Think, before you drink plant-based milk

In recent decades, plant-based alternatives for animal milk became very popular. Starting off with soy, now supermarkets offer wide range of milk substitutes, made from grains, such as rice, oats; and nuts, like almonds, cashews or hazelnut. Also, increasing interest in healthy lifestyle, guided by plant-based diet, decrease consumer interest in animal products.

There are wide range of reasons why people decide to swap cow’s milk for plant alternatives. Some of them, are related to medical conditions, such as lactose intolerance or allergy to proteins present in cows’ milk (casein). Others think that choosing plant-based milk products are more sustainable, ethical, or beneficial for health.

How is the reality? While plant-based diet, seems to decrease risk of cancer and metabolic diseases (Hardman, 2014), choosing plant-based alternatives over cow’s milk is unclear and depends on individual preferences. To make your choice more informed, I summarized some important facts, which you should consider before you face ‘milk-dilema’.

The ‘real’ milk 

Consumption of cow’s milk as well as other dairy products is a part of balanced diet. Especially, cow's milk is a rich and cheap source of valuable nutrients, including good quality protein, and minerals - calcium and iron. Milk and its derivatives contribute essential micro- and macronutrients to the diet, especially in infancy and childhood where bone mass growth is in a critical phase. It also appears to possess protective effects of against obesity, diabetes, and cardiovascular disease (Marangoni et al., 2018).

Dairy products reduce risk of cardiometabolic diseases as well as some cancers. The adverse effects were only implicated in individuals, who are not able to tolerate them or might be allergic. For general population there is no reason to limit diary intake. However, even lactose-intolerant adults can tolerate one glass of milk. The same applies to cow's milk protein allergy. For example, children who were diagnosed, and re-evaluated after 1 year, 69% tolerated cow's milk at re-evaluation (Host et al., 2002). It makes sense to warn the general population against allergies associated with dairy products; would be equivalent to warn against foods, such as peanuts or seafood due to the fact that a small subset of the population might be affected (Thorning et al., 2016).

Plant-based alternatives 

Plant-based milks are predominantly made from beans, such as soya; nuts, like almonds or cashew, but also from rice, coconut and oat. The nutrient density of plant-based milks varies a lot and depends on the raw material, as well as processing, fortification, usually with vitamins and minerals, including vitamin A, vitamin D and calcium; and the addition of other ingredients such as sugar and oil. However, milk substitutes have less nutrient-dense than whole milk from cow (Thorning et al., 2016).

*Unsweetened drink. 

Soymilk: the most common substitute for cow milk, and recommended choice for those with lactose intolerance. Soy milk is the highest in protein plant-based alternative.

Almond milk: good choice for adults and children who suffer from intolerances and allergies to animal milk. Almond milk has low in calorie and protein, so you might consider adding oats or nuts, to make nutritious meal.

Hemp milk: healthy choice (if you go for untweeted option), rich in polyunsaturated fatty acids and low in calories. Hemp milk is also lower in protein (when compared with cow milk), but higher than almond milk.

Oat milk: recommended for those who suffer from gluten intolerance or celiac disease. It’s higher in calorie than hemp and almond choices, due to rich carbohydrate content. In comparison with cow milk, oat milk provides riboflavin (vitamin B2) and some minerals.

Consider before you switch: 

• Low protein content: Oat and rice milks are extremely low in protein. Actually, only soymilk resembles the protein composition of cow's milk. 
• Low in saturated fat and cholesterol: plant-based drinks are low in saturated fat and cholesterol. Instead they are good source of plant sterols, which seems to have anti-inflammatory and anti-carcinogenic properties (Decloedt et al., 2017). 
• Low in minerals: several plant-based drinks might be lower in iodine, potassium, phosphorus, and selenium in comparison to semi-skimmed cow’s milk (Fødevarestyrelsen, 2015). 
• ADDED sugar: flavoured plant-based drinks might have a sugar content equal to sugar-sweetened beverages, which have been implicated in obesity (Jakobsen et al., 2010), and associated with increased body fat and blood pressure (Maersk et al., 2012).

It’s your choice 

We tend to think that plant-based milk alternatives have the same nutritional composition like cow’s milk. Cow's milk and plant-based drinks are completely different products, both regarding nutrient content and presumably also health effects (Thorning et al., 2016). As you can see above, plant-based substitutes are lower in protein and some minerals (in not fortified). Also, you should note that depending on manufacturer, some of plant milk choices might be added with sugar or even oil … Those who usually get calories and other nutrients from cow's milk should speak with a licensed dietitian to ensure they find suitable alternatives. This is especially important for children.

If you want to find out more: Schuster MJ, Wang X, Hawkins T, Painter JE. Comparison of the Nutrient Content of Cow’s Milk and Nondairy Milk Alternatives. Nutr Today. 2018;53(4):153Y159.

Hardman WE. Diet components can suppress inflammation and reduce cancer risk. Nutr Res Pract. 2014 Jun; 8(3): 233–240.

Thorning TK, Raben A, Tine Tholstrup T, Soedamah-Muthu SS, Givens I, Astrup A. Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence. Food Nutr Res. 2016; 60: 10.3402/fnr.v60.32527.

Host A, Halken S, Jacobsen HP, Christensen AE, Herskind AM, Plesner K. Clinical course of cow's milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol. 2002;13(Suppl 15):23–8.

Jakobsen MU, Dethlefsen C, Joensen AM, Stegger J, Tjonneland A, Schmidt EB, et al. Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index. Am J Clin Nutr. 2010;91(6):1764–8.

Maersk M, Belza A, Stødkilde-Jørgensen H, Ringgaard S, Chabanova E, Thomsen H, Pedersen SB, Astrup A, Richelsen B. Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study. Am J Clin Nutr. 2012;95(2):283–9.

Marangoni F, Pellegrino L, Verduci E, Ghiselli A, Bernabei R, Calvani R, Cetin I, Giampietro M, Perticone F, Piretta L, Giacco R, La Vecchia C, Brandi ML, Ballardini D, Banderali G, Bellentani S, Canzone G, Cricelli C, Faggiano P, Ferrara N, Flachi E, Gonnelli S, Macca C, Magni P, Marelli G, Marrocco W, Miniello VL, Origo C, Pietrantonio F, Silvestri P, Stella R, Strazzullo P, Troiano E, Poli A. Cow’s Milk Consumption and Health: A Health Professional’s Guide. Journal of the American College of Nutrition. 2018, 38;1-12. Decloedt AI, Van Landschoot A, Watson H, Vanderputten D, Vanhaecke L. Plant-Based Beverages as Good Sources of Free and Glycosidic Plant Sterols. Nutrients. 2017 Dec 29;10(1). pii: E21.

Fødevarestyrelsen. Slutrapport: Næringsstofindhold i ris-, havre-, mandel- og sojadrikke. Glostrup, Denmark: Ministry of Environment and Food of Denmark; 2015.

Almond, hemp, oat, soy and cow’s milk: Which is best? Medical News Today, June 2019. Available at: https://www.medicalnewstoday.com/articles/325425

Nutritional value of cows and plant-based products: Food Data Central. USDA. Available at: https://fdc.nal.usda.gov