How to Choose the Best Non-Dairy Milk for CKD

Introduction

Some common advice given to people with chronic kidney disease is to choose non-dairy milks instead of dairy milks.

For people with chronic kidney disease who are trying to reduce their animal protein, opting for plant-based milk is a simple swap to make!

However, it’s not quite as simple as “choose a plant-based milk”.

If you’ve been to a grocery store lately, you probably see an ever-expanding plant-based milk section, always featuring new brands and varieties. In contrast, 15 years ago, your only option at the local grocer was typically soy milk (if anything).

Now we have options available like:

• almond milk
• rice milk
• oat milk
• cashew milk
• coconut milk
• hemp milk
• flax milk
• macadamia milk
• pea protein milk
• & combinations of the above, such almond soy or almond coconut

Many choices! So, this begs the question, which non-dairy milk is best to choose if you have kidney disease?

Well, as is the case with most things kidney nutrition, the answer isn’t super straightforward. It all comes down to what’s best for you: based on your unique labs, the cause of your kidney disease, and any other medical conditions you may have.

By the way, if you need help better understanding your labs, your health, and what kind of diet is best for you, a Board Certified Renal Dietitian like me can help with that.

But without further ado, I present to you FIVE things to consider when choosing the best plant-based milk for you.

Protein

If you have chronic kidney disease (pre-dialysis), it’s likely you are working on adjusting your protein intake.

• People with stages 3-5 CKD (pre-dialysis) typically need to reduce how much protein they eat.
• People in stage 5D (dialysis, or end stage renal disease) typically need to increase how much protein they eat.

So depending on your protein needs, certain non-dairy milks might be a better choice.

For a frame of reference, let’s start by looking at the protein content of dairy milk. 1 cup of 1% dairy milk contains about 8 grams of protein. We consider this to be a higher protein option.

The non-dairy milk that is most similar nutritionally to dairy milk is soy milk. A 1 cup serving of soy milk contains about 7 grams of protein. If you are on a higher protein diet, soy milk might be a good option to help boost your daily protein intake. Another higher protein option is a non-dairy milk that uses pea protein, such as Ripple milk. This one has 8 grams of protein per 1 cup, same as dairy milk. Silk Protein milk, also made with pea protein, contains 10 grams of protein per 1 cup.

Now if you are on a lower protein diet, these high protein milks may not be the best choice for you. Options that tend to be lower in protein include almond milk, rice milk, oat milk, cashew milk, coconut milk, hemp milk, flax milk, and macadamia milk. A lower protein milk will fit more easily into your lower protein diet than a high protein milk like soy or pea protein.

In summary:

• Higher protein milk: soy, pea protein, and non-dairy milk advertised as high protein milk (usually contain added pea protein)
• Lower protein milk: almond, rice, oat, cashew, coconut, hemp, flax, and macadamia

Added sugars

Did you know dairy milk contains about 12 grams of sugar per 1 cup? This is a naturally occurring sugar, called lactose. Typically there are no added sugars in dairy milk, unless it is a flavored milk like chocolate or strawberry.

Natural sugars aren’t really something to be concerned about. They are naturally part of foods, packaged up with other beneficial nutrients.

Added sugars are a different story. The typical American consumes too much added sugar. It is best to minimize any sources of added sugars in the diet when you have kidney disease, especially if you have a condition like diabetes or polycystic kidney disease (where it is critically important to limit added sugars for best health outcomes).

When choosing a plant-based milk, I advise opting for unsweetened varieties. Unsweetened typically means there are no added sugars.

However, many non-dairy milks contain a sweetener. Look at the container closely to ensure you’re choosing the unsweetened option. Look how similar the sweetened and unsweetened varieties of Silk almond milk look:

I’ve made the error of grabbing the “original” variety at the store when in a rush. Always carefully examine the front of the package, as well as the nutrition facts panel on whichever non-dairy milk you purchase.

In summary:

If at all possible, choose a non-dairy milk with 0 grams of added sugar.

Added phosphorus

Some people with chronic kidney disease may need to limit how much phosphorus they get from their foods and drinks (not everyone, however – see my blog post which discusses myths about phosphorus for more on this). Dairy milk has 232 mg of phosphorus per 1 cup serving.

If you do need to limit your phosphorus, the most important kind to limit is added phosphates in foods. This is a form of phosphorus that companies use as a food additive, and it’s 90-100% absorbed into your bloodstream. If you have high phosphorus, this added phosphorus in foods can have a big impact on your blood phosphorus levels, so it’s best to limit or avoid it.

In contrast, naturally occurring phosphates in foods are only 20-70% absorbed.

