If you can’t drink cow’s milk anymore, here’s what to know about the alternatives at the supermarket.

After going to the doctor recently and getting a simple blood test, you found out you are lactose intolerant. That’s when your body can’t fully break down the sugar (lactose) in cow’s milk and other dairy products.

Now you’re trying to figure out what to do. If you’re one of the roughly 65% of adults worldwide with lactose intolerance, you may wonder what will happen if you switch from cow’s milk to one of the many plant-based milks at your supermarket.

There seem to be more new milk substitutes at the supermarket every year, with milks made from soy, almonds, rice, oats, cashews and more. But are they good for you? And are they as healthy as cow’s milk?

It turns out that all milks have their pros and cons. Below, find out how cow’s milk compares to various plant-based milks. But first, take a closer look at what it means to be lactose intolerant.

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Could you be lactose intolerant?

Those who were born with an intolerance to lactose have probably already made the switch from cow’s milk to some alternative.

But if you think you may be lactose intolerant, your doctor might test it in 1 of 2 ways:

• Hydrogen breath test. This measures how much hydrogen gas is in your breath before and after you drink a liquid that contains lactose.
• Glucose blood test: This is a series of blood tests that measure the amount of glucose (sugar) in your blood before or after you drink a liquid that has lactose.

Even if your test comes up negative, you may still have trouble digesting certain dairy products. In that case, you can just cut them out of your diet or switch to plant-based options.

“A person can suspect they are lactose intolerant if they often experience stomach discomfort after consuming dairy products,” says Gigi Rubin, M.S., RD, CDN. She’s a registered dietitian nutritionist based in New York City. “They may experience flatulence, diarrhea, cramping or even constipation.”

If you think you might be lactose intolerant, Rubin recommends keeping a food journal and recording your symptoms and when they occur. That way, you can let your doctor know what’s happening and when, so that they can help you feel better. At that point, they’d likely have you do the blood or breath test to confirm.

On the other hand, if you decide to become a vegan — someone who doesn’t consume or use anything made with animal products — you wouldn’t use cow’s milk anymore. But be aware that vegan diets tend to be low in vitamin B12, which helps keep your body’s blood and nerve cells healthy. This vitamin also helps make DNA, the genetic material found in your body’s cells.

Vegan diets also tend to be low in vitamin D, which helps strengthen your bones and muscles. Dairy products, such as cow’s milk, are good sources of vitamins B12 and D, but so are most plant-based milks. If you’re unsure, though, it’s always good to read the label and figure out how healthy your brand might be. You can consult a dietitian to find out which brand is the healthiest option for you.

If you’re neither lactose intolerant nor vegan, you might decide to switch to plant-based milk anyway. Though cow’s milk is a good source of protein, some forms can be high in fat, cholesterol and calories. While plant-based milks aren’t as good a source of protein as cow’s milk, they’re often lower in fat and calories.

The pros and cons of cow’s milk

Ever since you were a little kid, you’ve been told to drink your milk because it’ll make you grow up with strong bones. Cow’s milk even stars in its own advertising campaigns. But is it the healthiest option?

“Cow’s milk is the most nutrient-dense of the milks, and it’s naturally high in protein,” says Jill Weisenberger, M.S., RDN, CDCES®. She’s a registered dietitian nutritionist and the author of the guide Can I Eat That with Prediabetes? “You get nutrients in cow’s milk that you won’t get in other milks.”

Per Rubin, cow’s milk is a great source of:

• Calcium, a mineral linked to healthy bones and teeth
• Potassium, a mineral that’s linked to good cell growth
• Protein, which helps build and repair muscles and bones
• Riboflavin, or vitamin B2, which helps break down protein and fat

But cow’s milk can be difficult to digest if you’re lactose intolerant or have a dairy allergy, Rubin says. Plus, it’s higher in fat and cholesterol, and depending on what type of cow’s milk you drink, it may be higher in calories.

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The pros and cons of plant-based milk

Plant-based milk products can be a great alternative for those who can’t digest dairy or lactose, Rubin says. “They’re also friendly for those who are supportive of animal rights, they’re lower in calories, and they’re becoming increasingly more reasonably priced,” she says. “But compared to cow’s milk, most plant-based milks are lower in protein and have a lower amount of vitamins and minerals.”

Nondairy milks can be divided into several groups. These include:

• Grain-based milks, such as:
• Quinoa milk
• Oat milk
• Rice milk
  
• Legume-based milks, such as:
• Pea milk
• Soy milk
  
• Seed-based milks, such as:
• Flaxseed milk
• Hemp milk
• Sesame milk
  
• Nut-based milks, such as:
• Almond milk
• Cashew milk
• Coconut milk
• Hazelnut milk
• Peanut milk
• Pistachio milk
• Walnut milk

Below, find a guide to some of the more widely used examples from the above list:

Almond milk: As with cashew milk (see below) and other nut-based milks, you should avoid it if you have a nut allergy.

