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Why Runners Can't Eat Whatever They Want


Dave McGillivray at Fenway Park in 1978 completing a cross-country charity run. ENLARGE
Dave McGillivray at Fenway Park in 1978 completing a cross-country charity run. Associated Press



"My first reaction was, I was embarrassed," he said.

As race director of the Boston Marathon, McGillivray is a high-profile exhibit in a growing medical case against the devil-may-care diets of many marathoners. Their high-mileage habit tends to lower their weight, blood pressure, heart rate and cholesterol levels, leading them (and sometimes their doctors) to assume their cardiac health is robust regardless of diet.

"'I will run it off'—that attitude clearly prevails among the marathoners themselves, almost sometimes to an arrogance," said Paul Thompson, a veteran marathoner who is chief of cardiology at Hartford Hospital.

A growing body of research shows the error of that thinking. A study published in the current edition of Missouri Medicine found that 50 men who had run at least one marathon a year for 25 years had higher levels of coronary-artery plaque than a control group of sedentary men. A British Medical Journal study published this year compared the carotid arteries of 42 Boston Marathon qualifiers with their much-less active spouses. "We hypothesized that the runners would have a more favourable atherosclerotic risk profile," says the article. As it turned out, that hypothesis was wrong.


"Studies support a potential increased risk of coronary artery disease, myocardial fibrosis and sudden cardiac death in marathoners," Peter McCullough, a Baylor University cardiologist, wrote as lead author of an editorial in the current Missouri Medicine.

But many cardiologists are skeptical. "The science establishing a causal link between vigorous exercise and coronary disease is shaky at best," said Aaron Baggish, a Massachusetts General Hospital cardiologist who does triathlons and marathons. Even so, he said, "I've never once told a patient they need to run marathons or race triathlons to maximize health, as this is not accurate."

McGillivray (at right) greeting a runner during a Boston 10k race in June. ENLARGE
McGillivray (at right) greeting a runner during a Boston 10k race in June. Boston Globe/Getty Images

Reports of heart disease in runners are prompting some marathoners to obtain scans of their coronary arteries. Ambrose Burfoot, winner of the 1968 Boston Marathon and editor-at-large of Runner's World magazine, is 67 years old, 6 feet tall and only 147 pounds. A lifelong vegetarian, he subsists mostly on fruits, vegetables and nuts, though he also eats "cookies and all dairy products—cheeses, ice creams etc.," he wrote in an email.

"Last March I learned that I have a very high coronary calcium," he said, adding that "I have a condition perhaps similar to Dave McGillivray's."

The medical profession's recommendation for such runners depends on which cardiologist they visit. James O'Keefe, a Kansas City cardiologist and ex-triathlete who believes sustained endurance exercise can damage the heart, said he would recommend no more than 20 miles a week at a modest pace.

Thompson and Baggish, however, believe that in many cases endurance athletes diagnosed with heart disease can safely continue doing marathons and triathlons, if their conditions are treated. Thompson argues that risk must be weighed against quality of life, an idea the Burfoot embraces.

"I subscribe to the old saw: 'Exercise—it might not add years to your life, but it adds life to your years,'" said Burfoot.

But cardiologists are united in their campaign against the old notion that high-calorie workouts confer a free pass to eat anything.

Those who run several hours a day often dream about cookies and ice cream. When McGillivray ran from coast to coast in 1978, he tended to finish each day at a Dairy Queen. "It wasn't just replacing calories but a mental thing—that vanilla shake was my reward," he said.

Replacing thousands of calories with purely nutritious foods can be challenging. Since receiving his diagnosis last October—and radically changing his diet—the 5-foot-4 McGillivray has dropped to 128 pounds from 155, an improvement he celebrates.

Far from cutting back his workout regimen, McGillivray has amped it up, boosting his weekly mileage to 70 from about 60. As race director of the Boston Marathon, which is April 21, he plans to continue his tradition of running that course after the last runner has crossed the finish line. And to celebrate turning 60 in August, he plans to complete an Ironman-distance triathlon.

