Of Dairy, Almond Milk, Formula, and Common Sense
The most recent issue of the journal Pediatrics reported on a case of scurvy diagnosed in an infant after being fed nothing but a blend of almond milk and almond flour from 2.5 to 11.0 months of life.1 The patient, an 11-month old baby in Spain, was referred for pathologic fractures of the femur, irritability, and failure to thrive. He had typical signs of scurvy, such as osteopenia (low bone mineral density), cortical thinning, Wimberger ring and Frankel line (bone abnormalities associated with scurvy), fracture, and periosteal reaction. Moreover, his blood plasma vitamin C level was very low. The child was diagnosed with scurvy and was started on vitamin C replacement therapy at a dose of 300 mg per day. Over the following 3 months, his general condition, the pain in the legs, and the radiologic features improved; the plasmatic vitamin C level was normalized; and the child started walking. In summary, according to the researchers, this case demonstrates that scurvy is a new and severe complication of improper use of almond drinks in the first year of life. Manufacturers should indicate that these beverages are inappropriate for infants who consume a vitamin C-deficient diet.
According to the researchers, the baby was fed a cow milk-based formula until he was 2-and-a-half months old. He then developed skin rashes, and a doctor suggested changing the diet. The baby was switched to an almond-based prepared mixture, consuming 30 or more ounces of it daily. Once the baby turned six months old, his mother tried to feed him pureed fruits and vegetables, but to no avail, so he continued on with the almond-based formula.
The baby seemed to be progressing and could sit without support at seven months, but one month later "he showed less interest in interacting and was more unstable when sitting," the authors write. By the time he was 11 months, the baby seemed to be fairly healthy but was tired and irritable. "He refused to support his legs on a solid surface" and cried if someone tried to move his legs, the authors write. Doctors found he had femur fractures and his vitamin C levels were extremely low, and diagnosed him with scurvy.
Infants need about 50 to 60 milligrams of vitamin C per day, which they can get from breast milk, typical baby formulas, or fruits and vegetables. It should be noted that the mother tried to feed the child puréed fruits and vegetables after he reached 6 months old, but the child didn't want to eat them so the doctors continued him on the almond-based formula for 5 more months until the baby's problems became severe. At that point, the baby was placed on vitamin C and D replacement therapy, fed a mixture of formula, fruit and meat, and was cut off from the almond-based beverage. Over time, his health returned.
People, just because something is "alternative" and "natural" and marketed as "healthy" does not mean that it should be used without thought. It doesn't matter what health food store you buy something from, or what your pediatrician recommends for that matter; common sense is still required.
What Is Almond Milk, and Why Is it Sometimes the Wrong Choice?
The study's authors say that "plant-based beverages are not a complete food" and that pediatricians and parents should be aware of this when looking for alternatives to breast milk and traditional formula. As it turns out, this statement is both correct and misleading. It is correct in that plain almond milk and soy milk are not adequate replacements for breast milk. It is misleading in that cow's milk, a non-plant-based beverage, is not a complete food either--at least for humans. Vitamin C levels are very low in cow's milk too. And cow's milk, as we will discuss a little later, is a bad option for growing bones.
Now, what is almond milk?
The traditional recipe is to:
- Soak a cup of raw almonds overnight in filtered water.
- Rinse and drain the almonds.
- Put them in a blender along with 3.5 cups of filtered water.
- If you want, you can add things like whole vanilla bean, a couple Medjool dates, cinnamon, and a pinch of sea salt for flavor.
- Blend for one minute at high speed.
- Pour into a nut milk bag sitting in a large bowl.
- Gently squeeze the milk out through the bag into the bowl, or hang the bag over the bowl and let drip until all the liquid is in the bowl.
- Pour into a container and store in the refrigerator. Will keep 3-4 days.
As you can see, the only nutrients in here are the nutrients found in almonds. Since there's no vitamin C in almonds, there will be none in almond milk. Also, protein content is quite low. Nevertheless, it's creamy; it tastes delicious; and it can be used as a substitute for cow's milk--gastronomically, if not nutritionally, speaking. Its primary health benefit is that it's not cow's milk or soy milk, which are both high in allergens. Yes, if you are allergic to nuts, you will not be able to drink almond milk, but far fewer people are allergic to nuts than are allergic to soy and dairy.
Now, if you buy ready-made almond milk in the store, it will be nowhere near as creamy or as tasty. Quite simply, almonds are too expensive to be used to make almond milk commercially in the same way. Instead, very, very few almonds are used in making commercial almond milk. The creaminess in commercial almond milk comes from added thickeners such as: locust bean gum, sunflower lecithin, and gellan gum. These are not unhealthy. There's just nothing particularly healthy about them either. They're in the mix because they're far cheaper than almonds. In fact, here are the ingredients in Silk Almond Milk.
