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What Is the Best Milk for People with Diabetes?

Low fat? Full fat? Plant based? Low carb? A diabetes nutrition expert reviews the research to help you decide which "milk" choice is best for your health.

little girl with milk mustacheExperts say dairy gets a bad rap but with so many "milk" options in supermarkets today, it can be confusing. The best way to compare nutrition is to read the label carefully. (Photo:123rf)

Milk is a controversial topic. From the rise of plant-based milks to the debate of low fat vs. full-fat dairy and polemic health claims of milk causing all sorts of diseases, it’s no wonder why most Americans are confused on what milk to buy. Let’s review what the research says and break down the pros and cons to help you make the best decision for your health. 

Choosing the best foods to control your blood sugar remains the hardest aspect of living with diabetes. So many options in the grocery aisle and milk is not the exception. There are numerous milk alternatives that it can be confusing to know which is best. 

The rise in popularity of plant-based milks can make it seem like those options are better than cow’s milk. “With so many options, people assume milk alternatives are always healthier options” points out Cara Schrager, a diabetes educator at Joslin Diabetes Center. However, it comes down to knowing what you’re drinking as no two kinds of milk have the exact nutrition profile.

As a diabetes educator, I often get asked this same question “What is the best milk for people with diabetes?” As with everything related to nutrition: it depends”, the answer is not as black and white as you think.

Should You Be Drinking Milk?

Drinking milk is a personal choice, according to Academy of Nutrition spokesperson and diabetes educator, Vandana Sheth. “The choice depends upon your taste preference and your unique nutritional needs. Cow’s milk is a nutritious beverage as it is high in protein, provides a good mix of key nutrients such as calcium, magnesium, potassium, riboflavin, folate, vitamin B12 and is fortified with vitamin D,” Sheth says.

The fat content may vary depending on the type of milk you select, but the vitamins remain the same.  As far as research goes, dairy is shown to play a positive role in improving bone health, reducing blood pressure, muscle building and even weight loss. Two servings of dairy, milk or cheese a day lowers the risk of heart disease, stroke according to a study published in Lancet 2018. High-quality evidence from observational and cohort studies show a positive association between total dairy intake and lower diabetes risk. 

In another study published in Clinical Nutrition Journal, researchers examined the effects of total dairy and milk intake on the risk of type 2 diabetes in the 63,000 Chinese men and women. Individuals who consumed a glass of milk a day had a 12% decreased risk of type 2 diabetes, compared to non-milk drinkers. However, as with many observational studies, we need to be cautious as they show associations and not causations. 

According to Schrager, “Diary gets a bad rep,” many people with diabetes may stay away from milk because it contains carbohydrates which raises blood sugars. One cup of milk (8oz) contains 12g of carbohydrates, originating from lactose—a natural source of carbohydrates.

“It’s important for people with diabetes to pay attention to amounts and recognize cow’s milk contains carbs.” But contrary to popular belief, cow’s milk does not have added sugars. Moreover, it’s not just about the carbs; cow’s milk is rich in protein, fat and may have a lower glycemic index than some popular milk alternatives. Schrager’s advice: “If you are looking for lower carb options you can consider ultra-filtered milk, which still provides the same nutrition as cow’s milk but is lower in carbs and can be lactose-free”.

Milk SplashYes, cows milk contains carbs but not from added sugars. It's also rich in protein and other important nutrients that some popular milk alternatives lack. (Photo:123rf)

Cheese and Yogurt and Diabetes

Yogurt, in particular, has a positive health effect on people with diabetes. Yogurt is a natural source of probiotics, which is known to positively impact the body’s gut bacteria and antioxidant levels.  A 2014 Harvard study showed that individuals who consumed one yogurt a day had a reduced risk of type 2 diabetes.

Although we still don’t know the exact mechanisms or reasons as to why foods like yogurt may lower the risk of diabetes, we know they offer plenty of health benefits because of its complex nutrition profile including protein, calcium, vitamin D, and probiotics. Some yogurts like Greek are lower in carbohydrates and higher in protein which will also impact how food is absorbed and converted into sugar, explains Schrager. One serving (6 oz) of an unsweetened plain yogurt yields just 7 grams of carbs compared to 12g of carbs in a regular unsweetened (non-Greek yogurt).