Many non-dairy milks do unfortunately contain added phosphates. Some of the phosphorus-containing ingredients you might see on the ingredients list of your non-dairy milk carton include:

• dipotassium phosphate
• monocalcium phosphate
• tricalcium phosphate
• or other ingredients that contain “phos”

The further down the ingredient label the “phos” ingredient, the smaller the amount of phosphorus in the product. If you are having a hard time finding a phos-free non-dairy milk, aim to choose one where phos is further down the list.

Some examples of non-dairy milks with no added phosphates include:

• Silk Unsweet Almondmilk
• Silk Creamy Cashewmilk
• Califia Farms Unsweetened Almondmilk
• DREAM Ricemilk
• Elmhurst Cashew Milk & Oat Milk

This is not a definitive list of products, just several examples (updated August 2024). Keep in mind that manufacturers can change their recipes or ingredients, so you should always read the label to be sure.

In summary:

Limit non-dairy milks with added phosphates, especially if your dietitian or doctor tells you to restrict the phosphorus in your diet.

Potassium

If you have CKD, another reason you may be told to limit dairy milk is the potassium. 1 cup of dairy milk contains 366 mg of potassium.

Some people with kidney disease may follow a diet as strict as limiting potassium to 2,000 mg daily. If that’s the case, drinking 3 cups of milk per day adds up quickly. That said, not all people with kidney disease need to avoid potassium from foods.

If you are watching potassium (as advised by your doctor and renal dietitian) many non-dairy milks offer a lower potassium alternative to dairy milk. I reviewed at least 25 non-dairy milk products in writing this article, and they ranged between 30-200mg of potassium per 1 cup serving – significantly lower than dairy milk. One notable exception was NotMilk at 350mg per 1 cup.

Now that you are in the habit of looking at food labels and ingredient lists, you might have noticed some non-dairy milks contain added potassium. Does that need to be avoided?

In my opinion as a renal dietitian, if you are someone who does struggle with high blood potassium levels and your team concludes that non-diet causes are not a factor (as in the article linked above), you may want to consider avoiding non-dairy milks with potassium additives.

For everyone else though, there is likely no big cause for concern. In fact, many people with kidney disease could actually benefit from MORE potassium in the diet, due to its beneficial impact on blood pressure.

If you need help figuring out the right amount of potassium for you, consult with an expert renal dietitian.

In summary:

If your renal dietitian tells you to limit the potassium in your diet, consider choosing a lower potassium non-dairy milk, especially one free of any added potassium. Otherwise, this is nothing to lose sleep about.

Oxalates

Some people with certain kidney problems – such as polycystic kidney disease, or calcium oxalate kidney stones formers – may be advised to avoid a compound in food called oxalates. Oxalate is a compound found in some foods that is not considered a nutrient. This means the human body does not use it in any way. The body will excrete it rather than absorb and use it.

One higher oxalate food is almonds – the main ingredient in almond milk.

However, please note that current research indicates excessive restriction of oxalates is not necessarily the key to reducing kidney stones (especially if you form non-calcium oxalates stones).

It’s important to know that the body also makes oxalates itself, and for people who have high oxalate in the urine, much of this comes from the body rather than from food sources. Some more important strategies to prevent calcium oxalate kidney stones include consuming adequate calcium and drinking plenty of water.

In summary:

Limit high oxalate foods only if your renal dietitian specifically advises you to do so. If you have been advised to limit oxalates, a simple swap is to choose a non-dairy milk other than almond milk.

Final Takeaways

Because there is no one “right” diet for the kidneys, there is also no one “right” non-dairy milk for everyone with kidney disease. To determine which one is best for you, you’ll need to understand your labs and what that means for your specific nutrition plan.

Some of my favorite non-dairy milks to suggest to patients include:

• Silk Unsweet Almondmilk
• Three Trees Almondmilk (and other non-dairy milks such as pistachio and oat)
• Better Than Milk Unsweetened Oat Drink (other non-dairy milks such as almond, rice, and hazelnut)
• Eden Unsweetened Organic Soymilk (higher protein option)

Again, keep in mind that manufacturers can update their ingredients or recipes at any point in time. Always read the nutrition label to ensure you are buying the product that is best for you.

I hope this guide has helped you get a better understanding of the seemingly endless non-dairy milk options out there. For more help and guidance personalized to you, consult with a Board Certified Renal Dietitian (like me).

Also, be sure you’re following me on Instagram & TikTok to catch all my latest posts full of helpful information. Until then, be well. — Kate, Your Kidney Dietitian

This article was updated on 8.28.24.