Heartburn is one of the most common digestive complaints – and acid blockers such as proton pump inhibitors are among the most widely prescribed medications overall. For anyone looking to reduce or complement their use, research does offer a few approaches that go beyond simple kitchen wisdom. Here's an overview of what's supported by evidence – and what isn't (yet).
Why weight loss and sleep position are among the best-supported measures
Of all the non-drug approaches to reflux, two stand out as particularly well studied: weight loss and elevating the head of the bed. A systematic review published in 2016 in Clinical Gastroenterology and Hepatology evaluated the existing evidence on lifestyle measures for gastroesophageal reflux disease (GERD). The result: in randomised controlled trials (RCTs), weight loss measurably reduced the time the esophagus was exposed to stomach acid in two separate studies – from 5.6 to 3.7 percent, and from 8.0 to 5.5 percent of measured time, respectively. Notably, the effect was observed not only in people who were overweight, but also in normal-weight individuals with a comparatively modest reduction in weight.
Sleeping with the upper body elevated – for example using blocks under the bedposts or a wedge pillow – also showed a measurable effect in controlled trials: nocturnal acid exposure of the esophagus fell from around 21 to 15 percent of measured time in the reviewed literature. The review also found that eating a late evening meal – within two to three hours of bedtime – increased nighttime acid exposure, while an earlier dinner reduced it. For people with frequent nighttime heartburn, these two measures are therefore the best-evidenced first steps, ahead of any supplementary intake.
Other classic pieces of advice – such as avoiding coffee, chocolate, citrus fruits or spicy food – are frequently recommended in practice but are considerably less well supported by controlled studies than weight loss and sleep position. Smoking cessation is a different matter: tobacco use demonstrably lowers pressure in the lower esophageal sphincter and reduces bicarbonate buffering in saliva, both of which favour reflux. In population-based cohort studies, quitting smoking was associated with a clear improvement in reflux symptoms among normal-weight individuals.
How alginates form a physical barrier against rising stomach acid
Alginates – polysaccharides derived from brown algae – work through a different mechanism than classic acid blockers: rather than lowering acid production, they form a floating gel on contact with stomach acid that sits on top of the stomach contents like a raft, mechanically hindering reflux into the esophagus. A meta-analysis published in 2017 in Diseases of the Esophagus pooled 14 randomised controlled trials with a total of 2,095 participants. Compared with placebo or classic antacids, alginate-containing preparations significantly increased the likelihood of symptom improvement (odds ratio 4.42). Compared directly with proton pump inhibitors or H2 blockers, however, the difference was not statistically significant – suggesting comparable, though possibly somewhat weaker, efficacy.
This assessment aligns with a French multicentre study from 2012 that compared an alginate preparation directly with 20 mg of omeprazole daily: in both groups, it took an average of around two days to reach the first symptom-free 24-hour period – an indication that alginates may be a serious option for moderate, occasional heartburn without directly interfering with acid production.
What a recent clinical trial shows for a deglycyrrhizinated licorice extract
Licorice root (Glycyrrhiza glabra) is one of the most traditional plants in European and Asian herbal medicine for digestive complaints. Because its constituent glycyrrhizin can, in larger amounts, affect blood pressure and electrolyte balance, only deglycyrrhizinated licorice extract (DGL), from which this component has largely been removed, is used for longer-term application. A double-blind, placebo-controlled phase III trial published in 2025 tested a standardised DGL extract in 200 adults with reflux-type symptoms over 28 days. The treated group showed a more pronounced improvement in heartburn and regurgitation than placebo, measurable from as early as the second week of treatment; quality of life, assessed via a validated reflux questionnaire, also improved significantly more.
The presumed mechanism of action lies not in acid suppression but in stimulating the body's own mucus production, which is thought to protect the esophageal lining from irritation. This makes the approach fundamentally different from proton pump inhibitors – though the evidence base for DGL in reflux remains narrower than for established active substances, and further independent studies would be welcome to confirm these results.
What role classic European herbs such as chamomile, fennel and lemon balm play
Beyond specifically studied single substances, European herbal knowledge has a long tradition of addressing stomach complaints. Chamomile, fennel and lemon balm are among the longest-documented herbs for digestive unease and are traditionally used to soothe the gastrointestinal tract. Lemon balm extract is often standardised for its rosmarinic acid content, one of the characteristic plant compounds found in the herb. Fennel provides essential oils, while chamomile is best known for its flavonoids.
