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Milk and Nondairy Milks
by Nancy Cooper, R.D., C.D.E.

URL:  http://www.diabetesselfmanagement.com/article.cfm?aid=305

Buying milk today is no longer as simple as telling the milkman how many bottles of milk or cream to leave at your doorstep on Monday morning. Recent years have brought not only a sharp decline in the number of milk delivery services, but also great diversity to the dairy case in grocery stores. Most of us know about whole milk, reduced-fat milk (2%), low-fat milk (1%), and nonfat milk (skim milk). Did you know you can also buy milk with extra calcium added or with the lactose removed? And how about flavors? Milk now comes in not just chocolate but strawberry and even banana.

In addition to all these variations on good old cow juice, many grocery stores now stock beverages such as soy milk, rice milk, and almond milk. Although these drinks are not dairy products and don't have all the nutrients found in milk, they have a flavor and consistency similar to that of milk and can be used in the same ways: poured over cereal, added to coffee, or drunk straight from the container when no one is looking. Like regular milk, these nondairy "milks" come in lower-fat and higher-fat varieties. This installment of Supermarket Smarts reviews the many options available in the milk section of your supermarket.

Nutrients in milk

Milk is an exceptional food, nutritionally speaking. Like meat, milk provides high-quality protein that contains many essential amino acids. Milk is particularly high in the amino acid lysine, which is limited in many plant foods, especially grains. Therefore, milk is a good complement to cereals, breads, and other grain products. Milk is also an excellent source of calcium. In fact, it is the leading source of calcium in the American diet. In addition, it supplies vitamins A and D, riboflavin and other B vitamins, phosphorus, and magnesium.

Whole milk is high in fat, which is one of the reasons whole milk consumption dropped steadily between 1970 and 1990 while consumption of low-fat and skim milk rose. Today, the lower-fat varieties of milk are far more popular than whole milk in the United States. Fortunately, when fat is removed from milk, most of milk's other valuable nutrients—including the calcium and phosphorus the body needs to maintain bone—remain intact.

The Food and Drug Administration (FDA) requires that low-fat and skim milk be fortified with vitamin A, a fat-soluble vitamin that is lost when the fat is removed from milk. And all milk is fortified with vitamin D (only small amounts of vitamin D are naturally present in milk). Vitamin D deficiency interferes with the body's absorption of calcium, which can lead to rickets, a cause of bone malformation that affected many children in the early 1900's. The addition of vitamin D to milk has been credited with the virtual elimination of rickets in the United States.

Nearly all milk cartons have the words "pasteurized" and "homogenized" on the label. Pasteurization is a process that uses heat to destroy disease-causing bacteria, as well as yeast and mold. Unpasteurized, or raw, milk is considered unsafe; less than 1% of milk consumed by Americans is unpasteurized. Pasteurization not only ensures the safety of the milk, but also increases its shelf life without significantly affecting its nutritional qualities.

Homogenization is a process that distributes the fat evenly throughout the milk. Although the process was developed around 1900, it was not uncommon to find unhomogenized milk in the 1950's, with a layer of cream at the top of the bottle. Today, almost all milk is homogenized by forcing it through a small opening under high pressure. This breaks down the fat into tiny particles so it remains emulsified in the milk rather than floating to the top.

When purchasing milk, keep in mind that all fresh dairy products should be refrigerated; otherwise, they can turn sour within a matter of hours. Milk tastes better and lasts longer when kept cold. Store milk in its original container with the opening closed or sealed to prevent it from absorbing the flavors of other foods in the refrigerator. Check the freshness date on the package to make sure the milk is not already turning old before you buy it at the store: Buy milk with the longest freshness date possible. If you use a lot of milk at home, buying in bigger containers can be a bargain, but only if you will use it all within a few days. Also, store brands are typically less expensive than name brands.

Dairy milk

From a nutrition standpoint, the differences in types of dairy milk are primarily related to fat and calorie content. Milk solids—the part of milk that is neither fat nor water—constitute at least 8.25% of almost all milks, so their vitamin, mineral, carbohydrate, and protein content is essentially the same, regardless of fat content. (A cup of milk has about 12 grams of carbohydrate.) The percent of fat that defines different kinds of milk refers to the fat by weight, not by calories.

Whole milk. Whole milk, as defined by federal law, contains at least 3.25% fat, which translates to about 50% of its total calories from fat (about 8 grams of fat per cup). This high fat content means whole milk is the best choice for infants and young children (up to the age of two) who drink cow's milk, because they need a high level of fat and calories for growth.

Reduced-fat milk. Also known as 2% or 98% fat-free milk, this milk contains 2% fat by weight. This means that about 35% of its calories are from fat (with 5 grams of fat per cup). While drinking 2% milk is a good way to wean yourself off whole milk, it still may be too high in fat to use on a regular basis unless your diet is otherwise very low in fat.

