Dr. Emma Petshow on Naturopathic Approaches to Heart Health

Course director of cardiology and pulmonology at NUNM discusses common symptoms, lifestyle modifications, and personalized patient care to support cardiovascular health. 

Emma Neiworth Petshow, ND, CPT

From understanding risks and symptoms to making changes in diet and sleep, National University of Natural Medicine (NUNM) faculty member Emma Neiworth Petshow, ND, CPT shares her naturopathic approaches to maintaining a healthy heart.

“About 80 to 90% of cardiovascular disease itself can be prevented,” said Dr. Petshow, course director of Cardiology and Pulmonology and assistant professor, “so naturopathic doctors and naturopathic medicine can really fill that space and help support patients by reducing this big disease component.” 

Common Risk Factors & Symptoms 

Some of the most common risk factors for heart disease are silent. Examples of risk factors can include: 

  • high blood pressure 
  • elevated cholesterol 
  • tobacco use 
  • sedentary lifestyle 
  • chronic stress 

These along with symptoms such as dizziness, new onset headaches, or fatigue could indicate something is going on within your body that your doctor should look at. You can visit your primary care physician, which includes naturopathic doctors, to get screened for these risk factors, and then have conversations about what they mean and how you can optimize them to reduce your chances of cardiovascular disease.  
Examples of urgent or emergent symptoms, that could indicate acute coronary syndrome, include:  

  • chest pain  
  • feeling a sensation of an elephant sitting your chest 
  • having new onset shortness of breath 
  • trouble breathing 
  • feeling pain that radiates down your left arm  

“Those could all be signs of a heart attack or other emergent condition,” Dr. Petshow said, “so it’s important then to seek urgent evaluation. That would be straight ‘Don’t pass go,’ go to the ER, the emergency department, for proper evaluation.” 

Once you are stable and healthy, then you can revisit with your primary care physician, whether that is an ND, MD, or other medical provider, to help support you after that process. 

Simple Lifestyle Modifications 

As naturopathic doctors, there are four foundational health components to maintaining a healthy cardiovascular system:  

  1. nutrition
  2. exercise
  3. stress reduction
  4. sleep optimization


“Diet is a funny thing because it’s really one of the most intimate things we can change in our lives,” Dr. Petshow said. “It involves not only our personal relationship with food, like our experience and habits with food, but it also includes our culture, our family habits, and our social engagements. There are so many social aspects with food and eating, so there are many pieces that play into dietary change.” 

When working with patients, Dr. Petshow often starts with additions to a patient’s diet to help support healthy heart outcomes. “Some interesting research we’ve been talking about in the cardiovascular field is the addition of potassium rich foods,” she said, “things like bananas or sweet potatoes, that can actually help to promote cardiovascular health.” Depending on the patient, Dr. Petshow also looks at whole dietary framework shifts to optimize a patient’s cardiovascular health, such as the Mediterranean diet.  

“When talking with patients, I go from a health-at-any-size approach,” Dr. Petshow said, “so we talk about diet and exercise as ways of improving health, but not just for weight reduction. I want to support your health and your wellness journey wherever you’re at, and we don’t have to focus on a number on the scale to do so.” 


As a certified personal trainer through the American College of Sports Medicine, Dr. Petshow’s passion for physical movement guides her discussions with patients surrounding exercise activities they can do to support heart health. As a general guideline, NDs recommend 150 minutes (about 2 and a half hours) of moderate intensity aerobic activity per week. Dr. Petshow describes moderate intensity activity as “when you can speak in full sentences, but you cannot sing a song”. This amount of activity can be broken down into as small as one-minute increments, or it could be as large as whatever fits in your day.  

“I always say there’s twenty-four hours in a day. For twenty-three and a half of those hours, you can do whatever you want or need to do but save 30 minutes to put in some purposeful movement, whether that’s a dance break, a walk, a hike, playing basketball, whatever that looks like to you.”  

If patients come in with more extensive exercise backgrounds, Dr. Petshow will develop workout programs specially tailored to their needs.  

Stress Reduction and Sleep Support 

Since Dr. Petshow also teaches physiology and pathology within NUNM’s biomedical science curriculum, she uses her background to look at the body through three lenses: how the body should be working, what happens to the body when dysfunction or disease occurs, and how to move the body back into a healthy state. 

While stressed, we might feel our heart racing, feel butterflies in our stomach, or feel nauseous, but stress also causes effects inside the body. These effects of stress can be related to our nervous system, specifically the sympathetic nervous system, which releases norepinephrine and epinephrine.  

 “Norepinephrine and epinephrine can act on the heart causing an increase in heart rate, make our heartbeat faster, and can raise our blood pressure. Both of those things together can be risk factors for different heart conditions, whether it’s a weird heart rhythm like an arrhythmia or just high blood pressure in general, which is a risk factor for a whole host of different cardiovascular diseases.”  

 By improving our response to stress, we can directly see improvements in heart health. Practices like deep breathing exercises, meditation, and walks after meals are simple actions patients can implement to help improve their body’s stress levels. “Something as simple as gargling water can send a relaxation response through the body. It can trick our body by sending signals to our brain by stimulating the vagus nerve, which is this nerve that helps our nervous system relax and counters our stress response.” 

By improving our response to stress and decreasing chronic stress throughout the day, we can see improvements in sleep duration and quality of sleep. 

Personalized Care & Women’s Cardiovascular Health  

By embracing the role of “Doctor as Teacher,” a foundational principle of naturopathic medicine, Dr. Petshow says NDs can help educate patients on the symptoms of cardiovascular disease and the science behind preventive medicine. 

“The beauty of naturopathic medicine is I can spend 30 minutes with my patient talking about these risk factors and really educating and having conversations. I don’t have to try to synthesize it into a really short convo. I think that allows for a better understanding and better dialogue.” 

For example, cardiovascular disease is the leading cause of death in women globally, so it is important for women and people with monthly hormone cycles to understand that their symptoms and risk factors can vary and differ from men’s symptoms and risk factors. While a “classic presentation” of a heart attack is left-sided chest pain that like moves down the arm (common in men), women often present with nausea or vomiting as a standalone symptom. It also could present as shortness of breath, just back, or jaw pain. 

Females also go through hormonal changes that are completely different than men.  
Whether it’s going through puberty or menopause to certain conditions like endometriosis, polycystic ovarian cysts, or even pregnancy, all those different conditions can affect hormonal support within our bodies, and then that can affect cardiovascular disease outcomes. Even just going through menopause increases women’s risk of cardiovascular or heart disease.  

“It comes back to treating the whole human,” Dr. Petshow said. “We’re not cars where we can just treat one part of our body and then hope that everything else will be okay. If we affect the heart, we’re affecting another organ system. If we affect hormones, we’re affecting the heart or affecting metabolism, so it really is looking at us as humans as this interconnected system, and then approaching patient care holistically.” 

NUNM’s Naturopathic Medicine Doctoral Program includes over 4,100 hours of total instruction with 1,200 hours of hands-on clinical training. NUNM is also the first and only university to offer ND students the option of completing their first year entirely online. By offering the first year online, we’re giving prospective naturopathic medical students everywhere a more affordable and accessible option for their first year of medical school. 

by Jessica Salazar, Communications Manager