Why we hiccup
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Brian. No, um... What's your first thought when I say hiccups? Ugh, hate them. Do you get hiccups? Oh, yeah. I get triggered when I eat spicy foods. Mm-hmm. It all started, um...

I mean, you don't care. No, no, no. Tell me your hiccup origin story. It's not that crazy. It started in a galaxy far, far away. No, it started in New York City, where a lot of great dreams are dashed and destroyed. I must have been like 20 years old. Was out with friends, you know. You get hungry after a night out. And, you know, we went to one of those halal carts, which are delicious. And they always ask you, they have like the red sauce, which is like...

frickin' nuclear bomb of spice. Yeah, it'll kick you. And they'll ask for like one line or two. And I was like, give me two! Because I was young and invincible. And the spice hit me and I started hiccuping. This had never happened before and has kept happening since every time I eat something very spicy. And like the whole train ride home was just hiccuping. But now...

I want to go to the Thai restaurant and get the four chilies, but no, I just, it's too uncomfortable. That sucks. I'm sorry. Dreams destroyed, New York City. But honestly, that story, it's not...

all that unique. Like, it's tragic, but it's sort of how it goes with hiccups. Everyone has their after midnight in New York City moment. If not after midnight in New York City, so many people have their own, like, this is the thing that makes me hiccup. Oh, yeah. So I reached out to our listeners, and I wanted to know what causes them to hiccup, and I wanted to play you a few of my favorites. Yes!

To start, we had a lot of bread. Bread? It has to be drier bread, like sourdough or baguettes or rye bread. I can actually tell when it's going to give me hiccups the moment before I swallow. It's like an immediate reaction. Swallow, then hiccup. Brioche is okay. Yeah, brioche, totally fine, right? Yeah.

And one guy gets hiccups from baby carrots. Full-size carrots do nothing for me, but if I eat one or two baby carrots, then I have these violent, socially disruptive hiccups for an extended period of time.

There's spicy food. That's a trigger for lots of listeners, not just you. We had hiccups after burping, after eating and walking. And then there were some really strange ones. Sometimes when I am washing my left ear, just my left ear, I hiccup. That's a good one.

That's extremely strange. It's really weird. And then finally, someone wrote in and said his wife could always tell when he was going to tell a lie because he would hiccup. That's probably been good for their relationship. Yeah. And taking all of these things together, things like spicy food and bread and ears and lies, I wanted to try and figure out if they have a common thread. And that's what I want to talk about on this week's show.

Is there a grand unified theory of what causes hiccups? And if there is something there, can that help us figure out how to make them go away?

So to try and figure out what causes hiccups, I reached out to Tyler Simmet, who's a doctor. He's a professor. He's done tons of research on hiccups. And he says they're really interesting to think about because there's still so much we don't know about them. We don't know what causes hiccups. We don't know why people start hiccuping. But that doesn't exactly stop patients from asking Tyler to explain what's going on. So people will come to us saying, stop my hiccups.

And we have to redirect their thinking into why do you have hiccups? Tyler will come in and be like,

you know, I don't know, like maybe it's not the baby carrots. Maybe it's not the bread. Maybe there's some underlying thing. And thinking about hiccups helps us get to that like second level. Yeah, it strikes me like, you know, there's probably a difference between like a trigger and the cause or like the thing that's actually happening. Yeah, and that's exactly what Tyler tells people. Humans look for proximate causes. What's the one thing that comes right before hiccups?

In medicine, we have to teach people to think of a broad range of what it could be and not what it probably is. Okay, so...

Lots of different triggers, but the truth of hiccups, the essential, like what unifies the baby characters and the spicy hiccupers, like what unifies us. So we can start with what we do know about hiccups. So a hiccup is when you have a nerve stimulating the diaphragm to contract quickly.

So the diaphragm is the muscle under your lungs that controls your breathing and that contracts. And then once that happens, after the diaphragm contracts, the glottis closes. The glottis is basically the opening on the top of the throat. So that closes and you get the sound. That's the reflex arc. And then it happens again anywhere from two to 25 seconds later. And

And we have some ideas of why we might have this hiccup reflex. So I spoke to this researcher named Kim Whitehead who noticed that babies hiccup way more than adults.

And she thinks that it might be a way for babies to learn how to control their own breathing when they are born. Like the hiccup kind of forces them to get to know their own bodies. Oh, yeah. It kind of forces them to like, oh, my chest does something. My lungs do something.

