Dr. Carl Laird Birmingham | Advisory board & Consultant, NeonMind Biosciences

June 18, 2021
Spotlight
Dr. Birmingham is an expert in the treatment and study of eating and weight disorders. He has pioneered several new internationally recognized treatments. He has more than 40 years of experience in eating disorder and obesity research and treatment and has 285 publications and 9 books. He was Head of General Internal Medicine at St. Paul's Hospital and UBC, Head of the Obesity Clinic at St. Paul's Hospital, and Medical Director of the Woodstone Residential Treatment Centre for Eating Disorders.
Dr. Birmingham is currently providing his expertise to NeonMind Biosciences as a member of their advisory board.
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Can you talk about your background in the treatment and study of eating and weight disorders?

I have studied and treated patients with eating and weight disorders for more than 40 years as outpatients, inpatients, and in residential care. I was director of an obesity clinic where we treated obesity with surgery as well as diet, exercise, and medications. We took part in one of the early trials of fluoxitene in diabetics with weight loss. Surgically we did the ileojejunal bypass and various gastric reduction and bypass procedures.  I assessed patients for surgery and followed them medically long term.  

I started the St. Paul’s Hospital Eating Disorder Program and was the BC Provincial Director of Eating Disorders.  Next, I was Medical Director of the Woodstone Residential Treatment Program. Later I worked in an outpatient and clinic setting treating obesity and eating disorders.  Most recently I have spent 6 years studying the brain in eating disorders and obesity using LORETA (Low-resolution electromagnetic tomography) neuroimaging.  LORETA images the brain in 3 dimensions using technology like GPS with the electrical waves of the brain. 

I have about 294 publications regarding eating disorders and obesity.  I am Professor of Psychiatry at UBC where I was previously Professor of Medicine.  I am an epidemiologist and biostatistician and a specialist in Internal Medicine.  

 What have been some of the most surprising or most important takeaways you have discovered in your studies into eating disorders?

Psychological and behavioural disorders like eating disorders often respond to treatment - but most often only temporarily.  This is certainly the case in obesity where even obesity surgery is only successful long term in as little as 50%. 

Unsuccessful treatment of eating disorders is often caused by missing the diagnosis or treatment of co-occurring psychiatric disorders.  For example, if the patient has depression, anxiety, or obsessive-compulsive disorder in addition to the eating disorder.

Pinpointing the specific pathway in the brain coupled with treatment of that pathway can speed up treatment. 

What got you personally interested in psychedelics?

I had seen patients and knew friends who used psychedelics.  However, I have always been averse to the use of any nontraditional drugs or formulations - including cigarettes.  I have never used any recreational medications myself.  

I was asked to help NeonMind design a trial of psilocybin for the treatment of obesity. I declined.  However, I began asking my patients whether they used them. I then read a number of books about psychedelics. THEN I BECAME VERY INTERESTED!

What I realized was that a permanent shift in perspective can be achieved under certain circumstances using psychedelics. Since then, I can see why conditions such as post-traumatic stress disorder, depression, anxiety, and eating disorders could respond to psilocybin.

What evidence have you seen that demonstrates psilocybin’s efficacy as a treatment and therapy option for eating disorders?

Those afflicted with eating disorders want to be healthy and happy.  However, a strong fear, a psychological addiction, a constant nagging lack of satiation, an inability to continually see the “long game” makes this humanly impossible.  Or, as mentioned above, other psychological thoughts do the same.

I have read about and interviewed many patients who have achieved a change in perspective and the “long game” perspective who have achieved the health and happiness that they desired after using psilocybin.

Why has Neonmind decided to focus on psilocybin as their primary treatment option?

Of the psychedelic medications, psilocybin has a number of advantages.

1. Psychiatric side effects are rare compared to the others.

2. It markedly decreases the activity of the amygdala, insula, and default mode network, which allows the brain to function without the limitations of fear, continuous reevaluation, and negativity. This is how the patient can look at the issues at hand and form a different perspective. 

3. Its effect lasts long enough to achieve the desired effect.

4. It is now produced chemically and is therefore purer with fewer potential side effects.

5. It has been used for a very long time by a large number of people without problems.

How do serotonin receptors and neuroplasticity affect eating behaviors?

The brain is regulated by many neurotransmitters that are part of the “civil service” if you will. The brain is open to neuroplasticity all the time. That is how we learn. I believe many limitations in learning are inherent in this “civil service”.

What kind of clinical pathways exist that will help Neonmind obtain and expedite clinical approval of their psychedelic therapy programs?

The clinical pathways that help us design the trial are available from previous trials of other obesity medications and those of psilocybin trials.

 What is the most common misconception you hear about psychedelic medicine?

The most common misconception is that the psilocybin is causing an addictive or an impaired mental state and this is not true. Remember that the administration of psilocybin for the treatment of obesity will be done in a very controlled, clinical manner which is vastly different from recreational use.

How do you see psychedelic medicines making an impact on healthcare as a whole in the future?

If we can understand how much psilocybin to give along with psychotherapy and the circumstances that the patient must be in - for it to have the effect of changing the brain’s perspective - it could have a huge effect on healthcare.

Who is someone doing important work in the world of psychedelics that you think more people should be aware of?

Albert Garcia-Romeu from Johns Hopkins Medical School is a key researcher in psychedelics. I have been blown away by the depth of his experience and knowledge of psychedelics. We are very fortunate to have him on as part of the NeonMind R&D Working Group.
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