Firefighter nutrition matters because heart attacks are the leading medical cause of on-duty deaths, and diet is a risk factor a crew can change. In the NFPA count for 2025, sudden cardiac death caused 42% of on-duty firefighter deaths. Harvard-led studies of US career firefighters link a Mediterranean-style diet with better cardiovascular risk markers. A station-randomized trial in Indiana showed that whole firehouses can shift how they eat.
Why does nutrition matter so much for firefighters?
The fire service tracks its deaths closely, and the heart shows up every year. The National Fire Protection Association (NFPA) counted 65 on-duty firefighter deaths in the US in 2025. Heart attacks caused 27 of them, or 42%, the largest share of any cause. Another 18 firefighters died of heart attacks or other medical conditions within 24 hours of duty (NFPA, 2026).
The report notes that heart attacks have been a leading medical cause of on-duty deaths "year in and year out". It names diet, physical conditioning, sleep and hydration as areas where firefighters can lower the risk of heart attack. It also recommends annual physicals with cardiac screening, especially for older firefighters (NFPA, 2026).
The job itself puts sudden strain on the heart. A Harvard study of on-duty deaths from 1994 to 2004 found that heart disease caused 45% of them. During fire suppression, the odds of a fatal coronary event were roughly 10 to 100 times those of nonemergency duties (Kales et al., 2007). You cannot change the alarm. You can change the baseline you bring to it, and food is part of that baseline.
That baseline is often under pressure. Among 413 Indianapolis firefighters entering a diet study, the average body mass index was 30.0 (Christodoulou et al., 2022).
What does the research say about a Mediterranean diet for firefighters?
Most of the firefighter diet research comes from one group: Stefanos Kales and colleagues at Harvard, working with Midwest fire departments. Their work has focused on the Mediterranean pattern. That means vegetables, fruit, beans, whole grains, fish, nuts and olive oil as the main fat, with less red meat, fried food and sugar.
| Study | Who | Design | What it found |
|---|---|---|---|
| Yang et al., 2014 | 780 male career firefighters, US Midwest | Cross-sectional, no diet change | Higher Mediterranean diet scores went with less weight gain, fewer metabolic syndrome components, higher HDL and lower LDL |
| Christodoulou et al., 2022 | 413 Indianapolis firefighters | Dietary pattern analysis | A Mediterranean pattern went with more favorable cardiometabolic profiles; a Standard American pattern went the other way |
| Hershey et al., 2023 | 485 firefighters, 52 stations, 2 Indiana departments | 12-month cluster randomized trial | Stations given the program raised their Mediterranean diet scores; cardiometabolic changes were not significant at 1 year |
The 2014 firefighter study. Yang and colleagues built a modified Mediterranean diet score (mMDS) from a lifestyle questionnaire. They matched it against fire department medical exams. Higher scores went with lower odds of reporting weight gain over the past five years (odds ratio 0.57). They also went with lower odds of metabolic syndrome components (odds ratio 0.65). Higher scores went with higher HDL cholesterol and lower LDL cholesterol after adjusting for age, BMI and physical activity (Yang et al., 2014).
The same study looked at what firefighters with obesity were eating. They had lower diet scores and reported more fast food and take-out. They also drank more sweetened drinks with meals. This was a snapshot, not an experiment, so it shows an association rather than cause and effect. The authors said their results justified intervention studies.
What was the Feeding America's Bravest trial?
Feeding America's Bravest was that intervention study. It was designed to change the food culture of a fire department, not just individual habits. The plan combined behavior-change methods with economic incentives, family and peer support, and changes to the station food environment (Sotos-Prieto et al., 2017).
Fire stations, not individual firefighters, were randomized. In the intervention stations, firefighters got supermarket discounts and free samples of Mediterranean foods. They also got online nutrition lessons, email reminders, education for family and peers, and chef demonstrations. Control stations kept eating as usual (Hershey et al., 2023).
The results were published in JAMA Network Open in 2023. Diet scores run from 0 to 51. Compared with control stations, scores rose by 2.01 points at 6 months and 2.67 points at 12 months. Changes in cardiometabolic risk factors, a secondary outcome, were not statistically significant at one year. The paper discloses that some food samples were donated by food companies, including olive oil producers.
The fair reading is this: a station-wide program changed what firefighters ate. One year was not enough to show changes in blood markers. A 2022 review of 34 firefighter diet studies adds a useful detail. Firefighters' food choices are often shaped by colleagues, and team counseling worked better than one-on-one counseling (Joe et al., 2022). In a firehouse, the crew is the unit of change.
What makes eating well hard at the station?
Anyone who has worked a 24-hour shift knows the problems. None of them are about willpower.
- Calls interrupt meals. Dinner goes cold on the stove, or gets eaten fast in the rig. Food that holds well beats food that has to be eaten hot.
- The house meal sets the menu. One cook feeds the whole crew. If that meal is fried or heavy, everyone eats it.
- Night calls bring night eating. In a lab study of simulated night shifts, a big meal at 00:30 left people slower and sleepier at 04:00 than a snack (Gupta et al., 2019).
