The Benefits of Slow Breathing

There are all manner of purported hiccup “cures,” which include everything from chewing on a lemon, inhaling pepper, or, our dog’s favorite, eating a spoonful of peanut butter. In my video How to Strengthen the Mind-Body Connection, I talk about the technique I’m excited to try the next time I get hiccups: “supra-supramaximal inspiration,” where you take a very deep breath, hold for ten seconds, then, without exhaling, breathe in even more and hold for another five seconds, and then take one final, tiny breath in and hold for five last seconds to achieve “an immediate and permanent termination to hiccups…”

When I was a kid, I taught myself to control my own hiccups using slow-paced breathing, and, as an adult, was so excited to see there was finally a case report written up on it.

There’s a nerve—the vagus nerve—that goes directly from our brain, to our chest, and to our stomach, connecting our brain back and forth to our heart and our gut, and even to our immune system. The vagus nerve is like the “‘hard-wired’ connection” that allows our brain to turn down inflammation within our body. When you hear about the mind-body connection, that’s what the vagus nerve is and does. “There has been increasing interest in treating a wide range of disorders with implanted pacemaker-like devices for stimulating the vagal afferent [vagus nerve] pathways,” but certain Eastern traditions like Yoga, QiGong, and Zen figured a way to do it without having electrodes implanted into your body.  

“A healthy heart is not a metronome,” as a study titled exactly that explains. “Your heart rate goes up and down with your breathing. When you breathe in, your heart rate tends to go up. When you breathe out, your heart rate tends to go down.” Test this out on yourself right now by feeling your pulse change as you breathe in and out.

Isn’t that remarkable?

That heart-rate variability is a measure of vagal tone—the activity of your vagus nerve. Next time you’re bored, try to make your heart rate speed up and slow down as much as possible within each breath. This can be done because there’s an entirely other oscillating cycle going on at the same time, as you can see at 2:08 in my video, which is the speeding up and then slowing down of your heart rate, based on moment-to-moment changes in your blood pressure. And, as any physics student can tell you, “all oscillating feedback systems with a constant delay have the characteristic of resonance,” meaning you can boost the amplitude if you get the cycles in sync. It’s like pushing your kid on a swing: If you get the timing just right, you can boost them higher and higher. Similarly, if you breathe in and out at just the right frequency, you can force the cycles in sync and boost your heart rate variability, as you can see at 2:36 in my video.

And what’s the benefit again? According to the neurophysiologic model postulation it allows us to affect the function of our autonomic nervous system via vagal afferents to brainstem nuclei like the locus coeruleus, activating hypothalamic vigilance areas.

Huh?

In other words, it’s not just about curing hiccups. Practicing slow breathing a few minutes a day may have lasting beneficial effects on a number of medical and emotional disorders, including asthma, irritable bowel syndrome, fibromyalgia, and depression. In the United States, we’ve also put it to use to improve batting performance in baseball.

To date, most studies have lacked proper controls and have used fancy biofeedback machines to determine each person’s resonant frequency, but, for most people, it comes out to be about five and a half breaths per minute, which is a full breath in and out about every 11 seconds. You can see the graph at 3:34 in my video. When musicians were randomized into slow-breathing groups with or without biofeedback, slow breathing helped regardless. It’s the same with high blood pressure. As you can see at 3:52 in my video, you can use this technique to significantly drop your blood pressure within minutes. The hope is if you practice this a few minutes every day, you can have long-lasting effects the rest of the day breathing normally.

Practice what exactly? Slow breathing—taking five or six breaths per minute, split equally between breathing in and breathing out. So, that’s five seconds in, then five seconds out, all the while breathing “shallowly and naturally.” You don’t want to hyperventilate, so just take natural, shallow breaths, but be sure to simply breathe really slowly. Try it the next time you get hiccups. Works for me every time!


For more tips, watch my video on How to Stop Hiccups.

And, because slowing down our pulse in general may also have beneficial effects, I encourage you to check out:

Every time I’m amazed by ancient wisdom, I have to remind myself of the video I did on toxic heavy metals—Get the Lead Out. So, though traditional healing methods may offer a plethora of insights, they still need to be put to the test.

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:

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: