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In this article, The 1:1 Diet have teamed up with top nutritionist, Mark Gilbert, to take a look at the best milk alternatives and their pros and cons for nutrition and health.
The Healthiest Milk and Milk Alternatives
Many alternative ‘milks’ exist (the reason I put ‘milks’ in quotes is that they aren’t milks at all, because they don’t come from the mammaries of an animal - the UK court of appeal upheld the restriction of the word ‘milk’ exclusively to those produced by animals in 2024). They include (but are not limited to): soy, oat, almond, rice and coconut.
In my opinion, for most people, cow’s milk will be the most-healthy choice. This is because it has the most protein, the highest quality protein and it has the most naturally-occurring calcium and other essential nutrients. These characteristics and others explain why dairy intake is associated with being leaner and healthier – an outcome which can’t be claimed by alternative ‘milks’.
For instance, a review of the research conducted over 50 years and looking at a combined 185,000 subjects, showed that dairy intake increased muscle mass and decreased body fat and waist circumference1. It also concluded that dairy is a good choice to achieve these outcomes when restricting calories to lose weight. Also, a review of dairy intake, published in the American Journal of Clinical Nutrition, which considered over 5000 published studies, showed that dairy intake can significantly reduce the risk of cardiovascular disease – the world’s number one killer2.
In this article, we are going to be taking a look at milk and milk alternatives to see how they contribute to your health and which versions you should be considering for your desired outcome.
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Why Milk Isn't Always Just "Milk" Anymore
Plant-based milk alternatives seem to have gained favour due to at least four factors:
- A fairly recent phenomenon of people somehow becoming convinced that milk is unhealthy – a belief that no one who’s read the research on this topic could justify
- The similarly recent halo effect put on so-called plant-based foods
- The fact that some people don’t tolerate milk proteins and lactose (to be discussed later)
- That the alternatives are often lower in calories
The big trend towards coffee shops offering alternatives is likely based upon the factors above, but also to offer a wider choice of products and flavours to customers. However, as a nutritionist and not a demographer, I can’t offer any definitive reasons for this trend.
Dairy Milk: Pros, Cons, and Nutrition
A typical small glass of milk (250 ml – a decent sized teacup full) has over 300 mg of calcium, making it probably the best source of highly bioavailable calcium of any typical food. It also contains 9 grams of protein, 12 grams of carbs (from the natural sugar lactose) and 0, 2 or 3.5 grams of fat for skim, semi-skim and full-fat versions respectively. That equates to about 80 calories for skim, 100 for semi-skim and 115 for full fat.
Whole vs Skim vs Organic Milk
Most studies don’t show negative effects of eating dairy fat and many show benefits.
Fat is calorie-dense, and so drinking too much full-fat milk can swing your calorie balance towards weight gain. However, this should be seen in the context that the abundant high-quality protein in milk will increase metabolic rate and reduce appetite.
Skim milk has fewer calories per serving, yet still contains a similar amount of quality protein.
There is no strong evidence showing organic milk to be significantly healthier than typical milk; however, some studies have shown it to have slightly better nutritional content (probably due to farming practices and not specifically because of organic practices).
Organic will have very low to zero traces of pesticides, whilst normal milk will have small amounts (but within the range considered potentially harmful). In the UK, we don’t have to worry about antibiotics and hormones, as the former are used much more sparingly here and hormones are not allowed. So my personal opinion is that if you drink milk often and can afford it, you should probably choose organic. However, the breed of cow, their diet, the season and particularly the care with which farmers treat their herd can all affect the quality of milk more than the distinction between organic and non-organic.
Some people are interested in milk from grass-fed cows, which may provide some benefit. Most cows get most of their calories from foraging grass – either fresh grass or from silage (bales of grass that are preserved for later use) but are supplemented with other foods in winter. At this time, corn, other cereals and some soya can be as much as half the diet but these are generally made up of the remnants of food production or are inedible by humans.
Regardless, reviews of the research on the relative fat content of grass-fed versus normally-fed cows do not give consistent results3. Some show a substantial benefit in the form of higher levels of essential fats, but others show little difference. This probably depends upon cow species, when during the year the testing was done and the meat type.
Lactose Intolerance and Digestibility
Lactose intolerance occurs when humans stop producing the enzyme (lactase) which breaks down milk sugar (lactose) in the gut. This allows intact lactose to get into the lower gut where it ferments and causes gas production, bloating and often pain. Most of the world ceases producing significant lactase after weaning but many people of European and African descent have a variant of the LCT gene, which preserves production into adulthood. For those without this gene, lactose free milk (in which the lactose has been broken down for you) is a good solution.
In some people who don’t tolerate milk, it is actually an aspect of the protein that is giving them issues and not the lactose. Most milk we drink in the West is “A1” milk, which refers to milk from typical dairy cows who produce a particular type of casein protein. This can also cause a number of gut issues similar to those caused by lactose intolerance. Drinking A2 milk from cows that produce a slightly different protein can reduce or eliminate the negative effects. So if you don’t get on with milk, try lacto-free first and then you can try A2 milk (although it is not readily available everywhere).
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Plant-Based Milks: Popular Choices Compared
In General: Most of these alternatives (unless otherwise stated below) will have much less protein than dairy milk and the protein quality will be lower, meaning that the protein they do contain, will not provide as robust benefits as quality milk protein. Regarding fat levels, they will fall somewhere between skim and full-fat milk. Carb levels will usually be lower, unless sugar or some other sweetener that contains calories is added.
