Does milk actually help bones

If you drink milk to keep your bones strong, there’s good logic in it. Milk and dairy products are concentrated calcium sources, and we know calcium fortifies bones and prevents osteoporosis.

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However, a recent study suggests that while some milk may be good, more is not better. In fact, too much milk may be bad for your health.

The study, conducted with over 60,000 women (age 39-74) and 45,000 men (age 45-79) found that too much milk – three or more glasses a day – was not only associated with mortality but also an increased risk of fracture and hip fracture. Researchers found this surprising association after following the men and women in this study for 22 and 13 years respectively. Over this time, study participants completed questionnaires about their milk-drinking habits.

After adjusting for a other variables, they found that women who reported drinking three or more glasses of milk each day nearly doubled their risk of death in relation to women who drank less than one glass each day. Men were not as affected as women, but those who drank three or more glasses of milk each day still showed a significant increase in mortality.

Interpreting the results

Does this mean you shouldn’t drink milk? Don’t go shunning the jug just yet.

There are details to consider in understanding these study results, experts say. While milk and dairy are among the most calcium-rich foods you can eat, there are other substances in milk that may warrant some moderation.

The authors note that D-galactose, found in milk, has been shown to induce oxidative stress damage and chronic inflammation in animals, and such changes have been associated with cardiovascular disease, cancer, bone loss, and muscle loss in humans. They also caution that their findings “merit independent replication before they can be used for dietary recommendations.”

Gail Cresci, PhD, RD, a Cleveland Clinic researcher and dietitian , did not participate in the study but she agrees with the authors’ assessment. She says while the study raises interesting questions, there is not strong enough evidence to warrant a restriction on milk.

The role of vitamin D

She says there are some unanswered questions about the study participants – and whether or not they were lacking in vitamin D.

“Questions about vitamin D stood out to me right away. Calcium is linked with bone health, but vitamin D promotes calcium absorption and maintains adequate blood levels of calcium and phosphate to allow for normal bone mineralization.” Without enough vitamin D bones can become thin and brittle and the formation of strong new bone can be prevented. Vitamin D protects older adults against osteoporosis.

Dr. Cresci says it’s unclear whether or not the milk in the study, conducted in Sweden, was fortified with vitamin D or if a lack of sunlight in that part of the world could have contributed to a vitamin D deficiency.

“Additionally, as the authors point out, they cannot determine if people were taking higher amounts of milk because they were at risk or had osteoporosis and therefore higher risk for fractures anyway,” she says. Her advice? Try to consume 1200 mg of calcium and 600-800 IU of vitamin D daily, especially in winter months.

Dietary sources of calcium

While milk contains 300 mg of calcium/cup, there are many other good dietary sources including cheese, yogurt, greens (collards, kale), soy beans, figs, broccoli, oranges, sardines and salmon (with bones) and many fortified foods.

“If you want to drink milk for strong bones, I recommend no more than one glass a day. Do this in addition to a mixed diet rich in calcium. If you are unable to consume adequate amounts in your diet, consider supplementation, especially in the winter months,” Dr. Cresci says.

Is Milk Really Bad For Your Bones?

Most of us were taught at a young age that drinking milk builds strong bones, and it’s true that getting adequate calcium from foods is beneficial for skeletal health. However, new research linking high milk intake to increased risk of fractures is raising eyebrows this week.

Although this one study isn’t reason alone to make any changes to your diet, the recent media interest in this topic does present a good opportunity to examine whether you’re doing everything possible to maintain strong bones — and, heads up: Eating calcium-rich foods is just one part of the equation.

Milk and Fracture Risk: Research Is Mixed

The new study, published in the British Medical Journal, examined milk intake and its relationship to risk of bone fractures, death from any cause, and death from cardiovascular disease and cancer in a large group of Swedish men and women. Contrary to what might be expected, among middle-aged and older women, each additional glass of milk consumed daily was associated with a nine percent increased risk of hip fracture and a 15 percent increased risk of death from any cause. Adding an extra glass of milk was also associated with a 15 percent increased risk of death from heart disease.

Among men, however, there was no relationship between usual milk intake and fracture risk. The researchers observed a slight (three percent) increase in death from any cause for each additional glass of milk men consumed.

Interestingly, higher intake of other dairy products — namely cheese and yogurt — was associated with a lower risk of mortality and bone fracture among women.

