Could psychedelics change a damaged relationship with food and the body?

Psychedelic studies are underway for the potential treatment of Eating Disorders and obesity

For the duration that humans have been alive, our relationship to food has changed, from one of survival, to one encompassing nutrition, satiation, indulgence, therapy, and even neglect. Add to that a complicated relationship with our bodies or body image, and you have a high potential for mental illness.

Approximately one million Canadians have a diagnosis of an Eating Disorder (ED). Although an Eating Disorder is a serious mental illness, it is treatable. Despite that, EDs have the highest mortality rate of mental illnesses (between 10 to 15 percent). Among those with Anorexia Nervosa (AN), suicide is the second leading cause of death after cardiac disease, and 25 to 35 percent of people with Bulimia Nervosa (BN) may attempt suicide in their lifetimes. In female-identifying people aged 15 to 24 years old with AN, the mortality rate is 12 times greater than that of all other causes of death combined, so it’s important that we take a diagnosis seriously for this segment of the population.

What makes Eating Disorders a mental illness?

The brain’s default mode network (DMN)—the pathways of communication between brain regions—is overactive in certain mental health conditions. Cognitive flexibility is impaired in people with Anorexia Nervosa, which could stem from an overactive DMN. Compared to people with anxiety and depression, those with EDs are not as responsive to traditional psychiatric medicine.

Obesity potentially linked to mental illness

Obesity is a progressive chronic disease characterized by excessive fat accumulation that could impair one’s health. Health professionals diagnose obesity using clinical tests. It is a leading cause of type 2 diabetes, high blood pressure, heart disease, stroke, arthritis, cancer and other health problems. 

About a quarter of Canadian adults (26.6%) are currently living with obesity. In Canadian adults, obesity rates are higher in men compared to women. It is directly associated with one in 10 premature deaths among Canadian adults aged 20 to 64.

There is a two-way relationship between obesity and mental health conditions like depression and anxiety. Obesity can have an effect on our psychology, and weight gain is a recognized side effect of antidepressant medications.

A recent meta-analysis involving almost 18,000 participants showed higher rates of anxiety and depression symptoms among obese children or adolescents, compared with those who were not overweight. Another study showed a stronger correlation of depression preceding obesity, and evidence of bidirectionality of the disorders. Girls showed stronger associations between depression and obesity than male participants.

Photo: Diana Polekhina

The potential for psychedelics in treating Eating Disorders

Unlike cannabis, which can stimulate our appetite, psychedelics don’t have an obvious link to hunger-related hormones. The potential is rather in psychedelic-assisted psychotherapy. Instead of correcting neurochemical dysfunctions in the brain, psychedelic-assisted psychotherapy causes modifications in brain functioning and conscious experience, which can lead to emotional, cognitive, and behavioural changes.

Clinical psychiatrist Timothy Brewerton has been interested in the effects of psychedelics on serotonin and the 5-HT2A receptor. “Serotonin dysregulation can be linked to all of these co-occurring phenomena that we see associated with eating disorders,” he told Lucid News.

“Psilocybin binds very tightly to these 5-HT2 receptors. These drugs appear to have an effect on cognitive rigidity, which is certainly seen in anorexia and in the eating disorder spectrum of disorders,” he continued.

Brewerton co-authored a paper with Psychologist Adele Lafrance on the potential treatment of people diagnosed with EDs and PTSD with MDMA. In 2018, Dr. Lafrance co-wrote a paper on the impact of ceremonial Ayahuasca experiences on the EDs of 13 women.

Researchers from the Centre for Psychedelic Research at Imperial College published a study in 2020 that looked at various psychedelics in the treatment of depression and well-being among patients with EDs. Dr. Meg Spriggs, head of the trial, surveyed 27 participants reporting a lifetime diagnosis of an ED, and who had taken various psychedelics. The results showed improvements in both symptoms of depression and general well being two weeks after the psychedelic experience.

The Centre is now investigating whether psilocybin-assisted therapy could be an effective way of treating AN. “The study is a small pilot study, with only 20 participants,” Dr. Spriggs said in an interview with Reaction. “Because it’s a small study, we’re not going to be able to make any huge claims, but what it can do is lay the foundation for a more extensive, more randomized control study.”

In early 2021, Dr. LaFrance and Dr. Reid Robison published an opinion piece on Novamind that recognized the importance of family and caregiver involvement in psychedelic psychotherapies for the recovery of Eating Disorders.

UC San Diego Health is currently undergoing an evaluation of psilocybin in participants with AN.

Johns Hopkins University is seeking individuals ages 18 to 65 with Anorexia Nervosa to participate in a study looking at the effects of psilocybin, while the Multidisciplinary Association for Psychedelic Studies (MAPS) will conduct a multi-site study of MDMA-assisted psychotherapy for EDs, and has yet to recruit participants.

“For a long time, anorexia has been viewed as a complex condition to recover from and to work with. Still, hopefully we can start the ball rolling on new ways to treat and explore what is an incredibly devastating condition,” said Dr. Spriggs.

Photo: Chander R

The potential for psychedelics in reducing and treating obesity

In a recent study, researchers found associations between psychedelic drug use and markers of physical health (overall health, body mass index, and a heart condition and/or cancer), although the reasons and direction of causality are unknown. Psychedelic use was significantly associated with better self-rated health, and more strongly with reduced odds of obesity.

With the support of NeonMind Biosciences Inc., the University of British Columbia conducted a preclinical trial to investigate whether psilocybin could be used as a treatment for obesity. According to President and CEO Rob Tessarolo, NeonMind expects to initiate enrollment for a phase 2 human clinical trial by the end of 2021.

“Psilocybin has the potential to serve as a new and different tool to help people lose weight and maintain their weight loss by changing their neural pathways,” said Dr. C. Laird Birmingham in a company statement. Dr. Birmingham is a UBC psychiatry professor who specializes in EDs.

The company announced the completion of an integrated drug development plan for NEO-001, a high-dose psilocybin drug candidate targeting obesity, coupled with behaviour therapy and lifestyle intervention. Their second drug candidate, NEO-002, employs low-dose psilocybin as an agonist at the 5-HT2C receptor, which controls appetite. The company’s goal is to improve the efficacy of chronic weight management in adults.

An effect of psychedelics is their ability to “reset” our minds. Through more research and study, perhaps someday we can harness the potential of psychedelics to help us reset our relationships between food and our physical, mental, and emotional health for positive well-being.

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