Indication: Acid-reflux disorders (GERD), Peptic Ulcer Disease
Approximately 33 million adults in the United States are overweight, and more than a third of these are obese. Obesity carries a number or risks, ranging from hypertension and diabetes mellitus to gallstones. Treatment by restricted diet alone is often unsuccessful because of the inability of obese people to control the craving for food. Moreover, dieters often report ulcer-like pain and heartburn that are relieved by food, which further compromises compliance.
Recently Stoa-Birketvedt reported the results of a randomized double-blind trial evaluating the efficacy of the histamine-2 receptor blocker cimetidine for reducing hunger and improving compliance with dietary restriction. Study participants were 60 obese Norwegian adults (55 women and 5 men) aged 25 – 37, half of whom received cimetidine suspension 200 mg/10 mL, and half identical placebo, 30 minutes before breakfast, lunch, and dinner. The suspension was chosen because a viscous tasty “treat” may contribute to reducing food craving. Fiber supplements dissolved in a glass of water were taken immediately before the three main meals. Subjects were instructed to follow a 1200-kcal daily diet based on sample menus.
During the 8-week study all subjects lost weight, but the cimetidine group lost significantly more weight. Motivated obese dieters will usually lose 4.5 kg during 8 weeks. In this study there was no motivational support, so the placebo-treated dieters lost only 2.2 kg. By contrast, the cimetidine-treated dieters lost 9.5 kg. During the first week (and throughout the trial) the cimetidine group reported less hunger than subjects in the placebo group. Cimetidine (Tagamen) may have aided weight loss by reducing acid secretion and hunger sensation, or it may interact with certain gastrointestinal peptide hormones (i.e., cholecystokinin) involved in regulating food intake.
A Danish team tried to reproduce this study with a randomized, placebo-controlled trial of their own. They studied 60 subjects (51 women, 9 men) aged 18 – 60 who received cimetidine 200 mg/10 mL or identical placebo in an 8-week parallel phase followed by an 8-week crossover phase. They found no difference in weight loss between cimetidine-treated subjects and placebo-treated subjects (mean weight loss, 5.7 kg and 5.9 kg, respectively). The Danish investigators suggested that the results of the Norwegian trial were due to subjects correctly guessing which treatment group they were assigned to (cimetidine or placebo). In other words, the study was not really double blind.
Commenting on both studies, editorialist John Garrow wrote, “A mean loss of 9.5 kg in 8 weeks is a remarkably good result, and if such weight loss could be achieved by simply telling patients they were on cimetidine, that would be a therapeutic triumph … It remains baffling that cimetidine and placebo should have such different effects in Norway and Denmark.”