Clinical Context
Plant-based milk alternatives have surged in popularity, with many consumers perceiving them as healthier than dairy milk, particularly for blood sugar management. Almond milk, one of the most popular alternatives, is notably lower in carbohydrates and calories than cow’s milk. This has led to assumptions that almond milk would produce smaller blood sugar spikes and be preferable for people with diabetes.
However, the metabolic effects of foods extend beyond simple carbohydrate content. Dairy proteins (whey and casein) have unique insulinotropic properties—they stimulate insulin release independent of their carbohydrate content. Dairy also affects incretin hormones (GLP-1, GIP), glucagon secretion, and satiety. The net glycemic effect depends on the complex interplay of these factors, not just carbohydrate grams.
This RCT directly compared almond milk and 2% cow milk in patients with type 2 diabetes, measuring not just glucose but a comprehensive panel of postprandial metabolic responses. The carbohydrate-matched design controls for simple carbohydrate differences, allowing assessment of the milks’ distinct metabolic effects.
Study Summary (PICO Framework)
Summary:
In overweight/obese patients with type 2 diabetes, almond milk did not improve postprandial glycemia or metabolic parameters compared to 2% cow milk (carbohydrate-matched). Cow milk produced greater insulin and glucagon responses. Both well-tolerated.
| PICO | Description |
|---|---|
| Population | Overweight/obese adults with type 2 diabetes. |
| Intervention | Almond milk (carbohydrate-matched). |
| Comparison | 2% cow milk. |
| Outcome | No glycemic difference over 4 hours. No difference in FFAs, triglycerides, leptin, GI hormones. Cow milk: higher insulin and glucagon responses. |
Clinical Pearls
1. Lower carbohydrate doesn’t automatically mean better glycemic response. Almond milk has dramatically fewer carbohydrates per serving than cow’s milk, yet when matched for carbohydrate content, no glycemic advantage emerged. This challenges simplistic carbohydrate counting and highlights that food matrix, protein content, and hormonal effects matter for glycemic impact.
2. Dairy’s higher insulin response didn’t produce worse glycemia. Cow milk stimulated more insulin release, but this didn’t translate to hypoglycemia or obviously superior glycemic control. In diabetics with residual beta-cell function, this insulinotropic effect may help manage postprandial glucose. The higher glucagon response with dairy is intriguing and may reflect amino acid stimulation of alpha cells.
3. Neither milk produced concerning metabolic effects. Free fatty acids, triglycerides, leptin, and GI hormones didn’t differ meaningfully between groups. Both options appear metabolically acceptable for diabetics. The choice between them needn’t be driven by acute postprandial glycemic fears.
4. The study addresses a specific population—overweight/obese T2DM. Results may differ in lean diabetics, type 1 diabetics, or non-diabetics. However, this is precisely the population most commonly using plant-based milks for presumed metabolic benefits, making the findings clinically relevant.
Practical Application
Don’t recommend almond milk over dairy specifically for blood sugar: Based on this study, diabetic patients don’t need to avoid dairy milk for glycemic reasons. If they prefer cow’s milk for taste, cost, or nutritional profile (protein, calcium, vitamin D), it’s metabolically acceptable. The perception that plant-based milks are “better for blood sugar” isn’t supported by this evidence.
Consider total nutrition, not just glucose: Cow milk provides substantially more protein (~8g vs ~1g per cup for almond milk), naturally occurring calcium and vitamin D, and complete protein with essential amino acids. Almond milk is lower in calories, which may benefit weight management goals. The choice depends on individual nutritional priorities beyond acute glycemia.
For patients concerned about dairy, reassure that metabolic effects are similar: Some patients avoid dairy based on vague concerns about “inflammation” or “blood sugar spikes.” This study provides evidence that in diabetics, acute metabolic responses to dairy aren’t concerning compared to almond milk. Evidence-based reassurance can reduce unnecessary dietary restriction.
Account for whole meals, not isolated foods: This study examined milk in isolation. Real-world consumption involves milk with cereal, coffee, smoothies, or other foods. The glycemic impact of any single food is modified by the overall meal composition. Focus on overall dietary patterns rather than demonizing or glorifying individual foods.
How This Study Fits Into the Broader Evidence
Dairy’s insulinotropic effect is well-documented. Whey protein in particular produces rapid insulin release that can improve postprandial glucose management. Some studies suggest dairy consumption is associated with reduced diabetes risk, possibly through this insulinotropic mechanism or other bioactive components.
Plant-based milk alternatives vary enormously in nutritional content. Almond milk is low in calories, protein, and carbohydrates. Oat milk is higher in carbohydrates and may have different glycemic effects. Soy milk has protein content comparable to dairy. Generalizing across “plant milks” isn’t appropriate—each has distinct metabolic profiles.
Dietary guidelines generally recommend low-fat dairy as part of healthy eating patterns, including for diabetics. This study supports that recommendation by showing that dairy milk doesn’t produce worse glycemic outcomes than a popular plant-based alternative.
Limitations to Consider
This was an acute postprandial study (4 hours); chronic effects of long-term dairy vs. almond milk consumption weren’t assessed. Carbohydrate matching controls for one variable but doesn’t reflect real-world serving sizes (a cup of almond milk has fewer carbs than a cup of cow milk in practice). The specific almond milk formulation matters—sweetened vs. unsweetened, fortified vs. unfortified. Sample size and statistical power for detecting small differences should be considered.
Bottom Line
Almond milk did not improve postprandial glycemia, lipid responses, or gastrointestinal hormone profiles compared to 2% cow milk (carbohydrate-matched) in overweight/obese patients with type 2 diabetes. Cow milk produced greater insulin and glucagon responses, but this didn’t translate to glycemic disadvantage. Both options are metabolically acceptable for diabetics. The choice between dairy and plant-based milks for diabetes management should be based on total nutritional profile, personal preference, and cost rather than assumptions about glycemic superiority of plant-based options.
Source: Shilton Dhaver, et al. “Effect of Almond Milk Versus Cow Milk on Postprandial Glycemia, Lipidemia, and Gastrointestinal Hormones in Patients with Overweight or Obesity and Type 2 Diabetes: A Randomized Controlled Clinical Trial.” Read article here.
