What is a microdose?
“Microdosing” is a practice of ingesting psychedelics, typically psilocybin or LSD, which is typically 1/5th to 1/20th of a medium-strength dose of psilocybin or LSD. For psilocybin this would be approximately 0.1 to 0.3g of dried psilocybe fungus.
What is microdosing?
Typically, individuals will take a microdose 2 – 5 times per week. There are 2 popular protocols for microdosing: the Fadiman Protocol & the Stamets Stack
The Fadiman Protocol is named after Dr. James Fadiman, a psychedelic pioneer, researcher, and strong proponent of microdosing, especially LSD. This entails taking a microdose every 3 days (dosing on day 1 and Day 4 of a 7 day week) for 4 – 8 weeks followed by a break period.
The Stamets Stack is named after Paul Stamets, American mycologist and strong proponent of the medicinal properties of fungi. This entails taking a daily microdose of a combo of agents: psilocybin (not LSD) + 50 – 100mg of lion’s mane + 100 – 200mg of niacin. This is done for 4 – 6 weeks followed by a break period.
What does the research say about how well microdosing works?
Thus far, placebo-controlled studies on microdosing have not demonstrated significant improvement in mental health outcomes compared to placebo. So why so much excitement? This is in part related to the media attention on purported effects on productivity, creativity, mood, and well-being, which have brought early microdosing proponents like Dr. Fadiman to the limelight. This is also in part related to studies of generally less scientific rigor such as this one done by Paul Stamets and colleagues, demonstrating benefits to well-being from microdosing. However, these studies are not only rife with methodological flaws but also carry significant financial bias in the case of Paul Stamets who has filed a patent for his stacking protocol. My personal opinion: we should be remain curious about microdosing and conduct rigorous clinical research that may pick-up on subtle effects of microdosing. Perhaps through qualitative reports in a randomized-controlled setting with the aid of large-language models, we could pick up unexpected outcomes. But hey, what do I know! I’m just some schmuck.
Does microdosing affect the heart?
Many of my colleagues, including Dr. Kelan Thomas PharmD at Touro University, have voiced concerns over the risk that microdosing psychedelics may have on the heart, specifically the risk of damage to the heart valves. Psilocybin and LSD strongly activate a receptor (serotonin receptor 5HT2b) on heart valves that, when activated repeatedly, might cause a build up of tissue on the valves, leading to an irreversible condition called valvular heart disease (VHD). The affinity for psilocybin, especially for the 5HT2b, receptor is remarkable, even in low doses. For the scientifically curious: a recent and wonderfully thorough article remarks on some of these cardiac risks, among others: https://link.springer.com/article/10.1007/s43440-023-00539-4. Note that, as the author of this article also acknowledges, the risk of VHD is theoretical and we currently do not have human data to support that this process occurs when ingesting psychedelics repeatedly. In the absence of data, caution tends to be warranted.
So how can we remains safe?
The reality is that there is no such thing as a guarantee of safety. But we may strive for safer. The strongest recommendation here is to ensure that you do not have a personal history of heart disease, carry major risk factors for heart disease, nor have a family history of major cardiac issues. These risk factors are best addressed and discussed with your medical doctor.
Also, I recommend limiting microdosing frequency to no more than 5 times per week, even for a Stamets Stack, as well as always limiting the duration of microdosing to 1 month, followed by at least another 1 month break without psychedelic dosing. During that month, it can be helpful to reflect on the effects of your microdosing practices, check-in with your body, and re-consider if this practice is continuing to meet your needs.
I also want to recognize the risk of accidentally taking more psilocybin or LSD than anticipated, therefore it is imperative to utilize an accurate scale to measure what is ingested and to use a test kit for LSD. The major psychological risk of microdosing that we know of thus far is the risk of dosage mistakes which are common given that 0.3g of one psilocybe species and another of the same weight can be highly variable. This variation may even happen between the same species but was grown in different growing conditions.
Where can I learn more?
I highly recommend the following article with the Harvard Petrie-Flom Center & Dr. Thomas: https://blog.petrieflom.law.harvard.edu/2022/04/13/safety-first-potential-heart-health-risks-of-microdosing/
Penumbra Psychedelic Consultation 