Although running is one of the best ways to improve heart health, even runners are not immune from heart disease. You have undoubtedly heard reports of marathoners who die of heart attacks. Women runners, as well as men, need to pay attention to heart disease; it is the #1 killer of women, higher than all cancers combined.

To address the topic of heart disease among active people, the Sports and Cardiovascular Nutrition practice group of the American Dietetic Association. featured heart health as the theme of their annual convention (April 2008, Boston). The following bits of information from that conference might inspire you to eat wisely to keep your heart beating for a long and healthful lifetime.

First of all, when it comes to heart disease, you should know your cholesterol numbers. Get your blood tested for total, LDL, and HDL cholesterol. Having a low LDL is the primary goal for reducing heart disease. If your LDL is -160 mg/dl, the sooner you lower it to less than 130, the better off you will be.

Foods that actively lower LDL include oats, barley, soy, beans, almonds/nuts, and plant sterols/stanols (added to margarines such as Benecol). Although each single food might have only a small cholesterol-lowering effect--for example, consuming three glasses of soy milk a day might lower LDL by only five percent-- combining several of these foods becomes very powerful. For example, in subjects with high blood cholesterol, a diet rich in oats, nuts, soy, and phytosterol-enriched margarine reduced LDL by almost thirty percent in four weeks. That's as powerful as cholesterol-lowering drugs!

With minimal effort, you can consume LDL-lowering foods on a daily basis and achieve long-term benefits. Plus, by filling up on oats, nuts, and beans, you are not chowing on bacon, cookies and steak--and gain the added benefit of displacing those sources of artery-clogging saturated fats.

Oatmeal is easy to add into a sports diet. If cooking oats is not your style, simply eat them raw--mixed in with cold cereal. For example, Wheaties + raw oats + slivered almonds + (soy) milk + fruit creates an easy heart-healthy breakfast. Microwaving a packet of instant oatmeal (with a spoonful of peanut butter) creates a tasty, effective pre-exercise and/or afternoon snack.

Inflammation, caused by cholesterol-filled plaques in blood vessels, plays a role in heart disease. Foods that reduce inflammation include salmon and other oily fish, walnuts, fiber- rich whole grains, fruits, vegetables, and even dark chocolate. Among fruits and veggies, the Big Six are apricots, bananas, oranges, tomatoes, broccoli and spinach. Eat them often!

The Mediterranean diet, rich in olive oil, fruits, vegetables, fish, and seafood, is also protective and offers a seven percent reduction in mortality from heart disease. Consider using more olive oil for salad dressings, sauteing vegetables, and as a dip for bread (instead of butter)--but watch the calories!

Eating eight ounces of fish per week, especially cold water fish (salmon, mackerel, sardines, herring) rich in omega-3 fats, can reduce the risk of death from heart disease by thirty- six percent (and from other diseases by seventeen percent). Eating fish delays death within the hour after a heart attack, providing time to get the victim to the hospital for treatment. Plan one lunch with tuna (with low fat mayo) and one dinner with salmon each week.

Humans cannot make omega-3s; that is why we need to eat them. A healthy person can get the recommended intake from fish. Just eight ounces of salmon (the richest source) provides a week's worth of omega-3s. (Cardiac patients need more, necessitating fish oil pills.) Salmon is also a rich source of vitamin D. Three ounces canned pink salmon provides the daily requirement for vitamin D. D protects against high blood pressure, diabetes, cancer, and many other health issues.

What is good for the heart is good for the mind (and the rest of the body, for that matter, because all bodily systems are interconnected). Eating fish twice a week is associated with a thirteen percent slower decline in mental performance.

Some runners believe farmed fish have higher levels of PCBs and other toxins. According to Dr. Charles Santerre of Purdue, the risk is tiny compared to the strong heart-health benefits. PCBs are stored in the fat. To reduce intake of PCBs, don't eat the fish skin or the fat drippings.

The risk of heart disease increases with age, particularly as women enter menopause. Menopause increases fat deposition in the trunk/waist area, more so than on the legs and arms. This abdominal fat is linked to heart disease.

Why does midlife fat settle around the waist? One theory relates to cortisol, a hormone that increases with stress. Post- menopausal women seem to have a robust cortisol response to stress. Thank goodness exercise can be a good stress reducer; keep active! Lugging around excess body fat adds a major stress to the heart, but being too thin can also raise heart-health issues. Runners who severely under eat (such as those with anorexia) commonly develop irregular heart rhythms and have a dangerously low heart rate. Thinner is not always healthier.

The more you exercise, the more protection you have from heart disease--but only to a certain extent. The benefits plateau at about 2,000 calories per week; that is the equivalent of running about four miles a day (400 calories) for five days a week, with two rest days per week. No need to get compulsive . . .

The Bottom Line

Just as eating the wrong foods can be powerfully bad for your heart, eating the right foods can be powerfully good. Eat wisely to invest in an enjoyable future. If you need help creating a heart healthy sports diet, consult with your local sports dietitian; use the referral network at the American Dietetic Association.

RECIPE: Simple Salmon Patties
Looking for inexpensive ways to add more fish to your diet? Here's one of many family-friendly recipes from the new fourth edition of Nancy Clark's Sports Nutrition Guidebook (April, 2008).

These salmon patties are made with canned salmon, an inexpensive source of health-protective omega-3 fat. Enjoy them with brown rice and a green vegetable for a complete meal.

1 14-ounce (400 g) can pink salmon, drained and flaked
(remove the skin, but keep the bones for added calcium)
1 cup (70 g) crushed whole-wheat saltine crackers or breadcrumbs
1 egg or substitute, slightly beaten
1 cup (150 g) diced pepper, green or red
1/2 diced onion, preferably a sweet onion such as Vidalia
1/4 cup (60 ml) milk, preferably low fat
Lemon pepper or black pepper, as desired
1 to 2 tablespoons olive or canola oil, for cooking

Optional: 1 teaspoon Worcestershire sauce or soy sauce; dash of hot pepper sauce; 1/2 teaspoon dried dill, or 2 teaspoons fresh dill.

1. In a large bowl, stir together salmon, cracker or breadcrumbs, egg, bell pepper, and onion. Mix in milk (and Worcestershire sauce and hot pepper sauce, as desired). Add pepper (and dill), and mix well with your hands. Lightly press the mixture into eight patties.

2. Heat oil in large saute pan on medium heat. Once oil is hot, place the patties in the pan and cook on both sides until lightly browned, about 3 to 5 minutes.

Yield: 4 servings (8 patties)

Nutrition Information 1,200 total calories; 300 calories per serving (2 patties); 24 g carbohydrate; 27 g protein; 11 g fat (2 g omega-3).

Nancy Clark MS, RD, counsels casual exercisers and competitive athletes at Healthworks, the premier fitness center in Chestnut Hill, MA (617) 383-6100. Her NEW 2008 Nancy Clark's Sports Nutrition Guidebook 4th Edition, and her Food Guide for Marathoners and Cyclist's Food Guide are available via www.nancyclarkrd.com.