High-Fat or Low-Fat dairy?

For the longest time, we have been told to drink low-fat milk products, but recent studies have shown a potential benefit in consuming high-fat dairy products. Whole milk may not be as bad as we thought. Observational studies have either shown a positive or neutral effect in consuming full-fat dairy products and the risk of cardiovascular disease and diabetes.

Full-fat dairy contains mostly saturated fat which is associated with a higher cardiovascular risk. However, the type of saturated fat in dairy milk differs from that found in meats or other animal foods and is believed to have a heart-protective effect, according to a recent study. What about if you are overweight? Does full-fat dairy make a difference? Well according to a study in the American Journal of Clincal Nutrition, it does.

Premenopausal women who drank full-fat milk lost more weight on average those women who consumed low fat. However, results from intervention studies are inconsistent with mixed results. Some report says high-fat dairy help weight loss while others show no effect.

While we still don’t know the full answer, some possible explanations are that fat provides fullness and slows down the digestion of carbohydrates. Whole fat milk has a lower glycemic impact.

“When you remove the fat, you tend to replace it with sugar or carbohydrates which feed into insulin resistance and will be worse off,” explains Schrager.  Moreover, emerging randomized studies suggest it’s the milk fat globule membrane (MFGM) found in some dairy foods which can have a distinct effect on cardiovascular disease. 

However, this doesn’t mean to go crazy with the butter, cream, and full-fat milk. The recommendation remains to limit the amount of saturated fat to 20 grams/day. This is where individualization and seeing a registered dietitian come into play. For example, if you just consume milk and cereal in the morning, then it can be a good idea to include higher fat milk to help mitigate the rise in blood sugars and increase protein and fat in the diet,” explains Diabetes Educator Schrager. But again, everyone is different.

What to Look for In A Milk-Based Alternative

Whether you have a milk intolerance, follow a vegan lifestyle or just want to cut the carbohydrates from cow’s milk, it’s important to read the label and understand what you are getting in the milk-alternative. 

“The nutritional profile in milk alternatives is not the same," says Schrager. "You can find high sources of added sugar in many milk alternatives, and some are devoid of protein and essential nutrients which are naturally occurring in cow's milk.

Read the ultimate guide to choosing plant-based milk alternatives here.

There are many reasons why plant-based milk may be a good option for those who choose not to or are unable (for medical or ethical reasons) to have cow’s milk, explains Vandana who regularly sees individuals with diabetes in her private practice in Los Angeles and is a vegetarian herself. Nowadays there are so more plant-based beverages easily available in grocery stores “it's important to choose the correct one based upon your unique needs.”

Below is some useful advice when buying cow’s milk alternatives:

  • Look for unsweetened products to limit added sugars
  • Make sure it’s fortified with key nutrients like calcium, vitamin D.
  • Recognize the fat type and amount you are consuming
  • Look for total carbohydrates and make sure to include them in your daily meal plan

Can Full-Fat Milk Be Part of Healthy Diet?

Rather than focusing on just one nutrient, focus on yout eating patterns. Yes, cow’s milk has carbohydrates, but not from added sugars, and it also contains protein, fat, calcium, magnesium, phosphorus and vitamin D-all of which play an essential role in overall health. If you are a vegetarian or vegan or rather consume plant-based milk, that’s OK too. 

There is not one milk that is superior to others; it depends on your eating patterns and lifestyle. For example, if you choose almond milk in the morning, make sure to pair it with a protein since it doesn't contain it. If your daily breakfast is cornflakes and low-fat milk, you might benefit from higher fat milk to stabilize blood sugars.

What if you like the creamy taste of fuller fat milk? “Don’t be afraid to enjoy full-fat milk with your coffee,” says Schrager. Full fat can have a place in a healthy diet. It’s important to see the effect of food as a whole and not a sum of its parts. People don’t eat nutrients; we eat food. In the end, food is not just about nutrients; food is about taste, gatherings, satisfaction and yes health and nutrition as play a role as well.

Updated on: June 6, 2019
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