Sports Nutrition Considerations for Firefighters

ENERGY AND CALORIC INTAKE DEMANDS OF FIREFIGHTING

Firefighters require robust cardiorespiratory and musculoskeletal systems to meet their occupational demands, which are physically, physiologically, and mentally arduous and environment-dependent (14,17,18,33,43). Often, firefighters must carry heavy equipment and perform search and rescue operations while exposed to heat stress. In fact, during live fire suppression, firefighters are exposed to heat stress from the environment, and their personal protective equipment (PPE) poses additional issues (e.g., compromised thermoregulation) (3). In addition, firefighters have varied nutritional requirements that vary based on lifestyle factors (e.g., firefighters may have increased nutritional needs if they are engaged in heavy resistance and/or aerobic-based training) and personal health challenges (e.g., hyperenergetic and poor diets, physical inactivity, sleep loss, and excessive alcohol consumption). Nutritional needs can vary drastically depending on the context of the lifestyle and personal health choices the firefighter engages in. Importantly, energy provisions and nutrient timing are important principles of nutrition that firefighters need to consider to support physical and cognitive performance and ensure readiness to respond to occupation-specific stressors (17,23). In addition, strategies to ensure proper hydration and recovery from stressful occupation-specific response scenarios are paramount to the firefighter’s optimal health and performance.

It is well-established that structural firefighters experience high rates of significant cardiac events on duty (e.g., sudden cardiac death) due to the stressful nature of the occupation (11,12,15,24,25,26,27). Reports have shown a high prevalence of cardiovascular disease (CVD) risk factors, wherein approximately 75% of firefighters are classified as overweight or obese (40,46). These CVD risk factors have been strongly connected to poor nutritional habits, physical inactivity, and occupational stressors (17). Nutritional strategies that can improve health outcomes (e.g., improving blood lipids and aiding in weight loss) are also critical to a firefighter’s ability to meet their occupational demands. This article will highlight recent key dietary practices and provide practical applications for implementing these practices for firefighters.

GENERAL ENERGY AND MACRONUTRIENT GUIDELINES FOR FIREFIGHTERS.

Adequate energy, macronutrient provisions, and nutrient timing can substantially affect firefighters’ health and fitness. Nutritional needs of firefighters can drastically vary depending on individual factors, such as metabolic rate, pre-existing conditions, age, gender, and activity level. Therefore, it is critical to consider these. factors while being flexible in any diet approach being utilized. For instance, the firefighter may face a period of heightened energy expenditure, which will increase their nutritional needs to offset this and facilitate recovery. Conversely, there are times when the firefighter is less physically active (unless they are engaged in regular resistance and aerobic-based training) and will not have as much of an increased nutritional need. Recent guidance suggests that firefighters focus on consuming a diet that provides energy, macronutrients, and micronutrients to support their daily energy and nutritional needs (17). Importantly, these nutritional provisions mimic pre-established guidance for recreationally active individuals who may be engaged in general fitness programming (e.g., resistance and aerobic-based training three days per week for 30 – 40 min) or more intense training (e.g., 5 – 6 days per week of 1 – 2-hr training sessions) (16,17). Many of these guidelines have been published in free access journals and are therefore readily accessible for the individuals to use as general guidance for a nutritional approach that factors in exercise training (e.g., pre- and post-exercise food or drink consumption) (17,29,30). Firefighters must also consider their physical activity levels (e.g., exercise and occupational response activities) to estimate their daily energy and macronutrient needs. The Mifflin-St. Jeor or the Harris-Benedict equations can be combined with their appropriate physical activity factor and additional caloric expenditure from exercise and occupational tasks (38,41). Once energy expenditure is estimated, the firefighter can monitor their daily nutritional intake and weight over roughly 2 – 3 weeks to gauge a maintenance daily caloric goal. Based on practical experience, the following four-step approach is recommended for establishing one’s maintenance caloric goal:

• Step 1: Maintain your current lifestyle—do not change your eating, exercising, or training habits for two weeks.
• Step 2: Track your calories (and macronutrients) daily for two weeks. Do not change your eating habits (i.e., do not add or subtract from your normal eating habits yet); in other words, eat as you usually do and keep a food log of your normal diet.
• Step 3: Weigh yourself every morning after waking.
• Step 4: Take a two-week average of your body weight

Once this maintenance caloric goal is known, the firefighter can choose to eat in a surplus (to gain weight or muscle mass) or in a deficit (to lose weight). In addition, the firefighter can employ evidence-based diet and supplementation strategies, coupled with tracking one’s caloric intake. To date, 11 research studies have been carried out, highlighting dietary habits and potential diet and supplementation strategies that may help a firefighter be occupationally ready (1,6,13,20,35,36,37,44,47,48,49). These strategies will be summarized within the following section, and it is important to note that these are potential strategies for consideration, but these may not work for everyone.

