Have you ever heard of using granulated sugar to treat ongoing hiccups? Here’s a fun “blast from the past” In case you missed this item in our March monthly update.

One of my dearest old friends is Marc Chetta, MD, a family physician, brother in Christ, and now a professor and the premed/predental program advisor in the Division of Health Science at Bob Jones University. He recently wrote me:

One of my students who is now a 3rd year med/peds resident related the following incident to me.

He came on duty as hospitalist at 7pm and encountered a patient admitted for intractable hiccups going on for 12 hours.

The prior hospitalist had tried all the medicinal interventions, but to no avail.

My [former student] remembered reading in your book, Bryson City Tales about the patient with intractable hiccups and the Appalachian antidote of a tablespoon of granulated sugar.

So with nothing to lose he tried it. Within 30 minutes the patient was hiccup free!!!

Kudos to Bryson City Tales. You are a legend.

You may remember that for 10 years (1990-2000), while practicing with John Hartman, MD, in Kissimmee, FL, I was the first-author for a column, “Diary of a Practice” in the American Family Physician journal. In the June 1992 edition (Volume 45, Number 6, pages 2568-70) I wrote this:

While walking down the hospital corridor today, WLL was approached by one of his subspecialist colleagues, who relayed to him that he was having difficulty controlling a patient’s hiccups.  Wondering if WLL might know of other medications, he was surprised to hear the suggestion that the patient swallow a tablespoonful of granulated sugar.  WLL could almost see him chuckling as he left.  Later, however, he expressed his thanks to WLL for sharing this time-honored “old mountain trick” [which worked like a charm].

Here’s the original story from Bryson City Tales (Chapter 15, “White Lies”) shortened from pages 138-141), a book about my first years in practice (1981-1985):

One day after lunch I walked over to the hospital for afternoon rounds. I saw Louise coming down the hall. Ever since the case of the skintight cast, I had felt uncomfortable being around the ER nurse. I wasn’t sure why. Perhaps I was still wrestling with the fact that her clinical and practical experience so vastly outweighed mine. Perhaps it was the reality that she knew these people and their ways so much more intimately than I did. Although she was nice enough, around her I just felt uneducated. And what was even more painful, I felt unappreciated.

Louise was heading toward the ER with a syringe in her hand. I was trying to think of something to say, but she beat me to the punch.

“Dr. Larimore, you got a moment? I need a hand.” She continued on to the ER without comment. I followed like an obedient pup. As we walked toward the ER, I saw Louise place the syringe in her pocket. An elderly man was coming out of the ER, holding his paperwork and struggling into his plaid coat.

“Louise, the sugar worked like a charm. The hiccups are completely gone. You may never see me again in this place!” He smiled and turned to leave.

Louise smiled and glanced my way. “I’ll explain later.” …

“What’s this about sugar and hiccups?” …

Louise smiled and then slyly asked, “Why, Dr. Larimore, didn’t they teach these things to you all at the big Duke University?”

“Don’t believe so, Louise. We were too busy learning how to save lives.”

My hint of humor was obviously not received well as Louise glared at me over her spectacles. “Actually, Louise, I wasn’t taught [that] technique. What’s the deal?”

“What were you taught to do if someone comes into the ER with a bad case of hiccups that had been going on for hours or days?” Louise quizzed me.

“We usually used intravenous Thorazine. That seemed to work pretty well—at least in the two or three cases I’ve seen.”

“We’ve used Thorazine here, but I can’t even remember the last time. The sugar seems to work just fine. It’s sure a lot cheaper. … We try to do things the least expensive way we can. Many of these folks don’t have no medical insurance. ’Nother thing ’bout the sugar is that it has none of the side effects that meds like Thorazine can have.”

“How do you administer it?”

She looked confused. “The Thorazine?”

I chuckled. “No, no. The sugar.”

“Oh, well, it’s real simple. Just take a heaping tablespoon of granulated sugar—I get it from the staff lounge—and have the patient swallow it down.”

“That’s it?”

“Yep, that’s it. Usually works in ten to fifteen minutes.”

“How does it work?”

“Dr. Larimore, I don’t have a clue,” she answered bluntly. “I just know it does.”

Indeed, the medical literature confirms that swallowing a teaspoon of dry, granulated sugar is an effective, evidence-based, and widely recognized home remedy for treating hiccups. This method was prominently featured in The New England Journal of Medicine in 1971, which reported that 19 out of 20 patients experienced relief from persistent hiccups after using this technique.

According to studies and medical practitioners, the “sugar cure” works through physical irritation rather than a chemical reaction. The suggested mechanism of action is:

• Reflex Stimulation: The gritty texture of the granulated sugar causes irritation to the throat, specifically the pharynx and esophagus.
• Vagus Nerve Activation: This stimulation acts on the vagus nerve, which helps to “reset” or disrupt the nerve pathway responsible for the involuntary diaphragmatic contractions, or “hiccup reflex”.
• Forced Swallowing: The process forces a harder-than-normal swallow, which interrupts the spasm.

As Louise would have said, “I don’t have a clue how it works. I just know it does.”