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You are an Ironman

By Marc Zaré, MD

Fitness is the buzzword in today’s health-conscious world. Each year over 17 million people cross a Marathon or half-Marathon finish line in the US. Every January, nearly 50% of Americans have a New Year’s resolution to lose weight and improve fitness. In spite of all that effort, incidence of excess weight and related problems is on the rise. The food industry is constantly adding sugar and fat to our processed food, our digital world encourages sedentary lifestyle, and our busy schedules leave little time for physical activities. As a result, only 8% of us adhere to our health-oriented New Year’s resolution, and only for an average of 17 days.

I have personally never had a problem with excess weight or general fitness, but I was always challenged by long-distance endurance activities. I would attempt these activities every now and then and quit halfway, convinced that I would never be able to swim or run a long distance in my life. Then one day I came across interesting research suggesting that all humans are inherently endurance athletes. Over several millions of years, the genus Homo, to which we modern humans belong, developed specific characteristics that offered advantage during endurance activities. We developed Nuchal ligament, which helps stabilize our head while running, our larger joint surfaces absorb greater amount of shock, and longer limbs with decreased mass at distal parts provide metabolic advantage by decreasing energy consumption during running. These human characteristics are notably exaggerated in people from Kalenjin region – a small area in Kenya, known for producing more elite runners than any other region in the world.

It was an eye-opening revelation to learn about these evolutionary traits. It was around the same time that I also learned about recreational racing. My wife was participating in a 10-kilometer race called Summer Scamper, held each year at Stanford University to fund pediatric health research, and I was there to cheer her on. That day, seeing people of all ages crossing the finish line, arms in the air and feeling triumphant, set off a cascade of events in my life that eventually helped me finish the 2016 California Ironman race two years later. What I learned in the process was simple: given the right circumstances, we all possess the physiologic tools to adapt to the most strenuous conditions, climb the highest peaks, run the longest distances, and achieve the unthinkable.

The evening of that Summer Scamper event, I signed up for a 15-kilometer race and trained for a few months, slowly increasing my running distance each week. The training helped me have a comfortable run and a strong finish and the confidence to keep pushing forward. Next, I registered my entire family for a half-marathon, and took my young children along on a double stroller. It was a full family event, with lots of cheers and great bonding. But things were about to get more serious as I began exploring triathlons. A triathlon begins with a swim, transitions to a bike ride, and ends in a run. The total distance ranges from 15 to 140 miles, and you can pick a race that fits your needs. The shortest race is called Sprint distance, followed by Olympic distance, Half Ironman (also called Ironman 70.3), and Full Ironman (also called Ironman 140.6). As an average runner, a mediocre cyclist, and a hopeless swimmer, the idea of a combined sport that included a long-distance swim was daunting. So I got into the pool and increased the distance each day until I had enough mileage to get past my fear. For my first triathlon, I decided to bypass the shorter distances and chose the ‘Napa Half’ – a 70.3-mile triathlon held around Lake Berryessa in Napa. The race began in the cold waters of Lake Berryessa and ended in the hot and hilly terrain around the lake. It took a total of seven hours to complete. Between the elements of weather, distance and terrain, I found myself challenged physically and mentally in more ways than I could have imagined possible. And when it was all over, ironically, I was left wanting more. So, the same year in July, I raced the hilly and picturesque San Francisco marathon. But I already had my eyes set on a bigger goal: a full distance Ironman race.

Ironman dates back to 1978 when a group of athletes at Waikiki swim club were debating as to who were the fittest athletes: swimmers, bikers, or runners. They came up with the idea of a 140.6-mile triathlon that would begin with a 2.4-mile swim, continue with a 112-mile bike ride, and end with a 26.2-mile marathon. The first race was held in the island of Oahu with only 15 participants. The first race on the continental US was held in Sonoma County, California and was called the Vineman (recently renamed Ironman Santa Rosa). California Ironman has had the reputation of having a moderately difficult terrain with lots of rolling hills, and extremely hot weather. It is held in late July, few weeks after the summer solstice, when daytimes last 14 hours and temperatures often soar past 100 degrees Fahrenheit. That was going to be my first Ironman race.

The approach to Ironman training is holistic. At the core of the program is endurance training below anaerobic threshold, composed of nine sessions each week lasting a total of 8 hours in the beginning and 20 hours at the peak of the training. At the periphery of the program are other essential elements: optimizing form, acclimatizing to heat, finding the right nutritional supplements, replacing fluid and electrolytes, strength training, and identifying proper gear. Once you reach a baseline level of fitness, say after completing a marathon, it takes about 6-12 months to be ready for an Ironman. Within that time, training gets more and more rigorous, with weekend sessions lasting as long as 8 hours. I soon discovered that the discipline needed to make it through the training wasn’t far from what I had practiced surviving surgical residency two decades earlier. With a busy surgical practice and family life, most of my training took place before 7 am.

