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Milk Alternatives

      Prominence in American Culture

      Pizza, nachos, and lasagna. Ice cream, yogurt, and cheesecake. Lattes, frosties, and milkshakes. Milk's role in the American diet is undeniable, its presence is ubiquitous, and its forms are numerous. Milk was the beverage of choice for American families until the last few decades of the 20th century and the increased popularity of soda, sports drinks, energy drinks, and bottled water. A large part of milk's prominence as a food item can be attributed to its long-recognized nutritional benefits. For centuries, medical opinion accepted milk as beneficial to the general public's health. However, because of a lack of technology, widespread consumption was not possible until the mid-1800s, when rapid transport, artificial refrigeration, and pasteurization were introduced.
      • Rosenthal I.
      Milk and dairy products.
      • Mendelson A.
      Milk: the surprising story of milk through the ages.
      With the advent of these technologies, along with the discoveries of calcium, phosphorus, and vitamin D's roles in bone health, milk consumption took off in America.
      In more recent times, athletes, celebrities, and cultural icons have publicly praised milk in advertisements for the “Got Milk” campaign, attributing their strong bones and muscle health to regular consumption. Better sleep, mitigated symptoms of premenstrual syndrome, and healthier hair, skin, and nails have all been highlighted as possible benefits of regular dairy consumption.

      California Processor Board: Got Milk? Available at: http://gotmilk.com/#/home/benefits/. Accessed July 27, 2009.

      Aficionados have deemed, and continue to deem, milk as “nature's perfect food.” The government, acknowledging the nutritional benefits that dairy products can exert in the diet, recommends that Americans consume three servings of low-fat or fat-free milk products per day.
      United States Department of Health and Human Services, United States Department of Agriculture: Dietary guidelines for Americans 2005.

      Predicament of Chronic Kidney Disease Patients

      With milk's extensive history and publicity, it is not surprising that many people with chronic kidney disease (CKD) express hesitancy or resistance in limiting their milk intake. The National Kidney Foundation's recommendations of limiting consumption of dairy products to half a cup of milk, or half a cup of yogurt, or 1 ounce of cheese per day for those on dialysis

      National Kidney Foundation: Dietary guidelines for adults starting on hemodialysis. Available at: http://www.kidney.org/ATOZ/atozprint.cfm?id=178. Accessed July 14, 2009.

      may appear too restrictive to some. In the wake of the “Got Milk” campaign and the Dietary Guidelines for Americans, those with CKD are often concerned about ingesting inadequate calcium for their bones.
      Ironically, today, the medical community knows that excessive phosphorus and calcium consumption in those with CKD actually weakens bones and causes calcification in soft tissues.
      • Chertow G.M.
      • Burke S.K.
      • Raggi P.
      Treat to Goal Working Group: Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients.
      Eight ounces of whole milk, which contains 222 mg of phosphorus, 349 mg of potassium, and 276 mg of calcium,
      • Chertow G.M.
      • Burke S.K.
      • Raggi P.
      Treat to Goal Working Group: Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients.
      may be excessive to those who already struggle with keeping their laboratory values within the National Kidney Foundation's K/DOQI guidelines. Patients are often surprised to learn that lower-fat milks are in fact even less renal-friendly than whole milk, containing higher levels of potassium and phosphorus.

      United States Department of Agriculture, Agricultural Research Service: USDA national nutrient database for standard reference. Available at: http://www.nal.usda.gov/fnic/foodcomp/search/. Accessed July 27, 2009.

      Patients' concerns regarding bone health are often easily abated by providing them with more in-depth education on calcium and phosphorus dysregulation in kidney disease.

      Proliferation of Products

      In recent years, renal dietitians have been able to offer patients a growing number of alternatives to milk. Soy milks and flavored nondairy creamers have increased in popularity in the United States. Products such as rice milk and almond milk have also enjoyed a growing demand in supermarkets. Finding an appropriate dairy alternative in a local supermarket is not as difficult as it used to be.
      Table 1 lists the nutritional information of the most popular milk substitutes on the market today (only liquid nondairy creamers were included). Percentages for calcium and phosphorus were converted to milligrams, based on the Recommended Daily Allowance (RDA) of calcium as 1000 mg and phosphorus as 1000 mg.
      United States Department of Health and Human Services, Food and Drug Administration: Guidance for industry: a food labeling guide.
      Nutritional differences between refrigerated and shelf-stable versions were often negligible. Of the brands listed, notably absent from previous product updates are Dairy Delicious and Vitasoy. Dairy Delicious is no longer available, and Vitasoy, while once active in the United States market, discontinued their American line of soy milks in April 2009. (Their Asian brand of soy milks can still be found in Asian supermarkets.) For Trader Joe's products, the nutritional content may vary in different parts of the country, depending on the supplier. Some products listed in Table 1 may not be available in all states.
      Table 1Nutrition content of Milk Alternatives
      Parent companyBrandProductServing sizeCaloriesTotal fat (g)Saturated fat (g)Phosphorus (mg)Potassium (mg)Sodium (mg)Calcium (mg)Carbohydrate (g)Protein (g)
      Soy milks
      Whole Foods Market365 OrganicOriginal1 cup903.50.58035011030096
      Whole Foods Market365 OrganicUnsweetened1 cup7040.58035012030047
      Whole Foods Market365 OrganicVanilla1 cup903.50.580350110300106
      Whole Foods Market365 OrganicChocolate1 cup1403.50.5100360110300227
      Whole Foods Market365 OrganicOriginal (refrigerated)1 cup903.50.58035011030096
      Whole Foods Market365 OrganicUnsweetened (refrigerated)1 cup7040.58035012030047
      Whole Foods Market365 OrganicVanilla (refrigerated)1 cup903.50.580350110300106
      Whole Foods Market365 OrganicChocolate (refrigerated)1 cup1403.50.5100640120300237
      Stremicks Heritage Foods8th ContinentOriginal1 cup802.5025036010530078
      Stremicks Heritage Foods8th ContinentLite, Original1 cup502020038011530026
      Stremicks Heritage Foods8th ContinentFat-Free, Original1 cup600020038010030086
      Stremicks Heritage Foods8th ContinentVanilla1 cup10030.5220380105300116
      Stremicks Heritage Foods8th ContinentLight, Vanilla1 cup602020039011030056
      Stremicks Heritage Foods8th ContinentFat-Free, Vanilla1 cup7000NANA100300116
      Stremicks Heritage Foods8th ContinentChocolate1 cup14030.5320440125300227
      Stremicks Heritage Foods8th ContinentLight, Chocolate1 cup901.50270430120300127
      Stremicks Heritage Foods8th ContinentComplete1 cup8030.5NA38010030076
      Eden Foods, Inc.EdensoyEdenblend, Organic Rice and Soy Beverage1 cup12030.51002509033187
      Eden Foods, Inc.EdensoyCarob, Organic1 cup17040.51253509575287
      Eden Foods, Inc.EdensoyChocolate1 cup1803.5114341010597288
      Eden Foods, Inc.EdensoyExtra, Originial1 cup13040.51504401002001311
      Eden Foods, Inc.EdensoyExtra, Vanilla1 cup1503010031090200237
      Eden Foods, Inc.EdensoyLight, Original1 cup10020702209081155
      Eden Foods, Inc.EdensoyLight, Vanilla1 cup110106420011080224
      Eden Foods, Inc.EdensoyOriginal, Organic1 cup14050.51414401051041411
      Eden Foods, Inc.EdensoyUnsweetened Organic1 cup12061137460549512
      Eden Foods, Inc.EdensoyVanilla, Organic1 cup150301003208572247
      Organic Valley of FarmsOrganic ValleyOriginal1 cup11040.560-80260100300117
      Organic Valley of FarmsOrganic ValleyUnsweetened1 cup804060-8028011030037
      Organic Valley of FarmsOrganic ValleyVanilla1 cup1103.5060-80230100300146
