Nicotine gum is a widely used aid for smoking cessation, designed to deliver therapeutic nicotine and help manage withdrawal symptoms. A common side effect, however, is the sudden onset of hiccups. This reaction is so prevalent it is a known issue associated with nicotine replacement therapies (NRTs). The phenomenon is not a sign of improper manufacturing but rather an overreaction of the body’s nervous system to the product’s chemical and physical properties. Understanding the underlying causes can help users manage this reflex.
The Physiology Behind Hiccups
A hiccup is an involuntary spasm of the diaphragm, the large, dome-shaped muscle beneath the lungs that controls breathing. The spasm causes a sudden inhalation that is immediately cut short by the rapid closure of the vocal cords, or glottis, which produces the characteristic “hic” sound. This reflex arc is typically triggered by irritation along specific neural pathways.
The key nerves involved are the vagus and phrenic nerves, which transmit signals between the brain and the digestive and respiratory systems. The vagus nerve extends through the chest and abdomen and can be irritated by issues in the stomach or esophagus. The phrenic nerve directly controls the diaphragm, and its stimulation causes the muscle to contract erratically, initiating the hiccup reflex.
Specific Irritants in Nicotine Gum
The primary mechanism connecting nicotine gum to hiccups involves the irritation of these sensitive nerves by substances that travel down the throat. Nicotine is rapidly released from the gum when chewed, and if too much of this highly concentrated chemical is swallowed, it irritates the lining of the esophagus and stomach. This irritation directly stimulates the vagus nerve, initiating the hiccup response.
Nicotine itself is a known stimulant that can affect the nervous system, and its rapid absorption may overstimulate the phrenic nerve, causing the diaphragm to contract involuntarily. Furthermore, flavorings or sweeteners in the gum can contribute to the irritation of the digestive tract, compounding the effect of the nicotine. The resulting discomfort in the stomach or esophagus triggers the reflex arc.
Another physical factor is the unintentional swallowing of excess air, known as aerophagia, which often accompanies chewing gum. Swallowing air causes the stomach to distend, which physically pushes up on the diaphragm. This pressure directly irritates the phrenic nerve endings, providing a mechanical trigger for the hiccup reflex. Swallowing excessive saliva, a common result of chewing, can similarly contribute to stomach fullness and distension.
Why Chewing Technique Matters
The way nicotine gum is used is often the direct root of the problem, exacerbating the chemical and physical irritants. Unlike regular gum, nicotine gum is not meant to be chewed continuously and vigorously. Chewing too fast or without pausing releases nicotine too rapidly, which leads to swallowing a high concentration of the chemical and increasing the likelihood of chemical irritation to the esophagus and stomach lining. The correct technique, called “chew and park,” is designed to allow the nicotine to be absorbed slowly through the lining of the mouth, bypassing the digestive system. Improper technique also encourages excessive air swallowing, contributing to the stomach distension that pressures the diaphragm.
Preventing and Stopping Hiccup Episodes
Preventing hiccups starts with strictly following the recommended “chew and park” method for nicotine gum use. Users should chew the gum slowly until a slight tingling sensation or peppery taste is felt, indicating nicotine release. At that point, stop chewing and “park” the gum between the cheek and gum line to allow for slow absorption through the buccal mucosa. Preventing the swallowing of concentrated nicotine is the most effective way to avoid the chemical trigger. Users can also start with a lower dose of nicotine gum, such as the 2mg strength, to allow the body to adjust to the stimulant effects, and avoid acidic beverages like coffee or soft drinks for 15 minutes before and during use.
If a hiccup episode does occur, several remedies can help interrupt the nerve reflex arc. Holding your breath for a short period or breathing into a paper bag increases the level of carbon dioxide in the blood, which helps relax the diaphragm. Sipping a glass of water, especially cold water, or gargling with ice water can also stimulate the vagus nerve. This stimulation may reset the reflex and stop the spasms.