What is the Best Milk for PKD? 

Highlights

Ask yourself these three questions to help pick your best milk option:

1️⃣ What do I like?

2️⃣ What do I use the milk for, and how much do I use on the regular?

3️⃣ What am I looking for less of, or more of from my milk nutritionally?

Resources 

Workshop: Oxalate Management for PKD 

• https://www.thepkddietitian.com/oxalatemanagementforpkd

Episode #52: Fact vs. Fiction: Stop Eating Carbs if You Have PKD

•  https://www.thepkddietitian.com/podcasts/the-pkd-dietitian-podcast/episodes/2148878925

Connect With Me

1. Follow me on Instagram @the.pkd.dietitian
2. Send me an email, ask a question, request a podcast topic: [email protected] 
3. PKD Connect Call: https://p.bttr.to/3yDTdkE  (This is the first step in working together!)

Subscribe & Review ⭐️⭐️⭐️⭐️⭐️

If you loved the episode, please take a moment to subscribe and leave a review on Apple Podcasts! Your support helps the show reach more folks in the PKD Community who know that there is more to for PKD than sit back and wait for dialysis or transplant. 🎙 Thanks for tuning in to THE PKD DIETITIAN PODCAST.

Transcript

Is there one best milk to drink for PKD health? My short answer is no, because it depends on what your goals are and what you actually like. Today, on the PKD Dietitian Podcast, we're answering that listener question, and I'm going to look at the top six milks that my clients drink, that they use, or that I frequently get questions about. Now, milk used to automatically mean, well, cow's milk.

 Nowadays, it includes dairy, non-dairy, and plant-based milk alternatives, which include those nut and oat milks. And if you have scoped out the milk fridge at your local grocery store, you very well know there are a million and one different options to choose from. So the big question is, what is the best milk for PKD health? That answer, well, it really comes down to you, what your needs are, your preferences, and how to support your kidneys.

 And yes, your kidneys, and even your bones, can kind of dictate if one type of milk, or even if a different brand of milk, would be a better option. For today's episode, I am going to look at six readily available and popular types of milk. Cow's milk, almond milk, oat milk, coconut, soy, and rice milk.

 For each, I'm going to highlight what it has more of, what it has less of, and why someone might pick each milk as their milk of choice. And by the way, when I'm talking about milk today, I am really referring to all the different types, not just dairy. So let's get into it.

 When it comes to picking a milk, there are three questions I want you to think about. First, and foremost, this is the most important question, what milk do you like? Start there. You can explore if it is helping you, possibly hurting you, or even if it's neutral, because that's always an option too.

 The next question to ask yourself is, what am I using this milk for or in? Are you straight up drinking it? Are you adding a splash to your coffee? Are you baking with it? Are you mixing up some smoothies with it? Take note of how often and how much milk you actually use. This might factor into what your best option is. I've worked with folks who came to me with food fear around their milk favorite.

 And come to find out, they literally only added a splash to their coffee. And once we zoomed out to the big picture of what their day or what their week looks like, looking at their dietary patterns, that amount of milk was not concerning at all for them. Hold that thought, we'll come back to that in a little.

 And last but not least, ask yourself, what are my goals or needs? Now what I mean by this is, when it comes to milk, are you looking for a lower or perhaps higher protein milk? Maybe you're looking for a lower carb option. Maybe you want your milk to be a good source of calcium. Do you need low potassium or phosphorus because of a restriction? Or are you lactose intolerant, possibly have an allergy, or looking for a vegan option? When you are choosing your milk, is there a goal? It's okay if you don't have a goal.

 Often I find people do. When it comes down to it, the best milk for you and your PQD health is one that you like and that meets your needs. When working with my one-on-one clients, there is a list of notice.

 If we are looking at milks and which ones they are using, here's what we scope out. Sometimes they need less and sometimes they need more. We look at how much protein it has.

 We look at carbs, calcium, vitamin D, and phosphorus, those are both nutrients, potassium, oxalates, and any added stuff like sugar or additives. So now you know what we're looking at, let's get into the six different types of milk. And all of these examples are averages, are based on about one cup, so that's eight ounces of fluid and unsweetened versions of that milk.

 First up is cow's milk, and this includes skim, 2%, full fat, all of the above. Here's what's in it. Milk is pretty darn nutritionally dense.

 It's got over 300 milligrams of calcium, a natural source of vitamin D. It does have some natural carbs in it, natural sugar, which is lactase, and it also has natural phosphorus, magnesium, and potassium. Cow's milk is also pretty rich in protein, with about eight grams per cup, and this pertains to all of them. Now here's what's not in cow's milk.

 Oxalates, pretty much zero. Also, there's no added sugar. That is unless, of course, it's a flavored milk like chocolate or strawberry, and I even saw banana flavored milk the other day.

 Cow's milk is a good choice for you if you like it. Also, if you're looking for bone building nutrients, especially calcium, it might not be a good choice for you if you have been told to limit or avoid higher potassium foods on a potassium restriction or on a phosphorus restriction. Also, use it intentionally if you are on low carb or keto.

 Almond milk is our second milk. Here's what's in it. Guys, there's not a lot in almond milk.