Low-fat milk. Also known as 1% or 99% fat-free milk, this milk averages 2.5 grams of fat per cup, with around 20% of its calories coming from fat. For people who don't like fat-free milk, drinking 1% milk is a good compromise when taking steps to reduce fat intake.

Fat-free milk. Also known as skim or nonfat milk, this milk has as much fat removed as possible. It may not contain more than 0.5% fat by weight and usually has less than one-half gram of fat per cup, deriving just 5% of its calories from fat. Cup for cup, skim milk has half the calories of whole milk and is the best choice for most adults.

Lactose-reduced milk. Lactose is the form of sugar found in milk, and many people have trouble digesting it due to a deficiency of the intestinal enzyme lactase, which breaks lactose down into a form that can be easily absorbed. People who experience symptoms such as gas, bloating, diarrhea, and stomach cramps after consuming milk or other dairy products are likely to have lactose intolerance. Lactose intolerance affects about 80% of Asian-Americans and Native Americans, about 75% of African-Americans, and 50% of Hispanic-Americans. About 20% of Caucasian Americans have varying degrees of lactose intolerance.

To make life a bit easier for people with lactose intolerance, milk is now available with some or all of the lactose removed. (None of the milk's other nutrients are affected.) Another option is to add a lactase enzyme, available in tablets or liquid drops, to regular fluid milk before using it, or to swallow such a tablet before eating dairy products. Milk treated with lactase tastes slightly sweeter because the lactose has been broken down into simple sugars, which taste sweeter.

Chocolate milk. Many parents are able to coax a child to drink chocolate milk when he is unwilling to drink plain milk. But parents often worry about the nutritional value of chocolate milk. There is really no great cause for concern. If the chocolate milk is made from skim or 1% milk, one cup will provide fewer than 3 grams of fat. The chocolate syrup used to make chocolate milk is low in fat but high in sugar, and it is this extra sugar that makes chocolate milk almost twice as high in calories (and two to three times as high in carbohydrate) as plain milk. Calcium and other nutrients, however, are not affected. The same goes for strawberry and banana flavored milk.

Buttermilk. Even though its name implies richness and fat, buttermilk is a low-fat milk product (with less than 3 grams of fat per cup) made by culturing skim or low-fat milk with a lactic acid culture. Since it is cultured, buttermilk may have a lower lactose content and may be better tolerated by people sensitive to lactose. A small amount of salt is usually added to buttermilk, so the sodium content is generally higher than regular milk (about 250 milligrams per cup compared with 110 milligrams for regular milk).

Goat milk. Goat's milk contains most of the same nutrients as cow's milk, with slightly higher levels of calcium. It has a distinctive, tangy flavor. Some people believe goat's milk is easier to digest than cow's milk; however, research studies have not found that to be true. Goat's milk contains similar levels of lactose as cow's milk, so it is not a good substitute for people who are lactose-intolerant. The fat content of goat's milk is similar to that of regular whole milk, but lower-fat goat's milk is sold in some areas. Be sure the milk you buy is pasteurized; raw goat's milk is sold at farm stands in some states and carries a high risk of bacterial contamination.

Calcium-enriched milk. The addition of extra nonfat milk solids gives this milk a boost in calcium content, to about 40% to 50% of the recommended daily intake per cup. (A cup of regular milk provides 25% of a day's calcium.) The milk solids also add a bit of extra protein and give the milk a rich and creamy consistency, even though they are fat-free.

Organic milk. Milk qualifies as "organic" if the farm it comes from promises that their animal feed has been grown on land that has not had pesticides or fertilizers applied for at least three years. Organic dairies also do not treat their cows with the growth hormone recombinant bovine somatotropin (rbST). This hormone is injected into cows to increase their milk production. However, some people fear there may be a health risk to humans from using milk from hormone-treated cows, and others are concerned about potential side effects that the injections may cause in the cows. Some traditional, nonorganic dairies also do not treat their cows with the hormone, and their labels generally make this declaration.

The FDA approved the use of rbST in 1993, and U.S. health officials have stated that milk from hormone-treated cows is safe to consume and poses no health risk to humans. Approximately one-third of U.S. dairy cows are treated with rbST, and there is really no way to tell whether milk comes from treated or untreated cows unless it is clearly stated on the label. If you choose to avoid milk from hormone-treated cows, look for a statement on the package such as "this milk is produced without the use of hormones." Or you can buy organic milk (at a much higher price) if you wish to support organic farming, but there is no need to buy it (or other hormone-free milk) for fear that regular milk is unsafe to drink.

Ultrapasteurized milk. This milk product has been pasteurized at an especially high temperature to give it an unusually long shelf life. Also called ultra-high-temperature milk, it is typically sold in brick-style cartons that are sterilized and aseptically sealed and can be stored at room temperature for about six to 12 months. After opening, however, it must be refrigerated. For best flavor, thoroughly chill the milk in the sealed carton before serving.

Canned and dry milk

While most milk belongs in the refrigerator, canned and dry milk keep in the pantry for months—so it's there when you need it.