This study was an observational study, which means it was not designed to prove that drinking more milk actually causes an increased risk of death, fracture, or heart disease. Two previous meta-analyses, which pooled the results of multiple observational studies like this one from several countries, did not find that drinking more milk increased the risk of fractures. That said, they also did not find that higher milk consumption offered any protection against fractures.

The authors of the study urged caution when interpreting these findings, and emphasized that more research needs to be done before considering any changes to current dietary recommendations. The researchers also stated that the results may reflect what is known as reverse causation; the women drinking the most milk may have increased their intake because they had been told by their doctors that they had low bone density or a high risk of osteoporosis, and thus were already at an increased risk of having a fracture.

Eating Well for Strong Bones

If you enjoy and regularly drink cow’s milk, there is no need to change your daily habits based on the results of this one study. But don’t rely on milk alone to keep your bones in good shape.

Getting adequate calcium is certainly important, but in the U.S. especially, we tend to overemphasize the importance of this nutrient for bone health and brush over all the other vitamins and minerals that play a pivotal role in skeletal health. As with any other chronic disease, you absolutely have to look at the whole picture of your diet. Eating more veggies isn’t the only step you can take to reduce cancer risk. Increasing your fiber intake alone, without making other healthy changes, isn’t the optimal approach to heart disease prevention. And drinking milk isn’t a comprehensive dietary prevention plan for osteoporosis and fractures.

In addition to getting adequate calcium, it’s equally important to eat a varied diet rich in whole plant foods to make sure you’re getting all of the micronutrients your body uses to support healthy bones. Follow these strategies to optimize skeletal and overall health at any age:

  • If you eat dairy products, try to consume a mix of dairy-based foods. Yogurt (minimally sweetened) and cheese (in small portions) may impact health differently than milk, as suggested by the new Swedish study. Rather than guzzling three glasses of milk a day, enjoy a yogurt at breakfast or an ounce of cheese and some fruit as a midday snack. “Solid” dairy foods may also help to fill you up more than fluid milk.
  • If you don’t eat dairy products, it’s critical to eat a variety of calcium-containing plant foods. These include collard greens, kale, turnip greens, soybeans (edamame), bok choy, broccoli and broccoli rabe, tofu made with calcium, beans, almonds, and, if you choose, calcium-fortified foods (like most soy and almond milks).
  • Eat plenty of vegetables (including leafy greens), fruits, whole grains, and plant proteins (including beans, lentils, and nuts). These foods provide potassium, magnesium, vitamin K, and vitamin C, nutrients that, like calcium, are important for maintaining good bone structure.
  • Limit packaged and processed foods, which are typically low in the beneficial vitamins and minerals listed above and often contain high amounts of salt (sodium). A high-salt diet may increase calcium and bone loss over time.
  • Talk to your doctor about testing your vitamin D levels and taking vitamin D supplements, if necessary. Vitamin D is another critical nutrient for bone health, and it’s difficult to get enough from food.
  • Don’t take a calcium supplement unless you have reviewed your diet with your doctor or a registered dietitian and have determined that you are consistently falling short of your daily calcium requirement. Exceeding calcium recommendations may increase the risk of kidney stones and even heart problems, and, as with other nutrients, it’s always better to get calcium from food rather than pills.

In the United States, milk has become synonymous with strong bones. It’s long been a recommendation by doctors and the U.S. Department of Agriculture that everyone over eight years old include three cups of dairy in their diet every day. But over the years, experts have poked some holes in the milk-bone health connection. Is milk really all its cracked up to be?

One of the major ingredients for healthy bones is calcium. This mineral provides structural strength to bones and teeth, and helps the body perform numerous other functions, such as clot blood and transmit nerve impulses. Normally, your body gets the calcium it needs from your diet, but if that’s not possible, it’ll start pulling calcium from your bones, making them weaker in the process.

RELATED: Six Ways to Build Stronger Bones

It’s for this reason the National Osteoporosis Foundation recommends you get between 1,000 and 1,200 milligrams of calcium every day. “Milk and dairy products are good calcium sources,” says Dr. Michael Lewiecki of the New Mexico Clinical Research & Osteoporosis Center. “In general, each serving of dairy – one cup of milk, a small container of yogurt, an ounce of cheese – has 300 milligrams of calcium.” This means, essentially, that you can get almost your entire daily-recommended amount of calcium just by ingesting three servings of dairy, as recommended by the USDA.

In recent years, some researchers have argued that milk can actually cause the bones to lose calcium. The “acid-ash” hypothesis proposes that digesting milk leaves behind acidic residues that make your urine (and therefore your body) more acidic; to compensate for this, the body pulls alkaline minerals, such as calcium, from the bones. In 2011, however, a pair of scientists took a hard look at the evidence for this hypothesis and found it wanting.

They explain, for example, that the pH of urine is not indicative of the body’s pH. What’s more, they note that some studies have found that milk consumption actually results in alkaline urine, not acidic urine.

Some experts also point out that bone fracture rates appear to be highest in countries that consume the most dairy. But the 2011 review stresses that many factors affect bone health, such as physical activity, genetics, and weight. Indeed, the higher fracture rates in those developed countries – including the U.S. – may be due to less physical labor and more sedentary lifestyles, rather than milk consumption.

Over the years, research has gone back and forth on whether milk really does help build strong bones. A recent study found that elderly men who drank a lot of milk during their teenage years actually had an increased risk for hip fractures. Another study, however, showed that milk (and yogurt) consumption results in higher bone mineral density in the hip. Overall, the majority of research suggests that dairy has some beneficial effects on bone health, in part because of milk’s other nutrients.

“In terms of bone growth and health, you need a certain amount of protein, potassium, calcium, and other nutrients,” says Dr. René Rizzoli, head of the Division of Bone Diseases at Geneva University Hospitals in Switzerland. “The food that contains the most well balanced amount of these things is milk and other dairy products.”

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The researchers themselves made it clear that their study would need to be replicated before it was used to give dietary advice. Others said the public should be cautious about changing their consumption based on these results.

So until we know more, the current weight of evidence suggests that it is still OK to continue to drink milk if you like it. It probably does have benefits for bone health, albeit benefits which are shorter lived than you might have hoped.

It’s also worth keeping your bones strong through other methods such as exercise and getting enough vitamin D from your diet, from sunshine or (depending on where in the world you live) from supplements in winter. (Read more about whether everyone should be taking vitamin D supplements).

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It’s a fact-humans need calcium and vitamin D to build strong bones. And drinking milk that’s fortified with vitamin D is an easy way to get those nutrients. But does that mean drinking milk will help prevent osteoporosis-related fractures?

If you follow the health news, you may have noticed a report from researchers in Sweden; they reviewed data from more than 100,000 adults and found that drinking three glasses of cow’s milk a day did not lower the risk of fracture, and was associated with an increased risk of premature death.

The report follows the publication of a commentary co-authored by Walter Willett, M.D., a well-respected nutrition scientist. In the piece, which was published in 2013 in JAMA Pediatrics, Willett and his coauthor challenge the government’s advice on milk consumption for adults and children. What’s more, some research suggests that consuming a lot of milk and other dairy products may be associated with an increased risk of prostate and ovarian cancers.

If you are at risk for or have osteoporosis, you may be wondering if there’s any good reason to drink milk. Here’s a look at the controversy-and our advice.

A rational recommendation?

The U.S. government, in its Dietary Guidelines for Americans, has long recommended 3 cups (8 ounces) of milk a day for adults. The rationale: Milk provides a wealth of nutrients, including calcium and vitamin D, making it important for bone health. In recent years, the guidelines have recommended fat-free or low-fat milk over whole milk due to concerns about the cardiovascular risks associated with saturated fat.

But Willett and his co-author contend that the recommendation for 3 cups daily-an amount that comes close to supplying the recommended intake of 1,000 to 1,200 mg of calcium a day for adults-is not based on solid scientific evidence. They argue that, in an evolutionary context, animal milk is a fairly new and unnecessary addition to our diet. Indeed many populations throughout the world today consume little or no milk for biological reasons (lactase deficiency), lack of availability, or cultural preferences. And, paradoxically, bone fracture rates tend to be lower in countries that do not consume milk compared with those that do.

Willett is no lightweight. His opinion is informed by his extensive research in this area. For example, he is a co-author of:

  • A 2014 study in JAMA Pediatrics that reported that high milk consumption in adolescence, theoretically when the most calcium is needed to promote peak bone mass and prevent fractures later in life, actually raises the risk of hip fracture in men later in life by 9 percent and doesn’t reduce the risk in women.
  • A 2011 study in the Journal of Bone and Mineral Research that analyzed data from nine studies involving more than 270,000 adults and found that drinking cow’s milk did not appear to protect against fracture in women. There was insufficient data on men to reach a conclusion.

