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Blimey! Why the sandwich made Briton swoon

By Jasmin Aline Persch

You may think some sandwiches are scary – a Wendy’s Baconator, anyone? — but for one young British woman, eating a sandwich really was a dangerous act.

The otherwise healthy 25-year-old from Birmingham, England, regularly fainted while eating sandwiches or drinking fizzy sodas. Once while having a bit of grub behind the wheel, the young woman blacked out at a red light. Fortunately, she came to before the signal switched to green.

Having experienced the condition since she was 15, she realized a connection between certain foods and the fainting spells.

When she sought medical help, doctors didn’t recognize the curious symptoms. She was hospitalized several times and her blood, thyroid and pituitary glands were extensively tested, but everything was normal. She didn't smoke, drank only a little and didn't use drugs. Doctors suspected the problem was all in her head. They didn't realize that the glitch was in her heart.

“Because she’s young, everybody thought, ‘It can’t be her heart,’ ” said Dr. Howard Marshall, a cardiologist at University Hospital Birmingham who detailed her case with Dr. Christopher Boos in a recent article, dubbed “Dangerous sandwiches,” in the British medical journal The Lancet.

The University Hospital Birmingham doctors discovered that when she became light-headed, she was suffering a complete atrioventricular block, a delay in the electrical signals between the upper and lower chambers of the heart. It caused the pauses between her heart beats to last up to 2.5 seconds, Marshall said. 

The doctors discovered the young woman suffers from a rare disease called “swallow syncope,” a condition that causes the patient to lose consciousness when too little blood flows to the brain. Only about six cases have ever been reported, said Marshall, who has seen one other case besides this one. Swallow syncope was first recognized about 50 years ago, yet remains fairly mysterious due to its rareness, Marshall said.

Other cases have been linked to gastric disorders or problems with the esophagus. For this young woman an anatomical anomaly had caused the nerve systems in her throat and heart to intertwine in her brain stem. When she would take a big bite of a sandwich, a bolus -- or ball -- formed in the back of her throat. The “cross reaction” between her throat and heart in her brain that caused her heart to halt briefly starved her brain of blood long enough for her to pass out, Marshall explains.

During the medical exam to confirm the diagnosis, doctors had her eat various foods to find the link. One of the culprits? A ham sandwich, which the young woman had brought in herself.

Cold fizzy drinks and solid foods are the most common triggers, but there are others.

  • In 2005, a German medical journal described a 38-year-old man who fainted while drinking hot coffee.
  • In 2006, Japanese doctors detailed a 66-year-old woman whose heart stopped while she swallowed soup or sipped tea.
  • In 2007, an American doctor wrote about a 68-year-old woman who fainted while standing at the sink, gulping a glass of milk.

Swallow syncope has been described as a “potentially lethal disease,” but Marshall said that the young woman would not likely have died from the condition. “She had enough phyical warning to spit out the sandwich and stop herself from falling over,” he told

Marshall, who helped confirm her illness, said the young woman’s diagnosis brought not only physical, but emotional relief. She had endured years of fruitless medical examinations and meetings with psychiatrists after doctors questioned whether the symptoms stemmed from her imagination.

“I knew it wasn’t in my head. I knew it was real,” was her response to the diagnosis, Marshall recalled.

Rather than giving up ham sandwiches or soda for life, the young woman had a permanent pacemaker implanted to regulate her arrhythmia.

Because the condition had led her to eat very sparingly, the 5-foot-4-inch woman weighed only 102 pounds before the pacemaker was implanted last February. Now free of fainting spells, she’s no longer limiting her portions, or sandwiches. As a result, she' packed on a few pounds.

“You didn’t tell me I would put on half a stone in weight,” Marshall recalled her saying, using the British phrase “stone,” meaning 14 pounds.