Tips and Tricks for Improving Firefighters’ Diets

Every day, firefighters respond to calls that may require them to perform dangerous and physically demanding jobs. To push their bodies to this high level of exertion in high-stress situations, firefighters need healthy hearts. Unfortunately, cardiovascular disease (CVD) represents a leading cause of death in the United States and is even more prevalent among the firefighter population. More than 45% of firefighter line-of-duty deaths (LODDs) are cardiac related.1 Some of the leading risk factors for CVD are inactivity, poor diet, obesity, and smoking. Both volunteer and career firefighter populations have high percentages of each of these risks.

Currently, there is a major public health initiative to improve the American diet, as society knows that healthy eating is one great way to decrease risk for CVD. In fact, the recent statistics from the American Heart Association report that more than 45% of the deaths attributed to CVD are related to diet. (1) Despite this, a well-balanced diet is often overlooked by many firefighters whose jobs consist of unpredictable, stressful calls with often large stretches of sedentary behavior in between.2 Instead, eating whatever food is easiest or quickest to grab between calls is sometimes the norm. This type of eating pattern is not beneficial to the work requirements or the overall health of firefighters. Simple changes in diet habits and incorporating healthy choices into the daily regimen could save lives in the firehouse.

Firefighter Diet Compared to Recommended Diet

Currently, there is not much research focusing on the diet of volunteer firefighters. Therefore, the question we examined recently was, how does the diet of the suburban volunteer firefighter look? It has been reported that most firefighters tend to overestimate their overall health and diet,3 so we conducted nutrition workshops and collected three-day diet information from firefighters to see how their diet actually was. The workshops were held in fire stations from the greater Philadelphia suburban area. Crews were given context on healthy eating, and a group examination of several sample diets was done. Prior to the workshop, we asked the firefighters to report everything they ate and drank for three days. Using a diet analysis software program, we recorded and averaged macronutrient and micronutrient composition of the diets. We then compared the diets with the nationally recommended values.

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Overall, the volunteer firefighter diets did not meet portion-control recommendations and consisted of lots of processed and fried foods. Most of these foods were fast-food options that are easy to grab but are nutrient poor. We found that 44.4% of firefighters exceeded the recommended fat intake and did not meet the recommended carbohydrate intake. Furthermore, 75% of the firefighters in our study exceeded the saturated fat recommendation of less than 10 percent of overall calories. Also, it appears that many volunteer firefighters may lack in vital micronutrients, vitamins, and minerals. We found the following:

• 75% of the firefighters were below the recommended intake of >75 mg of vitamin C, with overall average consumption of 50.8 mg.
• 97% were below the recommended intake of >15 µg of vitamin D, with overall average consumption only at 4.2 µg.
• 75% were below the recommended intake of >1,300 mg of calcium, with overall average consumption of 961.9 mg.
• 94% were below the recommended intake of >410 mg of magnesium, with overall average calculated at 227.1 mg.
• 97% of the firefighters were below the recommended intake of > 4,700 mg potassium, with overall average consumption of 2,177.7 mg.
• 78% were below the recommended intake of >11 mg of zinc, with overall average consumption of 9.7 mg.
• 78% exceeded the recommended intake of < 2,300 mg of sodium, with overall average consumption measured at 3,406.3 mg.
• More than 90% of the firefighters did not consume enough fiber, 60% consumed too much sugar, and 33% exceeded cholesterol levels.

This pilot study proved to us that volunteer firefighter diets are severely deficient in many micronutrients.

Balanced Diet Important

The intensity and type of work firefighters engage in necessitate that they consume an adequate daily diet. Diet is a leading modifiable risk factor for CVD. Adequate consumption of micronutrients is crucial to maintaining a healthy heart and blood vessels. Decades of research have reported that diets rich in fruits and vegetables improve heart health. A balanced diet that is rich in vitamins and minerals can also help combat other diseases. For example, diets rich in micronutrients from consumption of fruits and vegetables are known to reduce cancer risk. Recent health protection initiatives in cancer prevention focus on cleaning gear and cabins and proper wipe-down of skin immediately following exposure. Lifestyle modifications may help as well.

