A Climactic Hiccup Cure (and your chance to help test it)

"Sex is good for lots of things - now it seems we can add hiccup cure to the list."

If you follow the annual presentation of the tongue-in-cheek Ig Nobel Prize, then you already know that modern medicine has come up with at least one promising hiccup cure. As is often the case for the Nobel Prizes that the Ig Nobel parodies, the recognition of Francis Fesmire's work came much later than it should have.

Back in 1988 Fesmire published a revolutionary paper entitled Termination of intractable hiccups with digital rectal massage in the journal Annals of Emergency Medicine (annals . . . that's funny).

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I've heard jokes about how he might have discovered the effect, but it's not really such a stretch. The key to Fesmire's discovery may be stimulation of the vagus nerve. Other researchers have noted the connection between the vagus nerve and hiccups. Unlike most of the nerves that make their way from your brain to other parts of your body through the spinal column, the vagus nerve is a major nerve bundle that starts at your brain stem and winds its way through your abdomen. In fact the FDA has approved an implantable vagus nerve stimulator for controlling hiccups with electrical bursts.

Personally, I think Fesmire's discovery is a much cleverer way to stimulate the nerve. It makes sense because, among other things, the vagus nerve connects to the sphincter muscles of the gastrointestinal system (including the anus) as well as many muscles and organs involved in hiccuping.

For those of you uncomfortable with the massage, there's an alternative. In 2000, Roni and Aya Peleg published a case report in The Canadian Family Physician journal reporting their observation of sexual intercourse as potential treatment for intractable hiccups.

Sex is good for lots of things - now it seems we can add hiccup cure to the list. That's cool, but it begs the question as to why (and if) sex has anything to do with hiccups.

Now, I consider myself to be a skeptic as a rule. But I also try to be open minded, so I've been withholding judgement on these particular cures until I could see further data. As it happens, I came down with a heavy duty case of hiccups a few days ago . . .

Naturally, I thought I would try one of the cures myself. The massage thing seemed a bit involved and messy, so I went with the alternative. Considering the fact that I was in a rush to try it before the hiccups ended on their own and I didn't want the confounding complication of involving anyone else in the experiment, I went solo.

It worked perfectly. At the climactic moment, my hiccups ceased.

As a result, I was inspired to see if any physicists had taken a look at hiccups and whether they had anything useful to say about the phenomenon.

It turns out that in 1995 W. A. Whitelaw of the University of Calgary, along with Parisians J.-Ph. Derenne of the Groupe hospitalier de la Pitié-Salpêtrière and J. Caban of the Hopital St. Antoine published a paper in the physics journal Chaos titled Hiccups as a Dynamical Disease."= They concluded that hiccups are produced by a central pattern generator (CPG). A CPG is a neuron circuit that generates a signal, which causes an action that in turn stimulates another signal, and the pattern repeats, sometimes indefinitely. Similar circuits apparently handle numerous other repetitive actions such as breathing and walking

The Hiccup Generator as a "Black Box"

Just what all the components are in the hiccup CPG isn't entirely clear. What's more, it doesn't really matter. Instead the researchers treated the hiccup CPG as a black box. To an engineer or scientist, a black box is a system that's studied in terms of what it does, rather than what it's made of. In other words, the physicists studied the behavior of the biological system that causes hiccups without worrying too much about the individual pieces that go into it. The work led to some interesting insights, including the fact that the rhythms of hiccups seem to be tied to breathing rates and heartbeats, but it didn't do much in the way of offering any new cures.

As I see it, the most important aspect of the research is the simplified perspective on hiccups. We have a hiccup black box in our bodies that normally is in the 'off' state. Any number of disturbances can turn it on: eating too quickly, coughing, drinking a hot liquid, drinking a cold liquid, a sudden shock, a sneeze, acid reflux, or even (though, thankfully, rarely) tumors, renal failure, or chemotherapy.

Many causes of hiccups (that aren't related to diseases, anyway) involve a chemical or physical shock that kicks the hiccup black box out of its resting state and into its annoying active state.

A simple way to generally illustrate this sort of thing is to imagine a bunch of kids playing soccer (football for those of you outside the US) at the bottom of a valley. When one of the kids kicks the ball hard enough, they might knock it over the ridge of the valley wall and into a neighboring valley. If the valley next door is not as deep, the kids over there will soon kick the ball back over the ridge to the soccer game. How long that takes depends in part on the height of the ridge between the valleys, and in part on the random chance that some kid kicks the ball hard enough to clear the hill.

We see lots of situations like this in physics; an electron in its lowest orbit in a hydrogen atom can absorb a photon and get kicked into a higher orbit; an atom possessing a characteristic called spin can be flipped from one orientation along a magnetic field to the opposite orientation (this is critical for magnetic resonance imaging); and some types of glass that radically change state when heated in certain ways (a technology based on these glasses may eventually lead to novel data storage chips), to name just a few of the countless examples.

Often in physics we see systems that have been knocked from their ground states (the states they naturally prefer to be in) to higher states, which spontaneously drop back some random amount of time later. If you don't feel like waiting, hitting a system with another shock that's similar to the one that bumped it out of its ground state often knocks it back. In the case of an electron in a higher orbit around its atom, this is called stimulated emission. It takes a photon to get the electron up there in the first place, and another photon can induce the electron to fall back to the ground state immediately instead of randomly.

Hiccups work essentially the same way - a shock to your system bumps the hiccup CPG into its active state. Simply waiting will often be enough that the bout stops on its own as the CPG randomly returns to its resting state. But if you're impatient, any number of hiccup cures that rely on physical or chemical shocks to your system may do the trick immediately.

Trying to scare the hiccups out of someone is obviously a physical shock. The spoon full of sugar cure is a chemical shock to your mouth, throat, and stomach. Holding your breath, breathing into a paper bag, and related asphyxiating cures cause a chemical shock through a relatively rapid build up of carbon dioxide. I could keep going down the list, but as far as I know just about every folk cure involves the equivalent of stimulated emission to kick your CPG to its resting state.

The interesting thing about Fesmire's digital massage is that he is taking advantage of the fact that while we know very little about what's inside the hiccup black box, we know about one thing in there - the vagus nerve. (Remember, the vagus nerve stimulator implant is the only FDA approved hiccup cure.)

The other thing we know about the vagus nerve is that it's involved in orgasm. This was shown in recent studies with paraplegic women who had lost sensation in their lower bodies as the result of back injuries. The startling outcome of the experiments was that they could still experience orgasm from stimulation of their genitals. The researchers believe that the orgasms must involve the vagus nerve because it's the only intact nerve pathway back to their brain stems.

Some folks might prefer Fesmire's massage, but I'm guessing that most people would choose the orgasm stimulation to tickle their vagus nerves and kick the hiccup CPG back to its resting mode.

Do Your Part for Science

As most scientists will tell you, anecdotal evidence is pretty unreliable. And even though I experienced the cure myself, I'm willing to accept the possibility that the success was coincidental. The Pelegs’ case study adds to the evidence, but that's still only two tests.

We need more data. I'm willing to try again, but I don't get hiccups very often.

I'm hoping that you will help test the cure. The next time you get hiccups, and have enough time and privacy to do the experiment, have an orgasm (alone or with a friend) and write to me to let me know whether or not it cured the problem.

I'll compile the data and report back as soon as we have a clear answer one way or the other.

You can post your results in the comment section of this post or email me the results at "BuzzSkyline at gmail dot com."