When determining if an adult or child is getting optimum nutrition from food choices, it is necessary to consider the whole picture. In the case of milk ‘substitutes’, many of the available alternatives are not a nutrient-for-nutrient substitute for cow’s milk. If you’ve been conclusively diagnosed with intolerance to certain elements of dairy, or if you’re making choices based on a vegan diet, switching to an alternative milk without making other dietary adjustments to compensate may leave you, and/or your children, vulnerable to nutrient deficiencies.
There seems to be much confusion, perpetuated by information overload from overzealous marketing campaigns, when it comes to milk and milk substitutes. In this article, I have addressed some of the most common alternatives, along with the pros and cons, to help provide some clarity and enable you to make informed choices for yourself and your family.
There are many scaremongers online touting the ‘dangers’ of consuming dairy products. I’ve now heard it’s responsible for everything from a snotty nose to cancer. Consequently many of us are sent in search of ‘healthier’ alternatives. Rather than listening to hearsay and unqualified opinions, let’s look at some facts…
COWS MILK & DAIRY PRODUCTS
Milk is a significant source of readily absorbed vitamins and minerals, particularly calcium. Despite persistent rumours about an association between dairy and ill health, there is no scientific evidence to qualify these myths, which include excessive mucous production, cancer and weight gain. There is, however, a plethora of peer-reviewed studies recognising dairy consumption for its important role in optimum health and nutrition.
Milk and milk products contain a good balance of protein, fat and carbohydrate and are a very important source of essential nutrients including calcium, riboflavin, phosphorus, pantothenic acid and vitamins A, D and B12. Milk products also contain high quality proteins that are well suited to human needs.
Cancer, inflammation & fatty acids:
Although the etiology of most cases of this disease is not known, risk factors include a variety of nutritional factors. The quantity and quality of fatty acids are especially crucial. Among fatty acids to which great importance in modification of cancer risk is attributed are conjugated linoleic acid (CLA). The main natural source of them is milk and dairy products and meat of different species. Studies show their possible health promoting effects in obesity, atherosclerosis, cardiovascular diseases, osteoporosis, diabetes, insulin resistance, inflammation, and various types of cancer – especially breast cancer.
Several recent peer-reviewed studies indicate that the recommended amount (3 servings/day) of dairy produce helps close gaps between current nutrient intakes and recommendations. In fact, consuming more than three servings of dairy per day leads to better nutrient status and improved bone health and is associated with lower blood pressure and reduced risk of cardiovascular disease and type-2 diabetes.
In Australia, 60% of children (9-16 years) are not meeting the estimated average requirement for calcium, and milk is an important dietary source of calcium.
Recommended Daily Intake (RDI) indicates the amount of any given essential nutrient required to prevent a deficiency in 97% of the population. It is by no means our optimum amount, rather a bare minimum. If your RDI of calcium is 1000mg/day and today you consume only 500mg, the other 500mg is pulled from your bone minerals. Repeat this for the next 10 years and you’ll likely find yourself with irreversible brittle bones.
Further research facts:
- Osteoporosis– if milk and milk products are removed from the diet, it can lead to an inadequate intake of calcium. This is of particular concern for women, children and the elderly, who have high calcium needs. Calcium deficiency may lead to disorders such as osteoporosis
- Colon cancer– some studies have found that people who regularly eat dairy products have a reduced risk of developing colon cancer.
- Blood pressure– research in the US found that a high intake of fruits and vegetables, combined with low-fat dairy foods, lowers blood pressure more than fruits and vegetables alone.
- Type 2 diabetes– a 10-year study of 3,000 overweight adults found that consuming milk and other milk products may protect overweight young adults from developing type-2 diabetes.
Adequate dairy consumption:
- reduces oral acidity (which causes decay)
- Stimulates saliva flow
- Decreases plaque formation
- Decreases the incidence of tooth decay
- Full cream– full cream milk contains around 4% fat and is a source of vitamins A and D. For children up to the age of 2 years, full cream milk is recommended.
- Reduced fat– expect around half as much fat (2%) in reduced fat milk as full cream. Children over the age of two years can drink reduced fat milk.
- Skim milk– contains less than 1% fat. Children older than five years can safely consume skim milk. Both reduced fat and skim milk have vitamin A and D added to replace the naturally occurring vitamins that are reduced when the fat is removed.
- Raw milk
Most milk is pasteurised (heat treated). While pasteurisation reduces the amount of some vitamins, such as vitamin C, it also kills bacteria. Unpasteurised milk is a health hazard because of the dangers of exposure to bacterial diseases.
- Goats milk
Some people switch to goat’s milk as an alternative to cow’s milk because of perceived sensitivities.
Allergies and sensitivities are usually due to one or more of the proteins found in milk. The proteins in goat’s milk are very closely related to those in cow’s milk so replacing one with the other usually doesn’t help.
