Are plant-based milks causing harmful nutritional deficiencies in children?

Set of vegan non diary milks.

colnihko / iStock

Set of vegan non diary milks.

colnihko / iStock

The American Academy of Pediatrics says yes, but other doctors haven’t seen it.

The milk wars are steaming up. The latest casualty⁠—or perhaps pawn⁠—is the children.

The dairy industry has been lobbying to crack down on plant-based “imitation milks” since at least 2000. This year, they won the support of the American Academy of Pediatrics (AAP), the influential professional organization representing more than 66,000 pediatricians.

Responding to a request for comments by the Food and Drug Administration (FDA) on using dairy food names for plant-based products, AAP President Kyle Yasuda wrote in January, “the AAP recommends that FDA reserve the label of ‘milk’ solely for traditional dairy products to ensure that children receive the optimal nutrition they need to thrive.”

The AAP’s recommendation hinges on anecdotal reports that “the term ‘milk’ in the labeling of dairy-free alternatives has caused parental confusion, leading to the purchase of products that they assume contain traditional dairy ingredients and, thereby, unintentionally causing harmful nutritional deficiencies in their children.”

There is no citation for this assertion: The letter does not specify how many pediatricians have made such reports nor how many children have been affected. It does not describe the severity of these deficiencies, or their consequences.

Outside of AAP, individual pediatricians are less strident in their recommendations.
The AAP does, however, cite two consumer surveys: One by the Midwest Dairy Association, and one by the National Dairy Council. These industry-funded studies found that consumers do not understand the nutritional differences between dairy and plant-based milks, and that many believe alternative milks to be nutritionally equal or superior to cow milk. Thus far, the dairy industry has failed to convince the courts that consumers have been mistakenly buying plant-based milks thinking they were dairy products; arguing that consumers think plant-based milks are nutritionally equivalent is a variation on a theme.

Dr. George Fuchs, a pediatric gastroenterologist and member of the AAP nutrition committee, told New Food Economy that as a practitioner he can attest that the public sees plant-based milks as a nutritionally equivalent dairy substitute, although he has not seen any of the “harmful nutritional deficiencies” described in Yasuda’s letter. Fuchs was not involved in drafting the letter to the FDA (and AAP was unable to connect me with anyone who was before publication) but says the recommendation is in line with AAP’s position on dairy consumption.

But Fuchs says he is not familiar with the studies cited.

“I am aware of the policy and the rationale for the policy as written I think is sound,” he says. “But if there’s a question about the data on which the policy is written, then I really can’t speak to that.”

I asked Fuchs if he thought that the dairy industry could produce fair and trustworthy studies on this topic.

“There’s a conflict of interest there,” Fuchs says. “That doesn’t mean that the study they sponsored is not accurate, but there’s conflict of interest that should be removed from the equation.”

Fuchs clarified by email that conflict of interest can be removed by inserting a firewall “between the study sponsor and implementation and interpretation of the study results.”

Students drinking milk at school

Outside of AAP, individual pediatricians are less strident in their recommendations.

“I don’t think that pediatricians generally have an issue with plant milks being called milk,” Dr. Michelle Dern, a pediatrician at Scripps Coastal Medical Center in Encinitas, California, wrote in an email to New Food Economy.

Deborah Tagliareni, the Clinical Nutrition Manager at the Hassenfeld Children’s Hospital at NYU Langone, says she is not aware of plant-based milks causing problems for parents or children.

Tagliareni says that giving plant-based milk like soy or almond to a child would only be problematic if they weren’t getting key nutrients from another source. Milk is nutritionally dense, containing calcium, magnesium, phosphorus, potassium, protein, vitamin B12 and zinc, but Tagliareni confirmed that children can have a perfectly healthy vegan diet “as long as the parent is aware of which foods contain which nutrients and how to meet vitamin and mineral requirements.”

Even the AAP website makes it clear that children do not need milk.

This is not the first time that AAP has made statements or endorsements sought by the dairy industry.
“While milk can be nutritious, it isn’t absolutely necessary for a healthy diet,” Dr. Claire McCarthy writes, addressing her comments to a parent whose child won’t drink milk. “Other dairy products, such as cheese and yogurt, can provide the same nutrients, as can “alterna-milks” such as soy milk or almond milk, although you should talk to [a] pediatrician before you switch to one of those.”

Tagliareni does not think it’s necessary to rename soy, almond, and other plant-based milks, but that education is important.

“It’s important that consumers are educated on what they’re choosing and how it diverges from what they’re replacing,” she says. “Many different nutrients—and proteins and carbs and fats and vitamins and minerals—can be met in other ways.”

AAP appears to be the only professional association of pediatricians to have taken a side on the issue: The American Pediatric Society did not respond to an email query, and a public relations strategist at the American Academy of Family Physicians said the organization does not have a specific policy on this topic. AAP was the only professional organization whose support was celebrated in a press release by the National Milk Producers Federation. (After this story published, a representative from NMPF pointed out that the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, also has expressed concern about the health effects of plant-based milk on children, as well as suggesting the possibility of confusion with traditional dairy products.)

This is not the first time that AAP has made statements or endorsements sought by the dairy industry. In 2011, former Washington Post reporter Ed Bruske wrote a series of articles about the hotly contested issue of chocolate milk in school cafeterias, which the dairy industry boasted was supported by leading health organizations like the American Heart Association and AAP. At the time, Bruske reported that one of the authors of an AAP statement on the nutritional benefits of dairy, including sugar-laden flavored milk, was also an advisor to the National Dairy Council.

Even the AAP website makes it clear that children do not need milk.
Bruske also reported that the AAP receives funding from the dairy industry. In the fiscal year 2012-2013, for example, the National Dairy Council gave between $100,000 and $249,999, and the Milk Processor Education Program (MilkPEP) gave between $25,000 and $49,999, according to an AAP Honor Roll of Giving. The dairy industry sponsors other influential organizations, too, including the Academy of Nutrition and Dietetics, and lobbied heavily to increase the federal recommendation for daily dairy intake from two to three servings a day.

Not unlike studies funded by the soda industry, one of the dairy industry’s tactics is to fund research that can be used to bolster their arguments, whether for keeping chocolate milk in schools or banning “imitation milks” from the dairy aisle.

“Biased though it may be, industry-funded research, with its gloss of scientific authority, makes its way into widely circulated professional journals such as the Journal of the American Dietetic Association and the Journal of Adolescent Health,” Bruske wrote in 2011. “It then migrates into findings of medical groups like the American Heart Association and the American Academy of Pediatrics… The result is a kind of public relations echo chamber in which dairy industry messages based on “research” it pays for are parroted by proxies in the health and education communities who also have financial ties to dairy.”

Considering how long the industry has been trying to force plant-based milks to be called “juices” or “beverages,” this claim that plant-based milks are hurting children seems merely like a new angle of attack in an old war.

Jessica McKenzie is an independent journalist based in Brooklyn, New York. Her work has been published in The New York Times, National Geographic, Audubon Magazine, Backpacker, and Grist. She also writes a newsletter called Pinch of Dirt.