Dairy and Plant-Based Milks: A Dietitian’s Guide to Research on Top Questions

Dietitians help people make sense of wide-ranging questions and misunderstandings about dairy milk and plant-based milks. Questions often focus on cardiovascular disease or cancer risk and survivorship, but also involve a variety of other issues.

 

Milk choices are more complex than people realize. Consumer research indicates that, while the majority of consumers understand that milk and plant-based milk alternatives are different products, many consumers may not be aware of the nutritional differences between them, according to the U.S. FDA.

 

 

Caution needed: Jumping from studies of mechanisms involving individual nutrients or compounds to conclusions about whole foods, especially as they’re consumed as part of an overall healthy diet, is not “evidence-based” nutrition. 

• Studies of potential influence of individual components in dairy milk and plant-based milks point to areas to investigate. 
• Ultimately, the influence of these choices on health needs to be considered in the context of their consumption as whole foods.

 

Questions about Dairy Milk Choices     

Conflicting claims about dairy milk products related to heart health and cancer leave many people confused about healthy choices.

 

Does dairy increase cardiovascular risk? Or does dairy support heart health?

Research on dairy and heart disease risk

Increased dairy product consumption does not increase risk of developing coronary heart disease, according to analysis of prospective observational studies that followed people over time. And that’s the case whether analysis examines full-fat and low-fat dairy together or separately; and also in individual analysis of milk, cheese, and yogurt.

Research on dairy and CVD Risk factors 

Hypertension

In an analysis combining 23 prospective observational studies that followed people for years, each additional daily serving of dairy products was associated with a 4% lower risk of hypertension [evidence quality graded moderate].

Randomized controlled trials (RCTs) don’t follow people for as long as prospective observational studies often do, but they allow more control to reduce influence of confounding variables. An analysis of eight RCTs in adults without chronic diseases other than obesity, higher intake of dairy (3 or more servings/day) showed no detrimental effects on blood pressure. In RCTs, both low-fat and possibly full-fat dairy reduced systolic blood pressure by about 5 to 8 mm Hg, although the evidence was graded as low certainty.  

 

LDL-cholesterol 

For many years, nutrition recommendations have emphasized choosing nonfat and low-fat dairy rather than full-fat dairy because of the saturated fat content in dairy products. In recent years, some research has suggested that the type of saturated fat in milk may be less likely to raise LDL-cholesterol than other types of saturated fat (such as the saturated fat found in meat and coconut oil).

Two odd-chain saturated fatty acids, pentadecanoic acid (15:0) and heptadecanoic acid (17:0), are produced by the gut microbiota in ruminant animals. Some studies show unique differences in these compared to other long-chain saturated fatty acids. However, they reportedly make up less than 2% of the fat in milk. And dairy fat also includes other saturated fatty acids (lauric, myristic, and palmitic acids) that do raise levels of LDL-cholesterol and ApoB.

📌 More research is needed in studies focused on physiologically relevant amounts of these fatty acids as consumed in an overall healthy diet. A key question involves what dairy products are compared to (what foods they replace or are replaced by) when considering influence on health. 

Higher dairy consumption showed no statistically significant effect on LDL-cholesterol in an analysis of 9 RCTs. Although high-fat dairy showed a tendency to raise LDL levels, the result was not statistically significant (it could have occurred by chance). Analyses of low-fat and full-fat dairy both showed wide variation between the studies involved. Some studies have found differences in effects on LDL levels and CVD risk based on type of dairy products (less elevation with cheese or yogurt than other types) and among individuals (more elevation in people whose LDL-cholesterol was higher at baseline).

 

The Scientific Report of the 2025 Dietary Guidelines Advisory Committee concluded:

• Blood lipids and cardiovascular disease mortality: The relationship of higher-fat compared to lower-fat dairy remains unclear because there is not enough evidence available.
• Risk of developing cardiovascular disease: Higher-fat dairy versus lower-fat dairy is not associated with a difference in risk, based on analysis of prospective cohort studies. This conclusion statement is based on evidence graded as limited, however. 
• Limiting total saturated fat in the diet to below 10% of calories is supported by well-established evidence. Therefore, until further definitive studies are conducted, it is prudent to continue recommending consumption of fat-free or low-fat milk, yogurt, and cheese as part of a dietary pattern that keeps total saturated fat intake to no more than 10% of calories.

These conclusions align with other major guidelines:

• The Academy of Nutrition and Dietetics nutrition practice guideline on saturated fat and CVD recommends that adults with and without CVD should reduce saturated fat and replace it with polyunsaturated fat. Reducing dietary saturated fat can lower LDL-cholesterol and reduce risk of CVD events. However, the guideline concludes that a variety of dairy products are not associated with an increased risk of CVD. Still, the evidence on dairy products is graded low certainty and clinicians are advised to consider that different choices may be best for different individuals.
• The National Lipid Association (NLA) clinical perspective on nutrition interventions for adults with dyslipidemia recommends limiting total saturated fat as one part of an overall healthy dietary pattern to reduce elevated LDL-cholesterol.

 

Inflammation

Although people may see claims in books and social media saying that dairy products promote inflammation, evidence does not support that claim.

Consumption of milk or dairy products did not show a proinflammatory effect in a systematic review that included 16 intervention studies – whether in healthy adults or in adults who had overweight or obesity, metabolic syndrome, or type 2 diabetes. If anything, results of long-term dairy supplementation trials show a weak anti-inflammatory effect in both populations.

 

Does dairy increase cancer risk?

Research on dairy and cancer risk

Despite claims you may hear about dairy products acting through hormones or growth factors to increase cancer risk, research as a whole does not support claims that even moderate dairy consumption increases cancer risk.

The American Institute for Cancer Research (AICR) Cancer Prevention Recommendations do not include any recommendation on dairy consumption. Nor do the American Cancer Society recommendations. 

• Colorectal cancer risk is reduced with dairy product consumption, according to evidence graded as convincing in the AICR/WCRF Third Expert Report and additional analysis.
• Breast cancer risk may be reduced with dairy consumption (the opposite of claims many women hear), but the evidence is categorized as too limited to support a recommendation.
• Prostate cancer is the only cancer for which evidence suggests a potential increase in risk related to higher dairy product consumption and diets high in calcium. But the evidence is graded too limited to support any recommendation. Research published since these reports continues to show inconsistent results, within a study and between studies, for different types of prostate cancer and different dairy products. And even when an increase in risk is statistically significant, the increase is so small that it may not be clinically meaningful.

 

Research on factors that promote cancer

Estrogen: Since milk contains some estrogen, people may worry that dairy consumption promotes development of estrogen-sensitive cancers. However, the amount of any compound (or nutrient) is crucial to influencing its effects. In the case of milk and other dairy products, the amount of estrogen is small compared to the amount produced by our own bodies. 

If estrogen content of dairy products promoted risk of breast cancer, for example, you’d expect higher risk of ER+ breast cancer specifically associated with dairy consumption. But it’s not. Current research does not show any association of total dairy and individual dairy products (milk, yogurt, cheese) with ER+ breast cancer risk.

Insulin-like Growth Factor: IGF-1 has long been identified as a factor that could promote cancer development by stimulating cell growth and reproduction and inhibiting apoptosis (self-destruction of abnormal cells), thus increasing the likelihood of mutations occurring. Circulating IGF-1 levels among participants in the UK Biobank study are associated with increased risk of several (such as colorectal, breast, prostate, and possibly others), but perhaps not all, types of cancer.

However, it’s important to remember that IGF-1 is not inherently “bad.” Just as too much and too little insulin both pose risk, adequate amounts of IGF-1 are important to maintain and rebuild muscle.

Although increased dairy consumption can raise IGF-1 levels, even statistically significant differences in IGF-1 associated with moderate dairy consumption are small compared to the broad range of normal human IGF-1 levels. So it’s not clear whether increases with moderate dairy consumption are clinically meaningful.

And IGF-1 levels tend to be somewhat higher with higher protein consumption from any source — especially with animal protein, but even with protein from plant foods. Still, more research is needed to understand what levels of consumption are associated with differences that are clinically meaningful.

Inflammation: Another factor that promotes development of cancer is chronic systemic inflammation. However, as noted above, overall research does not support claims that milk or dairy products promote inflammation, and suggests that if anything, the influence is anti-inflammatory.

 

Research on dairy products and cancer survivors

As with the evidence on dairy and cancer risk, research does not support association of milk or milk products with poor outcomes in people living with and beyond cancer. Most studies have involved breast, colorectal, and prostate cancer.

Breast cancer: Dairy product consumption is not associated with all-cause mortality, breast cancer mortality, or breast cancer recurrence, according to the WCRF/AICR CUP Global report. Evidence is graded too limited for any conclusions, however.

Colorectal cancer: Evidence on milk and dairy product consumption was graded as too limited for any conclusion about cancer outcomes in the 2024 WCRF/AICR CUP Global report. (You can see details of the dose-response analysis and high-vs-low intake studies in Figure S23 and Table S25, respectively.)

