Burps Per Minute 

On my last trip to Ohio, the guy in the next seat had hiccups the entire way. I didn't talk to him about it, but he did give me a "shrug and smile" like he couldn't stop. It about drove me crazy, but I still felt sorry for him. I spent the rest of the flight thinking about involuntary body functions and their purposes (like how throwing up, sneezing and diarrhea all get rid of something bad), but I couldn't figure out hiccups. So, why do we hiccup and could anything have made that guy stop?

—Paul

The term hiccup happens to be my second favorite onomatopoetic word—that is, a word whose sound suggests its meaning. The only one better has to be yoink, an utterance heard whenever anyone on The Simpsons steals something. Both words, however, are eclipsed by the term onomatopoetic itself. This one just begs to be pronounced, repeatedly, out loud. Try that next time, and I'll bet hiccup guy will ask the flight attendant to be moved away from you.

A hiccup is the result of an involuntary, forceful inspiration caused by a spasm of the diaphragm muscle. Within milliseconds of the spasm, either a drop in lung pressure or the mad rush of air causes the glottis (the space between the vocal cords) to snap shut, creating the "hic" sound. Most commonly, these occur a few times a minute until spontaneously disappearing well before totaling a hundred. Bouts that last beyond two days are termed persistent, while the unlucky individual who cannot stop for a month or more is said to have an intractable case. Not surprisingly, this latter group can end up with sleep disorders, depression and weight loss from the non-stop hiccuping.

The cause of normal, mild cases is often abrupt stomach stretching or irritation. Eating too quickly, filling the stomach with air (carbonated drinks), spicy food, alcohol and sudden unexpected laughter can all set off a bout. Though this list is curiously similar to Cinco de Mayo night at Cafe Ole, it doesn't include the more serious nerve irritation from disease or tumors that may result in the rare intractable case.

Why our bodies create this nuisance is only speculated upon, but hiccups have been recorded in fetuses only a couple of months along. Unless they've somehow managed to smuggle jalapeno poppers and margaritas into the womb, this indicates hiccups are hardwired into our genetics. One fairly convincing evolutionary theory notes that the same combination of diaphragmatic spasm and glottis shutting occurs when certain amphibians, like tadpoles, force water through their gills to breathe. Paul, did you notice if your seatmate had Evian squirting out of his neck?

Hundreds of home remedies exist, any one of which is better than the 19th century medical treatment of scorching the skin down the neck and back. Non-drug remedies fall into two loose categories: trying to increase the blood's carbon dioxide level (breath-holding methods), and attempting to overwhelm the nerves or brain with sensation (forcing multiple swallows or sudden frights).

A sampling of seemingly effective treatments includes: endless sips of water while holding your breath, dry swallowing a teaspoon of sugar placed on the back of your tongue, and the TV miracle cure, re-breathing air from a paper sack. More than one medical case study has reported that acupuncture may even be effective. Treatment to a point called GV14 (Da zhui), located at the base of the back of the neck, seems to show promise. Da zhui is known as the Great Hammer, which, hopefully, is not instructive of how to insert the needle.

My current favorite is the Supra-supramaximal inspirational technique, simply because the name reminds me of a motivational seminar. This recently published method was developed to treat hiccups in pregnant women for whom drugs are forbidden. The simple process is this: exhale as much as possible, then take a very deep breath. Hold 10 seconds, take in a little more air, and hold for five seconds more. Force in a third small breath and try to hold for five more seconds. Then breathe normally (if you didn't burst open like a popcorn kernel). Though the experiment only involved a few people, the doctors had instant success in every case.

It's hard to say whether any of these remedies would have helped your seatmate. I suppose you could have tried to startle the hiccups out of him with a loud shriek, but that's chancy enough on the ground. In the air, it's best you both just suffer rather than risk getting shot by an over-caffeinated Air Marshall.

Dr. Ed Rabin is a chiropractor practicing at Life Chiropractic Center in Boise. Send teaspoons of sugar and health-related questions to theantidote@edrabin.com (on the Web at www.edrabin.com).

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