Comparison of nutrient content and health aspects of milk and plant-based drinks

In recent decades, the market for milk and dairy substitute drinks based on, for example, soy, rice, oats, or almonds has expanded, and calcium-fortified plant-based drinks have become part of the nutrition recommendations as alternatives to milk in several countries, such as the United States, Sweden, Australia, and Brazil. Among the plant-based milk substitutes, soy drink dominates the market in the Western world, but the emerging of other plant-based drinks has influenced the market for soy drink (96).

The nutrient density of plant-based milk substitutes varies considerably between and within types, and their nutritional properties depend on the raw material used, the processing, the fortification with vitamins and minerals, and the addition of other ingredients such as sugar and oil. Soy drink is the only plant-based milk substitute that approximates the protein content of cow’s milk, whereas the protein contents of the drinks based on oat, rice, and almonds are extremely low, and the recent review of Mäkinen et al. (96) emphasises the importance of consumer awareness of such low-protein contents. Moreover, there are now cases of severe nutritional deficiencies in children being reported as a result of inappropriate consumption of plant-based drinks (97, 98).

Despite the fact that most of the plant-based drinks are low in saturated fat and cholesterol, some of these products have higher energy contents than whole milk due to a high content of oil and added sugar. Some plant-based drinks have a sugar content equal to that of sugar-sweetened beverages, which have been linked to obesity, reduced insulin sensitivity (99), increased liver, muscle, and visceral fat content as well as increased blood pressure, and increased concentrations of triglyceride and cholesterol in the blood (100, 101). Analyses of several commercially available plant-based drinks carried out at the Technical University of Denmark showed a generally higher energy content and lower contents of iodine, potassium, phosphorus, and selenium in the plant-based drinks compared to semi-skimmed milk (102). Also, rice drinks are known to have a high content of inorganic arsenic, and soy drinks are known to contain isoflavones with oestrogen-like effects. Consequently, The Danish Veterinary and Food Administration concluded that the plant-based drinks cannot be recommended as full worthy alternatives to cow’s milk (102), which is consistent with the conclusions drawn by the Swedish National Food Agency (103).

The importance of studying whole foods instead of single nutrients is becoming clear as potential nutrient–nutrient interactions may affect the metabolic response to the whole food compared to its isolated nutrients. As the plant-based drinks have undergone processing and fortification, any health effects of natural soy, rice, oats, and almonds cannot be directly transferred to the drinks, but need to be studied directly. Only a few studies have compared the effects of cow’s milk with plant-based drinks as whole foods on disease risk markers (104–108). However, none of these have included commercially available drinks or disease endpoints. Therefore, the evidence is currently insufficient to conclude that plant-based drinks possess health benefits above those of milk and dairy products. Until more research has been conducted and a scientifically sound conclusion can be drawn, health authorities should be cautious about recommending plant-based drinks as acceptable substitutes to cow’s milk for the general population.

Conclusion on nutrient content and health aspects of milk and plant-based drinks

Cow’s milk and plant-based drinks are completely different products, both regarding nutrient content and presumably also health effects. Although there are concerns about children consuming the low-protein drinks, further evidence-based assessment of the nutritional and health value of the plant-based drinks must await more studies in humans.

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