Milk and Milk Alternatives


By now we hope you’ve received your copy of Weekday Weekend and tasted some of Emma + Elsie’s delicious recipes. I’ve said it once, but again, what I love so much about this cookbook is its versatility and flexibility. So you eat meat? Cool! Unwilling to sacrifice cheese? (Guilty!) That’s okay too. That said, we’re received lots of wonderful feedback and questions regarding the “dairy rule,” so we wanted to go ahead and tackle milk and milk alternatives. While I’m so excited about this topic, in my reading it seems there are a lot of theories floating around and much research is still inconclusive. We dietitians believe in evidence-based practice, so hopefully we can keep this post as objective, unbiased and informative as possible.

In the cookbook, Lindsey and I preface the “dairy rule” with the disclaimer that we ourselves consume cow’s milk and cow’s milk products. However, we try to follow a few basic rules and shop smart (more on this below). Please understand if cow’s milk isn’t your thing, you can absolutely still consume a healthy, balanced and sometimes superior diet. Some studies even suggest the avoidance of cow’s milk can improve certain conditions like IBS andacne. Furthermore, cow’s milk allergy is considered the most common allergen in children under 2.5, so hallelujah, alternatives exist! Lindsey has already completed loads of research and gone into great detail about calcium and vitamin D, specifically geared towards those plant-based eaters out there—you can read more on recommended intakeshere. But without any further adieu, let’s begin by covering cow’s milk.

Cow’s Milk (8 g protein, 12 g carbohydrate, 0-8 g fat/8 oz )

Okay, so you drink cow’s milk and stock your fridge with cheese and yogurt. Fab. Cow’s milk is affordable, nutritionally balanced and the most easily accessible milk option available to consumers. Providing a healthy amount of protein, calcium, vitamin D and phosphorus, it has long been considered an integral part of every meal. However, is it really as great as some claim? From a socioeconomic perspective, when you consider that nearly20.1 million free lunches are distributed every day in the U.S., there is no arguing that a carton of white milk is a nutritive option when compared to other options available in schools. However, for most of us, it can be very easy to overdo it when it comes to dairy. Reality check: one ounce of cheese (about the size of a pair of dice) equals one dairy serving. (Waah!) That’d make for one sad looking cheese board.   

The RDA for calcium (for those 19 years and up) is 1,000-1,200 mg/day, which is easily achieved by consuming 1-2 sources of dairy alongside fresh fruits, veggies and meats. This is why the World Health Organization and the American Diabetes Association are now backing plant-based diets. Friendly reminder, a plant-based diet does not equate to a vegetarian/vegan diet. Plant based just means focusing on mainly fresh fruits, veggies, tubers, legumes and whole grains.

Back to the cows; when shopping for cow’s milk products, here’s what we recommend:  

No hormones, ever: Specifically rBGH and rBST. rBGH is a growth hormone given to cows to increase milk production and, interestingly, is not permitted for use in Europe or Canada. While studies are inconclusive, it has been shown that rBGH has caused adverse health effects in animals, so for now, probably best to avoid these hormones.

Try to keep it localHeck, if you can, tour a neighboring dairy farm so you see exactly where your dairy is coming from. If your local dairy is transparent and welcomes observation and community involvement, chances are the treatment and feeding practices are desirable. Look for cows to be grazing and active—these are signs of healthy cows, which equals healthier consumables for you!

Buy organic: As mentioned above, grass fed or pastured cows, are preferred. For a milk to be labeled organic, the cows must be pastured at least 30% of the time. Furthermore, grass fed cows produce milk with higher omega-3 and CLA content. I typically recommend 1-2 servings of whole fat dairy products a day as the fat aids in vitamin absorption and promotes satiety.


Milk Alternatives

Whether you’re playing by the ‘Weekday Weekend’ rules or if you avoid milk regularly, it’s important to be aware of the many different milk alternatives available to you. With more people seeking alternatives, the market is booming. Interestingly, certain regions of the world have been known to consume milk from camels, reindeer and elk as alternatives. However, for today’s post, we’re going to take a hard look at some of the more attainable milk alternatives:

1. Soy Milk (7 g protein, 4 g carbohydrate, 4 g fat/8 oz)

Perhaps the first real “milk alternative” to hit the scenes, soymilk appeared on U.S. shelves in the mid-1980s. Soy milk is easily accessible to shoppers and an excellent source of protein, vitamin A, vitamin B12, potassium and calcium —great news for vegans and vegetarians!