Yeah, it's kind of you take for granted, you know how to breathe, but maybe the hiccup is the way we learn. Okay. And then there's this other idea that hiccups may actually trace back evolutionarily, like hundreds of millions of years to our last common ancestor with amphibians. And what the hiccup does for them is it allows them to gill breathe. So it'll close off the glottis. So they're not having anything coming in and they're having the...

breathing going through the gills. Tadpoles still hiccup, and it's basically a mechanism to kind of quickly close things off, prevent water from getting in their lungs. Like a do not enter kind of response. Yeah, and our last common ancestor with amphibians was small, so the nerves didn't have to travel that far from the brain. But now that our bodies are so much bigger and they've changed so much, these nerves have this really long, circuitous route. So there are all these opportunities for them to get triggered,

which leads to all these different kinds of hiccup causes. I'm trying to create a visual in my mind about the system. And I'm wondering if it's a little bit like, I don't know, my apartment's very strangely electrically wired, or many switches that control the same light bulb. That actually makes sense. It's like our bodies are these old, weirdly wired houses. You can have a stimulus from the brain, from the belly, from the lungs, and...

One of the things we're trying to figure out is what else is associated with it. So given that Tyler is asking all of these hiccup questions, I wanted to ask him how these nerves and how this weird wiring system we have could be triggered by all of those things we heard at the top. Like, why would dry bread be that switch that makes you hiccup?

For as long as I can remember, bread has given me hiccups. Tyler says he hears this one a lot, actually. Like, dry bread is sort of a common hiccup cause. It's interesting. But he thinks it's actually the way you eat the bread. So if it's drier, you might chew harder, swallow more air, expand your stomach more. When you eat bread, you may have liquid with it, which expands. So there are more complicated responses that people aren't looking for.

Spicy food, you know, your hiccup thing, that can expand your stomach quickly. And believe it or not, so can baby carrots. Don't know what it is about baby carrots specifically. Well, I do think there's a good physiologic explanation. When you have baby carrots, maybe you eat them faster. Maybe you eat more of them. Cause your stomach to expand. I mean, baby carrots are just carrots, but it's eaten differently.

Then, you know, there's the left ear guy. Just my left ear. We usually say that's Arnold's nerve that's got a branch in the ear that does cause people to cough and can cause a hiccup as well. And that can just, you know, like your old wiring in your house, that can trigger a hiccup. So that's just an anatomic oddity where the nerve's got a branch in the ear. Yeah.

And then there's the lie person. If you're starting to get anxious, holding your breath a bit, if you get your diaphragm rigid, that could stimulate a hiccup. You're just tense? Like, that's the explanation? Yeah, tensing your diaphragm in a weird way could trigger these nerves. And, you know, I wouldn't discount anxiety or tension entirely. Like, once a certain thing causes hiccups for you, you might be primed to hiccup again every time. Right.

You know, if you eat baby carrots and you hiccup because you ate a bit faster than, you know, the next time you have baby carrots, you could be tensing your diaphragm a bit and you could be priming yourself to hiccup without even realizing it. Okay, so there's like a million ways to get this process happening. But why does sometimes it last for like an hour or something like... That's really frustrating. Like when you're hiccuping and it's uncomfortable and you just want to like...

Do something in peace. Yeah. So I think we're in very uncertain territory here because of how complicated the body is. But if you go back to the anxiety or tension thing, the hiccup might actually be creating like a feedback loop. Once you're in that loop and you're tight and spasm and you're waiting for the hiccup and not doing anything...

to really truly stop it, you're actually bringing them on and keeping the loop going. There's also a ton we really don't know here. Like, everyone hiccups in their own particular way. We know that people have their own intrinsic hiccup pattern. Some people every two seconds, some people every ten. And to be honest, scientists don't really know why these hiccup loops happen exactly. People are fascinating.

And I wish I understood better how they control themselves and how they get into this. But they do. A lot of times, once they've done it once, they continue to do it. People can hiccup in threes. They might hiccup once. It might just be something they got used to. And once they accept that as their pattern...

It becomes a sense of defining themselves. And it continues, even if it's not conscious. All of this ends up being pretty confusing, which is why Tyler's actually used hiccups as a teaching tool. He's used them to get medical students to think through problems that might seem straightforward, but they're actually a lot more complicated when you dig into them. So we've used a lot of...

