A user’s guide to the confusing world of milk – updated!

The Pediatric Insider

© 2019 Roy Benaroch, MD

Milk sure has gotten complicated. You’ve got, of course, milk—the white stuff that comes out of cows—in different varieties of fat content, and lactose-free versions, too. And soy milk, and rice milk, and almond milk, and hemp milk. And organic milk. Fortified with omega-3 acids, like DHA and ARA! And don’t forget goat milk, which has natural goaty goodness. How can you decide?

Let me suggest a definition to start with: milk is a beverage that’s high in protein, and has other nutritional stuff in there too. It’s a great food for mammal babies like our own. For about the last 8,000 years humans have domesticated animals to continue to drink milk and eat dairy products well past infancy.

Is milk necessary? For babies, yes—they can’t really eat other things. Rarely does one see a one-month-old thriving on Doritos Locos Tacos. By about 9 months of age, human babies are starting to get a significant chunk of their calories from solids, and by 12-15 months could probably do just fine without any milk at all. Some will just refuse it. Still, milk is an easy and tasty source of protein and calcium, so it’s traditionally a part of a child’s diet for many years.

A clarification: we sometimes refer to infant formula as “milk” — but it is very different stuff, designed to feed babies less than one year of age. Do not feed any ordinary “milk”, including all of the examples below, to babies before their first birthday.

What’s with all of the milk variants, then? Are they better than ordinary cow milk?


Mammal milks

Lowfat milk – Ordinary, full-fat milk has about 4% milkfat in the USA. It used to be thought that infants needed that high milkfat, but a 2008 AAP statement corrected that misimpression, and their most recent statement on cardiovascular health reiterated that for families with heart health or obesity concerns (that should be all of us), low fat milk is appropriate starting at age 1. Lowfat milk is usually available in a range from 1-2% milkfat.

Skim milk – Even lower in fat is skim (or “skimmed”) milk, which has 0% milkfat. It has correspondingly more protein and carbohydrate and even a little more calcium per serving than ordinary milk. But if you put it in coffee, it is an abomination.

Organic milk – I don’t think it’s worth the extra cost. The main concern seems to be the use of supplemental cow growth hormone by many conventional dairies to increase milk supply. There’s zero convincing evidence that this is harmful to humans, and zero biologic plausibility that it could cause trouble for our kids. To me, the most legitimate objection to conventional milk is that production may be unhealthy or cruel for the cows.

Raw milk – Ew. Stay away from unpasteurized things loaded with nasty microorganisms, OK?

Lactose-free milk – great for those with lactose intolerance. That means babies and young children almost never need it. Lactose intolerance is essentially non-existent in newborn humans and other mammals, because human milk is loaded with lactose. It develops later in life, typically in teens or young adults.

Goat milk –Expensive! It’s deficient in micronutrients like folate, and has no advantage over cheap and readily available cow’s milk. Still, it’s got that goat cache.

Omega-3 fortified milk – Omega-3s are so-called essential fatty acids that are part of brain and retina tissue. Children probably need some, and we really don’t know how much is ideal or sufficient. Conditions of omega-3 deficiency are difficult to identify, and may not even exist. Still, it’s probably a good idea to eat fish once in a while, or try an omega-3 supplement of some kind. I don’t know why it ought to be added to milk in particular. I wonder if they’ll make a Nestle Quik Fish Flavor?

A2 milk – Has a slightly different casein protein than ordinary cow’s milk (chemically, A2 differs by one amino acid.) The short version of the complex story is that there is no good, independent evidence that this version of milk is more healthful than conventional cow’s milk. The company that sells it claims otherwise.


Plant milks

All of these may be suitable for those allergic to cow’s milk protein. All are lactose-free, since plants don’t make lactose.

Rice milk – this isn’t milk. It’s high-carb, and low-protein. Drink it instead of apple juice, if you want. But it isn’t a milk substitute at all.

Coconut milk – I grew up with a coconut palm in my backyard. Coconut milk to me is when you get after you bash the husk off a ripe coconut and then pound a screwdriver through one of the spots on the inner, softball-sized thing. It takes 20 minutes to get about an ounce. The coconut milk you easily can buy as a beverage is high in sugar and low in protein, and really isn’t a milk at all.

Soy milk – Milk made from legumes (pea and soy, usually), often have the highest protein content of the plant-based milks. There may be some cross reactivity between cow’s milk and soy especially, so beware if you’re allergic. Fears about estrogen-like effects of soy are overblown and not worth the worry.

Pea milk – An unfortunate name, but a nutritious product, high in protein. If you want dairy-free and you don’t mind paying a premium price, brands like “Ripple” might be what you’re looking for.

Almond (and other nut) milk – Typically has about half the protein of cow’s milk. And some varieties add a lot of sugar, which makes them more of a delicious dessert than a milk.

Oat milk – Similar to nut milk in protein content (about half of cow’s milk), but the brands I’ve found also have quite a bit of added sugar too.

Hemp milkThis groovy milk has a moderate protein content, similar to nut or oat milk, and is also low in sugar.

Confusing? You bet. I pretty much just drink conventional skim. Though sometimes, a nice Café au Lait hits the spot.

Updated from a previous post


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3 Comments on “A user’s guide to the confusing world of milk – updated!”

  1. marcgrella Says:

    I think you have to be careful about who you appear to be recommending “milk” for. You mention that milk is great for “mammal babies” but you go right to discussing cow’s milk and milk substitutes while not mentioning that these are not appropriate for infants (due to their overabundance of protein and sodium and lack of most other essential nutrients). Also you completely avoid discussing infant formula and human milk, the most appropriate milk of all for infants. I realize that you were discussing commercial milk products, but you would not want to be misconstrued as recommending almond milk for infants.


  2. Lisa R Says:

    There’s oat milk too! I don’t know whether it’s nutritious, but the chocolate kind is very tasty.


  3. Dr. Roy Says:

    Marcgrella, you’re right — I will edit the post to make that clear.
    Lisa — I had never heard of oat milk. I’ll add that!


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