Many of my patients are avoiding dairy and opting for plant-based milk alternatives. Going to pick one out in the store, though, is not always straightforward. A report from 2022 noted that plant-based milk account for 16% of all milk sales (and this percentage is growing).1 As the market for plant-based milk alternatives grows, the number of brands and different types is becoming a bit overwhelming. Almond milk, soy milk, hemp milk, oat milk—how do you make a choice that you can feel good about?

Let’s start with the bad news to get it out of the way—many plant-based milks are not all that healthy. This may be a surprise and a disappointment. But many have large amounts of added sugar and other stabilizers and additives that can cancel out many of the benefits you may be getting by avoiding dairy.

On to the good news—there are still a lot of good options! And a few guiding principles can help you choose one that will work for you.

Here are some of the options when it comes to plant-based milk alternatives. It’s worth noting that, while plant-based milk alternatives are a somewhat recent addition to the modern culinary arsenal, many of them have been used for ages. Horchata, for example, is a traditional Mexican drink that is usually made with rice or tiger nuts. Kunu is a drink common in Nigeria made that is often made from sprouted millet.2

Nut milk: Options include almond, walnut, cashew, hazelnut, macadamia, and pistachio. As a group, these tend to have a higher fat content, a moderate amount of protein, and almost no carbohydrates. Almond is the most common of these; walnut milk is notable for higher omega-3 levels. For some people, nuts may be more immunogenic, so may need to be avoided, but they are good for people on Keto, paleo, gluten-free, and Whole30 diets.

Seed milk: The most common options are hemp and flax, though you might also find sunflower, chia, pumpkin, and sesame. As a group, these tend to have significantly more protein, a moderate amount of fat, and a moderate amount of carbohydrate.  

Grain milk: The most common options are oat and rice, though other options include sorghum, barley, fonio, maize, millet, rye, teff, spelt, wheat, and triticale. These tend to have little protein, little fat, and more carbohydrates, but may also contain more fiber (though not always—milk made from white rice, for example, would have no fiber).

Legume milk – The most common option is soy, though pea-based milks (usually based on extracted pea protein) are increasingly common. Rarer options include lupin and peanut. These often have more protein, moderate fat, and less carbohydrate. It’s harder to find versions of these with limited additives.

Other milk – Some of the other milks don’t fit neatly into these categories. Coconut milk for example, is quite common. It has higher fat (and specifically, higher saturated fat). Coconut is technically a drupe (essentially an inside-out fruit). There’s also tiger nut (which is a tuber) and pseudo cereals (amaranth, buckwheat, and quinoa).

Ok. So how do you choose? Here are the questions you should ask:

1.     Can you actually find it? Perhaps you’ve decided that you that you desperately want to try fonio milk. You could make your own, but otherwise it might not be in the cards for you to find a convenient premade product. Or more commonly, you might be very intrigued by the prospect of walnut milk, but just can’t find it in your stores. You could certainly order it online (these products are usually shelf stable at room temperature if unopened). Or you might just choose to get something you can find locally.

2.     Does it contain added sugar? Now it’s time to look at the ingredient list. Many plant-based milk alternatives contain added sugar, and sometimes quite a lot of it. I’ve seen some rice milks with 14 grams of added sugar per 8 oz. Many milks, on the other hand, have no added sugar. Unsweetened is preferred. If you strongly prefer sweetened, just be aware of the added sugar content.

3.     How many ingredients does it have? This is where things can sometimes get interesting. Some plant-based milks have 2 ingredients total. Others might have 15 or more. Common additional ingredients in these milks include seed oils and gums (such as gellan gum, carrageenan, acacia gum, etc) which are added for texture, thickening, and emulsification. Additives beyond the core ingredients can cause sensitivities (more on this in another post). Many milks also have added vitamins and minerals (commonly potassium, calcium, vitamin D, vitamin B12), which I would say is neutral. My general thought is that fewer ingredients is better.  

4.     What is the nutritional density? Two version of the same product may have vastly different nutritional qualities. Lower calorie is not necessarily better—it may very well just mean it has less of the major ingredient.

5.     Is it organic? Organic is optimal. If it is organic, it is automatically non-GMO.  If it’s not organic, it may still be non-GMO (and would likely be advertised as such).

6.     Do you like it? The best milk substitute for you is one that you actually like. It may be worth trying out a few and seeing which you like most. I think this is more important than the specifics of almond vs hazelnut vs other.

Let’s look at two almond milk examples.

Here’s the first one:

This one has 11 total ingredients, with 60 calories, 7 grams of added sugar and 1 g of protein.

Now compare that to this one:

This one has two ingredients, 130 calories, 0 g of added sugar, and 5 g of protein. This product is much more nutritionally dense, with twice as many calories, but with a fraction of the number of ingredients. There are clearly many more almonds in this product than in the first product. While it is not clear on the ingredient list, this product is also certified non-GMO (the first was not).

I would advocate for the second one in this lineup—it is nutritionally dense, without added sugar or additional ingredients.  

The brands that I have found that tend to have the highest nutritional density are Malk, Elmhurst, and Three Trees. None of these have added stabilizers or oils, and they are non-GMO verified.

If shopping for a plant-based milk alternative is an unpleasant experience for you, another option is to make your own. The process is simple—as simple as combining the nut, seed, or grain with water and blending (you can strain it afterward for a smoother finished product, though this is not required). If you typically use your plant-based milk alternative in a smoothie, you can also skip the milk part altogether. Instead of adding hemp milk to the smoothie for example, just add water and hemp seeds instead.  

One final point worth considering is the environmental impact of the product. While almond milk can be delicious, its production is very water intensive. It is still generally preferable to dairy from an environmental standpoint. One study suggests that oat and soy milks are the most environmentally friendly across 12 impact categories (like water use, land use, marine impact, etc).3 Some have also suggested that sesame milk is a reasonable choice, requiring as much as 95% less water than almond milk.4

 References

1.         Liu A. The Evolving Market For Plant-Based Milk: Alfalfa and Other Potential Sources - Innovation Institute for Food and Health %. Innovation Institute for Food and Health. Published October 28, 2022. Accessed August 17, 2023. https://foodandhealth.ucdavis.edu/plant-based-milk-market-report/

2.         Eze C. How To Make Kunu Zaki The Millet Drink. The Guardian Nigeria News - Nigeria and World News. Published April 8, 2022. Accessed August 17, 2023. https://guardian.ng/news/how-to-make-kunu-zaki-the-millet-drink/

3.         Geburt K, Albrecht EH, Pointke M, Pawelzik E, Gerken M, Traulsen I. A Comparative Analysis of Plant-Based Milk Alternatives Part 2: Environmental Impacts. Sustainability. 2022;14(14):8424. doi:10.3390/su14148424

4.         Which Plant-Based Milk Is Best for the Planet? You’d Be Surprised. The Beet. Published April 11, 2022. Accessed August 17, 2023. https://thebeet.com/youve-ditched-dairy-but-which-plant-based-milk-is-best-for-the-environment/