The Key Nutrients of Dairy Milk in a Plant Protein Alternative.

Demand has grown in recent years for plant-based dairy milk alternatives in Australia. This is partly driven by reported increases in intolerance responses to dairy milk(1), which may contribute to the reasons why so few Australians (~10 %) meet their recommended dairy intakes(2), but also because consumers are looking to explore new dietary options and include more plant-based foods in their diet.

Like Milk is a Pea Protein Milk Drink that has been created to contain similar levels of the key nutrients of cow’s milk. It has the protein, calcium, phosphorus and Vitamin B2 levels of cow’s milk. It also boasts a robust essential amino acid profile (Table 1).

Table 1: Like Milk compared with skim dairy milk

Like Milk contains added Vitamin B12, a hard to get nutrient for those following a vegan-based dietary pattern, plus Vitamin D2, because calcium absorption is maximised when Vitamin D status is optimal(3, 4). Ergocalciferol (Vitamin D2) is included in Like Milk rather than Cholecalciferol (Vitamin D3), to ensure that Like Milk is suitable for vegan-based diets.

The Like Milk Difference

The main difference between Like Milk and other plant milk alternatives is the combination of key dairy milk nutrients, all in one plant-based milk drink.

Specifically, the levels of protein, calcium, phosphorus and vitamin B2 are all similar to the levels in dairy milk. The pea protein essential amino acid profile is also impressive. The addition of Vitamins B12 and D2 provide extra nutritional benefits.

Like Milk is also lactose free and the unsweetened version has zero sugar while the sweetened version contains less than three quarters of the sugar of dairy milk.

So, Like Milk has considerably less energy than the equivalent serve size of dairy milk, which may help when planning nutrient dense, energy controlled dietary intakes.

Like Milk is a nutritious alternative to dairy milk, for those consumers who want the major nutritional benefits of dairy, without the dairy.

References

  1. Yantcheva B, Golley S, Topping D, Mohr P. Food avoidance in an Australian adult population sample: the case of dairy products. Public Health Nutrition. 2016;19(9):1616-23. Access Paper
  2. Australian Bureau of Statistics. 4364.0.55.012. Australian Health Survey: Consumption of Food Groups from the Australian Dietary Guidelines, 2011-12. Access Paper
  3. Daly RM, Brown M, Bass S, Kukuljan S, Nowson C. Calcium- and vitamin D3-fortified milk reduces bone loss at clinically relevant skeletal sites in older men: a 2-year randomized controlled trial. Journal Bone Mineral Research. 2006;21(3):397-405. Access Paper
  4. Aloia JF, Dhaliwal R, Shieh A, Mikhail M, Fazzari M, Ragolia L, et al. Vitamin D supplementation increases calcium absorption without a threshold effect. American Journal Clinical Nutrition. 2014;99(3):624-31. Access Paper

Like Milk Pea Protein Drink

Like Milk has been created to contain similar levels of the key nutrients in cow’s milk. It has the protein, calcium, phosphorus and Vitamin B2 levels of cow’s milk with added Vitamins D2 and B12. It also boasts a robust essential amino acid profile.

Protein satiety to stay fuller for longer

A steady supply of protein is a requirement to allow muscles, bones and other body tissues to continually grow and repair. Protein is also needed to synthesise enzymes, body fluids, messengers and hormones and a whole range of other important biological compounds, as well as providing energy and improving satiety.

By feeling fuller for longer, snacking on discretionary foods may be better controlled and this could have important knock on benefits for body weight maintenance. In a recent study, participants who ate a high-protein breakfast reported longer satiety and consumed fewer lunch-time calories, compared to their counterparts who consumed a low-protein breakfast(1). Similar results have been reported in ‘breakfast skipping’ teenagers(2).  When protein contributes a higher proportion of total energy it can assist with weight loss, as seen among participants who lost almost 5 kg over 12 weeks with a 30% protein contribution to total energy intake(3).  With protein levels as high as cow’s milk, adding Like Milk to a healthy breakfast may assist in providing longer lasting energy as part of a balanced diet.

