Ejection fraction (EF) is a measurement of how efficiently your heart is pumping blood each time it beats. Along with other clinical methods and tests, your EF can provide insight into different types and degrees of heart failure. 

Understanding how your EF measurement impacts your heart’s overall function can help you take appropriate steps to prevent complications from heart failure. In this article, we’re covering what you need to know about EF, plus foods to improve ejection fraction and other ways to help increase it naturally. 

What is Ejection Fraction?

EF is a measurement that represents the percentage of blood that is ejected from the left ventricle with each heartbeat. It’s a critical measurement in diagnosing and managing heart failure because it provides data about the heart’s overall function.

A lower EF is typically correlated with a more severe heart failure. People who have a severely low EF may be at higher risk for complications, such as arrhythmias or sudden cardiac death.

Heart Failure with Preserved EF vs Non-Preserved EF

Understanding EF helps differentiate between different types of heart failure: 

• Heart Failure with Preserved Ejection Fraction (HFpEF): This occurs when the EF is normal or near normal (usually above 50%), but the heart muscle is stiff and doesn’t fill properly. In other words, although the heart pumps a normal percentage of blood, the actual amount of blood being pumped is reduced.
• Heart Failure with Reduced Ejection Fraction (HFrEF): Also called non-preserved EF, this occurs when the EF is below 40%. It indicates that the heart’s left ventricle is not pumping blood effectively, often due to weakened heart muscle.

In both types, there’s an underlying factor of endothelial health (or dysfunction, rather). Heart failure is exacerbated by both endothelial dysfunction and arterial stiffness, which impair blood flow and increase stress on your heart, further deteriorating its ability to function properly and contributing to heart failure progression. 

The endothelium is the inner lining of your blood vessels, responsible for regulating vascular tone and maintaining vascular homeostasis. 

Endothelial dysfunction occurs when this lining becomes impaired, which results in reduced nitric oxide production and a reduced ability to dilate your blood vessels effectively. This also contributes to arterial stiffness, which forces your heart to work harder to pump blood throughout your body. This increased workload on your heart can reduce its efficiency, potentially lowering EF over time. 

Client Success Story

Before we get into how to improve ejection fraction, I want to share a client success story to encourage you that it’s possible to increase EF and improve heart health with science-based nutrition. 

A 60-year-old female with a history of genetic cardiomyopathy came to see me because, at her last echo, her ejection fraction was reduced to 25-30%. Her physician wanted her to go on a bunch of new medications and she was hesitant because of her history of bad side effects with various medications. She told the physician that she wanted to try to improve her diet for the next 3 months and retest her ejection fraction before she started any new medications. The physician agreed but he said he had insisted it wouldn’t change.

Despite her doctor’s skepticism, we worked closely together in my VIP Nutrition Program. Together, we focused on key areas affecting cardiovascular health: enhancing blood vessel integrity, reducing oxidative stress and inflammation, and improving gut health. Our strategy included adding specific, therapeutic foods into her diet to support her heart health.

Three months later, the results spoke for themselves. Her follow-up MRI showed an ejection fraction increase to 48% – a significant improvement that led her doctor to advise against adding more medications. This outcome was not just a victory for her but a testament to the power of nutrition in managing heart health.

When we focus on improving blood flow and reducing the cardiovascular burden on the heart through science-based nutrition, heart function can dramatically improve.

Science-based nutrition should be a part of every cardiovascular condition, whether it is genetic or lifestyle-induced because nutrition can help reduce the burden on the heart and improve cardiovascular function and quality of life.

This story is a powerful reminder of the role nutrition plays in cardiovascular health, whether addressing genetic conditions or lifestyle-induced issues. By focusing on science-based nutrition, we can reduce the cardiovascular burden and dramatically improve heart function and quality of life.

How to Increase Ejection Fraction Naturally: 5 Ways

You’re probably wondering how quickly you can see an improvement in EF when you implement lifestyle changes. Say, can ejection fraction improve in 3 months? While success stories are personal and depend on several factors, I can tell you that it’s certainly possible to see significant differences in EF when you know what to target. 

1. Manage Blood Sugar and Insulin Resistance 

Heart failure is associated with insulin resistance. Managing blood sugar may be important, even if you have not been officially diagnosed with diabetes, but may be experiencing symptoms of insulin resistance. 

When excess blood sugar levels are in the bloodstream, it can damage blood vessels and cause vascular disease, leading to dysfunctions in systolic or diastolic function, and negative left ventricular remodeling. Research also shows that insulin resistance can lead to the progression and decline of heart failure.

To protect your heart health, choose foods to improve ejection fraction that minimize spikes in blood sugar and support normal insulin sensitivity: 

• Spread your carbohydrate intake evenly throughout the day.
• Make half of your plate non-starchy vegetables. Non-starchy vegetables are also rich in vitamins and antioxidants that can protect against inflammation caused by diabetes.
• Increase the amount of soluble fiber in your diet to increase insulin sensitivity. Some foods that are major sources of soluble fiber include ground flax seeds, Brussels sprouts, artichokes, and avocados.
• Speak with a heart disease specialized registered dietitian about individualized daily carbohydrate needs to meet your lifestyle instead of following generic carbohydrate recommendations.

