The Milk Post

Soy milk, nut milk, pea milk, coconut milk, oat milk…when did milk get so complicated? Even among the one that started it all – cow’s milk – there’s lactose-free milk, ultrafiltered milk, A2 milk, and reduced fat milk. How can a consumer determine which milk or milk alternative is best for them? It really comes down to your taste preference, food allergies, and weight goals. This is a long post about the differences between these milks and identifying which milk is best for specific goals.

First off, let’s remember why there are “alternative” milk types in the first place. Many people have dairy allergies or sensitivities, and others are just looking for plant-based or lower carb alternatives. Even though milk may not taste sweet, it is quite high in sugar in the form of lactose. One cup of regular cow’s milk contains 12g of sugar. That’s the same amount of sugar that’s in 4 Hershey’s kisses. The biggest misstep I see people making that drink cow’s milk is that they choose a lowfat version - 2%, 1%, or skim – in the hopes of augmenting their weight loss efforts. However, the difference in calories between whole and skim milk is only about 60 calories per cup, and the carbs are about the same or sometimes slightly higher. Therefore, changing to lowfat milk from regular milk is unlikely to aid in weight loss.

If it’s the lactose in milk that leads to the high carbohydrate content, then “lactose-free” milk must be better, right? Nope. You might be surprised to learn that “lactose-free” milk is actually just regular cow’s milk (which contains lactose) with lactase enzyme added so that those with lactase deficiency can digest it. When lactose is broken down by lactase, it turns into glucose and galactose, two sugar molecules that are absorbed and raise blood sugar just like regular milk.

How about A2 milk? This type of milk is produced by cows that only make the A2 protein instead of both A1 and A2 (types of a milk protein called casein). A1 casein is thought to be the cause of milk intolerance in people who do not have lactase deficiency. A2 milk still contains lactose, so the carbohydrates in A2 milk are equivalent to those in regular cow’s milk.

There is one type of cow’s milk that is lower in carbohydrates than regular milk, and that is ultrafiltered (UF) milk. This milk is passed through a filter to separate out the larger fat and protein molecules from lactose and water, resulting in milk that has concentrated protein and lower lactose content. Therefore, one cup of UF milk contains half as many carbs and almost twice as much protein as regular milk – 6g carb and 13g protein. The big advantage of this type of milk over others that are even lower carb (see below) is that it tastes like normal milk. For those of you that have tried soy milk, nut milks, coconut milk, etc and decided you cannot tolerate the taste, this might be the right type of milk for you.

Moving on to non-dairy milk, even if unsweetened, rice milk, oat milk, and avocado milk are even higher in carbohydrates than cow’s milk. In my book, there is no reason to drink any of these milks, unless you are wanting to gain weight. Even then, you would be drinking a liquid with very little protein, so the overall nutritional value of these milks is low.

Unsweetened soy milk and pea milk are low in carbohydrate – 1-2g carb per cup – but also high in protein – 7-8g per cup. These are suitable options if you are struggling to get protein in your diet, which often is the case for those eating a mostly plant-based diet. However, for many people following a low carbohydrate diet that are not limiting their animal product intake, they tend to lean on sources of protein (e.g. meat, eggs, cheese) for meals and snacks. Therefore, their total daily protein intake tends to be high already, and excessive protein intake is not healthy. Thus, for most people trying to achieve weight loss through a low carbohydrate plan, soy milk and pea milk are not optimal.

Unsweetened nut milks, coconut milk, hemp milk, and flax milk are all low in carbohydrates and low in protein. A cup of any of these only has 1-2g carbohydrates and 0-2g protein. For my adult patients looking to lose weight, these milk choices are all preferred. Low in carbohydrates, low in protein, low in calories…basically they are almost like water. So why drink them? Mostly because people are used to putting milk in their coffee or tea or having milk as an accompaniment to their meals such as breakfast. These milks also are generally (but not always; check the label) fortified with calcium and thus can serve as a source of calcium in the diet. If you keep these milks in your house, just know that they are not appropriate for kids as they contain little nutritional value.

Here's the TL;DR version: milk that is low in carbs and protein is my milk of choice for patients that are working on weight loss: unsweetened nut milk, coconut milk, hemp milk, and flax milk. However, ultrafiltered cow’s milk, unsweetened soy milk, and unsweetened pea milk may also be appropriate depending on your eating plan and tastes. Regular cow’s milk, rice milk, and oat milk are high in carbohydrates and thus not recommended.