 The one thing it does have is oxalates, around 27 milligrams a glass. This is the highest oxalate load for any of the plant-based milks. Here's what's not in it.

 It's low protein, it is low carb, it's low calorie, and it's naturally low in phosphorus, potassium, and protein. I generally don't recommend it because of the oxalate load. That being said, if you don't have it often or if you just use a little, like in cooking or a splash in your coffee, this is doable, folks, and not an oxalate bomb.

 If the day-to-day is low or you're having some occasionally, there's likely no issue there. For sure, check in with your dietitian to look at the big picture and get a final thumbs up. When it comes to oxalates, if they stress you out or confuse you, check out my on-demand oxalate workshop.

 It will get you sorted around PKD and oxalates, and you'll get reliable resources and lists and walk away being able to manage your oxalates easily. I'll link out info for the workshop in the show notes. Number three of our milks is oat milk.

 Now, this one has seen a huge rise in popularity over the last several years. Here's what's in it. Oat milk's got moderate protein in it and moderate potassium too.

 It is one of the higher carb milks at about 15 grams a cup. It's got a little bit of fiber in it. Also, it's very common to have additives in oat milk.

 They help with the texture, and they help that it doesn't separate. Here's what's not in oat milk. It's pretty low-fat, and it's also low oxalate.

 Oat milk is a good choice for you, first off, if you like it. Also, if you're looking for low-fat, low-ox, just a little bit of protein, but it's not so much a good choice if you are doing low-carb or keto. A few years back, I was working with someone who was learning and living ketogenic therapy, and she absolutely loved oat milk lattes from Starbucks.

 Like, seriously loved them. But she had cut them out completely because she was doing ketogenic therapy and told me she really missed them. Well, guess what we did? We figured out a right way to order it.

 We figured out a good portion and how to work it into her day or her occasional fourth of week. And she went out and ordered it and loved it and was so happy. In fact, I was curious too, so I went and tried one myself.

 It wasn't bad, but oat milk lattes are not my jam. But I'm telling you this because if there's something that you absolutely love, there is a way if it is a component of your diet that you feel is on the restriction end. Next up is coconut milk.

 Now, I'm talking the beverage in a carton, not the creamy stuff in a can. In coconut milk, it's got natural sugars. Because of that, it's naturally got carbs.

 And it's the highest plant-based milk alternative when it comes to fat, about five grams. Here's what's not in it. Coconut milk is low calorie, it's low potassium, it's low in oxalates, and it's also nut-free and dairy-free.

 Here's what's not in it. Coconut milk is low calorie, low potassium, low oxalates and protein, and it's nut and dairy-free. Coconut milk is a good choice for you first, of course, if you like it.

 It's also a good choice if you're looking for a low potassium option or you have a nut allergy or a lactose intolerant and want fewer calories. The fifth milk we're going to look at is soy milk. And soy milk is naturally closest to the nutritional profile of cow's milk.

 In it, it's got about seven grams of protein, a little bit of fat. It is a rich potassium source, and it's naturally higher in a little bit of phosphorus. When it comes to oxalates, yep, soy milk has some, about 10 milligrams a cup, but this is low oxalate.

 Here's what's not in soy milk. It's lower in carbs, and it's low calorie. Soy milk is a good choice for you, of course, if you like it, if you're looking for a little protein, if you want something that is the closest naturally to milk, and it's important to have lower carbs.

 I do want to mention that there's something called phytoestrogens in soy milk. This just means that it's got plant-based estrogens. It's a natural compound, and there's been some combo around soy and polycystic liver disease or liver cyst because of the estrogen component.

 But studies have found no link between these two, an increased risk of larger cyst. In fact, they have found that the phytoestrogens like the isoflavones and other components are actually super protective. With my clients, if they choose not to have that because of the phytoestrogens, I 100% respect that choice.

 Last but not least is rice milk. Here's what's in it. Rice milk is the highest carb of all of the milks, coming in about 22 grams, and it's a little higher in calories than all the other non-dairy milks.

 Here's what's not in rice milk. Not a lot of protein, it is nut and dairy free, and it is super low in oxalates with less than one. Rice milk is a good choice for you, of course, if you like it, and if you need a milk that is lower in potassium, phosphorus, and perhaps protein.

 Now, I only really see folks who have these restrictions if they have really low kidney function and not always guaranteed with low kidney function too. If you notice, when talking about these six milks, I often said naturally low in when it came to potassium and phosphorus. These days, most plant-based milk alternatives have been fortified so that they're more nutritionally on par with cow's milk.

 I want to touch briefly on what's often added to milk alternatives through fortification and also added sugar. This is where different brands have different nutritional components, and it's always worth scoping out what yours has or different brands to see which one serves you best. When I say fortified, this just means that nutrients have been added, and the most common additions to plant-based milks are calcium and vitamin D. Multiple studies have looked at the nutritional value of milk alternatives.

 They report that about 70% of them have both added calcium and vitamin D, so a fair amount, and other common additions include vitamin A, vitamin B12, and potassium. And when you're looking at the front of a product, here's how they're going to market that fortification. They're going to say, of course, fortified, enriched, enhanced, extra, plus the nutrient levels that they add can vary from one product to another.