      Organic Valley of FarmsOrganic ValleyChocolate1 cup13030.560-80160160300205
      Pacific Foods of Oregon, Inc.PacificOrganic Soy, Unsweetened, Original1 cup904.50.5125400152049
      Pacific Foods of Oregon, Inc.PacificSelect Soy, Low-Fat, Plain1 cup702.50652201152095
      Pacific Foods of Oregon, Inc.PacificSelect Soy, Low-Fat, vanilla1 cup802.506522011520115
      Pacific Foods of Oregon, Inc.PacificUltra Soy, Plain1 cup12040.52503801503001110
      Pacific Foods of Oregon, Inc.PacificUltra Soy, Vanilla1 cup13040.52503801503001410
      Kikkoman Sales USA, Inc.PearlOriginal1 cup1103.50.5NA300110300127
      Kikkoman Sales USA, Inc.PearlCreamy Vanilla1 cup1103.50.5NA27090300117
      Kikkoman Sales USA, Inc.PearlGreen Tea1 cup1103.50.5NA28095300137
      Kikkoman Sales USA, Inc.PearlChocolate1 cup1504.51NA290180300218
      Kikkoman Sales USA, Inc.PearlUnsweetened1 cup904.51NA21013020068
      Kikkoman Sales USA, Inc.PearlCoffee1 cup15040.5NA210190300246
      White Wave FoodsSilkPlain (refrigerated and aseptic)1 cup10040.59530012030087
      White Wave FoodsSilkVanilla (refrigerated and aseptic)1 cup1003.50.59530095300106
      White Wave FoodsSilkChocolate (refrigerated)1 cup1403.50.595350100300235
      White Wave FoodsSilkChocolate (aseptic)1 cup15030.595350100300255
      White Wave FoodsSilkUnsweetened (refrigerated and aseptic)1 cup8040.5953008530047
      White Wave FoodsSilkSilk, Heart Health, Vanilla1 cup801.509530095300106
      White Wave FoodsSilkSilk Plus DHA Omega-31 cup11050.59535012040087
      White Wave FoodsSilkOrganic, Vanilla1 cup1003.50.59530095300106
      White Wave FoodsSilkOrganic, Plain1 cup10040.59530012030087
      White Wave FoodsSilkOrganic, Unsweetened1 cup8040.5953008530047
      White Wave FoodsSilkVery Vanilla1 cup13040.595300140350196
      White Wave FoodsSilkLight Silk, Vanilla1 cup802010030095300106
      White Wave FoodsSilkLight Silk, Plain1 cup702010030012030086
      White Wave FoodsSilkLight Silk, Chocolate1 cup1201.50100350100300225
      Hain Celestial GroupSoy DreamClassic Vanilla1 cup14040.510014013540187
      Hain Celestial GroupSoy DreamEnriched Original1 cup10040.515025013535087
      Hain Celestial GroupSoy DreamEnriched Vanilla1 cup12040.5150250135350147
      Hain Celestial GroupSoy DreamEnriched chocolate1 cup15040.5150290125350217
      Trader Joe'sSoy EssentialUnsweetened1 cup9040.5NA3507035067
      Trader Joe'sSoy MilkOriginal1 cup10020NANA120400135
      Trader Joe'sSoy MilkVanilla1 cup10020NANA120400165
      Trader Joe'sSoy MilkChocolate1 cup1302.50NANA110400235
      Trader Joe'sSoy MilkOrganic Unsweetened1 cup904.50.5NANA152049
      Trader Joe'sSoy Milk ExtraOrganic Original1 cup13030100NA120300177
      Trader Joe'sSoy Milk ExtraOrganic Vanilla1 cup13030100NA125300197
      Trader Joe'sSoy Milk ExtraOrganic Chocolate1 cup13030100NA120300177
      Hain Celestial GroupSoy SlenderPlain1 cup6030.525021010530036
      Hain Celestial GroupSoy SlenderVanilla1 cup7030.525021012530046
      Hain Celestial GroupSoy SlenderCapucchino1 cup7030.525021012530047
      Hain Celestial GroupSoy SlenderChocolate1 cup7030.525029012530057
      Hain Celestial GroupWestSoyOrganic, Originial1 cup1304.50.5NA24012540188
      Hain Celestial GroupWestSoyPlus, Plain1 cup903.50.525031012530077
      Hain Celestial GroupWestSoyPlus, Vanilla1 cup1003.50.5250310125300107
      Hain Celestial GroupWestSoyOrganic, Unsweeteneed1 cup904.50.5NA300304059
      Hain Celestial GroupWestSoyUnsweetened, Almond1 cup904.50.5NA300304059
      Hain Celestial GroupWestSoyUnsweetened Vanilla1 cup1004.50.5NA300304059
      Hain Celestial GroupWestSoyLow-Fat, Plain1 cup901.5015015090200144
      Hain Celestial GroupWestSoyLow-Fat, Vanilla1 cup1201.5015016090200214
      Hain Celestial GroupWestSoyLite Plain1 cup60201501608530064
      Hain Celestial GroupWestSoyLite Vanilla1 cup901.5015016075300195
      Hain Celestial GroupWestSoyNonfat plain1 cup7000150210105250106
      Hain Celestial GroupWestSoyNonfat Vanilla1 cup8020150220105250126
