Milk Alternatives
2010; Elsevier BV; Volume: 20; Issue: 2 Linguagem: Inglês
10.1053/j.jrn.2010.01.011
ISSN1532-8503
Autores Tópico(s)Nutritional Studies and Diet
ResumoPizza, nachos, and lasagna. Ice cream, yogurt, and cheesecake. Lattes, frosties, and milkshakes. Milk's role in the American diet is undeniable, its presence is ubiquitous, and its forms are numerous. Milk was the beverage of choice for American families until the last few decades of the 20th century and the increased popularity of soda, sports drinks, energy drinks, and bottled water. A large part of milk's prominence as a food item can be attributed to its long-recognized nutritional benefits. For centuries, medical opinion accepted milk as beneficial to the general public's health. However, because of a lack of technology, widespread consumption was not possible until the mid-1800s, when rapid transport, artificial refrigeration, and pasteurization were introduced.1Rosenthal I. Milk and dairy products. VCH Publishers, Inc, New York1991Google Scholar, 2Mendelson A. Milk: the surprising story of milk through the ages. Alfred A. Knopf, New York2008Google Scholar With the advent of these technologies, along with the discoveries of calcium, phosphorus, and vitamin D's roles in bone health, milk consumption took off in America. In more recent times, athletes, celebrities, and cultural icons have publicly praised milk in advertisements for the “Got Milk” campaign, attributing their strong bones and muscle health to regular consumption. Better sleep, mitigated symptoms of premenstrual syndrome, and healthier hair, skin, and nails have all been highlighted as possible benefits of regular dairy consumption.3California Processor Board: Got Milk? Available at: http://gotmilk.com/#/home/benefits/. Accessed July 27, 2009.Google Scholar Aficionados have deemed, and continue to deem, milk as “nature's perfect food.” The government, acknowledging the nutritional benefits that dairy products can exert in the diet, recommends that Americans consume three servings of low-fat or fat-free milk products per day.4United States Department of Health and Human Services, United States Department of Agriculture: Dietary guidelines for Americans 2005.6th ed. United States Government Printing Office, Washington, DC2005Google Scholar With milk's extensive history and publicity, it is not surprising that many people with chronic kidney disease (CKD) express hesitancy or resistance in limiting their milk intake. The National Kidney Foundation's recommendations of limiting consumption of dairy products to half a cup of milk, or half a cup of yogurt, or 1 ounce of cheese per day for those on dialysis5National Kidney Foundation: Dietary guidelines for adults starting on hemodialysis. Available at: http://www.kidney.org/ATOZ/atozprint.cfm?id=178. Accessed July 14, 2009.Google Scholar may appear too restrictive to some. In the wake of the “Got Milk” campaign and the Dietary Guidelines for Americans, those with CKD are often concerned about ingesting inadequate calcium for their bones. Ironically, today, the medical community knows that excessive phosphorus and calcium consumption in those with CKD actually weakens bones and causes calcification in soft tissues.6Chertow G.M. Burke S.K. Raggi P. Treat to Goal Working Group: Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients.Kidney Int. 2002; 62: 245-252Crossref PubMed Scopus (1339) Google