Health problems for ultra athletes could go beyond blisters, black toenails and knee pain

James Lawrence, Lehi’s ‘Iron Cowboy’, puts physiology to the test with 101 iron-distance triathlons in 101 days

(Matthew Norton) Lehi's James Lawrence, aka the Iron Cowboy, gets bodywork done in his home after completing an iron-distance triathlon. On June 8, 2021, Lawrence capped his Conquer 100 challenge in which he completed 100 iron-distance triathlons in 100 days.

James Lawrence woke up just after 5 a.m. March 13, stuffed a banana and some sweet bread in his mouth and pulled on his wetsuit. At least he knew the water at the Lindon Aquatics Center would be warm. The rest of the day had a high probability of developing into an icicle-coated suffer-fest.

A few hours later, the Garmin on his bike, which was already dripping with sleet, alerted him to a severe weather warning. The snow came, but he kept pedaling. Later that afternoon he pulled on his tights and running shoes and somehow found the will to pry himself away from the warmth of his comfortable Lehi home. He strode out toward the Murdock Canal path, where he would spend the next seven hours — much of it in the dark — logging a marathon on feet with blackened toenails as well as sore shins and a bulging, swollen ankle.

“What a day,” Lawrence, 45, wrote on Twitter before sinking into bed, having first devoured dinner and then collapsed onto a massage table. “It was so hard and so filled with love and support. #13.”

Just 87 more days like that to go.

Lawrence, better known as the Iron Cowboy, celebrated his 100th iron-distance triathlon in 100 days earlier this month by taking victory laps around the Mount Timpanogos High track, with hundreds of adoring fans trailing behind him and more than a thousand more on the field eager to witness the end of his ordeal. What he’d accomplished — he dubbed it the Conquer 100 — was a feat of endurance and inspiration. It was also a feat of science. He had pushed the human body past what pretty much everyone — other than Lawrence himself — believed it could endure.

Kevin Longoria, a clinical exercise physiologist and the chief science officer at Biostrap, which sponsored Lawrence in exchange for permission to monitor his vital signs and organ function throughout the challenge, told him as much weeks before the Conquer 100 began.

“I didn’t think he could do it,” admitted Longoria, “because physiologically nobody should be able to do this.”

Long-term effects

Ultra racers have long pushed the limits of what most mortals believe to be possible: 100-mile, single-day runs; swims across wide-open swaths of ocean; remote multi-day stage races. When it comes to athletic masochism, the imagination apparently knows no limits.

It does know pain, however. Blisters, bunions, rashes, rolled ankles and all sorts of stomach issues come with the territory. Recently, however, studies have shown that ultra athletes may be doing more and longer-lasting damage to themselves and especially their organs.

In an article published in Cancer Causes and Control, researchers in Norway said they found evidence that longtime endurance athletes double their risk of developing pancreatic cancer. Another study by a group of cardiologists at the University of Toronto found endurance athletes are three to five times more likely to experience atrial fibrillation, which can lead to blood clots, stroke or heart failure.

Those studies looked at athletes who competed in one to perhaps a handful of long-distance endurance events — defined as anything longer than 50 miles — a year. In crafting the Conquer 100, Lawrence set out to finish a 2.4-mile swim, a 112-mile bike and a 26.2-mile run every day.

How his body handled the stress of the distances and their compounding effects over time could indicate how detrimental to the body, or not, endurance competitions actually are. And that’s become more useful information as ultra events grow in popularity.

(Matthew Norton) Lehi's James Lawrence, aka the Iron Cowboy, swims 2.4 miles in the Lindon Aquatic Center on June 8, 2021. The swim was the last in his Conquer 100 challenge in which he completed 100 iron-distance triathlons in 100 days.

Participation in ultra running has increased 1,676% over 23 years and 345 percent over 10 years, according to Trail Runner Magazine. It has even outpaced marathons in terms of growth since 2009. This year, alone, at least two people will attempt to run across the United States. One is former MLS player Hellah Sidibe, who last month completed the journey from Los Angeles to New Jersey in 84 days. Another is Jordan Moon of Park City, who in September will try to break the speed record by running from San Francisco to New York in less than 42 days and six hours.

Competing in longer-distance events and competing in ultras with more regularity “increases your risk of cardiac arrhythmia, arterial calcification and myocardial fibrosis,” Longoria said. “These are essentially what you would see in the late-stage heart-failure patients, but [they are being found] in rather healthy, extremely active individuals. And so when James essentially met all of these criteria and ... condensed it into a very short period of time, the research indicates that these types of problems should occur.”

Lawrence submitted to a series of scans before and after the Conquer 100, including a CT angiogram and a stress test. To try to ward off any ill effects throughout the more-than-three-month ordeal, he made use of a hyperbaric chamber, red light therapy, stem-cell therapy, body manipulation and intravenous nutrition (he burned nearly 8,000 calories a day). He still encountered painful injuries to both shins and his right hip.

Nevertheless, while Longoria cautioned that all findings thus far are preliminary, all indications so far are that Lawrence not only survived, he’d thrived.

