How to Treat Hiccups

Nearly everyone has experienced hiccups, but what exactly are they? It used to be thought that a hiccup is just a simple muscle spasm of the diaphragm, but that was apparently disproven more than 40 years ago. Instead, hiccups involve a complex, orchestrated pattern of muscle contractions. But, why?

Hiccups might be a leftover from the womb. During fetal life, “hiccups are universally present, their incidence peaking in the third trimester…[This] suggest[s] that hiccups might represent a necessary and vital primitive reflex” that would permit in-the-womb training of the breathing muscles without choking on amniotic fluid.

In adulthood, nearly anything can trigger hiccups. Case in point: A 19-year-old woman presented with persistent hiccups. Her physical exam was normal except for an ant crawling on her eardrum. Once the ant was removed, her hiccups stopped.

There appear to be as many cures for hiccups as there are causes, as I discuss in my video How to Stop Hiccups. As the famous Dr. Mayo put it, the less we know about something, the more treatments we seem to have for it—and perhaps “there is no disease which has had more forms of treatments…than has persistent hiccups.”

There are drugs, of course. There are always lots of drugs, from thorazine to apomorphine, but there are also a whole slew of non-pharmacological approaches—from breathing into a paper bag and drinking from the far side of a glass to smearing mustard on your tummy (as you can see at 1:24 in my video). “Many of these ‘remedies’ have not been tested and some appear to have been invented ‘purely for the amusement of the patient’s friends’.” One method, “forcible traction of the tongue” (which means pulling on someone’s tongue) was attributed to the great Dr. Osler, the first Chief Physician at Johns Hopkins Hospital, but the “therapy, however, is much older and (perhaps not surprisingly) of French origin.”

Another trick that might work to cure hiccups is “a modified Heimlich maneuver,” consisting of just three thrusts and moderate pressure. In one instance, it was so successful the patient’s “hiccups ceased immediately.” In general, however, “[t]reatment is notably disappointing, as is evidenced by the hundreds of remedies have been tried, none of which have been regularly curative.” You know doctors are starting to get desperate when they suggest things like chilling the ear lobe, and you know they are really getting desperate when they have to add prayer to the end of a miscellaneous hiccup cures list.

“Use of vinegar to relieve persistent hiccups in an advanced cancer patient” was the paper that started me down the hiccup rabbit hole. I was reviewing the latest research on vinegar and stumbled across a case where, “[a]fter the failure of common treatments for hiccups, the patient was given a sip of vinegar and his hiccups abated”—stopped after just a single sip. Evidently, sour tastes, such as vinegar and lemon, have been used to treat hiccups since the 1930s, but “nonpharmacological remedies such as vinegar…fell out of favor with the widespread use of pharmacotherapy,” that is, drugs. After all, how much can you charge for a sip of vinegar?

If worse comes to worst, there is the “phrenic nerve crush” surgery, which is as bad as it sounds. Before going that route, though, you may find it “surprising how many patients with hiccups respond to digital compression of the eyeballs.” Yes, we’re talking about digit as in finger, as in pushing your finger into someone’s eyes as a counter-irritation measure. That will get their mind off their hiccups!

If a finger in the eye somehow doesn’t distract them enough, doctors can try “digital rectal massage.” A 27-year-old man presented to the ER with “intractable hiccups.” Emergency staff tried massaging other places and even tried the digital eyeball compression, but nothing seemed to do it. So, bend over. “Digital rectal massage was then attempted using a slow circumferential motion”—and it worked! So, before giving patients drugs, maybe we would give them a massage. It’s “easy to perform” and may be less dangerous than sticking your fingers into people’s eye sockets, which, if you’re in medical school and have to memorize all these ridiculous names, is known as the Dagnini-Aschner Maneuver. (Medicine loves its eponyms.)

Speaking of maneuvers, how’s this for a pick-up line? “Hello. (Hic!) Want to help me (hic!) cure my hiccups?” In one case, on the fourth day of continuous hiccuping, the patient’s hiccups finally “suddenly and completely ceased,” with some spousal help, at the point of climax. “It is unclear,” the doctor wrote, “whether orgasm in women leads to a similar resolution, an issue that could be investigated further.” 