Calcium and body health

Inadequate amounts of calcium are a major risk factor for osteoporosis and the importance of maintaining calcium stores increases with age. In addition to skeletal development and maintenance, calcium is essential for neuromuscular and cardiac health. As calcium plays a role in muscle contraction, it is heavily relied upon by the heart. While the role of calcium in the prevention of cardiovascular disease is unclear, a meta-analysis reported a dose-dependent relationship between calcium and cardiovascular-associated death(4). More recently, higher dietary calcium intakes were reportedly associated with a decreased risk of cardiovascular disease among Korean women(5). All this means that the benefits of calcium in the diet appear to go beyond those traditionally understood benefits associated with bone and muscle health.

Calcium, phosphorous and bone health

Along with magnesium and vitamin D, adequate intakes of calcium and phosphorous are essential for bone health. When the calcium and phosphorous minerals are present in the optimal ratio of 1-2:1, it is considered particularly beneficial for skeletal health during the developmental years(6, 7). Favorable ratios of calcium and phosphorous are also positively associated with bone mass density among adults(8). The calcium to phosphorous profile in Like Milk reflect this optimal ratio.

Vitamin B2 and its various roles in human health and wellbeing

The primary role of Vitamin B2 (riboflavin) is its involvement in energy production in the body. Vitamin B2 is also important for our sight and the integrity of our skin. Insufficient amounts of this metabolic catalyst may lead to a variety of complications including impaired vision, dermatitis, oral inflammation or normocytic anaemia. The role of Vitamin B2 in the risk of developing anaemia was demonstrated in a Chinese prospective study. At the beginning of the study, intakes of Vitamin B2 and anaemia were significantly associated among females, and five years later anaemia risk within the cohort was more likely in participants with low Vitamin B2 intakes(9). The results of this study indicate that an adequate supply of Vitamin B2 may benefit iron status(9). Dairy milk products are a major source of Vitamin B2, and that’s why Like Milk matches cow’s milk for Vitamin B2.

Vitamin B12 and the nervous system

Vitamin B12 has an important role in supporting cell growth, working in concert with folate to synthesise our DNA. Vitamin B12 is vital for the formation of blood cell function and by extension, for oxygen supply, impacting energy levels, immunity and work capacity. Inadequate blood levels of Vitamin B12 may also affect our mood. Indeed, several studies report the link between Vitamin B12 and depression among various populations(10-16). For those following a vegan diet, Like Milk offers a unique dairy alternative in that it also provides vitamin B12, a deficiency to which vegans and the elderly are particularly vulnerable.

Vitamin D and its role in human health

Vitamin D is more a hormone than a Vitamin, but it is called a Vitamin. The generic term of Vitamin D applies to two Vitamin D forms: cholecalciferol (Vitamin D3) and ergocalciferol (Vitamin D2). Cholecalciferol is formed through the action of ultraviolet B (UVB) radiation in the skin. This production in the skin is the main source of high quality vitamin D for people, as it is very difficult to meet more than 5%–10% of vitamin D needs through diet(17). Of course, excessive exposure to high UV levels is a risk factor for skin cancer, thus sunlight exposure for Vitamn D health should occur during low UV periods. Ergocalciferol (Vitamin D2), is produced by UV irradiation of the plant sterol ergosterol and so Vitamin D2 is a plant derived. Both forms of Vitamin D are transported to the liver and further metabolised to the major circulating Vitamin D form (25-OHD), which is the form routinely measured to assess overall Vitamin D status in humans. This form is further metabolised in the kidney to the active hormone form of Vitamin D, known as calcitriol (or 1,25-(OH)2D)(17). This Vitamin D form then promotes absorption of calcium and phosphorous from the gut, contributes to calcium and phosphate homeostasis directly and through an interaction with parathyroid hormone, facilitates mineralisation of the skeleton and is important for muscle function(18). Like Milk is fortified with Vitamin D2, which is the form suitable for those consuming a vegan diet.