Fun topics like goosebumps, hiccups, yawns, butterflies. And even though some of these things could seem harmless on the surface, hiccups that happen often or for a long time, they might actually be a sign of a deeper issue. There are a lot of people who are predisposed to them, and they're living on the edge of having hiccups. Which might be because of some sort of underlying cause. Anxiety, lack of sleep can all contribute. We know that people who have diarrhea who lose calcium, magnesium, selenium, and zinc.

are going to have twitchier muscles that are more likely to set off a hiccup round. And again, I think hiccups are an end symptom from something else going on.

So I don't want to scare people here. Like hiccups are often just, you know, you ate something spicy or you swallowed too quickly. But if you do keep hiccuping for a really long time, you might have something called intractable hiccups or chronic hiccups. So, you know, till now we've been talking about what's called acute hiccups, which don't last for more than a day or two, usually much shorter than that. But there are hiccups that could be caused by a brain issue or a nerve problem or a tumor pushing on your diaphragm or something like that.

And these can last for months or years. They do stop you from sleeping. They do affect your ability to have a good meal. They do change your appetite. So yeah, once it's two months, we're looking at some real changes. But overall, is there...

Is there anything we could do about hiccups or are we just forced to suffer through them until they go away? Yeah. So for intractable hiccups, it can be really hard to treat. Like the best options are surgery or some serious medications that can act on the brain or muscles. Yeah.

But when it comes to acute hiccups, you know, it's kind of a wild west out here. Like, everyone's got their own solution for hiccups. Like, I imagine you have a solution, right? Just gulping water, hoping for the best. Yeah, I usually just do a spoonful of peanut butter. Works pretty well for me, at least.

But I did come across one idea that could be a universal treatment for acute hiccups. Really? Something that works for everyone? Potentially. What? I'll tell you after the break. Support for Unexplainable comes from Greenlight. People with kids tell me time moves a lot faster. Before you know it, your kid is all grown up. They've got their own credit card.

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We're back. Hello. And I mentioned before the break that there's this new idea that could be a potentially universal treatment for acute hiccups. Next into the tank is a solution for an annoying problem. So I don't know if you watch Shark Tank, but if you do, you may have seen this last year. Guys, allow me, a doctor, to help. It's time to say goodbye to all of these silly tricks and instead say hello to Hiccaway.

So this is Ali Seyfi. He's the inventor of this hiccup remedy called Hiccaway. But he's also a professor of neurosurgery at the University of Texas Health Center in San Antonio. And he started working on hiccup treatments because he was seeing lots of patients who'd had strokes and couldn't stop hiccuping. We used to just give them, okay, just drink several cups of water or drink water upside down or some silly...

home remedies. But these home remedies didn't really seem to be helping the hiccups of these patients, especially one guy who'd had brain surgery. And then when I entered his room to see the patient, I saw he had cups of water on his table and he was keep drinking and to the point that he was throwing up. And he turned to me and said, Dr. Stafi, this is 21st century. You guys do heart transplant, you do brain surgery, you do all these cancer treatment. But there is nothing for hiccups.

Is this the time that you guys, the doctors, should make something for hiccups? And that was actually a trigger at that point for me. So this patient had intractable hiccups from a stroke, like an underlying brain issue. So there wasn't all that much Ali could do about it other than maybe prescribe an antipsychotic. But he started thinking, like, what about acute hiccups? Why are they still so hard to solve? And I said, you know what? Maybe I am the person who should make something.

So Ali started by looking at the home remedies that people said work for them. You know, like drinking from a glass of water, scaring someone. And then after a couple of months of research, I found, okay, most of these home remedies, either they're working on...

the phrenic nerve or vagus nerve, which are two nerves actually that control our diaphragm muscle and control our throat. And any of these home remedies without the people knowing, they are triggering those two nerves. Ali thought all of this was interesting, the home remedies, they were triggering the right nerves, but he also thought they weren't triggering the nerves in the right way. The problem is that most of these home remedies

It's hit and miss because the way the people do it, they don't trigger them enough. He thought if you could get the diaphragm to contract enough, it could interrupt the spasm. And then you might be able to short circuit this hiccup loop. Is it kind of like a cramp? Like if my foot cramps up, I gotta like, you know. Yeah, like when you're cramping. Engage the muscle. Yeah, you flex the muscle enough and then you won't keep cramping up.