Lactose is a type of carbohydrate that naturally occurs in milk from any mammal, including humans. Normally, an enzyme called lactase breaks down lactose so it can be absorbed into the bloodstream. Some people don’t produce enough lactase – undigested lactose is broken up by the bacteria in the gut causing gas, bloating, pain and diarrhoea. This condition is called ‘lactose intolerance’. You can be born lactose intolerant or develop it later in life. If you think you may be lactose intolerant, it’s advisable to see your health professional for a conclusive diagnosis.
Who is at risk for lactose intolerance?
Lactose intolerance is a common condition that is more likely to occur in adulthood, with a higher incidence in older adults. Lactase, the enzyme we produce to digest lactose, is a by-product of healthy gut flora. Therefore individuals with poor gut flora are commonly lactose intolerant.
Some populations are more affected than others, including African Americans, Hispanic Americans, American Indians, and Asian Americans. The condition is least common among Americans of northern European descent. Infants born prematurely are more likely to have lactase deficiency because an infant’s lactase levels do not increase until the third trimester of pregnancy.
What are the symptoms of lactose intolerance?
People with lactose intolerance may feel uncomfortable 30 minutes to 2 hours after consuming lactose. Symptoms range from mild to severe based on the amount of lactose consumed and the amount a person can tolerate. Common symptoms include abdominal pain, bloating, gas, diarrhoea and nausea. However, these symptoms may also be associated with other issues, so a professional diagnosis is essential.
How is lactose intolerance diagnosed?
Two tests are commonly used to measure the digestion of lactose.
Hydrogen Breath Test. The person drinks a lactose-loaded beverage and then the breath is analysed at regular intervals to measure the amount of hydrogen. Normally, very little hydrogen is detectable in the breath, but undigested lactose produces high levels of hydrogen. Smoking and some foods and medications may affect the accuracy of the results. You should check with your doctor about foods and medications that may interfere with test results.
Stool Acidity Test. The stool acidity test is used for infants and young children to measure the amount of acid in the stool. Undigested lactose creates lactic acid and other fatty acids that can be detected in a stool sample. Glucose may also be present in the stool as a result of undigested lactose. Because lactose intolerance is uncommon in infants and children younger than 2, a health professional should take special care in determining the cause of a child’s digestive symptoms.
Researchers have identified a possible genetic link to primary lactase deficiency. Some people inherit a gene from their parents that makes it likely they will develop primary lactase deficiency. This discovery may be useful in developing future genetic tests to identify people at risk for lactose intolerance. Secondary lactase deficiency results from injury to the small intestine that occurs with severe diarrheal illness, celiac disease, Crohn’s disease, or chemotherapy. This type of lactase deficiency can occur at any age but is more common in infancy.
Milk and milk products are highly nutritious, so those who suffer from lactose intolerance don’t need to give them up entirely. You can still consume cow’s milk in moderate quantities and you can also use lactose-free milk.
Those intolerant to lactose can generally tolerate:
- Half a cup of milk
- Three quarters of a cup of yoghurt
- Three quarters of a cup of unripened cheeses like cottage or ricotta.
Is all dairy high in lactose?
Lower-lactose dairy products include:
- Fermented milk products, including some yoghurts, mature cheeses (like cheddar cheese, fetta and mozzarella) and butter, generally pose no tolerance problems.
- Heated milk products, such as evaporated milk, seem to be better tolerated than unheated foods because the heating process breaks down some of the lactose.
Foods that contain lactose are better tolerated if eaten with other foods or spread out over the day, rather than being eaten in large amounts at once.
Daily calcium requirements
Getting enough calcium is important for people with lactose intolerance when the intake of milk and milk products is limited. Many foods can provide calcium and other nutrients the body needs. Non-milk products that are high in calcium include fish with soft bones such as salmon and sardines and dark green vegetables such as spinach.
The Recommended Dietary Intake (RDI) for calcium by age and gender:
|Women 51yr+ and the elderly||1300mg/day|
Table 2. Calcium content in common foods
|Non-milk Products||Calcium Content|
|Sardines, with bone, 90g||325 mg|
|Spinach, frozen, cooked, 1 cup||291 mg|
|Salmon, canned, with bone, 90g||181 mg|
|Soy milk, unfortified, 1 cup||61 mg|
|Orange, 1 medium||52 mg|
|Broccoli, raw, 1 cup||41 mg|
|Lettuce greens, 1 cup||20 mg|
|Tuna, white, canned, 90g||12 mg|
|Milk and Milk Products|
|Yogurt, with active and live cultures, plain, low-fat, vitamin D-fortified, 1 cup||415 mg|
|Milk, reduced fat, vitamin D-fortified, 1 cup||285 mg|
|Swiss cheese, 30g||224 mg|
|Cottage cheese, 1/2 cup||87 mg|
A2 milk is cow’s milk produced from cow’s whose milk is high in the beta-casein A2 form of casein and low in the beta-casein A1 form of casein (a type of protein present in milk). A1 is believed to be responsible for some of the intolerances to cow’s milk, while A2 is believed to be more easily digested.