Fast forward to the day of the race, twenty-five hundred athletes from all over the world had congregated early at the venue to set up their transition bags, check their tire pressures, put on their wet suites, and warm up for the first leg of the race. The swim venue was Russian River, a serene and rustic waterway carved through the ancient Sonoma redwoods. At dawn, the air was crisp and the water cold enough to be wet-suite legal. Sunrise was the cue for athletes to start heading toward the river. One moment there was anticipation and the next, rows of wetsuits clambering upstream in allocated waves, arms and legs clashing inadvertently, until rhythms were established, and enough spaces separated swimmers to restore calm. It was at first a chaotic and then a communal experience. Water was pleasant and I managed to keep a steady pace, sighting often to steer away from the shallow banks of the windy river while catching glimpses of bystanders on a bridge overhead. Ninety minutes later I had circled back to the starting point and surfaced at a muddy transition station where I crawled out of my wet suite and into my biking gear.

At the beginning of the bike course, the weather was still pleasant. The morning breeze had just enough cool to keep the core engaged, yet sting fingers and toes partly numb. The double-loop course traversed 112 miles of picturesque rolling hills, home to some of the most notable vineyards in the world. There were several break stations along the way, but not too many stoppers by yet. By the time I began the second loop, a lot had changed. The sun was beaming down, the air was heavier, and the crosswinds had picked up, jolting the bike around the bends and keeping the mind from drifting afar. By now the break stations were bustling with riders doing what they could to reduce core temperature. At mile 100, the steepest hill on the course, the Chalk Hill, known for its white and red varietals, was a memorable last effort before heading back toward the second transition. After more than six hours on the saddle, I was happy to dismount and prepare for the marathon.


Contrary to popular notion, the start of the Ironman marathon is not that daunting. It is actually comforting after all those hours on the wheels to feel the earth beneath one’s feet. By now the temperature was in the low 90’s and I could see through the corner of my eye a handful of athletes receiving intravenous fluids at a first-aid tent. The early part of the run course carved through a park in downtown and was lined with volunteers holding signs, cheering, and passing drinks. As we headed out toward the fields, the collective mood was more somber, befitting of the most challenging segment of the race where runners battle exhaustion, dehydration, hyperthermia, and hunger. By 5 pm the evening sun was beginning to lose its vigor and the head winds were dying down, providing a much-needed relief. There was even comic relief in the spectacle of runners in unexpected outfits. I saw a firefighter, hat, suite and even flashlights on hips, running alongside women in pompoms.

There was much inspiration to be found on the course that day. There were elderly veterans of the sport, determined to be the ones defining their age. There were physically disabled and individuals of size, proudly defiant in the face of their disadvantage. By this stage of the race, some athletes were giving it all they had – either professionals for obvious reasons or rookies from lack of experience. Most athletes, however, were keeping steady pace, deliberately conserving energy for the final miles. And the unfortunate or unprepared had succumbed to walking yet staying in the race, an act of sportsmanship by itself. No matter what the strategy, success in those final hours comes from how well the mind is trained to ignore bodily pain, because pain eventually comes. At 9 pm the sun had dipped below the horizon and the twilight lit the course as it winded through the downtown park. Looking at my watch, I knew I had a chance to end the race before total darkness and under my self-imposed goal of 14 hours. I would also get to meet my expectant wife and my daughter, who had traveled to support and inspire me, at the promised hour. With all those in mind and fueled by a rush of adrenaline, I found myself sprinting toward the finish line as though the day had just begun. The last few hundred yards were truly as uplifting and mystical as the familiar television clips of Ironman finishes. There was palpable energy in the air with people cheering, loud music playing, and lights blinding. Yet time had slowed down, as though giving me a chance to soak up and forever store in memory snapshots of that unique homecoming experience. As each athlete crossed the finish line, the announcer would do his ritual of calling the individual’s name and saying you are an ironman.

Human endurance is a fascinating study. Every day each one of us is tested in our ability to endure. Whether we are essential workers, breadwinners, educators, students, care givers, laborers, or athletes, we routinely endure physical and psychological stress, sometimes without conscious awareness. We can endure much more if we choose to, since we inherently possess the tools to do so. To endure higher levels of fitness and improve health we need the right frame of mind, proper conditioning, good support structure to nudge us along, a higher goal, and a healthy dose of hope. In 1962, Dick Hoyt, an officer in Air National Guard witnessed the birth of his son Rick Hoyt and but soon found out that his son had cerebral palsy. At the age of 15, Rick Hoyt asked his father to take him along on a 5-mile benefit run. Dick pushed his son on wheelchair that day and together they completed the race. That was the beginning of arguably one of the most admirable stories in endurance sports history. The Hoyt team went on to complete over 1000 long-distance races, including 257 triathlons and 72 marathons. They completed 6 ironman races in which Dick would pull his son in a special boat as he swam. The story of the Hoyts is that of limitless love, athleticism, and discipline, all perfectly aligned to rewrite the boundaries of human grit. It needs to be studied as it propels us to higher places, but it need not be exactly mimicked, for we each have our own stories to write. The only question is, are you ready to write yours.