Evaporated milk. This pantry staple is made by removing more than half the water in milk and then canning and heat-sterilizing it. Since it can be stored at room temperature (for up to about six months), evaporated milk is convenient to keep on hand. It is available in whole, low-fat, and fat-free varieties and is a versatile ingredient for cooking. Use it undiluted as a substitute for cream in soups, sauces, or quiche. When it is very well chilled, you can whip fat-free evaporated milk into a whipped topping that has a fraction of the calories of whipped cream. Evaporated milk can also be reconstituted with an equal amount of water to use in place of fresh milk. Store opened canned milk in the refrigerator, and use within three to five days.

Sweetened condensed milk. Like evaporated milk, sweetened condensed milk is made by removing half the water content of fresh milk; it is then sweetened by adding a large amount of sugar. It is a common ingredient in desserts such as ice cream, pudding, and candies. It is available in whole and fat-free forms, and, undiluted, contains around 1,000 calories per cup.

Dry milk powder. To make nonfat dry milk powder (whole dry milk is used mainly in food manufacturing), water is partially evaporated from fluid milk and then the milk is sprayed into a drying chamber to further evaporate the water. The remaining powder can then be reconstituted by adding water. Many people use dry milk regularly as a source of fluid milk at home or for cooking. It is also handy to use during travel or for camping.

Nondairy milks

Nondairy milks (primarily soy milk) have recently been gaining in popularity. In fact, the newly strong presence of soy milk in the dairy section of many supermarkets prompted the National Milk Producers Federation in February 2000 to file a complaint with the FDA, arguing that a product that doesn't originate from a mammal shouldn't be allowed to bear the name "milk." Soy industry spokespeople replied that soy milk has been around since the time of ancient China, and the name itself has been used in the United States for over 100 years.

Some people use beverages such as soy milk as substitutes for dairy milk because they cannot or choose not to drink dairy milk. But nondairy milks are interesting in their own right, too. Let's take a look at three of the personalities in the dairy-free parade: soy milk, rice milk, and almond milk.

Soy milk. This popular beverage is made by soaking soy beans in water and then expressing the rich liquid, resulting in a fluid that looks like whole milk. It is sold fresh in the refrigerator case and in aseptic packages that do not need refrigeration, and it comes in a variety of flavors (usually plain, vanilla, or chocolate).

One of the plusses of soy milk is that it contains soy protein, which has been making headlines because of the health benefits it carries. The FDA recently approved label claims stating that when consumed regularly, soy protein can help lower cholesterol. The phytoestrogens found in soy foods have also shown promise in relieving the symptoms of menopause, but more research is needed before definitive claims can be made.

Unlike cow's milk, soy milk varies in nutrient content from manufacturer to manufacturer, so it is important to read the label. Check to see if the soy milk is regular or fortified. Regular soy milk is a good source of protein and B vitamins and contains some iron and a little calcium. Fortified soy milk has larger amounts of calcium and other vitamins. Levels of fortification vary by brand, however, and not all brands are good sources of all these nutrients. Soy milk also varies in fat content (from 0 to 5 grams per cup) and carbohydrate, with higher levels in flavored and sweetened varieties. All soy milk is cholesterol-free with very low levels of saturated fat.

It's worth noting that soy milk tends to be on the pricey side. Try shopping around for the best deal.

Rice milk. As with soy milk, some varieties of rice milk are fortified with calcium and other nutrients and clearly offer more nutrition than unfortified types. All types of rice milk are much lower in protein than either soy milk or cow's milk, and they do not, by themselves, contribute very much toward the body's daily protein needs.

Almond milk. Made from almonds, almond milk offers a change from soy and rice beverages and can also be used in cooking. It is available fortified with calcium and vitamins A, D, and E. It is low in fat, cholesterol-free, and, like rice milk, low in protein.

If you would like more information on the uses of soy, rice, or almond milk, check the package label for a telephone number, address, or Web site address where you can find tips and recipes for using these products.

The table in Adobe Acrobat PDF format at the top of this page details nutrition information for a wide variety of milk products as well as nondairy options. Since the nutrition information is standard for many milk products, we do not include brand names for all listings. And for products listed with brand names, we included only a selection of items and may not have listed all available flavors or varieties.

For each entry you will find a listing of calories, calories from fat, total fat, saturated fat, cholesterol, sodium, carbohydrate, and protein per serving. In a diabetes meal plan, you can count one carbohydrate choice for every 15 grams of carbohydrate for any of these items.

Nancy Cooper is a Contributing Editor of Diabetes Self-Management. She is a Diabetes Nutrition Specialist at the International Diabetes Center in Minneapolis, Minnesota.

Copyright© 2004 by R.A. Rapaport Publishing, Inc. This material may not be reprinted for any purpose except with written permission from R.A. Rapaport Publishing. Send permission requests or inquiries to editor@rapaportpublishing.com.