Despite these perks, questionable claims regarding the health effects of soy have left many puzzled. From possibly causing cancer to affecting fertility, soy is the king of controversy when it comes to health foods. We could go on about this, as there is a lot to consider (spoiler alert: future blog post coming soon!). However, for the sake of this post, I’ll keep it concise. Quality soy is safe in moderation; it does not affect thyroid function in those with healthy thyroids and the American Cancer Society has stated whole soy foods can reduce the risk of certain cancers. When you shop smart (organic, non-sweetened versions), soy milk is an excellent choice when consumed smartly and in moderation.

2. Almond Milk (1 g protein, 1 g carbohydrate, 2.5 g fat/8 oz)

Made using ground almonds and water, almond milk is largely … water. So don’t be surprised when you notice the protein and fat content are significantly lower than, say, a handful of almonds. Almond milk is often fortified with vitamin E, calcium and vitamin D, so it is a good vitamin/mineral substitute if eliminating cow’s milk. Just remember you’ll need to balance your meal with protein and fat coming from other real food sources.

3. Coconut Milk (0 g protein, 2 g carbohydrate, 5 g fat/8 oz)

Coconut milk is quickly becoming all the rage, and for good reason! Remember, we’re talking about the slightly watered down version meant to mimic milk’s consistency, not the stuff you’ll find in the can on grocery store shelves. Coconut milk contains no protein and less calcium than cow’s milk (100 mg/8 oz in coconut milk vs. 300 mg/8 oz in cow’s milk). However, it is a good source of MCT’s, a healthier form of saturated fats which provide a wide range of health benefits when consumed in moderation. RD recommendations to counter the nutrient deficit? Toss in an extra handful of almonds or kale to split the difference and come out on top.

4. Rice Milk (0 g protein, 22 g carbohydrate, 2 g fat/8 oz)

Unless you suffer from multiple severe food allergies, rice milk isn’t my fave. Just look at the nutritionals—it’s basically just starch and water. No protein, minimal fats. Sure, some brands are fortified with calcium, iron and vitamin B12, but for all intents and purposes, I’d try another milk alternative first before settling with rice milk. Also notable, detectable levels of arsenic were found in Consumer Reports testing of rice milk, so it is recommended to consume no more than ½ cup per day and not give regularly to children under 5 unless otherwise advised by a physician.

5. Hemp Milk, Unsweetened (2 g protein, 1 g CHO, 6 g fat/8 oz)

Many say hemp milk is an acquired taste thanks to its earthy, seedy flavor. Once you get past the taste, as long as you are getting calcium from other dietary sources, I give hemp milk the green light! Made by mixing water with cannabis seed (sorry guys, no other snazzy side effects), hemp milk is a great source of healthy omega-3 fatty acids and is often fortified with calcium, vitamin D and vitamin B12. It’s a great option for those who battle with gas, bloating or other IBS symptoms as it is low in oligosaccharides, the gas producing sugar present in some milk and milk alternatives. The downside is the low calcium content and high price tag that comes with a carton of hemp milk.

6.  Goat Milk (9 g protein, 11 g CHO, 10 g fat/8 oz)

Goat’s milk has a nutrition breakdown similar to cow’s milk while being lower in lactose, making it easier for some to digest. It is also higher in vitamin A, potassium and calcium than cow’s milk, making it the preferred post-exercise drink for many, thanks to the extra load of electrolytes. It has a somewhat strong flavor and does contain casein, technically not making it approved for those with a true milk protein allergy. However, studies have shown that goat’s milk is very low in Alpha S1 casein and primarily contains Alpha S2 casein. In layman’s terms, this means that some who have traditionally been unable to tolerate cow’s milk are able to handle goats milk. Depending on the severity of your allergy, goat’s milk may be worth a try after discussing with your physician.