Scholar Eight ounces of whole milk, which contains 222 mg of phosphorus, 349 mg of potassium, and 276 mg of calcium,6Chertow G.M. Burke S.K. Raggi P. Treat to Goal Working Group: Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients.Kidney Int. 2002; 62: 245-252Crossref PubMed Scopus (1339) Google Scholar may be excessive to those who already struggle with keeping their laboratory values within the National Kidney Foundation's K/DOQI guidelines. Patients are often surprised to learn that lower-fat milks are in fact even less renal-friendly than whole milk, containing higher levels of potassium and phosphorus.7United States Department of Agriculture, Agricultural Research Service: USDA national nutrient database for standard reference. Available at: http://www.nal.usda.gov/fnic/foodcomp/search/. Accessed July 27, 2009.Google Scholar Patients' concerns regarding bone health are often easily abated by providing them with more in-depth education on calcium and phosphorus dysregulation in kidney disease. In recent years, renal dietitians have been able to offer patients a growing number of alternatives to milk. Soy milks and flavored nondairy creamers have increased in popularity in the United States. Products such as rice milk and almond milk have also enjoyed a growing demand in supermarkets. Finding an appropriate dairy alternative in a local supermarket is not as difficult as it used to be. Table 1 lists the nutritional information of the most popular milk substitutes on the market today (only liquid nondairy creamers were included). Percentages for calcium and phosphorus were converted to milligrams, based on the Recommended Daily Allowance (RDA) of calcium as 1000 mg and phosphorus as 1000 mg.8United States Department of Health and Human Services, Food and Drug Administration: Guidance for industry: a food labeling guide. United States Government Printing Office, Washington, DC2008Google Scholar Nutritional differences between refrigerated and shelf-stable versions were often negligible. Of the brands listed, notably absent from previous product updates are Dairy Delicious and Vitasoy. Dairy Delicious is no longer available, and Vitasoy, while once active in the United States market, discontinued their American line of soy milks in April 2009. (Their Asian brand of soy milks can still be found in Asian supermarkets.) For Trader Joe's products, the nutritional content may vary in different parts of the country, depending on the supplier. Some products listed in Table 1 may not be available in all states.Table 1Nutrition content of Milk AlternativesParent companyBrandProductServing sizeCaloriesTotal fat (g)Saturated fat (g)Phosphorus (mg)Potassium (mg)Sodium (mg)Calcium (mg)Carbohydrate (g)Protein (g)Soy milksWhole Foods Market365 OrganicOriginal1 cup903.50.58035011030096Whole Foods Market365 OrganicUnsweetened1 cup7040.58035012030047Whole Foods Market365 OrganicVanilla1 cup903.50.580350110300106Whole Foods Market365 OrganicChocolate1 cup1403.50.5100360110300227Whole Foods Market365 OrganicOriginal (refrigerated)1 cup903.50.58035011030096Whole Foods Market365 OrganicUnsweetened (refrigerated)1 cup7040.58035012030047Whole Foods Market365 OrganicVanilla (refrigerated)1 cup903.50.580350110300106Whole Foods Market365 OrganicChocolate (refrigerated)1 cup1403.50.5100640120300237Stremicks Heritage Foods8th ContinentOriginal1 cup802.5025036010530078Stremicks Heritage