Although McGillivray says that his cardiologist, Baggish, gave him "the green light" for such challenges, Baggish said in an email that, "I do not give patients (Dave included) green or red lights. We engage in an open discussion about known and uncertain risks and benefits and come up with a collective and very individualized plan about what is reasonable.

"In Dave's case," he added, "we did just this and he is leaning toward doing the (Ironman) with full knowledge of the fact this his risk is elevated compared to the general field."

Some critics say that continuing to engage in endurance athletics despite cardiac disease is evidence of addiction. "I'm not afraid to call myself an exercise addict," said Burfoot of Runner's World. "I have always been afraid of dying on a run. But the way I look at it now, it's not that running will have killed me. Running has enhanced my life immeasurably, but it could also 'trigger' a life-ending event that probably would have happened even sooner except for my running."

Write to Kevin Helliker at

David Zittin
David Zittin subscriber

Patient: Doc I want to live to be 100 years. What do I have to do?

Doc: No sex, no alcohol, get to bed early, eat a lot of prunes, no read meat, no ice cream, no pastries, no dancing, moderate exercise, no stressful activities.

Patient: Doc, if I do all these things will live to be 100 years?

Doc, I don't know, but you will feel like you are 100.

stevie garcia
stevie garcia

i am eating so great that i will live an extra 10 years. that is 10 years more to crave a great pastrami on rye.

John Daugherty
John Daugherty subscriber

10 extra years with dementia, brittle bones, RA and hemorrhoids. Sounds fun.

Tyler Hwang
Tyler Hwang profilePrivateuser

The fallacy here is assuming that these conditions are a result of diet choices rather than excessive running. Long-distance running is overrated and dangerous -- high-intensity interval training is much more effective in terms of both health and performance. I understand it can be 'therapeutic', but these guys (and there are many of them) who think they are healthy because they run numerous miles every single day are living under an illusion.

Tyler Hwang
Tyler Hwang profilePrivateuser


Mitchell-Annmarie Thomas
Mitchell-Annmarie Thomas subscriber

Eating a poor diet=bad.
Too much running=bad.
Sitting around too much=bad.
Too bad!

Mrs. A Thomas

Ernest Poku
Ernest Poku profilePrivateuser

Does this article actually contain a link between diet, running and heart disease. The links described all link excess running and heart disease. The references to diet seem unlinked to the article to me.

DONNA FELDMAN subscriber

No the article says nothing about a diet/running/heart disease link. In fact, it suggests that even with low body weight and low cholesterol -- the easiest risk factors to measure -- something else can increase heart disease. So what is that? Could be dietary, could be genetic, could be related to running, but only for susceptible people. I tend to agree with the last observation that perhaps these people would have had heart problems much sooner, but the running has actually helped them to some extent. So we need large studies and extremely detailed dietary records. I've got my suspicions about the other nutritional issues, nothing to do with cholesterol.

Betty Smith
Betty Smith subscriber

Vitamin K-2 (not the same as vitamin k-1)is essential to arterial health, including the coronary arteries. It moves the calcium to the bones, where it belongs, and keeps it out of the arteries. Japanese eat natto, a fermented soybean product, that is high in vitamin k-2 and those who eat this stuff have almost no coronary arterial calcification. See below articles to learn more.

Dennis Barberic
Dennis Barberic

Exactly. A deficiency in k2 will result in calcium being deposited in soft tissues, arteries, and other places you don't want it. K2 directs the calcium to your bones and teeth.

jack Canzonetta
jack Canzonetta subscriber

Stella, I have had and still have relatives well into their 90's that eat meat and use diary products, but they do nothing in excess including exercising.

Brian Kelly
Brian Kelly subscriber

That's nice Jack. Really.

However, Stella is referencing studies of many HUNDREDS OF MILLIONS of peoples' diets (not a handful of your relatives) and comparing rates of disease for correlation.

Nutrition trumps exercise. This is NOT new information. It's been known for decades.