Findings from the Swedish study, which was reported in 2013 in The BMJ, cast further doubt on the role of milk in fracture prevention. The researchers followed 61,433 women, who were age 39 to 74 at the start of the study, on average for 20 years; the 45,339 men in the study were ages 45 to 79 at the start, and they were followed for an average of 11 years. Over the years, the participants completed questionnaires about the foods they consumed, as well as how frequently they consumed them.

The researchers found that consumption of at least three glasses of milk each day (a total of 21 ounces or more) was associated with an increased risk of fracture in women and did not lower fracture rates in men. In addition, women who drank three glasses or more daily had a 93 percent increased risk of dying prematurely compared with women who drank less than one glass per day; men had a slightly increased risk of premature death. The researchers suggested that a compound called galactose found in milk could be to blame: When given to lab animals, galactose promotes premature aging, a shortened life span, and chronic inflammation.

To drink or not to drink?

If fracture prevention is your goal, the evidence suggests that drinking milk is not sufficient. But that doesn’t mean you shouldn’t drink it. Even Willett believes it’s OK to do so; he’s questioning the blanket recommendation for 3 cups per day for most people.

And what about the prostate and ovarian cancer risks associated with milk? While some studies support this, many others have found no increased risk.

Finally, should you be concerned about the increased risk of premature death reported by the Swedish group? The authors themselves advise interpreting their results with caution. That’s because in observational studies such as this one it’s virtually impossible to establish cause and effect. In this case, the findings are based on participants’ reports of their milk intake, which may not be reliable.

Our advice

If you like milk, pour yourself a glass or two. If you don’t like or can’t tolerate milk, there’s no reason to feel guilty about not drinking it. You can meet your needs by consuming a variety of other foods that are rich in calcium and vitamin D, such as fortified orange juice, sardines, salmon, and soybeans.

Measures you should take to reduce your fracture risk include not smoking, limiting your alcohol intake, and regularly performing resistance exercises to strengthen your bones and balance exercises to lower your likelihood of falling. In addition, if you’re at increased risk for a fracture, talk to your doctor about bone-boosting medications. Unlike milk, some have proved to reduce the risk of various types of fractures.

Christopher Gardner busts myths about milk

“This myth goes way back to before the food pyramid when the National Dairy Council offered to provide nutrition material to schools for free. And in all those materials, they said that you need multiple servings of dairy every day for a healthy diet,” Gardner said. “That was never agreed on. A lot of people are lactose-intolerant, and you don’t need it.”

Milk can be healthier than other options, like soda. He recommended checking the nutrition panel to make sure the milk isn’t just as sugary as soda though, particularly with plant-based milks. “The popular vanilla and chocolate versions of the plant-based milks are often loaded with added sugar. Even the plain is typically sweetened, but you can get unsweetened,” he said. “The lactose in milk isn’t that bad, so there is no need to water it down. Just avoid milks with added sugars.”

The nutrition label also allows you to compare the amount of fats, protein, carbohydrates and vitamins in each type of milk. “For example, the plant-based milks generally don’t have saturated fat like cow’s milk, so they don’t raise LDL-cholesterol as much as dairy milk, but they do have about the same amount of calcium,” he said. “And soy milk has the same amount of protein as dairy milk, but almond milk has much less protein.”

Another common misunderstanding is that 2-percent milk means that 2 percent of the calories are from fat. Really, it means that 2 percent of the weight is from fat. In 2-percent milk, 35 percent of the calories are from fat, Gardner noted. “Whole milk has close to 50 percent of its calories as fat, and 1-percent milk has about 20 percent,” he said.

Does milk help with weight loss?

However, your milk’s fat content may not affect your weight. The old belief was that drinking whole milk will make you fat and skim milk will help you lose weight. But this was refuted by Harvard’s Nurses’ Health Study, which followed the diets of over 100,000 nurses for more than 30 years, including how their diets changed.

“The Harvard study found that switching back and forth from whole-fat to 2-percent to 1-percent was not associated with changes in weight,” Gardner said.

