17 Jun 2022

Through BDA surveys during Danone’s 10-year corporate membership, it is clear that dietitians still have questions they would like answered about the role of plant-based drinks in the UK diet. Dietitian Kate Arthur, from Alpro, has pulled together some thoughts on the most commonly asked questions.

UK consumption of plant-based drinks such as those based on soya, oat, almond and rice is increasing. Reasons for choosing these are varied and include lactose intolerance, cow’s milk protein allergy, taste preference and wishing to follow a sustainable diet.1,2

Does the increase in plant-based alternatives reflect the vegan movement?

There are currently approximately 600,000 people following a vegan diet in the UK, making up 1.21% of the population.3 However, 33% of people in the UK now consume plant-based drinks, demonstrating that these beverages are regularly included as part of non-vegan dietary patterns.1 This is an important consideration when studying the nutritional impact of increasing plant-based drink consumption.

Is soya linked to the destruction of the Amazon rainforest?

A common misconception is that our intake of soya products contributes to the destruction of the Amazon rainforest, through land being cleared for soya plantations. The vast majority of Amazonian soya is grown for animal feed, particularly pig and poultry fodder, rather than for human consumption. In fact, over 90% of soya produced for direct human consumption in Europe comes from North America, Europe or Asia.4,5

If we swap cow’s milk for plant-based drinks, will we miss out on key nutrients?

Dairy is a key provider of protein, vitamins B2 and B12, iodine and calcium.6 Plant-based drinks (with the exception of coconut) are naturally low in saturated fat and the non-organic mainstream variants are fortified with calcium and vitamins B12 and B2, often to similar levels as those found in dairy. Many plant-based drinks are also fortified with vitamin D, which helps with the absorption of calcium. With regard to iodine, more brands are now introducing iodine fortification.

Will we get enough protein from plant-based drinks?

UK adults are recommended to get 10% of their energy intake from protein.7 According to National Diet and Nutrition Survey data, current intakes are 17.5-17.7% of energy and are therefore in excess of recommendations.6

Protein from soya drinks and alternatives to yogurt is comparable to dairy. Other plant-based drinks based on nuts, oats and rice are of course much lower in protein than dairy. However, it is important to remember that the dairy and dairy alternatives food group’s main contribution to the diet should be calcium and not protein for those five years and over.8

What is the calcium adequacy of plant-based drinks?

On average, UK adults currently meet dietary calcium requirements, with cow’s milk contributing 17-18% of the calcium in those aged 11-64 years.6 Cereal products are another key contributor at 30-38%, predominantly due to calcium-fortified wheat flours.

Most UK plant-based drinks are fortified with calcium at a comparable level to cow’s milk. A further benefit is the addition of vitamin D, which supports calcium absorption.  Consumers of plant-based drinks are recommended to choose unsweetened calcium-fortified options.8 Overall dietary adequacy and strength exercise alongside other health behaviours are also crucial for maintaining bone health.9,10

In the case of plant-based drinks, the majority of nonorganic varieties are fortified with vitamins D, B2, B12 and calcium, which are valuable nutrients and often lacking in UK diets

What about iodine and plant-based drinks?

Although average UK adults are iodine sufficient, populations at risk include those who avoid dairy and/or fish, pregnant women, and males between 11 and 18 years.8

Cow’s milk provides 20-30% of UK iodine intake.6 Other contributors of iodine in the UK diet include yogurt, cheese, fish and seafood, eggs, meat and cereal products.

Iodine fortification of plant-based drinks is increasing; however, this practice is unlikely to improve the iodine status of all at-risk groups. If cow’s milk is avoided and alternative iodine sources are not consumed, a 150μg non-seaweed supplement is recommended daily.11

Are plant-based drinks considered ultra-processed?

Concerns have been raised around the potential categorisation of plant-based drinks as ultra-processed foods. Although for some products, processing involves the addition of free sugars, fat and salt, which will make them less beneficial to health,12 some level of processing can be beneficial, producing a nutrient profile that supports the health of specific population groups. In the case of plant-based drinks, the majority of non-organic varieties are fortified with vitamin D, B2, B12 and calcium, which are valuable nutrients that are often lacking in UK diets.6 It is therefore important to consider the role of food in the overall diet, rather than solely the level of processing.13

Are nutrients from whole foods more bioavailable than synthetic additives?

Although a food-first approach is often preferential, foods and supplements containing isolated nutrients play a significant and cost-effective role in nutritional health, as seen in the fortification of cereals with iron and vitamin D.14

Multiple factors play a role in the bioavailability of nutrients, including structure, dosage, diet and gut microflora.9 Increased levels of phytate and oxalates in plant-based foods can hinder mineral absorption in the short term. However, in the case of iron, studies have found that the body adapts after consuming a higher phytate diet over the long term and becomes more efficient at how it absorbs and utilises the mineral.15-20 In the case of plant-based drinks, the level of phytates is questionable as the products are heavily diluted and the heat treatment would significantly reduce the binding capacity of phytates.

How can plant-based drinks complement sustainable eating recommendations?

A global shift towards a more sustainable food system is required to support climate change mitigation targets. Plant-based alternatives play a role in this movement, particularly in high- and middle-income countries.2 In addition, the British Dietetic Association states that a well-planned, fully plant-based diet can support nutritional needs at every life stage.21 Plant-based drinks therefore provide an ‘easy-win’ opportunity to complement a sustainable and nutritionally balanced diet.

