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With so many milk options available to consumers, how do you know which one is best for you and your clients? Linia Patel guides you through the various choices.

The natural diet for ruminant animals such as cattle is plain grass. Hard-to-digest grains radically alter the bacterial balance and composition in the animal’s gut

There are an increasing number of different types of milk available to consumers. Which one should you be drinking? Is organic milk the same as grass-fed milk? How does cow’s milk differ from goat’s milk or almond or coconut milk? How about the new A2 milk? This article aims to answer all these murky (or is it milky?) questions.

Cow’s milk

The most common variety of milk consumed is cow’s milk. Cow’s milk is available with a range of milk fat percentages: fat-free (skimmed), 1%, 2% (semi-skimmed) and milk where no fat has been removed (full-fat or whole). As a general rule, nutrition experts recommend low-fat milk from the age of two onwards. Within my clinical practice (depending on your nutritional goals), if you are consuming less than one pint of milk a day, I am increasingly open to the amount of fat you choose to have in your milk. For me, the quality of the milk you consume is key.

The milk you drink will only be as healthy as the cow that produced it. Surveys suggest that people associate organic milk with superior nutrition. Organic farmers must use organic fertilisers and pesticides and must not give cows preventative antibiotics or supplemental growth hormones. Studies have shown that organic milk contains at least 60% more omega-3 fatty acids than non-organic milk1. However, your choice should not stop at organic.

Grass feeding is not yet a familiar practice for all consumers. The definition of 100% grass-fed cow’s milk is milk from cows that have grazed in pasture (or eaten dry forage) all year round rather than being fed a processed diet of grains like corn and soya. Organic cows are not required to be solely grass fed; however, they must have at least 120 days per year of grazing. For the rest of the time, organic cows can be fed grains. The natural diet for ruminant animals such as cattle is plain grass. Hard-to-digest grains radically alter the bacterial balance and composition in the animal’s gut. Just as for humans, poor gut health in animals promotes disease and also radically alters the nutritional composition of the milk2.

A recent study from Couvreur et al showed that grass-fed cows produce milk with 15% more of the healthy-heart omega-3 fats and 32% more conjugated linoleic acid (CLA). CLA is a type of fatty acid that is found naturally in milk primarily from ruminants such as cows. CLA exhibits potent antioxidant activity, and some research indicates that CLA might be protective against heart disease, diabetes and cancer2.

A study from Elgersma et al also showed that grass-fed cows produce milk that is richer in micronutrients and phytochemicals than other options. In the study, the grass-fed cow’s milk contained 22.9% more vitamin B12 and 18.7% more iodine than the grain-fed cow’s milk, for example. The milk was also significantly richer in beta-carotene. Carotenoids such as beta-carotene are precursors to vitamin A that are found as pigments in plants. Cows that eat carotenoid-rich grass and forage, therefore, are able to incorporate significant amounts of these compounds in their tissue and therefore their milk1.

– Go organic
– Ask for 100% grass fed
– Consider local farmers

Milks compared per cup

Milk nutrition table, source: Nutritics professional dietary software

source: Nutritics professional dietary software

A2 Milk

Milk contains many proteins, one of which is called beta-casein. Recent nutrition surveys have shown that 20% of the UK population struggles to digest milk protein. A1 and A2 are two common forms of the milk protein beta-casein. Milk labelled as ‘A2 milk’ contains mainly the A2 type of beta-casein. The milk currently available in supermarkets and known as ‘conventional milk’ contains a mixture of A2 and A1 beta-casein (about 60% A2 and 40% A1). There is an emerging body of evidence implicating A1 beta-casein in a range of human health conditions, many of which have an auto-immune element to them (such as Type 1 diabetes, heart disease, mental health conditions, child development) 3, 4, 5 . If you have a diagnosed milk protein intolerance or have a family history of auto-immune diseases, you may want to consider A2 milk. However, one drawback is that the A2 milk currently on the market is not organic or 100% grass fed.

Goat’s milk

Goat’s milk is more easily digested by some people, as it contains smaller proteins and fat globules than those found in cow’s milk. It contains as much protein and calcium as cow’s milk and contains more tryptophan (an essential amino acid) than cow’s milk. However, goat’s milk still contains lactose, which will eliminate it as a choice for some6 . It also has a very distinct taste, which some may dislike.