Ingredients can include: Almond milk (Filtered Water, Almonds), Cane Sugar, Sea Salt, Natural Flavor, Locust Bean Gum, Sunflower Lecithin, Gellan Gum, Calcium Carbonate, Vitamin E Acetate, Zinc Gluconate, Vitamin A Palmitate, Riboflavin (B2), Vitamin B12, Vitamin D2
As you can see, this is not a complete food. There is very little protein, and the vitamin and mineral content come from added vitamins and minerals--of which vitamin C is not currently included.
Bottom line: almond milk is a great substitute flavorwise for those who don't want to drink dairy or soy, but it is by no means a complete food and should not be used as a primary nutrition source for either adults or children--and especially not for infants.
Then again, neither should cow's milk, or for that matter formula. Yes, formula contains added vitamin C so babies will not get scurvy, but there are so many things wrong with formula that it is by no means even close to breast milk in nutritional value. Here's the ingredient list for Similac® Advance Infant, one of the more popular baby formulas:
Nonfat Milk, Lactose, Whey Protein Concentrate, High Oleic Safflower Oil, Soy Oil, Coconut Oil, Galactooligosaccharides. Less than 2% of: C. Cohnii Oil, M. Alpina Oil, Beta-Carotene, Lutein, Lycopene, Potassium Citrate, Calcium Carbonate, Ascorbic Acid, Soy Lecithin, Potassium Chloride, Magnesium Chloride, Ferrous Sulfate, Choline Bitartrate, Choline Chloride, Ascorbyl Palmitate, Salt, Taurine, m-Inositol, Zinc Sulfate, Mixed Tocopherols, d-Alpha-Tocopheryl Acetate, Niacinamide, Calcium Pantothenate, L-Carnitine, Vitamin A Palmitate, Cupric Sulfate, Thiamine Chloride Hydrochloride, Riboflavin, Pyridoxine Hydrochloride, Folic Acid, Manganese Sulfate, Phylloquinone, Biotin, Sodium Selenate, Vitamin D3, Cyanocobalamin, Calcium Phosphate, Potassium Phosphate, Potassium Hydroxide, and Nucleotides (Adenosine 5'-Monophosphate, Cytidine 5'-Monophosphate, Disodium Guanosine 5'-Monophosphate, Disodium Uridine 5'-Monophosphate).
To translate, that's pretty much dairy, vegetable oil, and sugar (from added lactose as the number one ingredient in the formula)--with a whole list of added synthetic vitamins and minerals. While your baby won't get scurvy or weak bones using this formula, it's not even close to being a healthy substitute for real breast milk.
So once again, when it comes to almond milk, just because something is "alternative" and "natural" and marketed as "healthy" does not mean that it should be used without thought. It doesn't matter what health food store you buy something from; common sense is still required.
Let's Talk About Milk…Again
Over the years, I haven't had a lot of good things to say about milk. Unlike the National Dairy Council, I don't believe that "milk does a body good." It's great for turning baby calves into cows, but it's not so great for people. As I've pointed out in the past, drinking milk is associated with a number of diseases--from diabetes to heart disease. But most significantly, when it comes to its most touted benefit--building strong bones--milk comes up short. In fact, the countries that have the highest intake of milk have some of the highest rates of osteoporosis. Now, by itself, that doesn't prove cause and effect, but there are a number of studies that pretty much ice the cake on the argument.
Most notably, I'm looking at a 2014 Swedish study that tracked some 100,000 men and women over about 25 years, analyzing both bone fracture and mortality rates.2 While milk is often touted as one of nature's most perfect foods, the study found that consuming milk actually seemed to be associated with higher mortality and bone fractures in women and higher mortality rates in men--and the more they consumed, the higher those rates. The study, published in the British Medical Journal, utilized data from two large Swedish cohort studies, one with 61,433 women (39-74 years at baseline) and one with 45,339 men (45-79 years at baseline) which asked about their dietary habits including how much and what types of milk and dairy products they consumed.
