Foods for Special Dietary Needs: Non-Dairy Plant Based Milk Substitutes and Fermented Dairy Type Products

Abstract

Abstract A growing number of consumers opt for plant based milk substitutes for medical reasons or as a lifestyle choice. Medical reasons include lactose intolerance with a worldwide prevalence of 75% and cow's milk allergy. Also in countries where mammal milk is scarce and expensive, plant milk substitutes serve as a more affordable option. However many of these products have sensory characteristics objectionable to the mainstream Western palate. Technologically, plant milk substitutes are suspensions of dissolved and disintegrated plant material in water, resembling cow's milk in appearance. They are manufactured by extracting the plant material in water, separating the liquid and formulating the final product. Homogenisation and thermal treatments are necessary to improve the suspension and microbial stabilities of commercial products that can be consumed as such or be further processed into fermented dairy type products. The nutritional properties depend on the plant source, processing and fortification. As some products have extremely low protein and calcium contents, consumer awareness is important when plant milk substitutes are used to replace cow's milk in the diet e.g. in the case of dairy intolerances. If formulated into palatable and nutritionally adequate products, plant based substitutes can offer a sustainable alternative to dairy products.

Full text

* Corresponding author. E-mail e.arendt@ucc.ie
Foods for special dietary needs: Non-dairy plant based milk
substitutes and fermented dairy type products
Outi E. Mäkinen1, Viivi Wanhalinna2, Emanuele Zannini1 and Elke K. Arendt1,*; 1
Department of Food Science, Food Technology and Nutrition, University College Cork,
Ireland; 2 Department of Food and Environmental Sciences, University of Helsinki, Finland
Cite as: Crit. Rev. Food. Sci. Nutr. In press, 2015
http://dx.doi.org/10.1080/10408398.2012.761950
Abstract
A growing number of consumers opt for plant based milk substitutes for medical reasons or
as a lifestyle choice. Medical reasons include lactose intolerance with a worldwide
prevalence of 75% and cow’s milk allergy. Also in countries where mammal milk is scarce
and expensive, plant milk substitutes serve as a more affordable option. However many of
these products have sensory characteristics objectionable to the mainstream Western palate.
Technologically, plant milk substitutes are suspensions of dissolved and disintegrated plant
material in water, resembling cow’s milk in appearance. They are manufactured by extracting
the plant material in water, separating the liquid and formulating the final product.
Homogenisation and thermal treatments are necessary to improve the suspension and
microbial stabilities of commercial products that can be consumed as such or be further
processed into fermented dairy type products. The nutritional properties depend on the plant
source, processing and fortification. As some products have extremely low protein and
calcium contents, consumer awareness is important when plant milk substitutes are used to
replace cow’s milk in the diet e.g. in the case of dairy intolerances. If formulated into
palatable and nutritionally adequate products, plant based substitutes can offer a sustainable
alternative to dairy products.
1. Introduction
Plant milk substitutes are water
extracts of legumes, oil seeds, cereals or
pseudocereals that resemble cow’s milk in
appearance. There is a wide variety of
traditional plant based beverages around
the world, for example Horchata, “tigernut
milk” in Spain; Sikhye, a beverage made of
cooked rice, malt extract and sugar in
Korea; Boza, a fermented drink made of
wheat, rye, millet and maize consumed in

2
Bulgaria, Albania, Turkey and Romania;
Bushera, a fermented sorghum or millet
malt based beverage from Uganda, and
traditional soy milk originating from China
(Cortés et al., 2005; Prado et al., 2008;
Kim et al., 2012; Chen, 1989). The most
widely consumed plant milk substitute is
soy milk, a product that started its journey
from Asia to the supermarket shelves in
Europe and the US less than hundred years
ago. The first commercially successful
product was launched in Hong Kong in
1940 and the market grew rapidly during
the seventies and early eighties in Asia
after the development of technologies for
large scale production of mild flavoured
soy milk (Chen, 1989). The demand for
soy milk in the Western world was initiated
by consumers intolerant to cow’s milk, but
the market expanded in the 1990’s and
2000’s as a part of a health trend, and grew
from USD 300 m to USD 4 bn between
1992-2008 in the U.S. (Organic Monitor,
2005; Patisaul and Jefferson, 2010). After
soy received an FDA approved health
claim for lowering the risk for coronary
heart disease in 1999, more than 2700 new
soy products were introduced to the market
(Patisaul and Jefferson, 2010).
Soy products are still dominating the
market in the Western world, but the
emerging of alternative products from
other plant sources such as coconut, oat
and almond have decreased its share
(Mintel, 2011). Overall, the dairy
alternative market is still growing:
Packaged Facts (2012) estimated the U.S.
market for plant based milk substitutes to
have a total value on USD 1.33 bn in 2011,
which is expected to increase to USD 1.7
bn by 2016. Also the market for lactose-
and dairy free products in general,
estimated to be worth USD 3.6 bn in 2010,
is growing in the U.S. and Western Europe.
The figure includes lactose free dairy
products, but much of the growth has been
attributed to soy milk like products
(Leatherhead Food Research, 2011).
According to an estimate, 15% of
European consumers avoid dairy products
for a variety of reasons, including medical
reasons such as lactose intolerance (LI),
cow’s milk allergy (CMA), cholesterol
issues and phenylketonuria, as well as
lifestyle choices like a vegetarian/vegan
diet or concerns about growth hormone or
antibiotic residues in cow’s milk (Jago,
2011) (Leatherhead Food Research, 2011).
LI is generally an inherited
condition (primary hypolactasia) that
disables lactose digestion due to lactase
deficiency, causing abdominal pain,
bloating and flatulence upon the
consumption of lactose containing foods
(Swagerty et al., 2002). The prevalence of
LI varies between ethnic groups, being
below 20% only among white Europeans
and their descendants. The significantly
higher prevalence in other ethnic groups
(50-80% among Hispanic and Black and
nearly 100% among Asian and Native
American populations) has led to a theory
that lactase deficiency is a normal
condition for adult humans and the
frequency of the lactase persistency gene
has increased in cultures where milk has
offered a selective advantage (Sahi, 1994).
LI can also be caused by injuries to the
intestinal mucosa (secondary hypolactasia),
resulting from diseases such as untreated
celiac disease, cystic fibrosis and
gastroenteritis (Bode and Gudmand-Høyer,
1988; Swagerty et al., 2002). Sufferers of
the inflammatory bowel disease have a
higher dairy sensitivity prevalence
compared to the average population (10-
20%), and are often advised to avoid dairy
products (Mishkin, 1997). The main