References

  1. Rains TM, et al. A randomized, controlled, crossover trial to assess the acute appetitive and metabolic effects of sausage and egg-based convenience breakfast meals in overweight premenopausal women. Nut J. 2015;14:17. Access Paper
  2. Leidy HJ, et al. A high-protein breakfast prevents body fat gain, through reductions in daily intake and hunger, in “Breakfast skipping” adolescents. Obesity (Silver Spring). 2015;23(9):1761-4. Access Paper
  3. Weigle DS, et al. A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations. Am J Clin Nutr. 2005;82(1):41-8. Access Paper
  4. Wang X, et al. Dietary calcium intake and mortality risk from cardiovascular disease and all causes: a meta-analysis of prospective cohort studies. BMC Med. 2014;12:158. Access Paper
  5. Kong SH, et al. Dietary calcium intake and risk of cardiovascular disease, stroke, and fracture in a population with low calcium intake. Am J Clin Nutr. 2017;106(1):27-34. Access Paper
  6.  Sax L. The Institute of Medicine’s “Dietary Reference Intake” for Phosphorus: A Critical Perspective. J Am Coll Nut. 2001;20(4):271-8. Access Paper
  7. Koletzko B, et al. Global Standard for the Composition of Infant Formula: Recommendations of an ESPGHAN Coordinated International Expert Group. J Pediatr Gastroenterol Nutr. 2005;41(5):584-99. Access Paper
  8. Lee KJ, et al. Association between dietary calcium and phosphorus intakes, dietary calcium/phosphorus ratio and bone mass in the Korean population. Nut J. 2014;13:10-26. Access Paper
  9. Shi Z, et al. Inadequate riboflavin intake and anemia risk in a Chinese population: five-year follow up of the Jiangsu Nutrition Study. PloS one. 2014;9(2):e88862-e. Access Paper
  10. Seppälä J, et al. Association between Vitamin B12 levels and melancholic depressive symptoms: a Finnish population-based study. BMC Psychiatry. 2013;13(1):1-8. Access Paper
  11. Bell IR, et al. B complex vitamin patterns in geriatric and young adult inpatients with major depression. J Am Geriatr Soc. 1991;39(3):252-7. Access Paper
  12. Mischoulon D, et al. Anemia and macrocytosis in the prediction of serum folate and Vitamin B12 status, and treatment outcome in major depression. J Psychosom Res. 2000;49(3):183-7. Access Paper
  13. Penninx BW, et al. Vitamin B12 deficiency and depression in physically disabled older women: epidemiologic evidence from the Women’s Health and Aging Study. Am J Psychiatry. 2000;157(5):715-21. Access Paper
  14. Tiemeier H, et al. Vitamin B12, folate, and homocysteine in depression: the Rotterdam Study. Am J Psychiatry. 2002;159(12):2099-101. Access Paper
  15. Ng T-P, et al. Folate, Vitamin B12, Homocysteine, and Depressive Symptoms in a Population Sample of Older Chinese Adults. J Am Geriatr Soc. 2009;57(5):871-6. Access Paper
  16. Kim J-M, et al. Predictive value of folate, vitamin B12 and homocysteine levels in late-life depression. Br J Psychiatry: J Mental Science. 2008;192(4):268-74. Access Paper
  17. Nowson CA, et al. Vitamin D and health in adults in Australia and New Zealand: a position statement. Med J Aust. 2012;196(11):686-7. Access Paper
  18. Holick MF. Vitamin D deficiency. N Eng J Med. 2007;357(3):266-81. Access Paper

Plant Based Milk Alternatives

HOW WELL DO PLANT BASED ALTERNATIVES FARE NUTRITIONALLY COMPARED TO COW’S MILK?

Vanga, SK & Raghavan, VJ. Food Sci Technol. 2018 55: 10

Globally, various plant-based milk alternatives have been introduced to the market in response to the prevalence of lactose intolerance and allergy to cow’s milk. These products, such as almond milk and soy milk, have been promoted as healthy, wholesome alternatives to cow’s milk, but little evidence exists in relation to the nutritional implications of short- and long-term consumption, and whether consumer perception of these products as a direct substitute for cow’s milk can be justified. In this review, four of the most commonly consumed plant-based milk alternatives are compared to cow’s milk, in relation to their nutritional profile and health benefits, in order to assist in informing consumers.

