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Dear Dr. Roach: Everyone in my family except for me has converted to using almond milk instead of cow's milk. I just saw something on the internet that says almond milk is possibly the worst plant-based milk substitute. I trust your opinion and research. Can you please educate me on what is best? Are plant-based milks really better than cow's milk, and which plant-based milk is best? -- D.G.
Answer: When trying to compare plant-based milk substitutes with each other and with animal milks in their health impact, it's important to look at what each of them have in terms of macronutrients and micronutrients.
Cow's milk, like other animal milks, contains macronutrients like protein, sugars and fats as well as micronutrients like calcium. (Most cow's milk is fortified with vitamin D.) While most North Americans consume adequate protein, many people try to increase their protein intake through cow's milk.
Similarly, although the data are mixed, most experts agree that saturated fat, which is found in cow's milk, increases heart disease risk. (Cow's milk can be whole, low-fat, reduced fat or skim, varying in their percentages of overall fat.) However, cow's milk contains beneficial fats like conjugated linoleic acid and methyl-branched-chain fatty acids. Most North Americans consume much more simple sugar than what is optimal with cow's milk.
Almond milk has much less protein than cow's milk (1 gram versus 8 grams), and the quality of the protein based on the amount of essential amino acids is less. Soy milk is much higher in protein than almond milk -- almost as much as cow's milk, about 7 grams. Coconut milk has almost none.
However, almond and soy milk have no saturated fat (or almost none) and more monounsaturated fats. Coconut milk has about the same amount of saturated fat as cow's milk. Almond, soy and coconut milks are typically fortified with calcium to match what is found in cow's milk, but the calcium in plant milks is not absorbed as well.
So, is your family right that almond milk is the worst? No, I don't think so. In my opinion, the nonexistent protein and high saturated fat content of coconut milk makes it the least acceptable from a health perspective. Soy and almond milk seem like the better alternatives, but neither of them is really comparable to cow's milk in terms of other micronutrients.