milk alternatives: a dietitian’s definitive guide

Milk alternatives -how to pick the right one for you and your family's needs

Dairy milk and vegan (plant-based) milk alternatives are not created equal! Learn how to choose the best milk beverage for you and your family’s UNIQUE nutritional needs.  

Not too long ago you only had two choices when it came to buying milk: dairy or soy. Now there’s a whole aisle dedicated to all the plant-based milk alternatives! You could probably use a little help choosing your milk alternative, or figuring out if you should just stick with milk!

Table of contents:

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  1. Description of milks and alternatives
    • Dairy varieties
    • Kefir
    • Goat
    • Soy
    • Nut
    • Coconut
    • Hemp
    • Rice
    • Oat
    • Pea
  2. Nutrition comparison chart
  3. How to choose which is best for you and your family

Description of milks (and all the milk alternatives)

Dairy (cow’s) milk

Dairy milk is high in protein, calcium, magnesium, riboflavin, potassium, and vitamin B12. Fat content ranges from 0-3.25%.

The milk from cows goes through four processes before packaging.

  1. Standardization: to standardize the amount of milk fat in each jug, cream is first removed from the milk, which can then be sold as skim milk (0.1%), or the cream is partly added back in to make partly skimmed milk (1% or 2%). Whole milk (3.25% milk fat) does not go through the separation process.
  2. Pasteurization: The milk is heated to kill spoilage and illness-causing bacteria.
  3. Homogenization: The fat globules are reduced in size so that they are evenly distributed throughout the milk, instead of separating out and floating on top.
  4. Fortification: Vitamin D is added at a rate of 100 IU per cup. Vitamin A (540 IU/cup) is also added to skim and partly skimmed milk.

Why does this process matter? First of all, we just need to be clear about the fact that this process creates safe and healthy food for you and your family. Any milk alternative should be fortified to ensure the same level.

What About Lactose?

Cow’s milk contains the naturally occurring sugar called lactose. The human body produces an enzyme called lactase that breaks down lactose. Our bodies start producing lactase immediately as babies, since we need it to break down the lactose that’s also found in human breastmilk.

But our bodies are efficient, so they will stop producing unused enzymes. If we stop consuming dairy, our bodies will stop producing lactase. Caucasian people have typically continued to consume dairy their whole lives, so most Caucasians continue to have no problem consuming lactose into adulthood. Most cultures have traditionally not relied as heavily on dairy, so lactose intolerance is more common in other ethnic groups.

I had a professor who preferred to refer to lactose intolerance as “limited lactose tolerance,” since most people have a personal threshold of dairy they can manage. For example, some people might be able to handle half a cup of milk. For others, any fresh milk is a problem, while cheese and yogurt are okay (since the lactose is more broken down).

A quick Google search will reveal that there are a plethora of health concerns out there about cow’s milk, many of which are unfounded myths. Read more here.

Milk varieties available at the supermarket

  • Whole (homogenized milk): contains 3.25% milk fat
  • 2% milk fat: (partly skimmed milk)
  • 1% milk fat: (partly skimmed milk)
  • Skim milk: 0.3% milk fat
  • Lactose-free milk
  • A2 milk: This milk may help some with lactose intolerance. There’s evidence that some milk intolerance may actually be due to A1 proteins rather than lactose. While not widely available yet, these milk products contain ONLY the less problematic A2 proteins.

Pros of dairy milk: 

  • High protein
  • Good balance of nutrients
  • Low cost and easy to find
  • Most people are accustomed to the taste

Cons of dairy milk:

  • Doesn’t medically work for those with a cow’s milk allergy, A1 sensitivity, or lactose intolerance
  • Is not an ethical choice for those who have chosen a vegan diet

Is it a smart choice?

  • Nutritionally, with it’s high protein content and good balance of nutrients including calcium, magnesium, folate, and vitamin D, cow’s milk is a smart choice. Unless there’s a medical or ethical reason to avoid cow’s milk, it’s a nutritious, affordable choice.

Milk alternatives - cow's milk

Kefir

A traditional method of preserving milk, kefir is made by fermenting milk with a mixture of yeasts and bacteria collectively referred to as “grains.” The result is a slightly effervescent, tangy, yogurt-like drink.

To offset the tang, a lot of varieties are flavoured and contain added sugars. Buyer beware and look for the plain variety to keep your added sugars low.

