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Low Ejection Fraction | Causes and Treatments

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Low Ejection Fraction

Have you been told that your ejection fraction (EF) is low? The medical term for this is cardiomyopathy, literally meaning heart muscle dysfunction. To add more confusion, this situation is also known as congestive heart failure (CHF).

But where there is a cause, there is a cure. Pharma is always recommended by standard cardiologists, but there is a better way to heart health and longevity. The Cleveland Clinic page on low ejection fraction has the basics, but not real solutions. Pharma may be necessary in the short term, but the idea is to get people off meds as soon as possible. 

Let’s talk about what causes low ejection fraction, the standard medical approach and our holistic treatment strategies to fix low EF.

What does it mean to have a low ejection fraction?

The heart muscle pumps blood to the body. The left ventricle is one of the four chambers of the heart and is responsible for accepting oxygenated blood from the lungs and ejecting it to the body. Before the left ventricle ejects blood, it is relaxed. This is called diastole. The amount of blood volume in the heart during diastole is around 120ml for an adult. When the heart contracts, known as systole, the end volume is 60ml. That means 60ml was ejected. So 60/120 is 50% ejection fraction. Anything from 50 to 65% is typically considered normal at rest. 

If your ejection fraction is lower, that is known as cardiomyopathy or CHF. Number can range from 10% to 45%, with the lower the number, the more the severity. 

Symptoms of low ejection fraction include shortness of breath, leg swelling (edema) and abdominal distention (from fluid in the liver and intestines). Other symptoms include shortness of breath when lying flat/supine (orthopnea) or suddenly waking from sleep short of breath (paroxysmal nocturnal dyspnea/PND). 

Causes of low ejection fraction

The proximate causes of low ejection fraction include: heart attack as a cause of ischemic cardiomyopathy OR non-ischemic cardiomyopathy from hypertension, myocarditis, alcohol, tachycardia (fast heart rate usually from atrial fibrillation), vitamin deficiency, thyroid disorder, drug-induced, or valvular heart disease. Valve disease examples include such aortic stenosis, aortic insufficiency, or mitral regurgitation. 

Additional causes include radiation-induced, post-partum, infection, autoimmune, sleep apnea. 

Doctors typically say it was a virus, but this diagnosis is unlikely. 

But the above do not really tell us about the WHY or the real causes. 

The real causes of low ejection fraction are from violations of Eat Well, Live Well, Think Well. 

You can read about our Eat Well, Live Well, Think Well method in the Learning Center of our website by clicking the button on the menu bar above.


Tests that one can expect include: ECG, echocardiogram, coronary angiogram, MRI. Blood tests can help look at thyroid, vitamins/minerals, and viruses (unlikely).

The echocardiogram is the best test of the above with the least toxicity. An MRI can be done, but is usually not necessary.  

Please see below of the methods we use at Natural Heart Doctor. 


The typical pharma approach may include any of the following, typically in combination: beta-blockers, ACE inhibitors, ARB, spironolactone or eplerenone, Entresto (ARB/neprilysin inhibitor), digoxin, and diuretics such as furosemide (Lasix). Recently, a new class of pharmaceuticals have been added to the mix. SGLT2 inhibitors such as canagliflozin, dapagliflozin, and empagliflozin.

Pharma may result in some significant improvement but also significant side effects. And your cardiovascular issues are not related to a pharma deficiency. 

Is there a long-term plan to get you off the drugs? At NHD, our goal is always to safely reduce and/or eliminate pharmaceutical usage. 

NHD Testing (Test, Don’t Guess)

At Natural Heart Doctor, we believe in using the most advanced testing in the world to find the WHY someone has disease and use the information to FIX the problem. You can read more about testing on our website. Level 2 is usually a good place to start. 

You see, vitamin and mineral deficiencies are linked to low ejection fraction. What if a B1, zinc or copper deficiency is causing your heart failure? What if low levels of magnesium, potassium, copper and/or zinc are the source? Or mold mycotoxins or environmental toxins? 

Mainstream doesn’t get this as it is not how we are trained. But their lack of knowledge in this area is especially troublesome for so many. 

Don’t forget to get tested for sleep apnea. We recommend the WatchPAT home test here

Nutritional supplementation for low ejection fraction

It is very important to get appropriate lab testing and treat the results. But here are some recommendations based on data and what has worked for my patients.

We have a full protocol of options for people with low ejection fraction. You can learn more about our Level 1, 2, and 3 by clicking here. We suggest using the full spectrum of those products as tolerated. And if you have questions about any of the above, please email us or  schedule a free health coaching call. Our doctors, of course, are always available for consultation as well. Just click the appointments tab on the menu bar. 

Biohacking for low ejection fraction

I am not going to bore you with the science on why the following works. If you want more information on these modalities, please search our website or that of the companies we recommend for said biohacking strategies. Emailing us is always offered to you as an option. 