3
treatment for LI is the avoidance of lactose
containing foods and replacing milk and
dairy products with lactose free dairy or
dairy free alternatives.
CMA is a disorder in which the
immune system reacts to one or more milk
proteins causing an inflammatory response.
Cow’s milk is the most common allergen in
infants, but 80-90% of sufferers acquire a
tolerance by the age of 5 years. The true
prevalence of CMA is 2-6% in infants and
0.1-0.5% in adults, but the number of self-
diagnosed cases is 10-fold higher possibly
due to confusion with LI or misdiagnosis
without clinical evaluation (Crittenden and
Bennett, 2005). The only treatment for
CMA is the complete avoidance of cow’s
milk antigens. Infants with CMA may be
fed with hypoallergenic formulas based on
extensively hydrolysed whey or casein
(Kneepkens and Meijer, 2009).
This review aims to give an
overview on the technological, nutritional
and environmental aspects of plant milk
substitute production and consumption.
Soy milk has been extensively studied and
a body of scientific literature on peanut
beverage exists and reviewed recently
(Diarra et al., 2005; Giri and Mangaraj,
2012), but little has been published on
cereal or pseudocereal based beverages.
2. Technology
2.1. Overview of the process
Plant milk substitutes are colloidal
suspensions or emulsions consisting of
dissolved and disintegrated plant material.
They are prepared traditionally by grinding
the raw material into a slurry and straining
it to remove coarse particles. Although
countless variations of the process exist,
the general outline of a modern industrial
scale process is essentially the same: the
plant material is soaked and wet milled to
extract the milk constituents, or
alternatively the raw material is dry milled
and the flour is extracted in water (Figure
1). The grinding waste is separated by
filtering or decanting. Depending on the
product, standardisation and/or addition of
other ingredients such as sugar, oil,
flavourings and stabilisers may take place,
followed by homogenisation and
pasteurisation/UHT treatment to improve
suspension and microbial stabilities. These
extracts can also be spray dried to produce
powders (Diarra et al., 2005).
Figure 1. The general outline of the
manufacturing process of plant milk
substitutes.
Homogenisation
Pasteurisation/UHT
Packaging
Product formulation
Wet milling
Separation of solids
Extraction
Soaking
Dry milling
Grains / pulses / nuts

4
2.2. Raw material pre-treatments
Plant milk substitutes can be produced
by extracting the soluble material directly
either ground plant material with water or
wet grinding soaked grains or legumes into
a slurry (Diarra et al., 2005). Alternatively,
the product can be reconstituted using
protein isolates or concentrates and other
ingredients, e.g. oils, sugars, salts and
stabilisers (Debruyne, 2006). This
approach also allows the formulation of a
range of related products such as
pharmaceutical beverages, nutritional
supplements, infant formulas, meal
replacers, cream alternatives and fruit
smoothies (Paulsen et al., 2006).
Possible raw material pre-treatments
include dehulling, soaking and blanching
(Debruyne, 2006). Blanching is required to
inactivate trypsin inhibitors and
lipoxygenase that would produce off-
flavours in soy milk (Giri and Mangaraj,
2012). Roasting of the raw material
enhances the aroma and flavour of the final
product, but heating decreases the protein
solubility and extraction yield (Hinds et al.,
1997a; Rustom et al., 1991).
2.3. Extraction
The extraction step has a profound
effect on the composition of the resulting
product. To increase the yield of the
process, the efficiency of this step may be
improved by increasing the pH with
bicarbonate or NaOH, elevated
temperatures or the use of enzymes. Most
cereal and legume proteins have an
isoelectric point under 5, translating to the
lowest solubility (Wolf, 1970). Alkaline pH
during extraction increases the protein
extractability, but a neutralisation step may
be required in the process (Rustom et al.,
1991; Aidoo et al., 2012). A higher
extraction temperature increases the
extractability of fat, but the denaturation of
proteins decreases their solubility and yield
(Rustom et al., 1991). Hot water extraction
of cowpea milk decreases the yield and
protein content compared to cold water
extraction, but improves the protein
digestibility slightly due to trypsin inhibitor
inactivation, and leads to a reduced
extraction of phytic acid (Akinyele, 1991).
Partial hydrolysis of proteins and
polysaccharides using enzymes is another
way to increase the extraction yields (Table
1). Papain and enzymes extracted from
Pestulotiopsis westerdijkii increased the
protein yield of peanut and soy milks
(Rustom et al., 1993; Abdo and King
1967). In addition to proteolytic enzymes, a
mixture of amyloglucosidase and a
cellulase cocktail has been shown to
increase the carbohydrate recovery of
peanut milk (Rustom et al., 1993). Eriksen
(1983) used a variety of enzymes in soy
milk extraction, and found out that the
highest protein and total solids yield was
obtained using a neutral or alkaline
proteinases at their optimum pH, while
pectinase and β-glucanase had little effect.
Enzymes with low pH optima may not be
the most efficient extraction aids even if
the enzyme action per se increases the
yield, as the pH decrease influences the
protein solubility, and thus neutral and
alkali proteases may be the best options. In
addition to increasing the extraction yield,
proteolytic enzymes improve the
suspension stability (Rustom et al., 1991).
Also a cellulase treatment after
homogenisation has been reported to
decrease the particle size and yield a more
stable suspension (Rosenthal et al., 2003).