      Hain Celestial GroupWestSoySoy Shake Vanilla1 cup17030150380125300287
      Hain Celestial GroupWestSoySoy Shake, Chocolate1 cup1703.50150480130300307
      Hain Celestial GroupWestSoy LongevityPlain1 cup903.50.5NA230125300106
      Hain Celestial GroupWestSoy LongevityVanilla1 cup1003.50.5NA230125300136
      SuperValu Inc.Wild Harvest OrganicOriginal1 cup903.50.580420160300106
      SuperValu Inc.Wild Harvest OrganicChocolate1 cup1403.50.5100430170300237
      SuperValu Inc.Wild Harvest OrganicPlain1 cup9040.5NANA15030077
      SuperValu Inc.Wild Harvest OrganicVanilla1 cup10040.58042013030097
      Nondairy creamers
      NestleCoffeeMateFat-Free Originial1 tablespoon (15 mL)10001500020
      NestleCoffeeMateLow-Fat Original1 tablespoon (15 mL)100.501505010
      NestleCoffeeMateOriginal1 tablespoon (15 mL)20101500020
      NestleCoffeeMateFat-Free French Vanilla1 tablespoon (15 mL)3800120120110
      NestleCoffeeMateFrench Vanilla1 tablespoon (15 mL)351.5015010050
      NestleCoffeeMateHazelnut1 tablespoon (15 mL)351.5015010050
      NestleCoffeeMateSugar-Free Hazelnut1 tablespoon (15 mL)151015030010
      Rich'sCoffee RichRegular1 tablespoon201.5026510020
      Rich'sCoffee RichFat-Free1 tablespoon1500262610020
      White Wave FoodsInternational DelightFrench Vanilla1 tablespoon452115325060
      White Wave FoodsInternational DelightSouthern Butter pecan1 tablespoon401.5115325070
      White Wave FoodsInternational DelightIrish Cream1 tablespoon401.5115325070
      White Wave FoodsInternational DelightDulce de Leche1 tablespoon452115325070
      White Wave FoodsInternational DelightHershey's Chocolate Caramel1 tablespoon452115325070
      White Wave FoodsInternational DelightBelgian White Chocolate Macademia1 tablespoon452115325060
      White Wave FoodsInternational DelightAmaretto1 tablespoon401.5115325070
      White Wave FoodsInternational DelightCarribean Cinnamon Crème1 tablespoon452115325060
      White Wave FoodsInternational DelightHazelnut1 tablespoon452115325060
      White Wave FoodsInternational DelightEnglish Almond Toffee1 tablespoon452115325060
      Bay Valley FoodsMocha MixOriginal1 tablespoon201.509217010
      White Wave FoodsSilkOriginal1 tablespoon1510112510010
      White Wave FoodsSilkFrench Vanilla1 tablespoon2010112510030
      White Wave FoodsSilkHazelnut1 tablespoon2010112510030
      Other products
      Blue Diamond GrowersAlmond BreezeOriginal1 cup602.5010018015020081
      Blue Diamond GrowersAlmond BreezeOriginal, Unsweetened1 cup40304019018020021
      Blue Diamond GrowersAlmond BreezeVanilla1 cup902.50100180150200161
      Blue Diamond GrowersAlmond BreezeVanilla, Unsweetened1 cup40304019018020021
      Blue Diamond GrowersAlmond BreezeChocolate1 cup12030150250150200222
      Blue Diamond GrowersAlmond BreezeChocolate, Unsweetened1 cup453.504023018020032
      Manitoba HarvestHemp BlissOriginal1 cup11070.5NANA952075
      Manitoba HarvestHemp BlissVanilla1 cup15070.5NANA12020145
      Manitoba HarvestHemp BlissChocolate1 cup16070.5NANA12040175
      Good Karma Foods, Inc.Organic Rice MilkOriginal1 cup8030150NA170250121
      Good Karma Foods, Inc.Organic Rice MilkVanilla1 cup11030150NA170250191
      Good Karma Foods, Inc.Organic Rice MilkChocolate1 cup13030150NA190250251
      Pacific Foods of Oregon, Inc.PacificRice, Plain1 cup130201753560300271
      Pacific Foods of Oregon, Inc.PacificRice, Low-Fat, Vanilla1 cup130201753575300271
      Pacific Foods of Oregon, Inc.PacificOrganic Oat, Vanilla1 cup1302.50270120110300254
      Pacific Foods of Oregon, Inc.PacificOrganic Oat, Original1 cup1302.50270120110350244
      Pacific Foods of Oregon, Inc.PacificOrganic Almond, Vanilla1 cup702.50251401400111
      Pacific Foods of Oregon, Inc.PacificOrganic Almond,Chocolate1 cup10050.5471301400191
      Pacific Foods of Oregon, Inc.PacificOrganic Almond, Original1 cup602.5029140140081
      Pacific Foods of Oregon, Inc.PacificOrganic Unsweetened Almond, Vanilla1 cup402.50250180031