A1 and A2 are genetic variants of the beta-casein milk protein with different chemical structures. The A1 β-casein type is the most common type found in cow’s milk in Europe (excluding France), the USA, Australia and New Zealand.
A genetic test, developed by the A2 Corporation, determines whether a cow produces the A2 or A1 type protein in its milk. The test uses hair from the cow’s tail to determine this. The test allows the A2 Corporation to give licenses to milk producers once these producers prove their cows produce A2 β-casein protein in their milk.
Rice milk is a kind of grain milk processed from rice. It is mostly made from brown rice and may be manufactured as sweetened or unsweetened.
Compared to cow’s milk, rice milk contains more carbohydrates, but does not contain significant amounts of calcium or protein, and no cholesterol or lactose. Commercial brands of rice milk, however, are often fortified with vitamins and minerals, including calcium, vitamin B12, vitamin B3, and iron.
Rice milk is often consumed by people who are lactose intolerant, allergic to soy or have PKU. It is also used as a dairy substitute by vegans.
Rice milk is made by pressing the rice through a mill stream using diffusion to strain out the pressed grains. It is sometimes also made at home using rice flour and brown rice protein, or by boiling brown rice with a large volume of water, blending and straining the mixture.
Common Ingredients (will vary between brands): filtered water, brown rice (10%), sugar sunflower oil, calcium carbonate, salt, vegetable gum, flavour.
|250ml (1 cup) serve||Reduced fat cow’s milk||Unfortified Rice Milk|
As you will observe in the above nutrient comparison, rice milk is higher in carbohydrates and sodium and lower in protein and calcium (unless fortified). The protein in rice is not a complete protein (containing all essential amino acids), so is not as readily utilised at that in cow’s milk. If you choose to replace dairy with rice milk, you can see this is not a direct nutrient-for-nutrient substitute. Cow’s milk is also unique in that the absorption of calcium is superior to other sources. When it comes to infants (<2yrs), besides the insufficient calcium and protein, rice milk is not an adequate source of dietary fat. If chemicals and hormones are what you’re concerned about, perhaps you could consider organic milk.
Almonds are a rich source of vitamin E, Omega 6 fatty acids and minerals. Almond milk is made from ground almonds (friction, heat, oxygen) that are mixed with water, plus vitamins, stabilizers, and in most cases, sugar. Also, commercially manufactured almond milk is often fortified with calcium.
Typical ingredients list in commercial Almond Milk: Water, almonds, cane sugar, salt, sunflower oil, gum plus various added vitamins and minerals.
- It’s lactose-free
- It’s dairy-free for those who have dairy-related intolerances or allergies
(although, you can source lactose-free or A2 milk to cover these issues)
- Essential fatty acids (EFAs) are highly sensitive to heat, light and oxygen which, when exposed, can turn the EFAs rancid
- The source of calcium often used in fortification is calcium carbonate. This is the cheapest source of calcium supplementation and can cause gas and stomach upset as it requires adequate stomach acid to effectively digest and absorb.
- There have been cases where parents have substituted Almond Milk instead of infant formula or breast milk, providing inadequate nutrition for infants. This can result in low bone density, rickets, low muscle tone and a visible goitre.
- Almonds are a goitrogenic food, meaning, when consumed in large quantities, they can suppress the function of the thyroid gland by interfering with iodine uptake, causing an enlargement of the thyroid. Goitrogens can be negated by cooking, but many are opting for raw almond milk, thinking it’s the healthier option. Again, while cooking may reduce the goitrogen effect, it will further destroy the EFA’s.
- It often contains added sugar
- It often contains vegetable oil – generally high in Omega 6. Besides this oil likely being highly processed and exposed to heat, it is also further throwing out our already skewed omega 3:6 ratio (see previous blog regarding a balance between Omega 3 and 6)
Another ‘pretend’ milk and not my favourite choice. Many ‘rumours’ about detrimental health effects of soy, however, no conclusive scientific evidence either way. However, I tend to think that where there’s smoke, there’s fire. Food for thought…
- It’s lactose-free and doesn’t contain the proteins some individuals may have sensitivities to in cow’s milk
- Suitable for vegans
- Soy milk is ‘pretend’ milk, therefore the manufacturers add (processed) oils and sugar in an effort to make it resemble cow’s milk
- It is usually calcium fortified, which is not as well absorbed as the natural calcium found in dairy (see information earlier in this article)
- Soy milk is composed of an inferior profile of essential amino acids (absorbed and utilised protein) when compared to cow’s milk
- Flatulence – the amount of gas produced depends on the quantity consumed.
- Soy allergy – common allergic symptoms to soy milk include hives, coughing, digestive distress, fainting and wheezing.
- Thyroid function – soy is a goitrogen, which means it may interfere with thyroid function. The thyroid gland runs our metabolism and low thyroid during pregnancy and infancy (non-dairy formulas) can lead to retardation.
- Phytic acid – non-fermented soy milk contains large amounts of phytic acid, which can interfere with absorption of several essential nutrients, such as iron, calcium and iodine.