Table 1. Effect of enzymes in extraction yields of plant milk substitute substitutes.
Raw
material
Enzyme
Dosage/pH/T
Increase in yield
Reference
Peanut
Papain
1:50 protein/ 6.95;
8.0/20 °C; 60 °C
“Significant
increase in protein
extraction”
(Rustom et al.,
1991)
Peanut
Cellulase cocktail
(Viscozyme) and
amyloglucosidase
- / 4.5 / 50°C
13.4%
(carbohydrate)
(Rustom et al.,
1993)
Soy
Enzyme isolate from
Pestulotiopsis westerdijkii
- / 4.6 / 37 °C
22% (protein)
(Abdo and
King, 1967)
Soy
Neutral protease and β-
glucanase cocktail
(Neutrase)
0.5%/7.0 / 50 °C
31% (protein)
20% (total solids)
(Eriksen,
1983)
Soy
Pectinase
2% / 5.5 / 50 °C
11% (protein)
7% (total solids)
(Eriksen,
1983)
Soy
Pectinase, cellulase,
hemicellulase and
protease cocktail (SP-249)
2% / 4.5 / 50 °C
26% (protein)
16% (total solids)
(Eriksen,
1983)
2.4. Separation and starch
liquefaction
After the extraction step coarse
particles are removed from the slurry by
filtration, decanting or centrifugation
(Diarra et al., 2005; Lindahl et al., 2001).
When using raw materials high in fat, such
as peanuts, the excess fat can be removed
using a separator as in dairy processing
(Diarra et al., 2005).
Soy beans and nuts contain little starch,
but when using cereals or pseudocereals the
starch forms a thick slurry when heated
above the gelatinisation temperature (55-65
°C). To prevent this in the further
processing steps, starch can be gelatinised
and liquefied with α-amylase or a malt
enzyme extract (Mitchell and Mitchell,
1990; Tano-Debrah et al., 2005). The
patented process of Lindahl et al. (2001)
employs α- and β-amylases to hydrolyse
the starch until a desired level of sweetness
and viscosity is reached. The liquefaction
step may take place before or after the
removal of coarse particles. However,
according to Mitchell and Mitchell (2010)
and Giri and Mangaraj (2012), heating the
slurry above 50 °C before filtration
compromises the mouthfeel of rice and soy
milks.
2.5. Product formulation
Other ingredients can be added to the
product base after the removal of coarse
plant material. These include vitamins and
minerals used for fortification as well as
sweeteners, flavourings, salt, oils and
stabilisers. As suspension stability is an
issue in plant milk substitute substitutes,
hydrocolloids are often used to increase the
viscosity of the continuous phase, and also
emulsifiers have been proven to be
beneficial in some beverages. (Rustom et
al., 1995) yielded the most stable peanut
milk by using a stabiliser mix for dairy
products containing mono and diglycerides,
glyceryl monostearate, guar gum and
carrageenan, while Hinds et al. (2007b)