Prostate cancer: No consistent association of dairy products with cancer progression or prostate cancer mortality was found in an analysis of diet and lifestyle factors. Two studies found increased risk of deaths from all causes with higher dairy consumption. But inconsistencies in associations based on differences in dairy products and different types of prostate cancer don’t provide a strong basis for advice. Some might suggest keeping dairy products to moderate amounts and avoiding frequent consumption of high-fat dairy, but this would not be based on strong or consistent conclusions.

 

 

Questions about the Best Non-Dairy Milk

Consumer research shows that people are often unaware of the differences in nutrient content between dairy milk and plant-based milk products. Different kinds of plant-based milks differ considerably in nutrients. And even different brands of the same type of plant-based milk vary due to differences in nutrient fortification and added ingredients.

People may check calcium and vitamin D content in plant-based milk.

But there’s more to it than that.

Dairy products are categorized as important contributors — not only of calcium and vitamin D — but also of protein, vitamin A, potassium, phosphorus, riboflavin, vitamin B12, choline, and zinc. 

• Of these, the Scientific Report of the 2025 Dietary Guidelines Advisory Committee identifies calcium, vitamin D, and potassium as nutrients of public health concern across all age groups beyond infancy. Because of their significance, the FDA requires content to be declared on Nutrition Facts labels on food. 
• Others of these nutrients, such as choline, are nutrients that pose public health challenges, according to the 2025 advisory committee report. And for older adults, so do protein and vitamin B12.
• Nutrients that pose public health concern in excess — added sugars and saturated fat — also vary among milk and plant-based milk choices.

 

The significance of these nutritional differences for individuals varies based on their overall diet.

• The Dairy Group in dietary patterns in the 2020-2025 US Dietary Guidelines (and thus in MyPlate) includes soy beverages fortified with calcium, vitamin A, and vitamin D. Soy milk is similar to dairy milk based on nutrient composition and use in meals. The 2025 dietary guidelines advisory committee recommends continuing this approach. 
• Other plant-based milks are not included as part of the Dairy Group because of lower levels of nutrients of public health concern in some or many products. And an intensive review of this question in the 2025 dietary guidelines advisory committee report endorses this approach.
• Especially for people who avoid or significantly limit meat or who have elevated protein needs, differences in the protein content among plant-based milks and compared to dairy milk may be worth attention.

 

Are all plant-based milks the same? 

Plant-based milks are often – but not always – similar in calcium and vitamin D to dairy milk because of fortification. But in addition to checking content of these nutrients, the various types of plant-based milks differ considerably in several other ways:

• Protein: Milk is often considered a source of protein. But some plant-based milks contain much lower amounts of protein than dairy milk.
  📌 Most U.S. adults exceed the Estimated Average Requirement for protein, and lower protein content of a plant-based milk may not be a concern. However, for people who avoid or significantly limit meat, fish, and poultry, the protein from milk and/or plant-based milk may be important to meet recommendations. And especially for those who are likely to benefit from protein beyond the Recommended Dietary Allowance, such as people in cancer treatment, engaged in resistance training to increase muscle mass, and older adults, protein content of plant-based milk may be important.
• Calcium: Some plant-based milks are fortified with calcium, resulting in content as high or higher than dairy milk. However, without fortification, plant-based milks are substantially lower than dairy milk.
  📌 During stages when peak bone mass is being achieved and among post-menopausal females with rapid bone remodeling, relying on sources like green vegetables (which have much lower bioavailability of calcium) is unlikely to meet recommendations. 
• Vitamin D: As with calcium, fortification brings vitamin D content of many plant-based milks to levels as high or higher than dairy milk. Others, however, contain none.
  📌 Dairy and dairy alternative products fortified with vitamin D are especially important for people with reduced skin synthesis of vitamin D, such as older adults, people with limited sun exposure, and people with dark skin.
• Vitamin B12: Found only in animal-based foods, people who eat little or no meat, fish, poultry, eggs, or dairy need to include foods fortified with vitamin B12 and/or supplements.
  📌 Some older adults, as well as people with medical conditions or medications that reduce stomach secretion of the hydrochloric acid required for absorption of B12 naturally occurring in food, can absorb B12 from fortified foods better than from naturally occurring sources. 
• Potassium, Vitamin A, Phosphorus, Riboflavin, Choline, and Zinc also differ substantially among different plant-based milks, based on what naturally occurs and on fortification.
  📌 Depending on individual consumption of other foods that provide these nutrients, the importance of their content in choosing plant-based milk may vary. 