There are a lot of health claims made for kefir. However, it’s difficult to study the health benefits of kefir in general because kefir grains are not all uniform. Different grains will have different bacteria and yeast. The best we can say about fermented food products such as kefir is that they probably contribute to maintaining a healthy body, but we can’t make any claims for certain. There is some evidence that they lower cholesterol & blood pressure, prevent cancer, and improve immune function, but the majority of the studies have been conducted on animals. We need more research, especially on humans!

Pros of kefir: 

  • High protein
  • Good balance of nutrients
  • Low lactose so it MAY be suitable for those with lactose intolerance
  • Contains a high amount of several beneficial bacteria and yeast strains (probiotics), which may promote a healthy gut

Cons of kefir:

  • May not be fortified with Vitamin D
  • Need to look for unsweetened varieties
  • Most expensive milk alternative
  • Unique taste and texture – may take time to get accustomed to

Is it a smart choice?

  • While kefir is certainly a good choice nutritionally, the jury is still out on whether there are concrete health benefits from the probiotics. If budget is a factor, you may want to look into a DIY version or just sticking with regular old dairy milk.

Milk alternatives -kefir

Goat’s Milk

Both cows and goats are ruminant animals and therefore, the milk from these animals is naturally very similar. A few notable differences:

  • Goat’s milk is drastically lower in B12 than cow’s milk. As such, it may not be the best choice for a vegetarian whose only food sources of B12 are dairy and egg products.
  • Goat’s milk has about 10% the folate of cow’s milk. This is not a problem for adults who consume a varied diet, but there have been reports of low folate in infants who have been weaned to goat’s milk. Some goat’s milk has been fortified with folic acid (the synthetic version of folate), so look for this on the label if the milk is being offered to a young child.
  • Goat’s milk has more calcium, potassium, B6, and Vitamin A than cow’s milk.
  • While similar in fat content, goat’s milk contains a higher percentage of small and medium chain fatty acids, which may be easier to digest.
  • Goat’s milk has more A2 than A1 casein proteins. As discussed in the section on dairy milk, the A1 proteins may be responsible for some cases of dairy intolerance, so some people find they can tolerate goat’s milk better.

Pros of goat’s milk: 

  • Good source of protein
  • Good balance of nutrients for adults and omnivores
  • MAY be better tolerated in those with an A1 protein sensistivity
  • Higher source of several micronutrients (compared with dairy milk)

Cons of goat’s milk:

  • Higher cost
  • Harder to find
  • Not a substitute for a cow’s milk protein allergy as 90% of individuals with a cow’s milk allergy will also react to goat’s milk
  • May not be fortified with folate

Is it a smart choice?

  • Goat’s milk has a very similar nutrition profile to dairy milk so for those who prefer it and can afford the additional expense, it’s a smart choice.

Milk alternatives - goat's milk

Soy beverage

Made from cooked, ground, and pressed soybeans, soy beverage has the highest protein content of the vegan milk alternatives. The fat content is similar to 2% cow’s milk.

Some people are concerned about the effects of the phyto-estrogens found in soybeans. My full response is here, but the short version is that, unless you have hypothyroidism or are iodine deficient, consuming 2 servings of soy a day will not cause any health disturbances such as cancer. An 8 oz glass of soy beverage would be considered one serving.

Check out the label carefully when buying a soy beverage.

  • Look for the word UNSWEETENED. Otherwise, the manufacturer has probably added sugar. This is especially true of flavoured varieties such as vanilla or chocolate.
  • Look for the word FORTIFIED. If it’s not fortified, the vitamin and mineral content won’t match up to cow’s milk.

Pros of soy milk: 

  • High protein
  • Good balance of nutrients
  • Suitable for a vegan diet

Cons of soy milk:

  • May not be fortified with Vitamin D
  • Need to look for unsweetened varieties
  • More expensive than dairy
  • Not a substitute for a cow’s milk protein allergy as many individuals with a cow’s milk allergy will also react to soy
  • Due to phytoestrogen content, which could have adverse affects at high levels, it’s recommended to limit soy consumption to 2 servings a day. If someone drinks a fair amount of soy milk AND is consuming other soy products such as tofu, tempeh, or veggie “meats”, this would put them over their recommended limit

Is it a smart choice?

  • For someone who is not at risk of hypothyroidism, consuming 2 cups of soy beverage daily would not be a concern. Soy beverage is the closest nutritionally to dairy milk.

Milk alternatives - soy

Nut beverages

These are made by blending nuts with water and filtering out the solids. There are a LOT of nut options available. The more common types are almond and cashew, but I’ve also seen macademia, pistachio, and hazelnut.

If you have a high speed blender, you can make your own nut milks! An important thing to note, however, is that the DIY version will be unfortified. This means that it won’t have Vitamin D, calcium or other nutrients thrown in to match cow’s milk.