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Higher Protein Intake Improves Satiety

A RANDOMIZED, CONTROLLED, CROSSOVER TRIAL TO ASSESS THE ACUTE APPETITIVE AND METABOLIC EFFECTS OF SAUSAGE AND EGG-BASED CONVENIENCE BREAKFAST MEALS IN OVERWEIGHT PREMENOPAUSAL WOMEN

Rains TM, Leidy HJ, Sanoshy KD, Lawless AL, Maki KC. Nut J. 2015;14:17.

In a recent study, participants who ate a high-protein breakfast reported longer satiety and consumed fewer lunch-time calories, compared to their counterparts who consumed a low-protein breakfast. Participants were provided with a high-protein (30 g), a low-protein (3 g) or no breakfast meal. Each meal provided similar energy (~280 kcal), fat (12-14 g) and fibre (0-1 g) content. Appetites were assessed via Visual Analog Scale ratings and blood glucose and insulin concentrations were repeatedly measured. After four hours, participants were permitted to eat freely and their energy intake was recorded. The meals that provided 30 g of protein/serve produced greater control over appetite, lower postprandial blood glucose and insulin as well as reduced energy intake at the subsequent meal compared to a low-protein or no breakfast.

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A HIGH-PROTEIN BREAKFAST PREVENTS BODY FAT GAIN, THROUGH REDUCTIONS IN DAILY INTAKE AND HUNGER, IN “BREAKFAST SKIPPING” ADOLESCENTS

Leidy HJ, Hoertel HA, Douglas SM, Higgins KA, Shafer RS. Obesity (Silver Spring). 2015;23(9):1761-4

A randomised controlled trial of US overweight adolescents who reported they regularly skipped breakfast demonstrated the positive effect of a high-protein meal on body composition, satiety and caloric intake. For this 12-week study, participants were randomly chosen to consume a breakfast of either 13 g or 35 g protein. A third group were selected to continue to skip breakfast. Appetite, intake and body composition were measured pre- and post-study and were improved for those consuming the 35g protein breakfast compared to no breakfast. Researchers reported the daily consumption of a high-protein breakfast improves weight management indices, as body fat gain was prevented and reductions in both intake and appetite were observed for the adolescents who consumed a high-protein breakfast.

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A HIGH-PROTEIN DIET INDUCES SUSTAINED REDUCTIONS IN APPETITE, AD LIBITUM CALORIC INTAKE, AND BODY WEIGHT DESPITE COMPENSATORY CHANGES IN DIURNAL PLASMA LEPTIN AND GHRELIN CONCENTRATIONS

Weigle DS, Breen PA, Matthys CC, Callahan HS, Meeuws KE, Burden VR, Purnell JQ. Am J Clin Nutr. 2005;82(1):41-8

The authors of this study aimed to test the hypothesis that an increased protein content with constant carbohydrate content can reduce body weight via decreased appetite and subsequent caloric intake. Participants were placed sequentially on a weight maintaining diet, an isocaloric diet and an ad libitum diet for the study, throughout which insulin, leptin, and ghrelin plasma concentrations were measured. When protein contribution to total energy was increased from 15% to 30%, while carbohydrate intake was maintained, a sustained decrease in ad libitum caloric intake was observed.

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Calcium Intake and Health

DIETARY CALCIUM INTAKE AND MORTALITY RISK FROM CARDIOVASCULAR DISEASE AND ALL CAUSES: A META-ANALYSIS OF PROSPECTIVE COHORT STUDIES

Wang X, Chen H, Ouyang Y, Liu J, Zhao G, Bao W, Yan M. BMC Med. 2014;12:158

In response to the existing controversy regarding associations between mortality risk from cardiovascular disease and all causes and dietary calcium intake, a meta-analysis of 11 prospective studies with 12 independent cohorts, involving 757,304 participants was performed. Results indicated a non-linear association exists between dietary calcium intake and risk of mortality from cardiovascular disease and all causes. A dose-dependent relationship between calcium and cardiovascular-associated death was reported. The authors concluded that dietary calcium intakes above 900 mg/day are not associated with a decreased risk of all-cause mortality.