6
achieved good results with 0.02-0.04%
carrageenan and 0.2-0.4% mono- and
diglycerides. (Lee and Rhee, 2003) used
pine nuts to improve the stability of a rice
based beverage, as they contain proteins
with good emulsifying properties. Sodium
stearoyl-2 lactylate (SSL), a lipid
surfactant, has been found to bind
specifically to partially hydrolysed oat
proteins and thus enhance the stability of
oat protein suspensions (Chronakis et al.,
2004).
The addition of nutrients in food
substitutes may be necessary to ensure the
nutritional quality of the product. The
nutrients used must be bioavailable and
sufficiently stable, and not cause excessive
changes in product quality. The stability of
vitamins is influenced by several factors
during food processing, and may be
reduced as a result of e.g. heating oxygen
exposure (Richardson, 1990). The
challenge in mineral enrichment is the
reactivity of metal ions with other food
components, and the use of sequestrants
such as citric acid may thus be necessary
(Richardson, 1990; Zhang et al., 2007a).
Some mineral sources used in plant milk
substitutes include ferric ammonium citrate
and ferric pyrophosphate as iron sources
and tricalcium phosphate and calcium
carbonate as calcium sources (Zhang et al.,
2007a; Zhao et al., 2005).
2.6. Homogenisation and suspension
stability
Plant milk substitutes contain insoluble
particles, such as protein, starch, fibre and
other cellular material. These particles,
being denser than water can sediment,
making the product unstable (Durand et al.,
2003). The suspension stability can be
increased by decreasing the particle size,
improving their solubility or by using
hydrocolloids and emulsifiers (Durand et
al., 2003; Rustom et al., 1995). Many plant
milk substitutes coagulate when heating.
When proteins unfold as a result of heating,
the nonpolar amino acid residues are
exposed to water increasing the surface
hydrophobicity. This enhances protein-
protein interactions that can result in
aggregation and sedimentation or gelling
(Phillips et al., 1994). The heat stability of
proteins depends on the pH, ionic strength
and the presence of other compounds such
as minerals and carbohydrates
(McSweeney et al., 2004).
Homogenisation improves the stability
of plant milk substitutes by disrupting
aggregates and lipid droplets and thus
decreasing the particle size distribution
(Malaki Nik et al., 2008). When enough
lipids are present, an emulsion is formed
resulting in a creamier more homogenous
product (Chen, 1989). Homogenisation in
the conventional dairy processing pressure
range (ca. 20 MPa) increases the
suspension stability sufficiently of at least
soy, peanut and rice milk substitutes (Hinds
et al., 1997b; Lee and Rhee, 2003; Rustom
et al., 1995). Ultra high pressure
homogenisation (UHPH) of soy milk at
200-300 MPa reduces the particle sizes
intensely and improves the stability
compared to conventionally processed
products. The treatment also reduces
microbial counts and can be used for
preservation (Cruz et al., 2007). A higher
homogenisation temperature has been
reported to increase the stability of peanut
milk (Hinds et al., 1997a; Rustom et al.,
1995).
In soy milk, heat denaturation of
proteins is required for suspension stability.
Malaki Nik et al. (2008) studied the effect
of heat denaturation alone and in

7
combination with homogenisation (69
MPa) by characterising fractions obtained
by stepwise centrifugation. The protein and
solids content decreased after the first
centrifugation (8000 g) in the untreated
samples, while significant decrease in both
treated samples occurred after the third
centrifugation (40 000 g), indicating an
increase in the resistance to sedimentation
upon heating and homogenisation. Also the
ratios of β-conglycinin (7S) and glycinin
(11S) in the fractions were influenced by
the treatments. This indicates that although
heating decreased the solubility of β-
conglycinin, large glycinin aggregates were
disrupted, resulting in suspensions with
smaller particles and a narrower size
distribution.
2.7. Microbial shelf life extension
Commercial plant milk substitutes are
pasteurised or UHT treated to extend the
shelf life. However heat may cause changes
in protein properties that can influence the
stability, as well as changes in flavour,
aroma and colour (Kwok and Niranjan,
1995; Rustom et al., 1996). Pasteurisation
is carried out at temperatures below 100
°C, and it destroys enough micro-
organisms to enable a shelf-life of ca. 1
week at refrigerated temperatures. In the
UHT treatment the product is heated to
135-150 °C for a few seconds, yielding a
commercially sterile product (Kwok and
Niranjan, 1995). Rustom et al. (1996)
treated a peanut beverage for 4 and 20 s at
137 °C. The longer treatment time
decreased the suspension stability slightly,
but led to higher taste and acceptability
scores. Both treatments were effective in
increasing the microbial shelf life: no
vegetative bacteria, spores or moulds were
detected in the products.
The manufacturing process of
Horchata (tiger nut milk) takes another
approach: the product is not heated to
prevent the starch from gelatinising and the
occurrence of other sensory changes
resulting from heating. Prepared this way
the product has an extremely short shelf-
life. In commercial products, pulsed
electric fields has been suggested to extend
the microbial shelf life (Cortés et al.,
2005). Also other non-thermal processes
such as ultraviolet sterilisation, high
pressure throttling, high pressure
processing and ultra high pressure
homogenisation (UHPH) have been
explored as methods of soy milk
preservation (Bandla et al., 2011; Cruz et
al., 2007; Smith et al., 2009; Sharma et al.,
2009). Sikhye, a Korean rice beverage, is
commonly sold frozen to avoid UHT
related changes in flavour. However
Bacillus cereus spores are a risk, and their
number has successfully been reduced by
tyndallisation with CO2 injection, a
procedure consisting of heating to 80 °C to
activate spore germination, followed by
heating to 95 °C (Kim et al., 2012).
3. Fermented products
Fermentation with lactic acid bacteria
improves the sensory and nutritional
properties, and microbial shelf life of foods
(Leroy and De Vuyst, 2004). Plant milk
substitutes can be fermented to produce
dairy free yoghurt type products while
rendering the raw material into a more
palatable form. For example, the levels of
hexanal responsible for the undesired
beany flavour in peanut milk is efficiently
reduced with fermentation (Lee and
Beuchat, 1991). Also, the levels of
aflatoxin B1 commonly found in peanuts,
is reduced by fermentation with

