As a 10-mile-a-day runner, Dave McGillivray thought he could eat whatever he wanted without worrying about his heart. "I figured if the furnace was hot enough, it would burn everything," said McGillivray, who is 59.

But a diagnosis six months ago of coronary artery disease shocked McGillivray, a finisher of 130 marathons and several Ironman-distance triathlons. Suddenly he regretted including a chocolate-chip-cookie recipe in his memoir about endurance athletics.

"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.