Summary: In a small crossover trial of 22 adults with type 2 diabetes and overweight or obesity, almond milk offered no additional glycaemic benefit over 2% cow milk: the primary outcome, glucose incremental area under the curve over 240 minutes, did not differ across the three drinks. The only significant signal was a secondary one, with carbohydrate-matched 2% milk producing higher insulin and glucagon responses than almond milk.
PICO Summary
| Element | Detail |
|---|---|
| Population | 22 adults with type 2 diabetes and overweight or obesity (mean age 66 years, 36% female); three-way crossover, open-label randomised controlled trial, United States. |
| Intervention | Almond milk served with oatmeal, consumed on a separate day in random order (n=22; each participant served as own control). |
| Comparison | Carbohydrate-matched 2% cow milk and calorie-matched 2% cow milk, each served with oatmeal (n=22 each; within-subject comparison). |
| Outcome | Primary outcome (glucose iAUC over 0 to 240 minutes): no significant difference across the three drinks (null). Secondary postprandial outcomes (free fatty acids, triglycerides, leptin, gut hormones) also did not differ. The one significant finding: insulin and glucagon iAUC were higher for carbohydrate-matched 2% milk versus almond milk (FDR-adjusted p=0.002 and p=0.02). No confidence intervals, absolute risk reduction, or number needed to treat were reported for this acute mechanistic study. |
Expert Commentary
This trial answers a narrow mechanistic question and answers it honestly: over four hours, swapping 2% cow milk for almond milk in an oatmeal breakfast did not move the postprandial glucose curve, and the primary endpoint was frankly null. The headline that almond milk is glycaemically superior is not supported here. The only statistically significant signal was secondary and physiological, with carbohydrate-matched cow milk eliciting greater insulin and glucagon excursions than almond milk, a finding consistent with the protein and lactose content of dairy rather than evidence of harm. Several cautions temper interpretation. The design was open-label and the sample was just 22 participants, so it was powered to detect only large within-subject differences, and a true modest benefit could have been missed. The crossover acute format also tells us nothing about sustained glycaemia, weight, or HbA1c over weeks. Can I use this with my patients? Cautiously, yes, for a practical reassurance: a person with type 2 diabetes choosing unsweetened almond milk over 2% cow milk should not expect a meaningful single-meal glucose advantage, and either can fit a carbohydrate-aware plan. Longer, blinded, hard-endpoint trials are needed before any stronger claim.
References
Dhaver S, Al-Badri M, Mitri J, Barbar Askar AA, Mottalib A, Hamdy O. 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. Nutrients. 2025;17(13):2092. doi:10.3390/nu17132092