Foods8th ContinentLite, Original1 cup502020038011530026Stremicks Heritage Foods8th ContinentFat-Free, Original1 cup600020038010030086Stremicks Heritage Foods8th ContinentVanilla1 cup10030.5220380105300116Stremicks Heritage Foods8th ContinentLight, Vanilla1 cup602020039011030056Stremicks Heritage Foods8th ContinentFat-Free, Vanilla1 cup7000NANA100300116Stremicks Heritage Foods8th ContinentChocolate1 cup14030.5320440125300227Stremicks Heritage Foods8th ContinentLight, Chocolate1 cup901.50270430120300127Stremicks Heritage Foods8th ContinentComplete1 cup8030.5NA38010030076Eden Foods, Inc.EdensoyEdenblend, Organic Rice and Soy Beverage1 cup12030.51002509033187Eden Foods, Inc.EdensoyCarob, Organic1 cup17040.51253509575287Eden Foods, Inc.EdensoyChocolate1 cup1803.5114341010597288Eden Foods, Inc.EdensoyExtra, Originial1 cup13040.51504401002001311Eden Foods, Inc.EdensoyExtra, Vanilla1 cup1503010031090200237Eden Foods, Inc.EdensoyLight, Original1 cup10020702209081155Eden Foods, Inc.EdensoyLight, Vanilla1 cup110106420011080224Eden Foods, Inc.EdensoyOriginal, Organic1 cup14050.51414401051041411Eden Foods, Inc.EdensoyUnsweetened Organic1 cup12061137460549512Eden Foods, Inc.EdensoyVanilla, Organic1 cup150301003208572247Organic Valley of FarmsOrganic ValleyOriginal1 cup11040.560-80260100300117Organic Valley of FarmsOrganic ValleyUnsweetened1 cup804060-8028011030037Organic Valley of FarmsOrganic ValleyVanilla1 cup1103.5060-80230100300146Organic Valley of FarmsOrganic ValleyChocolate1 cup13030.560-80160160300205Pacific Foods of Oregon, Inc.PacificOrganic Soy, Unsweetened, Original1 cup904.50.5125400152049Pacific Foods of Oregon, Inc.PacificSelect Soy, Low-Fat, Plain1 cup702.50652201152095Pacific Foods of Oregon, Inc.PacificSelect Soy, Low-Fat, vanilla1 cup802.506522011520115Pacific Foods of Oregon, Inc.PacificUltra Soy, Plain1 cup12040.52503801503001110Pacific Foods of Oregon, Inc.PacificUltra Soy, Vanilla1 cup13040.52503801503001410Kikkoman Sales USA, Inc.PearlOriginal1 cup1103.50.5NA300110300127Kikkoman Sales USA, Inc.PearlCreamy Vanilla1 cup1103.50.5NA27090300117Kikkoman Sales USA, Inc.PearlGreen Tea1 cup1103.50.5NA28095300137Kikkoman Sales USA, Inc.PearlChocolate1 cup1504.51NA290180300218Kikkoman Sales USA, Inc.PearlUnsweetened1 cup904.51NA21013020068Kikkoman Sales USA, Inc.PearlCoffee1 cup15040.5NA210190300246White Wave FoodsSilkPlain (refrigerated and aseptic)1 cup10040.59530012030087White Wave FoodsSilkVanilla (refrigerated and aseptic)1 cup1003.50.59530095300106White Wave FoodsSilkChocolate (refrigerated)1 cup1403.50.595350100300235White Wave FoodsSilkChocolate (aseptic)1 cup15030.595350100300255White Wave FoodsSilkUnsweetened (refrigerated and aseptic)1 cup8040.5953008530047White Wave FoodsSilkSilk, Heart Health, Vanilla1 cup801.509530095300106White Wave FoodsSilkSilk Plus DHA Omega-31 cup11050.59535012040087White Wave FoodsSilkOrganic, Vanilla1 cup1003.50.59530095300106White Wave FoodsSilkOrganic, Plain1 cup10040.59530012030087White Wave FoodsSilkOrganic, Unsweetened1 cup8040.5953008530047White Wave FoodsSilkVery Vanilla1 cup13040.595300140350196White Wave FoodsSilkLight Silk, Vanilla1 cup802010030095300106White Wave FoodsSilkLight Silk, Plain1 cup702010030012030086White Wave FoodsSilkLight Silk, Chocolate1 cup1201.50100350100300225Hain Celestial GroupSoy DreamClassic Vanilla1 cup14040.510014013540187Hain Celestial GroupSoy DreamEnriched Original1 cup10040.515025013535087Hain Celestial GroupSoy DreamEnriched Vanilla1 cup12040.5150250135350147Hain Celestial GroupSoy DreamEnriched chocolate1 cup15040.5150290125350217Trader Joe'sSoy EssentialUnsweetened1 cup9040.5NA3507035067Trader Joe'sSoy MilkOriginal1 cup10020NANA120400135Trader Joe'sSoy MilkVanilla1 cup10020NANA120400165Trader Joe'sSoy MilkChocolate1 cup1302.50NANA110400235Trader Joe'sSoy MilkOrganic Unsweetened1 cup904.50.5NANA152049Trader Joe'sSoy Milk ExtraOrganic Original1 cup13030100NA120300177Trader Joe'sSoy Milk ExtraOrganic Vanilla1 cup13030100NA125300197Trader Joe'sSoy Milk ExtraOrganic Chocolate1 cup13030100NA120300177Hain Celestial GroupSoy SlenderPlain1 cup6030.525021010530036Hain Celestial GroupSoy SlenderVanilla1 cup7030.525021012530046Hain Celestial GroupSoy SlenderCapucchino1 cup7030.525021012530047Hain Celestial GroupSoy SlenderChocolate1 cup7030.525029012530057Hain Celestial GroupWestSoyOrganic, Originial1 cup1304.50.5NA24012540188Hain Celestial GroupWestSoyPlus, Plain1 cup903.50.525031012530077Hain Celestial GroupWestSoyPlus, Vanilla1 cup1003.50.5250310125300107Hain Celestial GroupWestSoyOrganic, Unsweeteneed1 cup904.50.5NA300304059Hain Celestial GroupWestSoyUnsweetened, Almond1 cup904.50.5NA300304059Hain Celestial GroupWestSoyUnsweetened Vanilla1 cup1004.50.5NA300304059Hain Celestial GroupWestSoyLow-Fat, Plain1 cup901.5015015090200144Hain Celestial GroupWestSoyLow-Fat, Vanilla1 cup1201.5015016090200214Hain Celestial GroupWestSoyLite Plain1 cup60201501608530064Hain Celestial GroupWestSoyLite Vanilla1 cup901.5015016075300195Hain Celestial GroupWestSoyNonfat plain1 cup7000150210105250106Hain Celestial GroupWestSoyNonfat Vanilla1 cup8020150220105250126Hain Celestial GroupWestSoySoy Shake Vanilla1 cup17030150380125300287Hain Celestial GroupWestSoySoy Shake, Chocolate1 cup1703.50150480130300307Hain Celestial GroupWestSoy LongevityPlain1 cup903.50.5NA230125300106Hain Celestial GroupWestSoy LongevityVanilla1 cup1003.50.5NA230125300136SuperValu Inc.Wild Harvest OrganicOriginal1 cup903.50.580420160300106SuperValu Inc.Wild Harvest OrganicChocolate1 cup1403.50.5100430170300237SuperValu Inc.Wild Harvest OrganicPlain1 cup9040.5NANA15030077SuperValu Inc.Wild Harvest OrganicVanilla1 cup10040.58042013030097Nondairy creamersNestleCoffeeMateFat-Free Originial1 tablespoon (15 mL)10001500020NestleCoffeeMateLow-Fat Original1 tablespoon (15 mL)100.501505010NestleCoffeeMateOriginal1 tablespoon (15 mL)20101500020NestleCoffeeMateFat-Free French Vanilla1 tablespoon (15 mL)3800120120110NestleCoffeeMateFrench Vanilla1 tablespoon (15 mL)351.5015010050NestleCoffeeMateHazelnut1 tablespoon (15 mL)351.5015010050NestleCoffeeMateSugar-Free Hazelnut1 tablespoon (15 mL)151015030010Rich'sCoffee RichRegular1 tablespoon201.5026510020Rich'sCoffee RichFat-Free1 tablespoon1500262610020White Wave FoodsInternational DelightFrench Vanilla1 tablespoon452115325060White Wave FoodsInternational DelightSouthern Butter pecan1 tablespoon401.5115325070White Wave FoodsInternational DelightIrish Cream1 tablespoon401.5115325070White Wave FoodsInternational DelightDulce de Leche1 tablespoon452115325070White Wave FoodsInternational DelightHershey's Chocolate Caramel1 tablespoon452115325070White Wave FoodsInternational DelightBelgian White Chocolate Macademia1 tablespoon452115325060White Wave FoodsInternational DelightAmaretto1 tablespoon401.5115325070White Wave FoodsInternational DelightCarribean Cinnamon Crème1 tablespoon452115325060White Wave FoodsInternational DelightHazelnut1 tablespoon452115325060White Wave FoodsInternational DelightEnglish Almond Toffee1 tablespoon452115325060Bay Valley FoodsMocha MixOriginal1 tablespoon201.509217010White Wave FoodsSilkOriginal1 tablespoon1510112510010White Wave FoodsSilkFrench Vanilla1 tablespoon2010112510030White Wave FoodsSilkHazelnut1 tablespoon2010112510030Other productsBlue Diamond GrowersAlmond BreezeOriginal1 cup602.5010018015020081Blue Diamond GrowersAlmond BreezeOriginal, Unsweetened1 cup40304019018020021Blue Diamond GrowersAlmond BreezeVanilla1 cup902.50100180150200161Blue Diamond GrowersAlmond BreezeVanilla, Unsweetened1 cup40304019018020021Blue Diamond GrowersAlmond BreezeChocolate1 cup12030150250150200222Blue Diamond GrowersAlmond BreezeChocolate, Unsweetened1 cup453.504023018020032Manitoba HarvestHemp BlissOriginal1 cup11070.5NANA952075Manitoba HarvestHemp BlissVanilla1 cup15070.5NANA12020145Manitoba HarvestHemp BlissChocolate1 cup16070.5NANA12040175Good Karma Foods, Inc.Organic Rice MilkOriginal1 cup8030150NA170250121Good Karma Foods, Inc.Organic Rice MilkVanilla1 cup11030150NA170250191Good Karma Foods, Inc.Organic Rice MilkChocolate1 cup13030150NA190250251Pacific Foods of Oregon, Inc.PacificRice, Plain1 cup130201753560300271Pacific Foods of Oregon, Inc.PacificRice, Low-Fat, Vanilla1 cup130201753575300271Pacific Foods of Oregon, Inc.PacificOrganic Oat, Vanilla1 cup1302.50270120110300254Pacific Foods of Oregon, Inc.PacificOrganic Oat, Original1 cup1302.50270120110350244Pacific Foods of Oregon, Inc.PacificOrganic Almond, Vanilla1 cup702.50251401400111Pacific Foods of Oregon, Inc.PacificOrganic Almond,Chocolate1 cup10050.5471301400191Pacific Foods of Oregon, Inc.PacificOrganic Almond, Original1 cup602.5029140140081Pacific Foods of Oregon, Inc.PacificOrganic Unsweetened Almond, Vanilla1 cup402.50250180031Pacific Foods of Oregon, Inc.PacificOrganic Unsweetened Almond, Original1 cup352.50290180021Pacific Foods of Oregon, Inc.PacificAll-Natural Hazelnut, Original1 cup1103.5019560120300182Pacific Foods of Oregon, Inc.PacificHemp Milk, Original1 cup14050.5300170130500204Pacific Foods of Oregon, Inc.PacificHemp Milk, Vanilla1 cup16050.5300170135500244Hain Celestial GroupRice DreamCarob, Classic1 cup1502.50NANA800301Hain Celestial GroupRice DreamOriginal, Classic1 cup1202.500010020241Hain Celestial GroupRice DreamVanilla, Classic1 cup1302.50NANA10520271Hain Celestial GroupRice DreamEnriched Original1 cup1202.501500100300231Hain Celestial GroupRice DreamEnriched Vanilla1 cup1302.501500105300261Hain Celestial GroupRice DreamHeartwise Original1 cup130201503080300271Hain Celestial GroupRice DreamHeartwise Vanilla1 cup140201503080300301Hain Celestial GroupRice Dream SupremeVanilla Hazelnut1 cup1402.50150NA65300291Hain Celestial GroupRice Dream SupremeChocolate Chai1 cup16030150NA70350351Hain Celestial GroupAlmond DreamOriginal1 cup502.50150NA10030061Hain Celestial GroupAlmond DreamUnsweetened1 cup302.50150NA10030011Hain Celestial GroupOat DreamOriginal1 cup12030NANA20300204Hain Celestial GroupOat DreamMaple Brown Sugar1 cup12030NANA20300204Hain Celestial GroupHemp DreamOriginal1 cup10060.5NANA530084Hain Celestial GroupHemp DreamVanilla1 cup11060.5NANA5300114Trade Joe'sRice DrinkOrganic Original Unsweetened1 cup1202.5015020100300231Trade Joe'sRice DrinkUnsweetened Vanilla1 cup1302.50150NA105300261Trade Joe'sWhole Grain DrinkOriginal1 cup702.5080NA130150120Trade Joe'sWhole Grain DrinkUnsweetened1 cup503080NA13515070Living Harvest Foods, Inc.TemptHempmilk, Original1 cup10060.5200NA25400102Living Harvest Foods, Inc.TemptHempmilk, Vanilla1 cup11060.5200NA25400122Living Harvest Foods, Inc.TemptHempmilk, Chocolate1 cup15060.5200NA35400231Living Harvest Foods, Inc.TemptHempmilk, Unsweetened Original1 cup6060.5200NA2540011Living Harvest Foods, Inc.TemptHempmilk, Original1 cup6060.5200NA2540011Hain Celestial GroupWestSoyRice Beverage, Plain1 cup1102.5010065110250201Hain Celestial GroupWestSoyRice Beverage, Vanilla1 cup1102.5010065110250201SuperValu, Inc.Wild Harvest OrganicRice Milk, Original1 cup100201575590300230SuperValu, Inc.Wild Harvest OrganicRice Milk, Vanilla1 cup120201506095300260Whole Foods Market365 OrganicRice Milk, Unsweetened1 cup452015015135200101Whole Foods Market365 OrganicRice Milk, Original1 cup902.5015030150250171Whole Foods Market365 OrganicRice Milk, Vanilla1 cup1202.5015035150250231 Open table in a new tab As previous authors noted, a challenge for dietitians involves keeping up to date with formulation changes. In the time span of writing this article, many product formulations were modified. Without contacting companies regularly, dietitians would be unaware of such changes. As such, by the time these data are published online, some may very likely be outdated (all nutritional data were current as of July 2009). The renal dietitian should keep one final consideration in mind regarding alternative dairy products, i.e., these products present their own challenges. Many soy milks on the market are fortified with calcium and phosphorus additives, making them no more renal-friendly than milk. Grain-based and nut-based milks are often low in protein, making them less than ideal for patients lacking high biological value proteins. However, because such a wide array of nondairy substitutes is available, patients can almost certainly find a product suitable for them, as long as they know where to look. This is often where the dietitian's expertise is required. When the dietitian helps a CKD patient make a choice tailored to individual needs and health status, the CKD patient will be spared one more frustration in the management of this difficult disease. Eden Foods, Inc. 701 Tecumseh Road Clinton, MI 49236 888-424-3336 http://www.edenfoods.com/ Good Karma Foods, Inc. 441 Beaver St. , Suite 201 Sewickley, PA 15143 412-749-9805 http://www.goodkarmafoods.com/ Hain Celestial Consumer Relations 4600 Sleepytime Dr. Boulder, CO 80301 800-434-4246 http://www.hain-celestial.com/ Living Harvest Foods, Inc. P.O. Box 4407 Portland, OR 97208 888-690-3958 http://www.livingharvest.com Manitoba Harvest, Inc. 69 Eagle Drive Winnipeg, Manitoba R2R 1V4 Canada http://www.manitobaharvest.com/ Nestle 800 North Brand Boulevard Glendale, CA 91203 800-225-2270 http://www.nestleusa.com/ Pacific Foods of Oregon, Inc. 19480 SW 97th Ave. Tualatin, OR 97062 503-692-9666 http://www.pacificfoods.com/ Stremicks Heritage Foods 4002 Westminster Ave. Santa Ana, CA 92703 800-371-9010 http://www.heritage-foods.com/ Trader Joe's PO Box 5049 Monrovia, CA 91017 626-599-3700 http://www.traderjoes.com/ Whole Foods Market, Inc. 550 Bowie St. Austin, TX 78703 512-477-4455 http://www.wholefoodsmarket.com/ White Wave Foods 12002 Airport Way Broomfield, CO 80021 303-635-4000 http://www.whitewave.com/
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