 

Other differences among plant-based milks people may ask about:

• Iodine: Dairy products are a primary source of iodine for many people because of farming practices (iodine in feed and in disinfectants used in the milking process). In the U.S., salt has been a major source of iodine for many years. However, as commercial foods (which use non-iodized salt) and non-iodized “gourmet” salts have grown in use, salt should no longer be assumed to provide the iodine needed to prevent goiter.
  📌 For people who don’t consume fish, eggs, or dairy milk or yogurt, choosing a plant-based milk that’s fortified with iodine may be advised. 
• Added sugars: Some plant-based milks are very low in sugar. But some contain more than a tablespoon of added sugar in an 8-ounce cup.
  📌 Checking for products with no added sugars is advised, although the priority of this choice could vary depending on overall consumption of added sugars in other foods.
• Emulsifiers: Some, but not all, plant-based milks include added emulsifiers to stabilize consistency and provide a creamy texture. In laboratory (in vitro and animal) studies, some emulsifiers cause changes in gut microbiota composition and gene expression that show potential to promote low-grade inflammation. Since some observational population studies show associations of high consumption of ultra-processed foods (UPFs) with greater risk of cardiovascular disease and possibly some types of cancer, questions have been raised regarding the use of emulsifiers in some of these UPFs as a factor in these associations.
  📌 However, a broad range of emulsifiers are used in foods that may have different effects. People who wish to avoid emulsifiers can select plant-based milks that don’t contain them. But avoid an all-or-nothing view of processed vs ultra-processed foods. Explain that high consumption of UPFs in observational studies can be a marker of poor overall diet quality and consider how plant-based milk choice and amount fit in their individual overall diet.

 

 

 

 

Is soy milk healthy?   

Unfounded fears: Some people may be afraid that soy milk’s isoflavones (polyphenol compounds that naturally occur in soy foods) could pose estrogen-related risks. Isoflavones are sometimes called “phytoestrogens” because their chemical structure has similarities to human estrogen. 

• Early fears were based on studies of athymic ovariectomized nude mice. Scientists now know that rodents metabolize isoflavones differently than humans.
  📌 The growth of implanted breast cancer cells in these mice involved dramatically higher circulating levels of the active form of these compounds than would occur in humans.
• Human studies do not show risks related to isoflavone consumption. Randomized controlled trials (RCTs) show no effects on breast density, estrogen homeostasis, inflammatory biomarkers, or expression of genes related to cell proliferation.
  📌 Research now shows that although isoflavones can bind to estrogen receptors, unlike human estrogen, isoflavones show a stronger binding affinity for receptors categorized as ER-beta, which do not promote cell proliferation.
• Soy foods are not associated with increased risk of any cancer. Laboratory studies even show potential for anti-inflammatory, antioxidant, and other protective effects.
  📌 It’s not clear whether protective effects occur in humans with amounts consumed in foods and after isoflavones are metabolized to other compounds. But major reports are clear in showing no increase in cancer risk.

 

Is soy milk safe for cancer survivors?

• Yes, soy foods can be included as part of a healthy diet after a breast cancer diagnosis. Soy food consumption may even be associated with reduced risk of all-cause mortality, breast cancer mortality, and breast cancer recurrence, based on evidence graded Limited Suggestive in the latest WCRF/AICR report on breast cancer outcomes. 
• A safe option, not a recommendation urging use: Evidence graded Limited Suggestive is not strong enough to recommend adding or increasing soy foods specifically for improving cancer outcomes. However, the evidence should allay fears for women who want to include soy milk and other soy foods.
• Moderate consumption of soy foods is one to two servings a day according to the American Institute for Cancer Research (AICR). One cup (8 fluid ounces) of soy milk is considered one serving based on protein and isoflavone content. Studies have demonstrated up to 3 servings/day – up to 100 mg/day of isoflavones – consumed in Asian populations long-term does not link to increased breast cancer risk. 

 

Is soy milk heart-healthy?

• Yes, the fat in soy milk is mainly unsaturated fat. Like other soy foods, saturated fat content is low.
• Soy foods’ heart health claim says diets with a total of 25 grams of soy protein per day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. However, each 8-ounce cup of soy milk provides 6 grams of protein, so the FDA-approved claim based on reducing LDL-cholesterol may refer to amounts beyond what most people would consume.
• Dietary patterns that use soy milk in a plant-focused dietary pattern can reduce LDL-cholesterol. For example, soy milk and other soy foods are used to replace less healthful foods high in saturated fat in the Portfolio Diet, which has been demonstrated to help lipid management and is associated with reduced risk of heart disease.

 

How can you choose the healthiest plant-based milk?     

