Plant-based drinks

What about using rice “milk”?

Drinks based on plants such as rice, coconut, almond, hemp, or potato look milky, but nutritionally they are very different from human and cow’s milk. They may contain lots of sugar and little protein. Many are not fortified with any minerals or vitamins. They are not suitable for babies and may be dangerous or even deadly. At least 30 cases of nutritional diseases have been documented in children whose primary “milk” was plant-based.

A) Plant-based drinks

Plant-based drinks may be based on:

  • Rice
  • Coconut
  • Almonds
  • Hemp
  • Oats
  • Potato
  • Soy (different from soy-based infant formula)

They look milky but are nutritionally very different from breast milk, infant formula, and cow’s milk. They often contain large amounts of sugar and other than soy milk, very little protein (Vanga 2018). Many are not fortified with any minerals or vitamins. Adults can use these drinks in small amounts without harm. They are not meant for the feeding of infants.

B) Risks of using plant-based drinks

Milk is a baby's only food for about the first six months of life and remains their main food for the remainder of the first year of life. Babies grow quickly during this time. Drinks that are not specifically designed for them may be extremely dangerous and even deadly.

At least 30 cases of nutritional diseases have been documented in children whose primary “milk” was plant-based (Vitoria 2017). These milks have many deficiencies including low amounts of (Carvalho 2001; Houck 2019; Le Louer 2014; Mesa Medina 2009; Vitoria 2016; Vitoria 2017):

  • Protein and energy, which can cause swelling, irritability, open wounds, and an enlarged liver and abdomen (kwashiorkor).
  • Iron, which can cause anemia.
  • Zinc, which can cause skin rashes, poor growth, and slow brain development.
  • Vitamin D, which can cause weakness, bowed legs, and a failure to grow (rickets).
  • Salt (sodium), which can cause seizures. 
  • Calcium, which can cause seizures.
  • Iodine, which can result in hypothyroidism.
  • Vitamin C, which can cause scurvy.

It is possible for children to be allergic to coconut, almond, and soy milks (Vojdani 2018).

C) When plant-based drinks can be used

If breast milk is not available, babies should receive appropriate infant formula until about 1 year of age and then be given at most 500 millilitres (2 cups) of whole cow’s milk a day.

Fortified soy milk can be given after a child is two years of age if the child cannot tolerate cow’s milk.  

For children over two years of age, as plant-based beverages (other than soy) are low in protein, children drinking a plant-based beverage as their main milk source should be offered a variety of lean meats, poultry, fish, beans and lentils, eggs, tofu and nuts to ensure adequate intake of protein. 

Please consult your health-care providers for more information.

References

Carvalho NF, Kenney RD, Carrington PH, et al. Severe nutritional deficiencies in toddlers resulting from health food milk alternatives. Pediatrics. 2001 Apr;107(4):E46
 
Houck J, Ganti L, Vera A E. A Case of Hyponatremia-induced Seizures in an InfantSecondary to Water Intoxication from the Use of Almond Milk. Cureus 2019;11(10):e5899
 
Le Louer B, Lemale J, Garcette K, et al. [Severe nutritional deficiencies in young infants with inappropriate plant milk consumption]. [Article in French]. Arch Pediatr. 2014 May;21(5):483-8
 
Mesa Medina O, González JL, García Nieto V, et al. [Infant metabolic alkalosis of dietetic origin].[Article in Spanish] An Pediatr (Barc). 2009 Apr;70(4):370-3
 
Vanga SK, Raghavan V. How well do plant based alternatives fare nutritionally compared to cow's milk? J Food Sci Technol. 2018 Jan;55(1):10-20
 
Vitoria I. The nutritional limitations of plant-based beverages in infancy and childhood. Nutr Hosp. 2017 Oct 24;34(5):1205-1214
 
Vitoria I, López B, Gómez J, et al. Improper Use of a Plant-Based Vitamin C-Deficient Beverage Causes Scurvy in an Infant. Pediatrics. 2016 Feb;137(2):e20152781
 
Vojdani A, Turnpaugh C, Vojdani E. Immune reactivity against a variety of mammalian milks and plant-based milk substitutes. J Dairy Res. 2018 Aug;85(3):358-365