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DIETARY CALCIUM INTAKE AND RISK OF CARDIOVASCULAR DISEASE, STROKE, AND FRACTURE IN A POPULATION WITH LOW CALCIUM INTAKE

Kong SH, Kim JH, Hong AR, Cho NH, Shin CS. Am J Clin Nutr. 2017;106 (1):27-34

In this prospective study of 4,311 Koreans aged over 50 years with low calcium intake, the risk of all-cause mortality, fracture, stroke and cardiovascular disease was evaluated over a nine-year period. At baseline, anthropometric data were collected by trained staff, socio-demographic data were obtained by either personal or telephone interviews and participants reported dietary data via a validated, purposely-developed Food Frequency Questionnaire. During the study, self-reported data on stroke, fracture and cardiovascular disease were collected via biennial questionnaires, while deaths were reported by family members. The results of this study did not show any significant associations for men. However, for women, higher dietary calcium intakes were associated with a decreased risk of cardio-vascular disease, but not with stroke- or fracture-risk. Among the limitations of this study, the authors acknowledge the sole assessment of dietary calcium intake at baseline and the exclusion of dietary supplement data.

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Calcium to Phosphorus Ratio in Calcium Balance

THE INSTITUTE OF MEDICINE’S “DIETARY REFERENCE INTAKE” FOR PHOSPHORUS: A CRITICAL PERSPECTIVE

Sax L. Journal of the American College of Nutrition. 2001;20 (4):271-278

In this article, Sax argues the importance of the calcium to phosphorous ratio with reference to numerous human studies concluding its significance in calcium balance and bone turnover. The author disputes the views of The Institute of Medicine chapter authors in relation to this, with a critical review of their supporting literature. In addition, Sax notes the absence of research of females and children among the studies that form the conclusions of the chapter authors.

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ASSOCIATION BETWEEN DIETARY CALCIUM AND PHOSPHORUS INTAKES, DIETARY CALCIUM/PHOSPHORUS RATIO AND BONE MASS IN THE KOREAN POPULATION

Lee KJ, Kim KS, Kim HN, Seo JA, Song SW. Nutrition Journal. 2014;13:10-26

This study analysed nationally representative data from 4,935 participants (2,309 men and 2,626 women) in the Korean National Health and Nutrition Examination Survey, which was conducted in 2010. The association between dietary intakes of calcium and phosphorus (estimated via 24-hour dietary recall) and bone mass among Korean adults aged ≥ 20 years was assessed. Additionally, the association between the ratio of dietary calcium and phosphorus and adult bone mass was assessed. Dual-energy X-ray absorptiometry was used to measure bone mass density for the whole body, femoral neck, and lumbar spine. The influence of calcium and phosphorus intakes and the dietary calcium to phosphorus ratio on bone mass was identified but differed among age and sex categories.  For men aged ≥ 50 years, a positive relationship between dietary calcium intake and dietary calcium to phosphorus ratio and bone mass density for femoral neck was observed. Among premenopausal women, dietary calcium intake was positively associated with bone mass density for the whole body.

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Riboflavin (Vitamin B2) and its Functions

INADEQUATE RIBOFLAVIN INTAKE AND ANEMIA RISK IN A CHINESE POPULATION: FIVE-YEAR FOLLOW UP OF THE JIANGSU NUTRITION STUDY

Shi Z, Zhen S, Wittert GA, Yuan B, Zuo H, Taylor AW. PLoS One. 2014; 9(2): e88862

Data from 1253 Chinese men and women who participated in both waves of the Jiangsu Nutrition Study (2002 and 2007) were analysed by the authors of this study to determine the relationship between riboflavin intake and anaemia risk. A validated Food Frequency Questionnaire was used to assess dietary intake. Haemoglobin levels, measured at baseline and follow up, below 13 g/dL for men and 12 g/dL for women indicated anaemia. Iron deficiency anaemia was defined as the presence of both anaemia and serum ferritin levels, measured at baseline only, <15 µg/l. At the beginning of the study, intakes of riboflavin and anaemia were significantly associated among females only, and five years later anaemia risk within the cohort was more likely in participants with low riboflavin intakes. The results of this study indicate that an adequate supply of riboflavin may benefit iron status.

