Dietitian Joel Feren looks at the pros and cons of a number of different milk options currently available.

Which milk is best for your patients?

It is a popular question these days, as new alternatives to cow’s milk seem to pop up with increasing frequency on supermarket shelves, on top of the broad selection already available.

Milk, in all its forms, is a rich source of energy and nutrients, and should be included as part of a healthy diet. Choosing the right one can be the challenging part.

In terms of nutrition, cow’s milk is still an excellent source of vitamins and minerals, particularly calcium, and is packed with low-GI carbohydrates and protein.

The nutritional qualities of other milks vary greatly, so it is important to take note of these differences when making a selection. Flavour, taste, texture and ‘mouth feel’ are all important considerations, as well.

Lactose-free cow’s milk
Lactose, a carbohydrate, is naturally found in cow’s milk. People who are lactose intolerant are unable to break it down into its single constituents, glucose and galactose, because they are deficient in lactase, the enzyme required to digest lactose. To rectify this, lactose-free milk simply contains lactase.

Lactose-free milk has the same amount of carbohydrates, protein, calcium, fat, phosphorous, potassium, and vitamins A, D, B2, B5, and B12 as ‘normal’ milk. This makes it a quality alternative for patients who get irritable bowel syndrome (IBS)-type symptoms from milk.

Soy milk
Soy milk is a rich source of protein, carbohydrates, vitamin B12 and riboflavin, just like cow’s milk, and, encouragingly, it contains less saturated fat.

However, soy lacks the calcium content of cow’s milk, so it is important to choose fortified soy milk with added calcium (ideally 300 mg calcium per 250 ml).

Soy milk also contains isoflavones, natural compounds that mimic the action of the hormone oestrogen. Research indicates that phytoestrogens can reduce the risk of coronary heart disease by lowering total cholesterol and low-density lipoprotein (LDL) cholesterol.

Almond milk
Unlike cow’s milk, almond milk is naturally lactose-free, with very little saturated fat. It also contains a number of key nutrients, including vitamin E, manganese, zinc and potassium.

However, almond milk contains only a modest amount of calcium and very little protein, and may be unsuitable for those who have elevated protein requirements, such as the elderly and athletes. Almond milk is also unsafe for those with nut allergies.

Rice milk
Similar to soy and almond milks, rice milk is lactose-free and low in saturated fat. But unlike cow’s milk, rice milk contains very little protein and calcium, but has a higher carbohydrate content, which may not make it a suitable option for people with diabetes.

Nevertheless, it is a safe choice for those with nut or soy allergies, and good for those with high energy requirements, such as athletes. Most commercially available brands are usually enriched with added nutrients (such as calcium), as rice milk does not naturally contain the breadth of nutrients as cow’s milk.

Oat milk
Oat milk is a good source of fibre, vitamin E, folate and riboflavin. Like rice milk, it is low in protein and calcium, but also high in carbohydrates.  It is therefore likely unsuitable for most people with diabetes.

Oat milk is also inappropriate for people with coeliac disease, due to the presence of avenin – a gluten-like compound. Nevertheless, it may be a good option for those with allergies to nuts, soy and/or cow’s milk.

This article was originally published on RACGP and has been adapted for dietitians