Not All Milks Are Created Equal

I see many children being fed with “milks” other than breast milk or cow’s milk. Often, when there is suspected or proven cow’s milk allergy parents will substitute a nut or vegetable-based beverage. Sometimes, the cow’s milk alternative has been chosen for other reasons.

Growing children get several things that are crucial to good growth and development from cow’s milk; calories, calcium, protein, and fats. As you can see from the table below, with the exception of soy milk, the nut and vegetable milks either provide too little protein, too few calories, not enough fat, or some combination of those problems. Coconut milk is particularly problematic as a dairy substitute not only because it is very high in fat but because the fats are 100% saturated. Saturated fats contribute to heart disease.

The information in this table was obtained from the FDA food labels for each product or the USDA database. However, not all vegetable milks are created equal either. The protein, fat, and calcium contents may vary widely by brand.

Recently, there have been reports of diminished growth in children receiving dairy-free diets. We have known for years that children subject to restricted diets are at risk for malnutrition. Parents should be mindful of the nutritional limitations of alternative milks and adjust their child’s diet to compensate.

For more than 20 years, concerns have been raised about isoflavones because of their similarity to the hormone estrogen. The concern is that consuming soy will influence the hormone balance of a developing child. Studies have shown that the hormonal effects of isoflavones are very weak and only likely to have an impact if very large amounts of soy were consumed. Other studies have failed to show any association between soy intake and endocrine problems. Soy milk has the advantages of acceptable amounts of calories, calcium, protein, and fat at a modest cost.

A brief word about milk allergy. Many patients tell me that friends or family members have recommended goat or sheep’s milk for their cow milk allergic child. The evolutionary tree shown here represents the relatedness of one animal to another. The more closely related two animals are the more similar their proteins will be. As one can see, although cow is not as closely related to sheep or goat as they are to each other, the three animals are in the same family. Therefore, the likelihood is high that a patient allergic to cow’s milk will also be allergic to sheep’s milk and goat’s milk because they are pretty close in evolution. The problem with these milks is not their nutritional value but the high probability of allergic cross-reactivity. It is possible but unpredictable, that camel’s or mare’s milk would be better tolerated. Camel and horse (not shown) are more distant.

Evolutionary Tree of Selected Mammals

In a patient with true, IgE mediated milk allergy or eosinophilic esophagitis or food protein-induced enterocolitis, it would be prudent to test alternative mammalian milks before introduction.

Dr. Richard Wasserman is an allergist/immunologist practicing in North Dallas.