Specific micronutrients that should be mentioned are fat, sodium, calcium, and vitamin D. It is known that excess fat consumption is a large contributor to CVD. High saturated fat intake has been linked to blood vessel disease, heart attack, atherosclerosis, stroke, heart disease, and overall high cholesterol levels. (2) Saturated fats are found in animal products such as red meat and dairy. According to the three-day firefighter diet analysis mentioned above, animal products were prevalent. Additionally, high sodium consumption has consistently been shown to be related to a higher risk of cardiovascular mortality.4 Sodium is often found in fried fast foods common in a firefighter’s diet. High levels of dietary sodium directly increase blood pressure, leading to hypertension, and can cause dysregulation in kidney function. High sodium intake is closely related to salt-sensitive hypertension, which is a huge risk factor for CVD and increased mortality. (4) Finally, calcium and vitamin D play a vital role in cardiac health. Deficiencies in both have been related to the onset of metabolic syndrome and atherosclerosis.5 It is thought that the association between low levels of vitamin D and calcium and cardiac death may be related to vitamin D’s role in the vagal response and calcium’s role in the parasympathetic response.6 Firefighters consume too much fat and sodium and not enough calcium and vitamin D.

Making Realistic Changes

Fire departments should initiate programs that improve the nutritional content of diets in the firehouse and on the fireground. A simple way to enable change is to evaluate the foods each time crews eat together—for example, snacks on training night, purchased meals, and food provided during long calls. Meals and snacks should be healthier options. It has been found that firefighters do want healthier diets. A recent study conducted to examine firefighter food preferences revealed that many firefighters would prefer to learn about and adopt a dietary pattern like the Mediterranean diet,7 reported to be one of the top two diets for heart health for several years now. This diet cuts down on the sugary and fatty foods, thus inherently reducing the risk of heart disease, and promotes whole grains, fruits, vegetables, fish, legumes, unsaturated fatty acids, and oils. It encourages moderate consumption of poultry, eggs, cheese, and yogurt as well as low consumption of sweets and red meats.8 There is no established diet called the Mediterranean diet; it is a dietary pattern. Firehouses can work toward modeling firefighters’ diet close to that advocated by the Mediterranean diet. Other diets that also promote similar eating habits include the Nordic, Paleo, TLC, and DASH diets.9

Tips and Tricks for Healthier Eating

Keep it simple. This is the easiest way to enable change and create healthy routines. Some simple and fun tips and tricks for improving eating habits include the following:

• Replace some of the starchy carbohydrates with fruits and vegetables.
• Try a smoothie for an easy snack on the go. Smoothies are super filling, as they are primarily water based, but they have many vitamins, minerals, and healthy antioxidants.
• Instead of snacking on a bag of potato chips, grab some cut-up fruits or vegetables. This is a simple way to reduce saturated fat and sodium consumption (often found in chips). If you don’t like raw vegetables, roast or bake them. If you don’t like plain vegetables or fruit, add nut butter (not regular butter) or cinnamon as a topping. Although dips such as nut butters are higher in calories than regular butter, these calories are much more nutrient dense and are, therefore, a healthier decision.
• Add fruit to sweeten any meal. Oatmeal, whole-wheat cereal, or whole wheat bread is much tastier when berries are added.

Lunch and Dinner Options

Sandwiches, wraps, and burgers can be converted into lower-fat options by swapping out fatty meats for leaner, healthier protein sources. Instead of beef, swap in some turkey, chicken, or fish. Salmon is a great option because it can help increase the healthy unsaturated fats that tend to be low in the firefighter diet.

Switch out white breads for whole-wheat varieties, or replace the bread slices with bell pepper slices or lettuce cups.

At dinner, swap regular pasta for whole-wheat noodles, spaghetti squash, or zucchini noodles. Replace white rice with cauliflower, broccoli, or brown rice. For dessert, choose a heart-healthy sweet treat. You can make apple nachos by slicing your favorite type of apple and drizzling some nut butter and cinnamon on top.