2. Choose Anti-Inflammatory Foods to Improve Ejection Fraction

Oxidative stress and inflammation are common with heart failure and the conditions that contribute to heart failure. Oxidative stress is an imbalance between the production of free radicals and the body’s ability to neutralize them with antioxidants, leading to cellular damage.

Excess oxidative stress and inflammation can be present when living with a heart condition and can be exacerbated by under or over-exercising, high stress levels, poor sleep, smoking, and unbalanced nutrition that is rich in saturated fat, refined sugars, and processed foods. 

What we add to the diet is equally important. Adding in antioxidant and phytochemical-rich foods, spices, and herbs to your diet can help improve blood vessel health and optimize blood flow. Various phytochemicals found in the diet are shown in research to be beneficial for heart failure. 

For example, blueberries are rich in phytonutrients including flavonols and polyphenols that protect against cardiovascular disease and other chronic diseases. The anthocyanins in blueberries are known to reduce inflammation, help reduce insulin resistance, support healthy fat metabolism, and support normal heart function.

Another example is cocoa flavonols from dark chocolate or cocoa powder are consistently associated with a reduced risk of heart failure, stroke, and overall cardiovascular disease incidence and risk. A 2021 review of studies shows that cocoa flavonols support improvements in blood pressure, arterial stiffness, and cholesterol levels.

3. Consume a Nutritionally Adequate Diet

Research finds that micronutrient and macronutrient deficiencies are more common in adults with heart failure and may contribute to worse health outcomes. This particular study found that above 20% of individuals with heart failure have a low intake of vitamin A, calcium, magnesium, selenium, and iodine, and up to 75% have a low intake of vitamin D. Another study would also add zinc to this list.

Other studies show that the prognosis of heart failure with a reduced fraction is poor when an iron deficiency is present, and it is present in above 59% of individuals with heart failure. 

Factors that contribute to nutrient deficiencies in heart failure include diuretic use, increased inflammation, reduced appetite, inadequate nutrient absorption, and changes in metabolism. High-quality diets can provide the nutrients needed to reduce your risk of heart disease and help prevent hospitalization and even death.

Focus on foods to improve ejection fraction, including heart-healthy vegetables and fruits, whole grains, heart-healthy fats, and lean protein. To support your gut health and reduce inflammation, choose foods that are rich in prebiotics and probiotics. Limit your consumption of added sugars and sugar-sweetened beverages, as well as red meat and highly processed meats.

4. Regular Exercise

Being sedentary increases mortality risk in heart failure patients. Not only can exercise protect against heart failure, but it can also help those with a diagnosis of heart failure strengthen their heart and slow the progression of heart failure. Studies find that consistent moderate-intensity exercise training can improve cardiorespiratory fitness, vascular stiffness, and cardiac structure and function.

Additionally, regular exercise is an important factor in weight management. Carrying excess weight puts additional strain on the heart, increasing the workload and contributing to conditions such as hypertension and arterial stiffness, which can worsen EF. 

Exercise needs to be gauged and individualized based on your medical history, and your exercise capacity. Your doctor or heart-focused dietitian can help make recommendations about the type and duration of exercise that might be best for you.

5. Smoking Cessation

Smoking increases heart failure risk and may contribute to ejection fraction decline by increasing systolic and diastolic blood pressure, pulmonary artery resistance, oxidative stress, and carbon monoxide exposure. It is also a risk factor for left ventricular hypertrophy, systolic dysfunction, and increased hospitalization from heart failure.

If you smoke, it is essential to speak to your doctor about quitting.

6. Optimize Your Stress and Sleep 

Chronic stress and poor sleep can lead to elevated levels of cortisol and other stress hormones. When left unmanaged, this can negatively impact heart function by increasing blood pressure and promoting inflammation. 

Managing your excess stress and ensuring adequate, restful sleep each night (experts recommend 7-8 hours per night for adults) can reduce strain on your cardiovascular system, and support a healthier EF and overall heart function. 

Stress management practices may include journaling, painting, listening to calming music, yoga, meditation, or going for a nature walk. Try to improve your sleep habits by implementing a consistent sleep-wake schedule, ensuring a comfortable sleep environment, and avoiding sleep disruptors close to bed, like eating a heavy meal, drinking alcohol or caffeine, and using technology. 

How to Increase Ejection Fraction: Final Thoughts

Ejection fraction is one key indicator of heart failure risk that, along with other tools, can provide data about how well your heart is functioning. There are things you can do to help improve arterial stiffness and EF and support your heart health naturally. Lifestyle changes and a science-based heart-healthy diet can support cardiovascular health and reduce the strain on your heart.

If you are looking for more of a 1 on 1 personalized approach for how to improve ejection fraction, I can help. Click here to schedule a 15 minute complimnentary discovery call to discuss further on how we can work together to create a personalized plan that helps you reach your heart health goals and improves your heart functioning.

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