  1. Sauna
  2. Red light therapy
  3. Essential oils (I like the Circulation blend)
  4. VieLight

Follow Up

Our typical approach is to try our methods and re-test the ejection fraction in 6 months. At that time, hopefully the EF is improved and pharma can be reduced. Either way, we give people options and discuss the best plan of action for the individual. 

Please consider:

  1. A free coaching call for the best plan for you
  2. A 2nd opinion consultation with one of our providers

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As a Naturopathic Physician, I am trained to treat the whole person and get to the root cause of disease.

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About Dr. Jack Wolfson DO, FACC

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Dr. Jack Wolfson is a board-certified cardiologist, Amazon best-selling author, husband, father, and the nation’s #1 Natural Heart Doctor.

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Our chiropractor is an expert at adjustments and holistic chiropractic care and works closely in conjunction with the other health care experts at Natural Heart Doctor.

Call (480) 535-6844 for details and scheduling.

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We use specially formulated natural vitamins and minerals that are injected into a vein to prevent or treat dehydration. Ideal for people in Arizona.

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Stimulate your body’s natural healing abilities and promote physical and emotional well-being with acupuncture at Natural Heart Doctor.

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Health Coaching

Our health coaches use evidence based skillful conversation, clinical interventions, and strategies to engage you actively and safely in health behavior changes.

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We use the most advanced testing in the world to assess heart health and to identify the root cause of your health issues.

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Office Visits

Schedule an office visit with one of our cardiologists, holistic physicians, chiropractor, or health coaches.

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Frequently Asked Questions

I’d like to receive an online second opinion from Natural Heart Doctor. What do I do next?

You can initiate a second opinion online through our website at any time. To begin, select the team member you’d like to speak with and open an account.

Click here for cardiologist Dr. Jack Wolfson.

Naturopathic Medical Doctor Dr. Lauren Lattanza. Get details.

Naturopathic Medical Doctor Dr. Tonia Rainier. Get details.

Click here for  Natural Heart Doctor Health Coach.

Alternatively, you can email A member of our care team will help guide you through the process of starting a second opinion.

What is the cost of a Natural Heart Doctor Online Second Opinion?

The cost for most second opinions varies by team member. This fee includes information collection, a phone or video consultation, a second opinion from a Natural Heart Doctor specialist and guidance throughout the process from your personal Care Team at Natural Heart Doctor.

Cardiologist Dr. Jack Wolfson’s Second Opinion Fee is $1500.

Holistic Physician’s Dr. Lauren Lattanza’s Second Opinion Fee is $250.

Naturopathic Physician Dr. Tonia Rainier’s Second Opinion Fee is $250.

Note: We apply the Online Second Opinion Call fee as a credit to any future consultations with Natural Heart Doctor, should you choose them.

Will my insurance cover the cost of a Natural Heart Doctor Online Second Opinion?

Most likely, no. Most health plans do not cover online second opinions or consultations. You are responsible for the cost of our second opinion. Natural Heart Doctor cannot file a claim with your insurance carrier, nor can we provide a procedure (CPT) code for this service.

What is the timeline to receive an online second opinion?

We do our best to schedule your second opinion as quickly as possible. Typically, it takes 5 to 7 business days after your information has been collected to receive your phone or video online second opinion.

What information do you need in advance of our call?

Our office will send you a short questionnaire to complete and return. We DO NOT need your complete medical records.

How many questions can I ask the expert during our call?

You may ask a maximum of five questions. This is to ensure that the expert has sufficient time to devote to each question. All questions must be finalized before your online meeting.

What should I expect to receive once my second opinion is complete?

You will receive a summary of our discussion along with our second opinion. The second opinion will be in written form. After you have reviewed the second opinion, a Natural Heart Doctor clinician will follow up with you by phone to address general medical questions about the information provided in the second opinion.

What if I have follow-up questions for the expert after I have reviewed my second opinion?

If you have a clarifying question about an expert’s response to one of the questions in your second opinion, and the Natural Heart Doctor clinician is unable to address it, then you may request a follow up session for an additional fee. 

Is my medical and payment information secure?

Natural Heart Doctor is strongly committed to protecting the privacy and security of all our patients. Our website meets all federal requirements for protecting personal health information under the Health Insurance Portability and Accountability Act (HIPAA). All financial transactions are processed by Natural Heart Doctor securely using industry standard payment processing tools.

I would rather visit Natural Heart Doctor for an in-person appointment. What should I do next?

If you would prefer an in-person appointment at Natural Heart Doctor instead of an online second opinion, please call (480) 535-6844 for details and scheduling.

Can I schedule a follow up appointment with the specialist who provided my online second opinion?

Yes, we’re happy to help you on an extended basis. Our clinician can discuss options with you when presenting our second opinion summary.