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An Innovative Approach to Firefighter Health | The Berkeley Fire Department piloted a wellness program to improve the diet and stress levels of new recruits in order to prevent problems down the line. By Elly Schmidt-Hopper

Nico Guilford was nervous about beginning his training as a Berkeley firefighter. He wasn't so much concerned about the fact that his new career would send him into burning buildings and require taxing physical training, but because he was going to have to give up carbs.

For the first time this year, the Berkeley Fire Department piloted a health and wellness program in conjunction with its 20-week training academy. Designed and executed by Berkeley-based California Center for Functional Medicine, or CCFM, the program taught the 10 new recruits about diet, sleep regulation, and stress management, in addition to traditional training.

Guilford stopped eating pasta and learned to cook Brussels sprouts. A physical trainer added stretching to his workouts, and a yoga instructor led the recruits through poses. For two weeks, Guilford tracked the quality of his sleep with a wearable device. By the end of the 20 weeks, he had shed almost 30 pounds and 5 percent of his body fat. His cholesterol lowered and his blood pressure dropped to an ideal 107 over 60.

"My heart responded to it. My whole body responded," Guilford said. "I had no idea how I'd react."

Some of the results even surprised Dr. Sunjya Schweig and Chris Kresser, co-directors of the California Center for Functional Medicine, whose team developed the wellness program. Although the participants were young (and male), with an average age of 27, all 10 had blood tests that showed markers for inflammation. Left untreated, that inflammation could lead to chronic illnesses such as heart disease and diabetes.

"It's the standard American diet, plus poor sleep and exercise patterns, that can develop into significant problems," said Schweig.

But simple changes led to measurable results. The recruits did a two-week diet reset and cut out sugar, alcohol, and refined carbohydrates. They wore glucose monitors that tracked their blood-sugar levels every five minutes throughout the day and wore an Oura Ring, a device that tracks and rates activity, heart rate, body temperature, and quality of sleep.

The results? The recruits lost an average of 5 pounds each for a total loss of about 57 pounds, according to Schweig. Average body fat decreased 3.5 percent and average blood sugar levels also decreased.

Firefighters are known for saving other people's lives, but when it comes to their own health, they could use some rescuing. A study by the National Institute for Occupational Safety and Health tracking the health of 30,000 firefighters from 1950 through 2009 showed that firefighters get cancer at a higher rate than the general population, especially respiratory, digestive, and urinary cancer. The incidence of heart disease is also higher than among the average population.

The motivation to start the Berkeley Fire Department's wellness program first came from Amory Langmo, a firefighter and apparatus operator. After years as a member of his union's health and wellness committee, he felt there was a better way to spend its $20,000 annual budget than buying workout equipment, conducting standard physicals, and responding after problems arose. He felt the department was being reactive instead of proactive about health care.

"This is more than just a doctor checking a box," Langmo said. Instead, the program focuses on education, lifestyle changes, and prevention.

If an aspiring firefighter decided to go rogue and eat a bunch of pizza and drink some beers, the glucose monitor would track the resulting spike in blood sugar and report it back to the wayward participant. This kind of immediate feedback spurred competition. Haakon Langmo, Amory's younger brother who's now a provisional firefighter in the Berkeley Fire Department, remembers everyone trying to beat one recruit who consistently scored in the high 90s out of 100 on sleep quality: They went to bed earlier, cut down on late-night screen time, abstained from alcohol, and then compared their ratings every morning. "Everyone wanted to beat Andrew," he said. "No one ever beat him."

"In that age group, one of the motivating factors was performance," said Tracey O'Shea, a nurse practitioner and health coach at CCFM who worked with the recruits. "Each cohort is different. As a health coach, I help them find what that internal motivation is."

Diet and weight aren't the only challenges facing the health of firefighters. The job is physically challenging and firefighters regularly suffer from acute injuries like broken bones, burns, back strains, and heat exhaustion.

Other health risks are longer-term and chronic, like exposure to toxic chemicals and asbestos from smoke. "If you did a 360 turn, almost everything that's in your house is made of plastic," Amory Langmo said. "When that plastic burns, it's very toxic. Imagine breathing in your house if everything in there was off-gassing."

There's also the issue of irregular sleep. Firefighters work in 48-hour shifts, sleep at the firehouse, and are on the clock throughout the night. It's normal to be woken up by an emergency call at least once, and sometimes up to five times a night. Haakon Langmo said that one night there were so many calls, he only slept a total of 30 minutes.

When a firefighter gets sick, not only does it cause stress to the department — others have to cover their shift, sometimes working 72 hours in a row — it's also expensive. A 72-hour shift is a lot of overtime. The city pays for the health care costs of firefighters, and pays workers compensation when firefighters are injured.

"It costs $14,000 a year to treat someone with diabetes," Kresser said. "If you can prevent a couple first responders from getting diabetes, it's not just a question of quality of life and employee morale, but also a question of saving money."

In 2018, the city of Berkeley will spend an estimated $16 million covering health care costs for city employees. Over the next decade, the city projects that figure will more than triple.

For those who work at the fire department, the issue of health is much more personal. Fellow firefighters become like a family.

"It's been heartbreaking for me to see so many of our brothers and sisters retire and pass away within a matter of years," Assistant Fire Chief David Sprague wrote in an email. "From the city's perspective, money that can be spent on prevention and education of the workforce is usually a drop in the bucket when compared to doing nothing and suffering the consequences of a member entering the workers compensation system."

The pilot wellness program was also a first for the California Center for Functional Medicine. Due to its success, Kresser and Schweig say they hope it will be the first of many: Already the fire departments in Santa Clara, Fremont, and San Ramon have contacted them with questions about the program.


Berkeley firefighters, left to right, Bradley Giacone, Amory Langmo, and Haakon Langmo tried the new wellness program and got great results. Photo by Lance Yamamoto.