Plant-based milks were at one time referred to as “plant-based milk alternatives” to clarify that they’re not actually produced from cows or other animals. Now the FDA allows use of the term “plant-based milk” based on recognition that the term is in common use. According to the FDA, consumer surveys show that people understand that products like soy milk, oat milk, almond milk and others are, indeed, made from the labeled plant food.

Plant-based milk can be produced from a wide range of sources:

• Grains: including oats, rice, and quinoa
• Legumes: such as pea and soy
• Nuts: in addition to the more common almond, cashew, and coconut; plant-based milk is also made from hazelnuts, macadamias, peanuts, pistachios, and walnuts
• Seeds: including flax, hemp and sesame

 

The composition and nutrient content of plant-based milks varies, depending on the plant source, how it was processed, and added ingredients.

 

Rather than trying to choose the “best” or healthiest plant-based milk, a better question is which plant-based milk choices best fit in an individual’s overall diet to meet their nutrient needs?

 

1. Protein: Pea milk (and soy milk) are the two plant-based milks that provide protein comparable to dairy milk. Other plant-based milks may include additional pea protein to raise total protein content. Hemp protein is a complete protein (provides the full range of essential amino acids), but hemp milk is relatively low in protein, like oat milk.
   📌 As discussed above, start by clarifying whether protein content is an important factor for a particular individual in choosing among plant-based milk options.
2. Calcium, Vitamin D, and B12: Content depends on fortification, which varies even between brands of the same type of plant-based milk. Some plant-based milks may contain even slightly higher amounts of calcium than dairy milk. However, data on bioavailability of the calcium from these many choices does not seem to be readily available.
   📌 As noted above, consider an individual’s need for these nutrients and how well other foods are meeting those needs. In order to be useful as a reasonable replacement for dairy products, fortification with at least these three nutrients is needed in a plant-based milk.
3. Overall contributions to a healthy diet: Fortification with other nutrients noted above and content of added sugar also affect how a plant-based milk complements and fits other food choices in someone’s typical dietary pattern.
   📌 Most plant-based milks are low in saturated fat, but coconut milk is an exception; full-fat versions are high in the type of saturated fat that can raise LDL-cholesterol. If plant-based milk is used instead of, and not in addition to, dairy milk, then (as discussed above) checking for iodine fortification may be another consideration.

 

How to put research on milk and plant-based milks in perspective

One of the questions examined in the Scientific Report of the 2025 Dietary Guidelines Advisory Committee was the use of plant-based milks in a healthy dietary pattern. Previous examples of healthy dietary patterns in the US Dietary Guidelines included recommended amounts of a group labeled Dairy and Fortified Soy Alternatives. 

Could other plant-based milks be used in these patterns instead of milk and soy milk?

As discussed here, fortification plays a considerable role in determining how plant-based milk contributes to a healthy diet. This results in widely varying nutrient content among different types of plant-based milks as well as between and even within a brand of the same type.

 

Conclusions of the 2025 Dietary Guidelines Advisory Committee regarding plant-based milk in a healthy dietary pattern: 

• Because of widely varying nutrient content among different types, brands, and individual products of plant-based milks, “The direct substitution of plant-based milk alternatives for cow’s milk within the patterns may introduce unintended consequences for meeting other nutrient recommendations and may vary by product selected.” 
• Considering plant-based milks as part of a healthy dietary pattern “requires meaningful guidance on how to select plant-based milks, which are not nutritionally equivalent to cow’s milk and exhibit variability in nutrient content across products.” 
• This would also require “meaningful guidance on integration with other food groups to identify where to otherwise obtain nutrients found in cow’s milk or soy milk.”  

 

Choice of milk and plant-based milk can involve a variety of factors

In discussing questions about milk and plant-based milk, people may have other concerns influencing their choice, too. In helping people create healthy diets that fit their personal and cultural preferences, it’s important to listen for how these may apply to individual clients.

• Cost of plant-based milk is often higher than that of dairy milk, although different types of plant-based milk also vary considerably in price. Price comparisons also shift if someone is considering a specialty dairy milk (such as lactose-free or high-protein options) or organic milk (which may be double or more the cost of conventional dairy milk).
• Environmental sustainability is often highlighted in media reports. Due to production of methane by cows, greenhouse gas emissions that contribute to global warming are reportedly significantly higher for dairy milk than for plant-based milks. However, that may change in the future as farmers are testing new technology and feed changes to reduce methane production. Meanwhile, plant-based milk production, especially almond milk, has been reported as water-intensive.
• Other health concerns, such as lactose intolerance and milk allergies, may prompt some people to choose plant-based milk. Modified versions of dairy milk are available to address some issues and sometimes provide a good solution. But for some people, they can be more expensive or more difficult to access than plant-based milk.