Cashew milk: “Cashew milk usually has a richer consistency and a creamier taste than soy milk,” Rubin adds. But remember, if you’re allergic to nuts, it will trigger symptoms. These could be anything from hives or a rash to something more serious such as swelling of your throat.

“If you have a nut allergy, I would stay away from all nut milks, as oftentimes there may be multiple different nut milks made in one factory,” Rubin says. That means trace amounts of the nut you’re allergic to could be present in the milk you consume.

Coconut milk: It’s typically used as a thickener to give texture to a particular dish. And if you have high cholesterol, coconut milk might not be the best thing for you. “Stay away from coconut milk if you have cholesterol concerns,” Weisenberger says.

Oat milk: Wondering what all the fuss is about with oat milk? “Oat milk has more protein compared to rice milk,” Rubin says. So, it’s one of the more nutritious options.

Rice milk: This milk can have extra nutrients added to it, such as calcium, vitamin A and iron, so it packs an extra-healthy punch. But it’s a lot lower in protein than cow’s milk and may have added sugar, so you’ll want to get in the habit of reading the label. “Rice is one of the least allergenic foods, so rice milk is a milk to try if you have allergy concerns,” Weisenberger says.

Soy milk: If you swear by soy milk on your morning cereal, know that it’s lower in calories than cow’s milk and has no cholesterol. This milk also can have other nutrients added, including calcium and potassium. That puts it right up there with oat milk as one of the healthiest options.

What about lactose-free milk? You can buy some types of cow’s milk at the supermarket that have had the lactose removed. But they’re still comparable in nutritional profile to regular cow’s milk. Some good news: If you have a dairy allergy or are lactose intolerant, you may be able to drink one of these lactose-free alternatives without getting any unpleasant symptoms.

You might even be able to have a little cow’s milk. “If you’re lactose intolerant, you may not have to eliminate dairy entirely,” Weisenberger says. “You may be able to have a cup of milk split between 2 meals. But if you want to drink a large glass of milk, you may be better off with lactose-free cow’s milk.”

Bonus: What to know about plant-based ice cream vs. cow’s milk varieties

Let’s get this out of the way up front: Eating ice cream occasionally won’t ruin your diet or health. But eating a lot of it, all the time, can be bad for you because ice cream is fattening and high in cholesterol and sugar.

So, how does cow’s milk ice cream compare to the plant-based stuff? You really need to compare ice creams side by side to see what the nutritional profile of each one looks like, Weisenberger notes. They vary widely in terms of added sugars, saturated fats and sodium.

If you’re a parent wondering whether to switch your child to a plant-based milk — or just a curious adult — it’s a good idea to understand that not all milks are created equal. Compare the Nutrition Facts labels and choose those that offer the best sources of protein, calcium and vitamin D, and have no added sugars. Plant-based milk can do a body good too, it turns out.

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For informational purposes only. This information is compiled by UnitedHealthcare and/or one of its affiliates and does not diagnose problems or recommend specific treatment. Services and medical technologies referenced herein may not be covered under your plan. Please consult directly with your primary care physician if you need medical advice.

Sources:

Cleveland Clinic. “Lactose intolerance.” March 3, 2023. Retrieved from https://my.clevelandclinic.org/health/diseases/7317-lactose-intolerance

University of California San Francisco. “Cholesterol content of foods.” Retrieved from https://www.ucsfhealth.org/education/cholesterol-content-of-foods Accessed June 21, 2024

University of Florida. “Plant-based beverages vs. cow’s milk.” Retrieved from https://animal.ifas.ufl.edu/media/animalifasufledu/dairy-website/docs/Plant-based-beverages-vs-cows-milk-(2).pdf Accessed June 21, 2024

University of Rochester Medical Center. “Tree nut allergy diet for children.” Retrieved from https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P01710 Accessed June 21, 2024

U.S. Food and Drug Administration. “Milk and plant-based milk alternatives: Know the nutrient difference.” February 22, 2023. Retrieved from https://www.fda.gov/consumers/consumer-updates/milk-and-plant-based-milk-alternatives-know-nutrient-difference

U.S. Food and Drug Administration. “Plant-based milk alternatives (PBMA)” February 22, 2023. Retrieved from https://www.fda.gov/food/food-labeling-nutrition/plant-based-milk-alternatives-pbma

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