7. Cashew Milk (0 g protein, 1 g CHO, 3.5 g fat/8 oz)

Cashew milk is the slightly more nutritious option than almond milk, thanks to the added fiber, antioxidants and copper present (which aids in iron absorption). Cashew milk is a good option for those who are wary of soy milk but still want a little more bang-for-their buck than almond milk. Take note of its miniscule protein content and be sure to incorporate real food protein to make up for this loss.

8.  Pea Milk (8 g protein, 7 g carb, 5 g fat/8 oz)

Pea milk is quickly becoming my new obsession. I mean really, it’s equivalent in protein to cows milk while providing fewer carbs, #winning! It has 50% more calcium than cow’s milk and legit, tastes a lot like milk. Only downside is the higher than usual amount of omega 6 fatty acids. However, some brands, likeRipple, do a great job at counteracting this by adding in extra omega 3’s.

Whichever route you choose to go with milk, just do your research and remember, everything is good in moderation. Unless you are affected by malnutrition, malabsorption or another medical condition where your physician asks you to supplement your diet, most of us following a healthy diet don’t need more than a glass or two of milk/milk sub a day. Lindsey is going to chime in with some information regarding pasteurization of milk products, as I think there is some confusion about this process. Thanks, as always, for reading and please feel free to comment with your favorite milk alternative!


A note from Lindsey:

Ultra-pasteurization. What in the world does this even mean? How is it done? Why is it done? Why does it seem like organic milk is always ultra-pasteurized? Does it mess my milk up? There are a few of the questions you may have around the subject of ultra-pasteurization and I am here to clear the air.   Pasteurization is a process that involves heating milk to kill potentially harmful (and beneficial) bacteria and extend shelf life. Your standard gallon of milk is typically pasteurized by a process called High Temperature Short Time or HTST. This involves heating milk to 161 degrees Fahrenheit for 15 seconds. Ultra-pasteurized milk is heated to a higher temp (280 degrees) for 2 seconds in a process called Ultra High Temperature (UHT) pasteurization. So why the difference? It all comes down to shelf life. While standard pasteurized milk and UHT milk both spoil in about five days after they’re opened, before opening UHT milk will not spoil for 70 days versus 15-21 days for standard pasteurization. This is desirable from a retailer’s standpoint and is why many organic milk brands offer a UHT version of their milk—the retailers are more likely to carry organic milk in their store when they are unsure of how it will sell if it can stay on the shelf longer. Critics of UHT milk cite that nutrient content is lower and proteins are damaged in the process that may be harmful. However, evidence suggests UHT and HTST milk is similar in nutrient content to raw milk. While changes to proteins in the milk may occur after pasteurization, evidence that this is harmful is lacking. Pasteurization does kill some bacteria that may be beneficial, but this does not make the milk unsafe. So, don’t feel alarmed when you see the terms pasteurized or ultra-pasteurized on your milk’s label.

Credits // Author: Sarah O’Callaghan with contributions from Lindsey Kelsay. Chart design: Mara Dockery. Photos: Emma Chapman, edited with ACS desktop actions.
  • thank you SO MUCH for your comments about UHT pasteurization. i work in milk manufacturing and my brain starts to boil when people talk about UHT as being “unhealthy” or “processed”. your explanation was wonderful.

  • Just an FYI in number 4: the phrase is “intents and purposes.” From a writer who got dinged at her job for writing “intensive purposes.” Cheers!

  • These posts are so helpful! These dietitian posts are packed with info that a video talking through everything would be so helpful!

  • Thank you for this very informative post! I have a question: where I live (The Netherlands – yes, that country with freakishly tall people who love their dairy), Almond milk is being advertised as actually not very healthy because of the high sugar content. I do not read anything about that in your post. Is this something that is different in the US perhaps? Or has it changed in the last couple of years?

    • Hmm. Yeah, I’ve never heard that. I do tend to always buy “unsweetened” almond milk as some will have added sugars (like chocolate almond milk) and while those may have their place it’s not what I’m looking for when I’m making a smoothie or adding some liquid to a soup. I don’t know if almond milk is made or marketed very different in the US vs The Netherlands. I haven’t had the pleasure of visiting your country yet so I can’t really say I’m familiar. But with ANY food it’s always good to check the ingredients. 😉

      • Thank you! I asked because I do like Almond milk :). But I will also check out pea milk for sure! Everything that tastes like real milk has a pre in my book!
        And weren’t you and Elsie in Amsterdam at some point? Or am I remembering this incorrectly? I admit I read a lot of blogs so it might have been someone else!

