency (with effects on oxidative phosphorylation documented in cell cultures), modulation of peripheral oxygen uptake, and a possible mild vasodilatory effect that improves blood flow to the active muscle; these effects are modest but replicable in people with low baseline aerobic capacity.
Cordyceps polysaccharides, especially beta-glucans, are known immunomodulators: several trials have shown increases in NK cell activity, improvements in T-cell function parameters, and a reduced frequency of viral respiratory infections in people using it long term, especially in older adults with aged immunity or in people with very high training loads who have greater susceptibility to upper respiratory tract infections.
The most mythical indication of Cordyceps in traditional Chinese medicine is as a sexual tonic; modern clinical data are limited, but some small studies suggest modest improvements in libido and, in men with mild to moderate erectile dysfunction, in sexual function scales with prolonged use at doses of 1-3 g/day for weeks; the mechanism may be related to effects on testosterone and modulation of endothelial nitric oxide.
In chronic kidney disease, several Chinese trials have shown improvements in kidney function (creatinine, urea, proteinuria) when Cordyceps is added to standard treatment; this is an important traditional indication in Chinese medicine, although the evidence is heterogeneous and products vary widely; in chronic liver disease and in diabetes there are interesting preliminary data that are not yet consolidated.
The doses studied range from 1 to 4 grams daily of standardized extract (CS-4 or Cordyceps militaris), divided into one or two doses with or without food; products standardized to 8-30 percent polysaccharides and 0.2-1 percent cordycepin are the ones with the most clinical support, whereas generic products without clear standardization may have highly variable activity.
Generally well tolerated; the most common adverse effects are mild digestive discomfort; people taking anticoagulants should be cautious because of a theoretical antiplatelet effect, those taking immunosuppressants should consult beforehand (the immunomodulatory effect may interfere with treatment), and patients with hematological conditions and a bleeding tendency should avoid it for the same reason; caution is advised in pregnancy and breastfeeding because of limited data.
Information, not medical advice. Scientific evidence reflects the quality of the studies.