      Pacific Foods of Oregon, Inc.PacificOrganic Unsweetened Almond, Original1 cup352.50290180021
      Pacific Foods of Oregon, Inc.PacificAll-Natural Hazelnut, Original1 cup1103.5019560120300182
      Pacific Foods of Oregon, Inc.PacificHemp Milk, Original1 cup14050.5300170130500204
      Pacific Foods of Oregon, Inc.PacificHemp Milk, Vanilla1 cup16050.5300170135500244
      Hain Celestial GroupRice DreamCarob, Classic1 cup1502.50NANA800301
      Hain Celestial GroupRice DreamOriginal, Classic1 cup1202.500010020241
      Hain Celestial GroupRice DreamVanilla, Classic1 cup1302.50NANA10520271
      Hain Celestial GroupRice DreamEnriched Original1 cup1202.501500100300231
      Hain Celestial GroupRice DreamEnriched Vanilla1 cup1302.501500105300261
      Hain Celestial GroupRice DreamHeartwise Original1 cup130201503080300271
      Hain Celestial GroupRice DreamHeartwise Vanilla1 cup140201503080300301
      Hain Celestial GroupRice Dream SupremeVanilla Hazelnut1 cup1402.50150NA65300291
      Hain Celestial GroupRice Dream SupremeChocolate Chai1 cup16030150NA70350351
      Hain Celestial GroupAlmond DreamOriginal1 cup502.50150NA10030061
      Hain Celestial GroupAlmond DreamUnsweetened1 cup302.50150NA10030011
      Hain Celestial GroupOat DreamOriginal1 cup12030NANA20300204
      Hain Celestial GroupOat DreamMaple Brown Sugar1 cup12030NANA20300204
      Hain Celestial GroupHemp DreamOriginal1 cup10060.5NANA530084
      Hain Celestial GroupHemp DreamVanilla1 cup11060.5NANA5300114
      Trade Joe'sRice DrinkOrganic Original Unsweetened1 cup1202.5015020100300231
      Trade Joe'sRice DrinkUnsweetened Vanilla1 cup1302.50150NA105300261
      Trade Joe'sWhole Grain DrinkOriginal1 cup702.5080NA130150120
      Trade Joe'sWhole Grain DrinkUnsweetened1 cup503080NA13515070
      Living Harvest Foods, Inc.TemptHempmilk, Original1 cup10060.5200NA25400102
      Living Harvest Foods, Inc.TemptHempmilk, Vanilla1 cup11060.5200NA25400122
      Living Harvest Foods, Inc.TemptHempmilk, Chocolate1 cup15060.5200NA35400231
      Living Harvest Foods, Inc.TemptHempmilk, Unsweetened Original1 cup6060.5200NA2540011
      Living Harvest Foods, Inc.TemptHempmilk, Original1 cup6060.5200NA2540011
      Hain Celestial GroupWestSoyRice Beverage, Plain1 cup1102.5010065110250201
      Hain Celestial GroupWestSoyRice Beverage, Vanilla1 cup1102.5010065110250201
      SuperValu, Inc.Wild Harvest OrganicRice Milk, Original1 cup100201575590300230
      SuperValu, Inc.Wild Harvest OrganicRice Milk, Vanilla1 cup120201506095300260
      Whole Foods Market365 OrganicRice Milk, Unsweetened1 cup452015015135200101
      Whole Foods Market365 OrganicRice Milk, Original1 cup902.5015030150250171
      Whole Foods Market365 OrganicRice Milk, Vanilla1 cup1202.5015035150250231
      As previous authors noted, a challenge for dietitians involves keeping up to date with formulation changes. In the time span of writing this article, many product formulations were modified. Without contacting companies regularly, dietitians would be unaware of such changes. As such, by the time these data are published online, some may very likely be outdated (all nutritional data were current as of July 2009).
      The renal dietitian should keep one final consideration in mind regarding alternative dairy products, i.e., these products present their own challenges. Many soy milks on the market are fortified with calcium and phosphorus additives, making them no more renal-friendly than milk. Grain-based and nut-based milks are often low in protein, making them less than ideal for patients lacking high biological value proteins. However, because such a wide array of nondairy substitutes is available, patients can almost certainly find a product suitable for them, as long as they know where to look. This is often where the dietitian's expertise is required. When the dietitian helps a CKD patient make a choice tailored to individual needs and health status, the CKD patient will be spared one more frustration in the management of this difficult disease.