Nut beverages are low in protein, fat, and carbs. Yes, I just named ALL three of the calorie containing nutrients! Nut beverages are a very low calorie option.

1 cup of nut milk has 25-35 calories, compared to skim milk, which has 80 calories. 
The fat content is similar to 1% cow’s milk.

As with soy beverages, look out for added sugars, especially in the flavoured versions. The sweetened varieties will give you an extra 20g of sugar per cup! That’s like ordering a coffee and asking for 5 sugars!

Homemade versions won’t be fortified with Vitamins A or D, B12, or minerals such as calcium.

Pros of nut beverages:

  • Contain heart healthy fats
  • Low calories
  • Have a neutral to nutty taste
  • Suitable for a vegan diet
  • Suitable alternative for a cow’s milk protein allergy

Cons of nut beverages:

  • May not be fortified with Vitamin D
  • Need to look for unsweetened varieties
  • More expensive than dairy
  • Low protein

Is it a smart choice?

  • For someone who consumes sufficient protein and fat from other foods, fortified nut beverages are a suitable choice.

Milk alternatives -nut milks

Coconut milk/beverage

Coconut milk is also made by blending coconut meat with water and filtering out the solids. Coconuts are naturally high in fat. There are two types of coconut milk:

  1. Cans: This is full fat coconut milk and is suitable for use in cooking to make curries and such. 1 cup contains 20-35g of fat, depending on the brand.
  2. Cartons: This one is suitable as a drinking beverage. 1 cup has 4.5g of fat, which is similar to 2% cow’s milk. Since these are designed to be a milk alternative, most brands have fortified the coconut milk with Vitamins A, D and calcium.

At only 0.2g per cup, coconut beverage has the lowest protein content of all the options.

Pros of coconut milk: 

  • Have a neutral to nutty taste
  • Suitable for a vegan diet
  • Suitable alternative for a cow’s milk protein allergy

Cons of coconut milk:

  • May not be fortified with Vitamin D or calcium
  • Need to look for unsweetened varieties
  • More expensive than dairy
  • Very low protein

SAVE MONEY AND LEARN HOW TO MAKE YOUR OWN COCONUT MILK HERE!

Is it a smart choice?

The pros and cons list for the nut beverages and coconut beverages are quite similar with two main exceptions: the coconut milk is very low in protein but higher in fat. Since the jury is out on whether coconut fats are heart healthy or not while most nutrition professionals would agree that nuts are heart healthy, it would be better to skip the coconut milk and opt for a nut beverage.

Stick to using coconut milk for curries and opt to drink another milk alternative.

Milk alternatives -coconut milk

Hemp beverage

One of the newest “milks” on the block, hemp beverage is a little bit harder to find. It has twice the protein as nut beverages. While that initially sounds impressive, it’s still only 2g per cup. Soy and cow’s milk have much more at 8-9g per cup. The fat content is similar to 2% cow’s milk.

The main feature hemp beverage has to offer is its omega 3 fat content! Each cup has 1g of omega 3 fatty acids. Omega 3 acids are important for our brain, nerves, skin, hair, and nails, but they aren’t widespread in food! The main source is fish and seafood.

Considering vegans and most vegetarians don’t eat fish, they have to find a good source elsewhere! Hemp is a fantastic source of plant-based omega 3 fats. Although there aren’t any standard intake recommendations, Jack Norris, a vegan focused dietitian recommends consuming 0.5g daily.

Pros of hemp beverage: 

  • Contain essential omega 3 fats
  • Suitable for a vegan diet
  • Suitable alternative for a cow’s milk protein allergy
  • Slightly higher protein than nut beverages

Cons of hemp beverage:

  • More difficult to find
  • May not be fortified with Vitamin D or calcium
  • Need to look for unsweetened varieties
  • More expensive than dairy

Is it a smart choice?

  • For vegans, vegetarians, and anyone else who doesn’t eat fish, it can be challenging to get enough omega 3s. For this reason, if protein intake is not a priority, hemp milk may be a smart choice for these individuals.

Milk alternatives - hemp milk

Rice beverage

At 130 calories per cup  the calories in rice beverage are higher than most of the other plant-based beverages. However, this isn’t due to a higher protein or fat content but rather, a lot more carbs! And the fat it does contain is attributed to added canola oil, not from the rice itself. The fat content is comparable to 1% cow’s milk.

