Diabetes and milk 30 July 2019 Long gone are the days of receiving milk fresh from the cow delivered in a glass bottle to your door, now there is a huge array of options to choose from. Milk and other dairy products are an important source of highly absorbable and readily available calcium. It is an important source of other key nutrients including protein, iodine, vitamin A, vitamin D, riboflavin, B12 and zinc, which are all important for good health. Milk is also a source of healthy, low glycaemic index carbohydrates that are important for energy. With so many non-dairy alternatives available now it is easier than ever for people with allergies, intolerances or following a vegan diet to find a substitute. Some people also choose milk alternatives due to taste preferences or the perceived health benefits. However it’s important to know that milk alternatives differ in the nutrition they provide. A common misconception is that dairy products increase mucus production, and while they can coat the lining of the throat and make it feel that way, there is no evidence to this claim. So how do you know which type of milk is the right choice for you? Full fat milk Full fat milk contains roughly 4% fat, which makes it an ideal choice for children under the age of two years who require the extra energy and kilojoules for growth and development. Full fat milk is also generally recommended for those struggling to gain weight or at risk of malnutrition. Low fat or skim milk Low fat milks contain roughly 1% fat, while skim milk is as low as 0.01% fat. For most of the population low fat or skim milk is recommended in order to reduce saturated fat and kilojoule intake. Some people don’t like the more watery taste of a skim milk, so reduced or low fat milk is a good compromise. There is a common misconception that more sugar is added to low fat or skim milk, however this is not the case. Unless it is a flavoured or sweetened milk, no sugar is added to cow’s milk. The naturally occurring sugar in milk is known as lactose and this is found in the watery portion of milk, meaning that when the fat is removed or reduced we do end up with slightly more sugar, protein and other nutrients. However the difference is very small and makes no measurable difference to blood glucose levels. The difference in naturally occurring sugar in a cup of full fat milk vs low fat milk is less than half a gram. Lactose free Lactose free milk is a great option for people who experience lactose intolerance or an inability to digest the naturally occurring sugar in milk. The milk is treated with the addition of an enzyme that pre-digests the lactose, meaning it can be tolerated by those with lactose intolerance. Although lactose is the naturally occurring sugar in milk, this doesn’t make any difference to the sugar content of milk. The sugar is simply broken down, not removed. A2 milk Milk is naturally comprised of two different proteins, a mix of A1 and A2 proteins. However we now have available milks that only contain the A2 type of protein due to special selection of the cows producing the milk. While lots of health claims are made about A2 milk, currently there is a lack of good quality evidence to suggest it is better than milk containing a mix of both proteins. However in some instances of intolerance symptoms, it is reported that people may experience less digestive discomfort with A2 milk. Soy milk Soy milk is free of lactose and milk protein, making it a great alternative for those who can’t or choose not to have dairy. It is the closest of the alternatives to cow’s milk in terms of protein and carbohydrate content, however it is naturally low in calcium. Be sure to choose a calcium-fortified variety that contains at least 100mg/100ml. Almond milk and other nut milks Low in both protein and carbohydrate, almond milk and other nut milks like macadamia contain a very small proportion of nuts and are mostly water. Like soy milk they are naturally low in calcium, and it is important to choose a calcium-fortified variety. Many options also have added sugar, so choose a no-added-sugar version if you use nut milk. While they can be a low carbohydrate and kilojoule option for those following a low carb diet, they don’t offer as much from a nutritional perspective as cow’s milk or soy. Oat milk and rice milk Made from grains, oat milk and rice milk are generally low in protein and high in carbohydrate. As they lack the fibre and nutrition of consuming the wholegrain, they may not make the best choice for people with diabetes. If you prefer the taste keep portion sizes small and like all non-dairy milks be sure to choose a calcium-fortified variety. Coconut milk Higher in naturally occurring saturated fat coconut milk is one to save for adding flavour to special dishes, rather than as an everyday milk alternative. So which milk do you choose? The bottom line is that for most people who do not follow a special or restricted diet a reduced fat cow’s milk is likely to be the best choice. Alternative milks can however add variety and interest to your diet, but should be chosen carefully to maximise nutrients and minimise added sugars.