And it was, back in 1845. An infamous, disturbing case report that amounted to effectively bragging about sexual assault was published in what was to be become the New England Journal of Medicine. A young, religious woman with intractable hiccups fell into the hands of a Dr. George Dexter. He first attempted the best modern medicine could offer—bloodletting—but she continued to hiccup, until he pressed his hand on her genitals for a few minutes and that apparently worked. This went on for month after month, with the doctor frequently calling in his colleagues to show them this “singular phenomena.”

Who was this guy? “Although his interaction with the young female patient would not meet today’s ethical standards”—you could say that again!—“his medical observation was valid…” Even though rectal massage and sexual stimulation may help, “this kind of recommendation is reserved for carefully selected patients!”

DO NOT drink vinegar straight. In this blog, I talked about taking a tiny sip, not full-on drinking it. If you do drink instead of sip, you can make the problem worse, as I discuss in my video Vinegar Mechanisms and Side Effects. Vinegar can be great stuff, though. Check out my video series to find out why I include it in my own family’s daily diet:

There’s another way to treat hiccups—one that I’ve used myself since I was a kid. Since then, I’ve never had more than one or two hiccups because I can stop them in their tracks. Learn my trick in my video How to Strengthen the Mind-Body Connection.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Vinegar Caveats

As I note in my chapter on greens in my book How Not to Die, vinegar may be one condiment that’s actually good for you. Randomized controlled trials involving both diabetic and non-diabetic individuals found that adding just two teaspoons of vinegar to a meal may improve blood sugar control, effectively blunting the blood sugar spike after a meal by about 20 percent. How? I discuss this in my video Vinegar Mechanisms and Side Effects.

Originally, we thought it was because vinegar delayed the gastric emptying rate, slowing the speed at which a meal leaves your stomach, which makes sense because there are acid receptors in the first part of the small intestine where the stomach acid is neutralized. So, if there is excess acid, the body slows down stomach emptying to give the intestine time to buffer it all. The acid in vinegar was thought to slow the rate at which food leaves the stomach, resulting in a blunted sugar spike. But then, studies were published where taking apple cider vinegar before bedtime resulted in lower blood sugars the next day. How does that work? That’s obviously not some acid-induced stomach-slowing effect. Indeed, anyone who actually went to the trouble of sticking an ultrasound probe on someone’s stomach could have told you that—no difference in stomach-emptying times was found comparing vinegar to neutralized vinegar. So, it’s not just an acid effect.

Back to square one.

Additional studies offered the next clue. Vinegar appeared to have no effect on blood sugars, but this was after giving people a straight glucose solution. Glucose is a byproduct of sugar and starch digestion, so if vinegar blunts the blood sugar spike from cotton candy and Wonder Bread but not glucose, maybe it works by suppressing the enzymes that digest sugars and starches. And, indeed, vinegar appears to block the enzyme that breaks down table sugar. It wasn’t just an acid effect, however. There appears to be something unique about acetic acid, the acid in vinegar. These findings were based on intestinal cells in a petri dish, though. What about in people? Feed people some mashed potatoes with or without vinegar, and glucose flows into the bloodstream at the same rate either way—so, there’s another theory shot down.

Let’s figure this out. If sugar enters the bloodstream at the same rate with or without vinegar, but vinegar leads to significantly less sugar in the blood, then logically it must be leaving the bloodstream faster. Indeed, vinegar ingestion appears to enhance sugar disposal by lowering insulin resistance (the cause of type 2 diabetes), and also appears to improve the action of insulin in diabetics. The mystery of how vinegar works appears to have been solved, at least in part.

So, diabetics can add vinegar to their mashed potatoes—or just not eat mashed potatoes. If you add vinegar to a high-fiber meal, nothing happens, which explains results such as no effects of vinegar in diabetics in response to a meal. That’s no surprise, because the meal in question in the study was mostly beans. If you are going to eat high glycemic index foods like refined grains, vinegar can help—though there are some caveats.

Don’t drink vinegar straight, as it may cause intractable hiccups and can burn your esophagus, as can apple cider vinegar tablets if they get lodged in your throat (not that apple cider vinegar tablets necessarily actually have any apple cider vinegar in them in the first place). Don’t pour it on your kid’s head to treat head lice either. It’s “not harmful except when it leaks on to the face or penetrates the eyes,” and it turns out it doesn’t even work. Vinegar can also cause third-degree burns if you soak a bandage with it and leave it on.