8
Flavobacterium aurantiacum (Hao and
Brackett, 1988). Fermentation of soy milk
reduced the amount of flatulence inducing
oligosaccharides depending on the α-
galactosidase activity of the strain, and
increased the angiotensin-converting
enzyme (ACE) inhibitory activity (Donkor
et al., 2007). The storage proteins of
various cereals contain known ACE
inhibitory peptides that can be released
using fermentation and exogenous
proteases as has been demonstrated with
rye malt (Hu et al., 2011; Loponen, 2004).
These cereals may have potential as raw
materials for dairy type functional
products.
In order to produce fermented
products, the starter cultures must be able
to grow and dominate the microflora in the
plant medium and produce a desired
texture. Lactic acid bacteria have been used
for cereal fermentations for centuries and
many cereals and pseudocereals are known
to support their growth, but low levels of
fermentable sugars present in some grains
may pose a problem (Zannini et al. 2012).
To overcome this, sugars and food grade
yeast extract can be added to the media
(Diarra et al., 2005). Also, germinating the
raw material to increase the amount of
fermentable sugars and amino acids before
processing improves the growth
performance of probiotic strains
(Charalampopoulos et al., 2002).
Mårtensson et al. (2000) studied the growth
and product characteristics of an oat milk
medium fermented with a range of starter
cultures. They found out, that strains of
Leuconostoc mesenteriodes, Leuc.
dextranicum, Pediococcus damnosus and
Lactobacillus kefiri produced the highest
levels of lactic acid, resulting in a pleasant
flavour. In addition, an EPS producing
strain of L. delbrueckii ssp. bulgaricus
yielded a viscosity comparable to dairy
yoghurts after 72 h fermentation at 25 °C
when glucose was used as a carbon source.
Jiménez-Martínez et al. (2003) obtained a
product with a viscosity similar to dairy
yoghurt but slightly lower hedonic rating
by fermenting milk extracted from Lupinus
campestris seeds with Streptococcus
thermophilus and L. delbrueckii ssp
bulgaricus.
Probiotic dairy products have been
available for years, but also non-dairy raw
materials can be used as vehicles for
probiotic strains for the dairy intolerant or
vegetarian/vegan consumers (Prado et al.,
2008). Donkor et al. (2007) reached desired
therapeutic levels of cells (108 cfu/ml) after
fermenting soy milk with a range of
probiotic strains for 48 h. Mårtensson et al.
(2002) reported inhibition of some
probiotic strains in an oat product when
used in combination with a yoghurt starter
culture, as the pH of the medium decreases
excessively due to a lower buffering
capacity in comparison to cow’s milk.
However a strain of L. reuteri was able to
survive at a therapeutic levelfo at least for
30 days (Mårtensson et al., 2002).
Some authors have used additives
such as CMC, coagulants (calcium citrate),
milk powder and gelatin to enhance the
texture and reduce syneresis in the final
product (Cheng et al., 2006; Yadav et al.,
2010). However, the use of animal
ingredients in this product category in the
Western market excludes the
vegetarian/vegan consumer segment. Yazici
et al. (1997) aimed to increase the calcium
content of peanut yoghurt to the level of fat
free dairy yoghurt, but the calcium salts
decreased the gel strength and promoted
syneresis. In addition to plant milk
substitutes, also suspensions of solid grain
material can been used as media for

9
fermentation, yielding a gruel like product
(Salovaara, 2004). This enables a more
economic utilisation of the raw material, as
well as better preservation of the nutritional
properties such as high fibre content.
4. Nutritional properties
Plant milk substitutes are often
perceived as healthy, possibly due to
negative perceptions about the nutritional
properties of cow’s milk and the health
claims associated with soy (Bus and
Worsley, 2003; Patisaul and Jefferson,
2010). In reality the nutritional properties
vary greatly, as they depend strongly on the
raw material, processing, fortification and
the presence of other ingredients such as
sweeteners and oil. The nutritional values
of plant milk substitutes purchased from a
local store in Ireland are presented in Table
2. When comparing the products, it is
evident that only soy milk has values
comparable to cow’s milk with protein
contents ranging from 2.9-3.7%. All other
products are very low in protein, with only
quinoa, hemp and Oatly oat milk
containing ≥1% protein. This may pose a
risk if plant milk substitutes are used to
replace cow’s milk without knowledge
about the differences, especially when
given to young children: several cases of
kwashiorkor, a protein-energy malnutrition
typical for areas of famine, have been
reported in Western countries as a result of
using rice milk (0.1-0.2% protein) as a
weaning food (Carvalho et al., 2001; Katz
et al., 2005). Also milks produced of
legumes other than soy, such as peanut and
cowpea can have a protein content as high
as 4% (Rustom et al., 1991; Tano-Debrah
et al., 2005). Although plant milk
substitutes are low in saturated fats and
most products have caloric counts
comparable to skim milk, some products
contain as much energy as full milk,
originating mostly from sugars and other
carbohydrates.
Table 2. Some plant milk substitutes on the market. Nutritional values per g/100 ml.
Beverage (manufacturer)
Energy
(kcal)
Protei
n
Carbohydrate
(sugars)
Fat
(saturated)
Fibre
Fortification
Cow’s milk (full) 1
64
3.3
4.6 (4.6)
3.9 (2.5)
-
-
Cow’s milk (skim) 1
33
3.5
4.8 (4.8)
0.3 (0.1)
-
-
Soy (Alpro, UK)
38
2.9
2.8 (2.7)
1.7 (0.3)
0.5
Ca, B2, B12, D, E
Soy (Tesco, UK)
32
3.4
0.2 (0.1)
1.9 (0.3)
0.6
Ca, E, D, B12
Soy (Triballat Noyal, FR)
45
3.7
3.1 (2.7)
2.0 (0.3)
0.8
Ca *
Oat (Alpro , UK)
66
0.4
12.7 (5.7)
1.5 (0.57)
0.0
-
Oat (Oatly, SE)
35
1
6.5 (4.0)
0.7 (0.1)
0.8
Ca, D2, B2, B12
Oat (Hain Europe, BE)
50
0.6
8.6 (4.5)
1.3 (0.2)
1.0
Ca, D2, B12
Kamut, (La Finestra Sul
Cielo,IT)
46
0.7
7.5 (4.6)
1.4 (0.2)
0.5
-
Amaranth (Ecomil, SP)
52
0.6
8 (5.0)
1.9 (0.5)
0.3
-
Sesame (Ecomil, SP)
51
0.6
6.7 (3.4)
2.4 (0.5)
0.2
-
Quino (Ecomil, SP)
46
1.5
3.7 (2.5)
2.8 (0.7)
0.6
-
Hemp (Braham and
Murray, UK)
36
1.3
2.2 (2.1)
2.4 (0.3)
0.2
Ca *, D2
Rice (Hain Europe, BE)
47
0.1
9.4 (4.0)
1.0 (0.1)
0.1
-
Rice (Alpro, UK)
60
0.2
12.2 (5.0)
1.2 (0.2)
0.0
Ca, B1, B6, B12
Almond (Alpro, UK)
24
0.5
3.0 (3.0)
1.1 (0.1)
1.6
Ca, B2, B12, D2
1 Food Standards Agency (2002) McCance and Widdowson’s The Composition of Foods, Sixth
summary edition. Cambridge: Royal Society of Chemistry.; * Seaweed used as a calcium source