So he used some machines in his lab to try and measure exactly how hard you'd need to suck on a straw to trigger your diaphragm enough. Like sucking pressure? Like I need to... Exactly, exactly. Like how much sucking pressure you need. And he got to 100 centimeters of water pressure, which is essentially the amount of pressure you need to drink water through a 100 centimeter long straw. Okay. I mean, imagine...

a one meter long straw in a glass of water and how hard you would have to, you know, engage your diaphragm to suck water through that straw. That's not a straw I really want to use. No, and that's exactly what Ali was thinking. Like, okay, this is going to be a problem. How do I get people to keep a meter long straw in their house for whenever they get hiccups?

So he got creative because he realized that if you change the size of the openings on each end of the straw, you can change the amount of pressure you need to use. Wait, so if you like change, if you make a smaller opening, it becomes harder to suck? Exactly. That generates enough pressure to trigger your diaphragm, which contracts the muscle and short circuits this loop.

Sounds nice. Does it work? Yeah. So Ali says it works. They did a trial on a couple hundred people. So we gave this device and they tested for four months and we asked them to compare this with home remedies that they have been done in the past.

So this definitely isn't a perfect study. Like, Ali was basically asking people to compare his straw to whatever home remedy they used. So there's a lot of variability there. You know, lots of people don't have this ready-made cure that works for them. Yeah. I mean, ideally, if this was like a medical intervention, you would...

give some people the Hickaway and then you'd give some people like a straw that kind of looks like the Hickaway. So he did do something sort of like that. He gave some patients straws that looked like Hickaways without the right pressure stuff. And he says it didn't work for them. Oh, that's. But that wasn't included in the study. That was just sort of anecdotal. And the study didn't actually have a control group. So that's a pretty big limitation here. Okay.

Still, Ali says he did get some interesting initial results. So then we collected this after four months and we came up with 92% better effectiveness of this device as compared to any home remedies.

And then we published this result in JAMA, which is Journal of American Medical Association. All right. I mean, the science editor in me must point out that it's not a great look to do

your own research on a product you have a financial stake in. Yep, very true. Which isn't to say it's wrong, but just like this happens all the time where like, you know, companies will sponsor research for their products. So cranberry companies will sponsor research into the health effects of cranberries. Right, right. And the results tend to like be aligned with what would...

make the product look good. Yeah, the cranberry study isn't normally going to say don't eat cranberries. Yeah, yeah, exactly. So that's definitely a big grain of salt there.

Yeah, I think there's reason to be skeptical here. Like, ideally, we'd want some independent researcher without a financial stake here to do a study on this. Yeah. But if we move past the specific product itself and just focus on the mechanism here of, you know, super flexing the diaphragm through suction, I did run it by Tyler, the doctor we heard in the first half of the show, and he thinks it makes sense. So it looked like it was a nice way of getting people to actively and strongly and efficiently...

close their glottis and contract their diaphragm. But there's two things to keep in mind here. We really don't know how well this would work on long-term intractable hiccups. Like, it might give some temporary relief, but if you really want to get at the underlying cause, you're going to need more serious medication or maybe even surgery. So,

So we haven't completely cracked the code of what's an easy hiccup solution for everyone. Yeah. And then the second thing to keep in mind is that even if you take these claims at face value that the Hiccaway really works on acute hiccups,

Tyler basically just said this isn't a perfect cure. It's overriding the hiccup as opposed to preventing or stopping the cause. This only works once a hiccup starts. Yeah, I would want to prevent them. Exactly. This is not preventing hiccups. This is just, okay, you can break your hiccup loop, but they're going to come back. So Ali's straw, it makes sense physiologically. It's got real potential. Yeah.

But I don't really think the research here is airtight enough to be like, okay, everyone stop using the home remedies that work for you. And these home remedies, you know, they're not exactly standardized, but they do really work. And they have these really interesting approaches that target the nerves or the diaphragm in so many different ways. So I wanted to hear what kind of creative treatments our listeners like to use and how they might trigger the hiccup nerves or the diaphragm.

You fill up your lungs and then you take another sip of air for good measure. Like, then you hold it for as long as you can and then you let it out as slow as you can.

So I checked with Tyler to see if this remedy makes sense. So expand your diaphragm, stop it from being able to contract on its own, and then dare it to contract. I like it. Place a steel table knife in a glass of water and drink the water with the flat side of the knife resting on your forehead. What? Okay. No. So that could be awareness of what's going on by using a one-piece that gives you vibrations and will let you know when it's about to start. Okay.