Any of these options will increase daily intake of essential vitamins, minerals, and fiber while cutting down on sugars, salts, and saturated fats. Additional tips and photos of healthy and creative food options are at Paige DeAlba’s page on Instagram (@Platedbypaigee).

Overlooking the diet can lead to LODDs that could be prevented. Collectively, our community needs to do a better job of addressing this issue. All firefighters need to make an effort to adjust their diet and support their fellow firefighters in doing the same. Even if the modifications are small at first, small steps will eventually lead to big health changes. Experimenting with different types of foods, cooking together at the firehouse, and challenging each other to improve the diet will lead to healthier hearts and overall healthier firefighters.

References

1. Soteriades, ES, DL Smith, AJ Tsismenakis, DM Baur, SN Kales. Cardiovascular disease in U.S. firefighters: a systematic review. Cardiol in Rev. 2011; 19(4):202-15.

2. Benjamin, et al. (2018) AHA Statistical Update. Heart Disease and Stroke Statistics – 2018 Update. A Report from the American Heart Association. Circulation, 137.

3. Baur, DM, CA Christophi, AJ Tsismenakis, SA Jahnke, & SN Kales. (2012). Weight perception in male career firefighters and its association with cardiovascular risk factors. BMC Public Health. 12(1).

4. Pilic, L, CR Pedlar, & Y. Mavrommatis. (2016). Salt-sensitive hypertension: mechanisms and effects of dietary and other lifestyle factors. Nutrition Reviews, 74(10), 645-658.

5. Lutsey, PL, & ED Michos. (2013). Vitamin D, calcium, and atherosclerotic risk: evidence from serum levels and supplementation studies. Current atherosclerosis reports, 15(1), 293.

6. Mann, MC, DV Exner, BR Hemmelgarn, DY Sola, TC Turin, L Ellis, & SB Ahmed. (2013). Vitamin D levels are associated with cardiac autonomic activity in healthy humans. Nutrients, 5(6), 2114-27.

7. Yang J, A Farioli, M Korre, SN Kales. Dietary Preferences and Nutritional Information Needs Among Career Firefighters in the United States. Glob Adv Health Med. 2015; 4(4):16-23.

8. Pastori, D, R Carnevale, S Bartimoccia, C Nocella, D Tanzilla, R Cangemi, P Pignatelli. (2015). Does Mediterranean Diet Reduce Cardiovascular Events and Oxidative Stress in Atrial Fibrillation? Antioxidants & Redox Signaling, 23(8), 682-687.

9. Park, YM, SE Steck, TT Fung, J Zhang, LJ Hazlett, K Han, & AT Merchant. (2016). Mediterranean Diet, Dietary Approaches to Stop Hypertension (DASH) style diet, and metabolic health in U.S. adults. Clinical Nutrition. 36(5):1301-13094.

EMILY BLASZKOW, EMT, is a biology major with plans to attend physician assistant school. She has worked as a student researcher in the HEART Lab with Dr. Deborah Feairheller for the previous three years, and she is the lead investigator on firehouse fitness. She is an EMT for Mill Creek (DE) Fire Company.

PAIGE DeALBA is a health and exercise physiology major with plans to become a registered dietician or a wellness coordinator. She has worked as a student researcher in the HEART Lab with Dr. Deborah Feairheller for the previous two years, and she is a lead diet investigator. She also works at Main Street Nutrition near the Ursinus College campus in Collegeville, Pennsylvania.

LAUREN STEPHENS CHAVIS is an employee at the National Institutes of Health and works as a clinical research assistant for the Environmental Autoimmunity Group. She is involved in patient research in autoimmune diseases, including myositis. She was the lead investigator on the diet workshop program when she was a researcher in the HEART Lab.

DEBORAH FEAIRHELLER, PhD, FACSM, is a firefighter with Collegeville (PA) Fire Company. She is an associate professor and a department chair in the Health and Exercise Physiology Department at Ursinus College in Collegeville. Her research lab, the HEART (Hypertension & Endothelial function with Aerobic & Resistance Training) Lab, examines the effect of lifestyle modifications on hypertension, ambulatory blood pressure, and vascular structure and function. As a firefighter, she has a vested interest in getting the fire service physically active and improving cardiac health.