To drink or not to drink milk… This is a dilemma that has gripped us in recent times thanks to claims and counterclaims about its benefits. Vegans argue that human beings are the only mammals who continue consuming milk beyond infancy and to make matters worse, it's milk derived from other mammals. The merits of consumption can be endlessly debated and health experts have yet to come to a definite conclusion, but what is clear is there are as many people who love milk as there are those who would like to drink milk but are lactose intolerant.
The latter are therefore compelled to look for healthy milk substitutes so they can enjoy a bounty similar to that in the lactose world, like smoothies, tea, coffee and the occasional pudding or an ice cream. Many dishes also benefit from the addition of milk substitutes to enhance their texture, flavour and taste.
Stephanie Karl, nutritionist, Dubai London Clinic, provides insights into milk substitutes - why we need them and how we can evaluate their nutritional content. However, before we get into weighing up the benefits of milk, let's take a quick look at the problem of lactose intolerance.
This condition occurs when the human body is unable to break down lactose - a kind of sugar present in milk - through the release of a digestive enzyme, lactase, during digestion. Usually as we grow older, the production of lactase decreases, but the level of intolerance differs from individual to individual. It is usually accompanied by a series of symptoms such as abdominal discomfort, a bloated and full feeling, flatulence and diarrhoea.
Karl advises: "If you suspect an intolerance to lactose, simply go without milk for two weeks and keep a ‘symptoms diary' to observe if whether things get better. These symptoms can be due to other things also, so it is important to be sure before making a self-diagnosis. Milk, however, is known for being high in calcium, protein and other valuable nutrients, and some good alternatives are available in supermarkets locally. If they aren't so easy to find, we have some simple recipes to try, with advice on how best to add milk substitutes to your daily plan."
Karl says those who are allergic to lactose can actually opt for lactose-free milk available in most sections of supermarkets in the UAE in the form of Ultra High Temperature processing (UHT) milks.
For those who don't wish to drink milk from animals other than cows, there is the option of lactose-free milk. But Karl cautions: "Lactose-free milk is suitable only for people with lactose intolerance. For people who are allergic to dairy products, it would still lead to the same problems as it contains the same proteins as milk. It is almost indistinguishable from "regular" milk - it is regular milk which has the lactase enzyme added to it to help break down lactose into simpler sugars and it tastes slightly sweeter. People can have up to four servings per day which will provide about 1,000mg of calcium."
What are milk substitutes?
There are many kinds derived from nuts, cereals and seeds that are a good source of calcium, magnesium, B12 vitamins, vitamin D and the entire range of nutrients that are present in regular milk. Karl gives us a checklist for each milk substitute's nutritional value (see pages 50-51). Clearly, no substitute is enough on its own, and so it is advisable to use a wide variety of substitutes to maximise the nutritional benefits.
To get the maximum benefits from drinking animal milk alternatives, it is advisable to drink the different types on a rotational basis over the week. There are a few salient nutritional points that people need to keep in mind when choosing these ‘mock milks' as many important nutrient groups may not be easily available in one kind of milk, advises Karl.
Carbohydrates and sugars
Milk extracted from plant varieties has sugar added to make it more appealing, and on an average contains about 8g carbohydrates and 6g sugar per cup.
- Rice milk is an exception. It is very high in carbohydrates (24g) and sugar (11g).
- Coconut milk has an extremely low sugar content; just 8g in a 240g measure, making it a good choice on a low-carb diet.
- While cow's milk is a great source of natural calcium - it has about 30 per cent of the 1,000mg recommended daily intake for most adults in one glass. Non-dairy milks are usually fortified to about this level and the content should be listed on the label. Otherwise unfortified beverages provide around two to four per cent of the daily calcium needs.
Plant variety of milk substitutes are not very rich in vitamin B12 which is an important nutrient that is naturally available from animal sources, including dairy products.
- Almond and rice milks contain a small amount (about 2 per cent of daily needs). Vitamin B12 is only available naturally from animal sources, including from dairy products.
- Plant milks may be fortified with B12 and this will be listed on the pack. Otherwise B12 is available in yeast and yeast products such as Brewer's yeast, which is a good food for vegans, or in eggs if you are vegetarian.
- Vegetarians need to consume more iron-rich foods than meat eaters because plant iron is poorly absorbed.
- Soy milk contains iron (10 to 20 per cent of daily needs) whereas cows' milk does not have iron.
Vitamins A and D
- Cows' milk is fortified with both vitamin A (10 per cent) and vitamin D (about 30 per cent).
- If vitamins A and D are not added to plant beverages, they are not present.
- Cows' milk contains 100mg sodium similar to plain soy milk (120mg) and rice milk (100mg).
- Almond milk is the higher (150mg) but low compared to the daily recommended intake requirement of 2,400mg/day.
Managing a balanced diet without dairy is important, especially for toddlers who need a good amount of protein and calcium. However, it is possible to maintain adequate nutrition without dairy products by juggling a few milk alternatives to suit your needs.
foods with high and low lactose content
Foods with a high lactosecontent include:
- Regular milk
- Ice cream
- Cream cheese
- Fresh cream
Foods with lower levels of lactose include:
- Fermented dairy products where bacteria converts some or all of the lactose into lactic acid - yoghurt, kefir, sour cream, laban, buttermilk, and crème fraiche.
- Hard cheeses are made only from milk protein and the lactose is lost to whey during production.
- Ruminant milk: A product obtained from goats, sheep and other livestock. This variety contains similar proteins to those in cows' milk as well as lactose, and is likely to cause the same symptoms. Up to four servingsper day of ruminantmilk can be consumed, including cheese.