Heartburn: Botanical Treatment

Herbal treatment for heartburn during pregnancy focuses on simple lifestyle and dietary modification, and the use

of gentle herbs to soothe and protect the esophageal epithelium (Table Botanical Treatment Strategies for Heartburn). A mild antacid herb may also be included in more bothersome cases. Nervines (e.g., cha-momile, skullcap, or passion flower) can be added to a protocol if heartburn is causing sleeping problems or if stress is contributing to digestive difficulties. Herbs for treating heartburn are best taken as teas or lozenges (e.g., slippery elm bark lozenges) rather than as tinctures, both to bathe the alimentary canal as they are ingested, and avoid the potentially irritating effects of alcohol in the tinctures. Further, demulcent herbs are best extracted in water for maximum efficacy.

Botanical Treatment Strategies for Heartburn

Therapeutic GoalTherapeutic ActivityBotanical NameCommon Name
Relieve esophageal irritation and inflammationDemulcentsAlthea officinalisMarshmallow root
Ulmus fulvaSlippery elm bark
Improve esophageal sphincter toneUnknownAmygdalis communisAlmonds


General Recommendations for Preventing / Relieving Heartburn

A number of foods have been associated with an increase in reflux, either by increasing gastric acid or relaxing lower esophageal sphincter pressure. Individuals with gastroesophageal reflux disease (gastroesophageal reflux disease) may wish to experiment with avoiding all, or some, of these possibly offending items or practices:

• Fatty or spicy foods

• Coffee (decaffeinated or caffeinated), chocolate, and alcohol’

• Eating for at least 2 hours before lying down

• Tomato products, for example., tomato sauce, pizza

• Peppermint and ginger

• Drinking more than one cup of fluids with a meal. Other practices may help to improve symptoms:

• Eat small frequent meals (six to eight a day)

• Elevate the head of the bed 6 inches

• Chew gum

Interestingly, almost no clinical trials have been conducted demonstrating beneficial effects of eliminating offending foods or practices, including those listed in the preceding, with the exception of elevation of the head of the bed. Nonetheless, many women report improvement with a combination of these changes.

Discussion of Botanicals


Chewing raw almonds is a treatment relied on by many midwives for the reduction of heartburn. Instruct clients to thoroughly chew 8 to 10 raw almonds and swallow. This may be repeated several times daily. Almonds are nutritive and there are no expected side effects or contraindications to the use of this food.

Marshmallow Root

Marshmallow root has similar properties to slippery elm — it is mucilaginous, soothing, and anti-inflammatory to epithelial surfaces. Evidence for the use of this herb stems largely from traditional use. Though this herb has been used for centuries, there are remarkably few clinical trials evaluating its safety or efficacy. It has no known expected toxic effects; however, it has been shown to lower blood sugar in animal studies. Caution should be observed when using this herb in combination with blood sugar lowering medications, though the risk is theoretical. It has been suggested theoretically that this herb might interfere with drug absorption. Although this has never been demonstrated clinically, it may be prudent to avoid taking this herb at the same time as taking other medicinal agents, and instead take marshmallow root and other medications several hours apart. Herbalists, however, commonly combine marshmallow with other herbs for the digestive tract. Unlike slippery elm, marshmallow is not available in convenient lozenges; therefore, it must be prepared as an infusion, and sipped as needed throughout the day or during an acute episode of heartburn.

Slippery Elm

Ulmus rubra is a nutritive demulcent, rich in mucilaginous polysaccharides. Slippery elm’s emollient actions have led to its traditional use for centuries for soothing irritated tissue, coating, and protecting the digestive tract. Its high calcium content may have some antacid effects. The herb may be taken as a tea; however, it has a thick, mucus-like consistency that can be unpleasant to women with nausea and vomiting of pregnancy. To avoid this, one to two teaspoons of slippery elm can be added to oatmeal instead; it is has a pleasant, slight maple syrup-like flavor and is easy to take this way. The easiest and most effective way to use the herb is in the form of slippery elm lozenges, which may be purchased in a conveniently prepared form (e.g., Thayer Slippery Elm Lozenges), are quite palatable, and may sucked on as needed up to 8 to 12 per day. Supporting evidence for the herb’s benefits is drawn from traditional use, and extrapolation from effects of the mucilaginous constituent of the herb. There is no known toxicity, and in fact slippery elm has been used in some baby foods and adult nutritional foods.