Pros of rice beverage: 

  • Suitable for a vegan diet
  • Suitable alternative for a cow’s milk protein allergy
  • Slightly higher protein than nut beverages

Cons of rice beverage:

  • Higher in simple carbohydrates
  • May not be fortified with Vitamin D or calcium
  • Need to look for unsweetened varieties
  • More expensive than dairy
  • Not suitable for young children as the typical level of inorganic arsenic found in rice beverages may be to high for their small bodies

Is it a smart choice?

Give this milk alternative a pass. I don’t see any nutritional or medical advantage of choosing this beverage over the plethora of other options now available on the market.

Milk alternatives -rice milk

Oat beverage

I thought I was done this guide and then I came across oat “milk” at the grocery store! Like the other grain and nut milks, oat beverage is made by blending oats and water then filtering out the solids. At 4g per cup (250 ml), oat beverage boasts a medium amount of protein and has a similar fat content to 1% cow’s milk.  As it’s a grain, the oat beverage does contain some naturally occurring sugars but less so than the rice beverage.

Pros of oat beverage: 

  • Suitable for a vegan diet
  • Suitable alternative for a cow’s milk protein allergy
  • Higher protein than nut beverages

Cons of oat beverage:

  • Lower protein that cow’s milk or soy beverage
  • Higher in simple carbohydrates
  • May not be fortified with Vitamin D or calcium
  • Need to look for unsweetened varieties
  • More expensive than dairy
  • Need to check label to ensure gluten free for people with Celiac disease

Is it a smart choice?

This is a good middle-of-the-road milk alternative. It has a medium amount of protein, a little bit of fat (from canola oil), and a moderate amount of carbs. Oat beverage is also the only milk alternative I’ve found that has some fibre! While it’s only 1g per cup (250 ml), oat fibre has been shown to improve cholesterol so this may be a smart choice for someone at risk of heart disease.

Milk alternatives -oat beverage

Pea protein beverage

The new kid on the block is pea protein milk! There are some brands (such as Rippl), that are entirely pea protein based while others have added pea protein to their nut milks.

Pros of pea protein beverage: 

  • Suitable for a vegan diet
  • Suitable alternative for a cow’s milk protein allergy
  • Higher protein than nut beverages
  • Lower carbohydrates: could be helpful for someone with diabetes

Cons of pea protein beverage:

  • May not be fortified with Vitamin D or calcium (check the label!)
  • Sugar added
  • More expensive than dairy

Is it a smart choice?

I’m pretty excited to see this one added to the market!  A lot of people have their hangups about soy or simply dislike the taste of it. For those wanting or needing a dairy free alternative, the choices have not been adequate… until now. Pea beverages are comparable in protein to dairy and have a good amount of fat. The pea/nut milks are a good blend: you get the protein from the pea and the taste and calcium from the nuts! Best of both worlds!

Milk alternatives -Pea milk

Nutrition comparison of 1 cup (250 ml) of milks and alternatives

There is a wide variety in calories and nutrients when it comes to all the milks and alternatives.

Vegan milk comparison chart

U = unsweetened              F= fortified

I’m a dietitian so I just love that raw data. But you’re probably looking for something a little more like this:

If you are ______ then choose _______.

Here’s my official guide for choosing the right milk or milk alternative for your needs!

Vegan

Vegans are likely to consume a lot of soy products (tofu, TVP, tempeh, edamame, etc). In that case, choosing a non-soy milk alternative is best, so as not to overdo the soy.

Vegan diets need to be carefully planned to include enough calcium. Make sure to choose either almond beverage or a milk alternative that has been fortified with calcium.

Vegetarian

Vitamin B12 is one vitamin that is ONLY found in animal products. For vegetarians who consume dairy and eggs, they will likely get enough Vitamin B12. 2 cups of milk gives nearly the full daily recommendation. If you don’t eat animal products, it’s important to choose a milk alternative that has been fortified with B12, or take a supplement. Our bodies are very efficient at recycling B12 so it can take a while for a deficiency to rear its ugly head, but when it does… a B12 deficiency can cause fatigue, brain fog, constipation, depression, and confusion. And that’s just a few of the symptoms!

Gluten free

If you’re eating gluten free, avoid oat beverages unless it explicitly states that it’s gluten free on the package. Otherwise, all other milks and alternatives should be safe to drink. Always check the package on milk alternatives to ensure there isn’t a “may contain” statement.

