The SA Journal Diabetes & Vascular Disease Volume 18 No 2 (November 2021)

24 VOLUME 18 NUMBER 2 • November 2021 RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 73 (24): e285–350. 30. Dawha S, Ayoola OO, Ibitoye BO, Ikem RT, Arogundade FA. An assessment of factors influencing resistivity and pulsatility indices in diabetes mellitus. Trop J Nephrol 2014; 9 (1 & 2): 15–22. 31. Milovanceva-Popovska M, Dzikova S. Progression of diabetic nephropathy: value of intrarenal resistive index (RI). Prilozi 2007; 28 (1): 69–79. 32. Afsar MN, Chi H. Millimeter wave complex refractive index, complex dielectric permittivity and loss tangent of extra high purity and compensated silicon. J Infrared Millim Terahertz Waves 1994; 15 (7): 1181–1188. 33. El Dayem SA, El Bohy AE, Hamed M, Ahmed S. Follow up of value of the intrarenal resistivity indices and different renal biomarkers for early identification of diabetic nephropathy in type 1 diabetic patients. Open Access Maced J Med Sci 2017; 5 (2): 188. 34. Škrha J, Šoupal J, Prázný M. Glucose variability, HbA 1c and microvascular complications. Rev Endocr Metab Dis 2016; 17 (1): 103–110. 35. Bruno RM, Daghini E, Landini L, Versari D, Salvati A, Santini E, et al. Dynamic evaluation of renal resistive index in normoalbuminuric patients with newly diagnosed hypertension or type 2 diabetes. Diabetologia 2011; 54 (9): 2430–2439. 36. Ritz E, Schmieder RE, Pollock CA. Renal protection in diabetes: lessons from ONTARGET ® . Cardiovasc Diabetol 2010; 9 (1): 1–10. Are milk alternatives healthier than cow’s milk? Oakland Group T here are a growing number of choices available to consumers when it comes to alternatives to dairy milk on supermarket shelves. However, with the exception of those who are lactose intolerant, to what extent should we be embracing these alternatives and just how healthy are they? ‘Non-milk alternatives – or what we call plant-based beverages – are not better from a health perspective than cow’s milk,’ says registered dietitianMonique Piderit. ‘In fact, most come with nutritional shortfalls compared to cow’s milk, particularly with regard to calcium and protein. They’re also very expensive, which is frustrating as a dietitian as it reinforces the assumption that healthy eating is expensive.’ It’s a common misperception that plant-based beverages such as soy milk, coconut milk, rice milk and almond milk are equal in nutritional value to cow’s milk. ‘While the assumption is that these alternatives are healthier than cow’s milk, consumers who are using them are actually taking a step backwards with their nutrition, given that many of these plant-based beverages fall short of nutrients like protein, calcium and vitamin D,’ reveals Piderit. Cow’s milk is a natural source of easily absorbed protein, calcium, riboflavin, vitamin B 12 , iodine, potassium and phosphorus. Most plant-based beverages, on the other hand, are not naturally high in these nutrients. Although it may be tempting to switch children away from dairy milk to plant-based beverages, experts warn that unless children are lactose intolerant they should stick to dairy milk for the simple reason that it supports growth in children, providing a good source of protein, calcium, vitamin D, amino acids, B12, iodine and magnesium, which are important for overall health as well as bone development and muscle function. ‘Switching a child to a non-dairy beverage means they will fall short of reaching their calcium and protein needs and is not advised,’ says Piderit. ‘The recommended daily allowance for calcium for children aged one to three is 700 mg per day and for those aged four to eight it is 1 000 mg a day. Teenagers should also be encouraged to consume dairy products given that adolescence is a time of significant skeletal development and calcium is required to support this growth.’ Ian Givens, a food chain nutrition expert at the University of Reading agrees that calcium is crucial during adolescence for the development of bone strength. He says that if you don’t get bone development right in your teenage years, you run a higher risk of bone weakness later in life, particularly for women. The South African food-based dietary guidelines recommend that adult consume two to three servings of dairy per day in order to help them reach their need for 1 000 mg of calcium daily. This can include milk, maas, yoghurt or cheese. One serving, which equates to 300 mg of calcium, is the equivalent of one glass of milk, 200 g of yoghurt, 30 g of cheese or 200 ml of maas. Most plant-based beverages are lower in protein, calories, sugar and fat to dairy milk, and have a higher water content. Some, but not all, are fortified with calcium and vitamin D to make them more like milk and many of them have added sugar. However, there is a question mark over whether products fortified with vitamins and minerals provide the same health benefits as those occurring naturally in dairy milk and the extent to which these fortified substances are actually absorbed. Cow’s milk, on the other hand, is a complete protein while the calcium in cow’s milk is highly bioavailable which means the calcium is easily absorbed. For those that are lactose intolerant, there are pros and cons to each plant- based beverage alternative so you need to figure out what properties are important to you given that the nutrient content varies quite significantly across products. Bear in mind, for example, that standard coconut ‘milk’ has on average 15 times more fat than other plant-based beverages, while even reduced fat coconut ‘milk’ has seven times more fat, adding both calories and saturated fat. Rice ‘milk’ has virtually no protein and is high in both carbohydrates and sugar content, which will increase blood glucose levels. Rice ‘milk’, on the other hand, can be harmful to babies and children. Almond ‘milk’ includes virtually no protein while oat ‘milk’ is high in carbohydrates. Piderit recommends making an informed decision before choosing a plant-based beverage. ‘You may need to take a calcium supplement to support the removal of calcium-rich cow’s milk from your diet. Vitamin D may also be low in these beverages so expose your arms and legs to sunlight during the mid-day hours three times a week to make up for this shortfall. Fish, eggs and mushrooms are also good sources of vitamin D. Sugar is commonly added to improve the taste of plant-based beverages so try to choose unsweetened versions.’ The consensus appears to be clear. Plant-based beverages or milk alternatives are not an adequate replacement for dairy products from a nutritional perspective. If you have no alternative but to switch, do your homework carefully. Speak to a registered dietitian to help you make the best choice for your needs.