Though as many as a total of six tablespoons a day of vinegar was not associated with any side effects in the short-term, until we know more, we may want to stick with more common culinary type doses, like two tablespoons max a day. For example, drinking 2,000 cups of vinegar was found to be a bad idea.

Other good-for-you condiments include (salt-free) mustard and horseradish. You may be interested in my Second Strategy to Cooking Broccoli video. For more on my book, check out the trailer.

This is the final installment of my five-part series on vinegar. If you missed any, here they are:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

How Much Vinegar Every Day?

Consuming vinegar with a meal reduces the spike in blood sugar, insulin, and triglycerides, and it appears to work particularly well in those who are insulin resistant and on their way to type 2 diabetes. No wonder the consumption of vinegar with meals was used as a folk medicine for the treatment of diabetes before diabetes drugs were invented.

Many cultures have taken advantage of this fact by mixing vinegar with high glycemic foods. For example, in Japan, they use vinegar in rice to make sushi, and, in the Mediterranean, they dip bread into balsamic vinegar. Throughout Europe, a variety of sourdough breads can lower both blood sugar and insulin spikes. You can get the same effect by adding vinegar to boiled white potatoes then cooling them to make potato salad.

Adding vinegar to white bread doesn’t just lower blood sugar and insulin responses—it increases satiety, or the feeling of being full after a meal. As you can see in my video Optimal Vinegar Dose, a study found that if you eat three slices of white bread, it may fill you up a little, but in less than two hours, you’re hungrier than when you began eating. If you eat that same amount of bread with some vinegar, though, you feel twice as full and, even two hours later, still feel nearly just as full as if you had just eaten the three pieces of bread plain. But this remarkable increase and prolongation of satiety took nearly two tablespoons of vinegar. That’s a lot of vinegar. What’s the minimum amount?

It turns out that even just two teaspoons of vinegar with a meal can significantly decrease the blood sugar spike of a refined carb meal, a bagel and juice, for instance. You could easily add two teaspoons of vinaigrette to a little side salad or two teaspoons of vinegar to some tea with lemon. Or even better you could scrap the bagel with juice and just have some oatmeal with berries instead.

What if you consume vinegar every day for months? Researchers at Arizona State University randomized pre-diabetics to take daily either a bottle of an apple cider vinegar drink—a half bottle at lunch, and the remaining half at dinner—or an apple cider vinegar tablet, which was pretty much considered to be a placebo control: While the bottled drink contained two tablespoons of vinegar, the two tablets only contained about one third of a teaspoon. So in effect, the study was comparing about 40 spoonfuls of vinegar a week to 2 spoonfuls for 12 weeks.

What happened? On the vinegar drink, fasting blood sugars dropped by 16 points within one week. How significant is a drop of 16 points? Well this simple dietary tweak of a tablespoon of vinegar twice a day worked better than the leading drugs like Glucophage and Avandia. “This effect of vinegar is particularly noteworthy when comparing the cost, access, and toxicities” associated with pharmaceutical medications. So the vinegar is safer, cheaper, and more effective. This could explain why it’s been used medicinally since antiquity. Interestingly, even the tiny amount of vinegar in pill form seemed to help a bit. That’s astonishing. And, no: The study was not funded by a vinegar company.

What about long-term vinegar use in those with full-blown diabetes? To investigate this, researchers randomized subjects into one of three groups. One group took two tablespoons of vinegar twice a day, with lunch and supper. Another group ate two dill pickles a day, which each contained about a half tablespoon’s worth of vinegar. A third group took one vinegar pill twice a day, each containing only one sixteenth of a teaspoon’s worth of vinegar. I wasn’t surprised that the small dose in the pill didn’t work, but neither did the pickles. Maybe one tablespoon a day isn’t enough for diabetics? Regardless, the  vinegar did work. This was all the more impressive because the diabetics were mostly well controlled on medication and still saw an additional benefit from the vinegar.

Make sure to check out my other videos on vinegar’s benefits:

This vinegar effect seems a little too good to be true. There have to be some downsides, right? I cover the caveats in Vinegar Mechanisms and Side Effects.

There are a few other foods found to improve blood sugar levels:

The best approach, of course, is a diet full of healthy foods:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: