Keto and the Menstrual Cycle: Is There Reason To Worry?

It seems every “keto for women” forum abounds with stories about menstrual cycles gone wild in the first few months of keto. Irregular cycles, breakthrough bleeding, and periods lasting much longer than normal are common complaints. Sometimes these stories are cited as evidence that keto isn’t good for women, at least not premenopausal women, and that we need carbs for healthy hormones. Yet, many women don’t notice any changes in their menstrual cycles at all, while others report improvement in PMS symptoms and cycle regularity from the get-go.

What gives? Why do some women’s cycles apparently become wacky when they start keto, while others feel like keto is the key to period bliss? Can keto “mess up” the menstrual cycle?

We know that diet—what and how much we eat—can profoundly affect our hormones. This is true for both women and men. One of the reasons people are so excited about ketogenic diets is specifically because keto shows promise for helping to regulate hormones and improve cellular sensitivity to hormones such as insulin and leptin.

At the same time, women’s hormones are especially sensitive not only to dietary changes but also to downstream effects such as body fat loss. Furthermore, one of the ways women’s bodies respond to stressors is by turning down the dial on our reproductive systems. It’s reasonable to hypothesize, then, that women might have a tougher time adapting to or sustaining a ketogenic diet. Keto can be stressful depending on one’s approach, and that might negatively impact women’s reproductive health. But do the data actually bear that out, or is so-called “keto period” more misplaced hype than genuine fact?

Note that throughout this post, I’m going to use the term “reproductive health” to refer to all aspects of women’s menstrual cycle, reproductive hormones, and fertility. Even if you aren’t interested in reproducing right now, your body’s willingness to reproduce is an important indicator of overall health. When your reproductive health goes awry—irregular or absent periods (amenorrhea) or hormone imbalances—that’s a big red flag. Of course, post-menopausal women can also experience hormone imbalances that affect their health and quality of life (and low-carb and keto diets can be a great option for them).

Menstrual Cycle 101

Let’s briefly review what constitutes a normal, healthy menstrual cycle, understanding that everybody’s “normal” will be a little different. A typical cycle lasts from 21 to 24 days on the short end to 31 to 35 days on the long end, with 28 days being the median. Day 1 is the first day of your period and begins the follicular phase, which lasts until ovulation. Just before ovulation, levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (a form of estrogen) spike. Next comes the luteal phase covering the approximately 14 days from ovulation to menses. LH, FSH, and estradiol drop, while progesterone rises. Estradiol bumps up again in the middle of the luteal phase. If a fertilized egg is not implanted, menstruation commences, and the whole cycles starts over again. All this is regulated by a complex communication network under the hypothalamic–pituitary–gonadal (HPG) axis, which is closely tied to the actions of the adrenal (the A in HPA axis) and thyroid glands.

Across the cycle, fluctuations in body weight are common as fluid is retained and then released along with shifts in estrogen and progesterone. Changes in blood glucose are also normal, and insulin-dependent diabetics often find that they need to adjust their dose at different times of their cycles to keep their blood sugar in check. The most common pattern is higher blood glucose readings in the pre-menstrual period (the second half of the luteal phase), and lower readings after starting your period and before ovulation. This is generally attributed to the fact that progesterone, which is highest during the luteal phase, is known to reduce insulin sensitivity. However, different women experience different patterns, which can also be affected by other factors such as oral contraceptive use.

Normal fluctuations in insulin resistance and blood glucose can mean that women get lower ketone readings at certain times of the month than others. When these occur premenstrually—and so they tend to coincide with a period of (transient) weight gain and food/carbohydrate cravings—women often feel as though they are doing something wrong. Rest assured that these variations reflect normal physiology.

The many factors that affect your cycle and the levels of your sex hormones include: other hormones, gut health and microbiome, metabolic health (e.g., insulin sensitivity), environmental toxins, stress, sleep, immune health, nutrient deficiencies, activity level and energy expenditure, and age. Each affects the others, and all (except age of course) can be affected by diet. It’s no surprise, then, that it can be extremely difficult to pin down a root cause of menstrual changes or reproductive issues.

What the Research Tells Us About Keto and Menstruation

As I said at the outset, there are lots of anecdotes, both positive and negative. In my experience, most women whose cycles seem to go crazy when they start keto find that things get back to normal—and often a better version of normal—after a few months.

First, it’s tricky to determine the effects of keto per se, since many people combine a ketogenic diet with calorie restriction (intentionally to lose weight or unintentionally due to the appetite suppressing effects of keto) and with fasting (intermittent and/or extended). Each of these can independently impact the factors listed above, lead to weight loss, and affect the menstrual cycle and reproductive health.

So, is there any evidence that keto itself causes changes to menstruation?

The scientific evidence is scant….

The one statistic you’ll see floating around the interwebs is “45% of (adolescent) females experience irregular menstrual cycles on keto.” This statistic comes from one small study of adolescent girls using a therapeutic ketogenic diet to treat epilepsy. Six of the twenty girls reported amenorrhea (loss of period) and three were diagnosed with delayed puberty. However, the ketogenic diet used for epilepsy is different and usually much stricter than an “everyday” keto diet needs to be, and epilepsy is frequently associated with menstrual dysfunction regardless of diet.

To extrapolate the findings of this study and argue that nearly half of teenage girls (or women generally) are likely to experience menstrual problems from going keto is a huge leap.

The fact is, I’m unable to find any studies done in healthy human females (or mice for that matter) demonstrating that otherwise normal menstrual cycles are disturbed by going keto.

5 Ways Keto-Related Factors *Might* Affect Your Menstrual Cycle

With the limited amount of research looking directly at keto and menstruation, let’s look first at whether there are direct effects of carbohydrate restriction or elevated ketone production on the menstrual cycle. Those are the defining characteristics of keto and what differentiates keto from other ways of eating. Then we can examine indirect effects that occur due to factors such as weight loss. These are not unique to keto, though they might be more likely on a ketogenic diet compared to other ways of eating.

Carbohydrate Restriction

There is no real body of evidence that looks at ketogenic levels of carb restriction and menstruation, but there are some clues. In this small study, functional hypothalamic amenorrhea (FHA) was associated with dietary fat restriction; women with FHA actually ate non-significantly more carbs than matched controls and nearly identical total calories. Likewise, in this small study, FHA was associated with lower fat intake but no significant difference in carb intake.

This meta-analysis looked at the effect of low-carb (not keto) diets on markers of reproductive health among overweight women. The researchers found four studies that examined effects on menstruation; all showed improved menstrual regularity and/or ovulation rates. Of six studies that looked at levels of reproductive hormones, five reported significant improvements.

Carb restriction also results in decreased insulin production. Hyperinsulinemia and insulin resistance are frequently associated with polycystic ovarian syndrome (PCOS), one of the leading causes of female infertility and a frequent cause of menstrual irregularity. There is currently a lot of interest in using keto to treat PCOS, but only one small study has so far directly tested the effectiveness of a ketogenic diet to treat PCOS, with positive results.

Ketones

No studies have looked at the direct effects of ketones on menstruation.

Weight Loss

Of course weight loss is not unique to keto, but keto can be very effective for weight loss. Some women experience rapid weight loss when first starting a keto diet. Weight loss in and of itself can impact menstruation through a variety of pathways (and, of course, keto isn’t the only way people lose weight). A key way is by reducing the hormone leptin. Leptin’s main job is to communicate energy availability to the hypothalamus—high levels of leptin tell the hypothalamus that we have enough energy on board, which also means we can reproduce. Low leptin can disrupt the menstrual cycle and is linked to hypothalamic amenorrhea.

Body fat loss can also affect estrogen levels since estrogen is both stored and produced in adipocytes (fat cells). While fat loss in the long term will decrease estrogen production, it is possible that rapid fat loss might temporarily raise estrogen levels and can also affect estrogen-progesterone balance. These transient changes in estrogen levels might underlie some of the menstrual irregularities women report.

Stress

Stress can impact the menstrual cycle in myriad ways. Cortisol acts on the hypothalamus and pituitary glands, affecting hormone levels, sleep, immune function, and gut health, to name a few. Diets can be a source of stress, both at the physiological and psychological levels. Keto has a reputation for being especially stressful because it is more restrictive than other low-carb diets, but this can be mitigated by following the Keto Reset tips for women.

Thyroid Function

Thyroid dysregulation is another common cause of menstrual irregularities, and there remains a pervasive belief that keto is bad for thyroid health. Indeed, the thyroid is sensitive to nutrient deficiencies and caloric restriction, and thyroid hormones, especially T3, do frequently decline on keto. However, as Mark has discussed in a previous post, changes in T3 levels might not be a problem, especially in the absence of other problematic symptoms. Moreover, many practitioners now use keto as a cornerstone in their treatment of thyroid disorders.

What Should I Take From These Findings?

The first takeaway: there just isn’t much direct evidence about how keto might affect your menstrual cycle, positively or negatively. We have some studies suggesting that low-carb diets improve some aspects of menstruation and reproductive health, but keto is more than just another low-carb diet. Ketones themselves have important physiological properties, such as being directly anti-inflammatory, which might positively impact women’s reproductive health.

Second, the ways that keto is likely to (negatively) affect menstruation aren’t unique to keto, they’re common to any diet: hormone shifts mediated by energy balance, stress, and weight loss.

Furthermore, since keto is so often combined with caloric restriction, time-restricted eating, and fasting, even the anecdotal evidence might not be able to tell us all that much. If a woman is eating ketogenically, in a big caloric deficit, and doing OMAD (one meal a day), and her leptin plummets, how are we to know what really caused it? We don’t have good evidence that otherwise healthy women start a well-executed ketogenic diet and end up messing up their menstrual cycles.

That said, women do need to be cognizant of the sum total of the signals they are sending their bodies when it comes to energy availability and stress. A lot of women come to the keto diet with a history of adrenal, thyroid, metabolic, and reproductive issues. It’s important that they’re extra careful about how they approach keto. Done correctly, it might be just what the doctor ordered. I encourage any woman who’s dealing with other hormonal issues to work with a medical practitioner to tailor a keto diet to her unique needs.

But I’m Telling You, Keto Made My Period Go Haywire!

Ok, I believe you, really! But changes do not necessarily equal dysfunction. It is normal to experience hormone fluctuations when you make a massive—or even a relatively small but important—shift in your nutrition. Sometimes those fluctuations are unpleasant or unwanted, such as a period that lasts 14 days or one that arrives a week before you planned while you’re on vacation. However, that doesn’t make them bad from a health perspective. We need to respect that our bodies are dynamic systems. Changing the input will invariably change the output, and the system might need a few months to adapt to a new normal.

If your cycle goes wonky but you’re otherwise feeling good, give it a few months to sort itself out. If after a few months it’s still all over the place (or definitely if you’re having other disruptive symptoms), enlist help. In the meantime, check to make sure you’re not short-changing yourself nutritionally or calorically. Scale back on fasting efforts, and consider shifting more toward a traditional Primal way of eating.

At the end of the day, if you go keto and experience negative effects, stop. Keto is super hyped right now, but if your body is sending you clear signals that keto is not a good approach for you at this time, don’t do it. You can always try again later. It might be that your first attempt at keto didn’t work, but with a few adjustments and some experimentation over time you can find a version of keto that works for you.

Thanks for reading, everyone. Do you have comments, questions, or feedback? Let me know below.

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References:

Comninos AN, Jayasena CN, Dhillo WS. The relationship between gut and adipose hormones, and reproduction. Human Reproduction Update 2014; 20(2): 153–174.

Fontana R, Della Torre S. The Deep Correlation between Energy Metabolism and Reproduction: A View on the Effects of Nutrition for Women Fertility. Nutrients. 2016;8(2):87.

Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obesity Reviews 2007;8(1):21-34.

Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women’s health. J Endocrinol Invest. 2014;37(11):1049–1056.  

Tena-Sempere M. Roles of Ghrelin and Leptin in the Control of Reproductive Function. Neuroendocrinology 2007;86:229-241.

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What’s the Pegan Diet? (And How Does It Compare To Primal?)

Because people don’t have enough diets to choose from already, there’s a new one on the scene: the Pegan diet. Actually it’s not that new—Dr. Mark Hyman started writing about it back in 2014, but it’s gained traction since he published his latest book last year, Food: What the Heck Should I Eat?

According to Hyman, Pegan is a somewhat tongue-in-cheek play on the fact that it’s not quite Paleo and it’s not really vegan, hence Pegan. It claims to combine the best of both diets, namely a focus on eating lots of vegetables, as well as an emphasis on sustainable agriculture and ethical and ecologically sound animal farming.

Setting aside the obvious issue that it’s 100% possible to be a vegan who eats few to no vegetables, or to be a paleo dieter who cares naught about the environment, Pegan is touted as being easier to stick to than either vegan or paleo (presumably because Pegan allows for consumption of foods not allowed on either). Frankly, trying to frame it as a bridge between the two hasn’t proved to be a seamless, happy compromise based on social media conversation, but that’s probably of little surprise to anyone here.

I’ve had some readers ask me about the merits of Pegan and whether it offers any particular advantages over paleo/Primal, and I’m taking up that question today. (Note that I’m only focusing on the Pegan diet proposed by Dr. Hyman, not the “Pegan 365” diet offered by Dr. Oz. The latter isn’t paleo at all, allowing whole grain bread and pasta, corn, tofu, and a weekly “cheat day.” You can imagine my response to this version.)

Defining the Pegan Diet

These are the basic tenets of the Pegan diet in a nutshell:

Focus on sourcing high-quality food – Prioritize organically grown and pesticide-free produce as well as meat, eggs, and fats from pasture-raised and grass-fed animals and finally sustainably harvested seafood. Choose seafood with the lowest possible mercury content. Buy local when you can. Avoid CAFO meats and foods containing chemical additives.

Eliminate processed modern food-like substances and franken-fats – Processed carbohydrates have a high glycemic load and lead to excessive insulin production. Refined vegetable and seed oils such as canola and sunflower are pro-inflammatory. Avoid all such products.

Go gluten-free – Even if you don’t have celiac disease or an obvious gluten sensitivity, modern wheat is still a frankenfood, and gluten can damage the gut. Occasional consumption of heirloom wheat (e.g., einkorn) is ok if you tolerate it.

Go dairy-free – Dairy is problematic for most people and is best avoided. If you do decide to include some dairy, consider choosing goat and sheep milk products instead of cow. Grass-fed butter and ghee are acceptable.

Make vegetables the centerpiece of your diet – Vegetables (mostly non-starchy) should comprise 75% of your diet.

Enjoy healthy fats – Focus on omega-3s, as from small, oily fish. Eat plenty of healthy fats from grass-fed and pastured meats and whole eggs, nuts and seeds, avocados, and coconut products. Use olive oil, avocado oil, and coconut oil for cooking.

Eat meat sparingly – Dr. Hyman uses the term “condi-meat” to emphasize that meat should be a side dish, not the focus of the meal. He recommends no more than 4 – 6 ounces of meat per meal.

Include gluten-free grains and legumes in small quantities – You may eat ½ cup of gluten-free grains like amaranth or quinoa, plus ½ – 1 cup of legumes (preferably lentils) per day. If you are insulin resistant, you should limit these or refrain altogether.

Limit sugar – Avoid refined sugar and conventional “treats.” The bulk of your vegetable intake should be from non-starchy varieties, and opt for low-glycemic fruit. Natural sweeteners like honey should be used only sparingly for the occasional treat.

How Does Pegan Compare to Primal?

If you’re reading this and thinking, “Gee, Mark, this sounds an awful lot like the Primal diet,” I agree. While there are some differences between Pegan and Primal, they aren’t particularly dramatic:

Primal allows full-fat dairy consumption. Pegan discourages but doesn’t outright ban dairy.

I don’t actively encourage people to consume gluten-free grains and legumes, but I’m not as strongly opposed to them as others are in the ancestral community. I’ve said before that I consider quinoa, amaranth, wild rice, and legumes to be moderation foods (when well-tolerated, which is more an individual thing). They deliver pretty substantial carb hits relative to their nutritional value, but they certainly aren’t the worst options out there. I don’t think they should be dietary staples by any stretch—and daily consumption is too much in my opinion—but if Primal folks want to eat them occasionally, I’ve seen it work for people.

The biggest difference is in regard to protein. The Pegan diet explicitly limits protein consumption, while the Primal Blueprint recommends moderate protein consumption tailored to your activity levels, goals, age, and medical needs. On the surface, this might seem like a substantial difference, it’s probably not very disparate in practice. If a Pegan eats 3 eggs for breakfast, a large salad with 4 ounces of sardines at lunch, and 4 ounces of skin-on chicken thigh at dinner, that gets him or her to about 70 grams of protein, not counting the (admittedly incomplete) plant protein from the salad and any additional veggies included with breakfast and dinner, plus nuts and seeds. That’s within the realm of Primal guidelines, albeit less than I’d recommend for some populations.

That said, if Pegans are taking the whole “treat meat as a condiment” mantra to heart, they are probably at greater risk of underconsuming protein compared to the average Primal eater. This could present a problem for athletes and older folks looking to preserve lean mass. Likewise it is surely harder to get enough protein while also practicing time-restricted eating—and perhaps only eat one or two meals per day—and trying to follow Pegan guidelines. That isn’t a knock against Pegan per se, just a cautionary note.

Finally, while we’re on the subject of protein, I must object to Dr. Hyman’s appeal to environmentalism as a reason to limit meat consumption. I’m not at all convinced that raising livestock taxes the environment more than monocropping acres and acres of corn and soybeans.

In my opinion, Pegan could simply be called “vegetable-centric Paleo with permission to eat small amounts of quinoa and lentils if it suits you.” That isn’t catchy, though, so Pegan it is.

That said, I appreciate how Dr. Hyman for his version of the Pegan Diet emphasizes that there is no single diet that is exactly right for each individual and, like me, he advocates for self-experimentation. Dr. Hyman also speaks out against diet dogmatism and encourages his followers to focus on big-picture health. These are obviously messages I can get behind.