As the study noted in its introduction, a diet rich in milk products is promoted to reduce the likelihood of osteoporotic fractures. Milk contains 18 of 22 essential nutrients, including calcium, phosphorus, and added vitamin D, which is of pecial importance for the skeleton. Intestinal uptake of these nutrients is theoretically enhanced by the enzymatic capacity to digest lactose into D-glucose and D-galactose by a mutation in the lactase gene, a variant common in those with northern European ancestry. An intake of dairy foods corresponding to three or four glasses of milk a day has been suggested by the medical establishment to save at least 20% of healthcare costs related to osteoporosis.3
Unfortunately, although it sounds good in theory, statistical evidence does not support it. As the study's lead author, Karl Michaelsson, a professor at Uppsala University, said, "I've looked at fractures during the last 25 years. I've been puzzled by the question because there has again and again been a tendency of a higher risk of fracture with a higher intake of milk." And this study confirmed those results. According to the study, women who consume three or more glasses of milk a day have a higher risk of fracture and a higher risk of death. Men who drink three or more glasses of milk a day have a slightly higher risk of death -- mostly associated with cardiovascular death -- compared to those who drink less than one glass a day. Incidentally, there is no reduced risk of fracture as milk consumption increases.
And it gets worse.
In both men and women, the higher the levels of milk they consume, the higher the levels climb of a biological stress marker associated with a shortened life span caused by oxidative stress damage, chronic inflammation, neurodegeneration, decreased immune response, and gene transcriptional changes. The marker we're talking about is D-galactose. D-galactose is known to induce aging in animals and is linked to increased oxidative stress and inflammation.
Importantly, the increase in fractures and/or mortality is only associated with milk consumption, not with fermented dairy products such as cheese, yogurt, sour milk, kefir, etc. (most likely because of their lower or non-existent lactose and galactose content). In fact, according to the study, each serving of cheese or fermented milk products actually reduces the rates of mortality and hip fractures by 10-15 percent, as well as a decreasing the risk of cardiovascular diseases. However, keep in mind that you still have allergy issues with fermented dairy.
In fact, a 2013 paper published in JAMA Pediatrics basically said that the USDA recommendations for milk consumption in children are not supported by scientific evidence.4 The paper even went on to state that there is, in fact, more evidence that humans -- who only recently began consuming milk with the domestication of large animals -- "have no nutritional requirement for animal milk."
When it comes to feeding infants:
- Breast milk stands head and shoulders above any alternative.
- Cow's milk is not designed for humans, is nutritionally incomplete, and is even dangerous long-term. Goat's milk is a better option in that the protein levels are closer to that found in breast milk, lactose and allergen levels are lower, and the fat globules are smaller and do not require homogenization.5
- Plant-based milk beverages have almost no nutritional factors required for infants. Although they are not innately "harmful" like cow's milk, they are dangerously incomplete. Unless the plant-based formula you use has been specifically designed for the needs of infants, you should not use plant-based milk beverages as an infant's primary food source.
- Most commercial baby formulas, although they are "closer" to being nutritionally complete than other options, are assembled from ingredients that are, to put it mildly, nutritional garbage. They are either dairy-based, which, as we've already discussed, is highly problematic, or they are soy based. And soy-based formulas should be avoided at all costs. The level of phytoestrogens in soy are simply too high for an infant's body to handle. The use of soy formula dramatically accelerates the onset of puberty--with serious health consequences, including an increased risk of cancer, down the line.
The bottom line is that when it comes to feeding infants, there really is no "good" alternative to breast milk--although theoretically one could be formulated around plant proteins. If you absolutely must use an alternative, then be sure to engage your common sense.
To all those commenters below who noted the sentence about baby formula that read, "Heck, they're even using vitamin D3, the synthetic, useless form of vitamin D." Yes, that was incorrect, and we pulled it. D3 is indeed the preferred form, and the article the sentence linked to explains why.
- 1. Isidro Vitoria, Berta López, Jacinto Gómez, et al. "Improper Use of a Plant-Based Vitamin C--Deficient Beverage Causes Scurvy in an Infant." Pediatrics. February 2016. http://pediatrics.aappublications.org/content/early/2016/01/15/peds.2015-2781
- 2. Karl Michaëlsson, Alicja Wolk, Sophie Langenskiöld, et al. "Milk intake and risk of mortality and fractures in women and men: cohort studies." BMJ 2014;349:g6015. http://www.bmj.com/content/349/bmj.g6015
- 3. Heaney RP. "Dairy and bone health." J Am Coll Nutr 2009;28 (Suppl 1): 82S-90S. http://www.ncbi.nlm.nih.gov/pubmed/19571166
- 4. David S. Ludwig, Walter C Willett. "Three Daily Servings of Reduced-Fat Milk: An Evidence-Based Recommendation?" JAMA Pediatr. 2013;167(9):788-789. http://archpedi.jamanetwork.com/article.aspx?articleid=1704826
- 5. Jason and Amanda Brengle. "4 Reasons to Drink Goat's Milk," Mother Earth News. 1/14/2016, (Accessed 2 Feb 2016.) http://www.motherearthnews.com/homesteading-and-livestock/4-reasons-to-drink-goats-milk-zbcz1601.aspx