I got hiccups. My husband felt bad for me and was like, come here and gave me a kiss. And after doing so, I realized my hiccups went away. I have to study that one more.

But I'm thinking when you pucker up and try and kiss, you're also closing your glottis. And then there's focus. Like a lot of listeners actually used my favorite hiccup cure. Just eat a spoonful of peanut butter. So I thought this one was really about sticking up your throat to stop a hiccup. But Tyler says that the stickiness might just get you to be conscious of all the parts of your body you're not usually aware of. When you're focusing on what's going on and you know your pattern of hiccups,

the peanut butter is going to make you tighten some muscles. That may help. But you also might need to do the opposite. Like you might need to relax and unclench your muscles. And for that, distraction really helps. I had hiccups and a friend of mine asked me to spell a word backwards and my hiccups stopped. Yeah.

Overall, the thing that stands out to me here is that the remedies themselves are often similar to the causes of hiccups. Oh, funny. Yeah. Like tightening the diaphragm too much can bring on a hiccup, but contracting it exactly enough can make it stop.

Too much focus can bring on a hiccup, but the right focus can make it stop. Like, so much depends on exactly how much you do these causes and remedies. And because we still don't know exactly what would prevent a hiccup, it's kind of up to everyone to just keep stumbling around in the dark trying to deal with this mysterious, ancient hiccup reflex with anything we can find. I mean, people will find great ways to get information about their bodies. This is terrific. Yeah.

Once when I was in high school, a student had the hiccups and the teacher finally stopped everything and looked at the girl and said, "Think of a green rabbit."

To our astonishment, she stopped hiccuping immediately. Grab a tall glass of water and have 10 small sips and two big sips. Try your best not to take breaths in between. It works for most people, I tell it to. Whenever someone else has hiccups, I will ask them a question about the last meal that they have. As soon as they answer, their hiccups will be cured.

Put your elbows out really far and point two fingers together and sort of stare at the point between the fingers. It doesn't work if you bring your elbows down, allegedly, but it works, allegedly. Take a straw and then plug your ears and drink as much water as you can without breathing.

I swear it works. Pour a glass of water, light a match, put the match out in the water, drink the water, throw away the match. I tell my brain, all right, it's time to stop hiccuping. We're not doing that anymore. And my brain, I guess, listens and I stop hiccuping. So like a lot of young boys, I taught myself to burp on commands like burp.

Excuse me. And I discovered this summer that when I make myself burp, it stops my hiccups. This episode was reported and produced by Noam Hassenfeld. Edits from Catherine Wells, Meredith Hoddenot, and me, Brian Resnick. Mixing and sound design from Christian Aiella. Music from Noam. And fact-checking from Zoe Mullick.

Mandy Nguyen staying funny, Neil Dinesha, he's right on time, and Bird Pinkerton? She heard the sound of clacking machinery coming from the wall. Suddenly, a slot opened up. Sitting inside was a single can of Dr. Pepper.

Thanks to Erevis, Carson, Kent, Sam, Vanessa, Erica, Siavash, Jessica, Alex, Nicole, another Nicole, Miles, Sue, Ben, and Peter for sharing their hiccup stories. And thanks for the tons of other people who emailed in with stories, remedies, and amazing hiccup questions for us. We couldn't have made this episode without all of you.

If you have thoughts about this episode or ideas for the show, please email us. We're unexplainable at vox.com. We'd also love it if you left us a review or rating. Unexplainable is part of the Vox Media Podcast Network, and we'll be back next week. What do you got for spicy food? Green curry, extra spicy. How many chilies? All of them. All of the chilies. All of the chilies. I even added some habaneros to this, so like, I don't know. Disaster. Amazing.

It's very spicy. Am I going to hiccup? It's usually like on the first two bites of something. This is very spicy, but I'm doing okay. What if trying to hiccup on purpose is like my cure? I mean, honestly, that works for a lot of people. This is very weird for me because I usually have like an immediate reaction to very spicy foods. And this is very spicy. Like I'm getting the sweats and I'm

It's not happening. Well, now you know. I mean, if you are eating spicy food in the future, all you got to do is pretend you're on a podcast, right? Pretend I'm talking. Maybe it's you. Maybe it's me. I think there's something to this. I think this is my cure. Imagining eating spicy food on a podcast.