Sheep’s milk

Like goat’s milk, sheep’s milk has smaller proteins and fat globules than cow’s milk, and more medium-chain triglycerides (MCTs), which aid digestion. As sheep feed 100% on grass, sheep’s milk has more CLA than the milk from cows or goats. This option also contains up to twice as much calcium and B vitamins as cow’s or goat’s milk. However, it contains the same amount of lactose as cow’s milk, so it isn’t a great alternative if you’re lactose intolerant7. One drawback of sheep’s milk is the cost. Sheep produce much less milk than cows and goats, so sheep’s milk is likely to be more expensive.

Lactose Intolerance

All milk that comes from an animal will contain some lactose sugar, so, if you are lactose intolerant, you may want to consider using a milk substitute from non-animal sources. Some examples include almond, rice and coconut milks. As the nutritional composition of these milk substitutes lacks many of the key micronutrients contained in animal milk, such as calcium or vitamin D, these milk substitutes are often fortified with nutrients to make them more marketable8.

Non-milk alternatives

Non-milk alternatives, such as almond, oat, coconut and soya milks, are now muscling in on the market hard and fast. Consumers are going nuts for plant-based alternatives and, as a result, sales of these products have soared over the last few years. Why the shift? The trend towards eating a vegan diet, an increase in ‘intolerances’ and because consumers increasingly perceive plant-based foods to be healthier than animal-based products.

Almond milk

Almond milk is a popular vegetarian alternative for those allergic to dairy or soya. Almond milk also has a naturally sweet taste. In terms of calcium content, it is comparable with cow’s milk. On the downside, despite containing only 60 calories per cup, almond milk is not a great protein source (1g per cup vs 7.9g-8g per cup in cow), and it is high in sugars. It is also not suitable for those with nut allergies and lacks the B vitamins found in cow’s milk. If you do choose almond milk as an option, go for one that is unsweetened and fortified with vitamin D8, 9.

Coconut milk

Coconut milk is one of the many options as an alternative to cow’s milk. It is lactose free and suitable for vegetarians and vegans. Coconuts are high in saturated fats but the fats come from MCTs. MCTs are fats with an unusual chemical structure that allows the body to digest them easily. These fats can be used immediately as an energy source. Coconut milk also contains a high level of potassium. The drawbacks to coconut milk are the low protein and calcium content and the high calorie count. One cup of coconut milk is approximately 450 calories, whereas a cup of whole cow’s milk is around 150 calories7, 8. If you do choose coconut milk, it is important that you consider coconut milk as a fat source rather than a protein source – and remember portion control!

Rice milk

Rice milk is another vegetarian/vegan option that is also lactose free. It is made from ground rice and so it is naturally lower in protein and calcium than cow’s milk and higher in carbohydrates. It is not recommended for children due to its low protein and calcium content8, 9. If you are choosing rice milk, choose a variety that has been fortified with calcium and protein.


While the research supports the inclusion of dairy in the diet (particularly fermented dairy) for weight management, bone health, hypertension and insulin control, it is important to remember that what suits one person may not suit the next – there are so many options. Include diary – or don’t – you can be healthy (or unhealthy) either way. The key is balance and context. If you do choose to look beyond the dairy aisle and go for plant-based milks, it is critical to look for other dietary ways to boost your protein, calcium and iodine levels.



  1. Elgersma, A. et al (2004) Quick changes to milk fat composition from cows alter transition from fresh grass to a silage diet, Animal Feed Science and Technology, 117: 1-2.
  2. Couvreur, S., et al (2006) The linear relationship between the proportion of fresh grass in the cow diet, milk fatty acid composition and butter properties, Journal of Diary Science, 89.
  3. Laugesen, M. and Elliott, R. (2003) Ischaemic heart disease, Type 1 diabetes, and cow milk A1 beta-casein, New Zealand Medical Journal, 116(1,168): U295.
  4. Haq, M.R. et al (2013) Comparative evaluation of cow β-casein variants (A1/A2) consumption on Th2-mediated inflammatory response in mouse gut, European Journal of Nutrition, Epub 2013/10/10.
  5. McLachlan, C.N. (2001) Beta-casein A1, ischaemic heart disease mortality and other illnesses, Medical Hypotheses, 56(2): 262-272.
  6. Mehaia, M. and Mohamed, A. (xxxx) Studies on goat milk proteins: Nitrogen distributions and amino acid composition, Nutrition Reports International, 39(2): 351-357.
  7. Milk Facts website (2018) Nutrient Content of Milk Varieties,, accessed 21 November 2018.
  8. The Diary Council website (2018), Milk: Nutrition information for all the family,, accessed 21 November 2018.
  9. Alpro Milk website,, accessed 21 November 2018.


To keep learning about nutrition, read about the additives in our favourite meals, here.