- Convenience is close. Fast food and take-out on the way back from a call are easy. In the 2014 study, they were more common among firefighters with obesity.
- The day room has snacks. Chips, candy and soda are easy to share and hard to avoid.
What practical swaps work in a firehouse kitchen?
The trial changed the station food environment, so start there. These swaps follow the Mediterranean pattern the studies measured. None of them needs special equipment or a bigger budget.
| Instead of | Try | Why it fits |
|---|---|---|
| Butter, margarine or seed oil as the house fat | Extra virgin olive oil for cooking and dressing | Olive oil is the main added fat in the Mediterranean pattern |
| Fries or creamy mayo sides | Greek potato salad with olive oil and vinegar | Same potatoes, no deep fryer, and it holds through a call |
| Iceberg with bottled ranch | A real Greek salad (choriatiki) | More vegetables, olive oil as the dressing |
| Take-out on the way back | A planned second-day meal, such as leftover chicken pasta salad | Fast food and take-out were linked with obesity in the 2014 study |
| Soda or sweet tea with meals | Water, sparkling water or unsweetened tea | Sweetened drinks with meals were linked with obesity in the same study |
| Chips and candy in the day room | Nuts, fruit, olives, boiled eggs | Whole foods that fit the pattern and keep well |
| Red or processed meat most nights | Chicken, fish or beans several nights a week | The Mediterranean pattern goes lighter on red and processed meat |
A few habits help more than any single recipe:
- Buy for the house, not the person. The trial used discounts and free samples to put Mediterranean foods in front of crews. A house fund can do the same with olive oil, nuts, canned fish and beans.
- Rotate the cook, share the plan. Agree on a weekly menu as a crew. Change sticks when it is the crew's idea.
- Cook twice, eat twice. Make dinner big enough for the next day's lunch. It beats the drive-through after a long call.
- Keep the night light. Eat the main meal before the overnight hours and keep a small snack for later.
Where does olive oil fit in a firefighter diet?
Olive oil is central to the Mediterranean pattern, and it is easy to use at scale. One bottle dresses a crew's salads, potatoes and chicken. It is also fine to cook with at normal kitchen temperatures, as we explain in why cooking with real olive oil is safe. For what the largest olive oil trial did and did not show, read what the PREDIMED trials really proved.
Not all olive oils are the same. Extra virgin oils differ in their polyphenol content. In the EU, one health claim is authorized for these compounds: olive oil polyphenols contribute to the protection of blood lipids from oxidative stress. The effect is obtained with a daily intake of 20 g of olive oil containing at least 5 mg of hydroxytyrosol and its derivatives (European Commission, 2012).
Pomoni's founder, Dr. Peter Matos, served as a US Army Major and Command Surgeon at Joint Munitions Command. He is board-certified in preventive and occupational medicine. He wrote about firefighter nutrition for CRACKYL magazine, which we summarize in The Tactical Plate. For the wider picture across fire, police, military and the trades, see our guide to nutrition for tactical athletes.
Pomoni high-phenolic olive oil is an early-harvest Greek oil. It measured 635 mg/kg total polyphenols by HPLC.
Sources
- Campbell R, Petrillo J. Fatal Firefighter Injuries in the US in 2025. National Fire Protection Association. June 2026. nfpa.org
- Kales SN, Soteriades ES, Christophi CA, Christiani DC. Emergency duties and deaths from heart disease among firefighters in the United States. New England Journal of Medicine. 2007;356(12):1207–1215. doi.org/10.1056/NEJMoa060357
- Yang J, Farioli A, Korre M, Kales SN. Modified Mediterranean diet score and cardiovascular risk in a North American working population. PLoS One. 2014;9(2):e87539. doi.org/10.1371/journal.pone.0087539
- Christodoulou A, Christophi CA, Sotos-Prieto M, Moffatt S, Kales SN. Eating habits among US firefighters and association with cardiometabolic outcomes. Nutrients. 2022;14(13):2762. doi.org/10.3390/nu14132762
- Sotos-Prieto M, Cash SB, Christophi CA, et al. Rationale and design of Feeding America's Bravest: Mediterranean diet-based intervention to change firefighters' eating habits and improve cardiovascular risk profiles. Contemporary Clinical Trials. 2017;61:101–107. doi.org/10.1016/j.cct.2017.07.010
- Hershey MS, Chang CR, Sotos-Prieto M, et al. Effect of a nutrition intervention on Mediterranean diet adherence among firefighters: a cluster randomized clinical trial. JAMA Network Open. 2023;6(8):e2329147. doi.org/10.1001/jamanetworkopen.2023.29147
- Joe MJ, Hatsu IE, Tefft A, Mok S, Adetona O. Dietary behavior and diet interventions among structural firefighters: a narrative review. Nutrients. 2022;14(21):4662. doi.org/10.3390/nu14214662
- Gupta CC, Centofanti S, Dorrian J, et al. Altering meal timing to improve cognitive performance during simulated nightshifts. Chronobiology International. 2019;36(12):1691–1713. doi.org/10.1080/07420528.2019.1676256
- European Commission. Commission Regulation (EU) No 432/2012 establishing a list of permitted health claims. 2012. eur-lex.europa.eu
