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Got Milk? by Annie Rubin, MS, RDN

Food shopping has become overwhelming these days. There are so many options to choose from, especially when it comes to alternative and processed foods. At the store where I shop, there is an entire refrigerated section of plant-based milk-alternative beverages. I often see people standing in front of the dairy case with blank stares, wondering which one is the “healthiest” or “best” for their diet. Should we be switching from cow’s milk to a plant-based non-dairy drink? With so many choices on the market, how do we know which is the best one for us?

The truth about cow’s milk

Humans are the only mammals that drink milk past the age of one; this was not always the case. Lactose, the primary sugar found in milk, needs a special enzyme called lactase to break down the sugar for digestion and absorption. Most mammals stop producing this enzyme as they are weaned off of their mother’s milk. Certain groups of humans, specifically those from pastoral or farming lifestyles in Eastern Europe, evolved to continue producing lactase and are able to digest milk. This “lactase persistence” is assumed to have begun around 5,000 years ago. There are also some populations where lactase persistence is rare, including those of African, Asian and South American descent, and milk is typically not included in their diet.

Cow’s milk (and dairy products in general) has since become a major staple of the diet for most North Americans. It is recommended because it provides more calcium, phosphorus, protein, magnesium, potassium and zinc per calorie than any other food typically found in our diet. And, indeed, it is a significant contributor to our overall calcium and protein intake. The calcium in milk and other dairy products is more bioavailable than the calcium found in leafy greens and other vegetables, such as spinach, which means that we absorb more calcium from milk than from vegetables.

There is considerable debate about the inflammatory effects of milk. On the one hand, milk contains many antioxidants, including selenium, vitamins A and E, and immune-supporting minerals such as zinc and magnesium. Although milk contains saturated fat, which is linked to the development of heart disease, several studies have shown an inverse relationship between milk consumption and cardiovascular disease risk.

On the other hand, milk contains insulin-like growth factors (IGF-1 and IGF-2). Consuming milk has been shown to increase our circulating IGF-1 levels. IGF-1 can suppress antioxidants, increase cellular inflammation and increase the production of sebum, leading to acne. Additionally, hormones, pesticides and antibiotics have shown up in conventional (non-organic) milk, with some amounts exceeding federal limits.

Should I make the switch to a plant-based milk alternative?

Making the switch to a nut- or grain-based milk really comes down to personal choice. If you have acne or suspect that you have lactose intolerance or low-grade inflammation, taking a break from cow dairy to see if symptoms improve might be a good start. If you are concerned with hormones, pesticides and/or antibiotics in conventional milk products, I would definitely consider switching to an organic brand. It is always good to know where your food comes from. Investigate dairy farms and choose one that has a philosophy and farming practice that aligns with yours.

What dairy alternative drinks are the best?

Nut- and grain-based milks vary greatly in terms of nutrition, taste, texture and sustainability. Below is a brief summary of the pros and cons of some common plant-based alternative milks.

Other considerations with plant-based milk alternatives:

  1. Look at the nutrition label for vitamins and mineral amounts. Some brands fortify their drinks with vitamins and minerals; others do not. I recommend looking at calcium and vitamin D, especially if your diet does not include animal-based dairy.

  2. Check the ingredient list. Some brands include a laundry list of fillers, sugars and flavorings. Choose brands that use less of these. Carrageenan is a common filler and has been linked to digestive issues.

  3. Avoid flavored and/or sweetened milks. They contain added sugars.

  4. Purchase organic plant-based milks to ensure you are not drinking genetically modified crops.


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  • Marshall, M. Why Humans have Evolved to Drink Milk. BBC Future. 19 Feb 2019. Retrieved 8 Nov 2019.

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  • Welsh, J. A., Braun, H., Brown, N., Um, C., Ehret, K., Figueroa, J., & Boyd Barr, D. (2019). Production-related contaminants (pesticides, antibiotics and hormones) in organic and conventionally produced milk samples sold in the USA. Public health nutrition, 22(16), 2972–2980.

Annie Rubin, MS, RDN

Annie Rubin is a registered dietitian and holds a Master’s degree in Nutritional Science. She completed her dietetic internship at Stanford Health Care. Before starting her private practice, Annie worked at Stanford as an outpatient dietitian in the Bariatric and Metabolic Interdisciplinary (BMI) clinic for surgical and non-surgical weight loss patients. She was also an adjunct professor at San Jose State University in the Nutrition, Food Science and Packaging Department. Annie is currently the dietitian at The Wellness Studio at The Village Doctor. In her spare time, Annie loves to run, hike and spend time with her family.

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