Milk alternatives: worth the hype or milking the health system?

Registered dietitian, Jessica Pieterse, educates us on the pros and cons of milk alternatives and which options are better.

Several years ago, the options for your coffee were adding milk, cream or nothing at all. Now baristas offer a bunch of options, including rice milk, almond milk, soy milk and more. Since there are so many choices available these days, should we be using these milk alternatives and if so, which is the better option?

Milk alternative vs. imitation dairy product

First off, using the term ‘milk alternatives’ is technically incorrect. According to the SA government Regulation 1510 of 22 November 2019: milk is defined as the normal secretion of the mammary gland of bovines, goats or sheep or the other milking of animals. Plant-based beverages should therefore be defined as an imitation dairy product.

The globally recognised Codex General Standard for the Use of Dairy Terms (GSUDT) updated terms in November 2020 also states that non-dairy foods, which do not contain milk and milk constituents, are not allowed to be referred to as being milk, a milk product or a composite thereof in any form. Companies will soon need to start changing what they call their products on the package label.

Why you could use milk alternatives?

Many people have swapped over to plant-based beverages to relieve gut problems or avoid animal products when following a vegan diet or aim for a more environmentally-friendly alternative.

Conventional dairy products contain lactose which is a natural milk carbohydrate. Some individuals struggle to break down lactose in the intestine which leads to gas, bloating, cramps and possibly diarrhoea. People may have less of the gut enzyme that is needed to break down lactose. Individuals who react to conventional dairy could try lactose-free cow’s milk as the lactose has been removed. A fermented milk, such as maas, could also be an option as the fermenting process partially breaks down the lactose, leading to improved digestion. Plant-based beverages don’t contain lactose therefore can provide some ease to gastric issues.

What to look out for?

When choosing milk alternatives (plant-based beverage), take note of the following factors:

  1. Total fat and saturated fat content

Most plant-based beverages (almond, rice, oat, and soy) have similar fat content to low-fat cow’s milk. Coconut options are a very different picture. Standard coconut ‘milk’ has on average 15 times more fat than other plant-based beverages. Reduced-fat coconut ‘milk’ has seven times more fat. This adds calories and lots of saturated fat. Saturated fat is the same fat found in chicken skin and steak fat. Diets high in saturated fats are linked to inflammation and heart disease. Therefore, coconut ‘milk’ options are not preferred.

  1. Sugar content and source

The sugar content is fairly similar between cow’s milk and plant-based beverages. Rice ‘milk’ options tend to be notably higher in carbohydrate and sugar content. Mainly because the raw product is a starch with naturally higher carbohydrate content. Rice ‘milk’ will increase blood glucose levels and the starch content needs to be considered, especially if you are carb counting with insulin dosing.

The sugar content of cow’s milk can be misleading. It may appear that it is higher in sugar than plant-based beverages when looking at the food package label. However, labels indicate all sugars, not added sugars versus naturally present sugars. Cow’s milk labels include the milk sugar (lactose) in the total sugar content.

  1. Total energy/calories content

Most plant-based beverages are similar in calorie contents. Almond, unsweetened soy and coconut rice mix options are the lowest in calorie options. Coconut ‘milk’ has more than three times the calorie content than average plant-based beverages. Mostly due to its fat content.

  1. Protein content

It’s interesting to see that soy ‘milk’ has almost equal protein content to cow’s milk. Other plant-based beverages have noticeably less protein or virtually none.

  1. Price

Most plant-based beverages are substantially more expensive. Soy ‘milk’ is the least expensive and coconut milk the most expensive plant-based beverage.

  1. Additional considerations

Rice ‘milk’ should not be given to infants and children as it naturally contains small amounts of arsenic and can be harmful.

Some individuals avoid soy milk as they believe it contains hormones. Soy products contain phytoestrogens which can mimic some oestrogen hormone functioning but they do not contain hormones. Research is conflicting but an overall review is that small quantities of minimally processed soy products can have several health benefits.

Final thoughts on plant-based beverages

Plant-based beverages provide a sustainable eco-friendly non-animal imitation-milk option. There are pros and cons to each milk alternative. Now that you have a summary of each type of milk (see below), you can decide which milk best suits your ethical, nutritional and personal needs. Please speak to your healthcare practitioner for more individualised advice.

Milk types

Disclaimer: There is no conflict of interest with the author and mentioned products. The dietitian does not work for any mentioned manufacturers and there was no payment received from any companies. The above is an average of some products found at grocery stores. Not all products on the milk and plant-based beverages market may be mentioned.


Jessica Pieterse is a registered dietitian and owner of Dish Up Dietitians. She practices in Edenvale, Johannesburg and has a special interest in women’s health and gut health.

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