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Vitamin B12 and its Functions

ASSOCIATION BETWEEN VITAMIN B12 LEVELS AND MELANCHOLIC DEPRESSIVE SYMPTOMS: A FINNISH POPULATION-BASED STUDY

Seppälä J, Koponen H, Kautiainen H, Eriksson JG, Kampman O, Leiviskä J, Männistö S, Mäntyselkä P, Oksa H, Ovaskainen Y, Viikki M, Vanhala M, Seppälä J. BMC Psychiatry. 2013 May 24;13:145

Researchers analysed data from 2,806 Finnish adults aged 45-74 years, from a cohort of a national diabetes prevention programme. The Beck Depression Inventory (BDI, cut-off ≥10 points), a self-reported questionnaire relating to depressive symptoms and attitudes, was used to identify depression among participants. Serum vitamin B12 was measured with a reference range of 138–652 pmol/L considered normal. For the 15% of participants identified with depression, subgroups were formed for those with melancholic (n=138) and non-melancholic (n=291) depressive symptoms, based on DSM-IV- criteria. Vitamin B12 was inversely associated with melancholic depressive symptoms. There was no association between vitamin B12 levels and non-melancholic depressive symptoms.

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VITAMIN B12, FOLATE, AND HOMOCYSTEINE IN DEPRESSION: THE ROTTERDAM STUDY

Tiemeier H, van Tuijl HR, Hofman A, Meijer J, Kiliaan AJ, Breteler MM. Am J Psychiatry. 2002 Dec;159(12):2099-101

As part of the Rotterdam population-based study, elderly citizens of Rotterdam were assessed for depression via the Centre for Epidemiology Studies Depression Scale during a home interview. Fasting blood samples were provided and vitamin B12 deficiency was defined as a level less than 258 pmol/litre. Subjects with depressive symptoms and disorders were compared with randomly selected comparison subjects who had negative screening results. Data analysis included adjusting for the following cofounders: age, gender, alcohol consumption, education, smoking, and cognitive function as measured by the Mini-Mental State Examination (MMSE), functional status, blood pressure, and history of stroke and myocardial infarction. The authors report that of the subjects fulfilling the DSM-IV criteria for depressive disorders, those with vitamin B12 deficiency were nearly 70% more likely than the comparison subjects to have a depressive disorder, independent of cardiovascular factors and functional status. It was concluded that “vitamin B12 deficiency may be causally related to depression in the elderly”.

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FOLATE, VITAMIN B12, HOMOCYSTEINE, AND DEPRESSIVE SYMPTOMS IN A POPULATION SAMPLE OF OLDER CHINESE ADULTS

Ng TP, Feng L, Niti M, Kua EH, Yap KB. J Am Geriatr Soc. 2009 May;57(5):871-6

This cross-sectional study of noninstitutionalized Chinese men and women aged 55 years and older residing in southeast Singapore, aimed to examine independent associations between folate, vitamin B12, and homocysteine levels and depressive symptoms in older adults. A Geriatric Depression Scale (GDS) score ≥ 5 was used to identify depression.  Results of the study indicated a significant association between vitamin B12 deficiency (<180 pmol/L) and depressive symptoms (OR=2.68, 95% CI=1.20-6.00), independent of folate and homocysteine, where deficient levels of vitamin B12 were associated with greater risk of depressive symptoms in older Chinese adults.

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B COMPLEX VITAMIN PATTERNS IN GERIATRIC AND YOUNG ADULT INPATIENTS WITH MAJOR DEPRESSION

Bell IR, Edman JS, Morrow FD, Marby DW, Mirages S, Perrone G, Kayne HL, Cole JO. J Am Geriatr Soc. 1991 Mar;39(3):252-7

The subjects of this study included 20 geriatric and 16 young adult inpatients of a private acute psychiatric hospital who were admitted between November 1987 and May 1989 with a diagnosis of major depression and no alcohol abuse issues or dependence, nor any known recent exposure to folate‐depleting medications. Fasting blood samples for vitamins B1, B2, B6, folate, and B12 were measured upon admission. Deficiencies of vitamins B2, B6 and/or B12 were observed for over one quarter (28%) of the subjects, while no vitamin B1 or folate deficiencies were observed. Serum folate levels were significantly higher among the geriatrics and vitamin B12 levels were lower among psychotic depressives.

