(Originally published September 2009 as a newsletter for The Dragontree Holistic Day Spa)

I am so frequently asked about milk substitutes by my patients that I decided to present a survey of the options. The purpose of this article is not to go in depth on why people use milk substitutes, but I’ll just share a few words on the topic. The biggest reason is that many people do not tolerate dairy products well, and this can cause a wide range of reactions, from skin rashes to ADD/ADHD. Second, milk quality has declined in recent decades due to cows having less opportunity to graze on healthful greens. Third, pasteurization “kills” the vitality of milk in much the same way it destroys any organisms that may be living in it. Fourth, much U.S. milk comes from cows that have been given synthetic growth hormone (rBST) in order to increase their production. While the FDA asserts that this milk is safe to drink, Canada, Japan, New Zealand, Australia, and most of Europe have banned the use of this drug.

I am not familiar with every milk substitute on the market, but over the past 15 years, I have tried probably 85% of them. Here are my recommendations:

First, when choosing a milk substitute, my number one recommendation is to go with one that isn’t sweetened. It may make the stuff tasty, but cow milk is not sweetened, and there’s no good reason to introduce added sweeteners into your diet through your milk substitute. If you read labels at all, you know that sweeteners are in almost all prepared foods, and it’s probably the single most drastic change that has occurred in human diets over the past few centuries: we eat hundreds of times more sugar than we ever have. So, first things first, look at the label and make sure there is no sugar, no corn syrup, no evaporated cane juice, no agave nectar, no malt, no rice syrup, no honey, etc. Stevia and xylitol are ok, but I don’t know of any manufacturers that use them. Most of the companies that make sweetened milk substitutes also have an unsweetened variety, which usually says UNSWEETENED prominently on the front of the box.

I think most people are looking for a milk substitute that is as milk-like and has as little non-milk flavor as possible. Soy milk is probably the best in terms of being milk-like. It’s on the thicker side, so it’s more like whole milk. It mixes well with hot drinks, goes okay in cooking, etc. My favorite is the unsweetened organic Kikkoman. It’s quite good. Trader Joe’s has a nice, cheap unsweetened soy milk in a green box that has almost no flavor, which is fine for most people. Soy Dream, which has long been one of the leading brands, has some tendency to separate and you may end up pouring a bunch of clumps of soy paste onto your granola or tea, which is kind of yucky. They also made what I consider to be a bad move by deciding to start sweetening their soy milk a few years ago. Now you have to get the “classic” kind if you don’t want sweetener.

Soy milk has a lot of protein in it. If you need more protein, it’s a good source (though soy and grain proteins are actually not the most biologically available). Soy milk has much more protein than any of the other milk substitutes. It has a small amount of fat, too. If you’re drinking soy milk, you want to be sure that it’s organic, or at least from non-genetically modified soybeans (most soy beans are genetically modified). If you have gastric upset or stinky gas, always suspect your soy milk and see your digestion improves from cutting it out. Soy sensitivity is quite common, so if you have any other chronic health problems – fatigue, joint pain, etc. – make sure the soy isn’t contributing or causing it. I love soy milk but my digestive system does not.

While soy products have long been embraced by vegetarians, there has also been an anti-soy movement for the past several years. This is another topic that’s too big to fully explore here. Much fuss has been made about the “phyto-estrogens” soy contains. Don’t believe it. Neither soy nor any other plant contains estrogen. It’s an erroneous term that just won’t die. A large study recently showed that, among breast cancer survivors, those who consumed the most soy had the lowest rates of recurrence and mortality. I say, be moderate in all things, soy included, but don’t fear soy unless you have a known issue with it.

If your milk substitute must be as milk-like as possible, you probably won’t like oat milk or hazelnut milk. These two tend to be more tan/off-white and have a certain grainy/nutty taste that not everyone likes. They can sometimes be a little less smooth than other milk substitutes, occasionally having a greater tendency to separate. They do, however, tend to be pretty well tolerated by sensitive individuals. For those with celiac disease or gluten sensitivity, oat milk might present some problems because it may contain gluten. Some oats are certified gluten free, and perhaps there is a manufacturer that uses them and labels their oat milk as such.

Almond milk is one of my favorites. The flavor is usually pretty mild, and almost everyone tolerates it quite well. It varies, brand to brand, in terms of how clean the flavor and color are. The best, in my opinion is the Blue Diamond stuff – Almond Breeze – regular or vanilla unsweetened. The Blue Diamond stuff in the shelf-stable aseptic containers is pretty good, but the kind in the half-gallon refrigerated containers is better. I’m not sure why this is, but they are definitely different. It has only 40 calories per cup. Unlike soy milk, it has almost no protein. It has 3 grams of good fat. The Pacific brand almond milk is pretty good, too. Almond Dream, made by the Soy Dream/Rice Dream people, has probably the strongest almond flavor of the ones I have tried. What I like about the Blue Diamond stuff is that there is almost no flavor (more in the aseptic box kind though), which is also why I’m not a big fan of the Almond Dream. Almond milk doesn’t always steam well for frothy coffee/tea drinks. We tried it for a while at the café we used to own. Some of the best baristas could do a decent job with it, but its lack of protein is an impediment in this regard.

