This post was last updated 5/1/2017. Please keep in mind that the ingredient list for products may change over time.
When it comes to the milk aisle the number of choices seems to grow daily. Consumers are clamoring for dairy alternatives to satisfy their love of milk without dairy. Skim, 2% and whole milk have now been joined by a wide variety of alternative “milks.” Soy milk, almond milk, cashew milk, hemp milk and coconut milk – to name a few, now grace the milk cases, both delighting and intimidating consumers. The question “which milk is best for me?” is a complicated one for individuals with renal failure especially since there are so many factors to consider. (Hey, no worries, we’re here for you!)
First off, individuals with renal disease are recommended to limit cow’s milk. Why? Damaged kidneys have a harder time clearing excess potassium and phosphorus, two nutrients that are naturally abundant in milk. An 8-ounce glass of 1% milk contains 102 calories, 8 grams of protein, 107 mg sodium, 232 mg phosphorus, and 366 mg potassium. To put that in perspective, the recommended amount of phosphorus per day is 800 mg. The recommended amount of potassium depends on many factors but ranges from 2000 mg per day for those who need to restrict potassium, all the way up to 4700 mg daily.
To some individuals avoiding cow’s milk is not a difficult dietary restriction. But for the avid cereal-eater and milk drinkers (me!!), cutting back on milk is a difficult challenge. While nothing truly compares to a glass of cow’s milk, there is a burgeoning industry of alternative “milks” such as almond milk, rice milk, oat milk, hemp milk, soy milk, etc…
Before you go switching to the first soy milk you can find consider this: Similar products (but different brands) are not created equal. Every brand has their own formulation with wide variations in phosphorus and potassium. Alternative milks are notorious for phosphate additives, so finding a good brand is critical.
First and foremost, always read your labels. Yes, always read your labels. And finally, always read your labels . The better you get at reading labels, the more power you have with your renal diet choices. Why is that?
PHOS in alternative milks
Label reading is your best tool to figure our you are really consuming especially phosphorus. Phosphorus (whom I call Pesky Phos) is naturally found in almost all the milk alternatives out there. Almond milk, rice milk, and soymilk naturally have 20 mg, 50 mg, and 80-150 mg of phosphorus per cup, respectively (psst…that’s not too bad compared to the 230 mg found in cow’s milk).
Almond milk and rice milk are naturally low in phosphorus, with soymilk being relatively higher. The real problem is that phosphorus is added to alternative milks. This significantly increases the phosphorus content of a product. For example, a cup of Great Value™ Soymilk Original has tri-calcium phosphate and 250 mg of phosphorus, whereas a class of soymilk without these additives only has 80-150 mg. Also important to note, the phosphates added to these milks are inorganic phosphates. That’s especially not good when it comes to phos because they are very bioavailable aka efficiently absorbed by the body..
Second thing you should know is how you’ll know if it actually has phos. Phosphorus is not always found on the nutrition facts panel, which makes it harder for you to know if it was added. This means you must get to know the “ingredients.” That’s the miniscule list below the nutrition facts on your label.
Common phosphorus additives in alternative milks include calcium phosphate, magnesium phosphate, or tri-calcium phosphate. The easiest way to know if phosphorus was added is to look for “P-H-O-S” embedded in the ingredients. If you’re not sure about a product you can always borrow the expert eyes of your dietitian (and make her day just by asking! Promise!)
Potassium in alternative milks
Next up for things to consider is potassium. After some extensive quality time in the natural foods and milk aisle of our local store, (brrr…) we were enlighted by the drastic variations in potassium among products. Soy milk is naturally high in potassium, having about 250-440 mg per cup. This doesn’t mean you can’t drink soy milk but for those with a potassium restriction, this is not your best choice. A lower potassium alternative would be almond milk and rice milk, which only have 150-250 and 20-80 mg per cup, respectively.
Specific products to love or lose
Let’s move on to talking about specific products. Rice milk, without additives (not “enriched”), is one of the best milk alternatives due to its low potassium and phos content. Rice Dream™ Rice Drink Original Unsweetened, or Vanilla is lowest in potassium and phosphorus. This product does not contain phosphate additives and only has about 65 mg potassium per serving. It is much thinner (“watery” being the derogatory term used here by purists) than the other alternative milk products. Almond milk, without additives, is another good milk alternative. The brands to look for are Silk™ Unsweetened Almond Milk (vanilla or plain) and Silk™ Almond Milk Light—these do not contain phosphate additives and are low in potassium (35 mg per serving).
When it comes to soy milk, it you can’t escape the potassium and naturally occurring phosphorus content so going for an different alternative milk is a good choices. HOWEVER, because we believe in making as many foods as possible, “can-do” and if you love soy milk , Pacific™ Soy Select is your best option. It contains 220 mg of potassium and 80 mg (or 8% DV) of phosphorus.
