A piece of advice commonly given to people with kidney disease is to choose plant-based milks instead of dairy milks.
Now… it’s not quite as simple as “choose a plant-based milk”. If you’ve been to a grocery store lately, you’ve probably noticed that the plant-based milk section is ever expanding with new brands and varieties. Whereas 15 years ago, your only option at your local grocer was, if anything, soy milk, 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 cashew, oat coconut & soy, or almond coconut
So – which plant-based 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.
Just as a quick note – if you could use guidance on better understanding your labs and your health, and what kind of diet is best, a Board Certified Renal Dietitian like myself 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.
If you have chronic kidney disease, it’s likely you’ve been advised (or found advice online) to adjust your protein intake.
- People with stages 3-5 CKD (pre-dialysis) are typically advised to reduce how much protein they eat.
- People in stage 5D (dialysis, or end stage renal disease) are typically advised 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. This would be considered 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 are plant-based milks made with 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.
- Higher protein milks: soy, pea protein, and non-dairy milks advertised as high protein milks (usually contain added pea protein)
- Lower protein milks: almond, rice, oat, cashew, coconut, hemp, flax, and macadamia
2. 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 way 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 conditions such as diabetes or polycystic kidney disease (where it is critically important to limit added sugars for best health outcomes).
When choosing a plant-based milk, it’s best to choose an unsweetened variety. Unsweetened typically will mean there is no added sugars.
Many non-dairy milks are sweetened however. Be sure to 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 definitely grabbed the “original” variety at the store before when I was in a rush and wasn’t looking closely. Be sure to carefully examine the front of the package, as well as the nutrition facts panel on whichever non-dairy milk you decide to pick up.
- If at all possible, choose a non-dairy milk with 0 grams of added sugar.
3. 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 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’s used as a food additive, as opposed to phosphorus that is naturally occurring in the food item/ingredients. It’s often added to foods as a preservative, 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.
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”
Some examples of products out there that currently contain no added phosphates include:
- Silk Unsweet Almondmilk
- Silk Creamy Cashewmilk
- Califia Farms Unsweetened Almondmilk
- Rise Brewing Co. Organic Oat Milk
- Elmhurst Cashew Milk & Oat Milk
This is not a definitive list of products, just several examples, and it is accurate as of November 2022. Keep in mind that manufacturers may change their recipes or ingredients, so always read the label to be sure.
- Limit or avoid non-dairy milks with added phosphates, especially if you have been advised to restrict the phosphorus in your diet.
One of the common reasons dairy milk is advised to be avoided for people with kidney disease is due to its potassium content. 1 cup of dairy milk contains 366 mg of potassium. Some people with kidney disease may be restricted to as low as 2,000 mg potassium daily, so drinking 3 cups of milk per day would add up quick. That said, not all people with kidney disease need to avoid potassium from foods.
If you are watching potassium, however, 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 570mg per 1 cup, but this is not typical for non-dairy milks.
Now that you are in the habit of looking at food labels and ingredient lists however, 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 it’s been determined that non-diet causes are not a factor (discussed in the article I linked above), you may want to consider avoiding non-dairy milks with potassium additives.
For everyone else though, there is likely not a big concern here. 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.
- If you have been advised to limit the potassium in your diet by your renal dietitian, consider choosing a lower potassium non-dairy milk, especially one free of any added potassium. Otherwise, nothing to get overly stressed about.
Some people with kidney problems – such as polycystic kidney disease, or people who are at a high risk to form certain types of kidney stones – may be advised to avoid a compound in food called oxalates. Oxalate is a compound found in some foods that is not considered to be a nutrient. This means it is not used by the human body in any way. It is excreted rather than being absorbed into the body.
One of these foods that is higher in oxalates 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. It’s important to know that oxalates are also produced in the body, and for people who have high oxalate urine, much of this comes from the body rather than from food sources. Some more important strategies for prevention of kidney stones include consuming adequate calcium and drinking plenty of water.
- Limit high oxalate foods only if your renal dietitian has specifically advised 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.
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 in regards to your diet and any nutrients you may need to limit.
Some of my favorite non-dairy milks to suggest to clients, that work for many people with kidney disease 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 could 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 to gain 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 😊). Until then, 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