Lactose intolerant

Any plant-based milk alternative will be free of lactose. For those who want to continue to drink dairy, there are four options:

  1. Lactose-free cow’s milk: the manufacturers have added the lactase enzyme to milk to break the lactose down into its two smaller sugar components: galactose and glucose. You can drink it straight out of the carton.
  2. Kefir: the bacteria and yeast used to transform milk into kefir breakdown the majority of the lactose. Many people find they can tolerate fermented dairy products such as kefir or yogurt.
  3. Lactose drops: these drops contain the lactase enzyme and can be added to milk before drinking to breakdown the lactose. You need to pre-treat the milk at least 24 hours before drinking to allow the enzyme time to work.
  4. Lactose supplement: this supplement contains the lactase enzyme. You swallow it just before drinking milk or eating dairy products. You need to match the dose of supplement to the amount of dairy you plan on eating or drinking.

If you experience digestive upset after consuming dairy but have not had a confirmed lactose intolerance, you may rather be experiencing an intolerance to the A1 proteins found in cow’s milk. There are a couple of options for trialing low A1 milk:

  1. A2 dairy milk, which is from specific breeds of cow’s that don’t produce the A1 in their milk
  2. Goat’s milk, which is naturally low in A1

Looking for more calcium

If you are specifically looking for a beverage that will help meet your calcium needs, consider the bioavailability of the following foods (how well a nutrient is absorbed by the body):

  • Dairy milk: 30%
  • Soy milk (and others with added tricalcium phosphate): 24%
  • Almond beverage: 21%
  • Beverages fortified with calcium carbonate: 15-40%

While dairy is generally the highest, the rest are all within a reasonable range. The important thing to look for is that the beverage chosen has a calcium content of ~30% daily value. Almonds are a naturally good source of calcium, but all the other alternatives need to state “fortified” on the package.

Every time you pour, remember to shake the carton first! The added vitamins and minerals can settle at the bottom.

More protein

Protein is one of the most filling nutrients. Choosing a high protein beverage can help to keep you feeling fuller for longer.

The only milks and alternatives with a good source of protein are

  • cow’s milk (all fat percentages)
  • goat’s milk
  • soy beverage
  • pea beverage

Milk alternatives -protein in dairy and plant based milks

For children

Before two years old, the only suitable milk beverages for a child’s growth and development are whole cow’s milk or an infant or toddler formula.  Once children turn two, they can be offered a milk alternative. If they are consuming high protein foods such as meat, eggs, and legumes at most meals, and are regularly consuming healthy fats, then any of the plant-based options may be fine. I would still recommend a higher protein/fat option. Protein and fat are needed to maintain adequate growth.

A recent study found that children aged 2-3 who drank plant-based “milk” beverages were 0.4cm/daily cup drank shorter than their peers who drank cow’s milk.  So if you compare the children who drank 3 cups of almond milk a day to those who drank 3 cups of cow’s milk, the children who drank almond milk were, on average, 1.5 cm shorter. We don’t know yet whether a shorter stature is a health concern so more studies are needed.

At this point, a good rule of thumb is to offer a milk beverage that has at least 6g protein in 1 cup. As far as I’m aware, the only plant-based milk alternatives that meets this standard are the soy and pea beverages.

If your child seems more selective with their eating, please consult with a pediatric dietitian to choose the best milk option for your child’s needs.


This post is part of my Virtual Grocery Store Tour series! With so many options these days, making healthy grocery choices can be confusing. I help you make the best choice for you and your family’s needs. If you have a grocery shopping question or would like me to review a product (such as when I gave the low down on Veggie Straws), send me a request at [email protected] 

 

 


 

Thanks to nutrition student volunteer, Maria Anna Kantounia, for her work in gathering data for the nutrition comparison chart and taking the product photos! Maria Anna is currently in her 3rd year of Human Nutritional Sciences pursuing her dream career as a dietitian. She is passionate about nutrition and her goal is to educate people about the relationship of nutrition and health. 

 

Milk alternatives - how to choose the right one for you and your family's needs.

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4 Comments on “milk alternatives: a dietitian’s definitive guide”

  1. Thank you for this great summary! One comment- non-homogenized milk is also available for those that prefer it. It’s often referred to as “standard milk”. Most people prefer to have the fat dispersed for them but for anyone who likes the “cream on the top”, it can be found in some stores 🙂

    1. Oh yes! Non-homogenized milk! I’ve been wanting to try that for years. Several years ago I called the dairy organization in my area to ask if it was available but it wasn’t. Since then I’ve heard that a small dairy in a city about an hour away sells it. I still need to get over there and check it out.

  2. Hi Jessica..great article! Lots of information in one spot to compare these milks! I’m wondering what you think about the sustainability of each of these milks? Is there evidence to say that some milk or milk substitutes are better for the environment than others?

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