    • I second Emma on this one – most unsweetened almond milks I’ve seen here in the states have very little to no sugar present. Just double check the label to be sure and avoid the sweetened options.

  • Yay milk alternatives! I LOVE whole milk in my coffee but I use unsweetened almond milk in my morning smoothies. I tried to ditch whole milk in my lattes, but I don’t like soy and almond milk tastes literally like water when it compliments coffee. I’ve never heard of pea milk though – would love to know more (what does it taste like, look like, etc!

    Funny thing about milk…I spent Christmas in France and though they are ahead of us in many ways with eating “real + whole” foods, their milk is pumped full of preservatives so much so the shelf life of a carton is over 6 MONTHS!! How crazy is that?! Their butter however, is simply perfect!

    http://www.shessobright.com

    • I’m pretty sure that, in France, if the milk has an extended shelf life, it’s because it’s UHT (which, like Lindsey explains in the article, prevent it to spoil for many months) and not because it’s loaded with preservatives. If you look at the ingredient list on the carton, you can see only one: milk 😉

  • So thankful for the dietitians view on milk. I’m trying to eat healthier and giving up cheese well there’s no point in living without cheese IMO so I’m glad to see it’s not totally wrong to keep on living my cheese truth! I will be trying to switch to organic though! Thanks for truthful non biased posts!

  • Thank you for this post! This is super helpful – I didn’t even know about the benefits of pea milk. I’m going to look for it 🙂

  • I would love to know where lactaid falls in all of this…is it healthy? We found out my autistic son had a milk allergy at 4 years old!!! They have had him on lactaid for the last year and all his skin problems disappeared, however, we do have some stomach issues.

    • Lactose-free milk, like Lactaid, is certainly a healthy option for those experiencing lactose intolerance. However, lactose-free milk (like Lactaid) still contains the same proteins as cow’s milk, so if your son has a milk protein allergy, Lactaid may not be the best option for him. Perhaps you could try one of the other alternatives listed to see if it helps 🙂

    • I would also be really interested in reading about where lactaid falls in the grand scheme of dairy. Over the last few years we have found out that my mom and three of my siblings are lactose intolerant and my 17yo brother has to rely heavily on lactaid sometimes.

  • Oh wow! I loved milk and dairy in general but I never knew it’s so easy to overdo it. I’ve been trying to cut out at least some of it this year so I’m glad to see all the alternatives. I’m from Europe so I am so happy to see that the hormones are forbidden here – it’s always good to know that. Not trying to sound mean but I think the ‘typical’ food in the US has much less restrictions than in here and I believe it’s not always good for the customer. Anyways – thank you for this post – very helpful!

    With kindness,
    https://gentileame.wordpress.com

  • Thank so much! It’s refreshing to read an article about milk and milk alternatives that is not preachy-preachy. I like to vary my choices depending what I cook because sometimes, you can’t just replace cow milk in recipes without messing it (been there, done that!)

  • Thank you for this post. I have given up dairy and my system cannot handle cow/goat milk since a long time ago. I usually make my own almond milk, which is not so nutritious, but usually combine it with a generous proportion of almonds and/or mixed nuts on a daily basis as well. I’d like to ask if homemade pea milk (and in general homemade plant milk) can be as a nutritious option as they one that is being sold on the shelves?

    • Sounds like you’re doing an amazing job! As far as making homemade milk alternatives – I’m always a fan of homemade as you can see exactly what is going into the product and (hopefully) keeping the food as “real” as possible. However, companies are able to fortify milk in ways we can’t always do at home, so just keep that in mind when choosing to make or buy your milk 🙂

    • I haven’t tried hazelnut milk but it sounds heavenly. From a nutritional standpoint, it’s a lower protein option (2g/cup) but dishes out a healthy amount of Vitamin E, Vitamin A & B vitamins.