Peppermint occupies a special position: while it too counts among the classic digestive herbs and is traditionally valued for bloating and a feeling of fullness, an early but still widely cited study from 1969 found in 27 subjects that concentrated peppermint essence lowered pressure in the lower esophageal sphincter within minutes, triggering measurable reflux in most participants. This mechanism – a relaxation of precisely the muscle that normally prevents reflux – continues to be cited in current literature as the reason why strongly peppermint-based products are not the first choice for people prone to reflux, even though peppermint is well studied and used for other digestive complaints such as irritable bowel symptoms.
| Approach | Evidence base | Practical note |
|---|---|---|
| Weight loss | Multiple RCTs | Measurable effect even in normal-weight individuals |
| Elevated sleep position | Multiple RCTs | Especially relevant for nighttime heartburn |
| Alginates | Meta-analysis, 14 RCTs | Physical barrier rather than acid suppression |
| DGL licorice extract | Individual RCTs | Only the deglycyrrhizinated form for longer use |
| Chamomile, fennel, lemon balm | Traditional use | Long history of use, few reflux-specific RCTs |
Safety and use: what to consider around children, pregnancy and interactions
Anyone taking acid blockers regularly, or who has received a diagnosis such as GERD or reflux esophagitis from a doctor, should discuss any change – including a switch to herbal approaches – with a doctor or pharmacist beforehand, particularly before reducing or stopping medication. Alginates are generally well tolerated but, depending on the preparation, may contain notable amounts of sodium, which is worth considering for people on a low-salt diet or with high blood pressure. Non-deglycyrrhizinated licorice root is unsuitable during pregnancy and for people with high blood pressure; even deglycyrrhizinated preparations should only be used during pregnancy and breastfeeding after consulting a professional. Evidence for the approaches described here is limited in children, so herbal preparations in this age group should generally be discussed with a doctor. As noted, people prone to heartburn are unlikely to find support in strongly peppermint-based products from a mechanistic standpoint; those who also experience other complaints such as bloating can still use peppermint separately and specifically for that purpose. Persistent, frequent or worsening heartburn, difficulty swallowing, or unintended weight loss should always prompt a medical evaluation, as these can also point to causes other than a simple tendency toward reflux.
Magen essentia
Four plants from European stomach-care tradition in one formula: Magen essentia by Natura Nova combines lemon balm, fennel, peppermint and chamomile with 310 mg of plant complex per capsule, standardised for the lemon balm compound rosmarinic acid – complemented by calcium, which contributes to normal function of digestive enzymes. Developed and produced in Switzerland to GMP standards, with lab-tested batches and a vegan capsule shell.
Conclusion: what the evidence supports – and where research is still needed
The most solid evidence for reflux still lies with two simple lifestyle measures: weight loss and elevating the head of the bed, both confirmed repeatedly in randomised controlled trials. With their physical mechanism of action, alginates form a well-studied middle ground that, in direct comparison studies, comes close to classic acid blockers. For DGL licorice extract, initial clinical data are encouraging but still numerically limited. Classic herbs such as chamomile, fennel and lemon balm rest mainly on a long tradition of use within European herbal knowledge, while for peppermint, some caution is warranted for people prone to reflux, for mechanistic reasons. Anyone looking to reduce or complement acid blockers has several genuine options here, supported by evidence to varying degrees – but the choice, and especially any change to existing medication, belongs in the hands of a doctor or pharmacist.
This article is for general information about heartburn and does not replace medical advice, diagnosis or treatment. If you have health concerns, please consult a doctor or pharmacist.
Sources
- Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle Intervention in Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol. 2016;14(2):175–182. PMID: 25956834 (systematic review)
- Leiman DA, Riff BP, Morgan S, et al. Alginate therapy is effective treatment for GERD symptoms: a systematic review and meta-analysis. Dis Esophagus. 2017;30(5):1–9. PMID: 28375448 (meta-analysis, 14 RCTs)
- Pouchain D, Bigard MA, Liard F, et al. An alginate preparation vs. omeprazole in symptomatic treatment of moderate gastroesophageal reflux: a direct comparative randomised trial. BMC Gastroenterol. 2012;12:18. PMID: 22361121 (RCT, human)
- Bethapudi B, Murugan SK, Nithyanantham M, et al. Efficacy and Safety of a Deglycyrrhizinated Liquorice Extract in Managing Gastroesophageal Reflux-Related Symptoms: A Phase III, Single-Centre, Double-Blind, Randomized Placebo-Controlled Trial. PMID: 39929150 (RCT, human)
- Sigmund CJ, McNally EF. The action of a carminative on the lower esophageal sphincter. Gastroenterology. 1969;56(1):13–18. PMID: 5765428 (physiological study, human)