Plant proteins are generally of a
lower nutritional quality compared to
animal derived proteins due to limiting
amino acids (lysine in cereals, methionine
in legumes) and poor digestibility
(Friedman, 1996). The nutritional value of
proteins depends mainly on the amino acid
composition and their physiological
utilisation, and absorption that is in turn
affected by processing. Several methods of
evaluating the protein quality have been
used, incl. protein efficiency ratio (PER)
based on weight gain of an experimental
animal and amino acid chemical score
based on comparison to a reference protein
(Friedman, 1996). The method currently
preferred by WHO/FAO is the protein
digestibility-corrected amino score
(PDCAAS) that compares the
concentration of the first limiting amino
acid to a reference pattern (child 2-5
years), that is corrected for the digestibility
(Schaafsma, 2000). PDCAAS and PER
values of some raw materials used in
commercially available plant milk
substitutes are listed and compared to the
values of cow’s milk in Table 3. Both
values are the highest for cow’s milk
followed by heat treated soy. PDCAAS
values for all other raw materials fall below
67.7%, quinoa and hemp scoring highest,
with the exception of amaranth protein
concentrate with a value of 83%. PER of
cow’s milk is 3.1, while the closest plant
protein sources are quinoa, amaranth and
soy (all heat treated) with values 2.7, 2.6
and 2.28, respectively. The extremely low
PER value for raw soy (0.46) reflects the
presence of protease inhibitors that are
inactivated upon heating (Friedman, 1996).
In addition to containing high value
protein, milk and other dairy products
provide 30–40% of dietary calcium, iodine,
vitamin B12 and riboflavin, and population
groups with low milk intakes often have a
poor status for these nutrients (Millward
and Garnett, 2010; Black et al., 2002). To
combat these shortcomings, some plant
milk substitutes are fortified with calcium
and vitamins, mainly B12, B2, D and E
(Table 1). However, consumer awareness is
important as many of these products are
not fortified.
Table 3. Protein efficiency ratio (PER) and PDCAAS values of raw materials used in some
commercially available plant milk substitutes in descending order. Values in italic indicate that the
plant material has been cooked or otherwise heat treated.
PDCAAS (%) a
PER
References
Cow’s milk
120
3.1
(Schaafsma, 2000)
Soy
91; 93
0.46; 2.28
(Schaafsma, 2000) (Michaelsen et al., 2009) (Friedman et
al., 1991)
Quinoa
67.7b
2.7
(Ruales, Grijalva, Lopez-Jaramillo, & Nair, 2002)
(Ranhotra et al., 1993)
Amaranth
63; 83c
1.9 ; 2.6
(Garcia et al., 1987) (Escudero et al., 2004)
Hemp
63-66
-
(House et al., 2010)
Oat
45-51; 60
2.3
(Michaelsen et al., 2009) (Hischke et al., 1968) (Pedo et
al., 1999)
Rice
54
2.0
(Michaelsen et al., 2009) (Juliano et al., 1971)
Wheat
42; 37
1.5
(Schaafsma, 2000) (Michaelsen et al., 2009)
Sesame
-
1.35
(Johnson et al., 1979)
Almond
30
-
(Ahrens et al., 2005)
a Nontruncated values: b Value from infant food formula; c Value from protein concentrate