The best almond milk on the planet is homemade almond milk. Whereas I don’t usually drink milk substitutes by the glass, I do drink my own almond milk straight. Mmmm. Puree 1 part raw almonds with 2 parts water, then strain the resulting mixture thru a very fine strainer. I use a gold coffee strainer and use a spoon with a back and forth rubbing motion inside the strainer to encourage the milk to pass through. It’s a bit labor intensive and a bit expensive, but it can be totally delicious. This is a case when I will sometimes sweeten it – perhaps with a bit of high quality raw honey – and often I’ll add some vanilla extract and cardamom. Delicious.

All in all, almond milk has minimal nutritional value – it’s just something you drink for the taste. One drawback to both the Blue Diamond and Almond Dream is that neither one is organic. However, I tend to be less concerned about getting nuts organically grown than almost any other crop, since they’re encased in a hard woody shell and a husk outside of that.

Rice milk is often an easy one for those who are new to milk substitutes. It tends to be sweet and mild in flavor. If you’ve ever had horchata, the tasty Mexican beverage, it’s basically sweetened rice milk with vanilla and cinnamon. (Incidentally, horchata comes originally from Spain, where it is made from barley, and many countries have their own variations on it, using all different kinds of grains and seeds.) Rice milk tends to be the thinnest of the milk substitutes, similar to skim milk. Therefore, it doesn’t work that well in coffee and black tea, if you like the lightening effect of cream. Nor does it really froth well, having basically no protein. It sometimes has a few grams of fat, due to added oils (presumably used for richness/smoothness). Even the unsweetened kinds of rice milk tend to be the most caloric of all the milk substitutes – about 120 calories per cup. It’s essentially rice-flavored sugary water. There are certainly less healthy things to drink, but keep in mind that you’re not really going to get nutrients from this stuff, unless it’s fortified. Rice Dream has long dominated the market in rice milk and they use organic rice.

Turtle Mountain has recently come out with a coconut based milk substitute. They call it Coconut Milk, which may be confusing, since it’s not the same as the stuff that comes in a can and is a staple in Thai curries. The main difference is that this milk substitute has a lot more water in it. It’s like watered down coconut milk. Incidentally, neither of these things is the same as coconut water, sometimes known as coconut juice. When you open a coconut, it is full of a watery substance we call coconut water, which is very refreshing and full of electrolytes. Young coconuts are usually used for this, since they have much more water than mature (brown) ones. Anyway, I digress. The Turtle Mountain Coconut Milk Beverage is a nice milk substitute. Again, only get the unsweetened kind if you’re using it as a milk substitute. All the calories in this coconut milk are from fat, though, surprisingly, that’s only 50 calories per cup. It has no sugars and essentially no protein. Due to the high fat content, this stuff tastes quite rich compared to most other milk substitutes (especially rice milk). In certain recipes, like french toast, it can lend a nice quality. It has a very mildly coconutty flavor, but is actually pretty close to tasteless. It doesn’t really steam well for frothy drinks since it’s basically devoid of protein, and despite its richness, it doesn’t seem to lighten drinks quite as well as soy milk.

Coconut previously got a bad rap, since it’s so high in saturated fat. Our understanding of fat has improved drastically in the past decade, though, and now we know that many saturated fats are quite healthy. And we’re starting to get past that simplistic thinking that began in the mid-1900s whereby we equated dietary fat equates with body fat accumulation. Actually, a 2009 study showed that a diet that included coconut oil did not raise cholesterol (instead, it positively benefitted it) and lowered body mass and waist circumference. Coconut is high in a class of fats called medium chain fatty acids, which have a wide range of health benefits. I think that possibly some of the wild claims about it are a bit over the top, but it does have some anti-microbial effects, it may benefit Alzheimer’s disease and brain function, it appears to support heart health, immune health, skin, and thyroid function. The only problem I have with this product is that, like most coconut products, it’s not organic.

Hemp milk is another relative newcomer to the milk substitute world. Like coconut milk, it has a very healthy fat profile. The two kinds I’ve tried are Living Harvest (Tempt) and Pacific. Twice I got a container of the Tempt that had mostly separated, so it was water with clumps of hemp paste. No amount of shaking could get it to mix well, so I had to throw it away. The Pacific stuff has been good and they use it next door now at The Clearing Cafe. It froths very well and it’s wonderful in a cup of the Five Hundred Mile Chai. Again, it’s very high in fat. 50 of its 60 calories (the unsweetened Tempt) come from fat, but hemp seeds have a good amount of beneficial omega-3 fatty acids and the healthy omega-6 fatty acid, GLA. Hemp also contains all 8 essential amino acids (plus the two conditionally essential ones). The Tempt milk has about 1 gram of protein, while the Pacific has 4 grams per cup. A useful thing about hemp milk is that almost nobody is sensitive to it; it’s very well tolerated. Hemp is also nice because as a crop it’s so easy to produce it in a sustainable way. On the other hand, hemp has been very trendy for the past decade, and despite the relative ease of growing it, hemp products are sometimes inordinately expensive. A couple drawbacks – neither brand is organic, and Pacific doesn’t make an unsweetened version.

One gripe I have with these products is that, while they chose to add vitamin D to their milk substitute, they use the form known as D2, which is much less useful in the body than the optimal form, D3. I don’t know why they all did this, but when you look at the vitamin D content on these products, you can just ignore it & assume it has no real value as a vitamin D source. Also, please keep in mind that when you order a milk substitute at a restaurant or café, it will virtually always be one of the sweetened kinds, since most people think it tastes so yummy. If it’s a latte you’re getting, that could be quite a lot of sugar.

That’s my not-quite-scientific rundown on milk substitutes. I hope it’s helpful. Go try some and let me know what you think!