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Vitamin D and its Functions

VITAMIN D AND HEALTH IN ADULTS IN AUSTRALIA AND NEW ZEALAND: A POSITION STATEMENT

Nowson CA, McGrath JJ, Ebeling PR, Haikerwal A, Daly RM, Sanders KM, Seibel MJ, Mason RS. Med J Aust. 2012;196(11):686-7

This document serves as a guide to clinicians and health professionals in relation to the role of vitamin D in adult health in light of the increasing prevalence of vitamin D deficiency in Australia and New Zealand.  Vulnerable population groups include the institutionalised or house-bound, those with dark skin, and those who refrain from regular exposure to sunlight, which is the main source of vitamin D for Australian and New Zealand populations. Dietary sources are unlikely to provide more than 5–10% of the vitamin D requirement for most adults. For people aged ≤ 70 years dietary and supplementary vitamin D of at least 600 IU (15 μg) per day is recommended when exposure to sunlight is minimal. For those aged over 70 years, the recommended intake increases to 800 IU (20 μg) per day. Higher doses may be required for those in high-risk groups. Optimal musculoskeletal health, particularly for older age groups, requires a serum 25-hydroxyvitamin D (25-OHD) level of ≥ 50 nmol/L at the end of winter, (10–20 nmol/L higher at the end of summer to allow for a seasonal decrease), in addition to weight-bearing or muscle strengthening exercise and recommended dietary calcium intakes. The authors highlight that vitamin D deficiency is an independent predictor for falls among older adults and they make reference to the body of evidence supporting the efficacy of vitamin D and calcium supplementation in reducing fractures and falls in older men and women.

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CALCIUM- AND VITAMIN D3-FORTIFIED MILK REDUCES BONE LOSS AT CLINICALLY RELEVANT SKELETAL SITES IN OLDER MEN: A 2-YEAR RANDOMIZED CONTROLLED TRIAL

Daly RM, Brown M, Bass S, Kukuljan S, Nowson C. J Bone Miner Res. 2006 Mar;21(3):397-405

This two-year randomized controlled trial assessed the effects of reduced-fat milk fortified with additional calcium and vitamin D3 on bone mineral density (BMD) in Australian men aged over 50 years. The participants were recruited via advertisement and pre-screened via telephone questionnaire. The pre-screening resulted in a sample of 235 men who were invited to Deakin University (Melbourne campus) for BMD assessment via DXA. Men with BMD Z scores within ±2 SD for total hip, femoral neck, or lumbar spine (n = 167) were eligible to participate in the trial where they were randomised to either a milk supplementation or control group. Those in the milk supplementation group were asked to consume 400 ml/day of reduced-fat (approximately 1%) ultra-high temperature (UHT) milk containing 1000 mg of calcium plus 800 IU of vitamin D3. At baseline and subsequently every six months, dietary intake of calcium, phosphorus, total energy, protein, carbohydrate and fat was recorded via 3-day measured food diaries, physical activity surveys were completed and details regarding medication and supplement use, smoking status, and alcohol consumption were confirmed by interview. Primary endpoints were changes in BMD, serum 25(OH)D, and PTH. This controlled trial demonstrated effective suppression of PTH, cessation or slowed bone loss at several skeletal sites with daily supplementation of the calcium-vitamin D3-fortified milk. The authors concluded that a simple, nutritionally sound and cost-effective strategy to reduce age-related bone loss at several skeletal sites at risk for fracture in the elderly may be to supplement the diets of men > 50 years of age with reduced-fat calcium- and vitamin D3-enriched milk.