But does drinking more milk help with weight loss? Some small, short-term studies showed that people lost weight if they drank more milk. According to Gardner, this raises the always-present nutrition-research challenge: Was it drinking more milk or was it consuming less of something else that caused the weight loss?

And what about raw milk? Raw milk proponents argue that pasteurization kills off important healthy bacteria, but Gardner said that it’s difficult to prove any health benefits from these bacteria. Some raw milk producers also claim it is easier to digest. However, a study overseen by Gardner found that lactose-intolerant participants had the same symptoms with raw and pasteurized milk.

And what does Gardner himself drink? He said he gave up cow’s milk for ethical reasons.

“Now, I drink unsweetened soy milk,” he said. “In our household, my wife doesn’t digest dairy milk very well, so we don’t even have it around. My four boys all drink unsweetened soy milk.”

White Lies? Five Milk Myths Debunked

Not surprisingly, the study was funded by the dairy industry. For decades, milk marketers have been spreading misleading information about the supposed health benefits of dairy products.

Thanks to these marketing campaigns, milk myths abound in our culture. But science doesn’t support them. Let’s take a look at five common claims about dairy products:

Myth 1: Milk builds strong bones.

The dairy and bone health link is one of the most pervasive milk myths. One large-scale Harvard study followed 72,000 women for two decades and found no evidence that drinking milk can prevent bone fractures or osteoporosis. Another study of more than 96,000 people found that the more milk men consumed as teenagers, the more bone fractures they experience as adults. Similarly, another study found that adolescent girls who consumed the most calcium, mostly in the form of dairy products, were at greater risk for stress fractures than those consuming less calcium.

Myth 2: Drinking milk can help you lose weight.

While advertisers would like you to believe that drinking milk can slim you down, studies consistently show that dairy products offer zero benefits for weight control. One major study even found that dairy products might lead to weight gain. In 2005, the Physicians Committee petitioned the FTC to put an immediate end to the dairy industry’s misleading campaigns about milk and weight control. In response, the government no longer allows advertising campaigns to claim that dairy products lead to weight loss.

Myth 3: Milk is “nature’s perfect food.”

Cow’s milk might be ideal for growing baby cows, but it’s far from a perfect food for humans. More than 60 percent of people are lactose intolerant, which can lead to uncomfortable symptoms like cramping, diarrhea, and bloating. Regular consumption of dairy products has also been linked to prostate cancer, lung cancer, breast cancer, and ovarian cancer.

Myth 4: Kids need milk to be healthy.

After babies are weaned from breast milk or formula, they do not need any type of milk to be healthy. Milk consumption during childhood has even been linked to colic and type 1 diabetes. Another study found no evidence that low-fat milk plays any role in preventing childhood obesity.

Myth 5: Milk is heart-healthy.

Milk and other dairy products are the top sources of artery-clogging saturated fat in the American diet. Milk products also contain dietary cholesterol. Diets high in fat, saturated fat, and cholesterol increase the risk of heart disease, which remains America’s top killer.

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Nutrition Diva listener Rona writes:

“My health coach says that I should avoid milk because it is acidic and, contrary to common belief, will actually deplete the calcium in my bones. I have always believed that milk was a good source of calcium. In fact, I insist that my children have at least 2 servings of milk a day! Does milk really deplete calcium from bones? Should I stop giving it to my kids?”

The idea that milk and dairy products weaken bones has been steadily gaining traction in alternative health communities. Of course, this runs contrary to the conventional wisdom that dairy products help build strong bones by providing calcium. Is the conventional wisdom wrong? Let’s take a closer look at the evidence.

Do Dairy Products Cause Osteoporosis?
People who are suspicious of milk’s role in bone health like to point out that the countries with the highest consumption of dairy products also have the highest incidence of osteoporosis. Is this convincing proof that dairy products cause osteoporosis? Not even remotely.

There are many things that affect bone health, including genetics, physical activity, body weight, smoking or exposure to second hand smoke, alcohol use, hormone levels, and medications. If any of those risk factors are more common in countries that have higher dairy consumption, then the link between dairy and osteoporosis may be nothing more than a coincidence.

>>Continue Reading on QuickAndDirtyTips.com

The dairy debate: Does milk build stronger bones?

Even those researchers who agree with the three-glasses-a-day recommendation say there is a limit to what dairy calcium can do. “The gene pool accounts for most of your risk,” Dawson-Hughes says.