Geraldo Bustone
Geraldo Bustone user

We also have several legitimate studies that indicate that simple carbohydrates are the culprit. The country of Sweden has just changed it's nutrition recommendations from low fat, high carb to high fat, low carb....based on their decades long studies.

Grains may a culprit....meats may be culprit.... dairy may be a culprit. We'll find out next week when some other group of "academics" comes up with new findings. In the meantime, one could consider eating what you moderation. It's unlikely that a balanced diet is going to kill you.

James Lane
James Lane user

This was an interesting article. I must admit, to my shame, that I've been guilty of over-indulging in food with the excuse that I would just run it off. It appears I might have been gravely mistaken in my position.

Leo Martin
Leo Martin user

Many times more people are at risk from too little exercise rather than too much.

James Lane
James Lane user

Absolutely true Mr. Martin.

Kevin Foster-Keddie
Kevin Foster-Keddie subscriber

Since I did not see a post on this and it is not mentioned in the article, the other real risk of marathon running, especially as a lifetime avocation, is atrial fibrillation. After 15,000 hours of high level use of the heart, your chances for this heart disease increases. The risk with this is stroke. Ask Larry Bird, Jerry West and Bill Bradley, all of whom have Afib (tall Caucasian people are more at risk as well). As more people run marathons later in life, the incidence of Afib has increased steadily.

Stephen Grant
Stephen Grant user

Title is confusing, as this wasn't a study of diet and coronary artery disease in athletes, but merely anecdotal reports and a few case series. Last time I looked, vegetarians and marathoners had the same mortality rate as smoking cough potatoes. One. That's why large population-based studies are needed. A actual RCT won't happen. Too many variables.


Of course women are left completely out of the 'study'….again.

Geraldo Bustone
Geraldo Bustone user

One study used 40 male marathoners and the second used 42 marathon runners and spouses. We don't know that the second study did not include women in the group of 42. When doing a study, if you want a quick sampling, you use a control group that is as much alike as possible and extrapolate the results. The results will be accurate for that group but not for the overall population.
I suggest that the writer of the article came up with the idea first and then looked for studies to reinforce what he/she was writing. Two studies, using a sampling of 82 people out of several thousand is hardly definitive.

Stella Ames
Stella Ames subscriber

Thank you Brian for clearing Jack's comment. Of course some people can get away with anything they eat.. smoke also. Just as someone who eats a simple vegan diet and exercise could also develop a pathology.

But as Damon Runyon used to said in Guys and Dolls... The race is not always to the swift, nor the battle to the strong, but that's the way to bet. In this case you are betting your life

And for those who are reading...may I suggest you never forget to breath out

Paula Dowling
Paula Dowling subscriber

Stella, it was Ecclesiastes (not Damon Runyon) and what he said was:

"Again I saw that under the sun the race is not to the swift, nor the battle to the strong nor bread to the wise, nor riches to the intelligent nor favor to men of skill but time and chance happen to them all."

But very good comment on your part!

Richie Lietch
Richie Lietch subscriber

Ah, to be young and able to eat at McDonalds without a care in the world. Usain Bolt estimates that during the 10 days he spent in the Beijing Olympic village, he downed 100 chicken McNuggets every 24 hours. That equals 1,000 chunks of chicken. “Man, I should have gotten a gold medal for all that chowing down,” Usain said

christopher mast
christopher mast subscriber

Running always makes the ice fly out of my vodka and tonic.

Leo Martin
Leo Martin user

I hope you put a lime wedge in there so you're getting some vegetables.

Ted Martin
Ted Martin user

Everything should be done in moderation. Including running... and running marathons is extreme, and not moderation...

Thomas Bishop
Thomas Bishop subscriber


the article conflates over-exercise with a bad diet. compare the quote above with the title. those who have a bad diet can exercise in moderation; those who over-exercise can have a good diet. what is purportedly causing the heart problems? over-exercise or a bad diet?

john dates
john dates user

Ought to try the Krispy Kreme Challenge diet............................