Calcium absorption depends on the
salt used for fortification as well as the
food matrix (Rafferty et al., 2007). A
comparison between cow’s milk and soy
milk fortified with tricalcium phosphate
revealed a 75% absorption in soy milk
compared to cow’s milk, while no
differences have been observed when
calcium carbonate was used (Heaney et al.,
2000; Zhao et al., 2005). Ionic calcium
precipitates soy proteins especially when
subjected to thermal treatments, which may
influence the calcium content of the
beverage consumed (Pathomrungsiyoung-
gul et al., 2010). Indeed, 82% to 89% of
the calcium in soy and rice milks,
respectively, are separable by
centrifugation at 3740 g, whereas the value
for cow’s milk is 11%, which may indicate
a decrease in the calcium content of a
beverage not properly shaken before use
(Heaney et al., 2005). Despite these
shortcomings, fortified plant milk
substitutes may be a valuable source of
calcium for individuals with medical
conditions that prevent the consumption of
dairy products, and offering soy milk as an
option in elementary schools has been
reported to increase the selection of a
calcium rich beverage slightly (Reilly et
al., 2006).
Some plant derived components
have favourable health effects, that may be
present in the beverages produced from
that raw material. For example, replacing
low fat cow’s milk with oat or soy milks
has been reported to decrease the plasma
cholesterol and low density lipoprotein
(LDL) concentrations of healthy
individuals after a 4 week consumption
period (Önning et al., 1998). Soy has been
perceived as a health food due to its
isoflavone content with reported impacts
on the prevention of e.g. cardiovascular
diseases, prostate cancer and osteoporosis
(Patisaul and Jefferson, 2010). The health
benefits of isoflavones have however
become increasingly controversial and
concerns have been raised especially about
maternal soy intake and the use of soy in
infant formulas. Isoflavones have a
complex interaction in the endocrine
network, and the effect of long term effect
of a soy based diet in early childhood is not
known. The serum isoflavone
concentration of infants on soy formula can
be as high as 10-fold compared to the
concentrations in Japanese adults (Patisaul
and Jefferson, 2010; Andres et al., 2011).
Seeds often contain antinutritive
compounds, such as inositol phosphates
and trypsin inhibitors. Trypsin inhibitors
decrease the digestibility of protein, but are
inactivated by heat treatments (Friedman,
1996). Inositol penta- and hexaphosphates
(phytates) present in all seeds bind divalent
cations such as calcium, zinc, iron and
magnesium, and reduce their physiological
availability (Reddy et al., 1982; Sandberg
et al., 2006). Mineral bioavailability of
seeds can be improved by germination,
fermentation, or by using chelating agents
or exogenous phytase (Reddy et al., 1982).
Zhang et al. (2007a) obtained the highest
increase in iron bioavailability of fortified
oat milk using citric acid in combination
with exogenous phytase.
Processing influences the
nutritional properties of foods. For
example, the beneficial effects of oat β-
glucan on serum LDL cholesterol and
postprandial glucose levels are attributed
mainly to the viscosity it forms in aqueous
solutions, which is sensitive to processing
(Wood, 2010). Both homogenisation and
thermal treatments have been reported to
alter the molecular properties of oat β-
glucan (Kivelä et al., 2011; Kivelä et al.,

12
2010). No significant loss of isoflavones
occurs during soy milk processing, but
coagulating the soy proteins in tofu
processing decreases the total isoflavones
by 44% (Wang and Murphy, 1996).
Another study reports a recovery of 54%
isoflavones during soymilk processing and
36% for tofu production (Jackson et al.,
2002).
Water soluble vitamins can be lost
if the raw material is soaked and/or
blanched before the manufacturing process
(Kwok and Niranjan, 1995). Also high
amounts of minerals (Ca, Fe, P, Zn) (45-
74%) are lost during the decanting step in
oat milk production (Ca, Fe, P, Zn) and
47% of native vitamin B6 (Zhang et al.,
2007b). The destruction of heat sensitive
vitamins depends on the time temperature
exposure (Kwok and Niranjan, 1995). UHT
treatment caused a 60% loss of D3 after 5 s
holding time, while increasing the holding
time to 20 s led to a 30% decrease in B12
concentration. The loss of thiamine (B1)
can be minimised by favouring high
temperature short time heat exposure in the
manufacturing process in soy milk
production (Kwok and Niranjan, 1995).
Significant losses of A, D3 and B12
occurred during the storage of oat milk,
while the levels of folic acid and vitamins
C, B6 and B12 are reduced in soy milk
(Zhang et al., 2007b; Kwok and Niranjan,
1995).
5. Consumer acceptance of plant milk
substitutes
Although the demand for plant milk
substitutes is increasing, the unwillingness
of the mainstream consumer to try
unfamiliar foods that are perceived as
unappealing may be a limiting factor. Many
modern day soy milks and related products
may have an improved sensory quality, but
the product group carries a stigma because
of early less appealing products on the
market (Wansink et al., 2005). Legume
milks tend to possess “beany” and “painty”
off-flavours originating from lipoxygenase
activity (Kwok and Niranjan, 1995). The
presence and intensity of the “beany”
flavour depends on processing and storage
conditions of soy milks and varieties with
less lipoxygenase have less “beany”
character (Chambers et al., 2006; Torres-
Penaranda and Reitmeier, 2001). Another
problem is a chalky mouthfeel some
products have due to large insoluble
particles (Durand et al., 2003; Hinds et al.,
1997c).
Palacios et al (2009) compared the
acceptance of lactose free cow’s milks and
soymilks on American adults. Lactose free
cow’s milk was preferred over soy milks,
with no interactive effect for ethnicity,
gender or dairy intolerances (Palacios et
al., 2009). Similar results were obtained in
a study with American school children
(Palacios et al., 2010). In a Swedish study,
oat milk scored higher than medium fat
UHT cow’s milk in general liking, while
soy milk had the lowest score (Önning et
al., 1998). The acceptance of peanut milk
has been shown to depend on the colour,
mouthfeel, the absence of peanut flavour
and similarity to cow’s milk (Diarra et al.,
2005).
Information can increase the
willingness to try novel foods. Taste is the
most important purchase criteria of foods,
and the information about a good and/or
familiar taste increase the willingness to try
an unfamiliar food most efficiently
(Magnusson et al., 2001; Pelchat and
Pliner, 1995). Possible health benefits are
also an important criteria and health
information may increase both the