Almond Milk
As with most alternative milks, this one is lower in calories than typical milk, but, unless something is added to it, it will have only about ¼ the protein. Carbs are usually less than 3-4 grams per cup (~250ml), unless it is sweetened with sugar, which can result in over 20 grams. Fat ranges from 2-7 grams per cup. Almond milk will also not contain significant amounts of calcium and vitamins unless they have been added in, with the exception of vitamin E, which can be at levels above the daily requirement in a single cup. Most almonds are grown in arid California, requiring enormous amounts of fresh water for every calorie produced, so from an environmental point of view, almond is not a good choice.
Oat Milk
The usual low protein status applies here but oat milk is higher in carbs (over half that in milk) than almond milk, so naturally sweet, due to the higher starch content of oats and often added sugar, but this higher carb/sugar content is probably behind its success at coffee shops. Oat milks often add refined oils (some have almost as much as full-fat milk), to give them a creamy mouth feel and a similar consistency to milk when added to coffee.
Most main brands in the UK fortify their products with vitamins and minerals to be somewhat close to those of milk. Oats are naturally high in beta glucan, which may have benefits to the heart, but it is not clear that these products have enough to provide any benefit.
This is probably a more sustainable choice, claiming to be more sustainable than dairy because it uses less water, although cows generally consume rainwater (whereas oats require regular watering, making this a possibly spurious claim).
Soy Milk
Of the alternatives, soy most resembles dairy from the perspective of the amount of protein, being virtually equal, and the quality is higher than other alternatives also, so this is your choice if you want all of the benefits of protein but would prefer not to drink dairy milk. Versions without added sugar contain negligible carbs and sugar but sugar-sweetened ones can have over half as many carbs as milk. Fat levels are generally about the same as semi-skim milk.
Soy contains phytoestrogens (plant chemicals, which act like oestrogens in the body). These may have some of the benefits associated with oestrogen but they may also possibly have negative consequences, such as oestrogen-like effects in some men and the potential to negatively influence oestrogen-sensitive cancers in women – more study is required to determine who may be at risk and the degree of the potential effects.
Coconut, Rice, and Other Alternative Milks
These are less common. Coconut will be naturally higher in fat, with some of the fats coming from medium chain triglycerides (MCTs), which may have health and body composition benefits and can boost levels of ketones. Rice will be low in fat and can be particularly good for people who have allergies or digestive issues, as it is generally tolerated well.
Coconut has a distinctive taste, which some people are attracted to and may mix well with hot drinks and food and drink recipes, whereas rice has a neutral flavour.
Some brands mix more than one alternative milks together to get unique flavours or nutrient profiles.
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Healthiest Milk by Goal or Lifestyle
Best for Weight Management
For weight management, consumers should concentrate on dairy, soy or other alternatives, which contain added protein. Try to ensure that the source of added protein is from soy or pea, as these are the highest quality plant-based proteins, and so they give you more bang for your protein buck. For those who are dieting, refer to the levels of carbs and fat above and choose those with the lowest levels.
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Best for Protein Intake
As with weight management, dairy, soy and those with added protein can be almost as good a protein source as diary. Remember, protein ups the metabolic rate so that much of its calories are used up and cannot be stored as fat and protein also reduces appetite, making it a useful one-two punch for weight loss.
Best for Heart Health
Some claim that the high saturated fat content of dairy milk makes it unhealthy for the heart (milk fat has the highest saturated fat percentage of any common food). However, this is not the case. In fact, as stated in the intro, most studies show reduced rates of heart and vascular disease in those who eat the most dairy. Also, with the enormous increase in seed/plant oil intake over the last several decades, heart health has not improved (if we take into account much lower smoking rates, cholesterol lowering drugs and better surgical interventions), despite lower intake of animal fats. So, it is difficult to say which of the milks is best for the heart and it would be irresponsible to speculate, given that no specific studies comparing them have been done.
As mentioned, regarding oat milk, the beta glucan has been associated with lowering cholesterol, which may provide heart and vascular benefits.
Best for Sustainability
Again, alt milks require freshwater irrigation (huge amounts in the case of almond milk) and usually fertiliser and pesticides. Fields must be ploughed, which requires substantial diesel fuel, releases large amounts of CO2 and kills and makes homeless birds, rabbits, insects and other creatures. So, when we consider the high-quality protein and nutritional content of the various milks, depending upon what you prioritise, dairy and soy may be best in this respect, although soy would have the lowest emissions per gram of quality protein. However, the consensus seems to be that oat milk is the most environmentally friendly alt milk by most commentators but not if you consider its content of protein and other nutrients.
Final Thoughts: Which Is the best Cow Milk Alternative?
There is no definitive answer to this question. As with all food choices, it depends upon your diet, your goals, if you exercise, your genetics/family history and other factors.
For people trying to maintain or lose weight, or who are going to the gym to build muscle or strength, dairy or soy would be the best choice (or an alt milk with added protein). If your diet is already high in quality protein, go for which ever one tastes best but watch the ones with added sugar or added refined seed/plant oils. If your diet is not the greatest, choose dairy milk or one of the options that has added protein, calcium, B vitamins and vitamin D.