RALEIGH, N.C. – Students at North Carolina State University have announced the 10th Annual Krispy Kreme Challenge, which will be held on Saturday, February 8, 2014 at 8:30 AM. The Krispy Kreme Challenge is a completely-student organized charity race benefiting the North Carolina Children’s Hospital. Starting as a competition between a few friends, it has grown to include over 8,000 runners and raised $184,000 for the N.C. Children’s Hospital in 2013. To date, the organization has raised $558,000.

To complete the Krispy Kreme Challenge competitors begin at the North Carolina State University Memorial Belltower, run 2.5 miles through scenic downtown Raleigh to the Krispy Kreme store at the corner of Peace and Person Streets, eat 1 dozen doughnuts, and run 2.5 miles back to the Belltower — all in under an hour. Participants can also sign up as Casual Runners, who are not required to eat all of the doughnuts, or Supporters, who do not run in the race but do receive a race T-shirt.

- See more at:

However, the Raleigh Street Dept. probably does not look forward to the post race clean up

Tom Topar
Tom Topar subscriber

How about keeping the t-shirt and eating 2 dozen donuts while sitting on a porch watching people gasp for breath and collapse at the finish line.

Max Davies
Max Davies subscriber

Anecdotal evidence can be totally misleading, even so I'm going to add my own: I've known numerous marathon runners and none of them ever looks like they are glowing with health. They all tend to look gray and many have recurrent colds and other infections. I have observed this over many years.

My hiking friends, and I'm a regular hiker and have hiked with groups from all over the world, look far healthier with glowing complexions and seemingly robust immune systems. So do my fellow gym-rats, with the exception of the hard-core heavy-lifters.

There is proper evidence from controlled studies that suggests that vigorous exercise beyond a certain point suppresses the immune system. My anecdotal evidence supports that.

Geraldo Bustone
Geraldo Bustone user

Overtraining can certainly cause a lot of problems. An exercise regimen that only includes running does little to strengthen bone structure or increase/retain muscle mass. Some distance runners include strength training in the regimen and look fine. with any sport, take it to extremes and that causes problems down the road.

Gary Best
Gary Best subscriber

I added weight training to my fun workout of mountain biking and running. From what I've seen diehard bikers and runners have little muscle mass and generally resemble Holocaust survivors. Having a condition best described as "old mans butt", meaning you don't have one, or having spindly arms is not something to strive for--ask any women.

Thomas Gordon
Thomas Gordon subscriber

Gary, I say that the start of the Olympic 1500 meters look like a bunch of Holocaust survivors. This always irritates the die hard runners I know. Jim Ryun looked healthy to me. These guys and gals now are fantastic athletes but they don't look sexy to me.

Darren Chesser
Darren Chesser subscriber

depends if you wanna win your races you need to look like Matthew Mcconaughey in Dallas Buyers Club, if you want to stay in shape and have fun racing then you can afford to carry a few extra LBs, but those LBs drag you down

Edward Harris
Edward Harris subscriber

I was similar to the guy in the article. I always exercised vigorously but in my early late 30's I discovered that I had very gradually put on about 40 pounds since high school, at a rate of about 1-2 pounds per year. Unfortunately, over this time period I did not get any taller. I also ate like a total pig: multiple trips to the buffet line, pie a la mode for dessert, and so on. I stabilized and held steady for about a decade.

Then, a few years ago, I cut sweets almost entirely out of my diet: no desserts at all except for the very occasional family member slice of birthday cake. I also became more conscious about portion sizes. No more third helpings of dinner. And I stepped up my workouts by about 20 percent.

I took off about 20 of the extra 40 lbs. As the years have gone by, I've also discovered that metabolism slows considerably with age. Like the Red Queen in Alice in Wonderland, you have to keep running faster (no pun intended) to stay in the same place.

I am also fanatical about sleep; it's almost like a religious value to me. If I don't get at least 7 hours, I find it challenging to muster the energy to exercise.

I used to believe I would someday complete a marathon, especially as I ran cross-country in high school, long before running was fashionable. The more I read about the health risks of excessive exercise, the less likely I will ever do so.