13
willingness to try and the perceived liking
of a food, while the environmental aspect
is less relevant (Pelchat and Pliner, 1995;
Kihlberg et al., 2005; Magnusson et al.,
2001). Repeated exposure has been shown
to enhance the liking e.g. in the cases of a
bitter beverage and a probiotic beverage
(Stein et al., 2003; Luckow et al., 2006).
Indeed, a 5 day exposure to rice milk
increased both the overall and the
pleasantness of the taste (Russell and
Delahunty, 2004). Also the liking scores
for oat milk increased over 3 weeks of
consumption in male subjects who initially
gave lower scores, while the scores given
by females remained unchanged (Önning et
al., 1998).
6. Impact on climate and land use
At the moment climate change is
considered one of the most important and
serious phenomena caused by human
action. Greenhouse gases (GHG) varying
in their global warming potential are a very
probable cause of global warming (IPCC,
2008). GHG emissions originating from
food production are remarkable: In the
European Union about 29% of total
contributions to global warming are
estimated to come from the food chain
(Huppes et al., 2008). According to FAO,
livestock is responsible of 18% of the
global GHG emissions, of which dairy
production and processing is estimated to
contribute 4% (Steinfeld et al., 2006)
(Gerber, 2010). Main contributors to global
warming from livestock sector are methane
from enteric fermentation, nitrous oxide
from manure and fertilizer, carbon dioxide
from land use changes and agricultural
energy use (Steinfeld et al., 2006). GHGs
differ in their radiative properties and
lifetimes in the atmosphere. The warming
potentials are commonly expressed as CO2
equivalents (CO2-eq), the amount of CO2
emission that would have the same
warming effect (IPCC, 2008).
In addition to GHG emissions,
another major environmental impact of
food production is land use and changes in
soil such as eutrophication and
acidification. Fertile land is a scarce
resource, and foods requiring large
production areas are less sustainable even
if the direct emissions are low (Sonesson et
al., 2010). On a per kg basis, the
production of plant foods generally emits
less GHG and requires less land than does
the production of meat and dairy products
(Sonesson et al., 2010; Nijdam et al.,
2012).
The global warming potential of
cow’s milk varies in the range of 0.84–1.3
CO2-eq/ kg product (De Vries and De Boer,
2010). Studies dealing with the GHG
emissions of plant milk substitutes are
scarce, but the few reports published
suggest lower values compared to cow’s
milk. According to Smedman et al. (2010)
the GHG emissions produced during a life
cycle of oat and soy drinks are 0.21 and
0.31 kg CO2-eq/kg product. The global
warming potential for commercial Oatly
oat milk is 0.32 g CO2-eq/l product
(Dahllöv and Gustafsson, 2008). Mikkola
and Risku-Norja (2008) compared the pre-
farm gate GHG emissions from optional
milk production systems in Finland. The
estimated emissions expressed as kg CO2-
eq per capita per year were 4-8 times
higher for cow’s milk compared to oat and
soy milks.
The nutritional profiles of dairy and
plant based products are different, which
makes the direct comparison of the GHG
emissions challenging. One approach is to
relate the environmental impact to the

14
protein content. Nijdam et al. (2012)
evaluated the GHG emissions and land use
of protein from different sources. The
productions of one kg protein from milk
emits 28-43 CO2-eq and requires 26-54 m2
land, whereas the figures are 4-10 CO2-eq
and 10-43 m2 for pulse protein and 6-17
CO2-eq and 4-25 m2 for vegetable based
meat analogue protein. González et al.
(2011) estimated so-called protein delivery
efficiency GHG values (g protein/kg CO2-
eq) for a range of foodstuffs. The values
were 31 g for milk and 505 g, 359 g and 56
g for unprocessed soybean, oat and rice
protein, respectively. Smedman et al.
(2010) developed a so-called nutrient
density to climate impact index (NDCI),
aiming to reflect the proportion of daily
nutrient requirements and the contribution
of each nutrient to the Swedish diet in
relation to the GHG emissions. As a result
the index for cow’s milk was superior to
oat and soy drinks. The equation used in
this study has however been criticised as
biased and the finding questioned by other
scientists in the field (Scarborough and
Rayner, 2010).
Judging from the very limited
literature, plant milk substitutes have a
lower impact on the climate and require
less land to produce, but the issue is more
complex as cow’s milk contains several
key nutrients that are challenging to
replace.
Conclusions and future outlook
Plant based milk substitutes have a
reputation of “health foods” but the
products on the market vary remarkably in
their nutritional profiles, some having very
low protein and mineral contents. If these
products are to be portrayed as substitutes
for cow’s milk, protein content and quality
as well as fortification has to be considered
by manufacturers. Attention should be
brought to the possible ways of improving
the nutritional properties by processing
means e.g. the use of enzymes and the
selection of raw materials based on their
protein quality. Also a reconstitution
approach may allow a more efficient
extraction of protein from the material and
the formulation of higher protein products.
This would however increase the costs and
also the environmental impact of the
products. More knowledge is required to
overcome the mineral fortification related
stability issues.
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