Should You Include Cow’s Milk in Your Diet?
Older adults need calcium and protein. Is milk still the right choice?
Decades ago, you probably urged your kids to drink milk to build strong bones and you practiced what you preached, putting real milk in your cereal and coffee.
Today, though, the beverage isn't as popular as it once was: Almost 4 billion fewer pounds of cow's milk were sold in the U.S. in 2016 than in 1976, according to United States Department of Agriculture data, even though the U.S. population increased by 105 million people during those years.
What's in your fridge may be a sign of the times: There are significantly more "milk" choices available, compared with 40 years ago. You may stock the fridge with non-dairy almond or soy milk. If you still buy cow's milk, you might opt for lactose-free.
Some older adults wonder if they need milk anymore. Experts note that cow's milk — which is rich in protein, calcium, vitamins and minerals — can be a beneficial part of an older adult's diet, but some non-dairy milk products are also healthy options.
"No single food or beverage will make or break your diet," says Angel Planells, a Seattle-based registered dietitian nutritionist and spokesperson for the Academy of Nutrition and Dietetics. "Whether young or old, it is important to remember that we consume foods and/or beverages that are nutritionally adequate in calcium and vitamin D, which can be met with a dairy or non-dairy product."
If you're deciding between cow's milk or non-dairy substitutes, consider this:
A 2011 study from Switzerland found that cow's milk didn't have protective effects against hip fractures among older women (more data were needed for men). And a 2014 Swedish study found that hip fracture risk and mortality was higher in older women who drank three or more glasses of milk per day, though researchers urged a "cautious interpretation of the results."
"My concern about this finding is that very few adults — especially older adults — consume greater than three cups of milk per day," says Sue Shapses, a registered dietitian and nutritional sciences professor at Rutgers University. "It is always good to consider whether a study was done in this country, because other populations often have different dietary practices."
A 2018 study from Harvard researchers found that American men and women who drank one glass of milk daily decreased their risk of hip fracture by 8 percent.
The bottom line: research doesn't provide conclusive answers, and some of the results are counterintuitive.
"If older adults are happy with drinking milk, there is no reason to stop for the lack of protection from fractures," says Vasanti Malik, a nutrition researcher at the Harvard School of Public Health, "but there is also no reason to encourage milk consumption among those that do not typically consume milk."
Cow's milk is protein-rich. If you switch to non-dairy, you may not get enough protein in your diet.
"Almond milk and rice milk generally have low amounts of protein," says Nurgul Fitzgerald, a registered dietitian and associate professor of nutritional sciences at Rutgers University. "Because some older individuals have difficulty in consuming enough protein, these may not be very good options for them."
Most non-dairy milk can't compare with the protein content in cow's milk.
"You don't get as much protein per unit intake for a vegetable as you do for a milk or meat source," says National Osteoporosis Foundation trustee Joan Lappe, a registered dietitian and professor of nursing at Creighton University's College of Nursing. "If you compared a glass of soy milk to a glass of cow's milk, you are going to get more with the cow's milk."
Cow's milk is rich in calcium, which is appealing if you're concerned about osteoporosis.
"Older adults require more calcium and vitamin D to help maintain their bone health as they age," Planells says. "Many older adults will automatically reach for a glass of milk or some cheese when they are told they need more calcium and vitamin D."
Many non-dairy milks contain calcium, too, but they're fortified, which means that the calcium is added to the beverage. Be sure to shake non-dairy milk before pouring.
"You really have to mix them well or you may not get the calcium," Lappe says. "One of my colleagues did a study — he put a container of almond milk in a paint-can shaker to make sure that the calcium at the bottom would have been mixed up. When he dumped out the milk, there was still a layer of calcium at the bottom."
Some non-dairy milks contain sugar to make the flavor appealing.
"The sugar in milk is lactose, which is naturally present in the beverage," Planells says. "If you see 'added sugar,' this means the manufacturer added some type of sweetener to sweeten the beverage."
These empty calories can lead to weight gain and health complications.
"Older adults who might be at risk for, or may have, type 2 diabetes should watch out for the added sugars in these 'milk' drinks and choose the unsweetened varieties, so that they can adjust their medication use accordingly and prevent packing extra calories," Fitzgerald says.
Some adults have trouble digesting lactose, a sugar that's naturally found in cow's milk. You can become lactose intolerant as you get older, but this doesn't mean that you have to stop drinking milk.
"If lactose digestion is a problem, then lactose-free milk or soy milk can be good substitutes," Fitzgerald says. "Soy milk is low in saturated fat and still is a good source of protein."
Saturated fat has earned a bad reputation, because too much may raise cholesterol levels or increase heart disease risk. Milk contains saturated fat, but the low-fat and skim varieties contain very little or none.
"Milk also has beneficial vitamins and minerals, which may lessen the potential negative impact," Fitzgerald says.
Coconut milk also contains saturated fat and it doesn't have the health benefits that cow's milk does.
"Coconut milk is usually high in calories and saturated fat, and unless it is fortified, it is not a rich source of vitamins and minerals," Fitzgerald says. "It would not be the best choice for older adults."