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VITAMIN D SUPPLEMENTATION INCREASES CALCIUM ABSORPTION WITHOUT A THRESHOLD EFFECT

Aloia JF, Dhaliwal R, Shieh A, Mikhail M, Fazzari M, Ragolia L, Abrams SA. Am J Clin Nutr. 2014 Mar;99(3):624-31

A placebo-controlled, dose-response, randomized, double-blind study was designed to assess the effect of vitamin D on calcium absorption in healthy postmenopausal women where 76 subjects (mean ± SD age of 58.8 ± 4.9 years) were randomly assigned to receive a placebo or 800 IU (20 μg), 2000 IU (50 μg), or 4000 IU (100 μg) vitamin D₃ dose for eight weeks. Calcium absorption at baseline and after eight weeks was measured via dual isotopes of stable calcium with a calcium carrier. The authors observed that age- and BMI-adjusted calcium absorption increased linearly with increasing vitamin D₃ dose or serum 25(OH)D concentration and concluded there was no evidence of a threshold where calcium absorption ceased to be maximised with a serum 25(OH)D range from 40 to 130 nmol/L.

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A group of 30 leading Australian dietitians were surveyed about Like Milk and had the following to say:

“Pea protein milk which is a grant plant source alternative – high in protein compared to many other plant based milks”

“Good ingredients and alternative milk option. It has a very similar nutrition profile to regular cow’s milk, unlike many plant based milk alternatives”

“Unlike other milk alternatives it provides a good amount of protein per serve”

“It uses pea protein to add a higher protein content. A lot of alternative milks can be very low in protein so if someone has to have an alternative this may be a good choice”

“The flavour is quite good and pea protein is non coagulating which is great. A lot higher in protein than other milk alternatives available.”

“Very good, great for those with allergies”

“Great alternative to dairy milk that I would recommend due to the addition of protein.”

“I loved the nutritional panel. I loved that it was high protein, fortified with Calcium and Vitamin D. I also love that it is low energy and low carbohydrate which may be suitable for TYDM and individuals on a weight loss journey.”

“I think it is excellent. One of the best plant-based milk compositions”

“Excellent, much better than most milk alternatives, particularly in terms of protein and calcium but great that it also contains B2, B12 and vitamin D.”

“I think it’s great! It provides a similar protein content to soy milk and it is calcium fortified! It provides people who need an additional milk alternative and are allergic to soy protein”

“Love the calcium and protein and reduced sugar, very exciting!”

“Looks good- great option for vegans, love that the protein content is close to milk”

“Like it a lot better due to high protein content. Also no added emulsifiers which many milk alternatives contain. Also unsweetened is a massive bonus.”

“I think it’s got a great nutritional composition as many plant milks are so low in protein”

“Better than expected. No fat, good protein, no sugar and carbs. Great array of vitamins and minerals”

“Higher protein content than other plant based milk alternatives (eg. almond) makes it a good choice.”

“The protein content is comparable to soy and cow’s milk making it a great vegan option.”

“FINALLY ANOTHER CALCIUM FORTIFIED PLANT MILK (I am very excited) especially as it also has vitamin B12!”

Ms. P. Yiu
Accredited Practising Dietitian (APD)


“For those following a vegan diet or are unable to have dairy and soy, Like Milk could be suitable alternative to milk. I like how the calcium, protein, B12, B2 and phosphorus content of Like Milk is comparable to milk unlike some of the other milk alternatives out there. The fortification also gives it some vitamin D. It differs in the way of fats and carbohydrates being fat free and lower in carbohydrates (almost none if you choose the unsweetened version).

It is palatable to drink and has a milky thickish texture. I find the texture and feel similar to soymilk; however, it does have a pea aftertaste. The aftertaste is a little less obvious in the original version than the unsweetened version. It works well with cereals, smoothies and some drinks such as a chai latte (it froths considerably well) but not so much with coffee.
Overall, it is a well made product as a milk substitute and gives those who are unable to tolerate dairy milk an alternative which still provides the nutrients dairy milk offers. “

Catherine Saxelby
Accredited Practising Dietitian (APD), Foodwatch

At first, this appears to be (yet) another plant milk (strictly mylk, the term I prefer to use).  But Like Milk’s got some differences that give it the edge over almond, oat and rice mylks, none of which are nutrient-dense or in the same league as cow’s milk. Like Milk’s big advantage is that it is not dairy, but also that it compares favourably in terms of protein, calcium, vitamin B2, B12 and D, things you can’t get easily from other plant mylks. 
Full review here

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