      Manufacturer Information

      Eden Foods, Inc.
      701 Tecumseh Road
      Clinton, MI 49236
      888-424-3336
      Good Karma Foods, Inc.
      441 Beaver St. , Suite 201
      Sewickley, PA 15143
      412-749-9805
      Hain Celestial
      Consumer Relations
      4600 Sleepytime Dr.
      Boulder, CO 80301
      800-434-4246
      Living Harvest Foods, Inc.
      P.O. Box 4407
      Portland, OR 97208
      888-690-3958
      Manitoba Harvest, Inc.
      69 Eagle Drive
      Winnipeg, Manitoba R2R 1V4
      Canada
      Nestle
      800 North Brand Boulevard
      Glendale, CA 91203
      800-225-2270
      Pacific Foods of Oregon, Inc.
      19480 SW 97th Ave.
      Tualatin, OR 97062
      503-692-9666
      Stremicks Heritage Foods
      4002 Westminster Ave.
      Santa Ana, CA 92703
      800-371-9010
      Trader Joe's
      PO Box 5049
      Monrovia, CA 91017
      626-599-3700
      Whole Foods Market, Inc.
      550 Bowie St.
      Austin, TX 78703
      512-477-4455
      White Wave Foods
      12002 Airport Way
      Broomfield, CO 80021
      303-635-4000

      References

        • Rosenthal I.
        Milk and dairy products.
        VCH Publishers, Inc, New York1991
        • Mendelson A.
        Milk: the surprising story of milk through the ages.
        Alfred A. Knopf, New York2008
      1. California Processor Board: Got Milk? Available at: http://gotmilk.com/#/home/benefits/. Accessed July 27, 2009.

      2. United States Department of Health and Human Services, United States Department of Agriculture: Dietary guidelines for Americans 2005.
        6th ed. United States Government Printing Office, Washington, DC2005
      3. National Kidney Foundation: Dietary guidelines for adults starting on hemodialysis. Available at: http://www.kidney.org/ATOZ/atozprint.cfm?id=178. Accessed July 14, 2009.

        • Chertow G.M.
        • Burke S.K.
        • Raggi P.
        Treat to Goal Working Group: Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients.
        Kidney Int. 2002; 62: 245-252
      4. United States Department of Agriculture, Agricultural Research Service: USDA national nutrient database for standard reference. Available at: http://www.nal.usda.gov/fnic/foodcomp/search/. Accessed July 27, 2009.

      5. United States Department of Health and Human Services, Food and Drug Administration: Guidance for industry: a food labeling guide.
        United States Government Printing Office, Washington, DC2008