The Bottom Line

I’m a fan of anything that gets people thinking about food quality instead of just robotically tracking macronutrient intake and/or plugging calories into a magic weight-loss formula. Supporting sustainable agricultural practices, eating locally and seasonally, and avoiding environmental pollutants have always been part of the Primal Blueprint recommendations. In short, there is a lot I like about the Pegan diet.

However, I don’t agree that the Pegan diet is necessarily easier to implement than vegan or Paleo, which is supposed to be one of its big draws. If you’re a vegan who gets by on bagels, pasta, and Oreos, or a Paleo person who dutifully eschew grains but relies on the myriad processed, packaged Paleo food options, Pegan is not going to be easier. Changing your diet to focus on carefully sourced “real food” is still going to be a massive shift. It’s going to be much more expensive and time consuming to prepare your meals, and it will probably be incredibly burdensome at the beginning.

Sure, being able to include a small serving of gluten-free grains and legumes might make life a little easier for Paleo folks… but how much really? (For this reason I’d be skeptical if you’re considering using the Pegan diet to lose weight.) Are a lot of Paleo folks really falling off the wagon because they are feeling deprived of ½ cup of lentils? Dr. Hyman has said that his issue with Paleo is “some use the paleo philosophy as an excuse to eat too much meat and too few plant-based foods.” I’m not really seeing this pervasively in the Paleo/ancestral community, to be honest (intentional carnivore dieters notwithstanding). This strikes me as an attempt to solve a problem that didn’t need solving.

Truthfully, the things I like about Pegan are all the ways in which it is similar to Primal, which are many. Both Primal and Pegan have vegetables as the base of their food pyramids. They similarly emphasize the importance of choosing healthy fats and oils, avoiding grains and processed modern junk foods, and moderating carbohydrate intake (which Dr. Hyman frames as maintaining low glycemic load, but the effect is the same). Still, for many people the tighter Primal guidelines around carbs are probably better suited for weight loss and even weight maintenance.

Most days, if you were a fly on the wall in my kitchen, you’d see me eat a big-ass salad for lunch and a piece of meat with several types of vegetables on the side for dinner, and you wouldn’t be able to discern if I was Primal or Pegan. Then again, those nights when I tear into a giant steak would you most certainly be able to tell… and, trust me, I’m not giving those up any time soon.

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Ultimate Guide to Non-Dairy Milks

Some people just don’t do milk.

There are many reasons why. Maybe you have a dairy intolerance. Maybe you don’t like the way cow’s milk tastes. Or maybe you think cow milk is unhealthy.

I won’t contest the reasons why. That’s another topic for another post, and I’ve already covered the most common anti-dairy arguments. If you want to read about my stance on the healthfulness (or lack thereof) of dairy, read what I’ve written about raw milk, cheese, yogurt, and dairy in general. If you want to learn how to identify dairy intolerance, read this.

But the fact is, lots of people either need or want a milk alternative. Water is great to drink, but it’s not the right smoothie substrate, and it can’t replace milk in recipes or coffee drinks. You need something vaguely white and thick enough to pass as milk.

Normally in a post like this, I’d cover all the different varieties and what sets each apart—their strengths and weaknesses, their nutrient profiles, their unhealthy ingredients. And I’ll certainly do that today, but first there’s good news and bad news.

The good news is that there are plenty of good choices available. If you want something to drink, use in smoothies, or add to coffee, there are many different plant-based milk that avoid overly offensive ingredients.

The bad news is that most non-dairy milks are usually very low in nutrients. The parent food to these plant-based milks—the almonds, the cashews, the hemp seeds, and so on—are extremely nutrient-dense in and of themselves. Just check out my posts on nuts and seeds to get the nutritional lay of the land. But almond milk isn’t almonds, cashew milk isn’t cashews, and hemp seed milk isn’t hemp seeds.

This isn’t surprising when you think about how nut milks are made: by blending the nuts with a bunch of water and straining out the solids to try to extract some of the nut-ness. It’s pretty inefficient. If you could press an almond to wring out the almond milk, then you’d have something interesting. But that’s not how it works. Most non-dairy milks are superficial mirages of the real thing.

To illustrate this, let’s look at the most popular non-dairy milks and compare the nutrients in the parent nut/seed/plant to the nutrients in the nut/seed/plant-milk (when applicable).

Nutrient Profiles Of Popular Non-Dairy Milks

Almond Milk

This is the go-to option for most strict paleo eaters starting out. It sounds like a great idea. Almonds are a nutritious nut, high in magnesium, copper, vitamin E, and manganese. They have a decent amount of protein, some nice prebiotic fiber. In your head, almond milk is fantastic. Unfortunately—and this goes for most of the other nut milks out there—the average jug of store-bought almond milk contains no more than a handful of almonds.

In an ounce of almonds:

  • 163 calories
  • 6 g carbs: 3.5 g fiber
  • 14 g fat: 8.8 g MUFA, 3.4 g linoleic acid (LA), 1.1 g SFA
  • 6 g protein
  • 50% vitamin E
  • 22% vitamin B2
  • 31% copper
  • 18% magnesium
  • 28% manganese

In a cup of almond milk:

  • 36 calories
  • 1.4 g carbs
  • 2.6 g fat: 1.7 g MUFA, 0.6 g linoleic acid
  • 1.4 g protein
  • 45% vitamin E (added)
  • 17% vitamin A (added)
  • 25% vitamin D2 (added)
  • 4% magnesium
  • 4% manganese
  • 39% calcium (added)
  • 8% copper

Not great carry over. No prebiotic almond fiber. Almost no protein, magnesium, manganese, or copper. The richest nutrients are all the ones they added after the fact.

Cashew Milk

Cashew milk is in the same boat: mostly water, not too much cashew.

In an ounce of cashews:

  • 156.8 calories
  • 8.6 g carbs: 0.9 g fiber
  • 12.4 g fat: 6.7 g MUFA, 2.2 g LA, 2.2 g SFA
  • 5.2 g protein
  • 10% vitamin B1 (thiamine)
  • 69% copper
  • 24% iron
  • 20% magnesium
  • 20% manganese
  • 15% zinc

In a cup of cashew milk:

  • 25 calories
  • 1.4 g carbs: 0.2 g fiber
  • 2 g fat: 1.1 g MUFA, 0.4 g linoleic acid
  • 0.8 g protein
  • 2% vitamin B1
  • 11% copper
  • 4% iron
  • 3% magnesium
  • 3% manganese
  • 2% zinc
  • 17% vitamin A (added)
  • 25% vitamin D2 (added)
  • 18% vitamin E (added)
  • 37% calcium (added)

Coconut Milk

Traditionally, you make coconut milk by pulverizing fresh coconut flesh, blending it with a little water, and passing it through a cheesecloth or fine strainer. This produces a very rich, very high-fat milk that runs about 550 calories per cup. This is the coconut milk used in cooking that comes in cans and cartons. A second pass with the coconut solids produces a thinner, less-rich coconut milk that runs about 150 calories per cup. This is often called “Lite Coconut Milk” and can be used to cook or to drink.

Besides the abundance of medium chain triglycerides and a lot of manganese, neither thick or thin coconut milk are nutrient-dense. A cup of rich, full-fat coconut milk gives decent amounts of magnesium, copper, zinc, selenium, and iron, but you have to realize that it takes 600 calories to get those nutrients. That’s not exactly nutrient-dense; the micronutrient-to-calorie ratio is skewed.

They do sell jugs of thin coconut milk as a milk replacement. Except for the fortifications they add (vitamin D, calcium, riboflavin, and the other usual suspects), these are

Flax Milk

In an ounce of flaxseed:

  • 151.4 calories
  • 8.2 g carbs: 7.7 g fiber
  • 12 g fat: 2.1 g MUFA, 6.5 g ALA (omega-3), 1.7 g LA, 1 g SFA
  • 5.2 g protein
  • 39% vitamin B1 (thiamine)
  • 38% copper
  • 20% iron
  • 26% magnesium
  • 31% manganese
  • 13% selenium
  • 11% zinc

In a cup of flax milk:

  • 25 calories
  • 1 g carbs
  • 2.5 g fat: 1.2 g ALA (omega-3)
  • 5% iron
  • 63% B12 (added)
  • 25% vitamin D2 (added)
  • 17% vitamin A (added)
  • 25% calcium (added)

The main standout is the omega-3 content. Flax milk has a little over a gram of alpha-linolenic acid (the plant form of omega-3) per cup.

Hemp Milk

I’m not talking about the oncoming wave of high-THC cannabis milks. This is hemp milk, produced by blending non-psychoactive hemp seeds with water and straining the solids out.

In an ounce:

  • 149.1 calories
  • 7.8 carbs: 7.8 g fiber (all fiber)
  • 10.1 g fat: 1.1 g MUFA, 2.2 g ALA, 4.8 g LA, 0.8 g SFA
  • 7 g protein
  • 24% vitamin A
  • 63% copper
  • 50% iron
  • 33% magnesium
  • 86% manganese
  • 13% selenium
  • 18% zinc

In a cup of hemp milk:

  • 70 calories
  • 2.2 g carbs, all fiber
  • 6 g fat, 1 g ALA (omega-3), 3 g omega-6
  • 2 g protein
  • 18% copper
  • 13% iron
  • 10% magnesium
  • 24% manganese
  • Plus all the usual fortifications (calcium, vitamin D, vitamin A, riboflavin, vitamin B12

That’s not too bad, actually. It picks up some decent mineral levels, and hemp fat is one of the only fats to contain stearidonic acid, an intermediate omega-3 fat in the conversion pathway from ALA to EPA that increases the EPA content of red blood cells in humans (a very good thing).

Macadamia Milk

There’s a product called Milkadamia. Great name, disappointing result.

In an ounce:

  • 203.5 calories
  • 3.9 g carbs: 2.4 g fiber
  • 21.5 g fat: 16.7 g MUFA, 0.4 g LA, 0.1 g alpha linolenic acid (ALA), 3.4 g SFA
  • 2.2 g protein
  • 28% vitamin B1 (thiamine)
  • 24% copper
  • 13% iron
  • 51% manganese

In a cup of mac nut milk:

  • 50 calories
  • 1 g carbs
  • 5 g fat
  • 1 g protein
  • 125% vitamin B12
  • 17% vitamin D
  • 25% vitamin A
  • 38% calcium

Despite having the best product name and the most potential for being a creamy milk substitute (has anyone tried adding mac nuts to a smoothie?—incredible!), the nutrient profile is low, and there’s not much going on.

Oat Milk

I’ve written about oats before. They have some interesting properties, some beneficial fiber, and a decent mineral profile. Adding oat beta-glucan fibers to fiber-free instant oatmeal reduces the postprandial glucose response, so at least in the context of refined starch, oat fiber can be helpful.

The most popular and widely-available oat milk is called Oatly. The website explains the process: mill raw oats with water, add enzymes to extract the starch, separate the beta-glucan from the bran, discard the bran, pasteurize it, bottle it. This retains the beta-glucans (2 grams of fiber per cup) and starch (16 grams carbs per cup). The only micronutrients they advertise are the ones they add, including calcium, potassium, vitamin A, riboflavin, vitamin D, and vitamin B12; there’s no indication that the normal oat-bound minerals like magnesium, manganese, and zinc make it into Oatly in significant amounts. To top things off, they add canola oil for texture and mouthfeel.

Rice Milk

Rice milk is made by blending water with cooked rice, brown rice syrup, and brown rice starch.

Like the others, its only real micronutrients comes from the ones they add to it. It’s higher in carbohydrates than any of the other milks I found.

Soy Milk

Believe it or not, of all the popular non-dairy milks out there, soy milk contains the most nutrients and is probably the closest to cow milk. It’s high in protein. It contains a nice balanced selection of minerals. A review comparing soy milk, coconut milk, almond milk, and rice milk to cow milk found that soy milk was the closest—mostly because it actually featured measurable nutrients.

In a cup of soy milk:

  • 74 calories
  • 3.6 g carbs; 2 g fiber
  • 4 g fat
  • 8 g protein
  • All the usual additions, like calcium, vitamin B12, vitamin D, riboflavin, and vitamin A
  • 10% magnesium
  • 15% manganese
  • 6% folate
  • 6% potassium
  • 19% copper
  • 10% selenium

It’s not ideal though. People who regularly drink soy milk tend to end up with micronutrient deficiencies. Kids who drink cow milk are less likely to have atopic eczema, while soy milk drinkers have no such protection (and may even have increased risk). The protein in soy milk can help people build muscle, but milk proteins work better and also provide other benefits to the immune system.

I’m not saying you shouldn’t use non-dairy milks. They are inoffensive and helpful for recipes. Just don’t expect any incredible health benefits from them.

3 Notable Brands With Extra Benefits

But there are a few specific non-dairy milk products that deserve a closer look, especially if you’re going to go this route.

Vita Coco Coconut Milk

Instead of blending coconut meat with water and filtering out the solids, Vita Coco mixes coconut cream into coconut water to produce a milk-like product. I haven’t tasted it myself, but the nutrient profile is pretty compelling.

  • Moderate levels of fat (5 grams per cup), primarily from saturated medium chain triglycerides.
  • Low carb (5 grams per cup). Naturally sweet from the coconut.
  • Decent mineral levels (RDIs: 45% calcium, 15% magnesium, 10% potassium, 10% zinc).

Some of the calcium, magnesium, and zinc is added, some is natural (coconut water can be a good source of all three). Still, it’s cool to see magnesium added because so many are deficient and supplementary magnesium is well-tolerated and effective.