 Know this, just because something has been fortified, it doesn't automatically mean it is a better option for you or your PKD health. Other things worth checking on the label are how much sodium it has if there's added sugar, if phosphorus is in the ingredients list, and also the potassium amount if it's needed for you because of a restriction. I recommend always flipping a product around and checking out the nutrition label and the ingredient list.

 Marketing health promotions on the front of a package aren't very well regulated, and I see some fast and free statements and claims made frequently. And this is true for most food with a label at the grocery store, by the way. Like I mentioned, the nutrition overview for the different milks today was based on unsweetened versions of them, so no sugar had been added.

 Many plant-based milks on the market have a ton of added sugar, especially the flavored options like vanilla or chocolate. Recent data from the U.S. estimates that over 50% of plant-based milks contain added sugar, and the amount of added sugar can be up to as much as 15 grams per serving. Folks, that's like drinking four teaspoons of sugar in one cup.

 So make sure to check that yours doesn't have added sugar or that it has as little as possible. And if you aren't sure how to read a label for added sugar, check out episode 52, the one right before this, where I break it down for you in that episode and all about carbs. I'll drop that link in the show notes also.

 Plant-based milks also frequently have additives. If it says enriched or any of those other words that I mentioned to signal fortified, it's going to generally have additives, and those frequently include phosphorus additives. Other common additives are gums, lecithin, seed oils, so check the ingredients.

 And these are often added because they help with the texture of milk, and they also help to keep it from separating, keeping it more stable. If you are someone who has low kidney function, so a low GFR, and have been told to limit your phosphorus-potassium, you need to know that those are both common additives. Phosphorus as an additive, which I call fake phosphorus, because it's not naturally in the food, gets absorbed at nearly 100%.

 When you're looking at a nutrition label, you'll see the calcium, the potassium, and the other items listed for the amount. Not phosphorus, though. You've got to check the ingredients.

 So anything with P-H-O-S, that's phos, in the word means it has that fake additive. If this is you, here's a little tip. Start by looking for the original or the organic versions of the milk that you like.

 These often have not been fortified, and they have fewer additives, if any at all. There you have it. A look at six of the most common milks my clients use, or I get asked about.

 Cows, almond, soy, oat, coconut, and rice milk. Plus a nice little overview of what's in them, what's not, and who they are a good nutritional choice for. Now let's go back to those three questions.

 Think about what kind of milk you like, how much or how frequently, and if there is intention behind your choice. Meaning your milk has more of or less of something that you're looking for for your health. So if you're looking for higher protein, cow's milk and soy milk are a good choice.

 If you need low protein, coconut milk and rice milk are a good choice. If you have restriction around potassium, and by the way folks don't automatically restrict potassium, your best choice for low potassium is coconut milk beverage and rice milk. Otherwise, high potassium milks are cow's milk and soy milk.

 Regarding oxalates, you can choose any milk except for almond milk. Almond milk is high in oxalates. If you are following keto or lower carb, soy milk is a good option.

 But if you really like one of the milks, there can be a way to figure out how to add it within your goals. If you're looking for those bone building nutrients, cow's milk is the only one that naturally provides calcium and vitamin D. And if those are important for you and you prefer plant-based milk, check to see if it's been fortified and has the addition of those nutrients. There you have it folks.

 A nice look at six milks where you get to pick which one works best for you. I hope you found this episode valuable and insightful. And until the next one, happy and healthy eating.

 

DISCLAIMER: The PKD Dietitian Podcast is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.  

References

1. Borin JF, Knight J, Holmes RP, Joshi S, Goldfarb DS, Loeb S. Plant-Based Milk Alternatives and Risk Factors for Kidney Stones and Chronic Kidney Disease. https://pubmed.ncbi.nlm.nih.gov/34045136/
2. Johnson AJ, Stevenson J, Pettit J, Jasthi B, Byhre T, Harnack L. Assessing the Nutrient Content of Plant-Based Milk Alternative Products Available in the United States. https://pubmed.ncbi.nlm.nih.gov/38871080/
3. Fukagawa M, Komaba H, Miyamoto K. Source matters: from phosphorus load to bioavailability. https://pubmed.ncbi.nlm.nih.gov/21292849/
4. Cupisti A, Kalantar-Zadeh K. Management of natural and added dietary phosphorus burden in kidney disease. https://pmc.ncbi.nlm.nih.gov/articles/PMC5797670/
5. U.S. Department of Agriculture, USDA FoodData Central. Retrieved from the USDA website https://fdc.nal.usda.gov/
6. U.S. Food & Drug Administration. (n.d.). Milk and Plant‑Based Milk Alternatives: Know the Nutrient Difference. Retrieved from the FDA website https://www.fda.gov/consumers/consumer-updates/milk-and-plant-based-milk-alternatives-know-nutrient-difference
7. Redan BW, Zuklic J, Hryshko J, et al. Analysis of Eight Types of Plant-based Milk Alternatives from the United States Market for Target Minerals and Trace Elements. J Food Compost Anal. https://pmc.ncbi.nlm.nih.gov/articles/PMC10392789/