  • I love that there are so many great options! For a while I was drinking raw cows milk (we have a Jersey cow), but I’ve had some auto-immune issues and have been wheat and dairy-free for several months as they are common allergens, so I’ve been using a lot of coconut milk. I hope I can drink raw cows milk again soon.

  • Thanks for this info! Almonds are also a VERY water intensive crop and are often grown in California, which as we know has experienced severe issues with drought in the past few years. So from an environmental standpoint it’s not the best option either. It would be interesting to know which of these options are preferable from an environmental standpoint as well!

    • Yes! Great point and certainly another aspect well-worth researching. For the record, I have read that the yellow peas used in pea milk require little irrigation when compared to other nuts, so there’s that 😉

  • Thank You for this article. I am a Third Grade teacher and this is great info to pass along. I have even toured a local dairy and three dairy farms. However, due to a freak experience from a corndog and the lasting effects of illness, I am now lactose intolerant. I liked soy milk before that time so switching wasn’t a problem for me. Cow’s milk tastes sour to me now. I wasn’t aware of the lack of protien in almond and coconut milk though. Thanks for the research and lay terms for the explanation I didn’t get from the dietician.

  • My son (2.5 years old) has a lot of allergies, milk being one of them. I found oat milk and he loves it. It is in box form and sold on the shelf. It doesn’t need to be refrigerated until opened. It has protein unlike coconut milk.

  • I love this segment; please keep it up! It’s especially helpful/interesting (to me, at least?) when you include links to sources to supplement these posts (basically, it’s be cool to be pointed in a direction if one wanted to read some additional research). It’s nice knowing what studies/sources are overall respected or trusted in the Registered Dietician world. Thanks, guys!!

  • Oatly, one of the oats substitute for milk (and the one I happend to have in my fridge today), has 1,0 g protein per 100 ml. There are several brands in Europe, and it’s also said to be easy to make your own. Definitely better for the environment than almond milk, and probably cheaper than almost all the others. Have you tried it? (Maybe an American milk substitute made from oats could be a new business idea? 🙂 )
    http://www.oatly.com/

  • Excellent read! At my restaurant in Miami we make our own almond macadamia blended milk. The macadamia nuts definitely add more fat and calories but lend a real creaminess to the milk that is missed with plain almond milk. It is in about a 3/1 proportion, so it is still mostly almond. I love love love it! Thank you for the great information!

  • Hello and thanks for the good article!
    I would just like to add one thing: soy milk does not naturally contrain B12 vitamin like it is implied here. I don’t know about the US, maybe there all the soy milk is supplemented in B12 but it’s not the case here in Europe so if you’re vegan you should still very much take B12 supplements.
    Also, and I don’t mean to be negative at all, but I don’t see why there is so much focus on the protein in this article. Proteins are really easy to come accross even if you only eat a plant-based diet and I personnally don’t rely on any milk for it.
    I really don’t mean to be a hater, it was a good read, I just wanted to add a bit on it!
    Also sorry for any english mistakes, french is my first language.

    • While I haven’t had the chance to try flax milk myself, it seems to be a good source of omega-3’s, calcium & B12 (when fortified), so I give it two thumbs up!

  • Hi, great post! I am glad to see more of these here on ABM. I agree with Guillemette though, I wouldn’t worry about protein intake on a healthy (whole food plant based) diet where you don’t drink milk or eat dairy products. There is protein in almost everything, no need to rely on milk alternatives for this reason!
    Choose milk based on how they fit into your diet, and choose low sugar, low or no oil content. I liked this honest review here: http://nutritionstudies.org/plant-based-doctors-take-on-choosing-plant-based-milk/

  • Is it okay to soak seeds in milk? I know that to get the best out of seeds you need to triturate/break them or soak them in water overnight…. Do you know if this process can be done with milk? Thank you!

  • Hi! What is your take on Oat milk? I have started to drink it instead of regular milk (in lattes), as I am lactose intolerant… and I never want to go back! I have a least one serving per day, but would love to understand the dietary/nutritional side of things. I drink Oatly. Is it healthy? Is there a point where it’s unhealthy?

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