CONSIDERATIONS FOR FIREFIGHTER HYDRATION

Hydration is vital for firefighters, who are subjected to extreme heat stress. Dehydration beyond two percent of bodyweight loss can impair physical and cognitive performance (7,39,50). Generally, individuals are not great at gauging their hydration status based on thirst, especially in hot environmental conditions. Therefore, a three-step approach is recommended to reduce the risk of hydration issues: 1) evaluate thirst, 2) monitor urine color via a color chart, and 3) weigh oneself each morning and/or after emergency responses (if possible) (8). From an educational standpoint, fire departments may consider placing urine color charts within the bathrooms to help reinforce monitoring urine color at the station. While specific guidelines for firefighters have yet to be established, males and females are recommended to consume approximately 3.7 L/day and 2.7 L/day, respectively

(21). Importantly, awareness and practice of this approach could aid firefighters in preventing serious complications during emergency responses.

DIETARY CONSIDERATIONS

Certainly, the foundational tenet of any weight loss program is maintaining a negative energy balance induced through reduced dietary intake and increased physical activity (4). This is important considering the high prevalence of overweight and obese firefighters (40,46). While there is no one-size-fits-all diet for any individual, several diets studied among firefighters have shown promise in combating CVD risk factors. The Mediterranean diet, carbohydrate-restricted diet, and time-restricted eating have all been employed by researchers to improve health and performance outcomes (1,13,20,36,37,44,48,49). These dietary approaches have some promise, and individuals likely practice these already. It is also critical that firefighters practicing these dietary approaches know the literature regarding these diets and how to leverage them best. For instance, consider time-restricted eating, which is focused on fasting and eating durations within a given day (i.e., 16 hr of fasting and eight hours of eating). The three studies employing a time-restricted feeding approach show promise in health (e.g., reductions in oxidative stress and inflammation biomarkers) and performance outcomes (e.g., maintained muscular strength and endurance) (13,36,37). However, a firefighter needs to be flexible, especially when responding to an emergency call during their fasting window. In this example, the firefighter should prioritize energy and nutrient provisions to facilitate quicker recovery and hydration to offset energy expenditure. Nevertheless, any of these diets studied among firefighters and others comprehensively reviewed can be coupled with the aforementioned energy and nutrient approach (some factors may vary) (4). Generally, individuals are not likely to accurately estimate (without tracking for accountability) their caloric intakes and may undereat or overeat, which has been shown in previous research (5,34,42). Firefighters need to be aware of their daily caloric consumption. Therefore, regardless of the diet practiced, the authors recommend that firefighters track their food and beverage intake.

DIETARY SUPPLEMENTATION FOR FIREFIGHTERS

Firefighters should prioritize lifestyle changes to reduce their risk of obesity, CVD, and other comorbidities. For example, firefighters should aim to consume a well-balanced diet while being mindful of the portions of their meals and caloric intake. However, several key nutrients can be supplemented to benefit active-duty firefighters and should be considered. Table 1 presents a list of potentially beneficial dietary supplements that firefighters should consider. It is paramount for firefighters to ensure the dietary supplements they are using are third-party tested (e.g., National Sanitation Foundation [NSF] third-party tested), and it is recommended to check with one’s physician or a registered dietitian before starting any supplementation. It is also worth mentioning that a “food-first, but not food-only” approach is likely needed considering the unpredictable nature of firefighting (9). For example, experiencing numerous response calls may limit time for firefighters to prepare meals, and on-the-go bars (e.g., carbohydrate or protein bars) and beverages (e.g., sports drinks) may be a quick go-to during these times. For a comprehensive review of these supplements, the interested reader should review the open access position regarding these nutrients (28).

PRACTICAL APPLICATION

Firefighting is a challenging occupation, and there is a critical need for more awareness and education regarding nutrition and how to implement the best evidence-based practices that can mitigate the deleterious effects they endure mentally and physically. Presently, there are limited data regarding firefighter nutrition, but there is growing interest in this research space. Firefighters will likely benefit from practicing guidelines outlined in the 2022 International Society of Sports Nutrition Position Stand (4). In summary, the firefighter and tactical facilitators must consider the demands of the occupation and how physically active the individual is. From there, one can estimate daily caloric needs and decide whether the goal is to gain or lose weight. Then, it is best to follow the guidelines for energy and macronutrient provisions and timing outlined in previously discussed research, which can be coupled with any diet of preference (7,29,30). Hydration is also necessary; firefighters should ensure they regularly consume water throughout the day and replenish it with electrolytes in response to emergency calls. Lastly, dietary supplements and grab-and-go bars and foods/beverages can be used as a quick solution when energy and nutrients are needed but time is limited. Taken together, this is a flexible blueprint for an evidence-based nutritional approach that firefighters should consider following.

Adapted with permission from Alvar, BA et al. (2).

*The reader is directed to the ISSN Position Stand on Research and Recommendations for a complete list of nutritional ergonomic aids of vitamins (29).

**The reader is directed to the ISSN Position Stand on Research and Recommendation and the ISSN Position Stand on Protein and Exercise (22,19).

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This article originally appeared in TSAC Report, the NSCA’s quarterly, online-only publication geared toward the training of tactical athletes, operators, and facilitators. It provides research-based articles, performance drills, and conditioning techniques for operational, tactical athletes. The TSAC Report is only available for NSCA Members. Read more articles from TSAC Report