During the years in which people build bone mass — from birth to about age 20 or 25 — bone density is determined 80% by genetics and only 20% by lifestyle factors such as exercise and diet. Bone loss, which starts to occur after age 25 or so, is determined half by genetics and half by lifestyle choices, Dawson-Hughes says.

Finally, there is an emotional side to this issue. The dairy debate is conducted in large part by two groups who accuse each other of twisting science and letting money or ideology cloud their views: the dairy industry and vegetarians.

The dairy industry accuses the anti-dairy camp of promoting an animal-free diet whether it makes nutritional sense or not. Dairy critics charge the dairy industry with bankrolling pro-dairy research and influencing the government’s dietary recommendations.

One thing both parties agree on is that exercise helps to build bones and maintain bone density throughout life.

  • Eating a calcium-rich diet is good for your overall health, but consuming high levels of calcium in your later years does not protect against thinning bones.
  • A six-year analysis of nearly 700 older women published in the Journal of Clinical Endocrinology & Metabolism found no difference in bone loss among those getting the highest and the lowest amounts of dietary calcium.
  • To protect your bones, adopt a strong-skeleton lifestyle, including weight-bearing exercise, adequate sun exposure, and maintaining a healthy weight.

More than 99 percent of your body’s calcium is stored in your bones. Dairy products like milk and cheese, as well as dark leafy greens, and of course, calcium supplements are rich sources of this bone-building mineral.

So for decades, the message has been simple: Get more calcium—the Institute of Medicine recommends 1,000 to 1,200 milligrams (mg) a day for adults—to protect your bones, especially as you get older when bones naturally start to thin.

Except it isn’t that simple. Though getting low amounts of calcium throughout your life can increase your risk for osteoporosis in older adulthood, getting high levels of the mineral in later life doesn’t appear to prevent bone loss.

In a recent study published in the Journal of Clinical Endocrinology & Metabolism investigating the impact of dietary calcium on bone mineral density, researchers studied nearly 700 postmenopausal women with thinning, but not osteoporotic, bones. The scientists measured the women’s bone mineral density (BMD) and calcium intake over a period of six years.

The women’s calcium intake was consistent over the study period and ranged from an average of 469 mg in the group getting the lowest daily amounts of calcium to 1,361 mg among the women with the highest average intake.

Despite the wide range in calcium intake, their BMD was remarkably similar from start to finish of the study period. The gradual decline in bone density was virtually identical among all the women in the study regardless of how much or how little dietary calcium they got each day.

There was also no difference in fracture rates among the women—those getting more than the recommended daily amount broke bones at the same rate as those getting well below the recommended amounts.

Though this study was conducted on older women, study author Ian Reid, M.D., says the results also apply to men.

“We have done a very similar study in men which also showed no association between calcium intake and bone loss,” Reid, who is a professor of medicine and endocrinology at the University of Auckland in New Zealand told Bicycling.

The study also echoes findings on calcium intake and fractures across genders. Notably, one analysis of dozens of studies including men and women concluded that getting high amounts of calcium did not reduce fracture risk in older adults.

What’s a cyclist who is concerned about bone density slipping away with age to do?

A healthy diet still matters—and dietary calcium (meaning food, not supplements) is good for your heart. So continue consuming calcium-rich foods like yogurt and canned fatty fish. And be sure to get adequate vitamin D (600 to 800 IUs a day) through sun exposure and foods like eggs and fortified milk.

Adopting a strong-skeleton lifestyle is key, Reid says.

“The lifestyle influences that matter for bone health are maintenance of a healthy weight through a balanced diet, adequate sunshine exposure, not smoking and not having too much alcohol, together with an active but safe lifestyle,” Reid says.

Maintaining a healthy body weight is particularly important for bone health at every age, Reid says. Research shows that being both overweight and underweight can increase your risk for low BMD.

Finally, make time for strength training year-round. Cycling is a non-weight bearing activity, so it doesn’t stress your bones enough to stimulate bone development. Strength training and impact exercises like plyometrics stress your bones to promote growth. Hit the weights at least twice a week.

Selene Yeager “The Fit Chick” Selene Yeager is a top-selling professional health and fitness writer who lives what she writes as a NASM certified personal trainer, USA Cycling certified coach, pro licensed mountain bike racer, and All-American Ironman triathlete.

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