In a national survey, 199 male and 152 female vegetarian runners and 7054 male and 1837 female omnivorous runners provided data on weekly intakes of alcohol, red meat, fish, and fruit, and weekly distance run. This information was compared with physician-supplied medical data to test whether 1) running benefits vegetarians, 2) alcohol and running distance contribute independently to concentrations of high-density-lipoprotein (HDL) cholesterol, and 3) running mitigates the hypertensive effects of alcohol. Greater reported weekly distance run by vegetarians was associated with greater HDL-cholesterol concentrations [slopes +/- SEs for men and women, respectively: 0.003 +/- 0.001 and 0.005 +/- 0.002 (mmol/L)/km] and lower waist (-0.06 +/- 0.02 and-0.08 +/- 0.02 cm/km), hip (-0.05 +/- 0.03 and -0.07 +/- 0.02 cm/km), and chest (-0.05 +/- 0.02 cm/km for both) circumferences. In men and women, alcohol and running distance contributed independently to higher HDL-cholesterol concentrations. Men who ran > 72 km and drank > 177 mL (6 oz) alcohol/wk were five times more likely to have clinically defined high HDL cholesterol (> or = 1.55 mmol/L, or > or = 60 mg/dL) than were nondrinkers running < 24 km/wk. Regardless of running level, men's blood pressure increased in association with alcohol intake. These data suggest that 1) running distance in vegetarians and vegans has the same relation to HDL cholesterol (increasing) and adiposity (decreasing) as reported previously for omnivores, 2) alcohol and running distance contribute independently to higher HDL cholesterol, and 3) running does not abate the hypertensive effects of alcohol in men. Also, vigorous exercise provides important health benefits beyond those obtained by diet.