Make your own!
Most of the products we’ve mentioned are store bought ready-to-drink. Making your own milk is actually quite simple and inexpensive for something like oat milk (my personal favorite). Making your own milk obviously allows you to eliminate any additives and sweeten it to your own taste. We hope to post our own alternative milk soon, but until then, here is one that we like from OhSheGlows.com: Oat Milk.
Your local dietitian
Also, an important mention here about your local dietitian. All dialysis units generally have a dietitian on staff (or they should) and she can guide you through local products and help you find one right for you. If you are a patient with earlier stage kidney failure, don’t hesitate to ask your doctor for a referral to visit with a registered dietitian specialized in kidney disease.
*Data is current as of 5/1/2017
Hi, I just started dialysis around a month ago. I am very new at this. Your website is very interesting and helpful. Thank you so much!!!
glad it can be helpful and hopefully more and more new ideas!
So glad you are finding new ideas! Thanks for visiting!
Rice dream Original Non-Fortified is the best (lowest Phos. & Pot.) for CKD and ESRD patients. It has been a staple on cereal and for cooking for me for years, making it easier for me to meet my highly restrictive dietary goals.
Make sure you get the Non-Fortified version; it is a little hard to find. I usually order it on-line by the case (it is very shelf stable).
Thanks for sharing your insight here! I agree with the Rice Dream Non-fortified milk sub. It is hard to find but the lowest in phos and potassium. I am always disappointed with the number of milk subs with added phosphates these days. Looking forward to updating this post in the next couple months as there have been lots of new products and product changes since I originally posted 2 years back.
“Silk” brand unsweetened Almond milk has 0 potassium and 0 phosphate:)
I am glad have drinks for kidney
Thank you. Cause I can’t have dairy products s. Cause of my kidney
I can’t see the table you mention, but due to the ‘wateryness’ Of rice milk we really like cashew milk as an option. It is very low in potassium, and doesn’t have added phosphates, but I’m not sure how much is naturally occurring.
Do you recommend silk unsweetened cashew milk for stage 4 CKD?
Agree! So many great products on the market now! Just always have to watch for those darn phos additives
Ok. So I have no gallbladder, diabetic sugar glucose runs 150 approx. And stage upper 3 kidney disease. What’s my best choice in non dary milks?
I am struggling to find out phosphorus content in various non-dairy yogurts. I do read labels but just because something has “phos” listed way down the label does this mean it’s bad?
Hi Helen – any time you see phos on the label means you should try and avoid. Oui Dairy Free by yoplait or Lava yogurt are good choices.
This is why,as a kidney patient. I do not buy or consume processed foods. Plant based milks are ridiculously easy and cheap to make and contain no harmful chemicals! Takes about 2 minutes costs about 35 cents a quart to make my own oat milk!
That is amazing Cheryl that you are making your own oat milk, this is definitely a great way to avoid any additives!
I just found out on October 2020 that I have CKD stage 2, high cholesterol, High BP, and pre-diabetic. I did a lot of research by DaVita and change the way I ate. We can prevent CKD by increasing by following strict diet to those are still in early Stage. I love meat and other junk food and it’s not easy to give up the food you love! But thinking forward what you’ll be facing later on in life if you don’t take care your health now. I am doing this diet to avoid dialysis and kidney transplant in the future. I know it’s boring to eat the food you don’t like but I feel healthier. These are my daily recipes: I eat Oatmeal with apple sauce (no salt and sugar added) every morning and 1 cup of smoothie. I blended 1 cup of cranberry juice cocktail or Oat Milk with frozen blueberries, cherries, strawberries, pineapple, kale, spinach, arugula and 1 red bell pepper. Then for lunch I eat, 1-slice of white bread with 100% mixed berries jam, almond butter spread (no added sugar and salt ), 2 boiled eggs not eating egg yolks and another 1 cup of smoothies I blended. Then, for dinner I made salmon fish sautéed with garlic, onions and seasoned with parsley powder, black pepper, oregano powder, rosemary and dill powder. Then for my vegetables I sautéed garlic, onions, mushrooms and cabbage seasoned with thyme powder, black pepper, oregano powder and parsley powder. I also eat 1 apple a day to keep the doctor away. I eat them over white rice because eating white rice it’s healthier than brown rice for CKD patient. Make sure to use 100% Olive Oil for cooking. Also, I walk 30 minutes a day too to keep my body healthy.
Hi Rhea,
That is so great that you are taking charge of your kidney health by researching and changing your diet and keeping physically active! It looks like you are eating lots of fresh fruit and vegetables which is wonderful. We like to include brown rice and white rice, but we know that there may be differenced in opinion on whole grains.
Thank you so much for sharing your experience with the KidneyRD community! We’d love it if you can share what you find useful on our website with others.