The idea that too much exercise can have negative health consequences seems logical. Certain "natural" diet supplements can make you sick and in extreme cases even be fatal. And I know firsthand the risks of believing an hour of running offsets an ice cream sundae.

Thomas Gordon
Thomas Gordon subscriber

The Journal is to be commended. They have run a lot of good articles on the subject of how much exercise is too much exercise. These guys are special. They ran for a long time and were able to keep doing it (they didn't blow out their knees or ankles which most people do). Most of the college level runners I know don't run any more. My credentials are that I ran the 1969 Palos Verdes Marathon and 2013 Bay to Breakers (signed up for 2014 with my son). I have a slightly different take on this heart situation. I have cut my running back to once a week (I'm over 60 and cross train with other aerobics). I wonder if running once a week is enough. It's kind of really active so maybe if you want to run over 60 you should do it at least twice a week. I'm trying to save my knees because I still play sand volleyball which is why I cut back. But for young people coming out of college I strongly advise that with exercise, more isn't always better. You can be in great shape, look great, and do anything any normal person would want to do by running 20 miles a week. And start cross training as soon as you can to wear everything out as slowly as possible.

Jack Ritchie
Jack Ritchie subscriber

If Mr. McGillivray weighed 155 lbs at 5 ft 4 inches tall, he was obese. Really a 10-mile per day runner? I doubt it. Mileage aside, is it news that if you're fat it will increase your risk of heart disease?

Richard Tavis
Richard Tavis subscriber

It makes sense if you end the day at Dairy Queen... ekkk!

Clint Tarkoe
Clint Tarkoe subscriber

Very good point - 5'4" at 155 give s BMI of 26 - which obese. So, a diagnosis of CAD is not surprising. What is surprising that someone running 10 miles a day is obese. This doesn't make sense.

Leo Martin
Leo Martin user

There are lots of people with coronary artery disease at low, middle and high BMIs. There are lots of people with no coronary artery disease at low, middle and high BMIs.

Geraldo Bustone
Geraldo Bustone user

Jack, if he is at 155 lbs and 10% bodyfat, he carries 15.5 lbs of fat...not 41. BMI has nothing to do with body fat but measure body mass...totally different. A bmi of 26 is just over the line for being overweight...if you ignore body fat percentage.
As I said before. I am at BMI of 26 and have very little fat on me but am considered overweight by the BMI standard.
Running, of course, doesn't undo the perils of being fat but body fat percentage must be taken into account instead of a generalization based on fallacious measurements.

Geraldo Bustone
Geraldo Bustone user

Funny....I used to compete in amateur olympic lifting and recall some male competitors who were in the 5' 4" to 5'5" range who were around 10% bodyfat. Most short statured bodybuilders come in at around 6% when competing and stay at 9-10% bodyfat during the offseason. I am 5"10" and 185 lbs at 10% bodyfat. My BMI is 26.

BMI is a poor indicator of how fat someone is.

Jack Ritchie
Jack Ritchie subscriber

I did not bring up BMI. The guy now weighs 128, and if we make a generous assumption that he has 10% body fat, then when he was at 155, he had 41 lbs of body fat. That's 26%, which is high for a male. Whether technically obese, this was a fat man. Details aside, this article hypes the idea that a 10 mile per day runner developed coronary artery disease. But probably they have their facts wrong, since very few if any fat men run 10 miles per day. And even if he does, he is not typical of most runners doing that distance, so you should not infer any lessons from his experience. If the point is, running does not undo the risks of being fat, okay.

Scott Marshall
Scott Marshall user

I log about 30 miles a week, drink bourbon, eat fritos, and have a resting pulse rate of 50. BP at 105/72. My says it's all the sex that keeps me healthy.

David Bianco
David Bianco subscriber

I'm going to tell my wife about that regimen and start immediately

Harlin Smith
Harlin Smith subscriber

Hate to break the news, but the asteroid is going to kill all of you skinny guys on the same day it is going to kill me....

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