For more evidence-based fully referenced information on the nutritional and environmental adequacy of plant-based diets and drinks please visit

References

  1. Food and Drink: The cream of the vegan milk crop: Sales of oat milk overtake almond in the UK. Mintel Press Office. https://www.mintel.com/press-centre/food-and-drink/the-cream-of-the-vegan-milk-crop-sales-of-oat-milk-overtake-almond-in-the-uk Published 2021. Accessed April 30, 2022
  2. Alae-Carew C, Green R, Stewart C et al. The role of plant-based alternative foods in sustainable and healthy food systems: Consumption trends in the UK. Sci Total Environ. 2022;807(Pt 3):151041. DOI: doi.org/10.1016/j.scitotenv.2021.151041
  3. Number of vegans in Great Britain from 2014 to 2019. Statista 2021. statista.com/statistics/1062104/number-of-vegans-in-great-britain/. Accessed May 3 2022.
  4. Rajao R, Soares-Filho B, Nunes F. The rotten apples of Brazil’s agribusiness. Science 2020;369(6501):246-248. DOI: doi.org/10.1126/science.aba6646
  5. Appetite for destruction. WWF 2017. wwf.org.uk/sites/default/files/2017-11/WWF_AppetiteForDestruction_Full_Report_Web_0.pdf. Accessed May 3 2022.
  6. PHE, FSA, MRC. Official Statistics: NDNS results from years 9 and 11 (combined) of the rolling programme 2016-2017 & 2018-2019. Gov.UK. Dec 11, 2020. Available at: gov.uk/government/statistics/ndns-results-from-years-9-to-11-2016-to-2017-and-2018-to-2019. Accessed April 30, 2022
  7. Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Department of Health Report of Health and Social Subjects. assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/743790/Dietary_Reference_Values__A_Guide__1991_.pdf. Published 1991. Accessed April 30, 2022.
  8. PHE. Eatwell Guide: From Plate to Guide: What, why and how for the eatwell model. Gov.UK. 2016. Available at: gov.uk/government/publications/the-eatwell-guide. Accessed April 30, 2022.
  9. Malmir H, Larijani B, Esmaillzadeh A. Consumption of milk and dairy products and risk of osteoporosis and hip fracture: a systematic review and Meta-analysis. Crit Rev Food Sci Nutr. 2020;60(10):1722-1737. doi: doi.org/10.1080/10408398.2019.1590800
  10. Thorpe DL, Beeson WL, Knutsen R et al. Dietary patterns and hip fracture in the Adventist Health Study 2: combined vitamin D and calcium supplementation mitigate increased hip fracture risk among vegans. Am J Clin Nutr. 2021;114(2):488-495. doi: doi.org/10.1093/ajcn/nqab095
  11. Bath S & Rayman M. Iodine: Food fact sheet. BDA May 2019. bda.uk.com/resource/iodine.html
  12. Monteiro CA, Bertazzi Levy R, Claro RM. A new classification of foods based on the extent and purpose of their processing. Cad Saude Publica. 2010;26(11):2039-49. doi: 10.1590/s0102-311x2010001100005
  13. BDA Position Statement: Processed Food: bda.uk.com/uploads/assets/06661eb4-b635-44a7-b3a1f753525c8f99/53f7356a-51eb-42c9-b1fbc6680230fbf3/Processed-Food-Position-Statement-FINAL-approved.pdf. Published 2020. Accessed April 30, 2022.
  14. Olson R, Gavin-Smith B, Ferraboschi C et al. Food fortification: The advantages, disadvantages and lessons from sight and life programs. Nutrients. 2021;13(4):1118 doi: doi.org/10.3390/nu13041118
  15. Gavin, M., McCarthy, D. and Garry, P. (1994). Evidence that iron stores regulate iron absorption – a setpoint theory. Am J Clin Nutr. 1994;59(6):1376-1380
  16. Gibson R. Content and bioavailability of trace elements in vegetarian diets. Am J Clin Nutr.1994;59(5Suppl):1223S-32S
  17. Hunt, J. and Roughead, Z. (2000). Adaptation of iron absorption in men consuming diets with high or low iron bioavailability. Am J Clin Nutr. 2000;71(1):94-102
  18. Hunt J, Roughead Z. Nonhemeiron absorption, fecal ferritin excretion, and blood indexes of iron status in women consuming controlled lactoovovegetarian diets for 8 wk. Am J Clin Nutr..1999;69(5):944-52
  19. Armah S, Boy E, Chen D et al. Regular Consumption of a High- Phytate Diet Reduces the Inhibitory Effect of Phytate on Nonheme-Iron Absorption in Women with Suboptimal Iron Stores. J Nutr.2015;145(8):1735-9
  20. Melina V, Craig W and Levin S. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016;116(12):1970-1980
  21. British Dietetic Association confirms well-planned vegan diets can support healthy living in people of all ages. BDA 2017. bda.uk.com/resource/british-dieteticassociation-confirms-well-plannedvegan-diets-can-support-healthyliving-in-people-of-all-ages.html. Accessed April 30, 2022
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Author

Kate Arthur RD

Nutrition Manager, Danone UK & Ireland