“It happened exactly the way I said it would,” said Lawrence, a motivational speaker by trade and the father of five children. “We got stronger, we adapted, we evolved and there was nothing to worry about. I passed with flying colors post-examination and I’m healthier than when I started. I have the artery health of a 12-year-old.”

Pattern of abuse

This wasn’t the Iron Cowboy’s first rodeo. Six years ago he’d completed the 50.50.50 project, in which he completed 50 iron-distance triathlons in 50 days in 50 states. The travel logistics became a major pain point, however, which is why he opted to attempt his newest endeavor in a more controlled environment.

After swimming in the Lindon pool, he biked three loops around Payson and Spanish Fork and then returned to his home near the Murdock Canal.

“The 50 was logistics and chaos and fatigue. And so the concept was, if we remove chaos, how many is physically and mentally possible to do?” Lawrence said. “And that’s why I said, ‘Well, 75 seems pretty easy, doesn’t scare me. A hundred? Yeah, that kind of frightens me. Let’s set that as the target.’”

Longoria said he was surprised Lawrence’s baseline report showed no residual damage from undertaking the 50 Project. But he was curious how his body would stand up to another enervating test.

(Biostrap) The biometric readout for James Lawrence, aka The Iron Cowboy, on June 8, 2021, the final day of his Conquer 100 challenge, in which he completed 100 iron-distance triathlons in 100 days.

Using feedback from a Biostrap band, similar to a fitness watch minus the watch, Longoria’s team monitored Lawrence day and night. They measured cardiovascular markers, things like his heart rate, arterial elasticity and atrial fibrillation indexes. They noted how long and how deep he slept and any weight gain or loss.

But they kept it all from Lawrence.

“We didn’t look at any data or anything like that because we didn’t want the mind to think that something was wrong,” Lawrence said, “when it was a red flag that maybe didn’t need to exist.”

The Biostrap team had been given the authority to put an end to the Conquer 100 if it thought Lawrence’s life was in danger. And the first seven weeks of races did nothing to shake Longoria’s belief that it would come to that. For one, Longoria said it’s almost impossible for an athlete not to develop a debilitating injury, most likely a stress fracture, with all that pounding on the body. Secondly, Lawrence’s body was showing signs of distress.

Chief among Longoria’s concerns was that Lawrence had begun having night terrors and full-body convulsions when he should have been sleeping. On a scale to 100, his sleep score had dropped to 2.5.

Then, on Day 51 — the day Lawrence officially snapped his own world record for most consecutive iron-distance triathlons — something else happened.

“Every metric was getting worse,” Longoria said. “And for whatever reason, somewhere around this Day 51, when he set the new world record, everything started to turn around and increase. Certain metrics were actually better than they were before the competition.”

The change, Longoria surmised, may have been mostly psychological.

It’s the mind that matters

On Day 13, when he had to persevere through the sleet and sludge, Lawrence three times posted the same message with different pictures on Twitter. It was as if he was trying to repeat a mantra: “Today is going to be a GOOD DAY!! Yesterday was bad, and we never have 2 bad days in a row.”

It wasn’t really a good day, but the Cowboy had to keep going anyway.

Lawrence’s physiological fortitude was perhaps the most surprising. But it was his mental wherewithal — getting up and continuing even after major setbacks, such as the bike crash he had on Day 59 — that most impressed many of his followers. That includes Dr. Jonathan Ravarino, the director of psychology at University of Utah Athletics and an ultra runner.

Ravarino said Lawrence would also be a great case study on mental tenacity.

“At some point .. the pain is going to come, and it’s just ‘How do I react to it when it does come?’ You hope it doesn’t come, but is going to come,” Ravarino said. “And he’s a master at that. He accepts it and he invites it.

“That’s that mindset thing. In some people, you can almost see it when they start to have doubt creep into their mind and they come up with reasons to stop. This happens to all of us. He’s able to not fold in those moments, to stay positive. That’s the most impressive thing to me.”

It took work to keep that positive bubble around him. An unwritten rule existed that anyone who joined Lawrence on a leg of his journey couldn’t complain and couldn’t ask Lawrence how he felt.

Lawrence said he didn’t have a choice but to keep going. He had tens of thousands of social media followers checking in on every leg of his journey not to mention a documentary crew following him. He had a place in history to carve out (He’s submitted the feat to Guinness World Records). And he had his word to keep.

“You get up and do because you said you would,” he said. “Broken and battered, the campaign continues.”

Few would fault Lawrence for stopping his racing career right there on the Mount Timpanogos football field. He’d put his body through hell and yet somehow seems none the worse for wear for it. Longoria might say that’s a bigger accomplishment than the 100 triathlons.

Lawrence said he’s satisfied and has no other wild ventures in mind.

His wife, Sunny, who knows him better than any of the medical personnel or psychologists, believes otherwise.

“Yes, of course,” she said shortly after Lawrence finished the Conquer 100 challenge. “I was just thinking to myself yesterday, ‘He gave me six years last time. I think I think he’ll give me another five years.’”

But he didn’t even give her that long. The very next day, he got up and completed No. 101.

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