Ripple

Back when I was toying with the idea of getting a significant amount of my protein from plant sources for a quick experiment (long story short: I didn’t do it, I like animals too much, and I found myself relying too heavily on processed powders), I got a bottle of something called Ripple. Ripple is pea-based milk, fortified with extra pea protein, algae-based DHA, calcium, iron, and vitamin D. It has as much protein per serving as milk (8 grams), using a type of protein that can promote muscle gain, and it tastes quite good. It uses high-oleic sunflower oil for fat, which is low in polyunsaturated fat. If I truly couldn’t have dairy and desperately wanted something to drink or make smoothies with, I’d probably do Ripple.

Tempt Hemp Milk

I’ve never tried this brand, or hemp milk in general. But just like the generic hemp milk analyzed above, Tempt Hemp Milk has a far better nutrient profile than most of the other nut or other non-dairy milks I ran across. If it tastes anything like hemp seed, which has a nutty, subtle flavor, I can imagine hemp milk having a pleasant taste.

Tips For Making Your Own

You’re all an enterprising bunch. Why not make your own non-dairy milk?

  1. You can make your own nut milk. There are thousands of recipes out there, but they generally seem to involve soaking nuts in water and a pinch of salt overnight, draining them, and blending the nuts with fresh water, straining out the solids, and sometimes adding a date or a dab of maple syrup for sweetening. The higher the nut:water ratio, the richer, more nutritious the milk.
  2. You can also make thicker, more nutrient-dense nut milk by blending nut butter and water until you reach the desired consistency. You aren’t discarding anything with this method.
  3. You can avoid nuts altogether. One scoop of MCT powder, one scoop of collagen peptides, whisked into water makes a decent approximation of milk. Use 3 tablespoons of water to make creamer for coffee. This isn’t a nutrient-powerhouse, but it provides medium chain triglycerides (which boost ketone production) and collagen.
  4. Or how about making a kind of nut broth? The usual audience for non-dairy milks is obsessed with consuming raw foods. They make a point to prevent their food from ever getting warmer than the hemp-clad crotch of a Trustafarian hitchhiking through Joshua Tree in the middle of summer. But consider that applying heated water to pulverized nuts will extract even more nutrients from the nut and deliver them into the water. Then you strain the solids and refrigerate the broth, producing “milk.” I bet that’d be quite tasty and more nutritious than a cold water nut wash.

The Bottom Line on Nut Milks…

Nothing on the market or that you cook up in your kitchen is going to rival the nutrient density of cow’s milk. From the protein to the healthy dairy fats to the dozens of micronutrients we know about and the dozens we have yet to catalogue, actual milk packs a real wallop that your basic almond, cashew, pecan, or flax milk simply can’t defeat. So, you’ll have to shift your view of “milk” as a whole food. Don’t give your kid four glasses of hemp milk and think you’re replacing cow dairy. Don’t wean your infant off the breast and fill a bottle with hazelnut milk instead; it’s not the same. Don’t eat a dog bowl-sized serving of cereal with some rice milk. The only nutritious part of cereal is the milk, and non-dairy milks do not qualify. Don’t rely on non-dairy milks for your nutrient intakes. Those are shoes they’ll never fill.

Instead, use non-dairy milks to make nutrient-dense smoothies. Use them in your coffee. Make protein shakes with them. In short, use these non-dairy plant-based milks to make it easier to eat more nutrient-dense foods.

Before you run out to buy cashew milk or pea milk or something similar, I will say this: I’m a fan of dairy. It’s a nutrient-dense source of bioavailable protein, healthy fat, calcium, vitamin K2, and other important and helpful compounds. If you can eat it without tolerance issues, you probably should. And if you can’t, you may be able to tolerate other animal milks, like goat’s milk. Many people who can’t do cow dairy can handle goat. It’s worth a try.

What about you? What’s your favorite non-dairy milk? Do you have any plant-based milks that you swear by?

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References:

Onuegbu AJ, Olisekodiaka JM, Irogue SE, et al. Consumption of Soymilk Reduces Lipid Peroxidation But May Lower Micronutrient Status in Apparently Healthy Individuals. J Med Food. 2018;21(5):506-510.

Hon KL, Tsang YC, Poon TC, et al. Dairy and nondairy beverage consumption for childhood atopic eczema: what health advice to give?. Clin Exp Dermatol. 2016;41(2):129-37.

Babault N, Païzis C, Deley G, et al. Pea proteins oral supplementation promotes muscle thickness gains during resistance training: a double-blind, randomized, Placebo-controlled clinical trial vs. Whey protein. J Int Soc Sports Nutr. 2015;12(1):3.

Wolever TMS, Jenkins AL, Prudence K, et al. Effect of adding oat bran to instant oatmeal on glycaemic response in humans – a study to establish the minimum effective dose of oat ?-glucan. Food Funct. 2018;9(3):1692-1700.

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